EMS AGENCY AMBULANCE RFP RECOMMENDATIONS

Addressing the Need for Strategic EMS ServicePatricia Frost RN, MS, PNP-BCDirector Emergency Medical Services

EMS SYSTEM MODERNIZATION STUDYHOW CAN WE DELIVER SERVICES AND…

EMS system flexibility Enhance value for the patient EMS/health care partnerships Optimize systems of care Understand current capabilities Create efficiencies Support sustainability Protect the public safety

FITCH EMS MODERNIZATION STUDY

12 month comprehensive study, 130 stakeholders 91 page report; 96 page public comment Assessed EMS System Status Described EMS science and evidence Conducted CCEMS system demand analysis Identified strategic short and long term objectives

to inform public policy decisions including opportunities to improve efficiency, expand funding and allocate resources

First Responders On-Scene Care to Transport Handoff

911 to First Response

Arrival

Ambulance Response to

Hospital Arrival

Hospital Bed Wait

Time

Medical First ResponseIndustry

Goal 8 minutes

Time to Definitive Care

Ambulance Medical ResponseIndustry Standard is 12 minutes Urban

Dispatch Aided Medical

ResponseGoal 90 sec

911 TO HOSPITAL = SYSTEM(S) OF CARETHE BEST PATIENT OUTCOMES DEPEND ON

EARLY RECOGNITION + EMS + DEFINITIVE CARE

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EMS SYSTEMS ARE MULTILAYERED SAFETY-NETS SYSTEM DESIGN AFFECTS SERVICE LEVEL

Intelligent DesignCoordination (Processes)Protocols (Standard Work)

Bystanders, Dispatch, Law, Fire, Ambulance, Hospitals,

54661

57008

6009760671

61567

50000

52000

54000

56000

58000

60000

62000

64000

2009 2010 2011 2012 2013

Fitch Findings: Contra Costa Emergency Medical ServicesIncreased Demand without Proportional Increase in Funding

Total EMS Transports by Year 2009-2013

>12 % volume increase2013

63% Government Payers18.9% No Insurance

1.8% HMOs & VA15.6% Private Payers

FINDINGS EMS SYSTEM DEMAND ANALYSISADJUSTMENTS IN URBAN AMBULANCE REQUIREMENTS NEEDED

Fitch Report Page 13

REIMBURSEMENT FLAT WHILE COSTS UPREIMBURSEMENT SUPPORTS EMS SERVICE DELIVERY

Fitch Report Page 77

OK FOR NOW…BUT CORRECTIVE ACTION RECOMMENDED Important EMS system

trends Decreasing revenue Decreasing

reimbursement Increasing call volume Increasing costs of

medical service delivery First responder fiscal

constraints

Fitch Report Page 81

FITCH: CONTRA COSTA EMS SYSTEM

“The Contra Costa County EMS system has delivered effective care to the sick and injured. Changes in

the roles of EMS System participants are anticipated and all

of the providers must be able to respond to these challenges and

opportunities.”Fitch Study Page 4

CONTRA COSTA EMS SYSTEM EXPERIENCEFIRE STATIONS CLOSURES

MEDICAL CONTROL: PRIORITIZE DEPLOYMENT TO PROTECT MOST CRITICAL

Contra Costa has lost approximately 20% of it’s fire stations since 2009 requiring

ambulance deployment modifications

HOSPITALS, EMERGENCY DEPARTMENTS AND SPECIALTY CENTERS IN TRANSITION

INCREASE AMBULANCE REQUIREMENTS

RiskDMC

Patient Focused EMS

System Adjustments

“HOW CAN WE USE THE FINDINGS IN THE FITCH STUDY TO OPTIMIZE THE

EMS SYSTEM IN THIS AMBULANCE

PROCUREMENT?”

KEY QUESTION

CONCEPT: PATIENT CENTERED EMS CARE AVAILABLE 365/24-7 REGARDLESS OF ABILITY TO PAY

EMS PUBLIC-PRIVATE PARTNERSHIP COORDINATED SERVICE CAPABILITIES

WHO USES EMS SERVICES?

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Reliable Timely Medical

Transportation + Comfort Required

Rapid Response+

Advanced Life Support + Systems of

Care Required

CONTINUE TO EXPAND MEDICAL FIRST RESPONSE BECAUSE IT ENHANCES SURVIVAL

Bystanders (CPR and AEDs)Dispatched Aided CPR (bystander instruction)Fire EMS (EMT, Paramedic)Law Enforcement (AEDs)HeartSafe Communities (CPR, PAD, Schools)

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EMERGENCY MEDICAL DISPATCH“THE VERY FIRST RESPONDER IN ANY EMERGENCY”

Opportunity to Optimize Coordination of EMS System ResourcesFuture Linkages with Health Services

STRATEGIC EMS SERVICE RELIES ON THE RELIABLE AVAILABILITY OF DATA

Provider Level Tools Focused on Patient Safety Coordinated Operations Reporting Transparency EMS System Efficiencies Performance Based Informed Public Policy

DASHBOARDS, REPORTING & ALERTS

“BUILDING A PROACTIVE EMS SYSTEM”

CAIRNS PRESENTATION NOV 19, 2013, INSTITUTE OF MEDICINE “THE IMPACTS OF AFFORDABLE CARE ACT ON PREPAREDNESS RESOURCES AND PROGRAMS: WORKSHOP SUMMARY”

DATA SYSTEMS PROMOTING IMPROVED EMS & COMMUNITY HEALTH OUTCOMES

Data critical to inform patients, providers and policymakers decisions in pursuit of high-value medical care.

EMS AGENCY SUPPORTS PATIENT CENTRIC EMS

Consolidated Emergency Medical Dispatch Nationally accredited & performance based

Deploy EMS Response based on Patient Condition Protocol driven: Who Goes and How Fast Tiered flexible deployment based on accredited dispatch

An innovation incubator for alternatives designed to serve the patient better Behavioral Health Mobile Response Teams Advice Nurse Consultation Community based EMS service Physician phone/telemedicine consults Reduction in long waits due to ED overcrowding

EMS AGENCY RECOMMENDATION HIGHLIGHTSSERVICES REDIRECTED FOR SYSTEM ENHANCEMENT

Modify response times based on patient condition and new demand analysis

Adopt appropriate countywide urban ambulance response time standard

Eliminate QRVs, STAR cars

Eliminate dual paramedic ambulance staffing

Respect community choice for Fire EMS first medical response

Never sacrifice patient safety

Support single emergency medical dispatch

Tier EMS response to patient need

Rigorous multidisciplinary performance/QI monitoring

Reinvest in dispatch, data systems, technology, and EMS Health Care Partnerships