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