County of Santa Clara Emergency Medical Services System
Emergency Medical Care Committee (EMCC) 700 Empey Way San Jose, CA 95128 408.794.0600 voice | www.sccemsagency.org www.facebook.com/SantaClaraCountyEMS
EMERGENCY MEDICAL CARE COMMITTEE (EMCC) Thursday, August 16, 2018 1:00 pm – 3:00 pm
Valley Specialty Center, Room BQ160, 751 South Bascom Avenue, San Jose, CA 95128
All reports and supporting material are available for review on the Santa Clara County EMS Agency website at www.sccemsagency.org and in the EMS Agency’s offices at least one week prior to the meeting. ( Indicates supporting documentation attached. Indicates committee action required).
Purpose of the Emergency Medical Care Committee (EMCC)
The purpose of the Emergency Medical Care Committee (EMCC) as specified in the California Health and Safety Code Section 1797.274 and 1797.276 is to review the operations of each of the following at least annually:
1. Ambulance services operating within the county.
2. Emergency medical care offered within the county, including programs for training large numbers of people in cardiopulmonary resuscitation and lifesaving first aid techniques.
3. First aid practices in the county.
The EMCC shall convene to provide the Santa Clara County EMS Agency with its observations and recommendations relative to its review of the items above in addition to providing feedback related to the EMS System Strategic Plan, policy, education and training, quality improvement, public access, and EMS system operations.
The EMCC will also make recommendations related to the use of EMS Trust Fund for the funding of Category C: Stakeholder Projects consistent with Santa Clara County Prehospital Care Policy EMS Reference #812Trust Fund Guide and Application.
Recommendations made by the EMCC, in the form of meeting minutes, will be provided to the Health Advisory Commission by the Chair and will be published to the EMS Agency website, and available for public review.
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AGENDA
1. Call to Order / Roll Call of Voting Members Harry Hall, Chair and Health Advisory Commissioner
2. Introductions and Announcements Harry Hall, Chair and Health Advisory Commissioner
3. Public Comment Harry Hall, Chair and Health Advisory Commissioner
This portion of the meeting is reserved for persons desiring to address the EMS Committee on a Committee-related matter not on the agenda. Speakers are limited to two (2) minutes. The law does not permit Committee action or extended discussion on any items not on the agenda except under special circumstances. Statements that require a response may be placed on the agenda for the next regular meeting of the Committee.
Consent Items
Introduction of Items Scheduled for Consent Patricia Natividad, Financial/Administrative Manager
Items 4-6 may be accepted as one motion. Item 4 – 6 is for informational purposes.
4. Approval of May 17, 2018 Meeting Minutes (Page 5)
5. Items Approved by the Board of Supervisors and/or Board Committees (Page 11) Copies of Board and Board Committee approved reports are provided for reference and information purposes.
6. EMS Trust Fund Status Report Accept written report on the financial status of the EMS Trust Fund (Page 81)
Regular Items
7. Health Advisory Commission and Items Referred by the Commission to the EMCC Receive verbal report from Harry Hall, Chair and Health Advisory Commissioner
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8. EMS System Initiatives: Personnel
A. Receive report on EMT Certification, Paramedic Accreditation, and Credentialing (Page 82) Daniel Peck, EMS Program Manager
B. Receive verbal report on EMS Investigations and Enforcement Daniel Peck, EMS Program Manager
C. Receive report on Medical Volunteers for Disaster Response Program (Page 83) Michael Cabano, EMS Program Manager
9. EMS System Initiatives: Equipment and Supplies
A. Receive verbal report Jason Weed, EMS Program Manager
10. EMS System Initiatives: Data Systems
A. Receive verbal report Michael Clark, EMS Program Manager
11. EMS System Initiatives: Clinical Care and Patient Outcome
A. Receive verbal report from EMS Agency Medical Director Dr. Ken Miller, EMS Medical Director
B. Receive report on Prehospital Care Policy Revision Activities (Page 86) David Sullivan, EMS Program Manager
12. EMS System Initiatives: Skills Maintenance/Competency
A. Receive verbal report Daniel Franklin, EMS Program Manager
13. EMS System Initiatives: Transportation/Facilities
A. Receive report on Santa Clara County Exclusive Operating Area 911 Ambulances Update (Page 87) John Blain, EMS Program Manager
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B. Receive report on Palo Alto Service Area 911 Ambulance Update (Page 92) Eric Nickel, Fire Chief, Palo Alto Fire Department
C. Receive report on Non-911 Ambulance Services (Page 129) David Sullivan, EMS Program Manager
D. Receive report on HHS Facilities (Page 130) David Sullivan, EMS Program Manager
E. Receive report on Transition of Care and Diversion (Page 131) Jackie Lowther, EMS Director
14. EMS System Initiatives: Public Education
A. Receive verbal report Daniel Franklin, EMS Program Manager
15. EMS System Initiatives: Preparedness A. Receive verbal report on Disaster and Significant events Michael Cabano, EMS Program Manager
16. EMS Strategic Plan / EMS Annual Report Jackie Lowther, EMS Director
17. EMCC Member Requests for Future Agenda Items / Announcements Harry Hall, Chair and Health Advisory Commissioner
Voting and non-voting members may request items for inclusion in future agendas or present announcements not requiring EMCC action.
18. EMS Stakeholder Requests for Future Agenda Items / Announcements Harry Hall, Chair and Health Advisory Commissioner
Members of the public or EMS System may request items for inclusion in future agenda or present announcements not requiring EMCC action.
19. Next Meeting and Adjourn Harry Hall, Chair and Health Advisory Commissioner
November 15, 2018 from 1:00-3:00 pm at Valley Specialty Center, Room BQ160, 751 South Bascom Avenue, San Jose, CA 95128
4 Emergency Medical Care Committee Valley Specialty Center, 751 S. Bascom Avenue May 17, 2018 at 1:00pm Meeting Minutes
Item Discussion Action 1. Call to Order/Roll Call Chairman Harry Hall called the meeting to Meeting called to order order at 1:00 p.m. A quorum was present.
2. Introductions and Announcements
3. Public Comment No members of public provided comment.
Consent Items Consent items approved by: 4. Approval of November 16, 2017 Meeting Minutes Eric Nickel / Josh Sanders 5. Summary of Items Present to BOS and HHC 6. EMS Trust Fund
7. Health Advisory Commission Updates HAC has nothing to report at this time.
8. Reports on EMS System Initiatives: Personnel. A. Daniel Peck went over the pie graph
A. EMT Certification, Paramedic Accreditation, and provided on page 50 regarding the Credentialing (Daniel Peck) stats for certification and accreditations. B. EMS Investigations and Enforcement (Daniel Peck) ‐ EMT reinstatement over 12 month
lapse. C. Medical Volunteers for Disaster Response Program (Michael Cabano) ‐ New Skills Form must be used, it is available on the EMS website.
B. Daniel Peck announced that a new module was built by Chris Duncan. We currently have a 104 cases. ‐ Central hub for documents. C. Jackie Lowther presented the MVDR report which can be found on page 51.
5 Item Discussion Action 9. Reports on EMS System Initiatives: ‐ Jason Weed announced that the Equipment and Supplies (Jason Weed) radio project and trainings have been completed. ‐ Aaron Herrera was introduced, he has replaced Ramon Ho.
10. EMS System Initiatives: Data Systems ‐ Michael Clark was not present. (Michael Clark)
11. EMS System Initiatives: Clinical Care and Patient A. Dr. Miller presented a power point on Outcomes. the Mental Health and Sobering Center Alternate Destinations Pilot A. Receive Verbal Report from EMS Agency Project. A few key points: Medical Director (Dr. Miller) ‐ The Gilroy Police Department, SCC Behavioral Health and Gilroy Fire Department are partners in the Pilot Project. ‐ Only applies to patients that have been assessed by Gilroy Fire Department Community Paramedic within the City of Gilroy. ‐ Patient Destinations will be determined by the on‐scene Gilroy Fire Department in collaboration with Gilroy PD. ‐ Approved Destinations are Emergency Psychiatric Services (EPS) and Mission Street Sobering Center. B. Receive report on Prehospital Care Policy B. Santa Clara County Prehospital Care These policies will be effective as of Revision Activities (David Sullivan) Policies are up for Public Comment. July 1, 2018. The Policies revision activities can be found on Page 54.
6 Item Discussion Action 12. EMS System Initiative: Skills A. Daniel Franklin has been Maintenance/Competency (Daniel Franklin) working on the redesign of the EMS website. ‐ Presented a video of “When to call 9‐1‐1” and “Hands‐Only CRP”.
13. EMS System Initiatives: Transportation/Facilities A. John Blain provided an overview and a summary regarding the A. Receive report on SCC EOA update (John Blain) finding/variances for the current EOA ambulance and fire department compliance. Report can be found on Page 55. B. Receive report on Palo Alto Service Area 911 B. Eric Nickel provided the Palo Ambulance update (Eric Nickel) Alto Service Area 911 Ambulance report, it can be found on Page 60. C. Receive report on Non‐911 Ambulance Services C. David Sullivan has completed a (David Sullivan) total of thirty seven (37) field inspections, we have utilized a total of 131 resources. The report can be found on Page 84. D. Receive report on HHS Facilities D. David Sullivan presented the (David Sullivan) HHS Facilities report which can be found on Page 85. E. Receive report on Transition of Care E. Jackie Lowther presented the (Jackie Lowther) Transition of Care and Diversion report which can be on Page 86. F. Receive verbal update on RFP F. Proposals are due May 30, 2018. (Jackie Lowther)
7 Item Discussion Action 14. EMS System Initiatives: Public Education A. Daniel Franklin announced that Daniel will be scheduling some trainings we have not had any recent in May. A. Receive verbal report on Hands‐Only CPR events. Training (Daniel Franklin)
15. EMS System Initiatives: Preparedness A. Michael Cabano was not present.
A. Receive verbal report on Disaster and Significant events (Michael Cabano)
16. EMS Trust Fund FY19 Category C Solicitation Open A. Jackie Lowther announced that Reminder letter will be sent out. Period (Jackie Lowther) Category C Solicitation period is open. All solicitations will be due in August.
8 Item Discussion Action 16. EMCC Member Request for Future Agenda None Items
17. EMS Stakeholder Request for Future Agenda None Items
18. Next Meeting August 16, 2018 from 1:00‐3:00pm at Meeting adjourned at 2:35pm. Valley Specialty Center, Room BQ160,
751 S. Bascom Ave, San Jose, CA 95128. Approved by: Dan Bobier / Joshua Sanders
VOTING MEMBERS PRESENT: Voting Alternates PRESENT:
Harry Hall, Chair, Health Advisory Commission Daniel Nunez, Public Sector Paramedic/EMT David Ghilarducci, MD, Emergency Department Physician Trisha Adcock, SCC County Communications Joshua Sanders, Private Sector Paramedic/EMT Michael Esslinger, County EOA Ambulance Provider Eric Nickel, Palo Alto EAO Ambulance Provider Dan Bobier, Private Ambulance Service Executive Officer David Sykes, City Manger Suwanna L. Kerdkaew, SCC County Communications
EMS STAFF PRESENT: Others in Attendance:
Jackie Lowther, EMS Director Josh Markowitz, Kaiser Dr. Ken Miller, Medical Director Michael Spath, PSCMA Ramona Aguilar, Executive Assistant Casey Potts, SCC Fire John Blain, EMS Specialist Dave Rose, Sunnyvale Ben Cortes, AED Registration Coordinator Jenny Lam, County Counsel Linda Diaz, Specialty Programs Nurse Coordinator Diane St Denis, SCVMC/MVDR/ARC Christopher Duncan, EMS Specialist Peter D’Souza, Stanford Life Flight Daniel Franklin, EMS Specialist Ian Iing, West Med Ambulance Aaron Herrera, EMS Specialist Andrew Thomas, West Med Ambulance Daniel Peck, EMS Specialist Dustin Gonzalez, County Ambulance Fannie Rackover, Epidemiologist Ryan Lugo, SCC Parks John Sampson, EMS Specialist Michael Baulch, Stanford Life Flight David Sullivan, EMS Specialist Yvonne Matagulay, Milpitas Fire Department
9 Jason Weed, EMS Specialist John Hosmoh, HCA Regional/ Good Sam Hector Estrada, SJFD Manuel Pereira, SJFD Christopher Mercado, County Communications Jeff Horner, CalStar David Gallagher, County Ambulance Leif Juliussen, Milpitas Fire Christoph Karch, SCVMC
Attachments, presentations and documents can be found at: www.sccemsagency.org
10 County of Santa Clara Emergency Medical Services System
Emergency Medical Services Agency 700 Empey Way San Jose, CA 95126 408.794.0600 voice | www.sccemsagency.org www.facebook.com/SantaClaraCountyEMS
Date: August 1, 2018
To: Santa Clara County EMS Committee Members
From: Patricia Natividad Senior Management Analyst
Subject: Summary of Approved or Pending Board of Supervisors and Health and Hospital Committee Items
Summary of Health and Hospital Committee Approved Items:
2017 EMS Annual Report – June 20, 2018
Receive report from Emergency Medical Services (EMS) relating to the status of the EMS Agency and EMS System for Calendar Year 2017.
During their meeting on December 14, 2010, the Board of Supervisors requested that the EMS Agency provide regular updates to the Health and Hospital Committee regarding the performance of the County Exclusive Operating Area 911 Ambulance Provider, Rural/Metro of California. On November 22, 2011, the Health and Hospital Committee requested that the EMS Agency provide an update in February 2012, and then provide semi-annual reports. On June 8, 2016, the Health and Hospital Committee authorized the EMS Agency to modify the timeline of the report submission, transitioning from a semi-annual report to an annual report which would cover a full calendar year and be submitted to the Committee in June of each year beginning in 2017. This report provides the requested information, including the status of the EMS System and highlights of some activities of the EMS Agency (including components of the EMS System Strategic Plan) during Calendar Year 2017.
The EMS Agency does publically post annual and quarterly performance reports to its website so that the people of Santa Clara County are able to view response time compliance reports, hospital performance data including hours of emergency department diversion and other quality indicators.
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This plan supports the Santa Clara Valley Health & Hospital System's Strategic Road Map as it relates to the Core Objectives by allowing for a seamless coordination of EMS services throughout the County.
See attached legislative file and reports.
Summary of Board of Supervisors Approved Items:
N/A
12 91920
DATE: June 20, 2018
TO: Health and Hospital Committee
FROM: Jackie Lowther, EMS Director
SUBJECT: Annual Report on EMS Agency and EMS System
RECOMMENDED ACTION Receive report from Emergency Medical Services (EMS) relating to the status of the EMS Agency and EMS System for Calendar Year 2017. FISCAL IMPLICATIONS This report is for informational purposes only; there is no impact to the General Fund. The County does not provide any direct funding in support of the services provided by the 911 emergency medical services system because the cost of the Santa Clara County Emergency Medical Services (EMS) System is paid by system providers, such as hospitals and ambulance companies, individuals who use these services and their medical insurers.
REASONS FOR RECOMMENDATION During their meeting on December 14, 2010, the Board of Supervisors requested that the EMS Agency provide regular updates to the Health and Hospital Committee regarding the performance of the County Exclusive Operating Area 911 Ambulance Provider, Rural/Metro of California. On November 22, 2011, the Health and Hospital Committee requested that the EMS Agency provide an update in February 2012, and then provide semi-annual reports. On June 8, 2016, the Health and Hospital Committee authorized the EMS Agency to modify the timeline of the report submission, transitioning from a semi-annual report to an annual report which would cover a full calendar year and be submitted to the Committee in June of each year beginning in 2017. This report provides the requested information, including the status of the EMS System and highlights of some activities of the EMS Agency (including components of the EMS System Strategic Plan) during Calendar Year 2017.
The EMS Agency does publically post annual and quarterly performance reports to its website so that the people of Santa Clara County are able to view response time compliance reports, hospital performance data including hours of emergency department diversion and other quality indicators. 13
This plan supports the Santa Clara Valley Health & Hospital System's Strategic Road Map as it relates to the Core Objectives by allowing for a seamless coordination of EMS services throughout the County.
CHILD IMPACT The recommended action will have no/neutral impact on children and youth.
SENIOR IMPACT The recommended action will have no/neutral impact on seniors.
SUSTAINABILITY IMPLICATIONS The recommended action will have no/neutral sustainability implications.
BACKGROUND The EMS 2017 Annual Report provides data on many aspects of the prehospital portion of the system. Response time performance by the fire departments and County Ambulance (operated by Rural/Metro) is included to provide a longer term illustration of monthly reports that are provided to the EMS Agency. Within the report, there is variation in the timeframes for which data is provided due to the timing in which data is received by the EMS Agency from hospitals and stakeholders.
CONSEQUENCES OF NEGATIVE ACTION The Health and Hospital Committee would not receive the information requested from the EMS Agency. ATTACHMENTS: • 2017 EMS Annual Report (PDF)
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Santa Clara County Emergency Medical Services Agency
2017 Annual Report
Presented June 20, 2018
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On behalf of the Emergency Medical Services (EMS) Agency, we are pleased to present this report on the Santa Clara County EMS Agency’s activities and accomplishments for 2017. The EMS Agency monitors and evaluates the quality of advanced life support (ALS) and basic life support (BLS) emergency medical care provided to the residents of and visitors to Santa Clara County by authorized prehospital personnel, provider agencies and hospitals. In this role, the EMS Agency: 1. Serves as the lead agency for the EMS system in the county and coordinates all system participants in its jurisdiction, encompassing both public and private sectors. 2. Provides system guidance and direction through provider and community driven policy development aimed at establishing and maintaining standards for care. 3. Monitors patient care through a comprehensive quality improvement program. Ensures medical disaster preparedness through the emergency planning process and coordinates response to local disasters and incidents with multiple casualties. 4. Ensures prehospital personnel competency through training, certification, accreditation, and continuing education program review. The EMS Agency is uniquely positioned to bring innovative practices to the community, before entering the health system, which has the potential for significant benefits and improved outcomes.
Other advances in medical treatment are likely to impact the level of care Santa Clara County’s EMS system is able to provide to patients. Emerging communications, technologies and clinical treatments are being evaluated to determine their impact on treatment cost, quality of care, and patient outcomes.
Jackie Lowther, RN, MSN, MBA Kenneth Miller, MD, PHD EMS Director Medical Director
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EMS STATISTICS CALENDAR YEAR (CY) 2017
COUNTYWIDE (CY2017) SYSTEM VOLUMES (CY2017) Population: 1,938,153 (2017 estimate) 9‐1‐1 EMS Responses: 131,878 911 Dispatch Centers: 15 9‐1‐1 EMS Transports: 85,880 Fire Departments: 11 EMS Aircraft Response: 118 Ground Ambulance Services: 9 EMS Aircraft Transports: 73 Air Ambulance Agencies: 2 Emergency Department (ED) Visits: 9‐1‐1 Receiving Hospitals: 11 514,683 Adult Trauma Centers: 3 Adult Trauma Center Visits: 7,411 Pediatric Trauma Centers: 2 Pediatric Trauma Center Visits: 847 Burn Center: 1 Burn Center Visits: 206 Primary Stroke Centers: 6 Stroke Center Visits: 3,026 Comprehensive Stroke Centers: 4 STEMI Center Visits: 656 ST Elevation Myocardial Infarct (STEMI/Cardiac) Centers: 8
PERSONNEL Emergency Medical Technicians: 2,374 Paramedics: 635 Mobile Intensive Care/Critical Care Transport Nurses: 114
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AMBULANCE SERVICES
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AMBULANCE SERVICES/PERMITTED VEHICLES – CY2017
Non‐911 Private Ambulance Providers
Provider Levels of Service Bayshore Ambulance BLS, CCT Falck North America ALS, BLS, CCT Norcal Ambulance BLS, CCT Pro Transport-1 ALS, BLS, CCT Royal Ambulance BLS, CCT Rural Metro General Transport BLS, CCT Silicon Valley Ambulance ALS, BLS Westmed Ambulance ALS, BLS, CCT
Number of Non‐911 resources
Provider Santa Clara County Resources Bayshore Ambulance 5 Falck North America 12 Norcal Ambulance 6 Pro Transport-1 31 Royal Ambulance 20 Rural Metro General Transport 15 Silicon Valley Ambulance 9 Westmed Ambulance 25 Total 123
Number of 911 resources (excluding Palo Alto)
Provider Santa Clara County Resources County Ambulances 68 (Rural/Metro) Fire Apparatus 219 Fire Department Ambulances 5
Number of field inspections of ambulances and fire apparatus during CY2017
Resource Type Inspections Ambulances 22 Fire Apparatus 15
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PUBLIC OUTREACH
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PUBLIC OUTREACH
PUBLIC EDUCATION CAMPAIGNS In 2017, the EMS Agency promoted several public education outreach campaigns. Each Public Education month, the EMS Agency provides educational Carbon Monoxide Poisoning campaign materials to every fire department Influenza Santa Clara County Emergency Alert System and ambulance service within the Santa Clara (AlertSCC) County EMS System. These materials include Pool Safety Preventing Snake Bites educational flyers, postcards, posters and STROKE Awareness pamphlets to distribute to the community, Heart Attacks, Heart Attacks and Women Heat Related Illness and talking points for use during Falls and Seniors presentations. By coordinating the public “Pull to the Right for Sirens and Lights” education campaigns within the EMS System, the public message is consistent, regardless of which organization provides the message. Education material are also provided in Spanish and Vietnamese. L.I.F.E. FILE In 2017, the Santa Clara County EMS Agency, working together with the Santa Clara County Fire Department and the Santa Clara County Public Health Department, produced the Lifesaving Information For Emergencies (L.I.F.E.) File. The L.I.F.E. File is a simple tool individuals and families may use to assist the emergency medical responders during medical emergencies. The L.I.F.E. File pouch is a
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vinyl magnetic pouch that is placed in an easily seen location on the refrigerator. The L.I.F.E. File form that is contained within the pouch is to be completed for each person living in the home (one form per person). The information on the form will allow emergency medical responders to quickly learn about the patient’s past medical history, list of current medications, identifies any medication allergies, and assists the responders in providing the best care possible for the patient. During 2017, over 10,000 L.I.F.E. files were distributed throughout the County.
AUTOMATED EXTERNAL DEFIBRILLATORS (AED) PROGRAM The EMS Agency has provided EMS Trust Fund dollars totaling $500,000 to the Santa Clara county‐ wide AED program to help purchase a total of 700 AEDs. This project is being undertaken to increase the survival rates of Sudden Cardiac Arrest (SCA) patients which can be improved with access to lifesaving heart defibrillators (AEDs).
Santa Clara County AED Program 2016‐2018 EMS Replacement AEDs SCC Parks & Rec Depart. SCC Sheriff’s Department Los Gatos Monte Ser. PD Alum Rock SD Homefirst Shelters Cupertino SD Milpitas SD SC Players Palo Alto Little League Evergreen SD Oak Grove Moreland SD Avenidas 2 Operation Freedom Paws Bill Wilson Center Franklin‐Mck. Santa Clara SD Morgan Hill, PD Open Space Opportunity Life Moves Mayview Health Avenidas Berryessa SD San Jose SD Cambrian SD Morgan Hill SD East Side SD
0 20 40 60 8022 100 120 140 160 Page | 7
TRAINING AND EDUCATION
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TRAINING AND EDUCATION
TRAINING
During 2017, the EMS Agency EMS Training and Education Totals provided 901 hours of continuing Training opportunities 12 education to 358 EMS personnel. Number of prehospital personnel in 358 Training classes included attendance psychological first aid, airway Number of continuing education hours 901 management, emergency disaster provided cache deployment, incident command, and resource allocation.
In 2017, the EMS Agency added EMS Orientation Exams Totals the local System Orientation Exams Proctored 40 Examination. This exam is now a Number of prehospital personnel 594 requirement for all providers tested (Emergency Medical Technicians Number of prehospital personnel 507 (EMT) and paramedics) entering obtaining a passing score within 3 the Santa Clara County EMS attempts System. The exam is designed to assess an individual’s knowledge of Santa Clara County policies and procedures, treatment protocols, radio communications, hospital/facility destination policies, and other unique system features to ensure providers are prepared to work within our EMS System. To help new providers understand the Santa Clara County EMS System, the EMS Agency has produced nine training videos, three of which were produced in 2017. Each video provides insight into the County’s EMS System, as well as highlighting some of the equipment and tools used by the EMS professionals who work in Santa Clara County.
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QUALITY IMPROVEMENT
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QUALITY IMPROVEMENT
EMERGENCY MEDICAL DISPATCH (EMD)
The Emergency Medical Dispatch Quality Improvement (EMD QI) Committee was formed through the hard work and dedication of the EMD Task Force. The purpose of the EMD QI Committee is to monitor and trend quality issues, discuss current trends and research in the EMD delivery process. The Committee is comprised of those Public Safety Answering Point (PSAP) in the County that utilize EMD in any part, which includes private ambulance dispatch centers. In addition to discussing QI Trends, Committee members rotate case presentations for the group. The EMD QI Committee continues to analyze 911 cancellation rates, ambulance resource management. Samples of a few trends the committee is tracking are seen below. The Committee is also working to align currently captured EMD data points. This will allow for center to center comparison, which will provide better countywide system analysis.
911 Ambulance Non‐Transport Rate (%) 2017
39.00 38.00 37.00 36.00 35.00 34.00 33.00 32.00 31.00 30.00 Jan‐17 Feb‐17 Mar‐17 Apr‐17 May‐17 Jun‐17 Jul‐17 Aug‐17 Sep‐17 Oct‐17 Nov‐17 Dec‐17 911 Ambulance Cancelled Before Arrival (%) 2017 12.50
12.00
11.50
11.00
10.50
10.00
9.50 Jan‐17 Feb‐17 Mar‐17 Apr‐17 May‐17 Jun‐17 Jul‐17 Aug‐17 Sep‐17 Oct‐17 Nov‐17 Dec‐17
911 Ambulance Did Not Transport From Scene (%) 2017 27.00 26.00 25.00 24.00 23.00 22.00 21.00 20.00 26 Jan‐17 Feb‐17 Mar‐17 Apr‐17 May‐17 Jun‐17 Jul‐17 Aug‐17 Sep‐17 Oct‐17 Nov‐17 Dec‐17 Page | 11
QUALITY IMPROVEMENT
AIRWAY INITIATIVE The Santa Clara County Quality
Improvement Committee continues to focus on increasing our intubation success rate. Endotracheal intubation is a medical procedure in which a tube is placed into the windpipe (trachea) to assist a patient to breathe. The efforts of the committee to improve this skill include; airway labs, trainings, policy changes and new equipment. New equipment to help the provider achieve successful intubation, such as a intubation guide (Bougie) have been added to the system and video laryngoscopy are in the process of being purchased. The overall success rate for the skill of intubation is 57%, which is 2017 Intubation Success by Month n=574 low compared to other EMS 100% 90% systems in the State. Crews will 80% 70% 67% 70% 63% 66% often choose to utilize alternative 60% 60% 54% 51% 52% 48% 45% 45% 48% airways to maintain good 50% 40% ventilation as a first choice. The 30% 20% efforts of the Committee 10% 0% demonstrates improved success rates in early 2018 reporting. 27 Page | 12
QUALITY IMPROVEMENT
SUDDEN CARDIAC ARREST (SCA)
The Santa Clara County EMS System cared for 1,139 non‐traumatic sudden cardiac arrest (SCA) patients in 2017. This demonstrates an incident rate of 59 per 100,000, which is slightly higher than the national rate of 55. Of the SCA witnessed by a bystander, CPR was performed 45% of the
time and is higher than the national rate of
41%. Bystander use of an automated
external defibrillator (AED) was at 3.5%, just below the 4% national rate. Public education and awareness campaigns continue to be a focus of the EMS System with hands‐only CPR events and AED placements.
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QUALITY IMPROVEMENT
SUDDEN CARDIAC ARREST (SCA) CONT. In 2018, the Agency will be launching a high performance CPR (HP‐CPR) campaign to all field personnel. This training will begin in the summer and continue into 2019. This method has demonstrated an increase in a person’s chance of survival in other EMS systems. The goal of HP‐CPR is to re‐establish and maintain a return of spontaneous circulation (ROSC) with high quality CPR VF/VT‐ Ventricular Fibrillation ROSC‐ return of spontaneous circulation and ultimately improve the patient’s neurological outcome upon discharge.
When a cardiac arrest patient is found in a shockable cardiac rhythm it is called Ventricular Fibrillation (VF) or Ventricular Tachycardia (VT). This type of rhythm has a much higher chance of survival if CPR or defibrillation is done early. Our current ROSC rate with patients in a witnessed cardiac arrest with a VF/VT rhythm is 62%. Asystole is commonly referred to as a flat‐line and typically has a much lower rate of survival.
Cardiac Arrest ‐ Neurological Outcome Asystole VF/VT Other Total Good Cerebral Performance, CPC 1 5 22 5 32 (62%) Moderate Cerebral Disability, CPC 2 3 3 2 8 (15%) Severe Cerebral Disability, CPC 3 0 2 2 4 (8%) Coma, vegetative state, CPC 4 5 3 0 8 (15%) Total 13 30 9 52
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QUALITY IMPROVEMENT
HEALTH AND HOSPITAL SYSTEM FACILITIES REPORT
The EMS Agency has monitored the number of 911 ambulances that respond to Santa Clara County operated healthcare facilities. In collaboration with health facility administration, the EMS Agency has provided on‐going data reports and education to these facilities in an effort to help ensure appropriate utilization of the 911 system. The project will continue to provide more focused care provider data, education and training as needed.
911 AMBULANCE RESPONSES TO JAILS 2017 80
70
60
50 35 36 32 30 37 41 45 40 28 21 46 31 35 29 30 30 31 19 28 26
20 33 30 29 29 32 27 25 27 24 10 19 22 19 20 20 15 16 16 17
0 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17 May‐17 Jun‐17 Jul‐17 Aug‐17 Sep‐17 Oct‐17 Nov‐17 Dec‐17
Elmwood Main Jail Ranches for Boys Juvenile Hall
911 Ambulance Responses to VHC/VMC Clinics 2017
160 151 148 144 141 140 138 136 140 131 132 125 117 120 107 106 105 106 106 97 100 91
80
60
40
20
0 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17 May‐17 Jun‐17 Jul‐17 Aug‐17 Sep‐17 Oct‐17 Nov‐17 Dec‐17
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QUALITY IMPROVEMENT
PRIMARY IMPRESSION
The EMS System transports and cares for a variety of patient types. Primary impressions depict the paramedic’s impression of the patient’s injury or illness. The graph below demonstrates the number of patients in each of the call type categories. The various illnesses and injuries encountered by EMS require our field personnel be trained and competent in a range of emergent treatment modalities. The most frequent reason for an ambulance transport remains traumatic injuries. It is important to recognize that this number includes everything from minor injuries (ankle injury) to a critically injured multi‐system trauma.
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Emergency Department
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Emergency Department
HOSPITAL VOLUME AND DESTINATIONS
Regional Medical Center Ambulance Destination by Hospital ‐ and Santa Clara Valley
2017 Medical Center receive the
VA ‐ PALO ALTO 1042 highest number of EL CAMINO ‐ LOS GATOS 1448 SAINT LOUISE 3410 ambulance transports KAISER ‐ SAN JOSE 7979 within the Santa Clara GOOD SAMARITAN 8237 VMC 16065 system. The volume for O'CONNOR 6412 REGIONAL ‐ SAN JOSE 16122 Stanford Health Care does KAISER ‐ SANTA CLARA 8592 not include patients EL CAMINO ‐ MT. VIEW 8620 STANFORD 5531 arriving from San Mateo
0 2000 4000 6000 8000 10000 12000 14000 16000 18000 County.
The number of 911 Ambulance Transports by Month ambulance transports 2017 remains fairly consistent with 7656 7249 7368 6984 7036 6977 7036 increases seen in 6780 6788 6847 December and January. 6481 6256 This was reflective of high flu patterns seen throughout the nation. JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
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Emergency Department
HOSPITAL DIVERSION OF AMBULANCES
Diversion can have a Ambulance Diversion by Hospital serious impact on the Jan ‐ Jun 2017 EMS System by 60 increasing transport 50 40 times and delaying a 30 patient’s treatment 20 time. The Santa Clara 10 0 EMS system continues JAN‐17 FEB‐17 MAR‐17 APR‐17 MAY‐17 JUN‐17 to allow diversion, Stanford (North) El Camino ‐ Mt. View (North) Kaiser ‐ Santa Clara (North) Regional ‐ San Jose (Central) O'Connor (Central) VMC (Central) although the hours of Good Samaritan (South) Kaiser ‐ San Jose (South) Saint Louise (South) diversion are monitored El Camino ‐ Los Gatos (N/A) closely.
Ambulance Diversion by Hospital The system noted Jul to Dec 2017 a significant 70 increase in 60 50 diversion time 40 30 during flu season. 20 Work continues 10 0 with each hospital JUL‐17 AUG‐17 SEP‐17 OCT‐17 NOV‐17 DEC‐17 to address surge Stanford (North) El Camino ‐ Mt. View (North) Kaiser ‐ Santa Clara (North) Regional ‐ San Jose (Central) O'Connor (Central) VMC (Central) time. Good Samaritan (South) Kaiser ‐ San Jose (South) Saint Louise (South) El Camino ‐ Los Gatos (N/A)
34 Page | 19
Emergency Department
INFLUENZA LIKE ILLNESS (ILI) SURVEILLANCE
Santa Clara County Flu (ILI) Transports vs. Percent of Flu (ILI) Visits reported by Health and Human Services (HHS) Region IX 2017/2018
300 8
7 Week) 250 IX
per R 6
200 HHS 5 (Count
Week,
150 4 Cold/ILI per
3 100 Visits 2 ILI
%
Impression 50 1
0 0 Primary
% ILI Visits, HHS R IX Santa Clara County Cold/Flu Transports
During high volume events, such as the flu season, the EMS Agency monitors the system’s ability to handle those surge increases. The above graph provides a comparison in the increase of EMS transports and its subsequent changes in diversion and transition of care times. In the chart above, Good Samaritan Hospital and Regional Medical Center saw a small increase in the number of EMS transports, but their Emergency Department (ED) diversion and Transition of Care times saw significant increases. It should be noted this graph does not include patients who arrived by private car. 35 Page | 20
Emergency Department
TRANSITION OF CARE TIME
Transition of Care Time ‐ 90th Percentile Jan ‐ Jun 2017 0:57:36
0:50:24
0:43:12
0:36:00
0:28:48
H:MM:SS 0:21:36
0:14:24
0:07:12
0:00:00 Jan Feb Mar Apr May Jun 2017
SHC ECH KSC RMC OCH VMC GSH KSJ SLH LGH
SHC ECH KSC RMC OCH VMC GSH KSJ SLH LGH Jan 0:14:34 0:16:47 0:25:44 0:28:14 0:28:42 0:56:07 0:45:03 0:25:53 0:24:14 0:18:47 Feb 0:15:34 0:15:21 0:22:53 0:20:03 0:22:35 0:40:11 0:28:59 0:21:17 0:23:47 0:12:27 Mar 0:14:12 0:15:03 0:20:52 0:17:13 0:18:29 0:41:57 0:31:13 0:23:10 0:23:16 0:19:13 Apr 0:14:47 0:15:59 0:19:43 0:18:20 0:21:55 0:38:31 0:29:16 0:20:34 0:26:21 0:12:51 May 0:14:01 0:15:13 0:21:50 0:16:29 0:20:43 0:50:40 0:25:18 0:19:38 0:23:44 0:09:45 Jun 0:14:32 0:15:53 0:20:17 0:18:23 0:21:14 0:46:43 0:30:10 0:20:54 0:23:59 0:13:12 Time is determined using “Arrived At Destination Time” and “Hospital Receiving Agent Signature Time” (or “Unit Back in Service Time” if unavailable) Transition of care time monitors how long it takes from the time an ambulance arrives at the
hospital to turn a patient over to hospital staff. Prolonged transition times can have a
significant impact on the EMS system by decreasing the number of ambulances available to the
911 system to meet system demands. The goal for transition of care time is 25 minutes, 90% of the time. Most facilities in our system are meeting those standards. The EMS Agency staff is
currently working with area hospitals and County ambulance providers to address those not
meeting the established goals. This graph and the one on the following page represent the entire year. 36 Page | 21
Emergency Department
TRANSITION OF CARE TIME CONT.
SHC ECH KSC RMC OCH VMC GSH KSJ SLH LGH Jul 0:14:58 0:14:40 0:19:26 0:18:34 0:19:54 0:52:21 0:20:31 0:19:27 0:21:15 0:10:22 Aug 0:16:24 0:14:38 0:19:16 0:17:27 0:18:42 0:49:35 0:21:37 0:22:44 0:20:07 0:11:38 Sep 0:11:10 0:14:36 0:19:43 0:19:44 0:18:29 0:48:50 0:22:23 0:23:25 0:21:46 0:09:03 Oct 0:12:02 0:15:50 0:19:38 0:18:12 0:20:20 0:52:50 0:21:10 0:21:44 0:20:18 0:09:01 Nov 0:10:08 0:13:56 0:21:52 0:16:51 0:20:06 0:43:00 0:21:04 0:20:49 0:20:31 0:08:37 Dec 0:10:37 0:16:13 0:26:59 0:30:54 0:24:49 0:43:46 0:38:09 0:26:21 0:20:42 0:10:42 Time is determined using “Arrived At Destination Time” and “Hospital Receiving Agent Signature Time” (or “Unit Back in Service Time” if unavailable)
37 Page | 22
Emergency Department
EMERGENCY DEPARTMENT VOLUMES
ED Visits per Bed ‐ 2017 900 845 350 326 800 300 685 700 281 675 585 250 600 542 472 498 500 197 202 196 200 195 449 400 150 140 135 300 112 120 261 100 200 134 50 100 43 49 45 37 12 29 24 24 23 8 0 0 RMC ECLG KSC KSJ VMC SHC GSH ECH OCH SLH
ED Bed Capacity Visits (x100) Visits per Bed (x10)
Total: 514,683 Office of Statewide Health Planning and Development; 2017 California
Hospital ED Capacity Visits Visits per Bed As the EMS system interfaces RMC 43 84,518 1,966 with the Emergency ECLG 12 13,421 1,118 Departments (ED), their KSC 49 68,497 1,398 volume and bed capacity has
KSJ 29 58,467 2,016 a direct effect on the ability to VMC 24 67,545 2,814 meet the system’s demands. SHC 45 54,194 1,204 Our system currently has 294 GSH 24 47,158 1,965 licensed ED beds and treated ECH 37 49,846 1,347 514,683 patients in 2017. On OCH 23 44,920 1,953 average, the system has 1,905 SLH 8 26,117 3,265 annual visits per ED bed. Total 294 514,683 1,905
Office of Statewide Health Planning and Development; 2017 ED Summary Report 38 Page | 23
Specialty Care Centers
39 Page | 24
Specialty Care Centers
ST‐ELEVATION MYOCARDIAL INFARCTION (STEMI) CENTERS Our EMS system has eight designated STEMI Centers that focus on the care provided to patients who have myocardial infarctions (commonly known as heart attacks). These patients have time sensitive illnesses that require quick intervention by the STEMI centers’ cardiac teams. The following graph demonstrates that patients who arrive by EMS transport are treated by cardiac catheterization on average 10 minutes faster than those arriving by private vehicle. This is largely due to the early notification from EMS providers and the treatment provided prior to hospital arrival.
During 2017, STEMI facilities admitted 656
STEMI patients. The centers met the 90 minute benchmark for door‐to‐ balloon (D2B) times 98% of the time; which is well above the national benchmark of 75%. 40 Page | 25
Specialty Care Centers
ST‐ELEVATION MYOCARDIAL INFARCTION (STEMI) CENTERS CONT.
STEMI Center benchmarks are provided by the American Heart Association. In the first graph, times are measured from EMS first medical contact (FMC) to hospital intervention (balloon time) with a benchmark of 90 minutes. In 2017, this was met 66% of the time, just below the national benchmark of 68%.
In the chart above, the FMC to scene departure (scene time) is 3 minutes above what is seen at a national level. The FMC to ED arrival is 3 minutes below national benchmarks. The difference between these can be attributed to our short transport times. 41 Page | 26
Specialty Care Centers
STROKE CENTERS
Stroke patients utilize EMS services 48% of the time to arrive at the hospital. Not calling EMS can have a significant impact on the patient by delaying lifesaving treatment. The EMS Agency will be producing a targeted public
information campaign this next year to help raise awareness to this issue. The data reflects an increase in interfacility transfers (IFT) during 2017, this is attributed to receiving a more comprehensive data set from our Stroke Centers that receive patients from other
IFT: Interfacility transfer counties.
Stroke by Race 2017 Stroke by Ethnicity 2017 6% 6% Caucasian 4% Asian/Pacific 18% Islander Hispanic Black Non‐Hispanic 25% 59% Other 82%
Unknown
42 Page | 27
Specialty Care Centers
STROKE CENTERS
There is a narrow treatment window for ischemic stroke patients due to a sudden loss of blood flow to areas of the brain caused by a blood clot. Medication to dissolve the clot (tissue plasminogen activator or tPA) must begin within 4.5 hours from the last time known well (LTKW). National benchmarks require that intravenous tPA is administered within 60 minutes from the patient’s arrival at the ED, 50% of the time. The Santa Clara County Stroke System had a median time of 44 minutes from ED arrival to tPA in 2017. Overall, the stroke system saw 3,026 stroke patients, with a median EMS scene time of 15:25 minutes. The American Heart Association identifies the EMS scene time benchmark as 15 minutes or less.
Stroke Type
Q4 2017 527 (76%) 130 (19%) 35 (5%)
Q3 2017 582 (77%) 122 (16%) 56 (7%)
Q2 2017 579 (76%) 113 (15%) 66 (9%)
Q1 2017 621 (76%) 131 (16%) 64 (8%)
Q4 2016 615 (81%) 89 (12%) 46 (6%)
Q3 2016 520 (81%) 91 (14%) 29 (5%)
Q2 2016 511 (80%) 97 (15%) 31 (5%)
Q1 2016 505 (79%) 98 (15%) 33 (5%)
Ischemic Stroke Intracranial Hemorrhage Subarachnoid Hemorrhage
TLKW: Time Last Known Well 43 Page | 28
Specialty Care Centers
STROKE CENTERS
Benchmark: 120 minutes Stretch Benchmark: 90 minutes
▪ED1 Arrival to Treatment ▪ED1 Arrival to ED2 Arrival ▪ED2 Arrival to Treatment
A small number of stroke patients have a clot that blocks the blood flow from a large blood vessel in the brain, which is termed as a large vessel occlusion. This type of stroke makes up less than 10% of our stroke population, but can have devastating effects to the neurological outcome of the patient. As new treatment options, guidelines and regulations become available, the Santa Clara County Stroke System is evolving to address this type of patient with the designation of Comprehensive Stroke Center (CSC). A CSC must have the ability to provide neuro‐ interventional capabilities, 24 hours a day, seven days a week and the ability to provide advanced services for the stroke population. The graph above represents the time from the patient arrival at the Emergency Department to the time of groin puncture (the beginning of treatment) for this type of patient. Efforts to improve these times are ongoing.
44 Page | 29
Specialty Care Centers
TRAUMA CENTERS The number of trauma patients seen within the Santa Clara County Trauma System are identified in the adjacent graph. Volumes have remained consistent
for the last five years.
With regards to the Deaths by Cause Number of Number of Case Fatality type of trauma, Cause of Injury Deaths Injuries Rate (%) gunshot wounds (GSW) Gunshot Wound 23 194 11.86% continue to be our Pedestrian 35 504 7.46% Stabbing 8 197 4.23% lowest in number of Fall 77 2,675 2.96% injuries, yet highest in Other Blunt 7 333 2.15% case fatalities at Motorcycle 11 555 2.02% Crashes 11.86%. Incidents Motor Vehicle 38 1.40% involving pedestrians Crashes 2,752 has the second leading Assault 4 339 1.19% Other Penetrating 1 115 0.88% case fatality rate. Bicycle 4 592 0.68% Impalement 0 2 0.00% Total 208 8,258 2.52%
45 Page | 30
Specialty Care Centers
MECHANISM OF INJURY BY TRAUMA CENTER CATCHMENT AREA
SHC: Stanford Health Care VMC: Valley Medical Center RMC: Regional Medical Center
Countywide, motor vehicle crashes are the
most common mechanism of injury at 33%, this
is narrowly followed by falls at 32%. This is consistent within the trauma catchment area for Regional Medical Center (RMC) and Santa Clara Valley Medical Center (VMC), with the
exception of Stanford Health Care (SHC) who
has a higher number of falls at 41%, and 26%
for motor vehicle crashes. 46 Page | 31
Specialty Care Centers
TRAUMA INCIDENTS BY CAUSE AND AGE RANGE‐ 2017
Age in Years <1 1‐4 5‐14 15‐24 25‐44 45‐64 >65 Total % Motor Vehicle Crash 14 55 138 715 958 594 278 2,752 33% (MVC) Fall 36 146 209 150 341 572 1221 2,675 32% Bicycle/Pedestrian 2 17 115 161 274 382 145 1,096 13% Motorcycle Crash 0 1 9 108 252 165 20 555 7% (MCC) Other 7 19 61 95 129 101 38 450 5% Assault 5 2 2 77 148 90 15 339 4% Stabbing 1 0 3 41 103 42 7 197 2% GSW 0 0 5 79 86 21 3 194 2% Grand Total 65 240 542 1426 2291 1967 1727 8,258 % (age) 1% 3% 7% 17% 28% 24% 21%
Motor vehicle crashes (MVC) continue to be our leading cause of traumatic injury. This is most prevalent with patients between the ages of 15‐44. Falls are the second leading cause of injury, seeing a 113% increase with patients over the age of 65 compared to 45‐64 year olds.
47 Page | 32
Specialty Care Centers
TRAUMA PATIENT OVERVIEW REPORT‐ 2017
The Trauma system saw 8,258 patient in 2017, with 80% of those arriving by EMS transport. The American College of Surgeons has identified a median scene time of 20 minutes as the benchmark, which is demonstrated in both air and ground units.
48 Page | 33
Specialty Care Centers
TRAUMA PATIENT EMERGENCY DEPARTMENT DISPOSITION‐ 2017
The EMS Agency monitors Emergency Department
dispositions for patients who have entered into our Trauma system. In 2017, patients transported by ground ambulance were discharged to home 45% of the time.
Patients with more severe
injuries went directly to the
Operating Room (6%) and 16% were admitted to the ICU. Air ambulances normally transport patients with more severe injuries. As noted in the pie chart, 28% of these patients are admitted to the ICU and 13% were taken directly to the Operating Room. Trauma Transports for air
ambulance may originate AMA: Against Medical Advice outside of Santa Clara ICU: Intensive Care Unit OR: Operating Room County.
49 Page | 34
Communications & Disaster Response
50 Page | 35
Communications & Disaster Response
RADIO PROJECT SILICON VALLEY REGIONAL INTEROPERABILITY AUTHORITY (SVRIA) The Santa Clara County EMS Agency purchased new radios for the private ambulance and air ambulance providers utilizing EMS Trust Fund dollars, replacing the existing radios provided by the EMS Agency in 2008. The new radios are compliant with the Silicon Valley Regional Interoperability Authority (SVRIA) requirements and increase communication coverage and interoperability between law, fire and EMS providers. The EMS Agency will provide one new radio for each permitted private ambulance and aircraft within Santa Clara County.
MEDICAL VOLUNTEERS FOR DISASTER RESPONSE (MVDR)
Currently the MVDR program in undergoing evaluation and revision. These revisions include the development of new standards and operational procedures for the program. The MVDR Program currently has 980 members: 102 are Level 4 (ready to be deployed individually), 259 are Level 3 (ready to deploy to augment operations as a unit) and 619 (Level 2) are available for disaster response support. The membership continues to be diverse and span a large range of medical capabilities and support functions including logistics personnel, physicians, pharmacists, nurses, paramedics, EMTs, dispatchers, and allied health personnel.
The MVDR Program’s current mission focuses on increasing the number of people trained to perform hands‐only CPR in the County. In 2017, approximately 1,100 additional people were trained by MVDR members and plans are in place to continue to increase these numbers over the next year. The program continues to provide support to both the EMS and Medical‐Health Mutual Aid System; during the year, the MVDR provided support to shelters that were opened during the flooding/storm incidents, activated for response to the North Bay Fires, participated in the Statewide Medical/Health Exercise and multiple other community outreach events. 51 Page | 36
ALL HAZARDS COORDINATOR
The Emergency Medical Services (EMS) System has staffed an “All Hazards Coordinator” positon since 2003. The position has been funded through the State Homeland Security Grant Program. The All Hazards Coordinator is tasked with providing technical reference and subject matter expertise for disaster and major incident planning, response, mitigation and recovery activities. In 2017, the EMS All Hazards Coordinator participated and collaborated on the following County focused projects:
led the efforts to increased knowledge about the County’s Medical‐Health Operational Area Coordinator (MHOAC) Program; developed and submitted requests in response to State Homeland Security Grants Program; began development of response protocols for active shooter and complex coordinated attack incidents; began a system‐wide approach to increasing awareness on reporting suspicious activity that may have a nexus to terrorism; conducted and participated in County‐wide collaborative training for EMS providers and medical volunteers; led the weekly development and distribution of an EMS System Action plan.
MEDICAL‐HEALTH OPERATIONAL AREA COORDINATOR (MHOAC) PROGRAM The Medical‐Health Operational Area Coordinator (MHOAC) is a shared role between the County Public Health Officer and the EMS Director or their assigned designee. The MHOAC works in cooperation with local Public Health Department, EMS Agency, the Department of Environmental Health and the Department of Behavioral Health to ensure Medical‐Health disaster planning, response, mitigation and recovery for their respective operational area. During the 2017 North Bay Fires, the EMS and Public Health designees coordinated the mutual aid response of the following Medical‐Health assets and resources: • Santa Clara County EMS Agency . EMS Director and 5 EMS Duty Chiefs
52 Page | 37
. 2 Field Supervisors and 7 ambulances from County Ambulance staffed by 7 Paramedics & 7 EMTs . 12 Medical Volunteers for Disaster Response (MVDR) placed on standby for deployment • Santa Clara County Public Health Department . 2 Public Health Nurses . 4 Public Health Nurses (Communicable Disease) • Santa Clara Valley Medical Center . 1 Emergency Department Registered Nurse (RN) • Santa Clara County Environmental Health Department . 10 Environmental Health and Hazmat Specialists placed on standby awaiting deployment • Santa Clara County Behavioral Health Department . 19 Employees from Mental and Behavioral Health Services • Stanford and Lucile Packard Healthcare Centers . 29 Hepa filters for air scrubbing . 7,700 N95 Masks, 3000 Mickey Mouse Children's Surgical Masks • Good Samaritan Hospital . 2 Hepa filters for air scrubbing
53 Page | 38
Agency Business
54 Page | 39
EMS Trust Fund
The EMS Trust Fund was created in 2000 and consists of revenue which is received from liquidated damages, which are paid by Rural/Metro (the contracted EOA 911 ambulance provider) for failing to meet per‐call response time standards; monthly zone response time standards; or for failing to meet other contract stipulations, such as maintaining minimum ambulance availability or avoiding ambulance breakdowns. In addition, revenue is also collected for first responder non‐performance. These revenues are deposited to the EMS Trust Fund and are intended to fund projects that provide a countywide benefit and enhance the services provided in the Santa Clara County EMS System.
There are four expense categories: Category A: EMS System Reserve Investment Each year at least 20% of the EMS Trust Fund revenue is generated in the previous fiscal year. This revenue is retained and used for significant and long term strategic projects that benefit the EMS System, as approved by the Board of Supervisors.
Category B: EMS System Support‐Training, Education and Recognition Funding authorized in this category would be primarily used for annual training, education, exercises and recognitions.
Category C: Benefit to EMS System Stakeholders During Fiscal Year 2017, Category C funds were allocated to the fire departments within Santa Clara County to provide hardware to support the County EMS System Data Project. This funding allocation was approved for $750,000, which provided fire departments with the ability to enter and transmit patient care data from the scene of an emergency, rather than waiting to enter data until the unit has returned to a fire station. This allocation was essential to creating a comprehensive EMS System data collection and analysis capability.
55 Page | 40
Additionally, the Public Health Preparedness Department received $5,000 in funding for key partners to attend the National Healthcare Coalition Preparedness Conference. The coalition promotes the sharing of information, member led trainings, peer to peer mentoring, and professional leadership opportunities in the County. The coalition also assists potential partners in bridging the gap in healthcare and community preparedness.
Category D: Strategic Initiatives Projects in this category strategically advance the Santa Clara County EMS System, often in the longer term. During FY 2017‐2018, a total of $500,000 was allocated to fund automatic external defibrillators (AED’s) for various County schools, community centers and emergency vehicles. The County’s AED matching fund program requires half the cost be secured through other sources. Through the County’s matching fund program, 700 AED’s have been placed throughout the community.
56 Page | 41
EMS Data System
THE SANTA CLARA COUNTY EMS DATA SYSTEM In 2017, the EMS Data System saw growth in a number of its components. The 911 System’s electronic patient care record (ePCR) solution, called Elite, was fully functional with all 911 providers submitting data. The only 911 provider that was not doing data capture within Elite was the Palo Alto Fire Department, who opted to utilize their own ePCR solution. All of the other 911 providers utilized Elite and performed data entry while at the patient’s side.
With having the ePCR data in one database, it then allowed for the EMS Agency to approach quality assurance (QA) and quality improvement (QI) system‐wide. Prior to this, QA and QI was performed by piecing together separate agency data reports. The unification of the data enables a reduction of time on task for both the service administrators, as well as the EMS Agency staff.
Another key data solution for the EMS System is the credentialing component of the ImageTrend licensure system. In late 2017, this solution was updated by ImageTrend which will allow the EMS Agency to begin to develop new online applications for each certification process. The goal of the EMS Agency is to reduce the number of forms that must be completed by the applicant, for any given certification or accreditation, to just one. By streamlining the process, the EMS Agency will be able to deliver better customer service by reducing the amount of time it will take to submit an application. This turn allows for a faster turnaround time for the entire certification process. The new application forms will be operational in 2018.
A fourth EMS Data System item is the partnership with several of the Santa Clara County based fire departments to include the integration of a fire service records management system (RMS) within the ImageTrend contract with the EMS Agency. Allowing local fire departments to piggyback their Elite RMS contract on the EMS Agency’s contract enables the real time data flow between the ePCR and RMS solutions. This integration will not only 57 Page | 42
ensure that both systems’ data entry will be accurately reflective of each other, but will also allow for time on task savings for the fire officers that are charged with data entry into the RMS. This project is slated to begin development in late 2018 in coordination with the ImageTrend contract extension.
Additional planned production for the EMS Data System in 2018 is the further development of the Hospital Hub and its user base. The Hospital Hub is the one tool that is utilized by the emergency department receiving facilities to retrieve the prehospital ePCR for patients who were transported from the 911 system to their emergency department.
58 Page | 43
Response Times
COUNTY EMERGENCY AMBULANCE CONTRACTOR (OPERATED BY RURAL/METRO) The County emergency ambulance contractor (Rural/Metro) has continued to meet required performance standards in 2017. The minimum response time standard is 90.00%. When Rural/Metro exceeds an adjusted per‐zone and code of response (lights and siren/non‐lights and siren) of 92.00%, liquidated damages are refunded on a monthly basis. During the January 2017 through December 2017 reporting period, Rural/Metro met contractual response time standards in each of the five zones, every month.
59 Page | 44
Response Times
FIRST RESPONDER RESPONSE TIMES TO EMERGENCY CALLS The County has entered into agreements with the cities of Gilroy, Milpitas, Morgan Hill, Mountain View, San Jose, Santa Clara, Sunnyvale, the Santa Clara County Central Fire Protection District and the South Santa Clara County Fire District for first responder servives. On a monthly basis, response time compliance is reviewed and reported. Compliance is measured by several key performance indicators that include: response time requirements based on population density; designated response areas; type of response priority (red lights & siren or non‐red lights & siren); total number of responses; total number of late responses; and total number of responses exempted (removed) from compliance calculations. Compliance is achieved when ninety (90.00%) percent or more of the responses meet the specified response time requirement in each response priority within each designated response area. The following charts represent monthly first responder EMS response time performance for 2017.
Gilroy, City of
100.00% 450
98.00% 400 392 394 96.00% 364 350 350 341 344 341 94.00% 328 331 314 305 305 300 92.00% 97.85% 98.64% 96.75% 98.94% 95.91% 95.92% 96.72% 97.64% 98.67% 97.55% 98.29% 96.90% 90.00% 250 Jan 17 Feb 17 Mar 17 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17
Code 3 Compliance Total EMS Responses
60 Page | 45
Response Times
Milpitas, City of
100.00% 370
353 350 98.00% 346 348 341 336 335 335 331 330 327 96.00%
309 310 304 94.00% 292 290
92.00% 270 95.88% 98.93% 98.14% 97.47% 97.22% 97.89% 97.29% 96.19% 96.41% 97.47% 96.18% 96.23% 90.00% 250 Jan 17 Feb 17 Mar 17 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17
Code 3 Compliance Total EMS Responses
Morgan Hill, City of
100.00% 270
98.00% 240 233 96.00% 222 223 218 221 212 209 208 210 207 204 94.00% 202 188 180 92.00% 98.51% 95.57% 96.43% 97.74% 96.50% 95.15% 98.15% 98.92% 96.83% 98.17% 93.78% 96.12% 90.00% 150 Jan 17 Feb 17 Mar 17 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17
Code 3 Compliance Total EMS Responses
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Response Times
Mountain View, City of
100.00% 420
403 400 98.00% 396
380 380 96.00% 362 364 361 357 358 360 94.00% 351 339 340 334 330 92.00% 320 95.13% 96.74% 98.09% 96.43% 97.27% 96.70% 95.64% 96.88% 96.54% 97.28% 95.09% 97.26% 90.00% 300 Jan 17 Feb 17 Mar 17 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17
Code 3 Compliance Total EMS Responses
San Jose, City of
100.00% 6,800
98.00% 6,630 6,592 6,497 6,417 96.00% 6,361 6,361 6,393 6,400 6,256 94.00% 6,234 6,131 92.00% 5,975 6,000 90.00% 5,707 88.00% 5,600
86.00% 89.76% 92.57% 92.04% 91.95% 89.86% 89.64% 90.50% 89.57% 90.17% 89.19% 90.43% 89.91% 84.00% 5,200 Jan 17 Feb 17 Mar 17 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17
Code 3 Compliance Total EMS Responses
62 Page | 47
Response Times
Santa Clara, City of
100.00% 600 587
550 98.00% 546 514 502 500 491 494 491 96.00% 485 479 465 450 439 94.00% 422 400
92.00% 350 95.19% 95.21% 95.13% 95.34% 94.15% 95.07% 95.31% 95.09% 95.33% 94.90% 95.73% 95.74% 90.00% 300 Jan 17 Feb 17 Mar 17 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17
Code 3 Compliance Total EMS Responses
Santa Clara County Central Fire District 100.00% 1,350
1,269 1,234 1,250 98.00% 1,217 1,185 1,182 1,180 1,176 1,153 1,150 1,127 96.00% 1,050 1,013
94.00% 937 950 866 850 92.00% 750 95.88% 95.29% 95.70% 95.03% 95.04% 96.72% 96.09% 97.06% 97.65% 97.61% 97.71% 97.98% 90.00% 650 Jan 17 Feb 17 Mar 17 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17
Code 3 Compliance Total EMS Responses
63 Page | 48
Response Times
South Santa Clara County Fire District
100.00% 170 161 98.00% 149 145 142 96.00% 139
128 94.00% 125 126 120 120 120 117 92.00% 107 90.00% 99 95 88.00% 93.04% 93.20% 88.70% 94.81% 92.56% 92.31% 91.67% 90.58% 91.60% 96.58% 90.82% 90.83% 86.00% 70 Jan 17 Feb 17 Mar 17 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17
Code 3 Compliance Total EMS Responses
Sunnyvale, City of
100.00% 700
98.00% 631 621 600 591 96.00% 587 571 564 544 548 550 546 94.00% 506 497 500
92.00% 97.86% 98.74% 97.85% 98.58% 98.61% 97.55% 98.79% 98.58% 97.84% 97.47% 97.40% 98.12% 90.00% 400 Jan 17 Feb 17 Mar 17 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17
Code 3 Compliance Total EMS Responses
64 Page | 49
Policy
SANTA CLARA COUNTY PREHOSPITAL POLICY
The EMS System continuously reviews the Santa Clara County Prehospital Policy. Each year, select EMS System policies are reviewed and then revised to ensure that they are maintained and updated as necessary. The standard review includes presentations to EMS System committees and work groups, a public comment period, and then a train‐the‐ trainer session for those policies that require all field EMTs and paramedics to be trained. In 2017, the Agency updated all of the EMS System’s treatment protocols.
Policy # Policy Name Effective Date 201 Emergency Medical Technician Certification 2/17/2017 204 Paramedic Intern Recognition 2/17/2017 205 Paramedic Accreditation 2/17/2017 214 EMS Personnel Training Standards 2/17/2017 617 EMS System Identification Badge 2/17/2017 116 Emergency Medical Dispatch Quality Improvement Committee 4/27/2017 301 Supplemental EMS System Resources 4/27/2017 302 Prehospital Care Asset ‐ Minimum Inventory Requirements 4/27/2017 310 911 Emergency Ambulance Use 4/27/2017 313 Naloxone Use By Public Safety First Aid Providers 4/27/2017 502 Patient Consent and Refusal for EMS Services 4/27/2017 600 Field Pronouncement of Death 4/27/2017 602 911 EMS Patient Destination 4/27/2017 700‐A01 Abdominal Emergencies 4/27/2017 700‐A02 Seizure 4/27/2017 700‐A03 Altered Mental Status 4/27/2017 700‐A04 Sepsis 4/27/2017 700‐A05 Bradycardia 4/27/2017 700‐A06 Burns 4/27/2017 700‐A07 Cardiac Arrest 4/27/2017 700‐A08 Chest Pain 4/27/2017 700‐A09 Environmental Emergencies 4/27/2017 700‐A10 Shock 4/27/2017 700‐A11 Respiratory Distress 4/27/2017 700‐A12 Allergic Reaction / Anaphylaxis 4/27/2017 700‐A13 Stroke 4/27/2017 700‐A14 Tachycardia with Pulses 4/27/2017 700‐A15 Poisoning and Overdose 4/27/2017
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700‐A16 Trauma Care 4/27/2017 700‐A18 Gynecological and Obstetrical Emergencies 4/27/2017 700‐A19 Crush Injury Syndrome 4/27/2017 700‐A20 Excited Delirium 4/27/2017 700‐P01 Pediatric Abdominal Emergencies 4/27/2017 700‐P02 Pediatric Seizure 4/27/2017 700‐P03 Pediatric Altered Mental Status 4/27/2017 700‐P05 Pediatric Bradycardia 4/27/2017 700‐P06 Pediatric Burns 4/27/2017 700‐P07 Pediatric Cardiac Arrest 4/27/2017 700‐P09 Pediatric Environmental Emergencies 4/27/2017 700‐P10 Pediatric Shock 4/27/2017 700‐P11 Pediatric Respiratory Distress 4/27/2017 700‐P12 Pediatric Allergic Reaction / Anaphylaxis 4/27/2017 700‐P14 Pediatric Tachycardia with Pulses 4/27/2017 700‐P15 Pediatric Poisoning and Overdose 4/27/2017 700‐P16 Pediatric Trauma Care 4/27/2017 700‐P18 Neonatal Resuscitation 4/27/2017 700‐S01 Cardio‐Pulmonary Resuscitation 4/27/2017 700‐S04 Routine Medical Care Adult 4/27/2017 700‐S05 Routine Medical Care Pediatric 4/27/2017 700‐M01 Airway Management 4/27/2017 700‐A16 Trauma Care 6/28/2017 700‐S04 Routine Medical Care Adult 6/28/2017 201 Emergency Medical Technician Certification 7/1/2017 208 EMS Field Supervisor Credentialing 9/6/2017 608 Standby Prehospital Resource 10/3/2017 612 Prehospital Ambulance Task Force and Strike Teams 10/3/2017 614 Fire Department Emergency Ambulance Use 10/3/2017 653 County EOA Emergency Ambulance Low Level Mitigation Plan 10/3/2017 651 County EOA Emergency Ambulance Response Times 12/1/2017 656 County EOA Resupply of First Responder Agencies 12/1/2017 102 Trauma System Organization and Management 12/18/2017 104 Trauma Center Designation Standards 12/18/2017 105 Trauma System Quality Improvement Process 12/18/2017 113 Trauma Center Designation Process 12/18/2017 403 Trauma Center Service Areas 12/18/2017 405 Trauma Center Fees 12/18/2017 407 Trauma Registry Data Collection and Management 12/18/2017 700‐A13 Stroke 12/18/2017
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Summary
In summary, the boundaries of prehospital EMS are evolving to meet the needs of the community based on local data and science from around the globe. The idea is for all communities to be served by well‐planned and highly coordinated emergency medical systems that are accountable for performance and serve the needs of patients of all ages within the system and improve the health of the entire community.
The year presented numerous challenges and opportunities for improvement to our system. The winter storms, the North Bay fire response and the flu season taxed our resources. At the end of the summer, work began on the community paramedicine pilot program and on modifying the Stroke triage protocol to recognize Comprehensive Stroke Centers, as well as many other ongoing EMS projects.
As in previous years, EMS expanded along with the needs of our system. We are confident in our sustainability and ability to adapt to the dynamic communities we serve. Maintaining our current capabilities and striving toward future success depends on the outstanding support received from the local system stakeholders and the leadership of the Santa Clara County Board of Supervisors and County Executive Office. Our primary goal is to provide the highest quality care for those in need of emergency medical services in the County. Through our coordinated network of paramedics, EMTs, nurses, physicians, and other emergency professionals who work together with a strong commitment to excel in all aspects of patient care the EMS Agency will continue to achieve and exceed this goal.
We are confident that 2018 will bring many more challenges and opportunities to grow. With the collaboration of our partners, we look forward to another year of providing the best care, anywhere.
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2017 Annual Report Board of Supervisors Health & Hospital Committee 06-20-18
68 Executive Summary On behalf of the Emergency Medical Services (EMS) Agency, we are pleased to present this report on the Santa Clara County EMS Agency’s activities and accomplishments for 2017. The EMS Agency monitors and evaluates the quality of advanced life support (ALS) and basic life support (BLS) emergency medical care provided to the residents of and visitors to Santa Clara County by authorized prehospital personnel, provider agencies and hospitals.
The EMS Agency is uniquely positioned to bring innovative practices to the community, before entering the health system, which has the potential for significant benefits and improved outcomes.
Other advances in medical treatment are likely to impact the level of care Santa Clara County’s EMS system is able to provide to patients. Emerging communications, technologies and clinical treatments are being evaluated to determine their impact on treatment cost, quality of care, and patient outcomes.
69 MarinCounty Sonoma of Santa Napa Clara Solano Emergency Contra Costa Medical Alameda Services Santa Clara System Santa Cruz San Mateo San Francisco | San Jose Oakland 2 EMS Statistic Calendar Year 2017
SYSTEM VOLUMES (CY2017) COUNTYWIDE (CY2017) 9-1-1 EMS Responses: 131,878 Population: 1,938,153 (2017 estimate) 9-1-1 EMS Transports: 85,880 911 Dispatch Centers: 15 EMS Aircraft Response: 118 Fire Departments: 11 EMS Aircraft Transports: 73 Ground Ambulance Services: 9 Emergency Department (ED) Visits: Air Ambulance Agencies: 2 514,683 9-1-1 Receiving Hospitals: 11 Adult Trauma Center Visits: 7,411 Adult Trauma Centers: 3 Pediatric Trauma Center Visits: 847 Pediatric Trauma Centers: 2 Burn Center Visits: 206 Burn Center: 1 Stroke Center Visits: 3,026 Primary Stroke Centers: 6 STEMI Center Visits: 656 Comprehensive Stroke Centers: 4 PERSONNEL ST Elevation Myocardial Infarct (STEMI/Cardiac) Centers: 8 Emergency Medical Technicians: 2,374 Paramedics: 635 Mobile Intensive Care/Critical Care Transport Nurses: 114 70 MarinCounty Sonoma of Santa Napa Clara Solano Emergency Contra Costa Medical Alameda Services Santa Clara System Santa Cruz San Mateo San Francisco | San Jose Oakland 3 Public Outreach
Lifesaving Information For Automated External Emergencies (L.I.F.E.) File Defibrillators (AED) Program
Santa Clara County AED Program 2016-2018
SCC Parks & Rec Depart. Los Gatos Monte Ser. PD Homefirst Shelters Milpitas SD Palo Alto Little League Oak Grove Avenidas 2 Bill Wilson Center Santa Clara SD Open Space Mayview Health Berryessa SD Cambrian SD East Side SD 0 20 40 60 80 100 120 140 160
71 MarinCounty Sonoma of Santa Napa Clara Solano Emergency Contra Costa Medical Alameda Services Santa Clara System Santa Cruz San Mateo San Francisco | San Jose Oakland 4 Training & Education
EMS Training and Education Totals PSA – When to call 911 Training opportunities 12 Number of prehospital personnel in 358 attendance Number of continuing education 901 hours provided
EMS Orientation Exams Totals Exams Proctored 40 Number of prehospital personnel 594 tested Number of prehospital personnel 507 obtaining a passing score within 3 attempts
72 MarinCounty Sonoma of Santa Napa Clara Solano Emergency Contra Costa Medical Alameda Services Santa Clara System Santa Cruz San Mateo San Francisco | San Jose Oakland 5 Quality Improvement
73 MarinCounty Sonoma of Santa Napa Clara Solano Emergency Contra Costa Medical Alameda Services Santa Clara System Santa Cruz San Mateo San Francisco | San Jose Oakland 6 Ambulance Diversion 2017
Ambulance Diversion by Hospital Jul to Dec 2017
70
60
50
40
30
20
10
0 JUL-17 AUG-17 SEP-17 OCT-17 NOV-17 DEC-17
Stanford (North) El Camino - Mt. View (North) Kaiser - Santa Clara (North) Regional - San Jose (Central) O'Connor (Central) VMC (Central) Good Samaritan (South) Kaiser - San Jose (South) Saint Louise (South) El Camino - Los Gatos (N/A)
74 MarinCounty Sonoma of Santa Napa Clara Solano Emergency Contra Costa Medical Alameda Services Santa Clara System Santa Cruz San Mateo San Francisco | San Jose Oakland 7 STROKE MODE OF ARRIVAL
75 MarinCounty Sonoma of Santa Napa Clara Solano Emergency Contra Costa Medical Alameda Services Santa Clara System Santa Cruz San Mateo San Francisco | San Jose Oakland 8 Trauma Incidents by Cause and Age Range - 2017
76 MarinCounty Sonoma of Santa Napa Clara Solano Emergency Contra Costa Medical Alameda Services Santa Clara System Santa Cruz San Mateo San Francisco | San Jose Oakland 9 TRAUMA BY HOSPITAL Causes of Injury: Motor Vehicle Crash Fall Assault Motorcycle Crash Pedestrian/Bicycle Gunshot Wound Stabbing Other
VMC: Valley Medical Center SHC: Stanford Health Care
RMC: Regional Medical Center 77 MarinCounty Sonoma of Santa Napa Clara Solano Emergency Contra Costa Medical Alameda Services Santa Clara System Santa Cruz San Mateo San Francisco | San Jose Oakland 10 Disaster Response
78 MarinCounty Sonoma of Santa Napa Clara Solano Emergency Contra Costa Medical Alameda Services Santa Clara System Santa Cruz San Mateo San Francisco | San Jose Oakland 11 DATA SYSTEM IMPROVEMENT The EMS Data System is fully functional with all 911 providers submitting data while at the patient’s bedside.
Fire Departments County Ambulance
PSAP
Private Ambulance Provider
Provider Cardiac Monitors
79 MarinCounty Sonoma of Santa Napa Clara Solano Emergency Contra Costa Medical Alameda Services Santa Clara System Santa Cruz San Mateo San Francisco | San Jose Oakland 12 SUMMARY
The EMS Agency continues to expand along with the needs of our system. We are confident in our sustainability and ability to adapt to the dynamic communities we serve. Maintaining our current capabilities and striving toward future success depends on the outstanding support received from the local system stakeholders and the leadership of the Santa Clara County Board of Supervisors and County Executive Office. Our primary goal is to provide the highest quality care for those in need of emergency medical services in the County. Through our coordinated network of paramedics, EMTs, nurses, physicians, and other emergency professionals who work together with a strong commitment to excel in all aspects of patient care the EMS Agency will continue to achieve and exceed this goal.
80 MarinCounty Sonoma of Santa Napa Clara Solano Emergency Contra Costa Medical Alameda Services Santa Clara System Santa Cruz San Mateo San Francisco | San Jose Oakland 13 County of Santa Clara Emergency Medical Services System
Emergency Medical Services Agency 700 Empey Way San Jose, CA 95128 408.885.4250 voice 408.885.3538 fax www.sccemsagency.org
Date: August 1, 2018
To: Santa Clara County EMS Committee Members
From: Patricia Natividad Senior Management Analyst
Subject: EMS Trust Fund – Liquidated Damages for Fiscal Year 2018
Monthly Liquidated Damages for Response Time
July 1, 2017 – Jun 30, 2018
Month / Year Amount
July-17 $119,750.00
August-17 $9,000.00
September-17 $57,500.00 . October-17 $230,750.00
November-17 $127,750.00
December-17 $230,250.00
January-18 $265,000.00
February-18 $64,500.00
March-18 $4,000.00
April-18 $6,000.00
May-18 $175,000.00
June-18 $14,000.00
Total for FY18 $1,303,500.00
Average Monthly Total In Period $108,625.00
81 Applications Approved April 1, 2018 – June 30, 2018
Paramedic Accreditation - Paramedic Intern, 21, 2% EMS ID Badge Lost/Stolen, Renewal, 102, 12% 0, 0%
Paramedic Accreditation - Initial, 19, 2% Supervisor Renewal, 1, 0%
ID Badge - Initial, 181, 21% EMT Certification - Renewal, 90, 10%
EMT Certification - Initial, 52, 6%
ID Badge - Renewal, 408, 47%
MarinCounty Sonoma of Santa Napa Clara Solano Emergency Contra Costa Medical Alameda Services Santa Cla Systemra Santa Cruz San Mateo San Francisco | San Jose Oakland
82 County of Santa Clara EMS Agency
MEDICAL VOLUNTEERS FOR DISASTER RESPONSE (MVDR) - MONTHLY REPORT
MVDR MEMBERSHIP REPORT AUGUST 2018
Current Membership:
Type of License Level 1 Level 2 Level 3 Level 4 Total
Physician 57 34 13 104
Registered Nurse 159 96 36 291
Physician’s Assistant 16 5 0 21
Nurse Practitioner 8 3 1 12
Paramedic 20 1 4 25
EMT 91 39 28 158
Pharmacist 14 3 2 19
Social worker 4 1 0 5
Psychologist 4 2 0 6
Dentist 3 7 0 10
Veterinarian 4 4 0 8
Other (Medical) 147 31 10 188
Other (Non-Medical) 92 33 8 129
Total 619 259 102 980
Membership by Level:
Level MARCH APRIL MAY JUNE JULY Level 1 0 0 0 0 0 Level 2 619 619 619 619 619 Level 3 259 259 259 259 259 Level 4 102 102 102 102 102 Total 980 980 980 980 980 Membership
Santa Clara County Emergency Medical Services MVDR Membership Report 83 County of Santa Clara EMS Agency
MEDICAL VOLUNTEERS FOR DISASTER RESPONSE (MVDR) - MONTHLY REPORT
Withdrawals:
Membership MARCH APRIL MAY JUNE JULY Withdrawals Withdrawn 0 0 0 0 0 Reason N/A N/A N/A N/A N/A Total 0 0 0 0 0 Withdrawals:
Event Participation:
MONTH MARCH APRIL MAY JUNE JULY EVENT SJ Mineta - Morgan Hill - DHV MRC Airport MCI Mushroom User Exercise Mardi Gras Group Training - - CA MRC - - Coordinators Workshop PARTICIPANTS 17 - 13 - 1 - - 1 - - TOTAL 17 - 14 - 1 MONTHLY PARTICIPANTS
Event Summary: The MVDR Program has participated in several different activities over the last quarter. On March 21, 2018, MVDR participated in the San Jose Mineta Airport MCI Exercise. During this event MVDR served as victim/volunteers so that the Airport and EMS System could test the response to a simulated aircraft crash. On May 26th & May 27, 2018, the MVDR Program staffed a community outreach booth at the Morgan Hill Mushroom Mardi Gras Festival where they trained approximately 390 citizens in the life saving skill of Hands Only CPR. On May 30th & May 31, 2018, the MVDR Program Manager participated in the State MRC Workshop in Sacramento. During the course of the workshop best practices of MRC’s nationwide were shared. On July 25, 2018, the MVDR Program Manager participated in a Disaster Volunteers/MRC User Group webinar. This webinar promoted information sharing among the State groups. Membership Summary: There was no documented increase in membership from the last report through April 2018.
Santa Clara County Emergency Medical Services MVDR Membership Report 84 County of Santa Clara EMS Agency
MEDICAL VOLUNTEERS FOR DISASTER RESPONSE (MVDR) - MONTHLY REPORT
Membership Level Definitions: Level I: the program has little or no advanced knowledge of member or prior training. Level I members require emergency credentialing and are last to be utilized to fill resource needs. Level I members and are ineligible to deploy unless sworn in as Disaster Service Workers (DSW) Level II: Basic volunteers who have expressed some level of interest in the program prior to attendance. These members have registered with the DHV but have yet to participate in a new member orientation. These members are used to fill resource needs after Level III and Level IV volunteers. Level II members and are ineligible to deploy unless sworn in as Disaster Service Workers (DSW). Level III: Intermediate volunteers are primarily called into service in disaster events and will be attached to existing infrastructure. These individuals regularly participate in training and exercises. They have completed the core competencies and have been issued an MVDR ID. Level IV: Level 4 members are first call for deployments and are deployable with little or no advanced notice. They have completed advanced training classes in addition to frequent participation in training and exercises.
Santa Clara County Emergency Medical Services MVDR Membership Report 85 County of Santa Clara EMS Agency
POLICY DEVELOPMENT REPORT
The following policies and protocols were released or updated by the County of Santa Clara EMS Agency since May 2018.
Policy # Policy Name and Changes Effective Date 656 County EOA Resupply of First Responder Agencies 6/1/2018 301 Supplemental EMS System Resources 7/1/2018 302 Prehospital Care Asset ‐ Minimum Inventory Requirements 7/1/2018 302‐B Spine Board Requirements 7/1/2018 611 EMS Air Resource Utilization 7/1/2018 621 Interfacility Transfer – Air Ambulance 7/1/2018 655 County EOA First Responder Agency Response Time 7/1/2018 Reconciliation 700‐M01 Airway Management 7/1/2018 700‐P07 Pediatric Cardiac Arrest 7/1/2018 104 Trauma Center Designation Standards 7/10/2018
Scheduled Future Policy Updates (Final versions will post to the EMS Agency website 30 days prior to effective date)
Policy # Policy Name and Changes Effective Date 700‐A17 Traumatic Cardiac Arrest 2/12/2019 700‐M17 Hemorrhage Control 2/12/2019 700‐S01 Continuous Cardiopulmonary Resuscitation 2/12/2019 700‐S13 Use of Physical Restraints 2/12/2019 811 Multiple Casualty Incident Plan 2/12/2019 811A MCI Documents/Tools 2/12/2019 315 Scope of Practice For Public Safety First Aid Providers TBD 603 Hospital Bypass TBD
86
Date: August 16, 2018
To: Santa Clara County Emergency Medical Care Committee
From: John Blain, EMS Specialist, EOA Contract Management
Subject: County EOA Service Area Response Time Performance Reports
History and Issue The County has entered into agreements with private and public entities to provide emergency medical response and advanced life support ambulance transportation services. Periodic response time compliance reports have been provided to the Emergency Medical Care Committee for the purpose of providing public review of those entities’ performance and compliance with contractual response time requirements. The County has performance based contracts with the following entities:
1. County Ambulance (Rural/Metro of California-AMR) 2. Gilroy, City of 3. Milpitas, City of 4. Morgan Hill, City of 5. Mountain View, City of 6. San Jose, City of 7. Santa Clara, City of 8. Santa Clara County Central Fire Protection District 9. South Santa Clara County Fire District 10. Sunnyvale, City of
Context Compliance is measured by several key performance indicators that include; response time requirements based on population density; designated response areas; type of response priority (red lights & siren or non-red lights & siren); total number of responses; total number of late responses; and total number of responses exempted (removed) from compliance calculations. Compliance is achieved when ninety (90.00%) percent or more of the responses meet the specified response time requirement in each response priority within each designated response area.
87 County Ambulance: Code 3 Response Compliance 100.00% 99.00% 98.00% 97.00% 96.00% 95.00% 94.00% 93.00% 92.00% 91.00% 90.00% 89.00% 88.00% Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18 Zone 1 Zone 2 Zone 3 Zone 4 Zone 5
County EOA Emergency Ambulance Service Responses 140,000 400 126,019 121,599 118,343 109,253 111,635 103,624 100,000 350
345 342 332 324 61,835 60,000 300 306 299
283
20,000 250 2012 2013 2014 2015 2016 2017 2018 County Ambulance Responses Average responses per day
County EOA Emergency Ambulance Service Transports 100,000 260 82,042 78,045 79,896 80,000 72,054 73,565 70,574 240
60,000 225 220 225 40,709 40,000 218 214 200 20,000 202 197 193 0 180 2012 2013 2014 2015 2016 2017 2018
County Ambulance Patients Transported Average patient transports per day
88 Gilroy, City of
100.00%
98.00% 98.67% 98.63% 98.29%
96.00% 97.97% 97.64% 97.55% 97.50% 97.47% 97.44% 97.27% 96.90% 96.72% 94.00%
92.00%
90.00%
88.00% Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18
Code 3 Compliance [%]
Milpitas, City of
100.00%
98.00% 98.50% 96.00% 98.47% 97.64% 97.47% 97.32% 97.29% 97.23% 96.41% 96.23% 96.19% 94.00% 96.18%
92.00% 93.54%
90.00%
88.00% Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18
Code 3 Compliance [%]
Morgan Hill, City of 100.00%
98.00% 98.92% 98.17% 96.00% 98.15% 96.83% 96.76% 96.39%
94.00% 96.12% 96.12% 95.22% 94.67% 92.00% 93.78% 93.69%
90.00%
88.00% Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18
Code 3 Compliance [%]
89 Mountain View, City of 100.00%
98.00% 99.66% 98.90%
96.00% 98.21% 97.95% 97.66% 97.28% 97.26% 96.88% 96.54% 94.00% 96.37% 95.64% 95.09% 92.00%
90.00%
88.00% Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18
Code 3 Compliance [%]
San Jose, City of 100.00% 98.00% 96.00% 94.00% 92.00% 90.00% 91.43%
88.00% 90.95% 90.50% 90.43% 90.31% 90.17% 89.91% 89.57% 89.57% 89.39% 86.00% 89.19% 88.32% 84.00% 82.00% Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18
Code 3 Compliance [%]
Santa Clara, City of 100.00%
98.00%
96.00% 97.50% 97.20% 97.14% 94.00% 95.74% 95.73% 95.43% 95.33% 95.31% 95.14% 95.09% 95.07% 94.90% 92.00%
90.00%
88.00% Jun 17 Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Apr 18 May 18
Code 3 Compliance [%]
90 Santa Clara County Central Fire District 100.00%
98.00%
96.00% 97.98% 97.71% 97.65% 97.61% 97.29% 97.22% 97.12% 97.06% 96.82% 96.49% 96.31%
94.00% 96.09%
92.00%
90.00%
88.00% Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18
Code 3 Compliance [%]
South Santa Clara County Fire District
100.00%
98.00%
96.00%
94.00% 96.58%
92.00% 93.81%
90.00% 92.63% 91.67% 91.60% 90.83% 88.00% 90.82% 90.58%
86.00% 86.51% 87.07% 87.33% 85.11% 84.00% Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18
Code 3 Compliance [%]
Sunnyvale, City of
102.00%
100.00%
98.00% 99.74% 99.48% 98.80% 98.79% 98.58%
96.00% 98.43% 98.12% 98.04% 97.84% 97.47% 97.40% 97.17% 94.00%
92.00%
90.00%
88.00% Jul 17 Aug 17 Sep 17 Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18
Code 3 Compliance [%]
91
City of Palo Alto (ID # 9054) City Council Staff Report
Report Type: Informational Report Meeting Date: 4/2/2018
Summary Title: PAFD Semi Annual Performance Report FY18
Title: Palo Alto Fire Department Semi-Annual Performance Report for the First Half of Fiscal Year 2018
From: City Manager
Lead Department: Fire
Recommendation Staff recommends the City Council review the First Palo Alto Fire Department Semi- Annual Performance Report for Fiscal Year 2018.
Background and Discussion In Fiscal Year 2015 the Palo Alto Fire Department (PAFD) identified performance reporting as a key initiative, and began reporting on key performance measures quarterly. Beginning Fiscal Year 2018, the Department will be submitting reports twice each year.
The report provides overall calls for service information, as well as more detailed information on the key service areas, including Emergency Medical Services, Fire Suppression, Rescue and Hazardous Materials Response, and Fire Prevention. The report also provides information on mutual and automatic aid with our regional public safety partners and internal workforce planning efforts.
Performance measures include the following:
Calls for Service: This data provides information on the final outcome of all emergency response calls. The data is tracked in the Fire Department’s Record Management System, and uses standardized call type codes, which are defined by the National Fire Incident Reporting System (NFIRS). The report includes overall call volume by primary category, and a detailed listing of call type in the service type sections.
In Fiscal Year 2018 the Department will be structuring and reporting on calls for service based on the NFIRS category groups in order to maintain consistency
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amongst various City performance reports and statistics sent to State and National reporting centers.
Response Times: This aspect measures the time it takes from an emergency call or request for response being created in the dispatch center to the arrival of resources to the scene of the emergency. This information is tracked in the Computer Aided Dispatch (CAD) System, and the performance goals, or service levels, are set by Council in accordance with county and national standards.
Ambulance Transports: The report provides the number of ambulatory transports to hospitals or other medical care facilities, and the proportion of Emergency Medical Calls that included transports. This information is tracked in the Fire Department’s Emergency Medical Record Management System.
Fire Containment: This measures the proportion of building and structure fires that are contained to the area or room of origin within Palo Alto and Stanford Campus.
Mutual and Automatic Aid: This includes the number and proportion of all incidents in which the PAFD provided aid to neighboring communities, as well as the aid received from neighboring Fire Departments. This information is tracked in the CAD System.
Permits: This provides the count of facility, electric vehicle, and solar permits issued by the Fire Prevention Bureau. This information is currently tracked in the Development Center’s Records Management System.
Inspections: A count of the total number of Hazardous Materials and State Mandated inspections is provided. In addition, an estimated number of inspections to be completed for the year is also provided to assess overall workload performance to date.
Fire and Life Safety Plans Reviewed: This provides a total count of all plans reviewed, as well as the proportion of plans that were reviewed within the time guidelines.
Vacancies and Off-Line Employees: This section provides the total number of budgeted full-time equivalent line personnel, current vacancies, and employees that are off line from workers compensation or light duty. This information is obtained from the Fire Department’s Staffing and Scheduling System (TeleStaff), as well as the City’s Personnel Management System.
Succession Planning Metrics: This provides the number and proportion of line personnel that are eligible to retire, or will be eligible within the next five years.
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This information is tracked in the City’s Personnel Management System. This report also provides the total number of hours line personnel have spent in an acting capacity. Personnel serving in an acting capacity are a key component of the Department’s overall succession planning efforts. Acting capacity allows junior officers to learn the responsibilities of higher ranks with guidance from senior officers. This information is tracked in TeleStaff.
Training hours: The total number of training hours completed by all line personnel is provided, as well as the average number of hours per each line personnel on staff. This information is tracked in the Fire Department’s Record Management System. Local, State and Federal mandates require fire personnel to train a minimum of 20 hours per month. Attachments: Attachment A: Coverletter Attachment B: Semi Annual Performance Report FY18.1 FINAL Attachment C: EMS Survey Attachment D: Thank You Notes
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94 City of Palo Alto Fire Department
Honorable Councilmembers,
I am pleased to provide the enclosed performance report for the first half of Fiscal Year 2018. After a review of the metrics, methodology and structure of the report as part of the Accreditation process the Department has made a few adjustments to the report. This includes moving to a semi-annual reporting frequency, aligning call type categories to mirror the National Fire Incident Report System categories, and improved tracking and methodologies.
Another important item of note is that this period reflects staffing and deployment levels prior to the recent changes that were made effective in January 2018. Since January, Fire Command Staff has frequently reviewed workload and performance. Preliminarily, the new deployment is performing as planned including the even distribution of calls among crews and handling nearly every ambulance call. More importantly, system performance remains consistent.
Turning to the events over these six months, the State faced the most difficult wildland fire season on record. The City of Palo Alto Firefighters did some of their best work to help protect life and property, minimize the damage and assist victims. There were five significant state fires this season, two of which were record breaking in their size and amount of destruction.
In July, Palo Alto Fire supported the Detwiler Fire in Mariposa County. The fire grew to over 80,000 acres prior to full containment and took over one month to contain. Palo Alto crews spent seven days of uninterrupted firefighting to assist in the containment efforts.
In late August, Palo Alto Fire deployed to the Helena Fire in Trinity County for a ten day commitment. The fire extended to the Trinity Alps Wilderness and reached over 21,000 acres before being contained in mid-November.
The Tubbs Fire in October 2017 was the most destructive wildfire in California history. It spanned Napa, Sonoma and Lake Counties burning over 36,000 acres and claiming 22 lives. During the month it took to contain the fire, a team of four Palo Alto Firefighters from Engine 65 worked eleven days straight on a strike team to assist in the statewide effort.
As part of the October Fire Storm, Engine 66 was deployed to the Mendocino Complex Fire as part of a multi-county task force as many strike team units were already on scene at the Tubbs fire. This fire extended to over 36,000 acres and claimed 546 structures. Crews were on duty for nine consecutive days.
P.O Box 10250 Palo Alto, CA 94303 650.329.2184 650.327.6951 fax
95 City of Palo Alto Fire Department
The final large fire in the State that we deployed units to was in December to Ventura County for the Thomas Fire. This fire spread to over 281,000 acres and is the largest wildfire in modern California history. It also had the largest firefighting force on record in California, totaling over 8,500 firefighters. Our crews were there for a 14 day deployment. This fire tragically claimed the life of CalFire Firefighter Cory Iverson, who was from the CalFire San Diego Unit. He died from smoke inhalation and thermal injuries. We honored his service and sacrifice by lowering the flags to half-mast and attending local services to mourn the loss of a fellow firefighter.
The courage and commitment to protecting our community and those who need us most is honorable, brave and demonstrated the best our City has to offer. The women and men of the Palo Alto Fire Department put their lives on the line at home and abroad. To those members and their families that stepped up to serve and fight these fires, I give my heartfelt gratitude and acknowledgement. These dauntless members of our team include: Fire Captain Barry Marchisio; Fire Captain Toby McDonnell; Fire Captain Marc Muzzi; Apparatus Operator Shelia Donovan; Apparatus Operator Carlos Gracia; Apparatus Operator Adam Palsgrove; Apparatus Operator Anthony Sozio; Firefighter Steven Fanchiang; Firefighter Adam Fortino; Firefighter Daniel Fortino; Firefighter Manny Macias; Firefighter Eban Johnson; Firefighter Nick Penko; Firefighter Chris Pombo; and Firefighter John Preston.
The gratitude received from residents and communities served were overwhelming, and I’ve not seen this level of gratitude in my 31 years as a professional firefighter. The Department received thank you notes and letters all of which are attached at the end of this report and decorate the walls of the sixth floor. Let these serve as a reminder of the reason we got into public service, and the impact we have on those we serve.
Sincerely,
Eric Nickel, EFO, CFC, CFO Fire Chief
P.O Box 10250 Palo Alto, CA 94303 650.329.2184 650.327.6951 fax
96 Palo Alto Fire Department First Semi-Annual Performance Report Fiscal Year 2018
Calls for Service The Palo Alto Fire Department (PAFD) responded to a total of 4,637 calls for service in the first six- month period of Fiscal Year 2018. This includes responses within Palo Alto, Stanford, and neighboring cities to provide Auto and Mutual Aid. Approximately seventy-nine percent (79%) of calls are generated from Palo Alto, fifteen percent (15%) from Stanford, and the remainder from neighboring cities or requests for regional fire deployment. The majority of calls were for Rescue and Emergency Medical Services, making up fifty-eight percent (58%) of the responses. Table 1 below shows the main categories of the calls to which PAFD responded. Calls are classified based on the actual event occurred, rather than the initial call request.
Call Type FY17 JUL-DEC FY18 JUL-DEC Rescue and Emergency Medical Services Incidents 2,768 2,692 Good Intent 703 804 False Alarm and False Call 616 695 Service Call 236 264 Fire 85 105 Hazardous Condition, No Fire 96 77 Overpressure Rupture, Explosion, Overheat, No Fire 1 0 Service Weather and Natural Disaster 1 0 Grand Total 4,506 4,637
Good Intent and False Alarm calls make up the second largest types of responses. Most calls for service that may be a true threat of fire, gas or other emergency hazard are actually found to be something else after Firefighters investigate the situation. These calls are coded as Good Intent calls. As well, many fire alarm activations are from causes other than fire or emergency hazard. These situations are categorized as False Alarm calls.
97
PAFD FY18 Bi-Annual Performance Report
Emergency Medical Services and Rescue Emergency Medical Service (EMS) is the primary service that the Palo Alto Fire Department provides to Palo Alto and Stanford. While this shift toward EMS is being seen across the region, the Palo Alto Fire Department is the only Fire Department in the County that provides ambulance and transport services. Of the 2,692 Emergency Medical Service calls the PAFD responded to in the first period of Fiscal Year 2018, the overwhelming majority were for medical, trauma and cardiac calls that did not involve a vehicle accident. Rescue and EMS Performance Measures FY17 JUL-DEC FY18 JUL-DEC Emergency Medical Service Incident 2708 2643 Lock-In 19 13 Extrication, Rescue 32 32 Water and Ice-Related Rescue 2 1 Rescue or EMS Standby 7 3 Total 2,768 2,692 Transports Number of Transports 1,865 1,703 Percent of EMS Calls resulting in transport 68% 63% Response Times Percent of first responder arriving on scene to EMS calls 93% 95% within 8 minutes Percent of paramedic responder arriving on scene to EMS 99% 99% calls within 12 minutes Average response time for first responder arriving on 4:47 4:48 scene to EMS calls This period reflects a slight dip in the number of Rescue and EMS Incident calls. The number of EMS calls that resulted in an ambulance transport to a local hospital or care facility, accounted for sixty three percent (63%) of all EMS calls. This is the primary source of revenue generated from emergency medical services, and the Department has seen the revenue flatten out over the last period. The most common rescue calls involve the removal of victims from a stalled elevator totaling twenty- nine (29) that is ninety-one (91%) of these call types. Lock-Ins revealed a decrease this period accounting for twenty seven percent (27%) of rescue calls. Response Time Goal Met: At least 90% of first responder arriving on scene to EMS calls within eight minutes. This period the PAFD first responder arrived on scene to EMS calls within eight minutes ninety-five percent (95%) of the time. Response Time Goal Met: At least 99% of paramedic responder arriving on scene to EMS calls within 12 minutes. This quarter the PAFD paramedic responder arrived on scene to EMS calls within 12 minutes ninety- nine percent (99%) of the time.
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PAFD FY18 Bi-Annual Performance Report
Fire Suppression Very few of the potential fire calls coming into dispatch turn out to be a real fire once PAFD investigates the scene and cause of the concerning elements. This period PAFD responded to 105 calls where fire was present, with 81 in Palo Alto or Stanford. There were twelve building fires that the Department responded to in Palo Alto and Stanford, ten of which were contained to the area of origin. The first fire occurred July 12 at an apartment building on 3800 block of Park Boulevard. The fire was determined to have started from cooking which then spread to cabinets and wall. Upon arrival, the first in unit, Engine 64, established Incident Command and secured a hydrant water supply from Engine 65. The fire was quickly extinguished and confined to area of origin. There were no injuries. All residents were allowed to return to their homes except for those from the involved unit. The American Red Cross arrived to assist the displaced residents. Another fire in July began with flames showing from a garage at the 2300 block of Waverly Street. Engine 62 was the first in unit and established Incident Command, then set up for a fire attack. The garage was a detached single story unit that was fully involved with fire. The fire was quickly confined to the garage, with no extension to the main house or neighbors. Utilities to the unit were disconnected and the structure was “red tagged” by the City Building Department. The cause of the fire was a hot barbecue with the lid off placed next to the door. The family had just used the grill and moved it before the unit had cooled sufficiently. Fire investigators estimated the damage at $500,000. On August 9 another kitchen fire occurred at a four-story mid-rise on 700 block of Escondido. The fire set off the alarm and activated sprinklers causing flooding on the floor. Engine 66 investigated the unit on the third floor and found the fire has been extinguished by two activated sprinkler heads. Crews opened the drain to decrease the water pressure. A burn patient approached crew and requested an ambulance, and Medic 62 administered patient care to the patient who stated that he was cooking in his kitchen when something caught fire and he was burned. This incident left water damage on all floors below the fire floor. Water evacuation procedures were implemented and salvage and overhaul of the affected units conducted. The building was secured and handed over to Stanford Maintenance for restoration. In early September in the 800 block of El Camino Real, Engine 61 responded to a fire alarm for water flowing. Upon arrival crews saw smoke coming from the rear of the building, out of the eaves and the vent and upgraded the event to a full first alarm. Crews forced the first floor door and found a light haze of smoke and some water coming from the hallway, and light smoke throughout the building. The source was determined to be a vent in the bathroom that contained heavy smoke and some heat where a sprinkler had been activated. Upon removing the ceiling tiles, crews were able to extinguish the fire. Another incident of note occurred in late November in the 3900 block of El Camino Real. Units arrived on scene to a laundromat with the interior charged with smoke. Engine 65 made entry with a hose line and found a dryer on fire, and was able to quickly extinguish the fire. Ventilation of the facility was conducted, and upon investigation it was determined that excessive storage to the rear of the structure had contributed to the fire.
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PAFD FY18 Bi-Annual Performance Report
Fire Suppression Measures FY17 JUL-DEC FY18 JUL-DEC Structure Fire 39 46 Mobile property (vehicle) fire 13 12 Natural vegetation on fire 11 20 Outside rubbish fire 17 22 Special outside fire 4 4 Cultivated vegetation, crop fire 1 0 Fire in mobile property used as a fixed structure 0 1 Total 85 105 Response Times Percent of first responder arriving on scene to Fire calls within 8 minutes 86% 90% Average response time for first responder arriving on scene to Fire calls 5:22 5:27 Fire Containment Percent of building and structure fires contained to the room or area of origin 90% 83%
Response Time Goal Met: At least 90% of first responder arriving on scene to Fire calls within eight minutes.
This quarter the PAFD first responder arrived on scene to Fire calls within eight minutes ninety percent (90%) of the time.
Fire Containment Goal Not Met: At least 90% of building and structure fires contained to the room or area of origin.
This period there were twelve building or structure fires within Palo Alto or Stanford, of which ten were contained to the room or area of origin. In both cases the fire had spread beyond the original area despite a response time under five minutes.
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PAFD FY18 Bi-Annual Performance Report
Hazardous Materials The Fire Department responded to a total of 77 calls related to hazardous material incidents. The most common Hazardous Material call is spills and leaks of either natural or liquid petroleum gas (LPG) which totaled 42. This number accounted for fifty-five (55%) percent of all Hazardous Material calls. The second highest Hazardous Material calls were related to electrical wiring or equipment problems. Twenty-six (26) of these calls account for thirty-four (34%) percent of all Hazardous Material calls.
Hazardous Materials Response Measures FY17 JUL-DEC FY18 JUL-DEC Combustible/Flammable spills and leaks 44 42 Chemical release, reaction, or toxic condition 12 1 Electrical wiring/Equipment problem 24 26 Biological hazard 2 4 Accident, potential accident 13 3 Attempted burning, illegal action 1 1 Total 96 77 Response Times Median response time for first responder arriving on 6:17 5:50 scene to Rescue & Hazardous Materials calls
5 | P a g e 101
PAFD FY18 Bi-Annual Performance Report
Mutual and Automatic Aid The Fire Department previously holds automatic aid agreements with five regional Fire Departments, including Mountain View, Menlo Park, Woodside, Los Altos, and Santa Clara County Fire. Palo Alto continues to primarily provide mutual and automatic aid to the City of Mountain View, at higher rates than aid received by Mountain View. The Department has made deployment changes and subsequent modifications to the mutual and automatic aid agreements with Mountain View. In the final report for Fiscal Year 2018 it is expected that these numbers will decline for both providing and receiving aid as a result.
In this period, the PAFD provided mutual or automatic aid to three other jurisdictions which it had not in the previous year. Of the seven other jurisdictions where mutual aid was provided Santa Clara County received the next highest aid from the department. Six other agencies provided mutual or automatic aid for calls within Palo Alto or Stanford on a total of 61 incidents.
Mutual Aid Performances FY17 JUL-DEC FY18 JUL-DEC Mutual and Auto Aid Provided Agency Mountain View Fire 202 221 Santa Clara County Fire 50 37 Menlo Park Fire 2 7 Sunnyvale 2 0 San Mateo City - 1 San Mateo County - 2 Out of Area - 3 All Mutual and Auto Aid Provided 256 271
Mutual and Auto Aid Received Agency Mountain View Fire 203 147 Menlo Park Fire 30 27 Santa Clara County Fire 16 13 Woodside Fire 6 15 Moffett Fire 1 2 Sunnyvale - 2 Cal-Fire - 2 All Mutual and Auto Aid Received 256 208
6 | P a g e 102
PAFD FY18 Bi-Annual Performance Report
Fire Prevention The Fire Prevention Bureau ensures compliance with the Fire Code for the safety of occupants and protection of property. Fire Inspectors perform fire sprinkler and fire alarm plan checks, permitting, and field inspections with the goal of ensuring all construction complies with local and national codes. This year the Prevention Bureau has been able to track inspections with more detail and we have modified the methodology for capturing this data point. Rather than tracking single locations, we are tracking each inspection. It more accurately captures the workload of inspections by capturing the number of inspections, as most locations require multiple inspections. The figure for Fiscal Year 2017 has been updated to reflect the same methodology. This period saw a decrease in the number of permits issued compared the same period in the prior year. The number of Fire Inspections and Hazardous Material inspections increased, and the number of plans to review slightly decreased.
Prevention Bureau Performance Measures FY17 JUL-DEC FY18 JUL-DEC Permits Fire Permits Issued 324 230 Sprinkler Permits Issued 131 114 Solar Permits Issued 39 26 Electric Vehicle Permits Issued 21 7 Inspections Fire Inspections 4205 4617 Hazardous Material Inspections Completed 170 219 Number of Hazardous Material Inspections for the year 563 563 Percent of Hazardous Material Facilities Inspections Complete 30% 39% State Mandated Inspections Completed 169 137 Number of State Mandated Inspections for the year 397 397 Percent of State Mandated Facilities Inspections Complete 43% 35% Fire and Life Safety Plan Review Plans Reviewed 998 853 Percent of Reviews Completed On-Time 97% 94%
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PAFD FY18 Bi-Annual Performance Report
Workforce Planning The Department operates daily emergency response operations with a total of 96.00 FTE line personnel. This includes three battalions of crews that staff six stations in the City and Stanford 24 hours each day. Over the last period, the department has operated with 17.0 positions vacant and 6.0 employees off-line creating a total of 23.00 FTE positions that require backfill. The vacant positions are primarily within the Firefighter and Apparatus Operator Classifications, with five vacant Fire Captain positions. During this Fiscal Year the Department will conduct a promotional process for Fire Captain, which will shift all vacancies to the Apparatus Operator and Firefighter ranks. In addition, 11.0 FTE of these vacancies were eliminated effective January 2018 due to the deployment changes resulting from extensive and detailed meet and confer processes with the labor union, and approval from City Council. The proportion of shift staff eligible to retire within the next five years continues to grow, currently making up more than half of all shift staff. The Department is focusing on bolstering succession planning and hiring efforts in order to prepare for the consistent turn-over expected over the next 5 to 10 years. Training hours reported for this period continue to reflect a reduction as the division is in transition to a new tracking and records management software. Vacancies and Off-Line Employees FY18 JUL-DEC Off-Line Employees Percent of Budgeted Personnel Classification Vacancies (Workers Comp/Light Personnel FTE On Line Duty) On Line Battalion Chief 4 0 0 4 100% Fire Captain 22 5 1 16 73% Fire Apparatus Operator 70 12 5 53 76% & Fire Fighters TOTAL 96 17 6 73 76%
Succession Planning FY17 JUL-DEC FY18 JUL-DEC Personnel Number of Shift Staff Currently Eligible to Retire 24 24 Number of Shift Staff Eligible to Retire in Five Years 17 19 Percent of all Shift Staff Eligible to Retire within Five Years 46% 51% Number of Acting Battalion Chief Hours 862 0 Number of Acting Captain Hours 3,292 3,045 Number of Acting Apparatus Operator Hours 12,599 7,053 Training Hours of Training Completed 25,605 14,748 Average Hours Per Line Personnel 328 202
8 | P a g e 104 City of Palo Alto Palo Alto, CA Client 9701
1515 Center Street Lansing, Mi 48096 1 (877) 583-3100 [email protected] www.EMSSurveyTeam.com
EMS System Report July 1, 2017 to December 31, 2017
Your Score Number of Your Patients in this Report 93.38 178 Number of Patients in this Report 36,690
Number of Transport Services in All EMS DB 145
Page 1 of 24 105 City of Palo Alto July 1, 2017 to December 31, 2017
Executive Summary
This report contains data from 178 City of Palo Alto patients who returned a questionnaire between 07/01/2017 and 12/31/2017.
The overall mean score for the standard questions was 93.38; this is a difference of 0.75 points from the overall EMS database score of 92.63.
The current score of 93.38 is a change of -2.06 points from last period's score of 95.44. This was the 32nd highest overall score for all companies in the database.
You are ranked 9th for comparably sized companies in the system.
80.59% of responses to standard questions had a rating of Very Good, the highest rating. 97.98% of all responses were positive.
Page 2 of 24 106 City of Palo Alto July 1, 2017 to December 31, 2017
Demographics — This section provides demographic information about the patients who responded to the survey for the current and the previous periods. The information comes from the data you submitted. Compare this demographic data to your eligible population. Generally, the demographic profile will approximate your service population.
Last Period This Period Total Male Female Other Total Male Female Other Under 18 8 3 5 0 6 3 3 0 18 to 30 2 1 1 0 2 1 1 0 31 to 44 7 3 4 0 4 3 1 0 45 to 54 9 7 2 0 8 4 4 0 55 to 64 25 16 9 0 12 7 5 0 65 and older 134 48 86 0 146 54 92 0 Total 185 78 107 0 178 72 106 0
Gender
Page 3 of 24 107 City of Palo Alto July 01, 2017 to December 31, 2017
Dispatch Analysis This report details results concerning dispatch performance. The report contains the mean scores for each survey item. The first column shows the organization score and the total EMS national database score; the second column is your difference from the database score.
Helpfulness of the person you called for ambulance service 0 100 Your Score Variance 94.54 1.82
Total DB 92.72
Concern shown by the person you called for ambulance service 0 100 Your Score VarianceVariance 92.69 0.15
Total DB 92.54
Extent to which you were told what to do until the ambulance arrived 0 100 Your Score Variance 90.09 -0.93
Total DB 91.02
Overall Section Score 0 100 Your Score Variance 92.48 0.40 Total DB 92.09
Page 4 of 24 108 City of Palo Alto July 01, 2017 to December 31, 2017
Ambulance Analysis This report details the section results that concern ambulance performance. The report contains the mean scores for each survey item. The first column shows the organization score and the total database score, the second column is your difference from the database score.
Extent to which the ambulance arrived in a timely manner 0 100 Your Score Variance 95.27 3.12
Total DB 92.15
Cleanliness of the ambulance 0 100 Your Score VarianceVariance 94.59 0.12
Total DB 94.47
Comfort of the ride 0 100 Your Score Variance 92.04 4.76
Total DB 87.28
Skill of the person driving the ambulance 0 100 Your Score Variance 95.48 1.69
Total DB 93.79
Overall Section Score 0 100 Your Score Variance 94.36 2.39 Total DB 91.97
Page 5 of 24 109 City of Palo Alto July 01, 2017 to December 31, 2017
Medic Analysis This report details the section results that concern medic performance. The report contains the mean scores for each survey item. The first column shows the organization score and the total database score, the second column is your difference from the database score.
Care shown by the medics who arrived with the ambulance 0 100 Your Score Variance 96.15 1.80
Total DB 94.35
Degree to which the medics took your problem seriously 0 100 Your Score Variance 95.38 1.07
Total DB 94.31
Degree to which the medics listened to you and/or your family 0 100 Your Score Variance 95.39 1.47
Total DB 93.92
Skill of the medics 0 100 Your Score VarianceVariance 94.95 0.67
Total DB 94.28
Extent to which the medics kept you informed about your treatment 0 100 Your Score VarianceVariance 93.01 0.45
Total DB 92.56
Extent to which medics included you in the treatment decisions (if applicable) 0 100 Your Score VarianceVariance 92.87 0.54
Total DB 92.33
Degree to which the medics relieved your pain or discomfort 0 100 Your Score VarianceVariance 91.11 0.73
Total DB 90.38
Page 6 of 24 110 City of Palo Alto July 01, 2017 to December 31, 2017
Medic Analysis This report details the section results that concern medic performance. The report contains the mean scores for each survey item. The first column shows the organization score and the total database score, the second column is your difference from the database score.
Medics' concern for your privacy 0 100 Your Score VarianceVariance 93.54 0.22
Total DB 93.32
Extent to which medics cared for you as a person 0 100 Your Score VarianceVariance 94.78 0.44
Total DB 94.34
Overall Section Score 0 100 Your Score Variance 94.25 0.94 Total DB 93.31
Page 7 of 24 111 City of Palo Alto July 01, 2017 to December 31, 2017
Billing Staff Assessment Analysis This report details the section results that concern office performance. The report contains the mean scores for each survey item. The first column shows the organization score and the total database score, the second column is your difference from the database score.
Professionalism of the staff in our billing office 0 100 Your Score Variance 81.69 -7.04
Total DB 88.73
Willingness of the staff in our billing office to address your needs 0 100 Your Score Variance 84.04 -4.59
Total DB 88.63
Overall Section Score 0 100 Your Score Variance 82.84 -5.84 Total DB 88.68
Page 8 of 24 112 City of Palo Alto July 01, 2017 to December 31, 2017
Overall Assessment Analysis This report details the section results that concern assessment of performance. The report contains the mean scores for each survey item. The first column shows the organization score and the total database score, the second column is your difference from the database score.
How well did our staff work together to care for you 0 100 Your Score VarianceVariance 93.59 0.07
Total DB 93.52
Extent to which our staff eased your entry into the medical facility 0 100 Your Score Variance 95.43 1.68
Total DB 93.75
Appropriateness of Emergency Medical Transportation treatment 0 100 Your Score Variance 94.66 1.08
Total DB 93.58
Extent to which the services received were worth the fees charged 0 100 Your Score VarianceVariance 89.03 0.89
Total DB 88.14
Overall rating of the care provided by our Emergency Medical Transportation service 0 100 Your Score VarianceVariance 94.59 0.89
Total DB 93.70
Likelihood of recommending this ambulance service to others 0 100 Your Score Variance 92.89 -0.33
Total DB 93.22
Overall Section Score 0 100 Your Score Variance 93.49 0.83 Total DB 92.66
Page 9 of 24 113 City of Palo Alto July 1, 2017 to December 31, 2017
Question Analysis This section lists a synopsis of the information about your individual questions and overall scores for this monthly reporting period. The first column shows the company score from the previous period, the second column shows the change, the third column shows your score for this period and the fourth column shows the total Database score.
Dispatch Analysis Last Period Change This Period Total DB Helpfulness of the person you called for ambulance service 95.23 -0.69 94.54 92.72
Concern shown by the person you called for ambulance service 93.71 -1.02 92.69 92.54 Extent to which you were told what to do until the ambulance arrived 92.65 -2.56 90.09 91.02
Ambulance Analysis Last Period Change This Period Total DB Extent to which the ambulance arrived in a timely manner 96.82 -1.55 95.27 92.15 Cleanliness of the ambulance 97.39 -2.80 94.59 94.47 Comfort of the ride 92.28 -0.24 92.04 87.28 Skill of the person driving the ambulance 96.63 -1.15 95.48 93.79
Medic Analysis Last Period Change This Period Total DB Care shown by the medics who arrived with the ambulance 97.73 -1.58 96.15 94.35 Degree to which the medics took your problem seriously 97.58 -2.20 95.38 94.31 Degree to which the medics listened to you and/or your family 97.26 -1.87 95.39 93.92 Skill of the medics 97.10 -2.15 94.95 94.28 Extent to which the medics kept you informed about your treatment 95.13 -2.12 93.01 92.56 Extent to which medics included you in the treatment decisions (if applicable) 95.87 -3.00 92.87 92.33 Degree to which the medics relieved your pain or discomfort 92.08 -0.97 91.11 90.38 Medics' concern for your privacy 94.46 -0.92 93.54 93.32 Extent to which medics cared for you as a person 96.78 -2.00 94.78 94.34
Billing Staff Assessment Analysis Last Period Change This Period Total DB Professionalism of the staff in our billing office 89.71 -8.02 81.69 88.73 Willingness of the staff in our billing office to address your needs 90.23 -6.19 84.04 88.63
Page 10 of 24 114 City of Palo Alto July 1, 2017 to December 31, 2017
Question Analysis (Continued)
Overall Assessment Analysis Last Period Change This Period Total DB How well did our staff work together to care for you 97.38 -3.79 93.59 93.52 Extent to which our staff eased your entry into the medical facility 97.01 -1.58 95.43 93.75 Appropriateness of Emergency Medical Transportation treatment 96.64 -1.98 94.66 93.58 Extent to which the services received were worth the fees charged 90.05 -1.02 89.03 88.14 Overall rating of the care provided by our Emergency Medical Transportation 97.15 -2.56 94.59 93.70 Likelihood of recommending this ambulance service to others 94.94 -2.05 92.89 93.22
Page 11 of 24 115 City of Palo Alto July 1, 2017 to December 31, 2017
Monthly Breakdown Below are the monthly responses that have been received for your service. It details the individual score for each question as well as the overall company score for that month.
Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016 2017 2017 2017 2017 2017 2017 2017 2017 2017 2017 2017 2017 Helpfulness of the person you called for ambulance service 83.33 97.73 95.83 100.00 91.91 95.83 100.00 93.52 92.39 96.43 91.67 100.00 97.22
Concern shown by the person you called for ambulance service 83.33 97.73 93.37 100.00 91.18 94.27 100.00 92.50 90.00 92.05 91.67 100.00 96.15
Extent to which you were told what to do until the ambulance 100.00 97.73 91.85 100.00 89.42 93.90 100.00 90.82 81.00 91.25 91.67 100.00 94.79
Extent to which the ambulance arrived in a timely manner 91.67 100.00 95.70 100.00 96.62 97.22 100.00 94.57 92.24 96.00 96.43 100.00 98.03
Cleanliness of the ambulance 100.00 100.00 96.05 100.00 97.86 97.64 100.00 95.63 88.46 94.79 92.86 100.00 97.22
Comfort of the ride 91.67 93.75 93.18 100.00 91.67 90.57 100.00 92.97 88.89 89.17 82.14 100.00 96.43
Skill of the person driving the ambulance 100.00 100.00 96.49 100.00 96.53 95.67 100.00 95.63 93.27 93.48 92.86 100.00 98.57
Care shown by the medics who arrived with the ambulance 100.00 100.00 97.50 100.00 96.32 98.11 100.00 97.76 92.89 94.57 96.43 100.00 96.56
Degree to which the medics took your problem seriously 100.00 100.00 97.13 100.00 95.45 98.58 100.00 97.39 91.07 94.57 96.43 100.00 95.17
Degree to which the medics listened to you and/or your family 100.00 100.00 96.61 100.00 94.70 98.61 100.00 96.64 93.04 92.05 96.43 100.00 96.46
Skill of the medics 100.00 100.00 96.31 100.00 98.44 96.23 100.00 97.22 92.04 90.26 95.83 100.00 95.71
Extent to which the medics kept you informed about your 100.00 97.92 93.10 100.00 94.86 96.30 100.00 95.63 88.58 86.96 100.00 100.00 93.97
Extent to which medics included you in the treatment decisions 100.00 97.92 94.32 100.00 98.00 95.00 100.00 94.02 88.29 91.25 100.00 100.00 93.27
Degree to which the medics relieved your pain or discomfort 100.00 95.45 92.02 100.00 91.94 90.45 100.00 92.59 86.84 86.41 87.50 100.00 95.03
Medics' concern for your privacy 100.00 91.67 93.53 100.00 93.18 96.43 100.00 94.08 85.87 94.05 92.86 100.00 97.66
Extent to which medics cared for you as a person 100.00 97.92 96.19 100.00 94.85 98.08 100.00 96.15 89.32 94.57 96.43 100.00 96.32
Professionalism of the staff in our billing office 100.00 96.88 86.11 100.00 89.47 90.91 100.00 85.64 77.08 90.00 68.75 75.06
Willingness of the staff in our billing office to address your 100.00 96.43 87.04 100.00 90.63 90.91 100.00 86.79 77.50 90.00 62.50 83.93
How well did our staff work together to care for you 100.00 100.00 96.61 100.00 96.88 97.64 100.00 95.24 89.13 90.91 96.43 100.00 94.56
Extent to which our staff eased your entry into the medical 100.00 100.00 96.93 100.00 93.94 98.04 100.00 96.88 91.67 94.57 96.43 100.00 96.00
Appropriateness of Emergency Medical Transportation treatment 100.00 100.00 94.32 100.00 97.50 97.55 100.00 95.42 94.32 89.17 96.43 100.00 96.88
Extent to which the services received were worth the fees 100.00 93.18 85.96 100.00 88.54 93.59 100.00 92.33 86.76 83.38 95.83 100.00 86.68
Overall rating of the care provided by our Emergency Medical 100.00 100.00 96.05 100.00 94.70 99.00 100.00 96.37 90.21 88.68 96.43 100.00 98.44
Likelihood of recommending this ambulance service to others 91.67 97.73 94.23 100.00 90.59 97.22 100.00 96.31 88.58 85.81 96.43 100.00 93.24
Your Master Score 96.93 98.08 94.50 100.00 94.17 96.17 100.00 94.71 89.47 91.39 92.97 100.00 95.09
Your Total Responses 3 13 68 3 40 58 3 73 31 26 7 1 40
Page 12 of 24 116 City of Palo Alto July 1, 2017 to December 31, 2017
Monthly tracking of Overall Survey Score
Page 13 of 24 117 City of Palo Alto July 1, 2017 to December 31, 2017
Greatest Increase and Decrease in Scores by Question
Last This Total DB Decreases Period Period Change Score Professionalism of the staff in our billing office 89.71 81.69 -8.01 88.73 Willingness of the staff in our billing office to address your needs 90.23 84.04 -6.19 88.63 How well did our staff work together to care for you 97.38 93.59 -3.79 93.52 Extent to which medics included you in the treatment decisions 95.87 92.87 -2.99 92.33 (if applicable) Cleanliness of the ambulance 97.39 94.59 -2.81 94.47 Overall rating of the care provided by our Emergency Medical 97.15 94.59 -2.57 93.70 Transportation service Extent to which you were told what to do until the ambulance 92.65 90.09 -2.56 91.02 arrived Degree to which the medics took your problem seriously 97.58 95.38 -2.20 94.31 Skill of the medics 97.10 94.95 -2.16 94.28 Extent to which the medics kept you informed about your 95.13 93.01 -2.12 92.56 treatment
Page 14 of 24 118 City of Palo Alto July 1, 2017 to December 31, 2017
Greatest Scores Above Benchmarks by Question
This Total DB Highest Above Benchmark Period Variance Score Care shown by the medics who arrived with the ambulance 96.15 1.81 94.35 Skill of the person driving the ambulance 95.48 1.70 93.79 Extent to which our staff eased your entry into the medical facility 95.43 1.68 93.75 Degree to which the medics listened to you and/or your family 95.39 1.48 93.92 Degree to which the medics took your problem seriously 95.38 1.07 94.31 Extent to which the ambulance arrived in a timely manner 95.27 3.11 92.15 Skill of the medics 94.95 0.67 94.28 Extent to which medics cared for you as a person 94.78 0.45 94.34 Appropriateness of Emergency Medical Transportation treatment 94.66 1.08 93.58 Cleanliness of the ambulance 94.59 0.11 94.47
Page 15 of 24 119 City of Palo Alto July 1, 2017 to December 31, 2017
Highest and Lowest Scores
Last This Total DB Highest Scores Period Period Change Score Care shown by the medics who arrived with the ambulance 97.73 96.15 -1.58 94.35 Skill of the person driving the ambulance 96.63 95.48 -1.15 93.79 Extent to which our staff eased your entry into the medical facility 97.01 95.43 -1.58 93.75 Degree to which the medics listened to you and/or your family 97.26 95.39 -1.87 93.92 Degree to which the medics took your problem seriously 97.58 95.38 -2.20 94.31
Last This Total DB Lowest Scores Period Period Change Score Professionalism of the staff in our billing office 89.71 81.69 -8.02 88.73 Willingness of the staff in our billing office to address your needs 90.23 84.04 -6.19 88.63 Extent to which the services received were worth the fees charged 90.05 89.03 -1.02 88.14 Extent to which you were told what to do until the ambulance 92.65 90.09 -2.56 91.02 arrived Degree to which the medics relieved your pain or discomfort 92.08 91.11 -0.97 90.38
Page 16 of 24 120 City of Palo Alto July 1, 2017 to December 31, 2017
Key Drivers — This section shows the relative importance of each question to the respondents' overall satisfaction. The greater the coefficient number, the more important the issue is to your patients' overall satisfaction. The questions are arranged based on their weighted importance value.
Correlation Question Your Score Coeffecient How well did our staff work together to care for you 93.59 .915719393 Extent to which medics cared for you as a person 94.78 .885796393 Degree to which the medics relieved your pain or discomfort 91.11 .879721189 Skill of the medics 94.95 .87665013 Care shown by the medics who arrived with the ambulance 96.15 .870284709 Extent to which the medics kept you informed about your treatment 93.01 .865489123 Extent to which our staff eased your entry into the medical facility 95.43 .858820885 Degree to which the medics listened to you and/or your family 95.39 .830764445 Degree to which the medics took your problem seriously 95.38 .822172712 Concern shown by the person you called for ambulance service 92.69 .818593783 Helpfulness of the person you called for ambulance service 94.54 .802746726 Cleanliness of the ambulance 94.59 .799495703 Skill of the person driving the ambulance 95.48 .795434446 Medics' concern for your privacy 93.54 .788144191 Appropriateness of Emergency Medical Transportation treatment 94.66 .747794888 Extent to which medics included you in the treatment decisions (if applicable) 92.87 .735321163 Extent to which the services received were worth the fees charged 89.03 .697821279 Extent to which you were told what to do until the ambulance arrived 90.09 .696571933 Willingness of the staff in our billing office to address your needs 84.04 .678736774 Comfort of the ride 92.04 .654295337 Extent to which the ambulance arrived in a timely manner 95.27 .610881936 Professionalism of the staff in our billing office 81.69 .602739238
Page 17 of 24 121 City of Palo Alto July 1, 2017 to December 31, 2017
Company Comparisons — The following chart gives a comparison of the mean score for each question as scored by comparable companies. Your company is highlighted. There is also a green-shaded highlight of the highest score for each question. This will show how you compare to similar companies.
Comparison Companies Your Company ABCDEF Helpfulness of the person you called for ambulance service 94.54 91.10 94.43 92.09 91.04 91.76 92.88 Concern shown by the person you called for ambulance service 92.69 91.17 94.76 90.77 91.20 91.38 92.58 Extent to which you were told what to do until the ambulance 90.09 88.42 90.52 87.93 91.33 89.98 91.67 Extent to which the ambulance arrived in a timely manner 95.27 86.27 93.75 90.10 90.07 91.64 92.87 Cleanliness of the ambulance 94.59 90.53 94.95 93.59 89.49 93.50 94.82 Comfort of the ride 92.04 83.74 87.65 86.77 82.35 88.45 87.33 Skill of the person driving the ambulance 95.48 92.49 94.51 94.33 90.58 92.02 93.81 Care shown by the medics who arrived with the ambulance 96.15 92.98 95.50 95.31 91.91 93.39 95.04 Degree to which the medics took your problem seriously 95.38 92.11 95.66 94.33 92.28 92.81 95.18 Degree to which the medics listened to you and/or your family 95.39 92.49 94.95 94.50 91.67 91.82 94.20 Skill of the medics 94.95 92.78 94.25 94.50 91.79 92.83 94.79 Extent to which the medics kept you informed about your 93.01 90.40 90.96 93.87 91.80 89.50 93.58 Extent to which medics included you in the treatment decisions (if 92.87 91.20 91.23 93.61 90.74 89.47 93.14 Degree to which the medics relieved your pain or discomfort 91.11 87.84 92.08 92.74 91.96 89.66 91.32 Medics' concern for your privacy 93.54 91.79 93.52 94.34 92.97 91.25 93.82 Extent to which medics cared for you as a person 94.78 93.32 95.30 95.23 91.79 92.37 94.63 Professionalism of the staff in our billing office 81.69 85.88 89.90 89.52 91.94 84.12 88.32 Willingness of the staff in our billing office to address your needs 84.04 84.37 87.69 87.06 92.50 84.55 88.79 How well did our staff work together to care for you 93.59 89.50 94.24 93.00 91.41 91.96 93.91 Extent to which our staff eased your entry into the medical facility 95.43 91.13 95.51 94.04 91.27 92.00 94.21 Appropriateness of Emergency Medical Transportation treatment 94.66 90.62 95.19 94.23 92.74 90.81 94.37 Extent to which the services received were worth the fees charged 89.03 84.39 88.74 88.88 89.90 83.25 86.22 Overall rating of the care provided by our Emergency Medical 94.59 90.45 95.52 94.73 93.65 91.74 94.19 Likelihood of recommending this ambulance service to others 92.89 88.63 94.05 92.77 93.33 89.92 93.86
Overall score 93.38 89.90 93.37 92.64 91.16 90.76 93.02
National Rank 32 84 33 47 77 79 42
Comparable Size (Medium) Company Rank 9 25 10 16 22 23 14
Page 18 of 24 122 City of Palo Alto July 1, 2017 to December 31, 2017
Benchmark Comparison Your Company Total DB Similar Sized California All Fire Departments Total Score 93.38 92.64 91.97 92.49 94.09 Helpfulness of the person you called for ambulance service 94.54 92.72 92.44 94.13 94.37 Concern shown by the person you called for ambulance service 92.69 92.54 92.17 92.62 93.54 Extent to which you were told what to do until the ambulance 90.09 91.02 90.87 90.80 92.01 Extent to which the ambulance arrived in a timely manner 95.27 92.15 91.69 93.69 95.27 Cleanliness of the ambulance 94.59 94.47 93.91 94.60 95.92 Comfort of the ride 92.04 87.28 86.88 88.54 90.38 Skill of the person driving the ambulance 95.48 93.79 93.33 94.22 95.55 Care shown by the medics who arrived with the ambulance 96.15 94.35 94.13 94.71 95.93 Degree to which the medics took your problem seriously 95.38 94.31 94.03 94.33 95.90 Degree to which the medics listened to you and/or your family 95.39 93.92 93.63 94.07 95.48 Skill of the medics 94.95 94.28 93.79 94.09 95.90 Extent to which the medics kept you informed about your 93.01 92.56 92.19 92.13 94.24 Extent to which medics included you in the treatment decisions 92.87 92.33 91.70 92.77 93.79 Degree to which the medics relieved your pain or discomfort 91.11 90.38 90.18 90.39 92.31 Medics' concern for your privacy 93.54 93.32 93.17 92.89 94.64 Extent to which medics cared for you as a person 94.78 94.34 94.03 94.16 95.90 Professionalism of the staff in our billing office 81.69 88.73 88.08 86.88 89.90 Willingness of the staff in our billing office to address your 84.04 88.63 87.93 87.92 90.30 How well did our staff work together to care for you 93.59 93.52 93.42 93.35 95.02 Extent to which our staff eased your entry into the medical 95.43 93.75 93.16 94.40 95.47 Appropriateness of Emergency Medical Transportation treatment 94.66 93.58 93.04 93.43 95.35 Extent to which the services received were worth the fees 89.03 88.14 87.33 88.71 90.60 Overall rating of the care provided by our Emergency Medical 94.59 93.70 93.49 93.81 95.43 Likelihood of recommending this ambulance service to others 92.89 93.22 92.67 93.07 95.03
Number of Surveys for the period 178
Page 19 of 24 123 City of Palo Alto July 1, 2017 to December 31, 2017
Benchmark Trending Graphic - Below are the monthly scores for your service. It details the overall score for each month as well as your subscribed benchmarks for that month.
Page 20 of 24 124 City of Palo Alto July 1, 2017 to December 31, 2017
Cumulative Comparisons This section lists a synopsis of the information about your individual questions and overall scores over the entire lifetime of the dataset. The first column shows the company score and the second column details the total database score.
Your Score Total DB Overall Facility Rating 94.21 91.86
Dispatch 93.82 91.64 Helpfulness of the person you called for ambulance service 94.81 92.35
Concern shown by the person you called for ambulance service 94.19 92.11 Extent to which you were told what to do until the ambulance 92.46 90.46
Ambulance 95.07 91.44 Extent to which the ambulance arrived in a timely manner 95.53 91.75 Cleanliness of the ambulance 96.25 93.97 Comfort of the ride 92.64 87.12 Skill of the person driving the ambulance 95.87 92.92
Medic 95.31 92.85 Care shown by the medics who arrived with the ambulance 96.71 93.88 Degree to which the medics took your problem seriously 96.52 93.80 Degree to which the medics listened to you and/or your family 96.11 93.51 Skill of the medics 96.42 93.92 Extent to which the medics kept you informed about your treatment 94.56 92.02 Extent to which medics included you in the treatment decisions (if 93.73 91.81 Degree to which the medics relieved your pain or discomfort 93.01 90.18 Medics' concern for your privacy 94.48 92.79 Extent to which medics cared for you as a person 96.21 93.75
Billing Staff Assessment 87.93 88.24
Page 21 of 24 125 City of Palo Alto July 1, 2017 to December 31, 2017
Cumulative Comparisons (Continued)
Your Score Total DB Overall Facility Rating 94.21 91.86
Billing Staff Assessment 87.93 88.24 Professionalism of the staff in our billing office 87.87 88.20
Willingness of the staff in our billing office to address your needs 87.99 88.29
Overall Assessment 94.29 91.96 How well did our staff work together to care for you 95.76 92.98
Extent to which our staff eased your entry into the medical facility 95.87 93.15 Appropriateness of Emergency Medical Transportation treatment 95.45 92.91 Extent to which the services received were worth the fees charged 87.72 86.97 Overall rating of the care provided by our Emergency Medical 96.08 93.06 Likelihood of recommending this ambulance service to others 94.86 92.68
Page 22 of 24 126 City of Palo Alto July 1, 2017 to December 31, 2017
Top Box Comparisons
The Top Box Analysis displays the number of responses for the entire survey by question and rating. The Top Box itself shows the percentage of "Very Good" responses, the highest rating, for each question. Next to the company rating is the entire EMS DB rating for those same questions.
Company Very Very % Very EMS DB % Poor Poor Fair Good Good Good Very Good
Overall Company Rating 35 33 69 517 2716 80.59% 76.11%
Dispatch 2 3 12 73 289 76.25% 74.34%
Helpfulness of the person you called for ambulance 1 0 2 20 105 82.03% 76.12% service
Concern shown by the person you called for ambulance 0 1 5 25 99 76.15% 75.20% service
Extent to which you were told what to do until the 1 2 5 28 85 70.25% 71.71% ambulance arrived
Ambulance 1 3 14 103 517 81.03% 74.52%
Extent to which the ambulance arrived in a timely 0 0 4 24 141 83.43% 75.03% manner
Cleanliness of the ambulance 0 1 2 27 127 80.89% 79.98%
Comfort of the ride 1 1 6 31 118 75.16% 64.28%
Skill of the person driving the ambulance 0 1 2 21 131 84.52% 78.78%
Medic 15 14 18 170 1119 83.76% 79.23%
Care shown by the medics who arrived with the 2 0 2 13 145 89.51% 81.78% ambulance
Degree to which the medics took your problem 1 2 1 18 140 86.42% 82.39% seriously
Degree to which the medics listened to you and/or 2 0 2 17 136 86.62% 81.12% your family
Skill of the medics 2 2 1 15 133 86.93% 81.44%
Extent to which the medics kept you informed about 2 2 3 22 121 80.67% 76.80% your treatment
Page 23 of 24 127 City of Palo Alto July 1, 2017 to December 31, 2017
Top Box Comparisons (Continued)
Company Very Very % Very EMS DB % Poor Poor Fair Good Good Good Very Good
Overall Company Rating 35 33 69 517 2716 80.59% 76.11%
Extent to which medics included you in the treatment 2 1 4 15 97 81.51% 76.82% decisions (if applicable)
Degree to which the medics relieved your pain or 2 4 1 25 100 75.76% 72.21% discomfort
Medics' concern for your privacy 1 1 3 24 114 79.72% 78.10%
Extent to which medics cared for you as a person 1 2 1 21 133 84.18% 82.44%
Billing Staff Assessment 3 5 8 58 73 49.66% 63.61%
Professionalism of the staff in our billing office 2 2 6 29 36 48.00% 63.42%
Willingness of the staff in our billing office to address 1 3 2 29 37 51.39% 63.80% your needs
Overall Assessment 14 8 17 113 718 82.53% 77.52%
How well did our staff work together to care for you 1 2 2 24 119 80.41% 78.91%
Extent to which our staff eased your entry into the 1 1 1 19 131 85.62% 79.31% medical facility
Appropriateness of Emergency Medical Transportation 1 2 3 15 124 85.52% 79.26% treatment
Extent to which the services received were worth the 4 1 10 16 94 75.20% 67.82% fees charged
Overall rating of the care provided by our Emergency 2 2 0 19 129 84.87% 80.06% Medical Transportation service
Likelihood of recommending this ambulance service to 5 0 1 20 121 82.31% 79.78% others
Page 24 of 24 128 County of Santa Clara EMS Agency
NON-911 AMBULANCE SERVICES/PERMITTED VEHICLES – As of August 1, 2018
Current Non-911 Private Ambulance Providers:
Provider Levels of Service American Medical Response - Sutter CCT, BLS Bayshore Ambulance CCT, BLS Falck North America CCT, ALS, BLS Norcal Ambulance CCT, BLS Pro Transport-1 CCT, ALS, BLS Royal Ambulance CCT, BLS Silicon Valley Ambulance ALS, BLS Westmed Ambulance CCT, ALS, BLS
Number of Non-911 resources (as of 8/01/18):
Provider Santa Clara County Resources American Medical Response - Sutter 7 Bayshore Ambulance 5 Falck North America 12 Norcal Ambulance 6 Pro Transport-1 31 Royal Ambulance 23 Silicon Valley Ambulance 9 Westmed Ambulance 26 Total 119
Number of field inspections of ambulances and fire apparatus during CY2018:
Resource Type Inspections Ambulances (Fire, EOA, and Non-911) 30 Fire Apparatus (Non-Transport) 4
129 County of Santa Clara EMS Agency
ADDITIONAL 911 AMBULANCE (COUNTY AMBULANCE) DATA
911 Ambulance Responses to County Custody Facilities
45 42 40 38 34 35 33 33 33 30 30 30 28 26 24 25
20 18
15
10
5 2 2 0 1 1 0 000011 0 Jan‐18 Feb‐18 Mar‐18 Apr‐18 May‐18 Jun‐18
Elmwood (MLP) Main Jail (SJS) Ranches for Boys (MRG) Juvenile Hall (SJS) Linear (Elmwood (MLP)) Linear (Main Jail (SJS))
911 Ambulance Responses to SCVMC Clinics 20
18
16
14
12
10
8
6
4
2
0
Jan‐18 Feb‐18 Mar‐18 Apr‐18 May‐18 Jun‐18
130 Transition of Care Time - 90th Percentile 0:57:36
0:50:24
0:43:12
0:36:00
0:28:48 H:MM:SS
0:21:36
0:14:24
0:07:12
0:00:00 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
SHC ECH KSC RMC OCH VMC GSH KSJ SLH LGH
SHC ECH KSC RMC OCH VMC GSH KSJ SLH LGH Jan-18 0:12:01 0:17:09 0:24:17 0:28:42 0:27:42 0:55:42 0:46:18 0:28:33 0:30:41 0:15:01 Feb-18 0:12:01 0:15:34 0:23:01 0:21:56 0:21:47 0:56:30 0:28:44 0:21:28 0:21:44 0:10:47 Mar-18 0:11:32 0:15:48 0:23:47 0:23:35 0:24:18 0:44:47 0:32:11 0:23:42 0:17:15 0:09:47 Apr-18 0:10:56 0:14:17 0:21:29 0:19:11 0:18:10 0:35:16 0:26:02 0:21:37 0:18:19 0:11:06 May-18 0:10:18 0:15:06 0:22:00 0:16:01 0:19:44 0:31:14 0:23:47 0:20:30 0:18:53 0:11:12 Jun-18 0:11:11 0:14:26 0:21:19 0:17:33 0:18:33 0:34:21 0:22:29 0:18:20 0:18:43 0:09:23
Time is determined using “Arrived At Destination Time” and “Hospital Provider Signature Time” (or “Patient Transfer of Care Time” if unavailable) 131 APOT 2 - June 2018
< 20 minutes 21-60 minutes 61-120 minutes 121-180 minutes >180 minutes Total Patients <25 minutes 371 8 0 0 0 374 SHC 379 SHC 97.9% 2.1% 0.0% 0.0% 0.0% 98.7% 656 15 0 0 0 662 ECH 671 ECH 97.8% 2.2% 0.0% 0.0% 0.0% 98.7% 595 72 2 0 0 630 KSC 669 KSC 88.9% 10.8% 0.3% 0.0% 0.0% 94.2% 1116 79 0 0 0 1156 RMC 1195 RMC 93.4% 6.6% 0.0% 0.0% 0.0% 96.7% 439 35 1 0 0 455 OCH 475 OCH 92.4% 7.4% 0.2% 0.0% 0.0% 95.8% 994 287 32 0 0 1084 VMC 1313 VMC 75.7% 21.9% 2.4% 0.0% 0.0% 82.6% 609 82 1 0 0 644 GSH 692 GSH 88.0% 11.8% 0.1% 0.0% 0.0% 93.1% 625 47 0 0 0 645 KSJ 672 KSJ 93.0% 7.0% 0.0% 0.0% 0.0% 96.0% 256 19 1 0 0 262 SLH 276 SLH 92.8% 6.9% 0.4% 0.0% 0.0% 94.9% 101 2 0 0 0 103 LGH 103 LGH 98.1% 1.9% 0.0% 0.0% 0.0% 100.0% 5762 646 37 0 0 6015 TOTAL 6445 TOTAL 89.4% 10.0% 0.6% 0.0% 0.0% 93.3%
132 CountyCooununtyy ooff SaSantSantanta ClClaraara County of Santa Clara EmergencyEmmergencyerergegencncy MeMMediMedicaledid cal SeServicesrvices SystemSystem Emergency Medical Services System MonthlyMonthlontnthhlly HHoHospitalossppitalititalal DDestination,estination, DiDiversionversion andand AdviAdvisorysory StatuStatuss ReReportport
Monthly Hospital Destination, Diversion & Bypass Status Report
Report for Time Period: June 2018 Table 1: Number of Patients Transported to Hospital ED from 9-1-1 System* Hospital (Diversion Zone) Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Total Stanford (North) 503 419 463 429 471 473 2,758 El Camino - Mt. View (North) 876 691 745 671 731 676 4,390 Kaiser - Santa Clara (North) 776 682 769 668 709 677 4,281 Regional - San Jose (Central) 1,369 1,174 1,257 1,221 1,293 1,201 7,515 O'Connor (Central) 640 525 602 488 528 470 3,253 VMC (Central) 1,430 1,203 1,346 1,436 1,417 1,328 8,160 Good Samaritan (South) 750 617 773 635 719 704 4,198 Kaiser - San Jose (South) 745 601 733 674 734 677 4,164 Saint Louise (South) 336 273 294 294 297 277 1,771 El Camino - Los Gatos (N/A) 168 100 114 96 110 104 692 VA - Palo Alto (N/A) 95 64 82 68 86 88 483 Total 7,688 6,349 7,178 6,680 7,095 6,675 41,665 Source: Santa Clara County Communications & Palo Alto Fire Department Table 2: Daily Average of 9-1-1 Patients Transported By Hospital* Hospital (Diversion Zone) Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 6 Mth Avg Stanford (North) 16 14 15 14 15 16 15 El Camino - Mt. View (North) 28 22 24 22 24 23 24 Kaiser - Santa Clara (North) 25 22 25 22 23 23 23 Regional - San Jose (Central) 44 38 41 41 42 40 41 O'Connor (Central) 21 17 19 16 17 16 18 VMC (Central) 46 39 43 48 46 44 44 Good Samaritan (South) 24 20 25 21 23 23 23 Kaiser - San Jose (South) 24 19 24 22 24 23 23 Saint Louise (South) 11 9 9 10 10 9 10 El Camino - Los Gatos (N/A) 5 3 4 3 4 3 4 VA - Palo Alto (N/A) 3 2 3 2 3 3 3 Total Daily Average 247 205 232 221 231 223 Source: Santa Clara County Communications & Palo Alto Fire Department *Notes for Tables 1 and 2: These numbers only reflect patients that originated in Santa Clara County and were transported by the County's EOA Ambulance Provider and Palo Alto Fire Department. Data for Stanford does not include patients from San Mateo County. The data includes but, does not differentiate specialty center status (TRAUMA, STROKE, STEMI, BURN) Page 1 of 2
133 Table 3: Total Monthly Hours of Emergency Department on "AMBULANCE DIVERSION" Hospital (Diversion Zone) Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Total Stanford (North) 13.56 4.10 7.78 1.56 1.60 2.72 31.32 El Camino - Mt. View (North) 32.02 10.57 10.56 3.02 12.74 9.04 77.95 Kaiser - Santa Clara (North) 51.50 24.23 34.69 35.61 9.67 10.56 166.26 Regional - San Jose (Central) 33.94 34.40 0.00 2.27 3.02 0.00 73.63 O'Connor (Central) 25.91 1.53 0.00 1.50 0.00 0.00 28.94 VMC (Central) 55.09 52.28 63.81 25.62 25.88 22.41 245.09 Good Samaritan (South) 38.31 13.10 6.06 3.01 1.50 0.02 62.00 Kaiser - San Jose (South) 35.80 7.61 5.88 3.01 3.03 6.04 61.37 Saint Louise (South) 18.44 12.57 3.02 3.90 2.38 3.13 43.44 El Camino - Los Gatos (N/A) 7.03 3.05 0.00 2.03 1.50 1.51 15.12 Total 311.60 163.44 131.80 81.53 61.32 55.43 805.12
Color Legend for "Ambulance Diversion Only" Above 37hrs Above 30hrs Below 30hrs
Table 4: Total Monthly Hours of Stroke Center on "STROKE" Bypass* Hospital (Diversion Zone) Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Total Stanford (North) 0.00 0.00 0.00 0.00 0.00 1.23 1.23 El Camino - Mt. View (North) 0.00 0.00 0.00 0.00 0.11 0.00 0.11 Kaiser - Santa Clara (North) 0.00 0.00 0.00 18.50 0.00 0.00 18.50 Regional - San Jose (Central) 2.43 9.02 0.00 0.00 0.00 1.37 12.82 O'Connor (Central) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 VMC (Central) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Good Samaritan (South) 46.79 20.70 0.00 0.00 0.00 0.02 67.51 Kaiser - San Jose (South) 2.91 0.00 1.57 6.14 0.00 1.59 12.21 Saint Louise (South) 180.42 53.22 2.52 3.91 0.96 5.79 246.82 El Camino - Los Gatos (N/A) 0.00 1.72 0.00 4.39 1.12 0.00 7.23 Total 232.55 84.66 4.09 32.94 2.19 10.00 366.43 Table 5: Total Monthly Hours of STEMI Center on "STEMI" Bypass* Hospital (Diversion Zone) Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Total Stanford (North) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 El Camino - Mt. View (North) 0.00 0.00 0.00 0.00 0.09 0.00 0.09 Kaiser - Santa Clara (North) 0.00 0.00 0.00 17.58 0.00 0.00 17.58 Regional - San Jose (Central) 2.44 9.00 0.00 1.64 0.00 1.35 14.43 O'Connor (Central) 0.00 1.73 0.00 0.00 0.00 10.40 12.13 VMC (Central) 0.00 0.00 0.00 0.00 1.73 0.00 1.73 Good Samaritan (South) 85.24 20.70 0.00 0.00 0.00 0.02 105.96 Kaiser - San Jose (South) 0.00 0.00 0.00 4.77 0.00 1.60 6.37 Total 87.68 31.43 0.00 23.99 1.82 13.37 158.29 Table 6: Total Monthly Hours of Trauma Center on "TRAUMA" Bypass Hospital (Diversion Zone) Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Total Stanford (North) 0.00 0.00 0.00 0.00 0.00 1.22 1.22 Regional - San Jose (Central) 1.00 0.00 0.00 0.00 0.00 1.10 2.10 VMC (Central) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total 1.00 0.00 0.00 0.00 0.00 2.32 3.32 Page 2 of 2
134