Alameda County EMS System Report -2012

Vision Alameda County EMS will explore new frontiers while creating an environment where collaboration and consensus building thrive among staff and stakeholders

Mission Alameda County EMS ensures the provision of quality emergency medical services and prevention programs to improve health and safety in Alameda County

Values Alameda County EMS values a caring environment sustained by empowerment, honesty, integrity and mutual respect. We embrace excellence through innovation, teamwork and community capacity building

Alameda County EMS System Report -2012

TABLE OF CONTENTS

Overview of the County ...... 1 Local Emergency Medical Services (EMS) ...... 1 Introduction ...... 1 Responsibilities ...... 2 EMS Funding ...... 2 The EMS Agency ...... 2 Contract for Ambulance Service ...... 3 First Responder Advanced Life Support (FRALS) ...... 4 Medical Control ...... 5 Receiving Hospitals ...... 6 Dispatch & Communications ...... 7 Highlighted Programs ...... 7 Sudden Cardiac Arrest – New Modalities that Improve Survival ...... 7 Systems Approach to Cardiac Arrest ...... 9 County-Wide Automatic External Defibrillators ...... 10 Project HeartSAFE – Putting More Defibrillators into the Community ...... 11 CPR7 – Training Seventh Graders to Save Lives ...... 11 Stroke Centers – Saving Brain Cells Through Early Recognition & Treatment ...... 12 Sepsis Program – Identifying Patients with Serious Systemic Infections ...... 13 Regional Disaster Medical/Health Coordination Program ...... 13 Programs for At-Risk Youth ...... 14 Program Specific Information ...... 14 Ambulance Ordinance ...... 14 Trauma System ...... 15 Disaster & Bioterrorism Preparedness: ...... 16 EMTs & Paramedics ...... 17 Critical Care Transport—Paramedic (CTT-P) Program...... 19 Information Technology ...... 19

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Unusual Occurrence Reports ...... 19 Health Equity ...... 20 Climate Change and Public Health ...... 20 Legislative Council Liaison ...... 20 ReddiNet ...... 20 EMS News ...... 21 EMS Week Activities ...... 21 Hospital Preparedness Program (HPP) ...... 21 Injury Prevention ...... 23 Injury Prevention Programs For Children ...... 23 Senior Injury Prevention Program (SIPP) ...... 26 Staff Directory ...... 30 Values, Mission, Vision Statement

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OVERVIEW OF THE COUNTY lameda County, located east of San Francisco across the Oakland Bay Bridge, is one of nine Aco unties that make up the San Francisco Bay Area. The eastern zone has a low population density and vast expanses of open space, working ranches and agricultural areas. The rest of the County is urban/suburban and industrial. Alameda The Bay Area Rapid Transit District (BART) runs north/south and east/west Albany Berkeley through the County, and services the counties of Alameda, Contra Costa, Dublin Emeryville San Mateo (San Francisco Airport), and San Francisco. The Bay Area has Fremont many commuters and most use automobiles. Rush hour traffic is Hayward Livermore particularly heavy on the four major freeways within the County, Newark Oakland Interstates 80, 580, 680 and 880. Piedmont Pleasanton The County has a population of approximately 1.5 million, and includes 14 San Leandro incorporated cities and five unincorporated communities. Alameda Union City County is connected to counties on the other side of the Bay by three Ashland Castro Valley bridges. Alameda County is connected to San Francisco via the Oakland Bay Bridge Cherryland San Lorenzo and to San Mateo County by the San Mateo and Dumbarton Bridges. Other Sunol surrounding counties are Contra Costa, Santa Clara, Marin, Solano and San Joaquin. There are a number of active earthquake faults in the area. Densely populated areas, including most of the hospitals in Alameda County, are located along the Hayward Fault. The area is also at risk for mudslides and wildfires.

LOCAL EMERGENCY MEDICAL SERVICES (EMS)

Introduction The Alameda County Emergency Medical Services (EMS) Agency continues to be a visionary leader in local, regional and national EMS. We provide oversight for all aspects of the EMS system in our county; this includes monitoring dispatch centers, first responder paramedic engines, transporting ambulances, and receiving hospitals. EMS is piloting several new projects. One of these is the sepsis program. It was designed to identify patients with infections during the prehospital encounter, thus reducing the time from arrival at an emergency department to the administration of antibiotics. This reduced time has been shown to decrease both morbidity and mortality in patients with sepsis, a severe infection that has spread throughout the patient’s body. The CPR7 program is another example of an innovative approach to improving prehospital cardiac arrest survival. CPR7 trains seventh graders in CPR and provides the tools for them to train family and friends, thus increasing the number of citizens who can provide this life saving intervention. This program has trained over 10,000 seventh graders as well as 30,000 of their family members in performing CPR each year.

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EMS is working with county and community partners to expand the newly created EMS Corps, a program to train at-risk urban youths as Emergency Medical Technicians (EMTs), a first step toward a career in EMS and other healthcare professions. EMS also conducts a robust Injury Prevention program aimed at seniors, teens and children to reduce the number and severity of traumatic cases.

Responsibilities Alameda County EMS is a part of the Health Care Services Agency and a division of the Public Health Department. The EMS Director is responsible for system oversight. The Local EMS Agency (LEMSA) is the local government agency designated to plan, implement, and evaluate the local EMS System. Each LEMSA is charged by the State with implementing statutes, regulations and local policies for the local EMS system. Every EMS Agency in the State is required to submit an EMS System Plan with annual updates. The most recent update of the EMS System Plan was approved by the State in June, 2011, and is available online at acphd.org/ems. EMS is responsible for procurement of emergency ambulance services for the countywide Exclusive Operating Area (EOA) and for monitoring contract compliance. In a disaster, EMS has authority for dispatching medical resources.

EMS Funding The County’s original timetable called for implementing paramedic service in 1978. However, Proposition 13 passed that year and the funding designated for this service was no longer available. The County asked voters to support an assessment of $10.00 per benefit unit to establish countywide paramedic service. The measure was approved by more than 80% of the voters and the EMS District was formed in 1984 to oversee and coordinate the EMS assessment. In November 1996, following passage of Proposition 218, Alameda County was required to again seek voter approval to maintain funding of the EMS system. In June 1997 Measure “C” went before the voters who overwhelmingly reaffirmed their support of the EMS system by passing Measure “C” by 81.3%. The current assessment is $27.68 per benefit unit.

The EMS Agency The history of a coordinated EMS system in Alameda County began in 1973. EMS Directors Ben Mathews was appointed to the new position of Coordinator of EMS and Disaster Planning in the county's fledgling Health Care Services Agency. Eight Ben Mathews (1973-1994) Diane Akers (1994-1997) individuals have held the director’s position. In 2012 EMS Director Dale Michael Harris (1998-2001) Fanning retired from the County in February but was called back to EMS as Cindy Abbissinio (2001-2005) the Interim Director in August when Tom Lynch left to accept another Michael King (2005-2008) Dale Fanning (2008-2012) position. The search for a permanent Director was held and staff member Tom Lynch (2012) Fred Claridge, PHCC, accepted the position as Director. EMS Medical Fred Claridge (2012-current)

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Director, Karl Sporer, MD, has been with EMS since December 2011. EMS Agency staff includes 43 positions, although not all positions are full-time nor were all positions filled at the time of this report (Figure 1). A directory of current staff can be found at the end of this report and on the EMS website at acphd/ems.

EMS Director

EMS Deputy Medical Director Director

Budget Liaison Secretary I

Retiree Annuitant Retiree Annuitant

Health Care Admin. Specialist Deputy Medical Supervising PHCC IS Manager Program Admin. Supervisor Director

PHCC PHCC Program Specialist Specialist Clerk Systems Analyst EMS Corps Manager Program Specialist

Pipeline Program Specialist PHCC Program Specialist Specialist Clerk Systems Specialist EMS Corps TAP Case Manager Administrator

EMS Corps TAP Pipeline Interim CAHAN - TAP PHCC Program Specialist Specialist Clerk Case Manager Placement Coordinator

Pipeline Program PHCC PHCC CHOW Specialist Clerk Liaison

Specialist Clerk PHCC PHCC CHOW (Unfunded) TAP EMS Organizational Structure January 2013 Retiree Annuitant PHCC Sr Injury Prevention [Boxes with double borders indicate supervisors]

Figure 1: EMS Organization chart 9-1-1 PROVIDER AGENCIES

Contract for Ambulance Service Alameda County began its paramedic emergency ambulance service program as a pilot project in 1982 and countywide paramedic service was implemented in 1986. In 1990 EMS issued a Request for Proposal for emergency ambulance services in the Exclusive Operating Area that includes all of Alameda County, except for the cities of Alameda, Albany, Berkeley, and Piedmont, where the

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local fire departments respond to and transport EMS patients. American Medical Response (AMR) was chosen as the county contracted ambulance service provider and provided this service for 21 years. In early 2010 the competitive bid process opened up the Exclusive Operating Area (EOA) for qualified ambulance companies interested in providing ambulance service for Alameda County to bid on the contract. Following a rigorous process and review of submitted proposals, Paramedics Plus LLC. was chosen as the county contracted ambulance service provider and began providing service November 1, 2011. The four cities excluded from the EOA are in accordance with California Ambulance Transport Health and Safety Code §1797.201. This statute allows for exclusivity if Departments the services provided in an area have been in the same manner and Paramedics Plus scope without interruption since June 1, 1980. These four cities qualify City of Alameda City of Albany under this provision and the fire departments provide primary City of Berkeley emergency ambulance response and transport within their cities. City of Piedmont

First Responder Advanced Life Support (FRALS) This innovative program began in 1986 with the Fremont Fire Department. By 1999, many of the non-transporting fire departments had a paramedic on the fire engine and many of the other departments were moving in that direction. An agreement was reached between AMR and the fire departments that provided ALS to respond in eight minutes:30 seconds, meeting the response time criteria, and thereby allowing the staffing configuration to go from two paramedics in an ambulance to one paramedic and one EMT. This FRALS Departments agreement also allowed for an extended response time for the Alameda County Fire ambulance to the scene of 10 minutes and 30 seconds. All FRALS Fremont Fire departments are under contract with EMS for which they are Hayward Fire Livermore/Pleasanton Fire compensated financially by the County, with funds provided by the Oakland Fire contract provider. This improved utilization of the workforce has improved response time compliance and patient care.

Response and Transport: Table 1 shows the total number of 9-1-1 responses by transporting ambulance providers to the scene and transports to receiving hospitals. These numbers continue to increase every year, with 2011 being the first year transports exceeded 100,000 calls.

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Responses Transports 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

Alameda Fire 4,206 4,814 3,999 3,904 4,260 3,226 3,754 3,079 2,967 3,365 Albany Fire 927 962 932 841 920 846 761 754 697 754 Berkeley Fire 6,805 7,955 7,534 8,374 8,490 5,969 6,245 5,876 6,695 6,584 Piedmont Fire 725 664 666 549 558 436 469 427 362 431 AMR/P+ 108,747 112,112 115,678 117,017 *117,571 82,059 84,946 87,195 88,446 *90,226

Total: 121,410 126,507 128,718 130,685 131,799 92,536 96,175 97,331 99,167 101,360 Table 1: Ambulance Responses & Transports (2007-2011)- * AMR Jan-Oct, 2011, P+ Nov-Dec, 2011

Response Time Compliance: Response times represent the time the 9-1-1 call is received Percent Response Time Compliance by the responding agency until the time they 98 2009-2011 (all providers arrive on the scene. The goal for the providers Nov-Dec is to achieve their contracted response time 96 at least 90% of the time. Response times are calculated based on severity of complaint (life 94 threatening vs. non-life threatening) and Jan-Oct location in the county (metro/urban, 92 suburban or rural). 90 Figure 2 shows the percentage of compliance 2009 2010 2011 by ambulance and first responder agencies AMR FD P+ Goal with the contractually agreed response times Figure 2: Response Time Compliance (2009-2011) for 9-1-1 calls.

Medical Control The EMS Medical Director has statutory and regulatory authority for medical control within the EMS system. Medical control includes the development of medical policies and procedures. The EMS Medical Director monitors compliance with the policies and investigates medical incidents and any possible infractions of the California Health and Safety Code, California Code of Regulations Title 22, and local EMS policies.

Medical control for field personnel is handled by the base hospital. Base Hospital Contacts Prior to 2004, specially trained nurses and physicians at three base 2006 2025 hospitals answered radio calls and provide orders to the paramedic. In 2007 1585 2004, a single base hospital was designated and physicians only now 2008 1533 respond to calls from the field by a direct telephone connection. 2009 1839 2010 2215 The Base Hospital physicians assist the paramedics in handling difficult 2011 2673 cases and scenarios as well as approve the use of a few high risk Table 2: Alameda County Medical procedures or medications. Table 2 shows the number of Base Center (Highland)

Hospital contacts from 2006-2011. The numbers for 2007-2009 are

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believed to be lower than actual as there was a change in the base hospital phone number and an undertermined number of calls went to a non-taped phone line.

Receiving Hospitals There are 13 in-county receiving hospitals in Alameda County with emergency departments providing emergency medical care (Figure 3). There are also two out-of-county hospitals (shaded) that are authorized to receive patients from Alameda County and several hospitals throughout the bay area that receive patients from Alameda County, as needed (Figure 4).

STEMI Stroke 5150 Medical Eval. 5150 Trauma Hospital Center Center adults & children Psych Eval. L&D Helipad Center Alameda x x Alta Bates x x x Children’s children < 11 only children < 11 x x Eden x x x x x Highland (ACMC) x x x John George adults Kaiser – Fremont x x Kaiser – Hayward x x x Kaiser – Oakland x x x Kaiser – Walnut Creek x x x San Leandro x San Ramon x x x St. Rose x x x Summit x x x ValleyCare x x x x Washington x x x x Willow Rock adolescents 12-17 Figure 3: Alameda County Approved Receiving Hospitals and Services Provided.

Base Trauma Stroke Burn Hospital Hospital Center Center Center Helipad John Muir Medical Center x x x x

Regional Medical Center x x x x

San Francisco General x

Santa Clara Valley Medical Center x x x x

Stanford Medical Center x x x

St. Francis Memorial x

UC Davis Medical Center x x x Figure 4: Alameda County Approved Out-of-County Receiving Hospitals and Services Provided.

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Hospital Diversion: Hospitals are permitted to divert patients to another Diversion Hours by Year facility when certain conditions exist that would make accepting additional 2006 1436 patients unsafe. Our agency has managed to limit the effect of diversion on 2007 1665 our citizens over the last few years by comprehensive policies and 2008 887 procedures for hospitals to request diversion and careful tracking and 2009 895 monitoring using the Reddinet system. Table 3 shows diversion hours for all 2010 778 hospitals in Alameda County for 2006-2011. 2011 843 A recent study of diversion in 21 counties in California1showed diversion Table 3: Alameda County Diversion Hours (2006-2011) hours were, at the high end, 3000 hours (up to over 5000 hours for one outlier) to a low of 0 hours in 20112.

Dispatch & Communications There are 18 Public Safety Answering Points (PSAPs) in Alameda County that receive 9-1-1 calls from the public. In addition, there are two emergency medical dispatch (EMD) centers (Oakland Fire and the Alameda County Regional Emergency Communication Center) that obtain information from the caller, dispatch appropriate personnel to the scene, and provide pre- arrival instructions on topics such as CPR, choking instruction or childbirth. EMD is used in all areas within the County with the exception of the cities of Berkeley and Piedmont.

HIGHLIGHTED PROGRAMS

Sudden Cardiac Arrest – New Modalities that Improve Survival The Problem: The Alameda County EMS system responds to approximately 1300 out-of- hospital cardiac arrests (OHCA) annually. Each year, approximately 300,000 persons in the United States experience an out-of-hospital cardiac arrest (OHCA); approximately 92% of persons who experience an OHCA event die. An OHCA is defined as cessation of cardiac mechanical activity that occurs outside of the hospital setting and is confirmed by the absence of signs of circulation. Whereas an OHCA can occur from non-cardiac causes (i.e., trauma, drowning, overdose, asphyxia, electrocution, primary respiratory arrests, and other non-cardiac etiologies), the majority (70%--85%) of such events have a cardiac cause. OHCA is the third leading cause of death in the United States. The majority of persons who experience an OHCA event, irrespective of etiology, do not receive bystander-assisted cardiopulmonary resuscitation (CPR) or other timely interventions that are known to improve the likelihood of survival to hospital discharge (e.g., defibrillation). Because nearly half of cardiac arrest events are witnessed, efforts to increase survival rates should focus on timely and effective delivery of interventions by bystanders and emergency medical services (EMS) personnel.3

1 Hsia, R.Y., Asch, S.M., Weiss, R.E., Zingmond, D., Liang, L.J., Han, W., McCreath, H., and Sun, B.C. (2012). California Hospitals Serving Large Minority Populations Were More Likely Than Others To Employ Ambulance Diversion.Health Affairs, August31:8, 1767-1776. 2 The mean number of hours on diversion for these hospitals was 724 per year (standard deviation: 889), with a median of 374 (interquartile range: 52–1,082) and a range of 0–5,088. 3 McNally, B., Robb, R., Out-of-Hospital Cardiac Arrest Surveillance --- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010. Morbidity and Mortality Weekly Report (MMWR), Surveillance Summaries, July 29, 2011 / 60(SS08);1-19

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Each year over 325,000 people, young and old, die of sudden cardiac arrest (SCA). This number of deaths is equal to two 747 aircrafts colliding in mid-air every day, or one person dying every two minutes. More people die of SCA than the combined number of deaths from prostate cancer, breast cancer, AIDS, hand guns, traffic accidents and house fires. The total number of annual EMS responses for suspected cardiac arrest includes medical and traumatic etiologies. Approximately 950 cases per year warrant resuscitation efforts; 650 are transported to a receiving hospital. Due to the bleak survival outcomes of traumatic cardiac arrest, this subset of patients is excluded from data analysis regarding annual cardiac arrest survival outcomes. Survival from Cardiac Arrest: UTSTEIN criteria # Bystander % of Bystander are the international guidelines for calculating Year # VF/VT CPR CPR cardiac arrest survival outcomes. Historically, a 2007 196 77 39.29% specific subset of cardiac arrest patients, those 2008 129 48 37.21% that are found by first responders to have an 2009 157 66 42.04% initial ECG rhythm of ventricular fibrillation (VF) 2010 163 86 52.76% or ventricular tachycardia (VT), a rhythm that can 2011 172 76 44.18% be converted to a normal rhythm using a Total 1183 499 42.18% Table 4: Number and Percent of Bystander CPR (2007 – 2011) defibrillator, have a much higher survival to hospital discharge rate than those who present with asystole (flatline). Also, those VF/VT patients that have a witnessed collapse and bystander CPR (Table 4) have an even higher survival rate compared to those that don’t.

Induced Therapeutic Hypothermia: There is compelling international evidence that shows patients suffering from sudden out-of-hospital cardiac arrest that have witnessed VF/VT and regain pulses but remain comatose, benefit from induced therapeutic hypothermia, which improves survival to hospital discharge as well as neurologic outcomes. Further international evidence suggests that approximately 60% of patients that suffer from sudden out-of-hospital cardiac arrest with VF/VT as the initial presenting ECG rhythm are in need of emergent coronary intervention in an effort to restore blood flow to the culprit artery. Heart Attack Hospitals: Alameda County paramedics screen over 40,000 patients per year for life threatening myocardial infarctions (heart attacks) by performing prehospital 12-lead electrocardiograms (12-lead ECG). Not all heart attacks present with the same symptoms or ECG abnormalities. The most acute life threatening ECG finding is that of ST-Elevation Myocardial Infarction (STEMI) and this can only be detected by a diagnostic quality 12-lead ECG. Definitive treatment once recognized is time sensitive therapy to re-open the coronary artery with emergent percutaneous coronary intervention (PCI), or systemic fibinolytics (IV clot dissolving medication) if PCI is unavailable.

EMS collaborates with the established ST-Elevation Myocardial SCARC Hospitals Infarction Receiving Centers that by definition are capable of emergent St. Rose Hospital coronary intervention, have well established Intensive/Coronary Care Summit Medical Center Units as well as a variety of rehabilitation services and can provide ValleyCare Medical Center Washington Hospital therapeutic hypothermia, if warranted. These comprehensive facilities

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are a logical fit for newly founded Sudden Cardiac Arrest Receiving Centers (SCARC). The strategic location and specialized services offered by these SCARC’s will be a pivotal element for a fully integrated systems based approach to improving survival regarding sudden out-of- hospital cardiac arrests in Alameda County.

Systems Approach to Cardiac Arrest Since out-of-hospital cardiac arrests (OHCA) in patients with no history of heart disease Survival to Discharge is the third leading cause of death in the 45 United States, and OHCA in those with 40 35 known heart disease is the second leading 30 cause, combined that makes OHCA the 25 number one killer in America. Historically 20

OHCA patients had a survival to hospital Survival % 15 discharge rate of about 5%. But patients 10 presenting with ventricular fibrillation or 5 0 pulseless ventricular tachycardia as the primary ECG rhythm have had a higher rate of survival at approximately 10%; this can be SCA with ACLS Vfib attributed to the short duration of the cardiac arrest and or the witnessed event. Figure 5: Cardiac Arrest Survival, Comparison to Other Areas

EMS has closely followed the cardiac arrest survival to hospital discharge outcomes in Alameda County for over half a decade (Figure 5). These outcomes non-specifically reflect patients with or without neurologic impairment. As EMS has constantly compared and nationally benchmarked against other systems, it has been found that our survival-to-discharge rate for OHCA is significantly higher than comparable systems and just under the national leader.

The continued improvement of survival over the past six years directly correlates with the many system enhancements (Figure 6). One contributing factor to success is that EMS continues to stay current on the latest international resuscitation research and evidence-based practice regarding cardiac arrest, as well as early adoption of these proposed best practices. Following implementation of a proposed process improvement Figure 6: Enhancements for Prehospital Cardiac Arrest Resuscitation (2005-2010)

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to the system, the intervention is closely monitored, measured, analyzed and adjusted if needed, as well as followed long term to identify any significant change in performance. The improvements to Alameda County’s EMS systems based approach regarding OHCA start with community involvement and continue through dispatch, prehospital and in-hospital care. The EMS goal for OHCA is success from detection to hospital discharge by improving the continuity of care through continued awareness and education for all involved. PulsePoint is a smartphone app designed to improve cardiac arrest survival rates through improved bystander performance and active citizenship. Where adopted, the PulsePoint app empowers everyday citizens to provide life‐ saving assistance to victims of Sudden Cardiac Arrest (SCA). Application users who have indicated they are trained in cardiopulmonary resuscitation (CPR) and willing to assist in case of an emergency can now be notified if someone nearby is having a cardiac emergency and may require CPR. If the cardiac emergency is in a public place, the location-aware application will alert trained citizens in the vicinity of the need for bystander CPR simultaneous with the dispatch of advanced medical care. The application also directs these citizen rescuers to the exact location of the closest publicly accessible Automated External Defibrillator (AED). Fire Departments that participate in PulsePoint are: Alameda County Fire Department, Alameda Fire Department, Fremont Fire Department, and Livermore Pleasanton Fire Department.

County-Wide Automatic External Defibrillators Automatic external defibrillators (AEDs) play a valuable role in emergency pre-hospital care. Cardio pulmonary resuscitation (CPR) and rapid defibrillation from an AED can restore certain heart rhythms to normal and increase chances of survival by as much as seventy percent. AEDs are meant to be used by non-medical people. The EMS Agency provides overall support to people and businesses in Alameda County that are interested in getting or registering an AED. State law requires AEDs to be registered with the local EMS Agency. There are approximately 1100 AEDs in the county and their information is shared with the two 9-1-1 dispatch centers. With the goal of increasing the number of AEDs and AED awareness, an Agency designed tri-fold informational flyer about AEDs is being distributed to local businesses by county fire department’s fire inspectors. Since 2008, we average 30 cardiac arrests a year where a non-medical individual used an AED. Eighteen to 21 had a shockable rhythm and 5 to 10/year survive to hospital discharge. Agency representatives are involved in the Northern California Chapter of the Sudden Cardiac Arrest Association and regularly meet with and share strategies with other local EMS agencies. In addition, we work on building relationships with area AED service providers and consultants.

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Project HeartSAFE – Putting More Defibrillators into the Community The Alameda County Project HeartSAFE became a reality in 2012. The project will place at least 185 AEDs in County and community buildings over 1½ years. To accomplish this aggressive plan, we partnered with Ice Safety Solutions of Fremont for the site assessments, set-up and installation of the AEDs, CPR training, and data management. The project requires the support of all County departments and divisions to place 100+ AEDs in County buildings, identify employees already CPR/AED certified, and train others, so each location with an AED has an AED Response Team. In addition, we will work with members of the Board of Supervisors to identify 50+ community buildings for AEDs. These could be schools, nonprofits, senior or community centers, or other locations. Support for the AEDs is scheduled for five-years with continued support beyond the five years as an additional option. The project will utilize publicity and promotion through local media outlets to spread the word about learning CPR and how to use an AED. EMS will work with local groups for additional AED support and promotion e.g.: Take Heart Northern California, Take Heart America, Heart Safe, and the Sudden Cardiac Arrest Association. Additional project enhancements being considered include HeartSAFE city designations, fire department AED support in yearly business inspections, a newsletter for county AED owners, and community CPR training and AED awareness

CPR7 – Training Seventh Graders to Save Lives Alameda County Emergency Medical Services, with assistance from School Health Services, has embarked on a program called CPR7. CPR is listed as one of the standards in the California Department of Education health standards. By utilizing 7th graders to increase community capacity and creating a multiplier effect, the County’s bystander CPR rate will increase. This program was preceded by a pilot project called CPR Anytime™ in 2007. This pilot trained a total of 14 demographically equivalent seventh and tenth grade classes in Alameda County. The children were trained at school and each child was told to take their kit home and train as many family members and friends as they could over the Thanksgiving break. A total of 317 children were trained, and then those trained 1357 family members and friends. The information obtained from the pilot was used in developing the CPR7 program. Alameda County public school 7th graders were trained during one class period in CPR by their science, health, or P.E. teacher. Each 7th grader received their own personal CPR kit complete with a mini Anne manikin and a watch-while-learning DVD to take home and keep. The teachers asked that each student train six friends and family members over 12 years of age using the “watch-while-learn” CPR Anytime kit. If all of Alameda County’s approximately 14,000 7th graders each train six friends and family members, we will have an additional 75,000 community members trained in CPR every year! If the program continues for seven more years, we will have taught CPR to half of the population of Alameda County

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During the 2010-2011 school-year CPR7 took place in Pediatric Cardiologist, Andrew Maxwell, MD 38 Alameda County Middle Schools in 15 of our 18 emphasized the importance of this project: school districts. The program was made available to “Teaching this skill to 7th graders 10,069 7th graders. The pilot was funded by the EMS is ideal; they are old enough to understand the physiology of the heart and general fund and going forward will be funded by SB circulation, they are strong enough to 12 funds. These funds are generated from speeding perform the skill and impressionable ticket fines. enough to retain the skill.” As part of this program, the students were asked to teach CPR to others at home. On average, each student taught three adults. One student from Alvarado Middle School, New Haven Unified School District in Union City trained 96 community members. This program means that 40,000 citizens are being exposed to CPR each year. This is the largest citizen CPR training program in the US. Alameda County EMS and School Health Services values the partnership with the school districts. The access to the staff and the students has been invaluable in implementing this innovative public health approach to increasing the bystander CPR rate. We are counting on our 7th graders, with support from their teachers, who have accepted the challenge and will continue to spread the word of CPR throughout our County.

Stroke Centers – Saving Brain Cells Through Early Recognition & Treatment Stroke is the fourth leading cause of death in the United States (JAMA 2008). Alameda County paramedics routinely screen for suspected stroke by a comprehensive history and physical when patients present with associated symptoms. A systems based approach for stroke patients is essential for maintaining continuity of care from dispatch to hospital discharge. The current countywide stroke program was established in 2008 and now consists of eight certified Primary Stroke Receiving Centers (PSRC). The most acute life-threatening of the two strokes is hemorrhagic (15% of patients) and warrants an emergency neurology/neurosurgical services consult. A patient suspected of an ischemic/occlusive stroke (85% of patients) may be a candidate for time sensitive therapy to re- open the cerebral artery with systemic fibinolytics (IV clot dissolving medication). International guidelines, the American Heart Association and American Stroke Association recommends fibrinolytic intervention be started no longer than 4.5 hours after the onset of symptoms. Suspected stroke patients are transported by paramedics to a PSRC immediately on completion of a comprehensive history and physician the field including: vital signs, pulse asymmetry, ECG, Cincinnati Prehospital Stroke Scale, blood glucose and confirmation by a valid historian of the time the patient was last seen normal/baseline. The stroke team at PSRC is activated by the emergency department giving all personnel involved ample time to prepare for patient arrival. The treatment for acute ischemic/occlusive stroke is time sensitive: international guidelines as

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well as the American Heart Association and American Stroke Association recommends systemic (IV) fibrinolytic intervention be started no longer than 4.5 hours after the onset of symptoms.

Sepsis Program – Identifying Patients with Serious Systemic Infections Sepsis starts out as an infection. It can then progress to Systemic Inflammatory Response Syndrome or SIRS. This syndrome can include fever, tachycardia (a fast heart rate), and tachypnea (rapid breathing). On December 1st of 2010 the Alameda County EMS system implemented a sepsis alert program county-wide. The program is designed to help paramedics identify potential sepsis patients more easily and to alert the receiving hospital that a potential sepsis patient is enroute. Ideally, this will lead to more aggressive assessment for sepsis and the initiation of Early Goal Directed Therapy (EGDT) in the Emergency Department. All of the hospitals in Alameda County have or will soon have internal sepsis programs. Over the past several years, the medical community has begun to pay much more attention to sepsis patients. Sepsis is the tenth leading cause of death according to the Centers for Disease Control. There are approximately 750,000 cases of severe sepsis in the U.S. annually. The mortality rate, 20-50%, is higher than AMI, CVA, and trauma. Once a patient reaches the septic shock phase of the pathological process, the mortality rate can be as high as 50-80%. A delay of even a couple of hours in starting antibiotic therapy can significantly increase mortality rates. A simple screening tool (Figure 7) was developed to help paramedics identify potential sepsis patients. If a patient meets the screening criteria, a sepsis alert is called into the receiving hospital. Early recognition by prehospital care personnel and alerting of the receiving hospital can start the “clock” earlier for potential sepsis patients. Training in the program Prehospital Sepsis Screening Tool was presented to EMS provider agencies A.Does patient have suspected or documented infection? Yes  No  and hospital Emergency Department (ED) B.Does patient meet two or more of the following criteria? staff. The goal of the alert program is to Yes  No  continue aggressive assessment for sepsis  Temperature > 100.4 or < 96  Heart Rate > 90? in the ED as soon as the patient arrives.  Respiratory Rate > 20? Early goal directed therapy can then be If A + B are YES, call in a Sepsis Alert to the receiving hospital. initiated rapidly; including intravenous If systolic Blood Pressure < 90 start IVF per EMS protocol. fluids, antibiotics, and other medications as Figure 7: Prehospital Sepsis Screening Tool these patients require rapid intervention. The Alameda County EMS system is one of the relatively few EMS systems in the country with such a program. Data gained during a study period may guide future enhancements. The overall premise is a simple one but this program could prove to be very beneficial to a significant group of patients in our system.

Regional Disaster Medical/Health Coordination Program The state of California is divided into six mutual aid regions for the purpose of coordinating disaster response during significant incidents. Alameda County is a part of Region II - a sixteen

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county region extending along the northern coast of California from Monterey County to Del Norte County on the Oregon border. The Regional Disaster Medical/Health Program coordinates medical/health disaster response and related emergency preparedness planning for each of the six regions. Each region has two positions assigned to coordinate that response and planning – a Regional Disaster Medical/Health Coordinator (RDMHC) and a Regional Disaster Medical/Health Specialist (RDMHS). The Alameda County Health Officer serves in the RDMHC role but the position is unfunded so the time the RDMHC can devote to regional coordination is limited. The RDMHS role is funded – on an annual basis – and is thus able to perform the day-to-day activities of regional medical/health coordination. The Alameda County EMS Agency entered into a year-long contract with the California Emergency Medical Services Authority on July 1, 2011 to provide RDMHS services for Region II. That contract is expected to be renewed on a bi-annual basis. The RDMHS position is served by a Prehospital Care Coordinator here at the EMS Agency.

Programs for At-Risk Youth Pipeline Partnership: The Alameda County Health Pipeline Partnership is a collaboration led by the Alameda County Public Health Department that encompasses 17 programs serving over 1000 youth. The mission is to create a “seamless” health career pathway by enhancing collaboration and communication among health pipeline programs in Alameda County to increase the number of underrepresented persons who enter health careers. EMS Corps: The EMS Corps is a highly selective rigorous academy that prepares youth who are from the community and are ready for careers in Emergency Medical Services. The mission is to increase the number of underrepresented emergency medical health care professionals through youth development, mentorship, job training, and shadowing. Camp Sweeney: The Camp Sweeney project is a program that exposes young men to careers in Emergency Medical Services. We offer a cognitive behavioral change model that focuses on cognitive restructuring, cultural realignment, and character refinement. Our mission is to reduce the recidivism rate in Alameda County by offering juveniles life coaching and a First Responder course. BAY EMT: The mission of BAY EMT is to increase diversity in the EMS profession by instructing inner city youth in the EMT curriculum. Our goal is to create civic minded EMTs who are willing to apply their newly learned skills to community based programs as well as in local EMS agencies.

PROGRAM SPECIFIC INFORMATION

Ambulance Ordinance Alameda County has four types of ambulance service providers: emergency 9-1-1 Advanced Life Support (ALS), Basic Life Support (BLS), Critical Care Transport Paramedic (CCT-P) and Critical

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Care Transport Nurse (CCT-RN). The 9-1-1 provider operates under a county contract. The other three are covered under the county’s Ambulance Ordinance, approved by the Board of Supervisors in 2008.

Eight companies have county offices in Alameda County and are permitted BLS & CCT Ambulances through the ordinance. These companies have a combined ambulance Alameda Fire BLS presence of 166 units throughout the County. In addition, there are five Norcal Ambulance Royal Ambulance out-of-county BLS and CCT providers permitted for service in the county: Patients Plus AMR, BayShore, Bay Medic, Cabulance, and Falcon. Providers are given a Priority-One, ProTransport-1 two-year Certificates of Operation, and after an inspection ambulances Westmed Ambulance receive a permit; spot inspections may be done at any time. Rural/Metro The Ambulance Ordinance provides a way for EMS to manage these non-emergency service providers. This ensures that providers follow EMS policies and protocols, use the same equipment carried according to equipment specifications, and provide continuity of service for the citizens of the county. In county providers also carry county radios and their dispatch centers have access to ReddiNet, the system that shows hospital diversion and bed availability.

Trauma System The trauma system began in 1987 when three receiving hospitals were designated as trauma centers. Over the 25 year history of the trauma system almost 95,000 critically injured persons have been treated at these state-of-the-art centers. Oversight of the trauma system is through a bi-county quality improvement and case review process with Contra Costa County. In May 2012 EMS hosted the American College of Surgeons (ACS) to perform a “Trauma Consulta- tion” survey of the three trauma centers according to the National Standards of Optimal

Patient Care. The completed consultations have Figure 8: Trauma Activations (2003-2011) assisted in creating a roadmap of improvements that will culminate in our three hospitals applying for formal ACS Trauma Center status over the next two years. The three trauma centers have completed the first step in becoming verified centers of excellence in trauma care by the ACS. The ACS is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. The ACS’ mission is to create national guidelines for the purpose of optimizing trauma care in the United States. This objective may be accomplished through a voluntary review of potential and existing trauma centers so that trauma centers may provide an organized and systemic approach to the care of the injured patient

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Disaster & Bioterrorism Preparedness: Emergency preparedness and disaster response are critical elements for man-made and natural disasters and emergencies. There are specific functions and responsibilities for emergency responders, healthcare providers, and community residents. These resources are provided to promote preparedness and increase awareness among all stakeholders. Alameda County Emergency Medical Services works with 9-1-1 responders and hospitals to ensure they are prepared to respond to large and small-scale disasters and emergencies. EMS plans, organizes and evaluates tabletop exercises and drills to test our capacity to communicate with each other, respond to resource requests, and move staff as needed. EMS is responsible for the planning, response, mitigation and recovery of the medical/health system regarding disaster, terrorism and other emergency surge events that would stress the medical and health system. The agency collects and reports situation status of the medical/health system and responds to immediate and projected needs. EMS processes medical/health requests and works with the Office of Emergency Services out of the Medical/Health Branch of the county’s Emergency Operations Section. EMS also responds to and offers assistance to out of area disaster/ med health events by allocating resources and mutual aid as needed. EMS insures appropriate training and staffing of the Medical/Health Branch as needed for drills, exercises and real events.  EMS Disaster/WMD Preparedness - work with many agencies from differing disciplines to better prepare the emergency medical community to prepare for and respond to terrorism attacks and other disasters.  EMS Terrorism Liaison Officer (TLO), law enforcement liaison - work with the intelligence and law enforcement communities to enhance relationships with the med/health community and help with training in areas such as Suspicious Activity Reporting (SAR), and terrorism awareness for the med/health community.  ALCO OES Medical/ Health Branch Director - Directs all operations out of the Medical/Health Branch of the Op Area Emergency Operations Center. Reports to the Operations Section Chief  Urban Area Security Area (UASI) - EMS representative for the Chemical Biological, Radiological, Nuclear, and Explosive (CBRNE) and training and exercise planning groups.  ChemPack, DTPA, Cyano-kit, and other disaster related caches of pharmaceutical and disaster related supplies.  Exercises & Drills - EMSA statewide medical health disaster exercise, Golden Guardian Exercise, Urban Shield, ALCO annual disaster exercise, and other large scale drills and exercises  Urban Shield - an annual full scale exercise involving about 3500 individuals from around the world. ALCO EMS plans, directs and coordinates one of the 32 sites where EMS and other medical personnel train and get integrated into a law enforcement

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scenario with mass casualties.(active shooter, terrorist attack, etc.). This scenario is repeated 32 times over 50 hours.

EMTs & Paramedics Certification/Local Accreditation: Becoming an EMT is a three step process.  Step one - successful completion of an EMT Training Program.  Step two -successfully completing the National Registry of EMTs (NREMT) psychomotor and computer-based exams.  Step three - apply for California EMT Certification through a local EMS agency (LEMSA), such as Alameda County EMS. Alameda County EMS verifies that each applicant submits an application and documents that ensure the applicants’ qualifications. In addition, Alameda County EMS requires a Live Scan background check on all EMT applicants. The California Department of Justice (DOJ) and FBI perform the applicant’s background check. This information is then made available to Alameda County EMS on the DOJ Database. This information is referenced when approving EMT applicants and when conducting investigations of certified EMTs. The information from the DOJ Database is transferred to Alameda County’s EMS DOJ Database. This database is used for tracking and storage of information regarding arrests and subsequent arrests of persons who have done a Live Figure 9: Certification, Accreditation, Training, and CE for 2011 Scan background check for Alameda County EMS. Only the medical director of Alameda County EMS may deny, revoke, suspend, or place on probation an EMT certificate. This includes EMTs certified by Alameda County EMS and its certifying entities. Enforcement & Investigations: In order to take disciplinary or certification action on an EMT, it must first be determined that a disciplinary cause has occurred by the applicant or certificate holder and there exists a threat to the public health and safety as listed in Section 1798.200(c) of the Health and Safety Code. In order to make this determination an investigation must take place. Investigations are carried out by appointees of the EMS Director. Training Programs: The EMS Agency provides oversight for five paramedic training programs and 19 EMT Training Programs. They consist of fire departments, post-secondary schools, and community colleges. In 2011 EMS conducted five EMT program renewals, and approved three new EMT programs and one paramedic training program. Continuing Education: The EMS Agency currently provides oversight for 32 continuing education providers. Continuing education is a requirement for all prehospital providers in

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order to maintain current certification and licensure. In 2011, EMS conducted four CE provider renewals and approved six new CE providers. Field Manual Updates: The field policy manual is updated on an annual basis. After input from field and hospital providers, a review of local data, and the latest research, 44 field policies were updated for 2013 (Figure 10).

General 23. Tachycardia 1. Overview of Patient Care Policies 24. VF/VT: Pulseless 2. Burn Patient Criteria Pediatric 3. CPR 25. ALOC 4. Crush Injury Syndrome 26. Asystole/PEA 5. Hyperkalemia 27. Pulseless VF/VT 6. Smoke Inhalation/CO Monitoring 28. Respiratory Depression 7. Transport Guidelines 29. Severe Nausea 8. Trauma Pt. Criteria. 30. Shock/Hypotension Adult 31. Submersion 9. Acute Stroke 32. Tachycardia 10. Airway Obstruction Operations 11. ALOC 33. ALS Responder 12. Asystole/PEA 34. Death In The Field 13. Bradycardia 35. Equipment/Supply 14. Chest Pain/ Acute MI 36. Psychiatric Evaluation/ 5150 Transports 15. Dystonic Reaction 37. Responding Units - Canceling/Reducing Code 16. Pain Management 38. Restraints 17. Pulmonary Edema/CHF Procedures 18. Respiratory Depression 39. EKG- 12 Lead 19. Poisoning/Ingestion/OD 40. IO Infusion (Adult/Pedi) 20. Post Resuscitation Care (ROSC) 41. Sedation 21. Sepsis 42. SMR/Spinal Injury Assessment 22. Submersion 43. Therapeutic Hypothermia 44. TCP

Figure 10: Updated Field manual Policies for 2013

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Critical Care Transport—Paramedic (CTT-P) Program The Critical Care Transport-Paramedic (CCT-P) program was developed to provide an alternative means of transferring stable patients from one acute care hospital to another. The CCT-P program provides an additional level of critical care service between the 911 paramedic transfer and the nurse-staffed critical care transfer. CCT-Ps complete specialized training in expanded practice skills authorized for use under local optional scope approval. Alameda County EMS authorizes and contracts with interested ambulance companies that meet the training, staffing, equipment and oversight requirements for providing this level of service and that agree to comply with program standards. During 2007, the CCT–P program strove to promote a bay area regionalization plan involving upwards of six Local Emergency Medical Services Agencies (LEMSA’s) for the standardization of operational and medical protocols. With the participation of the regional EMS Administrators and Medical Directors we were able to regionalize the CCT–P medical protocols for three bay area counties - Alameda, Contra Costa, and Santa Clara County.

Information Technology The EMS Information Systems group provides services to EMS staff that aid in the effective delivery of IT services that support the business needs of EMS staff and programs. Information Systems is a vital part of EMS, providing faster and better ways for our staff to do their jobs and for our community to access our programs/services. We continue to keep our technology current and to work with central IT Departments and management to provide the computing capabilities that are needed. Examples of services are:  Trauma Data Base  Cardiac Arrest database  Fire Department response time compliance database  Fire Department Patient Care Report (PCR) data collection and processing  Retrieving and collecting airway data.  Participate in electronic PCR implementation project relative to data reporting.  Prepare standard and ad-hoc reports for EMS leadership, partners, and the public.  Develop and maintain the EMS website: acphd.org/ems

Unusual Occurrence Reports EMS is responsible for investigating EMS system complaints and sentinel events in accordance with the California Health & Safety Code Section 1798.200. As part of the UO process EMS:  Establishes strong relationships with providers and hospital personnel to work through incidents and come to resolution.  Liaisons to EMSA for Paramedic investigations and licensure action for Alameda County

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accredited paramedics.  Monitors EMS field policies as directed by incident type and outcome through data collection and nature of UO reporting. Any agency or individual may submit an Unusual Occurrence (UO) form. Criteria for notification are as follows:  Morbidity or mortality to a patient.  Potential legal liability.  Issues with political ramifications or issues involving political figures.  Incidents resulting in termination or resignation pending investigation for clinical issues.  An action reported or intended to be reported to EMSA or other regulatory agency.  Major violation of EMS protocol (serious potential for patient harm).

Health Equity EMS has representation in the health equity work taking place in the Public Health Department (PHD). Health equity strategic planning and local policy work is addressing the root causes of equity. Staff participates on the Place Matters Planning and Coordination Team, Strategic Planning Implementation Team, and Cross Departmental workgroups. In addition, staff participates as a member of the Bay Area Regional Health Inequities Initiative, a membership organization of Bay Area public health departments.

Climate Change and Public Health EMS staff works with the National Association of County and City Health Officials (NACCHO), California Public Health Department, Alameda County staff, and regional and local efforts to support efforts to reduce the impacts of climate change (mitigation) and plan for the impacts of climate change (adaptation). The public health consequences are a specific focus for the community at large, individuals at greatest risk, and the impact of these events on the health and medical provider response capacity.

Legislative Council Liaison Figure 8: CCT-P Requests (2004—2007) 1500 EMS staff is represented on the Public Health Legislative Council. EMS staff review EMS related legislation to determine the impact of the legislation on the operations and delivery of services 1000 to the community. The Legislative Council makes recommendations on relevant health legislation to present to the Board of Supervisors for their vote. 500 ReddiNet 0 Reddinet is a computerized communication system that provides information-sharing between 2004 2005 2006 2007 EMS and hospitals during normal operations and in the event of a disaster. ReddiNet allows CCT-P requests Monthly Average EMS, providers, hospitals and 911 dispatchers to receive immediate alerts on hospital diversion,

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multiple casualty incidents and earthquakes. In 2012, the move to add all Alameda County clinics to ReddiNet for continuity in communication in the event of a disaster is a priority.

EMS News The EMS Agency newsletter, EMS News, is published quarterly, and is produced entirely by EMS staff. Each issue contains articles about EMS issues, medical topics, injury prevention, training and events. The newsletters are distributed electronically to EMS professionals and interested individuals. It is also available for download on the EMS website.

EMS Week Activities The EMS Week Children’s Day Committee plans an EMS hosted children’s day event at a different fire station in the County every year, inviting elementary school children to the event to learn about injury prevention, safety and the EMS system. The students are able to see what is inside of a fire station, an ambulance, and a police car. They learn about earthquake safety, poison prevention, bicycle safety and water safety. The 2012 EMS Week Awards luncheon was held at the Sunol Valley Golf Club in Sunol on May 23. Tom Lynch, the EMS Acting Director served as the Master of Ceremonies. Our keynote speaker was Richard Serino, FEMA Deputy Administrator. The posting of the colors was done by the Alameda County Fire Department Honor Guards. EMS honored providers who are instrumental to the success of our EMS system, and presented awards to those who have been chosen as having performed above and beyond the call of duty. In addition, we reunited several sudden cardiac arrest survivors with the EMS personnel and bystander “heroes” who saved their lives. These heartwarming survivor cases highlight their inspirational stories involving both the victims of cardiac arrest and the rescuers. Every year in Alameda County, hundreds of people are victims of cardiac arrest and only 10% survive to be discharged from the hospital. With the odds against them, the prompt action of bystanders and pre-hospital personnel gave these men and women their best chance at survival. We are fortunate to celebrate their lives this year at the EMS Banquet.

Hospital Preparedness Program (HPP) Alameda County EMS has been the recipient of the Federal Hospital Preparedness Program (HPP) grant since 2003. These funds are allocated to the California Department of Public Health/Emergency Preparedness Office and then to the County. The grant supports emergency preparedness planning and maintenance for health care facilities including: hospitals, clinics, skilled nursing facilities, EMS providers and other ambulatory specialty clinics. EMS is responsible for management and implementation of grant deliverables in collaboration with Alameda County and the City of Berkeley Public Health Department emergency preparedness

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staff. These deliverables include: interoperable communications, trainings and exercises, emergency preparedness plan development, planning for medical surge/alternate care sites, fatality management, evacuation and shelter-in-place, addressing medical needs of at-risk populations, promotion of the State Disaster Healthcare Volunteers and California Health Alert Network (CAHAN), and the purchase of medical equipment for appropriate emergency response. EMS works in partnership with 13 receiving hospitals, 10 clinics, the Alameda Health Consortium, Skilled Nursing facilities and other healthcare providers and community based organizations. EMS partners with County departments and agencies including Environmental Health, Behavioral Health Care Services, Sheriff’s Office of Homeland Security and Emergency Services, Social Services, and General Services Agency to ensure countywide integration of medical/health preparedness. The current grant allocation (Year 10) is $579,494.

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INJURY PREVENTION The goal of the Injury Prevention Program is to reduce the number of intentional & unintentional injuries to all age groups in Alameda County.

Injury Prevention Programs For Children The Emergency Medical Services Childhood Injury Prevention Program addresses issues specific to this vulnerable, at-risk population. Children are most at-risk for injury-related death and disability. Children of color and in the lower economic spectrum are particularly at risk. As a result, the Public Health Department’s Childhood Injury Prevention program created community-based education and awareness programs and provided resources throughout Alameda County. In 2007, the Injury Prevention program provided a number of resources to the affected communities. Childhood Injury Prevention also works to provide technical assistance to the professional and provider community. Injury Prevention continues to address the major injury areas including pedestrian safety, water safety and drowning prevention, poison prevention, car seats, and motor vehicle safety, falls prevention and fire/burn prevention. Cal-Trans Federal Safe Routes to School (SRTS) Grant: A collaboration of the Alameda County Partnership (i.e. Alameda County Public Health Department EMS/Injury Prevention Program, ACPHD Nutrition Services and TransForm) increased safe walking and biking at 90 elementary and middle schools throughout the County. The established Bike/Helmet Safety program was integrated with TransForms well-established Safe Routes to School curriculum to promote walking and bike/helmet safety. As a result of the success of the initial Cal-Trans grant, the partnership was awarded another three year grant in October 2011. The focus of the new grant will be establishing and managing safety patrols in elementary schools. Safe Kids Coalition USA (Alameda County): Alameda Safe Kids Coalition has been in existence since the early 1990’s. Alameda Safe Kids is one of 600 coalitions/chapters in the United States. In keeping with the national organization’s mission Alameda Safe Kids strives to prevent unintentional childhood injuries, the leading cause of death and disabilities to children ages one through 14. The Alameda Safe Kids Coalition membership includes Children’s Hospital and Research Center Oakland, Alameda County Medical Center, Consumer Product Safety Commission, Keeping Babies Safe, East Bay Regional Parks District, Contra Costa County EMS, John Muir Medical Center, Contra Costa Child Care Council, Alameda County Family Health Services, and other health and safety experts, educators and community based organizations. The past year accomplishments include:  Injury Prevention Calendar: participated in the development and distribution of a 16 month calendar with childhood injury prevention messages.  “OUCH”: collaborated on developing text messages with childhood injury prevention

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themes and promoted the use of the free program to families with children by outreaching to entities serving the target population.  Designated School Drop-Off Zone: successfully advocated for establishment of a drop zone for Hoover Elementary School (West Oakland) students who are transported to and from school.  Walk This Way: On International Walk to School Day (October 5th) EMS staff facilitated a school-wide event with Hoover Elementary (400 students) school administration and FedEx. Pedestrian safety was promoted through an increase in the number of crossing guards (FedEx and parent volunteers); distribution of educational materials to parents and children; distributed reflective wrist bands, students touring FedEx vehicles, and carrying large posters and chanting in a parade a square block around the school.  Halloween Pedestrian Safety: Posters with safety messages were displayed throughout the school and classroom education was conducted with each class. Coloring books and other educational materials were distributed to students at Hoover Elementary School and Safe Kids staff and volunteers participated in Hoover’s Harvest Festival. Seven hundred individuals attended this event.  Boo At the Zoo: In preparation for Halloween, collaborated with FedEx to distribute educational materials and incentive items to over 700 parents and children at the Oakland Zoo.  Start Safe Travel: Conducted train the trainer session with 15 Head Start personnel on pedestrian and car seat safety. Head Start personnel in turn trained 219 parents/guardians at 16 sites.  Main Street in Motion: Recruited certified Child Passenger Safety technicians who were responsible for properly installing car seats at a three-day GM sponsored event which allowed consumers to test drive GM and competitors vehicles. In addition to assuring the safety of the children during the test drive, it was an opportunity to answer parents questions and demonstrate proper car seat installation. Child Passenger Safety (CPS) Work Group: Collaborative effort of 16 multi- racial/multi-ethnic organizations to reduce child injury by educating caregivers and residents regarding car seat/seat belts proper installation, laws, and related motor vehicle safety. Distributed over 450 new car seats and provided over 1000 car seats check-ups annually. Child Passenger Safety (CPS) Training/Outreach:  CPS 8 hour training: annual entry level train-the-trainer program (25 participants)  CPS Certified Training: nationally certified CPS technician (25 participants)  Car Seat Check Ups: EMS staff participated in three and hosted eight car seat check-ups

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throughout various communities in the county  Car Seat Training to Parenting Groups: Provide presentations and information to parents or parent groups  Cal Safe Teen Moms/Child Passenger Safety Classes: Educate teen moms on the proper installation and use of a child passenger safety seat and current California Child Passenger Safety Laws and Best Practices  Car Seat Services Providers Training: CBO and other organizations (nurses/doctors/faith based org.)  Car Seat Community Outreach: Health fairs, block parties, and community groups presentations and/or dissemination of information (5 annually)  Court Diversion: Provided monthly car seat/seat belt violators classes Wheeled Vehicle Safety /Bicycle Helmet Law - Wheeled Vehicle Safety/Bicycle Helmet Law information is presented to elementary school age children in an assembly setting. During the assembly the children learn what the bicycle helmet law says, why they should obey the helmet law, safety gear, how to fit a helmet properly, how to maintain their bicycle and safety rules that must be followed during a wheeled vehicle activity. Emergency Medical Services for Children (EMSC) is a program that addresses the specific care of children within the EMS system to include the prevention, prehospital, emergency department, and inpatient and rehabilitation services. The EMSC Coordinator functions to facilitate the Alameda County EMSC program including:  Planning, implementation, management, policy development, and evaluation;  Reviewing guidelines and providing recommendations;  Conducting education, training, and assessment consistent with California/National EMSC standards/ guidelines;  Providing leadership and direction on the neonatal/pediatric prehospital care issues and needs;  Linking with health care partners as the ALCO EMSC point of contact; and  Disseminating information on EMSC issues and resources such as neonatal/pediatric disaster preparedness, medical surge planning, and injury prevention. Primary responsibility for administration of ALCO EMSC designation is pursuant to Chapter 4, State of California Health & Safety Code, Division 2.5, Section 1797.200.

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California EMSC Technical Advisory Group - Neonatal/Pediatric Disaster Coalition: A priority Alameda County EMSC project focus area is the Neonatal/Pediatric Disaster Coalition. The goal is to improve the neonatal/pediatric medical surge capability and capacity in an Alameda County disaster response. In order to build the effectiveness and sustainability of the program, a regional and state partnership has been developed with CA EMSA. The CA Neonatal/Pediatric Disaster Coalition has been sponsored and formalized under the state EMSC Technical Advisory committee (TAC) group. The Coalition has also leveraged partners from the regional RDMHC, ABAHO and EMDAC committees. Specific workgroups have been designated to address the pediatric issues related to transportation, evacuation, alternate care sites, regional communications, mental health, and medical surge. The coalition has over 200 members from throughout California. An annual training and meeting is held in Alameda County each year. Conferences & Training: The goal of the annual EMSC state and regional conferences is to improve neonatal/pediatric prehospital care and medical management. Each conference provides an opportunity for expert speakers to share current EMSC research and “best practice” guidelines with practical application to EMS providers and health care facilities that will make a difference for children. Hospital ED Pediatric Assessment: Emergency Department (ED) site-visits were conducted to improve the care of children. A representative from Children’s Hospital ED (Nurse Manager or Medical Director), a qualified pediatric ED physician (previously the PEPP curriculum author), and ALCO EMS staff conduct the evaluation. ED site visits occur approximately every two years or more often when needed. The EMSC Coordinator provides hospital EDs with EMSC references and resource materials to help the ED improve their capability and capacity to care for children.

Senior Injury Prevention Program (SIPP) The Alameda County Senior Injury Prevention Program (SIPP) continues to lead community discussion groups to provide older adults with information on falls prevention and driving safety & mobility. SIPP written materials have been translated into Spanish and Chinese and are also available through the Alameda County Library. In addition to older adult education, SIPP has conducted over 20 senior service provider trainings to acquaint providers with their roles in falls prevention and driving safety. The SIPP Coordinator participated in the California Stop Falls Network, and is a member of the California Department of Health Services - Safe California Team. SIPP has organized and hosted the Annual Statewide Senior Injury Prevention Conference since its first year in 2000. Conference co-hosts have included the California Department of Public Health, UC Davis, UC Berkeley, California Emergency Nurses Association, California Poison Control, and Cal State Fullerton. The purpose of the conference is to increase older adult injury

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prevention knowledge among senior service providers and healthcare professionals, build the senior injury prevention network, promote senior injury prevention advocacy and explore current IP models and research. SIPP partners have integrated physical activity programs, medication management assistance, falls prevention education, and home modification into their existing services. SIPP is an integral part of planning and hosting the Annual Healthy Aging Fair, which provides health screenings, information, lunch and entertainment to over 600 older adults. SIPP also received a commendation from the Board of Supervisors in May 2007. Senior Falls Prevention Program: Interactive falls prevention presentation and home improvement options (such as, Rebuilding Together Oakland (hand grips) to California Telephone Access Program) Senior Service Provider Program: Trains caregivers fall prevention awareness and home improvement options (such as nursing programs) Senior Emergency Preparedness Program: A carrying bag of home items for individuals to prepare for an emergency. Community Education/Fall Prevention Discussion Groups: These sessions began as focus groups in 1999 to help us collect data and understand when, where, and how falls occur in our community. The focus groups morphed into discussion groups that provide a safe environment for older adults to talk about their fall experiences, as many older adult are fearful about telling family or their doctors about falls, and hear how to lower their fall risk through:  Behavior Modification  Exercise  Medication Management  Home Safety Attendees receive the SIPP Fall Prevention Manual which was written by members of the SIPP Working Group in 2002 with expert coverage of fall prevention topics. The manual is also available at all Alameda County libraries. Approximately 1200 - 1500 seniors participate yearly. Physical Activity Training: Sessions to train lay people who are currently conducting exercise classes so that they are better able to provide instruction on appropriate and safe exercises that improve balance, strength, and flexibility which, combined, have been proven to reduce fall risk Taking Steps to Prevent Falls Video: The video, written and produced by EMS staff, was distributed to all county senior centers, and is included in the Alameda County Library’s bookmobile for homebound seniors. It has also been used by managers of Assisted Living Centers, Skilled Nursing Facilities and Senior Housing to educate staff about fall prevention.

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Bone Density Checks: Using a densitometer, SIPP provided approximately 300 older adults with information about their bone health. Each participant was given the results of their bone density screening with a recommendation to discuss the results with his/her physician. Health Fairs: Annual Healthy Living Festival, Healthy Aging Fair, West Oakland Ella Baker YMCA Community Block Fair and the Kohl’s/Children Hospital health fair. Driving Safety: These discussion groups provide attendees with information on the physical and mental changes that occur as we age which might affect driving skills. Discussion group leaders use information from the DriveWell Program which was developed by NHTSA and the American Society on Aging. The SIPP Coordinator was selected as one of 17 people Nationwide to be trained by NHTSA and ASA to become a DriveWell Expert. Subsequent to the training, the SIPP Coordinator conducted train the trainer sessions for Alameda County EMS Injury Prevention and Area Agency on Aging Staff, multiple counties in California, and in Nevada, and Montana. CarFit: This program was created by the American Society on Aging and developed in collaboration with the American Automobile Association, to help mature drivers learn how to adjust their car to “fit” them in a way that provides the best visual ability, safety and access to controls. Professional Education – In response to a request from Cal State Hayward, EMS staff conducts a training each semester for nursing students with emphasis on the role of nurses in identifying potentially “at risk” patients. This training covers:  Working With Older Adults  Communication Do’s and Don’ts  Driving Issues  Fall Prevention  Medication Safety The SIPP Coordinator provides educational seminars for staff at Skilled Nursing Facilities, Senior Residential Facilities, and Board and Care Facilities on request. The SIPP Coordinator conducts annual training sessions with In-Home Support Workers to educate them on fall risk factors and their role in reducing fall risk in their clients. These sessions are hosted by the Area Agency on Aging. SIPP organized and hosted the Annual Statewide Senior Injury Prevention Conference since its first year in 2000. Conference co-hosts have included the California Department of Public Health, UC Davis, UC Berkeley, California Emergency Nurses Association, California Poison Control, and Cal State Fullerton. The purpose of the conference is to increase older adult injury prevention knowledge among senior service providers and healthcare professionals, build the senior injury prevention network, promote senior injury prevention advocacy and explore

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current IP models and research. Five SIPP partners have contracts with the Area Agency on Aging (AAA) to provide home modifications, medication screenings & medication management assistance, and physical activity classes geared towards fall prevention. All fall prevention research has shown that this multi-faceted approach is most effective in reducing falls. The SIPP Coordinator works with the AAA to monitor compliance with the Measure A funding portion of those contracts. EMS staff conducts annual trainings sessions for Senior Companions for the City of Oakland to improve their knowledge of the components of fall risk and how they can help their clients reduce or eliminate their risk factors. Trainings on Emergency Preparedness and Driving Safety are also part of the curriculum for Senior Companions. These trainings consist of two sessions each, one for English speaking and one for Chinese and Korean speaking attendees. Presentations: SIPP made additional presentations to S.H.A.R.E. in Contra Costa County, PAPCO (transportation advisory committee), the Commission on Aging, Christian Church Homes, and at the OTS Traffic Safety Conference. The SIPP Coordinator was a panelist in a segment of “The Public’s Health.” SIPP developed a partnership with Rebuilding-Together-Oakland to provide all modification and repair recipients with fall prevention information. The partnership has resulted in the addition of non-skid strips and nightlights to the items that they distribute to recipients. Safe California: A California Department of Human Services project whose mission is to organize the direction of injury prevention efforts over the next three years. The SIPP Coordinator’s participation helped to ensure that senior injury prevention was established as a statewide focus. The committee ultimately agreed to include falls prevention and medication management in its recommendations.

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EMS Directory

EMS Leadership Direct Line (510)

Fred Claridge EMS Director 618-2055 Karl Sporer, MD EMS Medical Director 618‐2042 Jocelyn Garrick, MD EMS Assistant Medical Director 618‐2044 Rosemary Gutierrez Administrative Specialist Supervisor 618-2021 Howard Chen Financial Services Specialist 667-7414 Jim Morrissey PreHospital Care Coordinator Supervisor 618-2036 Adele Pagán Information Systems Manager 618‐2021 Michael Gibson EMS Corps Program Director/Camp Sweeney 618‐2050 Francell Haskins Injury Prevention Health Care Program Administrator 667‐7414

PreHospital Care Coordinators/Program Specialist

Policy Manual/CCT-P & Air Transport/QI Plan/EMS 618‐2036 Lee Siegel Orientation/Accreditation Joshua English Contract Compliance/Dispatch Liaison/Policy Manual/System Plan 667‐7533 Cynthia Frankel EMSC/Emergency Preparedness 618‐2031 Mike Jacobs SCA/SCARC/STEMI/PSRC/CPR7/Quality Council 618‐2047 Aminta Kouyate CAHAN Trainer 667-7412 Elsie Kusel HPP, Continuing Education, Training Program Approval 481‐4197 Mona Mena HPP/Place Matters & Built Environment/Legislative Council 618‐2035 Scott Salter EMT Certification/DOJ Data Base/Investigations 618‐2022 John Vonhof Ambulance Ordinance/Newsletter/AED/Project HeartSafe 618‐2038 Michelle Voos Trauma Coordinator/UOs/Reddinet/Enforcement/Investigations 667‐7984

Alameda County Health Pipeline Partnership

Sequoia M. Hall ACHPP Work Force Development Coordinator 618‐2032 Jacqueline Leon ACHPP Project Manager 618‐2043 Valerie Street EMS Corps/Camp Sweeney/Youth Alive/Pipeline 618‐2048

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Direct Line

EMS Corps (510)

Lucrecia Bobo Career Job Placement Coordinator 618‐2050 Deyante Newson Case Manager 618‐2074

Injury Prevention

Kathryn Woolbright Safe Kids Coordinator 667‐7415 Miriam Rabinovitz Senior Injury Prevention 481-4190 Tina Scott Teen Moms/Child Passenger Safety Classes/Wheeled Vehicle Helmet Safety 618‐2045 Godfrey Wilson Child Passenger Safety/Senior Injury Prevention 618‐2028

Information Systems

Leo Derevin Database Management 618‐2046 Wilman Woo Website/IT Support 618‐2029

Administrative Support Staff

Carmen Cortes EMS Secretary 618-2024 Erica Campos CPR 7/EMS Corps/Data Steering/General 618‐2059 Sonya Lee Certification 618‐2034 Norma Serrano Receptionist/Bay EMT/EMSC 667‐7413 Roberto Vallejo Injury Prevention 481-4191 Veronica Villegas General Office 618‐2039 EMS Main Line Number ‐Reception 618‐2050

Retiree Annuitants

Dale Fanning EMS 618-2050

Kris Daugherty EMS 618-2050

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Emergency Medical Services, a Department of Health Care Services Agency 1000 San Leandro Boulevard, Suite 200, San Leandro, CA 9577

(510) 618-2050 – http://www.acphd.org/ems