Health System: Emergency Medical Services- GF (5600P)

Program Outcome Statement

Maintain a timely and effective emergency medical services system.

Program Services

-Emergency Medical Services Coordination and Oversight

-9-1-1 Public Education

-Paramedic Accreditation

-Emergency Medical Technician Certification / Re-Certification

-Specialty Care Systems (Trauma, Stroke, STEMI)

-Medical and Public Health Emergency Disaster Response

Overview

Emergency Medical Services (EMS) provides oversight and coordination of the countywide emergency medical services system. The system receives 50,700 calls per year that include 9-1-1 emergency medical dispatch, fire paramedic first response, and emergency paramedic ground and air ambulance transport services. Of these calls, 34,400 result in transport to an emergency department (ED), representing 10 percent of the population seen at emergency departments. EMS provides leadership, develops specialty care systems, and is responsible for the designation of specialty care hospitals (Trauma, STEMI & Stroke). EMS develops improved response policies to multi-casualty incidents and mutual aid requests. EMS educates the public about: 9-1-1 activation for stroke victims; ST Segment Elevated Myocardial Infarction (STEMI), a type of cardiac arrest; bystander CPR; fall prevention; and the use of child car safety seats and bicycle helmets. EMS improves medical and public health surge capacity through the Hospital and Public Health Emergency Preparedness Program and strengthens emergency medical and public health response capability working with all healthcare providers in the county. EMS is responsible for accreditation of paramedics, and certification and recertification of Emergency Medical Technicians (EMTs). EMS receives court fines to pay approximately 11,000 claims from physicians and provides financial support to trauma hospitals totaling approximately $550,000 a year. For processing the claims, EMS receives an administrative fee from the EMS trust fund for general support of EMS activities. EMS is also partially funded by American Medical Response for oversight activities.

EMS helps to maintain the health and safety of the public by providing and monitoring an organized system of emergency medical care for San Mateo County. First responder and transport paramedics are available 24/7 county-wide to rapidly respond to 9-1-1 calls for emergency medical assistance. Immediate intervention and stabilization of an injury or illness and rapid, safe transport to the appropriate hospital save lives as well as limits morbidity. Behavioral health crisis response, services, and transportation are provided through the San Mateo County Mental Health Assessment and Referral Team (SMART) program operated by American Medical Response.

Percent of Requests for San Mateo County Mental Health Assessment and Referral Team (SMART) Program Services that are Responded to by a SMART Paramedic Below Target

Percent of All 9-1-1 Patients with a Heart Condition Who Receive Care at a STEMI Receiving Center in Less than 90 Minutes Exceeding Contract Target

 FY 2016-17 Year-End Story Behind Performance

Percent of Ambulance Emergency Medical Service Calls Responded to on Time Consistently Exceeding Target

Percent of Requests for SMART Program Services that are Responded to by a SMART Paramedic

The San Mateo County Mental Health Assessment and Referral Team (SMART) program is a behavioral health crisis response operated by American Medical Response. The SMART program was designed to provide immediate assessment, management, transport, and referral as appropriate to individuals presenting with behavioral emergencies in the pre-hospital setting. The system includes two SMART vehicles staffed 7:00 am - 9:00 pm, seven days per week with SMART paramedics who have successfully completed a special paramedic training program approved by the San Mateo County Health System.

The goal of the program is to provide the care and services that will best meet the needs of the individual. The Health System has established a performance target that SMART respond to 80 percent of all appropriate calls. At the end of fiscal year 2016-17, seventy-seven percent of requests were responded to by a SMART paramedic. EMS will review SMART staffing and performance with the ambulance contractor to determine where improvements can be made to achieve the target of 80 percent by fiscal year 2017-18.

Percent of All 9-1-1 Ambulance Identified and Transported Patients with a Heart Condition Who Receive Care at a STEMI Receiving Center with a Door-to-Device Time of Less than the 90 Minute National Average

EMS conducted site verification evaluations of all six STEMI center hospitals and renewed STEMI Agreements for continued STEMI center designation ensuring San Mateo County's STEMI system is meeting the highest standards of care. San Mateo County meets and exceeds national benchmarks for STEMI care. EMS works closely with pre-hospitals, STEMI referral hospital and STEMI centers to continue to review performance and improve the response to and treatment of STEMI cardiac conditions within San Mateo County.

Percent of Ambulance Emergency Service Calls Responded to On Time per Contract Standards

The AMR ambulance contract establishes a benchmark of 90 percent for the percent of all 9-1-1 medical calls that must be responded to on time. AMR maintains a high level of response time compliance, well above their contractual requirement of 90 percent, in spite of steadily increasing 9-1-1 responses and transports.

Future Priorities

  • Improve sudden cardiac arrest outcomes through the following activities: participation in the national CARES data registry system, continued implementation of a structured choreographed approach with all EMS Responders, and evaluation of hospital STEMI cardiac response programs.
  • Work with agencies that provide services to vulnerable populations on emergency preparedness, specifically focused on skilled nursing and long term care facilities.
  • Expand the emergency and disaster communication system "ReddiNet" capabilities at hospitals, skilled nursing facilities, EMS providers, and other healthcare partners.

Author: Gina Wilson, Chief Financial Officer, Health System

Contact Email: gwilson@smcgov.org

Last Updated: 08-24-2017