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

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

FY 2017-18 Year-End Story Behind Performance

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

The ability of American Medical Response (AMR) to meet the target for this measure is limited by the small pool of staff interested in and trained for the SMART program. In order to address this limitation and improve the percentage of calls responded to by a SMART paramedic, AMR implemented a new shift type to attract more paramedics to the program in mid-February of 2018. We believe the improvement in performance realized from Quarter 3 (67 percent) to Quarter 4 (74 percent) is due to this change. The EMS agency and AMR will continue to review the frequency and days/times of  SMART responses to determine potential areas for improvement.

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 reviews all cases of STEMI and NSTEMI and validates data with the STEMI center coordinators on a monthly basis. In addition, EMS, pre-hospital service providers, STEMI referral hospitals, and STEMI centers meet quarterly to review data, unusual cases and State and national policy changes. In November 2017,  San Mateo County set an internal standard to meet a door to device time of 60 minutes as recommended by the American College of Cardiology/American Heart Association, largely explaining the 100 percent compliance with the 90 minute benchmark. All  points of patient care starting with the 9-1-1 call and ending with device time are closely monitored to note and improve overall efficiency.

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

AMR's high level of response time compliance, in spite of steadily increasing 9-1-1 responses and transports, is due to their close monitoring of late calls with EMS and Public Safety Communications, routine re-education of paramedics and emergency medical technicians, and re-evaluating staffing and ambulance needs based on previous trends.


Future Priorities

  • Continue to focus on and work towards improving sudden cardiac arrest outcomes through participation in a national CARES data registry system, multi-disciplinary committee review of each and every cardiac arrest case on a weekly basis, and modification of policies, protocols, and first-responder techniques are modified for best practices.
  • Prioritize the establishment of automated processes for data collection and monitoring through the use of proprietary vendors who will keep up to date with State and national guidelines.
Author: Gina Wilson, Chief Financial Officer, Health System     Contact Email: gwilson@smcgov.org     Last Updated: 08-09-2018