Item # Summary of Contract Section Evidence of Compliance Status Article 2.2 Meet 91% response time performance in all RTZs for at least nine (9) non-consecutive months of preceding contract year.
Contractor has not met non consecutive 9 months out of the performance year in all RTZ's for the 91% enhanced response or 90% compliance requirement.
Not Compliant
Article 6.1 Licensing and Permits are current. Contractor has provided all copies of applicable CHP ambulance drivers permits, and Local Jurisfictional Business licenses. REMSA staff has verified all credentials to be in good standing.
Compliant
Article 8.1 Subcontract for work or services to have prior written approval of County Contract Administrator.
No changes for the 22/23 contract period. The Contractor holds public/private partnerships agreements with the City of Riverside, City of Corona, Morongo Band of Mission Indians, Soboba Band of Luiseno Indians. The contractor has also formalized an agreement with Morongo Fire Department to supply additional ambulances and an air ambulance to the Morongo Reservation and surrounding area in the Pass EMS zone. Contractor has recently begun negotiations for formalizing a similar agreement with Calimesa City regarding ALS services.
Compliant
3.1 Provide continuous ALS emergency ambulance services to residents and visitors of Riverside County 24 hours a day, every day; according to the EMS Plan.
Contractor has available to REMSA staff 24/7 access into Firstwatch to provide daily and retrospective Schedules including ALS/BLS, and CCT interfacility staffing hours that is required for Section 3.1 of the Ground Ambulance Contract. These reports are sub divided by EMS zone has outlined in our EMS plan.
This includes scheduled hours versus actual and lossed hours due to unforseen circumstances including out of service reasons for mechanical, staffing, restocking, etc. Hard copy core schedules has been provided in the Annual Review report and have been verified as part of the annual review.
Compliant
3.2 Contractor shall provide ground ALS emergency ambulance services for the exclusive operating areas and non-exclusive operating areas as stated in Attachments 1 & 2.
Contractor has available to REMSA staff 24/7 access into Firstwatch reports that have detailed posting plans and schedules by business unit, EMS zone. In addition the annual report they have provided a static posting location by Business Unit that details EMS zone posts. REMSA staff have independently confirmed that every EMS zone and Subzone have staffing/posting locations and are available for immediate need by the MHOAC and EMS Duty Officer programs for coordination. All ALS ambulances meet the criteria as outlined in Riverside County Ordinance 756.
Compliant
3.2.3 Contractor may enter into a subcontract or partnership with REMSA authorized ALS ambulance provider for the Mountain operating area, subject to approval by REMSA Contractor has a partnership through REMSA Operational Policy #2120 with Idyllwild Fire Protection District and has utilized AVL locators with applicable ambulances on the mountain plateau where they assign and refer calls to the closes most appropriate resource per Policy #2120 intent. Compliance is monitored through monthly compliance reports and REMSA staff have verified these calls to be referred appropriately since the operational policy has gone into effect.
Compliant
Item # Summary of Contract Section Evidence of Compliance Status
3.5.1 Establish and maintain operations centers to effectively support operations and field staff, including deployment/equipment, management/supervision, education/training, and adequate living quarters for 24 hour units/supervisors if needed, and equipped with generator for backup operation.
Contractor has demonstrated effective support operations for field staff which include equipment, supervision, education/training, and adequate living quarters for the 24 hour units and supervisors.
Evidence of backup generators have been provided. REMSA staff have conducted site visits of these locations. The annual review provides location evidence and documentation in relation to those wrap around services for the operation centers.
Compliant
3.5.2 Establish and maintain an administrative headquarters for Riverside County operations.
Contractor headquarters is located at 879 Marlborough Ave. Riverside, Ca 92507. REMSA staff frequently meet with Contractor leadership at this location.
Compliant
3.5.3 Maintain a communications center for system status management and dispatch of ALS emergency ambulances.
Contractor's communication center is located at 879 Marlborough Ave. Riverside, Ca 92507. REMSA staff frequently meet with Contractor leadership at this location.
Compliant
3.5.3.1 Communications center shall utilize radio and data communication plan approved by REMSA that digitally integrates Contractor communications and CAD with EMS response partners; plan shall contain provisions for redundancy in the event of primary.
Communications systems failure.
Contractor has a completed Radio and Data infrastructure model that has been in place since 2018 since its last over haul. Contractor maintains CAD to CAD integrations with four municipal fire departments, and One County Fire department and secondary PSAP. Contractor has worked in conjunction to replace those current integrations with a CAD to CAD Hub located with ConFire in San Bernardino. Contractor has supplied a Communications COOP plan which has sections regarding Response to a failure, recovery operations, and site migration if the current location is not suitable for operations. Those plans are due for revisions this next performance review for FY 23/24.
Compliant
3.5.3.2 Communications center shall be equipped with a generator capable of maintaining operations despite loss of power or other utilities.
Contractor generator and supplied inforamtion including load tests are conducted at normal intervals.
Site visits have been conducted by REMSA staff during past visits.
Compliant
Item # Summary of Contract Section Evidence of Compliance Status
3.5.3.5 Contractor shall provide REMSA with a written deployment and system status plan for the number of ambulances, their assigned locations, deployment strategies and shift schedules; changes to the plan must be provided to REMSA at least 30 days prior to implementation date of proposed change.
Contractor has deployed the Operational Performance Analytics Program (OPAP) to enhance analyses of demand and staffing. OPAP allows AMR to strategize and anticipate necessary staffing deployment during seasonal fluctuations. Contractor has available to REMSA staff 24/7 access into Firstwatch reports that have detailed posting plans and schedules by business unit, EMS zone. In addition the annual report they have provided a static posting location by Business Unit that details EMS zone posts. REMSA staff have independently confirmed that every EMS zone and Subzone have staffing/posting locations and are available for immediate need by the MHOAC and EMS Duty Officer programs for coordination.
Compliant
3.6 Contractor may place ambulances in specific cities or communities of Riverside County; any contracts are subject to approval of REMSA.
Contractor has no parallel contracts to provide ambulance services outside of the current ground ambulance contract and EMS plan.
Compliant
3.9 Contractor may provide non-transport special EMS programs as approved by REMSA.
Contractor has on occasion throughout the performance period provided EMS standby, and event medicine to large gathering events in Riverside County. Those events include but not limited to:
Coachella and Stagecoach, March Air show, and UC Riverside events. In conjuction contractor submitted applicable Event Actions Plans in Incident Command System Format, and Coordinated efforts with other jurisdictional partners as needed. REMSA staff have provided administrative policies when needed for these events. Refer to REMSA Policies #6203. In addition Contractor has specialty teams comprised of Tactical EMS, and Bicycle EMS teams when those services are needed.
Compliant
3.11 Capitalization: 5 year refresh cycle for technology; expand infrastructure as needed; rate increase may apply.
Contractor during this performance period did an equipment handheld and mounted radio refresh totaling $550,000 for Supervisors vehicle and handhelds.
Compliant
3.12 Disaster Assistance and Response: Contractor to be actively involved in planning for and responding; shall implement ambulance back up and system surge plan as requested, to be coordinated through MHOAC. Point of contact individual shall be designated by Contractor as primarily responsible for disaster preparedness and planning coordination.
Contractor has participated in several planned drill's that allow for our stakeholders to review and measure performance to mock drills of disaster including but not limited to: Hospital evacuations, Mass Gathering events, and Active Shooter drills. Evidence of compliance including correspondence of After action reviews were provided in the annual review documents.
Compliant
3.13 Contractor shall assign a primary point of contact for ECC personnel and shall pay a fee for dispatch services provided by the County.
Contractor has a primary POC for ECC personnel either the Communications Manager or their designee.
Contractor pays for dispatch services through a Semi Annual Payment process facilitated through REMSA as pass through to the ECC for services rendered.
Compliant
Item # Summary of Contract Section Evidence of Compliance Status
4.2 Continuous Quality Improvement (CQI) Program Plan - Contractor shall develop and implement a CQI program that ensures optimal patient care and effective operations for all services under this Agreement. (4.2.5.1 - 4.2.5.11)
Contractor submitted the current 2022 CQI Plan. Contractor also submitted current or updated OGL policies that cover but not limited to: Customer Patient Satisfaction, Patient belongings, Injury/illness prevention, Community Education, Human Resources, Safety, Fleet equipment peformance and materials management, Unusual Occurrences incidents and complaint management, Leadership, Communcations including deployment and system status management, and risk management. REMSA staff has reviewed and verified its contents.
Compliant
4.5 Contractor shall employ a Medical Advisor who shall be a California licensed physician (MD or OD) employed as a 0.25 FTE minimum, and shall serve as primary liaison between Contractor and REMSA Medical Director for medical issues. REMSA Medical Director shall participate in selection process.
The Contractor's medical advisor is Dr. William Seth Dukes - in addition to his role as the medical advisor, he also serves as the Medical Director for Riverside City Fire, Highland Fire, and AMR San Bernardino County.
Compliant
4.8 Contractor shall develop and implement a comprehensive Patient Satisfaction Program for services provided to patients in the Riverside County EMS System.
Contractor participates in a patient satisfaction survey process implemented by a company called EMS Survey Team. A percentage of patients from each division are randomly selected each month. The report aggregates and reports out for the performance period by division. Key demographics including customer satisfaction related to dispatching, ambulance, paramedic empathy, and billing service performance. Report also contains overall mean score and performance compared to similar companies of size and complexity. There was a considerable shift in decreased performance that began of Q3 January 1 to March 30 of the performance year. Overall drop of 6-10% on satisfaction with every survey question and category. This resulted in a sharp rise back to normal 93% range in June 2023 showing improvement in all categories and survey questions.
Compliant
4.9 Clinical Education and Training Program to be developed and implemented by Contractor using contemporary performance based methods and processes. Program shall be linked to the Contractor's CQI program and congruent with EQIP.
Contractor has concurrent field training officer program that is utilized for new hire employee training.
The contractor CQI plan identifies issues of individual paramedic performance and has options for remediation including concurrent field observation up to and including the providers medical director as neccessary. Contractor also has through the REMSIS solution instituted peer review CQI from the Field training officer's perspective to give ongoing feedback to field providers documentation and clinical performance. Contractor also has begun using REMSIS to document direct observation notes from the FTO regarding the employee that is undergoing training to be aggregated in reports.
Compliant
Item # Summary of Contract Section Evidence of Compliance Status
5.2.1 Contractor shall meet the response time standards, as described in Exhibit 5-A, a minimum of 90% of the time.
Response time reports have been received, reviewed, and validated by REMSA staff. Compliance for months of March through June have been submitted by REMSA declared deadlines. After conclusion of the performance reporting period the Firstwatch Online Compliance Utility will be reviewed and changed to address the lessons learned regarding this performance period challenge and settled methodology for Same Unit Concurrent Zone model developed by REMSA Data and Reporting Unit.
Compliant
5.2.3 Contractor agrees to cooperate with REMSA and EMS System participants to establish the Medical Dispatch System (MPDS).
Contractor has cooperated is various implementations of MPDS within City jurisdictions that have lauched ProQA software. MPDS currently is available in 97% of the County and AMR has complied with administration policies concerning low acuity Omega, Alpha calls where a BLS ambulance can be properly utilized. However the contractor has sent BLS resources on MPDS advanced life support calls on numerous occassions and has been included as part of the Annual Compliance Report Compliant
5.3 Contractor shall use REMSA approved CAD program synchronized to atomic clock and shall cooperate with REMSA and First Watch to provide and maintain continuous 24/7 data feeds and remote read- only access for real time monitoring and analysis of response time performance.
Tritech CAD by Central Square has been in place since the beginning of this Ground Ambulance Contract.
REMSA staff have full read only access to both VisiCAD tools and Firstwatch for system monitoring.
Response time performance reports are available to REMSA staff 24/7.
Compliant
5.3.2 Contractor shall utilize AVL/GPS linked to the digital CAD for real time tracking and monitoring capability.
AVL/GPS is integrated into the TriTech CAD. REMSA staff have access to VisiCAD for system monitoring.
Contractor also provides access to AVL/GPS data for response exemption approval process in the OCU and other drill down versions within every call in Firstwatch.
Compliant
6.1 Contractor shall have a program to retain employees and minimize turnover.
Contractor provided competitive benefits, sign-on bonuses, paramedic upgrade bonuses, location relocation bonuses, educational assistance program, employee assistance program, employee discounts and 401k program. Contractor also allows for certain plans to be accessed by employees at their cost including Legal plan, Auto and Home insurance, ID Theft, Pet Insurance, and optional life insurance plans for family and children. Contractor also provided an earn while you learn EMT program for AMR Riverside, and paramedic scholarship program to help reduce the numbers of paramedic vacancies.
Contractor is also offering a 15K sign on bonus for hard to recruit areas such as AMR Blythe.
Compliant
Item # Summary of Contract Section Evidence of Compliance Status
6.1.1 Working with unions and an employee group to create an ongoing employee satisfaction assessment and monitoring system.
Contractor maintains Open Door Policy for encouraging employees to share suggestions, problems, and complaints. Program in place meeting every third Thursday between Contractor management and Union leadership including representatives, union president, and union stewards. Contractor has an onboarding survery for new employees thats administered within the first 90 days. There is no ongoing satisfaction assessment or monitoring system in place outside of the labor management meetings at this time. However this is slated to be addressed in future REMSA contract meetings with AMR.
Compliant
6.1.2 Conducting exit interviews with employees leaving employment to identify the dissatisfies that could be driving employee turnover. Reports of such analyses and Contractor’s improvement strategies will be available to REMSA.
Contractor supplied results from employee exit survery relating to reasons why they had separated employment from the company. Contractor has an average of 6-8% turnover by quarter County wide.
Annual Review documents provided spreadsheet of all involuntary and voluntary separation by reason and by regualr/temp position. REMSA has reviewed all documents and are in good standing.
Compliant
6.1.3 Contractor will track and report employee turnover and results of employee satisfaction surveys annually to REMSA.
Contractor turnover survey results were reviewed and verified by REMSA staff. Contractor employee turnover by monthly performance ranges from 1.7% to as high as 3.0%. Top reasons are the same as previous performance years citing Hiring by Fire Department, Career advancement and return back to school as top three reasons.
Compliant
Item # Summary of Contract Section Evidence of Compliance Status
6.2 Workforce professionalism - Standards of behavior to be implemented (14 points, 6.2.1- 6.2.14) for all services rendered under this Agreement.
6.2.1Contractor’s workforce professionalism standards are in place and defined within the Operational Guidelines Manual (OGL) and Employee Handbook updated on July 1 2020. The OGL manual includes all required contract standards and is updated on a regular basis and was reviewed by REMSA staff. 6.2.2 Pre employment and screening forms were provided and reviewed by REMSA staff. 6.2.3 Prospective employee criminal background checks examples have been provided and inspected by REMSA staff. Contractor has policies in place to exclude people from employment if background process prevents employment. 6.2.4 Contractor has demonstrated policies and procedures in place for vehicle, equipment, and station use and maintenance. 6.2.5 Policies regarding personal clealiness and grooming are in place and inspected by REMSA staff. 6.2.6 Contractor has physical ability testing standards and policies in place to ensure a minimum physical fitness for duty. 6.2.7 Contractor maintains a regional and local Uniform standardization which includes clealiness and appearance standards. The policies and uniform standards have been observed by REMSA staff throughout the year. 6.2.8 Contractor has secondary credentialing monitoring tools that is required through CAAS accreditation as well. REMSA maintains information security that personnel must have and un expired medical credential and if they do are locked out of the system. Prompting them to seek help and identifying any personnel that may be working with an expired credential. 6.2.9 Contractor has an OGL for patient interaction requirements that has been inspected by REMSA staff. 6.2.10 Contractor has regular staff meetings to education and update personnel when REMSA develops and pushes out a Protocol Update Course. Class rosters are available for inspection by REMSA staff. 6.2.11 Contractor regularly attends all of REMSA committee meetings including but not limited to: EMCC, PMAC, Stroke, STEMI, TAC, ePCR workgroup, Riverside County Fire Chief's Association. Contractor also has an operational guideline regarding external party interactions that has been reviewed by REMSA staff. 6.2.12 Contractor participates in local events such as Chamber of Commerce, Hospital association, and general public safety events as requested. Contractor also provides regular community training and education. 6.2.13 Contractor has a standing policy addressing etiquette and expectations of conduct as it pertains to social media use. 6.2.14 Contractor has a standing policy that addresses interactions with family as well as ancillary parties potentially involved in emergency incidents.
Compliant
6.3 Organizational Staffing and Key Management Personnel: REMSA shall review and approve key management personnel. Contractor shall submit an organization chart and associated job descriptions to REMSA within sixty (60) calendar days of the signing of this Agreement (positions listed 6.3.1-6.3.9).
Contractor organization chart and job descriptions have been reviewed and approved by the REMSA contract administrator. compliant
Item # Summary of Contract Section Evidence of Compliance Status
6.4 Credentialing for EMTs and Paramedics is required for all field personnel and shall be in conformance with REMSA policies and procedures.
All copies checked and verified by REMSA staff. Additionally, all contractors employees are registered within the Riverside County Emergency Medical Services Information System (REMSIS) Licensure Management System (LMS).
Compliant
6.5 Ambulance Staffing requirements: Two REMSA accredited paramedics or a REMSA accredited paramedic and REMSA certified EMT. Field personnel uniforms and identifiers must conform to Contractor's policy, subject to REMSA approval. REMSA may authorize alterations to staffing requirements as part of EMD program.
Contractor’s ambulance staffing standards are in place and defined within the Operational Guidelines Manual (OGL). OGL manual was reviewed by REMSA staff. REMSA staff performs periodic scheduled and unscheduled field inspections. In the upcoming review period, REMSA plans to work with the Contractor to reinforce ambulance ride-alongs for real time views of system.
Compliant
6.6 Field Supervisor Program - one supervisor for every 15 ambulances in service by operation; meet REMSA credentialing criteria; have written program.
Contractor has a Riverside County Supervisor Plan and Operations Supervisor Training plan in place. The program was reviewed and approved by REMSA staff. Ratios are verified to be in compliance. REMSA has approved current supervisor staffing levels but has yet to establish a formal program for credentialing.
Compliant
6.8 Employees Health and Wellness Programs (6.8.1, 6.8.1.1, 6.8.1.2).
Reviewed by REMSA staff. Contractor Employee Health and Wellness program is all inclusive in scope and comprehensive in content based upon contract requirements and recommendations by the County Health Officer or designee.
Compliant
6.9 Contractor shall have a comprehensive FTO program approved by REMSA that establishes roles/responsibilities, employee eligibility criteria, credentialing and education/training requirements; FTO roles/responsibilities shall be integrated into Contractor's CQI plan and education/training programs.
Contractor has Field Training Officer (FTO) program in place. Reviewed by REMSA staff and approved by the Contract Administrator. FTO has begun utilizing REMSIS for peer review CQI for retrospective monitoring of new hire employees performance.
Compliant
7.2 Establish policies and procedures for integration of radio and data communications with PSAPs, base hospitals, Public Health and Medical Communications Center, and on-scene incident command.
AMR has radio and telephone communication procedures in place. Policies and AMR OGLs were reviewed and approved by REMSA. It is recommended to update those policies including utilization of Public Safety Enterprise Communication system.
Compliant
7.3 Operate a dispatch center located within Riverside County and maintain all hardware and software necessary to receive and fulfill requests for emergency ambulance services made by County PSAP Centers; capable of receiving and replying to requests by voice and by CAD interface; capable of dispatching all ambulance units. Contractor shall implement CQI program for evaluation of dispatch operations, education and training of dispatchers, problem identification and resolution. The Dispatch CQI Plan shall be submitted to REMSA within 180 days and updated with the Contractor CQI Plan.
Contractor’s ambulance dispatch center is currently located at 879 Marlborough Ave Riverside, CA 92507 and is operational 24/7/365. REMSA has verified communication center capacity during routine site visits. Contractor’s Dispatch CQI program is updated simultaneously with Contractor CQI Plan and is provided timely.
Compliant
Item # Summary of Contract Section Evidence of Compliance Status
7.3.1 CAD and IT Support - maintain a Computer Aided Dispatch (CAD) system according to the specifications of REMSA that assures a complete audit trail for all response times and assures REMSA access to the response time data at any time to assure Contractor
compliance.
Contractor has the TriTech CAD in place. REMSA utilizes the VisiCAD tools regularly to audit response time performance and monitor system status. Sample work orders for CAD upgrades and changes have been reviewed by REMSA staff.
Compliant
7.3.1.1 Contractor will establish and maintain digital CAD-to-CAD interfaces with PSAPs as requested and authorized by REMSA.
Over the past 6 years, AMR has established and maintained CAD integrations will all PSAPs who request are ready for integrations. Active CAD links have been established with: City of Riverside Fire Department, City of Corona Fire Department, City of Murrieta Fire Department, City of Hemet Fire Department, Riverside County Fire Department. AMR is working with the Palm Springs Fire Department to implement CAD links and has begun the onboarding process in the Countywide CAD-to-CAD project.
Although CAD link has not been established with all first response agencies, Contractor has fulfilled its obligation to progress towards CAD integration.
Compliant
7.3.1.3 Contractor shall ensure its own information system’s hardware, software and personnel are capable of receiving and processing required data including, but not limited to, the ability to continuously monitor data transfer system stability and resolve system failures. In the event of a CAD outage Contractor shall deploy a continuity of operations plan, which shall be submitted to and approved by REMSA within thirty (30) calendar days of the signing of this Agreement.
Contractor’s Business Continuity Plan is in place and has been reviewed by REMSA staff. Compliant
7.3.2 Supervisors - Contractor shall have a Dispatch Supervisor program for 24 hour supervision throughout the term of this agreement, which shall also contain requirements for employee eligibility, education and training.
Contractor Dispatch Supervisor Program is in place and is defined within the Operational Guidelines Manual (OGL). Program has been reviewed by REMSA staff. Compliant
7.3.3 Dispatcher/System Status Controller (SSC) and Call Taker Program shall be comprehensive and ensure effective dispatch operations 24 hours per day, every day throughout the term of this Agreement, which shall contain requirements for employee eligibility, education and training.
Contractor has continuously, 24/7/365, provided dispatch services to residence and visitors of Riverside County through performance period. Dispatcher/ System Status Controller and Call Taker program is in place and is defined within the Operational Guidelines Manual (OGL). Program has been reviewed by REMSA staff.
Compliant
Item # Summary of Contract Section Evidence of Compliance Status
7.4 Radio and Data Infrastructure and Equipment Requirements - Contractor will provide REMSA with a comprehensive radio system/network design including, but not limited to, site selection, power, security, IP backhaul and inter-site communications. Should Contractor’s radio communication system be upgraded or replaced within the term of the Agreement, Contractor at their cost will upgrade and/or replace their radio communication equipment to be compatible with and operate on the new system. Modifications to the radio system/network shall be proposed to REMSA for approval at least thirty (30) calendar days prior to initiation of work.
Contractor has provided a technical and architectural review of the radio communication system developed by Rivcomm. Upgrade of radio equipment installed in ambulance has been upgraded to a PSEC compliant system.
Compliant
7.4.1 Unit Mobile Radios - Contractor is responsible for the communications equipment on ambulances and supervisory units; Contractor shall equip all ambulances and supervisory vehicles with radio equipment for communications with Contractor's dispatch center on Contractor's radio channels.
Radio equipment is verified by REMSA staff during ambulance permitting inspection. REMSA intends to migrate all online medical control over to the Public Safety Enterprise Communications (PSEC) system. Compliant
7.4.1.1 Radio communications equipment used for ambulance-to-hospital communication shall be configured so that personnel providing patient care are able to directly communicate with base or receiving hospital staff regarding the patient.
All Contractor ambulances are equipped with cellular phones and MedNet Radio consistent with REMSA policy. REMSA intends to migrate all online medical control over to the Public Safety Enterprise Communications (PSEC) system. Compliant
7.4.1.2 Approved radio equipment shall be installed in conformance with existing REMSA policies prior to assignment of a vehicle to an emergency response area. Installations and removals will be at Contractor's expense.
Contractor radio equipment is installed in accordance with REMSA policies. Verified by onsite inspection by REMSA staff. Compliant
7.4.1.3 Contractor shall operate communications equipment in conformance with all applicable rules and regulations of the Federal Communication Commission, and in conformance with all applicable REMSA policies and operating procedures.
Operational guidelines (OGL) and FCC licenses reviewed and verified by REMSA staff. Found to be in conformance with all REMSA policies and procedures. Compliant
7.4.2 Portable or Handheld Radios - Contractor will provide each crew member assigned to an ambulance or supervisor unit with a VHF portable radio programmed annually as specified by REMSA. Contractor shall maintain a minimum cache of twenty (20) spare radios for back- up purposes.
Cellphones have been constistently used for review period. Contractor is utilizing Zipit application for cellular connectivity. Radios have been inspeted by REMSA staff to be in complaince with REMSA Radio Standards policy. Compliant
Item # Summary of Contract Section Evidence of Compliance Status
7.4.3 Mobile Data Computers (MDCs) – Contractor shall equip each emergency ambulance and supervisor vehicle with a MDC that is capable of receiving and sending response related information to and from the vehicles. Contractor shall provide REMSA with the specifications for approval of any new MDCs to be used in the vehicles prior to purchase. All existing MDCs shall be afforded grandfathered approval by REMSA upon signing of this
Agreement
Equipment has been verified by inspection by REMSA staff. Technical specifications and VisiNet Mobile Training Manual reviewed by REMSA staff. . GIS support services are being provided through EMD staff to support and facilitate latest mapping layers to ensure timely response for Contractors resources. Compliant
7.5 Global Positioning System (GPS) and Automatic Vehicle Location (AVL) - Contractor will provide an Automatic Vehicle Locator/Global Positioning System (AVL/GPS) solution integrated with ambulance and supervisor vehicle MDCs, including the equipment, software, and ongoing maintenance, solely at Contractor’s expense. Contractor’s ambulances and supervisor units must be equipped with a wireless modem and GPS receiver that links to its communications center’s CAD system to track vehicle locations and select the closest available unit. Contractor shall supply AVL/GPS feeds to REMSA and other public safety agencies as authorized and requested by REMSA.
Contractor GPS and AVL equipment is in place and frequently utilized by REMSA staff for monitoring response time performance and ambulance routing. GIS support services are being provided through EMD staff to support and facilitate latest mapping layers to ensure timely response for Contractors resources.
Compliant
7.6 Radio Frequency Use, Management and Credentialing - Contractor will provide REMSA copies of all radio frequency records and will coordinate all frequency licensure activity through REMSA.
FCC licensing reviewed, verified and found up to date by REMSA staff. REMSA communicates regularly with the County Communications licensing coordinator to assure compliance. (Updated License provided by Mark karlin) Compliant
7.7 Communications Equipment Replacement - Contractor agrees to replace communications equipment according to a five year technology refresh cycle. Equipment that provides new capabilities to operations above established baseline capabilities at the effective date of this Agreement may be included in annual improvement and enhancement goals; replacement of existing equipment that has reached the end of its five year cycle shall be considered baseline operating maintenance and shall not be included in the formulation of annual improvement and enhancement goals.
Contractor’s communications capital equipment list reviewed and verified by the Contract Administrator. Equipment purchase orders have been reviewed and verified. Contractor has provided proof of radio equipment capable of utilizing the Public Safety Enterprise Communication. (PSEC) Compliant
7.7.1 Contractor's computer aided dispatch (CAD) system will not be included in the technology refresh program; however, the Contractor shall utilize upgrades offered by their CAD vendor if they are applicable to the Contractor's service offerings under this Agreement.
Contractor's current CAD configuration meets the requirements. Regular CAD upgrades that provide for more robust daily and roll-up performance reporting and monitoring have been completed and are on- going. Compliant
Item # Summary of Contract Section Evidence of Compliance Status
8.1 Customer Service Excellence - Develop and implement customer service program to establish and maintain customer service excellence. Include qualitative and quantitative evaluation of customer feedback. Findings and metrics to be included in the APR shall document and incorporate feedback from, but not limited to, the following customers: (8.1.1 - 8.1.6) During the performance period AMR received consistent responses to surveys by various agencies and stakeholders including Fire Departments, Cities, Hospitals and other medical facilities. Results were overall positive with the majority of responses from hospital staff. There were no dissenting opinions about services or quality of personnel willing to help and integrate into the health teams. Most notable responses were from the AMR Hemet operation and Jack Hansen as their operations manager.
Compliant
8.2 Community Education Program - Provide a minimum of one hundred and twenty (120) hours per year for each ambulance operating area, as defined by Attachment 1, Operating Areas. Prepare an annual Community Education Plan with specific goals and objectives as to meet or exceed minimum acceptable levels set by the EMS Administrative Group for that operating area. Plan shall include but not be limited to the following elements: (8.2.1 - 8.2.5) Contractor provided evidence of public and partner education across the eight (8) ambulance operating areas and other areas of the County. Education included Health and Safety Fair, Community CPR, File of Life, Ambulance Demonstrations, Air Ambulance Demonstrations, Every 15 minutes awareness campaign, and Kid safe. All hours were accounted for in the Annual Report and verified by REMSA staff.
Contractor also has a deployable mobile training unit containing a high fidelity training simulator to complete any neccessary medical trainings to the public or internal staff.
Compliant
8.3 Communications with Electronic or Print Media - Contractor will notify REMSA of all communications with media when it pertains to services performed within the scope of this Agreement
REMSA received notification from the Contractor each time there was a media inquiry. Compliant
9.1 Ambulances - Shall meet the standards as specified in Riverside County Ambulance Ordinance No. 756 or any other REMSA approved program, policy, protocol or procedure governing the provision of ambulances and equipment. All emergency ambulances used for prehospital care and transport shall be Type III (Modular) ambulances that conform to the highest standards for crash safety rating, passenger/patient safety systems, and shall have less than 250,000 miles of service. All exterior colors, lettering, graphics and markings on ambulances and supervisor vehicles must be approved by REMSA.
All ambulances utilized for response to 9-1-1 and prehospital emergency calls shall meet or exceed CAAS standards.
For the review period in question, Contractor has complied with ambulance mileage standards. In the upcoming annual review period, due to changes in resources assigned to emergent responses, Contractor will be required to specify which BLS units are utilized for emergency responses.
Compliant
Item # Summary of Contract Section Evidence of Compliance Status
9.2 Vehicle Maintenance Program - Institute and maintain a preventative vehicle maintenance program approved by REMSA. The program shall include sufficient service sites strategically located throughout Contractor's service areas so that out-of-service time is limited. The program shall contain, but not be limited to, metrics for annual miles driven, lost unit hours due to mechanical failures, number of mechanical failures and vehicle accidents. These metrics shall be included in the annual performance report to REMSA.
Confirmed by REMSA staff through vehicle inspections and spot checks. All ambulances meet the required criteria. 100% of the ambulance fleet comprise of types III ambulances. Verified, through the permit process, that all ambulances meet CAAS standards. AMR has provided updated facility locations throughout Riverside County that has been verified by REMSA staff. Compliant
9.3 Field Supervisor Vehicles - Shall have less than 250,000 miles of service on the entire vehicle (engine, drivetrain, chassis, truck body and all associated major parts). Each field supervisor on-duty shall be assigned a dedicated emergency response vehicle (ERV) which shall meet all requirements for designation as an ERV and be equipped pursuant to REMSA specifications
Field Supervisor vehicle mileage logs and specifications submitted to REMSA and has been verified.
Contractor has purchased and begun using one all electric supervisor (Ford Mustang Mach-E) vehicle.
Compliant
9.4 Durable Medical Equipment - Provide field personnel standardized durable medical equipment as specified by the REMSA standard drug and equipment list or as approved by REMSA for use within a specialty EMS services program. Contractor shall fully support achievement of the County EMS System Strategic Plan objectives and comply with resulting REMSA policies for equipment standardization with First Responders.
REMSA staff reviewed the Contractors capital equipment, durable medical equipment, and ambulance par level sheets. All meet REMSA policy equipment standards for ALS and BLS ground transport services including the recent implementation of iGEL airway implemented during this performance period. Compliant
9.4.1 Contractor shall have a durable medical equipment maintenance program. Critical failures of medical equipment shall be reported consistent with applicable laws and to REMSA. Lost unit hours due to equipment failure or malfunctions shall be reported to REMSA monthly and included in Contractor’s annual performance report to REMSA.
All service agreements were submitted to REMSA for review including contracts for Stryker (Ambulance Gurney), and Zoll (Cardiac Monitor). Equipment failure records are available to REMSA upon request.
Lost unit hour reports are available through the Daily Management Report supplied by Firstwatch that tracks all out of service reasons available in real time and retrospective to REMSA staff 24/7. Compliant
9.4.2 Mandatory Cardiac Monitor Purchase – Contractor shall purchase new cardiac monitors for every ambulance used under this Agreement. REMSA shall specifically identify the new monitors to be purchased by Contractor and the new equipment shall be in service by January 1, 2016.
Contractor completed rollout of Zoll cardiac monitors and has been compliant with program for multiple review periods. Invoices for the new monitors were submitted to REMSA. The new monitors and associated field employee training were verified and approved by REMSA.
Compliant
9.5 Disposable Medical Equipment - Equip and supply ambulances according to REMSA policies, protocols and procedures. REMSA written approval required to modify inventory.
Contractor has provided up to date checklists that are compliant with the current REMSA equipment standards.
Compliant
Item # Summary of Contract Section Evidence of Compliance Status
9.5.1 Ambulance Equipment/Supplies Restock - Submit a detailed written plan to maintain adequate equipment and supplies on all ambulances. Include provisions for support services strategically located across the County to maximize unit in-service time and minimize out-of-service time. Report lost unit hours due to equipment restock monthly
and include in APR.
Plans is up to date and continues to be tested with the COVID-19: Contractor has established guidelines (OGL) for equipment restock and has deployment centers/restock locations in place across the County.
Out of Service hours continues to be tracked and available in the Daily Managment Report and trigger through firstwatch to REMSA staff.
Compliant
9.6 Equipment and Supply Cache - maintain an on-site inventory of equipment sufficient to ensure continued, uninterrupted operations for 14 calendar days in the event of a large scale disaster.
Contractor has provided evidence of compliance that shows 14 calender days of emergency supplies. Compliant
10.1 REMSIS - REMSIS shall consist of an ePCR platform, secure data base and analytical/reporting tools pursuant to REMSA specifications. Contractor shall utilize REMSIS ePCR to capture and transmit patient care reports and data, and by REMSA to perform clinical quality oversight for medical services provided by Contractor.
Contractor has updated its OGL effective 01/28/2020 to be complaint with ePCR ImageTrend requirements per REMSA policy 7701 and 7702. Contractor participates in the REMSIS data collection program including timely submission of NEMSIS 3.4.0 complaint records and is compliant with CEMSIS Title 22 regulations.
Compliant
10.1.01 An ePCR shall be created, completed and transmitted to the data server for every EMS response and prehospital transport by Contractor.
Contractor submits roughly 75% of all applicable ePCR's pertaining to an EMS response. Contractor does generate for every patient transport and operates above normal behavior of other EMS First response and transport agencies. Next performance period will include a reconciliation report and process tied to EMS responses with a fine structure attached as outlined in section 10.5 of the contract. Compliant
10.1.03 Contractor shall pay costs that include personnel, support, vendor maintenance, hardware and software procurement, annual maintenance and upgrades, annual County IT oversight for REMSIS and associated information systems as per County Fee Schedule, Exhibit 14-A.
Fees received by REMSA and verified by invoice and accounts receivable. EMD Fiscal staff are reviewing all REMSIS related documents as part of routine audit. Compliant
10.2 Dynamic Performance Monitoring - First Watch will be used as a data reporting application for the near real time evaluation of operational performance, response time data, clinical data and syndromic surveillance. First Watch shall interface with REMSIS, Contractor CAD and other data systems as required, and shall utilize the following features:
The FirstWatch integration, as part of the REMSIS program, is continuously utilized as a part of this agreement for concurrent and retrospective contract compliance and clinical data validation. The AMR CAD is directly linked with FirstWatch and the ImageTrend ePCR system. This process was used for COVID-19 response, Influenza like illness tracking, pediatric response and surge. This regulatory oversight method has improved situational awareness for all Riverside County stakeholders. The AMR Monthly reports are processed within the FirstWatch Online Compliance Utility (OCU) Module.
Compliant
Item # Summary of Contract Section Evidence of Compliance Status
10.3 Monthly and Annual Performance Reports - Monthly reports within 15 working days following the end of each month. The APR shall be provided by the first work day of September each year and shall include but not be limited to the following elements:
The Contractor's monthly reports are processed with the Firstwatch Online Compliance Utility (OCU) Module. In the upcoming review period, an automated compliance/exemption model has been completed and is currently providing monthly reports in the outlined time.
Compliant
10.3.12 Strategic plan goals/objectives for the year - completed system improvements and enhancements During the performance period, Contractor implemented multiple system enhancements/improvments including but not limited to; CAT Team, utilized to respond to psychological crisis, implementing BLS ambulances designated for the appropriately dispatched Alpha/Omega emergent responses and bolstering the "earn while you learn" program to sponsor over 50 EMT's through paramedic school. Compliant
10.3.13 Activities and results of the CQI Plan Compliant and submitted as part of the annual CQI update. Compliant
10.5 Missing Patient Care Reports (PCRs) - REMSA may assess a fee of $100 for every PCR that is not submitted to the REMSIS database within the time specified by REMSA. The fee amount will be included as part of the quarterly invoices.
Contractor has given report of reconciliation report of all ePCR's generated per ambulance response.
REMSA staff will develop a plan to increase performance of patient care generated reports to ambulance responses and attach fine reports through firstwatch as part of the monthly compliance intervals.
Compliant
11.1 Integration with the MHOAC Program - During response to mass casualty incidents or disasters within or effecting the County, Contractor operations shall fall under management and coordination of the MHOAC as a function of the Medical/Health Branch in support of the County Emergency Operations Plan (EOP). Contractor shall participate in disaster drills and DMS training programs as requested by REMSA.
Contractor demonstrated consistent ability to integrate with MHOAC and participate in large scale community events without an obvious impact to emergency system. Contractor was also able to respond in real time to large scale, multi patient incidents. Frequent participation in county and municipal emergency trainings/demonstrations. Compliant Item # Summary of Contract Section Evidence of Compliance Status
11.3 Contractor shall at all times have two (2) type II immediate need Ambulance Strike Team (AST) and one (1) type II planned need AST available for deployment upon authorization from the MHOAC. Contractor shall maintain and operate the two (2) County acquired Disaster Medical Support Units (DMSU), of which one will be located in the Eastern County and one will be located in the Western County.
The contractor maintains two DMSUs, (1) in Hemet and (1) in Palm Springs. The DMSUs were activated and deployed multiple times during the COVID-19 pandemic to augment supply and supervisory functions. The vehicle was inspected by REMSA staff during an ambulance permit inspection.
Compliant
11.5 Disaster Coordinator shall be identified and shall participate fully in all MHOAC planning and response activities as requested by REMSA.
The AMR Disaster Coordinator is Paramedic Supervisor, Gary Denham. The lasting effects of the COVID- 19 pandemic was continuous throughout this performance period including the influenza like illness cases that continue to rise in Riverside Coutny. Gary and many other AMR supervisors were integrated into to the Riverside County MHOAC program.
Compliant
12.1 Contractor shall enter into public/private partnerships with First Responder agencies to maximize the functional capacity and efficiency of an integrated and cooperative two tiered Regional EMS System.
Agreements are subject to approval by REMSA. Contractor response time requirements may be lengthened by a maximum of two minutes in Metro and Urban areas only to facilitate partnerships, with REMSA approval.
The Contractor holds public/private partnership agreements with the City of Riverside and Corona. The Response Time Standard in the City of Corona and the City of Riverside is 12 minutes (10 Minutes + 2 minutes). This agreement supports the first response paramedic (ALS) programs in each city, respectively. Contractor has recently entered into a agreement for augmented Ambulance response in the pass zone with Morongo Fire Department.
Compliant
12.1.03 Within one year of the signing of this agreement, Contractor shall demonstrate good faith effort to establish support agreements with all Fire Departments authorized by REMSA to provide ALS First Responder services.
No Changes for this reporting period: All requested agreements have been established with first responder agencies. No "supply" related complaints were reported to REMSA during the reporting period.
Compliant
12.2 Equipment Supply, Inventory and Restock - Contractor will develop mechanisms to restock disposable equipment and supplies (as detailed on the First Responder Standard Drug and Equipment lists) other than narcotics used by First Responders when treatment has been provided by First Responder personnel and the patient is transported by Contractor.
Contractor shall submit written plans for accomplishing First Responder restock to REMSA within 90 days of the signing of this Agreement.
No change: agreement review by REMSA staff and no "supply" related complaints were reported to REMSA during the reporting period. The agreements are current and active. Compliant
13.5 Financial Reports and Audits - Contractor will provide quarterly unaudited financial statements, in a format prescribed by REMSA. All financial documents provided as stipulated by contract. Compliant Item # Summary of Contract Section Evidence of Compliance Status
13.6 Billing/Collection Services - Contractor shall assist REMSA to evaluate the billing accuracy and customer service provided by their billing department. Contractor shall include customer/patient feedback in their customer services program. The APR will include metrics of the number of billing complaints and compliments.
Contractor supplied annual summary of billing accuracy as well as summary of customer feedbak.
Primary customer complaint was "billing" related with multiple sub-categories. (Wrong person, incorrect amount) Compliant