Monday, October 16, 2023
City Council Study Session
Santa Clara County 9-1-1 Ambulance Services
October 16, 2023
Presented by:
Robert Sapien, Jr., Fire Chief, Fire Department
Patrick Chung, EMS Battalion Chief, Fire Department
Study Session Agenda
Monday, October 16, 20232
Purpose: To provide the City Council with an overview of Emergency Medical Services (EMS) operations within Santa Clara County with a focus on 9-1-1 ambulance services and possible future service models.
1. Introduction
2. EMS Services in Santa Clara County
3. EMS System Models
4. EMS Trends
5. EMS System Revenues and Sustainability
6. Next Steps and Closing
Outcome: The City Council will gain a common understanding of the Santa Clara County EMS System, 9-1-1 ambulance services, system revenues, and service model trends in the State of California.
1. Introduction
Monday, October 16, 20233
• Tim Maybee, AP Triton, LLC
• Patrick Chung, Battalion Chief – EMS Division
• Robert Sapien, Jr., Fire Chief
Current agreement
with Rural/Metro
Ambulance will expire
on June 30, 2024 (with
option to extend
to June 30, 2027).
First responder
agency agreements
will expire on June
30, 2025.
First opportunity for
EMS System reform
since July 1, 2011.
1. Introduction
Monday, October 16, 20234
SJFD resources are deployed to
rapidly respond to all hazards in all
environments:
9-1-1 Communications
Fire (wildland, high-rise, residential,
commercial, etc.)
Rescue (vehicle extrication, water,
confined space, high angle, etc.)
Hazardous Materials
Multi-Casualty (transportation, active
assailant, etc.)
San José Fire Department "All Hazards" Response
Friday, October 13, 20235
Emergency Medical Services (EMS)
• First Aid "Resuscitator Calls"
• Basic Life Support / Emergency
Medical Technician (EMT Certification
created in 1970)
• Advanced Life Support / Paramedics
(1995)
2. EMS Services in Santa Clara County
Typical Emergency Medical Services Response
Monday, October 16, 20236
9-1-1 request is
received for
emergency
medical services
Advanced Life
Support Fire &
Ambulance
dispatched
Firefighter/
Paramedic arrives
and provides
treatment
Firefighter/Paramedic
retains patient care
for exigent transport
to Emergency
Department
Transfers care to
Ambulance for
transport to
Emergency
Department
2. EMS Services in Santa Clara County
Monday, October 16, 20237
Exclusive Operating Area (EOA)
Mountain View
Santa Clara
Cupertino
Milpitas
Sunnyvale
Los Altos
Los Altos Hills
Campbell
Los Gatos
Monte Sereno
Saratoga
San Jos
é
Morgan Hill
Gilroy
2. EMS Services in Santa Clara County
Monday, October 16, 20238
*"These responses resulted in 84,293 ambulance transports to local hospitals, which averaged to 231 transports per day."
2. EMS Services in Santa Clara County
Fire Department Ambulance Services
Monday, October 16, 20239
Santa Clara County EMS Stakeholder Group
Monday, October 16, 202310
The County convened a
facilitated stakeholder group to
identify priorities for selecting the
next emergency transport
provider for Santa Clara County.
Representatives from: Santa
Clara County 9-1-1
Communications, Santa Clara
County EMS, Santa Clara
County Procurement, Office of
the Chief Executive Officer, City
Managers, Area Hospitals, Law
Enforcement, Fire Departments,
South County Region
3. EMS System Models
Private: A for-profit company is awarded
a service area through a competitive
procurement process (e.g., current Santa
Clara County model).
Alliance: A Fire District or Fire
Department is the provider of record,
subcontracting with a private ambulance
company.
Public Third Service: A standalone
public agency is dedicated to emergency
ambulance services (e.g. Austin, TX and
Boston, MA).
Fire Department: Fire department
provides first responder EMS services
and 9-1-1 ambulance transport services
(e.g., City and County of San Francisco,
CA).
EMS System Models Evaluated by
Santa Clara County EMS Stakeholder Group
Monday, October 16, 202311
3. EMS System Models
Private
Monday, October 16, 202312
Santa Clara County EMS Stakeholder Group Opinions
Benefits Concerns
Cost South County service
disparities
Staffing Staffing
Response time compliance
standards
Response time
Equipment/supplies Equipment/supplies
Operations Inconsistency in service
Cost performance overall
3. EMS System Models
Alliance
Monday, October 16, 202313
Santa Clara County EMS Stakeholder Group Opinions
Benefits Concerns
Cost Cost
Operations Political Feasibility
Clear chain-of-command None
Performance
None/I don't know
3. EMS System Models
Public Third Service
Monday, October 16, 202314
Santa Clara County EMS Stakeholder Group Opinions
Benefits Concerns
Staffing Cost
Equipment Number of transports per
responses is high
Operations None
Contract includes other
services
None
3. EMS System Models
Fire Department
Monday, October 16, 202315
Santa Clara County EMS Stakeholder Group Opinions
Benefits Concerns
Performance Cost
Other services Political feasibility
Run by the Fire Department None
Staffing
None/I don't know
3. EMS System Models
4. EMS Trends
Monday, October 16, 202316
• Beginning in June of 2022, the Department experienced a dramatic increase in situations where either no ambulances were available to respond to a medical emergency and/or only a BLS-level ambulance was available. • When ambulance levels are low, Standard Dispatch Orders (SDOs) are activated countywide to meet demand and ensure stability of the EMS system. • SDO 10/11: place all available ambulances in service (including Fire Department ambulances and non-EOA private ambulances) to provide emergency transport. • Increase of 71% from Fiscal Year 2020-2021 to Fiscal Year 2023-2024 • SDO 17: due to a shortage or no available ambulances, suspends the dispatch of ambulances on any type of call until a first responder unit arrives on-the-scene and verifies that a patient needs emergency transport.
• Increase of 100% from Fiscal Year 2020-2021 to Fiscal Year 2023-2024
4. EMS Trends
Monday, October 16, 202317
0 2,000
4,000
6,000
8,000
10,000
12,000
0 200
400
600
800
1,000
Cumulative Minutes
Late Repsonses
MonthYear
Unadjusted Late Responses SDO 10, 11, & 17 Cumulative Mins. Trend Progression (Linear) Unadjusted Late Responses vs. SDO Activation Minutes
5. EMS System Revenues and Sustainability
Monday, October 16, 202318
Ambulance services are delivered on a fee
for service basis that includes ALS or BLS
ambulance user fees, mileage, staff time,
and fees for supplies and medications.
Service Level Price Basis
Advanced Life Support (1) $2,055.53 ALS 1 Emergency
Mileage $697.90 10 miles
Paramedic $130.06 1 hour
EMT $86.71 1 hour
EKG Monitor 12-Lead $172.59 1
Razor, Disposable $1.59 1
Intravenous Start Kit $72.62 1
Non-Rebreather Mask $19.98 1
Temperature
Measurement
$30.67
Pulse Oximetry $76.30
Normal Saline $179.23 1 (1,000 cc)
Total $3,523.18
There are four different categories of
payers:
• Medicare
• Medi-Cal
• Private Pay
• Commercial Insurances
Medicare makes up the largest percentage
of payers in Santa Clara County.
Cost Center Payer
Mix
Collection
Rate
Medicare/Medicare HMO 34% 85%
Medi-Cal/Medi-Cal HMO 23.3% 92%
Commercially Insured 21.1% 80%
Private Pay/Non-Insured/Other 21.6% 3%
The Public Provider Ground Emergency
Medical Transport (PP-GEMT)
Intergovernmental Transfer (IGT) Program
provides public providers with supplemental
reimbursement through add-on payments.
Monday, October 16, 202319
Procedure
Code
Procedure Code
Description
Current Fee
Schedule
Rate
Medi-Cal PP-
GEMT IGT
Add-on
Resulting
Payment
Amount
A0225 Neonatal Emergency Transport $179.92 $946.92 $1,126.84 A0427 ALS 1-Emergency $118.20 $946.92 $1,065.12
A0429 BLS-Emergency $118.20 $946.92 $1,065.12
A0433 ALS 2 $118.20 $946.92 $1,065.12
A0434 Specialty Care Transport $118.20 $646.92 $765.12
.
5. EMS System Revenues and Sustainability
PP-GEMT IGT is anticipated to
provide a reimbursement of an
additional $765.12 per Medi-Cal
transport.
On March 14, 2023, the County
Board of Supervisors passed a
resolution directing factors to
be considered by the County
EMS Agency when selecting an
exclusive provider amongst
competing proposals.
Santa Clara County Intent to Select an Exclusive Provider Monday, October 16, 202320
6. Next Steps & Closing
Questions?
Robert Sapien, Jr., Fire Chief
Fire Department, Office of the Fire Chief
Patrick Chung, EMS Battalion Chief
Fire Department, Bureau of EMS & Training
Monday, October 16, 202321
City Council Study Session
Santa Clara County 9-1-1 Ambulance Services
October 16, 2023