Thursday, March 21, 2024
Santa Clara County 9-1-1 Ambulance Services
Status Report and Fire Department Emergency
Medical Services Annual Report
Public Safety, Finance and Strategic Support Committee
March 21, 2024
Item (d)1.
Presented by:
Patrick Chung, Battalion Chief
Robert Sapien Jr., Fire Chief
2 Santa Clara County 9-1-1 Ambulance Services
Thursday, March 21, 2024
3 Exclusive Operating Area (EOA)
Mountain View
Santa Clara
Cupertino
Milpitas
Sunnyvale
Los Altos
Los Altos Hills
Campbell
Los Gatos
Monte Sereno
Saratoga
San Jose
Morgan Hill
Gilroy
EMS Services in Santa Clara County
Thursday, March 21, 2024
County Ambulance Impacts to the Fire Department
4 BLS Ambulance Escorts
and Late Responses
• Decreasing ambulance availability
leads to increased deployment of
Basic Life Support (BLS) resources to
mitigate service disruption
• Firefighter/Paramedic accompanies a
patient to provide the highest level of
patient care
• Department emergency response
company is “out of service” or “inservice BLS”
53 68
104
54 48
66 88 83
115
107
162 139
699 699
753
691 675
723
804
721
832
705
823
735
0 20
40 60
80 100
120
140
160
180
0 100
200
300
400
500
600
700
800
900
BLS Ambulance Escorts
Late Responses
BLS Ambulance Escort Total Raw Late Responses
Thursday, March 21, 2024
County Ambulance Impacts to the Fire Department
5 Thursday, March 21, 2024
0 20
40 60
80 100
120
140
160
180
400
450
500
550
600
650
700
750
800
850
900
BLS Ambulance Escorts
Late Responses
BLS Amb. Escorts
TOTAL RAW Late Resp.
County Ambulance Impacts to the Fire Department
6 Rescue Medic (RM) Transports
and Late Responses
• Rescue Medics provide emergency
patient transport in situations where
the County ambulance provider is
unavailable
• Correlation seen in deployment and
increased late responses particularly
observed with patient offload delays
55 39
77 48
70 131
49 47
100
63 127
53 699 699
753
691 675 723
804
721
832
705
823
735
0 20
40 60
80 100
120
140
0 100
200
300
400
500
600
700
800
900
RM Transports
Late Responses
RM Transport Total Raw Late Responses
Thursday, March 21, 2024
County Ambulance Impacts to the Fire Department
7 Thursday, March 21, 2024
0 50
100
150
200
250
400
500
600
700
800
900
1000
RM Transports
Late Responses
RM Transport
TOTAL RAW Late Resp.
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
8 EMS System Models
Thursday, March 21, 2024
9 EMS System: “Alliance” Model / AB 389
Thursday, March 21, 2024
10 EMS System: “Alliance” Model
Alliance Model Benefits
✓ Integrated Fire and EMS Services
✓ Deployment decisions
service/performance driven
✓ Increased reimbursement (PPGEMT)
✓ Reinvestment of revenues into
system
✓ Equipment and Staffing
✓ Stability through funding reserve
✓ Innovation / Evolution
Thursday, March 21, 2024
Ambulance Transport Revenues and Sustainability
11 Service Level Price
Advanced Life Support (1) $2,055.53
Mileage (10 miles) $697.90
Paramedic (1-hour) $130.06
EMT (1-hour) $86.71
EKG Monitor 12-Lead $172.59
Razor, Disposable $1.59
Intravenous Start Kit $72.62
Non-Rebreather Mask $19.98
Temperature Measurement $30.67
Pulse Oximetry $76.30
Normal Saline $179.23
Total $3,523.18*
Medicare Medi-Cal Commercial Private
43% 29% 15% 13% Payer Mix
$521.00 $118.00 $2,818.00 N/A Payment Cap
$946.00** PP-GEMT
Thursday, March 21, 2024
• Increased participation for public agencies in the Public Provider Ground Emergency Medical Transport (PPGEMT) Intergovernmental Transfer (IGT) Program • Participating public providers receive enhanced
reimbursement for transports of Medi-Cal patients –
approximately 29% of the payer mix estimated for
Santa Clara County
*fictitious ambulance service bill based on current County established rates. **estimate based upon current reimbursement rates
Santa Clara County 9-1-1 Ambulance and First
Responder Agreements Status
12 Thursday, March 21, 2024
• Current agreement with Rural/Metro Ambulance will expire on June 30, 2024 (with option to extend for a three-year term).
• First responder agency agreements will expire on June 30, 2025. • County (3/14/2023) passed resolution giving EMS Agency direction on selecting an exclusive provider (EOA).
• Opportunity to reform EMS system as Agreement(s) expire • Department sees need for EMS System reform (Alliance or Fire-Based Model) • Opportunity to optimize Fire/EMS integration
• Opportunity to retain revenues locally to recover costs and reinvest in the system • Opportunity to innovate and refine services to better meet communities' needs 13 Fire Department EMS Annual Report
Thursday, March 21, 2024
Incident Volume and County Responses 5-Year Trend
14 92,587 91,900 91,595 94,784
103,145
109,136
57,935 57,800 56,454 57,125
63,997
68,212
123,478 124,394 125,394 126,394
133,354 131,532
0 20,000
40,000
60,000
80,000
100,000
120,000
140,000
2017-2018 2018-2019 2019-2020 2020-2021 2021-2022 2022-2023 SJFD Total Incidents SJFD Medical Only Incidents County Ambulance EMS Responses Thursday, March 21, 2024
EMS Patient Age Distribution
15 348
1,326
2,104
3,959
5,488 5,489
7,528
9,207 9,308 9,168
4,234
3,336
0 2,000
4,000
6,000
8,000
10,000 • Projected 85% increase in Santa
Clara County residents 85 years or
older by 2030
• Projected 99% increase in Santa
Clara County residents 65 years or
older by 2030
• In FY 22-23, patients 60 years or
older accounted for over half of
Department EMS responses
Thursday, March 21, 2024
Major Observations on Patient Primary Impressions
16 Department Provider's Primary
Patient Impression
Fiscal Year
18-19
Fiscal Year
19-20
Fiscal Year
20-21
Fiscal Year
21-22
Fiscal Year
22-23
1 Traumatic Injury 8,978 8,252 7,701 9,259 9,746
2 General Weakness 3,545 3,355 3,886 4,387 4,914
3 Respiratory Distress 3,291 3,476 3,807 4,201 4,651
4 Abdominal Pain / Problems 2,776 2,743 3,156 3,521 3,978 5 No Medical Complaint / Findings 3,839 3,648 3,194 3,171 3,463 6 Behavioral/Psychiatric Crisis / Excited Delirium 2,395 2,282 2,564 2,785 3,064 7 Altered Level of Consciousness
(Not Hypoglycemia or Seizure) 2,082 2,274 2,591 2,617 2,894 8 Alcohol Intoxication / Overdose 2,436 2,411 2,274 2,488 2,583 9 Non-Traumatic Body Pain 2,234 2,132 2,315 2,473 3,015 10 Chest Pain / Dysrhythmia / Hypertension 2,027 1,965 1,861 2,210 2,431 Thursday, March 21, 2024
17 Thursday, March 21, 2024
EMS Training & Equipment
Mandatory Training for All Sworn Personnel (FY22-23)
Law Enforcement Disengagement
Controlled Substance Inventory Control
Geriatric EMS Patient Care
Health Insurance Portability and Accountability Act of
1996 (HIPAA)
Trauma Care
Active Assailant/Shooter with SJPD
18 Thursday, March 21, 2024
Department Paramedic Staffing
• Firefighter/Paramedic MCB hours
peaked @ 9,000 in the month of
December 2022
• Department has steadily expanded
the number of Support Paramedics
• Firefighter/Paramedic MCB hours
reduced to < 2,000 in the month of
July 2023 24
28 34
42 54
58 61 63
66 0
20 40
60 80
-
2,000
4,000
6,000
8,000
10,000
Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Personnel
Hours
Support Paramedics FF/PM-MCB Hours
19 Questions?
Patrick Chung, Battalion Chief
Bureau of EMS and Training
Robert Sapien Jr., Fire Chief
Fire Department
Santa Clara County 9-1-1 Ambulance Services Status Report and Fire Department Emergency Medical Services Annual Report
Public Safety, Finance and Strategic Support Committee
March 21, 2024
Item (d)1.
Thursday, March 21, 2024