Alameda County EMS Ambulance Transport … Ambulance Transport Provider Agreement i TABLE OF CONTENTS ... A municipality in Zone 1 that has a contract with EMS to provide its own

EmergencyMedicalServices

AmbulanceTransportProvider

Agreement

CountyofAlameda

and

ParamedicsPlus,LLC

June2010

EMSAmbulanceTransportProviderAgreement

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TABLE OF CONTENTS

DEFINITIONS AND ACRONYMS .......................................................................... VII

RECITALS OF AUTHORITY ................................................................................ 1

SCOPE OF WORK .......................................................................................... 2

1. SERVICES ...................................................................................................................................2

2. SERVICE AREA/EMERGENCY RESPONSE ZONES ..................................................................................2

3. SERVICES/STANDARDS .................................................................................................................3

4. ASSISTANCE TO OTHER COUNTY EOAS/EXPANSION OF THE EOA .........................................................3

5. LOCATION OF CONTRACTOR’S OFFICES ............................................................................................4

6. TRANSITION ...............................................................................................................................4

DISPATCH .................................................................................................. 4

7. ALAMEDA COUNTY REGIONAL EMERGENCY COMMUNICATIONS CENTER ................................................4

8. ACRECC AGREEMENT .................................................................................................................4

9. DEPLOYMENT SUPERVISOR AT DISPATCH CENTER ..............................................................................5

10. COUNTY COMPUTER AIDED DISPATCH SYSTEM .................................................................................5

11. CAD DATA ................................................................................................................................5

COMMUNICATIONS ....................................................................................... 5

12. RADIO EQUIPMENT ......................................................................................................................5

RESPONSE TIME REQUIREMENTS ....................................................................... 6

13. RESPONSE TIME PERFORMANCE AND MEASUREMENT ........................................................................6

14. RESPONSE TIME ACCOUNTABILITY ..................................................................................................6

15. RESPONSE TIME MEASUREMENT METHODOLOGY .............................................................................7

16. CALCULATING RESPONSE TIMES .....................................................................................................8

17. CALCULATING CHANGES IN CALL PRIORITY .......................................................................................8

18. CANCELED CALLS .........................................................................................................................9

19. EACH INCIDENT A SEPARATE RESPONSE ...........................................................................................9

20. 5150 RESPONSE .........................................................................................................................10

21. RESPONSE TIME PERFORMANCE REPORT .........................................................................................10

22. RESPONSE TIME LATE RESPONSE EXEMPTIONS ("EXEMPTION") ...........................................................11


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STAFFING REQUIREMENTS ............................................................................... 11

23. AMBULANCE STAFFING REQUIREMENTS ...........................................................................................11

24. WORK SCHEDULES ......................................................................................................................11

25. PERSONNEL LICENSURE/CERTIFICATION/TRAINING REQUIREMENTS ......................................................12

TRANSPORT REQUIREMENT ............................................................................. 12

26. DESTINATION .............................................................................................................................12

27. INFLUENCE ON DESTINATION .........................................................................................................13

28. AIR AMBULANCE AGREEMENTS ......................................................................................................13

MULTI‐CASUALTY INCIDENT/DISASTER RESPONSE .................................................. 13

29. MULTI‐CASUALTY INCIDENT/DISASTER RESPONSE .............................................................................13

30. DISASTER RESPONSE VEHICLE/EQUIPMENT ......................................................................................14

31. INCIDENT NOTIFICATION ...............................................................................................................14

32. AMBULANCE STRIKE TEAM ............................................................................................................14

33. INTERAGENCY TRAINING FOR EXERCISES/DRILLS ................................................................................15

34. MUTUAL‐AID REQUIREMENTS .......................................................................................................15

VEHICLES AND EQUIPMENT ............................................................................. 16

35. AMBULANCES .............................................................................................................................16

36. EQUIPMENT ...............................................................................................................................17

37. VEHICLE AND EQUIPMENT MAINTENANCE ........................................................................................17

ELECTRONIC PATIENT CARE REPORT AND DATA COLLECTION SYSTEM ........................... 18

38. PATIENT CARE REPORTS ...............................................................................................................18

39. DATA COLLECTION SYSTEM FOR PATIENT CARE REPORTS ....................................................................19

40. PCR DELIVERY TO RECEIVING HOSPITALS OR PSYCHIATRIC FACILITIES ....................................................20

MEDICAL OVERSIGHT .................................................................................... 21

41. MEDICAL PROTOCOLS ..................................................................................................................21

42. MEDICAL REVIEW/AUDITS ............................................................................................................21

PERSONNEL ................................................................................................ 21

43. TREATMENT OF INCUMBENT WORKFORCE ........................................................................................21

44. CHARACTER/COMPETENCE/PROFESSIONALISM .................................................................................22

45. INTERNAL HEALTH AND SAFETY PROGRAMS ......................................................................................22


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46. PERSONNEL TRAINING ..................................................................................................................23

47. CONTINUING EDUCATION PROGRAM ..............................................................................................23

48. WORKFORCE ENGAGEMENT ..........................................................................................................23

49. KEY PERSONNEL AND REQUIRED POSITIONS ......................................................................................24

QUALITY MANAGEMENT PLAN ......................................................................... 27

50. APPROVAL OF QUALITY MANAGEMENT PLAN ...................................................................................27

51. CALIFORNIA AWARD FOR PERFORMANCE EXCELLENCE ........................................................................28

REQUIRED REPORTS ...................................................................................... 29

52. REPORTING REQUIREMENTS ..........................................................................................................29

53. RESPONSE TIME PERFORMANCE .....................................................................................................29

54. HIGH‐RISK PCRS ........................................................................................................................30

55. COMPLIANCE WITH PROTOCOLS .....................................................................................................30

56. QUALITY IMPROVEMENT ...............................................................................................................30

PENALTY PROVISIONS .................................................................................... 30

57. FAILURE TO RESPOND ..................................................................................................................30

58. RESPONSE LEVEL .........................................................................................................................31

59. MISSING MANDATORY DATA FIELDS ...............................................................................................31

60. MISSING PCR AT THE RECEIVING HOSPITAL OR PSYCHIATRIC FACILITY ...................................................31

61. PCR GOOD CAUSE EXEMPTION .....................................................................................................32

62. FAILURE TO PROVIDE TIMELY REPORTS ............................................................................................32

63. FAILURE TO MEET MINIMUM IN‐SERVICE EQUIPMENT/SUPPLY REQUIREMENTS......................................32

64. FAILURE TO PROVIDE ARRIVAL AT INCIDENT TIME ..............................................................................32

65. RESPONSE TIME FINES .................................................................................................................32

66. FINES FOR OUTLIER RESPONSE TIMES ..............................................................................................33

67. FINE DISPUTES ............................................................................................................................33

68. INVOICING AND PAYMENT .............................................................................................................33

COUNTY‐WIDE COOPERATION ......................................................................... 34

69. COLLABORATION WITH FIRST RESPONDER AGENCIES ..........................................................................34

70. EMS SYSTEM PARTICIPATION ........................................................................................................35

HEALTH STATUS IMPROVEMENT/COMMUNITY EDUCATION ....................................... 35


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71. EMT TRAINING PROGRAMS, INTERNSHIPS AND RELATED OPPORTUNITIES ..............................................35

72. COMMUNITY PROGRAMS ..............................................................................................................35

ENVIRONMENTALLY FRIENDLY BUSINESS PRACTICES................................................ 36

73. BUILDINGS AND VEHICLES .............................................................................................................36

74. EQUIPMENT AND SUPPLIES ............................................................................................................37

75. MEDICAL EQUIPMENT AND SUPPLIES ..............................................................................................37

COMPLIANCE PROVISIONS ............................................................................... 37

76. MEDICARE COMPLIANCE PROGRAM REQUIREMENTS ..........................................................................37

77. HIPAA COMPLIANCE PROGRAM REQUIREMENTS ..............................................................................37

78. EMS POLICIES ............................................................................................................................38

79. MEDICAL AND OTHER STATE AND FEDERAL PROGRAMS ......................................................................38

CONTRACTOR REVENUE .................................................................................. 38

80. CONTRACTOR COMPENSATION ......................................................................................................38

81. PATIENT CHARGES AND FEES .........................................................................................................38

82. USER FEE ADJUSTMENTS ..............................................................................................................38

83. BILLING/COLLECTION SERVICES ......................................................................................................39

84. ACCOUNTING PROCEDURE ............................................................................................................40

85. CUSTOMER SERVICE TELEPHONE LINE .............................................................................................41

86. CONTRACTOR'S COMPENSATION TO THE COUNTY ..............................................................................42

ADMINISTRATIVE PROVISIONS .......................................................................... 42

87. ANNUAL PERFORMANCE EVALUATION .............................................................................................42

88. ASSURANCE OF PERFORMANCE ......................................................................................................43

89. MATERIAL BREACH ......................................................................................................................43

90. NOTICE AND CURE OF MATERIAL BREACH ........................................................................................44

91. COUNTY REMEDIES ......................................................................................................................45

92. CONTINUOUS SERVICE DELIVERY ....................................................................................................45

93. EMERGENCY TAKEOVER ................................................................................................................45

94. TERMINATION ............................................................................................................................46

FUTURE COMPETITIVE PROCUREMENT PROCESS / “LAME DUCK” PROVISIONS ................ 48

95. COMPETITIVE PROCUREMENT PROCESS ...........................................................................................48


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96. “LAME DUCK” PROVISIONS ...........................................................................................................49

GENERAL PROVISIONS ................................................................................... 49

97. PERMITS AND LICENSE ..................................................................................................................49

98. PRIVATE WORK ..........................................................................................................................50

99. PRODUCT ENDORSEMENT/ADVERTISING ..........................................................................................50

100. OBSERVATION AND INSPECTIONS ....................................................................................................50

101. NO COST TO COUNTY ..................................................................................................................51

102. COST OF ENFORCEMENT ...............................................................................................................51

103. RELATIONSHIP OF THE PARTIES .......................................................................................................51

104. INDEPENDENT CONTRACTOR ..........................................................................................................51

105. INDEMNIFICATION .......................................................................................................................52

106. INSURANCE AND BOND .................................................................................................................53

107. WORKERS’ COMPENSATION ..........................................................................................................53

108. CONFORMITY WITH LAW AND SAFETY .............................................................................................53

109. DEBARMENT AND SUSPENSION CERTIFICATION .................................................................................54

110. TAXES .......................................................................................................................................55

111. OWNERSHIP OF DOCUMENTS ........................................................................................................55

112. DOCUMENTS AND MATERIALS .......................................................................................................56

113. CONFLICT OF INTEREST/CONFIDENTIALITY ........................................................................................56

114. NOTICES ....................................................................................................................................57

115. USE OF COUNTY PROPERTY ...........................................................................................................58

116. EQUAL EMPLOYMENT OPPORTUNITY PRACTICES PROVISIONS ..............................................................58

117. DRUG FREE WORKPLACE ..............................................................................................................59

118. SMALL, LOCAL, AND EMERGING BUSINESS (SLEB) PARTICIPATION: ......................................................59

119. FIRST SOURCE PROGRAM ..............................................................................................................60

120. WAIVER ....................................................................................................................................60

121. ENTIRE AGREEMENT ....................................................................................................................60

122. HEADINGS .................................................................................................................................60

123. MODIFICATION OF AGREEMENT .....................................................................................................60

124. SUBCONTRACTING/ASSIGNMENT/SALE ...........................................................................................61


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125. SURVIVAL ..................................................................................................................................61

126. SEVERABILITY .............................................................................................................................62

127. PATENT AND COPYRIGHT INDEMNITY ..............................................................................................62

128. CHOICE OF LAW AND VENUE .........................................................................................................63

SIGNATORY ................................................................................................ 63

EXHIBITS .................................................................................................... 1

EXHIBIT A ‐ DEPICTION AND DEFINITION OF CONTRACTOR’S EOA AND

EMERGENCY RESPONSE ZONES ....................................................... 2

EXHIBIT B ‐ DEPICTION AND DEFINITION OF SUB‐AREAS .......................................... 3

EXHIBIT C ‐ MINIMUM INSURANCE REQUIREMENTS ................................................ 6

EXHIBIT D ‐ DEBARMENT AND SUSPENSION CERTIFICATION ...................................... 7

EXHIBIT E ‐ COMMUNICATIONS EQUIPMENT ......................................................... 8

EXHIBIT F ‐ RESPONSE TIMES REQUIREMENTS AND FINES ......................................... 10

TABLE A ‐ PERSONNEL AND RESPONSE TIME REQUIREMENTS ...............................................................10

TABLE B ‐ RESPONSE TIME FINES BY CATEGORY AND COMPLIANCE .......................................................10

TABLE C ‐ OUTLIER RESPONSE TIMES BY CATEGORY AND SUBAREA IN MINUTES & SECONDS .....................10

EXHIBIT G ‐ PARAMEDIC TRAINING REQUIREMENTS ................................................ 11

EXHIBIT H ‐ CONTRACTOR’S USER FEES ‐ 911 SYSTEM ............................................ 13

EXHIBIT I ‐ MANDATORY DATA FIELD REQUIREMENTS ............................................. 14

EXHIBIT J ‐ FIRST SOURCE AGREEMENT ............................................................... 15

EXHIBIT K – TRANSITION PLAN ......................................................................... 16

EXHIBIT L ‐ COMMUNITY EDUCATION PROGRAM ................................................... 22

EXHIBIT M ‐ FIRST RESPONDER SUPPORT ............................................................ 24

EXHIBIT N ‐ HIGH RISK PATIENT DESCRIPTION ...................................................... 25

EXHIBIT O ‐ PROPOSAL OF PARAMEDICS PLUS ...................................................... 26


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DEFINITIONS AND ACRONYMS

ThefollowingdefinitionsandacronymsarecontainedinthisAgreement:

5150Call

Servicesinvolvingapatientwhohasbeen(orshallbe)placedonaholdforpsychiatricevaluation,includingtransporttoapsychiatricfacilityinaccordancewiththeCaliforniaCodeofRegulationsWelfareandInstitutionsCode,Section5150andEMSPolicies.

Ambulance

AsdefinedpursuanttoTitle13oftheCaliforniaCodeofRegulations,section1100.2.Avehiclespeciallyconstructed,modifiedorequipped,andusedforthepurposeoftransportingsick,injured,convalescent,infirm,orotherwiseincapacitatedpersons,andcompliantwithstaterequirements.

AmbulanceStrikeTeam(s)

ReferencedescriptioninEMSAguideline#215

ACRECC AlamedaCountyRegionalEmergencyCommunicationsCenter

AlphaCall A911calldesignatedbyCountyDispatchCenterasanAlphaCallbasedonuseoftheMedicalPriorityDispatchSystem.

ALS AdvancedLifeSupport‐paramediclevelofserviceasdefinedinCaliforniaHealthandSafetyCode,Division2.5,§1797.52

ArrivalatIncident

ThemomenttheAmbulanceisfullystoppedattheIncidentLocationandFieldPersonnelnotifiestheCountyDispatchCenterofthearrival.

AVL AutomaticVehicleLocator

BaseHospitalAsdefinedinCaliforniaHealthandSafetyCode,Division2.5,§1797.58.TheBaseHospitalforAlamedaCountyisAlamedaCountyMedicalCenter,HighlandCampus.

BLS BasicLifeSupport‐EMTlevelofservice,asdefinedinCaliforniaHealthandSafetyCode,Division2.5,§1797.60

Board AlamedaCountyBoardofSupervisors

BravoCallA911calldesignatedbyCountyDispatchCenterasaBravoCallbasedonuseoftheMedicalPriorityDispatchSystem.

CAD ComputerAidedDispatch

CharlieCall A911calldesignatedbyCountyDispatchCenterasaCharlieCallbasedonuseoftheMedicalPriorityDispatchSystem.

ContinuingEducation(CE)

AsdefinedintheCaliforniaCodeofRegulations,Title22,Chapter11

Contractor ParamedicsPlus,LLC


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ContractingCity(ies)

AmunicipalityinZone1thathasacontractwithEMStoprovideitsownAmbulanceservicesinthatcity'sexclusiveoperatingarea.

County TheCountyofAlameda

CountyDispatchCenter

ThemedicaldispatchcenterdesignatedbyEMStodispatchContractor’sAmbulances,pursuanttothisAgreement.

DataCollectionSystem

Thesoftwareandhardwareusedtocollect,storeandreportoninformationfromtheprovisionofServices,whichincludesthePatientCareReports.

DeltaCall A911calldesignatedbyCountyDispatchCenterasaDeltaCallbasedonuseoftheMedicalPriorityDispatchSystem.

DTMF DualToneMultiFrequency(Touch‐Tone).

EchoCallA911calldesignatedbyCountyDispatchCenterasanEchoCall(non‐breathingand/orineffectivebreathing)basedonuseoftheMedicalPriorityDispatchSystem

EffectiveDate ThedatetheAgreementissignedbythePresidentoftheAlamedaCountyBoardofSupervisors

EMSUsedinthisAgreementtorefertoAlamedaCountyEmergencyMedicalServices,aDivisionofthePublicHealthDepartment,aspartoftheHealthCareServicesAgency

EMSDirector ThedirectoroftheAlamedaCountyEmergencyMedicalServices,aDivisionofthePublicHealthDepartment,aspartoftheHealthCareServicesAgency.

EMSMedicalDirector

ThephysicianinthepositionofMedicalDirectorforAlamedaCountyEmergencyMedicalServices,aDivisionofthePublicHealthDepartment,aspartoftheHealthCareServicesAgency..

EMSPolicies

PoliciesandproceduresissuedbytheAlamedaCountyEmergencyMedicalServicesthatarecontainedintheAlamedaCountyEmergencyMedicalServicesFieldManualand/orAdministrationManual,whichmayberevisedfromtimetotime

EMSwebsite acgov.org/ems

EMSA EmergencyMedicalServicesAuthorityoftheStateofCalifornia

EMT EmergencyMedicalTechnician

EOAAsusedinthisAgreement,referstotheExclusiveOperatingAreafor"Services"asdesignatedinAlamedaCounty’sapprovedEMSPlan,anddepictedinEXHIBITA‐DEPICTIONANDDEFINITIONOFCONTRACTOR'SEOAANDEMERGENCYRESPONSEZONES.

ERZ EmergencyResponseZone,asdepictedinEXHIBITA‐DEPICTIONANDDEFINITIONOFCONTRACTOR'SEOAANDEMERGENCYRESPONSEZONES.


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Federal ReferstoUnitedStatesFederalGovernment,itsdepartmentsand/oragencies

FieldPersonnel Contractor'sparamedicsandEMTsresponsibleforrespondingto911requestsforemergencymedicalgroundambulanceservicespursuanttothisAgreement

Fractile

Amethodofmeasuringdatainwhichallapplicabledataarestackedinascendingorderandthetotalnumberiscalculatedasapercentageofthetotalnumberofcalls.(e.g.:a90thpercentilestandardisonewhere90%oftheapplicableAmbulancecallsareansweredwithintheresponsestandard,while10%takelongerthanthestandard.)

FRALS

FirstResponseAdvancedLifeSupport–AfiredepartmentunitstaffedandequippedwithaminimumofoneCaliforniaStatelicensedandAlamedaCountyaccreditedParamediccapableofprovidingALSatscenesofmedicalemergencies.TheseunitsaredesignatedbytheCountyandhaveanexecutedagreementwiththeCountytoprovideservice

FirstResponderAgency(ies)

ThefiredepartmentswithintheEOA,andthoseinZone1thatareundercontractwiththeCounty,toprovidefirstresponsetothesceneofamedicalemergency

High‐RiskPCR APatientCareRecordforaHigh‐Riskpatient.SeeEXHIBITN‐HIGHRISKPATIENTDESCRIPTION

HIPAA HealthInsurancePortabilityandAccountabilityActof1996

IncidentLocation ThedestinationaddressorlocationofthepatienttheAmbulanceisdispatchedtobytheCountyDispatchCenter

IncumbentPersonnel

ThoseemployeesworkingforAmericanMedicalResponseundercontractwithCountyforemergencygroundambulanceservicestotheEOAontheEffectiveDate

KeyPersonnel Contractor’spersonnelprovidingServicesinthepositionsofa)OperationsManager(ChiefOperationsOfficer),b)MedicalDirectorandc)QualityManager

LaborCode CaliforniaLaborCode

LEMSALocalEmergencyMedicalServicesAgency,asdefinedinCaliforniaHealthandSafetyCode,Division2.5,§1797.94

MandatoryDataFields

TheminimumamountofinformationthatsatisfiestherequirementforacompletedPatientCareReportleftatthereceivinghospitalorpsychiatricfacility.

MedicalPriorityDispatchSystem(“MPDS”)

Thesystemthatcategorizesemergencycallsusinganescalatingscaleofseverityassignedtomedicalconditions,relativetothelevelandtimelinessofresponse.

Mutual‐AidEmergencyambulanceserviceperformedbyneighboringprovidersduringperiodsofsevereweather,multi‐casualtyincidents,orothereventsthatoverwhelmexistingresources


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Multi‐CasualtyIncident(“MCI”)

AMulti‐CasualtyIncident(MCI)isanyincidentwherethenumberofinjuredpersonsexceedstheday‐to‐dayoperatingcapabilitiesandrequiresadditionalresourcesand/orthedistributionofpatientstomultiplehospitals,asdefinedinEMSPolicies

OnboardMobileGateway(“OMG”)

Themobilenetworkingtechnologythatconnectsandmanagesequipment,informationandpeopleinthefield.Provideshighperformance,highsecurity,wirelessbroadbandnetworkingformobileapplications

Paramedic AsdefinedinCaliforniaHealthandSafetyCode,Division2.5,§1797.84

PCR PatientCareRecord,ineitherprintorelectronicform

ResponseTime ThetimeelapsedfromthetimeacallisreceivedbyContractorfromtheCountyDispatchCenter,untilArrivalattheIncidentLocationbytheAmbulance

RequiredPositions

Thepositionsofa)Clinical/EducationStaff,b)ClinicalFieldSupervisors,c)OperationalFieldSupervisors,andd)Analyst,forwhichContractorisrequiredtohaveindividualemployeeswhileprovidingServices

QualityImprovement

AsdefinedintheCaliforniaCodeofRegulations,Title22,Chapter12andEMSA#166:EMSSystemQualityImprovementGuidelines

State TheStateofCalifornia,itsdepartmentsand/oragencies

ServiceStartDate 12:00amonthedateContractorbeginsprovidingServices

Services

Contractor’sprovisionof911emergencymedicalgroundambulanceresponseandtransportationatanAdvancedLifeSupport(ALS)levelofservice,andwherespecifiedinthisAgreement,BasicLifeSupport(BLS);and,obligationsasrequiredbythisAgreementandinaccordancewithEMSPolicy

ServiceVehicles Contractor’svehiclesusedintheprovisionofServices,includingbutnotlimitedto,AmbulancesandSupervisorVehicles.

SubareaDesignationswithinanEmergencyResponseZoneofMetro/Urban,Suburban/RuralandWilderness,asdepictedinEXHIBITB‐DEPICTIONANDDEFINITIONOFSUBAREAS.

Supervisor(s) ClinicalFieldSupervisorsandOperationalFieldSupervisors

SupervisorVehicles

Avehicle,otherthananambulance,drivenbyaSupervisorandequippedforemergencymedicalresponse

UserFees Chargestopatientsand/orinsuranceproviders,includingMedicareandMedi‐CalforServicesprovidedbyContractor.


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ThisAgreement("Agreement")isbyandbetweentheCountyofAlameda,hereinreferredtoas

County,andParamedicsPlus,LLC.,hereinreferredtoasContractor,andshallbeeffectivethedate

thisAgreementissignedbythepresidentoftheAlamedaCountyBoardofSupervisors("Effective

Date").

ThisAgreementisfortheprovisionof911emergencymedicalgroundambulanceresponseand

transportationatanAdvancedLifeSupport("ALS")levelofservice,andwherespecifiedinthis

Agreement,BasicLifeSupport("BLS")levelofservice("Services")forafiveyearperiod,

commencingNovember1,2011("ServiceStartDate")andcontinuingthroughOctober31,

2016,withanoptiontoextendforanadditionalfive(5)yearperiodatCounty'ssolediscretion.

TheCountyshallprovideContractorwithwrittennoticeofitsintenttoextendthisAgreementat

leasttwelve(12)monthspriortothescheduledendofthetermoftheAgreement.

RECITALS OF AUTHORITY

Whereas,Division2.5oftheHealthandSafetyCodeSections1797.224and1797.85allowsthe

LocalEmergencyMedicalServicesAgency("LEMSA")tocreateExclusiveOperatingAreas("EOA");

and,

Whereas,AlamedaCountyEmergencyMedicalServices("EMS")isthedesignatedLEMSA;and,

Whereas,EMShascreatedanEOA;and,

Whereas,pursuanttoDivision2.5oftheHealthandSafetyCode,Section1797.200,theCountyof

AlamedahasdesignatedtheLEMSAtodevelopawrittenagreementwithaqualifiedparamedic

serviceprovidertoprovideServices,andparticipateintheadvancedlifesupportprogramin

AlamedaCounty;and,

Whereas,Title22,CaliforniaCodeofRegulations,Section100168,Division9,Chapter4,Article6,

requiresawrittenagreementforServices;and,


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Whereas,theCountyengagedinafaircompetitiveprocessinaccordancewithStatelawand

Countypolicy;and,

Whereas,onApril27,2010atitsregularmeeting,theAlamedaCountyBoardofSupervisors

determinedthatParamedicPlus,LLC.hadsubmittedtheproposalthatbestservestheoverall

interestsoftheCountyandattainedthehighestover‐allpointscore;and,

Whereas,CountyandContractordesiretoenterintoaperformance‐basedagreementfor

provisionofServicesinaccordancewiththisAgreement;

NOW,THEREFORE,thepartiesagreetothefollowingtermsandconditions:

SCOPE OF WORK

1. Services

1.1 ContractorshallprovideServices,asrequestedbytheCountyDispatchCenter,and

inaccordancewiththisAgreementandtheContractor’sproposal,whichisattached

heretoasExhibitO(Appendices1‐56incorporatedbyreference,butnotattached)

andincorporatedhereinbythisreference,exceptthatinthecaseofanyconflicting

provisionsthetermsofthisAgreementshallcontroloverthetermsoftheProposal.

1.2 ContractorshallprovideServicesinaccordancewiththerequirementsofCalifornia

StateHealthandSafetyCode,Division2.5,Sections1797etseq.,CaliforniaCodeof

Regulation,Title22,Division9,andanyamendmentsorrevisionsthereof.

1.3 ContractorshallemployallresourcesnecessarytoachievetheResponseTimesand

allotherrequiredperformance.

1.4 Contractoragreestoincreaseresourcesatitssoleexpensetomeetanyincreasein

needsordemandsforServices.

2. ServiceArea/EmergencyResponseZones

2.1 ContractorshallprovideServiceswithintheEOA,asdesignatedinCounty’s

EmergencyMedicalServicesPlanandapprovedbytheStateEmergencyMedical

ServicesAuthority("EMSA"),asdefinedinCaliforniaHealthandSafetyCode,

Division2.5,§1797.85.


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2.2 ServicesshallbeprovidedtoallareaswithintheEOAandasotherwiserequiredby

thisAgreement.AmapoftheEOA,dividedintospecificEmergencyResponseZones

("ERZ")isattachedasEXHIBITA‐DEPICTIONANDDEFINITIONOFCONTRACTOR'SEOAAND

EMERGENCYRESPONSEZONES.

3. Services/Standards

3.1 ContractorshallprovideServices24hoursperday,7daysperweek,52weeksper

yearwithoutinterruption,forthefulltermoftheAgreement.Servicesshallbe

providedwithoutregardtothepatient'srace,color,nationalorigin,religion,sexual

orientation,age,sex,orabilitytopay

3.2 Contractorshallbetheexclusive911medicalgroundAmbulanceprovider

authorizedbytheCountyintheEOAandallcallsforServicesoriginatingintheEOA

shallbereferredtoContractor,withtheexceptionofMutual‐Aidanddisaster

response.

3.3 ContractorshallworkcooperativelywiththeEMSDirector,theEMSMedical

Director,andotherCountystaffandagenciestofulfillthetermsandconditionsof

thisAgreement.

3.4 ContractorshallattainaccreditationbytheCommissiononAccreditationof

AmbulanceServices(“CAAS”)withineighteen(18)monthsoftheServiceStartDate.

TheContractorshallthereaftermaintainaccreditationthroughoutthetermofthe

Agreement.

4. AssistancetoOtherCountyEOAs/ExpansionoftheEOA

4.1 Contractorshall,tothebestofitsability,assistinservicinganyotherexclusive

operatingareawithintheCounty,ifrequestedtodosobytheEMSDirector.

4.2 IftheEOAexpandstoincludeAlameda,BerkeleyorPiedmont,Contractorshall

extenditsserviceareaatnocosttothecityorCounty.Thenocostextensionshall

notapplytotheCityofAlbanyunlessitisaddedtotheEOAinconjunctionwith,or

following,theadditionoftheCityofBerkeley.

4.3 TheContractor,theEMSDirector,andcityrepresentativesshallcollaborateona

transitionplanfortheexpansionoftheEOA,consistentwiththisAgreement.


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5. LocationofContractor’sOffices

ContractorshallmaintainoneormoreofficesforoperationswithinAlamedaCountyduring

thetermofthisAgreement.

6. Transition

6.1 At12:00AMonthedatefollowingthelastdayofservicesprovidedbythecurrent

serviceproviderContractorshallbeginprovidingServices("ServiceStartDate").

6.2 BeginningontheEffectiveDate,Contractorshalldevotetimeandresourcestobe

fullypreparedforbecomingtheAmbulancetransportproviderontheServiceStart

Date.ContractorshallmeetallmilestonesandrequirementsassetforthinEXHIBITK

‐TRANSITIONPLAN,whichmaybeamendedbymutualagreementoftheparties.

6.3 AllAmbulancesandSupervisorVehiclesshallbeinspectedbyEMSpriortothe

ServicesStartDate,andasdescribedinEXHIBITK‐TRANSITIONPLAN.

DISPATCH

7. AlamedaCountyRegionalEmergencyCommunicationsCenter

Contractor’sAmbulancesshallbedispatchedbytheCountyDispatchCenter,whichis

operatedbyAlamedaCountyRegionalEmergencyCommunicationsCenter("ACRECC").

8. ACRECCAgreement

8.1 ContractorshallmakeagoodfaithefforttoenterintoanagreementwithACRECC

fordispatchservicesforthesamelengthoftimeasthisAgreement,includingany

extensions.

8.2 IfContractorandACRECCareunabletoenterintoanagreementfordispatch

services,Contractorshallestablishitsowndispatchservicesorenterintoan

agreementwithanotherentitytoprovidedispatchservicesforthisAgreement

undertermsthataremutuallyacceptabletoCountyandContractor.IfContractor

andACRECCareunabletoreachagreementinsufficienttimeforthe

commencementofServices,thisAgreementshallbeamendedtoreflectmutually

agreeduponalternativedispatcharrangements.

8.3 Dispatchservicesshallinclude:a)EMScallintakefunctions,b)callprioritization

andc)pre‐arrivalinstructionsaccordingtoMedicalPriorityDispatchSystem


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(“MPDS”)protocolsdevelopedincollaborationwiththeCountyEMSMedical

Director.

9. DeploymentSupervisoratDispatchCenter

9.1 ContractorshallstaffaDeploymentSupervisorattheCountyDispatchCenter24

hoursaday,seven(7)daysaweek.Thispositionshallberesponsiblefor

coordinatingSupervisorsandFieldPersonnel,andmonitoringthedeploymentof

AmbulancesandSupervisorVehiclesinthefieldforoptimalResponseTimes.

9.2 TheDeploymentSupervisorshallworkcollaborativelywithCountyDispatchCenter

to:a)assistwithtraining,b)identifyimprovementareas,andc)facilitateapositive

andproductiveworkingrelationshipbetweenCountyDispatchCenterpersonnel

andFieldPersonnel.

10. CountyComputerAidedDispatchSystem

10.1 ContractorshallpayforanymodificationstotheCountyDispatchCenterComputer

AidedDispatch("CAD")systemnecessarytoeffectivelymonitor,deploy,redeploy

itsAmbulances,andprovideServices.

10.2 Contractorshallprovideasneededadditionalcomputerservers,workstations,and

employeetrainingtoCountystaff.

11. CADData

ContractorshallensurethattheCountyhasimmediateaccesstoallEMSrelateddata

maintainedbytheCADsystematACRECC.

COMMUNICATIONS

12. RadioEquipment

12.1 ContractorshallworkwithCountyandtheFederalCommunicationsCommission

("FCC")toenableContractortoeffectivelyreceivecommunicationsasdirectedby

theCountyDispatchCenter.

12.2 ContractorshallworkwithCountyandtheFCCtoenableContractortoeffectively

utilizetheCounty’sradioinfrastructuretocommunicatewiththeCountyDispatch

CenterandFirstResponderAgencies.


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12.3 ContractorshallequipeachAmbulanceandSupervisorVehiclewithanOnboard

MobileGateway(“OMG”)whichshallprovidewirelessaccesstoCADandbilling

systemdata.

12.4 ContractorshallequipandmaintaineachAmbulanceandSupervisorVehiclewith

communicationsequipmentassetforthinEXHIBITE‐COMMUNICATIONSEQUIPMENT,

whichmaybechangedfromtimetotime.

RESPONSE TIME REQUIREMENTS

13. ResponseTimePerformanceandMeasurement

13.1 ContractorissolelyresponsibleforServiceStartDateperformance:

a. ResponseTimestandardsforCharlie,DeltaandEchoambulanceresponses

shallbeineffectontheServiceStartDate.

b. ResponseTimestandardsforAlphaandBravoresponsesshallbeineffecton

theServiceStartDate,however,finesshallnotbeassessedforsixmonths

aftertheServiceStartDate.

13.2 TheCountyDispatchCentershallclassifyandassigncallsasAlpha,Bravo,Charlie,

Delta,andEcho,byMedicalPriorityDispatchSystem("MPDS").

13.3 RespondingFieldPersonnelshallbenotifiedbytheCountyDispatchCenterofthe

MPDSdesignationviapager,cellularphoneorotherportablehandhelddevice

capableofreceivingemergencyresponsedatafromtheACRECCpagingsystem.

13.4 AnyMutual‐AidcalloriginatingoutsidetheEOAshallnotbecountedinthetotal

numberofcallsusedtodetermineResponseTimecompliance.

14. ResponseTimeAccountability

14.1 Contractor'sResponseTimesshallbecalculatedonamonthlybasisforreporting

purposestodeterminecomplianceusingFractileResponseTimemeasurements.

14.2 Contractor'sResponseTimeforServicesintheEOAshallmeettherequirements

containedinEXHIBITF‐RESPONSETIMEREQUIREMENTSANDFINES(TableA,PERSONNEL

ANDRESPONSETIMEREQUIREMENTS)with100%compliance.


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14.3 ContractorshallbeassessedfinesifResponseTimecompliancefallsbelow90%,as

setforthinExhibitF‐RESPONSETIMEREQUIREMENTSANDFINES(TableB,RESPONSETIME

FINESBYCATEGORYANDCOMPLIANCE.)

15. ResponseTimeMeasurementMethodology

15.1 ResponseTimeshallbemeasuredinminutesandinteger(whole)secondsfromthe

timethecallisreceivedbyContractorfromtheCountyDispatchCenteruntilarrival

attheIncidentLocationbytheAmbulance,oruntilthecalliscancelledbyapublic

safetyagencyorCountyDispatchCenter.

15.2 DeterminationofResponseTimesdependsonthelocationoftheincidentwith

respecttotheEmergencyResponseZone(“ERZ”),depictedinEXHIBITA‐DEPICTION

ANDDEFINITIONOFCONTRACTOR'SEOAANDEMERGENCYRESPONSEZONES.

15.3 EachERZmaybecomprisedofoneormoreofthree(3)Sub‐areas,whichare

describedinEXHIBITB‐DEPICTIONANDDEFINITIONOFSUB‐AREAS.

15.4 InsituationswheretheAmbulancehasrespondedtoalocationotherthanthe

IncidentLocation(e.g.stagingareasforhazardousmaterials/violentcrime

incidents,non‐securedscenes,orwhereruggedterrainprecludesaccess),Arrivalat

IncidentshallbethetimetheAmbulancearrivesatthedesignatedstaginglocation

orthenearestpublicaccesspointtothepatient’slocation.

15.5 Allofthefollowingtimesshallbetracked:

a. TimecallreceivedattheCountyDispatchCenter(providedbyCounty

DispatchCenter)

b. TimecallansweredattheCountyDispatchCenter(providedbyCounty

DispatchCenter)

c. Timelocationverified(providedbyCountyDispatchCenter)

d. TimecallreceivedbytheContractorfromtheCountyDispatchCenter

e. Timeunitenroutetothecall

f. ArrivalatIncidenttime(vehiclestopped)

g. Timearrivalatpatient


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h. TimeAmbulancedepartsscene

i. TimeAmbulancearrivesatthereceivinghospitalorpsychiatricfacility

j. TimeFieldPersonneltransferscareofthepatienttoreceivinghospitalor

psychiatricfacilitypersonnel

k. TimeAmbulancedepartsthereceivinghospitalorpsychiatricfacility

15.6 TheContractormayberequiredtologadditionaltimesbytheEMSMedicalDirector

suchastimesofdefibrillation,administrationoftreatmentsandmedications,and

otherinstancesdeemedimportantforclinicalmonitoringandresearchactivities.

16. CalculatingResponseTimes

16.1 Contractormustsynchronizeitsmission‐criticalclocks(e.g.:PCRandcardiac

monitor),dailywiththeCountyDispatchCenter’sclock,soallreportsaccurately

reflectCountyDispatchCentertimes.

16.2 Contractor'sResponseTimesshallbecalculatedonamonthlybasisforreporting

purposesusingFractileResponseTimemeasurement.

16.3 ContractormustbeincompliancewithallResponseTimeswithinallEmergency

ResponseZonesandSubareasatalltimesforanyconsecutive30‐dayperiodor

Contractorshallbepenalized,assetforthinthisAgreement.TheCountyshall

periodicallyperformauditsofResponseTimesforarandomlyselectedconsecutive

30‐dayperiodinadditiontoanyotherreportingrequirementsunderthis

Agreement.

17. CalculatingChangesinCallPriority

17.1 Upgrades

IfanassignmentisupgradedpriortotheArrivalatIncidentoftheAmbulance(e.g.

fromaCharlietoDelta),Contractor’scomplianceandfinesshallbecalculatedbased

ontheshorterof:

TimeelapsedfromdispatchtotimeofupgradeplusthehigherpriorityResponse

Timestandard,or,

ThelowerpriorityResponseTimestandard.


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17.2 Downgrades

Ifacallisdowngraded,priortoarrivalonsceneoftheAmbulance(e.g.fromaDelta

toaCharlie),Contractor’scomplianceandfinesshallbedeterminedby:

a. Ifthetimeofthedowngradeoccursaftertheemergencyambulancehas

exceededthehigherpriorityResponseTimestandard,thehigherpriority

ResponseTimestandardshallapply;or,

b. Ifthetimeofthedowngradeoccursbeforetheemergencyambulancehas

exceededthehigherpriorityResponseTimestandard,thelowerpriority

ResponseTimestandardshallapply.

c. Inallsuchcases,documentationmustbepresentedforvalidationofthe

reasonwhytheprioritystatuswasdowngraded.Ifthedowngradewas

justified,inthesolediscretionoftheCounty,thelongerstandardshallapply.

17.3 ReassignmentEnroute

IfanAmbulanceisreassigneden‐routeorturnedaroundpriortoArrivalatIncident

Location(e.g.,torespondtoahigherpriorityrequest),complianceandfinesshallbe

calculatedbasedontheResponseTimeStandardapplicabletotheassignedpriority

oftheinitialresponse.TheResponseTimeclockshallnotstopuntilthearrivalofan

emergencyambulanceonthescenefromwhichtheambulancewasdiverted.

18. CanceledCalls

IfacalliscanceledpriortotheAmbulance’sArrivalatIncident,thecomplianceandfines

shallbecalculatedbasedontheelapsedtimefromdispatchtothetimethecallwas

canceled.

19. EachIncidentaSeparateResponse

19.1 Eachincidentshallbecountedasasingleresponseregardlessofthenumberof

unitsthatareutilized.TheResponseTimeoftheContractor'sfirstarriving

AmbulanceshallbeusedtocomputeContractorsResponseTimeforthatincident.

19.2 WhenContractorrequestsaMutual‐Aidresponsefromoneofthetransportingfire

departmentsinZone1,ContractorremainsresponsiblefortheResponseTimeto

theincident.


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20. 5150Response

20.1 5150ResponseswithintheEOA

a. ContractorshallrespondALSlevelpersonnelto5150Callsdispatchedasan

Echo,Delta,orCharlie.Ifthepatientdoesnotrequiremedicalclearanceatan

emergencydepartment,theALSAmbulancecanrequestthataBLS

Ambulancetransporttotheappropriatepsychiatricfacilityinaccordance

withEMSPoliciesregardingpsychiatricpatientcare.

b. ContractormayrespondBLSlevelpersonnelto5150callsdispatchedas

AlphaorBravo.

20.2 5150ResponsesintoZone1:

a. ContractormayrespondaBLStransportunitintoZone1for5150Callsifthe

callwasinitiallydispatchedasanAlphaorBravocallbytheCountyDispatch

Center.

b. ContractormayrespondaBLSunitintoZone1for5150callsinitially

dispatchedasEcho,Delta,orCharlie,followingmedicalclearancebyZone1

paramedics.TherequestmustbemadethroughtheCountyDispatchCenter

via911andinaccordancewithEMSPolicies.

c. ResponseTimesfor5150CallsinZone1aretobeincludedinthe

Contractor'sResponseTimeperformancecalculation.

21. ResponseTimePerformanceReport

21.1 ContractorshallsubmitamonthlyResponseTimePerformancereportin

accordancewithduedatesestablishedbyCounty.

21.2 EveryrequestfromtheCountyDispatchCenteroriginatingwithintheEOAand

those5150callsoriginatinginZone1shallbeincludedinContractor'smonthly

calculationofperformancetodeterminecompliancewithResponseTimestandards,

exceptasotherwiseprovidedinthisAgreement.

21.3 ContractorisrequiredtomeetthespecifiedResponseTimestandards;therefore,

Contractorshallmaintainmechanismsforexpansionofresponsecapacityshoulda

systemoverloadoccur.


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21.4 Themechanismsforexpansionofcapacityshallbeinawrittenplanandsubmitted

forapprovaltoEMS.

22. ResponseTimeLateResponseExemptions("Exemption")

22.1 Contractormayrequestthatalateresponsebeexcludedfromthecalculationof

ResponseTimestandards(“anExemption”),ifthatcallfallsintooneofthefollowing

categories:

a. AdeclaredMulti‐CasualtyIncident(“MCI”)ordisasterthattheEMSDirector

determineshashadamaterialimpactonContractor’sresources.

b. TherewasadelaybecauseinformationrelayedbytheCountyDispatch

Centerwassubstantiallyincorrectsoastoprohibittimelyarrivalatthecall.

22.2 ArequestforanExemptionmustbeinwriting,andreceivedbytheEMSDirector

withinten(10)calendardaysfollowingtheendofthemonthinwhichtheevent

occurred.Therequestmustincludeperformancereportsforthemonthinwhichthe

incidentoccurredandwrittendocumentationsupportingtherequest.

22.3 ResponseTimeExemptionsmaybegrantedbytheCountyonapercallbasis,

followingreviewandinvestigationbytheCounty.

22.4 CallsthatareapprovedasanExemptionshallnotbeincludedinthecalculationsfor

ResponseTimecompliance.

STAFFING REQUIREMENTS

23. AmbulanceStaffingRequirements

23.1 Contractorshallstaff,ataminimum,one(1)Paramedicandone(1)EMTforall

AmbulancesrespondingtoCharlie,DeltaandEchocalls,andcallstheCounty

DispatchCenterdeterminesanALSresponseisappropriate

23.2 Contractorshallstaff,ataminimum,two(2)EMTsforallAmbulancesrespondingto

AlphaandBravocalls,ormulti‐unitresponses,orcallstheCountyDispatchCenter

determinesaBLSresponseisappropriate.

24. WorkSchedules

24.1 24‐hourShifts:


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a. Contractor'semployeesassignedto24‐hourshiftsshallnotworkmorethan

24consecutivehourswithoutaminimumoftwelvehoursoff‐duty.

b. Anemployeemaycompleteacallthatwasinprogresspriortothe24‐hour

limit;however,thatemployeeshallnotbedispatchedtoanadditionalcall.

Thetotalhoursworkedshallnotexceedtwenty‐six(26)consecutivehours.

c. Contractorshallmonitortheworkloadforall24‐hourshiftsandsenda

reporttotheEMSDirectormonthly.IftheworkloadtrendshowsthatField

Personnelarenotaffordedatleasta4‐houruninterruptedbreakduringthe

24‐hourshift,onaconsistentbasisforgreaterthanthree(3)months,

ContractorshallworkwiththeCountytoidentifyalternatives,including

changestoshiftlengths.

24.2 Lessthan24‐hourShifts:

a. Contractor’semployeesassignedtolessthan24‐hourshiftsshallnotwork

morethan18consecutivehourswithoutaminimumoftwelvehoursoff‐

duty.

b. Anemployeemaycompleteacallthatwasinprogresspriortothe18‐hour

limit;however,thatemployeeshallnotbedispatchedtoanadditionalcall.

Thetotalhoursworkedshallnotexceedtwenty(20)consecutivehours.

25. PersonnelLicensure/Certification/TrainingRequirements

25.1 FieldPersonnelperformingServicesundertheAgreementshallatalltimesbe

appropriatelycertifiedand/orlicensedtopracticeintheStateofCaliforniaandin

thecaseofParamedics,accreditedinAlamedaCounty.

25.2 Contractorshall,atalltimes,retainelectroniccopiesofcurrentlicenses,

certifications,andtrainingdocumentationforFieldPersonnelperformingServices.

TRANSPORT REQUIREMENT

26. Destination

PatientsshallbetransportedinaccordancewithEMSPolicies,asmaybeamendedfrom

timetotime.


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27. InfluenceonDestination

FieldPersonnelshallnotattempttoinfluenceapatient’sdestinationselectionotherthanas

setforthintheEMSTransportGuidelinesPolicy.

28. AirAmbulanceAgreements

CountymayenterintoseparatetransportagreementswithAirAmbulanceproviders.

NotwithstandinganyotherprovisionofthisAgreement,Countymayprovideforair

transportofpatientswhensuchtransportationisdeemedtobemedicallyinthebest

interestofthepatient,asdefinedinEMSPolicies.

MULTI‐CASUALTY INCIDENT/DISASTER RESPONSE

29. Multi‐CasualtyIncident/DisasterResponse

29.1 ContractorshallcooperatewithCountyinrenderingemergencyassistanceduringa

declaredoranundeclareddisasterorMulti‐CasualtyIncident("MCI"),inaccordance

withtheEMSPolicies.

29.2 ContractorshallassignaFieldorDispatchManager/SupervisortotheOperational

AreaEmergencyOperationsCenter("EOC")‐MedicalHealthBranch(when

activated)asaliaisontoworkcloselywiththeMedicalHealthOperationalArea

Coordinator(“MHOAC”).

29.3 IfCountydirectsContractortorespondtoadisasterinaneighboringjurisdiction,

finesforResponseTimesmaybesuspended,butonlyifauthorizedbytheEMS

Director.Contractorshalluseitsbesteffortstomaintainprimaryemergency

servicesandmaysuspendnon‐emergencyservicesasrequired.

29.4 Withinone(1)yearfollowingtheEffectiveDateofthisAgreement,Contractorshall

submittotheEMSDirectorforreview,anEmergencyOperationPlan(“EOP”)forits

internalresponseandrecoveryintheeventofadisaster.Intheeventofadisaster,

ContractorshallfollowtheCounty'sdisasterplananditsEOP.

29.5 WhenContractorisnotifiedthatdisasterorMCIassistanceisnolongerrequired,

ContractorshallresumeResponseTimerequirementsinatimelymanner.


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30. DisasterResponseVehicle/Equipment

30.1 Contractorshallhouse,maintain,manageandstaffanyDisasterAmbulanceSupport

Unit(“DASU”)issuedtoCountybyEMSAfordisasterresponses.ADASUmaynotbe

usedbyContractorwithoutthespecificpermissionofandatthedirectionofCounty.

30.2 ContractorshallmaintaintheState‐issuedDASUingoodworkingorder,in

accordancewithEMSPoliciesandinaccordancewiththevehicleandequipment

maintenancerequirementssetforthinthisAgreement,forimmediatedisaster

deployment.

30.3 ContractorshallalsohouseandmaintaintheCounty’sEMSDisasterTrailersin

accordancewithEMSPoliciesandinaccordancewiththevehicleandequipment

maintenancerequirementssetforthinthisAgreement.Contractorshallnotusethe

EMSDisasterTrailers,unlessdirectedtodosobytheCountyDispatchCenter.

30.4 ContractorshallalsoprovideanadditionaltwotrailerstofurtheraugmentMCIand

disasterresponsewithinAlamedaCounty,whichshallbemaintainedinthesame

manner.

31. IncidentNotification

Contractorshallhaveamechanisminplacetocommunicatecurrentfieldinformationto

appropriateCountystaff,including,butnotlimitedtotheCountyDispatchCenterandthe

County’sEOCduringMCIs,disasterresponses,hazardousmaterialsincidentsandother

unusualoccurrences.

32. AmbulanceStrikeTeam

32.1 Contractor’sAmbulanceStrikeTeam("AST")shallatalltimesbestaffed,equipped,

andtrainedtorespondtoadisasterMutual‐AidrequestatCounty’sdirectionandin

accordancewiththeEMSAASTGuidelines.ContractorshallensurethatAST

membersandASTleadershavebeenappropriatelytrainedbyanEMSA‐approved

trainer.

32.2 TheContractorshallinsurethatanASTisavailabletorespondtodisasterrequests

fromEMSA.

32.3 ContractorshallnotifyEMSpriortodeploymentofanyAST.


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33. InteragencyTrainingforExercises/Drills

ContractorshallparticipateinCounty‐sanctionedexercises,disasterdrills,andinteragency

training.

34. Mutual‐AidRequirements

34.1 StateorFederalMutual‐Aidrequests

ContractorshallrespondtorequestsforMutual‐AidmadebyStateorFederal

agencies,ifdirectedtodosobytheEMSDirector.

34.2 In‐CountyMutual‐Aidrequests

a. ContractorshalluseitsbesteffortstoenterintoMutual‐Aidagreementswith

municipalitiesinZone1,orotherareaswhereMutual‐Aidisprovidedona

regularbasis.

b. AnyexecutedagreementsbetweenContractorandamunicipalityinZone1

forMutual‐AidshallbesenttotheEMSDirectorwithin45calendardaysof

execution.

c. IfContractorisunabletoenterintoanagreementforMutual‐Aidinany

municipality,ContractorshallnotifytheEMSDirector.

d. ContractorshallrespondtoMutual‐AidrequestsfromotherAlamedaCounty

agencieswithinAlamedaCountyaccordingtopriorwrittenagreementswith

thoseagencies.

e. ContractorshalldocumentthenumberandnatureofallMutual‐Aid

responsesitrequestsorprovides.

34.3 Stand‐ByService

a. UponrequestbyapublicsafetyagencywithinAlamedaCounty,Contractor

shallprovide,atnochargetoCountyortotherequestingagency,stand‐by

servicesatthesceneofanemergencyincidentwithintheEOAwhendirected

bytheCountyDispatchCenter.

b. AnAmbulanceanditsFieldPersonnelplacedonstand‐byshallbededicated

totheincidentforwhichithasbeenplacedonstand‐by.


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c. Stand‐byperiodsexceedingeight(8)hoursshallrequiretheapprovalofthe

EMSDirector.

VEHICLES AND EQUIPMENT

35. Ambulances

35.1 AllAmbulancesshallmeetthefollowingspecifications:

a. 2010EPAdieselandStateofCaliforniaemissionstandards

b. Title13,CaliforniaCodeofRegulations

c. CaliforniaVehicleCode.

35.2 Contractor,atitssoleexpense,shallacquireandmaintainServiceVehiclesandon‐

boardmedicalsuppliesandequipment,tobeusedtoperformServices.

35.3 VehicleMarkings

a. Emergencyvehicles,includingAmbulancesandSupervisor’sVehicles,shall

bemarkedasrequiredbytheNationalFireProtectionAgency(NFPA)

Standard1901(2009)thatincludesreflectivechevronmarkingsontherear

andareflectivestripeonthesidepanels.

b. ServicesVehiclesshalldisplaythefollowingsignage,onbothsides:

“AlamedaCountyEmergencyMedicalServices”inatleastfour(4)inch

letters,

Levelofservice(e.g.,"ParamedicUnit")

"911"emergencytelephonenumber

Contractor’sname

CAASlogoonceaccreditationhasbeenacquired

c. NoServiceVehicleshalldisplayanyotherwritingunlessapprovedbythe

County,otherthanvehicleidentification.

d. ContractorshallobtainEMSapprovaloftheoveralldesign,color,and

letteringusedforServiceVehicles.Contractorshall,withinten(10)calendar

daysofCounty'srequest,changeanynon‐approveddesign,colororlettering.


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36. Equipment

36.1 Contractorshallhavesoleresponsibilityandbearallexpenseforallequipment

necessarytoprovideService.Allon‐boardequipment,medicalsuppliesand

personalcommunicationsequipmentusedbyContractorshallmeetorexceedthe

minimumrequirementsoftheEMSPoliciesandthisAgreement.

36.2 ContractorshallhaveandsubmittoCountynolaterthantheServiceStartDate,

policiesregardingtheacquisition,stockingandsecurityofcontrolledsubstances

carriedonServiceVehicles.

36.3 EquipmentandsupplyrequirementsmaybemodifiedwiththeapprovaloftheEMS

Director,includingmodificationsduetochangesintechnology.

36.4 TheCountymayinspectServiceVehiclesatanytimewithoutpriornotice.

36.5 Failuretomeetminimumin‐serviceequipment/supplyrequirements:

a. IfanyServiceVehiclefailstomeettherequirements,ascontainedinEMS

Polices,theCountymayfineContractor.

b. Inadditiontoanyfines,iftheEMSDirectordeterminesthatthefailureto

meetrequirementsiscritical,theServiceVehicleshallberemovedfrom

serviceuntilthenon‐complianceiscorrected.

37. VehicleandEquipmentMaintenance

37.1 ContractorshallmaintainallServiceVehiclesingoodworkingorderconsistentwith

themanufacturer'sspecifications.

37.2 ContractorshallmaintainandprovidetoCountyondemandalistingofallService

Vehicles,includingreservevehicles.Theinformationforeachvehicleshallinclude

thelicensenumber,andnameandaddressoflienholder,ifany.Changesinlien

holder,aswellasthetransfer,sale,orpurchaseofvehiclesusedtoprovideServices

shallbereportedtoCountywithinthirty(30)calendardaysofanychange,sale,

transferorpurchase.

37.3 ForeachServiceVehicle,detailedrecordsshallbemaintainedastoworkperformed,

costsrelatedtorepairs,andoperatingandrepaircostsanalyseswhereappropriate.


Page18of63

RecordsshallbemadeavailableforinspectionbyCountyuponrequestoftheEMS

Director.

37.4 Repairsshallbeaccomplishedandsystemsshallbemaintainedsoastoachieveat

leasttheindustrynormsinvehicleperformanceandreliability.

37.5 ContractorshallensureanAmbulancemaintenanceprogramthatisdesignedand

conductedtoachievethehigheststandardofreliabilityappropriatetoamodern

high‐performanceAmbulanceserviceby:a)utilizingappropriatelytrained

personnel,knowledgeableinthemaintenanceandrepairofAmbulances,b)

developingandimplementingstandardizedmaintenancepractices,andc)

incorporatinganautomatedormanualmaintenanceprogramrecordkeeping

system.

37.6 Contractorshallreplaceorremountambulancesonafive‐year,250,000‐mile

schedule,unlessotherwiseagreedtobyContractorandCounty.

37.7 AllServiceVehicles,andanyequipmentthathasadefect,includinginsignificantbut

visiblecosmeticdamage,shallberemovedfromserviceforrepairwithoutdelay,

andinnoeventinlessthantwelvehoursafterarequestfromtheEMSDirector.

37.8 Contractorshallcomplywithorexceedthemaintenancestandardsestablishedby

theCAAS,asmaybeamendedfromtime‐to‐time.

37.9 Contractorshallmaintainallbio‐medicalequipmentinaccordancewith

manufacture'srecommendations,aswellasapplicablestandardsestablishedbythe

JointCommissiononAccreditationofHealthCareOrganizations,whichmaybe

updatedannually.

37.10 ContractorshallinstallandmaintainAutomaticVehicleLocator(“AVL”)deviceson

allServiceVehicles.TheAVLsystemshallbecompatibleandinterfacewiththe

CountyDispatchCenter’ssoftware.

ELECTRONIC PATIENT CARE REPORT AND DATA COLLECTION SYSTEM

38. PatientCareReports

38.1 ContractorshallusePatientCareReports("PCR")forpatientdocumentationonall

calls,including:


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a. patientcontacts;

b. canceledcalls;and,

c. non‐transports,withtheexceptionofrefusalofserviceanddisaster

response,pursuanttoEMSPolicies.

38.2 ThePCRshallclearlyidentifyanyinstancewheretwoormorepatientsare

transportedinthesameAmbulance.

39. DataCollectionSystemforPatientCareReports

39.1 ContractorshallworkwithEMStocreateanduseasingle,uniformPCRandData

CollectionSystemthatincludes,butisnotlimitedto:

a. Easeofuse

b. NEMSIS(NationalEMSInformationSystem)andCEMSIS(CaliforniaEMS

InformationSystem)compliant

c. EMSdataset,whichmaybeamendedfromtimetotime

d. Easeofmodifyingdataset

e. EaseofdescribingGraphicalUserInterfaceandinputmethods

f. Compatibleequipment/platforms

g. IntegrationwithCAD

h. Informationvalidation

i. Potentialforintegrationwithotherinformationsystemsincluding,butnot

limitedto,FireRMS(RecordsManagementSystem)

j. Regimeforversionupdates

k. Availabletechnicalsupport

l. Potentialforintegrationwithhospitalinformationsystems

m. Back‐enddataquerying,reportwriting,rawdataaccess

n. Aneffective,validatedprocesstoevaluateretentionofPCRs

39.2 ContractorandCountyshallupdate,asneeded,thePCRsystem,includingbutnot

limitedtoupdatestoallow:


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a. AdditionaldatafieldsonthePCR

b. EMSsystemdatacollection,

c. Thepreparationofreports;and

d. Softwareversions.

39.3 Contractorshallprovide,atitssoleexpense,toEMSallhardwareandsoftware

necessaryforreviewingandmonitoringthePCR.Contractorshall,atitssole

expense,alsoprovideaPCRreaderorviewertoreceivinghospitals.

39.4 ContractorshallusesoftwareinthePCRandDataCollectionSystemtoallowreal‐

timeaccessintheformatspecifiedbyEMS.Thesoftwareshallalsoprovidedetailed

operations,clinical,andadministrativedatainamannerthatfacilitates

retrospectiveanalysis.

39.5 ContractorshallensureitsemployeesaretrainedontheDataCollectionSystem.

39.6 ContractorshallprovidePCRsoftware,training,andmobilecomputersforeach

FRALSunit,includingContractingCitiesinZone1,assetforthinEXHIBITM‐FIRST

RESPONDERSUPPORT.

39.7 Contractorshallprovideupgradestosoftwareandhardwareasneededtomaintain

compatibilitywithPCRusers,includingEMSandreceivinghospitals.

40. PCRDeliverytoReceivingHospitalsorPsychiatricFacilities

100%ofPCRsshallbeprovidedtoreceivinghospitalsandpsychiatricfacilitiespriorto

departureofFieldPersonnel.ContractorshallbefinedifPCRcompliancefallsbelow90%.

40.1 Foreverypatienttransported,especiallyHigh‐Riskpatients(EXHIBITN‐HIGH

RISKPATIENTDESCRIPTION),acomplete,print‐copyofthePCRistobeleftatthe

receivinghospitaland/orpsychiatricfacilitypriortoFieldPersonnelleaving.

AccesstoanelectroniccopyofthePCRbythehospitalorpsychiatricfacility

shallnotsubstituteforleavingaprintedcopy,unlessauthorizedinwriting

bytheEMSDirector.

40.2 IntheeventFieldPersonnelareunabletocompletethePCRpriortoleaving

thereceivinghospitalorpsychiatricfacilityhe/sheshall:


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a. Leaveaprint‐copyofthePCRwithMandatoryDataFieldscompleted,

asdescribedinEXHIBITI‐MANDATORYDATAFIELDREQUIREMENTS);and,

b. DeliverafullycompletedPCRwithin24hoursofthetimeField

Personnelleftthehospital/facilityforthatpatient.

MEDICAL OVERSIGHT

41. MedicalProtocols

41.1 Contractorshallcomplywithmedicalprotocols,onlinemedicalcontrol,andother

requirementsasestablishedbytheEMSMedicalDirector,and/orprovidedbythe

County(e.g.:BaseHospitalservices,authoritytoperformcertainmedical

interventions,etc.).

41.2 Contractorshalldocumentcompliancewithsystemmedicalprotocolsrequiredby

EMSPoliciesandtheStateofCalifornia.

42. MedicalReview/Audits

IfrequestedbytheEMSMedicalDirector,Contractor’semployeesshallattendmedical

reviewsand/oraudits.

PERSONNEL

43. TreatmentofIncumbentWorkforce

43.1 Contractorshallofferemploymentinsubstantiallysimilarpositionstoall911

IncumbentPersonnel,whoarequalified,insurable,andpassdrugtestingand

criminalbackgroundchecks.Thisprovisionshallbecomeinvalidsix(6)months

aftertheServiceStartDate.Thisprovisiondoesnotapplytodispatchers,billingstaff

orseniormanagementpositions.

43.2 ContractorshallalsooffertothoseemployeescurrentlyworkingintheAlameda

CountyBLSInterfacilityTransportDivisionofAmericanMedicalResponseonthe

EffectiveDate,preferentialhiringinavailablepositionstothosewhoarequalified,

insurable,andpassdrugtestingandcriminalbackgroundchecks(e.g.:wherethere

areequallyqualifiedapplicantsforanopenposition,currentAlamedaCountyAMR

employeesshallbegivenpreference.)Thisprovisionshallbecomeinvalidsix(6)

monthsaftertheServiceStartDate.


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43.3 IncumbentPersonnelhiredbyContractorshallretaintheiroriginalhiringdatefor

senioritystatusforbiddingshifts,partners,orotherassignments,aspermittedby

anyapplicablelaboragreement.

43.4 Contractorshallprovideawageandbenefitprogramwhichis,ataminimum,

comparabletotheprogramprovidedtoIncumbentPersonnelontheEffectiveDate.

ContractorshallhonorlaboragreementsineffectasofJanuary1,2010regarding

wageincreases.

44. Character/Competence/Professionalism

44.1 Contractorshallensurethatallemployees,agentsandsubcontractorsconduct

themselvesinaprofessionalandcourteousmanner.Contractorshalladdressand

correctanydeparturefromthisstandardofconduct.

44.2 Contractor’semployees,agentsandsubcontractorsshall,atalltimeswhen

providingServices,becompetentandholdvalidlicenses,including,butnotlimited

to,aCaliforniadriver’slicenseand,certificates,accreditationsandpermits,asmay

berequiredforeachposition.

44.3 Contractorshallperformcriminalbackgroundchecks,pre‐employmentdrugtesting

andconfirmpossessionofarequiredlicense,certificates,accreditations,and

permitsforallemployees,includingIncumbentEmployees.

45. InternalHealthandSafetyPrograms

45.1 Contractorshallestablishandmaintainprogramstoenhancethesafetyandhealth

oftheworkforce.Theseshallincludebutarenotlimitedto:

a)drivertraining,b)safety,andc)riskmanagementtraining.

45.2 Contractorshallprovideadequatepersonalprotectiveequipment(“PPE”)to

employees,includinguniversalprecautionsforroutinecare,andpersonalprotective

geartoemployeesworkinginhazardousenvironments,rescueoperations,motor

vehicleaccidents,etc.

45.3 Contractorshallestablishacriticalincidentmanagementplan,whichincludesan

ongoingstressreductionprogramforitsemployees.Theplanshallalsoinclude

accesstotrained,experiencedprofessionalcounselors.Plansfortheseprograms

shallbesubmittedtotheEMSDirectorforreview.


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45.4 Contractorshallmakehealthscreeningandallcurrentlyrecommended

immunizationsavailableatnocosttoitsFieldPersonnel,make‐readystaff

(individualpreparingambulancesfordeployment),andmechanicsproviding

Services.

46. PersonnelTraining

ContractorshallensurethatFieldPersonnelperformingServicesmeetalltraining

requirementsasrequiredinEMSPolicies,asmaybeamendedfromtimetotime.Currently

applicableparamedictrainingrequirementsaresetforthinEXHIBITG,PARAMEDICTRAINING

REQUIREMENTS.

47. ContinuingEducationProgram

47.1 ContractorshallapplyforandmaintainapprovalasanapprovedContinuing

Education(“CE”)providerinAlamedaCounty.Allin‐serviceprogramsofferedforCE

creditmustcomplywithTitle22‐Chapter11andEMSPolicies.

47.2 Contractorshalldevelopandprovidein‐houseCEtrainingprogramsdesignedto

meetStatelicensure/certificationrequirementsand/orCountyaccreditation

requirements,atnocosttoemployees.

47.3 ContractorshallprovideCEprogramswitheducationalcontenttoaddressAlameda

Countyneeds.TheEMSMedicalDirectormaymandatespecificCEprogramsand

contentrequirements.CountypersonnelmayreviewandauditanyCEprograms

offeredbytheContractor.

47.4 ContractorshallcoordinateandmakeavailableCEprogramstofiredepartment

personnelincontractingcities,asmaybearrangedwiththeindividualagencies.

ContractormayalsomakeCEprogramsavailabletootherentities.

48. WorkforceEngagement

48.1 ContractorshallprovidetoallFieldPersonnelanidentificationcardthatshallbe

wornandvisible;includingarecentpictureandthatincludes,ataminimum,the

employee’s:

a. Firstname,lastinitial

b. Title(EMTorParamedic)


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c. Certificationorlicensenumber

d. Companyname

48.2 Contractorshalldevelopatwo‐waycommunicationprocessbetweenfront‐line

employeesandtheleadershipteam.

48.3 Contractorshallhaveamechanismfor:a)encouraging,b)gathering,

c)providingfeedbackonand,d)actingonemployeeimprovementsuggestions.

48.4 Contractorshalldevelopmethodsforprovidingsystemandindividualperformance

feedbacktoemployees.

48.5 Contractorshallhaveaprocessforinvolvingfront‐lineemployeesinqualityand

performanceimprovementprojects.

48.6 ContractorshalltrackcredentialingrequirementsforallEMTs,Paramedics,and

SupervisorsprovidingServices,includingContractor’semployeesworkinginthe

CountyDispatchCenter.

48.7 Contractorshalldevelopacareerladderandprofessionaldevelopmentprocessfor

employees,includingasuccessionplanforKeyPersonnel.

48.8 ContractorshallcollaboratewithfiredepartmentsintheCountytocreateacareer

ladderforParamedics,internshipsandfieldorientation.

48.9 Contractorshalluseexperiencedclinicianstotrain,mentor,monitor,andassistless

experiencedParamedicsandEMTsinthefield.

48.10 Contractorshallmakeeffortstohavediversityintheworkforce,includingthelevel

ofdiversityinalignmentwiththecommunity.Partofthiseffortshallincludea

targetedrecruitmentplanapprovedbytheEMSDirectornolaterthaneightmonths

priortoServiceStartDate.

48.11 Contractorshalldeveloppracticesandpoliciesdesignedtopromoteworkforce

harmonyandpreventdiscrimination,includingdiscriminationbasedonage,

nationalorigin,gender,race,sexualorientation,religion,andphysicalability.

49. KeyPersonnelandRequiredPositions

49.1 Contractorshallhaveanidentifiedpersonauthorizedandcapabletoactonbehalfof

theContractorinoperationalmattersavailableatalltimes.


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49.2 Contractor'sKeyPersonnelareasfollows:

a. OperationsManager(ChiefOperationsOfficer):Contractorshallprovide

afull‐timeOperationsManagertooverseeandberesponsibleforthe

provisionofServices.Thispersonshallhavepriorexperiencemanaginga

large,high‐performanceemergencymedicalsystem.Thisindividualshallbe

responsibleforensuringthatallupper‐levelmanagementpositionsare

trainedandparticipateintheContractor'sQualityManagementPlan.

b. ProviderMedicalDirector:Contractorshallprovideahalf‐time(0.5FTE)

physician,experiencedinemergencymedicalservices,tooverseeclinical

areas.

c. QualityManager:Contractorshallprovideafull‐timephysician,Registered

Nurse,orhighlyqualifiedandexperiencedParamedictoimplementand

overseeContractor'squalitymanagementplan.Thisindividualshallbe

responsibleforthemedicalQualityImprovement/Assuranceevaluationof

allServices.

49.3 KeyPersonnelpositionsmustbedistinctandseparatefromeachother.Innoevent

shallanyonepersonperformanytwooftheKeyPersonnelpositions.Contractor

shallnotifytheEMSDirectorinwritingofanychangesinKeyPersonnel.

49.4 ContractorshallremoveKeyPersonnelifintheopinionoftheEMSDirectoran

individualhasnotperformedinamanneracceptabletotheCounty.

49.5 TheapprovalofCountytoarequestedchangeinKeyPersonnelshallnotrelease

ContractorfromanyofitsobligationsunderthisAgreement.

49.6 ContractoragreesthatitshallnottransferorreassigntheindividualsinKey

PersonnelpositionswithouttheexpresswrittenagreementofCounty,which

agreementshallnotbeunreasonablywithheld.Shouldsuchindividualor

individualsintheemployofContractornolongerbeemployedbyContractorduring

thetermofthisAgreement,Contractorshallmakeagoodfaithefforttopresentto

theCountyanindividualwithgreaterorequalqualificationsasareplacement,

subjecttotheCounty’sapproval,whichapprovalshallnotbeunreasonably

withheld.


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49.7 Contractor’sKeyPersonnelshallparticipateinongoingtraininganddevelopment

programsforemergencymedicalservicemanagers.Theseprogramsshouldbe

offeredbyContractortothosepersonnelatnocost.

49.8 InadditiontotheKeyPersonnel,Contractorshallhireseparateindividualsforeach

RequiredPositions.

49.9 RequiredPositionsmustbestaffed,ataminimum,asfollows:

a. OperationalFieldSupervisors:thereshallbeatleastoneondutyatall

times.

b. ClinicalFieldSupervisors:thereshallbenofewerthanthree(3)Clinical

FieldSupervisorsondutyatalltimes.

Beexperienced,clinicallyandadministrativelycompetentParamedics

withpriorteaching/trainingexperience.

RespondtoallEchoLevelcallstoprovideoversightandassistanceas

required.RespondtoallDeltalevelcallswhenavailable.

RespondtoAlpha,Bravo,andCharliecallswhenavailabletoobserve

FieldPersonnelinthedeliveryofserviceandcare.

Providedirect,case‐by‐caseoversightofclinicalpersonnel

Notberesponsiblefordeliveryofsuppliesorequipment,withthe

exceptionofmulti‐casualtyincidentsanddisasterresponses.

Coordinatedatacollectionforongoingcomplianceincollectionand

reportingofcardiacarrest,airway,12‐leaddata

Directandassistwithresearchandcomplianceforresearchintrial

studies,focusedaudits,andState‐directeddemonstrationprojects

TeachandreinforceclinicalEMSPoliciesinthefieldandintrainings

IntroducenewtechniquesandproceduresasdirectedbytheEMSMedical

Director.

Facilitatetheuseofeducationalsoftware

CollaboratewithEMSLeadershipandPrehospitalCareCoordinators


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http://www.quality.nist.gov/HealthCare_

Beavailabletorespondasaresourcefordifficultclinicalissues

CommunicatewithbasephysiciansandEMSon‐callstaff

Betatestclinicaltrials,pilotstudies,andnewequipment

Coordinatewithotherproviders'clinicalsupervisors

ParticipateintheCounty’sEMSQualityCouncilwiththeQualityManager

and/orotherperformanceimprovementcommittees,asrequested.

c) Analyst:thereshallbeatleastonefull‐timeanalystassignedtoevaluate

PatientCareReports.

d) Clinical/EducationStaff:thereshallbeatminimum,twofull‐timeclinical

andeducationalstaffpositionstoassisttheQualityManager.

e) Inaddition,Contractorshallprovideforeighty(80)compensatedhoursa

monthfordesignatedFieldPersonneltoparticipateinclinicalquality

improvementactivities.

49.10 Contractor’sKeyPersonnelandRequiredPositionsshallreceivetrainingfromor

comparabletotheAmericanAmbulanceAssociation'sAmbulanceServiceManager

CertificateProgram.Thistrainingshalloccurwithintwenty‐four(24)monthsofthe

EffectiveDateorhiredate.

QUALITY MANAGEMENT PLAN

50. ApprovalofQualityManagementPlan

50.1 ContractorshallworkwithEMStodevelopaQualityManagementPlan.

TheQualityManagementPlanshall:

a. BeconsistentwiththerequirementsoftheStateCaliforniaforemergency

medicalsystemqualityimprovement,includingthosecontainedinTitle22,

Chapter12.

b. BeconsistentwiththemostcurrenteditionoftheBaldrigeNationalQuality

Program,HealthCareCriteriaforPerformanceExcellence.

c. BeconsistentwithEMSPolicies.


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d. BeintegratedwithFirstResponderAgencies,CountyDispatchCenter,and

EMSAgency.

e. Incorporatecomplianceassurance,processmeasurementandcontrol,and

processimprovements.

f. Measureclinicalindicatorsasdevelopedthroughcollaborativeeffortswith

theCounty.

h BebasedoncurrentEMSresearchandcalldemand.

i. Endeavortoensurethelong‐termeconomicviabilityoftheEMSsystem

whilemaximizingvaluetothecommunity.Contractorshallachievefinancial

andservicetargetsthroughprocessimprovement,standardization,and

evaluationofinternalprograms.

50.2 ThefinalQualityManagementPlanmustbesubmittedtotheEMSDirectorfor

approvalthree(3)monthspriortotheServiceStartDate.TheEMSDirectormay

revisetherequirementsoftheQualityManagementPlanfromtimetotime.

50.3 ContractorshallensurethatKeyPersonnelandRequiredPositionsactively

participateintheleadershipandoversightoftheQualityManagementPlan,

includingbutnotlimitedto:

a. ActivelyparticipatinginEMSgroupsand/orcommitteesdealingwithquality

management

b. DesignatingamanagertooverseeContractor’squalityprogram

c. SubmittingacomprehensiveQualityImprovementreportstotheCounty

d. Activelyparticipatinginprojectsdesignedtoimprovethequalityof

emergencymedicalservicesinAlamedaCounty.

51. CaliforniaAwardforPerformanceExcellence

ContractorshallapplyfortheCaliforniaAwardforPerformanceExcellenceinyearfiveof

thisagreement.


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REQUIRED REPORTS

52. ReportingRequirements

52.1 Contractorshallprovide,withinthirty(30)calendardaysafterthefirstdayofeach

month,reportsaddressingitsperformanceduringtheprecedingmonthwith

respecttotheclinical,operational,andfinancialperformancerequirement,inthe

formandmannerrequiredbytheEMSDirector.

Reportsshallinclude,butarenotlimitedto:

a. ResponseTimeCompliancereports

b. Reportsoncustomercomplaints

c. ClinicalReports(e.g.:protocolcompliance,cardiacarrestsurvivalrate,

intubationsuccessrate,etc.)

d. WorkloadtrendsforFieldPersonnelassignedto24‐hourshifts

e. OtherreportsasrequestedbyCounty.

52.2 Otherreportsmayberequiredlessfrequentlythanmonthly,asdeterminedbythe

EMSDirector.

52.3. CountyshallprovidenoticetoContractoratleasttwo(2)monthsinadvanceofany

changetorequiredreports,frequency,orduedates.

53. ResponseTimePerformance

53.1 ResponseTimedata,includingreportsreceivedfromCountyDispatchCenter,shall

beusedbyContractorandCountytoevaluateContractor'sperformanceand

compliance.ContractorshallmakeeffortstocontinuallyimproveResponseTime.

53.2 IfResponseTimecomplianceisbelow90%,Contractorshallidentifythecausesand

shalldocumenteffortstoeliminateproblemsonanongoingbasis.

53.3 ForanymonthinwhichcompliancewithResponseTimeislessthan90%,

Contractorshallsubmitaperformanceimprovementplanwiththemonthly

ResponseTimeperformancereport.Theperformanceimprovementplanshall

identifyeachproblemthatcontributedtoafailuretomeetResponseTimesand

stepsbeingtakentocorrecttheproblem.


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53.4 ResponseTimereportingandtimesshallbedocumentedassetforthinthis

Agreement.

54. High‐RiskPCRs

54.1 Contractorshallconductanauditbyrandomlyselectingandreviewingaminimum

oftenpercent(10%)oftheHigh‐RiskPCRs.Themonthlyauditshallreview

compliancewithEXHIBITI‐MANDATORYDATAFIELDREQUIREMENTS.

54.2 Eachnon‐compliantHigh‐RiskPCRfromthisauditshallbeevaluatedbyContractor

andtheEMSMedicalDirector.

54.3 ContractorshallprepareamonthlyreportdocumentingcompliancewithMandatory

DataFields(EXHIBITI‐MANDATORYDATAFIELDS)forHighRiskPCRs(EXHIBITN‐HIGH

RISKPATIENTDESCRIPTION).

55. CompliancewithProtocols

55.1 Contractorshallproducemonthlyreportsthatdescribetheoverallcompliancewith

EMSPoliciesandperformanceinallcalls.

55.2 Reportsforcomplianceshallbesubmittedinaggregateandstratifiedbycategories

identifiedintheQualityManagementPlanandapprovedbytheEMSDirector.

56. QualityImprovement

56.1 Contractorshalldevelopaclearandconcisesetofprocessesandpracticesdesigned

toidentifyandaddressopportunitiesforimprovement.Thedescriptionofthese

processesshallincludetheapproachforachievingandmaintainingmeasurable

outcomes.

56.2 Contractorshallprovidereportsthatupdateprogressonqualityimprovement

projectsasrequestedbytheEMSDirector.

56.3 Contractorshallprovidereportsonkeyperformanceindicatorsandkeyresultareas

asrequestedbytheEMSDirector.

PENALTY PROVISIONS

57. FailuretoRespond


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ContractorshallpaytoCounty$25,000foreachfailurebytheContractortoprovidean

AmbulancetoalocationwithintheEOAwherearesponsehasbeenrequestedbythe

CountyDispatchCenter.PaymentofsuchfinesdoesnotreleaseContractorofanyother

liabilityfromtheirfailuretorespond.

58. ResponseLevel

ContractorshallpaytoCounty$500foreveryincidentinwhichaBLSAmbulanceresponds

toacalland/ortransportsapatientrequiringanALSAmbulance.

59. MissingMandatoryDataFields

ContractorshallpaytoCounty$500foreachHigh‐RiskPCRwhereoneormoreofthe

MandatoryDataFieldsarenotcomplete.

60. MissingPCRattheReceivingHospitalorPsychiatricFacility

60.1 AcompletePCRisonewhereallpatientcareinformationrequiredhasbeen

entered,asdefinedinEMSpolicies.

60.2 Acompleteprint‐copyPCRshallbeleftatthereceivinghospitalpriortodeparture

ofFieldPersonnel.

60.3 IfFieldPersonnelareunabletoleaveacompleteprint‐copyofthePCR,aPCRwith

atleasttheMandatoryDataFieldscompletedshallbeleftatthereceivinghospital

orpsychiatricfacilitypriortodepartureofFieldPersonnelfromthehospitalor

facility.IfneitheracompletePCR,noraPCRwithatleasttheMandatoryDataFields

completedisleft,Contractorshallbefined$50peroccurrence.ForHighRiskPCRs,

thisfineshallbe$500.

60.4 WhereapartialPCRwithonlyMandatoryDataFieldscompletedwasleftinsteadof

acompletePCR,theContractorshalldeliveracompleteprint‐copyofthePCRfor

thatpatientwithin24hoursofthedepartureofFieldPersonnelfromthereceiving

hospitalorfacility.

60.5 Ifacompleteprint‐copyofthePCRisnotdeliveredwithinthe24‐hourperiod

specifiedabove,thatPCRshallbeconsideredlateandincomplete,andsubjectto

additionalfinesof$50peroccurrence.


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60.6 Ifinanyconsecutive30‐dayperiodContractorfallsbelowninetypercent(90%)

compliancewiththePCRprintcopysubmittalrequirements,Contractorshallpayto

Countyanadditionalfineof$10,000.

61. PCRGoodCauseExemption

61.1 ContractormayapplyforanexemptionforfinesrelatedtoanyPCR.Anyapplication

foranexemptionmustbeinwritingandincludejustificationforeachexemption

requested.

61.2 ItiswithinthesolediscretionoftheCountytograntanexemptionbasedonthe

factsandcircumstancesofeachcase.

62. FailuretoProvideTimelyReports

ContractorshallpromptlydelivereachrequiredreporttotheCounty.Contractorshallpay

toCountyafineof$50perdayforeachdayareportislate.

63. FailuretoMeetMinimumIn‐ServiceEquipment/SupplyRequirements

ContractorshallpaytotheCountyafineofupto$1,000foranyServiceVehiclethatfailsto

complywithEMSPolicies.

64. FailuretoProvideArrivalatIncidentTime

64.1 ContractorshallpayCountya$500fineeachandeverytimeanAmbulanceis

dispatchedandContractorfailstodocumenttheArrivalatIncidenttime.

64.2 WhentheArrivalatIncidenttimeforacallisnotaccurate,theresponsetothatcall

shallbedeemedtohaveexceededResponseTime.

64.3 ContinuedfailuretomeetResponseTimestandardsmaybeconsideredaMajor

BreachoftheAgreement.

65. ResponseTimeFines

65.1 ContractorshallpaytoCountyafineanytimeResponseTimecompliancedrops

below90%foranyconsecutive30‐dayperiod,asshowninEXHIBITF‐RESPONSETIME

REQUIREMENTSANDPENALTIES(TABLEB,ResponseTimeFinesbyCategoryand

Compliance).ResponseTimecomplianceshallbebasedonthepercentageof

complianceforeach:


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a. Category(Echo,Delta,Charlie,Bravo,Alpha)

b. ResponseZone,(Zone2,3,4,5),and

c. Subarea(metro/urban,suburban/rural,wilderness).

65.2 IfResponseTimecomplianceforEchocallsdropsbelow90%,aperformance

improvementplanmustbesubmittedtotheEMSDirectorwiththemonthly

compliancereport.Theperformanceimprovementplanmustidentifyeachproblem

thatledtothedelayedresponseandthestepsbeingtakentocorrecteachsuch

problem.

66. FinesforOutlierResponseTimes

66.1 AnOutlierResponseTimeisdefinedasgreaterthan150%ofthedesignated

ResponseTime(asdescribedinEXHIBITF–TABLEA)forthecategory.

66.2 FinesforOutlierResponseTimesshallbebasedontheindividualcallcategoryand

thesubarea.Inadditiontoanyotherfines,ContractorshallpaytoCountyfinesfor

OutlierResponseTimesasshownINEXHIBITF‐RESPONSETIMEREQUIREMENTSANDFINES

(TABLEC,OUTLIERRESPONSETIMESBYCATEGORYANDSUBAREAINMINUTES&SECONDS).

67. FineDisputes

67.1 IfContractorhasfailedtodocumentanArrivalatIncidentTime,anexemptionfrom

thefinemaybegrantedifContractordemonstrates,tothesatisfactionoftheEMS

Director,anaccurateArrivalatIncidenttime.

67.2 ContractormayappealafinetotheEMSDirectorinwritingwithinfourteen(14)

calendardaysofreceiptofnotificationoftheimpositionofapenaltyorfine

calculations.

67.3 TheEMSDirectorshallreviewallappealsandmakethedecisiontoeliminate,

modify,ormaintainthefine.TheEMSDirector’sdecisionshallbefinal.

68. InvoicingandPayment

68.1 CountyshallinvoiceContractorforanyfinesorpenaltiesunderthisAgreement

withinthirty(30)calendardaysfollowingCounty’sreceiptofContractor’smonthly

performancereports.ContractorshallpayCountywithinthirty(30)calendardays

followingreceiptoftheinvoice.Thepartiesshallmakeagoodfaithefforttoresolve


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anydisputesregardinganinvoicedamountwithinthis30‐dayperiod.Iftheparties

areunabletomutuallyresolvethedisputewithinthat30‐dayperiod,theinvoice

shallbepaidinfullandsubsequentinvoicesshallbeadjustedtoreflectthe

subsequentresolutionofthedispute.

68.2 FailurebytheCountytoassessorimposeanypenaltiesorfinesatanypoint,forany

reason,doesnotimpactCounty’srighttodosointhefuture;however,Countymay

notimposefinesretroactivelygreaterthanthree(3)months.

68.3 PaymentofanyfinedoesnotreleaseContractorfromanyotherliabilityrelatedto

thebreachthatresultedinfineimposition.

COUNTY‐WIDE COOPERATION

69. CollaborationwithFirstResponderAgencies

69.1 ContinuingEducation

AllALSandBLScontinuingeducationofferedbyContractortoitsemployeesunder

thisAgreementshallalsobeavailabletoFirstResponderAgencies.

69.2 TrainingandInternships

a. Contractorshallenterintoagreementswithemergencymedicalservices

trainingprogramswithinAlamedaCountytoprovidefieldexperiencefor

EMTand/orParamedictrainingprograms.

b. Contractorshalldevelopacollaborativepartnershipwherebyfieldpersonnel

fromallFirstResponderAgencies,andContractingCitiesareprovidedfield

internshipsopportunities,includingworkingwithfieldtrainingofficersfor

initialsystemtraining.

c. AlltrainingconductedshallcomplywithEMSPolicies.

69.3 ContractorshalldesignateaParamedicasaliaisonwithFirstResponderAgencies.

69.4 FirstResponderEquipmentandSupplies

a. ContractorshallprovidetheequipmentdescribedinEXHIBITM‐FIRST

RESPONDERSUPPORTforusebyallFirstResponderAgenciesatnocost.

Contractorshallmaintainownershipoftheequipmentatalltimes,andshall

beresponsibleformaintenanceofallequipment.


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b. Contractorshallprovide,atnocosttoFirstResponderAgencies,required,

standardizedexpendablemedicalsupplies,excludingpharmaceuticals,as

definedinEMSPolicies.

c. Contractor,attherequestofanyFirstResponderAgency,shallmanagetheir

inventoryincludingon‐siteinventoryauditsandinventoryordersplacedon

behalfoftheagency.

d. FirstResponderAgenciesmayrequestContractortoprovideapricequote

andordersuppliesorequipmentthatareinadditiontothosedefinedas

expendablemedicalsuppliesinEMSPoliciesatthecostoftherequesting

FirstResponderAgency.

e. ContractorshalldevelopasupplyconsortiumincollaborationwithFirst

ResponderAgenciestobuysuppliesandequipmentthatContractorisnot

obligatedtoprovideusingContractor'ssuppliers.

70. EMSSystemParticipation

Contractorshallparticipateandassistinchangesrelatedtoemergencymedicalservicesin

AlamedaCounty.Contractorshallparticipateinlocalactivities,committeemeetings,and

workgroupsrelatedtoprovisionofServices.

HEALTH STATUS IMPROVEMENT/COMMUNITY EDUCATION

71. EMTTrainingPrograms,InternshipsandRelatedOpportunities

71.1 Contractorshallimplementaplanned,multifacetedprocesstoattract,recruit,and

trainEMTsfromunderrepresentedpopulations.

71.2 Contractorshallestablishanin‐houseEMTtrainingprogramwherestudentsage18

orovercanparticipateinawork/studyprogram,earningfull‐timewages,while

progressingtowardtheNationalRegistryandCaliforniaEMTcertification.

72. CommunityPrograms

72.1 Contractorshallparticipateincommunityprogramsthatareofinteresttothe

County,withcommunityorganizationssuchasthosethatsupportyouth

developmentactivitiesandethnichealthinitiatives.


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72.2 Contractorshallplanandimplementanannualcommunityeducationprogramas

describedinEXHIBITL‐COMMUNITYEDUCATIONPROGRAM.

72.3 Inaddition,Contractorshallprovidethefollowingtothecommunityand/orto

benefitthecommunity:

a. Website‐Createandmaintainawebsiteshallbecreatedandmaintained

withlinkstocontinuouslyupdatedaudio/videofilesonvariousemergency

healthtopicssuchas“Calling911,”“WhattoExpectWhentheAmbulance

Arrives,”and“HowDoIBecomeaParamedic?”

b. Speakers'Bureau‐Organizeandmaintainaspeakers’bureautoprovide

speakersonhealthrelatedtopicstocommunityorganizations.

c. AutomaticExternalDefibrillator(AED)Distribution‐Contractorshall

purchaseandcausetobemaintained10AEDseachyearfordistribution

consistentwiththeEMSAEDprogram,atlocationsthroughoutAlameda

County.ContractorshallworkwithCountyEMStodeterminelocationsfor

AEDplacement.ThefinaldecisionregardinglocationsforAEDplacement

shallbeatthediscretionoftheEMSDirector.

d. CPRTraining–ContractorshallofferfreeCPRclassestothepublicatleast

onceamonthandencouragefamilymembersofheartattackpatients

transportedbyEMStoattendfreeclasses.Theseclassesaretoberotated

throughoutthenorth,south,centralandtri‐valleyareasofAlamedaCounty.

ContractormayworkwithEMStoassistinEMSCPRprograms.

e. EMSWeekandPublicEducation–ContractorshallusetheEMSWeek

platformtoconductpubliceducationactivitiesonavarietyoftopicswhich

mayincludestrokerecognitionandprevention,fallpreventionforelderly

citizens,heartattackwarningsigns,poolsafetyandchildplaygroundsafety.

ContractorshallcollaboratewiththeEMS,thePublicHealthDepartment,area

FireDepartments,andotherstakeholderstoidentifyandtargetthemost

appropriatetopics.

ENVIRONMENTALLY FRIENDLY BUSINESS PRACTICES

73. BuildingsandVehicles


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73.1 ContractorshallsearchforatleastonegreenbuildinginAlamedaCounty,consistent

withUSGreenBuildingCounsel,LEEDv3.0Silvercriteria.

73.2 AllServiceVehiclesshallbe2010modelyearorlater,lowemissionvehicles.

74. EquipmentandSupplies

74.1 Contractorshallreduce,reuse,andrecycle.

74.2 PurchasingshallbeconsistentwithguidelinesfromtheResponsiblePurchasing

Network.ConsiderationsinequipmentpurchasingshallincludeEPAEnergyStar

and/orElectronicProductEnvironmentalAssessmentTool(EPEAT)labeled.When

possible,productsshallberecycledcontentand/orbio‐based.

74.3 RecyclingshallbeimplementedtosupporttheAlamedaCountygoalofreducing

wastegoingtolandfillsby75percentandcoordinatedwithStopWaste.orgas

needed.

75. MedicalEquipmentandSupplies

ContractorshalliiimplementanEnvironmentallyPreferablePurchasingprogramwithan

emphasisonthePrecautionaryPrincipleforthepPurchase,handling,anddisposalof

medicalequipmentandsupplies.

COMPLIANCE PROVISIONS

76. MedicareComplianceProgramRequirements

76.1 ContractorshallimplementandmaintainacomprehensiveMedicarecompliance

programforallactivities,includingbutnotlimitedtodocumentation,claims

processing,billing,andcollection.

76.2 Contractor’sMedicarecomplianceprogramshallsubstantiallycomplywiththe

regulatoryapproachprogramoutlinedintheOfficeofInspectorGeneral(OIG)

ComplianceProgramGuidanceforAmbulanceSuppliersaspublishedintheFederal

RegisteronMarch24,2003(03FR14255),andanyamendmentthereto.

77. HIPAAComplianceProgramRequirements

77.1 ContractorshallimplementacomprehensiveplantoabidewiththeHealth

InsurancePortabilityandAccountabilityActof1996(“HIPAA”)andthecurrent

rulesandregulationsenactedbytheDepartmentofHealthandHumanServices.


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77.2 Theplanshallbesentviaimmediateemailandafollowuplettersentthesameday

toEMSDirector.

77.3 Contractorshallberesponsibleforallaspectsofcomplyingwiththeserulesand

particularlythoseenactedtoprotecttheconfidentialityofpatientinformation.Any

violationsofHIPAArulesandregulationsshallbereportedimmediatelytothe

CountyalongwithContractor’sactionstomitigatetheeffectofsuchviolations.

78. EMSPolicies

ContractorshallcomplywithCountyEMSPolicies,asmaybeupdatedorrevisedfromtime

totime.

79. MedicalandOtherStateandFederalPrograms

Contractorisresponsibleforcomplyingwithallrulesandregulationsassociatedwith

providingservicesforrecipientsofandbeingreimbursedbyStateMedi‐Calandotherstate

andfederallyfundedprograms.

CONTRACTOR REVENUE

80. ContractorCompensation

Contractor'scompensationunderthisAgreementisthroughfeeforservicereimbursement

ofpatientcharges(“UserFees.”)

81. PatientChargesandFees

UserFeesshallbeestablishedbytheCounty,byapprovalofamajorityvoteoftheBoard.

ContractorisprohibitedfromcharginginexcessoftheapprovedUserFeesassetforthin

EXHIBITH‐CONTRACTOR'SUSERFEES‐911SYSTEM.

82. UserFeeAdjustments

82.1 EMSDirectorshallapproveannualincreasestoUserFeesbasedonchangesinthe

ConsumerPriceIndexforAllUrbanConsumers,SanFrancisco‐Oakland(“CPI”).

Annualrateincreasesshallbethegreateroftwoandone‐halfpercent(2.5%)orthe

increaseintheCPIforthemostrecent12‐monthperiod,cappedatfivepercent

(5%).


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82.2 IntheeventthatchangesoccurwithinAlamedaCountythatsubstantiallyimpact

Contractor’scostsofprovidingservices,Contractormayrequestincreasesor

decreasesinUserFees.

83. Billing/CollectionServices

83.1 ContractorshallestablishadedicatedCustomerServiceTelephoneLine,assetforth

inthisAgreement,includingsection85.

83.2 Contractorshalldesignatealocalemployeetohandleserviceinquiresand

complaints.

83.3 Contractorshallprovideabillingandaccountsreceivablesystemthatiswell

documented,easytoaudit,anddesignedtominimizetheeffortrequiredofpatients

torecoverpaymentsfrominsurancecompaniesorotherthirdpartysources.

83.4 Contractorshallmakenoattemptstocollectitsfeesatthetimeofservice.

Contractorshallmaintainanduseabillingsystemthatelectronicallygeneratesand

submitsclaimsforpatientsreceivingMedicareorMedi‐Cal.

83.5 Contractorshallnotchargeorbillpatientscoveredby,orwhoprovideevidenceof

eligibilityfor,CountyMedicalServicesPlan(CMSP),norshallContractorchargeor

billCountyforservicestothesepatients.

83.6 ContractorshallnotchargetheCountyoranygovernmentalentityrequesting

Servicesforpatientstransportedintra‐countywhileincustodyoronapsychiatric

(5150)hold.Contractormaybillthepatient’sinsurance;however,Contractorshall

notbillthepatientdirectlyforServices.

83.7 ContractorshallnotbilltheindividualrequestingServicesforawork‐relatedinjury

atthetimeofinjury.Contractormaybilltheappropriateinsurer,unlessthe

employerisapublicentitythatisself‐insured.

83.8 Contractorshallincludeonallbillingstatementscontactinformationfortheperson

designatedtorespondtobillinginquiries.

83.9 Contractorshallconductallbillingandcollectionactivityinaprofessionaland

courteousmanner.


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83.10 ContractorshallsubmititsbillingandcollectionpolicytotheEMSDirectorfor

review,priortoServiceStartDate.

84. AccountingProcedure

Contractorshallallocatenomorethan$500,000annuallytocorporateoverheadcosts.This

limitshallbeadjustedannuallybasedontheConsumerPriceIndexforAllUrban

Consumers,SanFrancisco‐Oakland.

84.1 AuditsandInspections

a. ThroughoutthetermofthisAgreement,includinganyrenewalperiods,

Contractor,attheendofeachofitsfiscalyears,shallprovideastatementof

operationsrelatedtotheperformanceofdutiescontainedinthisAgreement.

Contractorshallreportearningsinthisstatementofoperationsusing

generallyacceptedaccountingprinciples(GAAP)withinninety(90)daysof

Contractor’sfiscalyearend.Suchstatementofoperationsshallbereviewed

byanindependentaccountingfirm,selectedandpaidforbyContractor.

b. Withreasonablenotificationandduringnormalbusinesshours,Countyshall

havetherighttoreviewanyandallbusinessrecordsincludingfinancial

recordsofContractorpertainingtotheAgreement.Allrecordsshallbemade

availabletoCountyattheEMSofficeorothermutuallyagreeablelocation.

c. TheCountymayaudit,copy,maketranscripts,orotherwisereproducesuch

records,includingbutnotlimitedtocontracts,payroll,inventory,personnel

andotherrecords,dailylogs,andemploymentagreements.

d. Additionally,Contractorshallprovidetheannualconsolidatedaudited

financialstatementsofEastTexasMedicalCenterRegionalHealthcare

SystemthroughoutthetermofthisAgreement,includinganyrenewal

periods.

84.2 ProfitCap

ContractorhasagreedtocapitsannualnetprofitforServicesat7%.Contractor

shallprovideanannualstatementofitnetprofitswithin120calendardaysofthe

endofContractor'sfiscalyear.Allprofitsinexcessof7%shallbedisbursedto

Countywithin30calendardays.


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85. CustomerServiceTelephoneLine

85.1 ContractorshallestablishandpublishaCustomerServiceTelephoneLinegiving

internalandexternalcustomersandsystemparticipantstheabilitytocontacta

designatedliaisonoftheContractor’sleadershipteam.Thetelephonelineshallbe

accessiblewithoutchargetoallcallerswithinthecontinentalUnitedStates.

85.2 Thenumbermaybeansweredbyadesignatedmanagerorprovideanopportunity

forthecallertoleaveavoicemailmessage.Thenumbershallbepublishedinthe

localtelephonedirectory,ontheContractor’swebsite,andpublicizedatlocalhealth

carefacilities,firestations,andpublicsafetyagencies.

85.3 Ifthenumberisansweredbyanautomaticgreetingand/ormenuselection,and

shouldacallerinadvertentlycallthecustomerservicelinelookingforemergency

service,theinitialmessagemustimmediatelyconveythatthisisacustomerservice

line,ifcallerhasanemergencyhangupanddial911.

85.4. MembersoftheContractor’sLeadershipTeamaretobeautomaticallynotifiedvia

pagerofanyincomingcalls.Amanagementdesigneemustreturnthecalltothe

customerwithin30minutes,90%ofthetime.Incidentsthatrequirefollowuptothe

customershouldberesolvedbytheendofthenextbusinessdayfromwhenthecall

wasreceived,andifnotpossible,acallshouldbemadetothecustomerwiththe

statusoftherequest.

85.5 HandlingServiceInquiriesandComplaints:

a. Contractorshalllogthedateandtimeofeachinquiryandservicecomplaint.

Contractorshallprovideapromptresponseandfollow‐uptoeachinquiry

andcomplaint.Suchresponsesshallbesubjecttothelimitationsimposedby

patientconfidentialityrestrictions.

b. ContractorshallsubmittotheCountyalistofallcomplaintsreceivedandthe

disposition/resolutiononamonthlybasis.Copiesofanyinquiriesand

resolutionsofaclinicalnatureshallbereferredtotheEMSMedicalDirector

usingtheEMSUnusualOccurrenceprocedure,withintwenty‐four(24)hours

oftheinitialinquiry.

c. ContractorshallsubmittotheEMSDirectoradescriptionoftheContractor’s


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processformanagingservicecomplaintspriortotheServiceStartDate.

86. Contractor'sCompensationtotheCounty

86.1 FirstResponderSupportFees

ContractorshallpaytotheCountyanannualfirstrespondersupportfeeoffour

millionsixhundredthousanddollars($4,600,000.00).Paymentshallbemadein

quarterlyinstallmentsof$1,150,000.00.Thefirstquarterlyinstallmentshallbe

madeonorbeforetheServiceStartDate.Thereafter,paymentshallbemadeupon

receiptofaninvoicefromCounty.

Theamountofthefirstrespondersupportfeesshallincrease3%peryearforthe

termoftheAgreement,beginningoneyearfromtheServiceStateDate.

86.2 DispatchSystemFees

ContractorshallpayDispatchfeesintheamountofonemillion,fivehundred

thousanddollars($1,500,000.00)annually.PaymentshallbemadetoACREEC,as

specifiedinContractor'sseparateagreementfordispatchservices,withverification

ofpaymentsentbyContractortotheEMSDirector.

ADMINISTRATIVE PROVISIONS

87. AnnualPerformanceEvaluation

TheCountymayevaluatetheperformanceoftheContractoronanannualbasis.Contractor

shallprovideareporttotheCountytoassistinthisevaluationwithin60calendardaysof

writtennoticebyCountyofitsintentiontoconductaperformanceevaluation.Thereportis

toincludethefollowinginformation:

a. ResponseTimeperformance

b. Clinicalperformance

c. Innovativeprogramsthathavebeeninitiatedtoimprovesystem

performance

d. Updateonitsworkforce,includingeffortstominimizeemployeeturnover

e. Updateoncommunityeducationprogramsandothercommunityinitiatives

f. OtherinformationasrequestedbyCounty


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g. OtherinformationContractorwouldlikeconsideredbyCounty.

88. AssuranceofPerformance

88.1 Ifatanytime,theCountybelievesContractormaynotbeadequatelyperformingits

obligationsunderthisAgreementorthatContractorisnotperformingtheServices

asrequiredbythisAgreement,CountymayrequestfromContractorpromptwritten

assurancesofperformanceandawrittenplanacceptabletoCounty,tocorrectthe

deficienciesinContractor’sperformance.

88.2 Contractorshallprovidewrittenassurancesandawrittenplanwithinten(10)

calendardaysofitsreceiptofCounty’srequestandshallthereafterdiligently

commenceandfullyperformsuchwrittenplan.

88.3Contractor’sfailuretoprovidesuchwrittenassurancesandwrittenplanwithinthe

requiredtimeisamaterialbreachofthisAgreement.

89. MaterialBreach

89.1 WillfulfailureofContractortoprovideServicesunderthisAgreementinsubstantial

compliancewiththerequirementsoftheapplicableFederal,State,andCountyof

Alamedalaws,rules,andregulationsshallconstituteamaterialbreachby

Contractor.Minorinfractionsofsuchrequirementsshallnotconstituteamaterial

breachunlesssuchinfractionsarewillfulandrepeated.

89.2 ActsoromissionsthatshallconstituteamaterialbreachbyContractorincludebut

arenotlimitedtothefollowing:

a. WillfulfalsificationofdatasuppliedtoCountyduringthecourseof

operations,includingbutnotlimitedtodispatchdata,patientreportdata,

ResponseTimedata,financialdata,orfalsificationofanyotherdatarequired

underAgreement;

b. Willfulfailuretomaintainequipmentinaccordancewiththerequirementsof

thisAgreement;

c. Willfulattemptstointimidateorpunishemployeeswhoparticipatein

protectedconcertedactivities,orwhoformorjoinanyprofessional

associations;


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d. Chronicandpersistentfailuretorequireemployeestoconductthemselvesin

aprofessionalandcourteousmanner,andtopresentaprofessional

appearance;

e. WillfulfailureofContractortocomplywithapprovedratesetting,billing,and

collectionprocedures;

f. RepeatedfailuretomeetResponseTimerequirementsafterreceivingnotice

ofnon‐compliancefromtheEMSDirector;

g. Failuretomaintaintherequiredinsuranceortoprovideandmaintainthe

requiredperformancesecuritybond;

h. Willfulfailuretocomplywithvehicleleaseprovisions;

i. WillfulandrepeatedmaterialbreachesofContractor’sbackupprovisions.

j. WillfulfailuretocomplywithexecutedMutual‐Aidagreements;

k. Failuretotimelyobtainandmaintainthenecessarylicensingand/or

certificationrequiredbylawtoprovideServices;

89.3 FollowingCounty’sannouncementofinitiationofanewprocurementprocess,and

priortoterminationofServicesunderthisAgreement,thefollowingshallbe

consideredamaterialbreachbyContractor:

a. Deliberate,excessive,andunauthorizedscaling‐downofoperations.

b. Attemptstointimidateorotherwisepunishemployeeswhodesiretosign

contingentemploymentcontractswithcompetingproviders.

90. NoticeandCureofMaterialBreach

90.1 CountyshallgiveContractorwrittennotice,returnreceiptrequested,settingforth

withreasonablespecificitythenatureofamaterialbreach.

90.2 Contractorshallhavetherighttocurethematerialbreachwithinten(10)calendar

daysofreceiptofnotice.Withintwenty‐four(24)hoursofreceiptofamaterial

breachnotice,ContractorshalldelivertoCounty,inwriting,aplanofactiontocure

thematerialbreach.


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90.3 Ifthematerialbreach,byitsnature,cannotreasonablybecuredwithinten(10)

calendardays,Contractormayrequestadditionaltimetocompletecureofthe

breach.

91. CountyRemedies

91.1 CountyshallhavetherighttoterminatethisAgreementinadditiontoanyother

legalremedyintheeventofamaterialbreachthatisnotcuredwithinthetime

specified.

91.2 County'sremediesforanybreacharenon‐cumulativeandinadditiontoanyother

remedyavailabletotheCounty.

91.3 IftheCountydeterminesanybreachhasoccurred,CountymayrequireContractor

tosubmitacorrectiveactionplan.Failuretosubmitandimplementanyrequested

correctiveactionplanmaybeconsideredamaterialbreach.

92. ContinuousServiceDelivery

ContractoragreesthatthereisapublichealthandsafetyobligationtoassistCountyin

everyefforttoensureuninterruptedandcontinuousservicedeliveryintheeventofa

materialbreach,evenifContractordisagreeswiththedeterminationofmaterialbreach.

93. EmergencyTakeover

93.1 IftheBoardbymajorityvotedeterminesthatthehealthandsafetyofAlameda

CountyresidentswouldbeendangeredbyallowingContractortocontinue

providingServices,CountymaytakeovertheprovisionofServicesonanemergency

basis(“EmergencyTakeover”).TheBoardshallgivenoticetoContractorofthedate

andtimetheEmergencyTakeovershallbeeffective.

93.2 UponnoticeofanEmergencyTakeover,Contractorshallpromptlyandcontinually

cooperatewithCountytoeffectuateanorderlytransition.Thisshallinclude,butnot

belimitedto:

a. ImmediatedeliverytoCounty,oritsdesignee,ofallServiceVehicles,and

equipmentusedtoprovideServices(“EmergencyTakeoverEquipment”).

EachAmbulanceshallbeequipped,ataminimum,withtheequipmentand


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suppliesnecessaryfortheoperationofALSAmbulances,inaccordancewith

EMSPolicies.

b. ImmediateaccesstoanduseofalllocationsusedtoprovideServices,

including,butnotlimitedto,thoselocationswhereContractorplacesits

Ambulances(“crewstations”)duringtheEmergencyTakeover.

93.3 FailureofContractortocooperatefullywiththeCountyintheeventofan

EmergencyTakeovershallconstituteamaterialbreach.

93.4 AsofthedatetheEmergencyTakeoveriseffective,allofContractor’sService

Vehicles,fullyequippedforprovisionofServices,shallbedeemedleasedtothe

County,duringtheEmergencyTakeover,attherateof$1.00(OneDollar)permonth

pervehicle.

93.5 CountymayrecoverfromContractorcostsassociatedwithanEmergencyTakeover

includingongoingrentpaymentsandotherliabilities.

93.6 Contractorshallinformandprovideacopyoftakeoverprovisionscontainedherein

toallvehicleandrealpropertylienholder(s)withinfive(5)calendardaysof

EmergencyTakeover

93.7 County,byamajorityvoteoftheBoard,maydiscontinuetheEmergencyTakeover

atanytime,andreturntheEmergencyTakeoverEquipmenttoContractor,who

shallresumeprovidingServicespursuanttothefulltermsandconditionsofthe

Agreement.

93.8 CountyshallreturnEmergencyTakeoverEquipmenttoContractoringoodworking

order,normalwearandtearexcepted,attheendoftheEmergencyTakeover.

Otherwise,CountyshallpayContractorthefairmarketvalueoftheEmergency

TakeoverEquipmentasofthecommencementoftheEmergencyTakeover,orshall

payContractorthereasonablecostsofrepair,orshallpromptlyrepairandreturn

suchEmergencyTakeoverEquipment.

94. Termination

94.1 MutualTermination


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ThisAgreementmaybeterminatedearlybymutualconsentoftheContractorand

theCounty.

94.2 WalkAwaybyContractor

IfContractorstopsprovidingServicespriortotheterminationofthisAgreement

(“WalkAway”),thefollowingprovisionsshallapply;howeverinnoeventshall

ContractorgivenoticetoCountylessthan90dayspriortostoppingServices:.

a. CountymayleaseanyandallServiceVehicles,including,butnotlimitedto,

fully‐equippedAmbulancesandSupervisorVehicles,foronedollar($1.00)

permonthpervehicle.Countyshallhavefulluseofvehiclesandequipment

andmay,atCounty'ssoleoption,hireamanagementcompanytomanage

ambulanceoperationsuntilareplacementproviderfortheEOAisselected

throughaCountyprocurementprocess.Theleaseagreementshallbenon‐

transferrabletoanewambulanceprovider,andshallterminateonthe

servicesstartdateofthenewprovider.

b. ContractorshallfullycooperateifCountyelectstoleaseanyorallService

Vehiclespursuanttothisprovision.Countyshallberesponsibleforinsuring

allvehiclesitleasespursuanttothisprovision.Alternatively,Countymay

electtopurchasethevehiclesattheirdepreciatedvalueasofthedateofsuch

election.Countyshallhavesolediscretionastowhichvehiclesitleasesor

purchasespursuanttothisprovision.

ContractorandCountyshallnegotiateacontingentleaseagreementpriortoService

StartDate.

94.3 TerminationforCause

a. IfContractorfailstocureanymaterialbreach,followingnoticeand

opportunitytocure,County,uponwrittennoticetoContractor,may

terminatethisAgreementforcause.Theterminationshallbeeffectiveonthe

datespecifiedinthewrittennotice.

b. ContractorshallberesponsibleforallcostsincurredbyCountydueto

terminationforcause.


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c. Intheeventofterminationforcause,CountymaypurchaseanyandService

Vehiclesatthecurrentdepreciatedvalueasoftheeffectivedateofthe

termination.Alternatively,CountymayelecttorenttheServiceVehiclesfor

fairmarketrentalprice,asoftheeffectivedateofthetermination,as

determinedbyaneutralappraiser.Countyshallhavesolediscretionasto

whichvehiclesitpurchasesorrentspursuanttothisprovision.

94.4 End‐of‐TermProvisions

a. Contractorshallmakenochangesinmethodsofoperationforpurposesof

reducingServiceorContractor’soperatingcostspriortoterminationofthe

Agreement,withoutthewrittenconsentofCounty.

b. ContractorshallmakenochangespriortoterminationoftheAgreementthat

couldincreasecoststoanewprovider.

c. Contractorshallhaveninety(90)calendardaysafterterminationofthe

AgreementinwhichtosupplytherequiredauditedfinancialStatementsand

othersuchdocumentationnecessarytofacilitatethecloseoutofthe

Agreementattheendoftheterm.

FUTURE COMPETITIVE PROCUREMENT PROCESS / “LAME DUCK” PROVISIONS

95. CompetitiveProcurementProcess

95.1 Countyhastherighttoconductacompetitiveprocurementprocessforthe

provisionofmedicalAmbulanceservicewithinitsEOA,andarequirementtodoso

atcertaintimeintervals.

95.2 CountymayselectadifferentAmbulanceserviceprovidertoprovideexclusive

medicalAmbulanceserviceswithintheEOAfollowingacompetitiveprocurement

process.

95.3 ContractorshallcontinuetoprovideallServicesafternotificationbyCountyofits

intenttoinitiateacompetitiveprocurementprocess.Contractorshallbeinmaterial

breachifitdoesnotcontinueServicesatthesamelevelofeffortandperformanceas

wereineffectpriortoanoticeofintenttoinitiateacompetitiveprocurement

process.


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95.3 Contractorshallnotpenalizeorbringpersonalhardshiptobearuponanyofits

employeeswhoapplyforworkonacontingentbasiswithcompetingproposers,and

shallallow,withoutpenalty,itsemployeestosigncontingentemployment

agreementswithcompetingproposers.Contractormayprohibititsemployeesfrom

revealingtradesecretsorotherinformationaboutContractor’sbusinesspractices

orfieldoperations.

96. “LameDuck”Provisions

96.1 IfandwhenCountyannouncesitsintenttochangeproviders,Contractoragreesto

continuetoprovideallServicesuntiltheCountyoranewproviderassumes

responsibilitiesforprovisionofServices.Thisshallincludeanytimeperiodafter

notificationbyCountyofitsintenttoinitiateacompetitiveprocurementprocess.

96.2 Contractorshallbeinmaterialbreachifitdoesnotcontinuealloperationsand

Servicesatthesamelevelofeffortandperformanceaswereineffectpriortonotice

ofintenttochangeproviders.

96.3 Contractorshallmakenochangesinmethodsofoperationforpurposesofreducing

ServiceorContractor’soperatingcostspriortoterminationoftheAgreement,

withoutthewrittenconsentofCounty.

96.4 ContractorshallmakenochangespriortoterminationoftheAgreementthatcould

increasecoststoanewprovider.Contractorshallallowitsemployeesproviding

Servicesreasonableopportunitiestodiscussissuesrelatedtoemploymentwitha

newproviderwithoutadverseconsequences.

GENERAL PROVISIONS

97. PermitsandLicense

97.1 ContractorshallberesponsibleforandshallholdanyandallrequiredFederal,State

orlocalpermitsorlicensesrequiredtoperformitsobligationsunderthe

Agreement.

97.2 Contractorshallmakeallnecessarypaymentsforlicensesandpermitsforall

Ambulancevehiclesused.

97.3 ItshallbeentirelytheresponsibilityofContractortoscheduleandcoordinateall

applicationsandapplicationrenewalsasnecessarytoensurethatContractoris


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meetingitsobligationundertheAgreementandisincompletecompliancewith

Federal,Stateandlocalrequirementsforpermitsandlicensesasnecessaryto

providetheservices.

97.4 Contractorshallberesponsibleforensuringthatitsemployee’sStateandlocal

certificationsasnecessarytoprovidetheservices,ifapplicable,arevalidand

currentatalltimes.

98. PrivateWork

Contractorshallnotbepreventedfromconductingprivateworkthatdoesnotinterfere

withtherequirementsoftheAgreementorallocationofoverhead.IntheeventContractor

doesprivateworkoutsideoftheAgreement,andifanyoverheadcostsaresharedbetween

thetwobusinesses,financialinformationprovidedregardingtheAgreementshallclearly

identifytherelationandpercentageshared.

99. ProductEndorsement/Advertising

ContractorshallnotusethenameofAlamedaCountyorAlamedaCountyEMSforthe

endorsementofanycommercialproductsorserviceswithouttheexpressedwritten

permissionoftheEMSDirector.

100. ObservationandInspections

100.1 Countyrepresentativesmay,atanytime,andwithoutnotification,directlyobserve

Contractor'soperationsattheCountyDispatchCenter,maintenancefacility,orany

Ambulancepostlocation.ACountyrepresentativemayrideas“thirdperson”onany

ofContractor'sAmbulanceunitsatanytime,providedthatinexercisingthisrightto

inspectionandobservation,Countyrepresentativesshallconductthemselvesina

professionalandcourteousmanner,shallnotinterferewithContractoremployee's

duties,andshallatalltimesberespectfulofContractor'semployer/employee

relationships.

100.2 Atanytimeduringnormalbusinesshoursandasoftenasmaybereasonably

deemednecessarybytheCounty,CountyrepresentativesmayobserveContractor's

officeoperations,andContractorshallmakeavailabletoCountyforitsexamination

anyandallbusinessrecords,includingincidentreports,patientrecords,financial

recordsofContractorpertainingtotheAgreement.Countymayaudit,copy,make


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transcripts,orotherwisereproducesuchrecordsincludingbutnotlimitedto

contracts,payroll,inventory,personnelandotherrecords,dailylogs,employment

agreements,andotherdocumentationforCountytofulfillitsoversightrole.

101. NoCosttoCounty

ContractoragreesthattheprovisionofServicestobeperformedbyContractorunderthis

AgreementshallbecompletedwithoutcompensationfromtheCounty.

102. CostofEnforcement

IfCountyorContractorinstituteslitigationagainsttheotherpartytoenforceitsrights

pursuanttoperformingtheworkcontemplatedherein,theactualandreasonablecostof

litigationincurredbytheprevailingparty,includingbutnotlimitedto:a)attorney'sfees,

b)consultantandexpertfees,orc)othersuchcosts,shallbepaidorreimbursedwithin

ninety(90)calendardaysafterreceivingnoticebythepartywhichprevails.

103. RelationshipoftheParties

NothinginthisAgreementshallbeconstruedtocreatearelationshipofemployerand

employeeorprincipalandagent,partnership,jointventure,oranyotherrelationshipother

thanthatofindependentpartiescontractingwitheachothersolelyforthepurposeof

carryingouttheprovisionsoftheAgreement.NothingintheAgreementshallcreateany

rightorremediesinanythirdparty,itbeingsolelyforthebenefitoftheCountyand

Contractor.

104. IndependentContractor

104.1 NorelationshipofemployerandemployeeiscreatedbythisAgreement;itbeing

understoodandagreedthatContractorisanindependentcontractor.Contractoris

nottheagentoremployeeoftheCountyinanycapacitywhatsoever,andCounty

shallnotbeliableforanyactsoromissionsbyContractornorforanyobligationsor

liabilitiesincurredbyContractor.

104.2 Contractor,itsemployees,subcontractorsandagentsshallhavenoclaimunderthis

Agreementorotherwise,forseniority,vacationtime,vacationpay,sickleave,

personaltimeoff,overtime,healthinsurancemedicalcare,hospitalcare,retirement

benefits,socialsecurity,disability,Workers’Compensation,orunemployment

insurancebenefits,civilserviceprotection,oremployeebenefitsofanykind.


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104.3 Contractorshallbesolelyliableforandobligatedtopaydirectlyallapplicable

payrolltaxes(includingFederalandStateincometaxes)orcontributionsfor

unemploymentinsuranceoroldagepensionsorannuitieswhichareimposedby

anygovernmentalentityinconnectionwiththelaborusedorwhicharemeasured

bywages,salariesorotherremunerationpaidtoitsofficers,agentsoremployees

andagreestoindemnifyandholdCountyharmlessfromanyandallliabilitywhich

CountymayincurbecauseofContractor’sfailuretopaysuchamounts.

104.4 ContractorshallcomplywithallapplicableFederalandStateworkers’

compensationandliabilitylawsandregulationswithrespecttotheofficers,agents

and/oremployeesconductingandparticipatinginthework;andagreesthatsuch

officers,agents,and/oremployeesshallbeconsideredasindependentContractors

andshallnotbetreatedorconsideredinanywayasofficers,agentsand/or

employeesofCounty.

105. Indemnification

105.1 Tothefullestextentpermittedbylaw,Contractorshallholdharmless,defendand

indemnifytheCountyofAlameda,itsBoardofSupervisors,employeesandagents

fromandagainstanyandallclaims,losses,damages,liabilitiesandexpenses,

includingbutnotlimitedtoattorneys’fees,arisingoutoforresultingfromthe

performanceofServicesunderthisAgreement,providedthatanysuchclaim,loss,

damage,liabilityorexpenseisattributabletobodilyinjury,sickness,disease,death

ortoinjurytoordestructionofproperty,includingthelosstherefrom,ortoany

violationofFederal,Stateormunicipallaworregulation,whicharisesoutoforis

anywayconnectedwiththeperformanceofthisAgreement(collectively

“Liabilities”),exceptwheresuchLiabilitiesarecausedsolelybythenegligenceor

willfulmisconductofanyindemnitee.TheCountymayparticipateinthedefenseof

anysuchclaimwithoutrelievingContractorofanyobligationhereunder.

105.2 IntheeventthatContractororanyemployeeoragentofContractorproviding

servicesunderthisAgreementisdeterminedbyacourtofcompetentjurisdictionor

theAlamedaCountyEmployees’RetirementAssociation(ACERA)orCalifornia

PublicEmployees’RetirementSystem(PERS)tobeeligibleforenrollmentinACERA

andPERSasanemployeeofCounty,Contractorshallindemnify,defend,andhold


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harmlessCountyforthepaymentofanyemployeeand/oremployercontributions

forACERAandPERSbenefitsonbehalfofContractororitsemployeesoragentsas

wellasforthepaymentofanypenaltiesandinterestonsuchcontributions,which

wouldotherwisebetheresponsibilityofCounty.

106. InsuranceandBond

106.1 PerformanceSecurityBond:UpontheEffectiveDateofthisAgreement,Contractor

shallfurnishaperformancebondpayabletoCountyissuedbyalicensedsurety,

acceptabletoCounty,intheamountofsixmilliondollars($6,000,000.00).The

PerformanceBondshallremainineffectatalltimesduringthetermofthis

Agreement,includinganyrenewalterm.

106.2. ContractorshallatalltimesduringthetermoftheAgreementwiththeCounty

maintaininforcetheinsurancecoveragespecifiedinEXHIBITC‐MINIMUMINSURANCE

REQUIREMENTS,andshallcomplywithallthoserequirementsasStatedtherein.

107. Workers’Compensation

ContractorshallprovideWorkers'Compensationinsurance,atContactor’sowncostand

expenseandfurther,neithertheContractornoritsinsurershallbeentitledtorecoverfrom

Countyanycosts,settlements,orexpensesofWorkers'Compensationclaimsarisingoutof

thisAgreement.

108. ConformitywithLawandSafety

108.1 InperformingServicesunderthisAgreement,Contractorshall,atalltimes,observe

andcomplywithallapplicablelaws,ordinances,codesandregulationsof

governmentalagencies,includingFederal,State,municipal,andlocalgoverning

bodies,havingjurisdictionovertheServices,including,butnotlimitedto,all

applicableprovisionsoftheCaliforniaOccupationalSafetyandHealthAct.Itshallbe

Contractor’ssoleresponsibilitytobefullyfamiliarwithallsuchapplicablelaws,

ordinances,andregulations.

108.2 ContractorshallindemnifyandholdCountyharmlessfromanyandallliability,

fines,penaltiesandconsequencesfromanyfailurebyContractortocomplywith

suchlaws,ordinances,codesandregulations.


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108.3 Accidents:Ifadeath,seriouspersonalinjury,orsubstantialpropertydamage

occursinconnectionwithContractor’sperformanceofthisAgreementandwarrants

submissionofanAlamedaCountyEMSUnusualOccurrenceReport(asperEMS

Policy).ContractorshallimmediatelynotifyCountybycontactingtheEMSDispatch

CenterandaskingtospeaktotheEMSpersononcall.TheEMSpersononcallshall

immediatelynotifytheAlamedaCountyRiskManager’sOfficebytelephone.Ifafter

businesshours,thismessagemaybeleftasavoicemail.Contractorshallpromptly

submittoCountyawrittenreport,insuchformasmayberequiredbyCountyofall

accidents,whichoccurinconnectionwiththisAgreement.Thisreportmustinclude

thefollowinginformation:a)nameandaddressoftheinjuredordeceased

person(s);b)nameandaddressofContractor'ssub‐Contractor,ifany;c)nameand

addressofContractor'sliabilityinsurancecarrier;andd)adetaileddescriptionof

theaccidentandwhetheranyofCounty'sequipment,tools,material,orstaffwere

involved.

108.4 Contractorshalltakeallreasonablestepstopreserveallphysicalevidenceand

informationwhichmayberelevanttoanaccidentinvolvingpersonalinjury,death,

orpropertydamage,whilemaintainingpublicsafety,inordertoaffordCountythe

opportunitytoreviewandinspectsuchevidence,includingthesceneoftheaccident

109. DebarmentandSuspensionCertification

109.1 ContractorshallcomplywithapplicableFederalsuspensionanddebarment

regulations,includingbutnotlimitedto7CodeofFederalRegulations("CFR")

3016.35,28CFR66.35,29CFR97.35,34CFR80.35,45CFR92.35andExecutive

Order12549.

109.2 Contractorcertifiestothebestofitsknowledgeandbelief,thatitanditsprincipals:

a. Arenotpresentlydebarred,suspended,proposedfordebarment,declared

ineligible,orvoluntaryexcludedbyanyFederaldepartmentoragency;and,

b. Shallnotknowinglyenterintoanycoveredtransactionwithapersonwhois

proposedfordebarmentunderFederalregulations,debarred,suspended,

declaredineligible,orvoluntarilyexcludedfromparticipationinsuch

transaction.


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110. Taxes

Paymentofallapplicablefederal,state,andlocaltaxesshallbethesoleresponsibilityofthe

Contractor.

111. OwnershipofDocuments

111.1 ContractorassignstoCountyallcopyrightandotheruserightsinanyandall

proposals,plans,specifications,reportsandrelateddocuments(including

computerizedorelectroniccopiesrelatingtoServices,whetherpreparedby

County,Contractor,orthirdpartiesatContractor’srequest(collectively,

“DocumentsandMaterials”).

111.2 Contractorshallbepermittedtoretaincopies,includingreproduciblecopiesand

computerizedcopies,ofanyDocumentsandMaterials.Contractoragreestotake

suchfurtherstepsasmaybereasonablyrequestedbyCountytoeffectuate

assignmentofrightsintheDocumentsandMaterialstoCounty.Ifforanyreason

thisassignmentisnoteffective,ContractorherebygrantsCountyandanyassignee

ofCountylicensetoretainandusesuchDocumentsandMaterialsatnocostto

County.TheCounty’srightsunderthisparagraphshallapplyregardlessofthe

degreeofcompletionoftheDocumentsandMaterials.

111.3 InContractorcontractswiththirdpartiestoprovideServices,Contractorshall

expresslyobligateitssubcontractorstograntCountytheassignmentandlicense

rightsregardingtheDocumentsandMaterialsassetforthabove.Contractoragrees

todefend,indemnifyandholdCountyharmlessfromanydamagecaused

Contractor’sfailuretosecuresuchrightsfromitssubcontractors.

111.4 Contractorshallpayallroyaltiesandlicensefeeswhichmaybedueforanypatented

orcopyrightedmaterials,methodsorusedbyContractorfortheServices,andshall

defend,indemnifyandholdCountyharmlessfromanyclaimsforinfringementof

patentorcopyrightarisingoutofsuchuse.TheCounty’srightsunderthisParagraph

shallnotextendtoanycomputersoftwareusedtocreatesuchDocumentsand

Materials.


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112. DocumentsandMaterials

112.1 ContractorshallmaintainandmakeavailabletoCountyforitsinspectionanduse

duringthetermofthisAgreementallDocumentsandMaterials,asdefinedabove.

Thisdutyshallcontinueforthree(3)yearsfollowingterminationorexpirationof

thisAgreement.Contractorshallnotdisposeof,destroy,alter,ormutilatesuch

DocumentsandMaterials,forthree(3)yearsfollowingterminationorexpirationof

thisAgreement.

112.2 RetentionofRecords‐Contractorshallretainalldocumentspertainingtothe

AgreementasrequiredbyFederalandStatelawsandregulations,andnolessthan

seven(7)yearsfromtheendofthefiscalyearfollowingterminationorexpirationof

thisAgreement.Uponrequest,andexceptasotherwiserestrictedbylaw,

Contractorshallmaketheserecordsavailabletoauthorizedrepresentativesofthe

County,theStateofCalifornia,andtheFederalgovernment.

112.3 TimeofEssence‐Timeisoftheessenceinrespecttoallprovisionsofthis

Agreementthatspecifyatimeforperformance.Thisrequirementshallnotbe

construedtolimitordepriveapartyofthebenefitsofanygraceoruseperiod

allowedbythisAgreement.

113. ConflictofInterest/Confidentiality

113.1 Contractorcovenantsthatitpresentlyhasnointerest,andshallnothaveany

interest,directorindirect,whichwouldconflictinanymannerwiththe

performanceofServicesrequiredunderthisAgreement.Withoutlimitation,

ContractorrepresentstoandagreeswithCountythatContractorhasnopresent,

andshallhavenofuture,conflictofinterestbetweenprovidingServicestoCounty

andtoanyotherpersonorentity(includingbutnotlimitedtoanygovernmental

agency)whichhasanyinterestadverseorpotentiallyadversetotheCounty,as

determinedinthereasonablejudgmentoftheBoardofSupervisorsoftheCounty.

113.2 Contractoragreesthatanyconfidentialinformation,whetherproprietaryornot,

madeknowntoordiscoveredbyitduringtheperformanceoforinconnectionwith

thisAgreementfortheCountyshallbekeptconfidentialandshallnotbedisclosed

toanyotherperson.ContractoragreestoimmediatelynotifyCountyinaccordance

withthisAgreement,ifitisrequestedtodiscloseanyconfidentialinformationmade


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knowntoordiscoveredbyitduringtheperformanceoforinconnectionwiththis

Agreement.

113.3 Theseconflictofinterestandconfidentialityprovisionsshallremainfullyeffective

five(5)yearsafterterminationofthisAgreement.

114. Notices

Allnotices,requests,demands,orothercommunicationsunderthisAgreementshallbein

writing.Noticesshallbegivenforallpurposesasfollows:

114.1 PersonalDelivery:Whenpersonallydeliveredtotherecipient,noticesare

effectiveondelivery.

114.2 FirstClassMail:Whenmailedfirstclasstothelastaddressoftherecipientknown

tothepartygivingnotice,noticeiseffectivethree(3)maildeliverydaysafter

depositinaUnitedStatesPostalServiceofficeormailbox.

114.3 CertifiedMail:Whenmailedcertifiedmail,returnreceiptrequested,noticeis

effectiveonreceipt,ifdeliveryisconfirmedbyareturnreceipt.

114.4 OvernightDelivery:Whendeliveredbyovernightdelivery(e.g.,Federal

Express/Airborne/UnitedParcelService/DHLWorldwideExpress)withcharges

prepaidorchargedtothesender’saccount,noticeiseffectiveondelivery,ifdelivery

isconfirmedbythedeliveryservice.

114.5 TelexorFacsimileTransmission:Whensentbytelexorfacsimiletothelasttelex

orfacsimilenumberoftherecipientknowntothepartygivingnotice,noticeis

effectiveonreceipt,providedthat:a)aduplicatecopyofthenoticeispromptly

givenbyfirst‐classorcertifiedmailorbyovernightdelivery,orb)thereceiving

partydeliversawrittenconfirmationofreceipt.Anynoticegivenbytelexor

facsimileshallbedeemedreceivedonthenextbusinessdayifitisreceivedafter

5:00p.m.(recipient’stime)oronanon‐businessday.

114.6 Addressesforpurposeofgivingnoticeareasfollows:

ToCounty: CountyofAlameda AlamedaCountyEMS 1000SanLeandroBlvd SanLeandro,Ca Attn:EMSDirector


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ToContractor: PARAMEDICSPLUS,LLC352S.GlenwoodDrive

Tyler,TX75702 Attn:AnthonyJ.Myers,President

114.7 Anycorrectlyaddressednoticethatisrefused,unclaimed,orundeliverablebecause

ofanactoromissionofthepartytobenotifiedshallbedeemedeffectiveasofthe

firstdatethatnoticewasrefused,unclaimed,ordeemedundeliverablebythepostal

authorities,messenger,orovernightdeliveryservice.

114.8 Anypartymaychangeitsaddressortelexorfacsimilenumberbygivingtheother

partynoticeofthechangeinanymannerpermittedbythisAgreement.

115. UseofCountyProperty

ContractorshallnotuseCountyproperty(includingequipment,instrumentsandsupplies)

orpersonnelforanypurposeotherthanintheperformanceofitsobligationsunderthis

Agreement.

116. EqualEmploymentOpportunityPracticesProvisions

116.1 ContractorshallcomplywithTitleVIIoftheCivilRightsActof1964andContractor

agreesthatnopersonshall,onthegroundsofrace,creed,color,disability,sex,

sexualorientation,nationalorigin,age,religion,VietnameraVeteran’sstatus,

politicalaffiliation,oranyothernon‐meritfactor,beexcludedfromparticipationin,

bedeniedthebenefitsof,orbeotherwisesubjectedtodiscriminationunderthis

Agreement.

116.2 Contractorshall,inallsolicitationsoradvertisementsforapplicantsforemployment

placedasaresultofthisAgreement,Statethatitisan“EqualOpportunity

Employer”orthatallqualifiedapplicantsshallreceiveconsiderationfor

employmentwithoutregardtotheirrace,creed,color,disability,sex,sexual

orientation,nationalorigin,age,religion,VietnameraVeteran’sstatus,political

affiliation,oranyothernon‐meritfactor.

116.3 UponrequestbyCounty,Contractorshallcertifythatithasnot,intheperformance

ofthisAgreement,discriminatedagainstapplicantsoremployeesbecauseoftheir

race,creed,color,disability,sex,sexualorientation,nationalorigin,age,religion,

VietnameraVeteran’sstatus,politicalaffiliation,oranyothernon‐meritfactor.


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116.4 UponrequestbyCounty,ContractorshallprovideCountywithaccesstocopiesofall

ofitsrecordspertainingorrelatingtoitsemploymentpractices,excepttotheextent

suchrecordsorportionsofsuchrecordsareconfidentialorprivilegedunderState

orFederallaw.

116.5 Contractorshallactivelyrecruitandencourageminorityandwomen‐owned

businessestobiditssubcontracts.

116.6 NothingcontainedinthisAgreementshallbeconstruedinanymannersoastorequire

orpermitanyactthatisprohibitedbylaw.

116.7 TheContractorshallincludetheprovisionssetforthinthissectionineachofits

subcontracts.

117. DrugFreeWorkplace

ContractoranditsemployeesshallcomplywiththeCounty’spolicyofmaintainingadrug

freeworkplace.NeitherContractornoritsemployeesshallunlawfullymanufacture,

distribute,dispense,possessorusecontrolledsubstances,asdefinedin21U.S.Code§812,

including,butnotlimitedto,marijuana,heroin,cocaine,andamphetamines,atanyCounty

facilityorworksite.IfContractororanyemployeeofContractorisconvictedorpleads

nolocontenderetoacriminaldrugstatuteviolationoccurringataCountyfacilityorwork

site,Contractorshall,withinfive(5)calendardaysthereafter,notifytheEMSDirector.

ViolationofthisprovisionshallconstituteamaterialbreachofthisAgreement.

118. Small,Local,andEmergingBusiness(SLEB)Participation:

118.1 TheCountyhaswaiveditsSmall,LocalandEmergingBusiness(“SLEB”)

requirementsforthisAgreement.Therefore,Contractorisnotrequiredto

subcontractwithanotherbusinessinordertosatisfytheCounty’sSLEB

requirements.

118.2 Ifcircumstanceschange,ContractormayberequestedtocomplywiththeCounty’s

SmallandEmergingLocalBusinessprovisions.


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119. FirstSourceProgram

ThisAgreementissubjecttotherequirementsoftheCounty’sFirstSourceProgram.A

copyoftheFirstSourceAgreementexecutedbyContractorisattachedasEXHIBITJ‐FIRST

SOURCEAGREEMENTtothisAgreementandincorporatedherein.

120. Waiver

Nowaiverofabreach,failureofanycondition,oranyrightorremedycontainedinor

grantedbytheprovisionsofthisAgreementshallbeeffectiveunlessitisinwritingand

signedbythepartywaivingthebreach,failure,rightorremedy.Nowaiverofanybreach,

failure,rightorremedyshallbedeemedawaiverofanyotherbreach,failure,rightor

remedy,whetherornotsimilar,norshallanywaiverconstituteacontinuingwaiverunless

thewritingsospecifies.

121. EntireAgreement

ThisAgreement,includingallattachments,exhibits,andanyotherdocumentsspecifically

incorporatedintothisAgreement,shallconstitutetheentireagreementbetweenthe

partiesrelatingtothesubjectmatterofthisAgreement.

ThisAgreementsupersedesandmergesallpreviousunderstandings,andallother

agreements,writtenororal,betweenthepartiesandsetsforththeentireunderstandingof

thepartiesregardingthesubjectmatterthereof.

122. Headings

Headingshereinareforconvenienceofreferenceonlyandshallinnowayaffectthe

interpretationoftheAgreement.

123. ModificationofAgreement

123.1 ThisAgreementmaybesupplemented,amendedormodifiedonlybythemutual

agreementoftheparties.Nosupplement,amendment,ormodificationofthis

Agreementshallbebindingunlessitisinwritingandsignedbyauthorized

representativesofbothparties.

123.2 WherethereismutualagreementbyContactorandtheEMSDirector,thefollowing

exhibitsmaybemodified,byawrittenamendmentsignedbyContractorandthe

DirectorofHealthCareServicesAgency:


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EXHIBITA DEPICTIONANDDEFINITIONOFCONTRACTOR'SEOAAND

EMERGENCYRESPONSEZONES

EXHIBITB DEPICTIONANDDEFINITIONOFSUB‐AREAS

EXHIBITE COMMUNICATIONSEQUIPMENT

EXHIBITG PARAMEDICTRAININGREQUIREMENTS

EXHIBITK TRANSITIONPLAN

EXHIBITL COMMUNITYEDUCATIONPROGRAM

EXHIBITM FIRSTRESPONDERSUPPORT

EXHIBITN HIGHRISKPATIENTDESCRIPTION

124. Subcontracting/Assignment/Sale

124.1 Contractorshallnotsubcontract,assignordelegateanyportionofthisAgreement

oranydutiesorobligationshereunderwithoutCounty’spriorwrittenapproval,

whichshallnotbeunreasonablywithheldordelayed.Countymayterminatethis

AgreementifParamedicsPlus,LLC.issoldoracquiredorotherwisechanges

ownershipwithoutCounty’spriorwrittenconsenttocontinuationofthis

Agreementunderchangedownership.

124.2 Neitherpartyshall,onthebasisofthisAgreement,contractonorinthenameofthe

otherparty.AnyagreementthatviolatesthisSectionshallconfernorightsonany

partyandshallbenullandvoid.

124.3 Contractorshallberesponsibleforcompliancebyitssubcontractorswithall

applicablethetermsofthisAgreement.

125. Survival

TheobligationsofthisAgreement,whichbytheirnaturewouldcontinuebeyondthe

terminationorexpirationoftheAgreement,includingwithoutlimitation,theobligations

regardingIndemnification,OwnershipofDocuments,andConflictofInterest,shallsurvive

terminationorexpiration.


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126. Severability

IfacourtofcompetentjurisdictionholdsthatanyprovisionofthisAgreementisillegal,

unenforceable,orinvalidinwholeorinpart,foranyreason,thevalidityandenforceability

oftheremainingprovisions,orportionsofthem,shallnotbeaffected,unlessanessential

purposeofthisAgreementwouldbedefeatedbythelossoftheillegal,unenforceable,or

invalidprovision.

127. PatentandCopyrightIndemnity

127.1 Contractorrepresentsthatitknowsofnoallegations,claims,orthreatenedclaims

thatthematerials,services,hardwareorsoftware(“ContractorProducts”)provided

toCountyunderthisAgreementinfringeanypatent,copyright,orotherproprietary

right.Contractorshalldefend,indemnifyandholdharmlessCounty,fromand

againstalllosses,claims,damages,liabilities,costsexpensesandamounts

(collectively,“Losses”)arisingoutoforinconnectionwithanyclaimthatany

ContractorProductsortheusethereof,infringeanypatent,copyrightorother

proprietaryrightofanythirdparty.Countyshall:1)notifyContractorpromptlyof

suchclaimorsuit;2)permitContractortodefend,compromise,orsettletheclaim;

and,3)provide,onareasonablebasis,informationtoenableContractortodoso.

ContractorshallnotagreewithoutCounty’spriorwrittenconsent,toany

settlement,whichwouldrequireCountytopaymoneyorperformsomeaffirmative

actinordertocontinueusingtheContractorProducts.

127.2 IfContractorisobligatedtodefendCountypursuanttothisSectionandfailstodoso

afterreasonablenoticefromCounty,Countymaydefenditselfand/orsettlesuch

claimorsuit,andContractorshallpaytoCountyanyandalllosses,damagesand

expenses(includingattorney’sfeesandcosts)incurredinrelationshipwith

County’sdefenseand/orsettlementofsuchclaimorsuit.

127.3 Inthecaseofanysuchclaimofinfringement,Contractorshalleither,atitsoption,

a)procureforCountytherighttocontinueusingtheContractorProducts;or

b)replaceormodifytheContractorProductssothatthattheybecomenon‐

infringing,butequivalentinfunctionalityandperformance.


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127.4 NotwithstandingthisSection,Countyretainstherightandabilitytodefenditself,at

itsownexpense,againstanyclaimsthatContractorProductsinfringeanypatent,

copyright,orotherintellectualpropertyright.

128. ChoiceofLawandVenue

ThisAgreementshallbegovernedbythelawsoftheStateofCalifornia.Venueforactions

andproceedingsbetweenthepartiesrelatedtothisAgreementshallbeAlamedaCounty

SuperiorCourtforstateactionsandtheNorthernDistrictofCaliforniaforanyfederal

action.

SIGNATORY

Bysigningthisagreement,signatorywarrantsandrepresentsthathe/sheexecutedthis

Agreementinhis/herauthorizedcapacityandthatbyhis/hersignatureonthisAgreement,

he/sheortheentityuponbehalfofwhichhe/sheacted,executedthisAgreement.

INWITNESSWHEREOF,thepartiesexecutethisAgreement:

CountyofAlameda Contractor

By:_______________________________________________Signature

By:_____________________________________________Signature

Name:AliceLai‐Bitker

Title:PresidentoftheBoardofSupervisors

Date:____________________________________________

Name:AnthonyJ.Myers

Title:President,ParamedicsPlus,LLC

Date:___________________________________________

ApprovedastoForm:

By:______________________________________________CountyCounselSignature


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PageE‐1of26

EXHIBITS

EXHIBIT A ‐ DEPICTION AND DEFINITION OF CONTRACTOR’S EOA AND

EMERGENCY RESPONSE ZONES ......................................................... 2

EXHIBIT B ‐ DEPICTION AND DEFINITION OF SUB‐AREAS .......................................... 3

EXHIBIT C ‐ MINIMUM INSURANCE REQUIREMENTS ................................................ 6

EXHIBIT D ‐ DEBARMENT AND SUSPENSION CERTIFICATION ...................................... 7

EXHIBIT E ‐ COMMUNICATIONS EQUIPMENT ......................................................... 8

EXHIBIT F ‐ RESPONSE TIMES REQUIREMENTS AND FINES ......................................... 10

TABLE A ‐ PERSONNEL AND RESPONSE TIME REQUIREMENTS .....................................................................10

TABLE B ‐ RESPONSE TIME FINES BY CATEGORY AND COMPLIANCE .............................................................10

TABLE C ‐ OUTLIER RESPONSE TIMES BY CATEGORY AND SUBAREA IN MINUTES & SECONDS ...........................10

EXHIBIT G ‐ PARAMEDIC TRAINING REQUIREMENTS ................................................ 11

EXHIBIT H ‐ CONTRACTOR’S USER FEES ‐ 911 SYSTEM ............................................ 13

EXHIBIT I ‐ MANDATORY DATA FIELD REQUIREMENTS ............................................. 14

EXHIBIT J ‐ FIRST SOURCE AGREEMENT ............................................................... 15

EXHIBIT K – TRANSITION PLAN ......................................................................... 16

EXHIBIT L ‐ COMMUNITY EDUCATION PROGRAM ................................................... 22

EXHIBIT M ‐ FIRST RESPONDER SUPPORT ............................................................ 24

EXHIBIT N ‐ HIGH RISK PATIENT DESCRIPTION ...................................................... 25

EXHIBIT O ‐ PROPOSAL OF PARAMEDICS PLUS ...................................................... 26


PageE‐2of26

EXHIBIT A ‐ DEPICTION AND DEFINITION OF CONTRACTOR’S EOA AND EMERGENCY RESPONSE ZONES

1. Therearefive(5)ERZsinAlamedaCounty,whichincludethecitiesandallunincorporated

areas.ThefollowingarecitiescontainedineachERZ:

a. Zone1–Alameda,Albany,Berkeley,Piedmont (thiszoneisnotincludedintheEOA)

b. Zone2–Oakland,Emeryville

c. Zone3–SanLeandro,CastroValley,Hayward

d. Zone4–Fremont,Newark,UnionCity

e. Zone5–Dublin,Pleasanton,Livermore‐exceptLawrenceLivermoreNationalLaboratory(ThisareaisnotincludedintheEOA).

2. ThefollowingisadepictionoftheeachEmergencyResponseZone(ERZ)withinAlamedaCounty

Zone1 Zone2 Zone3 Zone4 Zone5

21

1

3

2

4

56

7

10

11

1314

1516

17

20

198

9 1218 21

1‐Albany2‐Berkeley3‐Emeryville4‐Piedmont5‐Oakland6‐Alameda7‐SanLeandro8‐Ashland9‐Cherryland10‐SanLorenzo11‐CastroValley12‐Fairview13‐Hayward14‐UnionCity15‐Newark16‐Fremont17‐Dublin18‐Pleasanton19‐Livermore20‐Sunol21‐LLNL


PageE‐3of26

EXHIBIT B ‐ DEPICTION AND DEFINITION OF SUB‐AREAS

DensityAreaDesignation:Designationsofcalldensityareaswereaccomplishedbyreviewing

thecalldensityforeverysquarekilometergridintheCounty.Thegridswerenormalizedby

examiningtheunderlyingroadstructurewiththegoalofcreatingzoneswithRural/Suburban

contiguouswithMetro/Urban,eliminatinganomalouspocketsofhighorlowdensityinthemidst

ofoneofthedensityareas,andcreatingamapthatcanbeincorporatedintothecomputeraided

dispatchsystem.

Sub‐areadefinitionsareforgeneraldescriptivepurposesonly;theactualsub‐areasareidentified

onthemapsinthisExhibit.Themapdefinesthesubarea,nottheactualnumberofcallsreceived

duringanyperiod.TheidentifiedSub‐areasaresubjecttochangeatthediscretionoftheCounty.

Sub‐Areas:Thereare3possibleSub‐areascontainedwithineachERZ.

Metro/Urbancalldensitiesaredeterminedbyidentifyingthesquarekilometersthat

average2ormorecallspermonthandatleasthalfofthesurroundingsquarekilometers

alsoaverage2ormorecallspermonth.

Rural/Suburbanareasarethoseinwhichtheaveragecallspersquarekilometerare

between0.25andlessthan2.0callspermonthonaverage.

Wilderness/LowCallDensityisdeterminedbyidentifyingthesquarekilometersthat

averagelessthan0.25callspermonth(oronecallevery4months,onaverage).

AlamedaCounty:


PageE‐4of26

Zone2:

Zone3:


PageE‐5of26

Zone4:

Zone5:


PageE‐6of26

EXHIBIT C ‐ MINIMUM INSURANCE REQUIREMENTS WithoutlimitinganyotherobligationorliabilityunderthisAgreement,theContractor,atitssolecostandexpense,shallsecureandkeepinforceduringtheentiretermoftheAgreementorlonger,asmaybespecifiedbelow,thefollowinginsurancecoverage,limitsandendorsements:

TYPEOFINSURANCECOVERAGES MINIMUMLIMITS

A. CommercialGeneralLiability PremisesLiability;ProductsandCompletedOperations;ContractualLiability;

PersonalInjuryandAdvertisingLiability;Abuse,Molestation,SexualActions,andAssaultandBattery

$5,000,000.00peroccurrence(CSL)BodilyInjuryandPropertyDamage

B. CommercialorBusinessAutomobileLiability Allownedvehicles,hiredorleasedvehicles,non‐owned,borrowedand

permissiveuses.PersonalAutomobileLiabilityisacceptableforindividualContractorswithnotransportationorhaulingrelatedactivities

$5,000,000.00peroccurrence(CSL)AnyAutoBodilyInjuryandPropertyDamage

C. Workers’Compensation(WC)andEmployersLiability(EL) RequiredforallContractorswithemployees

WC:StatutoryLimitsEL:$1,000,000.00peraccidentforbodilyinjuryordisease

D.ProfessionalLiability/Errors&Omissions Includesendorsementsofcontractualliabilityanddefenseand

indemnificationoftheCounty

$5,000,000.00peroccurrence$10,000,000.00projectaggregate

E. EndorsementsandConditions:ADDITIONALINSURED:AllinsurancerequiredabovewiththeexceptionofProfessionalLiability,PersonalAutomobileLiability,Workers’CompensationandEmployersLiability,shallbeendorsedtonameasadditionalinsured:CountyofAlameda,itsBoardofSupervisors,theindividualmembersthereof,andallCountyofficers,agents,employeesandrepresentatives.

1. DURATIONOFCOVERAGE:AllrequiredinsuranceshallbemaintainedduringtheentiretermoftheAgreementwiththefollowingexception:Insurancepoliciesandcoverage(s)writtenonaclaims‐madebasisshallbemaintainedduringtheentiretermoftheAgreementanduntil3yearsfollowingterminationandacceptanceofallworkprovidedundertheAgreement,withtheretroactivedateofsaidinsurance(asmaybeapplicable)concurrentwiththecommencementofactivitiespursuanttothisAgreement.

2. REDUCTIONORLIMITOFOBLIGATION:AllinsurancepoliciesshallbeprimaryinsurancetoanyinsuranceavailabletotheIndemnifiedPartiesandAdditionalInsured(s).PursuanttotheprovisionsofthisAgreement,insuranceaffectedorprocuredbytheContractorshallnotreduceorlimitContractor’scontractualobligationtoindemnifyanddefendtheIndemnifiedParties.

3. INSURERFINANCIALRATING:InsuranceshallbemaintainedthroughaninsurerwithaminimumA.M.BestRatingofA‐orbetter,withdeductibleamountsacceptabletotheCounty.AcceptanceofContractor’sinsurancebyCountyshallnotrelieveordecreasetheliabilityofContractorhereunder.Anydeductibleorself‐insuredretentionamountorothersimilarobligationunderthepoliciesshallbethesoleresponsibilityoftheContractor.Anydeductibleorself‐insuredretentionamountorothersimilarobligationunderthepoliciesshallbethesoleresponsibilityoftheContractor.

4. SUBCONTRACTORS:Contractorshallincludeallsubcontractorsasaninsured(coveredparty)underitspoliciesorshallfurnishseparatecertificatesandendorsementsforeachsubcontractor.Allcoveragesforsubcontractorsshallbesubjecttoalloftherequirementsstatedherein.

5. JOINTVENTURES:IfContractorisanassociation,partnershiporotherjointbusinessventure,requiredinsuranceshallbeprovidedbyanyoneofthefollowingmethods:– Separateinsurancepoliciesissuedforeachindividualentity,witheachentityincludedasa“NamedInsured

(coveredparty),oratminimumnamedasan“AdditionalInsured”ontheother’spolicies.– Jointinsuranceprogramwiththeassociation,partnershiporotherjointbusinessventureincludedasa“Named

Insured.

6. CANCELLATIONOFINSURANCE:Allrequiredinsuranceshallbeendorsedtoprovidethirty(30)daysadvancewrittennoticetotheCountyofcancellation.

7. CERTIFICATEOFINSURANCE:BeforecommencingoperationsunderthisAgreement,ContractorshallprovideCertificate(s)ofInsuranceandapplicableinsuranceendorsements,informandsatisfactorytoCounty,evidencingthatallrequiredinsurancecoverageisineffect.TheCountyreservestherightstorequiretheContractortoprovidecomplete,certifiedcopiesofallrequiredinsurancepolicies.Therequirecertificate(s)andendorsementsmustbesentto:– Department/Agencyissuingthecontract– WithacopytoRiskManagementUnit(125–12thStreet,3rdFloor,Oakland,CA94607)


PageE‐7of26

EXHIBIT D ‐ DEBARMENT AND SUSPENSION CERTIFICATION

1. ParamedicsPlus,LLC,underpenaltyofperjury,certifiesthat,exceptasnotedbelow,the

company,itsprincipal,andanynamedsubcontractor:

2. Isnotcurrentlyundersuspension,debarment,voluntaryexclusion,ordeterminationof

ineligibilitybyanyFederalagency;

3. Hasnotbeensuspended,debarred,voluntarilyexcludedordeterminedineligiblebyany

Federalagencywithinthepastthreeyears;

4. Doesnothaveaproposeddebarmentpending;and,

5. Hasnotbeenindicted,convicted,orhadaciviljudgmentrenderedagainstitbyacourtof

competentjurisdictioninanymatterinvolvingfraudorofficialmisconductwithinthepast

threeyears.

6. Ifthereareanyexceptionstothiscertification,inserttheexceptionsinthefollowingspace.

7. Exceptionsshallnotnecessaryresultindenialofaward,butshallbeconsideredin

determiningProposerresponsibility.Foranyexceptionnotedabove,indicatebelowto

whomitapplies,initiatingagency,anddatesofaction.

8. Providingfalseinformationmayresultincriminalprosecutionoradministrativesanctions.

TheabovecertificationispartoftheAgreement.SigningtheAgreementonthesignature

portionthereofshallalsoconstitutesignatureofthisCertification.

Name:

Signature:

Title:

Date: / /


PageE‐8of26

EXHIBIT E ‐ COMMUNICATIONS EQUIPMENT

1. RadioEquipment:

1.1 ContractorshallpermanentlymountintoeachAmbulanceandoneachSupervisor

Vehicle,analoganddigitalcapable,700/800MHztrunkedmobileradiowithdual

controlheadsandatelephonestylemicrophoneinthepatientcompartmentwithan

externalantennamountedontheAmbulanceboxroof.Theseradiosshallhave

DUALTONE‐MULTIFREQUENCYcapabilitytoalerthospitalemergency

departmentradiosofincomingradiotraffic.Allmobileradiosshallbecompatible

withtheCounty’strunkedradiosystem(equivalenttoMotorolaAPX7500

(3600/9600)orbetter).

1.2 Contractor’sFieldPersonnelshallcarryanaloganddigitallycapable,700/800MHz

trunkedportableradiowithremotepublicsafetyspeakermicrophone.Allportable

radiosshallbecompatiblewithAlamedaCounty’strunkedradiosystem(equivalent

toMotorolaAPX7000(3600/9600)orbetter).

1.3 ContractorFieldPersonnelshallcarryCounty‐approvedradios,rebanding‐capable,

digitallyformattedandfullycompliantwithP‐25PhaseIandPhaseII(once

released)interoperabilitystandards.

1.4 Contractorshalloperatesubscriberradiosincompliancewithallrulesand

regulationsoftheFederalCommunicationsCommissionandAlamedaCounty.

1.5 ContractorshallequipallClinicalandOperationsFieldSupervisorVehicleswith

analog/digitalcapablemobileradioprogrammedforoperationontheCALCORD

(equivalenttoMotorolaAPX7500VHForbetter).

1.6 ContractorshallequipallAmbulancesandeachClinicalandOperationsField

SupervisorVehiclesusedinprovidingServicestotheCountywithradiosfor

communicationswithhospitalreceivingfacilitiesandforAmbulance‐to‐hospital

communications.

2. CellularPhones

Contractor'sSupervisorVehiclesshallbeequippedwithawirelesscellphonefordirect

landlinecommunicationswiththeBaseHospital,receivinghospitals,CountyDispatch

Centerandothernecessarypersonneloragencies.Cellularphoneorotherportable


PageE‐9of26

handhelddevicemustbecapableofreceivingemergencyresponsedatafromtheACRECC

pagingsystem.

3. 12LeadECGTransmission

Contractorshallinstall12‐Leadelectrocardiogram(“ECG”)monitorsincludingamodem

fortransmissioninallAmbulanceunits,ClinicalFieldSupervisorvehicles,andFRALS

apparatus(inaccordancewithEXHIBITM‐FIRSTRESPONDERSUPPORT),toallowtransmission

of12‐LeadECGstoreceivingfacilities..


PageE‐10of26

EXHIBIT F ‐ RESPONSE TIMES REQUIREMENTS AND FINES

ResponseTimefinesforCharlie,DeltaandEchoambulanceresponsesshallbeineffectonthe

ServicesStartDate.ResponseTimefinesforAlphaandBravoresponsesshallbeineffectsix

monthsaftertheServicesStartDate.

TableB‐ResponseTimeFinesbyCategoryandCompliance

Compliance:CATEGORY:

89.5–<90% 89‐<89.5% <89%

Echo $25,000.00 $35,000.00 $50,000.00

Delta/Charlie $15,000.00 $25,000.00 $35,000.00

Bravo/Alpha $5,000.00 $10,000.00 $15,000.00

TableC‐OutlierResponseTimesbyCategoryandSubareainMinutes&Seconds

Subarea:CATEGORY:

Metro/Urban Suburban/Rural WildernessFine:

Echo 12:45 21:00 27:00 $5,000.00

Delta 15.45 24:00 33:00 $2,500.00

Charlie 33:00 37:30 42:00 $2,500.00

Bravo 33:00 37:30 42:00 $1,000.00

Alpha 45:00 60:00 60:00 $1,000.00

TableA‐PersonnelandResponseTimeRequirements

MPDSDispatchCategory

SubArea:PersonnelConfiguration:

Metro/Urban Suburban/Rural Wilderness

Echo 2Paramedics 08:30min. 14:00min. 18:00min.

Delta 1Paramedic1EMT 10:30min. 16:00min. 22:00min.

Charlie 1Paramedic1EMT 15:00min. 25:00min. 28:00min.

Bravo 2EMTs

15:00min. 25:00min. 28:00min.

Alpha 2EMTs 30:00min. 40:00min. 40:00min.


PageE‐11of26

EXHIBIT G ‐ PARAMEDIC TRAINING REQUIREMENTS

1. AdvancedCardiacLifeSupport(ACLS)Certification‐AmericanHeartAssociationoran

approvedequivalent.

2. ECGTraining‐interpreting12‐LeadECGsforSTelevation

3. TraumaTraining‐PrehospitalTraumaLifeSupport(PHTLS)orInternationalTraumaLife

Support(ITLS)

4. PediatricEducation‐PediatricEducationforPrehospitalPersonnel(PEPP),Pediatric

AdvancedLifeSupport(PALS),orEmergencyPediatricCare(EPC).Contractorshallensure

thatallParamedicscompletethistrainingwithinsix(6)monthsofhirebyContractor.

5. CompanyOrientation‐Inadditiontoallotherrequirements,Contractorshallproperly

orientallFieldPersonnelbeforeassigningthemtorespondtoemergencymedicalrequests.

Suchorientationshallincludeataminimum,Contractor'spoliciesandprocedures;radio

communicationswithandbetweentheprovideragency,BaseHospital,receivinghospitals,

andCountycommunicationscenters;andAmbulanceandequipmentutilizationand

maintenance.

6. EMSOrientation‐ContractorshallensurethatallFieldPersonnelattendEMSorientation

sponsoredbyEMSonamonthlybasis.Thisorientationshallprovideanoverviewofthe

AlamedaCountyEMSsystem,reviewofEMSPolicies,documentationrequirements,and

CPRreview.

7. MCIResponse‐ContractorshalltrainallAmbulancepersonnelandsupervisorystaffin

theirrespectiverolesandresponsibilitiesundertheCountyMulti‐CasualtyIncidentPlanas

definedinEMSPolicies,andpreparethemtofunctioninthemedicalbranchoftheIncident

CommandSystem.ThespecificrolesoftheContractorandotherPublicSafetypersonnel

shallbedefinedbytherelevantplansandcommandstructure.

8. HomelandSecurity‐ContractorandContractor’semployeesshallparticipateinand

receivetraininginHomelandSecurityissues,includingparticipatinginexistingprograms

availablewithintheCountyfordealingwithterroristevents,weaponsofmassdestruction,

andotherHomelandSecurityissues.

9. AssaultiveBehaviorManagementTraining‐ContractorshallprovideAmbulance

personnelwiththetraining,knowledge,understanding,andskillstoeffectivelymanage


PageE‐12of26

patientswithpsychiatric,drug/alcoholorotherbehavioralorstressrelatedproblemson

anon‐goingbasis,aswellasdifficultscenes.Emphasisshallbeontechniquesfor

establishingaclimateconducivetoeffectivefieldmanagement,andforpreventingthe

escalationofpotentiallyvolatilesituations.

10. DriverTraining‐Contractorshallmaintainanon‐goingdrivertrainingprogramfor

Ambulancepersonnel.Theprogram,thenumberofinstructionhours,andthesystemfor

integrationintotheContractor'soperations(e.g.,accidentreviewboards,impactof

accidentsonemployeeperformancereviewsandcompensation,etc.)shallbereviewedand

issubjecttoapprovalbytheCountyinitiallyandonanannualbasisthereafter.Training

andskillproficiencyisrequiredatinitialemploymentwithannualtrainingrefresher

coursesandskillconfirmation.

11. InfectionControl‐Contractorshalldevelopaninfectioncontrolprogram,consistentwith

EMSPolicies,thatemphasizesaggressivehygienepracticesandproactivepersonal

protectiveequipmentdonning(e.g.eyeprotection,gloves,etc).TheContractorshall

developandstrictlyenforcepoliciesforinfectioncontrol,crosscontamination,andsoiled

materialsdisposaltodecreasethechanceofcommunicablediseaseexposureand

transmission.

12. ICSTraining‐AllfieldpersonnelmustcompletethefollowingIncidentCommandSystem

training:ICS100,200,700,and800.Coursesmaybecompletedthroughindependent

online‐learning;suchhasfreecoursesavailableontheFEMAwebsite.Additionally,ICS

300and400arerecommendedforSupervisorsandpersonnelwhoshallrespondtothe

CountyEmergencyOperationsCenter.


PageE‐13of26

EXHIBIT H ‐ CONTRACTOR’S USER FEES ‐ 911 SYSTEM

Effective11/1/2011

BundledBaseRate $1,560.17

Mileagepermile $35.90

Oxygen $117.63

*Treat,Non‐transportRate $433.39

*Treat,NonTransportFee‐shallbelimitedtopatientswhoreceiveamedicalintervention,such

asintravenousmedicationadministration,andsubsequentlyrefusetransport.Patient

assessment,includingECGmonitoring,doesnotconstitutetreatment.


PageE‐14of26

EXHIBIT I ‐ MANDATORY DATA FIELD REQUIREMENTS

A. Locationofincident

B. Approximatetimeofpatientcontact

C. Patientname

D. Residence

E. Age

F. Weight

G. Generalassessment

H. Pastmedicalhistory

I. Historyofpresentillness/injury

J. Mechanismofinjury

K. Medications

L. Allergies

M. Physicalassessment

N. Vitalsigns(BP,Pulse,Respirations,Skinsigns,SpO2)

O. Treatmentadministered

P. Responsetotreatment

Q. Narrative

R. GlasgowComaScale

S. Signature/nameofpersoncompletingPCR


PageE‐15of26

http://www.co.alameda.ca.u

EXHIBIT J ‐ FIRST SOURCE AGREEMENT

ContractoragreestoprovideAlamedaCounty(throughEastBayWorksandSocialServices

Agency),ten(10)workingdaystorefertoContractor,potentialcandidatestobeconsideredby

Contractortofillanyneworvacantpositionsthatarenecessarytofulfilltheircontractual

obligationstotheCounty,thatContractorhasavailableduringthelifeofthecontractbefore

advertisingtothegeneralpublic.ContractorshallalsoprovidetheCountywithspecificjob

requirementsforneworvacantpositions.Contractoragreestouseitsbesteffortstofillits

employmentvacancieswithcandidatesreferredbyCounty,butfinaldecisionofwhetherornotto

offeremployment,andthetermsandconditionsthereof,tothecandidate(s)restsolelywithinthe

discretionoftheContractor.

AlamedaCounty(throughEastBayWorksandSocialServicesAgency)agreestoonlyrefer

pre‐screenedqualifiedapplicants,basedonContractorspecifications,toContractorforinterviews

forprospectiveemploymentbyContractor(seeIncentivesforContractorParticipationunder

Contractor/FirstSourceProgramlocatedontheSmallLocalEmergingBusiness(SLEB)Website.

IfcompliancewiththeFirstSourceProgramshallinterferewithContractor’spre‐existinglabor

agreements,recruitingpractices,orshallotherwiseobstructContractor’sabilitytocarryoutthe

termsofthecontract,ContractorshallprovidetotheCountyawrittenjustificationofnon‐

complianceinthespaceprovidedbelow.

CompanyName:

ContractorsSignature:______________________________________________________________________________________

Title:

Date: / /

__________________________________________________________ Date: / /

(EastBayWorks/One‐StopRepresentativeSignature)


PageE‐16of26

EXHIBIT K – TRANSITION PLAN

April2010 AlamedaCountyBoardofSupervisorsawardsAgreement BeginnegotiationswithACRECCforCommunicationsandDispatchservices

May2010 IdentifyParamedicsPlusOperationsFacilityinAlamedaCountyandbeginnegotiating

lease MeetwiththeAlamedaCountyEMStodiscusstransitionandtonegotiatethefinalcontract

June2010 MeetwithNEMSAtodevelopanagreementtogetformonthlyupdateon#ofduespaying

members ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty

July2010 CompletenegotiationswithAlamedaCountyFDforCommunicationsandDispatchservices SchedulemeetingswiththecurrentAlamedaemployees.Theseinformalmeetingsare

designedtoquellanyrumorsandprovideemployeeswithusefulandfactualinformationaboutthetransitionandensureasmoothchangeover.

ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty

August2010 ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers ScheduleameetingwiththeEMSMedicalDirectorandParamedicsPlussenior

managementteamtoensurethatourtransitionplancoversallclinicalissuesandconcerns. ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty

September2010 RelocationofChiefOperatingOfficerbeginningSeptember1,2010 ExecuteagreementwithACRECCforCommunicationsandDispatchservices.Thisshould

includethefollowingitems.o ACRECCtohiredispatchers4‐6monthsinadvancefortrainingo ParamedicsPlustoparticipateonACRECCTechnical/Operationssubcommitteeo ParamedicsPlustosecurevotingmembershiponAdvisoryCommittee

MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers Formemployeeworkgroupsfor

o Equipmentlayoutinambulanceso OperationsFacilityprocessmanagemento EMSWarehouselayoutandprocessmanagemento Satellitestationlocations,layoutandprocessmanagement

ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty FinalizeandexecuteParamedicsPlusOperationsFacilityleaseandbeginlease‐hold

improvements.October2010

Establishane‐mailbasedmethodofcommunicationwiththeincumbentworkforceandothersystemstakeholders.Thepurposeofthesecommunicationswillbetomanagerumorsandprovideinterestedpartieswithinformationaboutthenewsystemandthetransition.


PageE‐17of26

MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty

November2010 MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty

December2010 MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty

January2011 ObtainappropriateCityBusinessLicense Placeorderswithvendorsforcapitalequipmentincludingambulancesandothersupport

vehicles Setmeetingdates,timesandlocationstobeginmeetingwithincumbentleadership MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty

February2011 Conductmeetingswithincumbentleadershiptohaveopendialogueregardingconcerns

fromworkforce,discussionaboutParamedicsplusphilosophyandculture,andsetoneononemeetingdatestodiscussindividualtransitionstoParamedicsplus


March2011 OngoingmeetingswiththeAlamedaCountyEMS,ParamedicsPlusseniorleadership

includinghumanresourcesandrepresentativesfromtheuniontoadjustandfinalizetheactivitiesandtimelineforstartuportakeoverofoperation

BeginmeetingwithallFireAgenciestodevelopMutual‐AidAgreements Monthlymeetingwithincumbentleadershiptodeveloptransitionplans Schedulemeetingwiththeincumbentprovider’smanagementteamtofinalizethe

transitionplan. FollowupmeetingwiththeSystemMedicalDirectorandParamedicsPlussenior

managementteamtoensurethatourtransitionplancoversallclinicalissuesandconcerns. MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting MonitorReviewmonthlyupdatefromNEMSAon#ofduespayingmembers ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty

April2011 MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers Initialdeliveryofcapitalequipmentandvehicles BegininstallationofePCRsystem

o WorkingbothwithEMSITandACRECCIT Obtainthefollowinginsurances:

o AutomobileLiability


PageE‐18of26

o ListofvehiclesbyVIN,modelandyearo Originalcostofvehicleo Listofalldrivers

Begintesting,installationandcheck‐offofallequipment ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty

May2011 CompleteoutfittingofallEMSvehiclesandprepareforAlamedaEMSandCHPinspection Beginestablishingmethodsandprocessesofthedaytodaybusinessandoperation

includingthefollowing: Obtainthefollowinginsurances:

o ProfessionalLiabilityandCommercialGeneralLiabilityo CommercialUmbrellaLiabilityo AutomobileLiabilityo ListofvehiclesbyVIN,modelandyearo Originalcostofvehicleo Listofalldrivers

Workers’Compensationo Numberofemployeesbyjobclassificationo Addressofeachlocationandnumberofemployeesateachlocationbyjob

classification AllNewEmployeesfromIncumbentProvider‐Totalwagesbyclassification EmployeeInsurance

o Clarifycoveragedetailsformedical,dental,visions,ShortandLongTermDisability,AD&D,LifeandEAP

o Numberofemployeesbygender Totalwages

o Establishemployee401(k)programo Establishpayrollsystem

Establishaccountspayablesystembyvendoro Completecreditapplicationprocesso GeneralLedgeraccountsforfinancials

Focusonemployeeneeds.Scheduleemployeemeetingsoverthreeconsecutivedaystoallowallemployeestheopportunitytoattend.Duringthismeetingwewill:o HaveallemployeescompleteaParamedicsPlusapplicationo Haveallemployeescompletedrugscreenapplicationo Haveallemployeescompletedrugscreenon‐sitebyutilizingamobiledrug

screeningunitorotherapprovedmobilecollectionpersonneloragency.o Obtaincopiesofallemployeecertificationso Obtaincopiesofalldriverslicensesandsocialsecuritycardso CompleteI‐9andEEOdocumentationo CompleteW‐4formso Completeinsurancecoverageformso Distributepolicyandproceduremanualswithsignedacknowledgmentofreceipt.

MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty BegindevelopmentofanEmergencyOperationsPlan


PageE‐19of26

BegindevelopmentofQualityManagementPlan BegindevelopmentofCISMPlan

June2011 FinalizeallFireAgencyMutualAidAgreements MeetwithCaliforniaHighwayPatrolandAlamedaEMStolicenseallvehicles MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty

July2011 Employeeorientationsbegin

o PoliciesandProcedureso ePCRsystem


August2011 MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting MeetwithNEMSAformonthlyupdateon#ofduespayingmembers ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty SubmitanEmergencyOperationsPlan SubmitQualityManagementPlan SubmitCISMPlan Submitcontrolledsubstancespolicy

September2011 MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty

October2011 MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting Finalcheck‐offofentireProjectPlanforcompletion ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty

November1,2011Start‐up ParamedicsPlusbeginsoperations


PageE‐22of26

EXHIBIT L ‐ COMMUNITY EDUCATION PROGRAM

1. Contractorshallprovideacommunityeducationprogram,basedontheneedsofthe

communityasdefinedbytheCountyandEMS.Thecommunityeducationprogramshall

containsomeorallofthefollowing,whichmaychangefromtime‐to‐timeascommunity

needschange:

2. Contractorshallannuallyundertakeatleastoneprojectthatshalldemonstrablyimprove

thehealthstatusinthecommunity.

3. Healthstatusimprovementprogramstargetedto“atriskpopulations”mayincludebutare

notlimitedto:

a. Seatbeltuse

b. Bikesafetyprogram

c. ParticipationinNTHSAsafecommunitiesprogram

d. CPRtraining

e. 911awareness

f. Gunsafety

g. Huntingsafety

h. Drowningprevention

i. Equestrianaccidentprevention

j. Seniorsafetyprogram

k. Homehazardinspectionprogram.

l. ChildPassengerSafetyProgram:

Contractorshallimplementachildpassengersafetyprogram(CPS)inAlameda

County.Theprogramshallincludethepurchaseanddistributionofcarseatsto

targetedpopulations,asdefinedbyEMS.

Within18monthsofEffectiveDateaminimumof:

– onememberoftheContractorstaffshallearninstructorstatusinthe

NationalChildPassengerCertificationProgramandshallbeginofferinga


PageE‐23of26

two‐hourintroductoryCPScourseaspartoftheorientationprocessforall

FieldPersonnel.

– twomembersoftheeducationstaffshallearnNationalChildPassenger

CertificationthroughtheNationalHighwaySafetyAdministration’s

curriculum.

ContractorshallofferCPSclassestothecommunityatnocost.Contractorshall

provideatleastoneprogramayearineachcityintheEOAincluding

unincorporatedareas.

Contractorshallmeasuretheeffectivenessofthechildpassengersafetyprogram

bymonitoringtheincreasedincidenceofchildrestraintuse.StateorCounty

observationstudiesshallbeutilizedtoprovideunbiaseddocumentation.

Contractorshallsetagoalofcontributingtoa1%increaseeachyearinchild

passengerrestraintusagefortheCounty.

m. GunSafetyProgram:

ContractorshallbringEddieEaglegunsafetyprogramtoAlamedaCounty

childrenfrompre‐Kthroughthirdgrade.Thisprogramshallfocusonteaching

youngchildrenwhattodowhenconfrontedwithafoundgun.

ContractorshallpartnerwithAlamedaCountyelementaryschoolsandday‐care

centerstoprovidethisprogramatnocosttothefacility.

Contractorshallcompilecomparativestatisticsregardingfirearmtraumato

childrenages10andyoungertotracktheeffectivenessofthisprogram.


PageE‐24of26

EXHIBIT M ‐ FIRST RESPONDER SUPPORT

1. Inadditiontothemonetaryprovisionforfirstrespondersupport,Contractorshallprovide

thefollowingequipment(orsimilarequipmentsubjecttomutualagreementwiththeFirst

ResponderAgencies)foreachFirstResponderapparatusoperatingwithinCounty,

includingContractingCitiesinZone1,aswellasforContractor’sClinicalFieldSupervisor

andOperationalFieldSupervisorVehicles:

1.1 RuggedmobilepersonalcomputersandsoftwareforthePCRsystemforeachFirst

Responderunitapparatus,includingupdateswhenrequiredformaintenanceof

compatibilitythroughouttheEMSsystem.

1.2 ITsupportforFirstRespondercomputersin#1above.

1.3 Ninety90LIFEPAK15monitor‐defibrillatorsincludingamodem(byVelocitor)for

transmissionof12‐leadECG’sforeachunit;aswellasasufficientdataplanthatcan

accommodateandsupportthisprocess.Contractorshallholdinreserve10

additionalmonitor‐defibrillatorstobedistributedasneededatContractor’s

discretion.

1.4 Ninety90Physio‐ControlChestCompressionSystemLUCASdevices.Contractor

shallholdinreserve10additionaldevicestobedistributedasneededat

Contractor’sdiscretion.

2. Contractorshallretainownershipofandberesponsibleformaintenanceoftheabove‐

listedequipment.

3. ContractorshallalsoprovideEMScontinuingeducationforallAlamedaCountyFirst

Responseagencies,regardlessofinclusionintheEOA.Recognizingtheinherentdifficulties

insendingFirstResponseagencypersonneltoContractor’slocation,continuingeducation

shallbemadeavailableatFirstResponseagenciesthroughContractorsfourclinical

educationcoordinators.Fornewfireemployees,collaborationwithFirstResponder

Agenciesshallalsoincludefieldinternships,ridingonAmbulancesandworkingwith

Contractor’sfieldtrainingofficersforinitialsystemtraining.


PageE‐25of26

EXHIBIT N ‐ HIGH RISK PATIENT DESCRIPTION

“A High‐Risk PCR” is a patient care report for a High‐Risk Patient. A High‐Risk Patient is

defined as follows:

1. STEMI(ST‐ElevationMyocardialInfarction)patienttransportedtoanyhospital,includinga

CardiacReceivingCenter,perEMSPolicies

2. CVA(Cardio‐VascularAccident)patienttransportedtoanyhospital,includingaStroke

Center,perEMSPolicies

3. CriticalTraumaPatientwithatraumaactivation,perEMSPolicies

4. Anypatientnotbreathingorbreathingineffectively(Echocall)

5. Anyemergent(lightsandsiren)returntothehospital

6. Anypatient(otherthana5150patientwhohasbeenmedicallycleared)whoisunable,for

anyreason,toprovideahistory

7. Anypatientaged10orless


PageE‐26of26

EXHIBIT O ‐ Proposal of Paramedics Plus

(Appendices1‐56incorporatedbyreference,butnotattached)