Santa Clara County Emergency Medical Services Agency Semi-Annual Report (2012 May)

7/27/2019 Santa Clara County Emergency Medical Services Agency Semi-Annual Report (2012 May)

1/26

Santa Clara County Emergency Medical

Services Agency

Semi-AnnualReport

M a y 2 0 1 2


2/26

2

Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee


3/26

3


Table of Contents

Table of Contents ................................................................................................................................... 3

EMS Agency Activities .......................................................................................................................... 4

Start of Rural Metro as New County Ambulance Provider ....................................................................... 4

Evaluation of the Impact on Inebriates on the EMS System .................................................................... 5

Strategic Assessment and Strategic Planning Process .............................................................................. 6

Receiving Hospital Contracts .................................................................................................................... 6

EMS Trust Fund ......................................................................................................................................... 6

EMS Agency Fee Schedule ........................................................................................................................ 8

EMS System Descriptive Statistics ................................................................................................. 10

Prehospital Clinical Care and Quality Improvement .............................................................. 11

911 Ambulance Response Times ............................................................................................................ 11

Santa Clara County EOA Response Subzones and City Boundaries ........................................................ 14

Mutual Aid Provided by County 911 Ambulance .................................................................................... 15

Fire Department First Responder Response Times ................................................................................ 16

Air Ambulance Transports ...................................................................................................................... 18

Hospital and Specialty Care Facilities .......................................................................................... 19

Hospital Volume and Destinations.......................................................................................................... 19

Hospital Diversion ................................................................................................................................... 20

Trauma Care System ............................................................................................................................... 21

Stroke Care System ................................................................................................................................. 23

Cardiac Care (STEMI) System .................................................................................................................. 24


4/26

4


EMS Agency ActivitiesStart of Rural Metro as New County Ambulance Provider

The period of July 1, 2011 through December 31, 2011 was marked by dynamic change for the Santa

Clara County EMS Agency and the EMS System. On July 1, 2011, the most significant change in 30 years

of EMS in Santa Clara County occurred, as Rural Metro became the Countys exclusive 911 ambulanceprovider, taking over from American Medical Response.

The exclusive 911 ambulance contract between Santa Clara County and Rural Metro is widely regarded

as the most comprehensive and progressive EMS contract in the State, and the personnel of the Chief

Executives Office, County Counsels Office, the Department of Public Health, and the EMS Agency

should be commended for outstanding performance in the development and execution of this contract.

Under the new contract,

ambulances are arriving on

scene of emergency and

non-emergency calls quickerthan before July 1. Except for

minor challenges during the

first two weeks of the contract implementation, Rural Metro has met response time standards for

emergency and non-emergency calls in all zones and in aggregate. The EMS Agency is working closely

with County Communications and Rural Metro to fine tune ambulance deployment and dispatch

performance to further improve system efficiency.

In addition to faster response times, the EMS System presents other significant improvements:

Improved medical support to law enforcement and fire services across the county. Rural Metrowill provide at no cost, standby ambulances and supervisors for critical public safety events,

such as large fires, and police SWAT operations.

Increased disaster response capability, including the ability to dispatch a strike team of fiveambulances and a field supervisor in less than 8 minutes of receiving a request.

Improved field supervision, coordination, and training through 24/7 staffing of EMS Duty Chiefs.

Improved public information and community education programs.

Implementing a comprehensive electronic data system. This system will provide criticalinformation about system clinical care, operational efficiency, and cost effectiveness. When

completed, all EMS System providers, including communications centers, fire and ambulance

providers, and hospitals will contribute data. This will allow the EMS System to make evidence-

based decisions and better evaluate the medical care we provide. Santa Clara County will be the

largest EMS System in the nation to have this level and sophistication of data integration.

More detailed information, including Rural Metros response time performance statistics, is provided on

pages 11 through 14.


5/26

5


Valley Medical Center 472

Regional Medical Center of San Jose 368

Kaiser San Jose 94

El Camino Hospital of Mt View 88

Kaiser Santa Clara 81

O'Connor Hospital 67

Good Samaritan Hospital 60

St. Louise Hospital 46

O'Connor Hospital 37

Palo Alto Veterans Admin Hospital 19

Stanford University Hospital 18

El Camino Hospital of Los Gatos 8

In the following pages, three of the EMS Agencys strategic projects are highlighted. These projects

include the evaluation of the Impact of Inebriates on the EMS System, the EMS System Strategic

Assessment and Planning Process, entering into contracts with hospitals to receive ambulance patients.

Additional information is provided regarding expenditures from the EMS Trust Fund and the EMS

Agencys fee schedule.

Evaluation of the Impact on Inebriates on the EMS System

At the direction of Public Health Administration, the EMS Agency began evaluating the need and

feasibility of establishing an inebriate care system. The impetus for this evaluation was numerous

comments from stakeholders identifying a large volume of inebriate patients intensively using EMS and

hospital services. The core group of stakeholders involved in the analysis included the Public Health

Department, Valley Medical Center, Valley Homeless Health Program, the Mental Health Department,

Department of Alcohol and Drug Services, Jail Health Services, Destination Home, and the EMS Agency.

This group identified four short-term objectives: 1) Quantify the volume of chronic inebriate

EMS transports and emergency department visits; 2) Estimate costs associated with these events; 3)

Determine the safety and efficacy of various types inebriate centers; and, 4) Identify other organizationsthat should be involved in inebriate system planning.

The preliminary analysis identified:

Between July 1, 2011 and December 31, 2011, Rural Metro had 1,453 transports of patients whoappeared to be only or primarily inebriated. This equates to 2,906 transports annually.

Inebriated patients' ages ranged from 13 to 110. Twenty-four percent of the patients werefemale, 76 percent of the patients were male. For both females and males, the most frequently

occurring age ranges were 40 to 49 and 50 to 59.

The top ten patients were transported 154 times during this six month period.

Many of the highest-frequency users were transported to multiple hospitals. The mostfrequently transported patient was transported to 8 different hospitals. Many of the top ten

highest frequency inebriated patients was transported to four or more hospitals during the six-

month period.

The patient who was transported mostfrequently was transported 38 times during this

6-month period. This equates to one and one-

half ambulance transports for inebriation per

week.

All of the top ten patients in this data analysis

were homeless and uninsured. In fact, themajority of frequent use patients (3 times or

more per year) were homeless.

The EMS System and hospitals within Santa ClaraCounty were impacted by the volume of

inebriate transports. The number of destination-

identified transports is shown on the right:


6/26

6


Additional stakeholders have joined the planning process. These stakeholders include the Sheriffs

Office, municipal law enforcement, hospitals, and Rural Metro Ambulance. The group is committed to

identifying a system that provides safe, respectful, clinically appropriate treatment of inebriates;

including pathways to comprehensive wrap around mental health, social, and other supportive services,

while reducing the operational and economic impact on EMS, hospitals, and criminal justice systems.

Strategic Assessment and Strategic Planning Process

During the summer of 2012, the EMS Agency will conduct a strategic assessment of the Santa Clara

County EMS System. This assessment will evaluate the opportunities and threats facing the EMS System,

from national, regional, and local influences. The assessment will consider those threats and

opportunities in the context of the strengths and weaknesses of the EMS System, and emphasize a 3 to

7 year horizon, focusing on maintaining or improving clinical care, improving operational efficiency,

assuring cost effectiveness, and the financial solvency of the EMS System. Following the strategic

assessment, the EMS Agency will lead the development of an EMS System Strategic Plan, based upon a 3

to 7 year timeframe. The desired output of this planning process is a high-level plan that identifies the

EMS Systems Mission, Vision, Values, Goals, and Objectives. The strategic plan will be an essential inputto future changes to the EMS System.

To date we have developed and released the Request for Proposal (RFP) to engage a professional

consulting firm, who will lead the strategic assessment and planning process. The scope of work portion

of the RFP was provided to EMS System Stakeholders for comments, and the EMS Committee reviewed

and approved the RFP scope of work at their March 1, 2012 meeting.

The consulting firm will begin their work near the anticipated release of the US Supreme Courts

decision on the Patient Protection and Affordable Care Act, because that decision will materially impact

the financing and provision of medical care, including emergency medical services, throughout the

nation.

Receiving Hospital Contracts

The EMS Agency entered into new contracts with eleven ambulance-receiving hospitals within Santa

Clara County. Through this agreement, hospitals agreed to comply with applicable EMS Agency policies

and procedures, to provide patient care data for analysis, and to participate in the EMS System Quality

Improvement Program. During development of the agreement, the EMS Agency and the hospitals

agreed to create a master hospital agreement, and have specific annexes for receiving facility, trauma

center, stroke center, and cardiac center services. This new contract structure and increasing the

contract renewal period to five years was well received by hospital executives, and will save the County

and hospitals significant time and resources.

EMS Trust Fund

The EMS Agency provided the detailed financial report to the Health and Hospitals Committee on the

EMS Trust Fund at its February 15, 2012. This EMS Trust Fund summary discusses how the expenditures

from the EMS Trust Fund improve EMS within Santa Clara County.


7/26

7


Category A: Reserve

At the Board of Supervisors direction, starting in Fiscal Year 2011-2012, a reserve category was

established in the EMS Trust Fund. This amount, which is at least 20% of the EMS Trust Fund, will be

placed into reserve and used only for significant strategic projects that benefit the EMS System with a

long range focus. These funds could also be used should the EMS System experience an unanticipated

financial burden, such as the failure of an ambulance provider or an extraordinary increase of cost ofservice or supplies, or a material decrease in system-wide third-party payor reimbursement. During the

2012 Fiscal Year, $342,000 of the EMS Trust was placed into reserve.

Category B: Training, Education, and Recognition

Allocations were approved to produce a public service announcement video that informs those in Santa

Clara County when to call an ambulance and what to expect when an ambulance is called. This multi-

lingual video will be made available in numerous formats. Additionally, the EMS Agency is providing a

series of courses to EMS System stakeholders to improve their response to mass casualty incidents and

to better understand the use of data and statistical processes to evaluate quality of care and operational

effectiveness. This training is critical to the strategic goal of basing EMS System decisions on data and

evidence. In May, the EMS Agency will host its annual conference and recognize outstanding EMSSystem participants from medical dispatch centers, hospital emergency departments, field EMTs and

Paramedics, and members of the public. During the 2012 Fiscal Year, $150,000 was allocated to training,

education, and recognition.

Category C: Benefit to EMS System Stakeholders

Funds were allocated from this category to assist EMS System Stakeholders with one-time or short-term

needs. During Fiscal Year 2012, funds were allocated to the fire departments within Santa Clara County

to establish computer aided dispatch links to the response time performance software package and to

provide minimal funding for hardware associated with the County EMS System Data Project. This

allocation was essential to creating a comprehensive EMS System data collection and analysis capability.

Funds were also allocated to the EMS Section of the Santa Clara County Fire Chiefs Association to hire a

contractor to develop an Employee Communicable Disease Exposure Plan and reporting system. This

plan and reporting system will be offered to all fire departments, law enforcement agencies, and

ambulance agencies within Santa Clara County. A common plan and reporting format among all

providers reduces the possibility that an exposed employee will not receive timely exposure

investigation and treatment.

Funding was also allocated to Santa Clara County Communications to enhance their use of Emergency

Medical Dispatch pre-arrival instructions and to install additional MARVLIS display terminals in County

Communications. MARVLIS is an ambulance deployment program, which suggests to the dispatcher

where ambulances should be placed to minimize response times. During the 2012 Fiscal Year, $108,000was allocated to short term and one time projects that benefit EMS System Stakeholders.

Category D (Strategic Initiatives)

Projects in this category emphasize the development of initiatives that strategically advance the Santa

Clara EMS System, often in the longer term. Funds were allocated to conduct a strategic assessment and


8/26

8


to pay for costs in developing the EMS S Data System. Details on the strategic assessment and strategic

planning process are provided on page 6. During Fiscal Year 2012, $250,000 was allocated to strategic

projects.

EMS Agency Fee Schedule

The EMS Agency relies on its service fees for funding operations. Effective July 1, 2011, the Board ofSupervisors authorized fee increases to offset the increased cost of providing EMS planning, regulation,

oversight, and quality improvement services. Fee increases were authorized for ambulance and air

ambulance companies, and to permit the individual vehicles operated by these companies. Additionally,

a new fee was instituted for all hospitals that receive ambulance patients, and fees for specialty services,

such as Trauma Centers, Stroke Centers, and Cardiac Centers, were increased to reflect the increasing

costs of system-wide planning, analysis, and quality improvement. The authorized changes are

indicated in the following charts and the complete EMS Agency Fee Schedule is on the following page.

Private Ambulance Permit Fees

Description FY11 FY12

Basic Life Support Ambulance Service (8) 5,000.00 5,500.00

Advanced Life Support Ambulance Service (4) 5,000.00 6,000.00

Critical Care Transport Ambulance Service (4) 5,000.00 6,000.00

Air Ambulance Service Permit (3) 5,000.00 8,000.00

Per Unit/Resource Permit (150 est) 800.00 950.00

EMS Receiving Facility Fees

Description FY11 FY12

911 Paramedic Receiving Facility (10) NEW 0 10,000.00

EMS Stroke Receiving Facility (9) 8,000.00 10,000.00

EMS Cardiac Receiving Facility (8) 8,000.00 10,000.00

EMS Trauma Receiving Facility (3) 75,000.00 100,000.00


9/26

9


2011 - 2012 EMS Agency Fee Schedule

ITEM/SERVICE FEE

INDIVIDUAL FEES

EMT-Basic Certification $50

EMT Basic Re-Certification (biennial) $50

EMT-P Local Accreditation $150

Identification Card $20

Replacement ID Card (certification, accreditation, system ID) $20

Photocopying $4.75 (1st page)

$.10/ea. Addl.

CORPORATE FEES

Ambulance Service Permits (annual fee)Basic Life Support $5,500

Advanced Life Support $6,000

Critical Care Transfer $6,000

Air Service $8,000

Ambulance Vehicle Permits (annual fee)

Basic Life Support $950

Advanced Life Support $950

Critical Care Transfer $950

Air Unit $950

Non-Transport BLS/ALS Unit (Quick Response) $800

Education Program Certification (every 4 years)

EMT Program $1,000

Paramedic Program $5,000

Pre-Hospital Continuing Education $1,000

Specialty Care Designation (annual fee)

Trauma Center Designation $100,000

Stroke Center Designation $10,000

STEMI Receiving Center Designation $10,000

911 Receiving Center Designation $10,000


10/26

10


EMS System Descriptive StatisticsListed below are statistics that describe the characteristics of the Santa Clara County EMS during

calendar year 2011.

The County of Santa Clara

DaytimePopulation

2.2 mil

ResidentPopulation

1.8 mil

GeographicSize

1,132 sq. mi.

GeographicDes.

2/3 rural

Municipalities 15

911 System Call Volume

Calendar Year 2011

TotalResponses

76,163

GroundAmbulanceTransports

69,508

EMS AircraftResponse

192

EMS AircraftTransports

110

CalendarYear 2010Total

Responses95,092

Ground

Ambulance

Transports

64,507

EMS Aircraft

Response176

EMS Aircraft

Transports103

Interfacility Transports

Ground Ambulance

(2011)22,627

Ground Ambulance

(2010)44,839

Ground Ambulance

(2009)39,603

Patients at Specialty Centers

Stroke Patients 2,642

Trauma Patients 7,619

STEMI Patients 423

Pre-hospital Care Provider

Agencies

Fire Departments 11

Ground AmbulanceServices

10

Air AmbulanceServices

3

Pre-hospital Care Personnel

Emergency MedicalTechnicians

3019

Paramedics 744

Mobile IntensiveCare Nurses

35

Accredited EMS FieldSupervisors

21

Permitted EMS Assets

Fire Apparatus 159

Private GroundAmbulances

*162

Private AirAmbulances

4

Private EMS Non-Transport Units

11

*26 additional ambulance arebeing added to the system

Communications Centers

Public Safety AnsweringPoints (PSAPs)

13

Secondary PSAPs 3

Private AmbulanceDispatch Centers

9

Air Ambulance DispatchCenters

3

Acute Care Facilities

Acute Care

Hospitals12

Emergency

Departments11

Level 1 Trauma

Centers2

Level 2 Trauma

Centers1

Base Hospitals 1

Burn Centers 1

Stroke Centers 9

STEMI Centers 8

County Managed Medical-

Health Resources

Field Treatment

Site Trailers9

Specialty Service

Trailers4

Electronic Patient

Tracking Systems0

Chem-Packs 8Medical-Health

Operations Center1

EMS Radio Caches 6

Disaster Medical

Support Unit1

Training Programs

Emergency Medical

Technician6

Paramedic 2

EMS Fellowship 1


11/26

11


Prehospital Clinical Care and Quality ImprovementThere were several advances in Clinical Care and Quality Improvement in 2011. In this report, we

highlight the implementation of therapeutic hypothermia, mechanical trauma tourniquets, and

improvements in our clinical performance indicators.

Therapeutic hypothermia is the process of intentionally cooling the bodys core temperature to improve

brain function following cardiac arrest. One European study showed a favorable outcome rate of 55

percent with therapeutic hypothermia, versus a favorable outcome rate of 39 without therapeutic

hypothermia1. A favorable outcome is defined as a discharge from the hospital and the patient is able to

live independently, work, and live a productive enjoyable life. Having the capability to induce

therapeutic hypothermia in the field provides the citizens of Santa Clara County a better chance of

surviving with intact brain function following a sudden cardiac arrest.

Mechanical tourniquets provide paramedics greater ability to control life-threatening bleeding from

extremities. These tourniquets are the type used by soldiers in battle, and can be applied quickly.

Mechanical tourniquets provide improved control of bleed and reduce tissue damage, improving thepatients chance of recovery and quality of life.

Clinical performance indicators (CPIs) are measures of elements of clinical care that provide a method of

assessing the quality and safety of care at a system level. The use of CPIs provides the EMS Agency the

ability to assess the efficacy of our treatment protocols and policies. In 2011, the EMS Agency used

clinical performance indicators to evaluate the appropriate use and frequency of intraosseous infusion

(placing a needle into a hollow portion of a bone to administer fluids), the efficacy of dispatch protocols

and medications used to treat patients experiencing chest pain from suspected cardiac ischemia, and

the time required to complete the first 12-lead EKG in patients having a heart attack. Based on the use

of clinical performance indicators, we are confirming that our processes work well, and are continuing toexamine potential improvements to clinical care in the Santa Clara EMS System.

911 Ambulance Response Times

Ambulance Response Times to Emergency Calls

The chart below identifies the ambulance response times to Code 3 (emergency red light and siren) calls

by month from July 2011 thought December 2011 in each of the five ambulance subzones within Santa

Clara County. The response time standard is 90% or greater, and is represented by the blue horizontal

line on this graphic. Note the response time for Sub-Zone One for July was 83.46%, and is not shown on

this graphic. The boundaries of each zone are displayed on page 14.

1Nolan, J.P and Morley, P.T. "Theraputic Hypotheria After Cardiac Arrest." Circulation 108 (2003): 118-121.


12/26

12


July August September October November December

Sub-Zone 1 83.46 92.25 93.17 93.50 93.49 91.68

Sub-Zone 2 90.36 95.64 94.58 93.45 93.77 94.91

Sub-Zone 3 93.40 96.69 95.03 95.28 94.63 96.10Sub-Zone 4 90.30 91.80 92.03 91.48 92.60 93.56

Sub-Zone 5 93.73 97.01 95.73 95.51 96.85 96.03

*The response time in sub-zone 1 was 83.46 percent. This number does not show on the chart, due to Excels scaling

characteristics.

88.00

90.00

92.00

94.00

96.00

98.00

100.00


Rural Metro Ambulance Code 3 Response Time

Sub-Zone 1

Sub-Zone 2

Sub-Zone 3

Sub-Zone 4

Sub-Zone 5


13/26

13


Ambulance Response Times to Non-Emergency Calls

The chart below identifies the ambulance response times to Code 2 (non emergency) calls by month

from July 2011 thought December 2011 in each of the five ambulance subzones within Santa Clara

County. The response time standard is 90% or greater, and is represented by the blue horizontal line on

this graphic.


Sub-Zone 1 94.27 97.33 97.16 95.95 97.52 96.88

Sub-Zone 2 92.89 95.85 96.61 94.71 92.78 94.88

Sub-Zone 3 93.01 96.75 97.30 96.39 95.30 95.99

Sub-Zone 4 93.17 94.38 95.54 91.74 93.86 91.57

Sub-Zone 5 100.00 98.91 98.82 94.51 100.00 94.59

The following graphic identifies the Response Subzones and the City Boundaries within Santa Clara

County.

88.00

89.00

90.00

91.00

92.00

93.00

94.00

95.00

96.00

97.00

98.00

99.00

100.00

Rural Metro Ambulance Code 2 Response Time

Zone 1-5

Sub-Zone 1Sub-Zone 2

Sub-Zone 3

Sub-Zone 4

Sub-Zone 5


14/26

14


Santa Clara County EOA Response Subzones and City Boundaries

Subzone 1: Los Altos Hills, Los Altos, Mountain View, Sunnyvale and unincorporated areas Loyola, Moffet FieldSubzone 2: Campbell, Cupertino, Los Gatos, Monte Sereno, San J ose (West), Saratoga and the unincorporated areas of Burbank,Redwood EstatesSubzone 3: Milpitas, San J ose (North), Santa ClaraSubzone 4: San J ose (East, South)Subzone 5: Gilroy, Morgan Hill and unincorporated areas San MartinSource: Santa Clara County Exclusive Operating Agreement, Exhibit BDeveloped by: Santa Clara County Emergency Medical Services AgencyCreated: 20090903


15/26

15


Mutual Aid Provided by County 911 AmbulanceThe chart below identifies the number of times neighboring EMS Systems requested assistance from the

Santa Clara County 911 ambulance provider by month from July 2011 through December 2011. In these

instances, a County Ambulance is immediately dispatched, unless the loss of that ambulance would

degrade response times in the Santa Clara County EMS System.


City of Palo Alto Requests 55 43 64 59 43 56

County of Santa Cruz Requests 4 3 1 0 0 2

County of San Mateo Requests 1 0 0 1 2 0

County of San Benito Requests 0 1 1 1 1 0

County of San Benito Requests 0 0 0 1 0 0

County of Alameda Requests 0 0 0 0 2 0

Total Requests 60 47 66 61 48 58

0

10

20

30

40

50

60

70

Requests for Mutual Aid Assistance from County Ambulance by

Month

City of Palo Alto Requests

County of Santa Cruz Requests

County of San Mateo Requests

County of San Benito Requests

County of Alameda Requests


16/26

16


Fire Department First Responder Response Times

Fire Department Response Times to Emergency Calls

The chart below identifies the fire department response times to Code 3 (emergency red light and siren)

calls by month from July 2011 thought December 2011 for each of the first-response fire departments

within Santa Clara County. Fire departments should achieve a response time of 90% or greater, andthose who achieve a response time of 95% or greater are exempted from any response time liquidated

damages incurred during that month.

Code 3 Response

(RLS)July August September October November December

Gilroy 98.24% 95.71% 97.92% 97.21% 98.27% 96.41%

Milpitas 97.79% 98.01% 97.66% 99.33% 99.31% 95.93%

Mt View 96.87% 97.40% 97.95% 97.14% 98.93% 96.70%

San Jose 92.67% 94.05% 92.80% 92.18% 92.62% 92.22%

Santa Clara City 96.22% 95.31% 95.29% 94.56% 96.20% 96.95%

Santa Clara Co. 96.07% 96.56% 96.97% 95.40% 95.59% 96.43%

So. Santa Clara Co. 96.36% 96.74% 97.52% 98.95% 100.00% 99.02%

Sunnyvale 97.49% 98.08% 98.88% 99.13% 98.47% 98.57%

90.00%

91.00%

92.00%

93.00%

94.00%

95.00%

96.00%97.00%

98.00%

99.00%

100.00%

Fire Department Code 3 Response Time Compliance by Month

J uly

August

September

October

November

December


17/26

17


Fire Department Response Times to Non-Emergency Calls

The chart below identifies the fire department response times to Code 2 (non-emergency) calls by

month from July 2011 thought December 2011 for each of the first-response fire departments within

Santa Clara County. Fire departments should achieve a response time of 90% or greater, and those who

achieve a response time of 95% or greater are exempted from any response time liquidated damages

incurred during that month. The jurisdictions that are do not have response time data in this graphic

below, did not submit the specified data to the EMS Agency.

Code 2 Response July August September October November December

Gilroy N/A N/A N/A N/A N/A N/A

Milpitas N/A N/A N/A N/A N/A N/A

Mt. View 100.00 100.00 100.00 100.00 100.00 100.00

San Jose 97.86 98.76 97.79 98.70 98.32 98.21

Santa Clara City 98.36 96.21 97.26 95.63 97.14 97.30Santa Clara Co. 100.00 100.00 100.00 99.48 99.00 99.52

So. Santa Clara Co. N/A N/A N/A N/A 100.00 100.00

Sunnyvale Dept

Public SafetyN/A N/A N/A N/A N/A N/A

90.00

91.00

92.00

93.00

94.00

95.00

96.00

97.00

98.00

99.00

100.00

Fire Department Code 2 Response Time Compliance by Month

July

August

September

October

November

December


18/26

18


Air Ambulance Transports

Air ambulance utilization continued at relatively low levels in 2011. This volume of responses and

transports has remained static since approximately 2009. The EMS Agency considers appropriate, this

volume of air ambulance responses and transports.

YearNumber ofDispatches

Number ofTransports

Dispatch totransport percent

2001 557 254 46%

2002 540 254 47%

2003 524 236 45%

2004 545 251 46%

2005 463 205 44%2006 443 221 50%

2007 442 207 47%

2008 248 137 55%

2009 184 111 60%

2010 176 103 59%

2011 179 107 60%

254 254

236

251

205

221207

137111 103 107

557540

524

545

463443

442

248

184176

179

100

200

300

400

500

600

ResponsevTrans

port

Air Ambulance Utilzation by YearTransports

Responses

Source: Santa Clara County EMS Agency, County Communications


19/26

19


Hospital and Specialty Care Facilities

Hospital Volume and DestinationsDuring 2011, there were 69,508 ambulance transports from the 911 System to hospitals within Santa

Clara County. This is an approximate increase of 8% over the transport volume of 64,507 patients in

calendar year 2010. The distribution of the patients to hospitals has not materially changed in the past

year.

Hospital

(2011)Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec Totals

Los Gatos-El Camino

92 70 86 89 86 80 89 76 69 81 82 85 985

Mt. View-

El Camino666 628 698 603 598 593 645 575 565 583 572 681 7,407

Good

Samaritan578 502 620 529 558 559 561 566 578 568 518 619 6,756

Kaiser-

San Jose606 566 614 640 639 577 574 577 591 578 550 580 7,092

Kaiser-

Santa

Clara

617 607 658 599 602 618 612 631 560 606 559 663 7,332

O'Connor 585 519 533 523 501 492 500 492 492 538 510 506 6,191

Regional-

San Jose1,133 958 1,099 1,039 1,031 973 1,005 971 1,060 1,054 1,002 952 12,277

Saint

Louise216 202 214 220 226 209 223 214 222 224 208 214 2,592

Stanford 421 437 398 413 416 365 256 165 161 157 148 410 3,747

VA - Palo

Alto49 53 47 47 63 47 57 46 42 54 45 63 613

VMC 1,123 1,049 1,154 1,134 1,136 1,227 1,327 1,248 1,239 1,363 1,236 1,280 14,516

Total 6,086 5,591 6,121 5,836 5,856 5,740 5,849 5,561 5,579 5,806 5,430 6,053 69,508

Source: Santa Clara County Communications; Palo Alto Fire Dept.*

0

1,000

2,0003,000

4,000

5,000

6,000

7,000

Patients Transported to Hospital Emergency

Departments from 911 System 2011

VMC

VA - Palo Alto

Stanford

Saint Louise

Regional - San JoseO'Connor

Kaiser - Santa Clara

Kaiser - San Jose

Good Samaritan

Mt. View - El Camino

Los Gatos - El Camino


20/26

20


Hospital DiversionHospital diversion is the practice by which a hospital closes to ambulances transporting non-critical or

non-specialty care patients. In the Santa Clara EMS System, hospitals should not use diversion more

than 36 hours per month. This standard is graphically identified in the blue horizontal line.

Hospital diversion levels appeared to trend toward stabilization, with hospitals in general achievinglower diversion levels in Calendar Year 2011. However, the EMS Agency is monitoring a concerning

trend of increased ambulance wall times. This is the practice of busy hospital emergency departments

not timely accepting the ambulance patient, causing the ambulance crew to wait for extended periods

at the hospital. The EMS Agency is developing measurement methods and metrics to quantify and

resolve this problem.

0.00

20.00

40.00

60.00

80.00

100.00

120.00

Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec

Hospital ED Diversion Hours

by Month 2011

El Camino - Los Gatos

El Camino - Mt. View

Good Samaritan

Kaiser - San Jose

Kaiser - Santa Clara

O'Connor

Regional - San Jose

Saint Louise

Stanford

VA - Palo Alto

VMC


21/26

21


Hospital Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec Totals

El Camino

Los Gatos0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

El Camino

Mt. View8.61 16.53 9.02 18.11 13.17 21.76 29.08 6.02 16.34 20.25 3.71 15.89 178.49

Good

Samaritan 10.52 30.05 10.52 9.02 7.52 9.04 3.90 0.00 2.46 0.66 7.12 8.12 98.93

Kaiser

San Jose0.00 0.00 0.00 0.00 0.00 0.00 0.21 0.00 0.00 0.00 0.00 0.00 0.21

Kaiser

Santa Clara9.49 3.01 1.22 0.00 4.51 0.00 1.50 1.50 1.50 1.50 1.51 4.50 30.24

O'Connor 22.55 29.64 23.21 35.02 21.04 32.14 16.54 5.83 4.26 4.52 3.42 12.02 210.19

Regional

San Jose33.51 23.92 19.15 25.55 25.30 27.08 16.90 16.53 4.51 4.50 7.91 4.51 209.37

Saint Louise 10.52 16.01 16.56 9.02 10.11 15.67 4.51 16.55 36.76 16.81 4.52 17.01 174.05

Stanford 42.96 19.65 23.90 15.03 7.53 16.71 9.02 0.00 3.00 1.51 0.00 13.29 152.60

VA - Palo

Alto

40.86 41.34 4.07 0.00 17.22 1.50 34.77 25.54 16.52 28.23 72.20 6.00 288.25

VMC 100.68 74.84 69.85 59.52 50.43 15.79 11.15 5.53 8.61 6.91 11.73 6.74 421.78

Total 279.70 254.99 177.50 171.27 156.83 139.69 127.58 77.50 93.96 84.89 112.12 88.08 1,764.11

Trauma Care SystemThe Santa Clara County Trauma Care System has existed for over 30 years. This evidence- based system

provides patients the opportunity to be transported to the closest, specially designated hospital, which

can provide immediate trauma care services to patients who are injured in Santa Clara County, or in

other adjacent counties. There are three trauma centers in Santa Clara County; Santa Clara Valley

Medical Center (SCVMC), Regional Medical Center of San Jose (RSJ), and Stanford University Hospital(SUH). SCVMC and SUH are also designated as Pediatric Trauma Centers. Each Trauma Center provides

service to an assigned catchment area.

There is much scientific evidence which supports the concept of the transport of severely injured victims

to a specially designated center that has a concentration of services able to provide rapid treatment and

continuing care to trauma victims. The low death rates and decreased limitations from injuries in

Trauma Centers is objective proof of the concept that was developed many years ago in battle field

medicine.

Since 2008 the trauma centers in Santa Clara County have served 29,640 patients. This includes 26,611

adults and 3029 pediatric patients.

Mode of transport to the Trauma Center: Ambulance transport occurred in 80% of all trauma cases.

Twelve (12) percent arrived by Air Medical Transport.

County of Injury: The primary county of injury is Santa Clara County which accounts for 19664 patients

(66%). The top four counties after Santa Clara are: San Mateo (14%), Santa Cruz (8%), Monterey (4%)

and San Benito (2%).


22/26

22


Type of Injury: Blunt injury (motor vehicle/motorcycle injuries, pedestrian struck, bicycle etc)

represents 91% of total injuries, while penetrating injuries (gunshot wounds, stabbings etc) are 9% of

total injuries.

Age factors: The age ranges of victims of trauma are as follows

Age range Total

0-5 years 1112

6-15 years 1752

16-21 Years 4629

22-35 Years 7515

36-45 years 3848

46-65 years 6480

66-75 years 1394

>75 years 2214

>100 years 11

Injury severity: Using a calculation referred to as the Injury severity score (ISS) we determined that 65%

of the trauma patients are in the minor injury (ISS less than 9) category, 19% are in the moderately (ISS 9

to less than 15) and 14% are in the severely ( ISS 15 to less than 75) injured category.

ISS Total Volume Percent volume

1 to less than 9 19266 65%

9 to less than 15 5632 21%

15 to 75 4150 14%

0%

10%

20%

30%

40%

50%

60%

70%

Santa Clara San Mateo Santa Cruz Monterey San Benito

Santa Clara County Trauma System

Percent Volume

County of Injury Percent vol


23/26

23


Disposition from Emergency Department: Forty five (45) percent of all trauma patients are admitted to

the hospitals. Overall 0.06% of patients expire in ED. Total discharges from the ED represent 47% of

trauma patients.

Disposition Total Volume Percent Volume

Admitted to hospital 13338 45%

Death in ED 17 0.06%

Discharged from ED 13931 47%

Stroke Care SystemThe Santa Clara County Board of Supervisors approved a stroke care system developed by the Santa

Clara County Emergency Medical Services Agency in March of 2006. This evidence- based system

provides patients the opportunity to be transported to the closest, specially designated hospital, which

can provide immediate stroke care services to patients who are showing symptoms of an acute stroke.

The need for rapid intervention is based on the a preponderance of scientific evidence that

demonstrates if the patient is treated with an anti clotting drug (IV tPa) within three and a half hours of

the onset of their symptoms, the opportunity exists to prevent and possibly reverse the effects of the

blocked circulation to the brain. In order to respond to the need for rapid treatment, the system was

designed with a specific goal: to increase the numbers of patients who arrived in the ED at the stroke

center within the time frame to allow administration of the drug.

A second goal of the stroke system has been to educate the public about stroke symptoms, and the

need to call 9-1-1 if symptoms are present. Historically the percentage of patients who come to a stroke

center by ambulance is approximately 45% of the total stroke population. Currently (2011) data showsthat 54% of the stoke patients now arrive by ambulance. This increase is potentially related to the

outreach activities accomplished by the Stroke Busters: All of the Santa Clara County Stroke Centers in

conjunction with the County EMS agency, the Prehospital transport provider, and the two non-profits

who assist with outreach, Stroke Awareness Foundation and the Peninsula Stroke Association. In

October of 2011 the Stroke Busters attended the Health Concern Outreach program at the San Jose

Flea Market. A total of 800 people of all ages and ethnicities were contacted by the group who took

their blood pressures and gave them stroke information. This annual event will continue indefinitely.


24/26

24


2011 Performance Data

Criteria County Performance Data

Total stroke patients 2546

Total number of Ischemic Strokes 2052

Total Stroke patients who arrived by EMS transport 1378

Total Stroke patients who self-transported 1087

Total Stroke patients who arrived by interfacility transfer 153Percentage of Ischemic Stroke Patients who were treated

with IV tPa11% National Avg. (1-8%)

Cardiac Care (STEMI) SystemSanta Clara County Emergency Medical Services Agency initiated a care system for patients who had

evidence of an acute heart attack (STEMI) on an electrocardiogram (EKG) performed by the Prehospital

paramedics. This is an evidence- based system which affords patients the opportunity to be transported

to the closest, specially designated hospital, which can provide immediate cardiology services including

a cardiac catheterization laboratory, to open their blocked artery.

The need for rapid intervention is based on the a preponderance of scientific evidence that

demonstrates if the patient is treated (opening up the blocked artery) within 90 minutes or less after

arrival, the opportunity exists to prevent and possibly reverse the effects of the blocked circulation to

the heart. In order to respond to the need for rapid treatment, the system was designed with a specific

goal: time of entry into the Emergency Department (ED) to the time of inflation of the balloon to open

the artery (D2B) in less than 90 minutes for 75% of all STEMI patients (this includes patients who are

0

2

4

6

8

10

12

2009 2010 2011

Santa Clara County Stroke System

Percentage of Ischemic Stroke Patients

Treated with IV tPa

IV tPa


25/26

25


transported by ambulance and those who self-transport to the ED) which is a national standard for

STEMI care.

In the beginning of the system paramedics did not electronically transmit the EKG prior to arrival at the

ED. Patients who had positive findings on the EKG were transported with only phone notification. The

paramedic would alert the receiving facility that they had a positive EKG, at which time the receivingED could elect to immediately notify the cardiology service that a STEMI patient was enroute, or the ED

would wait on the notification until the patient arrived with the EKG. Once the new transport provider

began providing service in July of 2011, the paramedic now obtains and electronically transmits an EKG

to the hospital with the notification. It was felt that this transmission would decrease the D2B time by

approximately 10-15 minutes.



Total cases with Documented STEMI 444

Median D2B in minutes 62 minutes

Goal Met (D2B in less than 90 minutes in 75% of

cases

98% of all cases were in less than 90

minutes

Total STEMIs who arrived by EMS transport 264

Total STEMIs who self-transported 160

Total STEMIs who arrived by interfacility

transfer20

60

61

62

63

64

65

66

67

68

69

70

2009 2010 2011

Santa Clara County STEMI System Performance

Median D2B time in minutes

D2B


26/26

26






cases


minutes




transfer6






cases


minutes




transfer16

Documents

Santa Clara County Emergency Medical Services Agency Semi-Annual Report (2012 May)