thirtythirtysomething:something:EMS in California 30 Years After SB EMS in California 30 Years After SB

125125

Workshop Presentation byWorkshop Presentation by

Emergency Medical Services Administrators’ Emergency Medical Services Administrators’

Association of CaliforniaAssociation of California

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Who is EMSAAC?Who is EMSAAC?

►Not-for-profit corporation formed in 1992 to Not-for-profit corporation formed in 1992 to represent all Local EMS Agencies in represent all Local EMS Agencies in CaliforniaCalifornia

►Member agencies are responsible for Member agencies are responsible for planning, implementing and evaluating planning, implementing and evaluating county/regional EMS systemscounty/regional EMS systems

► As authorized in statute, LEMSAs are As authorized in statute, LEMSAs are partners in governance with the State EMS partners in governance with the State EMS AuthorityAuthority

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EMSAAC’s MissionEMSAAC’s Mission

To provide EMS system leadership within the state and to foster excellence in all aspects of emergency specialty care services. We are a leading advocate for the development and maintenance of safe, effective, patient-oriented, community-based EMS systems.

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How Far Have We Come?How Far Have We Come?

Your view may depend on how your Your view may depend on how your local EMS system is “modeled”…local EMS system is “modeled”…

Local EMS System

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The “Sandbox” ModelThe “Sandbox” Model

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The “Partnership” ModelThe “Partnership” Model

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The Intent of SB 125The Intent of SB 125

► To create a statutory framework for To create a statutory framework for coordination and oversight of EMS systems coordination and oversight of EMS systems in Californiain California

► To establish a two-tiered (i.e., state and To establish a two-tiered (i.e., state and local) model for EMS governance in local) model for EMS governance in CaliforniaCalifornia

► To accommodate a transition for To accommodate a transition for existing existing EMS providers to be integrated into a local EMS providers to be integrated into a local EMS systemEMS system

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Where Do We Sometimes Where Do We Sometimes Disagree?Disagree?

► The scope of The scope of medical controlmedical control intended intended under the EMS Actunder the EMS Act

► The scope of The scope of administration of prehospital administration of prehospital EMSEMS for 201-eligible cities and fire districts for 201-eligible cities and fire districts

► The impact of The impact of providerprovider agreementsagreements on 201- on 201-eligible cities and fire districtseligible cities and fire districts

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Medical Control by LEMSAsMedical Control by LEMSAs

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What exactly is “Medical Control” ?What exactly is “Medical Control” ?

►Broadly defined in the EMS Act: 1797.90 "Medical control" means the medical

management of the emergency medical services system pursuant to the provisions of Chapter 5 (commencing with Section 1798).

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What exactly is “Medical Control” ?What exactly is “Medical Control” ?

►Additional references in the Act: 1798. (a)1798. (a) The medical direction and management The medical direction and management

of an emergency medical services system shall be of an emergency medical services system shall be under the under the medical controlmedical control of the medical director of of the medical director of the local EMS agency. This the local EMS agency. This medical controlmedical control shall be shall be maintained in accordance with standards for maintained in accordance with standards for medical control established by the authority.medical control established by the authority.

1797.202 (a)1797.202 (a) Every LEMSA shall have a… Medical Every LEMSA shall have a… Medical Director… to provide Director… to provide medical controlmedical control and assure and assure medical accountability throughout the planning, medical accountability throughout the planning, implementation and evaluation of the EMS system.implementation and evaluation of the EMS system.

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Administration of Prehospital EMS Administration of Prehospital EMS by 201 Entitiesby 201 Entities

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What exactly is “Administration of What exactly is “Administration of Prehospital EMS” ?Prehospital EMS” ?

► Not defined in the statuteNot defined in the statute► Limited to qualified cities and fire districts Limited to qualified cities and fire districts

onlyonly► Intended scope of this authority is unclearIntended scope of this authority is unclear

Context suggests administrative oversight Context suggests administrative oversight necessary to continue providing prehospital EMS at necessary to continue providing prehospital EMS at existing pre-statute levelsexisting pre-statute levels

► Integration of these existing services with the Integration of these existing services with the “new model” thru agreements was “new model” thru agreements was anticipated anticipated

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Provider AgreementsProvider Agreements

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1797.204 The local EMS agency shall plan, implement, and evaluate an emergency medical services system, in accordance with the provisions of this part, consisting of an organized pattern of readiness and response services based on public and private agreements and operational procedures.

Anticipated in Statute…

Health & Safety Code, Division 2.5

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100167. Paramedic Service Provider(b) An approved paramedic service provider

shall: (4) Have a written agreement with the local

EMS agency to participate in the EMS system and to comply with all applicable State regulations and local policies and procedures, including participation in the local EMS agency's QIP as specified in Chapter 12 of this Division.

And Regulation

Title 22. Division 9. Chapter 4. Emergency Medical Technician-Paramedic

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Advantages of AgreementsAdvantages of Agreements

► They are the way counties, cities and fire They are the way counties, cities and fire districts normally conduct businessdistricts normally conduct business

► They can specify mutual obligations and They can specify mutual obligations and include a remedy for breechinclude a remedy for breech

► They can mitigate potential impacts of They can mitigate potential impacts of unilateral changes in authority or unilateral changes in authority or responsibilities by either partyresponsibilities by either party

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Is It All About “Control”?Is It All About “Control”?

AdministrativeAdministrativeControlControl

MedicalMedicalControlControl

LOCAL EMS SYSTEM

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Other FactorsOther Factors

EMS Plan

PoliticsPersonalities

Self-Determination

CourtDecisions

LegalOpinions

Contracts PayerMix

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RecommendationsRecommendations

1.1. Promote a “partnership model” for your Promote a “partnership model” for your local EMS systemlocal EMS system

2.2. Acknowledge each stakeholder as essential Acknowledge each stakeholder as essential to the delivery of quality patient care in to the delivery of quality patient care in your EMS systemyour EMS system

3.3. Commit to effective conflict resolutionCommit to effective conflict resolution

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Recommendations (cont.)Recommendations (cont.)

4.4. Consider the use of written agreements as Consider the use of written agreements as a tool to clarify matters of local control, a tool to clarify matters of local control, authority and system integrationauthority and system integration

5.5. Ensure that all local stakeholders are Ensure that all local stakeholders are invited to participate in the process to invited to participate in the process to develop LEMSA policies, protocols and develop LEMSA policies, protocols and plans. plans.

6.6. Let the courts interpret the lawLet the courts interpret the law

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Let’s Invest WiselyLet’s Invest Wisely

Lawyers, Courts& Legislation

Quality PatientCare

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Thank YouThank You