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Santa Clara County Emergency Medical
Services Agency
Semi-AnnualReport
M a y 2 0 1 2
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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.
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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:
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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.
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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.
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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
July August September October November December
Rural Metro Ambulance Code 3 Response Time
Sub-Zone 1
Sub-Zone 2
Sub-Zone 3
Sub-Zone 4
Sub-Zone 5
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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.
July August September October November December
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
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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.
July August September October November December
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
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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%).
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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.
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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
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Santa Clara County EMS Agency May 2012 Report to the Hospitals and Health Committee
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.
2011 Performance Data
Criteria County Performance Data
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
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2010 Performance Data
Criteria County Performance Data
Total cases with Documented STEMI 324
Median D2B in minutes 65 minutes
Goal Met (D2B in less than 90 minutes in 75% of
cases
95% of all cases were in less than 90
minutes
Total STEMIs who arrived by EMS transport 209
Total STEMIs who self-transported 109
Total STEMIs who arrived by interfacility
transfer6
2009 Performance Data
Criteria County Performance Data
Total cases with Documented STEMI 97
Median D2B in minutes 69 minutes
Goal Met (D2B in less than 90 minutes in 75% of
cases
90% of all cases were in less than 90
minutes
Total STEMIs who arrived by EMS transport 176
Total STEMIs who self-transported 196
Total STEMIs who arrived by interfacility
transfer16