santa clara county (ca) emergency medical services agency semi-annual compliance report (may, 2013)

8/22/2019 Santa Clara County (CA) Emergency Medical Services Agency Semi-Annual Compliance Report (May, 2013)

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Santa Clara County EmergencyMedical Services Agency

Semi-Annual

Report

M a y 2 0 1 3January 1, 2012 to December 31, 2012


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County of Santa ClaraPublic Health Department

Emergency Medical Services Agency

976 Lenzen Avenue, Suite 1200

San Jos, CA 95126

408.885.4250 voice 408.885.3538 fax

www.sccemsagency.org

Board of Supervisors: Mike Wasserman, Dave Cortese, Ken Yeager, Joe Simitian

County Executive: Jeffrey V. Smith

April 5, 2013

Honorable Members of the Health and Hospital Committee and the Board of Supervisors:

The Santa Clara County EMS Agency is pleased to present to you its semiannual report reviewingthe operations of the EMS Agency and discussing the status of the Santa Clara County EMS System.

This report emphasizes the period from J uly 1, 2012 through December 31, 2012, but includesinformation from J anuary 1, 2012 through December 31, 2012, to provide context and precedent.

During 2012, much of the work of the EMS Agency and the EMS System focused in three areas: 1)fully implementing the contract between Rural/Metro of California, Inc. and the County of Santa Clara;2) assuring first responder and County Ambulance compliance with contractual response timestandards; and, 3) conducting long term EMS System strategic planning to position the Santa ClaraCounty EMS System to excel in an approaching era of health reform. Successes and challenges ineach of these areas are discussed in this report.

The Santa Clara EMS Agency and EMS System are embracing the concept of the Triple Aim:improving the quality of clinical care, improving efficiency and effectiveness, thus controlling or

reducing costs, and increasing levels of patient and stakeholder satisfaction. You can be assured thatthe Santa Clara County EMS System is meeting its responsibility to you, the system stakeholders,and the public to provide high quality, clinically-safe, and operationally-efficient emergency medicalservices to the County of Santa Clara.

As always, please dont hesitate to contact me with any questions. The EMS Agency appreciatesyour leadership and support to ensure a high quality EMS System in Santa Clara County.

Sincerely,

Michael PetrieEMS Director


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Santa Clara County EMS Agency May 2013

Table of Contents

Table of Contents ................................................................................................................................................ 2

EMS Agency Activities ....................................................................................................................................... 3

Rural/Metro serving as County Ambulance ...........................................................................................................3

EMS System Strategic Assessment and Strategic Planning Process .......................................................................4

Medication Shortages.............................................................................................................................................6

Diversion and Delay of Ambulances at Hospital Emergency Departments ...........................................................6

The Comprehensive EMS Data System ...................................................................................................................8

Wildland Fire and Multiple Patient Management Plan Exercises ..........................................................................9

Sobering System .....................................................................................................................................................9

EMS Trust Fund ................................................................................................................................................. 11

EMS Trust Fund Revenue..................................................................................................................................... 11

EMS Trust Fund Expense ..................................................................................................................................... 12

EMS Agency Fee Schedule ................................................................................................................................... 14

EMS System Descriptive Statistics .............................................................................................................. 16

Prehospital Clinical Care and Quality Improvement ........................................................................... 18

Rural/Metro Response Times .............................................................................................................................. 18Map of SCC EOA Response Subzones and City Boundaries ................................................................................. 20

Mutual Aid Provided by Rural/Metro .................................................................................................................. 21

Mutual Aid Provided to Rural/Metro .................................................................................................................. 22

Fire Department First Responder Response Times ............................................................................................. 23

Air Ambulance Transports ................................................................................................................................... 26

Hospital and Specialty Care Facilities ....................................................................................................... 27

Hospital Volume and Destinations ...................................................................................................................... 27

Hospital Diversion of Ambulances ....................................................................................................................... 28

Trauma Care System ............................................................................................................................................ 29

Stroke Care System .............................................................................................................................................. 30

STEMI Care System .............................................................................................................................................. 31


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EMS Agency ActivitiesThis semi-annual report emphasizes the six-month period from July 1, 2012 through December 31, 2012, but

includes information from throughout calendar year 2012 to provide context and precedent to the reader.

Consequently, some important activities that were previously discussed in the November 2012 annual report are

restated or revised in this report.

Rural/Metro serving as County AmbulanceRural/Metro of California, serving as County Ambulance, began providing 911 emergency ambulance and

paramedic services to the County of Santa Clara on July 1, 2011. However, it has taken approximately 18 months

to fully develop the comprehensive and integrated EMS System envisioned in the Emergency Medical Services

Agreement between Rural/Metro of California, Inc. and the County of Santa Clara. This agreement is widely

considered one of the most comprehensive in California; compelling Rural/Metro to provide service and system

benefit to the Santa Clara County EMS System at levels well beyond those provided in other EMS Systems

throughout California.

During 2012, the EMS Agency and Rural/Metro worked closely to fully implement the contract. One of the most

notable achievements was integrating fire departments and Rural/Metro into FirstWatch. FirstWatch is a data-mining, reporting, and analysis system that allows fire departments, Rural/Metro, and the EMS Agency to more

efficiently monitor and measure response time performance and automate performance reporting. FirstWatch

also allows organizations to more rapidly identify unusual system activity, such as rising call volumes and

sentinel events, such as a covert release of a chemical or biological agent. FirstWatch is also a powerful tool to

improve operational efficiency by helping trend periods of high and low call volume, facilitating demand-based

staffing patterns. FirstWatch is one of a number of technology-based information systems that will allow the

EMS System to meet the goals of the Triple Aim: to provide higher levels of clinical quality, to maintain or

improve efficiency, and, to improve patient and stakeholder satisfaction.

The contract with Rural/Metro has

brought numerous benefits to the Santa

Clara EMS System, and the County of

Santa Clara. During the past 18 months,

Rural/Metro has developed a system-

wide public education and information

program, a coordinated multi-agency

medical and continuing education

training program, improved security

measures for EMS personnel and

ambulances, and unprecedentedtransparency in performance, finance,

and operations, including publicly

posting performance and financial data

on their website.

During two months in the second half of 2012, Rural/Metro failed to meet contractual response time standards.

In October 2012, Rural/Metro recorded an 89.57% response time compliance rate to Code 3 (emergency red


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light and siren) calls in Zone 1 (Northwest Santa Clara County). In December 2012, Rural/Metro recorded an

89.66% response time compliance rate to Code 3 (emergency red light and siren) in Zone 4 (Southeastern San

Jose and incorporated area). These response time compliance rates failed to meet the contractually-mandated

90th percentile response time standard. Although Rural/Metro failed to meet the response time standards by

less than one-half of one percent and the EMS Agency is not aware of any detrimental patient outcomes related

to these delayed response times, these two failures constituted a material breach of contract, because

Rural/Metro failed to meet response time performance standards twice in a six month period. In response,Rural/Metro rapidly developed a comprehensive plan of correction and took other measures to correct this

breach. Rural/Metro has subsequently met response time standards for all emergency and non-emergency calls

in all zones.

In spite of these response time challenges, the EMS Agency believes that Rural/Metro is a capable partner in the

continued development of the Santa Clara County EMS System. The EMS Agency holds this position because

Rural/Metro has met response time performance standards in all zones in January 2013, February 2013, and

March 2013, and because Rural/Metro has materially met the deliverables in their contract, which signals a long

term investment in the Santa Clara EMS System. Detailed information about EMS System performance, including

Rural/Metros response time performance statistics, is provided on pages 15 through 31.

EMS System Strategic Assessment and Strategic Planning Process

The EMS System Strategic Assessment started in early July 2012 to help prepare the Santa Clara County EMS

System to adapt to changes in health care operations and financing driven by national health reform. This

project was intentionally scheduled to start soon after the US Supreme Court decided the Patient Protection and

Affordable Care Act (PPACA) cases, and is scheduled to conclude by late June 2013. The assessment and

planning process is considering a 3 to 7 year planning horizon, focusing on the Triple Aim: The project is divided

into three phases.

Phase 1 was the strategic assessment of the EMS System, which occurred between July and October 2012.During this phase, The Abaris Group, the consulting firm assisting the EMS Agency, interviewed key EMS System

stakeholders including County and Santa Clara Valley Health and Hospital System leadership, fire service

leadership, law enforcement, ambulance companies leadership and labor, hospital leadership, emergency

department physicians and nurses, EMS agency personnel, and the EMS Medical Director. The Abaris Group also

reviewed EMS System policies, procedures, and clinical protocols, and examined financial and operational

records and reports.

One essential component of the system analysis was the economic analysis of the projected financial effects of

the Affordable Care Act on the County of Santa Clara EMS System. The Abaris Group modeled the financial

effects of health reform based on Santa Clara County-specific data; rather than using more general state or

national data. This level of specificity increases the value, credibility, and applicability of the assessment. At the

end of Phase 1, The Abaris Group released the Santa Clara County EMS System Assessment report, which is

available on the EMS Agencys website.1

1http://www.sccgov.org/sites/ems/EMSStrategicPlanning/Pages/default.aspx
http://www.sccgov.org/sites/ems/EMSStrategicPlanning/Pages/default.aspxhttp://www.sccgov.org/sites/ems/EMSStrategicPlanning/Pages/default.aspx


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Phase 2 is the development of the Santa Clara County EMS System Strategic Plan, based on the information

contained in the Santa Clara County EMS System Assessment and developed during public strategic planning

workshops. Phase 2 started on November 1, 2012 and will conclude in June, 2013. During Phase 2, seven

strategic planning workshops were held, in which EMS System participants conducted a strategic environmental

analysis; crafted Mission, Vision, and Values Statements; and created and prioritized 10 goals for the EMS

System. These statements and goals are contained in the DRAFT EMS System Strategic Plan, which was released

to EMS Stakeholders is mid-February. The 10 Goals identified in the DRAFT EMS System Strategic Plan are:

Goal One: Research and design an Enhanced Contemporary EMS Medical Direction Model

Goal Two: Evaluate and redesign the EMS System Stakeholder Committee Structure for

effectiveness and focus

Goal Three: Develop an effective Continuous Quality Improvement (CQI) Program

Goal Four: Standardize EMS Communication and align the EMS Communication System

Goal Five: Create enhanced collaborative models with stakeholder organizations in which EMS is

an equal partner with other public safety and health organizations.

Goal Six: Assure the Long Term Financial Solvency and Stability of the Santa Clara County EMS

System

Goal Seven: Research, Design, and Implement Contemporary EMS Delivery Methods and Service

Delivery Options

Goal Eight: Partner with Public Health and Public Safety Organizations to Align and Enhance Public

Education and Prevention Efforts.

Goal Nine: Develop a Collaborative Model to Prevent and Respond to EmergencyDepartment/Hospital Capacity Issues and Resulting EMS System Delays.

Goal Ten: Develop a Common Legislative Action Plan to Support the Implementation of this EMS

Strategic Plan

From early March to late May, the EMS Agency and The Abaris Group will engage EMS System decision makers,

medical and government leaders and health insurance providers in focused dialogues to better understand

funding mechanisms, the local EMS healthcare environment, and to validate the Strategic Plans proposed goals.

Based on these discussions, the EMS Agency will release a third draft of the EMS System Strategic Plan in early

June, host a workshop to receive final comments from stakeholders in mid-June, and host a Strategic Planning

Summit in late June 2013 to roll out the final approved Santa Clara County EMS System Strategic Plan.

Phase 3 is the development of the implementation plan to support the goals and objectives in the EMS System

Strategic Plan. Phase 3 is occurring concurrently with Phase 2. As EMS System decision makers are engaged, the

EMS Agency and The Abaris Group will create best practice recommendations on implementing the goals and

objectives in the EMS System Strategic Plan. These recommendations will be included in the EMS Strategic Plan.


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Medication Shortages

During 2012, the EMS Agency and paramedic agencies continued to adapt to shortages of medication used to

treat patients in the prehospital setting, which is impacting medical providers nationwide. In Santa Clara

County, the EMS System experienced shortages of six classes of medication, including medications used to treat

cardiac arrest, severe allergic reactions, nausea, seizures, diabetic emergencies, and exposure to carbon

monoxide.

To adapt to these shortages, the EMS Agency authorized paramedic-provider agencies to use alternate

medications, limited the use of anti-nausea medications to the most serious cases, allowed the use of

differently-concentrated medications, and aggressively engaged pharmacies and medication vendors.

Paramedics received focused retraining on these medications to assure patient safety, and no detrimental

clinical incidents have been identified. The EMS Agency is also requiring paramedic-provider agencies to

implement specific inventory management systems to identify potential shortages earlier; providing more time

to mitigate the medication shortage.

Unfortunately, the EMS Agency does not anticipate a swift resolution to the root problems causing the national

medication shortagedecreased production, shortages of raw materials, and quality and purity problems. The

EMS System will continue to adapt, with the first and overriding priority being clinically-safe patient care.

Diversion and Delay of Ambulances at Hospital Emergency Departments

Nationally, and within Santa Clara

County, more patients present to

hospital emergency departments

than can be provided with

immediate service. This may be due

to the need to prioritize staffing and

resources to those patients with life

threatening medical conditions as

well as Hospital system efficiency

issues. These delays infrequently

have an unintended, yet detrimental

impact to the EMS system. Hospitals

closing to ambulances, called

diversion, impacts other local

Emergency Departments by

unexpectedly surging their volume of

patients. Another phenomenon

called extended wall times has a direct negative impact on the availability of pre-hospital EMS assets.

Generally defined, wall times are the time interval starting when the ambulance arrives at the emergency

department and ending when emergency department staff accepts responsibility for the patient and moves that

patient off the ambulance gurney. When emergency departments are extremely busy, wall times are often

extended. The EMS Agency has defined extended wall times as wall times greater than 15 minutes.


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Extended delays in off-loading and transferring the patient to the care of the Emergency Department team ties

up the Paramedic Ambulance, essentially removing it from service. This can increase Ambulance response times

across the rest of the EMS System and thus may degrade the overall quality of care. The California EMS

Authority and the California Hospital Association note that Delay in ED patient transfer has not been well

studied in relation to patient care outcomes, but the associated factors of diversion status and ED boarding both

have been linked to increases in patient morbidity and mortality2. In addition, extended wall time intervals

delay the transfer of care to the clinical team of physicians and nursed in the Emergency Department.

Since January 2012, the EMS Agency, working closely with the Hospital Council, has actively engaged hospitals

emergency department managers, Chief Nursing Officers, Chief Executive Officers, and Rural/Metro

management to reduce wall time intervals in Santa Clara County. Our collaborative work has been productive:

We have reduced aggregate wall time hours, based on patient turnover delays of greater than 15 minutes, from

approximately 437 hours in July 2011, to 240 hours in December of 2012a reduction of 54%. The EMS Agency

accepts that the measurement system used to assess wall time intervals is not perfectlogging the time the

ambulance arrives at the hospital until the time when a nurse signs the electronic patient care record and moves

the patient onto a hospital bed. Yet, it is the most accurate and uniformly applicable method identified.

While the reduction of aggregate extended wall times is a positive trend, the aggregate number of extended

wall times remains higher than desirable. Note that the 240 hours every month is analogous to having a full time

ambulance staffed but sitting idle for 24 hours a day for 10 days every month.

In the longer term, the EMS Agency is using a collaborative approach to reduce or eliminate diversion and

excessive wall times. The agency is engaging the hospitals and Rural/Metro in a Lean Six Sigma process to define,

measure, analyze, improve, and control the structures and processes relating to the root causes of ambulance

2Barton, Bruce, et al. EMS Patient Offload Delays in the ED: Background Information for a Stakeholder Meeting. California

Emergency Medical Services Authority and California Hospital Association. 5 March 2013

437 420 382 393 330

288 290291 279

552

312

280 264 261289

267 240254

0

100

200300

400

500

600

Santa Clara EMS System

Ambulance Wall Times > 15 Minutes

Aggregate All Hospitals

July 2011 through December 2012

Total

Linear (Total)


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diversion and excessive wall times. This project is planned to begin in the fall of 2013 and conclude by June 30,

2014. During this time, the EMS Agency will work with stakeholders and consider the need to implement an

administrative order to establish wall time standards and report on wall time performance.

The Comprehensive EMS Data System

The Santa Clara Comprehensive EMS Patient Care Data System will provide the infrastructure to enable Santa

Clara County EMS System providers, including medical communication centers, fire service first responders,Rural/Metro, non-emergency ambulance providers, and hospitals to comply with State and County mandated

EMS data reporting requirements. The EMS Data System will also support clinical, operational, quality

improvement of the Santa Clara County EMS System, and facilitate research to further the science of emergency

medical services.

The Comprehensive EMS Data System will integrate all prehospital 911 data into a common system. Rural/Metro

has been on the system since July 2011. As of March 2013, all fire departments (except Palo Alto Fire

Department) have completed system training and have implemented or will implement the system by June

2013. Consolidation of fire department first responder and Rural/Metros patient care data into a single,

consolidated EMS patient care record provides more accurate information to hospital medical personnel, and

facilitates a more rigorous quality improvement program.

The next steps in Comprehensive EMS Data

System implementation is capturing patient

care data (through the use of mobile

devices), in the prehospital field setting at

the patients side. This capability allows

patient care to be documented as that care

is provided; rather than waiting to return to

a station to complete the patient care

record. This improves the accuracy and

timeliness of the patient care record. A task

force has been created to develop data

standards, policies, definitions, and data

entry rules to support patients side capture,

and is expected to complete its work by

December 2013.

By December 2013, the EMS Agency will also integrate non-911 ambulance service provider data, and

countywide trauma, stroke, and cardiac databases into the Comprehensive EMS Data System. During 2014, the

EMS Agency would like to integrate hospital data, including emergency department data into theComprehensive EMS Data System. In aggregate, the Comprehensive EMS Data System will facilitate system

analysis and operational and clinical quality improvement. It will also improve EMS System efficiency, as those

with the rights and need to know can run detailed performance reports. Finally, information from the EMS

Patient Care Data System will be used to support injury prevention, public health, and epidemiological functions,

further enhancing healthcare in Santa Clara County.


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The EMS Agency has funded the Comprehensive EMS Patient Care Data without the use of any County general

fund monies. The program has been funded, and is expected to continue to be fully funded through the use of

EMS Franchise Fees, EMS Trust Fund monies, and grants.

Wildland Fire and Multiple Patient Management Plan Exercises

In July 2012, members of the Santa Clara County Medical Volunteers for Disaster Response (MVDR),

Rural/Metro, and the EMS Agency provided medical support for a three day wildland fire exercise, whichprepares area firefighters to fight fires in the rural and mountainous areas of the county. During the exercise,

MVDR, Rural/Metro, and the EMS Agency provided medical protection and support services, including first aid

and rehabilitation care for firefighters. EMS Agency personnel also serve on the Santa Clara County Overhead

Support Team responsible for the planning and coordination of the event.

In October 2012, Santa

Clara County EMS

conducted a full-scale

exercise to practice

multiple casualty incident

response. A full scale

exercise is an exercise

where field personnel

provide simulated rescue

and care to victims and

command and control is

provided in real time. This

exercise provided an

opportunity for fire

departments andemergency medical

services providers in

Santa Clara County to practice skills used during incidents that result in multiple patients, such as transportation

accidents, earthquakes, large gatherings, hazardous materials, etc. The primary focus of this years exercise was

rapid triage, treatment, and transport of patients. Capabilities tested during this event included the Santa Clara

County EMS Multiple Patient Management Plan, interoperable communications systems (radio and internet

based), countywide incident management practices, and use of emergency equipment provided through the

State Homeland Security and Hospital Preparedness grant programs. Five hundred Santa Clara County EMS

personnel and medical volunteers participated in this exercise over the course of three days.

The leadership, professionalism, expertise, and cooperation demonstrated by Rural/Metro, area fire

departments and fire districts, and the local non-emergency ambulance providers to plan, conduct, and evaluate

these exercises was impressive. The EMS Agency looks forward to equally valuable exercises in 2013.

Sobering System

A preliminary EMS study, using data collected from July 1, 2011 through December 31, 2011, indicated that

7,000 7,500 patients annually presenting with alcohol-related intoxication and other injuries, drugs, illnesses or


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complaints, are transported via 911 EMS ambulances each year to hospital Emergency Departments throughout

Santa Clara County. Of these patients, approximately 2,720 annually are transported primarily for alcohol

intoxication or other primarily-alcohol related effects, without drug, trauma, illness, or other confounding

factors. A more detailed analysis, conducted using clinical and ICD-9 data collected from January 1, 2012 through

June 30, 2012 indicated that approximately 1,120 patients annually could be transported directly from the field

by a sobering van to a Sobering Center, using appropriate clinical protocols. Many of the balance of these

patients could be medically screened and cleared at an Emergency Department, and then re-transported bysobering van to the Sobering Center, thus keeping the Emergency Department beds available for patients with

more serious illnesses and injuries.

Because many emergency departments are regularly overcrowded, the sobering system would reduce

emergency department wait times, improve patient safety, and allow scarce emergency department resources

to be focused on other patients with emergent conditions such as stroke, heart attack or serious injury. The

Sobering Center may also lead to some patients seeking additional substance abuse treatment services that will,

in the long term, prevent readmission in the Emergency Department for public intoxication.

Sobering System Concept of Operations

In the sobering system concept of operations, paramedics would respond to a 911 call for a medical emergency.

Upon arrival, a paramedic would evaluate the patient, using a clinical protocol developed by the EMS Medical

Director. If the paramedic determines that the patients primary clinical impression is alcohol intoxication

without other complicating clinical issues, the patient may be deemed appropriate for transport by the sobering

van directly to the Sobering Center. The sobering van would be a simple van, staffed by an Emergency Medical

Technician-Basic (EMT-B) that carries basic first aid equipment and has a radio to summon emergency

assistance. Should other medical concerns be present, the patient would be transported by ambulance directly

to a hospital emergency department. All alcohol intoxicated patients arriving at the Emergency Department

both those transported by ambulance and those who self-presentmay be medically screened and deemed

appropriate for transport from the emergency department to the Sobering Center. A single sobering van would

be operated 24 hours a day, 365 days a year. A second van would be staffed during peak periods.

Admission to the Sobering Center would be determined by clinical protocols developed by the EMS Medical

Director, the Medical Director of the Sobering Center and participating hospital emergency department medical

directors. Initially, admissions to the Sobering Center would be directed from an EMS response, law

enforcement or a patient cleared by a hospital emergency department and transported to the Sobering

Center. Walk-in admissions to the Sobering Center would likely not be appropriate at this time.

The Sobering Center would contain approximately 20 beds and operate 24 hours a day, 365 days a year. The

Center would provide limited medical care, such as oral fluids or over the counter medication, in addition to

providing a location for patients sleeping off their state of inebriation. Staffing would include an on-site

Registered Nurse(s) and other attendant personnel for the acute phase of sobering. Other staff, such as Medical

Social Workers, Mental Health specialists and Alcohol and Drug specialists may be on-site or connected with the

patient at the time of discharge. A physician would be available by phone and a physician Medical Director

would set overall clinical protocol and quality assurance. The typical length of stay for a patient would be

between 6-12 hours. Patients whose clinical status deteriorates beyond the level of care provide in the Sobering


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Center would be re-transported to a hospital Emergency Department. This concept of operations is illustrated in

the following graphic:

Future Steps

The Santa Clara Valley Health and Hospital System (SCVHHS) is reaching out to hospitals and other potential

funders of the sobering system. SCVHHS believes that a three-year pilot project is necessary to develop, fine-

tune, and evaluate the system. SCVHHS brought a report and recommendation to the Health and Hospital

Committee in the late Spring of 2013. If authorized by the Board of Supervisors, SCVHHS would anticipate the

release of an RFP by the summer of 2013, with the expectation of having an operational Sobering Center in

place by the winter of 2013.

EMS Trust FundThe EMS Trust Funds purpose is to provide funding for projects with a countywide benefit to EMS System

providers, enhance the services provided within the EMS System, and stand to improve the delivery of 911

emergency medical care in the County. The EMS Trust Fund is a backward-looking fund; that is, funds collected

in one year are expended the following year. This provides policy and spending oversight by the Board of

Supervisors, and provides adequate time to consider spending allocations in the context of strategic EMS System

change.

EMS Trust Fund Revenue

The EMS Trust Fund is funded with revenues from liquidated damages (fines) from the contracted 911

paramedic ambulance provider for failing to meet per-call response time standards; monthly zone response

time standards; or for failing to meet other contract stipulations, such as maintaining minimum ambulance


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availability or avoiding ambulance breakdowns. During Calendar Year 2012, Rural/Metro paid the following

liquidated damages, which were placed into the EMS Fund.

Month / Year Amount

January 2012 $170,250

February 2012 $256,750

March 2012 $214,000

April 2012 $220,000

May 2012 $211,250

June 2012 $231,500

July 2012 $198,250

August 2012 $233,750

September 2012 $222,000

October 2012 $297,750

November 2012 $284,000

December 2012 $281,250

TOTAL $2,820,750

Average Monthly Liquidated Damages $235,062

The amount of these liquidated damages is significantly greater than the amount of liquidated damages in

previous 911 paramedic ambulance contracts. However, the greater amount of liquidated damages is due to a

substantially more expensive fine structure; rather than poor system or provider performance. In some cases,

fine levels in the Rural/Metro contract are ten times greater than in the prior contract.

EMS Trust Fund Expense

EMS Trust Fund expenses are approved by the Health and Hospital Committee and the Board of Supervisors

before the start of the fiscal year. The EMS Agency routinely provides detailed financial reports to the Health

and Hospital Committee on the EMS Trust Fund. This EMS Trust Fund summary discusses how the expenditures

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

Category A: Reserve

At the Board of Supervisors direction, starting in Fiscal Year 2011-2012, a reserve category was established inthe 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 of service or supplies, or a material decrease in

system-wide third-party payor reimbursement. During the 2012-2013 Fiscal Year, $976,659 of the EMS Trust

Fund monies were placed into reserve.


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Category B: Training, Education and Recognition

Allocations were approved to produce two videos to inform the public to pull to the right for red lights and

sirens and to familiarize the public with the Santa Clara County EMS System. Videos are also being produced to

standardize EMS training across fire departments and ambulance providers countywide. These videos will

include Santa Clara County Emergency Medical Services System Overview, County EMS Radio

Communications, Establishment of Field Treatment Sites (FTS) and FTS Trailers Operations, Multiple PatientManagement Plan (MPMP) Review, and Ambulance Muster Stations. These training videos will help assure

that all EMS personnel, regardless of their employer or the shift they work, can access the same high quality

training to prepare them for EMS routine and disaster operations. Additionally, the EMS Agency will provide

another series of courses to EMS System stakeholders 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. During the 2012-2013 Fiscal Year, $220,000 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 2012-2013, funds were allocated to the fire departments within Santa Clara County to provide

hardware associated with the County EMS System Data Project. This funding allocation is one-half of total

funding of approximately $500,000, which will provide fire departments with the ability to enter and transmit

patient care data from the scene of an emergency; rather than waiting to enter data until the unit has returned

to a fire station. This allocation was essential to creating a comprehensive EMS System data collection and

analysis capability. During the 2012-2013 Fiscal Year, $250,000 was allocated to short term and one time

projects that benefit EMS System Stakeholders.

Category D: Strategic Initiatives

Projects in this category emphasize initiatives that strategically advance the Santa Clara County EMS System,

often in the longer term. During FY 2012-2013, funds were allocated to conduct a strategic assessment of the

EMS System and to develop a three to seven-year EMS System Strategic Plan. Monies were also allocated to

fund further development of the Comprehensive EMS Data System. Category D funds were also spent to replace

an aging EMS Duty Chief vehicle, to provide standardized personal protective equipment such as helmets and

reflective jackets to private ambulance providers, to develop an EMS injury prevention program, to update EMS

System policies and procedures, and to support development of the Sobering System. During Fiscal Year 2012-

2013, $1,095,000 was allocated to strategic projects.


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EMS Agency Fee Schedule

The EMS Agency relies on fee-for-service fees for funding operations, including system-wide planning, policy and

clinical protocol development, analysis, and operational and clinical quality improvement. The EMS Agency has

not increased its fees since July 1, 2011.

The EMS Agency did not request a fee modification from the Board of Supervisors for Fiscal Year 14, because

unprecedented changes in the EMS System operations and EMS Agency planning and quality improvementlinked to the EMS System Strategic Plan will occur in starting in the second half of Fiscal Year 14. The EMS

Agency will likely request fee modifications after the strategic plan is complete, and the structure and processes

of the revised EMS System are better quantified. The current fee structure is listed below:

Private Ambulance Permit Fees

Description FY12

Basic Life Support Ambulance Service $5,500.00

Advanced Life Support Ambulance Service $6,000.00

Critical Care Transport Ambulance Service $6,000.00

Air Ambulance Service Permit $8,000.00

Per Unit/Resource Permit $950.00

EMS Hospital Receiving Facility Fees

Description FY12

911 Paramedic Receiving Facility $10,000.00

EMS Stroke Receiving Facility $10,000.00

EMS Cardiac Receiving Facility $10,000.00

EMS Trauma Receiving Facility $100,000.00


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Fiscal Year 2013 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 $8,000Ambulance Vehicle Permits (annual fee)

Basic Life Support $950

Advanced Life Support $950

Critical Care Transfer $950

Air Unit $950

Non-Transport BLS/ALS Unit $800

Education Program Certification (every 4 years)

EMT Program $1,000

Paramedic Program $5,000

Prehospital 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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EMS System Descriptive StatisticsListed in the following set of tables are statistics that describe the characteristics of the Santa Clara County EMS

during Calendar Year 2012.

The County of Santa Clara

Daytime Population 2,200,000 persons

Resident Population 1,800,000 personsGeographic Size 1,132 square miles

Geographic Des. 2/3 rural

Municipalities 15

911 System Call Volume

January through December 2012

Total Responses 108,763

Total Events with Ground Ambulance Transports 75,713

Total Patients Transported by Ground Ambulance 74,695

EMS Aircraft Response 183

EMS Aircraft Transports 109

Specialty Center Patients

Stroke Patients 1,243

Trauma Patients 3,520

STEMI Patients 204

Pre-Hospital Care Provider AgenciesFire Departments 11

Ground Ambulance Services 10

Air Ambulance Services 2

Pre-Hospital Care Personnel

Emergency Medical Technicians 2,194

Paramedics 888

Mobile Intensive Care Nurses 33

Accredited EMS Field Supervisors 11

Permitted EMS Assets

Fire Apparatus 159

Private Ground Ambulances 209

Private Air Ambulances 3

Private EMS Non-Transport Units 18


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Communications Centers

Public Safety Answering Points (PSAPs) 13

Secondary PSAPs 10

Emergency Medical Dispatch Providers 6

Private Ambulance Dispatch Centers 9

Air Ambulance Dispatch Centers 2

Acute Care Facilities

Acute Care Hospitals 12

Emergency Departments 11

Level 1 Trauma Centers 2

Level 2 Trauma Centers 1

Base Hospitals 1

Burn Centers 1

Stroke Centers 9

STEMI Centers 8

County Managed Medical Health Resources

Field Treatment Site Trailers 8

Specialty Services Trailers 3

Chem-Packs 8

Medical-Health Operations Center 1

EMS Radio Caches 5

Disaster Medical Support Unit 1

Training Programs

Emergency Medical Technician 7Paramedic 2

EMS Fellowship 0

Ambulance Interfacility Transports

Ground Ambulance 2012* 54,254



* As self-reported by ground ambulance providers


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Prehospital Clinical Care and Quality Improvement

Rural/Metro Response Times

The chart below identifies Rural/Metros response times to Code 3 (emergency red light and siren) calls by

month from July 1, 2012 through December 31, 2012 in each of the five ambulance subzones within Santa Clara

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

graphic.

In October 2012, Rural/Metro recorded an 89.57% response time compliance rate to Code 3 (emergency red

light and siren) calls in Zone 1 (Northwest Santa Clara County). In December 2012, Rural/Metro recorded an

89.66% response time compliance rate to Code 3 (emergency red light and siren) in Zone 4 (Southeastern San

Jose and incorporated area). Both of these response time compliance rates failed to meet the contractually-

mandated 90th percentile response time standard. The EMS Agency is not aware of any detrimental patient

outcomes related to these delayed response times.

Code 3

ResponsesJul 12 Aug 12 Sep 12 Oct 12 Nov 12 Dec 12

Subzone 1 92.08% 91.61% 90.49% 89.57% 90.02% 90.66%

Subzone 2 94.05% 91.77% 90.48% 91.65% 90.26% 90.75%

Subzone 3 96.65% 94.95% 94.81% 94.27% 94.48% 93.77%

Subzone 4 94.61% 93.33% 92.10% 90.72% 90.59% 89.66%

Subzone 5 94.03% 93.03% 96.59% 93.40% 91.76% 94.72%

84.00%

86.00%

88.00%

90.00%

92.00%

94.00%

96.00%

98.00%

100.00%

Subzone 1 Subzone 2 Subzone 3 Subzone 4 Subzone 5

County Ambulance Code 3 Response Times Zone 1- 5

Jul 12

Aug 12

Sep 12

Oct 12

Nov 12

Dec 12


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19


Ambulance Response Times to Non-Emergency Calls

The chart below identifies Rural/Metros response times to Code 2 (non-emergency) calls by month from July 1,

2012 through December 31, 2012 in each of the five ambulance subzones within Santa Clara County. The

response time standard is 90% or greater, and is represented by the yellow horizontal line on this graphic.

Code 2 Responses Jul 12 Aug 12 Sep 12 Oct 12 Nov 12 Dec 12

Subzone 1 95.34% 93.36% 94.75% 94.98% 96.34% 97.34%

Subzone 2 96.30% 93.58% 93.81% 93.84% 94.00% 93.51%

Subzone 3 95.83% 95.62% 96.49% 92.32% 94.87% 92.84%

Subzone 4 95.90% 95.61% 92.02% 92.16% 92.66% 94.31%

Subzone 5 99.03% 95.05% 96.97% 96.20% 96.88% 97.62%

88.00%

90.00%

92.00%

94.00%

96.00%

98.00%

100.00%

Subzone 1 Subzone 2 Subzone 3 Subzone 4 Subzone 5

County Ambulance Code 2 Response Times Zone 1- 5

Jul 12

Aug 12

Sep 12

Oct 12

Nov 12

Dec 12


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Subzone 1

Subzone 2

Subzone 3

Subzone 4

Subzone 5

San Jose

PaloAlto

Gilroy

Sunnyvale

Milpitas

SantaClara

Saratoga

LosGatos

MonteSereno

MorganHill

MountainView

LosAltos

LosAltosHills

Campbell

Cupertino

Santa Clara CountyEOA 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 Jose (West), Saratoga and the unincorporated areas of Burbank, Redwood EstatesSubzone 3: Milpitas, San Jose (North), Santa ClaraSubzone 4: San Jose (East, South)Subzone 5: Gilroy, Morgan Hill and unincorporated areas San Martin

Source: Santa Clara County Exclusive Operating Agreeement, Exhibit BDeveloped by: Santa Clara County Emergency Medical Services AgencyCreated: 20090903


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Mutual Aid Provided by Rural/Metro

The chart below identifies the number of times neighboring EMS Systems requested assistance from

Rural/Metro by month from July 1, 2012 through December 31, 2012. In these instances, a Rural/Metro

ambulance is immediately dispatched, unless the loss of that ambulance would materially degrade response

times in the Santa Clara County EMS System.

The EMS Agency is working closely with the Palo Alto Fire Department to reduce the number of Rural/Metroresponses into Palo Alto. The high volume of Rural/Metro responses into Palo Alto is challenging to the Santa

Clara County EMS System, as these responses encumber scarce ambulance resources that would otherwise be

available for emergency response within the Santa Clara County Exclusive Operating Area. The Palo Alto Fire

Department is adding additional EMS resources and the EMS Agency expects a marked decrease in the number

of mutual aid calls into Palo Alto by May 2013.

Mutual Aid Out of County Jul 12 Aug 12 Sep 12 Oct 12 Nov 12 Dec 12 2012 Totals

City of Palo Alto 65 46 51 86 31 40 606

County of Santa Cruz 0 2 0 1 0 1 11

County of San Mateo 0 0 1 0 0 0 3

County of San Benito 0 0 0 0 0 0 0County of Stanislaus 0 0 0 0 0 0 0

County of Merced 0 0 0 0 0 0 1

County of Alameda 1 0 1 0 2 1 8

Total Requests 66 48 53 87 33 42 629

0

10

20

30

40

50

60

70

80

90100

Jul 12 Aug 12 Sep 12 Oct 12 Nov 12 Dec 12

Requests for Mutual Aid Assistance from Rural/Metro by Month (Jul

to Dec 2012)

City of Palo Alto

County of Santa Cruz

County of San Mateo

County of San Benito

County of Stanislaus

County of Merced

County of Alameda


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22


Mutual Aid Provided to Rural/Metro

Although infrequent, the Santa Clara County EMS System also relies on mutual aid to serve remote areas of the

county. This table identifies that during 2012, the Santa Clara County EMS System did not request ambulance

mutual aid.

Mutual Aid Into County Jul 12 Aug 12 Sep 12 Oct 12 Nov 12 Dec 12 Totals

City of Palo Alto 0 0 0 0 0 0 0

County of Alameda 0 0 0 0 0 0 0

County of Merced 0 0 0 0 0 0 0

County of San Benito 0 0 0 0 0 0 0

County of San Mateo 0 0 0 0 0 0 0

County of Santa Cruz 0 0 0 0 0 0 0

County of Stanislaus 0 0 0 0 0 0 0

Total Responses 0 0 0 0 0 0 0


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23


Fire Department First Responder Response Times

Fire Department First Responder Response Times to Emergency Calls

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

month from July 1, 2012 through December 30, 2012 for each of the first-responder 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 duringthat month.

Starting September 2012 through December 2012, the San Jose Fire Department failed to comply with the 90 th

percentile response time performance standard. The San Jose Fire Departments response time performance is

detailed on the chart and graph below. The EMS Agency is not aware of any detrimental patient care outcomes

assocated with these delayed response times.

The San Jose Fire Departments failure to comply with the 90th percentile response time performance standard

for four consecutive months constitutes a material breach of Annex B of their Agreement with Santa Clara

County to provide 911 Emergency Medical Services. Annex B is an optional annex, which provides funding from

Rural/Metro to fire departments, if fire departments meet optional stringent response times standards. Annex B

does not relate to the San Jose Fire Departments ability to provide paramedic service, nor are fire departments

required to enter into Annex B. Annex B provides that failure to meet the 90th percentile response time

requirments for three consequtive months or four months in any twelve month period constitues a material

breach of Annex B. San Jose Fire Departments breach of Annex B occured at the end of October 2012, because

San Jose Fire Department failed to meet the optional response time performance standards in February 2012,

April 2012, and September 2012.

Although the EMS Agency could have stopped payment from Rural/Metro to the San Jose Fire Department for

this breach of Annex B, the EMS Agency exercised provisions of Annex B that allowed the San Jose Fire

Department to implement a corrective action plan. San Jose Fire Chief Willie McDonald is personally involved infrequent meetings with the EMS Agency. He expects that that San Jose Fire Department response times will

meet the optional funding standards contained in Annex B by Summer 2013.


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24


Code 3 Response Jul 12 Aug 12 Sep 12 Oct 12 Nov 12 Dec 12

Gilroy Fire 97.45% 97.12% 97.04% 98.00% 99.00% 97.27%

Milpitas Fire 99.20% 98.72% 96.76% 93.95% 95.19% 95.00%

Mt View Fire 99.37% 98.12% 98.05% 99.12% 99.64% 98.73%

San Jose Fire 90.11% 91.67% 88.74% 88.01% 87.61% 87.44%

Santa Clara City Fire 95.39% 95.24% 95.02% 95.07% 95.59% 95.40%

Santa Clara County Fire 96.56% 96.14% 95.48% 95.74% 97.50% 97.11%South Santa Clara County Fire 97.39% 98.36% 96.58% 96.61% 97.37% 97.75%

Sunnyvale DPS 99.55% 98.76% 98.28% 98.31% 97.81% 98.16%

Fire Department Response Times to Non-Emergency Calls

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

1, 2012 through December 31, 2012 for each of the first-responder 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

cities of Gilroy and Milpitas respond Code 3 to all calls; therefore, they have no Code 2 responses.

80.00%

82.00%

84.00%

86.00%

88.00%

90.00%

92.00%

94.00%

96.00%

98.00%

100.00%

Gilroy Fire Milpitas

Fire

Mt View

Fire

San Jose

Fire

Santa Clara

City Fire

Santa Clara

County Fire

South

Santa Clara

County Fire

Sunnyvale

DPS

Fire Department Code 3 First Responder Response Time

Compliance by Month

Jul 12

Aug 12

Sep 12

Oct 12

Nov 12

Dec 12


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25


Code 2 Response Jul 12 Aug 12 Sep 12 Oct 12 Nov 12 Dec 12

Mt. View Fire 100.00% 100.00% 100.00% 94.12% 100.00% 100.00%

San Jose Fire 93.14% 94.80% 95.28% 93.27% 92.99% 94.08%

Santa Clara Fire 97.66% 97.24% 96.88% 97.62% 97.66% 100.00%

Santa Clara County Fire 100.00% 98.51% 97.87% 100.00% 100.00% 98.26%

South Santa Clara County Fire 100.00% 100.00% 100.00% 100.00% N/A 100.00%

Sunnyvale Public Safety Dept. N/A N/A N/A N/A N/A N/A

80.00%

85.00%

90.00%

95.00%

100.00%

Mt. View Fire San Jose Fire Santa Clara City

Fire

Santa Clara

County Fire

South Santa Clara

County Fire

Fire Department Code 2 Response Time Compliance

by Month

Jul 12

Aug 12

Sep 12

Oct 12

Nov 12

Dec 12


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Air Ambulance Transports

Air ambulance utilization continued at relatively low levels during 2012. This volume of responses and transports

has remained static since approximately 2009. The EMS Agency considers this volume of air ambulance

responses and transports appropriate.

557 540524

545

463443

442

248

184 176 179 183254 254

236 251

205221

207

137

111103 107 109

0

100

200

300

400

500

600

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Air Ambulance Transports Number of Dispatches

Number of Transports

Year Number of Dispatches Number of Transports Utilization 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%

2012 183 109 60%


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Hospital and Specialty Care Facilities

Hospital Volume and Destinations

From July 1, 2012 through December 31, 2012, ambulance transports from the 911 System to hospitals within

Santa Clara County occurred at the following volumes.

Hospital Jul 12 Aug 12 Sep 12 Oct 12 Nov 12 Dec 12 Total

El Camino - Los Gatos 73 99 87 64 88 79 981

El Camino - Mt. View 588 597 619 647 597 661 7,677

Good Samaritan 533 501 525 535 571 585 6,599

Kaiser - San Jose 514 609 534 547 538 630 6,808

Kaiser - Santa Clara 593 595 566 638 598 638 7,416

O'Connor 488 509 555 583 561 606 6,703

Regional - San Jose 983 1,063 1,091 1,120 1,062 1,041 12,525

Saint Louise 253 225 204 245 210 196 2,705

Stanford 423 414 451 463 457 421 5,176

VA - Palo Alto 52 64 69 58 69 66 752

SCVMC 1,318 1,369 1,281 1,364 1,256 1,311 15,681

Total 5,818 6,045 5,982 6,264 6,007 6,234 73,023

0

200

400

600

800

1000

1200

1400

1600


Ambulance Destination by HospitalJuly 1 to December 31, 2012

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

SCVMC


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Hospital Diversion of Ambulances

Hospital diversion levels appeared to trend toward stabilization, with hospitals in general achieving lower

diversion levels in Year 2012. However, the EMS Agency continues to monitor 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 working with the Hospital

Council and local hospitals to resolve this problem.

Hospital Jul 12 Aug 12 Sep 12 Oct 12 Nov 12 Dec 12 Totals

El Camino - Los Gatos 0 0 0 0 0 0 0

El Camino - Mt. View 6.25 9.03 4.5 1.5 5.68 8.54 114.16

Good Samaritan 7.51 13.52 13.53 3 5.48 0 77.67

Kaiser - San Jose 0 0 0 0 0 0 3

Kaiser - Santa Clara 4.51 0 0 1.5 3.01 3 34.59

O'Connor 6.01 9.02 9.24 6.02 13.17 15.05 115.53

Regional - San Jose 6.01 5.93 13.53 14.55 10.59 33.39 141.58

Saint Louise 4.94 6.41 3 8.45 7.18 16.72 77.67

Stanford 3.01 4.51 4.5 11.67 7.75 1.5 79.12

VA - Palo Alto 35.21 50.4 98.61 76.6 22.16 30.1 683.48

SCVMC 18.62 22.18 9.52 26.06 30.13 40.4 253.29

Total 92.07 121 156.43 149.35 105.15 148.7 1580.1

0

20

40

60

80

100

120


Ambulance Diversion by Hospital

July 1 to December 31, 2012El 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

SCVMC


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Trauma Care System

Between July 1, 2012 and December 31, 2012, 3,520 trauma patients were seen in the Santa Clara County

trauma system. This includes 3,181 adults and 333 pediatric patients (pediatric age range is 0 to less than age

15). Eighty percent of trauma patients were transported to a trauma center by ambulance. Eleven percent of

trauma patients were transported to a trauma center by an air ambulance, and nine percent of trauma patients

were brought to a trauma center by a private vehicle.

County of Origin

The primary county of origin for trauma patients that enter the Santa Clara County trauma system is Santa Clara

County with 68% of the total volume of trauma patients. The next four highest volume counties of origin are:

San Mateo County at 14%; Santa Cruz County at 5%; Monterey County at 4%; and San Benito County at 3%.

Mechanism of Injury

Ninety-six percent of the injuries in the Santa Clara County trauma system are caused by a blunt mechanism of

injury, such as motor vehicle/motorcycle injuries, pedestrian struck by car, and bicycle accidents. The remaining

four percent are caused by penetrating mechanisms, such as gunshot wounds, and stabbings. These percentages

are consistent throughout the past four years.

2229

438

162 135 80 96 40

Santa Clara

County

San Mateo

County

Monterey

County

Santa Cruz

County

San Benito

County

No County

Indicated

Other Counties

Santa Clara Trauma System-Injury County of Origin

July 1 to December 31, 2012


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Age Factors

The age ranges of trauma victims are:

Age Range Total number of victims

0 through 5 years 129

6 years through 15 years 205


22 years through 45 years 1,247




Injury Severity

Using a calculation referred to as the Injury Severity Score (ISS), the EMS Agency determined that sixty-four

percent (64%) of trauma patients have minor injuries (ISS less than 9), seventeen percent (17%) of trauma

victims have moderate injuries, and nine percent (9%) are severely injured (ISS 15 to 75).

Using a calculation referred to as the Injury Severity Score (ISS), the EMS Agency determined that seventy-four

percent of trauma patients have minor injuries (ISS less than 9), twenty-one percent of trauma victims have

moderate injuries, and four percent are severely injured (ISS 15 to 75).

ISS Score Total Volume Percent Volume

1 to less than 9 2,411 64%

9 to less than 15 631 17%

15 and greater 352 9%

Disposition from the Emergency Department

Forty-seven percent (47%) of trauma patients are admitted to the hospital. Fifty-three percent (53%) of trauma

patients are discharged from the emergency department. Less than one percent (0.70 %) of trauma patients die

in the emergency department.

Stroke Care System

The Santa Clara County Board of Supervisors approved a stroke care system developed by the Santa ClaraCounty 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 showing symptoms of an acute stroke.

The need for rapid intervention is based on the scientific evidence that if a stroke patient is treated with an anti-

clotting drug within three and a half hours of the onset of their symptoms, it is possible to prevent or reverse


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the effects of the blocked circulation to the brain. The stroke system was designed with a specific goal: to

increase the numbers of patients who arrived in the emergency department at the stroke center quickly enough

to allow administration of the anti-clotting drug.

A second goal of the stroke system is to educate the public about stroke symptoms and the need to rapidly call

9-1-1 if stroke symptoms are present. Historically in Santa Clara County, approximately 45% of patients come to

a stroke center by ambulance. However, from July 1, 2012 to December 31, 2012, 49% of stoke patients arrivedat a stroke center by ambulance. This increase is potentially related to the outreach activities accomplished by

the Stroke Busters. Stroke Busters is a collaboration of Santa Clara County Stroke Centers, the EMS Agency,

Rural/Metro, the Stroke Awareness Foundation, and the Peninsula Stroke Association, who are two non-profits

who assist with outreach. In October 2012, the Stroke Busters attended the Health Concern Outreach

program at the San Jose Flea Market. Nine hundred eight seven people of all ages and ethnicities received a

blood pressure check and provided with stroke information. This annual event will continue indefinitely.

July 2012 through December 31, 2012 Performance Data

Criteria County Performance Data Percentages

Total Stroke Volume 1,243 100%

Total Number of Ischemic Strokes 957 77%

Total Strokes Transported by EMS 612 49%

Total Strokes Self-Transported 553 44%

Total patients by interhospital Transfer 80 6%

% of Ischemic Stroke treated by IV tPA 10% National Average (1-8%)

STEMI Care System

Santa Clara Countys STEMI (S-T Elevation Myocardial Infarction) Care System continues to be regarded as a

model system of care. A STEMI is a serious type of heart attack associated with higher rates of morbidity and

mortality. Patients identified by paramedics as STEMI Alert patients, based on a 12 lead electrocardiogram, are

treated rapidly with Percutaneous Coronary Intervention (PCI), which includes balloon angioplasty and stents, to

open the blockage in the artery. The median length of stay in the hospital after the procedure is two days. From

July 2012 through December 2012, 95% of the patients treated with Percutaneous Coronary Intervention had

median door to balloon (D2B) of less than 90 minutes, versus a national benchmark of 75% of cases treated in 90

minutes or less. During the last quarter of 2012, 46% of PCI patients had a door to balloon time of 60 minutes orless. There has been some discussion in the cardiac literature of resetting the goal to 60 minutes or less;

however, for now, the benchmark remains at 90 minutes.


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July to December 2012 Performance Data

Criteria July to December 2012 2012 Annual Data

Total cases with documented STEMI 204 435

Median Door to Balloon time in

Minutes62 62

Goal Met (D2B

santa clara county (ca) emergency medical services agency semi-annual compliance report (may, 2013)

Documents