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AMR Proposal to County of San Joaquin for Emergency Ambulance Services

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I . Credentials

3.1 CREDENTIALS OVERVIEW

American Medical Response West (AMR) acknowledges that credentials are submitted as a part of this proposal document. Credentials will be used to determine our:

• Analogous Experience – Beyond our history of local service, AMR offers our experience as the nation’s leading provider of emergency ambulance service, our contracts to provide Advanced Life Support (ALS) services in 17 Northern California counties, and our experience in two neighboring, integrated EMS systems similar in population to San Joaquin County (San Mateo and Santa Clara), where we have created nationally renowned and award-winning public/private partnerships.

• Regulatory Compliance – A national history that includes more high-performance EMS systems than any other ambulance provider in the United States, nearby EMS systems where we successfully manage a community equity-based response-time strategy, and a proven ability to meet and exceed response-time compliance standards throughout Northern California.

• Financial Stability – Sufficient capital for contract implementation and financial reserves to sustain operations – just as we have for the past four decades – with no need to finance the costs of operations or start-up.

3.2. CONTENT OF CREDENTIALS 3.2 .A. H is tory and Exper ience Describe your organization’s history and experience in providing emergency and advanced life support ambulance service.

AMR and its predecessor companies have been providing emergency ambulance service to San Joaquin County for 43 years, with the inception of All-City Ambulance in 1962. Towards the end of the 1970s, we began providing ALS services to the rural areas of San Joaquin County and to the cities of Stockton, Lodi, and Tracy. A complete chronology of AMR and its predecessor companies appears later in this section under Number of Years in Business.


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AMR serves numerous other high-performance EMS systems in Northern California, offering a variety of innovative public-private partnerships and other methods of service delivery to ensure high-quality, cost-effective patient care based on individual community needs. More information on these local services may be found later in this section.

NATIONAL PRESENCE

AMR is part of American Medical Response, Inc. (AMR Inc), which is the nation’s largest provider of ambulance services, with operations in 34 states. Our company has considerable experience operating high-performance EMS models across the country, each tailored to our customers’ specific needs. This national experience, combined with our focus on information sharing among the various operations and benchmarking of “best practices”, offers significant benefits locally, including the development of innovative solutions to local issues, clinically and operationally,


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The following is a map of our national service area:

Our company provides a wide range of services to meet the needs of our customers as their systems evolve and grow. Our primary levels of service are as follows:

• Advanced Life Support (ALS) ambulance transportation

• Basic Life Support (BLS) ambulance transportation

• Critical Care Registered Nurse (CCT-RN) ambulance transportation

• Critical Care Paramedic (CCT-P) ambulance transportation

We also provide the following services:

• Emergency medical dispatching for other providers, including public safety agencies

• Neonatal and Pediatric Team ambulance transportation

• Bariatric Transports — Transport of patients weighing as much as 1,600 lbs

• Wheelchair transportation

• Helicopter air medical transportation


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For more information on our national organization and services, please visit our Website at www.amr.net.

Business Name

The legal entity submitting this proposal is American Medical Response West (AMR West), headquartered in Livermore, California — just 10 miles from the San Joaquin County border.

Our San Joaquin County operations center is located at: 888 E. Lindsay Street Stockton, California 95202 Phone: 209.948.5136

Legal Business Status

AMR West is a California corporation, doing business as American Medical Response (AMR). It is a wholly owned subsidiary of American Medical Response, Inc. (AMR Inc.), a Delaware corporation, which was established in August 1992, with headquarters in Greenwood Village, Colorado. The following chart illustrates these relationships:

American Medical Response, Inc.

Greenwood Village, Colorado

American Medical Response West

Livermore, California

American Medical Response

San Joaquin County

Stockton, California

Number of Years in Business

AMR West was incorporated on May 27, 1992. Locally, AMR has been serving San Joaquin County through our predecessor companies since the early 1960s, and our presence within the community remains extremely strong. This is perhaps exemplified best by AMR West’s Chief Executive Officer, Louis K. Meyer, who began his EMS career in San Joaquin, led a predecessor company – Life Medical


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Industries – from 1988 to 1993, and continues to oversee our operations from his office in Livermore. Mr. Meyer is a long-time resident of Stockton, is active in the community, and takes a significant, personal interest in the continued effectiveness and evolution of the local EMS system. In addition, AMR’s Vice President of Operations for the Central Valley of Northern California, Brad White, was born and raised in Stockton and began his EMS career in San Joaquin in 1979.

The following is a chronology of AMR’s history in the County:


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Other or Prior Business Names

AMR West is comprised of a variety of predecessor companies throughout Northern California. The following table lists other or prior business names for AMR West:

Other Business Names American Medical Response Metropolitan Ambulance Service AMR Mobile Life Support Northern California Training Institute PMI Acquisition Corp. Sonoma Life Support Vanguard Ambulance Services 911 Emergency Services

Prior Business Names 911 Emergency Services, Inc. Peninsula Paramedic Services, Inc. AMR West BLS Regional Ambulance, Inc. Cadillac Ambulance Service Sacramento Life Support Contra Costa Medical Systems, Inc. San Francisco Ambulance Service, Inc. Doctors Ambulance of Modesto, Inc. Santa Cruz Ambulance Service, Inc. Foothill Ambulance Service SCV Paramedical Services Fremont Ambulance Service Shirley Enterprises, Inc. Golden Gate Associates Stanislaus County Emergency Medical

Communications Intensive Care Ambulance, Inc. Stephens & Poletti Ambulance, Inc. Life Medical Industries, Inc. Superior Ambulance Medevac, Inc. Tri-Cities Ambulance Service Michael’s Ambulance Systems United Ambulance Service Pajaro Valley Ambulance Service, Inc.

Controll ing Interest

AMR West owns 100% of the controlling interest of Metropolitan Ambulance Service. (“Metropolitan” was a subsidiary of 911 Emergency Services, Inc., which AMR purchased on January 26, 1994. Metropolitan remains an active subsidiary of AMR West, but is due to be merged shortly.)

AMR West is a wholly owned subsidiary of American Medical Response, Inc. On February 10, 2005, American Medical Response, Inc. and its sister corporation, EmCare, Inc., along with their respective operating subsidiaries, were sold to a newly formed holding group. All of the issued and outstanding capital stock of


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American Medical Response, Inc. — including AMR West — and EmCare, Inc. are now held (indirectly through holding companies, AMR HoldCo, Inc. and EmCare HoldCo, Inc.) by Emergency Medical Services LP, a Delaware limited partnership.

The partnership interests of Emergency Medical Services LP are in turn held by management of American Medical Response, Inc. and EmCare, Inc., along with Onex Corporation, through certain of its subsidiaries. Onex Corporation is a diversified company with 71,000 employees worldwide, annual consolidated revenues of approximately $13 billion, and consolidated assets of approximately $11 billion. Onex is one of Canada’s largest companies with global operations in service, manufacturing, and technology industries. Its investments in Emergency Medical Services LP are Onex Partners’ fourth health care investment. Onex Partners has also invested in Magellan Health Services, Inc., Res-Care, Inc., and Center for Diagnostic Imaging, Inc. Other operating companies of Onex include Celestica Inc., ClientLogic Corporation, Cineplex Galaxy LP, J.L. French Automotive Castings, Inc., Commercial Vehicle Group, Inc., Cosmetic Essence, Inc., Performance Logistics Group, Inc., and Radian Communication Services Corporation.

Onex Partners LP is a $1.65 billion private equity fund established in 2003 by Onex Corporation. Its principal place executive offices are located at 712 Fifth Ave, 40th Floor, New York, NY 10019. Onex Partners provides committed capital for Onex sponsored acquisitions.

The following chart identifies the relationship of AMR, Inc. and AMR West to the new organization:

Emergency Medical Services LP, a Delaware limited partnership

American Medical Response HoldCo, Inc. EmCare HoldCo, Inc.

American Medical Response, Inc. EmCare Holdings, Inc.

Subsidiaries including American Medical Response West Subsidiaries


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The San Joaquin County operation is part of our company’s Northwest-Plains Region, outlined in the map earlier in this section. As part of that region, our local operation receives valuable support from regional personnel, based in Livermore, in the areas of human resources, clinical services, educational services, communications, deployment, safety, finance, fleet maintenance, purchasing, and information technology.

Due to the national organizational structure of AMR Inc., certain business activities, such as accounts payable and payroll processing, are handled at our National Resource Center in Greenwood Village, Colorado, on behalf of local operating units.

William Sanger, Chief Executive Officer of AMR Inc., is the sole director of both AMR West and AMR Inc.

Financial Interest in Related Business

AMR West is a stand-alone entity. We neither hold an equity interest in any other companies nor have current business partners. AMR West operates the Northern California Training Institute (NCTI) located in Roseville, California, as a division within its operations. Although NCTI does not provide ambulance services, it is integral to the training of Paramedic, EMT, and dispatch staff employed by AMR and numerous Fire agencies in Northern California.

AMR’s current operation in San Joaquin County functions as an autonomous entity from our parent company. By design, each operation has its own revenues, its own budget, and its own overhead and operational costs. As such, each operation may respond to the needs of its local community, while enjoying the clinical and operational resources of an experienced national company.

Business Partners

AMR West has no business partners, either today or in the past five years.


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3.2.B. Communi t ies Served Provide a list or table of every community your organization currently serves and every community it previously served. Indicate:

In Northern California, AMR currently serves 17 counties, as illustrated in the map to the right, working with public agencies to develop more efficient, clinically sophisticated EMS systems that raise industry standards and public expectations. As communities grow and evolve, their needs and the manner in which they respond to these needs change. AMR understands this. We constantly strive to find innovative and efficient solutions to communities’ needs, never forgetting that patient care is the reason we exist.

A table showing all communities currently served and previously served for the past five years, with the requested information, is included in Section I Attachments. We have never failed to complete a contract, have never had a contract terminated, and we have never been the subject of any allegations of deficient service.

3.2.C. Max imum Response T imes Document your organization’s experience providing emergency and ALS ambulance services meeting independently verifiable maximum (fractile) response times for both Code-2 and Code-3 requests. Present examples of compliance for at least a two-year period to fractile response times for metropolitan/urban, suburban, rural, and wilderness in analogous areas.

As the incumbent emergency ambulance provider in San Joaquin County, AMR offers unparalleled local experience and bench strength working with other stakeholders in this clinically focused, high-performance EMS system.

Currently, the San Joaquin County system does not operate using independently verifiable maximum (fractile) response-time standards. As such, we are unable to provide specific local data for a two-year period using the RFP criteria. However,


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the majority of our other ALS agreements throughout Northern California do include strict performance standards, requiring compliance with independently verifiable maximum fractile response times and stringent reporting guidelines. For these contracts and throughout hundreds of other EMS service areas in the United States, AMR has demonstrated history of successfully applying our expertise to meeting and exceeding performance expectations. The success of these operations in meeting and exceeding their response-time standards is strongly indicative of the commitment, skills, and knowledge we will apply to continue delivering outstanding ambulance services in San Joaquin County.

For the purposes of this RFP, AMR has chosen to present verifiable response-time compliance information for our ALS contract in Santa Clara County. None of our contracts in northern California require reporting for Code 2 and Code 3 compliance separated by response area such as Urban, Suburban, Rural, and Wilderness areas. As such, there is no data available for AMR West that correlates completely with the RFP requirements. Under our contract with Santa Clara County, however, we are required to document Code 2 and Code 3 response-time compliance in five zones, each of which contains an urban, suburban, rural, or wilderness component. This compliance information is provided in Section I. Attachments.

If members of the RFP review team require additional information on our company’s ability to meet response-time standards in Urban, Suburban, Rural, and Wilderness areas for both Code 2 and Code 3, we will be happy to provide information from our sister operation in Clackamas County, Oregon, which reports compliance under these guidelines.

3.2 .D. Equi tab le Response T ime Document your organization’s experience providing equitable response time among neighborhoods and/or communities.

AMR is dedicated to providing unparalleled and equal service to all residents in all areas served, regardless of location. Based on the principles of System Status Management (SSM), our current and proposed deployment plans are designed to ensure that all areas of the county are equitably served, regardless of demand. Details on AMR’s proposed response-time equity strategies for San Joaquin County may be found in Section II.B. System Design – Proposed Deployment Plan.

AMR has proven experience successfully managing an equity response-time strategy. In each of the following counties, the EMS system is designed so that every area of the county receives the same level of response and care through


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specific ambulance response-time compliance zones. Details of our response-time compliance for each of these counties, by zone, are included in Section I Attachments.

CONTRA COSTA COUNTY

The Contra Costa County EMS system is designed to meet an “Equality among Communities” approach to first Paramedic on-scene, or ALS ambulance, response times in the County’s 19 cities. With a county-wide goal of having a Paramedic on scene in 10 minutes or less for every emergency response, AMR has established creative deployment and staffing configurations in partnership with EMS and the seven county Fire agencies/districts. Since each of the seven Fire entities are in varied stages of considering or implementing ALS engine companies, the 10-minute paramedic goal is achieved through innovative SSM deployment plans using ALS ambulances, ALS First Responders, and AMR Quick Response Vehicles (i.e., solo paramedic squads), to augment BLS Fire response areas. Our response time compliance in each of the five zones, and the rural area, is documented in the form of a monthly performance report that is posted on the County website.

SANTA CLARA COUNTY

Santa Clara County is known for its advanced, high-performance urban EMS system. The Santa Clara County system covers 1.6 million people and 75,000 annual responses. AMR is contractually obligated to provide Paramedic First Response to code 3 calls within 8 minutes, 90 percent of the time, and provide a paramedic transport unit within 12 minutes, within five zones. Each of the five zones was designed by consensus to ensure they were similar in call demand. Within each zone, we have three separate response standards – urban, suburban, and rural. We also provide a month-to-date report that is updated daily and measures compliance by sub-zone and category. This allows us to continually redistribute resources to ensure a rapid response, thus providing both response-time compliance and superior patient care.

As with the other areas we serve, we actively manage our Santa Clara County ambulance deployment to meet response-time criteria by zone. AMR’s SSM vehicle deployment method uses an analysis of historical call demand to predict future call patterns. This analysis allows us to strategically place the appropriate number of


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ambulances throughout the county to meet anticipated demand in every community. We have consistently exceeded performance standards in Santa Clara County.

3.2.E . In tegrated EMS Systems Describe your organization’s experience in integrated EMS systems involving fire service and other public entities as subcontractors.

AMR is recognized as a committed industry leader, working with other EMS system stakeholders to develop more efficient, clinically sophisticated EMS systems that raise industry standards and public expectations. As demonstrated by our history throughout Northern California, we enthusiastically participate in system redesign activities as new trends or pressures in health care delivery systems emerge to ensure the continued evolution of the prehospital care system to meet patients’ needs. The following are two examples of innovative integrated EMS systems in which AMR is a primary provider and which include subcontracts with public entities. Each of these systems features unique public/private partnership solutions for local residents and our county partners.

Santa Clara

AMR was the principal partner in the innovative system design initiative in Santa Clara County in 1994. Our experience there provided the foundation for many other public-private partnership models now implemented throughout the nation. The agreement was renewed and supplemented in 2001 such that AMR now contracts directly with local government agencies to provide First Responder services, thus providing an enhanced level of accountability to the system.

Elements of this award-winning system design include:

• Revenue sharing with First Responder agencies in recognition of their value-added ALS services

• Reduced response times for ALS intervention

• Supplemental Fire Department-staffed ambulance units within the county for use in the case of unusual system demand

• Creation of full-time First Responder Liaison position

• Shared quality assurance and purchasing agreements


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San Mateo County

AMR has served San Mateo County since 1990. In 1999, AMR was the successful proposer in San Mateo County’s Request for Proposal process, which included an extensive system redesign, with an option to build on the Santa Clara system described above. Innovative elements of San Mateo County system include the following:

• Contracting with a Joint Powers Authority (JPA) composed of 17 cities and fire agencies to provide Paramedic First Responders on all engines

• System accountability rests solely with AMR, which is entirely responsible for meeting the county’s response-time requirements and is the sole contact for the county.

• AMR provides a variety of support services for the fire agencies, such as quality improvement program oversight, EMS education and training, medical equipment, and monitoring of fire personnel certifications.

• Use of a single resource management plan using a sophisticated “move-up” system so that dispatchers can shift both AMR and fire agency resources across city lines to meet anticipated demand

• Implementation of our proprietary electronic Patient Care Report (ePCR) system seven years ago.

3.2.F . Current Net Worth Document your organization’s current net worth and the form of that net worth including its capacity to convert non-liquid assets into cash if needed. Provide an audited financial statement of current assets and liabilities for the past two years.

AMR West holds the financial reserves to sustain operations and meet its commitments during any periods of unforeseen and unfavorable operating results. As documented in the accompanying audited financial statements located in Section I Attachments, AMR West and AMR, Inc. have substantial net worth: AMR West’s net worth was $56.5 million and $63.3 million at August 31, 2004, and August 31, 2003, respectively. The reports characterize net worth as an inter-company balance, an obligation due to the parent (AMR, Inc.). As described in the sixth paragraph of 5 – Transactions with Related Parties of the financial statements — the balance will be settled through future net cash transfers; however, “the timing of any such transfers is uncertain and not subject to any fixed repayment schedule.”


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AMR, Inc.’s net worth was $598.3 million, $573.8 million, and $560.5 million at January 31, 2005, August 31, 2004, and January 31, 2003, respectively.

The following financial metrics demonstrate AMR’s ability to convert short-term assets into cash if needed to meet our commitments and to ensure our stability in our role as a provider of high-quality emergency medical services.

AMR West 8/31/04

AMR Inc. 1/31/05

Current ratio: 2.84 2.23 Current assets $58,248,374 $520,443,000 Current liabilities $20,476,018 $233,309,000

Working capital: $37,772,356 $287,134,000 Current assets $58,248,374 $520,443,000 Current Liabilities $20,476,018 $233,309,000

Although the historical financial audit reports reference Laidlaw International as the company’s ultimate parent, American Medical Response, Inc., and its sister corporation, EmCare, along with their respective operating subsidiaries, were sold to a newly formed holding group on February 10, 2005, as described in Section 3.2.A above.

3.2 .G. Work ing Cap i ta l Document your organization’s access to working capital, including the finance of equipment needed to service a system such as the one in San Joaquin County.

Although AMR is an incumbent provider, the new contract will require nearly $2.8 million of investment capital for new equipment, including Type II ambulances, upgraded monitor/defibrillators, Automatic Vehicle Locator (AVL) equipment, dispatch equipment, an electronic patient data collection system, and so on. Our company holds sufficient liquidity to support this investment, as AMR West and AMR Inc. carried working capital balances of $37.8 million as of August 31, 2004, and $287.134 million as of January 31, 2005, respectively.

Additionally, and as described in Section 3.2.F, our company’s operations produce significant operating cash flow to meet working capital requirements and to handle unforeseen events among our business units. Funding for the acquisition of equipment for the San Joaquin County project will come from these operating cash flows.


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3.2 .H. Borrowing Power Provide evidence of the amount of current reserve borrowing power for your organization.

To demonstrate AMR West’s evidence of current reserve borrowing power for our organization, we have provided in Section I Attachments selected pages from the Credit Agreement among the American Medical Response group of companies and Bank of America and its affiliated lenders, dated February 10, 2005. This credit facility includes a $100 million revolving line to support the issuance of letters of credit. As this agreement is 189 pages in length, we are providing only certain pages to document its availability. Additional information is readily available should the County require further verification.

3.2. I . Commitments List commitments or potential commitments, which may impact assets, lines of credit, guarantor letters, or otherwise affect your abilities to perform this contract.

There are no known commitments or any other factor affecting our company’s ability to implement a new contract with San Joaquin County. Each AMR operation is autonomous, local leadership is empowered to make decisions, and by design, each operation has its own revenues, its own budget, and its own overhead and operational costs.

3.2.J . Bankruptcy F i l ings or Terminat ions Describe the circumstances of any bankruptcy filings or terminations of emergency ambulance service involving your organization within the past five years.

AMR West has not been directly involved in any bankruptcy filings. AMR, Inc., however, was held by Laidlaw Inc., for a short period of time and emerged from Chapter 11 Reorganization bankruptcy on June 23, 2003. The bankruptcy did not directly affect AMR West and had no effect on the assets held by the Company.

AMR has never been asked to leave a community for reasons of early termination, breach of contract, or failure to perform. We have also never refused to complete an agreement.


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3.2.K. L i t igat ion List all litigation in the past five years involving your organization or any principal officers in connection with any contract for similar services. Include the title of the case, case number, court, and monetary amount.

A list of litigation for AMR West and its principal officers during the past five years is included in Section I Attachments. Additional information for AMR Inc. is available for review if desired. Due to its local relevance, the following is presented regarding American Medical Response, Inc. v. City of Stockton, et al., Case No. 2:05-CV-01316.

On June 28, 2005, AMR West’s parent company, American Medical Response, Inc., (“AMR Inc.”) filed a Complaint in the United States District Court for the Eastern District of California against the City of Stockton (“Stockton”), seeking Declaratory Relief. Specifically, the Complaint seeks a determination from the Court that a Joint Venture Agreement entered into between AMR Inc. and Stockton to submit a bid in response to this RFP is unenforceable. On July 12, 2005, Stockton filed a counterclaim, alleging breach of contract, breach of the covenant of good faith and fair dealing, breach of fiduciary duty, and unfair competition/business practices, and seeking injunctive relief and damages in an unspecified amount. The parties filed cross motions for summary judgment or partial summary judgment, and Stockton filed a motion for preliminary injunction to preclude AMR Inc. from submitting a bid for this RFP. A hearing was held on all motions on September 14, 2005. By Order dated September 16, 2005, the Court denied the City’s motion for a preliminary injunction. The other motions remain pending before the Court and the litigation is ongoing.

3.2 .L . Regulatory Act ions or Sanct ions List any instances of major regulatory actions or sanctions against your organization, including suspension or revocation of any operating license or permit, any sanctions under Medicare or Medicaid programs, revocation of a business permit, or any sanctions by other third-party payers, whether public, private, or non-profit.

A list of regulatory actions is included in Section I Attachments.


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3.2.M. L icenses or Cer t i f icates List business or professional licenses or certificates held by your organization required to provide the services required by this contract.

AMR holds a statewide emergency ambulance license issued by the California Highway Patrol (CHP), which covers all our vehicles. We also operate emergency ambulance services under contracts with public agencies, and we hold business licenses in each city where we operate a facility. Copies of AMR’s permits to operate in each zone of San Joaquin County, a sample of our CHP-issued ambulance permit, and our business licenses for the cities of Lodi, Stockton, and Tracy are included in Section I Attachments.

3.2.N. Key Personnel Identify key personnel who will be responsible for operations within San Joaquin County including, but not limited to, the local operations manager and those responsible for quality improvement, education/training, billing, equipment maintenance, and dispatch services.

Our Core Asset

Before providing biographical descriptions of our key management personnel, we want to first acknowledge the invaluable contributions made by our field caregivers to the well-being and continued clinical excellence of the local EMS system. AMR’s San Joaquin County operation is a tightly knit organization, with long-time personnel at all levels. As a result, we have developed effective relationships and open communication born out of mutual respect for each other. Our Paramedics and EMTs are well-trained, highly experienced individuals who work virtually autonomously to provide disciplined and effective patient care. As the front line in the system, they work tirelessly to improve how the system works, providing valuable input and perspective on needed enhancements or changes. It is our strong belief that the San Joaquin County EMS system would not be what it is today were it not for the contributions of all our personnel, from our Paramedics and EMTs, to our fleet services, to customer service representatives, to our management team.

Key Personnel

AMR proposes to keep in place our highly experienced and talented leadership team, which averages almost 20 years of service to San Joaquin County. With its open and collaborative management style, this team has been extremely successful in


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working with our employees and system partners to deliver exceptional ambulance services as part of the current EMS system in San Joaquin County.

Daily operations are guided by Director of Operations, Barry Elzig, who reports to our Vice President of Operations, Brad White. Mr. White reports directly to Louis K. Meyer, CEO of the Northwest Plains Region. All three individuals are native to San Joaquin County. Mr. Meyer began his EMS career locally in 1972, and as a county resident, he continues to provide personal oversight and interest in the successful operation of our ambulance services in his home town.

The following chart illustrates the organizational structure of the operation with the assumption that AMR continues to serve the entire county.

San Joaquin County Operations

(For Zones A, B and C combined)

MEDICAL DIRECTOR

Dr. Kevin Mackey

FIELD TRAINING OFFICERS

(10)

ADMINISTRATIVE SUPERVISOR

TBD

DIRECTOR OF OPERATIONS

Barry Elzig

VICE PRESIDENT OF OPERATIONS

Brad White

CHIEF EXECUTIVE OFFICERNorthwest-Plains Region

Louis K. Meyer

DeploymentManager

Rick Goudy

Safety & Risk ManagerRich Silva

Communications Director

Joe Gear

FIELD SUPERVISOR

Bob Wattenbarger

Dotted line reporting denotes positions budgeted elsewhere

FIELD SUPERVISOR

Kelly Goens

FIELD SUPERVISORRob Henning

HR ManagerDebbie Mejia

COMMUNITY SERVICE

COORDINATORTBD

CLINICAL EDUCATION

COORDINATORGary Riggs

CUSTOMER SERVICE REP Martin Molina

IT TECHNICIAN(MEDS EPCR)

TBD

FLEET SUPERVISOR

Bob Weatherford

Patient Billing Director

Bill Shelton

AMR also offers San Joaquin County the following management advantages:

• Broad industry experience — all current leadership personnel have worked in the field as Paramedics or EMTs, and many have EMS experience from outside San Joaquin County.


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• A local leadership team that lives in the county and is immediately available for major events or if additional services are required

• Ability to call on additional expertise from our regional and national leadership teams for “best practices” and the latest industry standards. This adds particular value with data collection and trending for education, new technology, and access to new equipment.

LOCAL LEADERSHIP TEAM

The following individuals will oversee the implementation of contract enhancements, ensuring a seamless transition to the new contract and continued oversight throughout the term of the contract. All members of the current leadership team are available 24 hours a day via cell phone and pager. Resumes of all our key personnel — local and regional — including years of service and education/qualifications, along with their job descriptions, can be found in Section I Attachments.

Barry E lz ig , D i rector o f Operat ions

Mr. Elzig provides leadership and direction for the San Joaquin County operation, while also forging relationships with local public safety agencies and ensuring compliance with all aspects of the County agreement to provide ambulance service. He began his career as an EMT 23 years ago in Calaveras County, advancing to the EMT-II and Paramedic levels before moving into management. He served as a Field Supervisor and then Operations Manager before taking on his current position in 2003. Mr. Elzig has 15 years of management experience for AMR and its predecessor companies, working in and managing both rural and urban counties. Recently appointed to the Emergency Medical Care Committee by the County Board of Supervisors, Mr. Elzig is also a member of the San Joaquin Transportation Committee and the County Fire Chiefs’ Committee, and he is active with the Emergency Communication Dispatch Committee.

Dr. Kev in Mackey , Local Medica l D i rector

Our new Medical Director, Dr. Kevin Mackey, has a long history in San Joaquin County, beginning in 1986, when he was an EMT with Stockton Ambulance. He later became a Paramedic, Paramedic Supervisor, and Field Training Officer (FTO) with Stockton Ambulance and Manteca District Ambulance before attending the University Health Science Center in Pittsburgh, Penn. During his emergency


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medicine residency at the University of Pittsburgh, Dr. Mackey served as the EMS Command Physician for the City of Pittsburgh, Department of Public Safety, Bureau of EMS, and as a Flight Physician with STAT MedEvac in Pittsburgh. He is currently a physician in the emergency department at Kaiser Permanente / South Sacramento. As the local Medical Director for AMR in San Joaquin County, Dr. Mackey will provide overall direction for our clinical services, including policies and procedures, our comprehensive Continuous Quality Improvement (CQI) program and our continuing education and orientation programs. He will be supported by our full-time, local Clinical and Educational Services (CES) Coordinator, local FTOs, and a regional CES team. Dr. Mackey is a member of the National Association of EMS Physicians, the American College of Emergency Physicians, the Society of Academic Emergency Medicine, and the Sierra Sacramento Valley Medical Society.

Admin is trat ive Superv isor (TBD)

As an enhancement under the new contract, AMR is proposing to create a new Administrative Supervisor position to oversee payroll/scheduling/support Services and our local business office. This individual, who will be hired at the start of the new contract, also will serve as the Safety / Workers’ Compensation and Infection Control Coordinator.

Bob Wattenbarger , F ie ld Superv isor

Mr. Wattenbarger is responsible for overseeing the day-to-day operations of ambulance services in San Joaquin County, working with the Director of Operations. He has extensive experience in the EMS industry, starting as an EMT in Solano County in 1990 and becoming a Paramedic in 1992. Growing rapidly into a leadership role, Mr. Wattenbarger has 10 years of management experience for AMR and our predecessor companies, working in both rural and urban communities. He takes an active role in the company, serving as a Field Supervisor, local Safety Officer, and as our designated disaster liaison. In this latter role, he is a member of the County’s Terrorism Preparedness Exercise Subcommittee and assisted in the submission of a grant application to the California Health Resources and Services Administration in 2004, which resulted in the County EMS system receiving $567,373 from the federal government to cover equipment and training specifically for Weapons of Mass Destruction purposes. He is an alternate member of the San Joaquin Transportation Committee.


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Kel ly Goens, F ie ld Superv isor

Ms. Goens is responsible for the day-to-day operations of ambulance services in San Joaquin County. With 22 years experience in the EMS industry, she started her career as an EMT in Nevada County, advancing to the EMT-II and Paramedic levels. Ms Goens has 12 years of management experience for AMR and its predecessor companies, working in and managing both rural and urban communities. Ms Goens is currently responsible for overseeing the local FTO program.

Rob Henning, F ie ld Superv isor

Mr. Henning is responsible for the day-to-day operations of ambulance services in San Joaquin County, including working as an ALS Supervisor, the BLS Division Supervisor, and heading Support Services, which is charged with keeping our vehicles and crews in the field well-supplied with necessary equipment. He has more than 15 years experience in EMS, starting as an EMT in Sacramento County in 1988 and becoming a Paramedic in 1991. Mr. Henning relocated to San Joaquin County in 1993, where he has 12 years experience as a member of the EMS team in Stockton/Lodi/Tracy. Mr. Henning was instrumental in the development of the local FTO system and has been a FTO and a Paramedic Preceptor for several years. He also introduced the EMS Bike Team in San Joaquin County and still oversees the team.

Gary R iggs , C l in ica l and Educat ion Serv ices Coord inator

As a full-time employee dedicated to San Joaquin County, Mr. Riggs’ key role in this new position is to ensure CQI and quality Continuing Education programming for the local operation. Mr. Riggs has been with the company for his entire EMS career, beginning as an EMT in San Joaquin County 24 years ago and moving onto the Paramedic and Supervisor levels. While serving in the field as a Field Supervisor, he was specifically charged with CQI responsibilities and also worked as an FTO and Preceptor. Mr. Riggs has seven years of management experience for AMR and its predecessor companies, working in and managing both rural and urban areas. He is a member of both the San Joaquin and AMR Critical Incident Stress Management Teams.


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Bob Weather ford , F leet Maintenance Superv isor

Mr. Weatherford is responsible for all vehicle repair and maintenance for our San Joaquin and Stanislaus Counties operations. He plays a key role in all county and state vehicle inspections for licensing and permits and ensures all vehicles are in top working condition and available for deployment at all times. Mr. Weatherford has 48 years experience as a Diesel Mechanic and 25 years in the EMS industry, starting out as a line mechanic, senior mechanic, supervisor and manager. He has 16 years of management experience for AMR and its predecessor companies.

Mart in Mol ina, Customer Serv ice Representat ive

Mr. Molina is responsible for contracting and coordinating ambulance standbys and special events in San Joaquin County. He is also responsible for resolving customer service issues and for coordinating the return of lost and found items. In his Public Relations role, Mr. Molina handles the scheduling and participation in demonstrations, tours, health fairs, and career days, as well as providing services education for convalescent hospitals, board and care homes, and so on. He has also served as one of our CEVO-11 driving instructors for remedial safety training for our field crews. Mr. Molina has more than 31 years experience in the EMS industry in San Joaquin County, working as an EMT and Paramedic. He has 20 years of management experience for AMR and its predecessor companies in both urban and rural counties.

Communi ty Serv ices Coord inator (TBD)

We are committing to hire a new Community Services Coordinator to oversee our expanded Community Education and Outreach Program, providing an additional enhancement under the new contract. This individual will manage the program described in Section II.H. Community Education/Prevention, which includes EMS access, CPR programs, valuation of data, and injury prevention.

In format ion Technology Technic ian (MEDS ePCR)

With the proposed implementation of our electronic Patient Care Report system (MEDS ePCR™), AMR is proposing to hire a full-time Information Technology (IT) Technician to support both AMR and the County in the implementation and continued usage of the system. The IT Technician will be responsible for installing,


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managing, and troubleshooting the hardware and software needed for successful data integration and reporting, as well as training AMR and County staff in the use of the different technologies.

REGIONAL SUPPORT TEAM

San Joaquin County also benefits from the expertise to be found among our regional and national leadership teams. As part of a larger organization, our local team has access to, and support from industry specialists in finance, information services, safety and risk management, human resources, and other support departments. Many of these professionals are based nearby at our regional resource and support center in Livermore. The following regional staff will be instrumental in supporting our San Joaquin operation as it moves forward under the new contract.

Louis K. Meyer , CEO, Northwest P la ins Region

Mr. Meyer has been CEO of AMR’s Northwest – Plains Region, which includes 56 counties, since 1999. He oversees an operating budget of $425 million and the activities of more than 6,050 employees in California, Hawai`i, Oregon, Washington, Montana, South Dakota, Colorado, Kansas, Wyoming, Missouri, and Iowa. Previous to his current appointment, he was CEO of AMR’s Northern California/Hawai´i Division, and before that, was responsible for AMR's Mid-Atlantic Region, headquartered in Philadelphia, where he had executive oversight of an operating budget of $60 million and a staff of 1,100 people. While heading the Mid-Atlantic Region, Mr. Meyer instituted a new participatory management policy. He established consistency among systems of accountability and created a productive atmosphere and cooperative spirit between regional and local operations. He also created regional managed care contractual relationships and innovative complementary health care programs.

Earlier, as Chief Operating Officer with AMR West, Mr. Meyer was responsible for oversight of all administrative and field operations in the Central Valley. In that position, he was responsible for maintaining and enhancing service to 12 counties with a staff of 1,500 employees. At Life Medical Industries (LMI), Mr. Meyer was responsible for administrative and field operations, with executive oversight of the company. Under his leadership, LMI generated $7 million in annualized revenues by providing ambulance transportation services to 20,000 patients in a competitive market. He had oversight responsibilities for a staff of 150.


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Mr. Meyer is extensively involved in many professional organizations outside of his responsibilities with AMR. He is currently Chairman of the California Emergency Medical Services Commission, which he continues to serve as a member. Mr. Meyer also served as a liaison to the California Association of EMS Administrators, the California Emergency Medical Services Authority, and the California Paramedic Rescue Association. Recognizing the importance of community service, Mr. Meyer was Vice President of the Salvation Army Advisory Council of San Joaquin County. In 1986, he was named San Joaquin County’s “Paramedic of The Year,” and in 1996, was given the County’s EMS Pioneer Award.

Brad Whi te , V ice Pres ident o f Val ley Operat ions

Mr. White has more than 25 years of experience in the medical transportation industry, including 24 years in a variety of management roles with AMR and its predecessor companies. He began his EMS career as a Wheelchair Van Attendant and soon thereafter became an EMT, followed by an EMT Supervisor, with All-City Ambulance. All-City later merged with Lodi Ambulance to become LMI. He advanced to become LMI’s Marketing/Personnel Director, Director of Patient Business Services, and finally General Manager. In 1992, LMI merged with AMR, and Mr. White became the Director of Operations overseeing functions for San Joaquin, Stanislaus, and Merced counties. In 1997, he was promoted to Vice President and assumed responsibility for AMR’s State of Hawai`i Division. In 2003, he was assigned to oversee the AMR East Bay and Central Valley areas of Northern California in addition to Hawai`i operations. Mr. White has directed numerous internal re-engineering projects for which he identified improvement opportunities and implemented solutions resulting in exceptional team performance. He is responsible for strategic leadership, business retention and growth, budgetary modeling and implementation, contract negotiation and compliance, and government relations.

Joe Gear , Communicat ions Di rector

Mr. Gear will oversee the new communications center planned for San Joaquin County. He is currently responsible for the creation, build out, staffing, training, and operational management of the REDCOM Fire and EMS Dispatch Joint Powers Authority serving all Fire and EMS agencies in Sonoma County and southern Mendocino County. Mr. Gear has 33 years experience in public safety, starting out as a police officer, and four years of management experience for AMR. He was hired specifically for the REDCOM project after having successfully built out two


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other multi-agency / multi-discipline public safety dispatch centers. Mr. Gear currently serves as the Communications Officer for the Sonoma County Fire Chiefs Association. He also is a member of the Sonoma County Paramedics Association, APCO, Cal Chiefs Communications Officers, NENA, the California Ambulance Association and, by appointment of the Board of Supervisors, the Sonoma County Emergency Medical Care Council.

T im Dorn , V ice Pres ident of F inance

Mr. Dorn is responsible for financial planning, management, and reporting activities for AMR’s Northwest-Plains Region. His primary focus is on the pricing of services, expense control, and utilization of resources, and he is responsible for ensuring overall regional performance, including budget and contractual compliance. In addition, he develops regional finance objectives, including short- and long-range programs, and formulates plans to meet these objectives. He has considerable expertise in Medicare reimbursement. He formerly served as regional controller for AMR’s Midwest Region and was Senior Vice President of AzStar Casualty Company.

Lisa M. Chalmers, D i rector F inanc ia l Operat ions

Lisa Chalmers is responsible for Finance and Accounting for our Northwest Plains Region, where she has a key role in overseeing the daily financial operations of the local operations. Mrs. Chalmers started her career in EMS financial operations eight years as Manager of Financial Operations for AMR’s Bay Area and Hawaii operations and has been in her current position since 2000. She has an additional seven years as an accountant and accounting manager for two Bay Area accounting firms. Mrs. Chalmers has a bachelor of science degree in business administration – accounting and has been a Certified Public Accountant since 1993.

The following individuals will also be providing support services for the San Joaquin County operation:

• Debbie Mejia, Human Resources Manager

• Richard Silva, Safety and Risk Manager

• Rick Goudy, Deployment Manager

• Bill Shelton, Director of Patient Business Services


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LEADERSHIP TENURE

It is important to note that the majority of leadership team personnel in the San Joaquin County operation have been with the company on average for 20 years. This is a great achievement and speaks to the company’s focus on retaining high-functioning, dedicated leaders. During their time with the company, several members of our local team have advanced to leadership positions within the company, moving on to regional and national positions. The following table illustrates the length of service for each member of our local leadership team:

Name Title Years in Position (With AMR)

Local Leadership TeamBarry Elzig Director of Operations 3 in position and 23 with AMR

Predecessor: Rick Keiser (2) Dr. Kevin Mackey Local Medical Director New position Bob Wattenbarger Field Supervisor 9 (15) Kelly Goens Field Supervisor 2 (22)

Predecessor: Rich Silva (4). Promoted to Risk/Safety Manager

Rob Henning Field Supervisor 7 (15) Bob Weatherford Fleet Maintenance Supervisor 16 (25) Martin Molina Customer Service Representative 6 (31) Gary Riggs CES Coordinator New position (24)

Regional Leadership TeamLouis K. Meyer CEO, Northern Pacific Region 8 (33) Brad White Vice President of Operations 8 (25) Joe Gear Communications Director 4 (33), No predecessor Debbie Mejia Human Resources Manager 5 (8) Rich Silva Safety and Risk Manager <1 (23)

Predecessor: Dave Caraveo (6) Rick Goudy Deployment Manager 9 (11) Bill Shelton Director of PBS 3 (15)

New position: Previous position was PBS Manager, held by Mr. Shelton


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I I .A. Introduction

As required in the Request for Proposals, AMR is providing in this section the following items:

• A letter of transmittal from AMR to the County summarizing our proposal

• Proposal Identification Page – Attachment A

• Statement of Intent and Affirmation – Attachment B

• Investigative Authorization – Company – Attachment C

• AMR’s Acceptance of the Minimum Requirements – Attachment E

Also located in this section is Attachment F – Acceptance of Contract Language.


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Enhancement

AMR will begin implementing several enhancements immediately following contract award in January 2006.

I I .B. System Design and Rural Parity

American Medical Response is offering a high-performance EMS system design that ensures dedicated 9-1-1 Advanced Life Support (ALS) ambulance resources for San Joaquin County. In addition, our proven high-performance deployment strategies create a dynamic, cost-effective EMS system that has the flexibility to change as the County’s needs change.

The foundation of our proposal includes unit hours dedicated to the 9-1-1 system; an Auto-Aid partnership with Manteca District Ambulance (MDA) that ensures seamless ambulance coverage for an extensive area of the South County (including the City of Tracy); and equity of response time to local communities with enhanced response-time performance. Our system design strategies include:

• Providing 3,024 unit hours per week dedicated completely to the 9-1-1 system. This deployment model exceeds the standards of the RFP in terms of response time and unit availability.

• A commitment to maintain the 3,024 total weekly ALS ambulance unit hours as our minimum resource deployment for the life of the contract

• A posting plan developed using extensive local historical data to achieve exemplary response-time performance by knowing where and when demand will occur and placing units in the right place at the right time

• Emergency Medical Dispatching services provided through our brand-new LIFECOM communications center and using the latest in Computer Aided Dispatch (CAD) and vehicle locator technologies to enhance response-time performance

• Demonstrated commitment to seek out and implement agreements with providers in other zones to provide the County with seamless and integrated ambulance coverage throughout the County.

Finally, as an incumbent emergency transport provider in San Joaquin County, AMR already has in place the leadership and the infrastructure needed to ensure smooth and expedited implementation of the new contract. This, along with our key relationships in the County, including those with other Ambulance providers, Fire agencies, and community leaders, will allow us to begin implementing several


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enhancements and proposal features immediately following contract award in January 2006. This will give the County a smoother and more orderly transition to the new system requirements and benefit the community by providing system enhancements at an earlier date.

4.1.1 START-UP Describe how your organization would manage the start-up of services with the planned timeframe from the contract approval to implementation. (Include fleet, other equipment, communications system, staff, and key personnel.)

If anything in the proposed service will not be in place on the starting date of the service, it must be clearly identified and a deadline for its implementation provided.

AMR commits to implementing all our proposal features included in this section, on or before May 1, 2006. The following chart outlines our planned implementation schedule for San Joaquin County:

AREA KEY MILESTONES Sept. 05 Oct. 05 Nov. 05 Dec. 05 Jan. 06 Feb. 06 Mar. 06 Apl. 06 May 06

Order Fire Module CADImplement Fire CAD ModuleFinish Center ConstructionPassport ImplementationRadio Acquisition / Control StationsAVL Solution (need to coordinate with ops)Operator Selection / HiringOperator Training and certificationsPolicy Development/Work Flow Devel.Development of Disaster Recovery PlanSecondary PSAP ApplicationComm Center VehiclesInfiniMUX SwitchOffice Chairs / StuffRadio ConsolesMobile / Portables for the 2 VehiclesOrder TI or Microwave CircuitsInstall TI or Microwave CircuitsRecruit Customers to Sign up for ServicesSystem TestingSelect / secure post and facility locals.Equip all facilities with supplies and equip.Spec / order vehiclesEquip vehicles with radios, AVL, etc.Stock and final inspection of vehiclesOrder gurneys, stair chairs, transf. sheetsOrder MEDS laptops, printers, etc. Install MEDS equip in vehiclesMEDS printers, connections, etc in hospitalsOrder all other med / non med suppliesRecruit and hire new ops. field staffRecruit and hire local support staffTrain staff - orientationTrain staff - FTO time / credentiallingTrain staff - certification augmentationTrain staff - new system overall / proceduresTrain staff - MEDS process / toolsEstablish SSP GroupEstablish LIFECOM Users GroupIT equipment ordering [servers, terminals, etc.]IT connectivity to CAD for FDIT connectivity to local EMSA, CAD / MEDSCommunity outreach program start up

The timeline reflected in the table below is contingent on timely and satisfactory execution of a signed contract with the County.

AMR / EMSA / FIRETIMELINE FOR SYSTEM-WIDE IMPLEMENTATION

STA

RT

OF

SYST

EM-W

IDE

IMPL

EMEN

TATI

ON

CO

MM

UN

ICA

TIO

NS

OPE

RA

TIO

NS

CU

STO

MER

S


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4.1.2 INITIAL DEPLOYMENT PLAN Present a proposed deployment plan that complies with all minimum requirements of this Request for Proposal. The initial deployment plan shall be utilized for at least the first three months of operations.

AMR’s proposed deployment plan will exceed the minimum requirements outlined on pages 21-22 of the RFP.

AMR commits to the following enhanced response times:

Enhanced Response Time Commitment Category Standard (90%)

Enhancement Over RFP Requirement

Urban 7:29 31 seconds Suburban 9:29 31 seconds Rural 17:29 2 minutes and 31 seconds Wilderness 29:29 15 minutes and 31 seconds

(no current wilderness designation)

Details on our response time commitments may be found in Section II.C. Operations – Response Time Standards.

Enhancement

AMR commits to enhanced response times for all response-time categories county-wide

Developed using comprehensive demand-analysis techniques to forecast unit-hour requirements, along with extensive geographical analysis combined with many years of local experience, our posting plan offers:

• A minimum of 3,024 ALS ambulance unit hours dedicated to the 9-1-1 system

• Positioning of ambulance resources where and when they can be most effective in enhancing response-time performance to rural areas


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• Emergency medical dispatching services provided through our new LIFECOM center, using the latest in CAD and vehicle locator technologies to enhance response-time performance

• Extensive non-9-1-1 system resources available at both the ALS and BLS level to provide a “depth of response” to large incidents not available from any other provider.

• Extensive data analysis to achieve response-time equity Enhancement

Our posting plan dedicates and commits for sole use in the 9-1-1 system a minimum of 3,024 ALS unit hours county wide. These will be the minimum unit hours for the life of the EMS contract.

4 .1 .2 .A . Deployment Parameters All Contractor ambulance responses under the terms of the contract with the County shall be dispatched in compliance with policies and protocols established by the County.

All AMR ambulance responses will be dispatched in compliance with policies and protocols established by the County.

4.1.2.A.1 Proposed Ambulance Locations and Numbers Specify proposed locations of ambulances and numbers of vehicles to be deployed during each hour of the day and day of the week.

Proposed locations of physical ambulance stations and post locations are outlined in the following table:


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1 Center St. at Crosstown Freeway (Post) 1 Lodi Avenue at Hutchins (Post)2 Hwy 26 at Jack Tone Road (Post) 2 1709 South Stockton Street 3 Wilson Way at Harding Way (Post) 3 11 Louie Street 4 March Lane at I-5 4 617 So. Lower Sacramento 5 9305 North Thornton Road 5 Hwy 88 & Brandt Rd (Proposed 24-hr station)6 888 East Lindsay7 Hammer Lane at West Lane 8 6231 North Pacific Avenue 9 245 West Charter Way

10 4632 Georgetown Place 11 Waterloo at Filbert 12 2060 East Main Street 13 Benjamin Holt at I-514 3406 Delaware Zone C (Tracy)15 Hammer Lane at Hwy 99 (Post) 1 Tracy Blvd at I-205 (Proposed 24-hr Station)16 French Camp Road at I-5 (Post) 2 535 West Beverly 17 Eight Mile Road at West Lane (Post) 3 Valpico at MacArthur (Proposed 24-hr Station)

(24-hr Station)

(Post)(24-hr Station)

(24-hr Station)

Zone A (Lodi)

(24-hr Station)(24-hr Station)

Zone B (Stockton)

(24-hr Station)

(24-hr Station)

(24-hr Station)

(24-hr Station)

(Post)(24-hr Station)

(24-hr Station)(24-hr Station)(24-hr Station)

The following table summarizes unit hours and number of ambulances deployed at peak in each zone:

Features Zone A Greater Lodi

Area

Zone B Greater Stockton

Area

Zone C Greater Tracy Area

Dedicated Total Weekly Unit Hours

672 1,848 504

Dedicated 24-hour ALS Ambulances During Peak Demand (7 days a week)

4

9

3

Dedicated 12-hour ALS Ambulances During Peak Demand (7 days a week)

0

4

0

Total Number of Ambulances During Peak Demand (7 days a week)

4 13 3

The following tables show the distribution of the dedicated 3,024 ambulance unit hours by day and hour for each zone, and a cumulative total. The coverage outlined in the table will allow us to provide services at an enhanced level to the minimum standards defined by the County in the RFP. Each unit-hour represents an ALS ambulance on duty during that hour of the day.


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Zone A Staffing Summary (Lodi)

Day 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23Sunday 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4Monday 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4Tuesday 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4Wednesday 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4Thursday 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4Friday 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4Saturday 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

Zone B Staffing Summary (Stockton)


Zone C Staffing Summary (Tracy)


Total San Joaquin County Unit Hour Deployment


Total Weekly Unit Hours: 1848


Hour of Day


Hour of Day

Hour of Day


Hour of Day


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These ambulances will be distributed throughout the county as follows:

4 3 2 1 *2 2 2 13 4 44 55

13 12 11 10 9 8 7 6 5 4 3 * 2 15 5 5 5 5 5 5 4 4 1 1 1 16 6 6 6 6 6 6 5 5 7 7 77 7 7 7 7 7 7 6 7 3 32 2 2 2 2 9 9 7 9 49 9 9 9 9 10 10 9 1110 10 10 10 10 2 2 211 11 11 11 11 12 1312 12 12 12 12 138 8 8 8 814 14 14 1415 15 1516 1617

3 2 1 *1 1 12 23

2. Use Non-System Unit

1. Move Stockton unit if 6 or more units available -OR-2. Use Non-System Unit if Stockton Level is less than 6.

* Maintain Level 2--- Rules Governing Backup Unit Selection ---

--- Rules Governing Backup Unit Selection ---

--- Rules Governing Backup Unit Selection ---

Always Notify Manteca Ambulance of Level 1 Status.

Number of Units Available

Posting Plan for Zone A (Lodi)Number of Units Available

Post

s to

Fill

Posting Plan for Zone C (Tracy)

Number of Units Available

Post

s to

Fill

Posting Plan for Zone B (Stockton)

* Maintain Level 4

1. Move Lodi unit if 4 units available there --OR--2. Move Tracy unit up if 4 units available in Tracy --OR--

Post

s to

Fill

3. Use non-system unit

* Maintain Level 2

1. Move Stockton unit if 4 units available there --OR--


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4.1.2.A.2. 24-hour/SSM Strategies Describe 24-hour and system status management strategies

AMR is proposing to deploy ALS ambulances throughout the County 24 hours a day, seven days a week using the following strategy:

• A foundation that includes ambulances dedicated for use in the 9-1-1 system. This includes 20 total ambulances at peak deployment and 16 total ambulances at non-peak deployment.

• 16 fixed-deployment stations, plus 9 additional flexible locations that have been identified as central to the demand in that specific geographic area and that provide good driving access to calls for service in as many directions as possible. In Zone B, for example, our data analysis identified March Lane at Interstate 5 as a desired location due to its easy freeway access and 4-way egress.

With the Automatic Vehicle Locator (AVL) technology on each of our ambulances, integrated with our brand-new state-of-the-art CAD system, AMR dispatchers will be able to visually identify the location of every ambulance in the EMS system on a computer screen at all times, ensuring that the closest appropriate ambulance is dispatched to every call for emergency service.

Enhancement

AMR will install a server and CAD monitor at the County EMSA, providing real-time viewing of deployed ambulance resources and the ability to run reports if desired.

The County of San Joaquin will benefit through this technology, as AMR is offering to provide the County with on-line access to our CAD via a server and CAD monitor located at the EMSA office. Once we have installed the server and monitor, EMSA staff will be able to view the system in real-time – just as our dispatchers are seeing it, providing real-time oversight and understanding of system performance. For details on this enhancement, see Section II.C. Operations – Response Time Standards.


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SSM STRATEGIES

The ultimate goal of System Status Management (SSM) planning is to have the right EMS resource placed in the right location, at the right time to respond to a 9-1-1 event. This level of planning allows high levels of service to be provided while maintaining reasonable overall costs to the community. AMR is a proven leader in the methods, technology and art of developing system status response strategies. Our long-time success in meeting the County’s and patient’s needs is testament to this expertise.

AMR has taken the following steps in creating and implementing our customized deployment plan for San Joaquin County:

• Demand analysis and unit-hour requirement projection. We reviewed 9-1-1 response volume and location data for each hour of the day and day of the week. After extensive modeling and analysis, which included year-over-year growth patterns by zone for the past five years and future growth plans by zone and seasonality, we were able to project the expected requests for service for 2006. This allowed us to determine the number of ALS unit hours needed to meet the system’s call demand. Holiday staffing needs are determined 30 days ahead of time so there is sufficient lead time to staff extra ambulances if analysis indicates a need.

• Geographic and demographic analysis. We then analyzed the unique geographic and demographic needs of the three zones and 11 response-time compliance areas within the County, basing our posting plans on the results. The analysis includes evaluation of the impacts caused by:

Densely populated housing areas with limited roadway infrastructure (e.g., Highway 12)

Three distinct geographic districts requiring independent ambulance coverage plans with interactivity of resources (Zone A, Zone B, and Zone C)

Geography and roadway challenges (e.g., Delta Islands, Highway 88)

Hospital patient-diversion impacts

Commute patterns, such as on I-205 and I-5

Need to provide community equity in response times to the greatest extent possible


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• Development of the final plan. Using the results of the demand, geographic, and demographic analyses, we were able to build posting plans and coverage strategies specifically tailored to each zone.

Once developed, our posting plans allow us to position ambulance resources as indicated by predictable demand patterns, by time of day and day of week, to ensure consistent compliance with each community’s expectation of rapid response and intervention. In meeting the community’s expectation of equity of response-time performance, AMR is also adopting an “outside-in” deployment strategy. In this approach, the deployment model is based on keeping key ALS resources on the periphery of high-demand areas where they can also respond rapidly to less-dense (i.e. rural) communities. This approach, combined with our understanding of the unique demands of this system and the technology we are proposing with respect to AVL and dispatch capabilities, allows us to propose enhanced response times in all response categories.

We also ensure that the plan retains sufficient resources to allow for high call demand or specific high call-volume events.

4.1.2.A.3. Peak Period SSM Describe mechanisms to meet the demand for emergency ambulance response during peak periods or unexpected periods of unusually high call volume.

A key feature of SSM is the ability to move ambulances throughout a service area as needed to ensure consistent coverage for all demand levels, using established Operational Guidelines. An effective posting plan, created by people experienced in the area they serve and based on hard data over a sufficient period of time, will also include strategies or parameters to ensure coverage during peak periods or during unexpectedly high call volume. AMR’s proposed plan offers the following such strategies:

• Additional dedicated 12-hour units deployed during peak periods, as identified by our demand analyses. Under our plan, we are placing four 12-hour ambulances in Zone B to meet the increased demand during peak periods of the day. Continual SSM analysis allows us to monitor performance at all times and add resources as needed to ensure response-time compliance.

• Extensive primary local resources. Using our state-of-the-art CAD and AVL technologies, our skilled Emergency Medical Dispatchers can visually identify the location of our system ambulances on screen and, as needed,


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move them to areas experiencing a volume peak or unexpected high call volume.

• Additional secondary local resources. AMR can draw additional resources into the EMS system from our non-system ALS resources during unexpectedly high call volume. These additional resources include:

• AMR deploys as many as 7 non-system ALS ambulances that serve our interfacility market. Our System Status Plan (SSP) automatically shifts these resources into the EMS system as follows:

Zone A: At Level 1

Zone B: At Level 3

Zone C: At Level 1

The non-system ALS ambulances are fully and appropriately equipped and staffed to meet the County’s EMS requirements. It is important to note that our plan never contemplates bringing the system to Level 0 (or to a point where no ambulances are available to handle the “next” call for service).

• In addition, our Critical Care Paramedic ambulance currently housed in East Stockton can also be deployed during volume peaks.

• Auto-aid agreement with Manteca District Ambulance (MDA). Built into our SSP, the agreement ensures ambulance coverage between Zones C and D (cities of Tracy, Manteca and Lathrop). If demand exceeds capacity for either of the two zones, our LIFECOM Communications Center will pre-position MDA and AMR ambulances at strategic locations between the two zones to provide response if needed. AMR has requested that Escalon and Ripon Ambulance Services participate in a similar agreement to provide seamless coverage to the South County. AMR is the only bidder with an existing auto-aid agreement with MDA. A copy of our agreement is provided in Section II.B. Attachments.

• Ability to staff reserve ambulances with off-duty personnel when needed. AMR maintains ready for service a reserve fleet of 5 ambulances. The Director of Operations and Supervisors are licensed paramedics and – as is our practice today – can staff additional ambulances during volume peaks. In addition, each AMR caregiver is assigned an alphanumeric pager and can be contacted on an emergency basis for additional staffing.


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• Non-system BLS resources. Deployed throughout the county to serve our private customers, any (or all) of our 5 non-system BLS ambulances can be added to the San Joaquin 9-1-1 system as needed in the event of a disaster. The non-system BLS ambulances are fully and appropriately equipped and staffed to meet the County’s BLS requirements.

• External AMR resources. As outlined in Section II.C. Operations - Disaster Preparedness, our local operation is completely surrounded by sister operations in Sacramento, Placer, Yolo, Contra Costa, Alameda, Stanislaus, and Santa Clara Counties. We have the ability to immediately respond additional ALS resources in case of a disaster or multi-casualty event. This can be done without degrading operations in the areas sending resources to San Joaquin County. The following map demonstrates surrounding counties served by AMR and the number of AMR ambulances at peak deployment that can be drawn from in the event of a multi-casualty event or disaster in San Joaquin County:


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In an on-going or catastrophic situation, significant additional AMR resources can be activated from our northern and southern California operations and / or other AMR locations out of state. This was most recently exemplified during the aftermath of Hurricane Katrina, when AMR deployed more than 100 ambulances and 300 personnel from around the country to assist our operations in the stricken cities.

Details on our disaster resources may be found in Section II.C. Operations – Disaster Preparedness.

4.1.2.A.4. Map of Proposed Ambulance Stations/Locations

Include a map identifying proposed ambulance station or post locations and identifying those geographic areas within the response time compliance areas as indicated in this RFP.

The SSP establishes 25 total post locations (16 stations and 9 posts) strategically located throughout the County. These post locations have been tested and refined based on our experience serving the County.

Our Emergency Medical Dispatchers will manage the placement of available ambulances based on the pre-programmed posting plan using our TriTech VisiCAD dispatching system. The plan varies according to the number of ambulances available for calls at any given moment.

The following maps show identified ambulance stations and post locations by zone. They also serve as examples of where ambulances will be posted at various levels of ambulance availability. As the number of available ambulances changes, so do the posting plan and the strategic placement of available resources.


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ZONE A (LODI)

All post locations and ambulance placement when four ambulances are available (Level 4)

All post locations and ambulance placement when two ambulances are available (Level 2)


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ZONE B (STOCKTON)

Post locations and ambulance placement when 12 ambulances are available (Level 12)

Post locations and ambulance placement when eight ambulances are available (Level 8)


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Post locations and ambulance placement when four ambulances are available (Level 4)

ZONE C (TRACY)

Post locations and ambulance placement when four ambulances are available (Level 2)


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Post locations and ambulance placement when three ambulances are available (Level 3)


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4.1.2.A.5. Anticipated Response Times Specify the anticipated response times to each community at the 90% fractile, including variations based upon variable deployment patterns.

The following table outlines the proposed response times for each zone and compliance area within San Joaquin County:

Communities Response Zone Classification

RFP Minimum Response Time Requirements

AMR Proposed Response Times

Clements Rural 20:00 17:29

Collegeville Rural 20:00 17:29

Farmington Rural 20:00 17.29

Holt Rural 20:00 17:29

New Jerusalem Rural 20:00 17.29

Acampo Suburban 10:00 9:29

Linden Suburban 10:00 9:29

Mountain House Suburban 10:00 9:29

Terminous Suburban 10:00 9:29

Thornton Suburban 10:00 9:29

French Camp Urban 8:00 7:29

Lockeford Urban 8:00 7:29

Lodi Urban 8:00 7:29

Morada Urban 8:00 7:29

Stockton Urban 8:00 7:29

Tracy Urban 8:00 7:29

Victor Urban 8:00 7:29

Waterloo Urban 8:00 7:29

Woodbridge Urban 8:00 7:29


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EQUITY OF RESPONSE

To provide response-time equity among communities, our posting plans are designed with hard-to-serve areas in mind, as indicated in the following map:

This map indicates our posting-plan strategies to ensure equitable response time for the following (examples) of hard-to-serve areas in San Joaquin County:

• Zone A (Lodi) contains two areas that are not central to the main geographic area that generates a majority of the call volume and are also in opposite directions from each other: Thornton is northwest of Lodi, while Lockeford and Clements are east of Lodi. To better serve these areas, we have created a new post at Highway 12 and Bruella Road to address Lockeford and Clements. This post location supports our proposed enhanced response-time commitment and our outside-in deployment strategy. We have also designed our posting plan to maintain coverage on the west side of Lodi to keep us closer to the community of Thornton, improving response time overall to Thornton residents.


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• Zone B (Stockton) includes the community of Linden to the east. We have created a post at Highway 26 and Jack Tone Road to ensure we can provide coverage for this location. With coverage provided down through post Level 6, this post location supports our proposed enhanced response time commitment and response-time equity.

• Zone C (Tracy) has grown rapidly. Measure A, recently passed by voters, will slow growth significantly within Tracy proper through 2012, but areas such as Mountain House will not be affected by the growth limitations. Today, while there is insufficient demand to station an ambulance in the Mountain House community, AMR will place a primary station/post location at I-205 and Tracy Boulevard to support equitable response time to Mountain House. We will monitor this growing community closely and adjust unit hours as necessary in the future.

Further enhancing response-time equity throughout the county, AMR has been extremely proactive in supporting Fire Department implementation of early cardiac arrest-response capabilities through Automatic External Defibrillators (AEDs). Beginning in 1985, we provided the training to five rural Fire Departments to help them become AED-capable.

Under the new contract, AMR is proposing in the first contract year to make available 30 total AEDs / 10 per zone to rural Fire Departments, to county-wide community centers, and to other facilities yet to be identified. We will follow up this commitment in Years 2, 3, 4, and 5 of the contract with 3 AEDs per zone, for a total of 9 AEDs county-wide per year.

Enhancement

In the first year of the contract, AMR is proposing to purchase 30 AEDs: 10 per zone for rural Fire Departments, community centers, and other facilities.


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4.1.2.A.6. Staffing Describe the full-time and part-time work force necessary to fully staff ambulances identified in the deployment plans.

AMR currently has 155 field caregivers serving San Joaquin County, both in the —9-1-1 system and non-system; of those, 86 are assigned full-time to the 9-1-1 system. Under the new EMS contract, we are planning to hire an additional 28 full-time caregivers, bringing our full-time EMS system staffing levels to 112 employees, as identified in the following daily staffing plan. It is AMR’s practice to staff all 9-1-1 system ALS ambulances with full-time personnel:

Zone A Zone B Zone C Paramedics F/T Paramedics P/T

122

35 6

92

EMT P/T EMT F/T

122

35 6

92

Total F/T 24 70 18

The following tables illustrate our proposed staffing vs. demand for every day of the week, per zone:


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Zone A: Lodi

Sunday

0

1

2

3

4

5

6

0 2 4 6 8 10 12 14 16 18 20 22

Lodi Staffing Lodi Demand

Monday

0

1

2

3

4

5

6

0 2 4 6 8 10 12 14 16 18 20 22


Tuesday

0

1

2

3

4

5

6

0 2 4 6 8 10 12 14 16 18 20 22


Wednesday

0

1

2

3

4

5

6

0 2 4 6 8 10 12 14 16 18 20 22


Thursday

0

1

2

3

4

5

6

0 2 4 6 8 10 12 14 16 18 20 22


Friday

0

1

2

3

4

5

6

0 2 4 6 8 10 12 14 16 18 20 22


Saturday

0

1

2

3

4

5

6

0 2 4 6 8 10 12 14 16 18 20 22



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Zone B: Stockton

Sunday

0

3

6

9

12

15

0 2 4 6 8 10 12 14 16 18 20 22

Stockton Staffing Stockton Demand

Monday

0

3

6

9

12

15

0 2 4 6 8 10 12 14 16 18 20 22


Tuesday

0

3

6

9

12

15

0 2 4 6 8 10 12 14 16 18 20 22


Wednesday

0

3

6

9

12

15

0 2 4 6 8 10 12 14 16 18 20 22


Thursday

0

3

6

9

12

15

0 2 4 6 8 10 12 14 16 18 20 22


Friday

0

3

6

9

12

15

0 2 4 6 8 10 12 14 16 18 20 22


Saturday

0

3

6

9

12

15

0 2 4 6 8 10 12 14 16 18 20 22



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Zone C: Tracy

Sunday

0

1

2

3

4

5

6

0 2 4 6 8 10 12 14 16 18 20 22

Tracy Staffing Tracy Demand

Monday

0

1

2

3

4

5

6

0 2 4 6 8 10 12 14 16 18 20 22Tracy Staffing Tracy Demand

Tuesday

0

1

2

3

4

5

6


Wednesday

0

1

2

3

4

5

6


Thursday

0

1

2

3

4

5

6


Friday

0

1

2

3

4

5

6


Saturday

0

1

2

3

4

5

6

0 2 4 6 8 10 12 14 16 18 20 22

Tracy Staffing Tracy Demand


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4.1.2.A.7. On-call Crews Describe any planned use of on-call crews.

Our proposed deployment plan does not include the use of on-call crews. The only time AMR anticipates the possibility of using on-call crews is during a multi-casualty or disaster situation. Our alphanumeric paging system is designed to allow each of our communications centers in Northern California to page all on-and off-duty field and administrative staff in the event of a disaster.

4.1.2.A.8. Mandatory Overtime Requirements Describe any mandatory overtime requirements.

A key element of our SSP is ensuring that our caregivers are well-rested and in a position to provide dedicated patient care. As such, we design the plan to anticipate peak demand periods and ensure sufficient coverage by regularly scheduled ambulances during their normal shifts. In the unlikely event that extraordinary demand precludes the required level of coverage with these ambulances, we have worked with our labor groups to define a process through our Collective Bargaining Agreements (CBAs) that allows for the following:

• Personnel may be held over for a maximum of two and one-half hours after the regularly scheduled end of shift time during excessively busy periods.

• Additional holdover is allowed only with the employee’s full agreement.

• Although rarely utilized, the CBAs do allow for the use of mandatory shift assignment of overtime. Any employee who works a mandatory overtime assignment is paid an additional one times his or her pay, in addition to the regular applicable rate of pay. For details on our overtime policies, please see Section II.D. Personnel – Compensation/Working Conditions of this proposal.

4.1.2.A.9. Workload Monitoring for 24-hour Ambulances

Describe how workload will be monitored for personnel assigned to 24-hour units.

As part of our continual monitoring of the SSM process, we monitor the weekly Hour Utilization (UHU) — derived by dividing responses by hours worked — of every one of our ambulances to ensure its continued effectiveness and well-being. If


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the UHU of a 24-hour ambulance nears .40, we evaluate options to balance workload. Examples of methods to balance workload include:

• Adjust post locations or post priorities

• Shift hours to different times of day or day of week

• Add hours to ensure we maintain our response-time performance.

To best meet our patients’ and our employees’ needs, we offer flexibly scheduled shifts, and we provide comfort facilities for our 24-hour crews, with all stations offering kitchens, bathrooms, and recreation and rest facilities. As outlined in Section II.D, AMR places considerable emphasis on making sure that our personnel are well-rested and able to provide the highest quality patient care.

4.1.2.A.10. Identifying Response Time Performance Problems

Describe record-keeping and statistical analyses to be used to identify and correct response-time performance problems.

AMR extracts data from the CAD on a daily basis for analysis purposes. We will identify and correct response-time performance challenges by regularly reviewing our performance using reporting tools that identify measurements such as:

• On-going contract compliance by zone

• Call volume

• Transports vs. non-transports

• Length of time spent on scene

• Length of time spent at receiving hospitals.

These measurements are constantly watched for any trend that may indicate a decrease in performance. Late responses, for example, are reviewed for any correlation to a specific geographical area, day of the week, or time of day. Clustering in any of these parameters is investigated to determine whether there is a common underlying cause and opportunity to mitigate the challenge. The posting plan, ambulance schedules, and the number of hours deployed are all reviewed and can be adjusted as needed.


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AMR will retain and make available for inspection by the County during the term of the contract and for a three-year period from expiration of the contract all documents and records required.

Enhancement

AMR proposes to implement a comprehensive System Status Quality Program, including an SSM Committee, that involves the County and EMS system stakeholders.

SSM REVIEW AND PROCESS IMPROVEMENT/QI PROGRAM

AMR monitors our SSP daily, weekly, and monthly, as outlined in the following table:

Time Period Method Daily Flash Reports:

Number of transports Individual response times Number of late calls

Weekly System Status Committee Meetings to discuss the following Key Performance Indicators (KPIs): Response volume Transport volume Compliance with contractual performance requirements Critical failures Unusual events Potential safety or risk management issues.

Monthly Review of staffing vs. current demand

The information generated from these demand reviews, along with recommendations from our SSP Committee, described next, is used to fine-tune the coverage plan and adjust the posting configuration as needed to ensure system effectiveness. Any changes made to the SSP can be implemented in minutes through our CAD system, ensuring that the new coverage plan is in effect immediately. For example, if one of our daily Flash Reports indicates a system issue, we can quickly adjust the plan that day to ensure continued compliance. Likewise, if our weekly System Status


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Committee meeting indicates a potential non-compliance concern, we can adjust post locations or post priorities, shift unit hours to different times of day or day of week, and / or add unit hours to ensure we maintain our response-time performance.

Enhancement

Our proposal includes implementation of a System Status Quality Program that involves all EMS system stakeholders.

System Status Qual i ty Program

AMR proposes to implement a comprehensive System Status Quality Program that involves all stakeholders in the EMS system. The foundation of this system will be the System Status Management (SSM) Review and Process QI Committee, which will meet monthly to review and modify the SSP as needed to meet changing needs and demands of the system.

Proposed members for this new committee include:

• County EMSA Representative

• Fire Agency Representatives

• Ambulance Providers (see Section II.C. Operations – Dispatch and Communications Requirements)

• AMR Director of Operations

• AMR Field Supervisor

• LIFECOM Communications Director

The SSM Review and Process QI Committee will be responsible for reviewing the following data and recommending plan adjustments to increase the efficiency and effectiveness of the ambulance deployment plan:

• Current compliance by zone

• Time of day and day of week patterns from the demand analysis report

• Activity log, which helps identify patterns when ambulance availability is limited

• Compliant and non-compliant call patterns


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• Changing traffic patterns and accessibility to all areas from major arterial roads and surface streets

• Real-world input from field personnel who are using the plan in the county

• Input from Fire agency personnel

• Location and use of street posts

• Workload

• Transport ratios

If the Committee determines that a deployment problem exists, it will make recommendations to improve system performance and monitor progress, providing written updates to the County as appropriate.

4.1.2.A.11. Enhancing System Performance Describe any other strategies to enhance system performance and/or efficiency through improved deployment/redeployment practices.

Throughout this section, we have described strategies to enhance system performance and efficiency through multiple commitments and finely tuned deployment practices. The following summarizes these strategies:

• Enhanced ambulance response-time standards county-wide

• Deployment of 3,024 dedicated 9-1-1 weekly ALS ambulance unit hours

• A minimum of 3,024 weekly unit hours for the life of the EMS contract

• Modification of AMR’s conventional deployment strategies to prioritize move-ups and posting assignments on an “outside-in” priority basis. This results in posting ambulances on the periphery of high-demand areas with a response pattern “from the outside-in,” allowing these resources to be posted in areas that will allow them to serve many rural communities with enhanced response times at most system levels.

• An auto-aid agreement with Manteca District Ambulance and a commitment to seek similar agreements with Escalon and Ripon ambulance services

• Our continual monitoring of the SSM process, including the weekly UHU of every one of our ambulances to ensure its continued effectiveness. If the UHU of a 24-hour ambulance nears .40, we evaluate options to balance workload, including:

• Adjusting post locations or post priorities


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• Shifting hours to different times of day or day of week

• Adding hours to ensure we maintain our response-time performance

• AMR’s state-of-the-art LIFECOM Communications Center, which uses sophisticated CAD and AVL technologies to monitor ambulance locations and make response recommendations based on the shortest drive time

• System-wide stakeholder-involved review of our SSP and response-time performance through our comprehensive SSM Review and Process QI Effort

• EMSA-based CAD monitor with real-time, AVL-based system status display

Finally, AMR is thoroughly committed to developing innovative solutions to system issues through a collaborative process involving all system stakeholders and with clear expectations of performance. For example, in recent years, our SSM analysis identified a concern with the number of visitors flocking to San Joaquin County to participate in our numerous water-sports opportunities. To enhance response times and patient care in these areas, AMR partnered with the San Joaquin County Sheriff’s Department and now places Paramedics on their patrol boats in the delta region on major holiday weekends. Details on this program may be found in Section II. H. Community Education/Prevention.

4.1.2.A.12. Signed Contracts Include signed contracts or “letters of intent” signed by both parties detailing the relationship of organizations participating in the provision of services.

AMR has entered into an auto-aid agreement with the Manteca District Ambulance service in which both MDA and AMR participate in a posting plan that provides coverage for both Zones C and D. AMR has also requested Escalon and Ripon Ambulance services to participate in a similar agreement to provide fluid ambulance coverage to the South County. Our agreement with MDA is described earlier in this section under 4.1.2 A.3: Peak Period SSM; a copy of the agreement may be found in Section II.B. Attachments.

“We believe that American Medical Response is a premier provider of pre-hospital care and is an asset to any community they serve.”

-- Dana Solomon, CEO, Manteca District Ambulance Service


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4.1 .2.B. On-go ing Deployment P lan Requirements Minimum Requirements:

• Keep a current deployment plan on file with the San Joaquin County EMS Agency.

• Redeploy or add ambulance hours if response time performance standard is not met.

AMR will keep a current deployment plan on file with San Joaquin County EMS. We will redeploy or add ambulance unit hours if response-time performance standards are not met. Any proposed changes in the deployment plan will be submitted in writing to the EMS Administrator 30 days in advance of a change, unless waived by the County.

In addition, we commit that there will be no reduction in the minimum proposed 3,024 weekly ALS hours during the life of the EMS contract.

As outlined previously in this section, AMR continually monitors our system performance through daily, weekly, monthly, and quarterly reviews to ensure that we consistently meet response times. Additionally, EMSA will be provided with real-time monitoring ability through a CAD terminal in the County office and will be requested to participate in the SSM Review and Process QI Committee outlined earlier in this section.

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