Santa Clara County Emergency Medical Services Agency. Semi-Annual Report. To the Board of Supervisors Health and Hospital Committee.

(1)

Santa Clara County Emergency Medical

Services Agency

Semi-Annual Report

To the Board of Supervisors’ Health and Hospital Committee

November 2 0 1 4

January 1 to August 31, 2014

(2)

Table

of

Contents

Table of Contents ... 1

EMS Agency Activities ... 2

Ebola Preparedness and Response ... 2

Hospital Diversion and Delay of Ambulances at Hospital Emergency Departments ... 3

Training and Education ... 4

Rural/Metro serving as County Ambulance ... 7

EMS Trust Fund ... 7

EMS Trust Fund Revenue ... 8

EMS Trust Fund Expense ... 9

EMS Agency Fee Schedule ... 10

EMS System Descriptive Statistics ... 12

Prehospital Clinical Care and Quality Improvement ... 14

Rural/Metro Response Times ... 14

Air Ambulance Transports ... 19

Hospital and Specialty Care Facilities ... 20

Hospital Volume and Destinations ... 20

Hospital Diversion of Ambulances ... 21

Trauma System ... 22

Stroke System ... 23

STEMI Care System ... 24

(3)

EMS

Agency

Activities

This semi‐annual report emphasizes the eight‐month period from January 1, 2014

through August 31, 2014, and includes information and data from calendar year 2013 to

provide context and precedent to the reader.

Ebola

Preparedness

and

Response

The Santa Clara County Emergency Medical Services (EMS) Agency, in collaboration with

the Department of Public Health and County Health Officer, has acted rapidly and

comprehensively in response to the threat of Ebola. The EMS system’s efforts started in

late July by reeducating EMS providers about proper infection control techniques and

the use of Personal Protective Equipment (PPE). As the outbreak expanded, the EMS

System began to distribute information form the Centers for Disease Control and

Prevention (CDC) and the World Health Organization (WHO) to stakeholders to inform

emergency responders of the scope of the Ebola outbreak and to identify the signs and

symptoms of the disease.

The Ebola epidemic is the largest Ebola outbreak in history. Ebola is at epidemic levels in

Guinea, Liberia, and Sierra Leone. Following identification of the case in Dallas, Texas,

The EMS Agency instituted specific Ebola screening methods within the EMS System to

quickly identify potential Ebola cases within Santa Clara County. This immediate action

was necessary to protect pre‐hospital providers should they encounter a patient that

potentially has the disease, and to provide mechanisms to immediately notify the

County Health Officer and the Centers for Disease Control and Prevention. The EMS

Agency released an Administrative Order on October 8, 2014, that revised Santa Clara

County Prehospital Care Policies relating to infection control and implemented a new

policy regarding Ebola Virus Prevention and Control. These policies define different

types of infection control precautions, define minimum equipment inventories,

treatment guidelines, and created a screening mechanism for the Ebola virus. These

policies also prescribe the practice by which emergency responders identify suspect

cases and rapidly notify the Health Officers and EMS command staff.

As the epidemic evolves, care standards and CDC guidance continue to change. The

EMS Agency and Public Health Department are working to ensure our policies remain

(4)

System stakeholders, including representatives from fire agencies, ambulance providers,

communications centers, and hospitals. This committee is working together to ensure

that prudent policies and procedures are in place to properly identify, treat and

transport a potentially Ebola infected patient. The EMS Agency will continue to review

the tools, conduct exercises and make any corrections to the guidance as needed. All

responding agencies have initiated training activities.

While there is a very low likelihood that an Ebola infected person may present to the

Santa Clara County EMS System, there is a very high likelihood that system responders

will be able to safely identify, treat and transport this patient appropriately.

Hospital

Diversion

and

Delay

of

Ambulances

at

Hospital

Emergency

Departments

In summer of 2014, the Santa Clara County EMS Agency, collaborating with hospitals in

Santa Clara County, the County Communications Department, and Rural/Metro, hosted a

Lean Six Sigma Black Belt Course to provide advanced statistical process control training

to EMS System stakeholders and to statistically evaluate the root causes of extended wall

times in Santa Clara County. Generally defined, wall times are the time interval starting

when the ambulance arrives at the emergency department (ED) and ending when

emergency department staff accepts responsibility for the patient and moves that

patient off the ambulance gurney.

The results of this project were surprising. The conventional wisdom that most of the

wall time delays were attributable to hospitals failing to rapidly accept care of the patient

was statistically proven inaccurate in most instances in Santa Clara County. In fact, this

study identified that the mean time interval starting from the ambulance patient arriving

in the emergency department and ending when the ambulance was available for another

response was 31.32 minutes. Of that time, a mean of 1.57 minutes was used to enter the

facility, a mean of 10.42 minutes was used to place the patient in a bed and to transfer

care to the hospital, and a mean of 18.52 minutes was used by the ambulance crew to

restock and to complete paperwork. Thus we learned that most of the “wall time” delay

was attributable to the EMS crews restocking and completing their paperwork.

While this study had a small sample size, its findings are significant. In many instances,

(5)

periods at 30 minutes may increase out of service times. Therefore, EMS practices are

being revised to create a culture that strives for 20 minute hospital drop times for all

patients transported to hospital emergency departments, and hospitals are investigating

new methods of emergency department intake of ambulance patients. While this

problem will be solved in the long term, this study shows the importance of

understanding, defining and measuring the problem, before solving the problem. If the

EMS Agency would have tried to unilaterally reduce extended wall times through

regulatory fiat, before truly understanding the problem, the results would have angered

stakeholders, but not reduced wall times. This study is a great example of the EMS

System emerging as a learning and quality‐focused meta‐organization.

Training

and

Education

Training

From January 1, 2014, to August 31, 2014,

the Santa Clara County EMS Agency

provided 1,293 hours of continuing

education to 244 EMS personnel. From

October 2013 to February 2014 over 2,400

providers complete the annual EMS

Update Training. This mandatory annual

training emphasizes policies and protocols that have been revised; however, this

training cycle also included education and assessment training on the Santa Clara

Assessment for Missed Posterior Stroke (S.C.A.M.P.S) Trial.

EMS System Training and Education Videos

The Santa Clara County EMS Agency created and released the following videos as

educational resources for those who live, work and play in Santa Clara County. Each

video provides insight into the 911 Emergency Medical Services System and feature

some of the equipment used by the EMS professionals in the Santa Clara County EMS

System.

EMS Training and Education Totals

Training Opportunities 9

Number of Prehospital personnel in

attendance 244

Number of Continuing Education Hours

(6)

The Santa Clara County EMS System Overview

video provides a summary of the services provided

in the Santa Clara County EMS System.

AN INSIDE LOOK: Santa Clara County 911 Ambulances

This video provides an orientation to the

capabilities and equipment contained within Santa

Clara County 911 Ambulances known as "Medic"

units.

Santa Clara County EMS RADIO SYSTEM and COMMUNICATIONS PROCEDURES

This video provides guidance for the use of the Santa

Clara County’s EMS Communication System.

Santa Clara County Multiple Patient Management

Plan ‐ MPMP

This video provides an overview of how to implement the Santa Clara County Multiple

Patient Management Plan while responding to a multi‐causality incident (MCI).

Public Education

From January 1, 2014, to June 30, 2014, the EMS Agency promoted six public education

campaigns related to emergency medical services. These monthly campaigns included

(7)

Stroke Awareness, Preventing Snake Bites and “Pull to the Right for Sirens and Lights.”

Each month the EMS Agency provides educational campaign materials to every fire

department and ambulance company within the Santa Clara County EMS System. These

materials include educational flyers, postcards, posters, and pamphlets to pass out to

the community, and talking points for use during presentations. By coordinating the

public education campaigns for all providers within the EMS System, the public message

is consistent, regardless of which organization provides the message. This minimizes the

possibility of misinformation and assures a coordinated message countywide.

Social Media

The EMS Agency actively uses social

media to promote and distribute

information about EMS events. As a

result, the number of people following

(8)

doubled since last year. On the EMS Agency’s Facebook page or Twitter feed, you will

find information about monthly educational campaigns and training announcements,

recognition of EMS providers and information about EMS meetings and forums. An

example of recognition shared on the Agency’s Facebook and Twitter feed was the

Proclamation issued in recognition of EMS Week held in June of 2014. This provided a

way for the EMS Agency to share the event with the many EMS Providers that were

unable to attend the Board of Supervisors meeting. The EMS Agency’s Twitter feed is

@XSCEMS.

Rural/Metro

serving

as

County

Ambulance

Rural/Metro of California, operating as County Ambulance, has provided emergency

paramedic ambulance service for the Santa Clara Emergency Medical Services (EMS)

System since July 1, 2011. The

Santa Clara County EMS System

continues to be stable, and

assures that every person who

calls 911 for a medical

emergency will receive an

emergency paramedic

ambulance and trained first

responders.

From January 1, 2014, through August 30, 2014, Rural/Metro met contractual response

time performance standards, every month, in all five zones, for emergency and non‐

emergency calls. Detailed information about EMS System performance, including

Rural/Metro’s response time performance statistics, is provided later in this report.

EMS

Trust

Fund

The EMS Trust Fund’s purpose is to provide funding for projects with a countywide

benefit to EMS System providers, enhance the services provided within the EMS System

and to improve the delivery of 911 emergency medical care in the County. The EMS

Trust Fund is a backward‐looking fund; that is, funds collected in one year are expended

the following year. This process provides policy and spending oversight by the Board of

(9)

of strategic EMS System change. EMS Agency plans to bring its FY16 EMS Trust Fund

Recommendations to the Health and Hospital Committee for review and approval in

March 2015.

EMS

Trust

Fund

Revenue

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

contracted 911 paramedic ambulance provider (Rural/Metro) for failing to meet per‐call

response time standards; monthly zone response time standards; or for failing to meet

other contract stipulations, such as maintaining minimum ambulance availability or

avoiding ambulance breakdowns.

Month / Year Amount

July 2013 $183,000

July 2013 – Rural/Metro Bankruptcy Relief ($183,000)

August 2013 $209,250 September 2013 $217,750 October 2013 $272,500 November 2013 $271,750 December 2013 $278,280 January 2014 $238,750 February 2014 $281,000 March 2014 $278,280 April 2014 $249,000 May 2014 $182,500 June 2014 $330,500 TOTAL $2,809,560 Average Monthly Liquidated Damages $234,130

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

liquidated damages in previous 911 paramedic ambulance service contracts. However,

the greater amount of liquidated damages is primarily due to a substantially more

expensive fine structure. In some cases, fine levels in the Rural/Metro contract are ten

(10)

EMS

Trust

Fund

Expense

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

Board of Supervisors before the start of the fiscal year. The EMS Agency routinely

provides detailed financial reports to the Health and Hospital Committee about the EMS

Trust Fund. This EMS Trust Fund summary discusses how expenditures from the EMS

Trust Fund improve emergency medical services within Santa Clara County.

Category A: Reserve

At the Board of Supervisors’ direction, starting in Fiscal Year 2011‐2012, a reserve

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

the EMS Trust Fund, is placed into reserve and used only for significant strategic projects

that benefit the EMS System with a long range focus. Following approval by the Board

of Supervisors, these funds could also be used if the EMS System experiences an

unanticipated financial burden, such as the failure of an ambulance provider or an

extraordinary increase of cost of service or supplies, or a material decrease in system‐

wide third‐party payor reimbursement. During the 2013‐2014 Fiscal Year, $575,000 of

the EMS Trust Fund monies was placed into reserve.

Category B: Training, Education and Recognition

Funding authorized in this category was used for annual training, education, exercises,

and recognitions. Funds were used in the following subcategories:

∙ EMS System Information to the Public

∙ Training (which is not funded by grants or other sources) ∙ Exercises (which are not funded by grants or other sources)

∙ EMS Provider and committee member recognition, and EMS Week

During the 2013‐2014 Fiscal Year, $235,000 was allocated to training, education, and

recognition.

Category C: Benefit to EMS System Stakeholders

Funds were allocated from this category to assist EMS System Stakeholders with one‐

(11)

departments within Santa Clara County to provide hardware to support the County EMS

System Data Project. This funding will provide fire departments with the ability to enter

and transmit patient care data from the scene of an emergency; rather than waiting to

enter data until the unit has returned to a fire station. This allocation was essential to

creating a comprehensive EMS System data collection and analysis capability. During the

2013‐2014 Fiscal Year, $200,000 was allocated to short term and one time projects that

benefit EMS System Stakeholders, such as manikins to help emergency responders

improve their ability to secure patients’ airways and to better analyze EMS System

clinical data.

Category D: Strategic Initiatives

Projects in this category emphasize initiatives that strategically advance the Santa Clara

County EMS System, often in the longer term. During FY 2013‐2014, funds were

allocated to the implementation of the 10 Goals in the EMS System Strategic Plan.

Implementation of the EMS System Strategic Plan is necessary to allow the County EMS

System to adapt to the anticipated care and reimbursement changes associated with

the federal Affordable Care Act and national health care reform. Implementation of the

10 Goals in the strategic plan would allow the County EMS System to continue to

provide excellent clinical care, to better target patient needs to resources, to assure

operational efficiency, to remain financially stable, and have high levels of patient and

stakeholder satisfaction. Monies were also allocated to fund further development of

the Comprehensive EMS Data System. Category D funds were also spent to support the

development of the Integration of hospitals into the Comprehensive EMS Data System,

to support development of the Sobering System, Six Sigma Training, and the Public

Health Department Operations Subsidy. During Fiscal Year 2013‐2014, $1,640,000 was

allocated to strategic projects and $750,000 was provided as a general subsidy to the

Public Health Department.

EMS

Agency

Fee

Schedule

The EMS Agency relies on fee‐for‐service fees for funding operations, including system‐

wide planning, policy and clinical protocol development, analysis, and operational and

clinical quality improvement. The EMS Agency has not increased its fees since July 1,

(12)

The EMS Agency did not request a fee modification from the Board of Supervisors for

Fiscal Year 2014, because unprecedented changes in the EMS System operations and

EMS Agency planning and quality improvement linked to the EMS System Strategic Plan

will occur in starting in the second half of Fiscal Year 2014. The current fee structure is

listed on the following page:

Fiscal Year 2015 EMS Agency Fee Schedule

ITEM/SERVICE FEE

INDIVIDUAL FEES

EMT Certification $50

EMT Re‐Certification (biennial) $50

Paramedic Local Accreditation $150

Identification Card $20

Replacement ID Card

(certification, accreditation, system ID) $20

Photocopying $4.75 (1

st_page)

$.10/ea. Addl. COMPANY FEES

Ambulance Service Permits (annual fee)

Basic Life Support $5,500

Advanced Life Support $6,000

Critical Care Transfer $6,000

Air Ambulance Service $8,000

Ambulance Vehicle Permits (annual fee)

Basic Life Support $950

Advanced Life Support $950

Critical Care Transfer $950

Air Unit $950

Non‐Transport BLS/ALS Unit $800

Education Program Certification (every 4 years)

EMT Program $1,000

Paramedic Program $5,000

Prehospital Continuing Education $1,000

Specialty Care Designation (annual fee)

(13)

Stroke Center Designation $10,000 STEMI Receiving Center Designation $10,000

911 Receiving Center Designation $10,000

EMS

System

Descriptive

Statistics

Listed in the following tables are statistics that describe the characteristics of the Santa

Clara County EMS from January 1, 2014, through August 30, 2014.

The County of Santa Clara

Daytime Population 2.2 million

Resident Population 1.8 million

Geographic Size 1,132 square miles

Proportion of Rural/Urban Land 2/3 rural

Municipalities 15

911 System Call Volume

January through

August 31, 2014 Annualized

Total Responses 73,513 126,022

Total Events with Ground Ambulance Transports 48,521 83,778

Total Patients Transported by Ground Ambulance 48,987 83,977

EMS Aircraft Response 86 147

EMS Aircraft Transports 57 97

Ground Ambulance Interfacility Transports

January through

Ground Ambulance (Jan‐August 2014) 28,843 49,445

Ground Ambulance 2013 54,982

Specialty Center Patients

January through

(14)

Trauma Patients 3,923 6725

STEMI Patients 216 370

Pre‐Hospital Care Provider Agencies

Fire Departments 11

Ground Ambulance Services 11

Air Ambulance Services 2

Pre‐Hospital Care Personnel

Emergency Medical Technicians 2,489

Paramedics 754

Mobile Intensive Care Nurses 22

Accredited EMS Field Supervisors 17

Permitted EMS Assets

Fire Apparatus 159

Private Ground Ambulances 216

Private Air Ambulances 3

Private EMS Non‐Transport Units 16

Communications Centers

Public Safety Answering Points (PSAPs) 13

Secondary PSAPs 10

Private Ambulance Dispatch Centers 10

Air Ambulance Dispatch Centers 2

Acute Care Facilities

Acute Care Hospitals 12

Emergency Departments 11

Level 1 Trauma Centers 2

Level 2 Trauma Centers 1

Base Hospitals 1

Burn Centers 1

Stroke Centers 10

STEMI Centers 8

County Managed Medical and Health Disaster Resources

(15)

Specialty Services Trailers 3

Chem‐Packs 8

Medical‐Health Operations Center 1

EMS Radio Caches 7

Disaster Medical Support Units 2

Prehospital Training Programs

Emergency Medical Technician 7

Paramedic 2

EMS Fellowship 0

Prehospital

Clinical

Care

and

Quality

Improvement

Rural/Metro

Response

Times

Ambulance

Response

Times

to

Emergency

Calls

The chart below identifies Rural/Metro’s response times to Code 3 (emergency red light

and siren) calls by month from January 1, 2014, through August 30, 2014, in each of the

five ambulance subzones within Santa Clara County. The response time standard is 90%

or greater, and is represented by the yellow horizontal line on this graphic. During the

January 1, 2014 to August 31, 2014 reporting period, Rural/Metro met contractual

(16)

County Ambulance Code 3 Response Times

Code 3 Response Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14

Overall 93.30% 92.64% 92.83% 91.67% 94.03% 93.97% 92.66% 92.58% Zone 1 92.40% 92.07% 93.03% 91.38% 94.19% 93.46% 92.12% 92.65% Zone 2 91.93% 91.58% 92.46% 90.19% 94.09% 93.45% 91.50% 91.60% Zone 3 94.29% 93.41% 92.69% 92.86% 94.06% 94.01% 94.63% 93.70% Zone 4 93.38% 93.34% 92.85% 91.64% 93.40% 93.83% 91.82% 92.02% Zone 5 95.49% 90.62% 93.68% 91.45% 95.81% 97.12% 92.33% 92.62%

Ambulance

Response

Times

to

Non

‐

Emergency

Calls

The chart below identifies Rural/Metro’s response times to Code 2 (non‐emergency)

calls by month from January 1, 2014, through August 31, 2014, in each of the five

ambulance subzones within Santa Clara County. The response time standard is 90% or

greater, and is represented by the yellow horizontal line on this graphic. During the

January 1, 2014 to August 31, 2014 reporting period, Rural/Metro met contractual

response time standards in each of the five subzones, every month.

86.00% 88.00% 90.00% 92.00% 94.00% 96.00% 98.00% 100.00%

Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14

County Ambulance Code 3 Response Time Compliance by Month

(17)

County Ambulance Code 2 Response Times

Overall 94.60% 92.70% 94.60% 93.32% 94.79% 95.62% 93.18% 94.23% Zone 1 97.16% 95.34% 94.95% 95.64% 95.95% 96.87% 97.06% 95.83% Zone 2 94.76% 92.64% 93.72% 93.44% 96.27% 95.89% 91.67% 93.20% Zone 3 93.41% 90.79% 95.02% 93.36% 94.73% 96.30% 92.72% 92.67% Zone 4 93.80% 91.63% 93.74% 91.09% 92.13% 93.55% 91.48% 94.78% Zone 5 92.68% 95.24% 100.00% 94.12% 98.04% 97.35% 94.74% 95.83%

Fire Department First Responder Response Times

Fire

Department

First

Responder

Response

Times

to

Emergency

Calls

The chart identifies fire department response times to Code 3 (emergency red light and

siren) calls by month from January 1, 2014, through August 31, 2014, for each of the first

responder fire departments within Santa Clara County. Fire departments should achieve

a response time of 90% or greater, and those who achieve a response time of 95% or

greater are exempted from any response time liquidated damages incurred during that

month. 86.00% 88.00% 90.00% 92.00% 94.00% 96.00% 98.00% 100.00%

County Ambulance Code 2 Response Time Compliance by Month

(18)

The San Jose Fire Department has complied with the 90th percentile response time

performance standard three times during the Janaury 2014 through August 31, 2014

period. While this performance does not allow the City of San Jose to cure its

continuing Breach of Annex B, which is the voluntary reimbursement agreement, it

appears that since the Board of Supervisors’ action in February 2014, the San Jose Fire

Department’s response time performance is trending toward gradual improvement.

In February 2014, the Board of Supervisors directed its Management Audit Division to

conduct a limited scope of management audit of the San Jose Fire Department’s 911

EMS response policies and procedures to identify the issues impeding the department’s

ability to respond to emergency medical 911 calls in accordance with the goals specified

in the agreement between the County and City, and to make recommendations that

would enable the City to achieve the performance goals. The findings and

recommendations of the final audit report have not been released and are not included

in the report. A summary of the final audit report will be included in the next EMS

Agency’s Semi Annual Report to the Board of Supervisors’ Health and Hospital

Committee in May 2015. 80% 82% 84% 86% 88% 90% 92% 94% 96% 98% 100%

Fire Department Code 3 Response Time Compliance by Month

Gilroy Milpitas Morgan Hill Mt. View San Jose Santa Clara Santa Clara Co. So. Santa Clara Co. Sunnyvale

(19)

Fire Department Code 3 First Responder Response Time Compliance by Month

Gilroy 98.54% 98.18% 96.79% 98.18% 98.78% 99.59% 98.05% 98.45% Milpitas 98.27% 95.28% 96.60% 97.36% 96.04% 96.72% 95.17% 96.46% Morgan Hill 95.16% 95.65% 98.34% 98.33% 99.54% 96.32% 95.81% 95.48% Mt. View 96.76% 97.40% 97.20% 95.78% 95.33% 96.51% 97.61% 97.28% San Jose 88.06% 87.66% 88.75% 90.39% 88.94% 90.31% 92.53% 88.95% Santa Clara 96.54% 95.67% 96.91% 95.47% 95.40% 95.13% 96.07% 93.91%

Santa Clara Co. 96.12% 95.25% 96.10% 97.17% 96.30% 95.31% 95.39% 95.96%

So. Santa Clara Co. 93.15% 90.24% 97.03% 95.45% 94.12% 96.33% 90.91% 90.99%

Sunnyvale 97.78% 98.36% 98.81% 98.35% 98.25% 98.79% 99.20% 98.28%

Fire

Department

Response

Times

to

Non

‐

Emergency

Calls

The chart below identifies fire department response times to Code 2 (non‐emergency)

calls by month from January 1, 2014 through August 31, 2014 for each of the first

responder fire departments within Santa Clara County. Fire departments should achieve

a response time of 90% or greater, and those who achieve a response time of 95% or

greater are exempted from any response time liquidated damages incurred during that

month. Several fire departments choose to respond Code 3 to all incidents.

80% 82% 84% 86% 88% 90% 92% 94% 96% 98% 100%

Fire Department Code 2 Response Time Compliance by Month

(20)

Fire Department Code 2 Response Time Compliance by Month

Code 2 Response Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Mt. View 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 97.44% 97.87%

San Jose 94.46% 93.67% 96.18% 96.55% 96.55% 96.50% 97.86% 97.30%

Santa Clara 98.52% 98.58% 95.47% 98.47% 96.64% 98.62% 99.21% 97.35%

Santa Clara Co. 100.00% 98.73% 100.00% 99.37% 100.00% 98.67% 99.45% 99.35%

Air

Ambulance

Transports

Air ambulance utilization continued at relatively low levels during the first half of 2014.

The number of air ambulance dispatches and transports shown in this chart is based on

the first eight months of 2014. This volume of responses and transports has remained

relatively static since approximately 2009. The EMS Agency considers this volume of air

ambulance responses and transports appropriate.

Year Dispatches Transports Utilization Percent

2002 540 254 47% 2003 524 236 45% 2004 545 251 46% 2005 463 205 44% 2006 443 221 50% 2007 442 207 47% 2008 248 137 55% 540 ₅₂₄ 545 463 443 442 248 184 ₁₇₆ 179 183 129 86 254 ₂₃₆ 251 205 221 207 137 111 ₁₀₃ 107 109 74 ₅₇ 0 100 200 300 400 500 600 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Air Ambulance Utilization by Year

(21)

2009 184 111 60% 2010 176 103 59% 2011 179 107 60% 2012 183 109 60% 2013 129 74 57% 2014 (8 months) 86 57 66%

Hospital

and

Specialty

Care

Facilities

Hospital

Volume

and

Destinations

From March 1, 2014, through August 31, 2014, there were 37,782 ambulance

transports from the 911 System to hospitals within Santa Clara County. Santa Clara

Valley Medical Center continues to demonstrate the highest volumes.

Ambulance Destination by Hospital

Hospital Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Total

El Camino ‐ Los Gatos 100 107 95 86 90 82 560

El Camino ‐ Mt. View 694 637 667 661 594 670 3,923

Good Samaritan 594 568 567 595 588 589 3,501

Kaiser ‐ San Jose 596 559 599 543 513 519 3,329

Kaiser ‐ Santa Clara 675 685 677 629 597 624 3,887

O'Connor 595 583 564 551 496 575 3,364

Regional San Jose 1,080 1,120 1,116 1,072 1,033 1,145 6,566

0 200 400 600 800 1000 1200 1400

Mar‐14 Apr‐14 May‐14 Jun‐14 Jul‐14 Aug‐14

Ambulance Destination by Hospital March - August 2014

El Camino ‐ Los Gatos El Camino ‐ Mt. View Good Samaritan Kaiser ‐ San Jose Kaiser ‐ Santa Clara O'Connor

Regional ‐ San Jose Saint Louise Stanford VA ‐ Palo Alto VMC

(22)

Saint Louise 269 233 273 246 212 260 1,493

Stanford 441 440 511 511 492 521 2,916

VA ‐ Palo Alto 89 95 87 78 151 79 579

VMC 1,308 1,259 1,318 1,273 1,242 1,264 7,664

Total 6,441 6,286 6,474 6,245 6,008 6,328 37,782

Hospital

Diversion

of

Ambulances

Hospital diversion levels have dropped significantly over this six month period. EMS

Agency policy limits hospitals to no more than 36 hours of diversion per month and all

facilities have met this benchmark. This standard is represented by the yellow horizontal

line on this graphic. There was a significant increase in the hours noted for stroke

service advisory. This was attributed to a mechanical failure and resulted in a 124 hour

CT/stroke diversion. This issue has been resolved and the agency does not anticipate

any further problems.

0.00 5.00 10.00 15.00 20.00 25.00 30.00 35.00 40.00 45.00 50.00

Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14

Ambulance Diversion by Hospital March-August, 2014 El Camino - Los Gatos El Camino - Mt. View Good Samaritan Kaiser - San Jose Kaiser - Santa Clara O'Connor Regional - San Jose Saint Louise

(23)

Total Monthly Hours of "AMBULANCE DIVERSION" Status

Hospital Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Total

El Camino ‐ Los Gatos 0.00 0.00 0.81 0.00 0.00 0.00 0.81

El Camino ‐ Mt. View 21.09 12.51 12.04 10.11 12.78 14.83 83.36

Good Samaritan 1.51 1.50 0 0.00 3.01 0.00 6.02

Kaiser ‐ San Jose 2.91 9.78 4.51 11.63 6.00 10.99 45.82

Kaiser ‐ Santa Clara 0.00 6.02 1.5 0.00 0.00 1.51 9.03

O'Connor 3.00 1.50 1.51 3.00 6.63 3.00 18.64

Regional San Jose 0.09 0.00 3.11 3.58 3.01 1.26 11.05

Saint Louise 16.58 7.51 19.05 4.52 16.59 8.93 73.18 Stanford 4.53 0.00 3.03 1.50 9.05 4.52 22.63 VA ‐ Palo Alto 6.98 2.44 10.68 12.04 16.15 21.04 69.33 VMC 30.44 15.58 14.75 19.19 10.35 22.24 112.55 Total 87.13 56.84 70.99 65.57 83.57 88.32 452.42

Trauma

System

Between January 1, 2014, and June 30, 2014, 3,923 trauma patients were seen in the

Santa Clara County trauma system. This includes 3,257 adults and 323 pediatric patients

(pediatric age range is 0 to less than age 15). Eighty percent of trauma patients were

transported to a trauma center by ambulance, while eleven percent of trauma patients

were transported to a trauma center by an air ambulance. Effort continues to

standardize the trauma system within the Bay Area through the Regional Trauma Care

Committee. This committee is evaluating inter‐facility trauma transfers and working to

increase outreach to non‐trauma centers in order to facilitate an ease of transfers for

seriously injured patients.

County

of

Origin

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

Santa Clara County trauma system, producing 44% of the volume of trauma patients.

Other counties refer some of their trauma patients to Santa Clara County, producing

significant proportions of the total trauma volume in Santa Clara County. Those counties

include: Alameda County at 2%; San Mateo County at 13%; Monterey County at 5%; San

(24)

Mechanism

of

Injury

Ninety‐three percent of the injuries in the Santa Clara County trauma system are caused

by a blunt mechanism of injury, such as motor vehicle/motorcycle injuries, pedestrians

struck by car, and bicycle accidents. The remaining seven percent are caused by

penetrating mechanisms of injury, such as gunshot wounds and stabbings. These

percentages have remained constant for the past four years.

Disposition

from

the

Emergency

Department

Fifty‐one percent (51%) of trauma patients are admitted to the hospital. Forty‐eight

percent (48%) of trauma patients are discharged from the emergency department. Less

than one percent (0.80 %) of trauma patients expired in the emergency department.

Stroke

System

The Santa Clara County Board of Supervisors approved a stroke care system developed

by the Santa Clara County Emergency Medical Services Agency in March of 2006. This

evidence‐based system provides patients the opportunity to be transported to the

closest, specially designated hospital, which can provide immediate stroke care to

patients who show symptoms of an acute stroke.

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Santa Clara Alameda Monterey San Benito Santa Cruz San Mateo Injury by County of Origin

(25)

The need for rapid intervention is based on clinical evidence that treatment with an

anti‐clotting drug (IV tPa) within three and a half hours of the onset of their symptoms

may prevent and possibly reverse the effects of the blocked circulation to the brain. The

Santa Clara Stroke System was designed with two specific goals. The first goal is to

increase the number of patients who arrived in the emergency department at the stroke

center within the time necessary to allow administration of anti‐clotting agents. The

second goal is to educate the public about stroke symptoms, and the need to call 9‐1‐1

if symptoms are present.

January 1, 2014 through June 30, 2014 Performance Data

Criteria County

Performance Data Percentages

Total Stroke Volume 1,249 100%

Total Number of Ischemic Strokes 1,003 80%

Total Strokes Transported by EMS 648 39%

Total Strokes Self‐Transported 485 41%

Total patients by interfacility Transfer 96 8%

% of Ischemic Stroke treated by IV tPA 17% National Average (1‐8%)

STEMI

Care

System

Santa Clara County’s STEMI (S‐T Elevation Myocardial Infarction) Care System continues

to be regarded as a model system of care. A STEMI is a serious type of heart attack

associated with higher rates of morbidity and mortality. Patients identified by

paramedics as STEMI Alert patients, based on a 12‐lead electrocardiogram, are treated

rapidly with Percutaneous Coronary Intervention (PCI), which includes balloon

angioplasty and stents, to open the blockage in the artery.

The median length of stay in the hospital after the procedure is two days. From January

2014 through June 2014, 94% of the patients treated with Percutaneous Coronary

Intervention had median door to balloon (D2B) of less than 90 minutes, versus a

(26)

Median door to balloon times for patients that arrive by EMS is 55 minutes, well below

the national benchmark of 58 minutes. The median time for those who arrive by other

methods is considerably higher with a rate of 77 minutes.

Criteria Jan to Jun 2014 Jan to Jun 2013

Total cases with documented STEMI 216 217

Median Door to Balloon time in

Minutes 64 66

Goal Met (D2B <90 min 75% of cases

National standard)

94% of PCI cases were performed in less than 90

minutes

95% of PCI Cases were performed in less than 90

minutes

Total STEMI cases brought by EMS 123 124

Total STEMI Cases who self‐

transported 43 83

Total STEMI Cases brought by

Interfacility transport 8 12