All of the individuals interviewed by the Grand Jury indicated that the
present centralized team approach to delivering emergency medical assistance
is a substantial improvement over the system that existed prior to 1999.
Those interviewed stressed that services are now fully integrated; a single
dispatch center exists; training, protocols, quality improvement, equipment,
supplies and record keeping are standardized; considerable opportunities
exist at all levels for broad participant and citizen involvement.
All of the individuals interviewed also acknowledged that the current
response times for first response advanced life support are within or
better than contract terms, and better than they were in 1998 by as much
as two minutes. They also believe that response times can and should be
shortened even further. Administrators and service providers indicate
they are committed to working on a plan to achieve response time reductions
in the near future.
The Abaris Group prepared a September 2, 2001 interim report for the
California State Association of Counties and the League of California
Cities. That report identified both strengths and weaknesses in the system
raised at the time by service providers. The Abaris Group interviewed
a wide cross section of participants in the system and concluded that
the collaborative effort of the County EMS Agency, AMR and the JPA delivered
a documented high-performance advanced life support first response system
clearly above the standard of practice for similar size communities in
the United States.
The EMS Agency completed a countywide advanced life support first response
and emergency ambulance service contract compliance survey in May 2002.
As a result of this review, the EMS Agency concluded that AMR and its
subcontractors are in compliance with the contract in most areas and noted
that: “It is obvious that all parties are providing excellent service
to our community.” Operations that might be improved were recognized
and recommendations were made.
The overall rate at which both emergency first response and subsequent
ambulance transport services are meeting contracted response times for
all five zones for the years 2000 through 2003 are as follows (Year 2003
is from January to July only):
Advanced Life Support First Response (JPA)
2000 |
2001 |
2002 |
2003 |
93.8% |
94.1% |
94.4% |
95.3% |
Ambulance Transport (AMR)
2000 |
2001 |
2002 |
2003 |
93.5% |
93.9% |
95.6% |
95.3% |
In May 2003, the EMS Agency sent a patient satisfaction survey to those
in the county who were provided services by AMR and the JPA. Eighty-nine
percent (89%) of the returned surveys indicated that the services provided
were good to excellent in the areas of timeliness of response, how they
were treated medically and handled as patients, skills and knowledge of
providers, and how well the response teams worked together.
In cooperation with the EMS Agency, AMR and the JPA, the Quality Leadership
Council and the Medical Advisory committee have made measurable, important
improvements during the term of the contract in the quality of medical
treatment provided to advanced life support and ambulance patients.
The collaborative arrangement under which emergency medical service is
provided received awards from the following organizations: National Council
for Public-Private Partnerships, International City-County Management
Award for Outstanding Partnerships, and the League of California Cities
Helen Putnam Award for Excellence in Public Safety.
The concerns of the complainant as highlighted in the press, and concerns
regarding emergency services raised by individuals interviewed by the
Grand Jury, are currently being addressed jointly by the EMS Agency, AMR,
and the JPA.
Very few participants in the system believe that major changes in the
method of providing services should be made at this time. No stakeholders
indicated they are willing to abandon the JPA concept. While leaving open
the option for making improvements in the program, all except one fire
chief supported the decision of the Emergency Medical Care Committee not
to issue a Request for Proposals for a new system of providing services
when the present contract with AMR expires.
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