A Grand Jury investigation finds that advanced life support, paramedic, and ambulance medical emergency transport services in San Mateo County are being provided in compliance with the contract between the County and American Medical Response (AMR).

All of the individuals interviewed by the Grand Jury indicated that the current response times for first response advanced life support are within or better than contract terms, and better than they were before the present arrangement by as much as two minutes. Administrators and service providers indicate they are committed to working on a plan to achieve additional response time reductions in the near future.

The interest of the citizens is well served by the present arrangement within the county for delivering quality emergency medical response services. The emergency medical response and ambulance transport services are being provided in a manner that is in the best interest of the County and the health and safety of the ill and injured; and the County’s Emergency Medical Services Agency is appropriately monitoring the standards and contract for such services.

Press coverage and a citizen complaint regarding ambulance service response times and general operations of the emergency medical response system provided under contract, prompted the Grand Jury to initiate an inquiry into San Mateo County’s contract for the delivery of advanced life support paramedic and ambulance medical emergency transport services.

The County developed an emergency services program and has designated the Health Services Agency to administer it. It does so through the EMS Agency, one of its subdivisions. The EMS Agency reports through the Health Services Agency to the County Manager and the Board of Supervisors. In 1998, the County Board of Supervisors approved a five-year contract with American Medical Response (AMR), a private company, to provide countywide paramedic first response services, except within the City of South San Francisco, through a subcontract with the San Mateo County Pre-Hospital Emergency Services Group, a Joint Powers Authority (JPA). The JPA consists of sixteen jurisdictions, a mixture of cities and fire districts.

This arrangement provides advanced life support first response service to the entire County, and provides for assistance from four fire departments for primary and back-up ambulance transport services. AMR is directly accountable to the County for its performance. The JPA, and therefore its members, are accountable to AMR for response times and other performance requirements. While the contract for advanced life support paramedic and ambulance medical emergency transport services is administered by the EMS Agency, the system is independently supported by user fees.

There are five response time compliance zones designated in the contract. AMR and the fire districts must maintain response times at a compliance level of at least 90% in each of the five zones for both paramedic first response vehicles and emergency ambulances. Response times are measured monthly, and vary according to whether the incident is life threatening (Priority 1, in which responders use lights and sirens) or non-life threatening (Priority 3, no lights and sirens).

Within each of the five zones, there are three response time standards depending upon whether an area is classified as Urban/Suburban, Rural or Remote. Two of those priority levels are in use here. Zonal contract response time standards are listed in minutes below for each priority.

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)

Ambulance Transport (AMR)

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.