Section 100 - The EMS System

1. Assessment/determining trauma related needs & resrouces
2. trauma system design & planning
3. Submission of annual trauma plan update to the state
4. trauma center desgination & monitoring
5. maintaining a trauma registry & assuring compliance of data collection
6. submission of SCC data dictionary to CA EMS info sys on quaterly basis
7. maintain the SCC data dict with annual updated
8. monitoring compliance of sys: scheduled audits of pt care, periodic site visits, formal site evaluations by committee appointed by the Agency
9. Evaluating the sys

1. local public safety answering pts may participate in emrgncy med priority dispatch sys pre-arrival (instructions as approved by EMS MD)
2. all parameds shall be accreditesd & meet all trauma training in SCC required by SCC & EMS MD
3. prehosp trauma care shal be administered accordng to policies, procedures deved by the EMS agency
4. when multiple pts are injured at single site, Multiple Casulaty Incident plan may be activated
5. trauma pts triage according to EMS Agency policy

1. trauma service (located in surgery departmt, directed by a board certified surgeon)
2. Emgcy dptmt w/ special permit from CA to poerate as Basic or comprehensive EMS
3. surgery dprtmts/divisions/staffs/sections
4. ICU
5. post-anesthesia recovery room (PAR)
6. radiology
7. laboratory
8. social services
9. speciliazed radiological services
10. pharmacy
11. blood bank

equipment for resuscitation & diagonosis & to provide advanced life support for the critically & seriously injured adult/pediatric pt shall include a licensed genreal acute care hops w/ special permit for basic EMS, physician on duty in accordance

1. In Santa Clara County, patients with significant injuries, even if they don't meet the criteria for a major trauma victim, may be taken to hospitals by either the 911 system ambulances or private vehicles.

2. Ambulances only transport patients to hospitals with permitted Emergency Departments that meet specific state regulations. If a major trauma patient arrives at a non-trauma facility unable to treat their injuries, the facility will swiftly transfer them to the nearest trauma center following county transfer guidelines.

define standards that SCC EMS agency uses to desginate a hospital as a trauma center

outline the quality improvement process employed by the trauma system in SCC

identify standard methods to be used by the Agency when investifating & imposing disicolinary action in relation to prehosp care providers

agency will use established laws & regulations to ensure unifor investigation & enforcement of prehosp providers

1. location w/in department of surgery + directed by board certified surgeon
2. maintain a emergency department special permit in accordance to CA code of regulations
3. surgery departments/divisions/staffs/sections shall be staffed by specialists in: cardiothorcisc, general, maxilofacial, neurological, obstetric & gynecology, ophtalmic, oral, othorhinolaryngologic & plastic, pediatric, urologic, vascular surgery.
4. non surgery staffed w/: anesthesia,cardiology, gastroenterology, hematology, infectious diseas, internal medicines, nephrology, pathology, pediatrics, pulmonary medicine, radiology

purpose: establish standardized criteria for the timely reporting & submission of EMS system variance to the SCC EMS agency & define the reporting criteria for each level of variance

- 108 series
- Any incident that results in a threat to public safety, patient, bystander or responder harm
- Report immediately to the EMS Duty Chief via County Communications and submit the EMS System Variance Report (Form #903) to the EMS Agency within 24 hours
- Submit copy of PCR and statements of those involved in the incident

ex: fraud in procurement of any certificate/license, gross negligence, incompetence, conviction of any crim, etc.

- 108 series
- Any incident that does not result in patient harm, but is a deviation from EMS Agency protocols, policies, and procedures
- Report to EMS Agency within 5 business days (form #903 copies of dispatch record PCR + statements from those involved in incident)

ex: potential clinical care variance, poor interagency coordination, equipment failure or malfunction

- Incidents where responders provided outstanding care and went above and beyond expectations of responders
- Report within 7 business days to EMS agency (form #903 + copies of dispatch records PCR & statements from others who witnessed)

ex: good patient outcome, outstanding customer service, positive provider agency/hosp coop, field provider went above & beyond normal expectations

purpose: establish standards for the creation, revision & implementation of SCC prehops care policy (including plans, protocols, procedures, etc.)

EMS Ageny shal develop & maintain & standard policy format & development process

SCC EMS Agency is resp for creating & implement policy related to EM care & services w/in SCC

purpose: identify roles & areas of responsibilites for providers of EMS in SCC

1. Santa Clara County fire service manages scenes and provides Basic Life Support (BLS) as per state regulations.

2. They adhere to county policy and additional requirements specified in subcontracts with the Exclusive Operating Area (EOA) Contracted Ambulance Service, except for Palo Alto, which operates under a separate EOA.

3. Advanced Life Support (ALS) services are subcontracted through the County's EOA contractor to municipal fire departments or districts, except in Palo Alto where both BLS and ALS services are provided directly by the city.

1. Santa Clara County provides ambulance transportation services through a single provider, except for Palo Alto.

2. The contracted ambulance service provider is responsible for providing Advanced Life Support (ALS) transportation services for all municipalities and districts within the County.

3. Although ambulance units may arrive first at an emergency scene, the lawful scene authority remains with the public safety agency responsible for the incident location.

1. Non-EOA contracted ambulance services support the 911 System during high call volume, multi-casualty incidents, and disasters, operating similarly to EOA contracted services.

2. These services can provide care at Basic Life Support (BLS), Advanced Life Support (ALS), or critical care transport levels, depending on permits issued by the EMS Agency.

3. Non-EOA contracted ambulance providers adhere to state regulations, Santa Clara County Prehospital Care Policy, County Ordinance Code, and any additional agreements with the County.

purpose: identify primary responsibilites of all participants in the SCC EMS quality improvement program (EQIP) & to ensure quality of care for all patients who access the EMS system

def: The EMS Quality Improvement Program is a coordinated effort involving different disciplines to make the system better. They look at three main things: how things are set up (structure), what steps are taken (process), and what results are achieved (outcomes).

1. All prehospital care providers in Santa Clara County EMS system will take part in the EQIP.

2. EQIP indicators will comply with Title XXII, Division 9 Chapter 12 and follow guidelines from the State of California EMS Authority.

3. Oversight for EQIP will be under the EMS Medical Director with advice from the Prehospital System Quality Improvement Committee (PCSQIC).

4. Prehospital provider agencies must complete and review QI Indicators monthly, submitting findings to Santa Clara County EMS Agency, which will maintain the data.

5. Each agency must submit an annual report of quality improvement activities to the Santa Clara County EMS Agency.

6. The Santa Clara County EMS Agency will provide an annual report of all quality improvement activities to the State EMS Authority.

purpose:
1. Advise and assist Santa Clara County EMS Agency in monitoring and tracking quality issues reported by EMS system participants.

2. Discuss current trends and research in EMS care affecting prehospital treatment.

3. Review information developed using clinical indicators.

4. Utilize a multidisciplinary approach to resolve issues.

5. Promote county-wide standardization of quality improvement processes, focusing on education.

6. Provide prompt feedback to all prehospital caregivers on discussed issues and trends.

The Committee's review scope covers all patients in Santa Clara County's Prehospital system, including but not limited to:
1. Clinical care issues reported to the County (Unusual Occurrence Reports).
2. Protocol variations.
3. Deviations from Scope of Practice.
4. Medication errors.
5. Intubation complications.
6. Departures from standards of care.
7. Unusual issues with potential for educational opportunities.

1. Issues in the prehospital system will be reviewed and graded based on severity, with four levels:
- Level A: Reportable issue with low impact and risk, for trend analysis.
- Level B: Minor issue with low impact and risk, for trend analysis.
- Level C: Significant issue with possible system impact and medium to high risk, may require committee discussion.
- Level D: Outstanding quality of care issue or issue with unique educational potential.

2. The Pre-Prehospital Audit Committee (Pre-PAC) will create a bi-monthly report on quality improvement activities. All issues will be thoroughly investigated before being presented to the Prehospital Audit Committee (PAC). Agency/employment issues will be referred back to the provider agency for resolution.

1. Clinical indicator data will be presented in various formats at PAC meetings for discussion, evaluation, and potential solutions regarding recognized trends.

2. The committee will advise on systemic issues and trends to develop a system-wide approach to quality improvement.

3. Information developed by the committee will be shared with all personnel in the system based on identified issues.

4. Smaller subcommittees may be formed to discuss specific issues and solutions due to the committee's size, with membership on a voluntary basis.

purpose: define the process that SCC uses to desginate a trauma center

1. Trauma centers in Santa Clara County must be verified by the American College of Surgeons Committee on Trauma as Level 1, 2, 3, or 4 centers.

2. Before designating any additional trauma centers, the EMS Agency will conduct a needs assessment.

3. All designated trauma centers in the county must participate in the Trauma System Quality Improvement process.

purpose: identify methods of payment that are accepted by thr SCC EMS Agency

1. Personnel credentialing involves various certifications and recognitions including Emergency Medical Technician (EMT) Certification, Recertification, Paramedic Intern Recognition, Identification Cards, Paramedic Accreditation, Accredited EMS Field Supervisor, Mobile Intensive Care Nurse, and Medical Volunteer for Disaster Response.


2. All payments must be made electronically via credit or debit (EBT) card, either in person or online.

3. Cash, money orders, purchase orders, and checks are not accepted for payment.

4. Payment is required for each application submission, including incomplete ones, and no refunds are provided.

5. Payment is charged at the time of application submission, regardless of approval status.

1. Credentialing services offered include Ambulance Service Provider, EMS Asset Permits, 911 Receiving Facility, Specialty Center (e.g., Stroke, Trauma, STEMI), EMT or Paramedic Training Center, and Continuing Education Provider.

2. Payments for these services can be made electronically via credit or debit (EBT) card, either in person or online.

3. Cash, money orders, and checks are not accepted for payment.

4. Payment is required for each application submission, including incomplete ones, and no refunds are provided.

5. Payment is charged at the time of submission, regardless of application approval.

6. Purchase orders or government checks may be accepted if pre-approved by the EMS Agency and exceed $5,000 per invoice. 7. Payments cover a fiscal year from July 1st to June 30th, with no prorated payments allowed.

1. Payments for all services must be made electronically via credit or debit (EBT) card, either in person or online.

2. Cash, money orders, and checks are not permissible forms of payment.

3. Payment is required for each application submission, even those returned as incomplete.

4. No refunds are issued for payments made.

5. Purchase orders or government checks may be accepted only if pre-approved by the EMS Agency.

purpose: The committee monitors and tracks quality issues reported by EMD providers, discusses trends and research in prehospital care delivery, and reviews EMD clinical indicators.

It resolves issues through a multidisciplinary approach, promotes countywide standardization of the EMD Quality Improvement process, and provides timely feedback to all dispatchers and EMD program providers.

1. The committee will create quarterly reports on EMD Quality Improvement (QI) activities for public meetings.

2. All issues will be thoroughly investigated before presentation to the EMD QI Committee.

3. Agency/employment-related issues will be referred back to the provider agency for resolution.

4. Data will be presented at EMD QI Committee meetings for discussion and potential solutions.

5. The committee will advise on systemic issues to develop system-wide quality improvement approaches.

6. Information developed by the committee will be shared with all EMD personnel based on identified issues.

7. Subcommittees may be formed for smaller discussions and solutions.

8. Feedback on issues referred for follow-up will be provided to the QI Committee.

9. The Committee will annually develop and approve indicators with the EMS Medical Director.

A. The committee comprises the EMS Agency Medical Director, EMD QI representatives from each PSAP, EMS Program Managers, EMS Agency staff, and Provider Agency Medical Advisors.

B. Meetings occur every other month.

C. Leadership consists of two co-chairpersons, one of whom must be a certified EMD-Q, serving for two years.

D. The committee may identify issues needing formal recommendations to the EMS Medical Director, with member consensus constituting a recommendation.

E. Meeting minutes, excluding confidential information, are kept by the EMS Agency and distributed to committee members.

F. Other approved invitees may join medical audit reviews if their expertise is deemed essential.

G. The committee may provide educational opportunities open to all EMS System Stakeholders.