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San Mateo County Pre-Hospital Advanced Life Support Services

2000 NCPPP Project Award Winner
Project Location: Hillsborough, California
Public Sector Partner: San Mateo County Pre-Hospital Emergency Medical Services Group
Contact Name: Lawrence Olson, Administrator, 650.375.7427, Fax: 650.375.7448, larryu@firenet99.org
Private Sector Partner: American Medical Response
Contact Name: John Odle, Chief Administrative Officer, 650.652.5320

Project Summary
The Challenge
Prior to December 1998, San Mateo County had varying levels of pre-hospital emergency medical care. Only a couple of the twenty municipalities in the County provided fire department paramedic services while most of the other fire agencies had Emergency Medical Technicians (EMT’s). The County’s ambulance provider, however, with an average of eleven ambulances, response times were highly variable and erratic. The unincorporated and more remote areas of the County had even greater uncertainty in receiving a consistent and reliable level of pre-hospital care.

Thirteen of our twenty cities operated their own fire departments and had their own dispatch or communications centers. The remaining seven cities were served by fire protection districts, which also had separate communications systems. This situation resulted in seventeen separate local agencies, each operating relatively independent from the others and each providing its own pre-hospital first response medical service. While there was an established mutual aid program among the fire departments for fire suppression, there was no similar agreement for responding to medical calls. The calls for service were handled within municipal boundaries by the local fire department and were not subject to any response time standards.

Additionally, there were no uniform standards for training, other than the requirements established by State law. There were no uniform standards for medical equipment and supplies, which varied widely from one department to another. Also, there was very little in the way of standardization among policies and procedures.

The result was a somewhat fragmented system of pre-hospital care that varied widely from one community to another. Additionally, our cities had different priorities for their limited municipal budgets and several could see no financial way of upgrading to the more costly paramedic level of service. These communities would need some assistance in order to provide paramedic trained first responders.

The Solution
Several forward thinking Fire Chiefs, Firefighters, City Managers, and County staff began to work on this challenge in late 1996 and early 1997. In order to create a cooperative agreement among all the cities and fire protection districts, a provision of the California Government Code was utilized to form a Joint Powers Authority (JPA). The cities and fire districts in San Mateo County agreed to give us some of their local autonomy in order to work together in a unique shared arrangement.

The start-up group also understood the increased importance and value of public-private partnerships. They recognized the strengths and abilities of public agencies as well as those of the private sector. They knew that a solid cooperative relationship between the public and private sectors takes advantage of these positive attributes and maximizes the benefits for our communities. All people benefit when public and private organizations work together in a partnership arrangement to provide needed services.

In order to complete this new organizational structure, the JPA entered into a contract with its private partner, American Medical Response (AMR) to provide supplies, training, equipment, medical oversight, and some monetary assistance. The JPA also entered into a contract with San Mateo County to provide all communications services for fire and medical activities. The City of South San Francisco is the only City in the County that decided not to participate fully I n the newly formed JPA. The County Office of Emergency Medical Services provided assistance and oversight for the new program.

The Results
San Mateo County has increased the number of trained and equipped firefighter paramedics from about 60 to over 220. These medics staff 59 fire engines located throughout the County, 24 hours a day – 7 days a week. As the public partner, the fire departments are the first responder paramedics to the approximately 120 medical calls each day. AMR is the private partner and provides the paramedic transportation component of the pre-hospital advanced life support service.

The JPA and AMR operate pursuant to a contract with County EMS. This is a performance-based agreement and both agencies are subject to contractual response time requirements. The JPA and AMR pay fines to the County for any late or delayed responses. During the first year of this new program, the fire department first responders have achieved a 97.7 percent on-time record.

A unique and necessary feature of our program is that all agencies agreed to drop their city boundaries for responses to medical calls. Our centralized, County Computer Aided Dispatch Center tracks the closest available paramedic engine for every call and automatically designates this unit for response without regard to jurisdiction. The practice of disregarding city boundaries also applies to move-up, which means that fire engines from various jurisdictions are continuously moving into fire stations in other jurisdictions, which are vacant due to the resident engines responding to calls or participating in training or other activities.

The move-up procedure is based on a system of fire stations being grouped into clusters of two or more stations in each cluster, depending upon geographic area and the ability to meet response-time requirements. This cluster and move-up arrangement has had an added and unanticipated benefit of having a greater number of engines in position to provide much quicker response to multiple alarm fires and other emergencies.

There are several other innovative features that are important parts of the solution to the challenge of providing a consistent and uniform level of advanced life support in our County. These include the assignment of five AMR ambulances to public fire stations where they are operated and staffed with fire service paramedics. We also have several AMR ambulances and their crews housed in public fire stations. Additionally, our private partner provides direct financial payments to the JPA. These monthly payments first responder paramedic services and have made it possible for all cities to participate. Finally, AMR provides medical equipment, supplies, and training for the public fire service medics.

Summary
During the first year of operations the program has achieved its major goals. Our response times now average fifty percent faster than under the previous system. We have a first-responder, on-scene compliance rate of 97.7 percent. The most significant achievement is that we have greatly improved the quality of pre-hospital care for all persons in the County regardless of location or socioeconomic status.

San Mateo County’s pre-hospital advanced life support program is steadily developing and continues to produce positive results. We believe this innovative and creative program will endure for many years and that it can serve as a model and example to other jurisdictions across the country.