MEETING DATE:
FEBRUARY 14, 2017
SUBJECT:
Title
RESOLUTION NO. 2017-8301 - APPROVAL OF AGREEMENT FOR ADVANCED LIFE SUPPORT TRANSPORT SERVICES
Body
Recommendation
Recommendation
ADOPT the Agreement for Advanced Life Support (ALS) Transport Services between the City of San Marcos, the San Marcos Fire Protection District (collectively, “City/District”) and the San Marcos Fire Department.
Body
Board or Commission Action
Not Applicable
Relevant Council Strategic Theme
Quality of Life
Dynamic and Responsive Service Delivery
Relevant Department Goal
Customer Service
Introduction
The City of San Marcos (“City”) and surrounding unincorporated County of San Diego (“County”) area encompass the San Marcos Fire Protection District (“District”) service area, which spans 33 square miles and serves approximately 95,000 residents (“Service Area”). The District is an “exclusive operating area” (“EOA”) pursuant to California Health and Safety (“H&S”) Code section 1797.224.
H&S Code section 1797.201 (“201 Rights”) governs the local provision of Emergency Medical Services (“EMS”) Act, specifies contracting requirements, and states that counties set the parameters for EMS operations. In accordance with these “201 Rights,” the County requires the City and the District to go through a public procurement process for advanced life support (“ALS”) transport services and contract with the selected provider.
On August 25, 2009, the City/District approved an agreement with the San Marcos Fire Department (“SMFD”) for the provision of ALS transport services within the Service Area (“Initial Agreement”), attached hereto as Exhibit “A”. The Initial Agreement was for a term of four years, with the option to renew, at the City’s discretion, for two, three-year extension terms. The first extension was approved on September 10, 2013, and expired on September 14, 2016 (“First Extension Term”). Since that date, the SMFD has continued to provide ALS transport services within the Service Area pursuant to section 13.2 of the Initial Agreement, which provides for continuation of services until the next service provider is selected. The parties desire to have SMFD continue to provide ALS transport services within the Service Area for the remainder of the second extension term anticipated under the Initial Agreement. To effectuate this, the parties must enter into a new agreement.
Discussion
The proposed Resolution approves the new Agreement for Advanced Life Support (ALS) Transport Services (“New Agreement”) through September 14, 2019, at which point the County would require the City to coordinate with the County EMS Division to solicit bids from qualified service providers as part of the public procurement process. The New Agreement provides that during the public procurement process and any transition period for a new contract, SMFD would be required to continue providing ALS transport services. SMFD will have the opportunity to submit a bid to continue providing ALS transport services.
The current SMFD service level is four 24-hour full-time primary ambulance units, three reserve ambulance units, and one newly added 12-hour part-time ambulance unit. Response times have averaged approximately five minutes and nineteen seconds to ALS incidents. The ambulances are staffed with one Firefighter/Paramedic and one Emergency Medical Technician who are met on-scene by a fire engine operating with at least one additional Firefighter/Paramedic, allowing for both effective patient care and maximum flexibility to SMFD.
The City/District is not required to solicit bids to provide ALS transport services pursuant to the City Manager’s authority under the San Marcos Municipal Code purchasing ordinance. If the City Manager finds other purchasing procedures to be more advantageous to the City than soliciting formal bids, it may utilize those procedures, which the City Manager believes to be the case for these services. It is in the best interest of the City to authorize the award of the New Agreement to the SMFD without soliciting formal bids for the non-exclusive reasons outlined below.
Pursuant to the pricing terms contained in the New Agreement, the rate for ALS transport services provided by the SMFD would be adjusted to reflect the recovery of actual costs incurred by the City/District which have increased at rates higher than inflation, including, but not limited to, costs for medical care, medical supply, fuel, and fleet maintenance and costs, in addition to the increase in the Consumer Price Index (All Urban Consumers) for San Diego County provided for under the Initial Agreement pursuant to the Resolution of the Board of Directors of the District adjusting the base medical transport rates (Resolution No. FD 2003-237).
Additionally, in fulfilling the terms and conditions of the Initial Agreement, SMFD has demonstrated a strong performance in the following areas: response time standards, patient safety and quality care, management of quality assurance (“QA”) and quality improvement (“QI”) program, training and education, and external partnerships. Specific details regarding performance and compliance within each of these areas are outlined below.
Response Time Standards
Contract Requirement: Contractor shall maintain a maximum response time of nine minutes, zero seconds for all code three calls (i.e. life-threat response requiring the use of lights and sirens in order to achieve a rapid response) dispatched 90 percent of the time. First Responder ALS Engines/Trucks shall maintain a maximum response time of eight minutes, zero seconds for all code three calls dispatched 90 percent of the time (Section 6.1).
• SMFD placed an additional 12-hour part-time ambulance in service Monday through Friday.
• Since assuming ALS transport services, SMFD has maintained an average response time for ambulance to priority one EMS calls well within the requirements of the Initial Agreement, as demonstrated below:
|
Year |
Total Calls |
Average Response Time |
9 Minute Compliance |
|
2013 |
7,683 |
5:14 |
97.89% |
|
2014 |
8,133 |
5:17 |
99.70% |
|
2015 |
9,953 |
5:19 |
99.84% |
|
2016 |
11,048 |
5:26 |
99.97% |
Patient Safety and Quality Care
Contract Requirement: Clinical performance shall be consistent with approved medical standards and protocols of the County of San Diego (Article 7 of the 2009 agreement). To ensure appropriate on-site supervision for fire department paramedics in the pre-hospital care environment, the City/District shall employ a designated EMS Coordinator.
• SMFD has been an early adopter of optional treatment protocols and devices, while investing in two replacement ambulances, two replacement chassis and four power gurneys to improve patient transport.
• The City employs an RN/Paramedic EMS Coordinator and deployed comprehensive standards, policy and training to insure quality patient care that complies with medical protocols and standards of the County.
• The City also employs three Paramedic/Battalion Chiefs and six Paramedic/Captains.
• SMFD participated in the national Resuscitation Outcomes Consortium studies to aid research for evidence-based changes in clinical practice that will improve pre-hospital treatment of cardiopulmonary arrest and severe traumatic injury.
• Paramedic Intern training through Palomar College and EMSTA College.
• SMFD works with the Cardiac Task Force by entering CPR data in the Cardiac Arrest Registry to Survival (CARES) database which helps to determine outcome measures for out of hospital cardiac arrests and benchmarking capability to improve care and survival.
Quality Assurance and Quality Improvement Program
Contract Requirement: The Parties shall cooperatively maintain a comprehensive Quality Assurance (QA) and Quality Improvement (QI) Program as specified in Section 7.3 of the 2009 agreement.
• A QA and QI Program has been incorporated into the SMFD Emergency Medical Operations Manual.
• As an industry best practice, a cadre of Firefighter/Paramedics have developed as QA and QI subject matter experts who act as peer reviewers for SMFD. The cadre reviews cases to track compliance, evaluate protocols implemented, and recommend opportunities for improvement.
• Focused skilled and treatment audits are completed by the QA and QI team. During these audits, the team proactively reviews cases and treatment protocol.
• SMFD reviews and audits random patient care reports and takes steps to improve upon service issues, reduce, intervene or eliminate root causes, and recognize excellence in performance of care.
• Collaborative education, tape reviews, and feedback with local hospitals and base hospital nurse coordinators.
• QA quarterly newsletters are also generated to field personnel.
Training and Education
Contract Requirement: With the assistance of the EMS Coordinator, the Contractor shall be responsible for developing and providing continuing education (CE) training for driver training and paramedic certification on a shift basis.
• SMFD provides monthly two-hour CE classes for all shifts in addition to offering Target Solutions online CE classes to all SMFD personnel.
• SMFD supports Firefighter/Paramedic attendance at professional development and training seminars.
• Health Insurance Portability and Accountability Act (HIPAA) Training and Preceptor Workshops.
• Coordinate and participate in multi-agency active shooter drills.
External Partnerships
Contract Requirement: Contractor shall participate in public education events throughout the City and maintain all partnerships with regional fire agencies through the maintenance of local automatic and mutual aid agreements (Sections 5.11, 9.4).
• All regional partnerships have been maintained by SMFD through the maintenance of local automatic and mutual aid agreements.
• SMFD EMS personnel are both leaders and active participants in various groups, associations at the local, county, regional, and state level.
• Ambulance standby services for community and special events are provided by SMFD.
• Participation in multiple community events that include Poolside and Sidewalk CPR training, health screenings, and public safety campaigns.
• Participating with Cal State San Marcos in the Democracy in Action project.
The proposed New Agreement recommended for approval maintains most of the existing terms and conditions outlined in the Initial Agreement, with the exception of removing the term relating to the City’s option to extend the agreement, which is not permitted under the New Agreement. The proposed New Agreement also adjusts the rate for ALS transport services provided by the SMFD to reflect the recovery of actual costs incurred by the City/District, in addition to the annual increase in the CPI provided for under the Initial Agreement. The services will be re-bid at the close of the proposed contract period. Contract highlights continue to include a mandated QA and QI Program; an emphasis on training and education; maintaining response times; requiring a full-time EMS Coordinator who oversees the program; public outreach event requirements; and maintaining partnerships with regional fire agencies through maintenance of automatic and mutual aid agreements.
Fiscal Impact
ALS transport is a no-subsidy service in San Marcos, meaning that the City does not provide monetary support to the provider. Instead, all revenues needed for program operations are derived from billing for services provided.
Attachment(s)
Resolution No. 2017- ______
Attachment A: 2017 ALS Transport Services Agreement
Attachment B: 2009 ALS Transport Services Agreement
Prepared by: Heather Todd, Senior Management Analyst
Submitted by: Heather Todd, Senior Management Analyst
Reviewed by: Brett Van Wey, Fire Chief
Approved by: Jack Griffin, City Manager