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2014CONTRA COSTA

EMS SYSTEM PERFORMANCE REPORT

message from the directorContra Costa County’s Emergency Medical Services (EMS) system withstood several tests in 2014, from a community hospital forced by finances to stop its emergency ambulance traffic to the appearance of the Ebola virus in the United States, which prompted rapid, large-scale preparations locally and at all levels of government.

I am pleased to report that the system and all of its stakeholders performed as expected, working as a team to adapt and deliver on their promise of safe, high-quality care for the community. While 2015 has brought new challenges, we are confident in the system’s ability to adapt and persevere.

EMS is a highly coordinated network of first responders and other emergency professionals, who work together through a system of public-private partnerships to provide Contra Costa with round-the-clock access to acute medical care and transport, every day of the year.

This report is a snapshot of the system’s performance in 2014, during which our dedicated professionals handled 87,974 emergency responses, and this report reflects their invaluable efforts. It is a privilege to present this report on behalf of all participants in the Contra Costa EMS system.

A healthy system also strives to improve, and we worked hard to help the county navigate the changing EMS landscape. The EMS Modernization Project Report, released in June 2014, is a great example. Find it under “Documents & Reports” at cchealth.org/ems.

The project amounted to a comprehensive review of the entire system that included stakeholders and the public, with a goal of analyzing current performance and finding ways to improve before issuing a request for proposals for a new emergency ambulance contract, which we did this year.

The key message of that study was that we must all prepare—not just for emergencies or disasters, but for change. Contra Costa’s EMS system met all expectations in 2014, is well positioned to continue providing timely, high-quality service, now and in the future.

Patricia Frost RN, MS, PNPDirector, Contra Costa EMS

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table of contents

Message From The Director .................................................................................................................................................. 1Emergency Medical Services Mission Statement & Core Values ................................................................ 3Contra Costa EMS System ..................................................................................................................................................... 4EMS Timeline: Recent Accomplishments and Significant Events ...........................................................5–7Contra Costa EMS Modernization Project ................................................................................................................. 8EMS System Response Requirements .............................................................................................................................. 9 Ambulance Emergency Response Zone (ERZ) Chart ..................................................................................... 9Population Centers ...................................................................................................................................................................10Population Use of EMS Services ......................................................................................................................................11 Contra Costa County EMS Service Utilization by Population Chart ................................................11Contra Costa County Quick Population Facts .......................................................................................................12County Service Area EM-1 (Measure H) Funding ..................................................................................................13 Contra Costa EMS System Funding 2014 Chart ............................................................................................132014 Special Project Funding Supported By Measure H Funds ................................................................14Emergency System Resources .................................................................................................................................... 15–16EMS Resources In Contra Costa County ............................................................................................................. 17-18911 Specialty Care Receiving Centers .......................................................................................................................19EMS System Utilization .................................................................................................................................................20–23EMS and Hospitals Working Together ........................................................................................................................24Cardiac Arrest Program ..........................................................................................................................................................25 Incidence of Cardiac Events in Contra Costa County, 2013-14 Chart ..........................................25Cardiac Arrest Survival ...........................................................................................................................................................26 Survival to Hospital Discharge (Utstein) Chart ...............................................................................................26 Bystander Save Lives Chart .........................................................................................................................................26STEMI System: Time is Muscle .................................................................................................................................. 27–30Mission: Lifeline Bronze Award ..........................................................................................................................................29 Performance Standards ...................................................................................................................................................29 STEMI System Performance Indicators Chart ...................................................................................................29 Mean Time Intervals in Minutes Chart .................................................................................................................30 Prehospital Performance Measures, Patients Receiving Care by Task Chart ............................30Stroke System: Time is Brain ......................................................................................................................................31–32Trauma System .....................................................................................................................................................................33–34 All Trauma Patients vs Trauma Activations by Year Chart ....................................................................33 Trauma Patients in Contra Costa County Chart ...........................................................................................34Disaster, Medical Surge and Response ...............................................................................................................35–37 2014 Activities ........................................................................................................................................................................36 Contra Costa County Declared Multi-Casualty Incidents Chart .........................................................37Contra Costa Medical Reserve Corps (MRC) ...........................................................................................................38Public Access Defibrillation Program .................................................................................................................... 39–40Quality Improvement & Patient Safety 2014 ................................................................................................... 41–43Emergency Medical Services for Children ........................................................................................................ 44–45Contra Costa 2014–2015 EMS Staff Directory .......................................................................................................46Contra Costa County EMS The System of Emergency Medical Services ...........................................47

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mission statementThe mission of Contra Costa County EMS is to ensure that quality emergency medical services are available for all people in Contra Costa County, and that emergency medical care is provided in a coordinated, professional, and timely manner.

X Monitor and ensure patient safety at all times

X Inspire and emulate professionalism

X Provide services with high level of integrity

X Assure a reliable and high-quality emergency response

X Support and facilitate emergency and disaster preparedness

X Integrate with healthcare systems to improve outcomes

X Promote and support community resiliency

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Contra Costa’s coordinated EMS system began in 1968, when the Board of Supervisors appointed the Contra Costa Emergency Medical Care Committee to oversee EMS within the county. The first EMS System Plan was established in 1975.

medicalservices

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contra costa ems system

Emergency Medical Care

Committee (EMCC)

Ambulance Provider Committee

Dispatch Centers

Medical Advisory Committee (MAC)

Trauma Audit Committee (TAC)

Trauma Centers

Stroke Oversight Committee

Pre-Trauma Audit Committee (PRE-TAC)

First Responders

STEMI Oversight Committee

Facilities & Critical Care Committee

Air Ambulance Rescue Aircraft

EMS Training Programs & Continuing Education Providers

Quality Improvement Committee

Medical Health Disaster Forum

Ambulance Services

Hospitals

Health Services Director

ccc board of supervisors

ccc ems agency

ems system participants

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ems timeline:recent accomplishments and significant events

X Launched a STEMI system, including a 12-lead ECG program, in ambulances and five receiving hospitals: Doctors Medical Center in San Pablo, John Muir Health Walnut Creek and Concord campuses, San Ramon Regional Medical Center and Kaiser Permanente Medical Center in Walnut Creek. (STEMI is an acronym meaning "ST segment elevation myocardial infarction," a type of heart attack.)

X Developed online portal for access to prehospital training curriculum. X Sutter Delta Medical Center became the sixth receiving hospital for Contra Costa’s STEMI system.

X Implemented Contra Costa County Medical Reserve Corps. X Chest Pain Centers at John Muir Health’s Concord and Walnut Creek campuses received accreditation in percutaneous coronary intervention (PCI).

X Stroke System Stakeholder Advisory Group formed. X East Contra Costa Fire Protection District formed. X Implemented EMS Twitter feed. X Developed 911 inter-facility emergency response dispatch and prehospital protocols. X Drafted first countywide pediatric and neonatal disaster and medical surge toolkit.

X Awarded a $30,000 CEMSIS trauma grant to support statewide data sharing. X Initiated a paramedic fire agency contract compliance process. X Implemented the American Heart Association’s HeartSafe Community program locally.

X New EMS website launched. X Implemented state-mandated EMT regulation and oversight. X El Cerrito and all cities in the San Ramon Valley became HeartSafe Communities.

X The Board of Supervisors approves the Stroke System Program. X John Muir Health’s Concord and Walnut Creek campuses, Kaiser Permanente Medical Centers in Antioch, Richmond and Walnut Creek, Doctors Medical Center in San Pablo and San Ramon Regional Medical Center are designated Primary Stroke Receiving Centers.

X Acquired a Disaster Mobile Support Unit for county and regional response. X Implemented a 12-lead transmission program with six STEMI Centers. X Adopted Institute of Healthcare Improvement (IHI) Certificate of Quality, Patient Safety and Leadership core curriculum for EMS personnel.

X Implemented Continuous Quality Improvement Initiatives on Pediatric Medication Safety and Bariatric Resource Awareness.

2008

2010

2009

2011

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2013

2012 X Launched a comprehensive primary stroke system. X Kensington was designated as a HeartSafe Community. X Participated in the medical and public health response to a fire at the Chevron Richmond Oil Refinery that affected 15,213 patients.

X Published a white paper, “The Importance of Fire-EMS First Medical Response.” X Implemented prehospital high performance resuscitation protocols. X Sponsored a “Data Sanity” conference. X Provided matching funds for a FEMA Assistance to Firefighters Grant (AFG) to acquire new cardiac monitors.

X Co-sponsored the first California Neonatal/Pediatric Disaster Coalition Conference.

X Established ambulance provider quarterly training and meetings.

X All county Advanced Life Support (ALS) ambulance providers began transmitting real-time 12-lead information to hospitals.

X Began EMS System Modernization Study engaging more than 130 stakeholders. X Emergency radio communication became accessible to all county ambulance providers, community clinics and long-term care facilities.

X Received an Urban Areas Security Initiative grant allowing the East Bay Regional Communications System to purchase disaster communication equipment for hospitals.

X Presented at an Institute of Medicine conference in Washington DC about supporting local, regional and statewide disaster preparedness for children.

X Provided mutual aid in response to Asiana Airlines crash at San Francisco International Airport on July 6.

X California extended the sunset of the Maddy Emergency Medical Services Fund, providing Contra Costa with $2.2 million annually to help cover uncompensated emergency care, pediatric trauma and EMS programs.

X Contra Costa Regional Medical Center’s Health Information Exchange began using Electronic Patient Information Charts (EPIC) to track EMS patient care outcomes.

X The Cardiac Arrest Registry to Enhance Survival (CARES) showed Contra Costa’s Utstein survival rate was 25.6%, and Utstein survival when a bystander performs CPR was 35.5%.

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2014 X Instituted a new Spinal Motion Restriction protocol and policy. X Annual trauma and EMS System plan updates sent to the state EMS Authority.

X Presented on EMS stroke systems of care at the annual American Association of Neuroscience Nurses conference.

X Issued the final report for the Contra Costa EMS System Modernization Study. X Contra Costa EMS receives the American Heart Association’s Mission Lifeline EMS Bronze Award for STEMI System performance.

X Submitted a report to the California Department of Health Services and state Emergency Services Authority about the community impacts associated with the pending downgrade of services at Doctors Medical Center in San Pablo.

X EMS medical director approved Fireline Paramedic function for Fire Paramedics serving outside Contra Costa County.

X Contra Costa EMS’s response to the 2009 H1N1 epidemic was featured in a Department of Homeland Security/FEMA national course about pediatric disaster response and emergency preparedness.

X Provided mutual ambulance and medical aid to Napa County following the August 24 earthquake.

X Received a state EMS Authority Health Information Exchange Grant to support quality improvement and EMS System performance reporting.

X The Contra Costa EMS Never Event Initiative to maintain patient safety during transfer of patients is recognized as a best practice by the California EMS Authority. “Never events” are patient transfer-of-care delays between EMS and hospitals that take longer than 60 minutes.

X Awarded a Homeland Security grant to provide AEDs to law enforcement. X In partnership with American Medical Response, implemented an Infectious Disease Ambulance Response Team in response to Ebola.

X Dr. David Goldstein appointed new EMS Medical Director effective November 2015.

X Participated in regional medical health disaster exercises focusing on anthrax. X Issued a public report about Contra Costa’s community hospital transfer of care. X Issued a final report for the Doctors Medical Center Regional Planning Group.

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During 2014, hundreds of stakeholders and members of the public participated in the EMS Modernization Project. The purpose of this independent, comprehensive review of Contra Costa’s entire EMS system was to optimize operations to benefit patients and the community.

The report made numerous recommendations regarding local implementation of healthcare reform, financial issues, community health and clinical care, including:

X Explore development of alternative destinations and transport models to better serve patients.

X Integrate prehospital data between EMS providers and hospitals to support cost-effective health initiatives.

X A single, robust medical dispatch center that efficiently matches patients with the most appropriate EMS transportation resources.

X Cardiac arrest outcomes can be greatly improved by expanding the capabilities of bystanders through aggressive community CPR training, public access to defibrillators, community education and engaging public first responders.

X Future modifications of the EMS system should be based on quality and patient outcome data, and evidence from research supporting national standards of prehospital care.

The 2014 EMS System Modernization Project, facilitated by Fitch and Associates, can be found at http://cchealth.org/ems/pdf/2014-EMS-System-Modernization-Study.pdf

contra costa ems modernization project

10.5% Increase

The number of emergency calls in Contra Costa grew by

10.5% from 2009 to 2014.

emergency calls in contra costa

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ems system response requirements

ensuring quality ems deliveryThe County awards exclusive ambulance operating contracts through a competitive process for all Emergency Response Zones (ERZs), with the exception of that served by the Moraga Orinda Fire Protection District, which has a non-competitive ERZ. Emergency ambulance service delivery contracts require compliance with standards for response time, staffing, training and equipment. Providers must offer reliable programs to ensure the delivery of safe and competent patient care.

The quality of EMS delivery is frequently measured by response time, although it has been well established that factors such as early recognition of a serious condition, calling 911 early, dispatch-aided medical instruction, public access to defibrillation devices, bystander CPR capability, and rapid transport to the appropriate hospital are also important. Patients with critical conditions make up 7% to 13% of Contra Costa’s total 911 calls.

Response time requirements are established by the county for all emergency ambulance providers. American Medical Response (AMR) was awarded the current contract in 2005 and delivers approximately 90% of the emergency ambulance service in the county. The EMS agency is the Board of Supervisors’ designated contract manager and reviews AMR’s performance monthly. Monthly performance reports are posted at cchealth.org/ems/amr.php. Performance monitoring for independent fire districts providing EMS ambulance services is a responsibility shared by those fire districts and the EMS Agency.

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ambulance emergency response zone (erz)

response time requirements by minutes and response percent1

ERZ Provider Geographic Area Urban Rural Response %

ERZ A (AMR) City of Richmond 10:00 20:00 95%ERZ B (AMR) West County (non-

Richmond)11:45 20:00 90%

ERZ C (AMR) Central County 11:45 20:00 90%ERZ D (AMR) Antioch, Bay Point, Pittsburg

area11:45 20:00 90%

ERZ E (AMR) East Contra Costa County 11:45 16:452 Suburban 20:00 Rural

90%

ERZ Moraga Orinda Moraga Orinda Fire Protection District3

11:59 20:00 90%

ERZ San Ramon San Ramon Valley Fire Protection District3

10:00 20:00 95%

Source: Contra Costa EMS Agency Verified Provider Dispatch Data

1 Current ambulance response performance requirements for the contracted ambulance provider 2 Includes Bethel Island and Discovery Bay 3 A fire protection district provides emergency ambulance service in this zone. A fire district board is the local authority for establishing response

requirements in this service area.

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population centers

The industry standard for 911

ambulance response is 12 minutes.

contra costa county ambulance zones

ambulance response performance by zone and service providerERA ZONE/PROVIDER AREA SERVED 2014 AVERAGE CODE 3

(LIGHTS AND SIRENS) RESPONSE TIME IN

MINUTESERZ A/AMR City of Richmond 4:58ERZ B/AMR West County 4:46

ERZ C/AMR Central County 5:23ERZ D/AMR Antioch/Bay Point/Pittsburg 5:06ERZ E/AMR East County 6:24

Moraga-Orinda ERZ Moraga Orinda Fire Protection District 5:33San Ramon ERZ San Ramon Valley Fire

Protection District4:15

geographyContra Costa County is located in the San Francisco Bay Area of Northern California, northeast of San Francisco and southwest of Sacramento. The county covers roughly 716 square miles, including 19 cities and numerous unincorporated communities. The county has seven emergency response zones for ambulance-based paramedic service. Each response zone is geographically and demographically diverse, and average response times reported include urban, suburban and rural responses.

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POPULATION USE OF EMS SERVICES

In 2014, Contra Costa County had an estimated population of 1,111,339, making it the ninth most populous county in California. Concord, Richmond and Antioch were the three largest cities in the county, each home to more than 100,000 residents. Between 2010 and 2014, the county gained more than 62,000 residents. EMS utilization over the last three years is displayed below.

contra costa county ems service utilization by population

2012 2013 2014

Population4 1,078,257* 1,094,205* 1,111,339

EMS Responses5 86,134 85,033 87,974

EMS Responses/1000 population

84 78 88

Average EMS Responses/day

236 234 241

Square Miles EMS Serves

716 716 716

Population Density 1,438 1,465* 1,465

Responses per square mile

120 107 120

Response per square mile

120 119 123

Response per person ratio

0.08 0.08 0.08

County Median Household Income

$79,135 $78,187* $78,756

County Population below poverty

9.90% 10.2%* 10.5%

* All populations are estimated4 Source: US Census Bureau.5 Total includes all responses, including those that did not result in patient transport.

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contra costa county quick population facts

Population, 2010 1,049,197

Population, 2014 estimate 1,111,339

Population change as a percentage, April 1, 2010 to July 1, 2014 5.9%

People younger than 5 as a percentage, 2013 5.9%

People younger than 18 as a percentage, 2013 23.89%

People 65 and older as a percentage, 2013 13.8%

FFemales as a percentage, 2013 51.2%

White people as a percentage, 2013 67.9%

African-American people as a percentage, 2013 9.6%

Native American & Alaskan people as a percentage, 2013 1.0%

Asian people as a percentage, 2013 15.9%

Native Hawaiian or Pacific Islander people as a percentage, 2013 0.6%

People reporting two or more races, percentage, 2013 5.0%

People of Hispanic or Latino origin, percentage, 2013 24.9%

Non-Hispanic white people, percentage, 2013 46.3%

governanceThe County of Contra Costa was incorporated in 1850 as one of the original 27 counties of California, with Martinez as the county seat. Contra Costa County is governed by a board of five elected supervisors, each representing a geographical district. Under the board’s guidance, county government manages 35 divisions of service for the community. The division responsible for the statutory coordination, oversight and delivery of emergency medical services is the Contra Costa EMS Agency.

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county service area em-1 (measure h) funding

County Service Area EM-1 (Measure H) parcel levies provide limited but important support for the provision and quality of emergency medical services for the residents of Contra Costa County since 1988. In 2014, Measure H assessments generated approximately $4.7 million. Currently, fire districts receive 60% of that revenue for first-responder EMS programs. The remaining funds support EMS system programs (17%) and multi-casualty and medical mutual aid dispatch from the Contra Costa Sheriff ’s Office (5%), with the remainder allocated for other services. Priorities for Measure H funding include:

X Paramedic first responder and ambulance services

X Countywide first-responder and public-access defibrillation programs

X Fire equipment and training for multi-casualty and disaster response

X Emergency and disaster radio and communication systems

X Fire and ambulance dispatch technology enhancements

X Electronic patient care record system support for fire first responders

X Medical and quality oversight of paramedic personnel

X EMS "systems of care" programs (Trauma, STEMI, Stroke and Cardiac Arrest)

X Pre-hospital equipment and training to support safe and competent care

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contra costa ems system funding 2014

Measure H –

75%

($4,724,405)

Permits, certifications & other revenue

9% ($558,454)

Maddy EMS

Fund (SB 12)

9% ($542,771)

Hospital Preparedness

Grant7%

($423,941)

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2014 special project funding supported by measure h funds

2014

1ATRUS AED

Link and National AED

Registry$38,800

First Watch data system

enhancement$5,490

Institute of Health Care

Improvement scholarships

$1,800

EMS System Modernization

Project $116,000

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3

4

EMS system dispatch technology

enhancement

Technology enhancement

for EMS system performance

reporting

50+ IHI scholarships to

support EMS provider quality

improvement training

EMS system redesign to prepare

for emergency ambulance

procurement

total = $162,090

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emergency system resources

Contra Costa EMS System is composed of several partners working together to bring the highest level of patient care to our constituents.

247public safety

answering

POINTSand Dispatch Centers

A PSAP answers emergency calls for police, firefighting and ambulance services.

public safety answering points (psaps)Antioch Police DepartmentCalifornia Highway Patrol

Concord Police DepartmentContra Costa Sheriff ’s Office

East Bay Regional Park District PoliceMartinez Police DepartmentPinole Police Department

Pleasant Hill Police DepartmentRichmond Police Department

Walnut Creek Police Department

fire/medical dispatch centersContra Costa County Fire Protection District

Contra Costa Sheriff ’s Office (multi-casualty coordination)Richmond Police Department

San Ramon Valley Fire Protection District

ambulance dispatch centersAmerican Medical Response

Contra Costa County Fire Protection District (Moraga-Orinda only)


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emergency system resources

county fire protection districtsContra Costa County Fire Protection DistrictCrockett-Carquinez Fire Protection District

municipal fire departmentsEl Cerrito Fire DepartmentPinole Fire Department Richmond Fire Department

independent fire protection districtsEast Contra Costa Fire Protection DistrictKensington Fire Protection District

(served by El Cerrito Fire Department)Moraga-Orinda Fire Protection DistrictRodeo-Hercules Fire Protection DistrictSan Ramon Valley Fire Protection District

ems paramedic service providersAmerican Medical Response California Highway Patrol (helicopter unit)Concord Police Department (tactical paramedic program)Contra Costa County Fire Protection District

El Cerrito Fire Department Moraga-Orinda Fire Protection District Pinole Fire Department Rodeo-Hercules Fire Protection District San Ramon Valley Fire Protection District

public safety defibrillation programs Antioch Police DepartmentBrentwood Police DepartmentCalifornia State Parks (Mt. Diablo)Concord Police DepartmentContra Costa Sheriff ’s OfficeClayton Police DepartmentCrockett-Carquinez Fire Protection DistrictDanville Police DepartmentEast Contra Costa Fire Protection DistrictEl Cerrito Police DepartmentHercules Police DepartmentKensington Police DepartmentLafayette Police DepartmentMoraga Police DepartmentOrinda Police DepartmentPittsburg Police DepartmentRichmond Fire DepartmentRichmond Police DepartmentSan Ramon Police DepartmentNon-emergency ambulance providers

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ems resources in contra costa county

TYPE OF PERSONNEL 2012 2013 2014

Emergency Medical Dispatchers 52 52 52

Emergency Medical Technicians 1451 1149 1073

Paramedics 461 433 417

Mobile Intensive Care Nurses 61 51 56

Public safety dispatch centers (PSAPs) 10 10 10

Fire and EMS dispatch centers 3 3 3

Available emergency ambulance units per day 22–55 24–41 22–45

Non-emergency ambulance units 85 91 88

HOSPITALS Base Hospital 1 1 1911 Receiving Hospitals* 9 9 9

EMS

*Doctors Medical Center stopped receiving emergency ambulance transports in August 2014.

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ems resources in contra costa county

certification & professional standardsThe EMS Agency is designated by state law as the county’s regulatory agency for emergency medical technicians (EMTs) and paramedics. The agency certifies EMTs and accredits paramedics to ensure they meet professional and clinical standards for safety and service. The EMS Agency is also responsible under the County’s ambulance ordinance for the management of the county’s 911 ambulance contract with American Medical Response and for the permitting of ambulance providers who originate patient transports from within the county.

EMSEMS Certification & Professional Standards, 2014

EMT Certifications 684

Paramedic Accreditations 233

Ambulance Permits 11

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911 specialty care receiving centerS

EMS

Facility STEMI Helipad Labor & Delivery Stroke Trauma Behavioral

Contra Costa Regional Medical Center &Health Centers

Doctors Medical Center San Pablo*

Sutter Delta Medical Center Antioch

San Ramon Regional Medical Center

John Muir Health Concord Kaiser Medical Center Walnut Creek

Kaiser Medical Center Richmond Kaiser Medical Center Antioch John Muir Health Walnut Creek

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ems system utilization

Responses By Year 2014American Medical Response 79,707San Ramon Valley Fire Protection District

6,166

Moraga Orinda Fire Protection District

2,101

Total 87,974


5,704


2,003

Total 85,034


5,447


2,098

Total 86,134

total ems responses

*An EMS Response typically occurs after a 911 request for emergency medical services.

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Emergency Medical Dispatch (EMD) agencies receive 911 calls and, in cases of medical emergency, have specially trained dispatchers available to provide medical instructions to callers and direct appropriate resources to address the emergency.

EMS2014 Emergency Medical Dispatch (EMD) Activity

EMD Agency EMD Responses

Total 911 Calls

Contra Costa County Fire Protection District

45,262 56,677

Richmond Fire Department

11,641 16,358


4,208 6,166

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Transports By Year 2013American Medical Response 58,911San Ramon Valley Fire Protection District

3,926


1,296

Total 64,133


3,969


1,368

Total 64,870


3,825


1,314

Total 64,527

EMS transport totals include transports for both life-threatening and non-threatening conditions. In Contra Costa County, emergency transport for non-life threatening conditions makes up 87% to 93% of all calls for transport.

total ems transports

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Transports By Year 2014Contra Costa Regional Medical Center 10,538

Doctors Medical Center 4,224*

John Muir Medical Center—Concord 9,345

John Muir Medical Center—Walnut Creek 8,008

Kaiser Permanente Medical Center—Antioch

5,259

Kaiser Permanente Medical Center—Richmond

6,289

Kaiser Permanente Medical Center—Walnut Creek

6,907

San Ramon Regional Medical Center 2,021

Sutter Delta Medical Center 8,433

ems transports to hospital within contra costa county


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ems and hospitals working together

2012

2013

2014

Base Hospitals provide medical consultation to EMS personnel in the field when they encounter patients with conditions outside of standardized EMS protocols, or in situations that require real-time medical consultation. John Muir Medical Center in Walnut Creek serves as the base hospital for Contra Costa County.

base hospital calls by type

Trauma Medical Total

5502,643 3,193

5922,227 2,819

4722,075 2,547

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cardiac arrest program

EMS

2013 2014 Events Population Incidence

per 100,000

Events Population Incidence per

100,000East County 172 303,315 56.71 155 307,009 50.49

Central County 195 513,267 37.99 227 516,433 43.96

West County 154 246,524 62.47 161 247,651 65.01

Total 521 1,063,106 49.01 543 1,071,093 50.70

Incidence of Cardiac Events in Contra Costa County, 2013–14

Contra Costa County participates in a national cardiac arrest survival registry program, which allows for comparative benchmarking and improvement in cardiac arrest emergency care. Through our partnership with the Cardiac Arrest Registry to Enhance Survival (CARES), we collect uniform and reliable outcome information, and have made significant changes to enhance the delivery of CPR by bystanders and improve pre-hospital cardiac arrest care in our communities.

We track our progress using the Utstein survival measure, a standardized cardiac arrest reporting tool introduced in 1991. The measure is used nationally by EMS systems to set benchmarks and compare results.

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cardiac arrest survival

Cardiac patients who received care that met or exceeded benchmarks found in CARES and the Utstein Uniform Reporting Guidelines were more likely to survive to hospital discharge than patients who did not.

national benchmark

national benchmark

29%

38%

Source: Data obtained by the cardiac arrest registry to enhance survival (CARES). Inclusion criteria: A witnessed, out-of-hospital cardiac arrest where the patient is found in a shockable rhythm and resuscitation is attempted by an emergency responder.

Data show an increase in bystanders initiating CPR on someone entering cardiac arrest before emergency medical responders arrive. The CARES national benchmark for this kind of bystander interaction is 38% of all cardiac arrest cases. For more information about this program, visit cchealth.org/ems/cardiac-arrest.php.

Source: Data obtained by the cardiac arrest registry to enhance survival (CARES).

EMSSurvival to Hospital Discharge (Utstein)

2012 2013 2014

31% 36% 30%

EMSBystanders Save Lives

2012 2013 2014

38% 37% 38%

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stemi systemtime is muscle

Cardiovascular disease is the leading cause of death in the United States. Each year, approximately 250,000 people experience the most deadly type of heart attack, ST Elevation Myocardial Infarction (STEMI). Patients suffering from STEMIs have the best chance for survival when they receive rapid assessment and transport to a hospital that is a designated STEMI Receiving Center. These hospitals have specialized equipment and personnel to treat these deadly heart attacks.

Planning of the Contra Costa County STEMI System began in 2008. The first STEMI centers began receiving patients in January 2009. The system supports rapid field identification and prehospital management by paramedics, early notification of cardiac intervention teams and rapid transport to designated STEMI Receiving Centers. Paramedics use field transmission of 12-Lead ECGs and “STEMI Alerts” to provide the hospital with advance notification of patient arrival. This early notification allows the hospital to assemble the necessary resources to immediately treat the patient upon arrival.

There are currently five STEMI Receiving Centers in Contra Costa County: San Ramon Regional Medical Center, John Muir Medical Centers in Concord and Walnut Creek, Sutter Delta Medical Center in Antioch, Kaiser Permanente Medical Center in Walnut Creek.

Contra Costa community hospitals that do not provide STEMI services work closely with Receiving Centers to facilitate rapid treatment and transfer of any STEMI patients who arrive at their emergency departments.

The goal for the patient who is having a STEMI is to receive a procedure called Percutaneous Cardiac Intervention that quickly restores blood flow to the heart.

The STEMI system evaluates emergency responses based on how quickly specific steps of care are followed, including important clinical interventions, such as 12-lead ECG acquisition and aspirin administered by prehospital providers. STEMI system performance is based on standards developed by the American College of Cardiology, the American Heart Association and the California Department of Public Health.

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mission: lifeline bronze awardThe Contra Costa County STEMI System has consistently met or exceeded national and local benchmarks and performance measures for the last five years. In 2013 and 2014, Contra Costa’s system received Bronze Level recognition from the American Heart Association’s Mission Lifeline Program.The Mission Lifeline Program recognizes systems of care that meet the following performance measures: First medical contact to intervention in less than 90 minutes 75% of the time, and 12-lead ECGs obtained on patients having chest pain 75% of the time.

performance standards X Scene time—The time from arrival at the scene to the departure from the scene should be 15 minutes or less.

X First medical contact to intervention—The time the patient is first seen by medical (or prehospital) personnel to the time they receive intervention should be 90 minutes or less.

X 911 call to intervention—The total time from the first 911 call to intervention should be 120 minutes or less.

EMSSTEMI System Performance Indicators

2012 2013 2014Number of EMS STEMI Alerts

209 214 230

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EMS

EMS

Mean Time Intervals in Minutes

Prehospital Performance Measures, Patients Receiving Care by Task

2012 2013 2014911 to Hospital ED Arrival 31 32 32Mean Scene Time Interval 12 11 13911 to Hospital Intervention 83 81 90ECG to Hospital Intervention 66 69 72First Medical Contact to Intervention 78 80 82Door to Hospital Intervention 55 54 60

Patient Care Task 2012 2013 2014

Aspirin administered or noted as not indicated 92% 90% 92%12-Lead ECG acquired on STEMI patients 97% 98% 99%Patient identified as having a STEMI and transported to a STEMI Receiving Center

100% 100% 100%

Intervention in less than 90 minutes of 12-lead ECG 85% 81% 76%

For more information about this program, visit cchealth.org/ems/stemi.php.

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stroke systemtime is brain

Stroke is the third-leading cause of death nationally, and the leading cause of disability.

The Contra Costa County Stroke System of Care facilitates rapid assessment and transport of patients by paramedics to a designated Primary Stroke Center, enabling patients to receive life-saving treatment and prevent permanent impairment.

All participating hospitals are required to be certified as Primary Stroke Receiving Centers. This certification recognizes that a hospital has achieved a high level of compliance with national standards in stroke care, and is able to meet the specialized needs of stroke patients.

X Contra Costa County had approximately 757 stroke system activations in 2014 X The primary objective of a stroke system is to coordinate care between the emergency medical system and hospitals so that patients possibly suffering from stroke receive care within 3 to 4 1/2 hours of their first symptoms

Contra Costa County has designated six Primary Stroke Receiving Centers: San Ramon Regional Medical Center, John Muir Medical Centers in Walnut Creek and Concord, Kaiser Permanente Medical Centers in Antioch, Richmond and Walnut Creek.

Contra Costa’s Primary Stroke Receiving Centers participate in the California Stroke Registry (CSR), a statewide stroke database designed to promote improvement in acute stroke treatment. Through the CSR, participants can evaluate specific measurements of quality of care.

Contra Costa EMS participates in the development and refinement of state EMS stroke system performance measures, including national EMS benchmarks such as on-scene time and documentation of pre-arrival notification. These data are compiled using pre-hospital EMS transport provider documentation that has been stripped of patient identifiers. For example, one goal is to track how often the clot-busting medication TPA (Tissue Plasminogen Activator) is administered within 4 1/2 hours of symptom onset.

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stroke systemtime is brain

know the signsStroke

know the signsHeart Attack

know the signsCardiac Arrest

If someone experiences sudden:Trouble walking

Weakness on one sideTrouble seeing

Trouble speaking

If someone experiences:Chest discomfort

Arm, back, neck or jaw painShortness of breath

Sweating, nausea, lightheadedness

If someone collapses and is:Not respondingNot breathing

Begin Hands Only CPR; Use an AED as soon as one arrives.

Call 9-1-1

HeartSafe Community

call 9-1-1Act in Time

Contra Costa Health Services

www.cchealth.org/ems/heartsafe.php

if someone experiences

sudden: Trouble walking Weakness on one side Trouble seeing Trouble speaking

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trauma system

The Board of Supervisors approved a comprehensive trauma system plan for the county in 1986, and the EMS Agency designated John Muir Medical Center in Walnut Creek as the county's trauma receiving center. John Muir also provides and receives aid as needed from a regional network of trauma centers that includes hospitals serving Alameda, Marin, Solano and Sonoma counties. The goal of a trauma system is to ensure that coordinated emergency services are available to critical trauma patients. This is accomplished through EMS and hospital protocols that facilitate rapid identification, management, and transport of critical trauma patients to a designated trauma center within the "golden hour"— the first hour after injury, considered the most crucial time for successful treatment.

Ambulance and Base Hospital personnel use EMS-approved triage protocols to identify critical trauma patients. Ambulance crews provide the trauma center with an "early alert" so that the trauma team can be mobilized to manage the critical trauma patient upon arrival.

EMSAll Trauma Patients vs Trauma Activations by Year

2012 2013 2014

All Trauma Patients 1,636 1,588 1,526

All Trauma Center Activations 1,097 959 1,123

Source: Trauma One Data Base

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trauma system

Traumatic injury can cause significant disability or death and affects all age groups and communities. When emergency first responders arrive at a scene where trauma is involved, they quickly evaluate the patients to determine the appropriate destination for treatment.

Patients with severe, life-threatening injuries are considered Major Trauma Victims (MTV), and they are primary candidates to visit one of the region’s designated trauma centers. A “field activation” of the trauma system happens when a first responder triages an MTV directly to a trauma center.

John Muir Medical Center in Walnut Creek is the primary trauma center in Contra Costa County, while UCSF Benioff Children’s Hospital Oakland is the primary trauma center for pediatric cases.

Not all of the patients necessarily have traumatic injuries at a trauma scene. EMS providers quickly triage patients according to the severity of their injuries, their likely treatment needs and the hospital emergency department best suited to meet those needs.

EMSTrauma Patients in Contra Costa County

2012 2013 2014Patients transported to John Muir Medical Center in Walnut Creek from an emergency trauma scene

1,030 1,251 1,485

Patients transported to UCSF Benioff Children’s Hospital Oakland from an emergency trauma scene

87 90 71

Patients transported to another trauma center from an emergency trauma scene

21 22 10

Patients transported to a non-trauma center hospital from an emergency trauma scene

1,347 1,405 8111

1 John Muir Health changed its data collection methodology in 2014. Source: EMS Agency based on data from the John Muir Health, Walnut Creek Trauma Registry and Emergency Department Log.

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disaster, medical surge and response

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Healthcare systems are vulnerable to disruptions due to disasters and emergencies. Mass casualty events can rapidly overwhelm local and regional healthcare systems with large numbers of patients (known as “medical surge"). Healthcare systems, public and private entities, and the community, acting in concert, all play a role in managing these crises.The mission of the Disaster Preparedness/Medical Surge Program is to promote and support the emergency preparedness, response, recovery, and resiliency activities of Contra Costa Health Services, the local medical health system, and other external partners and stakeholders.The Disaster/Medical Surge Program team:

X Collaborates with EMS and medical health system participants in disaster/medical surge preparedness, response, and recovery activities

X Performs grant management functions in support of disaster/medical surge preparedness, response, and recovery activities

X Oversees the Contra Costa County Medical Reserve Corps (MRC) operations and administration

The goal is to ensure that Contra Costa County’s medical health system is prepared to quickly respond, manage and recover from disasters, emergencies and medical surges.


2014 ACTIVITIESAPRIL 5 The MRC was activated and deployed to Alameda County

APRIL 23 The MRC participated in a regional exercise to establish a point-of-dispensing site (POD)

JUNE 2013 to MAY, 2014 Conducted medical surge training and drills at long-term care and health centers

JUNE 16 Conducted burn care training for hospitals and first responders

JUNE to DECEMBER Conducted pediatric triage and evacuation training for hospitals

JUNE to DECEMBER Conducted bimonthly patient triage and tracking drills with American Medical Response and hospital emergency departments

JUNE 24 & 25, 2014 Conducted hazardous materials training for hospitals

OCTOBER 23, 2014 Participated in a state tabletop exercise for a simulated aerosolized anthrax event

OCTOBER to NOVEMBER Provided Ebola training to Doctors Medical Center in San Pablo

NOVEMBER 20 The MRC participated in a regional exercise to establish a point-of-dispensing site (POD)

DECEMBER Conducted multiple suspect Ebola patient transportation drills with ambulance providers and hospitals

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multi-casualty incidentsMulti-casualty incidents (MCI) are evaluated based on the number of patients involved. A Tier 0 MCI declaration has zero to five patients, and all EMS stakeholders are notified because the incident has potential to grow larger. A Tier 1 MCI involves six to 10 patients, a Tier 2 MCI has 11 to 50, and a Tier 3 MCI has more than 50 patients. Notifications and resource ordering happen at all levels commensurate with the Incident Command System (ICS), National Incident Management System (NIMS), and Standardized Emergency Management System (SEMS).

EMSContra Costa County Declared Multi-Casualty Incidents

2012 2013 2014

Tier 0 3 4 10

Tier 1 4 4 3

Tier 2 0 1 1

Tier 3 1 0 0

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contra costa medical reserve corps (mrc)

The Medical Reserve Corps (MRC) includes both medical and non-medical volunteers and is configured for three levels of response. This provides a scalable approach to incidents.

2014 MRC Membership

19 38 5

25 13 12

Doctors Nurses Physician Assistants/

Nurse Practitioners

Emergency Medical

Technicians (EMTs)

Public Health

Professionals

Non-medical Personnel

individual volunteers provide immediate, basic support to the community, often integrated with other community response partners.

teams provide up to eight personnel and their equipment for immediate or planned support for first aid stations, points of dispensing and shelter support.

unit activations combine multiple teams to support prolonged operations deploying staff, equipment, and a pharmaceutical cache to treat as many as 1,000 people.

Training and exercising the MRC ensures that volunteers are versed in county policies and procedures. In addition, collaborative training with community partners, such as Community Emergency Response Teams and the American Red Cross, prepares the Corps for a more robust public health response to meet the needs of local residents. Activities conducted in 2014 included:

X Providing medical screenings for clients at Contra Costa’s Project Homeless Connect X Teaching hands-only CPR for the HeartSafe Community Program X Administering measles and flu vaccines at county clinics X Conducting training and drills for first receivers at points of dispensing X Providing disaster preparedness education at community health fairs X Supporting community events with first aid stations

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supporting citizen heroes The EMS system’s public outreach efforts increase awareness and educate residents about the actions they should take in the event of a medical emergency. This includes knowing the signs of heart attack, stroke, or sudden cardiac arrest, calling 911 and acting in time to save lives.

Contra Costa EMS encourages our community members to learn CPR and how to use an automated external defibrillator (AED). Learning hands-only CPR is easy and takes only a few minutes for adults. The EMS Agency, HeartSafe communities, and numerous EMS system stakeholders partner to provide this training at community events, promoted at cccems.org.

Brochures and instructional packets are available that contain all the information necessary to implement a public-access defibrillation program and to register an AED. EMS also provides speakers for community organizations such as Rotary Clubs and schools.

In a heartsafe community, all elements of the Chain of Survival are in place—immediate recognition and access, early CPR, rapid defibrillation, effective advanced care and integrated post-cardiac arrest care. The EMS Agency and the American Heart Association are partnering with communities in Contra Costa County to improve cardiovascular health and increase the chances that anyone suffering a cardiovascular emergency–heart attack, stroke, or cardiac arrest—will have the best possible chance for survival. Contra Costa’s HeartSafe Communities are Alamo, Brentwood, Clayton, Concord, Danville, El Cerrito, Kensington and San Ramon. For more information about the program visit: http://cchealth.org/ems/heartsafe.php

public access defibrillation program

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public access defibrillation program

The goal of the Public Access Defibrillation Program is to ensure access to automated external defibrillators (AED) to anyone who needs them in Contra Costa County, and to train members of the public in their use.

The program began in 2005 when Contra Costa EMS distributed 42 automated external defibrillators (AEDs) to public agencies throughout the county, trained 121 county employees and provided AED orientations and trainings for other staff. EMS continues to work with American Medical Response to assist with the distribution of 25 AEDS annually in the community.

Contra Costa participates in a national AED registry that allows emergency dispatch centers to rapidly link registered public-access AEDs and trained responders with sudden cardiac arrest victims.

public safety aed programThe first-responder defibrillation program, established countywide in 1992, provides rapid access to life-saving care for patients with cardiac arrest. Initially the program was implemented in the fire service, but many police departments have since equipped patrol cars with defibrillators.

AEDs are currently carried on police cars in Antioch, Blackhawk, Brentwood, Clayton, Concord, Danville, El Cerrito, Hercules, Kensington, Lafayette, Martinez, Moraga, Orinda, Pinole, Pittsburg, Pleasant Hill, Richmond, San Pablo, San Ramon, Walnut Creek and Contra Costa Sheriff ’s Office. Many police agencies have already played critical roles in saving lives using AEDs. AEDs are also carried by fire apparatus in Crockett-Carquinez, Richmond and East Contra Costa County.

For more information about this program, visit cchealth.org/ems/aed.php

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quality improvement & patient safety 2014

Quality Improvement is an integral part of all aspects of EMS services in Contra Costa County. EMS activity and patient care outcomes are routinely measured to assure the system is performing as designed. These measures focus on patient and provider safety, quality of care and competency in the delivery of EMS services. During 2014, all EMS system performance levels were within normal statistical control limits, and they continued to meet or exceed established national benchmarks.

patient safety events

The EMS Agency is committed to supporting a culture of safety. As part of that effort we continue to expand and monitor our performance with a Patient Safety Events Program. Part of a comprehensive, continuous quality improvement program includes review and evaluation of all aspects of clinical and operational care for patient safety.

In 2014, the Quality Improvement Division created Quality Review Team (QRT) to address EMS safety events. EMS safety events are reported by the community or any member of the EMS team. Our team reviews each event report and acts upon it as part of a quality improvement process.

quality leadership council The performance of our systems of care is monitored and evaluated by the EMS Quality Leadership Council (QLC), which meets every six months. All representatives who provide EMS services in Contra Costa County are members of the QLC, including hospitals, fire departments, ambulance companies and others.In addition to evaluating and contributing to decisions about performance and performance standards, the QLC is also integral to implementing new quality initiatives and improving the system as a whole.

quality improvement initatives

high performance cardiac arrest & cpr GOAL: To increase the quality of CPR provided to patients in cardiac arrest.

Phase I: Staff Research & ReviewIndicators to measure quality such as compression, ratios, depth and pauses for shock were developed and data pulled.

Phase II: Task Team QLC ReviewA training program was developed with staff and an implementation plan was completed.

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Phase III: Approval & PlanningInitial indicators were presented to the QLC.

Phase IV: Implement & MonitoringThe same initial quality indicators will be reviewed by staff and the QLC in 2015.

Phase V: OutcomeTo be determined. Preliminary reports show improvement.

Phase VI: SustainingTo be determined

ems patient off-load time reduction GOAL: To monitor and reduce the handoff times between ambulances and hospital emergency departments.

Phase I: Staff Research & ReviewCurrent measures reflect that during high-volume periods, patients arriving at emergency departments by ambulance are often waiting longer than 30 minutes for offloading.

Phase II: Task Team QLC ReviewThe measures and other pertinent information were reviewed by internal staff and the QLC.

Phase III: Approval & PlanningA letter was sent to all hospitals and ambulance providers to announce more intense monitoring and solicit feedback on this issue.

Phase IV: Implement & MonitoringReports will be updated monthly and hospital leadership received an email linking to the report when it is posted.

Phase V: OutcomeEMS staff and QLC will measure in six months to evaluate reduction in off-load times.


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pediatric medication safetyGOAL: To check sustainability of our documented reduction in pediatric medication inaccuracies and to measure and sustain improvements.

Phase I: Staff Research & ReviewData was gathered and reviewed by EMS Staff and published in the EMS Best Practices newsletter.

Phase II: Task Team QLC ReviewThe information will be reviewed by internal staff and former task team leads.

Phase III: Approval & PlanningThe information was reviewed by theQLC.

Phase IV: Implement & MonitoringStaff and QLC will evaluate data and indicators for progress.

Phase V: OutcomeTo be determined


Phase IV: Implement & MonitoringReports will be updated monthly and hospital leadership received an email linking to the report when it is posted.

Phase V: OutcomeEMS staff and QLC will measure in six months to evaluate reduction in off-load times.


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EMERGENCY MEDICAL SERVICES FOR CHILDREN

The Emergency Medical Services for Children Program (EMSC) monitors and maintains a coordinated and comprehensive system that delivers high-quality emergency care for the children of Contra Costa County.

background In 2014, Contra Costa emergency departments saw 81,961 children. Fortunately, 94% of them did not require hospitalization. Contra Costa County’s designated pediatric critical care and trauma center is UCSF Benioff Children’s Hospital & Research Center Oakland. Inpatient pediatric services are provided at John Muir Medical Center in Walnut Creek, Kaiser Permanente Medical Center in Walnut Creek and San Ramon Regional Medical Center. In addition, all Contra Costa community hospitals and emergency departments are expected to be ready for emergencies involving children.

EMS < 1 year 1–9 years 10–19 years TotalContra Costa Regional Medical Center 857 2,923 4,167 7,947

Doctors Medical Center in San Pablo* 514 3,554 3,244 7,312

John Muir Medical Center in Concord 874 5,901 4,867 11,642

John Muir Medical Center in Walnut Creek 786 3,665 3,463 7,914

Kaiser Permanente Medical Center in Richmond 720 3,948 3,955 8,623

Kaiser Permanente Medical Center in Antioch 994 5,032 5,136 11,162

Kaiser Permanente Medical Center in Walnut Creek 711 4,431 4,306 9,448

Sutter Delta Medical Center in Antioch 1,518 6,875 6,037 14,430

San Ramon Regional Medical Center 185 1,509 1,789 3,483

Total 7,159 37,838 36,964 81,961

2014 Pediatric Emergency Department Visits

*Doctors Medical Center stopped receiving emergency ambulances in August 2014 and closed in April 2015.

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EMERGENCY MEDICAL SERVICES FOR CHILDREN

history In 1999, Contra Costa Emergency Medical Services began local implementation of the California EMS for Children Program. The program ensures that each EMS first responder, ambulance provider and emergency department has the equipment and training needed to effectively treat children. Since most pediatric emergencies are preventable, the program not only focuses on the coordination of pediatric emergency and critical care services but also focuses on injury prevention. In 2009, Contra Costa partnered with Alameda County on EMSC to support regional injury prevention, promote pediatric prehospital and emergency care capability, and promote statewide neonatal and pediatric disaster and medical surge planning.

accomplishments and significant events X Contra Costa community hospitals all participated in the 2013 California Pediatric Readiness Project, benchmarking hospitals on pediatric capability based on the most current national guidelines for care of children in the emergency department.

X Median Pediatric Readiness for all Contra Costa hospitals was over 82%, compared to the California statewide median of 70%.

X Contra Costa EMS is home to the California Neonatal/Pediatric and Perinatal Disaster Preparedness Coalition, which works to implement recommendations supported by the National Advisory Committee for Children and Disasters.

neonatal and perinatal disaster preparedness projectThe Neonatal and Perinatal Disaster Preparedness Project helps in planning to support newborns and mothers in the event of disaster, and prepares the system for medical surges from this population. Staff education has been successful, 25 bedside “go bags” were distributed at four of Contra Costa’s five neonatal intensive care units.

Over the next two years, Contra Costa EMS will update its EMSC Program Plan. To learn more, visit www.cchealth.org/ems/feature-emsc.php.

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contra costa 2014–2015 ems staff directory

Patricia Frost ---------------------------------------------------------------- EMS Director

Joe Barger --------------------------------------------------------- EMS Medical Director

David Goldstein -------------------------------------- Assistant EMS Medical Director

Jesse Allured ------------------------------------------------ EMS Program Coordinator

Bruce Kenagy ------------------------------------------- Prehospital Care Coordinator

Aaron Doyle --------------------------------------------- Prehospital Care Coordinator

Craig Stroup --------------------------------------------- Prehospital Care Coordinator

Chad Henry ---------------------------------------------- Prehospital Care Coordinator

Maria Fairbanks ----------------------------------------- Prehospital Care Coordinator

Marshall Bennett --------------------------------------- Prehospital Care Coordinator

Steve Huck ---------------------------------------- Emergency Preparedness Manager

Lisa Vajgrt-Smith --------------------------------Medical Reserve Corps Coordinator

Mateika Martin ------------------------------------- Emergency Preparedness Trainer

Leticia Andreas ------------------------------------------------------------------- Secretary

Jeanne Kerr ------------------------------------------------------- Administrative Analyst

Patti Weisinger -------------------------------------------------------------- Account Clerk

Carol Gray --------------------------------------------------------------------- Senior Clerk

contact information1340 Arnold Drive, Suite 126

Martinez, CA 94553925-646-4690 (phone)925-646-4379 (fax)www.cccems.org

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CONTRA COSTA COUNTY EMSTHE SYSTEM OF EMERGENCY MEDICAL SERVICESSTRENGTHEN THE CHAIN OF SURVIVALEMS Training Institutions, Administrative Agencies and Regulatory Bodies play a critical role in developing, refining and ensuring a high quality / effective EMS system.

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Learning the signs of a heart attack, stroke and sudden cardiac arrest and calling 9-1-1… all of these actions can play a part in saving a life.

Emergency Medical Dispatchers, First Responders (e.g. Firefighters, Law Enforcement), Paramedics, and EMTs respond to over 85,000 emergency calls for service in Contra Costa County each year.

Ambulance Transporting Providers (e.g. Paramedics, EMTs and Nurses) ensure patients are provided treatment and transported to the most appropriate receiving hospital.

Hospitals and Specialty Care Facilities (e.g. Nurses and Emergency Physicians ensure the continuum of emergency care by treating patients and providing definitive care services.

Quality improvement (QI) is a proactive process, that recognizes and solves problems, and ensures that EMS systems of care are reliable and predictable.

Together, through collaboration and local partnerships (e.g. MRC), Contra Costa County residents receive quality, efficient and highly effective emergency patient care.

cchealth.org/ems • 925-646-4690