state of california commission on emergency medical

STATE OF CALIFORNIA COMMISSION ON EMERGENCY MEDICAL SERVICES

September 22, 2021 10:00 A.M. – 1:00 P.M.

This meeting will be conducted pursuant to Governor Newsom’s Executive Order N-29-20 issued on March 17, 2020, which suspended certain provisions of the Bagley-Keene Open Meeting Act during the declared State of Emergency response to the COVID-19 pandemic. Consistent with the Executive Order, in order to promote and maximize social distancing and public health and safety, this meeting will be conducted by Zoom and teleconference only. The locations from which Commissioners will participate are not listed on the agenda and are not open to the public. All members of the public shall have the right to offer comment at this public meeting as described in the Notice.

Zoom: https://us06web.zoom.us/j/93827397992

Teleconference number:

1-669-900-6833

Webinar ID: 938 2739 7992

AGENDA

1. Call to Order and Pledge of Allegiance

2. Review and Approval of June 16, 2021 Minutes

3. Director’s Report

A. EMSA Program Updates – DMS / HIE / Personnel / Systems B. Vaccination Administration Update

4. Consent Calendar

A. Administrative and Personnel Report B. Legal Report C. Enforcement Report

https://www.gov.ca.gov/wp-content/uploads/2020/03/3.17.20-N-29-20-EO.pdf

https://www.gov.ca.gov/wp-content/uploads/2020/03/3.17.20-N-29-20-EO.pdf

https://us06web.zoom.us/j/93827397992

Commission on Emergency Medical ServicesSeptember 22, 2021

Agenda

Regular Calendar

5. EMS Administration A. Legislative Report B. Regulations Update and Approval of Emergency Regulations

6. EMS Response to Behavioral Health Patients

7. EMS Personnel

A. Community Paramedicine Pilot Project Status Update B. Revised Do Not Resuscitate (DNR) Forms

8. Disaster Medical Services Division

A. State Medical Response Update 9. EMS Systems

A. Ambulance Patient Offload Time (APOT) Report

10. Items for Next Agenda

11. Public Comment

12. Adjournment A full agenda packet will not be provided at the meeting; however, you can print a full packet, including the agenda from the Department’s website at www.emsa.ca.gov. This event will be held in an accessible facility. Individuals with disabilities requiring auxiliary aids or services to ensure accessibility such as language interpreting, assisted listening device, materials in alternate formats or other accommodation, should contact Zoë Jones at [email protected], no less than 7 days prior to the meeting.

STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY GAVIN NEWSOM, Governor

EMERGENCY MEDICAL SERVICES AUTHORITY 10901 GOLD CENTER DR., SUITE 400 RANCHO CORDOVA, CA 95670 (916) 322-4336 FAX (916) 324-2875

COMMISSION ON EMERGENCY MEDICAL SERVICES

QUARTERLY MEETING MEETING DATE: September 22, 2021 ITEM NUMBER: 2 SUBJECT: Review and Approval of June 16, 2021 Minutes

PRESENTER: Dave Duncan, Director CONSENT: ___ ACTION: X INFORMATION: ___

RECOMMENDATION Approve the meeting minutes from the June 16, 2021, Commission on Emergency Medical Services (EMS) Meeting. FISCAL IMPACT None. SUMMARY The prior meeting of the Commission on EMS occurred June 16, 2021. Each Commission on EMS meeting is transcribed by a third-party vendor. That vendor also drafts meeting minutes, which summarize what is said during the meeting. Those draft minutes are then edited by the Emergency Medical Services Authority (EMSA) to ensure accuracy and completion. The Commission on EMS may request modifications to the meeting minutes or may approve the version of the minutes included in this agenda item. ATTACHMENT(S) Minutes of Teleconference Meeting: Wednesday, June 16, 2021

Commission on Emergency Medical Services September 22, 2021

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STATE OF CALIFORNIA COMMISSION ON EMS

Minutes of Teleconference Meeting

Wednesday, June 16, 2021 Zoom

Call-In Number 669-900-6833; Code 962 2721 9322

COMMISSIONERS PRESENT: Steve Barrow, Sean Burrows, James Dunford, M.D., Thomas Giandomenico, Nancy Gordon, Mark Hartwig, James Hinsdale, M.D., Lydia Lam, M.D., Ken Miller, M.D., Ph.D., Jodie Pierce, Karen Relucio, M.D., Paul Rodriguez, Carole Snyder, Jim Suver, Atilla Uner, M.D., Todd Valeri, Kristin Weivoda COMMISSIONERS ABSENT: Brent Stangeland EMS AUTHORITY STAFF PRESENT: David Duncan, M.D., Louis Bruhnke, Caitlyn Cranfill, Sergy El-Morshedy, Kent Gray, Craig Johnson, Kim Lew, Jennifer Lim, Steven McGee, Lou Meyer SPEAKERS (partial list): Dave Magnino, Sacramento County EMS Agency

1. CALL TO ORDER AND PLEDGE OF ALLEGIANCE Chair Atilla Uner, M.D., called the teleconference meeting to order at 10:05 a.m. Seventeen Commissioners were present. He led the Pledge of Allegiance and reviewed the meeting protocols and meeting agenda. Chair Dunford asked Dr. Duncan to introduce the new Commissioner. David Duncan, M.D., EMSA Medical Director, introduced Jodie Pierce and welcomed her to the Commission.

2. REVIEW AND APPROVAL OF MARCH 17, 2021, MINUTES Action: Commissioner Hinsdale moved approval of the March 17, 2021, Commission on Emergency Medical Services Meeting Minutes as presented. Commissioner Barrow seconded. Motion carried unanimously with one abstention by Commissioner Pierce.

3. DIRECTOR’S REPORT A. EMSA Program Updates

David Duncan, M.D., EMSA Medical Director, presented his report:


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COVID-19 Response Update • There have been increased case rates across at least eight states in the

southern and western U.S. • California trends include closely tracking the Delta variant, which has been

upgraded by the Centers for Disease Control and Prevention (CDC) to a variant of concern. The vaccines work well against it.

• COVID-19-related emergency department visits and hospital admissions continue to trend slowly downward in California.

• The case rate is at 3.7 million total cases in California, approximately 10 percent of the population. o There are large numbers of positive cases beyond those which were

measured. o There were 628 new cases this month, which is consistent over the past

couple of months. • The Authority tracks important indicators for the COVID-19 burden in California:

the current R-effective remains incredibly low at .77; seven-day test positivity is at .7%, which is also at an all-time low for COVID-19 in California.

• As California transitions back to a normal economy, and the Blueprint for a Safer Economy Model, the color-coded tiered algorithm for California counties, is left behind, all counties are divided in a split between the two lowest tiers. o 50 percent of California counties are in the yellow-minimal tier and 50 percent

are in the orange-moderate. One county is in the red-substantial tier but will soon meet the orange-moderate requirements.

• OSHA is meeting tomorrow to discuss mask guidance and guidance for employees.

• Low vaccination rates are seen in other states and minimal masking requirements are on an upswing, while California continues on a downswing. o California continues to lead the country in the highest per capita vaccination

rate with 55 percent of the total population vaccinated. o California has the lowest case rate in the country because of all the work and

interventions aggressively instituted over the last year and a half. Health Information Exchange (HIE) EMSA received $7.9 million in funding in the form of a Budget Change Proposal (BCP) to help increase the number of HIEs by 7 to 9 from the current 16 local EMS agencies (LEMSAs), which will leave 7 to 9 remaining LEMSAs. Attaining HIE programs for all LEMSAs will bring the Authority closer to the ultimate goal of data integration for EMS in California, making data accessible to all stakeholders in the movement towards real-time access to data. Discussion


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Commissioner Barrow stated it is important to remember the devastating effects COVID-19 has had on both individuals who did and did not survive. Commissioner Barrow asked about the vaccination percentage of EMS first responder personnel and whether there are efforts underway to ensure that percentage is high. Dr. Duncan stated, while the EMS community can only estimate, the vaccination percentage is 70-80 percent, equivalent to or higher than general health care, and has risen due to vigilance, education, and training. Commissioner Barrow asked staff to research if there has been a request for more funding to support childcare provider training in the new state budget.

4. CONSENT CALENDAR A. Administrative and Personnel Report B. Legal Report C. Enforcement Report

Action: Commissioner Barrow moved approval of all items on the consent calendar. Commissioner Gordon seconded. Motion carried unanimously with one abstention by Commissioner Pierce. The item was noted and filed.

REGULAR CALENDAR

5. EMS ADMINISTRATION A. Legislative Report

Sergy El-Morshedy, Legislative Coordinator, summarized the EMSA Legislative Report of the bills currently being tracked and analyzed by staff, which was included in the meeting packet and posted on the website. Discussion Commissioner Barrow asked about funding for the Assembly Bill (AB) 450 Paramedic Board of California. Mr. El-Morshedy stated there is currently no language in AB 450 that specifies how the board would be funded. Previous sources of funding include licensure increases and general funds. Commissioner Barrow asked if the board would remove EMSA authority over adjudicating paramedic issues. Mr. El-Morshedy stated the board would make final decisions in place of the EMSA Director. Commissioner Barrow urged EMSA to take a strong preventative position against AB 122 and 1238, which will increase risks of vehicle collisions involving cyclists or pedestrians. Chair Uner asked staff to look at these bills.

B. Regulations Update


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Kent Gray, Regulations Manager, reviewed the Regulations Update of the regulations being promulgated, which was included in the meeting materials. Discussion Commissioner Burrows asked whether the review process is close to completion. Mr. Gray stated the review is less than half-completed. However, since the more complex material has been dealt with first, the time required to complete the review is halfway through. Commissioner Hartwig expressed concern over the Chapter 13 process. He stated the California Fire Chiefs Association decided not to participate in the process after being denied its choice of representation on the committee. He asked to reconsider the constitution of the workgroup. Dr. Duncan stated it was important to have all appropriate input in the Chapter 13 process. There was unanimous agreement that non-members, specifically including attorneys and contractors, would not participate. Unfortunately, some organizations’ best representatives fell under that non-participatory group; however, additional groups of participants were established to allow those representatives to participate to some degree. Concerns and recommendations may also be submitted in writing.

6. COMMISSION ON EMS SUBCOMMITTEE REPORT Chair Uner stated a Subcommittee was formed after the March 17th meeting, based on Commissioner recommendation to consider recommendations on the EMS response to agitated and combative patients. The Subcommittee came up with recommendations for Commission approval. The Subcommittee recommendations were discussed and voted on separately, as follows: Recommendation 1: The topic of behavioral health in EMS becomes a standing agenda item for discussion at Quarterly Commission on EMS Meetings. This is not to be part of the Consent Calendar. Discussion Chair Uner stated, although the recommendation is for the topic of behavioral health, the National Association of EMS Physicians (NAEMSP) paper, which was part of the Subcommittee discussion, mentions agitated or combative patients. He suggested changing “behavioral health” to “agitated or combative patients” so Recommendation 1 would read “the topic of agitated or combative patients in EMS becomes a standing agenda item for discussion at Quarterly Commission on EMS Meetings. This is not to be part of the Consent Calendar.” He stated the broader topic might include patients other than mental health patients. He asked for Commissioner input. Commissioner Miller advocated to leaving the topic as “behavioral health.” Commissioner Dunford suggested “behavioral health emergencies” to give more latitude. Commissioner Valeri stated the need for a better understanding of the authority of EMS providers to restrain and/or detain patients against their will.


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Commissioner Dunford asked if this is something every state is thinking about. Dr. Duncan stated it is a nationwide problem but it is an escalating problem in California. He agreed with the topic of “behavioral health emergencies” to better identify metrics, which help align interventions and funding more appropriately. Commissioner Barrow stated concern about differential enforcement. Chair Uner stated the Subcommittee did not address this concern, but it can be discussed if this becomes a standing agenda item. Commissioner Relucio agreed with the topic of “behavioral health emergencies” because it also opens up opportunities to address other issues such as suicide prevention or opioid overdoses. These are areas that need to be addressed. Not only are they health care issues or systems of care issues but they are also public health issues. This is an opportunity to come up with a good system of care that can address several issues. Public Comment There were no questions or comments from the public. Action: Commissioner Barrow moved the approval of Subcommittee Recommendation 1, as presented. Commissioner Relucio seconded. Motion carried unanimously with one abstention by Commissioner Pierce. Recommendation 2: The Commission on EMS recommends Clinical Care and Restraint of Agitated or Combative Patients by Emergency Medical Services Practitioners as a guiding principle for local emergency medical services agencies (LEMSAs), from which to create (or modify) policies and procedures. Discussion Commissioner Miller asked about future updates to the position paper. Chair Uner stated it is the best national guideline on behavioral health emergencies. Changes to the paper will be noted as part of the quarterly agenda item, which will signal opportunities for updates. Commissioner Miller moved to approve Recommendation 2. Commissioner Snyder seconded. Commissioner Barrow stated the position paper lacks clarity on the authority issue and the law enforcement documents reviewed. It does not address the complexities of law enforcement body-worn cameras and HIPAA protections for paramedics and EMTs in the field as they are treating patients who are in crisis, agitated patients with sedation, and those in restraints. He offered a friendly amendment to address the issue of clarity updates to the position paper. Chair Uner agreed that the position paper is lacking and does not apply to California in several areas. He stated the details need to be looked at at the LEMSA level.


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Commissioner Hartwig stated concern that adopting a position without public input may be contrary to the rulemaking process. He suggested legal clarification. Steven McGee, Chief Counsel, stated the Commission is not a rulemaking body and is not required to go through a public process to adopt a statement. Also, the position paper is not a rule or standard that applies to the LEMSAs or others. Commissioner Miller accepted Commissioner Barrow’s friendly amendment to address the issue of updates to the guideline. He suggested changing the title from “clinical care” to “patient care,” since it is about patient management. Public Comment There were no questions or comments from the public. Action: Commissioner Miller moved the approval of Subcommittee Recommendation 2, with peer review updates. Commissioner Snyder seconded. Motion carried unanimously with one abstention by Commissioner Pierce. Recommendation 3: The Commission requests EMSA to survey the LEMSAs regarding their current protocols and procedures for behavioral health responses.

• A report of this data is to be presented at the December 2021 Commission on EMS Meeting, and the survey is to be completed annually for three (3) consecutive years.

Discussion Commissioner Barrow moved to accept the recommendation from the Subcommittee. Commissioner Hinsdale seconded. Commissioner Rodriguez asked how LEMSAs are questioned about protocol in the survey. Chair Uner stated there is an inquiry box on page 68-69 of the agenda with yes/no questions about protocol that could be used as a template. Commissioner Dunford stated he created the table from core elements for quality assurance principles. It is not exhaustive and is open for discussion. Commissioner Rodriguez asked if there are plans to review the LEMSA protocols from the survey. Commissioner Dunford stated the survey was intended to stimulate thought regarding the future of the LEMSA work. Commissioner Barrow modified his motion to include doing a survey in December and using the presented table as a baseline starting point for consultation with LEMSA administrators. Commissioner Dunford suggested collecting information on race and ethnicity and other social factors in order to be mindful of their effects on care and quality assurance.


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Commissioner Barrow stated LEMSAs may not have the capacity to gauge those issues. Public Comment There were no questions or comments from the public. Action: Commissioner Barrow moved the approval of Subcommittee Recommendation 3, including doing a survey in December and using the presented table as a baseline starting point for consultation with LEMSA administrators. Commissioner Hinsdale seconded. Motion carried unanimously with one abstention by Commissioner Pierce.

7. EMS PERSONNEL Kim Lew, Chief, EMS Personnel Division, introduced herself and deferred to Lou Meyer to present this agenda item.

A. Community Paramedicine Pilot Project Status Update Lou Meyer, Project Manager for the Community Paramedicine Project and Liaison to the Community Paramedicine and Triage to Alternate Destination Advisory Group, congratulated Chief Lew on her promotion. He presented his report: Community Paramedicine Pilot Project Concepts and Enrollment

• 14 active pilot projects are ongoing.

• Over 11,524 patients have been enrolled in the pilot over the past five years.

• Age and ethnicity information is reported in the pilot quarterly data reports.

• A number of calls have been received from hospital facilities and providers interested in joining the Community Paramedicine Program.

Community Paramedicine and Triage to Alternate Destination Oversight Advisory Group Mr. Meyer stated the Authority established the Advisory Group to advise on the development and oversight of community paramedicine and triage to alternate destination program specialties. Mr. Meyer stated the Authority is in the process of drafting regulations that, after approval of the EMS Commission, will be adopted to establish minimum standards for the development of a community paramedicine or triage to alternate destination program based upon, and informed by, the Community Paramedicine Pilot Program and the protocols and operation of the pilot projects. Discussion Commissioner Dunford stated the California Medi-Cal plans include provisions for alternate destinations that would be funded by the managed care organizations themselves. Sobering centers will be an option for managed care organizations who are participating in Medi-Cal to fund. In the next few years, large insurance companies that participate in Medi-Cal will begin to have the opportunity to fund these centers in lieu of emergency department services.


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Public Comment There were no questions or comments from the public.

8. DISASTER MEDICAL SERVICES DIVISION A. State Medical Response Update

Craig Johnson, Chief of the Disaster Medical Services Division, reviewed the State Medical Response Update, which was included in the meeting materials. He provided information on the Authority’s response activities to date and highlighted current activities underway. Discussion Commissioner Relucio stated this is an opportunity to redefine or rebuild public health and EMSA itself. The Medical Health Operational Area Coordination (MHOAC) programs and Regional Disaster Medical Health Specialists (RDMHS) and Regional Disaster Medical Health Coordinators (RDMHC) are under-funded. While focusing on emergency preparedness and response, this is an area where there could be opportunities to build that out in the future. Mr. Johnson stated the RDMHS positions were doubled and funded going forward. There is a need for well-trained MHOACs. The California Department of Public Health (CDPH), RDMHS, local partners, LEMSAs, and health departments will work together collaboratively to do what they can to support California. Commissioner Relucio cautioned against getting caught in a cycle of neglect and panic during future pandemics. Mr. Johnson stated the EMS Authority is holding onto caches, primarily to support the medical response in the event of another pandemic. Commissioner Barrow recommended institutionalizing educational meetings during the interim in the fall with legislators, particularly leadership, and subcommittees that oversee budgeting. They must be educated ahead of time. Dr. Duncan stated education and training must remain funded and top-notch. Commissioner Dunford congratulated Dr. Duncan and Mr. Johnson for a magnificent demonstration of how EMS can do more than it was thought capable of doing. EMS has filled voids that were not capable of being filled by traditional providers. Commissioner Relucio stated the MHOAC programs are a link between EMSA and public health and require more funding. Public Comment Ms. Cranfill stated Kristin Thompson asked whether the meeting will be recorded. Ms. Cranfill stated the minutes will be included in the packet for the next Commission meeting. Anyone who would like to request a copy of the recording or the minutes can send an email to [email protected].

9. ITEMS FOR NEXT AGENDA


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Chair Uner asked Commissioners for suggestions for the next agenda. Commissioner Gordon suggested discussing demographic questions in terms of behavioral health. Commissioner Barrow asked if the September or December meetings will be in person. Ms. Cranfill stated the September meeting will be virtual, in accordance with the Governor's Executive Order, which is still in effect.

10. PUBLIC COMMENT Dave Magnino, Administrator, Sacramento County EMS Agency, representing the board of directors for the National EMS Memorial Bike Ride Foundation, spoke as a member of the Muddy Angels, a group of bike riders who ride at five different fundraising-type bike rides throughout the nation to honor the EMS personnel who have given their lives to EMS. The board of directors decided to do the rides simultaneously starting Monday, September 20th and ending Saturday, the 26th because of unknown COVID-19 restrictions. Mr. Magnino stated the West Coast EMS Memorial Bike Ride is a six-day ride from Reno to San Francisco. He asked everyone to nominate honorees and to register to support the bike ride by riding, being one of the support vehicles, or donating to the foundation can go to muddyangels.org. Ms. Cranfill stated Kristi Koenig asked if there is any evaluation underway on the threat to EMS systems operations and data systems from cyberattacks and how to mitigate that threat. Louis Bruhnke, Chief Deputy Director, stated EMSA is moving forward in its projected, anticipated data project, which will be an attempt to consolidate and rationalize EMS data collection. The process in California is rigorous to identify needs in data security. Dr. Duncan stated attacks on health care systems are violent in nature. Everyone in EMS needs to be taking appropriate precautions. Chair Uner agreed. Ms. Cranfill stated KR asked if future meetings will be hybrid. She stated this will need to be discussed, including technological and logistical capabilities. Chair Uner clarified that Commissioners will attend in person when the Governor’s Executive Order is lifted; hybrid meetings would allow the public to attend virtually. Mr. El-Morshedy stated EMSA has conducted its EMS awards program at the end of each year and holds a ceremony following the December meeting of the Commission on EMS. The 2020 awards were moved due to COVID-19; recipients were recently announced. Commissioner Weivoda, Yolo County EMS, is being awarded the Administrator of the Year award and Commissioner Hartwig, Santa Barbara County Fire, is being awarded a Distinguished Service Award. Chair Under congratulated Commissioners Weivoda and Hartwig.


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Dr. Duncan recognized and commended Commissioner Jane Smith as she steps down from 13 years on the Commission; she was a proponent in developing the EMS awards for California.

11. ADJOURNMENT Chair Uner asked for a motion to adjourn. Action: Commissioner Dunford moved to adjourn the meeting. Commissioner Snyder seconded. Motion carried unanimously. Chair Uner adjourned the meeting at 12:39 p.m.

Emergency Medical Services Authority Disaster Medical Services Division (DMS)

Major Program Activities September 22, 2021 – Item #3A

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Activity & Description Primary Contact EMSA (916) 322-4336

Updates

1. Ambulance Strike Team (AST) – Medical Task Force (MTF)

Michael Frenn, ext. 435 EMSA manages the statewide AST program and collaborates with local EMS Agencies and ambulance providers to support California during emergencies. To advance the program, EMSA has convened an AST workgroup to help EMSA develop appropriate revisions to the program. The modifications include further development of the AST Leader program and curriculum, effective utilization of the Disaster Medical Support Units (AST resupply and Leader vehicle), command and control during deployments, and overall program updates. The workgroup began work in late 2019, but efforts were postponed beginning early 2020 due to demands of the response to COVID by all participants. However, the various subgroups are now in the process of reconvening, and it is anticipated that a return to regular order will resume.

The AST program proved critical during the 2020 COVID and Wildfires response. ASTs were heavily engaged with COVID patient movement, fire evacuations, logistical support to various EMSA/CAL-MAT Missions, and support for Cal Fire operations. To date, 17 ASTs were utilized to support response activities.

2. California Medical Assistance Teams (CAL- MAT) Program

Michael Frenn, ext. 435 The CAL-MAT Program is modeled after the federal Disaster Medical Assistance Team (DMAT) program and is designed to provide additional capability at the State level to mitigate significant medical disaster situations. Five Units have now been stood up: San Diego, San Francisco Bay Area, Orange County, Sacramento, and Central California. Efforts to stand up units in the North State (Redding), Riverside/San Bernardino, and Los Angeles are underway. CAL-MAT supported the COVID-19 activities beginning in March. EMSA deployed



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over 1,100 CAL-MAT members, some multiple times (4,000 individual member deployments) to support approximately 140 missions throughout the State. The missions included support for COVID quarantine sites, Alternate Care Sites, Federal Medical Stations, medical shelter/clinics, Long-term Care Facilities, migrant hubs, vaccinations sites, monoclonal antibody infusion centers, and Cal Fire Base Camps. To meet the statewide pandemic, EMSA expanded the program from less than 200 members to over 2,000 members. Additionally, there is a substantial number of additional potential members EMSA is currently vetting for CAL-MAT membership. However, with the program's growth, EMSA is faced with many new challenges in maintaining the program effectively. Some of the challenges include having the resources (funding and staffing) to effectively manage the program, provide continuing training for members, and update equipment and supply caches to support the expanded program and new statewide expectations. Expectations for Unit Leaders are being refined to create a more effective management arrangement. Large capability video conferencing has been provided to the Units to conduct training and communicate with their membership, most of which number in the hundreds. Recently, qualified and competent personnel have been identified to lead Units in the Los Angeles and Riverside/San Bernardino areas. This will provide for a better span of control for the management of CAL-MAT personnel and will result in additional improvement in the program. CAL-MAT is contracted to by CAL FIRE to provide medical support at fire base camps. Several teams have already been deployed to the River Fire (Mariposa County) and the massive Dixie Fire.



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3. CAL-MAT Cache Kevin Olson, ext. 726 Since returning from deployment, 2 of the 3 caches have been rehabbed and ready for deployment. The third cache is being rehabbed, but we have experienced delays in procuring needed items for restock due to shortages in available items, staffing, and other minor factors. Despite the delays, the cache will be ready within the month. Additional time has been used to completely review all items carried in the cache and capture the lot numbers and expiration dates electronically. This will facilitate the removal and replacement of these items for recalls or have expired. We have also reviewed and removed items that no longer meet the current medical safety standard. An example would be all injection needles now meet current safety requirements. With the lifting of the COVID restriction, we are looking forward to deployment exercises with the CAL-MAT caches.

4. California Public Health and Medical Emergency Operations Manual (EOM)

Kelly Coleman, ext. 726 All EOM materials are posted on the EMSA website at https://emsa.ca.gov/plans/.

The Regional Disaster Medical and Health Specialists (RDMHS) continue to conduct EOM training on an ongoing basis. The EOM workgroup meetings have been postponed throughout 2020 due to COVID-19 response. The workgroup is expected to reconvene in 2021.

5. California Crisis Care Operations Guidelines

Kelly Coleman, ext. 726 Development is on hold until funding is made available.

https://emsa.ca.gov/plans/



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Updates

6. Disaster Healthcare Volunteers (DHV) of California (California's ESAR-VHP program): Registering, Credentialing, & Mobilizing Health Care Personnel

Lauran Molina, ext. 466 The DHV System has approximately 107,000 volunteers registered. The number of volunteers has nearly quadrupled since the COVID-19 Pandemic began. The DHV County Unit volunteers and the Medical Reserve Corps (MRC) have been crucial in California's COVID-19 response efforts. There have been approximately 7,000 individual DHV/MRC volunteers deployed for COVID-19 pandemic response. A total of 39 DHV/MRC Units have deployed in California, devoting approximately 202,000 volunteer hours for the COVID-19 response. DHV/MRCs have volunteered their time and skills in vaccination clinics, testing sites, COVID-19 hotlines, contact tracing, patient care, Alternate Care Site support, Emergency Operations Centers, etc. Registered volunteers fill 49 healthcare occupations. Over 19,000 of the 107,000 DHV registered volunteers are accepted/pending Medical Reserve Corps (MRC) members. EMSA trains and supports DHV System Administrators in each of the 32 participating MRC units. All 58 counties have trained DHV System Administrators in their MHOAC Programs. EMSA provides routine training, DHV User Group Webinars, and system drill opportunities for all DHV System Administrators every quarter. The last DHV Drill was conducted on July 14th, 2021. The DHV/MRC User Group webinar was held on July 29th, 2021. EMSA publishes the "DHV Journal" newsletter for all volunteers on a tri-annual basis. The Winter DHV journal was released in March 2021. The Summer DHV Journal is slated to be released in August 2021. The "DHV Journal" is available on the DHV webpage of the EMSA webpage: https://emsa.ca.gov/disaster-healthcare-volunteers-journal-page.

https://emsa.ca.gov/disaster-healthcare-volunteers-journal-page



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Updates

7. Training

Weapons of Mass Destruction (WMD)

Medical Health Operations Center Support Activities (MHOCSA)

Markell Pierce, ext. 1443 Kelly Coleman, ext. 726

The WMD course provided by EMSA has been canceled due to the COVID-19 response. Based on current priorities, EMSA has not determined when the course will be offered again. Medical Health Operations Center Support Activities (MHOCSA) training classes were conducted in early 2020. However, since March 2020, due to the COVID-19 response, no additional MHOCSA courses have been conducted.

8. 2019 Statewide Medical and Health Exercise (2019 SWMHE)

Kelly Coleman, ext. 726 The 2020 Statewide Medical and Health Exercise (SWMHE) was canceled due to COVID-19 response. The exercise planned for 2021 is still to be determined.

9. Hospital Available Beds for Emergencies and Disasters (HAvBED)

Kelly Coleman, ext. 726 The United States Health and Human Services discontinued funding the national HAvBED program in 2016. However, EMSA is working with the California Department of Public Health (CDPH) and other partners to continue integrating hospital data collection for California use.



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Updates

10. Hospital Incident Command System (HICS)

[email protected]

Craig Johnson, ext. 4171 The Hospital Incident Command System (HICS) is sponsored by the California Emergency Medical Services Authority (EMSA). EMSA has assembled a HICS National Advisory Committee to assist with activities relating to the HICS Program. The committee members serve as technical advisers on developing, implementing, and maintaining EMSA's HICS program and activities.

EMSA conducted the HICS National Advisory Committee Executive Group meeting in July 2021 to establish committee priorities. The focus moving forward is to identify best practices and lessons learned from hospital utilization of HICS during the COVID response. Several of the HICS tools and forms have been updated based on lessons learned. The Fifth Edition of HICS, Frequently Asked Questions (FAQs), and additional program information are available on the EMSA website: https://emsa.ca.gov/disaster-medical-services-division-hospital-incident-command-system-resources/.

11. Mission Support Team (MST) System Development

Michael Frenn, ext. 435

Activated by EMSA, the MST provides the management oversight and logistical support for State deployed medical and health teams. The MST program was utilized heavily during the COVID response. The effectiveness of the program enabled critical field logistical support for the deployed EMSA medical teams. To date, the program supported approximately 140 medical missions for the COVID-19 and 2020/21 wildfire responses. EMSA also grew the program membership during the COVID response to meet statewide needs. EMSA added hundreds

mailto:[email protected]

https://emsa.ca.gov/disaster-medical-services-division-hospital-incident-command-system-resources/

https://emsa.ca.gov/disaster-medical-services-division-hospital-incident-command-system-resources/



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Updates

of new members and established just-in-time training programs. Moving forward, EMSA will focus on program improvements from lessons learned and identified gaps.

12. Response Resources Kevin Olson, ext. 1802 The demand for "Response Resources" skyrocketed during the COVID pandemic. To meet statewide needs, EMSA greatly expanded all aspects of the Mobile Medical Assets programs. We have quadrupled the warehouse's size, increased physical assets, modernized tracking programs, and became the state repository for respiratory equipment, including managing over 15,000 ventilators. Currently, we are seeking to increase efficiencies and improve overall logistics operations. Short-term goals include filling the newly acquired positions gained through the State Budget Change Proposal (BCP) process, recovering and rehabbing deployed assets, and working with state partners to implement the new asset and inventory system NEXGEN. The Response Resources Unit (RRU) continues to integrate and update IT and telecommunications equipment to improve MST/CAL-MAT networking infrastructure.



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Updates

13. Information Technology

Rick Stricklin, ext. 1445 EMSA continues to address critical shortfalls within the EMSA Department Operations Center (DOC) and EMSA Station 4. IT infrastructure and communications upgrades and response configurations are being implemented to provide full disaster response functionality during activations. EMSA is continuing to design and expand the Meraki system to provide connectivity for data (cellular, VSAT, wired) and video capabilities during field deployments and incident response. EMSA has completed the upgrade of VSAT on the C3. EMSA continues to develop relationships with allied agencies and NGOs, to improve radio interoperability to include the implementation of the Shared Resources High-Frequency Radio Program (SHARES) and California Radio Interoperability System (CRIS). Procurements of High Frequency (HF) radio/data communications and antenna equipment are ongoing for improving long-range interoperability communication capability.

14. Mobile Medical Shelter Program (MMSP)

Craig Johnson, ext. 4171 Working with other state agencies and within existing resources, EMSA has redesigned the Mobile Field Hospital (MFH) program into the California Mobile Medical Shelter program. The purpose of the redesign is to modify and expand the potential uses of the equipment into general staging, stabilization, and shelter capacity. During the COVID response, EMSA deployed nearly 50 mobile medical structures to support medical surges at hospitals and other treatment



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Updates

sites. Also, EMSA worked with Local EMS Agencies to deploy four of the six Mobile Medical Shelter Modules (each module includes six structures plus durable equipment) EMSA placed strategically around the State with local partners. EMSA also provided just-in-time training for local partners on set-up, utilization, and teardown of the structures. EMSA, using the mobile medical structures, established a 50-bed mobile field hospital in Imperial County to expand hospital bed capacity during the COVID surge impacting the border communities. Additionally, EMSA has deployed structures to Crescent City in Del Norte County to expand hospital capability to support the current Delta variant surge.

15. Regional Disaster Medical/Health Specialists (RDMHS) Program and Medical Mutual Aid System

Jody Durden, ext. 702 The RDMHS program is a critical component of the Medical and Health Disaster Response System. The functions of the RDMHS are to manage and improve the regional medical and health mutual aid and cooperation systems; coordinate medical and health resources; support development of the Operational Area Medical and Health Disaster Response System and support the State medical and health response system through the development of information and emergency management systems.

EMSA and CDPH conducted the RDMHS quarterly meeting in July 2021. COVID and wildfire response efforts were discussed, and program strengths and weaknesses were identified. EMSA successfully secured ongoing funding for a total of 12 RDMHSs (two per mutual aid region).



10


Updates

16. Medical Reserve Corps (MRC)

Lauran Molina, ext. 466 Thirty-two (32) MRC units are in the Disaster Healthcare Volunteers (DHV) System and have trained System Administrators. These MRCs are regular users of the DHV System and are active participants in quarterly DHV Drills and DHV User Group webinars. Over 19,000 of the 107,000 DHV registered volunteers are accepted/pending MRC members. The MRC's have been crucial in California's COVID-19 response efforts. There have been over 4,500 individual MRC volunteers deployed for COVID-19 pandemic response and medical support across the State. 26 Medical Reserve Corps Units have deployed in California, devoting over 149,000 hours for the COVID-19 response. MRCs have volunteered their time and skills in vaccination clinics, testing sites, COVID-19 hotlines, contact tracing, patient care, Alternate Care Site support, and Emergency Operations Centers. Since pre-COVID, California MRC Units have more than doubled in size.

17. Statewide Emergency Plan (SEP) Update

Brad Gates, ext. 4728

The California Governor's Office of Emergency Services (Cal OES) released the update in October 2017. The updated version is located at http://caloes.ca.gov/PlanningPreparednessSite/Documents/California_State_Emerge ncy_Plan_2017.pdf. This version includes a brief description of the Public Health and Medical Mutual Aid System. A review and rewrite of the ESF8 annex were conducted in September 2019. The rewrite is in its final review and will be published soon. CAL-OES came back with edits to the Public Health / Medical annex; these edits are under review pending final approval by CDPH and EMSA.

http://caloes.ca.gov/PlanningPreparednessSite/Documents/California_State_Emergency_Plan_2017.pdf





11


Updates

18. Southern California Catastrophic Earthquake Response Plan

Brad Gates, ext. 4728 The California Governor's Office of Emergency Services (Cal OES) is currently leading the refresh of the Southern California Catastrophic Earthquake Plan. The Emergency Medical Services Authority continues to work with the Regional Disaster Medical Health Specialists (RDMHS), Medical Health Operational Area Coordinator (MHOAC), Emergency Support Functions, Cal OES, California Department of Public Health (CDPH), California Department of Healthcare Services (CDHS), the Assistant Secretary for Preparedness and Response (ASPR), and the Federal Emergency Management Agency (FEMA) to update the Public Health and Medical Fact Sheet, Survivor Movement plan, Mass Care Plan, Shelter Fact Sheet and Course of Action. Final review and approval are on hold due to the COVID response.

19. Patient Movement Plan

Kelly Coleman, ext. 726 The California Patient Movement Plan was released in November 2018 and can be found at https://emsa.ca.gov/plans/. The Plan was utilized extensively during the COVID response (over 6,500 patient transports). In particular, the Plan proved beneficial in providing direction as EMSA worked with local partners to transport 650 COVID patients out of Imperial County. Moving forward, EMSA will work with partners to update the Plan based on lessons learned from the current response.

20. Bay Area Catastrophic Earthquake Plan

Kelly Coleman, ext. 726 EMSA participated in the Medical Planning Group for the Bay Area Catastrophic Earthquake Plan revision. There have been no Plan activities in 2020 due to the COVID response. EMSA will continue to socialize the Plan in 2021.

https://emsa.ca.gov/plans/



12


Updates

21. Northern California Catastrophic Flood Response Plan

Kelly Coleman, ext. 726 EMSA worked with the Governor's Office of Emergency Services (Cal OES) to develop the Northern California Catastrophic Flood Response Plan. EMSA worked closely with the California Department of Public Health to develop a Public Health and Medical Information Analysis Brief. The Plan is posted on the Cal OES website. There have been no Plan activities in 2020 due to the COVID response. EMSA will continue to socialize the Plan in 2021.

Emergency Medical Services Authority Office of Health Information Exchange (OHIE)


1

Activity & Description Primary Contact EMSA (916) 322-4336 Updates

HITEMS Grant Leslie Witten-Rood On July 1, 2018, EMSA was awarded Federal funding through an Interagency Agreement with the California Department of Public Health (CDPH) for the development of health information exchange and interoperability for +EMS SAFR and PULSE. EMSA was awarded up to $36 million in federal funding, which requires $4 million in the Non-Federal match. On February 27, 2020, EMSA was awarded additional matching funds for $1.5 million from CARESTAR Foundation on February 27, 2020. This brings EMSA matching fund total to $3,665,000 million enabling EMSA to draw down $33 million of federal funding, which provides EMSA expenditure authority for $36,665,000 for the HITEMS Project to be spent by September 30, 2021. Matching Fund Source:

• CARESTAR Foundation $2.5 million • EMSA General Fund $1 million • San Mateo County Special Funds $100,000.00 • Santa Cruz County Special Funds $40,000.00 • California Health Care Foundation (CHCF) $25,000

+EMS SAFR Leslie Witten-Rood There are five (5) +EMS Awardees who have been granted a total of $14 million and will conclude their contract 9/30/2021. All Awardees are on target to complete their contracts on time. OHIE is working with Awardees to ensure milestone completion, data collection, invoicing, and final reporting criteria are met.



2


PULSE Leslie Witten-Rood In March of 2020, EMSA deployed the Office of Health Information Exchange (OHIE) PULSE Team to train CAL-MAT medical staff deployed at multiple Field Medical Stations in California. The OHIE staff traveled to Riverside, Imperial, San Mateo, Tulare, Orange, and Sacramento Counties, where EMSA Medical Teams CAL-MAT and Health Corps were treating COVID Patients. HIE staff created innovative solutions to train medical staff on PULSE while ensuring social distancing and other safety measures were used. A just-in-time training was designed and posted on the EMSA website so that medical providers could have access to the training and user guide 24/7. The training was also conducted for providers virtually by the HIE Staff. EMSA has trained an additional 250 medical providers in person on PULSE during the COVID-19 pandemic. EMSA deployed PULSE on August 9, 2020, in response to the California Wildfires. PULSE was deployed at one medical shelter staffed by CAL-MAT in Santa Cruz County at the Watsonville Fairgrounds. During the deployment, OHIE Team was asked to train CAL-MAT Teams supporting the firebase camps on the PULSE system. Onsite training was conducted at three fire camps — Monterey County in Salinas, Santa Cruz County in Scotts Valley, and in Santa Clara County at the Pleasanton Fairgrounds. The fire camps supported by EMSA provide care for firefighters working the fires in our state. PULSE was instrumental in delivering our CAL-MAT teams with past medical histories of the firefighters who were receiving medical care from CAL-MAT teams. PULSE was instrumental in providing history on the patients’ medication and allergies that were essential in treating multiple cases of severe poison oak exposure that many firefighters were struggling with. During this 2-day deployment, the OHIE team trained an additional 30 medical providers on PULSE.



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POLST Leslie Witten-Rood EMSA awarded all applicants who request funding to add a POLST Alert and POLST Registry connection to a +EMS SAFR System. The following received awards: Manifest Medex ($278,240.00), San Diego Health Connect ($379,300.00), and San Mateo County ($189,150.00).

MES Leslie Witten-Rood In July 2021 the Office of Health Information Exchange submitted their application to the Medicaid Enterprise Systems (MES) to obtain sustainability funds for the +EMS SAFR sites.

Emergency Medical Services Authority

EMS Personnel Division

Major Program Activities

September 22, 2021 – Item #3A

1

Activity & Description Primary Contact

EMSA (916) 322-9875 Updates

1. First Aid Practices for

School Bus Drivers

Joseph Bejarano

• EMSA currently has nine (9) approved School Bus Driver training

programs.

• EMSA approved one (1) program this quarter.

• EMSA currently has zero (0) programs under review.

• EMSA currently has zero (0) new programs under review.

• EMSA continues to provide technical assistance to school

staff, school bus drivers, the CHP, and the California

Department of Education.

2. Child Care Provider First

Aid/CPR Training Programs

Joseph Bejarano • EMSA currently has sixteen (16) approved First Aid/CPR programs.

• EMSA approved three (3) programs this quarter

• EMSA is currently reviewing one (1) renewal program.

• EMSA is currently reviewing one (1) new program.

• EMSA continues to provide technical assistance to

training program instructors and directors, licensing staff,

childcare providers, and other training entities. • Course completion sticker sales are ongoing.

• In response to COVID-19, EMSA is allowing programs to provide

the lecture portions of the training through a virtual classroom

setting that has real-time interactions with the instructor.

3. Child Care Preventive

Health Training Programs

Lucy Chaidez • EMSA currently has forty-one (41) approved Preventive

Health and Safety Practices training programs.

• EMSA approved four (4) programs this quarter. • EMSA is currently reviewing one (1) renewal program.

• EMSA is currently reviewing four (4) new programs.

• EMSA continues to sell course completion stickers.

• EMSA continues to provide technical assistance to the public and





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the Department of Social Services Community Care Licensing,

California Department of Public Health, and California

Department of Education.

4. Child Care Training

Provider Quality

Improvement/Enforcement

Lucy Chaidez • EMSA continues to revise Chapter 1.1.

• EMSA has no complaint cases involving EMSA-approved training

programs at this time.

5. Automated External

Defibrillator (AED)

Requirements for EMT’s,

Public Safety and

Layperson

Joseph Bejarano • EMSA currently has seven (7) approved public safety AED

programs.

• EMSA currently has three (3) approved EMT AED services provider

programs.

• EMSA provides ongoing technical support and clarification to

public safety agencies, LEMSAs, and the general public

regarding AED statutes and regulations.

6. BLS Training and

Certification Issues

Joseph Bejarano • EMSA continues to support and provide technical assistance to

EMTs, AEMTs, EMS applicants, and 68 certifying entities on

topics including but not limited to:

• EMT, AEMT, and central registry regulations.

• EMT enforcement processes.

• Training program approvals.

• EMR vs public safety clarifications.





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7. State Public Safety Program

Monitoring

Joseph Bejarano • EMSA currently has four (4) approved public safety, first aid & CPR

training programs.

• EMSA currently has two (2) approved EMT training programs.

• EMSA currently has two (2) approved EMT refresher training

programs.

• EMSA currently has five (5) approved continuing education

provider programs.

• EMSA provides ongoing review, approval, and monitoring of

EMSA-approved Public Safety First Aid/CPR, EMR, EMT, and

continuing education (CE) programs for statutory and

regulatory compliance.

• EMSA provides ongoing support and technical assistance to the

LEMSAs and all statewide public safety agencies.

8. My License Office/ EMT

Central Registry Audit

Brad Beltram • EMSA monitors the EMT Central Registry to verify that the 68

certifying entities are in compliance with the California Code

of Regulations regarding: • Data entry requirements.

• Correct certification processes.

• EMSA continues to provide ongoing support and technical assistance to certifying entities on the Central Registry and

application of regulations.

• In response to COVID-19, EMSA has released a number of

policies addressing the Governor’s Executive Orders.

These policies:

• Guide the continued training and certifications of all

levels of EMS personnel.

• Are located on EMSA’s COVID-19 webpage.





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9. AB 2293: EMT/AEMT

Demographic and Criminal

History Data Collection and

Reporting

Brad Beltram • Reporting for calendar year 2020 (which was due 7/1/2021)

has been collected from 60 of the 68 agencies.

• Reminders have been sent out to the agencies who have yet

to report.

• Currently compiling and reconciling all data in preparation for

final report.

• Will begin finalizing report once all agencies have reported.

10. Epinephrine Auto-injector

Certification

Jeffrey Hayes • EMSA processed and issued forty-four (44) applications for

epinephrine certification.

• EMSA continues to provide technical assistance to the general

public interested in certification.

11. Epinephrine Auto-injector

Training

Joseph Bejarano • EMSA currently has sixteen (16) approved training programs.

• EMSA currently has one (1) program under review.

• Zero (0) programs were approved this quarter.

• EMSA approved seventeen (17) training programs.

• EMSA continues to provide technical assistance, renew training

program certifications, and monitor training programs to ensure

regulatory compliance.

12. Hemostatic Dressings Lucy Chaidez • EMSA currently has three (3) approved hemostatic

dressings for use in the prehospital setting.





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13. Paramedic Licensure Nicole Mixon EMSA is responsible for receiving, processing, and auditing

paramedic license applications for approval in compliance with

the California Code of Regulations. During the past three (3)

months, EMSA has approved the following:

• 228 Initial In-State applications, • 13 Initial Out-of-State applications,

• 1,829 Renewal applications,

• 65 Reinstatement applications.

• EMSA received sixty-five (65)% of the applications

through the

online licensing system.

As of 06/30/21, all paramedics with active-restricted licenses due

to an inability to pass the NREMT exam(s) during the pandemic

have either passed their exams and received a standard 2-year

license or their license was deemed inactive.

14. Dept. of Child Support

Services (DCSS) System

Nicole Mixon DCSS resumed utilization of its State License Match System (SLMS)

for reporting and requesting EMSA licensure action against

licensees in arrears for child support.

Emergency Medical Services Authority EMS Systems Division


1


Updates

Grant Activity/Coordination/ Maddy EMS Fund Report

Lori O’Brien Ext. 3679

Summary of Activity • HRSA Grant: Annual Non-competing Continuation Performance

Report is currently in progress and will be submitted by August 20, 2021.

• Preventive Health and Health Services Block Grant (PHHSBG): The FFY 2020 Annual Reports were completed by staff, edited by the Grants Coordinator, and submitted to CDPH on July 7, 2021. The Memorandum of Understanding for the FFY 2021 PHHSBG was received and signed by Dr. Duncan and returned to CDPH on July 30, 2021. EMSA’s allocation this year is $2,727,396. Staff is currently working on the objectives and activities outlined in the FFY 2021 State Plan, and EMSA is up to date on all reporting and deliverables.

• Maddy EMS Fund Reporting: The Maddy EMS Fund Statewide Summary FY 2018-2019 was completed, approved by Agency, and submitted to the appropriate policy and fiscal committees of the State Legislature on August 10, 2021. Analysis and data review and consolidation for the FY 2019-20 report is on-going and is anticipated to be completed by the end of August 2021. The current template provided to counties for reporting is being streamlined, reevaluated for conformity to statute, and updated for ADA compliance with the goal of using it for FY 2020-21 reporting.



2


Updates

California Poison Control System

Lisa Galindo ext. 423

Contract

The EMS Authority has fully executed an agreement (contract) with the University of California Regents on behalf of University of California, San Francisco for the administration of the California Poison Control System. On June 18, 2021, the California Department of General Services approved the agreement. The EMS Authority has awarded $13.885 million for the period of July 1,2021 through June 30, 2022.

EMS Plans Lisa Galindo, ext. 423 EMS Plan Review

EMSA continues to review EMS Plans as they are submitted by LEMSA’s. Thus far in 2021, six local EMS plans have been submitted and three EMS plan approvals have been issued. Due to the ongoing COVID-19 pandemic significant response efforts, LEMSAs have been granted a 180-day extension upon the cessation of the declaration of emergency for the submission of their annual EMS Plan. Technical Assistance

Technical assistance is provided to LEMSAs, as needed, on the EMS Plan development and submission process. Contract

State General Fund is provided to assist six multi county LEMSAs in the planning, organizing, implementation, and maintenance of their EMS



3


Updates

systems. Updated contracts for July 1, 2021, through June 30, 2022, are currently in development. Quarterly Report

Quarterly reports are a deliverable in the multicounty contract for local assistance funding. These reports consist of a detailed description of work performed, the duties of all parties, and a summary of activities that have been accomplished during the quarter relevant to the eight EMS system components identified in Health and Safety Code 1797.103. The 4th quarter reports, end of the year, are currently under review.

Quality Improvement Michelle McEuen, ext. 1925

Core Quality Measures • The EMS Core Quality Measures Instruction Manual (EMSA

Publication SYS 100-04) for 2020 data was published to EMSA’s website on July 7, 2021. A memo with a copy of the manual and reporting instructions were sent to the LEMSA directors and administrators. The deadline for reporting Core Quality Measures (CQM) 2020 data was September 10, 2021. EMSA is developing the Annual Core Quality Measures Report to present CY 2020 data.

• EMSA created CQM CEMSIS reports for quarter 1 (January 1 – March 31) and quarter 2 (April 1 – June 30) of the 2021 calendar year. The reports were shared with each LEMSA and can be used as a tool by the LEMSA to identify reporting gaps related to elements used in reporting CQM information. The reports can also be used by LEMSAs as a tool to engage stakeholders and ensure appropriate representation



4


Updates

in EMS performance measurement and quality improvement. EMSA will run CQM reports in CEMSIS, extract data, perform analysis and populate a report for each LEMSA on a quarterly basis going forward. The report is currently pending approval.

Quality Improvement Programs • Sacramento County EMS Agency submitted their Quality

Improvement Program (QIP) on October 13, 2020. The program provided updates on efforts to improve documentation standards and accuracy of data submissions; the implementation of dashboards to report on three focused elements; and improved tracking and comparisons of APOT data. The QIP was approved on May 14, 2021.

EMS for Children Farid Nasr, ext. 424 Elizabeth Winward, ext. 460

EMS for Children (EMSC) Plan Submission

EMSA continues to provide technical assistance to LEMSAs requesting assistance regarding their EMSC program. EMSC plan submissions continue despite the provided extension. EMSA reviews each plan for compliance with statute and regulations. EMSA encourages LEMSAs who have had their initial Specialty Care System plan approved to submit subsequent annual EMSC Plans as part of their EMS Plan.



5


Updates

Educational Forum

Following a successful 2020 virtual EMSC Educational Forum, EMSA has decided to continue the virtual platform. The next event is tentatively scheduled for November 4, 2021, on Zoom. Additionally, EMSA is also planning smaller virtual trainings throughout the year. EMSC Surveys

The National Pediatric Readiness Project (NPRP) Assessment launched the week of May 3,2021. The assessment deadline was extended to August 31, 2021. Due to an attempted security breach on August 6th, the NPRP Project Office transitioned the assessment submission from online to paper submissions only. Submissions received as of August 6th show 259 of 332 hospitals have completed the assessment. A final number for participating hospitals will be provided to EMSA by October 1, 2021.

Trauma Elizabeth Winward, ext. 460

State Trauma Advisory Committee (STAC)

The State Trauma Advisory Committee is scheduled to meet through video conferencing on September 15, 2021. STAC members provided updates on regional trauma systems and provided direction to the Emergency Medical Services Authority (EMSA) on potential regulation. STAC members provided guidance for moderators to the 2021 Virtual Trauma Summit. The next STAC meeting is being scheduled for January 2022.



6


Updates

2021 Trauma Summit

On October 6, 2021, EMSA will host the Trauma Summit through Zoom Webinar. Admission is free and the event is expected to be at full capacity of 500 attendees. EMSA is working with Reach Air to provide continuing education/continuing medical education. Panel presentations are offered with topics focusing low acuity brain injuries, geriatric trauma patient care, and optimizing re-triage/associated challenges. Annual Trauma Plan Status Updates

Due to the ongoing COVID-19 emergency response, many Local Emergency Medical Services Agencies LEMSAs are overdue for submission of trauma plan status updates. LEMSAs are beginning to submit plan status updates in alignment with their annual EMS Plan submissions. Trauma Regulations

The Trauma Regulations Workgroup met via Zoom on June 28, 2021and September 2, 2021. EMSA will continue to hold meetings every 6-8 weeks with workgroup members until each section has been reviewed. Regional Trauma Coordinating Committees (RTCC)

Each Regional Trauma Coordinating Committee is meeting quarterly via virtual platforms. In-person meetings have been put on hold due to the



7


Updates

Delta variant surg in Covid cases. RTCC representative provides regional activity updates at each STAC meeting, and STAC members provide guidance on any issues that arise.

Specialty Care Systems

(STEMI & Stroke)

Farid Nasr Ext. 424

ST Elevation Myocardial Infarction (STEMI) and Stroke Programs

EMSA continues to provide technical assistance to LEMSAs requesting assistance regarding their STEMI and Stroke Systems. STEMI and Stroke plans continue to come in despite the provided extension. EMSA reviews each plan for compliance with statute and regulations. EMSA encourages LEMSAs who have had their initial Specialty Care System plan approved to submit subsequent annual STEMI and Stroke Plans as part of their EMS Plan.

STEMI & Stroke Summit

With American Heart/Stroke Association’s (AHA) collaboration, EMSA successfully conducted the first State Stroke Summit virtually on June 8, 2021, with over 900 registrants and the first State STEMI Summit on June 9, 2021, with over 700 registrants. Some of the education provided included current trends for optimal care, newest technology, and best practices on both aspects of clinical and system management of care for STEMI and Stroke patients. Working with the AHA, 3.25 hours of Continuing Education (CE) credits for Physician, Physician Assistant, Nurse Practitioner, Nurses, and EMS personnel were provided each day of the summit.



8


Updates

Ambulance Patient Offload Time (APOT)

Adam Davis, ext. 409 In July 2019, EMSA notified all LEMSAs of the new APOT reporting requirements pursuant to Health and Safety Code Section 1797.225. EMSA received APOT 1 and APOT 2 submissions from 32 of 33 LEMSAs, and one LEMSA failed to provide any submissions. Twenty nine of 33 LEMSAs provided a submission for quarter four of 2019. As anticipated, COVID-19 has significantly impacted APOT reporting for quarter one and two of 2020. To date, only 26 LEMSAs provided a submission for quarter one of 2020. 27 LEMSAs have provided a submission for quarter two of 2020. Only 26 LEMSAs have provided a submission for quarter three of 2020. 22 LEMSAs have provided a submission for quarter four of 2020. As of August 12, 2021, 25 LEMSAs provided submissions for quarter one of 2021 while only 18 LEMSA have provided a submission for quarter 2 of 2021. EMSA staff continue to monitor the impact of COVID-19 on local EMS systems through analysis of CEMSIS data related to APOT.

Pursuant to Health and Safety Code Section 1797.123, EMSA has fulfilled both statutory requirements to report bi-yearly to the EMS Commission and submit a legislative report on or before December 1, 2020. The Ambulance Patient Offload Delays legislative report is the product of a year-long collaborative effort by EMSA and LEMSAs to understand factors impacting APOT and to develop recommendations on how best to decrease delays statewide. The legislative report is currently published on the EMSA website.

Beginning in December 2020, EMSA developed and distributed APOT CEMSIS comparison reports for all LEMSA who are participating in CEMSIS



9


Updates

and have also provided at least one quarterly APOT submission. Based on the approved APOT specifications, EMSA staff extracted APOT information from CEMSIS to compare the count of offloads and 90th percentile times for all hospitals reported by each LEMSA. In total, 31 comparison reports were distributed to LEMSA administrators in the initial roll out covering Quarter 3 of 2019 through Quarter 3 of 2020. 15 LEMSA were provided with an APOT CEMSIS comparison report for Quarter 4 of 2020. 20 LEMSA were provided with an APOT CEMSIS comparison report for Quarter 1 of 2021, distributed in June of this year. LEMSAs are responsible for reaching out to EMSA with any questions or concerns they have regarding their APOT representation in CEMSIS. To date, EMSA has provided multiple LEMSAs with technical assistance regarding their CEMSIS representation and continues to work with LEMSAs through any APOT related data issues.

EMSA continues to produce quarterly comparisons for participating LEMSA and will develop reports for any retrospective APOT submissions received. EMSA staff has consolidated LEMSA APOT submissions and has developed a report which is part of the Commission packet. This information covers submissions between April 2020 and March 2021.

EMS Transportation Laura Little, ext. 412 Competitive Processes for Ambulance Zones

The following LEMSAs submitted competitive processes for review since the last Emergency Medical Services (EMS) Commission meeting: Coastal Valleys EMS (Sonoma County), San Diego County (CSA 17). This is consistent with Health & Safety Code Section 1797.224, which states



10


Updates

competitive processes for Exclusive Operating Areas go through a state review process to ensure they meet Federal and Statutory requirements. EMS Plan Review

EMS response and transportation data is submitted with each LEMSA’s EMS plan. When EMS plans are submitted, the transportation data is compared with data submitted from prior years. Since the last EMS Commission meeting, San Francisco City/ County EMS, Sacramento County EMS, and Kern County EMS submitted EMS response and transportation data via the transportation component of the EMS Plan.

No further EMS Plan Appeals have been received since the last EMS Commission meeting. EMSA intends to continue to review previous EMS Plan submissions and correspondence, conduct public records requests, review historical documentation to map out issues under appeal, and attend appeal hearings for support, when appeals are submitted. Technical Assistance

The EMS Transportation Coordinator continues to handle all calls and queries related to competitive processes, statutes, regulations, operating areas (exclusive and non-exclusive), prehospital aeromedical vehicles, and EMS transportation.

CEMSIS data matching and validation

Victoria Lupinetti 916-837-9345

EMSA is attempting to increase the patient match rate for records in California EMS Information System (CEMSIS) and the ImageTrend Patient



11


Updates

Registry by validating and reviewing the records for accuracy and completeness.

EMSA completed and submitted another report focused on matching EMS data to trauma data for the first half of 2019 (January 1 to June 30) for Riverside Community Hospital. The successful match rate is roughly 64%. The report of the findings is currently in review.

Currently, EMSA is working on matching EMS and patient trauma records related specifically to falls. This specificity in injury may lead to a better understanding of the data being collected and may garner a higher match rate.

EMSA is also attempting to link EMS patient records from data platforms (i.e. Statewide Integrated Traffic Records System, Office of Traffic Safety, Biospatial), which will add robust data to the analyses. EMSA is in the process of obtaining licenses for ArcGIS software, which will aid in analyzing geospatial EMS and various health-related data on a deeper level. Reports

In June and July 2021, San Francisco and Sacramento counties submitted their EMS plan updates for FY 2020-2021, and both are compliant in data collection requirements. Kern County also submitted their EMS plan for 2021-2022 and followed all data-related statutes and regulations.



12


Updates

Weekly trend reports related to statewide COVID-19 respiratory symptoms are currently being conducted through the CEMSIS database. Concurrently, monthly reports on other primary symptoms such as shortness of breath, chills, fever, fatigue, cough, etc. are being conducted. Additional reports on the success of EMS and trauma patient record matching is continuing, but progress is impacted by COVID-19 activities.

CEMSIS Trauma Elizabeth Winward, ext. 460

There are 27 LEMSAs with designated trauma centers. The 6 LEMSAs without trauma centers have agreements with trauma centers in neighboring jurisdictions to provide care to those critically injured within their boundaries. Trauma Centers are physically located in 38 of the 58 counties. One LEMSA is not transmitting data in any form to CEMSIS.

Approximately 95% of 2020 trauma data have been submitted by 31of 33 LEMSAs. For 2021, Q1, 18 of 33 LEMSAs have submitted trauma data. EMSA staff are providing technical assistance to any LEMSA experiencing difficulties with data submissions.

CEMSIS EMS Data Ashley Stewart, ext. 0910 As of August 2021, CEMSIS has received 3.7 million records for 2018, over four million records for 2019, almost four million records for 2020, and has received close to 2.6 million records for 2021 in Version 3.4. Once the final LEMSA onboards and all 911 EMS providers submit data, CEMSIS will have approximately 6 million records each year.



13


Updates

Reports The CY 2020 EMS Data report is expected to begin development in October 2021, and the CY 2018/19 Trauma Report is currently in development.

Support Staff John Skarr Support Personnel in Licensure 1. Send approval letters & license cards to paramedics and EMT’s 2. Send deficiency letters to individuals who need further

documentation for approval in the State of California

Support Management in communications with LEMSAs 1. Scribe meetings as necessary 2. Take notes on actionable information

SharePoint

1. Organize EMS Systems SharePoint site 2. Administer permissions as needed 3. Upload and manage documents for use by staff

Support Management

1. Daily calendaring, scheduling, and documentation 2. Provide support on communications with LEMSA’s 3. Compile and submit staff timesheets 4. Work directly with managers in completing tasks effectively and

efficiently



14


Updates

APOT Workgroup 1. Locate contact information for each participant in preparation of

workgroup launch 2. Provide management with updated information on workgroup

participants EMS Systems Support

1. Build LEMSA EMS Plan folders as needed 2. Organize materials and provide documents for use by Systems

staff within EMS Plans

Systems Tracking Tools 1. Updating and maintaining of database 2. Updating tasks and projects as new information on each become

available Supported all Systems staff as needed daily.




QUARTERLY MEETING MEETING DATE: September 22, 2021 ITEM NUMBER: 3B SUBJECT: Vaccination Administration Update

PRESENTER: Dave Duncan, Director CONSENT: ___ ACTION: ___ INFORMATION: _X_

FISCAL IMPACT None. SUMMARY Dr. Dave Duncan to provide an update on vaccine administration in California.




QUARTERLY MEETING MEETING DATE: September 22, 2021 ITEM NUMBER: 4A SUBJECT: Administrative and Personnel Report

PRESENTER: Rick Trussell, Chief, Fiscal and Administration Unit CONSENT: _X_ ACTION: ___ INFORMATION: ___

FISCAL IMPACT None. DISCUSSION Emergency Medical Services Authority (EMSA) Budget: 2021-22 The 2021-22 California State Budget includes expenditure authority in the amount of $85.1 million. Of this amount, $65.4 million or 76.9% is delegated for State operations and $19.7 million or 23.1% is delegated to local assistance. Accounting data for the new fiscal year is not yet available and we are continuing to monitor and adjust both State operations and local assistance budgets to meet changing program priorities. An updated report will be distributed prior to the next Commission meeting. 2020-21 The 2020-21 California State budget includes expenditure authority in the amount of $108.8 million and 79 permanent positions. Of this amount, $89.5 million is delegated for State operations and $19.3 million to local assistance. State operations funding was increased $73 million to provide critical Statewide emergency medical staffing and support during the Covid-19 pandemic.

Commission on Emergency Medical Services September 22, 2021 Item #4A Page 2 As of August 30, 2021, accounting records indicate that the Department has expended and/or encumbered $88.9 million or 81.8% of available expenditure authority. Of this amount, $75.8 million or 84.7% of State Operations expenditure authority has been expended and/or encumbered and $13.1 million or 79% of local assistance expenditure authority has been expended and/or encumbered. We are continuing to monitor and adjust both State operations and local assistance budgets to meet changing program priorities. An updated report will be distributed prior to the next Commission meeting. EMSA Staffing Levels: The Department staffing level includes 109 permanent positions and 22 temporary (blanket and retired annuitant) positions. Of the 131 positions, 45 positions are vacant as of August 30, 2021. Most of the currently vacant positions are new positions approved through the budget process with an effective date of July 1, 2021.

Division

Admin/Exec DMS EMSP EMS Total Authorized 34.0 37.0 24.0 14.0 109.0 Temporary Staff 17.0 3.0 0.0 2.0 22.0 Staffing Level 51.0 40.0 24.0 16.0 131.0 Authorized (Vacant) -13.0 -18.0 -9.0 -2.0 -42.0 Temporary (Vacant) -3.0 0.0 0.0 0.0 -3.0 Current Staffing Level 35.0 22.0 15.0 14.0 86.0

Additionally, EMSA through the emergency hiring process has hired and deployed approximately 1,562 California Health Corps and California Medical Assistance Team (CAL-MAT) members to assist with California’s COVID-19 response activities since March 9, 2020. These emergency hires have been deployed to field medical sites, alternate care sites, skilled nursing facilities, hospitals, and other locations throughout the State to provide both medical and logistical support.


EMERGENCY MEDICAL SERVICES AUTHORITY10901 GOLD CENTER DR., SUITE 400RANCHO CORDOVA, CA 95670(916) 322-4336 FAX (916) 324-2875


QUARTERLY MEETING

MEETING DATE: September 22, 2021 ITEM NUMBER: 4B

SUBJECT: Legal Report

PRESENTER: Steven A. McGee, Counsel CONSENT: _X_ ACTION: ___ INFORMATION: ___

FISCAL IMPACT

None

DISCUSSION

*NOTE: Due to the Covid-19 pandemic, the Office of Administrative Hearings and most courts in the state are conducting hearings only remotely through services such as Zoom, Microsoft Teams, etc. Disciplinary Cases:

From May 14, 2021, to August 12, 2021, the Authority issued thirteen new accusations against existing paramedic licenses, four statements of issues, two administrative fines, accepted three license surrenders in lieu of legal action, issued one temporary suspension order, and issued seven decisions on petitions for reduction of penalties and license reinstatements. Of the newly issued actions, one of the Respondents has requested that an administrative hearing be set. There are currently six hearings scheduled with the Office of Administrative Hearings. There are currently nineteen open active disciplinary cases in the legal office. Litigation:

Tagliere v. Backer: Los Angeles County Superior Court #BS1707101, Writ of Administrative Mandamus. Plaintiff filed a writ seeking to overturn the

Commission on Emergency Medical Services June 16, 2021 Item #4B Page 2 revocation of his license subsequent to an administrative hearing. A hearing was held at OAH on July 7, 2021. Closing briefs are due August 25, 2021. Contra Costa County EMS v. EMSA: The Authority is currently working to determine hearing dates and request a hearing through OAH for the appeal of a denial of a local EMS plan. Inland Counties Emergency Medical Agency v. EMSA: The Authority denied approval of ICEMA’s annual EMS plan submission because it did not comply with the regulation requiring an ALS agreement with all providers. ICEMA corrected the EMS plan submission and the matter was closed and taken off calendar. Gurrola v. Duncan: United States District Court, Eastern District, 2:20-CV-01238-JAM-DMC Plaintiff sued for a violation of his constitutional rights, alleging a violation for being precluded under the regulations from receiving an EMT certificate due to two felony convictions. The complaint was amended to add another individual with similar claims. On February 10, 2021 the Court granted the Authority’s motion to dismiss the complaint and found that the regulations barring certification to someone with two felony convictions are rationally related to the State’s interest in protecting the public’s health and safety. Gurrola appealed that dismissal and the court re-instated the suit. Briefing schedule to be set by the court. Waters v. EMSA: Sonoma County Superior Court #SCV-268267, Writ of Administrative Mandamus. Plaintiff filed a writ seeking to overturn the revocation of her license subsequent to her violation of a “last chance” agreement for testing positive on a random drug/alcohol test. Case management conference set for September 14, 2021.


EMERGENCY MEDICAL SERVICES AUTHORITY10901 GOLD CENTER DRIVE, SUITE 400RANCHO CORDOVA, CA 95670(916) 322-4336 FAX (916) 324-2875

COMMISSION ON EMERGENCY MEDICAL SERVICESQUARTERLY MEETING

MEETING DATE: September 22, 2021 ITEM NUMBER: 4C

SUBJECT: Enforcement Report

PRESENTER: Alexander Bourdaniotis, Chief Investigator

CONSENT: _X_ ACTION: ___ INFORMATION: ___

______________________________________________________________________________

RECOMMENDATION

Receive information on Enforcement Unit activities.

FISCAL IMPACT

None

BACKGROUND

Unit Staffing:

The Enforcement Unit is budgeted for five full-time Special Investigators, and onefull-time Associate Government Program Analyst (AGPA-Probation Monitor). Two Special Investigators retired, and one Special Investigator accepted a promotion with another state agency. In July, two Special Investigator positions were filled. The AGPA-Probation Monitor accepted a promotion to Special Investigator. Currently, there are active recruitments to fill one Special Investigator and AGPA position. Investigative Workload:

The following is a summary of currently available data extracted from the paramedic database:

Cases opened since January 1, 2021, including:

Commission on Emergency Medical Services September 22, 2021 Item #4C Page 2 Cases opened: 200 Cases completed and/or closed: 183 EMT-Paramedics on Probation: 240 In 2020: Cases opened: 297 Cases completed and/or closed: 292 EMT-Paramedics on Probation: 226 Status of Current Cases: The Enforcement Unit currently has 144 cases in “open” status, from 2018 to present. As of August 1, 2021, there are 57 cases that have been in “open” status for 180 days or longer, including: six Firefighters’ Bill of Rights (FFBOR) cases and 16 cases waiting for California Society of Addiction Medicine (CSAM) evaluations. Respondents are directed to a physician who specializes in addiction medicine for an examination/review in cases involving alcohol or other substance abuse. Those 57 cases are divided among four special investigators and are in various stages of the investigative process. These stages include awaiting documents, preparing for and/or setting up interviews, report writing and corrections to be made, awaiting action by local law enforcement jurisdictions, the courts, etc. Delays in the interview process are common due to unforeseen difficulties in obtaining certified copies of documents, court records, availability of witnesses and/or the subject(s) of an investigation due to medical action/disability issues, on-going investigations for FFBOR staff or on-going criminal investigations, court actions, strike team responses, plus the routine requirement for two or more follow-up interviews.




QUARTERLY MEETING MEETING DATE: September 22, 2021 ITEM NUMBER: 5A SUBJECT: Legislative Report

PRESENTER: Sergy (Esam) El-Morshedy Legislative & External Affairs Manager CONSENT: ___ ACTION: ___ INFORMATION: _X_

RECOMMENDATION Receive information regarding current bills potentially affecting EMS. FISCAL IMPACT None. DISCUSSION Due to the dynamic nature of the legislative process, the Legislative Report to the Commission on EMS will be posted on the EMSA website at https://emsa.ca.gov/legislative_activity/.

https://emsa.ca.gov/legislative_activity/




QUARTERLY MEETING MEETING DATE: September 22, 2021 ITEM NUMBER: 5B SUBJECT: Regulations Update and Approval of Emergency Regulations

PRESENTER: Kent Gray Regulations Manager CONSENT: ___ ACTION: _X_ INFORMATION: _X_

FISCAL IMPACT None. DISCUSSION The following information is an update to the Emergency Medical Services Authority (EMSA) rulemaking. In accordance with California Health and Safety Code § 1797.107, the EMSA is promulgating the following regulations: Community Paramedicine and Alternate Destination (Ch. 5)

Status: In development by EMSA with advisory group Purpose: Implement AB 1544 (Statutes of 2020, Chapter 138)

o The full project update will be addressed under Item 7A Trauma Care Systems (Ch. 7)

Status: Under review by EMSA Purpose: General update.

Emergency Medical Services System Regulations (Ch. 13) Status: Under review by EMSA Purpose: Regulations regarding Annual EMS Plans

Public Safety First Aid (Ch. 1.5) Status: In development by EMSA Purpose: Updates to include volunteers.

Lay Rescuer Epinephrine Auto-Injector Training Certificate Standards (Ch. 1.9)

Commission on Emergency Medical Services June 16, 2021 Item #5B Page 2

Status: Under review by EMSA Purpose: Updates, including required form.

Paramedic Fees (Ch. 4) Status: Section 100 submitted to OAL Purpose: Section 100172 fee schedule implementation.

Training Standards for Child Care Providers & Merger of Chapters 1.1 and 1.2. Status: Hold Purpose: General update.

California Emergency Medical Technician Central Registry (Ch. 10) Status: Hold Purpose: General update.

Emergency Medical Services System Quality Improvement (Ch. 12) Status: Hold Purpose: General update.

Dispatch Status: Pending Purpose: Implement SB 438 (Statutes of 2019)

Emergency Regulations regarding training. Status: Pending Purpose: Transition for State of Emergency procedures to normal

procedures ACTION Approval of Emergency Regulations: Triage to Alternate Destination

• Purpose: To enact the Triage to Alternate Destination portion of the Community Paramedicine and Alternate Destination proposed regulations as quickly as possible to address emergency issues arising from Covid-19. These will become permanent through the regular rulemaking process as part of the full package that was updated earlier in this agenda item.




QUARTERLY MEETING MEETING DATE: September 22, 2021 ITEM NUMBER: 6 SUBJECT: EMS Response to Behavioral Health Patients

PRESENTER: Atilla Uner, Chair, Commission on EMS CONSENT: ___ ACTION: ___ INFORMATION: _X_

FISCAL IMPACT None. SUMMARY Standing agenda item for the Commission on EMS to discuss the topic of EMS response to behavioral health patients. BACKGROUND A Subcommittee was formed after the March 17th, 2021 Commission on EMS Meeting, based on Commissioner recommendation to consider recommendations on the EMS response to agitated and combative patients. The Subcommittee came up with recommendations for Commission approval. The Subcommittee recommendations were discussed and voted on separately, as follows: Recommendation 1: The topic of behavioral health in EMS becomes a standing agenda item for discussion at Quarterly Commission on EMS Meetings. This is not to be part of the Consent Calendar. Action: Commissioner Barrow moved the approval of Subcommittee Recommendation 1, as presented. Commissioner Relucio seconded. Motion carried unanimously with one abstention by Commissioner Pierce.

Commission on Emergency Medical Services September 22, 2021 Item #6 Page 2 Recommendation 2: The Commission on EMS recommends the joint position paper Clinical Care and Restraint of Agitated or Combative Patients by Emergency Medical Services Practitioners1 as a guiding principle for local emergency medical services agencies (LEMSAs), from which to create (or modify) policies and procedures. Action: Commissioner Miller moved the approval of Subcommittee Recommendation 2, with peer review updates. Commissioner Snyder seconded. Motion carried unanimously with one abstention by Commissioner Pierce. Recommendation 3: The Commission requests EMSA to survey the LEMSAs regarding their current protocols and procedures for behavioral health responses. Action: Commissioner Barrow moved the approval of Subcommittee Recommendation 3, including doing a survey in December and using the table presented at the March 17th Commission on EMS Meeting as a baseline starting point for consultation with LEMSA administrators. Commissioner Hinsdale seconded. Motion carried unanimously with one abstention by Commissioner Pierce.

______________________

1 Douglas F. Kupas, Gerald C. Wydro, David K. Tan, Richard Kamin, Andrew J. Harrell IV & Alvin Wang (2021) Clinical Care and Restraint of Agitated or Combative Patients by Emergency Medical Services Practitioners, Prehospital Emergency Care, DOI: 10.1080/10903127.2021.1917736

https://doi.org/10.1080/10903127.2021.1917736

https://doi.org/10.1080/10903127.2021.1917736




QUARTERLY MEETING MEETING DATE: September 22, 2021 ITEM NUMBER: 7A SUBJECT: Community Paramedicine Pilot Project Status Update

PRESENTER: Lou Meyer, Community Paramedicine Pilot Project Manager CONSENT: ___ ACTION: ___ INFORMATION: _X_ _____________________________________________________________________________ RECOMMENDATION Receive information regarding the Community Paramedicine Pilot. FISCAL IMPACT The community paramedicine project manager and the independent evaluator funding by the California Health Care Foundation (CHCF) ended on June 30, 2021. EMSA is in the process of developing contracts for both the project manager consultant and the independent evaluator. Local pilot site providers participate with in-kind contributions and any local grants or reimbursement. BACKGROUND The community paramedicine HWPP #173 has encompassed 20 projects in 14 communities across California, testing seven different community paramedicine concepts. 14 projects are currently enrolling patients Five of the projects launched in 2015 have closed for various reasons, and one project has suspended operations. Status of Pilot Projects With the passage of Assembly Bill 1544 (Gibson), all the active Community Paramedicine Pilot Projects have transitioned to Community Paramedicine or Triage to Alternate Destination Programs, in accordance with Division 2.5 of the Health and Safety Code, commencing with Section 1800, effective January 1, 2021.

Community Paramedicine Pilot Project Status Update September 22, 2021 Item #7A Page 2 Community Paramedicine Pilot Project Concepts

Community Paramedicine Concept Lead Agency Date Implemented

Post-Discharge – Short-Term Follow-Up Alameda City EMS June 1, 2015

Post-Discharge – Short-Term Follow-Up Butte County EMS July 1, 2015*

Post-Discharge – Short-Term Follow-Up San Bernardino County and Rialto Fire Depts. August 13, 2015†

Post-Discharge – Short-Term Follow-Up UCLA Center for Prehospital Care September 1, 2015‡

Post-Discharge – Short-Term Follow-Up Medic Ambulance Solano September 15, 2015

All Post-Discharge –Follow-Up Projects Frequent EMS User Alameda City EMS July 1, 2015

Frequent EMS User City of San Diego October 12, 2015

Frequent EMS User San Francisco Fire Dept. September 12, 2018

All Frequent EMS User Projects Directly Observed Therapy for Tuberculosis Ventura County EMS June 1, 2015 Hospice Ventura County EMS August 1, 2015 Alternate Destination – Mental Health Mountain Valley –

Stanislaus EMS September 25, 2015

Alternate Destination – Mental Health Santa Clara County EMS June 6, 2018

Alternate Destination – Mental Health Central California EMS July 30, 2018

Alternate Destination – Mental Health Los Angeles Fire Dept. June 21, 2019

All Alternate Dest. – Mental Health Projects

Alternate Destination – Urgent Care UCLA Center for Prehospital Care September 8, 2015§

Alternate Destination – Urgent Care Orange County Fire Chiefs September 14, 2015||

Alternate Destination – Urgent Care Carlsbad Fire Dept. October 9, 2015||

All Alternate Dest. – Urgent Care Projects Alternate Destination – Sobering Center San Francisco Fire Dept. February 1, 2017

Alternate Destination – Sobering Center Santa Clara County EMS June 6, 2018

Alternate Destination – Sobering Center Los Angeles Fire Dept. June 21, 2019

All Alternate Dest. – Sobering Center Projects *Ceased enrolling patients on November 14, 2018. †Suspended operations on September 30, 2019, due to lack of referrals from partner hospital. ‡Ceased enrolling patients on August 31, 2017.

Community Paramedicine Pilot Project Status Update September 22, 2021 Item #7A Page 3

§Ceased enrolling patients on May 31, 2017. ||Ceased enrolling patients on November 13, 2017.

Community Paramedicine Pilot Project Enrollment

Enrolled for the First Time

Cumulative Enrolled*

Project No. Concept Jan -

21 Feb -

21 Mar -

21

CP001 Alternate Destination – Urgent Care Closed May 2017 12

CP002 Post-Discharge Closed in August 2016 154

CP003 Alternate Destination – Urgent Care Closed in November 2017 34

CP004 Post-Discharge Closed in December 2018 1,001 CP005 Tuberculosis 0 0 0 52 CP006 Hospice 0 2 0 462 CP007A Frequent EMS Users** ? ? ? 85 CP007B Post-Discharge 0 0 0 140 CP008 Post-Discharge 0 0 0 228

CP009 Alternate Destination – Urgent Care Closed in November 2017 2

CP010 Frequent EMS Users 0 5 0 70

CP012 Alternate Destination – Mental Health 4 4 5 507

CP013 Post-Discharge 0 0 0 293

CP014 Alternate Destination – Sobering Center 50 48 43 3,104

CP015A Alternate Destination – Sobering Center 0 0 0 0

CP015B Alternate Destination – Mental Health 1 2 4 115

CP018 Alternate Destination - Mental Health 4 2 4 105

CP019 Alternate Destination - Sobering Center 0 0 0 96

CP021 Frequent EMS Users 18 25 13 420

CP022 Alternate Destination – Mental Health 195 117 123 5,313

Total 272 205 192 12,193

Community Paramedicine Pilot Project Status Update September 22, 2021 Item #7A Page 4 Community Paramedicine and Triage to Alternate Destination Regulations Development In accordance with the provisions of AB 1544 the director of the Emergency Medical Services Authority established a community paramedicine and triage to alternate destination oversight advisory committee to advise the authority on the development and oversight of community paramedicine program and triage to alternate destination program specialties. The Authority is in the final stages of drafting regulations for public comment as informed by the Community Paramedicine Pilot Program and the protocols and operation of the pilot projects approved under the OSHPD Workforce Pilot Project No. 173. Following the receipt of public comments, the regulations will be submitted to the EMS Commission for approval and will establish minimum standards for the development of a community paramedicine or triage to alternate destination programs throughout the state of California.




QUARTERLY MEETING MEETING DATE: September 22, 2021 ITEM NUMBER: 7B SUBJECT: Revised Do Not Resuscitate (DNR) Forms

PRESENTER: Kim Lew, Chief Personnel Division CONSENT: ___ ACTION: _X_ INFORMATION: ___

RECOMMENDATION Review and approve the revised California Medical Association (CMA) Do Not Resuscitate (DNR) form. FISCAL IMPACT No fiscal impact. BACKGROUND On March 4, 2021, CMA, the responsible entity for developing DNR forms, notified the Emergency Medical Services Authority (EMS Authority) they were making style (logo) and contact information updates to their DNR forms. CMA requested the EMS Authority review the revised form for approval and to provide any EMS Authority specific requests for content changes. SUMMARY Upon request by the EMS Authority, CMA made the following changes to the form(s):

• Developed secondary form to meet accessibility standards pursuant to the 508 Americans with Disabilities Act (ADA)

• Replaced EMS Authority logo with current image on both the ADA compliant and standard form

• Revised form(s) to be PDF fillable

Commission on Emergency Medical Services September 22, 2021 Item #7B Page 2

• Updated the medallion contact information on both forms

Pursuant to Commission approval of the revised forms, the EMS Authority shall replace the currently used form referenced in the EMS Authority guideline #111, DNR and Other Patient-Designated Directives, with the approved forms. DISCUSSION None ATTACHMENT(S) Standard DNR Form ADA Compliant DNR Form DNR Guidelines #111, 2018

CMA PUBLICATIONS 1(800) 882-1262 www.cmanet.org

EMERGENCY MEDICAL SERVICES

PREHOSPITAL DO NOT RESUSCITATE (DNR) FORM

Purpose

The Prehospital Do Not Resuscitate (DNR) Form has been developed by the California Emergency Medical Services

Authority, in concert with the California Medical Association and emergency medical services (EMS) providers, for the

purpose of instructing EMS personnel to forgo resuscitation attempts in the event of a patient’s cardiopulmonary arrest.

Resuscitative measures to be withheld include chest compression, assisted ventilation, endotracheal intubation,

defibrillation, and cardiotonic drugs. The form does not affect the provision of other emergency medical care, including

palliative treatment for pain, dyspnea, major hemorrhage, or other medical conditions.

Applicability

This form was designed for use in prehospital settings – i.e., in a patient’s home, in a long-term care facility, during

transport to or from a health care facility, and in other locations outside acute care hospitals. However, hospitals are

encouraged to honor the form when a patient is transported to an emergency room. California law protects any health care

provider (including emergency response personnel) who honors a properly completed Prehospital Do Not Resuscitate

Form (or an approved wrist or neck medallion) from criminal prosecution, civil liability, discipline for unprofessional

conduct, administrative sanction, or any other sanction, if the provider believes in good faith that the action or decision is

consistent with the law and the provider has no knowledge that the action or decision would be inconsistent with a health

care decision that the individual signing the request would have made on his or her own behalf under like circumstances.

This form does not replace other DNR orders that may be required pursuant to a health care facility’s own policies and

procedures governing resuscitation attempts by facility personnel. Patients should be advised that their prehospital DNR

instruction may not be honored in other states or jurisdictions.

Instructions

The Prehospital Do Not Resuscitate (DNR) Form must be signed by the patient or by an appropriate surrogate

decisionmaker if the patient is unable to make or communicate informed health care decisions. The surrogate should be

the patient’s legal representative (e.g., a health care agent, a court-appointed conservator, a spouse or other family

member) if one exists. The patient’s physician must also sign the form, affirming that the patient/surrogate has given

informed consent to the DNR instruction.

The first copy of the form should be retained by the patient. The completed form (or the approved wrist or neck medallion

– see below) must be readily available to EMS personnel in order for the DNR instruction to be honored. Resuscitation

attempts may be initiated until the form (or medallion) is presented and the identity of the patient is confirmed.

The second copy of the form should be retained by the physician and made part of the patient’s permanent medical

record.

The third copy of the form may be used by the patient to order an optional wrist or neck medallion inscribed with the

words “DO NOT RESUSCITATE-EMS.” The Medic Alert Foundation (1-888-755-1448, 2323 Colorado Avenue,

Turlock, CA 95381) is an EMS Authority-approved supplier of medallions, which will be issued only upon receipt of a

properly completed Prehospital Do Not Resuscitate (DNR) Form (together with an enrollment form and the appropriate

fee). Although optional, use of a wrist or neck medallion facilitates prompt identification of a patient, avoids the problem

of lost or misplaced forms, and is strongly encouraged.

Revocation

If a decision is made to revoke the DNR instruction, the patient’s physician should be notified immediately and all copies

of the form should be destroyed, including any copies on file with the Medic Alert Foundation or other EMS Authority-

approved supplier. Medallions and associated wallet cards should also be destroyed or returned to the supplier.

Questions about implementation of the Prehospital Do Not Resuscitate (DNR) form should be directed to the local EMS

agency.

EMERGENCY MEDICAL SERVICES PREHOSPITAL DO NOT RESUSCITATE (DNR) FORM

An Advance Request to Limit the Scope of Emergency Medical Care

I, , request limited emergency care as herein described. (print patient’s name)

I understand DNR means that if my heart stops beating or if I stop breathing, no medical procedure to restart

breathing or heart functioning will be instituted.

I understand this decision will not prevent me from obtaining other emergency medical care by prehospital

emergency medical care personnel and/or medical care directed by a physician prior to my death.

I understand that I may revoke this directive at any time by destroying this form and removing any “DNR”

medallions.

I give permission for this information to be given to the prehospital emergency care personnel, doctors, nurses

or other health personnel as necessary to implement this directive.

I hereby agree to the “Do Not Resuscitate” (DNR) order.

Patient/Surrogate Signature Date

Surrogate’s Relationship to Patient

By signing this form, the surrogate acknowledges that this request to forgo resuscitative measures is consistent with the known desires of, and with

the best interest of, the individual who is the subject of this form.

I affirm that this patient/surrogate is making an informed decision and that this directive is the expressed wish

of the patient/surrogate. A copy of this form is in the patient’s permanent medical record.

In the event of cardiac or respiratory arrest, no chest compressions, assisted ventilations, intubation,

defibrillation, or cardiotonic medications are to be initiated.

Physician Signature Date

Print Name Telephone

THIS FORM WILL NOT BE ACCEPTED IF IT HAS BEEN AMENDED OR ALTERED IN ANY WAY

PREHOSPITAL DNR REQUEST FORM

Copy 1 – To be kept by patient



I,

, request limited emergency care as herein described. (print patient’s name)






medallions.
















Copy 2 – To be kept in patient’s permanent medical record



I,

, request limited emergency care as herein described. (print patient’s name)






medallions.
















Copy 3 – If authorized DNR medallion desired, submit this form with Medic Alert enrollment form to: Medic Alert Foundation, Turlock CA 95381

CMA PUBLICATIONS | (800) 882-1262 | cmadocs.org


Purpose The Prehospital Do Not Resuscitate (DNR) Form has been developed by the California Emergency Medical Services Authority, in concert with the California Medical Association and emergency medical services (EMS) providers, for the purpose of instructing EMS personnel to forgo resuscitation attempts in the event of a patient’s cardiopulmonary arrest. Resuscitative measures to be withheld include chest compression, assisted ventilation, endotracheal intubation, defibrillation, and cardiotonic drugs. The form does not affect the provision of other emergency medical care, including palliative treatment for pain, dyspnea, major hemorrhage, or other medical conditions.

Applicability This form was designed for use in prehospital settings – i.e., in a patient’s home, in a long-term care facility, during transport to or from a health care facility, and in other locations outside acute care hospitals. However, hospitals are encouraged to honor the form when a patient is transported to an emergency room. California law protects any health care provider (including emergency response personnel) who honors a properly completed Prehospital Do Not Resuscitate Form (or an approved wrist or neck medallion) from criminal prosecution, civil liability, discipline for unprofessional conduct, administrative sanction, or any other sanction, if the provider believes in good faith that the action or decision is consistent with the law and the provider has no knowledge that the action or decision would be inconsistent with a health care decision that the individual signing the request would have made on his or her own behalf under like circumstances. This form does not replace other DNR orders that may be required pursuant to a health care facility’s own policies and procedures governing resuscitation attempts by facility personnel. Patients should be advised that their prehospital DNR instruction may not be honored in other states or jurisdictions.

Instructions The Prehospital Do Not Resuscitate (DNR) Form must be signed by the patient or by an appropriate surrogate decisionmaker if the patient is unable to make or communicate informed health care decisions. The surrogate should be the patient’s legal representative (e.g., a health care agent, a court-appointed conservator, a spouse or other family member) if one exists. The patient’s physician must also sign the form, affirming that the patient/surrogate has given informed consent to the DNR instruction.

The first copy of the form should be retained by the patient. The completed form (or the approved wrist or neck medallion – see below) must be readily available to EMS personnel in order for the DNR instruction to be honored. Resuscitation attempts may be initiated until the form (or medallion) is presented and the identity of the patient is confirmed.

The second copy of the form should be retained by the physician and made part of the patient’s permanent medical record.

The third copy of the form may be used by the patient to order an optional wrist or neck medallion inscribed with the words “DO NOT RESUSCITATE-EMS.” The Caring Advocates (800-647-3223, 45 Bulkley Ave. #4 Sausalito, CA 94965), MedicAlert Foundation (1-800-432-5378, 101 Lander Avenue, Turlock, CA 95380), and Sticky Jewelry, Inc. (866-497-6265, 10801 Endeavor Way Unit B Seminole, FL 33777) are EMS Authority-approved suppliers of medallions, which will be issued only upon receipt of a properly completed Prehospital Do Not Resuscitate (DNR) Form (together with an enrollment form and the appropriate fee). Although optional, use of a wrist or neck medallion facilitates prompt identification of a patient, avoids the problem of lost or misplaced forms, and is strongly encouraged.

Revocation If a decision is made to revoke the DNR instruction, the patient’s physician should be notified immediately and all copies of the form should be destroyed, including any copies on file with the MedicAlert Foundation or other EMS Authority-approved supplier. Medallions and associated wallet cards should also be destroyed or returned to the supplier.

Questions about implementation of the Prehospital Do Not Resuscitate (DNR) form should be directed to the local EMS agency.



, request limited emergency care as herein described.

I understand DNR means that if my heart stops beating or if I stop breathing, no medical procedure to restart breathing or heart functioning will be instituted. I understand this decision will not prevent me from obtaining other emergency medical care by prehospital emergency medical care personnel and/or medical care directed by a physician prior to my death. I understand that I may revoke this directive at any time by destroying this form and removing any “DNR” medallions. I give permission for this information to be given to the prehospital emergency care personnel, doctors, nurses or other health personnel as necessary to implement this directive. I hereby agree to the “Do Not Resuscitate” (DNR) order. Patient/Surrogate Signature Date


By signing this form, the surrogate acknowledges that this request to forgo resuscitative measures is consistent with the known desires of, and with the best interest of, the individual who is the subject of this form.

I, (print patient’s name)

I affirm that this patient/surrogate is making an informed decision and that this directive is the expressed wish of the patient/surrogate. A copy of this form is in the patient’s permanent medical record. In the event of cardiac or respiratory arrest, no chest compressions, assisted ventilations, intubation, defibrillation, or cardiotonic medications are to be initiated. Physician Signature Date




Copy 1 – To be kept by patient












Copy 2 – To be kept in patient’s permanent medical record












Copy 3 – If authorized DNR medallion desired, submit this form with an EMS Authority-approved suppliers of medallions

Do Not Resuscitate (DNR) and Other Patient-Designated Directives


California Health and Human Services Agency

EMSA #311

6th Revision – October 2018

EMS Personnel Guidelines Limiting Pre-Hospital Care

HOWARD BACKER, MD, MPH, FACEP

DIRECTOR

DANIEL R. SMILEY

CHIEF DEPUTY DIRECTOR

SEAN TRASK

DIVISION CHIEF

EMSA #311

6th Revision -2018

5th Revision - 2016

4th Revision – 2013

3rd Revision – 2009

2nd Revision – 1993

Released – 1990

Table of Contents

INTRODUCTION ............................................................................................................. 1

BACKGROUND .............................................................................................................. 1

AUTHORITY ................................................................................................................... 2

IMPLEMENTATION PROCEDURES .............................................................................. 2

EMSA/CMA APPROVED PREHOSPITAL DNR FORM .............................................. 4

EMSA APPROVED POLST FORM ............................................................................. 5

DNR MEDALLION ....................................................................................................... 7

BACKGROUND MATERIAL ON OTHER ADVANCE DIRECTIVES ............................... 8

APPENDICES ............................................................................................................... 10

Appendix A- EMSA/CMA Approved Prehospital DNR Form ...................................... 11

Appendix B- EMSA Approved POLST Form .............................................................. 13

Appendix C – EMSA Approved DNR Medallions ....................................................... 15

EMSA #311

INTRODUCTION These guidelines are intended to assist local emergency medical services (EMS) agencies in developing policies that honor patient-designated choices regarding unwanted resuscitation attempts and other out-of-hospital interventions. These policies allow patients to refuse resuscitation and medical interventions and ensure that a patient’s rights are honored.

Local decision-making is essential in this sensitive area. When developing these policies, the local EMS agency should ensure that all stakeholders (providers, interested groups and individuals) have an opportunity to provide input during the process. Most importantly, non-EMS physicians and their patients must be aware of these policies and the ability to limit prehospital care options.

BACKGROUND The goals of emergency medical services personnel include saving lives, preventing disability and relieving suffering. Historically, EMS systems focused on sudden cardiac death and resuscitation. Patients were treated to the fullest extent possible, and discussions about patients' wishes regarding resuscitation or the extent of treatment were reserved for medical personnel in acute care facilities.

More frequently, patients or their families resist resuscitative measures. These patients are generally, although not always, victims of terminal illnesses, and are encountered in skilled nursing facilities, private residences and other care settings. They may or may not be hospice clients. They view resuscitation attempts as lacking sufficient benefit and merely prolonging the process of dying, while causing unnecessary discomfort and emotional distress.

Historically, emergency responders were obligated to initiate full resuscitative measures and these were usually continued until arrival at a hospital. Discouraging patients from using the EMS system when they do not wish resuscitation avoids difficult problems, including identification issues, but may deny patients palliative treatment, an important obligation of all health care providers. In some cases, these patients must use the EMS system solely to obtain transportation, sometimes forcing them to accept unwanted resuscitative measures.

Despite pre-planning to decline resuscitation, family members and employees of health or long-term care facilities may activate 9-1-1 when death is imminent. Performing resuscitation against a patient's wishes in this case is inappropriate because it denies them real authority over their health care.

While it is clear that care givers should acknowledge patients' wishes in regard to resuscitation, caution is needed in the field setting since there is generally no established relationship between the patient and emergency responder. Specific procedures are needed whereby patient directives regarding limited care will be respected in the home and long term care facility and during transport. This is best

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dealt with by standard requirements for DNR directives and clearly written policies and procedures for local EMS providers.

Cardiopulmonary resuscitation is similar to other medical interventions with advantages and disadvantages, risks and benefits. When possible, patients should give informed consent before resuscitation is attempted; however, in cases of sudden, unexpected cardiac arrest, treatment consent is not possible, so EMS systems operate on the principle of implied consent. Patients' rights to consent to or refuse resuscitation or other recommended medical care do not depend on the presence or absence of a terminal illness or the agreement of their physician.

The EMS system, as the extension of medical practice into the field, has the same ethical obligations to honor patient wishes regarding resuscitation. Do not resuscitate directives are a critical part of any EMS system. Patients cannot be refused their legal and ethical rights to consent to or refuse medical care simply because they are in the prehospital setting.

AUTHORITY Health and Safety Code Section 1797.220 gives local EMS agencies the authority to establish “policies and procedures approved by the medical director of the local EMS agency to assure medical control of the EMS system”, which can include patient care guidelines.

Health and Safety Code Section 1798 states that “the medical direction and management of an emergency medical services system shall be under the medical control of the medical director of the local EMS agency”.

Section 4780 of the Probate Code defines what constitutes a "Request regarding resuscitative measures" or a DNR as well as what forms must be accepted statewide. The EMS Authority is responsible for developing a pre-hospital DNR form and for approving the POLST form.

IMPLEMENTATION PROCEDURES All local EMS agencies shall have a policy that recognizes and accommodates a patient’s wish to limit prehospital treatment. This should apply to patients in long-term care facilities, during transport between facilities, and in patients' homes. Three instruments are used to assure standard implementation:

The statewide Emergency Medical Services Authority (EMSA)/California Medical Association (CMA) Prehospital DNR Form

The EMSA approved Physician Orders for Life Sustaining Treatment (POLST) Form

A standard EMSA approved DNR medallion.

In addition to the three statewide standards mentioned above, the local EMS agency Medical Director may also approve other documents, which may include, but are not limited to the following:

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Physician’s order in a patient’s chart

Physician’s prescription containing the words Do Not Resuscitate, No CPR, or No Code, that contains the patient’s name and is dated and signed by the physician

Advance Health Care Directives

These other documents may not be honored outside of a particular local EMS agency’s jurisdiction. If individuals want to ensure that their wishes are honored consistently throughout California, it is recommended that they utilize one of the standardized instruments mentioned above.

Patients have near-absolute authority to refuse resuscitation. The role of the physician signing the DNR directive should be to evaluate the patient for untreated or inadequately treated illness where additional treatment might change the patient's decision regarding resuscitation.

The physician should ensure that the patient understands the meaning of resuscitation and "do not resuscitate," explain the benefits and risks of a resuscitation attempt, and answer any questions the patient may have. Additionally, the physician should explain the differences in treatment protocols between the statewide EMSA/CMA approved Prehospital DNR, the EMSA approved POLST Form (which includes treatment options for patients admitted to hospitals and other healthcare facilities), and the standard DNR medallion.

The role of the base hospital should be defined. In some cases the base hospital will not be notified and all documentation will appear only on the patient care record. Other jurisdictions may wish to have the base hospital consulted.

In cases where EMS personnel question the validity of the request (e.g. DNR not identified in local DNR policy, conflicting requests by family members, etc.), EMS personnel should be allowed to temporarily disregard the DNR request and institute resuscitation measures while consulting their base hospital for assistance.

If the patient is conscious and states that they wish resuscitative measures, then the DNR Form should be ignored. In rare instances, when the patient is unable to state his or her desire and a family member is present and requests resuscitative measures for the patient, the family member's objection may call into question the validity or applicability of the DNR Form. Although the patient's wishes or instructions should remain paramount, resuscitation may be undertaken until the situation is clarified. Usually discussions with the family will make attempted resuscitation unnecessary.

Clarification may require only discussion with the family member, with explanation, reassurance, and emotional support. Assistance from a base hospital may be helpful. Again, the underlying principle is that the patient's wishes should be respected.

Local EMS agencies should have policies addressing the use of documents other than the EMSA/CMA approved Prehospital DNR Form (see Appendix A) or the EMSA approved POLST form (see Appendix B).

EMS personnel should attach a copy of the approved DNR Form to the patient care record, along with other appropriate written documentation. The DNR Form should

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accompany the patient so that it may be incorporated into the medical record at the receiving facility. When DNR orders are noted in medical records in licensed facilities, that fact should be recorded by the EMS provider, along with the date of the order and the physician's name. It should be noted on the patient care record that a written DNR order was present including the name of the physician, date signed and other appropriate information.

Patients who are dead at the scene should not be transported by ambulance however; local EMS agencies should consider policies for DNR patients who collapse in public locations. In these cases it may be necessary to transport the individual to a hospital even without resuscitative measures, in order to move the body to a location that provides the family with more privacy and where arrangements can be made more expeditiously. Local policies shall have the approval of the Medical Examiner/Coroner, who has the responsibility for investigating all deaths with other investigative bodies.

EMSA/CMA APPROVED PREHOSPITAL DNR FORM 1. Under the EMSA/CMA approved Prehospital DNR Form, do not resuscitate

(DNR) means no chest compressions, defibrillation, endotracheal intubation, assisted ventilation, or cardiotonic drugs.

2. The patient should receive all other care not identified above for all other medical conditions according to local protocols.

3. Relief of choking caused by a foreign body is usually appropriate, although if breathing has stopped and the patient is unconscious, ventilation should not be assisted.

4. Requests must be signed and dated by a physician. No witness to the patient's or surrogate's signature is necessary. Ensuring appropriate informed consent is the responsibility of the attending physician, not the EMS system or prehospital provider.

5. The DNR Form should be clearly posted or maintained near the patient in the home. A typical location might be in an envelope in a visible location near the patient's bed. Copies of the form are valid and will be honored. The patient or family should be encouraged to keep a copy in case the original is lost. The copy should be taken with the patient during transport.

6. In general, EMS personnel should see the written prehospital DNR Form unless the patient's physician is present and issues a DNR order.

7. Correct identification of the patient is crucial, but after a good faith attempt to identify the patient, the presumption should be that the identity is correct if documentation is present and the circumstances are consistent. There should be a properly completed standard EMSA/CMA DNR Form available with the patient. A witness who can reliably identify the patient is valuable.

A blank sample EMSA/CMA Prehospital DNR Form is contained in Appendix A.

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EMSA APPROVED POLST FORM EMS personnel who encounter the EMSA approved POLST form in the field should be aware of the different levels of care in Sections A and B of the form (Section C does NOT apply to EMS personnel).

Section A

Section A applies only to individuals who do NOT have a pulse and are NOT breathing upon arrival of EMS personnel.

1. If an individual has checked “Attempt Resuscitation/CPR”, then EMS personnel should treat the individual to the fullest extent possible according to local protocols regardless of what may be checked in Section B. For this individual this form as filled out does NOT constitute a DNR.

2. If the individual has checked “Do Not Attempt Resuscitation/DNR”, then no attempts should be made to resuscitate the individual and the EMS personnel should follow their local policies, procedures and protocols for declaration of death.

Section B

Section B applies only to individuals who have checked “Do Not Attempt Resuscitation/DNR” in Section A AND who have a pulse and/or are breathing upon the arrival of EMS personnel.

1. If an individual has checked “Full Treatment” then they should be treated to the fullest extent possible. This includes, but is not limited to, intubation and other advanced airway interventions, mechanical ventilation and defibrillation/cardioversion.

Should the individual’s condition deteriorate after EMS personnel have arrived and they have indicated “DNR” in Section A, then resuscitation efforts should be attempted up to, but NOT including, chest compressions. Then EMS personnel should follow local protocols regarding declaration of death.

EMS personnel shall ignore the check box marked “Trial Period of Full Treatment” as it is not applicable to pre-hospital care.

2. If an individual has checked “Selective Treatment” the following care may be provided (in addition to the care outlined below):

Administration of IV fluids.

May use non-invasive positive airway pressure to include: continuous positive airway pressure (CPAP), bi-level positive airway pressure (BiPAP), and bag valve mask (BVM) assisted respirations according to local protocols. This does NOT include intubation.

EMS personnel shall ignore the subjective phrase “avoid burdensome measures” when considering treatment options for the patient. EMS personnel shall follow their local protocols, policies and procedures

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regarding patient treatments and if necessary contact medical control for further guidance.

EMS personnel shall ignore the check box marked “Request transfer to hospital only if comfort needs cannot be met in current location”. EMS personnel shall follow their local protocols, policies and procedures regarding patient transport.

3. If an individual has checked “Comfort-Focused Treatment” the following care may be provided:

The patient should receive full palliative treatment for pain, dyspnea, major hemorrhage, or other medical conditions (includes medication by any route) according to local protocols.

Relief of choking caused by a foreign body is usually appropriate, although if breathing has stopped and the patient is unconscious, ventilation should not be assisted.

EMS personnel shall ignore the statement “Request transfer to hospital only if comfort needs cannot be met in current location”. EMS personnel shall follow their local protocols, policies and procedures regarding patient transport.

4. EMS personnel shall obtain online medical control prior to following any orders listed under “Additional Orders”.

EMSA approved POLST forms must be signed and dated by a physician, or a nurse practitioner or a physician assistant acting under the supervision of the physician and within the scope of practice authorized by law and the patient or legally recognized decision-maker. No witness to the patient's or legally recognized decision-maker's signature is necessary. Ensuring appropriate informed consent is the responsibility of the attending physician, not the EMS system or prehospital provider.

The EMSA approved POLST form should be clearly posted or maintained near the patient. A typical location might be in an envelope in a visible location near the patient's bed. Copies of the form are valid and will be honored. The patient or family should be encouraged to keep a copy in case the original is lost. The copy should be taken with the patient during transports.

In general, EMS personnel should see the written EMSA approved POLST form unless the patient's physician is present and issues a DNR order.

Correct identification of the patient is crucial, but after a good faith attempt to identify the patient, the presumption should be that the identity is correct if documentation is present and the circumstances are consistent. There should be a properly completed EMSA approved POLST form available with the patient. A witness who can reliably identify the patient is valuable.

A blank sample EMSA approved POLST Form is contained in Appendix B.

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DNR MEDALLION 1. The most accurate form of identification for patients outside of licensed facilities

is a medallion or bracelet attached to the patient. Use of such a medallion should never make the patient uncomfortable and should always be optional. Every local EMS system should accept an EMSA approved DNR bracelet or medallion.

2. All EMSA approved DNR medallions must include the following information: a. 24-hour, seven day a week, telephone number that is toll free to the

calling party, b. The words, “CALIFORNIA DO NOT RESUSCITATE – EMS”, Or;

“CALIFORNIA DNR – EMS”, c. An individual specific identification number to be used to identify the

enrollee’s medical information on file.

Medallions should only be issued after receiving a copy of the completed EMSA/CMA approved DNR Request Form or the EMSA approved POLST Form from an individual. Should an individual use a POLST form to acquire their medallion the acronym “POLST” shall be inscribed on the medallion.

3. Should EMS personnel encounter an individual with a DNR medallion, treatment should follow as outlined by the EMSA/CMA approved Prehospital DNR form. If the individual’s medallion indicates “POLST” in addition to “DNR” then if the POLST form is available to the EMS personnel, treatment should follow as indicated on the POLST form. In the absence of a POLST form, when a DNR/POLST medallion is encountered, the EMS personnel should treat the individual in a manner consistent with that outlined by the EMSA/CMA approved DNR until the individual’s valid EMSA approved POLST form is produced.

4. The emergency medical services system must not be used simply to pronounce death in nursing home patients. This inappropriate use of EMS Personnel should be addressed by service providers and/or EMS agencies. DNR orders are aimed at patients who may suffer cardiac arrest during treatment or transfer.

5. Base hospital physicians retain authority for determining the appropriateness of resuscitation. EMS personnel in the field have the ability to contact a base hospital and advise the physician of the details of a particular case if resuscitation appears unwarranted or unwanted by the patient. While field circumstances make this type of ad hoc decision difficult as a routine procedure, it may still apply to specific cases where patients' wishes are known and explicitly expressed.

There are currently three (3) California Approved Medallion Providers. They are the only venders in California that are currently approved to produce Statewide approved prehospital DNR medallions. Their contact information is the following:

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MedicAlert Foundation www.medicalert.org 1-888-633-4298 2323 Colorado Avenue Turlock, CA 95382

Caring Advocates www.caringadvocates.org 1-800-647-3223 2730 Argonauta St Carlsbad, CA 92009

StickyJ Medical ID www.stickyj.com 10801 Endeavour Way #B Seminole FL 33777 1-866-497-6265

BACKGROUND MATERIAL ON OTHER ADVANCE DIRECTIVES These guidelines have focused on the standardized prehospital EMSA/CMA DNR and the EMSA approved POLST form, and physician DNR orders in licensed facilities as the preferred methods for honoring patient decisions to forego cardiac resuscitation. There are several additional written documents or instruments that may be encountered. Local EMS agencies should decide what role, if any, these written instruments play in the prehospital care system. At the very least, emergency responders and base hospital personnel must be aware that these instruments exist and may be presented to the emergency care providers by patients or their families.

There are a variety of "living wills" and advance directives available from many sources. While these may communicate to the rescuer some sense of the patient's wishes regarding resuscitation, the wide variety of these documents and the inability to confirm the legitimacy of the orders makes them unsuitable for emergency use without prior confirmation. A base hospital may, however, elect to use these in guiding a patient's therapy.

Local EMS systems may recognize advance directives. Providers may also be directed to respect the decisions made by an attorney-in-fact at the scene of an emergency when the patient is unable to make decisions for her/himself. Decisions made by the attorney-in-fact should be consistent with any written expressions of the patient’s wishes. Secondly, providers may respect directions they find written in the advance directive regarding withholding or providing resuscitation. Finally, written information in the advance directive gives health care providers direction as to the patient's wishes and may be valuable in assessing whether to proceed with resuscitation.

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APPENDICES

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APPENDIX A- EMSA/CMA APPROVED PREHOSPITAL DNR FORM

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APPENDIX B- EMSA APPROVED POLST FORM

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APPENDIX C – EMSA APPROVED DNR MEDALLIONS

GUIDELINES FOR EMS PERSONNEL REGARDING DO NOT RESUSITATE (DNR) AND OTHER PATIENT-DESIGNATED DIRECTIVES LIMITING PREHOSPITAL CARE

Edmund G. Brown, Jr.

Governor

State of California

Diana S. Dooley

Secretary

Health and Human Services Agency

Howard Backer, MD, MPH, FACEP

Director


EMSA Publication #311

Updated October 2018

www.emsa.ca.gov




QUARTERLY MEETING MEETING DATE: September 22, 2021 ITEM NUMBER: 8A SUBJECT: State Medical Response Update

PRESENTER: Craig Johnson, Chief, Disaster Medical Services CONSENT: ___ ACTION: ___ INFORMATION: _X_

FISCAL IMPACT None. BACKGROUND For more than a year and a half now, EMSA has been on the frontlines providing statewide medical support for the COVID-19 Pandemic response. Efforts include medical support at quarantine sites, Alternate Care Sites, vaccination and monoclonal Antibody Infusion clinics, and medical care at migrant support hubs. EMSA also coordinated the acquisition of much-needed staffing for hospitals and assisted with building out hospital bed capacity for intensive care patients. EMSA also responded to the critical need to support Skilled Nursing Facilities by establishing medical strike teams to provide patient care and infection control education and training to prevent the collapse of impacted facilities. EMSA continues to coordinate statewide patient movement and provide critical respiratory and oxygen equipment for hospitals. SUMMARY Over the past year, EMSA, in collaboration with local, state, and federal partners, engaged in COVID-19 response activities to provide statewide medical support for victims and mitigate the impact of the multiple COVID surges. We have experienced three significant waves and are now seeing the fourth surge due to the Delta variant. Additionally, EMSA maintains preparedness to support response needs due to the current wildfires.

Commission on Emergency Medical Services September 22, 2021 Item #8A Page 2 DISCUSSION EMSA continues to provide statewide medical support for the COVID response. However, meeting the needs of the fourth surge and statewide fires is proving challenging due to staffing shortages. However, despite the challenges, EMSA continues to provide medical and logistical support statewide and has plans to recruit additional support through the end of the year. Current Response Activities:

• EMSA is co-leading the reactivated Emergency Support Function (ESF) 8 Multi-Agency Coordination (MAC) group for scarce resource allocation. The MAC Group activated on August 11, 2021, due to the Delta variant COVID surge and statewide wildfires.

• EMSA is providing medical first aid, screenings, and vaccinations to support multiple Migrant HUBS in Imperial and SD Counties. We expect to continue support for the foreseeable future using both contract staffing and CAL-MAT.

• EMSA is supporting Monoclonal Antibody Infusion Centers in SD at four different locations. Reports indicate the infusion centers are proving successful in reducing the impact of COVID. Therefore, EMSA plans to expand the number of available infusion centers over the next couple of months.

• EMSA is currently supporting the COVID surge in Northern California, including assisting the only hospital in Del Norte County to increase bed capacity and establish a vaccination and a monoclonal antibody infusion center.

• EMSA continues to support the Homebound Vaccine Ambulance Strike Team Program (VAST). The program has seen significant utilization with very positive outcomes, particularly in Southern California.

• EMSA continues to verify medical licenses and process out-of-state medical personnel as requested by hospitals and contract agencies to assist California's COVID response. An Executive Order extension to approve out-of-state medical personnel has been granted through December 31, 2021.

• EMSA, working with State partners, considers all options to support hospital staffing shortages due to the COVID Delta variant surge. Support includes:

o Assisting hospitals with obtaining contract staffing o Considerations to reinitiate state-level contract staffing for hospitals

(costs go to the hospitals) o Request for Federal teams to support hospitals similar to the third

COVID surge.

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• EMSA is providing CAL-MAT personnel for medical care and COVID testing at CAL-FIRE Base Camps for fire response. So far, in 2021, EMSA has supported three different Base Camps.

Challenges and Work in Progress:

• EMSA is experiencing critical internal staffing shortages and facing CAL-MAT scarcity due to a constitutional 189-day limit for all temporary hires in a continuous twelve-month period. EMSA is instituting a new recruitment campaign to bolster CAL-MAT and Health Corps participation to help overcome the shortages. In addition, EMSA has received funding to increase permanent staff and update response equipment.

• Despite shortages, EMSA is working to establish CAL-MAT Task Force Teams to support Long-term Care Facilities, Monoclonal Antibody Infusion Centers, and Vaccination clinics.

• EMSA is reestablishing the All Access Transfer Center (AATC) contract for COVID statewide patient movement coordination.

• EMSA, in collaboration with local partners, is looking to acquire a long-term facility in the southern part of the state to forward position EMSA Mobile Medical Assets and Biomedical Respiratory equipment.

• EMSA continues to gather data for After-Action Reports. EMSA plans to utilize lessons learned and best practices to improve statewide preparedness and response capabilities.

Despite the extremely long duration of the COVID response and worsening fires year after year, EMSA continues to provide the statewide medical support needed. We have been stretched beyond what we thought capable and have learned many valuable lessons in the process. The state medical response has improved over the past year, and we expect to continue to bolster our programs.




QUARTERLY MEETING MEETING DATE: September 22, 2021 ITEM NUMBER: 9A SUBJECT: Ambulance Patient Offload Time (APOT) Report

PRESENTER: Tom McGinnis, EMS Systems Division Chief CONSENT: ___ ACTION: ___ INFORMATION: _X_

RECOMMENDATION No Action Recommended. FISCAL IMPACT No Fiscal Impact. BACKGROUND Health and Safety Code (HSC) 1797.228 requires LEMSAs to submit APOT reports quarterly to the EMS Authority effective July 1, 2019, and HSC 1797.123 also requires the EMS Authority to calculate APOT times provided by the LEMSAs and provide biannual reports to EMS Commission. DISCUSSION EMSA collects and correlates APOT submissions from participating LEMSAs. COVID-19 significantly impacted all LEMSAs, which impacted timely reporting. The current submission status through Quarter 2 of 2021 for each LEMSA can be found below. EMSA continues to monitor COVID-19’s impact on APOT in each of California’s EMS Systems through analysis of CEMSIS data. Data is being analyzed on a weekly basis and will continue as needed. EMSA will maintain communication with LEMSAs to further understand the correlation between COVID-19 and offload times.

Commission on Emergency Medical Services September 22, 2021 Item #9A Ambulance Patient Offload Time (APOT) Page 2 Beginning in December 2020, EMSA developed and distributed APOT CEMSIS comparison reports for all LEMSAs who submit data into CEMSIS and have also provided at least one quarterly APOT submission. Based on the approved APOT specifications, EMSA extracted APOT information from CEMSIS to compare the count of offloads and 90th percentile times for all hospitals reported by each LEMSA. In total, 31 comparison reports were distributed to LEMSA administrators in the initial rollout covering Quarter 3 of 2019 through Quarter 3 of 2020,15 LEMSAs were provided with an APOT CEMSIS comparison report for Quarter 4 of 2020 and 20 LEMSAs were provided with an APOT CEMSIS comparison report for Quarter 1 of 2021, distributed in June of this year. LEMSAs are responsible for reaching out to EMSA with any questions or concerns about how their APOT data is represented within the APOT comparison report. To date, EMSA has provided several LEMSAs with technical assistance regarding their CEMSIS submission and continues to work through any APOT related data issues with them. EMSA continues to produce quarterly comparisons for participating LEMSAs and will develop reports for any retrospective APOT submissions received. EMSA has established a list of stakeholders who have either expressed interest or taken part in the prior APOT work group to participate in an advisory committee to the EMSA Director on APOT. Invitations were sent to these groups and individuals in August 2021 with the first meeting set to take place in October 2021. This group will be tasked with assisting EMSA with determining data reporting needs and developing strategies to move forward with reducing APOT. EMSA will provide the Commission with reports on APOT twice a year and update you on the progress of this program.

Commission on Emergency Medical Services September 22, 2021 Item #9A Ambulance Patient Offload Time (APOT) Page 3

2019 2020 2021 LEMSA Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2

Alameda 11/5/2019 1/2/2020 4/23/2020 7/13/2020 10/16/2020 3/2/2021 4/2/2021 7/2/2021 Central California 10/21/2019 1/28/2020 12/9/2020 12/9/2020 12/9/2020 1/5/2021 4/26/2021 7/27/2021 Coastal Valleys 11/27/2019 1/21/2021 1/21/2021 1/21/2021 1/21/2021 Contra Costa 10/30/2019 2/3/2020 8/12/2020 8/12/2020 10/7/2020 7/7/2021 7/7/2021 7/7/2021 El Dorado 11/1/2019 1/15/2020 Imperial Inland Counties 10/18/2019 7/21/2020 7/21/2020 7/16/2020 10/7/2020 1/13/2021 Kern 10/21/2019 1/22/2020 4/23/2020 8/3/2020 10/5/2020 1/7/2021 4/12/2021 7/13/2021 Los Angeles 12/16/2019 4/28/2020 6/25/2020 9/23/2020 2/8/2021 8/31/2021 Marin 11/19/2019 Merced 10/4/2019 1/16/2020 4/14/2020 7/2/2020 11/16/2020 4/12/2021 Monterey 10/31/2019 1/30/2020 6/11/2020 7/30/2020 1/21/2021 1/21/2021 4/9/2021 7/19/2021 Mountain Valley 11/1/2019 6/17/2020 6/17/2020 7/13/2020 11/5/2020 1/14/2021 7/13/2021 7/13/2021 Napa 10/30/2019 1/18/2020 9/15/2020 9/15/2020 11/11/2020 5/4/2021 8/23/2021 Northern Cal 10/23/2019 1/15/2020 4/30/2020 7/29/2020 10/27/2020 1/13/2021 4/19/2021 7/7/2021 North Coast 10/31/2019 1/15/2020 8/30/2020 1/19/2021 4/14/2021 Orange 10/8/2019 1/8/2020 4/20/2020 7/7/2020 10/7/2020 1/6/2021 4/8/2021 7/8/2021 Riverside 10/22/2019 1/16/2020 4/7/2020 12/10/2020 10/9/2020 1/8/2021 5/12/2021 Sacramento 10/10/2019 1/8/2020 5/7/2020 7/7/2020 10/9/2020 1/7/2021 4/8/2021 7/7/2021 San Benito 10/31/2019 1/9/2020 4/7/2020 7/9/2020 10/12/2020 4/13/2021 7/14/2021 San Diego 10/10/2019 1/15/2020 8/14/2020 8/12/2020 10/16/2020 1/12/2021 4/12/2021 7/19/2021 San Francisco 11/19/2019 3/16/2020 6/18/2020 8/3/2020 10/23/2020 1/19/2021 7/2/2021 San Joaquin 10/10/2019 1/6/2020 4/10/2020 7/13/2020 10/9/2020 1/8/2021 4/9/2021 7/6/2021 San Luis Obispo 10/24/2019 1/22/2020 5/19/2021 San Mateo 10/7/2019 1/2/2020 5/4/2020 7/2/2020 10/5/2020 1/4/2021 4/5/2021 7/5/2021 Santa Barbara 11/13/2019 2/11/2020 12/8/2020 12/8/2020 12/8/2020 5/24/2021 8/2/2021 Santa Clara 10/30/2019 1/29/2020 4/2/2020 7/29/2020 10/27/2020 2/25/2021 4/22/2021 8/25/2021 Santa Cruz 10/30/2019 2/11/2020 4/10/2020 7/7/2020 11/4/2020 1/5/2021 4/6/2021 8/4/2021 Sierra-Sac Valley 10/7/2019 1/5/2020 4/3/2020 7/23/2020 10/7/2020 1/11/2021 4/2/2021 7/8/2021 Solano 12/20/2019 1/13/2020 4/23/2020 7/28/2020 10/23/2020 1/21/2021 4/27/2021 8/4/2021 Tuolumne 12/26/2019 Ventura 12/3/2019 1/3/2020 4/7/2020 7/13/2020 10/7/2020 7/29/2021 7/30/2021 8/2/2021 Yolo 10/30/2019 1/7/2020 9/1/2021 9/1/2021 9/1/2021 9/1/2021 9/1/2021 9/1/2021 Updated 9/2/2021

ATTACHMENT(S) (Report to Commission: Ambulance Patient Offload Delays)

Report to Commission: Ambulance Patient Offload Delays

Emergency Medical Services Authority California Health and Human Services AgencySeptember 2021 Dr. Dave Duncan, Director

Table of Contents Local EMS Agency Quarter One (1) Ambulance Patient Offload Time (APOT) . 04

Alameda County EMS Agency ...................................................................... 04

Central California EMS Agency ...................................................................... 05

Contra Costa County EMS Agency ............................................................... 07

Kern County EMS Agency ............................................................................... 08

Merced County EMS Agency ......................................................................... 10

Monterey County EMS Agency ...................................................................... 11

Mountain Valley EMS Agency ........................................................................ 12

Napa County EMS Agency ............................................................................. 13

North Coast EMS Agency ................................................................................ 14

Northern California EMS Agency .................................................................... 15

Orange County EMS Agency ......................................................................... 16

Riverside County EMS Agency ....................................................................... 18

Sacramento County EMS Agency ................................................................. 20

San Bento County EMS Agency ..................................................................... 21

San Diego County EMS Agency ..................................................................... 21

San Francisco County EMS Agency ............................................................... 23

San Joaquin County EMS Agency ................................................................. 24

San Luis Obispo County EMS Agency ............................................................ 24

San Mateo County EMS Agency ................................................................... 25

Santa Barbara County EMS Agency ............................................................. 27

Santa Clara County EMS Agency .................................................................. 27

Santa Cruz County EMS Agency .................................................................... 28

Sierra-Sacramento Valley EMS Agency ........................................................ 29

Solano County EMS Agency ........................................................................... 31

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Ventura County EMS Agency ......................................................................... 32

Yolo County EMS Agency ............................................................................... 33

APOT – 1 Weighted Average 90th Percentile by LEMSA and Hospital .................. 35

APOT – 2 Offload Averages ....................................................................................... 44

Page 3

Alameda County EMS Agency APOT -1

Hospital Name Offloads 90th Percentile APOT Time Offloads

90th Percentile APOT Time

Offloads90th

Percentile APOT Time

Alameda Hospital 285 0:47:18 214 0:23:12 206 0:34:24Alta Bates Medical Center - Berkeley 448 0:48:18 380 0:44:00 423 0:43:00Alta Bates Medical Center - Summit 1222 0:43:00 1016 0:45:00 1131 0:42:00Children's Hospital Oakland 65 0:23:48 77 0:24:36 88 0:28:48Eden 848 1:17:00 815 1:01:00 899 1:09:00Highland 998 0:56:00 1007 0:57:00 1161 0:48:54John George 285 1:16:36 272 1:20:00 283 1:06:00Kaiser - Walnut Creek 455 0:48:24 397 0:42:00 498 0:44:54Kaiser Fremont 646 0:47:00 607 0:45:00 651 0:44:06Kaiser Oakland 673 0:42:00 626 0:42:00 689 0:41:00Kaiser San Leandro 220 0:24:24 200 0:28:00 226 0:26:42San Leandro Hospital 397 0:56:00 352 0:42:18 404 0:49:18St. Rose 545 0:49:00 458 0:52:00 454 0:45:42ValleyCare 546 1:16:00 483 1:22:48 558 1:20:00Washington Hospital 811 0:44:24 728 0:39:42 807 0:43:18Willow Rock Center 9 0:35:48 18 0:32:24 14 0:56:42

Alameda County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Alameda Hospital 213 52 8 3 9 186 18 0 2 8 166 30 4 2 4Alta Bates Medical Center - Berkeley 265 164 11 1 7 246 116 13 0 5 247 154 8 0 14Alta Bates Medical Center - Summit 714 452 30 1 25 621 346 25 7 17 720 352 28 4 27Children's Hospital Oakland 422 300 102 16 8 407 325 72 3 8 439 343 96 13 8Eden 508 401 51 13 25 491 432 58 11 15 613 470 46 4 28Highland 81 151 49 1 3 84 138 45 4 1 103 147 29 2 2John George 302 118 24 3 8 289 84 10 3 11 360 107 20 0 11Kaiser - Walnut Creek 323 286 24 5 8 335 242 20 2 8 385 232 26 1 7Kaiser Fremont 412 224 21 1 15 380 217 20 1 8 440 220 20 1 8Kaiser Oakland 173 44 1 0 2 153 44 1 1 1 181 43 1 0 1Kaiser San Leandro 225 136 31 3 2 234 101 11 1 5 232 143 25 1 3San Leandro Hospital 276 236 25 1 7 229 195 24 5 5 238 192 16 2 6St. Rose 320 151 50 12 13 268 136 57 15 7 323 143 70 14 8ValleyCare 53 11 1 0 0 66 10 0 0 1 66 19 3 0 0Washington Hospital 538 232 26 2 13 505 202 11 3 7 537 220 34 2 14Willow Rock Center 4 5 0 0 0 8 9 1 0 0 5 8 1 0 0

Alameda County EMS Agency

January 2021 Febuary 2021 March 2021

January 2021 February 2021 March 2021

Local EMS Agency Quarter One (1) Ambulance Patient Offload Time (APOT)

Page 4

Central California EMS Agency APOT -1



Offloads90th


Adventist Medical Center - Hanford 694 1:09:08 642 0:37:34 717 0:38:59Adventist Medical Center - Reedley 84 0:36:26 69 0:36:07 69 0:37:00Adventist Medical Center - Selma 118 0:36:18 128 0:22:47 147 0:30:13Adventist Medical Center - Tulare 26 1:34:45 15 0:40:26 25 0:49:39Clovis Community Hospital 1281 1:31:45 1116 0:48:09 1280 1:05:24Coalinga Hospital 16 0:33:41 29 0:21:28 22 0:32:20Kaiser Hospital - Fresno 657 0:52:15 635 0:40:38 663 0:35:58Kaweah Delta Medical Center 1397 1:05:56 1293 1:17:09 1493 1:18:12Madera Community Hospital 357 0:54:58 384 0:43:59 391 0:28:21Regional Medical Center 2590 1:31:12 2531 1:34:27 2857 1:32:47Saint Agnes medical Center 2004 0:49:27 1832 0:39:57 2105 0:43:50Sierra View District Hospital 476 1:21:16 457 1:02:07 526 1:03:02Valley Childrens Hospital 182 0:17:40 192 0:18:16 198 0:16:19Veterans Administration Medical Center 183 0:25:04 204 0:26:22 180 0:22:17

Central California EMS Agency


285 448

1222

65

848

998

285

455 646

673

220

397

545

546

811

9

214

380 1016

77

8151007

272

397607

626

200

352

458

483

728

18206

423 1131

88

899

1161

283

498651

689

226

404454

558

807

14

0:00:00

0:14:24

0:28:48

0:43:12

0:57:36

1:12:00

1:26:24

1:40:48

AlamedaHospital

Alta BatesMedicalCenter -Berkeley

Alta BatesMedicalCenter -Summit

Children'sHospitalOakland

Eden Highland John George Kaiser -WalnutCreek

KaiserFremont

KaiserOakland

Kaiser SanLeandro

San LeandroHospital

St. Rose ValleyCare WashingtonHospital

Willow RockCenter

Times

(h:m

m:s

s)

Hospitals

Alameda County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 5

Central California EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Adventist Medical Center - Hanford 352 252 65 13 12 467 154 21 0 0 520 166 28 3 0Adventist Medical Center - Reedley 59 24 1 0 0 56 12 0 0 1 55 13 1 0 0Adventist Medical Center - Selma 91 22 4 1 0 109 18 1 0 0 119 25 2 1 0Adventist Medical Center - Tulare 14 6 5 0 1 11 3 1 0 0 16 7 0 1 1Clovis Community Hospital 538 539 100 30 74 538 493 49 22 14 607 537 74 21 41Coalinga Hospital 10 6 0 0 0 21 8 0 0 0 19 1 2 0 0Kaiser Hospital - Fresno 385 220 46 5 1 437 168 27 1 2 452 195 15 0 1Kaweah Delta Medical Center 573 647 146 23 8 478 603 148 44 20 567 689 169 45 23Madera Community Hospital 254 69 20 7 7 288 74 16 3 3 330 50 8 1 2Regional Medical Center 819 1192 437 101 41 875 1071 441 97 47 951 1306 429 120 51Saint Agnes medical Center 793 1105 93 9 4 836 965 31 0 0 899 1146 53 5 2Sierra View District Hospital 122 275 65 7 7 143 264 38 6 6 175 283 59 8 1Valley Childrens Hospital 172 10 0 0 0 176 16 0 0 0 187 10 1 0 0Veterans Administration Medical Center 151 32 0 0 0 166 36 1 1 0 155 25 0 0 0

March 2021January 2021 Febuary 2021

694

84 118

261281

16

657

1397

357

2590

2004

476

182

183

642 69

128

15

1116

29

635

1293

384

2531

1832

457

192

204

71769

147

25

1280

22663

1493

391

2857

2105

526

198

180

0:00:00

0:14:24

0:28:48

0:43:12

0:57:36

1:12:00

1:26:24

1:40:48

AdventistMedicalCenter -Hanford

AdventistMedicalCenter -Reedley

AdventistMedical

Center - Selma

AdventistMedical

Center - Tulare

ClovisCommunity

Hospital

CoalingaHospital

Kaiser Hospital- Fresno

Kaweah DeltaMedicalCenter

MaderaCommunity

Hospital

RegionalMedicalCenter

Saint AgnesmedicalCenter

Sierra ViewDistrict Hospital

ValleyChildrensHospital

VeteransAdministration

MedicalCenter

Times

(h:m

m:s

s)

Hospitals

Central California EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 6

Contra Costa County EMS Agency APOT -1



Offloads90th


Alameda County Medical Center 12 0:45:01 10 0:42:51 14 0:52:21Alta Bates 171 0:58:00 160 0:44:26 156 0:49:39Childrens Oakland 25 0:26:07 21 0:27:35 34 0:27:07Contra Costa County Psychiatric Emergency 362 1:02:44 365 1:16:18 376 1:13:00Contra Costa Regional 433 0:46:22 425 0:49:20 391 0:51:15Eden 0 0:00:00 0 0:00:00 0 0:00:00John Muir - Concord 945 0:29:23 797 0:28:09 905 0:28:59John Muir - Walnut Creek 923 0:30:51 798 0:30:40 835 0:32:04Kaiser Antioch 739 0:44:50 602 0:47:30 699 0:37:05Kaiser Oakland 87 0:52:45 66 0:59:06 80 1:04:09Kaiser Richmond 935 0:38:38 823 0:39:57 906 0:44:24Kaiser Vallejo 76 0:35:10 72 0:33:59 66 0:39:21Kaiser Walnut Creek 598 0:35:36 533 0:34:10 652 0:33:27Marin General 5 0:18:45 2 0:22:26 6 0:24:16Other - Out of County 155 0:24:11 129 0:23:13 137 0:27:46San Ramon Regional 11 0:29:02 7 0:22:51 4 0:30:47Summit 39 0:46:17 49 0:44:12 46 0:46:20Sutter Delta 936 0:57:32 814 0:45:25 831 0:53:45Sutter Solano 13 0:29:04 8 0:22:24 17 0:22:09Valley Care 1 0:14:43 0 0:00:00 0 0:00:00

Contra Costa County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Alameda County Medical Center 8 3 0 0 1 1 9 0 0 0 6 7 1 0 0Alta Bates 40 115 16 0 0 40 115 5 0 0 35 116 5 0 0Childrens Oakland 19 6 0 0 0 13 8 0 0 0 22 12 0 0 0Contra Costa County Psychiatric Emergency 86 234 35 6 1 64 229 66 5 1 95 211 65 4 1Contra Costa Regional 194 218 17 2 2 196 206 20 3 0 179 192 19 1 0Eden 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0John Muir - Concord 692 247 6 0 0 578 218 1 0 0 664 240 1 0 0John Muir - Walnut Creek 624 289 10 0 0 538 258 0 2 0 541 290 3 1 0Kaiser Antioch 311 389 37 1 1 270 302 29 1 0 359 324 16 0 0Kaiser Oakland 18 63 5 1 0 12 47 6 1 0 16 55 9 0 0Kaiser Richmond 351 573 10 1 0 287 525 11 0 0 286 606 13 0 1Kaiser Vallejo 42 33 1 0 0 30 42 0 0 0 36 30 0 0 0Kaiser Walnut Creek 311 284 3 0 0 293 238 2 0 0 361 288 3 0 0Marin General 4 1 0 0 0 1 1 0 0 0 5 1 0 0 0Other - Out of County 132 20 3 0 0 108 21 0 0 0 112 25 0 0 0San Ramon Regional 7 4 0 0 0 5 2 0 0 0 2 2 0 0 0Summit 13 24 2 0 0 17 31 1 0 0 19 26 1 0 0Sutter Delta 357 497 73 8 1 343 438 31 2 0 357 417 54 3 0Sutter Solano 3 10 0 0 0 7 1 0 0 0 13 4 0 0 0Valley Care 1 0 0 0 0 0 0 0 0 0 0 0 0 0

Contra Costa County EMS Agency



Page 7

Kern County EMS Agency APOT -1



Offloads90th


Bakersfield Memorial Hospital 1101 1:04:00 1074 1:04:00 1150 1:04:00Adventist Health Bakersfield 1321 1:01:00 1160 0:54:00 1356 0:55:00Kern Medical 941 1:06:00 882 0:39:00 1085 0:39:00Delano Regional Medical Center 27 1:01:00 33 0:35:00 33 0:41:00Ridgecrest Regional Hospital 202 0:47:00 144 0:21:00 42 0:20:00Mercy Southwest Hospital 423 0:55:00 376 0:41:00 447 0:39:00Kern Valley Hospital 108 1:10:00 108 0:31:00 51 0:22:00Mercy Downtown 405 0:49:00 357 0:41:00 434 0:40:00Bakersfield Heart Hospital 215 0:58:00 165 0:44:00 191 1:03:00Adventist Health Tehachapi 211 0:36:00 172 0:26:00 156 0:28:00

Kern County EMS Agency


12

171

25

362

433

0

945923

739

87

93576 598

5

155

11

39

936

13

1

10160

21

365

425

0

797798

602

66

823

72 533

2 129 7

49 814

8

0

14156

34

376

391

0

905835

699

80

906

66

652

6

1374

46

831

17

00:00:00

0:14:24

0:28:48

0:43:12

0:57:36

1:12:00

1:26:24

AlamedaCountyMedicalCenter

Alta Bates ChildrensOakland

ContraCosta

CountyPsychiatricEmergency

ContraCosta

Regional

Eden John Muir -Concord

John Muir -WalnutCreek

KaiserAntioch

KaiserOakland

KaiserRichmond

KaiserVallejo

KaiserWalnutCreek

MarinGeneral

Other - Outof County

San RamonRegional

Summit Sutter Delta SutterSolano

Valley Care

Times

(h:m

m:s

s)

Hospitals

Contra Costa County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 8

Kern County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Bakersfield Memorial Hospital 387 587 93 27 7 341 610 109 12 2 368 643 118 17 4Adventist Health Bakersfield 237 949 127 7 1 256 829 73 2 0 319 929 105 3 0Kern Medical 444 480 16 1 0 374 499 9 0 0 461 611 13 0 0Delano Regional Medical Center 6 18 1 1 1 17 16 0 0 0 17 15 1 0 0Ridgecrest Regional Hospital 147 42 9 3 1 126 17 1 0 0 38 2 1 0 1Mercy Southwest Hospital 135 251 29 7 1 176 195 4 0 1 205 229 12 1 0Kern Valley Hospital 43 53 11 1 0 62 43 2 1 0 44 6 1 0 0Mercy Downtown 141 244 20 0 0 143 206 8 0 0 172 256 6 0 0Bakersfield Heart Hospital 73 120 17 5 0 64 91 7 3 0 67 103 16 5 0Adventist Health Tehachapi 146 54 10 1 0 125 44 3 0 0 121 34 0 0 1


11011321

941

27

202

423

108

405

215

211

1074

1160

882

33

144

376

108

357

165

172

1150

1356

108533

42

447

51

434

191

156

0:00:00

0:14:24

0:28:48

0:43:12

0:57:36

1:12:00

1:26:24

Bakersfield MemorialHospital

Adventist HealthBakersfield

Kern Medical Delano RegionalMedical Center

Ridgecrest RegionalHospital

Mercy SouthwestHospital

Kern Valley Hospital Mercy Downtown Bakersfield HeartHospital

Adventist HealthTehachapi

Times

(h:m

m:s

s)

Hospitals

Kern County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 9

Merced County EMS Agency APOT -1



Offloads90th


Doctor's Medical Center Modesto 21 1:20:49 16 0:58:29 19 1:13:30Emanuel Medical Center Turlock 144 0:53:53 119 0:47:55 111 0:52:36Memorial Hospital Los Banos 133 0:52:29 127 0:38:03 135 0:37:41Memorial Hospital North Modesto 12 1:07:44 17 1:08:38 10 1:24:05Mercy Medical Center Merced 724 0:59:07 686 1:01:01 769 0:55:04Valley Children's Hospital Madera 6 0:26:22 4 0:15:34 6 1:16:54

Merced County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Doctor's Medical Center Modesto 14 6 1 0 0 9 6 1 0 0 15 2 2 0 0Emanuel Medical Center Turlock 92 46 4 2 0 80 38 1 0 0 72 37 2 0 0Memorial Hospital Los Banos 93 35 5 0 0 89 37 1 0 0 99 35 1 0 0Memorial Hospital North Modesto 11 1 0 0 0 16 1 0 0 0 9 1 0 0 0Mercy Medical Center Merced 411 280 32 0 0 353 285 47 1 0 430 301 36 2 0Valley Children's Hospital Madera 6 0 0 0 0 4 0 0 0 0 6 0 0 0 0


January 2021 Febuary 2021

Merced County EMS Agency

March 2021

21

144 133

12

724

6

16

119

127

17

686

4

19

111

135

10

769

6

0:00:00

0:14:24

0:28:48

0:43:12

0:57:36

1:12:00

1:26:24

1:40:48

Doctor's Medical CenterModesto

Emanuel Medical Center Turlock Memorial Hospital Los Banos Memorial Hospital NorthModesto

Mercy Medical Center Merced Valley Children's HospitalMadera

Times

(h:m

m:s

s)

Hospitals

Merced County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 10

Monterey County EMS Agency APOT -1



Offloads90th


Community Hospital of the Monterey Peninsula 757 0:14:03 652 0:14:00 715 0:11:23Mee Memorial Hospital 40 0:18:54 29 0:14:21 40 0:07:29Natividad Medical Center 557 0:29:09 551 0:23:33 618 0:17:14Salinas Valley Memorial Hospital 627 0:22:00 521 0:17:08 583 0:13:41

Monterey County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Community Hospital of the Monterey Peninsula 731 26 0 0 0 630 20 1 1 0 702 13 0 0 0Mee Memorial Hospital 38 2 0 0 0 28 1 0 0 0 40 0 0 0 0Natividad Medical Center 435 110 11 0 1 478 71 2 0 0 570 45 3 0 0Salinas Valley Memorial Hospital 546 77 3 1 0 486 35 0 0 0 565 15 3 0 0


Monterey County EMS Agency


757

40

557

627

652 29

551

521

715

40

618

583

0:00:00

0:07:12

0:14:24

0:21:36

0:28:48

0:36:00

Community Hospital of the Monterey Peninsula Mee Memorial Hospital Natividad Medical Center Salinas Valley Memorial Hospital

Times

(h:m

m:s

s)

Hospitals

Monterey County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 11

Mountain Valley EMS Agency APOT -1



Offloads90th


Doctors Hospital Modesto 1715 0:31:07 1483 0:30:42 1606 0:31:16Emanuel Medical Center 637 0:43:07 559 0:35:04 538 0:31:01Kaiser Hospital Modesto Medical Center 401 0:35:57 353 0:34:42 397 0:40:38Memorial Medical Center 1533 0:26:56 1305 0:25:01 1424 0:26:40Oak Valley District Hospital 37 0:10:08 26 0:17:43 57 0:20:46

Mountain Valley EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Doctors Hospital Modesto 1341 326 41 6 1 1188 259 30 2 4 1266 309 29 0 2Emanual Medical Center 418 187 26 3 3 406 140 11 0 2 411 117 10 0 0Kaiser Hospital Modesto Medical Center 292 100 5 2 2 245 104 3 0 1 249 133 14 0 1Memorial Medical Center 1267 248 13 1 4 1118 170 15 1 1 1203 198 22 0 1Oak Valley District Hospital 36 1 0 0 0 24 2 0 0 0 50 6 1 0 0

Mountain Valley EMS Agency



1715

637

401

1533

37

1483

559 353

1305

26

1606 538

397

1424

57

0:00:00

0:07:12

0:14:24

0:21:36

0:28:48

0:36:00

0:43:12

0:50:24

Doctors Hospital Modesto Emanuel Medical Center Kaiser Hospital Modesto MedicalCenter

Memorial Medical Center Oak Valley District Hospital

Times

(h:m

m:s

s)

Hospitals

Mountain Valley EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021February 2021March 2021

Page 12

Napa County EMS Agency APOT -1



Offloads90th


Children's Hospital and Research Center - Oakland 0 0:00:00 1 0:03:15 1 0:05:07Kaiser Santa Rosa 7 0:19:42 5 0:16:20 12 0:17:45Kaiser Vacaville 0 0:00:00 2 0:13:18 3 0:16:47Kaiser Vallejo 171 0:21:00 131 0:17:00 158 0:17:34Northbay Medical Center 0 0:00:00 0 0:00:00 0 0:00:00Queen of the Valley Medical Center 479 0:10:31 439 0:10:00 470 0:12:23Saint Helena Hospital 44 0:06:22 40 0:08:23 42 0:09:19Santa Rosa Memorial Hospital 2 0:16:16 2 0:04:33 1 0:03:00Sutter Santa Rosa Hospital 0 0:00:00 1 0:04:00 0 0:00:00Sutter Solano Hospital 23 0:18:42 19 0:14:18 11 0:12:00

Napa County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Children's Hospital and Research Center - Oakland 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0Kaiser Santa Rosa 6 1 0 0 0 5 0 0 0 0 11 0 1 0 0Kaiser Vacaville 0 0 0 0 0 2 0 0 0 0 3 0 0 0 0Kaiser Vallejo 153 18 0 0 0 121 9 1 0 0 148 10 0 0 0Northbay Medical Center 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Queen of the Valley Medical Center 463 15 1 0 0 431 6 2 0 0 450 19 1 0 0Saint Helena Hospital 44 0 0 0 0 40 0 0 0 0 42 0 0 0 0Santa Rosa Memorial Hospital 2 0 0 0 0 2 0 0 0 0 1 0 0 0 0Sutter Santa Rosa Hospital 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0Sutter Solano Hospital 21 2 0 0 0 19 0 0 0 0 11 0 0 0 0


Napa County EMS Agency


0

7

0

171

0

479

44

2

0

23

1

5

2

131

0

43940

2 1

19

1

123

158

0

470

42

1

0

11

0:00:00

0:02:53

0:05:46

0:08:38

0:11:31

0:14:24

0:17:17

0:20:10

0:23:02

Children's Hospitaland Research

Center - Oakland

Kaiser Santa Rosa Kaiser Vacaville Kaiser Vallejo Northbay MedicalCenter

Queen of theValley Medical

Center

Saint HelenaHospital

Santa RosaMemorial Hospital

Sutter Santa RosaHospital

Sutter SolanoHospital

Times

(h:m

m:s

s)

Hospitals

Napa County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 13

North Coast EMS Agency APOT -1



Offloads90th


Adventist Health, Clearlake 291 0:11:00 230 0:09:25 250 0:10:31Jerold Phelps Community Hospital 14 0:01:00 14 0:02:00 20 0:06:00Mad River Community Hospital 158 0:03:00 164 0:03:00 166 0:03:00Redwood Memorial Hospital 136 0:06:00 109 0:05:00 134 0:04:00Saint Joseph Hospital, Eureka 487 0:05:00 463 0:06:00 518 0:05:00Sutter Coastal Hospital 165 0:03:00 119 0:02:00 129 0:02:00Sutter Lakeside Hospital 152 0:07:33 133 0:06:50 162 0:06:40

North Coast EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Adventist Health, Clearlake 285 6 0 0 0 225 5 0 0 0 248 1 1 0 0Jerold Phelps Community Hospital 14 0 0 0 0 14 0 0 0 0 20 0 0 0 0Mad River Community Hospital 158 0 0 0 0 164 0 0 0 0 165 1 0 0 0Redwood Memorial Hospital 135 1 0 0 0 109 0 0 0 0 134 0 0 0 0Saint Joseph Hospital, Eureka 487 0 0 0 0 461 2 0 0 0 517 1 0 0 0Sutter Coastal Hospital 165 0 0 0 0 119 0 0 0 0 129 0 0 0 0Sutter Lakeside Hospital 152 0 0 0 0 130 2 1 0 0 162 0 0 0 0

North Coast EMS Agency



291

14

158

136

487

165

152

230

14

164

109

463

119

133

250

20

166

134

518

129

162

0:00:00

0:01:26

0:02:53

0:04:19

0:05:46

0:07:12

0:08:38

0:10:05

0:11:31

0:12:58

Adventist Health, Clearlake Jerold Phelps Community Hospital Mad River Community Hospital Redwood Memorial Hospital Saint Joseph Hospital, Eureka Sutter Coastal Hospital Sutter Lakeside Hospital

Times

(h:m

m:s

s)

Hospitals

North Coast EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 14

Northern California EMS Agency APOT -1



Offloads90th


Banner Desert Medical Center 2 0:06:30 2 0:01:48Banner Lassen Medical Center 181 0:06:00 137 0:07:00 156 0:06:00Eastern Plumas Hospital, Portola Campus 34 0:04:42 33 0:04:48 31 0:05:00Enloe Medical Center, Esplanade 3 0:10:24 2 0:03:42 4 0:08:30Mayers Memorial Hospital District 6 0:09:00 7 0:26:26 5 0:14:24Mercy Medical Center, Redding 16 0:12:00 16 0:08:30 17 0:06:00Modoc Medical Center 56 0:04:00 40 0:04:00 51 0:03:00Oroville Hospital 1 0:07:00Plumas District Hospital 36 0:05:00 55 0:04:36 52 0:05:00Redwood Memorial Hospital 4 0:01:24 4 0:01:42 1 0:00:00Renown Medical Center 7 0:07:12 7 0:08:36 10 0:06:00Renown Regional Medical Center 17 0:12:00 10 0:13:24 20 0:16:12St. Mary's Regional Medical Center 10 0:07:24 12 0:07:36 5 0:06:24Seneca District Hospital 21 0:05:00 24 0:05:00 25 0:07:55Shasta Regional 1 0:02:00 2 0:06:30Shasta Regional Medical Center 8 0:10:12 4 0:05:06Sky Lakes Medical Center 1 0:06:00St. Elizabeth Community Hospital 1 0:03:00Tahoe Forest Hospital 3 0:02:00 3 0:07:24Trinity Hospital 38 0:06:00 30 0:05:00 50 0:05:00UC Davis Medical Center 2 0:11:48Veterans Administration, Reno 1 0:05:00 1 0:05:00

Northern California EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Banner Desert Medical Center 1 1 0 0 0 0 0 0 0 0 2 0 0 0 0Banner Lassen Medical Center 181 0 0 0 0 137 0 0 0 0 156 0 0 0 0Eastern Plumas Hospital, Portola Campus 34 0 0 0 0 33 0 0 0 0 31 0 0 0 0Enloe Medical Center, Esplanade 3 0 0 0 0 2 0 0 0 0 4 0 0 0 0Mayers Memorial Hospital District 6 0 0 0 0 6 1 0 0 0 5 0 0 0 0Mercy Medical Center, Redding 16 0 0 0 0 16 0 0 0 0 17 0 0 0 0Modoc Medical Center 56 0 0 0 0 40 0 0 0 0 51 0 0 0 0Oroville Hospital 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0Plumas District Hospital 36 0 0 0 0 55 0 0 0 0 51 1 0 0 0Redwood Memorial Hospital 4 0 0 0 0 4 0 0 0 0 1 0 0 0 0Renown Medical Center 7 0 0 0 0 7 0 0 0 0 10 0 0 0 0Renown Regional Medical Center 17 0 0 0 0 9 1 0 0 0 20 0 0 0 0St. Mary's Regional Medical Center 10 0 0 0 0 12 0 0 0 0 5 0 0 0 0Seneca District Hospital 21 0 0 0 0 24 0 0 0 0 25 0 0 0 0Shasta Regional 1 0 0 0 0 0 0 0 0 0 2 0 0 0 0Shasta Regional Medical Center 8 0 0 0 0 4 0 0 0 0 0 0 0 0 0Sky Lakes Medical Center 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0St. Elizabeth Community Hospital 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0Tahoe Forest Hospital 3 0 0 0 0 0 0 0 0 0 3 0 0 0 0Trinity Hospital 38 0 0 0 0 30 0 0 0 0 50 0 0 0 0UC Davis Medical Center 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0Veterans Administration, Reno 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0

Northern California EMS Agency



Page 15

Orange County EMS Agency

Orange County EMS Agency APOT -1



Offloads90th


Anaheim Global Medical Center 226 0:53:09 162 0:30:58 222 0:29:43Anaheim Regional Medical Center 380 0:45:49 356 0:38:01 430 0:33:55Chapman Global Medical Center 72 0:42:30 56 0:09:28 54 0:10:02Children's Hospital of Orange County 155 0:14:09 162 0:14:55 161 0:13:31Foothill Regional Medical Center 110 1:06:39 91 0:30:29 98 0:36:13Fountain Valley Regional Hospital and Medical Center 662 0:38:21 578 0:20:25 581 0:20:46Garden Grove Hospital & Medical Center 374 0:43:15 327 0:25:09 334 0:21:51Hoag Hospital Irvine 517 0:17:58 526 0:15:25 585 0:15:08Hoag Memorial Hospital Presbyterian 1545 0:18:54 1262 0:13:35 1485 0:14:42Huntington Beach Hospital 354 0:52:41 293 0:37:19 308 0:19:22Kaiser Permanente - Anaheim Medical Center 487 0:43:54 366 0:23:40 383 0:27:45Kaiser Permanente - Irvine Medical Center 451 0:33:16 302 0:21:00 336 0:22:30La Palma Intercommunity Hospital 191 0:28:00 180 0:19:03 210 0:24:46Los Alamitos Medical Center 618 0:58:07 554 0:44:02 573 0:46:29


2 18134

3

6

16

5636

4

7

17

10

21

1

8

13

381

137

332

7

16

40

1

55

4

7

10

12

24 4 30

2

15631

4

5

17

51

52

1

10

20

5

25

2 1

3

50

2

1

0:00:00

0:02:53

0:05:46

0:08:38

0:11:31

0:14:24

0:17:17

0:20:10

0:23:02

0:25:55

0:28:48

Times

(h:m

m:s

s)

Hospitals

Northern California EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 16

Orange County EMS Agency APOT -1 Continued…



Offloads90th


Mission Hospital - Laguna Beach 296 0:29:27 245 0:20:31 219 0:22:22Mission Hospital Regional Medical Center 1228 0:28:20 1091 0:26:06 1173 0:25:27Orange Coast Memorial Medical Center 451 1:09:02 412 0:20:48 410 0:20:45Orange County Global Medical Center 593 0:40:57 493 0:18:26 620 0:20:34Placentia Linda Hospital 426 0:40:38 283 0:18:50 322 0:15:03Saddleback Memorial Medical Center - Laguna Hills 725 0:20:51 639 0:18:33 751 0:18:16South Coast Global Medical Center 237 0:46:09 142 0:15:15 159 0:17:14St. Joseph Hospital 1017 0:30:43 784 0:18:58 867 0:20:36St. Jude Medical Center 1256 0:44:18 972 0:25:43 1120 0:27:23UCI Medical Center 946 0:35:50 819 0:30:54 948 0:30:03West Anaheim Medical Center 543 1:02:17 479 0:33:00 594 0:26:39

Orange County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Anaheim Global Medical Center 160 40 5 14 1 120 35 1 4 0 171 35 4 5 0Anaheim Regional Medical Center 257 94 7 15 1 266 62 8 8 1 313 97 10 3 0Chapman Global Medical Center 57 5 4 1 1 53 0 0 0 0 50 1 0 0 0Children's Hospital of Orange County 145 7 0 0 0 153 6 0 0 0 157 1 0 0 0Foothill Regional Medical Center 64 30 7 6 0 75 10 4 1 0 80 9 2 6 0Fountain Valley Regional Hospital and Medical Center 482 137 13 18 2 521 52 0 0 0 516 55 3 0 0Garden Grove Hospital & Medical Center 273 75 6 15 3 279 35 5 8 0 294 31 2 3 0Hoag Hospital Irvine 477 36 1 0 0 503 21 0 0 0 563 18 0 0 0Hoag Memorial Hospital Presbyterian 1403 106 5 4 0 1222 23 1 0 0 1437 32 0 0 0Huntington Beach Hospital 247 81 6 18 0 239 36 5 8 1 280 22 1 1 0Kaiser Permanente - Anaheim Medical Center 313 124 12 15 0 288 48 1 1 0 298 62 3 0 0Kaiser Permanente - Irvine Medical Center 341 97 6 4 0 270 30 1 0 0 293 40 2 0 0La Palma Intercommunity Hospital 94 23 2 4 0 86 14 0 1 0 111 26 0 0 0Los Alamitos Medical Center 262 240 28 27 0 308 172 11 13 1 308 164 25 15 0Mission Hospital - Laguna Beach 235 55 1 1 0 220 23 0 1 0 191 23 1 2 0Mission Hospital Regional Medical Center 987 223 12 3 0 895 178 7 3 0 984 172 7 0 0Orange Coast Memorial Medical Center 276 114 20 33 3 370 37 3 0 0 368 35 2 2 0Orange County Global Medical Center 446 116 13 12 2 456 30 0 0 0 551 49 6 4 1Placentia Linda Hospital 339 60 9 10 0 256 22 1 0 0 297 11 0 0 0Saddleback Memorial Medical Center - Laguna Hills 655 63 6 1 0 595 42 0 0 0 704 45 0 1 0South Coast Global Medical Center 176 45 8 6 1 134 7 0 0 0 153 4 2 0 0St. Joseph Hospital 781 185 9 15 1 700 60 1 1 0 753 77 3 6 0St. Jude Medical Center 739 320 30 34 2 712 141 4 2 0 793 202 7 1 0UCI Medical Center 695 195 20 9 0 646 139 9 4 0 749 171 7 0 0West Anaheim Medical Center 306 168 29 25 3 356 106 7 5 0 465 110 3 5 0



Page 17

Riverside County EMS Agency

Riverside County EMS Agency APOT -1



Offloads90th


Corona Regional Med Ctr 683 2:01:25 606 0:48:26 680 0:45:12Desert Regional Med Ctr 1174 0:37:11 969 0:29:51 1242 0:33:41Eisenhower Health 1302 0:16:41 1051 0:13:54 1272 0:16:29Hemet Valley Hospital 1085 1:57:52 1006 1:11:35 1229 0:44:40Inland Valley Med Ctr 806 1:17:17 733 0:42:49 829 0:32:43JFK Hospital 618 0:18:54 520 0:16:01 574 0:17:38Kaiser Hospital Moreno Valley 400 0:57:31 266 0:36:30 308 0:41:09Kaiser Hospital Riverside 642 1:05:19 459 0:41:33 507 0:45:58Loma Linda Univ Med Ctr Mur 714 1:08:32 546 0:50:09 630 0:47:56Menifee Med Ctr 274 2:39:05 204 1:02:12 237 0:40:00Palo Verde Hospital 169 0:19:40 128 0:14:22 110 0:11:03Parkview Community Hospital 565 1:20:48 384 0:40:56 442 0:34:33Rancho Springs Med Ctr 586 1:16:42 449 0:28:34 454 0:26:07Riverside Community Hospital 1405 1:14:58 1242 0:48:00 1406 0:37:29Riverside University Health System 1643 0:35:04 1240 0:29:10 1388 0:28:40San Gorgonio Mem Hospital 669 1:12:42 541 0:36:18 507 0:33:45Temecula Valley Hospital 586 0:45:00 504 0:34:02 505 0:36:37


226

38072

155

110

662374

517 1545

354

487

451191

618

296 1228

451

593 426

725

237

1017

1256

946

543

162

356

56

162

91

578327

5261262

293

366302 180

554

2451091

412493 283 639

142784

972819 479

222430

54 161

98

581 334

585 1485308

383336 210

573

219 1173410 620

322 751 159867

1120 948 594

0:00:00

0:14:24

0:28:48

0:43:12

0:57:36

1:12:00

1:26:24Tim

es (h

:mm

:ss)

Hospitals

Orange County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 18

Riverside County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Corona Regional Med Ctr 241 292 80 44 26 304 270 30 2 0 342 305 30 3 0Desert Regional Med Ctr 865 259 35 9 6 784 169 15 1 0 944 267 24 6 1Eisenhower Health 1218 81 3 0 0 1017 34 0 0 0 1203 68 1 0 0Hemet Valley Hospital 297 491 191 50 56 296 562 114 25 9 486 709 31 3 0Inland Valley Med Ctr 347 344 79 21 15 472 231 29 0 1 600 216 13 0 0JFK Hospital 565 52 1 0 0 490 30 0 0 0 538 36 0 0 0Kaiser Hospital Moreno Valley 249 116 24 5 6 190 66 8 1 1 210 84 11 2 1Kaiser Hospital Riverside 345 222 52 19 4 298 148 13 0 0 298 180 26 3 0Loma Linda Univ Med Ctr Mur 366 262 55 18 13 312 198 32 3 1 338 255 32 5 0Menifee Med Ctr 90 91 46 24 23 82 100 16 4 2 142 89 6 0 0Palo Verde Hospital 154 11 4 0 0 121 6 1 0 0 107 3 0 0 0Parkview Community Hospital 238 243 52 18 14 219 160 5 0 0 285 148 9 0 0Rancho Springs Med Ctr 260 243 59 16 8 340 103 5 1 0 351 101 2 0 0Riverside Community Hospital 366 804 187 41 7 447 735 59 1 0 678 711 16 1 0Riverside University Health System 870 760 13 0 0 854 379 7 0 0 940 443 4 0 1San Gorgonio Mem Hospital 264 305 78 13 9 303 223 13 2 0 314 183 10 0 0Temecula Valley Hospital 280 280 23 1 2 321 177 6 0 0 313 183 9 0 0


683

1174

1302

1085

806

618

400

642714

274

169

565586 1405

1643

669

586606

969

1051

1006

733

520

266459

546

204

128

384

449

1242

1240

541 504

680

1242

1272

1229

829

574

308507 630

237

110

442

454

1406

1388

507505

0:00:00

0:28:48

0:57:36

1:26:24

1:55:12

2:24:00

2:52:48

CoronaRegional Med

Ctr

DesertRegional Med

Ctr

EisenhowerHealth

Hemet ValleyHospital

Inland ValleyMed Ctr

JFK Hospital Kaiser HospitalMoreno Valley

Kaiser HospitalRiverside

Loma LindaUniv Med Ctr

Mur

Menifee MedCtr

Palo VerdeHospital

ParkviewCommunity

Hospital

RanchoSprings Med

Ctr

RiversideCommunity

Hospital

RiversideUniversity

Health System

San GorgonioMem Hospital

TemeculaValley Hospital

Times

(h:m

m:s

s)

Hospitals

Riverside County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 19

Sacramento County EMS Agency

Sacramento County EMS Agency APOT -1



Offloads90th


Kaiser Morse 1496 0:35:00 1283 0:33:00 1397 0:34:00Kaiser Roseville 650 0:43:00 563 0:42:00 649 0:35:00Kaiser South 1535 1:05:00 1198 0:46:00 1499 0:43:00Mercy General 695 0:49:00 646 0:49:00 704 0:49:00Mercy of Folsom 567 0:23:00 471 0:20:00 457 0:19:00Mercy San Juan 1451 1:04:00 1296 0:57:00 1412 0:59:00Methodist 862 0:57:00 731 0:41:00 746 0:48:00Sutter Sacramento 1279 1:13:00 1120 1:04:00 1323 1:09:00Sutter Roseville 350 0:41:00 293 0:28:00 340 0:32:00UC Davis 1134 0:55:00 939 0:48:00 1208 0:40:00VA Hospital 161 0:21:00 165 0:23:00 174 0:16:00Out of area hopitals 80 0:22:00 69 0:13:00 54 0:23:00

Sacramento County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Kaiser Morse 946 521 25 1 0 788 479 12 1 0 800 565 25 2 0Kaiser Roseville 429 188 23 7 0 391 152 16 2 1 448 176 22 0 0Kaiser South 1055 307 117 38 12 901 230 59 5 2 1123 278 75 19 2Mercy General 364 290 38 2 0 319 296 30 1 0 328 330 42 2 0Mercy of Folsom 497 64 3 0 0 427 43 0 0 0 418 36 0 0 0Mercy San Juan 874 416 116 33 10 768 413 94 15 5 879 396 105 23 6Methodist 348 439 53 12 8 366 343 19 1 0 312 399 31 3 1Sutter Sacramento 390 693 171 21 3 409 582 111 12 5 422 714 170 13 0Sutter Roseville 177 169 4 0 0 226 63 3 0 0 241 97 0 2 0UC Davis 738 288 45 34 27 606 259 33 20 18 870 252 50 16 14VA Hospital 145 14 2 0 0 147 18 0 0 0 160 12 0 0 0Out of area hopitals 72 7 0 1 0 68 1 0 0 0 48 5 1 0 0



1496

650

1535

695

567

1451862

1279

350

1134

161 801283

5631198 646

471

1296

731

1120

293

939

165

69

1397 649

1499704

457

1412

746

1323

340

1208

17454

0:00:00

0:14:24

0:28:48

0:43:12

0:57:36

1:12:00

1:26:24

Kaiser Morse Kaiser Roseville Kaiser South Mercy General Mercy of Folsom Mercy San Juan Methodist SutterSacramento

Sutter Roseville UC Davis VA Hospital Out of areahopitals

Times

(h:m

m:s

s)

Hospitals

Sacramento County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 20

San Benito County EMS Agency

San Benito County EMS Agency APOT -1



Offloads90th


Hazel Hawkins 175 0:11:51 151 0:12:03 162 0:06:36Natividad Medical Center 2 0:05:12 2 0:05:24 5 0:08:06

San Benito County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Hazel Hawkins 172 3 0 0 0 151 1 0 0 0 162 0 0 0 0Natividad Medical Center 2 0 0 0 0 2 0 0 0 0 5 0 0 0 0

San Diego County EMS Agency

San Diego County EMS Agency APOT -1



Offloads90th


Alvarado Hospital Medical Center 411 0:31:11 250 0:29:16 284 0:23:36Kaiser San Diego Medical Center 385 0:33:01 354 0:27:53 384 0:28:28Kaiser Zion Medical Center 565 0:29:02 372 0:28:43 425 0:35:12Naval Medical Center, San Diego 82 0:16:38 61 0:14:30 77 0:13:58Palomar Medical Center 668 0:47:07 695 0:36:09 746 0:37:23Palomar Medical Center-Poway 116 0:56:24 137 0:37:36 168 0:39:23Paradise Valley Hospital 37 0:58:40 37 0:53:47 55 0:36:31Rady Childrens Hospital 110 0:25:26 122 0:34:10 100 0:28:11Scripps Memorial Encinitas 690 0:39:26 570 0:31:01 529 0:23:12Scripps Memorial La Jolla 1121 0:17:52 819 0:17:36 838 0:16:08Scripps Mercy Chula Vista 429 0:47:47 373 0:38:08 408 0:38:37Scripps Mercy San Diego 608 0:38:26 614 0:31:48 678 0:33:56Sharp Chula Vista Medical Center 565 0:40:39 573 0:37:14 672 0:37:26Sharp Coronado Hospital 46 0:23:14 37 0:29:35 43 0:19:49Sharp Grossmont Hospital 1308 0:45:30 1314 0:40:28 1544 0:38:12Sharp Memorial Hospital 1364 0:29:30 1127 0:25:39 1176 0:21:38Temecula Valley Hospital 253 0:48:58 148 0:37:23 155 0:44:54Tri-City Medical Center 537 0:42:43 535 0:34:15 704 0:31:34UCSD La Jolla-Thornton 31 0:29:04 33 0:31:25 52 0:26:25UCSD Medical Center 398 0:51:46 510 0:39:13 838 0:34:50




175

2

151

21625

0:00:000:02:530:05:460:08:380:11:310:14:24

Hazel Hawkins Natividad Medical Center

Times

(h:m

m:s

s)

Hospitals

San Benito County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads


Page 21

San Diego County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Alvarado Hospital Medical Center 325 77 7 0 2 203 44 3 0 0 247 37 0 0 0Kaiser San Diego Medical Center 284 92 9 0 0 287 64 3 0 0 303 78 3 0 0Kaiser Zion Medical Center 441 113 7 1 3 291 80 1 0 0 296 122 7 0 0Naval Medical Center, San Diego 79 3 0 0 0 58 2 0 1 0 76 1 0 0 0Palomar Medical Center 362 268 33 5 0 429 258 7 1 0 463 276 7 0 0Palomar Medical Center-Poway 70 37 6 2 1 100 32 5 0 0 127 34 7 0 0Paradise Valley Hospital 18 16 2 1 0 23 11 3 0 0 35 19 1 0 0Rady Childrens Hospital 92 18 0 0 0 84 36 2 0 0 80 19 0 0 1Scripps Memorial Encinitas 464 206 19 0 1 420 138 12 0 0 455 74 0 0 0Scripps Memorial La Jolla 1038 82 0 1 0 761 58 0 0 0 786 51 1 0 0Scripps Mercy Chula Vista 175 236 17 1 0 227 137 9 0 0 238 163 7 0 0Scripps Mercy San Diego 366 231 10 1 0 416 192 6 0 0 408 266 3 0 1Sharp Chula Vista Medical Center 373 170 18 4 0 426 135 12 0 0 475 177 19 1 0Sharp Coronado Hospital 40 6 0 0 0 31 6 0 0 0 39 4 0 0 0Sharp Grossmont Hospital 866 353 76 11 2 967 283 59 5 0 1120 377 42 5 0Sharp Memorial Hospital 1092 254 17 1 0 960 165 2 0 0 1046 126 4 0 0Temecula Valley Hospital 108 131 14 0 0 73 72 3 0 0 71 80 4 0 0Tri-City Medical Center 328 179 24 5 1 345 177 13 0 0 482 215 7 0 0UCSD La Jolla-Thornton 25 6 0 0 0 24 9 0 0 0 43 9 0 0 0UCSD Medical Center 171 204 21 2 0 277 220 12 0 1 571 256 11 0 0


411385

565

82

668

11637

110

690

1121

429

608565

46

1308

1364

253

537

31

398

250354 372

61

695137

37

122

570

819

373

614

573

37

1314

1127

148

535

33

510

284

384

425

77

746168

55

100

529

838

408

678

672

43

1544

1176

155

704

52

838

0:00:00

0:07:12

0:14:24

0:21:36

0:28:48

0:36:00

0:43:12

0:50:24

0:57:36

1:04:48

Times

(h:m

m:s

s)

Hospitals

San Diego County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 22

San Francisco County EMS Agency

San Francisco County EMS Agency APOT -1



Offloads90th


CPMC Mission Bernal Campus 572 0:36:54 640 0:29:49 471 0:30:26CPMC Davies Campus Hospital 298 0:29:05 298 0:22:12 191 0:26:40CPMC-Van Ness 714 0:35:40 676 0:34:21 627 0:31:25Chinese Hospital 92 0:19:13 80 0:19:33 64 0:18:09Kaiser Permanente, San Francisco 502 0:22:33 561 0:22:00 430 0:22:51South San Francisco Kaiser 50 0:20:37 65 0:20:20 52 0:15:05Seton Medical Center 36 0:34:37 57 0:21:03 33 0:13:38Saint Francis Memorial Hospital 766 0:20:46 959 0:22:42 577 0:20:55St. Mary's Medical Center 395 0:27:14 399 0:27:58 329 0:24:02UCSF Medical Center - Benioff 49 0:21:58 78 0:20:38 31 0:20:00UCSF Medical Center - Parnassus 773 0:38:50 871 0:37:24 734 0:35:19Veterans Administration Medical Center, San Francisco 82 0:21:34 67 0:21:48 71 0:18:43Zuckerberg San Francisco General Hospital 1257 0:25:09 1285 0:30:00 1177 0:24:38

San Francisco County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

CPMC Mission Bernal Campus 405 143 21 3 0 473 157 10 0 0 365 93 12 1 0CPMC Davies Campus Hospital 233 56 6 3 0 252 46 0 0 0 157 33 1 0 0CPMC-Van Ness 479 218 13 4 0 422 241 12 1 0 464 160 3 0 0Chinese Hospital 85 6 0 0 1 74 6 0 0 0 60 4 0 0 0Kaiser Permanente, San Francisco 418 81 3 0 0 475 85 1 0 0 370 59 1 0 0South San Francisco Kaiser 43 7 0 0 0 58 7 0 0 0 50 2 0 0 0Seton Medical Center 30 6 0 0 0 51 6 0 0 0 32 1 0 0 0Saint Francis Memorial Hospital 678 87 1 0 0 822 137 0 0 0 513 61 1 1 1St. Mary's Medical Center 315 72 7 1 0 309 88 1 1 0 274 53 2 0 0UCSF Medical Center - Benioff 42 7 0 0 0 66 12 0 0 0 28 3 0 0 0UCSF Medical Center - Parnassus 414 341 14 3 1 503 349 19 0 0 440 287 7 0 0Veterans Administration Medical Center, San Francisco 71 11 0 0 0 59 8 0 0 0 66 5 0 0 0Zuckerberg San Francisco General Hospital 950 304 3 0 0 879 404 2 0 0 962 212 3 0 0



572

298

714

92502

50

36

766

395

49

773

821257

640

298

676

80561

65 57959

399

78

871

67

1285471191

627

64

430

52 33

577329

31

734

71

1177

0:00:00

0:07:12

0:14:24

0:21:36

0:28:48

0:36:00

0:43:12

CPMC MissionBernal Campus

CPMC DaviesCampus Hospital

CPMC-Van Ness Chinese Hospital Kaiser Permanente,San Francisco

South SanFrancisco Kaiser

Seton MedicalCenter

Saint FrancisMemorial Hospital

St. Mary's MedicalCenter

UCSF MedicalCenter - Benioff

UCSF MedicalCenter - Parnassus

VeteransAdministration

Medical Center,San Francisco

Zuckerberg SanFrancisco General

Hospital

Times

(h:m

m:s

s)

Hospitals

San Francisco County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 23

San Joaquin County EMS Agency

San Joaquin County EMS Agency APOT -1



Offloads90th


Adventist Lodi Memorial Hospital 634 0:31:06 546 0:26:52 641 0:29:12Dameron Hospital 580 0:35:00 454 0:31:43 465 0:30:05Doctors Hospital of Manteca 326 0:26:00 286 0:24:00 351 0:18:28Kaiser Hospital, Manteca 280 0:33:13 258 0:25:34 303 0:29:32San Joaquin General Hospital 1105 0:39:00 970 0:34:41 1,129 0:34:12St. Joseph's Medical Center 2,062 0:44:00 1750 0:39:08 1,989 0:38:01Sutter Tracy Community Hospital 330 0:39:51 285 0:27:13 322 0:31:00

San Joaquin County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Adventist Lodi Memorial Hospital 424 203 6 0 1 421 124 1 0 0 449 189 3 0 0Dameron Hospital 385 185 10 0 0 307 137 10 0 0 346 113 6 0 0Doctors Hospital of Manteca 268 57 2 0 0 244 42 1 0 0 321 30 0 0 0Kaiser Hospital, Manteca 195 81 4 0 0 186 72 0 0 0 214 83 6 0 0San Joaquin General Hospital 645 443 16 2 0 593 372 6 0 0 702 418 8 0 1St. Joseph's Medical Center 956 1025 78 3 0 806 926 18 1 0 951 1015 23 0 0Sutter Tracy Community Hospital 199 123 8 0 0 216 67 2 0 0 209 110 3 0 0

San Luis Obispo County EMS Agency

San Luis Obispo County EMS Agency APOT -1



Offloads90th


Arroyo Grande Community Hospital 213 0:14:14 182 0:12:45 240 0:12:46French Hospital Medical Center 213 0:13:49 227 0:12:27 216 0:12:04Marian Medical Center (Santa Barbara Co) 308 0:14:14 237 0:13:32 284 0:12:22Sierra Vista Regional Medical Center 345 0:15:02 304 0:12:51 335 0:12:13Twin Cities Community Hospital 79 0:15:17 58 0:14:22 73 0:12:26




634580

326

2801105

2,062330

546454

286 258

9701750

285641 465

351

3031,129

1,989

322

0:00:00

0:07:12

0:14:24

0:21:36

0:28:48

0:36:00

0:43:12

0:50:24

Adventist Lodi MemorialHospital

Dameron Hospital Doctors Hospital ofManteca

Kaiser Hospital, Manteca San Joaquin GeneralHospital

St. Joseph's MedicalCenter

Sutter Tracy CommunityHospital

Times

(h:m

m:s

s)

Hospitals

San Joaquin EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 24

San Luis Obispo County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Arroyo Grande Community Hospital 206 8 0 0 0 176 6 0 0 0 235 5 0 0 0French Hospital Medical Center 204 10 0 0 0 223 4 0 0 0 213 3 0 0 0Marian Medical Center (Santa Barbara Co) 77 2 0 0 0 54 4 0 0 0 72 1 0 0 0Sierra Vista Regional Medical Center 292 16 0 0 0 228 9 0 0 0 280 4 0 0 0Twin Cities Community Hospital 337 8 0 0 0 300 4 0 0 0 332 3 0 0 0

San Mateo County EMS Agency

San Mateo County EMS Agency APOT -1



Offloads90th


Cal Pacific - Davies 1 0:01:19 0 0:00:00 2 0:09:59California Pacific Medical Center 0 0:00:00 0 0:00:00 0 0:00:00Dominican 1 0:02:38 0 0:00:00 1 0:10:00Eden 0 0:00:00 1 0:02:04 1 0:45:00El Camino 0 0:00:00 0 0:00:00 1 0:10:00Kaiser Redwoood City 343 0:08:48 304 0:09:12 355 0:10:00Kaiser San Francisco 6 0:15:51 3 0:05:00 2 0:12:11Kaiser South San Francisco 221 0:15:43 225 0:12:00 245 0:10:34Mills-Peninsula 902 0:14:58 733 0:14:17 837 0:15:14Other Hospitals 0 0:00:00 0 0:00:00 0 0:00:00Palo Alto Veterans 35 0:08:52 22 0:14:28 24 0:07:00San Mateo Medical Center 274 0:09:06 252 0:10:00 248 0:09:02San Mateo Medical Center Psych 0 0:00:00 0 0:00:00 0 0:00:00Santa Clara Valley Medical Center 2 0:01:49 2 0:01:19 0 0:00:00Sequoia 189 0:08:44 158 0:10:00 190 0:08:00Seton 276 0:10:21 267 0:10:00 263 0:08:00Seton Coastside 0 0:00:00 1 0:10:38 0 0:00:00St. Luke's 0 0:00:00 0 0:00:00 0 0:00:00Stanford University Hospital 460 0:09:00 404 0:09:59 483 0:09:53UC San Francisco 3 0:40:13 1 0:30:08 6 0:17:56Zuckerberg San Francisco General 41 0:15:00 35 0:27:43 62 0:18:25

March 2021



213 213 308345 79

182 227237 304

58240 216 284 335 73

0:00:00

0:02:53

0:05:46

0:08:38

0:11:31

0:14:24

0:17:17

Arroyo Grande Community Hospital French Hospital Medical Center Marian Medical Center (SantaBarbara Co)

Sierra Vista Regional Medical Center Twin Cities Community Hospital

Times

(h:m

m:s

s)

Hospitals

San Luis Obispo County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 25

San Mateo County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Cal Pacific- Davies 1 0 0 0 0 0 0 0 0 0 2 0 0 0 0California Pacific Medical Center 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Dominican 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0Eden 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0El Camino 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0Kaiser Redwoood City 334 8 0 0 1 295 9 0 0 0 342 13 0 0 0Kaiser San Francisco 6 0 0 0 0 3 0 0 0 0 2 0 0 0 0Kaiser South San Francisco 206 15 0 0 0 222 3 0 0 0 241 4 0 0 0Mills-Peninsula 853 49 0 0 0 691 42 0 0 0 801 36 0 0 0Other Hospitals 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Palo Alto Veterans 35 0 0 0 0 20 2 0 0 0 24 0 0 0 0San Mateo Medical Center 270 3 1 0 0 248 4 0 0 0 245 3 0 0 0San Mateo Medical Center Psych 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Santa Clara Valley Medical Center 2 0 0 0 0 2 0 0 0 0 0 0 0 0 0Sequoia 185 4 0 0 0 154 4 0 0 0 187 3 0 0 0Seton 267 9 0 0 0 260 7 0 0 0 259 4 0 0 0Seton Coastside 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0St. Luke's 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Stanford University Hospital 456 4 0 0 0 395 9 0 0 0 469 13 1 0 0UC San Francisco 2 1 0 0 0 0 1 0 0 0 6 0 0 0 0Zuckerberg San Francisco General 40 1 0 0 0 29 6 0 0 0 58 4 0 0 0


10

10 0

343

6 221

902

0

35274

02

189276

0 0

460

3

41

0 0 01

0

304

3

225733

0

22

252

02

158 267 1

0

404

135

2

0

1

1

1 3552

245 837

0

24248

0 0

190 263

0 0

483

6 62

0:00:00

0:07:12

0:14:24

0:21:36

0:28:48

0:36:00

0:43:12

0:50:24

Times

(h:m

m:s

s)

Hospitals

San Mateo County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 26

Santa Barbara County EMS Agency

Santa Barbara County EMS Agency APOT -1



Offloads90th


Goleta Valley Cottage Hospital 92 0:11:50 89 0:14:23 106 0:14:47Lompoc Valley Medical Center 267 0:17:30 250 0:14:41 245 0:16:21Marian Regional Medical Center 701 0:18:23 558 0:20:44 603 0:17:16Santa Barbara Cottage Hospital 893 0:19:56 793 0:17:32 941 0:17:12Santa Ynez Valley Cottage Hospital 82 0:14:17 82 0:10:49 104 0:14:16

Santa Barbara County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Goleta Valley Cottage Hospital 91 1 0 0 0 85 4 0 0 0 104 2 0 0 0Lompoc Valley Medical Center 255 12 0 0 0 240 10 0 0 0 229 16 0 0 0Marian Regional Medical Center 642 57 1 1 0 493 65 0 0 0 566 36 0 0 1Santa Barbara Cottage Hospital 804 88 1 0 0 743 50 0 0 0 890 49 2 0 0Santa Ynez Valley Cottage Hospital 79 3 0 0 0 82 0 0 0 0 100 4 0 0 0

Santa Clara County EMS Agency

Santa Clara County EMS Agency APOT -1



Offloads90th


El Camino Hospital 722 0:17:09 717 0:15:00 703 0:14:13El Camino Hospital Los Gatos 146 0:11:04 100 0:09:13 120 0:08:25Good Samaritan Hospital 767 0:21:54 626 0:17:13 738 0:20:49Kaiser San Jose 693 0:29:57 593 0:23:42 644 0:19:28Kaiser Santa Clara 701 0:25:35 643 0:23:11 653 0:20:59O'Connor Hospital 953 0:21:34 687 0:15:41 730 0:14:02Regional Medical Center 1067 0:28:45 978 0:24:17 1075 0:20:14Saint Louise Regional Hospital 383 0:16:05 306 0:12:09 345 0:12:38Santa Clara Valley Medical Center 1192 0:53:59 1090 0:46:00 1305 0:51:48Stanford Health Care 443 0:13:23 420 0:09:25 465 0:09:18

March 2021




92

267 701893

8289 250

558

793

82

106245 603 941

104

0:00:00

0:02:53

0:05:46

0:08:38

0:11:31

0:14:24

0:17:17

0:20:10

0:23:02

Goleta Valley Cottage Hospital Lompoc Valley Medical Center Marian Regional Medical Center Santa Barbara Cottage Hospital Santa Ynez Valley Cottage Hospital

Times

(h:m

m:s

s)

Hospitals

Santa Barbara County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 27

Santa Clara County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

El Camino Hospital 692 96 1 0 0 695 22 0 0 0 691 12 0 0 0El Camino Hospital Los Gatos 142 3 1 0 0 100 0 0 0 0 118 2 0 0 0Good Samaritan Hospital 685 73 9 0 0 593 33 0 0 0 665 67 6 0 0Kaiser San Jose 584 85 17 7 0 524 62 7 0 0 593 46 5 0 0Kaiser Santa Clara 592 96 13 0 0 566 72 5 0 0 587 65 1 0 0O'Connor Hospital 848 104 1 0 0 657 29 1 0 0 707 23 0 0 0Regional Medical Center 908 112 31 10 6 868 92 12 6 0 976 93 6 0 0Saint Louise Regional Hospital 364 15 4 0 0 300 6 0 0 0 336 9 0 0 0Santa Clara Valley Medical Center 874 218 78 22 0 420 0 0 0 0 461 4 0 0 0Stanford Health Care

Santa Cruz County EMS Agency

Santa Cruz County EMS Agency APOT -1



Offloads90th


Dominican Hospital, Santa Cruz 751 0:26:01 709 0:22:30 837 0:20:05Good Samaritan Hospital, San Jose 2 0:27:56 2 0:08:51 2 0:25:58Natividad Medical Center 8 0:11:20 14 0:07:35 7 0:10:55Salinas Valley Memorial Hospital 1 0:10:13 1 0:08:45Santa Clara Valley Medical Center 13 0:11:08 15 0:10:11 25 0:13:45Watsonville Community Hospital 278 0:20:01 203 0:17:06 232 0:15:13

Santa Cruz County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Dominican Hospital, Soquel 661 86 4 0 0 641 65 3 0 0 782 55 0 0 0Good Samaritan Hospital, San Jose 1 1 0 0 0 2 0 0 0 0 1 1 0 0 0Natividad Medical Center 8 0 0 0 0 14 0 0 0 0 7 0 0 0 0Salinas Valley Memorial Hospital 1 0 0 0 0 1 0 0 0 0Santa Clara Valley Medical Center 13 0 0 0 0 15 0 0 0 0 23 2 0 0 0Watsonville Community Hospital 255 21 2 0 0 191 11 1 0 0 223 9 0 0 0

Febuary 2021


March 2021


January 2021

722146

767

693701

9531067

383

1192

443717100

626593 643

687

978

306

1090

420703

120

738 644 653730

1075345

1305

465

0:00:000:07:120:14:240:21:360:28:480:36:000:43:120:50:240:57:36

El CaminoHospital

El CaminoHospital Los

Gatos

Good SamaritanHospital

Kaiser San Jose Kaiser SantaClara

O'ConnorHospital

RegionalMedical Center

Saint LouiseRegionalHospital

Santa ClaraValley Medical

Center

Stanford HealthCare

Times

(h:m

m:s

s)

Hospitals

Santa Clara County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads


Page 28

Sierra-Sacramento Valley EMS Agency

Sierra-Sacramento Valley EMS Agency APOT -1



Offloads90th


Adventist Health +Rideout 1410 0:12:00 1288 0:13:00 1487 0:12:00Colusa Medical Center 52 0:09:00 58 0:10:00 59 0:09:00Enloe Medical Center 1188 0:09:00 957 0:09:00 1147 0:09:00Fairchild Medical Center 169 0:03:00 181 0:03:00 177 0:05:00Glenn Medical Center 43 0:05:00 42 0:05:00 54 0:05:00Kaiser Roseville Medical Center 676 0:47:00 605 0:40:00 638 0:40:00Mayers Memorial Hospital District 35 0:03:00 24 0:04:00 34 0:05:00Mercy Medical Center Mt. Shasta 130 0:05:00 118 0:05:00 144 0:05:00Mercy Medical Center Redding 985 0:18:00 891 0:17:00 1003 0:16:00Orchard Hospital 63 0:13:00 60 0:09:00 58 0:08:00Oroville Hospital 564 0:16:00 556 0:16:00 599 0:16:00Shasta Regional Medical Center 549 0:21:00 486 0:21:00 519 0:21:00Sierra Nevada Memorial Hospital 479 0:06:00 360 0:06:00 444 0:06:00St. Elizabeth Community Hospital 424 0:11:00 409 0:12:00 441 0:11:00Sutter Auburn Faith Hospital 386 0:15:00 320 0:14:00 389 0:14:00Sutter Roseville Medical Center 1310 0:39:00 1145 0:27:00 1316 0:28:00Tahoe Forest Hospital 207 0:06:00 164 0:06:00 180 0:07:00


7512

8 1 13

278709

2 14 1 15

203837

2

725 232

0:00:00

0:07:12

0:14:24

0:21:36

0:28:48

0:36:00

Dominican Hospital, Santa Cruz Good Samaritan Hospital, SanJose

Natividad Medical Center Salinas Valley MemorialHospital

Santa Clara Valley MedicalCenter

Watsonville CommunityHospital

Times

(h:m

m:s

s)

Hospitals

Santa Cruz County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 29

Sierra-Sacramento Valley EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Adventist Health +Rideout 1368 42 1250 38 1452 35Colusa Medical Center 52 58 59Enloe Medical Center 1188 957 1147Glenn Medical Center 169 181 177Fairchild Medical Center 43 42 54Kaiser Roseville Medical Center 436 200 35 5 372 199 30 4 395 215 28Mayers Memorial Hospital District 35 24 34Mercy Medical Center Mt. Shasta 130 118 144Mercy Medical Center Redding 923 62 830 61 957 46Orchard Hospital 63 60 58Oroville Hospital 536 28 529 27 575 24Shasta Regional Medical Center 487 58 4 426 57 3 456 63Sierra Nevada Memorial Hospital 479 360 444St. Elizabeth Community Hospital 424 409 441Sutter Auburn Faith Hospital 370 16 310 10 374 15Sutter Roseville Medical Center 787 497 26 849 292 4 975 336 5Tahoe Forest Hospital 207 164 180

March 2021January 2021 Febuary 2021

1410

52 1188

169

43

676

35130

985

63

564

549

479

424

386

1310

207

1288

58957

181

42

605

24118

891

60

556

486

360

409

320

1145

164

1487

591147

177 54

638

34144

1003

58

599

519

444

441

389

1316

180

0:00:00

0:07:12

0:14:24

0:21:36

0:28:48

0:36:00

0:43:12

0:50:24

AdventistHealth

+Rideout

Colusa MedicalCenter

Enloe MedicalCenter

FairchildMedical Center

Glenn MedicalCenter

Kaiser RosevilleMedical Center

MayersMemorial

Hospital District

Mercy MedicalCenter Mt.

Shasta

Mercy MedicalCenter

Redding

OrchardHospital

OrovilleHospital

ShastaRegional

Medical Center

Sierra NevadaMemorialHospital

St. ElizabethCommunity

Hospital

Sutter AuburnFaith Hospital

Sutter RosevilleMedical Center

Tahoe ForestHospital

Times

(h:m

m:s

s)

Hospitals

Sierra-Sacramento Valley EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 30

Solano County EMS Agency

Solano County EMS Agency APOT -1



Offloads90th


Children's Hospital Oakland 1 0:29:00 1 0:29:00 1 0:13:40Contra Costa Regional Medical Center 2 0:07:40David Grant Medical Center 79 0:19:00 59 0:18:00 77 0:18:05John Muir-Concord 13 0:27:10 15 0:22:40 26 0:18:00John Muir-Walnut Creek 15 0:29:00 8 0:17:45 15 0:16:00Kaiser Antioch 24 0:51:00 22 0:30:00 23 0:23:45Kaiser Vacaville 594 0:23:40 539 0:22:00 573 0:23:00Kaiser Vallejo 531 0:19:20 496 0:19:00 565 0:20:00Kaiser Walnut Creek 1 0:17:00 2 0:04:35 1 0:11:50Lodi Memorial 9 0:16:00 6 0:26:10 4 0:30:35NorthBay 747 0:21:40 651 0:21:40 739 0:21:10Queen of the Valley 3 0:22:30 4 0:17:45 3 0:12:00Sutter Davis 34 0:21:40 42 0:17:00 27 0:17:45Sutter Delta 23 0:45:30 27 0:34:30 23 0:29:55Sutter Solano 465 0:23:00 362 0:22:10 398 0:22:15UC Davis 1 0:38:30VacaValley 387 0:14:00 302 0:13:00 350 0:17:30Woodland Memorial Hospital 5 0:22:25 1 0:11:30

Solano County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Children's Hospital Oakland 1 1 1Contra Costa Regional Medical Center 2David Grant Medical Center 74 5 55 4 72 5John Muir-Concord 10 3 13 2 24 2John Muir-Walnut Creek 11 4 7 1 14 1Kaiser Antioch 14 9 1 12 10 17 6Kaiser Vacaville 469 124 451 86 2 475 96 1Kaiser Vallejo 486 45 463 33 517 48Kaiser Walnut Creek 1 2 1Lodi Memorial 9 4 2 3 1NorthBay 648 99 559 92 646 92 1Queen of the Valley 2 1 4 3Sutter Davis 29 5 40 2 27Sutter Delta 15 6 2 12 13 2 16 7Sutter Solano 388 73 4 309 52 1 340 58UC Davis 1VacaValley 370 15 1 1 291 9 2 328 21 1Woodland Memorial Hospital 4 1 1



Page 31

Ventura County EMS Agency

Ventura County EMS Agency APOT -1



Offloads90th


Adventist Health Simi Valley 535 0:22:21 438 0:15:40 543 0:15:43Community Memorial Hospital, San Buenaventura 513 0:23:38 433 0:19:06 468 0:20:04Los Robles Regional Medical Center 632 0:26:23 641 0:25:26 688 0:22:46Ojai Valley Community Hospital 116 0:16:18 103 0:11:59 95 0:17:35St. John's Pleasant Valley Hospital 340 0:19:07 346 0:16:21 356 0:15:16St. John's Regional Medical Center 1045 0:25:41 829 0:21:33 845 0:18:43Ventura County Medical Center 292 0:29:32 254 0:23:50 317 0:19:59Ventura County Medical Center - Santa Paula Hospital 184 0:32:24 150 0:22:06 145 0:19:20

Ventura County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Adventist Health Simi Valley 477 50 8 0 0 421 17 0 0 0 530 12 1 0 0Community Memorial Hospital, San Buenaventura 443 65 5 0 0 401 30 2 0 0 431 37 0 0 0Los Robles Regional Medical Center 526 96 10 0 0 535 101 5 0 0 600 86 2 0 0Ojai Valley Community Hospital 107 7 2 0 0 103 0 0 0 0 90 5 0 0 0St. John's Pleasant Valley Hospital 317 23 0 0 0 337 9 0 0 0 346 10 0 0 0St. John's Regional Medical Center 890 139 12 2 2 742 78 9 0 0 784 59 2 0 0Ventura County Medical Center 232 54 6 0 0 220 32 2 0 0 291 25 1 0 0Ventura County Medical Center - Santa Paula Hospital 150 21 10 2 1 134 15 0 0 0 134 9 1 0 0



1

79

1315

24

594531 1 9

747

3 34

23

465

1

387

5

1

59

15

8

22

539496

2

6

651

4 42

27

362

3021

1

2

77 2615

23

573 565

1

4

739

3

27

23

398350

0:00:00

0:07:12

0:14:24

0:21:36

0:28:48

0:36:00

0:43:12

0:50:24

0:57:36Tim

es (h

:mm

:ss)

Hospitals

Solano County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 32

Yolo County EMS Agency

Yolo County EMS Agency APOT -1

Hospital Name Offloads90th Percentile

APOT TimeOffloads


Offloads90th Percentile

APOT Time

Kaiser Hospital North Sacramento 43 0:30:04 29 0:34:54 36 0:34:51Kaiser Hospital South Sacramento 47 1:16:25 42 1:21:06 52 0:35:06Kaiser Vacaville Hospital 99 0:20:26 93 0:16:18 113 0:18:26Mercy General Hospital 57 0:39:50 62 0:51:14 58 0:42:41Sutter Davis Hospital 285 0:24:19 265 0:18:35 264 0:24:29Sutter Medical Center Sacramento 155 1:11:08 119 1:02:03 117 1:00:05UC Davis Medical Center 136 1:29:13 146 0:59:06 143 0:49:39Woodland Memorial Hospital 371 0:35:06 286 0:19:05 350 0:24:59Other 18 0:15:55 13 0:14:43 9 0:23:00

Yolo County EMS Agency APOT - 2Hospital Name 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5 2.1 2.2 2.3 2.4 2.5

Kaiser Hospital North Sacramento 20 22 1 15 14 22 13 1Kaiser Hospital South Sacramento 27 13 6 1 25 11 4 1 1 39 12 1Kaiser Vacaville Hospital 87 12 86 7 105 8Mercy General Hospital 31 23 3 20 39 3 32 25 1Sutter Davis Hospital 253 28 4 249 16 1 233 28 3Sutter Medical Center Sacramento 47 88 14 6 35 73 21 10 1 37 71 9UC Davis Medical Center 90 36 3 2 5 105 37 1 2 1 103 30 9 1Woodland Memorial Hospital 300 61 9 1 268 17 1 302 45 3

March 2021



535513

632

116

340

1045

292

184

438

433

641

103

346

829254

150

543

468

688

95356

845317 145

0:00:00

0:07:12

0:14:24

0:21:36

0:28:48

0:36:00

Adventist Health SimiValley

Community MemorialHospital, San

Buenaventura

Los Robles RegionalMedical Center

Ojai Valley CommunityHospital

St. John's PleasantValley Hospital

St. John's RegionalMedical Center

Ventura CountyMedical Center

Ventura CountyMedical Center -

Santa Paula Hospital

Tim

es

(h:m

m:s

s)

Hospitals

Ventura County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 33

43

47

99

57

285

155

136

371

18

29

42

93

62

265

119146

28613

36 52

113

58

264

117

143

350 9

0:00:00

0:14:24

0:28:48

0:43:12

0:57:36

1:12:00

1:26:24

1:40:48

Kaiser HospitalNorth Sacramento

Kaiser HospitalSouth Sacramento

Kaiser VacavilleHospital

Mercy GeneralHospital

Sutter DavisHospital

Sutter MedicalCenter

Sacramento

UC Davis MedicalCenter

WoodlandMemorial Hospital

Other

Tim

es

(hh:

mm

:ss)

Hospitals

Yolo County EMS Agency - Reported Hospital 90th Percentile APOT Times and Count of Offloads

January 2021

February 2021

March 2021

Page 34

APOT – 1 Weighted Average 90th Percentile by LEMSA and Hospital

LEMSA Hospital NameQ2 2020 - Q1

2021Total Offloads

Q2 2020 - Q1 2021

Weighted Average 90th

Percentile*Alameda Alameda Hospital 2725 0:26:29Alameda Alta Bates Medical Center - Berkeley 4960 0:45:56Alameda Alta Bates Medical Center - Summit 12342 0:41:16Alameda Children's Hospital Oakland 5306 0:53:44Alameda Eden 11675 0:56:23Alameda Highland 8195 0:59:34Alameda John George 3881 0:54:54Alameda Kaiser - Walnut Creek 5284 0:46:54Alameda Kaiser Fremont 6869 0:42:15Alameda Kaiser Oakland 4877 0:46:21Alameda Kaiser San Leandro 4995 0:58:11Alameda San Leandro Hospital 5055 0:44:27Alameda St. Rose 5560 0:55:02Alameda ValleyCare 3552 1:00:41Alameda Washington Hospital 8722 0:39:54Alameda Willow Rock Center 192 0:38:05Central California Adventist Medical Center - Hanford 9565 0:44:38Central California Adventist Medical Center - Reedley 1113 0:31:51Central California Adventist Medical Center - Selma 1712 0:30:29Central California Adventist Medical Center - Tulare 229 0:57:00Central California Clovis Community Hospital 15246 0:57:41Central California Coalinga Hospital 83 0:33:14Central California Kaiser Hospital - Fresno 8074 0:46:05Central California Kaweah Delta Medical Center 16908 1:11:50Central California Madera Community Hospital 4849 0:51:29Central California Regional Medical Center 37590 1:18:01Central California Saint Agnes medical Center 24993 0:45:36Central California Sierra View District Hospital 5867 1:15:24Central California Valley Childrens Hospital 2328 0:16:37Central California Veterans Administration Medical Center 2078 0:25:31Contra Costa Alameda County Medical Center 154 0:36:29Contra Costa Alta Bates 1769 0:49:28Contra Costa Childrens Oakland 314 0:25:25Contra Costa Contra Costa County Psychiatric Emergency 4811 0:57:37Contra Costa Contra Costa Regional 5080 0:51:40Contra Costa Eden 7 0:19:56Contra Costa John Muir - Concord 9673 0:26:26Contra Costa John Muir - Walnut Creek 9408 0:29:19Contra Costa Kaiser Antioch 7741 0:40:12Contra Costa Kaiser Oakland 778 1:01:43Contra Costa Kaiser Richmond 10276 0:40:21Contra Costa Kaiser Vallejo 740 0:34:02Contra Costa Kaiser Walnut Creek 6743 0:33:23Contra Costa Marin General 36 0:22:47

* EMSA calculates the weighted average for a data set by multiplying the reported 90th percentile time for a hospital by thenumber of offloads to that facility (all transports hold the same value or “weight”). This value is then divided by the total countof offloads for that data set period to determine a single weighted average value. This approach gives EMSA the opportunityto compare APOT times within a jurisdiction (to calculate a single monthly APOT value for a LEMSA), across the state, or acrossmultiple months and quarters.

Page 35


2021Total Offloads

Q2 2020 - Q1 2021


Percentile*

Contra Costa Other - Out of County 2658 0:22:27Contra Costa San Ramon Regional 1224 0:11:19Contra Costa Summit 482 0:43:04Contra Costa Sutter Delta 9699 0:43:45Contra Costa Sutter Solano 140 0:27:26Contra Costa Valley Care 5 0:44:14Inland Counties Arrowhead Regional Medical Center 8463 0:45:14Inland Counties Barstow Community Hospital 3611 0:15:55Inland Counties Bear Valley Community Healthcare District 1198 0:18:26Inland Counties Chino Valley Medical Center 3014 0:31:43Inland Counties Colorado River Medical Center 556 0:05:51Inland Counties Community Hospital Of San Bernardino 5082 0:50:54Inland Counties Desert Valley Hospital 7709 1:25:03Inland Counties Hi - Desert Medical Center 3656 0:18:35Inland Counties Kaiser Permanente, Fontana 10479 0:58:20Inland Counties Kaiser Permanente, Ontario 5674 0:50:39Inland Counties Loma Linda University Medical Center 10857 0:55:51Inland Counties Mammoth Hospital 319 0:09:48Inland Counties Montclair Hospital Medical Center 2001 0:28:28Inland Counties Mountains Community Hospital 626 0:17:04Inland Counties Northern Inyo Hospital 702 0:21:56Inland Counties Redlands Community Hospital 6539 1:13:40Inland Counties San Antonio Regional Hospital 12601 0:56:27Inland Counties Southern Inyo Hospital 134 0:06:12Inland Counties St. Bernardine Medical Center 11005 1:08:01Inland Counties St. Mary Medical Center 9397 1:19:52Inland Counties Veterans Administration Loma Linda Healthcar 858 0:29:37Inland Counties Victor Valley Global Medical Center 6681 0:54:11Inland Counties Weed Army Community Hospital (Wach) - Ft Ir 214 0:07:07Kern Adventist Health Bakersfield 16264 0:57:32Kern Adventist Health Tehachapi 2169 0:30:30Kern Bakersfield Heart Hospital 5063 0:55:36Kern Bakersfield Memorial Hospital 11430 1:03:25Kern Delano Regional Medical Center 1518 0:45:45Kern Kern Medical 12428 0:42:10Kern Kern Valley Hospital 1369 0:39:04Kern Mercy Downtown 5026 0:52:34Kern Mercy Southwest Hospital 5480 0:58:34Kern Ridgecrest Regional Hospital 2147 0:33:21Los Angeles Adventist Health--Glendale 2300 0:16:22Los Angeles Adventist Health--White Memorial 389 1:01:16Los Angeles Alhambra Hospital Medical Center 619 0:14:56Los Angeles Antelope Valley Hospital 5933 0:54:04Los Angeles Beverly Hospital 1489 0:35:36Los Angeles Cedars Sinai Medical Center 1479 0:26:49Los Angeles Centinela Hospital Medical Center 111 1:34:23Los Angeles Children's Hospital Los Angeles 42 0:07:44Los Angeles Coast Plaza Hospital 1041 0:57:29Los Angeles College Medical Center 1153 0:56:46Los Angeles Community Hospital of Huntington Park 1850 0:59:10Los Angeles Diginity Health--California Hospital Medical Center 6 0:24:30


Page 36


2021Total Offloads

Q2 2020 - Q1 2021


Percentile*Los Angeles Diginity Health--Glendale Memorial Hospital Medical Center 1073 0:14:37Los Angeles Diginity Health--Northridge Hospital Medical Center 33 0:14:24Los Angeles Diginity Health--St. Mary Medical Center 3498 0:34:57Los Angeles East Los Angeles Doctors Hospital 1066 0:31:57Los Angeles Emanate Health Inter-Community Hospital 1816 0:54:18Los Angeles Emanate Health Queen of the Valley Campus 2547 1:01:13Los Angeles Foothill Prebyterian Hospital 1659 1:04:44Los Angeles Garfield Medical Center 1053 0:15:55Los Angeles Good Samaritan Hospital 14 0:19:56Los Angeles Greater El Monte Community Hospital 1446 0:35:24Los Angeles Harbor-UCLA Medical Center 1584 0:54:59Los Angeles Henry Mayo Newhall Hospital 2910 0:28:26Los Angeles Huntington Hospital 3972 0:20:19Los Angeles Kaiser Foundation - Baldwin Park 1222 1:14:54Los Angeles Kaiser Foundation - Bellflower 1882 0:34:10Los Angeles Kaiser Foundation - Los Angeles 9 0:29:00Los Angeles Kaiser Foundation - Panorama City 1 0:16:00Los Angeles Kaiser Foundation - South Bay 556 1:06:41Los Angeles Kaiser Foundation - Sunset 1 0:51:00Los Angeles Kaiser Foundation - West Los Angeles 374 0:28:55Los Angeles Kaiser Foundation - Woodland Hills 64 0:34:43Los Angeles LAC Olive Medical Center 32 0:43:17Los Angeles LAC+USC Medical Center 1029 0:28:25Los Angeles Lakewood Regional Medical Cetner 2091 1:17:33Los Angeles Los Angeles Community Hospital at Norwalk 356 0:52:45Los Angeles Marina Del Rey Hospital 871 0:31:11Los Angeles Martin Luther King, Jr. Community Hospital 1340 1:22:14Los Angeles Memorial Care Long Beach Medical Center 3370 0:39:49Los Angeles Memorial Hospital of Gardena 164 0:23:38Los Angeles Methodist Hospital of Southern California 3624 0:45:44Los Angeles Monterey Park Hospital 421 0:20:28Los Angeles Olympia Medical Center 11 0:16:16Los Angeles Palmdale Regional Medical Center 2010 1:51:40Los Angeles PIH Health - Whittier 3174 0:52:05Los Angeles PIH Health- Downey 1968 0:39:09Los Angeles Pomona Valley Hospital Medical Center 5555 0:43:15Los Angeles Providence Holy Cross Medical Center 68 0:15:47Los Angeles Providence Little Company of Mary Medical Center - San Pedro 1189 0:56:06Los Angeles Providence Little Company of Mary Medical Center - Torrance 860 0:22:04Los Angeles Providence Saint John's Health Center 459 0:22:02Los Angeles Providence Saint Joseph Medical Center 1984 0:22:22Los Angeles Providence Tarzana Medical Center 21 0:22:23Los Angeles Ronald Reagan UCLA Medical Center 405 0:21:49Los Angeles San Dimas Community Hospital 767 0:43:17Los Angeles San Gabriel Valley Medical Center 970 0:36:23Los Angeles Santa Monica - UCLA Medical Center 645 0:17:40Los Angeles Southern California Hospital at Culver City 396 0:25:34Los Angeles St. Francis Medical Center 3286 1:48:03Los Angeles Torrance Memorial Medical Center 1671 0:42:20Los Angeles USC Verdugo Hills Medical Center 744 0:28:24Los Angeles West Hills Hospital and Medical Center 183 0:32:55


Page 37


2021Total Offloads

Q2 2020 - Q1 2021


Percentile*Los Angeles Whittier Hospital Medical Center 1171 0:33:24Merced Doctor's Medical Center Modesto 211 0:47:59Merced Emanuel Medical Center Turlock 1569 0:46:43Merced Memorial Hospital Los Banos 1036 0:35:09Merced Memorial Hospital North Modesto 795 0:36:54Merced Mercy Medical Center Merced 9016 0:46:32Merced Valley Children's Hospital Madera 71 0:26:29Monterey Community Hospital of the Monterey Peninsula 8347 0:13:14Monterey Mee Memorial Hospital 445 0:13:23Monterey Natividad Medical Center 6755 0:24:28Monterey Salinas Valley Memorial Hospital 6470 0:22:11Mountain-Valley Doctors Hospital Modesto 19228 0:28:07Mountain-Valley Emanuel Medical Center 6901 0:39:19Mountain-Valley Kaiser Hospital Modesto Medical Center 4392 0:37:56Mountain-Valley Memorial Medical Center 16316 0:27:13Mountain-Valley Oak Valley District Hospital 467 0:14:55Napa Children's Hospital and Research Center - Oakland 4 0:05:18Napa Kaiser Santa Rosa 64 0:14:37Napa Kaiser Vacaville 20 0:15:28Napa Kaiser Vallejo 1340 0:18:48Napa NorthBay Medical Center 1 0:06:55Napa Queen of the Valley Medical Center 4311 0:10:35Napa Santa Rosa Memorial Hospital 447 0:09:20Napa St Helena Hospital - Deer Park 10 0:08:01Napa Sutter Santa Rosa 3 0:07:14Napa Sutter Solano Hospital 148 0:16:37North Coast Adventist Health, Clearlake 2176 0:09:32North Coast Jerold Phelps Community Hospital 152 0:03:15North Coast Mad River Community Hospital 1410 0:03:14North Coast Redwood Memorial Hospital 1018 0:04:20North Coast Saint Joseph Hospital, Eureka 4652 0:05:18North Coast Sutter Coastal Hospital 1359 0:02:13North Coast Sutter Lakeside Hospital 1370 0:07:48Northern California Asante Rogue Regional Medical Center 1 0:28:00Northern California Banner Desert Medical Center 8 0:05:28Northern California Banner Lassen Medical Center (20030) 980 0:05:56Northern California Barrow Neurological Institute (62370) 512 0:05:11Northern California Eastern Plumas Hospital, Portola Campus (20111) 291 0:06:05Northern California Enloe Medical Center- Esplanade Campus (Not Recorded) 4 0:05:51Northern California Enloe Medical Center, Esplanade (20122) 34 0:07:06Northern California Lassen Nursing And Rehab (LNR) (Not Recorded) 1 0:03:00Northern California Mayers Memorial Hospital Burney Annex (62339) 9 0:05:32Northern California Mayers Memorial Hospital District (20273) 111 0:14:13Northern California Mercy Medical Center, Mt. Shasta 1 0:07:12Northern California Mercy Medical Center, Redding (20284) 293 0:08:07Northern California Modoc Medical Center (20298) 400 0:04:05Northern California Northern Nevada Medical Center (20551) 136 0:03:54Northern California Oroville Hospital 1 0:07:00Northern California Plumas District Hospital (20346) 445 0:04:45Northern California Redwood Memorial Hospital (20367) 51 0:08:30Northern California Renown Medical Center 47 0:16:11

* EMSA calculates the weighted average for a data set by multiplying the reported 90th percentile time for a hospital by the number of offloads to that facility (all transports hold the same value or “weight”). This value is then divided by the total count of offloads for that data set period to determine a single weighted average value. This approach gives EMSA the opportunity to compare APOT times within a jurisdiction (to calculate a single monthly APOT value for a LEMSA), across the state, or across multiple months and quarters.

Page 38


2021Total Offloads

Q2 2020 - Q1 2021


Percentile*Northern California Renown Regional Medical Center (20553) 158 0:12:12Northern California Renown South Meadows Medical Center (Not Recorded) 1 0:00:00Northern California Saint Joseph Hospital, Eureka (20454) 2 0:00:00Northern California Saint Mary's Regional Medical Center (61412) 1 0:04:00Northern California Saint Marys Regional Medical Center (Not Recorded) 9 0:04:50Northern California Seneca District Hospital (20412) 54 0:08:35Northern California Shasta Regional 186 0:05:43Northern California Shasta Regional Medical Center (20423) 3 0:05:00Northern California Sierra Nevada Memorial Hospital (20428) 72 0:11:12Northern California Sky Lakes Medical Center (20550) 112 0:06:05Northern California St. Elizabeth Community Hospital (20445) 15 0:12:02Northern California St. Mary's Regional Medical Center (61146) 11 0:06:45Northern California Tahoe Forest Hospital (20486) 30 0:04:38Northern California Trinity Hospital (20499) 468 0:04:38Northern California UC Davis Medical Center (20508) 2 0:11:48Northern California UCSF Benioff Children's Hospital (62404) 5 0:01:42Northern California Veterans Administration, Reno (61588) 8 0:03:07Orange Anaheim Global Medical Center 2337 0:31:19Orange Anaheim Regional Medical Center 5341 0:36:25Orange Chapman Global Medical Center 734 0:17:11Orange Children's Hospital of Orange County 1872 0:13:57Orange Foothill Regional Medical Center 1213 0:46:02Orange Fountain Valley Regional Hospital and Medical Center 7353 0:24:29Orange Garden Grove Hospital & Medical Center 4176 0:33:53Orange Hoag Hospital Irvine 6381 0:15:58Orange Hoag Memorial Hospital Presbyterian 17427 0:15:05Orange Huntington Beach Hospital 3885 0:28:18Orange Kaiser Permanente - Anaheim Medical Center 4740 0:33:07Orange Kaiser Permanente - Irvine Medical Center 4032 0:25:59Orange La Palma Intercommunity Hospital 2931 0:39:05Orange Los Alamitos Medical Center 6585 1:00:17Orange Mission Hospital - Laguna Beach 3100 0:23:44Orange Mission Hospital Regional Medical Center 13507 0:32:09Orange Orange Coast Memorial Medical Center 4970 0:29:47Orange Orange County Global Medical Center 6709 0:27:24Orange Placentia Linda Hospital 4285 0:20:14Orange Saddleback Memorial Medical Center - Laguna Hills 7954 0:20:01Orange South Coast Global Medical Center 2268 0:23:59Orange St. Joseph Hospital 10037 0:26:08Orange St. Jude Medical Center 13253 0:36:37Orange UCI Medical Center 9750 0:32:03Orange West Anaheim Medical Center 7041 0:36:18Riverside Corona Regional Med Ctr 7974 1:11:51Riverside Desert Regional Med Ctr 13217 0:31:09Riverside Eisenhower Med Ctr 13703 0:16:36Riverside Hemet Valley Hospital 14746 1:04:05Riverside Inland Valley Med Ctr 9808 0:46:25Riverside JFK Hospital 7172 0:18:03Riverside Kaiser Hospital Riverside 4274 0:54:07Riverside Loma Linda Univ Med Ctr Mur 6551 0:53:03Riverside Menifee Med Ctr 6280 0:50:46


Page 39


2021Total Offloads

Q2 2020 - Q1 2021


Percentile*Riverside Moreno Valley Hospital 3282 1:13:22Riverside Palo Verde Hospital 1753 0:14:44Riverside Parkview Community Hospital 6213 1:01:54Riverside Rancho Springs Med Ctr 5274 0:38:04Riverside Riverside Community Hospital 15892 1:11:07Riverside Riverside University Health System 16849 0:35:03Riverside San Gorgonio Mem Hospital 6720 0:38:52Riverside Temecula Valley Hospital 5908 0:38:16Sacramento Kaiser Morse 16369 0:39:05Sacramento Kaiser Roseville 6788 0:38:20Sacramento Kaiser South 16798 0:42:26Sacramento Mercy General 7797 0:50:24Sacramento Mercy of Folsom 4924 0:21:22Sacramento Mercy San Juan 17539 0:55:45Sacramento Methodist 8867 0:46:42Sacramento Out of area hopitals 700 0:20:30Sacramento Sutter Roseville 12234 1:11:38Sacramento Sutter Sacramento 6118 0:52:45Sacramento UC Davis 13989 0:54:41Sacramento VA Hospital 1943 0:21:28San Benito Hazel Hawkins 1533 0:07:48San Benito Natividad Medical Center 43 0:06:40San Diego Alvarado Hospital Medical Center 4303 0:26:40San Diego Kaiser San Diego Medical Center 3728 0:31:43San Diego Kaiser Zion Medical Center 4432 0:37:42San Diego Naval Medical Center, San Diego 897 0:14:59San Diego Palomar Medical Center 8886 0:42:44San Diego Palomar Medical Center-Poway 2153 0:44:26San Diego Paradise Valley Hospital 613 0:44:24San Diego Rady Childrens Hospital 1204 0:29:09San Diego Scripps Memorial Encinitas 7330 0:27:59San Diego Scripps Memorial La Jolla 10102 0:17:14San Diego Scripps Mercy Chula Vista 4616 0:41:41San Diego Scripps Mercy San Diego 9373 0:31:03San Diego Sharp Chula Vista Medical Center 7143 0:39:41San Diego Sharp Coronado Hospital 504 0:23:28San Diego Sharp Grossmont Hospital 15138 0:46:09San Diego Sharp Memorial Hospital 13861 0:28:29San Diego Temecula Valley Hospital 1900 0:43:30San Diego Tri-City Medical Center 7587 0:45:34San Diego UCSD La Jolla-Thornton 433 0:25:12San Diego UCSD Medical Center 7795 0:41:52San Francisco Chinese Hospital 1038 0:18:55San Francisco CPMC Davies Campus Hospital 3626 0:27:25San Francisco CPMC Mission Bernal Campus 5423 0:29:01San Francisco CPMC-Van Ness 8074 0:30:33San Francisco Kaiser Permanente, San Francisco 5320 0:23:05San Francisco Saint Francis Memorial Hospital 6531 0:21:15San Francisco Seton Medical Center 504 0:23:27San Francisco South San Francisco Kaiser 2590 0:20:31San Francisco St. Mary's Medical Center 4265 0:24:06


Page 40


2021Total Offloads

Q2 2020 - Q1 2021


Percentile*San Francisco UCSF Medical Center - Benioff 543 0:21:15San Francisco UCSF Medical Center at Parnassus 9021 0:34:33San Francisco Veterans Administration Medical Center, San Francisco 959 0:18:53San Francisco Zuckerberg San Francisco General Hospital 15810 0:26:20San Joaquin Adventist Lodi Memorial Hospital 7089 0:30:49San Joaquin Dameron Hospital 6215 0:34:18San Joaquin Doctors Hospital of Manteca 3740 0:24:46San Joaquin Kaiser Hospital, Manteca 3235 0:33:23San Joaquin San Joaquin General Hospital 13087 0:38:44San Joaquin St. Joseph's Medical Center 22932 0:41:27San Joaquin Sutter Tracy Community Hospital 3703 0:33:30San Luis Obispo Arroyo Grande Community Hospital 635 0:13:15San Luis Obispo French Hospital Medical Center 656 0:12:46San Luis Obispo Marian Medical Center (Santa Barbara Co) 829 0:13:24San Luis Obispo Sierra Vista Regional Medical Center 984 0:13:24San Luis Obispo Twin Cities Community Hospital 210 0:14:02San Mateo Cal Pacific - Davies 9 0:06:19San Mateo California Pacific Medical Center 1 0:03:06San Mateo Dominican 5 0:05:08San Mateo Eden 4 0:15:08San Mateo El Camino 7 0:06:26San Mateo Kaiser Redwoood City 3562 0:08:43San Mateo Kaiser San Francisco 40 0:08:50San Mateo Kaiser South San Francisco 2539 0:11:50San Mateo Mills-Peninsula 9250 0:13:08San Mateo Palo Alto Veterans 337 0:09:02San Mateo San Mateo Medical Center 2734 0:08:48San Mateo Santa Clara Valley Medical Center 241 0:08:45San Mateo Sequoia 2180 0:08:47San Mateo Seton 2974 0:09:26San Mateo Seton Coastside 2 0:06:19San Mateo Stanford University Hospital 5391 0:09:04San Mateo UC San Francisco 43 0:19:32San Mateo Zuckerberg San Francisco General 548 0:13:28Santa Barbara Goleta Valley Cottage Hospital 966 0:12:38Santa Barbara Lompoc Valley Medical Center 2096 0:12:48Santa Barbara Marian Regional Medical Center 5648 0:13:49Santa Barbara Santa Barbara Cottage Hospital 7304 0:17:47Santa Barbara Santa Ynez Valley Cottage Hospital 740 0:13:16Santa Clara Community Hospital of the Monterey Peninsula 1 0:05:38Santa Clara El Camino Hospital 8198 0:17:16Santa Clara El Camino Hospital Los Gatos 1413 0:11:05Santa Clara Good Samaritan Hospital 8266 0:22:47Santa Clara Kaiser San Jose 7675 0:23:48Santa Clara Kaiser Santa Clara 7720 0:27:03Santa Clara O'Connor Hospital 8323 0:19:34Santa Clara Regional Medical Center 12993 0:32:38Santa Clara Saint Louise Regional Hospital 3999 0:14:25Santa Clara Santa Clara Valley Medical Center 14763 0:51:11Santa Clara Stanford Health Care 4994 0:12:26Santa Cruz Dominican Hospital, Santa Cruz 9088 0:21:17


Page 41


2021Total Offloads

Q2 2020 - Q1 2021


Percentile*Santa Cruz El Camino Hospital Los Gatos 2 0:10:13Santa Cruz Good Samaritan Hospital, San Jose 22 0:17:49Santa Cruz Natividad Medical Center 143 0:10:35Santa Cruz Regional Medical Center of San Jose 6 0:08:16Santa Cruz Salinas Valley Memorial Hospital 3 0:12:03Santa Cruz Santa Clara Valley Medical Center 206 0:11:32Santa Cruz Stanford Health Care 6 0:12:15Santa Cruz Watsonville Community Hospital 3129 0:16:14Sierra-Sacramento Valley Adventist Health +Rideout 16627 0:11:19Sierra-Sacramento Valley Asante Rogue Medical Center (OR) 30 0:05:32Sierra-Sacramento Valley Colusa Medical Center 621 0:09:02Sierra-Sacramento Valley Enloe Medical Center 12999 0:09:40Sierra-Sacramento Valley Fairchild Medical Center 2095 0:04:29Sierra-Sacramento Valley Glenn Medical Center 599 0:05:37Sierra-Sacramento Valley Kaiser Roseville Medical Center 7071 0:41:29Sierra-Sacramento Valley Mayers Memorial Hospital District 478 0:04:46Sierra-Sacramento Valley Mercy Hospital of Folsom 46 0:27:44Sierra-Sacramento Valley Mercy Medical Center Mt. Shasta 1565 0:05:05Sierra-Sacramento Valley Mercy Medical Center Redding 11663 0:18:03Sierra-Sacramento Valley Mercy San Juan Medical Center 126 0:49:22Sierra-Sacramento Valley Orchard Hospital 673 0:09:33Sierra-Sacramento Valley Oroville Hospital 6995 0:15:00Sierra-Sacramento Valley Renown Regional Medical Center (NV) 111 0:07:29Sierra-Sacramento Valley Sacramento VA Medical Center 59 0:22:44Sierra-Sacramento Valley Shasta Regional Medical Center 6518 0:20:47Sierra-Sacramento Valley Sierra Nevada Memorial Hospital 4943 0:05:55Sierra-Sacramento Valley Sky Lakes Medical Center (OR) 35 0:05:14Sierra-Sacramento Valley St. Elizabeth Community Hospital 4884 0:10:52Sierra-Sacramento Valley Sutter Auburn Faith Hospital 4307 16:34:21Sierra-Sacramento Valley Sutter Roseville Medical Center 14464 0:53:08Sierra-Sacramento Valley Tahoe Forest Hospital 1438 0:06:24Sierra-Sacramento Valley UC Davis Medical Center 183 0:26:59Sierra-Sacramento Valley Woodland Memorial Hospital 13 0:07:09Solano Children's Hospital Oakland 14 0:14:05Solano Contra Costa Regional Medical Center 16 0:28:29Solano David Grant Medical Center 736 0:18:59Solano John Muir-Concord 250 0:20:32Solano John Muir-Walnut Creek 144 0:20:49Solano Kaiser Antioch 272 0:31:39Solano Kaiser Sacramento 2 0:05:30Solano Kaiser Vacaville 6180 0:22:33Solano Kaiser Vallejo 6097 0:21:16Solano Kaiser Walnut Creek 24 0:22:18Solano Lodi Memorial 82 0:22:32Solano NorthBay 8278 0:21:47Solano Queen of the Valley 30 0:18:27Solano Sutter Davis 432 0:22:23Solano Sutter Delta 246 0:32:51Solano Sutter Solano 4834 0:24:02Solano UC Davis 11 0:27:19Solano VacaValley 4177 0:14:10


Page 42


2021Total Offloads

Q2 2020 - Q1 2021


Percentile*Solano Woodland Memorial Hospital 41 0:19:09Ventura Adventist Health Simi Valley (Formerly Simi Valley Hospital) 5435 0:18:37Ventura Community Memorial Hospital 6013 0:19:49Ventura Los Robles Hospital and Medical Center 7489 0:23:10Ventura Ojai Valley Hospital 2633 0:20:06Ventura St. John's Pleasant Valley Hospital 5342 0:16:48Ventura St. John's Regional Medical Center 9114 0:20:20Ventura Ventura County Medical Center 3282 0:21:24Ventura Ventura County Medical Center - Santa Paula Hospital 1624 0:21:29Yolo Kaiser Hospital North Sacramento 402 0:41:19Yolo Kaiser Hospital South Sacramento 491 0:48:09Yolo Kaiser Vacaville Hospital 944 0:22:05Yolo Mercy General Hospital 659 1:00:54Yolo Sutter Davis Hospital 3038 0:23:32Yolo Sutter Medical Center Sacramento 1616 1:09:58Yolo UC Davis Medical Center 1899 0:57:48Yolo Woodland Memorial Hospital 3516 0:27:41


Page 43

APOT – 2 Offload Averages

LEMSA Hospital NameMonths

Represented

Total Offloads

<20 Minutes

Total Offloads

20-60 Minutes

Total Offloads 60-120 Minutes


Total Offloads

>180 Minutes

Monthly Average Offloads

<20 Minutes


20-60 Minutes

Monthly Average Offloads 60-120 Minutes



>180 Minutes

Lowest Estimated Monthly Hours of

Delay (20 Minutes or Greater)*

Alameda Alameda Hospital 12 2335 287 25 13 65 194.58 23.92 2.08 1.08 5.42 28.5Alameda Alta Bates Medical Center - Berkeley 12 3149 1560 129 9 113 262.42 130.00 10.75 0.75 9.42 83.8Alameda Alta Bates Medical Center - Summit 12 7600 4202 282 33 225 633.33 350.17 23.50 2.75 18.75 202.0Alameda Children's Hospital Oakland 12 760 166 13 1 13 63.33 13.83 1.08 0.08 1.08 9.1Alameda Eden 12 5456 3574 769 94 154 454.67 297.83 64.08 7.83 12.83 217.5Alameda Highland 12 5262 4607 650 88 204 438.50 383.92 54.17 7.33 17.00 247.8Alameda John George 12 2337 2415 485 40 66 194.75 201.25 40.42 3.33 5.50 130.7Alameda Kaiser - Walnut Creek 12 2146 599 31 2 27 178.83 49.92 2.58 0.17 2.25 26.3Alameda Kaiser Fremont 12 3594 1558 200 25 82 299.50 129.83 16.67 2.08 6.83 84.6Alameda Kaiser Oakland 12 3211 2455 305 26 85 267.58 204.58 25.42 2.17 7.08 119.2Alameda Kaiser San Leandro 12 4798 2590 257 20 113 399.83 215.83 21.42 1.67 9.42 124.9Alameda San Leandro Hospital 12 3070 2034 171 22 62 255.83 169.50 14.25 1.83 5.17 89.9Alameda St. Rose 12 2759 1574 201 25 64 229.92 131.17 16.75 2.08 5.33 80.6Alameda ValleyCare 12 3692 1541 469 85 102 307.67 128.42 39.08 7.08 8.50 121.6Alameda Washington Hospital 12 6132 2190 222 32 146 511.00 182.50 18.50 2.67 12.17 121.2Alameda Willow Rock Center 12 109 76 6 0 1 9.08 6.33 0.50 0.00 0.08 2.9Central California Adventist Medical Center - Hanford 12 6481 2533 469 59 23 540.08 211.08 39.08 4.92 1.92 125.0Central California Adventist Medical Center - Reedley 12 861 229 21 0 2 71.75 19.08 1.75 0.00 0.17 8.6Central California Adventist Medical Center - Selma 12 1359 308 39 6 0 113.25 25.67 3.25 0.50 0.00 12.8Central California Adventist Medical Center - Tulare 12 152 58 10 6 3 12.67 4.83 0.83 0.50 0.25 4.2Central California Clovis Community Hospital 12 7115 6730 852 220 329 592.92 560.83 71.00 18.33 27.42 376.9Central California Coalinga Hospital 4 63 16 4 0 0 15.75 4.00 1.00 0.00 0.00 2.3Central California Kaiser Hospital - Fresno 12 5308 2289 423 45 9 442.33 190.75 35.25 3.75 0.75 108.6Central California Kaweah Delta Medical Center 12 6887 7637 1756 349 279 573.92 636.42 146.33 29.08 23.25 486.4Central California Madera Community Hospital 12 3498 959 273 74 45 291.50 79.92 22.75 6.17 3.75 73.0Central California Regional Medical Center 12 14701 16820 4550 1036 483 1225.08 1401.67 379.17 86.33 40.25 1139.8Central California Saint Agnes medical Center 12 10685 13295 918 76 19 890.42 1107.92 76.50 6.33 1.58 463.2Central California Sierra View District Hospital 12 1702 3239 685 115 126 141.83 269.92 57.08 9.58 10.50 197.7Central California Valley Childrens Hospital 12 2191 122 13 1 1 182.58 10.17 1.08 0.08 0.08 4.9Central California Veterans Administration Medical Center 12 1702 356 19 1 0 141.83 29.67 1.58 0.08 0.00 11.6Contra Costa Alameda County Medical Center 12 90 59 4 0 1 7.50 4.92 0.33 0.00 0.08 2.2Contra Costa Alta Bates 12 489 1190 85 4 1 40.75 99.17 7.08 0.33 0.08 41.1Contra Costa Childrens Oakland 12 238 76 0 0 0 19.83 6.33 0.00 0.00 0.00 2.1Contra Costa Contra Costa County Psychiatric Emergency 12 1565 2797 412 27 10 130.42 233.08 34.33 2.25 0.83 119.0Contra Costa Contra Costa Regional 12 2236 2503 281 49 11 186.33 208.58 23.42 4.08 0.92 103.9Contra Costa Eden 5 4 3 0 0 0 0.80 0.60 0.00 0.00 0.00 0.2Contra Costa John Muir - Concord 12 7497 2155 17 3 1 624.75 179.58 1.42 0.25 0.08 62.0Contra Costa John Muir - Walnut Creek 12 6664 2712 27 5 0 555.33 226.00 2.25 0.42 0.00 78.4Contra Costa Kaiser Antioch 12 3982 3501 243 11 4 331.83 291.75 20.25 0.92 0.33 120.3Contra Costa Kaiser Oakland 12 212 486 68 11 1 17.67 40.50 5.67 0.92 0.08 21.3Contra Costa Kaiser Richmond 12 3948 6135 179 11 3 329.00 511.25 14.92 0.92 0.25 187.9Contra Costa Kaiser Vallejo 12 422 314 4 0 0 35.17 26.17 0.33 0.00 0.00 9.1Contra Costa Kaiser Walnut Creek 12 3688 3027 25 2 1 307.33 252.25 2.08 0.17 0.08 86.8Contra Costa Marin General 11 26 10 0 0 0 2.36 0.91 0.00 0.00 0.00 0.3Contra Costa Other - Out of County 12 2314 332 11 1 0 192.83 27.67 0.92 0.08 0.00 10.3Contra Costa San Ramon Regional 12 1196 27 1 0 0 99.67 2.25 0.08 0.00 0.00 0.8Contra Costa Summit 12 194 278 10 0 0 16.17 23.17 0.83 0.00 0.00 8.6Contra Costa Sutter Delta 12 5051 4261 362 24 1 420.92 355.08 30.17 2.00 0.08 152.8Contra Costa Sutter Solano 12 83 55 2 0 0 6.92 4.58 0.17 0.00 0.00 1.7Contra Costa Valley Care 3 2 3 0 0 0 0.67 1.00 0.00 0.00 0.00 0.3Inland Counties Arrowhead Regional Medical Center 9 5454 2532 397 64 16 606.00 281.33 44.11 7.11 1.78 157.4Inland Counties Barstow Community Hospital 9 3418 167 21 4 1 379.78 18.56 2.33 0.44 0.11 9.7Inland Counties Bear Valley Community Healthcare District 9 1091 100 7 0 0 121.22 11.11 0.78 0.00 0.00 4.5Inland Counties Chino Valley Medical Center 9 2684 619 92 16 3 298.22 68.78 10.22 1.78 0.33 37.7Inland Counties Colorado River Medical Center 9 554 2 0 0 0 61.56 0.22 0.00 0.00 0.00 0.1Inland Counties Community Hospital Of San Bernardino 9 2474 2276 281 38 13 274.89 252.89 31.22 4.22 1.44 128.3

*The Lowest Estimated Monthly Hours of Delay (20 Minutes or Greater) is calculated by multiplying the monthly average offload in each time interval (excluding <20 Minutes) by the lowest minute threshold of each interval.

The Sum of:Monthly Average Offloads 20-60 Minutes multiplied by 20 minutesMonthly Average Offloads 60-120 Minutes multiplied by 60 minutesMonthly Average Offloads 120-180 Minutes multiplied by 120 minutesMonthly Average Offloads >180 Minutes multiplied by 180 minutes.

The total number of minutes is then divided by 60 to determine the Lowest Estimated Monthly Hours of Delay. This is the most conservative estimate of the total hours of delay.

Page 44

LEMSA Hospital Name Months Represented

Total Offloads

<20 Minutes

Total Offloads

20-60 Minutes



Total Offloads

>180 Minutes


<20 Minutes


20-60 Minutes




>180 Minutes



Inland Counties Desert Valley Hospital 9 2816 3606 915 225 147 312.89 400.67 101.67 25.00 16.33 334.2Inland Counties Hi - Desert Medical Center 9 3366 268 17 4 1 374.00 29.78 1.89 0.44 0.11 13.0Inland Counties Kaiser Permanente, Fontana 9 5188 4299 825 134 33 576.44 477.67 91.67 14.89 3.67 291.7Inland Counties Kaiser Permanente, Ontario 9 2913 2335 366 53 7 323.67 259.44 40.67 5.89 0.78 141.3Inland Counties Loma Linda University Medical Center 9 5559 4366 781 109 42 617.67 485.11 86.78 12.11 4.67 286.7Inland Counties Mammoth Hospital 9 308 11 0 0 0 34.22 1.22 0.00 0.00 0.00 0.4Inland Counties Montclair Hospital Medical Center 9 1654 309 26 6 6 183.78 34.33 2.89 0.67 0.67 17.7Inland Counties Mountains Community Hospital 9 587 38 1 0 0 65.22 4.22 0.11 0.00 0.00 1.5Inland Counties Northern Inyo Hospital 9 608 92 2 0 0 67.56 10.22 0.22 0.00 0.00 3.6Inland Counties Redlands Community Hospital 9 2453 3059 812 157 58 272.56 339.89 90.22 17.44 6.44 257.7Inland Counties San Antonio Regional Hospital 9 5352 6184 946 98 21 594.67 687.11 105.11 10.89 2.33 362.9Inland Counties Southern Inyo Hospital 9 127 6 1 0 0 14.11 0.67 0.11 0.00 0.00 0.3Inland Counties St. Bernardine Medical Center 9 3408 6142 1228 182 45 378.67 682.44 136.44 20.22 5.00 419.4Inland Counties St. Mary Medical Center 9 2246 5303 1557 226 65 249.56 589.22 173.00 25.11 7.22 441.3Inland Counties Veterans Administration Loma Linda Healthcar 9 623 221 14 0 0 69.22 24.56 1.56 0.00 0.00 9.7Inland Counties Victor Valley Global Medical Center 9 3359 2729 488 85 20 373.22 303.22 54.22 9.44 2.22 180.9Inland Counties Weed Army Community Hospital (Wach) - Ft Ir 9 214 0 0 0 0 23.78 0.00 0.00 0.00 0.00 0.0Kern Adventist Health Bakersfield 12 4021 9824 1227 142 52 335.08 818.67 102.25 11.83 4.33 411.8Kern Adventist Health Tehachapi 12 1372 569 48 8 13 114.33 47.42 4.00 0.67 1.08 24.4Kern Bakersfield Heart Hospital 12 1130 1079 115 27 5 94.17 89.92 9.58 2.25 0.42 45.3Kern Bakersfield Memorial Hospital 12 5739 8201 1376 212 75 478.25 683.42 114.67 17.67 6.25 396.6Kern Delano Regional Medical Center 12 852 1055 146 20 9 71.00 87.92 12.17 1.67 0.75 47.1Kern Kern Medical 12 5804 6252 203 5 1 483.67 521.00 16.92 0.42 0.08 191.7Kern Kern Valley Hospital 12 908 715 77 8 5 75.67 59.58 6.42 0.67 0.42 28.9Kern Mercy Downtown 12 1832 2188 169 17 4 152.67 182.33 14.08 1.42 0.33 78.7Kern Mercy Southwest Hospital 12 1926 2300 264 46 11 160.50 191.67 22.00 3.83 0.92 96.3Kern Ridgecrest Regional Hospital 12 1752 984 207 48 19 146.00 82.00 17.25 4.00 1.58 57.3Los Angeles Adventist Health--Glendale 6 2164 134 11 0 0 360.67 22.33 1.83 0.00 0.00 9.3Los Angeles Adventist Health--White Memorial 5 249 148 32 7 2 49.80 29.60 6.40 1.40 0.40 20.3Los Angeles Alhambra Hospital Medical Center 6 601 17 1 0 0 100.17 2.83 0.17 0.00 0.00 1.1Los Angeles Antelope Valley Hospital 6 3540 2442 365 92 24 590.00 407.00 60.83 15.33 4.00 239.2Los Angeles Beverly Hospital 6 2069 414 33 5 3 344.83 69.00 5.50 0.83 0.50 31.7Los Angeles Cedars Sinai Medical Center 6 1209 289 4 1 0 201.50 48.17 0.67 0.17 0.00 17.1Los Angeles Centinela Hospital Medical Center 5 82 93 13 5 3 16.40 18.60 2.60 1.00 0.60 12.6Los Angeles Children's Hospital Los Angeles 6 41 3 0 0 0 6.83 0.50 0.00 0.00 0.00 0.2Los Angeles Coast Plaza Hospital 6 711 361 71 17 12 118.50 60.17 11.83 2.83 2.00 43.6Los Angeles College Medical Center 6 707 347 77 24 5 117.83 57.83 12.83 4.00 0.83 42.6Los Angeles Community Hospital of Huntington Park 5 926 938 153 27 8 185.20 187.60 30.60 5.40 1.60 108.7Los Angeles Diginity Health--California Hospital Medical Center 4 4 2 0 0 0 1.00 0.50 0.00 0.00 0.00 0.2Los Angeles Diginity Health--Glendale Memorial Hospital Medical Center 6 1020 48 6 0 0 170.00 8.00 1.00 0.00 0.00 3.7Los Angeles Diginity Health--Northridge Hospital Medical Center 5 38 1 0 0 0 7.60 0.20 0.00 0.00 0.00 0.1Los Angeles Diginity Health--St. Mary Medical Center 6 2749 623 113 12 1 458.17 103.83 18.83 2.00 0.17 57.9Los Angeles East Los Angeles Doctors Hospital 6 918 239 25 5 1 153.00 39.83 4.17 0.83 0.17 19.6Los Angeles Emanate Health Inter-Community Hospital 6 1286 678 133 16 11 214.33 113.00 22.17 2.67 1.83 70.7Los Angeles Emanate Health Queen of the Valley Campus 6 1838 792 215 51 13 306.33 132.00 35.83 8.50 2.17 103.3Los Angeles Foothill Prebyterian Hospital 6 1180 609 107 27 32 196.67 101.50 17.83 4.50 5.33 76.7Los Angeles Garfield Medical Center 6 1035 60 8 1 1 172.50 10.00 1.33 0.17 0.17 5.5Los Angeles Good Samaritan Hospital 4 15 2 1 0 0 3.75 0.50 0.25 0.00 0.00 0.4Los Angeles Greater El Monte Community Hospital 6 1303 332 47 4 1 217.17 55.33 7.83 0.67 0.17 28.1Los Angeles Harbor-UCLA Medical Center 6 1133 526 85 36 14 188.83 87.67 14.17 6.00 2.33 62.4Los Angeles Henry Mayo Newhall Hospital 6 2630 558 29 3 0 438.33 93.00 4.83 0.50 0.00 36.8Los Angeles Huntington Hospital 6 3689 370 35 7 0 614.83 61.67 5.83 1.17 0.00 28.7Los Angeles Kaiser Foundation - Baldwin Park 6 746 463 126 41 8 124.33 77.17 21.00 6.83 1.33 64.4Los Angeles Kaiser Foundation - Bellflower 6 1536 490 42 3 1 256.00 81.67 7.00 0.50 0.17 35.7Los Angeles Kaiser Foundation - Los Angeles 3 6 4 0 0 0 2.00 1.33 0.00 0.00 0.00 0.4Los Angeles Kaiser Foundation - Panorama City 1 1 0 0 0 0 1.00 0.00 0.00 0.00 0.00 0.0Los Angeles Kaiser Foundation - South Bay 6 313 224 41 12 8 52.17 37.33 6.83 2.00 1.33 27.3Los Angeles Kaiser Foundation - Sunset 1 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.0




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Los Angeles Kaiser Foundation - West Los Angeles 6 276 105 5 0 0 46.00 17.50 0.83 0.00 0.00 6.7Los Angeles Kaiser Foundation - Woodland Hills 5 39 25 1 0 0 7.80 5.00 0.20 0.00 0.00 1.9Los Angeles LAC Olive Medical Center 4 22 8 0 2 0 5.50 2.00 0.00 0.50 0.00 1.7Los Angeles LAC+USC Medical Center 6 1135 168 24 4 5 189.17 28.00 4.00 0.67 0.83 17.2Los Angeles Lakewood Regional Medical Cetner 6 1259 825 194 62 32 209.83 137.50 32.33 10.33 5.33 114.8Los Angeles Los Angeles Community Hospital at Norwalk 6 347 69 20 2 8 57.83 11.50 3.33 0.33 1.33 11.8Los Angeles Marina Del Rey Hospital 6 691 178 17 3 0 115.17 29.67 2.83 0.50 0.00 13.7Los Angeles Martin Luther King, Jr. Community Hospital 6 867 558 210 49 15 144.50 93.00 35.00 8.17 2.50 89.8Los Angeles Memorial Care Long Beach Medical Center 6 2832 468 137 52 18 472.00 78.00 22.83 8.67 3.00 75.2Los Angeles Memorial Hospital of Gardena 6 165 42 3 1 0 27.50 7.00 0.50 0.17 0.00 3.2Los Angeles Methodist Hospital of Southern California 6 2941 778 209 44 19 490.17 129.67 34.83 7.33 3.17 102.2Los Angeles Monterey Park Hospital 6 396 44 6 0 0 66.00 7.33 1.00 0.00 0.00 3.4Los Angeles Olympia Medical Center 3 10 1 0 0 0 3.33 0.33 0.00 0.00 0.00 0.1Los Angeles Palmdale Regional Medical Center 3 782 786 262 96 84 260.67 262.00 87.33 32.00 28.00 322.7Los Angeles PIH Health - Whittier 6 2624 1229 173 38 8 437.33 204.83 28.83 6.33 1.33 113.8Los Angeles PIH Health- Downey 6 1604 399 79 13 4 267.33 66.50 13.17 2.17 0.67 41.7Los Angeles Pomona Valley Hospital Medical Center 6 4279 1826 223 32 16 713.17 304.33 37.17 5.33 2.67 157.3Los Angeles Providence Holy Cross Medical Center 6 69 7 2 0 0 11.50 1.17 0.33 0.00 0.00 0.7Los Angeles Providence Little Company of Mary Medical Center - San Pedro 5 659 634 99 11 4 131.80 126.80 19.80 2.20 0.80 68.9Los Angeles Providence Little Company of Mary Medical Center - Torrance 6 780 94 6 0 2 130.00 15.67 1.00 0.00 0.33 7.2Los Angeles Providence Saint John's Health Center 6 407 52 4 0 0 67.83 8.67 0.67 0.00 0.00 3.6Los Angeles Providence Saint Joseph Medical Center 6 1741 237 7 0 0 290.17 39.50 1.17 0.00 0.00 14.3Los Angeles Providence Tarzana Medical Center 4 17 4 0 0 0 4.25 1.00 0.00 0.00 0.00 0.3Los Angeles Ronald Reagan UCLA Medical Center 6 370 41 6 1 0 61.67 6.83 1.00 0.17 0.00 3.6Los Angeles San Dimas Community Hospital 6 634 193 28 5 10 105.67 32.17 4.67 0.83 1.67 22.1Los Angeles San Gabriel Valley Medical Center 6 849 125 34 10 3 141.50 20.83 5.67 1.67 0.50 17.4Los Angeles Santa Monica - UCLA Medical Center 6 593 55 1 1 0 98.83 9.17 0.17 0.17 0.00 3.6Los Angeles Southern California Hospital at Culver City 6 334 62 2 0 0 55.67 10.33 0.33 0.00 0.00 3.8Los Angeles St. Francis Medical Center 6 2002 1236 558 163 116 333.67 206.00 93.00 27.17 19.33 274.0Los Angeles Torrance Memorial Medical Center 6 1170 552 74 5 2 195.00 92.00 12.33 0.83 0.33 45.7Los Angeles USC Verdugo Hills Medical Center 6 696 82 10 0 0 116.00 13.67 1.67 0.00 0.00 6.2Los Angeles West Hills Hospital and Medical Center 5 124 62 4 0 0 24.80 12.40 0.80 0.00 0.00 4.9Los Angeles Whittier Hospital Medical Center 6 1106 246 35 4 1 184.33 41.00 5.83 0.67 0.17 21.3Merced Doctor's Medical Center Modesto 9 153 51 7 0 0 17.00 5.67 0.78 0.00 0.00 2.7Merced Emanuel Medical Center Turlock 9 975 527 53 13 1 108.33 58.56 5.89 1.44 0.11 28.6Merced Memorial Hospital Los Banos 9 763 262 10 1 0 84.78 29.11 1.11 0.11 0.00 11.0Merced Memorial Hospital North Modesto 9 577 204 13 1 0 64.11 22.67 1.44 0.11 0.00 9.2Merced Mercy Medical Center Merced 9 5431 3187 377 16 4 603.44 354.11 41.89 1.78 0.44 164.8Merced Valley Children's Hospital Madera 9 63 8 0 0 0 7.00 0.89 0.00 0.00 0.00 0.3Monterey Community Hospital of the Monterey Peninsula 12 8123 221 1 1 0 676.92 18.42 0.08 0.08 0.00 6.4Monterey Mee Memorial Hospital 12 457 14 0 0 0 38.08 1.17 0.00 0.00 0.00 0.4Monterey Natividad Medical Center 12 5701 984 63 2 2 475.08 82.00 5.25 0.17 0.17 33.4Monterey Salinas Valley Memorial Hospital 12 5630 791 44 3 0 469.17 65.92 3.67 0.25 0.00 26.1Mountain-Valley Doctors Hospital Modesto 12 16951 3014 259 19 29 1412.58 251.17 21.58 1.58 2.42 115.7Mountain-Valley Emanuel Medical Center 12 4513 2128 226 23 11 376.08 177.33 18.83 1.92 0.92 84.5Mountain-Valley Kaiser Hospital Modesto Medical Center 12 2831 1449 98 4 10 235.92 120.75 8.17 0.33 0.83 51.6Mountain-Valley Memorial Medical Center 12 13561 2472 242 17 24 1130.08 206.00 20.17 1.42 2.00 97.7Mountain-Valley Oak Valley District Hospital 12 442 21 1 0 3 36.83 1.75 0.08 0.00 0.25 1.4Napa Children's Hospital and Research Center - Oakland 4 4 0 0 0 0 1.00 0.00 0.00 0.00 0.00 0.0Napa Kaiser Santa Rosa 9 62 1 1 0 0 6.89 0.11 0.11 0.00 0.00 0.1Napa Kaiser Vacaville 8 19 1 0 0 0 2.38 0.13 0.00 0.00 0.00 0.0Napa Kaiser Vallejo 9 1229 108 3 0 0 136.56 12.00 0.33 0.00 0.00 4.3Napa NorthBay Medical Center 1 1 0 0 0 0 1.00 0.00 0.00 0.00 0.00 0.0Napa Queen of the Valley Medical Center 9 4206 99 6 0 0 467.33 11.00 0.67 0.00 0.00 4.3Napa Santa Rosa Memorial Hospital 9 321 4 1 0 0 35.67 0.44 0.11 0.00 0.00 0.3Napa St Helena Hospital - Deer Park 6 130 0 0 0 0 21.67 0.00 0.00 0.00 0.00 0.0Napa Sutter Santa Rosa 3 3 0 0 0 0 1.00 0.00 0.00 0.00 0.00 0.0Napa Sutter Solano Hospital 9 100 8 0 0 0 11.11 0.89 0.00 0.00 0.00 0.3




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North Coast Adventist Health, Clearlake 9 2151 23 2 0 0 0.00 1.00 0.00 0.00 0.00 0.3North Coast Jerold Phelps Community Hospital 9 151 1 0 0 0 1.40 0.20 0.00 0.00 0.00 0.1North Coast Mad River Community Hospital 9 1397 11 2 0 0 71.44 0.22 0.00 0.00 0.00 0.1North Coast Redwood Memorial Hospital 9 1017 1 0 0 0 85.17 0.17 0.00 0.00 0.00 0.1North Coast Saint Joseph Hospital, Eureka 9 4630 18 4 0 0 25.55 0.00 0.00 0.00 0.00 0.0North Coast Sutter Coastal Hospital 9 1359 0 0 0 0 4.50 2.50 0.00 0.00 0.00 0.8North Coast Sutter Lakeside Hospital 9 1352 16 2 0 0 3.67 0.00 0.00 0.00 0.00 0.0Northern California Asante Rogue Regional Medical Center 1 0 1 0 0 0 1.00 0.00 0.00 0.00 0.00 0.0Northern California Banner Desert Medical Center 5 7 1 0 0 0 0.25 0.00 0.00 0.00 0.00 0.0Northern California Banner Lassen Medical Center (20030) 9 643 2 0 0 0 3.00 0.20 0.20 0.00 0.00 0.3Northern California Barrow Neurological Institute (62370) 6 511 1 0 0 0 1.00 0.00 0.00 0.00 0.00 0.0Northern California Eastern Plumas Hospital, Portola Campus (20111) 11 281 0 0 0 0 18.83 0.92 0.08 0.00 0.00 0.4Northern California Enloe Medical Center- Esplanade Campus (Not Recorded) 2 9 5 0 0 0 54.00 0.00 0.00 0.00 0.00 0.0Northern California Enloe Medical Center, Esplanade (20122) 9 33 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.0Northern California Lassen Nursing And Rehab (LNR) (Not Recorded) 1 1 0 0 0 0 3.00 0.00 0.00 0.00 0.00 0.0Northern California Mayers Memorial Hospital Burney Annex (62339) 4 1 0 0 0 0 48.00 0.08 0.00 0.00 0.00 0.0Northern California Mayers Memorial Hospital District (20273) 10 30 2 2 0 0 1.89 0.00 0.00 0.00 0.00 0.0Northern California Mercy Medical Center, Mt. Shasta 1 1 0 0 0 0 13.17 0.33 0.00 0.50 0.00 1.1Northern California Mercy Medical Center, Redding (20284) 12 226 11 1 0 0 13.82 0.45 0.09 0.00 0.00 0.2Northern California Modoc Medical Center (20298) 10 540 0 0 0 0 1.00 0.00 0.00 0.00 0.00 0.0Northern California Northern Nevada Medical Center (20551) 4 0 0 0 0 0 1.00 0.00 0.00 0.00 0.00 0.0Northern California Oroville Hospital 1 3 0 0 0 0 3.70 0.00 0.00 0.00 0.00 0.0Northern California Plumas District Hospital (20346) 12 576 1 0 0 0 0.10 0.00 0.00 0.00 0.00 0.0Northern California Redwood Memorial Hospital (20367) 9 17 0 0 0 0 147.50 0.50 0.00 0.00 0.00 0.2Northern California Renown Medical Center 6 79 2 0 3 0 0.27 0.00 0.00 0.00 0.00 0.0Northern California Renown Regional Medical Center (20553) 11 152 5 1 0 0 14.75 0.75 0.00 0.00 0.00 0.3Northern California Renown South Meadows Medical Center (Not Recorded) 2 2 0 0 0 0 1.00 0.00 0.00 0.00 0.00 0.0Northern California Saint Joseph Hospital, Eureka (20454) 2 2 0 0 0 0 0.88 0.00 0.00 0.00 0.00 0.0Northern California Saint Mary's Regional Medical Center (61412) 10 37 0 0 0 0 5.00 0.00 0.00 0.00 0.00 0.0Northern California Saint Marys Regional Medical Center (Not Recorded) 10 1 0 0 0 0 15.00 0.33 0.00 0.00 0.00 0.1Northern California Seneca District Hospital (20412) 2 295 1 0 0 0 13.82 0.00 0.00 0.00 0.00 0.0Northern California Shasta Regional 11 3 0 0 0 0 27.92 0.25 0.00 0.00 0.00 0.1Northern California Shasta Regional Medical Center (20423) 4 59 3 0 0 0 0.67 0.00 0.00 0.00 0.00 0.0Northern California Sierra Nevada Memorial Hospital (20428) 5 5 0 0 0 0 5.00 0.00 0.00 0.00 0.00 0.0Northern California Sky Lakes Medical Center (20550) 8 7 0 0 0 0 1.29 0.00 0.00 0.00 0.00 0.0Northern California St. Elizabeth Community Hospital (20445) 1 5 0 0 0 0 239.00 2.56 0.22 0.00 0.00 1.1Northern California St. Mary's Regional Medical Center (61146) 3 45 1 0 0 0 16.78 0.11 0.00 0.00 0.00 0.0Northern California Tahoe Forest Hospital (20486) 11 152 0 0 0 0 155.22 1.22 0.22 0.00 0.00 0.6Northern California Trinity Hospital (20499) 12 335 3 0 0 0 113.00 0.11 0.00 0.00 0.00 0.0Northern California UC Davis Medical Center (20508) 3 2 0 0 0 0 514.44 2.00 0.44 0.00 0.00 1.1Northern California UCSF Benioff Children's Hospital (62404) 1 5 0 0 0 0 151.00 0.00 0.00 0.00 0.00 0.0Northern California Veterans Administration, Reno (61588) 7 9 0 0 0 0 150.22 1.78 0.22 0.00 0.00 0.8Orange Anaheim Global Medical Center 12 1979 399 26 51 3 164.92 33.25 2.17 4.25 0.25 22.5Orange Anaheim Regional Medical Center 12 3969 1091 102 72 3 330.75 90.92 8.50 6.00 0.25 51.6Orange Chapman Global Medical Center 12 636 26 4 5 2 53.00 2.17 0.33 0.42 0.17 2.4Orange Children's Hospital of Orange County 12 1757 61 1 0 0 146.42 5.08 0.08 0.00 0.00 1.8Orange Foothill Regional Medical Center 12 939 152 42 54 12 78.25 12.67 3.50 4.50 1.00 19.7Orange Fountain Valley Regional Hospital and Medical Center 12 6406 779 54 56 3 533.83 64.92 4.50 4.67 0.25 36.2Orange Garden Grove Hospital & Medical Center 12 3463 501 64 103 13 288.58 41.75 5.33 8.58 1.08 39.7Orange Hoag Hospital Irvine 12 6070 277 6 3 1 505.83 23.08 0.50 0.25 0.08 8.9Orange Hoag Memorial Hospital Presbyterian 12 16619 484 11 12 0 1384.92 40.33 0.92 1.00 0.00 16.4Orange Huntington Beach Hospital 12 3241 443 44 65 3 270.08 36.92 3.67 5.42 0.25 27.6Orange Kaiser Permanente - Anaheim Medical Center 12 3493 894 54 51 4 291.08 74.50 4.50 4.25 0.33 38.8Orange Kaiser Permanente - Irvine Medical Center 12 3353 605 27 19 0 279.42 50.42 2.25 1.58 0.00 22.2Orange La Palma Intercommunity Hospital 12 1192 327 32 36 10 99.33 27.25 2.67 3.00 0.83 20.3Orange Los Alamitos Medical Center 12 3173 2169 242 318 15 264.42 180.75 20.17 26.50 1.25 137.2Orange Mission Hospital - Laguna Beach 12 2660 388 12 10 0 221.67 32.33 1.00 0.83 0.00 13.4Orange Mission Hospital Regional Medical Center 12 10485 2643 184 100 2 873.75 220.25 15.33 8.33 0.17 105.9




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Orange Orange Coast Memorial Medical Center 12 4173 629 52 74 5 347.75 52.42 4.33 6.17 0.42 35.4Orange Orange County Global Medical Center 12 5623 837 68 79 10 468.58 69.75 5.67 6.58 0.83 44.6Orange Placentia Linda Hospital 12 3869 275 22 20 3 322.42 22.92 1.83 1.67 0.25 13.6Orange Saddleback Memorial Medical Center - Laguna Hills 12 7253 655 14 6 0 604.42 54.58 1.17 0.50 0.00 20.4Orange South Coast Global Medical Center 12 2001 212 25 14 3 166.75 17.67 2.08 1.17 0.25 11.1Orange St. Joseph Hospital 12 8253 1301 61 80 4 687.75 108.42 5.08 6.67 0.33 55.6Orange St. Jude Medical Center 12 8574 2457 218 189 13 714.50 204.75 18.17 15.75 1.08 121.2Orange UCI Medical Center 12 7605 1642 121 101 9 633.75 136.83 10.08 8.42 0.75 74.8Orange West Anaheim Medical Center 12 5236 1465 128 106 14 436.33 122.08 10.67 8.83 1.17 72.5Riverside Corona Regional Med Ctr 12 3366 3664 667 162 115 280.50 305.33 55.58 13.50 9.58 213.1Riverside Desert Regional Med Ctr 12 10366 2533 263 39 16 863.83 211.08 21.92 3.25 1.33 102.8Riverside Eisenhower Med Ctr 12 12875 807 18 2 1 1072.92 67.25 1.50 0.17 0.08 24.5Riverside Hemet Valley Hospital 12 4973 8233 1187 226 127 414.42 686.08 98.92 18.83 10.58 397.0Riverside Inland Valley Med Ctr 12 6092 3163 453 70 30 507.67 263.58 37.75 5.83 2.50 144.8Riverside JFK Hospital 12 6642 513 16 1 0 553.50 42.75 1.33 0.08 0.00 15.8Riverside Kaiser Hospital Riverside 12 2559 1314 266 71 20 213.25 109.50 22.17 5.92 1.67 75.5Riverside Loma Linda Univ Med Ctr Mur 12 3667 2373 423 83 37 305.58 197.75 35.25 6.92 3.08 124.3Riverside Menifee Med Ctr 12 3351 2376 259 60 43 279.25 198.00 21.58 5.00 3.58 108.3Riverside Moreno Valley Hospital 12 1936 1181 238 76 54 161.33 98.42 19.83 6.33 4.50 78.8Riverside Palo Verde Hospital 12 1664 72 16 1 0 138.67 6.00 1.33 0.08 0.00 3.5Riverside Parkview Community Hospital 12 3032 2608 401 95 77 252.67 217.33 33.42 7.92 6.42 140.9Riverside Rancho Springs Med Ctr 12 3604 1485 135 37 13 300.33 123.75 11.25 3.08 1.08 61.9Riverside Riverside Community Hospital 12 4735 8941 1728 344 144 394.58 745.08 144.00 28.67 12.00 485.7Riverside Riverside University Health System 12 9782 6833 231 2 1 815.17 569.42 19.25 0.17 0.08 209.6Riverside San Gorgonio Mem Hospital 12 3960 2524 187 35 14 330.00 210.33 15.58 2.92 1.17 95.0Riverside Temecula Valley Hospital 12 3449 2306 146 5 2 287.42 192.17 12.17 0.42 0.17 77.6Sacramento Kaiser Morse 12 10068 5736 450 59 8 839.00 478.00 37.50 4.92 0.67 208.7Sacramento Kaiser Roseville 12 4844 1642 242 29 4 403.67 136.83 20.17 2.42 0.33 71.6Sacramento Kaiser South 12 12887 2931 732 160 34 1073.92 244.25 61.00 13.33 2.83 177.6Sacramento Mercy General 12 3969 3303 552 42 5 330.75 275.25 46.00 3.50 0.42 146.0Sacramento Mercy of Folsom 12 4384 509 11 1 1 365.33 42.42 0.92 0.08 0.08 15.5Sacramento Mercy San Juan 12 11294 4710 1127 282 88 941.17 392.50 93.92 23.50 7.33 293.8Sacramento Methodist 12 4343 4046 379 56 17 361.92 337.17 31.58 4.67 1.42 157.6Sacramento Out of area hopitals 12 626 97 8 1 1 52.17 8.08 0.67 0.08 0.08 3.8Sacramento Sutter Roseville 12 1813 1458 244 56 20 151.08 121.50 20.33 4.67 1.67 75.2Sacramento Sutter Sacramento 12 5177 7693 1566 225 51 431.42 641.08 130.50 18.75 4.25 394.4Sacramento UC Davis 12 9395 3490 545 266 247 782.92 290.83 45.42 22.17 20.58 248.4Sacramento VA Hospital 12 1723 207 6 0 0 143.58 17.25 0.50 0.00 0.00 6.3San Benito Hazel Hawkins 9 1527 5 0 0 0 169.67 0.56 0.00 0.00 0.00 0.2San Benito Natividad Medical Center 9 43 0 0 0 0 4.78 0.00 0.00 0.00 0.00 0.0San Diego Alvarado Hospital Medical Center 12 3562 701 34 3 3 296.83 58.42 2.83 0.25 0.25 23.6San Diego Kaiser San Diego Medical Center 12 2745 946 36 1 0 228.75 78.83 3.00 0.08 0.00 29.4San Diego Kaiser Zion Medical Center 12 2923 1404 94 7 4 243.58 117.00 7.83 0.58 0.33 49.0San Diego Naval Medical Center, San Diego 12 863 32 1 1 0 71.92 2.67 0.08 0.08 0.00 1.1San Diego Palomar Medical Center 12 4943 3642 278 21 2 411.92 303.50 23.17 1.75 0.17 128.3San Diego Palomar Medical Center-Poway 12 1520 525 97 8 3 126.67 43.75 8.08 0.67 0.25 24.8San Diego Paradise Valley Hospital 12 375 208 28 2 0 31.25 17.33 2.33 0.17 0.00 8.4San Diego Rady Childrens Hospital 12 939 253 11 0 1 78.25 21.08 0.92 0.00 0.08 8.2San Diego Scripps Memorial Encinitas 12 5854 1393 79 1 3 487.83 116.08 6.58 0.08 0.25 46.2San Diego Scripps Memorial La Jolla 12 9414 677 9 1 1 784.50 56.42 0.75 0.08 0.08 20.0San Diego Scripps Mercy Chula Vista 12 2560 1912 138 5 1 213.33 159.33 11.50 0.42 0.08 65.7San Diego Scripps Mercy San Diego 12 6670 2636 62 3 2 555.83 219.67 5.17 0.25 0.17 79.4San Diego Sharp Chula Vista Medical Center 12 4989 1909 212 28 5 415.75 159.08 17.67 2.33 0.42 76.6San Diego Sharp Coronado Hospital 12 426 74 3 0 1 35.50 6.17 0.25 0.00 0.08 2.6San Diego Sharp Grossmont Hospital 12 10230 3993 738 145 32 852.50 332.75 61.50 12.08 2.67 204.6San Diego Sharp Memorial Hospital 12 11356 2382 116 4 3 946.33 198.50 9.67 0.33 0.25 77.3San Diego Temecula Valley Hospital 12 960 870 69 0 1 80.00 72.50 5.75 0.00 0.08 30.2San Diego Tri-City Medical Center 12 4380 2811 352 37 7 365.00 234.25 29.33 3.08 0.58 115.3




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San Diego UCSD La Jolla-Thornton 12 370 59 3 0 1 30.83 4.92 0.25 0.00 0.08 2.1San Diego UCSD Medical Center 12 4274 3307 200 9 5 356.17 275.58 16.67 0.75 0.42 111.3San Francisco Chinese Hospital 12 963 74 0 0 1 80.25 6.17 0.00 0.00 0.08 2.3San Francisco CPMC Davies Campus Hospital 12 2297 409 20 4 0 191.42 34.08 1.67 0.33 0.00 13.7San Francisco CPMC Mission Bernal Campus 12 4764 1419 128 8 0 397.00 118.25 10.67 0.67 0.00 51.4San Francisco CPMC-Van Ness 12 5713 2280 75 6 0 476.08 190.00 6.25 0.50 0.00 70.6San Francisco Kaiser Permanente, San Francisco 12 4489 818 13 0 0 374.08 68.17 1.08 0.00 0.00 23.8San Francisco Saint Francis Memorial Hospital 12 7402 982 9 2 1 616.83 81.83 0.75 0.17 0.08 28.6San Francisco Seton Medical Center 12 432 72 0 0 0 36.00 6.00 0.00 0.00 0.00 2.0San Francisco South San Francisco Kaiser 12 649 76 0 0 0 54.08 6.33 0.00 0.00 0.00 2.1San Francisco St. Mary's Medical Center 12 3560 680 22 3 0 296.67 56.67 1.83 0.25 0.00 21.2San Francisco UCSF Medical Center - Benioff 12 479 64 0 0 0 39.92 5.33 0.00 0.00 0.00 1.8San Francisco UCSF Medical Center at Parnassus 12 5505 3413 98 3 2 458.75 284.42 8.17 0.25 0.17 104.0San Francisco Veterans Administration Medical Center, San Francisco 12 888 71 0 0 0 74.00 5.92 0.00 0.00 0.00 2.0San Francisco Zuckerberg San Francisco General Hospital 12 12010 3772 26 2 0 1000.83 314.33 2.17 0.17 0.00 107.3San Joaquin Adventist Lodi Memorial Hospital 12 4999 2014 70 3 4 416.58 167.83 5.83 0.25 0.33 63.3San Joaquin Dameron Hospital 12 4256 1816 135 6 2 354.67 151.33 11.25 0.50 0.17 63.2San Joaquin Doctors Hospital of Manteca 12 3154 552 35 3 2 262.83 46.00 2.92 0.25 0.17 19.3San Joaquin Kaiser Hospital, Manteca 12 2087 1085 62 1 1 173.92 90.42 5.17 0.08 0.08 35.7San Joaquin San Joaquin General Hospital 12 7597 5185 287 19 2 633.08 432.08 23.92 1.58 0.17 171.6San Joaquin St. Joseph's Medical Center 12 10649 11672 589 19 7 887.42 972.67 49.08 1.58 0.58 378.2San Joaquin Sutter Tracy Community Hospital 12 2406 1245 50 2 0 200.50 103.75 4.17 0.17 0.00 39.1San Luis Obispo Arroyo Grande Community Hospital 3 617 19 0 0 0 205.67 6.33 0.00 0.00 0.00 2.1San Luis Obispo French Hospital Medical Center 3 640 17 0 0 0 213.33 5.67 0.00 0.00 0.00 1.9San Luis Obispo Marian Medical Center (Santa Barbara Co) 3 203 7 0 0 0 67.67 2.33 0.00 0.00 0.00 0.8San Luis Obispo Sierra Vista Regional Medical Center 3 800 29 0 0 0 266.67 9.67 0.00 0.00 0.00 3.2San Luis Obispo Twin Cities Community Hospital 3 969 15 0 0 0 323.00 5.00 0.00 0.00 0.00 1.7San Mateo Cal Pacific - Davies 7 9 0 0 0 0 1.29 0.00 0.00 0.00 0.00 0.0San Mateo California Pacific Medical Center 1 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.0San Mateo Dominican 5 6 0 0 0 0 1.20 0.00 0.00 0.00 0.00 0.0San Mateo Eden 4 3 1 0 0 0 0.75 0.25 0.00 0.00 0.00 0.1San Mateo El Camino 6 7 0 0 0 0 1.17 0.00 0.00 0.00 0.00 0.0San Mateo Kaiser Redwoood City 12 3508 52 1 0 1 292.33 4.33 0.08 0.00 0.08 1.8San Mateo Kaiser San Francisco 12 40 0 0 0 0 3.33 0.00 0.00 0.00 0.00 0.0San Mateo Kaiser South San Francisco 12 2476 62 0 1 0 206.33 5.17 0.00 0.08 0.00 1.9San Mateo Mills-Peninsula 12 8909 338 3 0 0 742.42 28.17 0.25 0.00 0.00 9.6San Mateo Palo Alto Veterans 12 329 8 0 0 0 27.42 0.67 0.00 0.00 0.00 0.2San Mateo San Mateo Medical Center 11 2928 36 1 0 0 266.18 3.27 0.09 0.00 0.00 1.2San Mateo Santa Clara Valley Medical Center 8 9 1 0 0 0 1.13 0.13 0.00 0.00 0.00 0.0San Mateo Sequoia 12 2143 34 1 1 1 178.58 2.83 0.08 0.08 0.08 1.4San Mateo Seton 12 2901 66 5 1 1 241.75 5.50 0.42 0.08 0.08 2.7San Mateo Seton Coastside 2 2 0 0 0 0 1.00 0.00 0.00 0.00 0.00 0.0San Mateo Stanford University Hospital 12 5313 73 3 0 2 442.75 6.08 0.25 0.00 0.17 2.8San Mateo UC San Francisco 11 38 5 0 0 0 3.45 0.45 0.00 0.00 0.00 0.2San Mateo Zuckerberg San Francisco General 12 526 22 0 0 0 43.83 1.83 0.00 0.00 0.00 0.6Santa Barbara Goleta Valley Cottage Hospital 9 280 7 0 0 0 31.11 0.78 0.00 0.00 0.00 0.3Santa Barbara Lompoc Valley Medical Center 9 724 38 0 0 0 80.44 4.22 0.00 0.00 0.00 1.4Santa Barbara Marian Regional Medical Center 9 1701 158 1 1 1 189.00 17.56 0.11 0.11 0.11 6.5Santa Barbara Santa Barbara Cottage Hospital 9 2437 187 3 0 0 270.78 20.78 0.33 0.00 0.00 7.3Santa Barbara Santa Ynez Valley Cottage Hospital 9 261 7 0 0 0 29.00 0.78 0.00 0.00 0.00 0.3Santa Clara Community Hospital of the Monterey Peninsula 1 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 0.0Santa Clara El Camino Hospital 12 7824 433 8 0 0 652.00 36.08 0.67 0.00 0.00 12.7Santa Clara El Camino Hospital Los Gatos 12 1395 14 4 0 0 116.25 1.17 0.33 0.00 0.00 0.7Santa Clara Good Samaritan Hospital 12 7318 879 65 3 0 609.83 73.25 5.42 0.25 0.00 30.3Santa Clara Kaiser San Jose 12 6729 852 76 16 2 560.75 71.00 6.33 1.33 0.17 33.2Santa Clara Kaiser Santa Clara 12 6496 1114 103 8 0 541.33 92.83 8.58 0.67 0.00 40.9Santa Clara O'Connor Hospital 12 7601 694 25 2 1 633.42 57.83 2.08 0.17 0.08 21.9Santa Clara Regional Medical Center 12 10973 1507 368 103 42 914.42 125.58 30.67 8.58 3.50 100.2Santa Clara Saint Louise Regional Hospital 12 3868 120 10 0 0 322.33 10.00 0.83 0.00 0.00 4.2




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Santa Clara Santa Clara Valley Medical Center 12 9910 2381 779 166 17 825.83 198.42 64.92 13.83 1.42 163.0Santa Clara Stanford Health Care 12 3639 26 1 0 0 303.25 2.17 0.08 0.00 0.00 0.8Santa Cruz Dominican Hospital, Santa Cruz 12 8346 724 17 1 0 695.50 60.33 1.42 0.08 0.00 21.7Santa Cruz El Camino Hospital Los Gatos 2 9 1 0 0 0 4.50 0.50 0.00 0.00 0.00 0.2Santa Cruz Good Samaritan Hospital, San Jose 9 11 3 0 0 0 1.22 0.33 0.00 0.00 0.00 0.1Santa Cruz Natividad Medical Center 12 142 0 1 0 0 11.83 0.00 0.08 0.00 0.00 0.1Santa Cruz Regional Medical Center of San Jose 6 6 0 0 0 0 1.00 0.00 0.00 0.00 0.00 0.0Santa Cruz Salinas Valley Memorial Hospital 3 3 0 0 0 0 1.00 0.00 0.00 0.00 0.00 0.0Santa Cruz Santa Clara Valley Medical Center 12 201 4 1 0 0 16.75 0.33 0.08 0.00 0.00 0.2Santa Cruz Stanford Health Care 6 5 1 0 0 0 0.83 0.17 0.00 0.00 0.00 0.1Santa Cruz Watsonville Community Hospital 12 2980 138 11 0 0 248.33 11.50 0.92 0.00 0.00 4.8Sierra-Sacramento Valley Adventist Health +Rideout 12 8186 244 0 0 0 1.11 0.44 0.00 0.00 0.00 0.1Sierra-Sacramento Valley Asante Rogue Medical Center (OR) 6 8094 133 0 0 0 1.43 0.57 0.29 0.00 0.00 0.5Sierra-Sacramento Valley Colusa Medical Center 12 621 0 0 0 0 56.67 4.58 0.00 0.00 0.08 1.8Sierra-Sacramento Valley Enloe Medical Center 12 12999 0 0 0 0 18.25 2.50 0.08 0.00 0.00 0.9Sierra-Sacramento Valley Fairchild Medical Center 12 1295 0 0 0 0 10.42 1.58 0.00 0.00 0.00 0.5Sierra-Sacramento Valley Glenn Medical Center 12 1399 0 0 0 0 14.25 8.33 0.08 0.00 0.00 2.9Sierra-Sacramento Valley Kaiser Roseville Medical Center 12 4462 2279 282 37 1 1.00 0.00 0.00 0.00 0.00 0.0Sierra-Sacramento Valley Mayers Memorial Hospital District 12 478 0 0 0 0 434.25 79.83 0.50 0.25 0.00 27.6Sierra-Sacramento Valley Mercy Hospital of Folsom 6 35 11 0 0 0 440.92 67.00 0.08 0.00 0.08 22.7Sierra-Sacramento Valley Mercy Medical Center Mt. Shasta 12 1565 0 0 0 0 1.64 0.55 0.00 0.00 0.00 0.2Sierra-Sacramento Valley Mercy Medical Center Redding 12 10878 781 3 1 0 5.75 1.08 0.00 0.00 0.00 0.4Sierra-Sacramento Valley Mercy San Juan Medical Center 6 61 58 6 2 0 591.92 97.33 0.33 0.00 0.25 33.5Sierra-Sacramento Valley Orchard Hospital 12 673 0 0 0 0 2.27 0.45 0.00 0.00 0.00 0.2Sierra-Sacramento Valley Oroville Hospital 12 6680 315 0 0 0 31.92 3.75 0.33 0.00 0.00 1.6Sierra-Sacramento Valley Renown Regional Medical Center (NV) 6 111 0 0 0 0 13.00 6.92 0.58 0.00 0.00 2.9Sierra-Sacramento Valley Sacramento VA Medical Center 6 48 11 0 0 0 331.67 69.58 1.33 0.00 0.25 25.3Sierra-Sacramento Valley Shasta Regional Medical Center 12 5833 643 42 0 0 0.86 0.71 0.00 0.00 0.00 0.2Sierra-Sacramento Valley Sierra Nevada Memorial Hospital 12 4943 0 0 0 0 334.08 13.08 0.58 0.00 0.33 5.9Sierra-Sacramento Valley Sky Lakes Medical Center (OR) 6 447 0 0 0 0 2.00 0.55 0.00 0.00 0.00 0.2Sierra-Sacramento Valley St. Elizabeth Community Hospital 12 4472 0 0 0 0 682.17 20.33 0.00 0.00 0.00 6.8Sierra-Sacramento Valley Sutter Auburn Faith Hospital 12 4038 269 0 0 0 1349.00 22.17 0.00 0.00 0.00 7.4Sierra-Sacramento Valley Sutter Roseville Medical Center 12 7627 5704 914 167 38 51.75 0.00 0.00 0.00 0.00 0.0Sierra-Sacramento Valley Tahoe Forest Hospital 12 1437 0 0 0 0 1083.25 0.00 0.00 0.00 0.00 0.0Sierra-Sacramento Valley UC Davis Medical Center 6 134 47 2 0 0 107.92 0.00 0.00 0.00 0.00 0.0Sierra-Sacramento Valley Woodland Memorial Hospital 6 13 0 0 0 0 116.58 0.00 0.00 0.00 0.00 0.0Solano Children's Hospital Oakland 9 10 4 0 0 0 371.83 189.92 23.50 3.08 0.08 93.2Solano Contra Costa Regional Medical Center 7 10 4 2 0 0 39.83 0.00 0.00 0.00 0.00 0.0Solano David Grant Medical Center 12 680 55 0 0 1 5.83 1.83 0.00 0.00 0.00 0.6Solano John Muir-Concord 12 219 30 1 0 0 130.42 0.00 0.00 0.00 0.00 0.0Solano John Muir-Walnut Creek 12 125 19 0 0 0 906.50 65.08 0.25 0.08 0.00 22.1Solano Kaiser Antioch 12 171 100 1 0 0 10.17 9.67 1.00 0.33 0.00 4.9Solano Kaiser Sacramento 2 2 0 0 0 0 56.08 0.00 0.00 0.00 0.00 0.0Solano Kaiser Vacaville 12 5211 958 6 3 0 556.67 26.25 0.00 0.00 0.00 8.8Solano Kaiser Vallejo 12 5291 804 1 0 1 18.50 0.00 0.00 0.00 0.00 0.0Solano Kaiser Walnut Creek 11 18 6 0 0 0 8.00 1.83 0.00 0.00 0.00 0.6Solano Lodi Memorial 12 69 13 0 0 0 486.08 53.58 3.50 0.00 0.00 21.4Solano NorthBay 12 7103 1168 4 0 3 411.92 0.00 0.00 0.00 0.00 0.0Solano Queen of the Valley 11 25 5 0 0 0 74.50 0.00 0.00 0.00 0.00 0.0Solano Sutter Davis 12 383 45 4 0 0 372.67 0.00 0.00 0.00 0.00 0.0Solano Sutter Delta 12 156 83 7 0 0 336.50 22.42 0.00 0.00 0.00 7.5Solano Sutter Solano 12 3980 835 16 0 3 635.58 475.33 76.17 13.92 3.17 271.9Solano UC Davis 7 6 5 0 0 0 119.75 0.00 0.00 0.00 0.00 0.0Solano VacaValley 12 4009 157 7 0 4 22.33 7.83 0.33 0.00 0.00 2.9Solano Woodland Memorial Hospital 11 22 6 0 0 0 2.17 0.00 0.00 0.00 0.00 0.0Ventura Adventist Health Simi Valley (Formerly Simi Valley Hospital) 12 5484 375 19 0 0 457.00 31.25 1.58 0.00 0.00 12.0Ventura Community Memorial Hospital 12 5633 517 16 0 0 469.42 43.08 1.33 0.00 0.00 15.7Ventura Los Robles Hospital and Medical Center 12 6788 1066 36 0 0 565.67 88.83 3.00 0.00 0.00 32.6




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Ventura Ojai Valley Hospital 12 980 29 3 0 0 81.67 2.42 0.25 0.00 0.00 1.1Ventura St. John's Pleasant Valley Hospital 12 3758 183 1 0 0 313.17 15.25 0.08 0.00 0.00 5.2Ventura St. John's Regional Medical Center 12 9636 776 43 6 2 803.00 64.67 3.58 0.50 0.17 26.6Ventura Ventura County Medical Center 12 3444 374 17 1 0 287.00 31.17 1.42 0.08 0.00 12.0Ventura Ventura County Medical Center - Santa Paula Hospital 12 1588 130 23 2 1 132.33 10.83 1.92 0.17 0.08 6.1Yolo Kaiser Hospital North Sacramento 12 207 185 10 1 0 17.25 15.42 0.83 0.08 0.00 6.14Yolo Kaiser Hospital South Sacramento 12 328 128 24 8 2 27.33 10.67 2.00 0.67 0.17 7.39Yolo Kaiser Vacaville Hospital 12 844 99 0 0 0 70.33 8.25 0.00 0.00 0.00 2.75Yolo Mercy General Hospital 12 308 305 46 0 1 25.67 25.42 3.83 0.00 0.08 12.56Yolo Sutter Davis Hospital 12 2702 308 32 1 0 225.17 25.67 2.67 0.08 0.00 11.39Yolo Sutter Medical Center Sacramento 12 603 819 177 35 3 50.25 68.25 14.75 2.92 0.25 44.08Yolo UC Davis Medical Center 12 1231 542 70 28 26 102.58 45.17 5.83 2.33 2.17 32.06Yolo Woodland Memorial Hospital 12 3108 382 28 0 1 259.00 31.83 2.33 0.00 0.08 13.19




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