Title
Emergency Medical Services, a division of the Chief Administrative Office, recommending the Board provide conceptual approval, pursuant to Board Policy A-3, to amend County Ordinance Code Chapter 8.74 County Emergency Medical Service and Medical Transportation to allow for non-emergency interfacility transports (IFTs) to be staffed at the level of service determined by the physician responsible for the patient when an IFT is required.
FUNDING: N/A
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DISCUSSION / BACKGROUND
The County has established an emergency medical services program in accordance with California Health and Safety Code and has adopted Chapter 8.74 - County Emergency Medical Service and Medical Transportation, as a framework for the integrated operation of a local emergency and non-emergency medical services and medical transportation system in the County. The County's Emergency Medical Services (EMS) Agency, housed in the Chief Administrative Office, is the local regulatory body for EMS within the County, pursuant to the State EMS Act. The EMS Ordinance establishes exclusive operating areas, standards and requirements for emergency and non-emergency medical services including personnel and training, equipment and supplies, response times, communications, and medical transportation.
The County EMS Agency regulates emergency and non-emergency ambulance and medical transport services, which includes the provision of non-emergency interfacility transports. A non-emergency interfacility transport (IFT) occurs when a physician at a facility has determined that a patient needs care at another facility and does not need emergency transport. Non-emergency IFTs can strain the EMS system as they can require long transports that may not require advanced life support (ALS) services. ALS means special services designed to provide definitive pre-hospital emergency medical care administered by authorized personnel under the direct supervision of a base hospital as part of a local EMS system. Currently, the County’s Ordinance requires ALS as the minimum service level for all interfacility transports.
The County has established an application and permitting process for entities located outside the County, utilizing EMS personnel to provide IFTs. Entities located outside the County utilizing EMS personnel to provide IFTs may do so after successfully completing an application and permitting process and entering into an agreement with the County. Ordinance Code Section 8.74.100 outlines that each IFT shall be staffed with no less than one Emergency Medical Technician (EMT) and one EMT-P. Staff have determined that the EMS system would benefit from revising this requirement to allow for non-emergency IFTs to be staffed at the level of service determined by the physician responsible for the patient and shall be equipped with the minimum inventory list dictated by the EMS Agency. In the absence of a physician order specifying level of service, the transport agency shall default to one EMT-P and one EMT. This change would help preserve critical resources within the 911/emergency EMS system by keeping ALS ambulances available for 911 responses and would allow permitted providers to provide non-emergency IFTs at the appropriate level of service for eligible transports. This change is expected to improve resource allocation while still ensuring appropriate patient care standards are met.
Board Policy A-3 Ordinance - New or Amended states that “proposals for new ordinances and ordinance amendments shall first be presented to the Board for conceptual review and authorization to prepare the draft ordinance or ordinance amendment.” In adherence to Board Policy A-3, a draft ordinance has not been prepared without first obtaining the Board’s conceptual approval for the update. Consequently, a red-line draft of the changes is not attached to this item as it has not been prepared yet.
Staff are requesting that the Board provide conceptual approval to amend County ordinance code section 8.74 County Emergency Medical Service and Medical Transportation to allow for non-emergency IFTs to be staffed at the level of service determined by the physician responsible for the patient. If approved, staff will draft the ordinance revision, review it with stakeholders, and return to the Board for approval.
ALTERNATIVES
The Board could not provide conceptual approval or provide alternative direction.
PRIOR BOARD ACTION
11/17/2020 - Legistar file 20-1345 - Approval of update to Chapter 8.74.
07/21/2020 - Legistar file 20-0891 - Approval of updated Advanced Life Support (ALS) Interfacility Transport (IFT) and Critical Care Transport (CCT) Permitting Application/Agreement boilerplate.
OTHER DEPARTMENT / AGENCY INVOLVEMENT
N/A
CAO RECOMMENDATION / COMMENTS
Approve as recommended.
FINANCIAL IMPACT
There is no financial impact associated with this item.
CLERK OF THE BOARD FOLLOW UP ACTIONS
N/A
STRATEGIC PLAN COMPONENT
N/A
CONTACT
Sue Phillips, Chief Administrative Officer