HomeMy WebLinkAboutResolution No. 5848r
RESOLUTION NO. 5848
A RESOLUTION AUTHORIZING THE SIGNING OF A
CONTRACT, LEASE OR AGREEMENT
THE CITY COUNCIL OF THE CITY OF SAN RAFAEL RESOLVES as follows:
The MAYOR and CITY CLERK are authorized to execute, on behalf of the
City of San Rafael a contract, lease or agreement
RATIFYING EXECUTION OF PARAMEDIC SERVICE AGREEMENTS WITH
COUNTY SERVICES AREA NOS. 13 AND 19
a copy of which is hereby attached and by this reference made a part hereof.
I, JEANNE M. LEONCINI, City Clerk of the City of San Rafael, hereby
certify that the foregoing resolution was duly and regularly introduced and
adopted at a REGULAR meeting of the City Council of said City held on
MONDAY the 21ST day of JANUARY , 19 80 by the
following vote, to wit:
AYES: COUNCILMEMBERS: Breiner, Jensen, Miskimen, Nixon & Mayor
Mulryan
NOES: COUNCILMEMBERS: None
ABSENT: COUNCILMEMBERS: None
N LEONCINI, City Clerk
NT t
AGREEMENT BETWEEN COUNTY SERVICES AREA NO. 13
AND CITY OF SAN RAFAEL RELATING TO ADVANCE
LIFE SUPPORT AND BASIC LIFE SUPPORT EMERGENCY
AMBULANCE SERVICE
THIS AGREEMENT made and entered into this 1st day of
January, 1980, by and between the County Services Area No. 13
of the County of Marin, State of California, hereinafter referred
to as "Area" and the City of San Rafael, hereinafter referred to
as "Contractor";
W I T N E S S E T H:
FOR AND IN CONSIDERATION of the mutual promises and
covenants hereinafter contained, the parties hereto do hereby
agree as follows:
Section 1: Contractor shall provide advance life
support and basic life support emergency ambulance service to
the residents of Area as described in Exhibit A attached hereto
and by this reference incorporated herein.
Section 2: In consideration of the provision of such
services without charge to the residents of Area, Area will pay
to Contractor the sum of $12.00 minus $.50 for the County service
charge for provision of the service from January 1, 1980 to
December 31, 1980 and hereby authorizes the Auditor -Controller of
the County of Marin to pay such sum to Contractor out of the
proceeds of the assessment authorized by the voters of the Area
in November 1979.
IN WITNESS WHEREOF the parties hereto have set their
hand the date and year first above written.
ATTEST:
ATTEST:
Y7 B/9
COUNTY SERVICE AREA NO. 13
By zv�,_
"AREA"
CITY OF SAN RAFAEL
"CONTRACTOR"
MINIMUM REQUIREMENTS
AARIN COUNTY PARAMEDIC SERVICE
(. Coverage Requirements
A. Must provide continuous 211 -hour, 365 -day coverage of all urgent (Code2)
and emergent (Code 3) medical er•,ergencies in assigned service area.
B. Must provide ALS care and transport and provide for dedicated emergency
BLS care and transport to all patients regardless of their ability to
pay. Contractor shall assume costs of delivery of indigent care and
dry runs.
C. Must guarantee a maximum response time for ALS units and BLS ambulances
of ten minutes to 90% of -calls originating in assigned service area.
D. Must agree to respond available ALS units and/or BLS ambulances in a mutual
a'id capacity outside assigned area of responsibility if.directed to do so
by County Communications Center.
E. Must provide ALS care and transport when directed to do so by the Base .
Station Hospital.
F: Must not utilize an ALS unit to transport non -ALS patients unless pro-
vision Inas been made for back-up ALS service. This back-up may not
come from another service area.'
G. In the event that the ALS unit is in service on an authorized emergency
call, Contractor must guarantee that the BLS ambulance responsible for
the assigned service area will respond to all urgent (Code 2) and
emergent (Code 3) calls when directed to do so by County Communications_
H. BLS ambulance must be dedicated solely•for emergency use and may,no t
respond to private calls in or out of assigned service area.
1. In the event that a BLS ambulance from another service area must respond
into Contractor's service area for back-up, Contractor must assume respon-
sibility for payment of any dry runs or uncollectibles incurred-
11.
ncurred_
11. I•lanpower/Tra i ni nq
A. Advanced Life Support-Unjis must be staffed at all times by two, Marin
County -certified liobile Intensive Care Paramedics trained to levels
defined by the Wedworth/Townsend Act, with the exception that the field
internship portion of their training is at least 360 hours.
B. Paramedics must meet Marin County certification criteria through com-
pliance
om-
pliance with the following requirements.
1. Successful completion of a course of instruction in Ibbile lnten-
.sive Care Paramedic training approved by the Marin County Health
Officer.
2. Successful completion of written, performance and oral examinations
approved by the Marin County Health Officer.
3. Certification as an Advanced Cardiac Life Support provider accord-
ing to the standards of the American Heart Association.
4. Employment and recommendation by an approved Harin County paramedic
provider agency and the paramedic -training agency_
5. Certification will be valid For two years provided the candidate
fulfills the continuous service (1), continuing education (2),
and skills (3), requirements.
6. Individuals denied certification will be informed in writing of
the reason for d•;:nial. The individual will be granted, upon
request, a hearing before the County Health Officer_
- 1 -
C. Paramedic pe nnel are eligible for chalIen,- ig certification in
Marin County f the Following has been accomr.ished-
}, Submit verification of employment with an approved Marin County
paramedic provider agency- -
2. Successful completion of training program approved by the rlarin
County Health Officer.
3. Submit transcripts.from training institution.
4. Certification as an Advanced Cardiac Life Support provider
according to the standards of the American Heart Association_
5. Successful completion of written, performance, and oral exami-
nations approved by the Marin County Health Officer.
6. Completion of five field shifts supervised by a Marin County
Mobile Intensive Care Paramedic or Mobile Intensive Care Nurse.
D. Paramedic personnel -must maintain eligibility through compliance
with the following recertification criteria:
1. Satisfactory completion of continuing education, continuous
service, and skills requirements set forth by the County Health
Officer. -
2. Recommendation by the following:
a. Candidate's employer
b. Base Hospital bled i cal Director and the Base Hospital MI CN
Coordinator.
3. Satisfactory completion of written, performance, and oral exami-
nation approved by the County Health Officer.
4. Current certification as an Advanced Cardiac Life Support pro-
vider according to the standards of the American Heart Associa-
tion.
5. - Recertification will be valid for two years provided the candidate
fulfills the continuous service, continuing education, and
skills requirements.
6. Individuals denied recertification will be informed in writing
bf the reason for denial. The individual will be granted, upon
request, a hearing before the County Health Officer_
E. Paramedic personnel are required to be assigned to paramedic units
for not less than 72 hours per month, excluding vacation and sick
leave. If the Mobile Intensive Care Paramedic works less than 72 hours
per month for t% -,v consecutive months or for three months within a cal-
ender year, certification may be suspended by the Health Officer.
Certification may be re-establishcd by the Health Officer upon satis-
factory completion of skills performance exam, plus oral and/or
written exams if indicated.
F. Paramedic personnel must meet minimum continuing education requirements_
A minimum requirement of sixty (60) hours of continuing education per
calendar year has been established for all certified personnel- (A
minimum of 45 hours must be completed during the first year of the two-
year certification period.) Credit hours may be earned in the folio -ging
ways that relate to emergency medical care:
1. Lectures at hospitals (1 hour lecture for l hour credit)
2. Run review experience at hospitals. rlinimum of 10 credit hours/
year. (1 'hour critique for-) hour credii t) .
3. Supervised study (2 hours of study for 1 hour credit)
�t=
I hour creek t�
4. Teaching 'Lsi c life support) (1 hour clas'�, or
5. Professionaj lectures, workshops and semin..s approved in advance.
(1 hour lecture for i hour credit)
6. C 1 i n i cal. 1•1i n i mum of 30 credit hours/year. ' (Credit awarded on
individual basis.)
7. .'Acaderni c'courses - approved in advance. (One course unit for a
quarter course will equal 10 credit hours, semester units equal
15 credit hours.)
G. Paramedic personnel must participate in skills test twice per year as
directed by the EMS Training Coordinator and the Ileal th Officer_
11. Basic Life Support Units must be staffed at all times by two, Emergency
Medical Technician -1's (EI.1T's) currently certified as specified in
Section 6755.1, 6755.2 or 6755.3 of Title 13; California Administrative
Code.
F. At least annually, EMT -I's shall participate in a minimum of tiro hours
of refresher course training in Cardiopulmonary Resuscitation and
demonstrate proficiency in the techniques according to the standards
of the American Heart Association.
J. Driver must have in his possession al all times a valid California
Driver's License, and a current Ambulance Driver's Certificate issued
by California Department of Motor Vehicles, if not exempt by State law.
ltl. Communication and Dispatch Requirements
A. Contractor must agree to install, utilize and maintain the appropriate
radio equipment as follows:
1. All ALS units and BLS ambulances used for emergency medical
response must be equipped with tun -way radios on frequencies
designated by County Communications for the purpose of dispatch-
ing by, and status -keeping with, County Communications_
2. Radio equipment, approved by County Sheriff, must be installed prior
to assignment of a vehicle for zone coverage. -
3. Two-way radios must be operated in'conformance with all applicable
rules and regulations of the Federal Communications Commission,
and in conformance with all applicable County rules and operating
procedures.
If. All UHF radio equipment used for biomedical information and the
sending of medical telemetry information shall be provided at con-
tractor's expense. All patient monitoring equipment shall ba provided
at contractor's expense.
5. All mobile and portable radio equipment used must be approved•by
the County Sheriff.
6. County will agree to service contractor -owned radio equipment at
the current County time and material rate, provided a signed mainte-
nance agreement is in force.
7.' Contractor must maintain at contractor's expense, a direct tele-
phone line between Communications and his ALS and BLS dispatch
office(s) within 1.larin County.
8. All emergency calls requiring a Code 3 response which contractor
receives from sources other than County Communications }•rill be
reported immediately to County Communications_ County Communica-
tions shall assume the responsibility for dispatching the nearest
available ambulance.
- 3 -
Contractor must gree to abide by centralized c' patch procedures
monitored
by Marin County Communications including:
1.
All ALS units and BLS ambulances involved in emergency medical
care under this agreement shall be directly dispatched by County
Communications and shall be given an authorization number at the
time of dispatch.
2.
Upon receipt of verbal Code Eleven authorization, as promptly as
possible, Contractor must dispatch the appropriate vehicle and crew
to the designated location proceeding there in a manner specified
by Communications.
3.
Contractor shall inform Communications of any changes in avail-
ability, location, and status of ALS units and BLS ambulances,
in or out of service. •Those vehicles Which do not have the requir(-:cl
on -duty personnel shall be considered out of service and shall be
reported as such to Communications and to the County Health Officer_'
4.
All ALS units and BLS ambulances must use the unit number designated
by County Sheriff.-.
IV. Equipment and Supply Requirements
A. Vehicles
1. Ambulance vehicles shall meet standards specified in Title 13,
Chapter 2, California Administrative Code, and each shall possess
a valid Emergency Vehicle Permit issued by California Ilighway
Patrol.
2. Vehicles Will be maintained cleanly and in good mechanical and
body condition at.all times.
B. Safety Equipment: Saf ety Equipment to be carried on ALS and BLS units
and maintained in good Working order shall include the following:
1. An approved siren
2. An approved steady -burning, red -warning lamp, mounted as specified
in Section 808 of California Administrative Code, shall provide .
adequate Warning for at least 500 feet ahead of the vehicle in -day-
light under normal atmospheric conditions.
3. Approved safety belts installed for the driver and for a passenger
in the front seat if a seat is provided_
A fire extinguisher of the dry chemical or carbon dioxide type
With a minimum 4-B:C rating. The use of vaporizing liquid
extinguishers is prohibited.
5. A portable, battery-operated light '
6. A spare tiro
7. A jack and tire tools
8. Maps covering the areas in which the ambulance provides service_
C. Emergency Medical Equipment and Supplies
All equipment and supplies are to be carried on ALS and BLS units at
all times and maintained in clean condition and good Working order_
(Title 13, California Administrative Code):
1. An ambulance cot and collapsible stretcher; or two strcteners, one
of which is collapsible.
2; Straps to secure the patient to the stretchcr or ambulance cot, and
means of securing the stretcher or ambulance cot in the vehicle_
- 4
• acceptable_
3_ Ankle an rist restraints. Soft ties ate`
4. Sheets, pi l low cases, blankets, and towels For each stretcher or
,_:. ••::.- ambulance cot, .and two pillows for each ambulance.
5. Three, mouth-to-mouth resuscitation or oropharyngeal airways, one
each of a size for adults, children, and infants.
6. At least three, 3" by 15" arm splints and three, 3" x 3G" or longer
leg and thigh splints with a soft or cushioned surFace or roll
material for padding for immobilizing and protecting fractured
extremities. Equivalent padded board, wraparound, wire ladder,
inflatable, or cardboard splints will meet this requirement.
7. A resuscitator that meets the requirements of Vehicle Code Section
2418.5. A hand -operated, bag -valve -mask unit with clear masks
of adult, child, and infant sizes capable of use with oxygen will
meet this requirement.
8, Portable oxygen (USP),' regulator, and means for. administering
oxygen, including adequate tubing and semiopen, valveless, trans
parent masks in adult, child, and infant sizes. Oxygen may be
administered by resuscitator, bag mask unit', or inhalator.
9. Clean bandages and bandaging supplies:
12; Jill sterile bandage compresses or equivalent
Four 3" by 3" sterile guaze pads
Six 2" or 3" roller bandages
Four 40" triangular bandages
Two rolls of 1", 2" or 3" adhesive tape
Tato tourniquets
Bandage shears
Six tongue depressors
Large safety pins
T%%D additional sheets
Two universal dressings 10" x 30" or larger
10. Tvo padded mouth gags either commercial or made of three tongue
blades taped together and padded.
11. An emesis basis, or disposable bags and covered waste container_
12. Portable suction equipment.
13. Two sandbags, loosely filled, or equivalent material to restrict
movement.
14. Two rigid spine boards approximately ]!F " or more slide, one 32" or
more long, and one approximately 72" long, with straps for immobili-
zation of suspected spinal or back injuries. Combination short -long
boards are acceptable.
15. Half -ting traction splint for lower extremity with limb -support
slings, padded ankle hitch traction strap, and heel rest_
1G. Blood pressure manometer, cuff, and stethoscope.
17. Sterile obstetrical supplies including as a minimum: gloves'
umbilical cord tape or clamps, dressings, to:•iels, bulb syringes,
and clean plastic bags.
18. A gallon or more of clean eater in covered, secured, plastic
container.
D. In addition to the equipment listed above, County requires that all
ALS and BLS Units be equipped with:
1. Universal dressings, approximately 10" by 3G", compactly folded
and packaged in convenlent size.
2. Sterile guaze pads, J►" by Jill.
5 -
lam. � -
4
�� 5 yards
3. Soft rollr'self-adhering type bandages, (�
r fit. Roll of aluminum foil, lII" by 25', stern. -ed and wrapped
5. Two Sterile burn sheets
6. Cervical collars for child and adult use.
7. Poison kit
a. Normal saline irrigation solution
9. Scoop stretcher
10.' Cold packs
E. In addition to the equipment listed in C and D above, all ALS units
must carry the following: (items marked with astrisks (*) are to be
used only with specific orders of a Base Station hospital MICH or
Emergency Physician):
^1. IV sets•with pedi drip (60 drops per cc)
*2.- IV sets with solution drip (15 drops per cc)
3. Sterile alcohol wipes
IV cannulae and short needles, various sizes
*5. Blood tubes (red, purple and grey tops)
1�6. Maso-gastric tubes
7. Demand valve
Esophageal obturator airways - two `
=9. Cardiac monitor and defibrillator
*10. MAST -- trousers
11. Sterile normal saline for irrigation
*12, 5% Dextrose in %•rater IV solution -- 500 cc (four bottles)
::13. Mormal Saline IV solution - 1000 cc (four bottles)
}
*A. Lactated Ringers IV solution - 1000 cc (four bottles)
*15: Locked drug box containing the following:
a. Aminophylline - 250 m9/10 cc
b. Atropine - 1 mg/1 cc
c. Benadryl (Diphenhydramine) 50 mg/I cc
d. Cplcium Chloride 10% - 1 Gm/10 cc
e. Demerol (Meperidine) - 100 mg/l cc
f. Dextrose 50% - 25 Gm/50 cc
g. Epinephrine - 1:10,000 and 1:1,000
h. Glucose, oral
i. Ipecac Syrup �► oz.
-
j. Isuprel (Isopr'oteronol) - 2 mg/10 cc
k. Lasix (Furosemide) - 20 mg/2 cc
1. Lidocaine - 100 mg/lOcc and 2 Gms/50 cc
m. Morphine Sulphate - 15 mg/l cc
n. IIA11CO3 (Sodium Bicarbonate) 50 meg/50 cc
o. Narcan -- 0.4 mg/1 cc
p. Tditroglycerine - 0.4 mg tablets
q. Pitocin - 10 units/1 cc
r. Val i uin - 10 mg/2 cc
Ez'�
T.V Relationship with Co y Department of Health and Ilur n SIces
• - -A Commi ttees " - _• . •: -
'1.• Contractor agrees to designate an MI CP as+a member on the Paramt-dic
Advisory Committee.
2. Contractor agrees to designate a representative Lo the Ambulance
Committee
B. Data Collection
1. Contractor agIrees to utilize such standardized ambulance records
as County deems n-acessary for data collection_
2. Contractor agrees to supply County with other ambulance and PIICP
information as necessary for statistical reporting.
C.' System Coordination
•1. Contractor agrees to work with County in planning for and imple-
mentating coordinated and integrated emergency medical services_
2. The County Health Orficer or his designee 'shall have the right to
make inspections of vehicles and personnel, during normal business
hours, without prior notice to determine whether contractor is
complying with the terms and conditions of this agreement.
3. Contractor must designate a single 141CP as a liaison bet%;zen the
County EMS Unit,:the Base Hospital and the provider agency_
D. Public Education
1. Contractor shall be responsible for providing public education to
the community it serves. _
2. Pub] i c education programs wi 11 be coordinated with and consistent
with objectives established by the Public Education Sub -Committee
of the Emergency Medical Care Committee.
-7'-
OPERATIONAL GUIDELINES
The Contractor must agree to abide by the following operational procedures:
A. Local Fire Departments will be dispatched as first responders to
all Code 3 medical emergencies.
B. The ALS Unit assigned to the Service Area will be dispatched on all
Code 3 medical emergencies.
C. The MICP attendant will take charge of the paticnt(s) upon reaching
the scene.
D. The BLS Uni t ass igned to, the Sery i ce Area tai 11 be d i spatched on
all Code 2 medical emergencies.
E. Ambulance personnel will take charge of the patient(s) when released
by_the MICP or Fire Department EMT -1.
F. Each person requiring medical attention will be evaluated, and
given BLS care as required. Radio contact will be made with the
Base Station Hospital for all ALS orders when ALS care is deemed
necessary by either of the'attending MICP's.
G. Any person receiving ALS care will be transported by the ALS Unit
to the Receiving Hospital designated by the Base Station Hospital in
accordance with County Triage Protocols.
FI_ In those cases where ALS care is not deemed necessary, the MICP will
request Communications to dispatch the BLS ambulance responsible for
that Service Area, and the patient(s) will be attended until the BLS
ambulance arrives on the scene and assumes responsibility for the
patient(s). "
1. ALS units and BLS ambulances will proceed to the Receiving Hospital
designated by the Base Station Hospital in accordance with County
Triage Protocols in the manner (Code 2 or 3) deemed appropriate by
the person in charge (attendant).
J. Whenever conFlicts arise regarding a patient, his condition, hospital
destination, the code of travel, the method of handling, or other
matters of diverse opinion which might result in delay of treatment
or other potential harm to the patient, the person in charge (atten-
dant) shall communicate immediately with the Base Station Hospital
to receive instructions from the Emergency Physician on duty_
K. Whenever any doubt exists as to the patient being alive or dead, the
patient is to be considered to be alive and appropriate emergency
procedures are to be carried out.
i L. In an officially declared State of Emergency, either within or
outside of Marin County, County COMM Lin ications, on authority of the
County Administrator or Chairman of the Board of Supervisors may
request BLS ambulances and/or ALS units to provide assistance.
County will provide reasonable reimbursement for service rendered_
8 - ,
y1..- � ❑rvrsrOly Ut rI tALl/7 3r
_,�• COUNTY OF MAR1N
' HAL_ OF JUSTICE
civic CENTER
•- - SAN RAFAEL, CALIFORNIA .
PHONE 479-1100
TRIAGE•PROTOCOLS -- GLS AND ALS
197
PURPOSE: To insure that patients suffering from medical emergencies are taken
to the nearest facility appropriate to their medical needs. Fo11o:-:in_
stabilization, interhospital transfer guidelines %4`1] insure that the
patient is transported, when indicated, to the hospital -or critical
care center appropriate to his needs-
• These guidelines are based upon categorization profiles which reveal thy
follo%:i rig:
1. liar i n County has four tlosp i tal Emerg::ncy Departments categor' i red as
Basic (California guidelines) or General (Class 111 AMA guidelines).
2. All of these Hospi tal-s are equipped and staffed tvienty-four hours a day
to provide resuscitation and stabilization of all medical emergencies_
3. With the exception of the Intensive Care Nursery (neonatal) at Marin
General Hospital, there are no other regional Critical Care Specialty
Centers in Marin County (Trauma, Burn, Spinal•Cord, Poison)_
PROTOCOLS:
All ambulance transports %.;7 11 be either Code 11 indicating the patient's condi-
tion is stabilized or Code 111 indicating the medical emergency has not been stablized
and there exists a threat to the patient's life or limb. The determination of Code 11
or Code 111 transport is made by the senior attending ambulance personnel_ Consulta-
tion may be provided by the physician in charge of the Base Station or Receiving
Hospital Emergency Department.
CODE Ill
Any patient being transported Code 111 %•:hose medical condition, in the op i rr ion
of the senior attending ambulance personnel, has not been stabilized will be transpor
to the nearest Basic Emergency facility. The accompanying map may be used to assist
in the determination of the nearest facility.
CODE 11
The destination of the patient is determi ned. by:
1. The decision of the patient or the patient's family_
2. The decision of the patient's personal physician_
3. Kaiser members will be taken to Kaiser Hospital- '
4. In the event that the patient does not mare a choice or is incapable of
making a choice, the patient will be transported to the nearest Basic
facility.
�. Exceptions (non -Kaiser only) - Code 11 transport of obstetric or neonatal
patients will follow the following guidelines; _.
a) All obstetric, neonatal patients f roar West, Central and Southern -Marl n
will be transported to Marin General Hospital
b) All obstetric, neonatal patients from the Movato Fire District will be
transported to Novato Community Hos,pital-
- 9 -
. • �`, DIVISION OF NEAT --CH SERVICES
COUNTY OF MARIN
►IRLL OF JUSTICE
• CMG CENTER
SAA RAFA_L. CALIFORNIA
PHONE A79-1100
TRIAGE PROTOCLS - DLS AND ALS
1978 -
Patient'evaluation by senior attending ambulance personnel
not stabilized _ stabilizccl
1i.fe or limb at risk .
CODE 111 CODE 11
I
-- --.A --- • -
Ency_Facility
i(ospital MISER member No choice:
of incapable
Choice - cho1c
(patient, family)
HOSPITAL OF CHOICE }:11ISER HOSPITAi. rTEt Rr. TEAS
M-1CRGENCY
FACIT_,T_TY
• N.�nna��l�•-It7i(-ni c-2at-in t-
rlovato Fire District All other Marin County _-
NOV11T0 C' UNITY IIOSF'ITAL f. RTP' C:F.t1F AL HOSPITAL
- 10 -
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I
AGREEMENT BETWEEN COUNTY SERVICES AREA NO. 19
AND CITY OF SAN R.AFAEL RELATING TO ADVANCE
LIFE SUPPORT AND BASIC LIFE SUPPORT EMERGENCY
AMBULANCE SERVICE
THIS AGREEMENT made and entered into this 1st day of
January, 1980, by and between the County Services Area No. 19
of the County of Marin, State of California, hereinafter referred
to as "Area" and the City of San Rafael, hereinafter referred to
as "Contractor";
W I T N E S S E T H:
FOR AND IN CONSIDERATION of the mutual promises and
covenants hereinafter contained, the parties hereto do hereby
agree as follows:
Section 1: Contractor shall provide advance life
support and basic life support emergency ambulance service to
the residents of Area as described in Exhibit A attached hereto
and by this reference incorporated herein.
Section 2: In consideration of the provision of such
services without charge to the residents of Area, Area will pay
to Contractor the sum of $12.00 minus $.50 for the County service
charge for provision of the service from January 1, 1980 to
December 31, 1980 and hereby authorizes the Auditor -Controller of
the County of Marin to pay such sum to Contractor out of the
proceeds of the assessment authorized by the voters of the Area
in November 1979.
IN WITNESS WHEREOF the parties hereto have set their
hand the date and year first above written.
ATTEST:
�CvuJ lb�
ATTEST:
COUNTY SERVICE AREA NO. 19
By
"AREA"
CITY OF SAN RAFAEL
By
"CONTRACTOR"
27.1 B/9
f
MINIMUM REQUIREMENTS
MARIN COUNTY PARAMEDIC SERVICES
1. Coverage Requirements
A. Must provide continuous 24-hour, 365 -day coverage of all urgent (Code2)
and emergent (Code 3) medical emergencies in assigned service area.
B. Must provide ALS care and transport and provide for dedicated emergency
RLS care and transport to all patients regardless of their ability to
pay. Contractor shall assume costs of delivery of indigent care and
dry runs.
C. Must guarantee a maximum response time for ALS units and BLS ambulances
of ten minutes to 9O% of.calls originating in assigned service area.
D. Must agree to respond available ALS units and/or BLS ambulances in a mutual
aid capacity outside assigned area of responsibility if,directed to do so
by County Communications Center.
E. Must provide ALS care and transport when directed to do so by the Base .
Station Hospital.
F: Must not utilize an ALS unit to transport non -ALS patients unless pro-
vision has been made for back-up ALS service. This back-up may not
come from another service area. •
G. In the event that the ALS unit is in service on an authorized emergency
call, Contractor must guarantee that the BLS ambulance responsible for
the assigned service area will respond to all urgent (Code 2) and
emergent (Code 3) calls when directed to do so by County Communications.
H. BLS ambulance must be dedicated solely'for emergency use and may"not
respond to private calls in or out of assigned service area.
I. In the event that a BLS ambulance from another service area must respond
into Contractor's service area for back-up, Contractor must assume respon-
sibility for payment of any dry runs or uncollectibles incurred.
II. Manpower/Training
A. Advanced Life Support -Units must be staffed at all times by two, Marin
County -certified Fiobile Intensive Care Paramedics trained to levels
def i ned by the 1•ledwor th/Townsend Act, wi th the exception that the f i el d
internship portion of their training is at least 360 hours.
B. Paramedics must meet Marin County certification criteria through com-
pliance with the following requirements.
1. Successful completion of a course of instruction in Mobile Inten-
sive Care Paramedic training approved by the Marin County Health
Officer.
2. Successful completion of written, performance and oral examinations
approved by the Marin County Health Officer.
3. Certification as an Advanced Cardiac Life Support provider accord-
ing to the standards of the American Heart Association.
4. Employment and recommendation by an approved Marin County paramedic
provider agency and the paramedic -training agency -
5. Certification will be valid For two years provided the candidate
fulfills the continuous service (1), continuing education (2),
and skills (3), requirements.
6. Individuals denied certification will be informed in writing of
the reason for denial. The individual will be granted, upon
request, a hearing before the County Health Officer_
C. Paramedic personnel are eligible for challeng.ag certification in
Marin County if the following has been accomplished -
1. Submit verification of employment with an approved Marin County
paramedic provider agency- -
2. Successful completion of training program approved by the Marin
County Health Officer.
3. Submit transcripts.from training institution.
4. Certification as an Advanced Cardiac Life Support provider
according to the standards of the American Heart Association.
5. Successful completion of written, performance, and oral exami-
nations approved by the Marin County Health Officer.
6. Completion of five field shifts supervised by a Marin County
Mobile Intensive Care Paramedic or Mobile Intensive Care Nurse.
D. Paramedic personnel must maintain eligibility through compliance
with the following recertification criteria:
1. Satisfactory completion of continuing education, continuous
service, and skills requirements set forth by the County Health
Officer.
2. Recommendation by the following:
a. Candidate's employer
b. Base Hospital Medical Director and the Base Hospital MICN
Coordinator.
3. Satisfactory completion of written, performance, and oral exami-
nation approved by the County Health Officer.
4. Current certification as an Advanced Cardiac Life Support pro-
vider according to the standards of the American Heart Associa-
tion.
5. Recertification will be valid for two years provided the candidate
fulfills the continuous service, continuing education, and
skills requirements.
6. Individuals denied recertification will be informed in writing
of the reason for denial. The individual will be granted, upon
request, a hearing before the County Health Officer.
E. Paramedic personnel are required to be assigned to paramedic units
for not less than 72 hours per month, excluding vacation and sick
leave. If the Mobile Intensive Care Paramedic works less than 72 hours
per month for two consecutive months or for three months within a cal-
endar year, certification may be suspended by the Health Officer.
Certification may be re-established by the Health Officer upon satis-
factory completion of skills performance exam, plus oral and/or
written exams if indicated.
F. Paramedic personnel must meet minimum continuing education requirements.
A minimum requirement of sixty (60) hours of continuing education per
calendar year has been established for all certified personnel. (A
minimum of 45 hours must be completed during the first year of the two-
year certification period.) Credit hours may be earned in the following
ways that relate to emergency medical care:
1. Lectures at hospitals (1 hour lecture for i hour credit)
2. Run review experience at hospitals. Minimum of 10 credit hours/
year. (1 hour critique for 1 hour credit).
3. Supervised study (2 hours of study for l hour credit)
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4. Teaching f 7iic life support) (1 hour clas3�.:- i hour credit)
5. Professional lectures, workshops and seminars approved in advance.
:(1 hour lecture for 1 hour credit)
6. Clinical. Minimum of 30 credit hours/year. (Credit awarded on
individual basis.)
7. Academic courses - approved in advance. (One course unit for a
quarter course will equal 10 credit hours, semester units equal
15 credit hours.)
G. Paramedic personnel must participate in skills test twice per year as
directed by the EMS Training Coordinator and the Health Officer.
H. Basic Life Support Units must be staffed at all times by two, Emergency
Medical Technician -I's (EMT's) currently certified as specified in
Section 6755.1, 6755.2 or 6755.3 of Title 13; California Administrative
Code.
1. At least annually, EMT -I's shall participate in a minimum of two hours
of refresher course training in Cardiopulmonary Resuscitation and
demonstrate proficiency in the techniques according to the standards
of the American Heart Association.
J.' Driver must have in his possession al all times a valid California
Driver's License, and a current Ambulance Driver's Certificate issued
by California Department of Motor Vehicles, if not exempt by State law.
111. Communication and Dispatch Requirements
A. Contractor must agree to install, utilize and maintain the appropriate
radio equipment as follows:
1. All ALS units and BLS ambulances used for emergency medical
response must be equipped with two-way radios on frequencies
designated by County Communications for the purpose of dispatch-
ing by, and status -keeping with, County Communications.
2. Radio equipment, approved by County Sheriff, must be installed prior
to assignment of a vehicle for zone coverage.
3: Tv%o-way radios must be operated in conformance with all applicable
rules and regulations of the Federal Communications Commission,
and in conformance with all applicable County rules and operating
procedures.
4. All UHF radio equipment used for biomedical information and the
sending of medical telemetry information shall be provided at con-
tractor's expense. All patient monitoring equipment shall be provided
at contractor's expense.
5. All mobile and portable radio equipment used must be approved'by
the County Sheriff.
6. County will agree to service contractor -owned radio equipment at
the current County time and material rate, provided a signed mainte-
nance agreement is in force.
7.' Contractor must maintain at contractor's expense, a direct tele-
phone line between Communications and his ALS and BLS dispatch
office(s) within Marin County.
8. All emergency calls requiring a Code 3 response which contractor
receives from sources other than County Communications 'wi11 be
reported immediately to County Communications. County Communica-
tions shall assume the responsibility for dispatching the nearest
available ambulance.
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B. Contractor musL agree to abide by centralized , spatch procedures
monitored by Marin County Communications including:
^1.. All ALS units and BLS ambulances involved in emergency medical
care under this agreement shall be directly dispatched by County
Communications and shall be given an authorization number at the
time of dispatch.
2. Upon receipt of verbal Code Eleven authorization, as promptly as
possible, Contractor must dispatch the appropriate vehicle and crew
to the designated location proceeding there in a manner specified
by Communications.
3. Contractor shall inform Communications of any changes in avail-
ability, location, and status of ALS units and BLS ambulances,
in or out of service. Those vehicles which do not have the required
on -duty personnel shall be considered out of service and shall be
reported as such to Communications and to the County Health Officer.
4. All ALS units and BLS ambulances must use the unit number designated
by County Sheriff.
IV. Equipment and Supply Requirements
A. Vehicles
1. Ambulance vehicles shall meet standards specified in Title 13,
Chapter 2, California Administrative Code, and each shall possess
a valid Emergency Vehicle Permit issued by California Highway
Patrol.
2. Vehicles will be maintained cleanly and in good mechanical and
body condition at all times.
B. Safety Equipment: Safety Equipment to be carried on ALS and BLS units
and maintained in good working order shall include the following:
1. An approved siren
2. An approved steady -burning, red -warning lamp, mounted as specified
in Section 808 of California Administrative Code, shall provide
adequate warning for at least 500 feet ahead of the vehicle in -day-
light under normal atmospheric conditions.
3. Approved safety belts installed for the driver and for a passenger
in the front seat if a seat is provided.
4. A fire extinguisher of the dry chemical or carbon dioxide type
with a minimum 4-B:C rating. The use of vaporizing liquid
extinguishers is prohibited.
5. A portable, battery-operated light
6. A spare tire
7. A jack and tire tools
8. Maps covering the areas in which the ambulance provides service.
C. Emergency Medical Equipment and Supplies
All equipment and supplies are to be carried on ALS and BLS units at
all times and maintained in clean condition and good working order.
(Title 13, California Administrative Code):
1. An ambulance cot and collapsible stretcher; or two stretchers, one
of which is collapsible.
2. Straps to secure the patient to the stretcher or ambulance cot, and
means of securing the stretcher or ambulance cot in the vehicle.
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3. Ankle ai. 'wrist restraints. Soft ties acceptable.
4. Sheets,'pillow cases, blankets, and towels for each stretcher or
ambulance cot,.and two pillows for each ambulance.
5. Three, mouth-to-mouth resuscitation or oropharyngeal airways, one
each of a size For adults, children, and infants.
6. At least three, 3" by 15" arm splints and three, 3" x 3G" or longer
leg and thigh splints with a soft or cushioned surface or roll
material for padding for immobilizing and protecting fractured
extremities. Equivalent padded board, wraparound, wire ladder,
inflatable, or cardboard splints will meet this requirement.
7. A resuscitator that meets the requirements of Vehicle Code Section
2418.5. A hand -operated, bag -valve -mask unit with clear masks
of adult, child, and infant sizes capable of use with oxygen will
meet this requirement.
8. Portable oxygen (USP),'regulator, and means for- administering
oxygen, including adequate tubing and semiopen, valveless, trans-
parent masks in adult, child, and infant sizes. Oxygen may be
administered by resuscitator, bag mask unit, or inhalator.
9. Clean bandages and bandaging supplies:
12, 4" sterile bandage compresses or equivalent
Four 3" by 3" sterile guaze pads
Six 2" or 3" roller bandages
Four 40" triangular bandages
Two rolls of 1", 2" or 3" adhesive tape
Two tourniquets
Bandage shears
Six tongue depressors
Large safety pins
Two additional sheets
Two universal dressings 10" x 30" or larger
10. Twp padded mouth gags either commercial or made of three tongue
blades taped together and padded.
11. An emesis basis, or disposable bags and covered waste container.
12. Portable suction equipment.
13. Two sandbags, loosely filled, or equivalent material to restrict
movement.
11►. Trio rigid spine boards approximately 1!i" or more wide, one 32" or
more long', and one approximately 72" long, with straps for immobili-
zation of suspected spinal or back injuries. Combination short -long
boards are acceptable.
15. Half -ling traction splint for lower extremity with limb -support
slings, padded ankle hitch traction strap, and heel rest.
16. Blood pressure manometer, cuff, and stethoscope.
17. Sterile obstetrical supplies including as a minimum: gloves;
umbilical cord tape or clamps, dressings, towels, bulb syringes,
and clean plastic bags.
18. A gallon or more of clean viater in covered, secured, plastic
container.
D. In addition to the equipment listed above, County requires that all
ALS and ILLS units be equipped with:
1. Universal dressings, approximately 10" by 36", compactly folded
and packaged in convenient size.
2. Sterile guaze pads, 4" by 4".
MM
4 '
3. Soft roll` self -adhering type bandages, by 5 yards
4. Roll of aluminum foil, 18" by 25', sterilized and wrapped
~5. Two sterile burn sheets
6. Cervical collars for child and adult use.
7. Poison kit
8. Normal saline irrigation solution
9. Scoop stretcher
10. Cold packs
E.- In addition to the equipment listed in C and D above, all ALS units
must carry the following: (items marked with astrisks (*) are to be
used only with specific orders of a Base Station Hospital MICH or
Emergency Physician):
*1. 1V sets' wi th pedi drip (60 drops per cc)
*2.• IV sets with solution drip (15 drops per cc)
3. Sterile alcohol wipes
A. IV cannulae and short needles, various sizes
'5. Blood tubes (red, purple and grey tops)
*6. Naso -gastric tubes
7. Demand valve
*'8. Esophageal obturator airways - two
*9. Cardiac monitor and defibrillator
^-10. MAST - trousers
11. Sterile normal saline for irrigation
*12, 5% Dextrose in vrater IV solution - 500 cc (four bottles)
=13. Normal Saline IV solution - 1000 cc (four bottles)
*14. Lactated RingerslV solution - 1000 cc (four bottles)
%;15: Locked drug box containing the following:
a. Aminophylline - 250 mg/10 cc
b. Atropine - 1 mg/1 cc
c. Benadryl (Diphenhydramine) 50 mg/i cc
d. Colcium Chloride 10; - 1 Gm/10 cc
e. Demerol (14eperidine) - 100 mg/1 cc
f. Dextrose 50% - 25 Gm/50 cc
g. Epinephrine - 1:10,000 and 1:1,000
h. Glucose, oral
i. Ipecac Syrup - 4 oz.
j, Isuprel (Isoproteronol) - 2 mg/10 cc
k. Lasix (Furosemide) - 20 mg/2 cc
1. Lidocaine - 100 mg/lOcc and 2 Gms/50 cc
m. Morphine Sulphate - 15 mg/1 cc
n. NAHCO3 (Sodium Bicarbonate) 50 meg/50 cc
o. Narcan 0.4 mg/I cc
p. Nitroglycerine - 0.4 mg tablets
q. Pitocin - 10 units/] cc
r. Valium - 10 mg/2 cc
Relationship with County Department or Health and Hum—, Services
A. Commi ttees
I.* Contractor agrees to designate an MICP as a member on the Paramedic
Advisory Committee.
2. Contractor agrees to designate a representative to the Ambulance
Committee
B. Data Collection
1. Contractor agrees to utilize such standardized ambulance records
as County deems necessary for data collection.
2. Contractor agrees to supply County with other ambulance and MICP
information as necessary for statistical reporting.
C. System Coordination
.1. Contractor agrees to work with County in planning for and imple-
mentating coordinated and integrated emergency medical services.
2. The County Health Officer or his designee shall have the right to
make inspections of vehicles and personnel, during normal business
hours, without prior notice to determine whether contractor is
complying with the terms and conditions of this agreement.
3. Contractor must designate a single MICP as a liaison between the
County EMS Unit, 'the Base Hospital and the provider agency.
D.' Public Education
1. Contractor shall be responsible for providing public education to
the community it serves.
2. Public education programs will be coordinated with and consistent
with objectives established by the Public Education Sub -Committee
of the Emergency Medical Care Committee.
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OPERATIONAL GUIDELINES
The Contractor must agree to abide by the following operational procedures:
A. Local Fire Departments will be dispatched as first responders to
all Code 3 medical emergencies.
B. The ALS Unit assigned to the Service Area will be dispatched on all
Code 3 medical emergencies.
C. The MICP attendant will take charge of the patient(s) upon reaching
the scene.
D. The BLS Unit assigned to the Service Area will be dispatched on
all Code 2 medical emergencies.
E. Ambulance personnel will take charge of the patient(s) when released
by_the MICP or Fire Department EMT -1. -
F. Each person requiring medical attention will be evaluated, and
given BLS care as required. Radio contact will be made with the
Base Station Hospital for all ALS orders when ALS care is deemed
necessary by either of the attending MICP's.
G. Any person receiving ALS care will be transported by the ALS Unit
to the Receiving Hospital designated by the Base Station Hospital in
accordance with County Triage Protocols.
H. In those cases where ALS care is not deemed necessary, the MICP will
request Communications to dispatch the BLS ambulance responsible for
that Service Area,and the patients) will be attended until the BLS
ambulance arrives on the scene and assumes responsibility for the
patient(s). "
1. ALS units and BLS ambulances will proceed to the Receiving Hospital
designated by the Base Station Hospital in accordance with County
Triage Protocols in the manner (Code 2 or 3) deemed appropriate by
the person in charge (attendant).
J. Whenever conflicts arise regarding a patient, his condition, hospital
destination, the code of travel, the method of handling, or other
matters of diverse opinion which might result in delay of treatment
or other potential harm to the patient, the person in charge (atten-
dant) shall communicate immediately with the Base Station Hospital
to receive instructions from the Emergency Physician on duty.
K. Whenever any doubt exists as to the patient being alive or dead, the
patient is to be considered to be alive and appropriate emergency
procedures are to be carried out.
L. In an officially declared State of Emergency, either within or
outside of Marin County, County Communications, on authority of ttie
County Administrator or Chairman of the Board of Supervisors may
request BLS ambulances and/or ALS units to provide assistance.
County will provide reasonable reimbursement for service rendered.
'F DIVISION OP HEALTH SEP.VICES
: COUNTY OF MARIN
HALL OF JUSTICE
CIVIC CENTER
- SAN RAFAEL, CALIFORMIA
Pt10NE 479-1100
TRIAGE PROTOCOLS -- BLS AND ALS
1979
PURPOSE: To insure that patients suffering from medical emergencies are taken
to the nearest facility appropriate to their medical needs. Following
stabilization, interhospital transfer guidelines will insure that the
patient is transported, when Indicated, to the hospital•or critical
care center appropriate to his needs.
-These guidelines are based upon categorization profiles which reveal the
following:
1. Marin County has four Hospital Emergency Departments categorized 'as
Basic (California guidelines) or General (Class 111 AMA guidelines).
2. All of these Hospitals are equipped and staffed twenty-four hours a day
to provide resuscitation and stabilization of all medical emergencies_
3. With the exception of the Intensive Care Nursery (Neonatal) at Marin
General Hospital, there are no other regional Critical Care Specialty
Centers in Marin County (Trauma, Burn, Spinal•Cord, Poison).
PROTOCOLS:
All ambulance transports will be either Code 11 indicating the patient's condi-
tion is stabilized or Code 111 indicating the medical emergency has not been stablized
and there exists a threat to the patient's life or limb. The determination of Code 11
or Code 111 transport is made by th•e senior attending ambulance personnel. Consulta-
tion may be provided by the physician in charge of the Base Station or Receiving
Hospital Emergency Department.
CODE 111••
Any patient being transported Code 111 whose medical condition, in the opinion
of the senior attending ambulance personnel, has not been stabilized will be transport,
to the nearest Basic Emergency facility. The accompanying map may be used to assist
in the determination of the nearest facility.
CODE 11 '
The destination of the patient is determined.by:
1. The decision of the patient or the patient's family_
2. The decision of the patient's personal physician.
3. Kaiser members will be taken to Kaiser Hospital.
4. In the event that the patient does not make a choice or is incapable of
making a choice, the patient will be transported to the nearest Basic
facility.
5. Exceptions (non -Kaiser only) - Code 11 transport of obstetric or neonatal
patients will follow the following guidelines; _
a) All obstetric, neonatal patients from West, Central and Southern -Marin
will be transported to tlarin General Hospital.
b) All obstetric, neonatal patients from the Novato Fire District will be
transported to tlovato Community Hospital.
11
• - DEPAR'+�NT OF HEALTH Aria HUMAN ;f�„ Vlt` Ar
.._•
DIVISION OF HEALTH SERVICES
COUNTY OF MARIN
HALL OF JUSTICE
GMC CENTER _
SAN RAF'AEL. CALIFORNIA
PHONE 479-1100
TRIAGL FROTOCLS - DLS AND ALS i
1978 -
Patient 'evaluation by senior attending ambulance personnel
not stabilized stabilized
life or limb at risk
CODE 111 CODE 11
EEear�est Category 111 (Basic)
ner enc Facility
i Hospital KAISER member No choice
of Incapable
Choice choice
(patient, family)
HOSPITAL OF CHOICE KAISER HOSPITAL NEAREST BASIC
Et-IERGENCY
FACILITY
PXCF•PTIONS
Nronnaf-al nrytien pat-innt-
Novato Fire District Al- other Marin County
NOVATO COM1111UNITY IIOSPITAi 11ARIN CFNFRALHOSPITAL
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