HomeMy WebLinkAboutResolution No. 5824 (County of Marin Ambulance ServiceRESOLUTION NO. 5824
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 with
COUNTY OF MARIN RELATING TO ADVANCED LIFE SUPPORT AND BASIC
LIFE SUPPORT EMERGENCY AMBULANCE SERVICE
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
special meeting of the City Council of said City held on
Friday the 21st day of December , 193a_ by the
following vote, to wit:
AYES: COUNCILMEMBERS: Breiner, Jensen, Nixon & Mayor Mulryan
NOES: COUNCILMEMBERS: None
ABSENT: COUNCILMEMBERS: Miskimen
JCMNE M. LEONCINI,'City Clerk
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AGREEMENT BETWEEN COUNTY OF MARIN AND CONTRACTOR
RELATING TO ADVANCED LIFE SUPPORT AND BASIC LIFE SUPPORT
EMERGENCY AMBULANCE SERVICE
This is an agreement entered into this 1st day of JANUARY
1980, between the County of Marin, State of California, hereinafter referred to as
"County," and the City of San Rafael hereinafter referred to as "Contractor":
Section I
Definitions of Terms
The following definitions shall apply throughout this agreement:
A. Communications - the Communications Center operated by the County Sheriff.
B. Code Eleven Number - an authorization number issued by Communications
Indicating the call was dispatched or cleared by Communications.
C. Emergency Call - a request for dispatch of an ambulance to transport or
provide other assistance for a person apparently having a sudden and
unforeseen need of immediate medical attention.
D. Emergency Facility - a hospital.or other institution staffed and equipped
to provide emergency medical services.
E. Emergency Service - the service performed in response to an emergency
call.
F. Dry Run - any ambulance. trip made as a result of a Code Eleven authori-
zation that does not result in the picking up of a patient, either
because upon arrival at the scene, it is found that no ambulance was
needed or because the dispatch order for ambulance was cancelled enroute
by Communications.
G. Emergency Physician - refers to the physician group or organization
with which Hospital Base Station provides for emergency physician,
24-hour coverage at Hospital's Emergency Department.
H. Contractor - City of San Rafael
I. County - The County of Marin, California, or its governing body.
J. Procedures Manual - a written guide intended for reference and for
instruction to aid ambulance personnel in the handling of emergency
situations.
K. Advanced Life Support (ALS) - that level of emergency medical care
defined in Section 1480, et seq. of the California Health and Safety Code
(Wedworth-Townsend Act), approved by the Marin County Health Officer, and
authorized in the field and during transport to an emergency facility by
a County -approved Hospital Base Station.
L. Basic Life Support (BLS) - that level of emergency medical care which
includes advanced first aid and cardiopulmonary resuscitation with
the use of equipment, to the ill or injured at the scene and during
transport to an emergency facility.
M. Base Station Hospital - a Marin County Hospital that meets the require-
ments of a basic, 24-hour, emergency facility as defined in Title 22
of the California Administrative Code and has been designated by the
Marin County Board of Supervisors to direct pre -hospital ALS Services.
N. Mobile Intensive Care Nurse (MICN) - a Registered Nurse working in a
Base Station Hospital Emergency Department who has successfully com-
pleted a prescribed course of training in Advanced Life Support approved
in writing by the Marin County Health Officer and has been certified
by the Marin County Health Officer to direct pre -hospital ALS Services
while under the supervision of a licensed physician.
0. Mobile Intensive Care Paramedic (MICP) - a person who has been certi-
fied by the Marin County Health Officer to perform those pre -hospital
advanced life support medical services specified in the California
Health and Safety Code, Sections 1480 through 1485.
P. Emergency Medical Technician I (EMT -1) - a person possessing a valid
course -completion certificate from a program approved by the California
State Department of Health for the medical training and education of
ambulance personnel as defined by Title 17 of the California Adminis-
trative Code.
Q. ALS Unit - an ambulance or unit staffed with two, Marin County -certified
MICP's and equipped with appropriate medical equipment and supplies.
R. BLS Ambulance - an ambulance staffed with two EMT -I's and equipped
with appropriate medical equipment and supplies.
S. MEDS - Medical Emergency Dispatch System - a copy of operational manual
provided by County to each Contractor.
Section II. Services to be Rendered
Contractor shall, for the consideration set forth in this agreement, provide
Emergency Advanced Life Support services and provide for Basic Life Support
services to an assigned Service Ares which is described in Appendix "A"
attached hereto, and by this reference incorporated herein, in accordance
with the minimum requirements of County, which are set forth in Appendix "B",
attached hereto and by this reference incorporated herein, operations] pro-
cedures set forth in Appendix "C" attached hereto and by this reference
incorporated herein, and Triage Protocols set forth in Appendix "D" attached
hereto and by this reference incorporated herein as though fully set forth,
upon receipt of verbal Code Eleven authorization issued by Communications.
Advanced Life Support service is that level of emergency medical care defined
in Section 1480, et seq. of the California Health and Safety Code (Wedworth-
Townsend Act), approved by the Marin County Health Officer, and authorized in
the field and during transport to an emergency facility by a County -approved
Hospital Base Station.
Basic Life Support service is that level of emergency medical care which
includes advanced first aid and cardiopulmonary resuscitation with the use
of equipment, to the ill or injured at the scene and during transport to
an emergency facility.
Section III. Insurance
Contractor and any sub -contractors under this agreement must carry, at their
own expense, comprehensive Public Liability Insurance in an amount not less
than $1,000,000 for injuries or death to one person and $3,000,000 for
injuries or death to more than one person in one accident and Property Damage
Insurance in the amount of not less than $50,000. Contractor must also
carry Professional Liability Insurance in the amount of $1,000,000 per MICP.
Contractor must have the aforesaid policies name the County of Contra Costa
and the County of Marin, its officers, agents and employees as additional
insured under such insurance,and Contractor must file a certificate of such
coverage with the Marin and Contra Costa County Administrators within ten
days of acceptance of this contract. Certificates shall specify or be
endorsed to provide that 30 days notice must be given in writing to County
of any pending change in the limits of liability or of any cancellation or
modification in the policy.
Section IV. General Conditions
A. Contractor is an independent contractor and shall not be deemed an
agent, servant, or employee of the County of Marin, nor is this con-
tract to be construed as a partnership, joint venture, or association of
County and Contractor.
B. Contractor agrees to indemnify, defend and save harmless the County of
Marin, its officers, agents and employees from and against any and all
claims and losses, whatsoever accruing or resulting to any person, firm
or corporation for performance of this agreement.
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C. Contractor may sub -contract the Emergency Basic Life Support services
provided for in this contract, provided that such sub -contract contains
at a minimum the provisions herein applicable to Basic Life Support ser-
vice and the sub -contracting party is qualified to render such service.
D. If any of the provisions of this contract are violated by Contractor,
County Administrator shall notify Contractor's management representative,
hereinafter designated, of said violation by telephone and then confirm
in writing. If Contractor shall fail to correct said violation within
three days after receiving said written notice, the Board of Supervisors
of Marin County shall have the right to suspend the operation of this
contract until such violation has been corrected. The decision of the
Board of Supervisors as to the existence of a contract violation and its
resolution shall be final.
E. This contract shall be in full force and effect, and service shall com-
mence January 1, 1980, and shall continue on a year-to-year basis there-
after by mutual consent of both parties unless 60 days notice of termina-
tion is given in writing by either party. Amendments to the text of this
agreement may be initiated by either party and shall be incorporated
into this agreement by mutual consent.
F.' County reserves the right to modify standards for vehicles, personnel,
training or operating procedures to conform with new State or Federal
statutes. Notice of modification shall be mailed to Contractor at least
30 days prior to the effective date of said statutes unless such statutes
are urgency measures.
G. If any section or sub -section of this contract should be held invalid
by operation of law or by any tribunal of competent jurisdiction, or if
compliance with or enforcement of any section or sub -section should be
restrained by such tribunal, the remainder of this contract shall not be
affected thereby.
H. The attached appendices are by this reference herein incorporated as
part of this contract. They are: "A" - Zones and Substations; "B" -
Minimum Requirements; "C" - Operational Procedures; "D" - Triage Protocols.
A Procedures Manual shall be utilized by Contractor's personnel when
handling emergency ambulance calls under this agreement. County Communi-
cations and the Department of Health and Human Services shall have
available a copy of the Procedures Manual, including revisions as they
take place, and it shall be available for review, upon request, to other
agencies. Contractor shall ensure that drivers, attendants and dispatchers
are familiar with contents of said Manual. Contractor's Procedures Manual
shall not conflict with the County Communication Manual with regard to
dispatching and controlling ambulances.
J. Contractor shall make vehicles, personnel, and records available to
County or its designee.
ATTEST:
COUNTY OF MARIN
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Appendix "A"
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SERVICE AREA B-.
North central Marin beginning at the most northerly corner of the 2162 acre
Victor Sartori parcel as described in Book 177 at Page 160 of Official Records,
County of Marin, said point being on the northerly boundary of Rancho San Pedro
Santa Margarita y Las Gallinas; thence leaving said Rancho line southerly along
the westerly line of said Sartori tract to its point of intersection with the
southerly boundary of said Rancho; thence along said Rancho line easterly to
Its intersection with the southwesterly city limits of San Rafael; thence east-
erly along said San Rafael limits, the westerly line of parcel 6 and the south-
erly line of parcel I of CSA 19 to the easterly right of way of Sir Francis Drake
East at San Quentin Point; thence leaving said San Rafael limits and continuing
easterly along the southerly right of way of California State Highway 17 to the
shoreline of San Francisco Bay; thence northerly along the shoreline to the
northerly line of said Rancho San Pedro Santa Margarita y Las Gallinas; thence
westerly along said Rancho to the point of beginning.
Including also the lower deck (eastbound) of the Richmond -San Rafael Bridge
from its westerly terminus to the toll gate area.
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;,pendix "B"
MINIMUM REQUIREMENTS
MARIN COUNTY PARAMEDIC SERVICES
I . 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
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.,90q 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 Mobile 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 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 challenging 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 1 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 1 hour credit)
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4. Teaching (basic life support) 0 hour class for 1 hour credit)
5. Professional lectures, workshops and seminars approved in advance.
0 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.
I.. 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.
III. 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. 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.
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 will be
reported immediately to County Communications. County Communica-
tions shall assume the responsibility for dispatching the nearest
available ambulance.
B. Contractor must agree to abide by centralized dispatch 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. EauiDment and SUDDIV Reauirements
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.
3. Ankle and wrist restraints. Soft ties are 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 36" 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 ,spIints 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:
120 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. Two 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 14" 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 -ring 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 water 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 36", compactly folded
and packaged in convenient size.
2. Sterile guaze pads, 4" by 411.
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3. Soft roller self -adhering type bandages, 6" by 5 yards
4. Roll of aluminum foil, 18" by 25', sterilized and wrapped
5. Two Steri le 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 MICN or
Emergency Physician):
*I. IV sets with pedi drip (60 drops per cc)
*2. IV sets with solution drip (15 drops per cc)
3. Sterile alcohol wipes
*4. 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 water 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/1 cc
d. Calcium Chloride 10% - 1 Gm/10 cc
e. Demerol (Meperidine) - 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/1 cc
p. Nitroglycerine - 0.4 mg tablets
q. Pitocin - 10 units/1 cc
r. Valium - 10 mg/2 cc
V. Relationship with County Department of Health and Human Services
A. Committees
1. 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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Appendix "C"
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 -l.
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 patient(s) will be attended until the BLS
ambulance arrives on the scene and assumes responsibility for the
patient(s).
I. 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 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.
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Appendix "D
DEPARTMENT OF HEALTH AND HUMAN SL-RVICES
DIVISION OF HEALTH SERVICES
COUNTY OF MARIN
HALL OF JUSTICE
CIVIC CENTER
SAN RAFAEL, CALIFORNIA
PHONE 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 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 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 transported
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 wi l l be taken to Kaiser Hospital. 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 Marin General Hospital.
b) All obstetric, neonatal patients from the Novato Fire District will be
transported to Novato Community Hospital.
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DEPAR7,_,ENT OF HEALTH AND HUMAN SL- WICES
DIVISION OF HEALTH SERVICES
COUNTY OF MARIN
HALL OF JUSTICE
CIVIC CENTER
SAN RAFAEL, CALIFORNIA
PHONE 479-1100
TRIAGE PROTOCLS - BLS AND ALS
1978
Patient evaluation by senior attending ambulance personnel
not stabilized stabilized
life or limb at risk
CO 1
DE 11 CODE 11
nearest Category 111 (Basic)
Emergency Facility
Hospital
of
Choice
(patient, family)
HOSPITAL OF CHOICE
KAISER member
KAISER HOSPITAL
No choice
Incapable of
choice
NEAREST BASIC
EMERGENCY
FACILITY
F.XCEPTTON5
-Nennata 1 patient Obstetric- patient
Novato Fire District All other Marin County
NOVATO COMMUNITY FIOSPITA MARIN GENERAL HOSPITAL
�i1L4CJ."�ST I�aSPITAt�
1330
o
• � a i
1 4
_ 0 '3 r
41,
1130 ,�. wi� /•� '� Y
t 1150
i
�Lv:Z t
1142
,G
21 _ 114112
1;
1182_�-
.lint,
IN
�5
' = 12 1}1111
.s 1220
I 121T�
wcXVAT0 comm.
`1250 `.Oti �rtil�r'.l—{JSP.
1230 _
.. � _ —�� i" 1 P ►� 1 Cay l •� 1 S
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