MONTEREY COUNTY EMS AGENCY EMERGENCY MEDICAL CARE

To promote a green environment, full agenda packets are not provided at the meeting. However, a full

packet, including the agenda and supporting documents, is available for review at the EMS Agency during

working hours 72-hours before the meeting. Full agenda packets are also available on the EMS Agency’s

Website at www.MoCoEMS.org

MONTEREY COUNTY EMS AGENCY

EMERGENCY MEDICAL CARE COMMITTEE

AGENDA

Wednesday, September 9, 2020

**LOCATION**

10:30 A.M. to 1:00 P.M.

Monterey County Government Center

Board of Supervisors Chambers

168 West Alisal Street

Salinas, CA 93901

Meeting Available via Zoom

I. CALL TO ORDER/INTRODUCTIONS

II. PUBLIC COMMENT

Any member of the public may address the Committee for a period not to exceed three

(3) minutes on any issue not on the Committee’s agenda. The EMCC will listen to all

communications but may not take any action.

III. APPROVAL OF PAST EMCC MEETING MINUTES

A. July 8, 2020 EMCC Meeting Minutes—Approval

IV. REPORTS

A. Medical Advisory Subcommittee (MAC): July 8, 2020 Draft Meeting Minutes

B. Operations Subcommittee (Ops): July 8, 2020 Draft Meeting Minutes

C. EMS Agency (Teresa Rios)

D. Contract Compliance Working Group (CCWC) (Roxann Seepersad)

• AMR Response/Dispatch Time Performance

V. EMS SYSTEM PERFORMANCE METRICS

A. EMS System Performance Metrics (Steve Brooks)—Report

• ReddiNet and 800Mz. Radio Tests

B. Ambulance Patient Offload Times (APOT) (Laura Wallin)—Report

VI. OLD BUSINESS

A. EMS Agency Response to CoVid-19 and Fires (Jeff D’Andrea)—Report

B. RFP (Teresa Rios)—Report

VII. NEW BUSINESS

http://www.mocoems.org/







AGENDA

A. EMCC Membership (Chief Jim Langborg/Harry Robins)

• Role of Office of Emergency Services (OES) representative

• Adding representative from Monterey County Emergency Communications

B. Liquidated Damages Paid by Ambulance Provider (Chief Michael Urquides)—Report

• Amount paid to-date and use of funds

VIII. FUTURE EMCC AGENDA ITEMS

IX. ANNOUNCEMENTS/ FOR THE GOOD OF THE ORDER

Any member of the committee may make announcements or comments. The EMCC may

not discuss or take any action on any item raised during announcements, except to decide

whether to place the matter on a subsequent agenda.

NEXT MEETING

The next regularly scheduled EMCC meeting is scheduled for Wednesday, November 11,

2020 at 10:30 a.m. in the Cinnamon Room at 1441 Schilling Place, Salinas.

X. ADJOURNMENT

Attachments:

1. EMCC July 8, 2020 Draft Meeting Minutes

2. MAC July 8, 2020 Draft Meeting Minutes

3. OPS July 8, 2020 Draft Meeting Minutes

4. EMS Agency Updates Staff Report

5. AMR Response/Dispatch Time Performance Graphs

6. 800Mz. Radio Testing

7. Patient Offload Times (APOT) Staff Report

8. EMS Agency COVID-19 and Fire Response Staff Report

9. Liquidated Damages Paid by EOA Ambulance Services Provider

Notices

ALTERNATE AGENDA FORMATS: If requested, the agenda shall be made available in

appropriate alternative formats to persons with a disability, as required by Section 202 of the

Americans with Disabilities Act of 1990 (42 USC Sec. 12132), and the federal rules and

regulations adopted in implementation thereof. Individuals with a disability requiring a

modification or accommodation, including auxiliary aids or services, to participate in the public

meeting may make these requests to the EMS Director at least 3 days prior to the Emergency

Medical Care Committee Meeting.

TO ADDRESS THE COMMITTEE ON A MATTER ON THE AGENDA: When the agenda

item is called, raise your hand and wait for recognition by the Committee Chair. In order that all

interested parties have an opportunity to speak, please be brief and limit your comments to the








AGENDA

specific subject

under

discussion. Time limitations shall be at the discretion of the Chair, with equal time allocated to

opposing sides of an issue insofar as possible. Allocated time may not be reserved or granted to

others, except as permitted by the Chair.

TO ADDRESS THE ON A MATTER NOT ON THE AGENDA: When the agenda item for

public comment is called, raise your hand and wait for recognition by the Committee Chair.

Public comments shall not pertain to matters on the agenda. Time limitations shall be at the

discretion of the Chair, with equal time allocated to opposing sides of an issue insofar as

possible. Allocated time may not be reserved or granted to others, except as permitted by the

Chair.

DOCUMENT DISTRIBUTION: Documents related to agenda items that are distributed to the

Committee less than 72 hours prior to the meeting shall be available for public inspection at the

EMS Agency Office, 1441 Schilling Place, Salinas, California. Documents distributed to the

Committee at the meeting by EMS Agency staff will be available at the meeting.

MEETING AUDIO AND VIDEO RECORDED: This meeting is audio and video recorded. A

copy of the recording is available following the meeting on the EMS Agency website at

www.MoCoEMS.org



You are invited to a Zoom webinar. When: Sep 9, 2020 10:30 AM to 12:00 PM Pacific Time (US and Canada) Topic: Monterey County EMS - Emergency Medical Care Committee (EMCC) Please click the link below to join the webinar: https://montereycty.zoom.us/j/94103424577 Attending the Meeting by Video

Using a computer or laptop: Simply click the following link to get started: https://montereycty.zoom.us/j/94103424577 You will need to make sure that your computer or laptop is properly connected to working speakers and/or a microphone if you choose to participate with audio. If you plan on using your computer or laptop for video only, you can also join the audio portion of the meeting simultaneously by following the phone call instructions below, using a phone. Using an Android Phone or Tablet: Click on the link below to visit the Zoom app page on the Google Play store and select to install the app.

https://play.google.com/store/apps/details?id=us.zoom.videomeetings&hl=en_US Once the app has finished downloading to your device simply click the Zoom webinar link to begin: https://montereycty.zoom.us/j/94103424577

Please note, you are not required to create or have a Zoom account. Using an iPhone or iPad: Click on the link below to visit the Zoom app page on the App Store and select to Get then Install the app.

https://apps.apple.com/us/app/zoom-cloud-meetings/id546505307 Once the app has finished downloading to your device simply click the Zoom webinar link to begin: https://montereycty.zoom.us/j/94103424577

Please note, you are not required to create or have a Zoom account. Attending the Meeting by Phone Call To participate by phone call, you can use any of these numbers below:

https://montereycty.zoom.us/j/94103424577


https://play.google.com/store/apps/details?id=us.zoom.videomeetings&hl=en_US





https://apps.apple.com/us/app/zoom-cloud-meetings/id546505307





+1 669 900 6833 US (San Jose) +1 346 248 7799 US (Houston) +1 312 626 6799 US (Chicago) +1 929 205 6099 US (New York) +1 253 215 8782 US (Seattle) +1 301 715 8592 US (Washington, D.C.) Enter this Meeting ID number: 941 0342 4577 when prompted. Please note there is no Participant Code, you will just hit # again after the recording prompts you. You will be placed in the meeting as an Attendee. Public Comments There will be time allocated in the meeting for Public Comments. If you attend the Meeting through ZOOM via video and would like to make general public comment, or comment on a specific item on the agenda, you may Raise your Hand. If you are attending the meeting via Phone Call enter *9 on your keypad.

Zoom Desktop Client Video Conferencing Etiquette Reference Guide

1 Zoom: Video Conference Etiquette Reference Guide | County of Monterey | Van Rogers | Apr 20, 2020

Take the following information into consideration so you don't find yourself committing a major faux pas at the next big meeting. Or, share this

with a coworker to help them out the next time they're making one of these mistakes.

Video Conferencing Etiquette

1. Mute yourself when not speaking.

2. Be on time.

3. Ensure your technology works correctly.

4. Use technology to fully engage remote

participants.

5. Choose the proper software and

hardware.

6. Wear work-appropriate clothing.

7. Frame the camera correctly.

8. Have the right light.

9. Look into the camera.

10. Pay attention.

Review the video conferencing etiquette best practice guide for optimum user experience.



1. Mute yourself when not speaking. Even though you may not be speaking and think you're being quiet, most microphones can pick up minor background noises, like coughs, sneezes, or typing. These sounds can easily distract other video conferencing participants and potentially even cause annoyance.

2. Be on time. This one should be standard with any meeting, video or otherwise. However, when you're dialing in to a video conference, it's especially important. While you might be able to get away with sneaking into a physical meeting late, everything is more visible in a video conference.

3. Ensure your technology works correctly.

You don't want to have to delay a meeting with an important client because your video conferencing system isn't working properly. You need to do a few test runs with internal employees before trying to land the next big investor. Find someone willing to help, and make sure you understand the process fully before starting your first video conference. This will make sure everything runs smoothly during the real thing.

4. Use technology to fully engage remote participants.

You want your remote video conference attendees to feel like they can participate and are truly a part of the meeting.

5. Choose the proper software and hardware.

Having the right video conferencing hardware is only half the equation. (See: Zoom client)

6. Wear work-appropriate clothing. While it might be tempting to work in your favorite sweatshirt all day, consider wearing professional attire to any video conferences you're attending. You don't have to wear anything fancy, but choose something that would be appropriate if the meeting were face-to-face, rather than virtual.

7. Frame the camera correctly.

We've all been on video calls where we end up looking up people's nostrils or seeing the side of their face. When you're on video, make sure you frame your camera in a way that feels natural and allows you to look at the camera. Sit at eye level to the lens, and try to position yourself so that it shows midsection up. Placing it too high leaves other participants staring down at you like a bad tv show. Putting a camera too low can lead to unflattering and awkward angles.

Video Conferencing Etiquette: 10 Tips for a Successful Video Conference



8. Have the right light.

Poor lighting conditions have an enormous effect on the video quality that you send. You'll want to make sure that there is enough light in the room you're in so that your video isn't grainy and unwatchable. Try to not mix natural lighting and office lighting unless your office bulbs are daylight white. You also don't want any faces being lit from below, as this makes you look like a cartoonish villain from a silent film. Lighting from the sides will make faces look the best, so try for that if you have the ability.

9. Look into the camera.

A common mistake is looking at the video feed instead of the camera when speaking to a remote participant. While it may seem like the right thing to do, it makes it appear as if you're looking off and not paying attention. This will make you come across as more aloof and less professional. Looking into the camera lens is the equivalent of looking into the person's eyes, so practice doing so until you're comfortable with it.

10. Pay attention. Stop checking emails or working on your PowerPoint presentation during video conferences. Not only does research suggest only 3% of people can multitask effectively, but you also look rude to your participants.

For any technical issues or support,

please contact the Service Desk:

(831) 796-1400;

or email: [email protected]

1

MONTEREY COUNTY EMS AGENCY EMERGENCY MEDICAL CARE COMMITTEE

Meeting Minutes

Wednesday, July 8, 2020

Emergency Medical Services Agency

168 W. Alisal Street, Salinas, CA 93901

Board Chambers

Meeting Available via Zoom

10:30-1:00

Item Discussion Deliverable/Action

I. CALL TO ORDER/

INTRODUCTIONS

A. Dr. Sean McRoberts, Chairperson, called the meeting to order. EMCC

members and guests introduced themselves. Chair McRoberts provided

overview of Zoom. The following list reflects everyone who was

present.

Members Representing Present Absent

Sean McRoberts,

Chair

Emergency Physicians X

Carla Spencer,

Vice Chair

Hospital Administration X

Tino Arellano 911 EOA Ambulance Provider X

Jim Langborg BLS – Fire X

Tina Nieto Law Enforcement X

Harry Robins Citizen Representative X

Jodi Schaffer Citizen Representative X

Michael Urquides ALS – Fire X

Greta Steinbruner EMT/Paramedic X

Paul Wood City Managers X

Jon Anthony Monterey County Parks

Department X

Vacant Citizen Representative

• Meeting was called to

order and roll was

taken.

A quorum was present.

2



ExOfficio Members Representing Present Absent

Teresa Rios EMS Agency Director X

Gerry Malais Office of Emergency Services X

Alternate Members Representing Present Absent

Michael Esslinger 911 EOA Ambulance Provider

Vacant ALS Fire

Cheryl Goetz BLS Fire X

Vacant Citizen Rep 1



Ben Harvey City Managers

Vacant Emergency Physicians

Vacant EMT/Paramedic

Jo Coffaro Hospital Administration X

Chief Paul Tomasi Law Enforcement

Vacant Monterey County Parks

Department

EMS Agency Staff Representing Present Absent

Dr. John Beuerle EMS Agency Medical Director X

Steve Brooks EMS Analyst X

Laura Wallin Health Program Coordinator X

Roxann Seepersad Epidemiologist II X

Guests in Attendance

Scott Houchin

Eric Ulwelling

Sam Balesteri

Michelle Kalinski

Lizeth Vega

William Hiller

3



Ben Hitchcock

Sean Edwards

Warren Poitras

Dr. James Rawson

II. PUBLIC

COMMENT

A. none A. As noted

III. APPROVAL OF

PAST EMCC

MEETING

MINUTES

A. March 11, 2020

EMCC Meeting

Minutes--Approval

A. The EMCC Meeting Minutes of March 11, 2020 were approved as

presented. M/S/C Harry Robins/Tina Nieto.

A. The March 11, 2020

EMCC Meeting

Minutes were

approved as

presented.

M/S/C Harry

Robins/Tina Nieto

IV. REPORTS

A. Medical Advisory

Subcommittee

(MAC): March 11,

2020 Draft Meeting

Minutes

B. Operations

Subcommittee

(Ops): March 11,

2020 Draft Meeting

Minutes

A. Chair Dr. Sean McRoberts referred committee members to the draft

March 11, 2020 Medical Advisory Subcommittee (MAC) Meeting

Minutes that were included on the agenda packet.

B. hair Dr. Sean McRoberts referred committee members to the draft

March 11, 2020 Operations Subcommittee (Ops) Meeting Minutes

that were included on the agenda packet.

A. A draft of the March

11, 2020 MAC

Meeting Minutes was

included with the

agenda packet for

reference.

B. A draft of the March

11, 2020 Ops Meeting

Minutes was included

with the agenda

packet for reference.

4



C. EMS Agency--

Report

(Teresa Rios)

C. Teresa Rios reported Jared Bagwell is no longer with EMS Agency

and Troy Mead will be leaving the EMS Agency at the end of month.

The recruitment is underway. For now, the EMS Agency has brought

two EMS Analysts on a temporary basis to ensue continuation of

operations until the recruitments as done.

C. As noted

V. EMS SYSTEM

PERFORMANCE

METRICS

No reports

Chair McRoberts stated that this agenda item was moved to next

meeting to allow ample time for discussion on the RFP.

EMS system performance

metrics reports

presentation will be given

at the September meeting.

VI. OLD BUSINESS

A. EMS Agency

COVID-19

Response Update--

Report

(Teresa Rios)

A. Teresa informed the committee that Troy could not attend the meeting

and referred committee members to the staff report included with the

agenda. The staff report summarizes some of the COVID-19 activities

that have taken place since March. Teresa stated that the staff report

does not accurately reflect Troy’s role during the pandemic. Teresa

recognized Troy as a tremendous asset to the EMS Agency in his role

as the MHOAC and his ability to secure PPE and other supplies for

Monterey County. Troy has been very proactive and very engaged

with all our stakeholders. Teresa added that, based on the most recent

survey of the system, there are no shortages of PPE.

Gerry Malais second Teresa’s comment regarding Troy’s role and

importance as the MHOAC in the EOC. Gerry stated that the EOC

has been activated for 132 day. The role of the MHOAC plays under

the Logistics section cannot be understated in its importance to the

providers in the operational area but to the EOC itself. Troy has done

A. As noted

5



B. RFP

Discussion

(Teresa Rios)

an outstanding job. Gerry hopes there is no lag in the MHOAC in the

EOC because he expects the EOC will remain activated for many

more months.

Chief Michael Urquides asked whether the temporary EMS Analyst

have some type of EMS background that they would be able to

support the MHOAC with Troy’s departure? Teresa responded by

saying that neither temporary EMS Analyst has direct MHOAC

experience but both have translatable, adaptable skills and experience.

She added that, since Troy is staying with the EMS Agency until the

end of the month, we are going to do a lot of the cross-training needed

so that there is a smoother transition.

Chief Urquides also expressed his appreciation for the work Troy did.

B. Teresa Rios summarized the status of the RFP by reminding the

committee that the RFP was translated into Spanish and has been out

for public comment for more than 30 days. This was one to ensure

that anyone interested in the RFP had the opportunity to comment.

The EMS Agency advertised the release of the RFP for public

comment on newspapers, radio, websites, and social media. In the

ongoing effort to be transparent, all public comment received to date

has been posted on the EMS Agency’s website. The EMS Agency has

notified interested parties they can view public comment on the EMS

Agency website. Also in the ongoing effort to be transparent, and at

the request for the EMCC, the RFP was added to this meeting’s

agenda for discussion by the committee.

Teresa added that, to protect the sanctity of the process, EMS Agency

staff would not engage in the discussion or Q&A about the RFP

process. Teresa emphasized that the EMS Agency is listening and

considering all public comment received. Teresa provided some

B. RFP

6



highlights of the changes made to the RFP. She acknowledged that

developing a new ambulance services agreement and conducting an

RFP are very complex tasks. The EMS Agency is asked to be

innovative and to develop an RFP that can adapt to an EMS System

that is changing rapidly. She added that, given the complex

geography of the county, one of the major challenges is how to get

resources quickly to individuals located in remote or difficult-to-

access areas of the county. The EMS Agency must work to strike a

balance between the scope of services provided to our community and

the cost of providing those services. Despite the challenges, the EMS

Agency takes this responsibility very seriously.

In developing the new draft RFP, the EMS Agency applied lessons

learned from the 2019 procurement, reviewed the feedback received

during and since the 2019 procurement, surveyed RFPs from other

jurisdictions, and communicated with the EMS Authority. Some of

the changes were summarized.

Florentino Arellano clarified that response time is measured on

fractile response time standard rather than 90th percentile. It ensures

that we meet our response time within 90% of the time reliability.

AMR supports the clinical excellence. We also support response time

reliabilities to all the areas, and of course, we are also looking at

economic efficiency for everyone and customer satisfaction.

Harry Robins expressed his appreciation for the thought and

innovation that has gone into this RFP. He stated that he has made

comments separately in writing. Harry added that he is impressed

with the level of effort that has gone into this RFP and hopes that the

input from the community in general and the stakeholders will be

constructive as well.

7



Chief Michael Urquides thank Teresa for looking at lessons learned

from the last process. Chief Urquides stated that the public outreach

attempt by the EMS Agency was tremendous, the advertisement and

the print media were very helpful. He added that while there were

some minor IT glitches when submitting the comments, he

appreciates the outreach work, which was noted by some of the public

comments. Chief Urquides expressed his concern about the

information the State gave the counties to go out to bid every ten (10)

years, the 141 policy. They said you had to do it every ten years.

That is what this body was told last year with County Counsel’s

memo, and we know that not to be true anymore. We know that the

courts just ruled that the 141 memo and the information that was sent

to County Counsel is that it has to be done in periodic intervals.

Some Counties have said that is 15 years to go out to bid. Chief

Urquides stated that his only fear is going out to bid during a

pandemic or on the tail end of a pandemic if we can ever get this issue

fixed. He added that ambulance companies are struggling with the

reduction of transports, and of course, their PPE costs and all other

associated things. When companies bid, it is going to be at a higher

price. He believes County procurement needs to look at what its

policy is, and if they are following State guidelines that have just been

ruled illegal, then it is probably up to the County Board of

Supervisors to work with procurement to say what is periodic in their

mind just because, as a Fire Chief who runs an ambulance company

and saw a 30% reduction of transports, our associated costs are not

going down.

Chief Urquides also expressed his view that liquidated damages are

an extremely outdated mechanism for holding private ambulance

companies accountable because what they do is to build into their

base rate all the fines; therefore, the consumer pays that. He added

that the money does not go back to help the consumer. It goes into

8



someone’s budget. Chief Urquides rather see a fine mechanism that

reduces the length of the contract. It is not financially punitive.

When you charge all of those fines, it is the employees who bear that

in the equipment they get and the salary and benefits they get.

Chief Jim Langborg agreed with Chief Urquides comments and with

thanking the EMS Agency for the changes that were made to the RFP.

He added that the City of Greenfield and the Fire Chief Association

will be submitting their comments. Chef Langborg encouraged the

EMS Agency to include a more detailed explanation regarding

response times in the final RFP. He would also like to see the RFP to

be more specific if mutual aid and auto-aid will continue to be

allowed so that bidders understand that. Chief Langborg believes that

being more specific in the RFP may allow bidders to bring more to

the table.

Chief Langborg added that the RFP includes language about

partnering with the Health Department and other organizations. He

encourages the EMS Agency to expand who the provider may partner

with, which ties directly with the challenges with diversity and

response times in our county. It also ties with the ability to have

equity and some of the specific language to ensure that the bidders

know that these things are available to them so they can add it to their

bids. From a BLS Fire Department representative whose agencies are

primarily located in rural areas, which will be part of either the

suburban or rural zones, we are the ones that will deal with the longer

response times. We also realize that a private contractor is going to

look at things from a business perspective and make operational

decisions, and sometimes those things are not equitable. So, by

having the ability to have partnerships and by specifically stating

things clearly in the RFP, I think that enable them to put together

9



more competitive bids that will meet the needs of all areas within this

county.

Harry Robins stated that there is a section in the agreement that talks

about underserviced areas. It basically says that there will be no

underserviced areas within the contract. Harry feels the RFP needs

some verbiage. He feels it has the most applicability in our rural

areas and, perhaps, even some of the suburban areas as it has been

demonstrated by the performance over the last few years. We need

language that says we will not have underserved areas. Harry also

added that the closest ambulance provisions in the RFP need to be

very clear. Harry would like to avoid the situation from the last RFP

by specifying that the closest ambulance is going to respond.

Sam Balesteri expressed a concerned regarding Section 5.10.2.3 #2

that limits mutual aid to 3% of the total call volume for reporting

period. Limiting mutual aid will cost lives. Mr. Balesteri felt limit

should be set at a higher level to 5or 6%. Regarding #4 in the same

section, Mr. Balesteri felt that the $500.00 fine is excessive for the 3%

level. Regarding Exhibit J, Mr. Balesteri commented that response

level Echo and Delta call for closest ALS ambulance and first

responder. This means that mutual aid calls can easily go over 3% in

the reporting period.

Chief Eric Ulwelling quoted Section 2.2.8.5 regarding the Assess

Treat and Refer provision of the RFP and stated that, for those outside

the ambulance transport footprint, the community is already bearing

the cost of ALS first response. Chief Ulwelling said it is not fair that

tax payers should be subjected to an additional treatment without

transport fee from the contractor. In his view, tax payers would be

paying twice.

10



Harold Wolgamott stated that he worked on the contract compliance

committee. He expressed that combining the two zones together is a

lot of good work. He added that the response time are reasonable, and

it is a dramatic change from what we have done before. Harold added

that the map for the response areas should consider Jolon Road.

There are residents on Federal land. Harold stated that there may not

be a requirement for the Fort Hunter Liggett ambulance to cover that

area, which bring uncertainty as to what could happen in the future

even if the Fort Hunter Liggett ambulance does cover that area now.

We should consider including those into the response area required in

the contract.

Chief Ulwelling offered additional comments related to the

communications provision of the RFP. Regarding Section 5.2.7,

Chief Ulwelling stated that he fully supports the use of AVLs, but

they have been used inconsistently in past. He asked whether AVLs

will be used by all transport providers to achieve the stated goal of

closest ambulance response and not just contract ambulance provider.

Regarding communication center redundancy, Chief Ulwelling stated

that the 911 Communications Center does not have redundancy;

therefore he would like to know why we are asking a contractor to

bear this cost.

Mr. Sean Edwards thanked the EMS Agency for bringing a thoughtful

revised RFP to the table. Sean stated that, when comparing the

response time requirements of the 2019 RFP and the new RFP, he

sees significant, better response time criteria. On the other hand, Mr.

Edwards pointed out that there is a an area in the green zone of the

current agreement where response time for Priority 1is being increase

from 12 to 13 minutes in the new RFP. He expressed appreciation

for the decrease in response times in north county in the new RFP.

11



Mr. Edwards added that the people he has talked to feel the response

times are a lot better in comparison to the 2019 RFP. However, he

continued to express concern for those suburban and rural areas and

appreciates the foresight that the County EMSA is putting into that.

Regarding billing for possible treatment rendered without transport,

we are solely against because there may be people who may not want

to call 911 when it is needed. People do not understand that there is a

difference between ambulance company and first responder, all they

know is that they received a bill. Mr. Edwards added that the CSA-74

was established for first responder equipment to be provided. He also

added that he believes that mutual aid is for the betterment of the

people. We want to provide the best care for the citizens of Monterey

County, so we want to keep existing mutual aid contracts, closes

available resource response, and using AVLs as applicable.

Warren Poitras, Monterey County Regional, indicated that some

individuals have had difficulty to make comments and to get them

through to the County. He has had trouble getting his written

comments through to the County. The County was notified that there

was a problem with the system. He added that the County may want

to consider extending the public comment period another week.

Teresa provided clarification regarding the submittal of comments by

saying that the website includes the contact information for Gina

Encallado, the Contracts Purchasing Buyer assigned to this project.

Gina’s email address and physical address are both listed on the

website. The comment form on the website was not required for the

submittal of comments. The County accepts any formats. Comments

may be submitted through the website, emailed directly to Gina’s

email address, or mailed using her physical address.

12



Dr. James Rawson, Carmel Highlands resident and member of the

Fire Board, stated that he lives in a community of older residents and

wants to make sure we are taking care of all of our residents and

contracted with CalFire. He trusts CalFire to watch and make sure

that this contract is done properly and rely on them for most of the

details. He believes comments on the RFP have already been made

by his Chief. Dr. Rawson stated that he wants to support the

precedent of closest ambulance to his community, which is the City of

Carmel Ambulance service, Carmel Regional, as well as the County

RFP contract. Regarding the ten-year contract term in the RFP, Dr.

Rawson stated that, in Contra Costa County, where they had a ten-

year contract term, the Board changed the term to a five-year contract

because of circumstances that can change during that time.

Chief Jim Langborg inquired as to what happens with the public

comment received, how it will be processed, how members of the

public and EMCC know things that have been considered and/or

modified.

Susan Blitch, Senior Deputy County Counsel, stated that the EMS

Director will take all the public comments and incorporate or make

changes as she deems necessary or prudent. The next step would be

to submit the RFP to the State for approval. When the State approves

the RFP, then it will be released for bids.

Chief Langborg added that he would like to avoid any future

misunderstandings and therefore would encourage the EMS Director

to come up with a response or memo acknowledging some of the

changes, suggestions, or improvements that were put into the RFP.

This will provide an opportunity to ensure that the EMS Director

shows members of the public and stakeholders to say “we did hear

what you had to say.”

13



VII. NEW BUSINESS

A. Election of

Officers

(Teresa Rios)

B. EMCC

Membership

Report

(Teresa Rios)

A. Teresa Rios stated that pursuant to Monterey County Board

Resolution 10-029, the EMS Agency recommends that EMCC elect a

committee Chair and Vice-Chair with the elections being EMCC

effective September 9, 2020 through June 30, 2020.

Carla Spencer was nominated as Chair and Tino Arellano as Vice-

Chair. M/S/C Harry Robins/Tina Nieto.

B. Teresa Rios introduced the newly members of the EMCC. Teresa

added that the nominations of two individuals will be submitted to the

Board of Supervisors for appointment. to the Board of Supervisors for

approval. Teresa announced that Dr. Sean McRoberts, ER physician

representative, , decided to step down. The ER physician

representative must be nominated by the MAC committee. The MAC

committee nominated Dr. Nikolas Greenson to be the ER physician

representative and Dr. Noah Hawthorne to be the alternate.

Both nominations will be submitted to the Board of Supervisors for

appointment. A complete list of names was included with the agenda

packet.

Lastly, Teresa reported that all but one of the EMCC member

positions have been filled, stating that Harrold Wolgamott, also

decided to step down, leaving one Citizen representative position

open.

Teresa acknowledged and thanked both Dr. McRoberts and Harold

Wolgamott for the contributions they have made to the EMCC and to

the system.

Robin Harris expressed his appreciation for the EMS Agency’s

diligence for filling the vacant positions and the effort placed by Dr.

A. Motion to elect Carla

Spencer as Chair and

Tina Nieto and Tino

Arellano as Vice-

Chair. M/S/C Harry

Robins/Tina Nieto.

B. New members were

introduced and new

nominations

announced. Dr. Sean

McRoberts and Harold

Wolgamott’s

departures were

announced. Both

individuals were

recognized for their

contributions.

14



McRoberts and Harold Wolgamott during their tenures. They will

both be missed.

VIII. FUTURE EMCC

AGENDA ITEMS

Chief Michael Urquides requested a report that reflects how much in

liquidated damages have been paid to the County over the last 12

years and what the funds were utilized for, considering taxpayers

payed $1.8 mil funds on CSA 74 and only $3.5 mil on reserve. Harry

Robins supported that request.

• Staff to provide a report

on liquidated damages

paid to the County and

the use of those funds at

the September EMCC

meeting.

IX. ANNOUCEMENTS/

FOR THE GOOD OF

THE ORDER

Harry Robins moved for the EMCC to commend members of the

County Emergency Medical Care System for their diligence,

dedication, professional performance of duty, during the ongoing

response to the COVID-19 virus pandemic. Recommended that the

County Board of Supervisors do likewise. This commendation is

intended to include all members of the Health Department,

Emergency Medical Services Agency, the Office of Emergency

Services, and the Emergency Operations Center staff, our four

hospitals, the emergency room staff, and the first responders of the

ambulance, fire, and law enforcement service.

Harry Robins expressed his appreciation for those individuals leaving

the EMCC. He added that they deserve a commendation for their

efforts and welcome the new folks on board. He stated that the

productivity of this body has been sustained over a very difficult

period of time with the contract and now with COVID-19.

Chief Jim Langborg reminded the committee a previous discussion to

consider changing the role of the OES Director from an exofficio

member to a voting member of this committee. Chair McRoberts

clarified that some agenda items from previous meetings were table to

allow ample time for RFP discussion.

• Motion made by Harry

Robins to commend

everyone involved in

COVID-19 response and

recommended that the

County Board of

Supervisors do likewise.

15



Chief Michael Urquides thanked Chair McRoberts and Harold

Wolgamott for their time in the EMCC. He noted that Harold has

been involved in EMS for more than 40 years and has been an

instrumental voice for south county for at least the last three or four

bids.

X. NEXT MEETING The next regularly scheduled EMCC meeting will be held on Wednesday,

September 9, 2020 at 10:30 a.m. Location to be determined • As noted

XI. ADJOURNMENT Meeting was adjourned. • Meeting was adjourned.

1

Draft

Monterey County EMS Agency

Medical Advisory Committee (MAC)

Minutes: July 8, 2020

Monterey County Government Center

168 West Alisal Street

Salinas, California 93901

0830 to 1000 Hours


1) Call Meeting to Order and Introductions

MAC members and guests introduced themselves. The following people were present.


Dr John Beuerle (Chair)

EMS Agency X

Michelle Kalinski CHOMP ED Physician

X

Cole Klick NMC ED Physician X

Nikolas Greenson SVMH ED Physician

X

Vacant Mee ED Physician

Christy Soboleski CHOMP Base X

Cassie Caldera NMC Base X

Jeremy Hadland SVMH Base X

Michelle Villanueva

Mee ED Receiving X

David Craddock MCRFD Paramedic X

Gretta Steinbruner Contracted Ambulance Paramedic

X

• As noted

• Meeting started 08:40

2

Scott Houchin First Responder EMT

X

William Hiller Contracted Ambulance Provider

X

Jeff Horner Air Ambulance Provider

X

Chief Tina Nieto Law Enforcement Agencies

X

EMS Agency Staff

Teresa Rios Interim EMS Director

X

Dr. John Beuerle EMS Med Director X


Troy Mead EMS Analyst X

Laura Wallin Trauma Coord. X

Roxann Seepersad Epidemiologist II X

Guests Not Recorded

2) Public Comment None

3) Approval of Minutes Approval of March 2020 meeting minutes. Motion from S. Houchin / Second from J. Horner/ Motion passed.

4) EMS Recognition Dr. Beuerle expressed a general recognition of EMS field providers and ED staff for their efforts during this unusual and difficult time.

• EMS Agency accepting nominations.

5) Correspondence None • Information only

6) Old Business A. EMS Agency COVID-19

Response

A. T. Rios provided a brief description of EMS Agency activities performed during the COVID-19 State of Emergency.

• Information only

3

B. EMT Scope of Practice

C. EMR Scope of Practice

B. The EMT Scope of Practice was endorsed by MAC to include epinephrine auto-injector and naloxone. The effective date will be January 1, 2021. The intent to start January 1, 2020 is to allow adequate time to purchase the equipment and supplies necessary to function under the Scope of Practice as well as to have adequate time for training. Training materials and final drafts of the policies will be distributed around the end of August 2020. C. The EMR Scope of Practice was updated to include epinephrine auto-injector and naloxone for intra-nasal administration. The EMS Agency stated that they would establish an effective date. The effective date will be January 1, 2020. The final draft of the policy and supporting policies and protocols will be distributed with training materials around the end of August 2020.

• EMS Agency distribution of final policy draft and training materials by end of August 2020. Update website and EMS app prior to January 1, 2021.

• EMS Agency distribution of final policy draft and training materials by end of August 2020. Update website and EMS app prior to January 1, 2021.

7) New Business A. MAC membership

B. EMCC ED Physician Member Nomination

A. Consistent with EMS Policy #1020 EMS Advisory

Committees, certain members of MAC have their term of service expire on June 30, 2020. With their assent, they will be reappointed to MAC for a two-year term effective July 1, 2020 and ending on June 30, 2022. These members are:

• Jeremy Hadland-SVMH Base Coordinator

• Gretta Steinbruner-Paramedic-Ambulance contractor

• David Craddock-Paramedic-Other than ambulance contractor

• Scott Houchin-First responder personnel

• Will Hiller-Ambulance contractor

• Jeff Horner-Air ambulance providers

• Tina Nieto-Law enforcement agencies B. MAC is responsible to nominate an ED physician

representative on the EMCC. After several years of distinguished service, Sean McRoberts is stepping down as

• Assent provided. EMS Director will reappoint.

• Motion by M. Kalinski/Second by J. Horner/Motion passed.

4

C. Airway Management Policy

the ED physician representative on the EMCC. The EMS Agency recognizes Dr. McRoberts time and valuable contributions. Dr. Noah Hawthorne, ED physician at Mee Memorial, has expressed interest in the position on EMCC. Dr. Nikolas Greenson, ED physician at SVMH, has also expressed interest in the position on EMCC. The EMS Agency is recommending Dr. Hawthorne for the position on EMCC with Dr. Greenson as the designated alternate to increase participation by a representative with a South County focus. Discussion focused on active participation in the past, broad representation of the County, experience as a base hospital physician, and desire to have the Mee Memorial physician representative on MAC have active participation on this committee. Motion to nominate Dr. Greenson to the ED physician position on MAC with Dr. Hawthorne as the designated alternate.

C. The EMS Agency has reviewed the supraglottic airway in use currently in Monterey County and compared to other airways. A review of literature regarding comparison of the King Airway, iGel, and LMA was performed. The literature review indicated that those trained in use of each of the devices tended to feel more comfortable and confident in using the iGel. A cost comparison showed a significant cost benefit to the iGel over the King Airway. The airways were all found to have relatively equal effectiveness. The EMS Agency proposes moving to the iGel supraglottic airway. The effective date will be January 1, 2021. There will be a transition period to allow King Airways in stock to be used until July 1, 2021 when the iGel will be the approved supraglottic airway. Paramedics will use both adult and pediatric iGel supraglottic airways. EMT-Expanded Scope will utilize adult iGel supraglottic airways. The EMS Agency requests endorsement by MAC.

• Motion to endorse this and the following policies and protocols by D. Craddock/Second S. Houchin/Motion passed. Will release for public comment next week with an effective date of January 1, 2021. EMS Agency will distribute the policy with training materials about September 1, 2020 and post to the website and EMS app in December 2020.

5

D. Allergic Reaction and Anaphylaxis

E. Allergic Reaction/Anaphylaxis Pediatric

F. Overdose and Poisoning

G. Overdose and Poisoning-Pediatric

H. EMT Scope of Practice-Expanded Scope

I. Major Trauma Patient

J. Hemorrhage Control

K. Authorized Stock-BLS

L. Authorized Stock-ALS

D. Added the use of epinephrine auto-injector for anaphylaxis by EMT and EMR personnel. EMS Agency requests endorsement by MAC.

E. Added the use of epinephrine auto-injector for anaphylaxis by EMT and EMR personnel. Updated dosing based on patient weight of 15-30 kg. Over 30 kg and the EMT or EMR is to use the adult dose and auto-injector. Endorsement requested.

F. Reference to EMT only for naloxone administration is removed.

G. Reference to EMT only for naloxone administration is removed.

H. Terminology change from perilaryngeal to supraglottic airway. Added “adult” to limit pediatric use.

I. Policy revision to add reference to new Hemorrhage Control protocol. Revised section on treatment of crush injuries and adds better definition of crush injury. Added other revisions such as adding the use of commercial pelvic binder for pelvic fractures and clarified that the injury specific section applies to both BLS and ALS with specific treatments limited for EMT and EMR based on scope of practice. Will be released for public comment next week with an effective date of January 1, 2021.

J. New policy draft. Introduce the use of TXA for significant blood loss. Concern about use in GI bleed. Will update to exclude GI bleed as an indication for use. Endorsement requested. Will be released for public comment next week with an effective date of January 1, 2021.

K. Policy update to include epinephrine auto-injector for EMR. Will add pediatric auto-injector to list.

L. Policy update to remove King Airway and include iGel, add normal saline for use with TXA, add TXA, and correct

• Motion by C. Click/Second by W. Hiller/Motion passed.

• Motion to endorse ALS and BLS Authorized Stock policies by M. Kalinski/Second by S. Houchin/Motion passed

6

M. Paramedic Scope of Practice

N. EMS Policy and Protocol Revision Cycle 2020-2021

oversight to include hemostatic dressings and chest seals that are part of the BLS authorized stock.

M. Add TXA to paramedic scope of practice and minor clean-up.

N. List of policies and protocols for creation and revision

provided. Intend to release the draft new and revised policies on September 1 for public comment which will close on November 30, 2020. The EMS Agency request a review of current policies and protocols by members of the EMS system to identify any other policies and protocols for potential revision.

• Motion to approve by M. Kalinski/Second by G. Steinbruner/Motion passed


8) EMS System QI Program A. CQI TAG B. STEMI C. STROKE D. TEQIC

A. No report B. No report C. No report D. No report


9) Reports A. Emergency

Communication Drill Reports

A. Response compliance report provided with MAC materials.


10) Future Agenda Items:

11) Announcements • EMS Agency update: 1. New openings for EMS Analyst positions at the EMS

Agency. Jared Bagwell has left the EMS Agency and Troy Mead will be leaving soon.

2. Temporary EMS Analyst recently hired. 3. Recruitment started for an Administrative Assistant.


12) Good of the Order • Concern raised regarding transport of hospice patients to specialty care centers rather than to the local ED.

• Questionable use of albuterol nebulizer and concern for disease transmission. Consider use of Metered Dose

7

Inhaler in the place of the nebulizer. This is a safety issue for EMS personnel.

• Would like an off-line discussion about adopting an extended scope of practice for flight paramedics.

13) Next meeting date September 9, 2020 • Information only

14) Adjournment Meeting adjourned • Information only

Draft MONTEREY COUNTY EMS AGENCY

OPERATIONS SUBCOMMITTEE (OPS)

Meeting Minutes

July 8, 2020

1

Emergency Medical Services Agency

1441 Schilling Place

Salinas, California

2:00 – 3:30 p.m.


1. CALL TO ORDER

A. Introductions

Eric Ulwelling called the meeting to order at 2:00 p.m. A

quorum was present. Introductions of committee members,

staff, and guests were done.


Eric Ulwelling,

Chair

Fire Protection

District

X

Scott Houchin,

Vice Chair

Fire Department

from an

incorporated City

X

Cassie Caldera Base Hospital

Coordinator

X

Dave Jedinak

Fire-based

Ambulance

Provider

X

Jeff Horner

EMS Aircraft

Provider

X

Tino Arellano Primary

Ambulance

Contractor

X

Olivia Madrigal

Monterey County

Emergency

Communications

Department

X

A. N/A



Meeting Minutes

July 8, 2020

2


Tina Nieto Law Enforcement

Agency

X

Vacant EMT/Paramedic

from the

Contracted 911

Ambulance

Provider

Vacant

EMT or Paramedic

from a Fire-based

Ambulance

Provider

Ex-Officio

Member

Dr. John Beuerle EMS Medical

Director

X

Alternates

Lee Ann

Magoski

Communications X

EMS Agency

Staff

Teresa Rios EMS Director X

Laura Wallin Health Program

Coordinator

X


Roxann

Seepersad

Epidemiologist X

Guests

Susan Blitch County Counsel



Meeting Minutes

July 8, 2020

3


2. PUBLIC COMMENT

None • None

3. APPROVAL OF

MINUTES

A. OPS Subcommittee

Minutes of March 11,

2020--Approval

The Operations Meeting Minutes of March 11, 2020 were

approved as written. M/S/C Scott H./Tina Nieto

• The Operations Meeting

Minutes of March 11, 2020

were approved as written.

M/S/C Scott H/Tina Nieto

4. CORRESPONDENCE None

• None

5. OLD BUSINESS

A. EMS Agency COVID-19

Response Update-- Report

(Troy Mead)

Teresa informed to committee that Troy out of the office and

referred committee members to the staff report included with

the agenda packet that contains a summary of COVID-19

activities. Teresa stated that the staff report does not

accurately reflect Troy’s role during the pandemic. Teresa

recognized Troy as a tremendous asset to the EMS Agency in

his role as the MHOAC and his ability to secure PPE and

other supplies for Monterey County and distribution of the

PPE. Troy has been very proactive and very engaged with

all our stakeholders. Teresa added that, based on the most

recent survey of the system, there are no shortages of PPE.

Chair Eric Ulwelling agreed with Teresa’s statement and

added that there were some hiccups at the beginning as it

would be expected, but the flow of PPE has been consistent,

and all the agencies participating appreciate that. He

inquired as to the assignment of ongoing programs that were

assigned to staff who are no longer with the EMS Agency.

• As noted



Meeting Minutes

July 8, 2020

4


Teresa responded that the EMS Agency is in the process of

bringing two EMS Analysts on a temporary basis so that the

EMS Agency can start transitioning MHOAC responsibilities

since Troy is leaving at the end of the month and distributing

some of the responsibilities that Jared had.

6. NEW BUSINESS

A. Election of New Officers

(Steve Brooks)

B. OPS Subcommittee

Membership Re-

appointments--

Discussion

(Steve Brooks)

C. Contacting EMS Agency

Medical Director-

Discussion

(Eric Ulwelling)

A. Steve Brooks stated that the EMS Agency recommends

that the Operations Subcommittee elect a committee

Chair.

Eric Ulwelling was nominated as Chair. M/S/C Tino

Arellano/David Jedinak.

Scott Houchin was nominated as Vice-Chair. M/S/C

Lee Ann Magoski/David Jedinak

B. Olivia Madrigal, Jeff Horner, and Eric Ulwelling agreed

to continue to serve on the OPS Subcommittee.

C. Dr. John Beuerle stated that the best way to contact him

is through his County email with a copy to other EMS

Agency staff. This will ensure that any urgent matter that

requires his attention can be passed on to him through

internal channels. Non-urgent issues will be addressed

on his office days.

A. Eric Ulwelling was elected

as Chair.

M/S/C Florentino/David

Jedinak.

Scott Houchin was elected as

Vice-Chair

M/S/C Lee Ann

Magoski/David Jedinak

B. Olivia, Jeff and Eric were

reappointed to their

positions.

C. EMS Agency assigned Laura

Wallin as the point of

contact responsible for

bringing urgent matters to

Dr. Beuerle’s attention to

ensure a timely response.



Meeting Minutes

July 8, 2020

5


D. Ambulance RFP

Discussion

(Eric Ulwelling)

Teresa asked for Laura Wallin to be included in any

correspondence addressed to Dr. Beuerle. Laura will be

the single point of contact within the EMS Agency

responsible for bringing urgent matters to Dr. Beuerle’s

attention to ensure a timely response.

D. Chair Ulwelling stated that the RFP discussion during the

EMCC meeting have addressed his concerns. He added

that he was looking for an explanation as to when the

public comments were going to be distributed and heard,

and they were heard during the EMCC meeting. He did

not feel the need to repeat public comments that he

submitted.

David Jedinak stated that, in light of the global pandemic,

he would like for the County to reconsider its RFP

process at this time so that decisions are not made in

haste and the proper forum can be utilized to ensure that

the community is best served in its delivery of EMS

services. He added that everything we are looking at in

the next RFP still has some issues surrounding the

utilization of closest resources, the penalties associated

with the contractor utilizing mutual aid from its partners,

and we have been down this road before. We have seen

the failures. We have seen the successes. We have also

seen that putting the brakes on and slowing down and

analyzing it with all the proper input from the

community, the member agencies, the partnerships, is

pivotal in making sure that the next ten (10) years are

D. As noted



Meeting Minutes

July 8, 2020

6


utilized with all the right information and tools that are

given to us.

Lee Ann Magoski indicated that Emergency

Communications did submit comments internally to work

within so that the pieces related to 9-1-1 are worked out

internally. She provided clarification for members of the

committee regarding a public comment related to the 9-1-

1 not having redundancy by saying the 9-1-1 Center does

now have a backup center that includes the current EMS

provider.

Chair Ulwelling asked for further clarification as to

whether there is redundancy with the ambulance

contractor. Lee Ann explained that, because of COVID,

Emergency Communications set up a 12-seat back up

center. It is not a hot stand-up where people would have

to be deployed to, and it does include space for the

ambulance provider. Lee Ann added that, while the

space Emergency Communications has is temporary, it is

their intention to find a permanent home for it. The

County does now have a backup center.

Chair Ulwelling inquired as to the process by which the

EMS Agency or the Health Department responds to

public comments.

Susan Blitch, Senior Deputy County Counsel, stated that

the next step is for the EMS Director to get and review all

the public comment from the various entities and member



Meeting Minutes

July 8, 2020

7


of the public who submitted them. She will make any

changes or adjustments to the RFP as warranted or

deemed necessary. Then the next step is that the RFP

will be submitted to the State for approval. The State

may, or may not, have comments or issues. After it gets

back from the State, the RFP will be formally issued and

the bidding process would start.

Chair Ulwelling asked Susan Blitch if there would be

another opportunity for public input once the EMS

Director/Bureau Chief has collated and put out the

responses to the RFP. Susan responded by saying that,

once public comment is closed, that would be the end of

public input to the document with the caveat that the

State may have input.

7. ANNOUCEMENTS/

FOR THE GOOD OF THE

ORDER

Chair Ulwelling acknowledged the efforts of all county

agencies, public safety agencies, the EMS Agency, the

Health Department, the many people who are involved,

the Office of Emergency Services, in protecting our

community during this pandemic.

Chair Ulwelling also acknowledged the competency,

dedication and skills of the two employees who are

leaving the EMS Agency—Jared Bagwell and Troy

Mead. He added that Jared was instrumental in putting

together COVID-19 response plan starting in March. He

also recognized that Jared was not working alone and

acknowledged the efforts of everybody who was involved

in that collaboration. We had a functional plan very early

on.

• As noted



Meeting Minutes

July 8, 2020

8


Scott Houchin commended Lee Ann Magoski for the

amazing job Emergency Communications has done at

giving updates and asked if Emergency Communications

has been instructing patients to meet first responders

outside to help alleviate some of the contact points. Lee

Ann will follow up. However, with most calls being

medical calls, it will probably AMR Dispatchers who

would be providing that instruction.

Dr. John Beuerle stated that the topic was discussed and

by the EMS Agency. Obviously, if it is not safe for the

patient, then first responders would have to make entry.

The EMS Agency did encourage the practice of meeting

them at the door when at all safely feasible.

Scott Houchin added that there are more calls from

people who are testing positive who want help and who

live in multi-generational households, and we would like

to get them outside. We know we have to enter skill

nursing facilities, and we send one person in as our

“canary,” if you will, to go check it out first. With the

numbers growing, there are more people calling not for

medical need but for reassurance. We would like some

guidance as we would like to minimize our potential for

exposure.

Chair Ulwelling stated that there was an announcement

from ESO a couple of weeks ago that there were going to

be some software changes that would potentially impact

our CAD integration. He added that those concerns were



Meeting Minutes

July 8, 2020

9


sent to Laura Wallin. Chair Ulwelling indicated that he

received from messages from field personnel that ESO is

not working correctly and asked Lee Ann if she has heard

any information about that. Lee Ann responded that ESO

is the oversight of EMS, not of Emergency

Communications. She confirmed that there were no

changes to the CAD.

Laura Wallin reported that she did get confirmation form

Edgar at ITD that they are already on the right platform

to incorporate their changes. ESO sent an email

informing us that the changes were going to be delayed

for a day or two. Laura sent that to everyone. Eric added

that there appears to be issues with ESO Fire where

changes are not being saved.

Liz Vega stated that, as part of the EMD process, AMR is

asking, specifically if it is safe to do so, to take the

patient to the nearest exit. That way, first responders are

not having to go inside. If there is CPR in progress or

those other types of calls when it is not safe to take the

patient to the door, AMR Dispatchers are asking the

question to try to alleviate the worry about having first

responders go in.

David Jedinak echoed Chair Ulwelling’s comments about

Jared and the members of the EMS Agency during this

trying time. He reiterated that there is a lot of

transformation occurring throughout our communities, as

well as the EMS Agency and the County. It is important



Meeting Minutes

July 8, 2020

10


that we take the right steps to ensure that the plan for the

next ten (10) years is made with the involvement of all

the members.

Tino Arellano also acknowledge everyone, including

AMR staff for supporting the County and the fire

agencies and their needs during the difficult times. He

added that AMR’s operation has not changes and

continues to operate fully functional.

Dr. John Beuerle expressed his personal and the EMS

Agency’s appreciation for the work that the folks on fire,

EMS, police, hospitals, and Emergency Communications

are all doing to help us to get through this time. He

acknowledged the heroic efforts all involved. Teresa

echoed Dr. Beuerle’s statement.

8. NEXT MEETING The next regularly scheduled Operations Subcommittee

meeting will be held on Wednesday, September 9, 2020

at 1:00 p.m. Location to be determined

• As noted

9. ADJOURNMENT Meeting was adjourned. • Meeting was adjourned.

Monterey County EMS Agency 1441 Schilling Place, Salinas, CA 93901 Phone: 831-755-5013 Fax: 831-775-8040 www.MoCoEMS.org

Date: September 9, 2020

To: Emergency Medical Care Committee

From: Teresa Rios, EMS Director

Regarding: EMS Agency Update

The list below summarizes some of the most recent work in which the EMS Agency has been

engaged to meet our responsibility of system oversight and to respond to the needs of the EMS

System.

• Local Optional Scope of Practice (LOSOP):

o LOSOP for specially trained paramedics and EMTs to do nasopharyngeal swab

testing of EMS personnel

▪ Submitted application and received State approval

▪ Established policy to allow nasal swab testing by EMS personnel

▪ Developed approval process for approving individual departmental program’s

application

▪ Assisted two providers with training, handouts, consent forms, training

PowerPoint, and post test

▪ Processed two applications received

o LOSOP for paramedics and EMTs at a static site

▪ Researched requirements to provide optional scope of practice procedures

▪ Submitted application and received State approval

▪ Developed new policy

▪ Working with allied agencies to develop an implementation plan

o LOSOP for TXA

▪ Submitted application to the State – pending approval

▪ Developed training PowerPoint and post test

▪ Wrote protocol for the administration of TXA

▪ Revised other protocols to support Hemorrhage Control protocol

Nationally Accredited for Providing Quality Health Services

1270 Natividad Road, Salinas, CA 93901 831-755-4500 www.mtydh.org

• Patient care revisions

o Introduced iGel as the approved Monterey County supraglottic airway

▪ EMS system improvement to use a less costly item with a literature review

that indicates increased provider comfort and ease of use.

▪ Allow for a six month transition period to assist with managing the cost and to

use current stock of King Airways.

▪ Revised seven (7) policies and protocols to support the use of “supraglottic

airways” instead of King Airways

o Metered Dose Inhaler (MDI) allowed in place of albuterol nebulizer for provider

safety

▪ Memo distributed

o EMT and EMR use of epinephrine auto-injector

▪ Policy revisions in place for a January 1, 2021 start

▪ Worked with AMR to bring the AMR pricing to first responders

o EMT and EMR use of naloxone

▪ Policy revisions in place for a January 1, 2021 start

• Other programs and activities

o Developed a Naloxone Leave Behind Program

▪ Allows EMS responders to give at-risk individuals naloxone for their use

▪ Puts naloxone in the hands of people at-risk of overdose and who are likely to

be at the scene of an overdose

o EMT certification and paramedic accreditation

▪ Processed 270 EMT certification/re-certification applications

▪ Processed 60 Paramedic accreditation/re-accreditation applications

o Wrote new policy on Data Utilization and Governance


o Preliminary work on the 2021 Policies and Protocols Cycle

o Investigated Unusual Occurrence Reports

The EMS Agency appreciates the collaboration and support it has received from stakeholders.

Monterey County Health Department: Emergency Medical Services Agency

Presenter: Roxann Seepersad, Public Health Epidemiologist II

September 9, 2020

Emergency Medical Care Committee

(EMCC)

Prepared by Roxann Seepersad, Public Health Epidemiologist II

Response Time Compliance by Priority

Response Time Compliance: Green Zone“For each Priority within each Zone, compliance shall be considered achieved when 90% or more of calls on a monthly basis meet the specified response-time criteria.- ALS Provider Agreement :A-11610 §18.3

“ For every month in which 100 or more responses of any Priority originate within the Zone, 90% compliance is required for the calendar month.”- ALS Provider Agreement :A-11610

Response Time Compliance: Yellow Zone“For each Priority within each Zone, compliance shall be considered achieved when 90% or more of calls on a monthly basis meet the specified response-time criteria.”- ALS Provider Agreement :A-11610 §18.3

For example, to comply for Priority 1 responses in the Yellow Zone, the contractor must place an ALS unit on the scene of each call within 12 minutes not less than 90% of all calls within the Yellow Zone for the month.

Response Time Compliance: Orange Zone“For each Priority within each Zone, compliance shall be considered achieved when 90% or more of calls on a monthly basis meet the specified response-time criteria. ALS Provider Agreement :A-11610 §18.3

For example, to comply for Priority 1 Orange Zone, the Agreement:A-11610or must place and ALS ambulance on the scene of each call within 16 minutes not less than 90% of all calls within the Orange Zone for the month. ”

EMS Dispatch Performance: “Contractor Shall dispatch (Priority 1, 2, or 3) calls within fifty-nine (59) seconds of call, take receiving the call information, either telephonically or by CAD key stroke.”- ALS Provider Agreement :A-11610 §18.4.1.2

800MHz Disaster Medical Radio System TestingResponse Compliance June 2019 - May 2020

50%

60%

70%

80%

90%

100%

110%

Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20

CHOMP 97% 97% 100% 97% 100% 100% 90% 100% 100% 90% 100% 100%MMH 93% 90% 100% 97% 97% 90% 100% 97% 100% 77% 97% 97%NMC 86% 94% 90% 93% 97% 93% 100% 100% 96% 94% 100% 97%SVMH 90% 81% 68% 100% 94% 67% 94% 90% 93% 87% 90% 63%AMR 97% 100% 100% 100% 100% 100% 100% 100% 93% 100% 100% 97%STANDARD 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

CHOMP MMH NMC SVMH AMR STANDARD




From: Laura Wallin, RN, CEN, Health Program Coordinator

Regarding: Ambulance Patient Offload Times (APOT)

• Year-To-Date Analysis:

• Census dropped significantly in April of 2020, and APOT times also dropped due to

COVID-19.

• By August 2020, census is just about up to where it was at the beginning of the year.

Salinas Valley Memorial Hospital and Natividad Medical Center APOT times have

risen above what would be expected for the volume.

• With COVID-19, hospitals have been stretched to keep patients farther apart, close

some beds, use isolation rooms more frequently and cohort suspected COVID-19

patients, and develop processes to comply with infection control guidelines. Patient

acuity has been rising, necessitating more boarding in the ED, lengthening APOT

times in 2020.

0

500

1000

1500

2000

2500

0:00:00

0:07:12

0:14:24

0:21:36

0:28:48

0:36:00

Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20

2020 APOT-1 (APOT times by hospital and aggregated volume)

CHOMP Mee NMC SVMH Aggregate Volume


1441 Schilling Place, Salinas, CA 93901 831-755-4500 www.mtydh.org

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Jan Feb Mar Apr May Jun Jul Aug

APOT-2 2020 (breakdown of wall times)

0"-20" 21"-60" 61"-120" 121"-180"

• Year-To-Date Analysis:

o This chart shows that the percentage of calls where the APOT time is <20 minutes

is decreasing.

o The percentage of calls where the APOT time is 21 – 60 minutes and from 61 –

120 minutes is increasing.

o APOT times are climbing, particularly in the Salinas area. With COVID-19 and

rising patient acuity, hospitals are stretched to keep patients further apart, close

some beds, and develop processes to comply with infection control guidelines.

All of this has been lengthening APOT times in 2020.




From: Jeff D’Andrea, EMS Analyst, MHOAC

Regarding: EMS Agency Response to CoVid-19 and Recent Wildfires

The EMS Agency continues to monitor and relay information to EMS System stakeholders. The

following is a list of key actions taken during the declared public health emergency of COVID-19 and

the recent wildfires.

COVID-19

• The MHOAC has received and coordinated more than 1,000 requests for Personal Protective

Equipment (PPE) from various healthcare providers in Monterey County. Hospitals, Long Term

Care Facilities, and outpatient clinics rely on the MHOAC and its State and County partners for

access to no-cost PPE and other safety products. Fire departments, County agencies, correctional

facilities, and a range of other institutions also use the MHOAC to access PPE.

• The MHOAC has secured more than 100,000 N95 masks for local agricultural workers. This

population of essential workers has been significantly impacted by COVID-19.

• The MHOAC ensures an adequate supply of swabs and testing kits made available by the

California Department of Public Health is on hand for the various COVID testing sites within the

County.

• The MHOAC, in cooperation with the Emergency Preparedness Coordinator at SVMH, manages

the distribution of the anti-viral drug Remdesivir from the CDPH to the four acute care hospitals

in Monterey County, ensuring an adequate supply for all hospitalized COVID patients.

• Healthcare facilities experiencing critical staffing shortages have utilized the MHOAC to

broadcast requests for staffing support.



Carmel and River Fires

• The MHOAC, as part of a small team of County officials, coordinated the evacuation of Rippling

River, a senior residential apartment complex in Carmel Valley. Dozens of seniors, many with

functional disabilities, were safely transported to the Sherwood Hall shelter.

• The same team prepared an evacuation plan for Carmel Valley Manor, a skilled nursing facility in

Carmel Valley. This plan was much more complex than the preparations for Rippling River. The

Carmel Valley Manor population is much larger with many residents lacking mobility and in need

of medical care. There were multiple destinations involved and a need for diverse transportation

resources. Fortunately, the facility did not require evacuation. The event provided an excellent

real-time exercise in the evacuation of a skilled nursing facility.

In addition to the specific actions described above, the MHOAC is an effective resource for

communication between State and County health officials and for coordination amongst various public

and private responders in emergency situations.




From: Teresa Rios, EMS Director

Regarding: Liquidated Damages Paid by EOA Ambulance Service Provider

Section 18.12 of the current EOA Ambulance Service Agreement requires Contractor to pay

liquidated damages if Contractor does not achieve the response time requirements established in

the Agreement. Below is a summary of the liquidated damages paid by AMR since the start of

the current EOA Ambulance Services Agreement.

Fiscal Year Amount

Paid Period

FY09-10 0

FY10-11 600 Nov 2010-Apr2011

FY11-12 13,240 May 2011-Jul 2011

19,740 Aug 2011-Oct 2011

FY12-13 0

FY13-14 2,200 N/A

FY14-15 900 Nov 2014-Jan2015

FY15-16 41,440 May 2015-Apr 2016

FY16-17 18,470 May 2016-Jul2016

FY17-18 148,130 Aug 2016- Dec 2017

FY18-19 60,300 Jan 2018-Mar 2019

FY19-20 34,950 Jul 2019-Dec 2019

Total to Date $339,970 Annual Average $28,331

From the start of the current agreement on January 31, 2010 to December 31,2019, AMR has

paid a total of $339,970.00 in liquidated damages. That is an average of $28,331. The amount

of liquidated damages paid in FY17-18 and FY18-19 appear high; that is because they cover

more than one year of penalties. This is, at least in part, due to the change from Inspironix to

FirstWatch as the system used for the adjudication of the calls.



There have been no liquidated damages assessed to AMR in 2020. Penalties related to non-

compliance of response time requirements were waived for six months after the implementation

of MPDS.

Given that liquidated damages are not restricted for a specific purpose, they have been used by

the EMS Agency to support the EMS System. There are costs the EMS Agency incurs that go

beyond salaries and benefits of personnel, Medical Director services, or office supplies, that are

critical components of the EMS as demonstrated by the examples listed below.

Vendor Service Description Amount

Citygate Associates, LLC Development of an EMS Communications Plan $74,076

CityGovApp, Inc. Development and maintenance of mobile application $46,698

ESO Solutions, Inc. Unified electronic patient care reporting solution (ePCR) $450,000

Dr. James Stubblefield Narcotics Prescribing Physician Services $10,000

Total $580,774