SAN JOAQUIN COUNTY EMS AGENCY AMBULANCE SYSTEM PLAN

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1 JQ Y GY B Y raft February 25, 2014

2 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 an Joaquin ounty mergency edical ervices gency 2014 mbulance ystem lan (ublic omment raft) able of contents xecutive summary... 2 verview of planned system design... 2 ntroduction... 4 uthority... 4 urpose... 4 xclusive operating areas... 4 escription of current system... 5 on-transport emergency medical responders... 5 mbulance services... 5 ir ambulance services... 7 dvanced life support... 7 ispatch services... 7 egulatory process system redesign... 8 lan development... 9 lanning considerations and principles... 9 Zone design considerations... 9 ystem design verview of system design Ground ambulance services ir ambulance services dvanced life support ispatch egulatory process mplementation process and timeline Zone forms ppendices ppendix 1: evised ambulance zones ppendix 2: Zone X/Zone (anteca/athrop boundary change) ppendix 3: mbulance rdinance ppendix 4: Board of upervisors approval ppendix 5: esponse to public comment able of tables able 1: mergency ambulance providers:... 6 able 2: esponse volume and compliance rates, by zone:... 6 able 3: ir ambulance providers

3 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 xecutive summary he purpose of the an Joaquin ounty mergency edical ervices () mbulance ystem lan is to ensure the provision of effective and efficient emergency medical care in accordance with the declared policy of the tate of alifornia. he an Joaquin mbulance ystem lan outlines the structure and operations for ambulance transport and prehospital care services in an Joaquin ounty. he mbulance ystem lan will: etermine the number of and boundaries for ambulance zones; stablish a process for creating an exclusive operating area () and awarding ambulance permits to a limited number of ambulance providers to serve specific ambulance zones in an Joaquin ounty; efine the role of basic life support (B) and advanced life support () nontransport providers; dentify the process for designation of dispatch center(s); dentify the process for oversight and enforcement of standards for providers. verview of planned system design Ground emergency ambulance services: he system will reduce the number of emergency ambulance permit zones (ambulance zones) for ground ambulance providers from six to four. he ambulance zones currently subject to a competitive bid process are Zone (greater odi), Zone B (greater tockton), and Zone (greater racy). hese zones will be collapsed into one zone designated as Zone X and divided into subzones X-1 through X-11 for monitoring performance. Based on the performance of the current configuration and in order to maximize the economies of scale and system efficiencies, the gency will use a competitive process to select one provider to serve Zone X. he gency will maintain the current configuration of Zone (greater anteca), Zone (greater ipon), and Zone F (greater scalon) as non-competitively awarded s. inor zone border adjustments are being made to improve service and/or clarify boundaries. he gency will develop and issue a single request for proposals (F) for ambulance zone X. he F will specify the gency s desired performance standards for the emergency ambulance, inter-facility transfers, and dispatch services and the mechanisms used to ensure compliance with these standards. he use of a performance-based contract allows the selected provider to determine how to meet the gency s performance standards, and subjects the provider to penalties for its failure to meet performance standards. he F and resulting agreement will include provisions for: he scope of services to be performed and standards of performance. enalties to be assessed for failure to comply with specific performance standards (e.g., response times). ncentives to be earned for exceeded performance standards (e.g., penalty reductions, contract extensions). 2

4 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 erformance bonds and mechanisms for the take-over of vehicles and equipment by the gency to ensure the continuation of ambulance service during a major breach of contract. lame duck requirement to ensure the smooth transition in the event that another provider is selected in any future competitive procurement. ispatch: he ambulance contractor will be required to provide dispatch services matching those currently provided through the existing competitively awarded agreement and meeting gency standards. n addition to maintaining the accountability for meeting the standards, this allows the provider to implement its system status management plans (i.e., moving ambulances within the area and variable staffing patterns). he provider will be required to report to the gency key information that will be used to measure and evaluate the provider s performance, and to determine compliance with gency standards. ystem valuation: he an Joaquin ounty gency is responsible for the development of standards for the system including mbulance ystem and dispatch services, for implementing the system, evaluating performance and enforcing standards. his requires active gency oversight, including but not limited to the: udit and inspection of operational, financial, and patient care records and performance data; onitoring service delivery for compliance with defined standards; and roviding technical guidance, as appropriate. ransport and non-transport prehospital care providers will be required to furnish the gency with prehospital care, operational, financial, and other reports. he gency will utilize this data to monitor system performance and to identify situations where the providers may fail to meet their contractual requirements. 3

5 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 ntroduction uthority he an Joaquin ounty mbulance ystem lan was developed by direction of the an Joaquin ounty Board of upervisors and in compliance with ealth and afety ode, ivision 2.5, ections , , , and , et seq. urpose his plan outlines the structure and operations for prehospital care services within the an Joaquin ounty system. pecifically, the plan will: etermine the number of and boundaries for ambulance zones; stablish a process for creating an and awarding ambulance permits to a limited number of ambulance providers to serve specific ambulance zones in an Joaquin ounty; efine the role of B and non-transport providers; dentify the process for designation of dispatch center(s); dentify the process for oversight and enforcement of standards for specified providers. he plan establishes a timeframe for implementation of system changes. xclusive perating reas he tate of alifornia enacted ealth and afety ode sections , , and to authorize local agencies to create s awarding exclusive franchises for ambulance service, services, and limited services. he egislature enacted these sections of ealth and afety ode to prescribe and exercise the degree of state direction and supervision over emergency medical services as will provide for state action immunity under federal antitrust laws. ealth and afety ode section authorizes a local agency to create an using a competitive process and in limited circumstances a non-competitive process. he local agency must first submit a plan for creating the and awarding ambulance permits to the alifornia uthority. pproval of the mbulance ystem lan serves as the required tate oversight to achieve state action immunity from federal anti-trust laws. he primary advantages of creating an and selecting an exclusive provider for all or part of the county is that an curtails the chaos associated with retail street level competition and instead promotes planned public accountability furthering the stated policy of the tate of alifornia to ensure effective and efficient emergency medical care. he use of a competitive F process allows the an Joaquin ounty gency to establish the scope and level of service to be provided and set specific performance criteria otential providers are required to submit proposals meeting the standards established by the gency that describe how they would meet the requirements of the F. he F also establishes the rates to be charged by the provider. 4

6 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 he successful bidder, once selected, is accountable to the gency to provide service in compliance with a contract approved by the Board of upervisors. he contract will specify penalties for violation of standards and include a performance bond for default or major breach of contract. escription of current system on-transport emergency medical responders (s) an Joaquin ounty is served by 18 fire departments. f these, three departments provide non-transport and 15 provide B non-transport. nly one fire department, the ipon onsolidated Fire istrict, provides both transport and nontransport services. he an Joaquin ounty heriff s epartment boat patrol provides B service and water rescue on the elta waterways. s are dispatched to medical emergencies along with the emergency ambulance service according to gency policy approved by the edical irector. mbulance ervices From the late 1970s through 2005, an Joaquin ounty was divided into eight ambulance zones. f these zones, five were non-exclusive open market zones and three were non-competitively awarded exclusive operating areas. uring this time, a total of nine ground ambulance services operated in an Joaquin ounty. n arch 15, 2004, there were 30 permitted stations and 67 permitted vehicles. an Joaquin ounty revised its mbulance ystem lan in 2004, creating six exclusive ambulance zones maintaining the three non-competitively awarded s and establishing three new s to be competitively awarded. Following a F process in 2005, the three competitively awarded s (zones, B, and ) were awarded to merican edical esponse-west (), which established a single operations process for the three zones. mbulance zones,, and F remained noncompetitively awarded s continuing the use of the existing ambulance providers anteca istrict mbulance, ipon onsolidated Fire rotection istrict, and scalon ommunity mbulance. he performance-based mergency mbulance greement between the ounty and to provide emergency ambulance to zones, B, and ends on pril 30, s exclusive operating areas, only the ambulance provider awarded the may initiate emergency ambulance services in these zones. ll ambulance zones are listed in able 1 and shown in ppendix 1. 5

7 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 able 1: mergency ambulance providers: ommunity urrent provider Zone odi merican edical esponse Zone B tockton merican edical esponse Zone racy merican edical esponse Zone anteca/athrop anteca istrict mbulance Zone ipon ipon onsolidated Fire epartment Zone F scalon scalon ommunity mbulance he total number of emergency ambulance requests (including all ode 2 and ode 3 responses) for all exclusive operating areas combined in 2012 was 64,091. he number of ode 3 emergency ambulance requests for all exclusive operating areas combined in 2012 was 48,902. able 2 below lists the total call volume for each exclusive operating area or sub area along with the overall response time compliance for ode 3 responses. able 2: esponse volume and compliance rates, by zone: Zones ode 3 esponses ode 3 esponse ime ompliance ode 2 esponses Zone -1 (X-1) 4, % 1,868 Zone -2 (X-2) 1, % 308 Zone -3 (X-3) % 135 Zone B-1 (X-4) 13, % 5,045 Zone B-2 (X-5) 14, % 4,605 Zone B-3 (X-6) % 19 Zone B-4 (X-7) 1, % 379 Zone B-5 (X-8) 1, % 326 Zone -1 (X-9) 3, % 1,270 Zone -2 (X-10) % 72 Zone -3 (X-11) % 86 Zone %* 1613 Zone %* 0 Zone F %* 185 otal 48, % 15,911 * ompliance shown without exemptions identified : he existing zones, B, and will be collapsed into the new Zone X. 6

8 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 ir mbulance ervices: an Joaquin ounty has four permitted and authorized air ambulances services. is the only air ambulance service based within an Joaquin ounty and is located at the tockton etropolitan irport. ir ambulances are required by tate regulations to operate at not less than the level. ir ambulance services currently serving an Joaquin ounty are shown in able 3. able 3: ir ambulance providers rovider elicopter location odesto ir ethods odesto tockton and oncord oncord he emergency ambulance service agreements with the ground ambulance providers include a provision allowing the use of the air ambulances to transport patients from the scene of medical emergencies. n air ambulance may be requested by on-scene personnel with all such requests being forwarded to the gency s designated dispatch center. his policy of single point ordering for aircraft eliminates duplicate requests, improves coordination between multiple responding providers, and reduces the risk associated with multi-aircraft responding to the same scene. dvanced life support service is available universally throughout the county by the authorized emergency ambulance service providers. his standard achieves the intent of the tate of alifornia to maintain and promote the development paramedic programs throughout the state. dditional services are provided through agreements with the tockton Fire epartment, the racy Fire epartment (outh ounty Fire uthority), and the four authorized air ambulance providers serving an Joaquin ounty. dispatch services an Joaquin ounty has seven primary public safety answering points () and one secondary designated to receive all medical and ambulance requests. olicies o and 3001 require all primary s to transfer medical callers to the ounty s designated dispatch center without delay. he ounty s current designated dispatch center is s ifecom dispatch center (now d.b.a Valley egional mergency ommunications enter or V), which was selected as part of a competitive process for exclusive emergency ambulance service. ifecom interrogates callers using the ational cademies of mergency ispatch () emergency medical dispatch () protocols as approved by the gency s medical director. ifecom provides all emergency ground ambulance dispatch in an Joaquin ounty and ifecom serves as the designated single point of contact for the ordering of all air ambulance resources in the prehospital setting. ifecom also provides emergency 7

9 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 dispatch services for the Joint adio sers Group (JG), which is comprised of a majority of fire agencies in an Joaquin ounty with the notable exception of the cities of odi, anteca, and tockton. ifecom maintains a direct computer aided dispatch -to- link with the tockton Fire epartment s dispatch center to ensure the efficiency and accuracy of call information between the two dispatch centers. egulatory process ermitting: he an Joaquin ounty mbulance rdinance, (ivision 7, , et seq.), requires a permit for an ambulance provider to operate within the county. he applicant must comply with the standards set forth in the rdinance, which includes an application with detailed information about the ambulance provider s equipment, staffing, and ability to provide services. n inspection of the unit and ambulance station is made to ensure that it complies with all provisions within the rdinance and that the ambulance station meets health and safety requirements and zoning laws. versight: he gency s nalyst is responsible for overseeing the day-today enforcement of the ambulance ordinance and related ambulance permits and agreements. he edical irector and rehospital are oordinator provide medical and operational oversight of the services provided system redesign n 2004, a major system mbulance ystem redesign was undertaken to eliminate street level retail ambulance competition throughout the ounty. lthough implementation was controversial at the time, the redesigned an Joaquin ounty ambulance system is generally viewed today as a success. he system has settled into a successful form and functions as it was designed. mong the indicators of this success are: he single provider of ambulance service in zones, B, and operates more efficiently, resulting in better overall ambulance response times. single combined dispatch center gathers information quickly and accurately from reporting parties, provides immediate medical advice to callers, seamless coordination between emergency ambulance providers, increased coordination with partnering fire departments, and eliminates delays. he ever present conflict among and between fire departments and ambulance providers has been greatly reduced. gency oversight has improved. 8

10 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 lan development process his plan largely continues the existing ambulance system design, unlike the 2005 plan which completely overhauled the then existing system. With the ambulance providers contractually required reporting requirements and the gency s direct access to performance data, system problems and opportunities for improvement are identified and implemented on an ongoing basis. evelopment of this plan followed the an Joaquin gency s standard practice for policy adoption. nder this, draft policies are posted on the gency website for a minimum of 30 days to solicit public comment. he gency will notify system participants of the public comment period. he an Joaquin ounty gency will summarize and respond to the comments received during the 30 day public comment period. he comments and the gency s response to those comments will be made available on the gency s website. he an Joaquin ounty gency will revise the draft mbulance ystem lan following the public comment period and then submit the updated draft mbulance ystem lan to the an Joaquin ounty Board of upervisors for their consideration. he resolution showing approval of the plan by the Board of upervisors will be included as ppendix 4. lanning considerations and principles he an Joaquin ounty gency continued to work under the guidelines adopted by the mbulance teering ommittee. hese guidelines called for the revised system to be effective, efficient, and equitable, with the gency holding the ambulance provider accountable for its performance through the competitive process, the resulting contract, and the oversight process. Zone design evaluation criteria n the 2005 plan, potential zones were evaluated based on conomic viability. ttractiveness to bidders. perating efficiency. vailability of backup in case of breach. ntegration of dispatch services. ccountability to the public. mpact on existing local providers. mpact on the oversight process. everal possible zone configurations were evaluated in 2004 before adoption of a system design that merged the five non-exclusive zones into three zones that would be awarded by the F. n 2005, a single provider was selected to serve all three of the 9

11 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 newly designed and competitively awarded zones. Based on the success of this experience the gency is collapsing zones, B, and into one zone Zone X. ystem design verview of system design he system design proposed under this plan would make only minor adjustments to the system design adopted in the 2005 plan. Ground ambulance services Zones: he an Joaquin ounty system will modify its current six zones for ground ambulance providers by collapsing Zones, B, and into a single zone (Zone X) that is divided into eleven subzones. his reflects the current operation of these three zones by a single provider and the intent of the ounty to competitively seek a single provider for Zone X through an F. he ounty will continue the use of existing providers in zones,, and F, through non-competitively awarded exclusive operating area agreements. minor boundary change will move some territory from Zone X-11 to Zone (anteca/athrop) (ppendix 2). his area is undeveloped and received no requests for ambulance services during he ounty has approved plans to allow development to begin in January 2014 and, over a ten year project, the potential to add 11,000 homes with a town center, and 4000,000 square feet of office and lab space. ue to bridge access and other factors, this area will be better served by the Zone ambulance provider because the planned population center will be located contiguously with the population center of the ity of athrop. f the Zone X provider remained responsible for service, the area would be a population island making it more difficult to maintain consistent ambulance availability as part of a larger system status plan. n addition, the two fastest access points to the development will be from athrop and nterstate 5. he remainder of Zone and the existing Zones and F (ipon and scalon) will remain as currently configured although minor future border changes will be considered as appropriate. ny such modifications will be part of the system s ongoing quality improvement process and will be based on factors such as population density chances and changes in the road system. he existing grandfathered providers in these zones will continue to operate exclusively within these zones. he competitive process for Zone X will use a F. n the F, the gency will specify the desired performance standards for the ambulance service and the mechanisms used to ensure compliance with these standards. 10

12 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 cope of services for Zone X: he selected provider will receive exclusive market rights for all emergency ambulance service and all ambulance service, including: all 9-1-1/ requests for ambulance service; 7-igit requests for emergency ambulance service made directly to an ambulance service without going through an authorized 9-1-1/; ambulance transport to an emergency department from the scene of an emergency, including transports to an emergency department originating from a skilled nursing facility, physician s office, medical clinic, residential care facility, or other medical facility; inter-facility ambulance transports from a general acute care hospital in Zone X to any other general acute care hospital; critical care transport () ambulance transports, which shall conform to the definition of pecialty are ransport as defined in 42 F , from a general acute care hospital in Zone X to any other general acute care hospital, (excluding hospital based neonatal transport services and physician staffed ambulance transports). ccountability: While the F will allow the provider to be creative in how it meets the standards, it will be held accountable to the gency for its performance through the competitive process, the resulting contract, and the oversight process. he F will include pre-established standards for the ambulance service, economic incentives for the provider to comply with these standards, and a comprehensive system of contract monitoring. erformance standards: he an Joaquin gency is charged with developing the standards for the ambulance system, for implementing the system, and for monitoring and enforcing the contract. he standards will include: linical quality (staffing level, specific training requirements, and internal quality management program); esponse times for emergency ambulances; aximum unit-hour utilization ratios for the sub-zone compliance areas, and each ambulance; eployment/system status management plan; tandards for ambulances and equipment; Fleet maintenance program; Field supervision; and atient charges. performance-based contract is based on the premise that the selected provider is in the best position to determine how the standards are met, subject to penalty for failure to meet them. herefore: enalties will be used for failure to comply with specific performance standards (e.g., response times). ncentives (e.g., penalty reductions, contract extensions) will be used to provide incentives to exceed performance standards. 11

13 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 erformance bonds and mechanisms for take-over of vehicles and equipment will be put in place ensuring that ambulance service will continue in case of a major breach of contract. lame duck requirement will be used to ensure smooth transition in the event that another provider is selected in any future competitive procurement. enalties: he F and the contract will specify penalties for non-compliance with standards. hese will be approved by the Board of upervisors as part of the F development and contract approval processes. enalties will be assessed will include but not be limited to: xceeding allowable response time per call (by minute); xceeding allowable response time percentile by month. hese will be measured within sub-zone compliance areas; Failure to provide required information; Failure to meet dispatch performance; and ther minor breaches. dditional services: Finally, the F will provide for additional services to be provided by the contractor. hese may be mandated or may be offered for additional points in the scoring of proposals. Because the required performance standards and any additional requirements will increase costs, the gency will need to ensure that added requirements are worth these extra costs and that the total system cost is not excessive. ir ambulance services he gency will recommend changes to the ounty s mbulance rdinance to allow for the creation and implementation of exclusive operating areas for air ambulances. ir ambulances are generally viewed as a regional resource. n order to promote efficiency and improve performance the an Joaquin ounty gency will explore the desirability of creating one or more s for air ambulance service in cooperation with neighboring local agencies. dvanced life support ll emergency ground ambulance services are required to provide service. ispatch he F will require that the winning bidder provide dispatch services and meet minimum requirements to be the designated ispatch enter for all of an Joaquin ounty as set forth in an Joaquin ounty gency olicy o mergency mbulance ervice rovider ispatch equirements and the requirements specified in the F. s the provider of the designated ispatch enter, the winning bidder will be required to provide and ambulance dispatch services for all emergency ambulance services within the competitively awarded. n addition, the F will be configured 12

14 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 to require the winning bidder to have the expertise, capacity, and flexibility, to provide and fire dispatch services for all an Joaquin ounty ambulance providers and fire agencies currently served by ifecom. he winning bidder will be encouraged to propose a cost structure that will incentivize all ambulance providers and fire agencies in an Joaquin ounty to utilize the wining bidder s dispatch center services. egulatory process he an Joaquin ounty gency is responsible for the development of standards for the ambulance system, for implementing the system, for monitoring performance standards and enforcement. his requires active gency oversight, including: udit and inspection of operational, financial, and patient care records; onitoring service delivery for compliance with defined standards; and roviding technical guidance, as appropriate. roviders are required to furnish the gency with prehospital care, operational, financial, and unusual occurrence reports. he gency utilizes this data to monitor system performance and to identify situations where the provider may fail to meet its contractual requirements. mplementation process and timeline While the final schedule will depend on approval of this plan by the alifornia mergency edical ervices uthority, the anticipated timeline is: equest for proposals process ssue F for emergency ambulance service hursday - ay 1, 2014 etters of intent to submit a proposal and proposal fee Friday - ay 16, 2014 (by 12:00 noon) eadline for receipt of all questions regarding the F Friday ay 22, 2014 (by 12:00 noon) Bidders onference, amendments to F released (if any) Wednesday June 11, 2014 roposals and bidder bonds due onday July 7, 2014 (by 12:00 noon) roposal eview ommittee presentations onday July 28, 2014 ublic announcement of ealth are ervices gency Friday ug 1, 2014 irector s recommendation ecommendation protests Friday ug 8, 2014 (by Final recommendation of award to Board of upervisors by ealth are ervices gency irector and eclaration of ntent to ontract by Board of upervisors (erformance security due) 12:00 noon) ctober 7,

15 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 ontract negotiations resentation of final negotiated contract(s) to Board of upervisors and approval of contract(s) by Board of upervisors (48 days) Board of upervisors approval of contract... ecember 2, 2014 ystem implementation mplementation of service by the ontractor(s) ay 1, 2016 at 08:00 14

16 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 Zone forms B Z Y F n order to evaluate the nature of each area or subarea, the following information should be compiled for each zone individually. lease include a separate form for each exclusive and/or nonexclusive ambulance zone. ocal gency or ounty ame: an Joaquin ounty gency rea or subarea (Zone) ame or itle: Zone X (formerly Zones, B, and ) ame f urrent rovider(): nclude ompany ame() nd ength f peration (ninterrupted) n pecified rea r ubarea. merican edical esponse (11 Years) rea or subarea (Zone) Geographic escription: Greater odi, tockton, and racy areas tatement of xclusivity, xclusive or non-xclusive ( ): nclude intent of local agency and Board action. xclusive ype of xclusivity, mergency mbulance,, or ( ): nclude type of exclusivity (mergency mbulance,,, or combination) and operational definition of exclusivity (i.e., 911 calls only, all emergencies, all calls requiring emergency ambulance service, etc.). ype: mergency mbulance ervices evel: all 9-1-1/ requests for emergency ambulance service; all 7-igit requests for emergency ambulance service; / mbulance ervices; ethod to achieve xclusivity, if applicable ( ): f grandfathered, pertinent facts concerning changes in scope and manner of service. escription of current provider including brief statement of uninterrupted service with no changes to scope and manner of service to zone. nclude chronology of all services entering or leaving zone, name or ownership changes, service level changes, zone area modifications, or other changes to arrangements for service. f competitively-determined, method of competition, intervals, and selection process. ttach copy/draft of last competitive process used to select provider or providers. ompetitive bid. n open request for proposals will be issued following uthority approval of an Joaquin ounty mbulance ystem lan. nitial contract is expected to be for five years with potential five year extension prior to another open bid. 15

17 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 B Z Y F n order to evaluate the nature of each area or subarea, the following information should be compiled for each zone individually. lease include a separate form for each exclusive and/or nonexclusive ambulance zone. ocal gency or ounty ame: an Joaquin ounty gency rea or subarea (Zone) ame or itle: Zone ame f urrent rovider(): nclude ompany ame() nd ength f peration (ninterrupted) n pecified rea r ubarea. anteca istrict mbulance ervices (53 years) rea or subarea (Zone) Geographic escription: Greater anteca and athrop areas tatement of xclusivity, xclusive or non-xclusive ( ): nclude intent of local agency and Board action. xclusive ype of xclusivity, mergency mbulance,, or ( ): nclude type of exclusivity (mergency mbulance,,, or combination) and operational definition of exclusivity (i.e., 911 calls only, all emergencies, all calls requiring emergency ambulance service, etc.). ype: mergency mbulance ervices evel: all 9-1-1/ requests for ambulance service; all 7-igit requests for emergency ambulance services; ethod to achieve xclusivity, if applicable ( ): f grandfathered, pertinent facts concerning changes in scope and manner of service. escription of current provider including brief statement of uninterrupted service with no changes to scope and manner of service to zone. nclude chronology of all services entering or leaving zone, name or ownership changes, service level changes, zone area modifications, or other changes to arrangements for service. f competitively-determined, method of competition, intervals, and selection process. ttach copy/draft of last competitive process used to select provider or providers. Grandfathered. anteca istrict mbulance ervice () originally began providing ambulance services in ovember his service has continued, without interruption or competition and since then, no changes to the scope and manner of service have occurred. lso, provides advanced life support service in a setting and no significant changes to its zone have occurred. is an ambulance district operated by an independent board of directors. 16

18 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 B Z Y F n order to evaluate the nature of each area or subarea, the following information should be compiled for each zone individually. lease include a separate form for each exclusive and/or nonexclusive ambulance zone. ocal gency or ounty ame: an Joaquin ounty gency rea or subarea (Zone) ame or itle: Zone ame f urrent rovider(): nclude ompany ame() nd ength f peration (ninterrupted) n pecified rea r ubarea. ipon Fire rotection istrict (30 years) rea or subarea (Zone) Geographic escription: Greater ipon area tatement of xclusivity, xclusive or non-xclusive ( ): nclude intent of local agency and Board action. xclusive ype of xclusivity, mergency mbulance,, or ( ): nclude type of exclusivity (mergency mbulance,,, or combination) and operational definition of exclusivity (i.e., 911 calls only, all emergencies, all calls requiring emergency ambulance service, etc.). ype: mergency mbulance ervices evel: all 9-1-1/ requests for ambulance service; all 7-igit requests for emergency ambulance service; ethod to achieve xclusivity, if applicable ( ): f grandfathered, pertinent facts concerning changes in scope and manner of service. escription of current provider including brief statement of uninterrupted service with no changes to scope and manner of service to zone. nclude chronology of all services entering or leaving zone, name or ownership changes, service level changes, zone area modifications, or other changes to arrangements for service. f competitively-determined, method of competition, intervals, and selection process. ttach copy/draft of last competitive process used to select provider or providers. Grandfathered. ipon Fire rotection istrict originally began providing ambulance services in February his service has continued, without interruption or competition since then and no changes to the scope and manner of the service have occurred. lso, ipon Fire rotection istrict provides advanced life support service in a setting and no changes to its zone have occurred. ipon Fire rotection istrict is fire protection district operated by an independent board of directors which is responsible for the ambulance service. 17

19 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 B Z Y F n order to evaluate the nature of each area or subarea, the following information should be compiled for each zone individually. lease include a separate form for each exclusive and/or nonexclusive ambulance zone. ocal gency or ounty ame: an Joaquin ounty gency rea or subarea (Zone) ame or itle: Zone F ame f urrent rovider(): nclude ompany ame() nd ength f peration (ninterrupted) n pecified rea r ubarea. scalon ommunity mbulance (43 years) rea or subarea (Zone) Geographic escription: Greater scalon area tatement of xclusivity, xclusive or non-xclusive ( ): nclude intent of local agency and Board action. xclusive ype of xclusivity, mergency mbulance,, or ( ): nclude type of exclusivity (mergency mbulance,,, or combination) and operational definition of exclusivity (i.e., 911 calls only, all emergencies, all calls requiring emergency ambulance service, etc.). ype: mergency mbulance ervices evel: all 9-1-1/ requests for ambulance service; all 7-igit requests for emergency ambulance service ethod to achieve xclusivity, if applicable ( ): f grandfathered, pertinent facts concerning changes in scope and manner of service. escription of current provider including brief statement of uninterrupted service with no changes to scope and manner of service to zone. nclude chronology of all services entering or leaving zone, name or ownership changes, service level changes, zone area modifications, or other changes to arrangements for service. f competitively-determined, method of competition, intervals, and selection process. ttach copy/draft of last competitive process used to select provider or providers. Grandfathered. scalon ommunity mbulance originally began providing ambulance services in pril his service has continued, without interruption or competition since then and no changes to the scope and manner of the service have occurred. lso, scalon ommunity mbulance provides advanced life support service in a setting and no changes to its zone have occurred. scalon ommunity mbulance is an ambulance district operated by an independent board of directors. 18

20 an Joaquin ounty gency 2014 mbulance ystem lan raft: February 25, 2014 ppendices ppendix 1: evised ambulance zones ppendix 2: Zone X/Zone (anteca/athrop boundary change) ppendix 3: mbulance rdinance ppendix 4: Board of upervisors approval ppendix 5: esponse to public comment 19

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