San Joaquin County Emergency Medical Services Agency

San Joaquin County Emergency Medical Services Agency http://www.sjgov.org/ems Memorandum TO: All Interested Parties FROM: Shahloh Jones-Mitchell, EMS Analyst DATE: April 8, 28 Mailing Address PO Box 22 French Camp, CA 9523 Health Care Services Complex Benton Hall 5 W. Hospital Rd. French Camp, CA 9523 Phone Number (29) 468-688 Fax Number (29) 468-6725 SUBJECT: American Medical Response (AMR) Exclusive Operating Area Ambulance Contract The s (SJCEMSA) Report on the Exclusive Emergency Ambulance Provider Contract for AMR for the months of January and February 28, provides an in-depth review of AMR s performance. The contract establishes accountability for meeting specific standards and provides the SJCEMSA with complete access to data and information on AMR s operational, clinical, and administrative performance. The process for determining response time compliance includes a review of late response exemption requests to determine if a delay in response may be attributed to factors outside of the control of the ambulance provider. If an exemption request is approved (e.g. fog, train crossings, road construction, and delays in off-loading patients at hospitals) those responses are not included in response time compliance calculations. This report provides a clear picture of response time performance and contract compliance with and without the application of exemptions for late responses. While this report provides detailed compliance information for each of the eleven -Zones, it is important to note that ninety percent (9%) of the urban Red Lights and Siren (RLS) calls, when combining data for all -Zones, have a response time of less than 8 minutes and 48 seconds during the two-month period. This response performance is achieved without considering any late exemption requests. Sixty-six percent (66%) of the responses in this report are to urban areas and require RLS. The complete compliance report for January and February may be viewed or downloaded from the SJCEMSA website: www.sjgov.org/ems.

Exclusive Emergency Ambulance Provider Contract American Medical Response Response Time Report - Red Lights and Sirens (RLS) January, 28 through January 3, 28 Non-exempted Compliant Zone Total Responses Responses Percentage Yes No - 383 5 96.8% -2 4 6 85.96% -3* -4 74,335 2 34 83.78% 89.96% -5-6* -7,48 74 39 2 9.6%.% 87.93% -8-9 -* 5 293 78 22 4 9.43% 92.49% 94.87% -* 57 98.25% All Zones Combined 4,3 375 9.88% 4 3 * Minimum of responses used for calculation of compliance. See below for calculation of rolling compliance zones. Rolling Zones Requiring Multiple Months to Attain > RLS Responses January, 28 through January 3, 28 Rolling Zones (with Multiple Months for Rolling Rolling Non-exempted Call Minimum). Period From Period Through Total Responses Responses Percentage -3 January 28 January 28 74 2 83.78% -6 December 27 January 28 7.% - January 28 January 28 78 4 94.87% - December 27 January 28 94 3 96.8% Compliant Yes No Response Time Report - Red Lights and Sirens (RLS) February, 28 through February 28, 28 Non-exempted Compliant Zone Total Responses Responses Percentage Yes No - -2* 32 9 28 5 9.25% 83.52% -3* -4 57,82 4 4 75.44% 88.7% -5-6* -7,286 59 22 9 9.5%.% 88.5% -8* 97 88.66% -9 -* 285 65 2 2 95.79% 96.92% -* 47 6 87.23% All Zones Combined 3,6 37 89.72% 3 2 * Minimum of responses used for calculation of compliance. See below for calculation of rolling compliance zones. Rolling Zones Requiring Multiple Months to Attain > RLS Responses February, 28 through February 28, 28 Rolling Zones (with Multiple Months for Call Minimum). Non-exempted Responses Rolling Rolling Period From Period Through Total Responses Percentage -2 February 28 February 28 9 5 83.52% -3 January 28 February 28 3 26 8.5% -6 December 27 February 28 28.% -8 February 28 February 28 97 88.66% - January 28 February 28 43 6 95.8% - December 27 February 28 4 9 93.62% Compliant Yes No January-February 28 of 2 4/8/28

Response Time Report - No Red Lights and Sirens (NRLS) January, 28 through January 3, 28 Non-exempted Zone Total Responses Responses Percentage - 235 9 96.7% -2* 49 97.96% -3* 26 96.5% -4 762 36 95.28% -5 768 2 97.27% -6* 2.% -7* 66 2 96.97% -8* 62 98.39% -9 78 7 96.7% -* 24.% -* 7.% All Zones Combined 2,89 78 96.44% * Minimum of responses used for calculation of compliance. See below for calculation of rolling compliance zones. Rolling Zones Requiring Multiple Months to Attain > NRLS Responses January, 28 through January 3, 28 Rolling Zones (with Multiple Months for Rolling Rolling Call Minimum). Period From Period Through Total Responses -2 November 27 January 28 2-3 December 27 January 28 49-6 May 26 January 28 75-7 December 27 January 28 9-8 December 27 January 28 - November 27 January 28 65 - June 27 January 28 2 Non-exempted Responses 4 2 4 3 Percentage 96.69% 95.92%.% 96.64% 97.3%.%.% Response Time Report - No Red Lights and Sirens (NRLS) February, 28 through February 28, 28 Non-exempted Zone Total Responses Responses Percentage - 2 3 98.5% -2* 38 97.37% -3* 6 93.75% -4 645 3 95.9% -5 66 3 95.46% -6* 3.% -7* 66 3 95.45% -8* 44 97.73% -9 45 6 95.86% -* 2.% -* 2.% All Zones Combined,859 76 95.9% * Minimum of responses used for calculation of compliance. See below for calculation of rolling compliance zones. Rolling Zones Requiring Multiple Months to Attain > NRLS Responses February, 28 through February 28, 28 Rolling Zones (with Multiple Months for Call Minimum). Rolling Period From Rolling Period Through Total Responses Non-exempted Responses Percentage -2 February 28 February 28 38 97.37% -3 December 27 February 28 65 3 95.38% -6 May 26 February 28 78.% -7 February 28 February 28 66 3 95.45% -8 February 28 February 28 44 97.73% - November 27 February 28 85.% - February 28 February 28 2.% January-February 28 2 of 2 4/8/28

Response Time Report - Interfacility Transfer (IFT) January, 28 through January 3, 28 Interfacility Transfers ALS-IFT CCT-IFT Current Month Total 75 Rolling Total 55 75 Rolling Total Period From December 27 September 27 Rolling Total Period Through January 28 January 28 Rolling Non-exempted Rolling Compliant Responses After Yes No 8 4 94.84% 94.67% Response Time Report - Interfacility Transfer (IFT) February, 28 through February 28, 28 Interfacility Current Rolling Total Period Rolling Total Period Transfers Month Total Rolling Total From Through ALS-IFT 72 72 February 28 February 28 CCT-IFT 5 9 September 27 February 28 Rolling Non-exempted Rolling Compliant Responses After Yes No 2 97.22% 6 93.33% Response Time Report - Combined RLS and NRLS January, 28 through January 3, 28 Nonexempted Zone Total Responses Responses Percentage - 68 24 96.2% -2 63 7 89.57% -3 3 87.% -4 2,97 7 9.89% -5 2,248 6 92.88% -6 2.% -7 24 23 9.42% -8 77 2 93.22% -9 47 29 93.84% - 2 4 96.8% - 74 98.65% All Zones Combined 6,32 453 92.8% Response Time Report - Combined RLS and NRLS February, 28 through February 28, 28 Nonexempted Zone Total Responses Responses Percentage - 52 3 94.5% -2 29 6 87.6% -3 73 5 79.45% -4,827 72 9.59% -5,947 52 92.9% -6 4.% -7 225 22 9.22% -8 4 2 9.49% -9 43 8 95.8% - 85 2 97.65% - 67 6 9.4% All Zones Combined 5,459 446 9.83% January-February 28 3 of 2 4/8/28

Fines and Penalties Report Type of Penalty January 28 February 28 Out of compliance response zones $45, $7, Code 2 and Code 3 Late response minutes $5,5 $54,4 ALS IFT or CCT-IFT Late response minutes $8 $,2 Out of compliance monthly response ALS-IFT or CCT-IFT $ $ Failure to provide data $ $ Preventable mechanical failure $ $ Failure to meet staffing and clinical standards $ $ Failure to respond $ $ Failure to submit documentation at hospital $ $ Other minor breach $ $ Totals $97,3 $25,6 Detailed Response Time Analysis without Applied - RLS January 28 Zones - Urban -2 Urban -3 Urban -4 Urban -5 Urban -6 Urban -7 Urban -8 Urban -9 Urban - Urban - Urban -2 Suburban -3 Suburban -7 Suburban -8 Suburban -9 Suburban - Suburban - Suburban Response Response Response Time Time Interval Time Interval Interval 9th Responses Maximum Mean Std Deviation Percentile 383 5:47 4:4 2: 7:4 58 4:8 6: 2:8 8:3 3 :43 6:48 2:25 9:55,335 2:46 5:45 2:24 8:49,48 2:23 5:24 2:8 8:4 3 2:5 5:6 2:28 8:2 4:42 5:5 2:46 8:38 284 22:37 5:6 3:9 8:2 2 :27 6:33 2:43 9:4 6 7:8 6:23 :36 7:8 9 6:4 8: 3:33 3: 8 :27 6:29 2:2 :27 32 8:7 8:5 4:3 2:2 3 9:4 5:4 2:27 9:4 8 2:52 6:45 2:35 2:52 6 7:3 5: :7 7:3 9 9:29 7:3 :5 9:29 - Suburban-Moderate 37 7:56 :6 2:26 5: -2 Rural -3 Rural -5 Rural -6 Rural -7 Rural -8 Rural -9 Rural - Rural - Rural -6 Wilderness - Wilderness - Wilderness All Urban Areas All Suburban Areas All Suburban-Moderate Areas All Rural Areas All Wilderness Areas Total Responses 37 9:24 :28 4: 8:9 36 25:4 :34 3:52 5: 5 3:36 9:7 3: 3:36 9:57 2:5 4:32 7:9 2 9:58 9:29 4:24 5: 5:49 5:49 : 5:49 8 6:46 9:58 3:25 6:4 39 3:39 3:2 5:56 2:7 5 25: 8:2 5: 25: 5 4:28 :27 4:2 4:28 3 2:4 5:8 3:44 2:4 3,89 22:37 5:26 2:27 8:27 85 8:7 7:26 3:25 :53 37 7:56 :6 2:26 5: 59 3:39 :34 4:4 7:9 3 25: 4:57 5:22 2:38 4,3 January-February 28 4 of 2 4/8/28

Detailed Response Time Analysis without Applied - RLS February 28 Response Response Response Time Time Interval Time Interval Interval 9th Zones Responses Maximum Mean Std Deviation Percentile - Urban 32 6:5 5:3 2:34 8: -2 Urban 5 23:48 6:36 3:4 9:3-3 Urban 25 29:9 7:39 5:2 : -4 Urban,82 9:45 5:45 2:25 8:38-5 Urban,286 22:3 5:34 2:2 8:2-6 Urban -7 Urban 27 4:54 5:26 2:46 9:37-8 Urban 77 3:43 5:48 2:36 9:38-9 Urban 274 6:7 4:46 2:7 7:5 - Urban 8 7:28 6:3 : 7:28 - Urban 5 2:55 8:34 2:29 2:55-2 Suburban 2 2:3 7:23 2:54 :46-3 Suburban 9:55 7: 2:33 9:4-7 Suburban 23 4:4 8:7 2:46 2:34-8 Suburban 6 6: 4:35 :2 6: -9 Suburban 9:7 5:8 :47 6:55 - Suburban 6 4:27 6:8 3:45 4:27 - Suburban 7 2:58 8:2 2:23 2:58 - Suburban-Moderate 2 23:37 2:42 3:48 4:54-2 Rural 29 22:33 2: 4:4 2:22-3 Rural 2 23:5 9:46 4:25 2:55-5 Rural -6 Rural 6 3:28 9:43 2:4 3:28-7 Rural 9 2:55 3:2 4:3 2:55-8 Rural 4 2:46 9:3 4:26 3:7-9 Rural 6:25 6:25 : 6:25 - Rural 2 2:4 :3 4:3 6:36 - Rural 35 2:7 :4 4:5 5:6-6 Wilderness 4 24:5 5:36 8:57 24:5 - Wilderness 9 62: 2:5 4:57 62: - Wilderness All Urban Areas 3,354 29:9 5:34 2:29 8:29 All Suburban Areas 75 4:27 7:6 2:52 :46 All Suburban-Moderate Areas 2 23:37 2:42 3:48 4:54 All Rural Areas 36 23:5 :47 4:24 7:46 All Wilderness Areas 3 62: 9:24 3:38 25:54 Total Responses 3,599 January-February 28 5 of 2 4/8/28

Detailed Response Time Analysis without Applied - NRLS January 28 Response Response Response Time Time Interval Time Interval Interval 9th Zones Responses Maximum Mean Std Deviation Percentile - Urban 235 47:34 8:33 5:5 4:48-2 Urban 24 5:56 7:54 3:33 3:9-3 Urban 4 3:5 8:42 3:4 2:26-4 Urban 762 45: 9:54 5:5 6: -5 Urban 768 36: 8:49 4:48 4:6-6 Urban -7 Urban 5 2: 8:9 4:5 3:32-8 Urban 55 29:27 8: 4:58 3:54-9 Urban 77 33:4 7:34 5:25 3:46 - Urban 5 8:42 : 5:4 8:42 - Urban 2 8:3 5:34 2:55 8:3-2 Suburban 7 :43 8:8 :43 :43-3 Suburban 3 9: 3:4 4:52 9: -7 Suburban 8:44 :49 3:5 6:36-8 Suburban 4:45 4:45 : 4:45-9 Suburban 6:38 6:38 : 6:38 - Suburban - Suburban 4 53:6 8:23 2: 53:6 - Suburban-Moderate 6 22:7 4:2 4:2 2:29-2 Rural 8 3:47 5:34 6:26 25:3-3 Rural 9 7:3 :23 4:24 7:3-5 Rural -6 Rural 7:38 7:38 : 7:38-7 Rural 4 9:5 5:28 2:48 9:5-8 Rural 6 28:9 3:4 7: 28:9-9 Rural - Rural 3 : 7:4 2:3 : - Rural 2:5 6:8 3:55 2:33-6 Wilderness :45 :45 : - Wilderness - Wilderness :45 All Urban Areas 293 47:34 9:2 5: 4:55 All Suburban Areas 27 53:6 :7 9:5 8:44 All Suburban-Moderate Areas 6 22:7 4:2 4:2 2:29 All Rural Areas 52 3:47 4:6 5:5 2:33 All Wilderness Areas :45 :45 : :45 Total Responses 2,89 January-February 28 6 of 2 4/8/28

Detailed Response Time Analysis without Applied - NRLS February 28 Response Response Response Time Time Interval Time Interval Interval 9th Zones Responses Maximum Mean Std Deviation Percentile - Urban 2 28:38 7:23 4:2 :52-2 Urban 22 7:52 8:2 3:28 :3-3 Urban 7 27:48 9:35 7:37 27:48-4 Urban 645 39:2 9:26 4:53 5:54-5 Urban 66 34:22 9: 4:4 4:38-6 Urban -7 Urban 48 23:8 8:6 4:34 3:2-8 Urban 38 2:55 8:35 4:29 4:8-9 Urban 4 3:22 6:58 4:4 3:6 - Urban 4 4:53 :56 3:6 4:53 - Urban 2 8:45 8:6 :39 8:45-2 Suburban 4 5:34 :59 3:37 5:34-3 Suburban 2 :2 :9 : :2-7 Suburban 7 26:44 9:2 5:59 9:27-8 Suburban 2 9:25 8:46 :39 9:25-9 Suburban 4 :35 8:38 2:4 :35 - Suburban - Suburban 4 6:5 :35 4:5 6:5 - Suburban-Moderate 32:9 6:9 5:48 9:5-2 Rural 2 2: 3:45 4:4 7:47-3 Rural 7 4:3 :28 2:44 4:3-5 Rural -6 Rural -7 Rural 27:29 27:29 : 27:29-8 Rural 4 22:37 3:25 6:33 22:37-9 Rural - Rural 5 29:9 4:6 9:23 29:9 - Rural 4 29:37 5:46 7:33 25:26-6 Wilderness 3 2:5 8:33 3: 2:5 - Wilderness - Wilderness All Urban Areas,769 39:2 8:47 4:45 4:4 All Suburban Areas 33 26:44 9:35 4:54 5:34 All Suburban-Moderate Areas 32:9 6:9 5:48 9:5 All Rural Areas 43 29:37 4:3 6:48 24: All Wilderness Areas 3 2:5 8:33 3: 2:5 Total Responses,859 January-February 28 7 of 2 4/8/28

Comparison of with and without - RLS January, 28 through January 3, 28 Zone Total Responses Number of Late Calls Prior to Prior to Number of Late Calls After Approved After - 383 25 93.47% 5 96.8% -2 4 23 79.82% 6 85.96% -3 74 5 79.73% 2 83.78% -4,335 223 83.3% 34 89.96% -5,48 23 86.28% 39 9.6% -6.%.% -7 74 33 8.3% 2 87.93% -8 5 8 84.35% 9.43% -9 293 38 87.3% 22 92.49% - 78 5 93.59% 4 94.87% - 57 7 87.72% 98.25% All Zones Combined 4,3 59 85.66% 375 9.88% * Minimum of responses required for calculation. True compliance shown in rolling compliance zone tables. Comparison of with and without - RLS February, 28 through February 28, 28 Number of Number of Late Late Calls Calls After Prior to Prior to After Zone Total Responses Approved - 32 4 87.5% 28 9.25% -2 9 2 78.2% 5 83.52% -3 57 6 7.93% 4 75.44% -4,82 99 83.6% 4 88.7% -5,286 92 85.7% 22 9.5% -6.%.% -7 59 32 79.87% 9 88.5% -8 97 7 82.47% 88.66% -9 285 7 94.4% 2 95.79% - 65 6 9.77% 2 96.92% - 47 8 82.98% 6 87.23% All Zones Combined 3,6 547 84.8% 37 89.72% * Minimum of responses required for calculation. True compliance shown in rolling compliance zone tables. January-February 28 8 of 2 4/8/28

Comparison of with and without - NRLS January, 28 through January 3, 28 Number of Number of Late Late Calls Calls After Prior to Prior to After Zone Total Responses Approved - 235 95.32% 9 96.7% -2-3 -4 49 26 762 67 97.96% 96.5% 9.2% 36 97.96% 96.5% 95.28% -5 768 4 94.66% 2 97.27% -6 2.%.% -7 66 3 95.45% 2 96.97% -8 62 2 96.77% 98.39% -9 78 93.82% 7 96.7% - 24 95.83%.% - 7 94.2%.% All Zones Combined 2,89 39 93.65% 78 96.44% * Minimum of responses required for calculation. True compliance shown in rolling compliance zone tables. Comparison of with and without - NRLS February, 28 through February 28, 28 Number of Number of Late Late Calls Calls After Prior to Prior to After Zone Total Responses Approved - 2 3 98.5% 3 98.5% -2 38 97.37% 97.37% -3 6 93.75% 93.75% -4 645 5 92.25% 3 95.9% -5 66 48 92.74% 3 95.46% -6 3.%.% -7 66 6 9.9% 3 95.45% -8 44 2 95.45% 97.73% -9 45 7 95.7% 6 95.86% - 2 95.%.% - 2.%.% All Zones Combined,859 9 93.6% 76 95.9% * Minimum of responses required for calculation. True compliance shown in rolling compliance zone tables. Comparison of with and without - IFT January, 28 through January 3, 28 Interfacility Transfers Total Responses ALS-IFT 75 CCT-IFT Number of Late Calls Prior to 3 Prior to Number of Late Calls After Approved After 97.33% 96.% 2 9.%.% Comparison of with and without - IFT February, 28 through February 28, 28 Interfacility Transfers Total Responses Number of Late Calls Prior to Unadjusted Number of Late Calls After Approved After ALS-IFT 72 8 88.89% 2 97.22% CCT-IFT 5 2 86.67% 2 86.67% January-February 28 9 of 2 4/8/28

Exemption Request Reports Types of Approved January Denied Approved February Denied Bad Location / Address 3 Delays in Transferring Care at ED False Report of Emergency Freeway Access Location Change Other Reduced/Upgraded Response Road Closure Traffic Secondary to Call Train Weather Zone Assist 25 29 2 3 2 2 3 7 2 2 3 6 4 3 2 January-February 28 of 2 4/8/28

Mutual Aid Zone Provider January 28 February 28-3 Manteca District Ambulance -4 Manteca District Ambulance -5 Manteca District Ambulance 7-8 Escalon Community Ambulance -8 Manteca District Ambulance 6 6-9 Manteca District Ambulance 9 6-9 Escalon Community Ambulance - Manteca District Ambulance 5 - Manteca District Ambulance 4 6 - MOD Manteca District Ambulance 2 Failure to Provide Data Event Type N/A January 28 February 28 Mechanical Report Event Type N/A Date Preventable Community Service Report Event Type See Appendix A. January-February 28 of 2 4/8/28

January-February 28 2 of 2 4/8/28