The key recommendations The Abaris Group (the contractor evaluating Riverside County’s emergency medical system) will submit in the early spring to the Board of Supervisors, were discussed in public meetings last week.

A summary of the 11 recommendations can be found below.

“These are our observations and recommendations we’ve made after looking at the [Riverside County] system,” said Bill Bullard of Abaris. “Our direction was to develop a world-class emergency medical system, not just what is possible.”

Nine of the recommendations addressed managing and improving the overall county adminstration of the emergency medical system. These range from a program to discover and implement future innovations to the county’s staffing for its oversight.

The final two recommendations addressed the ambulance delivery system, which prompted the evaluation. Bullard said Abaris will offer the supervisors three options.

One will simply be continuing the current system, and negotiating a new contract with American Medical Response, the current countywide ambulance provider. “What we see today is what we’ll see tomorrow,” is how Bullard described this option.

“The other two options open up the possibility of more competition, but also open [the whole system] to more state review,” Bullard advised.

In both options two and three, Idyllwild Fire Protection District retains its exclusive ambulance rights in Idyllwild. However, County Service Area 38 (Pine Cove) and Zone 3 to the north and south, which it serves outside of the IFPD, would become part of the new competitive areas. Besides Idyllwild, the cove areas in the desert also maintain grandfathered rights and would be excluded from these options, too.

The second option would separate the county into several zones and a competitive contract would be awarded for each zone. “Each contract would have local parameters to be consistent with that area,” he said. “The challenge for this option is that the Mountain Zone [Pine Cove, Garner Valley and Anza] alone will probably offer very little interest for potential bidders.”

The third option recommends establishing a single operation for the entire county and requesting proposals for that service.

Bullard said the supervisors will have to decide which method will yield the best system for the county. The trade-off is between a more competitive contract and increased state oversight, which will be invited over the 10-year process until a new contract is completed.

Regardless of which option the board chooses, the county is aware of the unique situation the Mountain Zone poses.

“There will be service — good ambulance service on the Mountain,” Bruce Barton, director of Riverside County’s Emergency Service Agency, affirmed. “Supervisor [Jeff] Stone [3rd District] is watching this very closely. [The service] will not be less than the level now.”

Overall, the time ambulance crews must spend waiting to be released from local hospitals after transporting a patient is the biggest negative in the entire system, according to Barton. He hopes to establish a working group composed of emergency responders and hospital managers to address this problem.

Also, he critiqued the current process: “Treating every single call as if it were a cardiac incident and sending every one ‘code 3’ is massively expensive and archaic,” Barton said.

J.P. Crumrine can be reached at [email protected]


Recommendations to improve county EMS

Recommendations for improving the Riverside County emergency medical system, proposed by The Abaris Group:

1. Commence an EMS innovation project to better position the community for changes occurring both in the community and in health care with Health care reform (The Affordable Care Act).

2. Continue reinstituting a state-of-the-art continuous quality-improvement and medical-control program (such as enhanced medical direction) consistent with the report’s recommendations.

3. Collaborate and document opportunities to create an EMS system where the most appropriate and available EMS resource responds to an emergency request regardless of geographical jurisdiction.

4. Explore and develop improved efficiencies for EMS services provided to mental-health patients.

5. Address the “EMS-to-ED” [emergency department] off-load ambulance delays in the form of a multidisciplinary collaborative.

6. Adopt stronger inter-facility transport requirements and monitoring processes.

7. Adopt key communication recommendations for the report.

8. Change the EMS governance structure.

9. Evaluate and develop strategies to improve online medical direction.

10. Consider one of three models of ambulance exclusivity as documented in the report and, as appropriate, begin a request for the proposal process to establish appropriate providers throughout the county.

11. Address existing contract parameters with all of the county’s 9-1-1 ambulance providers.