Medical emergencies occur at any given time or location and require a coordinated effort involving multiple agencies, personnel and facilities to ensure an expeditious response and high standard of care. The Coastal Valleys Emergency Medical Services (EMS) system has been designed to incorporate these agencies and facilities into a dynamic emergency medical care delivery system that is focused on rapid access to emergency locations, patient assessment, stabilization of patients and their transportation.
The EMS Agency operates under State authority established in Division 2.5 of the California Health and Safety Code, and Title 22, Division 9 of the California Code of Regulations. Local regulation of the EMS system is effected through the County Emergency and Pre-Hospital Medical Services System Ordinances, and EMS Agency policies and procedures. By contract, Sonoma County also functions as the local EMS Agency for Mendocino and Napa Counties.
System Organization and Management
The California Health and Safety Code requires that each county which develops an emergency medical services program must designate a local EMS agency. Consistent with that requirement, the Sonoma County Department of Health Services has been designated as the Local Emergency Medical Services Agency (LEMSA) for Sonoma, Napa and Mendocino Counties. The EMS Agency provides the administrative and regulatory oversight responsibilities for the local EMS system within each of these counties. The primary function of the EMS Agency is to plan, implement, and evaluate the local EMS system and the various components contained within it. This includes the licensing/permitting of ambulance provider companies, hospitals, coordination and monitoring of air and ground ambulances, certification/accreditation of prehospital care personnel (Emergency Medical Technicians (EMT), paramedics), policy development and implementation, medical control, quality improvement, and disaster medical response preparedness.
EMS Agency Staff
The EMS Agency is staffed by ten full-time positions. The Regional EMS Manager is responsible for the overall operation and function of the Agency. EMS Coordinators are responsible for the operational components of the County portion of the EMS system including oversight and review of the ambulance providers, special projects, region wide disaster medical preparedness and communications-dispatch oversight are additional responsibilities assigned to these positions. The Advanced Life Support (ALS) Coordinator is responsible for the Quality Improvement (QI)/data system, training, AED program, medical control oversight, and certification functions within the system. EMS Specialists are assigned to both the operational and medical control programs. The Trauma Coordinator oversees the Level II trauma center in Sonoma County and manages the development of the regional trauma system. The Agency Clerical staff provides support services for each regional office including certification processing. Certification services for field personnel is centralized in the Sonoma office. In addition to County personnel, the EMS Agency contracts with an emergency physician to function as EMS Medical Director for the regional EMS system.
Sonoma - Santa Rosa Office
625 5th Street
Santa Rosa, CA 95404
Staffing and Training
Consistent with the California Health and Safety Code, the local EMS Agency is responsible for the approval of local EMS training programs provided by institutions and departments.
Santa Rosa Junior College, Mendocino Regional Occupation Program (ROP), and the United States Coast Guard are authorized by the EMS Agency to conduct basic Emergency Medical Technician (EMT-I) level courses. During the period of 1989-07, over 15,000 EMS personnel have received primary and/or re-certification training through these programs. Paramedic level training is available through Santa Rosa Junior College, Mendocino Community College and other institutions located outside of our region. There are over 400 Paramedics currently licensed and accredited to practice in the Coastal Valleys EMS system.
The dispatching of Sonoma County EMS ambulance providers is coordinated through Redcom, a Joint Powers Authority (JPA) which operates the Sonoma County EMS Dispatch Center. Redcom provides Emergency Medical Dispatch and pre-arrival instructions to all of the County's Public Safety Answering Points (PSAP) and dispatching of field resources services to most of the ambulance providers within Sonoma County. Within Mendocino County, the City of Ukiah and CaFire provide the primary EMS dispatch services. On-line medical direction and communications for EMS personnel in Sonoma County is provided by Santa Rosa Memorial Hospital as an approved base hospital. Three base hospitals (Ukiah Medical Center, Howard Memorial Hospital and Mendocino Coast District Hospital) provide on-line medical control in Mendocino County. All base hospitals utilize emergency room physicians for these purposes.
Disaster Medical Preparedness
All EMS Agency staff and local EMS personnel are trained in the Standardized Emergency Management System (SEMS), Incident Command System (ICS), and the National Incident Management System (NIMS) as required by law. During times of disaster, EMS Agency staff members fill a variety of positions within the respective County Emergency Operations Centers (EOC) and field command posts. The EMS Multi-Casualty Incident (MCI) plan is used for multi-patient incidents and disasters to coordinate prehospital care provider agencies, hospitals, the Office of Emergency Services (OES), law enforcement agencies, CalFire, state and county parks and recreational departments, and other emergency response organizations. Periodic drills and exercises are conducted to revise and improve this system.
At present there are 25 ambulance providers (3 air & 22 ground) and 75 first responder agencies providing EMS services in Coastal Valleys region.
In Sonoma County all ambulances are staffed at an advanced life support (ALS) level while most first responder services are at the basic life support (BLS) level. Nine ground ambulance provider agencies and two helicopter providers ( 1 air ambulance & 1ALS Rescue) provide emergency medical transportation in Sonoma County. In July 1999, Sonoma County entered into an exclusive franchise contract with Sonoma Life Support (SLS) to provide emergency ambulance and advanced life support services to a specified portion of the county. A mix of fire department based and private ambulance providers service the remainder of the County.
Within Mendocino County, five of the ambulance services are ALS - paramedic level (4 ground and 1 EMS Air Ambulance helicopter), and three are BLS -EMT-I level providers (3 ground). All first responder services are at a BLS level.
Oversight of the providers is provided by EMS Agency staff and the Provider Compliance Committees. The EMS Agency on a monthly basis reviews operational performance, including response times. While non-franchise providers are not obligated to the strict performance standards applied to franchisees, medical care and overall performance of these providers is monitored through the existing EMS quality improvement program.
Data Collection and Evaluation
In addition to the franchise provider's performance reports, other data regarding EMS system activity is gathered from prehospital care reports (PCRs) prepared by ambulance personnel for every EMS response. Information is gathered via a computerized, networked data collection system that routes and retrieves essential data which is reviewed by the Clinical Services Coordinator, Medical Director, and CQI Committees.
Public Information and Education
Sonoma County specific information pertaining to the EMS system is available through the Department of Health Services Health Profile. Direct education to the public regarding the local EMS system are presently limited to self-produced videotapes and printed materials distributed through the local EMS provider agencies and Sonoma County Paramedic Association. As with all public safety agencies, an effective on-going "9-1-1" education program is presented throughout the county at the elementary, secondary, and high school level, as well as general public notices distributed by other public safety agencies.
Hospitals and Specialty Care Centers
Hospital based emergency services are available through seven Sonoma County hospitals and three Mendocino County hospitals. The EMS Agency gathers information from these hospitals to identify the specific services and level of care offered. This information is utilized to review destination policies and the EMS Point-Of-Entry plan that guide the distribution of patients within the EMS system.
Santa Rosa Memorial Hospital has been designated as a Level II trauma center (on site specialists). Pediatric trauma patients are flown to Children's Hospital of Oakland (a pediatric trauma center).
Committees and Advisory Boards
The Agency Director answers to a Regional Advisory Committee comprised of the Health Services Department Directors from each of the member counties of the region. The EMS Agency also uses the Emergency Medical Care Committe (EMCC) in each member county as respective representative advisory committees. These committees have been created under the authority of Health and Safety Code Section 1797.270. Membership is established and appointed by the respective Boards of Supervisors. The primary responsibility of the committees is to act in an advisory capacity to the EMS Agency and the respective Boards of Supervisors. The committees focus on review of ambulance operations, dispatch, trauma system development, CPR/First Aid training for the public and training and education issues for field personnel. Sub-committees operating under the authority of the EMCC are used to review specific areas of the EMS system operation. Information regarding meeting dates and locations of these committees can be obtained from the EMS Agency regional office in Santa Rosa or the respective county offices in Mendocino.