Alameda_County_EMS_Ambulance_Transport_Provider_Agreement_ 133044 Alameda County Ems Ambulance Transport Provider Agreement Optimiweb
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Emergency Medical Services
Ambulance Transport Provider
Agreement
County of Alameda
and
Paramedics Plus, LLC
June 2010
EMS Ambulance Transport Provider Agreement
TABLE OF CONTENTS
D EFINITIONS AND A CRONYMS .......................................................................... VII
R ECITALS OF A UTHORITY ................................................................................ 1
S COPE OF W ORK .......................................................................................... 2
1.
SERVICES ...................................................................................................................................2
2.
SERVICE AREA/EMERGENCY RESPONSE ZONES ..................................................................................2
3.
SERVICES/STANDARDS .................................................................................................................3
4.
ASSISTANCE TO OTHER COUNTY EOAS/EXPANSION OF THE EOA .........................................................3
5.
LOCATION OF CONTRACTOR’S OFFICES ............................................................................................4
6.
TRANSITION ...............................................................................................................................4
D ISPATCH .................................................................................................. 4
7.
ALAMEDA COUNTY REGIONAL EMERGENCY COMMUNICATIONS CENTER ................................................4
8.
ACRECC AGREEMENT .................................................................................................................4
9.
DEPLOYMENT SUPERVISOR AT DISPATCH CENTER ..............................................................................5
10.
COUNTY COMPUTER AIDED DISPATCH SYSTEM .................................................................................5
11.
CAD DATA ................................................................................................................................5
C OMMUNICATIONS ....................................................................................... 5
12.
RADIO EQUIPMENT......................................................................................................................5
R ESPONSE T IME R EQUIREMENTS ....................................................................... 6
13.
RESPONSE TIME PERFORMANCE AND MEASUREMENT ........................................................................6
14.
RESPONSE TIME ACCOUNTABILITY ..................................................................................................6
15.
RESPONSE TIME MEASUREMENT METHODOLOGY .............................................................................7
16.
CALCULATING RESPONSE TIMES .....................................................................................................8
17.
CALCULATING CHANGES IN CALL PRIORITY .......................................................................................8
18.
CANCELED CALLS .........................................................................................................................9
19.
EACH INCIDENT A SEPARATE RESPONSE ...........................................................................................9
20.
5150 RESPONSE .........................................................................................................................10
21.
RESPONSE TIME PERFORMANCE REPORT .........................................................................................10
22.
RESPONSE TIME LATE RESPONSE EXEMPTIONS ("EXEMPTION") ...........................................................11
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EMS Ambulance Transport Provider Agreement
S TAFFING R EQUIREMENTS ............................................................................... 11
23.
AMBULANCE STAFFING REQUIREMENTS ...........................................................................................11
24.
WORK SCHEDULES ......................................................................................................................11
25.
PERSONNEL LICENSURE/CERTIFICATION/TRAINING REQUIREMENTS ......................................................12
T RANSPORT R EQUIREMENT ............................................................................. 12
26.
DESTINATION .............................................................................................................................12
27.
INFLUENCE ON DESTINATION .........................................................................................................13
28.
AIR AMBULANCE AGREEMENTS......................................................................................................13
M ULTI ‐ CASUALTY I NCIDENT /D ISASTER R ESPONSE .................................................. 13
29.
MULTI‐CASUALTY INCIDENT/DISASTER RESPONSE .............................................................................13
30.
DISASTER RESPONSE VEHICLE/EQUIPMENT ......................................................................................14
31.
INCIDENT NOTIFICATION ...............................................................................................................14
32.
AMBULANCE STRIKE TEAM ............................................................................................................14
33.
INTERAGENCY TRAINING FOR EXERCISES/DRILLS ................................................................................15
34.
MUTUAL‐AID REQUIREMENTS .......................................................................................................15
V EHICLES AND E QUIPMENT ............................................................................. 16
35.
AMBULANCES .............................................................................................................................16
36.
EQUIPMENT ...............................................................................................................................17
37.
VEHICLE AND EQUIPMENT MAINTENANCE ........................................................................................17
E LECTRONIC P ATIENT C ARE R EPORT AND D ATA C OLLECTION S YSTEM ........................... 18
38.
PATIENT CARE REPORTS ...............................................................................................................18
39.
DATA COLLECTION SYSTEM FOR PATIENT CARE REPORTS ....................................................................19
40.
PCR DELIVERY TO RECEIVING HOSPITALS OR PSYCHIATRIC FACILITIES ....................................................20
M EDICAL O VERSIGHT .................................................................................... 21
41.
MEDICAL PROTOCOLS ..................................................................................................................21
42.
MEDICAL REVIEW/AUDITS ............................................................................................................21
P ERSONNEL ................................................................................................ 21
43.
TREATMENT OF INCUMBENT WORKFORCE........................................................................................21
44.
CHARACTER/COMPETENCE/PROFESSIONALISM .................................................................................22
45.
INTERNAL HEALTH AND SAFETY PROGRAMS ......................................................................................22
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EMS Ambulance Transport Provider Agreement
46.
PERSONNEL TRAINING ..................................................................................................................23
47.
CONTINUING EDUCATION PROGRAM ..............................................................................................23
48.
WORKFORCE ENGAGEMENT ..........................................................................................................23
49.
KEY PERSONNEL AND REQUIRED POSITIONS......................................................................................24
Q UALITY M ANAGEMENT P LAN ......................................................................... 27
50.
APPROVAL OF QUALITY MANAGEMENT PLAN ...................................................................................27
51.
CALIFORNIA AWARD FOR PERFORMANCE EXCELLENCE ........................................................................28
R EQUIRED R EPORTS ...................................................................................... 29
52.
REPORTING REQUIREMENTS ..........................................................................................................29
53.
RESPONSE TIME PERFORMANCE .....................................................................................................29
54.
HIGH‐RISK PCRS ........................................................................................................................30
55.
COMPLIANCE WITH PROTOCOLS .....................................................................................................30
56.
QUALITY IMPROVEMENT ...............................................................................................................30
P ENALTY P ROVISIONS .................................................................................... 30
57.
FAILURE TO RESPOND ..................................................................................................................30
58.
RESPONSE LEVEL .........................................................................................................................31
59.
MISSING MANDATORY DATA FIELDS ...............................................................................................31
60.
MISSING PCR AT THE RECEIVING HOSPITAL OR PSYCHIATRIC FACILITY ...................................................31
61.
PCR GOOD CAUSE EXEMPTION .....................................................................................................32
62.
FAILURE TO PROVIDE TIMELY REPORTS ............................................................................................32
63.
FAILURE TO MEET MINIMUM IN‐SERVICE EQUIPMENT/SUPPLY REQUIREMENTS......................................32
64.
FAILURE TO PROVIDE ARRIVAL AT INCIDENT TIME ..............................................................................32
65.
RESPONSE TIME FINES .................................................................................................................32
66.
FINES FOR OUTLIER RESPONSE TIMES ..............................................................................................33
67.
FINE DISPUTES ............................................................................................................................33
68.
INVOICING AND PAYMENT .............................................................................................................33
C OUNTY ‐W IDE C OOPERATION ......................................................................... 34
69.
COLLABORATION WITH FIRST RESPONDER AGENCIES ..........................................................................34
70.
EMS SYSTEM PARTICIPATION ........................................................................................................35
H EALTH S TATUS I MPROVEMENT /C OMMUNITY E DUCATION ....................................... 35
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EMS Ambulance Transport Provider Agreement
71.
EMT TRAINING PROGRAMS, INTERNSHIPS AND RELATED OPPORTUNITIES ..............................................35
72.
COMMUNITY PROGRAMS..............................................................................................................35
E NVIRONMENTALLY F RIENDLY B USINESS P RACTICES ................................................ 36
73.
BUILDINGS AND VEHICLES .............................................................................................................36
74.
EQUIPMENT AND SUPPLIES............................................................................................................37
75.
MEDICAL EQUIPMENT AND SUPPLIES ..............................................................................................37
C OMPLIANCE P ROVISIONS ............................................................................... 37
76.
MEDICARE COMPLIANCE PROGRAM REQUIREMENTS ..........................................................................37
77.
HIPAA COMPLIANCE PROGRAM REQUIREMENTS ..............................................................................37
78.
EMS POLICIES ............................................................................................................................38
79.
MEDICAL AND OTHER STATE AND FEDERAL PROGRAMS ......................................................................38
C ONTRACTOR R EVENUE .................................................................................. 38
80.
CONTRACTOR COMPENSATION ......................................................................................................38
81.
PATIENT CHARGES AND FEES .........................................................................................................38
82.
USER FEE ADJUSTMENTS ..............................................................................................................38
83.
BILLING/COLLECTION SERVICES ......................................................................................................39
84.
ACCOUNTING PROCEDURE ............................................................................................................40
85.
CUSTOMER SERVICE TELEPHONE LINE .............................................................................................41
86.
CONTRACTOR'S COMPENSATION TO THE COUNTY ..............................................................................42
A DMINISTRATIVE P ROVISIONS .......................................................................... 42
87.
ANNUAL PERFORMANCE EVALUATION .............................................................................................42
88.
ASSURANCE OF PERFORMANCE ......................................................................................................43
89.
MATERIAL BREACH ......................................................................................................................43
90.
NOTICE AND CURE OF MATERIAL BREACH ........................................................................................44
91.
COUNTY REMEDIES ......................................................................................................................45
92.
CONTINUOUS SERVICE DELIVERY ....................................................................................................45
93.
EMERGENCY TAKEOVER ................................................................................................................45
94.
TERMINATION ............................................................................................................................46
F UTURE C OMPETITIVE P ROCUREMENT P ROCESS / “L AME D UCK ” P ROVISIONS ................ 48
95.
COMPETITIVE PROCUREMENT PROCESS ...........................................................................................48
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EMS Ambulance Transport Provider Agreement
96.
“LAME DUCK” PROVISIONS ...........................................................................................................49
G ENERAL P ROVISIONS ................................................................................... 49
97.
PERMITS AND LICENSE ..................................................................................................................49
98.
PRIVATE WORK ..........................................................................................................................50
99.
PRODUCT ENDORSEMENT/ADVERTISING..........................................................................................50
100.
OBSERVATION AND INSPECTIONS ....................................................................................................50
101.
NO COST TO COUNTY ..................................................................................................................51
102.
COST OF ENFORCEMENT ...............................................................................................................51
103.
RELATIONSHIP OF THE PARTIES.......................................................................................................51
104.
INDEPENDENT CONTRACTOR..........................................................................................................51
105.
INDEMNIFICATION .......................................................................................................................52
106.
INSURANCE AND BOND.................................................................................................................53
107.
WORKERS’ COMPENSATION ..........................................................................................................53
108.
CONFORMITY WITH LAW AND SAFETY .............................................................................................53
109.
DEBARMENT AND SUSPENSION CERTIFICATION .................................................................................54
110.
TAXES .......................................................................................................................................55
111.
OWNERSHIP OF DOCUMENTS ........................................................................................................55
112.
DOCUMENTS AND MATERIALS .......................................................................................................56
113.
CONFLICT OF INTEREST/CONFIDENTIALITY ........................................................................................56
114.
NOTICES ....................................................................................................................................57
115.
USE OF COUNTY PROPERTY ...........................................................................................................58
116.
EQUAL EMPLOYMENT OPPORTUNITY PRACTICES PROVISIONS ..............................................................58
117.
DRUG FREE WORKPLACE ..............................................................................................................59
118.
SMALL, LOCAL, AND EMERGING BUSINESS (SLEB) PARTICIPATION: ......................................................59
119.
FIRST SOURCE PROGRAM ..............................................................................................................60
120.
WAIVER ....................................................................................................................................60
121.
ENTIRE AGREEMENT ....................................................................................................................60
122.
HEADINGS .................................................................................................................................60
123.
MODIFICATION OF AGREEMENT .....................................................................................................60
124.
SUBCONTRACTING/ASSIGNMENT/SALE ...........................................................................................61
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EMS Ambulance Transport Provider Agreement
125.
SURVIVAL ..................................................................................................................................61
126.
SEVERABILITY .............................................................................................................................62
127.
PATENT AND COPYRIGHT INDEMNITY ..............................................................................................62
128.
CHOICE OF LAW AND VENUE .........................................................................................................63
S IGNATORY ................................................................................................ 63
E XHIBITS .................................................................................................... 1
E XHIBIT A ‐ D EPICTION AND D EFINITION OF C ONTRACTOR ’ S EOA AND
E MERGENCY R ESPONSE Z ONES ....................................................... 2
E XHIBIT B ‐ D EPICTION AND D EFINITION OF S UB ‐ AREAS .......................................... 3
E XHIBIT C ‐ M INIMUM I NSURANCE R EQUIREMENTS ................................................ 6
E XHIBIT D ‐ D EBARMENT AND S USPENSION C ERTIFICATION ...................................... 7
E XHIBIT E ‐ C OMMUNICATIONS E QUIPMENT ......................................................... 8
E XHIBIT F ‐ R ESPONSE T IMES R EQUIREMENTS AND F INES ......................................... 10
TABLE A ‐ PERSONNEL AND RESPONSE TIME REQUIREMENTS ...............................................................10
TABLE B ‐ RESPONSE TIME FINES BY CATEGORY AND COMPLIANCE .......................................................10
TABLE C ‐ OUTLIER RESPONSE TIMES BY CATEGORY AND SUBAREA IN MINUTES & SECONDS .....................10
E XHIBIT G ‐ P ARAMEDIC T RAINING R EQUIREMENTS ................................................ 11
E XHIBIT H ‐ C ONTRACTOR ’ S U SER F EES ‐ 911 S YSTEM ............................................ 13
E XHIBIT I ‐ M ANDATORY D ATA F IELD R EQUIREMENTS ............................................. 14
E XHIBIT J ‐ F IRST S OURCE A GREEMENT ............................................................... 15
E XHIBIT K – T RANSITION P LAN ......................................................................... 16
E XHIBIT L ‐ C OMMUNITY E DUCATION P ROGRAM ................................................... 22
E XHIBIT M ‐ F IRST R ESPONDER S UPPORT ............................................................ 24
E XHIBIT N ‐ H IGH R ISK P ATIENT D ESCRIPTION ...................................................... 25
E XHIBIT O ‐ P ROPOSAL OF P ARAMEDICS P LUS ...................................................... 26
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EMS Ambulance Transport Provider Agreement
DEFINITIONS AND A CRONYMS
The following definitions and acronyms are contained in this Agreement:
5150 Call
Services involving a patient who has been (or shall be) placed on a hold for
psychiatric evaluation, including transport to a psychiatric facility in
accordance with the California Code of Regulations Welfare and Institutions
Code, Section 5150 and EMS Policies.
Ambulance
As defined pursuant to Title 13 of the California Code of Regulations, section
1100.2. A vehicle specially constructed, modified or equipped, and used for the
purpose of transporting sick, injured, convalescent, infirm, or otherwise
incapacitated persons, and compliant with state requirements.
Ambulance Strike
Reference description in EMSA guideline #215
Team(s)
ACRECC
Alameda County Regional Emergency Communications Center
Alpha Call
A 911 call designated by County Dispatch Center as an Alpha Call based on use
of the Medical Priority Dispatch System.
ALS
Advanced Life Support ‐ paramedic level of service as defined in California
Health and Safety Code, Division 2.5, § 1797.52
Arrival at
Incident
The moment the Ambulance is fully stopped at the Incident Location and Field
Personnel notifies the County Dispatch Center of the arrival.
AVL
Automatic Vehicle Locator
Base Hospital
As defined in California Health and Safety Code, Division 2.5, §1797.58. The
Base Hospital for Alameda County is Alameda County Medical Center, Highland
Campus.
BLS
Basic Life Support ‐ EMT level of service, as defined in California Health and
Safety Code, Division 2.5, §1797.60
Board
Alameda County Board of Supervisors
Bravo Call
A 911 call designated by County Dispatch Center as a Bravo Call based on use
of the Medical Priority Dispatch System.
CAD
Computer Aided Dispatch
Charlie Call
A 911 call designated by County Dispatch Center as a Charlie Call based on use
of the Medical Priority Dispatch System.
Continuing
Education (CE)
As defined in the California Code of Regulations, Title 22, Chapter 11
Contractor
Paramedics Plus, LLC
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EMS Ambulance Transport Provider Agreement
Contracting
City(ies)
A municipality in Zone 1 that has a contract with EMS to provide its own
Ambulance services in that city's exclusive operating area.
County
The County of Alameda
County Dispatch
Center
The medical dispatch center designated by EMS to dispatch Contractor’s
Ambulances, pursuant to this Agreement.
Data Collection
System
The software and hardware used to collect, store and report on information
from the provision of Services, which includes the Patient Care Reports.
Delta Call
A 911 call designated by County Dispatch Center as a Delta Call based on use of
the Medical Priority Dispatch System.
DTMF
Dual Tone Multi Frequency (Touch‐Tone).
Echo Call
A 911 call designated by County Dispatch Center as an Echo Call (non‐breathing
and/or ineffective breathing) based on use of the Medical Priority Dispatch
System
Effective Date
The date the Agreement is signed by the President of the Alameda County
Board of Supervisors
EMS
Used in this Agreement to refer to Alameda County Emergency Medical
Services, a Division of the Public Health Department, as part of the Health Care
Services Agency
EMS Director
The director of the Alameda County Emergency Medical Services, a Division of
the Public Health Department, as part of the Health Care Services Agency.
EMS Medical
Director
The physician in the position of Medical Director for Alameda County
Emergency Medical Services, a Division of the Public Health Department, as
part of the Health Care Services Agency..
EMS Policies
Policies and procedures issued by the Alameda County Emergency Medical
Services that are contained in the Alameda County Emergency Medical Services
Field Manual and/or Administration Manual, which may be revised from time
to time
EMS website
acgov.org/ems
EMSA
Emergency Medical Services Authority of the State of California
EMT
Emergency Medical Technician
EOA
As used in this Agreement, refers to the Exclusive Operating Area for "Services"
as designated in Alameda County’s approved EMS Plan, and depicted in EXHIBIT
A ‐ DEPICTION AND DEFINITION OF CONTRACTOR'S EOA AND EMERGENCY RESPONSE ZONES.
ERZ
Emergency Response Zone, as depicted in EXHIBIT A ‐ DEPICTION AND DEFINITION OF
CONTRACTOR'S EOA AND EMERGENCY RESPONSE ZONES.
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EMS Ambulance Transport Provider Agreement
Federal
Refers to United States Federal Government, its departments and/or agencies
Field Personnel
Contractor's paramedics and EMTs responsible for responding to 911 requests
for emergency medical ground ambulance services pursuant to this Agreement
Fractile
A method of measuring data in which all applicable data are stacked in
ascending order and the total number is calculated as a percentage of the total
number of calls. (e.g.: a 90th percentile standard is one where 90% of the
applicable Ambulance calls are answered within the response standard, while
10% take longer than the standard.)
FRALS
First Response Advanced Life Support – A fire department unit staffed and
equipped with a minimum of one California State licensed and Alameda County
accredited Paramedic capable of providing ALS at scenes of medical
emergencies. These units are designated by the County and have an executed
agreement with the County to provide service
First Responder
Agency(ies)
The fire departments within the EOA, and those in Zone 1 that are under
contract with the County, to provide first response to the scene of a medical
emergency
High‐Risk PCR
A Patient Care Record for a High‐Risk patient. See EXHIBIT N ‐ HIGH RISK PATIENT
DESCRIPTION
HIPAA
Health Insurance Portability and Accountability Act of 1996
Incident Location
The destination address or location of the patient the Ambulance is dispatched
to by the County Dispatch Center
Incumbent
Personnel
Those employees working for American Medical Response under contract with
County for emergency ground ambulance services to the EOA on the Effective
Date
Key Personnel
Contractor’s personnel providing Services in the positions of a) Operations
Manager (Chief Operations Officer), b) Medical Director and c) Quality Manager
Labor Code
California Labor Code
LEMSA
Local Emergency Medical Services Agency, as defined in California Health and
Safety Code, Division 2.5, §1797.94
Mandatory Data
Fields
The minimum amount of information that satisfies the requirement for a
completed Patient Care Report left at the receiving hospital or psychiatric
facility.
Medical Priority
Dispatch System
(“MPDS”)
The system that categorizes emergency calls using an escalating scale of
severity assigned to medical conditions, relative to the level and timeliness of
response.
Mutual‐Aid
Emergency ambulance service performed by neighboring providers during
periods of severe weather, multi‐casualty incidents, or other events that
overwhelm existing resources
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EMS Ambulance Transport Provider Agreement
Multi‐Casualty
Incident (“MCI”)
A Multi‐Casualty Incident (MCI) is any incident where the number of injured
persons exceeds the day‐to‐day operating capabilities and requires additional
resources and/or the distribution of patients to multiple hospitals, as defined in
EMS Policies
Onboard Mobile
Gateway
(“OMG”)
The mobile networking technology that connects and manages equipment,
information and people in the field. Provides high performance, high security,
wireless broadband networking for mobile applications
Paramedic
As defined in California Health and Safety Code, Division 2.5, §1797.84
PCR
Patient Care Record, in either print or electronic form
Response Time
The time elapsed from the time a call is received by Contractor from the County
Dispatch Center, until Arrival at the Incident Location by the Ambulance
Required
Positions
The positions of a) Clinical/Education Staff, b) Clinical Field Supervisors, c)
Operational Field Supervisors, and d) Analyst, for which Contractor is required
to have individual employees while providing Services
Quality
Improvement
As defined in the California Code of Regulations, Title 22, Chapter 12 and EMSA
#166: EMS System Quality Improvement Guidelines
State
The State of California, its departments and/or agencies
Service Start Date 12:00 am on the date Contractor begins providing Services
Services
Contractor’s provision of 911 emergency medical ground ambulance response
and transportation at an Advanced Life Support (ALS) level of service, and
where specified in this Agreement, Basic Life Support (BLS); and, obligations as
required by this Agreement and in accordance with EMS Policy
Service Vehicles
Contractor’s vehicles used in the provision of Services, including but not limited
to, Ambulances and Supervisor Vehicles.
Subarea
Designations within an Emergency Response Zone of Metro/Urban,
Suburban/Rural and Wilderness, as depicted in EXHIBIT B ‐ DEPICTION AND
DEFINITION OF SUBAREAS.
Supervisor(s)
Clinical Field Supervisors and Operational Field Supervisors
Supervisor
Vehicles
A vehicle, other than an ambulance, driven by a Supervisor and equipped for
emergency medical response
User Fees
Charges to patients and/or insurance providers, including Medicare and Medi‐
Cal for Services provided by Contractor.
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EMS Ambulance Transport Provider Agreement
This Agreement ("Agreement") is by and between the County of Alameda, herein referred to as
County, and Paramedics Plus, LLC., herein referred to as Contractor, and shall be effective the date
this Agreement is signed by the president of the Alameda County Board of Supervisors ("Effective
Date").
This Agreement is for the provision of 911 emergency medical ground ambulance response and
transportation at an Advanced Life Support ("ALS") level of service, and where specified in this
Agreement, Basic Life Support ("BLS") level of service ("Services") for a five year period,
commencing November 1, 2011 ("Service Start Date") and continuing through October 31,
2016, with an option to extend for an additional five (5) year period at County's sole discretion.
The County shall provide Contractor with written notice of its intent to extend this Agreement at
least twelve (12) months prior to the scheduled end of the term of the Agreement.
RECITALS OF A UTHORITY
Whereas, Division 2.5 of the Health and Safety Code Sections 1797.224 and 1797.85 allows the
Local Emergency Medical Services Agency ("LEMSA") to create Exclusive Operating Areas ("EOA");
and,
Whereas, Alameda County Emergency Medical Services ("EMS") is the designated LEMSA; and,
Whereas, EMS has created an EOA; and,
Whereas, pursuant to Division 2.5 of the Health and Safety Code, Section 1797.200, the County of
Alameda has designated the LEMSA to develop a written agreement with a qualified paramedic
service provider to provide Services, and participate in the advanced life support program in
Alameda County; and,
Whereas, Title 22, California Code of Regulations, Section 100168, Division 9, Chapter 4, Article 6,
requires a written agreement for Services; and,
Page 1 of 63
EMS Ambulance Transport Provider Agreement
Whereas, the County engaged in a fair competitive process in accordance with State law and
County policy; and,
Whereas, on April 27, 2010 at its regular meeting, the Alameda County Board of Supervisors
determined that Paramedic Plus, LLC. had submitted the proposal that best serves the overall
interests of the County and attained the highest over‐all point score; and,
Whereas, County and Contractor desire to enter into a performance‐based agreement for
provision of Services in accordance with this Agreement;
NOW, THEREFORE, the parties agree to the following terms and conditions:
SCOPE OF W ORK
1.
Services
1.1
Contractor shall provide Services, as requested by the County Dispatch Center, and
in accordance with this Agreement and the Contractor’s proposal, which is attached
hereto as Exhibit O (Appendices 1‐56 incorporated by reference, but not attached)
and incorporated herein by this reference, except that in the case of any conflicting
provisions the terms of this Agreement shall control over the terms of the Proposal.
1.2
Contractor shall provide Services in accordance with the requirements of California
State Health and Safety Code, Division 2.5, Sections 1797 et seq., California Code of
Regulation, Title 22, Division 9, and any amendments or revisions thereof.
1.3
Contractor shall employ all resources necessary to achieve the Response Times and
all other required performance.
1.4
Contractor agrees to increase resources at its sole expense to meet any increase in
needs or demands for Services.
2.
Service Area/Emergency Response Zones
2.1
Contractor shall provide Services within the EOA, as designated in County’s
Emergency Medical Services Plan and approved by the State Emergency Medical
Services Authority ("EMSA"), as defined in California Health and Safety Code,
Division 2.5, §1797.85.
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EMS Ambulance Transport Provider Agreement
2.2
Services shall be provided to all areas within the EOA and as otherwise required by
this Agreement. A map of the EOA, divided into specific Emergency Response Zones
("ERZ") is attached as EXHIBIT A ‐ DEPICTION AND DEFINITION OF CONTRACTOR'S EOA AND
EMERGENCY RESPONSE ZONES.
3.
Services/Standards
3.1
Contractor shall provide Services 24 hours per day, 7 days per week, 52 weeks per
year without interruption, for the full term of the Agreement. Services shall be
provided without regard to the patient's race, color, national origin, religion, sexual
orientation, age, sex, or ability to pay
3.2
Contractor shall be the exclusive 911 medical ground Ambulance provider
authorized by the County in the EOA and all calls for Services originating in the EOA
shall be referred to Contractor, with the exception of Mutual‐Aid and disaster
response.
3.3
Contractor shall work cooperatively with the EMS Director, the EMS Medical
Director, and other County staff and agencies to fulfill the terms and conditions of
this Agreement.
3.4
Contractor shall attain accreditation by the Commission on Accreditation of
Ambulance Services (“CAAS”) within eighteen (18) months of the Service Start Date.
The Contractor shall thereafter maintain accreditation throughout the term of the
Agreement.
4.
Assistance to Other County EOAs/Expansion of the EOA
4.1
Contractor shall, to the best of its ability, assist in servicing any other exclusive
operating area within the County, if requested to do so by the EMS Director.
4.2
If the EOA expands to include Alameda, Berkeley or Piedmont , Contractor shall
extend its service area at no cost to the city or County. The no cost extension shall
not apply to the City of Albany unless it is added to the EOA in conjunction with, or
following, the addition of the City of Berkeley.
4.3
The Contractor, the EMS Director, and city representatives shall collaborate on a
transition plan for the expansion of the EOA, consistent with this Agreement.
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EMS Ambulance Transport Provider Agreement
5.
Location of Contractor’s Offices
Contractor shall maintain one or more offices for operations within Alameda County during
the term of this Agreement.
6.
Transition
6.1
At 12:00 AM on the date following the last day of services provided by the current
service provider Contractor shall begin providing Services ("Service Start Date").
6.2
Beginning on the Effective Date, Contractor shall devote time and resources to be
fully prepared for becoming the Ambulance transport provider on the Service Start
Date. Contractor shall meet all milestones and requirements as set forth in EXHIBIT K
‐ TRANSITION PLAN, which may be amended by mutual agreement of the parties.
6.3
All Ambulances and Supervisor Vehicles shall be inspected by EMS prior to the
Services Start Date, and as described in EXHIBIT K ‐ TRANSITION PLAN.
DISPATCH
7.
Alameda County Regional Emergency Communications Center
Contractor’s Ambulances shall be dispatched by the County Dispatch Center, which is
operated by Alameda County Regional Emergency Communications Center ("ACRECC").
8.
ACRECC Agreement
8.1
Contractor shall make a good faith effort to enter into an agreement with ACRECC
for dispatch services for the same length of time as this Agreement, including any
extensions.
8.2
If Contractor and ACRECC are unable to enter into an agreement for dispatch
services, Contractor shall establish its own dispatch services or enter into an
agreement with another entity to provide dispatch services for this Agreement
under terms that are mutually acceptable to County and Contractor. If Contractor
and ACRECC are unable to reach agreement in sufficient time for the
commencement of Services, this Agreement shall be amended to reflect mutually
agreed upon alternative dispatch arrangements.
8.3
Dispatch services shall include: a) EMS call intake functions, b) call prioritization
and c) pre‐arrival instructions according to Medical Priority Dispatch System
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(“MPDS”) protocols developed in collaboration with the County EMS Medical
Director.
9.
Deployment Supervisor at Dispatch Center
9.1
Contractor shall staff a Deployment Supervisor at the County Dispatch Center 24
hours a day, seven (7) days a week. This position shall be responsible for
coordinating Supervisors and Field Personnel, and monitoring the deployment of
Ambulances and Supervisor Vehicles in the field for optimal Response Times.
9.2
The Deployment Supervisor shall work collaboratively with County Dispatch Center
to: a) assist with training, b) identify improvement areas, and c) facilitate a positive
and productive working relationship between County Dispatch Center personnel
and Field Personnel.
10.
County Computer Aided Dispatch System
10.1
Contractor shall pay for any modifications to the County Dispatch Center Computer
Aided Dispatch ("CAD") system necessary to effectively monitor, deploy, redeploy
its Ambulances, and provide Services.
10.2
Contractor shall provide as needed additional computer servers, workstations, and
employee training to County staff.
11.
CAD Data
Contractor shall ensure that the County has immediate access to all EMS related data
maintained by the CAD system at ACRECC.
COMMUNICATIONS
12.
Radio Equipment
12.1
Contractor shall work with County and the Federal Communications Commission
("FCC") to enable Contractor to effectively receive communications as directed by
the County Dispatch Center.
12.2
Contractor shall work with County and the FCC to enable Contractor to effectively
utilize the County’s radio infrastructure to communicate with the County Dispatch
Center and First Responder Agencies.
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12.3
Contractor shall equip each Ambulance and Supervisor Vehicle with an Onboard
Mobile Gateway (“OMG”) which shall provide wireless access to CAD and billing
system data.
12.4
Contractor shall equip and maintain each Ambulance and Supervisor Vehicle with
communications equipment as set forth in EXHIBIT E ‐ COMMUNICATIONS EQUIPMENT,
which may be changed from time to time.
RESPONSE TIME REQUIREMENTS
13.
Response Time Performance and Measurement
13.1
Contractor is solely responsible for Service Start Date performance:
a.
Response Time standards for Charlie, Delta and Echo ambulance responses
shall be in effect on the Service Start Date.
b.
Response Time standards for Alpha and Bravo responses shall be in effect on
the Service Start Date, however, fines shall not be assessed for six months
after the Service Start Date.
13.2
The County Dispatch Center shall classify and assign calls as Alpha, Bravo, Charlie,
Delta, and Echo, by Medical Priority Dispatch System ("MPDS").
13.3
Responding Field Personnel shall be notified by the County Dispatch Center of the
MPDS designation via pager, cellular phone or other portable handheld device
capable of receiving emergency response data from the ACRECC paging system.
13.4
Any Mutual‐Aid call originating outside the EOA shall not be counted in the total
number of calls used to determine Response Time compliance.
14.
Response Time Accountability
14.1
Contractor's Response Times shall be calculated on a monthly basis for reporting
purposes to determine compliance using Fractile Response Time measurements.
14.2
Contractor's Response Time for Services in the EOA shall meet the requirements
contained in EXHIBIT F ‐ RESPONSE TIME REQUIREMENTS AND FINES (Table A, PERSONNEL
AND RESPONSE TIME REQUIREMENTS) with 100% compliance.
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14.3
Contractor shall be assessed fines if Response Time compliance falls below 90%, as
set forth in Exhibit F ‐ RESPONSE TIME REQUIREMENTS AND FINES (Table B, RESPONSE TIME
FINES BY CATEGORY AND COMPLIANCE.)
15.
Response Time Measurement Methodology
15.1
Response Time shall be measured in minutes and integer (whole) seconds from the
time the call is received by Contractor from the County Dispatch Center until arrival
at the Incident Location by the Ambulance, or until the call is cancelled by a public
safety agency or County Dispatch Center.
15.2
Determination of Response Times depends on the location of the incident with
respect to the Emergency Response Zone (“ERZ”), depicted in EXHIBIT A ‐ DEPICTION
AND DEFINITION OF CONTRACTOR'S EOA AND EMERGENCY RESPONSE ZONES.
15.3
Each ERZ may be comprised of one or more of three (3) Sub‐areas, which are
described in EXHIBIT B ‐DEPICTION AND DEFINITION OF SUB‐AREAS.
15.4
In situations where the Ambulance has responded to a location other than the
Incident Location (e.g. staging areas for hazardous materials/violent crime
incidents, non‐secured scenes, or where rugged terrain precludes access), Arrival at
Incident shall be the time the Ambulance arrives at the designated staging location
or the nearest public access point to the patient’s location.
15.5
All of the following times shall be tracked:
a.
Time call received at the County Dispatch Center (provided by County
Dispatch Center)
b.
Time call answered at the County Dispatch Center (provided by County
Dispatch Center)
c.
Time location verified (provided by County Dispatch Center)
d.
Time call received by the Contractor from the County Dispatch Center
e.
Time unit enroute to the call
f.
Arrival at Incident time (vehicle stopped)
g.
Time arrival at patient
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h.
Time Ambulance departs scene
i.
Time Ambulance arrives at the receiving hospital or psychiatric facility
j.
Time Field Personnel transfers care of the patient to receiving hospital or
psychiatric facility personnel
k.
15.6
Time Ambulance departs the receiving hospital or psychiatric facility
The Contractor may be required to log additional times by the EMS Medical Director
such as times of defibrillation, administration of treatments and medications, and
other instances deemed important for clinical monitoring and research activities.
16.
Calculating Response Times
16.1
Contractor must synchronize its mission‐critical clocks (e.g.: PCR and cardiac
monitor), daily with the County Dispatch Center’s clock, so all reports accurately
reflect County Dispatch Center times.
16.2
Contractor's Response Times shall be calculated on a monthly basis for reporting
purposes using Fractile Response Time measurement.
16.3
Contractor must be in compliance with all Response Times within all Emergency
Response Zones and Subareas at all times for any consecutive 30‐day period or
Contractor shall be penalized, as set forth in this Agreement. The County shall
periodically perform audits of Response Times for a randomly selected consecutive
30‐day period in addition to any other reporting requirements under this
Agreement.
17.
Calculating Changes in Call Priority
17.1
Upgrades
If an assignment is upgraded prior to the Arrival at Incident of the Ambulance (e.g.
from a Charlie to Delta), Contractor’s compliance and fines shall be calculated based
on the shorter of:
Time elapsed from dispatch to time of upgrade plus the higher priority Response
Time standard, or,
The lower priority Response Time standard.
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17.2
Downgrades
If a call is downgraded, prior to arrival on scene of the Ambulance (e.g. from a Delta
to a Charlie), Contractor’s compliance and fines shall be determined by:
a.
If the time of the downgrade occurs after the emergency ambulance has
exceeded the higher priority Response Time standard, the higher priority
Response Time standard shall apply; or,
b.
If the time of the downgrade occurs before the emergency ambulance has
exceeded the higher priority Response Time standard, the lower priority
Response Time standard shall apply.
c.
In all such cases, documentation must be presented for validation of the
reason why the priority status was downgraded. If the downgrade was
justified, in the sole discretion of the County, the longer standard shall apply.
17.3
Reassignment Enroute
If an Ambulance is reassigned en‐route or turned around prior to Arrival at Incident
Location (e.g., to respond to a higher priority request), compliance and fines shall be
calculated based on the Response Time Standard applicable to the assigned priority
of the initial response. The Response Time clock shall not stop until the arrival of an
emergency ambulance on the scene from which the ambulance was diverted.
18.
Canceled Calls
If a call is canceled prior to the Ambulance’s Arrival at Incident, the compliance and fines
shall be calculated based on the elapsed time from dispatch to the time the call was
canceled.
19.
Each Incident a Separate Response
19.1
Each incident shall be counted as a single response regardless of the number of
units that are utilized. The Response Time of the Contractor's first arriving
Ambulance shall be used to compute Contractors Response Time for that incident.
19.2
When Contractor requests a Mutual‐Aid response from one of the transporting fire
departments in Zone 1, Contractor remains responsible for the Response Time to
the incident.
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20.
5150 Response
20.1
5150 Responses within the EOA
a.
Contractor shall respond ALS level personnel to 5150 Calls dispatched as an
Echo, Delta, or Charlie. If the patient does not require medical clearance at an
emergency department, the ALS Ambulance can request that a BLS
Ambulance transport to the appropriate psychiatric facility in accordance
with EMS Policies regarding psychiatric patient care.
b.
Contractor may respond BLS level personnel to 5150 calls dispatched as
Alpha or Bravo.
20.2
5150 Responses into Zone 1:
a.
Contractor may respond a BLS transport unit into Zone 1 for 5150 Calls if the
call was initially dispatched as an Alpha or Bravo call by the County Dispatch
Center.
b.
Contractor may respond a BLS unit into Zone 1 for 5150 calls initially
dispatched as Echo, Delta, or Charlie, following medical clearance by Zone 1
paramedics. The request must be made through the County Dispatch Center
via 911 and in accordance with EMS Policies.
c.
Response Times for 5150 Calls in Zone 1 are to be included in the
Contractor's Response Time performance calculation.
21.
Response Time Performance Report
21.1
Contractor shall submit a monthly Response Time Performance report in
accordance with due dates established by County.
21.2
Every request from the County Dispatch Center originating within the EOA and
those 5150 calls originating in Zone 1 shall be included in Contractor's monthly
calculation of performance to determine compliance with Response Time standards,
except as otherwise provided in this Agreement.
21.3
Contractor is required to meet the specified Response Time standards; therefore,
Contractor shall maintain mechanisms for expansion of response capacity should a
system overload occur.
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21.4
The mechanisms for expansion of capacity shall be in a written plan and submitted
for approval to EMS.
22.
Response Time Late Response Exemptions ("Exemption")
22.1
Contractor may request that a late response be excluded from the calculation of
Response Time standards (“an Exemption”), if that call falls into one of the following
categories:
a.
A declared Multi‐Casualty Incident (“MCI”) or disaster that the EMS Director
determines has had a material impact on Contractor’s resources.
b.
There was a delay because information relayed by the County Dispatch
Center was substantially incorrect so as to prohibit timely arrival at the call.
22.2
A request for an Exemption must be in writing, and received by the EMS Director
within ten (10) calendar days following the end of the month in which the event
occurred. The request must include performance reports for the month in which the
incident occurred and written documentation supporting the request.
22.3
Response Time Exemptions may be granted by the County on a per call basis,
following review and investigation by the County.
22.4
Calls that are approved as an Exemption shall not be included in the calculations for
Response Time compliance.
STAFFING REQUIREMENTS
23.
Ambulance Staffing Requirements
23.1
Contractor shall staff, at a minimum, one (1) Paramedic and one (1) EMT for all
Ambulances responding to Charlie, Delta and Echo calls, and calls the County
Dispatch Center determines an ALS response is appropriate
23.2
Contractor shall staff, at a minimum, two (2) EMTs for all Ambulances responding to
Alpha and Bravo calls, or multi‐unit responses, or calls the County Dispatch Center
determines a BLS response is appropriate.
24.
Work Schedules
24.1
24‐hour Shifts:
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a.
Contractor's employees assigned to 24‐hour shifts shall not work more than
24 consecutive hours without a minimum of twelve hours off‐duty.
b.
An employee may complete a call that was in progress prior to the 24‐hour
limit; however, that employee shall not be dispatched to an additional call.
The total hours worked shall not exceed twenty‐six (26) consecutive hours.
c.
Contractor shall monitor the workload for all 24‐hour shifts and send a
report to the EMS Director monthly. If the workload trend shows that Field
Personnel are not afforded at least a 4‐hour uninterrupted break during the
24‐hour shift, on a consistent basis for greater than three (3) months,
Contractor shall work with the County to identify alternatives, including
changes to shift lengths.
24.2
Less than 24‐hour Shifts:
a.
Contractor’s employees assigned to less than 24‐hour shifts shall not work
more than 18 consecutive hours without a minimum of twelve hours off‐
duty.
b.
An employee may complete a call that was in progress prior to the 18‐hour
limit; however, that employee shall not be dispatched to an additional call.
The total hours worked shall not exceed twenty (20) consecutive hours.
25.
Personnel Licensure/Certification/Training Requirements
25.1
Field Personnel performing Services under the Agreement shall at all times be
appropriately certified and/or licensed to practice in the State of California and in
the case of Paramedics, accredited in Alameda County.
25.2
Contractor shall, at all times, retain electronic copies of current licenses,
certifications, and training documentation for Field Personnel performing Services.
TRANSPORT REQUIREMENT
26.
Destination
Patients shall be transported in accordance with EMS Policies, as may be amended from
time to time.
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27.
Influence on Destination
Field Personnel shall not attempt to influence a patient’s destination selection other than as
set forth in the EMS Transport Guidelines Policy.
28.
Air Ambulance Agreements
County may enter into separate transport agreements with Air Ambulance providers.
Notwithstanding any other provision of this Agreement, County may provide for air
transport of patients when such transportation is deemed to be medically in the best
interest of the patient, as defined in EMS Policies.
MULTI ‐ CASUALTY INCIDENT/DISASTER RESPONSE
29.
Multi‐Casualty Incident/Disaster Response
29.1
Contractor shall cooperate with County in rendering emergency assistance during a
declared or an undeclared disaster or Multi‐Casualty Incident ("MCI"), in accordance
with the EMS Policies.
29.2
Contractor shall assign a Field or Dispatch Manager/Supervisor to the Operational
Area Emergency Operations Center ("EOC") ‐ Medical Health Branch (when
activated) as a liaison to work closely with the Medical Health Operational Area
Coordinator (“MHOAC”).
29.3
If County directs Contractor to respond to a disaster in a neighboring jurisdiction,
fines for Response Times may be suspended, but only if authorized by the EMS
Director. Contractor shall use its best efforts to maintain primary emergency
services and may suspend non‐emergency services as required.
29.4
Within one (1) year following the Effective Date of this Agreement, Contractor shall
submit to the EMS Director for review, an Emergency Operation Plan (“EOP”) for its
internal response and recovery in the event of a disaster. In the event of a disaster,
Contractor shall follow the County's disaster plan and its EOP.
29.5
When Contractor is notified that disaster or MCI assistance is no longer required,
Contractor shall resume Response Time requirements in a timely manner.
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30.
Disaster Response Vehicle/Equipment
30.1
Contractor shall house, maintain, manage and staff any Disaster Ambulance Support
Unit (“DASU”) issued to County by EMSA for disaster responses. A DASU may not be
used by Contractor without the specific permission of and at the direction of County.
30.2
Contractor shall maintain the State‐issued DASU in good working order, in
accordance with EMS Policies and in accordance with the vehicle and equipment
maintenance requirements set forth in this Agreement, for immediate disaster
deployment.
30.3
Contractor shall also house and maintain the County’s EMS Disaster Trailers in
accordance with EMS Policies and in accordance with the vehicle and equipment
maintenance requirements set forth in this Agreement. Contractor shall not use the
EMS Disaster Trailers, unless directed to do so by the County Dispatch Center.
30.4
Contractor shall also provide an additional two trailers to further augment MCI and
disaster response within Alameda County, which shall be maintained in the same
manner.
31.
Incident Notification
Contractor shall have a mechanism in place to communicate current field information to
appropriate County staff, including, but not limited to the County Dispatch Center and the
County’s EOC during MCIs, disaster responses, hazardous materials incidents and other
unusual occurrences.
32.
Ambulance Strike Team
32.1
Contractor’s Ambulance Strike Team ("AST") shall at all times be staffed, equipped,
and trained to respond to a disaster Mutual‐Aid request at County’s direction and in
accordance with the EMSA AST Guidelines. Contractor shall ensure that AST
members and AST leaders have been appropriately trained by an EMSA‐approved
trainer.
32.2
The Contractor shall insure that an AST is available to respond to disaster requests
from EMSA.
32.3
Contractor shall notify EMS prior to deployment of any AST.
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33.
Interagency Training for Exercises/Drills
Contractor shall participate in County‐sanctioned exercises, disaster drills, and interagency
training.
34.
Mutual‐Aid Requirements
34.1
State or Federal Mutual‐Aid requests
Contractor shall respond to requests for Mutual‐Aid made by State or Federal
agencies, if directed to do so by the EMS Director.
34.2
In‐County Mutual‐Aid requests
a.
Contractor shall use its best efforts to enter into Mutual‐Aid agreements with
municipalities in Zone 1, or other areas where Mutual‐Aid is provided on a
regular basis.
b.
Any executed agreements between Contractor and a municipality in Zone 1
for Mutual‐Aid shall be sent to the EMS Director within 45 calendar days of
execution.
c.
If Contractor is unable to enter into an agreement for Mutual‐Aid in any
municipality, Contractor shall notify the EMS Director.
d.
Contractor shall respond to Mutual‐Aid requests from other Alameda County
agencies within Alameda County according to prior written agreements with
those agencies.
e.
Contractor shall document the number and nature of all Mutual‐Aid
responses it requests or provides.
34.3
Stand‐By Service
a.
Upon request by a public safety agency within Alameda County, Contractor
shall provide, at no charge to County or to the requesting agency, stand‐by
services at the scene of an emergency incident within the EOA when directed
by the County Dispatch Center.
b.
An Ambulance and its Field Personnel placed on stand‐by shall be dedicated
to the incident for which it has been placed on stand‐by.
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c.
Stand‐by periods exceeding eight (8) hours shall require the approval of the
EMS Director.
V EHICLES AND EQUIPMENT
35.
Ambulances
35.1
35.2
All Ambulances shall meet the following specifications:
a.
2010 EPA diesel and State of California emission standards
b.
Title 13, California Code of Regulations
c.
California Vehicle Code.
Contractor, at its sole expense, shall acquire and maintain Service Vehicles and on‐
board medical supplies and equipment, to be used to perform Services.
35.3
Vehicle Markings
a.
Emergency vehicles, including Ambulances and Supervisor’s Vehicles, shall
be marked as required by the National Fire Protection Agency (NFPA)
Standard 1901 (2009) that includes reflective chevron markings on the rear
and a reflective stripe on the side panels.
b.
Services Vehicles shall display the following signage, on both sides:
“Alameda County Emergency Medical Services” in at least four (4) inch
letters,
c.
Level of service (e.g., "Paramedic Unit")
"911" emergency telephone number
Contractor’s name
CAAS logo once accreditation has been acquired
No Service Vehicle shall display any other writing unless approved by the
County, other than vehicle identification.
d.
Contractor shall obtain EMS approval of the overall design, color, and
lettering used for Service Vehicles. Contractor shall, within ten (10) calendar
days of County's request, change any non‐approved design, color or lettering.
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36.
Equipment
36.1
Contractor shall have sole responsibility and bear all expense for all equipment
necessary to provide Service. All on‐board equipment, medical supplies and
personal communications equipment used by Contractor shall meet or exceed the
minimum requirements of the EMS Policies and this Agreement.
36.2
Contractor shall have and submit to County no later than the Service Start Date,
policies regarding the acquisition, stocking and security of controlled substances
carried on Service Vehicles.
36.3
Equipment and supply requirements may be modified with the approval of the EMS
Director, including modifications due to changes in technology.
36.4
The County may inspect Service Vehicles at any time without prior notice.
36.5
Failure to meet minimum in‐service equipment/supply requirements:
a.
If any Service Vehicle fails to meet the requirements, as contained in EMS
Polices, the County may fine Contractor.
b.
In addition to any fines, if the EMS Director determines that the failure to
meet requirements is critical, the Service Vehicle shall be removed from
service until the non‐compliance is corrected.
37.
Vehicle and Equipment Maintenance
37.1
Contractor shall maintain all Service Vehicles in good working order consistent with
the manufacturer's specifications.
37.2
Contractor shall maintain and provide to County on demand a listing of all Service
Vehicles, including reserve vehicles. The information for each vehicle shall include
the license number, and name and address of lien holder, if any. Changes in lien
holder, as well as the transfer, sale, or purchase of vehicles used to provide Services
shall be reported to County within thirty (30) calendar days of any change, sale,
transfer or purchase.
37.3
For each Service Vehicle, detailed records shall be maintained as to work performed,
costs related to repairs, and operating and repair costs analyses where appropriate.
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Records shall be made available for inspection by County upon request of the EMS
Director.
37.4
Repairs shall be accomplished and systems shall be maintained so as to achieve at
least the industry norms in vehicle performance and reliability.
37.5
Contractor shall ensure an Ambulance maintenance program that is designed and
conducted to achieve the highest standard of reliability appropriate to a modern
high‐performance Ambulance service by: a) utilizing appropriately trained
personnel, knowledgeable in the maintenance and repair of Ambulances, b)
developing and implementing standardized maintenance practices, and c)
incorporating an automated or manual maintenance program record keeping
system.
37.6
Contractor shall replace or remount ambulances on a five‐year, 250,000‐mile
schedule, unless otherwise agreed to by Contractor and County.
37.7
All Service Vehicles, and any equipment that has a defect, including insignificant but
visible cosmetic damage, shall be removed from service for repair without delay,
and in no event in less than twelve hours after a request from the EMS Director.
37.8
Contractor shall comply with or exceed the maintenance standards established by
the CAAS, as may be amended from time‐to‐time.
37.9
Contractor shall maintain all bio‐medical equipment in accordance with
manufacture's recommendations, as well as applicable standards established by the
Joint Commission on Accreditation of Health Care Organizations, which may be
updated annually.
37.10 Contractor shall install and maintain Automatic Vehicle Locator (“AVL”) devices on
all Service Vehicles. The AVL system shall be compatible and interface with the
County Dispatch Center’s software.
ELECTRONIC PATIENT CARE REPORT AND DATA COLLECTION SYSTEM
38.
Patient Care Reports
38.1
Contractor shall use Patient Care Reports ("PCR") for patient documentation on all
calls, including:
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a.
patient contacts;
b.
canceled calls; and,
c.
non‐transports, with the exception of refusal of service and disaster
response, pursuant to EMS Policies.
38.2
The PCR shall clearly identify any instance where two or more patients are
transported in the same Ambulance.
39.
Data Collection System for Patient Care Reports
39.1
Contractor shall work with EMS to create and use a single, uniform PCR and Data
Collection System that includes, but is not limited to:
a.
Ease of use
b.
NEMSIS (National EMS Information System) and CEMSIS (California EMS
Information System) compliant
c.
EMS dataset, which may be amended from time to time
d.
Ease of modifying dataset
e.
Ease of describing Graphical User Interface and input methods
f.
Compatible equipment/ platforms
g.
Integration with CAD
h.
Information validation
i.
Potential for integration with other information systems including, but not
limited to, Fire RMS (Records Management System)
39.2
j.
Regime for version updates
k.
Available technical support
l.
Potential for integration with hospital information systems
m.
Back‐end data querying, report writing, raw data access
n.
An effective, validated process to evaluate retention of PCRs
Contractor and County shall update, as needed, the PCR system, including but not
limited to updates to allow:
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39.3
a.
Additional data fields on the PCR
b.
EMS system data collection,
c.
The preparation of reports; and
d.
Software versions.
Contractor shall provide, at its sole expense, to EMS all hardware and software
necessary for reviewing and monitoring the PCR. Contractor shall, at its sole
expense, also provide a PCR reader or viewer to receiving hospitals.
39.4
Contractor shall use software in the PCR and Data Collection System to allow real‐
time access in the format specified by EMS. The software shall also provide detailed
operations, clinical, and administrative data in a manner that facilitates
retrospective analysis.
39.5
Contractor shall ensure its employees are trained on the Data Collection System.
39.6
Contractor shall provide PCR software, training, and mobile computers for each
FRALS unit, including Contracting Cities in Zone 1, as set forth in EXHIBIT M ‐ FIRST
RESPONDER SUPPORT.
39.7
Contractor shall provide upgrades to software and hardware as needed to maintain
compatibility with PCR users, including EMS and receiving hospitals.
40.
PCR Delivery to Receiving Hospitals or Psychiatric Facilities
100% of PCRs shall be provided to receiving hospitals and psychiatric facilities prior to
departure of Field Personnel. Contractor shall be fined if PCR compliance falls below 90%.
40.1
For every patient transported, especially High‐Risk patients (EXHIBIT N ‐ HIGH
RISK PATIENT DESCRIPTION), a complete, print‐copy of the PCR is to be left at the
receiving hospital and/or psychiatric facility prior to Field Personnel leaving.
Access to an electronic copy of the PCR by the hospital or psychiatric facility
shall not substitute for leaving a printed copy, unless authorized in writing
by the EMS Director.
40.2
In the event Field Personnel are unable to complete the PCR prior to leaving
the receiving hospital or psychiatric facility he/she shall:
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a.
Leave a print‐copy of the PCR with Mandatory Data Fields completed,
as described in EXHIBIT I ‐ MANDATORY DATA FIELD REQUIREMENTS); and,
b.
Deliver a fully completed PCR within 24 hours of the time Field
Personnel left the hospital/facility for that patient.
MEDICAL O VERSIGHT
41.
Medical Protocols
41.1
Contractor shall comply with medical protocols, online medical control, and other
requirements as established by the EMS Medical Director, and/or provided by the
County (e.g.: Base Hospital services, authority to perform certain medical
interventions, etc.).
41.2
Contractor shall document compliance with system medical protocols required by
EMS Policies and the State of California.
42.
Medical Review/Audits
If requested by the EMS Medical Director, Contractor’s employees shall attend medical
reviews and/or audits.
PERSONNEL
43.
Treatment of Incumbent Workforce
43.1
Contractor shall offer employment in substantially similar positions to all 911
Incumbent Personnel, who are qualified, insurable, and pass drug testing and
criminal background checks. This provision shall become invalid six (6) months
after the Service Start Date. This provision does not apply to dispatchers, billing staff
or senior management positions.
43.2
Contractor shall also offer to those employees currently working in the Alameda
County BLS Interfacility Transport Division of American Medical Response on the
Effective Date, preferential hiring in available positions to those who are qualified,
insurable, and pass drug testing and criminal background checks (e.g.: where there
are equally qualified applicants for an open position, current Alameda County AMR
employees shall be given preference.) This provision shall become invalid six (6)
months after the Service Start Date.
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43.3
Incumbent Personnel hired by Contractor shall retain their original hiring date for
seniority status for bidding shifts, partners, or other assignments, as permitted by
any applicable labor agreement.
43.4
Contractor shall provide a wage and benefit program which is, at a minimum,
comparable to the program provided to Incumbent Personnel on the Effective Date.
Contractor shall honor labor agreements in effect as of January 1, 2010 regarding
wage increases.
44.
Character/Competence/Professionalism
44.1
Contractor shall ensure that all employees, agents and subcontractors conduct
themselves in a professional and courteous manner. Contractor shall address and
correct any departure from this standard of conduct.
44.2
Contractor’s employees, agents and subcontractors shall, at all times when
providing Services, be competent and hold valid licenses, including, but not limited
to, a California driver’s license and, certificates, accreditations and permits, as may
be required for each position.
44.3
Contractor shall perform criminal background checks, pre‐employment drug testing
and confirm possession of a required license, certificates, accreditations, and
permits for all employees, including Incumbent Employees.
45.
Internal Health and Safety Programs
45.1
Contractor shall establish and maintain programs to enhance the safety and health
of the work force. These shall include but are not limited to:
a) driver training, b) safety, and c) risk management training.
45.2
Contractor shall provide adequate personal protective equipment (“PPE”) to
employees, including universal precautions for routine care, and personal protective
gear to employees working in hazardous environments, rescue operations, motor
vehicle accidents, etc.
45.3
Contractor shall establish a critical incident management plan, which includes an
ongoing stress reduction program for its employees. The plan shall also include
access to trained, experienced professional counselors. Plans for these programs
shall be submitted to the EMS Director for review.
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45.4
Contractor shall make health screening and all currently recommended
immunizations available at no cost to its Field Personnel, make‐ready staff
(individual preparing ambulances for deployment), and mechanics providing
Services.
46.
Personnel Training
Contractor shall ensure that Field Personnel performing Services meet all training
requirements as required in EMS Policies, as may be amended from time to time. Currently
applicable paramedic training requirements are set forth in EXHIBIT G, PARAMEDIC TRAINING
REQUIREMENTS.
47.
Continuing Education Program
47.1
Contractor shall apply for and maintain approval as an approved Continuing
Education (“CE”) provider in Alameda County. All in‐service programs offered for CE
credit must comply with Title 22 ‐ Chapter 11 and EMS Policies.
47.2
Contractor shall develop and provide in‐house CE training programs designed to
meet State licensure/certification requirements and/or County accreditation
requirements, at no cost to employees.
47.3
Contractor shall provide CE programs with educational content to address Alameda
County needs. The EMS Medical Director may mandate specific CE programs and
content requirements. County personnel may review and audit any CE programs
offered by the Contractor.
47.4
Contractor shall coordinate and make available CE programs to fire department
personnel in contracting cities, as may be arranged with the individual agencies.
Contractor may also make CE programs available to other entities.
48.
Workforce Engagement
48.1
Contractor shall provide to all Field Personnel an identification card that shall be
worn and visible; including a recent picture and that includes, at a minimum, the
employee’s:
a.
First name, last initial
b.
Title (EMT or Paramedic)
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48.2
c.
Certification or license number
d.
Company name
Contractor shall develop a two‐way communication process between front‐line
employees and the leadership team.
48.3
Contractor shall have a mechanism for: a) encouraging, b) gathering,
c) providing feedback on and, d) acting on employee improvement suggestions.
48.4
Contractor shall develop methods for providing system and individual performance
feedback to employees.
48.5
Contractor shall have a process for involving front‐line employees in quality and
performance improvement projects.
48.6
Contractor shall track credentialing requirements for all EMTs, Paramedics, and
Supervisors providing Services, including Contractor’s employees working in the
County Dispatch Center.
48.7
Contractor shall develop a career ladder and professional development process for
employees, including a succession plan for Key Personnel.
48.8
Contractor shall collaborate with fire departments in the County to create a career
ladder for Paramedics, internships and field orientation.
48.9
Contractor shall use experienced clinicians to train, mentor, monitor, and assist less
experienced Paramedics and EMTs in the field.
48.10 Contractor shall make efforts to have diversity in the workforce, including the level
of diversity in alignment with the community. Part of this effort shall include a
targeted recruitment plan approved by the EMS Director no later than eight months
prior to Service Start Date.
48.11 Contractor shall develop practices and policies designed to promote workforce
harmony and prevent discrimination, including discrimination based on age,
national origin, gender, race, sexual orientation, religion, and physical ability.
49.
Key Personnel and Required Positions
49.1
Contractor shall have an identified person authorized and capable to act on behalf of
the Contractor in operational matters available at all times.
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49.2
Contractor's Key Personnel are as follows:
a.
Operations Manager (Chief Operations Officer): Contractor shall provide
a full‐time Operations Manager to oversee and be responsible for the
provision of Services. This person shall have prior experience managing a
large, high‐performance emergency medical system. This individual shall be
responsible for ensuring that all upper‐level management positions are
trained and participate in the Contractor's Quality Management Plan.
b.
Provider Medical Director: Contractor shall provide a half‐time (0.5 FTE)
physician, experienced in emergency medical services, to oversee clinical
areas.
c.
Quality Manager: Contractor shall provide a full‐time physician, Registered
Nurse, or highly qualified and experienced Paramedic to implement and
oversee Contractor's quality management plan. This individual shall be
responsible for the medical Quality Improvement/ Assurance evaluation of
all Services.
49.3
Key Personnel positions must be distinct and separate from each other. In no event
shall any one person perform any two of the Key Personnel positions. Contractor
shall notify the EMS Director in writing of any changes in Key Personnel.
49.4
Contractor shall remove Key Personnel if in the opinion of the EMS Director an
individual has not performed in a manner acceptable to the County.
49.5
The approval of County to a requested change in Key Personnel shall not release
Contractor from any of its obligations under this Agreement.
49.6
Contractor agrees that it shall not transfer or reassign the individuals in Key
Personnel positions without the express written agreement of County, which
agreement shall not be unreasonably withheld. Should such individual or
individuals in the employ of Contractor no longer be employed by Contractor during
the term of this Agreement, Contractor shall make a good faith effort to present to
the County an individual with greater or equal qualifications as a replacement,
subject to the County’s approval, which approval shall not be unreasonably
withheld.
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49.7
Contractor’s Key Personnel shall participate in ongoing training and development
programs for emergency medical service managers. These programs should be
offered by Contractor to those personnel at no cost.
49.8
In addition to the Key Personnel, Contractor shall hire separate individuals for each
Required Positions.
49.9
Required Positions must be staffed, at a minimum, as follows:
a.
Operational Field Supervisors: there shall be at least one on duty at all
times.
b.
Clinical Field Supervisors: there shall be no fewer than three (3) Clinical
Field Supervisors on duty at all times.
Be experienced, clinically and administratively competent Paramedics
with prior teaching/training experience.
Respond to all Echo Level calls to provide oversight and assistance as
required. Respond to all Delta level calls when available.
Respond to Alpha, Bravo, and Charlie calls when available to observe
Field Personnel in the delivery of service and care.
Provide direct, case‐by‐case oversight of clinical personnel
Not be responsible for delivery of supplies or equipment, with the
exception of multi‐casualty incidents and disaster responses.
Coordinate data collection for ongoing compliance in collection and
reporting of cardiac arrest, airway, 12‐lead data
Direct and assist with research and compliance for research in trial
studies, focused audits, and State‐directed demonstration projects
Teach and reinforce clinical EMS Policies in the field and in trainings
Introduce new techniques and procedures as directed by the EMS Medical
Director.
Facilitate the use of educational software
Collaborate with EMS Leadership and Prehospital Care Coordinators
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Be available to respond as a resource for difficult clinical issues
Communicate with base physicians and EMS on‐call staff
Beta test clinical trials, pilot studies, and new equipment
Coordinate with other providers' clinical supervisors
Participate in the County’s EMS Quality Council with the Quality Manager
and/or other performance improvement committees, as requested.
c)
Analyst: there shall be at least one full‐time analyst assigned to evaluate
Patient Care Reports.
d)
Clinical/Education Staff: there shall be at minimum, two full‐time clinical
and educational staff positions to assist the Quality Manager.
e)
In addition, Contractor shall provide for eighty (80) compensated hours a
month for designated Field Personnel to participate in clinical quality
improvement activities.
49.10 Contractor’s Key Personnel and Required Positions shall receive training from or
comparable to the American Ambulance Association's Ambulance Service Manager
Certificate Program. This training shall occur within twenty‐four (24) months of the
Effective Date or hire date.
QUALITY MANAGEMENT PLAN
50.
Approval of Quality Management Plan
50.1
Contractor shall work with EMS to develop a Quality Management Plan.
The Quality Management Plan shall:
a.
Be consistent with the requirements of the State California for emergency
medical system quality improvement, including those contained in Title 22,
Chapter 12.
b.
Be consistent with the most current edition of the Baldrige National Quality
http://www.quality.nist.gov/HealthCare_
Program, Health
Care Criteria for Performance Excellence.
c.
Be consistent with EMS Policies.
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d.
Be integrated with First Responder Agencies, County Dispatch Center, and
EMS Agency.
e.
Incorporate compliance assurance, process measurement and control, and
process improvements.
f.
Measure clinical indicators as developed through collaborative efforts with
the County.
h
Be based on current EMS research and call demand.
i.
Endeavor to ensure the long‐term economic viability of the EMS system
while maximizing value to the community. Contractor shall achieve financial
and service targets through process improvement, standardization, and
evaluation of internal programs.
50.2
The final Quality Management Plan must be submitted to the EMS Director for
approval three (3) months prior to the Service Start Date. The EMS Director may
revise the requirements of the Quality Management Plan from time to time.
50.3
Contractor shall ensure that Key Personnel and Required Positions actively
participate in the leadership and oversight of the Quality Management Plan,
including but not limited to:
a.
Actively participating in EMS groups and/or committees dealing with quality
management
b.
Designating a manager to oversee Contractor’s quality program
c.
Submitting a comprehensive Quality Improvement reports to the County
d.
Actively participating in projects designed to improve the quality of
emergency medical services in Alameda County.
51.
California Award for Performance Excellence
Contractor shall apply for the California Award for Performance Excellence in year five of
this agreement.
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REQUIRED REPORTS
52.
Reporting Requirements
52.1
Contractor shall provide, within thirty (30) calendar days after the first day of each
month, reports addressing its performance during the preceding month with
respect to the clinical, operational, and financial performance requirement, in the
form and manner required by the EMS Director.
Reports shall include, but are not limited to:
a.
Response Time Compliance reports
b.
Reports on customer complaints
c.
Clinical Reports (e.g.: protocol compliance, cardiac arrest survival rate,
intubation success rate, etc.)
52.2
d.
Workload trends for Field Personnel assigned to 24‐hour shifts
e.
Other reports as requested by County.
Other reports may be required less frequently than monthly, as determined by the
EMS Director.
52.3. County shall provide notice to Contractor at least two (2) months in advance of any
change to required reports, frequency, or due dates.
53.
Response Time Performance
53.1
Response Time data, including reports received from County Dispatch Center, shall
be used by Contractor and County to evaluate Contractor's performance and
compliance. Contractor shall make efforts to continually improve Response Time.
53.2
If Response Time compliance is below 90%, Contractor shall identify the causes and
shall document efforts to eliminate problems on an ongoing basis.
53.3
For any month in which compliance with Response Time is less than 90%,
Contractor shall submit a performance improvement plan with the monthly
Response Time performance report. The performance improvement plan shall
identify each problem that contributed to a failure to meet Response Times and
steps being taken to correct the problem.
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53.4
Response Time reporting and times shall be documented as set forth in this
Agreement.
54.
High‐Risk PCRs
54.1
Contractor shall conduct an audit by randomly selecting and reviewing a minimum
of ten percent (10%) of the High‐Risk PCRs. The monthly audit shall review
compliance with EXHIBIT I ‐ MANDATORY DATA FIELD REQUIREMENTS.
54.2
Each non‐compliant High‐Risk PCR from this audit shall be evaluated by Contractor
and the EMS Medical Director.
54.3
Contractor shall prepare a monthly report documenting compliance with Mandatory
Data Fields (EXHIBIT I ‐ MANDATORY DATA FIELDS) for High Risk PCRs (EXHIBIT N ‐ HIGH
RISK PATIENT DESCRIPTION).
55.
Compliance with Protocols
55.1
Contractor shall produce monthly reports that describe the overall compliance with
EMS Policies and performance in all calls.
55.2
Reports for compliance shall be submitted in aggregate and stratified by categories
identified in the Quality Management Plan and approved by the EMS Director.
56.
Quality Improvement
56.1
Contractor shall develop a clear and concise set of processes and practices designed
to identify and address opportunities for improvement. The description of these
processes shall include the approach for achieving and maintaining measurable
outcomes.
56.2
Contractor shall provide reports that update progress on quality improvement
projects as requested by the EMS Director.
56.3
Contractor shall provide reports on key performance indicators and key result areas
as requested by the EMS Director.
PENALTY PROVISIONS
57.
Failure to Respond
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Contractor shall pay to County $25,000 for each failure by the Contractor to provide an
Ambulance to a location within the EOA where a response has been requested by the
County Dispatch Center. Payment of such fines does not release Contractor of any other
liability from their failure to respond.
58.
Response Level
Contractor shall pay to County $500 for every incident in which a BLS Ambulance responds
to a call and/or transports a patient requiring an ALS Ambulance.
59.
Missing Mandatory Data Fields
Contractor shall pay to County $500 for each High‐Risk PCR where one or more of the
Mandatory Data Fields are not complete.
60.
Missing PCR at the Receiving Hospital or Psychiatric Facility
60.1
A complete PCR is one where all patient care information required has been
entered, as defined in EMS policies.
60.2
A complete print‐copy PCR shall be left at the receiving hospital prior to departure
of Field Personnel.
60.3
If Field Personnel are unable to leave a complete print‐copy of the PCR, a PCR with
at least the Mandatory Data Fields completed shall be left at the receiving hospital
or psychiatric facility prior to departure of Field Personnel from the hospital or
facility. If neither a complete PCR, nor a PCR with at least the Mandatory Data Fields
completed is left, Contractor shall be fined $50 per occurrence. For High Risk PCRs,
this fine shall be $500.
60.4
Where a partial PCR with only Mandatory Data Fields completed was left instead of
a complete PCR, the Contractor shall deliver a complete print‐copy of the PCR for
that patient within 24 hours of the departure of Field Personnel from the receiving
hospital or facility.
60.5
If a complete print‐copy of the PCR is not delivered within the 24‐hour period
specified above, that PCR shall be considered late and incomplete, and subject to
additional fines of $50 per occurrence.
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60.6
If in any consecutive 30‐day period Contractor falls below ninety percent (90%)
compliance with the PCR print copy submittal requirements, Contractor shall pay to
County an additional fine of $10,000.
61.
PCR Good Cause Exemption
61.1
Contractor may apply for an exemption for fines related to any PCR. Any application
for an exemption must be in writing and include justification for each exemption
requested.
61.2
It is within the sole discretion of the County to grant an exemption based on the
facts and circumstances of each case.
62.
Failure to Provide Timely Reports
Contractor shall promptly deliver each required report to the County. Contractor shall pay
to County a fine of $50 per day for each day a report is late.
63.
Failure to Meet Minimum In‐Service Equipment/Supply Requirements
Contractor shall pay to the County a fine of up to $1,000 for any Service Vehicle that fails to
comply with EMS Policies.
64.
Failure to Provide Arrival at Incident Time
64.1
Contractor shall pay County a $500 fine each and every time an Ambulance is
dispatched and Contractor fails to document the Arrival at Incident time.
64.2
When the Arrival at Incident time for a call is not accurate, the response to that call
shall be deemed to have exceeded Response Time.
64.3
Continued failure to meet Response Time standards may be considered a Major
Breach of the Agreement.
65.
Response Time Fines
65.1
Contractor shall pay to County a fine any time Response Time compliance drops
below 90% for any consecutive 30‐day period, as shown in EXHIBIT F ‐ RESPONSE TIME
REQUIREMENTS AND PENALTIES (TABLE B, Response Time Fines by Category and
Compliance). Response Time compliance shall be based on the percentage of
compliance for each:
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65.2
a.
Category (Echo, Delta, Charlie, Bravo, Alpha)
b.
Response Zone, (Zone 2, 3, 4, 5), and
c.
Subarea (metro/urban, suburban/rural, wilderness).
If Response Time compliance for Echo calls drops below 90%, a performance
improvement plan must be submitted to the EMS Director with the monthly
compliance report. The performance improvement plan must identify each problem
that led to the delayed response and the steps being taken to correct each such
problem.
66.
Fines for Outlier Response Times
66.1
An Outlier Response Time is defined as greater than 150% of the designated
Response Time (as described in EXHIBIT F – TABLE A) for the category.
66.2
Fines for Outlier Response Times shall be based on the individual call category and
the subarea. In addition to any other fines, Contractor shall pay to County fines for
Outlier Response Times as shown IN EXHIBIT F ‐ RESPONSE TIME REQUIREMENTS AND FINES
(TABLE C, OUTLIER RESPONSE TIMES BY CATEGORY AND SUBAREA IN MINUTES & SECONDS).
67.
Fine Disputes
67.1
If Contractor has failed to document an Arrival at Incident Time, an exemption from
the fine may be granted if Contractor demonstrates, to the satisfaction of the EMS
Director, an accurate Arrival at Incident time.
67.2
Contractor may appeal a fine to the EMS Director in writing within fourteen (14)
calendar days of receipt of notification of the imposition of a penalty or fine
calculations.
67.3
The EMS Director shall review all appeals and make the decision to eliminate,
modify, or maintain the fine. The EMS Director’s decision shall be final.
68.
Invoicing and Payment
68.1
County shall invoice Contractor for any fines or penalties under this Agreement
within thirty (30) calendar days following County’s receipt of Contractor’s monthly
performance reports. Contractor shall pay County within thirty (30) calendar days
following receipt of the invoice. The parties shall make a good faith effort to resolve
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any disputes regarding an invoiced amount within this 30‐day period. If the parties
are unable to mutually resolve the dispute within that 30‐day period, the invoice
shall be paid in full and subsequent invoices shall be adjusted to reflect the
subsequent resolution of the dispute.
68.2
Failure by the County to assess or impose any penalties or fines at any point, for any
reason, does not impact County’s right to do so in the future; however, County may
not impose fines retroactively greater than three (3) months.
68.3
Payment of any fine does not release Contractor from any other liability related to
the breach that resulted in fine imposition.
COUNTY ‐W IDE COOPERATION
69.
Collaboration with First Responder Agencies
69.1
Continuing Education
All ALS and BLS continuing education offered by Contractor to its employees under
this Agreement shall also be available to First Responder Agencies.
69.2
Training and Internships
a.
Contractor shall enter into agreements with emergency medical services
training programs within Alameda County to provide field experience for
EMT and/or Paramedic training programs.
b.
Contractor shall develop a collaborative partnership whereby field personnel
from all First Responder Agencies, and Contracting Cities are provided field
internships opportunities, including working with field training officers for
initial system training.
c.
All training conducted shall comply with EMS Policies.
69.3
Contractor shall designate a Paramedic as a liaison with First Responder Agencies.
69.4
First Responder Equipment and Supplies
a.
Contractor shall provide the equipment described in EXHIBIT M ‐ FIRST
RESPONDER SUPPORT for use by all First Responder Agencies at no cost.
Contractor shall maintain ownership of the equipment at all times, and shall
be responsible for maintenance of all equipment.
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b.
Contractor shall provide, at no cost to First Responder Agencies, required,
standardized expendable medical supplies, excluding pharmaceuticals, as
defined in EMS Policies.
c.
Contractor, at the request of any First Responder Agency, shall manage their
inventory including on‐site inventory audits and inventory orders placed on
behalf of the agency.
d.
First Responder Agencies may request Contractor to provide a price quote
and order supplies or equipment that are in addition to those defined as
expendable medical supplies in EMS Policies at the cost of the requesting
First Responder Agency.
e.
Contractor shall develop a supply consortium in collaboration with First
Responder Agencies to buy supplies and equipment that Contractor is not
obligated to provide using Contractor's suppliers.
70.
EMS System Participation
Contractor shall participate and assist in changes related to emergency medical services in
Alameda County. Contractor shall participate in local activities, committee meetings, and
work groups related to provision of Services.
HEALTH S TATUS IMPROVEMENT/COMMUNITY E DUCATION
71.
EMT Training Programs, Internships and Related Opportunities
71.1
Contractor shall implement a planned, multifaceted process to attract, recruit, and
train EMTs from underrepresented populations.
71.2
Contractor shall establish an in‐house EMT training program where students age 18
or over can participate in a work/study program, earning full‐time wages, while
progressing toward the National Registry and California EMT certification.
72.
Community Programs
72.1
Contractor shall participate in community programs that are of interest to the
County, with community organizations such as those that support youth
development activities and ethnic health initiatives.
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72.2
Contractor shall plan and implement an annual community education program as
described in EXHIBIT L ‐ COMMUNITY EDUCATION PROGRAM.
72.3
In addition, Contractor shall provide the following to the community and/or to
benefit the community:
a.
Website ‐ Create and maintain a website shall be created and maintained
with links to continuously updated audio/video files on various emergency
health topics such as “Calling 911,” “What to Expect When the Ambulance
Arrives,” and “How Do I Become a Paramedic?”
b.
Speakers' Bureau ‐ Organize and maintain a speakers’ bureau to provide
speakers on health related topics to community organizations.
c.
Automatic External Defibrillator (AED) Distribution ‐ Contractor shall
purchase and cause to be maintained 10 AEDs each year for distribution
consistent with the EMS AED program, at locations throughout Alameda
County. Contractor shall work with County EMS to determine locations for
AED placement. The final decision regarding locations for AED placement
shall be at the discretion of the EMS Director.
d.
CPR Training –Contractor shall offer free CPR classes to the public at least
once a month and encourage family members of heart attack patients
transported by EMS to attend free classes. These classes are to be rotated
throughout the north, south, central and tri‐valley areas of Alameda County.
Contractor may work with EMS to assist in EMS CPR programs.
e.
EMS Week and Public Education – Contractor shall use the EMS Week
platform to conduct public education activities on a variety of topics which
may include stroke recognition and prevention, fall prevention for elderly
citizens, heart attack warning signs, pool safety and child playground safety.
Contractor shall collaborate with the EMS, the Public Health Department, area
Fire Departments, and other stakeholders to identify and target the most
appropriate topics.
ENVIRONMENTALLY F RIENDLY B USINESS PRACTICES
73.
Buildings and Vehicles
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73.1
Contractor shall search for at least one green building in Alameda County, consistent
with US Green Building Counsel, LEED v3.0 Silver criteria.
73.2
74.
All Service Vehicles shall be 2010 model year or later, low emission vehicles.
Equipment and Supplies
74.1
Contractor shall reduce, reuse, and recycle.
74.2
Purchasing shall be consistent with guidelines from the Responsible Purchasing
Network. Considerations in equipment purchasing shall include EPA Energy Star
and/or Electronic Product Environmental Assessment Tool (EPEAT) labeled. When
possible, products shall be recycled content and/or bio‐based.
74.3
Recycling shall be implemented to support the Alameda County goal of reducing
waste going to landfills by 75 percent and coordinated with StopWaste.org as
needed.
75.
Medical Equipment and Supplies
Contractor shall iiimplement an Environmentally Preferable Purchasing program with an
emphasis on the Precautionary Principle for the pPurchase, handling, and disposal of
medical equipment and supplies.
COMPLIANCE PROVISIONS
76.
Medicare Compliance Program Requirements
76.1
Contractor shall implement and maintain a comprehensive Medicare compliance
program for all activities, including but not limited to documentation, claims
processing, billing, and collection.
76.2
Contractor’s Medicare compliance program shall substantially comply with the
regulatory approach program outlined in the Office of Inspector General (OIG)
Compliance Program Guidance for Ambulance Suppliers as published in the Federal
Register on March 24, 2003 (03 FR 14255), and any amendment there to.
77.
HIPAA Compliance Program Requirements
77.1
Contractor shall implement a comprehensive plan to abide with the Health
Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the current
rules and regulations enacted by the Department of Health and Human Services.
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77.2
The plan shall be sent via immediate email and a follow up letter sent the same day
to EMS Director.
77.3
Contractor shall be responsible for all aspects of complying with these rules and
particularly those enacted to protect the confidentiality of patient information. Any
violations of HIPAA rules and regulations shall be reported immediately to the
County along with Contractor’s actions to mitigate the effect of such violations.
78.
EMS Policies
Contractor shall comply with County EMS Policies, as may be updated or revised from time
to time.
79.
Medical and Other State and Federal Programs
Contractor is responsible for complying with all rules and regulations associated with
providing services for recipients of and being reimbursed by State Medi‐Cal and other state
and federally funded programs.
CONTRACTOR REVENUE
80.
Contractor Compensation
Contractor's compensation under this Agreement is through fee for service reimbursement
of patient charges (“User Fees.”)
81.
Patient Charges and Fees
User Fees shall be established by the County, by approval of a majority vote of the Board.
Contractor is prohibited from charging in excess of the approved User Fees as set forth in
EXHIBIT H ‐ CONTRACTOR'S USER FEES ‐ 911 SYSTEM.
82.
User Fee Adjustments
82.1
EMS Director shall approve annual increases to User Fees based on changes in the
Consumer Price Index for All Urban Consumers, San Francisco‐Oakland (“CPI”).
Annual rate increases shall be the greater of two and one‐half percent (2.5%) or the
increase in the CPI for the most recent 12‐month period, capped at five percent
(5%).
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82.2
In the event that changes occur within Alameda County that substantially impact
Contractor’s costs of providing services, Contractor may request increases or
decreases in User Fees.
83.
Billing/Collection Services
83.1
Contractor shall establish a dedicated Customer Service Telephone Line, as set forth
in this Agreement, including section 85.
83.2
Contractor shall designate a local employee to handle service inquires and
complaints.
83.3
Contractor shall provide a billing and accounts receivable system that is well
documented, easy to audit, and designed to minimize the effort required of patients
to recover payments from insurance companies or other third party sources.
83.4
Contractor shall make no attempts to collect its fees at the time of service.
Contractor shall maintain and use a billing system that electronically generates and
submits claims for patients receiving Medicare or Medi‐Cal.
83.5
Contractor shall not charge or bill patients covered by, or who provide evidence of
eligibility for, County Medical Services Plan (CMSP), nor shall Contractor charge or
bill County for services to these patients.
83.6
Contractor shall not charge the County or any governmental entity requesting
Services for patients transported intra‐county while in custody or on a psychiatric
(5150) hold. Contractor may bill the patient’s insurance; however, Contractor shall
not bill the patient directly for Services.
83.7
Contractor shall not bill the individual requesting Services for a work‐related injury
at the time of injury. Contractor may bill the appropriate insurer, unless the
employer is a public entity that is self‐insured.
83.8
Contractor shall include on all billing statements contact information for the person
designated to respond to billing inquiries.
83.9
Contractor shall conduct all billing and collection activity in a professional and
courteous manner.
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83.10 Contractor shall submit its billing and collection policy to the EMS Director for
review, prior to Service Start Date.
84.
Accounting Procedure
Contractor shall allocate no more than $500,000 annually to corporate overhead costs. This
limit shall be adjusted annually based on the Consumer Price Index for All Urban
Consumers, San Francisco‐Oakland.
84.1
Audits and Inspections
a.
Throughout the term of this Agreement, including any renewal periods,
Contractor, at the end of each of its fiscal years, shall provide a statement of
operations related to the performance of duties contained in this Agreement.
Contractor shall report earnings in this statement of operations using
generally accepted accounting principles (GAAP) within ninety (90) days of
Contractor’s fiscal year end. Such statement of operations shall be reviewed
by an independent accounting firm, selected and paid for by Contractor.
b.
With reasonable notification and during normal business hours, County shall
have the right to review any and all business records including financial
records of Contractor pertaining to the Agreement. All records shall be made
available to County at the EMS office or other mutually agreeable location.
c.
The County may audit, copy, make transcripts, or otherwise reproduce such
records, including but not limited to contracts, payroll, inventory, personnel
and other records, daily logs, and employment agreements.
d.
Additionally, Contractor shall provide the annual consolidated audited
financial statements of East Texas Medical Center Regional Healthcare
System throughout the term of this Agreement, including any renewal
periods.
84.2
Profit Cap
Contractor has agreed to cap its annual net profit for Services at 7%. Contractor
shall provide an annual statement of it net profits within 120 calendar days of the
end of Contractor's fiscal year. All profits in excess of 7% shall be disbursed to
County within 30 calendar days.
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85.
Customer Service Telephone Line
85.1
Contractor shall establish and publish a Customer Service Telephone Line giving
internal and external customers and system participants the ability to contact a
designated liaison of the Contractor’s leadership team. The telephone line shall be
accessible without charge to all callers within the continental United States.
85.2
The number may be answered by a designated manager or provide an opportunity
for the caller to leave a voicemail message. The number shall be published in the
local telephone directory, on the Contractor’s website, and publicized at local health
care facilities, fire stations, and public safety agencies.
85.3
If the number is answered by an automatic greeting and/or menu selection, and
should a caller inadvertently call the customer service line looking for emergency
service, the initial message must immediately convey that this is a customer service
line, if caller has an emergency hang up and dial 911.
85.4. Members of the Contractor’s Leadership Team are to be automatically notified via
pager of any incoming calls. A management designee must return the call to the
customer within 30 minutes, 90% of the time. Incidents that require follow up to the
customer should be resolved by the end of the next business day from when the call
was received, and if not possible, a call should be made to the customer with the
status of the request.
85.5
Handling Service Inquiries and Complaints:
a.
Contractor shall log the date and time of each inquiry and service complaint.
Contractor shall provide a prompt response and follow‐up to each inquiry
and complaint. Such responses shall be subject to the limitations imposed by
patient confidentiality restrictions.
b.
Contractor shall submit to the County a list of all complaints received and the
disposition/resolution on a monthly basis. Copies of any inquiries and
resolutions of a clinical nature shall be referred to the EMS Medical Director
using the EMS Unusual Occurrence procedure, within twenty‐four (24) hours
of the initial inquiry.
c.
Contractor shall submit to the EMS Director a description of the Contractor’s
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process for managing service complaints prior to the Service Start Date.
86.
Contractor's Compensation to the County
86.1
First Responder Support Fees
Contractor shall pay to the County an annual first responder support fee of four
million six hundred thousand dollars ($4,600,000.00). Payment shall be made in
quarterly installments of $1,150,000.00. The first quarterly installment shall be
made on or before the Service Start Date. Thereafter, payment shall be made upon
receipt of an invoice from County.
The amount of the first responder support fees shall increase 3% per year for the
term of the Agreement, beginning one year from the Service State Date.
86.2
Dispatch System Fees
Contractor shall pay Dispatch fees in the amount of one million, five hundred
thousand dollars ($1,500,000.00) annually. Payment shall be made to ACREEC, as
specified in Contractor's separate agreement for dispatch services, with verification
of payment sent by Contractor to the EMS Director.
A DMINISTRATIVE P ROVISIONS
87.
Annual Performance Evaluation
The County may evaluate the performance of the Contractor on an annual basis. Contractor
shall provide a report to the County to assist in this evaluation within 60 calendar days of
written notice by County of its intention to conduct a performance evaluation. The report is
to include the following information:
a.
Response Time performance
b.
Clinical performance
c.
Innovative programs that have been initiated to improve system
performance
d.
Update on its work force, including efforts to minimize employee turnover
e.
Update on community education programs and other community initiatives
f.
Other information as requested by County
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g.
88.
Other information Contractor would like considered by County.
Assurance of Performance
88.1
If at any time, the County believes Contractor may not be adequately performing its
obligations under this Agreement or that Contractor is not performing the Services
as required by this Agreement, County may request from Contractor prompt written
assurances of performance and a written plan acceptable to County, to correct the
deficiencies in Contractor’s performance.
88.2
Contractor shall provide written assurances and a written plan within ten (10)
calendar days of its receipt of County’s request and shall thereafter diligently
commence and fully perform such written plan.
88.3 Contractor’s failure to provide such written assurances and written plan within the
required time is a material breach of this Agreement.
89.
Material Breach
89.1
Willful failure of Contractor to provide Services under this Agreement in substantial
compliance with the requirements of the applicable Federal, State, and County of
Alameda laws, rules, and regulations shall constitute a material breach by
Contractor. Minor infractions of such requirements shall not constitute a material
breach unless such infractions are willful and repeated.
89.2
Acts or omissions that shall constitute a material breach by Contractor include but
are not limited to the following:
a.
Willful falsification of data supplied to County during the course of
operations, including but not limited to dispatch data, patient report data,
Response Time data, financial data, or falsification of any other data required
under Agreement;
b.
Willful failure to maintain equipment in accordance with the requirements of
this Agreement;
c.
Willful attempts to intimidate or punish employees who participate in
protected concerted activities, or who form or join any professional
associations;
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d.
Chronic and persistent failure to require employees to conduct themselves in
a professional and courteous manner, and to present a professional
appearance;
e.
Willful failure of Contractor to comply with approved rate setting, billing, and
collection procedures;
f.
Repeated failure to meet Response Time requirements after receiving notice
of non‐compliance from the EMS Director;
g.
Failure to maintain the required insurance or to provide and maintain the
required performance security bond;
h.
Willful failure to comply with vehicle lease provisions;
i.
Willful and repeated material breaches of Contractor’s backup provisions.
j.
Willful failure to comply with executed Mutual‐Aid agreements;
k.
Failure to timely obtain and maintain the necessary licensing and/or
certification required by law to provide Services;
89.3
Following County’s announcement of initiation of a new procurement process, and
prior to termination of Services under this Agreement, the following shall be
considered a material breach by Contractor:
a.
Deliberate, excessive, and unauthorized scaling‐down of operations.
b.
Attempts to intimidate or otherwise punish employees who desire to sign
contingent employment contracts with competing providers.
90.
Notice and Cure of Material Breach
90.1
County shall give Contractor written notice, return receipt requested, setting forth
with reasonable specificity the nature of a material breach.
90.2
Contractor shall have the right to cure the material breach within ten (10) calendar
days of receipt of notice. Within twenty‐four (24) hours of receipt of a material
breach notice, Contractor shall deliver to County, in writing, a plan of action to cure
the material breach.
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90.3
If the material breach, by its nature, cannot reasonably be cured within ten (10)
calendar days, Contractor may request additional time to complete cure of the
breach.
91.
County Remedies
91.1
County shall have the right to terminate this Agreement in addition to any other
legal remedy in the event of a material breach that is not cured within the time
specified.
91.2
County's remedies for any breach are non‐cumulative and in addition to any other
remedy available to the County.
91.3
If the County determines any breach has occurred, County may require Contractor
to submit a corrective action plan. Failure to submit and implement any requested
corrective action plan may be considered a material breach.
92.
Continuous Service Delivery
Contractor agrees that there is a public health and safety obligation to assist County in
every effort to ensure uninterrupted and continuous service delivery in the event of a
material breach, even if Contractor disagrees with the determination of material breach.
93.
Emergency Takeover
93.1
If the Board by majority vote determines that the health and safety of Alameda
County residents would be endangered by allowing Contractor to continue
providing Services, County may take over the provision of Services on an emergency
basis (“Emergency Takeover”). The Board shall give notice to Contractor of the date
and time the Emergency Takeover shall be effective.
93.2
Upon notice of an Emergency Takeover, Contractor shall promptly and continually
cooperate with County to effectuate an orderly transition. This shall include, but not
be limited to:
a.
Immediate delivery to County, or its designee, of all Service Vehicles, and
equipment used to provide Services (“Emergency Takeover Equipment”).
Each Ambulance shall be equipped, at a minimum, with the equipment and
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supplies necessary for the operation of ALS Ambulances, in accordance with
EMS Policies.
b.
Immediate access to and use of all locations used to provide Services,
including, but not limited to, those locations where Contractor places its
Ambulances (“crew stations”) during the Emergency Takeover.
93.3
Failure of Contractor to cooperate fully with the County in the event of an
Emergency Takeover shall constitute a material breach.
93.4
As of the date the Emergency Takeover is effective, all of Contractor’s Service
Vehicles, fully equipped for provision of Services, shall be deemed leased to the
County, during the Emergency Takeover, at the rate of $1.00 (One Dollar) per month
per vehicle.
93.5
County may recover from Contractor costs associated with an Emergency Takeover
including ongoing rent payments and other liabilities.
93.6
Contractor shall inform and provide a copy of takeover provisions contained herein
to all vehicle and real property lien holder(s) within five (5) calendar days of
Emergency Takeover
93.7
County, by a majority vote of the Board, may discontinue the Emergency Takeover
at any time, and return the Emergency Takeover Equipment to Contractor, who
shall resume providing Services pursuant to the full terms and conditions of the
Agreement.
93.8
County shall return Emergency Takeover Equipment to Contractor in good working
order, normal wear and tear excepted, at the end of the Emergency Takeover.
Otherwise, County shall pay Contractor the fair market value of the Emergency
Takeover Equipment as of the commencement of the Emergency Takeover, or shall
pay Contractor the reasonable costs of repair, or shall promptly repair and return
such Emergency Takeover Equipment.
94.
Termination
94.1
Mutual Termination
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This Agreement may be terminated early by mutual consent of the Contractor and
the County.
94.2
Walk Away by Contractor
If Contractor stops providing Services prior to the termination of this Agreement
(“Walk Away”), the following provisions shall apply; however in no event shall
Contractor give notice to County less than 90 days prior to stopping Services:.
a.
County may lease any and all Service Vehicles, including, but not limited to,
fully‐equipped Ambulances and Supervisor Vehicles, for one dollar ($1.00)
per month per vehicle. County shall have full use of vehicles and equipment
and may, at County's sole option, hire a management company to manage
ambulance operations until a replacement provider for the EOA is selected
through a County procurement process. The lease agreement shall be non‐
transferrable to a new ambulance provider, and shall terminate on the
services start date of the new provider.
b.
Contractor shall fully cooperate if County elects to lease any or all Service
Vehicles pursuant to this provision. County shall be responsible for insuring
all vehicles it leases pursuant to this provision. Alternatively, County may
elect to purchase the vehicles at their depreciated value as of the date of such
election. County shall have sole discretion as to which vehicles it leases or
purchases pursuant to this provision.
Contractor and County shall negotiate a contingent lease agreement prior to Service
Start Date.
94.3
Termination for Cause
a.
If Contractor fails to cure any material breach, following notice and
opportunity to cure, County, upon written notice to Contractor, may
terminate this Agreement for cause. The termination shall be effective on the
date specified in the written notice.
b.
Contractor shall be responsible for all costs incurred by County due to
termination for cause.
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c.
In the event of termination for cause, County may purchase any and Service
Vehicles at the current depreciated value as of the effective date of the
termination. Alternatively, County may elect to rent the Service Vehicles for
fair market rental price, as of the effective date of the termination, as
determined by a neutral appraiser. County shall have sole discretion as to
which vehicles it purchases or rents pursuant to this provision.
94.4
End‐of‐Term Provisions
a.
Contractor shall make no changes in methods of operation for purposes of
reducing Service or Contractor’s operating costs prior to termination of the
Agreement, without the written consent of County.
b.
Contractor shall make no changes prior to termination of the Agreement that
could increase costs to a new provider.
c.
Contractor shall have ninety (90) calendar days after termination of the
Agreement in which to supply the required audited financial Statements and
other such documentation necessary to facilitate the close out of the
Agreement at the end of the term.
F UTURE C OMPETITIVE PROCUREMENT PROCESS / “L AME DUCK ” P ROVISIONS
95.
Competitive Procurement Process
95.1
County has the right to conduct a competitive procurement process for the
provision of medical Ambulance service within its EOA, and a requirement to do so
at certain time intervals.
95.2
County may select a different Ambulance service provider to provide exclusive
medical Ambulance services within the EOA following a competitive procurement
process.
95.3
Contractor shall continue to provide all Services after notification by County of its
intent to initiate a competitive procurement process. Contractor shall be in material
breach if it does not continue Services at the same level of effort and performance as
were in effect prior to a notice of intent to initiate a competitive procurement
process.
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95.3
Contractor shall not penalize or bring personal hardship to bear upon any of its
employees who apply for work on a contingent basis with competing proposers, and
shall allow, without penalty, its employees to sign contingent employment
agreements with competing proposers. Contractor may prohibit its employees from
revealing trade secrets or other information about Contractor’s business practices
or field operations.
96.
“Lame Duck” Provisions
96.1
If and when County announces its intent to change providers, Contractor agrees to
continue to provide all Services until the County or a new provider assumes
responsibilities for provision of Services. This shall include any time period after
notification by County of its intent to initiate a competitive procurement process.
96.2
Contractor shall be in material breach if it does not continue all operations and
Services at the same level of effort and performance as were in effect prior to notice
of intent to change providers.
96.3
Contractor shall make no changes in methods of operation for purposes of reducing
Service or Contractor’s operating costs prior to termination of the Agreement,
without the written consent of County.
96.4
Contractor shall make no changes prior to termination of the Agreement that could
increase costs to a new provider. Contractor shall allow its employees providing
Services reasonable opportunities to discuss issues related to employment with a
new provider without adverse consequences.
GENERAL PROVISIONS
97.
Permits and License
97.1
Contractor shall be responsible for and shall hold any and all required Federal, State
or local permits or licenses required to perform its obligations under the
Agreement.
97.2
Contractor shall make all necessary payments for licenses and permits for all
Ambulance vehicles used.
97.3
It shall be entirely the responsibility of Contractor to schedule and coordinate all
applications and application renewals as necessary to ensure that Contractor is
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meeting its obligation under the Agreement and is in complete compliance with
Federal, State and local requirements for permits and licenses as necessary to
provide the services.
97.4
Contractor shall be responsible for ensuring that its employee’s State and local
certifications as necessary to provide the services, if applicable, are valid and
current at all times.
98.
Private Work
Contractor shall not be prevented from conducting private work that does not interfere
with the requirements of the Agreement or allocation of overhead. In the event Contractor
does private work outside of the Agreement, and if any overhead costs are shared between
the two businesses, financial information provided regarding the Agreement shall clearly
identify the relation and percentage shared.
99.
Product Endorsement/Advertising
Contractor shall not use the name of Alameda County or Alameda County EMS for the
endorsement of any commercial products or services without the expressed written
permission of the EMS Director.
100. Observation and Inspections
100.1 County representatives may, at any time, and without notification, directly observe
Contractor's operations at the County Dispatch Center, maintenance facility, or any
Ambulance post location. A County representative may ride as “third person” on any
of Contractor's Ambulance units at any time, provided that in exercising this right to
inspection and observation, County representatives shall conduct themselves in a
professional and courteous manner, shall not interfere with Contractor employee's
duties, and shall at all times be respectful of Contractor's employer/employee
relationships.
100.2 At any time during normal business hours and as often as may be reasonably
deemed necessary by the County, County representatives may observe Contractor's
office operations, and Contractor shall make available to County for its examination
any and all business records, including incident reports, patient records, financial
records of Contractor pertaining to the Agreement. County may audit, copy, make
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transcripts, or otherwise reproduce such records including but not limited to
contracts, payroll, inventory, personnel and other records, daily logs, employment
agreements, and other documentation for County to fulfill its oversight role.
101. No Cost to County
Contractor agrees that the provision of Services to be performed by Contractor under this
Agreement shall be completed without compensation from the County.
102. Cost of Enforcement
If County or Contractor institutes litigation against the other party to enforce its rights
pursuant to performing the work contemplated herein, the actual and reasonable cost of
litigation incurred by the prevailing party, including but not limited to: a) attorney's fees,
b) consultant and expert fees, or c) other such costs, shall be paid or reimbursed within
ninety (90) calendar days after receiving notice by the party which prevails.
103. Relationship of the Parties
Nothing in this Agreement shall be construed to create a relationship of employer and
employee or principal and agent, partnership, joint venture, or any other relationship other
than that of independent parties contracting with each other solely for the purpose of
carrying out the provisions of the Agreement. Nothing in the Agreement shall create any
right or remedies in any third party, it being solely for the benefit of the County and
Contractor.
104. Independent Contractor
104.1 No relationship of employer and employee is created by this Agreement; it being
understood and agreed that Contractor is an independent contractor. Contractor is
not the agent or employee of the County in any capacity whatsoever, and County
shall not be liable for any acts or omissions by Contractor nor for any obligations or
liabilities incurred by Contractor.
104.2 Contractor, its employees, subcontractors and agents shall have no claim under this
Agreement or otherwise, for seniority, vacation time, vacation pay, sick leave,
personal time off, overtime, health insurance medical care, hospital care, retirement
benefits, social security, disability, Workers’ Compensation, or unemployment
insurance benefits, civil service protection, or employee benefits of any kind.
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104.3 Contractor shall be solely liable for and obligated to pay directly all applicable
payroll taxes (including Federal and State income taxes) or contributions for
unemployment insurance or old age pensions or annuities which are imposed by
any governmental entity in connection with the labor used or which are measured
by wages, salaries or other remuneration paid to its officers, agents or employees
and agrees to indemnify and hold County harmless from any and all liability which
County may incur because of Contractor’s failure to pay such amounts.
104.4 Contractor shall comply with all applicable Federal and State workers’
compensation and liability laws and regulations with respect to the officers, agents
and/or employees conducting and participating in the work; and agrees that such
officers, agents, and/or employees shall be considered as independent Contractors
and shall not be treated or considered in any way as officers, agents and/or
employees of County.
105. Indemnification
105.1 To the fullest extent permitted by law, Contractor shall hold harmless, defend and
indemnify the County of Alameda, its Board of Supervisors, employees and agents
from and against any and all claims, losses, damages, liabilities and expenses,
including but not limited to attorneys’ fees, arising out of or resulting from the
performance of Services under this Agreement, provided that any such claim, loss,
damage, liability or expense is attributable to bodily injury, sickness, disease, death
or to injury to or destruction of property, including the loss there from, or to any
violation of Federal, State or municipal law or regulation, which arises out of or is
any way connected with the performance of this Agreement (collectively
“Liabilities”), except where such Liabilities are caused solely by the negligence or
willful misconduct of any indemnitee. The County may participate in the defense of
any such claim without relieving Contractor of any obligation hereunder.
105.2 In the event that Contractor or any employee or agent of Contractor providing
services under this Agreement is determined by a court of competent jurisdiction or
the Alameda County Employees’ Retirement Association (ACERA) or California
Public Employees’ Retirement System (PERS) to be eligible for enrollment in ACERA
and PERS as an employee of County, Contractor shall indemnify, defend, and hold
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harmless County for the payment of any employee and/or employer contributions
for ACERA and PERS benefits on behalf of Contractor or its employees or agents as
well as for the payment of any penalties and interest on such contributions, which
would otherwise be the responsibility of County.
106. Insurance and Bond
106.1 Performance Security Bond: Upon the Effective Date of this Agreement, Contractor
shall furnish a performance bond payable to County issued by a licensed surety,
acceptable to County, in the amount of six million dollars ($6,000,000.00). The
Performance Bond shall remain in effect at all times during the term of this
Agreement, including any renewal term.
106.2. Contractor shall at all times during the term of the Agreement with the County
maintain in force the insurance coverage specified in EXHIBIT C ‐ MINIMUM INSURANCE
REQUIREMENTS, and shall comply with all those requirements as Stated therein.
107. Workers’ Compensation
Contractor shall provide Workers' Compensation insurance, at Contactor’s own cost and
expense and further, neither the Contractor nor its insurer shall be entitled to recover from
County any costs, settlements, or expenses of Workers' Compensation claims arising out of
this Agreement.
108. Conformity with Law and Safety
108.1 In performing Services under this Agreement, Contractor shall, at all times, observe
and comply with all applicable laws, ordinances, codes and regulations of
governmental agencies, including Federal, State, municipal, and local governing
bodies, having jurisdiction over the Services, including, but not limited to, all
applicable provisions of the California Occupational Safety and Health Act. It shall be
Contractor’s sole responsibility to be fully familiar with all such applicable laws,
ordinances, and regulations.
108.2 Contractor shall indemnify and hold County harmless from any and all liability,
fines, penalties and consequences from any failure by Contractor to comply with
such laws, ordinances, codes and regulations.
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108.3 Accidents: If a death, serious personal injury, or substantial property damage
occurs in connection with Contractor’s performance of this Agreement and warrants
submission of an Alameda County EMS Unusual Occurrence Report (as per EMS
Policy). Contractor shall immediately notify County by contacting the EMS Dispatch
Center and asking to speak to the EMS person on call. The EMS person on call shall
immediately notify the Alameda County Risk Manager’s Office by telephone. If after
business hours, this message may be left as a voicemail. Contractor shall promptly
submit to County a written report, in such form as may be required by County of all
accidents, which occur in connection with this Agreement. This report must include
the following information: a) name and address of the injured or deceased
person(s); b) name and address of Contractor's sub‐Contractor, if any; c) name and
address of Contractor's liability insurance carrier; and d) a detailed description of
the accident and whether any of County's equipment, tools, material, or staff were
involved.
108.4 Contractor shall take all reasonable steps to preserve all physical evidence and
information which may be relevant to an accident involving personal injury, death,
or property damage, while maintaining public safety, in order to afford County the
opportunity to review and inspect such evidence, including the scene of the accident
109. Debarment and Suspension Certification
109.1 Contractor shall comply with applicable Federal suspension and debarment
regulations, including but not limited to 7 Code of Federal Regulations ("CFR")
3016.35, 28 CFR 66.35, 29 CFR 97.35, 34 CFR 80.35, 45 CFR 92.35 and Executive
Order 12549.
109.2 Contractor certifies to the best of its knowledge and belief, that it and its principals:
a.
Are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntary excluded by any Federal department or agency; and,
b.
Shall not knowingly enter into any covered transaction with a person who is
proposed for debarment under Federal regulations, debarred, suspended,
declared ineligible, or voluntarily excluded from participation in such
transaction.
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110. Taxes
Payment of all applicable federal, state, and local taxes shall be the sole responsibility of the
Contractor.
111. Ownership of Documents
111.1 Contractor assigns to County all copyright and other use rights in any and all
proposals, plans, specifications, reports and related documents (including
computerized or electronic copies relating to Services, whether prepared by
County, Contractor, or third parties at Contractor’s request (collectively,
“Documents and Materials”).
111.2 Contractor shall be permitted to retain copies, including reproducible copies and
computerized copies, of any Documents and Materials. Contractor agrees to take
such further steps as may be reasonably requested by County to effectuate
assignment of rights in the Documents and Materials to County. If for any reason
this assignment is not effective, Contractor hereby grants County and any assignee
of County license to retain and use such Documents and Materials at no cost to
County. The County’s rights under this paragraph shall apply regardless of the
degree of completion of the Documents and Materials.
111.3 In Contractor contracts with third parties to provide Services, Contractor shall
expressly obligate its subcontractors to grant County the assignment and license
rights regarding the Documents and Materials as set forth above. Contractor agrees
to defend, indemnify and hold County harmless from any damage caused
Contractor’s failure to secure such rights from its subcontractors.
111.4 Contractor shall pay all royalties and license fees which may be due for any patented
or copyrighted materials, methods or used by Contractor for the Services, and shall
defend, indemnify and hold County harmless from any claims for infringement of
patent or copyright arising out of such use. The County’s rights under this Paragraph
shall not extend to any computer software used to create such Documents and
Materials.
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112. Documents and Materials
112.1 Contractor shall maintain and make available to County for its inspection and use
during the term of this Agreement all Documents and Materials, as defined above.
This duty shall continue for three (3) years following termination or expiration of
this Agreement. Contractor shall not dispose of, destroy, alter, or mutilate such
Documents and Materials, for three (3) years following termination or expiration of
this Agreement.
112.2 Retention of Records ‐ Contractor shall retain all documents pertaining to the
Agreement as required by Federal and State laws and regulations, and no less than
seven (7) years from the end of the fiscal year following termination or expiration of
this Agreement. Upon request, and except as otherwise restricted by law,
Contractor shall make these records available to authorized representatives of the
County, the State of California, and the Federal government.
112.3 Time of Essence ‐ Time is of the essence in respect to all provisions of this
Agreement that specify a time for performance. This requirement shall not be
construed to limit or deprive a party of the benefits of any grace or use period
allowed by this Agreement.
113. Conflict of Interest/Confidentiality
113.1 Contractor covenants that it presently has no interest, and shall not have any
interest, direct or indirect, which would conflict in any manner with the
performance of Services required under this Agreement. Without limitation,
Contractor represents to and agrees with County that Contractor has no present,
and shall have no future, conflict of interest between providing Services to County
and to any other person or entity (including but not limited to any governmental
agency) which has any interest adverse or potentially adverse to the County, as
determined in the reasonable judgment of the Board of Supervisors of the County.
113.2 Contractor agrees that any confidential information, whether proprietary or not,
made known to or discovered by it during the performance of or in connection with
this Agreement for the County shall be kept confidential and shall not be disclosed
to any other person. Contractor agrees to immediately notify County in accordance
with this Agreement, if it is requested to disclose any confidential information made
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known to or discovered by it during the performance of or in connection with this
Agreement.
113.3 These conflict of interest and confidentiality provisions shall remain fully effective
five (5) years after termination of this Agreement.
114. Notices
All notices, requests, demands, or other communications under this Agreement shall be in
writing. Notices shall be given for all purposes as follows:
114.1 Personal Delivery: When personally delivered to the recipient, notices are
effective on delivery.
114.2 First Class Mail: When mailed first class to the last address of the recipient known
to the party giving notice, notice is effective three (3) mail delivery days after
deposit in a United States Postal Service office or mailbox.
114.3 Certified Mail: When mailed certified mail, return receipt requested, notice is
effective on receipt, if delivery is confirmed by a return receipt.
114.4 Overnight Delivery: When delivered by overnight delivery (e.g., Federal
Express/Airborne/United Parcel Service/DHL Worldwide Express) with charges
prepaid or charged to the sender’s account, notice is effective on delivery, if delivery
is confirmed by the delivery service.
114.5 Telex or Facsimile Transmission: When sent by telex or facsimile to the last telex
or facsimile number of the recipient known to the party giving notice, notice is
effective on receipt, provided that: a) a duplicate copy of the notice is promptly
given by first‐class or certified mail or by overnight delivery, or b) the receiving
party delivers a written confirmation of receipt. Any notice given by telex or
facsimile shall be deemed received on the next business day if it is received after
5:00 p.m. (recipient’s time) or on a non‐business day.
114.6 Addresses for purpose of giving notice are as follows:
To County:
County of Alameda
Alameda County EMS
1000 San Leandro Blvd
San Leandro, Ca
Attn: EMS Director
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To Contractor:
PARAMEDICS PLUS, LLC
352 S. Glenwood Drive
Tyler, TX 75702
Attn: Anthony J. Myers, President
114.7 Any correctly addressed notice that is refused, unclaimed, or undeliverable because
of an act or omission of the party to be notified shall be deemed effective as of the
first date that notice was refused, unclaimed, or deemed undeliverable by the postal
authorities, messenger, or overnight delivery service.
114.8 Any party may change its address or telex or facsimile number by giving the other
party notice of the change in any manner permitted by this Agreement.
115. Use of County Property
Contractor shall not use County property (including equipment, instruments and supplies)
or personnel for any purpose other than in the performance of its obligations under this
Agreement.
116. Equal Employment Opportunity Practices Provisions
116.1 Contractor shall comply with Title VII of the Civil Rights Act of 1964 and Contractor
agrees that no person shall, on the grounds of race, creed, color, disability, sex,
sexual orientation, national origin, age, religion, Vietnam era Veteran’s status,
political affiliation, or any other non‐merit factor, be excluded from participation in,
be denied the benefits of, or be otherwise subjected to discrimination under this
Agreement.
116.2 Contractor shall, in all solicitations or advertisements for applicants for employment
placed as a result of this Agreement, State that it is an “Equal Opportunity
Employer” or that all qualified applicants shall receive consideration for
employment without regard to their race, creed, color, disability, sex, sexual
orientation, national origin, age, religion, Vietnam era Veteran’s status, political
affiliation, or any other non‐merit factor.
116.3 Upon request by County, Contractor shall certify that it has not, in the performance
of this Agreement, discriminated against applicants or employees because of their
race, creed, color, disability, sex, sexual orientation, national origin, age, religion,
Vietnam era Veteran’s status, political affiliation, or any other non‐merit factor.
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116.4 Upon request by County, Contractor shall provide County with access to copies of all
of its records pertaining or relating to its employment practices, except to the extent
such records or portions of such records are confidential or privileged under State
or Federal law.
116.5 Contractor shall actively recruit and encourage minority and women‐owned
businesses to bid its subcontracts.
116.6 Nothing contained in this Agreement shall be construed in any manner so as to require
or permit any act that is prohibited by law.
116.7 The Contractor shall include the provisions set forth in this section in each of its
subcontracts.
117. Drug Free Workplace
Contractor and its employees shall comply with the County’s policy of maintaining a drug
free workplace. Neither Contractor nor its employees shall unlawfully manufacture,
distribute, dispense, possess or use controlled substances, as defined in 21 U.S. Code § 812,
including, but not limited to, marijuana, heroin, cocaine, and amphetamines, at any County
facility or work site. If Contractor or any employee of Contractor is convicted or pleads
nolo contendere to a criminal drug statute violation occurring at a County facility or work
site, Contractor shall, within five (5) calendar days thereafter, notify the EMS Director.
Violation of this provision shall constitute a material breach of this Agreement.
118. Small, Local, and Emerging Business (SLEB) Participation:
118.1 The County has waived its Small, Local and Emerging Business (“SLEB”)
requirements for this Agreement. Therefore, Contractor is not required to
subcontract with another business in order to satisfy the County’s SLEB
requirements.
118.2 If circumstances change, Contractor may be requested to comply with the County’s
Small and Emerging Local Business provisions.
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119. First Source Program
This Agreement is subject to the requirements of the County’s First Source Program. A
copy of the First Source Agreement executed by Contractor is attached as EXHIBIT J ‐ FIRST
SOURCE AGREEMENT to this Agreement and incorporated herein.
120. Waiver
No waiver of a breach, failure of any condition, or any right or remedy contained in or
granted by the provisions of this Agreement shall be effective unless it is in writing and
signed by the party waiving the breach, failure, right or remedy. No waiver of any breach,
failure, right or remedy shall be deemed a waiver of any other breach, failure, right or
remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless
the writing so specifies.
121. Entire Agreement
This Agreement, including all attachments, exhibits, and any other documents specifically
incorporated into this Agreement, shall constitute the entire agreement between the
parties relating to the subject matter of this Agreement.
This Agreement supersedes and merges all previous understandings, and all other
agreements, written or oral, between the parties and sets forth the entire understanding of
the parties regarding the subject matter thereof.
122. Headings
Headings herein are for convenience of reference only and shall in no way affect the
interpretation of the Agreement.
123. Modification of Agreement
123.1 This Agreement may be supplemented, amended or modified only by the mutual
agreement of the parties. No supplement, amendment, or modification of this
Agreement shall be binding unless it is in writing and signed by authorized
representatives of both parties.
123.2 Where there is mutual agreement by Contactor and the EMS Director, the following
exhibits may be modified, by a written amendment signed by Contractor and the
Director of Health Care Services Agency:
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EXHIBIT A
DEPICTION AND DEFINITION OF CONTRACTOR'S EOA AND
EMERGENCY RESPONSE ZONES
EXHIBIT B
DEPICTION AND DEFINITION OF SUB‐AREAS
EXHIBIT E
COMMUNICATIONS EQUIPMENT
EXHIBIT G
PARAMEDIC TRAINING REQUIREMENTS
EXHIBIT K
TRANSITION PLAN
EXHIBIT L
COMMUNITY EDUCATION PROGRAM
EXHIBIT M
FIRST RESPONDER SUPPORT
EXHIBIT N
HIGH RISK PATIENT DESCRIPTION
124. Subcontracting/Assignment/Sale
124.1 Contractor shall not subcontract, assign or delegate any portion of this Agreement
or any duties or obligations hereunder without County’s prior written approval,
which shall not be unreasonably withheld or delayed. County may terminate this
Agreement if Paramedics Plus, LLC. is sold or acquired or otherwise changes
ownership without County’s prior written consent to continuation of this
Agreement under changed ownership.
124.2 Neither party shall, on the basis of this Agreement, contract on or in the name of the
other party. Any agreement that violates this Section shall confer no rights on any
party and shall be null and void.
124.3 Contractor shall be responsible for compliance by its subcontractors with all
applicable the terms of this Agreement.
125. Survival
The obligations of this Agreement, which by their nature would continue beyond the
termination or expiration of the Agreement, including without limitation, the obligations
regarding Indemnification, Ownership of Documents, and Conflict of Interest, shall survive
termination or expiration.
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126.
Severability
If a court of competent jurisdiction holds that any provision of this Agreement is illegal,
unenforceable, or invalid in whole or in part, for any reason, the validity and enforceability
of the remaining provisions, or portions of them, shall not be affected, unless an essential
purpose of this Agreement would be defeated by the loss of the illegal, unenforceable, or
invalid provision.
127. Patent and Copyright Indemnity
127.1 Contractor represents that it knows of no allegations, claims, or threatened claims
that the materials, services, hardware or software (“Contractor Products”) provided
to County under this Agreement infringe any patent, copyright, or other proprietary
right. Contractor shall defend, indemnify and hold harmless County, from and
against all losses, claims, damages, liabilities, costs expenses and amounts
(collectively, “Losses”) arising out of or in connection with any claim that any
Contractor Products or the use thereof, infringe any patent, copyright or other
proprietary right of any third party. County shall: 1) notify Contractor promptly of
such claim or suit; 2) permit Contractor to defend, compromise, or settle the claim;
and, 3) provide, on a reasonable basis, information to enable Contractor to do so.
Contractor shall not agree without County’s prior written consent, to any
settlement, which would require County to pay money or perform some affirmative
act in order to continue using the Contractor Products.
127.2 If Contractor is obligated to defend County pursuant to this Section and fails to do so
after reasonable notice from County, County may defend itself and/or settle such
claim or suit, and Contractor shall pay to County any and all losses, damages and
expenses (including attorney’s fees and costs) incurred in relationship with
County’s defense and/or settlement of such claim or suit.
127.3 In the case of any such claim of infringement, Contractor shall either, at its option,
a) procure for County the right to continue using the Contractor Products; or
b) replace or modify the Contractor Products so that that they become non‐
infringing, but equivalent in functionality and performance.
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127.4 Notwithstanding this Section, County retains the right and ability to defend itself, at
its own expense, against any claims that Contractor Products infringe any patent,
copyright, or other intellectual property right.
128. Choice of Law and Venue
This Agreement shall be governed by the laws of the State of California. Venue for actions
and proceedings between the parties related to this Agreement shall be Alameda County
Superior Court for state actions and the Northern District of California for any federal
action.
SIGNATORY
By signing this agreement, signatory warrants and represents that he/she executed this
Agreement in his/her authorized capacity and that by his/her signature on this Agreement,
he/she or the entity upon behalf of which he/she acted, executed this Agreement.
IN WITNESS WHEREOF, the parties execute this Agreement:
County of Alameda
Contractor
By:_______________________________________________
Signature
By:_____________________________________________
Signature
Name: Alice Lai‐Bitker
Name: Anthony J. Myers
Title: President of the Board of Supervisors
Title: President, Paramedics Plus, LLC
Date: ____________________________________________
Date:___________________________________________
Approved as to Form:
By:______________________________________________
County Counsel Signature
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EXHIBITS
E XHIBIT A ‐ D EPICTION AND D EFINITION OF C ONTRACTOR ’ S EOA AND
E MERGENCY R ESPONSE Z ONES ......................................................... 2
E XHIBIT B ‐ D EPICTION AND D EFINITION OF S UB ‐ AREAS .......................................... 3
E XHIBIT C ‐ M INIMUM I NSURANCE R EQUIREMENTS ................................................ 6
E XHIBIT D ‐ D EBARMENT AND S USPENSION C ERTIFICATION ...................................... 7
E XHIBIT E ‐ C OMMUNICATIONS E QUIPMENT ......................................................... 8
E XHIBIT F ‐ R ESPONSE T IMES R EQUIREMENTS AND F INES ......................................... 10
TABLE A ‐ PERSONNEL AND RESPONSE TIME REQUIREMENTS .....................................................................10
TABLE B ‐ RESPONSE TIME FINES BY CATEGORY AND COMPLIANCE .............................................................10
TABLE C ‐ OUTLIER RESPONSE TIMES BY CATEGORY AND SUBAREA IN MINUTES & SECONDS ...........................10
E XHIBIT G ‐ P ARAMEDIC T RAINING R EQUIREMENTS ................................................ 11
E XHIBIT H ‐ C ONTRACTOR ’ S U SER F EES ‐ 911 S YSTEM ............................................ 13
E XHIBIT I ‐ M ANDATORY D ATA F IELD R EQUIREMENTS ............................................. 14
E XHIBIT J ‐ F IRST S OURCE A GREEMENT ............................................................... 15
E XHIBIT K – T RANSITION P LAN ......................................................................... 16
E XHIBIT L ‐ C OMMUNITY E DUCATION P ROGRAM ................................................... 22
E XHIBIT M ‐ F IRST R ESPONDER S UPPORT ............................................................ 24
E XHIBIT N ‐ H IGH R ISK P ATIENT D ESCRIPTION ...................................................... 25
E XHIBIT O ‐ P ROPOSAL OF P ARAMEDICS P LUS ...................................................... 26
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EXHIBIT A ‐ DEPICTION AND DEFINITION OF CONTRACTOR’ S EOA AND
EMERGENCY RESPONSE Z ONES
1.
There are five (5) ERZs in Alameda County, which include the cities and all unincorporated
areas. The following are cities contained in each ERZ:
2.
a.
Zone 1 – Alameda , Albany , Berkeley , Piedmont
(this zone is not included in the EOA)
b.
Zone 2 – Oakland, Emeryville
c.
Zone 3 – San Leandro , Castro Valley, Hayward
d.
Zone 4 – Fremont, Newark, Union City
e.
Zone 5 – Dublin, Pleasanton, Livermore ‐ except Lawrence Livermore National
Laboratory (This area is not included in the EOA).
The following is a depiction of the each Emergency Response Zone (ERZ) within Alameda
County
1 ‐ Albany
2 ‐ Berkeley
3 ‐ Emeryville
4 ‐ Piedmont
5 ‐ Oakland
6 ‐ Alameda
7 ‐ San Leandro
8 ‐ Ashland
9 ‐ Cherryland
10 ‐ San Lorenzo
11 ‐ Castro Valley
12 ‐ Fairview
13 ‐ Hayward
14 ‐ Union City
15 ‐ Newark
16 ‐ Fremont
17 ‐ Dublin
18 ‐ Pleasanton
19 ‐ Livermore
20 ‐ Sunol
21 ‐ LLNL
1
2
3
4
6
5
7
8
10 9
17
11
12
19
18
21
20
13
14
16
15
Zone 1
Zone 2
Zone 3
Zone 4
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EMS Ambulance Transport Provider Agreement
EXHIBIT B ‐ DEPICTION AND DEFINITION OF SUB ‐ AREAS
Density Area Designation: Designations of call density areas were accomplished by reviewing
the call density for every square kilometer grid in the County. The grids were normalized by
examining the underlying road structure with the goal of creating zones with Rural/Suburban
contiguous with Metro/Urban, eliminating anomalous pockets of high or low density in the midst
of one of the density areas, and creating a map that can be incorporated into the computer aided
dispatch system.
Sub‐area definitions are for general descriptive purposes only; the actual sub‐areas are identified
on the maps in this Exhibit. The map defines the subarea, not the actual number of calls received
during any period. The identified Sub‐areas are subject to change at the discretion of the County.
Sub‐Areas: There are 3 possible Sub‐areas contained within each ERZ.
Metro/Urban call densities are determined by identifying the square kilometers that
average 2 or more calls per month and at least half of the surrounding square kilometers
also average 2 or more calls per month.
Rural/Suburban areas are those in which the average calls per square kilometer are
between 0.25 and less than 2.0 calls per month on average.
Wilderness/Low Call Density is determined by identifying the square kilometers that
average less than 0.25 calls per month (or one call every 4 months, on average).
Alameda County:
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Zone 2:
Zone 3:
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Zone 4:
Zone 5:
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EXHIBIT C ‐ MINIMUM INSURANCE REQUIREMENTS
Without limiting any other obligation or liability under this Agreement, the Contractor, at its sole cost and expense, shall secure and keep in force
during the entire term of the Agreement or longer, as may be specified below, the following insurance coverage, limits and endorsements:
TYPE OF INSURANCE COVERAGES
MINIMUM LIMITS
A. Commercial General Liability
Premises Liability; Products and Completed Operations; Contractual Liability;
Personal Injury and Advertising Liability; Abuse, Molestation, Sexual Actions,
and Assault and Battery
$5,000,000.00 per occurrence (CSL)
Bodily Injury and Property Damage
B. Commercial or Business Automobile Liability
All owned vehicles, hired or leased vehicles, non‐owned, borrowed and
permissive uses. Personal Automobile Liability is acceptable for individual
Contractors with no transportation or hauling related activities
$5,000,000.00 per occurrence (CSL)
Any Auto
Bodily Injury and Property Damage
C. Workers’ Compensation (WC) and Employers Liability (EL)
Required for all Contractors with employees
WC: Statutory Limits
EL: $1,000,000.00 per accident for
bodily injury or disease
D. Professional Liability/Errors & Omissions
Includes endorsements of contractual liability and defense and
indemnification of the County
$5,000,000.00 per occurrence
$10,000,000.00 project aggregate
E. Endorsements and Conditions:
ADDITIONAL INSURED: All insurance required above with the exception of Professional Liability, Personal Automobile
Liability, Workers’ Compensation and Employers Liability, shall be endorsed to name as additional insured: County of
Alameda, its Board of Supervisors, the individual members thereof, and all County officers, agents, employees and
representatives.
1.
DURATION OF COVERAGE: All required insurance shall be maintained during the entire term of the Agreement with
the following exception: Insurance policies and coverage(s) written on a claims‐made basis shall be maintained
during the entire term of the Agreement and until 3 years following termination and acceptance of all work provided
under the Agreement, with the retroactive date of said insurance (as may be applicable) concurrent with the
commencement of activities pursuant to this Agreement.
2.
REDUCTION OR LIMIT OF OBLIGATION: All insurance policies shall be primary insurance to any insurance
available to the Indemnified Parties and Additional Insured(s). Pursuant to the provisions of this Agreement,
insurance affected or procured by the Contractor shall not reduce or limit Contractor’s contractual obligation to
indemnify and defend the Indemnified Parties.
INSURER FINANCIAL RATING: Insurance shall be maintained through an insurer with a minimum A.M. Best Rating
of A‐ or better, with deductible amounts acceptable to the County. Acceptance of Contractor’s insurance by County
shall not relieve or decrease the liability of Contractor hereunder. Any deductible or self‐insured retention amount
or other similar obligation under the policies shall be the sole responsibility of the Contractor. Any deductible or self‐
insured retention amount or other similar obligation under the policies shall be the sole responsibility of the
Contractor.
3.
4.
SUBCONTRACTORS: Contractor shall include all subcontractors as an insured (covered party) under its policies or
shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall
be subject to all of the requirements stated herein.
5.
JOINT VENTURES: If Contractor is an association, partnership or other joint business venture, required insurance
shall be provided by any one of the following methods:
–
Separate insurance policies issued for each individual entity, with each entity included as a “Named Insured
(covered party), or at minimum named as an “Additional Insured” on the other’s policies.
–
Joint insurance program with the association, partnership or other joint business venture included as a “Named
Insured.
6.
CANCELLATION OF INSURANCE: All required insurance shall be endorsed to provide thirty (30) days advance
written notice to the County of cancellation.
7.
CERTIFICATE OF INSURANCE: Before commencing operations under this Agreement, Contractor shall provide
Certificate(s) of Insurance and applicable insurance endorsements, in form and satisfactory to County, evidencing
that all required insurance coverage is in effect. The County reserves the rights to require the Contractor to provide
complete, certified copies of all required insurance policies. The require certificate(s) and endorsements must be
sent to:
–
Department/Agency issuing the contract
–
With a copy to Risk Management Unit (125 – 12th Street, 3rd Floor, Oakland, CA 94607)
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EXHIBIT D ‐ DEBARMENT AND SUSPENSION CERTIFICATION
1.
Paramedics Plus, LLC, under penalty of perjury, certifies that, except as noted below, the
company, its principal, and any named subcontractor:
2.
Is not currently under suspension, debarment, voluntary exclusion, or determination of
ineligibility by any Federal agency;
3.
Has not been suspended, debarred, voluntarily excluded or determined ineligible by any
Federal agency within the past three years;
4.
Does not have a proposed debarment pending; and,
5.
Has not been indicted, convicted, or had a civil judgment rendered against it by a court of
competent jurisdiction in any matter involving fraud or official misconduct within the past
three years.
6.
If there are any exceptions to this certification, insert the exceptions in the following space.
7.
Exceptions shall not necessary result in denial of award, but shall be considered in
determining Proposer responsibility. For any exception noted above, indicate below to
whom it applies, initiating agency, and dates of action.
8.
Providing false information may result in criminal prosecution or administrative sanctions.
The above certification is part of the Agreement. Signing the Agreement on the signature
portion thereof shall also constitute signature of this Certification.
Name:
Signature:
Title:
Date:
/ /
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EXHIBIT E ‐ COMMUNICATIONS EQUIPMENT
1.
Radio Equipment:
1.1
Contractor shall permanently mount into each Ambulance and on each Supervisor
Vehicle, analog and digital capable, 700/800MHz trunked mobile radio with dual
control heads and a telephone style microphone in the patient compartment with an
external antenna mounted on the Ambulance box roof. These radios shall have
DUAL TONE ‐ MULTI FREQUENCY capability to alert hospital emergency
department radios of incoming radio traffic. All mobile radios shall be compatible
with the County’s trunked radio system (equivalent to Motorola APX 7500
(3600/9600) or better).
1.2
Contractor’s Field Personnel shall carry analog and digitally capable, 700/800MHz
trunked portable radio with remote public safety speaker microphone. All portable
radios shall be compatible with Alameda County’s trunked radio system (equivalent
to Motorola APX 7000 (3600/9600) or better).
1.3
Contractor Field Personnel shall carry County‐approved radios, rebanding‐capable,
digitally formatted and fully compliant with P‐25 Phase I and Phase II (once
released) interoperability standards.
1.4
Contractor shall operate subscriber radios in compliance with all rules and
regulations of the Federal Communications Commission and Alameda County.
1.5
Contractor shall equip all Clinical and Operations Field Supervisor Vehicles with
analog/digital capable mobile radio programmed for operation on the CALCORD
(equivalent to Motorola APX 7500 VHF or better).
1.6
Contractor shall equip all Ambulances and each Clinical and Operations Field
Supervisor Vehicles used in providing Services to the County with radios for
communications with hospital receiving facilities and for Ambulance‐to‐hospital
communications.
2.
Cellular Phones
Contractor's Supervisor Vehicles shall be equipped with a wireless cell phone for direct
landline communications with the Base Hospital, receiving hospitals, County Dispatch
Center and other necessary personnel or agencies. Cellular phone or other portable
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EMS Ambulance Transport Provider Agreement
handheld device must be capable of receiving emergency response data from the ACRECC
paging system.
3.
12 Lead ECG Transmission
Contractor shall install 12‐Lead electrocardiogram (“ECG”) monitors including a modem
for transmission in all Ambulance units, Clinical Field Supervisor vehicles, and FRALS
apparatus (in accordance with EXHIBIT M ‐ FIRST RESPONDER SUPPORT), to allow transmission
of 12‐Lead ECGs to receiving facilities..
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EXHIBIT F ‐ RESPONSE TIMES REQUIREMENTS AND F INES
Table A ‐ Personnel and Response Time Requirements
MPDS Dispatch
Category
Echo
Sub Area: Metro/Urban
Personnel
Configuration:
2 Paramedics
1 Paramedic
1 EMT
1 Paramedic
1 EMT
Delta
Charlie
Bravo
2 EMTs
Alpha
2 EMTs
Suburban/Rural
Wilderness
08:30 min.
14:00 min.
18:00 min.
10:30 min.
16:00 min.
22:00 min.
15:00 min.
25:00 min.
28:00 min.
15:00 min.
25:00 min.
28:00 min.
30:00 min.
40:00 min.
40:00 min.
Response Time fines for Charlie, Delta and Echo ambulance responses shall be in effect on the
Services Start Date. Response Time fines for Alpha and Bravo responses shall be in effect six
months after the Services Start Date.
Table B ‐ Response Time Fines by Category and Compliance
Compliance:
89.5 – < 90%
89 ‐ < 89.5%
< 89%
Echo
$25,000.00
$35,000.00
$50,000.00
Delta / Charlie
$15,000.00
$25,000.00
$35,000.00
Bravo / Alpha
$ 5,000.00
$10,000.00
$15,000.00
CATEGORY:
Table C ‐ Outlier Response Times by Category and Subarea in Minutes & Seconds
Metro/Urban
Suburban/Rural
Wilderness
Echo
12:45
21:00
27:00
$5,000.00
Delta
15.45
24:00
33:00
$2,500.00
Charlie
33:00
37:30
42:00
$2,500.00
Bravo
33:00
37:30
42:00
$1,000.00
Alpha
45:00
60:00
60:00
$1,000.00
CATEGORY:
Subarea:
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EXHIBIT G ‐ PARAMEDIC TRAINING R EQUIREMENTS
1.
Advanced Cardiac Life Support (ACLS) Certification ‐ American Heart Association or an
approved equivalent.
2.
ECG Training ‐ interpreting 12‐Lead ECGs for ST elevation
3.
Trauma Training ‐ Prehospital Trauma Life Support (PHTLS) or International Trauma Life
Support (ITLS)
4.
Pediatric Education ‐ Pediatric Education for Prehospital Personnel (PEPP), Pediatric
Advanced Life Support (PALS), or Emergency Pediatric Care (EPC).Contractor shall ensure
that all Paramedics complete this training within six (6) months of hire by Contractor.
5.
Company Orientation ‐ In addition to all other requirements, Contractor shall properly
orient all Field Personnel before assigning them to respond to emergency medical requests.
Such orientation shall include at a minimum, Contractor's policies and procedures; radio
communications with and between the provider agency, Base Hospital, receiving hospitals,
and County communications centers; and Ambulance and equipment utilization and
maintenance.
6.
EMS Orientation ‐ Contractor shall ensure that all Field Personnel attend EMS orientation
sponsored by EMS on a monthly basis. This orientation shall provide an overview of the
Alameda County EMS system, review of EMS Policies, documentation requirements, and
CPR review.
7.
MCI Response ‐ Contractor shall train all Ambulance personnel and supervisory staff in
their respective roles and responsibilities under the County Multi‐Casualty Incident Plan as
defined in EMS Policies, and prepare them to function in the medical branch of the Incident
Command System. The specific roles of the Contractor and other Public Safety personnel
shall be defined by the relevant plans and command structure.
8.
Homeland Security ‐ Contractor and Contractor’s employees shall participate in and
receive training in Homeland Security issues, including participating in existing programs
available within the County for dealing with terrorist events, weapons of mass destruction,
and other Homeland Security issues.
9.
Assaultive Behavior Management Training ‐ Contractor shall provide Ambulance
personnel with the training, knowledge, understanding, and skills to effectively manage
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patients with psychiatric, drug/alcohol or other behavioral or stress related problems on
an on‐going basis, as well as difficult scenes. Emphasis shall be on techniques for
establishing a climate conducive to effective field management, and for preventing the
escalation of potentially volatile situations.
10.
Driver Training ‐ Contractor shall maintain an on‐going driver training program for
Ambulance personnel. The program, the number of instruction hours, and the system for
integration into the Contractor's operations (e.g., accident review boards, impact of
accidents on employee performance reviews and compensation, etc.) shall be reviewed and
is subject to approval by the County initially and on an annual basis thereafter. Training
and skill proficiency is required at initial employment with annual training refresher
courses and skill confirmation.
11.
Infection Control ‐ Contractor shall develop an infection control program, consistent with
EMS Policies, that emphasizes aggressive hygiene practices and proactive personal
protective equipment donning (e.g. eye protection, gloves, etc). The Contractor shall
develop and strictly enforce policies for infection control, cross contamination, and soiled
materials disposal to decrease the chance of communicable disease exposure and
transmission.
12.
ICS Training ‐ All field personnel must complete the following Incident Command System
training: ICS 100, 200, 700, and 800. Courses may be completed through independent
online‐learning; such has free courses available on the FEMA website. Additionally, ICS
300 and 400 are recommended for Supervisors and personnel who shall respond to the
County Emergency Operations Center.
Page E‐12 of 26
EMS Ambulance Transport Provider Agreement
EXHIBIT H ‐ CONTRACTOR ’ S USER F EES ‐ 911 S YSTEM
Effective 11/1/2011
Bundled Base Rate
$1,560.17
Mileage per mile
$35.90
Oxygen
$117.63
*Treat, Non‐transport Rate
$433.39
*Treat, Non Transport Fee ‐ shall be limited to patients who receive a medical intervention, such
as intravenous medication administration, and subsequently refuse transport. Patient
assessment, including ECG monitoring, does not constitute treatment.
Page E‐13 of 26
EMS Ambulance Transport Provider Agreement
EXHIBIT I ‐ MANDATORY DATA F IELD REQUIREMENTS
A.
Location of incident
B.
Approximate time of patient contact
C.
Patient name
D.
Residence
E.
Age
F.
Weight
G.
General assessment
H.
Past medical history
I.
History of present illness/ injury
J.
Mechanism of injury
K.
Medications
L.
Allergies
M.
Physical assessment
N.
Vital signs (BP, Pulse, Respirations, Skin signs, SpO2)
O.
Treatment administered
P.
Response to treatment
Q.
Narrative
R.
Glasgow Coma Scale
S.
Signature/name of person completing PCR
Page E‐14 of 26
EMS Ambulance Transport Provider Agreement
EXHIBIT J ‐ F IRST S OURCE A GREEMENT
Contractor agrees to provide Alameda County (through East Bay Works and Social Services
Agency), ten (10) working days to refer to Contractor, potential candidates to be considered by
Contractor to fill any new or vacant positions that are necessary to fulfill their contractual
obligations to the County, that Contractor has available during the life of the contract before
advertising to the general public. Contractor shall also provide the County with specific job
requirements for new or vacant positions. Contractor agrees to use its best efforts to fill its
employment vacancies with candidates referred by County, but final decision of whether or not to
offer employment, and the terms and conditions thereof, to the candidate(s) rest solely within the
discretion of the Contractor.
Alameda County (through East Bay Works and Social Services Agency) agrees to only refer
pre‐screened qualified applicants, based on Contractor specifications, to Contractor for interviews
for prospective employment by Contractor (see Incentives for Contractor Participation under
Contractor/First Source Program located on the Small
Local Emerging Business (SLEB) Website.
http://www.co.alameda.ca.u
If compliance with the First Source Program shall interfere with Contractor’s pre‐existing labor
agreements, recruiting practices, or shall otherwise obstruct Contractor’s ability to carry out the
terms of the contract, Contractor shall provide to the County a written justification of non‐
compliance in the space provided below.
Company Name:
Contractors Signature: ______________________________________________________________________________________
Title:
Date:
/
/
__________________________________________________________
(East Bay Works / One‐Stop Representative Signature)
Page E‐15 of 26
Date:
/ /
EMS Ambulance Transport Provider Agreement
EXHIBIT K – TRANSITION PLAN
April 2010
Alameda County Board of Supervisors awards Agreement
Begin negotiations with ACRECC for Communications and Dispatch services
May 2010
Identify Paramedics Plus Operations Facility in Alameda County and begin negotiating
lease
Meet with the Alameda County EMS to discuss transition and to negotiate the final contract
June 2010
Meet with NEMSA to develop an agreement to get for monthly update on # of dues paying
members
Receive monthly EMS data dumps to monitor response volumes throughout County
July 2010
Complete negotiations with Alameda County FD for Communications and Dispatch services
Schedule meetings with the current Alameda employees. These informal meetings are
designed to quell any rumors and provide employees with useful and factual information
about the transition and ensure a smooth changeover.
Review monthly update from NEMSA on # of dues paying members
Receive monthly EMS data dumps to monitor response volumes throughout County
August 2010
Review monthly update from NEMSA on # of dues paying members
Schedule a meeting with the EMS Medical Director and Paramedics Plus senior
management team to ensure that our transition plan covers all clinical issues and concerns.
Receive monthly EMS data dumps to monitor response volumes throughout County
September 2010
Relocation of Chief Operating Officer beginning September 1, 2010
Execute agreement with ACRECC for Communications and Dispatch services. This should
include the following items.
o ACRECC to hire dispatchers 4‐6 months in advance for training
o Paramedics Plus to participate on ACRECC Technical/Operations subcommittee
o Paramedics Plus to secure voting membership on Advisory Committee
Monthly Paramedics Plus / Alameda EMS Planning and Transition Meeting
Review monthly update from NEMSA on # of dues paying members
Form employee work groups for
o
Equipment layout in ambulances
o
Operations Facility process management
o
EMS Warehouse layout and process management
o
Satellite station locations, layout and process management
Receive monthly EMS data dumps to monitor response volumes throughout County
Finalize and execute Paramedics Plus Operations Facility lease and begin lease‐hold
improvements.
October 2010
Establish an e‐mail based method of communication with the incumbent workforce and
other system stakeholders. The purpose of these communications will be to manage
rumors and provide interested parties with information about the new system and the
transition.
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EMS Ambulance Transport Provider Agreement
Monthly Paramedics Plus / Alameda EMS Planning and Transition Meeting
Review monthly update from NEMSA on # of dues paying members
Receive monthly EMS data dumps to monitor response volumes throughout County
November 2010
Monthly Paramedics Plus / Alameda EMS Planning and Transition Meeting
Review monthly update from NEMSA on # of dues paying members
Receive monthly EMS data dumps to monitor response volumes throughout County
December 2010
Monthly Paramedics Plus / Alameda EMS Planning and Transition Meeting
Review monthly update from NEMSA on # of dues paying members
Receive monthly EMS data dumps to monitor response volumes throughout County
January 2011
Obtain appropriate City Business License
Place orders with vendors for capital equipment including ambulances and other support
vehicles
Set meeting dates, times and locations to begin meeting with incumbent leadership
Monthly Paramedics Plus / Alameda EMS Planning and Transition Meeting
Review monthly update from NEMSA on # of dues paying members
Receive monthly EMS data dumps to monitor response volumes throughout County
February 2011
Conduct meetings with incumbent leadership to have open dialogue regarding concerns
from work force, discussion about Paramedics plus philosophy and culture, and set one on
one meeting dates to discuss individual transitions to Paramedics plus
Monthly Paramedics Plus / Alameda EMS Planning and Transition Meeting
Review monthly update from NEMSA on # of dues paying members
Receive monthly EMS data dumps to monitor response volumes throughout County
March 2011
Ongoing meetings with the Alameda County EMS, Paramedics Plus senior leadership
including human resources and representatives from the union to adjust and finalize the
activities and timeline for start up or takeover of operation
Begin meeting with all Fire Agencies to develop Mutual‐Aid Agreements
Monthly meeting with incumbent leadership to develop transition plans
Schedule meeting with the incumbent provider’s management team to finalize the
transition plan.
Follow up meeting with the System Medical Director and Paramedics Plus senior
management team to ensure that our transition plan covers all clinical issues and concerns.
Monthly Paramedics Plus / Alameda EMS Planning and Transition Meeting
Monitor Review monthly update from NEMSA on # of dues paying members
Receive monthly EMS data dumps to monitor response volumes throughout County
April 2011
Monthly Paramedics Plus / Alameda EMS Planning and Transition Meeting
Review monthly update from NEMSA on # of dues paying members
Initial delivery of capital equipment and vehicles
Begin installation of ePCR system
o Working both with EMS IT and ACRECC IT
Obtain the following insurances:
o
Automobile Liability
Page E‐17 of 26
EMS Ambulance Transport Provider Agreement
o
List of vehicles by VIN, model and year
o
Original cost of vehicle
o
List of all drivers
Begin testing, installation and check‐off of all equipment
Receive monthly EMS data dumps to monitor response volumes throughout County
May 2011
Complete outfitting of all EMS vehicles and prepare for Alameda EMS and CHP inspection
Begin establishing methods and processes of the day to day business and operation
including the following:
Obtain the following insurances:
o
Professional Liability and Commercial General Liability
o
Commercial Umbrella Liability
o
Automobile Liability
o
List of vehicles by VIN, model and year
o
Original cost of vehicle
o
List of all drivers
Workers’ Compensation
o
Number of employees by job classification
o
Address of each location and number of employees at each location by job
classification
All New Employees from Incumbent Provider ‐ Total wages by classification
Employee Insurance
o
Clarify coverage details for medical, dental, visions, Short and Long Term Disability,
AD&D, Life and EAP
o
Number of employees by gender
Total wages
o
Establish employee 401(k) program
o
Establish payroll system
Establish accounts payable system by vendor
o
Complete credit application process
o
General Ledger accounts for financials
Focus on employee needs. Schedule employee meetings over three consecutive days to
allow all employees the opportunity to attend. During this meeting we will:
o
Have all employees complete a Paramedics Plus application
o
Have all employees complete drug screen application
o
Have all employees complete drug screen on‐site by utilizing a mobile drug
screening unit or other approved mobile collection personnel or agency.
o
Obtain copies of all employee certifications
o
Obtain copies of all drivers licenses and social security cards
o
Complete I‐9 and EEO documentation
o
Complete W‐4 forms
o
Complete insurance coverage forms
o
Distribute policy and procedure manuals with signed acknowledgment of receipt.
Monthly Paramedics Plus / Alameda EMS Planning and Transition Meeting
Review monthly update from NEMSA on # of dues paying members
Receive monthly EMS data dumps to monitor response volumes throughout County
Begin development of an Emergency Operations Plan
Page E‐18 of 26
EMS Ambulance Transport Provider Agreement
Begin development of Quality Management Plan
Begin development of CISM Plan
June 2011
Finalize all Fire Agency Mutual Aid Agreements
Meet with California Highway Patrol and Alameda EMS to license all vehicles
Monthly Paramedics Plus / Alameda EMS Planning and Transition Meeting
Review monthly update from NEMSA on # of dues paying members
Receive monthly EMS data dumps to monitor response volumes throughout County
July 2011
Employee orientations begin
o Policies and Procedures
o ePCR system
Monthly Paramedics Plus / Alameda EMS Planning and Transition Meeting
Review monthly update from NEMSA on # of dues paying members
Receive monthly EMS data dumps to monitor response volumes throughout County
August 2011
Monthly Paramedics Plus / Alameda EMS Planning and Transition Meeting
Meet with NEMSA for monthly update on # of dues paying members
Receive monthly EMS data dumps to monitor response volumes throughout County
Submit an Emergency Operations Plan
Submit Quality Management Plan
Submit CISM Plan
Submit controlled substances policy
September 2011
Monthly Paramedics Plus / Alameda EMS Planning and Transition Meeting
Review monthly update from NEMSA on # of dues paying members
Receive monthly EMS data dumps to monitor response volumes throughout County
October 2011
Monthly Paramedics Plus / Alameda EMS Planning and Transition Meeting
Final check‐off of entire Project Plan for completion
Review monthly update from NEMSA on # of dues paying members
Receive monthly EMS data dumps to monitor response volumes throughout County
November 1, 2011 Start‐up
Paramedics Plus begins operations
Page E‐19 of 26
EMS Ambulance Transport Provider Agreement
EXHIBIT L ‐ COMMUNITY EDUCATION PROGRAM
1.
Contractor shall provide a community education program, based on the needs of the
community as defined by the County and EMS. The community education program shall
contain some or all of the following, which may change from time‐to‐time as community
needs change:
2.
Contractor shall annually undertake at least one project that shall demonstrably improve
the health status in the community.
3.
Health status improvement programs targeted to “at risk populations” may include but are
not limited to:
a.
Seat belt use
b.
Bike safety program
c.
Participation in NTHSA safe communities program
d.
CPR training
e.
911 awareness
f.
Gun safety
g.
Hunting safety
h.
Drowning prevention
i.
Equestrian accident prevention
j.
Senior safety program
k.
Home hazard inspection program.
l.
Child Passenger Safety Program:
Contractor shall implement a child passenger safety program (CPS) in Alameda
County. The program shall include the purchase and distribution of car seats to
targeted populations, as defined by EMS.
Within 18 months of Effective Date a minimum of:
–
one member of the Contractor staff shall earn instructor status in the
National Child Passenger Certification Program and shall begin offering a
Page E‐22 of 26
EMS Ambulance Transport Provider Agreement
two‐hour introductory CPS course as part of the orientation process for all
Field Personnel.
–
two members of the education staff shall earn National Child Passenger
Certification through the National Highway Safety Administration’s
curriculum.
Contractor shall offer CPS classes to the community at no cost. Contractor shall
provide at least one program a year in each city in the EOA including
unincorporated areas.
Contractor shall measure the effectiveness of the child passenger safety program
by monitoring the increased incidence of child restraint use. State or County
observation studies shall be utilized to provide unbiased documentation.
Contractor shall set a goal of contributing to a 1% increase each year in child
passenger restraint usage for the County.
m.
Gun Safety Program:
Contractor shall bring Eddie Eagle gun safety program to Alameda County
children from pre‐K through third grade. This program shall focus on teaching
young children what to do when confronted with a found gun.
Contractor shall partner with Alameda County elementary schools and day‐care
centers to provide this program at no cost to the facility.
Contractor shall compile comparative statistics regarding firearm trauma to
children ages 10 and younger to track the effectiveness of this program.
Page E‐23 of 26
EMS Ambulance Transport Provider Agreement
EXHIBIT M ‐ F IRST RESPONDER SUPPORT
1.
In addition to the monetary provision for first responder support, Contractor shall provide
the following equipment (or similar equipment subject to mutual agreement with the First
Responder Agencies) for each First Responder apparatus operating within County,
including Contracting Cities in Zone 1, as well as for Contractor’s Clinical Field Supervisor
and Operational Field Supervisor Vehicles:
1.1
Rugged mobile personal computers and software for the PCR system for each First
Responder unit apparatus, including updates when required for maintenance of
compatibility throughout the EMS system.
1.2
IT support for First Responder computers in #1 above.
1.3
Ninety 90 LIFEPAK 15 monitor‐defibrillators including a modem (by Velocitor) for
transmission of 12‐lead ECG’s for each unit; as well as a sufficient data plan that can
accommodate and support this process. Contractor shall hold in reserve 10
additional monitor‐defibrillators to be distributed as needed at Contractor’s
discretion.
1.4
Ninety 90 Physio‐Control Chest Compression System LUCAS devices. Contractor
shall hold in reserve 10 additional devices to be distributed as needed at
Contractor’s discretion.
2.
Contractor shall retain ownership of and be responsible for maintenance of the above‐
listed equipment.
3.
Contractor shall also provide EMS continuing education for all Alameda County First
Response agencies, regardless of inclusion in the EOA. Recognizing the inherent difficulties
in sending First Response agency personnel to Contractor’s location, continuing education
shall be made available at First Response agencies through Contractors four clinical
education coordinators. For new fire employees, collaboration with First Responder
Agencies shall also include field internships, riding on Ambulances and working with
Contractor’s field training officers for initial system training.
Page E‐24 of 26
EMS Ambulance Transport Provider Agreement
EXHIBIT N ‐ HIGH RISK PATIENT DESCRIPTION
“A High‐Risk PCR” is a patient care report for a High‐Risk Patient. A High‐Risk Patient is
defined as follows:
1.
STEMI (ST‐Elevation Myocardial Infarction) patient transported to any hospital, including a
Cardiac Receiving Center, per EMS Policies
2.
CVA (Cardio‐Vascular Accident) patient transported to any hospital, including a Stroke
Center, per EMS Policies
3.
Critical Trauma Patient with a trauma activation, per EMS Policies
4.
Any patient not breathing or breathing ineffectively (Echo call)
5.
Any emergent (lights and siren) return to the hospital
6.
Any patient (other than a 5150 patient who has been medically cleared) who is unable, for
any reason, to provide a history
7.
Any patient aged 10 or less
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EMS Ambulance Transport Provider Agreement
EXHIBIT O ‐ Proposal of Paramedics Plus
(Appendices 1‐56 incorporated by reference, but not attached)
Page E‐26 of 26
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