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California Fire Chiefs Association EMS Leadership Academy. Surfing the EMS System. “You Can’t Tell the Players Without a Program”. Learning to Surf. Reasons for System “Collisions” Statutory Experience Personalities READ and Learn Seek to understand first Collaboration versus collision.

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California Fire Chiefs AssociationEMS Leadership Academy

Surfing the EMS System

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Surfing the EMS System

“You Can’t Tell the Players Without a Program”

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Learning to Surf

  • Reasons for System “Collisions”

    • Statutory

    • Experience

    • Personalities

  • READ and Learn

  • Seek to understand first

  • Collaboration versus collision

Surfing the EMS System

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EMS Systems Standards and Guidelines

EMSA #101- 1993

“The delivery of emergency health care requires the participation of numerous independent individuals and organizations, including public safety agencies, ambulance services, physicians and hospitals. Despite their autonomy, these organizations have high degrees of functional interdependence as the work to provide care, sometimes simultaneously, to individual patients. Managing interdependence requires planning, standardization, and mutual adjustment.”

Surfing the EMS System

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Important Documents

  • State Statutes - Legislative Mandates

    • Health and Safety Code (70+ Amendments)

    • Welfare and Institutions Code

    • Government Code

    • Often open to interpretation

  • Regulations - Implement, Interpret Statutes

    • CCR Title 22 Division 9

  • Guidelines

    • System Standards and Guidelines EMSA #101

Surfing the EMS System

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More Important Documents

  • Court Cases

    • Numerous dating from 1966

  • Federal

    • Laws, Regulations, Rules, Publications, Manuals

      • SS Act, HIPPA, Paperwork Reduction Act

      • CLIA, Medicare, Medicaid, NHTSA Assessment

  • Mission statements and position papers

    • Web Sites

Surfing the EMS System

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Health and Human Services Agency

  • State Agency

    • Appointed Secretary, Grantland Johnson

  • 15 Boards and Departments

    • Health Services

    • Social Services

    • Mental Health

    • Emergency Medical Services Authority

Surfing the EMS System

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Emergency Medical Services Authority

  • Created in 1980 by SB125 (Div 2.5 HSC)

  • Establish a single state lead agency and centralized resource to deal with emergency and disaster medical services

  • Director appointed by and reports to Secretary of HHSA

  • Medical Director and Chief Deputy Director

  • Funding

    • State General Fund

    • Federal Preventive Health and Health Services Block Grant

    • Fees for paramedic certification testing and registry

    • Office of Traffic Safety

Surfing the EMS System

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EMS Authority

  • Program Responsibilities

    • EMS Systems Planning and Development

    • Trauma Care System Planning Development

    • Prehospital Emergency Medical Care Personnel

    • Drivers, Paramedic Licensure and Enforcement

    • Disaster Medical Services Preparedness and Response

    • and “stuff”

Surfing the EMS System

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Commission on EMS

  • Created by SB 125 , membership specified by statute

    • 16 members appointed by various elected officials

    • membership dated

  • Review and approve regulations, standards, and guidelines

  • Advise the Authority on the development of an emergency medical data collection system

  • Advise the Director concerning the assessment of emergency facilities and services

Surfing the EMS System

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Commission on EMS

  • Advise the Director with regard to communications, medical equipment, training personnel, facilities and other components of an emergency medical services system

  • Make recommendations for further development and future directions of emergency medical services in the State

  • Review and comment upon the emergency medical services portion of the State Health Facilities and Service Plan developed pursuant to Section 437.7.

  • Hear and determine appeals regarding County EMS Plans

Surfing the EMS System

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  • GOVERNORS Office of Emergency Services

  • Director appointed by/reports to Governor

  • Since1917 in various forms

  • Since 1970 similar to it’s form today

  • Disaster preparedness and recovery planning/coordination (duplication?)

  • “Grantee” for federal disaster assistance

  • Fire and Rescue Branch

Surfing the EMS System

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Local EMS Agencies

  • Created by SB 125

  • Each county having an EMS program is required to establish

  • Lives in or contracts with county health or JPA with counties also allowed

  • Responsibilities increasingly delineated by statute and case law

  • Originally “plan, implement and evaluate”

Surfing the EMS System

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Local EMS Agencies

  • Required to have a Medical Director

    • May assign administrative “staff”

  • Duties

    • Some specific, others inferred or interpreted

      • Medical Control

      • “Discipline” practitioners (Penalties)

      • Policies and Procedures

      • Planning

      • Exclusive Operating Areas

      • Facilities

Surfing the EMS System

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  • Emergency Medical Care Committee

    • “County EMS Commission”

  • Optional at county’s discretion

  • Membership prescribed by BOS

  • “Review and Report”

    • LEMSA

    • EMSA

    • BOS

Surfing the EMS System

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  • Emergency Medical Directors Association of California

  • “provide leadership and expert opinion in the medical oversight, direction and coordination of Emergency Medical Services for the people of the State of California”

  • “30-some” members

  • Scope of Practice

  • Commission Member

Surfing the EMS System

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  • Emergency Medical Services Administrators’ Association of California

  • “Staff”

  • Old Days Bossy Nuisance?

  • Daily oversight

  • Commission Member

Surfing the EMS System

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  • California Ambulance Association

  • Ambulance Owners/Managers

  • Professional Staff

  • Both State and National version (AAA) very active legislatively

  • Commission Member

Surfing the EMS System

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  • California State Association of Counties

  • Established in 1894

  • Membership - 58 Counties

  • 62 member BoD, 14 member Executive

  • Represent county government before the California Legislature, administrative agencies and the federal government.

  • Full time staff of 28

  • Very Active

Surfing the EMS System

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League of California Cities

  • Founded in 1898

  • Membership officials from 476 cities

  • 39 member BoD, 5 member Executive

  • “enhance their knowledge and skills, exchange information, and combine resources so that they may influence policy decisions that affect cities.”

  • Full time staff

  • Very active

Surfing the EMS System

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  • California Professional Firefighters

  • Union?

  • CPF represents 30,000 career firefighters in 150 affiliated local unions.

  • Approximately 60 years

  • “promote the interests of career firefighters”

  • Full time staff

  • Very active

Surfing the EMS System

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  • California State Firefighters Association

  • Union?

  • 28,000 members

  • Founded in 1922

  • ensuring our members a strong and united voice in the evolution of the fire service, through unity in leadership, political action, education, and quality member services

  • Full time staff

  • Very active

Surfing the EMS System

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  • Fire Districts Association of California

  • “Provide leadership and expert opinion in the medical oversight, direction and coordination of Emergency Medical Services for the people of the State of California”

  • Membership is FPD’s, CSD’s etc.

  • Governing BoD aligned with OES regions

Surfing the EMS System

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Metro Chiefs

  • Section of IAFC

  • “consists of chiefs of departments with a minimum authorized strength of 400 fully paid personnel and who are members of both IAFC and NFPA.”

  • An informed advisory body, they support, serve and provide input to the IAFC and the board of directors, focusing on issues facing metro fire department.

  • California “Chapter”

  • Active nationally, informal in California

Surfing the EMS System

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  • California Fire Chiefs Association

  • Fire Chiefs from over 1,100 fire departments operating in the state of California

  • “further the professional advancement of the fire service to ensure and maintain greater prevention and protection of life and property from fire, natural and human caused disaster, or other sudden emergencies”

  • 6 sections:Administrative, EMS, Communications, Fire Prevention, Mechanics, Training

  • VERY ACTIVE!!!!!!!!!!!!

Surfing the EMS System

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  • Service Employees International Union


  • 1.5 million members nationally

  • Represent some private ambulance employees

  • Very active

Surfing the EMS System

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Law Enforcement

  • Traditionally not a strong presence/interest in EMS

  • That is changing

  • COPA has commission seat

    • CHP

    • County Sheriffs

  • PSAP - they own them!

Surfing the EMS System

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Commission Task Forces

  • Various Task Forces of Commission and/or Director

  • Some are convened for a specified purpose/duration

  • Some are standing committees/task force

  • Examples

    • Inter-facility

    • EMT-P & EMT-1

    • Trauma

Surfing the EMS System

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Vision Committees

  • Assembled to work on Vision Process

  • 6 work groups divided by subject area

  • Work nearing completion

  • Unsure how they will move forward when Vision is concluded

  • Collaboration tool has value

Surfing the EMS System

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Local Governments

  • Individual Cities and Districts

  • Set and fund local emergency services

  • Advocate local needs individually or through larger organizations

Surfing the EMS System

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Private Providers

  • Variety of “for profit” privately or publicly owned entities

  • Stakeholders and participants in EMS delivery

  • Advocate needs individually or through larger organizations

Surfing the EMS System

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Cal ACEP **

Cal ACOS **

CMA **


ENA **


CAA **












** means groups with a Commission Seat

Surfing the EMS System

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Surfing the EMS System