As of January 1, under a new County Emergency Medical Service (EMS) contract, Quick Response Vehicles (QRV) stationed in Discovery Bay, Brentwood and other parts of the county have been removed from service and replaced with more traditional ambulances and reduced response time requirements.
QRV’s were first created in 2004 to provide paramedic response within a period of 10-minutes of a 911 call. However, over the last ten years the EMT’s scope of practice has increased and was considered a duplication of services according to Pat Frost, Emergency Medical Services (EMS) Director of Contra Costa County.
Frost believes under the new agreement the residents of west and east County will have a similar or better medical emergency response and transport coverage as they have become accustomed to.
“The EMS Agency assures the public of appropriate services by responsibly holding the ambulance contractor accountable for their performance contract as approved by the Board of Supervisors,” said Frost. “The compliance is publicly reported on our website.”
As part of an extensive study to determine EMS resource needs throughout the county, the urban response zone was expanded to include the community of Discovery Bay. Under this change, the Town of Discovery Bay is re-categorized as requiring an “urban” level of service and will require a minimum response of 11:45 minutes by an ambulance 90% of the time. This lowered response time requirement is faster than the previous requirement of 16:45 minutes.
Although the minimum response time has been lowered, call logs show ambulances were already responding to Discovery Bay in less than 11-minutes. The QRV’s were designed to provide faster care on-scene with quicker deployment but they were not able to transport patients to local hospitals and relied on AMR ambulances to provide those transport services. The QRV program has been considered to be more costly than effective, stimulating the change of direction according to County sources.
Contra Costa County Fire Chief Jeff Carman explained that what is being implemented is part of the agreement based off the RFP requirements the County EMS Agency placed on prospective bidders. Under the RFP, the QRV’s being eliminated were based on the county EMS Agency, not CONFIRE or AMR.
“We have eliminated the QRV’s and replaced both of them with an additional posted ambulance in East County to better service Discovery Bay and East County in general,” said Carman. “In addition, unit hours in all of East County were increased from the previous deployment plan. We feel that the new deployment plan will have an overall decrease in response time averages to the East Con Fire coverage areas.”
According to Chief Carman, at any given time (depending on available units) the Alliance will have between one and four units in East County–typically three units with at least an additional one or two more units in the eastern Antioch area who can assist.
“This is an increase in overall coverage to East County. In addition we have moved existing ambulances from the border areas further into east county areas to reduce (response) times,” said Carman.
While County EMS could not confirm the number of ambulances added to East Contra Costa’s coverage area, the ambulance contract agreement holds the ambulance provider to response time “performance” versus a specific number of ambulances explained Frost.
“They are required to put in as many ambulances it takes to meet their response time obligations. There are numerous provisions within the contract to assure the provider meets its performance obligations,” explained Frost. “The EMS Agency has extensive experience in dealing with fire station closures in both East and Central County and has worked closely with both Contra Costa Fire and East Contra Costa Fire for the last 5 years making adjustments in ambulance deployment to reduce the risk to the community.”
Those efforts will continue according to Frost. “The RFP and contract agreement was designed to assure sufficient ambulance resources under its many provisions and took into account fire station closures.”
At the time of the Modernization Study in 2014 the QRV cost reported to the EMS Agency was approximately $750K. The QRV’s, however, are not reimbursed by medical insurance and only those EMS services provided by ambulances are.
According to Frost, the ambulance provider relies on insurance reimbursement to provide EMS services throughout the county. Meanwhile, the goal is to improve definitive care by providing ambulances to faster transport patients to hospitals to improve patient care outcomes.
“The new agreement improves fiscal sustainability of the ambulance provider and opens up opportunities to increase that reimbursement. QRVs were never designed to replace Fire First Medical Response,” said Frost.
According to the June 14, 2014 EMS Modernization Project Report provided to the County, the report calls for the QRV’s to be eliminated multiple times based on their cost including at one point calling them a “Fiscal Issue” and was listed their removal as a Priority 1 in the “key recommendations”.
On page 87 of the report it states:
“Eliminate the QRV units staffed with a single paramedic in specific areas of the County. As indicated earlier, the benefit of Advanced Life Support (ALS) response does not outweigh the costs. Efforts should be made to create alternative first responder resources in the areas.”
Although the QRV’s were eliminated based off their financial burdens, East Contra Costa Fire Protection District Fire Chief Hugh Henderson believes the new agreement will help residents get better service noting that the QRV program was actually started in 1992 working on the Byron fire station. This program was a partnership between the ambulance provider, County EMS and the fire district with the Paramedic working with the engine crew.
Henderson further highlighted that the quick response vehicle/solo paramedic was not designed to respond by themselves for both the QRV safety and the safety of the patient.
“I believe that the new emergency ambulance contract will provide better care for the Far East for several reasons; first, parts of the district have been reclassified to an “urban area” such as Discovery Bay, reducing the response time from 16 minutes to 11:45 minutes which will get the patient to the hospital quicker and also free up the fire engine for the next emergency response. In needing to meet the shorter response times within the district naturally means there will be more ambulances available within the fire district at any given time which is a win/win for the community,” explained Henderson, who added. “The new contract also is a single point of dispatch for both fire and the ambulance meaning that both resources will get rolling at the same time with common communications.”
Frost noted that in terms of response times, in Brentwood for example, the QRV’s primary response was 6-minutes during the month of December. According to the recent ECCFPD service log, the average fire engine response was 7:01 minutes—as a District, it was 8:10 minutes.
Henderson stated that when it comes to response times in Brentwood, both the Engine and QRV respond together and it’s not a one-or-the-other type of response.
“If engine 52’s in quarters and the Quick Response Vehicle also is in quarters, they respond in tandem, normally with the QRV behind the engine. Normally the engine would stay on scene until the transporting ambulance arrives prior to clearing. We do not normally leave the QRV with the patient alone,” explained Henderson. “I believe (with the new program) you’ll see more ambulances in the system with fire district and canceling fire units more often on (medical) calls.”
Chief Carman agrees.
“Overall we believe that there will be faster and more efficient ambulance response times in East County than there was prior. In addition, now that the ambulances are dispatched by the same dispatch center as the east county fire resources you will see a reduction in response times and an improvement in communications that we never had before. Lastly, we can better monitor when east county is tapped for fire resources and hopefully the LEMSA will give the ambulance side of the house exemptions to be able to move more ambulances into east county to cover the district while fire is busy,” said Carman.
Carman further highlighted a benefit to East County that when it comes to East Contra Costa Fire and they are on a big fire and will be on scene for a while, with the LEMSAs approval, the Alliance could move ambulances east, which may result in a longer response times in other areas but they could manage that by making sure they have paramedics on engines and trucks available to respond to those incidents.
The new plan is not designed to delay paramedic care but to improve them and build in a stronger financial structure.
“We don’t throw people into an ambulance and drive fast anymore, we stabilize them on scene first when we can. So even though the ambulance may be delayed, paramedic care would not,” explained Carman. “The ambulances are now part of our resource pool that we can spread them and engines/ trucks out more evenly when resources are scarce. This kind of coordination was never able to be done before.”
According to the contract, if the system starts to back up in terms of response times then more ambulances will need to be added into the system. Carman highlighted that will not be an issue, but warns that the bigger problem right now is the wait times at hospital emergency rooms for ambulances and patient hand-off.
Vince Wells, President of the Professional Firefighters of Contra Costa County, Local 1230, stated East Contra Costa has many challenges with regards to getting residents the quickest patient care possible and they will be watching the response times and service levels.
“The goal of any EMS system is to get the right number of resources with the right amount of training and equipment to the scene of an emergency in time to make a difference. Once that is accomplished it is important to get that patient to the appropriate facility with the necessary level of definitive care,” said Wells. “East Contra Costa Fire Protection District residents are faced with many challenges to meet this goal. Hopefully the alliance allows for the ability to evaluate and adjust as necessary to meet the terms of the contract overcome these challenges.”
While the County EMS will be watching the numbers closely and could make adjustments, Chief Carman warned residents that a big issue that needs to be addressed in the coming year was ambulance wait times at local hospitals.
“The biggest issue in our county is the wait times at hospitals and east county hospitals are the worst,” said Carman. “We wait over an hour to move patients from our gurneys to the hospital gurneys. This keeps ambulances from being able to be put back into the system, which results in response time delays, which means more ambulances have to be put into service costing the citizens more money all because hospitals try and save money by keeping their staffing to a minimum.”
He believes the bigger solution is not to send fire trucks and ambulances to every EMS call like they currently do.
“I want to see us just send ambulances to the lower level calls which in our area is about 40% of them,” said Carman. “This is something we will work with the LEMSA on in the near future. This is one of my primary goals because it adds capacity back into our (non-medical) response system. If I can reduce the number of low level calls our engines and trucks go to, it’s a huge savings without compromising care to our citizens.”
Carman believes in East Contra Costa, this type of change will help.
“With only three fire engines for such a huge geographical area (ECCFPD), it is extremely important to free up fire apparatus when possible. The unnecessary use of fire apparatus not only affects East County but has a trickle-down effect on ConFire too,” said Carman.
Overall, Carman believes that with the consolidation of resources, the Alliance will be better able to balance resources in not only East County, but the entire county.
20 comments
I didn’t see in the article a requirement for the ambulance team to provide paramedic care with EMTs. In the past, ambulances relied on the fire department to provide the paramedic care, the ambulance crews were more likely than not to even have an EMT on their crew.
Never in this county Jerry. The 911 response ambulances have always had been staffed with paramedics. It used to be 2 paramedics on each ambulance, now it is 1 paramedic and 1 EMT. It is the fire departments in Contra Costa that have only recently started adding paramedics, and some still don’t have paramedics.
Thank you for that response … most of my knowledge comes from Alameda County near Pleasanton/Livermore…but can we also assume that in a situation that requires immediate evacuation, like an injured person trapped inside a car, that the ambulance crews will be equipped and trained to safely free that person?
I call BS! East County is going to get the short end of the stick like we do with fire service. Hey East County residents, the county just reduced your quality of care from a QRV getting to scene first to provide care in favor of two people showing up and transporting you. Shame on the County Board of Supervisors and County EMS for allowing this change. All about the MONEY not QUALITY of care.
Jerry….all of the ambulances in contra costa county have 1 medic and 1 emt, so all are considered ALS ambulances….and they have been as long as I can remember. ConFire does have medics on their engines but east county does not.
That’s a lot of mumbo jumbo from County EMS. You take away a QRV person coupled with trying to limit engine rolls and that’s supposed to be an upgrade?
This looks like sacrificing overall EMS response in order to make the few engines we have left available for fire calls. Did County just buy into the public outcry about 85% medical calls within the fire department without really thinking this through?
Yes, transport is important. But so is getting a Paramedic to your side in a time of need in the shortest time possible. I don’t see how this plan does that. It may work out for the center of the district. But this looks like the outer areas like BI and Discovery Bay are going to take another one on the chin.
Said before this is going to get a lot worse before it gets better. This looks like another sign.
If I am reading this right, we have replaced a rig that can provide care immediately for a transport unit? I am not seeing the logic by the county. Who are they kidding? Better service for who? Their budget? How about the focus being keeping people alive.
Can someone please explain to me what a QRV can do versus an ambulance?
The two are equivalent in terms of medical capacity.
Michelle….the QRV was put into service to provide ALS care earlier because transport times were extended. The only thing the QRV’s couldnt do was transport. But your right…ALS care may now be started later based on where the closest transport ambulance is. So, it does appear that far east county is taking it in the shorts a little bit on this one.
Michelle and Mike you’re both correct. When the budget became the responsibility of Chief Carmen, all of a sudden the QRV’s are too expense to keep around. But when AMR was responsible for them, County EMS demanded that AMR foot the bill for them if they wanted the 911 contract. Measure H money only paid for them for a very short time fyi. So East Contra Costa is left with less than we’ve had in over 20 yrs. The population out here, many of them seniors, should be very upset. Well, everyone should be very upset. If it’s good enough for Contra Costa Fire to have paramedics on their engines (sometimes the Captain, Engineer, and FF are trained paramedics) in Central County’ why shouldn’t we get to keep our QRV’s in Discovery Bay and Brentwood, with a single paramedic? And because it costs too much doesn’t fly. I’d really like to see the citizens attend the next meeting and ask some of these questions.
Grandma, you’re not yourself when you are hungry. Have a snickers bar, come back to reality and get your facts straight.
There is no excuse to reduce Paramedics in Far East County other than prop up Con Fire. Paramedics are not a part of the ECCFPD and do not affect their revenue. The responsible entity for this this service is Contra Costa County. However, taking these QRVs away Will Affect Our Fire Fighters Directly. It will also take money from our fire district to fill the gap. We may get lucky this time on the BOS to help not hinder East County. I pray.
I know a lot of things but I am not a fire chief or ems provider. Maybe we should see how this plays out before jumping to so many conclusions? We the public have been yelling for change in the way services are deployed. Now we are getting that change still no one is happy. The chief said it plainly “Carman believes in East Contra Costa, this type of change will help.”
Nothing they can do will make all of us happy. I fear the rest of the county sees things as they are. Friends, we are not painting ourselves in a good light. Second guessing the professionals and other actions don’t reflect well on us and have our fire department headed to ruins. Buyaclue is right it is going to get worse. We reap what we sow and now the weeds are sprouting. And yet we act surprised.
Walt,
Simple logical math says two less paramedics in east county is a travesty. We need to vote em out and vote no on any attempt to pull more underhanded moves by the BOS.The change requested by the public was not to reduce the number of paramedics in east county but to increase the firefighting resources. What the County Supervisors have done is reduce advanced life support abilities and place more burden on our over burdened fire district. Its not too late to throw the fire district all back to the BOS or reorganize with a less expensive employee cost. The county has a billion dollar budget but can only find enough money to give themselves raises. Right now we are treading way past unacceptable from our Board of Supervisors. Just give us back our QRV’s before innocent deaths occur. We have already paid for them. Diverting those savings to beef up Con Fire paramedics is dishonest and illegal. Final solution if others do not work, force a merge with Con Fire.
Citizen Jim again with the anger? I don’t think that makes your point at all. Maybe try posting some facts and I will consider your point. Who are you even suggesting gets voted out? Current situation is the county ems division, both fire chiefs, confire & east county, Carmen and Henderson, and amr, the ambulance provider believe this is the new model and a improvement over what we have. You don’t seem to agree and believe for whatever reason the board of supervisors should listen to you over all the experts. Where is the logic in that? It’s been pointed out, We don’t pay for the qrvs, you haven’t paid for them, we aren’t sure we are getting two less paramedics, we are getting more ambulances that have transporting capability, you don’t seem to understand the county, budgets, salaries, raises or provide anything other than scare tactics and dishonest statements. Nothing is illegal and how on earth can you say people will die? Please make some effort to contact the agencies as I have and then get back to us with your opinion because right now I just don’t see it Citizen Jim, especially when you don’t provide inaccurate information.
Thanks
Citizen Jim, another of your ECT aliases headed for the scrap heap?
You’re coming apart at the seams there, buddy. Might want to lay off the internet thing for awhile before you have to call your anger management sponsor. Wouldn’t want you becoming a 6 o’clock news lead story or something.
I appreciate the educated responses. Thank you.
When East County had the QRV it was staffed with 1 paramedic. The ambulance was/is staffed with 1 paramedic and 1 EMT. The Fire engine has 3 EMT’s. So when you called 911 you had 2 paramedics and 4 EMT’s arrive to your home. We no longer have the QRV so subtract 1 paramedic from the response. You now only have 1 Paramedic and 4 EMT’s arrive. That equals a reduction in care you will receive on scene. East County got the shaft again.
1 fire engine with 3 EMT’s and 1 ambulance with 2 EMT’S is considered a normal response across most of the state. It is an industry standard which we have now . East county citizens have lost sight of the fact that having 5 EMT’s on scene for most medical calls is more than enough!
Yes folks it is possible to have too many, especially in a cash strapped environment.
With this model we now have the same response as everyone else but pay far less into the district.
@ Old Firefighter,
You must be very old because today we have radio dispatch. You do not need to have everyone respond. However, as there is multiple call often we need multiple Paramedics. Kinda makes sense. If not, use your same logic on firefighters meaning we don’t need anymore. That would be just wrong. More importantly is the loss to east county capabilities and two million worth of our entitled tax revenue taken away from us by the BOS.
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