San Joaquin County Emergency and ALS Ambulance RFP August 1, 2015 San Joaquin County Emergency Medical Services Agency Request for Credentials/Proposals Emergency and Advanced Life Support Ambulance Services SJCEMS RFP No. 2014 - 01 Service beginning May 1, 2016 Bidder’s Conference September 4, 2014, 10:00 a.m. San Joaquin County EMS Agency EMS Classroom 500 W Hospital Road French Camp, CA 95231 Proposals Due September 24, 2014 by 12:00 p.m. Delivery to: Dan Burch, EMS Administrator San Joaquin County EMS Agency 500 W Hospital Road, Benton Hall Room 47 French Camp, CA 95231 Official Contacts Only: This RFP contains restrictions on contact with public officials, the County’s consultants or others working on behalf of the County. See the official contact policy in Section 2.2 of this document. Violation of this policy may lead to disqualification. San Joaquin County Emergency and ALS Ambulance RFP August 1 2014 AMBULANCE RFP TIMELINE August 1, 2014 • RFP Issued by Emergency Medical Services Agency August 25, 2014 • Letters of intent due by 12:00 p.m. • Letter of intent fee due by 12:00 p.m. • Deadline for receipt of all questions regarding the RFP by 12:00 p.m. September 4, 2014 • Bidders’ Conference, amendments to RFP released (if any) 10:00 a.m. September 24, 2014 • Deadline for submission of proposals by 12:00 p.m. • Proposal fee due by 12:00 p.m. • Investigation of bidder’s submissions and claims October 15, 2014 • Proposal Review Committee Presentations October 17, 2014 • Public announcement of EMS Administrator’s recommendation October 24, 2014 • Deadline for the submission of protests—due by 12:00 p.m. November 3, 2014 • Announcement of decision on protest(s) by Director of Health Care Services December 2, 2014 • Final recommendation of award to Board of Supervisors by EMS Agency and Declaration of Intent to Contract by Board of Supervisors April 7, 2015 • Presentation of final negotiated contract to Board of Supervisors and approval of contract by Board of Supervisors (Performance security due) May 1, 2016 • Implementation of service by the Contractor at 8:00 a.m. NOTE: These dates are subject to change. i San Joaquin County Emergency and ALS Ambulance RFP August 1 2014 Table of Contents Section 1: Introduction and Background .............................................................. 4 1.1 Invitation .......................................................................................................... 4 1.2 Scope of services ............................................................................................ 4 1.3 Description of San Joaquin County ................................................................. 5 1.4 Medical control ................................................................................................ 6 1.5 Advisory committees ....................................................................................... 7 1.6 EMS participants ............................................................................................. 7 1.7 Estimated EMS Responses ........................................................................... 10 Section 2: Submission and evaluation of proposals ......................................... 12 2.1 Notice to bidders ........................................................................................... 12 2.2 Contacts ........................................................................................................ 12 2.3 Bidder’s conference ....................................................................................... 12 2.4 Letter of intent ............................................................................................... 13 2.5 Proposal fee .................................................................................................. 14 2.6 Proposal format and requirements ................................................................ 14 2.7 Proposal options ............................................................................................ 15 2.8 Submission and receipt of proposals ............................................................. 16 2.9 Rejection of proposals ................................................................................... 17 2.10 Evaluation of proposals ............................................................................... 17 2.11 Waiver of requirements ............................................................................... 18 2.12 Protests ....................................................................................................... 18 2.13 Conditions for contract extension ................................................................ 19 Section 3: Credentials .......................................................................................... 20 3.1 Credentials overview ..................................................................................... 20 3.2 Analogous experience ................................................................................... 20 3.3 Financial stability ........................................................................................... 22 3.4 Managerial expertise ..................................................................................... 22 Section 4: Proposal requirements ........................................................................ 24 4.0 Introduction section ....................................................................................... 24 4.1 System design ............................................................................................... 24 4.2 Operations section ........................................................................................ 26 4.3 Personnel section .......................................................................................... 46 4.4 Quality/performance section .......................................................................... 53 4.5 Data and reporting section ............................................................................ 57 4.6 Financial and administrative section .............................................................. 59 4.7 Community education/prevention programs .................................................. 65 Section 5: Other contract language .................................................................... 67 5.1 Contract administration .................................................................................. 67 5.2 Term of agreement ......................................................................................... 67 5.3 Documents constituting contract .................................................................... 67 5.4 Contract response area .................................................................................. 67 5.5 Notices ........................................................................................................... 68 5.6 ALS provider agreement ................................................................................ 68 ii San Joaquin County Emergency and ALS Ambulance RFP August 1 2014 5.7 County’s functional responsibilities ................................................................. 68 5.8 Contractor’s functional responsibilities ........................................................... 69 5.9 Monitoring costs ............................................................................................. 70 5.10 End of contract transition Period .................................................................. 70 5.11 Relationships and accountability .................................................................. 70 5.12 General subcontracting provisions ............................................................... 71 5.13 Performance criteria ..................................................................................... 71 5.14 Termination for cause ................................................................................... 71 5.15 Declaration of major breach and takeover/replacement service ................... 73 5.16 Dispute after takeover/replacement .............................................................. 73 5.17 Breach not dangerous to public health and safety ........................................ 73 5.18 Liquidated damages ..................................................................................... 73 5.19 County responsibilities ................................................................................. 74 5.20 ‘Lame duck’ provisions ................................................................................. 74 5.21 Retention and audit of records ..................................................................... 74 5.22 Indemnification for damages, taxes and contributions .................................. 75 5.23 Equal employment opportunity ..................................................................... 75 5.24 Independent contractor status ...................................................................... 75 5.25 Non-assignment and non-delegation ............................................................ 76 5.26 Entire agreement .......................................................................................... 76 5.27 Binding on successors ................................................................................. 76 5.28 Captions ....................................................................................................... 76 5.29 Controlling law .............................................................................................. 76 Forms ...................................................................................................................... 77 Form 1: Proposal identification ............................................................................. 77 Form 2: Statement of intent and affirmation ........................................................ 78 Form 3 Investigative authorization–company ....................................................... 80 Form 4: Investigative authorization–individual ..................................................... 82 Form 5: Acceptance of minimum requirements ................................................... 83 Form 6: Acceptance of contract language ........................................................... 89 Form 7: EMT compensation package .................................................................. 90 Form 8: Paramedic compensation package ........................................................ 91 Form 9: Dispatcher compensation package ........................................................ 92 Form 10: Proposed operating budget .................................................................. 93 Form 11: Proposed ambulance rates .................................................................. 96 Form 12: Charge scenarios ................................................................................. 98 Attachments ......................................................................................................... 102 Attachment 1: San Joaquin County Ambulance Zones Map ............................. 102 Attachment 2: San Joaquin ambulance zones legal description ....................... 103 Attachment 3: San Joaquin population density/response time zone map ......... 107 Attachment 4: Documents available for review.................................................. 108 Attachment 5: San Joaquin County current emergency ambulance rates ......... 109 Attachment 6: CAD Record Requirements ......................................................... 110 Attachment 7: Definitions .................................................................................. 112 Attachment 8: Proposal Evaluation Tool ........................................................... 115 iii San Joaquin County Emergency and ALS Ambulance RFP August 1 2014 Section 1: Introduction and Background 1.1 Invitation The County of San Joaquin, California invites experienced and qualified bidders to submit proposals to provide emergency and advanced life support (ALS) ambulance services including emergency medical dispatch as specified in this document for San Joaquin County’s Ambulance Zone X, serving the greater Lodi, Stockton, Tracy communities (Attachment 1). The successful bidder will be granted a contract for exclusive market rights, as provided for in Section 1797.224 of the California Health and Safety Code, for emergency and ALS ambulance services for five years. The start date for the service will be May 1, 2016, at 8:00 a.m., Pacific Time. The Contractor will have the opportunity to earn up to five additional years of contract extension as described in Section 2.13. 1.2 Scope of services This Request for Proposal (RFP) and its provisions, attachments, addendums and exhibits constitute the RFP for the selection of a single provider of emergency and ALS ground ambulance service for San Joaquin County Ambulance Zone X. The operation of emergency and ALS ambulance service in this zone shall be consistent with the provisions of this procurement process including staffing and performance. This procurement process includes the provision of all emergency ambulance responses, all ALS inter-facility ambulance transports, as well as, the operation of the ambulance provider’s dispatch center, which shall be an approved emergency medical dispatch (EMD) center and 9-1-1 secondary answering point. The selected provider will receive exclusive market rights for all emergency ambulance service and all ALS ambulance service within Zone X. All of the following transports originating in the exclusive ambulance zone shall be referred to the holder of the exclusive franchise for that zone, and the holder of the exclusive franchise shall provide all responses and ground transports: • all 9-1-1/PSAP requests for ambulance service; • requests for emergency ambulance service made directly to an ambulance service without going through an authorized 9-1-1/PSAP; • ambulance transport to an emergency department from the scene of an emergency, including transports to an emergency department originating from a skilled nursing facility, physician’s office, medical clinic, residential care facility, or other medical facility; • ALS inter-facility ambulance transports from a general acute care hospital in Zone X to any other general acute care hospital; • critical care transport (CCT) ambulance transports, which shall conform to the definition of “Specialty Care Transport” as defined in 42 CFR 414.605, from a general acute care hospital in Zone X to any other general acute care hospital, (excluding hospital based neonatal transport services and physician staffed ambulance transports). 4 San Joaquin County Emergency and ALS Ambulance RFP August 1 2014 The Contractor’s scope of service is summarized as follows: • When a request for service is received by the Contractor at its dispatch center, an appropriately trained EMD Dispatcher must answer that request promptly, must follow approved EMD dispatch procedures, offer planned pre-arrival assistance (as appropriate) and must manage the appropriate EMS response, given the nature of the request, including timely backup ambulance coverage and the competing demands upon the system at that point and time, including, when appropriate, the notification of non-transport first responder and EMS air transport provider agencies. • Ambulance response times must meet the response-time standards set forth herein, and every ambulance unit provided by the Contractor for emergency response must, at all times, except as authorized by the contract, be equipped and staffed to operate at the advanced life support (paramedic) level on all ambulance responses, including immediate and urgent services. Clinical performance must be consistent with all EMS Agency policies and approved medical standards. The conduct and appearance of the Contractor’s personnel must be professional and courteous at all times. Services will be provided according to the EMS Agency’s Policies and Procedures as are or may be established or as approved by the County in the Contractor’s proposal and as developed or promulgated as part of this RFP. • Services and care delivered must be evaluated by the Contractor’s internal quality improvement program and as necessary, through the County’s quality improvement program in order to improve and maintain effective clinical performance. The Contractor must make an unrelenting effort to detect and correct performance deficiencies and to continuously upgrade the performance and reliability of the entire EMS system. Clinical and response-time performance must be extremely reliable, with equipment failure and human error held to an absolute minimum through constant attention to performance, protocol, procedure, performance auditing, and prompt and definitive corrective action. This procurement process requires the highest levels of performance and reliability, and mere demonstration of effort, even diligent and well-intentioned effort, shall not substitute for performance results. The holder of an exclusive franchise that fails to perform the standards required maybe found to be in major breach of their contract and promptly replaced in order to protect the public health and safety. 1.3 Description of San Joaquin County San Joaquin County was established in 1850 as one of California’s original 27 counties and derives its name from the San Joaquin River. It has since become the 15th largest county in California, covering more than 1,400 square miles. Within the County there are seven cities: Escalon, Lathrop, Lodi, Manteca, Ripon, Stockton, and Tracy. According to the US Census Bureau as of 2012, the estimated population of the County is 702,602 with the largest number (298,984) living in Stockton. By the year 2025 with an annual projected growth rate of 1.4%, San Joaquin’s total population is projected to be 872,000. San Joaquin County stretches over 75 miles from north to south, and nearly 65 miles from east to west, between the San Francisco Bay Area and the Sierra Nevada 5 San Joaquin County Emergency and ALS Ambulance RFP August 1 2014 Mountains. It is bordered on the north by Sacramento County, on the east by Amador and Calaveras Counties, on the South by Stanislaus County, and on the west by Alameda, Contra Costa, and Solano Counties. The San Joaquin Valley is crisscrossed with rivers and sloughs, forming the San Joaquin Delta System. As the northernmost county in the Central Valley, San Joaquin bridges northern and Central California. Its geographical position places the County within a dynamic growth corridor. San Joaquin has cultivated extensive transportation facilities. The Port of Stockton serves ships from around the world, via the Stockton Channel to the San Francisco Bay. Interstate highways transverse the County, both east-west and north-south. San Joaquin County is home to a number of major industries and service organizations. The County’s predominant industries are agriculture, trade, transportation and utilities, government, and educational and health services. Historically, San Joaquin has been one of California’s leading counties in gross value for farm products. 1.4 Medical control The San Joaquin County EMS system utilizes both on-line and off-line medical control. The County currently has one base hospital, which serves as a control facility for the purposes of patient dispersal during multi-causality incidents (MCIs). San Joaquin County operates primarily on a standing orders system, with on-line medical control reserved for a few ALS interventions, and physician consultation when required or needed. The San Joaquin County EMS Agency contracts with a physician, with substantial experience in the practice of emergency medicine, to provide medical control and to assure medical accountability throughout the planning, implementation, and evaluation of the local EMS system (Health & Safety Code 1797.202). 6 San Joaquin County Emergency and ALS Ambulance RFP August 1 2014 1.5 Advisory committees Transportation Committee: The Transportation Committee is advisory to the EMS Agency. Its primary role is to address operational concerns and comment on policies and procedures that primarily pertain to the operation of ambulances, their equipment and personnel, as well as response issues and automatic aid agreements. The Committee is comprised of management staff of the air and ground transportation agencies that are permitted by San Joaquin County EMS Agency and includes a representative from the secondary public safety answering point EMS Liaison Committee: The EMS Liaison Committee is comprised of representatives from each ALS ground provider and acute care hospital. The committee meets quarterly to address general EMS system concerns Continuous Quality Improvement (CQI) Council: The committee meets monthly to focus on medical care quality control issues, and to make recommendations concerning training and policy development to the EMS Agency. 1.6 EMS participants Public service answering points and dispatch centers San Joaquin County has seven primary public safety answering points (PSAP) and one secondary PSAP designated to receive all 9-1-1 medical and ambulance requests. EMS Policies No. 3001 and 3001A require all primary PSAPs to transfer medical 9-1-1 callers to the County’s designated EMS dispatch center without delay. The County’s current designated EMS dispatch center is American Medical Response’s (AMR) Valley Regional Communications Center (VRECC) which was selected as part of a competitive process for exclusive emergency ambulance service. VRECC interrogates 9-1-1callers using the National Academies of Emergency Dispatch (NAED) emergency medical dispatch (EMD) protocols as approved by the EMS Agency’s medical director. VRECC provides all emergency ground ambulance dispatch in San Joaquin County and serves as the designated single point of contact for the ordering of all air ambulance resources in the prehospital setting. VRECC also provides emergency dispatch services for the Joint Radio Users Group (JRUG) which is comprised of a majority of fire agencies in San Joaquin County with the notable exception of the cities of Lodi, Manteca, and Stockton. VRECC maintains a direct computer aided dispatch CAD-to-CAD link with the Stockton Fire Department’s dispatch center to ensure the efficiency and accuracy of call information between the two dispatch centers. Non-transport emergency medical responders (EMRs) San Joaquin County is served by 18 fire departments. Of these, three departments provide ALS non-transport EMS and 15 provide BLS non-transport EMS. Only one fire department, the Ripon Consolidated Fire District, provides both ALS transport and ALS non-transport services. The San Joaquin County Sheriff’s Department boat patrol provides BLS service and water rescue on the Delta waterways. EMRs are dispatched to medical emergencies along with the emergency ambulance service according to EMS Agency policy approved by the EMS Medical Director. 7 San Joaquin County Emergency and ALS Ambulance RFP August 1 2014 Table 1: First responder agencies First Responder Agency EMS Capacity Lodi Fire BLS Manteca City Fire Department BLS Clements Fire Protection District BLS Collegeville Fire Protection District BLS Escalon Fire Protection District BLS Farmington Fire Protection District BLS French Camp-McKinley Fire Protection District BLS Liberty Fire Protection District BLS Linden Peters Fire Protection District BLS Lathrop Manteca Fire Protection District BLS Mokelumne Fire Protection District BLS Montezuma Fire Protection District BLS Ripon Fire Protection District ALS San Joaquin County Sheriff’s Boat Patrol BLS Stockton Fire Department ALS Thornton Fire Protection District BLS South County Fire Authority ALS Waterloo Morada Fire Protection District BLS Woodbridge Fire Protection District BLS C. Current emergency ground ambulance providers In 2004, San Joaquin County created six exclusive ambulance zones— maintaining the three non-competitively awarded EOAs and establishing three new EOAs to be competitively awarded. Following a Request for Proposal (RFP) process in 2005, the three competitively awarded EOAs (zones A, B, and C) were awarded to American Medical Response-West (AMR) which established a single operations process for the three zones. Ambulance zones D, E, and F remained non- competitively awarded EOAs continuing the use of the existing ambulance providers Manteca District Ambulance, Ripon Consolidated Fire Protection District, and Escalon Community Ambulance. The performance based Emergency Ambulance Agreement between the county and AMR to provide emergency ambulance to zones A, B, and C ends on April 30, 2016. The Ambulance System Plan was again revised in 2014. Under this plan, zones A, B, and C were merged into a single Zone X. Exclusive rights to this zone will be competitively granted. The other zones will continue to be non-competitively awarded EOAs. Table 2: Emergency Ambulance Providers (2014) Community Current provider Zone A Lodi American Medical Response Zone B Stockton American Medical Response Zone C Tracy American Medical Response Zone D Manteca/Lathrop Manteca District Ambulance Zone E Ripon Ripon Consolidated Fire Dept. Zone F Escalon Escalon Community Ambulance 8 San Joaquin County Emergency and ALS Ambulance RFP August 1 2014 D. Air ambulance providers San Joaquin County has four permitted and authorized air ambulances services. REACH is the only air ambulance service based within San Joaquin County and is located at the Stockton Metropolitan Airport. Air ambulances are required by state regulations to operate at not less than the advanced life support level. Air ambulance services currently serving San Joaquin County are shown in Table 3. Table 3: Air ambulance providers Provider Helicopter location PHI Modesto Air Methods Modesto REACH Stockton CALSTAR Concord The emergency ambulance service agreements with the EOA ground ambulance providers include a provision allowing the use of the air ambulances to transport patients from the scene of medical emergencies. An air ambulance may be requested by on-scene EMS personnel with all such requests being forwarded to the EMS Agency’s designated EMS dispatch center. This policy of single point ordering for EMS aircraft eliminates duplicate requests, improves coordination between multiple responding providers, and reduces the risk associated with multi-aircraft responding to the same scene. E. Hospitals San Joaquin County is served by seven acute care hospitals. San Joaquin General Hospital was designated as a Level III trauma center in 2013. Major pediatric trauma patients are transferred by ground or air ambulance to the designated level I pediatric trauma center located at the U.C. Davis Medical Center in Sacramento County. F. Disaster Medical Services Facilities San Joaquin General Hospital serves as the disaster control facility (DCF) for the San Joaquin County Operational Area and as the Regional DCF for the State of California Office of Emergency Services (OES) Region IV. 9