RFP_Solano_Emergency_Ambulance_Services_V6_7.23.2025.pdf

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SOLANO COUNTY

GENERAL SERVICES DEPARTMENT

PROCUREMENT SERVICES

675 Texas Street

Suite 2500 Fairfield, CA 94533-6336

REQUEST FOR PROPOSAL (RFP) on behalf of Solano Emergency Medical Services Cooperative

NUMBER 990-0505-26

FOR

EXCLUSIVE OPERATING AREA PROVIDER

FOR EMERGENCY AMBULANCE SERVICES

Issue Date: 7/24/2025 Due Date: 10/10/2025

The governing version of this RFP document and related addenda are located at https://procurement.opengov.com/portal/solanocounty. It is the Bidder’s responsibility to ensure that the entire RFP package, in its latest version, and any addenda are reviewed prior to submittal of a proposal.

https://procurement.opengov.com/portal/solanocounty

Solano County

General Services/Purchasing

RFP #990-0505-26

Emergency Ambulance Service

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Section 1: Background / General Information

1.1 Overview

1.2 Background

1.3 Period of Operation

1.4 Action Dates

1.5 Questions Regarding RFP

Section 2: Scope of Work

2.1 Scope

2.2 Coordination within the Exclusive Operating Area

2.3 EMS Run Data

2.4 Level of Care

2.5 Response Time Standards

2.6 Dispatch Services

2.7 Performance Standards – Response Times

2.8 Performance Standards - Clinical

2.9 Performance Standards – Customer Service & Safety

2.10 Performance Standards – Employee Wellness

2.11 Performance Standards – Liquidated Damage Relief

2.12 System Status Plan

2.13 Mutual Aid/Standbys

2.14 Radio Equipment

2.15 Vehicle and Equipment Requirements

2.16 Data Collection and Evaluation Requirements

2.17 Financial Requirements

2.18 Fees for Service

2.19 First Responder/PSAP Training and Coordination

2.20 Implementation Schedule and Requirements

2.21 Safety and Risk Program

2.22 License to Operate

Section 3: Information for Bidder

3.1 Pre-Proposal Conference

3.2 Interpretation, Corrections and Addenda

3.3 Notice of Intent to Bid

3.4 Announcement of Apparent Successful Bidder

3.5 False or Misleading Statements

3.6 Investigation

3.7 Rules for Withdrawal or Revision of Responses

3.8 Independent Contractor

3.9 Explanation of Use of Subcontractors

3.10 Joint Ventures

3.11 Confidentiality

3.12 Pricing Conditions

3.13 Proposal Terms and Conditions

3.14 General Terms and Conditions – Contract

Table of Contents

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Section 4: General Provisions and Assurances

4.1 General Information

4.2 Public Disclosure

4.4 Qualifications of Bidder

4.5 Disqualification of Bidder

4.6 Integrity of Expenditure

4.7 Gratuities

4.8 Conflict of Interest

4.9 Federal, State, and Local Taxes

4.10 Compliance with Applicable Laws

4.11 OSHA Requirements

4.12 Environmental Protection

4.13 Drug Free Workplace

4.14 Legal Considerations

4.15 Business License

Section 5: Special Provisions

5.1 Performance Security Provisions

5.2 Emergency Takeover

Section 6: Submitting Responses

6.1 General Information

6.2 Number of Copies to be Submitted

6.3 Response Format

Section 7: Proposal Content Requirements

Section 8: Award, Selection, and Evaluation Criteria

8.1 Basis of Award

8.2 Selection of Response

8.3 Evaluation Criteria

8.4 Proposal Evaluation Process

8.5 Notice of Intent to Award

8.6 News Releases

8.7 Protest Procedures

Section 9: Signature Forms Form 1: Signature Page Form 2: Declaration of Minimum Qualifications

Form 3: Non-Collusion Declaration

Section 10: Attachments Attachment 1: EMS Data

Attachment 2: EOA Zone Map

Attachment 3: RFP Definitions Attachment 4: EMS Definitions

Attachment 5: Current Rates and Fees Attachment 6: Report Card

Attachment 7: 5-Year Budget Template

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Section 1: Background / General Information

1.1 Overview

In 1996, the County of Solano authorized the creation of the Solano Emergency Medical Services

Cooperative (SEMSC), a joint powers authority (JPA) whose membership includes the County and various cities and fire protection districts within the county, for the administration of emergency medical services (EMS). For the purposes of this Request For Proposal (RFP), references to

Solano County, as a legal entity, will be noted as “County” whereas geographical references will be noted as “county.”

The SEMSC, as the designated Local Emergency Medical Services Agency (LEMSA) for the

County, working with the Solano County General Services Department, invites proposals from qualified organizations to bid on the emergency ambulance service for an exclusive operating area (EOA), as defined more fully below. SEMSC is authorized to plan and implement such an

EOA, as provided for under California Health and Safety Code (H&SC), Section 1797.224. The EOA represents all incorporated and unincorporated areas of Solano County (County), except the

City of Vacaville, as detailed in this Request For Proposals (RFP). Proposals will be accepted for one provider servicing the entire EOA. That provider may subcontract as warranted to deliver optimal service to residents and visitors.

The county has a population of 449,551 and is strategically located between San Francisco and Sacramento. As one of California’s original 27 counties, it is rich in history and offers many resources to the public and the business community. In addition to the unincorporated area, the county serves seven cities: Benicia, Dixon, Fairfield, Rio Vista, Suisun City, Vacaville, and Vallejo, and is comprised of 909 total square miles, including 675 square miles of rural and farmlands, 150 square miles of urban land area, including cities and unincorporated areas, and 84 square miles of water.

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This RFP calls for proposals for all emergency ambulance services within the EOA, including the cities of Benicia, Dixon, Fairfield, Rio Vista, Suisun City, Vallejo, and the unincorporated areas of the County and is subject to the performance standards and other specifications herein. Bidders must meet all credentialing and scope of service requirements as listed in the RFP. Each proposal will be scrutinized in these areas before processing the application for full consideration. It is the intent of SEMSC and this RFP to have one (1) EOA, which excludes the City of Vacaville.

The Bidder shall describe how it will provide emergency ground ambulance service for EOA 1 in

Solano County in a manner and standard of care consistent with this RFP’s requirements for providing emergency ground ambulance service.

Bidder shall include plans, documentation, policies, and submissions that demonstrate the bidder’s ability to comply with:

a. All elements described in this RFP:

b. All applicable federal and state legal requirements for ground ambulance service;

c. All County ordinances and SEMSC/LEMSA policies.

The initial Contract period will be five (5) years. SEMSC may extend the Contract for one (1) additional five (5) year period based on historical performance at or above the Contract requirements as evaluated and approved by SEMSC. Any extension will be at the mutual agreement of both SEMSC and the contracted EOA provider. Contract compliance will be monitored by SEMSC utilizing the FirstWatch reporting system. This is a performance-based Contract. Details regarding the Contract, performance standards, and other details of the scope of work requested are described in this RFP. Bidders should note that the county is diverse in

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1.2 Background

Existing EMS Services

Currently in the county, there are two 9-1-1 ambulance providers, one serving the City of

Vacaville and the remainder of the county being served by a private provider. The future EOA provider is expected to ensure that the cities of Benicia, Dixon, Fairfield, Rio Vista, Suisun City, Vallejo, and the unincorporated areas of the county are adequately served, either by themselves or through mutual aid. The current EOA providers dispatch their own ambulances.

General Requirements and Governing Law

California H&SC, Section 1797.224 permits SEMSC to establish EOAs. In addition to California H&SC, SEMSC may establish certain rules and regulations that govern the operation of emergency ambulance services within the contractual jurisdiction. State law, contractual standards stipulated in the RFP and future addenda, SEMSC resolutions, ordinances, rules, regulations, and published operational and medical policies of the SEMSC, California EMS

Authority, and this RFP set forth the requirements for service for the EOA, and all Bidders shall comply with them. Collectively, they are referred to as the "governing law" in this RFP.

During the Contract term, the contract may be modified by consent of the SEMSC and the Contractor. Acceptable modifications include changes to improve the efficiency of the EMS system, reduce costs, or improve clinical care. This includes but may not be limited to: (1) modifying response time standards, response patterns, time standards, and geographic zones within the EOA, which are based upon clinical evidence or science; (2) implementing innovative services, non-ambulance transport, and treat and refer programs.

Exclusive Operating Areas

The County is currently divided into two EOA zones, with one covering the areas of Benicia, Dixon, Fairfield, Rio Vista, Suisun City, Vallejo, and the unincorporated areas, and the other covering the City of Vacaville. The latter is not part of this RFP process.

This RFP is for 9-1-1 ambulance services that includes the cities of Benicia, Dixon, Fairfield, Rio

Vista, Suisun City, Vallejo, and the unincorporated areas. The ambulance transport volume of multiple communities allows for all areas to be served - whether urban or rural. This approach ensures the county’s low population areas, and the densely populated cities are served equally.

The authority of SEMSC allows the restriction of operations to one emergency ambulance provider within the EOA. However, except as provided in statute and regulation, nothing limits a

Bidder from subcontracting the ambulance service for the betterment of the county residents and visitors, consistent with the requirements of this RFP. One example of a regulation that provides subcontract requirements is H&SC, Section 1797.231.

1.3 Period of Operation

Unless initiated earlier by mutual agreement, this Contract shall commence at 8:00 a.m. on May

1, 2026, and terminate at 7:59 a.m. on May 1, 2031, unless extended or terminated as provided for herein. SEMSC shall make any decision regarding renewal of this Contract or any extension thereof; those decisions shall be made at least 18 months prior to the scheduled termination date so that if no extension is approved, a new proposal process can be conducted on a schedule that will identify the new Contractor at least four months prior to that scheduled termination date.

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1.4 Action Dates

To the extent achievable, the following schedule shall govern the proposal's review, evaluation, and award. The dates below are subject to change in accordance with necessary addenda, state approvals, existing meeting dates, and sufficient review period.

Event Date

Final RFP Released 7/24/2025

Bidder's Conference 8/7/2025

Deadline for Written Questions (by 5:00 p.m.) 8/8/2025

Response to Written Questions (by 5:00 p.m. COB) 8/18/2025

Letter of Intent Due (submitted via email) 8/25/2025

Proposals Due (by 5:00 p.m.) 10/10/2025

Oral Presentations Completed (during this week) 10/20/2025

Notice of Intent to Award 10/29/2025

Approval of Agreement by Counsel 12/1/2025

Approval of Contract by SEMSC 12/4/2025

Implementation 5/1/2026

The purpose of the implementation period is to allow reasonable time for both outgoing and incoming Contractors (if needed) to plan and execute an orderly transition, allow SEMSC and its new Contractor to revise advertising, and allow time to finalize new service contracts, mutual-aid agreements, and other contracts previously serviced by the outgoing contractor.

A Contract with the highest scoring Bidder is executed only upon final approval by SEMSC.

1.5 Questions Regarding RFP

All questions concerning this RFP shall be submitted through the County’s online procurement system. Deadline for questions or clarifications concerning this RFP is provided above.

While SEMSC intends to enter into a contract for these services, it will not be bound to do so.

SEMSC reserves the right to reject any or all proposals that are not responsive with the requirements of the RFP. SEMSC shall be the sole judge of the highest scoring offer hereunder.

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Section 2: Scope of Work

2.1 Scope

This RFP and its provisions, attachments, addendums, and exhibits constitute a solicitation for the selection of the single provider of ground emergency ambulance service for an EOA that includes the cities of Benicia, Dixon, Fairfield, Rio Vista, Suisun City, Vallejo, and the unincorporated areas. The operation of such an emergency ambulance service shall be consistent with the provisions of this procurement process, including staffing and performance. This procurement process includes provision for all ambulance responses.

All of the following transports originating in the EOA shall be referred to the holder of the exclusive Contract, who shall be responsible for all responses and ground transports as follows:

(1) Made in response to 9-1-1/ PSAP requests;

(2) Made in response to requests for immediate emergency ambulance service transmitted through an authorized 9-1-1/PSAP;

(3) Made in response to requests for emergency ambulance service made directly to the ambulance provider from a seven-digit telephone call without going through an authorized 9-1-1/PSAP going to an emergency department;

(4) Any request for ALS or ALS-RN interfacility transport from a healthcare facility; and

(5) All Special Events and Standby By Services requiring the presence of an ALS ambulance.

Comprehensive definitions of service levels are available in EMS Definitions Attachment #4.

In rendering services under this Contract, the Contractor shall comply with all applicable federal, state, and local laws, rules, and regulations and shall not discriminate based on age, ancestry, color, gender, marital status, medical condition, national origin, physical or mental disability, race, religion, sexual orientation, or other protected status.

The Contractor’s scope of work is summarized as follows:

When a request for service is received by the Contractor, the Contractor must meet the response time and clinical standards set forth herein. Every ambulance unit provided by the Contractor for emergency response must, except as authorized by the Contract, be equipped and staffed to operate at the appropriate level on all ambulance responses, including emergency and non-emergency services. Clinical performance must be consistent with approved medical standards and protocols. The conduct and appearance of the Contractor’s personnel must always be professional and courteous. Patient transportation and disposition will be according to the SEMSC’s applicable Resolutions, Policies and Procedures, as established or approved 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 LEMSA’s quality improvement program in order to improve and maintain effective clinical performance. The Contractor must make every effort to detect and correct clinical and other performance deficiencies and to continuously upgrade the performance and reliability of the EMS system. Clinical and response-time performance must be reliable, with minimal equipment failure and human error 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 Contractor that fails to perform shall be replaced to protect the public health and safety.

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2.2 Coordination within the Exclusive Operating Area

The local fire agencies currently provide first responder EMS services in the EOA for emergency

9-1-1 requests for service. SEMSC considers the fire agencies an essential partner in the provision of EMS within the EOA. This includes agreements between the current Contractor and local fire departments for the current use of advanced life support (ALS) first responders to extend the ambulance response times in some communities. All Bidders shall clearly state how they will work with existing public service agencies. This portion of the proposal shall be scored under the

“Integration with Existing EMS Stakeholders and Behavioral Health” criteria.

2.3 EMS Run Data

See Attachment 1 for a summary of EMS data. Computer-Aided Dispatch (CAD) data is available for 2018-2024 upon request. There has been no independent validation of this data. Bidders are encouraged to use their own means to analyze the information to determine response and transport volumes. There is no guaranteed number of responses or transports.

2.4 Level of Care

The exclusive Contract holder will provide staffed ambulances for all initial requests for ground emergency ambulance service, including ALS, BLS, critical care paramedic, and ALS-RN urgent and scheduled ground ambulance service, as well as special event ALS ambulance stand-by originating within the EOA. Interfacility transports at the BLS, critical care transport (CCT), or

Mental Health level are specifically not included in the scope of this RFP. Air ambulance transports are excluded as well. Specialty care transports, such as neonatal and high-risk obstetrics, which require a specialized team from outside of the EOA, are outside the services to be provided.

2.5 Response Time Standards

A. General

It is the Bidder's sole responsibility to be familiar with the geographic considerations and response-time standards comprising this solicitation. Response times shall be calculated from the moment the unit is alerted by the Contractor’s communications center until the time the Contractor arrives at the scene with a fully functional and appropriately staffed/equipped ambulance. The term “scene” is defined as the dispatched location, gated community/driveway, mobile home park, apartment complex, or end of paved roadway. All response times are measured in seconds, not whole minutes.

SEMSC is interested in providing prompt, effective emergency ambulance services at a reasonable cost to the consumer. Any enhanced services above the standard of this RFP must include a separate cost estimate. However, clinical performance will not be sacrificed for economy.

Service to the EOA must be at or above the level of service as defined in this RFP.

Service must include primary response, backup, and move-up-and-cover plans that clearly define timely emergency ambulance coverage. Monitoring this requirement will include the use of CAD data, and the provider and oversight will be provided by the

SEMSC with technical expertise from fire, dispatch, hospitals, and other EMS stakeholders.

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B. Response Times

Response time requirements vary depending upon the time standard to which the ambulance provider must respond. Each standard is defined by ambulance call density.

The standards that comprise the EOA are distinguished by the different response time requirements. Based on call density, the time standards may not be contiguous. The standards are designated as urban/high call density (A), rural/lower call density (B), and remote/minimal call density (C). Maps are included as Attachment 2.

To safeguard equity within each time standard, geographic zones ensure one community is not receiving substantially lower compliance than other areas. The Contractor will be expected to meet compliance per time standard and zone.

These maps are based on ambulance industry standards for defining such time standards and zones; they may be changed by the SEMSC from time to time as population, call density, road access, effective Contract monitoring, and other relevant conditions change. No response-time amendments will be made without giving notice to, and opportunity for, consultation with the Contractor, fire departments/districts, and other interested parties and organizations in the affected area(s). The SEMSC will establish a procedure for making such changes that provides for such notice, comment, and input to be achieved.

In addition to the time standard and geographic evaluations, the SEMSC will biannually review population densities, call distribution, single communities, and response times in areas within the compliance time standards and zones and may request the Contractor alter its system status plan (SSP) to respond to needs of improved performance and adaptation to population trends. This alteration may also include adjusting the SSP to improve backup ambulance coverage. Contractor shall agree to work in good faith with the SEMSC and revise the SSP as needed to improve the performance to these communities, as determined by the SEMSC, in consultation with the Contract Administrator. Contractor shall also collaborate in good faith within 90 days on the issue of any impact on Contract terms these changes may have and include these in the process. Failure to work in good faith regarding these potentially underserved areas may constitute a Contract default.

C. Emergency (“CODE”)

Contractor must provide 24-hour, 365 days per year coverage for all emergency requests for service for the term of the Contract, as defined by approved medical dispatch protocols. Emergencies, for purposes of this RFP, is defined as all requests receiving a response with lights and siren for presumed life-threatening or non-life-threatening emergency conditions. The Contractor must guarantee response times, as specified below:

Time Standard

Density Emergency Compliance

A Urban 90 percent of all calls in 9:00 minutes or less. Calls exceeding 18:00 minutes will be subject to liquidated damages.

B Rural 90 percent of all calls in 20:00 minutes or less. Calls exceeding 40:00 minutes will be subject to liquidated damages.

C Remote 90 percent of all calls in 60:00 minutes or less. Calls exceeding 120:00 minutes will be subject to liquidated damages.

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If an ALS provider assesses a patient and determines they do not require an ALS ambulance transport, a BLS unit may be requested “no code” following the non-emergency response time criteria. The time will be measured from time of BLS request to

BLS unit arrival.

Bidders should familiarize themselves with population densities, transportation corridors, and other factors to provide effective and prompt emergency ambulance service.

D. Non-Emergency (“NO CODE”)

The current 9-1-1 system dispatches all requests for service as emergency. The SEMSC desires a methodical and careful transition to some 9-1-1 requests not using lights and siren. Contractor must agree to provide 24-hour, 365 days per year coverage for all non-emergency requests, as defined by medical dispatch protocols. Non-emergency, for purposes of this RFP, is defined as any call that does not require lights and siren but must have a response due to a presumption of an urgent, but non-life-threatening, medical condition. The response is defined as non-emergency by the Medical Priority

Dispatch System (MPDS) call type and SEMSC Medical Director guidance. During the term of the contract, there may be opportunities for BLS units to respond or transport 9-1-1 patients based on low acuity calls as approved by the SEMSC Medical Director.

If an ALS or BLS first responder assesses a patient and determines they do not require an ALS ambulance transport, a BLS unit may be requested following these same response time criteria. The time will be measured from time of BLS request to BLS unit arrival.

Time

Standard Density Non-Emergency Compliance

A Urban 90 percent of all calls in 25 minutes or less. Calls exceeding

36 minutes will be subject to liquidated damages.

B Rural 90 percent of all calls in 60 minutes or less. Calls exceeding 80 minutes will be subject to liquidated damages.

C Remote 90 percent of all calls in 90 minutes or less. Calls exceeding

120 minutes will be subject to liquidated damages.

E. Public Provider Partnership (PPP)

The current EMS system fully appreciates the value of first responders and the care available prior to the ambulance arrival. When a PPP agreement is in place, the transport response times are extended.

Time Standard Density Emergency Non-Emergency

A Urban + 3:00 minutes + 6:00 minutes

B Rural + 5:00 minutes + 10:00 minutes

C Remote + 10:00 minutes + 20:00 minutes

The on-scene arrival of the Contractor’s appropriately staffed and equipped quick response vehicle (QRV) would extend the transport unit response time, but only if the QRV satisfies the applicable response time standard for the call.

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F. ALS Interfacility

Contractor shall respond to hospital and healthcare facility requests for ALS interfacility transfer in the following manner and using the following definitions. This Contract includes ambulance interfacility transports for ALS, ALS-RN, and Critical Care Paramedic.

Any removal of 9-1-1 resources to perform transports outside of this Contract is at the risk of the associated response time compliance impact. The Contractor may perform

BLS interfacility transports originating within the County pursuant to a separate contract with SEMSC.

1) Emergency Transfer – Immediate ALS ambulance transport is requested to a higher level of care when any delay could result in placing the patient’s health in immediate jeopardy. The transport provider retains a response-time requirement for these transfers just as they would for any emergency (i.e., life-threatening) 9-1-1 request to the facility’s location. As these transfers may immediately remove an ambulance unit from the 9-1-1 system, facilities are expected only to request an emergency transfer when the patient’s condition warrants such a response. Examples would include confirmed stroke or STEMI, major trauma, and acute sepsis cases. It is understood that the requesting agency shall only request the emergency transfer such that the patient is prepared for transfer with all available transfer papers upon the arrival of the transfer unit. This would be considered a Code Response.

2) Urgent Transfer at the ALS Level – This should be requested when the patient’s medical condition requires ALS transport to a facility providing a higher level of care and is not considered to be in immediate jeopardy. This would be considered a No Code Response.

3) Pre-arranged Transfer at the ALS Level – shall be a pre-arranged ALS transfer for a medically stable patient. The timeliness of this type of transfer would have no foreseeable bearing on the patient’s medical condition. This would be considered a No Code Response.

2.6 Dispatch Services

The highest scoring Bidder shall provide an emergency medical dispatch center for the dispatching of its ambulances; public safety units will not be dispatched by the center. All Emergency Medical Dispatch (EMD) staff shall be trained and authorized to provide pre-arrival instructions, dispatch medical calls, and be certified in the Clawson Medical Priority Dispatch

System, and receive training specific to local conditions, geography, existing 9-1-1/PSAP centers, and first responder personnel in the County. Contractor shall cooperate, train with, participate in quality- control procedures, and communicate with each of the County’s 9-1-1/PSAPs to assure the delivery of dispatch services.

In addition, Bidders shall warrant and provide specific plans in their proposals that assure the key features of an in-County dispatch center, such as:

▪ Prompt access to CAD data (within eight hours of request during weekdays);

▪ Familiarity of staff with local conditions;

▪ Familiarity with public safety dispatching procedures;

▪ Access of dispatch staff to local training;

▪ Access of dispatch staff to local quality improvement activities;

▪ Access of dispatch staff to local meetings with local public safety personnel; and,

▪ Access by SEMSC staff to dispatch observation sessions and unannounced inspections.

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The Contractor shall provide sufficient EMS dispatcher staff at the EMS dispatch center to allow prompt answering of all telephone requests for ambulance service within five telephone rings.

No telephone request for immediate ambulance response shall be placed on hold except for rare times of system overload. This includes ring down lines with hospitals and other dispatch centers.

The following minimum standards form the objective performance data for EMS Dispatch operations:

a. For each month, a minimum of 98 percent of calls for service through the 9-1-1 system shall be answered in five rings or less.

b. Ninety (90) percent of medical calls shall be completed (i.e., call answered to unit dispatched) within 90 seconds, and 99 percent shall be completed within 120 seconds (i.e., NFPA 1221 standards)

c. For each month, no more than one-tenth of one percent (0.1%) of 9-1-1 calls that require the dispatch of an ambulance, per approved dispatch protocols, may be placed on hold at any time before an ambulance is dispatched.

d. Should the Contractor receive the initial call, first-response agencies shall be notified regarding emergency responses within 60 seconds of call receipt, 98 percent of the time from call receipt/phone pick up, as directed by the LEMSA.

e. Achieve and maintain Accredited Center of Excellence (ACE) accreditation within 24 months of Contract start.

The dispatch computer utilized by Contractor shall include security features preventing unauthorized access or retrospective adjustment and full audit trail documentation. SEMSC will be provided with access to all data maintained by the CAD system as necessary to analyze demand and determine deployment procedures. The Contractor agrees to allow SEMSC, at Contractor’s expense, to install an interface with the CAD to collect and monitor CAD information and patient care reports and provide access to the SEMSC to voice recording systems. This CAD and SEMSC-approved patient care report access shall be connected at the Contractor’s expense.

The interface made available to the SEMSC shall provide real-time monitoring of the Contractor’s CAD screens and, at a minimum, provide the location and status of active ambulance calls, pending calls, location, and status of ambulances and crews.

2.7 Performance Standards – Response Times

Performance standards may be adjusted by the SEMSC through the course of the Contract consistent with the modifications in EMS operational and medical standards that are developed by the SEMSC. The Contractor shall be notified with 60 days advance notice of the effective date of the change and shall define the Contract impact within 30 days of initiation.

A. Liquidated Damages: Emergency Calls

Contractor shall not refer exclusive Contract calls to another agency unless it is part of an approved mutual aid plan submitted by the Contractor and approved by the SEMSC.

Appropriate referral to air medical services is exempt from such requirement. Use of mutual aid from any source during disaster responses is also exempted from this requirement.

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Each month in which the Contractor fails to meet the 90.00 percent standard, within any compliance time standard, the Contractor shall pay $500 in liquidated damages for each one-tenth (1/10) of a percentage point by which the Contractor’s performance falls short of the standard. Each period in which the Contractor fails to meet the applicable response-time requirements, the Contractor shall submit to the SEMSC a corrective action plan including its SSP, unit-hour of production capacities, and/or other factors to determine the causes of non-compliance and plan for remediating the below standard performance.

All areas have a maximum specified response time (i.e., outlier). For every call where the ambulance fails to arrive within the maximum specified time, the liquidated damages will be $1,000 per occurrence.

Exclusive Contract calls referred to another agency (i.e., not an approved subcontractor or Mutual Aid provider) will be considered an outlier for calculating compliance.

The Contractor may be found in material breach if they fail to meet the 90 percent standard in three of five consecutive calendar months in any one area or four of seven consecutive calendar months with EOA taken in aggregate. At a minimum, Contractor shall produce a corrective action plan to mitigate or eliminate the material breach. The County may choose to start a new RFP process and/or institute the emergency takeover process (Section 5.2).

B. Upgrades, Downgrades, Canceled, and Incorrect Addresses

From time to time, special circumstances may cause changes in call-priority classification.

Response-time calculations for determination of compliance will be as follows:

1) Upgrades

If an assignment is upgraded prior to arrival of a unit at the scene (e.g., from non-emergency to emergency response), the Contractor's response time compliance and liquidated damages will be calculated based upon the emergency response time standard from the time the call was upgraded; provided they have not already exceeded the non-emergency response time standard for the time standard. If the total call time exceeds the non-emergency standard, it will be considered late.

Example: While enroute to a non-emergency call in an urban density time standard, new information is received, and the call is upgraded to emergency at

13:30:00. Contractor will have until 13:39:00 to arrive on scene (i.e., when the ambulance stops moving and is placed in park), provided they do not exceed the non-emergency standard.

2) Downgrades

If, prior to a unit’s arrival at scene, a call is downgraded; 1) by the 9-1-1/PSAP or

2) by any other person authorized by the SEMSC, compliance and liquidated damages will be determined as follows:

(a) If the time of downgrade occurs after the unit has exceeded the response time standard or maximum response time for the time standard involved, the response time standard or maximum will apply;

or,

(b) If the time of downgrade occurs before the unit has exceeded the response time standard or maximum response time for the time standard involved, the call will be treated as non-emergency. The total

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Example: While enroute to an emergency call in an urban density time standard, first responders on scene reduce the ambulance to no lights and siren (i.e., non-emergency call); if the response time has not exceeded 9:00 at the time of downgrade, there would be no liquidated damages, provided they do not exceed the non-emergency response time standard (i.e., 25:00).

3) Canceled Responses

If a call is canceled prior to the unit arrival at the scene, the Contractor's compliance and liquidated damages will be calculated based on the elapsed time from receipt of call to the time the call was canceled. Compliant canceled calls shall be excluded when calculating performance compliance. However, if

Contractor makes a request for mutual aid response as stipulated in this RFP, the

Contractor shall not cancel the mutual aid responder if the responding provider is closer to the call.

4) Incorrect Addresses

When the address (or approximate location for calls on a roadway) is incorrect through no fault of the Contractor, the response start time for compliance measurement will be the time when the correct address is given to the responding resources.

C. Interfacility Transports

When there is a need for an ALS (including ALS-RN) ambulance to transfer a patient to a higher level of care, it will be treated as an emergency call and treated like any 9-1-1 request for service.

D. Correction Requests

The SEMSC, in its sole discretion, may grant corrections to response-time performance requirements stated herein for allowable reasons. Such calls, when approved will be included when calculating performance compliance. To be eligible for such correction, delays must be noted in the mobile dispatch computer (MDC) or CAD and the Contractor shall notify the SEMSC within a reasonable amount of time of the occurrence.

The Contractor may apply to the SEMSC for a correction to response-time compliance calculations in the following situations:

1. Correction Appeals

(a) Upgrades and downgrades that are compliant are eligible for correction.

(b) On-scene times incorrectly captured (i.e., the button was pressed twice, unable to locate, delayed at gate, no at-scene time documented but verified by global-positioning system (GPS), etc.).

(c) Incorrect dispatch alert time.

(d) Other case-by-case situations as requested.

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E. Exemption Requests

The SEMSC, in its sole discretion, may grant exemptions to response-time performance requirements stated herein for declared multi-casualty incidents, disaster events, or other situations. Such calls will be excluded when calculating performance compliance. To be eligible for such an exemption, the Contractor shall notify the SEMSC within 15 days at the end of the prior month.

The Contractor may apply to the SEMSC for an exemption to response-time compliance calculations in the following situations:

1. Severe weather documented at the time of the response;

2. Access issues documented at the time of the response, including traffic secondary to the incident, train crossings, road construction, or other unanticipated barriers;

3. System overloads due to multi-casualty incidents or officially declared disasters;

4. Mutual aid responses originating from a Public Safety Agency out of the EOA when approved by the SEMSC;

5. Incorrect or incomplete location information provided to the dispatch center;

6. Inability to locate the address because it does not exist or is an off-road location or inability to locate patient because he/she has departed the scene;

7. Other calls that, in the judgment of the Contract Administrator, reasonably warrant exemption from response time compliance;

8. Government declared emergencies affecting Contractor’s ability to respond.

F. Other Response Time Issues

Where response-time areas are divided along the center line of a road, the shorter response time shall apply to both sides of the road.

The Contractor will not be held responsible for response-time performance on an emergency response to a location outside the EOA. However, Contractor shall use its best efforts in responding to mutual aid calls. Responses to emergencies located outside the EOA will not be counted in the number of total calls used to determine monthly

Contract compliance.

For each response in which the Contractor’s management or field staff fails to report the at-scene time, the next radio or electronic transmission will determine on-scene time.

Notwithstanding 2.7.A The Contractor will provide the necessary staffing to avoid having no ambulances available, known as “Level 0.” If the Contractor drops below Level 0, that is, there is a pending call without an ambulance going enroute within two (2) minutes;

this is defined as “Level -1.” There is liquidated damage for falling to Level -1.

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Table 1 summarizes categories and liquidated damages listed in this RFP.

Summary of Liquidated Damages

Category Liquidated Damage

1. Compliance evaluation below standard $500/tenth of percentage point

2. Extended response time (i.e., outlier) 1,000/call

3. Level -1 $2,500/call

Table 1

G. Liquidated Damage Fund

The funds generated through liquidated damages shall be used for EMS system enhancement as defined and directed by the SEMSC.

H. Online Compliance Utility

For the purposes of automated and objective performance tracking, the SEMSC uses an online compliance utility (OCU), currently FirstWatch.

2.8 Performance Standards - Clinical

The SEMSC and EMS stakeholders are strong proponents of the Institute for Health Improvement (IHI) focus on the “Triple Aim” – 1) improving the patient experience of care (including quality and satisfaction); 2) improving the health of populations; and 3) reducing the per capita cost of health care. As such, there is significant importance in providing a high level of patient care beyond arriving at the patient’s side in a timely manner. Clinical research indicates this may be more important than the speed of the response. Therefore, the SEMSC Medical Director has identified certain key performance indicators that impact the patient’s probability of a positive outcome. The LEMSA has identified benchmarks that indicate a well-functioning, EMS transport provider. These criteria and benchmarks are based on standards set by data-driven research and/or respected EMS organizations. Each criterion must meet three factors to be included; it shall be 1) measurable by the system, 2) manageable by the provider, and 3) meaningful to the patient.

Attachment 6 contains the proposed Contractor report card key performance indicators and expected standard benchmarks. The SEMSC Medical Director and Administrator may revise the included criteria and related standard benchmarks quarterly as clinical research, and other factors determine the optimal care path and customer-service experience for EMS patients.

Comprehensive electronic patient care report (ePCR) review is expected to identify individual and overall opportunities for clinical treatment improvement. All high acuity calls (e.g., heart attack, ST-elevation myocardial infarction [STEMI], stroke, trauma) shall have 20-30 percent random chart review. Similarly, 20-30 percent of non-transports resulting against medical advice (AMA) or release at scene (RAS), shall be reviewed. Five percent (5%) of remaining charts shall be randomly audited. The expected number of ePCRs to be reviewed by the Contractor staff shall be between 60-80 per month; this number may be adjusted if the review process can be more automated. The results of the audit will be summarized monthly and shared with the Contract

Administrator and SEMSC in a pre-approved format. This level of care review is expected to drive training and education and improve overall patient care.

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Between ePCR review and related training/education opportunities identified, it is the SEMSC’s belief that this requires at least three full-time employees, who are hired for the purpose of clinical oversight, training and education, data quality, documentation standards, and quality assurance/improvement and are unencumbered by other supervisory/management responsibilities. The three positions shall include clinical manager, training and education coordinator and clinical data coordinator, or similar classifications. Job descriptions for each position shall be included in attachments to the proposal. All the key performance indicators should be overseen by a medical director hired by the Contractor, preferably with experience working with EMS crews such as a local ED physician.

It is expected that all care provided will be to the standards of this RFP, cognizant of the diversity of the community. There shall be equity and inclusion for all patients, especially those who are vulnerable, underserved, under-resourced, and medically fragile.

2.9 Performance Standards – Customer Service & Safety

The SEMSC desires a patient satisfaction scoring mechanism that is independent, objective and measures the customer service provided by the EMS system. The Bidder shall offer a third-party survey tool (e.g., EMS Survey Team) approved by the SEMSC to poll patients about their experience. The Bidder shall follow Health Insurance Portability and Accountability Act (HIPAA) guidelines to protect patient privacy. Each month, the survey tool provider will send direct mail surveys to a representative group of transport and AMA/RAS ePCRs. The selected questions will be standardized to provide comparison with other providers and approved by the SEMSC.

2.10 Performance Standards – Employee Wellness

Ensuring the workforce is mentally and physically healthy is crucial to a high-performing EMS system. The Contractor shall support employee wellness through mental wellness programs, effective fatigue policies, and ensuring any 24-hour shift utilization rate does not place the crew, patient, or public in jeopardy for an accident, injury, medication error, or other negative impact.

The Bidders shall clearly describe the approach that will be implemented locally, define the financial obligation, and reference successful programs from other operations. Describe commitment to peer-to-peer support and critical incident stress management.

In addition to patient experience, the SEMSC wishes to ensure the employees have a good and safe working environment. This is measured by employee turnover and workplace injuries.

Employee turnover shall be defined as the number of full-time employees that resign, retire, transfer, are laid off, or change to part-time status divided by the average number of full-time employees over the same period. Involuntary separations, part-time employees, or job changes (e.g., EMT to paramedic, paramedic to supervisor) shall not be included in employee turnover.

Bidders are encouraged to share strategies for a positive working environment and reduction of workplace injuries.

2.11 Performance Standards – Liquidated Damage Relief

If the Contractor provides high levels of clinical, customer service, and safety excellence, a credit is available towards response time liquidated damages described within this section. The proposed report cards are available in Attachment 6. These may be adjusted annually based on clinical research, contemporary EMS benchmarking standards, and other factors. The liquidated damage relief is based on a sliding scale to reward positive movement. Table 2 summarizes the credit available.

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Response Time Liquidated Damage Relief

Report Card Score Relief

90-100 100%

80-89.99 50%

Table 2

2.12 System Status Plan

An SSP, posting plan, and the proposed maximum response Unit Hour Utilization (UHU) (for 24-hour units) shall be developed by Contractor, submitted to the SEMSC for review at least 21 days prior to implementation for SEMSC approval (that will be reviewed within no more than seven (7) days), and adhered to by the Contractor. Changes to the SSP and posting plan shall be forwarded to the SEMSC for review. All resources to be used in this Contract for emergency ambulance service shall be included in this SSP. The SSP must have clearly identified backup ambulance plans including arrangements in enough detail to convince the SEMSC that backup ambulance coverage in a timely manner will be consistently available.

2.13 Mutual Aid/Standbys

Within six (6) months of executing this Contract, the Contractor shall develop and execute mutual aid agreements with neighboring ambulance services. The Contractor agrees to respond to all requests for mutual aid services as part of those individual agreements. Should the delivery of mutual aid services to a neighboring jurisdiction become excessive (e.g., projected to exceed one percent of its annual call volume, absent a written agreement for that level of mutual aid), indicating a routine heavy reliance on the Contractor's resources for emergency calls, the Contractor shall inform the SEMSC. The SEMSC will then assess the situation and take appropriate steps as necessary to rectify the inequity.

Contractor agrees to provide standby services at the request of any public safety agency in the county for working fires, hazardous materials incidents, law enforcement incidents, and other allied agency events with a high potential for injury and shall provide, for the first 15 minutes of the public safety emergency at no cost, standby coverage with a non-dedicated unit if such coverage can be provided using units already included in Contractor’s SSP.

If Contractor is mandated by any public safety agency to perform standby coverage with dedicated units and that mandate hampers Contractor’s ability to maintain its system status plan, Contractor may invoice the public safety agency its standby charges for the required unit after the dedicated units have been on scene 15 minutes and have not been released by the incident commander. This transaction shall occur directly between the Contractor and the public safety agency and not involve the SEMSC. Contractor may submit a request to SEMSC, and SEMSC shall consider a possible exception to a response time penalty for delays that can be directly attributed to the standby coverage and not being released by the incident commander. The

Contractor may charge for standby services at private events. The standby services shall be based on a Contractor’s written policy that is subject to the SEMSC’s approval.

Contractor shall also participate in prevention events, emergency preparedness planning and development, disaster exercises, and other training to educate the public and prepare for…