Service Zone Planning

1
Service Zone Planning

• Local Jurisdiction
• EMS Planning Response
• Central Mass EMS Corp
• Holden, MA

2
Overview

• EMS 2000
• Service Zones/Plans
• Steps to Completion

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What is EMS 2000?

• Comprehensive overhaul of the states previous
  emergency medical services law
• Effective Date September 26, 2000
• Goal Establish system that provides pre-hospital
  patients right care, right provider, right
  facility at right time
• Features
• Service zones
• Trauma system development
• Enhanced and extended medical oversight
• Data collection and quality assurance

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What is a Service Zone Plan?

• Developed by local officials
• best use of local resources
• local EMS decisions and standards
• technical assistance and review by the Regional
  EMS Councils
• approved by DPH

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Service Zone Plans Purpose

• Identifies makes optimal use of all available
  EMS resources
• Sets out how emergency response is coordinated
  and carried out
• Ensures the dispatch and response of the closest,
  appropriate, available EMS resources

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Who has to have a SZ Plan?

• Every local jurisdiction

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Whos involved in SZ Planning?

• Local Jurisdictions municipal officials
• First Responder Agencies
• Emergency First Response (EFR) Services
• All Ambulance Services (both 9-1-1 and provider
  contracted services)
• Health Care Facilities

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What Is an EFR Service?

• OPTIONAL
• Designated by local officials in accordance with
  approved Service Zone Plan
• Obligated to respond and provide on-scene care
• Levels of service First Responder through
  ALS-Paramedic
• Subject to DPH service licensure and personnel
  certification standards
• Private or public entity

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EMS First Response (EFR)vs. First Responder

• Whats the same minimum training standard for
  first responders
• What makes EMS First Response different?
• Designation in service zone plan
• Duty to provide emergency medical care
• Equipped to provide emergency medical care
• Integration into the EMS response system
• Licensed services and certified providers

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What is a Service Zone?

• A geographic area comprised of one or more local
  jurisdictions where EMS is planned and implemented

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Service Zone Plan Components

• Part A Contact Info/Authorized Signatures
• Part B SZ Planning Process Participants
• Part C Local SZ Standards
• Part D Inventory of EMS Resources
• Part E Inventory of Health Care Facilities
• Part F Inventory of EMS Communications
• Part G Medical Control Plan
• Part H EMS Operation Plan
• Part J Trip Records

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Service Zone Plan Components

• In addition, copies of
• SZ Agreements between jurisdictions primary
  ambulance service and providers with contracts
  for emergency ambulance response
• Affiliation Agreements for medical control for
  all emergency ambulance response within the
  service zone (these do not need to be submitted
  if a current copy is already on file at OEMS)

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Elements of a Service Zone Plan
Per regulations

• Inventory (Part DE) of EMS public safety
  providers and resources, including
• Designated Primary Ambulance Service and services
  with whom there are SZ agreements
• Any other ambulance services whose regular
  operating area is in whole or part of SZ
• Designated EFR Services if any
• Health care facilities including nursing homes
• First Response Agencies locations of First
  Responders

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Elements of a Service Zone Plan
Per regulations

• Inventorycontinued
• Others trained to provide emergency response (ski
  patrols, EMTs at schools/senior centers)
• Emergency medical dispatch and public safety
  answering point (PSAP)
• AEDs and their locations

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Elements of a Service Zone Plan
Per regulations

• An open, fair inclusive process for the
  selection/changing of EMS service delivery or
  designated service zone providers
• Service Zone Agreements
• A process for monitoring compliance with the
  service zones local standards for specific EMS
  performance criteria

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Elements of a Service Zone Plan
Per regulations

• Criteria for the selection of designated service
  zone providers, including
• Response time
• Adequate backup
• Deployment of resources
• Level of service licensure
• Medical control
• Appropriate facility destinations in accordance
  with Regional Point-of-Entry Plans

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Elements of a Service Zone Plan
Per regulations

• A medical control plan, at a minimum, consisting
  of collection, review, and monitoring of
  affiliation agreements
• Designated service zone providers
• One primary ambulance service (mandatory)
• One or more EMS First Response Services (EFR
  Services are OPTIONAL)

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Elements of a Service Zone Plan
Per regulations

• Operational plan for coordinating the use of all
  first responder agencies (not EFRs) and first
  responder volunteers, including location of
  agencies and persons
• Procedures for delivery of trip records and
  unprotected exposure forms to receiving facilities

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Elements of a Service Zone Plan
Per regulations

• Operational Plan for ensuring dispatch response
  of the closest, appropriate EMS services,
  including
• Coordination/optimal use of
• Primary ambulance service
• Those listed in SZ agreements back-up services
• EFR services, if any
• Location of all licensed EMS services

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Elements of a Service Zone Plan
Per regulations

• Operational Plancontinued
• Clear criteria including
• Type of emergency or patient condition
• Base locations of services
• Hours of operation
• Number, hours and location of EMS personnel
• Services capabilities

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Elements of a Service Zone Plan
Per regulations

• No service zone plan may include criteria for
  the notification dispatch of a designated EFR
  service to a licensed facility where a licensed
  health care professional on site 24 hours/7days
  per week, AND there is a provider contract in
  place to provide primary ambulance response.

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Benefits of Service Zone Plans

• Local control of EMS service delivery
• Cost-efficient use of available resources
• Improved EMS system performance
• Better integration of relevant local services
• Improved public information/education
• Ability to rate service provision against patient
  outcome

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Service Zone Plan Deadline

• Local jurisdictions must be covered by a
  Department approved service zone plan by December
  31, 2006
• This means they need to be submitted to the
  Region well in advance!

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Steps to Completion

• Local Officials determine members of planning
  team and maintain ultimate responsibility
• All private providers of ambulance service
• First Response agencies
• EMS/Public Safety Committee
• Boards of Health
• Local hospitals/physicians
• School nurses, VNAs, hospice

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Team Steps to Completion

• 1. Account for Resources
• a. Pre-hospital Providers
• - Cost considerations
• - EMS resources and utilization
• - Needs analysis
• b. Community Services/Facilities
• - Skilled Nursing Facilities
• - Clinics, hospitals
• - other (e.g. AED locations)

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Team Steps to Completion .continued

• 3. Establish Local Performance Standards
• -Elements of an Effective EMS System
• -Response times for all services
• -Level of care
• -Staffing

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Team Steps to Completion .continued

• 4. Determine Deployment of Resources
• Call-taking/Dispatch
• Response
• On-scene coordination
• Transportation
• Facility destination

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Team Steps to Completion .continued

• Develop Plan
• - May use DPH EMS Service Zone Plan
  Application or alternate written format that
  includes all service zone plan elements
• - Submit to Regional EMS Council in time for
  Review and Approval before December 31, 2006.

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Grounds for Denial of Plan

• Department may deny approval of a plan if
• The applicant fails to meet each of the elements
  as previously outlined
• The applicant submits inaccurate or incomplete
  information to obtain plan approval or
  designation of a service zone provider

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Updates of Plans

• Local jurisdictions shall report changes to the
  approved plan to the Regional Council (this
  includes when a service zone begins a selection
  process for service provider or delivery changes)
• The Regional Council shall report updates to the
  Department

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Grounds for Revocation

• Department may revoke approval of plan for
• Failure to adhere to plan
• Failure to carry out selection process for
  service changes
• Knowingly omitting a fact or making false
  statement orally or in application or document
  filed with the Region or Department
• Violation of a correction order
• Failure to comply with plan of correction

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Summary

• EMS 2000
• Service Zones/Plans
• Steps to Completion

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Resources

• Central Mass EMS Corp
• 508-854-0111
• www.cmemsc.org
• MDPH/OEMS
• 617-753-7300
• www.mass.gov/dph/oems