PREVIOUS ACTION :

• August 2010 Washoe County BCC directed staff to convene a multi-stakeholder Emergency Medical Services Task Force.
• December 2010 Washoe County BCC provided direction on the membership of the Task Force.
• September 2011 Washoe County BCC approved the Multi-stakeholder EMS Task Force recommendation to select TriData Division, System Planning Corporation to conduct a comprehensive analysis of the county-wide emergency medical system.
• October 2012 (Joint Meeting) direction on three key points regarding the Emergency Medical System in Washoe County (from TriData Study):
  • "Fix Dispatch" (note: at least 10 TriData recommendations related to Dispatch);
  • Open the REMSA Franchise Agreement: specifically invite REMSA to participate with Reno, Sparks and Washoe County in the franchise negotiation;
  • Develop an EMS Agency that has authority and oversight in Reno, Sparks and Washoe County.
• October 2012: District Board of Health: directed Washoe County Health District staff to take the lead on reviewing and implementing the appropriate recommendations from the recent stakeholder task force and working with partners at the Cities and County to bring recommendations back to the District Board of Health.
• November 2012: Reno City Council - directed staff to work on implementation of appropriate TriData recommendations where the City has authority for implementation, and to work with Health District in implementation of those recommendations.
• November 2012: Washoe County Manager, Reno City Manager, Sparks City Manager and District Health Officer met to discuss the next steps in the EMS review process, including the three key points outlined at the October 18, 2012 meeting. Established EMS Working Group with Managers and Fire Chiefs.
• December 2012: Sparks City Council - directed staff to work with Health District Staff and partners at the cities and counties on reviewing and implementing the appropriate recommendations from the recent stakeholders’ task force and TriData study.
• December 2012: District Board of Health - letter inviting REMSA to participate in discussions with the goal of addressing concerns and establishing amendments to the REMSA Franchise Agreement.
• December 28, 2012: REMSA response - Committed to working with DBOH and public entities, participated in discussions with the goal of addressing concerns and establishing amendments to the REMSA Franchise Agreement. Additionally, REMSA asks for discussion on ''unaddressed issues:" co-response, 911 medical dispatch, quality assurance, medical direction, and other areas of the EMS system.
• February 11, 2013 (Concurrent Meeting) - report on progress and direction on three key points regarding the Emergency Medical System in Washoe County (from TriData Study): Presentation by Dr. Cohen on the TriData study was provided. Update on the progress of the EMS working group was provided. Specifically, Sheriff Mike Haley reviewed the actions of the Dispatch working group, and Cad to Cad link. Jim Gubbels presented, briefly discussed the Washko report, and stated REMSA was eager to begin working on the issues. Washoe County, City of Sparks and District Board of Health voted that County Manager and the City Managers for Reno and Sparks continue to work on implementing the 38 recommendations as appropriate. City of Reno was unable to vote on this item due to not having any action items placed on their agenda. They voted February 28 that County Manager and the City Managers for Reno and Sparks continue to work on implementing the 38 recommendations as appropriate.
• The EMS Working Group has conducted seven (7) meetings to find agreement on the TriData Study issues, prioritize what is most important and define the areas of negotiations.

BACKGROUND:  In 2011, a Multi-Stakeholder Emergency Medical System Task Force which included citizens, and representative from REMSA, State EMS, the Board of Health, emergency room physicians and fire agencies from throughout the region recommended TriData Division, System Planning Corporation to conduct a comprehensive analysis for the county wide emergency medical system. The Task Force was charged with the following:

• Develop a scope of services for the EMS system analysis;
• Develop recommendations to determine an outside agency to conduct inclusive/comprehensive performance audit of EMS delivery;
• Develop minimum performance measures;
• Identify benchmark metrics/reporting structure for data sharing.

The TriData Emergency Medical Services Systems Analysis Final Report was completed and submitted August 2012. The report provides an executive summary, the body of the report, and a summary of recommendations. The initial presentation was given to the Board of County Commissioners on August 28, 2012.

A subsequent presentation was given on October 18, 2012 to a meeting that included the District Board of Health, the City of Reno and the Board of County Commissioners. During that meeting, both the City of Reno and the Washoe County Commission gave direction to focus on the following key priorities from the TriData recommendations:

• "Fix" Dispatch;
• Open the REMSA Franchise Agreement: specifically invite REMSA to participate; with Reno, Sparks and Washoe County in the franchise negotiation;
• Develop an EMS Agency that has authority and oversight in Reno, Sparks and Washoe County.

The District Board of Health met on October 25, 2012 and approved the following motion:

• Direct the Health District staff to begin taking the lead on reviewing and implementing the appropriate recommendations from the recent stakeholder's taskforce and working with our partners at the cities and counties to bring recommendation back to the District Board of Health.

The City of Sparks met on December 10, 2012 and approved the following motion:

• Direct staff to work with the Health District staff and our partners at the cities and counties on reviewing and implementing the appropriate recommendations from the recent stakeholder's task force and the TriData study.

Direction that the regional partners at the Cities of Reno and Sparks, Washoe County and the Health District work together on reviewing and implementing the appropriate recommendations from the recent stakeholder's task force and TriData study is underway. Beginning in November, 2012 the Washoe County Manager, Reno City Manager, Sparks City Manager and the District Health Officer began meeting to discuss the next steps in the EMS review process, including the three priorities outlined in the October 18, 2012 meeting. The Managers established the EMS Working Group, which includes the Managers, the District Health Officer, the region's fire chiefs, and REMSA.

To aid in your review and formulation of directions to the Working Group, we have provided a decision matrix that brings insight into each of the parties’ positions and concerns with the TriData Study. You will find the top priority issues briefly discussed below, and the attached decision matrix will show the positions and provide a path for successful negotiation.

REMSA Franchise Agreement: Staff of each jurisdictions have individually reviewed the current REMSA Franchise Agreement and the Working Group has begun a coordinated review. It is recognized that improved patient care, greater administrative and operational transparency, and improved oversight are key elements for discussion. It is also recognized that an integration of ambulance services with Public Safety Operations is needed to ensure the high level of service our community receives today and well into the future. EMS is the extension of medical care outside of the hospital and ensuring patient care is the forefront of all medical action taken. It also needs to be a seamless component of public safety to ensure all emergency services are integrated to assure the best function of all systems. Staff will continue to work with various stakeholders to recommend changes that will improve patient care to the citizens within the respective jurisdictions. We would note that the City and County Managers have started the process of requesting REMSA and the Health Department reopen the Franchise Agreement to provide a new contract-based system that will move our region forward and resolve many of the long standing issues that need change. These negotiations need to continue, carefully balancing the system in place today with our primary goal of improving the EMS system for the future. We cannot change the past, nor have we focused on how we got here, time and decisions from the past provide the lessons learned to build a new future.

Dispatch: As recommended by Dr. Cohen of TriData, "fixing dispatch" is a top priority. Members of the Regional Dispatch Working Group will be present at the June 10, 2013 concurrent meeting to report on progress to date on recommendations related to dispatch. Sheriff Mike Haley has led a sub-committee to find a path forward on “fixing dispatch.” In fact, regional cooperation on improving dispatch efforts which was started by the Shared Services Committee is moving forward on several major fronts. The creation of a common dispatch system (Tiburon) and virtual CAD to CAD communications will be within reach in an integrated system. The Working Group is pleased to report Sheriff Haley and the Dispatching Subcommittee created by Shared Services is achieving a number of long desired changes that will place all public safety components on an integrated platform. This will assure that police officers, paramedics, firefighters and dispatchers are all within an integrated system.

EMS Agency Authority and Oversight: The TriData Report includes recommendations related to creating a lead EMS Agency to provide oversight over the entire EMS system, while maintaining the organizational identity of the individual provider services. Given the Working Group’s prioritization, the area of EMS Agency authority and oversight are just now reaching the Working Group’s negotiating table. It was important to spend the time on the first two areas to lay the ground work for these discussions to come forward in the coming weeks for negotiating solutions.

Other Issues: By utilizing a prioritized approach to the 38 issues identified in the report, the Working Group has found many areas where all parties reached concurrence and this will yield many needed advancements.

I move to accept the status report of the EMS Working Group, including progress on previous direction related to recommendations from the 2012 TriData Emergency Medical Systems Analysis Final Report, and further direct staff to........