October 2012: (Concurrent Meeting) - Direction on three key points regarding the Emergency Medical System in Washoe County (from TRIDATA STUDY):

•  "Fix Dispatch" (note: at least 10 TRIDATA STUDY 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: The 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.

December 2012: The District Board of Health issued a letter inviting REMSA to participate in discussions with the goal of addressing concerns and establishing amendments to the REMSA Franchise Agreement.

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 (WG) was also provided.
• Washoe County, City of Sparks and District Board of Health voted that County Manager, the City Managers for Reno and Sparks, and the District Health Officer 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 the County Manager, the City Managers for Reno and Sparks, and the District Health Officer continue to work on implementing the 38 recommendations as appropriate.

June 10, 2013: (Concurrent Meeting) - Status report on EMS WG progress on previous direction including areas which require further negotiation, seeking direction on how to proceed with REMSA negotiations and addressing TRIDATA STUDY’s 38 recommendations.

Washoe County, City of Reno, City of Sparks, and the District Board of Health voted that the EMS working group reach an updated agreement with REMSA within 120 days and continue to address the TRIDATA STUDY’s 38 recommendations. Subsequent to this action, an additional 120 days was provided to reach agreement through separate actions of these bodies during September 2013.

February 2013 – January 2014: The EMS WG conducted numerous sessions for the purpose of addressing the TRIDATA STUDY’s 38 recommendations. The EMS WG reached agreement on the high-level details to update the current Franchise Agreement between the Washoe County District Board of Health and REMSA for the purpose of providing an exclusive right to provide, through an amended and restated franchise agreement, Emergency Medical Transportation Services.

The end products developed by the EMS WG are:

(1) A Principles of Agreement document for the reworking of the EMS Franchise Agreement, and

(2) an Interlocal Agreement between the local government entities to address and provide authority for local government medical oversight; interagency communications; and performance monitoring of the providers of Emergency Medical Services in the region.

A Summary of Recommendations matrix was created to assure the TRIDATA STUDY’s 38 recommendations were addresses and resolved in one or both of the proposed documents above.

February 10, 2014: (Concurrent Meeting) - Principles of Agreement negotiated by the EMS WG and REMSA for an amended and restated franchise agreement were presented for discussion and approval. A Resolution providing for a structure and process for the District Board of Health to provide a Regional EMS Oversight Program, establishment of an EMS Advisory Board, and for a cooperative effort involving the Jurisdictions and EMS agencies to be established through development of an Interlocal Agreement was presented for discussion and approval. A summary of the 38 TRIDATA STUDY recommendations identifying where they were addressed in the Principles of Agreement, Resolution for Regional EMS Oversight, or otherwise was also presented.

City of Reno, City of Sparks, Washoe County and the District Board of Health voted to order that (A) the full development of an updated Franchise Agreement between the Washoe County District Board of Health and the Regional Emergency Medical Services Authority (REMSA) as proposed by the Emergency Medical Services Working Group be approved with the 25 percent Oversight Fee paid by REMSA (as noted in the Principles of Agreement 1.H.) changed to a 12.5 percent Oversight Fee, and that the Washoe County’s District Attorney’s Office be directed to prepare final legal agreements to match the Principles of Agreement to the Franchise Agreement; and, (B) that the full development of an Interlocal Agreement concerning the duties and responsibilities of the entities participating in the EMS Oversight Program be approved.

In addition to the significant actions identified above, throughout the process the EMS WG and Executive Committee met regularly to build consensus to address the TRIDATA STUDY and to discuss and agree upon the structure and process for Regional EMS System Oversight. Over fifty meetings occurred to address the Franchise and EMS oversight issues. The Executive Committee was composed of the following individuals or their designees:

• Sparks City Manager

• Reno City Manager

• Washoe County Manager

• District Health Officer

• President of REMSA

The EMS Working group included the Fire Chiefs of the Sparks Fire Department, Reno Fire Department, Truckee Meadows Fire Protection District, North Lake Tahoe Fire Protection District, the Washoe County Sheriff, the EMS Executive Committee, and designated staff.

Following the direction from the February 10, 2014 Concurrent Meeting, a draft Interlocal Agreement (ILA) for Emergency Medical Services Oversight was prepared based on the resolution presented at the February meeting. The Interlocal Agreement between the City of Sparks, City of Reno, Washoe County Health District, Washoe County and Truckee Meadows Fire Protection District (TMFPD) will create a Regional Emergency Medical Services Oversight function for the management, measurement and improvement of Emergency Medical Services within the Washoe County Health District.

The Interlocal Agreement was distributed to the EMS Executive Committee and TMFPD Chief Moore for review on May 14, 2014. A meeting with the EMS Executive Committee (without REMSA, which is not a signatory party to the ILA) was held on May 23, 2014 to discuss comments and modifications to the draft agreement. Based on these discussions and comments on the drafts of the agreement the Interlocal Agreement was finalized and distributed to the EMS Executive Committee and TMFPD Chief Moore on June 9, 2014 for presentation for approval to their governing bodies. This agreement provides for an EMS Oversight Program, and an EMS Advisory Board to be established under the District Board of Health to compile, analyze, evaluate and recommend response/performance standards, and protocols to allow for continuous improvement and optimization of the regional EMS system performance and ensure proper patient care. The ILA provides for the analysis of response data from each of the EMS agencies and review of a regional EMS response zone map on an annual basis. The ILA also provides for the cooperative participation of the City of Sparks, City of Reno, the Washoe County Health District, Washoe County, and the Truckee Meadows Fire Protection District in regional EMS oversight. The ILA responds to TRIDATA STUDY recommendations for oversight of the regional EMS system to ensure the EMS system is responsive to community needs and provides high quality patient care.

1. Council may approve an Interlocal Agreement for Emergency Medical Services Oversight between the City of Sparks, the City of Reno, Washoe County Health District, Washoe County, and the Truckee Meadows Fire Protection District through itself and the Sierra Fire Protection District to create a Regional Emergency Medical Oversight function for the management, measurement, and improvement of Emergency Medical Services as presented by staff.

2. Council may not approve an Interlocal Agreement for Emergency Medical Services Oversight between the City of Sparks, the City of Reno, Washoe County Health District, Washoe County, and the Truckee Meadows Fire Protection District through itself and the Sierra Fire Protection District to create a Regional Emergency Medical Oversight function for the management, measurement, and improvement of Emergency Medical Services as presented by staff.

3. Council may not approve an Interlocal Agreement for Emergency Medical Services Oversight between the City of Sparks, the City of Reno, Washoe County Health District, Washoe County, and the Truckee Meadows Fire Protection District through itself and the Sierra Fire Protection District to create a Regional Emergency Medical Oversight function for the management, measurement, and improvement of Emergency Medical Services as presented by staff and provide other direction to the City Manager.