EMSA Department Description
THE EMS AUTHORITY
The EMS Authority is charged with providing leadership in developing and implementing EMS systems throughout California and setting standards for the training and scope of practice of various levels of EMS personnel. The EMS Authority also has responsibility for promoting disaster medical preparedness throughout the state, and, when required, managing the state's medical response to major disasters. Emergency and disaster medical services in California are rooted in the skills and commitment of the first responders, EMTs, nurses, physicians, and administrators who deliver care to the public and operate the system. In order for high quality services to be delivered with high efficiency, all aspects of EMS systems must work together, mutually reinforcing and supporting each other for the benefit of the patient. The California EMS Authority, through standard setting, consensus building, and leadership, plays a central role in improving the quality of emergency medical services available for all Californians.
In California, day-to-day EMS system management is the responsibility of the local and regional EMS agencies. It is principally through these agencies that the EMS Authority works to promote quality EMS services statewide. EMS Authority staff also work closely with many local, state and federal agencies and private enterprises with emergency and/or disaster medical services roles and responsibilities.
HISTORY AND BACKGROUND
Prior to 1980, California did not have a central state agency responsible for ensuring the development and coordination of EMS services and programs statewide. Although the many stakeholders in EMS, including local administrators, fire agencies, ambulance companies, hospitals, physicians, nurses, and other health care providers did not agree on many issues, there was a consensus that a more unified approach to emergency and disaster medical services was needed. Thus, as the result of several years of effort by the EMS constituents to establish a state lead agency and centralized resource to over see emergency and disaster medical services, the Emergency Medical Services System and Prehospital Emergency Care Personnel Act (SB 125) was passed, creating the Emergency Medical Services Authority and adding Division 2.5 to the Health and Safety Code (Sections 1797-1799). The EMS Authority is one of thirteen departments within California's Health and Human Services Agency.
EMS Systems Planning and Development
The EMS Authority provides statewide coordination and leadership for the planning, development, and implementation of local EMS systems. California has 31 local EMS systems that are providing emergency medical services for California's 58 counties. Seven regional EMS systems comprised of thirty-four counties and twenty-four single county agencies provide the services. Regional systems are usually comprised of small, more rural, less-populated counties and single-county systems generally exist in the larger and more urban counties.
Responsibilities for EMS systems planning and development include the following:
- Assessment of EMS Systems in order to coordinate EMS activity based on community needs, for the effective and efficient delivery of EMS services;
- Provision of technical assistance to local agencies developing, implementing, or evaluating components of an EMS system;
- Development of statewide standards and guidelines for EMS systems as well as guidelines for the assessment of critical care capabilities of hospitals; and
- Review and approval of local EMS plans to ensure compliance with the minimum standards set by the EMS Authority.
Trauma Care System Planning and Development
The EMS Authority provides statewide coordination and leadership for the planning, development, and implementation of local trauma care systems. LEMSAs are responsible for planning, implementing, and managing local trauma care systems, including assessing needs, developing the system design, designating trauma care centers, collecting trauma care data, and quality assurance.
Responsibilities for trauma care systems planning and development include the following:
- Development of statewide standards for trauma care systems and trauma centers;
- Provision of technical assistance to local agencies developing, implementing, or evaluating components of a trauma care system; and
- Review and approval of local trauma care system plans to ensure compliance with the minimum standards set by the EMS Authority.
Emergency Medical Services For Children
The overall goal of the emergency medical services for children (EMSC) program is to ensure that acutely ill and injured children have access to high quality, coordinated, and comprehensive emergency and critical care services appropriate for children's special needs.
The EMS Authority, using a grant from the Maternal and Child Health Bureau, U.S. Department of Health and Human Services, and with the assistance of subcommittees of experts in various aspects of pediatric care, has developed guidelines, standards, and key products that make up a comprehensive model for EMSC services. The EMSC Model provides a continuum of care, beginning with the detection of an illness or injury to emergency department care and rehabilitation.
Responsibilities for EMS for Children systems planning and development include the following:
- Provision of technical assistance to local agencies integrating EMSC Model into their existing EMS systems; and
- Maintenance and update of the 13 components of the statewide standards and guidelines for EMSC systems, as necessary to ensure that the standards reflect developments in pediatric care.
Poison Control System
The EMS Authority oversees the operation of California's statewide poison control system. Poison control services, which can save lives, prevent disabilities, and reduce health care costs, are provided free of charge and can be accessed statewide by a single toll free telephone number.
Responsibilities for California's poison control system include the following:
- Development of state standards for poison control services and poison centers;
- Designation and monitoring of the poison control services contractor;
- Evaluation of poison control system operations and site reviews of poison center answering points;
- Provision of technical assistance to poison control center administrators; and
- Provision of assistance to the poison control services contractor in identifying sources of funding to support poison control services operations.
Prehospital Emergency Medical Care Personnel Standards
The EMS Authority is mandated by statute to develop and implement regulations that set training standards and the scope of practice for emergency medical personnel, including Emergency Medical Technician (EMT)-Is, EMT-IIs, Paramedics, Mobile Intensive Care Nurses (MICN), Firefighters, Peace Officers and Lifeguards.
Responsibilities for prehospital emergency medical care personnel standards include the following:
- Development of statewide standards for all prehospital personnel;
- Development, adoption, implementation, and maintenance of regulations for each level of personnel;
- Resolution of policy issues and development of policies as necessary; and
- Provision of technical assistance regarding regulations and policies to LEMSAs, prehospital care providers including fire agencies and ambulance companies, EMS personnel, persons seeking required training, and training program administrators.
Emergency Medical Dispatcher Standards and EMS Communications Systems
The EMS Authority is developing standards for emergency medical dispatcher (EMD) training and for the provision of pre-arrival emergency care instructions (emergency medical care advice given over the telephone by EMDs to persons at the scene of a medical emergency for the provision of emergency care until qualified prehospital medical care personnel arrive at the scene and take over care of the patient). The EMS Authority is also working with experts to evaluate the status of EMS communications systems in California and to develop a state plan for EMS communications systems.
Responsibilities for emergency medical dispatcher standards and EMS communications systems planning and development include the following:
- Development of statewide training standards for emergency medical dispatcher;
- Development of statewide standards for the provision of pre-arrival emergency care instructions;
- Provision of technical assistance to emergency medical dispatch agencies and dispatchers;
- Assessment of EMS communications systems; and
- Development of a state EMS communications plan.
First Aid and CPR Training Programs for Child Day Care Providers and School Bus Drivers
The EMS Authority is required by statute to set standards for and approve training programs in first aid and CPR for child day care providers and school bus drivers. Licensed child day care facilities in California are required to have at least one staff member certified in pediatric first aid and CPR on duty whenever children are present. School bus drivers in California are required to have basic knowledge of pediatric medical emergencies and to be certified in first aid and CPR. The CHP tests school bus drivers in first aid and CPR; however, the test may be waived if drivers take a training course approved by the EMS Authority.
Responsibilities for child day care provider and school bus driver first aid and CPR training programs include the following:
- Development, adoption, implementation, and maintenance of regulations for training programs;
- Review and approval of training programs;
- Provision of technical assistance regarding regulations and training program requirements to persons and organizations seeking approval of training programs;
- Provision of technical assistance regarding regulations and training requirements to child day care personnel, school bus drivers, schools, and others seeking information on required training, and approved training programs; and
- Investigation of complaints about training programs and disciplinary action, as necessary.
Paramedic Licensure and Enforcement
The EMS Authority operates the State Paramedic Licensure program. This program licenses and conducts disciplinary investigations of paramedics to ensure that the care they provide meets California's high standards for prehospital care.
Responsibilities for paramedic licensure and enforcement include the following:
- Review of paramedic license applications to ensure that licensing requirements are met including training, testing, and continuing education;
- Completion of criminal background checks for initial paramedic licensure applicants and for those whose licenses have lapsed for more than a year;
- Provision of technical assistance regarding licensure issues to paramedics, LEMSAs, fire agencies, ambulance companies, and training program administrators; and
- Investigation and prosecution of complaints regarding paramedic prehospital care, inappropriate conduct, and other related issues, including information revealed from the criminal background checks.
Disaster Medical Services Preparedness and Response
The EMS Authority, as the lead agency responsible for coordinating California's medical response to disasters, provides medical resources to local governments in support of their disaster response. This may include the identification, acquisition and deployment of medical supplies and personnel from unaffected regions of the state to meet the needs of disaster victims. Response activities may also include arranging for evacuation of injured victims to hospitals in areas/regions not impacted by a disaster.
The medical response to disasters requires the contributions of many agencies. The EMS Authority works closely with the Governor's Cal EMA, California National Guard, Department of Health Services and other local, state, and federal agencies to improve disaster preparedness and response. The EMS Authority also works closely with the private sector: hospitals, ambulance companies, and medical supply vendors.
Responsibilities for disaster medical services preparedness and response include the following:
- Development and maintenance of disaster medical response plans, policies and procedures;
- Provision of guidance and technical assistance to LEMSAs, county health departments, and hospitals for the development of local disaster medical plans, policies and procedures;
- Enhancement of state and local disaster medical response capabilities through the development of civilian disaster medical response teams (DMATs), response management teams, disaster medical communications systems, and a statewide medical mutual aid system;
- Testing disaster medical response plans through periodic exercises with local, state, and federal agencies and the private sector; and
- Management of California's medical response to a disaster.
Prehospital Data, Injury Prevention, and Public Education
The EMS Authority is working to increase and improve LEMSA and state EMS data capacities and capabilities; to standardize the collection of prehospital and trauma data in LEMSAs; to study the efficacy of EMS systems and traffic safety measures/conditions; and to reduce morbidity and mortality associated with traffic injuries in California by increasing the role/activity of EMS personnel in injury control activities. Injury prevention is part of EMSA's mission to coordinate and integrate emergency medical care and preventive services.
Responsibilities for data collection and injury prevention include the following:
- Development and maintenance of an aggregated statewide prehospital database;
- Establishment and maintenance of a core data set for California EMS;
- Provision of guidance and technical assistance to LEMSAs for the development and improvement of local EMS data collection systems;
- Promotion of injury prevention and public information and education activities including citizen first aid CPR programs as well as appropriate EMS access; and
- Development and promotion of a pedestrian safety plan for California.