The Rutherford Report—ICEMA: Behind-the-Scenes in EMS Response

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“There is nothing so strong or safe in an emergency of life as the simple truth.”

—Charles Dickens
ICEMA: Behind-the-Scenes in EMS Response

When a major accident or medical emergency happens, we dial 911 and help arrives.

We don’t stop to consider the inner workings that go into ensuring an ambulance and first responders get there, that the paramedics on board have the right training and equipment, or that the hospital we’re taken to has the appropriate medical personnel and expertise to treat us. But that’s what the team at the Inland Counties Emergency Medical Agency (ICEMA) thinks about all the time.

ICEMA is one of 33 emergency medical services agencies in California charged with coordinating, evaluating, and planning local emergency medical response systems.

The agency is a joint powers authority formed by San Bernardino, Inyo and Mono counties to comply with the Emergency Medical Services System and Prehospital Emergency Medical Care Personnel Act. The law, adopted in 1980, requires counties to create emergency medical service (EMS) agencies to carry out and implement state EMS requirements at the local level.

One of ICEMA’s responsibilities is the management of exclusive operating areas (EOA) for ambulance providers. These zones were created, in part, to avert the free-for-all ambulance responses that existed prior to 1980 in some parts of the country.

The lack of coordination meant multiple ambulances might arrive on scene when only one was needed. In addition, ambulance providers might “cherry pick” areas to serve, which meant potentially inferior service for low-income or difficult to serve areas such as rural parts of a county.

By granting ambulance providers the exclusive right to operate in specific zones, ICEMA can better manage emergency responses and ensure service to all. EOAs can serve to control and even lower the cost of ambulance service by reducing overhead costs (management, dispatch, vehicles, etc.) and the over deployment of resources.

“Without those economics of scale, ultimately prices start spiraling upward for consumers,” ICEMA EMS Administrator Tom Lynch said.

Counties can open EOAs up for competitive bids from ambulance providers, and they are required by law to do so when creating new EOAs.

ICEMA is also charged with coordinating the level of care available at local hospitals with ambulance and air rescue providers. For example, two San Bernardino County hospitals—Arrowhead Regional Medical Center and Loma Linda University Medical Center—qualify as trauma centers because they have the personnel, services and equipment necessary to care for trauma patients at a moment’s notice.

“Every small community hospital can’t have those trauma teams ready to go all the time,” Lynch said.

Other hospital categories including base hospitals, receiving hospitals, stroke centers, and ST-elevated myocardial infarction (STEMI) receiving centers.

The agency is also tasked with stepping in and helping manage responses during disasters or other emergency situations.

ICEMA coordinated the request for ambulances to respond to the San Diego fires last spring and for the tragic local rampage of a former Los Angeles police officer. During the recent Ebola scare, the agency helped draft a script for emergency dispatchers to use to screen patients to determine if they may have been infected with the deadly virus; it also developed the personal protective equipment and response standards for EMS responders.

ICEMA is also playing a major role in the transition to the electronic reporting of patient information by serving as the data repository for electronic patient and trauma reports from all of California’s local EMS agencies. Electronic reporting is key to creating a comprehensive health information exchange that will allow paramedics, doctors, and other healthcare providers to quickly access patients’ health information to improve care and safety.

Click here to learn more about ICEMA and its role in the management of emergency medical care.
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