|Type of Government:||State & Local|
|Posted Date:||Sep 16, 2019|
|Due Date:||Dec 6, 2019|
|Bid Source:||Please Login to View Page|
|Contact information:||Please Login to View Page|
|Bid Documents:||Please Login to View Page|
RFP 7310 Exclusive Operating Area Provider for Emergency Ambulance Service
|Category:||Administrative Services - Purchasing|
Issue Date: September 16, 2019
2222 M Street
Merced, CA 95340
(209) 725-3535 Fax
Equal Opportunity Employer
COUNTY OF MERCED
REQUEST FOR PROPOSAL
for emergency ambulance service
and secondary Medical PUBLIC SERVICE ANSWERING POINT (pSAP) for Merced County
Notice is hereby given that proposals will be received at the Merced County Department of Administrative Services-Purchasing Division for performing all work necessary in accordance with the “REQUIREMENTS” and other related documents provided herein. Please carefully read and follow the instructions.
Responses shall be presented under sealed cover with the Proposal Number and the Proposal Submittal Close Date clearly marked on the outside and forwarded to:
County of Merced
Department of Administrative Services-Purchasing
2222 M Street, Room 1, Merced, California 95340
Attn: Kim Nausin, Purchasing Manager
Any Bidder who wishes their response to be considered is responsible for making certain that their response is received in the Merced County Department of Administrative Services-Purchasing Office by the closing date.
RESPONSES RECEIVED AFTER THE DEADLINE WILL BE REJECTED WILL BE RETURNED TO THE BIDDER UNOPENED.
CLOSING DEADLINE DATE: 4:00 P.M., December 6, 2019
RESPONSES WILL BE CONSIDERED LATE WHEN THE OFFICIAL
DEPARTMENT OF ADMINISTRATIVE SERVICES-PURCHASING DIVISION
TIME CLOCK READS 4:01 P.M.
Section 1: Submittal Checklist
All items are required. This checklist is provided to assist you in ensuring you submit a complete proposal.
a. _____Signature Page (Form 1)
b. _____Acknowledgement of Amendment(s) (If any)
c. _____ Forms 2, 3, and 4
d. _____Bond(s) (If any)
e. _____Cover Letter
f. _____Table of Contents
g. _____Executive Summary
j. _____Bidder's Qualifications
Submit Separately (e.g., sealed envelope, DVD/flash drive)
A. _____ Cost Proposal
B. _____ Financial Statement and Sufficient Financial Information as listed in the RFP (Non-submittal is considered non-responsive and cause for rejection of proposal)
C. _____ Self-Insurance Retention (SIR), if applicable
Section 2: RFP-Specific Definitions
(For EMS Definitions, see )
Agreement - Comprises the Request for Proposal (RFP), any amendment thereto, the bid proposal, and the purchase order if appropriate. The Agreement constitutes the entire agreement between the County and the awarded Bidder.
American Institute of Certified Public Accounts (AICPA) – Association representing the accounting profession that sets ethical standards and auditing standards.
Bidder – A person, partnership, firm, corporation, organization, or joint venture submitting a bid proposal for the purpose of obtaining a County Agreement.
Fidelity Bond - Also referred to as a Dishonesty Bond. A fidelity bond is a form of protection that covers the County for losses as a result of fraudulent acts by the Contractor.
Proposal Security Bond – Also referred to as Bid Security. A bond that is submitted with Bidder’s response to compensate the County for damages it might suffer if successful bidder refuses to execute the Agreement that may be derived from their response. Generally, it is 10% of the amount of Bidder’s bid as bid security.
Performance Bond – A bond to ensure completion of the project as requested under the “Scope of Work”. The Performance Bond is backed by a surety who guarantees the project will be completed in accordance with the specifications of the proposal.
Payment Bond – This bond is to protect subcontractors and suppliers. It ensures that the surety backing the bond will pay the subcontractors and suppliers if the general Contractor does not.
Closing Date/Time – The day and time by which the RFP must be received in the office of the Department of Administrative Services-Purchasing for acceptance.
Consumer Price Index (CPI) – Monthly data on changes in the prices paid by urban consumers.
Contractor – The Bidder awarded the Contract derived from this RFP. The Bidder who is awarded the Contract and designated as the legal entity. The Prime Contractor will hereafter also be known as the Contractor. Any subcontracting, joint ventures, or other legal arrangements made by the Contractor during this project are the sole responsibility of the Contractor.
Contract Administrator – The Contract Administrator will be the single authority to act for the County under the Contract.
County – The County of Merced, a political subdivision of the State of California.
Evaluation Committee – A committee established to review and evaluate bid proposals to recommend the Contract award.
Formal Date of Award – Effective date the Board of Supervisors take formal action to award the subject RFP to the most responsive Bidder.
Joint Ventures – Two or more corporations or entities that form a temporary union for the purpose of the RFP.
Notice of Intent to Award – Letter sent by the County to all participating Bidders advising them of the date the County Board of Supervisors will hear and possibly take action in awarding the Agreement to the apparent successful Bidder as recommended by the Evaluation Committee.
Portable Document Format (PDF) – Commonly referred to as Adobe Acrobat format.
Prime Contractor – The Bidder who is awarded the Agreement and designated as the legal entity. The Prime Contractor will hereafter also be known as the Contractor. Any subcontracting, joint ventures, or other legal arrangements made by the Contractor during this project are the sole responsibility of the Contractor.
Proposal Deadline – The closing date associated with this proposal.
Proprietary – The information provided that is considered exempt from public disclosure defined as Trade Secrets under Civil Code Section 3426.1, pursuant to Public Records Act.
Request for Proposal (RFP) – This solicitation for emergency ground ambulance services within Merced County.
Scope of Work – The mutually agreed to document which describe tasks, dependencies, the sequence and timing of events, deliverables, and responsible parties associated with the various phases of the proposal.
Self-Insurance Retention (SIR) – Self-insured policy.
Subcontractors – Any person, entity, or organization to which Contractor or County has delegated any of its obligations hereunder.
Vendor - A person, partnership, firm, corporation, or joint venture submitting a bid or response for the purpose of obtaining a County Agreement.
Section 3: Intent of the Request for Proposal
The County of Merced Department of Administrative Services - Purchasing, on behalf of the Department of Public Health and its Emergency Medical Services (EMS) Agency, invites sealed proposals from qualified organizations to bid on emergency ambulance service for an exclusive operating area (EOA). Merced County (“County”) is authorized to plan and implement such an EOA as provided for under California Health and Safety Code, Section 1797.224. The EOA represents all incorporated and unincorporated areas of the county as detailed in this RFP, excluding the area serviced by the West Side Health Care District as shown in . Proposals will be accepted for one provider servicing the entire EOA.
Merced County has 274,765 residents (per 2018 U.S. Census Bureau population estimate) covering 1,979 square miles, of which 1,935 square miles is land and 44 square miles (2.2%) is water and is located in the northern San Joaquin Valley section of the Central Valley , north of Fresno County and southeast of Santa Clara County . Known as the "Gateway to Yosemite ," the county seat is less than two hours by automobile from Yosemite National Park to the east and Monterey Bay , the Pacific Ocean, and multiple beaches to the west. The county derives its name from the Merced River featuring a semi-arid climate , with very hot, dry summers and mild, wet winters and sunshine 252 days a year. There are six incorporated cities within Merced County. The largest is the City of Merced, followed by Los Banos, Atwater, Livingston, Gustine, and Dos Palos.
County and city municipalities are a major source of employment along with agricultural related industries, retailing, manufacturing, food processing and tourism. Merced County grows 90% of California's sweet potato crop. The excellent school system includes a modern community college, Merced College and the University of California, Merced, which is the first research university built in the U.S. in the 21st century. The former Castle Air Force Base and the U.S. Penitentiary, Atwater are located in an unincorporated area near Atwater .
This procurement calls for proposals to provide for all emergency ambulance service within the EOA subject to the performance standards and other specifications herein. Bidders must meet all credentialing and scope of service requirements as listed in Section 4 of the RFP. Each proposal will undergo significant scrutiny in these areas prior to processing the application for full consideration. For a further listing of definitions for the RFP, please see Section 2.
The initial Contract period will be for five (5) years. The local EMS agency (LEMSA) may extend the Contract for one (1) additional five (5) year period based on superior performance as evaluated and approved by the LEMSA. Any extension will be at the mutual agreement of both LEMSA and the current EOA provider. Contract compliance will be monitored by the LEMSA utilizing the FirstWatch reporting system.
This is a performance-based Contract. Details regarding the Contract, performance standards, and other details of the scope of work requested are described in this RFP. Bidders should note that Merced County is very diverse in its population and geography. A comprehensive proposal from a Bidder will require orientation and familiarity to the unique service requirements of the County.
Existing EMS Services
Currently, there is one ground emergency and non-emergency ambulance and Secondary Public Safety Answering Point (PSAP) provider serving the 9-1-1 needs of the residents and visitors of Merced County with one exception. The West Side Healthcare District (hereinafter referred to as “WSHD”) provides ambulance services to a small portion of northwestern Merced County under a subcontract with the current EOA provider. WSHD offers all Advanced Life Support (ALS) level of care, including 9-1-1 and interfacility. In addition, the current EOA provider offers Basic Life Support (BLS) 9-1-1, interfacility transfers and Critical Care Transport (CCT). Response time standards are in place for Emergency, Non-emergency, CCT and Interfacility transfers. WSHD dispatch is provided by the EOA provider’s dispatch center. There is one air ambulance provider with a county contract; Air Methods.
General Requirements and Governing Law
California Health and Safety Code 1797.224 permits LEMSAs to establish EOAs. In addition, and from time to time, the County may establish certain rules and regulations that govern the operation of emergency ambulance services within the contractual jurisdiction. The State law, contractual standards as stipulated in the RFP and future addenda, County resolutions, ordinances and rules and regulations, and published operational and medical policies of the LEMSA, California EMS Authority, and this RFP set forth the requirements for service for the County EOA, and all bidders shall comply with them. Collectively, they are referred to as the "governing law" in this RFP.
During the term of the Agreement, the Agreement may be modified by consent of the EMS Agency, the Board of Supervisors and the Contractor. Acceptable modifications include changes to improve the efficiency of the EMS System to reduce costs or to improve clinical care. This includes but may not be limited to: (1) modifying response time standards, response patterns, Response Areas and Response Zones within the EOA which are based upon clinical evidence or science; (2) implementing case management, alternate destination, non-ambulance transport and treat and refer programs.
Exclusive Operating Area
The response area to be served by this RFP is the "Merced County EOA - Ground" which is one, single EOA servicing the entire County, specifically excluding the Westside Health Care District. The District covers 475 square miles approximately equally divided between the southwest part of Stanislaus County and the western part of Merced County. Should the ambulance resources of the Westside Health Care District change, Contractor will negotiate in good faith to serve this area. The authority of the County allows the County to restrict operations to one emergency ambulance provider within the EOA.
3.3 Period of Operation
Unless initiated earlier by mutual agreement, this Agreement shall commence at 9:00 a.m. on July 1, 2020 and terminate at 8:59 a.m. on June 30, 2025, unless extended or terminated as provided for herein. LEMSA shall make any decision regarding renewal of this Agreement or any extension thereof shall be made at least 18 months prior to the scheduled termination date so that if no extension is approved, a new proposal process can be conducted on a schedule that will identify the new Contractor at least four months prior to that scheduled termination date.
The purpose of this requirement is to allow reasonable time for both outgoing and incoming Contractors to plan and execute an orderly transition, to allow the County and its new Contractor to revise advertising, and to allow time for negotiation of new service contracts, mutual-aid agreements, and other contracts previously serviced by the outgoing Contractor.
A Sample Agreement is included as an attachment to this proposal. This Agreement will become part of the final Agreement with the successful Bidder. An Agreement with the successful Bidder is executed only upon final approval by the County's Board of Supervisors.
3.4 Scheduled Activities
To the extent achievable, the following schedule shall govern the review, evaluation and award of the proposal. The County reserves the right to modify the dates below in accordance with its review process.
Activity Estimated Schedule
Availability of the Request for Proposal
September 16, 2019
Pre-proposal conference (if applicable)
October 14, 2019
Deadline for submission of interpretation and/or written questions in relationship to the Request for Proposal. (by 4:00 p.m.)
Questions submitted after this date will not be answered. The closing date will not be extended for questions submitted after this date.
October 21, 2019
Letter of Intent Due (may be scanned and submitted via email attachment to firstname.lastname@example.org)
November 4, 2019
Closing date for the Request for Proposal (by 4:00 p.m.)
A list of respondents will be posted to the web at close of RFP
December 6, 2019
Oral Presentations Completed
December 20, 2019
Notice of Intent to Negotiate
January 4. 2020
Approval of Agreement by Board of Supervisors
February 4, 2020
July 1, 2020
Section 4: Scope of Work
This RFP and its provisions, attachments, addendums and exhibits constitute a solicitation for the selection of the single provider of ground emergency ambulance service for the County EOA. The operation of such an emergency ambulance service shall be consistent with the provisions of this procurement process including staffing and performance. This procurement process includes provision for all ambulance responses.
All the following transports originating in the County EOA shall be referred to the holder of the exclusive Contract, and the holder of the exclusive Agreement shall be responsible for all responses and ground transports as follows:
(1) Made in response to 9-1-1/ PSAP requests;
(2) Made in response to requests for immediate emergency ambulance service transmitted through an authorized 9-1-1/PSAP;
(3) Made in response to requests for emergency ambulance service made directly to the ambulance provider from a seven-digit telephone call without going through an authorized 9-1-1/PSAP;
(4) Any request for ALS interfacility transport from a healthcare facility;
(5) All “Special Events” requiring the presence of an ALS ambulance; and
(6) All “Special Events” requiring ALS level of service, even if there is no ambulance required.
The Contractor’s scope of work is summarized as follows:
When a request for service is received by the Contractor from any of the PSAPs located in the County, ambulance response times must meet the response-time and clinical standards set forth herein. Every ambulance unit provided by the Contractor for emergency response must, always, except as authorized by the Agreement, be equipped and staffed to operate at the appropriate level on all ambulance responses, including emergency and non-emergency services. Clinical performance must be consistent with approved medical standards and protocols. The conduct and appearance of the Contractor’s personnel must always be professional and courteous. Patient transportation and disposition will be according to the County’s Policies and Procedures as established or approved in the Contractor’s proposal and as developed or promulgated as part of this RFP.
Services and care delivered must be evaluated by the Contractor’s internal quality improvement program and as necessary, through the County’s quality improvement program in order to improve and maintain effective clinical performance. The Contractor must make an unrelenting effort to detect and correct clinical and other performance deficiencies and to continuously upgrade the performance and reliability of the EMS system. Clinical and response-time performance must be extremely reliable, with equipment failure and human error held to an absolute minimum through constant attention to performance, protocol, procedure, performance auditing, and prompt and definitive corrective action. This procurement process requires the highest levels of performance and reliability and mere demonstration of effort, even diligent and well-intentioned effort, shall not substitute for performance results. The Contractor that fails to perform shall be promptly replaced to protect the public health and safety.
4.2 Coordination within the Exclusive Operating Area
The local fire agencies currently provide first responder EMS services in the EOA for emergency 9-1-1 requests for service. The County considers the fire agencies an essential partner in the provision of EMS within the EOA. All bidders shall clearly state their plans as to how they will work with existing public service agencies. This portion of the proposal shall be scored within the “Integration with Existing EMS Stakeholders” section of the Evaluator Scoring Tool (Attachment 7).
4.3 EMS Run Data
See for summary EMS data. Computer-Aided Dispatch (CAD) data is available for 2016-2018 upon request. There has been no independent validation of this data. Bidders are encouraged to use their own means to analyze the information to determine response and transport volumes. The County does not guarantee any number of responses or transports.
4.4 Level of Care
The exclusive Contract holder will provide ALS & BLS level of care for all requests for ground emergency ambulance service, ALS urgent and scheduled ground emergency ambulance service, as well as special event ALS stand-by originating within the EOA. Interfacility transports at the BLS, CCT or Mental Health level are specifically not included in the scope of this RFP. Air ambulance transports are excluded as well. Specialty care transports, such as neonatal and high-risk obstetrics, require a specialized team from out of the EOA and, as such, are outside the services to be provided.
Currently, CCT services are provided within the EOA Agreement. The low demand caused a significant impact on the EOA system overall. Moving forward, healthcare facilities will be responsible for contracting for CCT services (as well as non-emergency interfacility transports). This could involve partnerships with hospital nurses, air ambulance crews, etc. A Bidder may describe its approach to support CCT services, but CCT is not a required element of this RFP process.
4.5 Response Time Zones and Standards
It is the Bidder's sole responsibility to be familiar with the geographic considerations and response-time zones comprising this solicitation. Response times shall be calculated from the moment the Contractor receives the PSAP transfer of the calling party’s call, until the time the Contractor arrives on the scene with a fully functional and appropriately staffed/equipped ALS unit. All response times are measured in seconds, not whole minutes. All emergency ambulance dispatch services and times will be documented by the provider under strict procedures set by the County.
The County is interested in providing prompt, effective emergency ambulance services at a reasonable cost to the consumer. Any enhanced services above the standard of this RFP, while not encouraged, must include a separate cost estimate. However, clinical performance will not be sacrificed for economy.
Service to the EOA must be at or above the level of service as defined in this RFP. Service must include primary response, backup, and move-up-and-cover plans that clearly define timely emergency ambulance coverage. Monitoring of this requirement will include CAD data supplied by the provider and oversight will be provided by the County and the LEMSA with technical expertise from fire, dispatch, hospitals, and other EMS stakeholders.
To become familiar with the unique requirements of the County, bidders are urged to contact the various public safety and fire departments/districts in the County.
B. Response-Time Zones
Response time requirements vary depending upon the emergency response zone (ERZ) to which the ambulance provider must respond. Each ERZ is defined by ambulance call density. The two zones that comprise the EOA are distinguished by response times and each zone is applied to multiple areas of the County, which may not be contiguous. The zones are designated as high call density (A) and low call density (B).
The low call density zone includes any call beyond the one (1) mile buffer zone of a high call density zone. The black outlines surrounding the high call density zones indicate the one (1) mile buffer zone, i.e., the beginning of the low call density zone. When the boundary of the high call density zone corresponds with a roadway, locations immediately adjacent to the roadway on both sides are considered included in the high call density zone. For a map of the ERZs, please see .
Calls for patient locations that are greater than ten (10) road miles from the nearest boundary of the high call density zones are considered remote. Late responses to these remote calls may be excluded by requesting an exemption.
These maps are based on ambulance industry standards for defining such zones and may be changed by the LEMSA from time to time as population, call density, road access, effective Agreement monitoring, and other relevant conditions change. No response-time amendments will be made without giving notice to, and opportunity for, consultation with the Contractor, fire departments/districts, cities, and other interested parties and organizations in the affected area of the exclusive zone. The County will establish a procedure for making such changes that provides for such notice, comment, and input to be achieved.
In addition to the ERZ evaluation, the County will periodically review population densities, call distribution, single communities, and response times in areas within the compliance zones and may request the Contractor alter its system status plan (SSP) to respond to needs of improved performance and adaptation to population trends. This alteration may also include adjusting the SSP to improve backup and move-up-and-cover ambulance coverage. Contractor shall agree to negotiate in good faith with the County and revise the SSP as needed to improve performance to these communities, as determined by the County, in consultation with the Contract Administrator. Contractor shall also negotiate in good faith on the issue of any impact on Agreement terms these changes may have and include these in the negotiation process. Failure to negotiate in good faith regarding these potentially underserved areas may constitute an Agreement default.
C. Priority 1 and 2 Calls (Emergency)
Contractor must provide 24-hour, 365 days per year coverage for all Priority 1 and 2 requests for service for the term of the Contract, as defined by approved medical dispatch protocols. Priority 1 and 2, for purposes of this RFP, is defined as all requests receiving a response with lights and siren for presumed life-threatening or non-life-threatening emergency conditions. The Contractor must guarantee response times, as specified below:
High Call Density (A): 90 percent of all calls in 10:59 minutes or less. Calls exceeding 17:59 minutes will be subject to liquidated damages.
Low Call Density (B): 90 percent of all calls in 19:59 minutes or less. Calls exceeding 29:59 minutes will be subject to penalties.
Bidders should familiarize themselves with population densities, transportation corridors, and other factors to provide effective and prompt emergency ambulance service.
D. Priority 3 Calls (Non-Emergency)
Contractor must provide 24-hour, 365 days per year coverage for all Priority 3 requests, as defined by medical dispatch protocols. Priority 3, for purposes of this RFP, is defined as any call that does not require lights and siren but must have a response due to a presumption of an urgent, but non-life-threatening, medical condition. The response may be at the BLS or ALS level, depending on MPDS call type and LEMSA Medical Director policy. While there is no response time standard for Priority 3 calls, it is expected that the Contractor will respond promptly to these requests to 1) minimize first responder at scene time and 2) meet patient’s expectation for prompt service.
LEMSA policy allows Priority 3 calls to be held (i.e., “pended”) when there are three (3) or fewer available ambulances in the system during the day (0600-2200) and two (2) or fewer at night (2200-0600). Dispatch will contact the patient every 15 minutes to ensure no change in condition until an ambulance arrives at the scene. If first responders are on-scene and identify a life-threatening emergency, they will notify dispatch to upgrade the call to Priority 1 or 2.
E. Priority 4 Calls (Interfacility)
Contractor shall respond to hospital and healthcare facility requests for ALS interfacility transfer in the following manner and using the following definitions. This Agreement includes ambulance interfacility transports for ALS level of care only. Any removal of 9-1-1 resources to perform transports outside of this Agreement are at the risk of the associated response time compliance impact. Separate from this Contract, provider may perform interfacility transports originating within the County.
1) Emergency Transfer – Immediate ALS ambulance transport is requested to a higher level of care when any delay could result in placing the patient’s health in immediate jeopardy. The transport provider retains a response-time requirement for these transfers just as they would for any Priority 1 or 2 (i.e., life-threatening emergency) 9-1-1 request to the facility’s location. As these transfers may immediately remove an ambulance unit from the 9-1-1 system, facilities are expected to only request an emergency transfer when the patient’s condition warrants such a response. It is understood that the requesting agency shall only request the emergency transfer such that the patient is prepared for transfer with all available transfer papers upon the arrival of the transfer unit.
2) Urgent Transfer at the ALS Level – This should be requested when the patient’s medical condition requires ALS transport to a facility providing a higher level of care and is not considered to be in immediate jeopardy.
3) Pre-arranged Transfer at the ALS Level – shall be a pre-arranged ALS transfer for a medically stable patient. The timeliness of this type of transfer would have no foreseeable bearing on the patient’s medical condition.
Response Time Requirements Summary
Priority 1 and 2
High Call Density
90% < 10:59
Low Call Density
90% < 19:59
4.6 Dispatch Services
Contractor shall provide an emergency medical dispatch center. The dispatch center shall operate and equipped as a state-of-the-art EMS dispatch center and as a Secondary PSAP for medical emergencies. The Secondary PSAP shall meet all requirements of a Secondary PSAP set by the State of including having in place the equipment and interface needs with Primary PSAPs. It is the desire of the County that the dispatch center be physically located in . At a minimum, the Secondary PSAP shall be physically located within a 150-mile radius of the City of Merced, to provide for on-site inspection and reasonable access for the LEMSA staff. All Emergency Medical Dispatch (EMD) staff shall be authorized to dispatch medical calls (per LEMSA policy #201.00), certified in the Clawson Medical Priority Dispatch System, and receive extensive training specific to local conditions, geography and key 9-1-1/PSAP, first responder personnel in Merced County. Contractor shall cooperate, train with, participate in quality-control procedures and communicate with each of the County’s 9-1-1/PSAPs to assure a smooth delivery of dispatch services.
Should the dispatch center not be in Merced County, the bidder shall justify the location from the standpoint of cost savings, depth of dispatch staffing and expertise, disaster surge capacity or other relevant justification to the satisfaction of the County. In addition, bidders shall warrant and provide specific plans in their proposals that assure the key features of an in-county dispatch center such as:
• Prompt access to CAD data (within eight hours of request during weekdays);
• familiarity of staff to local conditions;
• familiarity with public safety dispatching procedures;
• access of dispatch staff to local training;
• access of dispatch staff to local quality improvement activities;
• access of dispatch staff to local meetings with local public safety personnel; and,
• access by County staff to dispatch observation sessions and unannounced inspections.
The Contractor shall provide sufficient EMS dispatcher staff (minimum of two per shift) at the EMS dispatch center to allow prompt answering all telephone requests for ambulance service (within five telephone rings) with no telephone request for immediate ambulance response shall be placed on hold except for rare times of extreme system overload. This includes ring down lines with hospitals and other dispatch centers.
The following minimum standards form the objective performance data for EMS Dispatch operations:
a. For each month, a minimum of 98 percent of calls for service through the 9-1-1 system shall be answered in five rings or less.
b. 90 percent of medical calls shall be completed (i.e., call answered to unit dispatched) within 90 seconds, and 99 percent shall be completed within 120 seconds (i.e., NFPA 1221 standards)
b. For each month, no more than one-tenth of one percent of 9-1-1 calls which require the dispatch of an ambulance, in accordance with approved dispatch protocols, may be placed on hold at any time prior to an ambulance being dispatched.
c. First-response agencies shall be notified regarding emergency responses within 60 seconds of call receipt, 98 percent of the time from call receipt/phone pick up, as directed by the County. The only exception to this standard will be for those jurisdictions in which the Primary PSAP initiates the first response to the call.
d. Other specifications as required in the sample Agreement (see Attachment 6).
The dispatch computer utilized by Contractor shall include security features preventing unauthorized access or retrospective adjustment and full audit trail documentation. LEMSA will be provided access to all data maintained by the CAD system as necessary to analyze demand and determine deployment procedures. The Contractor agrees to allow LEMSA, at Contractor’s expense, to install an interface with the CAD to collect and monitor CAD information and patient care reports and provide access to the LEMSA to voice recording systems. This CAD and patient care report access shall include the pending data repository being developed by the County.
The interface made available to the LEMSA shall provide real-time monitoring of the Contractor’s CAD screens and at a minimum provide the location and status of active ambulance calls, pending calls, location and status of ambulances and crews.
4.7 Performance Standards – Response Times
Performance standards may be adjusted by the County through the course of the Agreement consistent with the modifications in operational and medical standards which are developed by the County. The Contractor shall be notified with 60 days’ advance notice of the effective date of the change and shall define the Agreement impact within 30 days of initiation.
A. Liquidated Damages: Priority 1 and 2 Calls
Contractor shall not refer exclusive Agreement calls to another agency unless it is part of an approved mutual aid plan submitted by the Contractor and approved by the LEMSA with its proposal or subsequently offered and approved. Appropriate referral to air medical services is exempted from such requirement. Use of mutual aid from any source during disaster responses is also exempted from this requirement.
Each quarter in which the Contractor fails to meet the 90.00 percent standard, within any compliance zone the Contractor shall pay to the County $500 in liquidated damages for each one-tenth (1/10) of a percentage point by which the Contractor’s performance falls short of the 90.00 percent standard. Each period in which the Contractor fails to meet the applicable response-time requirements, the County will review the Contractor’s SSP, unit-hour of production capacities, and/or other factors to determine the causes of non-compliance. The Contractor shall develop a corrective action plan for remediating the below standard performance.
All areas have a maximum specified response time (i.e., outlier). For every call where the ambulance fails to arrive within the maximum specified time, the liquidated damages will be $500 per occurrence.
Exclusive Agreement calls referred to another agency (i.e., not an approved Subcontractor) will be considered an outlier for calculating compliance. Three consecutive failures to meet the standards (i.e., not achieving 90.00 percent) in one zone or five failures across all zones during any 12-month period may result in breach of Contract.
B. Upgrades, Downgrades, Canceled, and Incorrect Addresses
From time to time, special circumstances may cause changes in call-priority classification. Response-time calculations for determination of compliance will be as follows:
If an assignment is upgraded prior to arrival of a unit at the scene (e.g., from Priority 3 to Priority 1 or 2 response), the Contractor's response time compliance and liquidated damages will be calculated based upon the Priority 1 and 2 response time standard from the time the call was upgraded by any person authorized by LEMSA policy.
Example: While enroute to a Priority 3 call in a high call density zone, new information is received, and the call is upgraded to Priority 1 at 13:30:00. Contractor will have until 13:40:59 to arrive on scene (i.e., when the ambulance stops moving and is placed in park).
If, prior to a unit’s arrival at scene, a call is downgraded; 1) by the 9-1-1/PSAP or 2) by any other person authorized by policy, compliance and liquidated damages will be determined as follows:
(a) If the time of downgrade occurs after the unit has exceeded the response time standard or maximum response time for the zone involved, the response time standard or maximum will apply; or,
(b) If the time of downgrade occurs before the unit has exceeded the response time standard or maximum response time for the zone involved, the call will be treated as Priority 3.
Example: While enroute to a Priority 1 call in a high call density zone, first responders on scene reduce the ambulance to no lights and siren (i.e., Priority 3 call); if the response time has not exceeded 10:59 at time of downgrade, there would be no liquidated damages.
3) Canceled Responses
If a call is canceled prior to the unit arrival at the scene, the Contractor's compliance and liquidated damages will be calculated based on the elapsed time from receipt of call to the time the call was canceled. However, if Contractor makes a request for mutual aid response as stipulated in this RFP, the Contractor may not cancel the mutual aid responder if the responding provider is closer to the call.
4) Incorrect Addresses
When the address (or approximate location for calls on a roadway) provided is incorrect through no fault of the Contractor, the response start time for compliance measurement will be the time when the correct address is given to the responding resources.
C. Interfacility Transports
When there is an emergent need for an ALS ambulance to transfer a patient to a higher level of care, it will be treated as a Priority 1 or 2 call and treated like any 9-1-1 request for service.
D. Exemption Requests
The County, in its sole discretion, may grant exemptions to response-time performance requirements stated herein for declared multi-casualty incidents, disaster events, or other situations. Such calls will be excluded when calculating performance compliance. In order to be eligible for such exemption, the Contractor shall notify the County within a reasonable amount of time of the occurrence.
The Contractor may apply to the County for an exemption to response-time compliance calculations in the following situations:
1. Automatic Appeals
(a) Upgrades and downgrades that are compliant are eligible for exemption.
(b) Response canceled prior to the unit’s arrival at scene (must provide evidence that call was canceled within required response time).
(c) Primary PSAP error or inaccurate address by reporting party.
(d) Additional units responding to the same incident (first unit must meet response time standard).
(d) Multi-Casualty Incident (MCI) or locally declared disaster - The Contractor may apply for an exemption to response-time standards during MCIs or times of declared emergencies, locally or in a neighboring county, as defined by the emergency operations procedures of the jurisdictions involved (e.g., city or County).
2. Case-by-Case Appeals
(a) Traffic related to incident (e.g., car crash). At scene determined when unit reaches related traffic.
(b) Lack of documented on-scene time; Contractor may submit global positioning system (GPS) data to confirm on-scene time – otherwise next radio transmission is used.
(c) Weather (e.g., heavy fog, ice, heavy rain) that impairs visibility, require slower speeds, or create other unsafe driving conditions.
(d) Road closures/construction for areas with limited access.
(e) Traffic related to incident requiring response.
(f) Unusual system overload is defined as 200 percent of the countywide average demand for the day of the week and hour of day. The average demand for each day and hour is to be calculated on an annual basis using the prior calendar year’s actual run volume.
(g) Calls for patient locations greater than ten (10) road miles from the nearest high call density zone boundary. Road miles will be determined using Google Earth.
E. Other Response Time Issues
Where response-time areas are divided along the center line of a road, the shorter response time shall apply to both sides of the road.
The Contractor will not be held responsible for response-time performance on an emergency response to a location outside the EOA. However, Contractor shall use its best efforts in responding to mutual aid calls. Responses to emergencies located outside the EOA will not be counted in the number of total calls used to determine monthly Agreement compliance.
For each response in which the Contractor’s management or field staff fails to report the at-scene time, the next radio or electronic transmission will determine on-scene time.
Table 2 summarizes categories and liquidated damages listed in this RFP.
Summary of Liquidated Damages
1. Compliance evaluation below standard
$500/tenth of percentage point
2. Extended response time (i.e., outlier)
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Opportunity History Original Synopsis Oct 29, 2019 9:42 am Solicitation Number : H92240-20-R-0002
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