REPORT/RECOMMENDATION TO THE BOARD OF DIRECTORS
OF INLAND COUNTIES EMERGENCY MEDICAL AGENCY
AND RECORD OF ACTION
March 10, 2026
FROM
DANIEL MUÑOZ, EMS Administrator, Inland Counties Emergency Medical Agency
SUBJECT
Title
Amendment to Revenue Contract for Trauma Center Designation
End
RECOMMENDATION(S)
Recommendation
Acting as the governing body of the Inland Counties Emergency Medical Agency, approve Amendment No. 1 to Revenue Contract No. 24-358 with St. Mary Medical Center for changing the hospital’s designation from a Level IV Trauma Center to a provisional Level III Trauma Center, including requirements related to completion of the American College of Surgeons Level III Trauma Center verification process, without any change to the contract term of May 5, 2024 through June 30, 2027, with one three-year extension option.
(Presenter: Daniel Muñoz, EMS Administrator, 388-5807)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally-Responsible and Business-Like Manner.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost). Revenue Contract No. 24-358 (Contract) will continue to operate as a revenue agreement. St. Mary Medical Center will continue to remit Trauma Designation Fees in accordance with the Contract terms and the Inland Counties Emergency Medical Agency’s (ICEMA) Board of Director’s (Board) approved Specialty Care System Program rate structure. Applicable revenue and appropriation have been included in the ICEMA 2025-26 budget and will be included in future recommended budgets. Approval of this item will not impact the expected revenue from the Contract.
BACKGROUND INFORMATION
ICEMA, as the Local Emergency Medical Services Agency (LEMSA), is responsible for planning, implementing, and evaluating the Emergency Medical Services (EMS) system for the Counties of San Bernardino, Inyo, and Mono. This regulatory responsibility includes administration and oversight of the regional Trauma Care System pursuant to the California Health and Safety Code and California Code of Regulations, Title 22.
On May 7, 2024 (Item No. 60), the Board approved the Contract with St. Mary Medical Center (Hospital) for designation as a Level IV Trauma Center for the period of May 5, 2024 through June 30, 2027, with one three-year extension option.
Since approval of the Contract, the Hospital has continued to develop its trauma program and has demonstrated the operational capability to function at a higher trauma level designation. Based on ICEMA’s evaluation, the Hospital meets ICEMA requirements for designation as a provisional Level III Trauma Center. A Level III Trauma Center designation provides a higher level of trauma care than Level IV, including the availability of emergency surgery and expanded specialty support to manage more serious injuries. In contrast, a Level IV Trauma Center focuses on initial evaluation, stabilization, and transfer of trauma patients who require more advanced care.
A provisional Level III Trauma Center designation will allow the Hospital to operate as a Level III Trauma Center while completing external verification by the American College of Surgeons (ACS). The ACS verification process is conducted independently by the ACS and evaluates trauma program structure, staffing, policies, performance improvement processes, and clinical outcomes.
In addition to the ACS verification process, ICEMA conducts its own ongoing verification and oversight activities. ICEMA’s internal verification includes review and monitoring performed by ICEMA staff, including a licensed registered nurse in coordination with the ICEMA Medical Director. These activities include evaluation of trauma operations, compliance with ICEMA policies and Title 22 requirements, quality improvement participation, and data reporting.
Amendment No. 1 to the Contract will reflect the Hospital’s provisional Level III Trauma Center designation, establish requirements related to completion of the ACS verification process within a defined timeframe, and preserve ICEMA’s oversight responsibilities to take corrective action if requirements are not met.
Approval of this item supports continued enhancement of trauma services in the High Desert region while maintaining regulatory oversight, system accountability, and patient safety.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (John Tubbs II, Deputy County Counsel, 387-5455) on February 10, 2026; and County Finance and Administration (Carl Lofton, Administrative Analyst, 387-5404) on February 25, 2026.