REPORT/RECOMMENDATION TO THE BOARD OF DIRECTORS
OF INLAND COUNTIES EMERGENCY MEDICAL AGENCY
AND RECORD OF ACTION
REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF THE SAN BERNARDINO COUNTY
AND RECORD OF ACTION
May 7, 2024
FROM
DANIEL MUÑOZ, Interim EMS Administrator, Inland Counties Emergency Medical Agency
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Hospital Trauma Center Designation Agreements
End
RECOMMENDATION(S)
Recommendation
1. Acting as the governing body of San Bernardino County, approve Amendment No. 3 to Memorandum of Understanding No. 18-404 with Inland Counties Emergency Medical Agency for Level I Trauma Center designation for Arrowhead Regional Medical Center, for a current annual fee in the amount of $25,000, and extending the term by three years, for a new contract period of July 1, 2018 through June 30, 2027, with one three-year extension remaining.
2. Acting as the governing body of Inland Counties Emergency Medical Agency:
a. Approve Amendment No. 3 to revenue Memorandum of Understanding No. 18-404 with Arrowhead Regional Medical Center for Level I Trauma Center designation, for current annual fee revenue in the amount of $25,000, and extending the term by three years, for a new contract period of July 1, 2018 through June 30, 2027, with one three-year extension remaining.
b. Approve Amendment No. 2 to revenue Contract No. 18-393 with Loma Linda University Medical Center for Level I Trauma Center designation, for current annual fee revenue in the amount of $25,000, and extending the term for an additional three years, for a new contract period of July 1, 2018 through June 30, 2027, with one three-year extension remaining.
c. Approve Amendment No. 2 to revenue Contract No. 18-394 with Loma Linda University Children’s Hospital for Level I Pediatric Trauma Center designation, for current annual fee revenue in the amount of $25,000, and extending the term for an additional three years, for a new contract period of July 1, 2018 through June 30, 2027, with one three-year extension remaining.
d. Approve Amendment No. 1 to revenue Contract No. 22-1171 with Hi-Desert Medical Center for Level IV Trauma Center designation, for current annual fee revenue in the amount of $25,000, and extending the term for an additional three years, for a new contract period of November 15, 2022 through June 30, 2027, with one three-year extension remaining.
e. Approve revenue Contract with St. Mary Medical Center for Level IV Trauma Center designation, for current annual fee revenue in the amount of $25,000, with any partial year prorated, for a contract period of May 7, 2024 through June 30, 2027, with one three-year extension.
(Presenter: Daniel Muñoz, Interim EMS Administrator, 388-5807)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies and Stakeholders.
FINANCIAL IMPACT
Approval of this item will not impact Discretionary General Funding (Net County Cost). Arrowhead Regional Medical Center (ARMC) annual costs in the amount of $25,000 are funded by Medi-Cal, Medicare, private insurances, and other departmental revenue. Sufficient appropriation and revenue have been included in the Inland Counties Emergency Medical Agency (ICEMA) and ARMC 2023-24 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
ICEMA, as the Local Emergency Medical Services Agency (LEMSA), is responsible for ensuring effective Emergency Medical Services (EMS) for the Counties of San Bernardino, Inyo, and Mono. ICEMA administers State and local codes and regulations governing the provision of emergency medical care to the sick and injured at the scene of an emergency and during transport to a care hospital. ICEMA ensures an effective system of quality patient care and coordinated emergency medical response by planning, implementing, and evaluating an effective emergency medical services system including pre-hospital providers, specialty care hospitals, and hospitals.
California Health and Safety Code, Section 1798.165, provides the authority for a LEMSA to designate trauma facilities as part of the trauma care system pursuant to State Regulations. Additionally, the California Code of Regulations, Division 9, Chapter 7, Section 100255 requires LEMSAs and designated trauma centers to enter into written agreements. ICEMA is the LEMSA responsible for implementing the ICEMA Trauma Care System Plan, which was approved by the ICEMA Board of Directors (Board) on December 18, 2001 (Item No. 108). The Trauma Care System Plan provides for a formal basis of implementing, evaluating, and improving the trauma system in the ICEMA region.
There are four levels of trauma designation, with Level IV designation criteria focusing primarily on rapid assessment, resuscitation, stabilization, and treatment of patients and to expedite transfer to facilities that have more appropriate treatment capabilities. In contrast, a Level I designation would meet required patient volume minimums, meet robust specialty staffing and equipment requirements, and have implemented a trauma research program. Current ICEMA trauma designations for ARMC, Loma Linda University Medical Center (LLUMC), Loma Linda University Children’s Hospital (LLUCH), and Hi-Desert Medical Center (HDMC) are summarized below:
|
Hospital |
Board Date |
Item No. |
Designation |
Prior Term |
|
ARMC |
June 26, 2018 |
86 |
Level II |
July 1, 2018 - June 30, 2021 |
|
ARMC |
June 8, 2021 |
106 |
Level II |
July 1, 2021 - June 30, 2024 |
|
ARMC * |
July 12, 2022 |
53 |
Level I |
July 12, 2022 - June 30, 2024 |
|
LLUMC |
June 26, 2018 |
73 |
Level I |
July 1, 2018 - June 30, 2021 |
|
LLUMC * |
May 18, 2021 |
89 |
Level I |
July 1, 2021 - June 30, 2024 |
|
LLUCH |
June 26, 2018 |
73 |
Level I |
July 1, 2018 - June 30, 2021 |
|
LLUCH * |
May 18, 2021 |
89 |
Level I |
July 1, 2021 - June 30, 2024 |
|
HDMC * |
November 15, 2022 |
97 |
Level IV |
November 15, 2022 - June 30, 2024 |
* most recent Board action
On June 26, 2018 (Item No. 86), the San Bernardino County Board of Supervisors and ICEMA Board of Directors (Boards) approved Memorandum of Understanding (MOU) No. 18-404 between ARMC and ICEMA to designate ARMC as a Level II Trauma Center and to provide trauma services in the ICEMA region, for the period July 1, 2018 through June 30, 2021, with one, three-year extension option.
On June 8, 2021 (Item No. 106), the Boards approved Amendment No. 1 to MOU No. 18-404 to continue the MOU between ARMC and ICEMA to designate ARMC as a Level II Trauma Center and to provide trauma services within the ICEMA region. Amendment No. 1 extended the MOU for the period of July 1, 2021 through June 30, 2024, with one, three-year extension option.
On July 12, 2022 (Item No. 53), the Boards approved Amendment No. 2 to MOU No. 18-404 to continue the MOU between ARMC and ICEMA and to change ARMC’s designation from a Level II Trauma Center to a Level I Trauma Center, without any additional changes.
On June 26, 2018 (Item No. 73), the Board approved revenue Contract No. 18-393 with LLUMC and revenue Contract No. 18-394 with LLUCH to designate each hospital as a Level I Trauma Center and to provide trauma services in the ICEMA region, for the period July 1, 2018 through June 30, 2021, with one, three-year extension option.
On May 18, 2021 (Item No.89) the Board approved Amendment No. 1 to revenue Contract 18-393 with LLUMC and Amendment No. 1 to revenue Contract 18-394 with LLUCH to designate each hospital as a Level I Trauma Center and to provide trauma services in the ICEMA region. Each Amendment extended the respective Contracts’ period from July 1, 2021 through June 30, 2024, with one, three-year extension option.
On November 15, 2022 (Item No. 97) the Board approved revenue Contract No. 22-1171 with HDMC to designate HDMC as a Level IV Trauma Center and to provide trauma services within the ICEMA region, for the period November 15, 2022 through June 30, 2024, with one, three-year extension option.
St. Mary Medical Center (SMMC) has been examined by ICEMA and found to possess the performance characteristics, personnel and equipment required in the ICEMA Trauma Standards and California Trauma Regulations. SMMC Level IV Trauma Center will support the trauma system by providing initial stabilizing trauma care to patients that live in the high desert area.
SMMC is a licensed general acute care hospital that provides basic emergency services to the high desert community and has now established standards of care to be designated as a Level IV Trauma Receiving Center. The hospital has met the current American College of Surgeons standards for Level IV designation and is in compliance with all the requirements listed in the California Code of Regulations Title 22, Division 9, Chapter 7 - Trauma Critical Care System Regulations. SMMC has met the staffing requirements and is staffed with a Trauma Medical Director, Emergency Department Trauma Representative, and Trauma Program Manager. They have implemented a process for the treatment and triage of trauma patients, 24 hours per day, seven days per week, 365 days a year.
SMMC has obtained written transfer agreements with ICEMA Level I Trauma Receiving Centers, for the immediate transfer of those patients who require additional resources. The hospital has implemented a Continuous Quality Improvement Program, which includes providing outcome data on all trauma patients, and participation in the Trauma Advisory Committee.
The recommendation for designation was determined by ICEMA verification through an application process. The process included multiple site visits, an official survey, review of staff resumes, and verification of trauma education and certification provided to the staff. Approval of this item will designate SMMC as a Level IV Trauma Center for the period of May 7, 2024 through June 30, 2027, increasing the emergency medical services capacity and resiliency in San Bernardino County.
Additionally, approval of this item will allow ICEMA to continue to provide trauma designations, as appropriate, to each of the corresponding hospitals and for each hospital to provide trauma services in the ICEMA region. The specified levels of trauma services strengthen the overall trauma system in the ICEMA region by directing trauma patients to the closest hospital, with corresponding capabilities, to receive the appropriate level of treatment. Each of the listed hospitals meet the standards developed by ICEMA for designation as a Trauma Center.
PROCUREMENT
N/A
REVIEW BY OTHERS
This item has been reviewed by County Counsel (John Tubbs II, Deputy County Counsel, 387-5455) on April 9, 2024; County Counsel (Charles Phan, Deputy County Counsel, 387-5455) on April 9, 2024; Risk Management (Victor Tordesillas, Deputy Executive Officer, 386-8623) on April 9, 2024; Finance (Carl Lofton, Administrative Analyst, 387-5404) on April 19, 2024; and County Finance an Administration (Robert Saldana, Deputy Executive Officer, 387-5423) on April 22, 2024.