Emergency Medical Services

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All-Hazard Health Services Capacity Management Plan - LEVEL 3 Partial Activation

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System Stress Tool Tool Status Effective
4:1 Patient to EMS Professional ratio at EDs  ACTIVE  -- -- LEMSA-allowed procedure and available when necessary
9-1-1 Response Mode Alteration AVAILABLE 5/27/2022 -- P-801 waiver authorizations allow agencies without approved alternate dispatch plans to send one paramedic to calls for service when necessary. Agency reporting to the LEMSA REQUIRED.
Abbreviated Radio Report Option ACTIVE 12/28/2020 Until further notice  
Ambulance Strike Team AVAILABLE -- -- Agencies/Hospitals may request ASTs (or other resources) through the MHOAC at their expense
Assess and Refer Option ACTIVE 1/5/2023 2/28/2023 The use of the Assess and Refer policy REQUIRES agency reporting to the LEMSA 
DoD Beneficiary Destination Directive ACTIVE 9/1/2022 Until further notice  
EMS Transfer to ED Waiting Area Option ACTIVE 12/19/2022 Until further notice  
EMS Treatment Considerations ACTIVE 3/11/2020 Until further notice  
EMT Transport Option Following On Scene Paramedic Treatment ACTIVE 12/19/2022 Until further notice Agency reporting to the LEMSA REQUIRED.
Health Services Capacity Task Force Plan Level Staffing Augmentation ACTIVE Per MOA/ contract -- County-contracted Ambulance Operational Areas with Health Services Capacity Task Force Plan Level staffing augmentation should contact their County Contracting Officer’s Representative (COR)
Non-Patient Passenger Restrictions ACTIVE 3/12/2020 Until further notice  
Patient Masking Recommendation ACTIVE 4/3/2020 Until further notice To reduce the risk of viral spread, and in compliance with current CDPH regulations, EMS providers are reminded that masks must be worn in all healthcare settings
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Online Public Comment Submission


Community engagement and communications are important to the EMS Office. Stakeholder input is a critical element in the policy and protocol development process.

The new online public and stakeholder comment process is active! Please comment on policy drafts on this webpage.


EMS Office Strategic Plan Complete

CoSD EMS Strategic Plan Cover Image

The County of San Diego's EMS Strategic Plan 2023-2027 is complete. This new document brings a new focus to the strategic vision of County EMS and San Diego County EMS as a whole.

The plan development process included:

  • a community-led steering committee, 
  • key stakeholder interviews, 
  • community surveys, and 
  • other opportunities for feedback.

The EMS Office received more than 1,000 individual comments, suggestions, and recommendations.

We are pleased the community’s voices were heard and included in support of the Strategic Plan’s creation.

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EMS Cardiac Monitor Data Retention Community Consensus Guidance

A community workgroup was formed as part of the San Diego County EMS Office quality assurance/quality improvement (QA/QI) program. The workgroup has developed a consensus guidance document to provide communitywide standards in EMS cardiac monitor data management.

This guidance is intended to enhance the QA/QI process by ensuring standardization in EMS cardiac monitor data integration and retention. The EMS Medical Director has released a memo with more information.


Treatment on the EMS Gurney Community Consensus Guidance

A community workgroup has developed a consensus guidance document to provide focused, patient-centered guidance for hospital treatments that may be performed prior to patient Transfer of Care.

This guidance is intended bring clarity to interventions that are reasonable to perform during this time interval in order to facilitate a smoother patient handover process. The EMS Medical Director has released a memo with more information.

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Recommendation for COVID and Flu Vaccinations

With concern for the surge in COVID cases this fall, it is important for all of us to be up to date on our vaccinations. The harsh influenza season in the Southern Hemisphere suggests we may experience a severe flu season concurrent with this potential surge in COVID cases.

The EMS Medical Director strongly recommends COVID and flu vaccinations and has released a memo with more information.


2022 - 2023 Protocol Updates

2022-2023 protocol update graphic for web

2022 - 2023 protocol packet available now.

All changes take effect July 1, 2022.

Please see the protocol change log for updates.

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Xylazine Alert for EMS

Xylazine as a white crystalline solid

Please see the Xylazine Alert for EMS Professionals from the EMS Medical Director.  

Additional information may be found at this National Institute of Drug Abuse page and this Drug Enforcement Administration info sheet.

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Transfer of Care Data Collection Update

County EMS is pleased to announce implementation of modifications to the data collection system for Transfer of Care (TOC), effective July 1, 2022.

EMS transport units will no longer be required to manually record an electronic timestamped TOC within the FirstWatch application (the “TOC button”).

Instead, the ePCR receiving hospital signature timestamp will be imported into the County EMS TOC dataset. This improvement will result in a highly accurate, robust, and reliable data stream.

Please see this memo for more information.

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Medication and Equipment Shortage Information

The San Diego County EMS Office is aware that normal saline, epinephrine 1:10,000 1 mg/10 mL (0.1 mg/mL) pre-filled syringes, injectable glucagon, and injectable dextrose 50% vials are in limited supply and may be difficult to obtain.

Please see the EMS Medical Director's communications regarding these shortages:

Thoracostomy needle-related guidance  
October 6, 2022  
Activated charcoal-related guidance  
September 29, 2022  
Critical EMS pharmaceutical guidance  
August 9, 2022
Glucagon-related guidance  
August 9, 2022  
Normal saline-related guidance  
April 20, 2022  
Epinephrine-related guidance  
April 7, 2022
Use of expired medications
April 7, 2022
New option for push-dose epinephrine preparation
March 29, 2022 Mitigation strategies  
February 28, 2022   Cardiac and push-dose epinephrine guidance   
Dextrose-related guidance  
February 28, 2022    


Notify County EMS via EMSNotifications@sdcounty.ca.gov when medication or supply shortages resolve.


COVID-19 Information for EMS Professionals

COVID-19 Information for EMS



More information from County EMS, including links to policy updates and guidance for EMS professionals, are posted on the COVID-19 Information page.

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Behavioral Health Program for First Responders

Ryna Mitchell First Responder Behavioral Health Support Program logo

The Fire Captain Ryan Mitchell behavioral health support program is a free, confidential 24/7 peer-supported referral hotline.

This program aims to increase awareness about local mental health resources and decrease the stigma and barriers associated with First Responders seeking behavioral health support services.

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The County of San Diego EMS, with the cooperation of local EMS partners, has implemented a new electronic, cloud-based data program, called the CoSD Local EMS Information System (CoSD LEMSIS):

  • All prehospital personnel credentialing is now online through the LEMSIS Licensing Portal
  • For more information on the whole system, click HERE
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EMS Reference Materials

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County EMS Grantville offices have officially moved! 

All County EMS Staff are working remotely. There are NO in-person services available. Please call 619-285-6429 or email us with any questions.


Here is our new mailing address:

San Diego County EMS Office (MS O-302)
5560 Overland Avenue, Suite 400
San Diego, CA 92123