Emergency Medical Services

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All-Hazard Health Services Capacity Management Plan - LEVEL 2 Escalated Activation

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System Stress Tool Tool Status Effective Date End Date  Notes
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)
9-1-1 Response Mode Alteration AVAILABLE May 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.
Assess and Refer Option INACTIVE May 27, 2022 September 1, 2022 The use of the Assess and Refer policy REQUIRES agency reporting to the LEMSA 
4:1 Paramedic to Patient ratio at EDs  ACTIVE  -- -- LEMSA-allowed procedure and available when necessary
EMS Transfer to Waiting Area Option ACTIVE December 30, 2020 Until further notice  
Patient Masking Recommendation ACTIVE April 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
DoD Beneficiary Destination Directive ACTIVE September 1, 2022 Until further notice  
EMS Treatment Considerations ACTIVE March 11, 2020 Until further notice  
Abbreviated Radio Report Option ACTIVE

December 28, 2020

Until further notice  
Non-Patient Passenger Restrictions ACTIVE March 12, 2020 Until further notice  
Ambulance Strike Team AVAILABLE -- -- Agencies/Hospitals may request ASTs (or other resources) through the MHOAC at their expense

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.

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2023 - 2024 EMS Treatment Protocol Revision


Request for EMS Community Input

The San Diego County EMS Office invites your input on potential revisions to the EMS treatment protocols for the 2023-2024 cycle.

All treatment protocols (S-101 through S-190) are available for comment. To be considered for this protocol revision cycle, we must receive your comments no later than October 7, 2022.

Please provide your thoughts and suggestions via this weblink or QR code.


Human Monkeypox Guidance


Updated August 9, 2022: Updated Monkeypox 2022 Guidance for EMS Professionals. 

The American College of Emergency Physicians/VisualDX Monkeypox Emergency Medicine Project has visual images of patient lesions.

Updated August 4, 2022: Monkeypox Guidance for EMS professionals is published in the Prehospital and Disaster Medicine journal. A customizable Monkeypox 3I Tool is available here.

Please see the EMS Medical Director's guidance for EMS professionals regarding the Human Monkeypox public health emergency.  

The County of San Diego Epidemiology & Immunization Services Branch page contains current information on the Human Monkeypox outbreak.

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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.


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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County EMS Procurements

EMS Solicitations Name and Commodity Code(s)

RFP 11886

CLOSED 8/29/22

Consultant Services for Comprehensive Evaluation of the Base Hospital System and/or Trauma Center Catchment Area Designations

80100000, 80101504, 85100000, and 93131703

RFP 10978 


CSA-17 Paramedic Service Level Ambulance Services 


Please check BuyNet for updates:

  • Addendum 1, posted 6/10/2022 
  • Addendum 2, posted 6/24/2022
  • Addendum 3, posted 7/8/2022

Interested parties must register in BuyNet and select appropriate commodity codes in order to receive updates.   BuyNet registration instructions.

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Medication 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:

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 this page.


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