Comprehensive Evaluation of the Base Hospital System and Trauma Center Catchment Area Designation

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The San Diego County Board of Supervisors directed the County staff to develop a plan for comprehensive evaluation of the base station hospital system and trauma center catchment area designations, which included the recommendation to contract for a consultant. As the designated Local Emergency Medical Services Agency (LEMSA), the San Diego County Emergency Medical Services Office (County EMS) is responsible for ongoing oversight of the Emergency Medical Services (EMS) system, which includes designation of base station hospitals, trauma centers, and trauma center catchment areas. As a region, San Diego offers a robust system of emergency, specialty, and trauma medical care through its cooperating hospitals. 

The purpose of this project is to conduct a comprehensive review and evaluation of:

  1. the Base Station Hospital System (BSHS), and 
  2. the Trauma Center Catchment Area Designations (TCCAD). 

A critical component of this evaluation is providing opportunities to gain valuable stakeholder input through listening sessions, stakeholder interviews, and surveys. In addition, the study team will conduct industry research, carry out comprehensive analysis, and evaluate best practices.

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  • What is a Base Station Hospital?

    In San Diego County, Base Station Hospitals are designated by the County EMS Office to provide on-line medical direction to EMS professionals responding to 9-1-1 calls in the field. This medical direction, provided by the base station hospital physician through specially-trained Mobile Intensive Care Nurses (MICNs), focuses on patient treatment on the scene and assists in determining appropriate patient destinations.

    The base hospital also provides EMS continuing education, quality assurance review, and monitors compliance with associated prehospital protocols and policies.

    The base station hospital coordinates patient distribution in a large-scale disaster or other incidents, as described in the County of San Diego Emergency Operations Plan Annex D – Multi-Casualty Operations.

    In San Diego County, there are currently seven base hospitals in the EMS system:

    • Tri-City Medical Center, 
    • Palomar Medical Center,
    •  Scripps Memorial Hospital La Jolla, 
    • Scripps Mercy Hospital San Diego,
    • Sharp Memorial Hospital, 
    • UCSD Medical Center Hillcrest, and 
    • Sharp Grossmont Hospital. 

    Additionally, in San Diego County, there are 14 hospitals with emergency departments that are not Base Station Hospitals.

    With the exceptions of Sharp Grossmont and Tri-City, the designated Base Station Hospitals are also designated as Trauma Centers. 

  • What is a Trauma Catchment Area?

    Trauma catchments refer to geographic areas with defined boundaries assigned to a designated trauma center -  a trauma system designation "map." These Trauma Catchments are designated to determine where paramedics will transport a patient with significant traumatic injuries for specialized trauma care.

    Factors that determine the trauma catchment area include but is not limited to the following:

    Trauma Catchment Designations are an important element to high-quality, 24/7 available, trauma care. The County EMS Office, on behalf of the Board of Supervisors, designates specific hospitals with the staff and resources necessary to treat emergency medical patients identified by the Base Station Hospital as meeting San Diego County trauma patient criteria per County EMS Policy T-460, Identification of the Trauma Center Patient.

    In San Diego County, there are six trauma centers in the EMS system:

    • Palomar Medical Center, 
    • Scripps Memorial Hospital La Jolla,
    • Scripps Mercy Hospital San Diego,
    • Sharp Memorial Hospital, 
    • UCSD Medical Center Hillcrest, and 
    • Rady Children’s Hospital. 

    In the organized EMS delivery system, paramedics and EMTs transport patients meeting trauma criteria to the appropriate, designated trauma center based on the Trauma Catchment Area designation.

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This comprehensive review and evaluation began in January 2023 and is scheduled to be completed by December 31, 2023. PCG will work with the County of San Diego, BSHS and TCCAD stakeholders, and the public to ensure all voices are heard regarding the care provided to this community to inform recommendations that will assist the County in defining the future state of the EMS system. Key tentative timelines are:

  • March – April 2023
    • Perform EMS and Hospital Community stakeholder interviews 
  • May – June 2023
    • Distribute BSHS and TCCAD stakeholder surveys 
  • May – June 2023
    • Conduct in-person and virtual listening sessions with BSHS and TCCAD stakeholders
  • June – October 2023
    • Gather and analyze countywide EMS data, which will provide insight into the inner workings of the BSHS and TCCAD
  • November 2023
    • Conduct listening sessions and input surveys to obtain feedback on recommendations 
  • December 2023
    • Incorporate feedback related to initial findings and recommendations, and complete written reports  
  • Spring 2024
    • Present recommendations to the County of San Diego Board of Supervisors

Based on results from the data analysis, interview findings, input surveys, listening sessions, and best practices, PCG will develop an evidence-based final report of findings and recommendations to San Diego County EMS.

This calendar will be updated as these two projects progress (Last update: 01/16/24).

 

Upcoming Project Milestones

The next steps of this process will include completing the consultant’s written report and delivering the report to the Board of Supervisors as recommendations.

We anticipate the Board will give the Public Safety Group leadership direction to work closely with the San Diego County EMS Office, the community, EMS stakeholders, and others to methodically implement some or all of the report’s recommendations. 

County EMS pledges to work closely with stakeholders, EMS agencies, hospitals, and the general public to thoughtfully and efficiently mold future EMS policy to improve patient care in our EMS delivery system in San Diego County, which remains our primary goal.

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Listening Session Information

The Public Consulting Group’s team engaged stakeholders, partner services, and the public early in this evaluation process via interviews, surveys, public presentations, and in-person listening sessions to gather information. The consultant’s initial findings were presented via public community meetings held during the week of November 7, 2023.  A recorded version of these sessions is available for those who were not able to attend. Click this link to access the recording. County EMS felt it important to release these early findings for the public’s review and provide feedback to inform the process further. This evaluation is being conducted by Public Consulting Group LLC (PCG).


In the first phase, PCG collected stakeholder input via:

  • In-person and virtual listening sessions,
  • Public and stakeholder input surveys,
  • Ambulance ride-a-longs and base hospital MICN sit-ins, and
  • Other various stakeholder interviews.

In the second phase, PCG:

  • Presented their initial findings and recommendations. These findings included their analysis of the information collected during the first phase of the project.
  • Heard feedback from stakeholders and the public following the presentation at each of these in-person listening sessions.

 

The County of San Diego values all voices and is prepared to listen. We look forward to hearing from you. If you would like to provide any further feedback to PCG, please email the PCG team at publicsafetystudy@pcgus.com.

 

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  • Concluded In-Person/Virtual Listening Sessions

     

    Virtual Listening Sessions

    • Virtual Listening Session #1 (May 31, 2023) - Hospital Association of San Diego and Imperial Counties and other Hospitals/Trauma centers
    • Virtual Listening Session #2 (June 13, 2023) -  Emergency Department RNs, MICNs, & other ED clinicians
    • Virtual Listening Session #3 (June 15, 2023) - Trauma Directors, Program Managers, & other Trauma clinicians
    • Virtual Listening Session #4 (June 16, 2023) - Prehospital EMS Field Providers
    • Virtual Listening Session #5 (June 16, 2023) - Ambulance Association of San Diego County
    • Virtual Listening Session #6 (June 20, 2023) -  San Diego Fire Chiefs Association & SDCFA EMS Section Members

     

    In-Person Listening Sessions (1st Phase)
     
    • Listening Session #1 (May 23, 2023) - Lakeside County Library
    • Listening Session #2 (May 24, 2023) - North Inland Live Well Center
    • Listening Session #3 (May 24, 2023) - South Region Live Well Center National City
    • Listening Session #4 (May 25, 2023) - Joan Kroc Center
    • Listening Session #5 (May 25, 2023) - Encinitas Community Center

     

    In-Person Listening Sessions (2nd Phase)

    • Listening Session #6 (November 7, 2023) - Encinitas Community Center
    • Listening Session #7 (November 8, 2023) - South Region Live Well Center National City
    • Listneing Session #8 (November 8, 2023) - Lakeside County Library
    • Listening Session #9 (November 9, 2023) - North Inland Live Well Center
    • Listening Session #10 (November 9, 2023) - Joan Kroc Center

     

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Stakeholder Feedback Survey

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The County of San Diego is offering an anonymous survey to stakeholders of the Base Station Hospital System and Trauma Center Catchment Area Designations to gain vital feedback regarding each of these components of the County EMS  system.

Stakeholders are encouraged to express their honest opinions.

If you are:
  • A Member of the Public
  • A Physician or Advanced Care Provider
  • An EMT, Paramedic, Firefighter, or First Responder
  • A Community Partner
  • An Emergency Department RN or Clinician
  • An EMS System Participant
Survey concluded - Thank you for your participation!
This survey was created by the PCG team and is formatted with various styles of questioning. We want to emphasize that there are no right or wrong responses, and we encourage everyone to express their honest and anonymous opinions.
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County EMS is pleased to announce that Public Consulting Group LLC (PCG) was chosen to perform consulting services for the Comprehensive Evaluation of the Base Station Hospital System and Trauma Center Catchment Area Designations. PCG is a consulting, operations, and technology firm that has dedicated itself almost exclusively to serving the public sector for over 35 years. PCG Health is a recognized leader in the healthcare field and is at the forefront of developing and helping clients implement innovative solutions. The project team’s breadth of knowledge in the health care and emergency medical services (EMS) fields covers all programmatic facets. The dedicated project team includes subject matter experts (SMEs) with practical emergency medical services expertise (including trauma center and hospital), operations consulting for fire/EMS departments, public engagement, and project management experience. The SMEs have direct experience supporting California hospitals, EMS providers, and health organizations; bringing a relevant perspective to the County’s comprehensive emergency service operations, context, and challenges.

 

For additional information, please contact County EMS via EMSAdmin@sdcounty.ca.gov