Article Features Tracy Jarman

San Diego Partnership Thinks Outside “The Box” to Enhance Emergency Medical Services

Tracy Jarman is chief of the San Diego Fire-Rescue Department and can be reached at

San Diego Medical Services Enterprise (SDMSE) is a public-private partnership formed as a limited liability company between the City of San Diego’s Fire-Rescue Department and Rural/Metro, a private ambulance company. Since its founding in 1997, SDMSE’s paramedics and emergency medical technicians (EMTs) have worked hand-in-hand with city fire department responders on the scene of more than 90,000 emergency calls per year.

“SDMSE is unquestionably the safest, best managed and most competent emergency medical services (EMS) organization I have ever seen,” says Dr. James Dunford, San Diego’s medical director, who oversees emergency medical services. “The secret of its success lies in the basic structure of the enterprise as a public-private partnership, which hybridizes the best of both the San Diego Fire-Rescue Department and Rural/Metro ambulance company. The result is a public safety net stronger than either could create by itself.”

Cities have choices on how to structure their EMS programs. The most common options are to have Fire Departments run ambulance programs or to contract with private ambulance companies to provide emergency medical transport. San Diego’s hybrid model – one of the largest of its kind in the nation — has proved to be an innovative third option for many reasons.

Financial Strength

One of these reasons is that SDMSE is financially sound. Any excess revenue created by the partnership is split 50-50 between the city and Rural/Metro. Since its inception, the city has reinvested its share (more than $6 million) into upgrades to its EMS infrastructure. In addition, as
a national, publicly traded company, Rural/Metro provides the capital necessary to purchase and upgrade EMS equipment. Since 1997, it has invested millions in SDMSE.

“SDMSE blends the strengths of both the public sector and the private enterprise,” says Rod Ballard, deputy fire chief in charge of EMS and SDMSE president. “It operates as a private ambulance company but has the strength of a publicly supported company, and the private en terprise personnel and their business sense complement the public employees.”

SDMSE’s senior administration comprises both public and private employees. Its board of directors includes two private Rural/Metro employees, San Diego’s fire chief, a Fire Department senior admin istrator and the city’s Environmental Services director. In addition, the SDMSE contract is overseen by a city employee who ensures that all contractual compliance requirements, such as response times, are being met.

Furthermore, independent auditors reg ularly validate SDMSE’s financial ac counting. As a publicly traded company, Rural/Metro is compliant with SEC requirements and Sarbanes-Oxley legislation regarding corporate governance, thus increasing its openness and accountability.

The Ability to Expand Services

SDMSE’s services extend beyond responding to 911 emergency medical calls. In addition to handling all emergency medi cal transport in the City of San Diego, SDMSE has contracts to provide medical standby for San Diego Padres baseball games at Petco Park and San Diego Chargers football games at Qualcomm Stadium. SDMSE also provides EMS coverage at marathons, concerts and large community events.

A sizeable component of the organization is non-emergency medical transportation, such as transporting critically ill patients from hospital to hospital. SDMSE currently holds contracts to provide non-emergency transportation for Sharp Health Care, Palomar Pomerado Health and Kaiser Permanente, three large health care providers in San Diego County.

Since 2001, the County of San Diego has contracted with SDMSE to provide all 911 emergency transport to County Service Area 17 (CSA 17), which encompasses the northern San Diego County coastal towns of Del Mar, Solana Beach, Encinitas and the communities of Rancho Santa Fe, Elfin Forest and 4S Ranch. SDMSE responds to approximately 5,000 911 medical emergency calls annually in CSA 17. In summer 2007, using a competitive bid process, the county awarded SDMSE the contract to provide EMS service in CSA 17 through 2013 .

Innovative Programs

Another advantage of SDMSE’s public-private status is that the organization is able to run progressive programs and use innovative technology to improve patient care. One such success is the nationally recognized “TapChart” electronic patient data collection program. All 911 emergency patient records in the City of San Diego and CSA 17 are now captured electronically on hand-held computers using software developed in-house by San Diego Fire Captain Greg George.

TapChart makes patient care more thorough by prompting first responders to ask detailed follow-up questions. It also provides an electronic database to review calls for quality assurance and improvement purposes.

TapChart accelerates patient care. First responders can now beam patient information to each other and hospital staff instantaneously. And filling out forms electronically reduces turnaround time on emergency calls and gets responders back out in the community more quickly. TapChart also helps recover millions of dollars that previously went uncollected due to lost or incomplete patient reports.

Another highly successful SDMSE program is San Diego Project Heart Beat, a campaign to install automated external defibrillators (AEDs) in public places. Since Project Heart Beat was launched in 2001, more than 3,500 AEDs have been installed in offices, museums, schools, places of worship, parks, libraries and senior and community centers throughout San Diego County. Thus far, more than 43 lives have been saved as a direct result of San Diego Project Heart Beat.

“San Diego Project Heart Beat has been an outstanding success in San Diego and a model for other regions,” said San Diego City Council Member and League President Jim Madaffer, who helped launch the program in November 2001. “I’m very proud of this award-winning program and share its goal of making AEDs as widely available as fire extinguishers in order to save lives.”

As a limited liability company, SDMSE has the flexibility to take part in EMS research studies. Dr. Dunford, who is also a University of California, San Diego, professor of emergency medicine who has practiced in San Diego for 26 years, says SDMSE supports his efforts as a researcher to improve pre-hospital care for all EMS systems.

Dunford says that as a result of SDMSE’s participation in clinical trial studies, San Diego emergency responders have improved EMS care around the world in the areas of management of critical airways and traumatic brain injury.

Customer Service Emphasis

Thorough patient care, treating each patient and their family with dignity and respect, and building relationships with fire crews and the community are the founding principles of SDMSE.

The strength of SDMSE is the quality of care and service that the citizens of San Diego receive today versus the level of service provided prior to 1997. An integrated service delivery system, where everyone is on the same team and working toward the goal of providing the highest level of emergency service, is the key to its success.

Part of high-level customer service and building these relationships includes an extensive community outreach and education program. Since its founding, SDMSE employees have spent more than 4,000 hours in community education activities.

These outreach efforts include 911 emergency preparedness presentations to community and civic groups, CPR classes, blood pressure check clinics, visits to schools and senior centers, and participation in large community events such as parades and street fairs. All community education is offered at no cost to the public.

SDMSE also strives to be a good community partner by donating tens of thousands of dollars annually to dozens of charities and nonprofit organizations.

SDMSE is a national model of a fiscally
viable, well managed public-private organization that provides a critical public service. SDMSE proves that while San Diego’s paramedics and EMTs are thinking inside “the box” (a slang term for ambulance), the administrators and elected officials overseeing the program are thinking outside of it.

This article appears in the October 2007 issue of Western City
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