Focus of Study
1. What is the availability of medical emergency transportation (ambulances) in Los Angeles County?
2. Is this service appropriately distributed geographically?
3. Is current response time for a medical emergency situation within acceptable standards?
Methodology
1. Interview knowledgeable individuals in the industry involved in this special medical function to fully explore these questions.
2. Determine, on the basis of the information gained from the interviews and inspections, whether there is a need for an even more extensive review of this critical subject.
1. Interviews were conducted with personnel of the Emergency Services Department of Los Angeles County, and a Vice President for Operations of a large private sector commercial ambulance service in Los Angeles County, and the following information was disclosed:
a. Virtually all the municipalities in Los Angeles County directly provide ambulance service, or contract with a private sector commercial company to provide medical emergency transportation in their areas. When service is provided by the municipality, it is usually by local fire departments.
b. Unincorporated areas of the county utilize private sector commercial ambulance service exclusively.
c. There are an estimated 350 ambulances in service by these private sector companies; about 200 of these are operated by the largest company. A constantly changing number of smaller companies operate the rest. (New companies are frequently starting, and mergers are common.)
d. All ambulances must be licensed and appropriately equipped, and staffed by certified Emergency Medical Technicians (paramedics). Most ambulances are also outfitted with two-way voice and medical equipment transmission capability. This enables more efficient dispatching and routing, and the exchange of critical medical information between the paramedics and the hospital during the transportation phase of the patient's care.
e. It was estimated by both information sources that virtually any residence in Los Angeles County can be reached by an ambulance in about 20 minutes, which is the accepted standard.
2. Air evacuation services are available for emergency transportation and rescue by the following agencies:
a. Los Angeles City Fire Department: three helicopters.
b. Los Angeles County Fire Department: three helicopters.
c. Los Angeles Sheriff's Department: one helicopter on standby each weekend, flying from Bartley Flats, near Mt. Wilson. Three additional units are reportedly on order, which should result in an expanded service capability.
d. One private sector commercial helicopter company, based in San Bernardino County, provides medical evacuation service in Los Angeles County on an individual-for-hire basis, but it's primary activity is inter-facility transfers, not emergency evacuations.
e. Thirty-three hospitals in Los Angeles County have heliports on premises, including all the Comprehensive Emergency Departments and Trauma Centers.
Focus of Study
1. Are there enough Emergency Medical Departments and other support facilities to provide care of an emergency nature to the citizens of this county?
2. Is this care provided in a timely manner without bias?
3. Is ability to pay ever a barrier to service?
Methodology
1. Visit hospital emergency departments of large representative general hospitals and examine their facilities and staffing.
2. Review existing written Policies and Procedures for compliance with these guidelines.
1. Facilities - There are 150 hospitals and health care facilities listed by the Healthcare Association of Southern California, for Los Angeles County. Forty-nine of these provide only First Aid or on-call personnel: 81 provide fully licensed Basic Emergency Departments in hospitals approved by the Joint Commission for Accreditation of Health Care Organizations (JCHAD); 8 additional hospitals provide Comprehensive Emergency Services; and another 12 are designated as full service Trauma Centers. As mentioned above, all the trauma centers and comprehensive emergency departments are equipped with heliports, as are 13 additional basic emergency departments. The geographic distribution of these emergency facilities is broadly dispersed throughout the county.
2. Policies and Procedures - All hospitals that are approved by JCAHO are required to have available written policies and procedures outlining the scope of all medical care provided. The hospitals visited by the Committee either displayed copies of these documents, or testified to their existence. Excerpts of such documents are included in the report of our inspection of the Glendale Adventist Medical Center, below.
All persons presenting themselves for treatment for perceived medical emergencies must be evaluated promptly. Of concern to the Committee is the widely held, and often-repeated belief that a patient is required to furnish financial data before receiving treatment. All three hospitals visited adamantly denied requiring financial information of any type prior to medical evaluation and/or treatment.
3. Inspections - To determine whether the Committee should undertake a formal audit of emergency medical facilities in Los Angeles County, three JCAHO-approved large general hospitals were selected and visited by the full Committee or by individual members. The results are as follows:
a. Children's Hospital of Los Angeles: The entire Grand Jury visited several departments of this highly specialized state-of-the-art hospital. The emergency care department was particularly noted by the Committee. This department is a combined emergency department and trauma center. An extensive medical staff, as required for a trauma center, was either present in the department or on campus. The equipment was adequate and appeared to be well maintained. Although the patients are small in size, space constraints appear to be an on-going concern.
b. King-Drew Medical Center: The Trauma Center/Emergency Department has recently moved into a completely new structure that is spacious, well designed, and equipped with the latest in technological instrumentation, and the necessary support services.
c. Glendale Adventist Medical Center: This facility was chosen as a representative of the private not-for-profit sector of general hospitals in Los Angeles County.
1) Facility: The Emergency Department is well staffed, with at least one physician on duty and on premises at all times. All department physicians are Diplomates of the American Board of Emergency Medicine, and active members of the Medical Staff of the hospital. Specific areas within the department are designated and equipped for specialized types of treatment. The nursing staff is well trained and solicitous of patient needs. Triage is prompt and unrelated to financial concerns prior to treatment.
2) Policies and Procedures: Clearly worded and well-prepared documents were immediately available and promptly produced upon request. Portions of two related to the concerns previously expressed, are:
3-770.71 AVAILABILITY OF EMERGENCY SERVICES: "Emergency services will be offered to the community without respect to race, creed, sex, or financial status." "NO acutely ill or injured person will have treatment delayed pending financial arrangements."
3-770.77 EMERGENCY DEPARTMENT TRIAGE AND MEDICAL SCREENING: "Initial triage and subsequent medical screening will be based on the criticality of the patient, and not be delayed or refused for financial, religious, racial or socio-economic reasons."
On the basis of the above Findings, the Committee on Health and Human Services has concluded that the public is being adequately served by the current Emergency Medical System and there is no need to further audit the Emergency Medical Services of Los Angeles County at this time.
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