EMS services are typically provided in response to a medical emergency reported through the 9-1-1 system. A 9-1-1 call placed from any telephone is automatically routed to the appropriate designated Public Safety Answering Point (PSAP). There are 24PSAPs in the EMS Region operated by law enforcement agencies. A law enforcement dispatcher determines the nature of the emergency (police, fire, and/or medical assistance) and either dispatches the appropriate law enforcement personnel or transfers the caller to the appropriate fire service or ambulance dispatch center. The caller is transferred directly from the PSAP to the medical dispatcher at the EMS dispatch center. Depending on the location of the caller, 9-1-1 cellular phone calls may be routed to the California Highway Patrol dispatch center.
For medical emergencies in the region, the caller is transferred to a trained Emergency Medical Dispatcher. The nature of the medical emergency is determined, the call is prioritized as emergent or non-emergent, appropriate personnel and equipment are dispatched and pre-arrival instructions are given to the caller, if appropriate. There is one designated ambulance dispatch center for Fresno, Kings, and Madera Counties: Fresno County EMS Communications Center and one designated Ambulance dispatch center for Tulare County: Tulare County Consolidated Ambulance Dispatch (TCCAD).
The initial response to a potentially life threatening incident includes both fire and ambulance personnel. The location of fire stations throughout the county enables fire fighters to make a rapid initial response. As first responders, Fire personnel responding to emergencies are trained at the BLS or ALS First Responder level. BLS personnel function under a scope of practice established in regulations (Title 22, Chapters 1.5 and 2). The EMS Agency has developed BLS protocols and other policies and procedure for medical direction and a standardized level of care.
Ambulance services are provided by 16 ambulance provider agencies including public and private providers. An air ambulance service and an ALS air rescue service also reside in the Region. Paramedics function under a scope of practice established in regulations (Title 22, Chapter 4) approved by the EMS Authority and policies and procedure developed by the EMS Agency. Paramedics utilize these policies and procedures as guidelines and must always function within their scope of practice.
Medical care delivered by paramedics in the field is accomplished primarily through standing orders, however, some medications or procedures require the paramedic to contact the base hospital physician for consultation. Unstable patients are taken to the closest most appropriate hospital, which may include a receiving hospital, trauma center, burn center or pediatric facility. Stable patients may be taken to the facility of their choice. There are a total of 14 receiving hospitals in the EMS region, which includes one Level 1 regional trauma center, one Level 2 pediatric trauma center, one Level 3 regional trauma center, and 6 base hospitals.