EMS Overview

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Emergency Medical Services (EMS) is a specially organized system that provides personnel, facilities and equipment for the effective and coordinated delivery of emergency medical services within a geographical area.

What is EMS?

An effective EMS system involves many different agencies and organizations working together to provide rapid emergency medical response, treatment and transport to those in need of immediate medical attention. Agencies responsible for providing EMS include dispatch centers, public safety agencies, fire departments, ambulance services, hospitals and specialty care centers. In California, EMS systems are organized on a county or regional basis. The Local EMS Agency (LEMSA), is the lead agency responsible for local EMS system planning and coordination, consistent with State laws and regulations. The State EMS Authority (EMSA) approves local EMS system plans, provides guidance to LEMSAs, develops EMS regulations, administers the Regional Poison Control Center program and carries out other EMS related activities. The State EMS Commission, with members appointed by the Governor and other state officials, is an advisory board to EMSA and reviews and approves all EMS regulations.

How does our Local EMS Agency Function?

In Fresno, Kings, Madera, and Tulare Counties, each of the Boards of Supervisors designated the Fresno County Department of Community Health as the Local EMS Agency. The Central California EMS Agency carries out the functions of EMS under the direction of the EMS Division Manager. Several EMS advisory committees meet regularly to provide advice to the EMS Agency and Boards of Supervisors on EMS related matters. The principal functions of a Local EMS Agency are defined in the Health and Safety Code (Division 2.5). These include the planning, implementation and evaluation of emergency medical services including:
  • Monitoring and approving EMT, paramedic and Mobile Intensive Care Nurse (MICN) training programs.
  • Certifying EMTs and accrediting paramedics and MICNs.
  • Authorizing advanced life support programs.
  • Establishing policies and procedures for medical control of the EMS system, including dispatch, patient destination, patient care and quality improvement.
  • Establishing exclusive operating areas for the regulation of ambulance services.
  • Establishing and monitoring contracts with EMS system providers including, fire departments, ambulance transport agencies, trauma centers and base hospitals.
  • Developing, implementing and monitoring a trauma system plan.
  • Planning and coordinating disaster medical response.

How does the 9-1-1 System work?

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 18 PSAPs in the Fresno/Kings/Madera 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. Except in the non-incorporated areas of Fresno County, the caller is transferred directly from the PSAP to the medical dispatcher. In the non-incorporated areas of Fresno County, the Fresno County Sheriffs Office Dispatcher transfers the medical 9-1-1 call to Fresno County Fire Dispatch or North Central Fire Dispatch who will then conference the call with the trained medical dispatcher. All 9-1-1 cellular phone calls are 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.

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. Basic Life Support (BLS) 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 15 ambulance provider agencies including public and private providers. An air ambulance service and an ALS air rescue service also reside in Fresno County. 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 18 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 7 base hospitals.