Attachments - Contra Costa Health Services

ATTACHMENTS TABLE OF CONTENTS 

Required Documents 

Section 1 Attachments ....................................................................... Credentials And Qualifications 

Section 2 Attachments ....................................................................Commitment To Clinical Quality 

Section 3 Attachments .............................................................................Commitment To Employees 

Section 4 Attachments ..................................................................................Operations Management 

Section 5 Attachments ............................................... Commitment To EMS System & Community 

Section 6 Attachments .................................................................. Management And Administration 

Section 7 Attachments ..........................................................................Organizational Requirements

REQUIRED DOCUMENTS 

Form B – Paramedic Compensation 

Paramedic Wage Scales 

Form B – EMT Compensation 

EMT Wage Scales 

A — Patient Charges 

B — Service Price Sheet 

C — Optional Services Price List

REQUEST FOR PROPOSAL CONTRA COSTA COUNTY EMS AGENCY 

Paramedic and EMT-I Compensation Packages - FORM B 

Provider American Medical Response Personnel Category: X Paramedic EMT-I 

New Employee After 2 Yrs Employment After 5 Yrs Employment 

Hourly Wage: Lowest $ 18.66 /hr Lowest $ 20.50 /hr Lowest $ 22.52 /hr 

(Straight time) Highest $ 24.26 /hr Highest $ 26.66 /hr Highest $ 29.28 /hr 

See attached wage scales for additional detail. Median $ 18.66 /hr Median $ 20.50 /hr Median $ 22.52 /hr 

Average number of hours per week for full time employees: 

Average gross earning per year for full time employees (Base Schedule): 

Note: Including overtime, training pay, etc. the average grows to $82,930) 

Paid Vacation (sick and vacation) 

(1) 

10.5 days/year 11 days/year 14 days/year 

Paid Holidays 8 days/year 8 days/year 8 days/year 

Sick Leave (included above) - days/year - days/year - days/year 

Paid Continuing Ed. 28 hours/year 28 hours/year 28 hours/year 

Uniform Allowance (2) 

$ 333.88 /year $ 333.88 /year $ 333.88 /year 

Tuition Reimbursed (3) 

Health care 

$ - /year $ - /year $ - /year 

a. Medical 75 % covered 75 % covered 100 % covered 

(Co-payment) $ 20 deductible $ 20 deductible $ 20 deductible 

b. Dental 75 % covered 75 % covered 75 % covered 

c. Optical 50 % covered 50 % covered 50 % covered 

Stock Options: 

N/A 

Profit Sharing: 

N/A 

Daycare Services: 

N/A 

Career Development 

Pension Plan: 

***FORMS FOR PARAMEDICS AND EMT-I's MUST BE INCLUDED IN THE PROPOSAL*** 

60,149 

Development Dimensions International (DDI) Training is provided at no cost to employees; Advanced Development Program (ADP); 

Passport to Success Program 

AMR currently offers a 401(k) Plan in which AMR matches employee contributions, dollar for dollar up to 5% of the employee's gross 

wages. 

(1) Each employee earns a different number of PTO hours depending on years of service and the type of shift they are currently working. Above we have 

stated the number of days earned on a 12/42 shift (12 hrs a day/42 avg hrs per week). The number of PTO days increases to 17.5 days after 7 years 

of service and then to 21 days after 10 years of service. Employees working on a 24/56 shift (24 hrs a day/56 avg hrs per week) earn 7 days annually 

up to 4 years of service then 9.3 days up to 7 years, 11.67 days up to 10 years and 14 days with more than 10 years of service. Employees working 

on a 12/48 shift (12 hrs a day/48 avg hrs per week) earn 12 days up to 4 years of service, 16 days up to 7 years, 20 days up to 10 years and 24 days 

after 10 years of service. Employees working on a 10/50 shift (10 hrs a day/50 avg hrs per week) earn 15 days up to 4 years of service, 

20 days up to 7 years, 25 days up to 10 years and 30 days with more than 10 years of service. 

(2) Uniforms are provided at no cost. Additionally, each employee is provided a bi-weekly uniform laundary allowance payment as part of their payroll. 

(3) Employer will provide up to 24 hours of paid training and reimburse full-time Paramedics any fees paid to maintain their paramedic accreditation. 

Paramedics will be reimbursed for re-licensure and re-accreditation fees required by the state and county as well as the renewal cost of their State 

of California Ambulance Driver License fee. 

$ 

47.3 

American Medical Response 

Proposal dated November 4, 2004

Contra Costa County - Paramedic 

The following wage scales are effective July 1, 2005 

Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 8 Step 9 Step 10 Estimated Annual Base Wage 

New After 2 Yrs of After 5 Yrs of 

Shift Type 0-1yr 1-2yrs 2-3yrs 3-4yrs 4-5yrs 5-6yrs 6-7yrs 7-8yrs 8-10yrs 10+yrs 

Employee Employment Employment 

24/56 $ 15.11 $ 15.96 $ 16.56 $ 17.12 $ 17.94 $ 18.54 $ 19.61 $ 20.19 $ 20.75 $ 21.38 $ 50,428 $ 55,252 $ 61,881 

12/48 $ 18.66 $ 19.84 $ 20.50 $ 21.18 $ 21.85 $ 22.52 $ 23.18 $ 23.83 $ 24.49 $ 25.22 $ 50,589 $ 55,580 $ 61,051 

12/42 Low $ 18.66 $ 19.84 $ 20.50 $ 21.18 $ 21.85 $ 22.52 $ 23.18 $ 23.83 $ 24.49 $ 25.22 $ 42,806 $ 47,029 $ 51,658 Low 

12/42 Night High $ 24.26 $ 25.78 $ 26.66 $ 27.54 $ 28.39 $ 29.28 $ 30.14 $ 30.98 $ 31.82 $ 32.77 $ 55,667 $ 61,155 $ 67,168 High 

10/50 $ 18.66 $ 19.84 $ 20.50 $ 21.18 $ 21.85 $ 22.52 $ 23.18 $ 23.83 $ 24.49 $ 25.22 $ 53,507 $ 58,786 $ 64,573 

Median $ 18.66 

$ 20.50 

$ 22.52 

$ 50,589 $ 55,580 $ 61,881 Median 




Paramedic and EMT-I Compensation Packages - FORM B 

Provider American Medical Response Personnel Category: Paramedic X EMT-I 

New Employee After 2 Yrs Employment After 5 Yrs Employment 

Hourly Wage: Lowest $ 13.72 /hr Lowest $ 15.02 /hr Lowest $ 17.48 /hr 

(Straight time) Highest $ 18.47 /hr Highest $ 20.24 /hr Highest $ 23.52 /hr 

See attached wage scales for additional detail. Median $ 13.72 /hr Median $ 15.02 /hr Median $ 17.48 /hr 

Average number of hours per week for full time employees: 

Average gross earning per year for full time employees: $ 41,762 

Note: Including overtime, training pay, etc. the average grows to $51,860) 

Paid Vacation (sick and vacation) 

(1) 

10.5 days/year 11 days/year 14 days/year 

Paid Holidays 8 days/year 8 days/year 8 days/year 

Sick Leave (included above) - days/year - days/year - days/year 

Paid Continuing Ed. 16 hours/year 16 hours/year 16 hours/year 

Uniform Allowance (2) 

$ 333.88 /year $ 333.88 /year $ 333.88 /year 

Tuition Reimbursed (3) 

Health care 

$ - /year $ - /year $ - /year 

a. Medical 75 % covered 75 % covered 100 % covered 

(Co-payment) $ 20 deductible $ 20 deductible $ 20 deductible 

b. Dental 75 % covered 75 % covered 75 % covered 

c. Optical 50 % covered 50 % covered 50 % covered 

Stock Options: 

N/A 

Profit Sharing: 

N/A 

Daycare Services: 

N/A 


***FORMS FOR PARAMEDICS AND EMT-I's MUST BE INCLUDED IN THE PROPOSAL*** 

Development Dimensions International (DDI) Training is provided at no cost to employees; Advanced Development Program (ADP); 

Passport to Success Program 

Pension Plan: 

AMR currently offers a 401(k) Plan in which AMR matches employee contributions, dollar for dollar up to 5% of the employee's gross 

wages. 

(1) Each employee earns a different number of PTO hours depending on years of service and the type of shift they are currently working. Above we have 

stated the number of days earned on a 12/42 shift (12 hrs a day/42 avg hrs per week). The number of PTO days increases to 17.5 days after 7 years 

of service and then to 21 days after 10 years of service. Employees working on a 24/56 shift (24 hrs a day/56 avg hrs per week) earn 7 days annually 

up to 4 years of service then 9.3 days up to 7 years, 11.67 days up to 10 years and 14 days with more than 10 years of service. Employees working 

on a 12/48 shift (12 hrs a day/48 avg hrs per week) earn 12 days up to 4 years of service, 16 days up to 7 years, 20 days up to 10 years and 24 days 

after 10 years of service. Employees working on a 10/50 shift (10 hrs a day/50 avg hrs per week) earn 15 days up to 4 years of service, 

20 days up to 7 years, 25 days up to 10 years and 30 days with more than 10 years of service. 

(2) Uniforms are provided at no cost. Additionally, each employee is provided a bi-weekly uniform laundary allowance payment as part of their payroll. 

(3) Employer will provide up to 24 hours of paid training and reimburse full-time Paramedics any fees paid to maintain their paramedic accreditation. 

Paramedics will be reimbursed for re-licensure and re-accreditation fees required by the state and county as well as the renewal cost of their State 

of California Ambulance Driver License fee. 

47.4 



Contra Costa County - EMT 

The following wage scales are effective July 1, 2005 

Estimated Annual Base Wage 

New After 2 Yrs of After 5 Yrs of 

Employee Employment Employment 

Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 8 Step 9 

Shift Type 0-1yr 1-2yrs 2-3yrs 3-4yrs 4-5yrs 5-7yrs 7-9yrs 9-10yrs 10+ 

24/56 $ 10.13 $ 10.69 $ 11.19 $ 12.18 $ 12.75 $ 13.26 $ 13.68 $ 14.07 $ 14.51 $ 33,804 $ 37,344 $ 44,251 

12/48 $ 13.72 $ 14.32 $ 15.02 $ 16.21 $ 16.86 $ 17.48 $ 18.01 $ 18.55 $ 19.10 $ 37,194 $ 40,719 $ 47,402 

12/42 Low $ 13.72 $ 14.32 $ 15.02 $ 16.21 $ 16.86 $ 17.48 $ 18.01 $ 18.55 $ 19.10 $ 31,472 $ 34,455 $ 40,110 Low 

12/42 Night High $ 18.47 $ 19.29 $ 20.24 $ 21.85 $ 22.70 $ 23.52 $ 24.24 $ 24.97 $ 25.72 $ 42,376 $ 46,433 $ 53,973 High 

10/50 $ 12.97 $ 13.54 $ 14.23 $ 15.34 $ 15.92 $ 16.55 $ 17.04 $ 17.54 $ 18.08 $ 37,193 $ 40,802 $ 47,453 

Median $ 13.72 

$ 15.02 

$ 17.48 

$ 37,193 $ 40,719 $ 47,402 Median 




A. Patient Charges 

BLS Base Rate $ 

445.60 

BLS-Emergency Base Rate $ 

543.45 

ALS 1 Base Rate $ 1,001.87 

ALS 1-Emergency Base Rate $ 1,061.61 

ALS 2 Base Rate $ 1,238.77 

Loaded Ambulance Mile Rate $ 

20.34 

Treat and no transport charge $ 

198.00 

* Additional supply, drug, and procedure charges billed separately. 




B. Service Price Sheet 

Annual cost of 24/7 of paramedic staffed 

non-transporting ALS quick response vehicle (QRV): $ 414,335 per year 

Hourly cost of QRV: $ 47.30 per hour 

Marginal Paramedic Ambulance 

Hourly Reimbursement Rate: $ 74.20 per hour 




C. Optional Services Price List 

It is the intent of this procurement to result in a zero subsidy for the Ambulance Contractor. The 

Ambulance Contractor shall rely on collections from patient charges and reimbursement from the 

County for transporting patient for whom the County is financially responsible. 

The County may opt to purchase additional services or service levels from the Contractor. The 

purpose of this Optional Services Price List is to allow the County to identify the actual costs of 

these services. 

The Contractor will provide the following services if requested by the County for the amount 

entered on this Price List for the term of the Agreement plus any annual C.P.I. adjustments as 

provided for in the Agreement. 

Upgrading Ambulance Fleet 

If the Proposer submitted its Proposal with the intention of providing Type II (van-style) 

ambulances for emergency responses within the County, what would be the total additional 

annual cost to upgrade the Emergency Ambulance Fleet to Type III (van/modular) ambulances? 

Total annual cost of upgrading to Type III ambulances: $_150,400__________ per year 

Note: Based on a $16,000 price differential on 47 units, depreciated over the five years. 

Deployment of Reserve Ambulance Fleet 

If the County decides to deploy between five (5) and fifteen (15) fully stocked and equipped 

reserve ambulances throughout the County for Disaster and Mass Casualty situations, what 

would be the total annual cost for acquisition, insuring, maintaining, and equipping each 

ambulance. Please differentiate between the cost of providing Type II and Type III ambulances. 

Cost per reserve ambulance: Type II $_21,424_____ per year 

Type III $_24,624_____ per year 

Guaranteed Paramedic Response Time Performance for East Contra Costa County 

If the County decides to establish a performance-based response time requirement of 9:59/90% 

for the urban/suburban area of the East Contra Costa Fire Protection District (covering the cities 

of Brentwood and Oakley, the unincorporated communities of Bethel Island, Knightsen, Byron, 

and Discovery Bay and other unincorporated territory of the County served by the East Contra 

Costa Fire Protection District) and allows the Contractor to include response times of both 

ambulance units and Quick Response Vehicles, what would be the additional annual cost, if any? 

The assumptions to be used include: 

a. Three of the four QRVs required to be provided under this procurement would be stationed 

in the East Contra Costa County Fire District at fire stations located in Bethel Island, Byron (or 

Discovery Bay), and Oakley; 

b. These three QRVs would be dispatched by the Contractor; 

c. The 9:59 paramedic response time would be in addition to the 11:59 paramedic ambulance 

response time requirement; 

d. Penalties for failure to meet the paramedic response time requirement would be similar to 

those specified in this RFP for failure to meet the paramedic ambulance response standard and 

would be in addition to penalties for failure to meet the ambulance response standard. 

Cost to provide guaranteed paramedic response in East County $ _1,258,213______ per year 

Note: The annual cost identified above includes the addition of a fifth QRV and an additional 252 

transport unit hours per week. 



SECTION 1 ATTACHMENTS 

Credentials and Qualifications 

AMR Mission and Values Statements 

Response Time Compliance History for Comparable Counties

OUR MISSION: 

Our mission is to make a difference by caring for people in need. 

OUR VALUES: 

Patient Focused 

We will treat our patients like members of our own families 

We will provide for our patients’ needs, safety and comfort 

We will communicate clearly with our patients and their loved ones 

We will continue to learn new skills to improve patient care 

We will respect the dignity of each patient 

Customer Centered 

We will listen to and communicate with our customers 

We will know our customers and anticipate their needs 

We will be professional, reliable and innovative 

We will respect our customers’ time and financial resources as well as our 

own 

We will earn our customers’ trust by fulfilling our promises 

Caregiver Inspired 

We will be empowered to make a difference in the world 

We will celebrate our successes and grow from our failures 

We will value open communication and diverse perspectives 

We will invest in the people and tools that improve our effectiveness 

We will honor and respect each other in our shared quest to live by our 

values

Alameda County Compliance 

Code 3: 90% 10:30 Minutes 

North South East 

Month Requests Compliance Requests Compliance Requests Compliance 

Sep-03 3,216 91.82% 3128 90.07% 686 90.19% 

Oct-03 3,214 92.42% 3159 90.43% 710 93.67% 

Nov-03 3,072 91.10% 3062 90.47% 673 90.26% 

Dec-03 3,431 91.13% 3563 90.39% 778 90.68% 

Jan-04 3,153 91.40% 3182 90.65% 620 91.49% 

Feb-04 2,965 91.58% 3119 90.26% 713 92.69% 

Mar-04 3,294 91.21% 3429 90.02% 695 90.20% 

Apr-04 2,996 91.35% 3146 90.00% 716 91.26% 

May-04 3,229 91.41% 3190 90.55% 762 91.02% 

Jun-04 3,079 90.40% 3136 90.51% 760 90.77% 

Jul-04 3,131 91.48% 3128 90.08% 701 91.30% 

Aug-04 2,840 92.90% 3119 91.09% 739 93.14% 

Code 2: 90% / 20:00 Minutes 

North South East 

Month Requests Compliance Requests Compliance Requests Compliance 

Sep-03 1,213 90.12% 346 90.75% 68 92.65% 

Oct-03 1,230 93.98% 380 92.31% 79 92.41% 

Nov-03 1,096 91.33% 296 90.23% 56 94.64% 

Dec-03 1,147 91.98% 337 92.28% 70 90.00% 

Jan-04 1,229 92.68% 305 90.11% 73 94.52% 

Feb-04 1,121 91.70% 322 93.33% 67 92.54% 

Mar-04 1,162 90.45% 339 90.01% 79 90.33% 

Apr-04 1,095 91.51% 295 90.51% 62 90.32% 

May-04 1,125 92.44% 293 91.47% 62 96.77% 

Jun-04 1,128 90.15% 277 91.32% 74 92.13% 

Jul-04 1,106 94.48% 319 92.14% 69 92.75% 

Aug-04 1,345 90.62% 271 90.19% 67 90.06%

Santa Clara County Compliance 

San Mateo County Compliance 

Code 3: 90% / 12:00 Code 2: 90% / 17:00 

Code 3: 90% / 12:59 Minutes 

Month Requests Compliance Requests Compliance Month Requests Compliance 

Sep-03 3,785 95.88% 2261 93.42% Oct-03 2,939 93.70% 

Oct-03 3,913 95.54% 2182 92.03% Nov-03 2,872 94.20% 

Nov-03 3,913 95.54% 2182 92.03% Dec-03 3,173 92.80% 

Dec-03 3,770 96.02% 2128 94.39% Jan-04 2,835 94.70% 

Jan-04 4,314 96.48% 2323 93.44% Feb-04 2,812 94.70% 

Feb-04 3,924 95.65% 2203 92.85% Mar-04 2,716 94.60% 

Mar-04 3,704 96.79% 2138 92.46% Apr-04 2,780 93.10% 

Apr-04 3,982 95.61% 2387 92.54% May-04 2,803 94.00% 

May-04 3,749 96.46% 2320 92.77% Jun-04 2,748 93.60% 

Jun-04 3,878 96.13% 2351 93.23% Jul-04 2,880 92.20% 

Jul-04 3,853 96.80% 2253 93.86% Aug-04 2,764 91.40% 

Aug-04 4,201 96.60% 2154 92.75% Sep-04 2,887 91.50% 

Contra Costa County Code 3 Compliance 

West / East 95% / 10:00 Min. Central 90% / 10:00 Min. 

Month Requests Compliance Requests Compliance 

Sep-03 2,306 96.75% 1415 92.93% 

Oct-03 2,355 96.60% 1396 92.84% 

Nov-03 2,296 96.30% 1360 93.46% 

Dec-03 2,655 95.74% 1641 91.35% 

Jan-04 2,420 96.98% 1641 94.45% 

Feb-04 2,276 95.25% 1383 92.84% 

Mar-04 2,455 96.25% 1499 91.79% 

Apr-04 2,357 95.21% 1399 90.99% 

May-04 2,436 95.77% 1469 92.24% 

Jun-04 2,273 95.12% 1347 91.46% 

Jul-04 2,374 95.66% 1384 93.86% 

Aug-04 2,306 95.10% 1401 92.29%


Commitment to Clinical Quality 

Approach to Quality Improvement 

Job Descriptions 

Curricula Vitae for Medical Director 

Northern California Training Institute Description and Continuing Education Programs 

Continuing Education and Program Details 

Continuing Education Plan for Contra Costa County 

Hot Topics Continuing Education Brochure 

Trauma Symposium Brochure 

List of Onboard Ambulance Equipment 

ePCR Case Study

AMR’s Approach to Clinical Quality Improvement 

AMR’s approach to clinical quality improvement follows established best practices of 

the EMS industry. It starts with an approach to leadership that is characterized by a 

management team that leads by example to integrate quality improvement into the 

strategic planning process and throughout the entire organization and to promote CQI 

techniques in work practices. 

Our approach also includes information and analysis, managing the data needed for 

effective CQI. Since quality improvement is based on management by fact, 

information and analysis are critical to CQI success. AMR has been a long-term 

investor in quality, committing significant funding and resources to our clinical 

information systems. 

Strategic quality planning is another key aspect of our approach to clinical CQI, and 

it includes three major components: 

Developing long- and short-term organizational objectives for structural, 

performance, and outcome quality standards 

Identifying ways to achieve those objectives 

Measuring the effectiveness of the system in achieving quality standards 

Our approach also includes human resource development and management, 

working to develop the full potential of the EMS workforce. This effort is guided by 

the principle that the entire EMS workforce is motivated to achieve new levels of 

service and value. AMR (and its predecessors) founded and operates the largest 

Paramedic school and National Registry examination site in the nation, with a 17-year 

history of excellence. 

We also incorporate EMS process management into our approach to CQI, rewarding 

the creation and maintenance of high quality services. Within the context of quality 

improvement, process management refers to the improvement of work activities and 

work flow across functional or department boundaries. AMR recognizes that all

aspects of the organization ultimately contribute to quality patient care and, therefore, 

we have instituted quality improvement measures across the spectrum of our 

operations, including billing, customer service, and fleet maintenance. 

As part of our approach, we assess quality results, examining our organization's 

success at improving quality. Through our re-established Quality Leadership Council 

(QLC), we continuously review our results, measure the success of our CQI program, 

and make recommendations for improvement. The Council reports its findings to the 

Vice President of Operations, who co-chairs the Council meetings three times a year. 

At the same time, AMR recognizes that CQI processes are confidential and protected 

from disclosure. All system participants are required to enter into privacy agreements 

as required by law and that compel individuals involved to adhere to the confidentiality 

requirements of the process. 

Finally, our approach includes assessing the satisfaction of patients and other 

stakeholders, using a variety of methods. These include establishing a CQI Hotline 

giving customers and system participants the ability to leave commendations or 

suggestions for service improvements on a voice mailbox, with the hotline number 

publicized at local health care facilities, First Responder stations, and public safety 

agencies. AMR’s CES Coordinator is automatically notified via pager or email of any 

incoming calls, and incidents that require feedback are attended to by the end of the 

next business day.

SUMMARY: 

JOB DESCRIPTION 

RN/Continuous Quality Improvement Manager 

Contra Costa County Operations 

Assists the Director of Operations in the oversight, direction and evaluation of the delivery of 

clinical patient care services in the out-of-hospital setting by administrating the clinical 

quality improvement and quality assurance activities, training and continuing educational 

needs as determined by evaluation, and related processes of continuous quality improvement 

to enhance clinical services.. 

ESSENTIAL DUTIES AND RESPONSIBILITIES include, but are not limited to the 

following. Other duties may be assigned: 

Assists the Director of Operations with: 

Day-to-day staff supervision of CES operations within Contra Costa, County, California. 

Administration of a standardized and organized system of Clinical Quality Improvement 

designed to provide timely and thorough evaluation of all clinical patient care services 

provided. 

Administration of automated clinical databases containing detailed information about 

clinical patient care services provided. 

Administration of an on-going, formal peer review process for both validation of 

automated systems and clinical peer evaluation of patient care delivery and all factors 

affecting it. 

Supervision and direction of the day-to-day activities of the CES Coordinators and CES 

staff. 

Provides consultation and guidance on the detection, analysis, and improvement of 

individual or system factors found to affect patient care. 

Supervision and direction of the activities of the Clinical Data Analyst and Information 

Technologist in the management of the automated clinical databases, providing 

consultation and guidance on data manipulation and analysis. 

Supervision and direction of the activities of the Field Training Coordinator in the 

management of various programs of training and education (i.e., Health & Safety training, 

orientation training, driver training, and remedial training or education). 

Administration of organized programs of continuing education for EMTs, Paramedics, 

Nurses, Physicians and/or other allied healthcare personnel. Such programs would be 

designed and coordinated to meet educational requirements for maintenance of 

certification or licensure of such personnel.

Administration of organized programs of primary and continuing education for front-line, 

middle, and upper managers involved in the management of out-of-hospital healthcare 

systems. 

Development of department policies/procedures. 

Preparation of strategic plans (short and long term). 

Preparation of departmental budgets and annual objectives. 

Annual performance appraisals for departmental staff. 

Hiring and supervision of appropriate personnel to carry out the mission and assigned 

tasks. 

Monitoring income and expense through careful scrutiny of disbursements and review of 

program financial statements. 

Preparation of periodic reports concerning department activity and reconciliation of 

department income/expense reports and projected budgets. 

QUALIFICATION REQUIREMENTS: 

To perform this job successfully, an individual must be able to perform each essential duty 

satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or 

ability required. Reasonable accommodations may be made to enable individuals with 

disabilities to perform the essential functions. 

EDUCATION and/or EXPERIENCE: 

R.N. required. Three years experience in out-of-hospital care within the last 5 years; 

Experience working with adult learners in a vocational setting; Two years experience in an 

administrative or management level position; are all requirements. Experience developing 

budgets and strategic plans, as well as a bachelor's degree in a health related field or 

education is preferred. 

VERBAL & WRITTEN COMMUNICATION AND PRESENTATION SKILLS: 

Ability to read, analyze, and interpret the most complex documents. Ability to respond 

effectively to the most sensitive inquiries or complaints. Ability to write speeches and articles 

using original or innovative techniques or style. Ability to make effective and persuasive 

speeches and presentations on controversial or complex topics to top management, public 

groups, and/or health care professionals. 

MATHEMATICAL SKILLS: 

Ability to work with mathematical concepts such as probability and statistical inference and 

advanced algebra. Ability to apply concepts such as fractions, percentages, ratios, and 

proportions to practical situations. Ability to apply advanced mathematical concepts such as 

exponents and logarithms. Ability to apply mathematical operations to such tasks as 

frequency distribution, determination of test reliability and validity, analysis of variance, 

correlation techniques, sampling theory, and factor analysis.


Clinical & Educational Services Paramedic Coordinator 


SUMMARY: 

Plans, coordinates, and directs Clinical Quality Improvement activities designed to ensure 

continuous delivery of clinical services consistent with established standards by performing 

the following duties personally or through delegates. 


following. Other duties may be assigned: 

Reviews clinical data each morning to identify clinical issues and plan appropriate 

intervention. 

Reviews patient care reports as directed by established guidelines. 

Analyzes statistical data and clinical and procedural specifications to determine present 

standards and establish proposed quality and reliability expectancy of services rendered. 

Directs and conducts special studies for the purpose of analyzing available data to identify 

clinical performance above or below the expected standards of care. Identifies trends and 

determines the nature or origin to be either a system or individual issue, or a combination 

of the two. 

Formulates and maintains quality improvement objectives and coordinates objectives with 

patient care procedures in cooperation with other managers to maximize clinical and 

procedural reliability and minimize costs associated with excessive risk or liability. 

Coaches personnel to engage and participate in inspection and monitoring activities to 

ensure continuous adherence to clinical standards of quality patient care. 

Plans, promotes, and organizes training activities related to intervention, remediation and 

employee self-improvement to promote improved service quality and reliability. 

Maintains frequent communication, both written and verbal, with field personnel about 

issues of patient care. Personal interaction with field employees, to highlight positive 

issues as well as areas of concern accomplished via unit ride-alongs with direct 

observation and evaluation of patient care services. 

Investigates and responds to complaints regarding the quality of patient care or clinical 

services rendered. 

Establishes and maintains clinical files on clinical personnel. Creates and catalogs 

clinical information about the clinical performance of personnel. 

Liaisons with contractors, regulatory agencies, and healthcare facilities in matters of 

quality assurance and quality improvement, maintains frequent written and verbal 

communication. Attends and participates in structured patient care audits and organized 

external quality assurance or quality improvement activities.

Supervises and facilitates a peer review and or QLC committee for the purpose of 

promoting employee intervention into the improvement of clinical services. 







Bachelor's degree in health related field or education and two to four years experience in outof-hospital 

care is required. 

VERBAL & WRITTEN COMMUNICATION AND PRESENTATION SKILLS: 

Ability to read, analyze, and interpret professional journals, technical procedures, or 

governmental regulations. Ability to write reports, business correspondence, and 

procedure manuals. 

Ability to effectively present information and respond to questions from individuals or 

groups of employees, managers, health care professionals, and the general public. 

Ability to write articles for publication. 

CERTIFICATES, LICENSES, REGISTRATIONS: 

Current California licensure as a Paramedic (EMT-P) is required. Current provider level 

recognition in Basic Cardiac Life Support (BCLS), Advanced Cardiac Life Support (ACLS), 

Pediatric Advanced Life Support (PALS) and Basic Trauma Life Support (BTLS) or Pre- 

Hospital Trauma Life Support (PHTLS) is also required. Appointees to this position must 

obtain Instructor and/or Affiliate Faculty appointments in ACLS, PALS and BTLS within the 

first 6 months of employment, and maintain them. 

Alternative licenses or certifications will be considered. (i.e., Registered Nurse, Mobile 

Intensive Care Nurse, Physician's Assistant, or Physician,etc.) 

COMPUTER SKILLS: 

Functional competency with personal computers and ability to type at 40 words per minute is 

required. Proficiency with software programs such as Microsoft Office, Windows 2000 or 

XP, Access, Excel, PowerPoint, etc. is preferred. 

PHYSICAL DEMANDS: 

The physical demands described here are representative of those that must be met by an 

employee to successfully perform the essential functions of this job. Reasonable 

accommodations may be made to enable individuals with disabilities to perform the essential 

functions. 

While performing the duties of this job, the employee is regularly required to use hands to 

finger, handle, or feel objects, tools, or controls; reach with hands and arms; and talk or hear. 

The employee frequently is required to stand. The employee is occasionally required to walk; 

sit; climb or balance; stoop, kneel, crouch, or crawl; and smell.

The employee must occasionally lift and/or move up to 100 pounds. Specific vision abilities 

required by this job include close vision, distance vision, color vision, peripheral vision, depth 

perception, and the ability to adjust focus. 

WORK ENVIRONMENT: 

The work environment characteristics described here are representative of those an employee 

encounters while performing the essential functions of this job. Reasonable accommodations 

may be made to enable individuals with disabilities to perform the essential functions. 

While performing the duties of this job, the employee frequently works near moving 

mechanical parts and in outside weather conditions. The employee occasionally works in 

high, precarious places and is occasionally exposed to wet and/or humid conditions and fumes 

or airborne particles. 

The noise level in the work environment is usually moderate 

COMMENTS: 

On-going reinforcement of the Quality Improvement Coordinator's own clinical skills and 

abilities must be achieved. In order for the Quality Improvement Coordinator to maintain 

first-hand knowledge that is current and to maintain excellent working rapport with clinical 

personnel, it is imperative that the Coordinator be active in and among field personnel. 

24-hour accessibility will be required (pager) and some travel may be necessary to maintain 

contact with all parts of the operating division or region.

SUMMARY: 


Paramedic Field Training Coordinator 


Develops and conducts required training programs for out-of-hospital employees of the 

organization. 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties 

may be assigned. 

Confers with Operations Managers and the Director of Clinical Services to gain 

knowledge of work situations requiring training for employees to better understand 

changes in policies, procedures, and comply with statutes and regulations using advanced 

technologies. 

Formulates teaching outline and determines instructional methods such as individual 

training, group instruction, lectures, demonstrations, conferences, meetings, and 

workshops. 

Develops and/or utilizes teaching aids such as training handbooks, demonstration models, 

multimedia visual aids, computer tutorials, and reference works. 

Conducts training sessions covering specified areas such as new employee orientation, 

hazardous materials, infection control, illness and injury prevention, safety, 

 

documentation, internship and precepting, ACLS, CPR, MCI, health and safety practices, 

public relations, refresher and upgrade training. 

Measures progress and to evaluate effectiveness of training programs. 

Monitors progress of employees during training periods. 







Bachelor's degree in health related field or education and two to four years experience in outof-hospital 

care. 

LANGUAGE SKILLS: 

Ability to read and interpret documents such as safety rules, operating and maintenance 

instructions, and policy/procedure manuals. Ability to write routine reports and

correspondence. Ability to speak effectively before groups of students, customers or 

employees, and to individuals. 


Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, 

common fractions, and decimals. Ability to compute rate, ratio, and percent and to develop 

and interpret bar graphs. 

REASONING ABILITY: 

Ability to solve practical problems and deal with a variety of concrete variables in situations 

where only limited standardization exists. Ability to interpret a variety of instructions 

furnished in written, oral, diagram, or schedule form. 


Current California certification as a Mobile Intensive Care Paramedic is required. Instructor 

certifications in courses such as Driver Training, Hazardous Materials, ACLS, PALS, BTLS, 

CPR and other related programs are preferred. 

OTHER SKILLS and ABILITIES: 


Familiarity with personal computers and ability to type at 40 words per minute is required. 

Proficiency with software programs such as Microsoft Word, DOS 6.2, Windows 3.1, and 

Excel is preferred. 





functions. 

While performing the duties of this job, the employee is regularly required to talk or hear. The 

employee frequently is required to stand; use hands to finger, handle, or feel objects, tools, or 

controls; and reach with hands and arms. The employee is occasionally required to walk; sit; 

climb or balance; stoop, kneel, crouch, or crawl; and smell. 







may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee occasionally works near moving 

mechanical parts; in high, precarious places; and in outside weather conditions and is 

occasionally exposed to wet and/or humid conditions and fumes or airborne particles. 

The noise level in the work environment is usually moderate 

COMMENTS: 

This individual will conduct a number of training programs each month throughout the year, 

on-site at the various operating division locations. Due to the diversity of the geographic 

locations from which operations are conducted, it is expected that significant travel will be 

involved in the position. An ability to maintain student records via computer and submit 

them for processing via modem will be necessary and preferred. 

On-going reinforcement of the Field Training Coordinator's own clinical skills and abilities 

must be achieved. In order for the Field Training Coordinator to maintain first-hand 

knowledge that is current and to maintain excellent working rapport with clinical personnel, it 

is imperative that the Coordinator be active in and among field personnel.


EMS Epidemiologist / Clinical Data Analyst 


SUMMARY: 

Designs and maintains logical and physical clinical data bases and coordinates clinical 

data base development as part of the Clinical & Educational Services team by performing 

the following duties. 


following. Other duties may be assigned. 

Reviews project requests describing clinical data base user needs. 

Estimates time required to accomplish projects. 

Determines if project requires creating a series of new programs or modifying 

existing programs that access data stored in clinical data base. 

Attends specification meetings with CES team members and the Director of Clinical 

& Educational Services to determine scope and limitations of projects. 

Assist with data collection and participate in research studies with other CES staff. 

Develops and maintains a clinical data base management system manual for making 

changes to clinical data base such as defining, creating, revising, and controlling data 

base. 

Updates and revises company definition of data as defined in State and Federal EMS 

data dictionaries (information about data, including name, description, source of data 

item, and key words for categorizing and searching for data item descriptions). 

Incorporates changes or updates to EMS data dictionary descriptions upon approval 

of the Director of Clinical & Educational Services, including type, structure, and 

intended use of data within system. 

Develops data model describing data elements and how they are used. 

Creates and revises descriptions to enable programmer to understand how programs 

should access data. 

Writes descriptions of how users access data and request reports and output from the 

clinical data base. 

Writes physical data base description such as location, space requirements, and 

access method, to protect company data resources against unauthorized access and 

accidental destruction


To perform this job successfully, an individual must be able to perform each essential 

duty satisfactorily. The requirements listed below are representative of the knowledge, 

skill, and/or ability required. Reasonable accommodations may be made to enable 

individuals with disabilities to perform the essential functions. 


Associate's degree or other education and one to two years database experience is 

preferred. Other healthcare experience, experience with information management 

systems, and/or knowledge of medical terminology or Emergency Medical Services also 

preferred. 


Ability to read, analyze, and interpret professional scientific and technical journals. 

Ability to respond to common inquiries or complaints from customers, regulatory 

agencies, or members of the health care community. Ability to write speeches and articles 

for publication. Ability to effectively present information to the Director of Clinical 

Services, top management, public groups, health care professionals and boards of 

directors. 


Ability to work with mathematical concepts such as probability and statistical inference 

and advanced algebra. Ability to apply concepts such as fractions, percentages, ratios, 

and proportions to practical situations. 


Ability to define problems, collect data, establish facts, and draw valid conclusions. 

Ability to interpret an extensive variety of technical instructions in mathematical or 

diagram form and deal with several abstract and concrete variables. 


Extensive familiarity with personal computers and ability to type at a minimum of 40 

words per minute. Proficiency with software programs such as Microsoft Word, Excel, 

Access, DOS, Windows 3.1, Windows 95 and Windows NT is preferred. 




accommodations may be made to enable individuals with disabilities to perform the 

essential functions. 

While performing the duties of this job, the employee is regularly required to use hands 

to finger, handle, or feel objects, tools, or controls and talk or hear. The employee 

frequently is required to sit. The employee is occasionally required to stand and walk. 

2

The employee must occasionally lift and/or move up to 25 pounds. Specific vision 

abilities required by this job include close vision, color vision, and the ability to adjust 

focus. 


The work environment characteristics described here are representative of those an 

employee encounters while performing the essential functions of this job. Reasonable 

accommodations may be made to enable individuals with disabilities to perform the 

essential functions. 


mechanical parts and in outside weather conditions. 

The noise level in the work environment is usually moderate. 

COMMENTS: 

Due to the 24-hour nature of the data system utilized and the fact that a significant 

portion of the process is tied to automated procedures executed from multiple remote 

sites throughout the operating areas, 24-hour access by pager will be required, as well as 

some travel for system adjustment and troubleshooting. Some of these adjustments may 

be accomplished remotely via modem. All associated travel expenses will be reimbursed 

in accordance with published company standards. 

3


Director of Clinical & Educational Services 


SUMMARY: 

Oversees, directs and evaluates the delivery of clinical patient care services in the out-ofhospital 

setting by administrating the clinical quality improvement and quality assurance 

activities, primary training and continuing educational needs as determined by evaluation, and 

related processes of continuous quality improvement to enhance clinical services. 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties 

may be assigned. 

Administrates a standardized and organized system of Clinical Quality Improvement 

designed to provide timely and thorough evaluation of all clinical patient care services 

provided. 

Administrates an Automated Clinical Database containing detailed information about 

clinical patient care services provided. 

Administrates an on-going, formal peer review process for both validation of automated 

systems and clinical peer evaluation of patient care delivery and all factors affecting it. 

Supervises and directs the activities of Quality Improvement Coordinators and provides 

consultation and guidance on the detection, analysis, and improvement of individual or 

system factors found to affect patient care. 

Supervises and directs the activities of the Clinical Data Analysts in the management of 

the Automated-Clinical Database, providing consultation and guidance on data 

manipulation and analysis. 

Administrates standardized, organized programs of primary EMT and Paramedic 

education, as well as other emergency, critical care, or out-of-hospital primary education 

programs as deemed necessary. 

Administrates organized programs of continuing education for EMTs, Paramedics, 

Nurses, Physicians and/or other allied healthcare personnel. Such programs would be 

designed and coordinated to meet annual or bi-annual educational requirements for 

maintenance of certification or licensure of such personnel. 

Administrates organized programs of primary and continuing education for front-line, 

middle, and upper managers involved in the management of out-of-hospital healthcare 

systems. 

Administrates an automated database containing detailed information about certification, 

licensure, and educational status of all personnel associated with patient care services in 

accordance with applicable regulatory or statutory requirements. 

Development of department policies/procedures.

Preparation of strategic plans (short and long term). 

Preparation of departmental budgets and annual objectives. 

Hiring and supervision of appropriate personnel to carry out the mission and assigned 

tasks. 

Monitoring income and expense through careful scrutiny of disbursements and review of 

program financial statements. 

Preparation of annual reports concerning department activity and reconciliation of 

department income/expense reports and projected budgets. 

Supervises and directs the activities of the Programs Administrator and provides 

consultation and guidance in the direction of the primary EMT and Paramedic program 

coordinators, instructors, course medical directors, and the Field Training Coordinators. 







Bachelor's degree in a health related field or education and three years experience in out-ofhospital 

care within the last 5 years; Experience working with adult learners in the vocational 

setting; Three years experience in an administrative or management level position; and 

experience developing and administering budgets and strategic plans is required. 


Ability to read, analyze, and interpret the most complex documents. Ability to respond 

effectively to the most sensitive inquiries or complaints. Ability to write speeches and articles 

using original or innovative techniques or style. Ability to make effective and persuasive 

speeches and presentations on controversial or complex topics to top management, public 

groups, and/or health care professionals. 


Ability to work with mathematical concepts such as probability and statistical inference and 

advanced algebra. Ability to apply concepts such as fractions, percentages, ratios, and 

proportions to practical situations. Ability to apply advanced mathematical concepts such as 

exponents and logarithms. Ability to apply mathematical operations to such tasks as 

frequency distribution, determination of test reliability and validity, analysis of variance, 

correlation techniques, sampling theory, and factor analysis. 


Ability to apply principles of logical, scientific and/or critical thinking to a wide range of 

intellectual and practical problems. Ability to deal with nonverbal symbolism (formulas, 

scientific equations, graphs, etc.,) in its most difficult phases. Ability to deal with a variety of 

abstract and concrete variables. 

2


Current California licensure as a Mobile Intensive Care Paramedic is required; and, 

concurrent California licensure as a Registered Nurse is preferred. Instructor and/or State or 

National Affiliate Faculty appointments in Advanced Cardiac Life Support (ACLS), Pediatric 

Advanced Life Support (PALS), and Basic Trauma Life Support (BTLS) are also desirable. 

OTHER SKILLS and ABILITIES: 


Extensive familiarity with personal computers and ability to type at a minimum of 40 words 

per minute. Proficiency with software programs such as Microsoft Office 2000, statistical 

packages, and other industry specific software is preferred. 





functions. 

While performing the duties of this job, the employee is regularly required to talk or hear. The 

employee frequently is required to sit; use hands to finger, handle, or feel objects, tools, or 

controls; and reach with hands and arms. The employee is occasionally required to stand; 

walk; climb or balance; stoop, kneel, crouch, or crawl; and smell. 







may be made to enable individuals with disabilities to perform the essential functions. 


mechanical parts; in high, precarious places; and in outside weather conditions and is 

occasionally exposed to wet and/or humid conditions and fumes or airborne particles. 

The noise level in the work environment is usually moderate. Some travel within the region 

will be required but should be held to the amount necessary for cost-effectiveness. 

COMMENTS: 

The Director of Clinical Services will oversee an essentially autonomous division of activities 

and personnel focused on clinical excellence and improvement of patient care delivery at the 

individual and system levels. While these functions will require a high degree of both 

personnel and patient confidentiality, it is expected that the Director will act as the primary 

liaison between this division and the other operating divisions, frequently interacting with 

managers, directors and administrators at various levels internally. Further, the Director of 

Clinical & Educational Services will report directly to the Vide President of Administrative & 

3

Support Services so as to remain outside the direction or influence of the operational authority 

structure. In this way, the credibility of the process and its unbiased validity will be assured. 

Externally, it is expected that the Director of Clinical & Educational Services will liaison 

either directly, or through assigned subordinates, with any agency, organization or allied 

healthcare facility requiring such a role or the provision of information about the state or 

status of clinical care provided. Speeches, presentations, and proposals will frequently be 

employed for the communication of such information to external entities. 

4

SUMMARY 


Information Technologist 


Under the supervision of the Operations Director and with guidance from the Service and 

Support IT Manager, manages the support for Contra Costa County, including, but not limited 

to installing, modifying, and making all repairs to microcomputer hardware and software 

systems, and provide technical assistance to AMR, EMS, CDF, Fire, Hospital and County 

Coroner users by performing the following duties. 

PROJECT MANAGEMENT DUTIES 

Oversee installation and maintenance updates to all systems requiring Multi-EMS Data 

System (MEDS) and Hospital Administration Reporting Tool (HART). 

Work closely with AMR IT, Clinical and Educational Services (CES) and local 

Operations management as well as the Contra Costa EMS agency and field staff to 

provide overall system support as required for proper system operation. 

Participate in key committees and attend meetings as required for good coordination of 

effort and proper communication of system status. 

Function as a team member within the AMR IT department as well as Contra Costa 

Operations/CES, and the EMS Agency to accomplish the goals of the electronic PCR data 

system. 

Generate and maintain proper documentation for technical support at the AMR IT Help 

Desk. 

Assume responsibility for on site issues with MEDS and HART systems following all 

issues through to resolution. 

TECHNICAL DUTIES 

Troubleshoot problems related to microcomputer hardware / software. 

Install / replace hardware components on microcomputer systems. 

Install/update microcomputer software. 

Maintenance of microcomputer systems and peripherals. 

Interact with all microcomputer users and their issues. 

Document and revise all microcomputer procedures. 

Will be required to travel between sites as necessary. 

1

Assist network and telecom groups when on site as necessary. 

Perform other duties as assigned. 

QUALIFICATIONS 

Required 

Ability to negotiate with Information Technology and other departments to assure that 

the end user’s interests and needs are known and met. 

Ability to establish and maintain effective and cooperative working relationships with 

others. 

Ability to manage and execute large scale projects involving multiple agencies and 

levels of users. 

Ability to resolve microcomputer hardware/software problems. 

Ability to interact with users in a professional and courteous manner. 

Experience with MS DOS, MS Windows NT/2K, and MS Office applications. 

Experience with MS Windows NT/2K Networks. 

Excellent verbal and communication skills. 

Preferred 

A+ Certified, MCP, MCSE, Cisco Router 

Experience with MS Exchange. 

Experience with microcomputer system user training. 

2

License: 

Education: 

Gary William Tamkin, M.D., F.A.C.E.P. 

4 Valley High 

Lafayette, California 94549 

(925) 962-9414 

California Lic. #G078338; DEA #BT3935737 

Diplomat, American Board of Emergency Medicine 

Fellow, American College of Emergency Physicians 

EMS Medical Directors Course, National Association of EMS Physicians 

Advanced Cardiac Life Support & Advanced Trauma Life Support Certified 

Certified Medical Radio Operator (MRO)/Base Station Physician 

Approved Supervisor of Physician Assistants 

Resident Physician, Department of Emergency Medicine, Highland General 

Hospital/ University of California San Francisco 

Oakland, California 

June 1992 - July 1996 

Chief Resident, 1995 - 1996 

President, California Emergency Medicine Resident’s Association, 1994 - 1995 

Secretary/Treasurer, California Emergency Medicine Resident’s Association, 

1993 - 1994 

M.D., University of California, Irvine College of Medicine 

Irvine, California 

September 1987 - June 1992 

Student Body President, Senior Year 

Senior Humanitarian Award, Outstanding Senior 

Society for Academic Emergency Medicine Award of Excellence 

Class President, Junior Year 

President, American Medical Student Association, Irvine Chapter 

Awarded Western Region Outstanding Chapter 1990 

B.A., Brown University 

Providence, Rhode Island 

Major: Community Health 


Honors Graduate 

Committee Member, Brown University Health Services Advisory Board 

1


4 Valley High 


(925) 962-9414 

Graduate, The Harvard High School 

North Hollywood, California 


Student Body President, Senior Year 

Head Master’s Award, Outstanding Senior 

Dartmouth Book Prize, Outstanding Junior 

Continuing Education: 

Physician Management I Seminar completed August 1997 

Physician Management II Seminar completed February 1998 

Turning Conflict into Cooperation completed February 2001 

With plans to complete a certificate in Medical Management through 

The American College of Physician Executives. 

Emergency Medicine Experience: 

Bay Area Medical Director, American Medical Response 

Livermore, California 

April 2001 - Present 

Assistant Medical Director, Emergency Services, NorthBay Medical Center & 

VacaValley Hospitals 

Fairfield, California 

July 1997 - Present 

Assistant Clinical Professor, Division of Emergency Medicine, 

University of California San Francisco 

San Francisco, California 


Attending Physician, Alameda County Medical Center/ Highland General 

Hospital 



Physician Consultant, Vacaville City Fire Department 

Vacaville, California 

August 1998 – December 2001 

EMS Medical Director, NorthBay Medical Center 


July 1996 - December 2001 

2


4 Valley High 


(925) 962-9414 

Medical Director, Chabot Paramedic College 

Hayward, California 

January 1999 - April 2001 

Emergency Physician, VacaValley Hospital 

Vacaville, California 


Physician Consultant, Alameda County Sheriff’s Department 

Alameda, California 

August 1993 - Present 

Community Emergency Department Liaison, Alameda County Medical Center/ 

Highland General Hospital 


January 1999 - Present 

EMS Medical Director, OEA Aerospace, Inc. 


January 1997 - January 2000 

Consultant, Kent County Emergency Medical Services 


January 1985 – January 1986 

Emergency Medical Technician, Warwick City Fire Department 

Warwick, Rhode Island 

July 1985 – July 1986 

Director, Brown Emergency Medical Services 


August 1983 – August 1984 

Emergency Medical Technician, Tarzana Medical Center 

Los Angeles, California 

September 1982 – September 1983 

Emergency Medicine Committees: 

American College of Emergency Physicians, California Chapter, California 

Immediate Past President, 2003 – 2004 

President, 2002 - 2003 

President Elect, 2001 – 2002 

Treasurer, 2000 – 2001 

Director, 1999 – 2004, 1994 – 1995 

3


4 Valley High 


(925) 962-9414 

Member, National ACEP By-Laws Committee, 2001 - Present 

Chairman, 2002 Legislative Leadership Conference 

Co-Chairman, Emergency Medical Services Committee, 1999 - 2000 

Co-Chairman, Membership Committee, 1999 - 2000 

Co-Chairman, 2000 Scientific Assembly, Laguna Niguel, California 

Co-Chairman, 1999 Scientific Assembly, San Diego, California 

Marketing Director, 1998 Scientific Assembly, Monterey, California 

Co-Chairman, Membership Committee, 1995 - 1996 

Councilor, National ACEP Council, 1999 – 2003, 1994 – 1995 

California Emergency Medicine Political Action Committee, Sacramento, California 

Director, 2000 - Present 

Solano County Emergency Medical Services Cooperative, 

Solano County, California, 1996 - 2002 

Director 

Physicians Forum 

Emergency Medical Care Committee 

Pre-hospital Care Committee 

Chairman, Quality Improvement Committee 

Helicopter Utilization Review Committee 

NorthBay Medical Center, Fairfield, California, 1996 - Present 

Bylaws Committee 

Trauma Committee 

Interdisciplinary Committee 

Society for Academic Emergency Medicine, Michigan 

Disaster Medicine Subcommittee, 1994 – 1995 

California Medical Association 

Alternative Representative, Emergency Medical Section 

Young Physician Forum, 1996 

California Emergency Medicine Resident’s Association, California 

President, 1994 - 1995 

Secretary/Treasurer, 1993 – 1994 

Orange County Medical Association, Orange County, California 

Emergency Care Committee, 1991 - 1992 

Selected Emergency Medicine Publications: 

Tamkin, G., Emergency Medical Services & Gastroenterological Emergencies in: Pre-Test Self - 

Assessment And Review: Clinical Emergency Medicine, third edition, S.P. Promes, Ed. The 

McGraw-Hill Co., New York, N.Y. 2004. (In press) 

4


4 Valley High 


(925) 962-9414 

Tamkin, G., Seizure in: Clinical Cases in Emergency Medicine, first edition, B.K.Simon, Ed. 

The McGraw-Hill Co., New York, N.Y. 2004. (In press) 

Tamkin, G., Emergency Medical Services & Gastroenterological Emergencies in: Pre-Test Self - 

Assessment And Review: Clinical Emergency Medicine, second edition, K.L. Koenig, Ed. The 

McGraw-Hill Co., New York, N.Y. 2000. 

Tamkin, G., Reardon, D., The Emergency Department Approach to Nausea and Vomiting in: 

The Pathophysiology and Clinical Approach to Nausea and Vomiting, V. Heinreich and G. 

Bloomfield, Eds. The C.V. Mosby Co., St. Louis, MO. 1997. 

Tamkin, G., Diarrhea: The Emergency Department Approach to the Acute Scrotum. Emergency 

Medicine Magazine, 2000. 

Tamkin, G., Levitt, A.., Gee, G., Snoey, E., Prevalence of Cardiac Valve Abnormalities in 

Asymptomatic Intravenous Drug Users Presenting in an Urban Emergency Department. Acad 

Emerg Med, 1999, 6:9, 911 - 915. 

Tamkin, G., Oral Abstract Presentation, Society for Academic Emergency Medicine Annual 

Meeting, Washington, D.C., 1997. 

Tamkin, G., Diarrhea: Infection or Food Poisoning? Emergency Medicine Magazine, June 1998. 

Tamkin, G., Emergency Medical Services Systems. Lesson in ACEP Critical Decisions in 

Emergency Medicine, Vol. XII, Lesson 20, June 1998. 

Tamkin, G., Snoey E., Diarrhea. Lessons in ACEP Critical Decisions in Emergency Medicine, 

Vol. XI, Lesson 12, August 1997. 

Tamkin, G., Emergency Management of Brown Recluse Spider Bites: A Review. Global 

Emergency Medicines Archives, 1996 (http://www.gema.library.UCSF.edu: 8081). 

Promes, SP., Tamkin, G., Koening, KL., A Survey of Pre-hospital Resuscitation Policies in 

California: Are We Transporting Dead People? Pre-hosp and Disaster Medicine. 1994; 9:S64 

(abstract). Poster Presentation, National Association of Emergency Medical Service Physicians 

Annual Meeting, Portland, Oregon, 1994. 

Koening, KL., Tamkin, GW., Do-Not-Resuscitate Orders: Where are they in the pre-hospital 

care setting? Pre-hosp and Disaster Medicine 1993; 8:51. 

Tamkin, G., A Survival Guide for Interns. (Letter) Res and Staff Phys. 1992:38 (11): 102. 

5


4 Valley High 


(925) 962-9414 

Selected Emergency Medicine Lectures: 

2001-present Program Chair, Hot Topics in EMS, and “Lessons from the Street”: A 

Monthly Continuing Education Series for Paramedics and Nurses 

presented by American Medical Response. 

10/12/99 “You’re the Base Station Physician: What do you do Next? Case 

Studies in On - Line Medical Control.” 1999 American College of 

Emergency Physicians Scientific Assembly, Las Vegas, CA. 

10/14/99 “The Emergency Department Approach to the diagnosis and 

Management of the Acute Scrotum.” 1999 American College of 

Emergency Physicians Scientific Assembly, Las Vegas, CA. 

10/15/98 “Acute Diarrhea: Infection or Food Poisoning?”, 1998 American 

College of Emergency Physicians Scientific Assembly, San Diego, 

CA. 

10/16/97 “Acute Diarrhea: Infection or Food Poisoning?”, 1997 American 

College of Emergency Physicians Scientific Assembly, San 

Francisco, CA. 

04/10/97 “Cervical Spine Injuries: Up Close and Personal.”, 1997 UCSF 

Advances in Emergency Medicine, San Francisco, CA. 

02/19/97 “Pain Control and Conscious Sedation in Children.”, Grand 

Rounds, Department of Pediatrics, UCSF School of Medicine, San 


11/21/96 “Paramedic Education and Performance Evaluation: A Case Study 

of the Blue Angels.” Solano County EMS Base Station Meeting, 

Fairfield, CA. 

10/29/96 “The Emergency Physician Approach to Diagnostic Study of the 

Cervical Spine.” UCSF Radiology Technician Conference, San 


09/19/96 “Trauma Transport: All Dressed but Nowhere to Go.” Solano 

County EMS Base Station Meeting, Fairfield, CA. 

11/15/95 “The Emergency Department Approach to the Evaluation and 

Treatment of Pneumonia.”, Alameda County Medical Center/ 

Highland General Hospital, Oakland, CA. 

6


4 Valley High 


(925) 962-9414 

06/02/95 “The Emergency Medicine Round Table: Your First Job. What are 

the Options?” (Chairman) CAL/ACEP Scientific Assembly, 

Santa Barbara, CA. 

01/24/95 “First Annual California Emergency Medicine Resident’s 

Symposium.” Chairman, Manhattan Beach, CA. 

06/08/94 “Pain Control and Conscious Sedation in the Emergency 

Department.” Alameda County Medical Center/ Highland 

General Hospital, Oakland, CA. 

Professional Organizations: 

American College of Emergency Physicians 

American Medical & California Medical Associations 

Society for Academic Emergency Medicine 

National Association of EMS Physicians 

Emergency Medical Directors Association of California 

American College of Physician Executives 

National Eagle Scout Association 

Extracurricular Activities: 

Daddy, Husband, Home Owner, Fitness, Travel, Scuba Diving 

Excellent References Furnished Upon Request. 

7

Northern California Training Institute (NCTI) 

NCTI was founded in 1988 and maintains seven campuses stretching from Santa 

Barbara County in the south to Siskiyou County in the north, including a campus in 

Contra Costa County through Los Medanos College. NCTI is the largest Paramedic 

training school in the United States, graduating more than 500 Paramedics annually. It 

is also the largest school ever accredited by the Commission on the Accreditation of 

Allied Health Education Programs (CAAHEP). In addition, NCTI is the largest 

National Registry testing site in the nation, testing more than 850 candidates each year. 

Finally, NCTI is recognized by both the California Board of Registered Nursing and 

California EMS Authority as an accredited continuing education provider. Through its 

seven campuses, NCTI offers the following programs: 

Program Course Hours Courses Offered 

Per Year 

Annual Students 

EMT-Basic 138 12 400 

EMT-Basic 

Refresher 

24 8 300 

EMT-Paramedic 1,200 15 500 

NCTI also offers national registry exams, exam preparations, and refresher courses. 

Additionally, NCTI offers continuing education program as an affiliate training center 

for: 

American Heart Association Training Center: ACLS, PALS, CPR, AED 

certification 

American College of Emergency Physicians: BTLS certification 

American Academy of Pediatrics: PEPP certification 

National Association of EMTs: AMLS (Advanced Medical Life Support) 

All AMR field personnel are required to maintain their certifications through 

Continuing Education (CE) courses. Paramedics must obtain at least 24 hours of CE 

per year or 48 hours over a two-year period, while EMTs must obtain at least 12 hours 

of CE per year or 24 hours over a two-year period.

All courses taught by or on the behalf of AMR use highly qualified instructors, 

including EMTs, Paramedics, Nurses, Physicians and other health professionals. The 

CES Department also offers in-house CE using a vast array of educational programs, 

including interactive CD-ROM topics, a video loan program, classroom instruction, 

skills practice, and evaluation. To conduct the training, the CES department employs 

FTOs and instructors trained and certified in the courses they teach. 

Examples of CE classes offered in house, at no cost to employees, include: 

Risk and Safety Issues Crime Scene Preservation 

CPR for the Healthcare Provider WMD Awareness 

Geriatric Emergency Medicine Assaultive Behavior Management 

Effective Patient Communications Practicum on infrequently used 

and Advocacy 

skills 

Multiple Casualty Incident Drills AED 

Driver Training Basic Trauma Life Support (BTLS) 

Advanced Airway Management Advanced Cardiac Life Support 

(ACLS) 

National Incident Management Pediatric Education for Prehospital 

System 

Personnel (PEPP) 

Incident Command System 100 

(AMR provided); ICS 200 and 300 

(through the CA Ambulance 

Assoc.) 

Ongoing stress reduction program

CONTINUING EDUCATION PROGRAM DETAILS 

PREPARATION FOR MULTI-CASUALTY RESPONSE 

All employees receive training in the Incident Command System (ICS), which 

defines the duty and function of each person involved in managing an incident. 

Under the new contract, all of our Field Supervisors will receive Ambulance 

Strike Team Leader Training. 

ASSAULTIVE BEHAVIOR MANAGEMENT TRAINING 

This eight hour hands-on class consists of four components: 1) avoiding violence 

(care versus combat); 2) restraint asphyxia; 3) effective restraints; and 4) alcohol, 

drug abuse and mental health issues for pre-hospital providers. 

INFECTION CONTROL 

AMR has a comprehensive infection control program that includes specific 

policies and procedures to help reduce the risk of employee exposure to airborne, 

bloodborne, droplet, and contact pathogens. Key elements of the program are 

also reinforced as the Codes of Safe Practice. These codes are considered work 

rules under existing labor agreements and clearly identify consequences for noncompliance, 

up to and including termination. Before their first assignment in the 

field, employees are required to complete detailed education and training on our 

infection control policies, procedures, and exposure prevention methods. In 

addition, employees complete annual refresher classes on these subjects. 

CRITICAL INCIDENT STRESS MANAGEMENT 

AMR wholly supports the goals, objectives, and efficacy of Critical Incident 

Stress Debriefing (CISD)/Management teams. Our CISD program provides indepth 

training on the various aspects of CISD, including need recognition,

monitoring responders, conducting debriefing sessions, and a particularly valuable 

component incorporating responder families into the process. It covers: 

Pre-incident traumatic stress 

education 

Administrator and supervisor stress 

education and support programs 

Continuing stress education 

techniques 

Critical incident stress team 

Significant other support services Family support services 

Peer counseling Specialty debriefings for citizen 

groups when necessary 

On scene support services Individual intervention (one-on-one 

support) 

Disaster intervention services 

(demobilizations or de-escalations) 

Defusings 

Debriefings Follow-up and referral services after 

critical incident interventions 

Support for personnel involved by 

informal debriefings 

Chaplain service 

Research and development Referrals to Employee Assistance 

Program for in-depth stress reduction 

and/or counseling 

We also recognize that the emotional impact of a critical incident may go further 

than just the personnel actually involved in the incident. It can also affect family 

members and significant others. Therefore, we have developed a four-hour CISD 

course designed specifically for these loved ones. The course offers insight about 

behaviors and emotions a caregiver may experience and provides family members 

with methods they can use to assist the caregiver in coping with critical incident 

stress. 

Under the new contract, Peer Counselor level training in Critical Incident Stress 

Management will be required for all supervisors. As discussed earlier and 

covered in greater detail below, we will also establish business rules within our 

ePCR system to electronically “flag” potential critical incidents in real time for 

immediate supervisor and CISD team response.

HOMELAND SECURITY 

In this time of uncertainty, AMR has placed an added focus on domestic 

preparedness. To that end, all employees receive annual education in areas of 

nuclear, biological, and chemical events. By ensuring that our staff is prepared, 

we believe they will be able to continue serving the public during difficult times. 

All of our field personnel are instructed in disaster preparedness and are taught to 

ensure personal safety first. Topics include: 

Natural gas shutoff 

Electricity shutoff 

Fire extinguisher operations 

Basic navigation 

Coping techniques 

All field personnel are also required to successfully complete the federal 

Hazardous Materials (HazMat) first responder awareness program, which is 

included as part of our annual training module. Additionally, AMR will 

participate in community based training and disaster drill/readiness exercises.

The Continuing Education Plan for Contra Costa County 

Currently the county mandates for Paramedics: 

Pediatric Education for Prehospital Care Providers 

Advanced Cardiac Life Support 

Basic Trauma Life Support or Prehospital Trauma Life Support 

Basic Life Support CPR for the Professional Rescuer 

Pediatric Advanced Life Support (CCT-P) 

Infrequent Skills 

Working under the NCTI Training Center, AMR Contra Costa CES will work with 

the EMS Coordinators at the county fire departments to create a training process 

and schedule that provides standardized, high quality education to EMS 

providers in Contra Costa County at no cost to the providers. 

With oversight from AMR, the Coordinators for AMR, Contra Costa County Fire 

Protection District, East Contra Costa County Fire Protection District, Moraga- 

Orinda Fire Protection District and San Ramon Fire Protection District, will build a 

yearly calendar of required classes. These classes will be done in multiple county 

locations by a blend of agency instructors. 

Benefits would include: 

No cost to the employees 

No cost to the County or Fire Department agencies 

Standardizing training 

Including Medical Directors as instructors will allow them the opportunity to 

have direct communication with the field 

Inclusion of smaller fire departments like El Cerrito, Rodeo-Hercules and 

Pinole 

Integrated training AMR and fire personnel 

Utilization of NCTI training equipment so agencies don’t have to absorb 

the expense 

Sharing and standardization of county protocol update training 

Also, AMR has the ability to offer scheduling and geographic flexibility that no 

one else can. Many of the county ALS providers live outside Contra Costa 

County. With the vast network of satellite classes offered by NCTI, the Contra 

Costa paramedic, could take the class in most any of the Bay Areas counties. 

The education plan would also be inclusive of other county-wide continuing 

education offerings that would be a shared responsibility with EMS and county 

ALS provider agencies: Instructors are already in place for:

The Fall County Trauma Consortium 

Geriatric Education for Medical Services 

Traumatic Brain Injury 

Advanced Medical Life Support 

Weapons of Mass Destruction and Biological Terrorism 

BTLS for BLS 

PEPP for BLS 

Preceptor Training 

FTO Training 

12 Lead EKG 

Required courses include BTLS and ACLS. PEPP is offered through the Coco 

county EMS Coordinators. 

Number of ALS people accredited in Contra Costa County: 342 (as of 10/29/04) 

171 would need an 8 hour re-recognition every year for ACLS (2 year cert) 

114 would need an 8 hour re-recognition every year for BTLS (3 year cert) 

ACLS re-recognition = $160 X 171 = $27, 360 

BTLS re-recognition = $275 X 114 = $31, 350 

ACLS Provider X 4/year @ $260.00 X 20 students = $20,800 

BTLS Provider X 4/year @ $275 X 20 students = $22,000 

ACLS book fee = $44 = $7,524 

BTLS book fee = $55 = $6,200 

Total: $115,234. (AMR and ALS Fire Department personnel) 

Estimated annual cost per Paramedic: $337.00 

Number of ALS personnel accredited in Contra Costa County: 342 

171 would need an 8 hour re-recognition every year for ACLS (2 year cert) 

114 would need an 8 hour re-recognition every year for BTLS (3 year cert) 

171 would need an 8 hour re-recognition every year for PEPP (2 year cert) 

342 would need a 4 hour Infrequent Skills testing every year

ACLS re-recognition = $160 X 171 = $27, 360 

BTLS re-recognition = $275 X 114 = $31, 350 

PEPP re-recognition = $150 X 171 = $25,650 

342 X 4 = 1368 hours @ $30/hr = $41,040 ($120 per person) 

One paramedic needing all classes = $705/yr 

Incidental classes: 

ACLS Provider X 4/year @ $260.00 X 20 students = $20,800 

BTLS Provider X 4/year @ $275 X 20 students = $22,000 

PEPP Provider X 2/Yr @ $250 X 20 students = $10,000

Sponsored By: 

A trauma focused seminar to 

educate, enlighten and en- 

hance the knowledge base 

Emergency Medical Services 

and skills of hospital and 

prehospital care providers 

from EMT and paramedic 

to nurse and physician. 

Wednesday 

September 8, 2004 

Great speakers, lunch , 

continuing education. 

0800-1700 

John Muir 

Medical Center 

Ball Auditorium 

Hope to see you there !

Topics Include: 

Conference Information_______________ 

Registration Form 

Location: John Muir Medical Center 

Ball Auditorium 

__________________________________________ 

Name 

_________________________ 

Title 

_________________________ 

Agency/Department 

_________________________ 

Address 

_________________________ 

Phone 

_________________________ 

E-Mail 

1601 Ygnacio Valley Rd. 

Walnut Creek 

Cost: $10.00 includes course materials 

and lunch 

CE: This course is approved for 7 hours 

continuing education. (including Trauma 

Continuing Education) 

Registration: Mail 

registration form and check 

Payable to Contra Costa 

County Health Services to: 

Airway Management 

Management 

Gary McCalla, MD 

Medical Director 

REACH 

Traumatic Traumatic Brain Brain Injury 

Daniel R. Gerard, MS, RN, EMT-P 

Trauma Educator San Francisco 

General 

Challenges of of Pediatric Pediatric Trauma Care Care 

Stacey Hanover, RN 

Emergency Department/Trauma 

Services Manager 

Children’s Hospital Oakland 

Medical Medical Examiner Examiner Cases: Cases: Only Only the the 

Weird 

Brian Peterson, MD 

Medical Examiner 

Forensic Medical Group 

Burns 

Kim Franz, RN 

Director Critical Care 

Shriners Hospital 

Please circle: 

California Prehospital Continuing Education 

Provider # 07-0001. 

EMT Paramedic RN 

BRN Continuing Education 

MD Other 

Provider # 07-167 

Schedule & Times: 

Conference: 8:00am-5:00pm 

Check-in/Registration: 7:30am-8:00am 

Contra Costa County EMS 

Attn: Ruth Burk 

1340 Arnold Drive 

Suite 126 

Martinez, Ca. 94553 

Continental breakfast 

Geriatric Geriatric Trauma 

Howard Taekman, MD 

Contact Information: 

For additional information: 

Director Trauma Services 

John Muir Medical Center 

Email: rburk@hsd.co.contra-costa.ca.us 

rburk@hsd.co.contra costa.ca.us 

Field Assessment 

Please register no later 

than than August 25th, 2004 

Phone: (925)646-9214 OR 

Email: jsmith@hsd.co.contra-costa.ca.us 

jsmith@hsd.co.contra costa.ca.us 

Paul Naas, RN, CCRN, CFRN 

Flight Nurse, Calstar 

Any requests for refunds 

must be received by August 

25, 2004 

Phone: (925) 646-4487

On-Board Equipment and Supplies Lists 

ITEMS Quantity 

Oropharyngeal airways: 000, 00, 0, 1, 2, 3, 4, 5, 6 2 each 

Nasopharyngeal airways: 26, 30, 32, 34 2 each 

Padded bite sticks (commercial or homemade) 2 

Oxygen mask – adult/pediatric (non-rebreather) 5 each 

Oxygen mask – infant/pediatric 5 each 

Nasal cannula – pediatric/adult 

5 adult-5 

ped 

O2 tank – fixed in vehicle with regulator (M-tank or equivalent) 1 

Portable O2 tank with regulator (sufficient to provide patient with not less than 10 

lpm for 20 minutes) 

3 

Resuscitation Bag-Valve, capable of use with O2: Infant, Pediatric, Adult 2 each 

Clear mask for use with Bag-Valve and demand-valve (adult only): Adult 2 

Clear mask for use with Bag0Valve: Infant, Pediatric 1 each 

Portable Suction – mechanical/hand powered 1 

Pharyngeal tonsil tip (rigid) for suctioning 4 

Suction catheters: 8FR, 10FR., 18FR 1 each 

Band-Aids 12 

4” Sterile bandage compresses or equivalent 12 

3x3” or 4x4” sterile gauze pads 4 

2” or 3” rolled bandages 6 

40” triangular bandages 4 

10x30” or larger universal dressing 2 

1”, 2” or 3” adhesive tape 2 rolls 

Bandage shears 1 

Vaseline gauze 2 

Arm splints – with soft or cushioned surface or equivalent padded board, wrap 

around, wire ladder, inflatable or cardboard 

Traction splints – with lower extremity limb support slings, padded ankle hitch 

traction strap and heel rest or equivalent (reel, sager or equivalent): Adult/Pediatric 

Spineboard – long with 4 straps (or equivalent) 2 

Spineboard – short with 2 straps or equivalent (Kendrick Extrication Device) 1 

Head immobilizer – disposable or impervious to bodily fluids – sand bags are not 

acceptable 

4 

1 each 

Cervical collars – Hand: sizes to fit all patients over one (1) year of age 2 each 

Optional: adjustable cervical collar (hand only): sizes to fit all patients over 

one (1) year of age 

Scoop stretcher with traps (or equivalent) 1 

Blood pressure cuffs with manometers (portable): Adult, Large arm (obese), 

Pediatric, Infant 

4 

2 

1 each 

Page 1 of 4



Stethoscope: Adult/Pediatric (or combination) 2 

Burn sheets (sterile) – may be disposable or linen (with date of sterilization and 

expiration indicated) 

Irrigation tubing 1 

2 set 

Saline for irrigation, sterile: 2000cc 

Cold packs 2 

Obstetrical Kit (sterile, to include minimum of umbilical cord tape or clamps (2), 1 

scissors or scalpel, 1 aspirating bulb syringe, 1 pair gloves, 2 drapes, dressings & 

towels, clean plastic bag 

Newborn Stocking Cap 1 

Ambulance gurney – capability for elevating the head and be adjustable, straps for 

securing patient to gurney, wheels, non-permeable covering material, means of 

securing gurney in vehicle. 

Triage tags 20 

Current map of entire county (within 2 years) or ambulance zone maps 1 

Current Contra Costa EMS Field Treatment Guidelines and policies 1 

Over-size Readybed flat 1 

Stair chair 1 

Portable child car seat 1 

Restraints – leather ankle and wrist or other soft restraints (4 per set) 1 set 

Battery operated flashlight 1 

Emesis basin or disposable emesis bags and covered waste container 3 

Linen – towels, sheets, pillow cases, blankets, pillows 2 each 

Glucose Paste 1 tube 

ALS Ambulance Emergency Care Equipment and Supplies 


Cellular telephone 1 

Monitor/defibrillator (portable) – must have strip chart recorder and synchronized 

cardioversion capabilities 

Extra charged batteries for monitor/defibrillator 2 

Defibrillator paddles/patches: Adult, Pediatric 

1 set 

each 

Laryngoscope handle 2 

Laryngoscope blades: #0, 1, 2, 3, 4 Miller 2 each 

Laryngoscope blades: #2, 3, 4, Macintosh 2 each 

Endotracheal tubes: 6.0, 7.0, 8.0, 9.0 cuffed 2 each 

Endotracheal tubes: 2.5, 3.0, 3.5, 4.0 uncuffed 4 each 

Endotracheal tubes: 4.5, 5.0, 5.5, 6.0 uncuffed 2 each 

1 

1 

1 

Page 2 of 4



Water soluble lubricant – individual packets 3 

Magill forceps: Adult, Pediatric 1 each 

Batteries (extra) for laryngoscope 1 set 

Bulbs (extra) for laryngoscope 1 

ETT securing device: Adult, Pediatric 2 each 

Stylet: Adult, Pediatric 1 each 

Pen light 1 

End-Tidal CO2 (ETCO2) detector 2 

ETT placement assessment device (bulb) 1 

ETT Nebulizer Adapter 2 

Meconium aspirator 2 

Esophageal Tracheal Double Lumen Airway (ETDLA) 1 

Hand-held nebulizer for Inhalation 2 

Nebulizer mask 2 

Pleuran Decompression/Needle Thoracostomy kit: (or equivalent) 

Anglocatheter – 12 – 14ga 

Syringe – 30cc 

One-way valve 

Rubber connecting tube 

Betadine swabs (4) 

Alcohol swabs (4) 

Vaseline gauze (2) 

Sterile gauze pads (2) 

Tape 

Needle cricothyrotomy kit (or equivalent): 

Anglocatheter – 10 – 13 ga 


Scalpel with #11 blade 


Alcohol swabs (4) 

Vaseline gauze (2) 

Sterile gauze pads (2) 

Tape 

Oxygen tubing 

“Y” connector 

IV extension tubing 

Intraosseous IV kit (or equivalent): 

Sterile gloves (2 pair) 

Intraosseous needle (2) 



Syringes: 1cc, 30cc 2 

2 sets 

1 set 

2 sets 

Syringes: 3cc, 5cc, 10/12cc 2each 

Needles: 18ga 1:, 20ga 1:, 22ga 12”, 25ga “ (or equivalent) 2each 

Page 3 of 4



IV catheters: 14ga, 16ga, 18ga, 20ga, 22ga, 24ga 4 each 

2x2 sterile gauze pads 10 

Alcohol swabs 5 

Tourniquet 2 

Razor 1 

Armboard: Infant, child, adult 1 each 

IV warmers 1 

Normal Saline solution – 1000cc bag 4 

Normal Saline solution – 250mi or 500mi for pediatric patients 2 

Saline lock with extension tubing 2 

IV tubing: mini drip (60gtt), macro drip (10/15gtt), extension tubing (or equivalent) 4 each 

Glucometer (with lancets and test strips) 2 

Secured drug box 1 

Broselow tape (or length-based equivalent) 1 

Activated Charcoal (25gm) 2 

Adenosine (6mg) 5 

Albuterol (2.5mg/3mi unit dose ampule) 4 

Diphenhydramine (Benadryl) (50mg/1cc) 2 

Calcium Chloride (1 gm) 2 

Dextrose 25% 2 

Dextrose 50% (25mg/50cc) 2 

Dopamine (400mg/250cc premixed bag) (or equivalent) 1 

Epinephrine 1:10,000 (1mg/10cc) 4 

Epinephrine 1:1,000 (1mg/10cc) 2 

Glucagon (1mg/1cc) 1 

Furosemide (Lasix) 100 mg 

Lidocaine 2% 300 mg 

Midazolam (Versed) (5mg/ml ampule/vial) 20 mg 

Morphine Sulfate (10mg/1cc ampule/vial) 2 

Naloxone (Narcan) 6 mg 

Nitroglycerin (0.4 mg/tab or multidose spray) 1 bottle 

Sodium Bicarbonate (50mEq/50cc) 1 

Blanket Warmers 1 

Page 4 of 4

WIRELESS ELECTRONIC PATIENT CARE RECORD (EPCR) CASE STUDY 

INDUSTRY: 

Healthcare 

COMPANY: 


CHALLENGES: 

• Capture accurate patient clinical 

and demographic information 

electronically in the field and transmit 

it to the company’s information system 

in real time. 

• Overcome the limitations of 

hand-written patient care records. 

• Transform an inefficient, paper-based 

medical record process. 

RESULTS: 

• Electronic patient care records (EPCR) 

are sent wirelessly by paramedics in 

the field and are updated in real time, 

contributing to improved patient care. 

• Customer service is enhanced by 

providing complete, accurate patient 

information to hospital emergency 

department staff. 

• Redundant and error-prone data entry 

is eliminated, improving ambulance 

operations and back-office efficiencies. 

Wireless data solution improves patient care records 

Providing an essential service 

throughout the nation. 

Since 1992, American Medical Response 

(AMR) has responded to more than four 

million requests for emergency and nonemergency 

medical transport services each 

year. With more than 18,000 paramedics, 

EMTs (emergency medical technicians), 

nurses, doctors and other support staff, 

AMR serves more communities and 

customers than any other private 

ambulance service provider in the nation. 

Recognizing inefficiencies in 

patient documentation. 

Providing an essential service such as 

emergency medical transport to so many 

patients, AMR recognized that 

documenting patient information with 

efficiency and accuracy was a crucial 

component of its business. Not only did 

the company need to consider state and 

federal (HIPAA) regulations for patient 

documentation, but providing emergency 

department personnel with a thorough, 

accurate and legible medical record proved 

critical for delivering quality patient service. 

The company’s paper-based system was 

often inefficient and prone to error. After 

receiving a call from the dispatcher, 

paramedics were required to manually 

record data from the incident, hastily 

writing down information relayed by the 

dispatcher over the radio. 

After responding to the call and providing 

patient care in transport, the paramedic 

documented all activities on a paper 

form. The process to ensure the 

paramedic captured all information 

accurately and completely was labor 

intensive and inefficient—sometimes 

requiring weeks to provide feedback to 

the paramedic. 

The paramedic provided a paper copy 

of the patient documentation to 

emergency department personnel, 

requiring clinicians to decipher the 

paramedic’s handwriting. 

At the end of the shift, paramedics sent 

all paper forms from the shift back to 

their local operating center where the 

information would be manually entered 

into the company’s information system. 

The entire process, from the initial call to 

entering the data into the system, left a 

long, inefficient and error-prone paper trail. 

As noted by Paul Anderson, EPCR 

Program Director for AMR, “Currently the 

process of creating medical records is a 

very labor-intensive, paper-laden process.” 

Aware of the latest advances in wireless 

data systems, AMR knew that its patient 

documentation process could greatly 

benefit from a complete overhaul. 

>


“Using wireless technology as 

the basis for capturing key 

patient data will greatly enhance 

clinical care by our paramedics, 

and continue to position AMR as 

the ambulance industry leader.” 

Trace Skeen 

Vice President of Organizational 

Development 

AMR 

After researching all alternatives, the 

company quickly realized that a wireless 

data solution from AT&T Wireless and its 

alliance members would provide them 

with a practical, robust and cost-effective 

solution. As noted by Trace Skeen, 

AMR Vice President of Organizational 

Development, "Using wireless technology 

as the basis for capturing key patient data 

will greatly enhance clinical care by our 

paramedics, and continue to position 

AMR as the ambulance industry leader." 

Deploying a wireless 

electronic patient care 

record (EPCR) solution. 

At the foundation of AMR’s wireless 

solution is the MEDS ePCR system, 

an internally developed electronic patient 

care record (EPCR) application that 

allows patient information to be wirelessly 

transmitted and updated through each 

step of a patient’s transport and care. 

This custom application is housed on 

rugged notebook and tablet devices, such 

as those manufactured by Panasonic and 

Itronix, and runs on the AT&T Wireless 

GPRS/EDGE national network. Encryption 

and authenticated user access provided by 

the MEDS ePCR system ensure that the 

application is HIPAA compliant. 

AMR chose AT&T Wireless over other 

wireless carriers not only because it had 

an existing relationship with the company, 

but also because AT&T Wireless offered 

the most coverage in North America on 

the GPRS network. 

Finding success with wireless. 

With wireless devices, AMR paramedics 

have found greater efficiency in 

documenting patient encounters. Now, 

rather than manually recording information 

provided by the dispatcher, all of this 

information can be available in real-time 

on the wireless device, automatically 

populating the appropriate sections of the 

MEDS ePCR medical record. 

AMR's wireless solution enables emergency personnel to 

transmit and update patient data through each stage of a 

patient's transport and care. 

The paramedic records additional 

demographic information and all patient 

treatment information with a few clicks 

via drop-down menus and radio buttons. 

Full keypads are available for free-form 

text when needed, and signatures from 

the patient can be captured electronically 

through the device. 

The EPCR application prompts the 

paramedic to enter all the required 

information. “The system can act as a 

compliance monitor in a very active way,” 

said Anderson. “Any other type of 

compliance monitoring would have to 

occur after the fact—after someone 

received the paper record and reviewed it 

for its completeness—often days if not 

weeks by industry standard.” 

When the electronic patient record is 

complete, it can be wirelessly transmitted 

to the hospital’s emergency department, 

printed out upon arrival, or sent by fax, 

depending upon the hospital’s 

capabilities and preferences. In addition, 

many ambulances have rugged printers 

that allow them to print out the patient 

record for the emergency department. 

Once transport is done, the record is 

wirelessly transmitted to the paramedic’s 

local operating center, eliminating further 

work by the paramedic and manual data 

entry by back-office personnel. 

>


“I recall one paramedic in 

Washington telling me of a case 

where he was able to retrieve 

prior client data for a patient he 

was treating in Washington 

based upon service we provided 

her in Colorado one year earlier. 

The patient was a resident of 

Colorado, traveling in 

Washington at the time of her 

second emergency event." 

Paul Anderson 

EPCR Program Director 

AMR 

What’s more, supervisors can now 

monitor the progress of all cases in real 

time and compare them against 

dispatch logs. Rather than waiting for all 

paper records to arrive, the supervisor 

can confirm that all electronic records 

have been received before the end of a 

paramedic’s shift. 

Realizing tangible benefits. 

The wireless data solution has provided 

AMR with several important benefits. 

The system increases efficiency for 

paramedics, which means they can 

more quickly and easily document a 

patient encounter while providing 

attentive care. 

The MEDS ePCR software promotes 

regulatory compliance by prompting the 

paramedic to provide all essential 

information so that emergency 

department personnel can have all 

information from the transport. 

Most importantly, AMR’s wireless 

MEDS ePCR solution contributes to 

quality patient care when emergency 

department staff receive a record that is 

accurate, comprehensive and legible. 

“Having reviewed hundreds of records 

over the years, there is no comparison 

between the legibility of a hand-written 

medical record, with all of the medical 

abbreviations used today, versus the 

output of the MEDS ePCR system,” 

said Anderson. 

The quality of service provided is 

also enhanced by the fact that the 

paramedics can access patients’ 

medical histories in AMR’s records. 

“I recall one paramedic in Washington 

telling me of a case where he was able to 

retrieve prior client data for a patient he 

was treating in Washington based upon 

service we provided her in Colorado one 

year earlier,” said Anderson. “The patient 

was a resident of Colorado, traveling in 

Washington at the time of her second 

emergency event.” 

Paramedics and hospital personnel can more quickly and 

easily enter and retrieve patient information—resulting in 

faster treatment and greater productivity. 

The company has also noticed improved 

accuracy in its back-office systems. 

Because no manual data entry is required 

after the initial electronic patient record is 

received, there’s little room for error when 

the data is entered into the system. 

With all of these improvements, the 

company is better able to allocate 

resources so that all employees touched by 

the EPCR application are more productive. 

Rolling out in phases. 

The company currently has 1,700 

paramedics using the MEDS ePCR 

system and expects nearly 10,000 field 

employees to be using the system once 

the deployment is complete. In addition, 

as many as 1,000 back-office employees 

will be using the integrated system once 

it’s fully deployed. 

Finding acceptance 

among paramedics. 

When implementing any new system, a 

company can expect resistance from 

users who are required to learn new 

procedures. According to Anderson, 

however, “In every location where the 

solution is deployed, we have conducted 

internal opinion surveys. When asked if 

they would prefer to keep the electronic 

solution or return to pen and paper, the 

>


“The ePCR solution has the 

potential to transform our 

business by providing real-time 

information to our patients, 

healthcare professionals and 

hospital providers.” 

William Tara 

Chief Information Officer 

AMR 

paramedics resoundingly prefer the 

electronic solution.” 

In addition, Anderson noted, “The 

paramedics are quite proud of the 

professional appearance of the printed 

format of the electronic record that they 

present to the receiving hospital 

emergency department.” 

Examining wireless and 

its alternatives. 

After researching several alternatives, 

AMR discovered that a real-time wireless 

data solution would provide them with 

many more benefits than a telephonic or 

satellite channel system. 

A telephonic system proved impractical. 

And while a satellite channel system would 

provide all the features of a data solution 

and ubiquitous coverage, it proved 

expensive compared to a wireless system. 

Commenting on the need for a real-time 

wireless solution, Anderson said, “We 

selected a wide area wireless solution so 

we could provide connectivity to other 

information stores within our information 

system. The real-time access is important 

from the paramedics’ perspective; since 

the patient encounter lasts 20-40 minutes, 

the information is very perishable.” 

AMR realized that a wireless solution 

would enable paramedics to capture 

accurate, up-to-the-minute information 

on its patients. Likewise, the back-office 

staff would receive accurate patient 

documentation from the paramedic right 

after it was entered into the system. 

Recognizing the future 

potential of wireless 

in healthcare. 

Looking to the future, Anderson expects 

that patient information—including 

symptoms, treatment and complete 

medication histories—captured wirelessly 

by AMR’s MEDS ePCR application 

could be shared by hospitals, physicians 

and other providers throughout the course 

of a patient’s care. From the initial 9-1-1 

call to ambulance transport, emergency 

The wireless solution eliminates manual re-entering of data 

at the hospital. More accurate patient documentation means 

better care. 

department treatment, eventual 

discharge and post-operative care, 

all patient data could be recorded 

accurately and comprehensively. 

“If we can achieve greater connectivity 

with other stakeholders in the healthcare 

space,” said Anderson, “then we could 

potentially arm the paramedic with 

information pertinent to that case or to 

that particular patient, even if it’s someone 

that we have never treated before. “ 

A successful deployment. 

According to William Tara, AMR Chief 

Information Officer, “The EPCR solution 

has the potential to transform our 

business by providing real-time 

information to our patients, healthcare 

professionals and hospital providers." 

Paul Anderson concurs. "We are very 

pleased with the success of this 

program. Not only do the early results 

track favorably to our expectations, we 

believe we have only just begun to tap 

into the benefits of having wireless data 

connectivity at our paramedics’ fingertips.” 

For more information about 

AT&T Wireless data solutions, 

contact your AT&T Wireless 

Account Representative, 

call 1 866 429-7222 or visit 

attwireless.com/healthcare.


FLEET MANAGEMENT CASE STUDY 

IMPORTANT INFORMATION 

Results may vary by company and with selected wireless data solution. AT&T Wireless healthcare solutions require a minimum one-year business agreement or service 

agreement and, with respect to each end user, activation of an eligible AT&T Wireless Mobile Internet data plan on a compatible device. Service subject to applicable business 

or service agreement, the corresponding AT&T Wireless Mobile Internet plan brochure and coverage maps, and related promotional materials. Due to coverage and system 

limitations, service may not be accessible at all times. Availability, speed of delivery and timeliness of information is not guaranteed. Geographic limitations and other 

restrictions and charges apply. When outside the AT&T Wireless network, access will be limited to information and applications previously downloaded to or resident on your 

device. Third-party software, additional hardware, and/ or subscription to a third-party service also required. AT&T Wireless does not sell, supply, install or support such 

software, hardware, or services, including the customized MEDS ePCR system implemented by AMR. To view a list of AT&T Wireless certified solution providers, visit 

http://www.attwireless.com/developer/testing/certifiedSolutions/certifiedByIndustry/healthcare.jhtml and contact them directly for further details on a specific 

system. By using service you agree to abide by the terms and conditions of any applicable software licenses. Failure to comply with such terms and conditions may result in termination 

of service. Certain other restrictions may apply. 

© 2004 AT&T Wireless. All rights reserved. All marks are the property of their respective owners. 

V1/1004


Commitment to Employees 

Newsletters 

List of Employee Benefits 

Employee Advocate Job Description 

Training Checklists 

Standard Operating Procedures Table of Contents 

Emergency Vehicle Operator Course Outline 

EMS Management Institute Certificate 

Leadership Training 

Diversity Training Outline 

Magazine Advertisement to Recruit a Diverse Workforce 

Health and Safety Manual Table of Contents 

Safety Posters 

Back Injury Prevention Letter to Employees 

New Hire Academy Agenda 

Contra Costa Orientation Outline

Newsletters 

Fast Facts Newsletter 

AMR Contra Costa County Newsletter 

Insight, AMR's National Newsletter

AMR 

CONTRA COSTA COUNTY DIVISION 

At the Emergency Medical Care Committee (EMCC) today, the recommendation was to put the 

EMS contract out to a competitive bid process utilizing the recommendations of the Fitch Report 

with the following changes: 

1) The response time for code 3 requests will be 11:59 minutes rather than the 13-15 

minute recommendation. 

2) A 1:1 pilot program is to be developed with an implementation date of September 1, 

2004. Simultaneously, 4 AMR QRV’s will be established to ensure a 10 minute ALS 

response in all 5 zones. (Note: In the Fitch report it has zones without FD ALS to be 

phased in when ALS FD service is available) The QRV’s will eliminate this phase in 

plan. 

3) The system staffing will be 1 Paramedic and 1 EMT in all areas excluding zone A 

(City of Richmond). 

4) The EMS Proposal/Fitch which includes the financial changes and system 

enhancements to be initiated September 1, 2004. 

It was our desire to phase in the Fitch Report recommendations over a three year contract 

extension, however, without support from the labor unions (SEIU and Local 1230), the AMR/EMS 

proposal could not be adopted. To that end, the recommendation going to the Board of 

Supervisors from the EMCC is for a one year contract extension to allow for the necessary 

timelines of an RFP process. As part of the contract extension criteria, the current contract 

requirements will continue through August 31, 2004. However, effective September 1, 2004 the 

EMS proposal/Fitch must be implemented. (See EMCC spreadsheet posted at each station) 

It is still our commitment to make the system staffing changes of 1:1 through attrition, yet with the 

shortened timelines, we will need to collaborate with SEIU to identify effective strategies. 

I appreciate the involvement and support in designing our system that so many of you have 

contributed too. I know this is a challenging process and the uncertainty can be most unsettling. 

During the coming months of the pilot and planning, will work together for a successful RFP 

process and work highlighting the excellent service aspects we provide to the community. The 

COCO team is the best division, and I so value the awesome care you provide to the patients we 

are privileged to serve 24/7 hours a day 7days a week. If you have any questions, please contact 

any of us on the leadership team. Also for further information on the Fitch Report, the entire 

recommendation plan can be found on the EMSA website at ccc.ems.org. 

Be Safe! Leslie 

Contra Costa County 1 of 1 

April 16, 2004

CONTRA COSTA COUNTY NEWSLETTER 

July 7, 2004 Volume 1 Issue 3 

A MONTHLY PUBLICATION FOR YOU AND 

ABOUT YOU 

Every month, we will bring you this newsletter. It will contain 

tidbits and news about employees and AMR in Contra Costa County. 

Please call or email us with your input. You can change content of 

the newsletter with your suggestions. You can email Mark Buell @ 

mbuell@amr-ems.com. You can also phone him at OPS x27. Any 

input would be of value. We want to make this newsletter for you 

with the information you want to read. So please, take a moment 

and send a comment back to Mark so we can make this newsletter 

the best in the West. 

AMR CONTRA COSTA NEW SOFTBALL TEAM 

AMR Costa Costa is pleased to introduce our new softball 

team, The Grunts. Their first game was Saturday July 10 th . 

According to coach Fluke “we played great”. The game was 

close all the way to the last minute. The final score was, 

Grunts 6, the other team 10. The games are held at College 

Park High School, located at 201 Viking Drive, Pleasant Hill 

(Across from DVC). After the game, the employee action 

team provided several pizzas and sodas. The Grunts looks 

forward to seeing you at the next game. 

The Grunts Summer schedule: 

July 17 th at 10:00 am July 24 th at 11:10 am 

July 31 st at 12:20 pm August 7 th at 10:00am 

If you have any question about the team, call Coach Matt 

Fluke at 415-509-6964 

FOCUS ON: 

Astrid Laanen 

Astrid is new to AMR having just started her FTO period 

with Morgan Hastings. Astrid is a native of Holland and 

has been in the United States for the last 5 years. She 

moved here with her husband and three boys. Astrid 

said she looks forward to working on an ambulance 

because of the new and unexpected challenges she 

might face daily. 

Favorite color: Pink, a cool color 

Favorite sport: Running (3 miles a day) 

Favorite food: Chinese 

Favorite person: Her Husband 

EMPLOYEE BIRTHDAYS 

Micheal Frankina July 1 

Richard Petty July 2 

Scott Miller July 3 

Eric Thom July 3 

Michael Fanucchi July 4 

Brett Roby July 5 

Tim Davis July 7 

Chuck Bates July 8 

Michael Kricken July 8 

Mike Breiling July 10 

Jamal Miles July 11 

Nicholas Alexander July 11 

David Schiefelbein July 14 

Bill Bower July 15 

Von Sargent July 16 

Jose Romero July 16 

Gabe Ramirez July 19 

John Vogler July 20 

Andrew Schneider July 20 

Jeff Cozens July 20 

Robert Jenks July 21 

John McCarthy July 31 

Amiee Taqi-Eddin July 25 

James Hoyle July 27 

Anthony Hendricks July 27 

Kevin Fleeger July 28 

Michael Guest July 29

FUN STUFF AND DISCOUNTS 

Discount tickets now available: 

Six Flags Marine World $21.99 

This is 50 % off the gate price! 

Waterworld-Concord $14.99 

Waterworld-Sacramento $12.99 

If you are interested, call or email Debbie Mejia at 

800-989-1164 or Debbie_mejia@amr-ems.com 

Save 10% on any purchase from Men’s Wearhouse 

with a discount card. You can get a discount card 

from Debbie Mejia 

Thinking about buying a Ford vehicle? Heard about 

the X-plan? Well, the X-plan is a program that Ford 

Motor Company offers to its large customers and 

partners. The X-plan can save you hundreds, even 

thousands of dollars on brand new Ford, Lincoln, 

Mercury, Mazda, Volvo, Land Rover, and Th!nk 

Vehicles. If you are interested in taking advantage of 

this opportunity, the first step is to log on to 

www.fordpartner.com and follow the instructions. The 

partner code for AMR is XF758. Any questions call 

1-877-Xplan-00. 

NEW HIRES AND PROMOTIONS 

New Hires-E.M.T. 

Tracy Loftus 

Astrid Laanen 

New Hires- Paramedic 

Stephanie Speizer 

(Part-time from Dispatch) 

Account Manager 

Denise Cole 

Congratulations and let’s welcome them to the Contra Costa Team. 

UPCOMING CLASSES 

PEPP refresher ConFire 0800-1700 July 21 

CPR – Concord Ops 0800-1000 August 5 

CPR – Concord Ops 1000-1200 August 5 

Infrequent Skills 1300-1600 September 15 

ACLS refresh Alameda 0900-1800 July 19 

BTLS NCTI 0900-1800 July 22, 23 

Reach on Tour 

Reach will be at the Livermore Police Department for 

a one day lecture. Cost is $35.00 and you get 7 CEUs, 

lunch and a t-shirt. This lecture should be both 

informative and fun. Register early, class size is 

limited to 50. Call 1-888-660-9888 

Contra Costa County Trauma Symposium 

A trauma focused seminar to educate, enlighten and 

enhance the knowledge base and skills of hospital and 

prehospital care providers from EMT to paramedic to 

nurse and physician. The seminar is on Wednesday 

September 8, 2004 from 0800 to 1700. Cost is only 

$10.00 which includes lunch and 7 CEU’s. Space is 

limited so register quickly. 

Hot topics 

“You’ve got that tingling feeling…: Stroke Mimics and 

Miscues” July 20, 2004 at 0900 to 1200. Class will be 

held at AMR Alameda. 

Remember, your certifications have to be turned into 

Concord operations at a minimum of 7 days before 

expiration. Call Yvette if you are interested in any 

of the classes. 

CONGRATULATIONS!!! 

Congratulations to the following team members: 

Rachel Valenzuela and Stephen Morgan on the birth 

of their baby boy. His name is Conner and he arrived 

on 6-21-2004 at 7 pounds. 

Danny and Claudia Lewis on the birth of their baby 

boy. His name is Daniel Jacob Lewis, Jr. weighing in at 

7 lb 5 oz. Junior arrived July 2 at 11:20am. 

David and Suzanne Mullarky on the birth of their 

daughter, Erin Nicole. Erin was born on July 7 th and 

weighs 8 pounds. 

FUN COCO FACTS 

Miles Driven for the Month of June 

ALS 79,519 

Includes support and supervisors 

BLS 66,281 

Includes CCT 

25 TH ANNIVERSARY 

Reid Wilson has been with the company for 25 years as of 

July 9, 2004. When you see him, lets all give him a 

handshake for a job well done!!! 

EMAIL ADDRESSES 

In order to continue every effort to communicate 

with all employees, we are asking all of you for your 

email addresses. It will be one more way we can 

update you with the latest information and news. 

Please send your email address to Linda Mulgrew @ 

lmulgrew@amr-ems.com. This will be used only for 

company business.

ACTION COMMITTEE 

AMR’s strategic vision and employee feedback of important 

issues has resulted in the Action Committee. The Action 

Committee is composed of employees and management and 

their edict is to find new ways to recognize employees and 

solve common issues. If you are interested in participating 

in this monthly forum please contact Mark Buell. 

DANGER IS AROUND THE CORNER 

While fighting a grass fire, Con Fire engine 384 

attempted to access the fire up a steep hill. The 

engine rolled several times down the hill. Two 

firefighters where flown out by Calstar to John Muir 

Medical Center with minor injuries. 

AMR Santa Cruz supervisor vehicle, a Ford 

Expedition, hit head on. The other vehicle was driven 

by a driver reportedly under the influence of alcohol 

and drugs. The supervisor is being treated for a foot 

and back injury. We all wish him a quick recovery. 

Did you catch the front page of the Contra Costa 

Times on Saturday June 26, 2004? That’s right, Two 

AMR paramedics pulling hose during the Martinez 

grass fire. The fires quickly built up speed and 

threatened County Hospital, Our guys where quick to 

help. The paramedics are Anthony Hendricks and 

Brad Gates. Good Job!! 

High gas prices got you down? Well Beth Francis found a 

solution. Beth is not sure how many miles to the gallon 

her chopper gets because it does not hold a gallon of 

gas. Good luck Beth and maybe a flag on your chopper 

might help. 

AMR BUCK ON THE WAY 

What are AMR Bucks? These AMR Bucks are given out as a 

“Thank You” when we see you doing your job above and 

beyond the call of duty. Supervisors and administrative 

staff will be giving out these Bucks to trade-in for AMR 

apparel and gifts. You can trade in your bucks to Mark 

Buell. You can start to trade in your bucks most likely by 

July 30 th . Thank you for all of your hard work.






























might help. 






































might help. 









AMR Benefits 

for Contra Costa County Employees 

Medical, dental, and vision plan, with dependent coverage available 

Life insurance and accidental death and dismemberment insurance at two times 

the employee’s annual salary, with the option to purchase supplemental coverage 

Company-paid long term disability insurance and optional short term disability 

insurance 

Paid time off, with new field employees accruing a minimum of three weeks per 

year 

Eight paid holidays a year 

Educational financial assistance for employees who choose to pursue formal 

degrees or who take courses to directly assist them in their current work 

assignment, including an option for part-time employees to maintain medical 

benefits under COBRA – this financial assistance includes an identified number 

of Paramedic school scholarships for our EMTs, per our Core Bargaining 

Agreement 

A flexible spending program, allowing personnel to use pre-tax dollars to pay for 

dependent care and health care expenses 

Employee assistance program 

Leaves of absence 

Part-time employment opportunities 

Modified work assignments during pregnancy and injury recovery 

Options for employment in 19 counties in Northern California, as well as 

opportunities statewide or in the 32 states we serve across the nation


Employee Advocate 

Contra Costa County Operation 

SUMMARY: 

The Employee Advocate position will be developed in conjunction with labor for the purpose of 

improving operational performance and employee satisfaction. The goal of this position is to 

bridge the business and operational demands with increased communication and employee job 

fulfillment. Due to rapid changes in health care and a highly competitive market, the 

organization must adapt to an ever-changing environment by uniting with labor around a 

common purpose and working collaboratively to deliver quality patient care. The Employee 

Advocate will be instrumental in identifying the shared purpose, developing the Company/Labor 

partnership and will function as the employee liaison. 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other 

duties may be assigned. 

Participate in developing and integrating the organizational strategic vision 

Work in conjunction with management to review standard policies and processes with the 

goal of improving operational efficiency and employee job satisfaction 

Participate in developing employee incentive/recognition programs 

Participate regularly in the Employee Action Committee 

Participate in locally established committees: Safety, Labor Management, System Status 

Management 

Work with employees in maneuvering through the Workers Compensation process and assist 

in identifying trends in work place injuries and safety practices 

Act as employee liaison with company support departments 

Proactively work with management and workforce to decrease the number of grievances 

Proactively assist and coach employees with work performance challenges 


Paramedic in good standing 

Five (5) years employment with AMR and two years (2) in Contra Costa County 

Strong facilitation and communication skills 

Regularly accessible 

Strong knowledge of Collective Bargaining Agreement and Standard Operating Procedure

AMR Initial Classroom Orientation Agenda 

Overview of the field training process 

Diversity in the workplace 

Harassment-free workplace 

Medical and legal protocols 

Driver safety and emergency vehicle 

operations 

Injury and illness prevention program 

Hazardous materials management 

Critical incident stress management 

Workplace health and safety 

Violence in the workplace 

Code of Business Conduct 

Company structure and philosophy, 

including Vision, Principles, and Values 

Customer service 

Billing process 

Policies and procedures 

TB screening / Hepatitis-B immunization 

Human resources issues (e.g., benefits and 

payroll) 

HIPAA guidelines 

Disaster preparedness and weapons of mass 

destruction 

Geography overview 

Bloodborne/airborne pathogens 

Automatic External Defibrillator (AED) 

System status management 

Vehicle maintenance 

Quality improvement standards

Training Checklists 

AMR Initial Classroom Orientation Agenda 

ALS Checklist 

CCT Training Checklist 

EMT Checklist 

EMT Driving Checklist 

Ambulance Skills Station for Stryker MX-PRO 

Classroom Skills Station for Stryker MX-PRO

Clinical and Educational Services 

Paramedic Orientation Checkoff 

Orientee Name ______________________ FTO ________________________ 

Date of Completion ___________________ Total Training Hours ___________ 

SKILL DATE FTO 

INITIALS 

Assessment 

Scene Survey 

BSI Use 

Trauma Assessment 

Medical Assessment 

Neuro Exam 

Vital Signs 

Blood Pressure 

Pulse 

Respirations 

Lung Sounds 

Skin Signs 

Pupils 

Orthostatics 

Mneumonics 

SOAP 

OPQRST 

PASTE 

SAMPLE 

CMSTP 

AEIOU TIPS 

AVPU 

APGAR 

CRAMS 

Scenarios 

Trauma 

ALOC 

Respiratory 

Abdominal Pain 

Chest Pain 

Childbirth 

Psych - 5150 

NOTES

Other 

PCR Documentation 

Radio Reporting 

Fire 

SO and Calcord 

Area Familiarization 

Mapping 

Special Needs Patients 

Cell Phone Use 

Classroom 

Standard Operating Procedures 

Field Performance Standards 

CES Policies 

Coco Field Procedures 

Coco Goldenrods 

Coco County Orientation 

e-PCR Training 

TB Fitting and Logistics 

Prebilling Overview 

Billing Overview 

Scheduling Overview 

Morning Check In Process 

Customer Service 

Union Overview 

Haz Mat 

BART Response 

Equipment Review 

DAL’s 

Code 2 Driving 


ALS Skills 

Glucometer and Log 

Narcotic Process 

Lifepack 12 

Pulse Oximetry 

Drug Bag 

Pedi Bag 

Inline Nebulizer 

Safer Sharps 

Infrequent Skills

I, __________________________ confirm that I have been trained in all of the above items 

either in the classroom orientation or the field orientation. 

I have received training in the proper use of equipment utilized at AMR Contra Costa 

County. I affirm understanding of the use of the equipment, that I will use it appropriately 

and will assume responsibility for its upkeep and presence on the ambulance. 

I have a complete understanding of paperwork importance, the significance of complete 

and accurate documentation and compliance 

I also confirm training in the AMR and Contra Costa County protocols and policies. I will 

work within these protocols and policies. 

___________________________________________________ _____________ 

Signature Date

Clinical and Educational Services 

EMT Orientation Checkoff 

Orientee Name ______________________ FTO ________________________ 

Date of Completion ___________________ Total Training Hours ___________ 

SKILL 

Patient Lifting/Positioning 

Sit Pick 

Ground Lift 

Gurney Use 

DATE FTO 

INITIALS 

Airway Control 

Head Positioning 

OPA 

NPA 

Suction 

O2 Administration 

Tank Use 

Changing Regulator 

O2 Mask/Cannula 

BVM 

Bleeding Control/Bandaging 

Pressure Points 

Pressure Dressing 

Bleeding Control Technique 

Sling/Swath 

Impaled Object Stabilization 

Eye Injury Management 

Occlusive Dressing 

Splinting 

Open Fractures 

Upper Extremity 

Lower Extremity 

Hare Traction 

Sager Traction 

Pedi-Board 

Spinal Precautions 

Spider 

KED 

Helmet Removal 

NOTES

Assessment 

Scene Survey 

BSI Use 

Trauma Assessment 

Medical Assessment 

Neuro Exam 

Vital Signs 

Blood Pressure 

Pulse 

Respirations 

Lung Sounds 

Skin Signs 

Pupils 

Orthostatics 

Restraint Use 

Assist with Medication 

Five Rights 

Multidose Inhaler 

Epi Pen 

Nitroglycerine 

Oral Glucose 

Mneumonics 

SOAP 

OPQRST 

PASTE 

SAMPLE 

CMSTP 

AEIOU TIPS 

AVPU 

APGAR 

CRAMS 

Assist with ALS Skills 

ETT Ventilation 

IV Setup 

Monitor Set up 

Scenarios 

Trauma 

ALOC 

Respiratory 

Abdominal Pain 

Chest Pain 

Childbirth 

Psych - 5150

Other 

PCR Documentation 

Radio Reporting 

Area Familiarization 

Mapping 

Special Needs Patients 

Cell Phone Use 

Classroom 


Field Performance Standards 

CES Policies 

Coco Field Procedures 

Coco Goldenrods 

Coco County Orientation 

e-PCR Training 

TB Fitting and Logistics 

Prebilling Overview 

Billing Overview 

Scheduling Overview 

Morning Check In Process 

Customer Service 

Union Overview 

Haz Mat 

BART Response 

Equipment Review 

DAL’s 



I, __________________________ confirm that I have been trained in all of the above items 

either in the classroom orientation or the field orientation. 

I have received training in the proper use of equipment utilized at AMR Contra Costa 

County. I affirm understanding of the use of the equipment, that I will use it appropriately 

and will assume responsibility for its upkeep and presence on the ambulance. 

I also confirm training in the AMR and Contra Costa County protocols and policies. I will 

work within these protocols and policies. 

___________________________________________________ _____________ 

Signature Date

CONTRA COSTA COUNTY EMT-1 CRITICAL CARE TRANSPORT TRAINING 

CHECKLIST 

CANDIDATE NAME: ___________________ FTO NAME: ____________________ 

Subject/Skill Date Covered FTO Initials Trainee Signature 

Roles/Responsibilities 

Driver 

Attendant 

CCT Specific Policies & Procedures 

Use of CCT for BLS calls 

Unit Checkout 

Unit Restock 

Fuel Policy 

DNR 

Ambulance Diversion 

First On-Scene/First Responder Role 

Ride-Alongs 

Nextel Radio/Cell Phone 

Service Receipt 

Narcotics 

Intubation Equipment 

Expectations of CCT 

Response Times/Out of Chute Times 

Holdovers 

System Status Plan/Fluid Deployment 

AOC Availability 

Unit Familiarization 

Shore Lines 

Paperwork 

Propac Operation 

Paper Changing 

B/P Cuff Interval Settings and Application 

Lead Placement 

Pulse Oximetry Probes 

Additional Probes 

Mini-Med Operation 

Programming 

Pump Preparation 

Defibrillator 

Pad Placement 

Batteries 

Draeger Ventilator 

Circuits 

Oxygen Maintenance 

Quick Connects 

Oxygen and Air Blending

CANDIDATE NAME: ____________________ FTO NAME: _______________________ 

Contra Costa County EMT-1 Driving Evaluation Checklist 

1. Possesses a valid California Drivers License 

2. Possesses a valid California Ambulance Drivers License 

3. Possesses a valid Medical Examiners Certificate 

4. Verbalizes minimum Type I/III Vehicle Clearances 

5. Locates Vehicle Master Battery Switch and Operates without 

prompting 

6. Functions and Operates the Drivers Control Panel 

7. Verbalizes difference in braking distance between Type I/Type III 

Vehicles 

8. Maintains proper lane control while driving 

9. Performs proper left and right turning maneuvers 

10. Performs proper U-Turn maneuvers 

11. Performs proper Backing maneuvers 

12. Maintains appropriate space cushion techniques while driving 

13. Performs proper braking maneuvers 

14. Verbalizes knowledge of San Mateo County Hospital Diversion 

Policies 

15. Follows established DMV laws and AMR company policies for Code 3 

driving 

16. Demonstrates proper method for approaching, entering, and exiting 

intersections 

Date 

Covered 

FTO 

Initials 

Candidate 

Initials

AMR USE ONLY--NOT FOR RELEASE TO OUTSIDE ENTITIES 

Clinical and Educational Services (CES) 

1999 Health & Safety Training Program 

AMBULANCE Skills Station for Stryker MX-PRO TM 

Employee Name: ___________________________ Employee No. __________ County: _______________ 

Skills with Objective(s) & Rationale Complete Incomplete 

Loading Stryker MX-PRO TM with or without patient into ambulance. 

Checks brake before using any control. 

Ensures third stage of IV pole is down before loading. 

Determine gurney load height. For AMR Type II rigs, usually position 7 or 8, whichever 

engages safety hook more readily. 

Follows procedure outlined on Stryker “MX PRO COT TIPS”. Safety hooks are short 

and well marked to present less of a hazard when walking on ambulance floor. 

Maintains hold on wheel base while gurney is loaded to prevent jarring of patient and cot. 

Secures gurney to wall. 

Unloading Stryker MX-PRO TM with or without patient from ambulance. 

Ensures third stage of IV pole is down before unloading. 

Releases gurney from wall. 

Partner visualizes safety U-bar is engaged. 

Partner has hold on head end of wheel base. 

Squeeze release handle. 

Partner lowers wheel base to the ground. Never let wheels drop to the ground. 

Partner disengages safety U-bar. 

One person loading without patient into ambulance. 

Checks brake before rolling. 

Ensures IV pole is stowed before loading. 

Engages safety U-bar to right or left of indent. 

Pulls back to gain space for wheel base to clear. 

Lowers foot end of gurney to the ground. 

Lifts foot end and wheel base, loads into ambulance 

Secures gurney to wall. 

One person unloading without patient from ambulance. 

Ensures third stage of IV pole is down before unloading. 

Releases gurney from wall. 

WATCH FOR 

Engages safety U-bar to right or left of indent. 

PINCH POINTS 

Pulls back to gain space for wheel base to clear. 

Lowers foot end of gurney to the ground. 

Squeeze release handle. 

Slowly raises gurney from the ground. Never let wheels drop to the ground. 

Disengages safety U-bar. 

Uses proper lifting techniques at all times. 

WATCH FOR 

PINCH POINTS 

Employee Signature: _________________________ Supv./FTO: ____________________ Date: ________

AMR USE ONLY--NOT FOR RELEASE TO OUTSIDE ENTITIES 

Clinical and Educational Services (CES) 

1999 Health & Safety Training Program 

CLASSROOM Skills Station for Stryker MX-PRO TM 

Employee Name: ___________________________ Employee No. __________ County: _______________ 

Skills with Objective(s) & Rationale Complete Incomplete 

Have participant handle the ergonomic features that were a result of employee use and input. 

Foot end grips thinner and equipped with handlebar grips. 

Curl-bar design on lower rung of foot end controls (provides 2:1 mechanical advantage) 

Foot end release handle travel at a 45 degree angle. 

Lock and un-lock wheel brake. More than one brake would make a tip over more likely, but 

one brake is useful without patient. Make it a habit to check brake before using any control. 

Fold down head end wheels with only one release lever. Pouch must be unloaded first. 

Raise and lower rails using release lever at far end of rail. Note that because of the height 

of mattress, the rails do not do much to secure patient--must use harness system. Rails can 

stay down if patient is too large to raise them. 

Handle harness seatbelt system and demonstrate appropriate use. Patient is in danger of 

sliding off gurney if not used. 

Roll gurney. 

Checks brake before rolling gurney. 

Roll feet first. Push, do not pull. Do not use IV pole as a handle. Usually best for taller 

crew member to be at head end but MX-PRO TM can be rolled at any height. 

Optional: Show underside of gurney. Show teeth along mechanism that on allow gurney to 

settle to the next level and not hang up between levels. 

Raise and lower height of gurney with or without patient. 

Safety mechanism means that the weight must be lifted off the gurney before foot or side 

controls will work. 

One crew member at each end establishing eye contact as and good communication. 

Lift approximately ½ inch to take weight of mechanism. 

Gauge the weight of the patient while lifting. 

Squeeze release handle at 45 degree angle. 

Raise and lower the gurney to various levels. 

Release handle when desired height is reached. 8 height levels. 

One person height change without patient. 

As much as possible, lower gurney using two crew members at each end. 

Ergonomic use of side lever, with one foot on wheel frame to lower gurney. 

Watch for pinch points marked in red. 

With load wheels and head end wheels on ground, lower gurney to lowest level. 

Raise and lower IV pole. Operate various stages and tighten nut on lower stage when stowed 

(or IV pole with slide out and whack crew member at foot end). 

Uses proper lifting techniques at all times. 

Employee Signature: ___________________ Supv./FTO Signature: ___________________ Date: _______


“Patient Focused, Customer Centered, Caregiver Inspired” 

Introduction 

Mission Statement 

Vision/Guiding Principles 


Table of Contents 

SOP # Date Revised 

200 Company Rules April 2002 

201 Condition of Employment May 2001 

202 Personal Record Maintenance October 2001 

203 Uniforms and Personal Appearence May 2001 

204 Employee Conduct November 2001 

205 Attendence August 2003 

206 Recording Hours Worked November 2001 

207 Minimum Attendence for Part Time Employees May 2004 

208 Care and Handling of Patients August 2002 

209 Emergency Vehicle Operator August 2002 

210 Emergency Vehicle Operations August 2002 

211 Patient Care Person Responsibilities September 2004 

212 Joint Responsibility May 2001 

213 Fueling of Company Vehicles September 2002 

214 (Vacant) 

215 Paperwork Responsibilities September 2004 

216 Senior Paramedic September 2002 

217 Field Communications September 2004 

218 Communications Center December 2000 

219 Ambulance Readiness September 2004 

220 Vehicles and Equipment September 2002 

221 Crews Quarters September 2002 

222 Law Enforcement Request for Information October 2001 

223 Inter-agency Relationships September 2002 

224 Ride-a-long Observers August 2003 

225 Miscellaneous Regulations September 2002 

226 (Vacant) 

227 Meal Periods September 2004 

228 Fatigue on Duty July 2000 

229 Safety Helmet Use December 2000 

230 Hazard Materials Responses September 2002 

231 Controlled Substance Program September 2002 

232 BART Responses August 2003 

233 Scheduling Procedures September 2004 

234 AMR Paramedic First Responder September 2004 

235 Abuse/Assault Reporting September 2002 

236 24-Hour Shift Compensation August 2003 

237 (Vacant) 

238 Neo-natal Responses September 2004 

SOP Table of Contents Page 1 of 1 9/1/2004

AMR Emergency Vehicle Operator Course Outline 

Classroom instruction: 

Legal aspects of authorized emergency vehicle operations 

Selecting routes and reporting emergency operations 

Defensive driving and anticipating hazards 

Principles of vehicle control 

Routine vehicle safety checks 

Psychological aspects 

Fatigue management and training 

Vehicle specialized care; tire dynamics 

Behind-the-wheel training includes: 

Braking and control braking Forward-motion 3-point 

Backing, road position, fender 

judgment, and steering technique 

Specialized braking techniques: ABS, 

air, and hydraulics 

Slalom course Evasive maneuvers 

Steering technique during a skid Cornering 

Turn-around steering technique Code-three driving 

Diminishing capacity

Leadership Training 

Leadership Training Elements 

Development Dimensions International (DDI) 

Leadership Training Outline 

LEAD U Training Brochure

Leadership Educational Elements 

For Each Tier 

Supervisor Level 

Interdepartmental/cross-program exposure 

Local leadership/professional development seminars 

Development Dimensions International (DDI) management courses 

Leadership Development Program (LEAD U) 

Manager Level 

Seminars 

Community college courses (such as finance for non-financial professionals) 

DDI Intermediate Interactive Management Program 

LEAD U (including didactic modules/sessions) 

Director Level 

Industry-wide conferences 

Continuing education courses, such as DDI 

Seminars 

Business development/sales/negotiation training 

Finance for non-finance professionals 


Vice President Level 

Executive education programs at business schools 

Industry-wide conferences 

DDI courses 


CEO Level 

Executive education programs at business schools 

Personal development and advancement seminars 

DDI Interactive Management Program 

LEAD U (including didactic modules/sessions)

AMR / DDI – Basic 4 Day 

Interaction Management: Tactics for Effective Leadership 

OUTLINE 

Day One 

Core Skills for Building Commitment 

Day Two 

Helping Others Adapt to Change 

Preparing Others to Succeed 

Day Three 

Harassment Prevention and Investigation for Leaders 

Workplace Violence Prevention 

Conflict Resolution 

Day Four 

Facilitating Improved Performance 

Valuing Differences



Day 1 

Core Skills for Building Commitment 

In this session participants will: 

Explore the challenges of providing effective leadership in a changing and increasingly 

demanding EMS environment 

Examine the importance of skillful communication in providing effective leadership 

Learn interaction skills that help participants achieve patient care and business objectives while 

satisfying the personal needs of patients and providers 

Understand how feedback can be an effective leadership tool 

Practice and use these skills in a variety of situations and receive feedback to enhance 

participants skills 

Identify situations in which participants can apply newly learned skills 

Applying these concepts will enable participants to: 

Modify their leadership approach in response to the changing needs of patients, the workplace, and 

their teammates 

Enhance the efficiency and effectiveness of participants’ communications with others 

Meet people’s personal and practical needs and build their commitment to achieving solid clinical 

care, good customer service, and critical business results 

Ensure that people - including - participants get the feedback they need to perform at peak levels 

Day 2 

Helping Others to Adapt to Change 


Examine the effects of change on individuals, team, and the organization 

Explore how you can help others to adapt to change through commitment and involvement 

Identify the types of change discussions that occur in today’s workplace 

Learn to prepare for and conduct effective discussions about change using Interaction Guidelines 

and Key Principles 

Discuss and prepare for handling challenging change discussion 

Learning these concepts will enable participants to: 

Create more ownership of change in the workplace 

Prepare for and conduct discussions that involve exploring change, introducing change to others, or 

overcoming people’s resistance to change 

Minimize the potentially negative effects of not adapting to change on morale, collaboration, and 

productivity 

Foster trust and teamwork during times of change.


Define coaching 



Preparing Others to Succeed 

Identify opportunities to prepare others to succeed 

Recognize their role in coaching discussions as that of a catalyst, someone who “sparks” others to 

act 

Understand how and when to personalize their coaching 

Prepare for effective coaching discussions using the Interaction Guidelines and Key Principles 

Enhance participants’ skills in providing positive reinforcement to the people they are coaching 

Build skill in handling challenging coaching discussions 

Applying these concepts will enable participants to: 

Recognize and follow through on opportunities to coach people in a variety of patient care 

situations, such as learning new skills, solving problems, and making decisions 

Prepare for and conduct effective coaching discussions, using newly learned skills and the 

Discussion Notes form 

Personalize their approach to preparing others to succeed, based on the situation and the person(s) 

involved 

Encourage people to continually achieve success 

Handle coaching challenges, such as people who lack confidence, are overconfident or resistant to 

change 

Help others provide high levels of clinical care and customer service 

Day 3 

Harassment Prevention and Investigation for Leaders 


Learn to recognize many forms of harassment 

Learn the legal basis for the actions and policies organizations must adopt to prevent harassment 

Understand the victim’s perspective and reluctance to report incidents 


Take active steps to prevent harassment in their workplace 

Investigate and appropriately handle a harassment complaint 

Protect the victim, accused, and the organization while facilitating resolution to complaints



Prevention of Workplace Violence 


Understand the roots of violence in the workplace 

Understand the company’s responsibility in preventing workplace violence 


Take active steps to prevent employee violence in EMS organizations 

Establish a crisis response team to handle potentially violent employees in their workplace 

Conflict Resolution 


Examine how people’s differences can benefit the work group but can sometimes lead to conflict 

Identify the causes of conflict in EMS 

Recognize the stages of conflict and behavioral signs that point to escalation of conflict 

Explore approaches participants can take to guide conflict resolution 

Learn to prepare for and conduct effective discussions about resolving conflict using Interaction 

Guidelines and Key Principles 

Prepare for handling challenging conflict resolution discussions 

Applying these concepts/skills will enable participants to: 

Recognize the signs of conflict and its impact on patients, clinicians, groups, and the organization 

Choose an appropriate level of involvement for guiding conflict resolution 

Prepare for and conduct conflict resolution discussions 

Handle challenging conflict-related discussions effectively. 

Day 4 

Facilitating Improved Performance 


Distinguish between poor performance and poor work habits, including ways to approach each type 

of situation 

Identify the work habit and performance problems that occur most frequently in today’s workplace, 

as well as their impact (consequences) 

Recognize their role in improvement discussions as that of a catalyst, someone who “sparks” others 

to improve 

Prepare for effective improvement discussions using the Interaction Guidelines and Key Principles 

Develop and share tactics for handling difficult improvement situations



Applying these skills/concepts will enable participants to: 

Encourage people to acknowledge and take responsibility for performance gaps and poor work 

habits, commit to improvement, execute and improvement plan, and track their progress 

Through words and actions, communicate their confidence in the person or team’s ability to improve 

Prepare for and conduct successful improvement discussions using newly learned skills and the 

Discussion Notes form 

Handle improvement challenges, such as denial, resistance, and reluctance to take accountability 

for improvement 

Learn that giving effective feedback depends on active listening and questioning 

Plan a follow-up discussion for a patient care situation 

Valuing Differences 

By the end of this workshop, participants will understand: 

The types of differences that make each person and patients unique 

How differences in styles, abilities, and motivations are valuable to the team of group 

The importance of accepting, encouraging, and supporting differences 

Ways to value others 

Learning and applying these concepts will enable participants to: 

Improve decision making through seeking and considering diverse views and approaches 

Reduce conflict by valuing everyone’s contributions 

Increase moral, improve patient care, and increase teamwork by accepting and valuing differences

LEADU @ AMR 


Program 

May 2003

This Page Intentionally Left Blank

Introduction 

Purpose 

Structure 

Continuously developing the next generation of key 

contributors and leaders is critical for the long-term success of 

any organization. The practice of developing employees to 

their full potential, promoting from within, and growing our 

own leaders has many benefits, including: eliminating the 

steep learning curve experienced by outside hires, providing a 

career path for our employees, and improving employee 

morale. This program is intended to compliment other 

national, regional, and local educational and succession 

planning efforts. However, participation in this program does 

not constitute a guarantee of specific developmental opportunities or promotion. 

The purpose of AMR’s Leadership Development Program is to provide a core developmental 

curriculum for each supervisory/professional level within the company. The intent is to insure a 

baseline level of knowledge and competency at each level and to provide a foundation to build 

upon for future growth. 

Much like a college experience, the program is self-directed because participants complete 

assignments in no specific order or timeframe. Individual knowledge and skills vary, so 

participants are encouraged to formulate a learning plan that best meets their personal needs. Keep 

in mind, some assignments that are part of this program are self-study, some may be offered 

seasonally and regionally, and others require completion of activities outside of AMR. 

This program compliments AMR’s succession planning efforts by helping to prepare employees to 

take on new leadership roles. It also gives individuals an opportunity to demonstrate their 

motivation and competency, assisting decision-makers with evaluating those ready for 

advancement and promotion. 

To simplify this concept, we’ve likened the knowledge and skills required at each leadership level 

to what is required for progressive levels of college degrees. Here are the degrees one can obtain 

through LeadU @ AMR: 

Supervisor/Professional: AMR Associates Degree 

Manager: AMR Bachelors Degree 

Director: AMR Masters Degree 

Vice President: AMR Doctoral Degree 

The assignments at each level directly correlate to the key competencies required at each respective 

leadership position. Every leader and professional staff member at AMR is expected to complete 

the coursework required for the position they currently hold. Once this is completed, employees 

may then begin doing assignments at the next degree level. For example, all supervisors must 

complete the Associate’s Degree curriculum before they begin coursework at the Bachelor’s degree 

level. 

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Appendix A, Degree Curriculum Requirements, details the course requirements for each level. 

For external coursework, courses should be considered that will give the employee the greatest 

chance for success in the job requirements current job requirements. External courses have not 

been identified as there is a great variety in course titles and costs throughout the United States. 

The employee and manager should review courses available at local community colleges and 

private technical schools for applicability. 

Pre-Requisites 

During the initial start-up phase, managers/directors and vice presidents will be required to 

complete the core coursework for all levels they have achieved. For example, a director would need 

to complete the core course requirements for the Associate’s and Bachelor’s Degree curriculum in 

addition to the Master’s Degree. In the first year of implementation, managers, directors, and vicepresidents 

will be allowed to challenge core coursework that needs to be completed at lower levels. 

These pre-requisites must be completed before the participant can elect to pursue the next advanced 

degree. Developmental activities that are considered to be electives for the lower level degrees will 

not be required unless they are part of that employee’s personal developmental plan. 

All leaders must complete the degree requirements for their current level no later than 

3/31/04. 

Managers must complete the degree requirements for the Supervisor/Professional level no 

later than 3/31/05. 

Directors and VPs must complete the degree requirements for all levels below their current 

position no later than 3/31/06. 

Tracking and Degree Completion 

Every management or professional staff employee must complete a LeadU @ AMR Progress 

Report Sheet (PRS) annually. The PRS is completed in February, to coincide with the yearly 

evaluation period. An employee’s supervisor can use the PRS during this time to review completed 

goals and help establish new ones.

Eligibility 

The Human Resources Department assists with the annual Progress Report Sheets as follows: 

Distribution of the PRS to all eligible employees along with instructions and when they are 

due to their supervisor. 

Collection of PRSs from supervisors after they have reviewed with the employee. 

Making a copy set of all PRSs received for the divisional and regional vice presidents to 

review. 

Insuring that all PRSs collected are placed in the employee’s personnel file. 

When a participant believes that he or she has completed and mastered the 

coursework required for a given level, the employee completes a LeadU @ AMR 

Degree Completion Request (DCR) and submits it to their Human Resources 

Department. 

The Human Resources Department reviews the DCR, and validates that all of the 

required and elective course work has been completed. Human Resources will 

verify degree completion with the Regional Curriculum Advisory Committee and 

arrange an appropriate recognition event. The Regional HR Department is 

responsible for tracking their respective participants and degrees within the national 

database. 

The program will be open and available to all AMR leaders and professionals. However, only 

LeadU@ AMR Degree Completion Requests submitted by the following individuals will be 

considered for approval: 

Employees who have completed their Orientation and Introduction Period. 

Employees with no documented corrective action in the previous six-month period. 

Employees rated as Satisfactory or Meeting Standards on their annual review in the 

previous evaluation period. 

Faculty and Administration of the Program 

Faculty 

For DDI courses, training will be conducted by AMR employees who have been certified as 

trainers by DDI. Each region will train team members to serve on the faculty. Other courses will 

be taught by internal subject matter experts as determined by AMR. External courses will be 

taught by the faculty of the institution. 

Regional Curriculum Advisory Committee 

Each region will create a Regional Advisory Committee that is part of the Leadership Development 

Panel (also created to oversee the Accelerated Development Program). The Committee will have 

responsibility for administration of the program in that region. The Regional Curriculum 

Committees will be chaired by the Regional Vice President of Human Resources & Safety. Each 

operating department will have a representative on the Committee. The Committee will also 

endorse faculty members to teach courses. 

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4 

National Curriculum Advisory Committee 

National program administration will be overseen by the National Curriculum Advisory Committee 

that is part of the Executive Oversight Committee (also created to oversee the Accelerated 

Development Program). The Committee will be chaired by the National Vice President of Human 

Resources. Each region will have one advisory team member. The National Resource Center 

(NRC) Finance Department will also have a member on the team. The role of the Committee will 

be to review and amend the curriculum based on employee input and the recommendations of the 

Regional Advisory Curriculum Committees. The Regional HR leader is responsible for notifying 

the NRC Director of Organizational Development of the identity of their respective member for the 

National Curriculum Advisory Committee. 

Types of Coursework & Availability 

Coursework and assignments required for each degree will generally fall into the following 

categories: 

Development Dimensions International (DDI) 

Since 1970, DDI has helped thousands of corporations achieve superior business performance 

through workshops that build and assess specific, job-critical competencies and promote positive 

behavior changes that lead to better job performance. DDI classes are taught through LeadU @ 

AMR directly by DDI and by AMR employees who are certified DDI instructors. 

Course schedules and availability of DDI courses offered will vary by region. At the beginning of 

each calendar year, the Human Resources Department is responsible for publishing a DDI course 

schedule. Employees are responsible for requesting participation in these workshops directly with 

the facilitator, as well as making arrangements for time away from their normal duties. The 

employee’s supervisor will determine if such time will be granted, as well as securing any 

assistance with travel costs. 

LEAD-U CD-ROMs 

Leadership Education and Development (LEAD) University is an AMR-produced series of CD- 

ROM based and other training modules contained in the program that focus on understanding the 

business and key leadership skills. Many include a post-assessment of concepts reviewed.

Most operations have these available on a checkout basis, and may also have kiosks set up at the 

worksite specifically for viewing the CD-ROMs in this program. 

As the individual completes each CD-ROM, they must print out the available completion 

certificate for their records and for submission as back-up to their Degree Completion Request. 

The DCR is forwarded to the employee’s respective HR leader for tracking. 

AMR Workshops & Project Teams 

Throughout the year, AMR provides training to leaders on a 

variety of topics, many of which are specific to our business and 

operations. Inter-disciplinary courses will be developed by 

departmental subject matter experts and offered for each degree 

level. For example, the Safety & Risk team will conduct an entrylevel 

course on Accident Reporting as part of the Associates 

Degree program. 

Workshop schedules and availability will vary by region, so 

employees should check with their local Human Resources 

departments as to when they will be offered. 

In addition, throughout the year, cross-functional project teams are 

assembled to work on assignments that are intended to develop, 

improve, and implement programs related to clinical excellence, performance measurement, safety, 

business development, operational systems, etc. Employees should make their interest in 

participating on these project teams known to their supervisor and support department managers. 

Coach-Assisted Learning 

Some coursework will generally require the assistance of a content or functional area expert and 

internal teacher, or coach. Employees may select one or more coach to assist them based on their 

development needs. There is no formal process in place for participants to select coaches. They 

possibility for coaches may include peers, immediate supervisors, and departmental support staff at 

the employee’s location or outside the employee’s operation or department. Employees will 

identify the coaches who have assisted them when they submit their LeadU @ AMR Degree 

Completion Request. 

External Coursework 

External coursework are assignments that generally must be accomplished by the participant 

outside of AMR. These include seminars, conferences, college-level courses, and participation in 

trade organizations, community groups, etc. 

The candidates for an AMR Doctorate Degree will be required to attend an Executive Training 

Program delivered by an accredited institution. Due to the various courses offered throughout 

North America, the candidate should consult with the Regional Curriculum Advisory Committee to 

identify an appropriate course. 

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6 

The decision should be based on the candidate’s previous experience and education. Once the 

appropriate course is identified, the National Curriculum Advisory Committee will be consulted for 

approval. 

If external coursework is a core requirement for an employee’s degree program, the expenses for 

the course will be born by the company. If the coursework is elective or supplemental to the degree 

plan, the time commitment and any associated costs for external coursework are the responsibility 

of the employee, keeping in mind the following: 

Participants can complete many assignments during the course of performing their regular 

job duties. Arrangements should be made through, and approved by the employee’s 

supervisor for any extended time commitments, such as overnight travel. 

A final note about coursework completion: It is the responsibility of the employee to arrange 

attendance and document the dates involved, institution, instructor, final grade or pass/fail 

indicator. This information can be noted on the LeadU @ AMR Degree Completion Request and 

provided to the employee’s Human Resource Department. 

Challenging Coursework 

Should an employee feel they already possess the knowledge, experience, and 

competencies derived from a curriculum assignment—or they have already 

completed an assignment during his or her tenure with AMR (such as a DDI 

course or AMR workshop)—the participant should complete LeadU @ AMR 

Challenging Coursework Form 

The Regional Curriculum Advisory Committee has sole discretion in 

determining whether to consider a submission of challenge, and if considered, whether the 

participant has obtained the necessary skills and proficiency. If the challenge is unsuccessful, the 

employee is given feedback on the LeadU @ AMR Challenging Coursework Form. 

Resource Library 

The Resource Library, Appendix B, is an integral part of this program. It contains a synopsis of 

all the courses required or available for this program. Also included is a listing of materials 

maintained by your Regional Human Resources Department that supplement the coursework. This 

material may include a variety of books, training materials, and self-study tools. Contact your 

Human Resources representative for access to this material. Coaches may also be able to assist the 

employee in locating additional learning resources.

Program Communication & Revisions 

Information about the LeadU @ AMR Leadership 

Development Program will be included in leadership 

orientations, job-offers made to candidates, and during 

discussions at the employees annual review process. It 

should also be regularly discussed at departmental and 

operations divisional and regional meetings. 

The Human Resources Department in conjunction with a 

National and Regional LeadU @ AMR Curriculum Advisory 

Committee has the responsibility for on-going communication 

regarding the program, as well as annual program review and 

revisions. 

Program Disclaimer 

AMR is committed to the professional growth of its employees. This program is intended to 

develop knowledge and skills and prepare individuals for excellence in their current position and or 

future growth opportunities. Participation does not commit the company to promote or give 

preference to employees who are active in or complete this program, nor is it a contract of 

employment. AMR reserves the right to modify position descriptions, policies, or any other 

procedural documents, and discontinue the participation of an employee in this program at any 

time, for any reason, without prior notice. 

Please note that LEADU @ AMR is an internal development program. Any degree certificate that 

an employee receives through this program is issued by AMR only and there is no representation 

that the degree certificate is accredited by any public or private entity. 

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It’s It s Time to Experience… 

Experience 

DIVERSITY 

What is Diversity? 

It simply means differences 

Other factors in Diversity 

Age 

Gender 

Race 

Disability 

Barriers… Barriers 

•Diversity Diversity itself is not a problem 

•Negative Negative attitudes toward other 

people’s people s differences often engage 

in negative behaviors, including – 

•Prejudice Prejudice 

•Stereotyping 

Stereotyping 

•Discrimination 

Discrimination 

Snickers vs. Jolly Rancher 

Appreciating diversity in the 

workplace promotes the ideas of 

human dignity and respect for those 

who are different from us. 

They’re They re different than me… me 

•Different Different does not mean wrong 

or to be wary… wary 

•Different Different provides the 

opportunity to learn and grow in 

accepting those different than 

ourselves. 

Factors that create Diversity 

Personality 

Thinking 

processing 

Assertiveness level 

religion 

Values 

Energy level 

Habits 

Diversity 

Likes and dislikes 

Education and 

knowledge 

Goals and 

ambitions, job title 

Political views 

Lifestyle 

Sexual orientation 

Social status 

Prejudice, stereotyping and 

discrimination create a hostile work 

environment that robs all employees 

of the energy they need to be 

productive. Eliminating these 

negative behaviors can create 

constructive results. 

Now’s Now s the time …. 

Eliminate thinking in stereotypes and generalizations 

Demystify your differences by asking tactful questions 

Keep and open mind towards others 

Think before you speak, and be sensitive to others 

Don’t Don t judge, just listen 

Respect other points of view 

Value the strengths and experiences of others 

Treat all people fairly 

Allow others to be themselves 

Be careful with ethnic humor 

1

This may be your greatest 

challenge… 

challenge 

Throughout our day we are faced 

with all types of diversity… 

diversity 

Value Diversity…. 

Diversity 

Respect Differences… 

Differences 

2

Infection Control Program 

Health Maintenance 

Cleaning 

Sharps 

Personal Protective Equipment (PPE) 

Exposure Management 

Bloodborne Pathogens 

Tuberculosis 

Hazardous Materials 

Hazardous Communication 

Vehicle Safety 

Acknowledgment of Receipt 

Alcohol & Drug Policy 

Workplace Violence 

Ergonomics 

Fit for Duty Testing 

Cascade Systems 

Medical Device Failure Reporting 


HEALTH AND SAFETY PROGRAM MANUAL 

Job Safety Classes: Ambulance, Shop, Supply, Van, Office 

Work Areas: All Work Areas 

TABLE OF CONTENTS 

AMR Safety & Risk Management 

>

TO: David Borghelli 

FROM: Dave Borghelli, Operations Manager 

RE: BACK INJURY PREVENTION INITIATIVE 

DATE: August 1, 2004 

Your back is one of your most important assets. Back injuries are the most common type of injury in the field of EMS. In fact, back 

injuries are the most common type of worker injury in the United States. 

During your orientation at AMR, as well as during previous safety initiatives, you’ve learned how to lift correctly. You probably know 

how to use good body mechanics. For example: bending at the knees and keeping your back straight while lifting with your legs. This 

month we would like to talk about choices you make and how they impact your future. 

You can choose to reduce the chance for an injury by utilizing the skills you’ve learned or you can take chances that may be career 

ending and impact your quality of life. A split second decision can mean the difference between time with your family or sitting in pain 

visiting doctors’ offices and physical therapists. Even with treatment you may never reach the same quality of an active lifestyle, which 

you previously enjoyed. Please make the right choices and: 

Choose To: 

“Be Prepared”- Keep loose, stretch periodically and get out of the ambulance and walk around. Regularly practice “Street Corner 

Stretching.” 

“Coordinate the lift”- Ensure there are an adequate number of people for the lift and never lift more than you can handle. Communicate 

and lift as a team. 

“Use Proper Technique”- Focus on the load and keep it close, bend your knees, straighten your back, tighten your abdomen and use 

your arms. Keeping the load close to your body transfers the weight to the stronger muscles of your legs and arms. A tight abdomen 

forms a protective cylinder around your spine to support your back. 

Avoid: 

“Jerking”- Avoid sudden forceful motions, which can overload muscles, tendons and ligaments. Forceful exertions are commonly 

misused when lifting, pushing or pulling, such as in loading or unloading a gurney from the ambulance. 

“Twisting” - Avoid twisting motions when lifting, as the ligaments in the back do not support twisting movements very well, especially 

when the back is bent forward. Twisting during a lift places pressure on vertebral discs forcing them backward. This can cause bulging 

or ruptures that can damage surrounding nerves. 

10/26/2004 5:12 PM 

AMR World Class Safety Begins With You David! 

NOTE: Policy #202 requires you to maintain current Records/Certs/Licenses on file at Concord Operations. As a courtesy to you 

David, here is a list of all your Records/Certs/Licenses along with their expiration dates. If you have a more current card than what our 

records indicate be sure to give a copy of it to either Yvette Byers or Becky Hobson. 

TB EXPIRATION 02/09/05 

MEDICAL EXAM CARD 07/08/06 

ADL 11/17/05 

CDL 11/17/05 

CPR 12/31/05 

ACLS 03/31/06 

PEPP 07/09/05 

BTLS/PHTLS 11/30/04 

STATE ACCREDITATION (ALS) 05/31/05 

COUNTY ACCREDITATION 05/31/05 

(EMT Cert or Medic Accreditation)

NEW HIRE ACADEMY 

July 13-16, 2004 

TRACK 1 

ACTIVITY INSTRUCTOR TIME 

HR Paperwork Debora Hawkins 0800-0830 

Class Intro/Materials Review Monicque Vasquez 0830-0900 

Medical Legal/Documentation Monicque Vasquez 0900-0930 

Code of Conduct/HIPAA Monicque Vasquez 0930-1030 

LUNCH EVERYONE 1030-1100 

AT&T Language Line Video Monicque Vasquez 1100-1115 

True Professional/On-Time Monicque Vasquez 1115-1145 

Harassment Prevention Monicque Vasquez 1145-1245 

Patient Advocacy Monicque Vasquez 1245-1345 

TRACK 2 


Health & Safety Dave Caraveo 09:00 – 09:45 

BREAK EVERYONE 09:45 – 10:00 

Health & Safety Dave Caraveo 10:00 – 12:00 

LUNCH EVERYONE 12:00 – 13:00 

CISM Dave Caraveo 13:00 – 14:30 

BREAK EVERYONE 14:30 – 14:45 

Diffusing Assaultive Behavior Dave Caraveo 14:45 – 16:00 

TRACK 3 


EVOC Didactic EVOC Specialist 08:00 – 12:00 


EVOC Didactic EVOC Specialist 13:00 – 17:00 

TRACK 4 


EVOC Drive Day EVOC Specialist & 

FTO Team 

08:00 – 12:00 


EVOC Drive Day EVOC Specialist & 

FTO Team 

13:00 – 17:00


Orientation Agenda 

Tuesday July 20, 2004 

0900- 0930 Welcome Maddox / Byers 

0930-1030 Pre-Billing Rudd 

1030-1045 Safety Risk Hobson 

1045-1100 Break 

1100-1200 TB Mask Fitting Mike Austin 

Pager Distribution 

Logistics 

1200-1300 Lunch 

1300-1415 CES Policies and Procedures Sam Bradley 

1415-1430 Break 

1430-1600 Customer Service Mueller 

State of the County

Wednesday July 21, 2004 

0900-1000 Union Bill Bower 

1000-1200 EME Training Maddox 

1200-1300 Lunch 

1300-1430 County Policies & Procedures Maddox 

1430-1445 Break 

1445-1700 Equipment Review Maddox / FTO 

Infrequent Skills 

Thursday July 22, 2004 

0900- 0930 Hazmat Overview Buell 

Bart Response Video 

0930- 1015 Company Policies & Procedures Buell 

1015-1030 Break 

1030-1200 Gurney Training Caraveo 

Maddox 

1200-1300 Lunch 

1300-1330 Payroll / Scheduling Vanaman 

1330-1630 E-PCR Training (ALS) Banks 

PCR Training (BLS) Francis


Operations Management 

Proposed Posting Plan 

List of Responses by Chief Compliant 

Daily Ambulance Inventory Checklist 

Equipment Failure Form 

Gurney Failure Form 

Medical Equipment Failure Form\ 

Vehicle Critical Failure Form 

Vehicle Maintenance Schedule 

Preventive Maintenance Inspection Form

Sample Report Sorted by Chief Complaint 

Weekly Responses by Chief Complaint 

Code 3 Responses 

Complaint Sun Mon Tue Wed Thu Fri Sat Total 

Abdominal Pain 3 2 1 2 3 2 13 

Allergies/Hives/Med React/Stin 1 1 2 

Assault / Sexual Assault 3 1 1 5 2 12 

Back Pain (Non Traumatic) 1 1 1 3 

Breathing Problems 12 11 11 13 14 10 8 79 

Cardiac or Resp Arrest/ Death 2 3 5 

Chest Pain 6 8 7 8 7 6 12 54 

Choking 1 1 1 3 

Convulsions/ Seizures 1 3 5 5 3 17 

Diabetic Problems 1 3 1 3 3 11 

Electrocution/Lightning 1 1 

Falls 2 1 7 12 4 4 10 40 

Heart Problems/A.I.C.D. 1 1 2 2 1 7 

Heat / Cold Exposure 1 1 

Hemorrhage / Lacerations 3 2 3 4 3 3 18 

Overdose/ Ingestion/ Poisoning 1 1 3 2 1 4 12 

Pregnancy/ Childbirth/Miscarry 1 1 2 

Psychiatric / Suicide Attempt 1 1 1 1 5 9 

Sick Person (specific diagnosis) 2 6 3 3 3 17 

Stab/Gunshot /Penetrating Trauma 4 1 5 

Stroke (CVA) 3 1 4 2 2 1 5 18 

Traffic Accidents 5 5 14 9 7 8 12 60 

Traumatic Injuries, Specific 1 1 1 2 2 6 4 17 

Unconscious/Faint (Non Trauma) 7 10 9 7 8 4 2 47 

Unknown Problem ( Man Down) 3 3 1 4 4 3 2 20 

Total Code 3 Responses 60 60 71 76 64 64 78 473 

Code 2 Responses 

Abdominal Pain 1 3 2 2 1 9 

Assault / Sexual Assault 3 2 5 

Back Pain (Non Traumatic) 1 2 1 2 3 3 12 

Breathing Problems 1 1 

Burns / Explosion 1 1 

Carbon Monox / Inhale/ Haz Mat 2 2 

Chest Pain 1 1 

Choking 2 2 

Convulsions/ Seizures 1 1 2 

Diabetic Problems 1 1 1 3 

Falls 3 4 2 5 14 

Headache 1 1 2 

Hemorrhage / Lacerations 2 2 

Overdose/ Ingestion/ Poisoning 1 1 1 3 

Psychiatric / Suicide Attempt 1 1 

Sick Person (specific diagnosis) 2 8 2 4 6 6 4 32 

Traffic Accidents 1 1 3 2 1 1 9 

Traumatic Injuries, Specific 1 1 2 4 

Unconscious/Faint (Non Trauma) 1 1 

Unknown Problem ( Man Down) 2 1 1 4 

Total Code 2 Responses 15 21 12 6 24 17 15 110 

Total Responses 75 81 83 82 88 81 93 583

Date: ________/________/_________ 


Ambulance Daily Unit Check-off Radio Identifier __________ Phys. Unit __________ 

initials OPERATIONS CHECK 

Oil check 

Emergency Lights, Scene Lights 

Siren/Horn 

Turn signals 

Head Lights, Tail/Brake lights initials BLS Airway initials ALS Medical 

Tires/Spare Portable Oxygen with Regulator 1 1 IV Catheters (14-22) 4 ea 6 ea 4 ea 

Dash/Gauges Spare "D" Tanks 2 1 Tape, 1"/transpore 2 1 box 2 

Wipers OPA Set (000-6) 1 1 1 Sterile Saline (injection) 5 5 2 

Power Locks/Windows NPA Set (28, 30, 32, 34) 1 1 1 Tourniquets 2 10 2 

AC/Heater Ambu-Bags (Adult/Pedi/Infant) 1 ea 1 ea 1 ea. Alcohol Preps, Betadine Preps 5 1 box 5 

Brakes Nasal Cannula 2 8 2 Razor 1 2 1 

Company Radio/Portable Radio Non-rebreather Mask 2 6 2 Calcium Chloride 2 2 2 

MEDNET Radio/Scanner/Fire Radio Pediatric/Infant Non-rebreather Mask 2 ea. 3 ea. 2 ea. Activated Charcoal 1 3 2 

Gas Card Oxygen Extension Tubing 1 2 1 Adenosine 5 5 5 

Nextel TB Masks (sm., med., lg.) 1 ea. 2 ea 1 ea. Albuterol 6 12 6 

Gurney/Flat Strecher/Stair Chair Bite Stick 2 2 2 Atropine 4 6 4 

Main Oxygen with Regulator, Med. Air (if installed) Suction Tubing (8 Fr, 10 Fr, 18 Fr) 2 3 2 Benadryl 2 2 2 

initials CAB 

Norm Min Tonsil Tip 2 3 1 Dextrose 50% 2 2 2 

Thomas Bros. Map 1 1 Dopamine 1 1 1 

Vehicle Registration/CHP ID Card 1 1 initials ALS Airway Epinephrine 1:10,000 5 8 4 

Insurance Card 1 1 Nebulizer (hand-held and mask) 2 ea 2 ea 2 ea. Epinephrine 1:1,000 4 4 2 

Flashlight/Spotlight 1 ea. 1 ea. Combi-tube (Adult & Pedi) 2 ea 2 ea 2 ea. High dose Epi 1 1 1 

Fire Extinguisher 1 1 KY Gel Packs 3 3 3 Glucagon 1 1 1 

PCR's/Billing Forms 15 ea. 3 ea. ET Tubes (2.5-4.0) 3 ea. 3 ea. 3 ea. Lasix 5 6 5 

CPS/Elder Abuse Form 2 ea. 1 ea. ET Tubes (4.5-9.0) 2 ea 2 ea 2 ea. Lidocaine 4 4 3 

Clipboard 1 1 Stylet (Adult and Pedi) 1 ea 3 ea. 1 ea. Narcan 3 6 3 

Accident/Infectious Exposure Packets 2 ea. 2 ea. Laryngoscope Handle 1 1 1 Nitroglycerin Spray 1 1 1 

Gloves-box (sm,med,lg,XL) 1 ea. 1 ea. Miller Blades (0-4) 1 ea 1 ea 1 ea. Sodium Bicarbonate 1 2 1 

Helmets 2 2 Macintosh Blades (2-4) 1 ea 1 ea 1ea. Aspirin Bottle 1 1 1 

Fast Trac 1 1 ET Nebulizer Set 1 1 1 Morphine sulfate 10 2 

Cash Receipt Book 1 1 ETT Holder (Adult/Pedi) 2 ea. 3 ea 2 ea. Versed 6 2 

CCCEMS Protocols and SOP's 1 1 ET Tube Check Bulb 2 2 1 Syringes (10 and 30 cc) 1 ea 1 ea 1 ea. 

"C" Size Batteries 2 2 2 Syringes (1, 3, 5, 10 cc) 2 ea 2 ea 4 ea. 

Spare Bulbs (sm/lg) 2 ea. 2 ea. 1 ea. Needles (18-25) 3 ea 3 ea 3 ea. 

Magill Forceps (Adult/Pedi) 1 ea 1 ea 1 ea. Saline Locks 2 4 2 

ETVCO2 Detector Adult/Pedi 2 ea. 2 ea. 2 ea. Normal saline 1000 cc bag 2 10 2 

Meconium Asperator 2 2 2 IV Tubing Sets (10, 60 gtts) 2 10 3 

initials MONITOR Cricothyrotomy Kit 1 1 1 Arm Boards (long and short) 1 ea 2 ea 1 ea. 

Lifepack Batteries/inc monitor 2 2 2 Needle Thoracostomy Kit 1 2 2 Medication Labels 2 2 2 

Cables (2 and 3 Lead) 1 ea. 1 ea. 1 ea. initials Pediatric ALS Medical Gluc. Test Strips 1 1 1 

Electrode sets (adult/pedi) 4 ea 8 ea. 2 ea. IO Kit 2 2 2 Glucometer Lancets 5 10 5 

EKG paper rolls 2 3 1 Volutrol 2 2 2 Glucometer 1 1 

Monitor Normal 

Pulse Ox Set 4 4 2 Broslow tape 1 1 

Quick Combo Set (Adult and Pedi) 4 ea 4 ea 2 ea Dextrose 25% 2 2 2 

Box/Bag Normal 

Cabinet Normal 


Minimum In Service 


BLS Medical 

initials initials initials 

Triage Tags 30 20 Emesis/Wash Basins 2 1 Trauma Dressings 4 2 

Portable Suction/Vehicle Suction 1 ea 1 ea. Bed Pan/Urinal 1 ea 1 ea. 2 inch Adhesive Tape 1 box 2 rolls 

Head Bed 6 6 2 Occlusive Dressing 5 2 

KED 1 1 BP Cuff (Adult/Pedi/Infant/Thigh) 1 ea 1 ea 1 ea. Cold-packs 6 2 

Arm/Leg Splints 4 ea 2 ea. Stethoscope 1 1 1 Restraints 1 set 1 set 

Backboards 2 1 OB Kit 2 1 Sager or Hare Traction 1 1 

Spider Straps 2 1 Triangular Bandages 5 4 Paper Sheets, Blankets 1 case 2 ea. 

Scoop Stretcher 1 1 Sterile 4x4's 12 4 Sharps containers 2 1 

Pedi Board 1 1 Non-Sterile 4x4's Package 2 ea 1ea. Reflective Foil Blanket 4 2 

Cervical Collars Adult/Pedi 4 ea 2 ea. 2 ea. Kerlix Rolls 12 6 Bandage Shears 1 1 

Sterile Water/Sterile Saline 5 ea 2 ea. 5x9/8x10 Dressings 6 ea 4 ea Band-Aids 10 1 box 10 

Irrigation Tubing (equiv. IV tubing) 2 1 Face Shields 4 2 Insta-Glucose Tube 2 2 1 

Burn Sheets/Emergency Blankets 3 ea. 1 ea. Bio-Hazard Bags 5 1 Pen light 1 

Check-off9/1/2004 

1 1 












Minimum In Service

U:\safety\word\gl\eqfail 

Equipment Failure Report 

Safety & Risk Management 

Service, Vision, Leadership, Technology (For equipment other than vehicles) 

Operation (circle one) Spokane, Try-Cities, Yakima 

Date___________ Time___________ Equipment Involved______________________________ 

Unit #_________ Location of Incident_______________________________________________ 

Make ____________________Model #________________ Serial #_______________________ 

Date of Last PM _________________ BY___________________________________________ 

Driver____________________________ #________(EMT or Paramedic) 

Attendant_________________________ #________(EMT or Paramedic) 

Reporting Party_________________________________________________________________ 

Investigator____________________________________________________________________ 

Monitor / Defibrillator 

Monitor Serial #_______________________ Defibrillator Serial #_______________________ 

Battery (ies) Serial # involved in incident 1)____________ 2)_____________3)_____________ 

Battery Charging Bay Model #________________________Serial #______________________ 

Brand of Electrodes Used ____________________________ Mfgd. Date.__________________ 

Brand of ECG Cables_____________________________________________________ 

*Return ALL Items involved in the incident to your Supervisor (i.e., ECG Cables, Batteries, ect.) DO NOT ATTEMPT TO TEST OR 

OPERATE EQUIPMENT . 

*Attach a copy of PCR, DAL, Checkout Sheet and Test Strip to Report. *Attach ECG Strip if applicable. 

Was Patient Care Affected? YES NO ( PLEASE DESCRIBE HOW IT WAS OR NOT IN YOUR SUMMARY) 

Patient Name_________________________________________ Trip Ticket #______________ 

Receiving Facility_____________________________________ PCR(EMS)#_______________ 

Incident Summary___________________________________________________________________________________________ 

__________________________________________________________________________________________________________________ 

____________________________________________________________________________________________________________________ 

________________________________________________________________________________________________________________ 

NOTIFICATION 

Operations Director / Manager Date____________ Time____________ By____________ 

Safety & Risk Management Date____________ Time____________ By____________ 

Copies Forwarded to SRM Date____________ Time____________ By____________ 

IMPORTANT - 

1) ____ Tag and Remove any Failed Equipment from service, until it can be Checked and 

approved for service by Qualified Service Personnel. If patient was involved, contact 

SRM first to determine failure assessment and need for preservation prior to servicing. 

2) ____ Secure All Items ( Monitor / Batteries ect.) Involved, together with the paperwork. 

Completed by___________________________________________________Date___________ 

6/97

GURNEY INCIDENT REPORT FORM 

Note: This report must be completed any time a gurney “fails” during a call (regardless if injury occurs). A gurney failure may be mechanical and/or the 

result of operator error. In either case, it is critical to: (1) tag the gurney out-of-service, (2) complete each question on this report form, (3) attach a copy of 

this completed form to the gurney, and (4) fax this form to SRM. Be sure to also consult the SRM Notification Guidelines. Additional documentation or 

steps may be required. VERSION 2.0 8/16/99 

Date of incident Time of incident Trip/run # Location of incident 

Employee #1 Name Position on gurney Employee #2 Name Position on gurney 

Gurney Brand Gurney Model Gurney Serial # Date of last PM 

List names and gurney positions of all other persons handling the gurney when the incident occurred 

List names of all additional persons who witnessed this incident 

Patient height Patient weight Patient’s chief complaint before incident 

Patient age Patient gender Patient’s additional/aggravated medical complaint(s) after incident 

Describe what was happening when the incident occurred (ex: loading/unloading gurney, raising gurney height, placing patient on gurney, etc.) 

Describe the communication that took place while performing this operation 

Position of backrest Position of footrest Initial height/position of gurney Final position/height of gurney 

Describe the rolling surface on the floor/ground Rolling speed (stopped, slow, medium, fast) Was gurney moved/rolled at an angle? 

How many people had their hands 

on the gurney at the time of the incident? 

Any signs of gurney malfunction noticed prior to this incident? If so, please describe. 

Was anyone operating or otherwise touching the release levers of the gurney? 

If so, who? Why? 

Anything found that might have caused this incident? (Ex: gurney sheet in mechanisms, loose straps, debris on ambulance floor, etc.) 

What do you think could have prevented this incident? Please be specific. 

Additional comments 

Reporting employee’s signature Date County of operation 

C:\WINDOWS\TEMP\GURNINV1.RTF

Medical Equipment Failure Report 


Service, Vision, Leadership, Technology (For medical equipment such as monitors, suction units, etc.) 

County of Operation:________________________________________ State _______________ 

Date___________ Time___________ Equipment Involved______________________________ 

Unit #_________ Location of Incident_______________________________________________ 

Make ____________________Model #________________ Serial #_______________________ 

Date of Last PM _________________ BY___________________________________________ 

Driver____________________________ #________(EMT or Paramedic) 

Attendant_________________________ #________(EMT or Paramedic) 

Reporting Party_________________________________________________________________ 

Investigator____________________________________________________________________ 

Monitor / Defibrillator 

Monitor Serial #_______________________ Defibrillator Serial #_______________________ 

Battery (ies) Serial # involved in incident 1)____________ 2)_____________3)_____________ 

Battery Charging Bay Model #________________________Serial #______________________ 

Brand of Electrodes Used ____________________________ Mfgd. Date.__________________ 

Brand of ECG Cables_____________________________________________________ 

*Return ALL Items involved in the incident to your Supervisor (i.e., ECG Cables, Batteries, ect.) DO NOT ATTEMPT TO TEST OR 

OPERATE EQUIPMENT . 

*Attach a copy of PCR, DAL, Checkout Sheet and Test Strip to Report. *Attach ECG Strip if applicable. 

Was Patient Care Affected? YES NO ( PLEASE DESCRIBE HOW IT WAS OR NOT IN YOUR SUMMARY) 

Patient Name_________________________________________ Trip Ticket #______________ 

Receiving Facility_____________________________________ PCR(EMS)#_______________ 

Incident Summary___________________________________________________________________________________________ 

__________________________________________________________________________________________________________________ 

____________________________________________________________________________________________________________________ 

________________________________________________________________________________________________________________ 

NOTIFICATION 

Operations Director / Manager Date____________ Time____________ By____________ 

Safety & Risk Management Date____________ Time____________ By____________ 

Copies Forwarded to SRM Date____________ Time____________ By____________ 

IMPORTANT - 

1) ____ Tag and Remove any Failed Equipment from service, until it can be Checked and 

approved for service by Qualified Service Personnel. If patient was involved, contact 

SRM first to determine failure assessment and need for preservation prior to servicing. 

2) ____ Secure All Items ( Monitor / Batteries ect.) Involved, together with the paperwork. 

Completed by___________________________________________________Date___________ 

P:\2004\Contra Costa County - CA (2004)\Attachments\Ready to Format\Formatted and Finalized\4.3.x medical equipment failure report 

form.doc 8/16/99


Critical Failure Report 

Division (circle one) alco, coco, king, la, mar, maui, pdal, pla, pspr, redl, sac, sber, sf, sjqn, sanb, scl, scz, sha, sono, 

stan, tul, yolo 

Date____________ Time________ Vehicle Physical #________ Ticket # __________________ 

Driver _______________________# ______ Attendant ______________________# ______ 

(circle one) Paramedic or EMT or other (circle one) Paramedic or EMT or other 

2nd Unit 

Driver________________________# _____ Attendant _______________________#_____ 

Describe Failure ________________________________________________________________ 

Location of Call ________________________________________________________________ 

Patient Name __________________________________________________________________ 

Receiving Facility ______________________________________________________________ 

Failed Unit Times 2nd Unit Respnse Times 

Received _______ Dispatched _______ Code_____ 

Dispatched _______ Code_____ Responded _______ Code_____ 

Responded _______ Code_____ At Scene _______ 

At Scene _______ Left Scene _______ Code_____ 

Left Scene _______ Code_____ Destination _______ 

Failure Time _______ TOTAL RESPONSE _______ 

Patient Outcome ______________________________________________________________ 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

Date of last P.M.__________ Performed by _________________________________________ 

Mechanical Dept. Report_________________________________________________________ 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

Safety & Risk Notified ? Yes Time ________ How____________________ 

No If No Why? __________________________________ 

Completed By______________________________________ Date __________________ 

created by Ed Brown/ LA 10/26/2004 

u:\safety\word\auto\critfail.doc

(A) 

Every 5,000 Miles 

AMR VEHICLE MAINTENANCE SCHEDULE 

(B) 

Additional Services 


Lubrication Repeat of 5,000 mile 

inspection 

194 safety point and 

mechanical inspection 

Replace OEM and 

Bypass oil filters / 

Change oil 

Replacement of fuel 

filter 

(C) 



Repeat 15,000 Mile 

inspection 

(D) 



Repeat of 30,000 mile 

inspection 

Rear differential service Replace belts 

Replace idler pulleys 

and tensioner 

Replacement of air filter Replace vacuum pump 

Transmission service 

Batteries - Test and inspect every service. Replace in sets of two if required. 

Air Filter - Inspect every service and replace as needed. 

Shocks - Inspect and replace as needed. 

U-joints - Inspect every service and replace as needed.

AMERICAN MEDICAL RESPONSE 

Next PM Due __________ PM INSPECTION FORM Last P.M. miles 

IN SPACE BEFORE EACH ITEM INDICATE CONDITION AS FOLLOWS: Vehicle No. ___________________ 

() Item is O.K. (0) Adjustment Made Bypass Filter (Y ) (N ) () 

(X) Repairs Needed (-) Not Applicable Date: __________________ 

Circle Type Of Service A B C D 

V.M.R. Yes / No IN-CAB ROAD TEST Miles: __________________ 

Review Unit History Dash / vents / knobs Washers / Wipers 

Check Engine & Trans Oil Pedals and Pads Glass 

Reg., Amb. Lic. And Insurance card Back Up Alarm Heater and Defroster 

Headliner / Sun visor DRIVE TEST Air Conditioning 

Ignition Switch - lube Steering wheel / Shifter Steering Play____ (*1) 

Glow Plugs / Warning System Transmission Parking Brake 

Starter Action Horn / Siren High Engine Idle 

Oil Pressure Smoke Control Lights and Dimmers 

Instruments / warning lights Brake Performance C Pull Trouble Codes 

CAB AND BODY 

Locks and Latches Front Bumper & License Plate Grab Handles 

Hinges and Weather Stripping Fog Lights / Siren Speakers Backboard Compartment 

Door panels / Regulators / Switches Antennas Bench Seat / Upholstery / Belts 

Floors / Mats / Step well SIDE DOORS Jack / handle / lug wrench 

Pedals / Under dash Wiring Logos / Lights / Lenses / Body Ceiling / Straps / grab rails 

Seat base Protectors (top & front) Locks / Latches / Door stops Lights / suction / vent / Inverter 

Seat Adjuster Wires Hinges and Weather Stripping Compartments and Latches 

Arm Rests Grab Handles Int. Exhaust Vent 

Seats / Upholstery / Belts Suction / Charging Plug Gurney / Floor Mount / Latch 

Lightbar Fire Ext. / Safety Net STREETSIDE 

Lenses and Reflectors REAR DOORS Logos / Lights / Lenses / Body 

Mirrors and Brackets Rear Bumper / Current Lic.Tag External Exhaust Vent 

Body Panels Logos / Lights / Lenses Fuel Tank Door, / Cap / Chain 

Wiper Arms and Blades Locks and Latches External Receptacle 

Grill / Hood / lamp assemblies Hinges and Weather Stripping External Battery Door & Latch 

MAIN BATTERY TEST UPPER LOWER 

Battery Visual BATTERY LOAD TEST 6 __ Alternator Volts ___ (*6) 

Water Level _ Volts @ _____ Amps (*4) 7 __Alternator Amps ___ (*7) 

Cables / Connections _ Volts @ _____Amps (*4) 5 __ Starter Draw Amps (*5) 

AUXILIARY BATTERY TEST 

Battery Visual BATTERY LOAD TEST Battery Box and Holddowns 

Water Level 4 ___Volts (*4) Battery tray slides 

Cables / Connections 4 ___Volts (*4) Lube Battery Tray 

Bypass filter (Y ) (N ) () WHEELS AND BRAKES 

RAISE VEHICLE / SET LOCKS R.R._ /32”_____lbs. (*2-3) Rear Brakes / Drums 

Puncture Filter / Drain Fluids Inner_ /32”_____lbs. (*2-3) Right______/32” (*9) 

Hubcaps L.R._ /32”_____lbs. (*2-3) Left _____/32” (*9) 

Wheel Balance Inner /32”_____lbs. (*2-3) Machine Drums/ Rotors 

King Pins / Ball Joints Pull wheels, rotate Axle / Hub Seals 

Wheel Bearings / Dust Cap Studs, Nuts, Holes Wheel Cylinders - Calipers 

Rim / Sidewall Front Brakes / Rotors Park Brake Cables, Internal 

Tire Probe / Condition Left ____ /32” (*9) Cables / Springs / Adjusters 

Valve Caps / Stems Right ___ /32” (*9) Replace Drums 

Wheel Wells Machine rotors / repack brgs. Brake Adjustment (*10) 

Tread Depth / Pressure Brake hoses Replace Drain Plugs 

L.F.__ /32”_____lbs. (*2-3) Calipers Remove filters / check mounts 

R.F._ /32”_____lbs. (*2-3) Fill and install new filters

AMERICAN MEDICAL RESPONSE 

PM INSPECTION FORM 

IN SPACE BEFORE EACH ITEM INDICATE CONDITION AS FOLLOWS: 

() Item is O.K. (0) Adjustment Made 

(X) Repairs Needed (-) Not Applicable 

` 

Page 2 

Engine Area 

UNDERCARRIAGE AND CHASSIS 

Starter / Bolts Exhaust Pipe / Muffler 

Radiator / Core Support, Electrical connections Exhaust Hangers / Shields 

Siren Horn / Drivers / Mounts Exhaust Pipe / Manifolds Park Brake Cables, External 

Sway bar bushings / Tie Rods / Clamps Body Mounts Leaf Springs / Hangers 

Water pump Transmission Area Bushings / Clips / U-bolts 

Center Link / Steering Stops B,C Transmission Service Axle Snubbers 

Idler Arm / Pitman Trans Heat Shield Shocks 

Steering Box / Coupler Shift Linkage / Wiring Differential, Fluid / Brake Lines 

Power Steering Pump / Hoses Oil Lines D Differential Service 

I Beams / Mounts / Bushings Cross member / Mounts Rear Fuel Tank / Hoses 

Snubbers / Shocks Fuel / Brake Lines Tailpipe / Step Bumper 

Radius Arms / Bushings A/C / Heater Hoses Spare Tire ____PSI ___ (*2) 

Motor mounts Tail shaft Seal / Yoke Lower Vehicle / Add Fluids 

Lube Chassis U-Joints / Drive line Engine Oil______ Qts. (*15) 

Fluid Leaks Fuel Tank / Hoses Trans Fluid ______ Qts. (*15) 

ENGINE INSPECTION 

Coolant _______Volts (*13) Steering Pump / Fill Block Heater Cord 

Coolant _______Degrees (*13) Washer Bottle Fill Hood Light 

Pressure Test Cap / Radiator Master Cylinder Fill Install Wheels 

Radiator Core / Fins / Tank / Mounts Remove Pressure Tester lube Nuts / Studs 

Fan Shroud / Blades B,C Add 1 oz. FW16 coolant Torque Lug Nuts (*12) 

D Replace tensioner, idlers Coolant bottle fill Vehicle Completion 

D Replace vacuum pump C Replace air filter (*8) Final Road Test / 

D Replace All Belts (*14) B Replace fuel filter Leak check 

Vacuum / A/C / Heater Hoses Valve covers Engine / Trans Oil Level 

Electrical harness / connectors Run Engine Clean Maintenance Dirt 

Inj. Pump/ Throttle Linkage Oil Leak Check Complete Paperwork / Tag Dash 

* P.M.I. Specifications NOTES – BODY DAMAGE 

*1 Acceptable steering play 1 1/2” to 2” Veh. w/bypass oil filter, oil & 

*2 Tire pressure 80 psi. front and spare, 80 psi. rear (65 P.S.I. Duals) OEM filter change at “B” & “C” 

*3 Tire tread depth: 5/32” front and rear pull depth Bypass filter element at “C” 

*4 Battery voltage under load: minimum 9.6 volts @ 50% CCA for 15 sec. 

*5 Starter draw: maximum 500 amps for diesel 

*6 Regulated alternator voltage: 13.9 to 14.2 

*7 Alternator amps full fielded 75% of rated output 

Approx. 120 amps for 165 alt., 160 amps for 215 alt., 75 amps each dual alts. 

*8 Inspect at service, replace as necessary 

*9 Front brake pads new 14/32”, pull at 6/32” Rear pads new 12/32” Pull 4/32” 

*10 Rear brake shoes pull depth 2/32” bonded & 2/32” on Riveted at Rivet 

*11 Rear brake adjustment: slight drag 

*12 Torque lug nuts to 140 ft lbs. (cars and light duty(1/2 ton) 100Ft. Lbs.) 

*13 Coolant not more than .5 volts maximum 60/40/Mix. (0 degrees protection) 

*14 Serpentine inspect at service replace as nec. or at D service 

*15 88-94 (10 Qts. oil, 14 Qts. Trans fluid) 95 & later (16 Qts. oil, 14 Qts. Trans fluid) 

__________________________________ ________________________________________ __________________________________________ 

Date Completed Mechanic’s Signature Supervisor’s Signature


Commitment to EMS System & Community 

Letters of Support and Testimonials from Local Partners 

Support Letters from Patients 

Kensington Fire Protection District Award 

Community Education Manager Job Description 

Customer Survey Card 

Equipment List for Special Response Vehicle 

Ambulance Strike Team Leader Training Course Outline 

Community Outreach Prevention Posters 

MCI Basic Field Operations Course Outline 

Historical Community Outreach Event Materials

Letters of Support & Testimonials from Local Partners 

John Muir Medical Center 

Kaiser Permanente Hospital 

Sutter Delta Medical Center 

California Highway Patrol 

Rodeo-Hercules Fire Protection District 

Contra Costa County Health Services 

City of Brentwood Police Department 

Contra Costa County Health Services/Contra Costa 

Emergency Medical Services 

Dow Chemical 

Letters from Patients 

Testimonials

What people are saying about AMR…. 

“As much as I and my forces appreciate the Field 

Operations AMR provides, we appreciate their 

patient centered results oriented management style 

even more. In developing a solution to a service 

problem that ultimately led to the El Cerrito Fire 

Department Paramedic Program, AMR worked 

with stakeholders, including the County EMS 

agency, the Kensington Fire Protection District 

Board of Directors, members of the Kensington 

Community, and the El Cerrito City Council to 

solve a longstanding response problem created by 

Kensington’s relative isolation from service 

centers.” 

Chief Mark Scott, 

El Cerrito-Kensington Fire District 

“I wish to commend…each of them is a credit to 

your company.” 

Frank J Puglisi, Jr. Executive Director 

Contra Costa Regional Medical Center 

“They [paramedics] did an outstanding job both at 

the scene, and later in the ER of John Muir 

hospital.” 

Sergeant Steve Skinner 

Walnut Creek Police Department 

“…they [EMT’s] keep up this type of professional 

patient care and attitude; they will surely succeed 

furthering in EMS.” 

Captain Randy Trumpf 

Moraga-Orinda Fire District 

“Recently I became a patient…always known, their 

abilities and professional were exemplary, 

particularly when having to care for someone they 

know.” 

Kimberly Wood-Henricksen, M.S. R.N. 

Service Unit Manager 

Kaiser Permanente Antioch-Martinez 

“There is little doubt that the lifesaving efforts of 

your personnel directly contributed to Officer 

Keady’s ability to survive this incident.” 

Michael R. Davies 

Chief of Police, Brentwood 

AMR saves lives everyday- thank you for helping 

us do our part as well.” 

Tracey Purdy, Program Coordinator 

Every 15 Minutes Program Leader 

“We have had an excellent working relationship with 

AMR for many years. They have always been open to 

meeting to discuss community solutions for patient care 

and QRV partnerships.” 

Chief Doug Dawson 

East Contra Costa County Fire Protection 

District 

“Our City Council meeting tribute to 9-1-1 rescue 

groups would not have been complete without the 

AMR Response Team.” 

Donald P. Freitas, Mayor 

City of Antioch 

“I wish to share with you how caring and 

generous of their time and comfort your 

paramedics and EMT are when they come to the 

ER....” 

Fran Fontaconi, ER Customer Service Rep. 

Sutter Delta Hospital 

“…to express my appreciation for the professional 

response and high level of cooperation provided by 

your paramedics during a response to our 

facility…” 

Greg Clayton, Manager of Emergency 

Response and Preparedness 

Golden Eagle Refinery

What people are saying about AMR…. 

In response to “Every 15 Minutes” production- 

“Walt was instrumental in the planning and 

organization of the event, and his knowledge and 

participation helped us create a very realistic 

accident and rescue scene.” 

Thomas G. Soberanes, Chief of Police 

City of Walnut Creek 

“Thank you for being part of our success, together 

we shared about community and prevention to over 

350 people.” 

Scott R. Nelson, Public Service Officer 

Bay Point Family Service 

Contra Costa County Service Integration 

Program 

“They [Social Services] often cross paths with 

your paramedics in the Emergency Department 

and we find them very cooperative regarding 

patient care.” 

Noel Zinn, Supervisor Social Services 

John Muir /Mt. Diablo Health System 

On behalf of all the firefighters thank you for being 

there when we get injured on the frontline.” 

Darrell R. Lee, EMS Coordinator/Paramedic 

Moraga-Orinda Fire District 

“For the fourth year, AMR participated in medical 

standby and sponsorship of the “Relay for Life” 

fund raiser for the American Cancer Society. 

Joe Parker, RN / Paramedic 

“I enjoyed the tour and I was able to obtain the 

information I needed to explore a possible future 

career as a paramedic.” 

Caitlin Herrick, Senior 

College Park High School 

“To the AMR crew that was there for.we take our 

service people so much for granted, but you are 

always there when we need you!” 

Heath Velajleo, Valued Customer 

“Thank you so much for your support and help at 

the Tech. Center…” 

Pamela Ehler, Director of Finance 

City of Brentwood 

“As Chief, it is always a pleasure to see emergency 

service agencies sharing resources and working 

together to better serve our communities.” 

Terry L. Simpson, Chief of Police 

Contra Costa County Community College 

District 

“…resources available within our community in 

the event of a disaster. Our joint effort will assist 

in attaining our objectives.” 

Lonnie B. Karste, Administrative Police 

Manager 

City of Antioch 

“Your team was fabulous! What a great day for the 

kids and my folks. I can’t hank you enough for 

your support. 

Greg Steele, Principal 

NorthCreek Christian Academy 

“I would like to thank the crew of both response 

units for their wonderful care and help during the 

crisis of our daughter.” 

James P. Hargreaves 

“My kids favorite part of the show and tell was the 

heart rate machine and, of course the siren.” 

Jeanie Domingo, Gehringer Elementary School 

Oakley, California 

“My heartfelt thanks for such love and compassion 

you showed me when Roger had to be rushed to the 

hospital.” 

DeeAnn, Valued customer

SUMMARY: 


Community Outreach Coordinator 


Manages the requirements of the Community Outreach Programs in Contra Costa County, 

ensuring AMR is in compliance contractually with the communities served. 

PRINCIPAL RESPONSIBILITIES: 

Develops and maintains a community education/training program that meets or 

exceeds current county ASA contracts. The program will address EMS access; CPR 

programs, evaluation of data; and injury prevention. 

Provides and coordinates EMS and injury prevention courses with other EMS 

providers consistent with offerings made in county proposals. 

Provides a minimum of one CPR course per month to the public. 

Assists with ACLS, BCLS, PHTLS and PALS courses as requested. 

Provides in-service training to first responders consistent with offerings made in 

various county proposals. 

Functions as training liaison between long term care facilities and the company. 

Identifies and coordinates public education opportunities including EMS fairs, 

displays and exhibits. 

Coordinates public information articles to run in local newspapers and journals. 

Assists with the publishing of an AMR/EMS education newsletter. 

As a designated Public Information Officer, participates in informational interviews, 

providing public education services as requested. 

Assists with other community education as directed by the Director of Operations and 

Business Development Manager. 

Maintains accurate records of activities and prepares annual report for contract 

compliance review. 

SAFETY: 

Takes responsibility for and demonstrates safe work practices. 

Adheres to organization and OSHA safety guidelines. 

Identifies and reports safety problems. 

ESSENTIAL EQUIPMENT USED: 

Telephone 

1

Personal Computer 

Copier 

Fax Machine 

Internet 

System Email 

Pager 

QUALIFICATIONS: 

Ability to prioritize multiple tasks. 

Ability to work independently and as a team member. 

Ability to employ discretion and confidentiality in sensitive areas. 

Ability to read, interpret, and follow instructions on memos, letters and various 

documents. 

Ability to perform the essential job functions. 

Regular and predictable attendance. 

3-5 years prior experience in public relations, training programs, education programs in 

similar industry. 

Good public speaking ability. 

Knowledge of working exhibits, shows and marketing fairs to ensure company is 

presented in positive formats. 

Knowledge of community organizations, and their leaders to work with promoting AMR. 

Ability to work with people of all ages in communicating educational programs and 

promotional programs for AMR. 

CPR Instructor Certification preferred. 

Health Education/Community Education experience helpful. 

2

Customer Survey Card 

2350 Whitman Road, Suite F, Concord, CA 94518 

(925) 602-1300 - telephone 

Facility Name_____________________________ Date of Transport: ___/___/_____ Time: ______ A.M./P.M. 

Services rendered by AMR Unit # (if available)_________________________. 

Thank you for choosing AMR for your medical / non-medical transportation needs. 

AMR welcomes all ideas and suggestions to ensure that the patient’s transport needs are met and exceeded. AMR 

transport teams take pride in the work we do. In turn, we wish to continue to improve our services to you and your 

feedback will allow us to provide ways of consistently maintaining and improving our service standards. We appreciate 

your evaluation and comments regarding your overall experience with our team. Please complete the evaluation below: 

Transport Evaluation 

Please circle the letter that corresponds to your evaluation of the transport and team members. 

E=Excellent G=Good F=Fair N=Needs Improvement 

Professionalism: 

Overall professionalism of 

Transport Team 

Was the AMR team courteous 

& polite when obtaining 

necessary patient “transfer of 

care” information? 

Was AMR team professional 

& polite with the family? 

Response Time: 

Did team arrive within the 

specified time? 

Communication 

Did AMR Dispatch listen 

actively and professionally 

respond to the caller? 

How would you rate the 

overall performance of AMR 

as a patient transportation 

company? 

E G F N 

E G F N 

E G F N 

Y / N Comments:____________________________________ 

E G F N 

E G F N 

Would you most likely use AMR for your future medical/ non-medical transportation needs? ____Yes ____No 

Comments:___________________________________________________________________________________ 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________ 

Date: ____/____/_________ 

Your Name (Optional):_______________________________________ 

Telephone Number (Optional):______________________________ 

Please fax your response to Denise Cole, Account Manager at (925) 685-8804. 

Thank you for your time, we value your feedback.

AMR Contra Costa County 

Communications Equipment: 

Special Response Vehicle 

Equipment and Supplies 

Channel 900 MHz AMR Company Radio 

16-Channel 46 MHz Fire Agency Radio (County fire Agencies) 

Channel 488 MHz Medars Radio (Sheriff Dispatch / Hospital Ringdowns) 

50-Channel 800 MHz Alameda County Radio (AMR internal mutual aid) 

2-4-Channel 900 MHz portable radios (company portable radios) 

6 “Go Pack” ( Nextel ) cellular telephones ( fully charged ) 

Supplies & Equipment: 

50 amp inverter 1 case of extension sets 

3 portable flood lamps 1 case of all ACLS meds ( Epi, Atropine, 

D50, Etc.) 

10 backboards and straps Intubation ET Tubes and Supplies 

10 cervical “Stiffneck” collars Oxygen Delivery Equipment: 

14 Portable “D” size oxygen bottles 

1 “M” Size oxygen tank, with an 

“octopus” extension set capable of 

delivering oxygen simultaneously to 

multiple victims. 

10 “Head Bed” cervical immobilizers 1 Bariatric patient flat stretcher (1000lb. 

capacity) 

15 blankets 120 triage tags (CA Fire Chiefs Assn.) 

10 (5 ea.) leg splints and arm splints 5 multi-casualty identification vests 

(medical, triage, transportation) 

50 nasal cannula Contra Costa County MCI Plan checklists for 

Medical Supervisor, Triage/Treatment 

Officer, and Transportation Officer“North 

American Emergency Response Guidebook” 

50 non-rebreather oxygen mask Target hazard mapping for chemical plants 

and refineries 

1 case of burn sheets Contra Costa County maps 

1 case of trauma dressings 50 feet of “Caution” barrier tape 

1 case of trauma dressings 4 Nomex fire protective brush jackets 

1 case of Kerlix bandages 2 safety helmets 

2 cases of normal saline IV solution 1 LifePack 12 

1 case of macro drips, and 1 case of micro 

drips 

10 fully charged LP-12 batteries

AMBULANCE STRIKE TEAM/MEDICAL TASK FORCE 

LEADER 

Training Course 

Ambulance Strike Teams (AST)/Medical Task Forces (MTF) will be deployed in 

California in response to major incidents when the number of victims and/or 

duration of an event exhaust the local ambulance resources. An AST/MTF will 

be five ambulances and/or other related resources (i.e. rescue squad, etc.) and 

a Team Leader. These teams, activated on a regional or State level, are part of 

the statewide disaster response system. This course, developed in cooperation 

with the California Governor’s Office of Emergency Services (OES), the 

Emergency Medical Services Authority (EMSA), the California Ambulance Association (CAA), Emergency 

Medical Services Administrators’ Association of CA (EMSAAC), and the California Fire Chiefs Association, is 

designed to prepare leaders in the ambulance industry (fire based and non-fire based) for the role of AST/MTF 

Leader. 

Course Content: 16 hours in length (EMS C.E.s available through Provider #42-0100; 

Paramedic CE’s available through Provider # 42-9000; BRN C.E.s available through Provider 

# CPE988) 

Incident Command System (ICS) Review 

AST/MTF Overview: Team Make-Up, Training Requirements, Equipment Standards 

Leadership and Supervision Principles 

Pre-Dispatch Preparation 

AST/MTF Response and Code of Conduct 

Coordination with other ICS Functions 

Assignment Status 

Tactical Considerations – Multi Casualty Incidents 

Demobilization 

Forms, Plans, and Checklists 

Prerequisites (Certificates of Completion are required with registration): 

ICS 100 and Introduction to Standardized Emergency Management System (SEMS) – Available 

online at www.oes.ca.gov or FEMA IS 100 available online at www.fema.gov 

ICS 200 or FEMA IS 195 available online at www.fema.gov 

8-hour (Firescope) Multi-Casualty Incident (MCI) Field Operations Training Course, Course CD 

available through California Ambulance Association or EMSA; can be conducted by agencies’ 

official Training Officer or taken as a pre-course 8-hour day prior to this 16-hour course 

(separate fee required) 

Leadership Experience (Application for Course to be signed off by Employer) 

Recommended Additional Training/Experience: 

ICS 300 

Hazardous Materials First Responder Operational Course 

Weapons of Mass Destruction Awareness Course 

Three Years EMS Experience 

Maximum enrollment per class: 35; Minimum enrollment per class 20. Final Certification will be dependent 

upon completion of the AST/MTF Leader Task Book in conjunction with your employer. 

Course Times, Dates and Locations 8:00AM – 5:00PM – MUST attend both days 

November 6 and 7, 2004 Alan Hancock College 

(November 5, 2004 MCI Course) 1300 South College Drive 

P Bldg, Room P10D, Santa Maria, CA 93454-6399 

December 1 and 2, 2004 EMSA Station #1 

(November 30, 2004 MCI Course) 10173 Croydon #4, Sacramento, CA 95827 

January 20 and 21, 2005 March Air Reserve Base 

(January 19, 2005 MCI Course) Base Education Center, Building #441 

Graeber Street, Riverside, CA 92518

Watch out for kids… 

• Cross the street only at corners and use a 

crosswalk. Never cross from between parked cars. 

• When you cross a street look in all directions for 

cars, bicyclists and other dangers before you cross. 

• Always walk on the sidewalk. If there is no 

sidewalk, walk on the left facing traffic. 

• Carry a flashlight and wear something reflective 

at night to help drivers see you. 

The safety of our children is everyone’s responsibility. 

From all of us at American Medical Response… 

saving lives everyday. 

American Medical Response of Contra Costa 

County bringing Paramedic and Non-Emergency 

Ambulance service to our community. 

AMR of Contra Costa County 

2350 Whitman Road, Suite F • Concord, CA 94518 

Contra Costa Business Office (925) 602-1300 

Saving Lives Everyday

Vials of Life: 

Immediate information for immediate 911 care. 

American Medical Response and its community partners urge you to 

help save your own life with the simple, free, Vials of Life program. 

The purpose of the Vials of Life program is to provide AMR paramedics 

with readily available medical information such as medications, 

medical history, primary physician, allergies, “Do Not Resuscitate” 

orders and hospital of choice. Medical forms and magnetized vials 

can be obtained at the AMR operations site, from AMR ambulances, 

at health fairs, at Kaiser clinics and hospitals, or by calling 

888-816-5910. Vials of Life are brought to you through the cooperation 

of and with funding from AMR, the John Muir/Mount Diablo 

Hospital Partnership and the Commission on Aging. 

American Medical Response of Contra Costa 

County bringing Paramedic and Non-Emergency 

Ambulance service to our community. 

AMR of Contra Costa County 

2350 Whitman Road, Suite F • Concord, CA 94518 

Contra Costa Business Office (925) 602-1300 

Saving Lives Everyday

MCI Basic Field Operations Course 

COURSE DESCRIPTION AND OBJECTIVES: 

The MCI Basic Field Operations Course introduces students to the principles associated with the 

Incident Command System. It covers organization, terminology, and the common responsibilities or 

general instructions associated with managing multiple casualty incidents or event assignments. This 

course is a pre-requisite for the Ambulance Strike Team (AST) Leader course. It can be taught by an 

Agency’s Primary Training Officer (using materials available through the EMS Agency), or as a precourse 

day of instruction prior to the 16-hour AST Leader course. 

Upon successful completion of the course, the student will be able to describe or explain the: 

$ duties and responsibilities of the Medical Group Supervisor 

$ staffing and organizing units within the Medical Branch. 

$ duties and responsibilities of the units within the Medical Branch. 

$ how to effectively demobilize the Medical Branch. 

$ principles of the Standardized Emergency Management System of California 

$ systems of local and regional patient dispersal 

COURSE DATE, TIME AND LOCATION: 

November 5, 2004 – Alan Hancock College, Santa Maria CA 

November 30, 2004 – EMSA Station #1, Sacramento CA 

January 19, 2005 – March Air Reserve Base, Riverside CA 

COST and CONTINUING EDUCATION: 

The cost for the course is $55.00. The fee covers the cost of instruction, all student material, and 

continuing education certificate. Course fees are payable in advance and are non-refundable. 

Students who successfully complete the course will receive 8 hours of EMS CE. CE will be issued 

by EMS CE 

Provider # 42-0100. 

COURSE INSTRUCTORS: 

Mike Messina, Allan Hancock College 

Mike McDonough, Allan Hancock College 

Carmen Johnson, Allan Hancock College 

Jody Copeland, Allan Hancock College 

ENROLLMENT: 

To enroll in the course please complete the Ambulance Strike Team Leader course Registration form. 

For more information, please contact: Anne Bybee at California EMS Authority, (916) 322-4336 or 

anne.bybee@emsa.ca.gov


Management and Administration 

Key Personnel Resumes – Local Team 

Key Personnel Resumes – Regional Team 

Seven Elements of Effective Program Compliance 

Corporate Compliance Manual Table of Contents 

Compliance Statement 

Code of Conduct 

Code of Business Conduct Training 

HIPAA Training Manual 

Customer Service Handbook Table of Contents

Key Personnel Resumes – Local Team 

Leslie Mueller, Operations Director 

Dave Borghelli, Operations Manager 

Becky Hobson, Administrative Supervisor 

Mark Buell, Field Supervisor 

Linda Mulgrew, Field Supervisor 

Richard Silva, Field Supervisor 

Christopher Bonn, Field Supervisor 

Sandra Jo Bradley, CES Coordinator 

Mike Austin, Logistics Supervisor 

Denise Cole, Account Manager 

Yvette Byers, Operations Assistant

Leslie K. Mueller 

Director of Operations 


Ms. Leslie Mueller has more than 20 years of experience in the EMS 

industry, including 15 years in Administrative and Operations 

Management, Business and Strategic Development, and provision of 

direct patient care as a field Paramedic. Ms. Mueller is responsible for 

9-1-1 contract administration; budgetary and financial integrity; and 

partnership and leadership development to ensure accountability to the 

internal and external stakeholders of the Contra Costa County 

Operation. She has administrative and operational responsibility for 

more than 55,000 emergency and non-emergency ambulance 

transports across 812 miles with a team of 270 employees. She also has responsibility for 

contract negotiations and administration for all medical transports with acute and skilled 

nursing facilities. She also serves as a representative on the Emergency Medical Care 

Committee. And, she completed training through the EMS Management Training Institute in 

1995. Ms. Mueller is also active in the Contra Costa Chamber of Commerce and is a regular 

guest speaker at various Contra Costa County social clubs and business and community 

events. 

EXPERIENCE 


Director of Operations, Contra Costa County, Concord, CA 1998 to Present 

Director, Corporate Development 1995–1997 

Director, Business Development and Public Relations 

Regional Ambulance, Inc. 

1992–1995 

Director of Operational Services 1986–1992 

Mobile Intensive Care Paramedic 1984–1989 

Emergency Medical Technician/Dispatcher 1981–1984 

EDUCATION 

St. Mary’s College, Moraga, CA 

Bachelor of Arts Degree in Management 

2001 to 2004 

Management Training Institute, Kansas City, KS 

Ambulance Systems Management Certificate Program 

1994–1995 

Stanford University, Palo Alto, CA 

Pre-Hospital Care Paramedic Program 

1983–1984 

Los Medanos College, Pittsburg, CA 1981–1983 

General Educational Courses

Leslie Mueller Page 2 

PROFESSIONAL ASSOCIATIONS & AFFILIATIONS 

California Ambulance Association, 

Chairman- Political Action Committee 

Emergency Medical Care Committee 

Board Member 

California Association of Healthcare Facilities 

Richmond Chamber of Commerce 

Concord Chamber of Commerce 

Brentwood Chamber of Commerce 

CREDENTIALS 

Miller/Heiman Conceptual Selling/Strategic Selling 

Supervisor Development Course (Lead U 101) 

Manager’s Level Development Course (Lead U 201) 

Director’s Level Development Course (Lead U 201) 

Critical Incident Stress Management 

Emergency Medical Technician-Paramedic, State of California (inactive)

David J. Borghelli 

Operations Manager 


Mr. David Borghelli attended the Stanford University Pre-Hospital 

Program, Palo Alto, Calif., and received his Paramedic Certification in 

1989. He now has more than 16 years of experience in the EMS 

industry in California, including serving as an EMT for Valley 

Ambulance, Castro Valley; a Firefighter-Paramedic for the Bethel 

Island FPD; a Firefighter/Driver Operator, EMS Coordinator, and 

Captain for East Contra Costa FPD, Oakley. Mr. Borghelli has more 

than five years of management experience, including responsibility for 

AMR’s Contra Costa County Operation as both a Field Supervisor and 

Operations Manager. He plays a key role in providing leadership, support, and direction to 

Field Supervisors and field employees. In addition to chairing both the Employee Action, 

Health & Safety and System Status committees and serving as a Local Safety Officer, Mr. 

Borghelli is credentialed in numerous areas of EMS. 

EXPERIENCE 


Operations Manager-Contra Costa 2002 to Present 

Field Supervisor-Contra Costa 1999 – 2002 

Paramedic-Contra Costa 1989-1999 

East Contra Costa FPD (Oakley FPD), Oakley, CA 

Captain 2001-2003 

EMS Coordinator 1999-2003 

Firefighter/Driver Operator 1996-2001 

Bethel Island FPD, Bethel Island, CA 

Firefighter-Paramedic 1997 – 2002 

Valley Ambulance, Castro Valley, CA 

EMT 1987-1989 

EDUCATION 

Stanford University Pre-Hospital Program, Palo Alto, CA 1988 – 1989 

Paramedic Certification

David J. Borghelli Page 2 

CREDENTIALS 

Emergency Medical Technician-Paramedic, State of California, accredited in Contra 

Costa County. 

Advanced Cardiac Life Support. 

Pre-hospital Trauma Life Support/Basic Trauma Life Support 

Pediatric Advanced Life Support/ Pediatric Education for Prehospital Professionals 

California Ambulance Driver's Certificate. 

Firefighter 1, 5/98, California State Fire Marshall. 

California DMV Firefighters Class B License 

Hazardous Materials Course-First Responder Operations, 11/91, Calif. Specialized 

Training Institute. 

Hazardous Materials Course-Toxicology, 12/91, Calif. Specialized Training Institute 

Basic Incident Command System, 4/91, Calif. Department of Forestry. 

Pump Operations for Volunteers, 6/91, Calif. State Fire Marshall 

Auto Extrication, 5/91, Georgetown Fire Department 

Aviation Physiology, 8/92 EBRPD 

Paramedic Preceptor Training, 1/94, Los Medanos College. 

Paramedic Preceptor Training, 5/94, American Medical Response West 

Basic Life Support Instructor, 4/94, American Medical Response West 

Advanced Cardiac Life Support Instructor, 5/94, Northern California Training Institute. 

Emergency Vehicle Operators Course, 3/00, Santa Rosa Junior College 

Auto Extrication, 3/01, Calif. State Fire Marshall 

Emergency Vehicle Operators Course “Train the Trainer”, 9/01, San Jose Police 

Department 

Critical Incident Stress Management, 9/01, American Medical Response 

Miller/Heiman Conceptual Selling/Strategic Selling, 5/02, AMR, Denver, CO. 

Supervisor Development Course (Lead U 101), 12/02, AMR, Roseville, CA 

Development Dimensions International, DDI Training 101, 4/04, Roseville, CA 

Supervising in the Union Environment, 9/04 AMR 

Lead U 201 (Manager’s Level Development Course), 3/04, Roseville, CA 

Ongoing Clinical and Managerial Continuing Education

Becky Hobson 

Administrative Supervisor 


Ms. Becky Hobson has more than 16 years of experience in the EMS 

industry having started as an EMT-1A and then becoming a 

Paramedic. She has 14 years of management experience with AMR 

and its predecessor companies. During this time she managed 

responsibilities for the company’s operations in Solano County, Calif., 

and Broward and Palm Beach Counties in South Florida. Ms. Hobson 

is currently responsible for the administrative functions of our Contra 

Costa County Operation, serves on the Reimbursement Committee of 

the California Ambulance Association, and is the project lead for 

AMR’s ePCR program, known as MEDS. In conjunction with this program, she plays a key 

role in identifying and engineering process enhancements within AMR, as well as with 

external customers. 

EXPERIENCE 

American Medical Response – Concord, CA 

Administrative Supervisor – Contra Costa County 1998 – To Present 

American Medical Response – Ft. Lauderdale, FL 

Quality Improvement Specialist May 1998 to Nov 1998 

(Broward & Palm Beach Counties) 

Paramedic/FTO – Palm Beach County 1997 – 1998 

(CCT & Rescue trained) 

BayStar Medical Services – Vallejo, CA 

Paramedic Operations Supervisor/QI 1994 – 1997 

Solano Ambulance Company – Vallejo, CA 

Acting Operations Manager 1993 – 1994 

Paramedic Operations Supervisor 1990 – 1993 

EMT-1A 1988 - 1990 

EDUCATION 

University of Phoenix 1998 – 2000 

Bachelor of Science Degree – Business Management 

Diablo Valley College 1985 - 1988 

Associate of Science Degree – Biological Science

Becky Hobson Page 2 

Daniel Freeman Paramedic School 1990 

Paramedic Course Completion 

Med Help Training School 1988 

EMT Course Completion 


California Ambulance Association 

Member Reimbursement Committee 

CREDENTIALS 

EMT-P, State of California 1990 - 2000 

Critical Incident Stress Management 1992 

Safety Manager Certificate 1991 

Certified Drivers Training Instructor 1989

Mark A. Buell 

Field Supervisor 


Mr. Mark Buell has more than nine years of experience in the EMS 

industry, having started as an EMT. He received his Bachelor of 

Science degree in Economics from Texas A & M University, Texas in 

1992 and his Associate in Nursing degree from Excelsior College, New 

York in 2003. In addition, he has more than 10 years of management 

experience in the high-technology industry, having served as an 

International Sales Director for Silicon Valley Computer in Mountain 

View, Calif. where he negotiated several overseas contracts. Before 

joining the AMR team, Mr. Buell served as a Police Officer for the 

City of South San Francisco Police Department. He is credentialed as an EMT-P in the state 

of California and served as a Paramedic Field Training Officer in our Contra Costa County 

Operation. He currently serves as a Field Supervisor and is responsible for AMR’s daily 

operation in Contra Costa County. As such, he plays a key role in employee relations 

programs and development of the enhanced deployment system. 

EXPERIENCE 


Field Supervisor — Contra Costa County 2003 to Present 

Paramedic F.T.O. — Contra Costa County 1999 – 2003 

E.M.T. — San Mateo County 1996 - 1999 

City OF South Francisco Police Department, SSF, CA 

Police Officer — SSF 2000 – 2001 

Silicon Valley Computer, Mt. View, CA 

International Sales Director — Mt. View, CA 1992 – 1996 

EDUCATION 

Texas A & M University, College Station TX 1990 – 1992 

Bachelor of Science Degree – Economics 

Excelsior College, New York 2003 

Completing Associate in Nursing degree 

PROFESSIONAL ASSOCIATIONS 

United States Parachuting Association 

Master’s rating 

CREDENTIALS 

EMT-P, State of California

Linda A. Mulgrew 



Ms. Linda Mulgrew has worked in the EMS industry for more than 24 

years having started as an EMT. She then served as a Paramedic for 17 

years and eventually became a County Evaluator. In this role, Ms. 

Mulgrew evaluated potential Paramedic candidates for accreditation in 

Santa Clara County. In addition, Ms. Mulgrew served 14 years as 

Chief Steward of Local 250 — Santa Clara County Paramedics. Ms. 

Mulgrew has been a Field Supervisor in Contra Costa County for the 

last two and one half years. As Field Supervisor, she backs up the 

24-hour duty supervisor for day-to-day operations. Her duties entail 

oversight of maintenance and upgrading of the laptop computers used in AMR’s propriety 

ePCR platform, MEDS. She also serves on the MEDS Administrators Group, as well as a 

liaison for the System Status Committee for West County. Ms. Mulgrew is HazMat First 

Responder Operational (FRO) certified. 

EXPERIENCE 


Field Supervisor — Contra Costa County 2002 to Present 

Paramedic —Contra Costa County 1985 – 2002 

Mobile Life Support, Modesto, CA 

EMT — San Mateo County 1984 – 1985 

Summit Ambulance, San Mateo, CA 

EMT — San Mateo County 1980 – 1984 

EDUCATION 

San Francisco State University, San Francisco, CA 1974 – 1975 

35 units toward an Business Administration degree 

Stanford University/Foothill College, Palo Alto, CA 1984-1985 

Paramedic Certification 

CREDENTIALS 

EMT-P, State of California

Richard Silva 



Mr. Richard Silva has more than 22 years of experience in the EMS 

industry having started as a Wheelchair Driver then promoted through 

the ranks to Paramedic. He completed his Paramedic course studies in 

1986 while attending the Western Institute of Pre-Hospital Care in 

Burlingame, Calif. He began his career with AMR in 1982 as an 

EMT-1 in our Stanislaus County Operation. He then went on to 

become a Paramedic, Field Training Officer, County and Company 

Preceptor, and Alternative Supervisor. In 1999, Mr. Silva was 

promoted to Administrative Supervisor in our San Joaquin operation, 

where he was responsible for daily operations, relations with providers, vendors, and 

government regulating agencies all the while managing compliance under three separate 

union contracts and supervising more than 150 employees. Currently, Mr. Silva serves as a 

Field Supervisor for our Contra Costa County operation, where he supervises more than 250 

employees. Some of his responsibilities include direct line supervision of field personnel, 

resolution of customer complaints, oversight for equipment and fleet maintenance, 

scheduling, budgeting, employee relations, and contract compliance. Mr. Silva serves as 

liaison to the Contra Costa Fire Department and the Richmond Police Department. In this 

capacity he serves the MPDS committees that develop both internal and external policies for 

the communications centers. In addition, Mr. Silva is a member of the California 

Ambulance Association and holds the following credentials: EMT-Paramedic, State of 

California: and a California Community College Teaching Credential. He also serves as an 

instructor in Basic Trauma Life Support and Multi-Casualty Incidents, as well as Mountain 

Valley EMS Paramedic Preceptor, an Emergency Medical Dispatcher, and a San Joaquin 

EMS Accreditation Officer. 

EXPERIENCE 


Field Supervisor 2002 to Present 

Administrative Supervisor, San Joaquin Operation 1999 – 2002 

Paramedic, Stanislaus county Operation 1987 - 1998 

EDUCATION 

Modesto Junior College, Modesto, CA 1992-1994 

General Education classes toward AA 

Western Institute of Pre-Hospital Care, Burlingame, CA 1985 – 1986 

Paramedic Course Completion

Richard Sylva Page 2 

Heald Business College, Walnut Creek, CA 1982 

Certificate in Accounting 

AMR Supervisor Training, Quarterly Ongoing 


California Ambulance Association Member 

CREDENTIALS 

EMT – Paramedic, State of California 

Mountain Valley EMS Paramedic Preceptor 

California Community College Teaching Credential 

Emergency Medical Dispatcher 

Basic Trauma Life Support Instructor 

Multi-Casualty Incident Instructor 

San Joaquin EMS Accreditation Officer

Christopher E. Bonn 



Mr. Christopher Bonn received his Bachelor of Business 

Administration degree in 1981 from the University of Nebraska. After 

several successful years as an entrepreneur and sales manager, he 

returned to one of his initial interests — serving as a Paramedic. Mr. 

Bonn has served as EMT/Dispatcher for the San Francisco Ambulance 

Service and, since 1999, has worked with AMR as a Paramedic in the 

Contra Costa County operation. In 2001, he was promoted to Field 

Supervisor, responsible for overseeing day-to-day operations, as well 

as contract compliance, scheduling, and employee and community 

relations. Mr. Bonn’s credentials include: EMT-P, State of California; ACLS; PEPP 

instructor; BTLS; CPR; HAZMAT-FRO; and ICS-400 (Strike Team Leader). 

EXPERIENCE 


Field Supervisor— Contra Costa County 2001 to Present 

Paramedic — Contra Costa County 1999 – 2001 

Kal Kustom, Fremont, Ca. 

National Sales Manager 1992 – 1999 

North Bay Boat center, Oakley, Ca 

Owner — Oakley 1992 – 1987 

San Francisco Ambulance service, San Francisco, Ca. 

EMT/ Dispatcher — San Francisco, Marin and Alameda County’s 1987 – 1983 

EDUCATION 

University of Nebraska, Lincoln, NB. 

Business Administration Major 

1979 – 1981 

Los Medanos College, Pittsburg, Ca 

50 units for Paramedic AA 

1999 

U.S. ARMY aviation school, Ft Rucker, Alabama 

Rank WO-1, Qualifications UH-1, Black hawk 

1250 hrs 

1981-1983 

CREDENTIALS 

EMT-P, State of California # 16445 

ACLS, PEPP instructor, BTLS, CPR 

HAZMAT-FRO 

ICS-400 (Strike team leader)

Sandra Jo (Sam) Bradley 

Clinical and Educational 

Services Coordinator 


Ms. Sandra Jo (Sam) Bradley has more than 25 years of experience in the EMS industry. 

She began as an EMT, then became a Paramedic, and eventually became a Supervisor and 

Training Officer for an AMR predecessor company. She has more than 10 years of 

management experience with AMR and has served as a Regional Corporate Trainer and as a 

Field Supervisor. Ms. Bradley is responsible for all training and quality assurance / 

improvement for AMR’s Contra Costa County Operation, is in charge of the Field Training 

Officer (FTO) program, and is also the County Coordinator for the Critical Incident 

Management Team. 

While serving as the Outdoor Emergency Care Supervisor for the Far West Division of the 

National Ski Patrol, Ms. Bradley won numerous awards including the Leadership 

Commendation Award, the organization’s highest honor. In 1990, she was honored by the 

California Ambulance Association as the recipient of the “EMS Person of the Year” award. 

Ms. Bradley currently serves on the Medical Advisory Committee, 12 Lead Committee, and 

EMS Coordinator’s Group for Contra Costa County. In addition, she serves on the board of 

the regional Disaster Medical Assistance Team (DMAT), which AMR sponsored to assist at 

Ground Zero after the 9/11 terrorist attacks. Among other events, AMR also sponsored two 

missions to the Ukraine to provide medical equipment. For her participation, Ms. Bradley 

recently received the “Recognition of Excellence” award from the California National 

Guard for her involvement in the June 2004 Ukraine training operation conducted in 

conjunction with EMSA. 

Additional working groups in which Ms. Bradley participates include EMS training with 

both the Contra Costa County Fire and East Contra Costa Fire departments; monthly local 

and multi-county Medical Director meetings; the Contra Costa County Quality Improvement 

Committee; EMS Trauma Audit Committees (pre-TAC and TAC); and the county Trauma 

Conference Committee; as well as the county and multi-county ePCR data management 

committees. In addition, Ms. Bradley is a member of the Los Medanos College Advisory 

Committee, which oversees continuing education offerings. She has served throughout her 

career as a volunteer with Red Cross Disaster Services, has authored articles for EMS 

publications, and is a lecturer at EMS conferences. 

EXPERIENCE 


CES Coordinator Contra Costa County March 2003 to Present 

Operations Supervisor Contra Costa County Oct 1999- March, 2003 

Regional Training Coordinator, Livermore 1998 to Oct 1999 

CES Coordinator, Alameda County 1996-1998 

EMT/Paramedic/Field Supervisor, Training, QA, Dispatcher

Sandra Jo Bradley Page 2 

American Medical Enterprises, Whittier, Ca 1979-1996 

Company, City, State 

EMT Instructor, Los Medanos College, Pittsburg Ca 1996-present 


EMT Instructor, Cerritos College, Cerritos, Ca 1986-1996 


ER Technician Presbyterian Hospital, Whittier, Ca 1984-1996 

EMT/Paramedic Instructor, Daniel Freeman Paramedic School 1982-1995 

Paramedic Instructor, Mount San Antonio College, Walnut, Ca 1988-1994 

ER Technician, Coast Plaza Medical Center, Norwalk, Ca 1980-1984 

EDUCATION 

Cal State University Long Beach, Long beach, Ca 1965-1968 

62 units toward an Associate of Arts in Theatre Arts 

Santa Ana College, Santa Ana, Ca 1979-1980 

10 units toward EMT certificate 

Orange Coast College 1968-1981 

48 unit toward AS degree and certificate in EKG/echocardiology 

Daniel Freeman Paramedic School graduate 1980-1981 

Paramedic License 

Mount San Antonio College, Walnut, Ca 1988-1993 

63 units toward AS in Emergency Medical Services, AA in 1988-1993 

General Education and AS in Sign Language Interpreting 

California State University Northridge, Northridge, Ca 1990-1994 

9 units toward BA in Deaf Studies 

Cal State University Long Beach, Long Beach, Ca Jan, 2005 

Master’s Degree Program toward Emergency Medical Services 


Disaster Medical Team, CA-6 

Training Officer 

Board Member 

Cal Chief’s EMS Division Northern California 

Member 

National Ski Patrol Alumni 

Outdoor Emergency Care Supervisor, Far West Division North

Sandra Jo Bradley Page 3 

CREDENTIALS 

EMT-P, State of California 

Lifetime Limited Teaching Credential — Health-related technologies 

California Community Colleges 

Provider Certifications 

ACLS 

PALS 

PEPP 

PHTLS 

Haz Mat Operations 

Instructor Credentials 

ACLS 

PEPP 

WMD/haz mat

EXPERIENCE 

Mike Austin 

Logistics Supervisor 


Mr. Austin is responsible for inventory control of all medical supplies, 

ordering and repairing of telecommunications equipment, and uniform 

purchasing. He is responsible for the upkeep of twelve 24-hour 

stations located throughout Contra Costa County. He also oversees the 

day to day responsibilities of a Courier and Vehicle Service 

Technician. Mr. Austin has 10 years of experience in the EMS 

industry starting out as a Deployment Assistant in Alameda County. In 

addition, Mr. Austin has over 4 years of management experience for 

AMR. 


Logistics Supervisor — Contra Costa County 2000 to Present 

Logistics Coordinator — Contra Costa County 1995 – 2000 

Deployment Assistant — Alameda County 1994 – 1995 

Alameda Newspaper Group, Oakland, CA 

District Manager — Fremont Division 1982 – 1994

Denise A. Cole 

Account Manager 


Ms. Denise Cole has more than 10 years of experience with Customer 

Service, Sales and Account Management, and has consistently 

garnered awards along the way for outstanding performance and 

exceptional customer care. Ms. Cole earned her Bachelor of Arts 

degree in 1994 from De La Salle University, Manila, The Philippines, 

where she majored in Communications. She has since worked in a 

management and customer service/sales capacity for such entities as: 

Citibank, NA, Manila, The Philippines; Pitney Bowes, Oakland, Calif.; 

Digital Generation Systems, San Francisco, Calif; Starbucks Coffee, 

Business Alliances, United Kingdom; and Aramark, Palo Alto, Calif. Currently, Ms. Cole 

serves as the Account Manger for our Contra Costa County Operation, where she is 

responsible for business retention and growth. She maintains regular contact with our 

customers and key clients through weekly visits and daily telephone calls. She collaborates 

with both customers and regional AMR staff to further enhance and maintain our standards 

of service, reassuring that patient care is at the foremost of priorities. 

EXPERIENCE 

American Medical Response, Concord, CA 

Account Manager — Contra Costa June 2004 - Present 

Aramark, Palo Alto, CA 

Sales Manager, San Francisco Bay Area 2003 - 2004 

Starbucks Coffee, Business Alliances United Kingdom 

Account Manager, London, United Kingdom 2002 - 2003 

Digital Generation Systems, San Francisco, CA 

Senior Account Manager 2000 - 2001 

Account Manager 1999 - 2000 

Pitney Bowes, Oakland, CA 1998 

Sales Representative 

Citibank, NA, Manila, Philippines 1994 - 1998 

Assistant Manager 1996 - 1998 

Citiphone Officer 1994 - 1996 

EDUCATION 

De La Salle University, Manila, Philippines 1991 - 1994 

Bachelor of Arts, Major in Communications

Yvette M. Byers 

Operations Assistant 


Ms. Yvette Byers has more than five years of experience in the EMS 

industry. Her responsibilities include working with our local 

management team to ensure that the myriad tasks are carried out 

efficiently and accurately. She plays a key role in monitoring the 

employee database to ensure that all field personnel licenses and 

certifications are on file and current. Ms. Byers also maintains the 

Clinical and Educational Services (CES) database and prepares 

certificates of completion for Continuing Education hours for field 

personnel. She also processes employee expense reimbursements and 

all accounts payable invoices, takes minutes at various meetings, and maintains more than 

270 confidential employee files. Ms. Byers is an active member of the Safety Committee. 

During her 5 years with AMR, Ms. Byers has been recognized for exemplary performance 

and was also awarded Outstanding Team Mentor for her continued commitment to the 

successes of the Contra Costa County operation. 

EXPERIENCE 


Operations Assistant – Concord, CA 1999 to Present 

Bank of America 

Sr. MIS Analyst – Livermore, CA 1995 to 1999 

Bank of America 

Legal Secretary – San Francisco, CA 1993 to 1995 

Metropolitan Life Insurance Company 

Manager, Group Policyholder Services, So. CA Region 1985 to 1991 

Account Coordinator 1980 to 1985 

Loan Processor 1970 to 1980 

EDUCATION 

Heald Business College, Hayward, CA 

AA Legal Office Administration 1993

Key Personnel Resumes – Regional Team 

Louis Meyer, Chief Executive Officer 

Tim Dorn, Vice President, Financial Operations 

Brad White, Vice President, Operations 

James Richey, Vice President, Patient Business 

Services 

Lawson Stuart, Director, Clinical and Educational 


Jeff Taylor, Director, Communications, Deployment 

Planning and Performance Analysis 

Kevin Fenderson, Director, Fleet Maintenance 

Linda Kissling, Director, Human Resources 

Jan Anderson, Manager, Human Resources 

Dave Caraveo, Manager, Safety & Risk 

Management

Louis K. Meyer 

Chief Executive Officer 

Northwest Plains Region 

Mr. Louis Meyer is Chief Executive Officer of AMR’s Northwest–Plains Region, which 

includes 56 counties. He oversees an operating budget of $425 million and the activities 

of more than 6,050 employees in California, Hawaiì, Oregon, Washington, Montana, 

South Dakota, Colorado, Kansas, Wyoming, Missouri, and Iowa. 

Mr. Meyer was named CEO of the Northwest–Plains Region in early 1999. Previous to 

his appointment, he was CEO of AMR’s Northern California/Hawaiì Division from 

1993 to 1996, and took on the additional responsibility of leading the Oregon and 

Washington divisions, followed by the remaining states, in stride with the company’s 

reorganization strategies. 

Before taking his CEO position in California, Mr. Meyer was responsible for AMR’s 

Mid-Atlantic Region, headquartered in Philadelphia. He had executive oversight of an 

operating budget of $60 million. With a staff of 1,100, Mr. Meyer directed operations 

that included providing ambulance transportation services to 365,000 patients throughout 

Pennsylvania, New Jersey, and Delaware. 

While heading the Mid-Atlantic Region, Mr. Meyer instituted a new participatory 

management policy. He established consistency among systems of accountability and 

created a productive atmosphere and cooperative spirit between regional and local 

operations. In addition, he created regional managed care contractual relationships and 

innovative complementary health care programs. 

Earlier, as Chief Operating Officer with American Medical Response West, Mr. Meyer 

was responsible for oversight of all administrative and field operations in California’s 

vast Central Valley. In that position, he was responsible for maintaining and enhancing 

service to 12 counties with a staff of 1,500. 

At Life Medical Industries, Mr. Meyer was responsible for administrative and field 

operations, with executive oversight of the company. Under his leadership, Life Medical 

Industries generated $7 million in annualized revenues by providing ambulance 

transportation services to 20,000 patients in a competitive market. He had oversight 

responsibilities for a staff of 150. 

Mr. Meyer is extensively involved in many professional organizations outside of his 

responsibilities with AMR. He has served a one-year term as Chairman of the California 

Emergency Medical Services Commission and continues to serve as a member. In 

addition, Mr. Meyer served as liaison to the California Association of EMS 

Administrators, the California Emergency Medical Services Authority, and the California 

Paramedic Rescue Association. 

Recognizing the importance of community service, Mr. Meyer served as Vice President 

of the Salvation Army Advisory Council of San Joaquin County. In 1986, he was named 

San Joaquin County’s “Paramedic of The Year,” and in 1996, was given the county’s 

EMS Pioneer Award.

Louis K. Meyer Page 2 

Chief Executive Officer, Northwest - Plains Region 

EXPERIENCE 


Chief Executive Officer, Northwest - Plains Region 1998 to Present 

Divisional Chief Executive Officer, Northern California/Hawaií 1997–1998 

Chief Executive Officer, Mid-Atlantic Region 1996 

Chief Operating Officer 1993–1996 

Life Medical Industries, Inc. 

General Partner and Chief Executive Officer 1980–1993 

All City Ambulance Service 

Assistant Operations Manager 1972–1980 

Sergeant, United States Army, Military Intelligence 

EDUCATION 

Delta Community College, Stockton, CA 

Business Administration; EMS Paramedic Certificate 

Penn Valley Community College, Kansas City, MO 

EMS Management Academy 

Dale Carnegie & Associates, Inc., Stockton, CA 

Effective Speaking and Human Relations 

William Tennet High School, Warminster, PA 

General Education 


California Emergency Medical Services Commission — Member 

(Appointed by Speaker of the Assembly) 

Medical Advisory Committee San Joaquin County — Chairman 

(Responsible for Oversight of the California EMS System & Design) 

Salvation Army Advisory Council — San Joaquin County — Vice President 

California Ambulance Association — President (4 Terms); Vice President 

(2 Terms); Treasurer (2 Terms); Emergency Medical Services Liaison 

American Ambulance Association 

Chairman, Ethics Committee; Member, ByLaws Committee 

California Association of EMS Administrators — Liaison 

California Emergency Medical Services Authority — Liaison 

California Paramedic Rescue Association — Liaison 

AWARDS 

San Joaquin County — Paramedic of the Year — 1986 

California Ambulance Association — Man of the Year Award — 1990 

San Joaquin County — EMS Pioneer Award — 1996 

California Ambulance Association — Honorary Membership — 1996

Timothy J. Dorn 

Vice President, Financial Operations 


Mr. Timothy Dorn received his Bachelor of Science degree in finance from Arizona State 

University and went on to receive his Master of Business Administration from Saint 

Mary’s College. Before working at AMR, Mr. Dorn worked as a Securities Principal and 

as a Controller. In 1986 he became Senior Vice President of AzStar Casualty Company. 

In 1993, Mr. Dorn became Regional Controller for AMR and has successively moved his 

way up to Divisional Director of Financial Operations covering Northern California and 

Hawaiì. Since 1999, Mr. Dorn has been serving as the Regional Vice President of 

Financial Operations for AMR’s Northwest–Plains Region, which is composed of 18 

western states. He is responsible for financial planning, internal management controls, 

and other operations reporting activities. Working with operations management, his 

primary focus is on the pricing of services, expense control, and utilization of resources. 

WORK EXPERIENCE 


Regional Vice President of Financial Operations 1999 – present 


Divisional Director of Financial Operations 1997 – 1999 

Northern California and Hawaiì 

Regional Controller 1993 – 1997 

Denver, CO 

AzStar Casualty Company 

Senior Vice President, Phoenix, AZ 1986 – 1992 

The 1129 Investment Group 

Securities Principal, Phoenix, AZ 1985 – 1988 

Gregg-Miller & Associates 

Controller, Phoenix, AZ 1982 – 1986 

EDUCATION 

Saint Mary’s College, Master of Business Administration 

University of Colorado - Denver, MS Healthcare Administration 

(No degree as coursework was interrupted by relocation) 

Arizona State University, Bachelor of Science, Finance

Brad G. White 

Vice President of Operations 

East Bay, Valley and Hawaiì 

Operations 

Mr. Brad White has more than 24 years of experience in the medical transportation 

industry, including 22 years in a variety of management roles with AMR and its 

predecessor companies. Mr. White began his EMS career as a Wheelchair Van Attendant 

and eventually became an Emergency Medical Technician Supervisor with All City 

Ambulance, which later merged with Life Medical Industries. He later advanced to the 

company’s Marketing/Personnel Director and then Director of Patient Business Services. 

In 1992, Mr. White became the Director of Operations overseeing functions for San 

Joaquin, Stanislaus, and Merced counties. In 1997, the Hawaiì Division was added to 

his responsibilities and he was promoted to Vice President. In 2003, the Central Valley 

Division was added. 

Mr. White has directed numerous internal re-engineering projects win which he identified 

opportunities for improvement and implemented solutions resulting in exceptional team 

performance. Mr. White oversees AMR operations in 13 counties and two states. He is 

responsible for strategic leadership, budgetary modeling and implementation, contract 

negotiation and compliance, and government relations. In addition, Mr. White 

participates on the Public Health Fund Grant Commission — Hawaiì and the State of 

Hawaiì’s Health Planning & Development Agency Commission as an appointee of the 

Governor. 

EXPERIENCE 

AMR (formerly LMI), Stockton, California 

Vice President — Central Valley, CA & Hawaiì Operations 2003 to Present 

Vice President — Hawaiì Operations 1997–2003 

Director of Operations — San Joaquin, Stanislaus, Merced Counties 1992–1997 

Life Medical Industries / All City Ambulance 

Director of Patient Business Services 1989–1992 

Marketing/Personnel Director 1983–1989 

All City Ambulance 

Emergency Medical Technician Supervisor 1980–1983 

Wheelchair Van Attendant 1979–1980 

EDUCATION 

San Joaquin Delta College 

Business Administration and Emergency Medical Services 

A.A. Stagg High School, Stockton, California

Brad G. White Page 2 


Public Health Fund Grant Commission — Hawaii 

State of Hawaiì, Health Planning & Development Agency Commission 

Governor-Appointed

James Richey 

Vice President 

Patient Business Services 


Mr. James Richey has more than 20 years of experience in the EMS industry and in the 

management of accounts receivable. He received his Bachelor of Science in Mathematics 

from the University of Montevallo, Montevallo, Ala. in 1981, which he followed up with a 

Master of Science in Mathematics from the University of Alabama, Birmingham, 1984. He 

has held several upper management to executive level positions including: President, Broker 

and Owner of A-Plus Realty, Inc, Birmingham, Ala.; Vice President/Owner of Collection 

Consultants, Inc, Birmingham, Ala.; Vice President/CFO of Hank’s Ambulance, 

Birmingham, Ala.; Vice President of Administration for CareLine, Inc. /Hank’s Ambulance 

Company, Birmingham, Ala.; Regional Director of Reimbursement for MedTrans/CareLine, 

Atlanta, Georgia; and Director of A/R Systems for MedTrans, Atlanta, Georgia. 

In 1998, AMR absorbed MedTrans and Mr. Richey remained as the Regional Director of 

A/R Systems. In 2000, he was promoted to Senior Business Systems Manager for AMR’s 

then South Region, eventually becoming the Director of Patient Business Services for 

AMR’s entire Southern Pacific Region. In November of 2003, he accepted the position of 

Vice President of Patient Business Services for AMR’s Northwest–Plains Region where he 

is responsible for all aspects of the Patient Business Services operation. Mr. Richey has 

been selected as one of ten AMR employees to participate in the company’s Accelerated 

Development Program. 

EXPERIENCE 


Vice President of Patient Business Services Nov 2003 to Present 

Northern Pacific Region 

Director of Patient Business Services May 2002 to Nov 2003 

Southern Pacific Region 

Senior Business Systems Manager 2000 – 2002 

South Region, Atlanta, GA 

Regional Director of A/R Systems 1998 – 2000 

South Region, Atlanta, GA 

MedTrans / AMR 

Director of A/R Systems 1996 – 1998 

Atlanta, GA 

MedTrans / CareLine 

Regional Director of Reimbursement 1994 – 1996 

Atlanta, GA

James Richey - Page 2 

CareLine, Inc. / Hank’s Ambulance Company 

Vice President of Administration 1993 – 1994 

Birmingham, AL 

Hank’s Ambulance 

Vice President / CFO 1984 – 1993 


Collection Consultants, Inc 

Vice President / Owner 1984 – 1993 


A-Plus Realty, Inc 

President, Broker, Owner 1991 – 1993 


EDUCATION 

Jefferson State, Birmingham, AL 1990 

Certification as Real Estate Broker 

Birmingham Southern, Birmingham, AL 1989 

Accounting Course Work 

University of Alabama, Birmingham, AL 1983 – 1984 

Master of Science – Mathematics 

Auburn University, Auburn, AL 1981 – 1983 

Graduate Program – Mathematics 

University of Montevallo, Montevallo, AL 1977 – 1981 

Bachelor of Science - Mathematics

Lawson E. Stuart 

RN, EMT-P, MBA, CPHQ 

Director of Clinical and 

Educational Services (CES) 


Mr. Lawson Stuart has more than 24 years of experience in emergency medical services and 

has been board-certified in both emergency and trauma nursing. As Director of Clinical and 

Educational Services (CES), he is responsible for the education, monitoring, and clinical 

oversight of 4,500 EMS personnel in numerous counties throughout Washington, Oregon, 

Northern California, Hawaii, Montana, South Dakota, Colorado, Kansas, Missouri, and 

Iowa. He also oversees AMR’s QUICNET clinical data surveillance system in those areas 

and supervises a staff of 38 managers and investigators. Mr. Stuart also serves as the 

Director of AMR’s Northern California Training Institute (NCTI) in Roseville, Calif., which 

provides training for Paramedics, EMTs, and 9-1-1 Dispatchers, as well as professional 

continuing education for nurses and physicians. He is currently board certified in health 

care quality, maintains active Washington and California licensure as a Registered Nurse, 

and maintains Paramedic accreditation in Sacramento County. 

In addition to all of his responsibilities, Mr. Stuart volunteers one night per week as an 

AWANA leader (Christian youth program for grades K-2), as well as volunteer work with 

the White Cross medical ministry. This group prepares bandages from surplus fabric and 

also gathers surplus medical equipment and supplies to send to third-world countries in 

support of the ill and injured. Currently, Mr. Stuart is coordinating a campaign within AMR 

nationally, working with our purchasing department to obtain excess supplies and 

equipment. In one example, he has thus far helped to donate close to 1,000 glucometers. 

Many have recently been routed to the physicians and medical teams operating from the 

Banso Baptist Hospital in Cameroon, Africa. Many others have been distributed throughout 

Africa after being added to cargo containers and loaded aboard ships headed for that 

continent. AMR’s Contra Costa County Operation participated in this glucometer collection 

and donation process. 


Director, Clinical and Education Services 1991 to Present 


Director of Paramedic Training 1988 to Present 

Northern California Training Institute 

Clinical Nurse II (CEN) 1995-1996 

Sutter Roseville Medical Center 

Vice President, EMS Administration 1988-1991 

Sharpe Associates, Inc. 

Paramedic Operations Supervisor 1987-1988 

Foothill Ambulance Service, Inc. 

Mobile Intensive Care Paramedic 1989-1991 

Foothill Ambulance Service, Inc. 

Vice President, Ambulance Operations 1984-1986 

Valley Hills Rescue Ambulance, Inc.

Lawson E. Stuart Page 2 

EDUCATION 

Master’s of Business Administration (MBA) CA State University, Dominguez Hills 

Bachelor of Science-Health Education Columbia Pacific University 

Associate of Science-Nursing University of the State of New York 

Undergraduate Studies-Biochemistry Seattle Pacific University 

Mobile Intensive Care Paramedic Sierra-Sacramento Valley EMS Agency 

Emergency Medical Technician-II Auburn Faith Community Hospital 

Emergency Medical Technician-IV Yakima Valley Community College 

Emergency Medical Technician-I (A) North Seattle Community College 

LICENSES AND CERTIFICATIONS 

Registered Nurse State of California (#495736) 

Registered Nurse State of Washington (#RN00135220 

Board Certified Emergency Nurse National Recognition (#9411032) 

Board Certified Trauma Nurse National Recognition (#P002-1725) 

Board Certified, Healthcare Quality (CPHQ) National Assn., Healthcare Quality (#8915) 

Mobile Intensive Care Paramedic State of California (#P05651) 

Advanced Cardiac Life Support-Provider American Heart Association 

LICENSES AND CERTIFICATIONS (continued) 

Basic Trauma Life Support-Provider American College of Emergency Physicians 

Basic Trauma Life Support-National Affiliate Faculty American College of Emergency Physicians 

Basic Cardiac Life Support-Provider American Heart Association 

Post-Secondary Administration/Teaching Credential Council, Private Post-Secondary Education 


Emergency Medical Services Management Journal (EMSMJ) 

Editorial Board Member, 2003 to Present 

Commission on the Accreditation of Ambulance Services (CAAS) 

Site Reviewer, 1992 to Present 

California Ambulance Association (CAA) 

Education Committee, Chairman, 1999-2000; 2003-Present 

California Association of Paramedic Program Directors (CPPD) 

Charter Member, 1992 to Present 

California Emergency Nurses Association (CAL-ENA) 

Member, 1993 to 1995 

California Rescue Paramedic Association (CRPA) 

Life Member, President-1988 to 1992 

California Pediatric Critical Care Coalition (CPCCC) 

Member, 1988 to 1993 

California EMS for Children (EMSC) 

Pediatric Prehospital Curriculum Committee, 1990 to 1995 

California State EMS Authority (EMSA) 

Adv.Task Force, Paramedic Written Exam, 1993 to 1995 


Adv.Task Force, Paramedic Skills Exam, 1993 to 1995 


Visions Process, Education & Personnel Committee, 1999 to 2002 


Visions Process, Data & Quality Improvement Committee, 1999 to 2000

Lawson E. Stuart Page 3 

American Heart Association 

Emergency Cardiac Care Committee, CA Aff., Member, 1992 to 1994 

American Heart Association 

Emergency Cardiac Care Committee, Gldn. Emp., Chair, 1989 to 1994 

American Red Cross 

AIDS Education for Emergency Workers Project, Member, 1989 to 1992 

County of Sacramento 

Emergency Medical Services Operations Committee, Member, 1993 to 1994 

Sierra-Sacramento Valley EMS Agency 

EMS Data Task Force, Member, 1992 to 1996 

International Critical Incident Stress Foundation (ICISF) 

Advanced Peer Counselor 1991 to Present 

National Association for Healthcare Quality (NAHQ) 

Member, (CPHQ), 1998 to Present

Jeffrey S. Taylor 

Regional Director 

Communications, Deployment Planning 

and Performance Analysis 


Mr. Jeffrey Taylor oversees the Communications Centers in AMR’s Northwest Plains Region. 

His team manages 12 communications centers, 1.3 million ambulance responses per year, and 

tracks more than 650 ambulances. The team also manages the NAED-accredited Center of 

Excellence process for 7 centers, and is currently planning the implementation of a new 

Computer Aided Dispatch (CAD) platform. In addition, the team manages the radio 

infrastructure, including more than 320 FCC licenses and 150 radio towers. Mr. Taylor also 

oversees the system status planning and resource deployment processes and is responsible for the 

Performance Analysis Team, which manages all non-financial reports for the entire region. His 

Deployment Planning Team manages the overall system status planning for 53 counties, 

including post locations and core schedules. The Performance Analysis Team manages more 

than 500 reports per month for the region. 

Mr. Taylor has extensive background in the health care industry as it relates to ambulance system 

design, unit deployment, communications systems, and the use of technology in providing highquality 

customer service. In 2000, he was listed in the International Historical Society’s “Who’s 

Who” of Professionals. He also works with the Joint Commission on Accreditation of Health 

Care Organizations (JCAHO) as an Intermittent International Consultant for Medical 

Transportation Standards. He worked as part of a Task Force for JCAHO to develop the Medical 

Transportation Standards. Since he began his career in 1985, he has authored standard operating 

procedures manuals and training manuals, served as a 9-1-1 Paramedic, flight Paramedic, 

Paramedic course instructor, and managed the design and construction of the Burlingame Center 

— one of AMR’s largest and most advanced Communications Centers in the nation. 

EXPERIENCE 


Regional Director of Communications, 

Deployment Planning and Performance Analysis 2003 – Present* 

Director of Contract Management 2001 – 2003* 

Regional Manager of Provider Networks 2001 – 2001* 

Director of Communications 1996 – 2001* 

Joint Commission on Accreditation for 

Health Care Organizations (JCAHO) Oak Park, IL 2002 – Present 

International Consultant 

MedTrans of Illinois, Skokie, IL 1995 – 1996* 

Director of Communications 

Mercy Ambulance of Richmond, Richmond, VA 

System Status Controller – Field Paramedic 1990 – 1995* 

*All of these agencies are or were owned by the same parent organization.

Jeffrey S. Taylor 2 

EDUCATION 

Virginia Commonwealth University, Medical College of Virginia 1992 

Paramedic Certification 

Northern Virginia Community College, Fairfax, CA 1987 – 1988 

20 units toward an Associate of Science degree in Emergency Medical Services 


California Ambulance Association - Member 

Association of Public Safety Communications Officials – Active 

Virginia Governor’s Disaster Task Force - Past Member 

National Association of Aero-Medical Communications Specialist 

CREDENTIALS 

EMT-B, State of California

Kevin Fenderson 

Regional Director, Fleet 

Maintenance 


Mr. Kevin Fenderson has spent his adult life working in EMS. He first became certified in Oregon 

and worked as a Paramedic and lead technician. His expertise in fleet maintenance was developed 

during his tenure managing vehicle maintenance services for the Tri-Met Paratransit Program, 

overseeing a shop with 10 employees that maintained and repaired up to 108 minibuses used in 

providing transportation for elderly and disabled citizens throughout Portland’s Tri-County area. 

Mr. Fenderson took over management of all three of AMR’s maintenance facilities in the 

Northwest in 1992, overseeing on-site supervisors and the work of several service technicians. At 

that time, fleet maintenance was conducted out of three facilities that serviced the minibuses and a 

fleet of 90 vehicles, including ambulances and support equipment. Mr. Fenderson’s department 

was also responsible for the physical plant maintenance of 18 sites. 

In 1996 Mr. Fenderson transferred to Northern California as Fleet Manager to develop current 

preventive maintenance programs and audit all performance goals. All supervisors and mechanics 

from eight repair facilities reported directly to him. 

In 1997, Mr. Fenderson was named Director of Fleet Maintenance for Northern California and 

Hawaiì, and was responsible for the repairs and preventive maintenance of more than 600 

ambulances and support vehicles, 30 fleet employees, and 5 outside vendors. In March of 1999, 

Washington, Oregon, Montana, and South Dakota were added to Mr. Fenderson’s area of 

responsibility. He now oversees a fleet of 1,032 vehicles, 48 employees in 13 company-operated 

repair shops, and 12 outside vendors. 


Regional Director, Fleet Maintenance (Northern Pacific Region) Present 


Manager, Fleet Maintenance (Northern California Division) 1996 – 1997 


Manager, Fleet Maintenance (Oregon) 1993 – 1996 


Supervisor, Fleet Maintenance (Paratransit Division) 1990 – 1993 


EMT / Paramedic / Fleet Maintenance 1976 – 1990 


TRAINING 

Laidlaw Storm Water Review Session 

Concord, California 1997 – 2002 

Emergency Vehicle & Fleet Management 

Milwaukee, Wisconsin 1996 

Hazardous Waste Management Training 

California State University 1996

Kevin Fenderson Page 2 

Emergency Vehicle & Fleet Management 

St. Louis, Missouri 1994 

Hazard Communication Train-the-Trainer Compliance Course 

Portland, Oregon 1993 

How to Build a Better Team 

Portland, Oregon 1993 

Quality Assurance for Fleet Operations 

Nashville, Tennessee 1990 

COMPUTER SKILLS 

Proficient with MS Word, MS Excel, MS Access 

Dbase III+ Programmer 

AFFILIATIONS 

Member, Emergency Vehicle Technician Commission Current 

Chairman, Clackamas County Traffic Safety Commission 1993 – 1996 

Member, Paratransit Quality Assurance Committee

Linda L. Kissling 

Regional Director of Human 

Resources 


Ms. Linda Kissling studied as an Occupational Health Nurse at the Oregon Health Science 

University and received her Registered Nurse designation from the Good Samaritan/Linfield 

School of Nursing (Oregon). Having garnered much experience in the nursing field, she went on 

to become an Occupational Nursing Consultant for SAIF Corporation, then served as Coordinator 

of Occupational Health Services for Providence Milwaukie/Dwyer Hospital in Milwaukie, Ore. 

After a successful tenure, she accepted the position of Director of Occupation Health Services for 

Health Systems Management/Legacy Health System, Portland, Ore., followed by acceptance of 

the Director of Occupation Health Services position for the Center for Occupational Health at St. 

Vincent Hospital, also in Portland. In 1993, Ms. Kissling came to work at the Portland, Ore. 

office of American Medical Response as the Director of Employee Services, and eventually 

moved into the position of Vice President of Administration. In 1996, she accepted the position 

of Director of Human Resources for AMRs Central Region with offices located in Aurora, Colo.; 

then, in 1997, she assumed the Director of Human Resources position in the Livermore, Calif. 

office. In 2000, these functions were expanded to include oversight for operations in the states of 

Oregon, Washington, Montana, South Dakota, and Hawaiì. In 2003, she assumed overall 

responsibility for Human Resource functions throughout the Northwest–Plains Region by 

becoming the Regional Director of Human Resources. 

During her more than 20 years of experience in human resource management, Ms. Kissling has 

implemented and improved methods for testing and hiring field caregivers along with developing 

retention and recognition programs. In addition, she has served as a negotiator during labor 

negotiations and is knowledgeable in benefits administration. She has assisted in the 

development of programs to enhance managers’ skills and in increasing on-the-job safety 

programs for employees. She has served as a board member for Metro Crisis Intervention and as 

president of the Boys and Girls Aid Society and the Salem Hospital Auxiliary. 



Regional Director of Human Resources, Northwest Plains Region 2003 to Present 

Director of Human Resources, OR-WA-MT-SD-HI 2000 to 2003 

Director of Human Resources, NPR, Livermore, CA 1997 – 2000 

Director of Human Resources, Central Region, Aurora, CO 1996 – 1997 

Vice President of Administration, Portland, OR 1995 – 1996 

Director of Employee Services, Portland, OR 1993 – 1995 

Health Systems Management / Legacy Health System 1988 – 1993 

Portland, OR 

Director of Occupation Health Services 

Center for Occupational Health / St. Vincent Hospital 1983 – 1988 

Portland, OR 

Director of Occupation Health Services

Linda Kissling Page 2 

Providence Milwaukie / Dwyer Hospital 1981 – 1983 

Milwaukie, OR 

Coordinator of Occupational Health Services 

SAIF Corporation 1979 – 1981 

Occupational Nursing Consultant 

EDUCATION 

Good Samaritan / Linfield School of Nursing, Oregon 

Registered Nurse 

Oregon Health Science University, Oregon 

Occupational Health Nurse Curriculum 

COMMUNITY ACTIVITIES 

Metro Crisis Intervention, Board Member 

Boys and Girls Aid Society, Past President 

Salem Hospital Auxiliary, Past President

Jan Anderson 

Human Resources Manager 


Ms. Jan Anderson has more than 25 years of experience in Human Resources with the 

majority of that time spent in the medical field. She has served in the capacity of Human 

Resource Manager for such entities as the Modesto Psychiatric Center, Qualex, Inc., St. 

Joseph’s Regional Health Systems, and National Health Plans. Outside of the health care 

environment, Ms. Anderson has served as a Human Resources Manger for the Stockton 

Hilton Hotel, Blue Magic Products, and Valley Fresh, Inc. 

At AMR, Ms. Anderson is responsible for all aspects of Human Resources for the 

Bay/Valley/Hawaiì Operations and plays a key role in the interpretation of contracts and 

the handling of grievances. In addition, Ms. Anderson participates on the California 

Employer Advisory Council 


AMR — Bay/Valley/Hawaii Operations 

Human Resources Manager 1999–Present 

Valley Fresh, Inc. — Turlock, CA 

Human Resources Manager 1997–1999 

National HealthPlans 

Human Resources Generalist 1996–1997 

Blue Magic Products, Inc. 

Human Resources Director 1995–1995 

St. Joseph’s Regional Health Systems 

Human Resources Generalist 1991–1994 

Qualex, Inc. — Manteca, CA 


Modesto Psychiatric Center 


Stockton Hilton Hotel 


EDUCATION 

Delta Junior College, Stockton, CA 

Major – Business Administration 

Golden Gate University, San Francisco, CA 

Transportation Brokerage Certificate 1979 

PROFESSIONAL ASSOCIATIONS AND AFFILIATIONS 

California Employer Advisory Council

David Caraveo 

Regional Safety & Risk Manager 


Mr. David Caraveo has been in the EMS field for more than 23 years having started as a 

firefighter for the City of Livermore, and progressing to a Firefighter/Engineer and HAZ- 

Mat Officer for the Lawrence Berkeley Laboratory Fire Department for 8 years. In 1985, 

Mr. Caraveo was awarded EMT/Paramedic of the year (EMS Zone #1). He has also held 

the positions of Health Department Inspector, Fire Inspector, and Industrial Hygienist with 

the City of Berkeley Public Health Department. In addition, he was employed for six years 

as the Health Manager, Safety Manager, and Industrial Hygienist for the Olin/Primex 

Corporation, where he was responsible for the health and safety of three facilities and more 

than 400 employees in the EMF, weapons production, biological, and radiation research 

sections. Mr. Caraveo has been with AMR for more than 5 years. As the Regional Safety 

and Risk Manager, he is on call and available 24 hours a day, 7 days a week to answer calls 

on safety and liability issues. Mr. Caraveo is also responsible for AMR’s Safety and Risk 

Management Program in Contra Costa County. Notable in this regard was his response to 

the reported increase of the amount of skeletal muscular strains and sprains by AMR 

employees. Mr. Caraveo investigated the problem, and implemented strategies and training 

that resulted in an 80% reduction of these symptoms. 

Additionally, Mr. Caraveo is a Flight Medic with the East Bay Regional Park Police and is 

an instructor for the San Joaquin County Urban Search and Rescue team. He is also an 

EMT instructor for the San Joaquin Delta Junior College and for AMR’s Northern 

California Training Institute. In addition, he is an Industrial Hygienist/Safety consultant to 

various U.S. Corporations. Mr. Caraveo is involved with various fire agencies conducting 

training and compliance assistance and is involved in various Hispanic community groups 

serving as a role model for Hispanic youth. Finally, Mr. Caraveo also serves as an expert 

witness in the field of Hazardous Materials and Safety. 


AMR, Safety & Risk Manager 1999 to Present 

Northern Pacific Region, CA. 

Industrial Hygienist/Safety Consultant 2001 to Present 

Flight Medic, Regional Park Police 2000 to Present 

Health & Safety Administrator, Meyer Corporation 1997 – 1999 

Vallejo, CA 

Environmental, Health & Safety Manager Olin / Primex Corporation 1992 – 1997 

San Leandro, CA 

Safety and Environmental Consultant, CEC Environmental 1991 – 1992 

Benicia, CA

David Caraveo Page 2 

Health Inspector & Fire Inspector, City of Berkeley 1989 – 1991 

Health Department, Berkeley, CA 

Senior Haz Mat Specialist, San Joaquin County, OES 1987 – 1989 

Stockton, CA 

Firefighter, Engineer & Haz Mat officer 1982 – 1988 

Lawrence Berkeley Laboratory Fire Department 

EDUCATION 

Merritt College, Oakland, CA 1982 

AA – Fire Science / Welding - Ironworking 

Allen Hancock College, Santa Maria, CA 1986 

25 units in Fire Science / Hazardous Materials 

University of California, Davis, Davis, CA 1982-1984 

25 units in the Hazardous Materials Management Program 

United States Environmental Protection Association (USEPA) 1982 – 1984 


Environmental Assessment Association 

National Flight Paramedic Association 

Critical Care Transport Association of California 

CREDENTIALS 

EMT-1, State of California 

California State Firefighter I & II Level 

California State Fire Marshal Hazardous Materials Technician certificate 

Certified Helicopter Crew Chief – CDF 

Certified Environmental Specialist 

Environmental Assessment Association, Stamp # 12486

Seven Elements of Effective Program Compliance 

The AMR Compliance Program is based on the US Sentencing Guidelines as well as the 

recommended guidelines promulgated by the Department of Health and Human Services. 

The primary recommended standards include: 

1) Formal policies and written procedures 

2) Designation of a Compliance Officer 

3) Education and training programs 

4) Internal monitoring and reviews 

5) Responding appropriately to detected misconduct 

6) Open lines of communication 

7) Discipline and accountability

CORPORATE COMPLIANCE PROGRAM 

TABLE OF CONTENTS

March 2004 


March 2004 


Introduction to the Corporate Compliance Program 

PART I: General Policies 

Policy No. 

Corporate Policy on Duties of Compliance Personnel ......................................................10100 

Corporate Policy on Employee Training ...........................................................................10200 

Corporate Policy on Reporting of Potential 

Issues or Areas of Noncompliance .....................................................................................10300 

Corporate Policy on Exit Interviews ..................................................................................10400 

Corporate Policy on Print and Broadcast Media ...............................................................10500 

Corporate Policy on Records Management........................................................................10600 

Corporate Policy on Patient Confidentiality ..................................................................... 10700 

Brief Overview of Relevant Health Laws 

And Regulations .................................................................................................................10800

March 2004 


PART II: Policies Governed by Specific Health Care Laws and Regulations 

Marketing Policies 

Policy No. 

Contract Administration .....................................................................................................20100 

Corporate Policy on Direct-to-Consumer Marketing .......................................................20200 

Corporate Policy on Subscription Agreements .................................................................20300 

Corporate Policy on Marketing Activities with Sources 

of Patient Referrals..............................................................................................................20400 

Financial Relationships 

Corporate Policy on Public EMS Contracts ......................................................................30000 

Corporate Policy on Managed Care .................................................................................. 30100 

Corporate Policy on Contractual and Other Financial 

Relationships/Arrangements with Health Facilities...........................................................30200 

Corporate Policy on Personal Service Contracts ..............................................................30300 

Corporate Policy on Restocking ........................................................................................30400 

Corporate Policy on Rental Arrangements ........................................................................30500 

Corporate Policy on Relationships with Vendors..............................................................30600 

Corporate Policy on Compassionate Care..........................................................................30700 

Corporate Policy on Charitable Contributions ..................................................................30800 

Corporate Policy on Relationships With Billing Agents...................................................30900

Operations Policies 

March 2004 

Communications: 


Policy No. 

Corporate Policy for Intake and Dispatch Personnel.........................................................40100 

Service Delivery: 

Corporate Policy for Medical Transport Personnel (Field Providers) ..............................40200 

Corporate Policy on Obtaining Patient Signatures ............................................................40300 

Billing Policies 

Corporate Policy on General Reimbursement and Billing Procedures.............................50100 

Corporate Policy for Billing Personnel ..............................................................................50200 

Corporate Policy on Level of Service Billing ...................................................................50300 

Corporate Policy on Determination of Medical Necessity ...............................................50400 

Corporate Policy on Repetitive Patients.............................................................................50500 

Corporate Policy on Customer Waivers of 

Co-insurance and Deductibles ............................................................................................50600 

Corporate Policy on Post-Payment Audits.........................................................................50700

March 2004 


American Medical Response’s Commitment to Ethical Leadership 

For more than seven years, the American Medical Response (AMR) Executive 

Leadership, along with the Compliance Committee of the Laidlaw Board of Directors has 

provided governance, compliance oversight and ethical leadership for the Company. To 

help accomplish this monumental task, the Compliance Committee authorized the 

creation of the Ethics and Compliance Department and appointed a Chief Compliance 

Officer. 

From its inception, the Ethics & Compliance Department has had a threefold mission: to 

prevent, detect and mitigate regulatory risks. This mission is accomplished through: 

providing guidance, education and proper controls based on the regulatory risks 

associated with AMR unique business model and strategic plan; 

partnering with each of the operations and support functions to achieve greater 

efficiencies and enhanced profitability; 

resolving regulatory matters through the judicial process; and 

enhancing the ethical culture and leadership of the organization. 

The Ethics and Compliance Department plays an affirmative role in facilitating the 

strategic objectives of the Company. In this capacity the Ethics and Compliance 

Department is committed to providing clear guidelines to train and educate all employees 

regarding applicable laws, regulations, policies and procedures as they pertain to 

compliance. The AMR Compliance Program is based on the US Sentencing Guidelines 

as well as the recommended guidelines promulgated by the Department of Health and 

Human Services. The primary recommended standards include: 1) formal policies and 

written procedures; 2) designation of a Compliance Officer; 3) education and training 

programs; 4) internal monitoring and reviews; 5) responding appropriately to detected 

misconduct; 6) open lines of communication; and 7) discipline and accountability. The 

spirit and foundation of the Compliance Program is based on the overall goal of 

promoting a culture that encourages employees to conduct activities with integrity, 

dignity, and care for those we serve.

Code of Business Conduct Training 

Topics covered in the Code of Business Conduct training include the 

following: 

Reporting a Suspected Violation 

Accurate Books and Records 

Safety and Health 

Drug-free Workplace 

Fair Dealing and Antitrust 

Government Investigations 

Fraud and Abuse in Medicare, Medicaid and other Health-care Benefit 

Programs.

CUSTOMER SERVICE UNIT - PATIENT BUSINESS SERVICES 

POLICY AND PROCEDURES 


I. INTRODUCTION AND WELCOME 

What is AMR? 

New hire tour of business office, dispatch center, imaging and other departments within the 

business office. 

Explain to employee what they can expect about medical ground transportation and the billing 

procedure associated with the industry. 

Employee handbook and benefit package will be provided during orientation with the 

Administrative Assistant. 

Provide employee with break schedule and extension listing.

Page 2 

A. TABLE OF CONTENTS 

1. Section 1 

Customer Service Break Listing (to be given to you by your supervisor) 

Extension list 

Point of Contact for Customer Service Issues 

Telephone Numbers / Address listing 

Language Line 

CSR Crisis Line and Informational Phone Listings 

Dispatch Phone Numbers 

Legacy Accounts for Old Companies 

Implementation Chart 

2. Section 2 

Power Point Presentation 

Will demonstrate how to: 

1. Log in completely to your phone 

2. Bring a call to your phone line 

Internal 

ACD 

3. Greeting the caller 

4. Putting the caller on hold 

5. Transferring a call 

To another phone number 

To another extension 

To a voice mail box 

6. Use of all telephone functions 

7. Provide CSR Agent features sheet 

8. Answer the telephone after hours 

9. Log out completely 

Shift end 

Breaks / lunches 

Telephone etiquette handout 

Average talk time expectation (6 minutes) 

Standard volume of daily calls expected (72 daily) 

3. Section 3 

Trouble Shooting 

What does DNR mean? 

What is a Dry Run? 

Treat and Release 

On duty Police and Fire personnel 

Deceased patient 

5150 

Minor patients 

Viewing trips from History 

How to work from Inquiry 

Account Responsible

Page 3 

“Something about the caller is just not quite right…” 

Caller is not willing to give information 

How to handle an account that is already at collections 

How and when to change a Date of Service 

Multiple patient transport charges 

A caller using foul language 

“No Trip Summary Found” 

Auto Accident billing issues 

4. Section 4 

Queue Reference Guide 

Direct Trip Update 

How to update an insurance policy 

Documentation 

1. Trip vs. Patient comments 

The difference between: 

1. Dialer / Insource notes and what they look like 

2. AMR notes 

3. System notes 

Trip Inquiry reference 

5. Section 5 

Cash Control 

1. How to tell the difference between; 

Zero balance trips paid in full 

Zero balance trips written off to collection agency 

Zero balance trips written off to contract 

Zero balance trips written off to courtesy 

2. How to recognize a denial in the transaction screen 

3. How to tell the difference between; 

ECT 

CBT 

PBT 

PRT 

4. How and when to reverse a trip charge 

5. What is a negative balance and what creates a negative balance 

6. How to correct a negative balance 

7. When to request a refund 

8. Transaction codes 

9. Offsets 

6. Section 6 

Champus Billing 

7. Section 7 

Contracts Billing

Page 4 

1. Collection plans 

2. Contracted Health Plans and Insurance Companies 

3. Contract as a 2ndary payer 

4. Contract invoice billing 

5. Statement of Account 

8. Section 8 

Correspondence Unit 

9. Section 9 

Insurance/3 rd Party Billing 

1. Collection Plans 

2. 014 Entity Insurance codes 

10. Section 10 

Kaiser Billing 


Medical/Medicaid/GMC Billing 


Medicare Billing 


System Administrative Team and how this department works. 


Medical Records and Documents from Imaging 


Customer Service Policies and Procedures. 


Standard Forms used 


AM2000 Letters & Invoices

Page 5 


Standard Abbreviations 

Glossary 


Miscellaneous 

1. Motivational Tools 

Additional Standard Operating Procedures Covered In Training 

Small Balance Write Off Procedure 

Transferring Calls Procedure 

Changing Primary Bill To and Collection Plan Procedure 

Private CSR Queue Procedure 

CSR Refund Request Procedure 

Complaint Resolution Process 

25 Points, Customer Service 

Customer Service Scripts 

Dialer Process 

Collection Agency Process 

Compassionate Care Program 

Payment Plan 

Escalated Calls 

Liens 

Payment Plans 

Lost and Found Policy


Organizational Requirements 

Map of Bay Area Operations 

National Service Area Map 

Similar EMS Contracts 

Audited Financial Statements, AMR West 

Audited Financial Statements, AMR Inc. 

Business Licenses and Certifications 

Regulatory Investigations 

Litigation History 

Performance Bond

Sonoma 

Marin 

San Francisco 

Napa 

San Mateo 

Solano 

Contra Costa 

Alameda 

Santa Clara 

Santa Cruz 

Bay Area Counties 

Served by 

American Medical Response

Similar EMS Contracts for Subsidiaries of American Medical Response, Inc. 

Estimated Annual 

Contract Year Entered Services Provided 

Location Contracting Agency 

Net Revenue 

Provided under City 

Tuscaloosa, City of 

Ordinance Primary 9-1-1 $1,182,433 AL Tuscaloosa, City of 

Provided under 

Tuscaloosa, County of County Ordinance Primary 9-1-1 $359,156 AL Tuscaloosa, County of 

Alameda County Health 

Alameda, County of 2001* ALS & BLS Services $40,195,000 CA 

Services Agency 

Calaveras, County of 11/1/2001* ALS Services $182,500 CA Mountain Valley EMS Agency 

Chula Vista, City of 1989 ALS Services $3,433,517 CA City of Chula Vista 

Contra Costa County Health 

Contra Costa, County of 1997* ALS & BLS Services $28,308,000 CA 


No longer providing 

Costa Mesa, City of 1995-2000 BLS Services services CA City of Costa Mesa 

Fullerton, City of - Fire 


Department 1960-2003 BLS Services services CA City of Fullerton 


Garden Grove, City of 1996-2001 BLS Services services CA City of Garden Grove 

Grossmont Hospital 

Grossmont Hospital 

District 1987 ALS & BLS Services $2,046,500 CA 

Corporation 

No longer provide 

Kings, County of 11/1/1995-10/31/00 ALS & BLS Services services CA County of Kings 

Long Beach, City of 1998 BLS Services $2,917,865 CA City of Long Beach 

Los Angeles, County of 1995 ALS & BLS Services $55,526,020 CA County of Los Angeles 


Lynwood, City of 1991-2000 ALS Services services CA City of Lynwood 

County of Merced, 

Department of Public Health 


services CA 

Merced, County of 9/1/00-8/31/02* ALS Services 

Montebello, City of 2002 ALS Services $717,568 CA City of Montebello 

Monterey County Department 

of Health Services 

Monterey, County of 1995* ALS & BLS Services $5,400,000 CA 

Page 1 of 8




Net Revenue 


National City, City of 1987 ALS & BLS Services $1,586,933 CA City of National City 


Sierra-Sacramento Valley 

Placer, County of 

County Ordinance ALS & BLS Services $5,788,000 CA 

EMS Agency 

Riverside, County of 1998 ALS & BLS Services $52,663,132 CA Riverside County 

Sacramento Metropolitan 

Sacramento Metropolitan Fire 

Fire District 1999* ALS & BLS Services $6,170,000 CA 

District 

San Benito, County of 1991 ALS & BLS Services $800,000 CA County of San Benito 

San Bernardino, County of 1990 ALS & BLS Services $48,672,530 CA San Bernardino County 

San Diego, County of - 

Zone 2 Rural & Otay Mesa 2001 ALS Services $250,000 CA County of San Diego 

San Francisco, City and Provided under Back-up ALS 

County of 

County Ordinance Services $600,000 CA San Francisco EMS Agency 

San Joaquin, County of 1986* ALS & BLS Services $9,025,000 CA County of San Joaquin 

San Mateo County Health 

San Mateo, County of 1999 ALS & BLS Services $14,895,000 CA 


Santa Barbara, County of 1998* ALS & BLS Services $7,395,000 CA County of Santa Barbara 

Santa Clara, County of 2001* ALS & BLS Services $291,045,000 CA County of Santa Clara 

Santa Cruz, County of 2003* ALS & BLS Services $5,950,000 CA County of Santa Cruz 

Santa Monica, City of 1993-2004 ALS & BLS Services $1,000,133 CA City of Santa Monica 


Shasta, County of 

County Ordinance ALS & BLS Services $2,450,000 CA Nor-Cal EMS Agency 

Sonoma, County of 1999* ALS & BLS Services $7,960,000 CA County of Sonoma 

Stanislaus, County of 2001* ALS & BLS Services $15,350,000 CA Mountain Valley EMS Agency 

Tulare, County of 1979 ALS & BLS Services $2,205,000 CA County of Tulare 

Page 2 of 8




Net Revenue 


Ventura, County of 1996 ALS & BLS Services $10,628,279 CA County of Ventura 

West Covina, City of 1991 ALS & BLS Services $128,582 CA City of West Covina 


Westminster, City of 1994 BLS Services services CA City of Westminster 

Sierra-Sacramento Valley 

Yolo, County of 2002* ALS & BLS Services $4,035,000 CA 

EMS Agency 

Canon City Area Fire 

District 2001 ALS & BLS Services $750,000 CO Canon City Area Fire District 

El Paso County Emergency 

Medical Services Agency 

El Paso County Emergency 

Services Agency 1998 ALS & BLS Services $9,750,000 CO 

Golden, City of 2003 ALS & BLS Services $3,100,000 CO City of Golden 

Primary 9-1-1 

Avon, Town of 1989 

(ALS/BLS) $402,634 CT Town of Avon 

Primary 9-1-1 

Bridgeport, City of 1995 

(ALS/BLS) $4,292,344 CT City of Bridgeport 

Primary 9-1-1 

Fairfield, Town of 1994 

(ALS/BLS) $1,124,747 CT Town of Fairfield 

Primary 9-1-1 

Farmington, Town of 1989 

(ALS/BLS) $653,828 CT Town of Farmington 

Primary 9-1-1 

Hartford, City of 2002 

(ALS/BLS) $3,942,763 CT City of Harford 

Primary 9-1-1 

Milford, City of 1994 

(ALS/BLS) $1,158,613 CT City of Milford 

Primary 9-1-1 

New Haven, City of 1993 

(ALS/BLS) $6,379,894 CT City of New Haven 

Newington, Town of 1995 PI, Mutual Aid $449,065 CT Town of Newington 

Primary 9-1-1 

Orange 1995 

(ALS/BLS) $391,056 CT City of New Haven 

Primary 9-1-1 

Plainville, Town of 1989 

(ALS/BLS) $277,870 CT Town of Plainville 

Primary 9-1-1 

Southington, Town of 1987 

(ALS/BLS) $712,459 CT Town of Southington 

Page 3 of 8





Net Revenue 

Primary 9-1-1 

West Hartford, Town of 1996 

(ALS/BLS) $1,493,174 CT Town of West Hartford 

Primary 9-1-1 

Woodbridge, Town of 2001 

(ALS/BLS) $229,734 CT Town of Woodbridge 

Primary 9-1-1 

Key West, City of 1982 

(ALS/BLS) $1,000,000 FL City of Key West 

North Miami Beach / 

Primary 9-1-1 

Eastern Shores 1992 

(ALS/BLS) $212,500 FL City of North Miami Beach 

Primary 9-1-1 

Pinellas County EMS 

Pinellas, County of 1988-2004 

$19,000,000 FL 

(ALS/BLS) 

Authority 

Provide service by an 

ordinance of one 

Board of Commissioners of 

Troup, County of 

license issued Primary 9-1-1 $2,431,982 GA 

Troup County 

Hawaii County Fire 

Back-up ALS 

County of Hawaii Fire 

Department 2004 

Services $385,000 HI 

Department 

Honolulu, City and County 

Back-up ALS 

State of Hawaii, Department 

of 2004 

Services $175,000 HI 

of Health 


Kauai, County of 2002 ALS Services $3,835,000 HI 


ALS & Helicopter 


Maui, County of 2001 

Services $3,475,000 HI 


City of Charles City, County 

Charles City, City of 2001* ALS Services $225,000 IA 

of Floyd 

Primary 9-1-1 

Evansville, City of 1988 

(ALS/BLS) $1,504,225 IN City of Evansville 

Primary 9-1-1 

Three Rivers Ambulance 

Fort Wayne 1983 

(ALS/BLS) $2,486,461 IN 

Authority 

Primary 9-1-1 

Board of Commissioners of 

Vanderburgh, County of 1990 

(ALS/BLS) $76,986 IN 

Vanderburgh County 

Board of County 

Commissioners, County of 

Osage, County of 2001 ALS & BLS Services $290,000 KS 

Osage 


Commissioners, Shawnee 

Shawnee, County of 2001 ALS & BLS Services $3,150,000 KS 

County 

Page 4 of 8





Net Revenue 


Commissioners, County of 

Wabaunsee, County of 2003 ALS & BLS Services $70,000 KS 

Wabaunsee 

Provide service by an 

ordinance of one 

Ouachita Parish 

license issued Primary 9-1-1 $4,305,868 LA Ouachita Parish 

Primary 9-1-1 

Berwick, Town of 1999 

(ALS/BLS) $110,500 MA Town of Berwick 

Primary 9-1-1 

Town of Boxford Board of 

Boxford, Town of 1985 

(ALS/BLS) $40,000 MA 

Selectman 

Primary 9-1-1 

Brockton, City of 1991 

(ALS/BLS) $3,590,000 MA City of Brockton 

Carver, Town of Primary ALS $2,000 MA Town of Carver 

Boards of Selectmen for the 

East Longmeadow and 

Primary 9-1-1 

Town of East Longmeadow 

Hampden, Towns of 1996 

(ALS/BLS) $2,296,877 MA 

and Hampden 

Primary 9-1-1 

Eliot, Town of 1999 

(ALS/BLS) $103,000 MA Town of Eliot 

Primary 9-1-1 

Framingham, Town of 1993 

(ALS/BLS) $1,402,720 MA Town of Framingham 

Primary 9-1-1 

Groveland, Town of 1983 

(ALS/BLS) $71,825 MA Town of Groveland 

Primary 9-1-1 

Holden, Town of 1995 

(ALS/BLS) $357,225 MA Town of Holden 

Primary 9-1-1 

Holyoke, City of 2003 

(ALS/BLS) $1,833,657 MA Holyoke Medical Center 

Primary 9-1-1 

Kittery, Town of 1999 

(ALS/BLS) $179,019 MA Town of Kittery 

Primary 9-1-1 

Middleboro, City of 1985 

(ALS/BLS) $48,533 MA City of Middleboro 

Milford, Town of 1995 Primary 9-1-1 (BLS) $411,960 MA Town of Milford 

Primary 9-1-1 

Newburyport, City of 1989 

(ALS/BLS) $273,211 MA City of Newburyport 

Primary 9-1-1 

Newton, City of 1983 

(ALS/BLS) $1,485,513 MA City of Newton 

Page 5 of 8





Net Revenue 

Primary 9-1-1 

Northampton, City of 1997 

(ALS/BLS) $997,213 MA City of Northampton 

Primary 9-1-1 

Paxton, City of 1995 

(ALS/BLS) $52,433 MA City of Paxton 

Primary 9-1-1 

Pittsfield, City of 1995 

(ALS/BLS) $903,494 MA City of Pittsfield 

Primary 9-1-1 

Plymouth, Town of 1988 

(ALS/BLS) $1,407,639 MA Town of Plymouth 

Primary 9-1-1 

Rowley, Town of 1983 

(ALS/BLS) $88,275 MA Town of Rowley 

Primary 9-1-1 

Salisbury, Town of 1996 

(ALS/BLS) $219,600 MA Town of Salisbury 

Primary 9-1-1 

Springfield, City of 1996 

(ALS/BLS) $2,550,000 MA City of Springfield 

Primary 9-1-1 

Taunton, City of 1985 

(ALS/BLS) $1,438,203 MA City of Taunton 

Primary 9-1-1 

Waltham, City of 1983 

(ALS/BLS) $1,339,302 MA City of Waltham 

Primary 9-1-1 

Wellesley, Town of 1993 

(ALS/BLS) $449,352 MA Town of Wellesley 

Primary 9-1-1 

West Newbury, Town of 1995 

(ALS/BLS) $41,077 MA Town of West Newbury 

Southfield, City of 1996 Primary 9-1-1 $1,359,328 MI City of Southfield 

Independence , City of 1997 ALS & BLS Services $4,650,000 MO Independence City Council 

Hancock, County of 1975 Primary 9-1-1 $198,030 MS Madison County 

Harrison, County of 1995 Primary 9-1-1 $10,664,818 MS Harrison County 

Hinds, County of 1991 Primary 9-1-1 $11,331,581 MS Hinds County 

Madison, County of 1991 Primary 9-1-1 $2,111,625 MS Madison County 

Primary 9-1-1 

Atkinson, Town of 1988 

(ALS/BLS) $86,000 NH Town of Atkinson 

Primary 9-1-1 

Danville, Town of 1989 

(ALS/BLS) $64,500 NH Town of Danville 

Primary 9-1-1 

East Kingston, Town of 1989 

(ALS/BLS) $4,000 NH Town of East Kingston 

Primary 9-1-1 

Hampstead, Town of 1994 

(ALS/BLS) $163,818 NH Town of Hampstead 

Page 6 of 8





Net Revenue 

Primary 9-1-1 

Hampton Falls, Town of 1988 

(ALS/BLS) $29,856 NH Town of Hampstead Falls 

Primary 9-1-1 

Town of 1999 

(ALS/BLS) $18,515 NH Town of New Castle 

Primary 9-1-1 

Newton, Town of 1988 

(ALS/BLS) $79,715 NH Town of Newton 

Primary 9-1-1 

Plaistow, Town of 1992 

(ALS/BLS) $196,134 NH Town of Plaistow 

Primary 9-1-1 

Sandown, Town of 1988 

(ALS/BLS) $65,635 NH Town of Sandown 

Primary 9-1-1 

Somersworth, City of 1994 

(ALS/BLS) $266,992 NH City of Somersworth 

Primary 9-1-1 

South Hampton, Town of 2002 

(ALS/BLS) $10,740 NH Town of South Hampton 


Dona Ana, County of 2000-2003 ALS & BLS Services services NM Dona Ana County 

Otero, County of 2002 ALS & BLS Services $904,773 NM Otero County 

Roswell, City of 2001 ALS & BLS Services $1,262,610 NM City of Roswell 

Clark, County of - Nevada 2000 ALS & BLS Services $4,900,000 NV Clark County 

Las Vegas, City of 2000 ALS & BLS Services $7,200,000 NV City of Las Vegas 

Clackamas, County of 1994 ALS & BLS Services $7,250,000 OR County of Clackamas 

Multnomah County Health 

Multnomah, County of 1995 ALS & BLS Services $15,950,000 OR 

Department 

Pierre and Fort Pierre, 

Cities of Pierre and Fort 

Cities of 2002 ALS & BLS Services $154,000 SD 

Pierre 


City of Rapid City, 

Rapid City, City of 1998 ALS & BLS Services services SD 

Pennington County 

Arlington, City of 2001 ALS & BLS Services $8,152,890 TX City of Arlington 

Bexar County Hospital 

District 2000 CCT Services $900,000 TX Bexar County 

Page 7 of 8




Net Revenue 


Collin, County of 2003 ALS & BLS Services $600,000 TX Collin County 

Hunt Memorial Hospital 

District 2000 ALS & BLS Services $2,366,732 TX Hunt County 

Wichita, County of 2000 ALS & BLS Services $1,747,882 TX Wichita County 

Primary 9-1-1 

Richmond Ambulance 

Richmond 1991 

(ALS/BLS) $4,450,000 VA 

Authority 

Chehalis, City of - Lewis 

County Fire Districts 6, 12, 

13 and Grays Harbor 

Lewis County Fire District 

County Fire District 1 1999 ALS & BLS Services $177,000 WA 

#12 

Clark County Emergency 

Medical Services District #2 

Clark, County of 2004* ALS & BLS Services $8,700,000 WA 

Revenue included in 

Everett, City of 2000 BLS Services the City of Seattle WA City of Everett 

Josephine County 9-1-1 

Josephine, County of 2004* ALS & BLS Services $2,312,500 WA 

Agency 

Revenue included in 

the City of Seattle WA City of Kent 

Kent, City of 2000 BLS Services 

Longview, City of 1998 ALS & BLS Services $1,485,000 WA City of Longview 

Seattle, City of 2003 BLS Services $7,650,000 WA City of Seattle 

Spokane, City of 2003* ALS & BLS Services $2,830,000 WA City of Spokane 

Cheyenne, City of 2002* ALS & BLS Services $1,363,000 WY Laramie County 

Page 8 of 8

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PwC 

American Medical Response, Inc. 

Consolidated Financial Statements 

August 31, 2003 (Successor) and 2002 (Predecessor)


To the Management of 

American Medical Response, Inc.: 

Report of Independent Auditors 

PricewaterhouseCoopers LLP 

Suite 1000 

1670 Broadway 

Denver CO 80202-4870 

Telephone (720) 931 7000 

Facsimile (720) 931 7100 

In our opinion, the accompanying consolidated balance sheet (successor basis) and the related 

consolidated statements of operations (successor basis), changes in equity (successor basis) and cash 

flows (successor basis) present fairly, in all material respects, the financial position of American 

Medical Response, Inc. as of August 31, 2003, and the results of its operations and its cash flows for 

the period from June 1, 2003 to August 31, 2003, in conformity with accounting principles generally 

accepted in the United States of America. These consolidated financial statements are the 

responsibility of the Company’s management; our responsibility is to express an opinion on these 

financial statements based on our audit. We conducted our audit of these statements in accordance 

with auditing standards generally accepted in the United States of America, which require that we plan 

and perform the audit to obtain reasonable assurance about whether the financial statements are free of 

material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts 

and disclosures in the financial statements, assessing the accounting principles used and significant 

estimates made by management, and evaluating the overall financial statement presentation. We 

believe that our audit provides a reasonable basis for our opinion. 

As discussed in Note 1 to the financial statements, the Company is wholly owned by a subsidiary of 

Laidlaw International, Inc., previously Laidlaw, Inc. (“Laidlaw”). The United States Bankruptcy Court 

for the Western District of New York confirmed Laidlaw’s Third Amended Plan of Reorganization (the 

"plan") on February 27, 2003. Confirmation of the plan resulted in the discharge of all claims against 

Laidlaw and its subsidiary companies that arose on or before June 28, 2001and terminated all rights 

and interests of equity security holders as provided for in the plan. The plan was substantially 

consummated on June 23, 2003 and Laidlaw emerged from bankruptcy. In connection with its 

emergence from bankruptcy, Laidlaw and its subsidiaries, including the Company, adopted fresh start 

accounting as of June 1, 2003. As a result, the Company’s post-emergence (successor basis) financial 

statements reflect a different basis of accounting than its pre-emergence (predecessor basis) financial 

statements. 

December 24, 2003 

-1-


To the Management of 

American Medical Response, Inc.: 

Report of Independent Auditors 

PricewaterhouseCoopers LLP 

Suite 1000 

1670 Broadway 

Denver CO 80202-4870 

Telephone (720) 931 7000 

Facsimile (720) 931 7100 

In our opinion, the accompanying consolidated balance sheet (predecessor basis) and the consolidated 

statements of operations (predecessor basis), changes in net investment (predecessor basis) and cash 

flows (predecessor basis) present fairly, in all material respects, the financial position of American 

Medical Response, Inc. (the “Company) as of August 31, 2002 and its results of operations and its cash 

flows for the period from September 1, 2002 to May 31, 2003 and each of the two years in the period 

ended August 31, 2002, in conformity with accounting principles generally accepted in the United 

States of America. These consolidated financial statements are the responsibility of the Company’s 

management; our responsibility is to express an opinion on these consolidated financial statements 

based on our audits. We conducted our audits of these statements in accordance with auditing 

standards generally accepted in the United States of America, which require that we plan and perform 

the audit to obtain reasonable assurance about whether the consolidated financial statements are free of 

material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts 

and disclosures in the financial statements, assessing the accounting principles used and significant 

estimates made by management, and evaluating the overall financial statement presentation. We 

believe that our audits provide a reasonable basis for our opinion. 

As discussed in Note 1 to the financial statements, the Company is wholly owned by a subsidiary of 

Laidlaw International, Inc., previously Laidlaw, Inc. (“Laidlaw”). Laidlaw filed a petition on June 28, 

2001, with the United States Bankruptcy Court for the Western District of New York for reorganization 

under the provisions of Chapter 11 of the Bankruptcy Code. Laidlaw’s Third Amended Plan of 

Reorganization was substantially consummated on June 23, 2003 and Laidlaw emerged from 

bankruptcy. In connection with its emergence from bankruptcy, Laidlaw and its subsidiaries, including 

the Company, adopted fresh start accounting. As a result, the Company’s post-emergence (successor 

basis) financial statements reflect a different basis of accounting than its pre-emergence (predecessor 

basis) financial statements. 

As discussed in Note 3 to the consolidated financial statements, on September 1, 2002, American 

Medical Response, Inc. changed its method of accounting for goodwill. 

December 24, 2003 

-2-



Consolidated Balance Sheets 

August 31, 2003 (Successor) and 2002 (Predecessor) 

(U.S.$ 000s) 

Successor Predecessor 

2003 2002 

Assets 

Current assets: 

Cash 

Trade and other accounts receivable (net of allowance for uncompensated care of 

$ 7,883 $ 70,299 

$41,605 and $54,903 at August 31, 2003 and 2002, respectively) 246,472 244,165 

Parts and supplies inventory 17,444 17,160 

Other current assets 26,376 18,643 

Current deferred tax assets (Note 6) 25,518 - 

Total current assets 323,693 350,267 

Property, plant, and equipment, net (Note 4) 124,071 118,633 

Non-current assets: 

Intangible assets, net (Note 5) 46,918 450,439 

Non-current deferred tax assets (Note 6) 55,992 - 

Other non-current assets 52,911 18,293 

Total assets $ 603,585 $ 937,632 

Liabilities and Equity/Net Investment by Laidlaw 

Current liabilities: 

Accounts payable $ 39,028 $ 39,835 

Accrued liabilities (Note 7) 93,776 90,546 

Income taxes payable 3,000 - 

Current portion of long-term debt (Note 8) 6,563 6,526 

Total current liabilities 142,367 136,907 

Long-term debt (Note 8) 15,578 22,085 

Other long-term liabilities 54,852 36,069 

Total liabilities 212,797 195,061 

Commitments and contingencies (Notes 8, 10 and 11) 

Net investment by Laidlaw - 742,571 

Receivable from Laidlaw (37,623) - 

Common stock 14,376 - 

Additional paid in capital 423,471 - 

Accumulated deficit (9,436) - 

Total equity/net investment by Laidlaw 390,788 742,571 

Total liabilities and equity/net investment by Laidlaw $ 603,585 $ 937,632 

The accompanying notes are an integral part of these consolidated financial statements. 

- 3 -


Consolidated Statements of Operations 

for the 3 months ended August 31, 2003 (Successor), for the 9 months ended May 31, 

2003 (Predecessor), and for the years ended August 31, 2002 and 2001 (Predecessor) 

(U.S.$ 000s) 

Successor Predecessor Predecessor Predecessor 

3 months ended 9 months ended Year ended Year ended 

August 31, May 31, August 31, August 31, 

2003 2003 2002 2001 

Revenue, net of contractual provisions $ 332,249 $ 959,191 $ 1,258,450 $ 1,291,963 

Salaries and benefits 164,298 482,957 627,818 632,571 

Provision for uncompensated care 76,442 199,847 270,999 334,323 

Operating expenses 49,117 145,834 195,135 191,328 

Insurance expense 12,654 40,175 44,173 - 

Selling general and administrative expenses 7,926 27,152 44,686 37,765 

21,812 63,226 75,639 95,976 

Depreciation expense 9,480 28,700 40,905 38,878 

Amortization expense 1,101 4 21,320 21,144 

Impairment losses (Note 9) - - 262,780 - 

Restructuring charges (Note 9) 1,449 1,288 3,777 - 

9,782 33,234 (253,143) 35,954 

Allocated insurance expense (rebate) 11,522 3,058 (8,094) 71,908 

Allocated management fees 900 2,700 3,600 5,160 

Income (loss) from operations (2,640) 27,476 (248,649) (41,114) 

Interest expense (488) (1,619) (1,250) (1,045) 

Allocated interest income (expense) 500 157 - (27,955) 

Interest and other income 22 304 369 222 

Fresh-start accounting adjustments (Note 2) - (59,412) - - 

Loss before income taxes and cumulative effect of a 

change in accounting principle (2,606) (33,094) (249,530) (69,892) 

Income tax benefit (expense) (Notes 6) (6,830) (604) (795) 9,350 

Loss before cumulative effect of a change in accounting 

principle (9,436) (33,698) (250,325) (60,542) 

Cumulative effect of a change in accounting principle - (267,939) - - 

Net loss $ (9,436) $ (301,637) $ (250,325) $ (60,542) 


- 4 -


Consolidated Statements of Changes in Equity/Net Investment 



(U.S.$ 000s) 

Common Additional Retained Receivable from Net Investment 

Stock Paid In Capital Earnings Laidlaw By Laidlaw 

Net investment by Laidlaw, September 1, 2000 

(Predecessor) $ - $ - $ - $ - $ 1,045,767 

Net loss - - - - (60,542) 

Non-cash allocated expenses - - - - 69,456 

Net advances to Laidlaw - - - - (38,648) 

Net investment by Laidlaw, August 31, 2001 

(Predecessor) $ - $ - $ - $ - $ 1,016,033 

Net loss - - - - (250,325) 

Non-cash allocated expenses - - - - (8,094) 

Net advances to Laidlaw - - - - (15,043) 

Net investment by Laidlaw, August 31, 2002 

(Predecessor) $ - $ - $ - $ - $ 742,571 

Net loss (for the 9 months ended May 31, 2003) - - - - (301,637) 

Net advances to Laidlaw (for the 9 months ended 

May 31, 2003) - - - - (9,390) 

Net investment by Laidlaw, May 31, 2003 

(Predecessor) $ - $ - $ - $ - $ 431,544 

Fresh-start balances (Note 2) 14,376 423,471 - (3,238) 

Net loss (for the 3 months ended August 31, 2003) - - (9,436) - 

Net advances to Laidlaw (for the 3 months ended 

August 31, 2003) - - - (34,385) 

Balances August 31, 2003 (Successor) $ 14,376 $ 423,471 $ (9,436) $ (37,623) 


- 5 -


Consolidated Statements of Cash Flows 



(U.S.$ 000s) 


3 months ended 9 months ended Year ended Year ended 


2003 2003 2002 2001 

Cash Flows from Operating Activities 

Net loss 

Adjustments to reconcile net loss to net cash provided by operating 

activities: 

$ (9,436) $ (301,637) $ (250,325) $ (60,542) 

Depreciation and amortization 10,581 28,704 62,225 60,022 

Provision for uncompensated care 76,442 199,847 270,999 334,323 

Gain on disposal of property, plant and equipment (323) (300) (1,112) (429) 

Impairment losses - - 262,780 - 

Cumulative effect of a change in accounting principle (Note 3) - 267,939 - - 

Non-cash allocated expenses (income) 11,522 3,058 (8,094) 69,456 

Restructuring charges 1,449 1,288 3,777 - 

Deferred income taxes 3,830 - - (10,000) 

Fresh-start accounting adjustments (Note 2) 

Changes in operating assets/liabilities: 

- 59,412 - - 

Trade and other accounts receivable (72,621) (205,975) (265,782) (318,300) 

Parts and supplies inventory (517) 233 (153) (1,380) 

Other current assets 1,722 (9,455) (13,014) 1,551 

Accounts payable and accrued liabilities (12,232) (7,119) 23,615 20,514 

Income taxes payable 3,000 - - - 

Compliance and insurance accruals 3,225 16,262 33,791 - 

Restructuring charges and acquisition accruals (907) (5,344) (802) (1,734) 

Net cash provided by operating activities 15,735 46,913 117,905 93,481 

Cash Flows from Investing Activities 

Purchase of property, plant and equipment (17,581) (30,888) (26,670) (36,077) 

Proceeds from sale of property, plant and equipment 341 624 1,960 2,909 

Net (increase) decrease in deposits and purchase of other assets 1,536 (33,773) (8,771) (6,077) 

Net increase in other long-term investments - (2,400) (1,412) (416) 

Net cash used in investing activities (15,704) (66,437) (34,893) (39,661) 

Cash Flows from Financing Activities 

Net (repayments) additions of long-term debt and other non-current 

liabilities 1,311 362 (9,174) (12,832) 

Repayments of capital lease obligations (1,304) (3,042) (6,370) - 

Increase (decrease) in bank overdrafts 4,358 (833) (1,213) 10,247 

Net advances to Laidlaw (34,385) (9,390) (15,043) (38,648) 

Net cash used in financing activities (30,020) (12,903) (31,800) (41,233) 

Increase (decrease) in cash (29,989) (32,427) 51,212 12,587 

Cash, beginning of period 37,872 70,299 19,087 6,500 

Cash, end of period $ 7,883 $ 37,872 $ 70,299 $ 19,087 

Supplemental Cash Flow Information 

Cash paid during the period for interest $ 436 $ 1,605 $ 1,278 $ 1,368 

Acquisition of equipment through capital leases $ - $ - $ 26,320 $ - 


- 6 -


Notes To Consolidated Financial Statements 

(U.S. $000s) 

1. General 

Basis of Presentation of Financial Statements 

These financial statements have been prepared in accordance with accounting principles generally accepted 

in the United States of America (“ GAAP”) to reflect the consolidated financial position, results of operations 

and cash flows of American Medical Response, Inc. and its subsidiaries (the “Comp any”). In February, 1997 

a subsidiary of Laidlaw International, Inc., previously Laidlaw Inc. (“Laidlaw”) purchased all of the 

outstanding stock of the Company. The operations of the Company are the healthcare transportation services 

operations of Laidlaw. 

The Company operates in 32 states, providing a full range of medical transportation services from basic 

patient transit to the most advanced emergency care and pre-hospital assistance. In addition, the Company 

operates emergency (911) call and response services for large and small communities all across the United 

States, offers medical staff for large entertainment venues like stadiums and arenas, and provides telephone 

triage, transportation dispatch and demand management service. 

Included in the statement of operations are insurance expenses that represent an allocation of costs incurred 

by Laidlaw relating to the Company’s incurred and anticipated insurance losses, primarily for automobile, 

worker’s compensation and general liability coverage for policy periods through August 31, 2001. A charge 

has also been allocated to recover fixed insurance program costs based upon the Company’s share of 

Laidlaw’s consolidated revenue for the fiscal years ended August 31, 2001 and 2000. In addition, allocations 

are made of charges and credits related to the operating costs and the investment activities of Laidlaw’s 

captive insurance company. During fiscal 2002, the Company was allocated an insurance rebate relating to 

favorable development of prior year insurance losses . During fiscal 2003, the Company was allocated 

additional insurance expense relating to unfavorable development of prior year insurance losses which 

totaled $11,522 and $3,058 for the 3 months ended August 31, 2003 and the 9 months ended May 31, 2003, 

respectively. Effective September 1, 2002, the Company obtained insurance coverage from outside parties, 

rather than through Laidlaw. 

Management fees have been allocated to the Company based upon the Company’s share of Laidlaw’s 

consolidated revenue. Management fees are charged by Laidlaw to each of its operating groups in order to 

recover its general and administrative costs. Interest expense associated with Laidlaw’s financing has been 

allocated to the Company based on its share of Laidlaw’s net assets. During fiscal 2002, Laidlaw suspended 

interest accruals as a result of the bankruptcy as discussed below, and consequently the Company was not 

allocated interest expense. Income taxes were allocated based on the Company’s statutory income tax rate. 

For income tax purposes, intercompany interest, management fees and insurance are calculated based on 

different methodologies than those utilized for financial statement purposes. 

Through August 31, 2003, Laidlaw provided for a significant portion of the Company’s financing 

requirements. The Company transfers surplus funds to Laidlaw as necessary and, as described above, bears 

the cost of various allocated expenses. Laidlaw has the ability to significantly influence the operations and 

management of the Company through its sole ownership. Thus, the Company’s operating results, cash flows 

and financial position may significantly differ from those that would have been achieved in the absence of 

the Company’s relationship with Laidlaw. 

Except as outlined above, the Company directly incurs all other costs of doing business. To conform to the 

current year presentation, certain amounts in the prior years’ financial statements have been reclassified. 

Chapter 11 Reorganization 

On June 28, 2001 (the “Petition Date”), Laidlaw and certain of its affiliates (collectively, the “Laidlaw 

Debtors”) filed voluntary petitions for reorganization under chapter 11 of the Bankruptcy Code, 11 U.S.C. §§ 

101-1330 (the “Bankruptcy Code”), in the United States Bankruptcy Court for the Western District of New 

York (the “Bankruptcy Court”). During the pendency of the Chapter 11 case, the Laidlaw Debtors continued 

to operate their businesses as debtors -in-possession under the jurisdiction of the Bankruptcy Court and in 

accordance with the applicable provisions of the Bankruptcy Code and orders of the Bankruptcy Court. 

- 7 -



(U.S. $000s) 

The Laidlaw Debtors emerged from bankruptcy protection under the Third Amended Plan of Reorganization, 

which (i) was confirmed pursuant to an order of the Bankruptcy Court on February 27, 2003 and (ii) after 

each of the conditions precedent to consummation was satisfied or waived, became effective on June 23, 

2003 (“Effective Date”). For financial statement purposes, the effective date of the Plan was considered to 

be June 1, 2003. In accordance with American Institute of Certified Public Accountants Statement of 

Position 90-7, “Financial Reporting by Entities in Reorganization Under the Bankruptcy Code,” (SOP 90-7) 

the Company adopted fresh-start reporting on June 1, 2003 (“Fresh-Start Date”). See Note 2 for information 

related to fresh-start reporting. 

Upon emergence from Chapter 11, Laidlaw established a new senior secured credit facility (the “Exit 

Facility”). The Exit Facility is guaranteed by Laidlaw and certain Laidlaw subsidiaries including the 

Company. In addition, the Exit Facility is secured by the assets of Laidlaw and certain Laidlaw subsidiaries 

including the Company except for certain assets of the Company contractually excluded from the 

securitization. Under the terms of the Exit Facility Laidlaw is required to meet certain financial covenants 

including a fixed charge coverage ratio, leverage ratio, interest coverage ratio, net tangible asset ratio and 

maximum senior secured leverage ratio as well as certain non-financial covenants. As of August 31, 2003, 

Laidlaw was in compliance with all covenants. 

As a result of emergence from Chapter 11, Laidlaw also issued unsecured senior notes. These notes are also 

guaranteed by Laidlaw and certain Laidlaw subsidiaries including the Company. 

2. Fresh Start Reporting 

In connection with its emergence from bankruptcy on June 23, 2003, Laidlaw adopted fresh-start reporting in 

accordance with SOP 90-7 on June 1, 2003. Accordingly, the Company valued its assets, liabilities and 

equity at fair value. The fair value represents the Company’s best estimate based on independent appraisals 

and valuations and, where the foregoing have not yet been completed or are not available, industry trends and 

by reference to market rates and transactions. The Company’s equity value of approximately $435 million 

was determined with the assistance of financial advisors. In determining the equity value, the financial 

advisors and the Company considered several matters, including the following: (i) certain recent financial 

information of the Company; (ii) certain financial projections prepared by the Company; (iii) a discounted 

cash flow analysis prepared on a going concern basis; (iv) current and historical market values of publicly 

traded companies that are in businesses reasonably comparable to the Company and (vi) certain additional 

economic and industry conditions. The foregoing estimates and assumptions are inherently subject to 

significant uncertainties and contingencies beyond the control of the Company. Accordingly, there can be no 

assurance that the estimates, assumptions, and values reflected in the valuations will be realized, and actual 

results could vary materially. 

As a result of the adoption of fresh-start reporting, the Company’s post-emergence (“Successor Company”) 

financial statements are not comparable with its pre-emergence (“Predecessor Company”) financial 

statements, because they are, in effect, those of a new entity. The effects of the Plan of Reorganization and 

fresh-start reporting on the Company’s consolidated balance sheet as of May 31, 2003 are as follows: 

Predecessor Fair Value Successor 

Company Adjustments Company 

Assets 

Current assets 

Cash $ 37,872 $ -- $ 37,872 

Trade and other accounts receivable 250,293 -- 250,293 

Parts and supplies inventories 16,927 -- 16,927 

Other current assets 28,098 -- 28,098 

Current deferred tax assets -- (c) 25,518 25,518 

Total current assets 333,190 25,518 358,708 

- 8 -



(U.S. $000s) 

Property, plant and equipment, net 120,499 (a) (4,683) 115,816 

Intangible assets, net 182,519 (b) (134,500) 48,019 

Long-term deferred tax assets -- (c) 59,822 59,822 

Other long-term assets 54,447 -- 54,447 

Total non-current assets 357,465 (79,361) 278,104 

Total assets $ 690,655 (53,843) $ 636,812 

Liabilities and Equity 

Accounts payable $ 33,055 $ -- $ 33,055 

Accrued liabilities 92,901 (d) 1,000 93,901 

Current portion of long-term debt 6,815 -- 6,815 

Total current liabilities 132,771 1,000 133,771 

Other long-term liabilities 46,981 (d, e) 4,569 51,550 

Long-term debt 16,882 -- 16,882 

Total liabilities 196,634 5,569 202,203 

Equity 

Payable due to (receivable from) Laidlaw (10,386) (f) 7,148 (3,238) 

Common stock 14,376 -- 14,376 

Additional paid in capital 2,655,094 (f) (2,231,623) 423,471 

Retained earnings/(accumulated deficit) (2,165,063) (f) 2,165,063 -- 

Total equity 494,021 (59,412) 434,609 

Total liabilities and equity $ 690,655 $ (53,843) $ 636,812 

(a) Adjusts property, plant & equipment to reflect the fair value of the assets based on independent 

appraisals. 

(b) Eliminates the Predecessor Company’s historical goodwill and records identifiable intangible assets 

at fair value. 

(c) Records the net deferred income tax assets of the Company based on the guidance provided in the 

Statement of Financial Accounting Standards (“SFAS”) No. 109. 

(d) Records the operating leases at their fair value based on independent valuations and the current 

borrowing rate of the Company. 

(e) Adjusts the Company’s accident claims and professional liability reserves to their fair value by 

applying a risk premium and discounting at a risk-free rate. 

(f) Reflects the elimination of the accumulated deficit and revalues the receivable from Laidlaw. 

3. Summary of Significant Accounting Policies 

Use of Estimates 

The preparation of financial statements in accordance with GAAP requires the Company to make estimates 

and assumptions that affect reported amounts of assets, liabilities, revenue and expenses, and disclosure of 

contingencies. Future events could alter such estimates in the near term. 

Consolidation 

The consolidated financial statements include the accounts of the Company and its subsidiaries. All 

significant intercompany transactions within the Company are eliminated. 

Revenue Recognition 

Ambulance service fees are recognized at the time of service and are recorded at amounts estimated to be 

received under reimbursement arrangements with third party payors including Medicare, Medicaid, private 

insurers and managed care organizations. Historically, the Company has derived approximately 39% of its 

collections from Medicare, 4% from Medicaid, 40% from private insurers, including prepaid health plans and 

- 9 -



(U.S. $000s) 

other sources, and 17% directly from patients. 

Healthcare reimbursement is complex and may involve lengthy delays. Third party payors are continuing 

their efforts to control expenditures for healthcare, including proposals to revise reimbursement policies. 

The Company has from time to time experienced delays in reimbursement from third party payors. In 

addition, third party payors may disallow, in whole or in part, claims for reimbursement based on 

determinations that certain amounts are not reimbursable under plan coverage, determined medical necessity, 

or the need for additional information. Laws and regulations governing the Medicare and Medicaid 

programs are very complex and subject to interpretation. As a result, there is a reasonable possibility that 

recorded estimates will change materially. Retroactive adjustments may change the amounts realized from 

third party payors and are considered in the recognition of revenue on an estimated basis in the period the 

related services are rendered. Such amounts are adjusted in future periods, as adjustments become known. 

At August 31, 2003 and 2002, trade and other accounts receivable are net of contractual allowances of 

$84,856 and $87,056, respectively. Revenue has been recorded net of contractual provisions of $144,990, 

and $417,736, for the three months ended August 31, 2003 and for the nine months ended May 31, 2003, and 

$447,692, and $394,726 for the years ended August 31, 2002 and 2001, respectively. 

Recently Issued Accounting Pronouncements 

SFAS No. 142, among other things, prohibits the amortization of goodwill and instead requires an annual 

assessment of goodwill impairment by applying a fair value based test. In addition, the standard includes 

provisions upon adoption for the reclassification of certain existing recognized intangibles and 

reclassification of certain intangibles out of previously reported goodwill balances. SFAS No. 142 requires 

that any goodwill recorded in connection with an acquisition consummated on or after July 1, 2001 not be 

amortized, even if the statement is not adopted in its entirety at that time. The effective date for SFAS No. 

142 is fiscal years beginning after December 15, 2001. The Predecessor Company adopted this standard 

September 1, 2002. In connection with the adoption of this standard, the Predecessor Company recorded an 

impairment charge on goodwill of $267,939 included in the accompanying consolidated financial statements 

for the nine months ended May 31, 2003 as a cumulative effect of a change in accounting principle. 

In June 2002, the FASB issued SFAS No. 146, Accounting for Costs Associated with Exit or Disposal 

Activities. SFAS No. 146 is effective for exit or disposal activities that are initiated after December 31, 2002 

and provides guidance on recognizing liabilities for costs associated with an exit or disposal activity. The 

adoption of the standard did not have a material impact on the Company’s consolidated financial statements. 

In December 2002, the FASB issued SFAS No. 148, Accounting for Stock -Based Compensation-Transition 

and Disclosure-an amendment of FASB Statement No. 123. SFAS 148 provides transition guidance for those 

companies electing to voluntarily adopt the accounting provisions of SFAS No. 123, Accounting for Stock - 

Based Compensation. The adoption of the standard did not have a material impact on the Company’s 

consolidated financial statements. 

In April 2003, the FASB issued SFAS No. 149, Amendment of Statement 133 on Derivative Instruments and 

Hedging Activities. This statement amends and clarifies financial accounting and reporting for derivative 

instruments, including certain derivative instruments embedded in other contracts (collectively referred to as 

derivatives) and for hedging activities under FASB Statement No. 133, Accounting for Derivative 

Instruments and Hedging Activities. This Statement is effective for contracts entered into or modified after 

June 30, 2003 and for hedging relationships designated after June 30, 2003. The adoption of the standard did 

not have a material impact on the Company’s consolidated financial statements. 

In May 2003, the FASB issued SFAS No. 150, Accounting for Certain Financial Instruments with 

Characteristics of both Liabilities and Equity. SFAS 150 affects the issuer’s accounting for three types of 

freestanding financial instruments. These are mandatorily redeemable shares, which the issuing company is 

obligated to buy back in exchange for cash or other assets; put options and forward purchase contracts; and 

obligations that can be settled with shares, the monetary value of which is fixed, tied solely or predominantly 

to a variable such as a market index, or varies inversely with the value of the issuer’s shares. Most of the 

- 10 -



(U.S. $000s) 

guidance in Statement 150 is effective for all financial instruments entered into or modified after May 31, 

2003, and otherwise is effective at the beginning of the first interim period beginning after June 15, 2003. 

The adoption of the standard did not have a material impact on the Company’s consolidated financial 

statements. 

Income Taxes 

Deferred income taxes are provided for all significant temporary differences arising from recognizing certain 

expenses, principally interest, depreciation, restructuring and impairment charges, in different periods for 

income tax and financial reporting purposes. 

The Company is included in the consolidated U.S. income tax return with other Laidlaw U.S. subsidiaries. 

The tax allocation agreement calculates tax liability on a separate company basis and provides for 

reimbursement or payment for utilization of carryovers among members of the group. Costs related to 

income taxes are included as an intercompany payable or receivable, which are components of the Net 

Investment by Laidlaw Inc. for periods prior to the Fresh-Start Date. 

Cash and Cash Equivalents 

Cash and cash equivalents are composed of highly liquid investments with an original maturity of three 

months or less and are recorded at market value. 

At August 31, 2003 and 2002, bank overdrafts of $16,222 and $12,696, respectively were included in 

accounts payable on the accompanying consolidated balance sheets. 

Parts and Supplies Inventories 

Parts and supplies inventories are valued at cost, determined on a first-in, first-out basis. 

Property, Plant and Equipment 

Property, plant and equipment are stated at cost. Depreciation of property, plant and equipment is provided 

substantially on a straight-line basis over their estimated useful lives, which are as follows: 

Buildings 35 to 40 years 

Leasehold improvements the lesser of the estimated useful life or the term of the lease 

Vehicles and other 3 to 10 years 

Goodwill 

The Predecessor Company’s goodwill represented the excess of cost over the fair value of identified net 

assets. For the year ended August 31, 2002, goodwill was amortized on a straight-line basis over 40 years. 

Impairment of Long-lived Assets other than Goodwill and Other Indefinite Lived Intangibles 

Long-lived assets other than goodwill and other indefinite lived intangibles are assessed for impairment 

whenever events or changes in circumstances indicate that the carrying value may not be recoverable. 

Important factors, which could trigger impairment review, include significant underperformance relative to 

historical or projected future operating results, significant changes in the use of the acquired assets or the 

strategy for the overall business, and significant negative industry or economic trends. If indicators of 

impairment are present, management evaluates the carrying value of long-lived assets other than goodwill 

and other indefinite lived intangibles in relation to the projection of future undiscounted cash flows of the 

underlying business. Projected cash flows are based on historical results adjusted to reflect management’s 

best estimate of future market and operating conditions, which may differ from actual cash flows. 

Contracts 

At August 31, 2003, the Company’s contracts and customer relationships represent the amortized fair value 

of such assets held by the Company at June 1, 2003 (“Fresh Start Contract Assets”). The Fresh Start 

Contract Assets are amortized on a straight-line basis over the average length of the contracts and the 

expected contract renewal period of 10 years. 

- 11 -



(U.S. $000s) 

Radio Frequencies 

The radio frequency licenses included in net intangible assets on the accompanying balance sheet, total 

$4 million (June 1, 2003 — $4 million, Predecessor Company – August 31, 2002 — $00), and are considered 

to be indefinite lived intangible assets and as such they are not amortized. The radio frequency licenses will 

be reviewed for impairment on an annual basis. 

Other Long -Term Liabilities 

Noncurrent portions of noninterest bearing notes, acquisition related liabilities, insurance reserves and other 

liabilities are classified as other long-term liabilities. 

Financial Instruments and Concentration of Credit Risk 

The Company’s accounts receivable, accounts payable and long-term debt constitute financial instruments. 

Based on management’s estimates, the carrying value of the Company’s accounts receivable, accounts 

payable and long-term debt approximates their fair value as of August 31, 2003 and 2002. Concentration of 

credit risks in accounts receivable is limited, due to the large number of customers comprising the 

Company’s customer base throughout the United States. A significant component of the Company’s revenue 

is derived from Medicare and Medicaid. Given that these are government programs, the credit risk for these 

customers is considered low. The Company performs ongoing credit evaluations of its other customers, but 

does not require collateral to support customer accounts receivable. The Company establishes an allowance 

for uncompensated care based on the credit risk applicable to particular customers, historical trends and other 

relevant information. 

4. Property, Plant and Equipment 

Property, plant and equipment consisted of the following: 

Cost 

(Successor) August 31, 2003 (Predecessor) August 31, 2002 

Accumulated 

Depreciation 

and 

Amortization Net Cost 

- 12 - 

Accumulated 

Depreciation 

and 

Amortization Net 

Land $ 2,079 $ -- $ 2,079 $ 1,999 $ -- $ 1,999 

Buildings and leasehold 

improvements 10,214 365 9,849 24,165 13,481 10,684 

Vehicles and other 117,049 4,906 112,143 346,989 241,039 105,950 

Total property, plant and 

equipment $ 129,342 $ 5,271 $ 124,071 $ 373,153 $ 254,520 $ 118,633 

Vehicles and other assets include vehicles with a net book value of $19,042 and $24,105 at August 31, 2003 

and 2002, respectively, held under capital leases (see Notes 8 and 11). Accumulated depreciation and 

amortization includes $1,267 relating to such vehicles recorded by the Successor Company. 

5. Intangible Assets 

Intangible assets consisted of the following:



(U.S. $000s) 

Gross 

(Successor) August 31, 2003 (Predecessor) August 31, 2002 

Accumulated 

Amortization Net Gross 

- 13 - 

Accumulated 

Amortization Net 

Goodwill $ -- $ -- $ -- $ 619,565 $ 169,126 $ 450,439 

Covenants 19 1 18 -- -- -- 

Contracts 44,000 1,100 42,900 -- -- -- 

Radio frequencies 4,000 -- 4,000 -- -- -- 

Total intangible assets $ 48,019 $ 1,101 $ 46,918 $ 619,565 $ 169,126 $ 450,439 

Amortization expense on the intangible assets recorded at August 31, 2003 will be $4,400 annually over the 

expected life of the assets of 10 years. 

6. Income Taxes 

Deferred tax assets and liabilities consisted of the following at August 31: 


2003 2002 

Current deferred tax assets (liabilities): 

Accrued liabilities $ 37,223 $ 19,050 

Accounts receivable (11,705) (6,679) 

Net current deferred tax assets $ 25,518 $ 12,371 

Non-current deferred tax assets (liabilities): 

Goodwill and other intangibles $ 30,059 $ 14,570 

Interest carry forwards 75,278 80,488 

Net operating loss carry forwards 66,107 77,389 

Excess of tax over book depreciation (8,044) (6,222) 

Other -- (2,736) 

Net non-current deferred tax assets 163,400 163,489 

Total deferred tax assets 188,918 175,860 

Valuation allowance (107,408) (175,860) 

Net deferred tax assets $ 81,510 $ -- 

The Company established a valuation allowance for certain net deferred tax assets, due to a lack of evidence 

that such assets would be realized. The allowance was increased by $41,175 in fiscal 2002 and decreased by 

$68,452 in fiscal 2003 in conjunction with fresh-start reporting. 

The effective tax rates for the years ended August 31, 2003, 2002 and 2001 are different from the federal 

statutory rate of 35%, primarily due to state income taxes, non-deductible goodwill amortization and 

impairments, and the change in the deferred tax valuation allowance. 

The Company has interest carryovers of $198,100 limited by IRC Section 163(j) without expiration and net 

operating loss carry forwards of $173,965, which expire in the years 2005 to 2023.



(U.S. $000s) 

The components of income tax benefit (expense) were as follows: 


3 months 9 months Year Year 

ended ended ended ended 


2003 2003 2002 2001 

Current $ (3,000) $ (604) $ (795) $ (650) 

Deferred (3,830) -- -- 10,000 

Total income tax benefit (expense) $ (6,830) $ (604) $ (795) $ 9,350 

7. Accrued Liabilities 

The components of accrued liabilities were as follows at August 31: 


2003 2002 

Accrued wages and benefits $ 36,748 $ 39,586 

Current portion of accrued self-insurance estimates 19,438 10,800 

Accrued restructuring 3,089 3,656 

Current portion of compliance and legal 8,056 8,501 

Accrued profit sharing 6,552 5,963 

Other 19,893 22,040 

Total accrued liabilities $ 93,776 $ 90,546 

8. Long-term Debt 

Long-term debt consisted of the following at August 31: 


2003 2002 

Notes due at various dates from 2004 to 2022 

with interest rates from 6% to 10% $ 4,562 $ 6,372 

Mortgage loan due 2010 with an interest rate of 7% 

Capital lease obligations due at various dates from 2006 

2,242 2,289 

to 2007 (Note 11) 15,337 19,950 

22,141 28,611 

Less current portion (6,563) (6,526) 

Total long-term debt $ 15,578 $ 22,085 

The aggregate amount of minimum payments (deposit refunds) required on long-term debt in each of the 

years indicated is as follows: 

- 14 -



(U.S. $000s) 

Year Ending August 31, 

2004 $ 6,563 

2005 7,228 

2006 5,611 

2007 (27) 

2008 100 

Thereafter 2,666 

9. Restructuring Charges and Impairment Losses 

- 15 - 

$ 22,141 

2003 Restructuring Plan 

The Company’s Northern Pacific Region re-aligned the management structure of its operations. The first 

phase occurred in April 2003 and the Company recorded a restructuring charge of approximately $350 

relating to severance costs. The second and final phase occurred in August 2003 and the Company recorded 

a restructuring charge of approximately $540 relating to severance costs . As of August 31, 2003 

approximately $310 of costs have been paid with a remaining balance of $580. 

2002 Restructuring Plan 

During fiscal year 2002, in an effort to eliminate the differences in size among regions, the Company was re - 

aligned into four geographic regions. As a part of the re-alignment, operating units within the five original 

regions were shifted to create the new structure and the administrative offices of the former South region and 

one billing center were closed. National Products and Services was also closed. The functions previously 

performed by this group were distributed to the remaining AMR regions and the corporate offices. 

As a result of these changes, the Company incurred a pre -tax charge of $3,777. The charge was composed of 

severance and lease abandonment costs for the closed facilities ($1,517 and $2,260, respectively). As of 

August 31, 2003 and 2002, $559 and $456, respectively, in severance costs had been paid, with a remaining 

balance of $958 and $1,061, respectively and $710 and $149 in lease abandonment costs had been incurred 

as of August 31, 2003 and 2002 respectively, with a remaining balance of $1,550 and $2,111 for the same 

periods. 

2002 Impairment Losses 

During fiscal year 2002, the Company incurred an impairment charge of $262,780, including a $254,915 

goodwill impairment and a $7,865 property, plant and equipment impairment. The impairment losses 

resulted from the potential inability of the Company to recover the carrying value of the long-lived assets 

from expected future operating cash flows. The impairment loss reduced goodwill and property, plant and 

equipment balances to their estimated recoverable values. 

10. Retirement Plans 

The Company maintains three 401(k) plans (the “Plans”) for its employees and employees of its subsidiaries 

who meet the eligibility requirements set forth in the Plans. Employees may contribute a maximum of 15% 

of their compensation up to a maximum of $12 (thousand). The contribution is matched by the Company up 

to a maximum of 3% to 6% of the employee’s salary per year, depending on the plan. The Company’s 

contributions to the Plans for the three months ended August 31, 2003 was $1,896 and for the nine months 

ended May 31, 2003 was $5,719. For the years ended August 31, 2002 and 2001 the Company’s 

contributions to the Plans were $6,869, and $6,303, respectively, and are included in operating expenses on 

the accompanying consolidated statements of operations.



(U.S. $000s) 

11. Commitments and Contingencies 

Lease Commitments 

The Company leases various facilities and equipment under operating lease agreements. Rental expense 

incurred under these leases was $6,526 and $20,593 for the three months ended August 31, 2003 and for the 

nine months ended May 31, 2003 and was $28,393 and $25,782 in fiscal 2002 and 2001, respectively. 

In addition, the Company leases certain vehicles under capital leases. Assets under capital lease are 

capitalized using interest rates appropriate at the inception of each lease. 

Future commitments (deposit refunds) under capital and operating leases for vehicle, premises, equipment 

and other recurring commitments are as follows (the balances below include fair value adjustments as 

described in Note 2): 

- 16 - 

Capital 

Leases 

Operating 

Leases & 

Other 

Year Ending August 31, 

2004 $ 4,571 $ 23,070 

2005 5,436 16,492 

2006 5,480 11,868 

2007 (150) 8,803 

2008 -- 6,692 

Thereafter -- 14,589 

Total minimum lease payments 15,337 $ 81,514 

Current portion 4,571 

Long-term capital lease obligations $ 10,766 

Revenue 

A substantial majority of the Company’s revenue is attributable to payments received from third party payors 

including Medicare, Medicaid and private insurers. The Company is subject to various regulatory 

requirements in connection with its participation in the Medicare and Medicaid programs. The Center for 

Medicare and Medicaid Services (“CMS”) has enacted rules that will revise the policy on Medicare coverage 

of ambulance services focusing on the medical necessity for the particular ambulance services. Rule changes 

in this area will impact the business of the Company. The Company has implemented a plan to mitigate 

potential adverse effects of rule changes on its business. 

The Company, like other Medicare and Medicaid providers, is subject to government audits of its Medicare 

and Medicaid reimbursement claims. Accordingly, retroactive revenue adjustments from these programs 

could occur. The Company is also subject to the Medicare and Medicaid fraud and abuse laws, which 

prohibit any bribe, kick-back or rebate in return for the referral of Medicare or Medicaid patients. Violations 

of these prohibitions may result in civil and criminal penalties and exclusion from participation in the 

Medicare and Medicaid programs. The Company has implemented policies and procedures to assure that it 

is in substantial compliance with these laws and has accrued provisions, as appropriate, for settle ment of 

prior claims. 

The Company is currently undergoing investigations by certain government agencies regarding compliance 

with Medicare fraud and abuse statutes. The Company is cooperating with the government agencies 

conducting these investigations and is providing requested information to the governmental agencies. These 

reviews are covering periods prior to the Company's acquisition of the operations of certain businesses, as 

well as for periods after acquisition. Management believes that the remedies existing under specific purchase



(U.S. $000s) 

agreements and accruals established in the accompanying consolidated financial statements are sufficient. 

Letters of Credit 

At August 31, 2003 and 2002, the Company had $9,112 and $7,761, respectively, in outstanding letters of 

credit. 

12. Insurance 

Insurance coverage is provided for automobile, worker’s compensation, general liability and professional 

liability claims through policies with both fully-insured and self-insured components. The insurance policies 

cover known claims and incidents that may result in the assertion of additional claims, as well as claims from 

unknown incidents that may be asserted arising from the Company’s activities through August 31, 2003. All 

other coverage is provided through fully-insured policies. 

The Company engaged independent actuaries to assist with its evaluation of the adequacy of its insurance 

accruals related to these fully-insured and self-insured components as of August 31, 2003 and 2002. Based 

on the expected payout of the claims, the Company discounted the long-term accruals using an approximate 

2.5% discount rate. The table below summarizes the discounted insurance accruals included in the 

accompanying consolidated balance sheets as of August 31, 2003 (Successor): 

Accrued Other long-term Total 

liabilities liabilities liability 

Automobile $ 4,845 $ 6,244 $ 11,089 

Worker’s compensation 10,152 23,870 34,022 

General/Professional liability 4,441 11,643 16,084 

$ 19,438 $ 41,757 $ 61,195 

The table below summarizes the discounted insurance accruals included in the accompanying consolidated 

balance sheets as of August 31, 2002 (Predecessor): 

Accrued Other long-term Total 

liabilities liabilities liability 

Automobile $ 6,320 $ 13,168 $ 19,488 

Worker’s compensation 3,012 4,926 7,938 

General/Professional liability 1,468 6,627 8,095 

$ $10,800.00 $ 24,721 $ 35,521 

Certain insurance programs also require the Company to maintain deposits with an insurance broker to cover 

claims costs for automobile and worker’s compensation. The following table summarizes the remaining 

deposits: 


August 31, August 31, 

2003 2002 

Short-term (included in other current assets) $ 14,997 $ 9,200 

Long-term (included in other non-current assets) 28,626 15,100 

Total insurance deposits $ 43,623 $ 24,300 

- 17 -

Business Licenses and Certifications 

Contra Costa County 

Brentwood 

Concord (3) 

Antioch 

Walnut Creek 

San Pablo 

Pittsburg 

Pleasant Hill 

Richmond 

Pinole 

Contra Costa Health Services – Hazardous Materials 

Program

Regulatory Investigations 

Regulatory Investigation Disclosure List 

Regulatory Compliance Disclosures


Federal Compliance Investigations* 

August 2004 

Location and Regulatory agency Issue Summary Outcome or Current Status 

Time period 

covered 

1999 - 2000 Florida - State Attorney General Medicaid Billing Outcome: Negotiated settlement 

1992 - 2000 Florida/Texas - Department of Health & Human Services Medicare Billing Outcome: Negotiated settlement 

1995 - 1998 Northern California - Department of Health & Human Medicare Billing Outcome: Negotiated settlement 5-year Corporate Integrity 


Agreement 

1993 - 1998 Massachusetts - United States Department of Justice Medicare Billing Outcome: Negotiated settlement 3-year Corporate Integrity 

Agreement 

1995 - 2000 South Dakota - Office of Attorney General Medicare Billing Outcome: negotiated settlement 

1994 - 2002 Texas - Department of Health and Human Services Contract Discounts Outcome: unknown 

1998 - 1999 San Antonio, Texas - Department of Health & Human Issue Unknown Outcome: unknown 


1993 - 2002 Colorado, Georgia - Department of Health and Human Medicare Billing Outcome: Negotiated settlement for Texas; GA and CO 


outcome remain unknown. 

2001 - 2002 Colorado - State Attorney General Medicaid Billing Outcome: overpayment demand satisfied 

2/1/2002- Palm Springs-CALOSHA General citation for Outcome: CALOSHA withdrew the citation on the ground that it 

4/23/2002 

Failure to provide cited an inapplicable safety order. 

operating & rescue 

procedures to 

9/6/2002- Riverside-CALOSHA General citation for Outcome: CALOSHA withdrew the citation on the ground that 

10/6/2004 

folding N95 masks AMR provided a scientific research study documenting the fact 

and keeping them in that folding the mask does not inhibit the performance of the 

a waist pouch mask. 

preventing a gas 

tight seal 

1998 - 2004 Portland, Oregon - Department of Justice Issue Unknown Outcome: unknown 

*The reviews contained in this listing represent any known compliance investigations by any federal or state regulatory agency for AMR. This listing does not 

include random post-payment reviews conducted periodically by Medicare or Medicaid carriers.


AMR Regulatory Compliance 

DOCUMENTATION OF REGULATORY COMPLIANCE 

A. Regulatory Investigations, Findings and Actions. 

As a healthcare provider, Proposer has been, and continues to be, subjected to 

various random audits as part of the Carrier protocols. These random audits and 

appeals are not considered investigations and therefore are not included in this 

report. 

B. Compliance Investigations. 

Introduction. American Medical Response, Inc. (AMR) has been the subject of 

government investigations into alleged violations of the complex rules governing 

Medicare and other federal programs. 

As detailed below, AMR has entered into five civil settlements. Additionally, 

AMR resolved two overpayment requests totaling $22,000 for state Medicaid 

billing. Notably, none of these cases involve criminal misconduct, and AMR is 

unaware of any pending criminal investigations. In some cases, the alleged 

misconduct was committed by companies AMR acquired; as the legal successor 

of those companies, AMR accepted legal responsibility for that conduct and 

facilitated appropriate restitution to the government. In other cases, AMR had an 

honest disagreement with federal authorities regarding the proper interpretation of 

complex and confusing Medicare regulations. Since it is expensive and time 

consuming to litigate such disagreements, AMR chose to enter into civil 

settlements so that it could focus on its mission of providing health care to the 

communities it serves. AMR did not admit wrong doing in any of the settled 

cases. 

The settlements entered into by AMR are similar to those reached with the federal 

government by virtually every other large health care organization, including 

some of the most respected and prestigious governmental, non-profit and religious 

organizations in the country. Many of these organizations, like AMR, have been 

the subject of numerous investigations and settlements, proportionate to the size 

and complexity of their operations. 

With the foregoing as background, AMR’s investigations and settlements are 

described below: 

1. Regional Emergency Services, LP.-- Florida and Texas. 

Regional Emergency Services, LP (“RES”) is a limited liability company 

wholly owned by two AMR subsidiaries since 1997, following a two step 

acquisition which began in 1996. RES provided management services for 

hospital-based ambulance services for certain Adventist Health System 

(“Adventist”) hospitals in Florida and Texas between 1996 and October of 

1


2000. RES also managed certain hospital-based ambulance programs in 

Colorado and Georgia for a short part of this time frame. The 

management business operated by RES was acquired from three 

individuals who founded the business in 1992 and were employed by RES 

as its executive team following AMR’s acquisition. 

Unlike Part B ambulance providers such as Proposer, hospital-based 

ambulance services such as those operated by the Adventist hospitals are 

required to obtain certificates of medical necessity (“CMNs”)from a 

physician before billing Medicare for emergency (911) transports. The 

government alleged that, beginning in 1992 when the prior owners 

operated the business, the Adventist hospitals and the management 

company billed Medicare without obtaining compliant CMNs for some of 

their transports. More specifically, the government alleged that the 

ambulance service medical director responsible for signing the CMNs did 

not personally sign each one, but instead permitted the hospital to rely on 

CMNs with photocopied signatures in some cases. The government 

alleged that this practice began in 1992 when the business was founded by 

the prior owners, continued after AMR acquired ownership of RES (with 

the prior owners at the helm), and continued until AMR took steps to 

discontinue the practice. Although the claims in question were submitted 

on behalf of the Adventist hospitals, the government alleged that RES and 

the predecessor management company shared liability with the Adventists 

for the claims submitted. On August 20, 2004 AMR entered into a 

monetary only Settlement Agreement for $5 million dollars. The 

Settlement Agreement will cover the time period until October 2000, 

when RES discontinued operations. However, AMR took steps to 

discontinue the practice in question in 1998. 

The investigating agencies were the Department of Justice (DoJ”) and the 

Office of Inspector General of the Department of Health and Human 

Services (“OIG”). Those agencies have indicated that they may also 

review whether similar conduct occurred in connection with the hospitalbased 

ambulance services RES managed in Colorado and Georgia. As of 

the filing of this report, the government has not made any financial 

demands regarding Colorado or Georgia. 

2. AMR West – Northern California. This civil investigation arises from 

the government’s assertion that it was improper for AMR West to use the 

“emergency” HCPCS codes for all of its medically necessary 911 

transports, and for its hospital to hospital critical care transports, in 

Northern California between 1995 through 1999. The agencies involved 

are the Federal Bureau of Investigation (“FBI”), the OIG and the United 

States Attorney’s Office for the Northern District of California. AMR 

strongly disagrees with the government’s allegations, and has provided the 

government with declarations supporting its position by five of the 

nation’s top ambulance reimbursement experts, including the former chief 

2


of the fraud unit for one of the Medicare carriers responsible for Northern 

California during part of the time period in question. Although AMR 

believes it could have prevailed in litigation with the government, AMR 

chose to negotiate a settlement in light of the expense and inconvenience 

that would result from such litigation. On July 23, 2004 AMR entered 

into a civil Settlement Agreement for $3.5 million dollars and a five year 

Corporate Integrity Agreement (CIA). The conduct regarding 911 

transports that the OIG alleged as being improper was consistent with 

practice throughout the ambulance industry at the time and is now 

expressly permitted by the Medicare Fee Schedule for ambulance 

providers today. 

3. Laidlaw Medical Transportation – South Dakota. This investigation, 

which was resolved last year through a civil settlement, involved 

allegations that (a) it was improper for AMR of South Dakota to use the 

“emergency” HCPCS codes for all of it’s medically necessary 911 

transports; and (b) AMR improperly billed federal programs (Medicare 

and CHAMPUS) for so-called “paramedic intercepts,” wherein AMR 

paramedics treated patients in ambulances operated by volunteer 

ambulance services. The investigating agencies were the OIG and the 

United States Attorney’s Office in South Dakota. Although Laidlaw 

Medical Transportation, Inc. did not agree with the government’s position, 

AMR negotiated a civil settlement in the amount of $140,583, part of 

which was paid to Medicare and part of which was paid to CHAMPUS. 

The time period covered by the investigation was April 1994 through 

March 2001. 

4. AMR of Massachusetts. This civil investigation involved allegations of 

inappropriate billing to the Medicare program for services rendered during 

the years 1993 through 1998. The government alleged that AMR billed 

for transports which were not medically necessary. The investigating 

agencies were the DoJ and the OIG. Much of the conduct in question was 

committed by companies which AMR acquired. AMR agreed to settle the 

allegations by entering into a settlement agreement which required it to 

pay $20 million dollars, the majority of which was paid out of the 

escrowed proceeds of the acquired predecessor companies. In addition, 

AMR of Massachusetts entered into a three-year corporate integrity 

agreement, in which it agreed to continue operating an aggressive 

corporate compliance program. 

5. AMR of Texas. In January, 2002, AMR of Texas received a civil 

subpoena from the government requesting a variety of documents in 

connection with a federal investigation. AMR believes this investigation 

involves an industry-wide review of whether hospitals and nursing homes 

have been provided with discounts on transports for which they are 

financially responsible, as an inducement for the referral of Medicare Part 

B business. The government has indicated that such conduct violates the 

3


federal anti-kickback statute. In addition to AMR, numerous health 

facilities and certain trade associations, including the American 

Ambulance Association, have received subpoenas. 

In the last quarter of 2004, AMR was advised by the DoJ that the 

government continues to investigate certain business practices of AMR. 

Including discounting and whether transports were medically necessary. 

6. AMR of Texas. In March, 2002, AMR of Texas received subpoenas from 

the government for records related to Anderson Ambulance, a company in 

San Antonio that AMR purchased. AMR was informed by the 

government that the subject of the investigation was a hospital system, 

rather than AMR. AMR considers this a closed matter. 

7. AMR of Connecticut. Prior to being acquired by AMR, P&S Ambulance 

in Connecticut entered into a settlement agreement with the federal 

government arising out of allegations that P&S improperly billed 

Medicare for transports that were not medically necessary. When it 

acquired P&S, AMR assumed certain obligations under the settlement 

agreement, which required the company to implement specified corporate 

compliance measures, to obtain an annual audit of its billing practices and 

to file annual reports from the government until 1990. AMR fully 

complied with its obligations under the settlement agreement and its 

conditions have been deemed satisfied by the government. Investigating 

agencies were the OIG and the Department of Justice. 

8. AMR of Connecticut. The Attorney General for the State of Connecticut 

conducted an antitrust investigation arising from the merger of American 

Medical Response with Laidlaw Medical Transportation, Inc. In 1999, 

AMR entered into a consent judgment with the Connecticut Attorney 

General in which AMR agreed to divest itself of its ambulance operations 

in the Hartford, Connecticut service area, and to transfer a small number 

of ambulance permits to other ambulance carriers. AMR has complied 

with these obligations. The consent judgment stated that there was no 

determination that AMR had committed an antitrust violation. 

9. AMR of Colorado. In 2003, the State Attorney General for Colorado 

conducted a random review of Medicaid claims submitted by AMR from 

November 2001 through February 2002. In November 2003, the state 

completed its review and determined that AMR was erroneously paid 

approximately $1,400. AMR submitted a full refund and upon payment, 

the Attorney General closed the matter. 

4


10. AMR of Florida. In February 2004, AMR resolved an overpayment 

demand by the Florida State Attorney General as a result of a random 

review of Medicaid claims submitted by AMR between June 1999 and 

November 2000. Although AMR disagrees with the state’s findings, it has 

agreed to a negotiated settlement of approximately $20,000 and the matter 

is considered closed. 

11. AMR of Oregon. In May 2004 AMR received a subpoena from the DoJ 

requesting documents related to the AMR Oregon operation. AMR is 

cooperating with the government and continues to submit documents on a 

rolling production schedule. 

5


AMR Employment Litigation: Resolved and Ongoing 

A. California 

1. EMPLOYEE v. American Medical Response. On November 22, 2000, 

EMPLOYEE sued AMR and paramedic preceptor EMPLOYEE, and paramedic training 

school Emergency Training Services, Inc. in the Santa Cruz County Superior Court, 

alleging sexual harassment and wrongful termination. EMPLOYEE claimed that during 

her paramedic internship, AMR employee and preceptor EMPLOYEE sexually harassed 

her, when she complained about EMPLOYEE, AMR terminated her from employment as 

an EMT and ETS expelled her. EMPLOYEE requested compensatory and punitive 

damages in excess of $ 1 million. AMR denied EMPLOYEE allegations. On December 

19, 2001, AMR settled by paying EMPLOYEE $7,500 and converting her termination to 

a resignation in exchange for a release of all claims and a dismissal of her lawsuit. 

2. EMPLOYEE v. American Medical Response. On January 8, 2001, EMPLOYEE 

filed suit in the San Diego County Superior Court alleging wrongful termination. 

EMPLOYEE sought compensatory damages in excess of $100,000. AMR denied 

EMPLOYEE allegations, contending that he was terminated for not responding to various 

pages for shifts. On May 14, 2003, AMR settled by paying EMPLOYEE $17,500 in 

exchange for a release of all claims and dismissal of the lawsuit. 

3. EMPLOYEE v. American Medical Response. On June 28, 2001, EMPLOYEE 

filed suit in the Alameda County Superior Court alleging sexual harassment by a coworker 

and wrongful termination. EMPLOYEE claimed in excess of $100,000 in 

compensatory damages and requested punitive damages. AMR denied the allegations. 

On July 25, 2002, AMR settled by paying EMPLOYEE $7,000 in exchange for a release 

of all claims and dismissal of the lawsuit. 

4. EMPLOYEE v. AMR. On August 29, 2001, EMPLOYEE filed suit in the San 

Joaquin County Superior Court alleging sexual harassment and wrongful termination. 

EMPLOYEE claimed that she was sexually harassed by the Director of Operations and 

terminated for complaining about this sexual harassment. EMPLOYEE claimed in 

excess of $500,000 in damages. AMR denied the allegations, contending that 

EMPLOYEE was terminated for not properly assessing a patient. On November 4, 2003, 

AMR settled the case for payment of $15,000, in exchange for a release of all claims and 

dismissal of the lawsuit. 

5. EMPLOYEE v. AMR. EMPLOYEE filed suit in the Riverside County Superior 

Court on September 26, 2001, alleging wrongful termination. EMPLOYEE claimed 

damages in excess of $100,000. AMR denied the allegations, contending that 

EMPLOYEE was terminated for a variety of patient care issues. On July 18, 2003, AMR 

settled the case by paying EMPLOYEE $12,500 in exchange for a release of all claims 

and dismissal of the lawsuit. 

6. EMPLOYEE v. American Medical Response. On October 12, 2001, EMPLOYEE 

filed suit in the Alameda County Superior Court alleging wrongful termination and racial 

discrimination. EMPLOYEE contended that he was terminated because of his race - 

1


Native American and requested approximately $400,000 in compensatory damages, and 

punitive damage. On October 28, 2002, the Superior Court granted AMR's motion for 

summary judgment, and judgment was entered in AMR's favor. EMPLOYEE did not 

appeal. 

7. EMPLOYEE v. AMR. EMPLOYEE filed a claim with the California Labor 

Commissioner contending that AMR failed to pay him $6,875.00 in accrued PTO at the 

time of his resignation. After an administrative hearing, the Labor Commissioner 

awarded EMPLOYEE $6,875.00 for the PTO. AMR then filed for a trial de novo in the 

Los Angeles County Superior Court. On June 12, 2003, AMR settled EMPLOYEE claim 

by paying him $6,875 for the accrued PTO in exchange for EMPLOYEE waiving any an 

all claims against AMR, including attorney's fees and statutory waiting time penalties. 

8. EMPLOYEE v. AMR. On December 1, 2001, EMPLOYEE filed suit in the Los 

Angeles County Superior Court, alleging sexual harassment by a co-worker. 

EMPLOYEE claimed $250,000 in compensatory damages and requested punitive 

damages. AMR did not dispute the harassment, but contended that it was not liable, 

because it promptly investigated EMPLOYEE complaint and took appropriate action by 

discharging the co-worker. AMR filed a motion for summary judgment, which the 

Superior Court granted, and judgment was entered in AMR's favor. 

EMPLOYEE appealed. On April 28, 2003, the Court of Appeal affirmed the judgment 

and dismissed EMPLOYEE's appeal. The Court also awarded AMR costs against 

EMPLOYEE of $17,500. 

9. EMPLOYEE v. American Medical Response. On December 14, 2001, 

EMPLOYEE filed suit in the Alameda County Superior Court alleging claims for 

violation of the Family Medical Leave Act and the Labor Code and constructive 

discharge. EMPLOYEE contended that AMR had refused to grant her time away from 

work to take a handicapped child for diagnostic procedures. EMPLOYEE requested 

approximately $750,000 in compensatory and punitive damages. AMR denied 

EMPLOYEE allegations, claiming that she had been granted all time off requested, and 

voluntarily resigned. On May 2, 2003, AMR settled by paying EMPLOYEE $50,000, in 

exchange for a waiver of all claims and future employment with AMR and dismissal of 

her lawsuit. 

10. EMPLOYEE v. American Medical Response. On March 29, 2002, EMPLOYEE 

filed suit in the Los Angeles Superior Court, alleging wrongful termination, seeking in 

excess of $100,000 in damages. AMR denied the allegations, contending that 

EMPLOYEE was discharged for threatening a supervisor. AMR filed a motion for 

summary judgment, which was granted by the Superior Court on April 15, 2003, and 

judgment was entered in AMR's favor. EMPLOYEE did not appeal. 

11. EMPLOYEE v. American Medical Response. On April 4, 2002, EMPLOYEE 

filed suit in the Riverside County Superior Court alleging wrongful termination and 

requesting $500,000 in compensatory damages, and punitive damages. AMR denied 

2


EMPLOYEE allegations, contending that he was terminated for unprofessional conduct 

in that he had an extra-marital affair with a subordinate employee. On January 21, 2004, 

the Superior Court granted AMR's motion for summary judgment, and judgment was 

entered in AMR's favor. EMPLOYEE timely appealed, and his appeal is pending in the 

Court of Appeal. AMR is confident that the judgment dismissing EMPLOYEE suit will 

be affirmed on appeal. 

12. Labor Commissioner v. American Medical Response. On July 31, 2002, the 

California Labor Commissioner filed suit in the Orange County Superior Court alleging 

that AMR had violated the Labor Code by failing to pay some 40 Westminister 

employees daily overtime. On December 22, 2003, AMR settled by paying the 

employees $98,500 in exchange for waivers of attorney's fees and costs, waiting time 

penalties, and dismissal of the lawsuit. 

13. EMPLOYEE v. American Medical Response. On August 30, 2002, 

EMPLOYEE filed suit in the San Bernardino County Superior Court alleging racial 

discrimination. EMPLOYEE claimed that AMR had failed to promote him to various 

managerial positions because of his race. EMPLOYEE claimed $1 million in 

compensatory and punitive damages. AMR denied the allegations of EMPLOYEE claim, 

contending that it had chosen the most qualified candidates for the positions. On April 9, 

2004, the Superior Court granted AMR's motion for summary judgment, and judgment 

was entered in AMR's favor. EMPLOYEE did not appeal. 

14. EMPLOYEE v. American Medical Response. On October 17, 2002, 

EMPLOYEE filed suit in the Los Angeles County Superior Court, alleging wrongful 

termination. EMPLOYEE requested $300,000 in compensatory damages, and punitive 

damages. AMR denied EMPLOYEE allegations, contending that it properly terminated 

him for sexually harassing a co-employee. On March 10, 2003, the Superior Court 

granted AMR's motion for summary judgment, and judgment was entered in AMR's 

favor. EMPLOYEE did not appeal. 

15. EMPLOYEE v. American Medical Response. On December 23, 2002, 


termination. EMPLOYEE alleged that she was discharged because of her race - 

Hispanic. EMPLOYEE claimed $300,000 in compensatory damages. She also filed a 

workers' compensation claim alleging injury to psyche. AMR denied the allegations. 

On July 9, 2004, AMR settled by paying EMPLOYEE $9,000 in exchange for a release 

of all claims, including her workers' compensation action and dismissal of the lawsuit. 

16. EMPLOYEE v. American Medical Response. On January 29, 2003, 


termination and disability discrimination. EMPLOYEE contended that AMR discharged 

her due to a physical disability, which affected her auto-immune system. EMPLOYEE 

claimed in excess of $500,000 in damages. AMR denied EMPLOYEE allegations. On 

June 26, 2003, AMR settled by paying EMPLOYEE $3,100 in exchange for a waiver of 

all claims, and dismissal of the lawsuit. 

3



EMPLOYEE filed suit in the San Diego County Superior Court alleging disability 

discrimination. EMPLOYEE claims that AMR terminated him because he had incurred a 

foot injury away from work. He requests unspecified compensatory and punitive 

damages. AMR denies EMPLOYEE allegations. AMR contends that EMPLOYEE foot 

injury is not a covered physical disability, and it offered him a reasonable 

accommodation in any event. EMPLOYEE refused the accommodation and resigned. 

AMR has removed this matter to the U.S. District Court for the Southern District of 

California, where it remains pending. AMR is optimistic that this matter can be settled 

for a minimal payment, or will be disposed of in a motion for summary judgment. 

18. EMPLOYEE v. American Medical Response. On May 5, 2004, EMPLOYEE 

filed suit in the Alameda County Superior Court, alleging disability discrimination. 

EMPLOYEE claims that AMR refused to hire her for a billing position because she 

suffers from a back injury, which restricts her lifting ability. AMR denies the allegations 

of the complaint. AMR has commenced settlement negotiations with EMPLOYEE and 

anticipates this matter can be settled for a minimal payment. 

19. Local 250, SEIU v. American Medical Response. On May 11, 2004, Local 250 

filed an action in the Alameda County Superior Court requesting that the court issue an 

order compelling AMR to arbitrate a dispute arising out of a collective bargaining 

agreement governing the wages, hours and terms and conditions of employment of 

AMR's Glendale California employees. AMR contended that the grievance was not 

timely and removed the case to the U.S. District Court for the Northern District of 

California. The parties have agreed to arbitrate the dispute, including the timeliness 

issues, and the suit will be dismissed by October 22, 2004. 

20. EMPLOYEE v. American Medical Response. On July 13, 2003, EMPLOYEE 

filed suit in the Riverside County Superior Court, alleging wrongful termination, and 

requesting unspecified compensatory and punitive damage. AMR denies the allegations, 

contending that it properly terminated EMPLOYEE for engaging in extra-marital sexual 

activity with a female subordinate. 

The matter remains pending in the Superior Court. AMR is optimistic that it can be 

settled for a minimal payment, or will be disposed of on motion for summary judgment. 

21. EMPLOYEE v. American Medical Response. On September 1, 2004, 

EMPLOYEE filed suit in the Orange County Superior Court, alleging wrongful 

termination and requesting unspecified compensatory and punitive damages. AMR 

denies the allegations, contending that it properly terminated EMPLOYEE for violating 

AMR's safe driving standards. AMR has filed an answer in Superior Court, and will 

remove this matter to the U.S. District Court for the Central District of California by 

October 1, 2004. 

4


AMR anticipates that this matter can be settled for minimal payment, or will be 

disposed of on motion for summary judgment. 

B. Michigan 


EMPLOYEE filed suit in the U.S. District Court for the Eastern District of Michigan 

alleging wrongful termination, and requesting $250,000 in compensatory damages. 

AMR denied the allegations, contending it properly terminated EMPLOYEE for 

intentionally delaying his response to an emergency call. On August 30, 2004, AMR 

settled by paying EMPLOYEE $1,500 in exchange for a waiver of all claims and 

dismissal of his lawsuit. 

C. Indiana 

23. EMPLOYEE v. American Medical Response. On September 1, 2004, 

EMPLOYEE filed suit in the Allen County Superior Court, claiming gender and age 

discrimination. EMPLOYEE alleges that she was discharged based on her age and 

gender and claims unspecified compensatory and punitive damages. AMR denies the 

allegations, claiming that EMPLOYEE properly was terminated for violating its Vehicle 

Safety Policy. More specifically, EMPLOYEE was observed by a city official going 

through a stop sign at approximately 55 to 60 m.p.h. 

AMR will remove this matter to the United States District Court for Indiana. AMR 

anticipates that this matter can be settled for minimum payment, or will be disposed of on 

motion for summary judgment. 

D. Florida 

24. EMPLOYEE v. American Medical Response. In 2001 EMPLOYEE filed suit 

in Pinellas County Superior Court alleging physical disability discrimination. 

EMPLOYEE contended that AMR refused to place him in a dispatcher position because 

he stuttered. EMPLOYEE requested in excess of $1 million in damages. AMR 

contended that EMPLOYEE was not qualified for the position due to a speech 

impediment. The matter was tried to a jury, and the jury rendered a verdict in AMR's 

favor. Judgment was entered in favor of AMR, and EMPLOYEE did not appeal. 

E. Alabama 

25. EMPLOYEE v. American Medical Response. On April 23, 2003, EMPLOYEE 

filed suit in the U.S. District Court for the Northern District of Alabama. EMPLOYEE 

claimed that AMR discharged her because of her gender and race. She claimed 

unspecified compensatory and punitive damages. AMR denied the allegations and 

claimed that it properly discharged EMPLOYEE for misappropriation of AMR 

materials. After her deposition, EMPLOYEE voluntarily dismissed her lawsuit with 

prejudice. 

5


26. EMPLOYEE v. American Medical Response. On March 12, 2003, EMPLOYEE 

filed suit in the U.S. District Court for the Northern District of Alabama alleging that as 

an administrator of a group insurance plan, AMR had violated ERISA when the insurer 

failed to pay legitimate medical expenses, resulting in EMPLOYEE being sued by her 

physician. AMR determined that the carrier had failed to pay EMPLOYEE claim and 

paid EMPLOYEE $5,500, representing the principal amount of the claim, in exchange 

for EMPLOYEE dismissing her lawsuit against AMR, and waiving attorney's fees and 

punitive damages. 

F. New Mexico 

27. EMPLOYEE v. American Medical Response. On February 11, 2003, 

EMPLOYEE filed suit in the 12th Judicial District of Otero County, alleging that AMR 

had violated New Mexico labor laws by failing to pay him accrued PTO at the time of 

discharge. EMPLOYEE requested $638.00 in accrued PTO and $2,767.00 in waiting 

time penalties under New Mexico law. AMR determined that EMPLOYEE claim was 

well taken and paid him the accrued PTO and waiting time penalties, in exchange of 

dismissal of the lawsuit. 

G. Colorado 

28. EXECUTIVE v. American Medical Response. On July 12, 2002, EXECUTIVE 

filed suit in the District Court for Arapahoe County, alleging causes of action against 

AMR arising from his termination on May 14, 2002. EXECUTIVE claimed his 

discharge lacked just cause as required by an express employment contract, and alleged 

causes of action for breach of express employment contract, wrongful withholding of 

wages, promissory estoppel, and violation of the federal Employment Retirement 

Income Security Act. EXECUTIVE requested in excess of one million dollars in 

damages. AMR removed EXECUTIVE’s suit to the United States District Court for the 

District of Colorado. On October 15, 2004, the parties entered into a written confidential 

settlement agreement, and EXECUTIVE’s suit has been dismissed with prejudice. 

6

Litigation History 

Employment Litigation for Contra Costa County 

3-year AMR Litigation Rate Summary 

3-year AMR Litigation History 

Employment History 

Litigation History: Resolved and Ongoing

AMR Litigation History 

1. Providence Health Plan v American Medical Response Northwest, Inc. Providence sued 

AMR for overpayments it made to AMR. In response, AMR asserted that Providence 

voluntarily chose to pay in excess of the amount owed after receiving notice from AMR, and 

should be estopped from changing its position. AMR and Providence have settled the 

dispute. 

2. Bruce and Darlene Graddon v. Laidlaw Medical Transportation, Inc. Graddon sued Laidlaw 

Medical Transportation, Inc. to recover additional sums allegedly payable under a stock 

purchase agreement between the parties. The parties have tentatively agreed to settlement of 

this matter. 

3. Former Shareholders of Goodhew Ambulance Service, Inc. v. American Medical Response, 

Inc. (arbitration). Dispute arising under a stock purchase agreement between the parties. The 

former shareholders of Goodhew Ambulance Service, Inc. allege that under the stock 

purchase agreement they are entitled to proceeds from an insolvent insurance company. 

AMR disputes the claim. The matter is ongoing. 

4. American Medical Response of Texas, Inc., et al v Health Care Service Corporation dba Blue 

Cross Blue Shield of Texas, et al. AMR brought suit against Blue Cross/Blue Shield alleging 

that Blue Cross/Blue Shield failed to make timely payment for services provided to the 

defendants’ members by AMR in the state of Texas. The matter is ongoing. 

5. South-Med Emergency Services, Inc. and Johnnie Sue Hopper v. Laidlaw Inc., Careline, Inc., 

American Medical Response, Inc. et. al. (Related cases: Transcare: Richard D. Ellenberg, 

Trustee of the Estate of Transcare Ambulance Service, Inc., Bankrupt v. Laidlaw Medical 

Transportation, Inc., American Medical Response, Inc., American Medical Response of 

Georgia, Inc. et al. (Georgia); Lifeline: Griffin E. Howell, III, Trustee of the Estate of Lifeline 

Ambulance Service, Inc., Bankrupt and Greg Birge v. Laidlaw Medical Transportation, Inc. 

and American Medical Response of Georgia, Inc. (Georgia); Life-Call: Life-Call Ambulance 

Service Corporation v. Laidlaw Inc., Laidlaw Medical Transportation, Inc., American 

Medical Response, Inc. and American Medical Response of Georgia, Inc. (Georgia). Each of 

these four cases contain the same core claims – that information about the plaintiffs’ 

businesses were shared with AMR and/or CareLine/Laidlaw in contemplation of a potential 

purchase of their companies, and that the confidential information was used by 

AMR/CareLine/Laidlaw to unfairly put their companies out of business. The Transcare case 

settled. The Lifeline case proceeded to trial, and the jury ruled in favor of AMR. The 

LifeCall case was settled thereafter. 

6. Uni-Globe Business Enterprises, Inc. v Metro Ambulance Service by and through its joint 

venturers Randall Eastern Ambulance Service, Inc. and Medi-Car System, Inc. In 1997, an 

AMR affiliate entered into an agreement with Uni-Globe, for the consulting services of an 

attorney and lobbyist. The AMR affiliate terminated the Agreement for “good cause” due to 

an alleged violation of a noncompete provision in the Agreement by the consultant. Uni- 

Globe filed suit for wrongful termination of the Agreement. This matter has settled. 

7. Metro Ambulance Service, Inc. v Med Life Emergency Medical Services, Inc. and Pafford 

Emergency Medical Services, Inc. Metro commenced an action against Med Life and Pafford 

for operating “emergency” medical transports without the requisite license. Med Life and 

Pafford claim to be providing only “non-emergency” services, for which they are both 

licensed. This matter is ongoing. 

P:\2004\Contra Costa County - CA (2004)\Attachments\Ready to Format\Formatted and Finalized\Native document\7.13.x litigation AMR.doc 

1

AMR Litigation History 

8. Metro Ambulance Service, Inc. dba American Medical Response v Jim Graves, Metro Rural 

Services, L.L.C. AMR filed suit based upon the defendants’ alleged breach of fiduciary 

duties to AMR, breach of contract with AMR, violation of trade secrets act and interference 

with business relationship and conspiracy. Defendants deny the allegations. This matter is 

ongoing. 

9. Goodwill Steam Fire Engine Company v. The Health Maintenance Organization of 

Pennsylvania, et al. The plaintiff brought this action against the defendants due to an alleged 

failure to pay for medical transportation services. The HMO then filed a claim against AMR, 

stating that it had paid AMR for all services provided and AMR was obligated to turn such 

payments over to Goodwill. The matter is ongoing. 

10. Capital Credit, Inc. v. American Medical Response, Inc. Plaintiff claims that AMR failed to 

pay amounts due to plaintiff for collection services provided by the plaintiff. AMR disputes 

the claims of the plaintiff. The matter is ongoing. 

11. Investigation: The Federal Election Commission (“FEC”) has initiated an investigation in 

response to a complaint by a former employee of an AMR affiliate alleging that various 

employees of AMR received reimbursement for political campaign contributions. AMR 

disputes the allegations of the former employee. The matter is ongoing. 

P:\2004\Contra Costa County - CA (2004)\Attachments\Ready to Format\Formatted and Finalized\Native document\7.13.x litigation AMR.doc 

2


Rate Summary 

As of November 4, 2004 

American Medical Response utilizes a rating system to objectively measure the Safety Performance 

of each of our ambulance operations, for each major line of coverage. 

Automobile Liability is measured using Number of Automobile Collisions per 100,000 Miles Driven. 

(Collisions X 100,000) / (Miles) 

General & Professional Liabilities are measured using Number of these types of claims per 10,000 Transports. 

(Claims X 10,000) / (Transports) 

Worker's Compensation is measured using Number of Worker Injuries per 10,000 Payroll Hours Worked. 

(Injuries X 10,000) / (Hours) 

Current Safety Performance Rates by Major Line of Coverage (FY04) 

Worker's 

Compensation 

General & Professional 

Liability 

Automobile 

Liability 

1.00 

0.70 

0.77 

Northwest-Plains Region 

1.14 

0.86 

0.67 

Bay Division 

1.88 

1.01 

0.92 

Contra Costa Operations 

1 of 1


3-Year Litigation History 


Claim Number Event Number Claim Status Date of Loss Date of Suit Line Type State Cause Description (Interaction) 

A153002999-0003-02 A153002999 Closed 11/05/01 05/01/03 Automobile Liability CT Failure To Yield Rt-Of-Way 

20011183837-0003 A153002999 Closed 11/05/01 05/01/03 Automobile Liability CT Failure To Yield Rt-Of-Way 

20031114055-0001 A353005976 Open 11/05/01 10/31/03 Professional Liability MS Medical Treament 

20011292974-0001 A153003401 Closed 11/05/01 10/07/02 Professional Liability CA Medical Treament 

20011184566-0001 A152704828 Closed 11/05/01 Worker's Compensation CA Fall On the Same Level 

20011184992-0001 A117012116 Open 11/05/01 Worker's Compensation NH Struck/Injured By Object Being Lifted or Hand 

20011184943-0003 A153003065 Closed 11/06/01 07/30/02 Automobile Liability CO Intersection Accident (Not-At-Fault) 

20031115443-0001 A353006009 Open 11/06/01 11/24/03 Professional Liability CA Medical Treament 

20011185645-0001 A152904603 Open 11/07/01 Worker's Compensation CA Other Injury 

20011186356-0001 A152704926 Closed 11/11/01 Worker's Compensation CA Bodily Reaction 

20011186726-0001 A178403168 Open 11/12/01 Worker's Compensation NY Fall/Slip From a Different Level 

20011187793-0001 A152904716 Open 11/12/01 Worker's Compensation CA Twisting 

20011187424-0001 A178403190 Open 11/15/01 Worker's Compensation CT Struck or Injury By 

20011189172-0001 A153003253 Open 11/20/01 07/21/03 Automobile Liability CA Hit On Side By Other Vehicle 

20011189172-0002 A153003253 Open 11/20/01 07/21/03 Automobile Liability CA Hit Other Vehicle On Side 

20011190190-0001 A178403248 Open 11/21/01 Worker's Compensation NY Vehicle Upset 

20011190768-0001 A117012757 Closed 11/22/01 Worker's Compensation MA Caught In, Under or Between 

20011190610-0001 A152904796 Open 11/24/01 Worker's Compensation CA Lifting 

20011294997-0001 A153003490 Closed 11/26/01 11/08/02 General Liability TX Equipment 

20011191390-0001 A152705943 Open 11/27/01 Worker's Compensation CA Absorption, Ingestion or Inhalation NOC 

20020603974-0001 A252705126 Open 11/28/01 Worker's Compensation CA Repetitive Motion (after 7/1/94) 


20021107751-0001 A253005165 Closed 11/29/01 11/06/02 General Liability CA Mobile Equipment 

20011191946-0001 A117012923 Closed 11/29/01 Worker's Compensation RI Fall On the Same Level 


A153003409-0003-01 A153003409 Open 12/02/01 03/01/04 Automobile Liability FL Rear-Ended Other Vehicle 

20011292923-0001 A178403320 Open 12/03/01 Worker's Compensation NY Reaching 

A153003460-0005-01 A153003460 Closed 12/05/01 12/04/02 Automobile Liability CA Hit On Side By Other Vehicle 

20011295640-0001 A152904939 Open 12/06/01 Worker's Compensation CA Motor Vehicle 

20011295247-0001 A152706163 Closed 12/08/01 Worker's Compensation CA Lifting 

A253000113-0003-01 A253000113 Open 12/11/01 11/20/03 Automobile Liability CT Sideswiped Other Vehicle 

20011296518-0001 A152706439 Closed 12/11/01 Worker's Compensation CA Motor Vehicle 

20011296063-0001 A153003599 Closed 12/12/01 11/26/02 Automobile Liability CT No Contact 

A153003599-0001-02 A153003599 Closed 12/12/01 11/26/02 Automobile Liability ct No Contact 


20011296651-0002 A153003631 Closed 12/14/01 12/11/03 Automobile Liability CT Failure To Yield Rt-Of-Way 

A153003631-0002-02 A153003631 Open 12/14/01 12/11/03 Automobile Liability CT Intersection Accident (Not-At-Fault) 

20011201287-0001 A160904291 Closed 12/20/01 03/20/03 Worker's Compensation MS Strain or Injury By 

20011299947-0001 A152706619 Closed 12/21/01 Worker's Compensation CA Fall, Slip or Trip 

20020104114-0001 A253000154 Closed 12/23/01 12/20/02 General Liability LA Equipment 

20020101769-0004 A253000028 Closed 12/29/01 11/26/02 Automobile Liability CA Rear-Ended Other Vehicle 

A153003789-0002-02 A153003789 Closed 12/30/01 10/28/02 Automobile Liability CT Rear-Ended Other Vehicle 

20011201029-0002 A153003789 Closed 12/30/01 10/28/02 Automobile Liability CT Rear-Ended Other Vehicle 

20020210269- A252900315 Closed 01/02/02 Worker's Compensation CA Stress 


A253000072-0001-02 A253000072 Closed 01/05/02 11/22/02 Automobile Liability NY Mechanical Failure 

1 of 10




20020102842-0001 A253000072 Closed 01/05/02 11/22/02 Automobile Liability NY Mechanical Failure 


20020104403-0001 A217000437 Closed 01/07/02 Worker's Compensation MA Fall/Slip on Ice or Snow 



20020103359-0001 A217000281 Open 01/08/02 Worker's Compensation MA Motor Vehicle 

20020218403-0001 A252701317 Open 01/08/02 Worker's Compensation CA Overexertion 

20020109989-0001 A252700596 Open 01/08/02 Worker's Compensation CA Struck/Injured By Fellow Worker, Patient 

20020104649-0001 A252900125 Open 01/10/02 Worker's Compensation CA Cut, Punctured, Scraped 



A253000184-0003-02 A253000184 Closed 01/13/02 05/06/02 Automobile Liability NY Hit Veh Intersection - Traffic Controlled 

A253000184-0003-01 A253000184 Closed 01/13/02 05/06/02 Automobile Liability NY Sideswiped By Other Vehicle 

20020213825-0001 A252700884 Open 01/13/02 Worker's Compensation CA Continuous Trauma 


20020105982-0001 A217000587 Closed 01/17/02 Worker's Compensation MA Strain or Injury By 

20020327332-0001 A252702134 Closed 01/22/02 Worker's Compensation CA Continuous Trauma 

20020108166-0002 A253000384 Closed 01/23/02 12/10/02 Automobile Liability NY Loss Of Control-Hit Vehicle 

20020108162-0001 A278400242 Closed 01/23/02 Worker's Compensation NY Collision with Another Vehicle 

20020108770-0001 A217000908 Closed 01/26/02 Worker's Compensation MA Collision with Another Vehicle 

A318002164-0001-01 A318002164 Open 01/28/02 Worker's Compensation MI Fall/Slip on Stairs 


20020210910-0001 A253000495 Open 01/29/02 11/08/02 Professional Liability FL Medical Treament 

20020109922-0001 A217001049 Open 01/30/02 Worker's Compensation MA Twisting 

A253000469-0003-01 A253000469 Open 01/31/02 07/29/02 Automobile Liability IN Intersection Accident (Not-At-Fault) 

20040400857-0001 A453001605 Closed 01/31/02 01/16/04 General Liability CA False Imprisonment 

20020212469-0001 A253000562 Closed 01/31/02 Worker's Compensation CO Repetitive Motion (after 7/1/94) 

20020211920- A252900373 Open 02/02/02 Worker's Compensation CA Bodily Reaction 


20020211790- A217001329 Closed 02/05/02 Worker's Compensation MA Fall/Slip on Stairs 

20020212508-0001 A241400551 Closed 02/07/02 Worker's Compensation FL Motor Vehicle 

A253000609-0003-02 A253000609 Closed 02/08/02 02/25/03 Automobile Liability CA Rear-Ended Other Vehicle 


A253000582-0002-02 A253000582 Open 02/11/02 11/26/02 Automobile Liability NY Rear-Ended Other Vehicle 

20020213046-0002 A253000582 Closed 02/11/02 11/26/02 Automobile Liability NY Rear-Ended Other Vehicle 

20020214034-0001 A278400477 Closed 02/13/02 Worker's Compensation CT Pushing or Pulling 


20020218331-0001 A241400819 Closed 02/20/02 Worker's Compensation FL Struck/Injured By Fellow Worker, Patient 


A253000775-0002-02 A253000775 Closed 02/23/02 01/08/03 Automobile Liability FL Intersection Accident (Not-At-Fault) 

20020217256-0003 A253000775 Open 02/23/02 02/18/04 Automobile Liability FL Intersection Accident (Not-At-Fault) 

20020217256-0002 A253000775 Closed 02/23/02 01/08/03 Automobile Liability FL Intersection Accident (Not-At-Fault) 

20040115638-0003 A453000383 Closed 02/25/02 12/31/03 Automobile Liability NV No Contact 


20020505588-0001 A252703694 Open 03/01/02 Worker's Compensation CA Strain or Injury By 


20020321093-0001 A253000930 Open 03/03/02 02/24/04 General Liability NV Equipment 

2 of 10





20020320702-0001 A253000915 Closed 03/07/02 05/28/02 Automobile Liability NY Loading/Unloading 

20020321098-0001 A253000931 Closed 03/07/02 02/18/04 General Liability GA Equipment 


20020325157-0001 A252900818 Closed 03/09/02 Worker's Compensation CA Caught In, Under or Between 

20030207866-0001 A353000909 Closed 03/10/02 03/10/03 General Liability CA Breach of Contract 



20020323278-0001 A252900770 Open 03/13/02 Worker's Compensation CA Fall, Slip or Trip 

A253001031-0002-02 A253001031 Open 03/14/02 07/29/03 Automobile Liability CT Rear-Ended Other Vehicle 



A253001057-0003-01 A253001057 Open 03/15/02 03/11/04 Automobile Liability CT Hit On Side By Other Vehicle 


20020325459-0001 A253001120 Open 03/18/02 Worker's Compensation CO Collision with Another Vehicle 


20020437586-0001 A253001641 Open 03/20/02 06/16/03 General Liability KS Improper Use/Acting Outside of Authority 

20030205098-0001 A353000785 Closed 03/23/02 03/21/03 General Liability CA False Imprisonment 

20020326398-0001 A253001158 Closed 03/24/02 11/26/02 General Liability MA Slip & Fall Other Inside 



20020327803-0001 A241401250 Open 03/27/02 Worker's Compensation FL Struck/Injured By Motor Vehicle 

20020328536-0001 A252900924 Open 03/27/02 Worker's Compensation CA Trip 


20020504447-0001 A253001884 Closed 03/29/02 04/30/03 General Liability OH Claimant/Property Struck Barrier 

20020429244-0001 A241401299 Closed 03/29/02 Worker's Compensation FL Bending 


20020700632-0001 A253002616 Closed 03/31/02 08/15/02 General Liability MI Equipment 

20030202743-0001 A353000679 Closed 04/01/02 01/07/03 General Liability CA Defamation Of Character 


20020429870-0001 A217003263 Closed 04/03/02 Worker's Compensation MA Trip 




20030509420-0001 A353002605 Open 04/15/02 05/14/03 Professional Liability MT Medical Treament 

20020437140-0001 A252702981 Open 04/16/02 Worker's Compensation CA Overexertion 

20020436722-0002 A253001587 Closed 04/21/02 06/20/03 Automobile Liability CA Hit By Vehicle @ Intersection - Traffic Controlled 

20020436722-0003 A253001587 Closed 04/21/02 03/14/03 Automobile Liability CA Hit By Vehicle @ Intersection - Traffic Controlled 

A253001587-0002-02 A253001587 Closed 04/21/02 06/20/03 Automobile Liability CA Intersection Accident (At-Fault) 



A253001623-0002-02 A253001623 Open 04/23/02 11/24/03 Automobile Liability AL Rear-Ended Other Vehicle 

20020437320-0002 A253001623 Closed 04/23/02 11/24/03 Automobile Liability AL Rear-Ended Other Vehicle 

A253001653-0002-02 A253001653 Open 04/25/02 03/06/02 Automobile Liability MA Rear-Ended Other Vehicle 

20020438173-0002 A253001653 Closed 04/25/02 03/06/02 Automobile Liability MA Rear-Ended Other Vehicle 

20020809577-0001 A253003550 Open 04/27/02 04/23/04 General Liability CT Equipment 


3 of 10





20030806390-0001 A322508792 Closed 05/01/02 Worker's Compensation OR Repetitive Motion (after 7/1/94) 



A253001816-0004-01 A253001816 Open 05/04/02 06/05/03 Automobile Liability CA Intersection Accident (At-Fault) 

20020502423-0002 A253001816 Closed 05/04/02 05/02/03 Automobile Liability CA Intersection Accident (At-Fault) 



20040404150-0001 A453001689 Open 05/12/02 03/25/04 Automobile Liability CT Inattentive 

20020505275-0001 A241401980 Closed 05/13/02 Worker's Compensation FL Lifting 



A253002029-0004-01 A253002029 Closed 05/17/02 05/16/03 Automobile Liability CA Failed To Maintain Lane 

20020508501-0001 A217005144 Closed 05/17/02 Worker's Compensation NH Continuous Trauma 

20020508070-0001 A253002039 Closed 05/21/02 01/02/03 General Liability NY Equipment 

20020508067-0001 A217005013 Closed 05/22/02 Worker's Compensation MA Lifting 

20020600756-0001 A252901569 Closed 05/27/02 Worker's Compensation CA Holding or Carrying 

20020510027-0001 A253002113 Closed 05/29/02 04/03/03 Automobile Liability MA Backed Into By Other Vehicle 

20020600002-0001 A253002159 Open 05/29/02 General Liability CA Equipment 


20020705975-0001 A241402805 Closed 05/29/02 Worker's Compensation FL Stress 

A253002156-0002-02 A253002156 Closed 05/30/02 05/16/03 Automobile Liability CA Rear-Ended Other Vehicle 

20020601240-0001 A253002201 Open 05/30/02 04/02/04 General Liability TX Equipment 

A253002163-0003-01 A253002163 Open 05/31/02 10/15/03 Automobile Liability CT Failure To Yield Rt-Of-Way 

A253002163-0003-02 A253002163 Closed 05/31/02 10/15/03 Automobile Liability CT Failure To Yield Rt-Of-Way 


20020801151-0001 A222506431 Closed 06/01/02 Worker's Compensation OR Repetitive Motion (after 7/1/94) 



20020605319-0001 A278401863 Open 06/06/02 Worker's Compensation NY Pushing or Pulling 

A253002467-0006-01 A253002467 Open 06/07/02 06/07/04 Automobile Liability NV Failure To Yield Rt-Of-Way 

20020603722-0002 A253002314 Closed 06/07/02 04/11/03 Automobile Liability FL Failure To Yield Rt-Of-Way 

A253002314-0002-02 A253002314 Closed 06/07/02 04/11/03 Automobile Liability FL Intersection Accident (At-Fault) 


A253002293-0002-02 A253002293 Open 06/10/02 11/12/03 Automobile Liability MI Intersection Accident (Not-At-Fault) 

20020603485-0002 A253002293 Closed 06/10/02 11/12/03 Automobile Liability MI Intersection Accident (Not-At-Fault) 

20020606205-0001 A253002430 Closed 06/12/02 Automobile Liability MI Sideswiped Other Vehicle 



20040419180-0001 A453002057 Open 06/16/02 06/16/04 Professional Liability NV Medical Treament 

20020607848-0001 A253002489 Closed 06/19/02 10/07/03 Automobile Liability FL Rear-Ended Other Vehicle 

A253002489-0003-01 A253002489 Closed 06/19/02 10/07/03 Automobile Liability FL Rear-Ended Other Vehicle 

20020607265-0001 A241402473 Open 06/19/02 Worker's Compensation FL Lifting 

20020607532-0001 A252901741 Closed 06/20/02 Worker's Compensation CA Pushing or Pulling 

20020705335-0001 A253002940 Closed 06/25/02 01/15/03 General Liability FL Equipment 



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20030106258-0001 A353000240 Closed 06/27/02 12/20/02 Professional Liability MS Medical Treament 

A253002640-0002-02 A253002640 Open 06/28/02 01/06/03 Automobile Liability NY Hit On Side By Other Vehicle 

20020701126-0002 A253002640 Closed 06/28/02 01/06/03 Automobile Liability NY Hit On Side By Other Vehicle 

20020700402-0001 A252901815 Open 06/28/02 Worker's Compensation CA Striking Against or Stepping On 


20020700767-0001 A217006512 Closed 07/01/02 Worker's Compensation MA Motor Vehicle 

20020703054-0001 A252901849 Closed 07/05/02 Worker's Compensation CA Collision with Another Vehicle 

20020702401-0001 A217006576 Open 07/07/02 Worker's Compensation MA Lifting 






20020709134-0001 A252901956 Closed 07/12/02 Worker's Compensation CA Strain or Injury By 

20021103430-0001 A252711189 Closed 07/13/02 Worker's Compensation CA Stress 

20031203556-0001 A353006182 Closed 07/14/02 07/16/03 General Liability CA Equipment 

20021005083-0001 A253004413 Closed 07/15/02 04/10/03 General Liability IN Miscellaneous Bodily Injury or Property Damage 


20020709737-0001 A250900301 Open 07/18/02 Worker's Compensation NV Fall On the Same Level 



A253003242-0002-02 A253003242 Open 07/26/02 07/11/03 Automobile Liability CA Intersection Accident (Not-At-Fault) 

20020801121-0002 A253003242 Closed 07/26/02 07/11/03 Automobile Liability CA Intersection Accident (Not-At-Fault) 

20040806527-0001 A453003853 Open 07/28/02 06/21/04 Professional Liability OH Wrongful Death 


20030703613-0001 A353003485 Open 07/31/02 02/26/04 Professional Liability MI Medical Treament 


20020801574-0001 A253003249 Open 08/02/02 07/30/04 General Liability AL Faulty Equipment Maintenance 

20021202568-0001 A252903029 Closed 08/04/02 Worker's Compensation CA Strike Against/Step On Stationary Object 

20020806619-0001 A253003469 Open 08/07/02 05/20/03 General Liability FL Equipment 



20021005188-0001 A253004418 Open 08/08/02 05/20/03 General Liability CA Equipment 

20020806848-0001 A241403363 Open 08/09/02 Worker's Compensation FL Holding or Carrying 

20020812524-0001 A278402751 Closed 08/09/02 Worker's Compensation NY Holding or Carrying 

20020805065-0001 A252902110 Open 08/10/02 Worker's Compensation CA Twisting 

20020806017-0001 A252707699 Open 08/13/02 Worker's Compensation CA Holding or Carrying 

20020807242-0001 A218004601 Open 08/14/02 Worker's Compensation MI Fall, Slip or Trip 

20020806555-0001 A260901854 Closed 08/14/02 04/29/03 Worker's Compensation MS Lifting 

20020809965-0001 A278402679 Closed 08/15/02 Worker's Compensation CT Holding or Carrying 

20020813043-0001 A252902259 Open 08/19/02 Worker's Compensation CA Stress 

20020910540-0001 A260901868 Closed 08/23/02 Worker's Compensation MS Lifting 

20020810438-0001 A278402684 Open 08/25/02 Worker's Compensation CT Motor Vehicle 



20020813193-0003 A253003673 Open 08/30/02 02/11/03 Automobile Liability CT Rear-Ended Other Vehicle 

20020900764-0001 A253003691 Open 09/01/02 General Liability VA Lack Of Supervision 

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A253003911-0002-02 A253003911 Closed 09/17/02 Automobile Liability MA Rear-Ended By Other Vehicle 

20020907012-0002 A253003911 Closed 09/17/02 Automobile Liability MA Rear-Ended By Other Vehicle 

20021000636-0001 A278403084 Open 09/17/02 Worker's Compensation CT Pushing or Pulling 




20020910058-0001 A250900392 Closed 09/19/02 Worker's Compensation NV Strain or Injury By 


20021000369-0001 A241404097 Open 09/30/02 Worker's Compensation FL Motor Vehicle 

20030902012-0001 A353004556 Closed 10/02/02 08/18/03 General Liability CA Unlawful Detainment 

20021006190-0001 A222508285 Closed 10/07/02 Worker's Compensation WA Repetitive Motion (after 7/1/94) 

20030511021-0001 A352705185 Open 10/15/02 Worker's Compensation CA Continual Noise 


A253004767-0003-02 A253004767 Closed 10/26/02 08/16/04 Automobile Liability CT Hit On Side By Other Vehicle 


A253004898-0003-01 A253004898 Closed 10/26/02 04/03/02 Automobile Liability LA Rear-Ended Other Vehicle 

A253004898-0003-02 A253004898 Closed 10/26/02 04/03/02 Automobile Liability LA Rear-Ended Other Vehicle 

20021013130-0001 A217011055 Closed 10/30/02 Worker's Compensation RI Lifting 




A253004867-0004-01 A253004867 Open 11/05/02 11/04/03 Automobile Liability CT Sideswiped By Other Vehicle 

20021102329-0001 A253004919 Open 11/05/02 10/30/03 General Liability CA Contact Other 


A253005108-0002-02 A253005108 Open 11/13/02 11/19/03 Automobile Liability WA Rear-Ended Other Vehicle 

A253005108-0003-01 A253005108 Open 11/13/02 11/19/03 Automobile Liability WA Rear-Ended Other Vehicle 

20021106379-0002 A253005108 Closed 11/13/02 11/19/03 Automobile Liability WA Rear-Ended Other Vehicle 

20021106042-0001 A252711415 Open 11/13/02 Worker's Compensation CA Caught In/Between-Object Handled 

20021110247-0001 A241404926 Open 11/15/02 Worker's Compensation FL Collision with Another Vehicle 

20021108250-0001 A252902934 Closed 11/17/02 Worker's Compensation CA Struck/Injured By Fellow Worker, Patient 

20021110416-0001 A253005305 Open 11/18/02 03/22/04 Automobile Liability FL Loading/Unloading 

A253005305-0001-02 A253005305 Closed 11/18/02 03/22/04 Automobile Liability FL Loading/Unloading 

A253005946-0002-02 A253005946 Open 11/18/02 08/26/03 Automobile Liability CT Rear-Ended By Other Vehicle 

20021212233-0002 A253005946 Closed 11/18/02 08/26/03 Automobile Liability CT Rear-Ended By Other Vehicle 

20030907378-0002 A353004710 Closed 11/22/02 01/15/04 Automobile Liability MA Insured Hit Other-Lane Change 

A253005262-0003-01 A253005262 Open 11/22/02 04/03/04 Automobile Liability MA Intersection Accident (Not-At-Fault) 

20021200739-0001 A241404989 Closed 11/25/02 Worker's Compensation FL Repetitive Motion (after 7/1/94) 

20030105893-0001 A352900086 Open 12/02/02 Worker's Compensation HI Pushing or Pulling 

20021207853-0001 A253005726 Closed 12/06/02 12/04/02 Professional Liability GA Medical Treament 

A253005547-0003-01 A253005547 Open 12/07/02 04/20/04 Automobile Liability CA Rear-Ended By Other Vehicle 

20021203450-0001 A252712234 Open 12/07/02 Worker's Compensation CA Struck/Injured By Motor Vehicle 

20021203908-0001 A253005552 Open 12/08/02 Worker's Compensation CO Lifting 

A253005599-0002-02 A253005599 Closed 12/10/02 03/05/03 Automobile Liability CA Hit Other Vehicle On Side 

20021204818-0002 A253005599 Closed 12/10/02 03/05/03 Automobile Liability CA Hit Other Vehicle On Side 

6 of 10




20030402425-0001 A353001795 Open 12/10/02 04/07/03 General Liability MI Slip & Fall Other Outside 

20030205140-0001 A352701520 Open 12/10/02 Worker's Compensation CA Bodily Reaction 

A253005613-0003-01 A253005613 Open 12/11/02 04/23/04 Automobile Liability FL Rear-Ended Other Vehicle 


A253005864-0003-01 A253005864 Closed 12/15/02 07/23/03 Automobile Liability NY Hit On Side By Other Vehicle 

A253005864-0003-02 A253005864 Closed 12/15/02 07/23/03 Automobile Liability NY Hit On Side By Other Vehicle 

20030304346-0001 A317002127 Closed 12/17/02 Worker's Compensation NH Struck/Injured By Motor Vehicle 

20021209849-0003 A253005853 Open 12/20/02 05/27/03 Automobile Liability NY Intersection Accident (At-Fault) 




A253005936-0005-01 A253005936 Closed 12/26/02 02/26/03 Automobile Liability NY Hit Head-On By Other Vehicle 

A253005868-0002-02 A253005868 Open 12/26/02 10/27/03 Automobile Liability CT Rear-Ended By Other Vehicle 


20030100648-0001 A352900002 Open 12/30/02 Worker's Compensation CA Altercation 

20030813516-0001 A378402290 Open 12/30/02 Worker's Compensation CT Contact with Infectious Disease 

20030717171-0001 A353003911 Closed 12/31/02 05/27/03 Professional Liability TX Medical Treament 

20030107884-0001 A318000317 Open 01/02/03 Worker's Compensation MI Lifting 

20030103550-0001 A367000568 Open 01/08/03 Worker's Compensation GA Fall/Slip on Ice or Snow 

A353000172-0003-02 A353000172 Closed 01/09/03 07/29/03 Automobile Liability FL Hit On Side By Other Vehicle 

A353000172-0003-01 A353000172 Closed 01/09/03 07/29/03 Automobile Liability FL Hit On Side By Other Vehicle 


20030211016-0001 A352702057 Open 01/09/03 Worker's Compensation CA Fall/Slip From a Different Level 

A353001920-0003-01 A353001920 Open 01/13/03 Automobile Liability NY Sideswiped By Other Vehicle 

20030110726-0001 A317000790 Open 01/17/03 Worker's Compensation MA Fall/Slip on Ice or Snow 

20030108482-0001 A378400220 Closed 01/18/03 Worker's Compensation NY Fall, Slip or Trip 

20030109802-0001 A352700739 Open 01/20/03 Worker's Compensation CA Caught In/Between-Object Handled 

20030109195-0001 A341400290 Open 01/20/03 Worker's Compensation FL Needle Stick 


20030112499-0001 A353000510 Closed 01/24/03 04/04/03 General Liability CA Equipment 

20030615801-0001 A353003333 Open 01/30/03 05/29/03 General Liability TX Equipment 



20030205601-0003 A353000820 Open 02/07/03 03/25/03 Automobile Liability NY Slid On Ice/Rain 

20030205601-0004 A353000820 Open 02/07/03 03/05/03 Automobile Liability NY Slid On Ice/Rain 


A353000821-0003-01 A353000821 Open 02/11/03 07/09/03 Automobile Liability NY Hit Head-On By Other Vehicle 

20030209006-0001 A352900339 Open 02/11/03 Worker's Compensation CA Contact with Infectious Disease 

20030207734-0001 A352701755 Open 02/13/03 Worker's Compensation CA Fall/Slip on Stairs 


20030209013-0001 A341400809 Open 02/18/03 Worker's Compensation FL Bending 

A353000941-0003-01 A353000941 Open 02/19/03 06/19/03 Automobile Liability NY Rear-Ended By Other Vehicle 

A353000941-0003-02 A353000941 Open 02/19/03 06/19/03 Automobile Liability NY Rear-Ended By Other Vehicle 

20030304521-0001 A350900102 Open 02/21/03 Worker's Compensation NV Contact with Infectious Disease 

A353001071-0003-02 A353001071 Open 02/24/03 07/19/04 Automobile Liability CA Hit On Side By Other Vehicle 

A353001071-0003-01 A353001071 Closed 02/24/03 07/19/04 Automobile Liability CA Hit On Side By Other Vehicle 

20030301185-0001 A360900822 Open 02/28/03 Worker's Compensation MS Lifting 

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20030300855-0001 A352900427 Open 02/28/03 Worker's Compensation HI Motor Vehicle 

20030300806-0001 A352702243 Open 03/01/03 Worker's Compensation CA Struck/Injured By Body Fluid,Blood,Saliva, Etc 

A353001195-0002-02 A353001195 Open 03/04/03 03/24/03 Automobile Liability FL Intersection Accident (Not-At-Fault) 

20030301383-0002 A353001195 Open 03/04/03 03/24/03 Automobile Liability FL Intersection Accident (Not-At-Fault) 

A352703866-0001-01 A352703866 Closed 03/04/03 Worker's Compensation CA Continuous Trauma 

20030307408-0001 A353001484 Open 03/09/03 03/08/04 Professional Liability CA Wrongful Death 



20030304607-0001 A352702658 Open 03/11/03 Worker's Compensation CA Strike Against/Step On Stationary Object 

20030306179-0002 A353001432 Closed 03/13/03 03/10/04 Automobile Liability CA Hit On Side By Other Vehicle 

A353001432-0002-02 A353001432 Open 03/13/03 03/10/04 Automobile Liability CA Rear-Ended By Other Vehicle 

20030306163-0001 A352702768 Open 03/13/03 Worker's Compensation CA Collision with Another Vehicle 

20031010767-0001 A353005359 Closed 03/14/03 09/18/03 Professional Liability OH Neglect/ Breach of Duty 

A353001522-0002-02 A353001522 Open 03/19/03 05/12/04 Automobile Liability CA Sideswiped By Other Vehicle 

20030308819-0002 A353001522 Closed 03/19/03 05/12/04 Automobile Liability CA Sideswiped By Other Vehicle 

20031001530-0001 A322511746 Open 03/25/03 Worker's Compensation OR Bodily Reaction 

20030414210-0001 A352900824 Closed 03/25/03 Worker's Compensation CA Repetitive Motion (after 7/1/94) 

20030311894-0001 A353001679 Closed 03/27/03 Worker's Compensation CO Twisting 



A353001889-0003-01 A353001889 Open 04/05/03 10/20/03 Automobile Liability AL Rear-Ended By Other Vehicle 

20030404756-0001 A353001889 Open 04/05/03 Automobile Liability AL Rear-Ended By Other Vehicle 

A353001824-0003-01 A353001824 Open 04/06/03 11/10/03 Automobile Liability RI Hit On Side By Other Vehicle 


20030404712-0001 A352900697 Open 04/08/03 Worker's Compensation CA Struck or Injury By 

20030404750-0001 A318002165 Open 04/09/03 01/23/04 Worker's Compensation MI Fall/Slip on Ice or Snow 


20030409522-0002 A353002063 Open 04/17/03 03/03/04 Automobile Liability NV Hit Pedestrian-(?) Rt-Of-Way 

20030409481-0004 A353002059 Closed 04/17/03 05/07/04 Automobile Liability CA Loss Of Control-Hit Vehicle 

20040205042-0001 A453000662 Open 04/18/03 04/15/04 General Liability MA Equipment 

20030409545-0001 A317003162 Open 04/18/03 Worker's Compensation MA Fall/Slip From a Different Level 

20040503933-0001 A453002232 Open 04/21/03 05/04/04 Automobile Liability LA Loading/Unloading 

A453002232-0001-02 A453002232 Closed 04/21/03 05/04/04 Automobile Liability LA Loading/Unloading 

20030513267-0001 A318003604 Open 04/24/03 Worker's Compensation MI Lifting 

20030414519-0002 A353002255 Closed 04/29/03 09/03/03 Automobile Liability CT Hit On Side By Other Vehicle 

20031206498-0001 A353006251 Closed 05/03/03 11/10/03 General Liability WA Excessive Force 




20030802595-0001 A353004052 Open 05/11/03 09/02/03 Automobile Liability FL Loading/Unloading 


20030612829-0001 A352901201 Open 05/14/03 Worker's Compensation CA Pushing or Pulling 

20031002374-0001 A353005131 Open 05/28/03 09/23/03 Professional Liability NV Medical Treament 





8 of 10




20030604868-0001 A317004637 Closed 06/09/03 Worker's Compensation MA Fall, Slip or Trip 

20030607448-0001 A378401632 Closed 06/11/03 Worker's Compensation CT Reaching 

20030711938-0002 A353003736 Open 06/19/03 10/20/03 Automobile Liability NY Hit By Bicyclist 

A353003228-0004-01 A353003228 Open 06/20/03 01/29/04 Automobile Liability MS Hit On Side By Other Vehicle 

20030614774-0001 A341402517 Closed 06/25/03 Worker's Compensation FL Pushing or Pulling 

20030615723-0002 A353003335 Open 06/26/03 10/30/03 Automobile Liability CA Hit Other Vehicle On Side 

20030804902-0001 A353004113 Closed 06/27/03 05/04/03 General Liability CT Equipment 

20030703379-0001 A352901263 Open 07/03/03 Worker's Compensation CA Cut, Punctured, Scraped 


A353003551-0002-02 A353003551 Open 07/08/03 12/02/03 Automobile Liability NY Intersection Accident (At-Fault) 

20030705250-0002 A353003551 Closed 07/08/03 12/02/03 Automobile Liability NY Intersection Accident (At-Fault) 

20030705638-0001 A352901289 Open 07/10/03 Worker's Compensation CA Fall, Slip or Trip 

20031003211-0001 A322511891 Open 07/11/03 Worker's Compensation OR Bodily Reaction 

20030712621-0001 A378401973 Closed 07/11/03 Worker's Compensation NY Lifting 



A353003868-0004-01 A353003868 Open 07/24/03 03/11/04 Automobile Liability NV Hit On Side By Other Vehicle 

20030718815-0002 A353003961 Open 07/30/03 09/18/03 Automobile Liability FL No Contact 

A353004073-0003-01 A353004073 Closed 08/05/03 Automobile Liability MA Sideswiped By Other Vehicle 

20030808570-0002 A353004222 Open 08/14/03 02/03/04 Automobile Liability MA Rear-Ended Other Vehicle 

20030903796-0001 A350900336 Open 08/14/03 Worker's Compensation NV Lifting 







20040718575-0001 A453003554 Open 09/02/03 05/20/04 Professional Liability IN Medical Treament 


20030906744-0001 A317007520 Open 09/10/03 Worker's Compensation RI Vehicle Upset 

20040303755-0001 A453001115 Open 09/11/03 09/10/04 Professional Liability LA Neglect/ Breach of Duty 



20030918743-0001 A352901842 Open 09/24/03 Worker's Compensation CA Strike Against/Step On Stationary Object 

20030919771-0001 A322511542 Open 09/25/03 Worker's Compensation WA Lifting 

20030917418-0001 A352709677 Open 09/25/03 Worker's Compensation CA Vehicle Upset 

20031001225-0001 A352901863 Open 09/29/03 Worker's Compensation CA Struck/Injured By Moving Parts of Machine 





20031015572-0001 A317008912 Open 10/15/03 Worker's Compensation ME Lifting 

20031016227-0001 A352902016 Closed 10/17/03 Worker's Compensation CA Repetitive Motion (after 7/1/94) 




A353005813-0004-01 A353005813 Closed 11/01/03 06/24/04 Automobile Liability NY Intersection Accident (At-Fault) 

9 of 10











20031201829-0001 A353006147 Closed 11/14/03 11/24/03 Professional Liability LA Neglect/ Breach of Duty 

20031113316-0001 A341404291 Open 11/14/03 Worker's Compensation FL Absorption, Ingestion or Inhalation NOC 



20040101063-0004 A453000013 Open 12/31/03 07/16/04 Automobile Liability NY Hit On Side By Other Vehicle 

20040113814-0001 A450900039 Closed 01/12/04 Worker's Compensation NV Contact With Not Otherwise Classified 


20040117024-0002 A453000403 Open 01/22/04 04/30/04 Automobile Liability NY Hit Pedestrian-(?) Rt-Of-Way 

A453000403-0002-02 A453000403 Open 01/22/04 04/30/04 Automobile Liability NY Hit Pedestrian-(?) Rt-Of-Way 

A453000452-0007-01 A453000452 Open 01/24/04 04/20/04 Automobile Liability NV Intersection Accident (Not-At-Fault) 

A453000452-0007-02 A453000452 Open 01/24/04 04/20/04 Automobile Liability NV Intersection Accident (Not-At-Fault) 

20040200680-0001 A452900230 Open 01/26/04 Worker's Compensation CA Cumulative (All Other) 


20040201133-0001 A422501549 Open 01/28/04 Worker's Compensation OR Lifting 

20040301919-0001 A452900470 Open 02/09/04 Worker's Compensation CA Slipped, Did Not Fall 

A453000990-0002-02 A453000990 Open 02/11/04 03/23/04 Automobile Liability CT Hit On Side By Other Vehicle 

20040218395-0002 A453000990 Open 02/11/04 03/23/04 Automobile Liability CT Hit On Side By Other Vehicle 

20040412603-0001 A453001887 Open 02/23/04 04/08/04 General Liability CA Equipment 


20040303541-0002 A453001130 Open 02/25/04 05/12/04 Automobile Liability NY Hit On Side By Other Vehicle 

20040307285-0001 A453001184 Closed 03/02/04 03/02/04 Professional Liability LA Medical Treament 

20040316938-0001 A422503973 Open 03/20/04 Worker's Compensation WA Lifting 

20040609576-0001 A441401673 Open 04/03/04 Worker's Compensation FL Motor Vehicle 


20040625943-0001 A453003229 Open 04/14/04 06/22/04 General Liability CT False Imprisonment 


20040513404-0001 A453002497 Open 04/21/04 05/10/04 General Liability FL Another Person 



20040616815-0001 A478401147 Open 06/18/04 Worker's Compensation CT Motor Vehicle 

A453003360-0003-01 A453003360 Open 07/06/04 08/09/04 Automobile Liability CA Intersection Accident (Not-At-Fault) 

20040710812-0001 A452901725 Open 07/09/04 Worker's Compensation CA Struck/Injured By Falling or Flying Object 

20040717963-0001 A453003535 Open 07/11/04 07/02/04 Professional Liability MA Medical Treament 


20040812230-0002 A453003948 Closed 08/10/04 08/18/04 Automobile Liability NY Rear-Ended Other Vehicle 

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