The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Public Health
Division of Health Care Quality
10 West Street, 5th Floor 
Boston, MA 02111

MITT ROMNEY
GOVERNOR
KERRY HEALEY
LIEUTENANT GOVERNOR
RONALD PRESTON
SECRETARY
CHRISTINE C. FERGUSON 
COMMISSIONER	

MEMORANDUM

TO: 	Massachusetts Chief Municipal Officers

CC:	Massachusetts Fire Chiefs
	Massachusetts Police Chiefs
	MA Licensed Ambulance Services
	Regional EMS Councils

FR:	Paul Dreyer, Associate Commissioner
	Center for Health Quality Assurance and Control

DT: 	August 17, 2004

RE: 	Service Zone Planning Template
_______________________________________________________________________

The purpose of this letter is to inform cities and towns of a new statutory and regulatory obligation to develop and submit plans that coordinate the use of pre-hospital resources within their jurisdictions (“Service Zone Planning”).  The letter describes the new requirements and presents a tool that cities and towns may use as they develop their plans.  The law requires that each local jurisdiction be covered by a service zone plan by December 31, 2006.

M.G.L. c. 111C Amendments (EMS 2000) 

As you may be aware, the state law that governs the provision of emergency medical services (EMS) throughout the Commonwealth (Massachusetts General Laws Chapter 111C) was substantially amended in 2000. Among the changes (commonly known as "EMS 2000") are provisions for all cities and towns to submit to the Department of Public Health (the Department) service zone plans that define the local EMS resources and describe how those resources will be used and coordinated.  The statute allows for communities to develop service zone plans individually or, alternatively, communities may collaborate with their neighbors in submitting plans that have wider geographic coverage.  

While we would encourage you and those who have primary responsibility for oversight of EMS delivery in your community to review M.G.L. c. 111C in its entirety, we have attached Section 10, which specifically addresses service zone planning (Appendix A). It is important to note that the EMS 2000 changes, including Section 10, preserve the rights of cities and towns to establish certain local EMS response standards, to select EMS providers and to determine how available resources, including first responder resources, are utilized. It is likely that as communities focus on service zone plans, many will identify areas for improvement and will choose to make changes. Communities will have access to technical assistance from the Regional EMS Councils and the Department to assist them in making their planning decisions.

 It is important to note, however, that EMS 2000 imposes no new requirements upon communities regarding how EMS is delivered locally. Consequently, communities that choose to change their current EMS delivery systems will be responsible for the cost of those changes.   

Template for Service Zone Planning 

We have enclosed a template to assist you in developing your community's service zone plan.  While we hope you find the template helpful, we do not require that you use it. If you already have a written plan for EMS response, as, for example, a plan developed by your Local Emergency Planning Committee (LEPC) that covers all the elements listed in the regulations (See Appendix B: 105 CMR 170.510), please feel free to submit that to us. If you prefer to develop a written plan in a different format, that, too, is acceptable, provided that the document accounts for all required elements of a service zone plan. 

Service Zone Planning Process 

Municipal executives in many communities will rely on their fire and/or police chiefs to complete the service zone plan. Given the technical nature of what the plan must include and the need to coordinate EMS with all other emergency response, the involvement of fire and police chiefs is both logical and appropriate. However, municipal executives are ultimately responsible for the service zone plans in their communities. Service zone plans must be signed by the chief municipal official in each community that is a party to the plan, regardless of who prepared them. We therefore encourage executives in cities and towns to define appropriate levels for their own involvement and review 

Historically, local officials have recognized the need to involve fire and police along with the local "9-1-1” ambulance service provider in developing or revising local EMS response plans. Effective service zone must involve a broader range of participants. All ambulance services that respond to medical emergencies, including those that have contracts to respond to medical emergencies in nursing homes, assisted living facilities, special events, etc.,  need to be involved in developing service zone plans. Local hospitals and long-term care facilities, such as nursing homes, also need to participate in the process. (See 105 CMR 170.500(B)). Local officials should consider inviting to the table all parties providing health care services in their communities, including, for example, school nurses, visiting nurses and hospice personnel. 

Developing the Service Zone Plan 

The five Regional EMS Councils are available to assist you in completing your Service Zone plan. A list of the Regional EMS Councils' Executive Directors and the communities within each Region is attached (Appendix C). You may contact them prior to or at any time throughout the planning process that you want their consultation. Once you have a completed plan, you will need to submit it for technical review to the appropriate Regional EMS Council. 

Detailed instructions are provided in the template for each section of the application. Whether you choose to use the template or not, it may be helpful to review the instructions for each section to clarify what information what is being requested. The enclosed template includes the following components: 

	Part A: Contact Information; Authorized Signatures 

Part B: Service Zone Planning Process and Participants Part C: Local Service   Zone Standards 

Part D: Inventory of EMS Resources 

Part E:	Inventory of Health Care Facility Resources 

Part F:  Inventory of EMS Communications Resources 

Part G:  Medical Control Plan 

Part H: EMS Operational Plan 

In addition to supplying the information requested regarding the above components, service zones will also need to submit copies of:

(1)	Service Zone Agreements between ambulance services with provider contracts for emergency ambulance response (to nursing homes and assisted living facilities, for example), and 
(2)	Affiliation agreements for medical control for all emergency ambulance response within the service zone. 

We encourage you to contact the Executive Director in your EMS region for guidance regarding your service zone planning efforts. All Regional EMS Councils are prepared and willing to provide you technical consultation at your request. You can find a full set of the EMS regulations, 105 CMR 170.000, and more information about EMS in Massachusetts, by visiting the Office of Emergency Medical Service's website at www.mass.gov/dph/oems.