14 Since 1984, the Monterey County Emergency Medical Services (EMS) bureau has focused on developing a high standard for its public safety net services, including most notably, ambulance services. But ambulances are just part of this essential bureau of the Monterey County Health Department (MCHD). Before the mid-1980s, emergency services throughout Monterey County consisted of a patchwork of various private and public ambulance providers, said Teresa Rios, Emergency Medical Services Director at MCHD. “Many areas had no medical first response to help start care until the ambulance arrived. Coordination of response and patient care was limited at best,” Rios said. With the passage of the Emergency Medical Service and Emergency Medical Care Personnel Act in 1980, states across the nation were newly tasked with overseeing emergency medical services. In September 1986 the first paramedic ambulance based in Monterey County began operating on the Monterey Peninsula. In addition to standardized ambulance services, the nascent EMS department also began to tackle related tasks. “State laws require an EMS agency to have paramedics functioning in the prehospital environment,” said Rios. “All aspects of the EMS system from answering the phone at the EMS communications center, to response, patient care, and transport by first responders and transport providers, and specialty care within the hospitals are provided in a timely manner by (EMS) personnel who are qualified and trained to provide the service.” EMS operates with nine staff within a $1.8 million budget. In addition to the vast and diverse geographic area of Monterey County, Rios pointed out the fluctuation of visitors and residents to the area during tourist seasons or busy local events adds additional challenges to the department. “Most people assume the ambulance will just show up if they call 911,” said Rios. “There is a significant amount of planning and coordination that takes place.” In the last decade, EMS focused on improving outcomes on specific illnesses that improve with rapid, specialized interventions. This department developed precise services at designated hospitals to help patients suffering from STEMI (a specific type of heart attack requiring rapid care), stroke, and trauma. In 2015, EMS designated Natividad Medical Center as a Level II trauma center, further supporting better outcomes for illnesses like STEMI and installing much needed, local trauma care without leaving the county. Today, EMS also responds to opioid addiction and overdoses with medical assisted treatment. “Naloxone and buprenorphine distribution are two of the most recent evolutions keeping EMS relevant for today,” says Rios. “As EMS evolves, EMS systems become more involved in the health of the community.” Emergency Medical Services 1990 1990s The MCHD responds to the AIDS epidemic and other contemporary challenges like climate change, bullying, and obesity