To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera, 707-565-4774
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
9:35 A.M. Santa Rosa Memorial Level II Trauma Center - Sound and Air Quality Studies
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Recommended Action:
Recommended action
Receive an update on the Sound and Air Quality studies completed by Providence Santa Rosa Memorial Hospital required by the Level II Trauma Services Agreement.
end
Executive Summary:
On May 17, 2022, the Sonoma County Board of Supervisors authorized the Director of Health Services to execute an agreement with Providence Santa Rosa Memorial Hospital (SRMH) to continue Level II Trauma Designation Services for an 8-year term with an option to extend an additional 4 years. As part of the service agreement, Providence Santa Rosa Memorial Hospital agreed to conduct both a sound study and an air-quality study to assist in identifying impacts from the operation of aircrafts arriving or departing from the hospital because of the continued designation of the hospital as a Level II Trauma Center. The hospital agreed to an 18-month timeframe to complete both studies and submit final reports to the Emergency Medical Services (EMS) Agency. The Board of Supervisors directed staff to return to the Board with an update on the study and report findings. Based upon the findings in this air quality impacts study, the County of Sonoma can permit continued helicopter flights to SRMH without concerns about allowing unacceptable health and odor impacts to occur in the community due to helicopter exhaust emissions.
Report findings were submitted to the Coastal Valleys EMS Agency on August 4, 2023. This item is an informational report to the Board of Supervisors and includes a presentation of the air-quality and sound study report and findings.
Discussion:
State law requires each county to designate a local Emergency Medical Services Agency to be responsible for oversight and regulation of the local E.M.S. system. In 1981, the Board designated the Sonoma County Department of Health Services as the local EMS Agency for Sonoma County. The Department also provides local EMS Agency services for Mendocino County through an agreement approved by the Board. This two-county EMS agency is formally known as the Coastal Valleys EMS Agency.
Trauma Center
Trauma care is a key component of the regional EMS system. The trauma care program goal is to ensure an organized system of medical care for critically injured patients and includes the designation of trauma centers that provide high-level definitive medical care and rehabilitation services. Santa Rosa Memorial Hospital was selected and designated as a level II trauma center through a Request for Proposals process conducted in 1998-2000.
The original designation process for the level II trauma center began in 1998 and included a Request for Proposals (RFP) process, evaluation of the qualifications of the hospitals including utilizing an outside team of trauma care experts to review the quality of medical care and trauma services, and an environmental impact study. Upon conclusion of that R.F.P. process and the environmental study, Santa Rosa Memorial Hospital was selected and designated as a level II trauma center in 2000. The term of that initial designation was up to ten years contingent upon periodic reviews by the American College of Surgeons (ACS) and maintenance of ACS verification of meeting level II trauma center standards. SRMH has consistently maintained the required ACS verification and conditions stipulated in the terms of the Conditions of Designation established by the EMS Agency.
Near the end of each contract cycle, Coastal Valleys EMS Agency communicates with all hospitals serving within the County of Sonoma to determine if they would like to explore Level II Trauma Designation. To date, Providence Santa Rosa Memorial Hospital is the only facility that has expressed commitment in Level II Trauma Designation. Level II Trauma Designation comes with significant implementation and service costs that quickly escalate to millions of dollars.
Level II Trauma Designation Services Agreement - Air-quality and Sound Study
The provisions of the Level II Trauma Designation Services Agreement include providing the scope of services consistent with State laws and regulations and EMS Agency policies for level II trauma centers; providing appropriately trained and qualified medical professionals and associated critical care/trauma services; continued compliance with the mitigation plan developed through the environmental impact study in 2000; maintaining ACS verification as a level II trauma center; and continued participation in the regional trauma audit oversight program.
On May 17, 2022 the Sonoma County Board of Supervisors authorized the Director of Health Services to execute an agreement with Providence Santa Rosa Memorial Hospital to continue Level II Trauma Designation Services for an 8-year term with option to extend an additional 4 years. As part of the service agreement Providence Santa Rosa Memorial Hospital agreed to conduct both a sound study and an air-quality study to assist in identifying impacts from the operation of aircraft arriving at or departing from the hospital as a result of the continued designation of the hospital as a Level II Trauma Center. Agreement provisions regarding the air-quality and sound study:
• By completion of a sound study the hospital shall (1) evaluate current Caltrans identified helicopter flight paths and at least two alternative paths, and (2) identify which of the approved or alternative paths generates the least sound for persons residing in the vicinity of the hospital. The study shall be performed by a professional with the degree of skill, education, and experience commonly possessed by other sound professionals conducting similar studies.
• By completion of an air-quality study the hospital shall (1) examine the potential of trauma related flights to and from the hospital to affect air quality in the residential areas in the vicinity of the hospital, and (2) identify recommendations, if any, to respond to the study’s conclusions. The study shall be performed by a professional with the degree of skill, education, and experience commonly possessed by other air quality professionals conducting similar studies.
The hospital agreed to an 18-month timeframe to complete both studies and submit final reports to the EMS Agency. The Board of Supervisors directed staff to return to the Board with an update on the study and report findings.
Air-quality and Sound Study reports as required by the services agreement were submitted to the Coastal Valleys EMS Agency on August 4, 2023.
Air-quality Report:
The air-quality study (Attachment 1) examined the potential of trauma related flights to and from the hospital to affect air-quality in the residential areas in the vicinity of the hospital. Two (2) trauma center helicopter approach routes were reviewed, as well as one departure route. The maximum expected future hourly, daily and annual helicopter exhaust emissions modeled in this study were estimated from helicopter operation logs, from January 2001 through July 2023.
The air quality study used the United States Environmental Protection Agency (USEPA)- approved air dispersion model, AERMOD, to review the potential for residential health impacts due to helicopter jet fuel combustion exhaust, from the following criteria pollutant emissions: nitrogen dioxide (NO2), carbon monoxide (CO), fine particulate matter with diameter less than 10 microns and 2.5 microns (PM10 and PM2.5), and sulfur dioxide (SO2).
Residential cancer and non-cancer chronic and acute health risks from toxic air contaminants (TAC) emitted in helicopter jet fuel combustion exhaust were reviewed using AERMOD and the California state-approved Hot Spots Analysis and Reporting Program-Version 2 (HARP2) risk assessment model. Odors from jet fuel combustion exhaust were reviewed using modeled 1-hour average (short term) SO2 concentrations as representative for helicopter exhaust odors.
This study finds that modeled criteria pollutant concentrations in the exhaust emitted by trauma center helicopter flights at SRMH are less than the agency-approved health impact significant thresholds, and therefore, criteria pollutants are not expected to cause health impacts of concern in residential areas. Similarly, modeled cancer and non-cancer chronic and acute health risks at the residential area near SRMH are below the significance thresholds established by agencies regulating air quality, including the local Bay Area Air Quality Management District (BAAQMD). As a result, TAC emissions are not expected to cause health impacts of concern.
Modeled short-term SO2 concentrations are well below the threshold associated with the human perception of SO2 odors. As a result, odor issues in the residential areas near the hospital due to helicopter SO2 emissions, or from other components in jet fuel combustion exhaust such as organic compounds, are not expected.
The highly conservative nature of this air quality analysis and the intermittent nature of helicopter operations means that the actual air pollution health impacts on residences located near SRMH are likely to be much lower than those estimated in this study.
Based upon the findings in this air quality impacts study, the County of Sonoma can permit continued helicopter flights to SRMH without concerns about allowing unacceptable health and odor impacts to occur in the community due to helicopter exhaust emissions.
The Air-quality study was conducted by James A. Westbrook who founded BlueScape Environmental in 1997. Mr. Westbrook has 35 years of experience completing air quality impact studies for a wide range of mobile emission sources used in transportation, including heavy-duty trucks and automobiles, airborne craft, and ships. He has completed air quality studies for commercial and residential developments, ship and airports, refineries, power plans, and manufacturing facilities. Mr. Westbrook actively speaks to industry trade groups regarding air quality health studies and compliance issues. He is the co-instructor for the only publicly available training course on the Hotspots Analysis and Reporting Program (HARP) risk assessment software. His work background includes experience obtained at Kleinfelder in Pleasanton, California, Ramboll-ENVIRON in Emeryville, California. His formal education includes an M.S. in Environmental Science from Indiana University, Bloomington and a B.S. in Atmospheric Sciences from UCLA. He is a Certified Consulting Meteorologist (CCM) and is recognized as a Certified Permitting Professional (CPP) by the South Coast Air Quality Management District. Mr. Westbrook is listed as a CEQA Consultant for Air Quality by the County of San Diego, Planning Department.
Sound Study Report:
The sound study (Attachment 2) evaluated two of the current helicopter flight paths (College A and B); an inactive current flight path (Doyle Drive) and one additional path to determine which route may generate the least noise for persons residing in the vicinity of the hospital. Per the Federal Aviation Administration (FAA), the EMS Agency and County cannot dictate the routes of an aircraft, but the EMS Agency can recommend preferred flight routes into a hospital helipad through Caltrans. A total of 13 flights were recorded at six measurement positions around the hospital. Five residential neighborhoods, located at Parker and Doyle Park Drive, 435 Doyle Park Drive, behind 1224 Fair Oaks, 3rd and Pierce, and 12th and McDonald were chosen in addition to one measurement position on Sotoyome St. near Montgomery for informational purposes and to establish three measurement positions north of Santa Rosa Creek and three positions to the south. Measurements were taken continuously over a 7-day period between May 30, 2023 and June 5, 2023.
The variation in results and measured noise levels between the four flight paths was such that no single route was definitively identifiable as generating the least noise for persons residing in the vicinity of the hospital. As may be seen in the study, no single approach path consistently results in the lowest sound level in all communities. However, in the majority of neighborhoods, College B, Doyle and Montgomery routes are shown to generate the least noise for persons residing in the vicinity of the hospital.
As a result of the study, Providence SRMH leadership has been actively engaged with the EMS Agency and EMS Aircraft partners to minimize the use of the College A flight path.
The sound study was conducted by Professional Engineer, Joel A. Lewitz. Mr. Lewitz is an Acoustical Consultant and Registered Professional Engineer. A graduate of the University of Michigan Electrical Engineering program B.S, M.S,. Joel brings over 40 years of experience, managing over 1000 projects nationwide in both the public and private sectors. Project experience includes environmental sound control, acoustics, audiovisual systems, sound isolation, sound masking and speech privacy.
Community Engagement:
Providence Santa Rosa Memorial Hospital provided many community engagement opportunities since contract implementation last June 2022. The goal was to keep neighbors informed and solicit community feedback. Through the meetings, community members were able to provide recommended flight path options for the sound study and identify placement locations for the sound monitoring devices. The dates of the meetings are noted below:
• August 29, 2022 (11 participants)
• November 14, 2022 (14 participants)
• January 23, 2023 (16 participants)
• April 17, 2023 (9 participants)
• June 12, 2023 (10 participants)
• August 28, 2023 (10 participants)
Providence SRMH sent a neighborhood mailer for initial project notification, posted all public meetings on their website and communicated meeting announcements and reminders through their neighbor group email distribution list. The consultants participated in the meetings noted below:
James Westbrook: In person: 11/14/22 and 6/12/23; Virtual: 10/23/22 and 8/28/23
Joel Lewitz: In person: 11/14/22, 1/23/23, 6/12/23 and 8/28/23
Strategic Plan:
N/A
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
May 17, 2022 - Approval of Level II Trauma Services contract with Providence Santa Rosa Memorial Hospital.
April 19, 2022 - the Board approved an agreement with Santa Rosa Memorial Hospital for Level II Trauma Center Redesignation for a May 1, 2022 through April 30, 2030 term, with an option to extend for four years through April 30, 2034; and to make non-substantive changes to the agreement prior to execution; and to make non-substantive changes to the agreement prior to execution; and to make substantive change to par. 5(d) of the agreement prior to execution, so that it reads in full:
“(d) SRMH shall implement all noise attenuation and air quality improvement measures and recommendations identified in and consistent with the studies and to the extent allowable by law. Notwithstanding this paragraph, the EMS Agency may in writing extend the 18-month timeframe provided under Section 5 for the delivery of studies by up to six months for good cause shown.”
And authorized the Director of Health Services to negotiate and execute a memorandum of agreement with Santa Rosa Memorial Hospital the purpose of which is to develop improved communication and outreach to neighbors and the public.
March 22, 2022 - Board received a presentation on Emergency Medical Services Level II Trauma Center Redesignation Agreement with Santa Rosa Memorial Hospital and continued the item to April 19, 2022.
March 16, 2010 - Board approved an agreement with Santa Rosa Memorial Hospital for Level II Trauma Center services.
April 21, 1998 - EMS Agency report on trauma center Request for Proposals and Designation process.
Fiscal Summary
Narrative Explanation of Fiscal Impacts:
There are no fiscal impacts associated with this item.
Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - Air Quality Study
Attachment 2 - Noise Study
Related Items “On File” with the Clerk of the Board:
N/A