Con Conside sidera ration tion Sho hould uld Pa Para ramedic - - PowerPoint PPT Presentation

Sp Spark rks s Ci City ty Cou Counci ncil l Con Conside sidera ration tion

Sho hould uld Pa Para ramedic medic-Level Level Service ervice Be Be Imp mplemented lemented in in the S the Spa parks rks Fir ire e Dep epartment? rtment?

Two-Tiered Tiered EM EMS Sy S System tem

• Designed

igned in 1986 86

• Firs

rst-Tier Tier – Fire re Depar partm tments ents:

• Fir

ire e strat ateg egic icall ally y pla laced ed wit ithin hin 4 mi minute nute dri rive ve time me

• Provide

vide rapid id initi itial al care

• Second

cond-Tier Tier – REMSA SA Am Ambulan bulances: ces:

• Provide

vide Paramedic edic-lev level el serv rvice ice

• Provide

vide tran ansport port

His isto tory ry of EM f EMS I S In Sp Spark rks s Fir ire De Department rtment

• 1986

86 – First t Responder ponder

• 1996

96 – Basic ic EMT-D D (defibrillators) efibrillators)

• 2000

00 – Adva vance nced EMT

• 2016

16 – Paramedic? edic? *EMS S is is a a Core

• re Serv

rvic ice e of f the Spar arks ks Fi Fire re Depar partmen tment 45% % EMS 60% % EMS 74% % EMS 80% % EMS

Is There re A Ne Need ed fo for SF r SFD Par D Parame medi dics? cs?

• On

Only y if f SFD ar arri rive ves on scene ene fi first rst

• On

Only y if f SFD wai aits ts fo for r REMSA SA to ar arri rive ve

• On

Only ly if if these se EMS S cal alls ls ar are cla lassified ssified as as ur urgent gent

Do Does s SF SFD Ge D Get t to EM EMS Ca S Call lls Fir irst?

• Fro

rom m Jan anua uary ry 1, , 2015 15 through rough Mar arch h 31, , 2016, 16, there re were re 11,0 ,017 17 EMS cal alls ls where ere both th SFD D an and REMSA SA re responded sponded an and both th ar arri rived ved on sc scene ne

• SFD

D ar arri rive ved d fi firs rst t 6,6 ,656 56 time mes

• 60.4

.4% % of f the time me SFD ar arri rive ved d fi firs rst

How Long Do Does s SF SFD W D Wait it fo for RE r REMSA SA

Calls with Wait Times 0 to 5 Minutes

5384

Calls with Wait Times 5 to 10 Minutes

912

Calls with Wait Times More Than 10 Minutes

360

Total Calls where SFD Waited

6656

Average Wait Time

0:03:22

Maximum Wait Time

1:09:25

Median Wait Time

0:02:17

Count of Matched EMS Calls

11017

% of Time SFD First on Scene

60.4%

Wait Times for Fire Department

3:50 4: 4:47 47

Pe Perc rcent ent of ti f time me that SF SFD is D is fi firs rst

• n scene

ene by dis istric rict Ave verag rage e Wait it Tim imes

As As EMS cal alls s occur ccur fu furt rther her aw away ay fr from m the core re of f the e Cit ity y wai ait t time mes s increase rease

When n SF SFD Ar D Arri rive ves s Fir irst t Are re Urg rgent nt EM EMS S Em Emerge rgenci ncies es Found? d?

Provider Primary Assessment Number of EMS Incidents Airway obstruction 24 Allergic reaction 35 Altered level of consciousness 419 Cardiac arrest 74 Cardiac rhythm disturbance 51 Chest pain / discomfort 283 Diabetic symptoms (hypoglycemia) 114 Hyperthermia 6 Hypothermia 2 Hypovolemia / shock 16 Poisoning / drug ingestion 35 Pregnancy / OB delivery 16 Respiratory arrest 3 Respiratory distress 325 Seizure 189 Stroke / CVA 66 Syncope / fainting 183 Traumatic injury 886 Total 2727 Urgent EMS Call Volume

Pa Para ramed medic ic-Le Level vel EM EMS Se S Serv rvic ice Opport rtuni unity ty to Imp mpro rove ve Pa Patie ient nt Ca Care re

• SFD

FD is is ar arri riving ving at at EMS cal alls ls fi first rst

• SFD

D is wai aiting ting fo for r REMSA MSA to ar arri rive ve

• Ov

Over r 40% % of f these se EMS cal alls ls ar are clas assified sified as as urg rgent ent *Thes ese e 2727 27 cal alls ls re repres resent ent oppo port rtunities nities to imp mprove rove pat atient ent car are by pr y providing viding Par aram amedic edic-Lev Level el se serv rvice ice im immedia mediately tely upon Fire’s arrival

Medic icall ally y Sp Speaking ing – Why Upgra rade? de?

Sin ince ce the in inception ception of f our r Ad Adva vanced nced EMT se serv rvice ice in in 2000, 00, me medic icine ine an and as associat ciated ed technolog chnology y has as ad adva vanced: nced:

• The

e Par aram amedi edic c Scope

• pe of

f Pra ractice tice has as expan panded ed mu much ch mo more re than an the e Ad Adva vanced nced sc scope pe cre reating ating a a gr great ater er ga gap betwee tween n serv rvice ice leve vels ls

• Standa

andards rds of f Car are e re regar gardin ding g the ela lapsed sed tim ime e betwee tween re recognit cognitio ion n an and definitive finitive car are fo for r par articular icular me medic ical al eme mergenc rgencies ies now w exists sts fo for r me medic ical al sys ystems ems

EM EMS Ce S Cert rtif ific icati ation

• n Levels

vels

Ad Adva vanced nced EMT: T:

• Performs

rforms Bas asic ic an and a l a limite mited d set of f Ad Adva vanced nced an and phar arma macolo cological gical in inter tervention ventions: s:

• Some

me advanc nced ed airwa way proce

• cedure

dures

• I.V

.V. . access ess

• 8 medications

ications common mmon to EMS

EM EMS Ce S Cert rtif ific icati ation

• n Levels

vels

Par aram amedic edic:

• Includes

cludes Bas asic ic an and Ad Adva vanced nced skills ls coupl upled ed with th inva vasive ive inter terventions ventions an and phar armacolog macology: y:

• Car

ardiac diac car are including cluding car ardiac diac mo monitor nitor an and defibrillator fibrillator cap apabilities abilities

• Phar

arma macolo cological gical Intervention erventions s in includin cluding g ad adva vanced nced intrav ravenous enous techniques chniques an and an an expan panded ed me medica dicatio tion n list

• Ad

Adva vanced nced ai airw rway ay techniques chniques

Pa Para ramed medic ic Inter terventio ventions ns

Car ardiac: diac:

• 12

12-Lead Lead EKG KG

• End

d Tidal al CO2 mo monitoring nitoring

• Man

anua ual l Defibrillation fibrillation

• Syn

ynchronized chronized Car ardioversion dioversion

• Tra

ranscu scutane taneous us pac acing ing

• Vag

agal al ma maneuv euvers ers

• CPR

R fe feedback dback an and dat ata Ai Airwa rway y / Medic ical: al:

• Endotrac

dotrache heal l intubation ubation

• Cricothyrotomy

icothyrotomy

• Needl

edle e Thora

• race

centes ntesis is

• Gastric

ric tube e place cement ment

• CPAP

P ad adminis ministration tration

• Various
• us routes

tes of f medicine dicine ad admi ministr nistration ation

Pa Para ramed medic ic Medic icati ations

• ns
• Ad

Addin ing g si similar milar me medic ications ations as as ou

• ur

r re regional gional par artners ners would

• uld quadruple

adruple our r current rrent me medication ication list:

• 13 ad

additional itional car ardiac diac eme mergency rgency me medic ications ations

• Multiple

tiple pai ain n ma manag agement ement me medica dications tions

• Medic

ication ations s fo for r other her seriou rious s eme mergencies rgencies including cluding se seizur izures, es, pre regnanc gnancy y problems, roblems, re respir spiratory atory eme mergenci rgencies es an and al altered red leve vel l of f consciousness

• nsciousness
• Medic

ication ations s can an be tai ailore lored d to our r Commu mmunity nity needs eds

St Standards rds of Car f Care

• STEMI

EMI – re recognition cognition to notification tification to tra ransport sport to definiti finitive ve car are – AH AHA A re recomm commends ends to st stri rive ve to re reduce uce this s time me as as mu much ch as as possib ible le

• Pro

roto toco cols ls – pro rovides vides fo for r mo most st ap appropriate ropriate tre reatment atment

• Stro

rokes kes – AH AHA A pro romote motes ear arly y re recognition cognition as as po possible ssible

• Ai

Airw rway ay Man anag agement ement - bra rain in death ath can an occur ccur as as ear arly y as as 4 to 4 to 6 mi minutes nutes wit itho hout ut oxyge ygen

• Pai

ain Man anag agement ement – go good

• d patient

ient care and eff ffici icien ency cy *Core

• re Meas

asures ures an and Qu Qual ality ity As Assurance rance Crite riteria ria in high gh performing rforming EMS S Sys ystems tems

Pa Para ramed medic ic-Level Level EM EMS Se S Serv rvic ice Other er Reasons sons fo for Im r Imple lement mentati tion

• n
• Enha

hanced nced Au Automatic

• matic Ai

Aid with th TMFPD PD

• Bac

ack-up up plan an fo for r delivering livering Par aram amedic edic leve vel l car are

• City

ty of f Spar arks ks is a f a full-service ervice city

Recomme

• mmendat

datio ion

• Stat

atistical istical an and me medica dical l re reas asons

• ns that

at numerous merous

• ppo

portu rtunities ities exist ist to im improve rove pat atie ient t car are

• Thre

ree e other her re reas asons

• ns to justify

tify a P a Par aram amedic edic pro rogra gram

• Fi

Fire re Staf aff f re recomm

• mmend

ends s im impleme lementation ntation of f Par aram amedics edics in in the fi fire re department partment

• Two

wo plan ans pro roposed, posed, either ther would uld be ac acceptable eptable

Qu QuQues Questions? tions?ions ions