[PPT] - EMERGENCY MEDICAL SERVICES SYSTEM COLLABORATIVE MEETING Thursday PowerPoint Presentation

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EMERGENCY MEDICAL SERVICES SYSTEM COLLABORATIVE MEETING

Thursday November 3, 2016

MATTHEW CONSTANTINE DIRECTOR

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INTRODUCTIONS

MATTHEW CONSTANTINE DIRECTOR

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EMD QI

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Jul-16 Hall ECC Total Number of Cases Reviewed 105 228 333 High Compliance 100 175 82.6% Compliance 2 43 13.5% Partial Compliance 2 3 1.5% Low Compliance 1 0.3% Non-Compliant 1 6 2.1% Processed Calls 918 7364 8282

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Aug-16 Hall ECC Number of Cases Reviewed 105 216 321 High Compliance 100 165 82.6% Compliance 2 31 10.3% Partial Compliance 2 9 3.4% Low Compliance 0.0% Non-Compliant 1 11 3.7% Processed Calls 984 7043 8027

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911 to Hospitals

7/8/2016 26-A-02 San Joaquin to Mercy SW Hospital
7/9/2016 06-D-02 Kern Medical to San Joaquin

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EMD v. 13.0

EMD v. 13.0 started on October 1st as planned.

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Trauma Evaluation Committee October 19th 2016

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Core Measures- State

25.4 18.6 18.9 19 26.7 5 10 15 20 25 30 September August July June May Ground On-Scene Time- 90th Percentile

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Core Measure- Kern County

16.3 14.7 14.6 18.4 13.1 5 10 15 20 September August July June May Ground On-Scene Time- 90th Percentile

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Core Measures- Kern County

13.3 12.5 13.2 11 12.5 5 10 15 September August July June May Ground On-Scene Time- Average…

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Core Measure- Kern County

11.4 9.6 10 10.6 9.6 8.5 9 9.5 10 10.5 11 11.5 12 September August July June May Ground On-Scene Time- Average Filtered

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Core Measures

Reported Delay September August July June May None- Under 10 Min 11 9 21 13 20 None- Over 10 Min 8 7 12 12 7 Other- Description 8 4 6 1 2 Other- No Description Safety/Crowd/Staff 2 3 4 Language Barrier Extrication >20min 3 Distance/Vehicle Crash 1 Other Hospital 2 Reporting Error Extremis Calls Over 10 min (%) 13(56%) 24(53%) 14(51%) 12(37%) Total Calls 29 23 45 27 32

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Direct to Trauma Center

29 23 43 27 32 1 4 5 6 4 2 September August July June May

Direct to Trauma Center from Scene

Trauma Center Landing Zone Other Hospital

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Trauma Evaluation Committee

Next meeting-

– November 16th 2016 – Meeting begins at 1400Hrs. – Public Health Building- Mojave Conference Room

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ReddiNet

Bed Availability / MCI Response

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MCI Response

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Oct. Notice Response BHH 9 9 BMH 9 5 DRMC 1 1 KMC 9 8 KVH MER 9 7 MSW 9 5 RRH SJCH 9 8 Tehach

SLIDE 22 10 20 30 40 50 60 BHH BMH DRMC KMC KVH MER MSW RRH SJCH Tehach 76.47% 50.98% 64.29% 90.00% 83.33% 68.63% 48.00% 37.50% 96.08% 77.78% 39 26 9 45 5 35 24 3 49 7 51 51 14 50 6 51 50 8 51 9

Year To Date

Alerts Responses

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Patient Distribution

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I D M Total BHH 0.00% BMH 31 31 17.82% DRMC 2 6 8 4.60% KMC 11 12 66 89 51.15% KVH 0.00% MER 1 1 4 6 3.45% MSW 9 9 5.17% RRH 4 4 2.30% SJCH 17 17 9.77% Tehach 10 10 5.75% Total 174 Pt Dist

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Bed Availability

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October Number of Days B.A. Reported Number of Days B.A. not reported Number of Days B.A. reported >1 BHH 25 6 6 BMH 31 31 DRMC 28 3 17 KMC 31 29 KVH 17 14 4 MER 31 28 MSW 31 27 RRH 31 26 SJH 31 30 THD 30 1 29 Bed Availability Reporting

SLIDE 27 238 305 284 304 114 304 304 304 305 302 70 283 177 296 18 265 263 255 293 285 50 100 150 200 250 300 350 BHH BMH DRMC KMC KVH MER MSW RRH SJH THD

2016

Number of Days B.A. Reported Number of days B.A. reported >1

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Ambulance Patient Offload Times

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Ambulance Destination Decision Policies and Procedures

Added Ambulance Patient Offload Times to Appendix 4

– Maximum Off-Load Times at Emergency Departments

Revised Appendix 5 for consistency

– Criteria for Offloading Patients to the ED Waiting Room

Public Comment Period

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Defined

Patient Transfer

– EMSAAC adopted definition – The patient is off the ambulance gurney – Verbal report is given – The RN signs the ePCR – The paramedic/EMT timestamps the patient transfer field

Simultaneous
In presence of hospital and EMS crew

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Added to Policy

Definitions:

– Added multiple definitions. Consistent with State guidance. – APOT 1, and APOT 2 metrics defined

Time Standard:

– Adopt State benchmark of 20 minutes

Quality Assurance:

– Added sentinel events

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NEMSIS

Data Dictionary

NHTSA v3.4.0

Build 160713 Critical Patch 2

EMS Data Standard

Version Date: July 13, 2016

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SLIDE 36 eCustomConfiguration.01 Custom Data Element Title KC EMD eCustomConfiguration.02 Custom Definition KC Map Key eCustomConfiguration.03 Custom Data Type KC Trauma Activation eCustomConfiguration.04 Custom Data Element Recurrence KC EOA eCustomConfiguration.05 Custom Data Element Usage KC Dispatch Priority eCustomConfiguration.06 Custom Data Element Potential Values KC ZONE eCustomConfiguration.07 Custom Data Element Potential NOT Values (NV) KC eCustomConfiguration.08 Custom Data Element Potential Pertinent Negative Values (PN) KC eCustomConfiguration.09 Custom Data Element Grouping ID KC eDispatch.03 EMD Card Number KC 09E01 eDispatch.04 Dispatch Center Name or ID KC eTimes.02 Dispatch Notified Date/Time KC eTimes.16 EMS Call Completed Date/Time KC ePatient.04 Middle Initial/Name KC ePatient.18 Patient's Phone Number KC

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eScene.02 Other EMS or Public Safety Agencies at Scene KC eScene.03 Other EMS or Public Safety Agency ID Number KC eScene.04 Type of Other Service at Scene KC eSituation.18 Date/Time Last Known Well KC eArrest.19 Date/Time of Initial CPR KC eHistory.07 Environmental/Food Allergies KC eHistory.09 Medical History Obtained From KC eHistory.18 Pregnancy KC eHistory.19 Last Oral Intake KC eVitals.09 Mean Arterial Pressure KC eVitals.11 Method of Heart Rate Measurement KC eVitals.13 Pulse Rhythm KC eVitals.15 Respiratory Effort KC eVitals.25 Temperature Method KC eVitals.32 APGAR KC

SLIDE 38 eExam.03 Date/Time of Assessment KC eExam.04 Skin Assessment KC eExam.05 Head Assessment KC eExam.06 Face Assessment KC eExam.07 Neck Assessment KC eExam.08 Chest/Lungs Assessment KC eExam.10 Abdominal Assessment Finding Location KC eExam.11 Abdomen Assessment KC eExam.12 Pelvis/Genitourinary Assessment KC eExam.13 Back and Spine Assessment Finding Location KC eExam.14 Back and Spine Assessment KC eExam.15 Extremity Assessment Finding Location KC eExam.16 Extremities Assessment KC eExam.17 Eye Assessment Finding Location KC eExam.18 Eye Assessment KC eExam.19 Mental Status Assessment KC eExam.20 Neurological Assessment KC eMedications.11 Medication Authorization KC eProcedures.04 Size of Procedure Equipment KC eProcedures.11 Procedure Authorization KC

SLIDE 39 eAirway.05 Tube Depth KC eDivice.02 Date/Time of Event (per Medical Device) KC eDivice.03 Medical Device Event Type KC eDivice.06 Medical Device Mode (Manual, AED, Pacing, CO2, O2, etc) KC eDivice.07 Medical Device ECG Lead KC eDivice.08 Medical Device ECG Interpretation KC eDivice.09 Type of Shock KC eDivice.10 Shock or Pacing Energy KC eDivice.11 Total Number of Shocks Delivered KC eDivice.12 Pacing Rate KC eDisposition.13 How Patient Was Moved to Ambulance KC eDisposition.14 Position of Patient During Transport KC eDisposition.15 How Patient Was Transported From Ambulance KC eDisposition.26 Disposition Instructions Provided KC eOther.02 Potential System of Care/Specialty/Registry Patient KC eOther.03 Personal Protective Equipment Used KC eOther.04 EMS Professional (Crew Member) ID KC eOther.07 Natural, Suspected, Intentional, or Unintentional Disaster KC eOther.12 Type of Person Signing KC eOther.13 Signature Reason KC eOther.14 Type Of Patient Representative KC eOther.15 Signature Status KC eOther.19 Date/Time of Signature KC

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CARES

Cardiac Arrest Registry to Enhance Survival

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What is CARES?

Developed by the CDC in collaboration with Emory University and the AHA
Figure out how to improve survival from sudden cardiac arrest (non-

traumatic)

Registry developed to help LEMSAs and Medical Directors

– Find out who is affected – When cardiac arrest occur – Where cardiac arrest occur – Determine if system elements are functioning or not – Identify changes to improve sudden cardiac arrest survival

Internet based database with real-time feedback

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Data

EMS

– Data can be entered via desktop by EMS or Provider – Automatic extraction from ePCR

Hospital

– Contact at hospital would have to answer 4-5 questions through computer

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Good to Know

Database is secured to protect PHI
No HIPAA considerations
Once patient EMS records are matched with hospital, PHI is

scrubbed

EMS generate Survival reports, response reports, and

demographic reports

Used to promote health, monitor system changes to improve
utcomes, benchmarking with state and national participants

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Support

The Joint Commission
American Heart Association
The Red Cross
Centers for Disease Control and Prevention
King County EMS
National Association of EMS Physicians
Pan-Asian Resuscitation Outcomes Study

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Implementation

2017

– NEMSIS 3.4 implemented – Changes to Resuscitation policies implemented – Reduction of transport – CARES (grant funded) – Added to general QI activities of Division

mycares.net

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Cardiac Arrest Resuscitation

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?

Who ho shall shall liv live Who ho shall shall die die

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Disparity

All rhythm survival (communities with

ver 100 arrests annually)

3% to 30%

10 fold disparity

VF witnessed (communities with over 20 witnessed VF arrests) 4% to 62%

15 fold disparity

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0-10%

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50%

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55%

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in survival from VF cardiac arrest?

Why

such a large difference

is there

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Patient Event System

Factor actors s Whic hich h Det Deter ermine Sur mine Survival vival From

m Car

Cardiac diac Ar Arrest est

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Patient Event System

Factors Which Determine Survival From Cardiac Arrest

Gender Age Co-morbidity

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Patient Event System

Factors Which Determine Survival From Cardiac Arrest

Witnessed collapse Location Rhythm

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Patient Event System

Factors Which Determine Survival From Cardiac Arrest

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Patient Event System

Factors Which Determine Survival From Cardiac Arrest

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Recognition Rapid dispatch

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Community CPR training Telephone-CPR HP-CPR Digital alert of nearby rescuer Community mandatory CPR training

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Public access defibrillation Police defibrillation Digital alert of nearby rescuer Community AED responders

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Airway control Medications

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Heart cath for STEMI Targeted temperature Invasive vascular support

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Is it Quantitative?

Quantitative Factors

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Is it Quantitative?

Quantitative and Qualitative Factors

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Time to and quality of the interventions determine the outcomes

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Survival from Cardiac Arrests King County: 2005-2015 Witnessed VF Rhythm

Time to first shock Time to CPR 0-8 min 9-12 min 13+ min 0-4 min

64% 41% 30%

5-8 min

49% 27% 12%

9+min

N/A 10% 0%

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Typical Urban Response Timeline

00:30 02:17 03:44 PSAP Handling Turnout 00:30 01:47 01:27 Travel 09:16 05:32 At Scene Shock 01:00-02:00 01:00-02:00 09:16-11:16 11:16- 13:16

6

Dispatch With Patient Wheels roll

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Synergy Between T-CPR and HP- CPR

T-CPR slows the dying process

– Sooner it begins the better

HP-CPR virtually suspends the dying

process

– Allows time for additional shocks and ALS to succeed

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THE SLOPE OF DEATH

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THE SLOPE OF DEATH

T-CPR

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THE SLOPE OF DEATH

T-CPR HP-CPR Defibrillation

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100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 1 2 3 4 5 6 7 8 9 10 Minutes

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Assumptions

Dispatch time: 2 minutes Turnout time: 1 minute Travel time to scene: 4 minutes Scene to patient and start of HP-CPR: 1.5 min. HP-CPR to defibrillation: 1.5 minutes

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Under Performing

No HP-CPR Almost no T-CPR/bystander CPR Very few early AED applications No rapid dispatch 10% survival from VF

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100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 1 2 3 4 5 6 7 8 9 10 Minutes EMT CPR Defib Turn out At patient side Dispatch At scene

Under Performing: No T-CPR, no HP-CPR, no Rapid Dispatch

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Average Performing

HP-CPR Late T-CPR Occasional early AED application No rapid dispatch 30% survival from VF

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100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 1 2 3 4 5 6 7 8 9 10 Minutes HP-CPR Defib Turn out At patient side Dispatch At scene T-CPR Average Performing: Delay in T-CPR, no Rapid Dispatch

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Best Practices

100% HP-CPR 75% T-CPR AED applied < 6 minutes 5% of the time Rapid dispatch 50% survival from VF

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100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 1 2 3 4 5 6 7 8 9 10 Minutes HP-CPR Defib Turn out At patient side Rapid dispatch At scene T-CPR Best Practices: Rapid Dispatch, T-CPR, HP-CPR

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Aspirational

100% HP-CPR Rapid dispatch 75% T-CPR AED applied < 6 minutes 50% of the time 75% survival from VF

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100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 1 2 3 4 5 6 7 8 9 10 Minutes Turn out At patient side Stabilize Rapid Dispatch + Activation of AED alert At scene Defib by targeted responder Aspirational: Targeted AED Responder 75%

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TIME

The great healer or the great

destroyer

We measure life in years but

resuscitation in seconds

Life is finite, death is eternal,

between the two we have about 10 minutes

Time Time

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ANNOUNCEMENTS

MATTHEW CONSTANTINE DIRECTOR

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THANK YOU FOR COMING

HAVE A GREAT MONTH

MATTHEW CONSTANTINE DIRECTOR