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

EMERGENCY MEDICAL SERVICES SYSTEM COLLABORATIVE MEETING

Thursday October 5, 2017

MATTHEW CONSTANTINE DIRECTOR

INTRODUCTIONS

MATTHEW CONSTANTINE DIRECTOR

ARE WE PREPARED?

Turnover Patient Care Authority

10.Turn Over of Patient Care Authority A paramedic may transfer patient care authority to a BLS transport ambulance, when all of the following circumstances exist:  The BLS ambulance is immediately available.  ALS care has not been initiated.  It has been determined that ALS care is unneeded during transport.  Patients must be stable with medical complaints that can be cared for at the BLS level.  ALS assessment tools may be utilized (i.e. ECG 3- and 12 Lead cardiac monitor) in order to fully assess the patient and determine eligibility for turnover to BLS.  Patient airway, maintained without assistance or adjuncts.

• The patient must be hemodynamically stable. Vital signs

should be within the normal range for age.

• The patient must be of their normal mental status and

not impaired because of alcohol or substances.

• No mechanism of injury that would warrant a trauma

activation.

• No cardiac, respiratory, or neurological complaints that

may warrant ALS intervention.

• The EMT must be comfortable with the patients’

condition and accept the transfer of care.

• Base contact shall be made and must concur with

handoff.

• Both the ALS unit and the BLS unit MUST complete a

patient care report.

• Provider agency shall audit all ALS to BLS transfer of care

and provide a written report to the EMS agency monthly.

 Both the ALS unit and the BLS unit MUST complete a patient care report.  Provider agency shall audit all ALS to BLS transfer of care and provide a written report to the EMS agency monthly.

11.

Critical Care nurses may turn patients over to paramedics. These patients must not have or require any medications or therapies that are outside of the paramedics scope of practice.

32B02- Data Assessment Response Configuration: Unknown Problem – Medical Alarm Current: ALS Code 3 Response (Priority 2) Fire Response 2016 2015 2014 Cumulative Cumulative % Total 1158 1150 1040 3348 Transport 291 263 239 793 23.7% ALS 51 95 79 225 6.7%

Analysis of Primary Impression for ALS Patients

Analysis GCS of ALS treated patients

ReddiNet

Bed Availability / MCI Response

MCI Response

August Alerts Responses BHH 7 4 BMH 7 6 DRMC 3 2 KMC 7 7 KVH 5 2 MER 7 6 MSW 7 4 RRH 6 4 SJCH 5 5 Tehach 4 1

September Alerts Responses BHH 5 5 BMH 5 3 DRMC 2 1 KMC 5 5 KVH 2 1 MER 5 5 MSW 5 4 RRH 2 1 SJCH 5 5 Tehach 2

10 20 30 40 50 60 70 BHH BMH DRMC KMC KVH MER MSW RRH SJCH Tehach 56.90% 68.33% 70.37% 86.89% 65.38% 78.33% 62.71% 70.37% 94.74% 12.00% 33 41 19 53 17 47 37 19 54 3 58 60 27 61 26 60 59 27 57 25

Year To Date

Alerts Responses

Patient Distribution

I D M Total BHH 0.00% BMH 2 14 16 8.42% DRMC 1 3 4 2.11% KMC 13 23 63 99 52.11% KVH 0.00% MER 1 20 21 11.05% MSW 1 13 14 7.37% RRH 9 9 4.74% SJCH 1 18 19 10.00% Tehach 8 8 4.21% Total 190 Pt Dist

Bed Availability

August Number of Days B.A. Reported Number of Days B.A. not reported Number of Days B.A. reported >1 BHH 31 24 BMH 31 30 DRMC 30 1 23 KMC 31 26 KVH 14 17 MER 31 27 MSW 31 27 RRH 31 27 SJH 31 28 THD 30 1 28 Bed Availability Reporting

September Number of Days B.A. Reported Number of Days B.A. not reported Number of Days B.A. reported >1 BHH 29 1 19 BMH 30 29 DRMC 29 1 17 KMC 29 1 24 KVH 3 27 MER 30 26 MSW 30 28 RRH 30 25 SJH 30 25 THD 29 1 26 Bed Availability Reporting

September 30th = 273 Day of Year

200 273 266 260 92 272 270 272 272 259 84 258 195 222 1 240 238 231 248 234 50 100 150 200 250 300 BHH BMH DRMC KMC KVH MER MSW RRH SJH THD

2017

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

AMBULANCE PATIENT OFFLOAD TIMES

August and September 2017

APOT ‐ 1

Bakersfield Heart Hospital Bakersfield Memorial Hospital Delano Regional Medical Center Kern Medical Kern Valley Healthcare District Mercy Hospital Mercy Southwest Hospital Ridgecrest Regional San Joaquin Community Hospital Tehachapi Hospital EMS System Total (Aggregate) Hospital Transports 90th Percentile APOT Time 366 53.09 1775 85.81 464 26.8 1264 49.13 162 16 823 48.46 778 51.77 257 7 2285 58.52 138 28.93 8312 August

APOT – 2

Bakersfield Heart Hospital Bakersfield Memorial Hospital Delano Regional Medical Center Kern Medical Kern Valley Healthcare District Mercy Hospital Mercy Southwest Hospital Ridgecrest Regional San Joaquin Community Hospital Tehachapi Hospital 2.1 Within 20 minutes 2.2 Between 21 and 60 minutes 2.3 Between 61 and 120 minutes 2.4 Between 121 and 180 minutes 2.5 Greater than 180 minutes Hospital transp % transp % transp % transp % transp % 142 39% 194 53% 25 7% 2 1% 3 1% 551 31% 895 50% 263 15% 47 3% 19 1% 374 81% 87 18% 3 1% 0% 0% 442 35% 760 60% 56 4% 5 0% 1 0% 151 93% 9 6% 2 1% 0% 0% 350 43% 430 52% 36 4% 3 0% 4 0% 357 46% 371 48% 46 6% 4 1% 0% 255 99% 2 1% 0% 0% 0% 645 28% 1422 62% 186 8% 23 1% 9 0% 93 67% 45 33% 0% 0% 0% August 2.4 2.5 2.1 2.2 2.3

APOT ‐ 1

Bakersfield Heart Hospital Bakersfield Memorial Hospital Delano Regional Medical Center Kern Medical Kern Valley Healthcare District Mercy Hospital Mercy Southwest Hospital Ridgecrest Regional San Joaquin Community Hospital Tehachapi Hospital EMS System Total (Aggregate) Hospital Transports 90th Percentile APOT Time 372 46.96 1731 69.83 407 25.93 1130 48.1 133 14.86 764 42.6 711 53.92 185 5.02 2097 57.05 123 32.53 7653 September

APOT – 2

Bakersfield Heart Hospital Bakersfield Memorial Hospital Delano Regional Medical Center Kern Medical Kern Valley Healthcare District Mercy Hospital Mercy Southwest Hospital Ridgecrest Regional San Joaquin Community Hospital Tehachapi Hospital 2.1 Within 20 minutes 2.2 Between 21 and 60 minutes 2.3 Between 61 and 120 minutes 2.4 Between 121 and 180 minutes 2.5 Greater than 180 minutes Hospital transp % transp % transp % transp % transp % 176 47.31 179 48.12 17 4.57 555 32.06 946 54.65 195 11.27 28 1.62 7 0.4 347 85.26 54 13.27 6 1.47 429 37.96 649 57.43 49 4.34 2 0.18 1 0.09 123 92.48 10 7.52 349 45.68 389 50.92 23 3.01 3 0.39 328 46.13 325 45.71 46 6.47 8 1.13 4 0.56 182 98.38 3 1.62 688 32.81 1230 58.66 163 7.77 16 0.76 81 65.85 41 33.33 1 0.81 September 2.4 2.5 2.1 2.2 2.3

Thrombectomy Capable Stroke Centers

• The Joint Commission has released draft

language

• Creates a carve out for TCSC’s that is above a

Primary Stroke Center but less than a Comprehensive

Designation

• Require the facility to obtain certification

through The Joint Commission before being locally designated

• Added – Neurosurgeon or Neurointerventialist

shall not be “on‐call” for multiple facilities at any given time.

Transport Destination

• Start with the Cincinnati Stroke Scale like

normal.

– If Positive, they move to the Cincinnati Stroke Severity Scale – If, they score 2 or more on that scale, the patient gets transported to a TCSC – If, they score less than 2, they get transported to any Primary Stroke Center

CP Stroke Severity Scale

• CONJUGATE GAZE DEVIATION: (2 Points)
• Force full deviation of BOTH eyes to one side or the other
• Eyes will not pass midline
• ASK PATIENT AGE AND CURRENT MONTH: (1 Point)
• Both Correct (0 Points)
• One Correct or Neither Correct (1 Point)
• INSTRUCT PATIENT TO HOLD ARMS UP FOR 10

SECONDS: (1 Point)

• Can Do (0 Points)
• Can’t Do (1 Point)

Public Comment Period

• October 6th – November 24th 2017

Statewide Medical Health Exercise

• Table top was September 27th

– 70 people attended from approx. 30 organizations

• The Functional Exercise will be:

– November 15th – 9:00am – 2:00pm – Hotwash 1‐2 with lunch included – If you plan on participating please send me an email and I will get you appropriate info

ANNOUNCEMENTS

MATTHEW CONSTANTINE DIRECTOR

THANK YOU FOR COMING

HAVE A GREAT MONTH

MATTHEW CONSTANTINE DIRECTOR