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

EMERGENCY MEDICAL SERVICES SYSTEM COLLABORATIVE MEETING

Thursday October 1st, 2015

MATTHEW CONSTANTINE DIRECTOR

INTRODUCTIONS

MATTHEW CONSTANTINE DIRECTOR

STEMI QI

August 18th, 6pm San Joaquin Hospital

Core Measures

18.8 15.3 21.7 28.8 30.8 5 10 15 20 25 30 35 August July June May April Ground On‐Scene Time

Core Measure Kern County

12.4 13.2 14 11.1 19.7 5 10 15 20 25 August July June May April Ground On‐Scene Time

Core Measures

Reported Delay August July June May April None‐ Over 10 Min

• n Scene Time

20 10 11 10 9 Extrication >20min 2 3 3 3 1 No description Other 2 2 1 1 1 Safety 1 1 3 4 Crowd 1 1 1 Vehicle Crash Calls Over 10 min On Scene Time 34(59%) 22(61%) 22(61%) 19(58%) 20(62%) Total Calls 58 36 37 34 32

Direct to Trauma Center

46 32 33 27 28 4 3 2 6 3 4 1 2 1 1 August July June May April

Direct to Trauma Center from Scene

Trauma Center Landing Zone Other Hospital

Core Measure Trauma Death In The Field

Reported Core Measure July June April March February

No noted cause of injury

2 1 3 5

Trauma Death Pronounced in Field

1 5 3 3 9

Trauma Death Transported

3 8 4 4 2

Total Trauma Deaths

4 13 7 7 11

MICU Mandatory Inventory List

Public Comment

• Public comment period closed on September

6th.

• 47 comments received
• The full list of comments and the EMS

response will be available to view on the website in the next few days.

Public Comment Summary

• There were multiple comments received that requested to define the

contents of “kits” found in the inventory list.

• Most of the “kits” are self contained pre‐packaged items and did not

need to be further defined

• Other “kits” required additional contents that were already listed in
• ther places in the list
• Additionally, we have multiple different providers who obtain

equipment from different suppliers whose “kits” may be slightly different which makes it difficult to provide a universal kit contents

• To clarify, anything that refers to a “kit” in the inventory list, requires

that it contains the minimum amount of supplies and equipment to preform whatever procedure it is designed for.

Public Comment Summary

• There where multiple comments regarding

Ace bandages, Corban wraps, eye wash, triangle bandages, and moldable splints.

• Those items are only required in the FEMP

inventory list.

• The list was updated to be more clear.

Public Comment Summary

• Many comments requested changes to terminology.
• Example: Burn sheets vs. Burn towels or Kling vs. Roller

Gauze

• No Changes made.
• Multiple comments were received about having

multiple sizes of equipment

• Example: Large and Small Laryngoscope handles
• No Change made. This inventory list is intended to

describe the minimum requirements. If providers desire to carry multiple sizes they may.

Public Comment Summary

• A few comments addressed what types of

Thermometers were acceptable. (Ear, oral, or tympanic)

• The list was adjusted to simply list

“Thermometer”. Providers may carry whatever type they want.

• Bed Pan and Urinal was removed from the non‐

transport first responder list

• Back Board requirement was adjusted to be only

1 required across the list.

Public Comment Summary

• Electrodes changed to minimum of 20 or 2

multi‐packs of at least 10

• Ped electrodes increased to at least 8 

enough for 2 patients

• 10ml NS vials adjusted  vials or preloaded

syringes

• Additionally, a few items where listed in

multiple places and were adjusted.

Public Comment Summary

• As outlined in the FEMP policy, Fire line

paramedics will be required to have 12‐lead capabilities.

• This was adjusted in the FEMP inventory

requirement with a deadline for compliance of May 1st, 2016

Next Steps: November EMCAB for approval and implementation Thank you for your responses!

ReddiNet and MCI Compliance

August Number

• f Days

B.A. Reported Number

• f Days

B.A. not reported Number

• f Days

B.A. reported >1 BHH 19 12 1 BMH 31 30 DRMC 20 11 KMC 31 24 KVH 8 23 MER 31 23 MSW 31 23 RRH 31 25 SJH 28 3 13 THD 31 29 Bed Availability Reporting

August Notice Response I D M BHH 10 8 2 2 4.55% BMH 10 5 1 7 8 18.18% DRMC 1 0.00% KMC 10 9 2 2 9 13 29.55% KVH 1 1 0.00% MER 10 6 1 1 2.27% MSW 10 9 1 1 2.27% RRH 1 1 0.00% SJCH 10 9 1 18 19 43.18% Tehach 1 1 0.00% 44 Pt Dist

EMT Provider Policy and Protocols

Title 22 Chapter 2

• § 100064. EMT Optional Skills.
• There are four (4) total approved optional skills for EMT
• Currently we only approve the use perilaryngeal airway

adjuncts

EMT Provider Optional Skills

• We added the following skills and training

requirements:

– Naloxone – Epinephrine auto‐injector – Atropine/Pralidoxime Chloride

• Perilaryngeal airway adjuncts will be the only

mandatory skill to be an approved EMT provider

EMT Protocols

• EMT Protocols have been updated to include:

– Naloxone (Altered Level of Consciousness) – Epinephrine administration by auto‐injector (Anaphylaxis and Respiratory Difficulty) – Hemostatic Dressing (Chest Trauma, Soft Tissue Injury) – Added additional information on tourniquets – Added in pulse ox consideration for oxygenation – Clarified additional Spinal Immobilization updates with Spinal Motion Restriction – Other clarifications on several protocols

Public Comment

• Public comment will start:

– Start‐ October 1st 2015 – End‐ October 30th 2015

• The EMT Provider Policy and EMT Protocols

will be available for review on our website

• Please send comments to coxja@co.kern.ca.us
• n approved comment form

Stroke System of Care

Designation & Re‐designation

Data Elements

• Added specific data elements that the EMS

Division is required to monitor.

• Also added specific demographic elements to

the hospital data requirements

Public Comment Period

October 1st, 2015 – October 30th, 2015 Please send comments to Chris Niswonger at niswongerc@co.kern.ca.us **Reminder: Please identify exactly how you would like the document to read. Questions and comments with no changes requested will not be considered.

Pulse Point

Background

• History & development process
• Joint venture PulsePoint Foundation & Physio‐Control
• Mobile App
• Runs in the background of PSAP CAD

– Push Notification/Alerts those who’ve downloaded the app & identified themselves as CPR trained – AED Companion App

• Currently operating in 1,100+ communities & 22 States

Local Research

• Status of Program

– Working as advertised – QI Process in place

• E‐survey sent to responder by PulsePoint
• 100% audit of 1st responder crews on all PulsePoint citizen notification & responses
• Issues with Citizen Responders

– None; encouraging more citizens to download app

• Unintended Consequences of PulsePoint

– Notifications are quicker then traditional CAD – Added feature of geolocating available AEDs; requires visibly checking AEDs (lightduty fire personnel used)

• Liability Issues/Concerns

– Geolocating AEDs in pvt business – County Counsel had no issue

• Notification Area

– ¼ mile

Tacoma Incident

Open Discussion

Emerging Infectious Diseases

Grant from CDPH to support pre‐ hospital providers

CDPH Grant Funding

• $270,000 given to each CAL OES Region (1‐6)
• Funding supplied to OA that houses the

RDMHS

• Grant term is 5 years

PURPOSE

• To increase pre‐hospital providers ability to treat and

transport patients who are suspected of having infectious diseases

• Created to prepare for Ebola
• Will be used for future emerging infectious diseases
• Increase Region V ability to manage multiple PUI’s

Current Status

• RFA in progress
• CDPH has approved the work plan
• Contract is going through Kern County

purchasing process and to the Board of Supervisors for signature

What’s Next?

• Interested ambulance providers will submit

applications to become one of the Regional Infectious Disease transport providers.

• Selection of up to 2 providers who demonstrate their

ability to provide service to Region V for 5 years

• Formation of the Region V Infectious Disease

Treatment/Transportation Coalition

– Will consist of Regional stakeholders

• The Coalition will then begin drafting a Regional

Transportation Plan and begin working towards work plan activities

How will the money be spent?

• Increase PPE

– PAPR’s, masks, tyvex suits

• Create Regional Transportation Plan

– Jurisdictional lines, routes to assessment centers

• Exercises & Trainings

– PPE, personnel, transfer of care, multi agency

Time Line

• Applications for ambulance providers

– November 1, 2015 – January 30, 2016

• Selection of Providers

– April 1, 2016

• Coalition formation

– April 20, 2016

• Draft Regional Transportation Plan

– July 1, 2016

Protocol Revision

Option 1‐ Stay with Current Version

Option 2 – ICEMA/SB

Option 3 – Current/Col

• r Coded

Option 4 – New Mexico

Stats

• 71 Paramedics completed the survey

(roughly 30% of our county paramedics)

• Very even mix of new and seasoned medics

that participated

19% 6% 22% 44% 17% 18% 3% 21% 42% 21% 14% 11% 8% 49% 19%

0% 10% 20% 30% 40% 50% 60%

Before a call During a call After a call During my down time Before a test

When do you review the protocols?

0‐5 Year Medics 5‐10 Year Medics 10+ Year Medics

3.5 7.2 7.8 6.6 4.3 2.4 6.4 7.8 5.8 5.8 3.1 5.2 7.8 4.6 4.6

0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0

Protocol Review Per Month Current Protocol ICEMA/SB Protocol Color Coded Current Protocol New Mexico Style

Rate the protocols on ease of use

0‐5 Year Medics 5‐10 Year Medics 10+ Year Medics

Current Status

• We are going to forgo the Focus Group

– We felt like the opinion was well captured in the survey

• We are beginning work on the protocols but are

waiting on the new 2015 AHA guidelines to be released in November‐December so we don’t have to change things twice

FIRELINE PARAMEDIC POLICY

UPDATES/CHANGES

What has changed?

• Paramedic scope of practice for Level II

procedures and medications with radio communication failure

– Removed Morphine Sulfate – Removed Valium – Revised Versed for consistency with Paramedic Protocols * Fentanyl has moved to a Level I medication, therefore is not listed

Prior to update

After Update

Changes…

• Mandatory 12 lead Capabilities

– Fire line paramedics will be required to have 12 lead capabiltities – Monitor must have the capability to print and diagnose

• Implementation Date: May 1st 2016

Other changes

• Removed Inventory List

– Can be found in Provider Mandatory Inventory List

Public Comment Period

• October 1st 2015 – October 30th 2015

CHEMPACK POLICY

UPDATE

Twissleman Incident

• Revealed that we have the ability to manage a

large event and work efficiently together

• Identified where we need to concentrate our

training

• Exposed minor gaps in the system

Gaps

• All parties need to be familiarized with

CHEMPACK

• CHEMPACK requesting process needs to be

faster

– Incidents that are a far distance – TIME is essential!!!!

What has changed

• Kern County CHEMPACK policy updated

– Kern County EMS Division was removed from the “Activation Process”

• The EMS Division shall be notified after the request has

been made.

• The EMS Division shall be informed of all aspects of the

incident and CHEMPACK status

• Notification to EMS shall not delay Chempack

Deployment

Changes…

• CHEMPACK should be requested by Incident

Commander as soon as possible through ECC.

• CHEMPACK materials should be enroute to the

scene as soon as possible by the fastest means available.

Medication Expiration Dates

• Medications in the CHEMPACK have extended

expiration dates through the Shelf Life Extension Program (SLEP) by the CDC

• May cause confusion with paramedics who

are tasked with administrating medications.

Removal of Medication

• Materials that are removed from the

CHEMPACK must be returned to the container if not used

– CDC and local pharmacist may not take responsibility of medications that are removed and unused. – No specific funding to immediately restock the CHEMPACK

• Use it wisely

Reference Table

• Table has been attached to the policy for a

quick guide

• Identifies what medications and how much to

remove based on number of patients

CHEMPACK Training Coming Soon

• Plan of action

– Revision and approval from EMCAB in November – set implementation date – Conduct train‐the‐trainer courses on CHEMPACK for hospitals, fire departments, and ambulance providers

– Kern Counties Statewide Med/Health Exercise possibly CHEMPACK

Public Comment Period

• October 1st 2015 – October 30th 2015

ANNOUNCEMENTS

MATTHEW CONSTANTINE DIRECTOR

THANK YOU FOR COMING

HAVE A GREAT MONTH

MATTHEW CONSTANTINE DIRECTOR