MATTHEW CONSTANTINE DIRECTOR EMERGENCY MEDICAL SERVICES SYSTEM COLLABORATIVE MEETING Thursday October 1st, 2015
MATTHEW CONSTANTINE DIRECTOR INTRODUCTIONS
STEMI QI August 18 th , 6pm San Joaquin Hospital
Core Measures April 30.8 May 28.8 June 21.7 July 15.3 August 18.8 0 5 10 15 20 25 30 35 Ground On ‐ Scene Time
Core Measure Kern County April 19.7 May 11.1 June 14 July 13.2 August 12.4 0 5 10 15 20 25 Ground On ‐ Scene Time
Core Measures Reported Delay August July June May April None ‐ Over 10 Min 20 10 11 10 9 on Scene Time Extrication >20min 2 3 3 3 1 No description 2 2 1 1 1 Other Safety 0 1 1 3 4 Crowd 0 1 1 1 0 Vehicle Crash 0 0 0 0 0 Calls Over 10 min 34(59%) 22(61%) 22(61%) 19(58%) 20(62%) On Scene Time Total Calls 58 36 37 34 32
Direct to Trauma Center Direct to Trauma Center from Scene Trauma Center Landing Zone Other Hospital 46 33 32 28 27 6 4 4 3 3 2 2 1 1 1 August July June May April
Core Measure Trauma Death In The Field Reported July June April March February Core Measure No noted 2 0 1 3 5 cause of injury Trauma Death 1 5 3 3 9 Pronounced in Field Trauma Death 3 8 4 4 2 Transported Total Trauma 4 13 7 7 11 Deaths
MICU Mandatory Inventory List
Public Comment • Public comment period closed on September 6 th . • 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 other 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 1 st , 2016
Next Steps: November EMCAB for approval and implementation Thank you for your responses!
ReddiNet and MCI Compliance
Bed Availability Reporting Number Number Number of Days of Days of Days B.A. B.A. B.A. not reported Reported reported >1 August BHH 19 12 1 BMH 31 0 30 DRMC 20 11 0 KMC 31 0 24 KVH 8 23 0 MER 31 0 23 MSW 31 0 23 RRH 31 0 25 SJH 28 3 13 THD 31 0 29
August Pt Dist Notice Response I D M BHH 10 8 0 0 2 2 4.55% BMH 10 5 0 1 7 8 18.18% DRMC 1 0 0 0 0 0 0.00% KMC 10 9 2 2 9 13 29.55% KVH 1 1 0 0 0 0 0.00% MER 10 6 0 0 1 1 2.27% MSW 10 9 1 0 0 1 2.27% RRH 1 1 0 0 0 0 0.00% SJCH 10 9 0 1 18 19 43.18% Tehach 1 1 0 0 0 0 0.00% 44
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 1 st 2015 – End ‐ October 30 th 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 on 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 1 st , 2015 – October 30 th , 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 1 st 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
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