Sparks City Council Sparks City Council Consideration - - PowerPoint PPT Presentation

Sparks City Council Sparks City Council Consideration Consideration

Should Paramedic-Level Service Be Should Paramedic-Level Service Be Implemented in the Sparks Fire Implemented in the Sparks Fire Department? Department?

Two-Tiered EMS System Two-Tiered EMS System

• Designed in 1986

Designed in 1986

• First-Tier –

First-Tier – Fire Departments: ire Departments:

• Fire strategically placed within 4

Fire strategically placed within 4 minute drive time minute drive time

• Provide rapid initial care

Provide rapid initial care

• Second-Tier –

Second-Tier – REMSA Ambulances: EMSA Ambulances:

• Provide Paramedic-level service

Provide Paramedic-level service

• Provide transport

Provide transport

History of EMS In Sparks Fire Department History of EMS In Sparks Fire Department

• 1986 –

1986 – First Responder irst Responder

• 1996 –

1996 – Basic EMT-D (defibrillators) asic EMT-D (defibrillators)

• 2000 –

2000 – Advanced EMT dvanced EMT

• 2016 –

2016 – Paramedic? aramedic? *EMS is a Core Service of the Sparks Fire Department *EMS is a Core Service of the Sparks Fire Department 45% EMS 45% EMS 60% EMS 60% EMS 74% EMS 74% EMS 80% EMS 80% EMS

Is There A Need for SFD Paramedics? Is There A Need for SFD Paramedics?

• Only if SFD arrives on scene first

Only if SFD arrives on scene first

• Only if SFD waits for REMSA to arrive

Only if SFD waits for REMSA to arrive

• Only if these EMS calls are classified as

Only if these EMS calls are classified as urgent urgent

Does SFD Get to EMS Calls First? Does SFD Get to EMS Calls First?

• From January 1, 2015 through March 31, 2016, there

From January 1, 2015 through March 31, 2016, there were 11,091 EMS calls where both SFD and REMSA were 11,091 EMS calls where both SFD and REMSA responded responded

• SFD arrived first 6,705 times

SFD arrived first 6,705 times

• 60.5% of the time SFD arrived first

60.5% of the time SFD arrived first

How Long Does How Long Does SFD Wait for REMSA SFD Wait for REMSA

Calls with Wait Times 0 to 5 Minutes

5410

Calls with Wait Times 5 to 10 Minutes

922

Calls with Wait Times More Than 10 Minutes

373

Total Calls where SFD Waited

6705

Average Wait Time

0:03:24

Maximum Wait Time

1:09:25

Median Wait Time

0:02:18

Count of Matched EMS Calls

11091

% of Time SFD First on Scene

60.5%

Wait Times for Fire Department

3:50 3:50 4:47 4:47

Percent of time Percent of time that SFD is first that SFD is first

• n scene by
• n scene by

district district Average Wait Average Wait Times Times

As EMS calls occur As EMS calls occur further away from further away from the core of the City the core of the City wait times increase wait times increase

When SFD Arrives First Are Urgent EMS When SFD Arrives First Are Urgent EMS Emergencies Found? Emergencies Found?

Provider Primary Assessment Number of EMS Incidents Airway obstruction 24 Allergic reaction 35 Altered level of consciousness 421 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 326 Seizure 189 Stroke / CVA 66 Syncope / fainting 184 Traumatic injury 897 Total 2742 Urgent EMS Call Volume

Paramedic-Level EMS Service Paramedic-Level EMS Service Opportunity to Opportunity to Improve Patient Care Improve Patient Care

• SFD is arriving at EMS calls first

SFD is arriving at EMS calls first

• SFD is waiting for REMSA to arrive

SFD is waiting for REMSA to arrive

• Over 40% of these EMS calls are classified as

Over 40% of these EMS calls are classified as urgent urgent *These 2742 calls represent opportunities hese 2742 calls represent opportunities to improve patient care by providing to improve patient care by providing Paramedic-Level service immediately Paramedic-Level service immediately upon Fire’s arrival upon Fire’s arrival

Medically Speaking – Medically Speaking – Why Upgrade? hy Upgrade?

Since the inception of our Advanced EMT service in 2000, Since the inception of our Advanced EMT service in 2000, medicine and associated technology has advanced: medicine and associated technology has advanced:

• The Paramedic Scope of Practice has

The Paramedic Scope of Practice has expanded expanded much more than the Advanced scope creating a much more than the Advanced scope creating a greater gap between service levels greater gap between service levels

• Standards of Care regarding the elapsed time

Standards of Care regarding the elapsed time between recognition and definitive care for particular between recognition and definitive care for particular medical emergencies now exists for medical systems medical emergencies now exists for medical systems

EMS Certification EMS Certification Levels Levels

Advanced EMT: Advanced EMT:

• Performs Basic and a

Performs Basic and a limited set limited set of Advanced and

• f Advanced and

pharmacological interventions: pharmacological interventions:

• Some advanced airway procedures

Some advanced airway procedures

• I.V. access

I.V. access

• 8

8 medications commo medications common to EMS to EMS

EMS Certification EMS Certification Levels Levels

Paramedic: Paramedic:

• Includes Basic and Advanced skills coupled with

Includes Basic and Advanced skills coupled with invasive interventions and pharmacology: invasive interventions and pharmacology:

• Cardiac care including cardiac monitor and

Cardiac care including cardiac monitor and defibrillator capabilities defibrillator capabilities

• Pharmacological Interventions including

Pharmacological Interventions including advanced intravenous techniques and an advanced intravenous techniques and an expanded medication list expanded medication list

• Advanced airway techniques

Advanced airway techniques

Paramedic Interventions Paramedic Interventions

Cardiac: Cardiac:

• 12-Lead EKG

12-Lead EKG

• End Tidal CO

End Tidal CO2 monitoring monitoring

• Manual Defibrillation

Manual Defibrillation

• Synchronized Cardioversion

Synchronized Cardioversion

• Transcutaneous pacing

Transcutaneous pacing

• Vagal maneuvers

Vagal maneuvers

• CPR feedback and data

CPR feedback and data Airway / Medical: Airway / Medical:

• Endotracheal intubation

Endotracheal intubation

• Cricothyrotomy

Cricothyrotomy

• Needle Thoracentesis

Needle Thoracentesis

• Gastric tube placement

Gastric tube placement

• CPAP administration

CPAP administration

• Various routes of medicine

Various routes of medicine administration administration

Paramedic Medications Paramedic Medications

• Adding similar medications as

Adding similar medications as our regional partners

• ur regional partners

would quadruple our current medication list: would quadruple our current medication list:

• 13 additional cardiac emergency medications

13 additional cardiac emergency medications

• Multiple pain management medications

Multiple pain management medications

• Medications for other serious emergencies including

Medications for other serious emergencies including seizures, pregnancy problems, respiratory emergencies seizures, pregnancy problems, respiratory emergencies and altered level of consciousness and altered level of consciousness

• Medications can be tailored to our Community needs

Medications can be tailored to our Community needs

Standards of Standards of Care Care

• STEMI –

STEMI – recognition to notification to transport to ecognition to notification to transport to definitive care – definitive care – AHA recommends to strive to reduce HA recommends to strive to reduce this time as this time as much as much as possible possible

• Protocols –

Protocols – provides for most appropriate treatment rovides for most appropriate treatment

• Strokes –

Strokes – AHA promotes early recognition as HA promotes early recognition as possible possible

• Airway Management -

Airway Management - brain death can occur as rain death can occur as early early as 4 to 6 minutes without as 4 to 6 minutes without oxygen

• xygen
• Pain Management –

Pain Management – good patient care and efficiency

• od patient care and efficiency

*Core Measures and Quality *Core Measures and Quality Assurance Criteria in high Assurance Criteria in high performing EMS Systems performing EMS Systems

Paramedic-Level EMS Service Paramedic-Level EMS Service Other Reasons for Implementation Other Reasons for Implementation

• Enhanced Automatic Aid with TMFPD

Enhanced Automatic Aid with TMFPD

• Back-up plan for delivering Paramedic level care

Back-up plan for delivering Paramedic level care

• City of Sparks is

City of Sparks is a a full-service city full-service city

Recommendation Recommendation

• Statistical and medical reasons that numerous

Statistical and medical reasons that numerous

• pportunities exist to improve patient care
• pportunities exist to improve patient care
• Three other reasons to justify a

Three other reasons to justify a Paramedic program Paramedic program

• Fire Staff recommends implementation of Paramedics in

Fire Staff recommends implementation of Paramedics in the fire department the fire department

• Two plans proposed, either would be acceptable

Two plans proposed, either would be acceptable

Qu QuQuestions? Questions?ions ions