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

EMERGENCY MEDICAL SERVICES SYSTEM COLLABORATIVE MEETING

Thursday August 2, 2018

MATTHEW CONSTANTINE DIRECTOR

IN INTRODUCTIONS

MATTHEW CONSTANTINE DIRECTOR

ReddiNet

Bed Availability / MCI Response

MCI Response

April Alerts Responses BHH 2 1 BMH 2 2 DRMC 2 1 KMC 2 2 KVH 2 2 MER 2 2 MSW 2 1 RRH 2 1 AHB 2 2 Tehach 2 2

May Alerts Responses BHH 9 1 BMH 9 9 DRMC 8 5 KMC 9 8 KVH 6 5 MER 9 7 MSW 9 6 RRH 7 7 AHB 8 8 Tehach 6 3

June Alerts Responses BHH 5 BMH 5 4 DRMC 1 1 KMC 5 5 KVH 1 MER 5 4 MSW 5 2 RRH AHB 5 4 Tehach 1 1

July Alerts Responses BHH 4 4 BMH 4 4 DRMC 1 1 KMC 4 4 KVH 1 1 MER 4 4 MSW 4 4 RRH 2 2 AHB 4 4 Tehach 2 2

5 10 15 20 25 30 35 BHH BMH DRMC KMC KVH MER MSW RRH AHB Tehach 33.33% 90.00% 66.67% 96.67% 73.33% 90.00% 76.67% 93.75% 93.10% 81.25% 10 27 12 29 11 27 23 15 27 13 30 30 18 30 15 30 30 16 29 16

Year To Date

Alerts Responses

Patient Distribution

I D M Total BHH 0.00% BMH 8 8 11.43% DRMC 4 4 5.71% KMC 3 4 25 32 45.71% KVH 0.00% MER 2 2 4 5.71% MSW 1 1 1.43% RRH 2 8 10 14.29% AHB 1 10 11 15.71% Tehach 0.00% Total 70 Pt Dist

Bed Availability

April Number

• f Days

B.A. Reported Number

• f Days

B.A. not reported Number of Days B.A. reported >1 BHH

28 2 21

BMH

30 30

DRMC

30 26

KMC

30 26

KVH

6 25

MER

30 30

MSW

30 28

RRH

30 24

AHB

30 28

THD

9 21

May Number of Days B.A. Reported Number of Days B.A. not reported Number of Days B.A. reported >1 BHH 31 23 BMH 31 31 DRMC 27 4 21 KMC 31 30 KVH 5 26 MER 31 30 MSW 31 30 RRH 31 23 AHB 31 28 THD 7 24 1

June Number of Days B.A. Reported Number of Days B.A. not reported Number of Days B.A. reported >1 BHH 30 19 BMH 30 30 DRMC 29 1 19 KMC 30 27 KVH 2 28 MER 30 27 MSW 30 29 RRH 30 26 AHB 30 29 THD 10 20 4

July Number of Days B.A. Reported Number of Days B.A. not reported Number of Days B.A. reported >1 BHH 29 2 24 BMH 31 30 DRMC 27 4 17 KMC 31 27 KVH 3 28 MER 31 29 MSW 31 28 RRH 31 31 AHB 31 31 THD 5 26 3

204 211 195 207 26 211 211 211 210 75 147 207 137 183 1 202 197 186 200 18 50 100 150 200 250 BHH BMH DRMC KMC KVH MER MSW RRH AHB THD

2018

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

Date Incident # Unit Attendant *10-97 Primary Impression Base Contact Y/N Destination *10-7 *10-98 Elaspse time Rerouted to ER

Handoff to Triage Tracking

Pulse Point Statistics for July 2018

Total number of followers 4527 Total number of followers with CPR alerts enabled 2366 SCA incidents 156 SCA incidents in public location 26 CPR Alerts sent 11 Number of devices alerted to CPR needed events 23 Total number of incident notifications 720 Total number of incidents appearing in PulsePoint 7294 Followers by notification type (EOM July 2018) Structure Fire notifications enabled 853 Working Structure Fire notifications enabled 967 Vegetation Fire notifications enabled 1278 Working Vegetation Fire notifications enabled 1322 Traffic Collision notifications enabled 729 Traffic Collision Expanded notifications enabled 722 Technical Rescue notifications enabled 536 Hazmat Response notifications enabled 650 Water Rescue notifications enabled 552 NEWS notifications enabled 603 CERT notifications enabled 534 DISASTER notifications enabled 1043

CPR PUSH EVENT

Agency: Kern County (EMS1127)

Agency Incident Number: 5642018-00023352 Determinant Code: 11E01 - COMPLETE obstruction/INEFFECTIVE BREATHING Address: 329 REAL RD, STE 19, BAKERSFIELD, CA 93309 Common Place Name: LIFE HOUSE - REAL RD Call Received: 2018-07-29 14:29:24 PDT Crews dispatched: 2018-07-29 14:31:24 PDT Determinant trigger

received by PulsePoint: 2018-07-29 14:31:29 PDT (delay: 125 seconds from Call Received) Eligible responders notified 5 seconds after crews dispatched. Number of eligible responders: 1 Public Location?: YES Responder Radius: .25 mile (403 meters)

AMA Policy

Provides guidelines for:

• Who has the decision-making capacity.
• Provides examples of who does not have the decision-making

capacity (e.g., unconsciousness, mind altering substances, mental illness, and cognitive impairment).

• “AMA” what components need to be documented in the ePCR.
• “Release at Scene” what criteria must be met and what components

need to be documented.

• “Treat and Refer” an option for EMS to treat and refer non-

emergency patients and what components need to be documented.

AMA policy – Public comment period August 2nd to September 1st, 2018

ALS-BLS Handoff

November 2017- May 2018

71% 29%

Overall Compliance, Nov 2017-May 2018 (N=758)

Compliant Non Compliant

Reasons for Non-Compliance

Of the 224 hand-offs that were non-compliant…..

64% 33%

3%

144 (64%) did not document BASE CONTACT 73 (33%) had EXTENDED BLS ARRIVAL TIME

(>15 min) 6 (3%) recorded ALS INTERVENTION

Extended BLS Arrival Time

Down Time for Non-Compliant Handoffs

• Time difference between BLS unit response time and time from ALS

location to hospital (using Google Maps)

• Excluded ambulance crews in outlying areas with long transport times
• On average, waiting for a BLS unit to arrive was 8.9 minutes slower

than transporting directly to the hospital

• Based on April 2018 – June 2018 non-compliant handoffs

Distribution of Down Time for Non-Compliant Handoffs

2 4 6 8 10 12 14 16 18 20 0-5 6-11 12-17 18-23 23-28 Number of Handoffs Time (minutes)

Down Time

• Can be avoided by transporting directly to triage
• Direct-to-triage policy since April 1, 2018
• Recommendation to avoid down time:
• If unit is within 15 minutes of a hospital and estimated BLS arrival time is >15

minutes, crew should transport and bring patient directly to triage (if base concurs)

Impact of ALS-BLS Handoff

An Analysis of Ambulance Response Times in the Bakersfield Metro Area

Analysis of Impact on Response Times

• Based on call data submitted each month
• No 100 call rule
• Calculated 90th percentile of all calls
• Priority 1 and 2 metro responses
• EOA-4, EOA-5 (metro Bakersfield)
• ALS-BLS Handoff
• Implemented November 2017
• Direct to Triage
• Implemented April 2018

06:00 07:15 08:31 09:46 11:01 June July Aug Sept Oct Nov Dec Jan Feb March April May 2017 2018 Time (mm:ss)

Priority 1 Metro Reponse Times (90th Percentile)

EOA-4 EOA-5 Standard

06:00 07:16 08:32 09:48 11:04 12:20 June July Aug Sept Oct Nov Dec Jan Feb March April May 2017 2018 Time (mm:ss)

Priority 2 Metro Response Times, 90th Percentile

EOA-4 EOA-5 Standard

APOT

JUNE 2018

Agenda

• APOT-1
• Individual hospital data
• APOT-2
• Individual hospital data
• APOT and Patient Outcomes
• Review of Australian study and application to Kern County System

APOT-1: June 2018

Rank Hospital Number of Transports APOT-1 (Minutes)

1 Ridgecrest 83 22.3 2 Tehachapi 110 28.8 3 Delano 43 30.1 4 Mercy 444 36.9 5 Mercy Southwest 472 39.8 6 Kern Medical 764 42.5 7 KVHD 70 44.6 8 Adventist 1413 50.5

9

Bakersfield Heart Hospital 220 57.2

10

Bakersfield Memorial 1152 74.2

APOT-1 Bakersfield Hospitals: June 2017-June 2018

20 40 60 80 100 120 140 APOT-1 (minutes) Adventist Health Bakersfield Bakersfield Heart Hospital Bakersfield Memorial Hospital Kern Medical Mercy Hospital Mercy Southwest Hospital

APOT-1 Outlying Area Hospitals: June 2017- June 2018

5 10 15 20 25 30 35 40 45 50 June July Aug Sept Oct Nov Dec Jan Feb March April May June APOT-1(minutes) Delano Regional Medical Center Kern Valley Healthcare District Ridgecrest Regional Tehachapi Hospital

APOT-2

Individual Hospital Data

APOT-2: June 2018

Hospital

2.1 (N, %)

(<=20 min)

2.2 (N, %)

(21-60 min)

2.3 (N, %)

(61-120 min)

2.4 (N, %)

(121-180 min)

2.5 (N, %)

(>180 min)

Total Number of Transports Bakersfield Heart 97 (44.1) 103 (46.8) 16 (7.3) 3 (1.4) 1 (0.5) 220 Bakersfield Memorial 343 (29.8) 635 (55.1) 143 (12.4) 29 (2.5) 2 (0.2) 1152 Kern Medical 331 (43.3) 413 (54.1) 18 (2.4) 0(0) 1 (0.1) 764 Adventist Health 583 (41.3) 732 (51.8) 85 (6.0) 13 (0.9) 0 (0) 1413 Mercy Southwest 266 (56.4) 193 (40.9) 12 (2.5) 1 (0.2) 0 (0) 472 Mercy 224 (50.9) 211 (48.0) 5 (1.1) 0 (0) 0 (0) 445 KVHD 45 (62.3) 24 (34.3) 1 (1.4) 0 (0) 0 (0) 70 Tehachapi 73 (33.4) 37 (33.6) 0 (0) 0 (0) 0 (0) 110 Delano 24 (55.8) 19 (44.2) 0 (0) 0 (0) 0 (0) 43 Ridgecrest 74 (89.2) 9 (10.8) 0 (0) 0 (0) 0 (0) 83

Adventist: June 2017-June 2018

500 1000 1500 2000 2500 10 20 30 40 50 60 70 80 90 100 June July Aug Sept Oct Nov Dec Jan Feb March April May June Transport Volume Percent of Total Transports (%) 2.1 2.2 2.3 2.4 2.5 Total Volume

Bakersfield Memorial: June 2017-June 2018

200 400 600 800 1000 1200 1400 1600 1800 2000 10 20 30 40 50 60 70 80 90 100 June July Aug Sept Oct Nov Dec Jan Feb March April May June Transport Volume Percent of Total Transports 2.1 2.2 2.3 2.4 2.5 Transport Volume

Bakersfield Heart Hospital: June 2017-June 2018

50 100 150 200 250 300 350 400 10 20 30 40 50 60 70 80 90 100 July Aug Sept Oct Nov Dec Jan Feb March April May June Total Transport Volume Percent of Total Transports 2.1 2.2 2.3 2.4 2.5 Transport Volume

Kern Medical: June 2017-June 2018

200 400 600 800 1000 1200 1400 10 20 30 40 50 60 70 80 90 100 June July Aug Sept Oct Nov Dec Jan Feb March April May June Transport Volume Percent of Total Transports (%) 2.1 2.2 2.3 2.4 2.5 Transport Volume

Mercy: June 2017-June 2018

100 200 300 400 500 600 700 800 900 10 20 30 40 50 60 70 80 90 100 June July Aug Sept Oct Nov Dec Jan Feb March April May June Transport Volume Percent of all Transports (%) 2.1 2.2 2.3 2.4 2.5 Total Volume

Mercy SW: June 2017-May 2018

100 200 300 400 500 600 700 800 900 10 20 30 40 50 60 70 80 90 100 June July Aug Sept Oct Nov Dec Jan Feb March April May June Transport Volume Percent of Total Transports (%) 2.1 2.2 2.3 2.4 2.5 Total Volume

Delano: June 2017- June 2018

50 100 150 200 250 300 350 400 450 500 10 20 30 40 50 60 70 80 90 100 June July Aug Sept Oct Nov Dec Jan Feb March April May June Transport Volume Percent of Total Transports (%)

Delano APOT-2: June - December 2017

2.1 2.2 2.3 2.4 2.5

Tehachapi: June 2017-June 2018

20 40 60 80 100 120 140 160 10 20 30 40 50 60 70 80 90 100 June July Aug Sept Oct Nov Dec Jan Feb March April May June Transport Volume Percent of Total Transports (%) 2.1 2.2 2.3 2.4 2.5 Total Volume

KVHD: June 2017-June2018

20 40 60 80 100 120 140 160 180 200 10 20 30 40 50 60 70 80 90 100 June July Aug Sept Oct Nov Dec Jan Feb March April May June Transport Volume Total Percent of Transports (%) 2.1 2.2 2.3 2.4 2.5 Transport Volume

Ridgecrest: June 2017-June 2018

50 100 150 200 250 300 350 10 20 30 40 50 60 70 80 90 100 June July Aug Sept Oct Nov Dec Jan Feb March April May June Number of Transports Percent of Total Transports (%) 2.1 2.2 2.3 2.4 2.5 Total Volume

APOT and Patient Outcomes

Review of an Australian Study on patient outcomes and ambulance offload delays in emergency departments

Background

• Ambulance offload delay is an emerging issue world-wide that is

affecting care quality, patient safety, and resource availability for both EDs and ambulance providers

• In the US, the national wait time doubled from 20 minutes to 45

minutes from 2006-2014

• Patient-level consequences have not been well studied, but it is

hypothesized that offload delays could lead to delays in definitive care, poor pain control, increased morbidity, and increased mortality

• Understanding when delays are most likely to occur may guide quality

improvement efforts

Source: https://emsa.ca.gov/wp-content/uploads/sites/47/2017/07/Toolkit-Reduce-Amb-Patient.pdf

Australian Study

• Objective: to describe and compare characteristics and outcomes or

patients who arrive by ambulance to ED

• Compare patients with a delayed ambulance (<30) offload time with those

who were not delayed

Methods

• Retrospective study in 3 major public hospitals in Queensland,

Australia

• Patients
• Ambulance users from September 2007-2008
• Linked data from 3 separate databases: ambulance, ED, and hospital

discharge

• Compared outcomes for ambulance offload times designated

“delayed” or “non-delayed”

• Delayed: >30 min

Results: Patient Demographics

• Total Patient Population: 40,783
• 6,122 (15%) experienced offload delay
• Patients who experienced offload delays compared to those who did

not experience delays were:

• Older
• Transported during evening shift (between 15 and 22.59hr)
• Transported on a Friday
• Transported during winter months

Results: Patient Demographics (Hospital B)

Characteristic Non-delayed n=12711 (74.1%) Delayed n=4444 (25.9%) P-value (non- delayed vs delayed) Median Age 42 (22-64) 52 (32-72) <0.001 Shift Presentation Morning Evening Night 38.7% 36.9% 24.4% 43.1% 46.1% 10.8% <0.001 Weekday/Weekend Weekday Weekend 69.2% 30.8% 77.1% 22.9% <0.001 Season Summer Autumn Winter Spring 28.6% 23.2% 21.2% 27.0% 23.4% 24.1% 28.6% 23.9% <0.001

Results: Patient Outcomes

• Overall, patients offloaded within 30 min had better outcomes for:
• Time to triage
• Ambulance time at ED
• Time to see healthcare professional
• Being seen within triage scale time frame
• ED length of stay for both admitted and non-admitted patients
• Admission rates (for 1 out of 3 hospitals)
• Median hospital length of stay (for 1 out of 3 hospitals)
• No statistically significant differences for in-hospital mortality rates

Results: Patient Outcomes (Hospital B)

Outcome Non-delayed n=12711 (74.1%) Delayed n=4444 (25.9%) P-value (non- delayed vs delayed) Seen within Triage Scale Time Frame (n, %) 4758 (39.4%) 1034 (23.9%) <0.001 Median ED LOS (min) 265 357 <0.001 Admitted (n, %) 4121 (32.4%) 1651 (37.2%) <0.001 Median hospital LOS (days) 2 3 <0.001 In-hospital mortality, all admits (n, %) 144 (3.5%) 56 (3.4%) 0.848

Conclusions

• Off load delays affect how quickly patients can access medical care
• Off load delays may also affect hospital functioning
• Potential for more higher admission rates and longer hospital stays for those

with longer delays

• Off load delays may not have an affect on mortality rates for all

admissions

Limitations

• Hospital system evaluated in study may not be generalizable to Kern

County System

• Lack of comparisons within specific patient groups/diagnostic or

triage categories

Kern County System

January – June 2018

Queensland System

• Overall, 6,122 (15%) transports

experienced delays

• Median age of delayed vs. non-

delayed: 52 vs. 42

• Experienced highest percent of

delays on weekdays

Kern County System

• Overall, 12,199 (30.8%)

transports experienced delays

• Median age of delayed vs. non-

delayed: 58 vs. 53

• Experienced highest percent of

delays on weekdays

VS

The largest proportion of acute care visits arrive via ambulance during the weekdays.

100 200 300 400 500 600 Monday Tuesday Wednesday Thursday Friday Saturday Sunday Number of acute care interactions Total Visits Ambulance Tranports

Despite Sunday being the busiest day for acute care visits, most offload delays occur Wednesday-Friday

Overall Delayed

5 10 15 20 25 30 35 Monday Tuesday Wednesday Thursday Friday Saturday Sunday Percent of Transports

References

• Crilly, J., Keijzers, G., Tippett, V., Odwyer, J., Lind, J., Bost, N., . . .

Wallis, M. (2015). Improved outcomes for emergency department patients whose ambulance off-stretcher time is not

• delayed. Emergency Medicine Australasia,27(3), 216-224.

doi:10.1111/1742-6723.12399

• https://emsa.ca.gov/wp-content/uploads/sites/47/2017/07/Toolkit-

Reduce-Amb-Patient.pdf

Opioid Overdose Epidemic

National and local data

National Data

Centers for Disease Control and Prevention

Drug Overdose Death Data

• Opioids were involved in 42,249 deaths in 2016
• 5X higher than 1999
• States with the highest opioid-related death rates in 2016:
• West Virginia, Ohio, New Hampshire, Pennsylvania, and Kentucky
• CA did not experience a statistically significant increase in opioid-

related deaths between 2010 and 2016

Source: https://www.cdc.gov/drugoverdose/data/statedeaths.html

Synthetic Opioids

• Synthetic opioids (Fentanyl and Fentanyl analogs) were the most

common type of opioid involved in overdose deaths for 2015-2016

• Geographically clustered east of the Mississippi River
• Fentanyl powder is more readily mixed with white powder heroin than black

tar heroin

• Becoming increasingly available with non-opioid drugs
• Benzodiazepines, counterfeit opioid pills, ketamine, cocaine, and

methamphetamine

Source: https://content.govdelivery.com/accounts/USCDC/bulletins/1fdd9bf

What does this mean to EMS?

• CA recorded 373 fentanyl overdose deaths in 2017 (19% of all opioid
• verdose deaths)
• Suggests fentanyl /fentanyl analogs are not a huge issue yet
• CDC recommends the following:
• Use extreme caution when handling unknown substances and white powders
• If fentanyl is suspected, multiple doses of naloxone may be needed to

properly treat patient

Opioid Overdose Data: Kern County

California Opioid Dashboard

ePCR data

N=659

*Rate is per 100,000 population based on 2017 estimates

According to EMS call data, male les are more likely to overdose than females.

252, 38% 407, 62%

Female Male

The highest rate of EMS calls for opioid overdose is in the 25 25-29 29 year old age group.

20 40 60 80 100 120 140 160 180 Rate (per 100,000)

*Rates calculated from population based on 2017 estimates

Although we see a higher rate of calls in 25 25-29 yea ear old

• lds,

55 55-59 year old

• lds account have higher rates of hospital discharges for opioid-related

issues

Data from 2016

0.0 50.0 100.0 150.0 200.0 250.0 300.0 350.0 400.0 Rate (per 100,000)

According to *state data (2017), the 50 50-55 55 age group experiences the highest rate of opioid-related deaths

*Estimated crude death rate for 2017https://discovery.cdph.ca.gov/CDIC/ODdash/

5 10 15 20 25 30 Rate (per 100K)

Differences in *Estimated Crude Death Rates, by Opiate and Age Group (N=71)

*Data provided by: https://discovery.cdph.ca.gov/CDIC/ODdash/

2.91 7.98 4.67 1.69 1.88 11.94 5.93 4.66 8.97 5 10 15 20 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Rate (per 100K)

Heroin

1.52 7.28 1.33 3.38 9.39 5.86 7.96 19.76 11.64 4.11 9.41 5 10 15 20 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Rate (per 100K)

Prescription

For More Information about Kern County and California Opioid Overdose Deaths:

• https://discovery.cdph.ca.gov/CDIC/ODdash/
• State and County Dashboards
• Note the “Technical Notes” while interpreting data comparing Kern County to California

Narcan Use and Opioid Overdose

EMS Data

Percent of Calls where Narcan was used, by Age Group

10 20 30 40 50 60 70 80 90 Percent (by age group)

Patient Status after Administration of Narcan, by Age Group (N=331)

10 20 30 40 50 60 Number of Patients Age Group Unchanged Improved

Individual Zip Code Data

Where are overdoses occurring?

Where are Overdoses Occurring?

• Investigated zip codes with highest number or rate of EMS calls for
• verdose
• Did the overdose occur in a private residence vs public area?
• Based on incident address and zip code
• Google mapped the incident address
• Public area
• Parks, businesses, intersections, hotels
• Private residence
• If address of a house or apartment was listed

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 93268 93308 93307 Tehachapi Area 93306 Percent of Calls (by zip code)

Location of Incident, by Zip Code

Home Public Correctional Facility Other

Questions? Comments?

Sources

• https://www.cdc.gov/drugoverdose/data/statedeaths.html
• https://www.cdc.gov/drugoverdose/epidemic/index.html
• https://content.govdelivery.com/accounts/USCDC/bulletins/1fdd9bf
• https://discovery.cdph.ca.gov/CDIC/ODdash/

Mandatory Paramedic Update Training & Emergency Preparedness Division Changes

Mandatory Paramedic Update Training

THE UPDATE ON THE UPDATE May 21st, 2018 thru May 25th, 2018 Doctor’s and Nurse’s from Specialty care facilities as guest speakers at every class presentation 8 classes of 4 hour duration presented through the week with an average of 27 individuals per class Survey and quiz available the week following the update training with C.E.’s provided and a make-up online class for those who were excused and could not attend in person 217 Paramedics Attended in person and 21 attended the online make up course To date 139 individuals returned only the survey, 99 individuals have returned the survey and taken the quiz and received C.E.’s

Mandatory Paramedic Update Training Topics

• LOCAL ACCREDITATION
• I-GEL
• CORE MEASURES
• ALS TO BLS HANDOFF/TRANSPORT DIRECTLY TO ED WAITING ROOM
• NOTIFICATION OF DEATH TRAINING
• CHEMPACK
• PROTOCOL CHANGES/NEW PROTOCOL FORMAT – EPI ADMIN/ D-10 RAPID BOLUS

INFUSION/INTUBATION

• ePCR REVIEW/DOCUMENTATION

Mandatory Paramedic Update Training Topics

• STEMI SPECIALITY CENTER – Nursing Staff presented; CASE STUDIES, EARLY STEMI

ALERT NOTIFICAITON, 12-LEAD ECG CRITERIA, C/P & ACS PROTOCOL, THROMBOLYTIC BYPASS CHECKLIST, STEMI ALERT

• PEDIATRIC SPECIALITY CENTER – Katy Harker RN, Dignity Health; CASE STUDIES,

PEDIATRIC ANATOMY, RESPIRATORY DISTRESS vs RESPIRATORY FAILURE

• TRAUMA SPECIALTIY CENTER – Dr. Ruby Skinner, MD, Trauma Medical Director Kern

Medical Center; CASE STUDIES, PELVIC/LIVER/ABDOMINAL BLUNT TRAUMA/INJURY, PRE HOSPTIAL ULTRASOUND, PRE HOSPITAL TXA (TRANRXAMIC ACID), TRAUMA ALERT

• STROKE SPECIALITY CENTER – Joshua Pierce, EMS Coordinator, Bakersfield Memorial

Hospital; SIGNS & SYMPTOMS, TYPES OF STROKES, EMS INVOLVEMENT, TIMELINE OF TREATMENTS, STROKE RECEIVING CENTERS, STROKE SCALE, CASE STUDIES, STROKE ALERT

KCPHSD Emergency Preparedness (EP)Division

• The Kern County Public Health Services Department is

restructuring the EP Division into Financing and EMS Departments.

• The Emergency Preparedness Division has been

streamlined into Grants & Contracts sections placed under KCPHSD Financing and the HCC Coalition along with KMRC have been placed within the EMS Department.

Evolving Emergency Preparedness (EP) Division

HPP (Hospital Preparedness Program) is funded through the Assistant Secretary for Prevention and Response (ASPR); within the Department

• f Health and Human Services (HHS)

The HPP program involves;

• HCC Health Care Coalition meetings
• Support Healthcare preparedness for disasters and additional surge

capacity and an all-hazard disaster preparedness approach

• The HCC Coalitions are focused on facilitating an integrated and

coordinated response across the local area

• Developing PPA Partner Participation Agreement with subcommittee

hospital providers and coalition members.

EMS DEPARTMENT RESPONSIBILITES

• CHARLES BROCKETT
• HPP COORDINATOR

(HOSPTIAL PREPAREDNESS PROGRAM)

• HCC COALITION MEETINGS
• PPA (PARTNER PARTICIPATON

AGREEMENT)

• HPP PLAN SUBMITTAL TO STATE
• TABLETOP EXERCISE
• STATE WIDE MEDICAL HEALTH

EXERCISE (SWMHE)

• KIM TOLLISON
• KMRC VOLUNTEER COORDINATOR

(KERN MEDICAL RESERVE CORPS)

• ANNUAL REVIEW OF VOLUNTEER

LIST AND CLARIFYING MEMBERS

• OPEN HOUSE FOR VOULUNTEERS

TO MEET EMS DEPARTMENT REPS.

• WORKING CLOSELY WITH STATE TO

DEVELOP VOULNTEER DEPLOYMENT EXERCISES

Emergency Preparedness Department HPP COORDINATOR

• Engages with local hospitals, clinics, SNF’s, LTC’s to prepare, plan, and

exercise for response in coordination with Kern County Public Health Services Department, EMS, and Environmental Health.

• The HPP (Hospital Preparedness Program) Grant supports healthcare

coalition members’ preparedness activities, supplies, and equipment.

• Develop and foster PPA (Partner Participation Agreements) with the

KCHCC (Kern County Health Care Coalition) and encourage initiation and continued participation through quarterly meetings, tabletop and (SWMHE) functional exercises.

• Coordinate HVA (Hazard Vulnerability Assessments) Plans with HCC
• partners. Develop “Wish Lists” for HCC Coalition members for use in

disaster event preparedness.

HPP Grant Agreements PPA Requirements

• Health care system partners (hospitals/clinics) require an agreement

to be in place to request HPP grant funding assistance.

• Partners must fulfill requirements (HCC meeting attendance, exercise

participation, etc.) of Partner Participation Agreements (PPA).

• Awards are based on grant funding limitations and grant purchasing

guidelines.

• All supplies/equipment purchased with grant funds are considered

mutual aid. The agreement with the partners outlines their responsibility to provide annual inventory/disposition of all grant purchases.

New Protocol Format

BENEFITS

• SINGLE SET OF PROTOCOLS FOR ALL PRE-HOSPITAL PROVIDERS
• PROVIDES CONSISTENCY, REMOVES GAPS IN CARE AND PROVIDER

KNOWLEDGE FROM ONE LEVEL TO THE NEXT

• PARAMEDICS WILL BE RESPONSIBLE FOR BLS AND ALS SECTIONS

NEW FORMAT EXAMPLE

PARAMEDIC PRECEPTOR

• THE DIVISION WILL BE ASSUMING DIRECT RESPONSIBILITY FOR

VETTING, TRAINING AND MONITORING PARAMEDIC PRECEPTORS.

• THIS WILL BE A MULTI STEP PROCESS THAT INCLUDES

1. INTERVIEWS 2. E-PCR REVIEWS 3. PATIENT CARE AUDITS 4. LOCAL SYSTEMS KNOWLEDGE 5. DIRECT OBSERVATION 6. MANDATED PRECEPTOR TRAINING

EXPANDED ROLE OF PRECEPTORS

• PRECEPTORS WILL BE THE FIRST GROUP TO RECEIVE AND TEST NEW

PROTOCOLS, CLINICAL SYSTEM CHANGES, BEST PRACTICE ADDITIONS OR ALTERATIONS TO FIELD CARE, ETC.

• WILL ASSIST THE DIVISION WITH ASSIGNED EMT AND PARAMEDIC

REMEDIATION

• THE PRECEPTOR POLICY WILL BE PLACED ON THE WEBSITE FOR PUBLIC

COMMENT

ALS FIRST RESPONDER POLICY

• THE CURRENT NON-TRANSPORT AGENCY ALS FIRST RESPONDER POLICIES

ARE BEING CONSOLIDATED INTO ONE POLICY

• MULTIPLE POLICIES SERVE NO PURPOSE
• KERN COUNTY FIRE PINE MOUNTAIN CLUB, CALIFORNIA CITY FIRE AND

BAKERSFIELD CITY FIRE INDIVIDUAL POLICIES ARE NOW ONE DOCUMENT

• THIS POLICY WILL BE PLACED ON THE WEBSITE FOR PUBLIC COMMENT

MICU INVENTORY LIST

• THE MANDATORY PROVIDER INVENTORY LIST IS BEING REVISED AND

CONSOLIDATED

• MANY OF THE FIRST RESPONDER LISTS ARE BEING REVISED FOR

CLARITY

• SOME OF THE LISTS ARE BEING DELETED, FOR EXAMPLE FIXED WING

AIRCRAFT

HANDTEVY UPDATE

• THE DIVISION IS MOVING FORWARD WITH THE ADOPTION OF THE

HANDTEVY SYSTEM FOR KERN COUNTY

• CURRENTLY WE ARE LOOKING FOR FUNDING TO MOVE FORWARD
• SYSTEM WIDE IMPLEMENTATION OF THE ELECTRONIC SYSTEM WITH

MEDICATION GUIDES AND A LENGTH BASED TAPE BACKUP WILL COST $38,438.62.

• THIS SYSTEM IS NOT JUST FOR PEDIATRICS, IT ALSO INCLUDES ADULT

DOSING GUIDELINES

• THE HANDTEVY SYSTEM INTERFACES WITH AND DIRECTLY UPLOADS TO

MOST CHARTING SYSTEMS, INCLUDING ESO

Sunday, July 15th

ANNOUNCEMENTS

MATTHEW CONSTANTINE DIRECTOR

THANK YOU FOR COMING

MATTHEW CONSTANTINE DIRECTOR