MATTHEW CONSTANTINE DIRECTOR EMERGENCY MEDICAL SERVICES SYSTEM COLLABORATIVE MEETING Thursday November 3, 2016
MATTHEW CONSTANTINE DIRECTOR INTRODUCTIONS
EMD QI
Jul-16 Hall ECC Total Number of Cases Reviewed 105 228 333 High Compliance 100 175 82.6% Compliance 2 43 13.5% Partial Compliance 2 3 1.5% Low Compliance 0 1 0.3% Non-Compliant 1 6 2.1% Processed Calls 918 7364 8282
Aug-16 Hall ECC Number of Cases Reviewed 105 216 321 High Compliance 100 165 82.6% Compliance 2 31 10.3% Partial Compliance 2 9 3.4% Low Compliance 0 0 0.0% Non-Compliant 1 11 3.7% Processed Calls 984 7043 8027
911 to Hospitals • 7/8/2016 26-A-02 San Joaquin to Mercy SW Hospital • 7/9/2016 06-D-02 Kern Medical to San Joaquin
EMD v. 13.0 • EMD v. 13.0 started on October 1 st as planned.
Trauma Evaluation Committee October 19 th 2016
Core Measures- State May 26.7 June 19 July 18.9 August 18.6 September 25.4 0 5 10 15 20 25 30 Ground On-Scene Time- 90th Percentile
Core Measure- Kern County May 13.1 June 18.4 July 14.6 August 14.7 September 16.3 0 5 10 15 20 Ground On-Scene Time- 90th Percentile
Core Measures- Kern County May 12.5 June 11 July 13.2 August 12.5 September 13.3 0 5 10 15 Ground On-Scene Time- Average…
Core Measure- Kern County May 9.6 June 10.6 July 10 August 9.6 September 11.4 8.5 9 9.5 10 10.5 11 11.5 12 Ground On-Scene Time- Average Filtered
Core Measures Reported Delay September August July June May None- Under 10 Min 20 11 9 21 13 None- Over 10 Min 8 7 12 12 7 Other- Description 2 8 4 6 1 Other- No Description 0 0 0 0 0 Safety/Crowd/Staff 0 2 3 4 0 Language Barrier 0 0 0 0 0 Extrication >20min 3 0 0 0 0 Distance/Vehicle Crash 0 0 0 1 0 Other Hospital 0 0 0 2 0 Reporting Error 0 0 0 0 0 Extremis 0 0 0 0 0 Calls Over 10 min (%) 13(56%) 24(53%) 14(51%) 12(37%) Total Calls 29 23 45 27 32
Direct to Trauma Center Direct to Trauma Center from Scene Trauma Center Landing Zone Other Hospital 43 32 29 27 23 6 5 4 4 2 1 0 0 0 0 September August July June May
Trauma Evaluation Committee • Next meeting- – November 16 th 2016 – Meeting begins at 1400Hrs. – Public Health Building- Mojave Conference Room
ReddiNet Bed Availability / MCI Response
MCI Response
Oct. Notice Response BHH 9 9 BMH 9 5 DRMC 1 1 KMC 9 8 KVH 0 0 MER 9 7 MSW 9 5 RRH 0 0 SJCH 9 8 Tehach 0 0
Year To Date 60 50 40 30 Alerts Responses 20 10 0 BHH BMH DRMC KMC KVH MER MSW RRH SJCH Tehach 76.47% 50.98% 64.29% 90.00% 83.33% 68.63% 48.00% 37.50% 96.08% 77.78% 39 26 9 45 5 35 24 3 49 7 51 51 14 50 6 51 50 8 51 9
Patient Distribution
Pt Dist I D M Total BHH 0 0 0 0 0.00% BMH 0 0 31 31 17.82% DRMC 0 2 6 8 4.60% KMC 11 12 66 89 51.15% KVH 0 0 0 0 0.00% MER 1 1 4 6 3.45% MSW 0 0 9 9 5.17% RRH 0 4 0 4 2.30% SJCH 0 0 17 17 9.77% Tehach 0 0 10 10 5.75% Total 174
Bed Availability
Bed Availability Reporting Number of Number of Number of Days Days Days B.A. B.A. B.A. not reported >1 Reported reported October BHH 25 6 6 BMH 31 0 31 DRMC 28 3 17 KMC 31 0 29 KVH 17 14 4 MER 31 0 28 MSW 31 0 27 RRH 31 0 26 SJH 31 0 30 THD 30 1 29
2016 Number of Days B.A. Reported Number of days B.A. reported >1 350 305 305 304 304 304 304 302 296 293 300 285 284 283 265 263 255 250 238 200 177 150 114 100 70 50 18 0 BHH BMH DRMC KMC KVH MER MSW RRH SJH THD
Ambulance Patient Offload Times
Ambulance Destination Decision Policies and Procedures • Added Ambulance Patient Offload Times to Appendix 4 – Maximum Off-Load Times at Emergency Departments • Revised Appendix 5 for consistency – Criteria for Offloading Patients to the ED Waiting Room • Public Comment Period
Defined • Patient Transfer – EMSAAC adopted definition – The patient is off the ambulance gurney – Verbal report is given – The RN signs the ePCR – The paramedic/EMT timestamps the patient transfer field • Simultaneous • In presence of hospital and EMS crew
Added to Policy • Definitions: – Added multiple definitions. Consistent with State guidance. – APOT 1, and APOT 2 metrics defined • Time Standard: – Adopt State benchmark of 20 minutes • Quality Assurance: – Added sentinel events
NEMSIS Data Dictionary NHTSA v3.4.0 Build 160713 Critical Patch 2 EMS Data Standard Version Date: July 13, 2016
eCustomConfiguration.01 Custom Data Element Title KC EMD eCustomConfiguration.02 Custom Definition KC Map Key eCustomConfiguration.03 Custom Data Type KC Trauma Activation eCustomConfiguration.04 Custom Data Element Recurrence KC EOA eCustomConfiguration.05 Custom Data Element Usage KC Dispatch Priority eCustomConfiguration.06 Custom Data Element Potential Values KC ZONE eCustomConfiguration.07 Custom Data Element Potential NOT Values (NV) KC eCustomConfiguration.08 Custom Data Element Potential Pertinent Negative Values (PN) KC eCustomConfiguration.09 Custom Data Element Grouping ID KC eDispatch.03 EMD Card Number KC 09E01 eDispatch.04 Dispatch Center Name or ID KC eTimes.02 Dispatch Notified Date/Time KC eTimes.16 EMS Call Completed Date/Time KC ePatient.04 Middle Initial/Name KC ePatient.18 Patient's Phone Number KC
eScene.02 Other EMS or Public Safety Agencies at Scene KC eScene.03 Other EMS or Public Safety Agency ID Number KC eScene.04 Type of Other Service at Scene KC eSituation.18 Date/Time Last Known Well KC eArrest.19 Date/Time of Initial CPR KC eHistory.07 Environmental/Food Allergies KC eHistory.09 Medical History Obtained From KC eHistory.18 Pregnancy KC eHistory.19 Last Oral Intake KC eVitals.09 Mean Arterial Pressure KC eVitals.11 Method of Heart Rate Measurement KC eVitals.13 Pulse Rhythm KC eVitals.15 Respiratory Effort KC eVitals.25 Temperature Method KC eVitals.32 APGAR KC
eExam.03 Date/Time of Assessment KC eExam.04 Skin Assessment KC eExam.05 Head Assessment KC eExam.06 Face Assessment KC eExam.07 Neck Assessment KC eExam.08 Chest/Lungs Assessment KC eExam.10 Abdominal Assessment Finding Location KC eExam.11 Abdomen Assessment KC eExam.12 Pelvis/Genitourinary Assessment KC eExam.13 Back and Spine Assessment Finding Location KC eExam.14 Back and Spine Assessment KC eExam.15 Extremity Assessment Finding Location KC eExam.16 Extremities Assessment KC eExam.17 Eye Assessment Finding Location KC eExam.18 Eye Assessment KC eExam.19 Mental Status Assessment KC eExam.20 Neurological Assessment KC eMedications.11 Medication Authorization KC eProcedures.04 Size of Procedure Equipment KC eProcedures.11 Procedure Authorization KC
eAirway.05 Tube Depth KC eDivice.02 Date/Time of Event (per Medical Device) KC eDivice.03 Medical Device Event Type KC eDivice.06 Medical Device Mode (Manual, AED, Pacing, CO2, O2, etc) KC eDivice.07 Medical Device ECG Lead KC eDivice.08 Medical Device ECG Interpretation KC eDivice.09 Type of Shock KC eDivice.10 Shock or Pacing Energy KC eDivice.11 Total Number of Shocks Delivered KC eDivice.12 Pacing Rate KC eDisposition.13 How Patient Was Moved to Ambulance KC eDisposition.14 Position of Patient During Transport KC eDisposition.15 How Patient Was Transported From Ambulance KC eDisposition.26 Disposition Instructions Provided KC eOther.02 Potential System of Care/Specialty/Registry Patient KC eOther.03 Personal Protective Equipment Used KC eOther.04 EMS Professional (Crew Member) ID KC eOther.07 Natural, Suspected, Intentional, or Unintentional Disaster KC eOther.12 Type of Person Signing KC eOther.13 Signature Reason KC eOther.14 Type Of Patient Representative KC eOther.15 Signature Status KC eOther.19 Date/Time of Signature KC
CARES Cardiac Arrest Registry to Enhance Survival
What is CARES? • Developed by the CDC in collaboration with Emory University and the AHA • Figure out how to improve survival from sudden cardiac arrest (non- traumatic) • Registry developed to help LEMSAs and Medical Directors – Find out who is affected – When cardiac arrest occur – Where cardiac arrest occur – Determine if system elements are functioning or not – Identify changes to improve sudden cardiac arrest survival • Internet based database with real-time feedback
Data • EMS – Data can be entered via desktop by EMS or Provider – Automatic extraction from ePCR • Hospital – Contact at hospital would have to answer 4-5 questions through computer
Good to Know • Database is secured to protect PHI • No HIPAA considerations • Once patient EMS records are matched with hospital, PHI is scrubbed • EMS generate Survival reports, response reports, and demographic reports • Used to promote health, monitor system changes to improve outcomes, benchmarking with state and national participants
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