EMERGENCY MEDICAL SERVICES SYSTEM COLLABORATIVE MEETING Thursday - PowerPoint PPT Presentation

MATTHEW CONSTANTINE DIRECTOR EMERGENCY MEDICAL SERVICES SYSTEM COLLABORATIVE MEETING Thursday October 5, 2017

MATTHEW CONSTANTINE DIRECTOR INTRODUCTIONS

ARE WE PREPARED?

Turnover Patient Care Authority 10.Turn Over of Patient Care Authority A paramedic may transfer patient care authority to a BLS transport ambulance, when all of the following circumstances exist:  The BLS ambulance is immediately available.  ALS care has not been initiated.  It has been determined that ALS care is unneeded during transport.  Patients must be stable with medical complaints that can be cared for at the BLS level.  ALS assessment tools may be utilized (i.e. ECG 3- and 12 Lead cardiac monitor) in order to fully assess the patient and determine eligibility for turnover to BLS.  Patient airway, maintained without assistance or adjuncts.

• The patient must be hemodynamically stable. Vital signs should be within the normal range for age. • The patient must be of their normal mental status and not impaired because of alcohol or substances. • No mechanism of injury that would warrant a trauma activation. • No cardiac, respiratory, or neurological complaints that may warrant ALS intervention. • The EMT must be comfortable with the patients’ condition and accept the transfer of care. • Base contact shall be made and must concur with handoff. • Both the ALS unit and the BLS unit MUST complete a patient care report. • Provider agency shall audit all ALS to BLS transfer of care and provide a written report to the EMS agency monthly.

 Both the ALS unit and the BLS unit MUST complete a patient care report.  Provider agency shall audit all ALS to BLS transfer of care and provide a written report to the EMS agency monthly. 11. Critical Care nurses may turn patients over to paramedics. These patients must not have or require any medications or therapies that are outside of the paramedics scope of practice.

32B02- Data Assessment Response Configuration: Unknown Problem – Medical Alarm Current: ALS Code 3 Response (Priority 2) Fire Response 2016 2015 2014 Cumulative Cumulative % Total 1158 1150 1040 3348 Transport 291 263 239 793 23.7% ALS 51 95 79 225 6.7%

Analysis of Primary Impression for ALS Patients

Analysis GCS of ALS treated patients

ReddiNet Bed Availability / MCI Response

MCI Response

August Alerts Responses BHH 7 4 BMH 7 6 DRMC 3 2 KMC 7 7 KVH 5 2 MER 7 6 MSW 7 4 RRH 6 4 SJCH 5 5 Tehach 4 1

September Alerts Responses BHH 5 5 BMH 5 3 DRMC 2 1 KMC 5 5 KVH 2 1 MER 5 5 MSW 5 4 RRH 2 1 SJCH 5 5 Tehach 2 0

Year To Date 70 60 50 40 30 Alerts Responses 20 10 0 BHH BMH DRMC KMC KVH MER MSW RRH SJCH Tehach 56.90% 68.33% 70.37% 86.89% 65.38% 78.33% 62.71% 70.37% 94.74% 12.00% 33 41 19 53 17 47 37 19 54 3 58 60 27 61 26 60 59 27 57 25

Patient Distribution

Pt Dist I D M Total BHH 0 0 0 0 0.00% BMH 0 2 14 16 8.42% DRMC 1 3 0 4 2.11% KMC 13 23 63 99 52.11% KVH 0 0 0 0 0.00% MER 0 1 20 21 11.05% MSW 0 1 13 14 7.37% RRH 0 0 9 9 4.74% SJCH 0 1 18 19 10.00% Tehach 0 0 8 8 4.21% Total 190

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 August BHH 31 0 24 BMH 31 0 30 DRMC 30 1 23 KMC 31 0 26 KVH 14 17 0 MER 31 0 27 MSW 31 0 27 RRH 31 0 27 SJH 31 0 28 THD 30 1 28

Bed Availability Reporting Number of Number of Number of Days Days Days B.A. B.A. B.A. not reported >1 Reported reported September BHH 29 1 19 BMH 30 0 29 DRMC 29 1 17 KMC 29 1 24 KVH 3 27 0 MER 30 0 26 MSW 30 0 28 RRH 30 0 25 SJH 30 0 25 THD 29 1 26

2017 Number of Days B.A. Reported Number of days B.A. reported >1 300 273 272 272 272 270 266 260 259 258 248 250 240 238 234 231 222 September 200 195 200 30th = 273 Day of Year 150 92 100 84 50 1 0 BHH BMH DRMC KMC KVH MER MSW RRH SJH THD

AMBULANCE PATIENT OFFLOAD TIMES August and September 2017

August Hospital 90th Percentile Transports APOT Time Bakersfield Heart Hospital 366 53.09 Bakersfield Memorial Hospital 1775 85.81 Delano Regional Medical Center 464 26.8 Kern Medical 1264 49.13 APOT ‐ 1 162 16 Kern Valley Healthcare District Mercy Hospital 823 48.46 Mercy Southwest Hospital 778 51.77 Ridgecrest Regional 257 7 San Joaquin Community Hospital 2285 58.52 Tehachapi Hospital 138 28.93 EMS System Total (Aggregate) 8312

APOT – 2 August Hospital 2.1 2.2 2.3 2.4 2.5 transp % transp % transp % transp % transp % Bakersfield Heart Hospital 142 39% 194 53% 25 7% 2 1% 3 1% Bakersfield Memorial Hospital 551 31% 895 50% 263 15% 47 3% 19 1% Delano Regional Medical Center 374 81% 87 18% 3 1% 0 0% 0 0% Kern Medical 442 35% 760 60% 56 4% 5 0% 1 0% Kern Valley Healthcare District 151 93% 9 6% 2 1% 0 0% 0 0% Mercy Hospital 350 43% 430 52% 36 4% 3 0% 4 0% Mercy Southwest Hospital 357 46% 371 48% 46 6% 4 1% 0 0% Ridgecrest Regional 255 99% 2 1% 0 0% 0 0% 0 0% San Joaquin Community Hospital 645 28% 1422 62% 186 8% 23 1% 9 0% Tehachapi Hospital 93 67% 45 33% 0 0% 0 0% 0 0% 2.1 Within 20 minutes 2.2 Between 21 and 60 minutes 2.3 Between 61 and 120 minutes 2.4 Between 121 and 180 minutes 2.5 Greater than 180 minutes

September 90th Hospital Percentile APOT Transports Time Bakersfield Heart Hospital 372 46.96 Bakersfield Memorial Hospital 1731 69.83 Delano Regional Medical Center 407 25.93 Kern Medical 1130 48.1 APOT ‐ 1 133 14.86 Kern Valley Healthcare District 764 42.6 Mercy Hospital 711 53.92 Mercy Southwest Hospital Ridgecrest Regional 185 5.02 2097 57.05 San Joaquin Community Hospital 123 32.53 Tehachapi Hospital 7653 EMS System Total (Aggregate)

APOT – 2 September Hospital 2.1 2.2 2.3 2.4 2.5 transp % transp % transp % transp % transp % Bakersfield Heart Hospital 176 47.31 179 48.12 17 4.57 0 0 0 0 Bakersfield Memorial Hospital 555 32.06 946 54.65 195 11.27 28 1.62 7 0.4 Delano Regional Medical Center 347 85.26 54 13.27 6 1.47 0 0 0 0 Kern Medical 429 37.96 649 57.43 49 4.34 2 0.18 1 0.09 Kern Valley Healthcare District 123 92.48 10 7.52 0 0 0 0 0 0 Mercy Hospital 349 45.68 389 50.92 23 3.01 3 0.39 0 0 Mercy Southwest Hospital 328 46.13 325 45.71 46 6.47 8 1.13 4 0.56 Ridgecrest Regional 182 98.38 3 1.62 0 0 0 0 0 0 San Joaquin Community Hospital 688 32.81 1230 58.66 163 7.77 16 0.76 0 0 Tehachapi Hospital 81 65.85 41 33.33 1 0.81 0 0 0 0 2.1 Within 20 minutes 2.2 Between 21 and 60 minutes 2.3 Between 61 and 120 minutes 2.4 Between 121 and 180 minutes 2.5 Greater than 180 minutes

Thrombectomy Capable Stroke Centers • The Joint Commission has released draft language • Creates a carve out for TCSC’s that is above a Primary Stroke Center but less than a Comprehensive

Designation • Require the facility to obtain certification through The Joint Commission before being locally designated • Added – Neurosurgeon or Neurointerventialist shall not be “on ‐ call” for multiple facilities at any given time.

Transport Destination • Start with the Cincinnati Stroke Scale like normal. – If Positive, they move to the Cincinnati Stroke Severity Scale – If, they score 2 or more on that scale, the patient gets transported to a TCSC – If, they score less than 2, they get transported to any Primary Stroke Center

CP Stroke Severity Scale • CONJUGATE GAZE DEVIATION: (2 Points) • Force full deviation of BOTH eyes to one side or the other • Eyes will not pass midline • ASK PATIENT AGE AND CURRENT MONTH: (1 Point) • Both Correct (0 Points) • One Correct or Neither Correct (1 Point) • • INSTRUCT PATIENT TO HOLD ARMS UP FOR 10 SECONDS: (1 Point) • Can Do (0 Points) • Can’t Do (1 Point)

Public Comment Period • October 6 th – November 24 th 2017

Statewide Medical Health Exercise • Table top was September 27 th – 70 people attended from approx. 30 organizations • The Functional Exercise will be: – November 15 th – 9:00am – 2:00pm – Hotwash 1 ‐ 2 with lunch included – If you plan on participating please send me an email and I will get you appropriate info

MATTHEW CONSTANTINE DIRECTOR ANNOUNCEMENTS

MATTHEW CONSTANTINE DIRECTOR THANK YOU FOR COMING HAVE A GREAT MONTH