annual ems system report 2017 - kern county public...

Annual EMS System Report 2017

Title 22, Chapter 12, Article 4, effective January 1, 2006, mandated the Local EMS Authority (LEMSA)

develop a system wide implementation of a Quality Improvement Program for the delivery of EMS care

to the public. This includes mechanisms to track quality indicators for personnel, equipment and

supplies, documentation, clinical care and patient outcome, skills maintenance/competency,

transportation/facilities, public education and prevention, and risk management.

Health and Safety Code 1797.276, requires the Division to report the state annually regarding the

activities of this Board. Furthermore, it requires the report be submitted to the County Board of

Supervisors.

The EMS Division developed an annual report that compiled all the Quality Improvement activities we

are involved in and ensure they meet all the quality indicators required in Health & Safety Code and Title

22. This required the Division to compile numerous data elements from over 100,000 EMS electronic

patient care records. It also required cooperation with local hospitals to ensure an accurate and

complete analysis of our system is presented.

This report accurately summarizes the effectiveness of the Kern County EMS system and the activities of

EMCAB. The report meets all requirements set forth in Health & Safety Code, Title 22, and follows the

guidelines established by the Emergency Medical Services Authority (EMSA). The report contains a

multitude of statistics regarding our EMS system. In addition to including this report in your Board

member packets a copy will be submitted to EMSA and the Kern County Board of Supervisors.

Therefore IT IS RECOMMENDED, the Board receive and file the Annual EMS System Report - 2017.

Kern County EMS System Update: 2017

2017 System Demographics

EMS PRACTITIONERS 3796 EMD EMT

MICN Paramedic

PFSA

58 2711 163 321 543

TRAINING PROGRAMS 28 Paramedic Training Programs

EMT Training Programs Continuing Education Providers

First Aid

1 5 24 2

EMERGENCY RECEIVING HOSPITALS 10 Base Hospitals

Trauma Centers STEMI Receiving Centers

Stroke Centers Pediatric Receiving Centers

8 2 3 5 5

EMS PROVIDER AGENCIES 13 Air Ambulance

ALS Ambulance ALS Non-Transport

ALS Fire Dept BLS Non-Transport

PFSA O.S.

2 3 1 3 2 1

Response Mode to Scene

Q3 and Q4 2017

Code 2

3,Downgrade5,117 Code 529Code 2,Upgrade

65

Code 3

57,347

Type of Service Requested = 911 Response

Code 2 8.1%

Code 2,Upgrade 0.1%

Code 3 90.9%

Code 3,Downgrade 0.8%

Total: 100.0%


Patient Demographics for all 9-1-1 Calls: 2017 Quarters 3 and 4

0

1000

2000

3000

4000

5000

6000

7000

8000

Under 5 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Nu

mb

er o

f C

alls

Age Group

Age Group, 2017 Quarters 3 & 4


Patient Demographics for all 9-1-1 Calls: 2017 Quarters 3 and 4

50%50%

Patient Gender, 2017 Quarters 3 & 4

Female Male


Total EMS calls: 53,456


EMS Arrival Time to Destination: 2017, Quarters 3 and 4

0

500

1000

1500

2000

2500

3000

12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11

AM PM

Nu

mb

er

of

Tran

spo

rts

Time of Day

Number of EMS Transports by Destination Arrival Time, 2017 Quarters 3 and 4


Kern County EMS State Core Measures: 2017

STEMI

• ACS-1: Administration of aspirin for chest pain of cardiac origin

• ACS-2: 12 lead ECG performance

• ACS-3: Scene time for suspected heart attack patients

• ACS-5: Direct transport to a STEMI receiving center

Stroke

STR-2: Glucose Testing for Suspected Stroke Patients

STR-3: On-Scene Time of Suspected Stroke Patients (90th Percentile)

STR-5: Percentage of Suspected Stroke Patients Transported Directly to Stroke Center

Trauma

TRA-1: On-Scene Time (90th Percentile)

TRA-2: Direct Transport to a Trauma Center

Pediatric

PED-1: Percentage of Pediatric Asthma Patients Receiving Bronchodilators

Other

RES-2: Beta 2 Agonist Administration to Adults


Intraosseous Attempts and Success Rates for Adults and Pediatric Patients, 2017

100 100 100

80

0

20

40

60

80

100

0

2

4

6

8

10

12

Q1 Q2 Q3 Q4

Succ

ess

Rat

e

Nu

mb

er o

f P

atie

nts

Quarter, 2017

Pediatric Intraosseous Attempts and Success Rate, 2017

Success Rate


Intraosseous Attempts and Success Rates for Adults and Pediatric Patients, 2017

96

78

57

80

0

10

20

30

40

50

60

70

80

90

100

0

20

40

60

80

100

120

Q1 Q2 Q3 Q4

Succ

ess

Rat

e

Nu

mb

er o

f P

atie

nts

Quarter, 2017

Adult Intraosseous Attempts and Success Rate, 2017

Success Rate


STEMI: EMS Data, 2017

Kern County EMS System Update: 2017 STEMI: Patient Demographics, 2017 Quarters 3 and 4

0

100

200

300

400

500

600

700

35-44 45-54 55-64 65-74 75-85 85+

Nu

mb

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f Tr

ansp

ort

s

Age Group

Age Group of STEMI Patients, 2017 Quarters 3 & 4

Kern County EMS System Update: 2017 STEMI: Patient Demographics, 2017 Quarters 3 and 4

48%52%

Gender of STEMI Patients, 2017 Quarters 3 & 4

Female

Male

Kern County EMS System Update: 2017 STEMI: State Core Measures, 2017

*Please note: Change in database that occurred in Quarter 3 of 2017 allowed for more accurate measurement of denominator (chest pain of

cardiac origin).

39.1

82.3

58.3

43.5

82.3 82.4

60.3

88.4 88.8

65.9

8288.8

0

10

20

30

40

50

60

70

80

90

100

ACS-1 ACS-2 ACS-5

Pe

rce

nt

of

STEM

I Pat

ien

ts

STEMI Core Measure

STEMI Core Measures, 2017

Q1 Q2 Q3 Q4

Kern County EMS System Update: 2017 STEMI: State Core Measures, 2017

28.2

38.4

24.5 25.0

0

5

10

15

20

25

30

35

40

45

Q1 Q2 Q3 Q4

Tim

e (

min

ute

s)

Quarter, 2017

ACS-3: On-Scene Time for Trauma Patients (90th Percentile), 2017

State Benchmark


Stroke QI: EMS Data, 2017

Kern County EMS System Update: 2017 Stroke: Patient Demographics, 2017 Quarters 3 and 4

0

20

40

60

80

100

120

140

Nu

mb

er

of

Pat

ien

ts T

ran

spo

rte

d

Age Group

Age Group of Susected Stroke Patients, 2017 Quarters 3 & 4

Kern County EMS System Update: 2017 Stroke: Patient Demographics, 2017 Quarters 3 and 4

46%54%

Gender of Suspected Stroke Patients, 2017 Quarters 3 & 4

Female

Male

Kern County EMS System Update: 2017 Stroke: State Core Measures, 2017

79.0 80.0 81.084.0

90.085.0

74.080.0 80.3

84.4

71.077.0

0.00

20.00

40.00

60.00

80.00

100.00

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2015 2016 2017

Pe

rce

nt

of

Pat

ien

ts T

este

d (

%)

Year and Quarter

STR-2: Glucose Testing for Suspected Stroke Patients, 2015-2017

State benchmark


22.0

23.6

21.822.2

21.021.4

20.2

20.9

22.8

23.9 24.1

22.3

18

19

20

21

22

23

24

25

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2015 2016 2017

Tim

e (

in m

inu

tes)

Year/Quarter

STR-3: On-Scene Time (90th Percentile) for Suspected Stroke Patients, 2015-2017


81 82

64

81

87

80 80

8885 85

90

8179

93 9391

50

60

70

80

90

100

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2014 2015 2016 2017

Pe

rce

nt

of

Pat

ien

ts T

ran

spo

rte

d (

%)

Year and Quarter

STR-5: Percent of Suspected Stroke Patients Transported Directly to Stroke Center: 2014-2017

Benchmark

Kern County EMS System Update: 2017 Hospital Data, Stroke System of Care: 2016-2017

68

32.3 36

79

1938

3534

20

64 7460.5

46

146

83 88

304

256

223

304

382

449420

402

0

50

100

150

200

250

300

350

400

450

500

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2016 2017

Tim

e (M

inu

tes)

Year and Quarter

Compiled Average Times: All Stroke Receiving Centers, 2016-2017

Door to CT Door to IV t-PA LKW to Door

Kern County EMS System Update: 2017 Trauma: State Core Measures, 2017

29.2

20.2

15.2

24.426.4

33.1

27.529.5

0

5

10

15

20

25

30

35

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2016 2017

Tim

e (m

inu

tes)

Year and Quarter

TRA-1: On-Scene Time (90th Percentile), 2016-2017

State Benchmark

Kern County EMS System Update: 2017 Trauma: State Core Measures, 2017

86.7

82.0

88.7 89.0

91.5

85.5

87.0

85.0

75

80

85

90

95

100

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2016 2017

Per

cen

t o

f Tr

ansp

ort

s (%

)

Year and Quarter

TRA-2: Percent of Trauma Patients Directly Transported to Trauma Center, 2016-2017

State Benchmark

Kern County EMS System Update: 2017 RES-2: State Core Measure, 2017

*Please note: change in database after July 1st, 2017 allowed for more accurate measurement of the denominator (adults in acute

respiratory distress)

42.9 42.2

36.8

42.146.1

39.8

* 49.2

* 56.3

0

10

20

30

40

50

60

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2016 2017

Per

cen

t (%

)

Month and Year

RES-2: Beta 2 Agonist Administration to Adults, 2016-2017

Kern County EMS System Update: 2017 Pediatrics: State Core Measures, 2017

*Please note: change in database after July 1st, 2017 allowed for more accurate measurement of the denominator (pediatric patients

with acute respiratory distress)

37.5 4234.9 37 38

36.6

* 74.7

* 57.8

0

10

20

30

40

50

60

70

80

90

100

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2016 2017

Pe

rce

nt

of

Pe

ds

Pat

ien

ts in

Re

sp D

istr

ess

Year/Quarter

PED-1: Percent of Pediatric Asthma Patients Recieving Bronchodilators, 2016-2017


Total number of pediatric patients in 2017: 2,249

Pediatric Patient by Age

Pediatric Primary Impression

80

120

160

200

240

280

320

0 2 4 6 8 10 12 14

30 5

25 3

15 8 12 5 7 11 6 10 9 11 12 9 12 6 1 14 14 1 14 6

17 4 20 9

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Age


Pediatric Destination

ADVENTIST HEALTH BAKERSFIELD 171 Antelope Valley Hospital Medical Center 21 ANTELOPE VLLY MED CT 128 Bakersfield Memorial Hospital- 34th Street 19 BARSTOW COMM HOSP 4 BKFLD HEART HOSP 3 Childrens Hospital Central California 2 DELANO REG MED CNTR 26 Delano Regional Medical Center 155 Kern County Med Center 1 KERN MEDICAL 315 Kern Medical Center 11 Kern Valley Healthcare District 27 MEMORIAL HOSPITAL 1,035 MERCY HOSPITAL 42 Mercy Southwest Hospital 1 MERCY SW HOSPITAL 141 Ridgecrest Regional Hospital 69 SAN JOAQUIN COMM HOSP 57

San Joaquin Community Hospital 2 TEHACHAPI HOSPITAL 19 Total: 2,249

Kern County EMS: Quality Improvement Plan, 2017

Response Times (90th Percentile): Kern County Metro

0:00:00

0:01:26

0:02:53

0:04:19

0:05:46

0:07:12

0:08:38

0:10:05

0:11:31

0:12:58

June July Aug Sept Oct Nov Dec

2017

Tim

e (h

h:m

m:s

s)

Year/Month

EOA-1: Priority 1 Metro Response Times, June-Dec 2017

Standard

0:00:00

0:01:26

0:02:53

0:04:19

0:05:46

0:07:12

0:08:38

0:10:05

0:11:31

0:12:58


2017

Tim

e (h

h:m

m:s

s)

Year/Month


Standard



0:08:04

0:08:21

0:08:38

0:08:56

0:09:13

0:09:30

0:09:48

0:10:05

0:10:22


2017

Tim

e (h

h:m

m:s

s)

Year/Month


Standard

0:09:56

0:10:05

0:10:13

0:10:22

0:10:31

0:10:39

0:10:48

0:10:57

0:11:05

0:11:14

0:11:23


2017

Tim

e (h

h:m

m:s

s)

Year/Month


Standard



0:08:12

0:08:21

0:08:30

0:08:38

0:08:47

0:08:56

0:09:04

0:09:13


2017

Tim

e (h

h:m

m:s

s)

Year/Month


Standard

0:08:21

0:08:38

0:08:56

0:09:13

0:09:30

0:09:48

0:10:05

0:10:22

0:10:39

0:10:57

0:11:14


2017

Tim

e (h

h:m

m:s

s)

Year/Month


Standard


Ambulance Patient Offload Time (APOT): 90th Percentile, by Hospital

0

20

40

60

80

100

120

140

June July August September October November December

AP

OT

-1 (

min

ute

s)

Month

APOT-1: Bakersfield HospitalsJune - December 2017

Adventist Health Bakersfield Bakersfield Heart Hospital Bakersfield Memorial Hospital

Kern Medical Mercy Hospital Mercy Southwest Hospital


Ambulance Patient Offload Time (APOT): 90th Percentile, by Hospital

0

5

10

15

20

25

30

35

40

June July August September October November December

AP

OT

-1(m

inu

tes)

Month

APOT-1: Outlying Area Hospitals June-December 2017

Delano Regional Medical Center Kern Valley Healthcare District Ridgecrest Regional Tehachapi Hospital


Ambulance Patient Offload Time (APOT): Time Criteria and Transport Volume, by Hospital

APOT-2 Time Criteria

CATEGORY TIME (MINUTES)

2.1 <= 20

2.2 21-60

2.3 61-120

2.4 121-180

2.5 >180



0

500

1000

1500

2000

2500

0

10

20

30

40

50

60

70

80

90

100


Tran

spo

rt V

olu

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Pe

rce

nt

of

To

tal T

ran

spo

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(%)

Month

Adventist Health APOT-2: June-December 2017

2.1 2.2 2.3 2.4 2.5 Total Volume



0

50

100

150

200

250

300

350

400

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

July Aug Sept Oct Nov Dec

Tran

spo

rt V

olu

me

Per

cen

t o

f To

tal T

ran

spo

rts

(%)

Month

Bakersfield Heart Hospital APOT-2: June - December 2017

2.1 2.2 2.3 2.4 2.5 Transport Volume



0

200

400

600

800

1000

1200

1400

1600

1800

2000

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0


Tran

spo

rtV

olu

me

Pe

rce

nt

of

To

tal T

ran

spo

rts

(%)

Month

Bakersfield Memorial Hospital APOT-2: June-December 2017




0

200

400

600

800

1000

1200

1400

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0


Tran

spo

rt V

olu

me

Pe

rce

nt

of

To

tal T

ran

spo

rts

(%)

Month

Kern Medical APOT-2: June-December 2017




0

100

200

300

400

500

600

700

800

900

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0


Tran

spo

rt V

olu

me

Pe

rcen

t o

f al

l Tra

nsp

ort

s (%

)

Month

Mercy Hospital APOT-2: June-December 2017

2.1 2.2 2.3 2.4 2.5 Total Volume



0

100

200

300

400

500

600

700

800

900

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0


Tran

spo

rt V

olu

me

Pe

rce

nt

of

To

tal T

ran

spo

rts

(%)

Month

Mercy Southwest APOT-2: June-December 2017

2.1 2.2 2.3 2.4 2.5 Total Volume



0

50

100

150

200

250

300

350

400

450

500

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0


Tran

spo

rt V

olu

me

Pe

rce

nt

of

To

tal T

ran

spo

rts

(%)

Month

Delano APOT-2: June - December 2017




0

20

40

60

80

100

120

140

160

180

200

75.0

80.0

85.0

90.0

95.0

100.0


Tran

spo

rt V

olu

me

Tota

l Pe

rce

nt

of

Tra

nsp

ort

s (%

)

Month

KVHCD APOT-2: June - December 2017




0

50

100

150

200

250

300

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0


Tran

spo

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olu

me

Pe

rce

nt

of

To

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ran

spo

rts

(%)

Month

Ridgecrest APOT-2: June-December 2017

2.1 2.2 2.3 2.4 2.5 Total Volume



0

20

40

60

80

100

120

140

160

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0


Tran

spo

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olu

me

Pe

rce

nt

of

To

tal T

ran

spo

rts

(%)

Month

Tehachapi APOT-2: June - December 2017

2.1 2.2 2.3 2.4 2.5 Total Volume

annual ems system report 2017 - kern county public...

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