emergency medical services system collaborative...

EMERGENCY MEDICAL SERVICESSYSTEM COLLABORATIVE MEETING

ThursdayOctober 5, 2017

MATTHEW CONSTANTINEDIRECTOR

INTRODUCTIONS


ARE WE PREPARED?

Turnover Patient Care Authority10.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

AugustAlerts Responses

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

SeptemberAlerts Responses

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

0

10

20

30

40

50

60

70

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

Year To Date

Alerts

Responses

Patient Distribution

I D M TotalBHH 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

Pt Dist

Bed Availability

August

Number of Days B.A. Reported

Number of Days

B.A. not reported

Number of Days B.A. reported >1

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

Bed Availability Reporting

September

Number of Days B.A. Reported

Number of Days

B.A. not reported

Number of Days B.A. reported >1

BHH 29 1 19BMH 30 0 29DRMC 29 1 17KMC 29 1 24KVH 3 27 0MER 30 0 26MSW 30 0 28RRH 30 0 25SJH 30 0 25THD 29 1 26

Bed Availability Reporting

September 30th = 273 Day of Year

200

273266

260

92

272 270 272 272259

84

258

195

222

1

240 238231

248

234

0

50

100

150

200

250

300

BHH BMH DRMC KMC KVH MER MSW RRH SJH THD

2017Number of Days B.A. Reported Number of days B.A. reported >1

AMBULANCE PATIENT OFFLOAD TIMES

August and September 2017

APOT ‐ 1

Bakersfield Heart HospitalBakersfield Memorial HospitalDelano Regional Medical CenterKern MedicalKern Valley Healthcare DistrictMercy HospitalMercy Southwest HospitalRidgecrest RegionalSan Joaquin Community HospitalTehachapi Hospital

EMS System Total (Aggregate)

Hospital

Transports

90th Percentile APOT Time

366 53.091775 85.81464 26.81264 49.13162 16823 48.46778 51.77257 72285 58.52138 28.93

8312

August

APOT – 2


2.1 Within 20 minutes2.2 Between 21 and 60 minutes2.3 Between 61 and 120 minutes2.4 Between 121 and 180 minutes2.5 Greater than 180 minutes

Hospital transp % transp % transp % transp % transp %

142 39% 194 53% 25 7% 2 1% 3 1%551 31% 895 50% 263 15% 47 3% 19 1%374 81% 87 18% 3 1% 0 0% 0 0%442 35% 760 60% 56 4% 5 0% 1 0%151 93% 9 6% 2 1% 0 0% 0 0%350 43% 430 52% 36 4% 3 0% 4 0%357 46% 371 48% 46 6% 4 1% 0 0%255 99% 2 1% 0 0% 0 0% 0 0%645 28% 1422 62% 186 8% 23 1% 9 0%93 67% 45 33% 0 0% 0 0% 0 0%

August2.4 2.52.1 2.2 2.3

APOT ‐ 1


EMS System Total (Aggregate)

Hospital

Transports

90th Percentile

APOT Time

372 46.961731 69.83407 25.931130 48.1133 14.86764 42.6711 53.92185 5.022097 57.05123 32.53

7653

September

APOT – 2


2.1 Within 20 minutes2.2 Between 21 and 60 minutes2.3 Between 61 and 120 minutes2.4 Between 121 and 180 minutes2.5 Greater than 180 minutes

Hospital transp % transp % transp % transp % transp %

176 47.31 179 48.12 17 4.57 0 0 0 0555 32.06 946 54.65 195 11.27 28 1.62 7 0.4347 85.26 54 13.27 6 1.47 0 0 0 0429 37.96 649 57.43 49 4.34 2 0.18 1 0.09123 92.48 10 7.52 0 0 0 0 0 0349 45.68 389 50.92 23 3.01 3 0.39 0 0328 46.13 325 45.71 46 6.47 8 1.13 4 0.56182 98.38 3 1.62 0 0 0 0 0 0688 32.81 1230 58.66 163 7.77 16 0.76 0 081 65.85 41 33.33 1 0.81 0 0 0 0

September2.4 2.52.1 2.2 2.3

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 Neurointerventialistshall 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 6th – November 24th 2017

Statewide Medical Health Exercise

• Table top was September 27th

– 70 people attended from approx. 30 organizations

• The Functional Exercise will be:– November 15th

– 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

ANNOUNCEMENTS


THANK YOU FOR COMING

HAVE A GREAT MONTH


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