http://www.sjgov.org/ems Mailing Address PO Box 220 French Camp, CA 95231 Health Care Services Complex Benton Hall 500 W. Hospital Rd. French Camp, CA 95231 Phone Number (209) 468-6818 Fax Number (209) 468-6725 San Joaquin County Emergency Medical Services Agency EMS Liaison Committee Thursday, October 8, 2015 at 0900 hours Health Plan of San Joaquin Community Room 7751 S. Manthey Rd. French Camp, CA 95231 A G E N D A 1. Call to Order 2. Review and Approval of Minutes from July 9, 2015 3. EMS Agency Administrator’s Report 4. System Organization and Management A. EMS Agency Budget B. Maddy Fund 5. Staffing and Training A. EMS Enforcement B. Training Programs 6. Communications A. WebEOC 7. Emergency Ambulance Performance Reports A. American Medical Response B. Escalon Community Ambulance C. Manteca District Ambulance 8. Facilities and Critical Care A. Trauma System B. STEMI Program C. Ambulance Patient Off-load Delays 9. Data Collection and System Evaluation A. Continuous Quality Improvement 10. Disaster Medical A. EMResource B. Healthcare Coalition C. HPP Grant D. RDMHS 11. Member Reports/Comments 12. Next Meeting – Thursday, January 14, 2016 A full agenda packet will not be provided at the meeting. A full agenda packet may be viewed or downloaded from the EMS Agency’s website at www.sjgov.org/ems
Transcript
http://www.sjgov.org/ems
Mailing Address PO Box 220
French Camp, CA 95231
Health Care Services Complex Benton Hall
500 W. Hospital Rd. French Camp, CA 95231
Phone Number (209) 468-6818
Fax Number
(209) 468-6725
San Joaquin County Emergency Medical Services Agency
EMS Liaison Committee Thursday, October 8, 2015 at 0900 hours
Health Plan of San Joaquin Community Room
7751 S. Manthey Rd. French Camp, CA 95231
A G E N D A
1. Call to Order 2. Review and Approval of Minutes from July 9, 2015 3. EMS Agency Administrator’s Report 4. System Organization and Management
A. EMS Agency Budget B. Maddy Fund
5. Staffing and Training A. EMS Enforcement B. Training Programs
6. Communications A. WebEOC
7. Emergency Ambulance Performance Reports A. American Medical Response B. Escalon Community Ambulance C. Manteca District Ambulance
8. Facilities and Critical Care A. Trauma System B. STEMI Program C. Ambulance Patient Off-load Delays
9. Data Collection and System Evaluation A. Continuous Quality Improvement
10. Disaster Medical A. EMResource B. Healthcare Coalition C. HPP Grant D. RDMHS
11. Member Reports/Comments 12. Next Meeting – Thursday, January 14, 2016 A full agenda packet will not be provided at the meeting. A full agenda packet may be viewed or downloaded from the EMS Agency’s website at www.sjgov.org/ems
San Joaquin County Emergency Medical Services Agency DATE: September 30, 2015
TO: EMS Liaison Committee
PREPARED BY: Matt Griffin, Accountant Technician
SUBJECT: Fiscal Report
RECOMMENDED ACTION: Information only. FISCAL IMPACT: None. DISCUSSION: EMS Agency Budget 2015/16 The 2015/16 budget for San Joaquin County EMS Agency includes expenditure authority in the amount of $2.1 million and 9 permanent positions. EMS Agency funding is provided through the collection of fees, grants, general fund allocation and accumulated reserves from ambulance performance penalties and the EMS Maddy Fund. The EMS Agency administers the Hospital Preparedness Program grant, which provides funds for disaster planning in targeted areas. The EMS Agency also receives grant funds from the State of California EMS Authority to serve as the lead agency for disaster medical planning and coordination for the eleven counties comprising the Office of Emergency Services Mutual Aid Region IV. Included in the 2015/16 budget is funding to develop a computer interface with the computer-aided dispatch system operated by AMR to enable EMS, ambulance providers and receiving hospitals to perform real-time monitoring of ambulance patient offload delays (APOD). 2014/15 As of June 30, 2015, the EMS Agency has expended and/or encumbered $1.8 million or 87.1% of available budget authority.
Fiscal Report EMS Liaison Committee September 30, 2015 Page 2 of 2 EMS Agency Staffing The EMS Agency is authorized 9 full-time positions, all of which are currently staffed. The EMS Administrator also acts as the County’s Medical Health Operational Area Coordinator. The EMS Agency maintains an on-call EMS Duty Officer 24 hours a day/seven days a week to respond to mutual aid requests, coordinate disaster medical operations, and to assist hospitals and providers in managing the EMS system.
San Joaquin County Emergency Medical Services Agency DATE: September 30, 2015 TO: EMS Liaison Committee PREPARED BY: Matt Griffin, Accountant Technician SUBJECT: EMS Maddy Fund RECOMMENDED ACTION: Receive information on the EMS Maddy Fund. FISCAL IMPACT: None. DISCUSSION: EMS Maddy Fund 2014/15 In 1987, legislature found that emergency medical service providers incurred higher costs for their services than providers of other medical services, but often received little to no payment from patients. In response, the Maddy Fund (SB 12) was established to provide revenue to compensate physicians and medical facilities for emergency services provided to medically indigent patients during the first 48 hours of continuous service. The EMS Maddy Fund is derived from county penalty assessments for various criminal offenses and motor vehicle violations, traffic violator school fees and revenue from taxes on tobacco products deposited in the State’s Cigarette and Tobacco Products Surtax Fund. 10% of the total revenue is allotted to EMS fund administration, and the remainder is allocated to participating emergency service providers. The largest portion of this allocation is received by the physicians who provide emergency medical services to the medically indigent. Participating providers are currently submitting claims and receiving payments for services provided in fiscal year 2014/15. Claims are due from providers and payments are disbursed on a quarterly basis. A total of $99,038.68 has been disbursed to participating physicians through the 2nd quarter of 2014/15.
EMS Maddy Fund Report EMS Liaison Committee September 30, 2015 Page 2 of 2 Complete accounting data is most recently available for fiscal year 2013/14, during which payment was disbursed to emergency physicians for a total of 34,965 claims, as shown below.
FY 2013/14 Amount Disbursed Qtr. 1 $60,316.63 Qtr. 2 $50,074.22 Qtr. 3 $62,555.23 Qtr. 4 $76,360.60 Total: $249,306.68 2015/16 Participating providers are currently in the process of submitting their contracts to the EMS Agency for fiscal year 2015/16. Claims for the first quarter of 2015/16 will be due in January 2016, and the target payment date is April 2016.
http://www.sjgov.org/ems
Mailing Address PO Box 220
French Camp, CA 95231
Health Care Services Complex Benton Hall
500 W. Hospital Rd. French Camp, CA 95231
Phone Number (209) 468-6818
Fax Number
(209) 468-6725
San Joaquin County Emergency Medical Services Agency DATE: September 30, 2015 TO: EMS Liaison Committee PREPARED BY: Christine Tualla, EMS Specialist SUBJECT: EMS Enforcement Activities RECOMMEDED ACTION: Receive information on EMS Enforcement activities. FISCAL IMPACT: None. DISCUSSION: Active Probation: Emergency Medical Responder (EMR): 0 Emergency Medical Technician (EMT): 8 Emergency Medical Dispatcher (EMD): 2 Active Suspensions: Emergency Medical Responder (EMR): 0 Emergency Medical Technician (EMT): 1 Emergency Medical Dispatcher (EMD): 0 Revocation or denials taken since January 2015: Emergency Medical Responder (EMR): 1 Emergency Medical Technician (EMT): 0 Emergency Medical Dispatcher (EMD): 0 Status of Current Cases: The EMS Agency currently has 10 applications with pending the completion of a background investigation. Four of the applications are pending the results of an examination by a California Society of Addiction Medicine (CSAM) Physician.
San Joaquin County Emergency Medical Services Agency DATE: September 30, 2015 TO: EMS Liaison Committee PREPARED BY: Christine Tualla, EMS Specialist SUBJECT: EMS Training Programs RECOMMEDED ACTION: Receive information on EMS Training Program activities in San Joaquin County. FISCAL IMPACT: None DISCUSSION: The following is a summary of currently available EMS Training Program approved by San Joaquin County EMS Agency: Paramedic Training Programs: In September 2015, American Medical Response in San Joaquin was approved to host a onetime satellite training course from NCTI for AMR’s own employee candidates. The didactic and clinical portions of the course are due to be completed by July 2016. Approved EMT Training Programs: Expiration Date: Ripon Consolidated Fire District December 31, 2016 San Joaquin County EMS Agency Continuous Approved EMS Continuing Education Providers: Expiration Date: American Medical Response April 30, 2016 Lodi Fire Department October 31, 2016 Manteca District Ambulance December 31, 2016 Manteca Fire Department May 31, 2017 Montezuma Fire District April 30, 2016 Ripon Consolidated Fire Department December 31, 2016 San Joaquin County EMS Agency Continuous Stockton Fire Department December 31, 2016
Training Programs Report EMS Liaison Committee September 30, 2015 Page 2 of 2 EMS Training Status: Health and Safety Code, Division 2.5, Section 1797.208 assigns the EMS Agency responsibility for the approval and oversight of all EMS training programs operating in San Joaquin County. The EMS Agency verifies that new applicants and existing programs conform to the requirements of EMS Agency Policy and the California Code of Regulations. The EMS Agency provides technical assistance regarding compliance issues to the approved EMS training programs.
http://www.sjgov.org/ems
Mailing Address PO Box 220
French Camp, CA 95231
Health Care Services Complex Benton Hall
500 W. Hospital Rd. French Camp, CA 95231
Phone Number (209) 468-6818
Fax Number
(209) 468-6725
San Joaquin County Emergency Medical Services Agency DATE: September 30, 2015 TO: EMS Liaison Committee PREPARED BY: Phillip Cook, Disaster Medical Health Specialist SUBJECT: WebEOC RECOMMENDED ACTION: Receive information on the implementation of the San Joaquin Operational Area WebEOC System. FISCAL IMPACT: None DISCUSSION:
I. OVERVIEW WebEOC is a secured online emergency management and information sharing platform for authorized agencies and organizations within the San Joaquin Operational Area.
Authorized use includes: emergencies, disasters, planned events, exercises, trainings, and daily operations.
The information contained on the San Joaquin Operational Area WebEOC site shall be treated as For Official Use Only (FOUO) and shall not be released to the public, media or other personnel who do not have a valid need to know. The only exception would be information specifically intended for public or media use, e.g., press releases.
In 2014 the San Joaquin County EMS Agency, using 2013/14 Hospital Preparedness Program Grant funds ($200,000), purchased WebEOC Professional (unlimited user licenses), Mapper Professional, Resource Request and Deployment Module, and the necessary web and database servers, to improve EF-08 (Public Health and Medical) information sharing, operational coordination and resource management.
The San Joaquin Operational Area WebEOC system went live in July 2014, with the following agencies and organizations: San Joaquin County EMS Agency, Behavioral Health, Environmental Health, Public Health, Healthcare Services, OES, all hospitals, clinics, long term care, behavioral health facilities, ambulance companies, all fire
WebEOC Report EMS Liaison Committee September 30, 2015 Page 2 of 8
agencies and the Valley Regional Communications Center. There are currently over 300 WebEOC users.
II. INFORMATION SHARING As outlined in Section IV of the San Joaquin Operational Are Healthcare Coalition Governance, information sharing between Healthcare Coalition members is necessary for maintaining a common operating picture of the healthcare system. Information sharing consists of gathering, collating, consolidating, and disseminating incident information to all appropriate parties. Achieving a common operating picture allows the on-scene and off-scene personnel, such as those at an Incident Command Post, Hospital Command Center (HCC), Emergency Operations Center (EOC), Department Operations Center (DOC) or within the Medical Health Multi-Agency Coordination (Med MAC) Group to have the same information about an incident, including the availability and location of resources and the status of assistance requests. It helps to ensure consistency for all policy makers, emergency managers, and response personnel engaged in an incident. Simply put, the goal of information sharing is to get the right information to the right people at the right time.
Information sharing is both horizontal and vertical:
• Horizontal – Share information across disciplines (among public and private agencies and organizations) at all levels and across jurisdictions
• Vertical - Share information vertically (up and down from between the field level and the state) with appropriate agencies
A. Information Sharing Activation and Triggers
Healthcare Coalition members will share information horizontally with the Medical Health Operational Area Coordinator (MHOAC) whenever one or more of the following conditions exist:
• Activation of any element or annex of the agency’s or organization’s Emergency Operations Plan
• Activation of the agency’s or organization’s emergency management facility: Emergency Operations Center (EOC), Department Operations Center (DOC), Hospital Command Center (HCC), Clinic Command Center (CCC), etc.
• The occurrence of an “Unusual Event” as defined by the California Public Health and Medical Emergency Operations Manual (EOM)1
WebEOC Report EMS Liaison Committee September 30, 2015 Page 3 of 8
An unusual event is defined as an incident that significantly impacts or threatens public health, environmental health or emergency medical services. An unusual event may be self-limiting or a precursor to emergency system activation. The specific criteria for an unusual event include any of the following: 1) The incident significantly impacts or is anticipated to impact public
health or safety; 2) The incident disrupts or is anticipated to disrupt the Public Health and
Medical System; 3) Resources are needed or anticipated to be needed beyond the
capabilities of the Operational Area, including those resources available through existing agreements (day-to-day agreements, memoranda of understanding, or other emergency assistance agreements);
4) The incident produces media attention or is politically sensitive; 5) The incident leads to a Regional or State request for information; and/or 6) Whenever increased information flow from the Operational Area to the
State will assist in the management or mitigation of the incident’s impact.
The Medical Health Operational Area Coordinator will share information with the following, once aware of an unusual event occurrence within the Operational Area:
• California Medical Health Coordination Center (MHCC), if activated
• California Department of Public Health and Emergency Medical Services Authority Duty Officers
• Region IV Regional Disaster Medical Health Coordinator and Specialist
B. Information Sharing Tools There are five tools or systems available for Healthcare Coalition members to use for horizontal and vertical information sharing:
1. WebEOC is a secured web-based emergency management and information sharing platform for authorized agencies and organizations within the San Joaquin Operational Area. Real-time information is entered and displayed electronically through a series of boards, activity logs, maps and file library. Five medical and health specific boards are available to Healthcare Coalition members to use to communicate their status, both vertically and horizontally. As a web-based system, WebEOC works with any device with internet access, e.g., desktop computer, tablet, laptop, or smart phone.
WebEOC Report EMS Liaison Committee September 30, 2015 Page 4 of 8
The five medical and health WebEOC Boards: 1) Hospital Status Report
http://sjgov.org/ems/PDF/AppendixD.pdf 2) Clinic Status Report
http://sjgov.org/ems/PDF/AppendixE.pdf 3) Behavioral Health Facility Status Report
http://sjgov.org/ems/PDF/AppendixF.pdf 4) Long Term Care Facility Status Report
http://sjgov.org/ems/PDF/AppendixG.pdf 5) San Joaquin Medical/Health Interagency Situation Report
San Joaquin County Emergency Medical Services Agency DATE: September 30, 2015 TO: EMS Liaison Committee PREPARED BY: Rick Jones, MPA, EMS Analyst SUBJECT: Report on Emergency Ambulance Performance RECOMMENDED ACTION: Receive information on emergency ambulance performance for American Medical Response. FISCAL IMPACT: None DISCUSSION: The EMS Agency Report on the Exclusive Emergency Ambulance Provider Contract Compliance for AMR for the months of March and April, 2015, provides an in-depth review of AMR’s performance. The County’s contract with AMR establishes accountability for meeting specific standards and provides the EMS Agency with complete access to data and information on AMR’s operational, clinical, and administrative performance.
AMR’s March and April 2015, combined response time compliance for all ambulance zones met or exceeded the 90th percentile standard set by the County with 91.17% for March and 91.69% for April. AMR’s latest compliance report completes the fourth year of the second five-year contract period. AMR
exceeded compliance standards in seven (7) of the eleven subzones in March and eight (8) of the eleven subzones in April.
San Joaquin County Emergency Medical Services Agency DATE: September 30, 2015 TO: EMS Liaison Committee PREPARED BY: Rick Jones, MPA, EMS Analyst SUBJECT: Report on Emergency Ambulance Performance RECOMMENDED ACTION: Receive information on emergency ambulance performance for Escalon Community Ambulance. FISCAL IMPACT: None DISCUSSION: The EMS Agency Report on the Exclusive Emergency Ambulance Provider Contract Compliance for Escalon Community Ambulance (ECA) for the months of May and June 2015 provides an in-depth review of ECA’s performance. The County’s contract with ECA establishes accountability for meeting specific standards and provides the EMS Agency with complete access to data and information on AMR’s operational, clinical, and administrative performance.
ECA’s May and June 2015 compliance met the 90th percentile standard with 91.18% in May and 91.78% in June.
Note: Exemption requests for late calls meeting specific criteria were not calculated into the monthly response time compliance prior to November, 2014
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ECA's 12 Month Response Time Performance in Zone F
San Joaquin County Emergency Medical Services Agency DATE: September 30, 2015 TO: EMS Liaison Committee PREPARED BY: Rick Jones, MPA, EMS Analyst SUBJECT: Report on Emergency Ambulance Performance RECOMMENDED ACTION: Receive information on emergency ambulance performance for Manteca District Ambulance. FISCAL IMPACT: None DISCUSSION: The EMS Agency Report on the Exclusive Emergency Ambulance Provider Contract Compliance for Manteca District Ambulance (MDA) for the months of May and June, 2015, provides an in-depth review of MDA’s performance. The County’s contract with MDA establishes accountability for meeting specific standards and provides the EMS Agency with complete access to data and information on MDA’s operational, clinical, and administrative performance.
MDA’s May and June 2015, response time compliance met or exceeded the 90th percentile standard set by the County with 91.71 % for May and 91.16% for June. Note: Exemption requests for late calls meeting specific criteria were not calculated into the monthly response time compliance prior to November, 2014.
Manteca District Ambulance Service Performance Report
May-June 2015
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Manteca District Ambulance Service Performance Report
May-June 2015
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http://www.sjgov.org/ems
Mailing Address PO Box 220
French Camp, CA 95231
Health Care Services Complex Benton Hall
500 W. Hospital Rd. French Camp, CA 95231
Phone Number (209) 468-6818
Fax Number
(209) 468-6725
San Joaquin County Emergency Medical Services Agency DATE: September 30, 2015 TO: EMS Liaison Committee PREPARED BY: Jamie Nielsen, RN, EMS Trauma Coordinator SUBJECT: Trauma System RECOMMENDED ACTION Receive information on the Trauma System of San Joaquin County. FISCAL IMPACT None TRAUMA REGULATIONS Trauma Center designation in the State of California is the responsibility of local EMS agencies (LEMSA) in accordance with the Health and Safety Code, Division 2.5 and California Code of Regulations, Title 22, Chapter 7, Trauma Care Systems. http://www.emsa.ca.gov/Legislation_Regulation DISCUSSION San Joaquin County has one Level III Trauma Center; San Joaquin General Hospital (SJGH) designated August 1, 2013. The San Joaquin County EMS Agency rigorously monitors and evaluates the trauma system through trauma registry analysis, multi-disciplinary peer review of selected trauma cases, facility site visits and patient outcome studies. In addition to the EMS Agency’s quality improvement activities the trauma center is responsible for conducting an internal quality improvement program that includes trauma audits, trauma team peer review, trauma registry data collection, and evaluation of patient feedback. Below are the statistics and summaries of the pertinent areas involving trauma in San Joaquin County.
Trauma System Report EMS Liaison Committee September 30, 2015 Page 2 of 4 TRAUMA SYSTEM PROGRESS REPORT San Joaquin County Trauma Statistics Second Quarter 2015
Total Number of Trauma Activations = 542
476 - 88%
5
13
48
Method of Arrival
AmbulanceHelicopterPolice VehiclePrivate Vehicle
456 - 84%
1 85 - 16%
Blunt vs Penetrating
BluntBurnPenetrating
Trauma System Report EMS Liaison Committee September 30, 2015 Page 3 of 4
San Joaquin General Hospital Level III Trauma Center The American College of Surgeons conducted an EMS Agency required consultation visit of San Joaquin General Hospital’s trauma program on April 13-14, 2015. The published report was received and the trauma center has six (6) months to correct any deficiencies found before moving on to level III verification. The EMS Agency will be working with the American College of Surgeons to conduct the level III trauma center verification visit in the spring of 2016.
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269
Mechanism of Injury BoatATVBurnBikeOtherPedStabAssaultMCCFallGSWMVC
Trauma System Report EMS Liaison Committee September 30, 2015 Page 4 of 4 Trauma Audit Committee (TAC) The Trauma Audit Committee (TAC) is an EMS system level multi-disciplinary peer review committee established to review selected surgical cases performed at San Joaquin General Hospital based on audit criteria with the goal of reducing trauma patient morbidity and mortality and improving the provision of care to trauma patients in the EMS system. TAC is a required component of the EMS Agency’s approved trauma system plan. This meeting is conducted quarterly and is chaired by Dr. David V. Shatz, M.D., F.A.C.S. Professor of surgery at UC Davis Medical Center. EMS Case Review Run reviews have returned at the provider level and the case selection correlates with the cases reviewed at preceding TAC meeting. This meeting is also held quarterly at the local provider’s agency and involves a thorough review of each EMS case which includes; audio files of the radio report, pre-hospital care report (PCR), trauma registry summary and autopsy if applicable. Trauma Registry SJCEMSA reported all of 2014 trauma data to the State EMS Authority on August 6th, 2015 and will continue to report data on a quarterly basis. San Joaquin General Hospital reports trauma data quarterly to the National Trauma Data Bank (NTDB).
http://www.sjgov.org/ems
Mailing Address PO Box 220
French Camp, CA 95231
Health Care Services Complex Benton Hall
500 W. Hospital Rd. French Camp, CA 95231
Phone Number (209) 468-6818
Fax Number
(209) 468-6725
San Joaquin County Emergency Medical Services Agency DATE: September 30, 2015 TO: EMS Liaison Committee PREPARED BY: Rick Jones, MPA, EMS Analyst SUBJECT: Report on STEMI System in 2015 RECOMMENDED ACTION: Receive information on the STEMI System in San Joaquin County for January through June 2015. FISCAL IMPACT: None DISCUSSION: The San Joaquin County EMS Agency developed and implemented a system to identify “heart attack” patients experiencing an ST elevated myocardial infarction (STEMI) and to direct these patients to specially designated hospitals staffed and equipped with cardiac catheter laboratories capable of providing immediate “life-saving” intervention. The ability of the EMS Agency to evaluate the STEMI system relies upon data measuring the performance of prehospital and hospital timeliness and adherence to policies and procedures.
The STEMI system of care began with the designation of St. Joseph’s Medical Center and Dameron Hospital as the two STEMI Receiving Centers (SRCs) in San Joaquin County beginning on April 1 2012. The following Quality Indicators, used as a means to measure the effectiveness of the STEMI system in San Joaquin County, rely upon data derived from both prehospital and in-hospital sources. Prehospital Quality Indicators include measurement of the following:
1. Accurate and complete documentation 2. Time spent on-scene 3. Appropriate use of 12 lead ECGs (Pts correctly identified as possible cardiac patients) 4. Identification of STEMI patients (using criteria set forth in EMS Agency policy) 5. Timely and correct notification of SRCs for patient’s identified as having STEMI
Elapsed Time from Ambulance Arrival On-Scene to Pt Transport January through June 2015 for Cardiac Cases Reported through STEMI Data Collection Process
Time On-Scene
Linear (Time On-Scene)
Average On-Scene Time: 12 Minutes
6. Efficacy of ECG transmission
In-Hospital Quality Indicators include measurement of the following: 1. Timeliness of in-hospital STEMI alert in response to prehospital STEMI alert 2. Efficacy of prehospital STEMI identification method (e.g.percentage of false positives) 3. Timeliness of prehospital alert and ED arrival to cath lab/balloon times
Reports Ensuring accurate and complete documentation of STEMI patients from the prehospital setting requires a careful review of patient care reports. This review is conducted by staff at the SRCs in consultation with the SJCEMSA EMS Analyst. The EMS Analyst provides feedback to prehospital personnel to improve STEMI documentation, ensure appropriate use of 12 lead ECGs, and whether timely and correct notification of SRCs for patient’s identified as having STEMI has occurred. The efficacy of ECG transmission has been questionable due to technology challenges (slow or inoperable modems) and because not all 12 Lead ECG machines are equipped with the necessary capability. Time spent on scene by ambulance crews caring for potential STEMI patients have averaged just above ten (10) minutes since the inception of the STEMI program. The chart below shows the variation in the time on-scene during the first six months of 2015. Those cases in
which time on scene exceeds twenty (20) minutes are the result of challenges associated with speedily transporting patients from penal institutions.
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Percutaneous Interventions Following Prehospital STEMI Alerts and Ambulance Transport to Dameron and SJMC in
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Percutaneous Interventions Related to (911) Ambulance Transports to Dameron and SJMC in 2015
SJMC
Dameron
Volume of Percutaneous Interventions (PCIs) via 911 System The following two charts show the difference between the number of percutaneous
interventions (PCI) performed by SJMC and Dameron as a result of ambulance transports via the 911 system. The first chart includes only those ambulance transports with patients identified in the field as STEMI patients. The second chart includes all 911 system ambulance patients transported that received PCI. The slight increase in volume in this chart is due to the fact that some patients do not develop STEMI symptoms until after arrival at the hospital, or because they were not identified in the field. Reasons for failure to identify STEMI patients include: patients that do not present with cardiac symptoms; failure by ECG technology; or patients with an evolving STEMI that only presents upon arrival at the E.D.
False Positive STEMI Cases The false positive rate provides an indication of whether the method used to identify STEMI patients in the prehospital setting are appropriate to cause an in-hospital STEMI alert. During the first six months in 2015, the false positive rate reported by SJMC was 25 of 75 cases (33%); and the false positive rate reported by Dameron was 1 out of 23 cases (4.3%).
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Individual STEMI Alerts January through June 2015
Range of Elapsed Time from Prehospital STEMI Alert to In-Hospital STEMI alert at Dameron from January through June 2015
Range of Elapsed Time from Prehospital STEMI Alert to In-Hospital STEMI alert at SJMC from January through June 2015
SRC STEMI Alert Performance The entire premise for alerting a SRC of a STEMI patient in the prehospital setting is to provide the hospital with early notification in order to ensure that the cardiac cath lab teams
are prepared to immediately care to perfuse the heart and stop heart muscle cell death. The goal is that upon receipt of a STEMI alert from the prehospital setting, the SRCs should immediately call an internal STEMI alert. While both hospitals continue to improve, the charts below show that both facilities have room for improvement.
STEMI System EMS Liaison September 30, 2015 5 of 5
Door to Balloon Times Dameron Hospital and SJMC consistently meet or exceed the ACC/AHA < ninety (90) minute the door to balloon time interval minimum standard. Details of this performance will be provided in subsequent reporting periods.
http://www.sjgov.org/ems
Mailing Address PO Box 220
French Camp, CA 95231
Health Care Services Complex Benton Hall
500 W. Hospital Rd. French Camp, CA 95231
Phone Number (209) 468-6818
Fax Number
(209) 468-6725
San Joaquin County Emergency Medical Services Agency
DATE: September 30, 2015 TO: EMS Liaison Committee PREPARED BY: Rick Jones, MPA, EMS Analyst SUBJECT: Report on Ambulance Patient Off-load Delays RECOMMENDED ACTION: Receive information on Ambulance Patient Off-load Delays occurring in San Joaquin County. FISCAL IMPACT: None DISCUSSION: The San Joaquin County EMS Agency (SJCEMSA) is making a concerted effort to measure the scope of the problem and to identify the factors that contribute to the amount time needed to transfer patient care between prehospital personnel and the emergency department.
Ambulance patient offload time, also known as wall time, is the interval between arrival of an ambulance patient at the emergency department and the time the patient is transferred to an emergency department gurney, bed, chair, or other acceptable location and the emergency department personnel assumes responsibility for care of the patient.
The Standard
In San Joaquin County, we consider a reasonable amount of time for the transfer of patient care from ambulance personnel to emergency department staff to be no greater than 15 minutes. In San Joaquin County, ambulance patient offload delay (APOD) occurs when the ambulance patient offload time interval exceeds the established standard (30 minutes).
APOD Report EMS Liaison Committee September 30, 2015 Page 2 of 4
Goal
To reduce all wall times to less than 30 minutes. With cooperation, it’s an attainable goal.
Patient Care Impact:
When an ambulance is kept at an emergency department over 30 minutes the resulting ambulance patient offload delay impacts the ability of the EMS system to meet demand and adversely impacts the care of the patient waiting on an ambulance gurney.
Ambulance Patient Offload Delays (APOD) is the measurement of time produced when the ambulance patient offload time interval exceeds the established standard (30 minutes). The performance of the seven hospitals in San Joaquin County during the month on July 2015 is shown below in Chart 1. This chart compares the number of ambulance patient offloads (volume) between each facility and also shows the percent of each hospital’s offload times that fall within three measurement categories: less than 30 minutes; between 30 and 60 minutes, and greater than 60 minutes.
Financial Impact:
When an ambulance is kept at an emergency department over 30 minutes, the financial impact to the 9-1-1 system equates to approximately $2.58/minute. During the twelve (12) months from June 2014 through May 2015, it is estimated that ambulance patient offload delays resulted in a $3,646,933 impact on the EMS system (see Chart 2).
APOD Report EMS Liaison Committee September 30, 2015 Page 4 of 4
San Joaquin County
Emergency Medical Services Agency
http://www.sjgov.org/ems Mailing Address PO Box 220 French Camp, CA 95231 Health Care Services Complex Benton Hall 500 W. Hospital Rd. French Camp, CA 95231
Phone Number (209) 468-6818
Fax Number (209) 468-6725
DATE: September 30, 2015 TO: EMS Liaison Committee PREPARED BY: Adam Dampier, BA, MICP, Prehospital Care Coordinator SUBJECT: Overview of Prehospital Quality Improvement Activities
RECOMMENDED ACTION:
Receive information on Prehospital Continuous Quality Improvement (CQI) Activities.
FISCAL IMPACT:
None.
DISCUSSION:
The San Joaquin County EMS Agency has established an EMS CQI process and convened an EMS CQI Council to help fulfill its mandate to evaluate and ensure medical control of the EMS system. CQI is a method of evaluation composed of structure, process, and outcome measures that helps identify root causes of problems, intervenes to reduce or eliminate these causes, and take steps to correct the process.
The San Joaquin County EMS CQI Council meets on the second Thursday of every month. One of the responsibilities of the CQI Council is to select quality indicators, create action plans, and monitor performance. The submission of reports to the EMS Agency is required of the ALS ambulance providers, air ambulance providers, base hospital, receiving hospitals and the designated EMS dispatch center.
The following is an example of key performance indicator currently being measured by San Joaquin General Hospital.
Volume of Base Hospital Call-Ins During Six Week Study by Day of the Week
CQI Report EMS Liaison Committee September 30, 2015 Page 3 of 3
6.62%
93.38%
Comparison of Timeliness of Response to Call-ins to Base Hospital during a Six Week Period
% of Total Callsacknowedge > 1Minute
% of Total Callsacknowledge < 1Minute
San Joaquin County
Emergency Medical Services Agency
http://www.sjgov.org/ems Mailing Address PO Box 220 French Camp, CA 95231 Health Care Services Complex Benton Hall 500 W. Hospital Rd. French Camp, CA 95231
Phone Number (209) 468-6818
Fax Number (209) 468-6725
DATE: September 30, 2015 TO: EMS Liaison Committee PREPARED BY: Shellie Lima, MBA, Regional Disaster Medical Health Specialist SUBJECT: Report on EMResource (Intermedix) RECOMMENDED ACTION: Receive information on the EMResource System (Intermedix). DISCUSSION: Since 2007, the San Joaquin EMS Agency has administered the EMResource system (formerly EMSystem) via a Memorandum of Understanding for ten counties within Region IV (Amador, Calaveras, El Dorado, Nevada, Placer, Sacramento, San Joaquin, Stanislaus, Tuolumne, and Yolo). EMResource (owned by Intermedix) is a web-based communication solution that provides day-to-day hospital resource bed availability reporting, ensuring appropriate patient transport decisions during multi-casualty incidents. In addition, the system is a resource for reporting real-time Hospital Available Bed (HAvBED) Status from hospitals throughout the Region. As administrator, the EMS Agency provides new user logins, administers the system interface, provides train-the-trainer solutions for other counties and ensures the system meets the needs of the region. Updates and modifications are presented and agreed upon during quarterly Medical Health Mutual Aid Advisory Committee meetings. Over the past several years, EMResource has implemented additional capabilities for capturing wall time for ambulances at hospitals. The EMS Agency is currently evaluating the feasibility of incorporating the solution in the future. There are 32 Hospitals in the Region IV viewing area. All seven of the San Joaquin Hospitals are active users of the system. There are 401 individual users of the system throughout the Region.
San Joaquin County Emergency Medical Services Agency DATE: September 30, 2015 TO: EMS Liaison Committee PREPARED BY: Phillip Cook, Disaster Medical Health Specialist SUBJECT: San Joaquin Operational Area Healthcare Coalition RECOMMENDED ACTION: Receive information on the San Joaquin Operational Area Healthcare Coalition. FISCAL IMPACT: None DISCUSSION:
I. PURPOSE, SCOPE AND AUTHORITY
A. Purpose The purpose the San Joaquin Operational Area Healthcare Coalition is to improve and sustain the healthcare preparedness capabilities within the San Joaquin Operational Area.
B. Scope The San Joaquin Operational Area Healthcare Coalition encompasses all participating healthcare facilities, providers, public and private medical and health agencies/organizations, public safety agencies, non-government agencies, and other community partners operating within the geographic boundaries of San Joaquin County.
C. Authority This governance document is issued under the authority of the San Joaquin County Emergency Medical Services Agency Administrator, who serves as the Medical Health Operational Area Coordinator (California Health and Safety Code, Division 2.5, Article 4, Section 1797.153). Additionally the San Joaquin County Board of Supervisors has authorized San Joaquin County Emergency Medical Services Agency Administrator to enter into agreements and memorandums of understanding with participating healthcare facilities and providers as part of the FY 2013/14 HPP Grant (Board Order B-13-341).
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II. HEALTHCARE COALTION FUNCTIONAL GROUPS
The San Joaquin Operational Area Healthcare Coalition is made up of three distinct functional groups:
Medical/Health Multi-Agency Coordination Group (Med MAC)
Emergency Preparedness Committee (EPC)
Healthcare Coalition Memorandum of Understanding Signatories (MOU)
Healthcare Coalition
Figure 1
A. Medical/Health Multi-Agency Coordination Group (Med MAC) The Multi-Agency Coordination System or MACS is a component of the Incident Command System (ICS), California’s Standardized Emergency Management System (SEMS), and the federal National Incident Management System (NIMS).
Healthcare Coalition EMS Liaison Committee September 30, 2015 Page 3 of 4
The MACS process is used to ensure the integration and coordination of multi-agency emergency response and management. MACS provides the architectural framework for normally disparate organizations or agencies to work together to prioritize incident goals and objectives, determine allocation of shared or limited resources, establish joint communications, and share incident information. The San Joaquin Operational Area Medical/Health Multi-Agency Coordination Group (Med MAC) is comprised of representatives from San Joaquin County government agencies and healthcare facilities that have a shared responsibility for the delivery of healthcare during emergency conditions. Med MAC Group members are executive level leaders that are fully authorized to act on behalf of their agency or organization.
B. Emergency Preparedness Committee (EPC) The committee meets on a monthly basis and consists of the Emergency Preparedness Coordinators from Healthcare Coalition member agencies and organizations. The purpose of the committee is to provide a forum for joint emergency preparedness planning, training and exercising. In addition committee members are responsible to complete the deliverable requirements of the Hospital Preparedness Program (HPP) grant and determine how to use grant funds to improved healthcare preparedness capabilities.
C. Healthcare Coalition Memorandum of Understanding (MOU) Signatories The FY 2008/09 Hospital Preparedness Program (HPP) grant required participating hospital, clinic, and other healthcare providers to enter into a voluntary Memorandum of Understanding (MOU), in compliance with the 14 National Incident Management System (NIMS) implementation objectives1, for the sharing of personnel, resources and information during a medical/health disaster or other event. MOU participants agree to voluntarily share available resources with the requesting organization agreeing to replace or pay the cost of the resource. The Healthcare Coalition Mutual Aid Memorandum of Understanding is designed to establish a process for resource sharing among the hospitals, clinics and healthcare providers in San Joaquin County. The MOU augments the government authorized mutual aid process used during disasters.
San Joaquin County Emergency Medical Services Agency DATE: September 30, 2015 TO: EMS Liaison Committee PREPARED BY: Phillip Cook, Disaster Medical Health Specialist SUBJECT: FY 2015-16 Hospital Preparedness Program (HPP) Grant RECOMMENDED ACTION: Provide an overview of the FY 2015-16 Hospital Preparedness Program (HPP) Grant. FISCAL IMPACT: $280,491.00 DISCUSSION:
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II. WORK PLAN DELIVERABLES A. Capability 1: Healthcare System Preparedness
1. Monthly Emergency Preparedness Committee meetings 2. Quarterly WebEOC End User Training 3. Invite Skilled Nursing Facility Administrators to join the Healthcare Coalition
and activated WebEOC accounts for key personnel 4. Update the Operational Area public health and medical risk assessment 5. Maintain an Operational Area public health and medical resource directory 6. Develop custom WebEOC boards to meet coalition member needs 7. Medical needs of shelter population planning 8. Preparedness exercises 9. Preparedness training
C. Capability 3: Emergency Operations Coordination 1. Quarterly WebEOC End User Training 2. Mutual Aid resource requesting policies, procedures and training 3. WebEOC Notification Module purchase and implementation 4. Develop a WebEOC Improvement Plan tracking board 5. WebEOC tech support and software updates
D. Capability 6: Information Sharing
1. Bi-monthly Healthcare Ham Radio Communications Drills 2. WebEOC training, exercises and support 3. Quarterly Hospital Available Beds for Emergencies and Disasters (HAvBED)
drills 4. EMS dispatch CAD interface with EMResource 5. Maintain the California Health Alert Network (CAHAN), user registration,
training, and exercises 6. Attend the Intermedix Summit to learn EMResource and WebEOC best
practices
E. Capability 10: Medical Surge 1. Update the 2015 medical surge capacity and strategy, including pediatric
and neonatal surge capacity 2. Train coalition members of the surge strategy 3. Update the Long Term Care Facility Evacuation Plan 4. Update the Government Authorized Alternate Care Site Plan 5. Inventory all medical transport resources
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6. Participating in the development of Region IV Ebola patient transportation policies and procedures
7. Patient decontamination initial and refresher training 8. Psychological First Aid training 9. Crime Prevention through Environmental Design (CPTED) for Healthcare
Facilities Course 10. Add the Region IV MCI Plan to the Policy and Skills Review (PSR) course
curriculum.
F. Capability 15: Volunteer Management 1. Quarterly Disaster Healthcare Volunteer (DHV) system exercises 2. Continue to add volunteer healthcare professions to the San Joaquin County
Unit 3. Create and distribute a Survey Monkey survey to coalition members to
access the status of their emergency credentialing and volunteer management policies.
REFERENCES:
1. Hospital Preparedness Program http://www.phe.gov/preparedness/planning/hpp/pages/default.aspx
http://www.sjgov.org/ems Mailing Address PO Box 220 French Camp, CA 95231 Health Care Services Complex Benton Hall 500 W. Hospital Rd. French Camp, CA 95231
Phone Number (209) 468-6818
Fax Number (209) 468-6725
DATE: September 30, 2015 TO: EMS Liaison Committee PREPARED BY: Shellie Lima, MBA, Regional Disaster Medical Health Specialist SUBJECT: Report on RDMHS Region IV FY15-16 Grant RECOMMENDED ACTION: Receive information on the Regional Disaster Medical Health Specialist (RDMHS) Region IV FY15-16 Grant Program. DISCUSSION: Since 1994, the San Joaquin EMS Agency has received State grant funds to enhance medical mutual aid services and disaster preparation in San Joaquin and 10 other counties that make up OES Region IV (Alpine, Amador, Calaveras, El Dorado, Placer, Nevada, Sacramento, Stanislaus, Tuolumne, and Yolo). These services and staff funds have promoted the standardization of regional disaster response services, as well as provided for joint planning and training for pre-hospital, hospital, and public safety personnel. The grants have funded the RDMHS position within the EMS Agency to support disaster coordination in Region IV, and to fulfill the objectives of the grants. These efforts have been successful in promoting disaster planning and response, as well as promoting inter-county cooperation. The State has a long-term commitment to this program. The County Board of Supervisors approved the FY15-16 RDMHS Scope of Work and budget during the August 4, 2015 session. The signed documents were forwarded to California Emergency Medical Services Authority (EMSA) for final execution. The FY15-16 grant period is July 1, 2015 – June 30, 2016. A copy of the Scope of Work is attached. The evaluation of the project is based on the successful completion of each of the applicable tasks identified in the Scope of Work. The RDMHS completes evaluation measures on each of the tasks and provides quarterly updates to EMSA. The full grant value is $110,000.
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Regional Disaster Medical Health Specialist (RDMHS) 2015/2016 Contract Scope of Work
The Regional Disaster Medical and Health Specialist (RDMHS) is the component of the Regional Disaster Medical and Health Coordination (RDMHC) Program that directly supports regional preparedness, response, mitigation, and recovery activities. Activities to assist in accomplishing this shall include: 1 Continue to support the implementation of the California Public Health and Medical
Emergency Operations Manual (EOM). 1.1 Conduct and/or participate in local and Regional EOM trainings. When possible,
work with new EOM instructors to co-facilitate trainings. 1.1.1 Invite State partners that are based locally to participate, when
appropriate, in EOM trainings. 1.2 Provide input as requested on the EOM during the update process, including
improvement to the Situation Report. Seek input from local partners on EOM improvement opportunities during the update process.
2 Assist in the development of a comprehensive Medical Health Operational Area Coordination (MHOAC) program in each operational area within the region.
2.1 Conduct training for Medical Health Operational Area Coordinators (MHOACs) and other medical and health partners in the operational areas as needed.
2.2 Assist operational areas in developing contact lists to support the functions of a MHOAC program.
2.3 Provide updated MHOAC contact list to Emergency Medical Services Authority (EMSA) Program Lead on a monthly basis.
2.4 Assist operational areas in developing local Situation Report distribution procedures consistent with the EOM.
2.5 Assist operational areas in developing local Resource Requesting procedures consistent with the EOM.
2.6 Assist the Emergency Medical Services Administrators’ Association of California (EMSAAC), EMSA and CDPH with the development of a MHOAC Program Guide.
3 Continue to develop the Regional Disaster Medical and Health Coordination (RDMHC)
Program. 3.1 Develop and maintain RDMHC Program Response Procedures. Procedures to
include contact lists, medical and health agreements within region (i.e., automatic aid agreements, cooperative assistance agreements).
3.2 Conduct at least three medical and health regional planning meetings per year for the purpose of planning, coordination, training, and information sharing.
3.3 Participate in the local Mutual Aid Regional Advisory Committee (MARAC) meetings and represent the RDMHC Program as requested (ongoing).
3.4 Represent the RDMHC Program at regional emergency management meetings. 3.5 Continue to coordinate with regional coordinators as appropriate.
3.5.1 California Hospital Association Regional Coordinators
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3.5.2 California Governor’s Office of Emergency Services regional staff. 3.5.3 California Department of Public Health Emergency Preparedness Office
Contract Managers 3.5.4 Emergency Medical Services Authority’s Senior Emergency Services
Coordinators.
4 Assist EMSA and the Emergency Medical Services Administrators’ Association of California (EMSAAC) in the development, implementation and evaluation of the California Statewide Patient Movement Plan.
4.1 Participate in Patient Movement Workgroups to assist with specific tasks or content development as requested.
4.2 Review and provide feedback on draft work products developed by the contractor and workgroups.
4.3 Solicit input as requested from operational areas within the region on the Draft Patient Movement Plan.
4.4 Develop a training plan for the Patient Movement Plan. 4.5 Participate in exercise of Plan.
5 Participate in activities related to Medical Countermeasure (MCM) programs, including
the Strategic National Stockpile (SNS) program and CHEMPACK. 5.1 Participate on the monthly MCM and Local Health Department (LHD) Emergency
and provide feedback to the LHD as appropriate. Participate in the Cities Readiness Initiative (CRI) ORR assessments and assist EPO in review and analysis of all LHD SNS preparedness activities within the Mutual Aid Region.
5.3 Promote Regional CHEMPACK training to include dissemination of training flyers provided by EPO and encourage participation of emergency dispatchers and CHEMPACK host site representatives. Participate in the planning and conduct of annual Regional CHEMPACK training.
5.4 Develop and/or update regional CHEMPACK Plans annually and distribute to partners as appropriate.
5.4.1 Maintain current CHEMPACK host site point-of-contact lists. 6 Coordinate operational area participation in catastrophic planning projects, such as the
Southern California Catastrophic Earthquake Response Plan, the Bay Area Earthquake Response Plan and the Cascadia Subduction Zone Earthquake and Tsunami Response Projects.
6.1 Develop template to collect medical and health data from operational areas (as requested). Schedule meetings as needed with operational areas to discuss Plan and next steps.
6.2 Conduct meetings with operational areas in conjunction with EMSA, CDPH and United States Department of Health and Human Services Assistant Secretary for Preparedness and Response (ASPR).
6.3 Collect data to enhance Plan.
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6.4 Exercise Plan in conjunction with EMSA, CDPH and ASPR. 7 Coordinate inter-State collaboration workgroups, such as the California/Nevada Border
Counties Workgroup 7.1 Conduct at least three meetings annually of the California/Nevada Counties
Workgroup (ongoing). 7.2 Maintain point-of-contact lists for participants in the California/Nevada Border
Counties Workgroup (ongoing). 7.2.1 Participants include RDMHS from Region III, IV and Region VI.
8 Participate in regional and statewide exercises and other significant medical and health
related training and exercises authorized by EMSA and/or CDPH. 8.1 Participate in regional planning and post-exercise evaluation activities for the
Statewide Medical and Health Exercise and the Cal OES Golden Guardian Exercise (annually).
8.1.1 Participate in the Statewide Medical and Health Exercise performing the roles and responsibilities of the RDMHC Program during an actual disaster, including the coordination of medical and health mutual aid.
8.1.2 Participate in the Golden Guardian Exercise performing the roles and responsibilities of the RDMHC Program during an actual disaster, including the coordination of medical and health mutual aid.
8.2 Participate in the San Onofre Nuclear Generating Station and Diablo Canyon Nuclear Generating Station exercises as it applies to the region (Regions I & VI).
8.3 Participate in the CDPH/EMSA Emergency Preparedness TrainingWorkshop annually.
8.4 Attend conferences as requested by EMSA or CDPH-EPO, as budget allows. 9 Respond in accordance with the EOM to medical and health events in the region
(ongoing). 9.1 Maintain incident logs and data related to response. Data to be provided in
quarterly reports. 9.1.1 Report number of requests coordinated by the RDMHC Program for
medical and/or health mutual aid and/or assistance from within the region.
9.1.2 Report number of requests coordinated by the RDMHC Program for medical and/or health mutual aid and/or assistance from outside the region.
9.1.3 Report number of times that medical and/or health mutual aid or mutual assistance requests required reimbursement coordination.
9.1.4 Report number of times the RDMHC Program polled the operational areas within the region to assess available resources for a potential request.
9.1.5 Report number of times RDMHC Program assisted operational areas with completing the Medical and Health Situation Report or completed the Situation Report for the operational area.
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9.1.6 Report number of times the RDMHC Program assisted operational areas with completing the Medical Health Resource Request form.
9.1.7 Report number of times the RDMHC Program is contacted by the State for additional information regarding unusual events of emergency system activation within the region.
9.1.8 Report the number of times the RDMHC Program is requested to act as a conduit to share information with operational areas within the region. 9.1.8.1 Number of times operational areas from within the region
request the RDMHC program to share material/information with all operational areas within the region.
9.1.8.2 Number of times the State requests the RDMHC program to share material/information with all operational areas within the region.
10 Additional Provisions
10.1 Participate in the RDMHC Program quarterly onsite meetings and monthly conference calls convened by EMSA.
10.2 Submit quarterly reports to the EMSA RDMHC Program Lead. 10.3 Represent the RDMHC Program as a participant on working/advisory
committees as authorized by EMSA in conjunction with CDPH. Committee assignments reviewed annually and subject to change based on RDMHS workload and availability. Potential committee assignments include:
10.3.1 BioWatch program planning and response. 10.3.2 State workgroup for the 2015 and/or 2016 Statewide Medical and Health
Exercise. 10.3.3 Medical Reserve Corps Advisory Committee. 10.3.4 EOM workgroup. 10.3.5 Disaster Healthcare Volunteers (DHV) Deployment Operations Manual
Workgroup. 10.3.6 Ambulance Strike Team Project. 10.3.7 Emergency Function (EF) 8 Technical Workgroup. 10.3.8 California Disaster Mental Health Statewide Plan Development
workgroup. 10.3.9 HPP/PHEP Grant Guidance workgroup.
10.4 If additional activities are identified during this contract period, the RDMHS will work with the EMSA RDMHC Program Lead to evaluate current workload and responsibilities and determine how the additional activities support the tasks identified in this SOW. Both parties will agree on the appropriateness of the assignment prior to it becoming a requirement.
