THURSTON COUNTY MEDIC ONE OPERATIONS COMMITTEE ~ … Agenda... · February 7, 8 & 9, 2014 at the...

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THURSTON COUNTY MEDIC ONE

OPERATIONS COMMITTEE ~ REGULAR MEETING EMERGENCY SERVICES CENTER/EOC

December 5, 2013, 2:00 PM

AGENDA I. CALL TO ORDER/ROLL CALL II. APPROVAL OF AGENDA III. PUBLIC PARTICIPATION IV. REVIEW AND APPROVAL OF MINUTES A. Operations Committee - November 7, 2013 B. EMS Council - November 20, 2013 Meting Canceled V. COMMITTEE REPORTS A. West Region EMS Council B. Subcommittees 1. Equipment Committee (EqC) – Chair or Representative 2. Mass Casualty Incident (MCI) Committee – Chair or Representative 3. Training Advisory Committee (TAC) – Chair or Representative C. Staff Report VI. OLD BUSINESS

ITEM

PRESENTER

EXPECTED OUTCOME

A. Policy Review Fay Review/Comment B. Communicable Disease Exposure Plan Hambly Update C. D. E.

OLD BUSINESS - ISSUES & ACTIONS PENDING Paramedic exam/eval process (policy 20A)

Customer Satisfaction Survey Bylaws Committee

VII. NEW BUSINESS

ITEM

PRESENTER EXPECTED OUTCOME

A. B. C. D. E. F.

VIII. GOOD OF THE ORDER IX. ADJOURNMENT

11 ops november minutes 2013

THURSTON COUNTY MEDIC ONE OPERATIONS COMMITTEE ~ MEETING NOTES EMERGENCY OPERATIONS CENTER/ECC November 7, 2013 PRESENT: Greg Wright, Brian VanCamp, Steve Brooks, John Carpenter, Malloree Barnes, Mel Low, Larry Fontanilla MD

(MPD), Jim Quackenbush, Kathy Pace, Karen Hoffman,

EXCUSED: Mary Campbell

ABSENT: Dave Johnson, Jim Fowler, Scott Puhalla,

GUESTS: Tony Kuzma, Jody Halsey

STAFF: Steve Romines, Cindy Hambly, Fay Flanery, Alan Provencher

I. CALL TO ORDER/ROLL CALL - Chairman Wright called the regular meeting of the Operations Committee

to order at 2:05 PM. Roll was recorded by staff. Chair Wright acknowledged new member Malloree Barnes from St. Peters Hospital and round table introductions were made.

II. APPROVAL OF AGENDA – MSC (Carpenter/Brooks) move to approve.

III. PUBLIC PARTICIPATION – None

IV. REVIEW AND APPROVAL OF MINUTES 1. Operations Committee – August 1, 2013 UNOFFICIAL Mtg. Notes were acknowledged by the committee 2. EMS Council – October 16, 2013 (Informational Only)

V. COMMITTEE REPORTS

A. WEST REGION – Romines reported there is an upcoming meeting, and that he and Anne Benoit from West Region are participating in a State Roles & Responsibilities group to help identify what the roles and responsibilities are for each of the states regions. Hambly added there will be the annual WREMS conference February 7, 8 & 9, 2014 at the Great Wolf Lodge with a pediatric focus. Romines added, the WREM conference is good for several reasons to include giving our region identity. Brooks added that this year there will be a PALS 1 day class with certification for paramedics.

B. SUBCOMMITTES 1. Equipment Committee (EqC) – Provencher report on minutes handed out for the October meeting. He

highlighted on New Business item XXL gloves; they have found and will now stock these. Brooks inquired about Old Business item: ALS engine/split kit standardization/protocol. Committee discussion followed with Dr. Fontanilla commenting that he has not developed a scope for split kits and is working on it. Provencher to correct minutes removing MPD has directed not to split.

2. Mass Casualty Incident (MCI) Committee – Hambly reported MCI training is complete for the year, there were 2 makeup classes, and there are still some providers who have not completed the MPD required MCI training.

3. Training Advisory Committee (TAC) – Hambly reported on the minutes from the October 16, 2013 meeting handed out, highlighting the following: • EMS Instructor/Evaluator workshop is scheduled for January 25 & 26, 2014, currently working on the

agenda. • CPR density update to departments • On-going discussion to increase the Instructor pool. • Healthcare & ACLS providers requirement to include either an ACLS card or American Heart

Association Healthcare card at a minimum are being considered. • Reissuance Procedures, Hambly will develop a draft policy/procedure for reissuance process • Training records – working to allow departments to submit rosters instead of individual records for

attendance and completion of training classes. • Next meeting November 20, 2013

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C. STAFF Report – Romines reported on the staff report that was included in the meeting packet. He highlighted on the following: • Tablet technology – tablets in trial mode for council and committee members use. The idea is to

reduce paper use, copy costs, staff time etc. The idea consists of emailing the packet to members in a single file for viewing with anticipation to post agenda, approved minutes and packet information on the website for access by members and will also be available to the public.

• 2 medic units and 1 SPRINT unit were retired this year. 2 medic units are scheduled for replacement in 2014 with 2 then being surplused based on the mechanics recommendation.

• Protocol app is up and running • 3rd Qtr Business Plan updated and available • Nurse line use has increased but due to repeat users • Website – will post the BLS response time report • WATRAC – Washington tracking system for hospitals which monitors bed availability in hospitals. • Current EMT class is down to 15 students from 18 initially • TRPC study final report is available on the Medic One website • New dangerous Krokodil drug going around along with Gonorrhea cases on the rise

VI. OLD BUSINESS A. EMS Council Action Report– Wright reported EMS Council met in October. Wright added he presented the

BLS response time reporting on the Medic One website. Council discussion followed with a unanimous approval to post the report. He added the TRPC final report was accepted and is being recommended to the BOCC for acceptance and we are waiting direction following that. Romines added the Medic One enhanced budget has been approved and moved it forward. He added the Emergency Management budget was put through with a 5% cut.

B. Policy Review – Wright explained the process the Ops committee and EMSC agreed upon for reviewing and presenting policies that were being following. Flanery explained the synopsis report included in the packet, identifying items up for discussion at this meeting and what is expected for next month’s meeting. Flanery continued to highlight the redline edits to both policies 1 (Vehicle Accident Review) and policy 2 (Ridership Policy). Committee discussion followed with the Ops committee approving moving policy 1 forward to EMS council with the noted edits. Policy 2 had extensive committee discussion with recommended edits from committee members and the MPD. Staff will review and redraft to include committee & MPD recommendations and bring back to the December meeting. Committee requested update on the exposure plan procedure; Dr. Fontanilla provided an update on the status. Staff will add back to the agenda for December.

VII. NEW BUSINESS A. None.

VIII. GOOD OF THE ORDER – Romines passed around a thank you card Medic One received thanking Fire Districts,

Southbay, District 7, Olympia, Medic 4 and District 8 for the response to their mother. Wright added no meeting in January.

IX. ADJOURNMENT - 3:11 PM

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Operations Committee Meeting Medic One/EMS, Staff Report, Nov 2013 Happy Thanksgiving! EMS System Operational Review, TRPC as Process Project Manager, proposed at July meeting, recommending contract to BOCC. Signed by BOCC September 25, TRPC initiating, last session 12/19, contacting Chiefs/Com, Report 6/19 EMS Council meeting 3:30, presented, to EMS community for comment. Presentations: EMSC 6/19, Fire Commissioner/Chiefs Assoc 7/16, BOCC 8/7 (Medic One website, System Reports), comments due, EMS Council accepts 9/18, to BOCC. Retired Medic units to FD#9, (OFD bypass) FD#16 and SPRINT unit to Bucoda, BOCC 9/10, approved, awarded. Roles/Responsibilities workgroup for DOH/EMS, WREMS reps Anne Benoist & Steve Romines, report, completed EMS Key Performance Indicators (KPI) in final draft. Attached. Protocol app (iphone/android) contract signed, started July 5, 2013, received and functional, EMS agencies notified. Medic One website modified to include app links and provider registry number lookup. Expanding to EMT course, completed. 2014 Budget and Business plan drafted presented to EMSC, 9/18 meeting, budget approved, to BOCC, approved. 2013 Business plan Q3 report. Medic hiring and oral exams. May 2013 closed with 44 new apps/5 retest oral, 9 pass written, 7 pass oral board. Next exam, closed: written Nov 12, 2013, oral in progress. 28 applicants (25 to written), 3 retest oral, 5 total on current list. NurseLine Criteria Based Dispatch Program, started December 11, 8AM, calls routed to Evergreen Hospital “Healthline,” contract completed, implemented: 15 in August 2003, 14 September, 15 October, 15 November, 16 December, 11 January 2004, 13 February, 11 March, 8 April, 11 May, 7 June, 11 July, 8 Aug, 12 Sept, 8 Oct, 8 Nov, 13 Dec, 11 Jan 2005, 13 Feb, 12 Mar, 10 Apr, 11 May, 10 June; 11 July; 6 Aug; 4 Sept; 9 Oct; 5 Nov; 12 Dec; 14 Jan 2006; 11 Feb; 4 Mar; 14 Apr; 4 May; 9 June; 9 July; 11 Aug; 8 Sep; 7 Oct; 15 Nov; 6 Dec; 10 Jan; 12 Feb; 13 Mar; 7 Apr; 20 May; 15 June; 18 July; 10 Aug; 13 Sept; 8 Oct; 15 Nov; 11 Dec; Jan ‘08 11, 15 Feb, 10 Mar, 12 Apr, 14 May, 11 June, 14 July, 15 Aug; 22 Sept; 11 Oct; 14 Nov; 7 Dec. 5 Jan ’09, 7 Feb, 6 Mar, 17 Apr, 7 May; 10 Jun; 17 Jul; 7 Aug; 10 Sep; 11 Oct; 15 Nov; 14 Dec; 11 Jan 2010; 7 Feb; 14 Mar; 10 Apr; 10 May, 16 Jun, 21 Jul, 18 Aug, 23 Sep, 14 Oct, 10 Nov, 16 Dec; 11 Jan 2011, Feb 15 , Mar 24, Apr 19, May 20, Jun 10, July 21, Aug 14, Sep 17, Oct 15, Nov 10, Dec 21; 12 Jan 23, Feb 16, Mar 17, Apr 18, May 19, Jun 14, Jul 9 Aug 25, Sep 16, Oct 13, Nov 14, Dec 16; Jan 13, Feb 9, Mar 9, Apr 14, May 5, June 14, July 10, Aug 12, Sep 11, Oct 27: Total to date= 1,560/122 (avg 12.8/month) Rate $16.10/call EMS Data 2012 (TCOMM source), 25,729 system call volume +1,583 calls, +6.5% (2011 data volume 24,146). ALS response time 11.7 minutes average countywide, 94% goals achieved, call volume 8,742, -299 calls, responses -3.3% (2010 response time 11.7 minutes, 94% of goals, 9,041 responses). BLS call volume 16,987, -6, -0% (2011 16,993) Countywide BLS average response time 7.02 minutes, all BLS. BLS TCOMM Data Warehouse report, final draft to Chiefs Association then Ops Committee, to Chiefs Assoc, approved to Ops, Ops approved, to EMSC 9/18> to 10/16 approved, posted on website. Medic Unit in vehicle EMS data system. Field implementation beginning. Tiberon connectivity quote returned, $33,000 plus $4,000 annual maintenance cost, approved, interface completed. AVL Tiberon interface issue identified, AVL in test environment, mobile gateway/AVL interface created, ER&R completed, AVL operational test-halted CAD software issue, rewrite. EMS Council approves EMS agency by agency supervisor QI access to SafetyPad, interface stable, AVL trial, Restart Jan 9 7 AM to end May 12, reviewing. Initiating BLS data system pilot with Tenino (Strategic area) WATRAC Advisory Group member added, meeting 9/9, next meeting 12/2 TRAINING: average pass rate NR EMT exam = national 79%, WA state 85%, WR 90%, CR 93%, TC 93% First Responder Course, 2012? EMT Course 13-1 scheduled, Station 9-5, completed, 28 enrolled, 23 graduated 6/27 EMT Course 13-2 scheduled, Station 9-5, start 9/3, 18 enrolled, completing Dec NIMS online training available at http://training.fema.gov/EMIweb/IS/is700.asp J:\My Documents J\stfrp1213.ops.j.docx

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1 • Washington State EMS System Key Performance Indicators

ASPIRIN ADMINISTRATION FOR PATIENTS WITH CHEST PAIN/DISCOMFORT

MEASURE SET Acute Coronary Syndrome (ACS) MEASURE SET ID # ACS-1 Description Percent of patients over age 21/35 with suspected cardiac chest

pain/discomfort/ACS who received aspirin from EMS or had the aspirin administration protocol documented

Type of Measure Process Reporting Value and Units

(%) Percentage

Denominator Population

Number of patients over age 21/35 creating a provider impression of chest pain/discomfort/ACS

Denominator Inclusion Criteria

Criteria Data Elements

• eSituation.11 or eSituation.12 value “Unstable Angina” (I20.0), “Angina/Ischemic Chest Pain” (I20.9), “STEMI and NSTEMI” (I21), “Subsequent STEMI and NSTEMI” (I22), or “Pain, Chest (Cardiac)” (R07.9)

• Patients aged 21/35 years and older

• eDisposition.12 value “Patient Evaluated”, “Patient Refused Evaluation/Care”, or “Patient Treated”

• Provider’s Primary Impression (eSituation.11)

• Provider’s Secondary Impression (eSituation.12)

• Age (ePatient.15) • Age Units (ePatient.16) • Date of Birth (ePatient.17) • Incident/Patient Disposition

(eDisposition.12)

Exclusion Criteria Criteria Data Elements None Numerator Sub-Population

Number of patients over age 21/35 creating a provider impression of chest pain/discomfort/ACS with documentation of aspirin administration protocol by EMS

Numerator Inclusion Criteria




• eMedications.03 value “Aspirin” (1191) with or without Pertinent Negative value “Contraindication Noted”, “Denied By Order”,



• Age (ePatient.15) • Age Units (ePatient.16) • Date of Birth (ePatient.17) • Medication Given

(eMedications.03) • Medication Administered Prior

to this Unit’s EMS Care (eMedications.02)

• Medication Allergies

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“Medication Allergy”, “Medication Already Taken”, or “Refused” or eMedications.02 value “Yes”, OR eHistory.06 value “Aspirin” (1191)

(eHistory.06)

Exclusion Criteria Criteria Data Elements None Relation of Measure to Quality of EMS System

Early aspirin administration reduces patient morbidity and mortality rates

Established KPI Used by Whom

NHTSA, AHA, Metro Med Directors, CA Core Measures, WA ECS TAC

Performance Measure Goal

90%

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12 LEAD ECG PERFORMANCE


pain/discomfort/ACS who received a 12 Lead ECG in less than 10 minutes from EMS time of arrival on scene by first 12 Lead ECG-equipped unit


(%) Percentage







• eDisposition.12 value “Patient Evaluated” or “Patient Treated”

• Values for eTimes.06 and eProcedures.01, if present, are logical OR values for eTimes.06 and eVitals.01, if present, are logical




(eDisposition.12) • Unit Arrived on Scene Date/Time

(eTimes.06) • Date/Time Procedure Performed

(eProcedures.01) • Date/Time Vital Signs Taken

(eVitals.01)

Exclusion Criteria Criteria Data Elements • EMS agencies that do not have 12

Lead ECG capability AND/OR

• EMS units that are known to not be 12 Lead ECG-equipped AND/OR

• eScene.01 value “No” unless prior unit known to not be 12 Lead ECG-equipped AND/OR

• eProcedures.03 value “12 Lead ECG Obtained” (268400002) AND associated eProcedures.02 value “Yes” AND/OR

• eProcedures.03 value “12 Lead

• EMS Agency Procedures (dConfiguration.07)

• Unit/Vehicle Number (dVehicle.01)

• First EMS Unit of Scene (eScene.01)

• Procedure Performed Prior to this Unit’s EMS Care (eProcedures.02)

• Procedure (eProcedures.03) • Obtained Prior to this Unit’s EMS

Care (eVitals.02) • Cardiac Rhythm/ECG (eVitals.03) • ECG Type (eVitals.04)

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ECG Obtained” (268400002) WITH Pertinent Negative value “Contraindication Noted”, “Denied By Order”, “Refused”, or “Unable to Complete” OR [eVitals.03 value present WITH Pertinent Negative value “Refuse” or “Unable to Complete” AND eVitals.04 value “12 Lead”] OR [eVitals.04 value “12 Lead” AND associated eVitals.02 value “Yes”]

Numerator Sub-Population

Number of patients over age 21/35 creating a provider impression of chest pain/discomfort/ACS who received a 12 Lead ECG in less than 10 minutes





• Values for eTimes.06 and eProcedures.01 are present and logical OR values for eTimes.06 and eVitals.01 are present and logical

• eProcedures.03 value “12 Lead ECG Obtained” (268400002) AND Value of eProcedures.01 minus eTimes.06 is less than 10 minutes OR eVitals.04 value “12 Lead” AND value of eVitals.01 minus eTimes.06 is less than 10 minutes



• Age (ePatient.15) • Age Units (ePatient.16) • Date of Birth (ePatient.17) • Unit Arrived on Scene Date/Time


(eProcedures.01) • Procedure (eProcedures.03) • Date/Time Vital Signs Taken

(eVitals.01) • ECG Type (eVitals.04)


Early 12 Lead ECG acquisition and notification of receiving hospital allows cardiac care team to be assembled


NHTSA, AHA, AHA Mission, Lifeline


90%

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SCENE TIME FOR PATIENTS WITH CHEST PAIN/DISCOMFORT


pain/discomfort/ACS with an EMS scene time of less than 20 minutes Type of Measure Process Reporting Value and Units

(%) Percentage







• Patients with eDisposition.12 value indicating they were transported

• eResponse.05 value “911 Response (Scene)”

• Values for eTimes.06 and eTimes.09 are present and logical OR values for eScene.05 and eTimes.09 are present and logical




(eDisposition.12) • Type of Service Requested

(eResponse.05) • Unit Arrived on Scene Date/Time

(eTimes.06) • Date/Time Initial Responder

Arrived on Scene (eScene.05) • Unit Left Scene (eTimes.09)

Exclusion Criteria Criteria Data Elements • eScene.01 value “No” unless time

of initial responder’s arrival is present and logical



Number of patients over age 21/35 creating a provider impression of chest pain/discomfort/ACS with an EMS scene time of less than 20 minutes




• Patients aged 21/35 years and




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older • Patients with eDisposition.12

value indicating they were transported



• Value of eTimes.09 minus eTimes.06 or eScene.05 is less than 20 minutes


(eResponse.05) • Unit Arrived on Scene Date/Time

(eTimes.06) • Date/Time Initial Responder

Arrived on Scene (eScene.05) • Unit Left Scene (eTimes.09)


Delays in patient transport increase E2B time, thereby increasing patient morbidity and mortality


AHA, WA ECS TAC


90%

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TRANSPORT TO APPROPRIATE CARDIAC CENTER FOR STEMI PATIENTS

MEASURE SET Acute Coronary Syndrome (ACS) MEASURE SET ID # ACS-4 Description Percent of patients identified as STEMI by EMS taken to appropriate level,

designated EMS system cardiac receiving center Type of Measure Process Reporting Value and Units

(%) Percentage


Number of transported patients creating a provider impression of STEMI



• eSituation.11 or eSituation.12 value “STEMI of anterior wall (I21.0), “STEMI of inferior wall” (I21.1), or “STEMI of other sites” (I21.2) OR eVitals.03 value “STEMI Anterior Ischemia”, “STEMI Inferior Ischemia”, “STEMI Lateral Ischemia”, or “STEMI Posterior Ischemia”





• Cardiac Rhythm/ECG (eVitals.03) • Incident/Patient Disposition


(eResponse.05)


Number of patients creating a provider impression of STEMI taken to appropriate level, designated EMS system cardiac receiving center



• eSituation.11 or eSituation.12 value “STEMI of anterior wall (I21.0), “STEMI of inferior wall” (I21.1), or “STEMI of other sites” (I21.2) OR eVitals.03 value “STEMI Anterior Ischemia”, “STEMI Inferior Ischemia”, “STEMI Lateral Ischemia”, or “STEMI Posterior Ischemia”

• eDisposition.23 value “STEMI Center” AND/OR

• eDisposition.20 value(s) “Closest Facility”, “Protocol”, and/or



• Cardiac Rhythm/ECG (eVitals.03) • Hospital Designation

(eDisposition.23) • Reason for Choosing Destination

(eDisposition.20) • Destination/Transferred To,

Name (eDisposition.01)

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“Regional Specialty Center” AND/OR

• eDisposition.01 value deemed appropriate by local agency or evaluator


Transport to appropriate facility reduces time to treatment, decreasing patient morbidity/mortality


NHTSA, WA ECS TAC, CA Core Measures


100%

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FAST EXAM DOCUMENTED FOR SUSPECTED STROKE PATIENTS

MEASURE SET Stroke MEASURE SET ID # STR-1 Description Percent of patients with suspected CVA/TIA who received a FAST exam from

EMS or had the FAST exam protocol documented Type of Measure Process Reporting Value and Units

(%) Percentage


Number of patients creating a provider impression of CVA or TIA



• eSituation.11 or eSituation.12 value “Stroke” (I63.9) or “TIA” (G45.9)




• Incident/Patient Disposition (eDisposition.12)

Exclusion Criteria Criteria Data Elements • eExam.19 value “Unresponsive” • Mental Status Assessment

(eExam.19) Numerator Sub-Population

Number of patients creating a provider impression of CVA or TIA who received a FAST exam




• eVitals.30 value “Cincinnati” or “FAST Exam”



• Stroke Scale Type (eVitals.30) Exclusion Criteria Criteria Data Elements None Relation of Measure to Quality of EMS System

Early identification of potential CVA/TIA patients by EMS ensures that patients are transported to appropriate hospital with early notification


AHA, CA Core Measures, WA ECS TAC


90%

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BLOOD GLUCOSE CHECK FOR SUSPECTED STROKE PATIENTS

MEASURE SET Stroke MEASURE SET ID # STR-2 Description Percent of patients with suspected CVA/TIA who received a blood glucose

check Type of Measure Process Reporting Value and Units

(%) Percentage


Number of patients creating a provider impression of CVA or TIA









Number of patients creating a provider impression of CVA or TIA who received a blood glucose check




• eVitals.18 value present



• Blood Glucose Level (eVitals.18) Exclusion Criteria Criteria Data Elements None Relation of Measure to Quality of EMS System

Hypoglycemia can cause signs and symptoms with mimic a CVA/TIA, resulting in unneeded diversion to a stroke center, and additional costs for mobilization for a stroke “mimic”


CA Core Measures


90%

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SCENE TIME FOR SUSPECTED STROKE PATIENTS

MEASURE SET Stroke MEASURE SET ID # STR-3 Description Percent of patients with suspected CVA/TIA with an EMS scene time of less

than 20 minutes Type of Measure Process Reporting Value and Units

(%) Percentage


Number of patients creating a provider impression of CVA/TIA










• Type of Service Requested (eResponse.05)

• Unit Arrived on Scene Date/Time (eTimes.06)

• Date/Time Initial Responder Arrived on Scene (eScene.05)

• Unit Left Scene (eTimes.09) Exclusion Criteria Criteria Data Elements • eScene.01 value “No” unless time




Number of patients creating a provider impression of CVA/TIA with an EMS scene time of less than 20 minutes







• Value of eTimes.09 minus







• Unit Left Scene (eTimes.09)

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eTimes.06 or eScene.05 is less than 20 minutes


Delays in patient transport decrease opportunity of tPA use or other treatment, increasing potential morbidity/mortality


WA ECS TAC


90%

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TRANSPORT TO APPROPRIATE STROKE CENTER FOR SUSPECTED STROKE PATIENTS

MEASURE SET Stroke MEASURE SET ID # STR-4 Description Percent of patients with suspected CVA/TIA taken to appropriate stroke

center Type of Measure Process Reporting Value and Units

(%) Percentage


Number of transported patients creating a provider impression of CVA/TIA











Number of patients creating a provider impression of CVA/TIA taken to appropriate stroke center




• eDisposition.23 value “Stroke Center” AND/OR

• eDisposition.20 value(s) “Closest Facility”, “Protocol”, and/or “Regional Specialty Center” AND/OR




• Hospital Designation (eDisposition.23)

• Reason for Choosing Destination (eDisposition.20)

• Destination/Transferred To, Name (eDisposition.01)


Transport to a stroke center reduces time to treatment, decreasing patient morbidity and mortality


AHA, WA ECS TAC, CA Core Measures


100%

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BYSTANDER CPR PRIOR TO EMS ARRIVAL

MEASURE SET Cardiac MEASURE SET ID # CAR-1 Description Percent of cardiac arrest patients with suspected cardiac etiology who

received bystander CPR Type of Measure Process Reporting Value and Units

(%) Percentage


Number of patients creating a provider impression of cardiac arrest with cardiac etiology



• eSituation.11 or eSituation.12 value “Cardiac Arrest Due to Underlying Cardiac Condition” (I46.2) OR [eSituation.11 or eSituation.12 value “Cardiac Arrest” (I46.9) AND eArrest.02 value “Cardiac (Presumed)”] OR [eArrest.01 value “Yes, Prior to EMS Arrival” or “Yes, After EMS Arrival” AND eArrest.02 value “Cardiac (Presumed)”]

• eArrest.03 value “Attempted Defibrillation”, “Attempted Ventilation”, or “Initiated Chest Compressions”



• Indication of the Presence of a Cardiac Arrest At Any Time (eArrest.01)

• Cardiac Arrest Etiology (eArrest.02)

• Resuscitation Attempted By EMS (eArrest.03)


Number of patients creating a provider impression of cardiac arrest with cardiac etiology who received bystander CPR




• eArrest.03 value “Attempted Defibrillation”, “Attempted





• Resuscitation Attempted By EMS (eArrest.03)

• CPR Care Provided Prior to EMS Arrival (eArrest.05)

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Ventilation”, or “Initiated Chest Compressions”

• eArrest.05 value “Yes” AND eArrest.06 value “Family Member”, “Healthcare Professional (Non-EMS)”, or “Lay Person (Non-Family)”

• Who Provided CPR Prior to EMS Arrival (eArrest.06)


Bystander CPR improves VF patient survival rates


WACARES/Utstein, CA Core Measures


???

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DOCUMENTATION OF INITIAL ECG RHYTHM

MEASURE SET Cardiac MEASURE SET ID # CAR-2 Description Documentation of initial ECG rhythm Type of Measure Process? Structure? Reporting Value and Units

(%) Percentage


Number of patients creating a provider impression of cardiac arrest with cardiac etiology











Number of patients creating a provider impression of cardiac arrest with cardiac etiology with documentation of initial ECG rhythm




• eArrest.11 value present OR eVitals.03 value present





• First Monitored Arrest Rhythm of the Patient (eArrest.11)

• Cardiac Rhythm/ECG (eVitals.03)

Exclusion Criteria Criteria Data Elements None

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Relation of Measure to Quality of EMS System

Helps data collection inclusion or exclusion for WACARES


NHTSA


90%

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RESPONSE TIME FOR CARDIAC ARREST PATIENTS

MEASURE SET Cardiac MEASURE SET ID # CAR-3 Description Response time from Fire/EMS dispatch until first unit on scene for cardiac

arrest patients with suspected cardiac etiology Type of Measure Process Reporting Value and Units

(%) Percentage


Number of patients creating a provider impression of cardiac arrest with cardiac etiology by first unit on scene




• Values for eTimes.01 and eTimes.06 are present and logical OR values for eTimes.02 and eTimes.06 are present and logical

• eScene.01 value “Yes”





• PSAP Date/Time (eTimes.01) • Dispatch Notified Date/Time

(eTimes.02) • Unit Arrived on Scene Date/Time

(eTimes.06) • First EMS Unit of Scene

(eScene.01) Exclusion Criteria Criteria Data Elements None Numerator Sub-Population

Number of patients creating a provider impression of cardiac arrest with cardiac etiology with an Fire/EMS response time of less than 8 minutes




• Values for eTimes.01 and






(eTimes.02)

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eTimes.06 are present and logical OR values for eTimes.02 and eTimes.06 are present and logical

• eScene.01 value “Yes” • Value of eTimes.06 minus

eTimes.01 or eTimes.02 is less than 8 minutes




Minimizing response time improves cardiac arrest patient survival


AHA, NFPA, WACARES


90%

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TIME FROM DISPATCH UNTIL FIRST DEFIBRILLATION FOR CARDIAC ARREST PATIENTS

MEASURE SET Cardiac MEASURE SET ID # CAR-4 Description Time from Fire/EMS dispatch until first VF defibrillation for cardiac arrest

patients with suspected cardiac etiology Type of Measure Process Reporting Value and Units

(%) Percentage


Number of patients creating a provider impression of cardiac arrest with cardiac etiology who received VF defibrillation by first unit on scene




• Values for eTimes.01 and eProcedures.01 are present and logical OR values for eTimes.02 and eProcedures.01 are present and logical

• eProcedures.03 value “Defibrillation” (426220008)

• eScene.01 value “Yes”







(eProcedures.01) • Procedure (eProcedures.03) • First EMS Unit of Scene

(eScene.01)


Number of patients creating a provider impression of cardiac arrest with cardiac etiology who received VF defibrillation by first unit on scene in less than 8 minutes



• eSituation.11 or eSituation.12 value “Cardiac Arrest Due to Underlying Cardiac Condition” (I46.2) OR [eSituation.11 or eSituation.12 value “Cardiac Arrest” (I46.9) AND eArrest.02 value “Cardiac (Presumed)”] OR [eArrest.01 value “Yes, Prior to




• Cardiac Arrest Etiology

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EMS Arrival” or “Yes, After EMS Arrival” AND eArrest.02 value “Cardiac (Presumed)”]

• Values for eTimes.01 and eProcedures.01 are present and logical OR values for eTimes.02 and eProcedures.01 are present and logical

• eProcedures.03 value “Defibrillation” (426220008)

• eScene.01 value “Yes” • Value of eProcedures.01 minus

eTimes.01 or eTimes.02 is less than 8 minutes

(eArrest.02) • PSAP Date/Time (eTimes.01) • Dispatch Notified Date/Time


(eProcedures.01) • Procedure (eProcedures.03) • First EMS Unit of Scene

(eScene.01)


Survival drops for each minute of delay until defibrillation


AHA


90%

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WITNESSED VENTRICULAR FIBRILLATION PATIENTS WITH RETURN OF SPONTANEOUS CIRCULATION UPON EMERGENCY DEPARTMENT ARRIVAL

MEASURE SET Cardiac MEASURE SET ID # CAR-5 Description Patients with witnessed ventricular fibrillation with return of spontaneous

circulation upon emergency department arrival Type of Measure Process Reporting Value and Units

(%) Percentage


Number of transported patients with witnessed ventricular fibrillation



• eArrest.11 or eVitals.03 value “Ventricular Fibrillation”




• Cardiac Rhythm/ECG (eVitals.03) • Resuscitation Attempted by EMS

(eArrest.03) • Incident/Patient Disposition

(eDisposition.12)


Number of transported patients with witnessed ventricular fibrillation with return of spontaneous circulation upon emergency department arrival



• eArrest.11 or eVitals.03 value “Ventricular Fibrillation”



• eArrest.12 value “Yes, Prior to Arrival at the ED” and/or “Yes, Sustained for 20 consecutive minutes”


• Cardiac Rhythm/ECG (eVitals.03) • Resuscitation Attempted by EMS

(eArrest.03) • Incident/Patient Disposition

(eDisposition.12) • Any Return of Spontaneous

Circulation (eArrest.12)


Prolonged ROSC upon ED arrival is indicative of improved survival

Established KPI Used WACARES/Utstein

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by Whom Performance Measure Goal

???

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SCENE TIME FOR STEP 1 AND STEP 2 TRAUMA PATIENTS

MEASURE SET Trauma MEASURE SET ID # TRA-1 Description Percent of Step 1 and Step 2 patients with an EMS scene time of less than 10

minutes Type of Measure Process Reporting Value and Units

(%) Percentage


Number of transported Step 1 and Step 2 patients



• eInjury.03 value present • Patients with eDisposition.12




• Trauma Center Criteria (eInjury.03)





• Unit Left Scene (eTimes.09) Exclusion Criteria Criteria Data Elements • eScene.01 value “No” unless time


• eResponse.10 value “Extrication” or “Safety-Crew/Staging”


• Type of Scene Delay (eResponse.10)


Number of transported Step 1 and Step 2 patients with an EMS scene time of less than 10 minutes







• Value of eTimes.09 minus eTimes.06 or eScene.05 is less than 10 minutes






• Unit Left Scene (eTimes.09)

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Minimizing scene time can reduce patient mortality


American College of Surgeons, CA Core Measures


90%

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TRANSPORT TO APPROPRIATE TRAUMA CENTER FOR STEP 1 AND STEP 2 TRAUMA PATIENTS

MEASURE SET Trauma MEASURE SET ID # TRA-2 Description Percent of Step 1 and Step 2 patients taken to appropriate level, designated

EMS system trauma center Type of Measure Process Reporting Value and Units

(%) Percentage


Number of transported Step 1 and Step 2 patients










Number of Step 1 and Step 2 patients taken to appropriate level, designated EMS system trauma center



• eInjury.03 value present • eDisposition.23 value “Trauma

Center 1” or “Trauma Center 2” AND/OR

• eDisposition.20 value(s) “Closest Facility”, “Protocol”, and/or “Regional Specialty Center” AND/OR



• Hospital Designation (eDisposition.23)

• Reason for Choosing Destination (eDisposition.20)

• Destination/Transferred To, Name (eDisposition.01)


Transport of Step 1 and Step 2 trauma patients to the highest available level trauma center can reduce mortality


NHTSA, WA Trauma Triage, CA Core Measures


90%

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CPAP USED FOR SUSPECTED CONGESTIVE HEART FAILURE PATIENTS

MEASURE SET Congestive Heart Failure MEASURE SET ID # CHF-1 Description Percent of patients with suspected congestive heart failure who received

CPAP or had the CPAP protocol documented Type of Measure Process Reporting Value and Units

(%) Percentage


Number of patients creating a provider impression of congestive heart failure



• eSituation.11 or eSituation.12 value “CHF” (I50.9)





Exclusion Criteria Criteria Data Elements • EMS agencies that do not have

CPAP capability AND/OR

• EMS units that are known to not be CPAP-equipped




Number of patients creating a provider impression of congestive heart failure who received CPAP or had the CPAP protocol documented




• eProcedures.03 value “CPAP” with or without Pertinent Negative value “Contraindication Noted”, “Denied By Order”, “Refused”, or “Unable to Complete”



• Procedure (eProcedures.03)


CPAP can improve patient outcomes and decreases number of ETTs (NTT=6)


Metro Med Dir


90%

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NITROGLYCERIN ADMINISTRATION FOR SUSPECTED CONGESTIVE HEART FAILURE PATIENTS

MEASURE SET Congestive Heart Failure MEASURE SET ID # CHF-2 Description Percent of patients with suspected congestive heart failure who received

nitroglycerin or had the nitroglycerin administration protocol documented Type of Measure Process Reporting Value and Units

(%) Percentage


Number of patients with suspected congestive heart failure





• eResponse.15 value including ALS or specialty critical care unit




• Level of Care of This Unit (eResponse.15)


Number of patients with suspected congestive heart failure with documentation of nitroglycerin administration protocol by EMS





• eMedications.03 value “Nitroglycerin” (4917) with or without Pertinent Negative value “Contraindication Noted”, “Denied By Order”, “Medication Allergy”, “Medication Already Taken”, or “Refused” or eMedications.02 value “Yes”, OR eHistory.06 value “Nitroglycerin” (4917)




• Medication Given (eMedications.03)

• Medication Administered Prior to this Unit’s EMS Care (eMedications.02)

• Medication Allergies (eHistory.06)


Nitroglycerin can improve CHF patient outcomes


Metro Med Directors

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90%

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BETA-AGONIST ADMINISTRATION FOR PATIENTS WITH RESPIRATORY DISTRESS

MEASURE SET Asthma MEASURE SET ID # AST-1 Description Percent of bronchospasm patients with respiratory distress, indicative of

wheezing or known history of asthma or reactive airways disease, who received a beta-agonist or had the beta-agonist administration protocol documented by the first EMS crew able to provide such treatment


(%) Percentage


Number of patients creating a provider impression of bronchospasm and respiratory distress



• eSituation.11 or eSituation.12 value “Acute bronchospasm” (J98.01)

• eSituation.11 or eSituation.12 value “Asthma with Exacerbation” (J45.901) OR eSituation.09, eSituation.10, eSituation.11, or eSituation.12 value “Wheezing” (R06.2) OR eHistory.08 value “Asthma” (J45.90) or “Reactive Airways Dysfunction” (J68.3)





• Primary Symptom (eSituation.09)

• Other Associated Symptoms (eSituation.10)

• Medical/Surgical History (eHistory.08)



Exclusion Criteria Criteria Data Elements • EMS agencies that do not have

beta-agonist administration capability AND/OR

• EMS units that are known to not be beta-agonist-equipped AND/OR

• eScene.01 value “No” unless prior unit known to not be beta-agonist-equipped





Number of patients creating a provider impression of bronchospasm and respiratory distress with documentation of beta-agonist administration protocol by EMS

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• eSituation.11 or eSituation.12 value “Acute bronchospasm” (J98.01)

• eSituation.11 or eSituation.12 value “Asthma with Exacerbation” (J45.901) OR eSituation.09, eSituation.10, eSituation.11, or eSituation.12 value “Wheezing” (R06.2) OR eHistory.08 value “Asthma” (J45.90) or “Reactive Airways Dysfunction” (J68.3)

• eMedications.03 value “Albuterol” (435), “Epinephrine”, “Ipratropium” (7213), “Isoproterenol” (6054), “Levalbuterol” (237159), or “Terbutaline” (10368) with or without Pertinent Negative value “Contraindication Noted”, “Denied By Order”, “Medication Allergy”, “Medication Already Taken”, or “Refused” or eMedications.02 value “Yes”, OR eHistory.06 value indicative of beta-agonist allergy





• Medical/Surgical History (eHistory.08)



• Medication Allergies (eHistory.06)Date/Time Procedure Performed (eProcedures.01)


Treatment of bronchospasm patients with beta-agonist


Metro Med Directors


90%

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BLOOD GLUCOSE CHECK FOR SEIZURE PATIENTS

MEASURE SET Seizure MEASURE SET ID # SEI-1 Description Percent of still-seizing and post-seizing patients upon EMS arrival who

received a blood glucose check Type of Measure Process Reporting Value and Units

(%) Percentage


Number of patients creating a provider impression of seizing



• eSituation.11, eSituation.12, eSituation.09, or eSituation.10 value “Seizures With Status Epilepticus” (G40.901), “Seizures Without Status Epilepticus” (G40.909), “Seizure: Absence, Partial, Grand Mal (Tonic/Clonic)” (G40.3), “Seizure, Febrile” (R56.0), or “Seizure (Convulsive)” (R56.9)








Number of patients creating a provider impression of seizing who received a blood glucose check



• eSituation.11, eSituation.12, eSituation.09, or eSituation.10 value “Seizures With Status Epilepticus” (G40.901), “Seizures Without Status Epilepticus” (G40.909), “Seizure: Absence, Partial, Grand Mal (Tonic/Clonic)” (G40.3), “Seizure, Febrile” (R56.0), or “Seizure (Convulsive)” (R56.9)

• eVitals.18 value present





• Blood Glucose Level (eVitals.18)


Hypoglycemia is a common, easily treated cause of seizure activity, which can cause patient harm if untreated

Established KPI Used Metro Med Directors

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by Whom Performance Measure Goal

90%

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BENZODIAZEPINE ADMINISTRATION FOR STILL SEIZING PATIENTS

MEASURE SET Seizure MEASURE SET ID # SEI-2 Description Percent of still seizing patients upon EMS arrival who received a

benzodiazepine or had the benzodiazepine administration protocol documented


(%) Percentage


Number of patients creating a provider impression of seizing



• eSituation.11, eSituation.12, eSituation.09, or eSituation.10 value “Seizures With Status Epilepticus” (G40.901), “Seizures Without Status Epilepticus” (G40.909), “Seizure: Absence, Partial, Grand Mal (Tonic/Clonic)” (G40.3), “Seizure, Febrile” (R56.0), or “Seizure (Convulsive)” (R56.9) OR eExam.20 value “Seizures”






• Neurological Assessment (eExam.20)



Number of patients creating a provider impression of seizing with documentation of benzodiazepine administration protocol by EMS



• eSituation.11, eSituation.12, eSituation.09, or eSituation.10 value “Seizures With Status Epilepticus” (G40.901), “Seizures Without Status Epilepticus” (G40.909), “Seizure: Absence, Partial, Grand Mal (Tonic/Clonic)” (G40.3), “Seizure, Febrile” (R56.0), or “Seizure (Convulsive)” (R56.9) OR eExam.20 value “Seizures”

• eMedications.03 value





• Neurological Assessment (eExam.20)


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“Diazepam” (3322), “Lorazepam” (6470), or “Midazolam” (6960) with or without Pertinent Negative value “Contraindication Noted”, “Denied By Order”, “Medication Allergy”, “Medication Already Taken”, or “Refused” or eMedications.02 value “Yes”, OR eHistory.06 value indicative of benzodiazepine allergy


• Medication Allergies (eHistory.06)


Is there evidence that stopping seizure early lessens morbidity?


Metro Med Directors


90%

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PATIENTS INTUBATED WITH FIRST PASS SUCCESS

MEASURE SET Airway MEASURE SET ID # AIR-1 Description Percent of intubated patients with first pass success Type of Measure Process Reporting Value and Units

(%) Percentage


Number of patients who were intubated



• eProcedures.03 value “Intubation (Nasotracheal)” (232679009), “Intubation (Orotracheal)” (232674004), “Intubation (Orotracheal Through Laryngeal Mask Airway” (418613003), “Intubation (Rapid Sequence)” (241689008), “Intubation using exchange catheter to place invasive airway” (397874007), or “Retrograde Intubation” (397892004)



Number of intubated patients with first pass success




• eProcedures.05 value “1” • eProcedures.06 value “Yes”

• Procedure (eProcedures.03) • Number of Procedure Attempts

(eProcedures.05) • Procedure Successful

(eProcedures.06)

Exclusion Criteria Criteria Data Elements None Relation of Measure to ET intubation can provide optimal airway protection, but increased

5C


Quality of EMS System intubation attempts can increase patient hypoxia and complication rates Established KPI Used by Whom

???


60%, 70%?

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SUCCESSFUL INTUBATION RATE

MEASURE SET Airway MEASURE SET ID # AIR-2 Description Percent of intubated patients who are successfully intubated Type of Measure Process or Outcome? Reporting Value and Units

(%) Percentage


Number of patients who were intubated






Number of patients who were successfully intubated




• eProcedures.06 value “Yes”

• Procedure (eProcedures.03) • Procedure Successful

(eProcedures.06)


Measure of technical skill. ETI provides optimal airway protection; however, missed attempts can worsen patient outcome

5C



???


90%

5C


SUCCESSFUL PLACEMENT OF ENDOTRACHEAL TUBE OR SUPRAGLOTTIC AIRWAY

MEASURE SET Airway MEASURE SET ID # AIR-3 Description Percent of patients successfully intubated or who have a supraglottic airway

successfully placed Type of Measure Process Reporting Value and Units

(%) Percentage


Number of patients who were intubated or who had a supraglottic airway placed



• eProcedures.03 value “Intubation (Nasotracheal)” (232679009), “Intubation (Orotracheal)” (232674004), “Intubation (Orotracheal Through Laryngeal Mask Airway” (418613003), “Intubation (Rapid Sequence)” (241689008), “Intubation using exchange catheter to place invasive airway” (397874007), “Retrograde Intubation” (397892004), “Supraglottic Airway Insertion (Double Lumen)” (427753009), or “Laryngeal Mask Airway Insertion” (424979004)



Number of patients who were intubated or had a supraglottic airway placed successfully



• eProcedures.03 value “Intubation (Nasotracheal)” (232679009), “Intubation (Orotracheal)” (232674004), “Intubation (Orotracheal Through Laryngeal Mask Airway” (418613003), “Intubation (Rapid Sequence)” (241689008), “Intubation using exchange catheter to place invasive airway” (397874007), “Retrograde Intubation” (397892004), “Supraglottic Airway Insertion (Double Lumen)”

• Procedure (eProcedures.03) • Procedure Successful

(eProcedures.06)

5C


(427753009), or “Laryngeal Mask Airway Insertion” (424979004)

• eProcedures.06 value “Yes” Exclusion Criteria Criteria Data Elements None Relation of Measure to Quality of EMS System

Measures system performance managing airways with a variety of devices


???


???%

5C


DOCUMENTATION OF CONTINUOUS WAVEFORM ETCO2 FOR INTUBATED PATIENTS AND PATIENTS WITH SUPRAGLOTTIC AIRWAYS

MEASURE SET Airway MEASURE SET ID # AIR-4 Description Percent of patients successfully intubated or who have a supraglottic airway

successfully placed Type of Measure Process Reporting Value and Units

(%) Percentage


Number of patients who were intubated or who had a supraglottic airway placed



• eProcedures.03 value “Intubation (Nasotracheal)” (232679009), “Intubation (Orotracheal)” (232674004), “Intubation (Orotracheal Through Laryngeal Mask Airway” (418613003), “Intubation (Rapid Sequence)” (241689008), “Intubation using exchange catheter to place invasive airway” (397874007), “Retrograde Intubation” (397892004), “Supraglottic Airway Insertion (Double Lumen)” (427753009), or “Laryngeal Mask Airway Insertion” (424979004)



Number of patients who were intubated or who had a supraglottic airway placed and also had documentation of continuous waveform ETCO2



• eProcedures.03 value “Intubation (Nasotracheal)” (232679009), “Intubation (Orotracheal)” (232674004), “Intubation (Orotracheal Through Laryngeal Mask Airway” (418613003), “Intubation (Rapid Sequence)” (241689008), “Intubation using exchange catheter to place invasive airway” (397874007), “Retrograde Intubation” (397892004), “Supraglottic

• Procedure (eProcedures.03) • Carbon Dioxide (CO2)

(eVitals.16)

5C


Airway Insertion (Double Lumen)” (427753009), or “Laryngeal Mask Airway Insertion” (424979004)

• eProcedures.03 value “ETCO2 Colorimetric Detection” (428482009) or “ETCO2 Digital Capnography” (425543005) OR eVitals.16 value present


Misplaced ET tubes and SGA airways can increase patient mortality and morbidity. Waveform ETCO2 is recognized by the Am Assoc of Anesth. As the “gold standard” for confirming ET tube placement


???


90%

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Roles and Responsibilities Workgroup Recommendations

Community Health Systems

Washington State Department of Health

November 15, 2013

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Committee Members: CENTRAL REGION: Bob Berschauer Merrili Owens EAST REGION: Chris Mabbott, RN Patti Richards NORTH REGION: Mark Correira Paul Zaveruha, MD NORTHWEST REGION: Terry Anderson Terry Anderson NORTH CENTAL REGION: Linette Gahringer Suzy Beck, RN and NREMT SOUTH CENTRAL REGION: David Lynde Terry Thrall SOUTHWEST REGION: Denise Haun-Taylor, RN Lynn Wittwer, MD WEST REGION: Ann Benoist Steve Romines

Interested Parties who participated: Martina Nicolas Rene Williams Norma Pancake Bill Gates Miklos Preysz Heather Goding Department of Health Janet Kastl, facilitator Dolly Fernandes Sarah Studebaker Les Myhre Scott Hogan

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RECOMMENDATIONS

ROLES AND RESPONSIBILITIES WORKGROUP

November 2013

On September 26, 2012 the EMS and Trauma Steering Committee adopted the following recommendation:

“Mark recommended a workgroup to look at the EMS and Trauma System as it relates to the EMS hospital and pre hospital matters. …. The system was built a long time ago and much has changed… Some people think there is duplication on regional council and local governments and ask if there is a better way of doing business. Mark’s suggestion is for the workgroup to come up with some recommendations and bring those forward to the Steering Committee for consideration. If changes are recommended, the workgroup can come up with strategies to address them.”

To accomplish this, the workgroup reviewed the statutory roles and responsibilities of all levels of the Emergency care system (Attachment 1). The workgroup conducted a comprehensive SWOT of the emergency care system (Attachment 2) and categorized the issues by component. These were then evaluated on a matrix to identify problems, solutions and responsible TAC or other responsible party to address the issue.

The workgroup has completed its deliberations and offers the following recommendations for consideration by the EMS and Trauma Steering Committee.

RECOMMENDATIONS

CATEGORIES RECOMMENDATIONS DISCUSSION Regional Councils 1. The number of Region Councils

Maintain eight regional Councils.

The workgroup underwent extensive review of the roles and responsibilities or the Regional EMS and Trauma Councils. This review included analysis of organization, funding, staffing, strategic plans and other considerations. Information regarding the organization, funding, membership and activities of the local EMS and Trauma Councils was also reviewed. Local Councils are not required in statute. It was found that the eight regional councils are quite similar. The local councils vary considerably. The committee also looked at the relationship and needs that each level of the organization (local, regional and state) has of one another. The workgroup considered multiple options for organization, funding and staffing of the regional councils, assessing the opportunities and risks for each. The minimum number of regional councils is set in statute as “at least eight.” The workgroup did review options for changing the number up or down. A change to statute would be required to reduce the number of councils. It was determined that maintaining the current number of councils allows each council to continue to function. It still allows the councils to decide to share resources such as office space, executive directors, etc. A model of shared resources is currently in place in four of the eight regions.

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CATEGORIES RECOMMENDATIONS DISCUSSION 2. Staffing Models: The workgroup evaluated the option of having DOH employ the executive directors. 3. Funding methods: Limit funding by category

Continue regional council employment of Executive Directors, but allocate a specific amount of EMS and Trauma funding not to exceed 50% of the EMST GFS allotment to each region for administrative and executive director functions. Implement a funding process which allocates a specific amount of funding not to exceed 50% of the EMST GFDS allotment for administrative costs from the EMS and Trauma contract and that provides a set amount or share of the EMS and Trauma Funds for training, injury prevention and region specific programs. To do this, the recommendation is to establish 2 pots of funding for each region: a. Administration (including executive director, rent, supplies, director travel, etc.) b. Training, Injury prevention and specific priority regional programs/projects that are included in the Steering Committee and DOH approved Regional EMS and Trauma Plan. Next Fiscal year (FY 15): Administrative Allocation: $79,000/region/year Future Biennium: FY 16 and ongoing:

This allows regional council Boards to determine the best way to operate within these funding limitations. This recommendation includes the option to allow the regions and state to revisit the subject as positions for executive directors open, leaving open the option of a hybrid model. Currently, four regions have implemented shared executive director and administrative resources. The South West and South Central Regions are sharing executive direction and administrative costs such as rent. The East and North Central Regions are piloting this model. The recommendation allows for forced evolution from EMS and Trauma funds fully supporting all administrative costs to a model that allows each region to determine how best to operate with limited funds from EMS and Trauma. Some regions have additional sources of funding that might be used to help support these functions while others may want to share resources. The workgroup explored the alternative staffing model of creating state employed positions for 4 – 5 state funded executive directors, assigned to support up to 2 regions each. Currently the regional councils each receive approximately $151,000/year from the state EMS and trauma general fund to perform the functions in their approved EMS and Trauma Regional Plans. The regional councils determine how these funds are distributed among activities in their plans. The workgroup recommends that there be a transition between this year’s (SFY14) funding model and the goal of funding the model that would go into effect next biennium (FY 16-17).

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CATEGORIES RECOMMENDATIONS DISCUSSION 4. Transparency and consistency among regions around financial management and policies and procedures, especially those related to financial management.

Administrative Allocation: $75,000/region/year or NO more than 50% of the EMS and Trauma GFS allotment for each region. The Roles and Responsibilities Workgroup supports the current and ongoing RAC and DOH work to develop consistency among regional council policies and procedures such as travel policies, public disclosure, open public meetings, etc.

Training, Injury Prevention and other allocation: Remainder of available regional funds (based on this year’s funding ~ $72,000) Training, Injury Prevention and other: No less than 50% of total regional allocation. (For example, if funding is $151,000 this would allow ~ $76,000/region.) This recommendation is based on the fact that the regions will be audited by the State Auditor’s Office (SAO) beginning this year (FY14). This is the result of determination by the SAO that the regions are quasi-governmental and subject to audit as local entities. The statutory authority and primary funding for the regions comes from state general fund and state federal grants. In addition, two regions were investigated by the SAO for misappropriation of funds. In each case, the Executive Director at the time was terminated by the regional council. The DOH internal auditor has recommended that DOH provide assistance to the regional council boards to help them manage their fiduciary responsibilities and be prepared for state audits. The Roles and Responsibilities workgroup supports the current and ongoing work that the RAC and DOH are doing to address these concerns.

LOCAL COUNCILS

Regional Councils and DOH continue to work to improve communication with local councils. Regional councils find ways for staff or members to attend local meetings and share between the region and the local council.

Variability exists among local councils. Counties are not required to have local councils. It is recognized that the only way to reach the majority of volunteers and local agencies is through local councils. Continue to strengthen that flow of communication.

PREHOSPITAL

The Roles and Responsibilities Workgroup SWOT identified numerous areas where the pre hospital EMS system needs to be prepared to make changes or improvements. The majority of these should be evaluated by the Prehospital TAC for further analysis and action. Recommend a group to look at roles of EMT’s and paramedics to meet future needs. The face of EMS has changed over years – i.e. intubations have decreased. Inter hospital transfers require different skill set. We serve an aging population (i.e. ground level falls). Future system may require treat and leave or transport to alternative care site, scope of practice issues, Community paramedic discussion. Discuss having

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CATEGORIES RECOMMENDATIONS DISCUSSION 1. Volunteer issues 2. Protocols 3. EMS Scope of practice 4. Skill Maintenance 5. Verification 6. WEMSIS participation

Refer to Pre hospital TAC. Refer to Pre hospital TAC and MPD committee. Refer to Pre hospital TAC and MPD Workgroup to consider broadening EMS Scope of practice. Evaluate Community Para-medicine models Refer to Pre hospital TAC and MPD’s. Recommend discussing strategies on how to maintain critical skills such as intubations. 1. Refer to Prehospital TAC, RAC and DOH to evaluate rules for setting min/max numbers for pre hospital verification and recommend to Steering Committee if changes in rules are needed. 2. The workgroup support the efforts of DOH and the Prehospital TAC to educate councils and providers on the process for verification and evaluate the effectiveness of process once this education effort is completed. Refer to DOH, WEMSIS

standard paramedic protocols statewide, look at standardized medical direction. Lack of volunteers – reduction in rural volunteerism, time demands, recruitment and retention, advanced first aid requirements, access to training and skill maintenance. There is variability in paramedic protocols It was noted that it is difficult to maintain critical skills such as intubation. Requirements and method for min/max numbers should be to assess the option of changing from agency verification for response areas to vehicle or some other method of determining response unit. The verification process has been cumbersome and complex. It was recently revised. DOH is in the midst of evaluating and educating on this issue and should continue this effort. The workgroup supports the DOH and the Prehospital TAC to educate councils and providers on the process for verification and evaluating the effectiveness of the process once this education effort is completed. The workgroup supports the ongoing collaborative work currently being done to improve participation with a goal that all transport agencies actively participate

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CATEGORIES RECOMMENDATIONS DISCUSSION 7. EMS provider assessment

workgroup, Pre hospital TAC and MPDs Refer to Prehospital TAC to explore improving approval requirements for EMS evaluators.

MEDICAL PROGRAM DIRECTION

Pre hospital TAC, DOH and MPD workgroup to look into getting statutory coverage for MPD’s to provide medical oversight of EMS dispatch.

MPD’s do not have 911 medical oversight in statute.

CARDIAC AND STROKE

Refer to ECS TAC to develop a common method to analyze current system of ECS data collection to measure outcomes

The ECS system is an Unfunded Mandate: Cardiac and Stroke System was never funded by the legislature when the law was enacted. DOH was not funded to oversee the implementation of this law. DOH had a federal grant to assist in implementation of this law. This grant is no longer available for the ECS system. The law regarding categorization of emergency cardiac and stroke centers does not contain the same provisions for selection of emergency cardiac and stoke centers as trauma law. The law does provide for ECS issues to be discussed under the confidentiality provisions of the Trauma Quality Improvement section of RCW. It also requires hospitals which volunteer to participate in the system to provide participate in a national, state or local data collection system. However, there is no funding to establish statewide data collection systems or to require categorized facilities to provide data to the state. Some facilities are not sharing their data within the confidential regional QI meetings. If facilities do not share data in the regional QI environment, the purpose of regional QI efforts to improve outcomes is hampered. The workgroup suggest that the ECS TAC compare legislation in other states and how other states collect data and fund their systems.

HOSPITAL 1. Trauma Service Designation: 2. Lack of access to specialty care,

DOH and Hospital TAC implement the recommendations from the LEAN event for the trauma service designation process. Refer to Hospital TAC

The process is cumbersome and complex. The workgroup supports the implementation of changes recommended as a result of the recent LEAN process for Trauma Service Designation. The workgroup supports the infrastructure and development work that is currently being discussed in the Hospital TAC.

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CATEGORIES RECOMMENDATIONS DISCUSSION telemedicine and behavioral health resources. 3 Hospitals should continue to prepare for disasters – medical surge capacity is not always reported.

1. Refer to Hospital TAC, EMST office, and RAC TAC. The TAC should encourage use of WATRAC. 2. EMST office, and Hospital, RAC TACs build relationships with emergency preparedness partners.

The workgroup determined that behavioral health is out of scope of the EMST Steering Committee and is being addressed in the implementation of health care reform. The workgroup recommends that the TACs and EMST office encourage hospitals to use WATRAC. The groups should also begin / continue to build relationships and crosswalks with additional emergency preparedness partners.

REHABILITIATION

Refer to Rehab TAC to explore and report back to Steering Committee on the status of trauma rehabilitation in Washington

There is a lack of coordination and a statewide focus. The workgroup recommends this group explore and report back to Steering Committee on the status of trauma rehabilitation in Washington.

KNOWLEDGE OF THE EMERGENCY CARE SYSTEM 1. Public Education

Educate the community on the complexity of the Emergency Care System. To do so, we need to identify what we need from the community. Develop an effective marketing plan. We need to look outside the box for marketing options and funding? Recommendation: A new workgroup or TAC is established to identify resources to develop an effective marketing plan. Suggest seeking assistance from marketing students at the UW and or WSU.

SYSTEM Discussion: There is a lack of understanding of the system – for example, many players in the system do not understand the whole system. What do the regions do? What do Local Councils, local government, etc. do? Each one operates in a silo with a need for more face to face communication among the players within the system. The system requires the active involvement of a lot of people to make the system work on a continuous basis Lack of public understanding of the Emergency Care System.

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CATEGORIES RECOMMENDATIONS DISCUSSION 2. Prehospital Providers 3. Hospital Providers 4. Local and Regional Councils

Prehospital TAC, in coordination with MPD workgroup work to develop an educational plan to provide system knowledge during the orientation process for prehospital providers to better understand the system. TMD / Hospital TAC work to develop an educational plan to provide system knowledge during the orientation process for emergency department and other medical staff to better understand the system. Assign to RAC to develop simple tools to educate regional council members and local councils. Coordinate with DOH as needed. Create simple system educational tools and share extensively across the state with local councils, regional councils, steering committee and major stakeholder groups.

Lack of EMS provider knowledge of how the overall emergency care system works. Lack of knowledge of how the emergency care system works by Emergency Department staff and other health care providers.

SYSTEM FUNDING

Refer to Cost TAC to: 1.Look at future reimbursement models for trauma: 2. Identify creative options for

Inadequate funding for the emergency care system.

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CATEGORIES RECOMMENDATIONS DISCUSSION new revenue to offset emergency care system costs including emergency cardiac and stroke.

DEPARTMENT OF HEALTH

DOH share Office of Customer Service credentialing data (dashboard) with Prehospital TAC. Analyze time lines and determine where they are outside of expectations. Identify underlying issues.

A staff person from the customer service office will be invited to the Prehospital TAC to explain the process, identify underlying reasons for delays in credentialing and brainstorm how to speed up the process. Questions have arisen regarding role of state vs. local in credentialing as well as questions regarding background check requirements. These should be addressed in the presentation to PH TAC.

LEGISLATION AND WAC changes

Several areas were identified that might need RCW or WAC changes based on recommended study by TAC’s and future recommendations from the Steering Committee. These include:

MPD oversight for 911 center staff (RCW)

Pre hospital Verification min/max and verification process (WAC)

Broadened EMS Scope of Practice and/or community paramedicine (RCW) (WAC)

Access to telemedicine – protection of physicians providing services – (RCW?)

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ROLES AND RESPONSIBILITIES WORKGROUP MEETING

February 21, 2013 9:30 am – 2:30 pm

DOH Kent Facility, Room 307 Workgroup Members Present: Anne Benoist, Steve Romines, Paul Zaveruha MD, Mark Correira, Terry Thrall, David Lynde, Chris Mabbott, Denise Haun-Taylor, Linette Gahringer, Suzy Beck, Bob Berschauer, Merrili Owens, Steve Engle, Lynn Wittwer MD (via telephone), Patti Richards (via videoconference) Guests: Bill Gates, Heather Goding, Martina Nicholas, Miklos Preysz, Norma Pancake DOH Staff: Janet Kastl, Dolly Fernandes, Scott Hogan EXPECTATIONS: Lynn Wittwer Dates for future meetings/Better sense of where we are and where going

Anne Benoist Open discussion of where we are

Steve Romines Open discussion; what issues to improve system

Paul Zaveruha Improve system; future planning

Bob Berschauer- Where are we going to go?

Merrili Owens Where are we going?/EMST systems of the future

Bill Gates Listen/observe/what all is done

Mark Correira Sink teeth into what system will look like

Linette Gahringer Opportunity to identify where we are at/future outlook

Suzy Beck What was discussed then and how we are moving forward

David Lynde Where do we think we are and where going

Terry Thrall Ditto/30K view/shape future

Chris Mabbott Same/mature system/future

Denise Haun-Taylor Collaborate efforts/what working/dinosaurs/site review/rural and urban

Steve Engle Good business model for future viable system

Patti Richards Same/time change/$ change/greater collaboration

Rene Perret Clear goals/consistency/true definitions used across state

Scott Hogan Ideas for system growth

Miklos Preysz Hear where we are heading/make better decisions

Martina Nicolas Hoping for a business model

Heather Goding Good business model

Norma Pancake- What’s working/fix if broken/national and rural issues

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S://HSQA/CHS/CHSDirector/Roles & Respons Workgroup/RandR SWOT 022113 Page 2

STRENGTHS

• Mature system, well established/mature infrastructure

• Data - Trauma Registry

• EMS Training and educational product

• Multi-disciplinary EMST Steering Committee membership

• State created structure down to local level

• System is legislated

• There is $

• Strong link between hospitals and EMS, both trauma system and Emergency Cardiac & Stroke (ECS)

• Trauma system = spring board to create ECS

• Goal of this group = look to future

• Improved outcomes

• We are serving the population we need to serve

• Funding mechanism for trauma system

• Local control – Local EMS counties which coordinate locally

• Huge credibility with John Q Citizen

• Collaboration with DOH (unlike JACHO)for designation

• Regional Councils help think beyond local borders (Regional Coordination)

• Prevention is part of the system

• DOH EMST office is always there to help

• Engagement – Multi-disciplinary partnership

• More people want to participate

• Strong medical control; allows local and regional involvement

• 9-1-1 system developed parallel

• Education of providers

• Other states model after our system

• Engaged hospitals and medical provider - in a voluntary system

• Strong scientific backup – academic (i.e., Harborview, Michael Copass, Mickey Eisenberg

• Research

• Data/Evidence based

• Function by consensus – at all levels within system

• System components – varied but work together with public/private/hospital/prehospital, etc.

• Allows for rural volunteer system

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• Commitment to education for hospital and prehospital

• High caliber training centers in our state

• Quality improvement and quality assurance

• Designation system holds us (hospitals) accountable

• State defends and Holds Harmless MPDs

• Maturity of system

• Relationships to draw on in Disaster Management

• Local and regional forums for EMST system

• Analysis and development of plans to address issues identified

• Strategic planning process

• Pediatric and Rehabilitation very involved in system

• Our system is multi-state – Oregon, Idaho, Montana, Alaska

• People in Idaho participate in our state program

• People in Washington involved at national level

• State, rural and local involvement in prevention

• Air Medical transport

• Ability to triage to higher level for trauma, ECS, and Pediatrics

• Distribution of centers (hospital)

• Rules tell you what/how and also protect you – when doing it

• Organized system

• RCW and WAC – change requires thought

• Like the WAC review process – all inclusive process

• Adaptability – i.e., joint trauma services

• Prehospital – have public agencies and commercial agencies. In general, they work together

• The state is well covered (geographically)

• Fire Services does EMS

• Patient centered

• Scope of practice for our medics

• Mature people in system – Lots of people who have history of the system ( silver/backs) and also

have younger people involved to move the system forward

WEAKNESSES

• In QI area, Training and Education does not have QI built in…i.e., once an evaluator, always an evaluator

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• Money – not enough

• Regional processes need to be more consistent

• Requires active involvement of a lot of people to make system work on continuous basis

• Need new blood and fresh set of eyes

• MPDs don’t have control over certifying dispatchers – 9-1-1 oversight lacking

• Credentialing timelines

• State EMTs have state treatment protocols; but not same for paramedic. For paramedic, treatment

protocols are by county

• Lack of standardized paramedic protocols

• Working with a 1990 model – does this meet today’s needs?

• Redundancy between agencies, i.e., policies

• Done such a good job that everyone expects services

• Need to educate the community on complexity of this system

• Need to identify what we need from the community

• Lack of public understanding of system

• Lack of understanding of system between parts of system – i.e., regions and what they do

• Are we managing to our goals? Do we lose sight of goals? Do we measure to goals?

• Designation process cumbersome and complex

• Prehospital – verification process cumbersome and complex

• Some ER doctors don’t understand EMST system

• Emergency Departments with few or no board certified emergency physicians (smaller hospitals)

• Volunteers – fewer in rural areas

• Time demand burden to outlying areas/Recruitment and retention

• Advanced first aid required (40 hours)

• Rehab – implementation affected by lack of money

• Medics/EMTs want to do things that are on edge of their scope of practice

• EMS scope needs to be broadened

• Access to physician providers – specialty care (lack of)

• Access to telemedicine (lack of)

• Fear of job security – keeps from having open mind

• Don’t want change

• Scope territory

• Quality Improvement - turnover – inconsistent. Less mature area. What = future state

• Unprepared for disasters, i.e., no beds, flu epidemic, staffed beds – staffing ratio

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• No coordinated emergency disaster system at state

• Communication = weakness

• Local councils sometimes don’t understand system. In some regions = gaps

• No consistency among local councils

• Local councils are an important spoke in the wheel. They are the only way to reach volunteer and

local agencies

• Silo – need face-to-face communication. All over the map.

• Utilization of resources: Detox – Emergency Room – scope issue. Don’t know if detox available. Expensive! Portability issue. Includes mental health.

• Community needs resources to pay for these (above) services. We can identify issues; can’t solve… or come up with answers.

• Does EMS have adequate access to training? Difficult to get/maintain skills

• Need other kinds of training to meet requirements, eg. Intubations

• Injury prevention – lack of coordinated effort in what we want to do. What is the hot topic? Focus at state level eg. Senior falls. Focus on one or two injuries. Need to focus on what we can do. Do consistently across the state.

• CMS ratcheting down

• Participation in WEMSIS

OPPORTUNITIES

• Expansion (or supplement) of scope of practice of prehospital provider

• This could threaten our “hold harmless” law. Need to avoid this – be careful

• Define “prehospital”. (MPDs, Prehospital TAC need to work on this)

• Ask local councils what they need from state/regions to be successful

• Changes in healthcare system that could supplement prehospital system

• Baby boomers will be increasing. Hope they have insurance. More interfacility transfers

• Need to look at reimbursement

• Educate the public

• Look outside box for $ - marketing and funding opportunity

• Build consistent model of how regions/locals function. Communication with DOH

• Review and revamp trauma designation, verification processes

• WATRAC – what resources available where

• Building relationships with Emergency Preparedness

• Min/max numbers for verification. License and verify at same time. “Inter-verification”

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• Public education: Doctors don’t always know how BLS/ALS, emergency rooms work

• Who needs to be designated? Revisit/resource distribution?

• Look at creative $ options for revenue – eg. Marijuana to offset EMST system

• Look at insurance/reimbursement for EMST

• Look at resources/how distributed to support our system

• Look at BLS/ALS distribution of services

• Look at geographic structure of regions. We have eight regions…need 16? More/less?

• Need to look at technology, eg. Telemedicine. Bring doctors to patient. Social media, CPR-how fast

pumping was a recent successful marketing event

• Relationships with other systems to reduce duplication

• Technology: electronic patient care reporting. Need standardized way to do it. Good for data

collection. Get input for all agencies

THREATS

• Funding $. Access to resources

• Lack of effective marketing. Who we are; what we do

• Failure to adapt

• Legislation - a lot of things we are required to do

• Unfunded mandates

• Volunteerism – reduction in number of volunteers

• Federal legislation

• Liability. Lack of reform

• SILOS: of special interests

• Population boom

• Aging population

• Succession planning needed to continue work

• Public expectations

• Duplicative services, eg. when expanding scope, don’t duplicate

• Hospital surge capacity

• EMS surge capacity

• Reductions in community services – mental health, etc.

• Changes in health care practice, i.e. hospitalists

• Outdated facilities on the fire side

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• Other states changes in practice has impacts on us 5C

AGENDA ITEM INFORMATION SHEET Thurston County

Operations Committee Meeting December 5, 2013

Presenter/ Committee: Fay Flanery, Medic One Staff / Operations Committee Topic: Policy Review. Request: Rescind Policy 5 (Transfers by Medic One), Policy 11 (Interactions of Medic One

Personnel w/Medical Intervenors), Policy 12 (Out of County Responses), Policy 14 (BLS Protocols); and Policy 28 (Patient Refusal of Medical Evaluation, Treatment and/or Transport).

Background: In 1984 there were no Thurston County protocols and therefore the above listed

policies were developed and adopted. Since their origination and adoption, the Thurston County Protocols as we know today have evolved and currently incorporate the policies listed here outdating these policies and practices.

Policy 5 (Transfers by Medic One) – the language is outdated and conflicts with our

current Protocols. This policy should be rescinded and rewritten as a MPD policy referencing the current protocols.

Policy 11 (Interactions of Medic One Personnel w/Medical Intevenors) – Will be

included with the next update to our protocols. This policy is outdated and the policy as it stands no longer meets current practice and should not be followed in any scenario.

Policy 12 (Out of County Responses) – Emergency Management agreements are

now in place for mutual aid for out of County responses – staff is currently reviewing this policy as it is superseded by new interlocal agreements for mutual aid.

Policy 14 (BLS Protocols) – this Policy references the Washington State EMS

Protocols as reference for our BLS responders. All Thurston County EMS Responders are required to pass the Thurston County Protocol test and have a copy of the protocols at their immediate disposal for reference. This policy is outdated and is covered 100% by the current Thurston County Protocols and needs rescinding as it conflicts with current protocols and practices.

Policy 28 (Patient Refusal of Medical Evaluation, Treatment and/or Transport) –

This policy as it stands conflicts with the current Thurston County Protocols and should be rescinded as it is covered in the protocols.

Options Considered: No other options considered. It was the recommendation of both EMS

Council and Operations Committee to revise all policies to meet the approved standard format for review. The attached policies are entirely outdated and should be rescinded immediately as they conflict with our current Protocols used by our Responders.

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Financial Impact: None. Attachments: Reformatted Policy 5 (Transfers by Medic One); Policy 11 (Interactions of

Medic One Personnel w/Medical Interveners); Policy 12 (Out of County Responses); Policy 14 (BLS Protocols); and Policy 28 (Patient Refusal of Medical Evaluation, Treatment and/or Transport).

Recommendation: Review attached Policies recommended to be rescinded and prepare for

discussion and possible action on this recommendation at the December 5, 2013 Operations Committee meeting. These policies conflict with current protocols.

Staff Note: Policy 12 is covered under a mutual aid agreement that is currently under staff

review.

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Medic One POLICY

I. POLICY NUMBER: 5

II. POLICY TITLE: TRANSFERS BY MEDIC ONE

III. DATE EFFECTIVE: 8/84

IV. RELATED POLICIES:

V. AUTHORIZATION/REFERENCES RCW: WAC:

VI. SCOPE: Patient Transport Guidelines

VII. DEFINITIONS: (See Standard List) List Non-Standard Here VIII. POLICY PURPOSE: To promote the delivery of patient care and the effective utilization of System resources through the identification of the type of transfers Thurston County Medic One will facilitate and under what circumstances IX. POLICY STATEMENT:

1) Medic One will transport:

a. Thurston County hospital Emergency Room patients that need emergency transfer, upon

request of Base Hospital Emergency Room Physician. b. Field transports of patients to other than a Thurston County hospital can only be

approved by the on-duty Base Hospital Emergency Physician(s) OR the Medic One Medical Program Director when:

i. The hospital is closer to the field site than a Thurston County hospital (includes but

is not limited to Madigan, Tacoma VA, and Centralia Providence), AND

ii. The hospital has a level of care category equal to or greater than a Thurston County hospital for the patient's condition, OR

iii. Thurston County Base hospital is not able to accept more patients due to existing patient census, OR

iv. There exist state statutory requirements mandating transport to a particular hospital.

c. All transports deemed necessary by the Thurston County Base Hospital Emergency Physician.

2. It is not the intent of Thurston County Medic One to transfer:

a. Established hospital patients, unless emergent AND is approved by the Base Station

emergency physician. b. Patients from out-of-county hospitals to a Thurston County hospital.

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c. Thurston County clinic patients to out-of-county hospitals UNLESS it is an emergent

transfer of an unstable patient that a Thurston County hospital cannot care for AND is cleared through the Base Hospital Emergency Physician.

d. At the discretion of the ALS contracting agency, paramedic call back and secondary

medic unit activation procedures may be implemented to ensure the continuity of paramedic services in Thurston County during an out-of-county interfacility transport.

3. Transports which are not recommended by Thurston County personnel and are outside these

guidelines but which are demanded by patients, fall under the “Against Medical Advice Policy”. These patients should also be informed that it may be necessary for them to be transferred to a different county's ALS unit, for which they may be charged a fee, if they persist in this request and that is also not the advice of the Thurston County personnel.

MODE OF TRANSPORT Patients who are clinically unstable, should be give highest priority for transportation by an ALS unit. Situations prohibiting ALS transportation for such patients must be discussed with the Base Station physician prior to transporting by a non-ALS unit and with one of the supervising physicians as soon as possible after the run. Documentation of the extenuating circumstances must be provided in the patient record.

Patients who are stable on initial evaluation yet have potentially life threatening conditions for which there are effective ALS interventions, should routinely receive ALS transportation. Supplemental oxygen, cardiac monitor, intravenous line and other appropriate supportive measures should be provided. Deviation from this procedure must be approved in advance by the Base Station physician and the rationale documented in the patient record. Patients with a stable presentation and no evidence of potential life threat that can effectively be treated by ALS interventions have the lowest priority for ALS transportation. Transporting in such situations may monopolize an ALS unit preventing response to an illness for which there are effective ALS interventions. In general, such patients should not be transported by an ALS unit. Situations in which an ALS unit would not ordinarily transport, yet circumstances demand consideration of an ALS transportation should be resolved by consultation with the Base Station physician. Examples include, but are not limited to the following situations: an uncompromising demand by a patient or those accompanying the patient that an ALS unit only be used for transportation of a low priority illness or an uncompromising demand by a patient's physician to transport a low priority illness by an ALS unit. The usual patient evaluation must precede such consultation. When circumstances exist such that a delay that would be necessitated by a wait for a non-ALS transporting vehicle is likely to produce either adverse patient care or keep the ALS unit unavailable longer than if the ALS unit had transported, then the ALS unit should transport and inform the Base Station of the decision en route.

X. ATTACHMENTS:

XI. RECORDS OF ACTIONS:

Adopted date: __12/84________________ Signature: ___________________________________________________________ Chairman, Emergency Medical Services Council Amended date: __1/96________________ __________________ __________________

Signature: ___________________________________________________________ Chairman, Emergency Medical Services Council

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Rescinded date: __________________ Signature: ___________________________________________________________ Chairman, Emergency Medical Services Council Reformatted date: ___10/13_______________

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Medic One POLICY

I. POLICY NUMBER: 11

II. POLICY TITLE: INTERACTIONS OF MEDIC ONE PERSONNEL W/MEDICAL INTENVENORS

III. DATE EFFECTIVE: August 1984



VI. SCOPE: Guidelines for Interactions w/medical intenvenors

VII. DEFINITIONS: (See Standard List) List Non-Standard Here VIII. POLICY PURPOSE: To provide guidelines in respect to medical control, transportation with medical intervenors at the scene.

1. POLICY STATEMENT: 1. Medical Control Medical supervision of Medic One personnel ultimately rests with the Medic One supervising physicians. Direct supervision is delegated to the base-station hospital. When the patient’s private physician is available at the scene or by phone, direction for care at the scene may be accepted from that physician providing the standard operating procedures and/or protocols of the Medic One system are not violated. 2. Transportation Transportation of the patient muyst follow guidelines established by the Medic One system (see Policy #5). 3. Medical Intervenors Medical Intervenors at the scene who insist upon a course of therapy inconsistent with established Medic One policy/procedures should be diplomatically asked to speak to the base-station hospital emergency physician. They should be informed that there is a possible conflict between their orders and Medic One protocol. Such issues must be resolved by the base-station emergency physician who is directly responsible for the paramedic and EMT actions. The base-station emergency physician must subsequently speak to the Medic One personnel to relay instructions for the appropriate therapy. If patient care supervision is to be relinquished by the base-station hospital emergency physician, then the emergency physician must notify the physician at the scene of the following: (1) the physician at the scene becomes the physician of record, (2) the physician must accompany the patient to the hospital, and (3) the physician must sign the paramedic record and arrange for subsequent care at the hospital.

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4. Patient’s Medical Care Medical care of the patient should be the Medic One personnel’s foremost concern. Transport of the patient to a Medic or aid unit van may be necessary to remove the patient from well-meaning but obstructive spectators.

2. ATTACHMENTS:

3. RECORDS OF ACTIONS:

Adopted date: __________________ Signature: ___________________________________________________________ Chairman, Emergency Medical Services Council Amended date: __________________ __________________ __________________

Signature: ___________________________________________________________ Chairman, Emergency Medical Services Council Rescinded date: __________________ Signature: ___________________________________________________________ Chairman, Emergency Medical Services Council Reformatted date: __11/13________________

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Medic One POLICY


II. POLICY TITLE: RESPONDING TO OUT-OF-COUNTY INCIDENTS




VI. SCOPE: Guidelines for Out-of-County Incident Responses

VII. DEFINITIONS: (See Standard List) List Non-Standard Here VIII. POLICY PURPOSE: To define guidelines for Thurston County Medic One to respond to emergency medical calls outside of the county boundaries.

1. POLICY STATEMENT: Thurston Thurston County Medic One is not a party to any intergovernmental agreement authorizing an EMS response into another county. Thurston county Medic One does not have the authority to respond to incidents beyond the boundaries of Thurston County. The intergovernmental agreements between the Cities of Olympia and Tumwater, and Fire Protection District #3, with Thurston County define the service areas as Thurston County. However, Medic One is authorized under State protocols and County policy to transfer critically ill or injured patients to a facility providing a higher standard of care. This is based on the criterion of providing the patient with a higher standard of care than what is available in the community. Aside from the authorization to provide ALS transfers, State protocols do not authorize Thurston County Medic One to respond into another county in order to effect patient transfers to a hospital in Thurston County.

2. ATTACHMENTS: Policy 12 Procedure

3. RECORDS OF ACTIONS:


Signature: ___________________________________________________________ Chairman, Emergency Medical Services Council

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Rescinded date: __________________ Signature: ___________________________________________________________ Chairman, Emergency Medical Services Council Reformatted date: __11/13________________

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II. POLICY/PROCEDURE TITLE: RESPONDING TO OUT-OF-COUNTY INCIDENTS


IV. RELATED PROCEDURES:


VI. PROCEDURE PURPOSE: Authorization for Medic One to respond into another county’s jurisdiction to provide ALS services may be granted for the following cases:

1. When requested by another county to respond to a disaster involving mass casualties. Medic One’s response will be coordinated through the Thurston County Department of Emergency Services with the approval of the Thurston county Board of Commissioners.

2. Other out of county requests for Thurston County Medic One services will be approved by the

Thurston County Medic One Medical Program Director, the Base Hospital on-duty emergency room physician, or the Medic One Director.

VII. ATTACHMENTS:

VIII. RECORD OF ACTION:

Adopted date: __________________ Signature: ___________________________________________________________ Chairman, Medic One Operations Committee Amended date: __________________ __________________ __________________

Signature: ___________________________________________________________ Chairman, Medic One Operations Committee Rescinded date: __________________ Signature: ___________________________________________________________ Chairman, Medic One Operations Committee Reformatted date: __8/84________________

Medic One EMS Procedures

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Medic One POLICY


II. POLICY TITLE: PROTOCOLS FOR THURSTON COUNTY BLS PERSONNEL




VI. SCOPE: To establish protocols for BLS personnel working within the Thurston County Medic One system.

VII. DEFINITIONS: (See Standard List) List Non-Standard Here VIII. POLICY PURPOSE: To establish protocols for BLS personnel working within the Thurston County Medic One system.

IX. POLICY STATEMENT: 1. All EMT personnel will follow the Washington BLS Field Protocols.

2. All EMT personnel will provide prompt vital signs and an assessment of the patient(s) upon the request of the base hospital or paramedic unit en route. 3. No EMT personnel will be allowed to request cancellation of a paramedic unit until they are able to provide current vital signs and/or patient status. 4. EMTs are under the medical control of Thurston County’s Medical Program Director and the on-line Base Hospital’s ER physician. REFER to RCW 18.73.077 (2) (3).

X. ATTACHMENTS:



Signature: ___________________________________________________________ Chairman, Emergency Medical Services Council Rescinded date: __________________

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Signature: ___________________________________________________________ Chairman, Emergency Medical Services Council Reformatted date: __11/13________________

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Medic One POLICY

I. POLICY NUMBER:

II. POLICY TITLE: PATIENT REFUSAL OF MEDICAL EVALUATION, TREATMENT AND/OR TRANSPORT

III. DATE EFFECTIVE: February 1996



VI. SCOPE: To provide guidelines when a patient refuses a medical evaluation, treatment and/or transport.

VII. DEFINITIONS: (See Standard List) List Non-Standard Here VIII. POLICY PURPOSE: To provide guidelines when a patient refuses a medical evaluation, treatment and/or transport.

IX. POLICY STATEMENT: Occasionally, an EMS provider will be called to assist someone thought to be in need of medical evaluation/assistance, only to have that person refuse care. Competent adults have the right, in most circumstances to refuse such assistance. In the event of such an adult refusing emergency medical evaluation, treatment or advice: 1. Try to convince the person of the need for evaluation and/or treatment. 2. Encourage/solicit assistance from any friends, family, neighbors, bystanders, etc., who may be

more familiar and/or less threatening.

3. a. Mandatory: Contact the base physician to inform of the person’s refusal of assistance—inform the person of the physician’s recommendation to undergo emergency evaluation and/or treatment. Document this refusal and the name of the base physician on the Emergency Medical Services/Medical Incident Report (EMS/MIR) form.

b. In some instances it may be more appropriate, if possible, to contact a personal physician for advice; if the person continues to refuse, the base physician must also be notified. Document this refusal and the name of the physician contacted on the EMS/MIR form.

4. If it seems possible the person may be a threat to himself or others or seems incapable of making “normal” judgment, request Dispatch to contact the Crisis Clinic for the “Mental Health Professional” (MHP) on duty for assistance with psychiatric evaluation. No patient at jeopardy, in your reasonable judgment in consultation with the base hospital physician should be left unattended. The MHP can verbally authorize detainment and transportation to a hospital for psychiatric evaluation based upon police or paramedic evaluation. The police have authority for necessary restrain if necessary.

5. Be aware that no one can refuse medical care for life-threatening conditions for a minor.

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6. Since it is impossible to determine the validity of a living will in field situations, no action

should be based upon this. Instead, appropriate resuscitation should be started and an attempt be made to contact the personal physician for further guidance. If Thurston County EMS personnel are confronted with a valid EMS-NO CPR order, that standing order should be followed.

If the personal physician is unavailable, the base hospital physician should be consulted before any resuscitative efforts are withheld or ceased.

7. Using the following PROCEDURE, complete the Medical Release Form (Page 3, Attachment “A” to this Policy) on any patient refusing care and/or transport to definitive medical care. Document all facts on the EMS/MIR form.

X. ATTACHMENTS:


Adopted date: __2/96________________ Signature: ___________________________________________________________ Chairman, Emergency Medical Services Council Amended date: __________________ __________________ __________________

Signature: ___________________________________________________________ Chairman, Emergency Medical Services Council Rescinded date: __________________ Signature: ___________________________________________________________ Chairman, Emergency Medical Services Council Reformatted date: __11/13________________

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II. POLICY/PROCEDURE TITLE: PATIENT REFUSAL OF MEDICAL EVALUATION, TREATMENT AND/OR TRANSPORT


IV. RELATED PROCEDURES:


VI. PROCEDURE PURPOSE: Complete the MEDICAL RELEASE FORM using the following instructions: 1. Fill in the person’s name, date and time, EMS #, type of incident. Use back of Release Form to

report any other information you feel pertinent to this situation. 2. Check the appropriate category of refusal; be specific when the box marked “OTHER” is used.

More than one category may be appropriate. 3. Read the Release slowly and clearly to the patient. Ask the patient if she/he understands what

has been read, then read the Release to the patient again. 4. Obtain appropriate signatures; document refusal to sign it unable to obtain signatures 5. Give the patient the “REFUSAL INFORMATION SHEET” (See Page 4, Attachment “A.1.” to this

Policy). Have the patient initial acknowledgement of receipt of REFUSAL OF INFORMATION SHEET in the space provided on the Medical Release Form.

6. Sign the Release Form; obtain as many signature(s) of witness(es) as possible, preferably of

responders from your department/district. 7. Fill out the standard EMS Medical Incident Report (EMS/MIR) stating appropriate

circumstances, documenting the person’s apparent mental status and any obvious pertinent physical findings. Document the steps taken to encourage the person to allow assistance. (See steps 1-6 under POLICY above).

8. Distribute copies of the Release Form as follows:

a. ORIGINAL: Attach to your department/district EMS/MIR form. b. SECOND PAGE: Attach to Thurston County EMS/MIR form and forward to the Medic One

office. c. THIRD PAGE: Present this copy to patient/guardian.

VII. ATTACHMENTS:

VIII. RECORD OF ACTION:

Adopted date: ___2/96_______________

Medic One EMS Procedures

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Signature: ___________________________________________________________ Chairman, Medic One Operations Committee Amended date: __________________ __________________ __________________

Signature: ___________________________________________________________ Chairman, Medic One Operations Committee Rescinded date: __________________ Signature: ___________________________________________________________ Chairman, Medic One Operations Committee Reformatted date: ___11/13_______________

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MEDICAL RELEASE Refusal of Evaluation, Treatment and/or Transport

Patient Name: Date and Time: EMS #: Type of Incident: "I hereby acknowledge that I have been advised that evaluation, treatment and/or transportation is necessary for my condition. I have also been informed of the potential risk involved if l do not comply with this advice. I HEREBY STATE MY REFUSAL TO FOLLOW THE ADVICE GIVEN ME BY EMERGENCY MEDICAL PERSONNEL AND REFUSE FURTHER EVALUATION, TREATMENT AND/OR TRANSPORTATION TO A MEDICAL FACILITY. By the above statements, I hereby absolve and hold harmless of any responsibility all Emergency Medical Services personnel and their agents for any ill effects which may result from my actions." REFUSE EVALUATION REFUSE TO SIGN FORM

REFUSE TREATMENT OR PART OF TREATMENT

REFUSE TRANSPORT TO RECOMMENDED FACILITY OTHER

I have received a copy of the accompanying Refusal Information Sheet.Initals: Patient's Signature: Date/Time: Parent/Guardian Signature: Date/Time: EMS Personnel Signature: Date/Time:

Witness Signature: Date/Time:

EMS PERSONNEL INSTRUCTIONS

1. Make sure patent is capable of making this decision, is given recommendation and informed of potential medical risks.

2. Fill out this form in ink. 3. Fill in patient's name and the exact date and time. 4. Read this form slowly and clearly to the patient. 5. Ask the patient if she/he understands what has been read, THEN . . . ASK AGAIN! 6. Give patient information sheet and have patient initial acknowledgment of receipt of Refusal Information

Sheet. 7. Have patient sign "Patient Signature" line. 8. After patient has signed, you sign the form. 9. Obtain a signature from a witness (preferably someone from your agency). 10. Distribute copies of this form as follows:

a. Original: Attach to your district/department EMS/MIR form. b. Second Page: Attach to Thurston County Medic One EMS report and forward to Medic One. c. Third Page: Present to patient/guardian.

REFUSAL INFORMATION SHEET

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THURSTON COUNTY MEDIC ONE POLICY #28 Adopted: January 1996 Attachment A Page 2

PLEASE READ AND KEEP THIS FORM! This form has been given to you because you have refused treatment and/or transport by Emergency Medical Services (EMS). Your health and safety are our primary concern, so even though you have decided not to accept our advice, please remember the following:

1. The evaluation and/or treatment provided to you by the EMS providers is not a substitute for medical evaluation and treatment by a doctor. We advise you to get medical evaluation and treatment.

2. Your condition may not seem as bad to you as it actually is. Without treatment, your condition or problem could become worse. If you are planning to get medical treatment, a decision to refuse treatment or transport by EMS may result in a delay which could make your condition or problem worse.

3. Medical evaluation and/or treatment may be obtained by calling your doctor, if you have one, or by going to any hospital Emergency Department in this area, all of which are staffed 24 hours a day by Emergency Physicians. You may be seen at these Emergency Departments without an appointment.

4. If you change your mind or your condition becomes worse and you decide to accept treatment and transport by Emergency Medical Services, please do not hesitate to call us back. We will do our best to help you.

5. DON'T WAIT! When medical treatment is needed, it is usually better to get it right away. UNDER FEDERAL LAW, IT IS THE RESPONSIBILITY OF HOSPITALS TO PROVIDE A MEDICAL SCREENING EXAMINATION AND TREATMENT FOR AN EMERGENCY MEDICAL CONDITION, REGARDLESS OF A PERSONS ABILITY TO PAY.

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THURSTON COUNTY MEDIC ONE OPERATIONS COMMITTEE ~ … Agenda... · February 7, 8 & 9, 2014 at the...

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