prehospital medical advisory committee meeting … · 24/11/2008 · greg adams ; riverside county...

PREHOSPITAL MEDICAL ADVISORY COMMITTEE MEETING AGENDA

November 24, 2008, 9:00AM – 11:00AM Riverside County Regional Medical Center

26520 Cactus Avenue, Moreno Valley ROOMS A1018 and A1021

951/358-5029

SUBJECT TIME PRESENTED BY PURPOSE/ACTION ATTACHMENT I. Call to Order / Roundtable Introductions

5 min. Chairman Inform

II. Review of Meeting Minutes -- Sept. 22, 2008

A

III. Public Health A. Epidemiology B. General Devices, Inc. Presentation C. PHEPR Branch Report

15 min Danyte Mockus

Kevin Davey

Public Health Staff

Inform

Inform Inform

B

H/O

IV. EMS Agency A. Amb. Wait Time Report B. Communications C. Data System D. CQI 1. STEMI Rec. Center 2. Perf. Excell. Recog. 3. QI/TAG E. Trauma

30 min. Trevor Douville Trevor Douville

James Lee

Laura Wallin Laura Wallin Lisa Higuchi Cindi Stoll

Inform/Discuss

Inform Inform

Inform Inform Inform Inform

H/O

V. Committee/Task Force Reports A. Mass Gathering B. MCI C. 5150 Regional Task Force

15 min Art Durbin Art Durbin

Christina Bivona-Tellez

Inform Inform Inform

VI. New Business A. Policies B. PMAC Mtg. Sched. 2009

20 min

Karen Petrilla

Brian MacGavin

Discuss Discuss

C D

VII. Old Business A. Nominations/Elections: PMAC Chair PMAC Vice Chair PMAC Representative to EMCC

10 min

Chair

Action/Inform

VIII. Open Discussion/Comments A. Constituent Grps. Rep. per Policy 1630 B. EMT-P-At-Large C. EMT-I-At-Large

15 min

Discuss

Discuss Discuss

IX. Next Meeting (Jan. 26, 2009) /Adjournment

1 min. Chairman Inform

Please come prepared to discuss the agenda items. If you have any questions, call Brian MacGavin at (951) 358-5029. PMAC Agendas with attachments are available at our website: www.rivcoems.org.

The County of Riverside does not discriminate on the basis of disability in admission to, access to, or operations of its programs, services or activities. It is committed to ensuring that its programs, services, and activities are fully accessible to and usable by people with disabilities. If you have a disability and need assistance, contact Brian MacGavin at (951) 358-5029.

http://www.rivcoems.org/

September 22, 2008 Prehospital Medical Advisory Committee Attachment A Meeting Minutes

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Prehospital Medical Advisory Committee Meeting Minutes

September 22, 2008

Attendees Organization Represented Jeff Copeland American Medical Response Jim Price American Medical Response Lisa Higuchi American Medical Response Sam Chua, MD American Medical Response Wayne Ennis American Medical Response Josh Wiedehold Blythe Ambulance Service Scott Hines Burke, Rix, Hines & Associates, LLC Dwight Arakaki, MD Corona Regional Medical Center Sandra Andrews Crafton Hills College Heidi Anderson Desert Regional Medical Center Paul Duenas EMT Paramedic-At-Large Christina Bivona-Tellez Hospital Association of Southern California Reza Vaezazizi, MD Inland Valley Regional Med Ctr/Rancho Springs Michael Murphy Inland Valley Regional Med Ctr/Rancho Springs Claire Chambers J. F. Kennedy Memorial Hospital Pamela Steen Mercy Air Gerardo Salcedo, MD Mission Ambulance Kent McCurdy Mission Ambulance Rick Hartsock Mission Ambulance Robin Fisher, DO Moreno Valley Community Hospital Bill Herbert Moreno Valley Community Hospital Kristen Clements National College for Technical Instruction Gigi Kramer Palm Springs Fire Department Toni Culver Parkview Community Hospital Jesse Allured Pechanga Fire Department Bob Fontaine Riverside Community College Chris Nollette Riverside Community College Steve Patterson, MD Riverside Community Hospital Sabrina Magallanes Riverside Community Hospital Bruce Stumreiter Riverside County Fire Department Greg Adams Riverside County Fire Department Kevin Powell Riverside County Fire Department Lisa Halloway Riverside County Fire Department Scott Visyak Riverside County Fire Department


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Attendees Organization Represented Ann Yoshinaga Riverside County Fire Department/EMS Training Tim Nesper, MD Riverside County Regional Medical Center J. E. Blaine Riverside County Regional Medical Center Bruce Barton EMS Agency - Director Humberto Ochoa, MD EMS Agency – Medical Director Brian MacGavin EMS Agency – Assistant Director

Staff in Attendance Organization Represented Cindi Stoll EMS Agency – Trauma Nurse Coordinator James Lee EMS Agency – EMS Specialist Karen Petrilla EMS Agency – EMS Specialist Trevor Douville EMS Agency – Compliance Coordinator Lydia Alcaraz EMS Agency – Secretary I Kim Saruwatari PHEPR Branch - Director Britta Barton PHEPR Branch – Sr. EMS Specialist Saman Kashani PHEPR Branch – EMS Specialist Victoria Young Injury Prevention Services – Program Coordinator

I. Call to Order

The meeting was called to order at 9:00AM by Dr. Reza Vaezazizi and roundtable introductions were completed.

II. Review of Meeting Minutes

Meeting minutes for June 23, 2008 were approved as recorded. III. EMS Agency

A. Ambulance Wait Time

The first of the three charts presented by Trevor Douville showed ambulance wait times from 2006 to the present. From July to August 2008, there was a 25% increase in ambulance wait times with a less than 1% increase in total number of transports. The second chart was a comparative graph of average monthly hours versus average monthly transports. The data showed no direct correlation between the amount of transports and ambulance wait time. Christina Bivona-Tellez of the Hospital Association of Southern California (HASC) asked if these were the new figures because discrepancies in wall time hours were reported in the past. It was noted that these are not new figures, the data collected from the two beta test sites, County Hospital and Riverside Community Hospital, should be ready at the next PMAC. The last chart shows a quarterly average, by facility, of ambulance wait time from 2007 to the first two quarters of 2008. Most facilities decreased their ambulance wait times by greater than 50% since the last quarter. This data shows that diversion is not the solution to the issue of increasing ambulance wait time.


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B. Communications A Radio Communications Group was formed to complete the radio assessment of all hospitals in Riverside County. The group is looking at refurbishing the radio communications infrastructure, including radio contact with trauma centers for Mercy Air.

C. Data System The second round of software updates is taking place for providers utilizing HealthWare Solutions. Meetings with County Fire Department will be held in the coming weeks to discuss time frames for Phase 1 data implementation. The EMS Agency will work with AMR to meet the November 1 deadline, for electronic ePCR generation 95% of the time. Bruce Barton thanked Wayne Ennis of AMR-Palm Springs for their outstanding compliance.

D. Continuous Quality Improvement (CQI) 1. Policy 5730, STEMI Receiving Center (SRC) Bruce Barton said that the STEMI CQI Focus Group is evaluating possible

modifications to Policy 5730, STEMI Receiving Centers. The changes on the policy include reference to the chest pain and 12-lead policies to clear up confusion in the field. There was a discussion on Item 5.2.2 - ETA to the STEMI Receiving Center is 30 minutes or less from the scene. This time frame is to create a sense of urgency. Dr. Vaezazizi agrees with the suggestion of Dr. Chad Clark to qualify Item 5.2.2. with the statement, “unless the patient fails the fibrinolytic assessment.” This suggestion will be taken to the STEMI Committee for further consideration. The policy will be sent out for a 30-day public comment period.

Action Item: The EMS Agency will take Dr. Clark’s suggestion to the STEMI

Committee for consideration. 2. Policy 7200, Cardiac Chest Discomfort The changes generated in this policy came from the input from the STEMI

Committee. Item 2, MONITOR 12L – “Apply standard Lead II monitor. Treat rhythm as

appropriate. Perform 12L in conjunction with necessary treatments, which may include 3 – 7 below. Do not delay necessary treatments to obtain 12L, however,


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a 12L must be performed as part of the patient assessment.” Words in italics were

added for clarification. Field providers have to do 12L. It is not optional. CQI coordinators from provider agencies need to monitor this as this is now the policy.

Item 5, NITROGLYCERINE - the blood pressure threshold was changed from 100

to 90 mm Hg. to be consistent with AHA guidelines. Item 7, COMPLETE STEMI ASSESSMENT – “If 12L shows possible MI Refer to

Policy #7210, STEMI Assessment. Do not delay transport to complete this. Contact closest base hospital / STEMI Center for destination determination.” The concept does not change.

The committee unanimously approved Policy 7200. Public comment period is

forthcoming on the above policies. 3. Performance Excellence Recognition

The following prehospital providers demonstrated exceptional job performance:

Judo Bartlett AMR Dawn Carifi Riverside County Fire Department Joe Fuori Riverside County Fire Department Pat Hopkins Riverside City Fire Department Stephen Mattenson AMR Billy Milligan Riverside City Fire Department Cameron Oleson AMR Ray Orozco AMR Frank Romo AMR Tammy Rye AMR Glen Thronson AMR Julie Timmereck AMR Matt Ungeheier AMR

This year, there was an Appreciation Ceremony at Lake Elsinore Storm Stadium. For next year, there will possibly be a CQI Day or a Continuing Education Day and the EMS Agency will recognize prehospital providers.

4. QI/TAG

At the last QI/TAG meeting it was announced that the new deadline for CQI Plans is September 1, 2008. The group is focusing on helping provider agencies to finish their Plans. Those people currently working with Laura Wallin and in the process of completing CQI Plans have not missed the deadline. However, those that have not submitted a first draft missed the deadline. A letter will be sent out to this effect. Agencies are urged to complete their CQI Plans as soon as possible.


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E. Trauma

Cindi Stoll did a presentation on Trauma in Riverside County. For 2007, the number of trauma patients received at the Desert Regional Medical Center, Inland Valley Medical Center and the County Hospital dropped slightly. However, trauma volume went up at the Riverside Community Hospital. The cause of injury is mostly motor vehicle accidents. There is a graph showing Injury Severity Score (ISS), the lower the score the less the severity of the injury. The higher the score, the worse the injury, with an increasing rate of mortality. Trauma registry data for 2007 shows 3,245 patients were discharged alive and 201 patients died. For Air Ops Utilization, total trauma transported for 2007 dropped but helicopter utilization increased. Dr. Vaezazizi remarked that the pattern suggests we may be over utilizing helicopters. There should be better utilization criteria for air providers.

IV. Public Health

The Golden Guardian Full Scale Exercise (GG08) will be held on November 13 & 14, and the Recovery Tabletop Exercise on November 17. All partners in emergency preparedness, response and public safety will be participating. All hospitals participating in GG08 will be testing mass fatality and surge capacity. Volunteers are needed for the Mobile Field Hospital and the clinics.

DoPH Disease Control Branch does not have any information to suggest that the

upcoming flu season will be worse than the previous years. For several months now, Disease Control has been conducting extensive outreach services to educate the public on influenza. A flyer listing clinics that provide free flu shots was provided. If PMAC would like a presentation on their Outreach Program, Disease Control will be more than happy to oblige.

The Hospital Preparedness Program (HPP) Grant has been awarded just under $900,000.

Several items were identified for purchase after a planning meeting with the hospitals. V. Committee/Task Force Reports

A. Mass Gathering

It was reported at the last meeting that the EMS Agency will take the Mass Gathering document to County Counsel to seek guidance on whether the document should be a guideline, an ordinance or a policy. In conjunction with the guidelines, County Counsel’s recommendation is to turn the document into a policy. The task force is currently working on policy development.


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B. MCI

The Multiple Casualty Incident (MCI) Task Force is having meetings on a monthly basis. Majority of the policy has been completed. The group is working on the education and training components. Under this policy, increased responsibilities will be placed upon permitted ambulance providers in Riverside County.

C. 5150 Regional Task Force This is a multiple county (ICEMA and Riverside County) EMS Agency, 5150 Task Force. They are evaluating prehospital options available before 5150s are placed. They are also looking at tele-psychiatry and tele-neurology options. The next meeting is scheduled for October 6 at the HASC Conference Room. It is a multi-discipline meeting and everyone is invited to attend.

VI. New Business

A. Nominations

Dr. Reza Vaezazizi and Bruce Stumreiter, current PMAC Chair and Vice Chair, were nominated for said positions. It was noted the group prefers the Chair to be a physician in order to better connect prehospital providers to the medical community. The Vice Chair is basically open to anyone else. Please send additional nominations to Brian MacGavin by November 1. Voting will be conducted at the next PMAC on November 24.

B. PMAC Representative to EMCC The Emergency Medical Care Committee functions as advisory to the Board of Supervisors and the EMS Agency. Historically, whoever gets elected as Chair/Vice Chair of PMAC fulfills the function as representative to EMCC. The group may prefer to have a separate representative to EMCC. Dr. Vaezazizi stated this is a good change regardless of who gets elected as Chair/Vice Chair. Dr. Steve Patterson was nominated for the position to replace Dr. Brian Gordon who is no longer within the county. Send nominations to Brian MacGavin of the EMS Agency by November 1. It was noted that Pam Steen is the prehospital representative to EMCC.

C. Meeting Date Change PMAC meets on the 4th Monday for the months of January, March, June, September and November. It was suggested to change PMAC meeting days from Mondays to Tuesdays. Since there was no support to change the meeting days, PMAC meetings will remain on Mondays.

A. Policy Review


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Review of Policy 7200 has been discussed under III. D. Continuous Quality Improvement.

VII. Old Business

A. Policy 5310, Ambulance Diversion Last meeting, PMAC approved modifying the diversion policy to remove ED Diversions for all hospitals in Riverside County, allowing diversions for internal disaster and trauma only. Policy 5310 will be put out with the fall packet. For desert hospitals the implementation date is November 1.

VIII. Open Discussion

Ann Yoshinaga is the new chair for the training programs in the County, replacing Art Durbin. She represents EMT-I/EMT-P Training Programs to PMAC.

Dr. Gerardo Salcedo is the new Medical Director for Mission Ambulance.

Vicki Young of Injury Prevention Services asked for everyone’s participation in the

“Safe Haven” program. The County of Riverside does not have a coordinating lead agency for this program.

PMAC membership represents stakeholder groups such as PLNs, Receiving Hospitals, EMS Officers, etc. The EMS Agency would like these groups to provide updates on their activities. PMAC is the venue to give input and updates on projects that stakeholder groups are working on.

RCRMC’s Second Annual Trauma Conference is on Friday October 17, Rooms A1017 and A1018.

Desert Regional Conference is hosting a Pediatric Conference on Friday, October 10, 2008.

The EMS Nurse Network group will meet immediately after PMAC.

Every provider should pick up a copy of the memo from Dr. Steven Tharratt, State EMSA Director. It pertains to a federal regulation mandating use of high-visibility vests for emergency responders. It will be effective November 24, 2008. The memo will be sent out electronically. Action Item: EMS Agency will electronically send out the memo from Dr. Tharratt.

September 22, 2008 Prehospital Medical Advisory Committee Meeting Minutes

Attachment A Page 8 of 8

IX. Next Meeting/Adjournment

The next PMAC Meeting is: Monday

November 24, 2008 at 9:00AM Riverside County Regional Medical Center

Rooms A1018 with A1021 26520 Cactus Avenue, Moreno Valley

Influenza Season 2008/09 – Riverside County, California Influenza Surveillance Weekly Update

Week ending November 1, 2008

Percent of Emergency Department (ED) Visits Due to Influenza-Like Illness (ILI), Riverside County: 2008/09 Influenza Season

0.0

5.0

10.0

15.0

20.0

25.0

30.0

40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Oct Nov Dec Jan Feb Mar Apr

Report Week

% E

D V

isits

Due

to IL

I

2004/2005 2005/2006 2006/2007 2007/2008 2008/2009

During week 44, 7.0 percent of visits to Riverside County emergency departments were related to influenza-like illnesses. Compared to historical data, this is within normal limits.

Percentage of Deaths due to Pneumonia/Influenza (P&I), Riverside County, California

0%

5%

10%

15%

20%

25%

30%

40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Oct Nov Dec Jan Feb Mar Apr

Perc

enta

ge

2006/2007 2007/2008 2008/2009

Report Week

During week 44, 3.8 percent of deaths were due, in part, to pneumonia/influenza. Compared to historical data, this is within normal limits. School Absenteeism: As of week 43*, 6.6%** of students at sentinel school sites were absent due to illness. This is significantly lower than the same time last year when 20.4% of students at sentinel school sites were absent due to illness. *Data reporting delayed one week; **Data from schools who specifically report absence due to illness. State Influenza Activity: As of week 43*, Influenza activity remains low throughout California. National Influenza Activity: As of week 43*, a low level of influenza activity was reported in the United States, with only 13 states reporting sporadic activity. The proportion of deaths nationwide attributed to pneumonia and influenza (P&I) was below the epidemic threshold. *Data reporting delayed one week. Additional Resources Riverside County Influenza Vaccine Locations:

Call 1-888-246-1215 or visit http://www.rivco-diseasecontrol.org/pdf/flu.pdf State of California Influenza Information: http://www.dhs.ca.gov/ps/dcdc/vrdl/html/flu/fluintro.htm United States Influenza Information: http://www.cdc.gov/ncidod/diseases/flu/weekly.htm

Epidemiology and Program Evaluation (951) 358-5557 Department of Public Health / Riverside County Community Health Agency

http://www.rivcohealthdata.org/home/index.htm

http://www.rivco-diseasecontrol.org/pdf/flu.pdf

http://www.dhs.ca.gov/ps/dcdc/vrdl/html/flu/fluintro.htm

http://www.cdc.gov/ncidod/diseases/flu/weekly.htm

http://www.rivcohealthdata.org/home/index.htm

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OPERATIONS: General Policy (BLS/ALS) Policy: 5xxx Date: Draft

PATIENT CARE DOCUMENTATION STANDARDS

1. Documentation must be initiated for every patient response (Title 22, Section 100169); a patient care report (PCR) will be completed on all patients, except those involved in multi- casualty incidents (as defined in policy #5800, MCI Scene Management) and to which an approved triage tag is assigned. Anytime EMS personnel, either ALS and BLS level, make contact with a patient, documentation of that contact must be made. 1.1 A patient is defined as 1.1.1 Any person for whom the 9-1-1 system has been activated OR who is encountered by an authorized EMS provider functioning as part of an organized EMS system, and who meets any of the following criteria: 1.1.1.1 Has a chief complaint OR a witness / someone with personal knowledge of the person states the person has a chief complaint, 1.1.1.2 Makes a request for examination or treatment. 1.1.1.3 Has obvious signs or symptoms of injury or illness. 1.1.1.4 Has been involved in an event with sufficient mechanism of injury, or has given a (medical) history, such that the prudent responder is obligated to maintain an index of suspicion for illness or injury regardless of the patient’s clinical presentation. 1.1.1.5 Appears to be disoriented, to have impaired psychiatric function, or to be under the influence of chemicals 1.1.1.6 Has evidenced suicidal intent. 1.1.1.7 Is dead. 1.2 A patient contact / encounter is defined as purposeful contact between a patient and a provider who has responsibility for assessing and treating the condition of the patient and exercises independent judgment in the care of the patient. Contact is initiated with visualization. A patient contact is dependent on neither treatment nor transport nor cooperation from the patient.

2. A patient care report (PCR / ePCR) is the legal written record of a patient encounter. It is part of the patient’s medical record. As such , it shall accurately and completely describe pertinent scene conditions, chief complaint of the patient, patient assessment(s), any treatment(s) given, response to treatment(s), any changes in the patient’s condition, any advisements given to the patient/family, and his/her disposition. PCRs must contain the following information as mandated by: 2.1 California Code of Regulations (CCR), Title 22

• The date and estimated time of incident. • The time of receipt of the call (available through dispatch records). • The time of dispatch to the scene. • The time of arrival at the scene. • The location of the incident. • The patient's: name; age; gender; weight, if necessary for treatment; address. • Chief complaint.

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• Vital signs. • Appropriate physical assessment. • The emergency care rendered and the patient's response to such treatment. • Patient disposition. • The time of departure from scene. • The time of arrival at receiving facility (if transported). • The name of receiving facility (if transported). • The name(s) and unique identifier number(s) of the paramedics. • Signature(s) of the paramedic(s).

2.2 Riverside County EMS Agency • Standard medical abbreviations as defined by X, and Riverside County- approved EMS abbreviations shall be utilized. • Entries noting procedures/treatments administered or attempted shall include time of attempt and initials of person rendering care. • Entries noting any response or lack of response or any change in patient condition must be timed. • The individual component scores for GCS and APGAR, when utilized • The name(s) and any unique identifier number(s) of BLS providers rendering care and completing their own service provider’s PCR. • Signature(s) of the BLS provider(s) rendering care on their own service provider’s PCR. • If recommended treatments or transport was/were declined, a statement to document the explanation of possible consequences, the patient’s understanding of these consequences, and continued declination after explanation. • The providers’ unique incident #. 3. PCRs shall be legible. 4. An appropriately completed PCR will give a clear and sequential description of events from first contact to transfer of care. 5. PCRs are best completed by the person(s) directly involved in patient care. 6. All PCRs utilized must have the approval of the EMS Agency. 7. Patient care reports are both verbal and written. Patient Care Report forms are legal documents of patient assessment, treatment, and response to treatment. PCRs should be completed before handing a copy to the next care provider. However, when two or more providers are at the scene and patient transport must be expedited, it is expected that at time of transfer, a full verbal report will be given by the non-transporting care provider(s) and a written report will be consigned that is as complete as possible. The completed report will be faxed, with the original mailed, to the receiving center within 48 hours.

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7.1 Information added after-the-fact, whether immediately after consigning patient care responsibilities or prior to faxing the report to the receiving center, must be indicated as having been added after leaving the care of the patient. This can be done by italicizing, underlining, writing in a different color, creating an addendum, or otherwise identifying information added after leaving patient care. 7.2 Once a copy of a handwritten paper report is handed-off, it should not be rewritten on a new form. 7.2.1 Rewriting restrictions do not apply to the transference of information to an electronic PCR (ePCR). 8. PCRs must be retained by the EMS service provider agency for a minimum of seven (7) years. 9. When requested for purposes of quality review, PCRs will be provided by an EMS service provider to the EMS Agency or the involved base hospital. 10. Timely retrospective review of PCRs is a key component of EMS system improvement. Record review responsibilities shall be incorporated in each service provider’s approved continuous quality improvement (CQI) plan and are outlined in policies #2120, EMT-I and First Responder Provider Agencies, and #2140, ALS Provider Agencies. Base hospitals are required to review patient care records as described in Title 22, CCR, Section 100169(c)(1), and as incorporated in their EMS agency-approved CQI plans. 11. Provider agencies utilizing electronic PCRs (ePCRs) are required to adopt software that is compliant with the California Emergency Medical Services Information System (CEMSIS) or the Riverside County approved EMS data set, and whose data is integrable to the EMS data system. 12. All authorized EMS provider agencies that collect protected healthcare information shall include a HIPAA compliance program as part of their CQI plan. Included in the plan will be policies for the custody and security of PCRs. consign - to give over to another’s care; to give, transfer or deliver into the hands or control of another

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OPERATIONS: General Policy (BLS/ALS) Policy: 5500 Date: x/x/09

CONSENT AND REFUSAL OF MEDICAL TREATMENT

1. Consents:

1.1 Implied/Competent/Capable Consents: This group of patients represents no problem to treat and transport as appropriate.

1.2 Incapable patients (for whatever cause): The senior medical person individual on scene vested with the authority for patient health care management is responsible for determining if medical evaluation is necessary. If medically cleared law enforcement personnel then assume responsibility. (reference policy #5100, Authority for Medical Emergency Scene Management)

2. Refusals:

2.1 A competent adult (age 18 or older) may refuse care or transportation. Refer to Policy #5700, Prehospital Medical Destination. Medical personnel will have an “Against Medical Advice” (AMA) form that should be signed and witnessed. If the patient refuses to sign, witnesses to the refusal should sign the form.

2.2 Incapable Adults: Any patient who falls into one of the following categories SHOULD NOT BE ALLOWED to refuse treatment/transport (refer to 2.5 below): 2.2.1 With an altered level of consciousness. 2.2.2 Who has attempted suicide or verbalizes suicidal intent. 2.2.3 Who has severely altered vital signs. 2.2.4 Who is making a decision that is clearly irrational in the presence of an

obvious potential life-threatening condition. 2.3 Any patient on a 5150 hold CANNOT refuse transport. 2.4 Patients meeting the criteria in 2.2 and 2.3 above need to be transported to the

most appropriate facility. If a person is in custody, the officer assumes responsibility for the decision concerning the need for immediate medical treatment.

2.5 Juvenile Cases: Unless emancipated or the parent/guardian refuses treatment, a minor with a medical emergency shall be transported to the most appropriate facility for evaluation. An emancipated juvenile is one who is legally declared to be so by an established court of law, or is legally married, or is a member of the armed forces; clearly independent of parent/guardian control.

2.6 Problem considerations: 2.6.1 An incapable adult or a juvenile may persist in refusing medical treatment.

Civil law and County policy mandates their transportation to the most appropriate facility. With the exception of an attempted suicide/verbalized suicidal intent or other 5150 hold, there is no law empowering law enforcement personnel to force medical treatment upon a patient. A police officer may: 2.6.1.1 Provide supportive counsel in an effort to persuade a

patient to be transported for medical treatment. 2.6.1.2 Take an injured juvenile requiring medical treatment into

temporary custody (Welfare & Institution Code, Section 625).

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Date: 4/1/97

CONSENT AND REFUSAL OF MEDICAL TREATMENT

2.6.2 Persistent refusal of medical treatment will be documented by the medical personnel at the scene. 2.6.2.1 Law Enforcement personnel will be requested to witness,

sign and confirm the refusal. 2.6.2.2 In no event will the witness signature to a refusal by a

police officer be construed as assumption of medical responsibility for an individual.

2.6.3 Law Enforcement personnel shall not be required to converse with a Base Hospital physician over an ALS radio. Any transfer of necessary information should be through the medical personnel at the scene.

3. Assault and Battery

3.1 One of the more serious problems faced by emergency providers involves claims by patients that providers wrongfully rendered treatment without patient permission. Without proper consent, an individual can start a suit for assault and battery. It is a well-recognized principle of law that all competent persons have a right to accept/reject treatment. However, failure to give aid in an medical emergency can result in a negligence claim, unless the person clearly refuses medical treatment. Appropriate documentation of this refusal is required.

3.2 Only competent adults and emancipated juveniles should be capable of refusing medical treatment in accordance with civil law and county policy requirements.

4. Abandonment

4.1 Initial response units involved in a medical situation are responsible for patient care until the arrival of Advanced Life Support (ALS) personnel. Initial responders should remain with the patient until the patient is under the supervision of someone with equal or greater competence or refuses treatment as outlined above in Sections 2.1 and 3.2.

5. Documentation of Refusal of Care

5.1 In accordance with this policy, the following should be carefully documented on the Patient Care Report (PCR) form: 5.1.1 The individual’s chief complaint, mechanism of injury, level of

orientation/level of consciousness (e.g., if the person suffered a head injury or whether the person is suspected of being under the influence of drugs and/or alcohol).

5.1.2 Base Hospital contact should be made if there is any question regarding the disposition of the patient.

5.1.3 Any medical treatment or evaluation needed and refused. 5.1.4 The need for emergency transportation; also if transport by means other

than an ambulance could be hazardous due to the individual’s injury or illness.

5.1.5 Individual advised that potential harm could result without emergency medical treatment and/or transport.

5.2 A copy of the PCR will be kept by the EMS provider agency as per regulation.

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ADMINISTRATION: Policy Review Procedure Policy: 1800 Date: draft

POLICY REVIEW PROCEDURE

1. Introduction:

1.1 The policy review process is an advisory process to the County Health Officer, EMS Agency Director and the EMS Medical Director for the formulation of prehospital care policies. Policy suggestions and/or draft policies are accepted from committees, system participants, individuals and/or interested parties.

1.2 2 The EMS Agency tracks all policies in the review process. The status of each policy under consideration will be available during the review process.

2. Policy Process:

2.1 Public comment draft

• The EMS Agency will mail draft policies to the appropriate system participants and/or interested parties for written comments. Comments should identify specific recommendations for change.

• Policies under consideration that affect the EMS system as a whole will be sent out and/or posted on the Riverside County EMS Agency’s website at www.rivcoems.org for review by all system participants. A policy under consideration that applies to a limited group will only be sent to those who would be directly affected.

• The time frame allowed for the return of comments will be 30 days. Comments may be mailed, e-mailed, or faxed to the EMS Agency, but must be received no later than 4 p.m. on the deadline date.

• All comments will be reviewed by the EMS Agency Director. Suggestions for additions or deletions will be taken into consideration.

2.2 Public Testimony

• A final draft of the policy will be mailed out to all system participants and interested parties with the agenda for the next most appropriate Prehospital Medical Advisory Committee (PMAC) meeting.

2.2 Public Testimony (continued): • Time will be allotted at the appropriate committee(s) meeting for public

testimony and discussion by the committee(s) members. Specific recommendations may be made by the committee(s) regarding the policy. Public testimony and committee recommendations will be taken into consideration by the EMS Agency during the finalization of the policy.

• Responses from EMS Agency regarding the committee(s) recommendations will be distributed with the agenda for the subsequent

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ADMINISTRATION: Policy Review Procedure Policy: 1800

Date: draft


2.3 Finalization of Policies

• All policies will be prepared in final form by the EMS Agency.

• Finalized policies will either be held until the next EMS Policy Manual update, or, if appropriate, distributed as an interim policy.

3. New Policies and/or Major Revisions to Existing Policies 3.1 Public Testimony - Proposed new policies and major revisions to existing polices will be subject to public comment on a broad scale 3.1.1 The EMS Agency will make copies of the proposed changes/new policy available to the appropriate system participants and/or interested parties for comments. 3.1.1.1 Proposals that affect the EMS system as a whole will be sent out and/or posted on the Riverside County EMS Agency’s website at www.rivcoems.org for review by all system participants. 3.1.1.2 Proposals that apply to a limited group will only be sent to those who would be directly affected. 3.1.2 Time will be allotted at the appropriate committee(s) meeting for public testimony and discussion by the committee(s) members. Specific recommendations may be made by the committee(s) regarding the policy. 3.1.3 All comments will be reviewed by the EMS Agency Director and staff. Suggestions for additions or deletions will be taken into consideration. From these comments, a second draft proposal will be formulated. 3.2 Written Public Comment - The second draft of the proposal will be subject to

written comment. 3.2.1 The second draft will be included on the agenda as an attachment for the

next most appropriate Prehospital Medical Advisory Committee (PMAC) meeting.

3.2.1.1 2nd drafts that affect the EMS system as a whole will be sent out and/or posted on the Riverside County EMS Agency’s website at www.rivcoems.org for review by all system participants. 3.2.1.2 2nd drafts that apply to a limited group will only be sent to those who would be directly affected. 3.2.2 The time frame allowed for the return of comments will be no less than 30 days. 3.2.3 Comments should identify specific recommendations for change. 3.2.4 Comments may be mailed, e-mailed, or faxed to the EMS Agency, but must be received no later than 5pm on the deadline date. 3.2.5 Public testimony and committee recommendations will be taken into

consideration by the EMS Agency during the finalization of the policy.

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3.2.6 Responses from EMS Agency regarding the committee(s) recommendations will be distributed with the agenda for the subsequent appropriate committee(s) meeting.

ADMINISTRATION: Policy Review Procedure Policy: 1800

Date: draft


3.3 Policy Finalization 3.3.1 All policies will be prepared in final form by the EMS Agency. 3.3.2 Finalized policies will be held either until the next EMS Policy Manual update, or, if necessary, distributed immediately. 4. Minor Policy Changes Policy changes of a minor nature will be subject to the Public Testimony portion of review. Minor changes include but are not limited to • changes in wording to clarify the objective • changes in the listed order for clarity or better flow • changes because the new/changed policy failed to comply with other current policies • overlooked steps in a process • changes to deal with unforeseen consequences 5. After implementation of a new policy, it may be determined that changes are needed that were not initially foreseen in its development. Such necessary changes occurring within the first year of implementation will be subject to Public Testimony (only) prior to implementation. 6. Automatic changes Some policy changes will occur without any input from the public or specific committees These changes include: 6.1 Changes required in order to comply with state and local law and/or regulation 6.2 Correction of typographical or formatting errors Item #3, in regular type, is basically a reorganization (with name changes) of what the old Item #2 stated. Items #4, #5, & #6, in italics, are totally new material

Attachment D

PMAC Meeting Schedule 2009 (4TH Mondays)

Monday, January 26, 2009, 9:00AM – 11:00AM

Monday, March 23, 2009, 9:00AM – 11:00AM

Monday, June 22, 2009, 9:00AM – 11:00AM

Monday, September 28, 2009, 9:00AM – 11:00AM

Monday, November 23, 2009, 9:00AM – 11:00AM

All meetings will be held at the Riverside County Regional Medical Center, 26520 Cactus Avenue, Moreno Valley

Rooms A1018 with A1021

ALTERNATE PMAC Meeting Schedule 2009 (3RD Mondays or 4TH Mondays)

January April July

October

prehospital medical advisory committee meeting … · 24/11/2008 · greg adams ; riverside county...

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