san joaquin county emergency medical services agency€¦ · french camp, ca 95231 health care...

http://www.sjgov.org/ems

Mailing Address PO Box 220

French Camp, CA 95231

Health Care Services Complex Benton Hall

500 W. Hospital Rd. French Camp, CA 95231

Phone Number (209) 468-6818

Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency

EMS Liaison Committee Thursday, January 12, 2017 at 0900 hours

Health Plan of San Joaquin Community Room

7751 S. Manthey Road French Camp, CA 95231

A G E N D A

1. Call to Order

2. EMS Agency Administrator’s Report

3. System Organization and Management

A. EMS Maddy Fund

4. Communications A. Presentation of EMD Call Processing and CAD-to-CAD Notifications B. EMS Policy No. 3202 Medical Priority Dispatch System Assignments

5. Staffing and Training

A. 2017 Spring Personnel Care Symposium B. Haz Mat for Healthcare Train the Trainer Course C. EMS Policy No. 2715 Process for EMT and Advanced EMT Disciplinary Action –

Relevant Employer

6. Response and Transport A. Emergency Ambulance Performance B. Revisions to Ambulance Agreements and Air Ambulance Agreements

7. Facilities and Critical Care

A. Trauma System B. Stroke System Planning C. Ambulance Patient Off-load Delays and Mitigation of APOD Clusters

8. Data Collection and System Evaluation

A. Implementation of AB 1129

9. Disaster Medical A. Plausible Threat 2016 Exercise Program B. Regional Disaster Medical Health System Report

10. Hospital and Provider Reports


Liaison Committee Agenda January 12, 2017 of 2

11. Public Comment

12. Next Meeting – Thursday, April 13, 2017 A full agenda packet will not be provided at the meeting. A full agenda packet may be viewed or downloaded from the EMS Agency’s website at www.sjgov.org/ems.








Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: January 9, 2017 TO: EMS Liaison Committee PREPARED BY: Matt Griffin, Accounting Technician I SUBJECT: EMS Maddy Fund RECOMMENDED ACTION: Receive information on the EMS Maddy Fund. FISCAL IMPACT: The EMS Agency’s FY16-17 budget includes revenue of $54,215 for administering the EMS Maddy Fund. By statute administrative fees are capped at 10% of annual Maddy Fund revenue. DISCUSSION: EMS Maddy Fund In 1987, legislature found that emergency medical service providers incurred higher costs for their services than providers of other medical services, but often received little to no payment from patients. In response, the Maddy Fund (SB 12) was established to provide revenue to compensate physicians and medical facilities for emergency services provided to medically indigent patients during the first 48 hours of continuous service. The EMS Maddy Fund is derived from county penalty assessments for various criminal offenses and motor vehicle violations, traffic violator school fees and revenue from taxes on tobacco products deposited in the State’s Cigarette and Tobacco Products Surtax Fund. EMS Maddy Fund revenue, minus administrative costs, is proportioned as follows: 58% for eligible physicians and surgeons in a general acute care hospital providing basic or comprehensive emergency services; 25% to San Joaquin General Hospital for providing disproportionate trauma and emergency medical services; and 17% to the San Joaquin County EMS Agency for capital projects.


EMS Maddy Fund Report EMS Liaison Committee January 9, 2017 Page 2 of 2 FY 2015/16 A total of $138,316.03 has been dispersed on 7,727 claims to participating providers through the third quarter of 2015/16. Claims for the fourth quarter were due from providers on 10/31/16, with a target payment date of 1/31/17.

FY 2015/16 Amount Dispersed

Qtr. 1 $39,211.37 Qtr. 2 $52,070.33 Qtr. 3 $47,034.33 Total: $138,316.03

FY 2016/17 Provider agreements for 2016/17 were sent to participating providers in July 2016. Claims for the first quarter of FY 2016/17 are due from providers on 1/31/17, with a target payment date of 4/30/17.

SAN JOAQUIN COUNTY EMERGENCY MEDICAL SERVICES AGENCY TITLE: Medical Priority Dispatch System Assignments EMS Policy No. 3202

Effective: July 1, 2014 Public Comment Draft 12-20-16 Page 1 of 17 Supersedes: December 10, 2012July 1, 2014 (and draft July 20, 2016) Approved:

Medical Director EMS Administrator

PURPOSE: The purpose of this policy is to establish EMS resource assignments for Medical Priority Dispatch System determinants for use by emergency medical dispatch centers processing reports of medical emergencies and requests for ambulance service. AUTHORITY: Health and Safety Code, Division 2.5, Section 1797.220. DEFINITIONS: A. “Ambulance Provider” means an entity properly permitted to operate an

emergency advanced life support ambulance service in San Joaquin County. B. “NRLS” means an emergency response without delay not requiring or using

emergency red lights and siren except as may be required for scene access. C. “RLS” means an emergency response without delay using emergency red lights

and siren as appropriate for driving conditions. D. “SJCEMSA” means the San Joaquin County Emergency Medical Services (EMS)

Agency. E. “Emergency Medical Dispatch (EMD)” means a series of components that allow

the dispatcher to triage calls, send appropriate resources with the appropriate response, and provide pre-arrival/post-dispatch instructions as needed.

F. “Emergency Medical Responder (EMR)” means a basic life support (BLS) or ALS non-transport vehicle operated by an EMR provider.

G. “EMR Provider” means an organization authorized by the SJCEMSA to participate in the EMS system for the purpose of providing non-transport prehospital patient care.

H. “Fire” means public safety fire service resources separate from their role as an EMR.

I. “MPDS” means the Medical Priority Dispatch System. J. “NAED” means the National Academies of Emergency Dispatch. K. “Valley Regional Emergency Communications Center” or “VRECC” means the

EMD center operated by American Medical Response and designated as the EMS dispatch center for all of San Joaquin County.

POLICY: I. This policy is used in conjunction with NAED Medical Priority Dispatch System

(MPDS) Version 13.x. MPDS consists of 35 chief complaint protocols with standardized sections consisting of key questions, determinant codes, response assignments, medical information, post-dispatch instructions, and pre-arrival




instructions. The determinant codes are categorized into six levels: omega, alpha, bravo, charlie, delta, and echo (Ω-A-B-C-D-E). Determinant levels do not indicate the severity of situation. Each level reflects a response group designed to provide the appropriate resources needed for a specific situation which is identified through the call taking process based on the 35 chief complaint protocols.

II. VRECC shall dispatch ambulance and EMR resources and notify other dispatch centers to dispatch EMR resources to respond to medical emergencies in accordance with the assignments established by this policy. All public safety answering points and dispatch centers shall adhere to the requirements of this policy when managing the response of ambulance and EMR resources.

III. If resources are already en route when a determinant is reached or additional information is obtained changing the determinant and assignment, VRECC shall direct resources to upgrade, reduce, or cancel their response in accordance with revised or updated assignment. Accordingly, all ambulance and EMR resources shall comply with directions from VRECC to upgrade, reduce, or cancel their response.

IV. All ambulance and EMR resources shall comply with instructions from VRECC to upgrade, reduce, or cancel their response medical emergency or request for ambulance transport.

V. If an EMD determinant code cannot be ascertained through call taking and case entry within 90 seconds to 120 seconds, and the location of the medical emergency is known, the EMD call taker shall assign a default determinant of “Delta” and initiate an EMS response.

VI. For MPDS Protocols 1 through 32, and 34 assigned a NRLS ambulance response without an accompanying EMR response, VRECC shall establish a fail-safe procedure for CAD to recommend the to dispatch of an EMR resource response whenever the estimated time of arrival (ETA) of the assigned ambulance at time of dispatch to the scene is greater than 1519 minutes at the time of dispatch.

VII. An MPDS Protocol 9 with a determinant code of omega is an expected death of a hospice patient or another patient under supervised care. The base response for determinant code 9-Ω-1 shall be one ambulance supervisor and one EMR vehicle with a mode of NRLS. In general, the role of EMS in such situations is




support for the family and care givers. Hospice should be requested if not already on scene or en route.

VIII. SJCEMSA approved MPDS response and mode assignments for chief complaint

protocols 1 through 32 and 34 are as specified in Table 1 of Section IX. If a determinant level (Ω-A-B-C-D-E) does not list specific determinant codes or suffixes than the response and mode assignment for that level is the same for all determinant codes or suffixes applicable to that level. When in doubt about selecting the appropriate determinant level based on caller interrogation the EMD call taker should assign the higher priority response.

IX. Table 1:

Protocol 1 Level Response Mode

Abdominal Pain/Problems

Echo N/A N/A Delta Ambulance

EMR RLS

Charlie Ambulance EMR

RLS NRLSRLS

Bravo N/A N/A Alpha Ambulance NRLS


Allergies (Reactions)/ Envenomations (Stings, Bites)

Echo Ambulance EMR

RLS RLS

Delta Ambulance EMR

RLS RLS


RLS RLS

Bravo Ambulance EMR

RLS RLS

Alpha Ambulance NRLS Protocol 3 Level Response Mode

Animal Bites/Attacks


EMR RLS RLS

Charlie N/A N/A Bravo B-01; B-2; B-3

Ambulance EMR

RLS RLS




Bravo B-3 Ambulance EMR

Code 2 Code 2

Alpha Ambulance NRLS


Assault/Sexual Assault


EMR RLS RLS

Charlie N/A N/A Bravo (B-0; B-1s; B-2)

Ambulance EMR

RLS RLS

Bravo (B-1a,t; B-3)

Ambulance EMR

NRLS NRLS


Back Pain (Non-Traumatic or Non-Recent Trauma)


EMR RLS RLS


RLS NRLSRLS

Bravo N/A N/A Alpha Ambulance NRLS


Breathing Problems

Echo Ambulance EMR

RLS RLS

Delta Ambulance EMR

RLS RLS


NRLS NRLS

Bravo N/A N/A Alpha N/A N/A





Burns (Scalds)/ Explosion (Blast)

Echo Ambulance EMR

RLS RLS

Delta Ambulance EMR

RLS RLS


RLS RLS

Bravo Ambulance EMR

NRLS NRLS

Alpha (A-1) Ambulance EMR

NRLS NRLS

Alpha (A-2) Fire Per EFD Alpha (A-3; A-4; A-5)

Ambulance NRLS


Carbon Monoxide/ Inhalation/

Hazmat/ CBNR

Delta Ambulance EMR

RLS RLS


RLS RLS

Bravo Ambulance EMR

NRLS NRLS

Alpha N/A N/A Omega Fire Per EFD


Cardiac or Respiratory Arrest/ Death

Echo Ambulance EMR

RLS RLS

Delta Ambulance EMR

RLS RLS

Charlie N/A N/A Bravo (B-0) Ambulance

EMR NRLS NRLS

Bravo (B-1 a-e) EMR NRLS

Bravo (B-1 f-h) Ambulance EMR

NRLS NRLS

Alpha N/A N/A Omega Amb Sup

EMR NRLS NRLS





Chest Pain (Non-Traumatic)


EMR RLS RLS


RLS RLS

Bravo N/A N/A Alpha Ambulance

EMREMR NRLS NRLS


Choking

Echo Ambulance EMR

RLS RLS

Delta Ambulance EMR

RLS RLS

Charlie N/A N/A


EMR NRLS NRLS


Convulsions/Seizures


EMR RLS RLS


RLS NRLSRLS

Bravo Ambulance EMR

NRLS NRLS



Diabetic Problems

Delta Ambulance EMR

RLS RLS


RLS NRLSRLS






Drowning (Near)/ Diving/

Scuba Accident


EMR RLS RLS


RLS RLS

Bravo (B-0; B-1; B-3)

Ambulance EMR

RLS RLS

Bravo (B-2) Fire EFD

Alpha Ambulance EMR

NRLS NRLS


Electrocution/Lightning

Echo Ambulance EMR

RLS RLS

Delta Ambulance EMR

RLS RLS


NRLS NRLS

Bravo N/A N/A

Alpha N/A N/A Protocol 16 Level Response Mode

Eye Problems/Injuries


EMR RLS RLS

Charlie N/A N/A Bravo Ambulance

EMR RLS RLS

Alpha A-1

Ambulance EMR

NRLS RLS

Alpha A-2; A-3 Ambulance NRLS





Falls


EMR RLS RLS

Charlie N/A N/A Bravo (B-0 B-1; B-2; B-3) suffix code P

Ambulance EMR

RLS RLS

Bravo (B-0; B-1; B-2; B-3) suffix codes A,E,G,J or none

Ambulance EMR

NRLS NRLS

Alpha (A-1; A-2; A3) suffix code P

Ambulance EMR

RLS RLS

Alpha (A-1;A-2; A-3) suffix codes A,E,G,J or none

Ambulance EMR

NRLS NRLS

Alpha (A-4) all suffix codes

Fire EFD


Headache

Echo N/A N/A Delta N/A N/A Charlie Ambulance

EMR RLS NRLSRLS

Bravo Ambulance NRLS Alpha Ambulance NRLS


Heart Problems/ Automatic Implanted Cardiac

Defibrillator (A.I.C.D.)


EMR RLS RLS


RLS NRLSRLS


EMR NRLS NRLS





Heat/Cold Exposure


EMR RLS RLS


RLS NRLSRLS

Bravo Ambulance NRLS Alpha Ambulance NRLS


Hemorrhage/Lacerations


EMR RLS RLS


RLS NRLSRLS

Bravo (B-2) Ambulance EMR

RLS RLS

Bravo (B-0; B-1; B-3; B-4)

Ambulance NRLS


Inaccessible Incident/ Other Entrapments (Non-

Vehicle)


EMR RLS RLS

Charlie N/A N/A

Bravo with suffix codes B or Y

Ambulance EMR

RLS RLS

Bravo (B-0; B-1) suffix codes A, M, X or unknown

Ambulance EMR

NRLS NRLS

Bravo (B-2; B-3) suffix codes A, M, X or unknown

Fire EFD

Alpha Fire EFD





Overdose/ Poisoning (Ingestion)


EMR RLS RLS


RLS RLS

Bravo Ambulance EMR

NRLS NRLS

Alpha N/A N/A Omega (poisoning without priority symptoms)

Refer to Poison Control

Refer to Poison Control


Pregnancy/ Childbirth/ Miscarriage


EMR RLS RLS


RLS NRLSRLS

Bravo Ambulance NRLS Alpha Ambulance NRLS Omega Ambulance NRLS


Psychiatric/ Abnormal Behavior/

Suicide Attempt


EMR RLS RLS

Charlie N/A N/A Bravo (B-1)

Ambulance EMR

RLS RLS

Bravo (B-0, B-2, B-5)

Ambulance EMR

NRLS NRLS

Bravo (B-3; B4; B-6)

EMR NRLS

Alpha EMR law enforcement

NRLS N/A





Sick Person


EMR RLS RLS


RLS NRLSRLS

Bravo Ambulance

NRLS

Alpha Ambulance

NRLS

Omega (1 to 3; 5 to 8; 10 to 28)

Ambulance NRLS

Omega (9) EMR NRLS Omega (4) “Can’t

sleep” No EMS response, refer to primary care physician

N/A


Stab/Gunshot/ Penetrating Trauma


EMR RLS RLS


EMR RLS RLS

Bravo (B-0; B-1; B-2; B-4)

Ambulance EMR

NRLS NRLS

Bravo (B-5) EMR NRLS Alpha with suffix codes X, Y

Ambulance EMR

NRLS NRLS

Alpha with suffix codes S,G,P,I

Ambulance NRLS





Stroke (CVA)

Echo N/A N/A Delta N/A N/A Charlie with suffix codes C, D, E, F, I, J, L,M, X, Y, Z

Ambulance EMR

RLS RLS

Charlie with suffix codes H, K and “T” greater than 8 hours

Ambulance EMR

NRLS NRLS


NRLS


Traffic/ Transportation Incidents


EMR RLS RLS

Charlie N/A N/A Bravo (B-1; B-2) Ambulance

EMR RLS RLS

Bravo (B-0; B-3; B-4; B-5)

Ambulance EMR

NRLS NRLS


NRLS NRLS

Alpha (A-0; A-1) Ambulance EMR

NRLS NRLS

Omega Fire EFD





Traumatic Injuries (Specific)


EMR RLS RLS

Charlie N/A N/A Bravo (B-2; B-3) Ambulance

EMR RLS RLS

Bravo (B-0; B-1) Ambulance EMR

NRLS NRLS


NRLS NRLS

Alpha (A-2; A-3) Ambulance

NRLS


Unconscious/Fainting (Near)

Echo Ambulance EMR

RLS RLS

Delta Ambulance EMR

RLS RLS

Charlie (C-1) Ambulance EMR

RLS RLS

Bravo N/A N/A Alpha (A-1; A-2; A-3)

Ambulance EMR

NRLS NRLS


Unknown Problem (Man Down)


EMR RLS RLS


EMR NRLS NRLS

Bravo (B-1; B-2; B-3)

EMR NRLS

Alpha N/A N/A





Automatic Crash Notification (ACN)


EMR RLS RLS

Charlie N/A N/A Bravo (B-1; B-2; B-3; B-4; B-5)

Ambulance EMR

RLS RLS

Bravo (B-0) Ambulance EMR

NRLS NRLS

Alpha(A-1) Ambulance EMR

NRLS NRLS

Alpha (A-2) Fire EFD Omega Refer to law

enforcement

X. Exceptions to chief complaint protocols 1 through 32 as listed in Table 1 above:

A. Delta, Charlie, Bravo, and Alpha responses to the following medical clinics with a physician on site do not require the dispatch of EMR resources unless these resources are requested by medical clinic staff or responding ambulance personnel: 1. All Kaiser Permanente medical facilities. 2. St. Joseph’s Immediate Care 1801 E. March Ln, Stockton, CA. 3. Sutter Gould Medical Group 2505 W. Hammer Ln, Stockton, CA. 4. Sutter Gould Medical Group 2545 W. Hammer Ln, Stockton, CA. 5. Channel Medical Center 701 Channel St., Stockton, CA. 6. Veterans Medical Clinic 7777 E. Freedom Rd, French Camp, CA.

B. Delta, Charlie, Bravo, and Alpha responses to the San Joaquin County Jail do not require the dispatch of EMR resources unless these resources are requested by the SJC Sheriff’s Department staff or responding ambulance personnel.

C. Bravo and Alpha responses within the City of Stockton or areas served by the Stockton Fire Department (SFD) do not require the dispatch of EMR resources unless:

1. The response determinant specifies the dispatch of EMR resources without an accompanying ambulance such as ProtocolCard 32 B1 and B2 (Unknown Problem – Medical Alarm); or

2. Whenever the estimated time of arrival (ETA) of the ambulance to the scene is greater than 159 minutes at the time of dispatch.




XI. SJCEMSA approved MPDS response and mode assignments for chief complaint

protocol 33 are as specified in in this section and Table 2 of Section XII. A. If a determinant level (Ω-A-B-C-D-E) does not list specific determinant

codes or suffixes than the response and mode assignment for that level is the same for all determinant codes or suffixes applicable to that level.

B. When in doubt about selecting the appropriate determinant level based on caller interrogation the EMD call taker should assign the higher priority response.

C. Protocol 33 applies to is for use when receiving requests from non-acute care hospital medical facilities with onsite medical personnel that have performed an assessment of the patient and are requesting transport to an emergency department. Medical Ffacilities included within Protocol 33 areinclude: same day surgery centers, skilled nursing facilities, hospice facilities, and palliative home care with an onsite physician or registered nurse.

D. Protocol 33 shall be used for processing requests for ambulance service for patients at the California Health Care Facility (CHCF). Due to the unique nature of CHCF and the availability of onsite medical personnel EMR resources shall not be dispatch for patients at the CHCF unless those EMR resources are specifically requested by onsite ambulance personnel.

E. Basic Life Support (BLS) ambulances may be used to respond to Protocol 33 Alpha level determinants.

F. Based on the availability of ALS and BLS ambulances and the needs of the EMS system VRECC may delay dispatching an ambulance (“hold the call”) for a Protocol 33 Alpha level determinant without priority symptoms as follows:

1. Alpha Priority I may be held for up to 30 minutes; 2. Alpha Priority II may be held for up to 60 minutes; 3. Alpha Priority III may be held for up to 90 minutes.

G. Any ambulance response to Protocol 33 Alpha level determinants may be pre-arranged or scheduled at the request of the transferring facility.




XII. Table 2: Protocol 33 Level Response Mode

Transfer/ Interfacility/

Palliative Care


EMR RLS RLS

Charlie (C-2; C-5; C-7) Ambulance EMR

RLS RLS

Charlie (C-2; C-5) Ambulance RLS Charlie (C-1; C-3; C-4; C-6)

Ambulance NRLSCode 2

Bravo N/A N/A Alpha (Acuity I no

priority symptoms): 1. Blood pressure

abnormality (asymptomatic);

2. Dizziness/vertigo; 3. Fever/chills; 4. General weakness; 5. Nausea; 6. New onset

immobility; 7. Pain, non-traumatic; 8. Transportation only; 9. Unwell/ill; 10. Vomiting; 11. Possible meningitis; 12. Possible norovirus; 13. Possible infection. 13.14. Gastric tube

(in/out).

Ambulance (BLS or ALS)

NRLS

Alpha (Acuity II no priority symptoms): 1. Abnormal labs; 2. Transport for

diagnostic exam; 3. Urinary catheter


NRLS




(in/out) without hemorrhaging.

Alpha (Acuity III no

priority symptoms): 1. Boils; 2. Bumps; 3. Can’t urinate; 4. Constipation; 5. Cramps/Spasms; 6. Deafness; 7. Defecation/Diarrhea; 8. Earache; 9. Gout; 10. Hemorrhoids/piles; 11. Hepatitis; 12. Hiccups; 13. Itching; 14. Joint pain; 15. Nervous; 16. Object stuck; 17. Object swallowed; 18. Painful urination; 19. Penis problems/pain; 20. Rash/skin disorder; 21. Sexually transmitted

disease (STD); 22. Sore throat; 23. Toothache; 24. Wound infection.


NRLS

XIII. VRECC and other approved EMD centers shall monitor and regularly report compliance with this policy to the SJCEMSA.

2017

Spring

Prehospital Care

Symposium

When: Thursday, March 30, 2017

Registration: 8:00 a.m. – 9:00 a.m. Course: 09:00 a.m. – 16:00 p.m.

Breakfast and refreshments provided by REACH Lunch provided by American Medical Response

Where: San Joaquin Agriculture Center 2101 E. Earhart Ave., Stockton

Cost: Free, prior registration required.

Register online at: http://www.sjgov.org/ems/events.aspx

Intended audience: Paramedics, EMTs, MICNs, EMRs, base and receiving hospital physicians and nurses.

Course Objective: This course is designed to present information on the current standards of care for the assessment

and treatment of prehospital patients. Attendees will learn through lectures, case studies, and discussion with the faculty regarding trauma patient management, patient resuscitation, pediatric

patient management, Stroke care, communication and other topics.

Upon successful completion, participants will receive a course completion certificate for 6 hours of EMS Continuing Education and/or BRN contact hours. Provider is approved by the California Board

of Registered Nursing, Provider Number 1524 for 6 contact hours. CA EMS CE provided by San Joaquin County EMS Agency CEP# 39-0001.

Symposium Faculty to include: Richard N. Buys, MD, EMS Medical Director, San Joaquin County EMS Agency

David Shatz, MD, Trauma Surgeon/Professor of Surgery, UC Davis Medical Center Katherine Shafer, MD, Base Hospital Medical Director, San Joaquin General Hospital

Frank Kennedy, MD, Trauma Medical Director, San Joaquin General Hospital Stacie Crain, MSN, FNP-BC, CEN, Neurovascular Nurse Practitioner, Mercy San Juan Medical Center

A division of Healthcare Services Agency

http://www.sjgov.org/ems/events.aspx







Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: January 9, 2017 TO: EMS Liaison Committee PREPARED BY: Phillip Cook Disaster Medical Health Specialist SUBJECT: Haz Mat for Healthcare Train-the-Trainer Course RECOMMENDED ACTION: Provide an overview of the Haz Mat for Healthcare Train-the-Trainer Course. FISCAL IMPACT: Estimated $17,500 funded through the FY 2016-17 Hospital Preparedness Program Grant DISCUSSION:

I. OVERVIEW

The San Joaquin County Emergency Medical Services Agency and San Joaquin Operational Area Healthcare Coalition are sponsoring a Haz Mat for Healthcare Train-the-Trainer course April 26, 27, and 28, 2017. The course is being hosted by Doctor’s Hospital of Manteca. This course will provide Haz Mat patient decontamination and small spill response training for acute care hospitals and ambulance providers, in compliance with Cal OSHA regulation 8CCR 5192(q)(6). In addition, the course will enable hospitals and ambulance providers to have qualified in-house instructors to provide ongoing initial and refresher training in accordance with Cal OSHA regulation 8CCR 5192(q)(7) and (8). Cal OSHA Regulations: https://www.dir.ca.gov/title8/5192.html


https://www.dir.ca.gov/title8/5192.html

San Joaquin County Emergency Medical Services Agency and San Joaquin Operational Area Healthcare Coalition Presents:

Hazardous Materials First Responder Awareness First Receiver/Responder Operations

Small Spill Response & Patient Decontamination

Train-The-Trainer Course

“Haz Mat for Healthcare”

April 26, 27 and 28, 2017 0800-1700

Hosted by: Doctor’s Hospital of Manteca – Conference Center

1205 E. North Street, Manteca, CA

Open to All Acute Care Hospitals and Ambulance Providers in San Joaquin County

FREE Funded by 2016/17 Hospital Preparedness Program (HPP) Grant

Each participate will be required to bring the following items:

Respiratory Protection – PAPR or APR with Cartridges Chemical Protective Coveralls Under Suit – Tyvek Coveralls or Scrubs Gloves - Outer and Under (2 to 3 pairs of each) Chemical Protective Boots Sealing Tape (Duct tape or Chemtape®)

NOTE: Label all of your Personal Protective Equipment (PPE)

Continuing Education Credit This course is offered at no cost to participants. Upon the successful completion, participants will receive a course completion certificate for 24 hours of EMS Continuing Education and/or BRN Contact hours. Provider is approved by the California Board of Registered Nursing, Provider Number 1524 for 24 contact hours. CA EMS CE provided

by San Joaquin County EMS Agency CEP# 39-0001.

Register online at http://sjgov.org/ems/events.aspx

For more information contact: Phillip Cook 209-468-7494 or [email protected]

Space is Limited to 30 Participants

SAN JOAQUIN COUNTY EMERGENCY MEDICAL SERVICES AGENCY TITLE: PROCESS FOR EMT and ADVANCED EMT DISCIPLINARY EMS Policy No. 2715

ACTION – RELEVANT EMPLOYER

Effective: August 20, 2010 Page 1 of 3 Supersedes: Approved: Signature of File Signature of File


PURPOSE: The purpose of this policy is to specify the responsibilities of relevant employers for reporting, investigating and recommending disciplinary action for EMT and Advanced EMT employees that have or may have committed actions considered as evidence of a threat to public health and safety as specified in Heath and Safety Code Section 1798.200 (c).

AUTHORITY: Health and Safety Code, Division 2.5, Section 1797.220; 1798.200 DEFINITIONS: A. “Advanced Emergency Medical Technician (Advanced EMT or A/EMT)” means a

person who has successfully completed an advanced A/EMT course which meets the requirements of the California Code of Regulations, Title 22, Division 9, Chapter 3, and has passed all required tests and who has been certified by the Advanced EMT Certifying Authority.

B. “EMS Agency” means the San Joaquin County EMS Agency. C. “Certificate” means a valid Emergency Medical Technician (EMT) or Advanced EMT

certificate issued pursuant to Division 2.5 of the California Health and Safety Code. D. “Certifying entity” means the medical director of the San Joaquin County EMS

Agency or a public safety provider, if that provider has a training program approved pursuant to Health and Safety Code Section 1797.109.

E. “Emergency Medical Technician (EMT)” means a person who has successfully completed a basic EMT course which meets the requirements of the California Code of Regulations, Title 22, Division 9, Chapter 2, and has passed all required tests and who has been certified by an EMT Certifying Authority.

F. “Medical Director” means the San Joaquin County EMS Agency Medical Director. G. “Relevant employer(s)” means those ambulance services permitted by the

Department of the California Highway Patrol or a public safety agency (i.e. fire department or law enforcement agency) that the certificate holder works for or was working for at the time of the incident under review as an EMT or Advanced EMT whether as a paid employee or a volunteer.

H. “Validated” means for the purpose of this policy to determine by preliminary evaluation that an act specified in Health and Safety Code Section1798.200 may have occurred.

POLICY: I. All information received from any source, which purports a violation of or deviation

from state or local EMS statutes, regulations, policies, procedures, protocols, or standards shall be evaluated pursuant to the requirements set forth in this policy.





II. Responsibilities of Relevant Employers:

A. California Code of Regulation (CCR), Title 22, Division 9, Chapter 6, Process for EMT and Advanced EMT Disciplinary Action requires that relevant employers develop policies to address EMT or A/EMT disciplinary actions for incidents that occur while the EMT or A/EMT is on duty and directly related to their job as an EMT or advanced EMT (e.g. functioning outside their scope of practice).

B. Relevant employers may choose to enter into an agreement with the EMS Agency to allow the EMS Agency to conduct disciplinary investigations on behalf of the relevant employer. Relevant employers which choose not to enter into an agreement with the EMS Agency may request the EMS Agency to conduct an investigation on a case by case basis.

C. Relevant employers shall: 1. Notify the EMS Agency within three (3) working days after an allegation has

been validated as potential for disciplinary cause. 2. Notify the EMS Agency and the medical director that has jurisdiction in the

county in which the alleged action occurred within three (3) working days if the EMT or A/EMT: a) Certificate is terminated or suspended. b) Resigns or retires following notification of impending investigation based

upon the evidence that would indicate the existence of disciplinary cause.

c) Is removed from EMT or A/EMT related duties for disciplinary cause after completion of the employer’s investigation.

3. Upon completion of an investigation and upon determining the disciplinary or certification action to be taken: b) Complete a statement certifying the disciplinary decision made and the

date the decision was made. This statement shall contain: 1) Findings of fact. 2) A determination of issues. 3) A disciplinary plan in accordance with the Recommended

Guidelines for Disciplinary Orders and Conditions of Probation for EMT (Basic) and Advanced EMT, EMSA #134, effective 4-1-2010.

4) The date the disciplinary plan shall take effect. 4. Place a written statement in the EMT or A/EMT personnel file. 5. Submit the disciplinary plan within three (3) working days of adoption to:

a) The EMS Agency. b) If applicable, the local EMS agency that issued the EMT or A/EMT

certificate. c) If applicable, in instances where the EMT or A/EMT certificate was

issued by a non-LEMSA certifying entity, submit the plan to the local





EMS agency that has jurisdiction in the county in which the headquarters of the certifying entity is located.

6. When submitting the disciplinary plan as required above include all relevant findings of the investigation.

III. Off Duty Allegations or Occurrences:

A. Relevant employers shall notify the EMS Agency with 24 hours or 72 hours as specified in EMS Policies No. 6101 and 6102 respectively for any occurrence or allegation of conduct listed in Health and Safety Code Section 1798.200(c) by an EMT or A/EMT occurring while that person was off duty. This reporting requirement specifically includes any and all arrests.

IV. Relevant Employer Policy Requirements:

A. As stated above, California Code of Regulations, Title 22, Division 9, Chapter 6,

Section 100216 requires each relevant employer to develop and adopt policies and procedures for the implementation of the provisions of Chapter 6 for the Process for EMT and Advanced EMT Disciplinary Action. These policies and procedures must be in accordance with the provisions of Chapter 6 and address all of the applicable requirements of Chapter 6.

B. Relevant employers must submit their policies and procedures for the implementation of Chapter 6 for the Process for EMT and Advanced EMT Disciplinary Action to the San Joaquin EMS Agency by no later than October 1, 2010. Such policies and procedures must either provide details regarding implementation of Chapter 6 by the relevant employer, or state that the relevant employer has elected to enter into an agreement with the EMS Agency to implement Chapter 6.

C. The policies and procedures adopted by relevant employers of firefighters certified as an EMT or A/EMT shall be in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code.

D. Relevant employers choosing to enter into an agreement with the EMS Agency referring all disciplinary investigations to the EMS Agency in order to satisfy the requirements of Chapter 6 must notify the EMS Agency of their decision by no later than September 1, 2010.







Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: January 9, 2017 TO: EMS Liaison Committee PREPARED BY: Rick Jones, MPA, EMS Analyst SUBJECT: Report on Emergency Ambulance Performance RECOMMENDED ACTION: Receive information on emergency ambulance performance for American Medical Response (AMR), Escalon Community Ambulance (ECA), Manteca District Ambulance (MDA) and Ripon Consolidated Fire District (RCFD). FISCAL IMPACT: None DISCUSSION: SJCEMSA’s Report on the Exclusive Emergency Ambulance Provider Contract Compliance for AMR from July through August and for ECA, MDA, and RCFD for the months of May through August, 2016, provides a summary of the performance of each provider as required under each contract. The County’s contract with these emergency ALS ambulance providers establishes accountability for meeting specific standards and provides the EMS Agency with complete access to data and information on operational, clinical, and administrative performance. A detailed version of the compliance reports can be found at the SJCEMSA’s website: www.sjgov.org/ems. The process for determining response time compliance includes a review of late response exemption requests to determine if a delay in response may be attributed to factors outside of the control of the ambulance provider. Unless otherwise indicated in the tables below, if an exemption request is approved (e.g. fog, train crossings, road construction) those responses are not included in response time compliance calculations. The measurement of response performance requirements for Escalon Community Ambulance (ECA), Manteca District Ambulance (MDA) and Ripon Consolidated Fire District (RCFD) are currently limited to responses with red lights and sirens (RLS). As of May 1, 2016, the County’s written agreement with AMR includes additional performance measures, some of which are included in this report.



Emergency Ambulance Performance EMS Liaison January 9, 2017 2 of 6 American Medical Response (AMR)

Performance Measures AMR’s July and August 2016 contract, requires that AMR meet performance criteria for the following response types: Red Lights and Sirens (RLS), No Red Lights and Sirens (NRLS), Advanced Life Support (ALS) interfacility transfers (IFT), and Critical Care Transports (CCT). The two tables below show AMR’s compliance for responses with red lights and sirens (RLS) during the months of July and August for compliance zones calculated with exemptions:

When a compliance zone does not have a minimum of 100 responses, a determination of compliance is delayed until the month in which at least 100 responses have been tolled. Those compliance zones being tolled are greyed out in the compliance column.

The next table shows how compliance zones are tracked while accruing the requisite 100 minimum responses:

Response Time Compliance Report - Red Lights and Sirens (RLS)

Yes No

X

X

X

X

X

X

5 1

88.66%95.13%94.64%95.45%91.83%

33

SJ Zone X-10*SJ Zone X-11*

Compliance Zone Total Responses

Non-compliant,

Non-exempted

Responses

Compliance

Percentage

SJ Zone X-51,332

1113

341

56

* Minimum of 100 responses used for calculation of compliance. See below for

calculation of rolling compliance zones.

4,172

103

SJ Zone X-2

91.09%100.00%85.23%

141

66

022

SJ Zone X-6*SJ Zone X-7

SJ Zone X-3*

1,58224

SJ Zone X-8*SJ Zone X-9

97267

149

July 1, 2016 through July 31, 2016

22SJ Zone X-1 39492.75%95.52%91.52%

13867

113SJ Zone X-4

Compliant

94.42%

All Zones Combined

Response Time Compliance Report - Red Lights and Sirens (RLS)

Yes No

X

X

X

X

X

X

5 1

SJ Zone X-4 1,341

SJ Zone X-9 285

SJ Zone X-7 149 13 91.28%

* Minimum of 100 responses used for calculation of compliance. See below for

calculation of rolling compliance zones.

13 86.46%13 95.44%

122 90.90%SJ Zone X-5 1,561 97 93.79%

All Zones Combined 4,113 300 92.71%

SJ Zone X-10* 62 4 93.55%SJ Zone X-11* 44 1 97.73%

SJ Zone X-6* 21 0 100.00%

SJ Zone X-8* 96

91.38%5SJ Zone X-3* 58SJ Zone X-2 117 12 89.74%


Non-compliant,

Non-exempted

Responses

Compliance

Percentage

August 1, 2016 through August 31, 2016

SJ Zone X-1 379 20 94.72%

Compliant

Emergency Ambulance Performance EMS Liaison January 9, 2017 3 of 6

The two tables below show AMR’s compliance for responses that include both red lights and sirens (RLS) and no red lights and sirens (NRLS) during the months of July and August.

Rolling Compliance Zones Requiring Multiple Months to Attain > 100 RLS Responses

Yes No

X

X

X

93.60%SJ Zone X-6 May 2016 August 2016 87 0 100.00%SJ Zone X-8 July 2016 August 2016 193 24 87.56%


Compliant

1SJ Zone X-10 July 2016 August 2016 118SJ Zone X-11 August 2016 August 2016 44

SJ Zone X-3 July 2016 August 2016 125

797.73%94.07%

8

Rolling Compliance

Zones (with Multiple

Months for 100 Call

Minimum).

Rolling

Compliance Period

From

Rolling

Compliance Period

Through

Total

Responses

Non-compliant,

Non-exempted

Responses

Compliance

Percentage

Response Time Compliance Report - Combined RLS and NRLS


SJ Zone X-9 393 17 95.67%

SJ Zone X-4 1,864 136 92.70%SJ Zone X-5 2,217 104 95.31%SJ Zone X-6 24

SJ Zone X-11 66 1 98.48%SJ Zone X-10 78 4 94.87%


SJ Zone X-3 74 5 93.24%

Non-compliant,

Non-exempted

Responses

Compliance

Percentage

SJ Zone X-8 141 13 90.78%

0 100.00%SJ Zone X-7 216 13 93.98%


SJ Zone X-1 550 26 95.27%SJ Zone X-2 155 13 91.61%

Response Time Compliance Report - Combined RLS and NRLS


SJ Zone X-9


Non-compliant,

Non-exempted

Responses

Compliance

Percentage

SJ Zone X-2 188 12 93.62%

SJ Zone X-8 154 12 92.21%199 22 88.94%

SJ Zone X-4 1,901 125 93.42%

580 25 95.69%

32 0

SJ Zone X-3 80 3 96.25%

92.94%155

SJ Zone X-1

SJ Zone X-6SJ Zone X-5 2,195

100.00%

405 16 96.05%

SJ Zone X-7

SJ Zone X-10 68 3 95.59%


SJ Zone X-11 95 3 96.84%

Emergency Ambulance Performance EMS Liaison January 9, 2017 4 of 6 As discussed above, the process for determining response time compliance includes a review of late response exemption requests to determine if a delay in response may be attributed to factors outside of the control of the ambulance provider. A thorough discussion of the impact of exemptions for late responses is provided in the EMS Liaison Committee Report on Ambulance Patient Off-load Delays. The table below shows the difference in AMR’s compliance for responses with RLS both with and without exemptions applied during the July/August 2016 reporting period.

Comparison of Compliance with and without Exemptions - RLS


* Minimum of 100 responses required for calculation. True compliance shown in rolling compliance zone tables.

583 86.03%

100.00%

13 95.13%2327

3 94.64%

100.00%85.23%

032

SJ Zone X-11* 66 3 95.45%5

SJ Zone X-8* 97 11 88.66%SJ Zone X-9 267

76.29%89.89%91.07%92.42%5

SJ Zone X-10* 56

94.42%

113 91.52%SJ Zone X-5 1,582 141 91.09%

184242

SJ Zone X-3* 67 86.57%86.19%84.70%

92.75%95.52%9

SJ Zone X-2 138 10

SJ Zone X-6*



Number of Late

Calls After

Exemptions

Approved

Compliance After

Exemptions

3

SJ Zone X-7 149 2224

SJ Zone X-4 1,332

078.52%

90.36%86.96%

22SJ Zone X-1 394

Number of

Late Calls

Prior to

Exemptions

Compliance

Prior to

Exemptions

3818

Comparison of Compliance with and without Exemptions - RLS

95.44%SJ Zone X-10* 62 4 93.55%

* Minimum of 100 responses required for calculation. True compliance shown in rolling compliance zone tables.

316

89.12%90.32%

SJ Zone X-11* 44

SJ Zone X-9 285 13

1 97.73%All Zones Combined 4,113 300 92.71%

7606

84.09%85.27%

1,561 97 93.79%SJ Zone X-6* 21 0 100.00%

2090

71.88%SJ Zone X-8* 96 13 86.46%2927

86.61%100.00%

SJ Zone X-7

79.49%SJ Zone X-1 379SJ Zone X-2 117

42

149 13 91.28%80.54%

SJ Zone X-5SJ Zone X-4 220

81.03%83.59%

SJ Zone X-3*

Total Responses

Number of Late

Calls After

Exemptions

Approved

Compliance After

Exemptions

Number of

Late Calls

Prior to

Exemptions

Compliance

Prior to

Exemptions


Compliance Zone

1,341 122 90.90%91.38%5

20 94.72%12 89.74%

58 1124

88.92%

Emergency Ambulance Performance EMS Liaison January 9, 2017 5 of 6 Escalon Community Ambulance (ECA)

ECA’s May and June compliance was at 93.51% in May, and 87.04% in June for a combined two-month compliance of 90.84% based on 131 RLS responses. ECA’s July and August compliance was at 86.67% in July and 96.83% in August for a combined two-month compliance of 91.87% based on 123 RLS

responses. As illustrated by the chart, ECA is consistently above the 90th percentile when months are combined to increase statistical relevance. Manteca District Ambulance (MDA)

MDA’s May through August 2016, response time compliance met or exceeded the 90th percentile standard set by the County with 95.42%, 94.48%, 93.45%, and 92.26% for each of those four months. MDA’s average RLS response volume during this time period was 489 responses per month.

85

90

95

100

Sep

-15

Oct-

15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar-

16

Ap

r-16

May

-16

Ju

n-1

6

Ju

l-16

Au

g-1

6

Co

mp

lia

nc

e P

erc

en

tag

e

MDA's Combined Response Time Performance

90 Percentile

Response TimeCompliance

Emergency Ambulance Performance EMS Liaison January 9, 2017 6 of 6 Ripon Consolidated Fire District (RCFD)

RCFD’s response time compliance exceeded the 90th percentile standard set by the County for May with 92.31%, and dropped below the 90th percentile for June with 86.31%. The combined two-month percentile with 164 responses with RLS for May and June was 89.63%. RCFD’s response time compliance fell below the

90th percentile standard set by the County for July with 84.93%, and exceeded the 90th percentile for August with 90.63%. The combined two-month percentile with 137 responses with RLS for July and August was 87.59%. As illustrated by the chart, RCFD is consistently above the 90th percentile when months are combined to increase statistical relevance.

85

90

95

100

Ju

l/A

ug

-15

Sep

/Oct-

15

No

v/D

ec

-15

Jan

/Fe

b-1

6

Mar/

Ap

r-16

May

/Ju

n-1

6

Ju

l/A

ug

-16

Co

mp

lia

nc

e P

erc

en

tag

e

RCFD's Combined Response Time Performance

90 Percentile

Response TimeCompliance







Fax Number

(209) 468-6725


DATE: January 9, 2017 TO: EMS Liaison Committee PREPARED BY: Rick Jones, MPA, EMS Analyst SUBJECT: Report on Ambulance Patient Off-load Delays RECOMMENDED ACTION: Receive information on Ambulance Patient Off-load Delays (APOD) occurring in San Joaquin County. FISCAL IMPACT: The financial impact of APOD on the EMS system during 2016 is estimated to be $1,992,558, compared to the impact estimated in 2015 of $1,472,441. DISCUSSION: On January 1, 2016, AB 1223 became law and codified the definition for the term “ambulance patient offload time.” In addition, this law requires local EMS agencies to create a policy for the measurement and reporting of ambulance patient offload time (APOT) for their region. The San Joaquin County EMS Agency (SJCEMSA) continues to measure the scope of the problem and to identify the factors that contribute to the amount of time needed to transfer patient care between prehospital personnel and the emergency department.

APOT, also known as wall time, is the interval between arrival of an ambulance patient at the emergency department and the time the patient is transferred to an emergency department gurney, bed, chair, or other acceptable location and the emergency department personnel assumes responsibility for care of the patient. The current method of measuring this time relies upon data collected by the designated dispatch center for San Joaquin County which is not designed to time stamp APOTs as described above. The accuracy of measuring APOT will improve in 2017 when data from patient care reports replaces the current reliance on dispatch center data.


APOD Report EMS Liaison Committee January 9, 2017 Page 2 of 10

The Standard

The acceptable APOT cited by CMS is fifteen (15) minutes. While the San Joaquin County EMS Agency concurs with CMS, until technical issues are solved that will allow the use of PCR data to measure APOT, an APOT delay shall be deemed to have occurred when the APOT interval exceeds the standard of thirty (30) minutes.

Goal

To reduce all wall times to less than 30 minutes. With cooperation, this is an attainable goal.

Patient Care Impact

When an ambulance is kept at an emergency department over 30 minutes due to an ambulance patient offload delay, this impacts the ability of the EMS system to meet demand and may adversely impact the care of the patient waiting on an ambulance gurney.

While definitive patient outcome data is not available to support the claim that offload delays are deleterious to patient care, one way in which the impact of offload delays can be measured is through an analysis of ambulance response compliance data. Such an analysis indicates that offload delays directly reduce the number of ambulances available to respond to emergencies with response times required for contract compliance.1 The reduction in available ambulance services caused by offload delays can be measured in two ways: the relative increase in the number of exemption requests and the real impact of off-load delays on ambulance response time compliance.

Increase in Ambulance Response Compliance Exemptions: When the frequency and length of offload delays reach a trigger point, an ambulance provider may request an exemption from meeting ambulance response compliance requirements. An offload delay exemption trigger is activated when all of the following occurs:

There are a minimum of 3 ambulances are delayed at one or more Stockton area hospital (Dameron, St. Joseph’s Medical Center, San Joaquin General Hospital) for a time period > 60 minutes for each ambulance.

There are five (5) or fewer ambulances available in the greater Stockton area (Status 5 or less).

1 The process for determining response time compliance includes a review of late response exemption requests to determine if a delay in response may be attributed to factors outside of the control of the ambulance provider. If an exemption request is approved (e.g. fog, train crossings, road construction) those responses are not included in response time compliance calculations.


The three (3) ambulances referenced above must have been delayed at hospitals during the 60 minutes prior to the call in which an exemption is being sought.

Ambulance staffing must be at or above the contracted minimum staffing levels.

Beginning in the July/August 2014 reporting period, AMR has steadily increased the number of exemption requests submitted for responses that exceed response time standards. The percent of total responses with RLS that resulted in exemption requests during the July/August 2014 reporting period was 1.2% (91 requests out of 7519 responses). The percent of total responses with RLS that resulted in exemption requests during the July/August 2016 reporting period was 5.8% (548) requests out of 8285 responses). There has been greater than a five-fold increase in the number of all exemption requests between these two reporting periods (91 to 548).

The primary reason for this dramatic increase in exemption requests for failure to meet response time compliance standards is due to the increase in exemptions caused by ambulance patient off-load delays (APOD). In AMR’s July/August 2014 reporting period AMR requested 41 exemptions that met the APOD trigger out of a total of 91 exemption requests. In the current reporting period for July/August 2016, AMR requested 479 exemptions that met the APOD trigger out of a total of 548 exemption requests. This is an increase in the relative percent of exemption requests due to APOD (from 45% to 87% of all exemption requests) as well as an increase in APOD exemption requests from 41 to 479 (a nearly twelve-fold increase) since the middle of 2014.

The EMS system continues to experience a profound impact on ambulance availability and response caused by ambulance patient offload delays (APODs) at emergency departments. The inability of emergency departments to readily accept ambulance patients has a direct negative effect on the availability of ambulances to respond to emergency requests. APODs continue to rob the EMS system of efficiency and steals precious response-time minutes from acutely ill and injured patients. During the July/August 2016 reporting period, hospital caused APODs decreased monthly response-time compliance by more than 6%.


Ambulance Patient Off-load Delay performance

The performance of the seven hospitals in San Joaquin County during 2016 is shown in tables and charts as follows:

Table 1 provides a snapshot of 2016 by quarter for each hospital and compares the number of ambulance patient off-loads and the number of off-loads > 30 minutes.

“APOT 90th Percentile” indicates that 90% of APOTs are equal to or less than the number of APOT minutes indicated in the column.

TABLE 1 – 2016 APOT Data by Hospital and Quarter Number of Ambulance

Off-loads Number of APOTs > 30 Minutes

Percent APOTs > 30 Minutes

APOT 90th Percentile Minutes

Single Max Off-load Minutes

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

DHA 2,556

1992 1773 1,770

1,726

1,288

1,220

1,240

68%

65% 69% 70% 68 68 65 62 244 162

195

167

DHM 923

853 957 928

248

250

259

267

27%

29% 27% 29%

44 75 44 46 143 122

231

72

KHM 660

632 584 621

278

269

229

254

42%

43% 39% 41%

51 55 50 49 110 145

101

116

LMH 1,602

1587 1695 1625

914

936

1,081

1,060

57%

59% 64% 65%

51 52 53 53 117 119

113

93

SJGH 2,097

2029 2066 1691

1,435

1,530

1,584

1,181

68%

75% 77% 70%

64 80 68 62 228 349

166

161

SJMC 4,683

4911 5095 4784

3,950

4,201

4,407

4,206

84% 86% 87% 88%

75 82 77 88 258 283

263

289

STCH 847

783 723 853

471

453

433

509

56% 58% 60% 60%

47 47 50 52 85 97

95

127


Charts 1 through 4 provide a comparison of each hospital by quarter during 2016. Each chart shows the total number of ambulance patient offloads (volume) for each hospital and compares the percent of each hospital’s ambulance patient

offload times (APOTs) that fall within three measurement categories: less than 30 minutes; between 30 and 60 minutes, and greater than 60 minutes.


Chart 5 shows the ratio of the number of ambulance transports to each hospital compared to the cummulated offload hours that exceeded thirty (30) minutes during 2016.


Financial Impact

Every minute that an ambulance must remain at a hospital emergency department longer than 30 minutes (APOD), the financial impact to the 9-1-1 system is approximately $2.58 per minute or $154.80 per hour. It is estimated that ambulance patient offload delays cost the emergency ambulance system approximately $1,472,441 during 2015, compared to $1,992,558 in 2016. Table 2, shows how this cost to the system was distributed between the seven hospitals in San Joaquin County during 2015, and Table 3 shows how this cost was distributed during 2016.







Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: January 9, 2017 TO: EMS Liaison Committee PREPARED BY: Rick Jones, EMS Analyst SUBJECT: AB 1129 Implementation RECOMMENDED ACTION: Receive information on the implementation of AB1129 which added Section 1797.227 to the Health and Safety Code requiring all prehospital emergency medical care providers to collect and submit data to the local EMS agency using an electronic health record system. FISCAL IMPACT: To be determined. DISCUSSION: In 2015, the Legislature enacted AB1129 adding Section 1797.227 to the Health and Safety Code requiring all prehospital emergency medical care providers to collect and submit data to the local EMS agency using an electronic health record system that exports data in a format that is compliant with the current versions of the California Emergency Medical Services Information System (CEMSIS) and the National Emergency Medical Services Information System (NEMSIS) standards and includes those data elements that are required by the local EMS agency. In addition, the California EMS Authority is proposing to revise California Code of Regulations, Title 22, Section 100082 (e) as follows: “The local EMS agency shall develop and implement policies for the medical control and medical accountability that shall include, but not be limited to, the EMT completing an electronic patient care record (ePCR) compliant with the current versions of the California Emergency Medical Services Information System (CEMSIS) and the National Emergency Medical Services Information Systems (NEMSIS) standards.” Accordingly, the San Joaquin County EMS Agency (SJCEMSA) is in the process of drafting a policy to implement the provisions of Health and Safety Code Section 1797.227, with a projected implementation date of July 1, 2017. As required by statute all ePCR systems must be capable of integrating with and submitting data to the SJCEMSA’s data system.


AB 1129 Implementation EMS Liaison Committee January 9, 2017 Page 2 of 2 SJCEMSA recommends that each non-transport EMS provider plan for acquiring, implementing, and continuously maintaining an electronic patient care record (ePCR) compliant with the current versions of the California Emergency Medical Services Information System (CEMSIS) and the National Emergency Medical Services Information Systems (NEMSIS) standards by the start of FY2017-18. SJCEMSA is in the process of revising its process for accepting NEMSIS 3.4 compliant data from EMS providers. SJCEMSA expects to have a data platform capable of meeting this requirement before the end of January 2017. At such time as the data platform becomes available, all EMS providers within SJCEMSA’s jurisdiction will be contacted and provided with information necessary to submit the required data. All transport and ALS providers will be expected to submit NEMSIS 3.4 compliant data that includes records beginning January 1, 2017. Non-transport BLS providers will be expected to submit NEMSIS 3.4 compliant data that includes records beginning July 1, 2017.







Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: January 9, 2017 TO: EMS Liaison Committee PREPARED BY: Phillip Cook Disaster Medical Health Specialist SUBJECT: Plausible Threat 2016 Functional/Full-Scale Exercise RECOMMENDED ACTION: Provide an overview of the Plausible Threat 2016 Functional/Full-Scale Exercise. FISCAL IMPACT: Estimated $12,500 funded through the FY 2016-17 Hospital Preparedness Program Grant DISCUSSION:

I. OVERVIEW

The Plausible Threat 2016 Functional/Full-Scale Exercise was the fourth and final phase of the San Joaquin County Plausible Threat exercise program sponsored by the San Joaquin County Emergency Medical Services Agency and the San Joaquin Operational Area Healthcare Coalition. The exercise was part of the 2016 Statewide Medical and Health Exercise Program sponsored by the California Department of Public Health (CDPH) and the Emergency Medical Services Authority (EMSA) in collaboration with the California Hospital Association (CHA), California Association of Health Facilities (CAHF) and California Primary Care Association (CPCA). This exercise is evidence of the growing public safety partnership between local jurisdictions regarding response to active shooter/hostile events. Exercise play involved 400 participants from 53 agencies/organizations, at 14 local venues on November 16 and 17, 2016.

II. MAJOR STRENTHS

The major strengths identified during this exercise are as follows: This was the first full-scale exercise conducted to fully test the San Joaquin County

Active Threat Plan All participating agencies demonstrated excellent team work and cooperation

during the exercise. The Medical Branch positions were filled by personnel from multiple provider


Plausible Threat 2016 Full-Scale Exercise EMS Liaison Committee January 9, 2017 Page 2 of 5

agencies. All hospitals and clinics successfully activated and implemented their medical

surge plans. WebEOC was successfully used to share incident information at the local, regional

and state levels. The Disaster Control Facility was able to provide patient destinations to the Patient

Transportation Group Supervisor and track patients. San Joaquin County Behavioral Health Services successfully activated and

deployed their Psychological First Aid (PFA) Team. A law enforcement Contact Team was quickly formed and deployed to neutralize

the threat.

III. PRIMARY AREAS FOR IMPROVEMENT The primary areas for improvement are as follows: The Law Incident Commander delayed fire and EMS resources access to the

scene for 20 minutes. o The delay in allowing fire and EMS resources on scene inhibited the rapid

formation of the Rescue Task Force, and patient care. o An analysis of patient survivability indicated that 15 out of the 45 patients (33%)

that were alive when the first responders arrived on scene would have died due to delays in care.

The following hospitals were unable to update their facility status report in WebEOC: Doctor’s Manteca, Kaiser Manteca, and St. Joseph’s.

The following healthcare facilities were unable to provide a facility status report via amateur radio: Community Medical Center, Doctor’s Manteca, Kaiser Manteca, Lodi Memorial, St. Joseph’s, San Joaquin County Behavioral Health and Sutter Tracy.

Exercise Dates

November 16-17, 2016

Scope

This exercise was Full-Scale Exercise (FSE) in the field and a Functional Exercise (FE) at all other venues, conducted over two consecutive days. Day two of the exercise focused upon information sharing between healthcare facilities, the San Joaquin Operational Area, Region IV, and the California Medical and Health Coordination Center. Local exercise play was limited to the San Joaquin Operational Area.


Mission Area1 Response

Core Capabilities2

Operational Coordination Operational Communications On-scene Security, Protection, and Law Enforcement Public Health, Healthcare and Emergency Medical Services Situational Assessment

Threat or Hazard

Active Shooter/Hostile Event (ASHE)

Scenario An active shooter incident occurs at a large commercial business located in the unincorporated area of San Joaquin County, resulting in multiple causalities.

Sponsor San Joaquin County Emergency Medical Services Agency and San Joaquin Operational Area Healthcare Coalition

Participating Organizations

Federal

Congressman Jeff Denham’s Office, Military and Public Safety Liaison State

California Department of Public Health – Emergency Preparedness Office California Emergency Medical Services Authority (EMSA) Region IV

Regional Disaster Medical Health Coordinator (RDMHC) Regional Disaster Medical Health Specialist (RDMHS) San Joaquin County / Operational Area Medical Health Operational Area Coordinator (MHOAC) San Joaquin Operational Area Fire Coordinator San Joaquin County Behavioral Health Services (BHS) San Joaquin County Emergency Medical Services Agency (EMS) San Joaquin County Information Systems Department (ISD) San Joaquin County Probation Department San Joaquin County Sheriff’s Office (S/O) Ambulance Providers

1 https://www.fema.gov/mission-areas 2 https://www.fema.gov/core-capabilities

https://www.fema.gov/mission-areas

https://www.fema.gov/core-capabilities


America Medical Response (AMR) Citizen’s Medical Response (CMR) Manteca District Ambulance (MDA) Clinics

Community Medical Centers – Murray Drive (CMC) Community Medical Centers – Channel Medical Center (CMC) Community Medical Centers – Manteca (CMC) Dispatch Center

San Joaquin County Sheriff’s Office Valley Regional Emergency Communications Center (VRECC) Fire Service

Collegeville Fire District (CGV) Escalon Fire District (ESL) Farmington Fire District (FAR) French Camp-McKinley Fire District (FRC) Kilgore Texas Fire Department (Observer) Lathrop Manteca Fire District (LMD) Liberty Fire District (LIB) Linden Peters Fire District (LPE) Lodi Fire Department (LOD) Manteca Fire Department (MAN) Mokelumne Fire District (MKE) Montezuma Fire District (ZUM) Ripon Fire District (RIP) Stockton Fire Department (STO) Thornton Fire District (THO) Tracy Fire Department (TRY) Waterloo Morada Fire District (MWR) Woodbridge Fire District (WOO) Hospitals Dameron Hospital Association (DHA) Doctor’s Hospital of Manteca (DHM) Kaiser Hospital Manteca (KHM) Lodi Memorial Hospital (LMH) San Joaquin General Hospital / Disaster Control Facility (SJGH/DCF) St. Joseph’s Medical Center (SJMC) Sutter Tracy Community Hospital (STCH) In-Patient Behavioral Health


St. Joseph’s Behavioral Health Clinic (SJBHC) Law Enforcement

Ripon Police Department (RPD) San Joaquin County Sheriff’s Office (S/O) San Joaquin County Probation Department Stockton Police Department (SPD) Moulage Services

Image Perspectives San Joaquin County Unit of the California Disaster Healthcare Volunteers (DHV) Photography Services

Jack Lima

Stanislaus County

Stanislaus County Office of Emergency Services (Evaluator) Stanislaus County Sheriff’s Office (Observer) Videography Services

CEDR Media Venue (Field)

Diamond Pet Food Company Volunteers

Carrington College (Actors) Jack Lima (Photographer) San Joaquin County Office of Education – Venture Academy (Actors) San Joaquin County Unit of the California Disaster Healthcare Volunteers (Actors and Moulage Artists) Stockton Police Department Sentinels (Actors)







Fax Number

(209) 468-6725


DATE: January 9, 2017 TO: EMS Liaison Committee PREPARED BY: Shellie Lima Regional Disaster Medical Health Specialist (RDMHS) SUBJECT: Report on RDMHS Region IV Grant RECOMMENDED ACTION: Receive information on the Regional Disaster Medical Health Specialist (RDMHS) Region IV FY16-17 Grant Program DISCUSSION: Since 1994, the San Joaquin EMS Agency has received State grant funds to enhance medical mutual aid services and disaster preparation in San Joaquin and 10 other counties make up OES Region IV (Alpine, Amador, Calaveras, El Dorado, Placer, Nevada, Sacramento, Stanislaus, Tuolumne, and Yolo). These services and staff funds have promoted the standardization of regional disaster response services, as well as provided for joint planning and training for pre-hospital, hospital, and public safety personnel. The grants have funded the RDMHS position within the EMS Agency to support disaster coordination in Region IV, and to fulfill the objectives of the grants. These efforts have been successful in promoting disaster planning and response, as well as promoting inter-county cooperation. The State has a long-term commitment to this program. The SJCEMSA was awarded a base allocation of $110,000 for FY16-17 RDMHS Region IV Grant. A copy of the Scope of Work is attached. The grant period for FY16-17 is July 1, 2016 – June 30, 2017. During the past quarter, the RDMHS continued to play an active role in response, planning and preparedness activities throughout the region, attending 27 meetings, workshops and events noted in the scope of work. In November, the RDMHS participated in a regional role for the Statewide Medical and Health Exercise, coordinating with Medical Health Operational Area Coordinators throughout the region on situational awareness and resource requesting.


RDMHS Report January 9, 2017 Page 2 of 5

Regional Disaster Medical Health Specialist (RDMHS) FY16/17 Contract Scope of Work

The Regional Disaster Medical and Health Specialist (RDMHS) is the component of the Regional Disaster Medical and Health Coordination (RDMHC) Program that directly supports regional preparedness, response, mitigation and recovery activities. Activities to assist in accomplishing this shall include:

1 Continue to support the implementation of the California Public Health and

Medical Emergency Operations Manual (EOM).

1.1 Conduct and/or participate in local and Regional EOM trainings. When possible, work with new EOM instructors to co-facilitate trainings. 1.1.1 Invite State partners that are based locally to participate,

when appropriate, in EOM trainings. 1.2 Provide input as requested on the EOM during the update process, including

improvement to the Situation Report. Seek input from local partners on EOM improvement opportunities during the update process.

2 Assist in the development of a comprehensive Medical Health Operational Area Coordination (MHOAC) program in each operational area within the region.

2.1 Conduct training for Medical Health Operational Area Coordinators (MHOACs) and other medical and health partners in the operational areas as needed.

2.2 Assist operational areas in developing contact lists to support the functions of a MHOAC program.

2.3 Provide updated MHOAC contact list to Emergency Medical Services Authority (EMSA) Program Lead on a monthly basis.

2.4 Assist operational areas in developing local Situation Report distribution procedures consistent with the EOM.

2.5 Assist operational areas in developing local Resource Requesting procedures consistent with the EOM.

2.6 Assist the Emergency Medical Services Administrators’ Association of California (EMSAAC), EMSA and CDPH with the development of a MHOAC Program Guide.

3 Continue to develop the Regional Disaster Medical and Health Coordination (RDMHC) Program.

3.1 Develop and maintain RDMHC Program Response Procedures. Procedures to include contact lists, medical and health agreements within region (i.e., automatic aid agreements, cooperative assistance agreements).

3.2 Conduct at least three medical and health regional planning meetings per year for the purpose of planning, coordination, training, and information sharing.

3.3 Participate in the local Mutual Aid Regional Advisory Committee


(MARAC) meetings and represent the RDMHC Program as requested. 3.4 Represent the RDMHC Program at regional emergency

management meetings. 3.5 Continue to coordinate with regional coordinators as appropriate.

3.5.1 California Hospital Association Regional Coordinators 3.5.2 California Governor’s Office of Emergency Services regional staff. 3.5.3 California Department of Public Health Emergency Preparedness

Office Contract Managers 3.5.4 Emergency Medical Services Authority’s Senior Emergency Services

Coordinators.

4 Assist EMSA and the Emergency Medical Services Administrators’ Association of California (EMSAAC) in the development, implementation and evaluation of the California Statewide Patient Movement Plan.

4.1 Participate in Patient Movement Workgroups to assist with specific tasks or content development as requested.

4.2 Review and provide feedback on draft work products developed by the contractor and workgroups.

4.3 Solicit input as requested from operational areas within the region on the Draft Patient Movement Plan.

4.4 Develop a training plan for the Patient Movement Plan. 4.5 Participate in exercise of Plan.

5 Participate in activities related to Medical Countermeasure (MCM) programs, including the Strategic National Stockpile (SNS) program and CHEMPACK.

5.1 Participate on the monthly MCM and Local Health Department (LHD) Emergency Preparedness conference calls (ongoing).

5.2 Review LHD SNS Operational Readiness Review (ORR) annual self- assessments and provide feedback to the LHD as appropriate. Participate in the Cities Readiness Initiative (CRI) ORR assessments and assist EPO in review and analysis of all LHD SNS preparedness activities within the Mutual Aid Region.

5.3 Promote Regional CHEMPACK training to include dissemination of training flyers provided by EPO and encourage participation of emergency dispatchers and CHEMPACK host site representatives. Participate in the planning and conduct of annual Regional CHEMPACK training.

5.4 Develop and/or update regional CHEMPACK Plans annually and distribute to partners as appropriate. 5.4.1 Maintain current CHEMPACK host site point-of-contact lists.

6 Coordinate operational area participation in catastrophic planning projects, such as the Southern California Catastrophic Earthquake Response Plan, the Bay Area Earthquake Response Plan and the Cascadia Subduction Zone Earthquake and Tsunami Response Projects. 6.1 Develop template to collect medical and health data from operational areas

(as requested). Schedule meetings as needed with operational areas to


discuss Plan and next steps. 6.2 Conduct meetings with operational areas in conjunction with EMSA, CDPH

and United States Department of Health and Human Services Assistant Secretary for Preparedness and Response (ASPR).

6.3 Collect data to enhance Plan. 6.4 Exercise Plan in conjunction with EMSA, CDPH and ASPR.

7 Coordinate inter-State collaboration workgroups, such as the California/Nevada Border Counties Workgroup

7.1 Conduct at least three meetings annually of the California/Nevada Counties Workgroup (ongoing).

7.2 Maintain point-of-contact lists for participants in the California/Nevada Border Counties Workgroup (ongoing). 7.2.1 Participants include RDMHS from Region III, IV and Region VI.

8 Participate in regional and statewide exercises and other significant medical and health related training and exercises authorized by EMSA and/or CDPH.

8.1 Participate in regional planning and post-exercise evaluation activities for the Statewide Medical and Health Exercise and the Cal OES Capstone Exercise (annually). 8.1.1 Participate in the Statewide Medical and Health Exercise performing

the roles and responsibilities of the RDMHC Program during an actual disaster, including the coordination of medical and health mutual aid.

8.1.2 Participate in the Capstone Exercise performing the roles and responsibilities of the RDMHC Program during an actual disaster, including the coordination of medical and health mutual aid.

8.2 Participate in the Diablo Canyon Nuclear Generating Station exercises as it applies to the Region I. Participate in the CDPH/EMSA Emergency Preparedness Training Workshop annually.

8.3 Attend conferences as requested by EMSA or CDPH-EPO, as budget allows.

9 Respond in accordance with the EOM to medical and health events in the region (ongoing).

9.1 Maintain incident logs and data related to response. Data to be provided in quarterly reports.

9.2 Report number of requests coordinated by the RDMHC Program for medical and/or health mutual aid and/or assistance from within the region.

9.3 Report number of requests coordinated by the RDMHC Program for medical and/or health mutual aid and/or assistance from outside the region.

9.4 Report number of times that medical and/or health mutual aid or mutual assistance requests required reimbursement coordination.

9.5 Report number of times the RDMHC Program polled the operational areas within the region to assess available resources for a potential request.

9.5.1 Report number of times RDMHC Program assisted operational areas


with completing the Medical and Health Situation Report or completed the Situation Report for the operational area.

9.5.2 Report number of times the RDMHC Program assisted operational areas with completing the Medical Health Resource Request form.

9.5.3 Report number of times the RDMHC Program is contacted by the State for additional information regarding unusual events of emergency system activation within the region.

9.5.4 Report the number of times the RDMHC Program is requested to act as a conduit to share information with operational areas within the region. 9.5.4.1 Number of times operational areas from within the region

request the RDMHC program to share material/information with all operational areas within the region.

9.5.4.2 Number of times the State requests the RDMHC program to share material/information with all operational areas within the region.

10 Additional Provisions

10.1 Participate in the RDMHC Program quarterly onsite meetings and monthly conference calls convened by EMSA.

10.2 Submit quarterly reports to the EMSA RDMHC Program Lead. 10.3 Submit agendas for meetings held by RDMHSs to EMSA RDMHC program

Lead. 10.4 Represent the RDMHC Program as a participant on working/advisory

committees as authorized by EMSA in conjunction with CDPH. Committee assignments reviewed annually and subject to change based on RDMHS workload and availability. Potential committee assignments include: 10.4.1 BioWatch program planning and response. 10.4.2 State workgroup for annual Statewide Medical and Health Exercise. 10.4.3 Medical Reserve Corps Advisory Committee. 10.4.4 EOM workgroup. 10.4.5 Disaster Healthcare Volunteers (DHV) Deployment Operations

Manual Workgroup. 10.4.6 Ambulance Strike Team Project. 10.4.7 Emergency Function (EF) 8 Technical Workgroup. 10.4.8 California Disaster Mental Behavioral Health Statewide Plan

Development workgroup. 10.4.9 HPP/PHEP Grant Guidance workgroup.

10.5 If additional activities are identified during this contract period, the RDMHS will work with the EMSA RDMHC Program Lead to evaluate current workload and responsibilities and determine how the additional activities support the tasks identified in this SOW. Both parties will agree on the appropriateness of the assignment prior to it becoming a requirement.

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