RAINY RIVER DISTRICT EMS. 3rd & 4th Quarter Report

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1 RAINY RIVER DISTRICT EMS 3rd & 4th Quarter Report July 1- Dec 31, 2013

2 Introduction A Base Hospital is a hospital that has been designated as such by the Minister to assist and work with the Ministry to monitor and ensure the quality of ambulance based prehospital patient care. A Base Hospital provides medical direction and advice to ambulance based pre-hospital emergency healthcare providers within a broad based, multi-disciplinary, emergency health services system in a specified geographical area. This involves the Base Hospital acting as a resource centre and facilitator to assist the Ministry in ensuring that ambulance based pre-hospital care and transportation meets the patient care standards as set out in Regulation 257/00. The Base Hospital also functions in the advisory capacity to the Ministry of Health and Long-Term Care on matters relating to ambulance based pre-hospital emergency care. Base Hospitals will support and work cooperatively with the Ministry towards the accomplishment of Emergency Health Services Branch objectives. A Base Hospital is a vital part of the Ministry of Health & Long Term Care s team in its partnership with Upper-Tier Municipalities and Designated Delivery Agents for the provision of Land Ambulance Services. (Regional Base Hospital Performance Agreement, Page 5, Item 2.0) Thunder Bay Regional Health Sciences Centre (TBRHSC), formerly known as the McKellar Hospital, has been designated as a Base Hospital by the Minister since In 2008 the Ontario Base Hospital system was downsized from 22 provincial sites to 7; Thunder Bay Regional HSC was re-designated as the Host Hospital for the NW Region Base Hospital Program at that time. The NW Region Base Hospital Program services the geographical area of Northwestern Ontario; the combined area spanning east/ west from Manitouwadge to the Manitoba border and north/ south from Red Lake to Rainy River. Contact Ms. Elaine Graham, Program Manager NW Region Base Hospital 289 Munro St. Lower Level Thunder Bay, ON P7A 2N3 (807) grahame@tbh.net Dr. Andrew Affleck, Program Medical Director NW Region Base Hospital 289 Munro St. Lower Level Thunder Bay, ON P7A 2N3 (807) Rainy River District EMS 3rd & 4th Quarter Reports 1

3 Vision Mission Values Vision We will lead and inspire paramedics to provide exceptional pre-hospital care in Northwestern Ontario. Mission We will provide medical direction and oversight that promotes trust and supports best practice through our education, training, and quality assurance programs. Values We value patient and family centered care; we will instill dignity and respect, communication and information sharing, collaboration, and participation in the delivery of pre-hospital care. We value partnerships that are accountable, participative, and respectful. We value life-long learning and education that is supportive, innovative, and dynamic. We value continuous quality improvement that promotes safety, best practice, efficiency, and professionalism. We value research that is pre-hospital care focused. Key Performance Indicators (KPI) NW Region Base Hospital deliverables and performance measures are based on 4 Key Performance Indicators (KPI) as set out by the Minister of Health within the Regional Base Hospital Performance Agreement: Medical Delegation Medical Oversight Education Continuous Quality Improvement (CQI) This report is a combined 3 rd & 4 th December 31, 2013: Quarter Report for the period July 1, 2013 to Section 1: Regional Program Reports Section 2: Rainy River District EMS Service Reports Rainy River District EMS 3rd & 4th Quarter Reports 2

4 Rainy River District EMS 3rd & 4th Quarter Reports 3

5 SECTION 1: Regional Program Reports 3 rd & 4 th Quarter 2013 Rainy River District EMS 3rd & 4th Quarter Reports 4

6 Section 1: Regional Program Reports Medical Directorship Medical Director Name Dr. Andrew Affleck Dr. Bill MacGregor Dr. Paul Dupuis Title NW Regional Program Medical Director ACP Medical Director PCP Medical Director As of Dec 31, 2013 Designated Delivery Agents and Number of Paramedics Designated Delivery Agent EMS Service Name Manager /CAO/ Director/ or Chief of EMS Number of Paramedics Employed EMA / PCP / ACP Naotkamegwanning First Nations Rainy River District Services Administration Board Naotkamegwanning EMS Rainy River District EMS Jim Green Dan McCormick Kenora District Services Board Northwest EMS Andrew Tickner City of Thunder Bay Superior North EMS Norman Gale Number of Paramedics Employed by More than One EMS Service = 19 Total Number of Paramedics in NW Region minus the number of paramedics employed by more than one service = 339 As of Dec 31, 2013 Rainy River District EMS 3rd & 4th Quarter Reports 5

7 ALS Equipment & Data Management EMS Service Name ACR Type ACE Type ECG Type SAED Model Naotkamegwanning EMS Electronic Electronic Electronic Zoll Rainy River District EMS Electronic Electronic Electronic Zoll Northwest EMS Electronic Electronic Electronic Zoll Superior North EMS Electronic Electronic Electronic MRx As of Dec 31, 2013 Certification Requests Completed by NW Region Base Hospital 3 rd & 4 th QTR July 1-Dec 31/2013 Type of Certification Request Absence from practice/college < 90 days > 90 days to 1 year > 1 year to 2 years Over 2 years New Hire Initial Cert PCP 0 PCP 0 PCP 1 PCP 1 ACP 0 ACP 0 ACP 0 ACP 0 LOA Return to Work (RTW) Cert N/A PCP 6 PCP 3 PCP 0 N/A ACP 0 ACP 0 ACP 0 Sub Totals Total 11 Rainy River District EMS 3rd & 4th Quarter Reports 6

8 Advanced Life Support Patient Care Standards (ALSPCS) NW Region Base Hospital ensures that all current certified paramedics/emas are qualified to perform the Delegated Controlled Acts and/or other medical procedures as recommended by the Provincial Medical Advisory Committee (PMAC) and Director. The NW Region Base Hospital adheres to the Provincial Medical Directives recommended by the Provincial Medical Advisory Committee (PMAC) and approved by the Director; For this reporting period ALS patient care has been monitored by the NW Region Base Hospital in accordance with the Advanced Life Support Patient Care Standards (ALSPCS), Nov 2011, Ver. 3.0 Approved Non Delegated Controlled Acts: Medical Oversight Only Approved Non Delegated Controlled Acts PCP ACP Procedure/Therapy Requires Medical Oversight Lead II Cardiac Monitoring Yes Yes Lead II ECG Interpretation NSR, Bradycardia, Tachycardia, Asystole, V-Fib, Pulseless V-Tach, PEA Lead II ECG Interpretation PSVT, BBBs, A-Fib, A-Flutter, V-Tach (with pulse), Paced, Junctional, PVCs Yes No Yes Yes Supraglottic (King LT) Airway* Yes Yes Continuous Positive Airway Pressure (CPAP* Yes Yes As of June 30, 2013 Medical Oversight for Non Delegated Medical Acts may include, but is not limited to: Review and approval of all course material to ensure consistency with the provincial education requirements; Development of educational material; Approval/assistance in selecting service instructors and regional educators; Participation/presence (auditing) during train-the-trainer, didactic, and clinical sessions; Refresher training for regional educators and service instructors; Chart Audit Medical Quality Care Review Guidance on choice of patient care equipment Rainy River District EMS 3rd & 4th Quarter Reports 7

9 Approved Delegated Controlled Acts: Medical Delegation Required Delegated Controlled Act: Procedure/Therapy Requires Medical Delegation PCP Blood Sampling: Glucose Yes Yes Analyze-automated Device(no shock delivered) Yes No Semi Automatic Defibrillation: Adult & Pediatric Yes No Manual Defibrillation: Adult & Pediatric *Yes Yes 12 Lead Interpretation *Yes Yes ACP Central Venous Line Maintenance (Access) No Yes Extubation(unintentional) No Yes Extubation by Provider(Intentional) Needle/Surgical Cricothyroidotomy No Yes ORO-Tracheal Intubation No Yes Unsuccessful E.T.T Intubation No Yes E.T.T Suctioning No Yes E.T. Tube Verification No Yes IV Saline Lock *Yes Yes Ringers lactate No Yes Fluid Bolus *Yes Yes IV Discontinued by Provider(Intentional) *Yes Yes Intraosseous Infusion Initiation No Yes Unsuccessful Intraosseous No Yes Pronouncement of Death Yes Yes Cardioversion No Yes Carotid Sinus Massage No Yes IV Normal Saline *Yes Yes Valsalva Manoeuvre No Yes Needle Thoracostomy No Yes Unsuccessful Needle Thoracostomy No Yes Nasal Tracheal Intubation No Yes Unsuccessful E.T.T Nasal No Yes Laryngoscopy/Foreign Body Removal/McGill Forceps No Yes Return of Spon. Circulation(ROSC) Yes Yes Unsuccessful Attempt-Laryngoscopy/Foreign Body Removal/McGill No Yes * Currently not available in all NW Region EMS Services No Yes Rainy River District EMS 3rd & 4th Quarter Reports 8

10 Approved Delegated Controlled Acts: Medical Delegation Required Medication Administration and Fluid Therapy by Route Medication or Fluid Therapy Route PO SL NB AE ETT PR IM **IV IO Adenosine A A Aspirin A/P Atropine A A A Diphenhydramine (Benadryl) A/P A/P* A D50W A/P* A Dopamine A A Epinephrine 1:1,000 A/P A/P Epinephrine 1:10,000 A A A Glucagon A/P Glucose: Oral A/P Dimenhydrinate ( Gravol) A/P A/P* A Lasix(Furosemide) A A Lidocaine Drip A A A Lidocaine Spray.5% A Midazolam(Midazolam) A A A Morphine A A A Narcan(Naloxone) A A A Nitroglycerin A/P Normal Saline A/P* A Salbutamol (Ventolin) A/P A/P Valium(Diazepam) A A A A Sodium Bicarbonate A A A= ACP P= PCP *P= PCP (IV) **IV includes CVAD Rainy River District EMS 3rd & 4th Quarter Reports 9

11 On Line Medical Control: Base Hospital Physician Patches NW Region Base Hospital (NWRBH) ensures that all Base Hospital Patch Physicians (BHPPs) are knowledgeable regarding paramedic practice and provincial medical directives and that they are available for online medical direction and control on a 24/7 days a week basis. Every designated BHPP is appointed he/she attends an information session with the Program Medical Director or designate and is provided a BHPP information manual prior to commencing this work. Base Hospital Patch Physician and Paramedic online interactions (patches) are subject to medical quality care review on a regular basis by the Base Hospital. 100% of BHPPs are reviewed by the NW Region Base Hospital. Refer to the following Base Hospital Policies & Procedures for review of the patching procedures in your area: On Line Medical Control PCP - Policy MC 100 On Line Medical Control PCP Back Up Procedures (PCP) - Policy MC 100A On Line Medical Control ACP Policy MC 100B Base Hospital Patch Physician (BHPP) Report EMS Service Name 3 rd & 4 th QTR July 1- Dec 31/2013 Patches by PCPs Patches by ACPs Patch Failure Reports Superior North EMS Northwest EMS 11 2 Rainy River District EMS 2 0 Naotkamegwanning EMS 4 0 Total There were a total of 113 patches to BHPPs made by NW Regional Paramedics in the 3 rd & 4 th QTR 2013 (July - Dec) 6 reports of failed attempts to patch to the BHPP were received by the NW Region Base Hospital during this period. o Location of failed patch: 4 in Thunder Bay(City) reason: poor cell service/dropped call reason: put on hold/no BHP pick up reason: BHP unavailable to come to phone reason: patch number out of service o Location of failed patch: 2 in NWEMS reason: dispatcher error reason: BHP hung up, medic didn t hear doctor on line was speaking with patient at time. Rainy River District EMS 3rd & 4th Quarter Reports 10

12 Each report of patch failure is reported to the EHS Branch as per the Performance Agreement Follow up on each patch failure report is completed by the NW Region Base Hospital to ensure system and human errors are corrected as soon as possible Education The setting of standards for education, evaluation, continuing medical education and competency maintenance of Paramedics/EMAs is the exclusive right of the Ministry of Health and Long-Term Care (MOHLTC). The NW Region Base Hospital provides a process to confirm and/or ensure the education and standard of practical skills necessary for certification and delegation of specific Delegated Controlled Acts approved by the Provincial Medical Advisory Committee (PMAC) to Paramedics/EMAs; Regional Base Hospitals are required to provide a minimum amount of education per Paramedic/EMA each year. Currently the minimum requirements are: Primary Care Paramedic 8 hrs and Advanced Care Paramedic 24 hrs. Education Hours Level of Paramedic Annual Mandated Hrs of Education Annual Skills Review Clinical CME Didactic CME Voluntary CME* Total Hrs of Education Offered by NWRBH Each Year ACP 24 4 hours 8 hours 12 hours 24 PCP 8 4 hours 0 hours 4 hours 8 *Voluntary CME opportunities may be offered from time-to-time as resources permit. Attendance is strictly voluntary (non compensatory) and test results do not affect certification status. Rainy River District EMS 3rd & 4th Quarter Reports 11

13 Patient Care Deficiencies: Omissions If a paramedic has performed a Controlled Act or any patient care below the recognized standard/guidelines, the Base Hospital Medical Director s response is guided by the severity of the event in accordance with the following definitions provided within the current Maintenance of Certification Policy: Minor Omission/Commission is defined as an action or lack of action by the Paramedic/EMA that did not have any direct effect on patient morbidity, however, may have affected patient care in a minor way. If a minor deficiency is identified the paramedic may be given verbal counseling (confirmed in writing) or written counseling via the ambulance call review process. Major Omission/Commission is defined as an action or lack of action by the paramedic that has affected or has the potential to affect patient morbidity, however, the outcome would not be life threatening. If a major deficiency is identified, or there is a repetition of minor deficiencies, the paramedic will be given written counseling and may be required to complete remedial education. At the discretion of the medical director the paramedic may be deactivated. Critical Omission/Commission is defined as an action or lack of action by the paramedic that has a clear affect on patient morbidity with a potential life threatening outcome. If a critical deficiency is identified or there is a repetition of major or combination of major and minor deficiencies the paramedic will be given written counseling and will be required to successfully complete remedial education. At the discretion of the medical director the paramedic may be decertified. ACP and PCP Omission Report 3 rd & 4 th QTR July 1-Dec 31/2013 Minor Omission Major Omission Critical Omission Rainy River District EMS Northwest EMS Naotkamegwanning First Nations EMS Superior North EMS District Operations Superior North EMS City: ACP Superior North EMS City: PCP Total: Rainy River District EMS 3rd & 4th Quarter Reports 12

14 Remedial Education Program A remedial education program based on individual needs will be made available to the Paramedic/EMA at the Base Hospital Medical Director s discretion. Remedial education may consist of, but is not limited to, self directed didactic review, scenario practice, clinical rotations or supplementary educational programs as deemed necessary by the Program Medical Director. Deactivation and Decertification If at any time in the judgment of the Base Hospital Program Medical Director, conditions for certification have not been maintained, the Base Hospital Medical Director may deactivate or decertify the Paramedic/EMA. Deactivation is the temporary suspension of selected certified paramedic privileges to perform Controlled Acts by the Base Hospital Medical Director for the purposes of performing remediation. Decertification is the revocation of a paramedic s privileges to perform Controlled Acts. NW Region Base Hospital Deactivation and Decertification Report 3 rd & 4 th QTR July 1-Dec 31/2013 Administrative Deactivation Clinical Deactivation > 90 Day LOA Separated from Service Deficiencies/Remedial Education Required Administrative Reactivation Return to Work: Greater than 90 Days Greater than 1 Yr Greater than 2 Yr Number of Paramedics Clinical Reactivation Remedial completed 0 Decertification 0 Rainy River District EMS 3rd & 4th Quarter Reports 13

15 Continuous Quality Improvement (CQI) Paramedics/EMAs must demonstrate competency and adherence to standard protocol and legislation associated with the performance of Controlled Acts and the provision of patient care at their level of certification. This will be determined through Base Hospital CQI initiatives which may include, but are not limited to: Chart Audits Peer Review Ride-Outs Dispatch/Base Hospital Physician Communication Review Field Performance Evaluation Successful Performance at CME Call Review Policies & Procedures The NW Region Base Hospital Policy & Procedure Manual is reviewed annually and is otherwise updated as necessary. Notices of policy updates are distributed to all regional stakeholders as required. It is the responsibility of every certified Paramedic/EMA to ensure they have read all Base Hospital policies and procedures, remain current and are compliant with the required practices. Our policy and procedure manual is available electronically and can be located on the NW Region Base Hospital website: User Name: basehosp Password: policies Human Resources Inventory Maintenance of Certification requires that every Paramedic: Be employed by an Emergency Medical Service and work as a Paramedic or Paramedic Preceptor (and meet the annual eligibility requirements outlined in the Provincial Base Hospital Standards); Notify the Base Hospital of any period of absence from practice greater than 90 days; Be scheduled to work a minimum of 144 hours per year. Please ensure that your EMS services have established a tracking and reporting process to provide this information to the Base Hospital each year as required. Rainy River District EMS 3rd & 4th Quarter Reports 14

16 Regional Educator (RE) Report: Regional Educator By Name Certified Regional Educators Level of Certification 3 rd & 4 th QTR July 1-Dec 31/2013 EMS Service By Name Year of Certification Jesse Laybourne PCP NWEMS Feb 2005(Resigned Dec-2013) Charlene Mackey PCP NWEMS Feb 2005 Kristy McQuay PCP RRDEMS Feb 2005 Cheryl Kallaste PCP RRDEMS Feb 2011 Paula Verin PCP SNEMS Feb 2005 David Black PCP RRDEMS Mar 2013 Robin Pollard PCP RRDEMS Mar 2013 Amy Welsh PCP RRDEMS Mar 2013 Melanie Depue PCP SNEMS Mar 2013 Jennifer Hamilton PCP SNEMS Mar 2013 Kristen Perozik PCP SNEMS Mar 2013 Evan McDonald PCP NWEMS Mar 2013 Rachel Parsons PCP NWEMS Mar 2013 Martha Paris PCP NWEMS Mar 2013 As of Dec 31, 2013 Regional Educator Activity Report Session Type Annual Skills Review Return to Work Testing Activity Report 3 rd & 4 th QTR July 1-Dec 31/2013 Activity Type & Format Type: Scenario & Practical Skills Testing Format: Assisted / Testing Stations Type: Scenario & Practical Skills Testing Format: Independent/Testing Stations # Sessions Facilitated Paramedic Attendance CME(Spring) Format: Independent Teaching 0 0 Rainy River District EMS 3rd & 4th Quarter Reports 15

17 SECTION 2: Rainy River District EMS Service Reports 3 rd & 4 th Quarter 2013 Rainy River District EMS 3rd & 4th Quarter Reports 16

18 Section 2 Rainy River District Reports The Delegated Controlled Act Activity Report below indicates the number of times that each Delegated Controlled Act (DCA) was performed by EMS station. Delegated Controlled Act Analyze - Automated Device (no shock advised Delegated Controlled Act Activity Report By EMS Station Code rd QTR July 1-Sept 30/2013 Rainy River Fort Frances Emo Atikokan ASA Blood Sampling - Glucose Defibrillation - Semi- Automatic 307 Dimenhydrinate (Gravol) Diphenhydramine (Benadryl) Epinephrine 1: Glucagon Glucose Oral NTG Spray (.4 Mg/Spray) 615 Salbutamol (Ventolin) 650 Pronouncement of Death Rainy River District EMS 3rd & 4th Quarter Reports 17

19 Delegated Controlled Act Analyze - Automated Device (no shock advised) Delegated Controlled Act Activity Report Code 308 ASA 504 By EMS Station 4 th QTR Oct 1- Dec 31/2013 Rainy River Fort Frances Emo Atikokan Blood Sampling - Glucose Defibrillation - Semi- Automatic 307 Dimenhydrinate (Gravol) 533 Diphenhydramine (Benadryl) Epinephrine 1: Glucagon Glucose Oral NTG Spray (.4 Mg/Spray) Salbutamol (Ventolin) Pronouncement of Death Lead Interpretation This information has been reviewed by the Program Medical Director for quality assurance purposes. Paramedics may require additional education or follow up as deemed appropriate by Dr. Andrew Affleck. Rainy River District EMS 3rd & 4th Quarter Reports 18

20 Comments: Many of the approved Delegated Controlled Acts (DCA) are not being performed on a regular basis by Rainy River District EMS Paramedics/EMAs. This is most likely due to the low number of calls in the service areas; Base Hospital conducts a mandatory Spring CME each year to help offset the issue of low ALS patient assessment and ALS skills but self directed CME is also necessary; Maintenance of ALS skills is becoming increasingly difficult especially concerning Paramedics/EMAs who have worked for extended periods in the low call volume areas throughout their career or extended periods. Low call volume over time presents difficulties in retaining information and skills. NW Region Base Hospital would like to stress the importance and benefits of Paramedics being pro-active in performing regular self directed CME while at work; making sure to involve and or encourage your peers. Additionally Paramedics should contact Base Hospital should they have any questions or concerns related to their ALS skills. Medical Oversight Rainy River District EMS Combined 3 rd & 4 th QTR July 1- Dec 31/2013 ALS Skills Total Attempts Successful Attempts Unsuccessful Attempts King LT CPAP All Rainy River District EMS Operators are reminded to ensure King LT and CPAP is part of their audit and education processes - to ensure competence through review and training sessions for Paramedics. NW Region Base Hospital does incorporate review and education of these skills through call review and during certification re /testing, annual skills, and CME each year Total ALS Call Audited: ACE Distribution Report Rainy River District EMS 3 rd QTR July 1- Sept 30/ th QTR Oct 1- Dec 31/2013 Total ALS Calls Audited ACE Distribution: Teaching Points ACE Distribution: Response Required 4 4 Rainy River District EMS 3rd & 4th Quarter Reports 19

21 Chart Audit By Station Report Rainy River District EMS Rainy River District by Station 3 rd QTR July 1- Sept 30/ th QTR Oct 1- Dec 31/ 2013 Rainy River Fort Frances Emo Atikokan VSA: Save by Station Report Rainy River District EMS Rainy River District by Station Combined 3rd & 4th QTR July 1- Dec 31/2013 Number of VSA s Confirmed Saves Rainy River 1 0 Fort Frances 2 0 Emo 2 0 Atikokan 2 0 SAVE RECOGNITION We would like to clarify that we do not expect or encourage you to contact the receiving hospitals directly to obtain patient outcomes as this would violate the PIPHA legislation. If you feel there may have been a save in your area as a result of prehospital care, please contact us. We do not want to miss the opportunity to congratulate the paramedics involved in any save. We will continue to recognize paramedics for saves at the annual skills review. This has been well received by NW Region paramedics. We are pleased to take the opportunity to acknowledge your great work. Rainy River District EMS 3rd & 4th Quarter Reports 20

BASE HOSPITAL PHYSICIAN ORIENTATION HANDBOOK

BASE HOSPITAL PHYSICIAN ORIENTATION HANDBOOK ` BASE HOSPITAL PHSICIAN ORIENTATION HANDBOOK www.hsnsudbury.ca/portalen/basehospital BASE HOSPITAL PHSICIAN S ROLES AND RESPONSIBILITIES BASE HOSPITAL PHSICIAN (BHP) DEFINITION A physician that works