SLO EMSA Core Measures Report for 2016 The following information represents each of the required Core Measures for 2016 and is presented in one of two formats: (1) A numerical percent (numerator divided by the denominator multiplied by 100 to obtain the percent value) (2) The 90 th percentile of the given numbers in their ascending order. For comparative purposes, this report includes information previously submitted to the State EMS Authority for the 2012 through 2015 reporting periods. In comparing data from previous years with the 2016 data, it should be noted that a number of the indicators have been refined or redefined. In addition changes to the epcr program has allow for more accurate data collection. TRA-1 Scene time for trauma patients Patient population: Patients meeting the physiologic criteria found in the 2011 American College Of Surgeons - Guidelines for Field Triage of Injured Patients (Step 1). The 90 th percentile of the on-scene time measured from time ground ambulance arrives on scene until the time it departs for transport to a trauma center, including those requiring extrication, in minutes and seconds. Year Cases Included 90 th % of the On-scene Time in Minutes 2012 (*) (**) 52 23 min 2013 (**) 99 22 min 2014 (***) 51 25.62 min 2015 73 24:00 min 2016 73 23.00 min (*)Time period reviewed: 9 mos. in 2012 representing the first 9 months of the trauma system operational. (**) In 2012 and 2013 Revised Trauma (RTS) of <5 was utilized as a screening indicator. The RTS was omitted in 2014. In addition data from 2012 and 2013 may be incomplete or inaccurate as the EMS Agency did not track nor have the capability to obtain RTS or identify patients meeting Step One criteria without a data pull on each element and cross matching for duplicates. (***) In 2014 the epcr vendor added the ability to calculate RTS and the capability of running reports by the individual Trauma Triage Steps 1-4. The ability to report in times minutes and seconds was also added. 2015 and 2016 data pulls are from Patient Call-In Trauma Alert Step 1, which was a data mapping of trauma patients meeting the physiologic criteria defined by the American College of Surgeons. Challenges: Difficult to do comparison with Stet EMSA changing definitions so frequently
TRA-2 Direct transport to a Trauma Center for trauma patients meeting criteria Patient population same as in TRA-1 Patient population transported directly to a trauma center. Reported in a percentage 2012 (*) 52 41 79% 2013 99 92 93% 2014 51 49 96% 2015 73 71 97% 2016 73 69 95% (*) Time period reviewed: 9 mos. of 2012 representing the first 9 months of the trauma system operational 2016 4 patients were diverted to a closer hospital due to arrest enroute, airway management issues, or hemorrhage control. ACS-1 ASA Administration for Chest Pain Measurement Patients over 35 years old treated under SLO County chest pain protocol. Patient population identified above that received ASA from an EMS Provider prior to arriving at the hospital. Reported in a percentage 2012 768 552 71.9% 2013 657 456 69% 2014 617 603 97% 2015 559 552 99% 2016 542 533 98%
Data Challenges: The epcr data search does not pick up ASA administration in the narrative, thus a hand-review of calls was done for cases where the ASA was unable to be queried through the data search but was noted in the narrative. The final numbers were adjusted to include or exclude patients were ASA was self-administered prior to EMS arrival and noted in the narrative, or the patient was noted to be allergic to ASA. The PCR vendor has been asked if the confounders of administration can be added. ACS-2 12 Lead ECG Performance Patients 35 years old or older treated under SLO County chest pain protocol. Patients population identified above who received a 12 lead ECG. 2012 768 665 86.5% 2013 556 556 100% 2014 617 605 98% 2015 559 539 96% 2016 542 535 99% ACS-3 Scene time for Suspected Heart Attack (STEMI only) Population: Patients 35 years or older meeting SLO County STEMI Alert criteria. 90 th percentile of the on-scene time in measured ground ambulance arrived on scene to enroute minutes and seconds Year Cases Included 90 th % of the On-scene Time in Minutes 2012 56 22 min 2013 61 21 min 2014 (**) 62 19.85 min 2015 89 19.92 min 2016 120 19.65 min
ACS-5 Direct transport to a designated STEMI Center for patients meeting STEMI criteria Patients over 35 years old meeting SLO County STEMI Alert criteria. Patient population identified above who were transported directly to the STEMI Center. 2012 70 67 96.6% 2013 61 60 98% 2014 62 60 97% 2015 89 89 100%. 2015 120 119 99% CAR-2 Out of Hospital Cardiac Arrest with ROSC Number of EMS patients who experienced witnessed/heard cardiac arrest (Utstein definition) and were resuscitation was attempted by EMS personnel Patient population identified above who experienced a Return of Spontaneous Circulation (ROSC) per Utstein definition any time during the call. 2014 (*) 215 46 18.6% 2015 (**) 99 44 22% 2016 58 25 43% (*) Prior to 2016 the ROSC data was collected on all cardiac arrests including witnessed/unwitnessed, trauma, OD, and other causes. The State EMS Authority implemented the Utstein definition in 2016 thus refining the data to only witnessed/heard with a cardiac origin making the year to year data difficult to compare. (**)The 2015 data is reflective of 6 months data after the implementation of High Performance CPR CAR-3 Cardiac Arrest Survived to ED Discharge Data collection for this population began in January 2013
Number of EMS patients who experienced witnessed/heard cardiac arrest (Utstein definition) and were resuscitation was attempted by EMS personnel. Patient population identified above who survived to ED discharge. 2014 (*) 215 35 16% 2015 (**) 26 17 65% 2016 58 22 38% (*) Prior to 2016 the ROSC data was collected on all cardiac arrests including witnessed/unwitnessed, trauma, OD, and other causes. The State EMS Authority implemented the Utstein definition in 2016 thus refining the data to only witnessed/heard with a cardiac origin (**) In August of 2015 the High Performance CPR training program began the numbers while small and may not be statistically sufficient and only reflect data from July 2015-December 2015 Data challenges: Outcome data requires hospital cooperation and ideally the evolution of HEI to obtain outcome measures.. There is an additional staff time requirement at both the hospital and EMS Agency to collect and track the data. CAR-4 Out-of Hospital Cardiac Arrest Survival Number of EMS patients who experienced witnessed/heard cardiac arrest (Utstein definition) and were resuscitation was attempted by EMS personnel.. Patient population identified above who were discharged to home, transferred to rehab or skilled nursing facility. 2014(*) 215 13 6% 2015 (**) 26 9 35% 2016 58 15 26%
(*) Prior to 2016 the ROSC data was collected on all cardiac arrests including witnessed/unwitnessed, trauma, OD, and other causes. The State EMS Authority implemented the Utstein definition in 2016 thus refining the data to only witnessed/heard with a cardiac origin (**) In August of 2015 the High Performance CPR training program began the numbers while small and may not be statistically sufficient reflect data from July 2015-December 2015 Data challenges: Outcome data requires hospital cooperation and internal policies to acquire. There is an additional staff time requirement at both the hospital and EMS Agency to collect and track the data STR-2 Glucose Testing for Suspected Stroke Patients Total number of patients 18 years or older with primary or secondary impression/use of SLO County Suspected Stroke/Transient Ischemic Attack protocol. Patient population identified above documented to have received glucose testing prior to arrival at the hospital. 2012 (*) 89 82 92% 2013 72 68 94% 2014 122 120 98% 2015 154 141 92% 2016 162 162 100% STR-3 Scene Time for Suspected Stroke Patients Population: Total number of patients 18 years or older with primary or secondary impression/use of SLO County Suspected Stroke/Transient Ischemic Attack protocol and transported from the scene 90 th percentile of the on-scene time in minutes measured from arrival on scene to enroute in minutes and seconds. Year Cases Included 90 th % of the On-scene Time in Minutes 2012 89 17 min 2013 72 16 min 2014 122 17.67 min
2015 (*) Unable to report due to new definition 2016 (**) 162 17.00 min (*) The 2015 data definition changed the denominator was to equal the definition in STR-5 number of patients transported to a designated stroke center vs previous year s transported from the scene. San Luis Obispo County does not currently have designated stroke centers thus could not meet the definition. (**) In 2016 the definition was changed back to transport from scene to a hospital without restricting the transport to a Stroke Center. STR-5 Direct Transport to a Stroke Center for Suspected Stroke Patients meeting Criteria No data: No Stroke Centers have been designated in SLO County all hospitals have been awarded Primary Stroke Center certification by Joint Commission RES-2 Bronchodilator Administration in Adults (Beta2 Agonist) In 2014 the definition was redefined to include the total number of patients over 14 years with primary complaint of shortness of breath with signs and symptoms of suspected bronchospasm. The current SLO County Respiratory Distress protocol does not differentiate types of respiratory distress thus we were unable to run a report. The new NEMSIS 3 information being implemented in 2017 will address this data point Patient population identified above documented to have received a bronchodilator (Albuterol) by EMS personnel. 2010 563 359 64% 2011 564 314 56% 2012 533 334 63% 2013 522 351 67% 2014 Unable to report due to new definition 2015 Unable to report due to new definition 2016 Unable to report due to new definition
Data Challenges; Previous protocols address Respiratory Distress in a general format staff has developing new protocols and working with the epcr vendor to identify bronchospasm separately from other respiratory distress complaints i.e. CHF PED-1 Pediatric Asthma Patients Receiving Bronchodilators The 2014 the definition was redefined to include the total number of patients less than 14 years with primary shortness of breath- suspected bronchospasm. The current SLO County Respiratory Distress protocol does not differentiate types of respiratory distress thus we were unable to run a report. The new NEMSIS 3 information being implemented in 2017 will address this data point Patient population identified above with wheezing and documented to have received bronchodilator (Albuterol) by EMS 2012 31 20 65% 2013 17 12 71% 2014 Unable to report due to new definition 2015 Unable to report due to new definition 2016 Unable to report due to new definition Data Challenges; Previous protocols address Respiratory Distress in a general format staff has developing new protocols and working with the epcr vendor to identify bronchospasm separately from other respiratory distress complaints PAI-1 Pain Intervention in Patients over 14 Years with Pain Scale of 7 or greater Number of patients over 14 years with a pain value of 7 or greater Number of patients over 14 years with an intervention for pain relief (medication and/or procedures after pain value was assessed No outcome data: In 2014 pain scale measurements were added to the epcr In 2015 epcr data program was modified identify interventions.
The definition identified in the workbook is too broad to query as it included any intervention; including medications, splinting, ice and elevation. 2016 A general query identified approx. 800 patients over 14 yrs with a pain scale of 7. Approximately 50 patients were identified to have received either MS and/or splinting but unable to correlate if done before or after scale was performed. A hand review of a number of those without intervention identified some chief complains of constipation, multi-system injuries, ALOC, etc., none of which would have appropriately received intervention in the pre-hospital setting, A request of the EMS Authority to clarify intent and patient population was made. SKI-1 Endotracheal Success Rate Total number of endotracheal intubation procedures attempted. An attempt in SLO County is defined as an interruption of ventilation with insertion of endotracheal tube into the mouth. In 2014 the SLO EMSA began tracking the successful % of attempts and well as the successful % of patients intubated. Success is defined as completion on the first or second attempt.. Data is presented in both formats below Patient population identified above who were successfully intubated on first or second attempt. 2014 (patients) 118 102 86% 2014 (attempts) 166 102 61% 2015 (patients) 117 98 84% 2015 (attempts) 141 98 70% 2016 (patients) 74 63 85% 2016 (attempts) 105 63 60% SK-2 End Tidal CO2 or Capnography Documented on Intubated Patients The total number of all successful intubation procedures. Patient population identified as any successfully intubated patient and had a documented ETCO2 or capnography value
2012 148 65 44% 2013 122 68 56% 2014 108 70 65% 2015 99 75 76% 2016 63 52 83% Note; There were no improperly placed endotracheal tubes were identified. Airway challenges include: obesity, fluid/blood in airway and anatomic challenges. These are being addressed through regular training and the opportunity to annually attend an advanced airway lab. RST-1 Code 3 Ambulance Response Time by Zone RST-2 Code 2 Ambulance Response Time by Zone The SLO EMS Plan identifies zones that do not match the epcr response zones. A hand tally would be required to match the sub-zones of the epcr with the SLO EMS Plan response zones. Staff feels that more meaningful information and the ability to monitor response time requirements per contract agreements would be better accomplished if it were done by urban, remote, and rural response areas. RST-3 Percent of Code 3 Responses Transported to a Hospital The total number of Code 3 (lights and siren) responses that arrive on scene The number of patient in the above group transported to a hospital Year Number of Code 3 responses with arrival on scene ( includes 1144 and patient refusal) Number with arrival on scene and transported Percent transported to a hospital 2014 14,261 12,216 86% 2015 14,678 12,690 86% 2016 15,269 13,496 88%.