County of Santa Clara Public Health Department Emergency Medical Services System Impact Mitigation Plan San Jose Medical Center Closure November 15, 2004 Page 1 of 7
Impact Mitigation Plan San Jose Medical Center Closure TABLE OF CONTENTS Background Page 3 Objective Page 3 Disclosure Page 3 Patient Redirection Page 3 Facility Standby Page 3 Hospital Emergency Department Diversion Page 4 Trauma Patient Management Page 5 Trauma Center Status Options Page 6 Ambulance Deployment Modifications Page 7 Maps : Trauma Catchment Zones Attachment Page 2 of 7
BACKGROUND The San Jose Medical Center (SJMC) is scheduled to close as a general acute care hospital on December 9, 2004. This Plan is designed to identify measures that will be implemented to assist in the mitigation of anticipated impacts of the closure. OBJECTIVE Maintain an efficient and effective Emergency Medical Services System, within the County of Santa Clara, while addressing the actual or potential impacts of the closure of a general acute care hospital. DISCLOSURE The EMS Agency may, at any time, take any additional measures or modify any item detailed in this document to meet the needs of the System. MITIGATION ACTIONS 1. Patient Redirection 1.1 Patients transported by air and ground ambulances will be directed away from San Jose Medical Center starting at approximately 8:00 am on November 29, 2004. 1.2 Patients in extremis, who would have normally been transported to San Jose Medical Center, may continue to be transported to San Jose Medical Center December 8, 2004 at 5:00 pm. After that time, these patients will be transported to the closest general acute care hospital. 2. Facility Standby 2.1 San Jose Medical Center has contracted American Medical Response (AMR) to provide an Advanced Life Support/paramedic ambulance to be available at the SJMC site from December 9, 2004 through January 2, 2005 (24 hours per-day, 7 days per-week). This service is provided for walk-up patients in need of immediate emergency medical care. 2.2 The EMS Agency will reevaluate the need for extensions to the coverage period with HCA. This will occur prior to January 2, 2005. Page 3 of 7
3. Hospital Emergency Department (ED) Diversion 3.1 In order to fully realize the benefits of an ambulance diversion program, all hospitals in the County must be included in the program (excluding Saint Louise Regional Medical Center). The only exception is the Palo Alto Veterans Administration (PAVA) Hospital, which is federally exempt but would continue to receive 911 System patients who request transport to PAVA. The facility would also continue to assist in the case of multi-casualty incidents/disaster situations. 3.2 Emergency Department (ED) Diversion Zones must also be established so that hospitals are not required to open prior to gaining a benefit from reduced patient volumes. This means that during an ambulance diversion period, a facility must take internal actions to facilitate patient flow, admission, and discharge to make space for ambulance traffic. Without adequate time to accomplish these actions, a facility is not placed in any better position than if they did not have the benefit of temporary ambulance diversion. 3.3 Emergency Department (ED) Diversion Zones. All hospitals in the County (exception of Saint Louise Regional Medical Center) will be able to divert 911 System ambulance traffic (not including patients in extremis). One (1) facility may be on ambulance diversion (red) at any one time in a Zone. If an additional hospital wants to go on ambulance diversion status at the same time, they must wait until the red hospitals opens and then make the change through EMSystem. County Communications will not make status changes for facilities. Facilities may remain on diversion status for no more than 90 minutes. A hospital that has closed to ambulance diversion must remain open for at least 90 minutes before being able to divert again. Page 4 of 7
The Northern ED Diversion Zone includes the following hospitals: Stanford University Hospital El Camino Hospital Kaiser Santa Clara (Palo Alto Veterans Administration) The Downtown ED Diversion Zone includes the following hospitals: Regional Medical Center of San Jose Santa Clara Valley Medical Center O'Connor Hospital The Western ED Diversion Zone includes the following hospitals: Los Gatos Community Hospital Good Samaritan Medical Center Kaiser Santa Teresa Hospital 4. Trauma Patient Management 4.1 Catchment areas have been established to assist in the appropriate routing of trauma patients. Implementation of these areas will assist in ensuring that 911 patients do not unnecessarily overwhelm any one Trauma Center. 4.2 The Stanford Catchment Zone extends from the Northern border of the County (on the West side of the Bay) extending to DeAnza Boulevard in the City of Cupertino, and through the center of the City of Sunnyvale. The separation line in the City of Sunnyvale is Sunnyvale-Saratoga Road to East Remington/Fair Oaks Avenue to the bay. Incidents that occur on this line (or within a reasonable distance of the dividing line) shall be transported in accordance with the paramedics discretion. Helicopter transportation of critical trauma patients from locations North of Highway 237/Calaveras or in the more remote areas of the City of Milpitas and unincorporated areas are to be transported to Stanford University Hospital. Page 5 of 7
4.3 The VMC Catchment Zone extends from South of DeAnza Boulevard in the City of Cupertino and south of Sunnyvale-Saratoga Road to East Remington/Fair Oaks Avenue in Sunnyvale. Patients from south of Highway 237/Calaveras in the City if Milpitas and unincorporated areas are to be transported to Santa Clara Valley Medical Center. 4.4 In addition to the established Catchment Zones, excluding Service Limitation advisories (discussed later in this document), in-county and out-of-county trauma patients (from scene calls) transported by helicopter are to be transported to Stanford University Hospital with the following exceptions: 5. Trauma Center Status Options (1) Burn patients will continue to be transported to the Santa Clara Valley Medical Center, in accordance with current Santa Clara County Prehospital Policy. (2) Flight crews shall transport patients with suspected spinal cord injury to the closest available Trauma Center. (3) When a Trauma Service Limitation precludes transport to Stanford based on the patients condition as related to the lack of OR s or Neurosurgery resources. The following statuses apply to Trauma Center availability: 5.1 Open (Green) 911 System patients are transported to Trauma Centers as directed by clinical protocols and Trauma Center Catchments Areas. 5.2 Service Limitation Advisory (Orange) Advanced Life Support Personnel (Flight Crews and Paramedics) shall consider the specific type of service limitation and may either (1) continue transport to the destination or (2) Bypass the facility and go to the other Trauma Center. 5.3 Service Limitations may include (1) No available operating rooms or (2) No available neurosurgeons (only one Trauma Center may be Orange to the same Service Limitation at the same time). Paramedics shall evaluate the need for helicopter or ambulance transportation with red lights and siren, if appropriate, to honor service advisories. Page 6 of 7
Example 1: A patient with chest trauma may be transported to a Trauma Center with a Service Limitation noted as No Neurosurgeon. Example 2: A patient who is being transported because of mechanism of injury with stable vital signs may be transported to a Trauma Center with a Service Limitation noted as No Operating Room. 5.4 Bypass (Red) Diverting all 911 Ambulance Traffic (except those in extremis). Only one Trauma Center may be on Bypass at one time. Prior to executing Bypass status, the affected Trauma Center Medical Director shall notify the other Trauma Center Medical Director so that any appropriate measures may be implemented by the open Trauma Center. 5.5 In the event that the second Trauma Center changes status to Bypass, both will be automatically opened. 5.6 A Trauma Center may not remain on Bypass for more than (60) sixty minutes. A Trauma Center must remain open for at least (60) sixty minutes before they may execute Bypass status subsequent times. 6. Ambulance Deployment Modifications 6.1 AMR s revised System Status Plan has been modified to adjust for the loss of a hospital in the downtown area and to re-establish ambulance post locations. The number of available 911 System ambulances will increase by an additional 168 unit-hours per-week. 6.2 In addition to AMR, the County permits seven (7) other ambulance service providers. These ambulances are available in the 911 System when the Contractors resources have been depleted or in the event of a large-scale response. In such cases, the EMS Agency authorizes integration of these units into the EMS System as appropriate. Page 7 of 7