THURSTON COUNTY MEDIC ONE OPERATIONS COMMITTEE ~ REGULAR MEETING EMERGENCY SERVICES CENTER/EOC February 6, 2014, 2:00 PM AGENDA

THURSTON COUNTY MEDIC ONE OPERATIONS COMMITTEE ~ REGULAR MEETING EMERGENCY SERVICES CENTER/EOC February 6, 2014, 2:00 PM AGENDA I. CALL TO ORDER/ROLL CALL II. III. IV. APPROVAL OF AGENDA PUBLIC PARTICIPATION REVIEW AND APPROVAL OF MINUTES A. Operations Committee - December 5, 2013 B. EMS Council - January 15, 2014 Draft (Informational Only) V. COMMITTEE REPORTS A. West Region EMS Council B. Subcommittees 1. Equipment Committee (EqC) Chair or Representative 2. Mass Casualty Incident (MCI) Committee Chair or Representative 3. Training Advisory Committee (TAC) Chair or Representative C. Staff Report VI. VII. OLD BUSINESS ITEM PRESENTER EXPECTED OUTCOME A. EMS Council Action Report Wright Informational B. Communicable Disease Update Hambly Update C. D. E. NEW BUSINESS OLD BUSINESS - ISSUES & ACTIONS PENDING Paramedic exam/eval process (policy 20A) Customer Satisfaction Survey Bylaws Committee ITEM PRESENTER EXPECTED OUTCOME A. Ambulance License Renewal Wright Discussion B. Nominations Committee Wright Appointment C. Special Project Applications Process Romines Discussion D. E. F. VIII. IX. GOOD OF THE ORDER ADJOURNMENT K:\New Directory\Administration\Committees\Operations Committee\2010-2014\2014\Agendas\2 February 6 2014.doc

4A THURSTON COUNTY MEDIC ONE OPERATIONS COMMITTEE ~ MEETING NOTES EMERGENCY OPERATIONS CENTER/ECC December 5, 2013 PRESENT: Greg Wright, Steve Brooks, John Carpenter, Jody Halsey, Mel Low, Larry Fontanilla MD (MPD), Kathy Pace, Terry Ware EXCUSED: Jim Quackenbush, Brian VanCamp ABSENT: GUESTS: STAFF: Dave Johnson, Jim Fowler, Scott Puhalla Tony Kuzma, Bill Hurley Steve Romines, Fay Flanery, Pete Suver I. CALL TO ORDER/ROLL CALL - Chairman Wright called the regular meeting of the Operations Committee to order at 2:07 PM. Roll was recorded by staff. II. III. IV. APPROVAL OF AGENDA MSC (Carpenter/Brooks) move to approve. PUBLIC PARTICIPATION REVIEW AND APPROVAL OF MINUTES 1. Operations Committee November 7, 2013 MSC (Brooks/Low) move to approve. 2. EMS Council November 20, 2013 MEETING CANCELED (Informational Only) V. COMMITTEE REPORTS A. WEST REGION Romines reported West Region received a preliminary report from the Governors steering committee about changing the grant formula. He added, there were discussion about consolidating regions but that would be left to the regions for determination. Romines continued there was a State Audit and the WREMS region came out on top as other regions did not fare as good. The annual WREMS conference is set for February 7, 8 & 9, 2014 at the Great Wolf Lodge. B. SUBCOMMITTES 1. Equipment Committee (EqC) No report. 2. Mass Casualty Incident (MCI) Committee Suver reported there is one more MCI training to complete for the year. 3. Training Advisory Committee (TAC) No report C. STAFF Report Romines reported on the staff report that was included in the meeting packet. He highlighted on the following: Roles & Responsibilities work group made recommendations to the State, the report is available for anyone interested Key performance indicators is used by State committees to measure EMS systems effectiveness and is currently being reviewed by MPD s for additional indicators to use and report on 2014 Budget was adopted with reductions on the Emergency Management budget 3 rd Qtr Business Plan updated and available Nurse line use has increased but was due to repeat users BLS response time data set is now posted on the website WATRAC had an advisory committee meeting they do tracking system for hospitals which monitors bed availability in hospitals. EMT course will be completed this month Romines added items not included in the staff report were; 1) Illinois Supreme court case study about an ambulance accident where the ambulance was found not guilty after several appeals essentially giving immunity for any EMS call and 2) received a report on the Sandy Hook elementary school shooting if anyone is interested in a copy. 12 ops december minutes 2013

VI. OLD BUSINESS A. Policy Review Flanery highlighted the Agenda Item Summary included in the packet which presents 5 policies to be rescinded to include: Policy 5-Transfers by Medic One, MSC (Carpenter/Brooks) to recommend to rescind Policy 5; Policy 11-Interactions of Medic One Personnel w/medical Interveners MSC (Brooks/Pace) to recommend to rescind Policy 11; Policy 12-Out of County Responses MSC (Low/Carpenter) recommend to rescind Policy 12 including the procedure; Policy 14-BLS Protocols MSC (Brooks/Carpenter) recommend to rescind Policy 14 and; Policy 28-Patient Refusal of Medical Evaluation, Treatment and/or Transport MSC (Brooks/Carpenter) recommend to rescind Policy 28. Flanery reported the next round of policy review will include additional policy rescinding requests. Flanery added that Policy 2 Ridership policy will require additional review and input from Medic One staff and will come back when complete. B. Communicable Disease Exposure Plan Dr. Fontanilla reported no updates are available as the meeting with St. Peters Hospital was canceled and the next meeting is expected to be January 11, 2014. VII. NEW BUSINESS A.. VIII. GOOD OF THE ORDER No January 2014 meeting. 4A IX. ADJOURNMENT - 2:47 PM k:\new directory\administration\committees\operations committee\2010-2014\2013\minutes\12 ops december minutes 2013.doc Page 2 of 2

Thurston County Medic One Emergency Medical Services Council Regular Meeting Emergency Operations Center/ECC January 15, 2013 4B PRESENT: GUESTS: STAFF: Margaret McPhee, Dr. Tom Fell, M. John Way, Karen Valenzuela, John Ricks, Roger McMaster, Greg Wright, Frank Kirkbride, Russ Hendrickson, John Christiansen, Stan Moon John Carpenter, Lenny Greenstein, Mel Low, Dale Putnam, Janet Kastl, Betty Schultz, Steve Brooks Steve Romines, Fay Flanery, Cindy Hambly I. CALL TO ORDER/ROLL CALL Chairman McPhee called the regular meeting of the Emergency Medical Services Council (EMSC) to order at 3:34 PM. Roll was recorded by staff. II. III. IV. APPROVAL OF AGENDA MSC (Valenzuela/Way) move to approve agenda. PUBLIC PARTICIPATION Romines recognized Janet Kastl Retiring after 35 years as Director of the Washington State EMS system. Romines expanded that Janet has been an integral part in the development of the EMS system in Washington State. Chair McPhee presented her with a plaque acknowledging her contribution and dedication to the system. REVIEW AND APPROVAL OF MINUTES A. EMS COUNCIL December 18 2013 MSC (Kirkbride/Hendrickson) move to approve. B. OPERATIONS COMMITTEE January Meeting Cancelled. (Informational Only) V. COMMITTEE REPORTS A. OPERATIONS COMMITTEE Wright reported no January 2014 meeting. He added that Karen Roger s last meeting was December 2013 and Steve Langer is the new representative but was not able to attend and would like to request the meeting be moved back to 5:30, consensus was to keep the current meeting time.. B. WEST REGION EMS COUNCIL Romines reported the annual conference will be held at the Great Wolf Lodge February 7, 8 & 9, 2014. C. STAFF REPORT Romines highlight on the staff report included in the packet,: Working to finalize the 4 th quarter Business Plan report. EMT graduation was on January 7, 2014 with 14 graduating students. Annual levy projections Romines expanded on the updated annual levy/revenue/expense projection worksheet showing the current projections for restoring the levy lid. He noted that the year for the restoration continues to move out as Medic One targets to under expend their annual expense budget. Extensive Council discussion followed. VI. OLD BUSINESS A. TRPC EMS System Report Steering Committee Recommendations Kirkbride gave an overview of the TRPC recommendations that were discussed at last month s meeting. He handed out a recommendation summary to help elaborate on and clarify the TRPC recommendation and asked the group to help the Steering Committee by deciding what recommendations they want to move forward on. He added the Steering Committee is requesting 2 additional members be added to support the Steering Committee efforts and tasks. Extensive Council questions and discussions followed surrounding the recommendation summary handout. Kirkbride concluded the Steering Committee will bring back additional clarification with recommendations to Council at the March or April meeting. Questions arose regarding adding EMSC meeting materials to the Medic One website, Council discussion followed with a MSC (Valenzuela/Kirkbride) to have staff update the Medic One website to add EMSC meeting information. Follow up discussions surrounding the TRPC Steering Committee work and recommendations ended with Chair McPhee requesting any/all questions or comments be sent to staff for collection. B. EMSC Bylaw Modification, TRPC Recommendation Chair McPhee requested to separate out the two issues of adding a new Citizen/Physician position and adding back the Lacey representative position to the EMS Council. She requested Council discussion. Extensive Council discussion followed. MSC (Valenzuela/Way) move to approve the proposed language in 4.1.C to add a 4 th Citizen/Physician at-large position to the EMS Council. MSC followed (Kirkbride/Valenzuela) move to adopt change to bylaws article 4.1.A as proposed to add the k:\new directory\administration\committees\ems council\emsc meetings\2014\minutes\1 january\1 emsc minutes january 2014.docx Page 1 of 2

City of Lacey position back to the EMS Council. Council discussion followed. 4B VII. NEW BUSINESS A. Nominations Committee Chair McPhee asked for volunteers to the Nominations Committee, hearing none, Chair McPhee appointed Roger McMaster and M. John Way, in addition Karen Valenzuela volunteered. Nominations committee will bring a report back in February with a vote in March. VIII. IX. PUBLIC PARTICIPATION GOOD OF THE ORDER Romines gave a health line update reporting that after the 2 month spike in calls which resulted from repeat callers, the call volume is back to a normal cycle. In addition, Medic One received two thank you letters from Lacey Fire District citizens who both wanted to express gratitude to the EMS system for the rendering excellent patient care. X. ADJOURNMENT MSC Meeting adjourned at 5:11 PM. k:\new directory\administration\committees\ems council\emsc meetings\2014\minutes\1 january\1 emsc minutes january 2014.docx Page 2 of 2

Operations Committee Meeting Medic One/EMS, Staff Report, Feb 2014 Happy New Year! Janet Kastl (Griffith) retires from DOH/EMS EMS System Operational Review, TRPC as Process Project Manager, proposed at July meeting, recommending contract to BOCC. Signed by BOCC September 25, TRPC initiating, last session 12/19, contacting Chiefs/Com, Report 6/19 EMS Council meeting 3:30, presented, to EMS community for comment. Presentations: EMSC 6/19, Fire Commissioner/Chiefs Assoc 7/16, BOCC 8/7 (Medic One website, System Reports), comments due, EMS Council accepts 9/18, to BOCC, Steering Committee working, EMSC agenda/minutes recommendation 4.4 approved to staff, Governance recommendation 4.3.1 approved to BOCC. EMS Key Performance Indicators (KPI) in final draft. Attached. Protocol app (iphone/android) contract signed, started July 5, 2013, received and functional, EMS agencies notified. Medic One website modified to include app links and provider registry number lookup. Expanding to EMT course, completed. 2014 Budget and Business plan drafted presented to EMSC, 9/18 meeting, budget approved, to BOCC, approved. 2013 Business plan Q4 report finalizing. Medic hiring and oral exams. May 2013 closed with 44 new apps/5 retest oral, 9 pass written, 7 pass oral board. Next exam, closed: written Nov 12, 2013, completed. 28 applicants (25 to written), 3 retest oral, 5 total on current list. NurseLine Based Dispatch Program, started December 11, 8AM, calls routed to Evergreen Hospital Healthline, contract completed, implemented: 15 in August 2003, 14 September, 15 October, 15 November, 16 December, 11 January 2004, 13 February, 11 March, 8 April, 11 May, 7 June, 11 July, 8 Aug, 12 Sept, 8 Oct, 8 Nov, 13 Dec, 11 Jan 2005, 13 Feb, 12 Mar, 10 Apr, 11 May, 10 June; 11 July; 6 Aug; 4 Sept; 9 Oct; 5 Nov; 12 Dec; 14 Jan 2006; 11 Feb; 4 Mar; 14 Apr; 4 May; 9 June; 9 July; 11 Aug; 8 Sep; 7 Oct; 15 Nov; 6 Dec; 10 Jan; 12 Feb; 13 Mar; 7 Apr; 20 May; 15 June; 18 July; 10 Aug; 13 Sept; 8 Oct; 15 Nov; 11 Dec; Jan 08 11, 15 Feb, 10 Mar, 12 Apr, 14 May, 11 June, 14 July, 15 Aug; 22 Sept; 11 Oct; 14 Nov; 7 Dec. 5 Jan 09, 7 Feb, 6 Mar, 17 Apr, 7 May; 10 Jun; 17 Jul; 7 Aug; 10 Sep; 11 Oct; 15 Nov; 14 Dec; 11 Jan 2010; 7 Feb; 14 Mar; 10 Apr; 10 May, 16 Jun, 21 Jul, 18 Aug, 23 Sep, 14 Oct, 10 Nov, 16 Dec; 11 Jan 2011, Feb 15, Mar 24, Apr 19, May 20, Jun 10, July 21, Aug 14, Sep 17, Oct 15, Nov 10, Dec 21; 12 Jan 23, Feb 16, Mar 17, Apr 18, May 19, Jun 14, Jul 9 Aug 25, Sep 16, Oct 13, Nov 14, Dec 16; Jan 13, Feb 9, Mar 9, Apr 14, May 5, June 14, July 10, Aug 12, Sep 11, Oct 27, Nov 17: Total to date= 1,577/123 (avg 12.8/month) Rate $16.10/call EMS Data 2012 (TCOMM source), 26,012 system call volume +274 calls, +1.06% (2011 data volume 25,729). ALS response time 11.7 minutes average countywide, 94% goals achieved, call volume 8,676, -66 calls, responses -0.75% (2011 response time 11.7 minutes, 94% of goals, 8,742 responses). BLS call volume 17,336, +340, +2% (2011 16,996) Countywide BLS average response time 7.02 minutes, all BLS. BLS TCOMM Data Warehouse report, final draft to Chiefs Association then Ops Committee, to Chiefs Assoc, approved to Ops, Ops approved, to EMSC 9/18> to 10/16 approved, posted on website. Medic Unit in vehicle EMS data system. Field implementation beginning. Tiberon connectivity quote returned, $33,000 plus $4,000 annual maintenance cost, approved, interface completed. AVL Tiberon interface issue identified, AVL in test environment, mobile gateway/avl interface created, ER&R completed, AVL operational test-halted CAD software issue, rewrite. EMS Council approves EMS agency by agency supervisor QI access to SafetyPad, interface stable, AVL trial, Restart Jan 9 7 AM to end May 12, reviewing. Initiating BLS data system pilot with Tenino (Strategic area) WATRAC Advisory Group member added, meeting 9/9, next meeting 2/3 TRAINING: average pass rate NR EMT exam = national 79%, WA state 85%, WR 90%, CR 93%, TC 93% First Responder Course, 2012? EMT Course 13-1 scheduled, Station 9-5, completed, 28 enrolled, 23 graduated 6/27 EMT Course 13-2 scheduled, Station 9-5, start 9/3, 18 enrolled, 14 completed Dec 14, Grad 1/7 EMT Course 14-1 scheduled, Station 9-5, application closes 2/12 Instructor/Evaluator workshop completed NIMS online training available at http://training.fema.gov/emiweb/is/is700.asp J:\My Documents J\stfrp0114.ops.j.docx

Strategic and 2013 Business Plan EMS volumes 2013 2012 difference Change % EMS Call volume (TCOMM) 26,012 ALS Call volume (TCOMM) BLS Call volume, All BLS (TCOMM) 8,676 17,336 ALS unit responses (M1) 8,808 9,332 524-5.6% Transport volume (M1) 3,405 3,629 224-6.2% Thurston County Medic One/EMS System Page 3

Strategic and 2013 Business Plan BLS Agency average Emergency Response time by EMS agency (only EMS emergency responses) Jan 1 Dec 31, 2013 Fire/EMS Agency Click hyperlink to agency website for agency description Jurisdiction Area Sq Miles TRPC Jurisdiction Population 2012 TRPC EMS calls Emergency (lights/siren) Response 2013 Average response time MM:SS 2013 Lacey FD3 70.5 88,320 6914 06:53 Olympia Fire Dept (OFD) 19.7 47,500 6362 05:03 Tumwater Fire Dept (TFD) 17 19,150 2082 05:42 SETFA (Yelm/Rainier) (FD2, 4) 86.4 23,270 2094 08:24 WTRFA 162 21,660 1664 08:43 (Rochester/Littlerock)(FD1, 11, 14) McLane FD9/Black Lk FD5 84.5 15,710 706 07:13 E. Olympia FD6 30 12,650 564 08:32 Tenino FD12 46.4 6,060 412 08:38 S Bay FD8 23 7,810 378 07:56 Griffin FD13 24 5,030 267 07:51 Bald Hill FD17 26 4,020 209 10:27 N Olympia FD7 11 4,050 215 07:34 Bucoda Fire Dept 0.6 560 56 07:02 Gibson Valley FD16 31 570 31 13:37 County wide 632.1 256,360 21,954 6:41 Data selected for this annual EMS Agency Data Report: Only Emergency responses (lights and siren/ems RED) on EMS calls: excludes non-emergency and non-ems responses/calls for service Data Integrity Filters applied to this report: Reaction time between 0-360 seconds: excludes negative and errant reaction time data Response time between 0-3600 seconds: excludes negative and errant response time data Thurston County Medic One/EMS System Page 4

Strategic and 2013 Business Plan Thurston County Medic One/EMS System Page 5

1 Washington State EMS System Key Performance Indicators ASPIRIN ADMINISTRATION FOR PATIENTS WITH CHEST PAIN/DISCOMFORT MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Acute Coronary Syndrome (ACS) ACS-1 Percent of patients over age 21/35 with suspected cardiac chest pain/discomfort/acs who received aspirin from EMS or had the aspirin administration protocol documented Process (%) Percentage Number of patients over age 21/35 creating a provider impression of chest pain/discomfort/acs value Unstable Angina (I20.0), Angina/Ischemic Chest Pain (I20.9), STEMI and NSTEMI (I21), Subsequent STEMI and NSTEMI (I22), or Pain, Chest (Cardiac) (R07.9) Patients aged 21/35 years and older edisposition.12 value Patient Evaluated, Patient Refused Evaluation/Care, or Patient Treated Age (epatient.15) Age Units (epatient.16) Date of Birth (epatient.17) Incident/Patient Disposition (edisposition.12) Exclusion Numerator Sub-Population Numerator Inclusion Number of patients over age 21/35 creating a provider impression of chest pain/discomfort/acs with documentation of aspirin administration protocol by EMS value Unstable Angina (I20.0), Angina/Ischemic Chest Pain (I20.9), STEMI and NSTEMI (I21), Subsequent STEMI and NSTEMI (I22), or Pain, Chest (Cardiac) (R07.9) Patients aged 21/35 years and older emedications.03 value Aspirin (1191) with or without Pertinent Negative value Contraindication Noted, Denied By Order, Age (epatient.15) Age Units (epatient.16) Date of Birth (epatient.17) Medication Given (emedications.03) Medication Administered Prior to this Unit s EMS Care (emedications.02) Medication Allergies

2 Washington State EMS System Key Performance Indicators Medication Allergy, (ehistory.06) Medication Already Taken, or Refused or emedications.02 value Yes, OR ehistory.06 value Aspirin (1191) Exclusion Relation of Measure to Early aspirin administration reduces patient morbidity and mortality rates Quality of EMS System Established KPI Used NHTSA, AHA, Metro Med Directors, CA Core Measures, WA ECS TAC by Whom Performance Measure 90% Goal

3 Washington State EMS System Key Performance Indicators 12 LEAD ECG PERFORMANCE MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Acute Coronary Syndrome (ACS) ACS-2 Percent of patients over age 21/35 with suspected cardiac chest pain/discomfort/acs who received a 12 Lead ECG in less than 10 minutes from EMS time of arrival on scene by first 12 Lead ECG-equipped unit Process (%) Percentage Number of patients over age 21/35 creating a provider impression of chest pain/discomfort/acs value Unstable Angina (I20.0), Angina/Ischemic Chest Pain (I20.9), STEMI and NSTEMI (I21), Subsequent STEMI and NSTEMI (I22), or Pain, Chest (Cardiac) (R07.9) Patients aged 21/35 years and older edisposition.12 value Patient Evaluated or Patient Treated Values for etimes.06 and eprocedures.01, if present, are logical OR values for etimes.06 and evitals.01, if present, are logical Age (epatient.15) Age Units (epatient.16) Date of Birth (epatient.17) Incident/Patient Disposition (edisposition.12) Unit Arrived on Scene Date/Time (etimes.06) Date/Time Procedure Performed (eprocedures.01) Date/Time Vital Signs Taken (evitals.01) Exclusion EMS agencies that do not have 12 Lead ECG capability AND/OR EMS units that are known to not be 12 Lead ECG-equipped AND/OR escene.01 value No unless prior unit known to not be 12 Lead ECG-equipped AND/OR eprocedures.03 value 12 Lead ECG Obtained (268400002) AND associated eprocedures.02 value Yes AND/OR eprocedures.03 value 12 Lead EMS Agency Procedures (dconfiguration.07) Unit/Vehicle Number (dvehicle.01) First EMS Unit of Scene (escene.01) Procedure Performed Prior to this Unit s EMS Care (eprocedures.02) Procedure (eprocedures.03) Obtained Prior to this Unit s EMS Care (evitals.02) Cardiac Rhythm/ECG (evitals.03) ECG Type (evitals.04)

4 Washington State EMS System Key Performance Indicators Numerator Sub-Population Numerator Inclusion ECG Obtained (268400002) WITH Pertinent Negative value Contraindication Noted, Denied By Order, Refused, or Unable to Complete OR [evitals.03 value present WITH Pertinent Negative value Refuse or Unable to Complete AND evitals.04 value 12 Lead ] OR [evitals.04 value 12 Lead AND associated evitals.02 value Yes ] Number of patients over age 21/35 creating a provider impression of chest pain/discomfort/acs who received a 12 Lead ECG in less than 10 minutes value Unstable Angina (I20.0), Angina/Ischemic Chest Pain (I20.9), STEMI and NSTEMI (I21), Subsequent STEMI and NSTEMI (I22), or Pain, Chest (Cardiac) (R07.9) Patients aged 21/35 years and older Values for etimes.06 and eprocedures.01 are present and logical OR values for etimes.06 and evitals.01 are present and logical eprocedures.03 value 12 Lead ECG Obtained (268400002) AND Value of eprocedures.01 minus etimes.06 is less than 10 minutes OR evitals.04 value 12 Lead AND value of evitals.01 minus etimes.06 is less than 10 minutes Age (epatient.15) Age Units (epatient.16) Date of Birth (epatient.17) Unit Arrived on Scene Date/Time (etimes.06) Date/Time Procedure Performed (eprocedures.01) Procedure (eprocedures.03) Date/Time Vital Signs Taken (evitals.01) ECG Type (evitals.04) Exclusion Relation of Measure to Quality of EMS System Early 12 Lead ECG acquisition and notification of receiving hospital allows cardiac care team to be assembled Established KPI Used NHTSA, AHA, AHA Mission, Lifeline by Whom Performance Measure 90% Goal

5 Washington State EMS System Key Performance Indicators SCENE TIME FOR PATIENTS WITH CHEST PAIN/DISCOMFORT MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Acute Coronary Syndrome (ACS) ACS-3 Percent of patients over age 21/35 with suspected cardiac chest pain/discomfort/acs with an EMS scene time of less than 20 minutes Process (%) Percentage Number of patients over age 21/35 creating a provider impression of chest pain/discomfort/acs value Unstable Angina (I20.0), Angina/Ischemic Chest Pain (I20.9), STEMI and NSTEMI (I21), Subsequent STEMI and NSTEMI (I22), or Pain, Chest (Cardiac) (R07.9) Patients aged 21/35 years and older Patients with edisposition.12 value indicating they were transported eresponse.05 value 911 Response (Scene) Values for etimes.06 and etimes.09 are present and logical OR values for escene.05 and etimes.09 are present and logical Age (epatient.15) Age Units (epatient.16) Date of Birth (epatient.17) Incident/Patient Disposition (edisposition.12) Type of Service Requested (eresponse.05) Unit Arrived on Scene Date/Time (etimes.06) Date/Time Initial Responder Arrived on Scene (escene.05) Unit Left Scene (etimes.09) Exclusion escene.01 value No unless time First EMS Unit of Scene of initial responder s arrival is (escene.01) present and logical Numerator Sub-Population Numerator Inclusion Number of patients over age 21/35 creating a provider impression of chest pain/discomfort/acs with an EMS scene time of less than 20 minutes value Unstable Angina (I20.0), Angina/Ischemic Chest Pain (I20.9), STEMI and NSTEMI (I21), Subsequent STEMI and NSTEMI (I22), or Pain, Chest (Cardiac) (R07.9) Patients aged 21/35 years and Age (epatient.15) Age Units (epatient.16) Date of Birth (epatient.17) Incident/Patient Disposition

6 Washington State EMS System Key Performance Indicators older Patients with edisposition.12 value indicating they were transported eresponse.05 value 911 Response (Scene) Values for etimes.06 and etimes.09 are present and logical OR values for escene.05 and etimes.09 are present and logical Value of etimes.09 minus etimes.06 or escene.05 is less than 20 minutes (edisposition.12) Type of Service Requested (eresponse.05) Unit Arrived on Scene Date/Time (etimes.06) Date/Time Initial Responder Arrived on Scene (escene.05) Unit Left Scene (etimes.09) Exclusion Relation of Measure to Quality of EMS System Delays in patient transport increase E2B time, thereby increasing patient morbidity and mortality Established KPI Used AHA, WA ECS TAC by Whom Performance Measure 90% Goal

7 Washington State EMS System Key Performance Indicators TRANSPORT TO APPROPRIATE CARDIAC CENTER FOR STEMI PATIENTS MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Acute Coronary Syndrome (ACS) ACS-4 Percent of patients identified as STEMI by EMS taken to appropriate level, designated EMS system cardiac receiving center Process (%) Percentage Number of transported patients creating a provider impression of STEMI value STEMI of anterior wall (I21.0), STEMI of inferior wall (I21.1), or STEMI of other sites (I21.2) OR evitals.03 value STEMI Anterior Ischemia, STEMI Inferior Ischemia, STEMI Lateral Ischemia, or STEMI Posterior Ischemia Patients with edisposition.12 value indicating they were transported eresponse.05 value 911 Response (Scene) Cardiac Rhythm/ECG (evitals.03) Incident/Patient Disposition (edisposition.12) Type of Service Requested (eresponse.05) Exclusion Numerator Sub-Population Number of patients creating a provider impression of STEMI taken to appropriate level, designated EMS system cardiac receiving center Numerator Inclusion value STEMI of anterior wall (I21.0), STEMI of inferior wall (I21.1), or STEMI of other sites (I21.2) OR evitals.03 value STEMI Anterior Ischemia, STEMI Inferior Ischemia, STEMI Lateral Ischemia, or STEMI Posterior Ischemia edisposition.23 value STEMI Center AND/OR edisposition.20 value(s) Closest Facility, Protocol, and/or Cardiac Rhythm/ECG (evitals.03) Hospital Designation (edisposition.23) Reason for Choosing Destination (edisposition.20) Destination/Transferred To, Name (edisposition.01)

8 Washington State EMS System Key Performance Indicators Regional Specialty Center AND/OR edisposition.01 value deemed appropriate by local agency or evaluator Exclusion Relation of Measure to Quality of EMS System Transport to appropriate facility reduces time to treatment, decreasing patient morbidity/mortality Established KPI Used NHTSA, WA ECS TAC, CA Core Measures by Whom Performance Measure 100% Goal

9 Washington State EMS System Key Performance Indicators FAST EXAM DOCUMENTED FOR SUSPECTED STROKE PATIENTS MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Stroke STR-1 Percent of patients with suspected CVA/TIA who received a FAST exam from EMS or had the FAST exam protocol documented Process (%) Percentage Number of patients creating a provider impression of CVA or TIA value Stroke (I63.9) or TIA (G45.9) edisposition.12 value Patient Evaluated or Patient Treated Incident/Patient Disposition (edisposition.12) Exclusion eexam.19 value Unresponsive Mental Status Assessment (eexam.19) Numerator Sub-Population Numerator Inclusion Number of patients creating a provider impression of CVA or TIA who received a FAST exam value Stroke (I63.9) or TIA (G45.9) evitals.30 value Cincinnati or FAST Exam Stroke Scale Type (evitals.30) Exclusion Relation of Measure to Quality of EMS System Early identification of potential CVA/TIA patients by EMS ensures that patients are transported to appropriate hospital with early notification Established KPI Used AHA, CA Core Measures, WA ECS TAC by Whom Performance Measure 90% Goal

10 Washington State EMS System Key Performance Indicators BLOOD GLUCOSE CHECK FOR SUSPECTED STROKE PATIENTS MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Stroke STR-2 Percent of patients with suspected CVA/TIA who received a blood glucose check Process (%) Percentage Number of patients creating a provider impression of CVA or TIA value Stroke (I63.9) or TIA (G45.9) edisposition.12 value Patient Evaluated or Patient Treated Incident/Patient Disposition (edisposition.12) Exclusion Numerator Sub-Population Number of patients creating a provider impression of CVA or TIA who received a blood glucose check Numerator Inclusion value Stroke (I63.9) or TIA (G45.9) evitals.18 value present Blood Glucose Level (evitals.18) Exclusion Relation of Measure to Quality of EMS System Hypoglycemia can cause signs and symptoms with mimic a CVA/TIA, resulting in unneeded diversion to a stroke center, and additional costs for Established KPI Used by Whom Performance Measure Goal mobilization for a stroke mimic CA Core Measures 90%

11 Washington State EMS System Key Performance Indicators SCENE TIME FOR SUSPECTED STROKE PATIENTS MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Stroke STR-3 Percent of patients with suspected CVA/TIA with an EMS scene time of less than 20 minutes Process (%) Percentage Number of patients creating a provider impression of CVA/TIA value Stroke (I63.9) or TIA (G45.9) Patients with edisposition.12 value indicating they were transported eresponse.05 value 911 Response (Scene) Values for etimes.06 and etimes.09 are present and logical OR values for escene.05 and etimes.09 are present and logical Incident/Patient Disposition (edisposition.12) Type of Service Requested (eresponse.05) Unit Arrived on Scene Date/Time (etimes.06) Date/Time Initial Responder Arrived on Scene (escene.05) Unit Left Scene (etimes.09) Exclusion escene.01 value No unless time First EMS Unit of Scene of initial responder s arrival is (escene.01) present and logical Numerator Sub-Population Numerator Inclusion Number of patients creating a provider impression of CVA/TIA with an EMS scene time of less than 20 minutes value Stroke (I63.9) or TIA (G45.9) Patients with edisposition.12 value indicating they were transported eresponse.05 value 911 Response (Scene) Values for etimes.06 and etimes.09 are present and logical OR values for escene.05 and etimes.09 are present and logical Value of etimes.09 minus Incident/Patient Disposition (edisposition.12) Type of Service Requested (eresponse.05) Unit Arrived on Scene Date/Time (etimes.06) Date/Time Initial Responder Arrived on Scene (escene.05) Unit Left Scene (etimes.09)

12 Washington State EMS System Key Performance Indicators etimes.06 or escene.05 is less than 20 minutes Exclusion Relation of Measure to Quality of EMS System Delays in patient transport decrease opportunity of tpa use or other treatment, increasing potential morbidity/mortality Established KPI Used WA ECS TAC by Whom Performance Measure 90% Goal

13 Washington State EMS System Key Performance Indicators TRANSPORT TO APPROPRIATE STROKE CENTER FOR SUSPECTED STROKE PATIENTS MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Stroke STR-4 Percent of patients with suspected CVA/TIA taken to appropriate stroke center Process (%) Percentage Number of transported patients creating a provider impression of CVA/TIA value Stroke (I63.9) or TIA (G45.9) Patients with edisposition.12 value indicating they were transported eresponse.05 value 911 Response (Scene) Incident/Patient Disposition (edisposition.12) Type of Service Requested (eresponse.05) Exclusion Numerator Sub-Population Number of patients creating a provider impression of CVA/TIA taken to appropriate stroke center Numerator Inclusion value Stroke (I63.9) or TIA (G45.9) edisposition.23 value Stroke Center AND/OR edisposition.20 value(s) Closest Facility, Protocol, and/or Regional Specialty Center AND/OR edisposition.01 value deemed appropriate by local agency or evaluator Hospital Designation (edisposition.23) Reason for Choosing Destination (edisposition.20) Destination/Transferred To, Name (edisposition.01) Exclusion Relation of Measure to Quality of EMS System Transport to a stroke center reduces time to treatment, decreasing patient morbidity and mortality Established KPI Used AHA, WA ECS TAC, CA Core Measures by Whom Performance Measure 100% Goal

14 Washington State EMS System Key Performance Indicators BYSTANDER CPR PRIOR TO EMS ARRIVAL MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Cardiac CAR-1 Percent of cardiac arrest patients with suspected cardiac etiology who received bystander CPR Process (%) Percentage Number of patients creating a provider impression of cardiac arrest with cardiac etiology value Cardiac Arrest Due to Underlying Cardiac Condition (I46.2) OR [esituation.11 or esituation.12 value Cardiac Arrest (I46.9) AND earrest.02 value Cardiac (Presumed) ] OR [earrest.01 value Yes, Prior to EMS Arrival or Yes, After EMS Arrival AND earrest.02 value Cardiac (Presumed) ] earrest.03 value Attempted Defibrillation, Attempted Ventilation, or Initiated Chest Compressions Indication of the Presence of a Cardiac Arrest At Any Time (earrest.01) Cardiac Arrest Etiology (earrest.02) Resuscitation Attempted By EMS (earrest.03) Exclusion Numerator Sub-Population Number of patients creating a provider impression of cardiac arrest with cardiac etiology who received bystander CPR Numerator Inclusion value Cardiac Arrest Due to Underlying Cardiac Condition (I46.2) OR [esituation.11 or esituation.12 value Cardiac Arrest (I46.9) AND earrest.02 value Cardiac (Presumed) ] OR [earrest.01 value Yes, Prior to EMS Arrival or Yes, After EMS Arrival AND earrest.02 value Cardiac (Presumed) ] earrest.03 value Attempted Defibrillation, Attempted Indication of the Presence of a Cardiac Arrest At Any Time (earrest.01) Cardiac Arrest Etiology (earrest.02) Resuscitation Attempted By EMS (earrest.03) CPR Care Provided Prior to EMS Arrival (earrest.05)

15 Washington State EMS System Key Performance Indicators Ventilation, or Initiated Chest Compressions earrest.05 value Yes AND earrest.06 value Family Member, Healthcare Professional (Non-EMS), or Lay Person (Non-Family) Who Provided CPR Prior to EMS Arrival (earrest.06) Exclusion Relation of Measure to Bystander CPR improves VF patient survival rates Quality of EMS System Established KPI Used WACARES/Utstein, CA Core Measures by Whom Performance Measure??? Goal

16 Washington State EMS System Key Performance Indicators DOCUMENTATION OF INITIAL ECG RHYTHM MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Cardiac CAR-2 Documentation of initial ECG rhythm Process? Structure? (%) Percentage Number of patients creating a provider impression of cardiac arrest with cardiac etiology value Cardiac Arrest Due to Underlying Cardiac Condition (I46.2) OR [esituation.11 or esituation.12 value Cardiac Arrest (I46.9) AND earrest.02 value Cardiac (Presumed) ] OR [earrest.01 value Yes, Prior to EMS Arrival or Yes, After EMS Arrival AND earrest.02 value Cardiac (Presumed) ] edisposition.12 value Patient Evaluated or Patient Treated Indication of the Presence of a Cardiac Arrest At Any Time (earrest.01) Cardiac Arrest Etiology (earrest.02) Incident/Patient Disposition (edisposition.12) Exclusion Numerator Sub-Population Number of patients creating a provider impression of cardiac arrest with cardiac etiology with documentation of initial ECG rhythm Numerator Inclusion value Cardiac Arrest Due to Underlying Cardiac Condition (I46.2) OR [esituation.11 or esituation.12 value Cardiac Arrest (I46.9) AND earrest.02 value Cardiac (Presumed) ] OR [earrest.01 value Yes, Prior to EMS Arrival or Yes, After EMS Arrival AND earrest.02 value Cardiac (Presumed) ] earrest.11 value present OR evitals.03 value present Indication of the Presence of a Cardiac Arrest At Any Time (earrest.01) Cardiac Arrest Etiology (earrest.02) First Monitored Arrest Rhythm of the Patient (earrest.11) Cardiac Rhythm/ECG (evitals.03) Exclusion

17 Washington State EMS System Key Performance Indicators Relation of Measure to Quality of EMS System Established KPI Used by Whom Performance Measure Goal Helps data collection inclusion or exclusion for WACARES NHTSA 90%

18 Washington State EMS System Key Performance Indicators RESPONSE TIME FOR CARDIAC ARREST PATIENTS MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Cardiac CAR-3 Response time from Fire/EMS dispatch until first unit on scene for cardiac arrest patients with suspected cardiac etiology Process (%) Percentage Number of patients creating a provider impression of cardiac arrest with cardiac etiology by first unit on scene value Cardiac Arrest Due to Underlying Cardiac Condition (I46.2) OR [esituation.11 or esituation.12 value Cardiac Arrest (I46.9) AND earrest.02 value Cardiac (Presumed) ] OR [earrest.01 value Yes, Prior to EMS Arrival or Yes, After EMS Arrival AND earrest.02 value Cardiac (Presumed) ] Values for etimes.01 and etimes.06 are present and logical OR values for etimes.02 and etimes.06 are present and logical escene.01 value Yes Indication of the Presence of a Cardiac Arrest At Any Time (earrest.01) Cardiac Arrest Etiology (earrest.02) PSAP Date/Time (etimes.01) Dispatch Notified Date/Time (etimes.02) Unit Arrived on Scene Date/Time (etimes.06) First EMS Unit of Scene (escene.01) Exclusion Numerator Sub-Population Number of patients creating a provider impression of cardiac arrest with cardiac etiology with an Fire/EMS response time of less than 8 minutes Numerator Inclusion value Cardiac Arrest Due to Underlying Cardiac Condition (I46.2) OR [esituation.11 or esituation.12 value Cardiac Arrest (I46.9) AND earrest.02 value Cardiac (Presumed) ] OR [earrest.01 value Yes, Prior to EMS Arrival or Yes, After EMS Arrival AND earrest.02 value Cardiac (Presumed) ] Values for etimes.01 and Indication of the Presence of a Cardiac Arrest At Any Time (earrest.01) Cardiac Arrest Etiology (earrest.02) PSAP Date/Time (etimes.01) Dispatch Notified Date/Time (etimes.02)

19 Washington State EMS System Key Performance Indicators etimes.06 are present and logical OR values for etimes.02 and etimes.06 are present and logical escene.01 value Yes Value of etimes.06 minus etimes.01 or etimes.02 is less than 8 minutes Unit Arrived on Scene Date/Time (etimes.06) First EMS Unit of Scene (escene.01) Exclusion Relation of Measure to Minimizing response time improves cardiac arrest patient survival Quality of EMS System Established KPI Used AHA, NFPA, WACARES by Whom Performance Measure 90% Goal

20 Washington State EMS System Key Performance Indicators TIME FROM DISPATCH UNTIL FIRST DEFIBRILLATION FOR CARDIAC ARREST PATIENTS MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Cardiac CAR-4 Time from Fire/EMS dispatch until first VF defibrillation for cardiac arrest patients with suspected cardiac etiology Process (%) Percentage Number of patients creating a provider impression of cardiac arrest with cardiac etiology who received VF defibrillation by first unit on scene value Cardiac Arrest Due to Underlying Cardiac Condition (I46.2) OR [esituation.11 or esituation.12 value Cardiac Arrest (I46.9) AND earrest.02 value Cardiac (Presumed) ] OR [earrest.01 value Yes, Prior to EMS Arrival or Yes, After EMS Arrival AND earrest.02 value Cardiac (Presumed) ] Values for etimes.01 and eprocedures.01 are present and logical OR values for etimes.02 and eprocedures.01 are present and logical eprocedures.03 value Defibrillation (426220008) escene.01 value Yes Indication of the Presence of a Cardiac Arrest At Any Time (earrest.01) Cardiac Arrest Etiology (earrest.02) PSAP Date/Time (etimes.01) Dispatch Notified Date/Time (etimes.02) Date/Time Procedure Performed (eprocedures.01) Procedure (eprocedures.03) First EMS Unit of Scene (escene.01) Exclusion Numerator Sub-Population Numerator Inclusion Number of patients creating a provider impression of cardiac arrest with cardiac etiology who received VF defibrillation by first unit on scene in less than 8 minutes value Cardiac Arrest Due to Underlying Cardiac Condition (I46.2) OR [esituation.11 or esituation.12 value Cardiac Arrest (I46.9) AND earrest.02 value Cardiac (Presumed) ] OR [earrest.01 value Yes, Prior to Indication of the Presence of a Cardiac Arrest At Any Time (earrest.01) Cardiac Arrest Etiology

21 Washington State EMS System Key Performance Indicators EMS Arrival or Yes, After EMS Arrival AND earrest.02 value Cardiac (Presumed) ] Values for etimes.01 and eprocedures.01 are present and logical OR values for etimes.02 and eprocedures.01 are present and logical eprocedures.03 value Defibrillation (426220008) escene.01 value Yes Value of eprocedures.01 minus etimes.01 or etimes.02 is less than 8 minutes (earrest.02) PSAP Date/Time (etimes.01) Dispatch Notified Date/Time (etimes.02) Date/Time Procedure Performed (eprocedures.01) Procedure (eprocedures.03) First EMS Unit of Scene (escene.01) Exclusion Relation of Measure to Survival drops for each minute of delay until defibrillation Quality of EMS System Established KPI Used AHA by Whom Performance Measure 90% Goal

22 Washington State EMS System Key Performance Indicators WITNESSED VENTRICULAR FIBRILLATION PATIENTS WITH RETURN OF SPONTANEOUS CIRCULATION UPON EMERGENCY DEPARTMENT ARRIVAL MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Cardiac CAR-5 Patients with witnessed ventricular fibrillation with return of spontaneous circulation upon emergency department arrival Process (%) Percentage Number of transported patients with witnessed ventricular fibrillation earrest.11 or evitals.03 value Ventricular Fibrillation earrest.03 value Attempted Defibrillation, Attempted Ventilation, or Initiated Chest Compressions Patients with edisposition.12 value indicating they were transported First Monitored Arrest Rhythm of the Patient (earrest.11) Cardiac Rhythm/ECG (evitals.03) Resuscitation Attempted by EMS (earrest.03) Incident/Patient Disposition (edisposition.12) Exclusion Numerator Sub-Population Number of transported patients with witnessed ventricular fibrillation with return of spontaneous circulation upon emergency department arrival Numerator Inclusion earrest.11 or evitals.03 value Ventricular Fibrillation earrest.03 value Attempted Defibrillation, Attempted Ventilation, or Initiated Chest Compressions Patients with edisposition.12 value indicating they were transported earrest.12 value Yes, Prior to Arrival at the ED and/or Yes, Sustained for 20 consecutive minutes First Monitored Arrest Rhythm of the Patient (earrest.11) Cardiac Rhythm/ECG (evitals.03) Resuscitation Attempted by EMS (earrest.03) Incident/Patient Disposition (edisposition.12) Any Return of Spontaneous Circulation (earrest.12) Exclusion Relation of Measure to Prolonged ROSC upon ED arrival is indicative of improved survival Quality of EMS System Established KPI Used WACARES/Utstein

23 Washington State EMS System Key Performance Indicators by Whom Performance Measure Goal???

24 Washington State EMS System Key Performance Indicators SCENE TIME FOR STEP 1 AND STEP 2 TRAUMA PATIENTS MEASURE SET Trauma MEASURE SET ID # TRA-1 Description Percent of Step 1 and Step 2 patients with an EMS scene time of less than 10 minutes Type of Measure Process Reporting Value and (%) Percentage Units Denominator Number of transported Step 1 and Step 2 patients Population Denominator Inclusion einjury.03 value present Trauma Center Patients with edisposition.12 (einjury.03) value indicating they were Incident/Patient Disposition transported (edisposition.12) eresponse.05 value 911 Type of Service Requested Response (Scene) (eresponse.05) Values for etimes.06 and Unit Arrived on Scene Date/Time etimes.09 are present and logical (etimes.06) OR values for escene.05 and Date/Time Initial Responder etimes.09 are present and logical Arrived on Scene (escene.05) Unit Left Scene (etimes.09) Exclusion Numerator Sub-Population Numerator Inclusion escene.01 value No unless time of initial responder s arrival is present and logical eresponse.10 value Extrication or Safety-Crew/Staging First EMS Unit of Scene (escene.01) Type of Scene Delay (eresponse.10) Number of transported Step 1 and Step 2 patients with an EMS scene time of less than 10 minutes einjury.03 value present Patients with edisposition.12 value indicating they were transported eresponse.05 value 911 Response (Scene) Values for etimes.06 and etimes.09 are present and logical OR values for escene.05 and etimes.09 are present and logical Value of etimes.09 minus etimes.06 or escene.05 is less than 10 minutes Trauma Center (einjury.03) Incident/Patient Disposition (edisposition.12) Type of Service Requested (eresponse.05) Unit Arrived on Scene Date/Time (etimes.06) Date/Time Initial Responder Arrived on Scene (escene.05) Unit Left Scene (etimes.09)

25 Washington State EMS System Key Performance Indicators Exclusion Relation of Measure to Minimizing scene time can reduce patient mortality Quality of EMS System Established KPI Used American College of Surgeons, CA Core Measures by Whom Performance Measure 90% Goal

26 Washington State EMS System Key Performance Indicators TRANSPORT TO APPROPRIATE TRAUMA CENTER FOR STEP 1 AND STEP 2 TRAUMA PATIENTS MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Trauma TRA-2 Percent of Step 1 and Step 2 patients taken to appropriate level, designated EMS system trauma center Process (%) Percentage Number of transported Step 1 and Step 2 patients einjury.03 value present Trauma Center Patients with edisposition.12 (einjury.03) value indicating they were Incident/Patient Disposition transported (edisposition.12) eresponse.05 value 911 Type of Service Requested Response (Scene) (eresponse.05) Exclusion Numerator Sub-Population Numerator Inclusion Number of Step 1 and Step 2 patients taken to appropriate level, designated EMS system trauma center einjury.03 value present edisposition.23 value Trauma Center 1 or Trauma Center 2 AND/OR edisposition.20 value(s) Closest Facility, Protocol, and/or Regional Specialty Center AND/OR edisposition.01 value deemed appropriate by local agency or evaluator Trauma Center (einjury.03) Hospital Designation (edisposition.23) Reason for Choosing Destination (edisposition.20) Destination/Transferred To, Name (edisposition.01) Exclusion Relation of Measure to Quality of EMS System Transport of Step 1 and Step 2 trauma patients to the highest available level trauma center can reduce mortality Established KPI Used NHTSA, WA Trauma Triage, CA Core Measures by Whom Performance Measure 90% Goal

27 Washington State EMS System Key Performance Indicators CPAP USED FOR SUSPECTED CONGESTIVE HEART FAILURE PATIENTS MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Congestive Heart Failure CHF-1 Percent of patients with suspected congestive heart failure who received CPAP or had the CPAP protocol documented Process (%) Percentage Number of patients creating a provider impression of congestive heart failure value CHF (I50.9) edisposition.12 value Patient Evaluated, Patient Refused Evaluation/Care, or Patient Treated Incident/Patient Disposition (edisposition.12) Exclusion EMS agencies that do not have EMS Agency Procedures CPAP capability (dconfiguration.07) AND/OR Unit/Vehicle Number EMS units that are known to not (dvehicle.01) be CPAP-equipped Numerator Sub-Population Numerator Inclusion Number of patients creating a provider impression of congestive heart failure who received CPAP or had the CPAP protocol documented value CHF (I50.9) eprocedures.03 value CPAP with or without Pertinent Negative value Contraindication Noted, Denied By Order, Refused, or Unable to Complete Procedure (eprocedures.03) Exclusion Relation of Measure to CPAP can improve patient outcomes and decreases number of ETTs (NTT=6) Quality of EMS System Established KPI Used Metro Med Dir by Whom Performance Measure 90% Goal

28 Washington State EMS System Key Performance Indicators NITROGLYCERIN ADMINISTRATION FOR SUSPECTED CONGESTIVE HEART FAILURE PATIENTS MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Congestive Heart Failure CHF-2 Percent of patients with suspected congestive heart failure who received nitroglycerin or had the nitroglycerin administration protocol documented Process (%) Percentage Number of patients with suspected congestive heart failure value CHF (I50.9) edisposition.12 value Patient Evaluated, Patient Refused Evaluation/Care, or Patient Treated eresponse.15 value including ALS or specialty critical care unit Incident/Patient Disposition (edisposition.12) Level of Care of This Unit (eresponse.15) Exclusion Numerator Sub-Population Number of patients with suspected congestive heart failure with documentation of nitroglycerin administration protocol by EMS Numerator Inclusion value CHF (I50.9) eresponse.15 value including ALS or specialty critical care unit emedications.03 value Nitroglycerin (4917) with or without Pertinent Negative value Contraindication Noted, Denied By Order, Medication Allergy, Medication Already Taken, or Refused or emedications.02 value Yes, OR ehistory.06 value Nitroglycerin (4917) Level of Care of This Unit (eresponse.15) Medication Given (emedications.03) Medication Administered Prior to this Unit s EMS Care (emedications.02) Medication Allergies (ehistory.06) Exclusion Relation of Measure to Nitroglycerin can improve CHF patient outcomes Quality of EMS System Established KPI Used Metro Med Directors by Whom

29 Washington State EMS System Key Performance Indicators Performance Measure Goal 90%

30 Washington State EMS System Key Performance Indicators BETA-AGONIST ADMINISTRATION FOR PATIENTS WITH RESPIRATORY DISTRESS MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Asthma AST-1 Percent of bronchospasm patients with respiratory distress, indicative of wheezing or known history of asthma or reactive airways disease, who received a beta-agonist or had the beta-agonist administration protocol documented by the first EMS crew able to provide such treatment Process (%) Percentage Number of patients creating a provider impression of bronchospasm and respiratory distress value Acute bronchospasm (J98.01) value Asthma with Exacerbation (J45.901) OR esituation.09, esituation.10, esituation.11, or esituation.12 value Wheezing (R06.2) OR ehistory.08 value Asthma (J45.90) or Reactive Airways Dysfunction (J68.3) edisposition.12 value Patient Evaluated, Patient Refused Evaluation/Care, or Patient Treated eresponse.15 value including ALS or specialty critical care unit Primary Symptom (esituation.09) Other Associated Symptoms (esituation.10) Medical/Surgical History (ehistory.08) Incident/Patient Disposition (edisposition.12) Level of Care of This Unit (eresponse.15) Exclusion EMS agencies that do not have EMS Agency Procedures beta-agonist administration (dconfiguration.07) capability Unit/Vehicle Number AND/OR (dvehicle.01) EMS units that are known to not First EMS Unit of Scene be beta-agonist-equipped (escene.01) AND/OR escene.01 value No unless prior unit known to not be betaagonist-equipped Numerator Sub-Population Number of patients creating a provider impression of bronchospasm and respiratory distress with documentation of beta-agonist administration protocol by EMS

31 Washington State EMS System Key Performance Indicators Numerator Inclusion value Acute bronchospasm (J98.01) value Asthma with Exacerbation (J45.901) OR esituation.09, esituation.10, esituation.11, or esituation.12 value Wheezing (R06.2) OR ehistory.08 value Asthma (J45.90) or Reactive Airways Dysfunction (J68.3) emedications.03 value Albuterol (435), Epinephrine, Ipratropium (7213), Isoproterenol (6054), Levalbuterol (237159), or Terbutaline (10368) with or without Pertinent Negative value Contraindication Noted, Denied By Order, Medication Allergy, Medication Already Taken, or Refused or emedications.02 value Yes, OR ehistory.06 value indicative of beta-agonist allergy Primary Symptom (esituation.09) Other Associated Symptoms (esituation.10) Medical/Surgical History (ehistory.08) Medication Given (emedications.03) Medication Administered Prior to this Unit s EMS Care (emedications.02) Medication Allergies (ehistory.06)date/time Procedure Performed (eprocedures.01) Exclusion Relation of Measure to Treatment of bronchospasm patients with beta-agonist Quality of EMS System Established KPI Used Metro Med Directors by Whom Performance Measure 90% Goal

32 Washington State EMS System Key Performance Indicators BLOOD GLUCOSE CHECK FOR SEIZURE PATIENTS MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Seizure SEI-1 Percent of still-seizing and post-seizing patients upon EMS arrival who received a blood glucose check Process (%) Percentage Number of patients creating a provider impression of seizing esituation.11, esituation.12, esituation.09, or esituation.10 value Seizures With Status Epilepticus (G40.901), Seizures Without Status Epilepticus (G40.909), Seizure: Absence, Partial, Grand Mal (Tonic/Clonic) (G40.3), Seizure, Febrile (R56.0), or Seizure (Convulsive) (R56.9) edisposition.12 value Patient Evaluated or Patient Treated Primary Symptom (esituation.09) Other Associated Symptoms (esituation.10) Incident/Patient Disposition (edisposition.12) Exclusion Numerator Sub-Population Number of patients creating a provider impression of seizing who received a blood glucose check Numerator Inclusion esituation.11, esituation.12, esituation.09, or esituation.10 value Seizures With Status Epilepticus (G40.901), Seizures Without Status Epilepticus (G40.909), Seizure: Absence, Partial, Grand Mal (Tonic/Clonic) (G40.3), Seizure, Febrile (R56.0), or Seizure (Convulsive) (R56.9) evitals.18 value present Primary Symptom (esituation.09) Other Associated Symptoms (esituation.10) Blood Glucose Level (evitals.18) Exclusion Relation of Measure to Quality of EMS System Hypoglycemia is a common, easily treated cause of seizure activity, which can cause patient harm if untreated Established KPI Used Metro Med Directors

33 Washington State EMS System Key Performance Indicators by Whom Performance Measure Goal 90%

34 Washington State EMS System Key Performance Indicators BENZODIAZEPINE ADMINISTRATION FOR STILL SEIZING PATIENTS MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Seizure SEI-2 Percent of still seizing patients upon EMS arrival who received a benzodiazepine or had the benzodiazepine administration protocol documented Process (%) Percentage Number of patients creating a provider impression of seizing esituation.11, esituation.12, esituation.09, or esituation.10 value Seizures With Status Epilepticus (G40.901), Seizures Without Status Epilepticus (G40.909), Seizure: Absence, Partial, Grand Mal (Tonic/Clonic) (G40.3), Seizure, Febrile (R56.0), or Seizure (Convulsive) (R56.9) OR eexam.20 value Seizures edisposition.12 value Patient Evaluated, Patient Refused Evaluation/Care, or Patient Treated Primary Symptom (esituation.09) Other Associated Symptoms (esituation.10) Neurological Assessment (eexam.20) Incident/Patient Disposition (edisposition.12) Exclusion Numerator Sub-Population Number of patients creating a provider impression of seizing with documentation of benzodiazepine administration protocol by EMS Numerator Inclusion esituation.11, esituation.12, esituation.09, or esituation.10 value Seizures With Status Epilepticus (G40.901), Seizures Without Status Epilepticus (G40.909), Seizure: Absence, Partial, Grand Mal (Tonic/Clonic) (G40.3), Seizure, Febrile (R56.0), or Seizure (Convulsive) (R56.9) OR eexam.20 value Seizures emedications.03 value Primary Symptom (esituation.09) Other Associated Symptoms (esituation.10) Neurological Assessment (eexam.20) Medication Given (emedications.03)

35 Washington State EMS System Key Performance Indicators Diazepam (3322), Lorazepam (6470), or Midazolam (6960) with or without Pertinent Negative value Contraindication Noted, Denied By Order, Medication Allergy, Medication Already Taken, or Refused or emedications.02 value Yes, OR ehistory.06 value indicative of benzodiazepine allergy Medication Administered Prior to this Unit s EMS Care (emedications.02) Medication Allergies (ehistory.06) Exclusion Relation of Measure to Is there evidence that stopping seizure early lessens morbidity? Quality of EMS System Established KPI Used Metro Med Directors by Whom Performance Measure 90% Goal

36 Washington State EMS System Key Performance Indicators PATIENTS INTUBATED WITH FIRST PASS SUCCESS MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Airway AIR-1 Percent of intubated patients with first pass success Process (%) Percentage Number of patients who were intubated eprocedures.03 value Intubation Procedure (eprocedures.03) (Nasotracheal) (232679009), Intubation (Orotracheal) (232674004), Intubation (Orotracheal Through Laryngeal Mask Airway (418613003), Intubation (Rapid Sequence) (241689008), Intubation using exchange catheter to place invasive airway (397874007), or Retrograde Intubation (397892004) Exclusion Numerator Number of intubated patients with first pass success Sub-Population Numerator Inclusion eprocedures.03 value Intubation (Nasotracheal) (232679009), Intubation (Orotracheal) (232674004), Intubation (Orotracheal Through Laryngeal Mask Airway (418613003), Intubation (Rapid Sequence) (241689008), Intubation using exchange catheter to place invasive airway (397874007), or Retrograde Intubation (397892004) eprocedures.05 value 1 eprocedures.06 value Yes Procedure (eprocedures.03) Number of Procedure Attempts (eprocedures.05) Procedure Successful (eprocedures.06) Exclusion Relation of Measure to ET intubation can provide optimal airway protection, but increased

37 Washington State EMS System Key Performance Indicators Quality of EMS System Established KPI Used by Whom Performance Measure Goal intubation attempts can increase patient hypoxia and complication rates??? 60%, 70%?

38 Washington State EMS System Key Performance Indicators SUCCESSFUL INTUBATION RATE MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Airway AIR-2 Percent of intubated patients who are successfully intubated Process or Outcome? (%) Percentage Number of patients who were intubated eprocedures.03 value Intubation Procedure (eprocedures.03) (Nasotracheal) (232679009), Intubation (Orotracheal) (232674004), Intubation (Orotracheal Through Laryngeal Mask Airway (418613003), Intubation (Rapid Sequence) (241689008), Intubation using exchange catheter to place invasive airway (397874007), or Retrograde Intubation (397892004) Exclusion Numerator Number of patients who were successfully intubated Sub-Population Numerator Inclusion eprocedures.03 value Intubation (Nasotracheal) (232679009), Intubation (Orotracheal) (232674004), Intubation (Orotracheal Through Laryngeal Mask Airway (418613003), Intubation (Rapid Sequence) (241689008), Intubation using exchange catheter to place invasive airway (397874007), or Retrograde Intubation (397892004) eprocedures.06 value Yes Procedure (eprocedures.03) Procedure Successful (eprocedures.06) Exclusion Relation of Measure to Quality of EMS System Measure of technical skill. ETI provides optimal airway protection; however, missed attempts can worsen patient outcome

39 Washington State EMS System Key Performance Indicators Established KPI Used by Whom Performance Measure Goal??? 90%

40 Washington State EMS System Key Performance Indicators SUCCESSFUL PLACEMENT OF ENDOTRACHEAL TUBE OR SUPRAGLOTTIC AIRWAY MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Airway AIR-3 Percent of patients successfully intubated or who have a supraglottic airway successfully placed Process (%) Percentage Number of patients who were intubated or who had a supraglottic airway placed eprocedures.03 value Intubation Procedure (eprocedures.03) (Nasotracheal) (232679009), Intubation (Orotracheal) (232674004), Intubation (Orotracheal Through Laryngeal Mask Airway (418613003), Intubation (Rapid Sequence) (241689008), Intubation using exchange catheter to place invasive airway (397874007), Retrograde Intubation (397892004), Supraglottic Airway Insertion (Double Lumen) (427753009), or Laryngeal Mask Airway Insertion (424979004) Exclusion Numerator Sub-Population Numerator Inclusion Number of patients who were intubated or had a supraglottic airway placed successfully eprocedures.03 value Intubation (Nasotracheal) (232679009), Intubation (Orotracheal) (232674004), Intubation (Orotracheal Through Laryngeal Mask Airway (418613003), Intubation (Rapid Sequence) (241689008), Intubation using exchange catheter to place invasive airway (397874007), Retrograde Intubation (397892004), Supraglottic Airway Insertion (Double Lumen) Procedure (eprocedures.03) Procedure Successful (eprocedures.06)

41 Washington State EMS System Key Performance Indicators (427753009), or Laryngeal Mask Airway Insertion (424979004) eprocedures.06 value Yes Exclusion Relation of Measure to Measures system performance managing airways with a variety of devices Quality of EMS System Established KPI Used??? by Whom Performance Measure???% Goal

42 Washington State EMS System Key Performance Indicators DOCUMENTATION OF CONTINUOUS WAVEFORM ETCO2 FOR INTUBATED PATIENTS AND PATIENTS WITH SUPRAGLOTTIC AIRWAYS MEASURE SET MEASURE SET ID # Description Type of Measure Reporting Value and Units Denominator Population Denominator Inclusion Airway AIR-4 Percent of patients successfully intubated or who have a supraglottic airway successfully placed Process (%) Percentage Number of patients who were intubated or who had a supraglottic airway placed eprocedures.03 value Intubation Procedure (eprocedures.03) (Nasotracheal) (232679009), Intubation (Orotracheal) (232674004), Intubation (Orotracheal Through Laryngeal Mask Airway (418613003), Intubation (Rapid Sequence) (241689008), Intubation using exchange catheter to place invasive airway (397874007), Retrograde Intubation (397892004), Supraglottic Airway Insertion (Double Lumen) (427753009), or Laryngeal Mask Airway Insertion (424979004) Exclusion Numerator Sub-Population Numerator Inclusion Number of patients who were intubated or who had a supraglottic airway placed and also had documentation of continuous waveform ETCO2 eprocedures.03 value Intubation (Nasotracheal) (232679009), Intubation (Orotracheal) (232674004), Intubation (Orotracheal Through Laryngeal Mask Airway (418613003), Intubation (Rapid Sequence) (241689008), Intubation using exchange catheter to place invasive airway (397874007), Retrograde Intubation (397892004), Supraglottic Procedure (eprocedures.03) Carbon Dioxide (CO2) (evitals.16)

43 Washington State EMS System Key Performance Indicators Airway Insertion (Double Lumen) (427753009), or Laryngeal Mask Airway Insertion (424979004) eprocedures.03 value ETCO2 Colorimetric Detection (428482009) or ETCO2 Digital Capnography (425543005) OR evitals.16 value present Exclusion Relation of Measure to Quality of EMS System Established KPI Used by Whom Performance Measure Goal Misplaced ET tubes and SGA airways can increase patient mortality and morbidity. Waveform ETCO2 is recognized by the Am Assoc of Anesth. As the gold standard for confirming ET tube placement??? 90%

THURSTON COUNTY PRIVATE AMBULANCE LICENSING PROCESS APPLICATION CHECK LIST - 2012-2014 7A 2014 ITEMS TO BE LISTED/INCLUDED WITH APPLICATION APPLICANT 1. BUSINESS ID 2. LIST OFFICERS 3. INSURANCE CARRIER 4. OPERATIONS LOCATION(S) 5. VEHICLE FEATURES 6. VEHICLE ID 7. EMPLOYEE EMPLOYEE LIST/CERT LIST/CERT 8. SCHEDULE OF RATES AMERICAN MEDICAL RESPONSE OLYMPIC AMBULANCE SERVICE STAFF NOTES: 1. Rate comparison 2012-2014 attached. 2. Applications complete as submitted, including filing fee. 3. Staff Recommendation: Approve as submitted and move forward to BOCC for approval & licensure OPERATIONS COMMITTEE ACTION: Approved Rejected Greg Wright, Operations Committee Chair Date

Thurston County Medic One Emergency Medical Services System 7C SPECIAL EMS PROJECTS IMPLEMENTATION Information Packet - 2014 I. PROGRAM DESCRIPTION This program was implemented by the Thurston County Board of County Commissioners on recommendation by the Thurston County Emergency Medical Services (EMS) Council in 1995. The EMS Council and EMS community requested that a means be developed to encourage the advancement of the countywide EMS system. It is recognized that this process is a product of observations, ideas, research, ingenuity, finances and hard work. Modeled after a state/regional EMS grant program that had been discontinued, the local program encourages continued advancement of our EMS system by reviewing ideas from provider agencies and contributing toward their implementation. These agencies are closest to provision of EMS services and are best able to observe field situations. 70% of Thurston County s EMS services are volunteer agencies and may lack the necessary financial resources to implement programs to improve EMS services. Recognizing that the Medic One/EMS system encourages EMS response as a coordinated countywide entity, it therefore has an interest in implementing programs that are a benefit to the citizens of the system. Any publicly funded fire agency providing Basic Life Support (BLS) services within Thurston County is considered eligible to apply for Special Projects funding. II. GOALS A. Provide for the establishment and initial development of new components of the Thurston County Medic One/EMS system. B. Provide for the expansion and improvement of the Thurston County Medic One/EMS system. C. Purchase of special equipment for the operation of the Thurston County Medic One/EMS system. D. Provide for special training for personnel of the Thurston County Medic One/EMS system. III. CRITERIA The following criteria define components eligible for consideration in the Special Projects Implementation Program. The Thurston County EMS Council will consider projects which meet the following criteria (in order of priority): A 1. Implementation of New EMS Project(s) Includes implementation of special training for instructors or providers, or equipment that improves EMS system effectiveness/efficiency regarding patient care. A2. Special Rescue Team Project(s) Equipment or training related to enabling and/or enhancing approved countywide special rescue teams (i.e., urban, water, rope, high angle, or confined space rescue, search and rescue, etc). B. Enhancement of Current EMS Project(s) Includes enhancement of provider training or equipment that further improves system effectiveness/efficiency regarding patient care. C. Replacement of Current EMS Project(s) or Equipment Includes replacement of EMS project(s) or equipment with a similar project or equipment that would maintain the effectiveness/efficiency of the EMS system. Without replacement, the EMS system would incur loss of patient care effectiveness/efficiency or potentially gain significant liability. D. Repair of Current EMS Project(s) or Equipment Includes repair of current EMS project or equipment that continues to be an effective/efficient component of the EMS system. Without repair, the EMS system would incur loss of effectiveness/efficiency or potentially gain significant liability.