Sacramento County Department of Health and Human Services Emergency Medical Services Agency Joint Medical Oversight (MOC) / Operational Oversight (OOC) Committees March 12, 2015 Sacramento County Emergency Medical Services Agency (SCEMSA) 9616 Micron Ave Ste 960 Sacramento, CA. 95827 Facilitator: Hernando Garzon, M.D. EMS Medical Director David Magnino, EMS Administrator, Acting Scribe: Kathy Ivy, EMS Specialist Meeting Attendees MOC: Nathan Beckerman, M.D. Mercy San Juan Medical Center Jay Thomas, M.D.UC Davis Medical Center Jack Wood, D.O. American Medical Response Ambulance Karen Scarpa, M.D. Sutter General Hospital, Sacramento SCEMSA Staff
Meeting Attendees OOC; Ken Armstrong, TLC EMS Ambulance Troy Blair, Cosumnes Fire Department Dana Bentley, R.N. Mercy San Juan Medical Center Adam Blitz, American Medical Response Ambulance Candi Hayhurst R.N. Kaiser Hospital South Sacramento Calvin Howard, Folsom Fire Department Loni Howard, R.N. Sutter General Hospital, Sacramento Maurice Johnson, Sacramento Metropolitan Fire Eric Larimer, Norcal Ambulance Barbara Law, Sacramento Metropoliatn Fire Linda Lichty, Cosumnes Fire Department Kathy Nacey, R.N. Methodist Hospital Sacramento Joe Thuesen, Sacramento Regional Fire/EMS Communication Center Peter Van Niekerk, AlphaOne Ambulance Trent Waechter, R.N.Scarmento City Fire Department Dionne Weadon, Mercy Hospital of Folsom David Buettner, R.N. UC Davis Medical Center SCEMSA Staff 2 of 8
Guest: Matthew McHugh, Cosumnes River College Chris Ryther, American River College Scott Perryman, Sacramento Metro Fire Cristy Jorgensen, Cascade Bryce Dewitt, Alpha One Ambulance Becky Rowe, Life Assist Ed Doerr, Hartwill Scott Williams Approved by: Dr. Garzon, SCEMSA Medical Director-Chairman- From January 8, 2015 3 of 8
Welcome and Introductions Old Business A Chaiman s report- QIP- Has been distributed for comment. SCEMSA staff will review the comments and then revise the QIP plan. The revised edit will go out on March 20There will be two (2) hour open discussion on March 26, 2015 in Ste 960, staff will then take those comments into consideration and make edits if necessary and put final document out by April 6, 2015, which will then be submitted to State Emergency Medical Services Authority (EMSA) for approval. Reminder that this is a plan not a protocol and will be implemented over time. A Medication shortages updates: Normal Saline (NS). This has been on agenda for a while now and if things remain quiet, we can move to have this taken off the agenda in the next meeting or two. B Revisit previous documents from January MOC/OOC 1) PD# 7501-MCI critique: SCEMSA staff made edits based on comments from the previous meeting to clarify which incidents were to be completed and turned into SCEMSA and which ones didn t need to be. Some formatting issues cleared up. Out-of-Hospital Providers Form had Destination Facility changed to Designation Facilities(s) and Any compromise to patient care changed to Any barriers to patient care? Approved with edits 2) PD# 4503-Public Safety EMT AED Service Provider Approval: Comments, edits, issues? Approved 3) PD#4504-AED Medical Control: No comments. Approved 4) QIP Policy- SCEMSA received public comments and included them in changes to the document. The largest percentage of comments centered around the use of discipline in a QI program. SCEMSA staff reworded and clarified language to state that if it s a disciplinary issue that it is taken out of the QI process/policy and handled appropriated, however the skill or issue may need to be brought back as part of the QI community to be looked at. Is it a personnel issue or a system wide issue. Some confusion was brought up about public comments on the policy vs plan and the providers would like to see the policy come back at the March 26, 2015 meeting because 4 of 8
the plan and policy mirror each other. Confidentiality was a concern. Staff state other county LEMSA administrators are also discussing this and it will depend on what County Council states. SCEMSA staff state that if it s a QI issue, then names should be taken out of it. Staff look at it as a possible systemic issue not personnel issue. SCEMSA staff will draft and institute a confidentiality form for all TAG members. Not Approved to bring back at stakeholders meeting. NEMSIS v3 Timeline- SCEMSA staff want to remind everyone to start moving that direction. Data collection will be important as we move forward with the QIP. NEMSIS v3 will help and the state is planning on Jan. 1, 2016. NEMSIS v3 will stop accepting NEMSIS v2 December 31, 2016, allowing a year to convert over.scemsa staff inform providers that SCEMSA intends to switch data vendors July 1, 2015 and will ask providers to submit directly to the state repository (ICEMSA). New Business Medication administration of Midazolam- Dr. Garzon states he received a comment about the dosing on the Midazolam policy and it did not reflect accurately in other protocols. Since Midazolam is a standard medication in Sacramento County, Dr. Garzon suggests we delete the policy. and create a separate type of document that is not a policy or protocol but a LEMSA formulary that goes for each type of medication and its indications, contraindications and other useful information and it can be referenced in the specific policy. Policy deleted and Dr. Garzon to work on the other format/formula with a timeline of May 2015. Scheduled program documents for review; A PD# 2033-Determination of Death: Hours of submersion greater than or equal to six (6) hours (EMT or Paramedic) and moved it to Paramedic only, equal to, or greater than, sixty (60) minutes, confirmed, documented of greater than sixty (60) minutes. Change to Paramedic Only: Documented Submersion greater than or equal to 60 minutes Approved with the suggested edits. B PD# 2036- Medical Scene Authority: Suggestions, comments, edits? None, Approved C PD# 2039-Physician and-or Registered Nurse at the Scene: Suggestions, edits, 5 of 8
Roundtable comments? Ben to post link to CMA card on our website. Approved. D PD#2050 Direct Admit Patient Transports: Approved E PD# 2055-On-Viewing Medical Emergencies by ALS and BLS Providers: Approved F PD# 2060 Hospital Services: Changed to or equivalent for 12 lead computer interpretation. Dr. Wood has issue with last sentence about request a Kaiser facility should be directed to a Kaiser or Mercy catherization facility. Possibly remove this from policy? Discussion surrounding the removal. SCEMSA to keep the wording as it currently is written. Change Mercy to Dignity Health G PD#2080-EMS Organ Donor Information: Approved H PD#2085 DNR: Discussion around the definition of DNR. Edits to be made to PD bring back in May. Not Approved I PD#5001-Equipement and Supply Shortages: Approved J PD#8028- Environmental Emergencies: Approved K PD#8065-Hemorrage in Trauma: Dr. Garzon informs committee that we are bringing all Trauma Policies to the TRC prior to the MOC/OOC meetings. Edits were made by TRC. MOC/OOC committee ask the time tourniquet placed be documented on tourniquet when possible, and PCR. Discussed quick clots and Dr. Garzon discussed this at TRC and Dr. Shatz and they don t feel it is necessary in this county. Approved w/edits 1) Kathy Nacey: One issue, Pts who are stable and request to go to a specific hospital (ie surgery at particular hospital) and medics tell the pts they can t take them to pt. requested hospital because of the wait time and the pts. end up needing a secondary transport. Kathy Nacey wanted to know if other hospitals are having this same issue. Dr. Wood states it s not uncommon at all but Kathy states she is told to provide the information about the crews/medic on call to providers and she does, but yet it continues. Kathy said the pt satisfaction regarding ambulance transport is affected and she is told that they won t call an ambulance again because of the inability to go to the ER of choice. Suggestion is to contact the on-duty EMS Officer and he/she will deal with it immediately. 2) Loni Howard: Sutter Memorial move, May 2 nd, postponed to a projected date of August 8, 2015. When they move and consolidate, it may affect some little things in policies, like the 6 of 8
name will no longer be Sutter General/Memorial, it will be Sutter Medical Center, Sacramento wasn t sure if the radio channels would need to be changed and SCEMSA staff states it will remain as Sutter General on med radio due to the difficulty of changing the name on radio. Dr. Scapra reminds that the ER will have little changes, like triage area, but Loni will send out the details of that when the new area opens. 3) Ben Merin: SCEMSA actively working on developing online application(s) for EMT, Paramedics and MICNs. Go live date is scheduled for July 1, 2015. Gave overview of how it will look and how it will be done. Initial applications will still need approval done face to face but can submit all paperwork online. Secondary portion, but not available July 1, the providers and hospitals will have accounts built in to the system and they can send affiliation letters to employees, all inspections SCEMSA staff does will be available under each providers account. Hoping to have it all in place by next year s inspections. 4) Dave Magnino: Front office/offices being redesigned and a kiosk will be placed up front for applicants who come in. Updating to modern furniture. Would like to put up photos of providers, so send some in if you haven t done so yet. 5) Dr. Hernando Garzon: Guest Becky Rowe from Life Assist and Ed Doerr from Hartwill Medical to discuss the air splints. If interested please stay after the MOC/OOC to see demonstration. 6) David Buettner: Introduced himself as new Prehospital Care Coordinator at UC Davis and will put out a blast email shortly for all those who don t have his contact information. 7) Scott Williams: Introduces himself and is replacing Ron Potter at Sacramento City Fire. 8) Calvin Howard: Difficult times at Folsom Fire over last few years, but happy to announce, with the strong leadership under Fire Chief Phillips they have secured funding through the city of Folsom to begin an aggressive apparatus replacement program which they have desperately needed, will include three (3) new ambulances, which will replace our existing 7 of 8
fleet and additional fire engines and beginning an aggressive restaffing process. Over the last two (2) years they have been discussing and finalized the Pilot Program Telestroke program (grant from Elliot foundation) with the robitic/computer screen in ambulance for strokes. Implementation is to begin in about a week, with test runs to see how it works out. The goal is to reduce the door to needle time by 15-20 minutes. Calvin Howards hopes to have some calls or numbers to discuss at the next MOC/OOC. Distribution: 9) Chief Maurice Johnson: epcr to go live at Sacramento Metro Fire on March 24, 2015 10) Troy Bair: Starting Monday, March 16 Cosumnes Fire will be transmitting 12 leads to Kaiser South with hopes to extend it to other facilities soon. Meeting adjourned at 1115 sent via email prior to meeting date. Action Item Assignee Due Date Completed Create new document, formulary on Sacramento County EMS medications Dr. Hernando Garzon May 14, 2015 Bring back PD#2085 DNR for review of revised wording SCEMSA Staff May 14, 2015 QIP Review and QIP Policy approval SCEMSA Staff May 14, 2015 8 of 8