MINUTES EMERGENCY MEDICAL SERVICES OPERATIONS COMMITTEE MAY 9, 2018 11:30 A.M. ATTENDANCE: Ambulance Providers: Lisa Epps, R.N. Jamie Martin Ben Garcia, EMT-P Tim England, EMT-P Smokey Beavers, EMT-P Lance Hoffrage, EMT-P Nick Friesen, EMT-P Chris Ferbrache, EMT Allen Wilkinson Hospitals: Lieslle Sprague, R.N. Amy Campbell, R.N. Marci Quintanilla, R.N. Kris Chatterton, R.N. Mary Jo Quintero, R.N. Guests Present: Steve Melander Air Methods/SkyLife American Ambulance - Dispatch American Ambulance Fresno Kingsburg Fire Department LifeStar/APATC Pistoresi Ambulance Sequoia Safety Council Sierra Ambulance Visalia Fire Department Adventist Health - Hanford Community Regional Medical Center St. Agnes Medical Center Sierra View Medical Center Valley Children s Hospital American Ambulance EMS Agency: Ronele Brooks Dale Dotson Curtis Jack Dan Lynch Mato-Kuwapi Parker Nick Friesen called the meeting to order at 11:35 a.m. I. MINUTES The Minutes of the March meeting were reviewed and approved as written. II. COMMITTEE REPORTS A. Base Hospital Committee Mary Jo Quintero reported on the May 2 Base Hospital Committee meeting. There was a report on false positive and negative ECGs in the field. American is working to fix this problem. Tape Review will be held today at St. Agnes following the EMS Operations Committee meeting.
Page 2 There have been no significant issues since the Special Memorandum requiring call-ins on Fentanyl was released. SVMC s E.D. Physician s Group, Vituity, will be leaving once their contract expires. A new group will need to be brought in starting August 3 at midnight. An RFP was submitted, but it is unknown who will take over. B. Medical Control Committee Dan Lynch gave an update on some of the legislation impacting EMS: AB 1795 This bill would allow EMS Systems with Community Paramedicine Programs to transport to alternate destinations, such as CSC. It continues to move forward. SB 944 is a similar bill; however, it requires that Community Paramedicine Programs be offered to public safety agencies first. The program cannot be part of an existing contract or EOA. The EMCC would have to be reorganized to assure that public agencies are represented. AB 1772 requires protocols for the transport of police dogs, injured in the line of duty, to a facility capable of provider veterinary emergency care; however, it has been changed to be specific to San Bernardino. San Bernardino will conduct a trial study. Contact Dan for more specific information on EMS-related legislation. Dan attended a meeting with the State EMS Authority last week. The State is collecting data from most EMS Agencies on AMA/RAS and is looking at developing Release at Scene Guidelines. We are in line with what they are working on, so we probably will not need to make any changes. Community Paramedicine classes were held at American Ambulance, and they are ready to implement the program. Dr. Andrews is working with UCSF on the IRP, and then we can officially start collecting data. The Critical Care Paramedic Protocols are being finalized and will be released soon. American has 4 paramedics who have completed class and 4 who are in progress. American will be bringing the class to Fresno on June 19, in conjunction with the University of Maryland, Baltimore. There are 24 slots in the class. American is filling 6, leaving the remainder available for outside agencies. The cost is $1150 for 100 hours of training. Registration is available on American Ambulance s website. The deadline to register is May 23. Dan Lynch noted that he hopes to implement the program on June 1. The EMS Agency is updating policies and has been releasing drafts for review. Narcan, EpiPens, Glucometers and Aspirin have been added to the EMT Scope of Practice. The patient turnover policy was revised. One of the ALS first responder agencies was concerned that it would limit them, but the intent was just to get ambulances enroute
Page 3 faster and to keep first responder resources available to respond in their communities. The equipment and medication standards were also revised. Feedback was received, and the policies are being finalized. Dispatch policy revisions were reviewed with the Dispatch Centers but were not released for public comment. The have already been implemented. Work is needed on the Paramedic Protocols. Pediatric Intubation will be removed from the protocols effective June 1. Intubation is being replaced with BLS airway for pediatrics rather than an alternative device. Laryngoscopes, blades and forceps will remain on the equipment list for foreign body removal. Dan hopes to implement all of these policies on June 1; however, he realizes it will take time to get everyone trained. Coalinga Regional Medical Center gave notice that they would be closing the hospital and all of their facilities on June 15, 2018; however, once the notice was released, contracted physicians and travelling nurses did not show up to work in the E.D. They had not been paid for some time. The E.D. then had to close the following day. There should not be much of an impact on ambulances. There were 700 visits to the E.D. last month. 370 were ambulance requests, but only 58 were transported to CRMC. There are concerns that the walk-ins will now call an ambulance for transport to other areas, but so far, there has not been an increase in requests. Coalinga also operates two large SNFs. There are 100 beds between these two facilities, and 67 are filled. They are currently looking to transfer these patients to other facilities. They are also planning to close their rural health clinic. Since they are a District, it is hoped that they will reopen a clinic in the future. Adventist Health has a clinic in the area, but it is only for their patients. CCEMSA is opening an EMS Education Center at First and Shaw (770 E. Shaw). They are in the process of moving in, but IT will take some time to complete. The Paramedic Class will meet at the new location and will not need to travel between the FCC campus on Annadale and the Health Department. The new facility will provide a better learning environment for students. EMS plans to schedule an Open House once the facility is complete. Mato-Kuwapi Parker reported that EMS is recruiting for the July Paramedic Class. Information is available on the EMS Website. Testing dates are June 5, 8 and 12. Call CCEMSA to sign up. C. CQI Committee The CQI Committee did not meet today. D. Disaster Committee There will be a Surge Table Top Exercise on Monday. The Tri-Annual Airport Exercise is scheduled for Wednesday.
Page 4 An active shooter exercise was held in Madera County. It focused on law enforcement, but first responders and EMS were also invited to participate. Dan Lynch reported that it went well, and Sierra Ambulance did a good job. Chris Ferbrache noted it was a good exercise and a refresher on MCI roles. Madera S.O., SWAT, Sierra Ambulance and the Fire Department participated, as well as 25 students. Curtis Jack reported on a disaster response at a Motel 6. Two patients committed suicide using sulfuric acid. A hazmat was called. The incident turned into a 9 patient MCI, with 3 transported to the hospital. The incident was handled well. Curtis Jack reported on the West Hills College incident. EMS was notified just before noon of a possible active shooter on the campus. Dale Dotson responded to the scene, and Dan and Curtis monitored from the office. EMS sent a message out to the hospitals over StatusNet so they would be prepared. No command post was set up, so communications was an issue, and not much information was coming from the scene. Although it turned out to be a false alarm, the EMS response was very good. A BOS member was present and was very impressed. Curtis will look at putting together a hot wash for the EMS side of the incident. It was noted that some hospitals took a long time or did not respond at all to the notice over StatusNet. Facilities need to assure that their alarms are left on. There have been some issues with hospitals contacting Dispatch to conduct their StatusNet test. Curtis stated that it is the hospital s responsibility to conduct these tests. Staff needs to know how to do operate StatusNet, and they should no longer contact Dispatch to conduct the test for them. A State Regional Unified Response to Mass Violence Event was held in Dinuba. EMS providers, fire and law participated. Nick Friesen noted that the incident went well. Policies and procedures are being developed for warm zones to allow personnel to go in and provide care rather than holding while waiting for the scene to be called safe. III. FACILITY REPORTS A. Visalia Fire Department Allen Wilkinson reported that Visalia Fire Department is in the process of hiring firefighters. B. Central California EMS Agency Dale Dotson reported that he received an email from the Heart Hospital regarding parking from June 17-19 during Grizzley Fest. Ambulances should enter off Friant. Dale will forward the information to the providers. American Ambulance will be posting ambulances at the event which is being held at Woodward Park. Dale received some phones calls regarding EpiPen Jr. EMS reviewed the data that showed that it is very rarely used; therefore, they will not be required.
Page 5 C. Pistoresi Ambulance Lance Hoffrage reported that Pistoresi Ambulance participated in three Every Fifteen Minutes Programs. All three went well. They should only have one program next year. Pistoresi has hired some new paramedics, and they have one who will be finishing Paramedic Class soon. They will be testing the tiered EMT System next week, using BLS ambulances. If it goes well, they will implement the system. Fair season is coming, and Pistoresi will be busy covering them. D. American/EMS Communications Jamie Martin reported that nine new dispatch trainees will be taking their final exam tomorrow. E. St. Agnes Medical Center Marci Quintanilla was introduced as the new PLN for St. Agnes Medical Center. F. Adventist Health - Hanford Lieslle Sprague reported that Tape Review is scheduled for June 12 at AH-Hanford; however, the class is full. The Tape Review includes a StatusNet component, so there is limited space. She has started a waiting list. G. Valley Children s Hospital Mary Jo Quintero reported that VCH has been busy and is seeing 350-400 children per day. There have been some cases of pertussis, and they received a TB case from Merced County last month. VCH conducted two night-time evacuation exercise for rehab. There were some communications issues; however, it was a very good learning opportunity. Mary Jo thanked everyone for helping with May Day. SkyLife and CHP landed their helicopters at the event. Jaime Martin sent 911 dispatchers to present information to the children. Mary Jo discussed a case where a child was brought in without a parent. VCH can only provide emergency care until they receive permission to treat from the patient. A parent had not shown up by the following morning, so CPS was contacted. Mary Jo reported that a South Valley Pediatric Conference will be held on June 8, 2018, at the Kern County Public Health Department. There is no cost to attend, and participants will receive 5 CE credits. She will be forwarding flyers with information on the conference.
Page 6 H. Community Regional Medical Center Amy Campbell reported that the Annual Trauma Symposium will be held on May 24. The cost is $95 for 7 hours of C.E. Registration is through EventBrite. Tape Review will be held at St. Agnes following this meeting. Amy asked the providers to please pick up their backboards and equipment at RMC. The cabinets are being cleared out. I. Adventist Health - Selma Curtis Jack reported that Selma will have their water shut off tonight for a few hours; however, they have made contingencies and will not be going on diversion. V. ADJOURNMENT/NEXT MEETING The meeting was adjourned at 12:35 p.m. The July meeting is cancelled. The next meeting is scheduled for September 12, 2018.