Emergency Medical Services System

Emergency Medical Services System

MISSION STATEMENT To coordinate, develop, improve and maintain a comprehensive and dynamic emergency medical services system to prevent and reduce premature death and disability. This system shall be integrated within the entire health care network. The emergency medical services system will ensure prompt, effective and unimpeded service to all residents and visitors of the Commonwealth.

EMS Agenda For the Future National Consensus Document 15 Components August 1996 1. Integration of Health Services 2. EMS Research 3. Legislation & Regulation 4. System Finance 5. Human Resources 6. Education System 7. Public Access 8. Communication System 9. Medical Direction 10. Clinical Care 11. Disaster Response National Highway Traffic Safety Administration (NHTSA) 12. Public Education 13. Prevention Health Resources and Services Administration (HRSA) 14. Information Systems 15. Evaluation

LEGISLATION & REGULATION The EMS Act Pa.C.S. 6921-6938 Act 37 formally Act 45 Regulations Promulgated October 14, 2000, currently in the process of being re-written Statewide EMS Development Plan (currently being updated)

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Our Regional EMS Councils are, Between the Bureau and EMS Providers

1014 Ambulance Services

517 Quick Response Services

63 Air Ambulances operated by 13 services

Voluntary Rescue Services 125 Organizations

EDUCATION First Responder Emergency Medical Technician EMT - Paramedic Pre-Hospital Registered Nurse Rescue Technician

EMS SYSTEM Pennsylvania Department of Health Bureau of EMS (Lead Agency) 2 Poison Control Centers Pennsylvania Emergency Health Services Council (State Advisory Council) Pennsylvania Trauma Systems Foundation (Trauma Center Accreditation Regional EMS Councils (16) Training and Licensure Accreditation of Quality Assurance Public Education Credentialing of Medical Command and System and Services Facilities and Maintenance Provider Con. Ed. Training Institutes

Partners PA Emergency Health Services Council Ambulance Association of PA PA Trauma System Foundation PA Fire & Emergency Services Inst American Trauma Society Hospital Association PA American College Emergency Physician American Heart Association.

FACILITIES In Pennsylvania 177 Hospital with Emergency Departments BEMS Accredits 148 Medical Command Facilities 32 Trauma Centers

DISASTER RESPONSE

PA EMS STRIKE TEAMS Deployed to Louisiana August and September 2005 August and September 2008

MSEC Trailers

PA EMS System Data 2008 1.8 Million dispatches One every 18 seconds 14.68 are on Sunday 13.94 are on Tuesday Around 14% daily

Cardiac Arrests/Sym Sunday 14.68% Cardiac Arrest Monday 15.54% Cardiac Sym 13464 Arrests at Residence 74.06% Arrests at Extended Care 10.14% 11537 Strokes at Residence 66.38% Strokes at Extended Care 15.39%

Arrest Condition at Hospital 14.41% Improved 10.97% Stable 53.95% Unstable 20.66% Worse

Arrest Condition at Hospital 14.41% Improved 10.97% Stable 53.95% Unstable 20.66% Worse

Cardiac Conditions @ Hospital 9.40% Life Threat 21.25% Minor 69.34% Moderate ************************************************** Improved 26.82% Stable 67.69% Unstable/Worse 5.49% 74,918 total

Stroke Conditions @ Hospital 15.85% Life Threat 16.22% Minor 67.94% Moderate ************************************************** Improved 12.80% Stable 74.59% Unstable/Worse 12.61% 17,317 total

Arrest/Symptoms by Counties Philadelphia 11.38% Allegheny 10.24% Montgomery 6.00% Westmoreland 5.57% *************************** Cameron 0 Elk 2 Fulton/Columbia 4 Forest 7 Allegheny 10.82% Philadelphia 7.0% Westmoreland 5,0% York 4.9% *************************** Cameron 0 Columbia 43 Elk 45 Fulton 56

Strokes by County 1899 Allegheny 10.79% 1149 Philadelphia 6.5% 830 Westmoreland 4.7% 829 Bucks 4.71% 807 Erie 4,59% 0 Cameron 6 Columbia 9 Elk 14 Fulton 20 Snyder

Dispatch to Response Cardiac Arrest 90% 14 minutes 50% 7 Minutes Stroke 90% 16 minutes 50% 7 minutes Cardiac Sym 90% 16 minutes 50% 7 minutes

Dispatch to Hospital Cardiac Arrest 54 minutes 90% 24 minutes 50% Cardiac Sym 60 minutes 90% 26 minutes 50% Stroke 57 minutes 90% 26 minutes 50%

90% Response Time to Cardiac Arrest Montgomery County 9.0 minutes Delaware County 9.0 minutes Montour County 10.0 minutes Blair County 10.0 minutes Sullivan County 40 minutes (50% 15 minutes) Fulton County 29 minutes (50% 10.5 minutes)

90% Dispatch to Hospital by County McKean 180 minutes (50% 42.5 minutes) Potter 117 minutes (50% 58 minutes) Greene 105 (50% 42.5) Northumberland 33 minutes (50% 13 minutes) Lehigh 35 minutes (50% 17.5 minutes) Montgomery 38 minutes (50% 18 minutes) Delaware 38 minutes (50% 19 minutes)

Bystander/Witness CPR Blank 42% Blank 45.1% YES 26.6% YES 28.2% NO 24.7% NO 26.3% Unknown 6.3%

Time from witness to start of CPR 50 45 40 35 30 25 20 15 10 5 0 blank (6169) unknown (3791) less then 4 minutes (1390) 4 to 10 minutes (1247) greater than 10 minutes (1057)

Time to Defib by BLS or Public 50 45 40 35 30 25 20 15 10 5 0 blank (6426) unknown (2614) less then 4 minutes (2457) 4 to 10 minutes (1506) greater than 10 minutes (651)

EMMCO West Project 4 Hospitals and 4 EMS Organizations EKG by EMS Provider and transmitted to hospitals

SUSQUEHANNA TIOGA BRADFORD LYCOMING WYOMING SULLIVAN CAMERON WAYNE CLINTON POTTER PIKE McKEAN ELK MONROE JEFFERSON WARREN ERIE MERCER VENANGO CRAWFORD CLARION FOREST MONTOUR LUZERNE LACKAWANNA TIOGA EMMCO West Regional EMS Councils MIFFLIN UNION ALLEGHENY BLAIR WESTMORELAND BEDFORD ADAMS DAUPHIN CARBON LEHIGH FAYETTE GREENE CLEARFIELD FULTON PERRY NORTHAMPTON INDIANA ARMSTRONG CENTRE SOMERSET JUNIATA SCHUYLKILL SNYDER BUCKS LANCASTER YORK LEBANON MONTGOMERY CHESTER DELAWARE FRANKLIN BUTLER LAWRENCE PHILA- DELPHIA CUMBERLAND COLUMBIA BEAVER WASHINGTON CAMBRIA HUNTINGDON BERKS NORTHUMBERLAND

EMMCO West 12 Lead Project 12 Lead EKG EMS Provider Transmitted via 400 MHZ radio system Receiver at hospital, set up to printer for Physician review

Provide information to EMS units Strokes and/or STEMI? Facility Name? 24/7 CT? 24/7 CT Onsite? Special notes? 24/7 Neuro? Neuro Source? RECOMMENDATION LIST ONLY

Pennsylvania Statewide Advanced Life Support Protocols Pennsylvania Department of Health Bureau of Emergency Medical Services Effective November 1, 2008

? Pennsylvania Emergency Health Services Systems Working Together!