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EMSA DISPATCH - April 2011

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Daniel R. Smiley - Acting Director

April 2011

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EMSA Dispatch at a Glance...
National Registry Exam Pass Rates for California
Welcome to EMSA's New Home
California's Mobile Field Hospital Funding Eliminated
Changes to California's EMS Personnel Training Requirements
A Statewide Trauma System in the Making
EMS Week is May 15-21: What Are Your Plans?
Observations from EMS Enforcement: Document Every Call
Commission on EMS Welcomes New Members and Bid Farewell to Veterans

National Registry Exam Pass Rates for California

California pass rates for both paramedic and EMT National Registry of EMTs examinations continue to top the national averages for the respective examinations. Paramedic examination results are significantly higher than the national averages.

This table shows the cumulative results for all EMT and paramedic training programs in California compared to the national averages.

Attempted the exam

Pass 1st attempt

Pass within 3 attempts

Pass within 6 attempts

Failed all 6 attempts

Eligible for retest

Did not complete within 2 years

Paramedic

National

10,354

71%

82%

83%

0%

17%

0%

California

1,118

85%

93%

94%

0%

6%

0%

EMT

National

66,377

68%

77%

78%

0%

22%

0%

California

10,391

71%

78%

78%

0%

22%

0%

For the full breakout of National Registry pass rates by training program for California, click here.

EMS Law Book 2011

Get your copy of the

2011 California EMS Law Book

This portable yet complete Health & Safety Code Division 2.5 reference in a handy 5.5" x 8.5" booklet that is spiral bound to lay flat is yours for the asking. It includes a thorough table of contents. One book will be mailed per request. while supplies last. Request Here

If you prefer to go paperless, an electronic version that features search capability, links from the table of contents to the relevant section, and a legislative history is posted in Adobe PDF and Microsoft Word formats on our website under Laws, Regulations and Publications.

Welcome to EMSA's New Home

New EMSA Building

EMSA is now located on the 4th floor of this building at 10901 Gold Center Drive in Rancho Cordova.

After 25 years in our little brick building in Sacramento's downtown, the Emergency Medical Services Authority has moved to the suburbs.

When EMSA moved into the old building at the corner of 9th and T Streets in Sacramento in 1991, it was still a relatively new department with just 20 employees. We only used the first floor of the two-story building, which was shared with Capitol Weekly Magazine.

Since that time, the department has been charged with additional responsibilities and the staff has grown proportionately. EMSA now has 69 staff members and another half-dozen or so students and retired annuitants.

"We were bursting at the seams," said Daniel R. Smiley, Acting Director of EMSA who has been with the department since those early days. "For the past several years we've had people sharing desks, working at our response station and working in conference rooms while we planned the move. It was just not sustainable." In addition, the lease has ended on the downtown building and the building is being put up for sale.

"I've worked in this building for 19 years and I'm sad to leave," said Lucy Chaidez who administers the Childcare Provider Training program. "Although the new building is closer to where I live, I'll miss being downtown. The commute from Folsom has been worth it to be close to the shopping and dining opportunities here, but I'll come back to visit with my friends."

Old EMSA Building
EMSA's old office Downtown.

The new office at 10901 Gold Center Drive, Rancho Cordova, which is about a 15-minute drive from downtown, provides EMSA with over 25,000 sq.ft. of space - double the size of the previous office. That is how much room a department EMSA's size actually needs to function efficiently based on standards set and enforced by the Department of General Services.

The new location also has enough conference space to comfortably host large stakeholder meetings at the office. "We expect that eliminating the cost and hassle of parking downtown will offset the distance for those who come to meet with us," said Smiley. Additionally, EMSA now has teleconferencing capability so staff can attend meetings remotely.

Rick Trussell
Rick Trussell is in there somewhere.


Benefits of the new office include a reduced cost per square foot, easy freeway access, proximity to Light Rail service (compared to the downtown location), upgraded information technology infrastructure, and free and ample parking for employees and visitors. Additionally, the building meets state requirements for energy savings and disabled access, which the old building did not.

Rick Trussell, Chief of Administration for EMSA, has been the point person on the relocation effort from the first step of identifying the department's needs and searching for a suitable space. "We have meetings downtown on a regular basis with our parent agency, with the administration, with legislators and with partner organizations, so we did take distance into consideration," Trussell said. "Some of our employees will have a longer commute, but they will also have free parking which is a huge benefit."

Supply Room
Luanne Noiseaux and others had their hands full unpacking the supply room.

Sandy Salaber has been with EMSA for 18 years and says that, although the new location will double her commute time, she is glad to move into a nicer building. Sandy helps administer the California Poison Control System, Emergency Medical Services for Children program, local EMS plan review and regional EMS agency contracting. "Going through all my files was a good experience for me. I couldn't believe how much I had kept," she said. Altogether, the department shredded, recycled, repurposed, archived and disposed of what appeared to be about half the contents of the building.

EMSA is in good company in the suburbs - many state departments are already located along what is known as the Highway 50 Corridor. They include the California Emergency Management Agency, the California Army National Guard, the Department of Child Support Services, the Franchise Tax Board, the Contractors State Licensing Board, the Bureau of Automotive Repair and the Department of Technology Services.

Boxes stacked
As unpacking progresses, Jason McGee stacks some of the hundreds of boxes it took to move us all. The end is in sight.

To make the move more organized, each division was assigned a "relocation team" member who ensured that there was an ample supply of packing materials, recycle bin space, archive boxes and labeling supplies. The team members were Cecile Freeman, Reba Anderson, Robin Adams, Tim DeHerrera, Tom McGinnis, June Leicht, Cheryl Lepley, Virginia Fowler, Lauren Chandler, and Ed Armitage. They worked very hard to make sure the process stayed on track and that every little detail was covered. They did all of this on top of their regular duties, so the rest of EMSA sends them a hearty Thank You.

California's Mobile Field Hospitals become a Casualty of the State Fiscal Crisis

The Governor's proposed 2011/2012 Budget eliminates $1.7 million in funding that sustains the State's Mobile Field Hospitals in response ready condition. This includes vendor management of the supplies and Bio-Medical equipment as well as the rent for the three warehouses where the MFHs are strategically stored. The MFH Program was established in 2006 with the majority of funds, $18.3 million, provided by the State General Fund. Federal funds from the Department of Homeland Security and the Hospital Preparedness Program were provided for hospital equipment and program development to ensure disaster medical preparedness for California's hospital surge needs during catastrophic emergencies. The three (3) hospitals, of 200-beds each, are strategically located in Sacramento, the Bay Area, and Southern California to allow for transportation, set-up and patient treatment processing within 72 hours or less anywhere in the State (ED, ICU and OR ready in about 48 hours) after a disaster.

With the elimination of $1.7 million in funding, EMSA is attempting to identify alternative solutions to sustain the MFH Program. We are working with public partners at the local and state level as well as with private entities to accomplish this goal.

Over 75% or 321 of California's hospitals are located in areas of high earthquake potential according to the California Office of Statewide Health Planning and Development (OSHPD).

OSHPD also reports that these 321 hospitals contain 577 buildings that "pose a significant risk of collapse and a danger to the public" in accordance with seismic safety requirements. There are 56 hospitals within 10 miles of the Hayward fault alone. The Mobile Field Hospitals may augment hospital care or serve as full hospital replacements.Mobile Field Hospital inuse

The MFH Program was designed with an "all-hazards" approach. In addition to earthquakes; floods, fires, pandemics, and man-made events (i.e., industrial or terrorism) may also result in a significant medical or health impact that would generate the need for Mobile Field Hospitals.

Hurricanes Katrina and Rita reinforced the need for a state level response to catastrophic disasters that have significant medical impact and when the hospital infrastructure is damaged.

The Mobile Field Hospitals serve as full General Acute Care Hospitals. They can be transported by ground, sea or air. Each of the three Mobile Field Hospitals contains:

    1. 20 Emergency Department stations
    2. 2 Operating Room stations
    3. 20 Intensive Care Unit beds
    4. 10 Reverse Isolation beds
    5. 170 Flexible medical-surgical ward beds
    6. Digital X-Ray
    7. Point of Care lab testing
    8. Pharmacy
    9. Cascade oxygen system with concentrators to re-supply the oxygen system
    10. 130 ventilators

Personnel (approximately 200 personnel for 24-hour operations) would be utilized from specialized California Medical Assistance Teams (CAL-MATs) and Hospital Administrative Support Units (HASUs).

The Mobile Field Hospitals have been deployed twice for exercises and have been placed on alert four times for potential deployments in California in response to wildfires and H1N1. They have not been deployed for a real world medical mission as California has not had a catastrophic disaster that exceeded available hospital bed capacity in the past four years.

training

Training Hours Change to Incorporate New National Standards

As we move closer to implementing changes in California that will reflect the new "Emergency Medical Services Education Agenda for the Future: A Systems Approach" from the National Highway Transportation Safety Administration, the EMS Authority is revising the EMT and Advanced EMT Regulations to adopt the new education standards and instructional guidelines.

The EMS Authority is also drafting training standards for Emergency Medical Responders (EMR), which is currently referenced in the First Aid Standards for Public Safety Personnel.

In addition to adopting the education standards and instructional guidelines for these three levels, the minimum hours of training will also be changed, those proposed changes are:

EMT - Increased from the current minimum of 120 hours to 160 hours.

AEMT - Increased from the current minimum of 88 hours to 160 hours.

EMR training will be a minimum of 60 hours.

The revisions to the EMT regulations coincide with the National Registry of EMTs transition of their EMT examination to the new instructional guideline content. This transition occurs on January 1, 2012.

In terms of the AEMT Examination, the EMS Authority does not currently require an AEMT to pass the National Registry AEMT examination, however, when the new instruction guidelines are adopted in the AEMT regulation revision, and after a transition period, the NREMT exam will then become California's AEMT certification examination.

The EMS Authority is planning to release the AEMT regulations for public comment at the end of March and the EMT regulations in mid-May.

A Statewide Trauma System in the MakingTrauma Room


Most Americans don't realize that traumatic injury is the leading cause of death for those aged 35 or younger. In fact traumatic injuries are estimated to be responsible for over 161,000 deaths each year in the United States and for an estimated death rate of 55.9 for every 100,000 persons. Children account for 25 percent of all traumatic injuries.

Those statistics bear out the importance of ensuring that emergency medical services are tailored to manage trauma as well as we possibly can. That means getting the right patient to the right place at the right time - and that's what the California Statewide Trauma System is all about.

The National Highway Traffic Safety Administration defines trauma as a serious injury that requires timely diagnosis and treatment by a multidisciplinary team of health care professionals, supported by the appropriate resources, to diminish or eliminate the risk of death or permanent disability. Providing that care depends on an organized, coordinated trauma "system" in a defined geographic area that delivers the full range of care to all injured patients and is integrated with the local medical and public health systems. According to the NHTSA, "The true value of a trauma system is derived from the seamless transition between each phase of care (pre-hospital, hospital, and rehabilitation), integrating existing resources to achieve improved patient outcomes."

In California, the Emergency Medical Services Authority provides statewide coordination and leadership for the planning, development and implementation of local trauma care systems. EMSA responsibilities include the development of statewide standards for trauma care systems and trauma centers, the provision of technical assistance to local agencies developing, implementing, or evaluating components of a trauma care system, and the review and approval of local trauma care system plans to ensure compliance with the minimum standards set by the Emergency Medical Services Authority.

The vision for California is to develop a statewide inclusive trauma system that ensures rapid access to care for all individuals within one hour following major injury. The system focuses on prevention, quality care improvements and rehabilitation to return injured individuals to a productive life. The system is informed by data for policy decision making, and is supported by ongoing funding.

Local emergency medical services agencies (LEMSAs) are responsible for planning, implementing, and managing local trauma care systems, including assessing needs, developing the system design, designating trauma care centers, collecting trauma care data, and providing quality assurance. LEMSAs are not required to implement a trauma system, but if they do, they must follow state regulations and submit a trauma system plan to the EMS Authority for approval. There are currently 72 recognized trauma centers in California.

In 2006, the EMS Authority released the "California Statewide Trauma Planning: Assessment and Future Direction," followed by an implementation guide in 2008. The documents analyze current trauma care in California and make specific recommendations to address limitations. The EMS Authority reviewed and analyzed information related to current trauma care in the state, including statutes and regulations, national standards and guidelines, trauma care costs and losses, and national trauma and emergency care reports and developed recommendations for a statewide system. The objectives are to strengthen trauma leadership, develop a statewide trauma registry, provide trauma system local assistance funding; and education.

The EMS Authority has also established a standing State Trauma Advisory Committee, comprised of some of California's most knowledgeable trauma care experts. Committee members represent the major constituent groups involved in trauma care and the newly formed Regional Trauma Coordinating Committees to advise on trauma care issues and work on the development of a statewide trauma care system.

The EMS Authority hosted the first California Trauma Summit in July 2008 to discuss the history of trauma systems development in California, examine various publications on trauma care systems, and develop a strategy for implementation working groups to improve care for the critically injured patient on a statewide level. Since then, there have been two more trauma summits and a fourth is now scheduled for March 2012 in Los Angeles.

The State Trauma Advisory Committee expert writing group has taken all of the input from these summits and from the RTCC meetings and has been working to develop it into a draft state trauma plan. Once that is complete, the draft document will be made available for public comment. Watch the EMSA Dispatch for updates. In the meantime, for more information, please visit www.emsa.ca.gov/systems/trauma.

EMS Week

EMS Week is May 15-21

The pride EMS professionals feel in their chosen career is clear. EMTs and paramedics throughout California work hard every day to continually improve the level of care they can provide to the people of their communities.

EMS Week was created to give all EMS organizations an opportunity to speak with one loud voice at one time, to get the attention of the public, decision-makers, and the government. For ideas to help your organization recognize EMS Week, the National Association of EMTs has created a website full of information at http://emsweekideas.com/home.

Please let us know how you're celebrating EMS Week so that we can recognize your efforts and share your successes with the rest of our EMS community. Send an email to june.iljana@emsa.ca.gov.

Document Every Call:

Observations from EMS Enforcement

By Dr. Jerry Allison, Medical Consultant to EMSA Enforcement Unit

THE CASE

It has been another long day on the ambulance and you are looking forward to finishing your shift. As you and your partner head back to the station for a crew change you hear on the radio, "Medic 1, respond to an auto vs. bicycle involving a police car at the corner of 1st and Main."

police car

As you arrive on scene you see the police cruiser facing you on the opposite side of the street. There is a bicycle in front of the police car, on the ground. The bike appears remarkably intact. You do not see a patient lying on the ground or anyone that looks like a patient. You observe no blood on the ground, no dent on the cruiser, no signs of a head impact on the windshield. The officer, standing by the car waving to you does not look too excited.

You park the ambulance safely and walk up to the officer. He explains this was a minor accident in which an intoxicated bicyclist ran into the police car. The bicyclist was walking after the incident and is now in the back seat of the patrol car. The officer explains he is going to bring him in for "drunk in public." You are relieved. On the way back to the station you radio in, "canceled en route." Your tell your partner there is no need to file a report as there was no patient contact made.

Six months later the EMS Chief calls you into the office and informs you that a patient from several months back is suing the police department because he sustained a fractured wrist after being hit by the patrol car. The record said you responded to the call, but they cannot find your PCR. The dispatch record says, "cancelled en route." "Do you recall this case?" It has been six months and 500 cases since this incident and you do not recall responding. The Chief says they have a video from the police cruiser showing you walking up to the police cruiser, speaking to the officer, and looking at the patient. The Chief wants to know if you completed a patient care report (PCR) and if you know what the requirements are for completing a PCR.

THE PROBLEM

By now you should have been able to identify several potential medical and legal problems with this scenario. This is just one of many similar cases we investigate at the EMS Authority. Other similar cases include responding to intoxicated patients lying on the ground or in alleys who are later found to have a head injury or hypoglycemia; calls for "assists" back to bed who are later found to have injuries from the fall; other types of motor vehicle crashes, etc.

Documenting the work you do, whether it involves an actual patient, is required under the California Code of Regulations, Title 22, Section 100169 (a)(6)(A). The regulations specify that all EMS responses, regardless of patient contact or transport, require a PCR. Failure to comply with the Health and Safety Code or your local protocols, policies and procedures may result in the charge of gross negligence and subsequent disciplinary action, which could be as severe as revocation of licensure.

As EMS providers, we are given the responsibility of evaluating patients that have been injured or are having an emergency medical condition. The public and other non-medical professionals we work with hold us in high esteem and rely on us to make prudent medical decisions. We have an obligation to provide them and our patients the reassurance they require which can only be made after an adequate history and physical examination. Just as a physician would document their findings after assessing a patient, we must also document our finding, or lack thereof, following our assessment.

Another consequence of this action is the inability to reflect back on this case which occurred last month, last year, or in some cases several years ago. Professionals often respond to numerous calls over the course of a year, or their career. By the time a problem is identified details of the incident may not be available or clear. Patient's perception of the event may change, too. The only way to credibly recall the event is by having a record written at the time of the incident. Wouldn't it have been great if you could have pulled up the PCR, read your documentation, and with or without a jog of the memory state exactly what you saw, what injuries the patient did or did not suffer, and why the patient was not transported?

THE SOLUTION

We believe that California has the best EMS professionals in the country. As such maintaining our EMS workforce is a priority at the Authority. To do this we offer the following suggestions. Remember that all EMS providers on scene have an obligation to the patient, to the rules, and to protect their license. Know your regulations, protocols, policies, and procedures. Whether you are the "junior" or "senior" provider on scene you must do what is right and not be afraid to communicate to your partner because of seniority. Submit a PCR on EVERY case that you respond to, whether you are cancelled en route, on-scene, or the patient has left the scene. At a minimum, complete a basic history and physical exam on every patient contact, whether transported or not.

Most experts will tell you that the documentation on patients not transported should be even more thorough than for those that were transported. If there were unusual circumstances be sure to document those findings, too. Keep in mind that you may need to recall this case in 3-5 years. Any details that may help you recall the incident or describe the situation is important. If this is a legal case involving a criminal, worker's compensation, suspected abuse, etc, be sure to assess and document thoroughly. It is a good idea to look around for additional problems or injuries, and document your negative findings, too.

EMS is the practice of medicine, and documenting your findings, present or absent, is the standard of care.You have an amazing profession and are given tremendous responsibility. If you make "patient first" your motto and your personal "test" then you will rarely have a problem.

Changes to the Commission on EMS

This month we welcomed three new members to the Commission on EMS and said farewell to two Commissioners.

Lou Meyer, Senior Vice President at American Medical Response, has retired from AMR and from the Commission on EMS. Meyer spent 18 years on the Commission as an active participant in the full spectrum of EMS issues. He has held leadership positions as chair and vice chair during his tenure. Meyer has participated on numerous Commission committees including the recent subcommittee to examine the complex issue of EMS transportation with regard to the roles of cities and counties, exclusive operating areas and grandfathering providers into service areas.

We also said goodbye to Helen Najar, who has been a committed public representative on the Commission for the past five years. Helen's dedication to learning about EMS and her efforts to ensure that the layperson's perspective was considered were much appreciated. Najar is a real estate agent in Long Beach where she also serves on the Board of Directors for Goodwill Industries, and on the Los Angeles County Public Social Services Board of Trustees and the Long Beach Police Foundation Advisory Committee.

Jaison Chand, of Fortuna, was appointed to the Commission by Assembly Speaker John A. Perez on February 10th representing ambulance providers. Chand is a paramedic and registered nurse. He has been an EMT and paramedic for City Ambulance of Eureka, Inc. since 1994, and currently serves as the company's Chief Operating Officer. He is also a flight paramedic/RN with Cal Ore Life Flight since 2007. He is an EMT instructor with College of the Redwoods and was previously an instructor in the Humboldt Regional Occupational Paramedic Program. He began his EMS career with the Fortuna Fire Department in 1991 and retired as a chief officer in 2002.

Aaron Hamilton, of Santa Ana, has been appointed to the Commission as a public member by former Governor Arnold Schwarzenegger. He has worked as chief technology officer at GPS Logic since January 2010 and as systems engineer, dispatcher, and emergency medical technician at Care Ambulance Service since 2000. Hamilton previously worked as reserve firefighter and driver-operator at the Orange County Fire Authority from 1998 to 2006.

David Rose, of Livermore, has been appointed to the Commission representing local fire protection by former Governor Arnold Schwarzenegger. He has worked as a fire captain and paramedic for the Santa Clara Fire Department since 2000 and as an emergency medical technician (EMT) instructor since 1993. Rose has worked as an EMT instructor for Mission College in Santa Clara, where he also serves as an EMT training program director. He previously served as a driver, engineer and paramedic for the Santa Clara Fire Department from 1998 to 2000 and as a firefighter and paramedic from 1991 to 1998. Rose worked as a firefighter and paramedic for the South San Francisco Fire Department from 1986 to 1991, and as a mobile intensive care paramedic for Santa Clara Valley Paramedical Services from 1985 to 1986.

Also, Commissioner Jane Smith, who has represented the Calfiornia Rescue Paramedic Association on the Commission since 2008, was reappointed by Senate President Darrell Steinberg through 2013.

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