EMSA DISPATCH - August 2009
Welcome to the inaugural issue of the new EMSA DISPATCH
Over the past year serving as Director of the California Emergency Medical Services Authority, I have placed a priority on communicating effectively with all of our partners. I spent months visiting each of the Local EMS Agencies, continued quarterly meetings of the Director's Advisory Group, and oversaw significant changes to our website to provide more and better information on our efforts. The next step is to broaden our outreach to a greater audience through a newsletter, so the EMSA DISPATCH is born... or I should say re-born.
Though named for the newsletter produced by the EMS Authority in the early 1990s, this is a whole new animal. We're taking advantage of technology to produce timely, interesting news and information for those who are interested in issues affecting emergency medical services in California. Look around, note the many ways you can subscribe or unsubscribe to this e-mail list, forward the newsmail to friends, and jump around from this e-mail message to the full articles that are posted on our website at www.emsa.ca.gov.
In this first issue, we have a wealth of interesting items to share with you but that won't always be the case. So if there's something you would like to see covered, send us a note. I look forward to hearing from you.
R. Steven Tharratt, MD, MPVM
The spring’s H1N1 outbreak that made so much news has not abated from doctor’s offices and hospitals over the summer as a typical flu virus might. It may be on the evening newscast less frequently, but people have continued to contract the virus throughout the summer and throughout the world, and the worst is yet to come with the fall influenza season according to Dr. Steve Tharratt, director of the Emergency Medical Services Authority (EMSA). “We are looking for an upswing in H1N1 cases beginning in the next six to eight weeks. The preparations and implementation of our influenza plans are similar to the approach of a hurricane” he said. “It’s critical that local EMS agencies prepare now.”
Because the virus is new and people do not have immunity, infection rates are expected to be much higher than a regular influenza season. According to the Centers for Disease Control, “Widespread susceptibility to this virus among young persons creates the potential for large numbers of cases with more hospitalizations and deaths among younger age groups than would be expected for a typical routine seasonal influenza virus.”
The California Department of Public Health reports that as of August 5, 2009, there have been 892 H1N1 hospitalizations to date statewide, with 92 deaths and 275 cases requiring intensive care.
In the Southern Hemisphere, where the influenza season is opposite ours, H1N1 infection is having a significant effect on health care capacity and delivery. In some parts of the world, up to twenty-two percent of intensive care beds are being occupied by people with H1N1 Influenza. Hospitals are seeing multi-organ failure and widespread need for ventilators. In Peru and Australia, elective operations are being postponed as health care facilities focus on providing life-saving care to flu victims.
According to Tharratt, providers should be putting Continuity of Operation plans into operation now. “Throughout our health care system, we will need to keep our eye on three elements: capacity, capability and access. We have to make sure we have medical professionals healthy and available to provide care, that we temper spikes in infection locally, and that hospitals and clinics are prepared with resources.”
“We need to be ready for a marathon, not a sprint,” Tharratt said. “Local EMS agencies and providers should be focusing on making sure that policies and procedures are in place for dispatch, patient assessment and use of personal protective equipment.“ This is the time for trainers and continuing education providers to cover the new Cal OSHA standards on airborne communicable diseases and local EMS managers should be ensuring that staff members are trained to avoid infection.
EMSA is currently recommending that all EMS agencies and providers have on hand sufficient personal protective equipment including masks or respirators, gloves and gowns to last for 12 weeks. EMSA will provide ongoing information and guidance to local EMS agencies and providers in the coming weeks, but stressed that the State cannot run this crisis from Sacramento. “This is a bottom-up, long-term, local emergency and local agencies will need to be ready to handle the influx of illness. This is not like a fire – mutual aid won’t be as available because the entire state will likely be involved,” Tharratt explained. “Health care providers need to take the initiative to have a sufficient stockpile to meet their anticipated needs.”
The Commission on Peace Officer Standards and Training (POST) last week unanimously approved the nation’s first “Tactical Medicine Operational Programs and Standardized Training Recommendations.”
The California Emergency Medical Services Authority (EMSA) is responsible for setting the statewide tactical medical standards, which grew from the 2005 SWAT Guidelines that describe the critical role tactical medical personnel play in medical contingency planning as part of the SWAT operational plan.
EMSA Chief Deputy Director Dan Smiley, who spoke at the July 23, 2009 POST Commission meeting in Sacramento, recognized the work of the Tactical Medicine Committee members who spent two years developing and refining the document. ”In today’s asymmetric environment, the need for medical care capability is critical,” Smiley said. “We were pleased to be part of this extraordinary collaborative effort that brought together law enforcement, fire chiefs and ambulance services to define a program for optimal care of officers and victims during special operations.”
The guidelines provide a template for operational programs developed by any public safety agency in California, and are intended to serve as the minimum standard for initial tactical medicine training.
“This is the first such document of its type in the nation and it will undoubtedly set the standard for many other states,” said Ken Whitman of POST. “This is a very significant project that will benefit law enforcement and emergency medical service agencies in California and across our country.”
POST and EMSA would like to extend their gratitude to the law enforcement and emergency medical service professionals who gave of their time and expertise to contribute to the success of this project.
California Ambulance Association (CAA)
California Association of Tactical Officers (CATO)
California Emergency Medical Services Authority (EMSA)
California Fire Chiefs Association (CFCA)
California Highway Patrol (CHP)
Emergency Medical Directors Association of California (EDMAC)
Emergency Medical Services Administrators Association of California (EMSAAC)
Huntington Beach Police Department
Illinois Department of Public Health – Tactical EMS Committee
Los Angeles County Sheriff’s Department
Palm Springs Police Department
San Diego Police Department
San Francisco Police Department
Last December, the first emergency medical services license plate was ordered, starting the clock ticking on a special program to honor and recognize EMS professionals and raise money to benefit causes that are important to EMS providers.
The Department of Motor Vehicles authorized EMSA to administer the specialty license plate as one of a dozen different plates currently available along with the popular Yosemite, Coastal Commission and Kids’ Plates programs. Unfortunately, orders for all specialty plates are suffering along with the economy as a whole and the EMS license plate program is facing an uncertain future.
A minimum of 7500 license plates must be pre-ordered within one year for the license plate program to go forward. For the EMS plates, the deadline to reach that point is December 8th of this year. If this goal is not met, the EMS License Plate opportunity will die. With fewer than 200 applications received so far, the program is in serious jeopardy.
If the 7500 applications target is not met in time, all application fees will be refunded. Once the DMV begins issuing the EMS plates, at least 7500 new or renewal plates must be registered each year or the program will be cancelled.
“This license plate program offers a great opportunity to recognize the important contributions EMS providers make to Californians every day, but we are challenged by bad timing,” said Nancy Steiner, chief of the EMS Personnel Division at EMSA. “It’s really unfortunate that this program coincided with a time when people have little disposable income so that even those who are dedicated to the field of EMS have not been able to make the investment.”
Another contributor to the lack of response may be old-fashioned foot-dragging. “Knowing that the license plate program doesn’t actually take effect until the end of the year, many people may just be waiting to order their plates until the time draws nearer,” explained Dan Smiley, EMSA chief deputy director. “Call it procrastinating or timing it, we expect a flood of orders in the next couple of months.”
EMS license plates cost $50 initially, with a $40 annual renewal fee. You can also get personalized EMS license plates for $90 initially and $70 to renew. For more information and to order your license plates, visit the EMSA website, or contact Adam Morrill at 916-322-4336 x436 or firstname.lastname@example.org.
“EMS professionals as a group are very proud of what they do. They are proud of their training, their experiences and the value that they bring to society,” said Smiley. “With the deadline nearing, I am calling upon all EMTs and paramedics to get their applications in so we can make the license plate a reality in California.”
(L to R) Paul Somerhausen, Steve Sellars, Estelle Rubinstein, Dr. Isaac Ashkenazi, Eytan Elterman, Dr. Tzipi Kahane, Yael Rosenthal, Dr. Steve Tharratt.
The Emergency Medical Services Authority (EMSA), the California Emergency Management Agency (Cal EMA), and the Senate Office of International Relations recently co-hosted a special presentation by a panel of Israeli terrorism and disaster medical response experts. EMSA and Cal EMA staff members were joined by emergency medical response professionals from throughout state government for a two-hour presentation July 20th at the State Operations Center.
The delegation came to share their experience in the area of incident management and medical preparedness and response, focused on recent lessons learned as a result of ongoing violence in Israel, and the application of those lessons to California.
Dr. Isaac Ashkenazi, Retired Chief Medical Officer of the Israeli Defense Force Home Front, spoke about public health preparedness and response to mass casualty/terror incidents. His presentation was a fascinating look at how the government of Israel has developed its response to terror and mass casualty incidents over the past decade. Dr. Ashkenazi is considered one of the world’s foremost experts in medical preparedness for complex emergencies and disasters and that was evident in the depth of his presentation.
Dr. Tzipi Kahane, a Forensic Anthropologist and Liaison Officer at the National Center of Forensic Medicine discussed the challenges of identifying victims while working under tight timelines and within the context of religious faith. She presented information on injury typology, and the role of the forensic center in mass casualty incidents.
Mrs. Estelle Rubinstein, Deputy Director of the Department of Social Work Services at Hadassah University Hospital, gave a thought-provoking presentation on meeting the social and emotional needs of terror victims, including preparedness, incident management, and post-traumatic stress.
Each gave a presentation about the many emergencies Israel has faced in recent history and presented a fresh train of thought in emergency preparedness and management which would be beneficial in applying to emergency situations here such as earthquakes, fires, or a terror attack. Opportunities such as this to share experiences and techniques make us all better prepared for an incident.
Our appreciation to Eytan Elterman and Yael Rosenthal of the Israeli Consulate in San Francisco, to Ezilda Samoville and Paul Somerhausen of the Senate Office of International Relations, and to Steve Sellars and Angela Smith of Cal EMA for their work in making the day valuable for all participants.
In the year since Governor Schwarzenegger signed Assembly Bill 2917, the Emergency Medical Services Authority (EMSA) and our partners have made great progress toward implementing the features of the legislation.
Authored by Assembly Member Alberto Torrico, the statute calls for re-vamping the EMT certification process and procedures, creating a centralized database, and requiring criminal background checks on all EMTs.
EMSA’s EMS Personnel Division, led by Chief Nancy Steiner and Manager Sean Trask, is working with a dedicated team of stakeholder participants that includes:
- California Fire Chiefs Association
- Emergency Medical Services Medical Directors Association of California
- Emergency Medical Services Administrators Association of California
- California Professional Firefighters
- California State Firefighters Association
- California Ambulance Association
- California Paramedic Program Directors
- California Highway Patrol
- State Fire Marshal’s Office
- California Department of Parks and Recreation
- California Department of Forestry and Fire Protection
With the assistance of our expert writing group, we have amended the EMT-I, EMT-II, Process for EMT-I and EMT-II Certification Disciplinary Action, and Paramedic Regulations and created a new Chapter of Regulations called the California EMT Central Registry Regulations. In addition to these regulation revisions, we also amended a draft of Recommended Guidelines For Disciplinary Orders and Conditions Of Probation For EMT (Basic) and Advanced EMT. These draft documents were released for a 60-day pre-public comment period.
Representatives from our stakeholder groups reviewed comments received from the pre-public comment period and made recommendations for further amendments. The draft Paramedic Regulations were made available for public comment from July 17, 2009 to August 31, 2009. The EMT-I, EMT-II, Process for EMT-I and EMT-II Certification Disciplinary Action, California Central Registry Regulations and the Recommended Guidelines For Disciplinary Orders and Conditions of Probation For EMT (Basic) and Advanced EMT will be available for public comment from July 24, 2009 to September 8, 2009.
We are working to upgrade the paramedic licensing system to incorporate the central registry requirements and extend out, through the internet, to the 68 certifying entities to use as their certifying software.
The EMS Authority is also working with the Department of Justice and the certifying entities to establish the process for requesting and receiving criminal background checks on EMTs from the California Department of Justice and the Federal Bureau of Investigation.
As the process of implementing AB 2917 moves forward, we will conduct training and information opportunities to ensure a smooth transition for all of our partners. Please watch the EMSA Dispatch for dates and locations.
by Lisa Schoenthal, Deputy Chief, Disaster Medical Services Division
During the recent Influenza A H1N1 outbreak, nurses, physicians, and other healthcare volunteers who are enrolled in the State’s Disaster Healthcare Volunteers (DHV) Registry provided hundreds of hours of volunteer service to their local health departments.
The DHV Registry enrolls medical and healthcare professionals from 47 different healthcare professions and automatically verifies their licensure with each of the professional licensing boards. “Pre-qualifying healthcare volunteers before an emergency makes it so much quicker and easier to make the best use of their skills when a disaster strikes,” said Jeff Rubin, chief of the Disaster Medical Services Division at the Emergency Medical Services Authority. The division manages the DHV program in conjunction with the California Department of Public Health
Since April 26, 2009, during the height of H1N1 response, more than 900 additional licensed healthcare professionals have completed the DHV registration and verification process. “Although a high-profile crisis like the H1N1 outbreak makes the program more visible, to be most effective we need to maintain a robust volunteer database in advance of an emergency,” said EMSA Director Dr. Steve Tharratt. “Volunteering is critical in our state, and within the DHV program there is a home for every California health professional.”
Some DHV volunteers are also members of a local Medical Reserve Corps (MRC). MRCs are teams of volunteers that train together to serve their communities when needed. The Sacramento Regional Medical Reserve Corps and the Marin Medical Reserve Corps are two examples of volunteers jumping to action. Their MRC Volunteers have assisted local agencies by staffing informational hot-line phone banks, performing epidemiology surveillance and by performing follow ups at local hospital emergency rooms. They have also donated their time and resources to pick-up and deliver specimens to local health departments; perform H1N1 testing at clinics; provide health education; and staff Public Health Department Emergency Operations Centers.
Dr. Asha Devereaux, a long-time Medical Reserve Corps member and disaster healtcare volunteer, says the volunteer program is uniquely positioned to help with a crisis such as widespread H1N1 outbreak. "Membership is comprised of a wide variety of medical specialties and roles including people who can administer vaccines, staff medical shelters, provide public education and, in some cases, backfill hospital needs."
DHV was created in response to lessons learned after September 11, 2001. The use of volunteer healthcare professionals continued to increase after Hurricane Katrina and California’s DHV has become a model for the nation. DHV’s ability to verify licensure before disaster strikes assures that qualified medical and healthcare volunteers will be available when needed.
For more information about becoming a Disaster Healthcare Volunteer please go to www.healthcarevolunteers.ca.gov and register today or contact the California Emergency Medical Services Authority at (916) 322-4336. DHV is managed by the California Emergency Medical Services Authority in partnership with the California Department of Public Health.
The Commission on Emergency Medical Services held its quarterly meeting in Sacramento Wednesday, June 24. Ten of the 15 currently appointed Commissioners were in attendance. The agenda was wide-ranging as many of the Emergency Medical Services Authority’s major projects have seen significant progress over the past quarter.
The meeting began with a report by EMSA Director Dr. Steve Tharratt that included an update on the impact of California’s budget crisis on the EMS Authority. At the time of the commission meeting, a budget had not been signed; however, Tharratt anticipated that the State General Fund contribution for the California Poison Control Program would be reduced by half and funding for regional agencies would not be reduced. Tharratt also provided a report on the H1N1 Influenza A Response followed by questions from commissioners, most of whom were themselves directly involved in the response through their own organizations.
Additionally, Tharratt announced that a new commissioner has been appointed to the Commission on EMS. Dr. Dev A. GnanaDev, of Upland, was selected by Senate Rules Committee to replace Dr. Anmol Mahal, M.D., as the California Medical Association representative. Dr. Ramon W. Johnson, M.D., was reappointed by the Senate Rules Committee to continue to serve on the Commission.
EMSA staff presented to the Commission updates on the EMT 2010 Project, revisions to the EMT-II Regulations, EMS for Children, the Air Transport Task Force, the California Poison Control System and the Statewide Trauma System. The Commission considered and approved revised Do Not Resuscitate (DNR) directives which included a thorough discussion of the form requirements. The next step is for EMSA to consider standards for DNR medallions.
The next Commission meeting will be held on Wednesday, September 23, in San Diego California at the DoubleTree Club Hotel. For an agenda and travel information, go to http://www.emsa.ca.gov/meetings/default.asp or contact Robin Robinson at email@example.com.
Dr. Steve Tharratt, director of the Emergency Medical Services Authority, participated in a briefing for Governor Arnold Schwarzenegger August 19th regarding the H1N1 virus and steps the state is taking to prepare for the upcoming flu season. Also briefing the Governor were California Health and Human Services Secretary Kim Belshé, Department of Public Health Director Dr. Mark Horton, Acting Secretary of the California Emergency Management Agency Matt Bettenhausen, Health and Human Services Agency Associate Secretary Dr. Howard Backer, and Department of Public Health Deputy Director and State Epidemiologist Dr. Gil Chavez. This photo was taken in the Cabinet Room of the Governor’s Office in Sacramento, CA.
In conjunction with UC San Diego Trauma Department, the EMS Authority is hosting the 2nd State-wide Trauma System Summit focusing on the Regionalization of trauma services in California and progression toward a state-wide trauma system. The Summit will be held September 21, 2009 at the Doubletree Club Hotel in San Diego and is free to participants. To register, please email your contact information to Johnathan Jones, RN, BSN, EMSA Trauma Coordinator, at Johnathan.Jones@emsa.ca.gov.
EMS Commissioner Matt Powers, has been elected to a three-year term as the National Director for the Emergency Nurses Association (ENA). Matt is the ENA representative on the Commission on EMS. Contact Matt at firstname.lastname@example.org.
Kaiser Permanente Medical Center South Sacramento became the newest Adult Level II Trauma Center AND Paramedic (Trauma Only) Base Hospital August 1. Congratulations to Kaiser and Sacramento County for successfully coordinating to augment this critical function in the Sacramento area. For details, contact Bruce Wagner, Sacramento County EMS Administrator and Medical Health Operational Area Coordinator at (916) 875-9753 or email@example.com.
Marshall Medical Center was designated as a Level III Trauma Center by El Dorado County EMS Agency on July 28, 2009 becoming the sixty-fifth trauma center in California. Level III trauma centers providee initial stabilization of trauma patients and general surgical coverage. El Dorado County EMS Agency has been studying trauma patient data in their region through the use of data registries and came to the conclusion that a Level III trauma center would decrease mortality and morbidity through organized trauma resuscitation.
The San Francisco Paramedic Association has released the schedule for its upcoming Regional Emergency Medical Conference entitled “The ABC’s of Emergency Medicine.” The event will take place September 24-25 with pre-conference education opportunities September 22-23. For more information, visit www.sfparamedics.org.