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EMSA DISPATCH - December 2009

EMSA Director's Update

The Emergency Medical Services Authority Presents EMS Awards

CEMSIS Training Prepares Local Agencies for System Launch

EMSA Investigator puts his Medical Skills to Work

EMT 2010 Project Update

EMS Commission Approves Do Not Resuscitate Guidelines

Honoring the Fallen

It's Up to You to Stop the Flu

Hands-Only CPR Campaign


EMSA Director's Update
By Dr. Steve Tharratt, EMSA Director

Here at the Emergency Medical Services Authority, we are ending the year on a high note with a number of successes under our belts and having made positive progress on several key initiatives. Although there have been some hills between us and our goals this year – the worst economic crisis since the Great Depression combined with the first widespread public health disaster in our history as a department – it’s been a very productive year for EMSA.

EMT 2010: One of the primary and ongoing priorities at EMSA for the past year has been implementing the provisions of AB 2917 (Torrico). The statute requires the EMS Authority to create a statewide emergency medical technician (EMT) certification process, including criminal background checks and a centralized EMT database, to protect patient safety and ensure statewide consistency in certification and discipline for EMTs by July 1, 2010. I am happy to report that all of the regulations needed to implement the statute were unanimously approved by the Commission on EMS at its December 2 meeting. That was a significant milestone and allows us to focus on the IT and training elements of the project.

As we enter the final stretch toward July delivery, we’re working to upgrade our existing computer systems to incorporate the central registry requirements. An important phase will be a series of roll out meetings throughout the state to introduce all participants to the central registry, certification requirements, investigatory processes, the disciplinary process, and related fees. This has been an immense effort on the part of our EMS Personnel Division, IT staff and stakeholder partners and I applaud the grace and vigor they have demonstrated throughout the process.

Poison Control: Another significant challenge for EMSA this year has been the potential closure of the California Poison Control System due to the fiscal year 2009/10 General Fund reduction of 50% ($2.95 million). With insufficient funding to maintain operations, CPCS planned to cease operating effective November 15, 2009. In an inspiring demonstration of teamwork and creativity, EMSA staff identified and secured a bridge funding source that averted closure of the CPCS using federal dollars. Through the California Managed Risk Medical Insurance Board (MRMIB), we were able to leverage the remaining General Fund appropriation ($2.95 million) to access matching funds through the Healthy Families Program on the basis that CPCS provides vital services to the target population they serve. MRMIB prepared a state plan amendment to the Center for Medicaid Services (CMS) to provide federal match funding of $5.3 million for CPCS program operations.

H1N1: EMSA has been fully engaged in managing California’s medical response to the H1N1 influenza pandemic in close partnership with the Department of Public Health and the Health and Human Services Agency. Under CHHS leadership, EMSA and CDPH are defining the medical and health goals and principles for response to H1N1. EMSA is focusing on EMS system daily operations (dispatch, field care, transport and Emergency Department/Trauma Center).

This response has been the first broad test of the statewide Disaster Medical Response and Mutual Aid Plan (approved by CHHS) and Medical Operations Manual (adopted by the Commission on EMS). EMSA took the lead in development of these documents which are intended to define and guide the medical response to a disaster and the provision of mutual aid assistance to impacted jurisdictions. Building upon EMSA’s work on statewide Medical Operations, CDPH is working with EMSA to develop a Health Operations Manual further defining mutual aid procedures. EMSA and CDPH plan to merge these documents in 2010.

DHV: EMSA’s Disaster Medical Services Division has established and deployed the Disaster Healthcare Volunteers (DHV) system, a web-based registry of credentialed health professionals with real time verification of licensure status. The program now has more than 9000 registrants representing 47 professional license types including doctors, nurses, paramedics, pharmacists, dentists, mental health practitioners, and a range of clinical technicians. Our goal is to enroll 20,000 registered Disaster Healthcare Volunteers so we’re focusing on recruitment and on incorporating the remaining Medical Reserve Corps Units. We also anticipate developing protocols for deploying, tracking, and demobilizing DHV volunteers for deployment intrastate, interstate and during Federal activations and coordination with volunteer health professional/emergency entities.

DHV is being used to support community health education programs as medical and public health operations related to fires, drills and the ongoing H1N1 influenza vaccination effort. Trained DHV System Administrators are in 55 of the 58 counties and 24 Medical Reserve Corps Units. In 2009, county and MRC Units initiated 33 missions involving 249 separate deployments of volunteers.

Despite budget reductions and mandatory furloughs, EMSA staff and managers have remained focused on our objectives and have many accomplishments to celebrate as 2009 closes. Their dedication to doing the best job they can for the people of California, their commitment to our stakeholders and partners, and their pride in making California’s EMS system top notch are the great strengths of the Emergency Medical Services Authority. Thank you all for the work you have done over the past year.


The Emergency Medical Services Authority Presents EMS Awards

The California Emergency Medical Services Authority (EMSA) paid tribute to nine EMS professionals at a meeting of the Emergency Medical Services Commission in San Francisco December 2. The EMS awards are intended to honor noteworthy or exceptional acts and service while working as EMS certified or licensed personnel, administrators, trainers, or volunteers within the EMS system.

EMSA Director Steve Tharratt, M.D., MPVM, presented the EMS Awards for the 2008 year in a brief ceremony acknowledging the accomplishments of each recipient.
“The EMS Awards provide us an opportunity to recognize the outstanding efforts of California’s dedicated emergency medical responders,” said Tharratt. “Some of the recipients have demonstrated a superior level of commitment to improving the emergency medical services system in California and others have made an extraordinary effort to help someone under extreme conditions. All reflect great credit on the profession of emergency medical response.”

The Medal of Valor was awarded to Officer Craig Scott, EMT-P, California Highway Patrol Northern Division, for actions on October 16, 2008, to rescue a child under extreme conditions.

The Distinguished Service Medal was awarded to Donald H. Cheu, M.D., FACS, San Mateo County EMS Agency for providing statewide disaster leadership for more than 30 years.

The Distinguished Service Medal was awarded to David Hoyt, M.D., FACS, University of California, Irvine Medical Center, for providing statewide Trauma system leadership for over 25 years. Dr. Hoyt’s medal was awarded in a separate ceremony at a meeting of the Trauma Advisory Committee (TAC) December 7 in Orange, CA.

The Meritorious Service Medal was awarded to Terry Crammer, R.N. Los Angeles County EMS Agency, for providing educational leadership in paramedic training for more than 18 years. Pictured: EMSA Director Dr. Steve Tharratt (left) and Commission on EMS Chair Bruce Lee (right) present the medal to Terry Crammer (center).

The Meritorious Service Medal was awarded to Jeremiah Glass, EMT-P, of Chico, First Responder EMS, for actions on December 23, 2008, to successfully intervene in a dangerous situation above and beyond the call of duty. Glass was not able to attend the ceremony.

The Inter-Service EMS Recognition Medal was awarded to Officer Scott Lindsay, Ripon Police Department, for providing life-saving treatment on January 27, for a victim of an obstructed airway.

EMS Administrator of the Year was awarded to Barbara Pletz, R.N., San Mateo County EMS Agency, for providing leadership for EMS Education and EMT2010.

EMS Medical Director of the Year was awarded to Joe Barger, M.D., of Martinez, Contra Costa County EMS Agency, for providing leadership on the Statewide EMS Scope of Practice Committee.

EMS Educator of the Year was awarded to Doug Boileau, MBA, EMT-P, of Arcata, North Coast Paramedic Training Program, for providing leadership for EMS education in rural California.

Pictured Below: Officer Craig Scott; Dr. Donald H. Cheu; Terry Crammer (with EMSA Director Dr. Steve Tharratt and Commission on EMS Chair Bruce Lee); Officer Scott Lindsay; Barbara Pletz; Dr. Joe Barger; and Doug Boileau.



CEMSIS Training Prepares Local Agencies for System Launch
By Phillip Leach, EMSA Data Systems Coordinator

After five years of planning and a year of solid work, California’s EMS and Trauma data collection system known as the California Emergency Medical Services Information System (CEMSIS) is a reality.

“The effort to create a comprehensive and unified EMS data collection system for California has been high on our priority list for the past year and, thanks to wonderful cooperation from our partners at the local level, we are pleased to announce the successful kick-off of the CEMSIS-EMS,” said Dr. Steve Tharratt, Director of the Emergency Medical Services Authority.

CEMSIS is an outgrowth of NEMSIS - the National Highway Traffic Safety Administration’s National EMS Information System. The project was funded and developed specifically to correspond with the national database for collecting injured patient data to assist efforts in injury prevention related to traffic safety, but it offers a larger picture of EMS beyond traffic collisions.

“CEMSIS began accepting data from local EMS agencies throughout the state in the first week of December. The data will be used to create a timely, accurate and uniform overview of EMS use and outcomes to assist in policy development, system evaluation, prevention activities, and quality improvement measures.

“In California, data is collected at the local EMS agency level, yet due to variances in local mechanisms for collecting data including selection of data elements and associated definitions, the information collected is not the same across the State,” explained EMSA’s EMS Systems Division Chief Bonnie Sinz. “With CEMSIS providing a uniform data collection system, valuable information regarding care and outcome for patients will be available for use in assessing performance and quality and to inform future policy decisions and directions for EMS and trauma care in California.”

Initially, 15 EMS agencies are participating in the CEMSIS-EMS system, and 15 EMS agencies are participating in CEMSIS-Trauma. The EMS Authority recently completed nine training sessions for 300 participants across the state to introduce local agencies to the EMS component of the CEMSIS system. The training included a visual tutorial of NEMSIS’ national data query and data cube, use of an electronic prehospital data record, how to build a data collection system from the ground up, use of data for surveillance, grant funding opportunities, and how to read and understand the EMS data dictionary. Additionally, each attending agency received free probabilistic matching software to assist in the matching of patient records from divergent data systems.

EMSA would like to thank the presenters who volunteered many hours of their time to help make the training a success:

  • Cathy Ord, RN, EMS Manager, Newport Beach Fire Department
  • John Pringle Paramedic/Firefighter and Program Manager for Electronic Documentation City of San Diego Fire and Rescue
  • Laurent Repass, NREMT-P, QI / Data Program Coordinator, County of Orange Health Care Agency, Health Disaster Management Emergency Medical Services
  • Wendy Weber and Rene Enriquez, Data Managers, NEMSIS Technical Assistance Center in Salt Lake City, Utah
  • Leslie Ray, Senior Epidemiologist for County of San Diego, Health and Human Services Agency, Public Health Services Division, Emergency Medical Services Branch.

Please take the time to visit the EMS Systems page on EMSA’s website at http://www.emsa.ca.gov/systems/default.asp . There you will find valuable information on the California EMS Information System.

CEMSIS Training Class

CEMSIS class in Eureka on October 02, 2009.


EMSA Investigator Puts his Medical Skills to Work

EMS Authority Senior Investigator Ken Bobinski was just outside the city of Angels Camp, enroute to conduct an enforcement interview in Tuolumne County in late November, when he saw a small dust cloud ahead.

As he neared, two elderly women at the side of the road were waving frantically for help. In his marked EMSA emergency vehicle, Bobinski pulled as far onto the narrow shoulder as he could and activated his emergency lights. Hearing that a car was in a ravine ahead with two men injured inside he called 911, grabbed the trauma kit from his vehicle and rushed to help.

Accident sceneThe vehicle had major front end damage, having been stopped by a large oak tree. The front seat passenger, an elderly male who would later succumb to his injuries, had a head injury and an abnormal protrusion on his right hip near the head of the femur. The patient was conscious but his left leg was pinned under the dash and he was in considerable pain.

Bobinski attempted to control the bleeding and assess the situation to inform the dispatch center that the man’s injuries were serious and that extrication would be needed. The Altaville-Melones Fire Chief quickly arrived on scene, followed by two American Legion Ambulances , the California Highway Patrol, Angels Camp Fire Department, and San Andreas Fire Department. Using the Jaws of Life, the man was extricated from the vehicle. He was transported by ambulance to the landing zone in Angels Camp and then flown to Doctor's Medical Center in Modesto. Bobinski assisted the paramedics in setting up the IV, bandaging and carrying the patient up to the roadway. “All the things I did were basic life support skills,” Bobinski said.

Although Bobinski’s focus for the past decade has been on making sure paramedics are following the rules, he spent twenty years as a licensed paramedic. “Before I take one of the EMSA trucks out, I always check the trauma bag to make sure all the equipment is there. That’s just habit,” Bobinski said, but he doesn’t really expect to put his medical skills directly to use on the job.

“As an investigator I do a lot of office work now and a lot of traveling, and my interactions with field personnel aren’t always positive. It was good to interact with the field personnel again on a friendlier basis. The teamwork among those crews was incredible. This was a good reminder to me of what it’s like to be on a crew and to help people directly every day.”


EMT 2010 Project Update
By Sean Trask, Manager, EMS Personnel Division

Seven months remain before the EMT 2010 project is implemented on July 1, 2010 and there is still plenty of work that needs to be done. A significant milestone was reached last week when the Commission on Emergency Medical Services unanimously approved all five sets of regulations implementing the provisions of AB 2917.

The EMS Authority with the assistance of a dedicated group of stakeholders worked diligently for many months to revise multiple chapters of regulations to meet the requirements of AB 2917. The revised regulations cover: Emergency Medical Technician, Advanced Emergency Medical Technician, Paramedic, Disciplinary Regulations and the new Central Registry Regulations and the Recommended Guidelines for Disciplinary Orders and Conditions of Probation for EMT and Advanced EMT.

The EMS Authority has also been working with the 68 certifying entities to assist them in obtaining approval from the Department of Justice (DOJ) to receive state and federal (FBI) criminal background check reports. In order to receive the FBI background checks, a certifying entity must be a governmental agency and must have a specifically worded resolution approved by their governing board. The FBI background checks are a one time report and do not include subsequent arrest notifications. Earlier, the EMS Authority had sent out boiler plate resolution language that was provided by DOJ. Unfortunately after some of the certifying entities had their resolutions approved by their governing board, the FBI did not accept the resolution. This was because the FBI changed the boiler plate language requirement. For those certifying entities whose resolutions have not been approved by their governing board, the EMS Authority recommends contacting DOJ for the most recent language required.

The EMS Authority has learned that certifying authorities have various degrees of approval from DOJ. Some do not receive criminal background checks, some receive the initial background check, but not the subsequent arrest notifications, and some receive both initial and subsequent arrest reports but all certifying authorities need approval for FBI background checks. Several certifying entities have informed the EMS Authority that they have all of their approvals, including FBI. Another requirement from the FBI and DOJ is that joint powers authorities applying for FBI background checks need to submit a copy of their joint powers agreement to DOJ for review. This way DOJ can verify that a joint powers authority is a governmental agency.

The EMS Authority has been receiving questions about “grandfathering” EMTs into the background check process. There are three conditions for an individual to be grandfathered: 1) the individual must have had a state level criminal background check prior to July 1, 2010 for certification or employment purposes, and, 2) The organization receives subsequent arrest notifications, and 3) the organization requiring the background check certifies that the individual is not precluded from certification based on these actions: (a) has committed any sexually related offense specified under Section 290 of the Penal Code; (b) has been convicted of murder, attempted murder, or murder for hire; (c) has been convicted of two (2) or more felonies; (d) is on parole or probation for any felony.

If the individual meets these conditions, they will be grandfathered for the purposes of the criminal background check and will not be required to obtain a new FBI background check. The only time one of these individuals would need to be re-live scanned would be if they change their certifying entity or leave their employer because nobody would be receiving their subsequent arrest notification and they would fall outside the background check system.

For questions about the EMT 2010 Project including the criminal background check requirements, please call Adam Morrill at (916) 322-4336.

For the most updated information about the EMT 2010 project, please visit the EMS Authority’s web page, www.emsa.ca.gov, and click the EMT 2010 Project Status Report link.


EMS Commission Approves Do Not Resuscitate Guidelines
By Sean Trask, Manager, EMS Personnel Division

On June 24, the Commission on EMS approved revisions to the Emergency Medical Services Authority’s (EMSA) “Guidelines for EMS Personnel Regarding Do Not Resuscitate (DNR) Directives.”

DNR policies allow patients to refuse unwanted resuscitation attempts and medical interventions and ensure that a patient’s rights are honored. The EMS Authority’s DNR guidelines were created to guide local EMS agencies in developing their local DNR policies for prehospital providers. This revision provides a much needed update to the DNR Guidelines, which have not been revised since 1993, and adds a new DNR instrument - the Physician’s Order for Life Sustaining Treatment (POLST) Form.

The POLST Form was added to California’s Probate Code as an alternative to the current EMS Authority/California Medical Association Prehospital DNR Form. The POLST Form is a physician’s order that is intended to cross multiple healthcare settings, whereas the other form may not be universally accepted in the hospital setting because the title uses the term “prehospital.”

The POLST Form contains three sections that allow the patient to:

  1. Choose resuscitation or not
  2. Specify other life sustaining treatments such as comfort measures, limited medical interventions, or full treatment
  3. Specify if they want artificial nutrition

The POLST Form is gaining popularity across the nation. Nine states have POLST programs up and running and 23 other states are in various stages of implementing a POLST Form. Even though the POLST Form is a physician’s order, prehospital providers, both ALS and BLS, are reminded to follow their local policies, procedures, and protocols when treating and/or transporting patients with a valid DNR instrument.

The DNR Guidelines identify a minimum of three instruments that would be acceptable by prehospital providers.

  1. The EMSA/ CMA Prehospital DNR Form
  2. The POLST Form
  3. A standard DNR Medallion

In addition, the local EMS agency medical director may approve other documents in their local DNR policy, which may include, but are not limited to:

  1. Physician’s order in a patient’s chart
  2. Physician’s prescription containing the words Do Not Resuscitate, No CPR, or No Code, that contains the patient’s name and is dated and signed by the physician
  3. Advance Health Care Directives

Additional information about EMSA’s DNR Guidelines, DNR instruments or obtaining the EMSA/CMA Prehospital DNR Form and/or the POLST Form are available at the EMS Authority’s web site at www.emsa.ca.gov under the Laws, Regs, Pubs tab, Publications link. Additional information about the POLST Form may be obtained at www.capolst.org.


Bits and Pieces

In Memoriam

Honoring the Fallen
The Emergency Medical Services Authority honors our fallen colleagues Pilot James Bradshaw, 39, of Hawaii, Chief Flight Nurse Clinton Reger, 40, and Chief Flight Paramedic Christopher Ritz, 37, both of Susanville, who died when their Mountain Lifeflight air ambulance helicopter crashed in Hallelujah Junction near Susanville November 14. Our heartfelt sorrow is with their family and friends.

 

“It’s Up to You to Stop the Flu” Campaign
The California Department of Public Health unveiled the first components of a $7.2 million public education campaign aimed at preventingthe spread of H1N1 Influenza. The outdoor components, shown below, will hit streets, busses and bus stops throughout California in all major media markets including Sacramento, San Francisco Bay Area, Central Valley, LA and San Diego beginning Monday, December 7. “We believe this campaign will reach many more Californians including those who may not have access to standard advertising sources like television, radio and Web sites, but do depend on public transportation for day-to-day living,” said Dr. Gil Chavez, CDPH Chief Deputy Director and State Epidemiologist.

American Heart Association Hands-Only CPR Campaign
The American Heart Association just announced a new public service advertising campaign developed with the Ad Council to raise awareness about Hands-Only CPR. “The PSAs send the powerful message that hands can do incredible things, but nothing compares to using them to save a life,” explained AHA Executive Vice President Michael C. Bell. View the ads, download a Hands-Only CPR iPhone app, and learn about the entire “Hands-Only CPR” campaign at www.handsonlycpr.org.

 

Be Careful Out There

“Nearly three-quarters of EMS line-of-duty deaths are from transportation-related accidents... The National Highway Traffic Safety Administration believes the number (of accidents) to be in excess of 8,500 accidents annually, resulting in more than 10,000 EMS injuries, and these numbers are thought to be underreported.” – Borrowed from EMSResponder.com. Read the entire article at Reducing Ambulance Collisions: New Jersey service employs a range of strategies to cut number, severity, cost of accidents.

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