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EMSA DISPATCH - July 2010

July 2010 Has Arrived... EMT Central Registry Debuts

Farewell to Retiring EMSA Staff Members

California's LEMSA Regional Structure

.201 Today & Tomorrow: A Workshop on EMS System Coordination

In Memorium: A Tribute to Fire Chief Mike McGroarty

EMSC National Heroes Award Winners

EMSA Awards Data Collection Grants


July 2010 Has Arrived... EMT Central Registry Debuts

EMT 2010 is now a reality -- the EMT Central Registry was implemented on July 1, 2010. This culminates more than a two year effort by many dedicated people to create a central registry for EMTs and Advanced EMTs (AEMT). Local EMS agencies and certifying entities will utilize this system to certify and recertify individuals as part of a process to ensure consistent and standardized background checks and certification actions. The newly revised EMT, AEMT, Disciplinary Regulations and the new Central Registry Regulations went into effect on June 17, 2010. After certification by a certifying entity, the individual EMT or AEMT will receive a State EMT Card. The State fee for this process is $75 for initial certification and $37 for recertification every two years. Additional local fees may apply.Additionally, a public lookup is now available for all EMT, AEMT, and Paramedic personnel to allow for employers and the public to verify licensure and certification of individuals.

EMT Central Registry
The Central EMT Registry has been configured and customized by EMS Authority staff and our system integrator consultants. The system in use is the MyLicense Office software by System Automation to meet the requirements of the EMT 2010 project. On June 10, 2010 the EMS Authority hosted a meeting for user acceptance testing. This testing was designed to test the new screens for inputting initial certification information, inputting recertification information, and certification action information. With a little bit of practice, inputting a new application for certification took approximately three minutes. The input screens are easy to use and input information. Certifying entities uploaded their EMT certification data between June 25 and 30, 2010. Access the Central Registry Public Look-Up Site at www.centralregistry.ca.gov

EMT Cards
The EMS Authority has created new standardized EMT and Advanced EMT certificate cards that are used by all certifying entities. The information printed on the certificate cards will include the certificate holder’s name, central registry number, the effective and expiration dates, and the status of the certificate. These certificate cards will be printed from the central registry. The central registry will have the text and format preset so that the certifying entity does not have to adjust their printers. The printing information will be in the Microsoft Word format, so as long as the certifying entity has Microsoft Word, they will be able to print to the new certificate cards.

Paramedic Regulations
The revisions to the Paramedic Regulations went into effect on June 18, 2010. The regulations increase the fee for paramedic licensure $35 this year, and an additional $35 on July 1, 2011. Previously, fees have not been increased since initial implementation of paramedic licensure since 1994.

Training
In order to make this implementation possible, the EMS Authority held three two-day rollout meetings in various locations throughout California during April and one in May of this year. The first day of the rollout meetings was dedicated primarily to revisions to the EMT, Advanced EMT, Paramedic, and Central Registry Regulations. The second day was dedicated to a review of the Disciplinary Regulations, investigative processes, and legal issues. The rollout meetings were well attended and were very interactive with the attendees. The various power point presentations used in the rollout meetings are posted on the EMS Authority’s web page under the EMT 2010 Project Information link. The EMS Authority along with our system integrator consultant hosted several just-in-time webinars for Central Registry users for the preproduction period, prior to July 1, 2010. Further webinars in the post production period are planned. The webinars provide training on the central registry’s screens and features. The post production webinars are intended to provide central registry users with additional training and a forum for asking questions after they have had a chance to use the system. The post production webinars dates and times have not been set yet. The EMS Authority recorded the webinars for future training by certifying entity users after the webinars are offered. Certifying entities will be notified by email of the dates and times for the upcoming webinars.

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Farewell to Retiring EMSA Staff Members

This month we are celebrating the accomplishments of several people who have served the people of California well for many years and are now preparing to enjoy the fruits of their labors in retirement. Jeff Rubin, Nancy Steiner, Donna Nicolaus and Donna Westlake have all selected this month to officially step out of their roles with the EMS Authority to focus on other parts of their lives. They will certainly be missed in the office and we are challenged to find high caliber professionals to continue their work.

Jeff Rubin, Chief of our Disaster Medical Services Division, is widely known and respected throughout the state and the nation as a leader in medical response to disasters. He began his career with the state 32 years ago working with rural health programs. In 1982, he joined EMSA’s disaster team and has devoted his professional life to developing and improving our response capability ever since. Over the course of his career, Jeff’s vision and leadership have been instrumental in developing California’s system for medical response to disasters, as well as the training programs and organizational structure needed to make that system efficient and effective. His dedicated efforts have been instrumental in establishing statewide guidelines for disaster medical services planning, response and recovery, a series of annual health and medical disaster exercises, and the nation’s largest registry of volunteer disaster healthcare workers. He worked toward creation of a statewide program of mobile medical assets for rapid, tiered disaster response including the three largest mobile field hospitals in the nation, Ambulance Strike Teams and Disaster Medical Ambulance Support Units for emergency field care and patient transport, and California Medical Assistance Teams of on-call medical professionals and equipment.Jeff’s work has certainly left a legacy for a generation of emergency medical response professionals and his example of dedication will be missed here as we continue to develop, maintain and move forward in our disaster capabilities.

Nancy Steiner retired as Chief of EMSA’s EMS Personnel Division. Her most recent accomplishment is the development and implementation of California’s Central Registry for EMS Personnel, affording up-to-date information to the public on the status of licenses for Emergency Medical Technicians, Advanced Emergency Medical Technicians, and Paramedics, which debuts today. Nancy has worked in state service since 1975 and joined EMSA in 1983 as our Basic Life Support Program Coordinator. For the past 13 years, Nancy has served in management roles in the EMS Personnel Division providing oversight for the development and update of standards for the training, scope of practice, licensure, and discipline of Paramedics, Advanced Emergency Medical Technicians, and Emergency Medical Technicians, as well as the establishment and update of first aid and CPR standards for Day Care Providers, School Bus Drivers, Public Safety Personnel, and Lay Person Defibrillation. Nancy has also provided leadership for EMS nationwide, serving on the Executive Board of the Continuing Education Coordinating Board for Emergency Medical Services, including terms as President and Secretary/Treasurer, to ensure the integrity and quality of continuing education offerings nationwide for all levels of EMS personnel. She has also served on the Executive Board of the National Registry of Emergency Medical Technicians for the national registration of EMS personnel and as the state representative to the National Association of State EMS Officials/National Council of State EMS Training Coordinators to facilitate and promote national consistency in quality training and certification of EMS personnel. Beyond her contributions to EMS policy and management, Nancy will most be missed for her kindness, her consistently positive attitude, and her ability to work effectively with a wide variety of stakeholders.

Donna Nicolaus retired this month as our EMS Systems Manager, where she worked closely with the local EMS agencies to oversee the development and organization of local trauma plans. Donna’s work and commitment to the EMS field has lead to the advancement of local trauma plans throughout California.During her time as EMSA’s Trauma Coordinator, Donna actively worked towards improving California’s trauma plans in all local EMS agencies. Donna led the program that established our current trauma regulations in 1999 and promoted trauma systems that have improved the quality of care for patients throughout the state. Donna also managed the Trauma Care Fund, a multi-year program that awarded millions of dollars each year to local EMS agencies to develop and improve trauma plans. Donna was also responsible for coordinating the distribution of the program’s funds each year.Our EMS Systems Division Chief, Bonnie Sinz, describes Donna as being both her right and left hand due to how knowledgeable and dependable she is. With over 30 years of dedicated service to the people of California, Donna has been an integral piece in California’s EMS system and she will be missed.

Donna Westlake retired this month from our Emergency Medical Services for Children (EMSC) Program. Donna found her passion in the EMSC Program and has played an important role in its development. Between 1991 and 1993, Donna was Project Coordinator for a federally funded EMSC grant used to create a model of EMSC in California. As a result of this work, California’s EMSC plan has been used as a template for other states across the nation when implementing their own EMSC program. Donna has worked closely with the Federal EMSC Program to ensure the continued improvement of EMSC guidelines and the overall care of children in California. Donna also organized EMSA’s annual EMSC Conference. The annual conference brings EMS personnel from all over California to address and discuss vital children’s health issues. Donna’s commitment to the well being of California’s children has been a driving force behind our EMSC program. We are going to miss Donna and her dedication to the EMS field.

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California's LEMSA Regional Structure

In 1983, the California Legislature authorized EMSA to provide funding to local EMS agencies for planning, organizing, implementing and maintaining regional EMS systems. The goal of this program was to take advantage of efficiencies afforded through consolidation of effort, particularly in rural areas with extensive tourism and limited resources. Currently, regional agencies must consist of three or more counties and typically have large coverage areas, low population density, and may sustain heavy tourist traffic.

There are now seven multi-county agencies covering over two-thirds of the state’s geography and providing service to thirty-four counties that have a total resident population of 6,809,509. Last year’s budget provided $2.2 million of state general funding to be distributed to the regional agencies based on a calculation formula which includes a base amount, the number of counties served, and the population of area served.

The benefits of regionalization were recently identified in an Institute of Medicine report indicating that an EMS system should be regionalized in that the neighboring hospitals, EMS, and other agencies work together as a unit to provide emergency care to everyone in that region. The OIM stated that patients should be taken to the optimal facility within the region based on their condition and the distances involved. Regionalization of services directs patients to designated hospitals with greater experience and resources thereby improving outcomes and resulting in reduced costs. Regionalization should be based on logical geographic groupings with complementary patient flow.

The designation of a local EMS agency is the responsibility of a county. Historically, these regional systems have predominantly been contiguous, following patient flow and accessibility to services. However, over the past two years, California’s regional EMS agencies have been undergoing significant change and more change is expected as counties move from one regional agency to another, or opt not to be part of a region at all. Counties have cited dissatisfaction with current regional structure, financial issues, need for increased autonomy, or deciding to function as a single county agency as reasons for making a change.

The result has moved the configuration of regional EMS agencies away from regional areas that are based on logical patient flow, caused fragmentation in the local EMS system, geographically discontiguous regions, diminished efficiencies, and burdened some regions with sudden changes in workload. Half of California’s EMS regions as they exist now are non-contiguous and/or are bisected by geographical barriers.

The EMS Authority is concerned that this is not the most effective use of General Fund assistance. Therefore, we have proposed that we move away from the current entitlement-type process to a grant process that is purposefully developed to support logical, effective geographic regions that will enhance patient care, best utilize resources, alleviate fragmentation, provide stability within the regions, encourage coordination among counties, and ensure efficient use of limited state funding.

EMSA has grouped the counties into seven defined area EMS system groupings based on patient flow and resource use and that entities participate in a competitive grant process to provide as the regional EMS services. In addition, it is proposed that funding be made available to regional agencies that serve rural areas with extensive tourism. This would stabilize the EMS system in California, ensure that regions are logically based on patient flow and resource usage, encourage the counties to work cooperatively, and use the general fund dollars most efficiently by ensuring outcome base usage.

On June 7, 2010, Dr. Steve Tharratt, EMS Authority Director, discussed the framework of these potential changes in funding to regional EMS agencies during his regular address to the EMS Administrators Association annual meeting. Over the next six months, the EMS Authority will develop grant guidance and determine the funding formula with ongoing participation by local EMS agency partners. Grant guidance will be released in December 2010 and grants will be awarded in late-spring 2011.

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.201 Today and Tomorrow: A Workshop on EMS System Coordination

On May 4, 2010, the EMS Authority held .201 Today and Tomorrow: A Workshop on EMS System Coordination at the Radisson Hotel in Sacramento. The workshop was designed to be an educational session to allow EMS system participants to provide information on their views of Health and Safety Code Section 1797.201, particularly relevant to the rights of fire districts to provide EMS service.

The law states: “Upon the request of a city or fire district that contracted for or provided, as of June 1, 1980, prehospital emergency medical services, a county shall enter into a written agreement with the city or fire district regarding the provision of prehospital emergency medical services for that city or fire district. Until such time that an agreement is reached, prehospital emergency medical services shall be continued at not less than the existing level, and the administration of prehospital EMS by cities and fire districts presently providing such services shall be retained by those cities and fire districts, except the level of prehospital EMS may be reduced where the city council, or the governing body of a fire district, pursuant to a public hearing, determines that the reduction is necessary.”

Referred to commonly just as “.201,” this section of the law has been controversial for many years as interpretations of the language vary widely among different interest groups, and the differences of opinion have resulted in several court cases. The workshop gave all parties an opportunity to carefully discuss and respond to the important questions raised now 30 years after passage of the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act (EMS Act) in 1980. Almost 200 people attended including representatives from fire service, the private ambulance industry, local EMS agencies and medical directors just to name a few.

During the morning session of the day long workshop, representatives from various EMS constituent groups were given the opportunity to provide 30 minute presentations to the audience. In the afternoon, four panel discussions were held that gave the audience the opportunity to ask questions of representatives from the fire service, ambulance industry, local EMS administrators and medical directors. The panels discussed the following questions:

  • What is the relevance of .201 today?
  • Is .201 the cause or the symptom of conflict in EMS System design?
  • What are the areas of agreement?
  • What are potential solutions to .201 issues and ideas for improving EMS system coordination?
  • The panel discussions yielded many questions and gave the attendees some good information to consider. All of the presentations and whitepapers are available at http://www.emsa.ca.gov/systems/Transportation/201_Workshop.asp.

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In Memoriam: A Tribute to Fire Chief Mike McGroarty

By Lisa Schoenthal and Ken Martzen

The Emergency Medical Services Authority (EMSA) lost a true hero and friend with the passing of Fire Chief Mike McGroarty on June 7th, 2010. Chief McGroarty remained a Retired Annuitant in the Disaster Medical Services Division at EMSA until his untimely death so that he could quickly deploy if needed for a disaster response. Words can’t express what the heart feels in remembering his warmth, humor, and generous spirit. Chief McGroarty’s expertise and practical approach were second to none and his legacy will never be forgotten.

The following biography was presented at his Memorial Service on June 19th in Corona, California where he was given a full fire service sendoff that included eulogies by several of his fire service brethren, a full honor guard, a piper, and a large display of fire and rescue apparatus. At the end of the service, Chief McGroarty was honored with a Final Alarm service with the bell on the antique fire engine that he had helped to restore. The final bell was tolled out by Chief McGroarty's grandchildren.

“J. Michael McGroarty, 60 who braved disasters around the country and the world to protect the lives of thousands and educated others to protect the lives of countless more, died in his Corona, Calif., home on June 7, 2010, after a hard-fought battle with prostate cancer.

Mike was born Sept 2, 1949, in Los Angeles to Charles and Jane McGroarty. He graduated from Pacifica High School in Garden Grove, and then achieved a bachelor’s degree in public administration from the University of La Verne. He also held associate’s degree in fire technology and paramedical science from Rancho Santiago College, as well as a Lifetime California Community College teaching credential.

Mike gave 27 years of service to the La Habra Fire Department (including 10 years as an emergency medical technician-paramedic, six years as a captain, eight years as a battalion chief, and seven years as fire chief), then retired in 2001 to provide the state the benefit of his lifesaving expertise through the Governor’s Office of Emergency Services as the Deputy Chief, Special Operations, Fire and Rescue Branch.

His titles and the programs he led are too numerous to list, but include the State Urban Search and Rescue Response Program, the State/National Urban Search and Rescue Training Program, terrorism and weapons of mass destruction-related operations, flood and swift water rescues, and Hazmat operations planning.

When large-scale tragedy struck, Mike’s expertise saved lives. He instructed in rescue operations for California’s Office of the State Fire Marshall, the California Office of Emergency Services, and the FEMA Urban Search and Rescue Response System Advanced Task Force. He developed statewide incident management guidelines, consulted on safety protocol, and designed disaster contingency plans for businesses.
Over the years, he responded to emergency situations near and far, including the Leninakan earthquake in Soviet Armenia; the Loma Prieta earthquake; Hurricane Emily; the Northridge earthquake; and the Oklahoma City Federal Building bombing.

Mike cited his most memorable response as coordinating the first wave of California’s Urban Search and Rescue task forces sent to New York City on Sept. 11, 2001. His work there integrated New York Fire Department and FEMA rescue efforts in the face of confusion and extremely hazardous conditions.

Mike retired from the Office of Emergency Services in 2004 and began work as a contract instructor for large scale disaster incident management. True to Mike’s dedication and work ethic; he then took a position at the California Emergency Medical Services Authority as a Retired Annuitant. Mike was responsible for the development of initial EMS criteria, tactics and strategies for the State Terrorism Threat Assessment Center (STTAC) and Medical Threat Analysis, Planning and Response Program.

Mike McGroarty is survived by Dee McGroarty, his one true love and wife of 40 years; son Mike and daughter-in-law Destiny McGroarty; daughter Kelly McGroarty; granddaughter Brittany Sherman; grandson Garrett McGroarty; mother Jane McGroarty; sister Katee Cross; and sister Sue Simonson. True to his proud Irish heritage, Mike valued love, friendship, and loyalty—characteristics he revealed to all who met him. He was often described simply as a hero.”

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2010 EMSC National Heroes Award Winners

Emergency Medical Services Authority team members Bonnie Sinz and Donna Westlake have been recognized by the Federal Emergency Medical Services for Children (EMSC) for their long-standing commitment to developing the EMSC program in California.

The federal EMSC program was created to ensure that all children, no matter where they live, receive proper emergency medical care. Bonnie and Donna received the Project Coordinator/Manager of Distinction Award at the EMSC's annual National Heroes Awards Ceremony held last month in Bethseda, MD.

Donna has served as California's EMSA program coordinator since 2005 and previously held the position from 1993 to 1996. Bonnie is the principal investigator for the California EMSA State Partnership Grant.

Both women have been extremely influential in implementing EMSC activities throughout California. Their more recent accomplishments have included implementing pediatric trauma center regulations and developing guidelines for pediatric interfacility transport programs, interfacility pediatric trauma and critical care consultation, and care of pediatric patients in emergency departments.

The women were also involved in disseminating emergency first-aid guidelines to schools, assessing prehospital pediatric ambulance equipment, creating prehospital pediatric ambulance equipment and creating pediatric disaster preparedness guidelines for hospitals and local EMS agencies.

Bonnie Sinz, an RN involved in EMS since 1972, has been an ardent supporter of EMSA activities long before she joined the team. Bonnie became one of the first Mobile Intensive Care Nurses in California in 1974. Bonnie worked as the Associate Director of the Sacramento-Sierra Valley EMS Agency and as the Senior Program Manager for the Los Angeles EMS Agency prior to joining EMSA. Since coming to EMSA in 2000, she has led the Emergency Medical Systems Division which coordinates EMSA activities in all 31 of California's local EMS agencies and includes such sticky issues as EMS plans, regional development, and EMS data systems. Bonnie has been active in the development of the California EMS Information System (CEMSIS), a 10-year collaborative effort. To her credit, CEMSIS is now beginning to produce data that will help call attention to California's EMSA activities.

Donna Westlake, who just retired from EMSA June 30 after more than 25 years of service to the people of California, has worked in a variety of different roles with EMSA but found her passion working on the Emergency Medical Services for Children program. Throughout her experience here, her focus has returned to the EMSC program.

Over the years, her efforts have led to the introduction and use of Pediatric Education for Prehospital Providers within California, the development of a statewide EMS-trauma database and the instatement of regulation allowing for a full-time EMSA program coordinator. She has also provided longtime oversight to the EMSC Technical Advisory Committee and the EMSA Coordinators Group.

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California EMS Authority Awards $635,000 to local EMS Agencies for Data Collection

The Emergency Medical Services Authority (EMSA) has awarded $635,000 to local EMS agencies statewide to support the development and collection of statewide EMS and Trauma data for the new California Emergency Medical Services Information System (CEMSIS).

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.

“Comprehensive and unified collection of EMS system data is critical to continual improvement of our emergency medical services system in California,” said Dr. Steve Tharratt, Director of the Emergency Medical Services Authority. “CEMSIS is providing valuable information regarding care and outcome for patients that we can use in assessing performance and quality and to inform future policy decisions and directions for EMS and trauma care in California.”

“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. “Coordinating the data collection wouldn’t work without cooperation from our partners at the local level. We recognize that incorporating a new system is resource-intensive, so we are pleased to be able to provide some funding to offset those costs.“

CEMSIS began accepting data from local EMS agencies throughout the state in the first week of December. Initially, 15 EMS agencies are participating in the CEMSIS-EMS system, and 15 EMS agencies are participating in CEMSIS-Trauma.Amounts up to $12,800 were awarded to local EMS agencies to assist in enhancing their electronic systems to be compliant with the CEMSIS database. In addition, many of the participating counties will receive a maintenance stipend to help offset their investment in this important effort. The participating agencies are:

Alameda County
Central California
Coastal Valleys
Contra Costa County
Imperial County Public Health Department
Inland Counties
Los Angeles County
Marin County
Merced County
Monterey County
Mountain Valley
North Coast EMS Agency
Northern California
Orange County
Riverside County
Sacramento County
San Benito County
San Diego County
City and County of San Francisco
San Joaquin County
San Luis Obispo County
San Mateo County
Santa Barbara County
Santa Clara County
Sierra-Sacramento Valley
Solano County
Tuolumne County

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