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EMSA DISPATCH - June 2013

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Director's Message: Howard Backer, MD, MPH, FACEP

National EMS Week 2013 was May 19-25.

During 2013 EMS Week, we recognized California’s EMS personnel, who provide comfort and life-saving services to individuals in need.

Emergency medical services provide a critical public service and form an integral part of our medical safety net. From trauma to stroke, our network of EMS professionals ensures that quality emergency medical care is only minutes away. In times of community crisis, responders rush to the chaos and provide initial medical services with a focus and determination that set a tone of reassurance and comfort. Moreover, responders often put the welfare of those in need above their own safety, as demonstrated by EMS response to the Boston bombing and the West Texas fire and explosion.

Emergency medical services in California are provided by a mosaic of public, private, and volunteer entities and jurisdictions. They coordinate with public safety agencies, EMS and health agencies, and hospital-based emergency care to provide excellent patient care. The California EMS Authority takes this opportunity to honor and to express our gratitude to the personal sacrifice, professional dedication, and commitment to quality values embodied by EMS professionals throughout California.


Gov. Brown Makes Appointments to California Commission on Emergency Medical Services

Governor Jerry Brown made the following appointments on April 30, 2013:

Linda Broyles, 57, of Coronado, has been appointed to the California Commission on Emergency Medical Services. Broyles has been the continuous quality improvement coordinator at the Regional Cooperative Care Program since 2006 and clinical coordinator at American Medical Response since 2007. She was the base hospital nurse coordinator at Scripps Memorial Hospital La Jolla from 2005 to 2007, and served in various positions at Scripps Mercy Hospital from 1989 to 2005, including base hospital nurse coordinator. Broyles has been a registered nurse since 1977 and a certified emergency nurse since 1990. She is a member of the California Emergency Nurses Association. Broyles earned a Master of Science degree in nursing from California State University, Dominguez Hills. Ms. Broyles replaces Matthew Powers on the Commission.

Richard Johnson, 66, of Mammoth Lakes, has been appointed to the California Commission on Emergency Medical Services. Johnson has been a pediatrician at the Southern Mono Healthcare District since 1996. He has been the health officer at the Mono County Health Department since 2002 and Inyo County Health and Human Services Department since 2006. Johnson has also been a clinical specialist for the Infant Botulism Treatment and Prevention Program at the California Department of Public Health since 2003 and an adjunct professor at Biola University since 1991. He was a managing partner and pediatrician at Pediatric Associates of Pasadena from 1979 to 1996. Johnson is chair of the Public Health Emergency Preparedness and Response Committee for the California Conference of Local Health Officers. He is a member of the American Public Health Association and the National Association of City and County Health Officials. Johnson earned a Doctor of Medicine degree from the Albany Medical College of Union University and a Master of Public Health degree from the University of California, Los Angeles, School of Public Health. Dr. Johnson replaces Dr. David Herfindahl on the Commission.

The Commission on Emergency Medical Services supports the role of EMS agencies to ensure that patients have adequate access to quality emergency medical services, and to ensure the long term stability of these services. The Commission meets quarterly at locations throughout the state to provide advice to the Director of the California Emergency Medical Services Authority and to approve regulations, standards and guidelines developed by the EMS Authority.


EMT and Paramedic Regulation Amendments

By Lisa Witchey

Revised regulations for EMTs and Paramedics became effective April 1, 2013. Both the former and current versions of the regulations are posted on EMSA’s website, along with “marked up” copies of both regulations reflecting the changes.

We thank those who provided comments during the public comment period of the regulation process, ensuring that the changes are clear and necessary.

The EMT regulations involved amendments to the basic scope of practice and training standards. Additions to the basic scope of practice include:

  • Pulse oximetry;
  • Humidifiers;
  • Partial non-rebreathers & venturi masks;
  • Continuous positive airway pressure;
  • Tourniquets and hemostatic dressings;
  • OTC Medications with LEMSA approval;
  • Aspirin

The training standard changes incorporated the National Education Standards and the inclusion of training on hemostatic dressings. Patient contacts were increased from five to ten. Training course hours were increased from 120 hours to a minimum of 160 hours. Training programs have until April 1, 2014 to incorporate the new requirements into their programs; however many approved programs have already amended their course content and increased hours to comply.

The Paramedic regulations underwent significant revisions to the basic and local optional scope of practice, and created a new level of EMS provider: the Critical Care Paramedic.

Additions to the basic scope of practice include:

  • Utilization and monitoring of electrocardiographic devices;
  • External cardiac pacing;
  • Use of perilaryngeal airways;
  • CPAP (Continuous positive airway pressure)/BPAP (Bi-level positive airway pressure)/PEEP (Positive end-expiratory pressure);
  • Use of intraosseous (IO) needles and catheters;
  • Use of laboratory devices, including prehospital point of care testing, including glucose, capnometry, capnography, and carbon monoxide when appropriate authorization is obtained from State and Federal agencies;
  • Performance of nasogastric and orogastric tube insertion and suction;
  • Additional medications: amiodarone, fentanyl, ipratropium bromide, lorazepam, magnesium sulfate, ondansetron

The following two items were removed from the basic scope and placed into the local optional scope:

  • Pediatric intubation;
  • Furosemide

The Critical Care Paramedic (CCP) is a new level of provider, with a distinct scope of practice in addition to the Paramedic scope. To enter a CCP training program, an individual must be currently licensed and accredited in California as a paramedic with three (3) years of basic paramedic practice. The minimum hours of CCP training are 202 hours and are divided into a minimum of 108 hours of didactic and lab and a minimum of 94 hours of clinical training in various clinical areas. After completion of an approved CCP training program, the Paramedic must successfully pass the examination given by the Board for Critical Care Transport Paramedic Certification (BCCTPC), and receive accreditation from the Local EMS Agency.


California Disaster Healthcare Volunteers Participate in Four-State Deployment Tabletop Exercise

On March 28th, California Emergency Medical Services Authority (EMSA) staff led a four state tabletop exercise (TTX) for the interstate deployment of volunteer healthcare professionals (VHP) during a disaster. This Homeland Security Exercise and Evaluation Program (HSEEP)–compliant tabletop exercise included participation from the ESAR-VHP program coordinators from California, Arizona, Nevada, and Oregon. ESAR-VHP is the federally funded Emergency System for Advance Registration of Volunteer Health Professionals program. In California, the ESAR-VHP program is called “Disaster Healthcare Volunteers” (DHV). The TTX gave participants the opportunity to consider a broad range of issues from Emergency Management Assistance Compact agreements and communications procedures to the logistics of identifying, transporting, assigning and tracking volunteer healthcare professionals in a simulated emergency environment.

The exercise utilized a webinar system to enable participants to share visual and oral participation via the internet. The Response Personnel Unit at EMSA hosted the tabletop exercise at EMSA Headquarters in Rancho Cordova, CA. Two representatives from Oregon’s ESAR-VHP Program, “SERV-OR” traveled to Rancho Cordova to participate in person. Representatives from Nevada and Arizona participated from their respective sites.

The scenario involved two separate disaster incidents, one in the northern portion of the state, and one in the southern portion that created a need to request mutual assistance for healthcare professionals from California’s neighboring states. Attendees from the four participating states were led through a facilitated discussion regarding how the ESAR-VHP programs in each state would manage a medical surge requiring VHPs.

This discussion resulted in the identification of a number of actions that will improve the ability of the states to accomplish joint volunteer deployment. The thousands of volunteer healthcare professionals who have registered on the four states’ systems will be a vital resource when states are confronting major disasters requiring a surge of healthcare resources.

This exercise was coordinated by EMSA in partnership with the California Department of Public Health (CDPH).


EMS Authority Developing New Website

By Adam Willoughby

No longer are physical brick and mortar structures the first impressions people experience when reaching out to their government. In an era of ever-present computers, smart phones, tablets and readily accessible Wi-Fi connections, websites are most often the first place people go to when seeking information. Now more than ever, it is critical that websites be well designed, easy to navigate and regularly updated.

EMSA’s current website is based on an antiquated 2004 design, and consequently leaves room for improvement. In the last ten years, there have been myriad advances in mobile technologies, accessible design standards and template organization and design.

Eighteen months in the making, the new 2013 Responsive Design State Template incorporates the most current industry standards, adaptive mobile technologies, and is fully compliant with ADA accessibility requirements. The HTML-5 Responsive Design feature allows for visibility on a standard computer or mobile device. The smart-template responds to the device being used to automatically provide the user with the best view for their screen size and type. In addition, the new template features user-friendly navigation tools, including breadcrumbs and multi-tier subtopics triggered by cursor rollover. The new modern layout conveys a look, feel and experience to the user that is clearer, more intuitive and less “busy.” New social media connections allow users to access the site via social platforms and will afford EMSA the ability to deliver content to broader audiences.

In conjunction with the new website, EMSA will be utilizing a new, dynamic content management system (CMS) that will allow for rapid content updates, trending topics, and the most visited pages to be updated in real-time.

We anticipate transitioning to the new site in mid August of this year. While the URL will remain the same, the layout will be different than what users have become accustomed to over the past nine years. The new layout was designed using a number of sources, including traffic metrics, usability study testers, industry best practices and intra-office consensus. We are confident that visitors to the new site will appreciate the intuitive layout and find the information they seek quickly and easily.


EMS Authority Promotes Children’s Health and Safety

By Lucy Chaidez

Nathan Salomonis and Heather Myers suffered a tragic loss when their 4-month-old son, Milo, died in a child care center in California in 2009. As new parents, they were anxious about leaving their baby in child care and selected a licensed center. They noted that some of the babies in the infant room were sleeping on their stomachs. They asked that Milo be put to sleep on his back and they alerted the staff to the “Back to Sleep” campaign supported by the American Academy of Pediatrics.

On the day Milo died, he had been asleep on his stomach on a small crescent pillow on the floor. The police report said that multiple caregivers were in the infant room that day but no one checked on Milo for about an hour – when he was discovered dead in the infant room play area.

No federal or California law currently requires safe sleep practices for infants in child care.

Preventing SIDS (Sudden Infant Death Syndrome) deaths, such as Milo’s, in child care homes and facilities is one of the reasons the EMS Authority has been working with a statewide team of childrens advocates to review California’s child care practices to improve the health and safety of children who are in licensed child care.

In September 2011, the EMS Authority began participating in the Health and Safety Regulatory Workgroup, a multi-disciplinary team made up of child advocates, child care agencies, and various state department representatives involved in children’s health. The workgroup was assembled by the Department of Defense (DoD) Military Child Care Initiative in conjunction with Child Care Aware® of America, a national child care advocacy agency.

The EMS Authority was chosen to participate because of its role in California child care; EMSA's Child Care Unit oversees the child care training program and is responsible for setting the standards used to train the state’s child care providers in first aid, CPR, and preventive health and safety practices. In the EMSA-approved training, child care providers learn about injury and illness prevention, as well as what to do in a medical emergency.

The work of the regulatory committee includes review of child care regulations, policies, procedures, and data regarding children’s health and safety topics, and development of white papers to create awareness of the problems that exist in child care health and safety and to offer solutions. Solutions are based upon the best practices set forth by the American Academy of Pediatrics.

Nationally, deaths that occur during sleep are the leading cause of death among post-neonatal infants under twelve months of age. Due to research showing that child care settings account for 20% of all SIDS deaths in the United States, infant safe sleep was the topic chosen for the development of the workgroup’s first white paper.

According to the Safe Sleep White Paper, the National Association of Child Care Resource and Referral Agencies (NACCRRA) noted in its 2011 report on child care center licensing regulations that in spite of extensive research and recommendations from organizations like the American Academy of Pediatrics (AAP) and the National Centers for Disease Control and Prevention (CDC), simple life-saving safe sleep strategies that act to eliminate the serious risk factors for SIDS and SUID (Sudden Unexpected Infant Death) are not universally required in child care regulations There are seven states, including California, that do not currently address the issue of safe sleep in child care center regulations.

The Safe Sleep white paper was completed in September 2012 and is currently posted on the Child Care Aware® of America website. The EMS Authority has already made changes in its child care provider training to include the latest guidelines to reduce SIDS and SUID risks in child care homes and centers.

Nathan Salomonis, Milo’s father, who serves on the Regulatory Workgroup stated, “This regulatory committee represents a crucial piece in a much bigger picture, which is the global reduction of infant death due to unsafe sleep conditions, including SIDS."


Paramedic Licensure Renewal

By June Leicht

EMSA is now sending postcards as a reminder to paramedics that their license is due for renewal. The postcard will replace the renewal letter and will save the department over $11,000 annually. The renewal form is now available on our website at www.emsa.ca.gov. Click on the “Paramedics” tab, then click on “Paramedic Forms and Applications.”

If you require instruction or have questions on completing paramedic licensure forms, there are three videos available: In State Initial Application, Out of State Application and the Renewal Application. Links to these videos are also on our website. Click on the “Paramedics” tab, then click on “Paramedic Application Informational Videos.”

The Paramedic Licensure Unit currently reviews the Continuing Education (CE) log on the second page of the renewal application to ensure paramedics meet the minimum requirements as set forth in the Health and Safety Code and Title 22 of the California Code of Regulations, Division 9, Chapter 11, EMS Continuing Education, Article 2. EMSA is currently developing a procedure to randomly audit the CEs that paramedics submit on their renewal applications. The audit process may include, but is not limited to, requesting copies of CE certificates and verifying attendance with the CE providers. It is our responsibility ensure that all paramedics meet the minimum requirements.


EMS Authority Welcomes New Deputy Director

EMSA is pleased to announce that Jennifer Lim joined the Department as the Deputy Director for Policy, Legislative, and External Affairs in May.

Jennifer worked at the California Department of Rehabilitation in charge of Public Affairs since 2009 and served as their acting Chief of Legislation from 2011-2012. While at the Department of Rehabilitation, Jennifer led key external affairs programs, worked with stakeholders, and advised the department on the policy implications of various legislative proposals.

Jennifer received her Bachelor of Arts degree in Industrial and Organizational Psychology from California State University, Los Angeles in 1992 and her Master of Arts degree in Organizational Leadership from Chapman University in 1999.


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