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EMSA DISPATCH - September 2010

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R. Steven Tharratt, MD, MPVM - Director September 2010
EMSA Dispatch at a Glance...
EMS Authority Hosts Medical Reserve Corps Conference
Tactical Medical Training Levels in California
California's Poison Control System Reduces Healthcare Burden
Announcements
California's Medical Reserve Corps Units Build for the Future
by Brian Bolton, EMSA Response Personnel Unit

Marin Medical Reserve Corps members Maria Kuder, Erin Sicher, Scott Haskins, Jim Yoke, John Hansen, Brian Waterbury and Vivian Cohen. Photo by Brian Bolton, EMSA.
Marin MRC

More than fifty leaders of California's Medical Reserve Corps (MRC) Units gathered at the Shriners Children's Hospital in Sacramento August 18-19 to participate in a dynamic two-day workshop themed "Build for the Future." The focus of the conference was to share strategies and information that will enhance each unit's capabilities and further strengthen the MRC network that California will need when future disasters strike.

Dan Smiley, EMSA Chief Deputy Director, kicked off the event by thanking the MRC leaders for their participation and challenging the group to continue to build upon the successful foundation they have established in forty-three communities across the state. "When California communities are hit by emergency, leaders look quickly to their MRC teams to support the surge in need for emergency medical services," Smiley said.

The EMS Authority serves as the statewide coordinator for the national Medical Reserve Corps program, and evaluates MRC units in California for federal recognition. EMSA also manages the Medical Reserve Corps Advisory Committee and incorporates MRC units in statewide disaster response exercises. Each MRC unit is primarily a resource for their own communities, and they recruit and train independently, however they are also a well-coordinated organization capable of responding to disasters or other medical needs anywhere in the state.

(From lower picture moving back) Brian Waterbury, Lisa Schoenthal, Patrick Lynch, Maria Kuder, Erin Sicher, John Hansen, Christine Erlach and Vivian Cohen.
MRC Meeting
"California's Medical Reserve Corps Program is a model for the nation," said Lisa Schoenthal, EMSA's Chief of Disaster Medical Services. "Having attended recent national meetings, I've heard comments from all quarters about the professionalism and readiness of California's MRCs. All the great work you have done has resulted in the creation of Medical Reserve Corps Units that are the envy of other states," she said.

Schoenthal announced that EMSA is developing two large-scale disaster preparedness and response exercises for 2012 and 2013, which will provide an excellent training opportunity for the MRCs. She also gave the members an update on the many activities of the Disaster Medical Services Division at EMSA, which includes both the Disaster Healthcare Volunteers Program and the State Medical Reserve Corps Program.

The MRC programs in California are all working on standardizing their training, increasing statewide recognition of the MRC as a community asset, and developing detailed plans for crisis care sheltering. "This workshop was a great opportunity to share information and learn of the new directions the MRC is heading," said Steve Johnson, MRC Coordinator in Ventura County.

Members reported they were energized by the sessions and looked forward to implementing some of the information when they returned to their local MRC units. "You folks put on one heck of a great two-day workshop and we appreciate it," said Jim Yoke, MRC Director from Saratoga, CA.

"One of the best MRC Workshop's I've ever attended. Congratulations! The venue was the perfect size and I got a real sense of personal interaction between the attendees. There was some kind of "bonding" that took place among the attendees that I've never experienced at any other MRC event," said Chief Brian Waterbury, MRC Director, Marin County.

Adam Sutkus, Jodie Monaghan, and Nicole Ugarte from the California State University, Sacramento, Center for Collaborative Policy, facilitated the event. Presentations included:
· Austere Medicine: Haiti Case Study - Barbara Morita, PA
· Medical/Healthcare Operational Area Coordinators and Local MRCs - Ed Hill, Regional Disaster Medical Health Specialist, Region V
· Communications: Radio Assets - Jim Yoke, Saratoga MRC Coordinator and Steve Johnston, Ventura County MRC Coordinator
· Pet Care Resources for Veterinary Response - Peter Mundschenk, DVM, California Veterinary Association MRC
· National MRC TRAIN Internet Resources - Ilya Plotkin, MRC TRAIN Administrator
· Deployment Training: A Response Framework for MRC Programs - Mike Ciraolo and Brian Budds of Ciraolo Consulting;
· Recruitment: Social Networking Tools and Policies - Constance Terrell-Peters; Riverside County MRC Coordinator and Diane McClure, DVM, California Veterinary Association MRC
Volunteer Retention: Best Practices - Brian Waterbury, Marin County MRC Coordinator, Lynn Pesely, Sacramento Region MRC Coordinator and Jee Kim, Los Angeles County MRC Coordinator.
Facts about the Medical Reserve Corps
· A Medical Reserve Corps (MRC) is a community-based network of volunteers that assists public health efforts in times of special need or disaster. Members of an MRC may also volunteer their time throughout the year in order to promote community public health and education.
· In order to be effective during times of emergency, volunteers must be organized and trained to work in emergency situations. An MRC meets regularly to provide organizational structure and promote appropriate training of volunteers according to local community needs and vulnerabilities.
· Anyone with an interest in helping their community may volunteer in their local MRC. Volunteers include current or retired health professionals such as physicians, nurses, mental health professionals, dentists, dental assistants, pharmacists and veterinarians as well as other disciplines including social workers, communications/public relations professionals, health care administrators, clergy, etc.
· The Medical Reserve Corps is part of Citizens Corps, a national network of volunteers dedicated to making sure their families, homes and communities are safe from terrorism, crime, and disasters of all kinds. For more information, visit
www.medicalreservecorps.gov.

Find a Volunteer Opportunity that Suits You
There are many ways for healthcare providers to make a difference during their off hours and help their communities during times of great need. Whether you want to be part of an organized, standing unit that trains and prepares on a regular basis, or you just want to make sure your name and skills are on the list of people to be contacted when the call for help goes out, or you are ready to head off to any disaster on short notice, we have a volunteer option for you. Visit Disaster Healthcare Volunteers website at https://www.healthcarevolunteers.ca.gov/ to learn more.

Tactical Medical Training Levels in California

by Michael Duggan

Tactical Medicine TrainingAdrenaline junkies are the foundation of emergency medical services, but for some, it takes more than daily traumas to peg their excitement meter. The truly hard core medics thrive on testing not only their medical skills, but their personal mettle as well. These are just the people law enforcement agencies around the nation are looking for as they add on-scene medical support to their tactical plans.

Tactical medicine is a relatively new discipline in EMS training, but it's certainly not a new idea - there have been medics on the front line in every war. Increasingly, urban tactical law enforcement teams are adapting the concept to ensure immediate life-saving measures are on hand for their own members.

"The distinction between tactical medicine and standard emergency medicine is the concept of providing lifesaving care while under fire and to support the successful completion of the mission at the same time," said Dan Smiley, Chief Deputy Director of the EMS Authority.

Smiley was one of the authors of the state's tactical medicine training guidelines, released last year by the California EMS Authority in conjunction with the Commission on Peace Officer Standards and Training (POST). The partnership between the Commission on POST and the EMS Authority in establishing training standards for tactical medicine highlights the linkage between law enforcement and EMS in a new way.

"Whether peace officers are cross training to add medical skills to their bag, or medics and EMTs are learning the tactical aspects of a SWAT operation, there is a lot to learn in order to become proficient enough to enter a potentially deadly environment where other people are relying on you," Smiley said.

Over the past two decades, a growing demand for tactical medics has resulted in the development of a variety of training programs that range from a one-day introduction to bleeding control and shock to a comprehensive course that covers it all. Because the training options are so varied, EMSA and POST worked together to categorize the different training options and establish standardized minimum curriculum and terminology to improve training consistency.

The guidelines and regulations don't require a one-size fits all approach, but they do regulate how the training is referenced to help perspective students understand what they are getting. Three different levels of medical training in the tactical environment have been established: Tactical First Aid, Tactical Lifesaver, and Tactical Medicine. The chart below provides an overview of what each category entails.

Course Title

Target Audience

Hours of Training

Training

Topics

Scope of Practice

Tactical

First Aid

Law Enforcement Officer

8

Care Under Fire, Basic Hemorrhage Control, Basic Airway Management,

Extraction and Movement of Patients

Tourniquet

Emergency Trauma Dressing

Extraction

Basic Airway

Treat for Shock

Tactical

Life-Saver

SWAT team member or other specialty team member in high risk environment (non-EMT)

24

As above plus,

Tactical Casualty Care Model, Tactical Field Care Principles, Naso-Pharyngeal Airway (NPA), Sucking Chest Wound, Basic Team Movement Scenarios

As above plus

Tactical Casualty Assessment

Airway plus NPA

Occlusive Dressings

Tactical

Medicine

Medical component as part of SWAT team: EMT, Paramedic

or MD

80 hours,

or 40 hours if EMT and prior SWAT

As indicated in POST and EMSA approved Tactical Medicine Guidelines.

As indicated in Guidelines, plus

current certification or licensure,

approved EMS provider, and

local accreditation

Smiley evaluates tactical medicine programs offered in California and determines which meet the standards. "Our focus is on helping training centers correctly categorize the level of training they are providing. Some programs being offered are short-term courses that teach hunters and gun enthusiasts basic skills to be able to respond in a medical emergency, and that's great, but it's not actually tactical medicine by our standard. It's more appropriately termed "tactical first-aid."

Tactical Medicine Training

These distinctions are important for providers of tactical medicine training because California regulations and guidelines require that tactical medicine training programs located in California, or providing training services in California, may not hold themselves out as providing tactical medicine training programs, or any derivation thereof, unless they are approved by POST and EMSA prior to advertising a course. Programs training at the tactical first aid and tactical lifesaver levels do not need to be approved in advance; however, additional requirements for program approval may be necessary if POST or Homeland Security funding is being used.

Although tactical first aid and tactical lifesaver programs do not require approval, EMSA recommends that they follow the minimum training topics and curriculum in the guidelines and the balance between classroom and skills/scenario training should be approximately 50-50.

Photos by June Iljana, EMSA
FAQs about Tactical Medicine Training

Can I teach advanced life support skills to students in a tactical first aid or tactical lifesaver course?
No. As part of these basic instructional areas, programs are strongly advised that teaching of advanced life support topics may constitute a violation of existing Health and Safety Code statutes concerning scope of practice. These advanced life support topics include, but are not limited to, needle decompression of a tension pneumothorax, use of hemostatic agents for severe bleeding, cricothroidotomy for airway control, medication administration, or Intravenous Line insertion.

After I complete a tactical medicine course, do I get a special certification or license as a tactical medic (tactical EMT or tactical paramedic)?
No. At this time, there is no special State specialty certification. The employer is responsible for ensuring that tactical EMS personnel are currently trained at the appropriate level.

Are law enforcement agencies, with a SWAT program, required to implement a tactical medicine program?
No. A law enforcement agency with a SWAT team is not required to have a tactical medicine program. However, the POST SWAT Operational Guidelines and Standardized Training Program Recommendations (2005) recommend that this be incorporated into the SWAT program. If a law enforcement agency elects to have a tactical medicine program, that tactical medical program shall have personnel who are trained as a "TACTICAL EMT", "TACTICAL PARAMEDIC", "TACTICAL PHYSICIAN", and shall have completed an approved tactical medicine class.

Where Can I Get Further Information?
Further information can be obtained from the POST website dedicated to Tactical Medicine Training at http://www.post.ca.gov/Training/Tactical_Medicine/default.asp


California Poison Control Centers Reduce Emergency Visits
By Sandy Salaber, EMSA California Poison Control Center Coordinator


1-800-222-1222
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It only takes a brief moment for the unexpected to happen. And that can seem like a lifetime when your child or loved one has been exposed to a poisonous agent. One call to the California Poison Control System (CPCS) means immediate help; to a paramedic it means time-saving coordination; to a physician it means expert consultation; and to a victim or parents of a child it means life-saving instructions. Having access to expert medical advice is never more important than when a small child suffering from a serious, accidental poisoning is treated.
The Emergency Medical Services Authority is the state department responsible for providing poison control services to Californians. For the past 13 years, EMSA has contracted with the University of California, San Francisco to operate the CPCS, which is financed using a combination of State General Funds; the Healthy Families Program; Federal Poison Control Grants; federal and private sector grants and in-kind support from the University of California system and the host institutions for each poison center. In addition to providing funding, the EMS Authority sets the standards for program operation and oversees the effort.

The CPCS centers are located at and hosted by San Francisco General Hospital, UC Davis Medical Center in Sacramento, UC San Diego Medical Center and Children's Hospital Central California in Fresno/Madera - but a single toll-free number serves all areas of California. By calling 1-800-222-1222 anywhere in California, you can obtain emergency information on: swallowing poison, eye or skin irritation from toxic substances, inhalation of noxious fumes, ingestion of toxic plants, animal, insect, snake and spider bites, food poisoning, drug reactions, attempted suicides, drug overdoses and pet poisoning exposures.
The CPCS operates three toll-free help lines: a public hotline for poison information and advice for managing poison exposure on-site, referrals to health care facilities when necessary and follow-up telephone calls, a medical consultation line for health professionals and a hotline for 9-1-1 emergency dispatchers and fire and police personnel. All operate 24 hours a day, 7 days a week and are answered by highly trained and specialized staff member physicians, pharmacists, nurses and poison information providers. Also available are interpreting services for more than 100 languages and a toll-free TTY help line for use by the hearing and speech impaired.

"No other community healthcare service has the facilities and expertise to monitor the hundreds of thousands of consumer products by which children are unintentionally poisoned every day or to provide the proper advice once a poisoning occurs," said Dr. Stuart Heard, Executive Director of the CPCS. "Healthcare providers cannot possibly keep track of every new medicine on the market, let alone medicines from other countries. The CPCS experts provide this information in just seconds, which can mean the difference between life and death for poison victims both young and old."

According to the California Department of Public Heath's most recent injury data from 2007, poisonings are the most common form of unintentional death in California. The CPCS receives more than 300,000 poison exposure calls each year and has managed nearly 4,000,000 cases since its inception in 1997. The majority of all calls come from residences, and more than half of these calls involve children aged five years and under. Three out of four poison exposures are treated at home preventing unnecessary and costly trips to hospital emergency rooms.
Public education and consumer outreach is a significant function of CPCS, promoting poisoning prevention and awareness. Educational outreach program efforts focus on groups most at-risk for poison exposure (small children and older adults), targeting parents of small children, the elderly and many individuals who generally avoid other healthcare settings. They help individuals and families learn to prevent common household poisonings. The planning, education, and training activities with local, regional and state organizations are a trademark of the statewide CPCS consumer outreach and education program.

"Our greatest challenge with this program is to keep it from being a victim of its own success," explained Dr. Steve Tharratt, EMS Authority Director and a toxicologist who served with the CPCS for twenty years. "The CPCS prevents so many negative outcomes from poisoning that poisoning isn't in the news and isn't seen as a significant problem so funding for the program is at risk each year. Fortunately, our case is easily made when the statistics bear out the fact that the toll-free number reduces hospital visits and, therefore, health care costs."
Announcements
EMS Commission meets September 22nd
The Commission on Emergency Medical Services will meet September 22, 2010 at 10 a.m. at the Doubletree Hotel in San Diego. The agenda and hotel information are available on the EMSA website at http://www.emsa.ca.gov/meetings/2010/09-22-10/default.asp.
Join the Pediatric Surge Professionals Network

A googlegroups listserve has been created to connect pediatric and neonatal, emergency department, and disaster professionals with ideas, information, resources and strategies for supporting regional pediatric and neonatal surge and disaster preparedness throughout California. To join, contact Pat Frost at patricia.frost@hsd.cccounty.us

 

EMS for Children Conference
Plans are underway for the 13th Annual EMS for Children Conference to be held at the Doubletree Hotel in Sacramento November 16, 2010. The agenda and registration form are posted online at http://www.emsa.ca.gov/systems/files/EMSCRegistrationForm.pdf.

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