San Joaquin County Emergency Medical Services Agencyone-time satellite training course from NCTI for...

http://www.sjgov.org/ems

Mailing Address PO Box 220

French Camp, CA 95231

Health Care Services Complex Benton Hall

500 W. Hospital Rd. French Camp, CA 95231

Phone Number (209) 468-6818

Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency

EMS Liaison Committee Thursday, October 13, 2016 at 0900 hours

Health Plan of San Joaquin Community Room

7751 S. Manthey Road French Camp, CA 95231

A G E N D A

1. Call to Order

2. EMS Agency Administrator’s Report

3. System Organization and Management

A. Maddy Fund

4. Staffing and Training A. EMS Personnel B. EMS Training Program C. Enforcement Activity D. SJCEMSA Sponsored Training

5. Communications

A. EMS Policy No. 3202 Medical Priority Dispatch System Assignments

6. Response and Transport A. Emergency Ambulance Performance B. Revisions to Ambulance Agreements and Air Ambulance Agreements

7. Facilities and Critical Care

A. Trauma System B. STEMI Program C. Ambulance Patient Off-load Delays and Mitigation of APOD Clusters D. EMResource Dashboard

8. Data Collection and System Evaluation

A. Continuous Quality Improvement

9. Disaster Medical A. Plausible Threat 2016 Exercise Program B. Regional Disaster Medical Health System Report

10. Hospital and Provider Reports


Liaison Committee Agenda October 13, 2016 of 2

11. Public Comment

12. Next Meeting – Thursday, January 12, 2017 A full agenda packet will not be provided at the meeting. A full agenda packet may be viewed or downloaded from the EMS Agency’s website at www.sjgov.org/ems.








Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: October 6, 2016 TO: EMS Liaison Committee PREPARED BY: Matt Griffin, Accounting Technician I SUBJECT: EMS Maddy Fund RECOMMENDED ACTION: Receive information on the EMS Maddy Fund. FISCAL IMPACT: The EMS Agency’s FY16-17 budget includes revenue of $54,215 for administering the EMS Maddy Fund. By statute administrative fees are capped at 10% of annual Maddy Fund revenue. DISCUSSION: EMS Maddy Fund In 1987, legislature found that emergency medical service providers incurred higher costs for their services than providers of other medical services, but often received little to no payment from patients. In response, the Maddy Fund (SB 12) was established to provide revenue to compensate physicians and medical facilities for emergency services provided to medically indigent patients during the first 48 hours of continuous service. The EMS Maddy Fund is derived from county penalty assessments for various criminal offenses and motor vehicle violations, traffic violator school fees and revenue from taxes on tobacco products deposited in the State’s Cigarette and Tobacco Products Surtax Fund. EMS Maddy Fund revenue, minus administrative costs, is proportioned as follows: 58% for eligible physicians and surgeons in a general acute care hospital providing basic or comprehensive emergency services; 25% to San Joaquin General Hospital for providing disproportionate trauma and emergency medical services; and 17% to the San Joaquin County EMS Agency for capital projects.


EMS Maddy Fund Report EMS Liaison Committee October 6, 2016 Page 2 of 2

FY 2014/15 Physician and surgeon claims are due from providers and payments are disbursed on a quarterly basis. A total of $202,191.38 was disbursed to participating physicians through FY 2014/15 for 10,093 claims.

FY 2014/15 Amount Disbursed

Qtr. 1 $51,663.54

Qtr. 2 $47,375.14

Qtr. 3 $50,353.88

Qtr. 4 $52,798.82

Total: $202,191.38

FY 2015/16 A total of $91,281.70 has been dispersed on 5,312 claims to participating providers through the second quarter of 2015/16. Claims for the third quarter were due from providers on 7/31/16, with a target payment date of 10/31/16.

FY 2015/16 Amount Dispersed

Qtr. 1 $39,211.37

Qtr. 2 $52,070.33

Total: $91,281.70

FY 2016/17 Provider agreements for 2016/17 were sent to participating providers in July 2016. Providers are in the process of returning completed agreements to the EMS Agency so that they will be eligible to submit claims for FY 2016/17.







Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: October 6, 2016 TO: EMS Liaison Committee PREPARED BY: Christine Tualla, EMS Specialist SUBJECT: EMS Personnel Report RECOMMEDED ACTION: Receive information on EMS Personnel activities. FISCAL IMPACT: None DISCUSSION: The following is a summary of the number of EMS personnel currently certified, accredited, or approved to practice in San Joaquin County; and the EMS personnel application activity of the SJCEMSA between January 1, 2016, and September 30, 2016. EMR Certification Total: 41 Applications processed Initial Certification: 17 Re-certification: 6 EMT Certification Total: 750 Applications processed Initial Certification: 84 Re-certification: 260 Reciprocity Certification: 2 Paramedic Accreditation Total: 338 Applications processed Initial Accreditation: 27 Re-accreditation: 126 EMS Dispatcher Accreditation Total: 88 Applications processed Initial Accreditation: 6 Re-accreditation: 41


EMS Personnel Report October 6, 2016 Page 2 of 2

MICN Authorization Total: 44 Applications processed Initial Authorization: 1 Re-authorization: 15 Paramedic Field Internship Authorization Total: 23 Applications processed Initial Authorization: 23 Extended Authorization: 5 Paramedic Preceptor Authorization Total: 36 Allocation by ALS provider organization American Medical Response: 15 Escalon Community Ambulance: 2 Manteca District Ambulance: 6 Ripon Consolidated Fire District: 2 Stockton Fire Department: 9 Tracy Fire Department: 2 Each July, the SJCEMSA accepts applications for Paramedic Preceptor authorization. Applicants are required to complete an eight (8) hour paramedic preceptor training course and be approved by a peer review panel.







Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: October 6, 2016 TO: EMS Liaison Committee PREPARED BY: Christine Tualla, EMS Specialist SUBJECT: EMS Training Programs RECOMMEDED ACTION: Receive information on EMS training programs in San Joaquin County. FISCAL IMPACT: None DISCUSSION: The following is a summary of currently available EMS Training Programs approved by San Joaquin County EMS Agency: Paramedic Training Programs: In September 2015, American Medical Response in San Joaquin was approved to host a one-time satellite training course from NCTI for AMR’s own employee candidates. The didactic and clinical portions of the course are due to be completed by July 2016. Approved EMT Training Programs: Expiration Date: Ripon Consolidated Fire District December 31, 2016 San Joaquin County EMS Agency Continuous Approved EMS Continuing Education Providers: Expiration Date: American Medical Response April 30, 2018 Farmington Rural Fire Protection District May 31, 2018 Lodi Fire Department October 31, 2016 (renewal in progress) Manteca District Ambulance December 31, 2016 Manteca Fire Department May 31, 2017 Montezuma Fire District April 30, 2018 Ripon Consolidated Fire Department December 31, 2016 San Joaquin County EMS Agency Continuous


Training Programs Report EMS Liaison Committee October 6, 2016 Page 2 of 2 Approved EMS Continuing Education Providers: Expiration Date: Stockton Fire Department December 31, 2016 Tracy Fire Department May 31, 2018 EMS Training Status: Health and Safety Code, Division 2.5, Section 1797.208 assigns the local EMS agency responsibility for the approval and oversight of all EMS training programs operating in San Joaquin County. SJCEMSA verifies that new training program applicants and existing training programs meet the requirements of statute, regulation, and SJCEMSA policy. SJCEMSA provides technical assistance to training programs regarding adherence to standards and best practices.







Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: October 6, 2016 TO: EMS Liaison Committee PREPARED BY: Christine Tualla, EMS Specialist SUBJECT: EMS Enforcement Activities RECOMMEDED ACTION: Receive information on EMS Enforcement activities. FISCAL IMPACT: The SJCEMSA is mandated to protect the public health and safety by taking action against an individual’s licensure/certification when necessary. The costs associated with investigations and enforcement is covered by the collection of licensure/certification fees, penalties/fines, and County general fund. DISCUSSION: Active Probation: Emergency Medical Responder (EMR): 0 Emergency Medical Technician (EMT): 4 Emergency Medical Dispatcher (EMD): 2 Active Suspensions: Emergency Medical Responder (EMR): 0 Emergency Medical Technician (EMT): 2 Emergency Medical Dispatcher (EMD): 0 Revocation or denials taken since January 2016: Emergency Medical Responder (EMR): 0 Emergency Medical Technician (EMT): 2 Emergency Medical Dispatcher (EMD): 0 Pending Cases: SJCEMSA has 6 active investigations that may result in disciplinary action.








Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: October 6, 2016 TO: EMS Liaison Committee PREPARED BY: Christine Tualla, EMS Specialist SUBJECT: SJCEMSA Sponsored Training RECOMMEDED ACTION: Receive information regarding SJCEMSA sponsored EMS training programs and continuing education. FISCAL IMPACT: None DISCUSSION: Upcoming training 2017 Spring Prehospital Care Symposium: **Save the Date** the 2017 Spring Prehospital Care Symposium will be held on March 30, 2017, at the San Joaquin County Agricultural Center. Mobile Intensive Care Nurse (MICN) Course: SJCEMSA will hold a MICN course starting October 17, 2016, and ending October 24, 2016. Enrolled: 9 initial MICN applicants Course objective: Upon successful completion of the course the student will be able to: describe the role of the MICN; identify the prehospital management of patients who experiencing various medical and trauma emergencies; describe the scope of practice of various prehospital providers; and, effectively simulate communication between field and base hospital personnel. Course overview: This course is thirty-two (32) hours of training which includes (8) hours of ambulance ride time. This course meets the requirements for initial authorization as a San Joaquin County Mobile Intensive Care Nurse. This course is offered to San Joaquin General Hospital registered nurses that meet the minimum requirements for MICN authorization.


SJCEMSA Sponsored Training EMS Liaison Committee October 6, 2016 Page 2 of 2

Paramedic Preceptor Training Course: SJCEMSA will hold a Paramedic Preceptor Training course on October 26, 2016. Enrolled: 5 initial paramedic preceptor applicants 3 renewal paramedic preceptor applicants Course objective: Upon successful completion of the course the student will be able to: identify preceptor requirements according to CCR Title 22, including documentation; define ALS contacts and the minimum number required by CCR Title 22; describe the student processes through cognitive, psychomotor, and affective domains; identify problem(s) and corrective actions for intern improvement; describe how behaviors can be corrected using various learning styles; establish a positive and supportive learning environment; and, utilize effective counseling techniques. Course overview: This course is an eight (8) hour course. This course meets the requirements for initial authorization as a San Joaquin County Paramedic Preceptor. Course enrollment is limited to personnel that submitted applications during the July 2016 paramedic preceptor application period and had been approved through the paramedic peer review oral board exam.







Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: September 19, 2016 TO: City and District Fire Chiefs FROM: Dan Burch, EMS Administrator SUBJ. Revision of EMS Policy No. 3202, Medical Priority Dispatch System

Response and Mode Assignments for Cards 1-34

I am writing to provide you with an update on the San Joaquin County EMS Agency’s (SJCEMSA) process for revising EMS Policy No. 3202, Medical Priority Dispatch System Response and Mode Assignments for Cards 1-34, a policy first enacted in 2006 and revised on several occasions, most recently in 2014.

On August 30, 2016, I met with several city and district fire chiefs including the president of the San Joaquin County Regional Fire Dispatch Authority. This meeting afforded the SJCEMSA the opportunity to explore the concerns expressed by some cities and fire agencies with the proposed revisions to EMS Policy No. 3202. By all accounts each attendee now has a clearer understanding of the concerns of the fire service and the need for and purpose of EMS Policy No. 3202.

Accordingly, SJCEMSA agreed to make several changes to the proposed revisions specifically to address the concerns raised by the San Joaquin Regional Fire Dispatch Authority. SJCEMSA has also committed to meeting with these same representatives and other interested jurisdictions to review the next version of the draft policy prior to its re-release for public comment. SJCEMSA expects to have a revised draft available for discussion by the end of September with an additional period of public comment occurring in October-November 2016.

I am hopeful that the collaborative nature demonstrated between the county’s fire service leaders and SJCEMSA will continue and enable SJCEMSA to institute the innovations and efficiencies required to sustain a high performing prehospital health care system.

At this time none of the proposed revisions included in the draft policy released for public comment have been implemented by SJCEMSA. However, at the requests of both Valley Regional Communications Center, the County’s designated EMS dispatch center, and the San Joaquin Regional Fire Dispatch Authority, the SJCEMSA authorized each center to begin implementation of the International Academies of Emergency Dispatch (IAED), Medical Priority Dispatch System (MPDS) version 13. Questions regarding MPDS version 13 should be directed to each department’s respective dispatch center.








Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: October 6, 2016 TO: EMS Liaison Committee PREPARED BY: Rick Jones, MPA, EMS Analyst SUBJECT: Emergency Ambulance Performance Report RECOMMENDED ACTION: Receive information on emergency ambulance performance for American Medical Response (AMR), Escalon Community Ambulance (ECA), and Manteca District Ambulance (MDA). FISCAL IMPACT: None DISCUSSION: SJCEMSA’s Report on the Exclusive Emergency Ambulance Provider Contract Compliance for AMR, ECA, and MDA for the months of March and April, 2016, provides an in-depth review of their performance. The County’s contract with these emergency ALS ambulance providers establishes accountability for meeting specific standards and provides SJCEMSA with complete access to data and information on AMR’s operational, clinical, and administrative performance is summarized below. Of particular interest are the reports for AMR which mark the end of AMR’s second, five-year contract period. AMR began providing service under this contract on May 1, 2006 for Zones A, B and C which represent the greater Lodi, Stockton, and Tracy areas respectively. AMR was awarded a new contract to provide service to these same areas (renamed Zones X-1 through X-11) for a period of five years, plus the potential for an additional five years based upon meeting performance standards. The new contract period began May 1, 2016. The detailed version of the compliance reports can be found at the SJCEMSA’s website: www.sjgov.org/ems/www.sjgov.org/ems/transportationcompliancereports.htm.htm. The process for determining response time compliance includes a review of late response exemption requests to determine if a delay in response may be attributed to factors outside of the control of the ambulance provider. If an exemption request is approved (e.g. fog, train crossings, road construction) those responses are not included in response time compliance calculations.



http://www.sjgov.org/ems/transportationcompliancereports.htm

Emergency Ambulance Performance Report EMS Liaison October 6, 2016 2 of 3

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AMR's Combined Response Time Performance

90 Percentile

ResponseTimeCompliance

American Medical Response

AMR’s March and April 2016, combined response time compliance for all ambulance zones met or exceeded the 90th percentile standard set by the County with 92.84% for March and 91.89% for April. AMR exceeded compliance standards in nine (9) of the eleven subzones in both months.

Escalon Community Ambulance

ECA’s March and April 2016, response time compliance met or exceeded the 90th percentile standard set by the County with 95.45% for March and 95.12% for April.

Emergency Ambulance Performance Report EMS Liaison October 6, 2016 3 of 3 Manteca District Ambulance

MDA’s March and April 2016, response time compliance met or exceeded the 90th percentile standard set by the County with 91.58 % for March and 94.50% for April.

Ripon Consolidated Fire District

RCFD’s March and April 2016, response time compliance met or exceeded the 90th percentile standard set by the County with 92.50 % for March and 93.98% for April.

Complete compliance reports for March and April may be viewed or downloaded from the EMS Agency’s website: www.sjgov.org/ems/transportationcompliancereports.htm.

http://www.sjgov.org/ems/transportationcompliancereports.htm







Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: October 6, 2016 TO: EMS Liaison Committee PREPARED BY: Jamie Nielsen, RN, EMS Trauma Coordinator SUBJECT: Trauma System Report RECOMMENDED ACTION Receive information on trauma system activity. FISCAL IMPACT None STATE UPDATE None REGIONAL TRAUMA COORDINATING COUNCIL (RTCC) The northern California RTCC’s next meeting is scheduled for January 11, 2017, in Sacramento, CA. During this quarterly meeting the committee has a focused trauma case review in addition to four (4) subcommittees that report on trauma bylaws, data and performance improvement, ACS-COT verification/system evaluation and prehospital trauma protocols. DISCUSSION On Friday, September 9, 2016, the San Joaquin County EMS Agency (SJCEMSA) imposed a plan of correction on San Joaquin General Hospital (SJGH) in accordance with their trauma center designation agreement. SJCEMSA then acted to temporarily reduce the trauma service catchment area for SJGH in order to reduce the trauma workload on SJGH thereby allowing SJGH administration and medical staff to focus their attention on successfully implementing the plan of correction. SJCEMSA coordinated the temporary change in trauma patient destinations with the Sacramento County EMS Agency and the Mountain-Valley EMS Agency. The imposed plan of correction addresses the overall delivery of trauma services at SJGH including: the management of major trauma patients in the intensive care unit, operating suite


Trauma System Report EMS Liaison Committee October 6, 2016 Page 2 of 5 availability, staffing and availability of qualified personnel in the ICU, and ensuring that all prehospital communications with paramedics are handled by a qualified mobile intensive care nurse (MICN) in the emergency department. On Friday, October 1, 2016, SJCEMSA reduced the trauma catchment area further to direct all major trauma patients to be transported to trauma centers in Sacramento or Stanislaus counties. This action was taken after consultation with SJGH administration over SJGH’s inability to ensure an effective trauma surgeon call panel for the month of October. SJCEMSA is working closely with SJGH to assist them in meeting all trauma service standards. San Joaquin General Hospital Level III Trauma Center An MICN course is being held October 17 through October 27, 2016. Nine (9) San Joaquin General Hospital Registered Nurses are currently enrolled in the course. Upon successful completion of the course, the RN should be able to perform online medical control in accordance to EMS Agency policies. MICN’s must be capable of responding and providing guidance to prehospital care personnel in a variety of situations including patient treatment and destination decisions, mass casualty incidents and disaster management. Trauma Audit Committee (TAC) The most recent TAC meeting, TAC 10, was held Tuesday, October 4, 2016. The committee reviewed 20 trauma cases. The next TAC meeting is scheduled for Tuesday, January 17, 2017. EMS Trauma Case Review (TCR) American Medical Response (AMR) is scheduled to participate in their seventh trauma case review in November hosted by SJCEMSA at AMR Operations. This is a three (3) hour closed session, focused review, that will cover ten (10) 2nd quarter trauma cases of 2016. Each trauma presentation includes the audio notification report to the trauma center, prehospital care report (PCR), trauma patient registry summary, and autopsy if applicable. Trauma Registry Currently the trauma registry has 5,886 patients entered since the start of the trauma program on August 1, 2013.

Trauma System Report EMS Liaison Committee October 6, 2016 Page 3 of 5 TRAUMA SYSTEM PROGRESS REPORT San Joaquin County 2016 Second Quarter Trauma Statistics

Total Number of Trauma Activations by SJGH = 594

Trauma System Report EMS Liaison Committee October 6, 2016 Page 4 of 5

Trauma System Report EMS Liaison Committee October 6, 2016 Page 5 of 5







Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: October 6, 2016 TO: EMS Liaison Committee PREPARED BY: Rick Jones, MPA, EMS Analyst SUBJECT: STEMI System Report – January through June 2016 RECOMMENDED ACTION: Receive information on the STEMI System in San Joaquin County for January through June 2016. FISCAL IMPACT: The San Joaquin County EMS Agency (SJCEMSA) receives $25,000 per year from each designated STEMI center to offset the costs associated with STEMI system planning, implementation, and evaluation. DISCUSSION: The SJCEMSA developed and implemented a system to identify “heart attack” patients experiencing an ST elevated myocardial infarction (STEMI) and to direct these patients to specially designated hospitals staffed and equipped with cardiac catheter laboratories capable of providing immediate “life-saving” intervention. The ability of SJCEMSA to evaluate the STEMI system relies upon data measuring the performance of prehospital and hospital timeliness and adherence to policies and procedures.

The STEMI system of care began with the designation of St. Joseph’s Medical Center and Dameron Hospital as the two STEMI Receiving Centers (SRCs) in San Joaquin County beginning April 1, 2012. The following Quality Indicators, used as a means to measure the effectiveness of the STEMI system in San Joaquin County, rely upon data derived from both prehospital and in-hospital sources. Prehospital Quality Indicators include measurement of the following:

1. Accurate and complete documentation 2. Time spent on-scene


STEMI System Report - January through June 2016 EMS Liaison October 6, 2016 2 of 9

3. Appropriate use of 12 lead ECGs (Pts correctly identified as possible cardiac patients) 4. Identification of STEMI patients (using criteria set forth in SJCEMSA policy) 5. Timely and correct notification of SRCs for patient’s identified as having STEMI 6. Efficacy of ECG transmission

In-Hospital Quality Indicators include measurement of the following:

1. Timeliness of in-hospital STEMI alert in response to prehospital STEMI alert 2. Efficacy of prehospital STEMI identification method (e.g. percentage of false positives) 3. Timeliness of prehospital alert and ED arrival to cath lab/balloon times

Report Parameters Data collected for this report that comprise “N” contains two subsets: 1) Ambulance transports with STEMI patients identified in the prehospital setting and 2) ambulance transports that arrive at SRCs that were not identified as possible STEMI patients in the prehospital setting. When cases from both subsets are included, they can be broken into the following categories: Table 1. Reporting Categories SJMC Dameron True Positive 53 19 False Positive 49 7 Evolving Subsequent 3 0 False Negative 1 1 Atypical Presentation 0 2 True Negative 16 0 NA 11 3 Total 133 32 Cases in the second subset include those reported as True Negative, NA, False Negative, and Evolving Subsequent. True Negative are cases in which the SRC concurred with the prehospital finding of no STEMI. Those reported as NA include a variety of cardiac related but non-STEMI cases. False Negatives and Evolving Subsequent include those cases in which the prehospital ECG did not indicate a STEMI, but was determined to be a STEMI sometime after arriving at the STEMI Receiving Center. SJCEMSA policies, (and this report) primarily focus on how well system participants perform in the first subset. For example, once a patient was identified as a STEMI patient in the prehospital setting, did the ambulance crew provide the SRC with a pre alert in a timely manner, and did the hospital respond by calling an in-hospital STEMI alert in a timely manner?

STEMI System Report - January through June 2016 EMS Liaison October 6, 2016 3 of 9 After removing the cases from the second subset to focus solely on ambulance transports with STEMI patients identified in the prehospital setting, the number of cases is as shown in Table 2: Table 2 Cases with Prehospital STEMI Alerts

SJMC Dameron

True Positive 53 19 False Positive 49 7 Total Prehospital STEMI Alerts

102 26

Map of STEMI Alerts

The adjacent map displays the locations from which potential STEMI patients originated in the prehospital setting as shown in Table 1 above. (Two addresses were not captured in the mapping program).

STEMI System Report - January through June 2016 EMS Liaison October 6, 2016 4 of 9 Reports Ensuring accurate and complete documentation of STEMI patients from the prehospital setting requires a careful review of patient care reports. This review is conducted by staff at the SRCs in consultation with the SJCEMSA EMS Analyst. The EMS Analyst provides feedback to prehospital personnel to improve STEMI documentation, ensure appropriate use of 12 lead ECGs, and whether timely and correct notification of SRCs for patient’s identified as having STEMI has occurred. Time Spent On-Scene

The SJCEMSA policy that directs patient care in the prehospital setting (EMS Policy No. 5719, ALS Chest Pain) directs prehospital providers to “initiate rapid transport to a STEMI receiving center.” The adjacent chart shows the elapsed time from patient contact to the initiation of transport for all patients that were determined to have a STEMI in the prehospital setting.

STEMI System Report - January through June 2016 EMS Liaison October 6, 2016 5 of 9 False Positive Report The false positive rate is an important measure to track in order to determine whether the current reliance on the prehospital ECG monitors provide the best method of identifying

prehospital STEMIs. As shown in the adjacent chart, the data indicates that there has been a significant increase in the false-positive rate during the previous eighteen (18) months. Of those cases in the first half of 2016, in which SJMC received 102 STEMI Alerts from prehospital personnel, there were 49 false positive cases (48%). This is a significant increase (14%) from the previous year in which the false positive rate was 34%. The false positive rate for Dameron

was 7 out of 26 cases (27%) which is an 11% increase from the previous year’s false positive rate of 14.9%. As of the writing of this report there is a high index of suspicion that the increase in the false positive rate is due to software errors in the new Life Pak 15 monitors. The investigation is ongoing. Return of Spontaneous Circulation Per EMS Policy No. 5201, Medical Patient Destination, medical patients with a return of spontaneous circulation (ROSC) shall be transported to the closest STEMI receiving center. SJMC reported (18) eighteen patients transported by ambulance due to ROSC during the first half of 2016. Patient outcomes are categorized below by whether they were determined as non-STEMI or STEMI in the prehospital setting. Non-STEMI in Prehospital Setting

STEMI in Prehospital Setting

1 Expired in Cath Lab 1 Expired in ED 4 ROSC sent to Cath Lab (no lesion found) 2 ROSC in ED (not sent to Cath Lab) 1 ROSC (not a Cath Lab candidate)

2 Expired in ED 3 sent to Cath Lab with successful PCI 3 ROSC in E.D. (determined to be non-STEMI) 1 sent to Cath Lab (found to have total occlusion of RCA)

STEMI System Report - January through June 2016 EMS Liaison October 6, 2016 6 of 9 SRC STEMI Alert Performance Report The premise for alerting a SRC of a STEMI patient in the prehospital setting is to provide the hospital with early notification in order to ensure that the cardiac cath lab team is prepared to provide the care necessary to perfuse the heart and stop heart muscle cell death. The goal is that upon receipt of a STEMI alert from the prehospital setting, the SRCs will immediately call an internal STEMI alert. The two charts below compare SJMC and Dameron Hospital’s In-Hospital STEMI Alert performance during the first half of 2016.

STEMI System Report - January through June 2016 EMS Liaison October 6, 2016 7 of 9

Volume of Percutaneous Interventions (PCIs) via 911 System The number of patients identified in the prehospital setting as STEMI patients exceed the number of patients that receive percutaneous interventions (PCI) due to two primary reasons. First, the identification of STEMI patients in the prehospital setting relies upon the analysis of each patient’s 12-Lead ECG by the computer in each device. Upon arrival at the emergency department at the SRC, the emergency department physician (often in consultation with a cardiologist) performs an in-hospital 12-lead ECG and either confirms or cancels the SRC STEMI alert. Second, some patients that are confirmed at the SRC as a STEMI patient may not be candidates for PCI for a variety of reasons related to their particular medical condition. SJMC received 102 STEMI alerts and performed 45 PCIs from January through June 2016 as a result of cases received through public access via the 911 system. Dameron Hospital received 28 STEMI alerts and performed 17 PCIs during the same time period.

STEMI System Report - January through June 2016 EMS Liaison October 6, 2016 8 of 9 Door to Balloon Times

Data used in the two adjacent charts include all cases in which an ambulance transported a patient from the prehospital setting to an SRC but is not limited to those cases in which a STEMI alert was initiated in the prehospital setting. These charts include data from subset 1 and subset 2.

Dameron Hospital and SJMC consistently meet or exceed the ACC/AHA < ninety (90) minute the door to balloon time interval minimum standards

STEMI System Report - January through June 2016 EMS Liaison October 6, 2016 9 of 9 Transmission of ECGs from the Prehospital Setting To minimize on-scene delays in the prehospital setting, current SJCEMSA policy does not require that prehospital personnel transmit an ECG to the SRC. Instead, paramedics are

encouraged to transmit ECGs to the SRC while enroute. During the first half of 2016, ECGs were transmitted to Dameron twice (out of a total of 28 prehospital STEMI alerts). ECGs were transmitted to SJMC 51 times out of a total of 102 prehospital STEMI alerts as shown in the adjacent graph.







Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: October 6, 2016 TO: EMS Liaison Committee PREPARED BY: Shellie Lima Regional Disaster Medical Health Specialist (RDMHS) SUBJECT: EMResource (Intermedix) Report RECOMMENDED ACTION: Receive information on EMResource (Intermedix). DISCUSSION: Since 2007, San Joaquin County EMS Agency (SJCEMSA) has administered the EMResource (formerly EMSystem) via a Memorandum of Understanding for ten counties within Region IV (Amador, Calaveras, El Dorado, Nevada, Placer, Sacramento, San Joaquin, Stanislaus, Tuolumne, and Yolo). EMResource is a web-based communication solution that provides day-to-day hospital resource bed availability reporting, ensuring appropriate patient transport decisions during multi-casualty incidents and reporting of Hospital Available Bed (HAvBED) status. As the EMResource administrator SJCEMSA provides new user logins, maintains the program interface, provides train-the-trainer solutions for other partnering Local EMS Agencies (LEMSAs), and endeavors to ensure EMResource meets the needs of the LEMSAs in Region IV. Modifications to the program are presented and agreed upon during quarterly Region IV Medical Health Mutual Aid Advisory Committee meetings. A total of 32 hospitals participate in the Region IV viewing area. SJCEMSA has completed the interface between EMResource and the Valley Regional Emergency Communications Center (VRECC). This interface allows real time ambulance resource data to display in the EMResource system for each hospital in San Joaquin County. As designed, EMResource receives updates once a minute from VRECC creating an information dashboard for receiving hospital displaying (figure 1):

Number of ambulances enroute to each hospital.

Number of ambulances that have arrived at each hospital.

The average wait time (off-load time) of all ambulances that have arrived at the hospital and are waiting to off-load patients.


EMResource (Intermedix) Report October 6, 2016 Page 2 of 2

The maximum wait time (off-load time), meaning the wait time of the ambulance that has been waiting the longest at the hospital to off-load a patient.

Figure 1 - Screen shot from EMResource







Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency DATE: October 6, 2016 TO: EMS Liaison Committee PREPARED BY: Phillip Cook Disaster Medical Health Specialist SUBJECT: Plausible Threat 2016 Exercise Program RECOMMENDED ACTION: Provide an overview of the Plausible Threat 2016 exercise program. FISCAL IMPACT: Estimated $40,000 to be funded through the FY 2016-17 Hospital Preparedness Program Grant DISCUSSION:

I. OVERVIEW

The Plausible Threat 2016 Exercise Program is designed to establish a learning environment for players to evaluate and exercise emergency response plans, policies and procedures as they pertain to the consequences of an active shooter/hostile event. The exercise program consists of the following discussion based and operations based exercises:

1. Tabletop Exercises – Designed to discuss and evaluate the San Joaquin County Active Threat Plan in response to a simulated active shooter/ hostile event.

a. Field Operations – August 8, 2016

b. Control Facility Operations – August 11, 2016

c. Multi-Casualty Branch Operations – August 23, 2016

All exercise materials are available on the EMS Agency Active Threat webpage https://www.sjgov.org/ems/activethreatplan.html#Exercises

2. Functional/Full-Scale Exercise – The purpose of this exercise is to evaluate the San Joaquin Operational Area’s ability to respond to, manage and mitigate an active shooter/hostile event.


https://www.sjgov.org/ems/activethreatplan.html#Exercises

Plausible Threat 2016 Exercise Program EMS Liaison Committee October 6, 2016 Page 2 of 2

Exercise Dates

November 16-17, 2016

Scope

This exercise will be Full-Scale Exercise (FSE) in the field (November 16, 2016) and a Functional Exercise (FE) at all other venues, planned for two consecutive days. Day two of the exercise will focus upon information sharing between healthcare facilities, the San Joaquin Operational Area, Region IV, and the California Medical and Health Coordination Center. Local exercise play is limited to the San Joaquin Operational Area.

Mission Area Response

Core Capabilities

Operational Coordination Operational Communications On-scene Security, Protection, and Law Enforcement Public Health, Healthcare and Emergency Medical Services Situational Assessment

Threat or Hazard

Active Shooter

Scenario An active shooter incident occurs at a large commercial business located in the unincorporated area of San Joaquin County, resulting in multiple causalities.

Sponsor San Joaquin Operational Area Healthcare Coalition

Participating Organizations

Ambulance Providers, Behavioral Health, Clinics, Disaster Control Facilities, Emergency Medical Services Agency, Fire Service, Hospitals, Law Enforcement, San Joaquin County Unit of the California Disaster Healthcare Volunteers, San Joaquin County Office of Education, California Emergency Medical Services Authority, and California Department of Public Health.







Fax Number

(209) 468-6725

San Joaquin County Emergency Medical Services Agency

DATE: October 6, 2016 TO: EMS Liaison Committee PREPARED BY: Shellie Lima Regional Disaster Medical Health Specialist (RDMHS) SUBJECT: RDMHS Region IV Grant Report RECOMMENDED ACTION: Receive information on the Regional Disaster Medical Health Specialist (RDMHS) Region IV FY 2016-17 Grant. DISCUSSION: Since 1994, the San Joaquin EMS Agency (SJCEMSA) has received State grant funds to enhance medical mutual aid services and disaster preparation in San Joaquin and 10 other counties make up OES Region IV (Alpine, Amador, Calaveras, El Dorado, Placer, Nevada, Sacramento, Stanislaus, Tuolumne, and Yolo). These services and staff funds have promoted the standardization of regional disaster response services, as well as provided for joint planning and training for pre-hospital, hospital, and public safety personnel. The grants have funded the RDMHS position within SJCEMSA to support disaster coordination in Region IV, and to fulfill the objectives of the grants. These efforts have been successful in promoting disaster planning and response, as well as promoting inter-county cooperation. The State has a long-term commitment to this program. SJCEMSA was awarded a base allocation of $110,000 for FY 2016-17 RDMHS Region IV Grant. The contract has been signed by San Joaquin County Board of Supervisors and awaits final processing by the California EMS Authority. A copy of the proposed Scope of Work follows. The grant period for FY 2016-17 is July 1, 2016, through June 30, 2017.

Regional Disaster Medical Health Specialist (RDMHS)

FY16/17 Contract Scope of Work The Regional Disaster Medical and Health Specialist (RDMHS) is the component of the Regional Disaster Medical and Health Coordination (RDMHC) Program that directly supports regional preparedness, response, mitigation and recovery activities. Activities to assist in accomplishing this shall include:


RDMHS Region IV Grant Report October 6, 2016 Page 2 of 5

1 Continue to support the implementation of the California Public Health and Medical Emergency Operations Manual (EOM).

1.1 Conduct and/or participate in local and Regional EOM trainings. When possible, work with new EOM instructors to co-facilitate trainings. 1.1.1 Invite State partners that are based locally to participate,

when appropriate, in EOM trainings. 1.2 Provide input as requested on the EOM during the update process, including

improvement to the Situation Report. Seek input from local partners on EOM improvement opportunities during the update process.

2 Assist in the development of a comprehensive Medical Health Operational Area Coordination (MHOAC) program in each operational area within the region.

2.1 Conduct training for Medical Health Operational Area Coordinators (MHOACs) and other medical and health partners in the operational areas as needed.

2.2 Assist operational areas in developing contact lists to support the functions of a MHOAC program.

2.3 Provide updated MHOAC contact list to Emergency Medical Services Authority (EMSA) Program Lead on a monthly basis.

2.4 Assist operational areas in developing local Situation Report distribution procedures consistent with the EOM.

2.5 Assist operational areas in developing local Resource Requesting procedures consistent with the EOM.

2.6 Assist the Emergency Medical Services Administrators’ Association of California (EMSAAC), EMSA and CDPH with the development of a MHOAC Program Guide.

3 Continue to develop the Regional Disaster Medical and Health Coordination (RDMHC) Program.

3.1 Develop and maintain RDMHC Program Response Procedures. Procedures to include contact lists, medical and health agreements within region (i.e., automatic aid agreements, cooperative assistance agreements).

3.2 Conduct at least three medical and health regional planning meetings per year for the purpose of planning, coordination, training, and information sharing.

3.3 Participate in the local Mutual Aid Regional Advisory Committee (MARAC) meetings and represent the RDMHC Program as requested.

3.4 Represent the RDMHC Program at regional emergency management meetings.

3.5 Continue to coordinate with regional coordinators as appropriate. 3.5.1 California Hospital Association Regional Coordinators 3.5.2 California Governor’s Office of Emergency Services regional staff. 3.5.3 California Department of Public Health Emergency Preparedness

Office Contract Managers


3.5.4 Emergency Medical Services Authority’s Senior Emergency Services Coordinators.

4 Assist EMSA and the Emergency Medical Services Administrators’ Association of California (EMSAAC) in the development, implementation and evaluation of the California Statewide Patient Movement Plan.

4.1 Participate in Patient Movement Workgroups to assist with specific tasks or content development as requested.

4.2 Review and provide feedback on draft work products developed by the contractor and workgroups.

4.3 Solicit input as requested from operational areas within the region on the Draft Patient Movement Plan.

4.4 Develop a training plan for the Patient Movement Plan. 4.5 Participate in exercise of Plan.

5 Participate in activities related to Medical Countermeasure (MCM) programs, including the Strategic National Stockpile (SNS) program and CHEMPACK.

5.1 Participate on the monthly MCM and Local Health Department (LHD) Emergency Preparedness conference calls (ongoing).

5.2 Review LHD SNS Operational Readiness Review (ORR) annual self- assessments and provide feedback to the LHD as appropriate. Participate in the Cities Readiness Initiative (CRI) ORR assessments and assist EPO in review and analysis of all LHD SNS preparedness activities within the Mutual Aid Region.

5.3 Promote Regional CHEMPACK training to include dissemination of training flyers provided by EPO and encourage participation of emergency dispatchers and CHEMPACK host site representatives. Participate in the planning and conduct of annual Regional CHEMPACK training.

5.4 Develop and/or update regional CHEMPACK Plans annually and distribute to partners as appropriate. 5.4.1 Maintain current CHEMPACK host site point-of-contact lists.

6 Coordinate operational area participation in catastrophic planning projects, such as the Southern California Catastrophic Earthquake Response Plan, the Bay Area Earthquake Response Plan and the Cascadia Subduction Zone Earthquake and Tsunami Response Projects. 6.1 Develop template to collect medical and health data from operational areas

(as requested). Schedule meetings as needed with operational areas to discuss Plan and next steps.

6.2 Conduct meetings with operational areas in conjunction with EMSA, CDPH and United States Department of Health and Human Services Assistant Secretary for Preparedness and Response (ASPR).

6.3 Collect data to enhance Plan. 6.4 Exercise Plan in conjunction with EMSA, CDPH and ASPR.

7 Coordinate inter-State collaboration workgroups, such as the California/Nevada


Border Counties Workgroup

7.1 Conduct at least three meetings annually of the California/Nevada Counties Workgroup (ongoing).

7.2 Maintain point-of-contact lists for participants in the California/Nevada Border Counties Workgroup (ongoing). 7.2.1 Participants include RDMHS from Region III, IV and Region VI.

8 Participate in regional and statewide exercises and other significant medical and health related training and exercises authorized by EMSA and/or CDPH.

8.1 Participate in regional planning and post-exercise evaluation activities for the Statewide Medical and Health Exercise and the Cal OES Capstone Exercise (annually). 8.1.1 Participate in the Statewide Medical and Health Exercise performing

the roles and responsibilities of the RDMHC Program during an actual disaster, including the coordination of medical and health mutual aid.

8.1.2 Participate in the Capstone Exercise performing the roles and responsibilities of the RDMHC Program during an actual disaster, including the coordination of medical and health mutual aid.

8.2 Participate in the Diablo Canyon Nuclear Generating Station exercises as it applies to the Region I. Participate in the CDPH/EMSA Emergency Preparedness Training Workshop annually.

8.3 Attend conferences as requested by EMSA or CDPH-EPO, as budget allows.

9 Respond in accordance with the EOM to medical and health events in the region (ongoing).

9.1 Maintain incident logs and data related to response. Data to be provided in quarterly reports.

9.2 Report number of requests coordinated by the RDMHC Program for medical and/or health mutual aid and/or assistance from within the region.

9.3 Report number of requests coordinated by the RDMHC Program for medical and/or health mutual aid and/or assistance from outside the region.

9.4 Report number of times that medical and/or health mutual aid or mutual assistance requests required reimbursement coordination.

9.5 Report number of times the RDMHC Program polled the operational areas within the region to assess available resources for a potential request.

9.5.1 Report number of times RDMHC Program assisted operational areas with completing the Medical and Health Situation Report or completed the Situation Report for the operational area.

9.5.2 Report number of times the RDMHC Program assisted operational areas with completing the Medical Health Resource Request form.

9.5.3 Report number of times the RDMHC Program is contacted by the State for additional information regarding unusual events of emergency system activation within the region.

9.5.4 Report the number of times the RDMHC Program is requested to act as


a conduit to share information with operational areas within the region. 9.5.4.1 Number of times operational areas from within the region

request the RDMHC program to share material/information with all operational areas within the region.

9.5.4.2 Number of times the State requests the RDMHC program to share material/information with all operational areas within the region.

10 Additional Provisions

10.1 Participate in the RDMHC Program quarterly onsite meetings and monthly conference calls convened by EMSA.

10.2 Submit quarterly reports to the EMSA RDMHC Program Lead. 10.3 Submit agendas for meetings held by RDMHSs to EMSA RDMHC program

Lead. 10.4 Represent the RDMHC Program as a participant on working/advisory

committees as authorized by EMSA in conjunction with CDPH. Committee assignments reviewed annually and subject to change based on RDMHS workload and availability. Potential committee assignments include: 10.4.1 BioWatch program planning and response. 10.4.2 State workgroup for annual Statewide Medical and Health Exercise. 10.4.3 Medical Reserve Corps Advisory Committee. 10.4.4 EOM workgroup. 10.4.5 Disaster Healthcare Volunteers (DHV) Deployment Operations

Manual Workgroup. 10.4.6 Ambulance Strike Team Project. 10.4.7 Emergency Function (EF) 8 Technical Workgroup. 10.4.8 California Disaster Mental Behavioral Health Statewide Plan

Development workgroup. 10.4.9 HPP/PHEP Grant Guidance workgroup.

10.5 If additional activities are identified during this contract period, the RDMHS will work with the EMSA RDMHC Program Lead to evaluate current workload and responsibilities and determine how the additional activities support the tasks identified in this SOW. Both parties will agree on the appropriateness of the assignment prior to it becoming a requirement.

San Joaquin County Emergency Medical Services Agencyone-time satellite training course from NCTI for...

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