SCC EMT policy exam

Santa Clara county EMS

* Oversight and management of Trauma System
* Planning, implementation, evaluation

EMS Medical Director

* Medical control, clinical operations, management of trauma system
* Ensuring proper training
* Developing treatment protocols
* Developing triage and destination policies
* Trauma system quality improvement
* Monitoring clinical compliance

One at each trauma center!

EMS Director

\- Admin. and oversight of trauma system

- Allocating resources and personnel

- Developing agreement with trauma centers

Standing Committees

Advise and assist management of EMS system.

Trauma Centers

\- Located in Department of Surgery

\- Directed by a surgeon

* Maintain an Emergency department
* Staffed by surgery specialists
* Staffed by non-surgical specialists

Director of Trauma

\- Coordinate with in-hospital services and with ED

\- Be a researcher in trauma care (only required at Level 1 center)

\- Attend 16 hours/year of continuing education

Trauma program manager

\- Has to be an RN

\- Attend 16 hours/year of continuing education

- Coordinate day-to-day clinical process

\- Collaborate with trauma program medical director

Intensive care unit (ICU)

ave bed available within 3 hours \n - Has to be designated medical director \n - A physician on duty and available 24hrs/day \n - Staff nurses with ratio of 1 nurse per 2 patients

24 hour personnel

\- Physician in post-anesthesia room \n - RNs in post-anesthesia room \n - Lab and pulmonary techs \n - Certified radiology tech \n - CT scan tech \n - Pharmacist

operating suite

\- Operating room staffed and available 24hrs/day \n - Have a second operating room available within 30 min

level A variance

\- Any incident that results in a threat to public safety, patient, by-stander, or responder \n - Reported immediately to EMS Duty Chief via country comm.

level A variance ex

EXAMPLE: \n \n Deviation from EMS policy, errors with patient harm, failure to respond to request for aid, equipment failure with patient harm, unprofessional conduct.

level B variance

\- Any incident that does not result in patient harm, but is a deviation from EMS policy \n - Reported to EMS agency within 5 business days

level B variance example

EXAMPLE: \n \n General compliant, equipment failure, etc.

level C variance

\- Any incident where a responder provided outstanding care above expectations \n - Reported within 7 business days

EMS agency variance process

\- The compliance officer will receive report, assign tracking number, and ensure correlation between variance and incident. \n - The compliance officer will within 6 business days send an acknowledgement to reporting party \n - EMS agency will evaluate report

policy generation

\- SCC EMS Agency responsibility \n - Any system stakeholder may request \n - Open comment period of 30 days or more \n - Suggestion must be electronically written and submitted to SCC EMS \n - EMS director makes final decisions, but must have agreement and signature of EMS medical director \n - Policies become effective 30+ days after approval

policy revision

\- All policies reviewed every 3 years \n - All protocols reviewed every 2 years \n - EMS Director may make minor revisions without public comment

EMS agency

\- Responsible for all aspects of SCC EMS \n - Responsible for disaster and medical and health management

fire service providers

\- Responsible for scene management and hazard mitigation \n - Required BLS knowledge \n - In accordance with EOA except in Palo Alto

EOA contracted ambulance service

\- Single provider except Palo Alto \n - Lawful scene authority responsible for public safety

non-EOA contracted ambulance service

\- Support 911 as necessary \n - May provide BLS, ALS, or critical transport depending on permits \n - In accordance with state regulations

air resource provider

\- Requested by incident commander \n - Critical care transport or 1st response in rural areas

Trauma center designation

\- Level 1, 2, 3, or 4 \n - Request for proposal (RFP) to create a new one

accepted methods of payment

\- Only electronic; credit or debit; online or in person \n - No refunds

EMS course completion by challenge

\- 1 chance to pass exam (NREMT) \n - If fail need to take EMT course \n - In order to qualify must be MD, RN, PA, LVN, LPN

EMT optional scope of practice accreditation

\- May take the exam up to 3 times in 12 months \n - Accreditation lasts 6 months

Paramedic accreditation

\- Must complete additional training in the local optional scope of practice: pediatric intubation \n - Must pass exam with 85% \n - Must be affiliated with local paramedic company

Paramedic preceptor \n \n \n (Clarification - Intern practices under Medical Director, not the preceptor)

\- Must have 2 years experience \n - Must be MD, PA, RN, or paramedic \n - Responsible for intern at all times

Mobile intensive care nurse accreditation

\- Minimum of 1 year ED experience \n - Completion of training program \n - Hospital evaluation of assessment of 6 ALS patients with field paramedics \n - Must be renewed every 2 years

EMS field supervisor credentialing

\- Requires min. of 3 years experience \n - Must be paramedic or EMT \n - Min. of 85% on field supervisor exam \n - 8 hours credentialing/year to maintain

EMS duty chief

\- Must operate in accordance with EMS supervisor field operations guide

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Emergency medical dispatcher accreditation

\- Must be employed by safety comm. agency OR classified as inactive \n - Complete a BLS-C and training \n - Becomes level 1 or level 2 dispatcher \n - Accreditation lasts 2 years

Ambulance strike team and medical task force leaders

\- Min. of 3 years experience \n - Must be EMS filed supervisor or duty chief and paramedic license \n - Must complete AST leader course \n - Responsible for safety, coordinating movement of team, public relations, ensuring vehicles have comm. ability

EMS program manager

\- Must be EMT/ paramedic with 3 years experience \n - Responsible for clinical and operational aspects \n - Authority to operational and financial commitments \n - Provide clinical info from Medical Director \n - Oversee maintenance of employee accreditations

Advanced life support provider

\- Must submit a letter of intent to agency and receive approval.

EMS Field supervisor

\- Utilized for filling command and control responsibilities.

Continuing education provider approval

\- Must submit a written request to Agency \n - Must include resumes of program director and clinical director \n - Approved for no more than 4 years \n - Applicants must be received no less than 60 days prior to course start date Procedure for Suspension or Revocation of Program \n - Must establish need to review based on info received from credible sources \n - Investigation and submission of accusations to Medical director \n - Issuance of formal accusation

EMS Dispatch program proposal

\- Agency authorities Level 1 and Level 2 ONLY

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Level 1 dispatcher: Transfers medical responses to Central Med. Emer. Dispatch \n \n Level 2 dispatcher: Determines whether call is emergency or not; takes actions on request, determines level and type of response, provides pre-arrival response, medical response is ALWAYS dispatched. \n \n Level 3 dispatcher: Level 2 and determines if medical response is needed and may dispatch alternative resource.

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ECH

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El Camino Hospital Mountain View

EPS

Emergency Psych Services

GSH

Good Samaritan Hospital

What are differences between a pediatric and adult MTV?

Age 15 and up is adult

Who has scene/patient authority?

Person who is medically licensed and most qualified for medical situation

What factors decide if a person is a candidate to be considered for MTV?

Penetrating object injury \n 2 bones fractured \n Paralysis \n Flail chest \n Amputations \n Pelvic fracture \n CNS \n Crushed extremity \n Open skull

MTV

major trauma victim

KRC

Kaiser Redwood City

Who are identified as major burn victims?

10% of body \n Major joints \n 3rd degree \n Electrical/chemical/inhalation \n Burn with preexisting condition

KSC

Kaiser Santa Clara

LSP

Louise Packard Children's

OCH

O'Connor

VMC

SC Valley Medical Center

SLH

Saint Louise Regional

What are some special considerations for MTVs?

Age \n Pediatric \n Co-morbid \n Alcohol-drugs \n Anticoagulants \n End stage renal failure/time sensitive \n Burn \n EMS judgement

What options are available when a patient dies en route?

Go to pre-arranged destination \n Return to point of departure \n Go to closest emergency dept

SEQ

Sequoia Hospital

SUH

\

Stanford University Hospital

Can a patient normally decide which hospital they wish to be taken to?

Normally yes \n No during EMS system surge

What are some special circumstances for patient destination?

Closest during code 3 or specialty service or accepting emergency patients

WTH

Washington Township Hospital

PAV

Palo Alto Veterans

What levels of assistance can a physician on scene provide up to?

Relinquish patient care \n Assist in care \n Manage care (take over)

What is appropriate identification of a physician?

Valid CA medical license \n Must include license number and business address

What system will be used in place of field pronouncement when a MCI is present?

MPMP and START which uses triage tags

STH

Kaiser San Jose

What are your options when death is pronounced?

Withhold resuscitation \n Cancel personnel on their way \n care for family \n call law enforcement \n fill out a PCR

HHH

Hazel Hawkins Hospital

RSJ

Regional Medical Center of San Jose

KFF

Kaiser Fremont

LGH

El Camino Hospital Los Gatos

How often are policies and protocols revised?

Annually

When can field personnel pronounce death?

Decapitation \n Incineration \n Decomposition \n Rigor Mortis \n Pulseless plus damaged heart, lungs, or brain \n Apneic and DNR \n Pulseless and right to die \n ALS: \n same as BLS plus... \n asystole, no shock, no rosc, or cardiac arrest after 20 minutes of rescusitation

Who can refuse care?

Adult \n Capacity to understand and communicate \n Legally authorized minors \n Legal representative \n Implied consent \n Legal guardian

How often should a PCR be completed?

Every EMS response

Who is allowed to make a base call?

Only paramedics.

How quickly should a level A variance report be submitted?

ASAP; within 24 hrs

Automated vehicle location (AVL)

\- Program that tracks position of vehicles \n - Solely for dispatching closest unit to 911 \n - Only observable white vehicle is logged in

County data hub

Receives and stores PCR data from all prehospital care providers.

Electronic PCR solution

Software that receives categorizes, secures, and transmits PCR data.

911 Emergency Ambulance Use

\- 911 amb. must be cancelled as soon as not needed or not desired by patient \n - Ideally transports 1 patient \n - Not compelled as option in lieu of arrest

Authorized use of data system

\-All data submitted to the County Data Hub may be accessed by the county \n - All data submitted to the country data hub remains the property of the submitting organization \n - Data accuracy is always the responsibility of the submitting organization \n - Access is granted to hospital staff, reports, and admin

Naloxone use by public safety first aid providers

Must receive authorization to use for opioid overdose.

PCR

\-Long form can be transport or non-transport \n - Short form for initial contact at patients side

Hospital emergency services reduction impact

Agency must notify Board of Supervisors, SCC Public Health Dept and CA Dept of Health Services.

Interfacility transfers

Should never be requested to 911 but to private ambulance company.

Trauma center service areas

\- Stanford (SUH) Catchment Zone --> North \n - SC VMC Catchment Zone --> Southwest \n - Regional MC of SJ (RSJ) Catchment Zone --> Southwest \n - Trauma centers must be approved by SCC EMS Agency

Quality improvement committee

Works with the Medical Director.

Trauma registry data

\- Each trauma center will enter all trauma-related data into the SCC Trauma Registry system \n - Each trauma center will ensure the data is accurate

STEMI

A type of myocardial infarction that generates an ST segment elevation on the 12-lead EKG.

Percutaneous coronary intervention (PCI)

A broad group of techniques used to diagnose and treat STEMI patients.

TIMI grade III flow

MI scale that defines flow rate through artery-grade III.

To become a STIMI center

Requires SCC receiving facility approval and permits from CA state department of health services.

Primary stroke center standards

\- Certification obtained from Joint Commission for Primary or Comprehensive Stroke Center \n - Has to be a 911 receiving facility \n - Stroked treated/analyzed within 1 hour \n - A medical director who is preferably a neurologist

STEMI receiving center designation

\- Designated by SCC EMS Agency \n - Must have a medical direction and program manager

Primary stroke center designation

\- Designated by SCC EMS Agency and approved by Join Commission Disease \n - Must have a medical director and program manager

Stroke registry standards

Inclusion criteria: Patients diagnosed with Ischemic stroke, subarachnoid hemorrhage, or intra-cerebral hemorrhage

Exclusion criteria: Patients diagnosed with TIA, CEA without infant, or subdural hematoma

STEMI registry standards

Inclusion criteria: Patients who present with STEMI to the ED on the 12-lead ECF to the prehospital personnel "on the..." \n \n Exclusion criteria: Patients who do not present with STEMI on ECG or at least no to ED or prehospital personnel

Prehospital care patient documentation

\- A PCR should be completed for every EMS response/event \n - An MCI with 5+ patients does not require individual patient PCRs but a multi-patient tracking tool and triage tags

Hospital radio reports

\- Provide receiving facilities with notification of impending patient arrival, not medical direction

\- Via cell phone or service dispatch, not county comm. \n - When contact is not possible, use self-initiated radio on EMS command 92 \n - NO interfacility transfers on command 92 or SCC EMS freq. \n - Receiving hospitals may not refuse patients \n Report format: Unit ID, ETA, Patient age, Patient sex, Primary impression, chief compliant, SAMPLE, Vital signs, Treatments provided \n \n ONLY paramedics may contact base hospital for direction (not EMTS).

Patient consent and refusal for EMS services

Capacity: ability to understand and comm. the nature and consequences of a decision. \n

\- Minors can consent if legally married, on active duty in military, has a court-declared emancipation, is pregnant \n \n Legal representative: authorized guardian \n \n - Individuals may refuse care: as an adult who has capacity, a minor authorized to consent and who has capacity, or a legal representative who has capacity \n \n - Individuals may not refuse care: if not legally authorized, is suicidal, or is a SISO. \n \n - Individual should be asked whenever possible for consent. \n Refusal = refusal of service form \n \n - Patients have a right to alternative transport