Committee Report to State Council

January 2018: 
At the November meeting, we reported the Stroke and STEMI Task Forces were complete. That has been reversed and we may see more information sent out for public comment this year. There is not an update on AB 909 – placing the Stop the Bleed kits in public buildings. With a new legislative session just beginning, we need to follow the progress of this legislation. AB 1650 – Community Paramedic Programs is currently at a standstill. We may see this legislation dropped or we may see it written allowing LEMSAs to make decisions independently for their jurisdiction. The EMS and the Government Affairs Committees recommend CA ENA stay neutral but follow this legislation As always we had an interesting discussion on Wall Time. San Bernardino County reported the ambulance company puts an EMT 1 in the ED hallway to watch over patients not turned over to the Emer Dept staff. Sometimes the EMS Committee has two or more subcommittees reporting the same information. We are going to try to combine reports to eliminate giving duplicate information. At each meeting it was decided to have a discussion segment. The topic shall be send in advance to all members who are on the current mailing list so members can prepare and gather facts and figures in advance.

Committee Meeting Minutes

EMS Commissioner Report

March 2018

Minutes to EMSA commission meeting can be found on the EMSA site: https://emsa.ca.gov/ems_commission_meetings/

Core Measures: EMSA has revised the Core Measures program to accommodate the transition to the NEMSIS Version 3.4 standards. EMSA initiated an ad-hoc work group comprised of EMS stakeholders to enhance the existing Core Measure set. This group, which met on November 2nd, 2017, reviewed each of the California Core Measures as well as those developed through the EMS Compass Initiative. The recommendations from the ad-hoc group were discussed and reviewed by the Core Measures Task Force on November 28, 2017. The EMSA commission deferred approval until the June meeting.

Disaster: There will be a 4% cut to HPP funding for the state.

Drug Shortages: EMSA is reporting pain medication shortages and is considering adding Ketamine, IV Tylenol and Nirtous Oxide to the optional scope of practice for paramedics.

Regulations: The following information is an update to the regulation rulemaking calendar approved by the Commission on EMS on December 6, 2017. In accordance with Health and Safety Code Section 1797.107, the Emergency Medical Services Authority is promulgating the following regulations: EMSC Open for public comment until April 30th. STEMI and Stoke regulations passed through finance department.

APOT: Ambulance patient offload times: Ambulance patient offload times (APOT) continue to be submitted quarterly to EMSA. To date, 15 of the 33 LEMSAs have provided at least one Quarter’s worth of APOT information, represented 238 (non-unique) hospitals for 2017 Data. Of those reporting LEMSAs, only 8 LEMSAs provided the full years’ worth of 2017 data. Currently, EMSA is working to develop a repository for this information to enhance the ability for review and analysis. Doing so will help to streamline future submissions of APOT information. Additionally, EMSA revised the APOT reporting spreadsheet to include clearer instructions, formatting enhancements, additional aggregate information, and cost per unit hour. EMSA continues the review of APOT submissions and is working to determine the best ways to visualize the information in a meaningful way. LEMSAs are encouraged to complete and submit APOT information to EMSA each quarter and continue to monitor and analyze APOT data to help identify and implement quality improvement strategies where needed.

The DHV Program has over 23,500 volunteers registered. Over 20,900 of these registered volunteers are in healthcare occupations. All 58 counties have trained DHV System Administrators in their MHOAC Programs. EMSA provides routine training and system drill opportunities for all DHV System Administrators. Over 9,300 of the 23,500 plus DHV registered responders are Medical Reserve Corps (MRC) members. EMSA publishes the “DHV Journal” newsletter for all volunteers on a tri-annual basis. The most recent issue was released on January 29, 2018. The “DHV Journal” is available on the DHV webpage of the EMSA webpage: http://www.emsa.ca.gov/disaster_healthcare_volunteers_journal_page. The DHV website is: https://www.healthcarevolunteers.ca.gov.

Ongoing technical support and clarification is provided to public safety agencies, LEMSA’s and the general public regarding all AED statutes and regulations. EMSA is working on a webpage to provide information regarding AED statutes for clarification. Review and approval of public safety AED programs according to Chapter 1.5 Section 100021 continues.

December 2017

California EMSA met September 13 in San Diego:

Jennifer Lim, EMSA Deputy Director of Policy, Legislative, and External Affairs, spoke about two bills that are inactive at this point but were significant and continue to be on the serious watch list for the two-year session. • AB 263 (Rodriguez) is entitled Emergency Medical Services Workers Rights and Working Conditions. It would require private employers that provide ground emergency medical services to authorize and permit its employees engaged in pre-hospital emergency services a prescribed rest and meal period. It would also require EMSA to publish an annual report containing specified information regarding violent incidents involving EMS providers. • AB 1116 (Grayson) is entitled Peer Support and Crisis Referral Services Act. It would create a Peer Support and Crisis Referral Services Program under the California Office of Emergency Services (Cal OES) with three separate tracks: o Fire service o Correctional officers o Rescue or emergency responders The Commission had some concern about the communication between the peer support member and the employee being confidential and not subject to civil or administrative disclosure.

Data: The Core Measures Report for the 2016 information will be posted soon, as will the report from UC Davis on how the Core Measures program is going. Dr. Backer felt that it is time to take a new look at the Core Measures – especially since all the providers in the state have moved over to the National EMS Information System (NEMSIS) 3.4 which gives more uniform and consistent data across the board. Data problems are now coming from the field entry level; we need to work with providers to not shortcut data entry. As they become facile in working with their ePCRs, they need to know the most important fields and the most important data to enter consistently.

APOT This Commission has shown an interest in ambulance patient offload times and delays (APOT). Because of the statute and our efforts to make standardized reporting, we need to see a statewide picture of APOT. Therefore, we are going to make the argument that we need all of the local EMSAs (LEMSAs) to report this data. An EMS fellow is going to work with us to write a report on the process. The next EMS Commission meeting will be held on December 6. Regards, Carole Snyder, RN.

Statewide Trauma Planning:

  • The Trauma Plan was revised and renamed. This does not require the same levels of approvals a state-approved plan, which had unforeseen challenges.
  • The American College of Surgeons’ Report on the California state-level trauma system review has now been posted on the EMSA website.

APOT

The first data on the ambulance patient offload times has started to arrive. The data confirms that the problem is localized, but it also confirms that the problem can be managed, since some health care systems with similar volumes have resolved the problem. Further data will point out examples of best practices and will also point out which medical centers the local EMS agencies and the California Hospital Association (CHA) need to work with to help improve this problem.

Community Paramedic Pilot Program Update:

The majority of the projects are moving forward with no difficulties.
The Alternate Destination Urgent Care Project has relatively few patients enrolled to date.
The UCLA Project in Santa Monica terminated on June 1st at the request of the fire chief due to the lack of patient enrollment.
The Carlsbad and Orange County urgent care projects are still active but do not have enough enrollees to support meaningful data analysis.
The San Francisco City and County Alternate Destination Sobering Center project is growing and is enrolling over one hundred patients per month.

May 12, 2017
California Crisis care guidelines” EMSA is working with CDPH to acquire funding to develop a crisis care/scarce resources guidance document Disaster Healthcare volunteers has over 22k volunteers registered Epi auto injector training; EMSA began accepting applications for training programs to provide training ad certification for the admin of epi auto injectors to the general public and off duty EMS personnel. They have approved 8 training programs to date. They continue to review and revise paramedic regs-they hope to present the revised regs to the commissions in December. EMT regs-see attached look at website for title 22 language POLST e registry guidelines are out Stroke and Stemi guidelines keep moving forward As of March they weren’t following any legislation-nothing posted on website.
To contact our EMS Commissioner: carole.snyder@pihhealth.org
January 2017
The Commission on Emergency Medical Services met on December 14, 2016 at the Marines Memorial in downtown San Francisco. Community paramedicine project has one year of data: EMSA will not sponsor any legislation for changes. They will be looking for stakeholders going forward. Stroke and Stemi regs have gone out for public comment. EMSA will be working with CDPH regarding deficits in behavior health during disaster. DAG may be brought back to a working committee this year. The POLST guidelines were not yet available but should be out in near future. EMT Regulation revisions went out for public comment. Ambulance Patient Offload Time (APOT) methodology guidelines was moved through the committee. Cal ENA respectfully voted no to these guidelines. LEMSA’s may establish an APOT that exceeds the threshold set forth in the guidelines. CHA rep. BJ Bartleson invitedCalENA to the December meeting to further discuss the APOT guidelines. CalENA will replace the CHA rep during the January meeting.

Are You Registered?

The California State Emergency Medical Services Authority (EMSA) is always making strides to better prepare our State for disasters. While California does well in disaster situations because of its preparedness and mitigation activities, new resources are frequently added to enhance our response including a statewide volunteer registry for healthcare professionals called Disaster Healthcare Volunteers (DHV).

The Disaster Healthcare Volunteers (DHV) program is California’s solution to the nationwide Emergency System for Advance Registration of Volunteer Healthcare Professionals (ESAR-VHP). It’s a system specifically designed for California and its 58 counties to identify, recruit and mobilize healthcare professionals that are willing to volunteer their services and skill sets to assist locally and regionally in times of need. The registry is strictly voluntary. You can opt to help when you can and decline if you are unable to assist. And whether you’re already committed to a response team (D-MAT, MRC), DHV provides you with another opportunity to help out in case your response team is not deployed.

By registering with Disaster Healthcare Volunteers at www.healthcarevolunteers.ca.gov, you will be joining many of your professional colleagues who have already committed themselves to volunteering when they can to mitigate the negative impact disasters have on a community, including saving the lives of others.

Documents & Information

State EMS AuthorityState of California EMS Authority
Homeland DefenseHomeland Security Levels
Homeland DefenseChemical Decontamination Documents
Homeland DefenseDecontamination Water Containment
Homeland DefenseWhat’s going on with Smallpox Vaccinations in California?
Dept. of Homeland SecurityDepartment of Homeland Security
FEMAFederal Emergency Management Agency
Ready.GovPreparedness Advice from DHS
Disaster Medical Assistance Team – Orange Countywww.dmatca-1.org
American National Red Crosswww.redcross.org
U.S. Fire Administration (DHS/FEMA) Training & Educationwww.training.fema.gov
HazmatState of California: Hazardous Materials Medical Management Protocol (EMSA #231) Managing Hazardous Materials Incidents booklets, free quick reference guide to hazmat can be obtained from: Agency for Toxic Substances and Disease Registry Division of Toxicology Emergency Response and Scientific Assessment Branch (E57) 1600 Clifton Road, N.E. Atlanta, Georgia 30333 Telephone (404)639-6360
Natural HazardsNatural Hazards Center at the University of Colorado, Boulder Their links for GREAT Internet Resources On Hazards and Disasters
Disaster Recovery Training (Free)etraintoday.com/about-us/disaster-recovery
Natural Disasters: Be Informedwww.ready.gov/be-informed
Disaster Recovery Center Locatorwww.fema.gov/disaster-recovery-centers