HomeMy WebLinkAboutAgenda - 12-05-94-X-C 1
ORANGE COUNTY
BOARD OF COMMISSIONERS
Action Agenda
Item No
ACTION AGENDA ITEM ABSTRACT
Meeting Date: December 5, 1994
SUBJECT: Emergency Medical Services Strategic Planning Process
DEPARTMENT Emergency Management PUBLIC HEARING YES NO X
ATTACHMENT(S) INFORMATION CONTACT
12/5/94 Commissioner Insko Letter Nick Waters, ext 3030
"People Affected" Matrix TELEPHONE NUMBER
Footnotes to "People Affected" Matrix Hillsborough 732-8181
"Impact on Patient Outcome" Matrix Chapel Hill 968-4501
Mebane 227-2031
Durham 688-7331
PURPOSE: To receive a report on the Emergency Medical Services (EMS)
Strategic Planning process.
BACKGROUND: Beginning in August 1991, a strategic planning process for
the future of EMS in Orange County was undertaken by County staff,
volunteers, health care professionals, and other interested citizens.
Extensive committee work was done in four high priority areas -
cardiac, trauma, pediatrics, and mass casualty. The central theme of
the entire strategic planning process has been a shift to focus on
patient outcome as the main factor in planning delivery of emergency
medical service in Orange County.
Norm Gustaveson, Chair of the EMS Strategic Planning Task Force and Dr.
Tom Griggs, Medical Affairs Officer, will provide a brief review of the
strategic planning process and results to date. Recommendations in
five areas - prevention/public health education, training and staff
development, equipment, communication/integration, and evaluation and
followup - are included in the attached matrices.
RECOMMENDATION: The Manager recommends that the Board receive the
report as information only.
1 ,,01
b-'
I
December 5, 1994
Orange County Board of Commissioners
P.O. Box 8181
Hillsborough, NC 27278
Dear Chairman Carey and Commissioners:
RE: EMS Strategic Planning Task Force
One of the most valuable learning experiences I had as an Orange
County Commissioner was to Chair the EMS Advisory Council, and, as such, to
participate in the EMS Strategic Planning Task Force. A set of matrices
summarizing the recommendations of the Task Force is attached for your
information.
The Task Force followed a process that produced and is still producing
evolving recommendations and an on-going self-assessment. Many of the
easy-to-do recommendations were implemented as they were identified; others
will be put into place during the next few months; and still others have
been assigned to a new standing committee of the Council for further
refinement. Those which have policy implications or require new funding
will be brought back to the Commissioners for a final review and approval.
The process began informally in 1990, when the EMS Advisory Council
invited Kurt Jenne from the Institute of Government at UNC-CH to introduce
us to strategic planning. Soon after that, the Board of Commissioners
appointed the EMS Strategic Planning Task Force and named Norm Gustaveson
to serve as its Chair. Norm, with the able guidance of Medical Director
Tom Griggs and the support of Carol Lorenz, a Hillsborough Town
Commissioner, assembled a group of citizens and health care professionals
to serve on the Task Force.
Tom Griggs asked the group to try something different. He challenged
them to create, for themselves and the citizens of Orange County, a
different way of thinking about emergency medical services. The focus was
Chairman Carey and Commissioners
December 5, 1994
Page 2
always on the citizen who needed the service rather than on the system or
the people who staffed the system. For the next three years, this talented
group of professional-level consultants volunteered their time and creative
energy to shape this process. They were ably assisted by staff from the
EMS Department, the Manager's office and the Triangle J COG.
Norm Gustaveson and Tom Griggs will be present at the December 5th
Commissioners' meeting to discuss the process and to answer questions.
Sincerely,
Verla C. Insko, Chair
EMS Advisory Committee and
Member, Orange County Board
of Commissioners
Outline of Comments IC
Orange Countg Board of Commissioners
December 5, 1994
11 : • ! • . : / ' 1 ! • 111 • - . . _ . . 4
Norm Gustaveson
A. Recognition of Volunteers who made it possible (attached)
(A total of 153 general, steering, medical, and miscellaneous
meetings held.)
0. Major change in thinking about the Orange County EMS System:
Paradigmatic shift to Patient Outcome,
C. November 9, 1992, report to commissioners indicated the major
focus of the final recommendations. Ali suggested within the
context of Patient Outcome.
1 . Medical sub-committees completed their work and presented
an analytic tool for combining recommendations, evaluations,
resources, and cost. Their summary is now finished and presented in
the suggested matrix. The color coded matrix is attached.
2. One major theme of all medical committees: the importance of
public health education.
3. This recommendation underscored the importance of linking
the EMS system with other Orange County human services and EMS
objectives of patient outcome.
4. Another recommendation related to the importance of the EMS
Advisory Council and the need to expand its responsibility and
broaden its membership so it can continue the ideas and work
started with the strategic planning effort.
5. Perhaps the most critical recommendation of all was the
importance of useful and relevant data, combined with methods of
evaluation, that will focus on patient outcome goals and meaningful
resource and cost considerations. This probably will be a; of the
major ongoing tasks or the EMS Council to Initiate, encourage,
oversee, and assist.
6. An equally important goal related both to patient outcome and
data is the important necessity of public information about the
system and avenues for public feedback about the services received
and the perception of services expected. This is an important
element of the whole data cycle. This has been done and will
continue to be a function of the EMS Council.
H. EMS Strategic Planning - Next Stage of Thinking:
Total Quality Management and
Some Implications for Resource Reallocation
Dr. Thomas Griggs
tiecommendation :
Health Education
-- lo NUMBED OF PEOPLE AFFECTED
LOW MEDIUM HIGH
=TRAIN INSTRUCTORS IN CPR, °INSTRUCTORS TRAIN COMMUNITY' -MLIC SERVICE ANNOUNCEMENTS v
FIRST.AID,INJURY AND TRAUMA'-- 'MEMBERS: : ON.USE r SYSTEM ]d( (Ypl�
.PREVENTION ''® m CALL1 -
ElA Sl1PPORT.OF.EXISTING FIRE;RESCUE=
LOW AND TRAUMAPREVENnON PROGRAM SUDS SHOW UPDATE-TO BE
(BURN CENTER;..BIKE PROGRAMS,-ALCOKOL SHOWN TO PUBLIC SCHOOLS,
AND DRUGABUSE,'DOMESTIC VIOLENCE; COMMUNITY GROUPS
CHILD ABUSE PREVENTION;-CAR SEATS AN
SEATBELTS;ETC.} .
CQQRDINATE RMOURCES=
C TRAINING(EMD TYPE)FOR DOCTORS• _
O °RECEPTIONISTS FOR CARDIAC9
J MEDIUM EMERGENCIES' i
T
PEDS HOT LINE(MM COST)FORA # TRANSPORTATION FOR MEDICAL
i(1RS==LESS THAN 209 C FORA,
POPULATION 'S NEEDS FOR NON-EMERGENCY—EG:
CONVALESCENT,PEDS,RANGE FROM
;TAXI TO WHEELCHAIR TO STRETCHER
HIGH PTS:-_QVOES NOT REQUIRE MEDICAL—
ATTENTION ENROUTE=COORDINATION OF
RESOURCES IS NEEDED"°° `
PEOPLE REFERS TO PATIENTS/PUBLIC
RECOMMENDATION :
AND STAFF DEVELOPMENT
NUMBER OF PEOPLE AFFECTED
lop
LOW MEDIUM HIGH
CONTINUING EDUCATION FOR ALL- :
LEVELS(ISSUE:SOURCE OF FUNDING--,-
HOSPITAL VS COUNTY)EG:MONITOR-
TYPES,PEDS SKILLS,1Vs TIONS;
MEDICAL
Law �--�
- bmwsu qR�ARDIA,cTS-
INYt}I�F AEI* EVELS;�"$T#tESP.
THI I Hd§i`ITAL-STAFF
INCREASED EMS TIME IN ER CD
INTEGRATION OF DIFFERENT::
C TRAINING FOR COMMUNICATORS— =COMPONENTS OF MEDICAL.'
KEEP UP WITH NEW TECHNOLOGIES PORTION OF EMS—FIRST RESP.Y
O LIKE CAD AND GIS THRU HOSPITAL STAFF,DISPATCH
S MEDIUM (JOINT DRILLS,-PROTOCOLS DEVIL)
DEFIB TECH TRAI IM FOR FIRST
T RESPONDERS "(j, }
CLEEIMEE
MAINT;.MAPS,SPANISH LARG,c
FIRE AND FASCUE TRAINING AND ADVANCEMENT THRV EMT LEVELS,3
HAZMAT STATE AND NAIL CONFERENCES
HIGH
PEOPLE REFERS TO SERVICE PROVIDERS BOTH PAID AND VOLUNTEER —
RECOMMENDATION :
EQUIPMENT
.k '1 NUMBER OF PEOPLE AFFECTED
. � )afi
LOW MEDIUM HIGH
12 LEAD EKG ACCESSIBLE ON`
ADMISSION TO ER(HOSPITAL RE-EVALUATION OF TYPESIS1ZESl'
RESPONSIBILITY BUT VITAL TO NECESSITY OF PEDRIATRIC EQPTJ"
WHOLE EMS PT.CARE SYSTEM) _ :SUPPLIES(WOULD AFFECT HIGH
LOW RE-EVALUATION OF TYPESISIZES OF; PERCENTAGE OF THE PEDIATRIC
`Y
.PEDIATRIC EQUIPMENT/SURPLUS POPULATION
,(WOULD AFFECT LOW PERCENTA
OF TOTAL PUBLIC POPULATION)0 t
C VEHICLE MAINTENANCE ot-2. MAP BOOK SYSTEM RE-DONE'
O
S MEDIUM ALL FIRST RESPONDERS HAVING OZ
TANKS AND MEANS O AINTAINING,
T EXCHANGING,ETC. l� (J N�►a
- MAINTENANCE OF MEDICAL EQPT.
UP ES AND TRACKINT
EQUIPMENT
EARS MON ORIDEFIBRILLATOR4 �3
-(REPLACINQ�AND�IP�3hXMG DEDICATED TRAINING EQPF(FOR
CURRENT MODELSYEG.WPACINQ'ETC, INITIAL TRAINING AND.CONT.ED.)-=
E EG:PEDS INTUBATION�VDULi`
HIGH MANNEQUONS,ETC:
AED*FOR FIRST RESPONDERS' FIRST RESPONDERS HAVING S
(DEPENDS ONAPPROVAC FOR FIR%T RADIOS-AWTURNOUTOEAR-�
*RESPONDER USE) PURCHASE OF NEW VEHICLES
(REPLACINGOLD WITH NEW)AN ^ ((o
?NEED FOR EXPANSIONS
PEOPLE REFERS TO THE GENERAL PUBLIC `CeQ
fILCUMMENDATION :
COMM UNICATION/INTEG
NUMBER OF PEOPLE AFFECTED
i
LOW MEDIUM HIGH
REPORTING SOCIAL AND ENV.
FACTORS VIEWED ON-SITE To HOUR STAFF(INCLUDES CHILD- CONTINUE TO IMPROVE!ENHANCE MEDICAL REPORTS-EMS TO ER AND ABUSE PO UBLIC HEALTH" EMS DISPATCH INFO TO CALLER BACK,ETAs UPFRONT, STREAMLINE
" REPORTS--TRAUMA TEAM ACTIVATION
/�lx' ISSUES,ETC.) -�� RELAY OF PERTINENTINFO TO
LOW Y Y CONSISTENT USE OF INCIDENT CQ WHEN APPROPRIATE,EARLY NOTIFICATION
RESPONDING EMS PERSONNELS OF PEDS PTS_,VERIFY DRUG DOSAGES ESP
Q
AND UPDATES OF ACTIVITIES AT_a FOR PEDS DOSE
a SCENE--INCLUDES PROPER MAPS,- Zia
THRQMBYUTiC SCREENING Q�
QUEST.DEVL AND RECOMMENDED(�.. CROSS STREETS,DUPLICATI
21'
O
S MEDIUM
T
,HANDS FREE COMMUNICATiOff ADD RADIOS THAT ALLOW
DEVICES(EG:VOXj? DIRECT.COMMUNICATIOW
BETWEEN FIRST RESP.*AND-1
HIGH EMS PERSONNEL(NEW;
RADIOS?NEW CHANNE
Z2
PEOPLE REFERS TO GENERAL PUBLIC
1 .
RECOMMENDATION :
EVALUATION ANA FOLLOW= UP.
-tilt-
NUMBER OF PEOPLE AFFECTED
LOW MEDIUM HIGH
INCREASE NURSING AND HOUSE UPGRADE EMS COUNCIL TO HAVE
COORDINATION WITH COUNTY STAFF AWARENESS OF REHAB A TRUE ADVISORYIEVALUATIVE
HEALTH DEPT.AND EDUCATION POSSIBILITIES AND PROGRAMS, NATURE
AND SOCIAL SERVICES,ESP.FOR ESPECIALLY FOR CARDIAC PATIENTS CONSISTENT,ROUTINE FEEDBACK TO
LOW PEDS PATIENTS(✓ 'EMS PERSONNEL ON PT.OUTCOMES=°
LOW Y LINK FIELD TX,ER TX,HOSPITAL TX,
IMPROVED SYSTEM OF REHAB REFERRALS FOLLOW-UP TO PATIENT OUTCOM
FOR TRAUMA AND CARDIAC PATIE
CONTINUALLY REASSESS OVERALL
EFFECTIVENESS OF EMS SYS
C AND PROVIDE FEEDBACK TO
COMMITTEES
Q -CRITICAL INCIDENT STRESS-
DEBRIEFING j- ESTABUS14 TRACKING SYSTEM FOR 'DEFINE"OUTCOMES"
S CARDIAC PT FLOW IN ED AND POLICY, WHAT TO MEASURE WHO TO DO IT;'
PARENT SURVEY REGARDING FOR CHEST PAIN MGT.IN ED SSA?,FREQUENCY,DATA DISTRIBUTION
T MEDIUM -PEDS,CURRENT PRACTICES, r(COORDINATION BETWEEN
PROGRAMS;.ET(:N ,CARDIOLOGY AND ED) Z� DATA COLLECTION-
:WHAT,WHO,HOW,WHEN,$$$?ETC.
PEDS"HOT LINE"TRACKING.
COORDINATE WITH CURRENT DATABASE
,FOLLOW-OP OF SUSPECTED EFFORTS EMERGING IN DEPT OF EMERG..
CHILD ABUSE CASES" 4 MED..
IMPROVE FOLLOW-UP OF CARDIAC
PATIENTSFOR RISK FACTOR
HIGH MODIFICATION AFTE DISCHA
PEOPLE REFERS TO PATIENTS
t ^
October 10, 1994
6 ^
EMS STRATEGIC PLANNING STEERING COMMITTEE
CURRENT STATUS OF MEDICAL SUBCOMMITTEE RECOMMENDATIONS
FOOTNOTES TO COST-NUMBER OF PEOPLE AFFECTED MATRIX
Page 1 - Prevention/Public Health Education
1. American Red Cross has increased the number of CPR provider
and instructor courses in Orange Co. The American Heart
Association numbers have remained fairly constant. This is most
likely a reflection of the 1994 changes in course curriculum and
the time it is taking to retrain the current instructors
2 . Orange Co. Emergency Management has begun to have
announcements'-on local access TV. They are working with the
county social services offices to educate their clients on the
use of 911. They have designated one communicator and one EMT-P
as outreach educators, and respond to requests for educational
programs in such places as the public schools.
3 . Non-emergency, convalescent transport has been contracted to a
private ambulance provider. This has actually resulted in a cost
savings to the county, rather than the original estimate of being
a high-cost item. The issues of transport for other patients that
request emergency services but turn out not to actually need an
ambulance transport has not been totally addressed. The EMS
Medical director is working on guidelines for non-emergent
transports.
Page 2 - Training and Staff Development
4 . On hold, pending State OEMS approval. Pilot projects have been
done in other counties.
5. Hazmat training is in progress. Other fire training has not
yet been scheduled. The training calendar is full at this time,
but the need for "cross-training" of EMS/Fire personnel has been
recognized by County Emergency Management.
6. Funding issue has not been totally resolved. Orange Co. Is
currently covering most expenses. The EMS Division of the Dept.
Of Emergency Medicine is not yet fully funded. However,
continuing education in EMS is well planned and ongoing. It is
being coordinated by the EMS Nurse liaison from UNC Hospitals.
7 . There has been a small increase in time spent in the Emergency
Dept. by EMS personnel. There has not been time spent in EMS by
ED staff due to scheduling/staffing difficulties.
8 . Due to a full training calendar there has been no effort to
coordinate or plan integration of training among the various
segments of the system.
9 . Vehicle maintenance training is in progress. Some work has
been done on maps, but more is needed. No progress on rest.
,,4
page 3 - Equipment:
10. UNC Hospitals is working on this issue.
11. OCRS volunteers have taken responsibility for inventory of
Peds equipment and have worked with Orange Co. EMS to implement
changes and improvements. County has purchased recommended
equipment. OCRS volunteers have purchased some equipment. May not
yet be all distributed and in use.
12 . Orange Co. has taken responsibility for vehicle maintenance.
Training has been addressed and preventative maintenance is a
goal.
13 . A new restocking cabinet has been installed in the UNC
Hospital Emergency department, inventories' have been done. More
work remains in tracking equipment and supplies. This is a joint
responsibility of the County and volunteer squads.
14 . Orange Co. EM is building up an inventory of training
equipment. Currently some equipment is borrowed and transported
to classes from UNC Hospitals.
15 . First responder radios have been updated &/or replaced. There
is no current information on whether the first responders have
sufficient turnout gear.
16. The purchase of new ambulances by the county is on a cycle of
replacing 2 per year. More data needs to be collected to evaluate
the need for increasing the number of ambulances.
17 . No information available on the status of first responders
oxygen supplies and exchange of tanks. System needs clarification
Page 4 - Communication & Integration:
18 . Hospital position exists for Social worker assigned to the
Emergency department part-time (position shared with Walk-in
clinic and Family Medicine outpatients) , but position is
currently vacant.
19 . County EM has considered this issue. it is hard to keep new
staff trained, and they recommend that the future training. focus
on staff in command and supervisory positions. More training is
needed.
20. Questionnaire has been developed and adopted by EMS Medical
director, and training is planned for late 1994 or early 1995 .
21. Progress has been made on improving information flow. The
number of "UNKNOWN" calls has decreased, and the dispatchers are
giving out cross-streets approx. 90% of the time.
22 . New tactical operations channels have been designated for
direct communication. County EM has worked on this.
23 . There has been some training and improvement in reports, but
progress is inconsistent.
Pace 5 - Evaluation and Follow-up:
24 . Issue has been addressed by County EMS. , but coordination of
efforts with County Health Department has not made much progress.
25.A Insufficient data, feedback from Cardiology.
25 .B Insufficient data from Cardiology, Trauma services.
26 . Dept. Of Emergency Medicine and Cardiology service are
working on this issue. ED staff are developing a proposal for
chest pain management in the ED to present to the joint "Chest
Pain" committee. An evaluator has met with the ED staff.
27 . Insufficient data from Cardiology service.
28 . Patient case review sessions are held once a month at Orange
County Rescue Squad in Hillsborough.. These are facilitated by the
EMS Medical Director and EMS Nurse liaison. Attendance is not
optimal. Feedback on individual cases is available upon request
to EMS Nurse liaison.
29 . A second "customer" satisfaction survey is being developed by
some members of the EMS Strategic planning steering committee.
This will survey how the system is meeting the needs of the
citizens. The Steering committee has also produced this report on
the status of the previous recommendations.
30 . UNC Hospitals/Dept. of Emergency Medicine is making progress
on data collection and management. Staff have been hired to do
EMS data entry for the EMS Medical director, and data manager has
been hired to set up data collection systems for the Emergency
Department itself. Plans exist to integrate this data (from EMS
and the ED) . This data will enable the EMS director and the
hospital to do research and better track patient outcomes.
•
t Recommendation : Prevention/Public
Health Education
IMPACT TO PATIENT OUTCOME
LOW MEDIUM HIGH
PUBLIC SERVICE ANNOUNCEMENTS=a' `EMS-SUPPORTOF-EXISTING''`
WNG TIME BEFORE EFFECT IS SEEN 1% TRAUMA PREVENTION PROGRAMSs
AND BEFORE IMPACT TO PT.'OUTCOME"
LOW IS POSITIVE 4.
C VMMNG(EMD TYPE)FOR DOCTOR
pECEPTIONISTS FOR CARDIAC
EIr1ERGENClES�"
S MEDIUM
T
NON-EMERGENCY TRANSPORT—
LEAVES EMERGENCY PERSONNEL
AVAILABLE FOR TRUE EMERGENCIE
AND GETS PTS WITH NON-ACUTE
HIGH NEEDS HANDLED WITHOUT INVOLV-
ING EMS-COOFiDINATION.Ok.
-,EXISTING RESOURCES MIGHT
ADDAESS*SOME OF THIS f
RECOMMENDATION :
AND STAFF a
DEVELOPMENT
f,
IMPACT TO PATIENT OUTCOME
LOIN MEDIUM HIGH
CONTINUING EDUCATION(EG:
CARDIAC)MONITOR TYPES,PEDS
SKILLS,WS AND INTUBATIONS,
LOW MED ASSESSMENT)
V CARDIAC ARREST DRILLS
,INTEGRATION OF DIFFERENT Con-
C EMS r
TRAINING FOR COMMUNICATORS-
0 KEEPING UP WITH NEW TECHNOLOGY QEFIB TECH TRG-'LOW%OF TOTAL'
S MEDIUM LIKE CAD AND GIS PATS CREATE[?8Y EMS BUT
MOH IAAPACT TO INDIVIDUAL PTS.
T SKILLS ENHANCEMENTS(VEHICLE
MAINT,"!fiAPS F,TQ -
FIREJRESCUEIHAZMAT TRAINING
FOR ALL EMS PERSONNEL
HIGH
RECOMMENDATION :
EQUIPMENT
IMPACT TO PATIENT OUTCOME
LOW MEDIUM HIGH
12 LEAD EKG READILY ACCESSIBLE
UPON ADMISSION TO ER(HOSPITAL.
RESPONSIBILITY BUT VITAL TO WHOLE
LOW EMS PT CARE SYSTEM
RE-EVALUATION OF TYPES,SIZEWT
'NECESSITY OF PEDS EOPT
C ALL FIRST RESPONDERS HAVING 02
TANKS,MEANS OF MAINTAINING, VEHICLE MAINTENANCE
O EXCHANGING,ETC, MAPBOOK SYSTEM REDONE `
S MEDIUM �N
T
FIRST RESPONDERS HAVING RADIOS AND BACKUP SUPPLIES&TRAINING'
-AND TURNOU GEAR EOPT:
EMS MONITOR-OEEf 9RILLATORS-- DEDICATED TRAINING EOPT IN ALL;
��^^++u REPLACINQ AND CIPGRADING CURR£NF AREAS INCLUDING PEM I
HI G I 1 40DEI #
4ED'S FOR FIRST RESPONDERS
EHICLES(REPLACE DEPENDENT ON APPROVAL FOR
ING'0LDj AND % d} �XAS10Nf FIRST RESP USEj
RECOMMENDATION :
COMM UN ICATION/I NTE RATION
IMPACT TO PATIENT OUTCOME
LOW MEDIUM HIGH
CONTINUE USE OF EMD
RELAY OF PERTINENT INFO TO RESPONDING UNIT AND UPDATES OF
ACTIVITIES AT SCENE FROM 1ST RESP(INCLUDES PROPER MAPS,
LOW CROSSROADS,NO STREET NAMES DUPLICATED,ETC.)4
MEDICAL REPORTS--EMS TO ER AND BACK;CLEAR ID OF WHO 19
SPEAKING, ETAs UP FROWT;STREAMLINE REPORTS TO HOSPITAL,
APPROPRIATE NOTIFICATION OF TRAUMA AND PEDS TEAMS
REPORT SOCIAUENV FACTORS TO ER-TO INCLUDE CHILD ABUSE
C POTENTIAL,PUBLIC HEALTH ISSUES,ETC.
O CONSISTENT USAGE OF INCIDENT COMMAND
s . THROMBOLYTIC SCREENING QUEST RECOMMENDED
T VERIFY DRUG DOSAGES,MED AVAILABILITY FOR PEDS ORDERS
MEDIUM
HIGHRADIOS THAT ALLOW DIRECT COMMUNICATION FROM FIRST
HIGH RESPONDER TO EMS UNIT -i
HANDS FREE COMMUNICATION DEVICES(VOX)-HIGH IMPACT ON=
,x SMALL NUMBER OF PATIENTS't
RECOMMENDATION :
r w
EVALUATION
IMPACT TO PATIENT OUTCOME
LOW MEDIUM HIGH
INCREASE NURSIN A D HOUSESTAFF UPGRADE EMS COUNCIL TO HAVE A TRUE
AWARENESS OF REHABPOSSIBILITIES AND ADVISORYIEVALUATIVE NATURE
PROGRAMS,ESPECIALLY FOR CARDIAC PTS
IMPROVED SYSTEM OF REHAB FERRALS CONTINUALLY REASSESS OVERALL EFFECTIVENESS
L�i�d FOR TRAUMA PATIENTS U � OF EMS SYSTEM AND PROVIDE FEEDBACK TO
Y Y COMMITTEES
,COORDINATION WITH COUNTY HEALTH DEPT., DEFINE"OUTCOMES
EDUCATION AND SOCIAL SERVICES,ESP.FOR WHAT TO MEASURE WHO TO DO IT,
PEDS PATIENTS $U7,FREQUENCY,DATA DISTRIBUTION"
C CONSISTENT,ROUTINE FEEDBACK TO — IpATA COLLECTION'
EMS PERSONNEL ON PT.OUTCOMES
0 LINK FIELD TX,ER TX,HOSPITAL'TX, 49 WHAT;'WHO,HOW,WHEN,$W ETC.
FOLLOW-UP TO PATIENT OUTCOMES-
S °$COORDINATE WITH CURRENT DATABASEI
T - EFFORTS EMERGING IN DEPT OF EMERG_MED.`
CRITICAL INCIDENT'A ESTABLISH TRACKING SYSTEM FOR CARDIAC"
f��REI![T SURVEY REGARDING PEPS CURRENT.- PT=FLbW IN ED AND POLICY FOR CHEST PAIN
MEDIUM STRESS DEBRIEFING pRAC-"CES,PROGRAMS,-:ETC'7 = MGT.IN ED{COORDINATION BETWEEN
CARDIOLOGY AND EDf
'PEDS"HOT LINE7 TRACKING r
;-FOLLOW UP OF SUSPECTED CHILD ABUSE CASE
IMPROVE FOLLOW-UP OF CARDIAC PATIENTS FOR
HIGH RISK FACTOR MODIFICATION AFT R DISCHARGE
U �� /V
ORANGE COUNTY EMERGENCY MEDICAL SERVICES
EMS STRATEGIC PLANNING STEERING COMMITTEE
MEDICAL SUBCOMMITTEES
PHASE II REPORT
SUMMARY OF RECOMMENDATIONS
COST/BENEFIT MATRIX
December 5, 1994
Respectfully submitted by:
Subcommittee Chairs:
Pediatrics: Jan Smith, MPH, RN, EMT-P
Doug Noell, EMT-P
Cardiac: Barbara Steckler, EMT-P
Trauma: Cheri Elliott, RN, EMT-P
Facilitator: Carol Lorenz, Ph.D.
Consultant: Dee Gray, MPH, RN
DRAFT
ORANGE COUNTY EMERGENCY MEDICAL SERVICES AS 0�
EMS Strategic Planning Steering Committee 1215197
9/21/94
MISSION STATEMENT:
The vision of Orange County Emergency Medical Services is to
participate as an integrated part of a seamless health care
system that serves all citizens; a system where all
components function collaboratively and cooperatively.
VISION STATEMENT ELABORATED:
We envision EMS as a part of a system that optimizes the
appropriate use of emergency medical and rescue personnel.
This system supports quality primary and continuing
education for all out-of-hospital responders, dispatches
appropriate personnel promptly, and delivers timely health
care to assure optimum patient outcomes.
This visionary system goes beyond the traditional approach
of EMS and efficiently utilizes well trained personnel in an
integrated effort to minimize cost, morbidity and mortality.
Outline Of Can,Enents to
Orange County Board of Commissioners
December 5, 1994
!. EMS Strategic Planning Committee. 1992- 1994
Norm Gustaveson
A. Recognition of Volunteers who made it possible (attached)
(A total of 153 general, steering, medical, and miscellaneous
meetings held.)
B. Major change in thinking about the Orange County EMS System:
Paradigmatic. shift to Patient Outcome,
C. November 9, 1992, report to commissioners indicated the major
focus of the final recommendations. All suggested within the
context of Patient Outcome.
1, Medical sub-committees completed their work and presented
an analytic tool for combining recommendations, evaluations,
resources, and cost. Their summary is now finished and presented in
the suggested matrix. The color coded matrix is attached.
2. One major theme of all medical committees: the importance of
public health education.
3. This recommendation underscored the importance of linking
the EMS system with other Orange County human services and EMS
objectives of patient outcome.
4. Another recommendation related to the importance of the EMS
Advisory Council and the need to expand its responsibility and
broaden its membership so it can continue the ideas and work
started with the strategic planning effort.
5. Perhaps the most critical recommendation of all was the
importance of useful and relevant data, combined with methods of
evaluation, that will focus on patient outcome goals and meaningful
resource and cost` onsiderations. This probably will be one of the
major ongoing tasks of the EMS Council to initiate, encourage,
oversee, and assist.
6. An equally important goal related both to patient outcome and
data is the important necessity of public information about the
system and avenues for public feedback about the services received
and the perception of services expected. This 1s an important
element of the whole data cycle. This has been done and will
continue to be a function of the EMS Council.
II. EMS Strategic Planning - Next Stage of Thinking:
Total Quality Management and
Some Implications for Resource Reallocation
Dr. Thomas Griggs
/4,/g/e6/ Ce-S 406,0471
ORANGE COUNTY COMMISSIONERS /° /5/9V
P.O. Box 8181
HILLSBOROUGH, N.C.
27278
Moses Carey, Jr, 732-8181
Alice M. Gordon 9684501
Stephen H. Halkiotis 688-7331
Verla C. Insko 227-2031
Don Willhoit 644-3004 (Fax)
December 5, 1994
Orange County Board of Commissioners
P.O. Box 8181
Hillsborough, NC 27278
Dear Chairman Carey and Commissioners:
RE: EMS Strategic Planning Task Force Final Report
One of the most valuable learning experiences I had as an Orange
County Commissioner was to Chair the EMS Advisory Council, and, as such, to
participate in the EMS Strategic Planning Task Force. A summary of the
Task Force results is attached for your information. These recommendations
will not be put on a shelf to collect dust. Indeed, many of the
recommendations have already been implemented. While this document
represents a formal end to the task force, the work will continue through
a new standing committee of the Advisory Council.
This report describes a process that produced evolving
recommendations. It also summarizes and gives a status report on those
recommendations. Those which have policy implications or require new
funding will be brought back to you for a final review and approval. Many
of the easy-to-do recommendations were implemented as they were identified;
others will be put into place during the next few months; and still others
have been assigned to new sub-committees for further refinement. In
addition, the process provides for the emergence of new issues and an on-
going self-assessment.
The process began informally in 1990, when the EMS Advisory Council
asked Kurt Jenne from the Institute of Government at UNC-CH to present
information on strategic planning. Soon after that, the Board of
Commissioners appointed the EMS Strategic Planning Task Force and named
Norm Gustaveson to serve as its Chair. Norm, with the able guidance of
Medical Director Tom Griggs and the support of Carol Lorenz , a Hillsborough
Town Commissioner, assembled a group of citizens and health care
professionals to serve on the Task Force.
Tom Griggs asked the group to try something different. He challenged
them to create, for themselves and the citizens of Orange County, a
different way of thinking about emergency medical services. The focus was
always on the
YOU COUNT IN ORANGE COUNTY
Chairman Carey and Commissioners
December 5, 1994
Page 2
citizen who needed the service rather than on the system or the people who
staffed the system. For the next three years, this talented group of
professional-level consultants volunteered their time and creative energy
to shape this process. They were ably assisted by staff from the EMS
Department, the Manager's office and the Triangle J COG.
Norm Gustaveson will be present at the meeting to give an oral report.
Sincerely,
C
Verla C. Insko, Chair
EMS Advisory Committee and
Member, Orange County Board
of Commissioners
_ t
Hecommuridation : Prevention/Public
.x alts Education
10f7- NUMBER OF PEOPLE AFFECTED
LOW MEDIUM HIGH
ITRAIN INSTRUCTORS IN CPR, "INSTRUCTORS TRAIN COMMUNITY"` -PUBLIC SERVICE ANINOUNCEMENTS
IFIRSTAIDJ"JURY AND TRAUMjC 'MEMBERS°' °ON USE
OF SYSTEM-= �jYOt
PREVENTION -;CAL.I
LOW �Zz"ZLREVENTION OF ExISTINa FlRE,I�ESicul�-AND PROGRAMSr,, { SLIDE SHOW UPDATE—TO BE
(BURN CENTER,.BIKE PROGRAMS;ALCOROL SHOWN TO PUBLIC SCHOOLS,
AND DRUB ABUSEMOMESTIC VIPLENCE;- COMMUNITY GROUPS
CHILD ABUSE PREVENTK%% CAR SEATS ANID
.SEAT DELTS,`ETC.j
B.IZNATE MUR=,
C TRAINING(EMD TYPE)FOR DOCTORS`-` _
Q RECEPTIONISTS FOR CARDIAC;
EMERGENCIES° i
S MEDIUM
T
PL'sDS HOt LINE(M/H COST)FORt , TRASPORTATION FOR MEDICAL'
KIDS-LESS THAN 20%OF COUNT'. FI
-�POPUL ATION T:)'. NEEDS FOR NON=EMERGENCY`—EG:
CONVALESCENT,PEDS.'-RANGE FROM
�^
TAXI TO WHEELCHAIR TO STRETCHER�r
HIGH PTS.=DOES NOT REQUIRE MEDICAL,�-�
ATTENTION ENRO _ '
flESOURCES IS N' D D'"
PEOPLE REFERS TO PATIENTS/PUBLIC
, mECOMMENDATION :
pol(
AND STAFF DEVELOPMENT
NUMBER OF PEOPLE /AFFECTED
LOW MEDIUM RICH
CONTINUING EDUCATION FOR ALL.
LEVELS(ISSUE:SOURCE OF FUNDING
HOSPITAL VS COUNTY)EG:MONITOR
TYPES,PEDS SKILLS,IVs, TiONS ,
LOW MEDICAL ASSESSMENTS
Y Y - A S--
INL RSY�RESP
TNl ACSTAFF .i
INCREASED EMS TIME IN EnO
INTEGRATION OF DIFFERENT`
TRAINING FOR COMMUNICATORS-- =-b6M0QNENTS OF MEDICAL
C n KEEP UP WITH NEW TECHNOLOGIES PORTION OF EMS--FIRST RESP:°
O MEDIUM LIKE CAD AND GIS THRU HOSPITAL STAFF,DISPATCH
(JOINT DRILLS,PROTOCOLS DEVL.)
DEFIB TECH TRAI G FIRST
'
T RESPONDEng �(�FOR
MAINT MAPS,SPANISH t Am0,;
FIRE AND RESCUE TRAINING AND ADVANCEMENT THRU.EMT LEVELS,
HAZMAT` STATE AND NAIL CONFERENCES
HITCH
PEOPLE REFERS TO SERVICE PROVIDERS BOTH PAID AND VOLUNTEER
Ci
® V
■
EQUIPMENT
rye 'Cl
E NUMBER OF PEOPLE AFFECTED
ECTED
LOW MEDIUM HIGH
12 LEAD EKG ACCESSIBLE ON"
ADMISSION TO ER(HOSPITAL RE-EVALUATION OF TYPEStSIZESt'
RESPONSIBILITY BUT VITAL TO' NECESSITY OF PEDRAATRIC EOPTJ
WHOLE EMS PT.CARE SYSTEM)_ Q — :SUPPLIES(WOULD AFFECT HIGH
LOW RE-EVALUATION OF TYPES/SIZES Oil,. PERCENTAGE OF THE PEDIATRIC
PEDIATRIC E®IlIPMENTlSUIiPLUS
POPULATION,
;(WOULD AFFECT LOW PERCEN 'A
OF TOTAL PUBLIC POPULATION)71
C VEHICLE MAINTENANCE MAP BOOK SYSTEM RE-DONE
O
S MEDIUM ALL FIRST RESPONDERS HAYING 02
TANKS AND MEANS O,fAAINTAINING,
' l
�
EXCHANGING,ETC. j� U N�p� /`k
_ MAINTENANCE OF MEDICAL Et)PT.
AN I
EQUIPMENT 13
EIYiS WIC '�`l'l�l/DEPIBRII.LATORSt DEDICATED TRAINING E®PT.(I'QA
(REPLAC�It#1f,1I�PCif(d1tN�IG 1NTMl TRAINING AND C(}Nt:ED. "�
CURRENT NIDDEIS) Et�i PACINf;ETC. * EG:PEDS INTUBATION ADULT
HIGH MANNEQUIINS,ETC.,
AEDoFOR FIRST RESPONDEUS FIRST RESPONDERS HAVING p
(DEPENDS ON APPROVAL`FOR FIAIT RADIOSAU+t0 TURNOUT GEAR l
-*RESPONDER USE) PURCHASE OF NEW VEHICLES
(REPLACING OLD WITH NEW)AN
?NEED FOR EXPANSION: "
PEOPLE REFERS TO THE GENERAL PUBLIC '{' '
11 fiLCUMMENDATION :
Fro�yl
T �rn� NUMBER OF PE
OPLE AFFECTED
LOW MEDIUM
. REPORTING SOCIAL AND ENV:' I
FACTORS VIEWED ON-SITE TO CONTINUE TO'IMPROVE1 ENHANCE MEDICAL REPORTS-EMS TO ER,AND
HOSP.STAFF(INCLUDES CHILD' EMS DISPATCH INFO TO CALLER BACK,ETA9 UPFRONT, STREAMLINE
ABUSE PO WUBLICHEALTHI�ISSUES,ETC} RELAY OF PERTINENT INFO TO REPORTS--TRAUMA TEAM;ACTIVATION
LOW CONSISTENT USE OF INCIDENT CO " WHEN APPROPRIATE,EARLY NOTIFICATION
RESPONDING EMS PERSONNEL:" OF PEDS PTS.,VERIFY DRUG DOSAGES ESP
t a
AND UPDATES OF ACTIVITIES AT.; FOR PEDS DOSE
THROMBYLITIC SCREENING SCENE--INCLUDES PROPER MAPS,
QUEST.DEVL AND RECOMMENDED CROSS STREETS,DuPUCATto_ 23
n
2l
0
S MEDIUM
T
m RANDS FREE COMMUNICATION, ADD RADIOS THAT ALLOW
DEVICES`(EG.VOX" DIRECT COMI4IUNICATION'
BETWEEN FIRST RESP.AND f
NIGH EMS PERSONNEL(NEW,'
RADIOS?NEW CHANNE
Z2
PEOPLE REFERS TO GENERAL PUBLIC
_ w
RECOMMENDATION .
EVALUATION
NUMBER OF PEOPLE AFFECTED
LOW MEDIUM HIGH
INCREASE NURSING AND HOUSE UPGRADE EMS COUNCIL TO HAVE
COORDINATION WITH COUNTY STAFF AWARENESS OF REHAB A TRUE ADVISORY/EVALUATIVE
HEALTH DEPT.AND EDUCATION POSSIBILITIES AND PROGRAMS, NATURE
AND
PEDS PATIENTS SERVICES,ESP.FOR ESPECIALLY FOR CARDIAC PATIENTS -CONSISTENT,R)UTINE FEEDBACK To
LOW �:/ "EMS PERSONNEL.ON PT.OUTCOMES-�
IMPROVED SYSTEM OF REHAB REFERRALS LINK FIELD TX,ER TX,HOSPITAL TX,
FOR TRAUMA AND CARDIAC PATIEN FOLLOW-UP TO PATIENT OUTCOM
U�� ��fJS
�� EFFECTIVENESS OF EMS OVERALL
COMMITTEES FEEDBACK TO �'c�� L
O `CRITICAL INCIDENT STRESS
S DEBRIEFING ' ESTABLISH TRACKING SYSTEM!FOR DEFINE"OUTCOMES"
CARDIAC PT FLOW IN ED AND POLICY, WH ATTO MEASURE WHO TO DO IT,!'
PARENT SURVEY AEGARDING FOR CHEST PAIN MGT.IN ED ,FREQUENCY,DATA DISTRIBUTION
T MEDIUM TEDS,CURRENT PRACTICES, `(COORDINATION BETWEEN
PROGRAMS ETC {CARDIOLOGY AND ED) Z(o DATA COLLECTION'41 �C
PEDS"HOT LINE"TRACKING_ :WHAT,WHO I HOH►WHEN 't ETC,
,FOLLOW-UP OF SUSPECTED COORDINATE WITH CURRENT DATABASE
CHILD ABUSE CASES EFFORTS EMERGING IN DEPT OF EM ERG.
MED.
IMPROVE FOLLOW-UP OF CARDIAC
HIGHPATIENTSFOR RISK FACTOR
HIGH MODIFICATION AFTEq DISCHA
PEOPLE REFERS TO PATIENTS
1 ..
October 10, 1994
EMS STRATEGIC PLANNING STEERING COMMITTEE
CURRENT STATUS OF MEDICAL SUBCOMMITTEE RECOMMENDATIONS
FOOTNOTES TO COST-NUMBER OF PEOPLE AFFECTED MATRIX
Page 1 - Prevention/Public Health Education
1. American Red Cross has increased the number of CPR provider
and instructor courses in Orange Co. The American Heart
Association numbers have remained fairly constant. This is most
likely a reflection of the 1994 changes in course curriculum and
the time it is taking to retrain the current instructors
2 . Orange Co. Emergency Management has begun to have
announcements-on local access TV. They are working with the
county social services offices to educate their clients on the
use of 911. They have designated one communicator and one EMT-P
as outreach educators, and respond to requests for educational
programs in such places as the public schools.
3 . Non-emergency, convalescent transport has been contracted to a
private ambulance provider. This has actually resulted in a cost
savings to the county, rather than the original estimate of being
a high-cost item. The issues of transport for other patients that
request emergency services but turn out not to actually need an
ambulance transport has not been totally addressed. The EMS
Medical director is working on guidelines for non-emergent
transports.
Page 2 - Training and Staff Development
4. On hold, pending State OEMS approval. Pilot projects have been
done in other counties.
5. Hazmat training is in progress. Other fire training has not
yet been scheduled. The training calendar is full at this time,
but the need for "cross-training" of EMS/Fire personnel has been
recognized by County Emergency Management.
6 . Funding issue has not been totally resolved. Orange Co. Is
currently covering most expenses. The EMS Division of the Dept.
Of Emergency Medicine is not yet fully funded. However,
continuing education in EMS is well planned and ongoing. It is
being coordinated by the EMS Nurse liaison from UNC Hospitals.
7 . There has been a small increase in time spent in the Emergency
Dept. by EMS personnel. There has not been time spent in EMS by
ED staff due to scheduling/staffing difficulties.
8 . Due to a full training calendar there has been no effort to
coordinate or plan integration of training among the various
segments of the system.
9 . Vehicle maintenance training is in progress. Some work has
been done on maps, but more is needed. No progress on rest.
Page 3 - Equipment:
10. UNC Hospitals is working on this issue.
11. OCRS volunteers have taken responsibility for inventory of
Peds equipment and have worked with Orange Co. EMS to implement
changes and improvements. County has purchased recommended
equipment. OCRS volunteers have purchased some equipment. May not
yet be all distributed and in use.
12 . Orange Co. has taken responsibility for vehicle maintenance.
Training has been addressed and preventative maintenance is a
goal.
13 . A new restocking cabinet has been installed in the UNC
Hospital Emergency department, inventories have been done. More
work remains in tracking equipment and supplies. This is a joint
responsibility of the County and volunteer squads.
14 . Orange Co. EM is building up an inventory of training
equipment. Currently some equipment is borrowed and transported
to classes from UNC Hospitals.
15. First responder radios have been updated &/or replaced. There
is no current information on whether the first responders have
sufficient turnout gear.
16. The purchase of new ambulances by the county is on a cycle of
replacing 2 per year. More data needs to be collected to evaluate
the need for increasing the number of ambulances.
17 . No information available on the status of first responders
oxygen supplies and exchange of tanks. System needs clarification
Page 4 - Communication & Integration:
18 . Hospital position exists for Social worker assigned to the
Emergency department part-time (position shared with Walk-in
clinic and Family Medicine outpatients) , but position is
currently vacant.
19 . County EM has considered this issue. It is hard to keep new
staff trained, and they recommend that the future training focus
on staff in command and supervisory positions. More training is
needed.
20. Questionnaire has been developed and adopted by EMS Medical
director, and training is planned for late 1994 or early 1995.
21. Progress has been made on improving information flow. The
number of "UNKNOWN" calls has decreased, and the dispatchers are
giving out cross-streets approx. 90% of the time.
22 . New tactical operations channels have been designated for
direct communication. County EM has worked on this.
23 . There has been some training and improvement in reports, but
progress is inconsistent.
Page 5 - Evaluation and Follow-up:
24 . Issue has been addressed by County EMS. , but coordination of
efforts with County Health Department has not made much progress.
25.A Insufficient data, feedback from Cardiology.
25.B Insufficient data from Cardiology, Trauma services.
26. Dept. Of Emergency Medicine and Cardiology service are
working on this issue. ED staff are developing a proposal for
chest pain management in the ED to present to the joint "Chest
Pain" committee. An evaluator has met with the ED staff.
27. Insufficient data from Cardiology service.
28 . Patient case review sessions are held once a month at Orange
County Rescue Squad in Hillsborough.. These are facilitated by the
EMS Medical Director and EMS Nurse liaison. Attendance is not
optimal. Feedback on individual cases is available upon request
to EMS Nurse liaison.
29 . A second "customer" satisfaction survey is being developed by
some members of the EMS Strategic planning steering committee.
This will survey how the system is meeting the needs of the
citizens. The Steering committee has also produced this report on
the status of the previous recommendations.
30 . UNC Hospitals/Dept. of Emergency Medicine is making progress
on data collection and management. Staff have been hired to do
EMS data entry for the EMS Medical director, and data manager has
been hired to set up data collection systems for the Emergency
Department itself. Plans exist to integrate this data (from EMS
and the ED) . This data will enable the EMS director and the
hospital to do research and better track patient outcomes.
iiecommeandation : Prevention/Public
Health Education
IMPACT TO PATIENT OUTCOME
LOW MEDIUM HIGH
;PUBLIC SERVICE ANNOUNCEMENTS-- ? SSUPPOFiT-OF-EXISTING
LONG TIME BEFORE EFFECT IS SEEN'77 TRAUMA PREVENTION PROGRAMS
��,
' AND BEFORE IMPACT TO PT.OUTCOME
LOW`�y r Y IS POSITIVE 4.
C TRAINING(EMU TYPE)FOR DOCTOR
RECEPTIONISTS FOR CARDIAC
O EMERGENCIES
S MEDIUM
T
NON-EMERGENCY TRANSPURT---
LEAVES EMERGENCY PERSONNEL
AVAILABLE FOR TRUE EMIERGENCIE
AND GETS PTS WITH NON-ACUTE
HIGH NEEDS HANDLED WITHOUT INVOLV-
ING EMS-COORDINATION OF
EXtSTiN.G RESOURCES MIGHT
A£D?RESS SOME OF THIS
RECOMMENDATION : TRAINING
AND STAFF DEVELOPMENT
u ,
IMPACT TO PATIENT OUTCOME
LOW MEDIUM HIGH
CONTINUING;EDUCATION(SG:
CARDIAC 1�IONITOR TYPES PEDS
sKILLS,IY"S JtND!N?UBATIO("IS,`
LAW MED ASSESSMENT)
CARDIAC ARREST DRILLS
INTEGRATION OF DIFFERENT COM-
G
EMS
TRAINING FOR COMMUNICATORS-
0 KEEPING UP WITH NEW TECHNOLOGY DEFIS TECH!TRG-LOW%OF TOTAL`
CJ' MEDIUM LIKE CAD AND GIS OATIENTS TFIEATEQ ICY EMS BUT
HIGH IMPACT TO INI*16 AL M.
T SKILLS ENHANCEMENTS(VEHICLE
MAINT,'VAPS;UC.'"
FIRFJRESCUEIHA?MAT TRAINING
FOR ALL EMS PERSONNEL'
HIGH
mECOMMENDATION :
EQUIPMENT
r '
IMPACT T4 PATIENT OUTCOME
LOW MEDIUM HIGH
12 LEAD EKa READILY ACCESSIBLE
UPON ADMISSION T(?ER(HOSPITAL
RESPONSIBILITY BUT VITAL TO WHOLE
LOW EMS PT CARE SYSTEM
RErALTION OF TYPES,SIZE%'
TJECEvSITY 13A OF PEDS EOPTi
C ALL FIRST RESPONDERS HAVING 02
TANKS,PAEANS OF MAINTAINING, VEHICLE MAINTENANCE
Q MEDIUM EXCHANGING,ETC. MAPSOOK SYSTEM REDONE
�NIC. 1
T
FIRST RESPONDERS HAYING RADIOS AND BACKUP SUPPLIES&TRAINING,''
AND TURNOUT GEAR
EMS Iti ONITOR-DEIt13RILLATORS-- �DEDICATED TRAINING EOPT IN ALL
RPEPLACING AND UPGRADINGCURRENT .AREAS INCLUDING PEDS!
HIGH MODO
AWS FOR FIRST RESPONDERS
�EFIICL S REIsIAG f1 EAEN 1EhI7 t AOPR+I VAL FOR
1140 OLP)AND= ftD-THFJ P s'fowl FIRST RESP USE)! �a
� s
RECOMMENDATION ,
r
COMM UNICATION/I NTEG RATION
IMPACT TO PATIENT OUTCOME
LOW MEDIUM HIGH
CONTINUE USE OF EMD
RELAY OF PERTINENT INFO TO RE AND UPDATES OF
A.C71YIT1ES XT SCENE FRAM 1 T RESR(INCLUDES PROPER MAPS,
LOW DUPLICATED,ETC.)
MEDICAL REPORTS-EMS TO ER AND BACK;CLEAR ID OF WHO IS
SPEAKING, ETA* UP FROWT;STREAM144' EPORTS TO HOSPITAL,
APPROPRIATENOTIFICATION OF TRAUMA AND PEDS TEAMS
REPORT SOCIALIENV FACTORS TO ER--TO INCLUDE CHILD ABUSE
C POTENTIAL,PUBLIC HEALTH ISSUES,ETC.
C CONSISTENT USAGE OF INCIDENT COMMAND
s ` THROMBOLYTIC SCREENING QUEST RECOMMENDED
T VERIFY DRUG DOSAGES,MED AVAILABILITY FOR PEDS ORDERS R,h
MEDIUM
AQD RADIOS THAT ALLOW DIRECT COMMUNICATION FROM FIRST
HIGH RESPONDER TO EMS UNIT
HANDS FREE COMMUNICATION DEVICES(VOX)--HIGH IMPACT ON'
•-SMALL NUMBER OF PATIENTS'
l .,
RECOMMENDATION :
EVALUATION
IMPACT TO PATIENT OUTCOME
LOW MEDIUM HIGH
INCREASE NURSIN A D HOUSESTAFF UPGRADE EMS COUNCIL TO HAVE A TRUE
AWARENESS OF REHABPOSSIBILMES AND ADVISORY/EVALUATIVE NATURE
PROGRAMS,ESPECIALLY FOR CARDIAC PTS
IMPROVED SYSTEM OF REHAB��F^E,RRALSI CONTINUALLY REASSESS OVERALL EFFECTIVENESS
LOVV FOR TRAUMA PATIENTS U�V v OF EMS SYSTEM AND PROVIDE FEEDBACK TO
LOW
COORDINATION WITH COUNTY HEALTH DEPT., DEFINE OUTCOMES"
EDUCATION AND SOCIAL SERVICES,ESP_FOR WHAT TO MEASURE WHO TO DO IT,
N'
�-+
PEDS PATIENTS " SSS?,_.FREQUENCY,DATA DISTRIBUTIO
C CONSISTENT,.ROUTINE FEEDBACK TO° - DATA.COLLECTION
EMS PERSONNEL ON PT.OUTCOMES-
lINKFIEID ' WHAWH ,HOW,WHEN,X,ER TX .F ` ETC.
FOLLOW-UP.TO PATIENT OUTCOMES
s *COOROiNATE WITH CURRENT DATABASE
EIFORTS EMERGING IN DEPT OF EMERG.MED:
T _.
bAITIOACINCIQENTa ESTABLISH TRACKING SYSTEM FOR CARDIAC-'
STRESS DEBRIEF G' , PARENT SURYEY_REGARDING_PEDS CURRENT; PTFLOVII IN ED AND POLICY FOR CHEST PAIN
MEDIUM PRACTICES;pROGFiAMS ETG° MGT.IN ED(COORDINATION BETWEEN
CARDIOLOGY AND ED)''
_'PEDS"HOT LINE"TRACKING T.
t�FOLLOW-UP OF SUSPECTED CHILD ABUSE CASES'-
IMPROVE FOLLOW-UP OF CARDIAC PATIENTS FOR
HIGH RISK FACTOR MODIFICATION AFT R DISCHARGE
OWN, omm
litUummtNUATION .
EVALUATION AND FOLLOWmUP
40'
IMPACT TO PATIENT OUTCOME
LOW MEDIUM HIGH
INCREASE NURSIN A D HOUSESTAFF UPGRADE EMS COUNCIL TO HAVE A TRUE
AWARENESS OF REHABPOSSIBILITIES AND ADVISORY/EVALUATIVE NATURE
PROGRAMS,ESPECIALLY FOR CARDIAC PTS
IMPROVED SYSTEM OF REHAB FERRAL�S) CONTINUALLY REASSESS OVERALL EFFECTIVENESS
FOR TRAUMA PATIENTS �1 j�,(jd V OF EMS SYSTEM AND PROVIDE FEEDBACK TO
LOW COMMITTEES
COORDINATION WITH COUNTY HEALTH DEPT., DEFINE-71DUTCOMES
EDUCATION AND SOCIAL SERVICES,ESP.FOR WHAT TO MEASURE WHO TO DO IT;`'
PEDS PATIENTS ° 0$?,FREQUENCY,DATA DISTRIBUTIOW
C9NSISTENT,ROUTINE FEEDBACK TO"' _
EMS PERSONNEL ON PT.OUTCOMES-1 :'DATA COLLECTION"
LINK FIELD TX,ER TX,HOSPITAL TX, : WHAT,WHO,HOW,WHEN,"$?ETC.
FOLLO*UP TO PATIENT OUTCOMES ;
COORDINATE Wrnl CURRENT DATABASE'
EFFORTS EMERGING IN DEPT OF EMERG.HIED.'
CRInCAL INCIDENTI. ESTABLISH TRACKING SYSTEM FOR CARDIAC'.
MEDIUM STRESS DEBRIEFING ; =
PARENT SURVEY REGARDlNt3 PEPS CURRENT' P'. FL®�'+/IN ED AND POLICY FOR CHEST PAIN
PIRACTICES,'PROGRAMS,ETC.'7 MGT.IN ED,(COORDINATION BETWEEN
C RDIOLOOY AND ED)#
PEDS"HOT LINE"TRACKING
FOLLOW-UP OF SUSPECTED CHILD ABUSE CASESO
IMPROVE FOLLOW-UP OF CARDIAC PATIENTS FOR
HIGH RISK FACTOR MODIFICATION A R DISCHARGE