HomeMy WebLinkAboutAgenda - 06-19-2018 4-d - Emergency Services EMS Initiative to Promote Community Well-being
ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 19, 2018
Action Agenda
Item No. 4-d
SUBJECT: Emergency Services EMS Initiative to Promote Community Well-being
DEPARTMENT: Emergency Services
ATTACHMENT(S):
PowerPoint Presentation
INFORMATION CONTACT:
Dinah Jeffries, 919-245-6123
Kim Woodward, 919-245-6133
Dr. Joey Grover, 919-245-6100
PURPOSE: To receive information on several Emergency Medical Services initiatives and
activities to promote community well-being.
BACKGROUND: Emergency Medical Services (EMS) has been preparing for several months
to launch several initiatives that focus on critical issues in the community and to foster
collaboration with EMS’s partners to enhance the development of EMS as a coordinated system
of care.
1. Freedom House Alternative Destination Transport
This initiative allows ambulances to evaluate behavioral crisis patients and ensure that
the most appropriate facility is utilized. EMS has worked closely with the Freedom
House, Cardinal Innovations and the State Office of EMS to develop alternative
destination protocols that have been approved. The target date to begin these transports
is August 13, 2018.
2. Naloxone Distribution and Clean Needle Exchange
Beginning July 1, 2018, paramedics responding to opioid overdoses will be able to
provide naloxone to patients who refuse transport to the hospital. Utilizing a State Office
of EMS sponsored protocol; paramedics will leave naloxone with the patient, family or
friends. Patients may also request clean needles aiding in the prevention against
spreading blood borne diseases through the use of shared and/or dirty needles.
Paramedics will also provide literature from the Sheriff’s Office and the Health
Department.
3. Coordinated Opioid Overdose Reduction Effort (COORE)
Paramedics work with the Sheriff’s Office, Criminal Justice Resource Department and the
Health Department to provide follow up services to patients who received naloxone
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during an overdose episode. These patients receive education regarding the COORE
program as well as are able to receive additional naloxone, access to clean needles and
access to prescription lock boxes.
4. Do Not Resuscitate (DNR) Bracelet Project
In collaboration with Carol Woods, UNC Hillsborough Hospital and Chapel Hill Fire
Department, EMS is testing the feasibility of the DNR bracelet through a ten (10) person
focus group from Carol Woods. Through drills using the uploaded DNR information,
responders have vastly reduced the time and confusion of accessing a patient’s DNR.
Implementation for this project will be fall 2018.
FINANCIAL IMPACT: This is no financial impact anticipated as a result of these discussions on
the topics listed above.
SOCIAL JUSTICE IMPACT: The following Orange County Social Justice Goal is applicable to
this item:
• GOAL: ENSURE ECONOMIC SELF-SUFFICIENCY
The creation and preservation of infrastructure, policies, programs and funding necessary
for residents to provide shelter, food, clothing and medical care for themselves and their
dependents.
RECOMMENDATION(S): The Manager recommends that the Board receive the presentation
as information and provide any comments or questions.
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Joseph Grover, MD
Medical Director
Orange County Emergency Services
Kim Woodward, Paramedic
EMS Operations Manager
Orange County Emergency Services
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Behavioral Health
EMS has responded to over 135 behavioral emergencies
since January 1, 2018.
Currently the only option for these patients is
transport to the Emergency Department
There are often long waits at the ED for psychiatric
consultation and even longer waits for psychiatric
admission
EMS has been in communication with the Freedom
House and Cardinal Innovations for a solution
We will closely monitor and evaluate the success of the
diversion project
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Alternative Destination Protocol
to Freedom House
If patient meets protocol and agrees, behavioral and
substance abuse patients can be transported
DIRECTLY to Freedom House and bypass ER
This project has taken over a year to implement
Goal to start in August after the last of our supervisors
receive necessary training
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Freedom House Diversion Protocol
Facility has 23 observational chairs that allow short
term evaluation of mental health crisis and
stabilization
Specific inclusion criteria are used to ensure
appropriate patients are diverted from the Emergency
Department
The EMS response will include evaluation by a
paramedic and approval from the EMS Supervisor
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Entry from Behavioral Emergencies or Inebriated Person Protocols AND patient agrees wnh transport to alternative destination
Patient less than 18 years of age
NO
0 Patient has acute medical or traumatic conditions?
NO
Vital signs
Temperature > 100.4 °F
Heart Rate < 60 or a 120
Respirations > 241min
SBP � 100 or BP> 2001100
BG � 70 or > 250
NO
"1 Alertness: Any alteration in mental status?
I " I Exit to appropriate protocol and transport
Patient cannot safely ambulate without assistance YES W to Emergency Department
NO
E, ic:ence or recent history of intentional overdose?
Major surgery in pasth+m weeks?
History of seizure within past 72 hours?
NO
History of seizures related to ETOH withdrawal?
Expressed suicidal or honticidal ideation ?
NO
Actively hallucinating (see Pearls)
Q Evidence of ETON and BAC 0.35 1
Contact Freedom House Recovery Center Liason for
bed availability at 919.667.5910. If available, transport to
Patient meets all criteria for alternative FHRC.
destination AND on scene CIT Supervisor YESi0-
concurs following assessment If no bed available, transport to appropriate ED; FHRC
Liason will coordinate patient transport from ED when
bed is available
Opioid Abuse in Orange County
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Naloxone Use in North Carolina
Naloxone was administered 16,037 times by EMS
agencies across the State in 2017
This is an 89 % increase since 2011
Naloxone is administered 44 times a day across
North Carolina by EMS agencies
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OC
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Incidence in Orange County
2013 – EMS administered
Naloxone 34 times
2017 – EMS administered
Naloxone 80 times
2018 – 32 administrations as of
5/31/2018
Law Enforcement Naloxone
Initiative in 2015
30 reversals (and rising)
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New Opiate Overdose Protocol
New optional State Protocol we are adopting in July
2018
Provides for a pathway when overdose patients refuse
transport
Clean needle exchange
Naloxone kit to the patient/bystander/family
Resources in the area for detoxification and support
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Policy:
Patients who have experienced an isolated IV opiate overdose should be offered a variety of options
to more appropriately manage their addiction.
Purpose:
The purpose of this policy is to:
• Ensure that the patient is offered various options for treatment of substance abuse.
• Provide harm reduction measures.
Procedure:
1. All patients must be over 18 years of age and must not have been in cardiac arrest during the
incident.
2. The patient must regain a normal mental status and respiratory effort after the administration of
Naloxone.
3. Transport to the Emergency Department should be offered to all patients.
4. For patients who decline transport to the Emergency Department, alternative destinations should
be offered when possible. These options could include assistance with inpatient treatment centers
such as Freedom House, outpatient facilities, mobile crisis solutions, addiction specialists, other
local treatment options.
5. In order to decline transport, the patient must meet the following criteria:
a) Be 18 years or older
b) Maintain a GCS of 15
c) Fully alert and oriented
d) Be able to understand the risk of refusing transport, as described in Universal Protocol 1
(UP 1)
6. If the patient declines transport to the Emergency Department, an additional dose of 2mg Naloxone
should be administered IM by EMS. A Naloxone kit should be left with the patient, family, and/
or friends on the scene. EMS will provide education on how to use these kits.
7. In addition to the medication, the following items should be utilized when possible:
a) Offer to dispose of any dirty needles
b) Provide clean needles /syringes when possible
c) Refer to a community peer support team if available
d) Leave literature on resources for substance abuse treatment
e) Notification of policy utilization should be made to the EMS Operations
Manager via email after any naloxone kits are distributed.
Orange County COORE Program
Our part of the program is to provide Naloxone kits
and education for patients who experience a reversal
with naloxone
Cooperation between Orange County Sheriffs Office,
Orange County Emergency Services, The Criminal
Justice Department, and the Health Department
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DNR Pilot Program
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DNR Pilot Program
The bracelet contains a pdf of the original DNR. This is a sample DNR.
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DNR Pilot Program
This pilot involves OCES, UNC Hospitals, Carol
Woods, and NCOEMS
The state’s first use of an electronic version of Do
Not Resuscitate orders
A pdf file of the resident’s DNR is placed on the
bracelet
Bracelet stores DNR on a standard USB drive
USB is readable on standard USB port
This pdf is considered a live DNR by the State of NC
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Next Steps!
Continued testing
8 information sessions are being scheduled at Carol
Woods
Over 100 additional Carol Woods residents have
requested access to the DNR bracelet
Several information sessions hosted by our
Department on Aging have resulted in enthusiastic
interest in expanding this program County wide.
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