Committee Report to State Council
Elizabeth Basnett, Acting Director, thanked everyone, especially the Commissioners, for their resilience and dedication through ongoing issues such as COVID response, drought, infant formula shortage, wildfire season, and many others. She emphasized her intention for the Emergency Medical Services Authority (EMSA) and the California Emergency Medical Services (EMS) System to stay patient-centered in all their efforts and decisions.
Acting Director Basnett reviewed EMSA’s three focus areas: data and technology, strategic planning, and partnerships and service orientation. She provided an overview, with a slide presentation, of the background, makeup, four working groups, goals, and timeline of the California EMS Strategic Planning Subcommittee (Advisory Committee).
Approval of Community Paramedicine and Transport to Alternate Destination Proposed Regulations
Mr. Meyer stated, based in part on the success and outcomes of the pilot project, the proposed regulations are being promulgated as required by AB 1544, which was approved by the Governor on September 25, 2020. The Community Paramedicine or Triage to Alternate Destination Act of 2020 authorizes a local EMS agency to develop community paramedicine or triage to alternate destinations programs, and requires the EMSA to develop and adopt regulations and to establish minimum standards for the development of these programs.
Mr. Meyer stated the proposal provides for approving and renewing LEMSA programs, approving training programs, community paramedicine providers, triage to alternate destination providers and facilities, training requirements for paramedics to become accredited to participate in these programs, and procedures for obtaining, renewing, and reinstating official accreditation as well as procedures for actions taken against the various approvals and accreditations.
Ambulance Patient Offload Time (APOT) Report
Tom McGinnis, Chief of the EMS Systems Division, provided an overview of the APOT Report, which was included in the meeting materials. He stated AB 2961 required that LEMSAs submit APOT reports quarterly to the EMS Authority effective July 1, 2019. The bill also required the EMS Authority to calculate APOT times provided by the LEMSAs and provide biannual reports to EMS Commission. This report is the first report for the 2022 calendar year.
Ambulance Patient Offload Time Committee Update
Acting Director Basnett stated the Ambulance Patient Offload Time Committee was created seven months ago with the purpose of developing recommendations to reduce ambulance patient offload delays. The Committee continues to move toward the goal of developing two sets of recommendations: one set for the Emergency Medical Services System and one set for the Hospital System. This committee will conclude by June 30, 2022, and will bring recommendations for Commission approval at a future meeting.
C. After-Action Reporting Presentation: Ambulance Patient Offload Times Teams
Acting Medical Director Garzon reported on APOT during the Omicron Surge and the response to support hospitals, emergency departments, and the EMS. He reviewed the background, purpose, methodology, conclusion, and next steps of the APOT Deployment Survey, as provided in the staff memo for this agenda item in the meeting materials. He stated the feedback received from the survey confirmed that a sizable difference was seen in decreasing wall times, releasing ambulances back to service, and supporting emergency departments in their operations, especially during COVID surges.
Commissioner Dunford asked about services provided to expedite a reduction in APOT times.
Acting Medical Director Garzon stated 52 percent served as nurse extenders. The original concept of the APOT team was doctors, mid-level providers, nurses, and paramedics to help support and staff the emergency department. Having more hands to do the work has an indirect benefit on emergency department throughput. Getting to the work quicker theoretically decreases wall times. Later, assigning paramedics specifically to take transfer of care meant that the transporting medics can return to the field.
Commissioner Dunford suggested looking at the reduction in APOT times for those teams.
Acting Medical Director Garzon agreed that that would be beneficial. It is a potential strategy in managing APOT going forward.
Commissioner Snyder asked about the cost of these teams.
Acting Medical Director Garzon stated he will follow up with Commissioner Snyder on that figure.
1. Pre-meeting update, The meeting was held on August 1st, and attendance was low. Future pre-meeting will be assessed for need, and reminders will go out prior to the meeting.
2. EMS Commission/ DAG Carole Snyder provided an update on both the DAG meeting and the June commissioner’s meeting
3. Emergency Medical Services Advisory Council no update provided. EMSAC is meeting today as well.
1. State Trauma Regulation Revisions Workgroup-This advisory committee will meet in November. The virtual State Trauma Summit will be held on October 6th. Flyers will be sent out for members interested in attending.
2. STEMI/Stroke Technical Advisory Committee-The State Summit was well attended on June 27, 28th, and feedback from the attendees was very positive.
3. EMSC Technical Advisory Committee-The ENA will now have a seat on this advisory committee. The next meeting and summit will be in November more information to come.
EMSAAC/EMDAC-The next meeting will be held in San Diego on September 20-21st. Both virtual and live
options will be available.
Community Paramedicine Regulations-EMSA will be forming a workgroup to build an implementation toolkit to assist the LEMSAs. ENA may want to have a representative join this committee.
APOT- Interim Director Bassinett has released formal Recommendations, these will be voted on in September. The ENA is currently drafting a letter to the Commission to express concerns with several of these recommendations.
• AB2117-Mobile Stroke Unit: Status: In Senate
• AB2130-EMS: Training Status: In Senate
Roundtable Discussion-ENA will be meeting regularly with CHA to discuss current Legislation. Discussion of the importance of our relationship with EMS among the tension of APOT and initiatives not aligning between hospitals/Fire/Ambulance agencies. What can we do personally to promote or continue a strong relationship with our EMS partners?
Chair: Loreen Gutierrez & Leslie Duke
EMS Commissioner: Carole Snyder
AGENDA and update May 20, 2022
1. Pre-meeting update -no meeting was held prior to the State meeting
2. EMS Commission/ DAG (Carole Snyder)-Next meeting scheduled for June 15, 2022; DAG hasn’t met.
3. Emergency Medical Services Advisory Council (Matt Powers)-New Director for the Office of EMS, Gamunu Wijetunge. Working on current advisories to set direction to Federal Interagency Committee on EMS (FICEMS). One advisory, Profession Safety working on is recognizing EMS practitioners as healthcare workers when it comes to healthcare guidance during national emergency healthcare crises. 4. Task Forces:
a. State Trauma Regulation Revisions Workgroup-The workgroup is now meeting every 6 weeks and reviewing the current California State Regulations section by section.
b. STEMI/Stroke Technical Advisory Committee-STEMI/Stroke Summit June 27 &28. Free, virtual, and CE’s provided. https://www.eventbrite.com/e/california-state-stroke-summit-2022-tickets-288659808257?aff=ebdssbonlinesearch https://www.eventbrite.com/e/california-state-stemi-summit-2022-tickets-288681914377?aff=ebdssbonlinesearch
c. EMSC Technical Advisory Committee-Conference on June 3rd in San Diego C. EMSAAC/EMDAC- Meeting on 5/31/2022 and Conference June 1 & 2 in San Diego
D. Community Paramedicine Regulations- Second public comment period ended. Last meeting on 3/17/2022, looking at changing the structure and possibly needing a complete re-write, moving toward making the language a statute more than a regulation. There may be a longer public comment period in the future. Discussions about the addition of a public substance as an alternate destination option.
E. APOT- (Stephanie Jensen)-AB1770: on 4/29/2022 the bill failed the deadline and is not moving forward.
F. Legislation- AB 2117 Mobile Stroke Units: All financial and re-imbursement verbiage was removed and now the bill just reflects that the mobile stroke unit would be defined to mean a multijurisdictional mobile facility that serves as an emergency response critical care ambulance under the direction and approval of the local emergency medical services (EMS) agency. AB2130 Emergency Medical Services: Training: On 5/19 it was placed on assembly consent calendar, read, passed, and moving onto Senate. AB2729 EMS: Workplace Violence Prevention: On 5/4 referred to the assembly appropriations suspense file and held by the author. SB1022 EMS: Certifying examination: 5/6/2022 Failed deadline and died in the Com. On Health.
G. Roundtable- Discussion on Narcan leave behind in SB and Riverside County. There are some hospitals that are starting Substance Abuse activations and follow up by a case managers or social workers to connect patients with support after discharge from the ED or hospitalization. Some Fire Departments are starting Narcan kit education to school districts.
Introduction to a LEMSA-presentation
EMS pre-state meeting held 3/14/2022
Legislative bills on the watch list include:
SB1022- EMS Certifying exam>watch
AB 2130- EMS Training human trafficking>watch
AB 2729- Emergency Ambulance Services>watch
EMS Commission update by Carol Snyder
EMS Advisory Council update by Matt Powers
STEMI/Stroke Technical Advisory Committee-State Summit June 27 & 28 APOT update by Stephanie Jensen
Community Paramedicine Regulations in another 15-day public comment period
EMSAAC Conference June 1 & 2 EMSC Conference June 3.
12.21 EMSA meeting Elizabeth Basnett, Acting Director, provided an overview of her background, her role at Agency, and the EMS Authority vision for 2022. She reviewed the three goals for 2022: data and technology; partnerships and service orientation, and strategic planning. Hernando Garzon, M.D., Medical Director, provided an overview of the status of health care in California and what the EMS Authority has been doing to support and assist during the COVID-19 surge. EMS RESPONSE TO BEHAVIORAL HEALTH PATIENTS Chair Uner reviewed the background and details on the recommendations made by the Subcommittee on Behavioral Health, which were included in the meeting materials.
The Subcommittee recommendations were as follows: 1. The topic of behavioral health in EMS becomes a standing agenda item for discussion at Quarterly Commission on EMS Meetings. This is not to be part of the Consent Calendar. 2. The Commission on EMS recommends the joint position paper Clinical Care and Restraint of Agitated or Combative Patients by Emergency Medical Services Practitioners as a guiding principle for local emergency medical services agencies (LEMSAs), from which to create (or modify) policies and procedures. 3. The Commission requests EMSA to survey the LEMSAs regarding their current protocols and procedures for behavioral health responses. Ambulance Patient Off-Load Time (APOT) Report Tom McGinnis, Chief of the EMS Systems Division, reviewed the background, process to date, and the second report to the Commission for this year regarding the APOT tracking.
Future reports will come out in June and December. Staff is considering display options for the tracking data. The APOT Committee has been established with 20 members, including EMSA staff and stakeholders, and is chaired by Sean Trask, former Chief of the EMS Personnel Division. The Committee is discussing avenues, processes, and toolkits to help decrease APOT and to make the data more useable and accessible. Discussion Chair Uner stated the third APOT Committee meeting will be held on January 5th. Minutes Dec. EMSA meeting.
Carole provided her EMS Commissioner report, announcing that Dr. Backer has retired. EMSA has formed a Stroke/STEMI technical advisory task force to assist with implementation of the newly enacted regulations. EMSA is now beginning to look at revising the trauma regulations. The scope of practice committee has recommended several additions to the local optional scope, including the use of I-gels, which is part of the plan to help replace the removal of intubation in the prehospital field.
Commissioner Barrow asked how Assembly Bill 1, youth athletics, California Youth Football, integrates with AB 2007 from 2016 and if it will just add on an EMS Component to the law. AB 1 focuses on youth tackle football. EMSA’s concern s the liability protection of the EMTs and paramedics for issuing a return to play or a removal from the game.
Carole provided an update on the ongoing discussion around 1544.
CalChiefs filed three petitions on February 4th on underground regulations dealing with EMS plans and exclusive operating area. EMSA filed a Section 280 Certification in response acknowledging that they would not enforce these guidelines.
There was a presentation at the last Commission meeting on the Centers for Medicare and Medicaid Services (CMS) Innovation Center Emergency Triage, Treatment, and Transport (ET3) Model.
Ambulance Patient Offload Times – EMSA stated that beginning July 1, 2019, all LEMSAs will be required to submit APOT data to EMSA quarterly,
The EMS-T committee met in June. Much of the time was spent on data, collecting it, what to collect, value of the data as well as obstacles to collecting it. More to follow.
BJ Bartleson discussed her presentation at the EMSAAC conference and the ambulance provider who just invoiced a hospital. One of our committee members mentioned an area where a hospital has possibly been billed and paid this to EMS – further research is planned and we’ll find out more. Part of the identified priority items for this committee is emergency services data and story collection. We need good data and transparency.
CHA has updated its Discharge Planning for Homeless Patients guidelines. This toolkit can be downloaded from their website.
Sue is our representative to the State Trauma Regulation Revision workgroup.
EMSA is putting together a Stroke and STEMI technical advisory committee. This group will inform EMSA on the systemization of the recently approved statewide STEMI and Stroke regulations.
National Association of EMS Physicians has formed a California Chapter. There’s some work going on to update Section 1157 of the evidence code to include EMS. Currently EMS is not protected from discovery under 1157. Sometime down the road they are looking for Cal ENA support.
EMDAC – they’ve established a set of standardized quality assurance measures for local optional scope of practice approval that that will be extended to other airway interventions as well, allowing for an unprecedented look at airway management, performance improvement, and data analysis.
EMSAAC – Their legislative committee has been very active, specifically 1544 and 438 (a dispatch bill). EMSAAC has started planning their May 2020 conference, it will be in San Diego.
The EMS Authority, after significant review is now proposing that alternate destination strategies are within its regulatory power. This means that the EMS Authority is clarifying that local EMS operations are legally allowed to transport patients to places other than emergency departments, such as sobering centers or behavioral health facilities.
During round table there was discussion on the move for “planned” power outages during high-wind/high fire risk days. Discussion around how to plan for 3-5 days on generator power.
Carole Snyder provide her EMS Commissioner report – the commission last met on 3/19. New Commission chair elected: Jim Dunford. Carole touched on our continued work to maintain the ENA Chair on the commission. The EMS-Trauma Committee last met in March, next meeting is June 5th. In March the challenge of collecting LOS data was discussed, in particular behavioral health patients and how do we define a psych hold. How do we standardize the definition of the metrics? Attendance at the annual California Hospital ED Forum has not increasing significantly and it has been suggested that the date and time of the forum be changed to separate it from the Behavioral Health Symposium. They also expressed interest in pairing with Cal ENA for this ED Forum. EMSA update: the State Trauma Regulation Revisions workgroup has requested an ENA rep. Sue is working with the committee to identify a rep. The paramedic regulations are currently open for revisions. Any comments are due by May 20th. If you have suggested comments to submit as a group please send them to me by May 16 to allow enough time for the board to review prior to submission. The EMSAAC (EMS Administrators Association of California) Conference was held last week, at this same lodge. Some great speakers and topics. The last panel of the day was related to wall times. One panelist administers a large ambulance company and he recently submitted a 2.6 million dollar bill to a hospital in his area – charging for their staff time due to off load delays. It cannot be emphasized enough the importance of the hospitals taking control of collecting accurate turn over of care times. The State is requesting LEMSA’s submit their offload times on July 1 and we expect it will be posted on the publicly facing EMSA website. The National Association of EMS Physician’s group recently started a California Chapter. Two highlights from the summary they provided: They are focusing on advocating over the critical drug shortages. Also they are having a CPR video challenge to get bystander CPR videos to go viral on social media platforms. Everyone is welcome to submit a video, in fact they are encouraging participation. They provided several links related to their blog and podcast, I’ll post the links on the website, on the EMS Committee page. The Emergency Medical Director Association of California or EMDAC, scope of practice committee approval an expanded scope for flight paramedics, including pediatric intubation. Specific criteria must be met for paramedics to practice with this expanded scope. We’ve been talking with leadership of the California Paramedic Foundation. They are focusing on several things but in particular the safety and wellness of EMS providers. There’s an opportunity here for a collaboration. Finally – two LEMSA administrator’s have expressed interest in ENA representation on their Emergency Medical Care Committees. We will follow up with specific chapter leadership.
EMS Commissioner Report
California EMS System Strategic Planning Advisory Committee: acting director Basnett discussed Strategic plan with overarching advisory group and 4 sub committees.
1. Policy and data-evidence based data analysis for medical and system decisions.
2. Operational working group looking at real time data and working data. How do we use data for real time decision making? Mutual aid and ability to get the right resources to the right place at the right time 3. Equity working group-an equitable group that looks at the issues from different ways. Look at gaps and sustainability.
4- Administration and resilience-threat and risk administration-workforce and demand. Looks to stand up the group towards the end of April and speak to stakeholders.
Legislative Report-EMS watching these bills Disaster bill going through many amendments.
AB1770 APOT introduced formally-workgroup to be established and report to commission on the aspects of off load time. Significant collaboration with stakeholders and legislators
AB2130 Cunningham EMS training-would 20 minutes of new instruction on licensure for human trafficking.
SB979 Dodd health emergencies-clarification would authorize cdph to trigger out of state provisions to allow out of state license to work in state. Currently allowed to allow under business codes statue.
Spot bill-SB1022 EMS certifying exam AB.
Regulations Update: Kent Gray-Comm Para medicine and alt destination-45 day comment period, EMSA noticed an issue and offered a 15 day comment period, in process of finishing new draft and will send out for additional comment period. Meeting to take place 3.17.22.
Ambulance Patient Offload Time Update: APOT committee to come up with recommendations hosted hearing on apot with legislators and stakeholders. Panel sent letter outlining thoughts that came up in packet.
Dr. David Duncan was appointed as the new EMSA Director. Paramedic regulations: Alternate destination has been removed from current version of regs. In the latest public comment draft, EMSA removed the proposed alternate destination language found under subsection (a) of from Section 100170 under Article 7 of Chapter 4, Title 22 of the California Code of Regulations (CCR). Throughout the regulatory process, it has become clear to EMSA that further discussion about these details will take more time than initially expected. The changes noticed on September 13 are necessary to allow a new EMS Authority Director the opportunity to work with stakeholders and collaborate on a path forward for both alternate destination and community paramedicine policy. Presently, EMSA’s immediate priority is to proceed with the remaining proposed revisions to Chapter 4 of Title 22 of the CCR, including, but not limited to, modifying paramedic licensure fees and paramedic training program requirements. In order to meet the one-year (1) rulemaking process timeline pursuant to Section 11346.4 of the Government Code, and the Rulemaking Calendar schedule approved during the December 2018 Commission meeting, the EMS Authority is requesting the Commission on Emergency Medical Services to consider the proposed regulatory action for approval at the meeting scheduled for December 4, 2019. Community Paramedicine projects have been extended through November 2020.
This is copied from the minutes “DEPUTY DIRECTOR OF LEGISLATIVE, REGULATORY & EXTERNAL AFFAIRS LIM: The next bill is the AB 1544 and that is Community Paramedicine or Triage to Alternate Destination Act. This bill would authorize the local EMS agency to adopt a community paramedicine or triage to alternate destinations program and provide community paramedicine services, in which we have had pilot programs since 2014. This bill would require EMSA to develop regulations to establish minimum standards. It also would augment the Commission as it stands now in its compilation, among other features of the bill. Again, this bill has had a similar look in last session and that bill was 3115, I believe. I can’t remember but before that it was SB 944. We understand there is a lot of discussion around this bill. Is there any discussion that anyone would like to have? CHAIR DUNFORD: Commissioner Barrow. COMMISSIONER BARROW: This bill is a pretty contentious bill at the Capitol and there are alternative legislators exploring alternatives because they are unhappy with different provisions in this. One of the biggest concerns is the local political and monetary costs associated with this bill in changing EMS system unnecessarily when there is already a collaborative setting at LEMSA to handle CP. I think there is going to be more legislation coming out soon. The administration has made it really clear that they are not really happy that this is the only discussion happening at the Capitol so it will be interesting to see what happens by our September meeting, what the landscape looks like on this. DEPUTY DIRECTOR OF LEGISLATIVE, REGULATORY & EXTERNAL AFFAIRS LIM: Thank you. CHAIR DUNFORD: And Commissioner Snyder. COMMISSIONER SNYDER: Carole Snyder, Emergency Nursing Association. Just to reiterate, this is a sneaky bill that changes the makeup of this commission. It removes the Emergency Nursing Association and it removes the California Paramedic Association, which are not representing anything but the right type of care. And I just want to reiterate that if it was a clean bill ENA may be in support of it; but we are definitely in opposition right now and I would like you guys to take that into consideration. CHAIR DUNFORD: Thank you. Other comments? Commissioner Uner. COMMISSIONER UNER: I would like to second what Carole just said. I think removing emergency nurses and paramedics from this commission is not a good move. CHAIR DUNFORD: Thank you. Others? Commissioner Hinsdale. COMMISSIONER HINSDALE: Echo that, also agree with Carole. Thank you.
The Trauma regulations are starting to be revised. EMSA will align with the American College of Surgeon guidelines, their verification process and their quality improvement process as the regs are reviewed and revised. They will concentrate on tracking patients and secondary transfers which may flow over to other specialty transport regulations. Other issues for trauma are how to look at regional issues. Do the current RTCCs accomplish the desired goals? Do we need to re-look at that concept and how can we integrate the concept of some regional evaluation or care into regulations? There are EDs around our state, who are beginning to initiate medically-assisted therapy. In other words, start patients on SUBOXONE, as opioid replacement, through something called the ED-BRIDGE Program. Recently the Scope of Practice Committee has recommended and Dr. Backer approved several additions to Local Optional Scope of Practice. These were either recommended through trial studies that were approved by this Commission such as TXA, or approved through evidence-based literature reviews and these include IV acetaminophen, ketorolac or Toradol which can be given through multiple routes, ketamine. Also approval for paramedics to monitor IV medications during transport to a higher level of care, medications that are initiated at the sending facilities, such as blood, pressors, anticoagulants and antibiotics. Per Dr. Backer-These expansions to Local Optional Scope of Practice provide better patient care, especially for our rural areas and our regional systems of specialty care when it is preferable to transport by paramedic ground ambulance because CCT is not readily available and air ambulance might be too much and too expensive. Dr. Backer announced his retirement from EMSA.
Minutes to EMSA commission meeting can be found on the EMSA site: https://emsa.ca.gov/ems_commission_meetings/ Stroke and STEMI regulations were adopted, the full text of the proposed final regulations is posted on the website. Ambulance Patient Offload Time Update Mr. McGinnis stated staff continues to collect and work with data from the Ambulance Patient Offload Time project. 17 LEMSAs have provided information this year compared to 18 last year. Staff is learning more about ways to display this data. In working with the LEMSAs, staff learned that forms and ways data is collected can be difficult at times and is working to improve the process. Mr. McGinnis stated his hope that more submissions and more information will continue to come in and that, as staff learns better ways to visually display the information, it will present a good picture of what is happening in the state. Questions and Discussion Commissioner Dunford asked if there is any trend in favor of showing improvement based on the limited capacity of the current data. Mr. McGinnis stated there is no definitive trend. Dr. Backer noted that the data is only for the first year, 2017. There is variation year by year. Commissioner Dunford stated there are some significant outliers and asked if there is evidence of people trying to fix major problems. Mr. McGinnis stated it is early to say concretely. Action: Commissioner Stone moved to accept the ambulance patient offload time update as presented. Commissioner Burch seconded. . EMS Quality Core Measures Guidelines were approved. Alternate Destination The EMSA received a letter from EMS administrators and medical directors advocating implementing alternate destination by policy rather than seeking it legislatively. Staff will work with EMS administrators and medical directors on best strategies to achieve this. Disaster Medical Medical care support in times of disaster is one of EMSA’s key responsibilities. Medical and mental health care issues in shelters during large-scale evacuations are often underestimated. Individuals who end up in shelters often require a higher level of care because their usual home health care resources are unavailable in general population shelters. There is a need to explore alternative resources and concepts to medical shelters.
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.
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.
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.
California State EMS Commission Meet June 20, 2018
Ketamine: Commission passed- Move Ketamine from Trial Study to Local Optional Scope
Community Paramedicine: The Community Paramedicine Project Manager and the Independent Evaluator are funded by the California HealthCare Foundation. Local pilot site providers participate with in-kind contributions and any local grants or reimbursement. Strong progress continues with the Community Paramedicine Projects. The data, as well as the independent evaluator’s public report continues to show these projects have improved patient care as well as having reduced hospital re-admissions and visits to emergency departments. The UCSF’s Healthforce Center issued an update Evaluation Report in February 2018, containing their findings for the first 28 months of the project, (see link below) which in summary states:
“The evaluation found that community paramedics are collaborating successfully with physicians, nurses, behavioral health professionals, and social workers to fill gaps in the health and social services safety net. The evaluation has yielded consistent findings for six of the seven community paramedicine concepts tested. All of the post-discharge, frequent 911 users, tuberculosis, hospice, and alternate destination – mental health projects have been in operation for 21 or more months and have improved patients’ well-being. In most cases, they have yielded savings for payers and other parts of the health care system. Preliminary findings regarding the sixth concept, alternate destination – sobering center, suggest that this project is also benefiting patients and the health care system.” The following links contain the UCSF February 2018 Evaluation Report as well a Research Highlight Document: https://healthforce.ucsf.edu/publications/evaluation-california-s-communityparamedicine-pilot-program
The following is a status update on the additional Pilot Projects:
|Local EMS Agency||Sponsor||Concepts||Status|
|Santa Clara County||Santa Clara County EMS||Agency Alt Destination Behavioral Health Alt Destination Sobering Center||CORE and Site-specific training has been completed, an IRB has been approved for this Pilot Project OSHPD implementation approval is pending.|
|Sierra Sacramento Valley||Dignity Health||Post Discharge||CORE and Site-specific training and an approved IRB are pending|
|El Dorado County||Cal Tahoe JPA||Alt Destination Behavioral Health Post Discharge||This project has withdrawn due to lack of JPA Board approval and funding.|
|Marin County EMS Agency||–||Frequent 911 User||CORE and Site-specific Training and an approved IRB are pending, awaiting the outcome of the Legislative process.|
|City & County of San Francisco||San Francisco Fire Department||Frequent 911 User Alt Destination Behavioral Health Post Discharge||Site-specific Training and an approved updated IRB are pending.|
|Central California EMS Agency||Central California EMS Agency||Alt Destination – Behavioral||CORE and Site-specifc Training has been completed. Currently awaiting an approved IRB|
There are currently two (2) pieces of Legislation making their way through the legislative process which would enable the ability for EMSA and the Local EMS Agencies to approve Community Paramedicine and/or Alternate Destination to Mental Health Facilities or Sobering Centers programs throughout the State of California.
AB 1795 (Gipson) Allows a local emergency medical services agency (LEMSA) to submit, as part of its emergency medical services (EMS) plan, a plan to transport specified patients who meet triage criteria to a behavioral health facility or a sobering center. This bill authorizes a city, county, or city and county to designate, and contract with, a sobering center to receive patients, and would establish sobering center standards. Specifies the training requirements for paramedics to transport individuals to behavioral health facilities. Requires the Emergency Medical Services Authority (EMSA) to adopt guidelines for the triage criteria and assessment procedures by July 1, 2020 and requires EMSA to annually analyze administration of local plans and issue a report. (Sponsored by California Hospital Association (CHA) & Los Angeles County)
SB 944 (Hertzberg)
This Bill is sponsored by the California Professional Firefighters (CPF)
The Bill would enact the Community Paramedicine Act of 2018. This bill would create the statutory authority to transition community paramedicine (CP) from the Health Workforce Pilot Project #173 to a statewide program. The bill would authorize local EMS agencies to develop a community paramedicine program that is consistent with regulations that would be developed by the Emergency Medical Services Authority (EMSA), in consultation with the Community Paramedicine Medical Oversight Committee, which would be formed by this bill. Community paramedicine programs would provide services in one or more of the following five roles: (1) providing short term post discharge follow up; (2) providing directly observed tuberculosis therapy; (3) providing case management services to frequent emergency medical services users; (4) providing hospice services in coordination with hospice nurses to treat patients in their homes; and, (5) providing patients with transport to an alternate destination, which can either be an authorized mental health facility or an authorized sobering center.
Disaster: EMSA is working with CDPH to acquire funding to develop a Crisis Care/Scarce Resources guidance document.
The DHV Program has over 23,700 volunteers registered. There are over 21,000 healthcare occupations filled by registered volunteers. 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 23,700 plus DHV registered responders are Medical Reserve Corps (MRC) members. EMSA trains and supports DHV System Administrators in each of the 36 participating MRC units. DHV System Administrator training, DHV user group webinars, and quarterly DHV drills are ongoing. On, April 4, 2018, EMSA conducted a quarterly DHV drill for System Administrators. On April 11, 2018, EMSA conducted a quarterly DHV User Group webinar.
Patient Movement Plan: EMSA is currently incorporating comments received during the public comment period. The release of the California Statewide Patient Movement Plan will be summer 2018.
Epinephrine Auto-injector Training and Certification: On January 1, 2016 the EMS Authority began accepting applications for training programs to provide training and certification for the administration of epinephrine auto-injectors to the general public and off-duty EMS personnel. EMSA has approved14 training programs and has issued 717 lay rescuer certification cards.
STEMI/Stroke Systems of Care: STEMI and Stroke Regulations EMSA has opened the rulemaking process with the Office of Administrative Law for the Stroke and STEMI regulations. The public was invited to submit written comments on the proposed regulations during the 45-day public comment period from April 6, 2018, through May 21, 2018. At the end of the public comment period, EMSA held a public hearing on May 21, 2018, beginning at 9:00 am and ending at 11:00 am to go over the regulations with any member of the public who had questions. The comments received during the comment periods will be reviewed against the draft regulations and considerations for change will be made. Should substantive changes be indicated, EMSA will engage the working group who helped develop the regulations prior to an additional comment period.
EMS for Children Program:
Regulations: The EMS for Children regulations completed the 45-day public comment period on Friday, April 27, 2018. The public hearing was held on Monday, April 30, 2018. NO members of the public appeared at the hearing to discuss the EMSC regulations draft. Revisions to the draft EMSC regulations are being considered based on the comments received during the first comment period. EMSA is engaging the EMSC TAC to assist us with revision considerations. Upon the completion of the revisions, a second comment period will be held.
Educational Forum: The 21st Annual EMS for Children Educational Forum will be held on Friday,
November 9, 2018 in Fairfield, CA. The venue has changed to the North Bay HealthCare Administration Center. Speakers and vendors/sponsors are being recruited for the forum.
The EMSC Program survey of California hospitals for Performance Measures EMSC 06 and 07 will be conducted May – August 2018. This survey will pertain to EMSC Interfacility Transfer Guidelines and Agreements of pediatric patients.
Legislative Report: http://www.emsa.ca.gov/current_legislation
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 Authority||State of California EMS Authority|
|Homeland Defense||Homeland Security Levels|
|Homeland Defense||Chemical Decontamination Documents|
|Homeland Defense||Decontamination Water Containment|
|Homeland Defense||What’s going on with Smallpox Vaccinations in California?|
|Dept. of Homeland Security||Department of Homeland Security|
|FEMA||Federal Emergency Management Agency|
|Ready.Gov||Preparedness Advice from DHS|
|Disaster Medical Assistance Team – Orange County||www.dmatca-1.org|
|American National Red Cross||www.redcross.org|
|U.S. Fire Administration (DHS/FEMA) Training & Education||www.training.fema.gov|
|Hazmat||State 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 Hazards||Natural 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 Informed||www.ready.gov/be-informed|
|Disaster Recovery Center Locator||www.fema.gov/disaster-recovery-centers|