1 / 75

EMS Base Station Meetings Fall 2013

EMS Base Station Meetings Fall 2013. What, How and Why. Objectives – What, How and Why. State EMS Authority Quality Core Measures Project Review – where do you fit in… Review 2012-2013 STEMI Benchmarks Review six months data from 2013 cardiac arrest study. Objectives – continued.

ksena
Download Presentation

EMS Base Station Meetings Fall 2013

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. EMS Base Station MeetingsFall 2013 What, How and Why

  2. Objectives – What, How and Why • State EMS Authority Quality Core Measures Project Review – where do you fit in… • Review 2012-2013 STEMI Benchmarks • Review six months data from 2013 cardiac arrest study

  3. Objectives – continued Trauma system- the first 12 months • Discuss opportunities of improvement through case studies • Communication • M- mechanism • I - injuries • V - vital signs • T – treatment • Documentation • Destination

  4. State Core Measures

  5. State Quality Core Measures Why… • California first to establish statewide standard set of core measures • Purpose: increase accessibility and accuracy of prehospital data • Measures process data vs. outcome data

  6. State Quality Core Measures • System Core Quality Measures include: • Trauma • Acute coronary syndrome • Cardiac Arrest • Stroke • Respiratory • Pediatric • EMS Provider skill performance • EMS response and transport • Public education/by-stander CPR

  7. STATE CORE MEASURES • ACS-1 “ASA Administration for Chest Pain”

  8. Core Measures How can you help? • Challenges • Consistent data reporting – check your charts • Acquiring data from non-transporting agencies including: • First responders • Dispatch agencies • Hospitals • Understand we only ask for information that we need

  9. STEMI

  10. STEMI Benchmarks

  11. STEMI Feedback

  12. Cardiac Arrest 6 Month Review

  13. Cardiac Arrest Study Four time sensitive links to survival: • Early recognition of the emergency and activation of the local emergency response system • Early bystander CPR • Early delivery of a shock with a defibrillator • Early, advanced life support followed by post resuscitation care

  14. Data Overview

  15. CPR/AED

  16. Cardiac Arrest Rhythms

  17. Survivor Rhythms

  18. Times

  19. What Now? (Goals) • Data collection – request PCR from all providers (BLS and ALS) for cardiac arrest that are transported • Obtain dispatch information – pre-arrival instructions etc. • Improve by-stander CPR from 44% - classes and public education • AED access – identify locations and add to CAD • Improve out of hospital survival – “Pit-crew CPR”

  20. Trauma 2012-13

  21. Trauma Call Volume

  22. Consults - MOI and GLF

  23. 2013 – Quarter 2 Consults

  24. MOI – Step 3 Criteria • Falls • Adults: >20 feet (one story is equal to 10 feet) - Children: >10 feet or two or three times the height of the child • High-risk auto crash • Intrusion of passenger compartment >12 inches occupant site or >18 inches any site including roof/floor • Ejection (partial or complete) from automobile • Death in same passenger compartment · • Auto vs. pedestrian/bicyclist thrown, run over, or with significant (>20 mph) impact • Motorcycle or unenclosed transport vehicle crash >20 mph

  25. Special Considerations - Step 4 • EMS provider judgment –Anything not listed • Age >65 or <14 yrs. • Two or more proximal long bone fractures • Anticoagulation therapy (excluding aspirin) or other bleeding disorder with head injury (excluding minor injuries) • Pregnancy >20 weeks • Burns with trauma mechanism (*) Trauma Consultation is not required for ground level/low impact falls with GCS ≥ 14 (or when GCS is normal for patient) – follow SLO County patient destination policy

  26. PCR Missing After 24 HoursSVRMC Fax line for all PCRs - 805-596-7509

  27. Prehospital Performance • Transports > 30 min • Responses > 20 min • Scene time > 10 without extrication • MCI/Multiple Patients • Law Enforcement Questioning • Total call times Fall outs are reviewed with the providers to determine if there is a system issue that needs further attention.

  28. EMS Helicopter Resource

  29. High Risk SituationsConsider EMS Air Resources • High risk motor vehicle accidents • Major damage to vehicle e.g. head-on/entrapment • Patients ejection (partial or complete) from an automobile • Multiple injured patients/reported death • Auto vs. pedestrian/bicyclist – thrown or run over with significant injuries • Motorcycle (or like vehicle) crash > 20 mph with significant injuries • Falls – adults greater than 20 feet or children greater than 10 feet or 2-3 times their height with injuries • Unconscious person(s) • Penetrating (stabbing or gunshot) injuries to head, neck or torso • Paralysis • Amputations and/or mangled limbs • Burns to face or major portion of the body • Multi Other situations not covered but dispatcher/FR believes condition of patient is critical

  30. Scene considerations Questions to ask yourself Do you think this patient requires specialty care? Is this a time sensitive injury or illness? Does the county have this capability, i.e. intubated pediatric patient Is the patient inaccessible by ground? Are ground resources maxed out? Is this a MPI? Should these patients be dispersed over a larger area?

  31. Time Considerations

  32. Trauma Center

  33. SVRMC Trauma Registry Data

  34. SVRMC Trauma Registry Volume by Age

  35. SVRMC Trauma Registry Volume by MOI

  36. Trauma Center Quality and Performance • Quality Indicators ED through hospital discharge • GCS < 14, no head CT • GCS >8, no definitive airway • Under and Over Triage rates • Surgeon response times to activation • ED/Resuscitation: ED throughput, CT tech + tat, ATLS/TNCC standards, time on the backboard, IR, transfer • OR- room- team- anesthesia • ICU: transfer to, readmission to, reintubation, monitoring • Blood Bank: MTP, blood availability • All transfers, All mortalities

  37. Trauma Center Quality and Performance • Transfers IN • Trauma Transfer Line- 1-877-903-0003 • One central point of contact for all transfer decisions, recorded and reviewed • Transfers OUT • All recorded and reviewed by the TPM/TMD/TOPPIC • Relationships with tertiary centers • Reasons for transfer: • Complex pelvic fractures, acetabular fractures, reimplantation, aortic injuries, pediatric patients needing PICU level of care

  38. Communication • Points to remember • TC prefers Med Channel 3 - overhead PA • TC point of medical control - even if with change in destination • iPhone app – its free • Tools include: • GCS calculator • Time and distance to TC and other hospitals • Trauma Guidelines • Drug formulary • Other protocols

  39. Case #1- Friday night @ 1915-”The Good” • Medic 52 “ SV Base this is Medic 52 calling in with a Trauma Alert” • “Medic 52 this is SV Base MICN 844 go ahead” • “SV Base this is Paramedic 007, we have a 17 yo male patient meeting Step 1 trauma criteria” • M:”Pt is a football player from a local HS was tackled by another player, taking a hard hit to his head” • I: “pt. walked off the field c/o severe headache and then collapsed” • V: 97/50- 52- 10- GCS- 4 –decer posturing, R pupil is 5mm nr, L is 2 mm and sluggish • T: Pt is in full C-spine precautions, 1 IV right AC, our ETA to you is 8 minutes” • Medic 52 this is SV Base, we copy that report, we’ll see you in 8 minutes, proceed to room 8A on arrival”

  40. “The Bad & Ugly” What if you don’t have the information…. What is the …? Really…..

  41. Trauma Radio Report Include the trauma step criteria at the beginning of the call • “Trauma Alert- patient meeting… • Step 1 – MVC- Driver with GCS 8” • Step 2 – Stabbing to upper chest with SOB • “Trauma Consult- patient meeting…. • Step 3 - Auto vs. tree with >18” intrusion (meets MOI) • Step 4 – Auto vs. tree with major front end damage, no PSI (paramedic judgment, + seat belt sign)

  42. Communication • Paint the picture

  43. Case #2 “Non-Stat Trauma” 0118: 911 TC car into telephone pole at 50 mph- 2 pts 0123: PM arrival to 25 yo female passenger, + restrained, sitting up in seat with SLOFD holding C-Spine. Vehicle had front end damage, no PSI. Pt admitted to ETOH. Denies any c/o. 0125: 90/P-110-22-GCS 14. PE- bleeding form nose, L eye hematoma, L shoulder hematoma from seatbelt, stable chest wall, no pain on palpation, RUQ/RLQ painful on palpation, hematoma RUQ, pelvis stable, no neuro deficit 0146: Report to the TC 8 minute ETA- BP 110/46- 108-14- GCS- 14

  44. Case # 2 Outcome • Tier 2 activation- no documentation of criteria met • Stable in ED, FAST neg, CT, admitted to trauma service/surgeon on SDU • DX- Basilar skull fracture, orbital fx, L ptx- small, small liver laceration, fx sacrum, coccyx, metatarsal fx • TX: NPO, serial hgb, serial exam • W/in 24 hours developed increasing abdominal pain and distention • To OR next am- laceration + repair to sigmoid colon, adm to ICU

  45. Paramedic Evaluation + Assessment SB Position Driver or Passenger?

  46. Penetrating Mechanisms • Stabbings and GSW – Step 2 • Not always what you see • High risk - “killer zone” head, neck, torso, proximal extremities • Patterns – female vs male • Caliber and distance

  47. MOI Predictors • Motorcycle crashes> 20 mph • ATV – dunes vs ranch • Falls from > 20ft adults or > 10 feet or 2-3 times the height in children Considerations • Lower speed with sudden deceleration ( MC vs wall) • Landing surface impacted • Protective gear • Age

  48. MOI Predictors • Bicycle Crashes • Bike Crash • Auto vs bike Yes! ??

  49. Injuries • Expose the injuries – clothes off! • Signs + symptoms suggestive of injury • Seat belt marks • Steering wheel or other impression on the chest or abdomen • Pain in any of the abdominal quadrants • Chest pain with air bag deployment or steering wheel damage • Pelvic deformity, instability, pain • Special considerations • Pediatric patients • Older adults • AMS

  50. I-Injuries • Isolated Orthopedic Injury?

More Related