Altered Standard of Care Training for Administrative Personnel

Altered Standard of Care Training for Administrative Personnel Module 3

Welcome to the S-SV EMS Agency Altered Standard of Care Administrative Module 3 • This is the third of three modules of the Altered Standard of Care Training. This section focuses on: • Altered Field Response Protocols • Family/Patient Brochure • Just-In-Time Training (JITT) • This module will take approximately 1hour to complete. At the end of this module there will be a 10 question quiz. You must complete the quiz with an 80% success rate to pass. The questions will be based on the information learned during the training module. • NOTE: Completion of the quiz is required to receive CE credit.

Disclaimer This training provides an example of how the current 911 system may be altered during a major disaster or pandemic outbreak. The scenario and changes shown in this module are hypothetical only and should not be taken as actual changes to the system. System changes may follow the model that is shown in this training, but could vary based on the severity and type of incident.

Purpose The purpose of the Altered Standard of Care Training is to provide information regarding the alteration of the EMS system in response to an increased demand for medical-aid services, beyond the capacity of the current system providers.

Objectives • After completing this training, you should be able to: • Describe the purpose and process for establishing QRV’s. • List several changes that might be made to the paramedic scope of practice. • Identify elements to include in a Family/Patient Brochure. • List several important elements of Just-In-Time Training.

SCENARIO A pandemic outbreak has affected a large portion of the population. It is a severe variation of the annual flu virus. The EMS system has increasingly become overwhelmed, and there is no estimated time when this impact will end. We simply do not have the resources and personnel to handle the demand for more ambulances. Ahead we will discover what changes can be made to the system to handle this type of overload Something has to change! What can we do?

SO FAR… • Now that we have modified the medical dispatch system by altering dispatch protocols, developing a Scheduled Transport Center, and establishing a Public Access Number, we will now look at alterations to the EMS Field Response protocols. How can we quickly expand available EMS response resources?

Field Response The MHOAC and EMS Agency Medical Director must collaborate with the OA EOC to develop a plan that will allow the EMS system to expand and meet the needs of the EMS system when the demand for response exceeds the ability of the current system. www.disasterdoug.com

Field Response One solution may be to convert all ALS ambulances to BLS transport units, allowing us to place paramedics on Quick Response Vehicles (QRVs) This implementation will quickly expand available EMS resources. With this change, we may see paramedics responding to 911 calls in a supervisor vehicle, fire engine, fire battalion chief vehicle, public works vehicle, or any other vehicle modified to be used for 911 response. www.disasterdoug.com

Field Response Establishing QRVs will allow the paramedic to: • Rapidly respond to 911 medical calls • Provide ALS intervention as needed • Transfer care to a BLS transport unit • Clear the scene quickly to be able to respond to the next call www.disasterdoug.com

Field Response QRVs Vehicles Secured for use as must be modified and equipped with ALS equipment/supplies, communications, etc.

Field Response In cooperation with fire, ambulance, and OES; establishing strategic EMS staging areas throughout the county, will allow us to share resources, including: • personnel, • equipment, and • supplies. Consolidating our resources will reduce duplication, and ensure that only the necessary resources are deployed to each call.

Lets examine what we have learned so far… Paramedics have been taken off of the ambulance and placed in a QRV in order to respond to more calls without having to transport the patients to the hospital. Which of the following would be considered a QRV? • Company Vehicle • Ambulance Supervisor Vehicle • Fire Engine • All of the Above www.disasterdoug.com

Lets examine what we have learned so far… If you answered, , you are CORRECT Paramedics may be placed in an alternate vehicle for response to 9-1-1 calls known as a Quick Response Vehicle or QRV. D. All of the Above

Now we have staffed and equipped vehicles that may be used by paramedics as QRVs and our ambulance fleet has been converted to all BLS transport. How do we determine which patients get transported and which patients get referred or released?

Now let’s look at an altered triage process that ranks patients based upon the severity of need. This triage system will use the following categories: requires immediate medical intervention needs medical attention, however, the response can be somewhat delayed. May be assisted with self-care or system resources other than 911 medical resources. Needs non-medical community services. Immediate: Delayed: Minor: Deceased: www.disasterdoug.com

Example of Altered 911 Field Triage IMMEDIATE DELAYED MINOR DECEASED Treat and Transport Treat and Release or Refer Refer to Public Access Number Witnessed= Use First Round ACLS protocols Unwitnessed = refer to public access number

IMMEDIATE Patients presenting with life threatening conditions such as Acute MI, uncontrolled hemorrhage, severe shortness of breath, ALOC, etc., will require treatment and transportation. www.disasterdoug.com

DELAYED • Patients who respond to treatment on scene and afterward present with normal mental status, normal vital signs, and blood sugar will be given a patient brochure then released or referred. Treat & Release or Refer • Options for referring patients may include: • The Public Access Number • Doctors office • Self-care www.disasterdoug.com

MINOR Upon arrival, if the patient does not present with life-threatening conditions and does not require any EMS medical intervention, the patient would be given a Patient/Family Brochure and released on scene. www.disasterdoug.com

DECEASED • Only if the patient had a witnessed cardiac arrest would the field responders intervene. The patient would be given first round ACLS care and if there is no response the patient would be determined dead in the field. Family would be given a patient brochure prior to clearing the scene. www.disasterdoug.com

To relieve the impact on the emergency rooms, the MHOAC and the EMS Agency Medical Director might expand the paramedic protocols to include a Disaster Flu Cache. This cache should include indications and contraindications, along with the revised protocols for items such as: powdered Gatorade, Compazine suppositories, ibuprofen, etc. Disaster Flu Cache www.disasterdoug.com

Lets examine what we have learned so far… Using the Altered Standard Field Triage, who would be considered IMMEDIATE? • A patient with nausea and vomiting with no other symptoms. • A patient with signs and symptoms of an MI. • A patient bleeding from an abrasion on his knee.

Lets examine what we have learned so far… If you answered, B. A patient with signs and symptoms of an MI, you are.. CORRECT Patients presenting with life threatening conditions such as Acute MI, uncontrolled hemorrhage, severe shortness of breath, ALOC, etc., will require treatment and transportation.

Patient Brochure In addition to implementing the Altered Standard of Care plan, the MHOAC and the EMS Agency Medical Director, in collaboration with the OA EOC , must develop a Patient/Family Brochure. that may be distributed by EMS field personnel to patients and family members. www.disasterdoug.com

Patient Brochure • This brochure is designed to be distributed by EMS field personnel to patients and family members, including: • Family members of patients transported to the hospital • Patients treated and released on scene • Family of deceased patients • Patients with non-medical emergencies www.disasterdoug.com

Patient Brochure The Patient/ Family Brochure should contain: • information about the current situation, explaining the significant impact of the incident on the population www.disasterdoug.com

Patient Brochure The Patient/ Family Brochure should contain: • health threats, including current and projected effects www.disasterdoug.com

Patient Brochure The Patient/ Family Brochure should contain: • impact on the hospitals, describing limited resources and alternatives www.disasterdoug.com

Patient Brochure The Patient/ Family Brochure should contain: • EMS system changes, including changes in 911 protocols, as well as, what to expect when EMS responders arrive. www.disasterdoug.com

Patient Brochure • The Patient/ Family Brochure should contain: • -Information regarding the local Public Access Number for individuals with non-medical emergencies www.disasterdoug.com

Patient Brochure The Patient/ Family Brochure should contain: -Information regarding Web-based health informationsuch as the CDC website, local Public Health website, or other private sites such as WebMD, etc. www.disasterdoug.com

Patient Brochure The Patient/ Family Brochure should contain: -Information regarding self-care such as at-home treatment for fever, flu symptoms, minor first-aid, etc. www.disasterdoug.com

Lets examine what we have learned so far… The Family/Patient Brochure will be provided to: • Family members of patients being transported to the hospital. • Patients treated and released on scene. • Family of deceased patients • All of the above.

Lets examine what we have learned so far… If you answered, D. All of the above, you are… CORRECT The Patient/Family Brochure is designed to be distributed by EMS personnel to any patient or family member during a significant event.

Just-In-Time Training (JITT)

In the event that a major disaster takes place and overwhelms the system, field responders and dispatchers must be provided with “Just-In-Time Training” on the Altered Standards of Care. This training should include didactic as well as practical application of the revised protocols. In this section we will discuss important principles of Just-In-Time Training (JITT).

Just-In-Time (JITT) Training • After establishing Altered Standard Orders, responders must be provided with training including: • Rolls and responsibilities of EMS system providers, • Changes made to system protocols, and • Changes made to overall system design www.disasterdoug.com

Just-In-Time (JITT) Training Just-In-Time training would normally be conducted by supervisors or management at each provider agency. www.disasterdoug.com

Just-In-Time (JITT) Training • Following any Just-In-Time Training, personnel should be provided an opportunity to: • Practice any new skills • Become familiar with any new equipment or tools • Review new or revised protocols www.disasterdoug.com

What is it? Just-In-Time Training is a process that allows responders or dispatchers to have just the right information or skills at just the right time using just the right presentation.

The goal of JITT… Just the right information Just the right time Just the right presentation

Just the Right Information

Just the right Information Just-In-Time Training incorporates only the pertinent information that is needed to take care of the situation at hand. Information not pertaining to this situation could overwhelm the responder or dispatcher causing them to make mistakes or overlook important steps.

Learning Detentions Research confirms that understanding (i.e., knowing)—especially in times of stress—depends on effective neural pathways that connect action (i.e., doing) and emotion (i.e., feeling). Next are examples of each:

Intellectual Needs (Knowing) Although responders need to know about their assigned tasks, they also need information beyond their role and specific duties. For example, a responder may want a better understanding of how the overall response organization operates, and who is involved in each part of the operation.

Behavioral Needs (Doing) Responders must understand how to perform their assigned task(s). Examples of how JITT encourages hands on learning include: • Incident-specific scenarios • Practicing administering vaccines/meds • Practicing filling out forms and other documentation • Practicing interviewing techniques with peers • Practicing using assigned communication equipment (for example, two-way radios)

Emotional Needs (Feeling) Responders need to feel comfortable with a given skill set and feel motivated to continue performing under pressure. Responders also need to be reassured that their contributions to a response effort are valued. Failing to provide this feedback may result in decreased job performance and affect a responder’s sense of duty— potentially compromising the overall response.

Just the right time… It is impossible to be trained prior to an incident until the circumstances are actually known. Once this information is known, the ability to be trained on when, what, where, why, and how can begin. This also gives personnel a chance to understand what is expected of them.

Just the right presentation… In order for personnel to make sense of what they are being trained on, the information must be presented in a logical manor according to the incident or circumstance. It must capture their interest and have a flow to it that can be easily followed.

Altered Standard of Care Training for Administrative Personnel