2. Welcome to the S-SV EMS Agency Altered Standard of Care Administrative Module 1 This is the first of three modules of the Altered Standard of Care Training. This section focuses on: Assumptions & Definitions Regulations that allow for changes to our current 911 system MHOAC and EMS Agency Medical Director collaboration, and Multi-Agency Coordination This module will take approximately 1 hour 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.

3. 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.

4. 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.

5. After completing this training, you should be able to: Describe the rolls and relationships of the OA EOC, MHOAC, and the EMS Agency. Recognize terms used within the Altered Standard of Care Pre-Planning Guide. Explain the importance of the MHOAC and EMS Agency Medical Director collaboration. Identify components of the Altered Standard Order Form.

6. 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

7. We know that things have to change in order to respond to the increased demand. But prior to being able to discuss system changes, we must first review some Assumptions and a few Definitions used in the Altered Standard of Care Pre-Planning Guide.

8. A.The Medical/Health Branch of the OA EOC (MHOAC) has established collaboration with the EMS Agency Medical Director and other affected agencies to coordinate changes to the EMS response. B.Mutual-aid resources are scarce or unavailable. C.Appropriate waivers, proclamations, or declarations required to implement specific system changes have been identified and secured.

9. Altered Standard of Care simply refers to a level of medical care delivered to individuals under conditions of distress, such as after a disaster or when supplies are insufficient for the demand for emergency care.

10. The "Medical/Health Operational Area Coordinator (MHOAC)" is the Public Health Officer and local EMS Agency Administrator or designee who is responsible, in the event of a disaster or major incident where mutual aid is requested, for obtaining and coordinating services and allocation of resources within the Operational Area (county) border.

11. Within the S-SV EMS Agency's member counties, the "Medical/Health Operational Area Coordinator (MHOAC)" is often a role filled just by the Health Officer, but in a few counties, it is a joint role of the Health Officer and EMS Agency Administrator.

12. The Operational Area Emergency Operations Center or OA EOC is the designated location for coordinating and supporting emergency services among all the major disciplines (law, fire, health/medical, public works, etc.) and local jurisdictions (cities, county, districts, etc.) within an Operational Area or county.

13. A Quick Response Vehicle or QRV is a vehicle that is staffed with at least one paramedic, and equipped with Advanced Life Support (ALS) equipment/supplies per local EMS Agency protocol. Such vehicles may include: ALS supervisor vehicles, shared resources from other emergency response agencies, company cars, rental cars, private cars, etc.

14. In this scenario, who is responsible for obtaining and coordinating services and allocation of medical and health resources within the Operational Area border?

15. If you answered,, you are The MHOAC, or Medical Health Operational Area Coordinator, is responsible in the event of a disaster or major incident, for obtaining and coordinating services and allocation of medical and health resources within the Operational Area (county) border.

16. So far we have reviewed some and that are necessary to move forward in altering the system in response to this pandemic outbreak. With the threat of this pandemic flu creating such a havoc on the 911 system, Do the current rules that regulate EMS allow us to make adequate changes to address this type of impact, or will some rules have to be ?

17. In this section, we will examine some of the authorities or rules that may need to be waived in order for the EMS system to function differently during a disaster or unusual circumstance such as this pandemic flu.

18. This section of the Health and Safety Code allows for changes in the scope of practice for paramedics. The Medical Director of the local EMS agency, in consultation with a state committee of local EMS Medical Directors, may implement changes to the paramedic protocols.

19. This regulation allows for the use of additional procedures and administration of other medications that are outside the normal scope of practice of the paramedic, with approval of the Director of the EMS Authority and proper training and testing of these skills.

20. This code gives authority to take preventive measures during emergency. “The county health officer may take any preventive measure that may be necessary to protect and preserve the public health from any public health hazard during any "state of war emergency," "state of emergency," or "local emergency," as defined by Section 8558 of the Government Code, within his or her jurisdiction.

21. This regulation exempts the requirement of having personnel on an ambulance that possess a certification or license evidencing compliance with the emergency medical training and educational standards for ambulance personnel established by the State EMS Authority during a “state of emergency,” or duly proclaimed “state of emergency,” or “local emergency” defined in Government Code Section 8558.

22. …regarding the operation, equipment, and certification of drivers of all ambulances used for emergency services… The commissioner should exempt, upon request of the county board of supervisors…, noncommercial ambulances operated within the county from the regulations adopted under this section.

23. Now that we have looked at which waivers are needed to allow for changes in the 911 system, let’s look at how Altered Standard Orders are activated by the MHOAC or the EMS Agency Medical Director.

24. The EMS agency has been notified by the ambulance dispatch center that they can no longer handle the amount of calls coming in. They are at status zero with no ambulances available. The EMS Agency Medical Director and Health Officer have been notified and have activated the MHOAC function. Moving forward, it is imperative that there be multi-agency coordination to address this impact.

25. Following a local declaration of emergency, the MHOAC will play the lead role, and should collaborate with the EMS Agency Medical Director and other appropriate agencies to modify the EMS delivery system.

26. The Altered Standard Order Form is a tool used by the MHOAC and EMS Agency Medical Director to communicate which parts of the system will be altered. The system components that may be altered include: Dispatch Control Facility operations EMS provider response

28. www.disasterdoug.com The ASO form contains the Date and Time of the Orders, as well as the Effective Date and End Date of the Orders.

29. www.disasterdoug.com The ASO form is designed to be used as a check-list of possible system changes.

30. www.disasterdoug.com The ASO form is divided into major program areas, including: Dispatch, Control Facility, and EMS Providers.

31. www.disasterdoug.com Additional changes may be listed at the bottom of the form, and previous orders may be discontinued.

32. Once the Altered Standard Order Form is completed, the MHOAC and EMS Agency Medical Director will inform all Public Safety Answering Points (PSAPs), ambulance dispatch centers, Control Facilities, hospitals, and EMS providers of these orders.

33. In order to communicate which parts of the system will be altered, the MHOAC and the EMS Agency Medical Director will use the ___________.

34. If you answered, you are… This form is used by the MHOAC and EMS Agency Medical Director to communicate which parts of the system will be altered.

35. Now, we’re going to break down the system changes into each program area, beginning with

36. The MHOAC and the EMS Agency Medical Director have collaborated with the OA EOC and have established new priorities for dispatch. These changes are designed to help significantly reduce the time spent with each “reporting party,” and provide the dispatcher with new alternatives. www.disasterdoug.com

37. Before we begin to look at how the medical dispatch system will be altered, let’s take a look at how most medical dispatch systems work today. www.disasterdoug.com

38. Is it a Medical Emergency? 911 Call Center Reporting Party Calls 911 Reporting Party Calls 911 All calls coming in to the 911 center are assessed for medical need.

39. End Call Center YES Is it a Medical Emergency? 911 Call Center Reporting Party Calls 911 Reporting Party Calls 911 Callers requesting medical aid are then transferred to an Emergency Medical Dispatcher.

40. EMD – Pre-arrival Instructions Dispatch ALS ambulance End Call Center YES Is it a Medical Emergency? 911 Call Center Reporting Party Calls 911 Reporting Party Calls 911 Dispatch Fire First Responders The medical dispatcher will then provide the appropriate medical response. www.disasterdoug.com

41. So, we see that almost all people seeking medical assistance, who call 9-1-1, receive EMD pre-arrival instructions, Advanced Life Support (ALS) ambulance, fire first responders, and transport to the hospital. our goal during this event will be to reduce the amount of time that dispatch personnel spend on the telephone with each caller in order to meet the increased demand on the system.

42. The MHOAC and EMS Agency Medical Director have collaborated to authorize altered triage and response protocols for the 911 system. These alterations include:

43. As you can see, there are many components of the EMS system that may need to be modified during a disaster. EVERYONE must work jointly to make the 911 system run as proficiently as possible. You will now be quizzed on what you have learned in this module. Thank you for your participation in the…