1. Impact Mitigation Plan ~San Jose Medical Center Closure~ Santa Clara County Emergency Medical Services Agency Revised 11/15/04

2. Background  SJMC is scheduled to close December 9, 2004 at 5:00 pm.  Impact Report Completed  Mitigation plans will be implemented on November 29, 2004.  Regional Trauma Center has submitted an application for Trauma Center Designation.

3. Objective Maintain an efficient and effective Emergency Medical Services System, within the County of Santa Clara, while addressing the actual or potential impacts of the closure of a general acute care hospital.

4. Patient Redirection  Effective November 29, 2004 @ 0800 hours – All ground and air ambulances directed away from SJMC.  Extremis patients may continue to SJMC until December 8, 2004 at 1700 hours.

5. Standby at SJMC  AMR paramedic ambulance on site from December 9, 2004 to January 2, 2005 (24/7 coverage).  Provide care for life threatening emergency medical events.  Evaluation with HCA and EMS Agency – May extend coverage period as appropriate.

6. ED Diversion  Maximum of 90 minutes on ED diversion per- occurrence.  Must remain open for 90 minutes after being on diversion.  Closed changed to Diverting Ambulances (red)  Hospitals do not “auto open” based on others requesting diversion status.  One hospital, per- Zone, may be on diversion status.  First Come – First Serve diversion

7. ED Diversion - Zones  Northern ED Diversion Zone – Stanford – El Camino – Kaiser Santa Clara – PAVA (excluded)  Western ED Diversion Zone – Los Gatos Community – Good Samaritan – Kaiser Santa Teresa

8. ED Diversion - Zones  Downtown ED Diversion Zone – Valley Medical Center – Regional Medical Center – O-Connor Hospital  Most impacted zone  Use of Yellow/Census is important. Patients must have the choice to selected hospitals that are not severely impacted.

9. Trauma Patient Management  Trauma Center Catchment Zones established to assist in keeping any one Trauma Center from being overwhelmed.  Use of air resources may increase.  New Trauma Center Status Options designed to keep the facilities open.  Air units are routed to Stanford (some exceptions)

10. Stanford Catchment Zone  Northern County Line to the Bay  DeAnza divides Cupertino  Sunnyvale/Saratoga and East Remington/Fair Oaks divides Sunnyvale  North of 237/Calaveras in the City of Milpitas/ unincorporated areas  Air traffic (some exceptions)

11. VMC Catchment Zone  South of DeAnza in the City of Cupertino.  South of Sunnyvale/Saratoga and East Remington/Fair Oaks in Sunnyvale.  South of 237/Calaveras in the City of Milpitas/ unincorporated areas.

12. Catchments Zone Considerations  Established lines are flexible based on available resources, traffic, scene considerations.  Better to transport by air or ground?  Milpitas air vs. ground transport considerations.

13. Air Operations  Critical burn patients to be transported to Valley in accordance with existing Policy.  Flight crews shall transport patients with suspected spinal cord injury to the closest available Trauma Center.

14. Air Operations  May use ALS Rescue Aircraft  Ground crews are responsible to provide a hospital ring-down if a rescue aircraft or mutual aid air ambulance is used.  CHP H30 notification of all incidents in the San Antonio Valley to go with air & ground ambulance.  BLS rescue aircraft may require paramedic to ride- along.

15. Air Operations  More air unit use may occur in urban settings.  Providers need to review safety practices related to working with air resources.  SJFD establishing landing zones.  Dispatch centers may view EMSystem and provide hospital status to responding units to launch air resources as soon as possible.

16. Trauma Status/EMSystem  Moved into separate section of the screen.  Status reasons revised to help Trauma Centers stay open longer.  Paramedic/Flight Crew discretion.  All changes must be done through EMSystem not County Communications. Orange  One Trauma Center on the same “Orange” status at the same time.

17. Trauma Status  Open/Green – no change  Yellow Census  Yellow Census – Eliminated  Yellow- CT  Yellow- CT – Eliminated  Service Advisories/Orange  Service Advisories/Orange Added – Orange/OR – Orange/Neurosurgery  Bypass/Red – no change

18. Service Advisory/Orange  Advanced Life Support Personnel (Flight Crews and Paramedics) shall consider the specific type of service limitation and may either: Service Advisory – Continue transport to the hospital with a Service Advisory – Bypass the facility and go to the other trauma center (consider air transport if necessary).

19. Example: Orange/Neurosurgery  A patient with chest trauma may be transported to a Trauma Center with a Service Limitation/Orange noted as “Neurosurgery”.  This assumes that the patient does not have suspected head trauma. Previously this facility may have been “Red”.

20. Example: Orange/OR  A patient who is being transported due to mechanism of injury with stable vital signs may be transported to a Trauma Center with a Service Limitation noted as “No Neurosurgery”.  This assumes that the field crew does not believe that the patient is in immediate need of surgical intervention.

21. Bypass/Red  Duty Chief is notified as soon as any Trauma Center is on Bypass.  Facility opens as soon as possible  Trauma Medical Director, or designee, immediately contacts the other Trauma Center Medical Director.  The Duty Chief and Trauma Center Medical Director of the facility on Bypass discuss appropriate mitigation actions.

22. Bypass/Red Service Limitations  If both Trauma Centers are on Bypass status – Both will immediately open (but may have Service Limitations).  The EMS Agency may take any actions necessary to ensure safety of the public during this time.  A Trauma Center may not be on Bypass for more than 60 minutes.

23. STAR’s  SJFD STAR’s responding to more calls  STAR’s may be used to transport to LZ’s if the patient has a severe and imminently life- threatening condition and will be flown to a Trauma Center.  STAR provider departments must review activation criteria and radio communication practices in preparation for increased volume.

24. Policy Changes  Policy 101- Provider Codes  Policy 403 – Trauma Center Service Areas  Policy 501 – Hospital Radio Reports  Policy 504 – County EMS Communication System  Policy 602 – Prehospital Patient Destination  Policy 603- Hospital Diversion  Policy 611 – Air Resource Utilization

25. Reference Revisions  EMS 804 – Santa Clara County Acute Care Hospitals  EMS 805 – Santa Clara County Permitted Ambulance Services

26. Important Dates  November 29, 2004 @ 0800 Hours – all 911 System ambulance traffic is directed away from SJMC (except extremis).  December 8, 2004 @ 1700 Hours – all 911 System ambulance traffic is directed away from SJMC (INCLUDING extremis).

27. Important Dates  December 9, 2004 @ 1700 Hours – San Jose Medical Center closes.