Emergency Medical Services (EMS) System S-SV EMS MICN Course Module 1 Emergency Medical Services (EMS) System S-SV EMS Agency MICN Training (Updated 12-2017)

S-SV EMS Agency MICN Training (Updated 12-2017) What Is EMS? Dispatch Medical Priority Dispatch Systems (MPDS) EMS call determinants and response priority using approved protocols (based on caller reported pt. condition) Emergency Medical Dispatch (EMD) Pre-arrival instructions (first aid, hands only CPR, etc.) First responders (law enforcement, fire dept.) Ambulance transport (ground and air) S-SV EMS Agency MICN Training (Updated 12-2017)

S-SV EMS Agency MICN Training (Updated 12-2017) What Is EMS? Acute Care Hospitals Receiving hospitals Base hospitals (utilize MICNs) Modified base hospitals (no MICNs) Specialty receiving centers (stroke, STEMI, trauma) S-SV EMS Agency MICN Training (Updated 12-2017)

California EMS Laws & Regulations Health and Safety Code, Division 2.5 Establishes the EMS Authority (statewide EMS oversight) Requires each county to designate a local EMS agency (LEMSA) Contains all California EMS laws Code of Regulations, Title 22 Contains all California EMS regulations S-SV EMS Agency MICN Training (Updated 12-2017)

California EMS Authority (EMSA) State EMS oversight entity Director of EMS Physician, appointed by the Governor Chief Deputy Director Administrative staff position Additional administrative and staff support positions Approximately 80 personnel S-SV EMS Agency MICN Training (Updated 12-2017)

California EMS Authority (EMSA) Responsibilities Develop EMS regulations EMS training program standards EMS personnel scope of practice EMS personnel certification/licensure and enforcement requirements EMS system requirements (local EMS agencies, EMS providers, trauma, disaster, etc.) Review and approve local EMS plans S-SV EMS Agency MICN Training (Updated 12-2017)

California EMS Authority (EMSA) Responsibilities (continued) Trauma system planning Develop standards for trauma care Review and approve local trauma system plans Stroke & STEMI system planning Development of stoke and STEMI regulations currently in progress S-SV EMS Agency MICN Training (Updated 12-2017)

California EMS Authority (EMSA) Responsibilities (continued) EMS for children Ensure critically ill/injured children have access to appropriate emergency care Poison Control system Develop standards, monitor and evaluate S-SV EMS Agency MICN Training (Updated 12-2017)

California EMS Authority (EMSA) Responsibilities (continued) Disaster medical management Statewide disaster planning and response coordination Disaster Medical Assistance Teams (DMAT) Ambulance Strike Teams (AST) Disaster Healthcare Volunteers/Medical Reserve Corps S-SV EMS Agency MICN Training (Updated 12-2017)

California EMS Authority (EMSA) Responsibilities (continued) Public education Statewide EMS data collection Injury prevention First Aid and CPR training requirements for bus drivers and day care providers S-SV EMS Agency MICN Training (Updated 12-2017)

Local EMS Agencies (LEMSAs) 33 California LEMSAs 26 single county Primarily urban and suburban counties 7 regional Primarily suburban and rural counties At least 3 counties required to qualify for state matching funding S-SV EMS Agency MICN Training (Updated 12-2017)

Local EMS Agencies (LEMSAs) Responsibilities Provide local regulatory oversight and ensure public heath and safety as it relates to prehospital EMS care Lay rescuer AED program monitoring EMS dispatch entities (MPDS, EMD) EMS aspects of law enforcement and fire agencies Ambulance transport providers (ground, air) Specialty EMS programs (tactical, fireline, etc.) EMS aspects of acute care hospitals S-SV EMS Agency MICN Training (Updated 12-2017)

Local EMS Agencies (LEMSAs) Responsibilities (continued) Develop EMS policies and treatment protocols (including specialty care center designation and EMS patient destinations) Receiving hospitals, base/modified base hospitals Specialty care centers (stroke, STEMI, trauma) S-SV EMS Agency MICN Training (Updated 12-2017)

Local EMS Agencies (LEMSAs) Responsibilities (continued) Approval and oversight of prehospital personnel EMR – certification and enforcement EMT/AEMT – certification and enforcement Paramedic – accreditation (enforcement referred to EMSA) MICN – authorize (enforcement referred to BRN) S-SV EMS Agency MICN Training (Updated 12-2017)

Local EMS Agencies (LEMSAs) Responsibilities (continued) Authorize and monitor EMS training programs Develop and implement county/regional EMS plans (EMS system, stroke, STEMI, trauma, etc.) Medical and heath disaster planning and response (in collaboration with local public health) Multiple other EMS system oversight activities S-SV EMS Agency MICN Training (Updated 12-2017)

S-SV EMS Agency MICN Training (Updated 12-2017) Regional LEMSA established through a joint powers agreement (10 counties) Butte, Colusa, Glenn, Nevada, Placer, Shasta, Siskiyou, Sutter, Tehama, and Yuba counties 1.3 million population 21,000+ square miles 150,000+ annual EMS calls S-SV EMS Agency MICN Training (Updated 12-2017)

S-SV EMS Agency MICN Training (Updated 07-2017) 96 BLS first responder agencies 9 ALS/LALS first responder agencies 30 BLS and ALS ground ambulance providers 8 EMS aircraft providers 3000+ EMS prehospital personnel 18 acute care hospitals (located in the S-SV EMS region) S-SV EMS Agency MICN Training (Updated 07-2017)

S-SV EMS Agency Org. Chart S-SV EMS Agency MICN Training (Updated 12-2017)

S-SV EMS System Committees Individual county EMCCs/EMAGs Regional Medical Control Advisory Committee (EMS policy & treatment protocol development) Regional Continuous Quality Improvement Committee Regional EMS Aircraft Committee Regional STEMI Quality Improvement Committee Regional Trauma Quality Improvement Committee S-SV EMS Agency MICN Training (Updated 12-2017)

S-SV EMS Base Hospitals Enloe Medical Center Fairchild Medical Center Feather River Hospital Mercy Medical Center Mount Shasta Mercy Medical Center Redding Oroville Hospital Rideout Regional Medical Center Shasta Regional Medical Center Sutter Roseville Medical Center St. Elizabeth Community Hospital UCDMC (trauma only) S-SV EMS Agency MICN Training (Updated 12-2017)

S-SV EMS Modified Base and Receiving Hospitals Modified base (EMS medical direction by physicians only) Kaiser Roseville Medical Center Mayers Memorial Hospital Sutter Auburn Faith Hospital Sierra Nevada Memorial Hospital Tahoe Forest Hospital Receiving hospital (no EMS medical direction) Orchard Hospital Glenn Medical Center S-SV EMS Agency MICN Training (Updated 12-2017)

S-SV EMS Trauma Centers UCDMC (Level 1 & Pedi) Enloe Medical Center (Level 2) Sutter Roseville Medical Center (Level 2) Mercy Medical Center Redding (Level 2) Mercy Medical Center Mt. Shasta (Level 3) Rideout Regional Medical Center (Level 3) St. Elizabeth Community Hospital (Level 3) Fairchild Medical Center (Level 4) S-SV EMS Agency MICN Training (Updated 12-2017)

S-SV EMS Stroke Receiving Centers Enloe Medical Center Feather River Hospital Kaiser Roseville Medical Center Mercy Medical Center Redding Oroville Hospital Rideout Regional Medical Center Sierra Nevada Memorial Hospital Sutter Auburn Faith Hospital Sutter Roseville Medical Center Shasta Regional Medical Center S-SV EMS Agency MICN Training (Updated 12-2017)

S-SV EMS STEMI Receiving Centers Enloe Medical Center Kaiser Roseville Medical Center Mercy Medical Center Redding Rideout Regional Medical Center Shasta Regional Medical Center Sutter Roseville Medical Center S-SV EMS Agency MICN Training (Updated 12-2017)

S-SV EMS Agency MICN Training (Updated 12-2017) Base Hospitals MICN requirements RN with ED experience (recommended by base hosp.) Trained and authorized as an MICN by S-SV EMS MICN roles and responsibilities Provide medical direction to EMS prehospital personnel according to S-SV EMS policies/protocols Liaison with base hospital physicians for EMS consultation and orders when necessary S-SV EMS Agency MICN Training (Updated 12-2017)

S-SV EMS Agency MICN Training (Updated 12-2017) Base Hospitals Prehospital Coordinator requirements RN with ED experience Employed/appointed by the base hospital Prehospital Coordinator responsibilities Resource for MICNs Educate MICNs on new/revised S-SV EMS policies/protocols Prehospital CQI Liaison with base hospital medical director, EMS prehospital providers and S-SV EMS S-SV EMS Agency MICN Training (Updated 12-2017)

S-SV EMS Agency MICN Training (Updated 12-2017) Base Hospitals Base Hospital Medical Director requirements Physician licensed in California (MD/DO) Regularly works in ED of base hospital (hospital appointed) Experience and knowledge in base hospital radio operations and S-SV EMS policies/protocols Base Hospital Medical Director responsibilities Resource for Prehospital Coordinator, MICNs and EMS prehospital providers/personnel S-SV EMS Agency MICN Training (Updated 12-2017)

EMS QI Program (EMSQIP) All EMS system participants required to develop and maintain an S-SV EMS approved EMSQIP, including: Description of EMS QI processes Monitoring and reporting of EMS QI indicators Involves EMS process/personnel improvement, education, remediation, and recognition S-SV EMS Agency MICN Training (Updated 12-2017)

EMS QI Program (EMSQIP) EMS issues/questions should be referred to the Prehospital Coordinator Protocol deviation (without base physician order) Patient presentation does not match report given Radio report not effective Critical/unusual cases with good learning components Questionable destination decisions Conflict that could not be resolved at time of event Noting a job well done that deserves recognition S-SV EMS Agency MICN Training (Updated 12-2017)

EMS QI Program (EMSQIP) Cases are reviewed and education information is shared with involved entities Cases that require further investigation, involve multiple providers, or may require S-SV EMS policy/protocol revision are referred to the appropriate regional QI committee(s) S-SV EMS Agency MICN Training (Updated 12-2017)