1. S-SV EMS MICN Course Module 1 Emergency Medical Services (EMS) System S-SV EMS Agency MICN Training (Updated 05-2016) 1

2. What Is EMS? Dispatch  Medical Priority Dispatch Systems (MPDS) o EMS call determinants and response priority using approved protocols (based on reported patient condition)  Emergency Medical Dispatch (EMD) o 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 05-2016) 2

3. 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 05-2016) 3

4. 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 05-2016) 4

5. California EMS Authority (EMSA) State EMS oversight entity  Director of EMS o Physician, appointed by the Governor  Chief Deputy Director o Administrative staff position  Additional administrative and staff support positions o Approximately 45 personnel S-SV EMS Agency MICN Training (Updated 05-2016) 5

6. California EMS Authority (EMSA) Responsibilities  Develop EMS regulations o EMS training program standards o EMS personnel scope of practice o EMS personnel certification/licensure and enforcement requirements o EMS system requirements (local EMS agencies, EMS providers, trauma, disaster, etc.)  Review and approve local EMS plans S-SV EMS Agency MICN Training (Updated 05-2016) 6

7. California EMS Authority (EMSA) Responsibilities (continued)  Trauma system planning o Develop standards for trauma care o Review and approve local trauma system plans  Stroke & STEMI system planning o Development of stoke and STEMI regulations currently in progress S-SV EMS Agency MICN Training (Updated 05-2016) 7

8. California EMS Authority (EMSA) Responsibilities (continued)  EMS for children o Ensure critically ill/injured children have access to appropriate emergency care  Poison Control system o Develop standards, monitor and evaluate S-SV EMS Agency MICN Training (Updated 05-2016) 8

9. California EMS Authority (EMSA) Responsibilities (continued)  Disaster medical management o Statewide disaster planning and response coordination o Disaster Medical Assistance Teams (DMAT) o Ambulance Strike Teams (AST) o Disaster Healthcare Volunteers/Medical Reserve Corps S-SV EMS Agency MICN Training (Updated 05-2016) 9

10. California EMS Authority (EMSA) Responsibilities (continued)  Public education o Statewide EMS data collection o Injury prevention  First Aid and CPR training requirements for bus drivers and day care providers S-SV EMS Agency MICN Training (Updated 05-2016) 10

11. Local EMS Agencies (LEMSAs) 33 California LEMSAs  26 single county o Primarily urban and suburban counties  7 regional o Primarily suburban and rural counties o At least 3 counties required to qualify for state matching funding S-SV EMS Agency MICN Training (Updated 05-2016) 11

12. Local EMS Agencies (LEMSAs) Responsibilities  Provide local regulatory oversight and ensure public heath and safety as it relates to prehospital EMS care o Lay rescuer AED program monitoring o EMS dispatch entities (MPDS, EMD) o EMS aspects of law enforcement and fire agencies o Ambulance transport providers (ground, air) o Specialty EMS programs (tactical, fireline, etc.) o EMS aspects of acute care hospitals S-SV EMS Agency MICN Training (Updated 05-2016) 12

13. Local EMS Agencies (LEMSAs) Responsibilities (continued)  Develop EMS policies and treatment protocols (including specialty care center designation and EMS patient destinations) o Receiving hospitals, base/modified base hospitals o Specialty care centers (stroke, STEMI, trauma) S-SV EMS Agency MICN Training (Updated 05-2016) 13

14. Local EMS Agencies (LEMSAs) Responsibilities (continued)  Approval and oversight of prehospital personnel o EMR – certification and enforcement o EMT/AEMT – certification and enforcement o Paramedic – accreditation (enforcement referred to EMSA) o MICN – authorize (enforcement referred to BRN) S-SV EMS Agency MICN Training (Updated 05-2016) 14

15. 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 05-2016) 15

16. S-SV EMS Agency Regional LEMSA established through a joint powers agreement (9 counties)  Butte, Colusa, Nevada, Placer, Shasta, Siskiyou, Sutter, Tehama, and Yuba counties 1.2 million population 20,000+ square miles 120,000 annual EMS calls S-SV EMS Agency MICN Training (Updated 05-2016) 16

17. S-SV EMS Agency 87 BLS and 9 ALS fire department agencies 30 BLS and ALS ground ambulance providers 8 air ambulance and air rescue providers 3000+ EMS prehospital personnel 17 acute care hospitals S-SV EMS Agency MICN Training (Updated 05-2016) 17

18. S-SV EMS Organizational Chart S-SV EMS Agency MICN Training (Updated 05-2016) 18

19. 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 05-2016) 19

20. 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 S-SV EMS Agency MICN Training (Updated 05-2016) Rideout Regional Medical Center Shasta Regional Medical Center Sutter Roseville Medical Center St. Elizabeth Community Hospital UCDMC (trauma only) 20

21. 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 S-SV EMS Agency MICN Training (Updated 05-2016) 21

22. 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) S-SV EMS Agency MICN Training (Updated 05-2016) Rideout Regional Medical Center (Level 3) Shasta Regional Medical Center (Level 3) St. Elizabeth Community Hospital (Level 3) Fairchild Medical Center (Level 4) 22

23. S-SV EMS Stroke Receiving Centers Enloe Medical Center Feather River Hospital Kaiser Roseville Medical Center Mercy Medical Center Redding Oroville Hospital S-SV EMS Agency MICN Training (Updated 05-2016) Sierra Nevada Memorial Hospital Sutter Auburn Faith Hospital Sutter Roseville Medical Center Shasta Regional Medical Center 23

24. 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 05-2016) 24

25. 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 05-2016) 25

26. 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 05-2016) 26

27. 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 05-2016) 27

28. 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 05-2016) 28

29. 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 05-2016) 29

30. 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 05-2016) 30

31. The Future of EMS Expanded use of priority dispatch (MPDS) Further development and implementation of clinically based treatment and destination policies/protocols Community Paramedicine S-SV EMS Agency MICN Training (Updated 05-2016) 31