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Impact Mitigation Plan Impact Mitigation Plan ~San Jose Medical ~San Jose Medical Center Closure~Center Closure~
Santa Clara County Emergency Medical
Services AgencyRevised 11/15/04
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.
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.
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.
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.
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
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
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.
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)
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)
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.
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.
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.
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.
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.
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. One Trauma Center on the same “OrangeOrange”
status at the same time.
Trauma Status
Open/Green – no change Yellow CensusYellow Census – Eliminated Yellow- CTYellow- CT – Eliminated Service Advisories/OrangeService Advisories/Orange Added
– Orange/OROrange/OR– Orange/NeurosurgeryOrange/Neurosurgery
Bypass/Red – no change
Service Advisory/Orange
Advanced Life Support Personnel (Flight Crews and Paramedics) shall consider the specific type of service limitation and may either:– Continue transport to the hospital with a
Service AdvisoryService Advisory– Bypass the facility and go to the other trauma
center (consider air transport if necessary).
Example: Example: Orange/NeurosurgeryOrange/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”.
Example: Orange/ORExample: 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.
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.
Bypass/Red
If both Trauma Centers are on Bypass status – Both will immediately open (but may have Service LimitationsService 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.
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.
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
Reference Revisions
EMS 804 – Santa Clara County Acute Care Hospitals
EMS 805 – Santa Clara County Permitted Ambulance Services
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).
Important Dates
December 9, 2004 @ 1700 Hours – San Jose Medical Center closes.