Welcome & Introductions

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Welcome & Introductions. March 28, 2012 (10am – Noon). Altered Standard of Care Preplanning Guide Exercise. Purpose. - PowerPoint PPT Presentation

Text of Welcome & Introductions

  • To introduce local Health Officers, Public Health Directors, LEMSA Administrator, and LEMSA Medical Director and other staff to the Altered Standard of Care Pre-Planning Guide.

  • The Altered Standard of Care Pre-Planning Guide is designed as a tool to assist local emergency planners with modifying the current EMS delivery system in response to a catastrophic incident.

  • Developed with HPP Year 8 grant funds Based upon best practices and source documents including:

    Santa Clara County Altered Standards Tool, San Francisco County Altered EMS Protocols, CDC and NHTSA guidelines

  • Designed as an all-hazards tool for any type of disaster, including:

    Severe floodingEarthquakesPandemic OutbreakOther catastrophic incidents


  • In early February, confirmed reports from the U.S. Centers for Disease Control revealed a novel strain of the influenza virus.

  • The World Health Organization declared a global pandemic alert as more than 214 countries and overseas territories or communities worldwide have reported laboratory confirmed cases of the novel virus.

  • As of last week, most developed countries reported widespread infection, including at least 18,449 deaths.

  • Community Mitigation measures include school closures, cancellation of mass gatherings, isolation and quarantine, and other social distancing measures.

  • Health care systems experiencing significant stress; reporting regional surges in hospital, emergency department, and outpatient visits.

    Some countries reporting hospital bed, equipment and medication shortages.


  • CDC is reporting that the most impacted populations include:Children and young adultsPersons with underlying chronic medical conditions (e.g. chronic lung disease, heart disease, immunosuppression, neurological and neurodevelopment diseases)Pregnant womenIndigenous populationsPossible risk groups: Obesity (Body Mass Index 35), Extreme/Morbid obesity (Body Mass Index 40)

  • Oseltamivir (Tamiflu) and zanamivir are the only FDA-approved antiviral drugs effective against this virus.

  • President Obama has signed a proclamation declaring this influenza pandemic a National Emergency to facilitate our ability to respond to the pandemic by enabling if warranted the waiver of certain statutory Federal requirements for medical treatment facilities.

  • In particular, this proclamation is aimed at providing HHS the ability to waive legal requirements that could otherwise limit the ability of our nations health care system to respond to the surge of patients with the novel influenza virus.

  • Hospitals request to set up an alternative screening location for patients away from the hospitals main campus (requiring waiver of sanctions for certain directions, relocations or transfers under EMTALA).

    Hospitals request to facilitate transfer of patients from ERs and inpatient wards between hospitals (requiring waiver of sanctions under EMTALA regulations).

  • Critical Access Hospitals requesting waiver of 42 CFR 485.620, which requires a 25-bed limit and average patient stays less than 96 hours.

    Skilled Nursing Facilities requesting a waiver of 42 CFR 483.5, which requires CMS approval prior to increasing the number of the facilitys certified beds.

  • Gubernatorial Declaration

    NOW, THEREFORE, I, EDMUND G. BROWN JR., Governor of the State of California, in accordance with the authority vested in me by the California Constitution and the California Emergency Services Act, and in particular California Government Code sections 8558(b) and 8625, find that conditions of extreme peril to the safety of person and property exists within the State of California and HEREBY PROCLAIM A STATE OF EMERGENCY in California.

  • Gubernatorial Declaration (Cont.)

    IT IS HEREBY ORDERED that all agencies and departments of state government utilize and employ state personnel, equipment, and facilities as necessary to assist the State Department of Public Health and the Emergency Medical Services Authority in immediately performing any and all activities designed to prevent or alleviate illness and death due to the emergency, consistent with the State Emergency Plan as coordinated by the California Emergency Management Agency.


  • Butte: Both Oroville Hospital and Feather River Hospital reporting >100% capacity. Ambulance turn-around times greatly delayed (60 - 90 minutes).

  • Colusa: Colusa Regional Medical Center has converted the Physical therapy and Outpatient areas into additional inpatient beds, and also reports significant delays in ambulance response.

  • Nevada: Tahoe Forest and Sierra Nevada Memorial Hospital are both using surge tents and have created surge beds within their facilities. Dispatch is complaining about lack of available ambulances and lack of mutual-aid resources.

  • Placer: All three hospitals have implemented internal surge plans. Kaiser and Sutter Roseville have been in discussions with Public Health to convert a portion of the Maidu Center into an ACS for additional inpatient beds.

  • Shasta: Fire personnel in Redding reported an incident in which they performed CPR on-scene for 29 minutes before ambulance arrival. 5 ambulances are currently being held at Shasta Regional Medical Center with patients on their gurneys, 2 of these have been waiting more than 90 minutes.

  • Siskiyou: Mercy Medical Center Mt, Shasta and Fairchild Medical Center are reporting zero inpatient beds, and are holding multiple admissions in the ED. 911 callers are complaining of being put on hold, and ambulances have delayed turnaround times.

  • Sutter: Fremont Medical Center has a full census, and is reported no available beds. Bi-county ambulance has staffed two additional units, and are complaining about the ED status and turnaround times at Rideout.

  • Tehama: Due to the recent MCI at the Red Bluff Airport, St Elizabeth Hospital has been dealing with several trauma patients, and has no inpatient beds available. Fire personnel have been unavailable to assist on medical calls due to the MCI and fire.

  • Yolo: The Yolo Emergency Communications Agency has implemented their Emergency Rule Stage 3 for suspending pre-arrival instructions to attempt to respond to the increased 911 medical-aid requests. Sutter Davis and Woodland Memorial have both activated internal surge plans, and are holding admits in the ED. AMR Yolo is reporting significant delays at the ERs, and are unable to staff additional units due to sick calls.

  • Yuba: Rideout is reporting a significant staffing crisis due to sick call-ins. The HERT team has set up surge tents in the parking lot to receive/triage patients. However, ambulance personnel are reporting that there are no nurses staffing the triage area, and there are three ambulances waiting outside for more than an hour.

  • In response to overwhelming numbers of local requests from MHOACs, Public Health Departments, ambulances, and hospitals; S-SV has been in contact with EMSA and the RDMHSs in Region III and Region IV regarding ambulance mutual-aid, and no additional resources are available at this time.

  • Since outside resources are unavailable, each operational area must determine how to continue to support the 911 system with the current local resources.


  • Its a toolnot a policyOnce reviewed, and signed by the MHOAC or EMS Agency Medical Director it becomes an Emergency Policy and Protocol

    EMERGENCYPolicy and Protocol

  • In response to this Pandemic Outbreak, the EMS Agency staff has met, and would like to present their proposal to the Health Officers to get feedback and consensus.

  • We are going to review those proposals in two segments:Public Access Changes, andField Protocol Changes

    Following each segment, there will be a time for open discussion.


  • Public Access Number/ WebsiteScheduled Transport CenterAltered 911/EMD triage

  • By establishing a Scheduled Transport Center the stress on the 911 system will be significantly decreased, and will allow dispatchers to manage a higher call volume and improve call turn-around times.

  • Activating this separate center will allow the Transport Center staff to explore all the alternatives for the transportation needs of the calling party.

  • The Scheduled Transport Center is designed to coordinate all medical transportation requests from all system access points including:

    hospitals, health facilities,Public Access Number, 911, and the field.

  • The Scheduled Transport Center responsibilities include:

    Augmenting medical transportation with alternative vehicles: buses, taxis, etc.

    Developing and implementing a medical transportation scheduling process

    Working with Control Facilities to coordinate the destinations of all transport resources including those to possible Alternate Care Sites, clinics, etc.

  • Direct the patient to use this transportation resource to seek medical attention YESDoes the patient have access to public transportation?NODoes the patient have friends/family that can transport them?NODoes the patient have their own vehicle? For Ambulatory PatientsYESYESNOSchedule transport service (taxi, bus, or BLS transport)

  • Schedule wheelchair transportSchedule BLS transportNOIs patient able to sit in a wheelchairFor Non-Ambulatory PatientsYES

  • Two way radio communication between the: