Altered Standard of Care Training for Administrative Personnel

1. Altered Standard of Care Training for Administrative Personnel Module 2

2. Welcome to the S-SV EMS Agency Altered Standard of Care Administrative Module 2 • This is the second of three modules of the Altered Standard of Care Training. This section focuses on: • The addition and use of a Scheduled Transport Center, • Creating a Public Access Number, and • Changes in the medical dispatch protocol • This module will take approximately 1hour to complete. At the end of this module there will be a 10 question quiz. You must complete the quiz with an 80% success rate to pass. The questions will be based on the information learned during the training module. • NOTE:Completion of the quiz is required to receive CE credit.

3. Disclaimer This training provides an example of how the current 911 system may be altered during a major disaster or pandemic outbreak. The scenario and changes shown in this module are hypothetical only and should not be taken as actual changes to the system. System changes may follow the model that is shown in this training, but could vary based on the severity and type of incident.

4. Purpose The purpose of the Altered Standard of Care Training is to provide information regarding the alteration of the EMS system in response to an increased demand for medical-aid services, beyond the capacity of the current system providers.

5. Objectives • After completing this training, you should be able to: • Describe the use of a Scheduled Transport • Center • Explain the use of a Public Access Number • including the use of 2-1-1 • Identify changes made to dispatch protocols • using the altered standard of care. • Understand the use of a Scheduled • Transport Center.

6. SCENARIO A pandemic outbreak has affected a large portion of the population. It is a severe variation of the annual flu virus. The EMS system has increasingly become overwhelmed, and there is no estimated time when this impact will end. We simply do not have the resources and personnel to handle the demand for more ambulances. Ahead we will discover what changes can be made to the system to handle this type of overload Something has to change! What can we do?

7. Public access Due to this pandemic outbreak, many people have been calling 911 for various reasons. To address the impact, the public access system must be altered in order to meet the increased demand. In Module 1 we looked at how the normal dispatch priority system works, now let’s look at how the process might be changed, beginning with the Scheduled Transport Center and Public Access Number.

8. The MHOAC has decided to implement two additional resources reduce the impact on the local EMS system. These resources include: • Scheduled Transport Center, and • the Public Access Number

9. Scheduled Transport Center Scheduled Transport Center The is designed to coordinate all medical transportation requests from all system access points including: • hospitals, • health facilities, • Public Access Number, • 911, and • the field.

10. Scheduled Transport Center 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.

11. Scheduled Transport Center 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.

12. Scheduled Transport Center • All calls coming into the Scheduled Transport Center will have already been triaged. • Immediate/Emergent patients will have been referred to 911. • Minor/Worried-Well patients will have been referred to the Public Access Number. • Therefore, all incoming calls to the Scheduled Transport Center are assumed to be “DELAYED.”

13. Scheduled Transport Center • Upon receiving a call, the Scheduled Transport Center staff will obtain the following information from the calling party; • Patient’s name, age, and chief complaint • Location and call-back number

14. Scheduled Transport Center After obtaining the location and patient information, the call taker will assess the patient’s ability to walk unassisted.

15. Scheduled Transport Center Ambulatory patients will be directed to be transported to their private doctors office, clinic, urgent care, or emergency department. If the patient does not have transportation available to them, the Transport Center may provide public transportation vouchers, send a shuttle bus, or schedule BLS transport.

16. Scheduled Transport Center Alternative Transport Options – Benchmarking the Phoenix Fire Department Phoenix Fire Rescue has a system of paramedic-engine non-emergency alternative transport referrals. Results of the authors research visit, interviews and field observations in Phoenix demonstrated a well functioning system of alternative transport for non-emergency patients once they had been thoroughly assessed on the scene.

17. Scheduled Transport Center Alternative Transport Options – Benchmarking the Phoenix Fire Department (con’t) If the patient is mobile without need of assistance and meets the criteria of a non-emergency case, the PFD paramedics, in concert with their station officers have the discretion to refer the patient to self-transport or public taxi service. PFD provides patients with a taxi voucher if they lack their own transportation. - http://www.usfa.fema.gov/pdf/efop/efo35927.pdf

18. Scheduled Transport Center • Non-ambulatory patients will fall into two categories: • Wheelchair transport • OR • BLS/Gurney transport

19. Scheduled Transport Center For any patient requiring transport to the emergency department, the Scheduled Transport Center will coordinate destinations with the Control Facility.

20. Scheduled Transport Center Call to Scheduled Transport Center Obtain Patient information and chief complaint. Is patient able to stand and walk unassisted? NO YES Ambulatory Non-Ambulatory

21. Scheduled Transport Center Ambulatory Does the patient have their own vehicle? Direct the patient to use this transportation resource to seek medical attention YES NO Does the patient have friends/family that can transport them? YES NO Does the patient have access to public transportation? YES NO Schedule transport service (taxi, bus, or BLS transport)

22. Scheduled Transport Center Non-Ambulatory Is patient able to sit in a wheelchair Schedule wheelchair transport YES NO Schedule BLS transport

23. Scheduled Transport Center The Scheduled Transport Center will ideally have coordination with the 911 dispatch center and Public Access Number via 2-way radio communication in the event of an emergency requiring BLS transport. Emergency calls will always take precedence over scheduled BLS transport calls. Therefore, BLS ambulances may be rerouted and patients rescheduled due to accommodate more urgent calls.

24. Lets examine what we have learned so far… The Scheduled Transport Center is designed to coordinate all medical transportation requests from: • Hospitals and health facilities • Public Access Number • 911 and the field • All of the above

25. Lets examine what we have learned so far… If you answered, D. All of the above, you are… CORRECT The Scheduled Transport Center will schedule all transportation from all access points.

26. We have reviewed how a Scheduled Transport Center might be established and operated during a disaster. In the next section, we will review principles for establishing a Public Access Number and a website for providing public information.

27. Public Access Number Creating a Public Access Number would greatly relieve the stress on the 911 system by referring the public to the appropriate resources without having to call 911 and utilize emergency responders unnecessarily.

28. Public Access Number In July 2000, the Federal Communications Commission (FCC) reserved the 211 dialing code for community information and referral services. The FCC intended the 211 code as an easy-to-remember and universally recognizable number that would enable a critical connection between individuals and families in need and the appropriate community-based organizations and government agencies.

29. Public Access Number • 211 works a bit like 911. • Calls to 211 are routed by the local calling center. • The 211 center’s referral specialists: • question callers, • access databases of resources available from private and public health and human service agencies, • match the callers’ needs to available resources, and • link or refer them directly to an agency or organization that can help.

30. Public Access Number 211 played a critical role during the San Diego wildfires of 2007 by providing information and support to more than 130,000 residents in 5 days. “The 211 service was an invaluable resource during the firestorm in that it freed up calls from 911. We could give information on repopulated neighborhoods to the 211 operators. We saw 911 calls diminish over time because of that.” -- San Diego Sheriff Bill Gore

31. Public Access Number As of October 2011, 2-1-1 serves over 260 million Americans (86.6% of the entire population) covering all 50 states (including 37 states with 90%+ coverage) plus Washington DC and Puerto Rico. Blue- >80% Green- 100%

32. Public Access Number As of April 2011, 27 Counties in California have adopted the use of 211. According to California Alliance of Information and Referral services (CAIRS), there are currently three of the ten counties within the S-SV EMS Agency system (Shasta, Nevada, and Yolo) that have an active 211 system, with other counties scheduled to roll-out the 211 system in the near future.

33. Public Access Number www.211shasta.com www.dial211.com

34. Public Access Number During a disaster or emergency activation, call-takers for the Public Access Number should be trained to triage calls in a similar fashion as 911 call-takers. Consideration should be given to staffing the call center with Registered Nurses.

35. Public Access Number One King County, Washington study (Smith, W.R., 2001) that was presenting in the pre-hospital Research Forum in Orlando, concluded that transferring non-urgent 911 calls to a nurse on the front end resulted in a decrease in BLS responses in the Seattle area over a four month period with no reported adverse patient outcomes and the maintenance of high levels of patient satisfaction. -www.usfa.fema.gov/pdf/efop/efo35927.pdf

36. Public Access Number Let’s look at how the Public access number Process might work…

37. Public Access Number As mentioned before, the Public Access Number, Scheduled Transport Center, and the 911 call center will ideally have coordination with each other via 2-way radio communication.

38. Public Access Number • If a call comes in to the Public Access Number that is a medical emergency, the call taker will: • contact the Transport Center to request a BLS ambulance and QRV response* to the patient’s location. • Stay on the line with the calling party to provide medical care instructions until field responders arrive. • *The Transportation Center will communicate with the 911 dispatcher to request a QRV and first responders to respond as needed.

39. Public access algorithm 211 or Other Public Access Number Call Taker • Obtain: • Incident Location • Call back number • Patient age • Level of Consciousness • Status of breathing • Chief Complaint

40. Public access algorithm Call-taker will contact the Transport Center to request field response. Medical Emergency? YES NO Provide Pre-Arrival Care Instructions Assess the level of medical need No medical need At home care Higher level of care

41. At home care • If it is determined that the caller has only minor medical care needs, they may be: • Given self care or family care instructions • Directed to sources of health information on the internet

42. At home care • Examples of medical web support include: • WebMD.com • CDC.Gov (Centers for Disease Control) • Bepreparedcalifornia.ca.gov (CDPH), and • Local Public Health Department websites

43. Higher level of care • If it is determined that the caller needs to be seen by a medical practitioner they should be assessed for their ability to obtain necessary transportation. • If the patient is unable to transport themselves or have family transport them to their personal physician, they should be transferred to the Scheduled Call Center.

44. No medical need • If it is determined that the caller has no medical need, they may be: • Transferred to other social or public service call center, • Referred to other public information websites, • Referred to appropriate agency or county services.

45. A Public Access Number is the number people will use in emergency situations where a paramedic is needed. Lets examine what we have learned so far… • True • False www.disasterdoug.com

46. If you answered, B. False, you are… CORRECT A Public Access Number is the number used to guide people to resources available from private and public health and human service agencies and will match the callers’ needs to these available resources. Lets examine what we have learned so far… www.disasterdoug.com

47. The establishment of a Public Access Number and Scheduled Transport Center should decrease the public demand for resources. System Access / Emergency Medical Dispatch But is this enough? www.disasterdoug.com

48. In order to respond to those with the greatest needs in the community, the standard protocols used by the emergency medical dispatch centers will need to be altered.

49. The Altered Standard Order Form lists these nine areas to be considered for implementation. Items to be altered will be initialed by the MHOAC, EMS Agency Medical Director, or designee.

50. In this scenario, the MHOAC and EMS Agency have elected to discontinue: • Discontinue Use of Emergency Medical Dispatching (EMD) Procedures & Implement Altered Triage Algorithm • Discontinue Use of Pre-Arrival Instructions (PAI)