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HomeMy WebLinkAboutMINUTES - 06231987 - FC.1 To BOARD OF SUPERVISORS FROM; Finance Committee Contra DATE; June 15 , 1987 Costa County SUBJECT; Redundant Emergency Response SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECOMMENDATION• Accept the attached report from the Health Services Director and Request Report from Emergency Medical Care Committee by December, 1987 . BACKGROUND- At Supervisor Torlakson' s request, the Finance Committee was asked to look into the issue of redundant emergency response problems experienced by fire and ambulance services. The attached report was reviewed by the Committee. The report states that there are ways to reduce redundant response by better coordination between agencies and dispatcher training. It was reported at the Committee meeting that the fire service is currently working with the Health Services Department to achieve better coordination. Additionally, the Emergency Medical Care Committee also considered this referral and asked for an additional six months to fully review the issue and develop a complete report for the Committee' s consideration. It is, therefore, recommended that this issue remain on referral to the Committee, and that the EMCC be asked to respond to the Committee by December, 1987 . CONTINUED ON ATTACHMENT! _ YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMME 1 OF BOARD COMMITTEE APPROVE OTHER SIGNATREIs): Supervisor Powers u. Uvisor Schroder 1 ACTION OF BOARD ON June 23, 783 APPROVED AS RECOMMENDED X OTHER VOTE OF SUPERVISORS 1 HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENT I, IV AND CORRECT COPY OF AN ACTION'. TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVI S ON THE DATE SHOWN. CC: County Administrator ATTESTED Health Services Department --- -- PHIL BATCHELOR, CLERK OF THE BOARD OF Art Lathrop, EMC SUPERVISORS AND COUNTY ADMINISTRATOR M382/7-83 By— Y DEPUTY CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT To: Finance Committee Date: May 20, 1987 via County Admini ator's Office From: Mark Finu� Subject: Request from Supervisor Health Services Director Torlakson Regarding "Redundant Emergency Response" The request from Supervisor Torlakson that the Emergency Medical Care Committee (EMCC) "consider a study of the duplicate and redundant emergency response pro- blem and an examination of whether cross-training of firefighters and paramedics could provide that service in a more cost-effective manner" has been referred to the EMCC and will be considered at their next regular meeting scheduled for May 20, 1987. Since some immediate input has been requested, the following staff response has been prepared for your consideration prior to receiving a report from the EMCC. Supervisor Torlakson raises two issues: 1. Are there ways to reduce multiple agency responses to reported medical emergencies? 2. Can cross-training firefighters as paramedics reduce the need for private ambulance response on medical emergencies? Summary The answer to the first question is "yes". There are ways to achieve some reductions in unnecessary multiple agency responses through dispatcher training and the adoption of dispatch procedures based upon the standards for priority dispatch which we have developed. However, the costs of dispatch training must be considered against the likelihood that multiple responses could thereby be eliminated. The answer to the second question is that while cross-training firefighters as paramedics could reduce the need for private ambulance response, such training would not be cost-effective and would not eliminate the need for both paramedic unit and first responder unit response. AD-LB-EMCC1 A-41 3{81 2. Multiple Agency Response The standard of response for potentially life threatening medical emergencies in most urban areas throughout the State includes a first responder--usually a fire engine company--and a two person paramedic squad with patient transport capabi - lity. When law enforcement issues are involved, police respond as well . The reasons for including a fire first responder as part of the response team for medical emergencies are to provide: - rapid initial arrival of first aid trained personnel to provide necessary life saving assistance (e.g. , initiate CPR, clear an obstructed airway, stop severe bleeding) ; - assistance to ambulance personnel in patient management on scene, while loading, and en route to the hospital for critical cases (some cases, such as CPR cases, requre a four person team to load the ambulance and a three person team for transport); and - triage and scene management for multiple victim incidents. While a full response is necessary for the optimal management of critical emergencies, experience does show that many emergency medical responses could, in retrospect, be handled by fewer responders. The training of medical dispatchers and the adoption by medical dispatch centers of policies and proce- dures for determining the appropriate level of dispatch could result in reducing the number of ambulance responses with red lights and siren and the number of first responder dispatches. However, there are a number of factors contributing to overresponse, some of which would not be eliminated by dispatcher training. Factors contributing to overresponse include: - A legitimate emergency (e.g. , choking, shortness of breath, possible drowning) may be resolved before rescue units arrive; - The reporting party may not have first hand information regarding the emergency (e.g. , passing motorist who stops at pay phone to report an accident, bystander instructed to call an ambulance); - The reporting party may be too excited to provide adequate infor- mation to the dispatcher; - The dispatcher may not be trained to distinguish between potentially life threatening emergencies and those which clearly do not requre a full response; - The reporting party may purposely exaggerate the nature of the emergency in the belief that a more rapid response will be obtained. AD-LB-EMCC2 3. In order to assist localities interested in reducing unnecessary fire response on medical calls, the County EMS Agency has developed standards for priority dispatch which enable medical dispatch centers to adopt policies and procedures and train dispatchers in call screening. (See attached "Dispatch Standards Ad Hoc Committee Report" issued September 12, 1986. ) These standards were deve- loped at the request of the City of Richmond for use in their dispatch center. Training programs are currently under consideration by both Richmond and Consolidated Fire. Once one of these is implemented, we will begin to accumu- late some data on the effectiveness of dispatch training in reducing unnecessary multiple agency responses. Cross-Training Firefighters as Paramedics Paramedic training involves some 1,000 hours of training and cannot be conducted "in-house" by the fire service. (The nearest paramedic training program is at Chabot College in Hayward. ) While reduction of unncessary paramedic ambulance response is a worthwhile goal , training firefighters as paramedics would repre- sent a significant cost to the County. Since the County does not now subsidize ambulance service, there would be no direct County savings as a result of any reduced ambulance reponse. Paramedics are highly trained medical technicians who must have the opportunity to practice their skills and participate in both formal and informal continuing education in order to maintain optimal proficiency. Cost considerations aside, providing paramedic service from every fire station would not enable the number of paramedics that would be required to maintain advanced technical skills or proficiency in patient assessment. In communities where paramedic ambulance service is provided by the fire service, typically only a few fire stations house a paramedic unit, the nearest engine company is dispatched as a first reponder as we do now. The County could consider options of providing paramedic ambulance'service itself either through the fire districts or through a "third service". While the County would be able to realize revenue from patient charges, there is no evidence that this approach would be cost-effective. In fact, our existing model for ambulance service is generally recognized as the most cost-effective approach from the local government standpoint. MF :AL:bgg attachment cc: Art Lathrop AD-LB-EMCC3 9/12/86 DISPATCH STANDARDS AD HOC COMMITTEE REPORT The Dispatch Standards Ad Hoc Ccmmittee has been given two specific directives (listed below) in re,ard to EMS Dispatch Standards by the Emergency Medical Care Committee Chairperson. Prior to making a final recommendation, input on the medical component was requested and received from the Medical Advisory Committee. Comments were also requested from the public and private dispatch agencies throughout the County. The recommendations- of the Dispatch Standards Ad Hoc Committee by directive are as follows: 1. Determine the level of emer:.ency medical dispatching appropriate for Contra Costa County: The Emergency Medical Dispatcher Training Guidelines from the California EMS Authority were reviewed and discussed. It is recommended that the Level II Priority Dispatching as described in the State Guidelines be established as the County standard for emergency medical dispatching. 2 . Identify those conditions warranting a Code III Ambulance respon- Based on the recommendaiton of the Medical Advisory Committee it is recommended that the "Minimum Standard for Conditions Warrant- ing a Code III Response" dated 7/16/86 be adopted as a minimum standard for conditions warranting a Code III ambulance response. In addition, the ad hoc co-,mmittee recommends : 1. That the minimum standard for conditions warranting a Code III ambulance response could be adopted as a minimum standard for fire fizst-in response. It was noted that certain system issues would need to be addressed in this standard as well , such as lack of an ambulance to respond to the scene within 10 minutes . 2 . That the minimum standard for conditions warranting a Code III response be further developed. This should be done to provide uniformity among all EMS dispatch centers in dispatcher questioning for each patient category. 3 . That the EMS office determine whether pre-arrival instructions should be issued by EMS Dispatchers . If so , these should be identified as part of the standard_ LEVELS OF EMERGENCY MEDICAL DISPATCHING from the "Emergency Medical Dispatcher Training Guidelines" issued by the California Emergency Medical Services Authority There are three levels of Emergency Medical Dispatch identified as: A. Level I Dispatch Action Dispatch Options (Call Routing) Always Dispatzhed Pre-arrival Instructions. This level of service is characterized by a dispatcher who is limited to determining whether a request for services requires a medical or non-medical response. When a medical response is required, they either transfer the call to the responsible medical dispatch agency or they send the highest level of care available. They make no determination as to what kind of medical service is needed or how many agencies should respond. If the agency despatzhes, then they may elect to have the dispatcher use a medical reference card to ask the caller if the victim is conscious, breathing, victims age and chief. complaint. This information would be forwarded to the EELS responder en route. The local agency has the option of providing pre-arrival instructions. B. Level II (Priority Dispatching) Dispatch Dispatch Action Options AlwaysLife Threatenin Fre-arrival Disnatclie Instructions Non-Life Threatenin This level is characterized by a dispatcher who is responsible for determining, through key medical questions, whether the call is a life threatening, or non-life threatening emergency. - The dispatcher takes action on the request and, using established guidelines, determines the level and type of response. In all cases, .a. medical response is dispatched. This level of service may, depending on local approval, include pre-arrival instructions after emergency medical services have been sent. .- C. Level III (Call Screening) Dispatch Options Dispatch Ac:ion Life Threate.14n 21 Dispatc Pre-arrival Non-Life T_hreatenin instructions Non-urgent, medica Non-D4sDatcnf—" problem. Recommends sending alternate resource. This level perfors all of the functions of a Level II dispatcher including giving pre-arrival inst--uctions when authorized. The most significant characteristic of this level is that the Emergency Medical Dispatcher determines whether an EMS unit or alternative resources such as fire or police will be sent, based on the criteria set forth by the local Emergency Medical Services Agency and associated medical control. The determination is made through established key questions and local protocols. The Authority strongly recommends that extreme caution be utilized when deciding not to dispatch a medical unit. First aid information and referral to other medical resources, if included in the approved _3 pre-arrival instructions, may be given if authorized by the local E*!S A lncrrr AuanCV. MINIMUM STANDARD FOR CONDITIONS WARRANTING A CODE I_II RE=PONS, (Previously titled "Paramedics Dispatched Code III 6/36) PROBLEM Abdominal Palin* Allergic Reaction* Asthma* stab/Gunshot Wound - Back pain wi`q Sancoue Breathing Problems* Burns (all but small) Cardiac/Respiratory Arrest Chest Pain* Cold Exposure Convulsions/Seizures* CO Poisoning/Inhalation Diabetic Problems* Disaster/Multiple -Patients Drowning (near drowning) Electrocution Eye Problem* Falls (other than ground level) Headache (with CNS changes) Heart Problems Heat Rxnosure Hemorrhage* Overdose/Poisoning/Ingestion Pregnancy/childbirth/`^_i s carriage* - Psychiatric/Behavioral (violent or suicidal)-* Stroke/CVA (unless conscious without reser. distress) Traffic Injury Accident* Traumatic Injuries* Unconscious/Fainting Unknown Problem (man down) P.ny out-of-the ordinary medic=-1 problem allow for a lesser resoonse.