HomeMy WebLinkAboutMINUTES - 04221997 - C97 ;�
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TO: BOARD OF SUPERVISORS F&HS-01 Contra
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FROM: FAMILY AND HUMAN SERVICES COMMITTEE Costa
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xy;. County
DATE: April 15, 1997 S>q �a�K
SUBJECT:
EMERGENCY MEDICAL SERVICES REGIONAL PLANNING
SPECIFIC REOUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATIONS:
1. DIRECT the Health Services Director to respond as fully as possible to the
directions from the Board of Supervisors on April 8, 1997, to the Family and
Human Services Committee on April 28, 1997.
2. DIRECT the County Counsel to respond as fully as possible to the directions
from the Board of Supervisors on April 8, 1997, to the Family and Human
Services Committee on April 28, 1997.
3. DIRECT the Health Services Director and County Counsel to jointly advise the
Family and Human Services Committee on April 28, 1997 of authority the
Board of Supervisors or EMS Agency already has under current State law to
further regulate elements of the emergency medical services system which is
not currently being exercised.
4. DIRECT the Health Services Director to outline for the Family and Human
Services Committee on April 28, 1997 the composition and membership of the
Facilities Sub-Committee of the Emergency Medical Care Committee and the
role of that Sub-Committee.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S): kARK�SALJL_NlFR 66KNNA r.FR R
ACTION OF BOARD ON Affil 22, 1997 APPROV RECOMMENDED OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
X UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
CC: ATTESTED April 22, 1997
PHIL BATCHELOR,CLERK OF THE BOARD OF
County Administrator SUPERVISORS AND COUNTY ADMINISTRATOR
Health Services Director
Art Lathrop, EMS Director
BY / DEPUTY
M382 (10/88)
F&HS-01
5. DIRECT the Health Services Director to outline in at least a preliminary
manner additional legislation the Health Services Director recommends the
Board pursue which would improve the emergency medical services system
in Contra Costa County and forward his suggestions to the Family and Human
Services Committee on April 28, 1997.
BACKGROUND:
On April 8, 1997, the Board of Supervisors considered a recommendation from
Supervisor Uilkema regarding regional planning of emergency medical services with
profit and non-profit health care providers. The Board made the following orders on
this subject, as outlined by the Clerk of the Board's summary:
"REQUESTED County Counsel to provide a legal opinion on the authority of the
County Board of Supervisors and/or Health Services Director to require health care
providers to continue to offer emergency and/or intensive care services; REFERRED
to the Family and Human Services Committee the matter of regional planning of
emergency medical services with profit or non-profit health care providers with this
referral on the agenda for review by the Committee at its April 14, 1997 meeting, and
INSTRUCTED the Health Services Director to send a letter to all providers
requesting a voluntary freeze on levels of emergency medical and ICU services at
hospitals in the County pending the results of the referral to the Family and Human
Services Committee."
Our Committee considered this referral on April 14, 1997 and had a preliminary
discussion with the Health Services Director, EMS Director and representatives from
Kaiser. The Health Services Director, Dr. Walker, summarized the discussion which
took place at a community forum sponsored by Congressman George Miller which
took place on April 12, 1997. Questions were raised about who has authority over
various pieces of the emergency medical care system among the State Department
of Health Services, the State Department of Corporations and the County. The
forum also discussed the use of the term "standby emergency room" which is
confusing to professionals in the field, not to mention the general public, in terms of
what services an individual can expect to receive from a hospital with a standby
emergency room. He suggested that a facility is either an emdrgency room or an
urgent care center.
Art Lathrop, EMS Director for the County, outlined the role the EMS Agency has and
the role the Emergency Medical Care Committee has been playing. He noted that
the Facilities Sub-Committee will be considering several issues, including the need
for an on-line tracking system for the availability of Intensive Care Unit (ICU) beds.
He also noted that there is confusion regarding the how to obtain an emergency
ambulance at a hospital facility. One of the types of ambulance that has become an
issue is a so-called "critical care units" which are ambulances staffed with a nurse
so that a patient can be transferred between facilities after having been stabilized at
the first facility. This type of unit with a nurse is necessary whenever the patient has
medications being administered which are beyond the scope of practice of a
paramedic. This type of ambulances is not regulated by the County or EMS agency.
It is not clear whether response times apply to critical care units. We need to work
with the hospitals and American Medical Response to work out procedures for these
types of units.
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F&HS-01
American Medical Response has three such units in Contra Costa County, although
some of them may be pulled from time to time to back up units in Alameda County.
.It was noted that a critical care unit is not a substitute for a full service emergency
room.
The County does have transfer guidelines. The EMS Office has done some study
of inter-hospital transfers to determine their compliance with the guidelines. The
hospitals are asked to complete a form whenever there is a problem with a transfer.
The receiving hospital is supposed to complete the form. Only about 50% of the
forms are being returned to EMS. The Transfer Review Committee is considering
changes to the procedure to require the sending hospital to complete the form, since
the receiving hospital is often outside of this County. The emphasis will be on the
type of equipment that is used and the type of staff that is used. This is much more
clearly within the jurisdiction of the EMS Agency.
The County's current response time for ambulance units is 10 minutes 95% of the
time. When an emergency room goes to stand-by status, response times may be
extended because of the longer distances ambulance units have to travel to
transport a patient to an emergency room. This keeps the unit out of service for a
longer period of time. The only ready solution to this problem is to add additional
ambulance units in order to keep response times within acceptable limits.
Supervisor Gerber noted that a hospital either needs to be a full-service inpatient
facility or not. It is when the service level is somewhere in between that we get into
trouble.
We are asking that the additional information outlined above, plus the referrals made
by the Board on April 8, 1997 be reported to our Committee on April 28, 1997. We
anticipate reporting back to the Board on May 6, 1997 in order to stay within the
Board's 30-day response deadline.
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