AN OVERVIEW OF WASHINGTON COUNTY EMS

RITU SAHNI, MD, MPH

MEDICAL DIRECTOR

WASHINGTON COUNTY EMS

If youve seen one EMS system Youve seen one EMS system.

Bob Swor, DO

WHAT THE PUBLIC THINKS

You call We haul Thats all

IN REALITY

WASHINGTON COUNTY

724 square miles

Population 574,326

Urban, suburban, rural and frontier

LETS GO THROUGH A 9-1-1 CALL

TYPICAL CALL

WASHINGTON COUNTY CONSOLIDATED COMMUNICATIONS AGENCY

Independent government agency

Budget $16.4 million

9-1-1 Dispatchers specially trained over 11 months

Completion of 80 hour Telecommunicator Academy

Completion of 40 hour EMD Academy (of which WCCCA teaches in house via APCO EMD protocol)

Completion of CPR and First Aid training

Completion of Telecommunicator and EMD Field training manuals

Robust Quality Management program

Medical Direction provided by Dr. Mohammud Daya

9-1-1 Call

FIRST RESPONSE

DUAL RESPONSE SYSTEM

Fire department first responders

Varying levels of service ALS dual ALS is relatively unique to Oregon

BLS

Some volunteer and some paid

Typically arrive ~4-6 minutes

AMBULANCE

Metro West Ambulance

Franchised ambulance provider under Washington County ASA plan

Dispatched by Metro West dispatch after notification by WCCCA

SO WHO ARE THESE PEOPLE RESPONDING?

EMS RESPONDERS

Licensed by State Paramedics*

EMT-Intermediates

Advanced EMT*

Emergency Medical Technician (EMT)*

Emergency Medical Responders

* National certification initially required (NREMT)

MEDICAL OVERSIGHT

All licensed ambulance services must have an EMS Medical Director. All licensed EMS practitioners must have a Medical Directors AND standing orders (protocols) EMS Medical Direction Team

Ritu Sahni, MD, MPH Washington County Medical Director

Terri Schmidt, MD, MS Washington County Associate Medical Director

Mohamud Daya, MD, MS* TVFR, Banks Fire, Forest Grove Fire, Gaston Fire, Cornelius Fire, WCFD2

Mike Shertz, MD* - Hillsboro Fire

Matt McCoy, MD Metro West Ambulance

Rahul Rastogi, MD Metro West Ambulance

Protocols Development Committee Multiple county participation

EMS Consortium protocols (Washington and Clackamas Counties) *Board certified in EMS

SO WE NEED TO GO TO THE HOSPITAL

WHERE DOES THE PATIENT GO?

Five hospitals within Washington County Kaiser - Westside

Legacy Meridian Park

Providence St. Vincents

Tuality - Forest Grove

Tuality Hillsboro

SPECIALTY CARE?

Heart attack cath lab - St Vincent, Tuality Hillsboro, Meridian Park

Primary Stroke Center Tuality Hillsboro, Meridian Park, Kaiser - Westside

Comprehensive Stroke Center Providence St. Vincents

Pediatric care St. Vincents, Randall Childrens Hospital, Doernbecher Childrens Hospital

Trauma Centers Level 1 Legacy Emanuel Hospital, OHSU

Burn Unit Oregon Burn Center at Legacy Emanuel

Mental Health Future - Unity Center and Mental Health Urgent Care Center (MHUCC)

OTHER EMS PROVIDERS?

Other ambulance services may operate Non-emergent

Inter-facility

Air ambulance

GOVERNMENTAL OVERSIGHT

State EMS/Trauma Program Dana Selover, MD State EMS Director and David Lehrfield, MD State EMS Medical

Director

Licenses personnel

Licenses ambulance services

Licenses ambulances

Designates trauma centers

Manages Area Trauma Advisory Boards (ATAB 1)

State law requires for counties to provider for AMBULANCE SERVICE

GOVERNMENTAL OVERSIGHT

County level Ambulance Service Area Plan (ASA)

Implement/Manage plan

Determine ambulance franchisee

Monitor franchise contract compliance

Systemwide QI

Training

Joint training

Simulation ambulance

HOW IS THE SYSTEM EVALUATED?

Franchisee main metric is response times Dispatch within 60 seconds

8 minutes response time is primarily measure

Other measures County wider heart attack (STEMI) process

Cardiac arrest outcomes (CARES database)

Key Performance Indicators?

WHAT NEXT?

EMS AND TECHNOLOGY

COMMUNITY PARAMEDICINE/MOBILE INTEGRATED HEALTHCARE

What is it?

WORKING DEFINITION

A community paramedic is a state licensed EMS professional that has completed a formal internationally standardized educational program through an accredited college or university and has demonstrated competence in the provision of health education, monitoring and services beyond the roles of traditional emergency care and transport and in conjunction with medical direction. The specific roles and services are determined by community health needs and in collaboration with public health and medical direction.

2012 North Central EMS Institute. Community ParamedicTM. All rights reserved

MIH EXAMPLES

Frequent utilizer programs

High risk for readmission CHF

Infection

Psychiatric evaluation

Hospice revocation risk

WHAT DOES IT ALL MEAN?

Washington County is big place with a lot of dedicated EMS professionals

We have a lot of great stuff and resources

The timesthey are a changing

QUESTION, COMMENTS, CRITICISMS?

THANKS!

Washington County EMS Advisory CouncilIntroductionsAdditional QuestionsAn overview of Washington county EMSSlide Number 5What the public thinksIn realityWashington CountyLets go through a 9-1-1 callTypical callWashington County Consolidated Communications AgencySlide Number 12First responseDual response systemAMBULANCESo who are these people responding?EMS respondersMedical oversightSo we need to go to the hospitalWhere does the patient go?Specialty care?Other EMS providers?Governmental oversightGovernmental oversightHow is the system evaluated?What next?EMS and TechnologyCommunity Paramedicine/Mobile integrated healthcareWorking DefinitionMIH examplesWhat does it all mean?Question, comments, criticisms?Thanks!