System Utilization 2013

Contra Costa County 911 Ambulance Response and Transport

By Month 2012 Through 2013

(2013 Data excludes SRVFD)

Transport

Response

0

1000

2000

3000

4000

5000

6000

7000

8000

1/1/

2012

2/1/

2012

3/1/

2012

4/1/

2012

5/1/

2012

6/1/

2012

7/1/

2012

8/1/

2012

9/1/

2012

10/1

/201

2

11/1

/201

2

12/1

/201

2

1/1/

2013

2/1/

2013

3/1/

2013

4/1/

2013

5/1/

2013

6/1/

2013

7/1/

2013

8/1/

2013

9/1/

2013

10/1

/201

3

11/1

/201

3

12/1

/201

3

%

Contra Costa County 911 Ambulance % Transport per Response

by Quarter 2012 Through 2013

Mean=76.1% (2013 Data excludes SRVFD)

77%

76% 76% 76%

77%

76%

77%

76%

72%

73%

74%

75%

76%

77%

78%

79%

80%

Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2012 Q4 2013

412

171

118

56

20 6 0 0

0

50

100

150

200

250

300

350

400

450

SRMC CCRMC DSP KR JMMCWC SDMC JMMC-C KWC

Power Outage

Contra Costa Hospitals EMS Diversion by Cumulative Hours

2013 N=584 hr.'s

2013 CCRMC DSP JMCON JMWC KRICH KWC KANT SRRMC SDMC Total

January 0:00:00 0:00:00 0:00:00 0:00:00 0:29:30 0:00:00 0:00:00 0:12:38 0:02:08 0:04:08

February 0:00:00 0:00:00 0:00:00 0:00:00 0:17:12 0:00:00 0:00:00 2:34:00 0:00:00 0:16:47

March 0:00:00 0:00:00 0:00:00 0:00:00 0:00:59 0:00:00 0:00:00 0:00:00 0:14:36 0:08:23

April 0:00:00 0:00:00 0:00:00 0:00:00 0:04:38 0:00:00 0:00:00 0:08:31 0:00:00 2:10:27

May 0:00:06 0:00:00 0:00:00 0:00:00 0:00:00 0:00:00 0:00:00 0:00:00 0:00:00 0:21:48

June 1:42:04 0:00:00 0:00:00 0:00:00 0:00:00 0:00:00 0:00:00 0:18:26 0:06:13 2:10:46

July 0:00:00 0:00:00 0:00:00 0:00:00 0:04:14 0:00:00 0:00:00 0:47:53 0:00:00 0:15:06

August 0:00:00 0:00:00 0:00:00 0:00:00 0:16:22 0:00:00 0:00:00 1:08:30 0:00:00 0:22:08

September 0:00:00 0:00:00 0:00:00 0:00:00 0:00:00 0:00:00 0:00:00 1:47:26 0:00:00 0:18:22

October 0:00:00 0:00:00 0:00:00 0:00:00 0:04:47 0:00:00 0:00:00 0:11:03 0:00:00 0:07:55

November 0:08:28 0:00:00 0:00:00 0:00:00 0:12:12 0:00:00 0:00:00 0:37:09 0:00:00 0:14:40

December 0:00:00 0:00:00 0:00:00 0:00:00 0:14:36 0:00:00 0:00:00 1:11:42 0:00:00 0:36:43

Totals 1:50:38 #REF! 0:00:00 0:00:00 1:44:30 0:00:00 0:00:00 8:57:18 0:22:57 7:07:13

Mean Month 0:09:13 0:00:00 0:00:00 0:00:00 0:08:42 0:00:00 0:00:00 0:44:46 0:01:55 0:35:36

Contra Costa Hospitals EMS Diversion Mean Daily Hours by Month 2013

Contra Costa EMS 2013 % Hospital Diversion by Type

N=842 hrs.

CT 62%

STEMI 35% Other

3%

Trauma INT

Base Hospital 2013 Report

Base Hospital Mean Daily Calls By Year to 2013

N=1587

Ave Calls per day

12.1 11.5

10.1 9.9 9.4

9.0

7.9 8.1 8.8 8.6 8.7

0

2

4

6

8

10

12

14

2002 2003 2004 2005 2007 2008 2009 2010 2011 2012 2013

Note: Pediatric age 14 or below

2002 2003 2004 2005 2006 2007 2008 2009 2010 2012 2013Pediatric Calls 421 369 390 360 290 297 216 258 138 209 214Adult Calls 3988 3815 3309 3239 3153 2983 2673 2708 3084 2930 2979

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Ann

ual B

ase

Con

tact

Ca

lls

Base Contact for Adult vs. Pediatric Patients 2013

Cardiac Arrest 2013

Data Source: CARES Registry through June 2012. Excludes Medical Facilities (hospitals, clinics, SNF); Excludes arrest after EMS arrival

32%

44% 42%

0

5

10

15

20

25

30

35

40

45

50

Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013

Mean: 39%

% Bystander Initiated CPR By Quarter 2011 through 2013

2013 N= 469 CA of Cardiac Etiology

%

32%

25%

37%

17%

36%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Q12011

Q22011

Q32011

Q42011

Q12012

Q22012

Q32012

Q42012

Q12013

Q22013

Q32013

Q42013

Cardiac Arrest Survival - Utstein Standard By Quarter 2011 – 2013

N= 469 2013 CA resuscitations attempted

Mean: 31%

National Benchmark: 30% Source: CARES

National CARES Data

Percent NumberTotal Number of Cardiac Arrests of Cardiac Etiology 28253 509

Overall Cardiac Arrest Survival 10.4% 10.8% 55/509Bystander Witnessed Arrest Survival 16.0% 15.6% 40/257Utstein (VF/VT Witnessed) Survival 32.6% 31.0% 32/103Utstein (VF/VT) Survival with Bystander CPR or AED 38.4% 41.7% 60Unwitnessed Arrest Survival 4.5% 3.9% 8/206

Witnessed Arrests - Frequency of rhythm NationalVF/VT (Shockable) 36.1% 40.0% 103/257Other 30.3% 26.4% 68/257Asystole 33.9% 33.4% 86/257Unwitnessed - Frequency of rhythmVF/VT (Shockable) 13.9% 15.5% 32/206Other 23.5% 18.9% 39/206Asystole 62.4% 65.5% 135/206EMS Witnessed - Frequency of rhythmVF/VT (Shockable) 24.3% 10.8% 5/46Other 51.6% 45.6% 21/46Asystole 62.4% 65.5% 13/46

Survival Rate - Witnessed - by Rhythm NationalVF/VT (Shockable) 32.6% 31.0% 32/103Other 10.3% 8.8% 6/68Asystole 3.4% 2.3% 2/86Survival Rate - Unwitnessed - by RhythmVF/VT (Shockable) 16.3% 12.5% 4/32Other 5.8% 7.6% 3/39Asystole 1.2% 0.7% 1/135Survival Rate - EMS Witnessed - by RhythmVF/VT (Shockable) 41.3% 41.6% 5/12Other 13.0% 0.0% 0/21Asystole 10.7% 15.3% 2/13

NationalWitnessed Arrests 38% 50% 303Unwitnessed Arrests 51% 40% 206EMS Witnessed Arrests 10% 9% 46Total 28253 509

National Cardiac Arrest CARES Registry Data vs. Contra Costa Data01/01/2012--12/31/2012

Contra Costa CARES Data

Contra Costa

Contra Costa

Contra Costa

National CARES Data

Percent NumberTotal Number of Cardiac Arrests of Cardiac Etiology 30841 469

Overall Cardiac Arrest Survival 8.6% 7.6% 36/469Bystander Witnessed Arrest Survival 12.8% 11.1% 25/224Utstein (VF/VT Witnessed) Survival 26.0% 25.6% 20/78Utstein (VF/VT) Survival with Bystander CPR or AED 30.0% 35.5% 50Unwitnessed Arrest Survival 3.7% 1.0% 2/189

Witnessed Arrests - Frequency of rhythm NationalVF/VT (Shockable) 35.0% 34.8% 78/224Other 31.6% 33.4% 75/224Asystole 33.2% 31.6% 71/224Unwitnessed - Frequency of rhythmVF/VT (Shockable) 13.9% 16.4% 31/189Other 24.3% 28.0% 53/189Asystole 62.4% 55.5% 105/189EMS Witnessed - Frequency of rhythmVF/VT (Shockable) 24.8% 22.4% 13/58Other 51.2% 58.6% 34/58Asystole 23.8% 18.9% 11/58

Survival Rate - Witnessed - by Rhythm NationalVF/VT (Shockable) 25.9% 25.6% 20/78Other 8.4% 5.4% 34/58Asystole 3.0% 1.4% 1/70Survival Rate - Unwitnessed - by RhythmVF/VT (Shockable) 14.1% 6.4% 2/31Other 4.5% 0.0% 0/52Asystole 1.1% 0.0% 0/115Survival Rate - EMS Witnessed - by RhythmVF/VT (Shockable) 35.9% 38.4% 5/13Other 9.6% 8.8% 3/34Asystole 9.0% 9.0% 1/11

NationalWitnessed Arrests 39% 47% 222Unwitnessed Arrests 50% 40% 189EMS Witnessed Arrests 11% 13% 58Total 30841 469

National Cardiac Arrest CARES Registry Data vs. Contra Costa Data 01/01/2013-12/31/2013 AMR and NonAMR

Contra Costa CARES Data

Contra Costa

Contra Costa

Contra Costa

STEMI System Q1 2013 Report

32

14

94 88

77

59

32

12

88

79

70

54

31

13

83 78

66

55

32

11

81 80

69

54

0

10

20

30

40

50

60

70

80

90

100

911 to EDArrival

Scene Time 911 to PCI Pt Contact toPCI

ECG to PCI Door to PCI

Med

ian

in M

inut

es

Contra Costa Emergency Medical Services STEMI System Prehospital Performance Intervals

2010-2013

YTD 2010 YTD 2011 YTD 2012 YTD 2013

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ASA administered ornoted as

contraindicated

ECG Acquired inSTEMI Patient

Identified STEMIDelivered to PCI

Center

Diagnostic ECG toPCI <90 minutes

PH 12 lead < 5minute from patient

contact

Contra Costa Emergency Medical Services STEMI System Performance Prehospital Patient Care Benchmarks

YTD 2010 YTD 2011 YTD 2012 YTD 2013

17

14.5

13 13 12.7

12

11

10 10

11

12

13

14

15

16

17

Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013

Contra Costa STEMI System Median Prehospital Scene Time Interval

Run Chart Analysis by Quarter 2012-13

Time In Mins

Benchmark 15 mins

Stroke System 2013

Data Source: MEDS 3 California Stroke Registry

Begin Stroke System

11

11.5

12

12.5

13

13.5

14

14.5

Q3 20

11

Q4 20

11

Q1 20

12

Q2 20

12

Q3 20

12

Q4 20

12

Q1 20

13

Q2 20

13

Q3 20

13

Q4 20

13

Med

ian

Tim

e in

Min

s

Spec ial Cause Detec ted Chart Type: Chart for Indiv iduals Database Column1

Av g of Data Shown 12.7 A. 1 Beyond Control Limit E. 2 of 3 Beyond 2 SigmaMedian Data Shown 12.75 B. 9 On One Side of Average F. 4 of 5 Beyond 1 Sigma

Sigma for Limits 0.3940 C. 6 Trending Up or Down G. 15 Within 1 SigmaBase for Limits Average MR D. 14 Alternating Up & Down H. 8 Outside 1 Sigma

X. Excluded or Missing Data

Centerline: 12.70 Process Limits: Lower: 11.52 Upper: 13.88

Stroke Scene Median Time Interval Run Chart Analysis by Quarter 2011-2013

N=1263 Stroke Assessments in 2013

Benchmark < 15 mins

45%

94% 88%

0

10

20

30

40

50

60

70

80

90

100

Field Alerts Glucose Obtained Hx Last known

%

Contra Costa County Stroke System 2013

Field Stroke Guideline Compliance

N=1263 Stroke Assessments 2013

45%

15%

15%

14%

11%

Other Neuro

Other Non-Neuro

TIA

Hemorrhage

Contra Costa County Stroke System Disposition of Stroke Alerts 2013

N=579

Seizures

ALOC

Sepsis

Enceph

Headache

Weakness

Other Neuro

CVA

0:51

1:24

1:17

1:01

1:38

1:31

0:00

0:14

0:28

0:43

0:57

1:12

1:26

1:40

1:55

Door to TPA Dispatch to TPA EMS On-Scene to TPA

Contra Costa County Stroke System TPA System Metrics 2013

N=121

Hours/ Mins

Trauma System 2013

Trauma System % Discharge Based on Injury Severity Score (ISS)

Shown by Quarter 2012-13

N= 2780 Total Trauma Patients Source: Contra Costa Trauma registry

0%

5%

10%

15%

20%

25%

30%

Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013

Trauma System Activations Based on Injury Severity Score (ISS)

Shown by Quarter 2012-13

N= 2780 Total Trauma Patients Source: Contra Costa Trauma registry

249

306 311

232

210

270 267

212

0

50

100

150

200

250

300

350

Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013

Num

ber o

f Act

ivat

ions

Penetrating Blunt

Trauma System Mean Prehospital On Scene Time Interval

Blunt vs. Penetrating Trauma By Quarter 2013

Time in Mins

0

2

4

6

8

10

12

14

16

18

Q1 2013 Q2 2013 Q3 2013 Q4 2013

Patient Safety Q2 2013

Operations

Clinical

Other

N=67 N=31

N=20

Contra Costa EMS Patient Safety Events by Frequency and Type

2013: N=118

Contra Costa EMS Reported Patient Safety Events

by year 2010 to 2013

72

28

48

118

0

20

40

60

80

100

120

2010 2011 2012 2013

No Per Year

CONTRA COSTA COUNTY EMS AGENCY - CQI Division Project Status Board

2014-15 Quality Initiatives PROJECT TITLE OUTCOME

STATEMENT

Phase I Phase II Phase III Phase IV Phase V Phase VI

Staff Research & Review Task Team QLC Review Approval & Planning Implement & Monitoring Outcome Sustaining

Field Advisory Forum

To provide a forum for increased flow and exchange of pertinent clinical and operational information between EMS field personnel and agency staff.

Staff is currently gathering scheduling and planning for inaugural meeting

Members at large will be appointed

Program objective and members will be announced at the Quality Leadership Committee (QLC) meeting scheduled for March 2014

The first Field Advisory Forum (FAF) is scheduled to meet in late March or early April of 2014 to assess value.

After the first three (3) meetings – staff and members will assess the value and productivity of the FAF

To be determined

High Performance

Cardiac Arrest & CPR

To increase the quality of CPR provided to patients in cardiac arrest.

Indicators to measure quality such as compression, ratios, depth, & pauses for shock developed and data pulled.

Training program developed with staff and implementation plan completed.

Initial indicators to be presented to Quality Leadership Council (QLC) in March 2014

The same initial quality indicators will be reviewed by staff and QLC Mar & Sep 2015

To be determined To be determined

EMS Patient Off-Load Time

Reduction

To monitor and reduce the “hand-off” times between Emergency Department (ED) and 911 ambulances in Contra Costa County

Current measures reflect that during high volume periods, patients arriving by 911 ambulance are often waiting longer than 30 minutes for off-load to ED

The measures and other pertinent information are reviewed by internal staff and county wide Quality Leadership Committee (QLC)

Letter to all hospitals and ambulance providers sent out to announce more intense monitoring and feedback on this issue.

Reports will be updated monthly and hospital leadership will receive an email with a link to the report when it is posted

EMS Staff and QLC will measure in six months to evaluate reduction in off-load times.

To Be determined

Spinal Motion Restriction

To implement changes in “Spinal Immobilization” that will improve patient care and comfort.

Staff researched current trends in “spinal immobilization” and identified potential issues within Contra Costa County.

Task team was developed which included field providers. Developed new treatment guideline and equipment.

Proposed changes reviewed with QLC, MAC and other EMS Committees. Funding for equipment through Measure H.

Training of all EMS personnel in Q4 of 2013. Implementing use of new equipment and treatment guideline January 1, 2014.

Spinal Motion Restriction (SMR) use rates will be monitored in AdHoc reports as part of QLC. SMR will be compared to historical trends.

To be determined.

Pediatric Medication

Safety

To check sustainability of our documented reduction in pediatric medication inaccuracies and to measure and sustain improvements

-Data to be queried June 2014 & reviewed by EMS Staff --Published in EMS Best Practices

The information will be reviewed by internal staff and former task team leads

The information will be reviewed by Quality Leadership Council (QLC) at Sept 2014 meeting.

Staff and QLC will evaluate data and indicators for progress

To be determined June 2014 if error rate continues to drop and improve

Further action may be required to sustain gain.

Video Laryngoscopy

Trials

To implement and evaluate the efficacy of Laryngeal videography for the purposes of increasing efficiencies of airway management

Equipment has been demonstrated at various EMS public meetings and training sessions.

Specific providers are currently piloting this adjunct at both local and national levels.

Medical Director has approved the trial evaluations. QLC advised March 2014 meeting

Providers to report out to MD and record information on the procedure. Timeline to still be determined

To be determined To be determined

Adhoc Studies Current Initiatives

2013

END REPORT 2013