Altered Standard of Care Training for Administrative Personnel

Altered Standard of Care Training for Administrative Personnel Module 1

Welcome to the S-SV EMS Agency Altered Standard of Care Administrative Module 1 • This is the first of three modules of the Altered Standard of Care Training. This section focuses on: • Assumptions & Definitions • Regulations that allow for changes to our current 911 system • MHOAC and EMS Agency Medical Director collaboration, and • Multi-Agency Coordination • This module will take approximately 1 hour 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.

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.

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.

Objectives • After completing this training, you should be able to: • Describe the rolls and relationships of the OA EOC, MHOAC, and the EMS Agency. • Recognize terms used within the Altered • Standard of Care Pre-Planning Guide. • Explain the importance of the MHOAC and • EMS Agency Medical Director collaboration. • Identify components of the Altered Standard • Order Form.

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?

We know that things have to change in order to respond to the increased demand. But prior to being able to discuss system changes, we must first review some Assumptionsand a few Definitions used in the Altered Standard of Care Pre-Planning Guide.

Assumptions • The Medical/Health Branch of the OA EOC (MHOAC) has established collaboration with the EMS Agency Medical Director and other affected agencies to coordinate changes to the EMS response. • Mutual-aid resources are scarce or unavailable. • Appropriate waivers, proclamations, or declarations required to implement specific system changes have been identified and secured.

Definitions Altered Standard of Care • Altered Standard of Care simply refers to a level of medical care delivered to individuals under conditions of distress, such as after a disaster or when supplies are insufficient for the demand for emergency care.

Definitions Medical health operational Area coordinator (mhoac) • The "Medical/Health Operational Area Coordinator (MHOAC)" is the Public Health Officer and local EMS Agency Administrator or designee who is responsible, in the event of a disaster or major incident where mutual aid is requested, for obtaining and coordinating services and allocation of resources within the Operational Area (county) border.

Definitions Medical health operational Area coordinator (mhoac) • Within the S-SV EMS Agency's member counties, the "Medical/Health Operational Area Coordinator (MHOAC)" is often a role filled just by the Health Officer, but in a few counties, it is a joint role of the Health Officer and EMS Agency Administrator.

Definitions Operational area Emergency operations center (OA EOC) • The Operational Area Emergency Operations Center or OA EOC is the designated location for coordinating and supporting emergency services among all the major disciplines (law, fire, health/medical, public works, etc.) and local jurisdictions (cities, county, districts, etc.) within an Operational Area or county.

Definitions Quick response vehicle (qrv) • A Quick Response Vehicle or QRV is a vehicle that is staffed with at least one paramedic, and equipped with Advanced Life Support (ALS) equipment/supplies per local EMS Agency protocol. Such vehicles may include: ALS supervisor vehicles, shared resources from other emergency response agencies, company cars, rental cars, private cars, etc.

Let’s examine what we have learned so far… • In this scenario, who is responsible for obtaining and coordinating services and allocation of medical and health resources within the Operational Area border? • OES Coordinator • The MHOAC • Public Works Director

If you answered, , you are The MHOAC, or Medical Health Operational Area Coordinator, is responsible in the event of a disaster or major incident, for obtaining and coordinating services and allocation of medical and health resources within the Operational Area (county) border. Let’s examine what we have learned so far… B. The MHOAC Correct

So far… assumptions So far we have reviewed some and that are necessary to move forward in altering the system in response to this pandemic outbreak. With the threat of this pandemic flu creating such a havoc on the 911 system, Do the current rules that regulate EMS allow us to make adequate changes to address this type of impact, or will some rules have to be ? definitions how can we alter our system? waived

Waivers / Authorities In this section, we will examine some of the authorities or rules that may need to be waived in order for the EMS system to function differently during a disaster or unusual circumstance such as this pandemic flu. Now lets take a look…

Altered Treatment Protocols / Scope of Practice H&SC. Div. 2.5 Section 1797.172(b) This section of the Health and Safety Code allows for changes in the scope of practice for paramedics. The Medical Director of the local EMS agency, in consultation with a state committee of local EMS Medical Directors, may implement changes to the paramedic protocols.

Altered Treatment Protocols / Scope of Practice CCR Title 22 Div. 9 Ch. 4, Art. 2. Section 100145 (2) This regulation allows for the use of additional procedures and administration of other medications that are outside the normal scope of practice of the paramedic, with approval of the Director of the EMS Authority and proper training and testing of these skills.

Altered Treatment Protocols / Scope of Practice HSC § 101040 This code gives authority to take preventive measures during emergency. “The county health officer may take any preventive measure that may be necessary to protect and preserve the public health from any public health hazard during any "state of war emergency," "state of emergency," or "local emergency," as defined by Section 8558 of the Government Code, within his or her jurisdiction.

Ambulance Transport CCR Title 13, Div. 2 Ch. 5, Art. 1, Section 1100.3 (b) This regulation exempts the requirement of having personnel on an ambulance that possess a certification or license evidencing compliance with the emergency medical training and educational standards for ambulance personnel established by the State EMS Authority during a “state of emergency,” or duly proclaimed “state of emergency,” or “local emergency” defined in Government Code Section 8558.

Ambulance Transport VC Div. 2, Ch. 2.5, Art. 2, Section 2512. (a) …regarding the operation, equipment, and certification of drivers of all ambulances used for emergency services… The commissioner should exempt, upon request of the county board of supervisors…, noncommercial ambulances operated within the county from the regulations adopted under this section.

Now that we have looked at which waivers are needed to allow for changes in the 911 system, let’s look at how Altered Standard Orders are activated by the MHOAC or the EMS Agency Medical Director.

The EMS agency has been notified by the ambulance dispatch center that they can no longer handle the amount of calls coming in. They are at status zero with no ambulances available. The EMS Agency Medical Director and Health Officer have been notified and have activated the MHOAC function. Moving forward, it is imperative that there be multi-agency coordination to address this impact.

Multi-Agency Coordination • Following a local declaration of emergency, the MHOAC will play the lead role, and should collaborate with the EMS Agency Medical Director and other appropriate agencies to modify the EMS delivery system.

Altered Standard Orders • The Altered Standard Order Form is a tool used by the MHOAC and EMS Agency Medical Director to communicate which parts of the system will be altered. The system components that may be altered include: • Dispatch • Control Facility operations • EMS provider response

Altered Standard Orders Now let’s take a look at the Altered standard Order tool…

Altered Standard Orders The ASO form contains the Date and Time of the Orders, as well as the Effective Date and End Date of the Orders. www.disasterdoug.com

Altered Standard Orders The ASO form is designed to be used as a check-list of possible system changes. www.disasterdoug.com

Altered Standard Orders The ASO form is divided into major program areas, including: Dispatch, Control Facility, and EMS Providers. www.disasterdoug.com

Altered Standard Orders Additional changes may be listed at the bottom of the form, and previous orders may be discontinued. www.disasterdoug.com

Altered Standard Orders • Once the Altered Standard Order Form is completed, the MHOAC and EMS Agency Medical Director will inform all Public Safety Answering Points (PSAPs), ambulance dispatch centers, Control Facilities, hospitals, and EMS providers of these orders.

Let’s examine what we have learned so far… • In order to communicate which parts of the system will be altered, the MHOAC and the EMS Agency Medical Director will use the ___________. • Altered Standard Orders Form • Site assessment Form • Unusual Occurrence Form

If you answered, you are… Let’s examine what we have learned so far… • A. Altered Standard Orders form, Correct This form is used by the MHOAC and EMS Agency Medical Director to communicate which parts of the system will be altered.

Now, we’re going to break down the system changes into each program area, beginning with System Access. • System Access / Emergency Medical Dispatch • Field Response

System Access / Emergency Medical Dispatch The MHOAC and the EMS Agency Medical Director have collaborated with the OA EOC and have established new priorities for dispatch. These changes are designed to help significantly reduce the time spent with each “reporting party,” and provide the dispatcher with new alternatives. www.disasterdoug.com

How it works now Before we begin to look at how the medical dispatch system will be altered, let’s take a look at how most medical dispatch systems work today. www.disasterdoug.com

9-1-1 Medical-aid Requests Reporting Party Calls 911 911 Call Center Is it a Medical Emergency? All calls coming in to the 911 center are assessed for medical need.

9-1-1 Medical-aid Requests Reporting Party Calls 911 911 Call Center Is it a Medical Emergency? YES End Call Center Callers requesting medical aid are then transferred to an Emergency Medical Dispatcher.

9-1-1 Medical-aid Requests Reporting Party Calls 911 911 Call Center Is it a Medical Emergency? YES End Call Center Dispatch Fire First Responders EMD – Pre-arrival Instructions Dispatch ALS ambulance The medical dispatcher will then provide the appropriate medical response. www.disasterdoug.com

9-1-1 Medical-aid Requests • So, we see that almost all people seeking medical assistance, who call 9-1-1, receive EMD pre-arrival instructions, Advanced Life Support (ALS) ambulance, fire first responders, and transport to • the hospital. • our goal during this event will be to reduce the amount of time that dispatch personnel spend on the telephone with each caller in order to meet the increased demand on the system.

9-1-1 Medical-aid Requests The MHOAC and EMS Agency Medical Director have collaborated to authorize altered triage and response protocols for the 911 system. These alterations include: • Suspension of Pre-Arrival Instructions • Implementation of symptom-specific triage (e.g. Pandemic Outbreak EMD) • Implementation of austere triage protocol

summary As you can see, there are many components of the EMS system that may need to be modified during a disaster. EVERYONE must work jointly to make the 911 system run as proficiently as possible. You will now be quizzed on what you have learned in this module. Thank you for your participation in the… Altered standard Of care training Module 1

Altered Standard of Care Training for Administrative Personnel