Transcript Modifying Your EMD and EMS Response Plan for Pandemic Flu:

Modifying Your EMD
and
EMS Response Plan
for Pandemic Flu:
Lessons Learned from Maryland
By
Richard Alcorta, MD FACEP
State EMS Medical Director
MIEMSS
MIEMSS
The following information is
provided courtesy of the
Maryland Institute for
Emergency Medical Services
Systems (MIEMSS)
MIEMSS
Overview
Overview of Decision points
NHTSA Guidance Documents
Dynamic System Status Score
Modified EMD
Assessing Current Practices
and Profiles
 On-Scene Protocol
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MIEMSS
Pandemic Influenza Criteria
1. New influenza virus must emerge for
which there is little or no human
immunity;
2. It must infect humans and cause illness;
and
3. It must spread easily and sustainably
(continue without interruption) among
humans
MIEMSS
http://www.ems.gov/portal/site/ems/menuitem.5149822b
03938f65a8de25f076ac8789/?vgnextoid=839d10d89831811
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MIEMSS
Preparing for Pandemic Influenza:
Recommendations for Protocol
Development for 9-1-1 Personnel and
Public Safety Answering Points (PSAPs)
 Facilitation of Call Screening
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Automated Data Gathering & Surveillance
Protocol Expansion/Modification
Protocol Updates (dynamic)
Triage/Patient classification
 Assistance with Priority Dispatch of
Limited Emergency Medical Services
(EMS) Assistance
 Tiered Responses/Altered Responses
 Dispatch Protocol Modifications
 Secondary Triage (Nursing Hotline)
MIEMSS
Facilitation of Call Screening
 Objective: For purposes of monitoring,
surveillance, treatment and the potential of
contamination and quarantine, during the
influenza pandemic period it will be important
for the PSAP to be able to identify callers who
are likely afflicted by the pandemic influenza
virus and to assign the appropriate resource to
help them. This resource may not be a
responding EMS unit, but an alternative source
of care, such as a nurse assist line or other health
care call line.
MIEMSS
Recommendations for 9-1-1 Public
Safety Answering Points (PSAP)
http://www.cdc.gov/swineflu/guidance_ems.htm

MIEMSS
It is important for the PSAPs to question callers to
ascertain if there is anyone at the incident location
who is possibly afflicted by the swine-origin
influenza A (H1N1) virus, to communicate the
possible risk to EMS personnel prior to arrival, and
to assign the appropriate EMS resources. PSAPs
should review existing medical dispatch
procedures and coordinate any modifications with
their EMS medical director and in coordination
with their local department of public health.
Recommendations for 9-1-1 Public
Safety Answering Points (PSAP)
http://www.cdc.gov/swineflu/guidance_ems.htm
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Interim recommendations:
PSAP call takers should screen all callers for any
symptoms of acute febrile respiratory illness.
Callers should be asked if they, or someone at the
incident location, has had nasal congestion, cough,
fever or other flu-like symptoms.

MIEMSS
If the PSAP call taker suspects a caller is noting symptoms
of acute febrile respiratory febrile illness, they should
make sure any first responders and EMS personnel are
aware of the potential for “acute febrile respiratory
illness” before the responders arrive on scene.
Call to 911
Dispatch asks
questions
Dispatch
EMS Unit
Protocol
s
Triage
question
s YES
Commercial
Protocol
s
question
s
Delayed
EMS
How
Type of
response
Non Transport
Immediate
NO
Return to
Dispatch for
transport
Home Care
Case Manager
(Phone Line)
Refer to
Protocol
s
question
s
Protocol
s
Triage
question
s
Private
Physician
Home Health
(House Call)
Other Transport
EMS Assess
Pt.
Referral or
Transport
Transport Pt.
ER
Through centralized
routing
Alternate
Care Site
In Pt.
Out Pt.
Waiting
Room.
MIEMSS
Fast
Track
Acute
Care
Principles
 An appropriate response will need to be
dynamic, changing swiftly according to
circumstances and local resources.
 State EMS agency, working with State
Department of Health and local Public
Health officers, will provide the EMS
Operational Program Medical Director and
911 Center Operational Officer the
authorization to activate the Pandemic Flu
Modified EMD Plan.
MIEMSS
Principles
 The EMS Operational Program will
determine their Dynamic System
Status score using the four criteria.
 The Pandemic Severity Score and the
Current Hospital capacity (which can
also be acquired locally) will be
provided so the 911 center can modify
the EMD unit(s) dispatch criteria.
MIEMSS
Principles
 The Pandemic Flu Modified EMD
Plan is to be based on current
practices and tiered response by 911
dispatch centers then modified in the
event of a declared Pandemic Flu
event with authorization for
activation. (See criteria below chart.)
MIEMSS
Dynamic System Status Score
A. Pandemic Severity Score
B. EMS/Dispatch System Demand for
Services
C. Reduction of EMS/Dispatch Workforce
D. Facility Capacity (Bed availability)
Each is scores with a number 1 through 5
MIEMSS
CDC Pandemic
Severity Index
MIEMSS
WHO Pandemic
PHASE
1.
2.
3.
4.
5.
6.
MIEMSS
No new influenza virus subtypes have been detected in
humans
No new influenza virus subtypes have been detected in
humans, However a circulating animal influenza virus
subtype poses a substantial risk of human disease
Human infection(s) with a new subtype, but no human to
human spread
Small cluster(s) with limited human to human transmission
but spread is highly localized
Larger cluster(s) but human to human spread still localized,
suggesting that the virus is becoming increasing better
adapted to humans but may not yet be fully transmissible
Pandemic phase: increased and sustained transmission in
general population
Pandemic Severity Score
Category 5 (>2.0% lethality & >1,800,000 ill)
= 5 points
Category 4
= 4 points
Category 3
(0.5 to <1.0% lethality & 450,000 to <900,000 ill) = 3 points
Category 2
= 2 points
Category 1 (<0.1% lethality & <90,000 ill)
= 1 points
MIEMSS
EMS/Dispatch System Demand
for Services
Critical Increase
Severe Increase
Moderate Increase
Mild Increase
Standard Operating Mode
MIEMSS
= 5 points
= 4 points
= 3 points
= 2 points
= 1 points
Reduction of EMS/Dispatch
Workforce
Absentee Rate over 40%
Absentee Rate 35-40%
Absentee Rate 25-35%
Absentee Rate 15-25%
Absentee Rate 15 or below%
MIEMSS
= 5 points
= 4 points
= 3 points
= 2 points
= 1 points
Facility Capacity
(Bed availability)
Occupancy exceeds 100%
Occupancy Rate 98-100%
Occupancy Rate 95-98%
Occupancy Rate 90-95%
Occupancy Rate at 90% or below
MIEMSS
= 5 points
= 4 points
= 3 points
= 2 points
= 1 points
Dynamic System Status Score
(DSSS)
 6 -10 points DSSS CATEGORY ONE
 11-15 points DSSS CATEGORY TWO
 16-20 points DSSS CATEGORY THREE
MIEMSS
Impact Areas of DSSS
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MIEMSS
Triage
Treatment
Equipment
Transportation
Destination
SAMPLE Protocols
Dynamic System Status
Category 1
Dynamic System
Status Category 2
Dynamic System
Status Category 3
(Pandemic Severity Index
Category 1)
(Pandemic Severity Index
Category 2-3)
(Pandemic Severity
Index Category 4-5)
Daily use algorithms and protocols
Determine whether to implement triage
and treatment protocols that
differentiate between non-infected and
potentially infected patients based on
CDC case definition.
Triage would focus on identifying
and reserving immediate
treatment for individuals who have
a critical need for treatment and
are likely to survive. The goal
would be to allocate resources in
order to maximize the number of
lives saved
Using screening algorithm to
ensure only severe get
response
Jurisdictional daily treatment
protocols
Ambulatory patients will be redirected to
alternate care sites within or outside of
the hospital.
Treatment protocols may be
modified to enable and encourage
patients to receive care at home.
Certain lifesaving efforts may
have to be discontinued.
Provision of antiviral prophylaxis
if effective, feasible and quantity
sufficient.
Response
(Standard Operating Mode)
Triage
(to occur both at the
9-1-1 center and on
scene)
Treatment
Consider provision of antiviral
prophylaxis if effective, feasible
and quantity sufficient.
No restrictions
Equipment
Implementation of strict PPE/infection
control protocols for patients meeting
case definition established by CDC
during the response phase of a 9-1-1
call.
Selective criteria in place for
priority use.
Some scarce and valuable
equipment, such as ventilators,
may not be used without staff
available who are trained to
operate them.
Strict criteria in place for
equipment use.
Some scarce and valuable
equipment, such as ventilators,
may not be used without staff
available who are trained to
operate them.
Routine use of EMS resources
Non-urgent and ambulatory victims may
have to walk or self-transport to the
nearest facility or hospital.
Emergency medical services may
transport victims to specific
quarantine or isolation locations
and other alternate care sites
Only severe cases transported
via ambulance
Routine hospital based facilities
Alternate care sites will be used for
triage and distribution of vaccines or
other prophylactic measures, as well as
for quarantine, minimum care, and
hospice care.
Ambulatory and some nonambulatory patients may be
diverted to alternate care sites
(including non-medical space,
such as cafeterias within
hospitals, or other non-medical
facilities).
Emergency department access
may be reserved for immediateneed patients.
Transportation
Destination
Prudent use of equipment
Call to 911
Dispatch asks
questions
Dispatch
EMS Unit
Protocol
s
Triage
question
s YES
Commercial
Protocol
s
question
s
Delayed
EMS
How
Type of
response
Non Transport
Immediate
NO
Return to
Dispatch for
transport
Home Care
Case Manager
(Phone Line)
Refer to
Protocol
s
question
s
Protocol
s
Triage
question
s
Private
Physician
Home Health
(House Call)
Other Transport
EMS Assess
Pt.
Referral or
Transport
Transport Pt.
ER
Through centralized
routing
Alternate
Care Site
In Pt.
Out Pt.
Waiting
Room.
MIEMSS
Fast
Track
Acute
Care
Triage
 Occur both at the 9-1-1 center and on
scene
 Authorization and Activation of DSSS
level of triage and EMS triage (Critical
Authorization)
MIEMSS
DSSS Category One
 Determine whether to implement
triage and treatment protocols that
differentiate between non-infected
and potentially infected patients based
on CDC case definition.
MIEMSS
DSSS Category Two
 Triage would focus on identifying and
reserving immediate treatment for
individuals who have a critical need
for treatment and are likely to survive.
 The goal would be to allocate
resources in order to maximize the
number of lives saved.
MIEMSS
DSSS Category Three
 Using screening algorithm to ensure
only severe get response
 Resources assigned to those that can
most benefit from EMS response
MIEMSS
Dispatch Priority Level
(match vendor or call center
based dispatch protocol/tiered
algorithm)
Response
(Standard Operating
Mode)
Level 1 (A)
Activation of Card 36
and ONLY for use in 6,
10, 18, and 26
DSS1
BELOW IS BACK UP
STRATEGY FOR EMD
WITHOUT CARD 36
Level 2(B)
Implement Declining
Response /Configuration
CAD Table (Moderate) +
Card 36 (6,10,18 & 26)
Level 3(C)
Implement Declining
Response /Configuration
CAD Table (Severe) +
Card 36 (6,10,18 & 26)
DSS2
DSS 3
Classification 1 (*Echo)
Confirmed Cardiac Arrest
(Not Breathing, Unresponsive
per 911 call)
(MPD cards- 2, 6, 9, 11,15,
31)
Closest AED Unit and
Closest 1st Responder
and
Closest ALS Ambulance
Closest AED Unit and
Closest 1st Responder and
Closest BLS Ambulance if
available
-Closest AED Unit and
-Closest 1st Responder if available
- Closest AED Unit if available
- If no unit available, no response
Classification 2 (*Delta)
Life Threatening
Emergency/Potentially Life
Threatening/Confirmed
Unstable Patient(s)
Closest 1st Responder and
Closest ALS Ambulance
- Closest 1st Responder and
Closest ALS Ambulance if
available;
- BLS ambulance if ALS unit not
available
Closest 1st Responder and Closest
Ambulance available (ALS or
BLS)
-Closest 1st Responder and
-If available Closest Ambulance
available (ALS or BLS)
Classification 3 (*Charlie)
Non-Critical/Currently Stable
Patient(s) Requiring ALS
Assessment
Closest ALS Ambulance
Closest Ambulance available (ALS
or BLS)
Closest Ambulance Available (ALS
or BLS)
- Closest 1st Responder if available
or
-Closest stand-in responder unit
Classification 4 (*Bravo)
BLS Assessment for
unknown/possibly
dangerous scenes
Closest 1st Responder and
Closest BLS Ambulance
Closest 1st Responder and
Closest BLS Ambulance if
available
Closest 1st Responder
- Trauma
Closest 1st Responder
- Medical
Referral to Nurse or Health
Department Advice Telephone
service if available; or self-transport
advice to Alternate Care Site
Classification 5 (*Alpha)
BLS Treatment
BLS Ambulance
Alternate Care Referral
Alternate Care Referral
Alternate Care Referral
Classification 6 (*Omega)
Non Ambulance Care
Alternate care such as
Poison Control Center;
Police/Fire service call,
etc
Alternate care such as Poison
Control Center; Police/Fire
service call, etc
Alternate care such as Poison
Control Center; Police/Fire
service call, etc
Alternate care such as Poison
Control Center; Police/Fire
service call, etc
Pandemic Flu Modified EMD
Plan
 Left column is Classification and
matches the Medical Priority Dispatch
(MPD) named response profiles
 Across the top is the Response Mode:
Standard Daily Operations then the
DSSS Categories: One, Two and Three
MIEMSS
How does this apply to each
EMS Operational Program?
 Must have a defined Standard Daily
Operations
 The DSSS Category modifies that Standard
Daily Operations in a progressively
increasing restriction of resource allocation
 Each EMS Operational program would
apply the DSSS chart and adjust their
Classification of response profile so all
Dispatchers would have clear direction
MIEMSS
Cornerstone
 For this exercise, the dispatcher’s
response profile was based on his
understanding and application of the
DSSS Category Three.
MIEMSS
Pandemic Flu EMD Modified
Plan
MIEMSS
Types of Dispatcher
Resources
 First Responder
 Engine Company
 Utility
 Do they all have AEDs?
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MIEMSS
BLS Ambulance
ALS
Supervisor
Others?
Combination of Resources
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MIEMSS
First Response + BLS
First Response + ALS
First Response + BLS + ALS Chase
First Response + BLS + ALS
Above Plus Supervisor
Current Jurisdictional
EMD Profiles
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Alpha = ?
Bravo = ?
Charlie = ?
Delta = ?
Echo = ?
 Omega =?
MIEMSS
Case
Consistent Responses Profiles
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MIEMSS
Snake Bite
Chest pain
Sudden Sick
Heart Attack /Cardiac Arrest
Choking
Traffic Accident
Shot in the foot
Underwater
Pandemic Flu
Evaluation Tool
 Resources Dispatched
 No

Disconnect or Refer to Health Department phone line
 Yes
 Type of Resource (s)
 Start point: All units are available for exercise
calls but will be consumed and not returned to
service before completion of the exercise.
 Record the Specific units sent
Units specific and Alpha through Omega)
 Not testing hot or cold response
MIEMSS
Goal
 With today’s consistent standardized
response, MIEMSS compared the
Standard response profiles to the
Pandemic Flu dispatched resources.
 MIEMSS compared center to center for
dispatch type to see if the protocol has
variable interpretation.
MIEMSS
EMD and On-Scene
 Two Phases
( BOTH DRAFT PROTOCOLS)
 Modified Emergency Medical
Dispatch
 On- Scene Triage
MIEMSS
Dispatch Priority Level
(match vendor or call center
based dispatch protocol/tiered
algorithm)
Response
(Standard Operating Mode)
Dynamic System
Status Category 1
Dynamic System
Status Category 2
Dynamic System Status
Category 3
Classification 1 (*Echo)
Confirmed Cardiac Arrest
(Not Breathing, Unresponsive
per 911 call)
(MPD cards- 2, 6, 9, 11,15,
31)
Closest AED Unit and Closest
1st Responder and
Closest ALS Ambulance
Closest AED Unit and
Closest 1st Responder and
Closest BLS Ambulance if
available
-Closest AED Unit and
-Closest 1st Responder if
available
- Closest AED Unit if available
- If no unit available, no response
Classification 2 (*Delta)
Life Threatening
Emergency/Potentially Life
Threatening/Confirmed
Unstable Patient(s)
Closest 1st Responder and
Closest ALS Ambulance
- Closest 1st Responder and
Closest ALS Ambulance if
available;
- BLS ambulance if ALS unit not
available
Closest 1st Responder and
Closest Ambulance available
(ALS or BLS)
-Closest 1st Responder and
-If available Closest Ambulance
available (ALS or BLS)
Classification 3 (*Charlie)
Non-Critical/Currently Stable
Patient(s) Requiring ALS
Assessment
Closest ALS Ambulance
Closest Ambulance available
(ALS or BLS)
Closest Ambulance Available
(ALS or BLS)
- Closest 1st Responder if available
or
-Closest stand-in responder unit
Classification 4 (*Bravo)
BLS Assessment for
unknown/possibly
dangerous scenes
Closest 1st Responder and
Closest BLS Ambulance
Closest 1st Responder and
Closest BLS Ambulance if
available
Closest 1st Responder
- Trauma
Closest 1st Responder
- Medical
Referral to Nurse or Health
Department Advice Telephone
service if available; or self-transport
advice to Alternate Care Site
Classification 5 (*Alpha)
BLS Treatment
BLS Ambulance
Alternate Care Referral
Alternate Care Referral
Alternate Care Referral
Classification 6 (*Omega)
Non Ambulance Care
Alternate care such as Poison
Control Center; Police/Fire
service call, etc
Alternate care such as Poison
Control Center; Police/Fire
service call, etc
Alternate care such as Poison
Control Center; Police/Fire
service call, etc
Alternate care such as Poison
Control Center; Police/Fire
service call, etc
Participants
Modified EMD Plan
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Baltimore County
Caroline County
Charles County
Fredrick County
Harford County
Montgomery County
Prince George’s County
Queen Anne County
Washington County
NOTE: (Last year Dorchester and Talbot participated)
MIEMSS
Implement the Pandemic Flu
Emergency Medical Dispatch
Modified Plan appropriately
1. All 911/PSAP centers implemented the
Pandemic Flu Emergency Medical Dispatch
Modified Plan using the DSSS Category 3
column.
2. One of the 911/PSAP centers initiated standard
daily dispatching of resources, then realized that
they would run out of resources. They then
implemented the appropriate Pandemic Flu
Emergency Medical Dispatch Modified Plan.
3. All 911/PSAPs received and managed all 50
patient complaint scenarios, and the
determinant coding of the scenarios was
consistent with national standards.
MIEMSS
Implement the Pandemic Flu
Emergency Medical Dispatch
Modified Plan appropriately
4. Corrected the education of the
dispatchers and the briefing provided to
the Call Takers during the exercise which
was learned from last years exercise.
5. Jurisdictions with Police units that have
AED resources help reduce the depletion
of EMS resources for ECHO category
patients.
MIEMSS
Implement the Pandemic Flu
Emergency Medical Dispatch
Modified Plan appropriately
6.
7.
MIEMSS
The 911/PSAP that used its standard daily resource
allocation of resources and many of the other
smaller Counties stated that they had run out of
county resources by the end of the 50 complaints. It
was evident that multiple counties even with a
modified EMD protocol would not be able to
sustain a surge of this magnitude in the face of 40%
absenteeism.
All of the smaller and several of the larger Counties
ran out of ALS response and transport resources.
To determine if there is any change in
resource allocation during a pandemic
influenza event when compared to
standard daily resource allocation.
 All of the Counties liberally used the
referral to a nursing hotline/case manager
or directed patients to an Alternate Care
Facility without sending resources for the
“lesser severity” patients based on the
standard screening MPD protocol
algorithm. The use of alternate care centers
for referral and a nursing hotline/case
manager clearly would reduce the burden
on the 911 center.
MIEMSS
To determine if there is any change in
resource allocation during a pandemic
influenza event when compared to
standard daily resource allocation.
 When comparing the three counties that
had two separate Call Taking episodes, it
was impressive how consistent both
operators were in assigning determinate
codes.
 All 911/PSAP demonstrated consistent
reduction in resource allocation per
determinant code with the exception of one
county who tried to maintain daily
operational dispatch until they realized they
were going to run out of resources to send.
MIEMSS
 Based on interviews with the Call
Takers from the Dispatch centers, they
felt that this type of exercise is
essential for all dispatchers to go
through so that they can change their
frame of reference and more rigidly
apply the Modified EMD protocol
MIEMSS
Results
 Each center accepted all 50 requests
for EMS resources over 75 minutes
 The 911 Centers successfully applied
the Modified EMD Plan
 Several 911 Centers ran out of
resources to dispatch and could no
longer send resources even with the
modified response
MIEMSS
Actual Responses EMD
Profiles
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Alpha = No resources sent
Bravo = No resource sent or only First Responder/
BLS ambulance

Charlie = BLS or ALS ambulance

Delta = ALS ambulances until they ran out then
BLS ambulance

Echo = AED units *** Dispatchers were very
uncomfortable with this limited response
MIEMSS
Participants in On-Scene Triage
 Statewide invitation
 All Levels of EMS provider
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Front line Fire Fighters
First Responders
EMT- Basic
Cardiac Rescue Technician
Paramedic
 Need to educate Dispatchers and EMS
providers about the lethality and severity of
the Case Defined Disease
MIEMSS
Screening Questions of EMS
Providers
i) Are you willing to leave a patient on scene if you
believe the patient does not need transport?
Current Daily Practice
YES 82% BLS, 87.5% ALS
Pandemic Flu Conditions YES 100% BLS, 100% ALS

ii) Are you willing to leave a patient on scene if the
patient is an EMS/Do Not Resuscitate (EMS/DNR)
and you know the patient is dying?
Current Daily Practice
YES 88% BLS, 87.5% ALS
Pandemic Flu Conditions YES 100% BLS, 100% ALS

MIEMSS
Screening Questions of EMS
Providers
iii) Are you willing to leave a patient on scene if the
patient is not an EMS/ Do Not Resuscitate and you
know the patient is dying?
Current Daily Practice
YES 29% BLS, 37.5% ALS
Pandemic Flu Conditions YES 82% BLS, 75% ALS

iv) Are you willing to leave a patient on scene if the
patient has life threatening flu and is dying at
home?
Current Daily Practice
YES 18% BLS, 50% ALS
Pandemic Flu Conditions YES 82% BLS, 75%ALS

MIEMSS
Managing Arrests
 If the patient is in recent cardiac arrest. CPR
for 5 cycles than apply AED. Shock and
continue to shock with 5 cycles CPR if
indicated.
1. If return of pulse, initiate transport and
rendezvous with ALS if available and can beat
your arrival time at the ED
2. No shock indicated or when shock indicated
stops with no return of pulse, Consult Medical
Direction to withdraw care and leave patient on
scene.
MIEMSS
Treat Non- Flu Normally
 If patient has an obvious non-flu
related illness or injury , apply
appropriate Maryland Medical Protocol
for EMS Providers then treat and
transport appropriately
MIEMSS
Critical Vital Signs
MIEMSS
Critical Vital Signs
Normal Vital Signs
Transport to ED
Consider Alternate Care
Pulse
Equal or Greater than 130
Less than 130
Respiratory rate
Equal or Greater than 30
Less than 30
Blood Pressure Systolic
Less than 90
Equal or Greater than 91
Pulse Oximeter
Less than 92 on room air
Equal or Greater than 93
Temperature
No fever
Fever
AVPU
Pain or Unresponsive
Alert or Verbal
Lung sounds
Rales/ Wheezing
Clear
Inclusion with
Normal Vital Signs

If patient has Normal Vital Signs (Table #1) then
go to Case Definition Signs and Symptoms for Flu
(Table #2)
a)
b)
MIEMSS
If the patient has three or more Case Definition Signs or
Symptoms for Flu transport patient to Alternate Care
Facility
If the patient has two or less Case Definition Signs or
Symptoms for Flu (symptoms), EMS provider shall call
for Medical Consult (state central resource physician) to
determine if EMS provider can leave the patient on scene,
self quarantine and refer to nurse /public health hotline
for further assistance.
Case Definitions Signs and
Symptoms for the FLU
1.
2.
3.
4.
5.
6.
MIEMSS
Difficulty breathing
with exertion
Has doctor diagnosed
flu
Cough
Fever
Shaking Chills
Chest Pain (pleuritic)
7.
Sore throat (no
difficulty breathing or
swallowing)
8. Nasal congestion
9. Runny nose
10. Muscle aches
11. Headache
Call to 911
Dispatch asks
questions
Dispatch
EMS Unit
Protocol
s
Triage
question
s YES
Commercial
Protocol
s
question
s
Delayed
EMS
How
Type of
response
Non Transport
Immediate
NO
Return to
Dispatch for
transport
Home Care
Case Manager
(Phone Line)
Refer to
Protocol
s
question
s
Protocol
s
Triage
question
s
Private
Physician
Home Health
(House Call)
Other Transport
EMS Assess
Pt.
Referral or
Transport
Transport Pt.
ER
Through centralized
routing
Alternate
Care Site
In Pt.
Out Pt.
Waiting
Room.
MIEMSS
Fast
Track
Acute.
Care
Assessment
 Questionnaire to providers
 Comparison of predetermined normal
response and transports against those
referred to alterative care
 Behavioral observations
MIEMSS
Results
 On-Scene Triage- Providers are very
uncomfortable leaving patients on
scene
 Data was collected but there is a
verbalized lack of willingness to leave
someone on scene who may die due to
Pandemic Flu
MIEMSS
Results
 Education drives the actions of the
EMS providers and leaving lethally ill
patients on scene is currently against
EMS provider decision making
MIEMSS
On-Scene Triage Accuracy
 Comparing providers decision to the
exercise design team’s (physician based)
 BLS was only 48%
 ALS was 86%
 Therefore the protocol needs adjustment to
meet all provider needs
 There was very little over triage to a
hospital based emergency department by
both the BLS and ALS providers with 1.1%
BLS and 1.0% ALS
MIEMSS
On-Scene Triage Accuracy
 Both BLS (18.7%) and ALS (17.5%) tended
to inappropriately over triage patients to
leave them on scene after medical consult.
This is the largest group of patients that did
not match the expected outcome.
 The second largest inappropriate over triage
for both BLS (17.6%) and ALS (13.5%) was
to the Alternate Care Facility
MIEMSS
Results
 Critical recommendations:
 Standardize Alternate Care Facility
Capabilities to determine what they can
receive ( flu only, minor trauma, ??)
 Nursing Hotline loop with PSAP
MIEMSS
Questions ?
MIEMSS