Impact Mitigation Plan ~San Jose Medical Center Closure~ Santa Clara County Emergency Medical Services Agency Revised 11/15/04.

Impact Mitigation Plan Impact Mitigation Plan ~San Jose Medical ~San Jose Medical Center Closure~Center Closure~

Santa Clara County Emergency Medical

Services AgencyRevised 11/15/04

Background

SJMC is scheduled to close December 9, 2004 at 5:00 pm.

Impact Report Completed Mitigation plans will be implemented on

November 29, 2004. Regional Trauma Center has submitted an

application for Trauma Center Designation.

Objective

Maintain an efficient and effective Emergency Medical Services System, within the County of Santa Clara, while addressing the actual or potential impacts of the closure of a general acute care hospital.

Patient Redirection

Effective November 29, 2004 @ 0800 hours – All ground and air ambulances directed away from SJMC.

Extremis patients may continue to SJMC until December 8, 2004 at 1700 hours.

Standby at SJMC

AMR paramedic ambulance on site from December 9, 2004 to January 2, 2005 (24/7 coverage).

Provide care for life threatening emergency medical events.

Evaluation with HCA and EMS Agency – May extend coverage period as appropriate.

ED Diversion

Maximum of 90 minutes on ED diversion per-occurrence.

Must remain open for 90 minutes after being on diversion.

Closed changed to Diverting Ambulances (red)

Hospitals do not “auto open” based on others requesting diversion status.

One hospital, per-Zone, may be on diversion status.

First Come – First Serve diversion

ED Diversion - Zones

Northern ED Diversion Zone– Stanford– El Camino– Kaiser Santa Clara– PAVA (excluded)

Western ED Diversion Zone– Los Gatos Community– Good Samaritan– Kaiser Santa Teresa

ED Diversion - Zones

Downtown ED Diversion Zone– Valley Medical Center– Regional Medical

Center– O-Connor Hospital

Most impacted zone Use of Yellow/Census

is important. Patients must have the choice to selected hospitals that are not severely impacted.

Trauma Patient Management

Trauma Center Catchment Zones established to assist in keeping any one Trauma Center from being overwhelmed.

Use of air resources may increase. New Trauma Center Status Options

designed to keep the facilities open. Air units are routed to Stanford (some

exceptions)

Stanford Catchment Zone

Northern County Line to the Bay

DeAnza divides Cupertino

Sunnyvale/Saratoga and East Remington/Fair Oaks divides Sunnyvale

North of 237/Calaveras in the City of Milpitas/

unincorporated areas Air traffic (some

exceptions)

VMC Catchment Zone

South of DeAnza in the City of Cupertino.

South of Sunnyvale/Saratoga and East Remington/Fair Oaks in Sunnyvale.

South of 237/Calaveras in the City of Milpitas/

unincorporated areas.

Catchments Zone Considerations

Established lines are flexible based on available resources, traffic, scene considerations.

Better to transport by air or ground?

Milpitas air vs. ground transport considerations.

Air Operations

Critical burn patients to be transported to Valley in accordance with existing Policy.

Flight crews shall transport patients with suspected spinal cord injury to the closest available Trauma Center.

Air Operations

May use ALS Rescue Aircraft

Ground crews are responsible to provide a hospital ring-down if a rescue aircraft or mutual aid air ambulance is used.

CHP H30 notification of all incidents in the San Antonio Valley to go with air & ground ambulance.

BLS rescue aircraft may require paramedic to ride-along.

Air Operations

More air unit use may occur in urban settings.

Providers need to review safety practices related to working with air resources.

SJFD establishing landing zones.

Dispatch centers may view EMSystem and provide hospital status to responding units to launch air resources as soon as possible.

Trauma Status/EMSystem

Moved into separate section of the screen. Status reasons revised to help Trauma

Centers stay open longer. Paramedic/Flight Crew discretion. All changes must be done through

EMSystem not County Communications. One Trauma Center on the same “OrangeOrange”

status at the same time.

Trauma Status

Open/Green – no change Yellow CensusYellow Census – Eliminated Yellow- CTYellow- CT – Eliminated Service Advisories/OrangeService Advisories/Orange Added

– Orange/OROrange/OR– Orange/NeurosurgeryOrange/Neurosurgery

Bypass/Red – no change

Service Advisory/Orange

Advanced Life Support Personnel (Flight Crews and Paramedics) shall consider the specific type of service limitation and may either:– Continue transport to the hospital with a

Service AdvisoryService Advisory– Bypass the facility and go to the other trauma

center (consider air transport if necessary).

Example: Example: Orange/NeurosurgeryOrange/Neurosurgery

A patient with chest trauma may be transported to a Trauma Center with a Service Limitation/Orange noted as “Neurosurgery”.

This assumes that the patient does not have suspected head trauma. Previously this facility may have been “Red”.

Example: Orange/ORExample: Orange/OR

A patient who is being transported due to mechanism of injury with stable vital signs may be transported to a Trauma Center with a Service Limitation noted as “No Neurosurgery”.

This assumes that the field crew does not believe that the patient is in immediate need of surgical intervention.

Bypass/Red

Duty Chief is notified as soon as any Trauma Center is on Bypass.

Facility opens as soon as possible Trauma Medical Director, or designee,

immediately contacts the other Trauma Center Medical Director.

The Duty Chief and Trauma Center Medical Director of the facility on Bypass discuss appropriate mitigation actions.

Bypass/Red

If both Trauma Centers are on Bypass status – Both will immediately open (but may have Service LimitationsService Limitations).

The EMS Agency may take any actions necessary to ensure safety of the public during this time.

A Trauma Center may not be on Bypass for more than 60 minutes.

STAR’s

SJFD STAR’s responding to more calls STAR’s may be used to transport to LZ’s if the

patient has a severe and imminently life-threatening condition and will be flown to a Trauma Center.

STAR provider departments must review activation criteria and radio communication practices in preparation for increased volume.

Policy Changes

Policy 101- Provider Codes

Policy 403 – Trauma Center Service Areas

Policy 501 – Hospital Radio Reports

Policy 504 – County EMS Communication System

Policy 602 – Prehospital Patient Destination

Policy 603- Hospital Diversion

Policy 611 – Air Resource Utilization

Reference Revisions

EMS 804 – Santa Clara County Acute Care Hospitals

EMS 805 – Santa Clara County Permitted Ambulance Services

Important Dates

November 29, 2004 @ 0800 Hours – all 911 System ambulance traffic is directed away from SJMC (except extremis).

December 8, 2004 @ 1700 Hours – all 911 System ambulance traffic is directed away from SJMC (INCLUDING extremis).

Important Dates

December 9, 2004 @ 1700 Hours – San Jose Medical Center closes.