Clinical Advisory Subcommittee of the Emergency Medical Care Committee Meeting Agenda 11:00 A.M., Tuesday May 13.2014 Health Agency Second Floor Large Conference Room 2180 Johnson Avenue San Luis Obispo Members Chair: Dr. Mark Eckert, County Medical Society Sue Fortier, RN, MICNs TBD, Fire Service Paramedics Joe Piedalue, Ambulance Paramedics Paul Quinlan, Fire Service EMTs Dr. Jana Reed, Non-Base Station ED Physicians Chad Robertson, ad hoc Dr. Joe Robinson, Base Station ED Physicians Dr. Stefan Teitge, County Medical Society Staff STAFF LIAISON: Kathy Collins, RN, SCS Coordinator Steve Lieberman, EMS Division Director Dr. Tom Ronay, Medical Director Vicci Stone, EMS Specialist Tracy Eby, Administrative Assistant Marigrace Waage, Ambulance EMTs TBD, Non-Base Station Hospital ED Nurses John Prickett, Lead Field Training Officer AGENDA ITEM LEAD Call to Order Introductions Dr. Eckert Public Comment Discussion Discussion on field use and need: Dopamine – policy change to make “optional” for non- transporting ALS agencies V-fib with ROSC to STEMI Centers -discussion Trauma o Spinal Immobilization – draft policy o Trauma polices- General Trauma Head/Neck/Facial Trauma Chest/Abdomen Trauma Extremity Trauma Traumatic Arrest Triage criteria (staff summary) Saline shortage Intranasal Narcan Dr. Ronay- staff Adjourn Announcements Dr. Eckert Adjourn Declaration of Future Agenda Items Updating/reformatting polices Dr. Eckert Next Meeting – May 13, 2014 11:00 a.m. – 12:30 p.m. 2 nd floor Conference Room, Health Agency
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Clinical Advisory Subcommittee of the Emergency Medical Care Committee
Meeting Agenda 11:00 A.M., Tuesday May 13.2014 Health Agency Second Floor Large Conference Room 2180 Johnson Avenue San Luis Obispo Members Chair: Dr. Mark Eckert, County Medical Society Sue Fortier, RN, MICNs TBD, Fire Service Paramedics Joe Piedalue, Ambulance Paramedics Paul Quinlan, Fire Service EMTs Dr. Jana Reed, Non-Base Station ED Physicians Chad Robertson, ad hoc Dr. Joe Robinson, Base Station ED Physicians Dr. Stefan Teitge, County Medical Society
Staff STAFF LIAISON: Kathy Collins, RN, SCS Coordinator Steve Lieberman, EMS Division Director Dr. Tom Ronay, Medical Director Vicci Stone, EMS Specialist Tracy Eby, Administrative Assistant
Marigrace Waage, Ambulance EMTs TBD, Non-Base Station Hospital ED Nurses John Prickett, Lead Field Training Officer
AGENDA ITEM LEAD
Call to Order Introductions Dr. Eckert
Public Comment
Discussion Discussion on field use and need:
Dopamine – policy change to make “optional” for non-transporting ALS agencies
V-fib with ROSC to STEMI Centers -discussion
Trauma o Spinal Immobilization – draft policy o Trauma polices-
Emergency Medical Services Agency 2156 Sierra Way, San Luis Obispo, CA 93401
805-788-2511 ▪ FAX 805-788-2517
www.sloemsa.org
Policy 153 Trauma Triage
MEETING DATE Clinical Advisory Committee
STAFF CONTACT Kathy Collins, Specialty Care Systems Coordinator, 788-2514
SUBJECT Policy 153 Trauma Triage and Destination
SUMMARY The current triage guidelines in SLO county are not in line with triage guidelines of neighboring counties or the CDC recommendations. Specifically the following falls out occur in Step 2 Mechanism of Injury for patients with” significant injures”:
Two proximal long bone fractures
Crushed, degloved, mangled or pulseless extremity
Amputation proximal to the wrist or ankle
Pelvic instability/fractures
When the State EMS Authority approved the SLO Trauma Plan it was with the direction that a QI process would review the criteria that were not in line with the CDC recommendations. The Trauma Center and the EMS Agency reviewed trauma consults in 2013 with “two or more proximal long bone fractures” and identified 8 patients with two more proximal long bone fractures. Of these patients, 6 were associated with other injuries, 4 were transferred to higher level of care, and 3 did not meet any other triage criteria but had serious injuries.
REVIEWED BY Trauma Advisory Committee EMS Staff Thomas Ronay, MD, SLO County Medical Director Steve Lieberman, EMS Division Director Sierra Vista Trauma Advisory
RECOMMENDED ACTION(S)
A high association of serious injury for patients with two proximal long bone fractures was demonstrated though a review of the SLO data, and noting it is also national and regional standard in other programs - staff is recommending “two proximal long bone fractures” be moved to Step 2 for patients that are “significantly injured” and that the other anatomic injures continued to be monitored over the coming years.
ATTACHMENT(S) Policy 153 trauma triage and destination matrix
SAN LUIS OBISPO COUNTY HEALTH AGENCY
DRAFT 5.6.2014 TRAUMA TRIAGE DECISION SCHEME
“significantly injured” patients meeting one or more criteria activates
Adult Physiologic Criteria · Glasgow Coma Scale ≤ 13 · Systolic blood pressure <90mmHg · Respiratory rate <10 or >29 breaths per minute Pediatric Physiologic Criteria - <14 years or < 34Kg · Glasgow Come Scale ≤ 13· Evidence of poor perfusion – color, temperature, etc · Respiratory Rate >60/min or respiratory distress or apnea <20/min in infants <1 yr ● Heart Rate
≤5 yrs (<22 Kg) - <80/min or >180/min≥6 yrs (23-34 Kg) - <60/min or >160/min
● Blood Pressure- Newborn (<1mo) SBP<60 - Infant (1mo-1yr) SBP<70- Child (1yr-10yrs) SBP <70 + (2x age in yrs)
- Child (11-14yrs) SBP <90
Anatomic Criteria· All penetrating injuries to head, neck, torso, and extremities
proximal to elbow or knee · Chest wall instability or deformity (e.g. flail chest)· Open or depressed skull fracture· Two or more proximal long bone fractures· Paralysis
Special Patient and System Considerations (*)· EMS provider judgment· Age >65 or <14 yrs (SBP <110mmHg in elderly may represent shock)· Anticoagulation therapy (excluding aspirin) or other bleeding
disorder with head injury (excluding minor injuries) · Pregnancy >20 weeks· Burns with trauma mechanism(*) Trauma Consultation is not required for ground level/low impact falls with GCS ≥ 14 (or when GCS is normal for patient) – follow SLO County patient destination policy
Mechanism of Injury and PARAMEDIC JUDGMENT for Injuries· Falls
- Adults: >20 feet (one story is equal to 10 feet)- Children: >10 feet or two or three times the height of the child
· High-risk auto crash - Intrusion of passenger compartment >12 inches occupant site or
>18 inches any site including roof/floor - Ejection (partial or complete) from automobile - Death in same passenger compartment· Auto vs. pedestrian/bicyclist thrown, run over, or with significant
(>20 mph) impact· Motorcycle or unenclosed transport vehicle crash >20 mph
TRAUMA ALERT and transport to
closest TC
Assess for mechanism
Follow SLO County destination policy
Contact TC and transport to closest ED with· Unmanageable airway· Uncontrollable bleeding· Penetrating injury w/ traumatic
cardiac arrest
Assess for anatomic injury
Assess for special patient or system considerations