Dispatch 052418

MAY 24, 2018

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PROJECT UPDATE: BARIATRICS TRANSPORT AIM STATEMENT • A project to design and recommend a standardized process for utilization of resources in transportation of bariatric patients for both ALS and NET responses.

• Reason for the Effort: • Currently, there is no standardized process in place to meet the needs of a bariatric patient or utilize bariatric stretchers.

• A standardized process will define appropriate use of resources, avoid unnecessary deployment of the bariatric equipment and the delays that accompany, and better provide for the safe and comfortable transport of bariatric patients.

• Risks to be mitigated include delays in transportation of critically ill or injured patients, compromised crew safety if not utilizing the most appropriate resource for their patient, and liability associated with not utilizing the most appropriate resource in the transportation of a bariatric patient.

• How does it impact patients? The proper use of specialized bariatric resources will increase patient comfort and safety throughout transport.

EXPECTED OUTCOMES • A standardized process for requesting, dispatching, responding, and utilizing bariatric resources when they are needed and appropriate for the transportation of a bariatric patient • Financial impact for Medic will vary by recommendations. There may be new or additional equipment, and/or other resources, and training of personnel that would help accomplish project goals.

• The project will produce a recommendation of a new process and an implementation plan in 90 days from the beginning of work. (Work to

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begin immediately upon approval of charter.)

HOW DO WE KNOW THAT A CHANGE IS AN IMPROVEMENT? • Utilization of specialized resources, and adherence to a standardized process • Patients report they feel safe and are treated properly throughout their care by Medic • Business case supports final recommendation by the team • Total task times remain in an acceptable range for care and transportation of bariatric patients WHERE ARE THEY NOW? As stated in May In-Service, Medic will deploy MEDSLEDs to all ALS trucks. The MEDSLEDs are due to arrive at the end of May and will be deployed in the trucks as soon as they arrive. Please note the following: • On the legacy trucks (old internationals), the MEDSLED will be kept in the spare tire compartment.

• On the new trucks, the MEDSLED will be kept in the stair chair compartment.

FRIENDLY REMINDERS • The MEDSLED is used to assist with the movement of patients and to extend the width of the stretcher.

• The MEDSLED can be used on patients that are between 100 and 1000 lbs • The MEDSLED should not be used on any patient that is less that 48 inches tall • The MEDSLED will not be used for stairway descent. The MEDSLED cannot be used in the sprinters.

• Patients in the MEDSLED must be secured to the stretcher using all stretcher straps.

For more information, email Amy Broughton at amyb@medic911.com.

PERIOD 3 (3/1/18 - 6/30/18) WEEKLY RESULTS THRU’ 5/18/18

EST. PAYOUT : $0 FINANCIAL STANDING VS. BUDGET (GOAL: > 0.25%)

QUALIFYING CRITERIA Budget, Patient Satisfaction and Total Task Time goals must be met to turn on Performance Pay. If one of these three goals is not met, Performance Pay will not be paid.

OFF TARGET

PATIENT SATISFACTION RATED AS “EXCELLENT” 70%** (GOAL: > 50%; LOW: 50%-59%; MID:60%-64%; HI: > 65%)

TOTAL TASK TIME

66:39**

(GOAL: < 70:00; LOW: 69:00-70:00; MID: 68:01-68:59; HI: < 68:00)

$0

$150 $300

$0

$150 $300

AGENCY DRIVER SAFETY SCORING AVERAGE (GOAL: > 8%) 9

PERFORMANCE CRITERIA ($100 EA.)

CMED MPDS HIGH COMPLIANCE (GOAL: > 70%) 77%

RESPONSE TIMES P1: 98.56%/P2: 95.73% (GOAL: P1, P2: > 90%; P3: > 85%) P3: 90.94%*

P1 TRAUMA SCENE TIMES (GOAL: < 10:00) 8:29 Response Times through 5/4/18 Pat Sat and TTT through 5/11/18

The latest Performance Pay Tracking Period began on March 1. We are striving to meet the Patient Satisfaction goal of a ≥ 50% rating (experience as “Excellent”). In order to create a comfortable margin of performance, while continuing to improve the patient experience, we would like to share some feedback from recent patient focus groups.

The two areas that patients value the most are: 1. Communication from the treating crew:

“Explain treatment options and procedures”

“Provide reassurance and compassionate communication with the patient”

SEPTEMBER 2014

2. Setting clear expectations:

“Set transport length expectation”

“Set a triage level expectation before arriving at the hospital”

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Every month, Medic provides a written Agency update to key stakeholders including the Board of County Commissioners, the County Manager’s office and the Agency’s Board of Commissioners; it is referred to as the Board Bulletin. This one page communication is comprised of six charts representing key performance indicators specifically chosen for this audience coupled with a brief narrative aimed at conveying Medic related news.

Following is Medic’s Board Bulletin for the month of March. This month’s narrative is focused on the ongoing move process, with an aim of assuring Agency stakeholders that continuity of service to this community was fully maintained throughout this complex endeavor – thanks in large part to outstanding planning and execution by the men and women who choose to make Medic’s mission their own. Enjoy!

NARCAN DISTRIBUTION Medic recently began distributing Narcan in the community as part of a program being administered by the North Carolina Office of EMS (NCOEMS). The program is aimed at getting the life-saving medication into the hands of people who have a high likelihood of being around situations involving an opioid overdose.

Medic received 500 doses of Narcan and developed a strategy for distribution and tracking by field personnel. Medic’s field care providers were trained in March and community distribution commenced in line with state requirements April 2. The program will last until the NCOEMS donated kits have been distributed in their entirety.

STRATEGIC PLANNING UPDATE Medic’s annual strategic planning, which commenced on November 1, 2017, has consisted of multiple workshops designed to engage supervisors, managers and directors from across the Agency.

The workshops included the review of industry and agency-specific data while using various exercises to capture relevant EMS themes. This development recently concluded and resulted in the following FY 2019 strategic objectives: • Quantify the value Medic provides to our patients and improve the value of NET and 911 service delivery by 3% in 24 months • Identify and utilize waste reduction methods to reduce the 2020 budget by 1% as compared to the 2019 actual budget to reinvest in improvement efforts • Utilize workspace to improve employee experience and ability to do their work at Medic headquarters over the next 12 months These strategic objectives are now being used to align the Agency’s budget plans, project priorities, and performance management targets for the coming year.

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CONTEXT FOR KEY PERFORMANCE INDICATORS The data on the following page is presented in control charts. Each dot represents a monthly average, count or proportion. The middle green line is the average performance for the displayed periods, while the red lines are the upper and lower control limits.

• Response time compliance performance goal is 90%.

• Cardiac arrest survival is measured for patients that meet a nationally standardized case definition.

• Patient satisfaction is determined using a random telephone survey of up to 200 transported patients per month. This results in a proportion which rated their overall quality of care as excellent.

The target is > 65% excellent.

• County cost per transport is based off of the total number of transports in a month divided by the monthly subsidy provided to Medic.

SEPTEMBER 2014

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COMPLIANCE CLASS TRAINING In order to successfully complete this LMS training, please be aware of the following:

tions, contact Pam Jackson at pamelaj@medic911. com. For technical questions, contact Medical Services at eqs@medic911.com

Passwords and Login It is your responsibility to ensure that you have access to the Success Factors Learning Management System (LMS). You will need to log into the LMS to complete your compliance training and to set up your fit testing/TB test, if applicable.

ATTENDEES Dakota Anaya, Jason Barr, RaShae Billings, Eric Bitler, Scott Blair, Nina Bost, Christopher Brown, Dalton Burleson, Desiree Casey, Gabriella Catanzaro, Stephen Church, Kacey Cline, Ieshia Clyburn, Lauren Cofield, Stephen Collado, Cory Colvin, Jessica Lucas, Dale Cordice, Luke Danek, Matthew Deedrick, Shauna Downs, Michael Durham, Andrew Ek, Alan Elam, Robin Farrar, Anthony Ferrante, Taylor Gibson, Candace Gilliland, Noah Godbey, Robert Graf, Charles Gunter, Eric Hall, Victoria Hartsell, Adam Jewell, Angela Johnson, Alexander Jones, Austin Joseph, Angela Kaufman, Elizabeth Kennedy, Ethan Kenney, Mark Kern, Christopher Lamb, Malcolm Leirmoe, Antonia Macklin, Taylor Marcus, Zachary Marshburn, Brittany Martin-Ovid, Recarla Massey, Chamika McClain, Milan Merges, Matthew Mohr, Meaghan Moriarty, Jacob Nelson, Barry Nixon, Brian Norton, Savannah Nunnery, Oluwafemi Opelami, Robert Parker, Alex Patrone, Gabrielle Pegram, Anne Pentland, Michael Perrott, Michelle Polino, Christine Ranjit, James Roinick, Justin Rowe, Robin Roy, Bryan Rucker, Brian Shimberg, Emily Spicer, Chandler Spires, Alexis Tewell, Jeffrey Tumas, Shane Walcott, Danielle Walcott, Andrew Walker, Parker Wallace, Emily Webster, Jennifer White, Scott Wilson, Rebecca Zamagni-Mander and Chris Zornow.

If you have never logged into the LMS then you will do the following: • Go to: https://medic911.plateau.com • User ID: Employee ID number with preceding zeros if applicable • Default Temporary Password is: ‘medic911’ If you have forgotten your password please use the “forgot password’ function. If that fails then contact Medical Services at eqs@medic911.com. Password resets will only occur during business hours • You must be sure that you have your correct login information before attempting to complete work in the lab For complete instructions, visit https://www.medic911.com/extranet/my-medic/corporate-compliance If you have Corporate Compliance content ques-

June 2018

• In-service dates coming soon.

• Calendar week starts on Monday.

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PROTOCOL CLARIFICATIONS (For protocols dated 04/01/2018) 1. When placing the defibrillation pads in an A/P position, the anterior pad should be placed slightly off center to allow for continued use of the qCPR device 2. If 5 epinephrines have been administered and ROSC is obtained but then lost, Medical Control should be contacted for additional doses of epinephrine 3. If ROSC is obtained on scene but the patient loses pulses prior to moving to the ambulance treatment should resume from where ROSC was obtained. Depending upon the situation, transport may or may not be indicated. Medical Control should be contacted to determine best course of action.

4. Medical control should be contacted for pronouncing patients who are without pulses and previously had ROSC 5. For blunt and penetrating traumatic arrests – the time to hospital clock (5 mins for blunt arrest; 15 mins for penetrating arrest) starts at time of arrest. Consider all factors when determining transport time, i.e. distance, traffic, need for extrication, location etc.

6. An allergy to sulfa is not a contraindication for sodium thiosulfate 7. The breakpoint for administering sodium thiosulfate is AMS/Confusion/Unconsciousness.

8. Code stroke is now defined as symptoms less than 24 hours. We will transport these patients in an emergent fashion as we have with all other code strokes in the past.

9. The 5 epinephrine max does not apply to pediatric cardiac arrests. However, Dr. Swanson encourages providers to make contact with medical control prior to a 6th dose for consultation For more information, email Trevor Taylor at trevort@medic911.com.

GEOTAB TRANSITION We are pleased to finally announce that the transition from Road Safety to GeoTab is complete!

What does this mean for you?

• The driving scores are now fully converted to a 1 – 5 point scale, with 5 being the highest score in the rubric • Performance payout measurements for driving scores will be based on the GeoTab point scale (1 – 5) as of the current tracking period beginning March 1st, 2018 • Monthly driver score sheets will be posted again beginning May 1st, 2018 by the breakroom for your review • Performance appraisals during common review period will reflect scoring based on the GeoTab point scale (1 – 5) as of September 1st, 2018 As a reminder, please be sure to review the below Agency expectations and GeoTab specifics: • Your key fob is part of your uniform and should be with you at all times. If you misplace your fob, please check-out a spare from the Operations Supervisor/OA and check the fob back

in at the completion of your shift.

• Scoring is based on five categories – braking, accelerating, cornering, speed and seatbelt use.

• Each infraction is equivalent to one point against the driver’s score.

• There is no option to remove points from your total score, regardless of circumstances.

• Agency policy mandates the use of a backer at all times and will continue to be enforced.

• There is no audio alert/beep when the vehicle is placed in reverse. The device will only beep when the spotter switch is engaged.

• The use of shorelines is strongly encouraged to prevent a low voltage state on vehicles.

• If a low voltage state occurs, the spotter switch may need to be engaged 4 – 5 times to restart the device. Do not take the unit out of service unless you have an unsuccessful reset attempt.

Thank you for your patience with this elongated transition and if you have any questions regardSEPTEMBER ing the implementation or use of GeoTab, 2014 please contact Steve Vandeventer at stevenv@medic911.com.

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COMMENDATION LISTS Medic’s monthly Commendation list is now on the extranet. To view April’s list, visit https://www. medic911.com/extranet/incentives-and-recognition/commendations.

Questions? Email PR@medic911.com