# Presentation: 687233

## Strengthening EMS Systems of Care 2007 HDSP State Programs Training Atlanta, Georgia

- 3:30-5:00 PM Sept. 18, 2007
- Dory Masters, M.Ed., CHES
- Director, Heart Disease & Stroke Prevention
- Community Health and Chronic Disease Prevention
- SC Dept. Health & Environmental Control

## EMS in SC

- More than 200 services
- Mix of County, Private & Volunteer
- EMS Division, SC DHEC develops and enforces all standards and regulations necessary for the maintenance and improvement of emergency medical services

## Different Deputy Areas

**Different Deputy Areas**

## Different Regional Structures

**Different Regional Structures**

- EMS:  4 Regions/Regional Councils

- Health Services:  8 Public Health Regions

## HDSP-EMS Collaboration

- Important partners and EMS champions
- EMS Division, SC DHEC
- SC EMS Association - Board
- SC EMS Educator’s Association
- Doug Silk, NREMT-P
- American Heart /American Stroke Association

## 2007 South Carolina EMS Capacity survey 

- Victor Grimes & Khosrow Heidari
- Div of Emergency Medical Services &
- Chronic Disease Epidemiology

## Describe the EMS Community

- EMS Agencies
- Number
- Level of service
- Location
- Size
- Volume
- EMS Personnel
- Numbers
- Level (EMT, EMT-Intermediate, EMT-Paramedic
- Location
- Patients
- Number of events
- Number of patients
- Numbers based upon population and service area

## Survey Methodology:

- Paper and pencil
- N = 190  46 County + 144 Other
- n = 103 completed response (54%)
- County EMS: 27  59% response rate
- Other EMS: 76  53% response rate

## Software utilization? (based on n=103 responses)

- Yes: 38% computer data enter:
- 26 commercial,
- 5 State developed and
- 5 in-house software to enter PCR data
- No: 62%

## What land mass does your agency provide service for? (based on n=82 Primary responses)

| Land Mass | Number |
| --- | --- |
| City | 0 |
| County | 48 |
| Industrial | 8 |
| Statewide | 2 |
| Township | 21 |
| Other | 2 |
| Total | 81 |

## How many Square miles are in the service area:

- 30,111
- Sq Miles

## What is the population of the area that your system serves (the resident population)? (based on n=82 Primary responses)

- 2005 Pop Estimate
- 4,255,083

## How many EMS 911 dispatches and patient contacts did your service have in the last 6 months (July to December), including all types of calls?  (based on n=82 Primary responses)

## Survey Conclusions:

- The majority (59%) of the primary  respondents do not use any software for their data entry.
-  71% of those who do their own data entry use a commercially developed product and aren’t considering changing it within next year.
- The largest data documentation of the calls takes place at the station, then at the hospital by primary EMS.
- The majority of the  written documentation usually takes place within 30 minutes (socially desirable response?) by EMS personnel.

## National Efforts

## Active Data System Status

**Source: NEMSIS TAC (****Jan. 2007****)**
**http://www.nemsis.org/referenceMaterials/presentations.html**

## Lessons Learned – Other States 

- Legislation: need support for an electronic data system
- Funding: need $ for maintenance, personnel, upgrades & hardware
- Human Resources: qualified people are needed for technical development, system design, program management, training, marketing and other
- Hardware:
- EMS Data Warehouse,
- EMS data via Internet
- Data Entry Equipment
- Software (in house, commercial . . .etc)
- Training
- Marketing
- Implementation
- Maintenance
- Reporting

## Standard Protocols

- SC EMS Board Adopted Univ. of **M**iami’s **E**mergency **N**eurologic **D**eficit Exam (MEND) as part of statewide protocols (2002)
- MEND training approved for CEUs by SC EMS Advisory Council (2003)
- MEND checklist incorporated in EMS training curriculum (National)
-  MEND rebranded ASLS
**	****A**dvanced **S**troke **L**ife **S**upport

## Provider Training

- AHA/ASA Operation Stroke sponsored 1 EMT-P in Univ. of Miami’s Emergency Neurologic Deficit (MEND) master train the trainer course (2003)
- Operation Stroke disbanded (2004)
- ?...How to sustain MEND course & support instructors?

## Training Process

- SC HDSP sponsored MEND TTT course at the SC Annual Emergency Care Symposium (FY ’04)
- SC HDSP sponsored 4 regional MEND trainings (FY ‘05)
- SC HDSP and HDSP funded regions sponsored 4 regional ASLS trainings (FY ’06)
- SC HDSP and HDSP funded regions sponsored 4 regional ASLS-H trainings (FY ’07)
- SC HDSP committed to ongoing ASLS-H support – priority with hospitals pursuing JCAHO Stroke Center  and disparate areas

## Number of ASLS Trained Providers as of 6/30/07

## ASLS Train the Trainer Challenges...	

- Secondary trainings
- Training support/advocacy (EMS service level)
- Training materials availability/costs
- Tracking/reporting of trainings not comprehensive as reporting not required by Division of EMS
- Individual EMS provider CE records updated with recertification (3 yr) at state system level
- State EMS CE system not electronic or easily searchable
- Registry of trainers & courses
- Current trainer registry not within EMS system
- Current ASLS-H trainer courses coordinated by HDSP

## Activity:  Data linkage

- Less than 30 services report electronically
- Capacity to link to hospital records exist but so do challenges...
- Financial (local & state)
- Proprietary feelings

## Next Steps

- Regional ASLS Hospital course
- Targets pre-hospital & hospital providers
- Supported by HD&SP funded regions
- Explore additional venues for education
- Data linkage
- Impact & outcome measures

## Where NEMSIS wants us to be

- State EMS database on every EMS patient encounter
- Electronic data transmission
- Privacy and confidentiality protection
- System and patient
- Statutory authority

## Conclusion

- Establishing a strong relationship with the EMS Division staff is essential in developing successful policy to enhance EMT capacity
- Cultivating such a relationship requires a long term vision, mutual trust and respect.
- Future activities will focus on
- ED staff
- NEMSIS
- Rehab centers

- EMS providers eager for continuing education
- Systems changes seen at county level
- Protocol changes
- Annual training requirements for staff
- Must link data (our biggest challenge)

## Thank You!

- Check us out
- www.scdhec.gov/hdsp