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Findings and Recommendations 12 findings
F1
Current Med-Com policy and practice (i) immediately initiates the emergency medical helicopter dispatch process under Policy 119 whenever an Incident Commander requests an emergency medical helicopter and (ii) does not permit Med-Com dispatchers to question or cancel the request.
No recommendations for this finding
F2
Both County emergency medical helicopter operators have equipment and procedures enabling them to contact flight crews for ETAs and provide Med-Com with ETAs within three (3) minutes of requests.
Related Recommendations (1)
R1
EMSA should revise Policy 119 to require that Med-Com dispatch the emergency medical helicopter that has responded to Med-Com with an ETA, if no ETA has been received from the other emergency medical helicopter within three (3) minutes after it was simultaneously requested by Med-Com to provide an ETA. (Finding 2)
F3
Policy 119 authorizes the Incident Commander, in consultation with the most medically- qualified first responder, to determine that a requested medical helicopter is not needed and to cancel the request.
Related Recommendations (1)
R2
EMSA should consult with State Parks Rangers concerning application of the Policy 119 cancellation procedure at the Dunes and determine what, if any, revisions should be made in either State Parks procedures or Policy 119 so the cancellation procedure and actual cancellation practice are consistent. (Findings 3-6)
F4
A State Parks Ranger is usually the Incident Commander for a medical emergency at the Dunes and under Policy 119 is authorized to make the final determination of whether an emergency medical helicopter is needed.
Related Recommendations (1)
R2
EMSA should consult with State Parks Rangers concerning application of the Policy 119 cancellation procedure at the Dunes and determine what, if any, revisions should be made in either State Parks procedures or Policy 119 so the cancellation procedure and actual cancellation practice are consistent. (Findings 3-6)
F5
State Parks training and procedures are the opposite of Policy 119 and require Rangers to defer to the determination of the most medically-qualified first responder on scene as to whether an emergency medical helicopter is needed.
Related Recommendations (1)
R2
EMSA should consult with State Parks Rangers concerning application of the Policy 119 cancellation procedure at the Dunes and determine what, if any, revisions should be made in either State Parks procedures or Policy 119 so the cancellation procedure and actual cancellation practice are consistent. (Findings 3-6)
F6
In medical emergency calls at the Dunes, the Policy 119 procedure for canceling an emergency medical helicopter requested by the Incident Commander is often reversed and the most medically-qualified first responder (usually the ground ambulance paramedic) on scene, in consultation with the Incident Commander (usually a State Parks Ranger), determines whether or not the requested emergency medical helicopter is needed.
Related Recommendations (1)
R2
EMSA should consult with State Parks Rangers concerning application of the Policy 119 cancellation procedure at the Dunes and determine what, if any, revisions should be made in either State Parks procedures or Policy 119 so the cancellation procedure and actual cancellation practice are consistent. (Findings 3-6)
F7
The ground ambulance paramedics responding to medical emergencies at the Dunes do not make any entries in their patient care records to confirm consultation with the Incident Commander or the determination by the Incident Commander that the emergency medical helicopter is not needed.
Related Recommendations (1)
R3
EMSA should require that ground ambulance paramedics include in patient care reports a confirmation that they consulted with the Incident Commander. The note should identify the Incident Commander and confirm that the Incident Commander decided the helicopter was not needed following consultation. (Finding 7)
F8
EMSA does not include a representative of the State Parks Rangers on its Operations or Quality Improvement Committees.
Related Recommendations (1)
R4
EMSA should include a representative from State Parks Rangers on its Operations and Quality Improvement Subcommittees. (Finding 8)
F9
State Parks Rangers are generally not aware of the formal and informal processes available for them to request EMSA review of whether their requests for an emergency medical helicopter were cancelled in accordance with Policy 119.
Related Recommendations (1)
R5
EMSA should advise State Parks Rangers of the formal and informal procedures available to them for requesting that the appropriate EMSA Committee review cancellation of an emergency medical helicopter request the Rangers believe was in violation of Policy 119. (Finding 9)
F10
Policy 119 does not incorporate the recently approved EMSA Policy 201.2 on STEMI triage and destination and therefore does not permit Incident Commanders to request an emergency medical helicopter for any medical emergency call involving a possible heart attack that meets STEMI criteria.
No recommendations for this finding
F11
Transport of a heart attack patient on the Dunes who meets STEMI criteria to Marian Medical Center by emergency medical helicopter will result in a time savings of more than ten (10) minutes over ground ambulance transport to French Hospital.
No recommendations for this finding
F12
Policy 119 does not give paramedics or flight nurses any discretion to consult with an available and more medically-qualified authority and to obtain their authorization to deviate from Policy 119 based on the particular circumstances of a case.
No recommendations for this finding
Additional Recommendations 2
These recommendations are not explicitly linked to specific findings.
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R6The responses shall be submitted to the Presiding Judge of the San Luis Obispo Superior Court by July 25, 2011. Please provide a paper copy and an electronic version of all responses to the Grand Jury, as well. The San Luis Ambulance Company is required to respond to Findings 3, 6, 7 and 12 and Recommendations 3 and 7. The responses shall be submitted to the Presiding Judge of the San Luis Obispo Superior Court by July 25, 2011. Please provide a paper copy and an electronic version of all responses to the Grand Jury, as well. The CalStar Santa Maria Base is required to respond to Findings 2 and 12 and
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R7The responses shall be submitted to the Presiding Judge of the San Luis Obispo Superior Court by July 25, 2011. Please provide a paper copy and an electronic version of all responses to the Grand Jury, as well. The mailing addresses for delivery are: Presiding Judge Grand Jury Presiding Judge Charles S. Crandall San Luis Obispo County Grand Jury Superior Court of California P.O. Box 4910 1050 Monterey Street San Luis Obispo, CA 93402 San Luis Obispo, CA 93408 The email address for the Grand Jury is: [email protected] State agencies are not subject to the jurisdiction of the Grand Jury and are not required to respond to any Grand Jury Findings or Recommendations. However, the two state agencies discussed in this report are important components of the County emergency medical response system, particularly at the Dunes. The Grand Jury wishes to thank representatives of these state agencies who voluntarily provided assistance to the Grand Jury during its investigation. The Grand Jury requests that these state agencies voluntarily respond to the Findings and Recommendations resulting from the Grand Jury investigation that are noted below. Any such responses may be submitted to the Presiding Judge of the San Luis Obispo Superior Court by July 25, 2011. Please provide a paper copy and an electronic version of all responses to the Grand Jury. The addresses for these responses are listed above. The California Highway Patrol is requested to respond to Finding 2. The Oceano District Office of the California State Parks Department is requested to respond to Findings 4-6 and 9 and Recommendations 2 and 4-6.
Conclusions 1
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CL1Med-Com failed to promptly implement revisions to Policy 119 that require immediate and unquestioned dispatch of an emergency medical helicopter requested by an Incident Commander. A 2009-2010 Grand Jury recommendation and pressure from CalFire resulted in the implementation of these revisions to the apparent satisfaction of all emergency responders and to the benefit of injured victims. 2010-2011 San Luis Obispo County Grand Jury Page 15 A recommended 2009-2010 Grand Jury revision to Policy 119 that would require dispatch of an emergency medical helicopter with an ETA, if the second emergency medical helicopter cannot be immediately contacted, will not be made. The equipment and procedures are in place to make this revision to benefit injured victims requiring an emergency medical helicopter. There is no apparent justification for not making this recommended revision and instead developing a separate Memorandum of Understanding to document a procedure for the amount of time Med- Com waits for an ETA response. Policy 119 procedures for cancellation of emergency medical helicopter requests by Incident Commanders are not consistently followed and require further review and possible revision. This is particularly true at the Dunes where training and procedures for State Parks Rangers are in direct conflict with the cancellation procedure 119. Need criteria for the use of emergency medical helicopters also require further review and possible revision in light of the new STEMI policy for transport and destination of patients who have a cardiac medical emergency defined in the STEMI policy.
* This report's PDF did not contain easily extractable text and required Optical Character Recognition (OCR) for analysis. There may be minor errors in the extracted findings and recommendations due to OCR limitations with scanned documents.