Impact Mitigation Plan San Jose Medical Center Closure

1
Impact Mitigation Plan San Jose Medical Center
Closure

• Santa Clara County Emergency Medical Services
  Agency
• Revised 11/15/04

2
Background

• SJMC is scheduled to close December 9, 2004 at
  500 pm.
• Impact Report Completed
• Mitigation plans will be implemented on November
  29, 2004.
• Regional Trauma Center has submitted an
  application for Trauma Center Designation.

3
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.

4
Patient Redirection

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

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

5
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.

6
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

7
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

8
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.

9
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)

10
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)

11
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.

12
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.

13
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.

14
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.

15
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.

16
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 Orange status at
  the same time.

17
Trauma Status

• Open/Green no change
• Yellow Census Eliminated
• Yellow- CT Eliminated
• Service Advisories/Orange Added
• Orange/OR
• Orange/Neurosurgery
• Bypass/Red no change

18
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
  Advisory
• Bypass the facility and go to the other trauma
  center (consider air transport if necessary).

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Example Orange/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.

20
Example 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.

21
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.

22
Bypass/Red

• If both Trauma Centers are on Bypass status
  Both will immediately open (but may have Service
  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.

23
STARs

• SJFD STARs responding to more calls
• STARs may be used to transport to LZs 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.

24
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

25
Reference Revisions

• EMS 804 Santa Clara County Acute Care Hospitals

• EMS 805 Santa Clara County Permitted Ambulance
  Services

26
Important Dates

• November 29, 2004 _at_ 0800 Hours all 911 System
  ambulance traffic is directed away from SJMC
  (except extremis).
• December 8, 2004 _at_ 1700 Hours all 911 System
  ambulance traffic is directed away from SJMC
  (INCLUDING extremis).

27
Important Dates

• December 9, 2004 _at_ 1700 Hours San Jose Medical
  Center closes.