Duke Regional Advisory Committee Meeting

Date: July 23, 2020 Location: Virtual Meeting Time: 09:30AM – 12:30PM Attendees: Georgina Durst, Carolyn Foley, Sean Gibson, Chris Tucker, Jonathan Pernell , Courtney Roach, Afton, Christopher Rigg, Cote Team, Sean Dudley, Kim Yarborough, Carrie Farmer, Tricia Smar, Lou Ann Reaves , Jordan Kittelson, Danika Davis, Kevin Mumma, David Marsee, Sarah Morgan, Kippy Woodlief, Rene Borghese, Valerie Barmach, Lee Van Vleet, Tina Retallick, Katia Ferguson

Agenda Speaker Discussion Action Steps Welcome/ Georgina Durst  Welcome remarks by Georgina. Looking forward to being able to go out and greet Introductions/ folks again with limited exposure and consideration for COVID restrictions. Minutes  David M- motion to approve minutes  Sean G - second to approve minutes  Minutes approved. No changes or modifications required.

 Brenda Lanan relocated to Texas. Will miss her. Appreciate her participation and

support in DCEMS, Disaster Management Coalition and more.

 Cheryl left Maria Parham ED as Director  Dr Michael Smith passed away recently. He served as Med Dir Vance County EMS and worked as a physician at Granville ED. Thoughts continue to be with community and family.  Dr Benson replacing Dr Smith as Vance Co EMS Medical Director and will continue as Maria Parham ED Medical Dir.  MPH introduction Kippy Woodlief. Background: last worked Wake Med 15yrs, L1 Trauma Center. Served in the role of WakeMed ED nursing leadership. She has returned home to MPH to assume ED nursing leadership. Trauma Center Georgina Durst  Recognized everyone’s hard work across the Region. Thank you expressed. Georgina will Criteria  ESO - Georgina has been working with ESO since November. June 5 was able to meet follow-up with ESO virtually. Provided an overview to ESO regarding trauma criteria language challenges and they seem to comprehend. Plan to correct language output on PCR. Samantha was not able to give Georgina a time for completion but felt like it can be done quickly. No updates as of last week. ESO also appreciated attention to GCS spelling correction.  EMS Charts – GCS language modified for correct verbiage. Chris R. spoke with Jay

Duke Regional Advisory Committee Meeting

for clarification. Recent EMS Chart update occurred causing a reversal of corrected language. A manual correction performed. Please monitor for any potential reversal. Monitor each time there is an update.  REMINDER to everyone to ask crews to complete the criteria and set default as “EMS PROVIDER JUDGEMENT” to ensure data is correctly entered for compliance.  Thank you for being leaders and participating in this endeavor. Sean G acknowledges this is great work that influences the nation. Georgina shares data across the state keeping her colleagues updated and informed regarding findings and RAC agency participation for excellence.

State Trauma Georgina Durst  Monthly meeting to discuss trauma system across NC. There are 121 hospitals across Systems state, only 18 are trauma centers. Goals of committee include determining: Resource Subcommittee allocation, trauma care approach, trauma patient outcomes, NC trauma epidemiology. Update  Attempts to gain trauma data across all NC hospitals has been unsuccessful to date. o Challenges with EMS PIC delineating trauma patients. o Currently working with NC Hospital Assoc. No data available to date. o Decision to ask RAC coordinators to review: acuity assessment, ED LOS, transport resource/allocation, Transfer patterns/transfer volume, RAC participation. Georgina is your advocate and she is glad the State is asking RAC coordinators to share your hard work, such as trauma transfers. o Data examples include noting high ISS scores transported by BLS/ALS transport services that are not EMS ALS services. Facility resources that influence trauma care potential.  State is looking for trauma care areas that require support or have lacking resources to consider.  Duke RAC Data Overview: o Review of ISS chart for severity regarding RH ED LOS 4 hrs. with ISS range 10-15. Performance for moving patients within 4 hours good always with opportunities to improve. Question becomes, is this related to transport availability or other services required? Additionally, these numbers only represent data that we had for arrival time and discharge time on RH record. o Review of ISS range >15 for ED LOS RH. Great work in general across the board for RH transfer of sickest patients within 4 hours. Great work! Proud of everyone for work. o Missing documentation of arrival or departure time of RH record reveals significant opportunity for documentation capture in the ISS>9 range.

Duke Regional Advisory Committee Meeting

Reviewed screenshot for best practice documentation from one RH in RAC. Generally always completed. Asked where best place to look within medical record for these times would be . Durham VA – no response . Granville – Danika: relates patient and physician summary contains the info (first page, ED summary report). Requested to know if those times are missing . MPH – Kippy: there is documentation. Request to know if it is not being sent . Person – not present  Summary, each facility has something that is generated and we should be able to expect to locate the documentation. Will review further and share findings TXA Carolyn Foley  A brief overview of TXA administration ranging across July 2019 to April 2020 was Administration provided. Graphs reflecting TXA initiation volume by agency reviewed with greatest initiation occurring across EMS and Duke ED/OR. Of note, RH Maria Parham has initiated TXA as well. TXA administration compliance reflects approximately one third of MTP patients receiving 2Gms TXA per protocol. Another third receives 1Gm while the last third received no TXA. We will continue to monitor for improvement and request ongoing participation according to established protocols.  Georgina notes interest in reviewing TXA administration compared to institutional or agency protocol for individual compliance. Prehospital Georgina Durst  Discussion regarding screening process of EMS and hospital COVID processes. To COVID meet Duke rule/regulation for COVID containment, OR patients are critical to screen Screening for timely surgical intervention. Please share your screening process: o Caswell- not available o DCEMS - . 911 SCREENS, PROTOCOL 36 . May dispatch as COVID dependent on screen, minimizes fire dept. exposure . If patient unable to answer questions, crew wear full PPE . If patient does not meet positive screening criteria, staff wears mask with minimum level of protection . Staff should apply surgical mask to all patients . First 30 seconds mask patient . Likely overtriaging, going through more PPE . Challenges with varying N95 vendors and sizing. Half face respirators

Duke Regional Advisory Committee Meeting

being provided to prevent N95 challenges . Good mask supply, good supply of all . Concern for second wave in the fall and adequate stock for that period. . Staff reminded to apply masks for trauma patients as recent as the last few weeks. o Granville – No answer o Robeson – Not present o Vance – . 911 screens, advised to use advanced PPE N95, etc. . EMS ask further questions to patient . Do not have amount of PPE to place surgical masks on all patients . Only applied to grave concerns . All crews wear N95 o Person – No answer o Warren – . Same as Vance . Half face respirators given to all crews . All patients provided masks . Vendor is able to provide all the PPE they need . If patient refuses they notify receiving agency PTA o DRH- . DCEMS pre masks . Masked on arrival otherwise o DRAH – . DCEMS pre masks . Masked in ambulance bay o MPH – . Vance EMS pre mask . Otherwise, mask as soon as enter building COVID Georgina Durst  Reviewed process of NCOEMS reporting infectious disease protocol Reporting o Identified no allocation of prehospital notification/participation for contact of Process ID o Lessons Learned: close relationship with Co Health Dept crucial o Tracking form completion can vary from health dept. : resources, variance in notification  COVID and Trauma

Duke Regional Advisory Committee Meeting

o Developing process for COVID exposure notification (Duke to agency) o Sean is working with compliance o Date, time and agency will be provided to EMS (no demographics for HIPPA) o Process for trauma patients only regarding this discussion o Discussions reopened regarding needle sticks and other exposures. More to come o Sarah Morgan recommends including police departments for notification of COVID positive patient Duke Healthcare David Marsee  Accomplishments David Marsee Preparedness o AHEPP, National HPC Conference, NC Disaster Symposium Coalition o IAEM, NC EM Today, EMI, CDP. Updates o Training Exercises: DTCC IMT Training, UNC MHA Program TTX, Caswell, Robeson, etc. o Additional Activities: Festival on the ENO, Vance County Car Show, Granville County Hot Sause Festival, Assist with Grady Hospital Response, Hurricane Dorian, Assist Person County with M8, Assist Warren County with large fire, COVID – ongoing o DCHP M8: 53ft trailer photos shared. Can use as 18 bed facility or folded up beds for conference room. o Delivered PPE over 70+ agencies, see slide for detail. Assisted 74 different partners across 7 counties o Assistance provided for warehouse organization: Duke Health provided 4, Volunteers 8 personnel for 762 hours. Stockpiles viewed in photos

D-RAC Georgina Durst  Aug - Georgina will be at Southeastern with new grad trauma education Coordinator  Can provide education up to 10 people per entity Updates  Forthcoming supplies to share with agencies for staff, will deliver next few weeks. Educational Georgina Durst  Duke Hospital Education still providing small classes TNCC. We regret having to Opportunities cancel MPH April and July due to COVID constraints.  Schedule of classes (TNCC/ATLS) provided with Rob Vandrick’ s contact information. D-RAC Lou Ann Caswell Family Medical Center Regional Reaves  No Updates Updates Kimmie Caswell Co EMS Yarborough  No Updates Tina Retallick Durham VA  No Updates

Duke Regional Advisory Committee Meeting

Lee Van Vleet Durham Co EMS  No Updates Valerie Milelli Duke Regional Hospital  No Updates Sarah Morgan Duke University Hospital Emergency Services Brooks  No Updates Katia Ferguson Duke Raleigh Hospital  No Updates Jonathan Granville EMS Pernell  No Updates Danika Davis Granville Medical Center  No Updates Kippy Maria Parham Woodlief  No Updates Chris Rigg Vance Co EMS  Dr. Benson taken over from Dr. Smith as Medical Director Kimmie Person Co EMS Yarborough  Person security was breached but now receiving email Not Present Person Memorial Hospital Not Present Robeson Co EMS Not Present Southeastern Health Kevin Mumma Duke Life Flight  No major updates. Still at Henderson. Very busy and incredible to see the work everyone is doing Warren, Vance, MPH, etc. Reports the appreciation of what all the counties do and see every day with limited resources and spread thin. Glad LF is there to participate. Eye opening. Chris Tucker Warren CO EMS  Received Grant for Rural Domestic Preparedness. Event will be held at EMS station 1, Oct 19, 30 participants, need to register by Oct 5 Case Review Chris Rigg  Case Review Kevin Mumma Carolyn Foley

Duke Regional Advisory Committee Meeting

Adjourn Georgina Durst Next meeting October 23, 2020