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Dozier-Libbey Medical High School students Katty Wu Deng, Jei Zarate, Aseel Shatnawi, Nick Mooney, Chinua Ezike.

Dozier-Libbey Students Earn Recognition for Partnership With Medical Reserve Corps
Lisa Vajgrt-Smith RN, BSN, MPH, CPH, Medical Reserve Corps Coordinator, Contra Costa EMS

A group of students at Dozier-Libbey Medical High School in Antioch that trains with the Contra Costa Medical Reserve Corps (MRC) earned a gold medal at a state conference last month and will move on to a national competition in Nashville, Tenn. from June 22 to 25. The school's Health Occupations Students in America (HOSA) chapter took top honors in an MRC Partnership competition at the HOSA State Leadership Conference in Anaheim, profiling 14 events in which they worked alongside the MRC, including by playing the role of victims during disaster drills and co-staffing a medical countermeasure point-of-dispensing (POD) site during a drill. In all, more than 20 MRC members have volunteered to work with more than 70 of local HOSA students - we want to foster interest in medical careers and stress the importance of volunteer work too. Congratulations to the Dozier-Libbey HOSA team!

Treating Overdose from Fentanyl and Other Opiates
-By Dr. David Goldstein, MD, Medical Director, Contra Costa County EMS, Deputy Contra Costa Health Officer

In recent weeks multiple Northern California counties, including Contra Costa, have reported overdose cases linked to counterfeit Norco sold on the street containing fentanyl.

Fentanyl is much more powerful than other street opiates and is regularly substituted into counterfeit pharmaceuticals, as well as heroin.

From an EMS standpoint, treatment of opiate overdose is first and foremost supportive. BLS airway support and, when indicated, safe use of Narcan (naloxone), are the mainstays of overdose treatment. Employ oxygen support, bag-valve-mask ventilation and, in borderline cases, end-tidal carbon dioxide monitoring.

If the respiratory rate is suppressed below 12 or there is significant concern for airway protection, Narcan may be indicated. Narcan should NOT be administered simply for decreased level of consciousness.

Habituated opiate users may experience acute chest pain, pulmonary edema and seizures when Narcan is administered. These complications may be mitigated by titrating small increments of Narcan IV. There is clearly a higher risk of complications in the elderly.

It is prudent to be prepared for an agitated and combative response to Narcan administration. Once Narcan is administered, the patient may also be reticent to accept transport to an emergency department.

Patients who receive Narcan should ALWAYS be transported, due to Narcan's short half-life and the risk of recurring respiratory depression.

It may require a concerted effort on the part of the EMS responder to convince the patient to be transported. Enlist family and base hospital support if needed to persuade the patient to accept ED evaluation.

In recent Sacramento County cases, there have been anecdotal reports of deaths associated with release of patients shortly after Narcan was administered.

Fentanyl and other opiate intoxication are increasingly being seen by EMS. Supportive care, prudent use of Narcan and transport to the emergency department - even if the patient is reticent - are the mainstays of treatment.

Extra Extra-Contra Costa EMS Policy & Protocols Available by App!

Contra Costa EMS policies and treatment guidelines (protocols) are now available via app for both Android and iOS. We encourage providers to use this option, as it will always have the latest updated version.

You can download the app by searching for Contra Costa County EMS on Apple's iTunes Store or Google's Play Store.

In addition, the 2016 Contra Costa EMS Prehospital Care Manual is now available electronically in PDF format. We are no longer providing printed copies of this manual.

For more information, contact the EMS Agency at 925-646-4690 or visit cchealth.org/eh

Contra Costa Helps Lead State Efforts to Support Timely Transfer of Care
-This information is republished from the April 2016 edition of the California Emergency Medical Services Authority Dispatch:

The ongoing frustration over the impact of patient delays on EMS systems led to legislation. AB 1223 mandates that EMSA develop a statewide standard methodology for the calculation and reporting by a local EMS agency (LEMSA) of ambulance patient off-load time. It also authorizes a LEMSA to adopt policies and procedures relating to ambulance patient off-load time. The bill does not mandate an end to off-load delays or institute a penalty for delays, but it does require an important first step, which is to create a uniform measure that will support collection of comparable data. Currently, only about six LEMSAs collect data on the delays, and only Contra Costa, Riverside, Inland Counties EMS Agency, Alameda, and San Joaquin counties make data available on their websites.

Measurement specifications were developed through input from a stakeholder group. The time interval for ambulance patient off-load time begins when the ambulance stops at the site of unloading at the hospital ED. The statute says the ending time is when "the patient is transferred to the ED gurney or other location AND the ED assumes the responsibility for the patient." The assumption is that transfer of care has occurred when the patient is transferred from the EMS gurney to an ED gurney, chair or sent to the waiting room. In some EMS systems, the CAD automatically documents these time stamps. In others, the medics will initiate the time stamps in their ePCR. NEMSIS 3 compliant data systems have data fields for these times.

The target goal is to have patient transfer occur within 20 minutes in the ED 90% of the time. Even when this is impossible due to volume or other circumstances, the transfer time should not exceed one hour. To a large extent, how this problem is managed in the future will depend on the data collected by EMS providers. Measuring a problem is the first step toward focusing attention and finding a solution.
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