Friday Update 1-22-21
Updated On: Feb 12, 2021
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FRIDAY UPDATE 
 

Sisters & Brothers,

As we head into this weekend your Local 1014 Executive Board Members are busy preparing for our Biennial Convention which will be held virtually this year as a result of COVID-19.  This provides many more challenges than an in-person convention so extra preparation has been the order of the day to ensure our ability to review and weigh in on all resolutions and elections.
The IAFF Convention is where Fire Union Leaders from across the United States and Canada come together to set a two-year agenda for our members. Resolutions written by members and by Executive Board members of the IAFF will be considered as well as the nominations and elections for our IAFF officers.  

Resolutions deal with budget, policy, constitution, and by-laws items. Issues regarding health and safety, cancer and toxins in PPE, NIOSH and OSHA, human relations, and behavioral health, will all be considered, debated and voted on next week. 

Your Local 1014 Executive Board will be part of the 10th District representing California, Arizona, New Mexico, Hawaii and Guam, the largest IAFF District.  We have been working together with Unions from our district to review the resolutions and content to take positions and debate and vote for our members' best interests.  We will be posting information and content on Convention next week as we handle our work.  

OT Annual CAP 
We continue to ride the Department Administrative Chiefs and the Fire Chief to lift the arbitrary OT Annual CAP and let the workers work. As we have seen, specialty positions go over the cap in all ranks including chiefs, and the need for workers is as strong as ever.  We are getting recalled when there are many many members who would rather work.  Also we have seen numerous issues with the new electronic Performance Net system that could, at this point, be named the "lack of performance net" system. We have contacted the Department and made them aware of the issues and the need to fix this system as it specifically pertains to allowing documentation of our members' work for the appraisal of promotability and accurate documentation.  

Please see the article below from Director Pat Dolan in collaboration with Dr. Clayton Kazan, to help protect our members regarding EMS documentation on calls. This is especially important in this environment of COVID and changing treat and transport policies. 
    The Art of Documentation
    Director Pat Dolan 

Needless to say, 2020 was a year like no one has ever seen in regards to how we provide our EMS service.  Since March 2020, we wear masks, gowns, face shields, do assessments outside in parking lots, and try to maintain a social distance (when possible).  This is the new normal and I don’t see it going away anytime soon.  Call volume has skyrocketed and so has the toll on our personnel.  Constant staffing, in a normal world, is a benefit this Union has negotiated and strived to protect.  Yet, in a pandemic, it can stretch us to our breaking points, both physically and mentally, and Local 1014 understands this.  We see it also, as we are out on the front lines with all of you.
 
With all that being said, the Emergency Medical Services Bureau (EMS), in the last several months, has had several instances in which the documentation on COVID-19 patients has been missing key, essential information.  Your documentation, or lack thereof, puts you, as the Scene Manager, or you, as the Paramedics, at risk for potential liability and  punitive action, and no one wants to see that happen.
 
In March 2020, the Los Angeles County Emergency Medical Services Agency, or LEMSA, adopted Reference 834.1 which dealt specifically with “low risk” COVID-19 patients in anticipation of a potential surge of COVID-19 patients inundating local emergency rooms.  When this didn’t materialize, Reference 834.1 was rescinded.  Fast forward to December 2020 and the surge DID materialize, and the EMS Agency adopted Reference 845, which is the guideline for “Treat and Refer” for mild respiratory illness during the COVID-19 outbreak.
 
The purpose of Reference 845 is not to convince patients to avoid the ERs.  It is to help you provide good advice to your patients when they either don’t want to go to the hospital or ask you for your opinion.  Patients that meet ALL of the criteria in Reference 845 could be classified as Low Risk for bad outcomes, and it is OK to advise them that EMS transport and an ER visit do not appear necessary.  In this instance, “Treat and Refer” would be the appropriate disposition.  However, if the patient still wants to be transported, then they should be transported.  If a patient does not meet all of the criteria in 845 and does not want to go to the hospital, then the appropriate disposition is “Against Medical Advice (AMA),” no matter how good they may appear.
 
Good documentation is so important.  If a patient does not want to go to the hospital, even if they meet 845 criteria, document it.  If a patient is signing out AMA, make base contact and get it documented on a recorded line.  We all know that COVID patients sometimes have bad outcomes, and we never want to be accused of denying transport to someone who wants to go to the hospital or inappropriately triaging a patient as “low risk” when they do not meet the criteria.  Remember, it’s not the patient that sues you, it’s their next of kin.  And, it’s not the obviously critical case that winds up in a lawsuit...it’s the patient that nobody believed was very sick or injured.  Good documentation is a habit that can spare you enormous heartache later. 
 
Please familiar yourself with reference 845; either through our Department e-mail or through the DHS website, as there are 15 criteria a patient must meet before we can “Treat and Refer” them.  To help you, these criteria will auto-populate if you choose the Provider Impression “Cold/Flu.  
 
The EMS Bureau also has another tool at our disposal which is starting to gain more traction.  It’s the “Telemedicine Consultation” program which can be requested through Dispatch.  This program is live 7 days a week, from 0800-1800 hours, but sometimes will be monitored after hours.  The Nurse Practitioner on AP-11 is first up for contact.  Simply ask LA to have telemedicine added to your incident, and they will send it to the telemedicine MDC.  The NP will review the call and open a telemedicine call to your tablet, usually within 60 seconds.  Once you answer, a Zoom call is opened.   When the NP is on another call, then the telemedicine call goes to the Medical Director on duty (Drs. Kazan, Kashani, or Gupta).  Understand, the NPs and Medical Directors are NOT bound by Reference 845 and therefore can prescribe medications and even contact the patient’s primary care doctor to arrange a follow up appointment if needed.  The telemedicine team is devoted to help keep minor patients in their homes and to help refer appropriate mental health patients to psychiatric urgent care centers.  There is no question that telemedicine will play a huge role in the future of EMS, so give it a chance so we can continue to refine it here.
 
In closing, we are doing an OUTSTANDING job given the circumstances we are dealing with.  We are not perfect and no one expects us to be.  This is just a little reminder to document what you do, what you see, and what you hear to protect yourself, your crew, and your Department.  Keep up the good work. 
1014 Blood Drive

Finally, we would like to remind you that we are hosting another blood drive! The Red Cross is experiencing a severe shortage of blood due to the COVID-19 pandemic which has not only limited donors but also available sites for blood drives. 


This drive will be open to the public but by appointment only. No walk-in accepted. We also require donors to fill out an online form in advance, wear a face covering or mask for your appointment, and adhere to our social distancing requirements. 

Schedule Your Donation Here
As always, stay safe and take care of each other. 

In Solidarity, 

President Dave Gillotte and the Local 1014 Executive Board 

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