County EMS Medical Director Dr. Gregory Kann

Tune in to the latest episode of County Conversations and discover the groundbreaking work happening at Sacramento County Emergency Medical Services (EMS).

Join host Kim Nava as she speaks with Dr. Gregory Kann, Medical Director for Sacramento County EMS, to learn about innovative initiatives revolutionizing emergency care in the region.  Dr. Kann discusses the agency's mission to provide world-class prehospital healthcare efficiently and effectively.

Episode Transcript

(00:06):
Welcome to
Sacramento County podcast seriesCounty conversations.
I'm your host, Kim Nava.
Today we're here with doctorGregory Kan, medical director
for the SacramentoCounty emergency medical Services, or EMS.
Welcome, Doctor Khan,and thank you so much for being here.
It's great to be herethis morning. Wonderful.
So can you start

(00:27):
just by telling us about your agencyand what your role is at E.M.S.?
Sure.
So I'm the medical directorfor Sacramento County,
for the EMS Emergency Medical Services.
So we are a organization which is tasked
with providing the regulatory oversightfor our emergency

(00:48):
medical services, primaryfor first responders for the community.
Okay.
So we have a mission of providingthe folks who live in Sacramento
County with world classpre-hospital health care,
and doing so in an efficientand effective manner,
and use those resources that we havein the best way possible.

(01:09):
Well very good.
Well, that that's a great segueto some things I wanted to ask you about.
First of all.
So this month, EMS is launching the triage
to alternate destinationand or Tad program.
Can you talk about this programand how it will change the way
emergency services handle behavioraland mental health cases that you see?

(01:32):
And how will this
change impact people's experience ofif they need emergency medical services?
Absolutely. This is a great question.
So this is a programthat we've been working for a long time
to try to stand up here in South County.
So trash alternate
destination gives us the abilityto take certain patients who don't need
an emergency department directlyto the type of care that they need.

(01:53):
Okay.
So that through some legislative activityacross the state,
emergency medical services
agencies up and down Californiahave had an opportunity to to stand up,
triaged alternate destination programsthat deal specifically with people
who are in psychiatric crisisor people who have a sobering need.
So intoxicationfrom alcohol or substances.

(02:16):
And these folks generallydon't need an emergency department.
So in historically, if you call 911and you're suicidal or if you're having
a psychiatric crisis, you would be broughtto an emergency department.
And as a as a current emergency physicianhere in Sacramento County, I can say that
that wasn't always the best placefor people like you can imagine.

(02:39):
Somebody who's in crisis coming into ainto a busy, active emergency
department where there's traumas and heartattacks and strokes and everything else.
That's not a calm and supportive
and healing environmentfor those types of patients.
It doesn't offer the type of specializedcare.
Exactly. Right. Exactly right.
So as an emergency physician, I do whatwhat I, what I think is best, and I work

(03:02):
and I try to help these patients as bestI can, but I am not a psychiatrist.
I'm not somebody who
specialized in and managingthat type of a patient presentation.
So by standing up,trying to alternate destination,
what it allows us to dois for specially trained paramedics
who are accredited for triagedalternate destination,
through some additional trainingthat we provide here in the county

(03:24):
to be able to assessa patient in the field, understand
what their needs are,ensure that they're stable
and they don't have another medical needthat they would need to see me for.
And and if they're stable,they can take them directly
to one of our psychiatric urgent cares,where they can be evaluated by a
psychiatric professional and get the carethey need at the time they need it.

(03:46):
So we we also know that folks that come
to our emergency departmentsfor psychiatric care, in particular,
they spend an inordinate amount of timein the emergency department.
So if somebody comes in who just needs
to speak to a therapist,maybe have some medications adjusted,
they can spend hours to daysin an emergency department.

(04:07):
And that gets back to my earlier statement
that this is not a supportive environmentfor them.
You can imagine you or I wouldn't
want to sit in a hospital bedin the Ed for days on end.
So by being able to get them to the carethat is appropriate at that time,
they can get the care that they needand and start healing faster.
So this is something that is goodfor all patients for the patients

(04:30):
that get the specialized care,
that can go to a centerthat can address their needs.
And also folks who are coming intothe emergency department,
they can be seen soonerbecause other folks are steered.
Absolutely, absolutely.
This has a ripple effect all the waythrough our health care system.
So in in historically,those those bed spaces would be taken up

(04:51):
with, with patients in psychiatric crisisif those beds are available.
Now all of a suddenwe have a place to offload ambulance
patients that are coming in.
So I knowwe're going to speak about ambulance
patient offload times,which is near and dear to my heart.
And also if you'recoming in the front door of the E.D.,
so if you have chest painor if you have stroke symptoms,
or if you think you have an infectionor some other emergency situation,

(05:14):
you're going to get a bedthat much quicker.
If those bed spaces are available.
And then the people again,
going back to the peoplethat are there for a psychiatric crisis,
they're going to they're going to begetting the care that they need,
not in the emergency department,which is better for them ultimately.
Right.
Well,
thank you
for saying something about a pod,
because you've been reallyon the forefront of that.

(05:35):
So first of all,I want to mention what a pot stands for.
It's ambulancepay ambulance patient offload times.
And so can you give a brief description
of what a pot mean meansand then describe how the county
is leading the wayin reducing these times.
You know, sowe're very proud about this particularly.

(05:56):
So ambulance
patient offload times is so you canyou can imagine a patient calls 911.
They're brought to an emergency departmenton on in an ambulance.
And they're on an ambulance gurney.
And they're broughtinto the emergency department.
They're registered.
And the time from themarriving at the emergency department
to the timewhere that patient is physically removed
from the ambulance gurneyand put onto an emergency department bed

(06:18):
and care is transferred overto emergency department staff.
That is that is the time that is ambulancepatient offload time.
We have targets in Californiaand specifically in Sacramento.
Now we're running on a 30 minute targetfor that transfer of care to occur.
But traditionally or historicallySacramento has not been very good at this.

(06:40):
And we've had we've had some some very,very long ambulance patient offload times
where patients would arrivein the emergency department,
they wouldn't be transferred overto emergency department care,
and they would sit on the ambulancegurney in a hallway,
just waiting for that care to take place.
So you can imagine that the patientthat has an emergency medical condition,
like chest pain,

(07:01):
or maybe they're having a stroke,or maybe they've got a serious infection.
They're sitting on an ambulance gurneyjust waiting,
and they're not havingthat issue addressed.
So there's notthere is a patient care question.
There is is are we delaying patientsgetting the care that they need
when they're sitting on a wallin an ambulance?
Patient offload delay situation.
So we tackled this programessentially day one,

(07:24):
when I came on board at SACCounty EMS back in 2003 or 23
and and because we knowwe recognize that this was an incredible,
I think, hurdle or opportunityfor Sacramento to try to get better.
Right.
So through a whole host of of innovationsand and opportunities to engage
with different stakeholder groups,

(07:46):
we've been able to gofrom really the worst in the state
to one of the best in the state.Absolutely.
We we have right now,six of our, of our local hospitals
are compliant with the, the state statutefor ambulance patient offload times
and the ones that aren't compliantare within actually
withinshooting distance of getting compliant.

(08:06):
Very close.
So there was a lot of work you had to dowith our local hospital systems.
Right. To to get to this, this moment.
I think I read somewhere that beforeit was the average was maybe over an hour.
And now we've we've really come downthanks to your efforts
and, and working in partnershipwith our hospitals.
Yeah. And this and this is a team effort.
You know, I think I sit at the forefrontof, of the SAC County EMS agency.

(08:30):
So I, I tend to havea lot of conversations
and people thank me for this work.
But this is not just me.
You know, this is a team effort.
This is all of the emergency departmentstaff at all of our local hospitals.
This is all of our EMS providerslooking for innovations
and how they can get patients offthe gurney quicker.
I thinkwhen when we shine a light on this issue,

(08:51):
we were able to really highlight kindof areas of opportunity, highlight areas
where we were missing the markand to and to do some innovative things.
I, you know, I point to
some of our local hospitalsthat have dedicated ambulance patient
offload areas where they have dedicatedstaff to that endeavor.
These are these are some really lowhanging fruit interventions

(09:13):
that have paid off in in incredible waysand are being looked at by our peer
agencies up and down the state.
Well, Sacramento County certainly
has received recognition as a leaderin these kinds of improvements.
And so just overall,what would you say we're doing differently
from other counties and how are we settingthe standard for emergency

(09:34):
medical services in the state? Sure.
I think that we we've donea really good job
of bringing everybodythat is involved in emergency care.
So that's not only our pre-hospitalproviders, but our emergency departments
and our hospital administratorsand the folks that deal with patients.
When you're admitted to the hospitaland and bringing everybody together

(09:54):
with an understanding that we're all partof the same health care team,
and that if any one
kind of phase of patient care is not,
is not where it should be,everybody suffers.
And that's not good for the patient.
It's not good for the overall healthand safety
of our of the folkswho live in, in the Capital region.
And I think everybody's bought into this,into this idea

(10:17):
that we are all part of the same team.
And I think that what we've done at thatcounty EMS
agency is, is really fosteran air of collaboration,
which I think is different than whatwe've seen up and down the state.
We've brought in asome other different collaborators
from some of ourlike from Sacramento State and other

(10:39):
subject matter experts in, in
kind of process efficiency,which, which has allowed us to really open
the doors to some new out-of-the-boxthinking about who touches the ambulance
patient offload time questionand to bring those stakeholders in
and that that's kind of the futureof where we're going is we're looking at
not only the the the patient arrivingin the emergency department

(11:01):
or whatwe can do to innovate in that space.
But we're also looking at
when when a patient's in the hospitaland how they get home.
How do we clear the bottlenecksfor discharge
from somebody who's in the hospital
to going to a skilled nursing facility or,or some post-acute care place?
How do we how do we make it so that those,those pathways are smoother?
The patient that's going home,how do we make sure that they can get the

(11:23):
equipment that they need to go home safelyand to thrive while they're at home?
These are all pieces of the puzzle thatI don't think I've ever been looked at.
And I'm proud that we're doing itin Sacramento County, and I'm hopeful
that we can be a really a modelfor everybody, not only in California
but across the country.
Well, thank you
very much, Doctor Can for that,for the improvements you've made, for what

(11:47):
you're continuing to do for emergencymedical services in Sacramento County.
This is something that touchesevery resident.
And so very appreciativeof what you've done.
Been a leader in the state,and we look forward to more and hearing
about everything else that you're doing.
So thank you again for coming in todayand sharing your knowledge
and your perspective with our listeners.

(12:09):
To our audience.
Thank you so much for joining us.
We hope you enjoyed this podcast,and we hope you'll listen again
as we feature different county departmentleaders throughout our series.
County conversations.
This podcast is produced by Sacramento
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