New and winning strategies for EMS leaders.
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DIGITAL EDITION: Read it Anywhere! EXPERT ADVICE Community Life Support Is a New Approach for Better Survival Rates Improving survival from witnessed out-of- hospital cardiac arrest is largely dependent on reducing the time interval between col- lapse and intervention. Notice that I did not say the 9-1-1 call received to arrival on scene time. A respectable four-minute medi- cal first response time interval does not tell even half of the story. You need to add the time intervals from collapse to placement of the 9-1-1 call, and 9-1-1 call received to unit notification before the unit goes en route. Once it arrives, there is time from on-scene arrival to patient contact, and from patient contact to making that first intervention (i.e., chest compressions or defibrillation). That’s how a respectable four-minute medical first response time interval, typically measured from the unit en route to scene arrival, col- lapses to an intervention interval closer to eight-and-a-half minutes (see Figure 1). This much elapsed time is not associated with high survival rates. The challenge for EMS leaders is finding ways to get interven- tions started sooner. Increasing the percentage of the general population trained to provide CPR is worth- while. Having a strong emergency medical dispatch program for coaching 9-1-1 callers to provide CPR via pre-arrival instructions is important. Encouraging the distribution of more public access defibrillators can also help. The problem is that despite all such efforts, they aren’t engaged very often. It’s probably too expensive for most com- munities to build enough additional fire or ambulance stations to make a significant difference in the response intervals to wit- nessed cardiac arrest cases. So what else is there? A new idea being is considered in several communities, called Community Life Support. The premise is that other resources in the community may be willing to aid a wit- nessed cardiac arrest victim if such efforts can be appropriately managed. Envision a scenario in which an emer- gency medical dispatcher identifies a case of witnessed onset cardiac arrest. Simultane- ous with coaching the caller to initiate chest compressions, a new layer is displayed on the map of the computer-aided dispatch (CAD) screen. In addition to the unit(s) responding to the scene, additional icons show the loca- tions of nearby: s ,AW ENFORCEMENT UNITS s $ELIVERY TRUCKS E G &ED%X 503 5303 s -EDICAL COURIER VEHICLES AND s -UNICIPAL STAFF VEHICLES All of these vehicles belong to organiza- tions that volunteered to participate in their local Community Life Support program. Some of these vehicles may also have been equipped with AEDs. The idea can be extended further. Envi- sion a scenario that also includes the display of icons for off-duty EMS and other medical personnel that have opted in to participate. Could a process be created to train and vet others—from CERT programs, neighbor- hood watch and homeowners associations? Perhaps, but patient safety and security must be protected with appropriate screen- ing of participants and other safeguards in the process design. The enabling technology behind this idea is the widespread availability of smartphone GPS technology and software apps that can leverage it. Envision an app that alerts you if you are in proximity to a witnessed onset Figure 1: Collapse to Intervention Time Interval Breakdown Mic Gunderson is the mod- erator of NAEMSP Dialog and president of the consulting firm IPS. He served on the editorial board of and as an editor for several NAEMSP textbooks. 6. 6 UNLAWFUL TO COPY WITHOUT THE EXPRESS PERMISSION OF THE PUBLISHER. APRIL 2011 EMS INSIDER Figure 2: Collapse to Intervention Time Interval Breakdown Step Onset of arrest to calling 9-1-1 Call received to closest unit notified 5NIT NOTIlED TO EN ROUTE En route to arrival on scene On scene to patient arrival Patient arrival to CPR started or first defibrillation Total cardiac arrest. The app could also tell you where the closest defibrillator is. The CAD would direct those closest to the victim to go to the scene to start CPR. Those closest to the defibrillator may be directed to get it first and then go the scene. The key to securing and maintaining the participation of the organizations and individuals who opt-in may be limit- ing the number of alarms. That is why the program is being considered for just-witnessed arrest cases, where the incidence is low and their interventions have the best chance of making a dif- ference. Too many responses with too many non-viable cases will likely dis- courage participation. There will undoubtedly be a wide range of issues to work through to make this idea operational. Such issues may include: s !PPROPRIATE SCREENING AND TRAIN- ING OF NON MEDICAL PERSONNEL s 0OPULATING THE APPS WITH THE LOCA- TIONS OF ALL AVAILABLE DElBRILLATORS s ,IMITING THE NUMBER OF RESPOND- ERS TO A REASONABLE LEVEL AND s )NTERFACING THE APP TO THE #!$ There are many reasons why such a program might not work—but I think that if an EMS system wants to get seri- fyi 4. 5. 15 Things Not to Do On Facebook This past month in Baltimore, EMS Today Conference & Exposition attendees packed a session titled, “Fired for Facebook?: 15 Common Sense Principles to Help Keep Your Face on Your EMS Agency’s Profile.” Steve Wirth and Doug Wolfberg of the EMS law firm Page, Wolfberg & Wirth offered the following tips for staying out of Facebook trouble: 1. Don’t post inappropriate pictures of yourself or others; 2. Don’t post pictures or make comments about patients; 3. Don’t complain about your job, supervisors or coworkers; Don’t post conflicting information about your creden- tials or résumé; Don’t lie about your profile information or lie in your postings; Don’t post statuses you wouldn’t want your boss to UNLAWFUL TO COPY WITHOUT THE EXPRESS PERMISSION OF THE PUBLISHER. EMS EMS INSIDER APRIL 2011 Step Time Interval 60 seconds 30 seconds 60 seconds 240 seconds (4:00) 60 seconds 60 seconds Cumulative (elapsed) Time 60 seconds (1:00) 90 seconds (1:30) 150 seconds (2:30) 390 seconds (6:30) 450 seconds (7:30) 510 seconds (8:30) 510 seconds (8:30) ous about trying to improve their sur- vival rates from cardiac arrest, that old saying will apply—where there’s a will, there’s a way. Discussions about Community Life Support programs are still in the very early stages in several communities, INCLUDING 0INELLAS #OUNTY &LA -EMPHIS 4ENN AND +ENT #OUNTY -ICH Note: The San Ramon Valley Fire De- partment recently released an app that notifies lay CPR providers of a nearby SCA and also directs them to the near- est AED. See “Fire Department (SCA Alert, AED Finder),” this issue, on p. 9. see; 7. Understand and check your settings; 8. 10. 11. Don’t accept or “troll” for “friends” who aren’t really friends; 9. Don’t post things while engaged in work activities; Don’t make statements about others that can lead to defamation or slander claims; Don’t violate copyright laws or misuse other peoples’ stuff; 12. Don’t share confidential or proprietary information; 13. Don’t “trash talk,” pick fights or harass others; 14. Avoid politically charged statements or statements that indicate “biases”; and 15. Correct your mistakes! “It’s kind of a free for all out there these days,” Wirth told attendees. “Ultimately only you have responsibility for what you post.” —Jennifer Berry MAY 2011 VOLUME 38 NUMBER 5 Changing Hands Is the move to private equity firms a bad thing for U.S. ambulance companies? 7 So far this year, two of the largest private ambulance companies in the U.S. are being purchased by private equity firms, and two regional ambu- lance service providers have been purchased by a global player that boasts it’s the largest private ambu- lance services provider in Europe. According to industry insiders, this isn’t your typical buyout. This is a potential game-changer for EMS service in this country. Typically, when a buyout occurs, the acquiring company takes one of two paths. Either it breaks up the company it purchased and sells off the pieces for cash, or it holds onto the company, betting that it—and the industry it represents—is on the leading edge of a financial wave. “I believe that the private equity firms are looking at private ambu- lance companies as being at the base of a wave,” said Kittitas Valley Fire and Rescue Fire Chief John Sinclair. Sinclair is a long-time, active member of the International Association of Fire Chiefs (IAFC) EMS Section and the section’s inter- national director. Sinclair said the potential growth is spurred by several dramatic mar- ket shifts. The first is the addition of an estimated 34–40 million peo- ple to the insured ranks thanks to healthcare reforms. Many people who had been covered by Medicaid programs and, thus, under-insured, FICEMS Asks for Comments Report on federal role in EMS due May 15 The Federal Interagency Commit- tee on Emergency Medical Services (FICEMS) held a stakeholder tele- conference April 11 to receive input on whether to establish a lead fed- eral agency for EMS. The resound- ing answer was “yes.” Further, the lead agency should be within the healthcare system. FICEMS was established in 2005 by the U.S. Department of Transpor- tation to help ensure coordination among federal agencies involved with state, local, tribal and regional EMS providers and 9-1-1 systems. The April 11 meeting was the last of several seeking input on the topic. The first, which was held Dec. 16, assessed the current and future role of the federal government in EMS. Another meeting was held in March at the EMS Today Confer- ence & Exposition in Baltimore. The April meeting was the final opportu- nity for stakeholders to provide ver- bal input before an options paper is developed and delivered to the National Security Staff Resilience Directorate by May 15. The April meeting was moder- ated by FICEMS Chair Alexander Garza, MD, MPH, assistant secretary CONTINUED ON PAGE 6 will be switching to insurance poli- cies that provide higher reimburse- ment rates—a potentially positive outcome for EMS transports. Second, the first of the baby boomer generation reached retire- ment age this past year. Over the next 15 years, 78 million Americans will reach retirement age. “We know that when people retire and don’t remain active, they begin to have health problems,” Sinclair said. “As a result, there’s a demo- graphically significant infusion over CONTINUED ON PAGE 4 New & Winning Strategies for EMS Leaders INSIDE 2 MEDICAL DIRECTOR ENGAGEMENT 6 NATIONAL PREPAREDNESS POLICY 7 FIELD EMS BILL UPDATED 8 COLUMBUS EMS & SOCIAL SERVICES 10 RESEARCH WORTH READING FYI 5 Questions about Radiological Risk 9 Federal Budget Cuts Read the latest issue on your mobile device, smartphone, or iPad, with new download options and features. Quality content is always within reach. START YOUR SUBSCRIPTION TODAY! EMS Medicine Prehospital Emerg enc y