Putting a Screen on the Door

     There aren't many industries in our world that could stand to have a little less business. But ask your local EMS providers if they'd like to reduce the public's need for their services, and they'll likely give you a resounding "Sure."

     Some excellent content in this issue deals with ways EMS services might do that, and this last space will recognize one more. Gig Harbor (WA) Fire & Medic One offers its constituents an annual Health and Safety Expo at which they can have a range of screenings done, talk to clinicians and take steps to proactively spot and head off problems.

     "We try to identify things you should see your doctor about," says Paul Berlin, MS, EMT-P, the department's medical division chief, who coordinates the event. "Then you can meet with a healthcare professional at the end of the screening process, and they'll give you advice."

     This isn't just a little stethoscope-and-cuff thing; this year it attracted more than three dozen participating vendors, who offered attendees opportunities to check things like blood sugar and bone density, cholesterol and caloric intake, cardiovascular fitness and body mass index, vision and hearing. There were screenings for colon and prostate and breast and skin cancer. Physical trainers, psychological services, insurance advice. Find a red flag, get expert counsel. It's a comprehensive one-stop-health-shop deal, now taken advantage of by around 300 people a year. A number of them have discovered and treated potentially life-threatening conditions.

     "It's our form of fire prevention," says Berlin. "Fire departments have done such a good job at fire prevention, why can't we?"

     The key to success, in this case, was adaptability. This program started more than two decades ago as an endeavor to screen school district employees. The fire department supplemented that with some basic fire- and child-safety education. Local service groups supported it, and the idea worked and grew, but then the school district dropped it, and there was a period of disarray.

     When Berlin took it over a decade ago, he spotted a demographic mismatch: Gig Harbor is an older community. Its patients tend to call 9-1-1 with old-people issues—cardiovascular problems, respiratory difficulties, stroke. To maximize bang for the buck, any prevention activities would better be focused toward diseases and conditions of the aged. Not that little Johnny doesn't need to know how to call 9-1-1, but how about averting grandpa's MI in the first place?

     "Probably 65% of our ambulance transports are paid for by Medicare—that tells you we're an older community," Berlin says. "So this gives us a chance to try and help citizens before they have to call us. We've helped them identify some significant issues. We've had people come through with cholesterols of 200, 300, and they talk with a doctor and change their ways."

     This wide-angle view is a feature of the department's care in the field as well. Gig Harbor Fire & Medic One was the first department in its area to outfit all its engines with AEDs, and the first agency in Pierce County to perform field 12-leads. And it offers a broad range of point-of-care testing with clinical analyzers on its paramedic ambulances. Testing includes sodium, potassium, chloride, BUN, hematocrit, hemoglobin, PCO₂, TCO₂, pH, base excess, anion gap and glucose levels. Providers can also test for troponin-I and BNP, which are reliable markers of acute myocardial infarction and heart failure. With all this information, they can direct patients to cardiac cath labs more expeditiously. For others, having prehospital blood chemistry results available on arrival at the ED means faster triage and treatment. For more on this capability, see Just Point & Click in our August issue.

     Still, the best 9-1-1 call is one that never happens, and the Expo's prophylactic efforts will grow. Screening day has become a huge success; attendees have been known to save and bring last year's test results with them for comparison, to see how they're doing. Attendance has been steady. High-level sponsors (hospitals at the forefront, along with the Gig Harbor Firefighters Association and the union local) and donors now cover essentially all costs.

     There's one last convincing argument for efforts like Gig Harbor's, and it's this: The life you save may be your own.

     "This year, on a personal note, I stopped in to have a skin cancer screening," Berlin says. "The lady grabs my ear and says 'Ooh—gotta look at that.' It's the back side of my ear, I can't even feel anything there, but I go to my doctor and ask him to look at it. He says it doesn't look like much, but he biopsies it. Well, it was skin cancer. And I've since gone and had this skin cancer removed. So did I personally benefit from the screening? Absolutely! And that's just me. How many other people could have a similar benefit?"