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Original Contribution

Coalition`s Goal: Slower Traffic, Faster Clearing of Crash Scenes

February 2008

Coalition's Goal: Slower Traffic, Faster Clearing of Crash Scenes
     Top emergency-response organizations have joined with leading traffic-safety groups in a campaign to improve highway safety and efficiency.

     The cornerstone of the effort, which was rolled out for the 2007–08 holiday season, is the National Unified Goal for Traffic Incident Management (NUG for short). Under the NUG, responder organizations pledge to work together to improve communication and coordination at crash scenes, with a goal of minimizing factors that can delay road clearance. In turn, they ask motorists to slow down and move over when they approach incident scenes, hopefully reducing the number of responders hurt and killed by passing vehicles.

     Traffic congestion costs the U.S. around $200 billion a year, Federal Highway Administrator J. Richard Capka said in supporting the NUG, and traffic incidents account for about a quarter of it. For every minute a freeway lane is blocked during a peak travel period, four minutes' delay result after the incident is cleared.

     The effort is being led by the National Traffic Incident Management Coalition. Participating member organizations include the National Association of State EMS Officials, International Association of Fire Fighters, International Association of Fire Chiefs, National Fire Protection Association, National Volunteer Fire Council, National Emergency Number Association and Association of Public-Safety Communications Officials (APCO) International.

     "If you or your family members are involved in a crash, you will depend on our emergency medical system to care for you," NASEMSO's Kevin McGinnis told the public as the NUG was unveiled. "We ask that you, in turn, care for us. We join with other traffic incident responders in asking that you slow down and move over when you see ambulance crews and other responders working at crash scenes."
     For more: https://timcoalition.org.
NTIMC

HOUSE NAMES DAY to honor FFs
     The U.S. House of Representatives has passed a resolution calling for the establishment of a National Firefighter Appreciation Day. Introduced by Rep. John Campbell (R-CA), the resolution was supported by 70 cosponsors and passed by voice vote.

     A resolution is a show of support and lacks the force of law. No Senate action is required on the resolution.

     "Every day, [our] firefighters place themselves in harm's way to protect precious lives and property," Campbell noted.
GAC

CONGRESSIONAL STAFF RECEIVE FIRE TRAINING
     More than 70 Congressional staffers spent a day in November receiving training at the Maryland Fire and Rescue Institute. Under the Congressional Firefighter Training Program, sponsored by MFRI and the Congressional Fire Services Institute, instructors guide attendees through a series of training evolutions designed to improve their understanding of the jobs of the fire service. Later in the month, staffers also did ride-alongs with area fire departments.

     Such programs "can have a profound impact in educating" lawmakers and their staff on emergency-services issues, CFSI executive director Bill Webb said.
CFSI

SAFETY STAND DOWN EVENT REPACKAGED, BULKED UP FOR 2008
     The fire service's annual Safety Stand Down event has been recast into Fire/EMS Safety, Health and Survival Week, and is one of three components of a comprehensive new fire/EMS safety support system developed by the International Association of Fire Chiefs' Safety, Health and Survival section.

     The week will be devoted to reviewing safety policies, evaluating existing initiatives and discussing health and fitness. Fire/EMS personnel are encouraged to use the week to work to correct safety deficiencies within their organizations. This year's event will be June 22–28.

     Other components of the system are a monthly series of bulletins called Take 5 for Safety, to be published on www.iafc.org, and Priority Survival Notifications, warnings for major safety issues that arise during the year. They will be e-mailed to all IAFC members to explain the need to take immediate action.
IAFC

HEART ASSOC. UNVEILS NEW PEDIATRIC COURSE
     A new intermediate-level pediatric course from the American Heart Association, PEARS (for Pediatric Emergency Assessment, Recognition and Stabilization), is aimed at bridging the training gap between those who regularly provide advanced life support for children and those who rarely care for critically ill and injured kids.

     The primary focus of PEARS is prevention of cardiac arrest and respiratory failure. It is designed to help providers recognize certain signs and symptoms of a child in cardiopulmonary distress who urgently needs assistance.

     PEARS is not a prerequisite for PALS, but provides a foundation for it. For more: www.americanheart.org/cpr.
AHA

CALL AHEAD TO REDUCE DOOR-TO-BALLOON TIMES
     A study presented at the American Heart Association's Scientific Sessions late last year bolstered the case that alerting hospitals as early as possible before the arrival of heart attack patients can reduce vital door-to-balloon times.

     Having paramedics activate cath labs as soon as patients are diagnosed lets catheterization personnel and equipment be readied before the patients' arrival, Fouad Bachour, MD, told attendees. Bachour is director of interventional cardiology at Hennepin Co. Medical Center in Minnesota.

     Hennepin medics began doing this in 2005, and found that average door-to-balloon times dropped from 73 minutes to 49 during regular workday hours, and from 94 minutes to 65 after regular business hours.
Hennepin Co. Medical Center

TRAUMA CENTERS SHOW benefit in new study
     Transfers from small-town hospitals to major trauma centers improve seriously injured patients' rates of survival, an Oregon study shows.

     Transporting such patients long distances poses some risk, authors concluded, but it is outweighed by the benefits top trauma centers can provide.

     The transfer decision can be difficult, a Portland trauma surgeon told The Oregonian newspaper; patients' conditions can deteriorate suddenly, and weather and the availability of aircraft, trauma surgeons and beds can impact the process. A previous study from Rhode Island found long delays and that some patients ultimately arrived in urgent need of interventions. More than half of those patients died.

     The Oregon study found that death rates for transfer patients, adjusted for differences in injury severity, were around 33% lower than for patients staying at the smaller hospitals.
The Oregonian

CRASH DATA: SEAT BELTS SAVE LIVES
     When drivers use seat belts, their odds of dying in a multi-vehicle collision are reduced by almost 70%, an analysis of 2006 traffic data concluded.

     Farmers Insurance announced the findings after reviewing federal crash-fatality statistics and analyzing factors such as road and traffic conditions, time and location, driver demographics and vehicle specifics and safety features.

     Other conclusions: Dry roads reduce the risk of fatality by more than 10% over wet ones; nighttime and winter driving have more deadly accidents; and larger vehicles such as trucks, vans and SUVs appear to protect drivers better than regular automobiles.

     For a copy of the study, e-mail kevin.mabe@farmersinsurance.com.
Farmers Insurance

FFS GET CRASH course in new vehicles
     Fire groups and educators in central Pennsylvania got together to train around 50 York County firefighters in working safely with new vehicle technologies at a special session in North York last December.

     Hybrids and other new higher-mileage vehicles are increasingly common on U.S. roads and can pose risks to emergency responders. Providers should know how to work safely at scenes involving these vehicles, program architects say.

     The program was conducted by the borough of North York, the York County Fire School and three local fire departments. The York Water Co. contributed a hybrid gas/electric vehicle for their use. Such vehicles should be turned off before rescue/treatment of occupants begins, attendees were told, as they can carry voltages up to 700 volts.
York Dispatch

MODEL STATE EMS SYSTEM DOCUMENT COMING SOON
     The National Association of State EMS Directors has contracted with NHTSA's Office of EMS to develop Model State EMS System document for systems in the U.S.

     The document, currently under development, will describe a model state EMSS plan and provide a self-assessment tool. Though managed by NASEMSO, the effort will entail collaboration with other EMS stakeholders and federal partners.

     A draft is available at www.nasemso.org.
NASEMSO

NEMSMA NAMES BOARD
     The National EMS Management Association (NEMSMA) has named its Board of Directors for 2008–09. Raphael M. Barishansky, executive director of the Hudson Valley Regional EMS Council in Newburgh, NY, assumed the group's presidency on January 1. He is a frequent contributor to EMS Magazine and a member of its editorial advisory board.

     Returning NEMSMA board members are Darryl Coontz, Skip Kirkwood, Gary Wingrove and Bill Dunwoody. New members are Troy Hagen, H. Larry Roberts and Forrest "Woody" Wood, Jr.

     Several new projects will be announced soon, Barishansky said.
NEMSMA

PA Interop Conference Brings Together State & County Agencies
     By James Careless

     It was billed as the 2007 Commonwealth of Pennsylvania Statewide Interoperability Summit. But what this one-day event really amounted to was a meeting of minds between state and county communications officials, says Charlie Brennan, deputy secretary of Pennsylvania's Office of Public Safety Radio Services. "Our goal was to bring everybody together to talk about PA-STARNet, the Commonwealth's statewide interoperability plan in the 800 MHz band. It worked: Over 200 public safety officials attended from the state and county levels, for a wide-open discussion of what we're doing and what we can provide to them."

     Held on June 14, 2007, in State College, the Statewide Interoperability Summit was spurred by the Commonwealth's receipt of a $34 million grant from Homeland Security. The grant is drawn from a $1 billion program, aimed to funded interoperability projects nationwide. In return for receiving the $34 million, the Commonwealth had to actively reach out and listen to the counties it plans to serve with its statewide interoperability network. Fortunately, this is precisely what Charlie Brennan wanted to do. "A lot of money has been wasted in other jurisdictions on interoperability efforts; in part because the project leaders have dictated to the stakeholders," Brennan says. "Our approach is different: We want to aid our county partners in doing their jobs, not tell them what to do. We also want to help in ways that won't necessarily cost them money, which always appeals to them."

     Based on feedback from the Summit's 200-plus attendees, this approach sat well with the counties. "It was clear they were happy not having things shoved down their throats," Brennan says. "They are also eager to improve their interoperability options, and are supportive of our focus on interconnecting 911 centers, rather than trying to put everyone on the same radio network." The real fruits of the Summit will be seen in future months, when PA-STARNet is fully rolled out and operational. For more on PA-STARNet, visit www.radio.state.pa.us.

James Careless is a freelance journalist with extensive experience covering public-safety communications issues.

GRANT FUNDS INCREASED IN FY08 OMNIBUS APPROPRIATIONS BILL
     A wide-ranging appropriations bill passed by Congress just before Christmas directs FEMA to examine and report on EMS disaster preparedness capabilities and instructs it to require state and local governments to include EMS in their Statewide Homeland Security and Urban Area Security Initiative (UASI) plans.

     The $550 billion omnibus appropriations package, which covers fiscal 2008, requires FEMA to report back on what's required for EMS to meet current national preparedness goals. It also contains three-quarters of a million dollars in funding for the National EMS Information System, which had initially been given nothing in House transportation appropriations. The Senate had assigned $1 million for the program in its version of the bill, Advocates for EMS reported, but it called the final negotiated amount "a huge success" because NEMSIS did better than splitting the difference.

     Funding for the Assistance to Firefighters and SAFER grant programs is increased under the bill: The SAFER (Staffing for Adequate Fire and Emergency Response) program, designed to help emergency services provide more front-line personnel, gets an additional $75 million, and the AFG (FIRE Act) program an extra $13 million. Spending on UASI grants rises by $50 million, on Emergency Management Performance grants by $100 million, and there's even a hike of $7.5 million for federal USAR teams. Interoperable communications grants, not funded in FY07, get $50 million this time around.

     Overall, first responder grant programs will receive $4.1 billion in FY 2008, an increase of $693 million over fiscal '07.

     President Bush was expected to sign the bill into law.
Advocates for EMS; IAFC

Literature Review: ACS Prehospital Delays
     By Angelo Salvucci, Jr., MD, FACEP

     Thoughts, actions, and factors associated with prehospital delay in patients with acute coronary syndrome. Thuresson M, Jarlöv MB, Lindahl B, et al. Heart Lung 36(6):398–409, Nov–Dec 2007.

Abstract
     The authors studied patients' interpretations, thoughts and actions after symptom onset in acute coronary syndrome (ACS) in total and in relation to gender, age, history of coronary artery disease, type of syndrome, and residential area and its influence on prehospital delay. They performed a national survey comprising intensive cardiac care units at 11 hospitals in Sweden. A total of 1,939 patients with diagnosed ACS and symptom onset outside hospitals completed a questionnaire containing standardized questions within three days after admission. Three-quarters of the patients interpreted their symptoms as cardiac in origin, and the most common reason was that they knew someone who'd had an acute myocardial infarction. The majority contacted a family member, whereas only 3% directly called for an ambulance. Interpreting the symptoms as cardiac in origin and severe pain were major reasons for deciding to seek medical care. Approaching someone after symptom onset and the belief that the symptoms were cardiac in origin were factors associated with shorter prehospital delays, whereas taking medication to relieve pain resulted in the opposite. The reaction pattern was influenced by gender, age, a history of coronary artery disease and the type of ACS, but to a lesser extent by residential area. The authors concluded that interpreting symptoms as cardiac in origin and approaching someone after symptom onset were major reasons for shorter prehospital delays in ACS.

Comment
     Treatment of ST-elevation myocardial infarction (STEMI) has been a popular topic over the last several years. Many EMS systems have looked at ways to decrease the 9-1-1-call-to-reperfusion interval by obtaining prehospital 12-lead ECGs and performing prehospital thrombolysis or immediate transport to hospitals with cardiac catheterization capabilities. We are also learning that with extremely rapid door-to-balloon times, myocardial damage is so small that the patient is left with a virtually undamaged heart.

     However, the much more important time interval in determining an outcome after STEMI starts not when the patient calls 9-1-1 or arrives at the hospital door, but with the onset of symptoms. Even with a prompt 9-1-1 response and ultrashort door-to-balloon time, there is a limit to how much benefit a patient will receive if they have already waited hours before seeking medical care.

     An important component in the treatment of ACS is to educate the public on how to recognize the symptoms and what to do when they occur. This study helps us learn what behaviors are helpful (calling a friend/relative) and which are not (taking a medicine and trying to ignore the pain). By designing educational campaigns that promote behaviors leading to more rapid treatment, we can expect to shorten time to treatment, reduce myocardial damage and improve patient outcomes. EMS systems should look to include this in their injury-prevention efforts.

Angelo Salvucci, Jr., MD, FACEP, is an emergency physician and medical director for the Santa Barbara County and Ventura County (CA) EMS Agencies, and chair of the California Commission on EMS.

CALIFORNIA MEDICAL TEAMS SEE ACTION
     California's newest medical resource got its first action in October when a state medical assistance team was deployed to support care of wildfire evacuees in San Diego County.

     The 43-member Cal-MAT team, one of three created by Gov. Arnold Schwarzenegger in the wake of Hurricane Katrina, treated patients, conducted needs assessments at shelters and helped the Red Cross set up a clinic at a major evacuation center, the San Mateo County Times reported.

     The teams are staffed with physicians, nurses and EMS providers. They are dispatched under mutual-aid requests to support local services, and can mobilize within hours and be self-sufficient for up to three days. They can also bring and operate field hospitals with up to 200 beds.

     The team's roster is taken from the federal teams on which California's are modeled. Members have responded to such incidents as the attacks of September 11 and Hurricane Katrina.
San Mateo County Times

NEXT OF KIN REGISTRY
     In the wake of the southern California wildfires, the Next Of Kin Registry (NOKR), a free emergency contact system, is working with the San Diego County Office of Emergency Service and FEMA to help reunite families and assist others who were displaced. NOKR requests that anyone who may have a missing or potentially injured family member register them with the Registry (www.nokr.org). The NOKR securely stores users' personal medical information, emergency contacts and next of kin for use by participating emergency response organizations.

     For more: www.nokr.org.
Custom Coaches Int'l.

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