February 2004 Vital Signs

Former Paramedic Named ACEP President-Elect

Robert Suter, DO, MHA, FACEP, emergency department medical director at Spring Branch Medical Center in Houston, TX, and a partner in Greater Houston Emergency Physicians, has been named president-elect of the American College of Emergency Physicians (ACEP). Suter is the first physician to serve in this role who has worked full time as an EMT and paramedic.

Suter's EMS career began as a teenager when he volunteered on a search and rescue squad in St. Charles, MO. He then worked as an EMT and later as a paramedic in St. Charles and St. Louis Counties, where he worked part time until he graduated from medical school. He completed his residency in emergency medicine at the Joint Military Medical Centers in San Antonio in 1993, was elected to ACEP's Board of Directors in 1999, and was re-elected in 2002. In 1993, Dr. Suter was appointed to work with NHTSA as the physician co-chair of the group that developed the EMS Agenda for the Future—a document that lays out basic strategies for ensuring the future viability and community value of EMS systems.

Suter is confident his new position will strengthen ACEP's relationship with prehospital providers. "ACEP has been dedicated to sustaining an excellent relationship with EMS personnel and EMS organizations, but there is always room for improvement," he says.

"For example, ACEP is the originator of EMS Week and has always put a lot of resources into sponsoring it. They are very positive toward EMS. I hope my presidency will reinforce that and personalize it, so the EMS community can see that one of them rose to the top of the organization."

Many of ACEP's objectives include areas of great importance to prehospital providers, says Suter. Some of these include: professional liability; ED overcrowding that results in ambulance diversions; quality and patient safety; and reducing errors in emergency care. "Those are objectives that should hit home in the EMS community and things we can work on together," he says. "They are areas that, in my position as president, I will look for EMS input on."

—MN

PAD Trial Shows Benefit to Public-Access Defibrillation

Public-access defibrillation makes sense on an intuitive basis—placing defibrillators in public venues and training people to use them seems like it should save lives. Now the results of the largest-ever study of the issue bear that out.

Installing AEDs at public sites and training volunteers to perform CPR and use them roughly doubles the number of victims who survive sudden cardiac arrest episodes in such environments, according to a National Heart, Lung and Blood Institute-funded study presented in November at the American Heart Association's Scientific Sessions in Orlando, FL.

For the Public Access Defibrillation (PAD) Trial, AEDs were placed at nearly 1,000 North American community sites (apartment complexes, shopping centers, office buildings, sports arenas) identified as having the potential for a large number of cardiac arrests, and approximately 20,000 volunteers were trained in CPR or CPR and using an AED. Subsequent SCA victims at these sites received either CPR and AED treatment on-scene, or just CPR, before the arrival of trained medical responders. They were then tracked for survival to hospital discharge. Of the CPR/AED cohort, 29 survived to that point. Of the CPR-only recipients, 15 did.

"This study shows that lives can be saved by training community volunteers to use external defibrillators," acting NHLBI Director Barbara Alving, MD, declared.

In both groups, a majority of victims were white men in their late 60s/early 70s. Increased survival was seen more in truly public sites than in residential settings, where the AEDs did not seem to make as much difference. There were no major injuries incurred or safety issues for the volunteers, who received 2-4 hours of initial training and, in many cases, refresher training as the study progressed.

Additional information from the trial—including long-term survival rates, quality of life and mental function of survivors, and cost—is still being analyzed. Meanwhile, the NHLBI is funding an ongoing 7,000-patient study to see if providing AEDs to the families of heart-attack patients can improve SCA survival rates in the home.

—JE

NAEMSE Introduces New Educator Course

After finding a wide range of instructor training across the country, from states that offer 140-hour courses to states that require little to no formal training, the National Association of EMS Educators (NAEMSE) has developed its first-ever EMS Educator Course.

The course was designed by some of the same national faculty who served on the task force for the DOT/NHTSA 2002 National Guidelines for Educating EMS Instructors, says NAEMSE's Managing Director, Joann Freel. It provides a basic introduction of concepts for beginning EMS educators.

"It's an interactive, four-day course that takes students through the different aspects of what it means to be an educator, from presentation styles and learning styles of adults to domains of learning," she says. "There are many activities and handouts, and a post-test is given at the end. All participants are required to participate in an online component before they come to class, and the post-test includes questions from it. Students currently receive a certificate saying they've completed the course. Our goal is to have a certification program by 2005.

"We're working hard to raise the bar on professionalism," Freel adds. "If we want salaries that are commensurate with experience and education, we can't just say, 'I'm worth it; pay me.' Once people can say they're a certified EMS instructor, it will help with their reviews and, hopefully, result in a better salary and benefits. That's one aspect of it. But they also gain the education and knowledge that they can teach a class to the best of their ability."

Instructors will not be required to take the NAEMSE course, says Freel. The organization is working with state directors and training coordinators to develop a reciprocal arrangement whereby certification can be earned through either NAEMSE or a state-approved instructor educator course.

The new course was tested on 130 students during NAEMSE's 2002 annual conference in Portland and repeated in New Orleans in October 2003 to great reviews, says Freel. The first class of 2004 was held in Ontario, CA, and plans are in the works for New York State, Ohio and northern California.

For more information on the course, visit www.naemse.org or call 412/429-9550.

—MN

Coast Guard Looking for Healthcare Providers

Due to the demands of the "new normalcy" and the war in Iraq, the Coast Guard's manpower requirements have increased exponentially. To fill the gap, the Coast Guard is looking for volunteer healthcare professionals to provide health services to members of the Coast Guard family in their own community. Members of the Coast Guard or Coast Guard Reserve require yearly checkups, which can be done by local health professionals, rather than have them drive to a Coast Guard health facility. Volunteer auxiliarists will be asked to donate two days per month, and must submit documentation of training and experience. Physicians, dentists, physician assistants and nurse practitioners will need to have their credentials vertified and request clinical privileges.

Interested EMS providers should read the rules and regulations for the program, found at www.uscg.mil/hg/G-W/g-wk/g-wkh/g-wkh1/Pubs/COMDTINST 6010.2.pdf and follow the application procedures in the document, or call Richard Lavy, MD, CG Auxiliary at 800/842-8740, ext. 7-0410, 202/267-0410, or email RLavy@comdt.uscg.mil.

—MN

Personal Protection Against Airborne Pathogens Curriculum Available

The New Hampshire Department of Safety, Bureau of EMS, in cooperation with the NH Department of Health & Human Services and a multidisciplinary work group has developed an educational program to enhance EMS providers' knowledge of respiratory communicable diseases and improve their ability to protect themselves against airborne pathogens.

During the winter months, with the return of the flu season and an increase in respiratory diseases, including the potential return of SARS, more attention is being placed on protecting EMS providers and their patients by practicing good infection control techniques. The Enhancing Personal Protection Against Airborne Pathogens curriculum helps promote a greater awareness for EMS responders at all levels about using facemask and eye protection when treating patients with any type of respiratory illness.

The curriculum is a PowerPoint presentation that may be downloaded from the Preparedness Section of the NH Bureau of EMS website at www.state.nh.us/safety/ems.

—MN

Michigan System Lets EKG Data Beat Heart Patients to Hospital

Keith Wasson couldn't have timed his heart attack much better.

When Wasson, of Southfield, MI, called 9-1-1 on October 1, 2003, he became the first beneficiary of a new system by which Southfield Fire Department paramedics can digitally transmit EKG readings from the field ahead to the city's Providence Hospital. This allows physicians in the emergency department there to diagnose the patient's condition and prepare for treatment as the patient is being transported, thus saving valuable time upon his/her arrival.

Using Lifenet technology from Medtronic Physio-Control, Southfield medics send high-resolution 12-lead EKG data that are received on a special station and viewed in real time. If a heart attack is diagnosed, cardiology staff is alerted, allowing them to get treatment teams assembled and ready to perform an angioplasty as soon as the patient arrives.

From the time Wasson called 9-1-1, his artery was unblocked in just 59 minutes.

"We activate the cath lab team as the patient is leaving the house, so they bypass the ED completely and go right to treatment," says the hospital's chief cardiologist, Shukri David, MD. "In the first three cases we've seen, from the time they hit our ED door until the artery was opened was, on average, 29 minutes."

Previously, Southfield medics had only been able to send one- or two-lead rhythm strips. The hospital's Heart Institute worked with paramedics from the Southfield FD to study Lifenet's capabilities this summer, and subsequently became the first in Michigan to utilize the technology.

Three hospitals in surrounding Oakland County perform emergency angioplasties, and the hope is that MI patients, their condition remotely confirmed as they're in transit, can be transported directly there, saving the time that's so crucial to their outcomes.

"There are small hospitals in Oakland County that will see you and take care of you and do a good job, but then they'll have to transfer you to get definitive treatment. All of that is time wasted," says David. "We hope to develop these designated heart attack centers and start using more of this type of technology to refer these patients directly to them."

—JE

Secrets to Success: Education, Retention, Customer Service

It may not have the magic bullet that will end attrition and retention problems in EMS, but with an annual employee loss rate of just 1.72%, Texas' Williamson County EMS must be doing something right.

The department also has a budget that steadily grows, attracts quality EMS providers without recruiting and frequently turns out high-achieving up-and-comers. Small wonder it's garnered so much recognition.

"Above all else, we demand and expect quality customer service," says the agency's director, John Sneed. "And that's not just what we provide for our patients, but what we provide for each other, for other agencies—whomever we come into contact with."

In 2003, Williamson County was named NAEMT's Paramedic Emergency Medical Service of the Year. That honor is the latest in a long line for the agency, following the Texas Department of Health's 2002 Best in State for Public Education and Injury Prevention Award; 2002 Medical Director of the Year; 1997 Administrator of the Year; 1995 Best in State for Administrative Excellence; and 1994 Public Provider of the Year.

Among the unique aspects of the service is its emphasis on education. Sneed and other top officials have academic backgrounds and have infused education as an agency-wide value. The medical director rides out regularly to emphasize calls as learning experiences, and WCEMS has arranged its work rotations to ensure its people have time for academic pursuits. Of its 93 full-time paramedics, 11 work a set weekly "school" schedule (24/48 shifts M/F, Tu./Th. or Wed./Sat. plus every third Sunday) to facilitate continuing education. In addition to its own paramedics, the agency also develops continuing-education curricula for 18 county first responder groups.

"Our top-level administration recognize that for us to be successful, we have to focus on education," says WCEMS' Clinical Education and Outreach Coordinator, Louis Gonzales. "We feel it's only fair to our staff to give them the knowledge and skills they need to do the job we're asking them to do."

That commitment to education is a factor in WCEMS' enviable retention rate. The agency has affiliations with a pair of local colleges and holds preceptor training classes using their EMT and paramedic students. That lets WCEMS leaders see who the most promising students are and, once they graduate, bring them aboard.

"We see them early in their educational phases, and see how quickly they learn and how they interact with people," says Gonzales. "We get a good idea what their abilities and knowledge levels are, and that plays a real role in hiring for us."

Also rare is the department's financial health. Its budget has increased every year despite an economic downturn and falling tax revenues in its area. WCEMS is active in billing and grant-seeking, but community support is also strong. The agency stays visible to its constituents through initiatives like child safety seat inspections; Shattered Dreams, which demonstrates the dangers of drinking and driving to high school students; and an emergency-contact program for families of small children.

"We're fortunate to be under a county government that supports EMS," says Sneed. "We feel the best way to educate the commissioners is to go out and do a great job, then let the public tell them we're doing a great job. Through practicing good medicine and demanding quality customer service, we really have not had a huge problem in funding."

If there's a lesson for other agencies in Williamson County's success, it's this: Customer service is about more than just good patient care.

"Almost everybody provides quality patient care—if they didn't, they wouldn't be in business," says Sneed. "But sometimes where folks can miss the mark is customer service. If you provide quality customer service—from patients to first responders to hospitals to staff—and truly buy into that and make it what your system does, that will make the difference."

—JE