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NEMSAC Meeting Examines Maternal Deaths, Rural EMS, Stroke Triage
The National EMS Advisory Council (NEMSAC) held its regular meeting via webcast on March 2–3, 2022. Presentations looked at subjects like reducing maternal deaths; the challenges of providing EMS services in rural, tribal, and frontier areas; and improving stroke triage and transport protocols for EMS.
During her March 2 presentation, “The Need for EMS and Obstetric Collaboration,” Sharon Phelan, MD, professor emeritus at the University of New Mexico’s Department of Obstetrics and Gynecology, examined maternal deaths and how better collaboration between EMS and obstetrics departments might reduce them.
“In many cases of maternal death, the deceased had sought or obtained services from EMS or emergency departments, and based on detailed chart reviews, there were opportunities…to possibly change the trajectory that eventually led to the woman’s death,” Phelan said. “Now, we’re not saying there were mistakes done by the ED or EMS. But they didn’t have the support, as far as referral systems and education, to be able to go that little extra step that might have changed that trajectory.”
Through her research Phelan discovered EMS personnel in New Mexico received initial training in dealing with pregnancy-related emergencies, which “generally seemed appropriate given [their] scope of practice,” she said. “But what we found is that ongoing educational requirements are variable, and rarely are there modules that deal with pregnant or postpartum women and some of the unique issues there.”
This lack of continuing education support makes it difficult for career EMS people to maintain their skills with respect to “some of the issues that occur during pregnancy,” said Phelan, “because they may not see a lot of it in their day-to-day activities.” One solution for EMS and small-town EDs that lack maternity departments would be to provide them with resources and medical simulations to enhance their emergency pregnancy response skills.
Rural Issues
The next day three presenters talked about “Rural, Tribal, and Frontier EMS Challenges.”
Jules Scadden, paramedic and director of Iowa’s Dysart Ambulance Service, spoke about the problems of attracting and retaining volunteers in rural EMS agencies. “We just can’t staff with volunteers like we used to,” she said. Issues such as expecting volunteers to pay for equipment through fundraising and inadequate educational opportunities are causing volunteers to quit. Meanwhile, low wages and call volumes make it hard for rural EMS agencies to attract paid staff.
As for funding coming from rural EMS being designated an essential service? “A lot of states stepped up and passed bills…but in doing so they put the onus of funding back onto the local governments,” Scadden said. The result is that actual EMS funding is hard to come by.
Chelsea White IV, MD, is director of the Center for Rural and Tribal EMS at the University of New Mexico. White focused on the unique nature of tribal EMS service, which varies from one indigenous group to another. Paraphrasing the old EMS adage, White quipped, “If you’ve seen one tribe, you’ve seen one tribe.” The difficulties that confront tribal EMS services include a serious lack of funding, inadequate equipment, very remote locations, and not enough personnel, White said. In some instances, “tribes have no EMS of their own…[and rely] on neighboring municipal or private EMS agencies to provide EMS coverage within their borders.”
Stroke Triage and Transport
The Society of NeuroInterventional Surgery’s Donald Frei, MD, rounded out this trio of talks with his presentation, “Improving Stroke Triage and Transport for EMS.” He called for improvements to EMS stroke triage and transport protocols based on current protocols that are shown to reduce death and disability in ischemic stroke patients. They include transporting patients directly to Level 1 stroke centers to receive thrombectomies.
“You can lose up to 1.9 million neurons per minute with an artery occluded,” Frei explained. “So any delay in treatment can be devastating for the patient… If EMS brings a patient with a large vessel occlusion to the nearest hospital and they can’t perform a thrombectomy, they can’t help the patient. If the appropriate hospital’s [just] a few more minutes down the road, that could be millions of neurons saved.”
Frei concluded his talk by thanking NEMSAC for collaborating with the society in developing new stroke treatment guidelines for EMS personnel. “We think these guidelines that are put out nationally to EMS will help elevate the standard of care for patients with ischemic stroke,” he said.
James Careless is a freelance writer and frequent contributor to EMS World.
