Driving clinical innovation through EMS


A.J. Heightman, MPA, EMT-P | Paul E. Pepe, MD, MPH | From the Driving the Course of Care Issue

In the early years of EMS, the only advanced assessment and clinical items crews used were BP cuffs, three-lead ECG units, manual defibrillation and, in some systems, rotating tourniquets for congestive heart failure cases. Telemetry was primitive and often inaccurate, making Emergency Department (ED) physicians reluctant to order advanced treatment until they saw the patient.

Ventilators, pleural decompression, crics, CPAP and intraosseous infusion for adult patients were rarely used or performed in the field; in fact, many hospitals called IV or surgical team personnel to the ED to start difficult IVs or subclavian lines, or to perform crics or needle decompressions. Respiratory department personnel were, and still are in some areas, called to the ED to place patients on ventilators and CPAP.

But with new technological advances and high-quality training, over time trust developed in EMT and paramedic capabilities. And improvements in training and medical direction—in both prehospital and hospital systems—has allowed technology and advanced medical treatment to rapidly expand in the field, hospitals and EDs. In many instances, innovative prehospital systems and their medical directors are on the front lines leading the charge.

Today, EMS is equipped with more advanced technology to help speed decision-making and help hospitals better prepare for patient treatment prior to arrival. Now when EMS arrives on scene, they connect patients to cardiac monitors that measure and analyze a multitude of parameters (12-lead ECG, SpO2, CO2, tidal volume, temperature, CO levels and much more), and they send real-time vital-sign parameters and trends to the receiving hospital. In many cases, EMS personnel also send the transmissions simultaneously to the cath lab, a cardiologist, the trauma team or their medical director’s mobile phone.

Most ALS systems, and many BLS systems, are now starting CPAP early in the field, quickly reversing the patient’s frightening sense of drowning from congestive heart failure (CHF), greatly reducing the number of patients who need to be intubated, and ultimately reducing the number of patients who develop ventilator-associated pneumonia (VAP) and die unnecessarily.

More importantly, by driving the technological care of CHF patients in the field with adult IO and CPAP, many hospitals have begun to place IO devices and CPAP units in their EDs, breaking from the traditional processes of delivering equipment to the ED to care for patients.

And, resuscitation is moving rapidly from being treated as an individual effort to a carefully orchestrated set of steps, including an effective biphasic defibrillation shock, high-quality CPR and therapeutic hypothermia. When cooling is initiated in the field, evidence shows that the best results occur when the receiving hospital continues hypothermia for 24–48 hours. As with stroke and trauma, the emergence of the Cardiac Arrest Center may be upon us largely driven by the capability of EMS to achieve return of spontaneous circulation (ROSC) more frequently and begin cooling the patient before hospital arrival.

This JEMS supplement presents new ways in which EMS is leading the pack in offering advanced monitoring and medical care in the field and driving additional advancements to their receiving EDs. Advanced monitoring and diagnostics, coupled with Bluetooth technology, computer-aided dispatch and electronic patient care record systems, will mean earlier field recognition of conditions and trends, and earlier reporting and care in receiving hospitals, both of which will greatly benefit our patients.

Read it carefully. These advances will place the future of emergency patient care in your hands.

Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Patient Care, Cardiac and Circulation, Leadership and Professionalism, Airway and Respiratory, Technology, Operations and Protcols, Patient Management

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A.J. Heightman, MPA, EMT-P

JEMS Editor-in-Chief A.J. Heightman, MPA, EMT-P, has a background as an EMS director and EMS operations director. He specializes in MCI management.


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Paul E. Pepe, MD, MPHFor more than 3 decades, Dr. Paul Pepe has pioneered the concept of full-time specialty practice as an EMS Physician and has been formally recognized and honored in many governmental and professional society circles as the “most accomplished emergency services physician of our generation”. An extremely distinguished scientist/academician (over 500 published scientific papers/abstracts, including many landmark publications in multiple disciplines), Dr. Pepe has served simultaneously as a high-level municipal or state employee for the past quarter century. Renown for a grass-roots, “street-wise” style in planning, implementing and overseeing a “systems” approach to saving lives, both operationally and through scientific clinical trials, his programs have resulted in some of the highest cardiac arrest and trauma survival rates worldwide.


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