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The Challenges of Clinical Leadership

This supplement is both a tribute and challenge to prehospital EMS systems. It’s a tribute because it recognizes multiple areas where EMS agencies have been leading the way in clinical innovation, technology, educational and operational planning, and resuscitation advances.

It’s a challenge because in illustrating pre-planning and operational changes that EMS agencies have effectively used to improve their delivery of patient care and resuscitation results, it challenges your agency to do the same.

You’ll read some common themes throughout this supplement, starting with the need for a team approach to deliver high-quality chest compressions through the consistent application of currently accepted standards, and the use of feedback devices as a key to ensuring that consistency.

“Links in the Chain” points out what we often forget: Despite our best efforts, we often can’t arrive in the critical first 3–5 minutes after a cardiac arrest. Bystander CPR continues to be a necessary, but often neglected, area in every EMS system’s response plan. Systems must focus more on this area.

With some EMS agencies still trying to get their local hospitals to accept therapeutic hypothermia (TH) patients from the field, “Driving Toward ‘Cool’ Resuscitation Care” arms you with important facts about the use of cold normal saline in the post-arrest setting and updates you on some dramatic discharge results in New York.

Dovetailing off the critical aspects of optimal response times, early patient access/care and consistency in the delivery of compressions, this supplement also focuses on two other important EMS challenges: providing care at mass-gathering events and large participatory events such as marathons.

Although most agencies currently cover special events, progressive agencies pre-plan strategic deployment of AEDs and ALS teams, and use Bluetooth transmission devices to send patient data and progress reports to field treatment centers in advance of a patient’s arrival.

It is our hope that these articles will prompt you to think about, and improve, your daily EMS response plans, procedures and equipment and enhance your mass-gathering EMS approach, pre-planning well in advance of your next event.

This article originally appeared in an editorial supplement to the September 2010 JEMS as “The Challenges of Clinical Leadership”
 



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