David Reinis, EMT-P, has been a paramedic for more than 30 years, an EMS educator for four and a creative, out-of-the-box thinker all his life. His unique way of looking at the world, combined with his educational talent, has taken dissection to a new level and given EMS providers a chance to elevate their hands-on skills in a most unique and proactive way.
Different Type of Lab
“Nursing and pre-med students and physicians all get cadaver labs, and they all get to take a look at the body’s anatomy at some point in their training,” says Reinis, who is an EMS educator with Centura South Denver EMS in Denver.
“In EMS, our training usually isn’t that in depth. We are taught anatomy and physiology, but when it comes down to how anatomy functions, and seeing and feeling that in a meaningful way, it’s just not done,” he says.
Reinis set out to change that—with the help of some pigs. Reinis found out about a pig dissection class being offered by St. Jude Medical Center and Parker, Porter, Littleton Adventist hospitals to a group of metro-Denver hospital employees. The idea intrigued him so much that he began investigating the possibility of modifying the dissection class to teach anatomy to prehospital providers as it related to myocardial infarction (MI) and 12-lead ECG patterns. Reinis figured that if it were modified properly, it would give providers a hands-on approach to heart anatomy and bring realism to cardiac care and treatment.
“This new program is training paramedics to actually visualize and dissect the internal structures of the heart, allowing them to feel the vessels that feed the different parts of the heart and how they correspond to ST-elevation and depression levels,” he says. “This ‘real world’ approach has given EMS personnel the opportunity to work directly on the heart and fully understand their own role in treating those with cardiac issues.”
Up Close & Personal
Like many of us, Reinis has sat in numerous presentations being “PowerPointed to death.” Reinis says he knows that while those static presentations can be valuable, actually holding a heart, seeing the anatomy up close and feeling the texture would bring reality to the bullet points on a slide.
“Most paramedics have not seen the leaflet of a heart valve; most don’t realize the leaflets are transparent,” he says. “The structure of a heart is nothing like we picture. I wanted to take the actual physiology, put it in their hands, and let them realize and connect that to what we are teaching, which is cardiac alert.”
Reinis was convinced that if paramedics could feel the right side of the heart and realize it’s half the thickness of the left side of the heart, and then observe the heart valves up close, they could understand on a visceral level why people with hypertension or other heart ailments could have their heart fail so quickly.
“We are always doing simulations with prehospital providers because that’s the best way we have to put them in a situation that they may come across one day,” he says. “Why not take that one step further and give them anatomy that is comparative to human anatomy? They can take a look at the different heart structures, so they have a meaningful understanding of what they are dealing with.”
The class goes as far as letting the prehospital students perform hands-on cardiac catheterization on their pig hearts. “They got to see the coronary arteries and what it’s like to try to catheter a coronary artery,” says Reinis. “This helped them understand what they need to do to prevent a myocardial infarction.”
Devoted to an Idea
Naturally, when he approached various people with his new and innovative idea of using pig dissection to train paramedics, he thought there would be wholehearted acceptance. Well, not quite. “It took a little bit of selling because the idea didn’t strike a lot of people initially,” he says. But Reinis persisted. He knew his idea was a good one that would save lives.
He prevailed. In cooperation with the hospitals and under the guidance of team physician and advisor, Eugene Eby, MD, FACEP, the first class was launched. The first time paramedics held a pig heart in their hands, they loved it. To date, more than 400 paramedics have been trained in Reinis’ program, and another 200 are scheduled to take the training.
You might think that the class is a success and Reinis would be satisfied. But you’d be wrong. Remember that part about him being a lifelong creative thinker? Well, Reinis is now taking his pig dissection idea and moving the concept into brain dissection—with the help of some sheep.
“I’m having a neurosurgeon come in and assist me with that,” he says. “Anatomically, sheep brains are the same as pig hearts, except for size, so I’m going to do a lab with those.”
Why the brain?
“What I’m trying to tie in with the brain is not only the structure and stroke-like criteria, but to relate it to trauma,” he says. His goal is to have the neurosurgeon teach class participants brain structures and anatomy, along with the presentations of various brain damage. “What we are going to do is show brain anatomy, and then trace that to the signs and symptoms when presented with that portion of the brain.”
In other words, if someone has a stroke, or is suffering from multiple sclerosis, they may have plaque that has built up in a particular region of the brain. The neurologist will visually point out what the presentation in that part of the brain might look like in those situations.
As if all this weren’t enough, Reinis also reviews and explains STEMI mimics from this anatomical perspective, instead of expecting paramedics to memorize ECG patterns. He wants paramedics to be able to make sound judgments and educated calls from the field, especially when having to call in-hospital personnel for stroke or cardiac alert situations.
The same people aren’t always working in the hospital at the same time. This means that, when you have an alert situation, sometimes key personnel have to be called in.
And sometimes heart signs mimic one thing when the patient is actually suffering from another condition. “We want to make sure people are being called appropriately. Or if a patient presents with myocardial infarction that isn’t, we want to narrow that down so when medics make the call, they are making the right call on the patient,” Reinis says. “You can have patients present with a MI on an ECG for numerous reasons: Pericarditis, hypothermia, or Osborn Waves that look similar to ST changes.”
One of the best examples of a mimic is a patient presenting with Takotsubo cardiomyopathy, also known as broken heart syndrome. “It’s usually brought on by huge stress in a patient’s life, and they will have specific ECG changes that look exactly like MI,” Reinis says. “But when we catheterize them, there is no obstruction in the coronary arteries.”
If paramedics working in the field have knowledge of these mimics and how they work, and if they come across a case that they have high suspicion might be a mimic, then they can better relate that to the hospital during their call and let them make the decision on what to do.
Although Reinis conducts these classes mainly in the Denver metro area, he would like to see his pig-heart and sheep-brain dissection courses go national, providing all paramedics with the opportunity the chance to work on the anatomy in a realistic setting.
“Most of us are very hands-on, and if we can look at the anatomy, that’s the way we learn best,” Reinis says. “Why are we doing scenarios and simulations when we can actually put an organ in their hands? A scenario is a make-believe situation. Instead of make believe, I give them realism to hold in their hands that draws a connection in their mind.”
In the end, Reinis wants all of this hands-on training to not only help paramedics in delivering more accurate and useful life-saving procedures, but also to help, perhaps, reignite their passion for medicine and the EMS profession.
“Because we are not physicians or nurses, I think paramedics can feel a little neglected,” he says. “We feel a little on the outside. All these paramedics are bright eyed in these classes because they are truly excited to have the opportunity to utilize tissue that has a relationship to their practice.”