Administration and Leadership, Cardiac & Resuscitation, Training, Trauma

The 2012 EMS 10 Winners Build a New Reality for the Future

Issue 4 and Volume 38.

Dale Becker, NREMT-P, had an idea because of a burned out light bulb. You’ll see how the burned out bulb played a significant role in an airplane tragedy and how Becker believes that incident, and the lessons it taught, can provide valuable insights for EMS responders.
Becker has taken these lessons and created a unique way of managing cardiac arrest treatment in the field. He wants EMTs to stay focused on administering CPR and doing effective chest compressions, not worrying about what role they should play when they first walk through the door or wondering who should execute what procedure. By assigning specific duties and responsibilities to EMTs before they respond to a call, patients are getting better treatment and outcomes and his EMTs are executing in a more efficient and professional manner.

The day John Curry, Jr.’s mother had a stroke changed his life forever. Her stroke was the impetus in helping him drive the Fire Officers Association of Miami-Dade Consortium (FOAM-D) into focusing on stroke prevention and management.
Specifically, Curry wanted to do something deemed radical at the time: send primary stroke patients to primary centers and send massive stroke patients to comprehensive stroke centers, even if it meant bypassing primary centers. He called together some of the top interventional neurologists in the community to ask for their assistance with his plan. You’ll see how the committee threw 100% of its support behind Curry and his stroke initiative and the outcome of that movement.
The concept is now being adopted by other groups, and Curry hopes that one day it will migrate across the nation, particularly given the prevalence of stroke. This first-of-its-kind network has helped save thousands of lives, while bringing a new awareness to stroke and stroke prevention.

Most typical college students are just that: typical. They spend their time studying, listening to music, completing schoolwork, dating and worrying about their futures. But 19-year-old Jessica DeMarzo, EMT-B,  is anything but a typical teenager.
The EMT found that studying and completing college work at her New York community college wasn’t enough to satisfy her. She wanted to do more. And when a friend of hers became ill on campus, DeMarzo saw just how stretched the community EMS system was.
She decided to start a collegiate emergency medical services program on campus—the first of its kind. She partnered with the local EMS agency and brought together a variety of city, state and university officials to make her idea—and campus agency—a reality. Her initiative created the first on-campus student EMS agency in the college’s history. You’ll read how she managed to pull all of these resources together, the challenges she overcame and the result of her ambitious efforts.

An estimated 240 million calls are made to 9-1-1 in the U.S. each year, according to the National Emergency Number Association, and the medics in the city of San Diego are doing something to address their frequent 9-1-1 callers. Under the leadership of James Dunford, MD, FACEP, the San Diego Fire-Rescue and Rural/Metro Ambulance implemented the San Diego Resource Access Program (RAP) and the electronic Resource Access Program (eRAP), an EMS-based surveillance technology and case management system.
You’ll read how the RAP system concentrates on bringing resources to individuals and communities and is designed to help people find appropriate avenues of care other than calling 9-1-1 to be transported to the emergency room. The system uses advanced health information technology to track, prioritize and even alert case managers of individuals in real-time. The system also pinpoints “hotspot” areas of increased problems, such as sudden cardiac arrest incidents, and tracks individuals who may be in need of social and mental health services. Dunford has hopes of quickly expanding the system regionally and nationally.

For David Grovdahl, EMT-P, EMS and rural America are inescapably intertwined. The EMS executive director has taken a rural Oklahoma EMS system and brought it to a level of patient care that would rival many large citiy agencies. His partnerships with local physicians and technology developers and distributors have allowed his small team to deliver big results.
By using this knowledge and advanced technology, Grovdahl has been able to track and serve frequent 9-1-1 callers so they get the medical and social resources they need without further burdening an already overtaxed EMS system. You’ll read about how he’s also gotten other agencies in the area talking to, and assisting, each other in ways that have improved care, as well as saving money and lives. The small but powerful agency is more than willing to share what they know and have learned, taking their knowledge and pushing it out to others when they can.

Although many EMS agencies strive every year to improve the service they provide to their communities, Fort Worth, Texas-based MedStar Mobile Healthcare, under the direction of MedStar Executive Director Douglas Hooten, has taken that model and gone a step further by transforming itself into a modern, high-tech state-of-the-art mobile healthcare agency.
The MedStar team have used technology to identify and reach out to frequent 9-1-1 callers, offering them nursing services, access to physicians, urgent care centers, or social workers who can help them obtain the resources they need to better their lives. You’ll see how the agency works to identify those patients who are at risk for readmission to the hospital for chronic conditions such as congestive heart failure and what is being done to help them.
The agency also assists families with hospice needs and works with local corporations in responding to minor industrial injuries. MedStar is also actively changing some of the EMS paradigms to community care. You’ll read how the mobile healthcare agency has been visited by numerous agencies from 24 states and four countries, all of whom are eager to learn how MedStar is providing quality care while working with community and medical leaders in Texas.

Graham Nichol, MD, MPH, FRCP(C), FACP, FAHA, knew that the American Heart Association had created Mission: Lifeline, a program to respond to opportunities for prompt, appropriate STEMI treatment. The program was a big step forward in such treatment, but Nichol thought more could be done, specifically by incorporating out-of-hospital cardiac resuscitations into the program’s protocols.
So the hospital director became deeply involved in Mission: Lifeline by encouraging EMS and hospital personnel to work together as a team to improve the patient outcomes of out-of-hospital cardiac arrest. This approach offers the best chance of increasing survival rates and equalizing those survival rates across communities. Nichol stresses the need for EMS and hospitals to work together in harmony because it’s such a common problem and community survival rates can vary so widely. The approach works, and Nichols has played a key role in showing that the whole process would not work if it weren’t for EMS.
A simple kiss on the cheek pointed Joseph Ornato, MD, FACP, FACC, FACEP, into a life-changing direction: developing an advanced and comprehensive post-resuscitation center for central Virginia. But the real achievement was his initiative to implement cooling in the field by administering iced saline via the IV or IO line before the heart restarts.
This endovascular cooling during resuscitation has resulted in “miracle saves” for many sudden cardiac arrest patients, as Ornato and his team have successfully provided therapeutic hypothermia to more than 500 people. Their overall survival to hospital discharge rate is now more than 50%.

David Page, MS, NREMT-P, cares about culture, and he cares about diversity. He sees himself as someone who is responsible for helping to bring different perspectives through diverse cultures into a mostly homogenous EMS system.
To address the a perceived lack of cultural diversity in EMS, and to help train minority and diverse at-risk youth to one day qualify as EMTs and paramedics, Page created the Saint Paul Emergency Medical Services Academy, also known as Freedom House. With help from the city of St. Paul, he converted a fire station into a training facility for EMTs and renamed it Station 51 in honor of the 1970s television show, EMERGENCY!
Page’s program has now trained more than a dozen students who have since been hired by the St. Paul Fire and Rescue ambulance service. You’ll read about his challenges in getting such a program off the ground and what he had to do to make it a success. You’ll also read about his philosophy in giving everyone who wants a chance the opportunity to succeed, if only they have access to the training and support they need.

Richard Price had an idea over a lunchtime sandwich that may very well revolutionize how CPR is administered in the field. You’ll read about how he has taken this idea and created an international smartphone app that is taking the practice of CPR for sudden cardiac arrest to a whole new level. The app allows those who are trained in CPR to register and then act as citizen rescuers in assisting in emergency cardiac arrest situations near their location.
From Price’s idea, a network of citizen rescuers, a clinical trial, and a foundation have been created. By using this app, citizen rescuers from all over the U.S. have banded together and saved countless lives, simply by looking at their smartphone, seeing a need and acting accordingly.

Each and every one of the winners profiled in this supplement is breaking new ground in EMS. Their vision and determination is changing the landscape of how prehospital care is administered, and perceived, by those inside and outside the EMS community.
The profiles of these individuals highlight the tremendous inroads they’re making in altering the minds and methods of their patients and colleagues. You will see the passion, caring and concern they have for the EMS industry and the drive they exhibit in trying to make it more patient-centered and success-based.
We hope you enjoy reading these profiles and seeing the impact that just a few people can make on an industry, a nation, even the world. We also hope their example will prod you to think bigger and bolder, to think in entirely news ways about patient care and disease prevention. If you’ve been thinking about developing a new project, or enhancing an existing protocol, we hope these stories will push you to move in that direction.
Should you have the opportunity to speak to one of these profiled innovators, or if you come across a previous EMS Innovator winner, please take a moment to acknowledge their contribution to EMS and thank them for having the will and courage to step out and make the hard choices that fundamental change requires. It’s through their efforts, and the efforts of the people who support them, that the entire EMS profession is boldly moving forward into the next century.

Cynthia Kincaid is an award-winning writer who has written numerous articles for medical and healthcare publications and organizations. She was the recipient of a 2007 Excellence in Journalism award from the Society of Professional Journalists. Cynthia holds a bachelor’s degree in journalism and a master’s degree in public administration.