JEMS editor-in-chief A.J. Heightman is in Dallas for the 2016 Gathering of Eagles reporting on key sessions that will impact the future of medical direction for EMS agencies.
- EMS State of the Science: A Gathering of Eagles XVIII
- The Eagles Wing It: Highlights from the Lightning Rounds
Nursing (and Doctoring) You Back To Health via 9-1-1
Sessions in this track focused on deployment tactics in the new era of healthcare. Below are key takeaways from various speakers.
ETHANization in Houston: Early Results of a 9-1-1 Based Telemedicine Program in Space City
David E. Persse, MD, reported on his system’s ETHAN project, which has earned him a JEMS/Physio-Control EMS 10 Innovator of the Year award. The ETHAN (Emergency Telehealth and Navigation) program is working very well in Houston, where every fire department vehicle, equipped with two-way audio/video Panasonic G1 tablets, can triage and connect low-acuity 9-1-1 callers with community primary care resources through consultation via a skilled physician at a centralized control console. His early results are very promising.
Specialized Nursing Staff in LA, Atlanta and the U.K.
Marc K. Eckstein, MD, MPH, spoke about the challenge of acute, unscheduled care and how the Los Angeles Fire Department is using a nurse practitioner response unit in south L.A., an underserved area of the city with an average of 5.8 responses per day with up to 12 so far. The nurse practitioner responders can perform all types of wound care, write prescriptions, manage asthma problems, perform iSTATS and much more.
Nurse practioner response unit, now on duty in Los Angeles.
Fionna P. Moore, MD, explained how London Ambulance Service is using a community treatment team in the far northeast area of London to improve the care of frail, older “fallers” after it was determined that more than a third of patients going to one hospital were elderly fall victims.
Arthur H. Yancey II, MD, spoke about how Atlanta is bringing primary care physicians to patients in need. The program is designed for frequent users (those who have been in their response system on five or more occasions per month) and patients discharged from the hospital (CHF, pneumonia, post-MI, post-operative hips, etc. They are impacting environmental (fall hazards), physiological (ambulatory stability, activities of daily living) and psychological issues (psychosis) among other factors. In its first month of operation (Nov. 2015), the system managed 1,300 patients. Grady provides the SUV and paramedic, and Home Physician Care Services, LLC, provides the home healthcare staff.
A New Version of Gentle Coercion Using Diversion Inversion: Re-Directing Ambulances Away from “Parking Facilities”
Glenn H. Asaeda, MD, spoke about the New York City EMS system process in place whereby they put hospitals on diversion if they are delaying crew turn-around, versus systems where the hospitals place themselves on diversion. It has been effective for their very busy system.
Finding a Way to Lay Away the Day-to-Day On-Scene Stay Delay: Decreasing Job Cycle Times in the LAS
Fionna P. Moore, MD, noted that her system in London is focusing on ways to evaluate and address increasing assessment and overall job cycle (total time) on calls.
Advances in modern dispatch were the fore-front of this track of sessions. Below are key takeaways.
A Faster Ignition for Arrest Recognition: Making Dispatch Modifications to Save More Lives
Marc K. Eckstein, MD, MPH explained Los Angeles’ new tiered dispatch system (in place for one year) that improves call processing and dispatch aspects by modifying and shortening the information taken before dispatching resources. He notes that they now ask if the patient is breathing normally. This helps to identify agonal or gasping breathing, because most people know what normal breathing is. Call-processing time dropped from 1:27 to 1:04; cardiac arrest/CPR processing time dropped from 2:16 to 1:34 per call.
Hatching New Matching for Cardiac Arrest Dispatching: The Anchorage Move to Criteria-Based 9-1-1 Call-Taking
Michael K. Levy, MD, explained how his system in Anchorage, Alaska, now empowers their responders to use modified dispatch protocols to get callers started earlier after reporting a cardiac arrest (they call this a “fast track” approach). They have reduced cardiac arrest dispatch time from 1:21 to an average of just 53 seconds now. They also initiated an audible metronome at the communications center and ask callers to place their telephone in speakerphone mode so they can talk to the caller and the caller can then hear the metronome in the background to help them do compression-only CPR (a great idea, in my opinion).