Township of Haverford Department Of Emergency Medical Services Report March 2, 2015
Purpose: The purpose of this report is to inform the Commissioners and Administration of the Township of the state of the Emergency Medical Services system. How the system is meeting the emergency needs of the Township s residents and visitors as well as the state of the contract with the University of Pennsylvania are included within this document. Improvements that have been made as well as those subjects that require improvement are included as well. It is this department s goal to present this material in the most direct and clear manner possible. Current Status: When the Township s Administration made the decision to take the EMS Department in a new direction, it looked to improve the basics seen in any health-care system. First and foremost, maintaining excellence of care and safety had to be assured. Secondly, reduction in the time it takes to that deliver care. Thirdly, the containment of costs associated with the care and the delivery of care. On November 1, 2013, the Township partnered with the University of Pennsylvania Health System to combine the talents and resources of both entities to deliver EMS care. This was Penn s first foray into the area of municipal EMS. While Penn has provided air-medical support to the Tri-State area since 1988, the Township of Haverford is their first 911 partnership. It was recognized that the Township excelled at the logistics and support of an EMS system but was handicapped by the lack of a deep medical infrastructure to support this system with buying power, continuing medical education, and a medical command structure. After a lengthy vetting process, it was judged that the University of Pennsylvania Health System provided the proper complement to the Township by providing these needed components. Immediately there were detractors. This was anticipated. Assumptions were made that patients had to go to Penn or that Penn was going to bill or collect aggressively. Each of these criticisms has been proven incorrect and the overwhelming response has been very positive. To demonstrate the point regarding patient destinations, please see the graph included below. The figure shows the call volume and destinations of all patients from November 1, 2014 through February 02, 2015 showing 41 of 740 patients being taken to a UPHS facility (Note: Each of the 41 met Criteria for Trauma Center evaluation). While it is true that Penn does not offer any sort of membership or other subscription service, it must be recognized that the fire companies within the Township see about a 20% participation rate among the residents within their coverage areas. This level of participation is not cost effective for a township-wide program. To this date, neither the Township nor Penn have received a complaint regarding billing.
450 400 350 358 382 300 250 200 257 212 150 100 50 0 4 4 77 61 63 21 15 18 1 1 2 2 1 1 Column Labels PennSTAR HAV Medic 108-7 Column Labels PennSTAR HAV Medic 108-7A 11/30/21014-02/01/2015 Destinations 800 700 728 600 500 400 432 300 200 100 0 2 5 113 30 137 3 0 0 2 0 4 01/01/2014-03/31/2014 Destinations (Note: units are combined) Progressive Patient Care:
The partnership with UPHS is truly an expansion of a relationship that is almost fifteen years old. The original agreement placed Dr. Edward Dickinson in the position of Medical Director and the new agreement retains him in this role. Under Dr. Dickinson the Township has been at the forefront of therapies, medications, and interventions that have proven to save the lives of those in need of emergency care. Aside from regular training and certification requirements, our health professionals regularly implement new methods of care and recognize where changes are needed to increase the quality of care our residents receive. Here are just a few of the developments within our department: I.O. Needles - Our units have transitioned to utilizing Intraosseous (I.O) vascular access as a primary means of medication delivery in cardiac arrest situations or any case that requires intervention and a vein is not easily accessed. Utilizing a special device, the patient s bone marrow is accessed directly and life-saving medication is administered immediately. New Trauma Center - Patients meeting the Pennsylvania Department of Health s protocols for trauma center evaluation will now be transported to the new Trauma Center at Penn Presbyterian Medical Center. Please click the below link to learn more about this facility and take a virtual tour. http://www.uphs.upenn.edu/shaping-ourfuture/trauma.html Blood Thinners - The elderly population of Haverford Township is increasing, as is the use of prescription blood thinners. While these medications truly increase the span
and quality of one s life, they have a downside. There is an increased risk of significant, life threatening hemorrhage if a subject using these medications suffers trauma. This is particularly true in cases of a head injury and the patient may have little, if any exterior signs of trauma. Our rescuers have received extensive training and have experience in the recognition and treatment of patients suffering from this form of injury. Left Ventricular Assist Devices Unlike most disciplines of medicine. EMS providers must be proficient and knowledgeable in all emergency procedures, dosages, devices, and medications. This includes all patients and conditions from the smallest pediatric patient to the geriatric patient. New devices called LVADs are now being utilized by the region s many prestigious cardiac centers. These devices are designed to support a failing heart while the recipient heals or awaits a heart transplant. The device allows the patient to return home during this waiting period. These devices require regular external charging and a special manually operated pump is employed in the rare case of failure. Again, our rescuers have met the training challenge and are prepared to assist these patients as needed. This care includes a significant measure of preplanning. Coordination with the center implanting the device, family members, and a care plan are formulated, as needed, by the Township s EMS Department Administration. LVAD device Learn more at http://heartmateii.com or http://www.abiomed.com Naloxone The Township of Haverford s EMS Department has taken an important role in District Attorney Jack Whelan s program to put Naloxone, aka Narcan in the hands of police throughout Delaware County. This medication can save the life of a subject who has overdosed from an opiate-based drug. Simply by spraying Naloxone in the subject s nostril, a police officer or other first responder can reverse the effects of a heroin, morphine, oxycontin, or other opioid overdose. Dr. Edward Dickinson, the Township of Haverford s own Medical Director, serves as the medical director for the DA s program that places two doses of the antidote in every police car throughout the County and provides training for every officer. EMS Chief J.P. McCans was named to the County s Heroin Task Force and serves as an administrator for the Naloxone program by tracking the results of the medication, providing training for the police, and securing
stock for the project. Since October 30, 2014 twenty eight near fatal overdoses have been reversed by police interaction in Delaware County including two in the Township of Haverford. Please see more about District Attorney Whelan s efforts to combat heroin at http://www.delcoda.com/. AEDs The EMS department continues to provide a free service to all AED owners, public or private, who own an Automatic External Defibrillator or AED. On a monthly basis all units are checked for condition, battery life, and expiration dates of the disposable patient contact pads. If replacement pads or batteries are needed, they are immediately replaced and the owner is notified of the actions taken. Community CPR Training the Township continues to offer free CPR classes to all who are interested on the second Monday of the month (excluding holidays). Classes are held at 7:00 pm in the CREC at Haverford Reserve. Adult, Child, and Infant certifications are provided. CPR Pro, required for some healthcare providers can be scheduled but are not offered on the Monday night session. Please contact the EMS department at (610) 446-1000 ext. 2222. Team Changes and Improved Base Locations: This agreement has changed the model of the Township s delivery of emergency care. The new model places two teams of one emergency medical technician and one paramedic together on each transporting ambulance to form two Mobile Intensive Care Units. One unit is stationed in the southwestern section of the Township at the Bon Air Fire Company and the second is located on the Haverford College Campus in the 800 block of Ardmore Avenue, in the northeastern section. These changes have resulted in reduced response times and an increase the level of care provided. Both units are in service 24 hours a day, every day. The Haverford College and the Township formed a true working relationship to deal with the enormity of the US Open in 2013. That relationship provided avenues of communication that lead to the EMS base that is now located on their campus. The generosity of the college has provided the Township with an apartment to stage EMS crews, store supplies, complete patient records and paperwork. The College also provided a section of a parking lot for the placement of a pole barn to secure unit Medic 108-7 and the department s ATV ambulance. This have kept the on duty ambulance out of the weather and prepared to respond without delay. Haverford College has provided this facility as a service to the community and at no charge to the Township. The Bon Air Fire Company on Royal Ave hosts Medic 108-7A. The Fire Company has provided facilities for the crew to stage within their offices and provided a bay for the unit to be housed. This facility also houses the Department s oxygen filling station and stores the associated large tanks for the system. This location provides an excellent response location for the southern and western portions of Haverford Township. While many changes have been made to the Emergency Medical Services that serve the Township of Haverford, some things have not changed.
1. Any and all emergencies should still be reported via 911. All emergencies: Fire, Medical, and/or Police are dispatched via 911. 2. Hospital Destination remains your choice. Please understand that there are Pa. DOH guidelines that indicate when it is appropriate to transport a patient to a specialty center. On occasion EMS providers are asked to transport someone to a facility that is incapable of handling their injury or sickness. An example of this would be a patient who is suffering from a myocardial infarction (heart attack) and is requesting to be transported to a hospital that does not perform cardiac catheterizations. In that case EMS would inform the patient of the issue and advise transport to the nearest appropriate hospital. Specialty centers include those handling strokes, trauma, burns, obstetrics, psychological emergencies, and pediatrics. 3. Billing remains the same and our EMS Department deals directly with the patient s insurance company. 4. Care is the greatest priority. The EMS Department s rescuers, medical director, and administrators remain committed to providing the best care possible to our residents and visitors. Respectfully submitted; Chief James P. McCans MS, NREMT-P, FP-C Director of Emergency Medical Services Township of Haverford