OREGON EMS UPDATE Oregon Department of Human Services A Newsletter of the EMS & Trauma Systems Section Spring 2004 From the Desk... By Jonathan Chin State EMS Director Is the cup half full or is it half empty? One step forward one step backward! Be an optimist, but If You Would Like This Information in an Alternate Format, Please Contact EMS (503) 731-4011. Every EMT is taught, while responding to a call, to think what the best case scenario and what the worst-case scenario is for the type of patient they are responding to. They are also taught to be prepared for whatever they find at the scene, which we all know can be completely different and unrelated to what we were dispatched for. Well, as of recent, working for the State hasn t been much different. With a struggling economy, the State s budget crisis and the failed referendum, there are a lot of challenges and unknowns. As an eternal optimist: the cup IS half full, that is a BIG step forward and small shuffle backwards and DHS-EMS is postured for the State s RECOVERY! In spite of taking close to $900K in budget reductions and another $116K looming in a referendum contingency; the EMS and Trauma Systems Section has not lost any positions nor have any programs been cut. A number of operational and program items have been scaled back but overall our programs remain intact. Over the past two years DHS-EMS has had as many as five out of seventeen positions vacant. Between hiring freezes, positions have been filled. Our last essential position, the Prehospital Systems Manager position was filled mid- December. Things are pretty skinny here, the belt has been cinched up tight, but as of this writing, the market and the economy are looking better! It just needs to trickle down to Oregon and then on down to DHS-EMS! Pending no new hits, DHS-EMS will have weathered the storm, intact and ready to reestablish reduced program functions. While there have been steps backwards, these have been offset by some pretty significant steps forward. Staff has focused on low cost and no cost projects keeping the forward momentum going. A new trauma registry has been spec ed out and a review and revision process for the OARs has begun. Surveys on the EMT-Intermediate scope of practice have revealed the need to revise and refocus the program itself that process is just beginning. The Oregon Prehospital Registry (OPR) and electronic documentation programs that have been hobbled, and at one time threatened to go unfunded, have managed to achieve some significant milestones. The OPR is online accepting incident data and the Electronic Prehospital Care Information System (EPCIS) Oregon s electronic charting program, was released in a limited version. Albeit limited, the field application and testing of EPCIS permits end product development to continue on schedule.
Spring 2004 Oregon EMS Update page 2 Oregon s airmedical providers have banded together and established the Oregon Air Ambulance Workgroup. This association provides the mechanism and forum for the further organization and development of Oregon s airmedical resources. Oregon s EMT Consortium is doing some hard internal work and refocusing the purpose of their association. And within the Section, formal work plans have been put in place for each of our individual programs. Clearly these are some big steps forward for EMS in Oregon. In spite of some very challenging circumstances good and significant things have been accomplished during the past two years. Fiscal and political constraints have caused us to focus our efforts and energies back to fundamental and foundational areas. That s right, the kind of areas we often don t have time for well, time was made for us. And as a result we are better prepared to step into the recovery and rebuilding phase. We are better staffed and the staff is focused on serving the EMS Community. Technology and data systems are being set in place to drive the planning and decision-making processes. And most importantly, priority has been given to developing effective and functional working relationships within the EMS Community. Recovery and rebuilding will be a collaborative process with many challenges. Knowing this, the Oregon EMS and Trauma Systems Section is positioned and postured to be a part of the State s recovery. Optimistic and idealistic, yes we are! We are also being purposeful and deliberate in planning and preparing for what s next thanks for hanging in there with us and together we ll see what s next!!! NEW PREHOSPITAL SYSTEMS MANAGER By Paul Bollinger Prehospital Systems Manager I began my career in EMS and the fire service in 1986 in Northern California. For over ten years I have worked as an EMT in San Francisco and as a volunteer firefighter in my local community. I also worked as an EMT in rural Wisconsin and served as a health volunteer in the U.S. Peace Corps stationed in Sri Lanka. Recently my career experience was managing a project funded by the Centers for Disease Control and Prevention (CDC) to increase healthcare access for children in the state of Wisconsin. In the fall of 2003 I finished my Masters degree in Public Health at Oregon State University. Part of my research at OSU included public perceptions of EMS from the urban and rural perspective and the development of performance standards for international EMS programs. Over the next few months I plan on meeting some of you as I travel around the state. I wish to learn more about the services YOU as prehospital providers would like from the office of Emergency Medical Services and Trauma Systems Section. Additionally, I will be visiting each of the 19 EMT and Paramedic training programs in Oregon within the coming year. I am
Spring 2004 Oregon EMS Update page 3 excited to join all of you as we continue to provide the highest quality of prehospital care to the citizens of Oregon. WORKING FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS EDUCATIONAL MATERIALS AVAILABLE NOW!! By Debbie Danna, RN, BSN EMS-Children Coordinator Thousands of children and adolescents each year are rushed to emergency departments following serious injury or illness. Approximately 20,000 of these children lose their lives and another 50,000 are permanently disabled. In 2002, 19.6% of the patients entered into the Oregon Trauma Registry were pediatric patients age 18 or younger. The needs of all children including those with special health care needs must be considered when preparing for and responding to severe illness or injury. Children with special healthcare needs have medical conditions that could place them at greater risk during a medical emergency. Working through a grant the EMS-C program in Oregon is making available three sources of educational materials to aide the pre-hospital professional in assisting in the care of the child with special healthcare needs (CSHCN). 1. A Child in Need CD-Rom is an interactive multi-media tool that explains various medical conditions and equipment you may encounter and explains how those medical conditions or equipment may affect your assessment and intervention. 2. Children with Special Health Care Needs Technology Assisted Children (TAC) books are available. This book identifies educational objectives and guidelines for pre-hospital personnel who are challenged with providing emergency care for these children. 3. Working for Children with Special Healthcare Needs Fact Sheets are also available. The above materials may be obtained by calling Debbie Danna, EMSC Coordinator at 503-731- 4011 or request by email at Debra.M.Danna@state.or.us. Supplies are limited.
Spring 2004 Oregon EMS Update page 4 PREHOSPITAL DATABASE USE By Will Worrall Prehospital Data Systems Coordinator Use of prehospital databases is spreading throughout the State. Twenty agencies have adopted EPCIS, the State-supplied prehospital database. Forty more agencies are expected to adopt EPCIS within the next three to six months. Additionally, some agencies are purchasing databases from private vendors. 2004 EMS AWARDS PROGRAM By Catherine J. Schmitz Prehospital Standards Unit Assistant Use of a prehospital database will lead toward better care for the patient. Besides producing a more legible PCR (a great improvement in itself!), the data gathered will allow your agency to perform better Quality Improvement. Aggregating data at the State level will allow agencies to know how they are performing relative to their peers. We hope that you and your patients will benefit from this technology as it comes into widespread use. The DHS-EMS Awards Program will be presented during the Oregon EMS Conference Banquet on Friday September 24, 2004. Nominations for this year's program are due to the office no later than May 31, 2004. The Awards Program Manual may be viewed on our website at www.dhs.state.or.us/publichealth/ems. There are still three months remaining to submit a nomination. NOMINATION PROCESS The incident must have occurred between the dates of June 1 of the prior year through May 31, of the current year to qualify. For a nomination to be considered for presentation at the annual Oregon EMS Awards Ceremony, the Oregon Emergency Medical Services & Trauma Systems section must receive a nomination no later than May 31, 2004. Nominators are expected to sponsor nominee's banquet costs if selected. Direct all nominations and supporting documentation to: Department of Human Services Emergency Medical Services & Trauma Systems Attention: AWARDS PROGRAM 800 NE Oregon Street, Suite 607 Portland, OR 97232
Spring 2004 Oregon EMS Update page 5 Nominations require the following items: 1. Award Nomination Form with all the requested information (Category for nomination must be indicated on form). 2. Self addressed, stamped postcard that will be returned to you from the EMS & Trauma Systems section to verify receipt of nomination. 3. Not more than three typewritten pages of background narrative and supporting documentation. Media award nominations may exceed the page limitation and may include VCR tapes of TV footage, cassette recordings of radio reporting, or photocopies of print media stories. 4. Electronic photo of the nominee, Agency logo, and brief synopsis (300 words or less) of the event or individual contribution for use in the preparation of the award presentation. Don t forget to mark your calendars OREGON EMS CONFERENCE 2004 Portland, Oregon Double Tree Jantzen Beach Pre-conference, September 22 & 23 Conference, September 24 & 25 GETTING PAST ABC By Jerry D. Andrews, AS, NREMT-P Mobile Training Unit 2 Coordinator Every First Responder, EMT, and even CPR providers have been trained to recite ABC, ABC, ABC (Airway, Breathing, and Circulation) until they have nightmares. It is drilled into the brains of every EMS responder during training and though continuing education. ABC s are frequently the only real EMS words physicians (not the EMS Medical Directors, of course) know. They are therefore compelled to remind EMT s that it is essential that we, as EMT s, manage the patients ABC s. The simple question is, Is ABC enough? Is it enough to simply recite and assess the airway, breathing, and circulation? What if you were offered a method that would more than double the information you could collect about a patient s life threatening status in the very same period of time? Would you use it?
Spring 2004 Oregon EMS Update page 6 Consider this: AA - Airway and Aspiration: Assess the patients airway as you always have, or even actually check to see if the patient actually has a patent airway. Correct any airway problems immediately. At the same time, ask yourself if there is a potential for aspiration. If the patient has a patent airway but is at risk for aspiration, correct the problem immediately. BB - Breathing and Bleeding: As you Look, Listen and Feel for respiration, assess the respiratory rate, rhythm, and quality. Don t guess; actually measure it. Observe for a life threatening bleeding, and use appropriate methods to control the bleeding. CC - Circulation and C-Spine: When you check a patient for circulation, include rate, rhythm, and quality. Again, don t guess, establish the baseline. Consider the possibility of a cervical spine injury. The consideration of injury should include mechanism of injury, age, and overall patient condition. DD - Deficits and Deformities: The patient should be evaluated for deficits by assessing the level of consciousness, usually expressed as Alert, Verbal, Painful or Unresponsive (AVPU). Instead, consider assessment of the Glasgow Coma Score, assessing Eye, Verbal, and Motor response. (Remember that even a tree scores a 3, although, interestingly enough, GCS scores of 28 and 0 have been recorded.) On the subject of deformities, this is not a detailed assessment, or what you may remember as a secondary assessment ; rather it is an assessment of obvious deformities, which should alter your handling of the patient. Obvious deformities of the upper arm or lower leg, or significant respiratory distress should alert you to change how you log roll a patient. EE - Expose and Expedite: EMT s have been told repeatedly, You can t treat what you can t see. Yet, many EMT s are reluctant to expose patients; patients regularly arrive at Trauma Centers or Emergency Departments clothed or with IV lines and/or ECG or Pulse Oximetery monitor wires snaked in and amongst clothing. Expose your patient, and cover them to maintain body heat and to preserve modesty. (And get rid of the paper sheets for the patients sake! They do nothing to maintain body heat.) Expedite means, at this point make a decision to load and go or decide that you and the patient have time to continue the assessment. This decision point may suggest or require, depending on local protocol, to call for paramedics, the helicopter or just get en route to the most appropriate
Spring 2004 Oregon EMS Update page 7 hospital. If you find but can not correct immediate life threats at this point, consider emergent transport. FF - Fahrenheit and Fast: Is the patient too hot or too cold? Is the environment too hot or too cold? Can you correct either the patient or the environment? What about just getting the patient off the ground, on a backboard or into a warmer space? Fast - Keep this in mind through the next assessment phases. GG - Glucose and Go: What is the patient s glucose? Low - fix it; high-fix it, if you can; normal-ok, move on. Go - Add to fast; fast go...keep reading. HH - Hospital or Help: At this point you should have a clear indication if your patient is experiencing any potential life threatening conditions. The pneumonic reminds you to either fast go (to the) hospital or fast go (for) help. Keep in mind that help can be additional personnel, higher trained personnel, or on-line medical control. There you have it, a quick, easy, reliable method of gathering more information about your patient and identifying potentially life threatening conditions. My thanks to Bill Alguire, EMT-P, Keizer Fire District and Elizabeth Morgan, NREMT-P, DHS-EMS for the foundation of the Double ABC s. Truly two of the best patient care providers I know. EDUCATIONAL FUNDS FROM NORTHEAST OREGON AHEC By Sandy Ryman Northeast Oregon AHEC Northeast Oregon AHEC is awarding leftover SB911 Education Funds for the March 1, 2004 and July 7, 2004 funding cycles. These will be the last two funding cycles unless there is future legislative action to restore the monies. The March 1st cycle will award $85,000 and the July 7th cycle will award $125,000. The award process is the same as before and you can obtain information and applications by calling Kathy Davis at 541-962-3899 or by checking the website at: www.eou.edu/neoahec.
Spring 2004 Oregon EMS Update page 8 Due to the limited amount of funds to be awarded, it is likely the statewide review committee will fund only volunteer agencies. Currently, the committee policy is that they will fund paid agencies only IF there are enough funds leftover after awarding the volunteer groups. Therefore, it is always OK to apply if you meet the rest of the criteria for eligibility. Applying does not assure funding. I HAVE A QUESTION By Tim Hennigan Prehospital Standards Representative I have a question. These are usually the first four words that we hear when someone calls DHS-EMS looking for assistance. In the short time I have been working with DHS-EMS I quickly realized that the same questions and issues arise over and over again. Some more than others, but it instantly becomes clear when a topic is up in the air and answers are needed. I thought that I would try to answer some of these questions by writing I have a question for this and future EMS Updates. The following two questions are common ones. Unfortunately, some EMTs and students discover the answer too late. Question: I m an EMT-Paramedic student and I am almost finished with school. When working for my EMS employer, can I work within the EMT-Paramedic scope of practice? Question: I m an EMT-Paramedic student and I am signed up to do a ride-along with an agency. Can I perform skills within the EMT-Paramedic scope of practice during my ridealong? EMTs generally understand scope of practice as it relates to EMTs working in the field, however, both Intermediate and Paramedic students are confused when it comes to being in school and working at the same time. Looking back into past cases as well as looking at some current issues, it is clear that the answer is not as simple as it may appear on the surface. Whether they are working EMTs upgrading their certification, or unaffiliated EMTs planning to seek employment after becoming a paramedic, paramedic students need to understand when they can and cannot function at the
Spring 2004 Oregon EMS Update page 9 paramedic level. The issue becomes two-fold when a certified paramedic allows a student to function inappropriately. The certified paramedic shares equal responsibility in the scope of practice violation for allowing the paramedic student to perform a skill beyond the scope of his/her certification. EMT-P preceptors working next to the student must understand when a paramedic student can and cannot function as a paramedic. All too often we receive information like this: An EMT-P student is employed by an agency where he is also performing his internship. During his normal shift, he works as an EMT-Basic. On his day off he rides as an extra person on the crew and functions as a paramedic student with his preceptor watching. A call comes in and the individual responds with his partners. They arrive on scene to find a patient in serious condition. Life-saving interventions are performed, the paramedic student practices his skills and the patient is transported. While completing the paperwork, the crew realizes that the paramedic student was working a regular scheduled day and is not riding along as a paramedic intern. The paramedic student has exceeded his scope of practice and the crew of EMTs has allowed the paramedic student to exceed his scope of practice. Similarly, an EMT-Paramedic student is only allowed to function in the paramedic student role when participating in a formal field internship. Educational institutions have contracts in place with agencies which allow students perform field internships. The student, upon completion of the didactic portion of his/her paramedic training is assigned an internship site through the paramedic program and works under the observation of a preceptor. Only when working as an intern, with an assigned agency and under the supervision of a preceptor, may a paramedic student perform skills within the EMT-P scope of practice. Paramedic students may not sign up for a civilian ride-along and function as a paramedic intern. If a paramedic student performs skills while participating in a civilian ride-along the student as well as the ambulance crew would be responsible for the violations of scope of practice. Although the scenarios are different, the underlying question is the same. When can a paramedic student function within the paramedic scope of practice? An EMT-Paramedic student can only work within the paramedic scope of practice when providing care under a preceptor in a hospital clinical setting or while participating in the field internship phase of paramedic school under the supervision of the preceptor. Additionally, a student must successfully demonstrate a skill in the classroom lab or hospital clinical setting before that skill can be performed in a field internship. I would be remiss if I didn t mention EMT-Intermediate students before I close. At this time, the Oregon EMT-Intermediate curriculum provides for classroom lab experience only. There is not an allowance for hospital clinical rotations, nor is there an allowance for a field internship experience. If an EMT-Intermediate student practices skills within the EMT-Intermediate scope of practice in a setting other than the classroom, that student is violating his/her scope of practice.
Spring 2004 Oregon EMS Update page 10 It is up to every EMT to be familiar with the Oregon Revised Statutes and Oregon Administrative Rules. The only way to protect yourself from misinformation is to either know the answer or know where to find the answer. Stay Safe. The following ORSs and OARs were used as reference for the preceding article: ORS 682 OAR 333-265 OAR 847-035 The website address for the rules is: www.dhs.state.or.us/publichealth/ems/rules MOBILE TRAINING UNITS By Donna Wilson Mobile Training Unit 1 Coordinator Last year the MTU s conducted 170 classes, provided 7528 hours of continuing education, and met with 2660 providers. The 2004 letter requesting scheduling the MTU can be found on our website at www.dhs.state.or.us/publichealth/ems/mtu/mtu.pdf. Please fill it out and return it. If you desire one can be sent to you via e-mail or regular mail. How can we make your jobs teaching EMS topics easier? I d like to take a few moments of your time to discuss professional development of our continuing education professionals and Training Officers. Instructor workshops have been discussed a number of times in the past that discussion is still open and we would like to hear from you regarding this topic. E-mail me at ohdmtu@teleport.com. Are you interested in developing your teaching skills and presentation creation skills? Does your agency support professional development or are you on your own? We have super-sized our plates and are being asked to do more with less. In this article I have asked questions rather than giving you stats or facts. As we plan for 2004 these questions need answers so that we might better plan MTU offerings. Please take a few minutes to think about your professional development. Send us your comments by e-mail to ohdmtu@teleport.com.
Spring 2004 Oregon EMS Update page 11 2004 Paramedic Exam Schedule National Registry Type of Exam Date of Exam EMS Filing Deadline Location Written April 16, 2004 March 19, 2004 Portland Practical April 17, 2004 March 19, 2004 Portland Written July 23, 2004 June 25, 2004 Roseburg Practical July 24, 2004 June 25, 2004 Roseburg Written September 24, 2004 August 27, 2004 TBA Practical September 25, 2004 August 27, 2004 TBA MAKING THE GRADE TRAUMA CENTER SURVEYS By Raelene Jarvis, RN, MS Trauma Coordinator Ambulances and EMTs aren t the only ones regulated by the EMS & Trauma Systems Section at DHS. Every three years, each of the 45 hospitals regulated by the Oregon Trauma Program are visited for an on-site survey. An expert team composed of a physician, a nurse and DHS Trauma staff tours the hospital, reviews medical records, and interviews hospital staff. Prehospital personnel are welcome to provide their input during the survey. The survey team may request to meet with your agency s representatives to assess the hospital s interaction with prehospital personnel in the care of the trauma patient and in the regional coordination of the trauma system. Your local trauma coordinator can advise you of the hospital s next scheduled trauma center survey visit. Trauma hospitals are evaluated on criteria listed in OAR 333-200-0090 (1) Exhibit 4, which describes the resource and system requirements for trauma hospitals at each level of care. Trauma hospitals are distinguished from other facilities in that they guarantee the immediate availability of surgeons, anesthesiologists, physician specialists, nurses, ancillary services, and resuscitation/life-support equipment on a 24-hour-a-day basis, dedicated to the care of trauma patients. Trauma facilities are designated or categorized as Level I, II, III, or IV. Oregon has two Level I trauma hospitals, both located in Portland. The role of the Level I trauma center is to provide the highest level of definitive, comprehensive care for the severely injured adult and pediatric patient with complex, multi-system trauma. In Oregon, there are three Level II trauma hospitals, located in Corvallis, Eugene and Bend. We also rely on the Level II trauma hospitals across our borders, in Vancouver WA and Boise ID to provide care to Oregon patients. The role of the Level II trauma center is to provide definitive care for severely
Spring 2004 Oregon EMS Update page 12 injured adult and pediatric patients with complex trauma. The services available at a Level II trauma facility and the resource requirements are similar to those at a Level I trauma center. There are 21 Level III trauma hospitals across Oregon, and three located along our border in Washington. The role of the Level III trauma center is to provide initial evaluation and stabilization, including surgical intervention, of the severely injured adult or pediatric patient. A Level III trauma center provides comprehensive inpatient services to those patients who can be maintained in a stable or improving condition without specialized care. Eighteen rural hospitals throughout Oregon, and one across the border in California, provide the services as a Level IV trauma hospital. The role of the Level IV trauma center is to provide resuscitation and stabilization of the severely injured adult or pediatric patient prior to transferring the patient to a higher level trauma system hospital. Resuscitation and stabilization may involve surgical intervention. 5 th Annual Emergency Medical Services for Children Conference OCTOBER 22 ND AND 23 RD, 2004 (PEDIATRIC TRAUMATIC BRAIN INJURY PRE-CONFERENCE, OCTOBER 21 ST, 2004) EUGENE HILTON CONFERENCE CENTER EUGENE, OREGON A valuable pediatric educational program for prehospital & hospital caregivers View our web site for updated information at http://www.dhs.state.or.us/publichealth/ems Coordinated by Department of Human Services, EMSC Conference Planning Committee
Spring 2004 Oregon EMS Update page 13 DID YOU KNOW???? 654 Total EMS Agencies 136 Transport Agencies 518 Nontransport Agencies 136 Transport 73 (54%) Fire Based 257 (50%) Fire Based 518 Nontransport 63 (46%) Non Fire 261 (50%) Non Fire
Department of Human Services Emergency Medical Services and Trauma Systems 800 NE Oregon Street, Suite 607 Portland, Oregon OREGON EMS A SYSTEM TO SAVE LIVES The Oregon EMS Update can be found on the web at: www.dhs.state.or.us/publichealth/ems/readingroom STATE OF OREGON Theodore Kulongoski, Governor Gary Weeks, Director, DHS Barry Kast, Assistant Director, Health Services, DHS Grant Higginson, M.D., M.P.H., State Public Health Officer Gail Shibley, Administrator, DHS, Office of Public Health Systems Jonathan Chin, State EMS Director, Emergency Medical Services and Trauma Systems Section Address: 800 N.E. Oregon Street, Ste. 607 Portland, OR 97232 Telephone: (503) 731-4011 Fax: (503) 731-4077 TTY: (503) 731-4031 www.dhs.state.or.us/publichealth/ems/ The Oregon EMS Update is a publication of the State of Oregon, Department of Human Services, Emergency Medical Services and Trauma Systems Section. OREGON EMS STAFF (503) 731-4011 Education & Certification Services Paul Bollinger, Prehospital Systems Mgr. Nancy Gillen, Exam Coordinator Michele (Shelley) Shute, Cert. Coordinator X650 x632 x635 Outreach & Special Projects Donna Wilson, MTU 1 (503) 807-5850 ohdmtu@teleport.com Will Worrell, Prehospital Data Systems Coord. x685 Prehospital Standards Unit Tim Hennigan, PSU Representative Elizabeth Morgan, PSU Representative Catherine Schmitz, PSU Assistant Trauma Systems Susie Werner, Trauma Program Manager Raelene Jarvis, Trauma Coordinator Debbie Danna, EMSC Coordinator Donald Au, Trauma Research Analyst Susan Harding, Trauma Registrar Administration Karen Baker, Administrative Assistant Kristen Hampton, Receptionist x631 x633 x621 x626 x629 x662 x627 x628 x630 x622