Rural EMS Issues for Medical Directors

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Rural EMS Issues for Medical Directors




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Presentations text content in Rural EMS Issues for Medical Directors

Slide1

Rural EMS

Issues for Medical Directors

Brian Barhorst, MD

Slide2

ACEP FINANCIAL DISCLOSURE SLIDE

Slide3

Objectives

Discuss several differences between Rural and Non-rural EMS

Discuss some difficulties and benefits that may arise for the Medical Director

Slide4

Case Study #1

Your Volunteer EMS Service is paged to a home at the edge of the county for a 65 year old diabetic who is “not acting right.” An additional page 5 minutes later is needed to get a full 2 man crew at the station to begin response. On arrival, 22 minutes after the first page, the BLS crew radios dispatch for a paramedic for the full arrest. They also call the local ED, and ask the locums ED Physician if they should wait for the paramedic or transport immediately… or should they even start CPR?

Slide5

Case Study #2

Tones drop for multiple squads in response to a call for school shooting with 12 victims at a village school. The local squad has one ambulance, and all ten members respond, 2 leaving their tractors in the fields, as the county seat sends two city crews, and five surrounding districts start the 1 ambulance they each have available, leaving half of the county uncovered. The village’s single police officer on duty has never drawn his duty weapon on a live scene before, the local ED 30 minutes away has four beds, and the two helicopter services in the region are unable to fly due to fog this morning.

Slide6

Case study #3

The community is holding it’s Fall Festival Bake Sale to hopefully enable the local EMS service to replace its aging LifePak 10

®

, since the tax levy failed and the grant fell through. The MAST trousers sit proudly out as part of the display, as the Chief feels they are life-saving devices, and wonder why you, as the volunteer Medical Director, want to remove them from the Protocols…

Slide7

VOLUNTEERs/RUN Coverage

Strong call to serve – Dedicated

Roster vs Active Members

“Chute” times – from page to en-route

Physical Fitness

Fatigue

Paramedic Paradox

ALS intercept plan

Funding

Slide8

Experience / Skills maintenance

Rural Squad Volumes as low as 100/year

How many are kids?

Rural Medics may only get 1-2 intubations/year

Simulation time?

OR time?

HOW MANY ARE KIDS?

Using your friendly neighborhood HEMS outreach…

Slide9

Quality assurance

Rural Medical Directors rarely have help

Single Rural EMS coordinator in a county

Hospital Based, focused on Education

Volunteer squad run review

How many is enough? Benchmarks?

Corrective Actions

Communications

Social Media? E-mail?

Slide10

Continuing Education sources

Slide11

DISPATCH

Dispatch / PSAP experience

Over-the-Phone care

Call volume vs staffing

Slide12

(Controlled) Drug tracking/SECURITY

Slide13

Austere environments / Special ops

Slide14

Being an engaged Med Director…

Medical Director Experience/Expectations

Community Involvement

On Scene Response?

Ride Along Time?

Advocate for self-care/preparedness

Difficulties

Distance

Full Time Jobs / Stipend vs Volunteering

Being heard by the State / Nation

Regional Physician Advisory Boards

Rural EMS Committee at NAEMSP

Slide15

Suggestions for progress

The Key is Teamwork and Collaboration

Research focused on rural EMS.

Regionalization of High Price items (education, communication)

Website

E-mail?

Educational website / Sim set-ups.

Emergency Medical Dispatch?

Be involved with local Emergency Planning Committees.

Slide16

Realistic Case resolutions

Case #1 – ALS intercept is arranged half way to the ED. Unfortunately, this unwitnessed arrest with no bystander CPR dies.

Case #2 - The community pulls together to help, and the ten volunteers triage the 12 victims, keeping the ambulance on scene for supplies. The incoming squads transport all of the patients to the local hospital, overloading the single coverage physician, but the school has no mass shooting kits, and tourniquet supplies are short. Out of the 6 dead, five would have survived in an urban school district.

Case #3 – The community pulls through, thanks to the awesome brownies the Medical Director made, and a refurbished LifePak 12

®

is bought. The local hospital’s biomed department agrees to do periodic maintenance free of charge as a charitable contribution with no strings attached.

Slide17


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