Brian Barhorst, MD. ACEP FINANCIAL DISCLOSURE SLIDE. Objectives. Discuss several differences between Rural and Non-rural EMS. Discuss some difficulties and benefits that may arise for the Medical Director. ID: 758320
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Issues for Medical Directors
Brian Barhorst, MDSlide2
ACEP FINANCIAL DISCLOSURE SLIDESlide3
Discuss several differences between Rural and Non-rural EMS
Discuss some difficulties and benefits that may arise for the Medical DirectorSlide4
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
Strong call to serve – Dedicated
Roster vs Active Members
“Chute” times – from page to en-route
ALS intercept plan
Experience / Skills maintenance
Rural Squad Volumes as low as 100/year
How many are kids?
Rural Medics may only get 1-2 intubations/year
HOW MANY ARE KIDS?
Using your friendly neighborhood HEMS outreach…Slide9
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?
Social Media? E-mail?Slide10
Continuing Education sourcesSlide11
Dispatch / PSAP experience
Call volume vs staffingSlide12
(Controlled) Drug tracking/SECURITYSlide13
Austere environments / Special opsSlide14
Being an engaged Med Director…
Medical Director Experience/Expectations
On Scene Response?
Ride Along Time?
Advocate for self-care/preparedness
Full Time Jobs / Stipend vs Volunteering
Being heard by the State / Nation
Regional Physician Advisory Boards
Rural EMS Committee at NAEMSPSlide15
Suggestions for progress
The Key is Teamwork and Collaboration
Research focused on rural EMS.
Regionalization of High Price items (education, communication)
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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