iaff 2449

Published by the Tidewater EMS Council and Medical Transport, L.L.C. Dedicated to Emergency Medical Services Vol. 32 No. 3 May / June 2015
Tidewater EMS Council
Board Elects Directors
and Officers
Recognize Excellence in
Emergency Medical Services
ON
March 19, 2015 the Tidewater EMS Council Board
of Directors held board, officer and executive
committee elections for a two year term. Stewart W.
Martin, MD of Virginia Beach was reelected president
of the board. Dr. Martin is an attending physician with
Emergency Physicians of Tidewater and medical director
for the Virginia Beach Department of Emergency Medical
Services and all of the volunteer rescue squads in Virginia
Beach. He is board certified in emergency medicine and
hyperbaric and undersea medicine.
Richard A. Craven, MD of Virginia Beach was elected Vice President. Dr. Craven is an at-large director, board
certified in emergency medicine and preventative medicine, and practices in Chesapeake and Virginia Beach.
Kent J. Weber of Suffolk was reelected treasurer.
Weber was the organization’s first executive director and
held that position from 1974 until 1986 when he retired.
He continues to serve as a director of the board and is an
active Rotarian.
Directors elected to the board were:
Charles Ray Pruitt, representing Accomack County
Donna Marchant-Roof, LCSW, John W. McNulty, III and Thomas E.
Schwalenberg, representing the city of Chesapeake
Terry A. Bolton, representing the city of Franklin
Jeffrey T. Terwilliger, representing Isle of Wight County
Paul S. Holota, MD, Daniel A. Norville and Jeffrey F. Wise and
representing the city of Norfolk
Hollye B. Carpenter, representing Northampton County
Jeffrey J. Meyer, representing the city of Portsmouth
Brian L. Steelman, representing Southampton County
John C. Hoffler, representing the city of Suffolk
Bruce W. Edwards, Christopher I. Jacobs, JD, Stewart W. Martin,
MD, Wayne E. Shank, and Kent J. Weber representing the city of
Virginia Beach
Lewis H. Siegel, MD, representing the Virginia College of
Emergency Physicians
Janice E. McKay, RN, representing the Tidewater Emergency
Nurses Association
Teresa W. Babineau, MD, representing the Eastern Virginia Medical
School
Genemarie W. McGee, RN, representing the Virginia Hospital and
Healthcare Association
Recognize the dedication and
devotion of your fellow EMS
providers and those who support
the EMS system by nominating
someone today for a Regional
EMS Council Award!
Submit a nomination in one of the following award
categories for the 2015 TEMS Regional EMS Awards:
•Excellence in EMS
•Prehospital Provider
•Prehospital Educator
•EMS Telecommunications Dispatcher
•EMS Agency
•Contribution to EMS Health & Safety
•Contribution to EMS for Children
•Nurse with Contribution to EMS
•Physician with Contribution to EMS
•$1,000 Scholarship - Contribution to
EMS by a High School Senior
•EMS Administrator
Visit www.tidewaterems.org/awards to submit your nominations.
Nominations are due by May 17, 2015.
Find out more about the regional and state award programs at
http://www.vdh.virginia.gov/OEMS/ProviderResources/GovernorAwards/index.htm.
T. J. McAndrews, representing the region’s special operations (technical rescue, hazardous
materials, marine rescue)
Richard A. Craven, MD, at-large director
In addition to the officers, the board elected four members of the executive
committee: Bruce W. Edwards, John C. Hoffler, Genemarie W. McGee and
Daniel A. Norville.
While many of the directors were reelected, four new persons joined the
board. They are Charles “C Ray” Pruitt with the Accomack County Department
of Public Safety; Terri Babineau, MD, Assistant Dean for Student Affairs at
the Eastern Virginia Medical School; Donna Marchant-Roof, LCSW, Director
of Comfort Care, Home Health and Hospice at Chesapeake Regional Medical
Center; and, Thom Schwalenberg, Chief Medical Officer for the Chesapeake
Fire Department.
The board recognized and thanked retiring directors Dan Fermil, Geoff
Miller, Chris Smith and George Yacus.
The Educator’s Corner
Capnography, Standards of Care and the
Healthcare Provider
By: Lisa Cooley, BSN, RN, CEN Flight Nurse
Nightingale Regional Air Ambulance
The use of capnography and end-tidal carbon dioxide (ETCO2) monitoring has become the
standard for verifying endotracheal tube (ETT) placement and monitoring the effectiveness of CPR
as well as an early indicator for return of spontaneous circulation (ROSC). ETCO2 monitoring is a
great tool for EMS providers that is often overlooked when providing care in the pre-hospital care.
The science behind capnography is amazing!. Oxygen is inhaled into the lungs where gas exchange
occurs at the alveolar-capillary membrane. From there, oxygen is transported to the tissues through
the blood stream. At the cellular level, oxygen and glucose combine to produce energy, causing
carbon dioxide, a waste product that is released into the blood stream. The blood carries the carbon
dioxide to the alveoli, where it is exhaled by the lungs through ventilation. The ETCO2 monitor
detects the CO2 level, providing a waveform and CO2 reading. As we all know, pulse oximetry
is a standard practice for determining the patients respiratory status. Capnography, however, is
not widely used on every patient. Capnography has an advantage over pulse oximetry because it
provides an immediate picture of a patient’s condition, where pulse oximetry is delayed.
Pulse oximetry readings drop when there is a
decrease of oxygen in the blood stream, or hypoxia.
Hypoxia, however, follows hypoventilation, and may take
30 seconds or more for the pulse oximeter to register
the decline. A basic example of this is if you hold your
breath, capnography will show apnea immediately while
the pulse oximetry will show a high saturation for several
minutes. Monitoring ventilation through capnography provides trends in respirations and early
warnings for impending respiratory crisis. An ETCO2 ranging between 35-45mmHg is considered a
normal capnography value. It is important to know that hyperventilation will cause the ETCO2 level
to go down below the normal range and hypoventilation will cause the ETCO2 level to go up above
the normal range. Knowing this simple piece of information will help immensely when it comes to
assessing and caring for your patients. Causes for hyperventilation include, but are not limited to
anxiety, bronchospasm and pulmonary embolus. In contrast, some causes of hypoventilation include
altered mental status, head trauma and sedation.
There’s more to it than just knowing the numbers and possible causes. It is also important to
know what a normal capnography waveform looks like because it allows you to pick up subtle
changes in your patients status. For example, an excellent way to assess the severity of an
asthmatic or COPD patient is to hook them up to continuous ETCO2 monitoring. Because of the
uneven alveolar emptying that occurs as the patient struggles to exhale, bronchospasms produce
a “shark fin” capnography waveform (see picture below). Several studies have confirmed that the
sloping “shark fin” shape correlates to both bronchospasm and obstructive lung disease. ETCO2
monitoring also helps in evaluating the effectiveness of your bronchodilator treatment because
successful treatment will lessen or eliminate the “shark fin” shape and return the ETCO2 to normal
range with a normal waveform. It has also been suggested that ETCO2 monitoring can assist with
differentiating between obstructive airway wheezing (seen in COPD) and the “cardiac asthma” of
CHF. This is because in patients with CHF, the alveoli are still mostly full as they exhale, so the wave
form should be upright and normal in shape, rather than sloped. As you can see, capnography
can be a useful and fairly simple adjunct for monitoring patients. Since ETCO2 is more sensitive
in detecting respiratory issues, we should be incorporating this simple intervention, with pulse
oximetry, into our everyday practice as pre-hospital providers.
2
Navy, Coast Guard
& Sentara Train for
Trauma
By:Dale Gauding, Communications Advisor,
Sentara Healthcare
Navy and Coast Guard helicopter squadrons,
guided by Navy E-2C Hawkeye aircraft, recently
conducted an offshore search and rescue
exercise designed to improve communication and
coordination.
Part of the exercise involved a Navy MH-60
helicopter landing at Sentara Norfolk General
Hospital to deliver a heavy mannequin to the
Level I trauma center there. The inbound pilots
communicated by radio with the Nightingale
dispatch center to alert the hospital they were
coming and transmit details of injuries and vital
signs.
The air crew and a Navy corpsman, assisted
by the Nightingale team, placed the ‘patient’ on a
gurney and rolled into the trauma center, where
the corpsman conducted a verbal handoff to the
trauma team. It was only a taste of the real thing,
but, conveyed the importance of an effective
handoff to assuring proper care and potentially,
saving a life.
“This is a great opportunity for the hospital
and the Navy to learn each other’s capabilities and
help assure safe operations at our helipad,” said
Nightingale manager Denise Baylous, RN. “We
get a lot of medical helicopters here, but not a lot
of Navy and Coast Guard, and these interactions
help us all do a better job working together.”
Military reporter Mike
Gooding of 13-NewsNow
conducts interview
about the exercise.
πNavy corpsman hands off ‘patient’ to trauma team at
Sentara Norfolk General Hospital.
EMS Today Conference
Looks to the EMS Future
By:Jim Chandler
I attended the EMS Today conference in Baltimore in February. This sort of national
conference is a great opportunity to meet the rest of the EMS world and to see and hear
about the future of EMS.
I encourage all EMS providers, no matter your level of certification or position in your
organization, to take advantage of the education and experience offered by a national
EMS conference. EMS Today will be in Baltimore again next year, and it offers a drivable
alternative. Also, in case you were not aware, the Tidewater EMS Council offers grants for
EMS providers in the region to attend national EMS conferences. See the TEMS website
www.tidewaterems.org for more information.
I was interested in research, quality improvement, EMS data, mobile integrated
healthcare and EMS of the future. The conference included plenty of clinical topics, too.
Here are a few of the nuggets I learned:
We have a long way to go with EMS research. Unlimited opportunities exist. We need
to “prove” our clinical and educational methods. EMS research can be really simple, at
practically no cost or it can be an expensive, randomized trial, and everything in between.
We need all of this. There are opportunities to learn how to conduct EMS research through
the UCLS Prehospital Research Forum www.pcrf.mednet.ucla.edu/pcrf/ including free
“EMS Research 101” online learning, podcasts and more. FISDAP is another good course of
information and support www.fisdap.net/research. I hope we can get EMS research built-in
as part of the Virginia EMS Symposium, and more local EMS providers involved in research.
Lots of EMS providers around the country are conducting and presenting EMS research.
Not much from Virginia.
The feds and others are using GIS to map healthcare data. The concept isn’t earthshattering, but the feds are asking “how can we engage EMS in broader healthcare policy”
continued on page 4
CHESAPEAKE PROFESSIONAL FIREFIGHTERS
www.iaff2449.org
EMS Excellence
Education Series
• Monthly CE Program for
BLS and ALS providers
• 3 hours per session
• Taught in a flip/flop
format
• Meets National Registry
and Virginia CE
requirements
• Open to any providers in
the region
• FREE !!!!
January—June
2015
May 19th and/or 20th
Handle with Care: Crisis
Intervention Skills for EMS
June: 16th and/or 17th
Bird is the Word!
Trauma and Aeromedical
Operations
The EEE Series
The Chesapeake Professional
Firefighters, IAFF Local 2449,
is proud to announce the
EMS Excellence Education
Series.
The EEE series is a monthly
direct delivery Continuing
Education program for any
EMS providers in the region
looking for EMS CE in a fun,
engaging, challenging, and
participatory environment.
Subject matter experts and
guest speakers will ensure
timely and high quality
infor-mation is presented.
Isle of Wight Rescue
Stephen Haige / 357-2587
HRMMRS
Judy Shuck / 963-0632
Nansemond - Suffolk Rescue
Doug Schneider / 539-6870
Medical Transport LLC
Daniel Green / 962-6813
Norfolk Fire/Rescue
Robert Brant / 441-5252 x304
NorthStar First Response
Ashley Staley / 410-7518
Southside Regional Fire Academy (SRFA)
Janet McDaniel / 393-8155
Special Event Providers
Kevin Renshaw / 284-1786
TCLS - CPR, First Aid
Gordon Degges / 446-5926
Classes are from 1800—2100
hours.
TCLS - ACLS/PALS
Tom Mingin / 446-5993
Classes are free to all providers.
June 16/17: Bird is the word
Franklin
Tim Dunn / 562-8581
TCC VA. Beach Campus
Jason Ambrose / 822-7335
Classes will be held at the
Chesa-peake Fraternal Order of
Police Lodge but may occasionally
use other venues in order to meet
educational objectives.
May19/20: Handle with Care
Eastern Shore
Hollye Carpenter / 678-0411
Suffolk Fire
Ryan Praither / 514-4546
Virginia and National Registry
CE are available for both Basic
Life Support and Advanced Life
Support Providers.
Second quarter preview
Chesapeake Fire
Gary Burke / 673-8741
Portsmouth Fire Rescue
Amy Ward / 393-8123
IAFF LOCAL 2449
Special points of
interest:
Training
Contacts
Chesapeake Professional
Firefighters
Local 2449
To register for any classes or
for more information, contact:
[email protected]
Or use the doodle link below
to register: http://
doodle.com/8bu5g6yngvqxffxe
TEMS
Jay Porter / 963-0632
Virginia Beach
John Bianco
385-5002
3
EMS Today Conference Looks to the EMS Future
NIMS:
ICS – 300 & ICS – 400
Courses
WHO SHOULD ATTEND?
These
courses
are
recommended
for
supervisory level personnel assigned
to the Fire Service, Emergency Medical
Services, Law Enforcement, Emergency
Management, Public Health, Public
Works and Social Services. Key
personnel from the Medical Reserve
Corps, CERT, American Red Cross and
other VOAD and disaster
response organizations are
also encouraged to attend.
COURSE HIGHLIGHTS:
Theses 2-day courses are
VDEM approved and taught by certified
instructors. The courses are free to
students and student materials are
provided. The parking is free. Classes
run from 8:30 am to 5:30 pm.
PREREQUISITES: Student in both
courses must complete ICS 100, 200,
700 & 800. ICS-400 students must
also complete the ICS-300 course.
All prerequisites must be completed
before the start of the course.
2015 COURSE DATES
ICS 300 COURSES:
June 24-25; October 28-29
ICS 400 COURSES:
August 26-27; December 15-16
To Register:
Go to the Training Calendar at:
www.tidewaterems.org
Or call (757) 963-0632
Course Location
Tidewater EMS Council
1104 Madison Plaza
Chesapeake, VA 23320
(757) 963-0632
4
continued from page 3
and they are looking at data mapping to help make a connection. In one
example, opioid overdoses were discussed. Nationally, there was a 288%
increase in opioid prescriptions from 1991-2011. There was a similar increase
in hospital admissions and opioid deaths during that same period. The feds
looked at opioid overdose using GIS mapping in Baltimore. It clearly showed
much higher instances in certain sections of the city which has an implication
for EMS and hospital preparedness, law enforcement, social services and
more. Could those specific areas get targeted interventions, including by EMS,
to try to curb the overdoses and deaths?
Three main federal initiatives at the National Highway Traffic Safety
Administration right now relate to EMS. The transition of military medics
to civilian medical jobs, specifically EMS jobs, is a high priority. NHTSA has
contracted with the National Association of State EMS Officials to help figure
out strategies to streamline this process. Another initiative is development of
evidence-based EMS treatment guidelines. There are five published so far
– find them at www.ems.gov/research.htm. The national strategy to promote
evidence-based EMS treatment guidelines is at www.naemsp.org. The third
initiative is ambulance safety. NHTSA and its research arms have examined
ambulance crashes over time and have published substantial data and safety
recommendations that are driving ambulance safety improvements. Find more
info at www.ems.gov/safety-GA.htm.
FirstNet is the future of our national public safety communications system.
Federal law gives the First Responder Network the duty to build, operate
and maintain the first high-speed, nationwide wireless broadband network
dedicated to public safety. FirstNet has already obtained bandwidth and initial
funding. When it launches, FirstNet will provide mission-critical, public safetygrade, high-speed data services including data, video, images and text to
supplement existing voice communications, and eventually will include voice.
Is this the first time you have heard of FirstNet? More info at www.firstnet.
gov. FirstNet is working with state points of contact to gather requirements
for developing the network. Virginia’s contact is Adam Thiel, 804-786-5351,
[email protected]. Virginia is apparently one of the last states
to become involved with FirstNet development.
Finally, mobile integrated healthcare is clearly taking off around
the country. Many experiences were shared. Of particular interest is the
development of funding (“billing”) mechanisms for MIH programs in states
that have obtained waivers to a section of federal regulations that allow
reimbursement for certain MIH services. Many other MIH funding methods
were presented that involve relations between MIH programs and hospitals,
hospice, physician groups, home health and third party payers. MIH is part of
the future of EMS with a predicted shift of EMS reimbursement to outcomebased models, shared risk contracting and pay for performance.
MIH and EMS also play a part in today’s hospital reimbursements (penalties
and bonuses) more so than just last year or the year before. And it’s growing.
Hospitals are penalized, or given bonuses, based on patient satisfaction surveys
and other clinical and economic factors. Can their EMS experience influence
the way a patient feels about their hospital service for patients transported by
EMS, or managed by MIH programs? Hospitals are penalized due to early readmissions of a growing number of diagnosis categories. Can MIH programs
help reduce re-admissions? These are but a few of the areas where EMS and
MIH programs are already partnering with healthcare systems to make a
difference. If MIH isn’t on your radar, it should be.
Tidewater EMS and Emergency Nurse Education Expo 2015
By: Daniel B. Green II, BS, NRP, CCP, Operations Supervisor – Medical Transport
Once again Medical Transport, LLC had
the privilege to both sponsor and serve as
staff support for the Tidewater EMS and
Emergency Nurse Education Expo held
March 19-22 in Suffolk. Our team assisted
with running the registration table, serving
as runners to bring supplies to the TEMS
staff and the instructors, and served as room hosts where we scanned
the participants to ensure that they received CEU hours. The MTI staff
members who served this year were Shawn Tanses, Holly Martens,
Gene Barker and Dell Brooks. This is a long and busy week but they
jumped in where needed without question and assisted TEMS with
making this another successful event.
The TEMS staff did an exceptional job planning this event and
brought several unique opportunities to the EMS providers in this
region and from across the state who attended. The program this
year included many new instructors who brought interesting and
informative classes to present. Attendees had the opportunity to choose
from over 20 different classes to attend during this four day educational
event! One highlight included national speaker Tim Phalen who did an
awesome job with presenting his EKG and Capnography classes. Kirk
Mittlemann also flew in and taught several classes and is known for
keeping his classes fun and entertaining. Back by popular demand was
Gene McDaniel’s assessment based patient management class which
involves teams of students who evaluate and provide appropriate care
for standardized patients in realistic scenarios and environments. This
year the TEMS staff also enhanced the nursing track and we had many
nurses from around the region who participated in classes all weekend.
The highlight of the weekend for many of the attendees, including
myself, was the opportunity to interact with Randolph Mantooth, who
played Paramedic/FF Johnny Gage in the iconic TV show Emergency!
Many EMS providers attribute their careers to watching this show when
they were children or in reruns today. The weekend presented several
opportunities for interaction with Mantooth. The first opportunity
came on the movie night that is done every year as a part of Expo. This
year there was a unique twist. The TEMS staff, Mantooth and his staff
had identified Emergency! clips to show and have Mantooth provide
commentary. This was a great opportunity and something that had
never been done before! Participants next had the opportunity to talk
with Mantooth and to get autographs. During a lunch and learn event
Mantooth talked about the kind of person that it takes to be an EMS
provider. He also reminded us that we are always in the public eye and
to remember that we have our own unique humor in public safety that
not everyone in the general public understands. Finally he reminded
us to remember why we got into EMS and that we need to take care
of ourselves sometimes to deal with the stressful situations that we
encounter on a regular basis.
I would highly recommend attending this unique opportunity that
exists in our own backyard. They offer national conference caliber
speakers for an extremely reasonable price and you don’t have to
travel that far. It truly is an exceptional experience and we at Medical
Transport, LLC are proud to be a part of it!
Next year’s Expo dates are March 17-20, 2016.
5
Tidewater EMS Council, Inc.
1104 Madison Plaza, Suite 101
Chesapeake, Virginia 23320
In this Issue:
Tidewater EMS Council Board Elects Directors and Officers
Capnography, Standards of Care and the Healthcare Provider
Navy, Coast Guard & Sentara Train for Trauma
EMS Today Conference Looks to the EMS Future
NONPROFIT
ORGANIZATION
U.S. POSTAGE
PA I D
NORFOLK, VA.
PERMIT NO. 2325
Tidewater EMS and Emergency Nurse Education Expo 2015
ADDRESS SERVICE REQUESTED
RESPONSE is published by the Tidewater Emergency
Medical Services Council with financial support from
Medical Transport, LLC and the Virginia Office of
Emergency Medical Services. Should you wish to be placed
on our mailing list, or have any editorial comments,
please write to:
RESPONSE, Tidewater EMS Council
1104 Madison Plaza, Suite 101 • Chesapeake, VA 23320
E-Mail: [email protected]
Website: www.TidewaterEMS.org
President: Stewart W. Martin, MD
Executive Director: James M. Chandler, CAE
Editor: Wendi Ambrose
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NEWS BRIEFS
Recently ALS Sanctioned Providers in the region: EMT-I Courtney Coleman, Christina Crater, Kevin Gurecki, Anthony Metelski, Tomie Ogren,
Edward Tuck and James Villers,
EMT-P: Joel Acree, Benjamin Clifford, Alaina Copsey, Cheryl King, Charles Malone, Jamie Maricle, Anthony Pacella IV, Justin Poole, Laurel
Thomas and Robert Zeller. Congratulations to all!!!!
The TEMS Regional EMS Awards Nomination Deadline is Sunday May 17. More information and the nomination forms are located at
www.tidewaterems.org/awards.
The annual Tidewater EMS Family Picnic and Awards presentation will be held Sunday June 28 at Harbor Park in Norfolk. This year’s event will
include dedicated EMS section seating in the park for Norfolk Tides vs. Toledo Mudhens, a delicious picnic lunch, concourse games – and EMS kids
under 12 can run the bases after the game. Awards will be presented on the field at 12:30 pm and the game begins at 1:05 pm. The picnic
food times will be in groups of 400 with the first group starting at 11:15. Register online at www.tidewaterems.org/picnic
The Peninsulas EMS Council is sponsoring their 3rd Annual Rural EMS Education Expo, May 15-17 at the Glenn’s Campus of Rappahannock
Community College. PEMS helps support our expo, and let’s help support and promote theirs as well. More info and register at: www.conference.
com/eventmanager/OnlineRegistration.asp?EventCode=395
Staff Update: As reported previously, Bill Ginnow, former MMRS program manager, stepped down from that position on December 31 but has
remained on staff part time to support the transition of the program manager position to David Long. Bill has since “graduated” to full retirement
as of March 31. Bill was our first MMRS program manager who started in January 2002 and developed our MMRS program into a model of regional
mass casualty preparedness. We are sad to see him leave but thankful for his 13+ years of talented program development and guidance. Bill and
his wife plan to split time between Virginia Beach and southwest Florida.
In Honor & Memory Of:
We mourn the loss of retired Fire Fighter / Paramedic Allan H. Manning. Al served with Norfolk Fire - Rescue for over 29 years (February 1,
1983 to August 1, 2012). “Big Al” was also well known in our community for his service of nearly 15 years at Sentara Leigh Memorial Emergency
Department. Please keep his family in your thoughts and share your favorite “Big Al” story with your family and coworkers.