Summer 2006
Volume II, No. 2

Emergency Medical Services
Data source:  Kent County Emergency Medical Services (KCEMS)

Health Status

þ          All patients requesting an ambulance are transported regardless of severity of illness or injury and regardless of ability to pay, as mandated by Michigan’s Public Health Code.  Patients are evaluated based upon severity of their condition, as follows:

o          Priority 1 -- life threatening; all dispatched EMS vehicles respond lights and sirens

o          Priority 2 -- potentially life threatening; First Responders respond with lights and siren, the ambulance responds without

o          Priority 3 – non-life threatening; no lights and sirens

þ          In 2005, 47,878* ambulance calls occurred in Kent County is as follows:

o         Medical                  – 36,558 (Chest Pain, Shortness of Breath, Abdominal Pain, etc.)

o         Trauma                  – 10,421 (Injuries to the body from any external mechanism)

o         Environmental      – 70        (Heat and Cold emergencies)

o         Cardiac Arrest      – 829     

§          Dead on Scene            – 437      (Not viable upon EMS arrival)

§          Treated/Deceased      – 188      (Potentially viable, treated and remained deceased)

§          Treated/Transported   – 204      (Potentially viable, treated and transported)

 *          This number does not include interfacility transfers not going to a hospital, calls that disregard prior to EMS arrival, ambulance stand-bys, and refusals without Advance Life Support Intervention. Some of these incidents had multiple patients and some were ALS refusals, terminated cardiac arrests or DOA’s that were called through and were not transported to the hospital.

þ      Emergency medical services are provided by four levels of licensed providers: 

o         Medical First Responders (658 active in Kent Co.) – require 60 hours of CPR and first aid training; typically work for police and fire departments, often in a volunteer capacity. 

o         Basic Emergency Medical Technicians (EMT’s) (298) -- require (at minimum) 162 hours of classroom education and 32 hours of practical training. 

o         EMT Specialists (21) -- receive 70 additional hours of classroom education and 30 hours of practical training beyond the basic EMT.

o         Paramedics (286) – require 600 additional hours of classroom education, 250-300 hours of practical training and 250-300 hours of field internship beyond the EMT and Specialist requirements.

Access

þ          A total of 17 transporting ambulance services provide services in the twelve counties of West Central Michigan.  (Allegan, Ionia, Kent, Lake, Mason, Mecosta, Montcalm, Muskegon, Newaygo, Oceana, Osceola and Ottawa Counties). Throughout this geographical area there are also 106 Medical First Response and Basic Life Support (non-transporting) agencies.

þ          For the region’s population of 1,454,971, there are 133 licensed transporting ambulances within West Central Michigan that are available to be in service (1:10,939 ratio of ambulances per person), 91 of these are routinely in service at peak times (1:15,989).

þ          911 access is in use throughout the entire West Michigan region, with many areas utilizing enhanced 911, which displays the origin address and phone number.

 Cost

þ          Every ambulance on the road represents an investment of $100,000 - $150,000 in vehicle and equipment costs. 

þ          The cost* for ambulance transport in West Michigan is as follows.  The majority of the costs are covered by insurance; varying by individual plans.

o         $150-160 for a basic, non-emergency call;

o         $300-350 plus mileage for a call requiring advanced life support services (level 1) and

o          $450-500 plus mileage for a call requiring advanced life support level 2 services. 

 *These rates, for the most part, are dictated by Medicare and Medicaid set reimbursement rates.

Quality

þ          The quality of the EMS system throughout the region is driven by established standards of care such as state law, administrative rules, protocols, policies, procedures and provider standards.  Every aspect of an EMS call, from the initial call to 911 through the delivery of the patient to the hospital best suited to care for the specific problem, has been designed to be as effective and efficient as possible. Call takers, dispatchers and ambulance personnel are trained to standards that exceed state and national requirements.

o         Individual dispatchers do not decide whether an ambulance is sent or not; if a call is received with a request for an ambulance, one is sent.

o         Prearrival instructions are provided by dispatchers to callers. These are instructions for what to do until the ambulance arrives. In cases where a patient is choking, not breathing, in cardiac arrest or in labor, the dispatcher will provide the caller with step-by-step instructions on how to help the patient.

þ          Kent County EMS (KCEMS) has established response time* standards for the ambulances in Kent County.  The standard for response time for Kent County varies by the nature of the call and the call location. All local medical dispatch services utilize the Medical Priority Dispatch System (MPDS); the MPDS is a system that assigns a priority to each call, based on the nature of the call and its severity. Once the nature and severity of a call has been determined, a priority is assigned to the call and an ambulance is dispatched.     In Kent County, response time standards are as follows:

 Priority 1calls –

8 minutes in urban areas

12 minutes for suburban areas

15 minutes for rural zones

Non-emergency calls – the ambulance must arrive within 20 minutes.

Ambulance agencies are required to meet response time standards at least 90% of the time. Each county in the region has its own MCA to establish similar standards.

 *Response time is measured from the time a call is answered in the medical dispatch until an EMS unit arrives at the address of the call.

þ          Efforts are underway throughout the state to incorporate electronic patient care reporting in all transporting ambulance services by July 1, 2007. Electronic data collection will further enhance the ability to quickly and reliably gather data on system performance both at the local and state levels.

þ          Throughout West Michigan, law enforcement, fire, EMS, public health, hospitals, public works, the Red Cross and many other organizations have been working together to prepare for disasters of all types, man-made or natural. They routinely practice and prepare for different scenarios, from small scale events such as a multiple vehicle accident, to a large scale event such as pandemic influenza. Efforts to improve preparedness are an ongoing process.

þ          Residents in West Michigan are reminded to always call 911 in the event of an emergency – especially if experiencing heart attack or stroke symptoms – better outcomes are possible with ambulance transport and care.

Feature Article -

“Pre-Hospital 12-Lead ECG – Who Cares?”  

Of 1.5 million acute coronary syndrome events per year in the United States, it is estimated that 500,000 of these are what is known as STEMI[1].  STEMI refers to a type of heart attack, or MI, (myocardial infarction) with ST segment elevation (hence STEMI), also referred to as a  "Q-wave MI.”  It can be diagnosed with an electrocardiogram.  This heart attack is caused by a prolonged period of blocked blood supply. It affects a large area of the heart muscle, and causes changes on the electrocardiogram (ECG, also known as EKG) as well as chemical markers in the blood[2].  STEMIs have been identified by the American Heart Association as the most common form of heart attack.  If caught early, the most effective form of treatment for this type of heart attack is called percutaneous coronary intervention (PCI) or angioplasty, where a balloon is threaded up to the blocked artery in the heart and inflated, thereby opening the blood vessel and allowing blood to resume its flow.  Sometimes a device called a stent is inserted to help keep the blood vessel open[3].   

When an individual suffers a heart attack, minutes matter and  “time equals muscle.”  In other words, the longer it takes to restore blood supply to the heart, the more heart muscle dies.  Early diagnosis and quick intervention usually translates to a better recovery and quality of life for the heart attack patient.   

To provide earlier recognition and intervention for heart attacks, a pre-hospital 12-lead ECG program was established.  The program involves the cooperation, coordination and participation of area hospitals, ambulance services, emergency physicians, cardiologists and medical control authorities throughout the region, especially Kent, Ottawa and Muskegon Counties.  Protocols were developed and Kent County ambulances invested over $1 million to purchase portable 12-lead ECG machines.  Other counties in the region also currently have or are in the process of purchasing machines.   

What this means to a STEMI patient, is that once an ambulance is called, a paramedic is able to diagnose a heart attack in the home or at the location of the call and transmit ECG results directly to the hospital.  The hospitals have improved their processes and are able to make preparations for the patient.  This means that upon arrival at the hospital, patients spend minimal time in the emergency department and, if appropriate, are moved quickly and effectively to the cardiac catheterization lab so that PCI intervention can be initiated.   

The American College of Cardiology’s current standard for the amount of time from when a patient enters the doors of the hospital to the time a PCI is performed is 90 minutes.  This is referred to as “door-to-balloon” time.  In Kent County, for patients arriving by ambulance, the door-to-balloon time is under 60 minutes.  Unfortunately, only 40% of heart attack patients call an ambulance when they experience heart attack symptoms with the other 60% of heart attack victims getting to the hospital by means other than an ambulance.   

By choosing to not call an ambulance, the door-to-balloon time for these heart attack patients increases to almost 90 minutes.  This is still a good time and within the American College of Cardiology’s standards, but calling an ambulance and taking advantage of the 12-lead ECG program can offer a better time, thereby improving patient survival and quality of life.  The health care system has shown it cares by investing in this program and offering this service.  Now it is up to those who need it to utilize the service – call 911 if heart attack symptoms are experienced!  The pre-hospital 12-lead ECG program…we all need to feel fortunate to have this program available in West Michigan!

Don’t Delay – Call 911 in Emergencies

 HEART ATTACK WARNING SIGNS
Some heart attacks are sudden and intense, but most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:

• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.   
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.   
• Shortness of breath. May occur with or without chest discomfort.  
• Other signs: These may include breaking out in a cold sweat, nausea or lightheadedness       

For WOMEN:  the most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

STROKE WARNING SIGNS

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body   
• Sudden confusion, trouble speaking or understanding   
• Sudden trouble seeing in one or both eyes   
• Sudden trouble walking, dizziness, loss of balance or coordination   
• Sudden, severe headache with no known cause

If you or a family member experiences any of these symptoms:

1.      Call 911
2.      Seek medical care  
3.      Don’t delay 
4.      Don’t drive yourself or a family member to the hospital

 For More Info:  http://www.americanheart.org; http://www.strokeassociation.org

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