The Pittsburgh Business Times recently wrote a story about more ground-breaking research that is underway at UPMC and Pitt that could change the way prehospital providers manage patients in shock. The article includes quotes from our Chief Medical Officer Dr. Paul Paris about the importance of recognizing shock early, and STAT MedEvac’s Associate Medical Director, Dr. Frank Guyette about the study STAT recently completed using a lactate meter for patients flown by helicopter.

Follow this link to read the entire article and hats off to the research gurus spearheading this incredible new program.

From Doug Garretson

Tom Liebman, Director of Field Operations, and Dr. TJ Doyle, Assistant Medical Director for STAT MedEvac, both had the opportunity to present at the recent Air Medical Transportation Conference. STAT continues to be recognized as a leader in the air medical industry as evidenced by the number and type of people who engaged us with questions or comments – from vendors, to flight crew, to fellow industry executives.  On more than one occasion, people commented on our program, mentioned they would like to work with us, or sought our input in small group discussions.  Our reputation for quality and safety and the commitment of our Board to invest in the best was clearly evident and in some cases, envied.

The program descriptions of Tom’s and TJ’s presentations follow.  If you would like more information about their presentations, please send them an email.

tliebman(at)statmedevac.com

doyle(at)statmedevac.com

Ground Transport Safety -- Applying Aviation Tools to Ground Transport
Thomas Liebman, MBA, FP-C, CMTE
STAT MedEvac, Pittsburgh PA

The purpose of this session was to explain two tools developed and applied within the STAT MedEvac program to enhance ground safety for our crews -- a ground mission checklist and a winter weather risk assessment matrix -- both of which can be adapted to other programs. Both of these concepts have been borrowed from standard aviation practices.

Employee Turnover - The Real Reasons People Leave
Thomas Liebman, MBA, FP-C, CMTE
STAT MedEvac, Pittsburgh PA

This program explored the pathway to employees leaving for greener pastures. Tom discussed the hidden reasons employees leave and discussed strategies to avoid losing good people.

Medical Director Strategies for Improving Reimbursement and Reducing Claim Denials
Thomas J Doyle, MD, MPH
STAT MedEvac, Pittsburgh PA

This lecture was designed to give air medical directors lessons in managing claim denials. TJ discussed strategies to use to improve documentation to reduce denials, the appeal process and medical necessity. TJ also shared the multiple strategies he has successfully used to fight unjustified appeals and presented some of his original research related to this topic.

As if developing an EMS system and redesigning an Emergency Department that sees thousands of people each day in Qatar all while taking the nation's premier paramedic training program on the road this year wasn't enough to occupy their time, CEM's own educational gurus Dr. Walt Stoy and Dr. Tom Platt have been working on a new project as well. The good doctors recently received word that the Physician Assistant Program they have been developing received accreditation last week, and can begin enrolling students in January 2010. This two-year masters degree program offered through the School of Health and Rehabilitation Sciences at the University of Pittsburgh will give people an unparalleled clinical experience working with the experts at UPMC, and will have a heavy emphasis on real-life, clinical problem solving while in the classroom. The program will be directed by Dr. Deb Opacic, who has recently joined the faculty in the School of Health and Rehabilitation Sciences, and seems to be coping well with the, ahem, unique working environment that surrounds us EMS folks.

To learn more about the new program, check out this site and contact Marsha LaCovey at 412-647-8265. You may want to hurry though, as the program has already received loads of applications for the 48 available spots.

Congratulations Walt, Tom and Deb.

No one is really sure what the next few days will look like for Pittsburgh, other than traffic is expected to be heavier than usual due to the traffic restrictions in the downtown area. While traffic will be open for emergency vehicles, residual commuter delays may make navigating through the area difficult during peak periods. If you are transporting a critical patient during these times and believe that the traffic delays may have a negative effect on the patient’s outcome, we recommend you consider calling STAT MedEvac to transport the patient. STAT MedEvac will make additional resources available to ensure that all critical patients can continue to be quickly transported to tertiary care facilities.

Governor Rendell signs SB240 into law, Act 37 of 2009.  Pictured from left to right:  Seated are Senator Baker, Governor Rendell and Representative Melio.  Standing are Don DeReamus representing the AAP, Representative Tim Solobay, State Fire Commissioner Ed Mann, Bureau of EMS Director Joe Schmider, Department of Health Secretary Everett James, Representative RoseMarie Swanger, Deputy Director of the Bureau for Health Planning and Assessment Michael Huff, EHS Federation Executive Director Steve Lyle, and PEHSC President JR Henry.Text and photo credit: Heather Sharar, Executive Director of the Ambulance Association of Pennsylvania

Less than ten days ago Governor Rendell signed a new EMS Act into law. Below is an email interview with Pennsylvania Bureau of EMS Director Joe Schmider about the implications for the new act.

Dan: It seems like the Act is total re-write as opposed to just a revision to Act 45. So the most important question is obviously what do we call the new Act? Act 45 version 2.0? Chapter 72? Joe's bill?

Director Schmider: The old EMS Act 45 is now Act 37.

Dan: What do you think are the most significant changes between the new legislation and the old EMS Act?

Director Schmider: Act 37 gives the Commonwealth EMS system flexibility to meet current and future emergency care needs. This Act allows the Department to expand the scope of practice of EMS Providers within 60 days and includes EMS within the public health system.

Dan: That’s certainly a subject near and dear to our hearts. Will the average EMS provider notice any difference in the way they do their job, or will the new Act be transparent to them?

Director Schmider: There are many new things in this new Act, titles of providers, changing first responders to emergency medical responders, adding Advance EMTs, Physician Extenders and emergency vehicle operators. Ambulance services will become agencies and each agency will be required to have a medical director. Peer review protection to ensure a quality EMS system and the Department will have the ability to assess fines for repeat violators. PA is true a leader a national leader in the drafting of this Act.

Dan: It certainly seems so. How about recruitment, retention, reimbursement and recognition which are constant issues for EMS agencies? Does the new Act provide any new resources for agencies and providers for these problems?

Director Schmider: The new EMS Act will benefit the EMS community by giving providers the tools they need to do their job into the future. It will also move our system forward as a profession and open many new doors in the medical community to advance your career. After 10 years of rewriting the EMS Act the Department heard from 1000s of EMS providers asking for what you see in this Act, now it up to all of us to take this legislation and us it to benefit the patients we care for each day.

Dan: I know you put a lot of time on the road to gather all of that input, now that the bill has been signed, what comes next ? How long do you think it will take before the system starts to reap the benefits of the new Act?

Director Schmider: Most major changes go into effect in August of 2012. Currently the Department is in the process of rewriting the rules and regulations and there will be EMS stakeholder meeting in the spring of 2010 to review the draft documents. This will allow all EMS stakeholders to have input into the development of the Rules and Regulations so that when we have hearings toward the end of 2011 we will be in position to move the rules along quickly with strong support from the EMS community.

Dan: Thanks for your time and for your efforts Joe. I know you put a lot of sweat, and probably some blood and tears into making this Act a reality. I think we are all looking forward to seeing what the future holds for PA EMS.

Click here for a copy of Senate Bill 240, which was signed into Law as Act 37.

*Special thanks to Heather Sharar from the Ambulance Association of Pennsylvania for sharing the photo of the signing ceremony for Act 37.

The Pennsylvania Bureau of EMS and PEHSC awarded Saundra Kozar, Flight Nurse at STAT MedEvac 2’s base in Greensburg, the Pennsylvania Prehospital RN of the Year last week at their annual EMS Conference. Saun is truly a remarkable individual, flying with STAT for 22 years and always providing both compassion and outstanding clinical skills to her patients. She has trained hundreds of preceptees, including nearly everyone on our clinical department management team (including our Medical Director Dr. Cole). While we can’t blame her for their shortcomings, it’s clear that her mentorship has helped set the high standards we have for everyone in our system.

Saun is pictured above holding the award flanked by PEHSC Executive Director Jeanette Kearney and Pennsylvania Bureau of EMS Director Joe Schmider.

Congratulations Saun! We are incredibly proud of your accomplishments and are incredibly grateful to have you a part of the STAT MedEvac family.

The Center for Emergency Medicine of Western Pennsylvania, Inc. is pleased to announce two new original EMS provider courses being held at off campus locations for the first time in over a decade. Since we've been in Oakland so long, we are a little concerned about our faculty traveling away from home. Assuming they can find their way, here are the locations and schedules for the classes.

We are also very happy to announce that UPMC is offering significant scholarships for these programs. Please contact UPMC Prehospital Care at 1-888-647-9077 extension 1 for more information about the scholarship opportunity through UPMC.  For more details and to register for the program, call Susan at 412-647-4674.

Ah, July. One of my favorite months. Our esteemed leader and resident EMS Futurist returns from a "think week" from the shores of Lake Chautauqua serene and at peace with the world. On his return this morning I was inspired by his Zen-like words. To quote "Swayze, why the F@^% haven't you updated the blog recently?"

"But," I foolishly protest, "there hasn't been much to write about. Sure cities are considered cutting back on EMS systems because of the economy. And sure, EMS Week 2009 came and went. And, ok, there is that pesky pandemic flu thing."

But of course we would not call him a Futurist if all he cared about were current events. Hence, the following...

Paul Paris, MD and Daniel Patterson, PhD, are pleased to announce the formation of the Office of EMS Patient and Provider Safety within the Center. The two hope to conduct investigations and direct resources from the national patient safety movements seen in other areas of healthcare to our EMS patients and (as importantly) our EMS brothers and sisters.

In his recent editorial in our bigger, smarter and better looking brother's journal Prehospital Emergency Care, Dr. Paris explains why we need to start looking at these important issues.

How safe is EMS? The truth is, we simply do not
know. Aside from a small series of reports and anecdotes,
we know very little about national patient safety
in EMS. It is clear that prehospital care is challenged by
many factors known to augment error: time urgency,
interruptions, an uncontrolled environment, stress,
variable initial training, and inconsistent continuing education.

The statistics he quotes in the article regarding EMS Provider Safety are staggering.

Occupational injuries other than ambulance crashes
are also very common. EMS providers are subject to a
myriad of musculoskeletal injuries, are victims of violence,
are exposed to potentially infectious body fluids
and airborne pathogens and stress-related illnesses.
In 2000 the rates of injury reported to the Department
of Labor were higher than any other industry.7 An urban
study reported rates of occupational injury of 50
cases per 100 full-time male EMS workers and 86 per
100 females.8 Another study from six New England
states reported back injury rates of 25 per 100 full-time
employees per year and an assault rate of 20 per 100
employees per year.9 Pandemics and other emerging
infectious disease hazards require us to plan for the
safety of our emergency responders.

Unlike other public safety agencies however, there is no system to investigate or mitigate the risks for EMS providers. Dr. Paris suggests that it might be time to recreate the Fire Fighter Fatality Investigation and Prevention Program for EMS providers.

The good doctors welcome and will reward your ideas and contributions. Paul's challenge to all of you is to list the top three things you consider to be safety risks to either your patients or our providers. Leave a comment below, or email him directly at parispm (at) upmc (dot) edu. Those that contribute will receive the famous Molly Evers designed T-Shirt, but supplies are running low. If not for the t-shirt, then for your safety- please reply quickly.

For Paul's entire editorial, follow this link, or use the reference below.

PREHOSPITAL EMERGENCY CARE 2008;12:92-94

Please join me in congratulating Dr. Frank Guyette, STAT MedEvac's Associate Medical Director, on his recent recognition as one of the top ten innovators in EMS. Frank received his well deserved award last week at the EMS Today conference in Baltimore.

I consider Frank not only a friend, but an inspiration. We are incredibly fortunate to have him on our team. His dedication to EMS is almost inconceivable. In addition to his day jobs with STAT MedEvac and working in the Emergency Department, he is the Medical Director for a number of local EMS agencies, and is part of a three man team that supervises every post-cardiac arrest patient at UPMC Presbyterian Shadyside. In his spare time he likes to conduct research related to EMS with new tools such as lactate monitoring, new airway adjuncts, and various hypothermia protocols. My guess is that he averages about 30 to 40 seconds of sleep a day. Although knowing him, he spends that time dreaming about EMS.

JEMS has a nice write up on Frank and his work in this article. If you send him a comment to this post, I will pass it along. Chances are that if you are in EMS in Western Pennsylvania, you'll be seeing him around sometime soon.

Saturday morning at 0900 at the EMS Update 2009 Conference, Dr. Paris will be sharing his thoughts, and yours, on the past, present and future of EMS. While he is putting the final thoughts to his PowerPoint masterpiece, there is still time to let him know what you think.

Oh yeah, and if you get something to him before the weekend, there is a free t-shirt in it for you.

To contribute your ideas, reply to this post, the original, or email him directly at parispm(at)upmc(dot)edu.

PS- sorry for the spelled out email address. We post email addresses that way to cut down on the spambots offering completely unnecessary enhancements.