A New Sphere for EMS

     Since its inception in the late 1960s, fire-based EMS has continually improved upon the original concept of providing rapid response to medical emergencies with trained firefighter/paramedics. Among the first in the United States to implement the concept, the Seattle/King County Medic One system often garners honors for the long-term survival rates of its sudden cardiac arrest patients. Many other excellent models exist, and annual incremental improvements have come to be expected as technology and medical studies further refine the state of the art. Everything from closest-unit dispatching to automated external defibrillators placed in public venues has been employed to help reduce the time needed to answer calls and give lifesaving care to those in need. But what if the very best response time to a medical emergency was actually 0:00?

     Through the SPHERE program in Seattle/King County, there is a new goal in place: to actually prevent future 9-1-1 calls by identifying potentially life-threatening conditions whenever a patient is seen by responders.

     Consider these two scenarios:

• EMTs evaluate a 57-year-old with a mild allergic reaction. Prior to EMS arrival the patient self-administered diphenhydramine (Benadryl) and has improved upon arrival of fire department EMTs. He is stable on exam, with a mild rash on his arms and trunk. His blood pressure is 170/105 and blood glucose (checked because the patient says he has bouts of low blood sugar) is 182 mg. He says he will follow up with his doctor. The EMTs casually mention to the patient that his blood pressure and blood sugar are both high. But because of his stable condition, the EMTs decide that evaluation in a hospital is not needed. The medical incident report is completed and duly filed.
• Same situation, but this time the EMTs not only mention that the blood pressure and sugar are high, but also give the patient a personalized written "High Blood Pressure Alert" and "High Blood Sugar Alert" that strongly advise him to have follow-up for possible hypertension and diabetes. They indicate on the incident report that the alerts were given, and one month later the patient receives a call from the EMS office asking if he has followed up with a physician.

     Which scenario do you think best serves the patient?

THE SPHERE PROGRAM
     Every day, EMTs respond to countless medical emergencies. While providers' top priority is to deal with the immediate problem, stabilize the patient and arrange further appropriate care, they also have opportunities to identify and help control major public health problems. In the second scenario above, the patient's abnormal blood pressure and blood sugar are discussed, and he is given written, personalized and specific sets of instructions for follow-up. Such practice is now routine in the Seattle/King County metropolitan area.

     The program is called SPHERE, which stands for Supporting Public Health with Emergency Responders. The sphere represents the concept of obtaining clinical information and feeding it back to the patient in a useful and consistent fashion—a circle of information from the patient to the EMT and back. SPHERE is designed to help identify and control two major public health problems: hypertension and diabetes. Though the program is an expansion of the traditional role EMS personnel play in their communities, it affords the opportunity to have a large impact with little extra effort. EMS personnel can respond to medical emergencies and simultaneously help fight chronic disease (and possibly prevent future emergency responses).

     High blood pressure (HBP) and diabetes are two major public health problems. High blood pressure affects 65 million Americans. It is estimated that one third of patients with HBP are unaware they have the condition, and another third inadequately control it. Around 20 million Americans have diabetes (85% have type II diabetes), and another 6–7 million have undiagnosed type II diabetes. Both conditions are major contributors to heart disease, stroke and kidney failure.