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Clinical Sophistication in Rural EMS is Possible

Trading the fast pace of city EMS for a rural setting doesn’t mean you have to lose out on a clinically sophisticated system.

That was the overriding theme of a presentation last month at EMS World Expo in Nashville, TN, from David Grovdahl, MS, NREMTP, executive director at LeFlore County EMS, OK. Grovdahl discussed how rural systems can see similar patient outcomes as urban systems in regard to STEMI, CVA, trauma, CPR and sepsis.

Grovdahl used LeFlore County EMS as an example. LeFlore occupies a super rural area in Oklahoma, he said, and response times average 1–2 hours. With just seven ambulances covering 6,700 calls per year, that’s a lot of time spent in the ambulance transporting patients.

As rural agencies look for ways to stay current with their practice and technology, it’s important to utilize all the data available to see where they can improve. But Grovdahl emphasized it’s equally important not to get lost in the data. Rural EMS leaders should determine their objectives and their data points, and then clean their data to weed out things that aren’t helpful or productive. At that point they can evaluate their answers and make sound adjustments to improve the service.

Grovdahl also advocated taking that data, from ePCRs and elsewhere in the agency, and using it in the political arena. That information is political capital, or currency, he said, and it can be used to encourage political leaders to provide more support for a successful system.

He also discussed the STEMI guidelines updated in 2013 by the American College of Cardiology. The concept of door-to-balloon time is out, Grovdahl said, and first medical contact to device time is in. There’s increased importance placed on immediately calling 9-1-1 and EMTs are encouraged to do 12-leads to facilitate rapid triage and treatment.

Off of that, Grovdahl said rural agencies should track their ePCR data for the following to help improve their service:

  • 12-lead interpretation accuracy
  • Correct treatment modality
  • Time to ER activation
  • Delays in the ER that can be resolved by EMS

There are plenty of other considerations to take into effect as well, besides just data. Is mechanical CPR right for your system? Are other interventions effective, such as ITD, hypothermia or IV drip meds? What medication quantities do you keep on the unit? What durable items do you invest in? IV pumps,

When it comes to trauma, LeFlore County follows the CDC guidelines for trauma hospitals regarding decisions on whether to drive patients to the trauma center or fly them. They also use advanced interventions in trauma, such as TXA, tourniquets, clotting agents, and blood products on their rigs.

Continually working on skills proficiency with paramedics is also of vital importance, Grovdahl stated. Agencies can easily track the skills usage of medics and get information on the number of attempts vs. success rate for a variety of procedures, including starting IVs, intubation, decompression, traction and establishing surgical airways. That information can then be used to help providers work on the skills they need to most, including skills they rarely have a chance to perform to ensure they remain proficient.

Grovdahl added that beyond these improvements to the actual clinical practice, agencies should consider other improvements to enhance the patient experience during those long transports when life and limb aren’t at stake. He suggested putting DVD players in the back of ambulances for long trips to improve patient comfort and satisfaction, something that can be especially helpful for long transports with pediatric patients.

EMS World Expo 2015 is scheduled for September 15–19 in Las Vegas, NV.

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