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Idaho Project Helps Improve Coordination, Response Times for Medical Emergencies

Nov. 20--Until recently a typical medical emergency call in north central Idaho might have involved a scenario like this:

A patient is injured in a serious accident and emergency medical technicians are summoned. The patient is transferred to the nearest critical access hospital, such as Clearwater Valley in Orofino or Syringa at Grangeville, where his condition is assessed.

The injuries go beyond what the rural hospital can treat, so St. Joseph Regional Medical Center at Lewiston is contacted. St. Joe's staff relay that they can't provide the type of surgery that will be needed and suggest contacting a larger medical center, such as one in Spokane or Coeur d'Alene.

Valuable life-saving time is lost.

Recognizing that response and coordination by medical agencies was fractured to three of the most serious calls -- trauma, heart attack and stroke -- the Idaho Legislature two years ago created the statewide Time Sensitive Emergency Council.

"We didn't have a system," said Bill Spencer, head of the emergency medical services at Syringa. "That means that things didn't happen uniformly. There (was) not standardization on how we treat people and there (were) a lot of issues as far as getting people to the definitive care that they need in a timely manner."

In October, Clearwater Valley Hospital was named the second Level 4 hospital in the state -- meaning it is designated by the state Time Sensitive Emergency Council for having developed best practices to deal with trauma, such as the accident described above.

"It's been shown if you don't intervene quickly, outcomes are really poor," said Kelly McGrath, a physician at Clearwater Valley Hospital and Clinics.

"There's great outcome data to show -- particularly with trauma -- having a state system that rules how you do this and making all players work together improves outcome."

In 2013, the Legislature put together a work group to define the elements of a Time Sensitive Emergency program. Idaho was one of only two states in the country that did not have such a program. The next year legislation was passed.

The 45-member work group, of which Spencer and McGrath are members, included emergency medical service providers, hospitals, health care providers, public health, insurers, rehabilitation providers, legislators and community members.

The group is responsible for developing a system that provides nationally evidence-based practices to time-sensitive emergencies; ensure that standards are adaptable to all providers; reduce deaths from time-sensitive emergencies and collect data to analyze the effectiveness of the system.

System shown to save lives

According to the Time Sensitive Emergency website, in 2012 nearly half of the preventable deaths in Idahoans younger than age 75 were due to trauma, stroke or heart attack.

In Montana, where a trauma system has been in place since 2006, the death rate has been reduced from 55.3 per 100,000 people to 54.3 deaths per 100,000. If Idaho had reduced the trauma death rate by the same amount, according to the Time Sensitive Emergency website, 47 lives could have been saved in 2012.

Utah established a statewide response system for serious heart attacks. If Idaho had matched Utah's death rate due to heart attacks in 2012, 184 Idahoans might have survived their heart attacks. Washington established a statewide stroke system in 2010. If Idaho had reduced deaths caused by stroke at the same rate as Washington in the same amount of time, 13 lives could have been saved in Idaho in 2012.

McGrath said the Level 4 designation at the Orofino hospital is important because it creates a template for how medical providers involved in responding to a trauma work together.

"It was just clear it could have been better," McGrath said of the climate before the Time Sensitive Emergency system was adopted. "There was a lot of frustration for everybody in our whole region about not playing well together.

"Everybody was trying to do a good job, but everybody sees it from their own" perspective, he said. "It was just like we were working together on this complex process and there were all these hand-offs and if you don't have a system of care around that, it's not going to be good. I think everybody intuitively knows that."

The new system creates a mandate about how medical agencies respond to critical health incidents and coordinate their efforts to care for patients from beginning to end.

"Our intent at (Clearwater Valley Hospital)," McGrath said, "was to have an engaged staff. This (system) was one that was an easy sell because everybody could understand why it was going to be better. It lowers everybody's stress to have a system of care."

One of the big advantages to being part of the Time Sensitive Emergency system, he added, is the improved working relationships between medical service agencies. Regular meetings are held for all the participants to review and critique past cases and offer suggestions on how procedures can be continually improved.

"So we all sit down and it's really been great," McGrath said. "Everybody does a good job of leaving their egos and not-so-good agendas outside the door and we go in the room and talk about what could have gone better. It's people that have not traditionally worked together as a system and it's been amazing how everybody has rolled up their sleeves and put the patient first.

"I see it as a paradigm of what we need to do for non-TSE things," he said. "We're going to have to work as a team. Yeah, we compete on some things but there are some things we don't compete on."

Ultimate goal is for all hospitals to be state designated

Shelli Triplett, who is the regional Time Sensitive Emergency program coordinator of trauma, cardiac and stroke at St. Joe's, said the goal is to get all hospitals and emergency medical service agencies in the state designated.

"The reason for the designation system is really to fine-tune the way we take care of trauma or specific medical conditions like cardiac and stroke," Triplett said.

"And it gives those benchmark standards of what (is) the best way to take care of those patients and how to do it in a system of care."

There are different levels of designation: Some hospitals, such as Clearwater Valley, are so far designated only for trauma. Others have developed systems for cardiac and stroke care and have higher levels of designation.

St. Joe's was designated for all three events through the state of Washington before Idaho adopted its system.

Spencer said Syringa is in the process of applying for Level 4, or trauma, designation.

Triplett said she is encouraged by the enthusiasm and cooperation of the people on the statewide and regional councils and the eagerness by medical professionals to sign on to the program.

"It's a systematic approach," Triplett said. "It's everybody following the same standards of care in order to provide the level of care at your facility -- knowing when to transfer to a higher level of care. And having the same verbiage throughout the system gives better care to our patients if we're all speaking the same language."

Spencer said it's still too early to know if the Time Sensitive Emergency practices adopted in this region have actually saved lives, but there's no question about the immediate benefits.

"We're just beginning this process but I think in two years, or even six months from now, we might be able to take some case reviews and say, 'Yeah, that saved a life,' " Spencer said.

"To do it right now, it's pretty hard. But we do know that we've improved care because we've brought some best practices home."

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Hedberg may be contacted at kathyhedberg@gmail.com or (208) 983-2326.

Copyright 2016 - Lewiston Tribune, Idaho

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