Kinsie Clarkson

Ouachita County Medical Center (OCMC) is a not-for-profit hospital with 99 beds, serving residents of the rural community surrounding the city of Camden in southern Arkansas, about 100 miles from Little Rock. As a smaller, non-PCI facility, OCMC often coordinates transfers for their STEMI patients to PCI facilities.

Previously, when a patient arrived in the OCMC emergency room with a STEMI, whether by ambulance or private car, staff would first page a cardiologist at the patient’s preferred receiving facility, then wait for the physician to call back. Only then could they start the process of transferring the patient to a percutaneous coronary intervention (PCI) facility that could provide critical care. “Then we had to get a bed confirmed, and then we had to wait to get our EMS service to take the patient. And then, usually, most of those patients at that time went to Little Rock, which is about an hour and a half from where we are,” explained Jennifer Ray, RN, OCMC’s ER and ICU manager. “So the timeliness of the patient getting in and out was very, very slow.” How slow? During 2017, the average door-in, door-out (DIDO) time was 72 minutes for the 19 STEMI patients who came into the OCMC ER—more than double the 30 minutes or less recommended by the American College of Cardiology Foundation and the American Heart Association.

The past two years have done a great deal to redefine the shifting identity of EMS. COVID-19 changed a lot about how we provide care, and some of the solutions we came up with have led to a watershed of self-discovery. With that, though, comes an equal number of questions. What does the shifting landscape of healthcare mean for EMS? What will the role of EMS be going forward? As the identity of EMS evolves and medics are given more agency, will they be able to help find solutions for problems like overcrowded emergency departments, while also giving patients both a better and more appropriate care experience? 

Corey Ricketson, Pulsara's Vice President of Strategic Accounts, recently had the opportunity to discuss these and other hot topics in EMS with Chris Cebollero on The Inside EMS podcast, hosted by EMS1. Corey shares his experiences visiting multiple EMS agencies throughout the country, as well as some top takeaways from how leading EMS agencies are finding solutions to issues like ED overcrowding. Chris and Corey talk community paramedicine, how EMS needs to adapt for the future, the importance of meeting patients where they are, and how interoperability, connection, and communication should be a main focus for EMS agencies.

Listen to the podcast below, and read on for part 2 of the interview! (If you missed part 1, check it out here.)

The past two years have done a great deal to redefine the shifting identity of EMS. COVID-19 changed a lot about how we provide care, and some of the solutions we came up with have led to a watershed of self-discovery. With that, though, comes an equal number of questions. What does the shifting landscape of healthcare mean for EMS? What will the role of EMS be going forward? As the identity of EMS evolves and medics are given more agency, will they be able to help find solutions for problems like overcrowded emergency departments, while also giving patients both a better and more appropriate care experience? 

Corey Ricketson, Pulsara's Vice President of Strategic Accounts, recently had the opportunity to discuss these and other hot topics in EMS with Chris Cebollero on The Inside EMS podcast, hosted by EMS1. Corey shares his experiences visiting multiple EMS agencies throughout the country, as well as some top takeaways from how leading EMS agencies are finding solutions to issues like ED overcrowding. Chris and Corey talk community paramedicine, how EMS needs to adapt for the future, the importance of meeting patients where they are, and how interoperability, connection, and communication should be a main focus for EMS agencies.

Listen to the podcast below, and read on for part 1 of the full interview! 

Baptist Health in Little Rock, Arkansas, is using new technology to reduce treatment times and deliver better patient care. Dr. Wendell Pahls, Medical Director of Emergency and Transfer Services at Baptist Health, spoke to The Vine about how Pulsara is helping them streamline communication and cut down treatment times. 

"It's really cool," said Dr. Pahls. "We've taken a very fundamental concept, which is that the sooner that we can treat you for time-sensitive illnesses—like strokes, heart attacks, and things like that—the sooner we can get you into definitive care, the better off you'll be. Everybody these days carries around one of these: a cell phone," he said. With Pulsara's communication and logistics platform, Baptist Health has been able to link all their different providers together on one patient channel, facilitating better communication around each patient—and, as a result, better, faster patient care. 

Check out the video interview here! 

In April of 2021, New Zealand Health Minister Andrew Little announced plans to abolish the 20 district health boards (DHBs) and replace them instead with a single organization called Health New Zealand, which will be responsible for hospitals across the country. 

The unexpected announcement was a major indicator of changes to come in New Zealand's health system. As the system reforms its organizational and decision-making structure, they are also looking for a solution to a fragmented data system in health IT. 

New Zealand has struggled with a fragmented process for transmitting patient data for many years. Current processes don't allow for the seamless, secure transmission of patient data between facilities.

It has been a rough eighteen months for all disciplines within healthcare. Since the start of the pandemic, call volumes have increased. More people need help. And yet, as the pandemic drags on, there are fewer and fewer providers still on the job. Emergency services organizations around the world are experiencing staffing shortages. Headline after headline after headline has demonstrated that the problem is both severe and widespread.

Many factors have contributed to staffing shortages in EMS across the United States, as well as ambulance services in the UK and Australia. These factors will need to be addressed soon. In the meantime, however, those still on the job are left looking for ways to continue providing care for their patients. Staffing shortages are hard enough but are made even worse for those left behind when the lack of providers starts to impact the level of care they can provide. 

Over the past year, telehealth became a favored tool in non-emergent care for helping clinicians treat patients from a distance. However, many EMS organizations are now discovering that leveraging telehealth as a part of normal practice can actually help save time, preserve resources, and increase the output of smaller crews. 

If you're struggling with staffing shortages, here are a few ways telehealth may be able to help you work with the resources you have. 

As a tertiary care center and Level I trauma facility in Colorado Springs, Colorado, the trauma team at UCHealth Memorial Hospital Central had their patient care process dialed in. However, there was one part of their process they weren’t satisfied with: their communication system.

The team was receiving notifications through an alarm dispatch system, which ran through the hospital operators and was then manually managed by each individual service line. UCHealth’s Associate Nurse Manager, Nikki Schroeder, BSN, RN, CEN, TCRN, described their process: “Prehospital providers would call in to our ED charge nurse, relay pertinent information, and then the ED charge nurse would determine what level of activation was required. To notify our hospital team, the charge nurse would give the information to our unit clerk, and our unit clerk would page our 811 paging system. That’s how the trauma surgeon, the ICU, and the whole trauma team got notified.”

The COVID-19 pandemic has impacted the world in innumerable ways, but it's growing increasingly apparent that it's contributed to a worldwide crisis of another kind: mental health.

The need for mental health resources in the UK is on a sharp incline. Dr Adrian James, the president of the Royal College of Psychiatrists, recently stated that the pandemic has posed a great threat to mental health, and threatens to undo years of progress without a new injection of funds into the system. 

While mental health has been a growing need for a number of years, the demand has increased exponentially since the start of the COVID-19 pandemic. In June of 2021, a record 1.5 million people across the UK received mental health treatment from the National Health Service (NHS). According to Dr James, many more desperately need that treatment. After a year of lockdowns, an estimated 1.6 million more people have come forward looking for help, and are waiting for treatment.

PART 2 of 2

Editor’s Note — This is Part 2 on the events that took place on September 11, 2001, through the personal account of Chief John Peruggia, retired Chief of FDNY EMS. If you haven’t yet, please read Part 1 — Remembering 9/11 Through the Lens of FDNY’s Chief of EMS.

Planes hit. 

Buildings collapse. 

Lives are lost. 

Loved ones are lost. 

Grief. Fear. Anger. Mourning. 

Tragedies shape everything that comes after them, separating time into two distinct frames: Before, and After. 

The dust settles, and those left behind in its wake are left to pick up the pieces. 

Through the loss, through the darkness, come sparks of innovation. 

PART 1 of 2

Editor’s Note — I recently had the privilege of spending time with Chief John Peruggia, retired Chief of FDNY EMS. He shared his vivid memories of September 11, 2001, and how the world has (and hasn’t) changed over the past 20 years. Chief, thank you for your time and sacrifice to the EMS community.

Where were you on September 11, 2001? Instantly, each of us can vividly remember what we were doing when two planes collided with the World Trade Center. The stories that came from that day continue to echo down through the years, as we approach the 20th anniversary of the event.

But few people quite know the story like those who were there. 

Chief John Peruggia was one of those people. 

When COVID-19 struck Texas in early 2020, Montgomery County Hospital District suddenly faced a whole host of new problems. Patients were still calling 911 and needed emergent care, but not all of them needed—or wanted—to be transported to the hospital. Paramedics were daily putting themselves at risk as they entered environments that could expose them to COVID-19. 

“Early on, we didn't know what was going to happen,” said Rob Dickson, MD, FAAEM, FACEP, FACEM, and EMS Medical Director at MCHD. “And we were all—across the nation, across the world—struggling with procedures and PPE and how we could best look after our employees.”

MCHD had a brief window to come up with innovative solutions. They had been using Pulsara to streamline care team communication around stroke and STEMI patients. But in response to the crisis, they began using Pulsara for a completely different purpose: regularly checking in with their employees who had contracted or had been exposed to COVID-19.

When the COVID-19 pandemic flared in the state of Texas in early 2020, the state struggled to load balance their COVID-19 patients. Some areas of the state experienced overwhelming waves of surge, while other areas had available beds and resources. Matching the particular needs of complex patients with available beds and other resources necessary for each patient was difficult.

They sought out a solution that would help create a virtual placement center for smooth patient transfers—supporting effective COVID-19 management and surge mitigation and a 75% reduction in excessive phone calls.

Time is everything in time-sensitive emergencies. But you don’t need us to tell you that. 

You know that time is tissue. You know that every minute counts, and every minute impacts your patient’s outcome. It’s your job: care for the patient, stabilize them, and transport them to the next stage in their care journey as quickly as possible. 

So why does it sometimes feel like the system isn’t built to support that? 

Delays in care happen for many, many reasons, but they all boil down to one thing: communication. 

We have a lot of different communication technologies that do the job they were meant to do: radios, pagers, phones, and fax machines. But they don’t talk to each other. With every middleman a message travels through, it’s another delay for your patient. And when time is of the essence, it’s essential to make sure that the right information gets to the right person at the right time.

As a medic, you matter to your patients’ care. 

You are the first person on the scene. You are the first to see the patient, to assess them, and to decide what kind of treatment they need. You decide whether they need transport to the ED, or whether they are safe to stay at home. 

Your decisions guide and influence the rest of their care journey. 

For most medics, involvement with a patient’s case ends when they drop the patient off at the hospital. Most don’t receive any feedback on the patient’s case, how their treatment went, or what their outcome was. Only one in three EMS agencies reports having any access to electronic, patient-specific medical information.

But...you need this kind of feedback. (What gets tracked gets improved.)

Do you ever get tired of repeating yourself as you tell the same patient story multiple different times, to multiple different audiences?

You write on the back of your glove to keep track of what’s happening with your patient on scene and during transport. You deliver your report to the hospital via radio, to let them know what to expect when you arrive. You give an in-person inpatient report when you hand off the patient at the bedside, and you may also have to complete a leave-behind hand-written “short form.” And finally, you’ve got the patient care report that you complete afterward, within 24 hours of the case. 

That’s at least five different times you have to repeat the same basic information to update everyone who needs to be in the know. 

What if there was a better way? (Hint: there is!)

In time-sensitive emergencies, it’s easy to see how each passing minute impacts a patient’s outcome, for better or worse. The faster a patient receives treatment, the better chances they have at a good outcome. When you’re performing a time-sensitive intervention for a stroke or trauma patient, you know that every minute matters. 

But what happens after the patient is admitted to the hospital? What about the minutes slipping past that aren’t quite as noticeable: the time while a patient recovers, waiting to be discharged? 

How does the length of a patient’s stay in the hospital impact their outcome?

New technology is often an exciting prospect. It's fun to experiment with, especially when it promises to help streamline a cumbersome process. But ultimately, the true test of technology is whether it actually improves the way you do things...and when it comes to technology in healthcare, how it helps you provide better care for your patients.  

So when a group of leading experts and clinicians in Victoria, Australia implemented Pulsara to improve communication between their care teams, they were curious about what the innovative new technology could do for them. But more importantly, they wanted to see what it could do for their patients.

Over the past few years, they have successfully developed a streamlined system for making sure everyone on the team has the right information at the right time. And, they're happy to report, their new system has helped them provide stellar care for their patients.