A paradigm shift in the emergency medical services field has resulted in the implementation of new technology and procedures within the Montgomery County Hospital District over the past year.
The procedures are in an effort to improve patient outcomes for three of the biggest time-sensitive emergencies paramedics respond to in the county: ST-elevation myocardial infarction heart attacks, strokes and trauma.
“[It used to be EMS] picked up patients, took care of them [and] did a few interventions, but you weren’t really considered part of the health care system,” MCHD Medical Director Robert Dickson said. “I think more and more, EMS—especially in Montgomery County—has moved into where we are considered a vital part of the health care system, especially with these emergencies.”
New technologies
One of the biggest successes for the MCHD has been the STEMI technology used, which earned the department a Mission Lifeline Gold Award for 2015. Quality Coordinator Brad Ward said a STEMI is a specific type of cardiac event visible on an electrocardiogram, or EKG. There are roughly two cardiac arrests in the county on a daily basis, and the STEMI technology allows paramedics to set up a makeshift catheterization lab on location before arriving at a hospital.
“We can send [an EKG] from our monitor in our ambulance to the hospital so it can be viewed by the physician and the cardiologists,” Ward said. “From there, we can activate a cath lab, which is where you get the balloon and stint placement to fix the blockage to the heart. We can activate that in your front yard, which is the remarkable part.”
Ward said the technology has improved patient survivability and quality of life as well.
“They have a better quality of life afterward,” Ward said. “I like to say they have more Christmases.”
One of the newest technologies in place at MCHD is a procedure called the Rapid Arterial Occlusion Evaluation Scale, which is used if a patient is suspected of having a stroke. The new procedure helps paramedics diagnose strokes in the field, Quality Coordinator Coty Aiken said.
“Not only does it identify a stroke, it identifies the severity of a stroke,” he said. “If [the procedure] gets a five or greater on the RACE [Scale], we suggest a patient goes to a comprehensive stroke care center. The heart can take a lot more damage than the brain can, so we have to get there as fast as we can.”
MCHD began training every paramedic in the county on the procedure over the summer. Since then, the percentage of patients with severe strokes who have been transported to the correct facility on the first attempt has increased from roughly 36 to 76 percent, Aiken said.
“Ultimately, that’s what we’re here for: affecting patient outcomes in a positive way,” Dickson said.
MCHD also implemented a new sepsis care procedure earlier this year to better identify when a patient has the disease. Sepsis is a systemic response to a bacterial infection like staph.
“It’s a huge problem in the U.S.; there’s about 1 million cases a year with a 20 to 30 percent mortality rate,” Quality Supervisor Kevin Crocker said.
If patients have two positive markers on the score for the new procedure, QSOFA, or quick sequential organ failure assessment, they are strongly suspected of having sepsis, Dickson said, allowing them to get care faster.
“We’re fortunate enough here to have experts in each discipline,” he said. “Our big-time sensitive initiatives are STEMI, stroke and trauma—three of the biggest killers. We have a dedicated employee that does nothing but look at the research.”
