December 2005

Revision to Initial Dispatch Codes/Criteria Based Dispatch Guidelines

December 9, 2005 -- The King County Criteria Based Dispatch (CBD) Guidelines have been revised to include a mechanism to gather information pertaining to request from scenes. 

Effective Jan 1, 2006 if a BLS unit requests an ALS unit from the scene, the dispatcher will change the Initial Dispatch Code (IDC Code) to reflect that situation.  The letter code for this will be the letter Q.  The Qwill simply denote that a BLS unit arrived on-scene and requested that a medic unit be dispatched.  In other words, if a BLS unit responds to a Breathing Difficultywhich is coded 5R1 and requests a medic unit upon arrival, the dispatcher will change the IDC to 5Q1.

The King County Dispatch Review Committee (DRC) and the EMS Division conducted a review of the request from scenedata over the last 12 months. After review it became apparent that the information marked Request from Sceneon the MIRF was not always correct and/or complete. The Qcode well enable us to get a clear picture of the actual request from scenecalls. The box on the ALS MIRF for Paramedic Responsehas been eliminated on the 2006 version of the ALS MIRF form.

If you have questions regarding this dispatch code revision, please contact EMS Division staff Cleo Subido, 206-296-4559, or Linda Culley, 206-296-4956.

Updated AHA CPR Guidelines

December 1, 2005 -- We have reviewed the newly-issued American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. A summary of these changes may be found in the AHA Currents Winter 2005-2006 Issue. We are pleased to note that 80% of the new guidelines have already been in place in King County for the last year. In fact, information from King County was in part responsible for many of the new American Heart Association recommendations. The EMTs, fire fighters, and paramedics have done a commendable job in undertaking and implementing new protocols over the last year. This, again, underscores the important teamwork between the field providers, training, and medical direction, and demonstrates how good clinical data drives rational scientific change.

There are a handful of new recommendations that are not already implemented in King County relating to the compression/ventilation ratio of CPR. We intend to incorporate these modest changes into a planned and organized training session that will run concurrently with training for the ROC studies set to begin in Spring of 2006. Revisions to dispatch CPR protocols will also occur in Spring of 2006. We believe this is the most efficient and effective mean to train the EMS personnel in your department. -- Mickey Eisenberg MD, Tom Rea MD, Mike Helbock, and Linda Culley.

September 2005

SPHERE - Using Incident Report Data to Identify Untreated Hypertension

September 14, 2005 -- SPHERE (Support Public Health with Emergency REsponders) is a new initiative of the King County EMS Division. The essence of SPHERE is to use routinely-collected information on the medical incident report form to identify cases of untreated hypertension and under-controlled hypertension. Based on this information the EMS Division will then send a letter to the patient about the possible diagnosis and recommend a visit to a physician.

A pilot project involving the Federal Way Fire Department has tested this approach and a second more focused pilot project will occur later this year. In the upcoming pilot the EMS Division will call the patient to determine if her or she saw a physician or had medication adjusted in response to the letter.

In 2004 EMTs in King County identified over 10,000 patients with systolic pressure above 160 mmHg and there were 4200 patients with diastolic pressure above 100 mmHg. A partnership betwee the EMS Division and local fire departments and EMTs offers a tremendous opportunity to help identify and manage large public health problems such as hypertension. The SPHERE concept can also work to help identify new cases of diabetes or under-treated cases of diabetes.

July 2005

2006 CBT/AED Instructor Workshops

July 28, 2005 -- King County BLS Training and Education announces the CBT/AED Instructor Workshops for 2005. Attendance at one of the workshops is required for all instructors who plan to teach CBT and/or AED in 2006.

Click here to see more information, workshop schedule and availability.

February 2005

Left Ventricular Assist Device (LVAD) Alert

February 17, 2005 -- Left ventricular assist devices (LVADs) are approved for use in patients with severe congestive heart failure. An LVAD is a pump planted within the abdominal cavity that has an external power source and is connected via tubes to the heart. There are currently two patients in King County with LVADs. EMS personnel should be aware that someone with an LVAD may go into ventricular fibrillation (VF) and still be conscious and alert--a patient may be in VF and still be speaking to you because the pump is working to propel blood to the brain. These patients may call 911 because they experience a decrease in energy or may complain of weakness.

If you encounter such a patient please call the phone number on the pump for further directions. The call goes to a support nurse who is on call 24/7. Together you can decide what is best for the patient. Options include using the AED (if the patient is comatose) or waiting for paramedics who may be instructed to sedate prior to defibrillation (if the patient is conscious). Click here for more information on the FDA website.

January 2005

Glucometry Alert

January 24, 2005 -- It is important to remember that several of the glucometry devices currently being used by BLS providers in King County require a coded chip that is linked to the reading strips. This chip is included with each bottle of reading strips and must be in the device when strips from that bottle are being utilized. The chip and strips will be coded with a like number for identification. Failure to link the strips and device with this chip may result in abnormal blood sugar readings.

Revised EMT Patient Care Guidelines

January 1, 2005 -- King County EMS has released a new version of the EMT Patient Care Guidelines that went into effect January 1, 2005. There are some changes in the guidelines and improved formatting. Copies of the pocket-sized book will be delivered to area EMS agencies by January 15th. Click here to get a PDF file from the Downloads page.

King County EMS has also created a three-page summary of the Patient Care Guidelines revisions. Click here to go to the Downloads page to retrieve a PDF file of this summary document--click Patient Care Guidelines Rev Summary (2005). A powerpoint file is also available for instructors teaching the new guidelines--click here.

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