December 2007

MRSA

MRSA (methicillin-resistant Staphylococcus aureus) has been in the news a lot lately. As EMS providers we are at risk of encountering this resistant bacteria. Below are links to two documents that I think are worthy of reading. --Mickey Eisenberg MD, PhD, Medical Program Director, Seattle/King County EMS

MRSA Factsheet
Public Health - Seattle/King County (external link/PDF document)

CDC Factsheet
Centers for Disease Control (external link)

August 2007

Relaunch of ROC PRIMED Cardiac Arrest Study (ROC-ON)  

Chiefs and EMS Training Officers and ROC EMS Liaisons

Effective Monday, August 20 the ITD valve portion of the ROC PRIMED cardiac arrest study will restart in King County.  The FDA did a thorough review of the study and found that all portions including EMS care were in order.  The FDA acknowledged their misunderstanding that had prompted their decision to put a hold on the study back in July.  As a consequence, the FDA affirmed that the study should proceed unchanged so that all EMS training and use related to the ITD valve stands.

Crews should proceed as before with the plan to apply the ITD valve early on during resuscitation, achieve a tight seal between the BVM and patient, and maintain the valve during CPR (off with return of spontaneous pulses).  The Analyze Early-Analyze Late CPR procedures will continue, but will now be done as part of the overall study.  After each CPR, please continue to have crews contact the ROC study nurses via the hotline and then download AED recordings per agency protocol.

Few EMS systems can rigorously evaluate the care they deliver.  To this end, the EMS agencies of King County are again distinguishing themselves as they proceed with the ROC PRIMED study.  We appreciate your dedication and persistence. 

Mickey Eisenberg MD, PhD, Medical Program Director, Seattle/King County EMS

June 2007

Revised King County CBD Guidelines  

The King County Criteria Based Dispatch (CBD) Guidelines have been revised and will go into effect July 1, 2007. The revisions are relatively minor but we want you to be aware of them since the impact may redistribute some EMS calls to the most appropriate level of care, meaning there may be patients that will no longer receive an ALS response. Attached is a summary of the 2007 CBD Revisions.  

The King County Dispatch Review Committee (DRC) and the EMS Division conducted a review of the CBD Guidelines over the last 18 months. The DRC includes representatives from dispatch, BLS and ALS providers in King County. The revisions are for King County, outside the city of Seattle. Data for each dispatch criterion was reviewed, including annual call volume, level of response, transport data, code greens and request from scene. The King County Medical Directors approved the new guidelines in December, 2006. Training for dispatchers has been completed.

All EMTs and paramedics are strongly encouraged to review the materials online prior to July 1st (see links below). The review of the materials should take no longer than 15 minutes. Training Officers will receive a mailing including posters describing the changes and one copy of the CBD Guidelines for each station in your department. Please post the brightly colored cards on your station reader boards and make the CBD Guidelines available to EMTs and paramedics to review. If you have additional questions regarding these dispatch revisions, please contact EMS Division staff Cleo Subido, 206-296-4559, or Linda Culley, 206-296-4956.

View summary of CBD revisions (PDF)
View medical knowledge card (PDF)

ROC PRIMED Trial Set To Start in King County July 2nd  

The ROC PRIMED study, which includes the ITD valve and analyze early versus analyze late will start July 2nd. In anticipation of the start of the trial, EMTs and paramedics in King County are required to complete the "ROC103c - ROC-ON (ROC103 Refresher)" training course on EMS Online before July 1, 2007.

This short course is a refresher of the original ROC PRIMED Trial course (ROC103) that your EMS providers completed last year. You will find the course on the EMS Online home page (after logging in) under the heading "ROC Courses" titled "ROC103c - ROC-ON (103 Refresher)."

If any EMS provider has not completed the original "ROC 103 - ROC PRIMED Trial" course, he or she can complete that course in lieu of ROC103c. Those who have completed ROC103 as of today must complete ROC103c. The ROC103 course is available for optional review.

February 2007

SPHERE Goes Live

SPHERE (Supporting Public Health with Emergency Responders) was launched in January.  We thank the thousands of EMTs who support this innovative program. SPHERE targets two massive public health problems:  Hypertension and diabetes. It helps identify new cases of each disease as well as identifies patients whose hypertension or diabetes is out of control. The following questions and answers may help in the implementation of SPHERE.

Who is eligible to receive the cards?
Anyone except the following:  paramedic transported patients, nursing home patients, and possibly trauma patients (use judgment for trauma patients).

Who specifically should receive the alert cards? 
Anyone with the following:
Blood pressure >=160 systolic or >=100 diastolic
Blood sugar in a diabetic:  >=300
Blood sugar in a non diabetic:  >=175

How will you follow up with patients who receive the alert cards?
During the year my office will call approximately 1000 patients who receive alert cards to determine the actions they took. All that we learn about the impact of the program will be shared with the fire departments. Thus it is crucial to confirm the patient’s phone number.

Will we learn how many alerts we distribute? 
In a short while the EMS Online web site will have a SPHERE link that will allow you to tract the alerts from your department.

Should I test everyone for high blood glucose?
I encourage you to screen all reasonable patients for diabetes. We know that risk factors for diabetes are overweight, older, and having a first degree relative with diabetes. Currently 20 million Americans have diabetes (85% are type II diabetes). This is 7% of the population. It is estimated that an additional 2% (another 6-7 million) have type II diabetes and do not know it. That is a lot of diabetes!

Do I need to get informed consent from the patient to check the glucose? 
If the glucose determination is part of your regular evaluation of the presenting problem you do not need informed consent. But if it is being offered as a service you should say something like the following before testing:  “_____ Fire Department is conducting free health screening for diabetes. Would it be okay, while we are here, if we checked you for diabetes?  It will only take a minute.” 

Is a random glucose of 175 in a non diabetic diagnostic of diabetes?
No, but it certainly is suggestive of the disease and deserves follow up. 

How many new cases of hypertension am I likely to find? 
Our pilot data indicates that 80% of patients identified with blood pressure >=160 or >=100 already knew they had hypertension. But these patients clearly are not in good blood pressure control and need to see their doctor for better control. Thus of the eligible patients approximately 20% may be new cases.

Can I hand out alert cards to patients who walk into the station for a blood pressure or glucose check?
Absolutely. There is no need to fill out a MIRF for walk in patients.

Does SPHERE work? 
Information from pilot studies in King County indicates that 65% of patients who receive alert cards follow up with a health care provider. 95% of patients appreciated the firefighters for giving them the alert card. EMS sees almost 10% of the population in any given year. This is a golden opportunity to reach out and help identify and control the major public health diseases of hypertension and diabetes. Furthermore EMS provides services to a disproportionate share of the underinsured population, people who may not have good access to medical screening.

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