CBT 2008 - EMS Online

CBT 2008 - EMS Online

opyright 2008 Seattle/King County EMS CBT 2008 Mickey Eisenberg, MD, PhD Medical Program Director opyright 2008 Seattle/King County EMS Key Points for 2009 opyright 2008 Seattle/King County EMS

1. Meticulous CPR is Critical Minimize hands-off time This keeps the left ventricle filled with blood which keeps the coronary perfusion pressure high which makes a defibrillatory shock successful Attention to details makes a difference opyright 2008 Seattle/King County EMS

Cardiac Arrest Survival 1990 - 2008 50 45 40 35 30 25 20 15 10

5 0 opyright 2008 Seattle/King County EMS 2008 Survival 48.5% Goal is 50% opyright 2008 Seattle/King County EMS

2. Always Take Vital Signs Every patient MUST have BP, pulse, and RR Only exceptions: DOA patients (BP is not needed) Pediatric patients (BP not immediately required) use Pediatric Assessment Triangle (PAT) Patient assist calls with absolutely no patient assessment or clinical decision

making opyright 2008 Seattle/King County EMS 3. Abnormal Vital Signs MUST be Addressed What is abnormal?

BP > 160/110 Pulse > than 100-120 RR > than 20 All in the appropriate clinical setting opyright 2008 Seattle/King County EMS 4. Physical MUST Match the Complaint

Headache requires neurological exam GI complaint requires abdominal exam SOB requires lung exam And so on opyright 2008 Seattle/King County EMS

5. Patients left at home MUST have documentation of instructions You MUST indicate on MIRF that the patient was informed to seek medical care or call 911 if not improved or symptoms worsen opyright 2008 Seattle/King County EMS 6. Inform Patients of Options

Transportation options should be discussed with patients. FD transport Private ambulance (inform patient of charges) Taxi Family member, friend Document that you did so opyright 2008 Seattle/King County EMS

7. You MUST Include Verified Phone and Address in Computer King County EMS contacts many patients by mail or phone We MUST have a valid address and best-contact phone number We MUST spell the patients name correctly!! These MUST be entered in the computer

opyright 2008 Seattle/King County EMS 8. Sick/Not Sick MUST be Applied to Every Patient. Critical thinking MUST be applied to every patient This is the basis for our entire EMS system Always consider MOI, NOI, and IOS

opyright 2008 Seattle/King County EMS 9. You MUST Document Your Actions All procedures (glucometry, oximetry, CPR, oxygen, ASA administration) MUST be documented on MIRF and in computer If it isnt on the MIRF or in the computer it didnt happen All hypoglycemia patients MUST have before treatment and after treatment

glucometry After care instructions MUST be left with patient if patient is left at scene opyright 2008 Seattle/King County EMS 10. SPHERE Alerts Make a Difference EMTs have handed out thousands of Alert Cards for patients with high blood pressure and high blood sugar

This is a real service Encourage your EMTs to keep doing this and do what you can to facilitate Alert Cards Remember to check the boxes on the MIRF and enter into the computer opyright 2008 Seattle/King County EMS MIRF

opyright 2008 Seattle/King County EMS EMS Online Sphere Cards opyright 2008 Seattle/King County EMS 11. Be Safe! Getting to scene At scene During transportation Your health

opyright 2008 Seattle/King County EMS Plans for 2009 Continued attention to details of CPR and defibrillation Emphasis on rapid assessment and transport of acute MI patients by paramedics Emphasis on EMT administration of aspirin for patients with ACS Emphasis on rapid assessment and transport

of stroke patients by EMTs (Code CVA) Left at scene documentation Creation of EMT Advisory Group opyright 2008 Seattle/King County EMS Study Updates ROC study keys on BLS care and performance Correct compliance with ITD valve and analyze early versus analyze late. King County has set the standard for study

performance: 99% compliance with contacting study nurses 85% correct compliance with AE/AL assignment 85% compliance and early ITD valve placement 80% AED downloads All the while achieving the highest survival among sites. (This high study performance and superior survival is not a chance County coincidence

but a tribute to training, effort, and skills) opyright 2008 Seattle/King EMS Study Updates Enrolled 6000 patients study wide1500 from King County Next switch from AE vs. AL scheduled for mid-March, 2009 Be aware that the paramedics will be infusing cold IV fluid in some resuscitated patients as part of the

Hypothermia Study. You may be able to help by grabbing and preparing the cold fluid from the medic unit refrigerators. In conclusion, still opportunities to make incremental improvement in particular cases, but over all care is very solid and sets the standard for other EMS systems. Thank you.and keep pushing. opyright 2008 Seattle/King County EMS

Thank You opyright 2008 Seattle/King County EMS

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