January - March, 2003

Emergency

Ready and waiting for the call: pre-hospital care evolves to life-saving treatment on the way

You may not notice them until you need them. But they are right next door and ready for a rapid response should you or a loved one get ill or injured. Emergency medical personnel have long been the everyday heroes, carrying an almost mythic reputation as they go about their daily lives in their job of saving lives.
Today they are an even more integral part of hospitals’ seamless life-saving operations.
“Without the men and women in the field, carrying the torch day in and day out, lives would be lost,” says Janet Jordan,M.D., medical director, St. John’s EMS (Emergency Medical Services).
St. John’s has provided its own paramedics and ambulance operation since 1982 when it purchased privately run Safety Ambulance.
"Back in the '60s and '70s, there were funeral homes providing ambulance service, which changed to private ambulance services," St. John's EMS Director Bob Patterson says. "There were two private services in Springfield before the hospitals got involved in the early '80s. St. John's purchased one and Cox purchased the other.”
What began as an ambulance-only operation 19 years ago serving only south Springfield now provides services to the Missouri counties of Greene, Dallas, Lawrence, Wright, Cedar, Stone, Howell, Laclede, Camden and Shannon and Arkansas' Carroll County.
St. John’s total EMS program comprises 215 field and administrative staff members, 42 ambulances, a training vehicle and a trailer equipped for mass casualty and specialized training.
EMTs are trained in basic life support procedures and patient handling, and assist paramedics with advanced procedures. EMT training is the starting point for a career in emergency medical services. Paramedics train in advanced life support procedures–IVs, medications, advanced airway procedures and comprehensive EKGs. The emergency medical dispatchers are EMTs who have gone on to specialized dispatch training. They’re trained to provide pre-arrival instructions to callers to help the patient until the ambulance or helicopter arrives on the scene.
In some remote locations, EMS personnel are the only healthcare providers for miles. Keeping these operations open is an expensive proposition, yet a necessary one St. John’s Vice President Charles Wollard says, because of the mission they fulfill.
St. John’s Health System spends approximately $750,000 per year to support EMS service. It’s money well spent, according to residents.
“In a lot of these communities, they become almost like primary care givers,” explains Vickie Keeney, St. John’s Director of Mission Services. “People end up coming to them for help.”
Of course, then there’s the life-saving emergency response.
Reducing time to treatment is always a goal for St. John’s physicians and staff. The sooner patients receive appropriate treatment, the more likely they are to survive. Identifying the appropriate treatment and acting quickly is the hard part, says Roger Huckfeldt, M.D, St. John’s chief trauma surgeon.
“If you’re in a crash, your paramedic must recognize the severity of the injuries and know how to safely get you from point A to point B and to the right person at point B,” Huckfeldt says. “Trauma care has to be seamless from the first responder all the way to rehab.”
Patterson says he staffs 25 ambulances at advanced life support level, with an additional 17 ambulances in reserve for additional staffing at special events, high census weekend or mass casualty situations.
In addition to emergency medical response, they also provide local and long-distance routine transfers and special event standby, as well as support to law enforcement and fire departments by providing standby service at major incidents and tactical operations. The total EMS staff includes emergency medical technicians, paramedics, emergency medical dispatchers and an administrative staff in Springfield.
St. John’s EMS boasts an ever-growing arsenal of tools and specialized skills that allow them to stay on the cutting edge. One such tool used in the fight against heart disease and stroke is the clot-busting drug. St. John’s was the first rural multi-county EMS system in the nation to have these drugs on board ambulances and was a leader in the use of cellular EKG technology to transmit the activity of the heart to a physician in the Emergency Trauma Center allowing the physician to initiate patient care while en route.
Breakthroughs like these help decrease time to treatment in important cases where time can mean a life-saving difference, says Jordan.
“Many heart attack victims have been saved thanks to the coordinated and timely care provided by first responders, EMS personnel, emergency room physicians and staff,” Jordan says. “This coordination is what makes a difference.”
The Missouri Emergency Medical Association recognized the significance of such accomplishments by naming St. John’s as the EMS System of the Year.
Patterson says a few of the department's benchmarks include the following.
• St. John's was the first health system in the state to implement a 12-lead EKG program that includes initial training of all paramedics, ongoing competency assessment, refresher training in acquisition and interpretation of data, thrombolytic checklist prescreening and heparin and aspirin treatment;
"Our goal to expedite care for the patient suffering myocardial infarction (heart attack) has been quite successful," Patterson says. "The time to intervention has been significantly reduced with improved outcomes. Our approach to 12-lead EKG and out-of-hospital cardiac care is serving as a model for other services across the country," Patterson says.
• EMS was the first service in the nation to participate in a Troponin-T rapid assay test for heart attack. This clinical trial established the feasibility of paramedics to draw blood from patients suspected of suffering a heart attack, and complete a rapid Troponin test while the patient was en route to the hospital;
• St. John's was the first health system in the state to implement a pre-hospital clot-busting treatment program;
• EMS established a first responder automatic external defibrillator pilot program that facilitated passage of legislation that has increased utilization of AEDs statewide;
• EMS began working with other St. John's departments to develop clinical pathways to ensure continuity of care from the field to recovery. The department is a member of the heart attack and stroke teams and the trauma service line and cardiovascular service line committees.
Three communication specialists are on duty 24 hours a day, seven days a week, in the EMS dispatch center, located in the Medical Gardens Building on the Springfield campus. They dispatch ambulances to Greene, Lawrence and Laclede counties.
A dedicated dispatcher provides flight following services for St. Johns' air ambulances, Life Line I, which is based in Springfield and Life Line II, which is based in St. Robert.
St. John's Life Line is the oldest emergency flight program in southwest Missouri and employs staff of 30 including pilots, nurses and paramedics.
Life Line staff responds to more than 1,500 emergency calls per year and has the most accident-free hours of any flight program in southwest Missouri.
Patterson says the flight crew provides landing zone training to emergency services personnel at every opportunity.
"Our ground and flight crews enjoy a professional, team-oriented approach to patient care," Patterson says.
St. John’s also provides EMT and paramedic training programs and refresher courses, adult and pediatric basic trauma life support courses and several continuing education courses. Quarterly competency training is provided at each service area to ensure consistent skill levels of all field personnel.
"We provide first responder and other training to law enforcement and fire departments on a regular basis. Community education is achieved through public presentations. EMS personnel provide programs to civic groups, churches and schools," Patterson says.
"The evolution of EMS over the last 20 years is just unbelievable. The difference between when we purchased the first ambulance service in 1982, and what we're doing now is just remarkable," Patterson says.
Education levels among EMS personnel have increased tremendously since St. John's began offering emergency medical services, as well, Patterson says.