2014 ems banquet - dane county,...

2014 EMS Banquet The 2014 EMS banquet was held on Saturday, February 22nd, at The Heights in Verona. We celebrated many member years of service awards and three agencies were recognized. The survivor portion of the banquet was of course the highlight with 8 of the 20 survivors in attendance with their families and crews. This year’s recipient of the Robert L Brunning award of excellence was Cathy Rigdon from Stoughton Area EMS. Cathy has been in her role as the director since 2003, at that time the agency roster was at 29 and call volume was at 1054. She was the only full time paid employee, she then lobbied for a full time administrative assistant to support the agency in times when municipal cuts ran deep. Their agency now has 41 members and responded to 1391 calls in 2013. She takes extreme pride in the fact that their service is funded with no tax dollars. Cathy is all about the community and she doesn’t just stop with EMS care. She is very involved in civic organizations, nursing homes, the senior center and the local hospital to work towards overall wellness in the community. Her work goes beyond just one municipality; the entire County has benefited from her service. She has had an instrumental voice on our ALS and BLS Subcommittees and EMS Commission. She also served as the Secretary and Treasurer for the Dane County EMS Association for the past 10 years! Beyond EMS, Cathy also served 21 years as a firefighter. She serves on the Southwest Incident Management Team and received her State Certification in Emergency Management in 2011, which required an extensive amount of hours of training over several years. Lastly, she brought humor, to every meeting, event or call she was ever at. Her forward thinking, ability to listen and show compassion, fighting for what’s right and always putting her service and community as number one made her the perfect recipient of this years award.

DANE COUNTY EMS NEWSLETTER

2014 Banquet Continued—

Agencies Years of Service Awards

Waunakee Area EMS—

35 Years

DeForest FD/EMS— 40 years

Sauk Prairie Ambulance—

45 Years


Individual Years of Service Awards 20 Years Award Barbara Kalscheur—Waunakee Denny Grejczyk Sr.—Marshall Dennis O’Connell—District One Missing From Picture: Sarah Mamerow—Marshall Craig Brinkmann—Mount Horeb Dustin Haglund—Mount Horeb Gary Haglund—Mount Horeb Robin Powers—Oregon Jean Stauffacher—Plain

25 Years Award Melvin Yasick Jr.—District One James Kluetzman—Marshall Missing From Picture: Robert Kelter—Sauk Prairie Rikky Schiller—Sauk Prairie Edward Bailey—Stoughton Garry Hanson—Stoughton Scott Griffin—Stoughton

30 Years Award Matthew Wright—Town of Madison Terrance Weiss—Spring Green Jim Wick—District One Jennie Carthew—Marshall Maureen VanDinter—Waunakee Missing From Picture: Cynthia Haag—Plain Dennis Sweno—Waunakee


35 Years Award William Brue—Stoughton Missing From Picture: Gary Clark—Monona

40 Years Award John VanDinter—Waunakee

45 Years Award Robert Henry—Sauk Prairie

SURVIVOR CELEBRATIONS—20 Total Saves in 2013

Services with Saves in 2013: Blooming Grove Fire/EMS Deer-Grove EMS DeForest Fire/EMS Madison Fire Marshall EMS McFarland EMS Middleton EMS Sauk Prairie Ambulance Stoughton Area EMS Sun Prairie EMS Town of Madison Fire/EMS Assistance from: Dane County Communications Center Stoughton PD DeForest FD DeForest PD Madison PD Dane County Sheriff’s Office

STEMI Coordinators Update: Brenda Larson, Denise Mitton and Jeanne Pinnow

The EKG is a diagnostic tool used by many clinicians including EMS and physician providers to diagnose and treat ischemia, myocardial injury and arrhythmias. As such the tools we use (wires, electrodes and skin) must be optimized to deliver a diagnos-tic quality EKG. The patient’s body habitus, skin type and electrode placement influ-ence the quality of the EKG which in turn may lead to inaccurate EKG analysis. To assure the best possible EKG tracing a few simple steps will go a long way in produc-ing a good quality EKG. Step 1 – Clip chest hair if hair is present. Hair will prevent the electrodes from adher-ing to the skin and there is a greater risk of poor quality EKG. If we are ruling in or ruling out STEMI, we must have quality tracings to accurately diagnose the situation and clipping will only take a few minutes. Step 2 – Rub the skin with a 2x2 to remove dead skin cells. Again this will provide a surface in which there will be better electrode adherence. Step 3 – Connect the electrodes to the lead wires before placing on the electrodes on the patient. Press around the electrode and not on the center of the electrode to re-tain the integrity of the gel center. Avoid placing electrodes over bone or areas where there is a lot of muscle movement. Place electrodes accurately to reduce the possi-bility of misdiagnosing an EKG finding or missing EKG changes that would be identi-fied if the electrode was placed properly.

V1 Right 4th intercostal space

V2 Left 4th intercostal space

V3 Halfway between V2 and V4

V4 Left 5th intercostal space, mid-clavicular line

V5 Horizontal to V4, anterior axillary line

V6 Horizontal to V5, mid-axillary

Left lower leg

Right lower leg

Using the lower extremities is not always practical in the pre-hospital setting and using the abdomen below the umbilicus is

acceptable.

If the EKG baseline does not stabilize such as in the EKCG’s above, troubleshoot the problem: 1. Verify the electrodes are connected properly to the patient. Reposition the electrodes and/or lead wires to prevent the electrodes from pulling away from the patient. 2. Verify the gel of the electrode is not dry. Check expiration date on the electrode package. 3. Use Silver/Silver Chloride electrodes. 4. Verify patient cable is connected properly and held motionless. Verify that the ECG snaps and connectors are clean. 5. Make sure that the patient is motionless. Support patient’s limbs, if necessary. 6. Unplug electrical equipment near the patient if 60 cycle interference does not go away. 7. Move electrodes to muscle area where there is less movement. 8. When all measures have failed to resolve a poor data quality EKG, please indicate in the report the reason for the poor quality data EKG ie, “patient in respiratory distress, agitated etc.”

STEMI Alert (ST Segment Eleva on Myocardial Infarc on) Acquire the ECG within 5 minutes of arrival to the pa ent. Early no fica on/ECG transmission to the receiving facility is impera ve for ac va on of

the cardiac cath lab team. Prior to transport no fy receiving hospital of STEMI Alert Criteria.

○ A STEMI Alert will be ins tuted for pa ents having chest pain or ischemic equivalent symptoms for <12 hours, and any of the following

▪ ST segment eleva on > 1 mm in two or more con guous leads ▪ Computer interpreta on of ***ACUTE MI*** on 12‐lead ECG ▪ New Le Bundle Branch Block (confirmed by comparing to prior ECG)

○ Verbiage should include “STEMI Alert” not “possible STEMI” ▪ To the receiving centers, the term “possible” indicates uncertainty and

pa ent may not be expedited to the cath lab as needed. ▪ Pa ents mee ng STEMI Alert criteria should be transported to a PCI (Percutaneous Coronary Interven on) capable hospital

○ PCI Capable hospitals in the Madison Area: ▪ University of Wisconsin Hospitals and Clinics

▪ Meriter Hospital ▪ St. Mary’s Hospital (not Sun Prairie ED)

Garrett from the Mallards is inviting all the EMS Agencies to a special EMS Appreciation night at the Mallards. They will be recognizing EMS and having one person from each agency go out to the field to throw out a group first pitch! If you have any questions feel free to give Garrett a shout. [email protected]

-The Pepsi Tailgate area gets you all-you-can-eat ballpark food, water, soda, or beer. This runs for 90 minutes from when the gates open to the first pitch, and includes a reserved Diamond Box Ticket for just $18 total (or $23 for the beer option.) -The TDS Triple Play Club gets you unlimited ballpark food, soda, and wa-ter throughout the game with a private concession stand. Located adjacent to our Kids Zone, it includes a reserved seat down the left field line in refurbished Wrigley Field seats, and costs $27 with the option of 3 beer vouchers or Kids Zone activities throughout the game. -There is also the Duck Blind with first-come, first-serve seating, and this is very fun and relaxing area, great for mingling and socializing. It is all-you-can-eat/drink, and the cost ranges from $23-$33, depending on beer or soda and the day of the week. I realize that not all from each area EMS would be able to attend on one night due to the nature of your jobs, but we could give away vouchers redeemable at any game for those that might be on call during the game. We would have all of the EMS groups that come out that night get recognized on the field prior to the game, and then throw out the first pitch as well. Garrett Notstad Madison Mallards Baseball Club Inside Sales Manager

YOU’RE INVITED!! EMS Appreciation Night with the Mallards on June 25th

Treatment of the Asthmatic Patient—Dr. Michael Mancera

Asthma Overview Greetings from the Associate Medical Director for Dane County Emergency Management. I would like

to start by first thanking the Dane County EMS community for such a warm welcome since starting here last July. I am truly honored and privileged to be working with such talented EMTs, paramedics and leadership that are dedicated to serving our fellow citizens. I would like to spend a few minutes this month discussing asthma care.

Asthma affects people of all ages, but it most often starts during childhood. In the United States more

than 25 million have asthma, and about 7 million of these are children. When the airway reacts, the smooth muscles around them tighten. (See picture below). This narrows the airways, causing less air to flow into the lungs. This causes the symptoms associated with asthma such as wheezing, coughing, and shortness of breath.

Thankfully, in Dane County many people have access to primary care physicians that are able to help people control their asthma with long acting preventative medications (inhaled corticosteroids) in addition to providing education and treatment plans in regards to how to use short-term medications (albuterol inhalers) for breakthrough symptoms. The best treatment for asthma is prevention, however this is not always possible.

The medications used to treat acute asthma exacerbations help counteract some of these processes. Be-ta-2-agonists (albuterol) help dilate the smooth muscle of the airway tracts to allow better airflow. Atrovent (ipratroprium) is an anticholinergic bronchodilator that dilates the smooth airway muscles. For the advanced level providers, corticosteroids (solumedrol) help reduce the inflammation of the airway lining and Magnesi-um is an additional agent that acts by again allowing smooth muscle relaxation at the bronchial level.

Those people with severe asthma need to be treated aggressively. Those with a history of prior intuba-tions are at especially high risk of requiring advanced airway management. Quick recognition of symptoms is crucial. Starting nebulized treatments early can be the most beneficial treatment as those with severe asthma can decompensate very rapidly. If more advanced airway measures are required (King, LMA, ETT), don’t for-get that these patients still require the addition of the medications above to help treat the underlying broncho-constriction. CPAP may also be beneficial for moderate to severe asthma exacerbations, that is of course only if the patient is awake and able to tolerate CPAP and if CPAP is available.

As always, follow the protocols approved by your medical director and contact medical control if questions arise, as this up-date is intended to be a brief general overview of asthma care. Please contact our office with any questions or suggestions for top-ics to cover. Keep up all the good work and thank you for your time.

Mike Mancera, MD

Associate Medical Director, Dane County

Pre-Alert Pilot—Carrie Meier

The Pre-Alert pilot is slated to begin during the first week of May 2014. The Pre-Alert subcommittee has been meeting for over a year now working to determine the best way to utilize this pre-alerting concept. For this initial pilot the following fire codes will be pre-alerted: Structure Fire Outdoor Fire Car Fire Significant Rescue Agencies will be able to opt in for Fire or Fire & EMS. EMS calls are not included in the pilot because the Emergency Medical Dispatch Protocol (EMD) currently being followed already has a mechanism of pre-alerting by shunting the call to the dispatcher early on if it is discovered the patient it PNB. Throughout the Pilot, the subcommittee will evaluate how things are going with the help of your agencies and the 911 Center. Please share feedback. You can email [email protected] and it will be shared with the subcommittee. Here’s how it will work:

Call taker receives a 911 call: - Collect and Verify Address - Collect and Verify Phone # - Collect Caller Name - Okay, tell me exactly what happened. - Call taker choses from drop down menu

Structure Fire Outdoor Fire Vehicle Fire Significant Rescue

Pre-alert arrives at dispatcher’s desk. Simultaneously Call taker continues down the EFD questions/protocol.

Pre-Alert Pilot continued—Carrie Meier

Once Dispatcher sees the pre-alert: Outside City of Madison MFD

*after the 90 day pilot the subcommittee will review whether this should be automated* Once Call taker reaches send point in EFD protocol and determines an EFD

code it will arrive again at the dispatcher’s desk with the updated infor-mation. Simultaneously the call taker will continue the protocol.

Once the Dispatcher sees this update: Outside City of Madison MFD

Please remember this is a pilot with the intention of getting responders

moving sooner in the call when it is high acuity. You will be dispatched sooner and the call takers will be deciding on acuity with minimal information from the caller. When you answer up on the radio please be patient as the dispatcher is still gathering information and will update you as soon as they are able. Feel free to send feedback on the pilot to [email protected].

Pre-alerts by pager the responsible depart-ment (Authority having Jurisdiction – AHJ) with location and problem nature (If agency opted in to pilot) – this can be jurisdictional Fire or Fire & EMS, agencies can decide. Example: “PreAlert Middleton Fire and EMS - 2020 Par-menter Street, City of Middleton, Structure Fire – C-Charlie assignment”

Alerts specific units as recommended by CAD

Pages responsible department(s) and addition-al running order/auto aid with a full dispatch message, then interacts by radio with respond-ing unit(s) as updates arrive

Updates responding unit(s) via two-way radio, and makes any needed response adjustments

Cardiac Care - STEMI Coordinators (a

Protocols continued:

As long as the user is using a modern browser (anything current IE 10+, Chrome, Safari, etc.) the site uses the browsers cache. The first me you visit the site, the browser downloads the en re site and caches it locally. When connected to the internet it checks a file on the server to see if it needs to download a new ver‐sion of the site. When clicking on links that open the pdf file it uses the cached version of the file that the browser already has. In essence each user has a copy of the site on their pc/mobile device. Any mobile device will have a modern browser on it (unless it's an older book reader kindle/nook/etc.) There are a couple of things to keep in mind. 1) You will need to obviously bring up the site once while connected to the inter‐net for it to cache. It would be preferable to ini ally load is using a wireless con‐nec on rather than a cell connec on. 2) If for some reason you are using a 3g/4g connec on on the ini al download, you need to give it some me to download. It took 2‐3 minutes on my iPhone5 with 1 bar. 3) You also shouldn't bring up the site in private browsing mode because it won't persist the cache, it will clear when you close the browser. 4) Clearing the browser data/cache will remove the site.

Important Information To Know...

Have you noticed a concern or something you would find helpful in the protocols? PLEASE let us know. The group will soon be reconvening to work on the next protocol roll

out and we would appreciate your input. You can email any suggestions to:

[email protected]

Medical Director’s Corner—Dr. Michael Lohmeier

The April 2014 Medical Director’s Corner is now uploaded to the Dane County EMS Website for your viewing under Training/Webcasts.

www.countyofdane.com/emergency/ems

Password: dane Included in this month’s “Episode” is: ◊ Official introduction of the Associate Medical Director—Short “Get to Know” of Dr. Michael Mancera

◊ There’s an App for that—Welcome the Dane County EMS Protocol App

◊ Supplemental EMS Education—3rd year residents from UW develop presentation directed towards pre-hospital providers

◊ The M.A.R.V.—(Medical Assist Response Vehicle)

Several positions for the Operating Practices Subcommittee need to be filled. OPS meets on the 2nd Thursday of the month at 9am. We are looking for: Director of a basic level service and an alternate Training Director of an IV tech level agency

Contact [email protected] to apply.

Positions Open for Operating Practices Subcommittee

2014 ems banquet - dane county,...

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