March 27, 2011
Orange Cross keeps up with the gold standard with Critical Care Transport service
Recently, a 911 call came from a resident experiencing chest pain. Orange Cross Critical Care Transport arrived on scene and determined that the resident was experiencing an active heart attack.
Time is of the essence in serious situations like this, so after consulting with a local hospital, Orange Cross paramedics took the resident directly to a tertiary care center in Grafton, where a catheter was inserted and a balloon was used to open blocked arteries.
There’s an industry “gold standard” for this type of response time, and from the time a call is placed to the moment a balloon is inserted, 90 minutes is considered optimal.
Thanks to the Critical Care Transport team at Orange Cross, that time was sliced to a little under 60 minutes.
“A lot of the (ambulance) services are going in the direction (of Critical Care Transport) but we have it in place, up and running and established,” said Matt Hill, Orange Cross operations director.
Although the Critical Care Transport service has been available since April 2010, since then, two Critical Care paramedics have undergone the training required to enable Orange Cross to offer the service on a 24/7 basis.
“We’re the only service in the region that provides that at all times,” said Hill, who is also certified in critical care.
The advanced training includes areas such as cardiology, neurology, pediatrics, obstetrics and trauma care, critical to allowing the paramedics to provide expanded services that focus on intensive care concepts and practices.
“The paramedics have an expanded scope of practice,” Hill said. “They have more education and more training on certain types of processes. And in a 911 setting, it’s that knowledge base that helps.”
St. Nicholas Hospital and Aurora Sheboygan Memorial Medical Center are co-owners of Orange Cross, and although both facilities offer a wide range of critical care services, patients sometimes require the specialized care found at tertiary facilities. That’s where the Critical Care Transport steps in, taking the patient to the facility and providing advanced care on the way.
“In the past, (hospitals) may have had to call a flight crew over,” Hill said. “Now, we can provide that level of care on the ground, especially if the patient’s needs aren’t time-sensitive or if the helicopter isn’t flying.”
Orange Cross’ partnership with the local hospitals is critical — three administrators from each facility serve on the board of directors for Orange Cross, and it’s these relationships that serve as avenues of communication, allowing the paramedics to stay current on the latest healthcare trends and procedures.
Dr. Suzanne Martens, co-medical director of Orange Cross, is also an EMS Medical Director, working within a web of health care professionals throughout the country that provide her with emerging health care trends. It’s this information, combined with feedback from her staff at St. Nicholas Hospital, and the staff at Aurora Sheboygan Memorial Medical Center and other facilities, that allows her to work with paramedics at Orange Cross to identify areas in which to expand treatment and service.
“Our highly trained paramedics do not forget all this extra knowledge,” Martens said. “They are able to perform better assessments, consider a wider range of possible complications and treatments, anticipate the care to be provided and facilitate the transition at the local hospital.”
She said it’s routine for patients to be transported to tertiary care facilities, simply because the local demand for those facilities may not be high enough to support the creation of specialty departments.
That’s why it’s necessary for paramedics to be able to quickly assess a patient’s needs on site, suggesting transport to a specialty care center when necessary.
“When the paramedics contact medical control at the local emergency departments and indicate the patient would likely benefit from care at a (specialized center), the vast majority (of patients) end up requiring these services,” Martens said. “The recognition of this in the field saves up to 30 minutes of transfer time, which can have an impact on outcomes.”
She said this time is “particularly pertinent” for those patients experiencing a heart attack, who may require “emergency intervention at a cath lab, none of which exist in this county…We have delivered heart attack patients in record time.”
Although Orange Cross paramedics respond to hundreds of emergency-related calls annually, both Executive Director Gerry Isbell and Hill said the staff is kept busy with a wide variety of non-emergency services as well.
“Our call volume for 2010 was a little over 3,600 calls,” Isbell said. “That includes emergency, non-emergency, interfacility, everything.”
Paramedics and staff in three locations — Sheboygan Falls, St. Nicholas Hospital and Ashland Avenue in Sheboygan — regularly schedule transport for non-emergency issues, including taking nursing home residents to and from the hospital or clinic; transporting people with non-emergency issues to the hospital, and bringing critically ill or injured patients to tertiary care
“We want to focus on a broad range of services, not just emergency,” Hill said. “There’s so much more to what we do.”
And much of that takes place behind the scenes, as dispatchers man the phones, while account specialists assist customers with billing and other questions.
“We have a 24/7 dispatch center here, so (people) can call us anytime to get assistance on their transportation needs or their bills,” Isbell said. “We’re also a billing service for the ambulance.”
Along with those responsibilities, paramedics regularly update their skills and knowledge through various training seminars.
“Most of our office staff is trained to the paramedic level,” Hill said. “We can still accommodate scheduled and non-emergency requests and still provide 911 coverage.”
That’s because once an ambulance is called out from one station, ambulances at other stations are immediately moved to a central point to provide continued coverage.
“It’s called ‘System Status Management,'” Hill said. “”As calls go out, we reposition units around our coverage area to assure the best overall coverage for our service area. Our 24/7 dispatch center has medically trained dispatchers that really help make this effective.”
Currently, the three stations house a total of six ambulances; two new rigs have been ordered, and Hill expects to take delivery of the first one in mid-April.
In addition to the new ambulances, a 15-lead electrocardiogram, or EKG, has been ordered. Hill said this device allows for an expanded view of the heart’s electrical
“We can pinpoint a specific location of a heart attack,” he said. “We’ll implement that in the near future as a progression of what we already do, which is look at (the heart) from 12 views.”