S.D. medics have latest tools for patient monitoring and treatment

Aberdeen fire and rescue looks for improvements with 15-lead ECG, invasive blood pressure monitoring, mechanical CPR, and impedance threshold devices

By Elisa Sand
American News

ABERDEEN, S.D. — In the constantly evolving field of emergency medical services, Aberdeen Fire and Rescue is always looking for the latest tool to help improve the quality of care it offers.

One of the department’s newer pieces of equipment is a 15-lead defibrillator.

While defibrillators are commonly found on ambulances, Aberdeen’s Emergency Medical Services Coordinator Rob Senger said they’ve evolved beyond the two-paddle variety that’s depicted on television. Those devices are more common now in public places, he said. Meanwhile, paramedics are responding with devices that have 12 and even 15 leads that are attached to the patient and collect all sorts of data about that person’s current medical condition.

Senger said that additional information helps paramedics determine not only what’s happening with the patient, but if medication is helping. This 15-lead defibrillator isn’t the first for Aberdeen Fire and Rescue, but it also isn’t something every paramedic team has, and it provides some new capabilities.

“Like invasive pressure monitoring,” Senger said.

Invasive pressure monitoring involves inserting a needle into a patient’s bone marrow, which provides real-time blood pressure. Senger said the option is extremely important for critical patients, so the paramedics can get instant feedback on whatever treatment is provided.

“Even before the patient says they feel better, we see a change in the patient,” Senger said.

The additional leads on the defibrillator also provide medics with more data about a patient’s heart condition. Senger said the electrocardiogram using a 12-lead defibrillator may indicate a heart attack. But using additional leads, paramedics can collect data from other parts of the heart to see, for instance, if the right side of the patient’s heart is causing the problem or if the issue is coming from the back.

That additional perspective, he said, helps medics determine which course of treatment to pursue.

In addition to the defibrillators collecting more patient information, medics also have several other tools available, such as ventilators, that mechanically do the breathing for the patient as opposed to using a bag to provide manual breaths.

The department also has systems that mechanically provide consistent chest compressions. While paramedics started using similar chest compression systems statewide in the last year, Senger said, Aberdeen has been using them now for four years.

The department also uses a ResQpod device that attaches to tubes inserted into the windpipes of patients. Senger said the ResQpod helps provide suction that draws the blood back into the heart when CPR is being performed. Those tools, combined with lowering the patient’s body temperature, all help improve the chances of restoring a heartbeat during a cardiac event.

Fire Chief Kevin VanMeter said lots of changes have taken place in the last 20 years, but they have been so gradual, as opposed to sudden, that it’s been difficult to implement them.

”I’ve seen it progress,” he said. “I’ve been there every step of it. It has changed a lot, but it’s been so progressive.”

VanMeter said one of the changes includes the department’s ability to electronically transmit electrocardiogram information about the patient to the doctor at the hospital. That provides an advantage for the doctor, he said, because he or she can then decide the best course of treatment for the patient before arrival.

More than just tools

Quality care is more than just having the newest equipment.

”I can’t emphasize enough the training,” Senger said, explaining that the goal behind training is to push the paramedics to be critical thinkers.

”Training constantly enhances us over the typical paramedic,” he said.

Nationally, paramedics are required to have 72 hours of training every two years, he said.

”Our staff probably triples that pretty easily,” Senger said.

Even with all the new technology, Senger said, changes are implemented solely because of knowledge gained through training. One of those changes, he said, is a pit crew model of response. Through the approach, he said, medics will have pre-determined tasks based on when they arrive at a scene.

Senger said there are many people responsible for getting Aberdeen Fire and Rescue where it is today. They include Dr. Steven Redmond from Sanford Aberdeen Medical Center, and Kirby Kleffman, Sanford’s director of trauma and emergency.

”Systemwide, there’s a lot of key players who have driven the system to where it is today,” Senger said, also crediting the fire chief for his support of training and new equipment purchases.

VanMeter said he doesn’t automatically approve all equipment purchase requests. Some are simply too expensive. One of the defibrillators was a $35,000 purchase from a budget line item that sets aside $50,000 for new equipment. In the two years he’s been budgeting for those expenses, VanMeter said, he hasn’t increased the department’s overall budget. Instead, other parts of the budget have been cut back or grants have been secured to make the purchases.

New capabilities planned

Some new services planned for 2015 include blood-testing capabilities and improving communication with local hospitals about what happens to patients after care is transferred to doctors and nurses.

The blood testing — also called point-of-care testing — gives paramedics immediate data that can help determine treatment before medications start changing the chemistry of the blood.

Senger said the earlier the blood test, the more helpful it can be in determining if a patient has a widespread infection, what her or his lactate level is and the level of a patient’s cardiac enzymes. Senger said knowing those numbers before treatment and being able to provide that to the doctors in the emergency room all helps in determining appropriate treatment.

”We always want to know if what we’re doing is what’s best for the patient,” Senger said.

Even with all the equipment, training and time medics spend with patients before they’re taken to the hospital, emergency responders now don’t learn how long patients spend in the hospital or what kind of treatment they receive after being admitted. Senger said he hopes there’s a way to share that information in the future.

”We’re treating symptoms a lot of times,” he said. “Sometimes we never know (what’s going on with the patient).”

In those cases, he said, it’s helpful to see what kind of treatment patients received at the hospital and what health problems were ultimately confirmed. That information, he said, will help medics diagnose problems more quickly and provide better services in the future.

©2015 the American News (Aberdeen, S.D.)

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