North Carolina EMS workers are playing a major role in increasing the supply of donated corneas available for sight-restoring transplants. Over the past two years, referrals from EMS agencies throughout the state to The North Carolina Eye Bank may have helped restore sight to several hundred people, says Jarrett Nykamp, former director of EMS for North Hampton County, N.C., and now the development specialist for The North Carolina Eye Bank, the state’s designated eye tissue recovery organization.
Typically, there is little EMTs and paramedics can do to make sure fatally injured or terminally ill patients are able to donate organs, other than remembering to retrieve their wallets so hospital staff can quickly and easily determine donor status by looking for a special designation on their driver’s licenses. But when it comes to corneas, EMS workers are uniquely positioned to make referrals, Nykamp says. While organ donors generally have to be relatively young and disease-free and be placed on a ventilator and declared brain-dead, corneas from donors who are up to age 75, who have been dead for up to 24 hours and who have died from one of many disparate causes, even cancer, may be transplantable. In addition, while federal law says that organs have to be recovered at a hospital, corneas can be recovered at a funeral home or hospice, Nykamp adds.
Two years ago, Nykamp, with the help of Greg Mears, M.D., North Carolina’s EMS medical director, spearheaded an EMS/eye bank donor referral program. When EMS responds to a call and the responders determine the patient is unable to be revived, they call the Eye Bank’s toll-free, 24-hour hotline and answer a few basic questions about the patient. (HIPAA laws permit EMS and other medical and public safety professionals to release information to organ procurement organizations and eye banks without patient consent, Nykamp says.) From there, Eye Bank staff search state donor databases to determine if the patient is a donor and dispatch a surgical recovery team to recover the corneas. “For EMS, the whole referral process takes about five minutes,” Nykamp says. “We handle everything else. We have trained professionals who determine if the person is a donor and talk with the family. Paramedics are not expected to facilitate the ‘donation conversation.’”
In North Carolina last year, there were nearly 9,000 calls in which the person died before he or she could be taken to the hospital and was not transported by EMS; about 60 percent of residents in the state have designated themselves donors on their driver’s license. Prior to the referral program, all of those corneas would have gone to waste.
Now, some 52 EMS agencies statewide are actively referring to the Eye Bank, Nykamp says. Last year, EMS workers made several hundred referrals, resulting in more than 100 transplants. “The whole point of the EMS referral program is to honor the wishes of donors and to help restore the gift of sight to people who need corneas,” he says.
While Eye Bank referrals are not yet mandatory, the State EMS Office has made the cornea referral protocol an “optional approved policy,” making it easy for other EMS agencies to implement it rather than have to write their own procedure.
Each year, there are about 50,000 corneal transplants in the United States, according to the Eye Bank, but there are not enough corneas to meet demand. In addition to restoring sight, corneas can be used for people with corneal scarring due to infection, eye injuries or prior eye surgeries, or to prevent blindness in people who have inherited corneal disease. Donated eye tissue such as the sclera, or outer shell of the eye, can also be used to make prosthetics, while even corneas not suitable for transplantation can be donated to research. Last year, The North Carolina Eye Bank was responsible for more than 3,500 corneal transplants and received 5,000 donations.
To learn more about The North Carolina Eye Bank, visit nceyebank.org. To read the North Carolina cornea referral protocol, click here. For more on starting a referral program in your state, contact Nykamp at jnykamp@nceyebank.org.
Want to know just how well the ED where you’re leaving your patients is performing? For the first time, HealthGrades, an independent health care ratings organization, has compared the mortality rates of ED patients in nearly 5,000 hospitals nationwide.
HealthGrades researchers examined more than 5 million Medicare records from patients entering EDs between 2006 and 2008. Researchers then analyzed the risk-adjusted mortality rates for 11 of the most common life-threatening conditions that bring people to EDs.
The 255 best-performing hospitals, or the top 5 percent, had a 39 percent lower risk-adjusted mortality rate than other hospitals. “Half of hospital admissions now begin with hospital emergency departments, up from 36 percent in 1996,” says Rick May, M.D., HealthGrades’ vice president and a co-author of the study. “With more individuals expected to visit emergency departments, this HealthGrades study should prove to be a valuable resource … in that it identifies hospitals that are the nation’s quality leaders in emergency medical care.”
If all hospitals performed as well as the top 5 percent, an estimated 118,000 lives could have been saved during the research period, the study found.
About 119 million people visit EDs annually even as the number of EDs has been decreasing, according to the Centers for Disease Control and Prevention. The HealthGrades analysis found that the quality of emergency medical care varies widely according to hospital and state. Mississippi, Alabama and Hawaii had the highest mortality rates; Ohio, Arizona and Michigan had the lowest. More than half of the hospitals in the top 5 percent were in five states: California, Florida, Illinois, Michigan and Ohio.
The conditions included in the analysis included bowel obstruction, chronic obstructive pulmonary disease (COPD), diabetic acidosis and coma, gastrointestinal bleed, heart attack, pancreatitis, pneumonia, pulmonary embolism, respiratory failure, sepsis and stroke. The most common causes for admission through the ED by Medicare patients over the three years studied were pneumonia, COPD and sepsis. The highest in-hospital mortality rates were among patients with a primary diagnosis of sepsis, respiratory failure or heart attack.
To view the entire report, click here.
EMS providers in North Carolina will soon have $2.15 million in grants available to purchase 12-lead electrocardiograms (ECGs) and capnography equipment. The grants should make it possible for all in-service ambulances in the state to be equipped with the technology, according to the North Carolina Department of Health and Human Services. About one-third of North Carolina’s 1,000 ambulances don’t have capnography equipment, which monitors carbon dioxide in a patient’s breath and helps determine how well he or she is breathing. One-fourth don’t have 12-lead ECGs that monitor the heart and identify who is having a STEMI. Together, the equipment can help determine if the patient should be taken to hospitals specializing in heart, stroke, trauma or intensive care services.
The grant, awarded to the state Department of Health and Human Services by the Duke Endowment on June 29, could provide funding for as many as 282 ECGs and 350 capnography devices.
EMS services in North Carolina provide emergency care to about 7,500 people who are in cardiac arrest and another 100,000 who have serious conditions that could develop into cardiac arrest or require aggressive treatment and monitoring. Across the state’s county-based EMS systems, cardiac arrest survival rates vary from as low as 5 percent to as high as 40 percent. The national average survival rate for an out-of-hospital cardiac arrest is less than 7 percent, according to the state Department of Health and Human Services.
The funds will be made available through the North Carolina Office of Emergency Medical Services (OEMS). Drexdal Pratt, chief of North Carolina OEMS, says there will be an application process for those in need of the equipment.
Life EMS in Kalamazoo, Mich., is one of the first EMS agencies in the nation to operate from a LEED-certified building. LEED, or the Leadership in Energy & Environmental Design, is a certification process developed by the U.S. Green Building Council.
At 18,000-plus square feet, Life EMS’ new $2.2 million building is triple the size of the original building and features renovated office space, state-of-the-art vehicle maintenance bays and education/training areas. The new design is focused on enhancing workflow and streamlining processes, Life EMS officials say. Its “green” designation comes in part from the fact that the original structure was modified and added on to, as opposed to being completely demolished. Motion-activated LED interior lights; an energy-efficient white reflective roof; and the use of recycled demolition materials also contribute to the designation.
Conducting training online, instead of in the classroom, can yield substantial savings for fire and EMS organizations, researchers say—and it holds other significant benefits as well. In a survey of approximately 400 fire and EMS agencies, respondents reported reductions in overtime costs (81 percent of agencies), instructor costs (52 percent) and fuel/vehicle costs (47 percent).
The survey, conducted by Best Practices partner RFG Research, which specializes in tracking trends in public health and emergency services, noted additional benefits in administrative/operational efficiency, including greater convenience in training times (87 percent of agencies), easier distribution of training materials (76 percent), easier record keeping (66 percent) and simplified scheduling of training (65 percent).
The survey measured benefits reported by agencies using 16 different online learning vendors.
“Online learning has seen increased use among fire departments and EMS systems over the past few years, but until recently, little has been known about the benefits that emergency services are experiencing from it,” the researchers report. “The survey results suggest that a significant majority of agencies using online learning are achieving both financial and administrative benefits from doing so.”
To download a copy of the report, click here.
