Maine EMS Week by Bangor Daily News

Maine Emergency Medical Services Week 2013 • May 17, 2013

Maine Emergency Medical Services Maine Emergency Medical Services

Director: Jay Bradshaw Medical Director: Matt Sholl, MD Address: 152 State House Station, Augusta, ME 04333-0152 Phone: 626-3860 • Fax: 287-6251 Email: MEMS@maine.gov

Region 1: Southern Maine EMS

Region 4: Atlantic Partners EMS

Region 2: Tri County EMS

Region 5: Aroostook EMS

Region 3: Atlantic Partners EMS

Region 6: Mid-Coast EMS

Medical Director: Kate Zimmerman, DO Coordinator: Marc Minkler Address: 176 Narragansett Street, Gorham, ME 04038 Phone: 741-2790 • Fax: 741-2158 Online: www.smems.org • Email: smems@smems.org Medical Director: Rebecca Chagrasulis MD Coordinator: Joanne LeBrun Address: 300 Main Street, Lewiston, ME 04240 Phone: 795-2880 • Fax: 795-2883 Online: www.tricountyems.org • Email: info@tricountyems.org Medical Director: Timothy Pieh MD Coordinator: Rick Petrie Address: 71 Halifax Street, Winslow, ME 04901 Phone: 877-0936 • Fax: 872-2753 Online: www.apems.org • Email: office@apems.org

Emergency Medical Services Then and Now

Medical Director: Jonathan Busko MD Coordinator: Rick Petrie Address: 354 Hogan Road, Bangor, ME 04401 Phone: 974-4880 • Fax: 974-4879 Online: www.apems.org • Email: office@apems.org Medical Director: Peter Goth MD Coordinator: Steven D. Corbin, EMT-B Address: 111 High Street, Caribou, ME 04736 Phone and Fax: 492-1624 Online: www.reg5ems.org • Email: arems@maine.rr.com Medical Director: Whitney Randolph DO Coordinator: Rick Petrie Address: 123 John Street, Suite 1, Camden, ME 04843 Phone: 785-5000 • Fax: 785-5002 Online: www.apems.org • Email: office@apems.org

BDN File photo by Diana Graettinger

Today, in Maine, we have Paramedics who can interpret 12-lead cardiac monitors (or EKGs) and activate hospital heart centers; administer medications to change cardiac rhythms and reduce the load on the heart, and medications to reverse a drug overdose or anaphylactic shock. Maine EMS has an organized trauma system; air medical transport; pediatric and neonatal intensive care units. It hasn’t always been so. Emergency Medical Services has come a long way, considering it didn’t even exist until about 40 years ago. In the 1970s, in Maine and elsewhere, there were no consistent training or testing standards for emergency care of the ill or injured before reaching the hospital. The National Registry of Emergency Medical Technicians describes those days as, “… an abysmal state of affairs ... The patient was being twice victimized: once by the injury or illness and once by failing to receive competent emergency medical care.” “What was once little more than a horizontal taxi service is now an Emergency Department on wheels”, says Kevin McGinnis, a longtime paramedic who is now Chief of North East Mobile Health Services, and former director of Maine EMS (1986-1996). As Central Maine Medical Center trauma surgeon Dr. Larry Hopperstead describes it, “In the old days a person would maybe be bandaged, put on a stretcher, and transported to the hospital, with no intervening care.” Now, with basic EMT training, a person can control bleeding, apply a splint, administer oxygen and assist in childbirth, says Rick Petrie, Paramedic and Executive Director of Atlantic Partners EMS. Basic EMTs can also use a defibrillator to re-start a heart that has stopped beating, administer an Epi-Pen to avert potentially life-threatening allergic reactions, and save lives SUCCEED PAGE 3 This material contained in this section was produced for Maine EMS by Nancy McGinnis, a freelance writer and photographer who has also been a member of the Maine EMS community for 25 years. Learn more at communicado.us Production of this publication was by the Bangor Daily News and its staff. LAYOUT: Debra Bell | AD SALES: Linda Hayes, Sam Hoad, and Heidi Martin | COVER: John Koladish

Maine Emergency Medical Services Week 2013 • May 17, 2013

SUCCEED FROM PAGE 2 by activating the trauma system or the code stroke program as necessary. “Trained paramedics can do IV’s, medications, intubations, EKG’s, chest tubes,” Hopperstead said. “When it’s needed, we can provide air medical transport to a specific hospital relative to patient’s specific, acute, time-sensitive needs.” In addition to the establishment of national and state standards for certification and licensure, the emphasis has shifted from mere transport to definitive prehospital care: treatment at the scene and en route that makes all the difference to the outcome. Over the past two decades especially, there has been tremendous progress in a collaborative, statewide mission to develop a strategic and system-wide approach. In 1992, Maine EMS succeeded in obtaining a federal planning trauma grant, and set out to create a forward thinking system to increase the likelihood that even in a vast, rural state like Maine, no matter how remote their location, patients would receive the care they needed within the critical “golden hour” from the time of traumatic injury. “The HRSA grant was an important catalyst to getting everyone in the state together at Maine EMS to talk about organizing trauma care in Maine, and Dr. Bill Horner

and Dr. Larry Hopperstead emerged as surgical leaders in Bangor and Lewiston,” notes Dr. David Clark, of Maine Medical Center. “I was impressed that once everyone was in the same room, it was not that difficult for EMS and medical professionals to agree on the design of a system that would be appropriate for specific types of injury at

Centers: Eastern Maine Medical Center, Maine Medical Center, and Central Maine Medical Center. Dr. Kevin Kendall cites the outstanding success of the catheterization lab activation program at CMMC that has already benefited hundreds of STEMI (a common type of heart attack) patients. While Kendall was Director of

“What was once little more than a horizontal taxicab service is now an Emergency Department on wheels.” Paramedic and former Maine EMS Director Kevin McGinnis specific locations in the state,” he said. Standards were created, modeled after those of the American College of Surgeons but reflecting Maine’s unique challenges, says McGinnis. A Trauma Technical Advisory Assistance Program was established. Maine hospitals began using this voluntary self-assessment resource as a way to identify their strengths and weaknesses, in order to determine the types of patients they could help and the care they could provide. Streamlined clinical decision-making now benefits Maine patients, who are treated at Designated Trauma Hospitals, or sent to the state’s three Regional Trauma

EMS at CMMC, the hospital partnered with United Ambulance to conduct a feasibility study, in which paramedics were empowered to not only perform and transmit but also to interpret 12-lead EKG’s in the field. The Paramedics’ success rate at identifying STEMI’s was 100 percent. Beginning in July, 2005, Central Maine Heart and Vascular Institute authorized United Ambulance Service medics who diagnosed a STEMI to activate the catheterization lab en route to the hospital, thus bypassing the Emergency Department and saving critical time for the patient. Since then, many more services have joined in this initiative, and over 250 cath lab activa-

tions have taken place. Astonishingly, the “door-to-balloon time” which refers to the time from patient arrival to successful surgical remediation of the cause of the STEMI has averaged less than an hour and a half. “It’s so exciting,” says Kendall. “We were able to get a hiker who collapsed from a cardiac arrest on the Appalachian Trail transported by LifeFlight [helicopter] and into the cath lab in under 60 minutes. A fire chief who collapsed from a STEMI at the scene of a fire was in the cath lab within 20 minutes, and well enough to go home within a couple of days.” As an emergency physician at EMMC and Medical Director of Maine EMS Region 4, Dr. Jonathan Busko has been treating stroke patients in Maine since 2005. “Until 20 years ago, stroke was considered a disease with a grim prognosis and no good treatment,” he says. In the mid 1990s, the advent of thrombolytics, or clot busters. revolutionized hospital care — but not EMS. Those advancements all depended on high-tech studies including CT scans and expensive medications. “For almost a decade after the first study, while hospital care continued to evolve and improve, there was no real change in EMS care because people focused on the technique of care, not the process,” he said. RESPOND PAGE 15

In an emergency, we couldn’t ask for a better partner. An emergency can happen anywhere. Thankfully, Mainers can rely on brave EMS professionals to be on the scene and provide care that can save lives. We’re proud to call these courageous responders our colleagues. Being Maine’s only ACS Level 1 verified trauma center* means we deliver the nation’s highest standard of emergency care. It also means we’re the first place these brave men and women think of in an emergency. And for that, we’re truly honored.

www.mmc.org *American College of Surgeons Level 1 designation is the highest level of emergency care.

Maine Emergency Medical Services Week 2013 • May 17, 2013

Maine EMS Service Profile Region 1: Ogunquit Fire & Rescue The town of Ogunquit’s Fire and EMS department is staffed 24/7 by two full-time firefighter/medics: a Paramedic and an Advanced EMT. Mark O’Brien, who started out as a Junior Firefighter 31 years ago, was named Chief of the service last July. About 20 volunteers assist, and from mid-June until after Labor Day the department also has a contingent of 18-20 lifeguards. “Mike Roche, who’s a Division 1 Football referee in the off season, has done a great job for us as our lifeguard captain for 15 years now,” says O’Brien. The department maintains two ambulances as well as four wheel drive ATV vehicles for beach rescue, and just added a new Jet-ski last year. Ogunquit Fire & Rescue responds to about 650 calls a year — about 400 of them are EMS-driven, says O’Brien. The majority calls are medical to hotels and restaurants. The service also responds to vehicle accidents on a five mile portion of Interstate 95. While drownings are rare, keeping the crowds safe during the Fourth

Emergency Medical Dispatch

The first of the first responders

Enthusiastic lifeguards gathered for a photo op on the beach last summer with Laura Rose (center), her sons (l to r) Alexander, Kevin, and Nicholas Lumenello, and dad Chris Lumenello. The rescue Jet Ski was presented by the family to the Ogunquit Lifeguard Service, thanks to donations raised at Christian’s Lifeguard Dash. The 5K race/walk on the beach has become a yearly tradition to celebrate the life of Christian Lumenello (19942010); and to raise funds for the Lifeguard Service. Learn more at christianslifeguarddash.com

of July fireworks is an annual challenge. 70 percent of all Ogunquit calls occur between June and September, when the population of this 4.5-square-mile town skyrockets from 1,200 to 40,000 with summer residents and tourists.

Stroke Strikes Fast. You should, too — Call 9-1-1. Advanced stroke care. Right here in the Kennebec Valley. Stroke is a brain attack, cutting off vital blood flow and oxygen to the brain. It is the third-leading cause of death in the United States.

Act F.A.S.T.

MaineGeneral has launched the Massachusetts General Hospital TeleStroke program to provide advanced stroke care to our communities.

Face

Look for an uneven smile.

Arms

Check if one arm is weak.

Speech

Listen for slurred speech.

Time

Photo by Nancy McGInnis

Emergency Medical Dispatcher and volunteer firefighter John Thibodeau and his colleagues at the Sagadahoc Communications Center are some of the voices on the other end of the 9-1-1 line.

The average person dials 9-1-1 for medical help once in a lifetime,according to national statistics. But at the other end of the phone line, Emergency Medical Dispatchers may be responding to those calls dozens of times in one shift. “Most people have no idea what happens at the other end when you call 9-1-1,” says Paramedic Drexell White, EMD Program Manager for Maine Emergency Medical Services. “When you need help, seconds can seem like minutes, and minutes like hours.” In Maine, some 700,000 to 800,000 calls are placed annually; more than 110,000 of those calls are for medical emergencies. When EMD receives a 9-1-1 call, White says, a proprietary software system called Priority Medical Dispatch is used to ensure accuracy. DISPATCH PAGE 5

Thank you to the men and women of Capital Ambulance for the outstanding service they provide to the residents of eastern and northern Maine.

Call 911 right away.

Augusta Campus, 207.626.1000 Thayer Campus, 207.872.1000

If you have questions about MaineGeneral’s services, call toll-free 1-855-4MGH-INFO

Emergency Medical ServicesWeek 2013 AFFILIATED HEALTHCARE SYSTEMS

Calling 9-1-1 If you call 9-1-1 for a medical emergency, keep in mind that: 1. The dispatcher is doing everything possible to provide services and get help. 2. The information that you will be asked to provide is needed to help both the patient and the responders. 3. Emergency Medical Dispatchers strive to consistently give all callers excellent service, whatever the reason for the call.

Maine Emergency Medical Services Week 2013 • May 17, 2013

DISPATCH

FROM PAGE 4

“Specific questions are asked in a specific order,” he said. “The goal is to get the right EMS response to the correct place in the appropriate time frame, according to the emergency.” At every one of Maine’s 26 Public Safety Answering Points, or 9-1-1 centers, each

tion is lost. The call may be coming from a hazardous scene such a fire or flood, or the caller may be a victim of domestic violence, a shooting or terrorist act with limited communication options. If the call for help is coming from a cell phone a dropped connection due to lost cell reception could be disastrous. After the location of the emergency

“You can help us to help you, when you call 9-1-1. Answer the questions as they are asked. The protocols we use are established and tested. Know that we are not delaying, just getting the most appropriate help to the scene, in the shortest possible time.” Laura Downing, EMD, Sagadahoc Communications Center of Maine EMS’ 488 licensed dispatchers uses the same protocols to process a call for medical assistance, explains White. For every call, Emergency Medical Dispatchers are trained to follow a specific script that is being generated by the caller’s information as it is received and entered into the computer data system. The software, originally devised by a physician 30 years ago, is now used in 15 languages and 37 countries. In addition, it is continually updated and revised to reflect best medical practice and to maximize successful communication and comprehension under stressful conditions. Last year, White notes, 63 million calls for medical assistance were processed globally using the same protocols as are employed in Maine. It may come as a surprise to learn that the very first question is not “what’s the nature of the emergency?” — but rather, “what is your location?” It is critical to know this — and to repeat the question or cross-verify the answer via caller ID or GPS — in case the connec-

is determined, the next concern is the reason for the call. Some responses, such as “trouble breathing,” will trigger an immediate dispatch of emergency medical services personnel to the scene. The caller may not even realize this, because the information is being recorded and shared with others as it is received. The dispatcher who answered the call may stay on the line to obtain more information and offer further instructions — while a second dispatcher is using the preliminary information to radio dispatch EMS to the scene. For other scenarios, the dispatcher will methodically and efficiently ask more questions to help provide the best response before dispatching assistance. “All of this typically takes place within the space of a minute and a half,” he said. While not acting as a diagnostician, by following the EMD protocol the dispatcher can identify the priority of the need and the appropriate response. In communicating with the caller, EMD’s can often do much to EMD PAGE 12

Maine EMS Service Profile Region 2: Med-Care Ambulance “In it for life” is the tagline of Med-Care Ambulance, providing emergency medical response to the towns of Andover, Byron, Canton Dixfield, Hanover, Mexico, Newry, Peru, Roxbury, and Rumford in Oxford County, as well as to the town of Carthage in Franklin County. Chief Dean Milligan, Paramedic says that Med-Care’s service area covers 550 square miles, with a mostly rural population of about 17,000. Three of their six ambulances are staffed daily and the service is licensed at the Intermediate level, permitted to Paramedic. “Our policy is to staff two Paramedic level ambulances everyday,” says Milligan, who oversees 65 employees, about 15 of them full time. Covering Maine’s western mountains

region, Med-Care responds to hiking and other outdoor mishaps, logging accidents, and occasional paper mill industrial injuries as well. Annual call volume averages 4,000 and is divided about equally between emergencies and transfers. “For the past seven months, we’ve been working on building a new ambulance facility in the center of our service area, at 290 Highland Terrace in Mexico,” says Milligan, who started his EMS career in 1989. He and his Assistant Chief Chris Moretto, also a Paramedic, are looking forward to welcoming the entire community next month to an open house celebration, with tours, speakers and refreshments.

Med-Care Ambulance will be welcoming the entire community next month to an open house celebration with tours, speakers, and refreshments.

Maine Emergency Medical Services Week 2013 • May 17, 2013

Maine EMS Service Profile Region 3: Mt. Vernon Rescue Pat Rawson, Chief of Mt. Vernon Rescue, has been with the service since its inception 33 years ago. She and June Leighton are the remaining members of the founding five. The squad has 12 active members, all Basic EMT’s. “We’re all volunteers, with a range of ages, experience and professional backgrounds,” says Rawson, a grandmother and retired educator at Maranacook Middle School. “Mt. Vernon is a separate entity with our own vehicle and station, under the Fire Department’s umbrella.” Four of her EMT’s also happen to be firefighters. Two people are on call whenever possible, covering 12 hour shifts from 6 a.m.-6 p.m. Her crew responds to calls such as car accidents, falls, chest pain, and difficulty breathing. With 20 area lakes and ponds, their service area of Mt. Vernon and Vienna plus camp roads and a section of Fayette off Sandy River Road encounters a dramatic

seasonal population increase. The EMT’s sometimes respond in their own vehicles, and whoever is closest to the station will get the rescue truck. Their mission is to use their basic EMT skills to care for and treat patients at the scene, while waiting for Winthrop Ambulance covering Mt. Vernon, or North Star covering Vienna, to arrive. “We strive to provide continuance of care, rather than just handing over the patient,” saws Rawson. Keeping volunteer numbers sustainable is an ongoing challenge. Volunteering takes a commitment of time, motivation, training, and skills practice to remain current. Mt. Vernon recently sponsored a new EMT class and will sponsor a summer class for first responders who will be paired with EMT’s to respond to Mt. Vernon Rescue calls, beginning in June. Contact Kelly Roderick, Atlantic Partners EMS to learn more: 877-0936.

A day in the life

What it takes to become an EMT

No question, doing what it takes to become an EMT is challenging, and to be a Paramedic, even more so. But across the state, men and women of all ages are rising to the challenge. Some are pursuing their studies through community-based courses and local continuing education, while others are enrolled in college degree programs. At 55 years of age Jeff Toorish is one of the latter, a nontraditional student and the oldest in his paramedic class at Southern Maine Community College. An avid adventurer and a successful business entrepreneur with a communications background and a bachelor’s degree in theater, Toorish admits he never intended to study science or medicine. But a near-disaster during a Yucatan cave exploring expedition propelled him to acquire skills beyond the now-rusty basic first aid training he received in the Navy. At first Toorish was surprised at the in-

“Ready When You Least Expect It”

Photo courtesy Jon Ljunggren

The basic EMT’’s of Mt. Vernon Rescue are a dedicated group. Standing (from left): Joe Lemieux, 5 years; Susan Lemieux, 7 years; Tony Dunn, 10 years; Pat Rawson, 33 years; Laura Reville, 14 years; and Michelle Pelton, 20 years. Seated (from left): Janet McIver, 1 year; Leslie Grenier, 31 years; Amanda Mills, 7 years; and June Leighton, 33 years. Missing: Roger Scott, 5 years; Becky Kent, 2 years.

Southern Maine Medical Center’s medical and emergency response team trains regularly with emergency response personnel throughout York County to ensure emergency preparedness. Training exercises often include practicing decontamination of patients exposed to chemical, biological, radiological nuclear, or explosive hazards. Hospital staff must wear advanced personal protective clothing and treat patients using nontraditional measures.

For what you do everyday. We value your partnership.

Our community. Our health. midcoasthealth.com

tensity of both the coursework and the pace, but he also found EMS “utterly captivating.” Seeking “ride along” experience as part of his EMT education, Toorish joined North Yarmouth Fire and Rescue, and then Yarmouth Fire and Rescue, attracted by their dive team. By the time Toorish was hired by Old Orchard Beach as a per diem EMT, he was hooked… and he knew he wanted to go beyond the basics and become a Paramedic. Toorish describes the transition from basic first aid to Basic EMT is comparable to the leap from riding a bike to driving a car. “But from Basic to Paramedic — that’s like learning to fly a plane,” he said. Beyond medical knowledge requirements, there are leadership considerations, he says. Every student will one day be in charge, in the back of that ambulance. His advice to would-be EMT students?

continued on next page

Maine Emergency Medical Services Week 2013 • May 17, 2013

Prepare to be focused and on your game all the time, and don't be surprised if, at least while you're in school, get-togethers with family and friends, and holiday celebrations tend to fall by the wayside. But through hands on practice, critical thinking exercises

Fallon previously acquired a familiarity with medical billing and coding by earning her Certificate in Medical Administrative Assistance. To finish up her course requirements, Fallon was taking a two-and-a-half-hour

“Everyone can become an EMT if you have the ambition.” sarah jean fallon and collaboration, you and your EMS student colleagues develop a close-knit bond. At the opposite end of the spectrum, in terms of age and gender, is 20-year-old Sarah Jean Fallon, who also took a few minutes from her busy schedule to share her perspective earlier this spring. Fallon was juggling her Eastern Maine Community College studies with a two to three days per week work-study position at Atlantic Partners EMS. “Everyone can become an EMT if you have the ambition,” Fallon said. “I knew it was what I wanted, because I found it fast paced in every respect, even the work-study part.”

night class that met two evenings a week, as well as all day Saturday once a month, in addition to two required non-EMS electives. She was grateful that the nature of her work study position afforded her some flexible access to equipment for hands-on practice, but she still had to find additional time for 15 hours of studying every week — not including homework. Fallon admits she thrives in an environment where there always seems to be something to be done, and always a way to get involved and be helpful. “I’m a pharmacy technician in Milford, and hopefully I’ll be able to volunteer for

Maine EMS Service Profile Region 4: Mayo Hospital EMS Mayo Regional Ambulance is one of a handful of hospital-based EMS services in Maine, says Mayo EMS Director Eric Young, Paramedic. “We run 24/7 with a staff of about 60, including full time and per diem employees,” he adds. There are six “trucks” (or ambulances) in service, with crews responding from three bases: in Dover-Foxcroft, where the hospital is located, in Dexter, and in Corinth’s Fire Department. “We’re the seventh or eighth busiest service in the state,” Young said. Covering 800 square miles in the center of Maine, Mayo EMS responds to 4,500 calls a year, including transfers and

emergencies. “A portion of the Appalachian Trail is in our service area,” Young explains, “Most of our medics are trained in wilderness rescue. Mayo EMS also provides [Advanced Life Support] back-up for surrounding services. Young is justifiably proud of the Piscataquis County Crisis Intervention Team and the distinction his service has earned as the first rural program to offer a rigorous weeklong annual crisis training. The training has been held for eight years, in collaboration with local hospitals and mental health facilities, police and corrections departments, and the sheriff ’s office.

“Most of our medics are trained in wilderness rescue. Mayo EMS also provides [Advanced Life Support] back-up for surrounding services.”

Age is just a number Photo by Nancy McGinnis

Flanked by Liberty Ambulance Asst. Chief Kathy Foley (L) and driver Peter Maruhnic, Edna Mitchell, center, is delighted to hold the honor of being Maine’s oldest practicing EMT. Mitchell, who will celebrate her 85th birthday next week, says her interest dates back to her youth, during World War II. Her parents had signed up for a community first aid class, and the local game warden who was teaching it said he didn't mind if she tagged along. Read more of her story on page 12.

We’re Proud and Ready to be a Part of the Team... We

t St. Joseph Hospital’s Emergency Department, we salute our region’s Emergency Medical Technicians. We would like to say “Thank you” for your hard w work, dedication and extraordinary service to our patients and our communities.

And Prepared for Life’s Little Emergencies, Too... In most non life-threatening cases, all patients are greeted promptly in our Emergency Department. Nurses and providers work quickly to evaluate the needs of each patient. In most instances the initial evaluation is within twenty n minutes. Our goal is to provide quality, efficient and comfortable care. Jamie Perry BSN, CEN Director Charles F. Pattavina MD, FACEP Medical Director

mayo EMS director Eric Young, EMT-P

zero to hero Maine’s largest and most innovative EMS provider proudly offers

How can YOU help, before help arrives? Want to go from ‘ zero’ prepared to ‘hero’ prepared? No one plans to be in an emergency-- but everyone should be ready to handle one!

Whether it’s a mass disaster... or a single person in distress-our jumpstart class can empower you to make a difference. Bring your skills up to speed! Earn your AHA First Aid card in our 3.5 hour class, geared for the general public. Space is limited, $25 fee, day or evening sessions throughout central, southern & midcoast Maine.

Your Doctors l Your Technology l Your Choice St. Joseph Healthcare St. Joseph Hospital

In the Spirit of Healing Sponsored by Covenant Health Systems Founded by the Felician Sisters

360 Broadway l Bangor, Maine l www.stjoeshealing.org

(207) 510-0073 www.MobileHealthMedics.pro

Maine Emergency Medical Services Week 2013 • May 17, 2013

You are invited to the Maine EMS Celebration Join EMS professionals, their families and friends, and the public on May 18 By Nancy McInnis

THE MAINE EMS MEMORIAL AND EDUCATION CENTER SITE:

EMS personnel from across the state, their families and friends, and the general public are all cordially invited to join Maine EMS on Saturday morning, May 18 on the capitol grounds in Augusta. This first-ever celebration in observance of National EMS Week will take place on the site of the groundbreaking for the EMS Memorial and Education Center, between the Police and Firefighter Memorials adjacent to State Street. The program, beginning at 9:30 a.m., will feature a celebration of the Maine EMS Memorial and Education project, the Maine EMS Board's annual statewide awards presentation, and the kickoff of the National EMS Memorial Bike Ride.

Remembering each sacrifice; honoring every contribution dedicated to those who have built the system; to those who gave their lives, saving others; and to those who make the system work every day. The Memorial, located on the Capitol grounds in Augusta, is flanked by the existing fire and law enforcement memorials near the State House. Not a traditional memorial, it has been uniquely designed as a visually striking, contemplative space around an illuminated glass “Star of Life’ panel, a number of granite columns, and a remarkable audio component. Visitors can hear representatives of Maine EMS describe in their own

words and voices the system and how it was founded. Loved ones and colleagues recall those EMS providers whose lives have been lost in the line of duty. All will be lit for night display. While the Memorial pays tribute to those who have sacrificed their lives during EMS duty, it also recognizes those who serve EMS patients every day throughout Maine, and those who have helped build the statewide system. Using a cell phone, visitors can listen to interesting and moving stories on the audio tour. This innovative audio component was created to give the Memorial a meaningful public education role as well. With Phase 1 of the site to be completed this summer, support is being actively

solicited for Phase 2, which will commence when funding is in place. Donations for this non-profit project are welcomed in any amount. Individuals, businesses, groups and organizations are encouraged to support this 100% privately funded project. Gifts can be made in honor or in memory of loved ones or colleagues. To learn more, follow the link at www. apems.org or find the Maine EMS Memorial on Facebook.

Make a donation Donations, payable to Maine EMS Memorial/APEMS, may be sent to: Atlantic Partners EMS 71 Halifax Street Winslow, ME 04901

About the Memorial The Maine EMS Memorial Site is envisioned to recognize the sacrifices of EMS professionals who have lost their lives in the line of duty, to honor EMS leaders who have helped build Maine’s EMS system, and to inform you about that system and those who make it successful every day. Because this memorial is made possible entirely thanks to donations, it is being established in two phases, as funding allows. During your visit, you will find both visual and audio features. When the second phase is completed, there will be an additional glass panel depicting the Maine EMS system, more benches, landscaping, and illuminated granite posts for each person honored and each EMS role described in the Audio Tour.

Richardson and Associates drawing

AUDIO TOUR To listen to the voices of Maine EMS, call (207) 480-3104. You may select any story at any time. Just press the number of the story on your keypad. 1 Welcome! 2 The “Star of Life”: EMS’ Symbol 3 The Story of the Memorial 4 A Two Part Building Project: Help us With Part 2! 5 For Those Who Have Given Their Lives

6 Richard Farrar, Paramedic, 1/30/92 7 Matt Jeton, Flight Paramedic, 11/19/93 8 Donald MacIntyre, Flight Nurse, 11/19/93 9 Robert Washington, Paramedic, 1/27/96 10 Don Martin, Paramedic, 8/3/98 11 Alan Parsons, Paramedic, 7/5/07 12 Peter Carbonneau, Paramedic, 4/8/12 13 For Those Who Helped Build the System 14 Dr. Alan Hume 15 Dr. Larry Hopperstead 16 Dr. Robert Tredwell 17 For Those Who Make the Maine EMS System Successful Every Day

18 Volunteer EMS Responder (Wayne Seeley; Dennysville) 19 EMT (Randy Bossie, Patten) 20 Paramedic (David Buccello; Southwest Harbor) 21 Emergency Physician/ EMS Medical Director (Dr. Rebecca Chagrasulis; Norway) 22 Trauma Surgeon (Dr. David Burke; Bangor) 23 Interventional Cardiologist (Dr. Mirle “Bud” Kellett; Portland) 24 Trauma Nurse (Tammy LaChance; Portland)

25 Emergency Nurse (Carmen Hetherington; Lewiston) 26 Emergency Medical Dispatcher (Jennifer Rairdon; Houlton) 27 Flight Nurse/Flight Paramedic (Lori Metayer; Lewiston) 28 Community Paramedic (Adam Michaud; Presque Isle) 29 Regional EMS Director (Joanne LeBrun; Lewiston) 30 State EMS Director (Jay Bradshaw; Augusta)

Maine Emergency Medical Services Week 2013 • May 17, 2013

Emergency Medical Services: In their own words... Dr. David Burke, Trauma Medical Director, Eastern Maine Medical Center “One person doing this doesn’t work.”

Photo by Rob Rosenthal

Carmen Hetherington, Registered Nurse and Clinical Educator at CMMC “Because emergency medical practices are dynamic and changing on a daily basis, education is essential for EMS personnel.”

Tammy Lachance, Trauma Program Manager at Maine Medical Center “Emergency nursing tends to attract people who like variety and chaos. It also has to be somebody who’s physically and emotionally tough and doesn’t mind blood and guts.”

Photo by Rob Rosenthal

Mary Jeton, mother of Maine EMS professional Matthew Jeton

Photo by Rob Rosenthal

Mother of the late Matthew Jeton, shares her thoughts on the Maine EMS Memorial audio tour. Air medical transport was relatively new to Maine when her 25 year old son lost his life in the Casco Bay crash of an Airmed Skycare helicopter on November 19, 1993. Jeton, of Portland, was a Paramedic with United Ambulance of Lewiston as well as for Airmed. Flight Nurse Donald MacIntyre of Concord, NH also died in the crash, that occurred while they were transporting an elderly burn victim from Ellsworth to Portland. Rick Petrie, a fellow Paramedic at United at the time, organized the memorial service for these first line of duty deaths in Maine EMS history. “Matt and Don will be with us always, urging us to learn and grow and improve,” said Kevin McGinnis, then director of Maine Emergency Medical Services. Petrie and McGinnis have worked tirelessly for almost a decade now, leading a dedicated volunteer committee toward making their vision of a EMS Memorial and Education Center a reality.

Dr. Larry Hopperstead, Central Maine Medical Center trauma surgeon “In years of performing trauma surgery at CMMC, I’ve saved hundreds, perhaps thousands of lives. But what I think is even more important is my role in helping to build a system. One that can be reliably counted on to make decisions about where you need to go, how you need to get there, and what needs to be done in the time frame before you can get there” Photo by Rob Rosenthal

Maine Emergency Medical Services Week 2013 • May 17, 2013

Maine EMS Service Profile Region 5: Caribou Fire and Ambulance Located in the northern most section of Maine, in Aroostook County’s year-round outdoor recreation hub, Caribou Fire and Ambulance relies on snow sleds, five ambulances and two fixed-wing aircraft operated in collaboration with Cary Medical Center. Fire Chief, Service Director, and Paramedic Scott Susi oversees three crews of four, working 24 hours on and 48 off. His crews, which include Paramedic InterFacility Transport Paramedics, cover eight communities in a 348-square-mile area. Each year they respond to about 2,300 ambulance calls. “With all-season trail systems running from here to Cross Lake, and the sum-

The Emergency Department

What to know and when to go

mer influx to Madawaska Lake, we cover everything from snowmobile to fourwheeler to summer boating accidents,” says Susi. In addition to outdoor sports, the Caribou area’s forestry activity occasionally brings rescue calls for logging accidents, skidder injuries and falls on job lots, and even extricating folks who have become trapped under fallen trees. “We can bring patients in on one of our ambulances and fly them out on a plane, taking off from Presque Isle or Caribou,” says Susi. His service also holds the northern region contract serving transfers for veterans residing from Millinocket to the Canadian border.

“With all-season trail systems running from here to Cross Lake, and the summer influx to Madawaska Lake, we

Photo by Nancy McGinnis

In the MaineGeneral Emergency Department in Augusta, (from left) registered nurse Nancy Jackson and physicians Tim Pieh and Tom Liscord discuss a patient’s care.

cover everything from snowmobile to four wheeler to summer boating accidents.” Fire Chief and Service Director Scott Susi, Paramedic

No one enjoys a trip to the hospital emergency department, but most people are grateful this resource exists for, well, emergencies. Emergency departments are never closed, and no one in need of care is turned away. The MaineGeneral Medical Center Emergency Departments in Augusta and Waterville receive a total of 63,000 visits a year. But is the emergency department the best place to go? And are there things to know ahead of time, to make the experience as successful as possible? “It’s important to keep in mind that the priority is making sure that people who are in need of quality medical care receive it, whether it’s delivered by us or facilitated by other care options,” says Dr. Tim Pieh, who spent two years as a primary care physician

before joining the MaineGeneral Emergency Department six years ago. “Your primary care provider should be your central resource,” he continues. “When you’re not feeling well, the first phone conversation you have should be with the PCP." Even at night or over the weekend, he adds, there is a covering provider, whether a physician, nurse practitioner, or physician’s assistant. What’s behind this advice? It assures continuity of care, Pieh said, something that is more difficult to achieve when a patient is seen for the first time by the attending physician who happens to be covering the ED. Instead, the primary care provider, who already has an established relationship EMERGENCY DEPARTMENT

PAGE 11

Maine Emergency Medical Services Week 2013 • May 17, 2013

EMERGENCY DEPARTMENT

FROM PAGE 10

with the patient and knows their medical history and prescriptions will make arrangements to see a patient in need, even outside of office hours. Some PCPs schedule regular acute visit hours, when patients can walk in and be seen with little or no waiting time. If it is determined there is a critical need for care, the office can call 9-1-1 on the patient’s behalf, and fax a medication list, office notes, and other information directly to the ED. “Before you need it, now is the time to find out what care options are available through your primary care provider,” echoes Nancy Jackson, a registered nurse at MaineGeneral for 25 years who has worked in its Emergency Department for the past 13. “The next time you see your own doctor, be sure to ask how he or she recommends you should handle an emergency.” Express Care — also known as “Urgent Care” — can sometimes be an expedient and cost effective alternative to the emergency department. MaineGeneral maintains Express Care facilities in Augusta and Waterville, open daily including weekends and holidays, for non-emergency illnesses and injuries such as cold, cough, flu, seasonal allergies, ear and urinary infections, fractures, and wounds. “Every health system in Maine has the equivalent of this,” says Dr. Barbara Crowley, a longtime area physician who is now Executive Vice President at MaineGeneral Health. Last year, MaineGeneral Health launched a new initiative to connect patients with primary care. By calling tollfree (855) 464-4463, community members can find a PCP or specialty care provider. “More than that, they can get personalized help finding a provider, a class or support group, or just answers to any questions they may have about MaineGeneral’s 1health care system,” says Jackson.

Going to the ED When it is necessary to go to an Emergency Department, remember these tips: • Bring a complete, up-to-date medication list or bring the actual medications in a paper bag. • Inform ED staff of any implanted devices or hardware, such as a pacemaker, artificial hip or surgical pins.

Biking for a Memorial During the National EMS Memorial Bike Ride last year, “Muddy Angel” Carl French, Firefighter/EMT-P with Sanford Fire is shown relaxing in Eastern PA “on a 90 degree day in the shade.” French, who is also a member of the Maine Honor Guard, will be riding for the third time this year. Over a hundred cyclists are expected to participate in the 2013 Ride, which will depart from the Maine EMS Memorial and Education Site on the state capital grounds Saturday morning. Photo by Isaac Greenlaw, Communications

• Bring a family member or trusted support person to be your advocate. In a stressful situation such as an ED visit, MaineGeneral Emergency Department’s Dr. Tim Pieh explains, the average patient only hears and retains about 10-20 percent of information presented. A support person can provide comfort and advocate for your care; and later help you understand your care instructions and treatment plan.

Pieh echoes that. “We’ve been working to get the word out that we maintain a list, updated monthly, of area practices accepting new patients,” he said. “Primary care is available on a sliding fee scale basis, so the services are based on need, not ability to pay.” Other Maine hospitals offer similar assistance. Maine Medical Center, for example, has created a user-friendly website, findadoc.mmc.org to make it easy to search for a specialty or primary care provider, including those accepting new patients. Another valuable resource for Maine residents searching for a PCP is MAINE ED

PAGE 15

Specialist, Medcomm LLC, Bangor Maine. Firefighter/EMT with Glenburn Public Safety

Maine Emergency Medical Services Week 2013 • May 17, 2013

Maine EMS Service Profile Region 6: Liberty Ambulance Liberty Ambulance is a private, nonprofit service covering the towns of Liberty and Montville, each with a population of 800 to 900, says Director Chris Birge. He is one of the service’s eight Basic EMT’s, along with two Intermediate EMT’s and one Paramedic, who respond with their one ambulance to 160-190 calls a year. It’s a small, friendly bunch, and their calls include neighbors who have suffered a fall, the occasional chain saw accident, bee stings Liberty Ambulance Basic EMT Edna Mitchell, a lifetime local resident and longtime crew member, poses with and other outdoor injuries at the DamarAsst. Chief Kathy Foley and driver Peter Maruhnic. iscotta Lake State Park, and sadly, some suicide attempts. “Half of us have been doing three Waldo County high schools. this for 10 years or more,” says Birge. “That’s the one call we don’t want to go And then there’s Edna Mitchell. A former to,” the mother of five said. Foley hopes local school teacher, she’s an active EMT to host a community CPR class and is acwho has been a member of Liberty Amtively seeking funding to purchase AED’s. bulance since 1978. Though Mitchell will “When you live in a rural area, it can celebrate her 85th birthday next week, she seem like a lifetime waiting for the amstill keeps her sneakers handy every night, with the laces loosened just in case the pager bulance,” she said. It could easily take 20 minutes or more, to traverse the service goes off. Her colleagues miss her when she area’s 40 or 50 miles of roads. and her husband spend winters in Florida. “It was a really difficult decision for me, She is warmly welcomed back every spring. to jump into the back of an ambulance,” “Edna’s such a wonderful resource — Foley confesses. After we moved here I not just as for her great skills as a medic would hear pages for Liberty Ambulance but because she knows the area and the once, then again and even a third time, on townspeople, at least those who’ve been here a while, better than anyone,” says As- my husband’s fire department radio… and I would think “what if that call were my sistant Chief Kathy Foley, who relocated family in need, and waiting? I joined Libwith her family in 2010 from Washington erty Ambulance because it seemed really state to a working farm in Montville. important for someone to come forward.” Birge and Foley have collaborated But joining the ambulance service has diligently to keep the volunteer ambulance also opened doors, she says, helping her service in compliance with state regulations, policies and guidelines, and to explore feel part of the community and allowing her to get to know wonderful people, like ways to improve, such as reducing response times. Birge credits Foley with spearheading Edna Mitchell, whom she might never have initiatives including a planned presentation, met had she stayed on the farm. “Everyone should think about volunteering — even complete with simulators, on the dangers auxiliary members can be a big help.” of distracted driving for the students in the

EMD

FROM PAGE 5

help the caller and the person in need, before the arrival of EMS. In addition to reassurance, they can provide detailed, step by step coaching so that the caller can deliver a baby, perform CPR or use an external defibrillator, or restore a choking victim’s airway. Licensed Emergency Medical Dispatchers complete a three-day course, as well as extensive orientation, job shadowing their experienced counterparts before they start answering calls. “You have to build confidence in order to

EMD will stay on the line with the caller until help arrives. If the patient is stable, before signing off the EMD will advise the caller that the ambulance is on its way. In preparation, pets should be secured, and the patient’s medications gathered; nothing should be given to the patient to eat or drink. It is helpful to turn on the porch light, and of course, to call 9-1-1 back immediately if anything changes. EMD’s are the ultimate customer service agents, White affirms, with a unique skill set. At any given moment, they must be able to communicate effectively over the

“Unlike other EMS providers, we’re obliged to trust the caller or the patient for information, relying on what they say and the tone of their voice … and when people are distraught we need to reassure them, without being able to pat their shoulder or hold their hand.” Laura Downing, EMD and EMD-Q, EMT-I, Sagadahoc County Communications Center

do this job,” says John Thibodeau, an EMD at Sagadahoc County Communications Center and a longtime volunteer firefighter. EMD’s are required to complete vigorous training and continuing education requirements to be eligible to renew their licensure. For quality assurance, their calls, which are automatically logged and recorded, are frequently sampled for review and feedback. Determinant codes — identified by using the protocols — can be used to categorize calls from “alpha” (lowest priority: perhaps a twisted ankle) to “echo” (top priority: such as respiratory difficulty, altered mental status, chest pain, and bleeding). The codes can avoid misuse of resources, such as sending an advanced life support ambulance lights and sirens to a patient with a sprained ankle. If the patient’s condition is unstable, the

phone, remain calm and courteous, follow the protocol, stay grounded and focused for the duration of the call, and simultaneously acquire and enter data while monitoring the computer screen and radio traffic. They may be using touch screens, keyboards, a phone, a headset, a radio, even a pen and paper — or all of the above. They are trained to employ techniques such as repetitive persistence to handle callers who may be understandably hysterical. “When someone is panicked and out of it you need to bring the person back down by saying, several times if need be, exactly what you need them to do and why they need to do it,” says White. There may be minutes or hours between emergencies, yet EMD’s must be alert and ready to handle a call whenever it comes in. It’s an art as well as a science to succeed in such a non-visual environment, without the advantage of eye contact or body language,” said longtime Sagadahoc Communications dispatcher Laura Downing, EMD and EMD-Q, EMT-I. Downing is also the EMD representative to the Maine EMS Board. “Unlike other EMS providers, we’re obliged to trust the caller or the patient for information, relying on what they say and the tone of their voice… and when people are distraught we need to reassure them, without being able to pat their shoulder or hold their hand,” she said.“EMD’s are the first of the first responders.”

Maine Emergency Medical Services Week 2013 • May 17, 2013

Ensuring people are “Stayin’ Alive”

Knowing the proper way to do CPR can keep your community safe “The sad truth is most people don’t survive a cardiac arrest,” stated the American Heart Association. “Four to six minutes is the window of opportunity for someone to start CPR before it’s too late, but fewer than one-third of cardiac arrest victims get CPR from someone nearby.” Bystander CPR can double, or even triple, a cardiac arrest victim’s chance of survival. It’s not just older folks who are susceptible to cardiac arrest, points out Joanne LeBrun, executive director of Tri-County EMS in Lewiston. “These days, we’ve seen young people suddenly collapse on the ball field or athletic track,” she said. That’s why taking prompt action is critical and CPR is easier than ever to learn. “Two things: if someone collapses in front of you, call 9-1-1 and immediately start chest compressions especially if the person is suffering from a particular, common kind of arrest known as ventricular fibrillation,” she said. “Your action can save a life by getting the heart, which is misfiring, back on track and pumping again in an organized fashion." Since 2008, the American Heart Association

How can you learn CPR? There are a number of widely available classes offered through the American Heart Association, the Red Cross, and local adult education programs. Training for the general public is minimal, says LeBrun, and there is no written exam. Instead, the emphasis is on practical skills. It takes just two minutes to watch the informative hands-only CPR instructional video at heart.org. In addition to demonstrating the technique, the video suggests using the tempo of the classic disco song, “Stayin’ Alive” as a guideline for the correct chest compression timing of 100 beats per minute. Knowing that without swift intervention the cardiac arrest will be fatal, what have you got to lose? Even if CPR attempts fail, Maine has a Good Samaritan law that protects citizens from liability, LeBrun advises. Another observation: when someone collapses in a public place, some would-be rescuers hesitate, thinking “there’s probably someone else more qualified than me.” But experience has shown that when one person stops to help, “others will jump in and we’ll get the job accomplished.” She also recommends attending a class in order to build confidence, since participants

photo courtesy Maine EMS

AEDs like this one can be found in public and the Maine EMS community welcomes the public to learn how to use one.

Automatic External Defibrillator, or AED. Thousands of AED’s have now been installed in Maine and everywhere — in schools, shopping malls, churches, bingo halls, airports — wherever people gather. The AED is a portable device that can be used to shock the heart back to normal rhythm. While the AED is designed to be user friendly for the untrained person — just turn it on, and follow the instructions it provides — many

“Don’t be afraid; your actions can only help. If you see an unresponsive adult who is not breathing or not breathing normally, call 911 and push hard and fast on the center of the chest.” American Heart Association, heart.org has endorsed CPR utilizing chest compressions alone, without mouth-to-mouth resuscitation. Research has found that during the first six minutes after collapse, there is enough residual oxygen remaining in the system. Because of that, restoring the heart is the focus.

receive supervised, coached practice and the opportunity to ask questions, as well. In addition, classes include mouth-to-mouth or mouth-toface-mask resuscitation, which can be helpful especially in circumstances such as drownings. Classes also provide an introduction to the

SMMC Salutes

EMS Responders Partnering to keep our communities healthy and safe. 1 Medical Center Drive, Biddeford

smmc.org

WHERE EXCELLENCE HAPPENS

people benefit from the chance to learn more in advance, and while not in the middle of an emergency situation. It’s a good idea, says Lebrun, to find out the locations of AED’s in venues where you and your family spend time; and to look into getting them if they

photo by nancy mcginnis

On behalf of North East Mobile Health Services and its staff, Division Commander Lori Rice, Paramedic (left) presents an Automatic External Defibrillator to Bette Horning, director of the Golden Oldies Senior Center. The lifesaving device will be permanently installed in the Center, where it can be employed in emergencies to restart a stopped heart. The poster in the foreground shows the NEMHS crew members and others at the Polar Dip last December, where North East employees collected on pledges by braving the frigid water — all to support this good community cause.

are not already in place. “Over and over, I’ve seen bystander CPR mean the difference between life and death,” Lebrun emphasizes. “CPR gives people who have collapsed in cardiac arrest the chance to survive to get to the hospital, receive treatment, and go home and be back to work in a matter of days. It’s really happening, right here in Maine.”

Maine Emergency Medical Services Week 2013 • May 17, 2013

Community Paramedicine

A new role for Maine Emergency Medical Services Community Paramedicine is a visionary opportunity for emergency medical services to identify other local health care partners and address unmet needs in their community, says Jay Bradshaw, director of Maine Emergency Medical Services, the bureau within the Department of Public Safety that is responsible for the state EMS system. Especially in rural communities in Maine and elsewhere, though EMS providers are ready to respond 24/7 they may not be called upon often. “Community paramedicine is a way to expand their sphere, not their scope, of practice,” Bradshaw explains. This innovative approach has been catching on across the nation since it was first conceived some years ago, with the landmark publication of the Rural and Frontier EMS Agenda for the Future, authored by Kevin McGinnis in 2004. The vision for Community Paramedicine in Maine is not limited to Paramedic level EMS providers, but would focus on any

EMS personnel with the training and skills to meet the needs identified in their local community, and required for proficiency in assessment skills. With up to 12 services authorized by the Maine Legislature to participate in a CP pilot project, Maine EMS set about crafting a purposely open application process earlier this year. “We didn’t create a box,” says Bradshaw. “We provided a framework, avoiding the ‘one size fits all’ route.” Maine EMS strategically involved the

Maine Hospital Association, Maine Medical Association, the Board of Nursing, Office of Rural Health DHHS, hospital representatives, family practice and emergency department physicians, to form a steering committee involved with clinical as well as and administrative aspects. Creative proposals were invited, through an application process which required services to learn more about the unmet needs in their communities, and develop partnerships to address them. To date, six services have been approved and all will have launched their CP Pilot Projects before the end of the year. In order to participate, each service needs to assess its own resources as well. There is no provision for Medicare, Medicaid or insurance company reimbursement at present, and for the purpose of this project, no charge to community members and patients. Each service is expected to pick up the cost of its three-year pilot project. Maine EMS provides an annual report on the pilot project

to the Legislature and others, and Bradshaw expects that the data will either support CP in Maine or not. It already has elsewhere. “We’ll be looking to see if our hospital readmission rates are decreased, or there is a reduced number of patients being seen in emergency departments,” Bradshaw said. Some applications have been specific and narrow in focus, says Bradshaw. In one project, North East Mobile Health Services will work with 9-1-1 ambulance services to help patients who have fallen to retain their independence. The goal will be to interact with these patients who have been identified as likely to fall again, and help them modify their activities and environment in order to significantly lower their fall risk — a major cause of morbidity and mortality. North East is also piloting a CP project in conjunction with Maine Medical Center, using telemedicine to work with their patients recovering from traumatic injuries. Community paramedics can assess the paPARAMEDICINE PAGE 16

“This is all about relationships.” Director of Maine EMS, Jay bradshaw

Maine Emergency Medical Services Week 2013 • May 17, 2013

From Civil War Days to Modern Days: EMS was there

Photos by Nancy Mcginnis

Technology might have changed, but the need for emergency medical personnel doesn’t. Pictured at left is a Civil War era ambulance, pulled by horses to get soldiers to urgent care areas. Times have changed, and so has technology, but the need for medical care in emergencies remains constant.

RESPOND FROM PAGE 3 Eventually, however, hospitals realized that their practices and technologies ran into an unbreakable barrier: time. EMS experts began to realize that EMS providers could give that precious resource to hospitals through early identification and early notification. Taking an integrated, parallel processing approach profoundly impacts the event to treatment window. The Stroke Identification and Early Notification Protocol Busko developed in 2009 for Maine EMS Region 4, later became, the MEMS Statewide Stroke Protocol. Since last year, when EMMC rolled out the EMS Blood Draw for Stroke program, “our percentage of door-to-drug times under one hour has gone up considerably, due to a combination of prehospital and hospital based practice changes to streamline patient movement flow,” Busko said. At Mount Desert Island Hospital, for example, door-to-CT-scan time for EMStransported stroke patients is now typically under 10 minutes. The expedited process is made possible by the early notification protocol: “a dramatic change” from four years ago. The clinician meets EMS on arrival, and performs the assessment while the

patient is being transported to imaging — where staff are ready and waiting. Over the course of his 18 years performing trauma surgery at CMMC, Hopperstead has saved hundreds, perhaps thousands of lives. “But what I think is even more important,” he says, “is my role in helping to build a system. One that can be reliably counted on to make decisions about where you need to go, how you need to get there, and what needs to be done in the time frame before you can get there.” Hopperstead also takes enormous pride in how EMS has evolved in our state. “EMS folks wanted to do more, and we learned that they could do more ... to the level where they are actually taking better care of patients. They have developed a sense of esprit de corps, and are now constantly pushing their own envelope to try to do more, within the limits of licensure.” Thanks to trained and dedicated EMS providers in every nook and cranny of the state, “people in need don’t have to wait so long for help. EMS providers deserve the utmost respect for constantly putting themselves in trying and difficult decision making situations — and making consistent and reliable patient outcomes a reality.”

MAINE ED

FROM PAGE 11

mainequalityforum.gov. Crowley has been spearheading a team effort to craft a vision for population health management at MaineGeneral and beyond. The effort would provide area residents access to good, affordable medical care, options and resources, she notes that quality, experience, and cost are among the key factors, and a variable delivery system is critical. “Of the 190,000 residents in our primary and secondary service areas, 115,000 have indicated they are connected to a primary care provider,” she said. “When someone shows up in our ED or Express care, we’re paying attention to who should be receiving primary care, but isn’t.” The effort will encourage people without a PCP who are seeking care at an express care or emergency facility to choose one. Assistance is offered. The bottom line, she said, should be the bottom line, Pieh emphasizes. “The Emergency Department is open 24/7. If you come here, we not only have to take care of you, we want to take care of you. But it’s always better when there is continuity of care.”

Maine Emergency Medical Services Week 2013 • May 17, 2013

PARAMEDICINE

FROM PAGE 14

tient at home and using an iPad-like device to communicate findings to the doctor. This will spare the wear, tear, time, and expense of travel for patients — some of whom would have been originally transported to the Trauma Center from afar by helicopter. Other proposals are taking a broader approach, focusing for example on patients after they have been discharged from the hospital. Delta Ambulance is working with MaineGeneral, along with Dr. Amy Madden and staff at the Belgrade Health Center, to identify patients whose follow-up needs could be met outside of a clinic visit. Community Paramedics can check patients’ weight and vital signs, draw blood and help them manage their prescriptions. Delta will schedule the CP visits and provide regular reporting back to the physician. Patients will receive the care they need, provider time and resources will be better utilized, transportation logistics simplified, and hospital re-admission rates ameliorated. These examples spotlight how some patients are currently very resource-dependent largely because of the way their care is being managed. Bradshaw stresses that CP is intended to be conducted in collaboration with a primary care provider. It may benefit a pa-

Photo by Nancy Mcginnis

In March 2012, at a forum hosted by Maine EMS, Jay Bradshaw and Kevin McGinnis members of Maine’s EMS, hospital and physician, nursing, home health care and other institutional and professional organizations to learn more about Community Paramedicine.

tient who is not eligible for, or has exhausted, home health care services, but CP is intended to be limited to short term or episodic care. In addition to Delta and North East Mobile Health Services, the first round of CP pilot projects also includes Crown Ambulance in Presque Isle; St. George Ambulance in Port Clyde; Calais Fire Department, and

United Ambulance in Lewiston/Auburn. “This is all about relationships,” he said. “We’re increasingly aware of primary care clinics, hospice facilities, patient centered medical homes and other entities that already work together as a team of sorts, with or without EMS providers.” “And it’s really appropriate that EMS

would be involved. We are a great resource, as the mobile unit potentially bridging the gap for primary care, home health, hospitals and emergency departments. As providers, we are already uniquely experienced at going into patients’ homes, where we are given access to the individual and his or her property, and we’re viewed with high regard and trust.”