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Craig Goodrich, Fire Chief Anchorage Fire Department
Michael Levy, MD, FACEP (above left) being presented the 2004 State of Alaska Medical Director of the Year. Award presenter is Alaska Lt. Governor Loren Leman |
To access the official website of the Anchorage Fire Department, click on the banner above Anchorage Fire Department EMERGENCY MEDICAL SERVICES Late Summer 2008 Update AFD EMS Operations AFD EMS Safety, Projects and Initiatives
The new revision of the
Medical Operations Manual (MOM) has been electronically published. The AFD
Medical Director, Dr. Michael Levy, has directed that annual revisions and
dating of the MOM will become a thing of the past, and instead the MOM 3.0 will
move to become a living electronic document where updates are placed directly
into the MOM and can be printed from departmental intranet or the “Documents”
section of this website as soon as they become “live.” One major change includes
reducing the size of the MOM by introducing hyperlinks versus including the
full language of relevant AFD EMS SOGs, P&Is, and other documents as all personnel should be
familiar with these. The second major change is the continuation of the
migration of pediatric orders into a separate document. MOM 3.0 is still
mixed, but more pediatric-specific language has been pushed into Section 3. Field guide books will be
following later in the summer and it’s envisioned as a scaled down version of
the MOM with the important “2 A.M.” medications and protocols, et al. Staff
will be looking at the format or something similar as used with the AFD SOG
FOG so the MOM field guide can be easily updated. All of this will cut down
on the annual expenditures at the print shop as well. A revised EMT patient care initiative is nearing completion and will be released in early August. The goal is to bring EMTs up to speed with providing BLS patient care in the field and will include a phased implementation program. Many EMTs are already taking patients, and this initiative is to provide a refresher for those EMTs who have not since their probationary period. More to come.
A grant request has been made to purchase bariatric transport gurneys, ramps, and removable winches. Should the money be approved, the department will identify designated MICU(s). The initial plan is to utilize the regular Stryker Power Pro and if a bariatric cot is needed the crew will be dispatched and swap out the cots in-station. This is still in the planning stages, so nothing specific yet. Realistically, moving bariatric patients is a slow process so a delay in getting the bariatric cot to location is acceptable. The other important point to remember is the bariatric gurneys do not fit through most doorways, so moving the patient from Point A to Point B (the gurney) may very well be the biggest challenge to begin with. This might change again, but this is the current direction the department is moving in.
I had sent the survey out on LP12 mounting brackets in an attempt to gauge interest and usability. Overall I was impressed with the positive replies. In the end the availability of purchasing the brackets would have been a challenge and the costs for equipping the ambulances was not cost effective for the safety results when other options are available. Many paramedics I have talked with feel the seatbelts securely fasten the LP12s. I’m having a memo developed with pictures for examples, and this will eventually go into the MOM.
Therapeutic hypothermia is being used in the field on cardiac arrest patients with return of spontaneous circulation. For the foreseeable future, the shift EMS Battalion Chiefs on EMS 1 will be carrying the chilled saline and vecuronium. Once the department has experience with this treatment the deployment may be expanded to the far flung reaches of the service area such as St. #11 in Eagle River and maybe St. #9 in south Anchorage; although this is not even in the planning stages at the moment. EMS 1 will also be responding to cardiac arrests with the Chugiak VFD and most likely intercepting with their ambulances to begin therapy if it’s indicated. Girdwood FD is in the planning stages of beginning therapeutic hypothermia within their service at this time. This is a rapidly developing science that I foresee will include improvements and expansion into other areas (e.g., pediatric cardiac arrests). The research to this point has been impressive on improving the survival of patients.
The AFD is still moving forward with the IMMEDIATE Trial. Some delays have occurred recently, but these are outside of the department’s control. It’s a minor blessing the Trial has not begun with the Glucose-Insulin-Potassium (GIK) solution as there would have been a need for some refocusing. Instead the AFD should see no affect other than a latter start date than originally planned. Dr. Levy has advised it could be starting anytime within the next two or three weeks.
The ePCR replacement project continues. EMS Battalion Chief Mike Crotty gave a presentation on the project status to the EMS Board at June’s meeting. Pay attention for the EMS Board minutes next month for a brief at where the program is today.
Also at June’s EMS Board Meeting a resolution on a new public inebriate assessment model will be field tested with Community Service Patrol (CSP) over this summer and fall. The model will move away from the BRAC indicator for transferring inebriates to the hospital EDs for clearance (currently at 0.350). Instead a mix of assessment and vital sign parameters will be used. The goal of this change is to reduce the number of times the CSP van(s) have to be transferring public inebriates to and from the hospitals for medical clearances and make the vans more available for public safety service requests. Also in discussion is a “taxi” car, a surplused Anchorage Police Department vehicle with one CSP employee that will return the inebriates from the hospitals to the Transfer Station, again freeing up the van(s) to be available for direct services.
3rd Quarter EMS was trauma training and EMT checkoffs. Two new skills were introduced during the
training. One is the use of tourniquets (and the removal of them if
necessary) by EMTs and paramedics. Secondly we will
be using the EZ-IO with pediatric patients in the weight range of 3-39
kilograms. EZ-IO sites for both adults and peds
will be the distal and proximal tibia, and the proximal humerus.
For peds under 3 kilograms
we will still be using the Jamshidi IOs. Dr. Levy is checking with pediatric specialists on
whether to flush first or aspirate bone marrow with the Jamshidis;
the EZ-IOs continue to be flushing only. A new
combined IO protocol for adults and peds with the
EZ-IO has been created; the old protocol for the Jamshidi
IO will be modified once Dr. Levy has completed researching it and talking
with pediatric intensivists. Deployment will begin
in the first weeks of August upon delivery of the orders. Another new change
coming with the EZ-IOs includes their use by AFD
EMT-2’s and EMT-3’s under the direct supervision of an AFD paramedic when
indicated in unconscious adult patients. 3rd Quarter EMS Field Training
will provide all ALS providers with more hands on training and review of the
protocols.
The 2008 Resuscitation Conference went off with a resounding success. The lectures were excellent, and a survey of vendors, speakers, and attendees had nothing but good things to say. The 2009 Resuscitation Conference is being moved up a month to the beginning of May and will be at a different venue (possibly the Captain Cook Hotel). Eleven speakers have already been identified and tentatively given the nod to present. More to come later in the year on this.
Here are some other important AFD EMS items of interest:
This summer and fall will
be busy around AFD EMS Operations. Enjoy what sunshine there is and be safe
out there (on and off duty). Erich Scheunemann, MICP Assistant Chief (EMS
Operations and District 3)
May 2009 - Anchorage, Alaska The documents contained within this website require Adobe Acrobat Reader to view. Click on this link below to download the free Reader 8.0 program.
Last Updated August 2, 2008 |
