The Wall Street Journal: At Boston Hospitals, Ordinary Day Turns to Pandemonium

Dr. Abdul Kader Tabbara, a neurosurgery fellow at Boston Medical Center, was wrapping up appointments with patients in his clinic Monday afternoon when colleagues began streaming into the office, talking about explosions.
There was a lot of blood, they were saying. And a lot of wounded. And they were coming to his hospital.
Dr. Tabbara, a 28-year-old from Ann Arbor, Michigan, heard the sirens and went to the window: ambulances were lined up in front of the emergency room, and as quickly as one left, another arrived.
He made his way to the emergency room, his pager already thrumming.
“All the beds were taken. Stretchers were lining the walls. You could see surgeons from different teams waiting for the next victim to come in. Sheets were soaked with blood, patients were crying and screaming,” Dr. Tabbara said.
Seven of the 23 victims taken to the hospital from the scene of Monday’s Boston Marathon bombing arrived in critical condition, Peter Burke, the chief of Trauma at Boston Medical Center, said Tuesday, having sustained “multiple traumatic amputations, vascular injuries and some abdominal injuries.” Two patients lost both their legs, he said. As of Wednesday afternoon, 18 remained hospitalized and two were in critical condition, including a 5-year old boy who sustained severe lung damage.
Dr. Tabbara, the neurosurgeon, looked around and found his patient: a man in his early 20s on a stretcher, with blood covering his chest from a head wound. His hair smelled singed; the man had been on fire.
The man was a runner. He told Dr. Tabbara he had just finished the race and was waiting for a family member or a friend to finish when he was caught “very close” to the explosion. The man was knocked off his feet, and he got up and “just started to run, and he noticed his sweatshirt was on fire and he ripped that off,” Dr. Tabbara said.
The man didn’t stop running until he got to a medical tent, Dr. Tabbara said.
A brain scan showed the man had a complex laceration to his scalp, and a ball bearing embedded in his temple—but it hadn’t penetrated his skull. He had another ball bearing embedded in his nose.
Police officers sprang into action near a Boston Marathon runner.
The man was taken into surgery, where Dr. Tabbara scrubbed in and assisted another surgeon removing the ball bearing from the man’s temple. Dr. Tabbara said his phone rang and he asked a nurse to answer—it was Dr. Tabbara’s wife anxious to know if he was OK. “Tell her I’m OK,” Dr. Tabbara said he instructed the nurse.
Dr. Tabbara and the medical team cleaned the man’s head lacerations and removed the ball bearing from his temple. They left the operating room so a team of ear, nose and throat specialists could remove the ball bearing embedded in the man’s nose.
Dr. Tabbara then plunged back into the emergency room, helping where he could and checking on his patient, deep into the night.
More than 170 patients were treated at at least seven hospitals, some of them with minor injuries.
Paul Biddinger, chief of emergency preparedness at Massachusetts General Hospital, was part of the medical support team stationed at “heartbreak hill” near mile 20 of the marathon. As word of the bombings spread, he raced to the hospital and found the response well under way. Thirty patients who had been in the emergency department were transferred upstairs to make room for those wounded in the bombing. Trauma surgeons, orthopedic surgeons, nurses, respiratory therapists were standing by.
Two of the patients taken to Massachusetts General Hospital were near death. Their mangled legs were destroyed, with bones hanging by shreds of muscle and skin. Blood flowed profusely. Many had suffered massive wounds and burns.
Mass General says four of the patients remained in critical condition Wednesday, though none are expected to die.
Most of the patients were in shock, said Dr. George Velmahos, the hospital’s chief trauma surgeon. The hospital had to start amputating legs, completing four within a few hours. “Amputating wasn’t a hard decision,” Dr. Velmahos said.
Dr. Velmahos said the hospital—from its janitors to highest management—had prepared for such an event, with ample blood supply and materials for an influx of near-death patients. The hospital had finished trauma drills before with mannequins, and several of the doctors, including Dr. Velmahos, have worked in war-torn countries.
Dr. Alasdair Conn, chief of emergency medicine, praised Boston’s EMTs for equitably spreading patients across the city and not deluging any trauma center with too many critical patients.
Bill Mergendahl, Chief Executive of Cambridge-based ProEMS, which sent six ambulances to the scene Monday in Boston, said his fleet transported patients with “traumatic amputations,” the medical term for the accidental severing of all or part of a body part.
“There was a lot of quick good work done by people first on the scene with tourniquets to stop bleeding before we got there, which was fortunate for the victims,” he said. Heavy blood loss can cause a condition known as hypovolemic shock, in which severe blood and fluid loss make the heart unable to pump enough blood into the body and cause organs to shut down.
The day after the bombings, “things were calmer” at Boston Medical Center and Dr. Tabbara visited with his young patient, who was able to speak and had been reunited with his family and friends.
He had facial swelling, but was in good condition, Dr. Tabbara said. He is unlikely to suffer brain damage, but there is the potential for nerve damage.
“He was grateful,” he said.
Dr. Tabbara says he is grateful, too, for some good news.
“This is a great city, it’s just a shame this happened,” Dr. Tabbara said,
–Melinda Beck, Lisa Fleisher, Joshua Dawsey and Laura Landro
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The Wall Street Journal: The Ultimate Lifesaver

A new push is under way to improve the care people get after they call 911, when minutes can make the difference between life and death.
The inside of the ambulance is changing as it is being stocked with new techniques and devices to improve trauma victims’ survival. Laura Landro has details on Lunch Break.
There is plenty of room for improvement: Survival rates among sudden-cardiac-arrest patients, for example, vary widely among different regions in the country. One problem: Medical advances that save lives in hospitals and on the battlefields are often slow to become available to civilian emergency responders.
Emergency medical systems and ambulance companies are driving the efforts to change. A growing number of communities are training their 911 call centers to instruct bystanders by telephone in the best way to administer cardiopulmonary resuscitation, or CPR, which has been shown to increase a patient’s chance of surviving. Some emergency responders are equipping ambulances with new technologies like digital transmission systems to beam electrocardiograms to hospitals and quick-clotting bandages, developed for troops fighting in Iraq, to stop bleeding faster. Paramedics—the most skilled providers of pre-hospital emergency care—also are being trained to chill cardiac-arrest patients after resuscitating them, as is often done in hospitals; the procedure has been shown to increase patients’ chances of surviving without brain damage.
Cardiac arrest kills close to 300,000 people a year in the U.S., and trauma is the No. 1 killer of people under age 44. Of those who die, more than half do so in the first two hours, before they ever arrive at a hospital.
“The goal is to train the paramedics to be as good as physicians when treating patients in the field,” says Andreas Grabinsky, head of emergency and trauma anesthesia at the University of Washington-Harborview Medical Center in Seattle, where the city and county EMS providers offer free training programs to other emergency systems.
It is difficult to introduce innovations. Emergency medical systems are generally overseen by a state or regional agency and vary by community. Ambulances may be operated by fire departments, hospitals, volunteer groups or private companies. When a 911 call comes in, firefighters, who at minimum have basic emergency medical technician certification and may also be paramedics, are dispatched as first responders. Ambulances staffed by paramedics with advanced life support equipment are summoned either by their proximity to the call or on a rotation.
Paramedics at Pro EMS, a Cambridge, Mass., ambulance company, train to use hand-held ultrasound devices, which can assess internal bleeding.
Emergency responders must meet basic regulatory standards, but it is generally voluntary whether they equip their vehicles with the latest technologies and train their crews in the most up-to-date procedures and skills. A 2008 study led by Graham Nichol, director of the University of Washington-Harborview Center for Prehospital Emergency Care, found that survival rates for EMS-treated cardiac arrest in 10 major regions varied from a high of 16.3% in Seattle to a low of 3% in Alabama. New data for 2010, though not yet available by city, show the national average has been improving, according to Dr. Nichol.
Some ambulances are being fitted with machines that provide continuous chest compressions so paramedics can insert breathing tubes and perform other lifesaving procedures without pausing to restore breathing.
Another new device finding its way into some ambulances is a digital transmission system that speeds sophisticated electrocardiogram readings to the hospital so cardiac patients can get treated faster. When heart-attack victims require a balloon angioplasty, a procedure that opens blocked blood vessels, hospital staff often rush to get this done within 90 minutes, the time required to avoid heart-muscle damage. The transmission device is usually combined with a monitor to track the patient’s pulse, heart signs and breathing.
The new digital technology helped save the life of 43-year-old Robert Douglas, who passed out at his home in Cambridge, Mass., in August, feeling weak with chest pains radiating to his left arm. Paramedics from the Cambridge fire department and ambulance company Professional Ambulance and Oxygen Service Inc., known as Pro EMS, performed the ECG at Mr. Douglas’s home. Trained to interpret electrocardiograms, they transmitted to Mount Auburn Hospital images showing signs of a type of heart attack in which an artery is totally blocked by a blood clot. Doctors in the ER were able to get Mr. Douglas in for a balloon angioplasty within 42 minutes.
“Before this system, the communication was like a child’s game of telephone,” with paramedics and doctors at the hospital often not understanding each other’s verbal descriptions, says Todd Thomsen, an emergency physician at Mount Auburn. “Had this system not been in place or had there been other delays, Mr. Douglas would have had a worse outcome.” Mr. Douglas says he has recovered fully.
Pro EMS has been participating in a program at Emory University in Atlanta called the Cardiac Arrest Registry to Enhance Survival, or CARES, which the ambulance company says has helped it double its cardiac-arrest-survival rate in the last two years. CARES has been gathering data from 911 call centers, EMS providers and hospitals around the country since 2004 to compare results and to help communities improve emergency care.
At Pro EMS, which submits data to the CARES program as part of Cambridge’s fire-department EMS system, staff members undergo about five times the national standard of 72 hours of continuing education, refresher courses and recertification in CPR and advanced life-support skills, says chief executive Bill Mergendahl. The company has also purchased 16 sophisticated monitors, including the ECG systems, cardiac- and breathing-monitoring devices and defibrillators at a cost of $25,000 each. “It can get expensive to add new technologies to EMS, but we are improving outcomes that lead to savings in health care all the way down the line,” Mr. Mergendahl says.
The San Francisco fire department, which began participating in CARES in 2009, trained all 1,400 of its staff last year in updated CPR and advanced cardiac-life-support techniques. The department purchased electronic monitors that provide visual feedback about the effectiveness of chest compressions, and it is using new airway tubes that are easier to insert without interrupting CPR.
Fire department captain Justin Schorr says the emergency survival rate in the city has risen over the two-year period. But the city wanted also to measure survival in another way—-for victims whose cardiac arrest was witnessed and someone, either a bystander or EMS staff, intervened with CPR or a defibrillator. “We focused on how well we did when we had the best chance to help someone,” he says, and results improved dramatically—from 9% to 23% over the period.
Researchers also are investigating possible new techniques to boost survival rates. For example, people admitted to the hospital ER at high risk for traumatic brain injury or hemorrhagic shock currently are given a dose of estrogen within two hours of injury, which has been shown to reduce dangerous inflammation. The Resuscitation Outcomes Consortium, a group of 10 regional centers based at the University of Washington that conducts clinical trials, plans to investigate whether estrogen given intravenously before the patient gets to the hospital would improve survival.
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Pro EMS Chief Executive Officer Bill Mergendahl Named to the Board of Directors of the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP)

Cambridge, Mass., October 2009 – Professional Ambulance Service (Pro EMS), one of the premiere providers of emergency medical services in Massachusetts, is pleased to announce that Chief Executive Officer Bill Mergendahl has been named to the Board of Directors of the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions. CoAEMSP is the only, comprehensive National EMS education accreditation agency in the United States.
Mergendahl was appointed by the American Ambulance Association to serve as one its two representatives on the CoAEMSP Board. The purpose of CoAEMSP is to improve the quality of EMS education by implementing a rigorous accreditation process for qualifying paramedic training programs. CoAEMSP’s 26-member board consists of some of the most prominent leaders and educators in EMS, each of whom has distinguished themselves for their commitment to the CoAEMSP mission.
“The people at Pro EMS, the Pro EMS Center for MEDICS, and the agencies we work with in the City of Cambridge, are all dedicated to upholding the high standards established by organizations such as CoAEMSP,” Mergendahl said. “I am pleased to have the opportunity to work directly with the organization to find ways to further improve the quality of care being provided by EMS field providers across the country.”
Pro EMS has invested in state-of-the-art EMS-related technology as well as training through its Pro EMS Center for MEDICS Simulation Lab and is currently working toward CoAEMSP Accreditation.
Pro EMS has been recognized previously by national organizations for its commitment to excellence. Pro EMS was the first ambulance service in Massachusetts, and one of only five in New England, to be accredited by the Commission on Accreditation of Ambulance Services for its compliance with national standards. This recognition was in the wake of the Cambridge Fire Department’s recognition as the only ISO Class I Fire Department in Massachusetts. With the CAAS accreditation, Cambridge became one of only eight communities in the United States to be served by an ISO Class 1 Fire Department and a CAAS Accredited Ambulance Service.
Pro EMS Center for MEDICS also has achieved accreditation from Massachusetts’ Office of Emergency Medical Services. According to OEMS, the six-month accreditation process is a signature of training excellence achieved through strict compliance to the highest standards. OEMS mandates accreditation compliance for all initial Emergency Medical Technician (EMT) and Paramedic training programs conducted in the state.
CoAEMSP aims to serve the public, the emergency medical services professions, as well as the programs that provide professional education to EMS professionals, by acting as a national voluntary accreditation agency for paramedic programs in the U.S.
Accredited Paramedic programs are generally sponsored by colleges, universities, hospitals, clinics, medical centers, U.S. armed forces, governmental educational or medical services, and by consortium. Programs can vary in length and must include an appropriate sequence of classroom, laboratory, hospital, and field internship activities. More information about CoAEMSP can be found at about Pro EMS can be found by visiting or by calling (617) 492-2700.

About Professional Ambulance Service
Professional Ambulance Service (Pro EMS) provides emergency medical services to the City of Cambridge, Massachusetts in conjunction with the Cambridge Fire, Police, Emergency Communications and Public Health Departments. Additionally, Pro EMS provides emergency medical services to Harvard University and the Massachusetts Institute of Technology. Professional Ambulance has proudly served the citizens, students, and visitors of Cambridge for over 35 years. For more information, visit
Media Contact:
Christine Dunn
Savoir Media
(617) 484-1660

Pro EMS Center for MEDICS Uses State-of-the-Art Equipment to Train Nurses from Cambridge Health Alliance

Every Wednesday afternoon, 14 nurses from the Cambridge Health Alliance (CHA) spend four hours at the Pro EMS Center for MEDICS, using the state-of-the-art equipment and Simulation Lab to learn emergency skills for their new positions as emergency department (ED) staff.
Pro EMS Center for MEDICS Director Chris Kerley works in conjunction with CHA Nurse Educators to teach the group critical ED procedures and protocols such as intubation and cardiac arrest management with equipment, including the Adult and Infant Airway Management Trainers, Multi-Venous IV Training Arms, and PROMPT Birthing Simulator. The nurses also have the opportunity to work with high-fidelity patient mannequins, SimMan and SimNewB. Pro EMS Center for MEDICS is the only EMS agency that has a SimNewB mannequin available for training in the Northeast.
The CHA class has covered techniques such as how to properly immobilize patients and manage their airways. Kerley has also taught participants how to initially assess and respond to a wide variety of clinical scenarios, from babies who are not breathing, to adults presenting with an acute abdominal emergency, to pregnant women in the final stages of labor.
“Chris Kerley is extremely knowledgeable and has a great teaching style,” said Karen Harrington-Hiltz, a Somerville Hospital staff nurse and one of three individuals who coordinate the class.
The course – which also includes a weekly Wednesday morning didactic component at Somerville Hospital – was created in response to recent administrative changes at Cambridge Health Alliance’s three hospitals: Somerville Hospital; Cambridge Hospital; and Whidden Hospital in Everett. When some of the hospitals’ intensive care, medical-surgical and psychiatric units were recently closed, nurses from those units were offered the opportunity to participate in the emergency medicine class, retrain, and work in one of the three 24-hour EDs.
According to Harrington-Hiltz, the group – whose diverse members range from recent nursing school graduates to ICU nurses with decades of experience – began attending the weekly lectures in July 2009 and should complete their practical skills training by this November. Concurrent with their training, the nurses work shifts with preceptors in the EDs.
“This is a major transition for all of them. The emergency department has a completely different focus,” said CHA Nurse Educator Bill McCarthy, another class coordinator.
“You never know what’s going to come through the door at any given moment,” he added. “These nurses are being exposed to a lot of things so that when they encounter them in the ED, they will have had exposure to them.”
With SimMan, a patient simulator with realistic features, participants have an unparalleled learning experience. During the lesson on abdominal emergencies, for example, the nurses practiced placing a Foley catheter in the mannequin and draining “urine.”
The seven-pound SimNewB was used when the class covered neonatal resuscitation. Harrington-Hiltz said this experience was particularly helpful as most of the class had limited exposure to pediatric patients in their previous positions.
“Pediatric emergencies, which involve dealing with critically ill children, are a very emotional and difficult time for health-care providers,” she said.
Harrington-Hiltz, McCarthy, and the third coordinator, CHA Critical Care Clinical Nurse Specialist Margaret Buckley, based the lectures and skills sessions on the Emergency Nurses Association’s Emergency Nursing Core Curriculum. The material covered is guided by the types of patients their EDs treat most frequently.
Participants in the class will also receive certification in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS), Kerley said. In fact, as part of the class, the nurses will have the opportunity to ride along with paramedics in an ambulance and observe emergency medical care in the field.
CHA chose to implement the practical training portion of the class at the Pro EMS Center for MEDICS as they were previously familiar with Pro EMS’s equipment. On Cambridge Hospital’s Annual Competency Day, all of the nurses in every department travel to Pro EMS to run through a clinical scenario, Buckley said.
Further, as part of the collaboration between Pro EMS and CHA, any CHA staff physician, nurse or physician assistant can take any of the Center’s courses – including monthly ACLS and PALS credentialing classes and a 12-lead EKG interpretation class offered every one to two months.
Pro EMS also benefits from this longstanding working relationship with CHA. Pro EMS Center for MEDICS paramedic students perform clinical time and receive training at CHA facilities. Paramedic students rotate through the Cambridge Hospital emergency department and gain clinical experience in several areas of the hospital including pediatrics, psychiatric emergency service, ICU/CCU, and geriatrics. CHA facilities and staff provide superior training and clinical experiences to the future paramedics of the EMS system.
About Cambridge Health Alliance:
CHA serves more than 400,000 residents in the metro-north Boston area, including Cambridge, Somerville, Everett, Revere and Malden. The integrated healthcare system is comprised of the Somerville Hospital, Cambridge Hospital and Whidden Hospital, 20 primary and specialty care sites, the Cambridge Health Department, and the health plan Network Health.
CHA is a teaching affiliate of a number of institutions, including Harvard Medical School, Tufts University School of Medicine, Harvard School of Public Health, and the Harvard School of Dental Medicine.

For more information:
Pro EMS Center for MEDICS
Cambridge Health Alliance

Tewksbury Paramedic Makes a Difference

Tewksbury –

KeriPNG 2At 6 a.m. each morning, paramedic Keri Cook, a resident of Tewksbury, arrives at the offices of Pro EMS and collects the latest reports detailing the emergency calls recently handled by her colleagues.

“I review every single patient care report, whether it was a transport or cancelled,” said Cook, who serves as Pro EMS’s Director of Continuous Quality Improvement (CQI).

It adds up to more than 20,000 cases a year. But for Cook the process allows her to collect and analyze clinical data — and gives her the ability to directly impact the quality of the services provided by Pro EMS.

As director of CQI, Cook spearheads one of the biggest initiatives at Pro EMS: To increase the clinical sophistication of every member of the Pro EMS team, and in doing so, improve the quality of patient care.

The CQI process that Cook helps to implement involves a continuous loop of analyzing data from emergency calls; providing consistent feedback to field members; enhancing skills through training; and implementing the latest technologies in order to advance care.

Importantly, Pro EMS also incorporates customer satisfaction surveys in its review process so that the patients themselves have a voice in the quality of the care they have received.

“Our job is to make them better EMTs,” Cook said. “People who join Pro EMS are drilled from the moment they’re interviewed. The training never ends.”

Gaining perspective

A paramedic for 15 years, Cook said she draws on her field experience as she reviews cases and provides feedback.

Whether praising situations that were handled particularly well, or pointing out when protocols were not followed, Cook stresses the educational aspect of this process. She said her goal is to frame the feedback as a learning experience.

Cook’s experiences as a paramedic, and as a manager, also expanded her perspective on what it means to “make a difference” — a big reason many individuals say they want to get into EMS as a career.

Twenty years ago, as a new EMT working at Pro EMS, Cook eagerly anticipated the “blood and guts” calls and their accompanying adrenalin rush.

Over time, Cook learned, calls are often less exciting: the 80-year-old woman who is lonely and not feeling good in the middle of the night, or the intoxicated homeless man who routinely requires transportation to the hospital.

While treating a gunshot or stabbing victim can be overtly lifesaving, Cook has come to realize that even on seemingly mundane calls, she and her colleagues can positively impact a patient’s life.

“Most people [in EMS] want to make a difference and are in it to help others,” Cook said. “It’s not for the financial gain.”

In fact, dedication and commitment are qualities Cook and her colleague Rachid Sbay, director of operations at Pro EMS, seek when initially interviewing potential employees.

“We interview by committee…and tell people that [at Pro EMS] we want to make them the best EMT or medic they can possibly be.”

Adding technology to the field

In addition to acting as an educational resource, Cook and some of her colleagues are charged with the task of finding cutting-edge technologies and new protocols for patient care.

Over the past few years, a group of top managers from Pro EMS attended the annual “Gathering of Eagles” conference in Texas, hosted by the U.S. Metropolitan Municipalities EMS Medical Directors Consortium, also known as the Eagles Coalition. Attended by the 30 largest EMS systems in the country, this conference discusses the newest advances in pre-hospital patient care.

“We find that we stack up well with the rest of the country, but we always bring one or two things back,” Cook said.

Constant attention to new, evidenced based treatment modalities and equipment has allowed the Cambridge EMS system to be early adopters of the EZ-IO (intraosseous) drill; myriad advanced airway procedures; continuous positive airway pressure (CPAP); and the implementation of a therapeutic hypothermia after cardiac arrest protocol.

Lifelong commitment

Cook said she always knew that she wanted to work in the medical field. After graduating from high school in 1987 in Cambridge, she first considered a career in nursing.

“I didn’t want to stay inside all the time,” she said.

She became an EMT in 1989 and started working at Pro EMS. Cook recalls being terrified on her first calls.

“It took about six to seven months to get used to the job,” she said.

After a year on the road, Cook began working in dispatch. In 1993, to further her education, she enrolled in a paramedic training program in Hyannis, and graduated a year later.

She’s since served in various roles, including operations supervisor and field training officer. But she siad it’s her current role that really makes Cook feel that she has a personal stake in the success of Pro EMS and the people who work there.
Speaking with potential employees, she and Sbay describe the unique culture of the company.
“We weed out a lot of people. We are looking for people who want to do the job and be great,” she said.

A resident of Tewksbury, Cook is married and has an 11-year-old daughter.

Cambridge EMS Tracks Influenza A (H1N1) in Real Time with FirstWatch®

EMS organizations around the country are on alert, preparing for an anticipated worsening of the current Influenza A(H1N1) pandemic.
The Cambridge EMS system – comprised of the Cambridge Fire Department and Pro EMS, as well as the Cambridge Police, Emergency Communications, and Public Health Departments – have taken their preparations one step further: Cambridge is the only emergency medical services system in New England to incorporate a real-time surveillance technology into its daily operations.
With the Centers for Disease Control and Prevention (CDC) expecting an increase in the number of new H1N1 flu cases this fall, particularly as the academic year kicks into full gear, paramedics and EMTs will be increasingly called upon to respond to, treat and transport suffering individuals.
The ability to utilize real-time surveillance to follow the numbers of suspected H1N1 flu cases, as well as pinpoint their specific geographic locations, can give paramedics and EMTs an advantage on their calls — maximizing both their safety as well as the health of the general public. Moreover, this real time surveillance is providing data and information that can be used by all providers to improve response and provide data on public health and quality of life issues.
“We purchased the system to identify trends,” said Pro EMS Chief Executive Officer Bill Mergendahl. “We can track what we are seeing in the field. We can monitor how many flu cases we respond to, and where they are, so that we can have advanced warning for the future.”
The FirstWatch Advantage
Pro EMS implemented the surveillance program, called FirstWatch, about a year ago. It is currently used by only 90 agencies – primarily EMS-related organizations – nationwide
The software automatically detects emerging trends, patterns, and geographic clusters in real-time for a range of public health and safety concerns for emergency services, hospitals and homeland security.
As part of its commitment to continuous quality improvement, Pro EMS has implemented a variety of new technologies over recent years to improve the quality of care and service. FirstWatch complements and interfaces with existing technology of Pro EMS.
FirstWatch monitors the Pro EMS computer-aided dispatch (CAD) and electronic patient care reporting system, specifically RescueNet Tablet PCR. When keywords – previously determined by Pro EMS – indicating possible H1N1 flu symptoms surface in the CAD and run reports, FirstWatch is immediately triggered to capture data about that patient.
All aspects of all systems are HIPAA compliant and are maintained to protect patient confidentiality.
The patient’s data is sent to FirstWatch’s primary server, where it is compared to existing information and patterns about medical symptoms and geographic characteristics.
When a suspicious or statistically significant pattern is detected, FirstWatch immediately sends an alert to supervisory staff phones. At the same time, they also receive a detailed email with clinical information, a statistical graph, and an area map.
In this way, Cambridge’s emergency system can track the rapidity of spread of H1N1 flu across the city.
Knowing which patient populations may be severely affected and what the prevalent symptoms appear to be can assist personnel in providing the most appropriate and effective care.
Seeing how the trends develop can also provide valuable data to assist Cambridge EMS make administrative and logistical decisions about staffing, protocols and resource allocation.
Better Prepared
Cambridge EMS workers in the field are also better prepared to respond to potential H1N1 flu-related calls with the help of FirstWatch.
Suppose, for example, that EMS workers receive a call for a patient with symptoms such as fever, difficulty breathing, or persistent vomiting. The EMS workers can look at the surveillance program and see if it identifies a statistically significant cluster of flu cases in the patient’s immediate area.
Advanced knowledge of the situation will result in responders putting on their personal protective equipment –N95 respirators, gowns, gloves and eye goggles – before even entering the patient’s residence.
Implementing these mandated “scene safety” precautions – well before getting within six feet of a patient – in addition to placing a mask on the patient to contain secretions can be vital in preventing the transmission of the disease.
Not only will future patients the EMS personnel come into contact with and transport have a reduced chance of encountering the virus, but the precautions will help the paramedics, EMTs, and First Responders stay healthy so that they can continue their critical work during the pandemic.
Not Just for Influenza
In addition to monitoring current H1N1 flu trends with FirstWatch, Pro EMS uses the program to track substance abuse overdoses and situations involving certain hazardous materials leaks or poisonings.
Pro EMS shares the information gathered about opioid (such as heroin and OxyContin) overdoses with the Cambridge Prevention Coalition, which operates under the auspices of the City of Cambridge Department of Human Service Programs.
“FirstWatch has been an incredible resource; it helps track what’s going on in real time in the community. We’re able to put the information together to identify causal factors,” said Gisela Rots, Director of the Cambridge Prevention Coalition.
Her organization broadly focuses on substance abuse prevention. Currently, one of their projects involves collaborating with a number of organizations, including Pro EMS, on a state-funded opioid overdose prevention program.
“I haven’t heard of any other ambulance company [besides Pro EMS] in the state who provides data or comments on trends going on.”
She added, “Pro EMS is a great partner; they are willing to share their information to benefit our project.”
Rots hopes the work of the Cambridge Prevention Coalition will soon reciprocally benefit Cambridge EMS by leading to decreased numbers of opioid overdose-related 9-1-1 calls and transports.
Facts about H1N1 Influenza
The World Health Organization (WHO) declared a pandemic of Influenza A(H1N1) in June 2009 due to the rapid spread of the disease. While the future course of the virus is still unclear, WHO officials estimate that between 15 and 45% of the world’s population will eventually contract the virus.
H1N1 flu is spread from person to person. The virus is airborne; tiny droplets that are released into the air when infected individuals cough or sneeze can then be breathed in by others within a three- to six-foot radius. In addition, if people touch a contaminated surface or object, neglect to wash or clean their hands, and then touch their own mouth, nose or eyes, they can also become sick.
Currently, most infected individuals only experience mild symptoms. Symptoms of H1N1 flu may include fever, cough, sore throat, runny or stuffy nose, fatigue, body aches, diarrhea or vomiting.
The CDC recommends that people with suspected or confirmed H1N1 flu stay home from school or work for at least 24 hours after their fever has gone, and limit their contact with others during their illness.
Uninfected individuals can help keep themselves healthy by washing their hands or using alcohol-based hand cleaners frequently, as well as avoiding unnecessarily touching their eyes, nose or mouth.
Several H1N1 flu vaccines are currently being tested, but may not be available for distribution until October. The first recipients are expected to be people most at risk, including health care and emergency medical personnel, pregnant women, people with chronic illnesses, and children.

For more information:
Cambridge Prevention Coalition:
Centers for Disease Control and Prevention: fluflu/general_info.htm

World Health Organization: Pandemic (H1N1 FLU) 20009:A

Metropolitan Boston EMS Council, Lahey Clinic Team Up for Regional H1N1 Flu Preparedness

Members of the Metropolitan Boston Emergency Medical Services Council (MBEMSC) have come together to help area EMS providers prepare their workforces for the H1N1 flu pandemic.
It is another example where members of the MBEMSC regional group have come together to create a coordinated effort that proactively implements disaster preparedness ahead of an event.
The Lahey Clinic is supporting the MBEMSC’s community preparations through its Community Benefits Initiative. The Lahey Clinic has awarded a $64,000 Emergency Preparedness Grant for a project aimed at decreasing pre-hospital emergency personnel person-to-person transmission of the virus.
The MBEMSC have used the funds to purchase a substantial cache of Personal Protective Equipment (PPE) that is accessible to EMS providers in the 61 communities of EMS Region IV in the event of a severe H1N1 outbreak or other catastrophe.
“Community based safety and health care workers that provide emergency and trauma services often get overlooked from public funding sources. We are in a position to help supplement the pre-hospital emergency medical system,” said Jeff Doran, Senior Vice President of Operations at the Lahey Clinic, and a member of the Community Benefits Initiative Committee.
The Lahey Clinic’s Community Benefits Initiative – overseen by a Community Benefits Initiative Committee comprised of both hospital and community representatives – has been funding projects in response to identified community health and wellness needs for more than 12 years. Some of their other recently implemented community-based programs have benefitted senior citizens, victims of domestic violence, people with tuberculosis and children.
Disaster Preparedness Post 9/11
Funding for the Community Benefits Initiative comes from the Lahey Clinic’s annual operating budget, Doran said.
“We are a non-profit health-care system; part of our mission is to serve the community,” he said.
About five years ago, partly as a response to 9/11, some of the Lahey Clinic’s community funding became specifically earmarked for emergency and disaster preparedness.
Money from this Emergency Preparedness Grant has been used over the past few years, for example, to help the MBEMSC as well as the Northeast Emergency Medical Services (Region III) purchase emergency vehicles and equipment. It’s also been used to fund educational seminars
Cache of Equipment
A few months ago, when the World Health Organization declared an H1N1 flu pandemic, MBEMSC Executive Director John Guidara approached Doran to inquire whether the Emergency Preparedness Grant could be directed to support H1N1 flu preparedness.
“I thought that was a fantastic opportunity and conferred with the committee’s leadership. If the Regional Council has targeted strategies that will advance community health efforts, that is something we love to support,” said Doran, who has also served on the MBEMSC Board of Directors for a number of years.
The MBEMSC has used the grant to purchase a cache of PPE that includes 25,000 gowns; 25,000 N95 respirators; 150,000 surgical masks; 5,000 goggles; and 20 fit test kits.
The cache of equipment is being maintained at Fallon Ambulance Service, Cataldo Ambulance Service, and Pro EMS in Cambridge. EMS organizations urgently needing PPE will be able to request and purchase supplies from the stockpile. Using the purchase money, the cache will be replenished over time.
“When the H1N1 flu hits, providers might not be able to order this equipment,” said Bill Mergendahl, Chief Executive Officer of Pro EMS, who also serves on the MBEMSC’s Board of Directors. “This coordinated effort will meet an enormous need.”
Mergendahl recalls the recent June 2009 H1N1 flu pandemic, when protective equipment was backordered from suppliers. Many EMS organizations were unable to obtain all of the PPE necessary to protect the health and safety of both patients and providers.
Certain conditions contribute to the pressing need for community emergency preparedness: the as-yet unavailability of a vaccine; the fact that H1N1 is a novel virus to which no one is immune; and the complicating presence of the expected seasonal flu.
Helping prevent transmission of the H1N1 virus – including implementing vaccination programs when an H1N1 vaccine becomes available – is crucial in planning for the anticipated severe outbreak.
The PPE cache plan is “a good front-line prevention measure,” with the entire community of EMTs, paramedics, health care providers, and residents benefitting, Doran said.
For an article by the MBEMSC on these Emergency Preparedness efforts, click here. (Link to MBEMSC article.)
About the Lahey Clinic:
The Lahey Clinic, founded in 1923, is a non-profit, physician-led group practice. Approximately 500 physicians and 4,500 nurses, therapists and other support staff provide comprehensive services to patients at two Lahey Clinic Medical Center (LCMC) sites in Burlington, MA, and Peabody, MA, as well as in community-based practices throughout northeastern Massachusetts.
Specialized centers such as the Cerebrovascular Disease Center and the Heart & Vascular Center provide advanced care using the most current technology and procedures. In addition, Lahey Clinic’s excellence in treating urological conditions has been recognized for the past six years in U.S. News & World Report’s “America’s Best Hospitals”.
A teaching hospital for Tufts University School of Medicine, LCMC trains new physicians in both general medicine and subspecialty residency and fellowship programs.
Committed to research, Lahey Clinic’s physicians and researchers participate in both national and international studies. Currently, more than 200 clinical trial protocols are in progress.
For more information, see:
About Metropolitan Boston EMS Council:
The MBEMSC is the agency that has been designated by the Massachusetts Department of Public Health to coordinate the delivery of emergency medical services to more than 2 million residents living in EMS Region IV.
Governed by a Board of Directors, which includes representatives from EMS organizations, hospitals, fire departments, state and local government, and the public, the group meets quarterly to work toward maximizing the availability and quality of emergency care.
The 61 communities in EMS Region IV are served by 70 licensed ambulance services – public, private and volunteer – and 25 acute-care hospitals.
For more information about the MBEMSC, see:

Merg’s Corner Newsletter of Summer 2009

Over the years, the Cambridge Fire Department, Police Department, Emergency Communications Department, and Pro EMS have developed a unique public-private partnership that has enabled us to build one of the best EMS systems in the country.
This partnership reflects our collective commitment to setting high standards for training and technology so that we can provide the highest quality EMS services to the City of Cambridge. It also demonstrates our commitment to fostering and supporting the community – whether they are residents of Cambridge or members of the EMS system, such as hospitals and other emergency providers.
We were reminded of the importance of this community when we honored retired Cambridge Police Officer Robert “Bo” Ahern at the dedication of the new Cambridge Police North Cambridge Reporting Station at Pro EMS. Police officers, firefighters and paramedics joined Bo’s sons, grandchildren and other family members to remember Bo, who served the City for more than three decades. We’d like to thank everyone who joined us for this special occasion.
I’d also like to thank Keri Cook for her efforts as Pro EMS Director of CQI. Keri has been integral to the development of the continuous quality improvement program. From investigating new technologies, to setting the standards for EMTs and paramedics and – importantly — upholding them, Cambridge’s EMS system has benefited from Keri’s dedication.
Each year, Keri is among a group representing the Cambridge EMS System that attends the annual “Gathering of Eagles” conference in Texas. The group investigates new procedures and technologies presented at the conference, and makes recommendations on how the Cambridge EMS system can implement them. This year, those recommendations included therapeutic hypothermia, details of which you can also read about in this newsletter.
As always, thank you for your hard work and dedication to EMS.

Pro EMS Medical Director Dr. Gary Setnik Receives Two Teaching Awards From Harvard Medical School

For the past 20 years, Dr. Gary Setnik, South Middlesex EMS (SMEMS) Medical Director, has helped Harvard Medical School students prepare for the realities of their careers as physicians by teaching a course on Emergency Medical Care. His dedication to the students was recognized by the school this year with the granting of two awards.
Setnik shared The Best Clinical Teacher at Mount Auburn Award as well as the Faculty Prize for Excellence in Teaching, established in memory of Charles McCabe, M.D. Setnik’s accomplishments were recognized at both Harvard Medical School’s graduation and at the school’s Faculty Awards ceremony in June.
The Emergency Medical Care course, currently Harvard Medical School’s second-largest elective, was created about 40 years ago at the behest of students who wanted more experience with the practical application of their skills before becoming interns.
With that objective in mind, when Setnik took over the course, he employed a variety of teaching tools to help the medical students get ready for emergency situations they might encounter as house officers. The activities range from lectures that can be accessed online; to case- and procedure-based simulation training; to the use of an online textbook -– which Setnik created himself.
“I have received notes from many students over the years telling me how helpful certain elements of the course were to them in their subsequent training years,” he said.
One former student – called upon to assist a fellow airline traveler who suddenly became ill – later thanked Setnik for teaching them how to handle emergencies in flight.
Part of Setnik’s class also involved paramedics from Pro EMS, who were asked to teach and certify the students in BLS and ACLS.
“The [Pro EMS] paramedics are outstanding instructors – truly amazing,” he said. “I would not have received these two awards had it not been for the participation of those individuals.”
In his role as SMEMS Medical Director, Setnik provides medical oversight to the local area’s EMS organizations, including Cambridge, Belmont, Arlington, Watertown and Lexington. He credits Chris Kerley, director of the Pro EMS Center for MEDICS, for the high caliber of its providers.
“Chris is one of the primary reasons our training has been so successful. He has the highest standards, and that shows in every one of the medics and in their techniques.”
Having worked at both Harvard Medical School and Mt. Auburn Hospital for 32 years, Setnik currently serves as the Department of Emergency Medicine Chair at Mt. Auburn Hospital. He is also an assistant professor at the medical school.
As SMEMS Medical Director, Setnik’s responsibilities include participating in quality assurance programs, signing off on medics’ credentials, and leading monthly morbidity and mortality rounds with SMEMS Executive Director John Conceison.
Setnik and his wife live in Winchester, MA. They have three children, one of whom is an emergency physician in New Hampshire. They also have four grandchildren.