Published by the Tidewater EMS Council and Medical Transport, L.L.C. — Dedicated to Emergency Medical Services Vol. 28 No. 3 May / June 2011

The EMS Week theme for 2011 is “Everyday Heroes.” This theme celebrates the exceptional service

being provided to countless patients every day, often under incredibly challenging circumstances. It illustrates the fact that EMS providers are dedicated to saving lives and limiting suffering on a daily basis. They are selfless professionals who put their own lives on hold, day after day, to respond to the emergency needs of others.

EMS providers, agencies and hospitals are encouraged to conduct EMS Week activities that draw public attention and recognize the great work of EMS. Two websites, www.acep.org/emsweek hosted by the American College of Emergency Physicians and www.emsweekideas.org hosted by the National Association of EMTs are great starting places for ideas and EMS week information.

The Tidewater EMS Council thanks our everyday heroes who work behind the scenes (like our dispatchers, instructors and administrators), on the street (our responders) and in the ED and specialty care centers who make a positive difference in the lives of people everyday. To show our thanks, you and your family are invited to our EMS family picnic and awards presentation on Saturday May 21 at the Virginia Zoo in Norfolk.

continued on page 4

National EMS Week is May 15 - 21

Tidewater EMS Council Board Elects Directors and Officers

On March 25, 2011 the Tidewater EMS Council Board of Directors held board, officer and executive committee elections for a two year term. Stewart W. Martin, MD of Virginia Beach was reelected president of the Board. Dr. Martin is an attending physician with Emergency Physicians of Tidewater and medical director for the Virginia Beach Department of Emergency Medical Services and all of the volunteer rescue squads in Virginia Beach. He is board certified in emergency medicine and hyperbaric and undersea medicine.

Dominador “Dan” F. Fermil, Jr. of Virginia Beach was elected vice president of the board. Fermil, a nationally registered paramedic, is a Deputy Fire Chief with Chesapeake Fire Department.

Kent J. Weber of Suffolk was reelected treasurer. Weber was the organization’s first executive director and held that position from 1974 until 1986 when he retired. He continues to serve as a director of the board and is an active Rotarian.

You are Invited…Responders, dispatchers, ED staff and families are invited to the

19th annual EMS family picnic and awards presentation

Saturday May 21, 2011 • Virginia Zoo in NorfolkFree zoo admission, 10 am – 3 pm New: Asia Trail of the Tiger Exhibit

Free food, drinks, entertainment and prizes, 11:30 am – 2 pmEMS awards presentation, 1 pmRSVP online at www.tidewaterems.org

(1 RSVP per family) or call 757 963-0632.Primary Sponsor: TEMS Platinum Partner Bon Secours

Virginia Emergency Services

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I discussed the new National EMS Educational Standards in the last few Educator’s Corner articles. I hope each of you understands the upcoming implementation and the changes. This article highlights how the standards will affect you as a current EMS provider in Virginia.

I will start with EMT instructors and ALS Coordinators since this group is affected first. If you are an EMT instructor, in order to announce and teach classes that will end after June 30, 2012 you need to take and pass the written instructor pretest. (If you have have taken the pretest since February 15, 2010 you have already met this requirement.) The pretest is based on the new Virginia and National EMS Education Standards at the EMT level.

If you are an ALS coordinator and wish to announce and coordinate initial ALS programs that end after June 30, 2012, you also will have to take and pass the written instructor pretest. As an ALS coordinator if you do not take and pass the written pretest, you may continue to announce continuing education classes and auxiliary programs.

EMT Instructors and ALS Coordinators can register for the instructor pretest (aka “VEMSES Knowledge Competency”) at any test site and you will have 4 attempts to pass. A letter of eligibility obtained from Greg Neiman at the Virginia Office of EMS is required.

For all current providers: those who begin the recertification testing process before July 1, 2012 will be tested on the current National Standard Curricula. Current providers who begin the recertification testing process after June 30, 2012 will be tested on the new Education Standards.

The First Responder program will change to Emergency Medical Responder. Not many First Responders are certified in the Tidewater Region and the two programs remain similar. As new programs are offered, some differences in skills and content will be included.

As an EMT-B, your certification will not change at present but as you come due for recertification after June 30, 2012 you will take the recertification exam based on the new national standards. When you pass the new exam you will become the Emergency Medical Technician (dropping the “B”) provider as outlined in the standards.

As an EMT-Enhanced, you will be required to take part in some sort of bridge program that will cover all of the information that is in the new educational standards for the Advanced Emergency Medical Technician provider. Once you complete either a bridge program or an entire Advanced Emergency Medical Technician program, you will test out at AEMT level.

The level of provider that receives the largest number of questions is EMT-Intermediate. This level of provider in Virginia is not going to change although in the near future the National Registry will no longer test EMT-Intermediate and the National Standards do not recognize EMT-Intermediate. Virginia has decided to keep this level within the state. To all of the concerned individuals: you have nothing to worry about. EMT-Intermediate testing will simply be a state test rather than a national test.

Lastly, Paramedic. The new standards outline the expected goals of a Paramedic program and will affect future paramedics that will be trained to the new educational standards. If you are currently a paramedic in Virginia, you also have nothing to worry about. Your level will not change although you will see content changes as you participate in continuing education.

I hope each of you has taken an opportunity to review the new standards and realize that the upcoming changes are actually good for providers, our profession (volunteer or career) and our patients. You can find more information at www.ems.gov/education/nationalstandardandncs.html and on the Virginia Office of EMS website www.vdh.state.va.us/OEMS/Training/Transition.htm.

What do the new Educational Standards mean for me?By Jay Porter, EMS Education and Performance Improvement Coordinator

The Educator’s Corner

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EMS Education Expo Draws 150Some 1700 hours of category 1 EMS continuing education

along with close-up and personal interaction with instructors and fellow attendees and an evening of fun and games were the highlights of the 2011 Tidewater EMS Education Expo in Suffolk.

Held April 1 - 3 at the Suffolk Hilton Garden Conference Center, this year’s Expo drew 150 attendees, mostly EMS providers, from around the region, state and even as far as Michigan. Tidewater EMS Platinum Partner Sentara was the Expo’s main sponsor with support also from a Virginia EMS Rescue Squad Assistance grant and Physio-Control.

New this year was an extension of the program to include Friday daytime. The Friday day program included hands-on skills on topics like CPR and AED, childbirth emergencies, heart anatomy, advanced airway techniques and patient assessment. All three days featured three tracks: BLS, ALS and either hot topics or critical care.

Also new this year was an evening of games featuring corn hole, ring toss, ball throwing and more. Game winners, those who visited exhibitors and those who purchased pink shirts to support the Pink Heals women’s cancer awareness received raffle tickets for a number of prize baskets.

Expo course handouts and a larger photo gallery are posted on the TEMS website at www.tidewaterems.org.

Pink Ambulance Honors Cancer Battle

By Elizabeth Beatty

Medical Transport, LLC is proud to introduce “Miss Vicki-Medic 23” our pink ambulance. Placed in service on March 12, 2011, she made her debut in the Ocean View St. Patrick’s Day Parade. “Miss Vicki” has been named in honor of our Senior Billing Representative, Vicki Prescott. Vicki is a two time warrior in the Battle known as Cancer.

Medical Transport worked with Pink Heals Guardians of the Ribbon-Virginia Chapter to promote support of women and their families while battling cancer-All Women, Any Cancer! “Miss Vicki” proudly displays their emblem. Further information on this organization can be found on www.pinkfiretruck.org.

“Miss Vicki” is in service daily and can be seen transporting patients all over Tidewater. She also will be on display at many community service events. Contact Elizabeth Beatty of Medical Transport at exbeatty@sentara.com for more information on “Miss Vicki” or scheduling her for display.

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Chesapeake Fire Gary Burke / 673-8741

Critical Care Concepts “C3” Richard Patterson / 986-2879

Eastern Shore Hollye Carpenter / 678-0411

Franklin Tim Dunn / 562-8581

Isle of Wight Rescue Grady Miller / 357-2587

HRMMRS Judy Shuck / 963-0632

Kent J. Weber - Simulation Center Laura Walker / 963-0632

Nansemond - Suffolk Rescue Kevin King / 539-6870

The Center For EMS Training Bobby Ward / 465-0100

Medical Transport LLC Elizabeth Beatty / 962-6813

Norfolk Fire/Rescue Michael Oneil / 441-5252

NorthStar First Response Ashley Staley / 410-7518

Portsmouth Fire Rescue Charisse Orton / 396-0517

Southside Regional Fire Academy (SRFA) Janet McDaniel / 393-8155

Special Event Providers Kevin Renshaw / 284-1786

Suffolk Fire Rainey Cross / 514-4546

TCC Va. Beach Campus Lorna Ramsey / 822-7335

TCLS - CPR, First Aid Gordon Degges / 446-5926

TCLS - ACLS/PALS Tom Mingin / 446-5993

TEMS Jay Porter / 963-0632

Virginia Beach Bruce Nedelka / 385-2970

Training Contacts

Directors elected to the board were:

Jason R. Loftus, representing Accomack County

Dominador F. Fermil, James E. Manley and George M. Yacus, PhD, representing the city of Chesapeake

Terry A. Bolton, representing the city of Franklin

Joseph R. “Rusty” Chase, representing Isle of Wight County

Barry J. Knapp, MD, Daniel A. Norville and Jeffrey F. Wise and representing the city of Norfolk

Hollye B. Carpenter, representing Northampton County

James E. Hoffler, representing the city of Portsmouth

Robert S. Grizzard, representing Southampton County

John C. Hoffler, representing the city of Suffolk

Bruce W. Edwards, Stewart W. Martin, MD, Wayne E. Shank, Kent J. Weber, and James O. Carleo, MD, representing the city of Virginia Beach

Lewis H. Siegel, MD, representing the Virginia College of Emergency Physicians

Janice E. McKay, RN, representing the Tidewater Emergency Nurses Association

Joseph P. Lang, MD, representing the Eastern Virginia Medical School

Genemarie W. McGee, RN, representing the Virginia Hospital and Healthcare Association

T. J. McAndrews, representing the region’s special operations

Richard A. Craven, MD, at-large director

In addition to the officers, the board elected four at-large members of the executive committee: Bruce W. Edwards, John C. Hoffler, Genemarie W. McGee and Daniel A. Norville.

While many of the directors were reelected, three new persons are joining the board. James O. Carleo, MD of Virginia Beach is one of the founders of Emergency Physicians of Tidewater and the emergency medicine training program at the Eastern Virginia Medical School. He currently practices with Team Health. Daniel A. Norville of Virginia Beach is a Battalion Chief with Norfolk Fire Rescue, a Logistics Chief with Virginia-1 Disaster Medical Assistance Team and winner of the Tidewater EMS Council’s excellence award in 2007. Richard A. Craven, MD of Virginia Beach practices occupational medicine in Chesapeake and he has received various local, regional and state awards for EMS and teaching.

The board recognized and thanked retiring directors Robert W. “Rusty” Hundley of Suffolk who was a charter director and served on the board since 1974 and Robert N. Sayles of Norfolk who served on the board since 2005.

The term of office begins April 1, 2011 and extends through March 31, 2013. The number of directors representing a locality is based on population: one director for each jurisdiction then an additional director for each population increment of 100,000.

The mission of the Tidewater EMS Council is to reduce morbidity and mortality by facilitating regional cooperation, planning and implementation of an integrated emergency medical services delivery system. The Council is a 501 (c) (3) non-profit organization chartered in 1974. The Tidewater EMS region, designated by the Virginia Board of Health, consists of ten cities and counties in southeastern Virginia represented by the board.

Tidewater Ems Council Board Elects Directors and Officerscontinued from page 1

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On behalf of the Tidewater Emergency Nurses Association (TENA), we are requesting your support of our request for EMS personnel to bring patient medications to the Emergency Department whenever obtaining such medications will not delay transport or impede other duties.

The basis for this request is our shared concern for patient safety and medication error prevention. Nurses from the various emergency departments in the Tidewater area brought this up for discussion at a recent TENA meeting. The Joint Commission recommends that a list of medications and dosages

be obtained from all patients when presenting to the hospital. Unfortunately, it is often difficult to obtain a complete and accurate medication history in the emergency department, especially during initial assessment. We often encounter discrepancies including omissions, duplications, and unclear information from the patient and significant others. Having EMS personnel bring medications with the patient to the emergency department can help to alleviate some of the problems that arise when obtaining the medication history.

Specifically, we are asking that current medications, including those

taken at scheduled times and those taken on an as-needed basis, be brought to the emergency department with the exception of medications requiring refrigeration. An additional exception to this request is patients transported from nursing homes where a current medication administration record (MAR) is available.

Medication reconciliation begins with the patient’s first contact with EMS. We appreciate your collaboration with Tidewater Emergency Nurses Association in taking a proactive approach to improving medication safety across the continuum.

Power Outage Causes Rare ‘Critical Divert’ at

Sentara Norfolk General HospitalBy Dale Gauding, Sentara Corporate Communication

When a car hit a power pole in Norfolk on Monday, April 4, it caused a widespread power outage affecting thousands of customers, including Sentara Norfolk General Hospital and Children’s Hospital of The King’s Daughters.

All four emergency generators at Sentara Norfolk General came on as designed, however, the massive surge from the Dominion Virginia Power circuit failure damaged an automatic control circuit that controls distribution of power throughout the complex, leaving Sentara Heart Hospital, the River Pavilion wing and part of the Kaufman wing without power.

“It was a worst-case scenario,” says Elisabeth ‘Rusty’ Bradfield, Director of the ED at Sentara Norfolk General Hospital, the region’s only Level I trauma center. “Damage to the control circuit left us with dark ORs, which forced us to go on ‘critical divert’ just after 4:00 o’clock in the afternoon on a very busy day.”

Bradfield can barely remember the last time Sentara Norfolk General went on divert, but it has been several years.

“We’re a trauma center.” Bradfield continues. “My bias is to never go on divert, but this was a situation in which we had no access to surgery.”

Having heard the hospital was on diversion, local news people reported that Sentara Norfolk General’s ED was not taking any patients, which was inaccurate. Walk-ins were being accepted throughout the event and the hospital had merely requested diversion from EMS, a nuance often lost in the rush of breaking news.

Ultimately, EMS personnel in the field have discretion in where to take patients and Sentara Norfolk General did accept two bravo trauma cases from motor vehicle accidents during the time they were on diversion.

Emergency Nurses Urge EMS To Bring Medications With PatientsAntoinette Higgins, RN, President, Tidewater ENA and Janice McKay, RN, Immediate Past President

“Going on diversion affects our EMS partners and all the other hospitals in the area,” Bradfield says. “It takes ambulances longer to handle patients, it pushes the capabilities of hospitals that are not trauma centers and when you come off diversion, they’re often at capacity.

“EMS knew this was serious for us for request diversion,” Bradfield recalls, “and they did their best to work with us.”

Fortunately, power was restored at Sentara Norfolk General after about 40 minutes. The ED lifted critical divert at 6:30pm after just over two hours.

That night, the hospital brought in a high-capacity generator mounted on a tractor-trailer and large enough to serve the buildings affected by the damaged controller just in case the power went out again while a critical repair part was flown in from Atlanta. Crews worked through the night to assure power delivery was uninterrupted.

“It was a learning experience,” Rusty Bradfield concludes. “We’ll use this event to improve our systems and responses and hopefully avoid anything like it in the future.”

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Bon Secours DePaul Earns Primary Stroke Center CertificationBy Jennifer A. Smith, FACHE, FACCA, CAAMA

The designation of Bon Secours DePaul Medical Center in Norfolk by The Joint Commission as a Primary Stroke Center is the highest attainable national recognition of service excellence in the care of persons experiencing an acute stroke.

To become a TJC accredited Primary Stroke Center, a healthcare facility must demonstrate a commitment to excellence. This process requires an interdisciplinary coordination of services to recognize, diagnose and rapidly treat acute ischemic and hemorrhagic stroke, often within a very small time window of opportunity.

A very dedicated team of Bon Secours workers began meeting over a year ago – forming the Bon Secours DePaul Stroke Operations & Quality Team. Through this Team’s efforts resulted in neurology education and training of the primary stroke units as well as ensuring house-wide awareness training on stroke prevention and warning signs. Stroke order sets and nursing clinical pathways are in use and, in addition, this past fall Bon Secours DePaul implemented tele-neurology - an innovative service that provides 24/7 coverage by board-certified neurologists using high-resolution audio/video equipment - in the emergency department. This service has allowed DePaul to increase its brain reperfusion (rtPA) capability, thus already greatly improving the quality of care to stroke patients.

National guidelines demonstrate that establishing a primary stroke center significantly improves the outcomes for stroke patients.

The Joint Commission Certified Primary Stroke

Centers in the Tidewater EMS Region

(as of 3-31-11)

Bon Secours Health Center at Harbour View

Bon Secours Maryview Medical Center

Bon Secours DePaul Medical CenterChesapeake Regional

Medical CenterSentara Leigh Hospital

Sentara Norfolk General HospitalSentara Virginia Beach

General Hospital

POST Helps Caregivers Honor End-Of-Life WishesBy Jim Chandler

Somewhere between Advanced Directives, Durable Do Not Resuscitate and a patient’s wishes is a gray area about end-of-life patient care. A program begun on the west coast helps caregivers identify and honor those end-of-life wishes. That program has taken root in the Roanoke area of Virginia, and will soon come to Norfolk.

The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm program is designed to improve the quality of care people receive at the end of life. It is based on effective communication of patient wishes, documentation of medical orders on a brightly colored form and a promise by health care professionals to honor these wishes. The program acronym can and does change from state-to-state. In Virginia, the program is known as POST (Physician Orders for Scope of Treatment).

Sentara Leigh Hospital, in partnership with long term and hospice care facilities within its catchment area in Norfolk, will begin a pilot POST program sometime this late Spring or early Summer. There will be a similar pilot program on the Peninsula out of Riverside Regional Medical Center.

Differing from DDNR, POST can list additional medical interventions desired by a patient. Those interventions are generally grouped into three levels:

a comfort measures only (usually with no hospital admission)b limited intervention (possible hospital transport but no ICU)c Full treatment (including ICU care)Each level is slightly more detailed than this list, providing a menu of end-of-life choices within each level.Studies have shown that POLST experience elsewhere is associated with decreased hospitalizations at the time of death, but to

be effective it needs to be integrated into the healthcare and hospital system and included in regular healthcare provider training, including EMS.

Facilities and agencies partnering with Sentara Leigh have been in discussions about POST since late in 2010. After caregivers gain experience during the pilot program, Sentara plans to expand the program and will closely coordinate such expansion with impacted agencies and facilities. General information about this topic can be found at the website www.polst.org.

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They are the first responders...

They are Virginia’s Emergency Medical Service teams...

the selfless...

dedicated...

tireless ones.

and they are the unsung heroes. Day after day, night after night, EMS teams give their all...

and all of us at Bon Secours want to give our thanks.

EMS Week: May 15-21

Good Help to Those in Need®

bshr.com | Maryview | DePaul | Mary Immaculate | Harbour View | 889-CARE 2273

BON SECOURS VIRGINIA EMERGENCY SERVICES

BON SECOURS VIRGINIA EMERGENCY SERVICES

BON SECOURS VIRGINIA EMERGENCY SERVICES

In this Issue:National EMS Week is May 15 - 21Tidewater EMS Council Board Elects Directors and OfficersEMS Education Expo Draws 150Pink Ambulance Honors Cancer BattleEmergency Nurses Urge EMS To Bring Medications With PatientsPower Outage Causes Rare ‘Critical Divert’ at Sentara Norfolk General

HospitalBon Secours DePaul Earns Primary Stroke Center CertificationPOST Helps Caregivers Honor End-Of-Life Wishes

ADDRESS SERVICE REQUESTED

NONPROFITORGANIZATIONU.S. POSTAGE

PAIDNORFOLK, VA.

PERMIT NO. 2325

Tidewater EMS Council, Inc.6353 Center Drive, Suite 101Norfolk, Virginia 23502

RESPONSE is published by the Tidewater Emergency Medical Services Council with financial support from Medical Transport, LLC and the Virginia Office of Emergency Medical Services. Should you wish to be placed on our mailing list, or have any editorial comments, please write to:

RESPONSE, Tidewater EMS Council6353 Center Drive, Suite 101 • Norfolk, VA 23502

E-Mail: tidewater@vaems.orgWebsite: www.TidewaterEMS.org

President: Stewart W. Martin, MDExecutive Director and Editor: James M. Chandler, CAE

NEWS BRIEFSRecently sanctioned ALS providers in the region – EMT-I: Chris Case, Amy Dunn-Brown and Jeremy Windley. EMT-P: Erol Aydar, Shamera Boone, Amanda Mullen, Hunter Stafford and Kellie Wells. Congratulations!Dr. Audrey Grant, medical director for Bon Secours DePaul, Maryview and Harbour View and winner of the TEMS 2010 Outstanding EMS Physician Award has resigned to care for a family member in Northern Virginia. A replacement search is underway. In the interim, Dr. Joanne Lapetina, Medical Director for Emergency Services at DePaul Medical Center will assume the Medical Director role at Maryview. She will be assisted by Dr. Brian Gruber who will provide support for day-to-day operations at DePaul.TJ McAndrews and Jeffrey Wise have been appointed by TEMS Board president Stewart Martin to its Governance Committee. They will work with committee chair George Yacus and John Hoffler in support of the Board’s review of the strategic plan, board development, board effectiveness, leadership development and filling board vacancies.The TEMS Board of Directors agreed to an addendum to the TEMS-Hampton Roads Planning District contract which will provide funding for personnel to support projects in the FY10 federal MMRS Homeland Security Grant.Critical Care Concepts in Suffolk has announced a new toll-free telephone number 888-224-1451, new services and a new website: www.CriticalCareConcepts.net.The Virginia Beach Department of EMS, the ten volunteer rescue squads of Virginia Beach and the fire department have successfully completed their bi-annual Virginia Department of Health EMS agency inspection. This process included a detailed review of electronic medical records (EMR), training records and administrative documents. All ambulances, fire engines, ladder trucks, zone cars and the air ambulance were inspected—83 vehicles in all.