University of California San Francisco

SFFD EMS SYSTEM

•40 dynamically deployed ambulances•Shifts starting time from 0500 until 2130 from 1 central station•Only SFFD ambulances are participating in RAMPART•8 receiving hospitals participating in study•RAMPART implemented 6/19/09 on 10 rigs initially•First enrollment 6/27/09•45 enrollments•7 enrollments in 1 week in November•Prior PHTSE experience

Study Challenges

Continued Paramedic training

Informed Consent

RAMPART boxes/Megabundle management

Keeping the medics involved/informed and happy!!

And locating them!

RAMPART bulletin board w/FAQs, opt out bracelets, auto injector instructions, recent enrollment info, enrollment #s, coordinator contact info, etc.

Flyers with unit #/medics names for each enrollment

RAMPART FAQs Contact every crew that enrolls a subject Flyers with protocol clarifications posted or placed

in medic’s mailbox. Practice with expired auto injectors. In person review to start in January Mandatory on line CE for medics with RAMPART

included in sz/neuro/AMS module.

Protocol Clarifications

• If patient stops seizing after IM and before IV study drug, they don’t receive IV study drug.

• No focal seizures.• Getting medics to wait 5 min prior to

enrollment. • Patient must be actively convulsing.

Informed Consent

Challenges

• Homeless without any contact info, or marginally housed.

• With psych/substance abuse issues other seizure threshold lowering lifestyles.

• Subjects discharged from ED prior to investigator arrival or leave AMA prior to investigator arrival.

• Addresses not valid with notification letters returned

• In SF approximately 30% of subjects• Language issues • Cultural differences/Educational Issues

• Notification letters left in patient chart and/or mailed out to patient.

• Call ED prior to investigator arrival• Attempt to locate case manager,

LAR, psychiatrist, emergency contact or PMD.

• Make extra hospital visits• ED info form given by medics to ED

staff

RECE IVIN G ED RAM PA RT IN FOR MA TI ON CA RD

This patient has been enrolled in the RAMPART Prehospital

Seizure Study comparing paramedic treatment with IM Midazolam versus IV Lorazepam.

The patient has received

Adult Dose

Either

10mg Midazolam IM Or

4mg Lorazepam IV

Pediatric Dose

Either 5mg Midazolam IM

Or

The on call investigator will be calling the attending MD within 30 min to find out if the patient was seizing on arrival at the ED.

If you have further questions, please call the RAMPART pager at:

415-443-1500 If the patient is being discharged from the ED, please

call the RAMPART pager prior to discharge.

Thank you!

Adult Dose*

Either 10mg Midazolam IM

Or 4mg Lorazepam IV

Pediatric Dose*

Either 5mg Midazolam IM

Or 2mg Lorazepam IV

Thank you!

Jeany DuncanRAMPART EMS Coordinator

UCSFduncanj@sfgh.ucsf.edu

415-206-4106