Transcript Seattle Fire Department Medic One

Harborview Medical Center
Advanced Trauma Life Support
An Intro to Seattle Medic One

The year was 1969
 No standardized
system of prehospital
care
 Agreement between
a University of
Washington
Cardiologist and the
Seattle Fire Chief
starts a wild
experiment
A Historical Confluence
Seattle Medic One Early Directions
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Address 2 questions
 Can lives be saved?
 Can non-physicians be trained to provide
ALS satisfactorily?
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Acquire a better understanding of sudden
cardiac death
The Medic One Mantra
“To provide the quality of
emergency care comparable
to that by an appropriately
trained physician on the site”
-Dr. Cobb
Objectives
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Establish a Paramedic Training Program (Medic I)
 Teach cardiac arrest resuscitation
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Teach the citizenry of Seattle “C.P.R.” (Medic II)
1971- Army Major Dr. Copass Arrives
at Harborview
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Dr. Copass directs the Paramedic
Training Program and adds trauma care
to the curriculum
Medic One Accomplishments
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VF survival to discharge rate ~45%
 National ~3%
Amiodarone
 Prehospital Hypothermia after resuscitation
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 Initial trial 66% discharged alive (VF/VT)
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Change from 15/2, stacked shocks
 Continuous CPR (2005 ACLS)
 Seattle VF/VT rate ~35% to ~45%
Paramedic Training
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10 Months
2400 hrs (national average ~1000hrs)
Based at Harborview
Taught by Senior Paramedics & UW
Medical School Faculty
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Anesthesia
Cardiology
Pulmonary
Surgery
Emergency Medicine
Orthopedics
And many many more
Who are the Medic
Students?
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Identified by their
“White Coat” &
gunner attitude
16-24 of them per year
October to July
 Rotate in the ER
when not in class
or on the rigs
 Teach them stuff!
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The Trauma Doc
WAMI and You
The reality of Trauma Doc is you get
called about every major trauma in 25%
of the land mass of the USA!
 Or about 8.3 million people who live in
areas of those states who transfer to
Harborview
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 ~ One Level 1 trauma center
for all of NYC
King County EMS
Seattle
 Shoreline
 Redmond
 Bellevue
 South King County
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Seattle Medic Units
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7 Medic units
1
 10
 16
 18
 28
 31
 32
1 MSO Medic 44
 Medical Director Medic 55
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Seattle EMS: Who is Who?
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Tiered response system
 Engine, Truck, or Aid Car
 All Seattle Firefighters (EMT-B)
 Medics are ONLY dispatched on runs that
need ALS care or evaluation
 Practice makes perfect
○ In Seattle we have 86 medics total
○ In some large EMS agencies paramedics treat
an average of 1 cardiac arrest per/year
Who is Who:
Dispatch
When you call 911 you get a Medic One
dispatcher
 They can instruct telephone CPR and
dispatch appropriate BLS &/or ALS units
 They work for Seattle Fire and follow Seattle
Fire Department protocols
 They also page Trauma Doc/ Medic One Doc
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 You may never meet them, but you will work
closely with them
Who’s Who: SFD BLS crews
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Fire Engine, Ladder Trucks, and Aid
Units
 All trained to EMT-B level (~120hrs)
 ~3 minute response time
 Rescue and extrication of patients
 BB/CC and O2 prior to medic arrival
 Transports are rare
○ Aid Units
Who’s Who: AMR Ambulance
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Private BLS Ambulance
 All trained to EMT-B level (~120hrs)
 Contracts with the City for BLS transport
 Patient is billed for transport
 <10 minute response time
 Transport of BLS patients after evaluation by SFD
 Use their own company protocols
 Transports are abundant
○ Will not call ahead
○ Check in at back triage
Who’s Who: Medic One Paramedics
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Seattle ALS Transports
 Two paramedics per Unit, (with two medic students)
 <5 minute response time
 Start ALS care while BLS crews BB/CC, O2 , splinting
 Transports frequent (but most are medicine)
○ Will have dispatch page Trauma Doc
○ Short report to Trauma Doc via Radio
○ Need your permission for medications (FDA requirement)
Who’s Who: Medic One Paramedics
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Trauma specific ALS skills
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Airway: Intubation, RSI, TTJV*, Cricothyroidotomy*
Breathing: Flutter Valves
Circulation: IV’s, EJ’s, IO’s*, CVC*, pericardiocentesis*
Disability: GCS, avoiding: hypotension, hypoxia, & hypocapnea
Exposure: Patient will be naked for you
They will ask you for permission for all of these
unless patient is UNSTABLE
 Covered by Plan A-2 (Standing Order for Shock)
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Drugs: Etomidate, Succinylcholine, Rocuronium,
Midazolam, Morphine, Lactated Ringers
Trauma Scenario
MED-6 Response
North Aurora & N Aloha
 E10, M1
 Motorcycle vs. car
 Patient thrown 100ft
 Unconscious / is breathing
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E-10 arrives at 3 minutes
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Priorities
 Helmet removal
 BB/CC
 Initial exam
 Vital signs
○ BP, HR, RR, AVPU
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They have about 2 minutes to do this
M1- Arrives at 5 minutes
Charge medic jumps out to eval the
patient
 Skills medic sets up for ALS procedures
 Once patient is BB/CC they go in the
back of the medic unit
 Once charge medic has an exam he will
call dispatch to page the Trauma Doc
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Trauma Doc Gets a Page
Go to the radio room
The Radio SHORT Report
Age, gender, Mech, eval, injuries,
 BP, HR, RR, GCS
 Ask for:
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 IV, LR, NT, RSI Meds, Intubation
 Blood Run
 ETA
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Vital to REPEAT back to the medics
After the radio report
Medics start their treatment plan and
begin to drive
 Trauma doc has ~5 min to do
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 Radio announcement
 Huddle with Charge RN to asses needs
 Heads to Resus 2 to set up for trauma
 Makes a plan with the trauma team for
arrival
Patient Arrival
Room should be quite
 Medic will give a FULL report in Resus 2
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 As patient is transferred
 Monitors are attached, blood draw
 Medics will take questions after report
 This is where ATLS begins!
Last thing!
YOU have the chance to help evaluate
paramedic students on ride along
 June through July
 You get paid
 Email sign up sheet
 Thanks!
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