Seattle Fire Department Medic One

1. Harborview Medical Center Advanced Trauma Life Support Seattle Fire DepartmentMedic One

2. 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

3. A Historical Confluence

4. Seattle Medic One Early Directions • Address 2 questions • Can lives be saved? • Can non-physicians be trained to provide ALS satisfactorily? • Acquire a better understanding of sudden cardiac death

5. The Medic One Mantra “To provide the quality of emergency care comparable to that by an appropriately trained physician on the site” -Dr. Cobb

6. Objectives • Establish a Paramedic Training Program (Medic I) • Teach cardiac arrest resuscitation • Teach the citizenry of Seattle “C.P.R.” (Medic II)

7. 1971- Army Major Dr. Copass Arrives at Harborview • Dr. Copass directs the Paramedic Training Program and adds trauma care to the curriculum

8. Medic One Accomplishments • VF survival to discharge rate ~45% • National ~3% • Amiodarone • Prehospital Hypothermia after resuscitation • Initial trial 66% discharged alive (VF/VT) • Change from 15/2, stacked shocks • Continuous CPR (2005 ACLS) • Seattle VF/VT rate ~35% to ~45%

9. Paramedic Training • 10 Months • 2400 hrs (national average ~1000hrs) • Based at Harborview • Taught by Senior Paramedics & UW Medical School Faculty • Anesthesia • Cardiology • Pulmonary • Surgery • Emergency Medicine • Orthopedics • And many many more

10. Who are the MedicStudents? • 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!

11. The Trauma Doc

12. 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 • ~ One Level 1 trauma center for all of NYC

13. King County EMS • Seattle • Shoreline • Redmond • Bellevue • South King County

14. Seattle Medic Units • 7 Medic units • 1 • 10 • 16 • 18 • 28 • 31 • 32 • 1 MSO Medic 44 • Medical Director Medic 55

15. Seattle EMS: Who is Who? • 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

16. 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 • You may never meet them, but you will work closely with them

17. Who’s Who: SFD BLS crews • 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

18. Who’s Who: AMR Ambulance • 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

19. Who’s Who: Medic One Paramedics • 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)

20. Who’s Who: Medic One Paramedics • Trauma specific ALS skills • 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) • Drugs: Etomidate, Succinylcholine, Rocuronium, Midazolam, Morphine, Lactated Ringers

21. Trauma Scenario

22. MED-6 Response • North Aurora & N Aloha • E10, M1 • Motorcycle vs. car • Patient thrown 100ft • Unconscious / is breathing

23. E-10 arrives at 3 minutes • Priorities • Helmet removal • BB/CC • Initial exam • Vital signs • BP, HR, RR, AVPU • They have about 2 minutes to do this

24. 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

25. Trauma Doc Gets a Page

26. Go to the radio room

27. The Radio SHORT Report • Age, gender, Mech, eval, injuries, • BP, HR, RR, GCS • Ask for: • IV, LR, NT, RSI Meds, Intubation • Blood Run • ETA • Vital to REPEAT back to the medics

28. After the radio report • Medics start their treatment plan and begin to drive • Trauma doc has ~5 min to do • 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

29. Patient Arrival • Room should be quite • Medic will give a FULL report in Resus 2 • As patient is transferred • Monitors are attached, blood draw • Medics will take questions after report • This is where ATLS begins!

30. 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!