Scottsdale fire, hospital partner to meet call demand

Twice in his career, Andy McDonald has slit someone’s throat to save their life.

The “cric,” short for cricothyrotomy, is an emergency airway technique in which a tube is inserted down a patient’s throat when using the mouth isn’t an option. A small, vertical incision is typically made just below the Adam’s apple and a tube is inserted into the slit.

“The hardest part about performing a cric is deciding to perform a cric,” McDonald explained to a trainee, during a recent practice session that featured rubber dummies and medical-grade equipment.

McDonald hasn’t attended a day of medical school — he’s an emergency medical services captain for the Scottsdale Fire Department. And the training took place not in a lab or hospital, but on the first floor of a Scottsdale fire station.

For years, firefighters throughout the Valley and nation have toed the line between firefighter and living-room medic. The trend is only increasing as more calls come in for emergency medical care than actual fires.

As an answer to this trend, the Scottsdale Fire Department partnered with Scottsdale Healthcare about 18 months ago to improve EMS preparedness. The partnership capitalized on existing emergency-room doctor oversight, but the doctor now is involved in the daily EMS operations of the fire department.

Firefighter paramedics and emergency medical technicians now are able to digitally transmit real-time information to emergency-room physicians while firefighters are on-scene, allowing treatment decisions to be made quicker than before.

Officials say these decisions dramatically cut down the time it takes for doctors to stop or minimize damage to a patient.

“This is a huge benefit when we talk about heart attacks, strokes and trauma,” McDonald said.

The partnership is producing measurable benefits.

For the past several quarters, the team has unfailingly met national benchmarks for emergency cardiac care and is helping to boost the industry standards.

“Door-to-balloon” time is the period between when a heart-attack patient enters the hospital and when he or she receives a balloon angioplasty. The Scottsdale team has hit the goal of 90 minutes or less 100 percent of the time for the past 16 months, and is now pushing to make 60 minutes or less the new norm. They currently meet the goal about half the time.

“That translates to better outcomes,” said Dr. Franco Castro-Marin, a Scottsdale Healthcare medical director and the city’s medical director for public safety. “The sooner that artery gets open, the better your heart is, and the less likely that you are going to die or suffer permanent disability from that heart attack.”

The Southwest Alliance for Excellence named Scottsdale Healthcare a 2013 Showcase in Excellence Award winner for the process “Door to Balloon — 60 is the New 90.”

Since around the turn of the century, in the Valley and around the nation, a firefighter’s daily role has steadily evolved into a medical focus, primarily based on demand.

Only 4 percent of all U.S. fire department calls in 2012 were for an actual fire, while 68 percent were for medical aid, according to the National Fire Protection Association.A decade earlier, fire calls accounted for about 8 percent of the calls to the department, medical about 61 percent; and in 1986, the earliest year of the survey, fire reports claimed 19 percent of the calls, and medical 54 percent.

“Firefighting is not our daily bread anymore,” McDonald said.

Subsequently, a new sub-specialty in medicine was born for doctors whose careers are focused on educating and overseeing emergency medical service personnel. In 2010, the American Board of Medical Specialties announced that emergency medicine doctors could now become certified in emergency medical services. The first wave of doctors to receive this certification did so last year.

Castro-Marin, who is studying to become one of the first physicians in the Valley with this certification, said he aims to train EMTs and paramedics to treat patients with the same level of quality that he would in the ER.

“For me, we’re at a flashpoint of really starting to accept that, in EMS, the ‘m’ stands for’medicine,’ ” he said. “Through engaged physician oversight, our paramedics and EMTs are truly providing hospital-level care, that even though it’s happening in your living room, can possibly change your outcome when you’re discharged from the hospital.”

Scottsdale Fire Division Chief John Whitney said the partnership has opened the paramedics and EMTs up to a new technology-focused model to benefit the patient.

“We’re really leaving no stone unturned to find the best way to find the best possible outcome for the patients we treat,” he said.

Castro-Marin said he brings with him the principles doctors use to measure patient outcomes. Doctors receive internal report cards to underline areas that need improvement. Similarly, paramedic and EMT performance is measured in quantifiable categories: How many breathing-difficulty patients got oxygen? How many heart attack patients received aspirin?

Castro-Marin then crunches the numbers and uses the results to tailor his training. Recently the data showed that quality had slipped in advanced airway techniques, and the figures provided for a March refresher course on the subject.

“We isolate the trends, good and bad, and then we just hammer the bad,” Castro-Marin said.

Article source: http://www.azcentral.com/story/news/local/scottsdale/2014/04/28/scottsdale-fire-hospital-partner-meet-call-demand/8407725/