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Health Check: State rolls out biggest change to EMS protocols in 20 years

Significant changes to the state’s emergency medical protocols will soon be rolled out and officials at the Rhode Island Department of Health want to put patients and their families on alert.

It has been more than 20 years since the protocols have been revamped. Some of the changes have been met with opposition from a few fire departments.

“Historically, this is the biggest change in protocols since 1995,” Jason Rhodes, chief at the Center for Emergency Medical Services at Rhode Island Department of Health , told NBC 10 News.

Bringing the hospital to the field

The most notable and controversial change is with the state’s cardiac arrest protocol, which now states emergency responders are to spend 30 minutes on scene resuscitating a cardiac arrest patient where they are found.

Prior to the change, emergency responders would move and load patients while performing CPR and get them into the ambulance and to the hospital as soon as possible, a move often referred to by responders as “scoop and run.”

The previous protocol allowed the provider with the opportunity to leave, but now with scientific-based evidence in hand, the health department says it’s best to stay and provide compressions for a longer period.

Performing CPR in an ambulance proved to be ineffective, but hands-only CPR was found to be a key step in the chain of survival for patients.

“Survival rates jumped from 20 percent to about 47 percent in North Carolina after the medical director instructed this process four years ago,” Rhodes said. “And recently published studies show people who were being revived in the field are leaving the hospital neurologically intact.”

John Potvin, emergency cardiovascular care liason with the American Heart Association Regional Board of Directors, also told NBC 10 News that communities that use the 30-minute protocol have seen great results.

“We as the heart association recommend prompt CPR where the patient is found and then rapid use of an AED,” Potvin said.

Rhodes agreed adding that the additional time to work on a patient in cardiac arrest allows EMS practitioners to focus on what they’re are doing rather than rushing to get the patient into the ambulance and to the hospital.

“When you have to move them down stairs, out on a stretcher and to the truck, you lose the time of the pump,” Rhodes said.

Concerns with change

Some emergency personnel first expressed concerns about the change during an Ambulatory Services Board meeting in September, others expressed concerns outside of meetings. The concern? How the public would react to their loved ones not being taken to the ER immediately, the amount of time fire departments had to prepare and the impact it would have on resources and budgets.

“We want to quell these fears,” Rhodes told the emergency personnel during the September meeting. “It’s been approved, it’s done and we want to educate people on what will get done in the future.”

While the protocols were approved, they were not going to be made mandatory until January 1, 2017, giving municipalities a few more months to prepare and address the issues.

Aside from the concern over public perception, Rhodes said some are concerned about provider safety because a family member may try to assault a responder for not rushing the patient to the hospital.

An additional concern is allocation.

“Some thought it would extend the time on the scene and take vehicles out of service,” Rhodes said. “Medically related cardiac arrests in Rhode Island average out to about two a day across the state, so we don’t feel (the new protocol) will place a huge burden on them.”

Paul Casey, EMS director at the Cranston Fire Department, agreed that the new orders will use more resources and tie up assets longer, but added that it’s no different than a ladder truck being tied up for a water pump out.

Casey said he personally embraces the new protocol. “For the last 30 years, EMS has arrived on scene and we’ve been scooping and screwing to the hospital and the public perception has been hurry up and get them to the hospital,” he said.

But what the hospital does and the EMTs do in the field in that first 30 minutes is the same, according to Casey.

“We need to adapt to change,” he said. “Rhode Island is one of the last states to grasp this concept of doing CPR for 30 minutes where you found the patient.”

NBC 10 contacted a number of departments including Coventry and Tiverton, but they were not willing to comment.

Strongest opposition

The strongest opposition was from the Rhode Island Association of Fire Chiefs, according to Rhodes. “They have a different angle – they look at it from a financial perspective,” he said.

Richard Susi, a former fire chief and now spokesperson for the association, said members did have some concerns, but also understands the health department’s ultimate goal to increase survival rates.

“If this is what they are saying and experts and data say it’s the best change for EMS providers to save someone’s life, that’s how we have to do it,” Susi said.

The association’s biggest concern was with the required training that would be needed before the protocols were to be enacted – January 1, 2017.

“They needed this little bit of extra time on how to enact this,” Susi said of association members. “The timeframe was getting tight.”

Since then, the association and ambulatory services board has had a number of productive meetings and are on board with the new protocol. Those municipalities needing an extension were required to request one and were granted a 60-day extension bringing the deadline to March 1, 2017.

As for public perception, the association has a resolution for that – a public education campaign that will launch a public service announcement to bring Rhode Islanders at ease and up to speed on the new protocol.

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