here - Suffolk REMSCO

EMS LIFELINE—VOLUME 2,
ISSUE 3
MARCH 2011
EMS LIFELINE
Suffolk County Executive
Steve Levy
Commissioner, Dept. of Health Services
James L. Tomarken, MD
MSW, MPH, FRCPC, FACP
Division of Emergency Medical Services
Linda K. Mermelstein, M.D., M.P.H., Interim Medical Director
Robert Delagi, M.A., NREMT-P, Acting Director
IN THIS ISSUE:
New York State DOH/BEMS
Issues Policy Statement #11
-02, Revised MOLST Form
EMS Leaders
Left Ventricular Assist Devices
(LVAD) and EMS
National EMS Memorial Bike
Ride
VHF/UHF Narrowbanding
AMAZING MEDICAL
FACTS
Our lungs inhale over
two million liters of air
every day, without even
thinking. If laid out flat,
they are large enough
to cover a tennis court.
NYS-DOH/BEMS Announces NEW MOLST Form
Policy Statement # 11-02
1
MOLST (Medical Orders for
Life Sustaining Treatment) is an alternative
form for patients to document
their end-of-life care preferences and
to assure that those preferences are
made known to health care providers
across the health care delivery system.
Unlike the Nonhospital Order To Not
Resuscitate, the MOLST form documents
DNI orders and orders regarding
other life-sustaining treatment, in
addition to DNR orders. MOLST should
be honored by EMS agencies, hospitals,
nursing homes, adult homes, hospices
and other health care facilities
and their health care provider staff.
One major change regarding the new
MOLST form is that it has been approved
by the Office of Mental Health and
the Office for People with Developmental
Disabilities for use as a nonhospital DNR/
DNI form for persons with developmental
disabilities, or persons with mental illness,
who are incapable of making their own
health care decisions or who have a guardian
of the person appointed pursuant to
Article 81 of the Mental Hygiene Law or
Article 17-A of the Surrogate’s Court Procedure
Act. The second major change is
that the new MOLST form addresses what
EMS providers should do if they encounter
a newly completed MOLST Form that does
not have an authorizing physician’s signature.
The MOLST form was updated in
June 2010 to make it more user-friendly
and to align the form with the recently enacted
Family Health Care Decisions Act. The
MOLST form is currently utilized by many
health care systems. If a patient has a prior
version of the MOLST in place and signed
by a physician, the form is still considered
VALID, and the patient care orders
should be honored, unless it is known
that the patient’s form has been revoked.
EMS providers and agencies who
are interested in more specific training regarding
the MOLST form and process may
go to http://www.compassionandsupport.org.
This site has a specific training program for
EMS providers and contains frequently
asked questions as well as a training video
that would be useful to better understand
the MOLST form and process.
++++++++++++++++++++++++++
Adapted from NYS DOH/BEMS Policy
Statement #11-02
kwk

EMS LIFELINE—VOLUME 2, ISSUE 3
OSHA’s “Top Ten”
Citations for 2010
The requirements for
agencies with ―at risk‖
personnel has been in
place since 1990 and
contaminated sharps
injuries represent 80%
or more of healthcare
worker exposures! The
following are the ―top
ten‖ violations issued by
OSHA in 2010:
1. Not having an Exposure
Control Plan.
2. No annual plan update.
3. No initial or annual
training offered to
staff and at no cost.
4. Not offering HBV
vaccine and titers to
staff.
5. No employee input
to selection of needle
safe devices.
6. Not having declination
forms.
7. Not having sharps
containers at the
site of use.
8. Not offering HBV
and post-exposure
medical follow-up.
9. Not maintaining
proper medical records.
10. Not maintaining a
sharps injury log.
From The Chief’s Desk...
Bob Delagi, MA, NREMT-P, Chief of Pre-Hospital Medical
Operations and Acting Director
+++++++++++++++++++++
EMS Leaders Seminar
As one of our Program Agency contract
deliverables, EMS Division staff are required
to meet with the leadership of
every certified ambulance and first response
service operating in Suffolk
County to offer our assistance in helping
you meet your agency’s management
and operational needs. This EMS
Leader’s Seminar has proven successful
in the past, and affords newly elected
or appointed individuals the opportunity
to learn about the issues associated with
managing an ambulance or first response
service in this highly regulated
environment. We have scheduled a
series of meetings throughout the county
during the first half of 2011, as listed
below. For convenience, we have arranged
the schedule by township / division.
However, you are welcome to attend
any session that is more convenient
for your schedule. Each meeting will
begin at 7:00 P.M.
We appreciate your active participation.
Meetings such as this are important to stimulate
honest, open discussion about the
issues that you deem important to the success
of your operation. At the same time,
meetings such as this give us - as the Suffolk
Regional EMS System administrators -
an opportunity to ensure that agency
leaders and managers are well informed
on the issues you are responsible for.
Please accept our invitation to two (2) or
three (3) key individuals in elected or appointed
positions from your organization
responsible for managing your ambulance
or first response service to share best
practices and barriers alike, so that we
may work together to ensure continued
success of our regional EMS system. Kindly
RSVP to the EMS Office by calling Deborah
Johnson at 853-5800 or via email:
deborah.johnson@suffolkcountyny.gov
—————————————————
NOTE: One or more of these sessions may
have already been held by the time this
Newsletter is distributed (see schedule below)
Date Division Township Location
March 7 1st/3rd Babylon/Islip Bay Shore-Brightwaters Ambulance HQ
March 21 2nd/4th Huntington/
Smithtown
Huntington Community FAS HQ
CANCELLED DUE TO LACK OF ENROLLMENT
April 4 5th South S. Brookhaven South Country Ambulance HQ
May 2 7th/9th Southampton/East
Hampton
May 16
6th/8th/
10th
Riverhead,
Southold, Shelter
Island
Sag Harbor Ambulance HQ
Southold FD HQ
June 6 5th North N. Brookhaven Miller Place FD HQ
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EMS LIFELINE—VOLUME 2, ISSUE 3
Left Ventricular Assist Device (LVAD)
A new device, designed to help patients with
advanced heart failure while awaiting a
heart transplant may be seen by EMS personnel.
This device is known as an implanted
left ventricular assist device (LVAD).
Heart failure occurs when the heart becomes
too weak to pump enough blood to meet the
body's needs. The heart is a muscular pump
divided into four chambers. The upper chambers
are called the atria and the lower
chambers are called the ventricles. The left
ventricle is your heart's main pumping chamber
and is responsible for pumping blood to
the body. For some people with heart failure,
the left ventricle weakens to the point that it
can no longer pump enough blood on its own.
“The task of the
leader is to get his
people from where
they are to where
they have not been.”
Henry Kissinger
An LVAD is a surgically implanted, batterypowered
pump that helps the left ventricle
pump adequate amounts of blood to the
body. The LVAD is implanted in the patient’s
upper abdomen and connected to a power
supply located outside the body. Blood is
sent through a tube in the left ventricle into
the LVAD, which pumps the blood through
another tube into the aorta and throughout
the body. An LVAD can be implanted in people
who are candidates for a heart transplant
as a "bridge to transplant."
Patients with LVADs will not have a palpable
pulse because the centrifugal pump is doing
the work; additionally, normal CPR may NOT
be indicated as the pump may actually be
working. Chest compressions may result in
aortic anastomosis or dislodgement of the
LVAD inflow tract. Clinical judgment should
be used when deciding to perform external
chest compressions.
When the Regional LVAD Center at University
Hospital discharges a patient to their home
who resides in your district, they will notify
your agency and provide specific training on
the management of the patient. As always, if
you encounter a patient in the field with this
or any other medical device that you may
not be familiar with, please contact Medical
Control for direction.
(Information above courtesy Stony Brook LVAD
Center—used with permission)
The Suffolk County EMS Division will be hosting
LVAD training on Wednesday, June 29, 2011
from 7pm-9pm. Please call 853-5800 to register
for this course.
Top picture: LVAD Heartmate XVE (older)
Middle picture: LVAD Heartmate II (newer)
Bottom picture: Patient on home tethered
unit with Power Base Unit (PBU)
For additional information on LVAD training,
contact the SCEMS office.
++++++++++++++++++++++++
Karl W. Klug, B.S., CIC, EMT-CC
Deputy Chief of Operations
3
“You Make The Call”
Your patient is a 63 year
old male with a history of
degenerative heart disease
who is awaiting a heart
transplant. Your ambulance
has been called because
the patient’s wife found her
husband unconscious in a
chair in his living room.
The wife states her husband
was watching TV and
suddenly lost consciousness.
Your patient is unresponsive,
apneic, and has
an LVAD device attached to
him. You and your crew
move the patient to the
floor, open his airway and
deliver two breaths which
results in adequate chest
rise. You check the patient’s
carotid pulse, and there is
no palpable pulse. As your
partner bares the patient’s
chest, you notice that the
percutaneous lead has become
disconnected from
the System Controller.
Would you reconnect the
percutaneous lead to the
S y s t e m C o n t r o l l e r ?
Why or why not?

Answers to ECG Quiz: 1-A; 2-C; 3-A; 4-A
EMS LIFELINE—VOLUME 2, ISSUE 3
2011 National EMS Memorial Bike Ride
Is Your Department Compliant With The FCC
Narrowbanding Requirements?
The National EMS Memorial Bike Ride Inc.
is proud to announce the 2011 East Coast Bike Ride.
This event starts May 14, 2011 in Boston, MA and will
travel over 8 days and end on May 21, 2011 in Alexandria,
VA.
Route information:
May 14–Boston to South Kingston, RI
May 15–South Kingston, RI to Riverhead, NY
May 16–Riverhead, NY to Westbury, NY
May 17–Westbury, NY to Bangor, PA
May 18–Bangor, PA to Ephrata, PA
May 19–Ephrata, PA to Gettysburg, PA
May 20–Gettysburg, PA to Alexandria, VA
May 21–Ending Ceremony/celebration
Please note that on May 15, the ride will arrive in Orient
via ferry from Rhode Island and will travel west towards
Riverhead. On May 16, the ride starts again from Riverhead
and continues west towards Nassau County. The
Suffolk County EMS Division has been in contact with the
event organizers and is coordinating EMS assistance at
rest stops along the route. You can help support this
worthy event by providing stand-by coverage at the rest
stops in your district, or by registering and riding by going
to: http://muddyangels.org/
For further information, please contact Karl W. Klug at
853-8309or karl.klug@suffolkcountyny.gov.
On December 11, 2009, the Federal Communications Commission
announced that private land mobile services that operate
in the 150-174 (MedCom Dispatch, ―F3‖) and 421-512
MHz frequency bands must migrate to narrowband technology
(12.5 kHz or narrower). The Commission also stated that
as of January 1, 2011, they would no longer accept license
applications for new wideband 25 kHz (i.e., operating with
only one voice path per 25 kHz of spectrum) operations, nor
modification of existing wideband 25 kHz stations that expands
the authorized interference contour (19 dBu VHF, 21
dBu UHF). Additionally, the Commission stated that by January
1, 2013, Public Safety Radio Pool licensees must operate
on 12.5 kHz (11.25 kHz occupied bandwidth) or narrower
channels, or employ a technology that achieves the narrowband
equivalent of one channel per 12.5 kHz of channel
bandwidth (voice) or 4800 bits per second per 6.25 kHz
(data).
So, where does that leave your organization? If your agency
operates on a frequency within the 150-174 MHz (―VHF Hi‖)
or 421-512 MHz (―UHF/T-Band) frequency range, your radio
equipment MUST be capable of operating in 12.5 kHz bandsplit
and a new license must be filed that has the correct emission
designator. If equipment that is not compliant with narrowbanding
is used, it will not only not work with compliant
equipment but will cause harmful interference with compliant
equipment. This action is carried as a willful violation of FCC
rules, which may result in significant monetary fines and/or
license revocation.
The Suffolk County EMS Division has taken the initiative to
address this requirement by making public announcements of
this requirement to all EMS agencies and fire/EMS organizations
for over a year. The EMS Division has maintained contact
with the Department of Fire, Rescue and Emergency Services
and verified that collectively, we intend to support the
FCC requirement by ensuring that all base stations, mobiles,
and portable radio equipment are in compliance with this
FCC mandate. Additionally, the EMS Division has requested
funding for a Capital Project that will provide a new mobile
radio in the ―VHF Hi‖ range for every ambulance in Suffolk
County. The continued use of ―VHF Hi‖ mobiles in ambulances
is necessary as part of the County and State’s EMS Mutual
Aid plan(s), as well as on-site coordination, contact with Medical
Control, and lessening of burdening of the County’s 800
MHz system during a widespread disaster or potential failure
of the 800 MHz radio system.
Karl W. Klug, Deputy Chief of Operations
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EMS LIFELINE—VOLUME 2, ISSUE 3
Suffolk County Emergency Medical Services
P.O. Box 6100
100 Veterans Highway
Hauppauge, New York 11788-0099
Phone: 631-853-5800
Fax: 631-853-8307
WE’RE ON THE WEB! WWW.SUFFOLKREMSCO.COM
“It is the mission of the Emergency Medical Services
Division of the Suffolk County Department of Health
Services to provide the leadership, support, education,
and cooperation necessary to enable emergency
medical services agencies serving our County to provide
the best emergency medical care possible, and
to provide that leadership, support, education and
cooperation in a lasting and professional partnership
with the dedicated men and women of the Suffolk
County Emergency Medical Services System”
ECG Quiz Answers on Page 4
1.
This ECG rhythm is called:
a) Sinus arrhythmia c) Sinus bradycardia
b) Wandering pacemaker d) Atrial fibrillation
2.
This ECG rhythm is called:
a) Junctional rhythm with ST elevation and a PVC and a PAC
b) Sinus rhythm with ST elevation with a PVC and a PJC
c) Sinus bradycardia with ST elevation with a PVC and a PJC
d) Sinus arrhythmia with ST elevation and a PVC
3.
This ECG rhythm is called:
a) Sinus arrhythmia with a non-conducted PAC and a ventricular escape beat
b) Sinus bradycardia with a non-conducted PAC and a PVC
c) Wandering pacemaker with a non-conducted PAC and a PVC
d) Sinus rhythm with a non-conducted PAC and a PVC
4.
This ECG rhythm is called:
a) Sinus arrhythmia with aberrant intraventricular conduction
b) Sinus rhythm with aberrant intraventricular conduction and PACs
c) Accelerated junctional rhythm with aberrant intraventricular conduction
d) Accelerated idioventricular rhythm with aberrant intraventricular conduction
Visit www.suffolkremsco.com for the latest information on courses and special announcements.
Note: We want your input to the newsletter. Please submit your ideas and suggestions to the Editor,
Karl W. Klug at 853-8309 or via e-mail, karl.klug@suffolkcountyny.gov.
SANE (Sexual Assault
Nurse Examiner)
The SANE program provides
victims of sexual assault
comprehensive and compassionate
health care while
simultaneously ensuring that
accurate and appropriate
forensic evidence is collected.
In Suffolk County, three
(3) Emergency Departments
are affiliated with SANE:
Good Samaritan Hospital,
University Hospital and Peconic
Bay Medical Center.
Statistically, a very small
percentage of sexual assault
victims have significant
physical injury which would
necessitate ambulance
transport or emergency department
evaluation. There
is no expectation that ambulances
transport patients
directly to the doors of a
SANE Center as the physical
locations of these centers
are shielded from public
view. Please refer to Suffolk
County EMS Operations
Policy Statement # 1-004
as well as the March 2010
EMS Division memo that further
clarifies Out-of-Hospital
Management of Sexual Assault
Cases.
Karl W. Klug, SCEMS, Editor
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