1375085179566Curtis S. Mason, Sr.

1951 – 2018

The Peninsulas EMS Council region lost an EMS leader when Curtis S. Mason, Sr. passed away on 6 July, 2018.

Curtis was a strong proponent of EMS in his community and in our region.  Over his career, he served with Central Virginia Ambulance Services and Richmond Ambulance Authority before founding the Mattaponi Volunteer Rescue Squad in 1995, where he served as president and chief officer until his retirement in 2017.

He was active in the greater PEMS region through his work on regional EMS committees, assisting agencies in purchasing equipment and ambulances and by providing counsel and advice to all.

Curtis’ life continues to be an example to us all of selfless duty and responsibility to our neighbors and our community.  Our thoughts and prayers go out to his family and friends.  We will miss him greatly.

Clarification to Change 2 of the PEMS Protocols

There has been some confusion regarding the recent change to the PEMS Regional Patient Care Protocols, Policies & Procedures.  This change involved two areas of the protocols:

Item 1:  The window for transport of RACE positive stroke patients was extended from 6 to 24 hours.  This change impacted the following protocols:

  • Administrative Policy: Stroke Field Triage
  • Adult Protocol: Medical – Stroke/TIA

Item 2:  In response to an anticipated shortage of Dopamine, and the large quantity of our supply expiring on 30 June, 2018, PEMS Medication Kits may not be stocked with any of this medication.  Norepinephrine (Levophed) has been added to the Medication Kits to provide an alternative medication for hypotension that is not related to trauma.  This change impacted the following protocols:

  • Adult Protocol: Medical – Hypotension/Shock (Non-Traumatic)
  • Pharmacology: Norepinephrine

Please note that Norepinephrine has only been approved for use in non-traumatic hypotension in this emergent change.  Epinephrine remains the secondary medication for treating hypotension for cardiac conditions and is also an acceptable substitute for Dopamine for non-traumatic hypotension.

Emergent changes to PEMS Regional Patient Care Protocols, Policies & Procedures are not taken lightly.  We understand that they place a significant burden on agencies and providers to provide just-in-time training to providers.  When our medical directors concur that an emergent change is necessary to provide proper care to our citizens however, we will act quickly to produce and publish the changes.  We are continuing to improve this process and we greatly appreciate the input of our constituent agencies and providers in ensuring that the final product is clear, concise and accurate.

Please update your In-Service Training curriculum to address these changes and ensure that they receive maximum distribution within your organizations.

Thank you.

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When Everything Goes Right

Debbie Thomas

While attending the bi-monthly EMS Collaborative meeting at Sentara Williamsburg Regional Medical Center recently, attendees were notified about a Stroke case in which everything came together perfectly and produced optimal outcome for the patient.

Great things often happen at every hospital and for every agency in the PEMS region. Sometimes we hear about it, sometimes we don’t. As the Clinical Programs Coordinator for PEMS, I facilitate meetings for our Stroke Task Force and I know first-hand the great stuff we are doing region-wide. I am sharing this report because it demonstrates best practices in Stroke care across the spectrum.

In this particular area of the PEMS region, direct transport to a Comprehensive Stroke Center for patients with RACE scores of 5 or greater would extend transport time by more than 15 minutes, so agencies routinely transport to the closest Primary Certified Stroke Center.

Even though an agency here isn’t going to bypass based on the RACE score, SWRMC stresses it is still important for them to perform the RACE evaluation, issue a Stroke pre-alert and report the score enroute to the hospital. Doing so enables the hospital to prepare and initiate their plan for management of the patient which may include transfer to a Comprehensive center.

Here’s the story:

  • 82 year old male traveling from PA to Florida with family
  • Family states the patient had no complaints and seemed normal.  He got up from the table, took a few steps and collapsed to the floor; awake but unresponsive at approximately 1515 hours.  Family immediately suspected a stroke and called 911.
  • James City County Fire Department dispatched a medic unit at 15:21 hours.
  • Patient had a RACE score 7 with right-side paralysis and aphasia (inability to speak).
  • Blood glucose checked - 107
  • Blood drawn and IV established.
  • JCCFD medic marked enroute to SWRMC at 15:41 and called in the "stroke alert" to SWRMC at 15:42.
  • JCCFD marked arriving at SWRMC 15:48 (33 minutes after stroke onset)
  • SWRMC documents an EMS door time of 15:53.
  • Patient is seen briefly by Dr. Boesler and taken directly to CT by EMS (Having EMS transport directly to CT eliminates time otherwise spent transferring the patient to an ED bed only to transfer again in CT.)  Every minute counts!
  • Patient's weight was recorded at 16:00.  Accurate patient weight is essential for correct dosage of tPA.
  • CT started at 16:02 – 9 minutes after arrival.  (The CT scan is required to diagnose a hemorrhage, which would be a contraindication for tPA.)
  • Neurology evaluation in CT 16:07 – Patient had an NIHSS (National Institute of Health Stroke Score) of 21, which is quite high.  Nuerology orded alteplase and a CT-Angiogram.  (The CT-Angiogram uses an injection of iodine contrast medium along with the CT to evaluate the condition of blood vessels.  In this case, within the brain. 
  • Alteplase (a medication used to dissolve blood clots) was started in CT 16:15

22 minutes from Door to Needle - Excellent!

1 hour from Stroke Onset - Amazing!

  • Patient exhibits marked improvement in movement to right upper and lower extremities within 30 minutes of alteplase administration.
  • NIHSS changed from 21 to 6 within 24 hours
  • Discharged to Inpatient Physical Rehabilitation on day 4.
  • Discharged to home on day 15.
    • Able to ambulate with walker
    • Able to do most Activities of Daily Living with little assistance
  • The patient has shared his story here:

https://www.sentara.com/hampton-roads-virginia/healthwellness/data/patient-stories/stroke-disrupts-vacation-plans.aspx

stroke

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Protocol Changes (2)

Two Protocol changes will go into effect today (29 June 2018) at 1400. Both are emergent clinical changes. Change 1 was directly developed and approved by the Stroke Task Force. Per PEMS Policies, both Change 1 and 2 have been reviewed and approved by the Medical Advisory Committee, the Chair of the Policies, Procedures, and Protocols Committee, and by the PEMS Executive Director.

Change 1 is located in the Administrative Policies: Stroke Field Triage.

  • The Stroke Task Force has extended the window for transport of RACE positive patients from 6 to 24 hours.  This change affected the "Stroke Field Triage" and the "Stroke/TIA Protocol".

Change 2 is to the "Medical: Hypotension/Shock (Non-Trauma)" Protocol and Pharmacology Section.

  • In response to a potential shortage of Dopamine, EMS providers may receive Norepinephrine (Levophed) in the PEMS Regional Drug Box.  This change affected the "Hypotension/Shock (Non-Trauma)" Protocol and Norepinephrine (Levophed) has been added to the Pharmacology Section.

PEMS website links to protocol files have been updated.

Agencies with printed protocols be sure to download, print, and insert change pages.

All users of the protocol app will update automatically when connected to Wi-Fi.

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