Proposal Request: Form an ALS advisory committee to the board I am - PDF document

Proposal Request: Form an ALS advisory committee to the board I am requesting the formation of an advisory committee to the White Lake Township Board to review the need for, and obligations related to a White Lake Township fire based ALS service. It is proposed that this committee consist of at least 2 township board members, Fire Chief Gurka, myself (David Mills), 2 other firefighter paramedics, the Oakland County Medical Control Authority Executive Director, Bonnie Kincaid, Ph.D., and Medical Control Physician, Tressa Gardner, DO. What is Advanced Life Support (ALS)? Advanced life support or ALS consists of a collection of advanced skills, procedures, and equipment that a paramedic working for a licensed ALS agency is authorized to perform or use by protocol. The tables on pages 1 and 2 outline and contrast advanced life support and basic life support (BLS) capabilities. Procedures ALS BLS  Cardioversion*  Defibrillation  TCP*  Supraglottic  Defibrillation airway  Peripheral intravenous  Oxygen therapy access*  CPAP  Intraosseous access*  Pulse oximetry  ET intubation*  Blood glucose  Supraglottic airway monitoring  12 Lead ECG interpretation*  Cardiac rhythm interpretation*  Waveform capnography*  Surgical airways*  Pleural decompression*  IV fluid therapy  Patient sedation  Pain management  Nebulizer therapy  Oxygen therapy  CPAP  Pulse oximetry  Blood glucose monitoring (*) Find descriptions for these ALS procedures on pages 2-4. 1

Medications ALS BLS   Acetaminophen Naloxone kit  Adenosine  BEES kit (IM  epinephrine) Albuterol   Amiodarone Oral glucose  Aspirin  Atropine  Calcium chloride  Dextrose  Diphenhydramine  Epinephrine 1mg/10mL  Epinephrine 1mg/1mL  Fentanyl  Ipraptropium bromide  Ketamine  Toradol  Lidocaine  Magnesium sulfate  Methylprednisolone  Midazolam  Morphine  Naloxone  Nitroglycerin  Zofran  Zofran ODT  Prednisone  Racepinephrine  Sodium bicarbonate  Sodium chloride See below for a description of several of the ALS procedures listed in the tables on pages 1 and 2.  Advanced electrical therapies, including: o Cardioversion o Transcutaneous pacing (TCP) These electrical therapies are delivered with the use of a cardiac monitor/defibrillator and allow a paramedic to treat life threatening heart arrhythmias related to extremely slow or fast heartbeats.  Vascular access with intravenous and/or intraosseous (bone) catheters. Vascular access allows paramedics to deliver saline infusions to support and stabilize blood pressures. More importantly, vascular access also provides paramedics with a route to deliver critical lifesaving medications. Intra 2

osseous access is vascular access established by using a device to place a catheter in the medullary space within a long bone. This is used when intravenous access is delayed or unavailable.  Endotracheal (ET) intubation ET intubation is the gold standard for advanced airway stabilization and access. ET intubation provides definitive airway security that is unmatched by other advanced airway options. ET intubation provides paramedics with direct access to the patient’s lower airway. This procedure allows for the removal of foreign body airway obstructions that are not cleared by abdominal thrusts or chest compressions. ET intubation also allows for deep tracheal suctioning, and the ability to secure the airway of a patient with special challenges, like a patient with a tracheostomy.  Medications ALS agencies throughout the Southeast Michigan region carry medication boxes that allow paramedics to deliver medications in the field. These medications treat a wide-ranging set of critical and life threatening conditions, including: o Cardiac arrest o Life threatening electrolyte abnormalities o Heart attacks o Seizures o Diabetes (severe hypoglycemia) o Severe pain o Opioid overdose o Septic shock o Anaphylactic shock o Cardiogenic shock o Bradycardia o Tachycardia o Severe nausea/vomiting o Severe respiratory distress o Severe croup in pediatrics o Allergic reactions o Severe asthma attacks o Congestive heart failure o Eclampsia The bulleted list above does not cover all of the conditions paramedics are capable of effectively treating with medications in the prehospital setting. However, it should provide an understanding of the scope of conditions paramedics are capable of treating, when authorized to provide ALS care. In contrast, a basic life support agency is unable to even offer an aspirin to a patient suffering from a heart attack. 3

 Surgical airway In the event of a severe foreign body airway obstruction or in the presence of severe upper airway trauma, paramedics working for an ALS agency can perform a lifesaving surgical procedure on adults and pediatrics to establish an open airway and breathing.  Pleural decompression This procedure allows paramedics working for an ALS agency to perform a critical intervention for those patients who have suffered a collapsed lung and hypotension due to blunt or penetrating trauma to the chest.  12-lead ECG, cardiac rhythm interpretation, and waveform capnography 12-Lead ECG capability and interpretation allow paramedics working for an ALS agency to recognize life threatening heart attacks and administer critical medications as well as provide early notification to the receiving emergency cardiac interventional center. Advanced cardiac monitors allow paramedics working for an ALS agency to identify potentially fatal cardiac arrhythmias and perform lifesaving interventions in the field. Waveform capnography offers numerous benefits to patients suffering from a range of conditions including severe respiratory distress due to asthma or COPD, cardiac arrest, and intubated patients. Waveform capnography allows paramedics working for an ALS agency to confirm advanced airway placement, monitor the quality of chest compression during CPR, immediately detect the return of spontaneous circulation for patients resuscitated from cardiac arrest, screen for pulmonary embolisms, and immediately detect signs of respiratory depression. Why is a fire department based ALS service needed in White Lake Township now more than ever before? Staffing shortage and increasing call volume Life support agencies across the United States report a critical labor shortage of paramedics and EMTs. As a result, it has never been more challenging for these agencies to meet the growing demand for emergency medical services and keep life support units on the road. The field of private EMS has always dealt with challenges regarding staffing and employee turnover. The rigors of the job, it’s exhausting schedule, and low wages have made it difficult to retain people in the field of EMS. In many cases, individuals working for private EMS agencies use their education and experience as EMTs and paramedics as a stepping-stone into a more advanced field of medicine. Another reason for losing EMS providers prematurely is on the job injuries. One report states, 1 and 4 EMS providers leave the field within the first 4 years of employment due to injury. 4