Program delivering better emergency care to residents
By Mike Heine/The Week
(Published Feb. 2, 2007, 9:38 a.m.)
Did you know that most Walworth County citizens who dial 911 for an emergency medical condition wouldn't always have a certified paramedic squad come to the scene?
And did you know that the 911 dispatchers here aren't able to give medical advice on many potentially life-saving techniques such as CPR and the Heimlich maneuver?
Without a major metropolitan center, Walworth County is left with mostly volunteer emergency medical technician crews and 911 dispatchers at the sheriff's department and three city police stations that don't have the training or certifications of the larger municipality staffs.
Not that that's a bad thing, but the sum of those parts has occasionally left patients suffering from serious ailments from getting the attention they need in the quickest manner possible.
In June, a partial solution to the problem was set in motion and those in the medical field have seen positive results from it.
A cooperative effort between Aurora Lakeland Medical Center, Mercy Walworth Medical Center and Hospital, three private paramedic services and more than a dozen volunteer EMT squads, now made available more advanced life-saving techniques available to county residents.
The program, developed jointly by doctors and emergency medical service coordinators at the two county hospitals, set new protocols for private paramedics to respond to calls jointly with volunteer EMT squads.
Paramedics have more training and medicines available to them than volunteer EMTs and are automatically being sent to such reported calls as difficulty breathing, chest pains, severe allergic reactions, cardiac arrest, extensive burns, drowning or near drowning, major trauma, unstable low blood pressure, patients who are unresponsive for unknown reasons, severe hypothermia and any overdoses.
Prior to this summer, the more advanced rescue workers would come only after volunteer EMTs got to the scene and requested their presence. Now, the paramedics' wheels are in motion when the severe calls go out.
"Dozens of people are alive or are doing better because they've had these services available to them," said Chief John Kramer of Delavan Rescue Squad Inc., one of three paramedic companies in the county. The others are Paratec and Medix ambulance services.
The effort came about because, "We were seeing too many cases where the patient really wasn't getting the service they should have," said Kevin Kenney, EMS coordinator at Mercy Walworth.
The program was somewhat contentious when first developed since the private ambulances were stepping into EMT territories and into EMT work. Things are, however, improving, Kramer said.
"The EMTs from all the rescue services are becoming much more comfortable with it and saying, 'I could use a hand here' instead of saying, 'This is my call,'" he said.
Aurora Lakeland EMS Coordinator Mark Messina agreed.
"Some of the agencies balked at this," he said. "When we laid out the premise of what's in the best interest of the patient and what would you want for your family member, I don't think anyone can disagree that we're providing the best patient care and the best practice."
One of the downsides is the cost to patients in some cities has gone up since two medical crews are attending to them. For instance, if an Elkhorn citizen has a heart attack, Elkhorn EMTs will go to the home as will a paramedic from Delavan Rescue Squad Inc. Even if the Elkhorn ambulance takes the patient to the hospital, the patient is billed by Delavan Rescue Squad if the paramedic provides care.
Insurance usually takes care of the bill, Messina said.
For patients on Medicare or Medicaid, the bill is split evenly between the volunteer and private ambulance squads.
Private paramedics are charging minimal amounts or not charging at all if they head to calls but are told to stand down before getting there, Messina and Kramer said.
A major step in bettering the system would be to have all dispatchers with emergency medical dispatch (EMD) training. That is at least a few years off until dispatch centers receive more staffing. EMD dispatchers need to stay on the phone longer than untrained dispatchers, said Communications Capt. Jay Maritz of the Walworth County Sheriff's Department.
EMD dispatchers can better assess the need for paramedics at an emergency scene, Maritz said.
"The county is working real well on this," Messina said. "It's not perfect, but it's the next best step that we can get at this point. You're looking at an allegiance between two hospitals and the private sector to make something work in a situation where we don't have the right answer, but we're doing the best we can until we get the budget to put the proper system in place."