2015-03-19 / News

Advanced life support now available for medical emergencies

By Ken Shane

Advanced life support technician Ernie Robin is one of 14 experts to join the local EMS team. From left, Prim Bullock, Fire Chief Jim Bryer, Robin, Janine Tatzel, Deputy Chief Howie Tighe and Mary Ann Joyce. 
Photo by Andrea von Hohenleiten Advanced life support technician Ernie Robin is one of 14 experts to join the local EMS team. From left, Prim Bullock, Fire Chief Jim Bryer, Robin, Janine Tatzel, Deputy Chief Howie Tighe and Mary Ann Joyce. Photo by Andrea von Hohenleiten The town’s emergency medical team is able to provide advanced life support for the first time. The new qualification allows EMS workers to administer medications to patients, and to take them to hospitals other than Newport.

Previously, the town offered only basic life support.

According to Deputy Chief Howie Tighe, who oversees emergency medical services, when the EMS team merged with the fire department in 2011, one of the goals was to transition to advanced life support. Advanced support is considered the standard of care in Rhode Island, and Jamestown was one of only two communities in the state that didn’t offer it.

“It gives the provider the ability to treat patients in a far more advanced way than they could previously,” Tighe said.

EMS workers can now monitor, interpret and treat heart rhythms, administer medications, diagnose more injuries, and take patients to the best hospital equipped to treat their injuries. Under the basic system, providers are required by law to take patients to the local hospital. In the past, all patients were transported to Newport or South County.

As an example, if someone was having a heart attack, the local ambulance can now transport the patient to a catheterization lab at Rhode Island Hospital in Providence. Also, people suffering from traumatic injuries can be taken to a trauma facility, and children with advanced issues can be taken directly to Hasbro Children’s Hospital.

“We now have the opportunity to give the patient proper care, and to take them to the appropriate facility,” Tighe said. “We were never able to do that before.”

Two years ago, EMS began training internal staff to be advanced technicians. Due to the lack of patient contact by the current staff, the plan was to hire experienced healthcare workers at a per-diem rate. A total of 14 workers were hired, and there is always a trained person on duty who has experience with advanced life support. The technicians work with the existing volunteers, mentoring them so that they can eventually qualify as advanced workers themselves. The advanced workers also participate in daily training. They are paid $20 per hour, but they can’t work more than 24 hours a week and there are no benefits. On basically every call, the experienced technician is dispatched.

“Ultimately, they’re responsible for every call, so you know that the patient is getting the highest level of care from a very experienced provider,” Tighe said.

With the advanced technicians currently training volunteers, there is a process in place to accomplish that. However, it’s a stringent one. At the end of the training process, the candidates are evaluated by Tighe and the state, as well as the town’s new medical director, Dr. Devin Tsai.

Every EMS department has to hire a medical director. When Jamestown transitioned to advanced life support, the former director no longer had the time to commit. Tsai was approached to take the job. As an emergency room doctor at Newport Hospital, he was someone who the local emergency workers had dealt with on a regular basis.

Among Tsai’s duties, he reviews cardiac calls to make sure all protocols are followed. Tighe also reviews the calls, and then the two confer on how the case was handled. Tsai also reviews training procedures and advises workers on equipment updates.

“This is a big step,” Tighe said. “You’re taking a community that relied on volunteerism to provide ambulance service, and really elevating it to an amazing level of patient care.”

Although the new service adds to the town budget, it also saves lives, Tighe said. There have already been several calls where advanced support was crucial in providing better patient care than would have been possible a year ago.

Advanced life support has been offered for six weeks, and Tighe is already seeing an improvement in patients when they arrive at the hospital. Now patients come in with cardiac monitors, intravenous lines and medications already ad- ministered. By the time patients reach the hospital, Tighe says, the immediate impact of their situation has often been resolved.

Tsai completed his residency training at the University of Connecticut in 2010, followed by a two-year fellowship in EMS at Brown. For the last 18 months, Tsai has been the medical director for Newport County, a consortium that includes Jamestown, Newport, Middletown, Portsmouth and the U.S. Navy. He serves as the primary emergency room contact for EMS personnel, and holds quarterly meetings with the service chiefs from each department.

On the administrative side, Tsai makes sure that EMS crews have the appropriate medication, and that technicians are receiving the proper training.

According to Tsai, many of Jamestown’s newly hired technicians have full-time roles with other EMS departments. They also have certifications as paramedics, for example, and Tsai makes sure they are up to date on their training.

The biggest advantage of advanced life support, says Tsai, is that emergency workers now have “broader range of capabilities. At all times there is a physician here in the emergency room, whether it’s me or one of my colleagues, available for medical control. If they have a question about a treatment, they can certainly reach out to us and we can advise them from the emergency department.”

Tsai said he can also direct emergency workers to another hospital if the patient’s condition is beyond the scope of Newport Hospital. In the past, the patients would have been taken to Newport Hospital by law, and then transferred elsewhere if necessary, causing a delay in getting the proper treatment for the patient.

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