Lawler Teaches in Ghana

Summer 2015 Compassion, Excellence, Community

Service

F-M AMBULANCE SERVICE

VITAL SIGNS

exam. Other members of the team that traveled to Ghana included Kelli Sears (ND Division of EMS and Trauma), George Gerhardt

(ND Emergency Preparedness Team), Ken Reed (NDDEMST and Golden Heart Ambulance), and Dan Ell (NDARNG and Sanford

AirMed - Bismarck).The Ghanaian students were very motivated and eager to learn from the team. All of them are supervisors of

ambulance stations from across the country. All 30 of the students took and passed the practical exam on the last day of the trip.

The next step will be for them to pass the NREMT computer adaptive exam and be fully certified. After that, they will be able to

teach the EMT course and continue to build their ambulance service.

Sanford Health is also sponsoring two of these students to attend our paramedic program here in Fargo. They will be moving here

in August and staying in the USA for a year. They will then move back to Ghana and form the core of their ALS instruction in the

future.

Sanford Health currently has five clinics in Ghana with a goal of ten clinics that will provide primary care for children and families.

Sanford found Ghana to be an attractive site for long-term development due to its political and economic stability, its need for

permanent health care infrastructure (particularly in the rural areas), and its potential for sustainability due to Ghana's National

Health Insurance Scheme.

This May, Ron Lawler, Director of Sanford Health EMS Education (SHEMSE),

participated in a two-week EMT education program in Ghana. The North Dakota Army

National Guard (NDARNG) has been in a partnership program with the West African

nation of Ghana since 2004. As part of this program, the National Guard has designated

healthcare, including EMS, as an area for emphasis. Several divisions of the North

Dakota Department of Health have provided instruction on Emergency Response and

EMS topics to members of various government departments in Ghana for years.

The group traveled to Ghana to teach members of the Ghana National Ambulance

Service (NAS, a division of the Ghana Ministry of Health) and several observers from

their National Disaster Management Organization. The leadership of NAS want to

improve the professionalism and skills of their staff by having them earn NREMT EMT

certification and eventually paramedic certification. Since Ghana is not currently an

NREMT “state”, ND DEMST has sponsored them as an educational institution and is

working with the NREMT to approve classes and testing for their people. This event

focused on how to study for, take and teach the practical skills portion of the NREMT

exam

“EMS Strong”

The theme for EMS Week 2015 was “EMS Strong”. F-M Ambulance Service and Sanford AirMed teamed up for a

joint open house on May 17 at the Sanford AirMed hangar.

F-M Ambulance Service was the winner of the 2015 EMS Strong Competition! The competition was fierce. Sanford

AirMed pulled out to an early lead when they won “Card Ninja” (flinging a playing card into half of a watermelon). F-M

Ambulance was back in the competition when we won “Sticky Situation” (bouncing a ping pong ball onto a piece of

peanut butter bread). F-M Ambulance gained the lead when we won “Stack Attack” (stacking cups). It was all tied

up when AirMed got a last-minute win with “A Bit Dicey” (stacking dice on a Popsicle stick).

It all came down to a tie-breaker, the tug-of-war. It seemed as if F-M Ambulance wouldn’t have a challenge – we

definitely had a weight advantage. About a minute into the tug-of-war, it looked as if F-M Ambulance may have been

too confident; AirMed was definitely giving us a run for our money. In the end, F-M Ambulance Service got the win

(and a little muddy)!

F-M Ambulance Service and Sanford AirMed want to thank everyone who came to the Open House – employees,

families, other first responders and the public – we truly appreciate everything that our community does to support

Emergency Medical Services! Check out more pictures from the Open House on the next page of this newsletter and

also on our Facebook page!

American Heart Association Gold Award

F-M Ambulance Service received the American Heart Association’s

Mission: Lifeline EMS Gold Award. This award recognizes F-M

Ambulance Service for implementing quality improvement measures

for the treatment of patients who experience severe heart attacks.

Every year, more than 250,000 people experience a STEMI, or ST

Elevation Myocardial Infarction, a type of heart attack caused by a

complete blockage of blood flow to the heart that requires timely

treatment. To prevent death, it’s critical to restore blood flow as quickly

as possible, either by surgically opening the blocked vessel or by giving

clot-busting medication.

Mission: Lifeline seeks to save lives by closing the gaps that separate

aa STEMI patients from timely access to appropriate treatments. Mission: Lifeline’s EMS recognition program

recognizes those emergency responders for their efforts in improving STEMI systems of care and improving the

quality of life for these patients.

Emergency Medical System providers are vital to the success of Mission: Lifeline. EMS agencies provide education

in STEMI identification and access to 12-lead ECG machines and follow protocols derived from American Heart

Association/American College of Cardiology guidelines. The correct tools and training allow EMS providers to rapidly

identify the STEMI, promptly notify the medical center and trigger and early response from the awaiting hospital

personnel.

Agencies that receive the Mission: Lifeline Gold award have demonstrated at least 75 percent compliance for

each required achievement measure for two years and treat at least eight STEMI patients for the year.

Hospital Surge

Welcome to F-M Ambulance Service!

Welcome to all of our new employees!

Have you ever wondered how a hospital would handle a large

amount of patients arriving all at once? On April 24, F-M Ambulance

Service worked with both Sanford Health and Essentia Health to

create a surge drill to simulate this scenario.

Volunteer “patients” were moulaged in the early morning and then

transported to a hospital. Some patients were able to walk, while

others were seriously injured. Patients ranged in age from 4 to over

60. Emergency Department staff had to triage and treat a large

number of patients arriving at the same time, testing their mass

casualty response systems. Staff at both Sanford and Essentia

handled the scenario very well.

F-M Ambulance Service would like to thank everyone who took part

in this drill. Everyone hopes that something like this will never

happen in our community, but if it does, we are prepared and

everyone will be well taken care of!

Helmets Donated to Madison Elementary

F-M Ambulance Service was

proud to partner with the Lake

Agassiz Kiwanis (LAK) this spring

to donate helmets to students at

Madison Elementary School.

Approximately 75 bike helmets

were delivered to the school just in

time for kids to use them this

summer.

Pictured are Don Martin (FMA),

Ann Ham (LAK), Bobby Olson

(Madison Elementary Principal),

Norma Swanson (LAK) and Bob

Monson (LAK).

Eric Leedahl EMT FMA Sapphire Watchorn EMT FMA Paul Grommesh EMT FMA Adam Barnick EMT FMA Ruth Danuser EMT FMA Ryan Morrison Paramedic FMA

Cody Boody EMT FMA Stacey Rice Paramedic FMA Matt Hockert EMT FMA Cassie Landegaard EMT FMA

Welcome to the team!!

Heart Health

Did You Know… What’s New at F-M?

In March, F-M Ambulance Service outfitted and had

detailing done on our new truck!

In May, Valley News Live (VNL) featured a segment on

what it’s really like to have a heart attack. Paramedics

Jason Eblen and Alanna Velo filmed with the VNL crew

to show the reporter exactly what happens during a

heart attack – from the back of an ambulance all the

way to the cath lab.

Jason showed the reporter what a heart attack might

look like on our cardiac monitor while Alanna explained

some of the medications that a patient may receive.

They also talked about the signs and symptoms of a

heart attack and all of the different things that can be

done for someone with chest pain. VNL had two

cameras along, as well as the Go Pro that the reporter

was wearing.

We Kids with Helmets!

F-M Ambulance Service is proud to partner with Culver’s every summer to

encourage kids to wear helmets. Our EMTs and Paramedics have Culver’s

coupons in their trucks – if they see a kid with a helmet, they will try to stop and

hand one out!

Our crews are also busy with many other activities this summer. F-M

Ambulance Service recognizes the benefits of showing the public what

emergency services is all about. We provide tours at no cost whenever we are

able to. We are also proud to take part in as many community activities as we

can, such as the Safety Safari, Riblet Fest, Midwest Kids Fest, Safety Town,

Fargo Police Picnic, and many upcoming events such as Night to Unite. Look

for us out and about this summer and come check out our ambulances!

Rick Cameron, Wade Hockert and Dwayne

Chevalier were recognized for their years on the

Red River Valley SWAT Team as Tactical EMS

(TEMS) Medics.

The Commission on Accreditation of Ambulance

Services visited F-M Ambulance Service in May.

They will announce the results later this year.

The Community Paramedic (CP) program is

thriving. F-M Ambulance Service has 5 CPs

working in our community and hopes to add more

soon!

Kathy Lonski and Kristi Engelstad spoke about new

changes in EMS treatment at the Toward Zero

Death regional conference in Fergus Falls, MN in

May.

Health Highlight

Backboards – Help or Harm?

You are watching your favorite TV drama. Two characters argue about which as the shapeliest

nose (or something similar) and then one jumps into their sports car and races off in a huff. Ten

miles of road rage later, the shot changes to a jumpy montage of an accident scene. Troopers

directing traffic, firefighters cutting off the roof, bystanders with their hands over their mouths in

horror. And what is EMS doing? Running up to the car, backboard in hand. They load the patient

on it and then the scene cuts to lights and sirens. Miraculously, the patient is then on a bed in the

ER with perfectly done hair and makeup repenting their earlier anger. So what does the public see

of EMS? That we scoop onto boards, run with it to the truck and then drive fast. This is also what

we have taught in our courses for the last 50 years.

So what is the big deal all of the sudden? Why are we told to “do this,” then “nope, don’t do that,”

then “actually, maybe it wasn’t that big a deal and we can do this modified version of it”? It feels

like a rollercoaster of changing priorities, protocols and rules. The answer is, in its simplest form,

research. The rollercoaster happens because of our own nature and desire to do what is best for

the patient at the time.

Backboards started out as strictly extrication devices. Bystanders used rigid planks long before we had ambulances. Even when

EMS began, board didn’t have handholds or straps. Over time, straps and c-collars were added, but little to no research was

conducted on these “improvements” at any time – only small changes made over years with what was thought to be best for the

patient.

Research into spinal immobilization has been conducted for decades now. Some recent studies have shown that patient might

actually do better without backboards. Some people may say, “But if we don’t do this, we could make the injury worse.” This is

where we need to move away from a MOI based protocol to an assessment based criteria for using immobilization.

With any change in your medical practice, it is important to get your medical director involved early. Several organizations have

new recommended algorithms for spinal immobilization, including the NEXUS criteria, which is based on a research study for

deciding which patients should receive x-rays after spinal trauma. Medical directors across the country have adapted these

findings to EMS to come up with this tool:

Do not immobilize unless:

- The patient is intoxicated, unresponsive or uncooperative, or

- There is a significant distracting injury, or

- There is any complaint of pain or tenderness to the spine or neck, or

- The patient fails a neurologic exam (of some kind).

To further this, the National Association of EMS Physicians and the Committee on Trauma – American College of Surgeons

2013 have come out with a position paper stating that:

Utilization of the backboard for spinal immobilization during transport should be judicious so that the potential benefits outweigh

the risks.

Patients with penetrating trauma to the head, neck, torso, and no evidence of spinal injury should not be immobilized on a

backboard.

Spinal precautions can be maintained by application of a rigid collar and securing the patient to the stretcher and may be most

appropriate for patients who are ambulatory at the scene or patients who must be transported for an extended time.

Your specific protocol may add, subtract or modify these to fit your specific crew, training, equipment and environment. And who

knows, future product development and research may guide us to another tool that is better for the patient and accomplishes our

goal of high-quality care. As they would say at the end of that TV drama, “stay tuned.”

This article is an excerpt of an article written by Dr. Heidi Lako-Adamson, Medical Director for F-M Ambulance Service and Ron Lawler, Director of Sanford Health EMS Education. For the full article, please see Volume 36, Issue 2 of the ND EMS Association’s Response Times Magazine (Spring 2015).

We hope that you have enjoyed this edition of “Vital Signs”, a quarterly newsletter distributed by F-M Ambulance. An electronic edition of Vital Signs can be found on our website, www.fmambulance.com. If you have any ideas, questions, or comments about “Vital Signs”, please contact Kristi at (701) 364-1759, or kristi.engelstad@fmambulance.com.

Fargo Marathon 2015 Weather was on the minds of many people – including the staff

of F-M Ambulance Service – on the morning of the Fargo

Marathon. “Weather obviously affects the runners in many

different ways,” says Dr. Heidi Lako-Adamson, Fargo Marathon

Medical Director. “Even with temperatures in the 70’s, we can

see cases of hyperthermia. On the other hand, with cooler

weather, we need to be prepared for other issues, including

hypothermia, especially in runners who are in the shorter races.”

Since the temperature and weather can change drastically from

the morning to afternoon on the day of the marathon, responders

need to be ready for everything. “We never know what will

happenaa happen, so we always prepare for the worst,” says Don Martin, Operations Manager at F-M Ambulance Service.

“Our crews train for every scenario that we can think of. Luckily, due to the weather this year, we had very few

patients. It was nice and cool – perfect long distance running weather.”