Saturday, October 13, 2007

Peoria and Houston's EMS is Not the Same

On October 11, 2007 the USA Today had an article: Fast Help for a Failing Heart.

Congestive heart failure (CHF) kills 53,800 people in the U.S. each year and costs the nation 28 billion dollars in health care expenses.

Because the heart has been weakend by disease in patients with CHF, blood does not flow through the lungs with normal force. This blood can seep out into the tiny sacs of the lung and people with CHF feel like they are suffocating.

For more than 30 years paramedics have been inserting a breathing tube (intubation) into the patient’s lungs suffering from acute CHF. As USA Today explains, it is the “street version” of a hospital’s mechanical ventilator. The tube has saved many lives over the years.

A breathing device called CPAP has been used for 15 years within hospitals for patients with CHF. The CPAP device often prevents the need for a breathing tube because oxygen can be given through the CPAP breathing mask to push the fluid out of the lungs and back into the bloodstream where it belongs. The relief for the patient is almost immediate.

CPAP machines, about the size of a football, are now being used by EMS teams in Boston, Austin, Columbus, Houston, Miami, New Orleans, Raleigh, and San Anotonio. Other cities that are planning to have the device in EMS units within the next 12 months include: Atlanta, Cincinnati, Dallas, El Paso, Fort Worth, Honolulu, Los Angeles, Lousiville, Memphis, Milwaukee, Philadelphia, Portland, Richmond, San Diego, San Francisco, and Tucson.

Dr. David Persse is Houston’s EMS medical director and he is also head of Houston’s Public Health Authority. I have spoken to him about the conflict of interest that plagues Peoria’s EMS.

In Houston, the Houston Fire Department provides advanced cardiac life support with paramedic firefighters. In Peoria, the Peoria Fire Department is basic life support and cannot transport patients. Also, the PFD firefighters that are paramedics cannot act as paramedics unless asked to do so by Advanced Medical Transport (AMT) at the scene of a medical emergency. Dr. Persse understood how Peoria works.

Dr. Persse explained to USA Today that, “…the paramedics can do the more dramatic thing and intubate the patient, but that is not necessarily the best thing to do. It’s the wise paramedic who knows we need an alternative to intubating the patients.” It is also wise and prudent doctors who direct EMS systems who make patients the number one priority in a community.

Some states are going further with CPAP, allowing emergency technicians with only basic training, like the PFD, to use the CPAP device.

Wisconsin started allowing EMTs to use the device in 2003 and now makes it part of their basic training, according to a report in the Journal of Emergency Medical Services.

An alternative out-of-hospital airway is needed in Peoria. It needs to be performed by the PFD for patients who call 911 and cannot breathe due to acute CHF. Patients who arrive at the hospital with breathing tubes typically end up in the intensive care unit, where the first day of ventilator care alone costs $8,000 dollars.

Medical studies have shown that CPAP reduces mortality and the need for intubation in patients with CHF.

In Houston, Memorial Hermann’s medical center has donated to the Houston Fire Department enough CPAP machines and breathing devices to treat 900 patients as part of a growing partnership that aims to provide higher quality care while streamlining emergency medical services.

Where is Peoria?

Why doesn’t OSF-SFMC do the same in Peoria? It would be great if OSF-SFMC, the medical resource hospital for EMS, would donate CPAP devices to the PFD. This would save lives while saving the taxpayer money. However, AMT is an affiliate of OSF, so will OSF and their medical directors agree to take business from AMT?

As usual, what will come first in Peoria…profit or the person struggling to breathe?

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