By: Makeba Walcott, Public Relations Officer, 2016-2017
The Arlington Fire District (AFD) has changed how patients are transported to the hospital, with Mobile Life Services, Inc. now being the provider of emergency ambulance and transportation services for the district. Since 1981, Mobile Life Services, developed by the Arlington’s Board of Fire Commissioners, has been operating in Hudson Valley. Prior to January 1st, 2017, Arlington operated its own ambulances. This decision came as a result of a new contract agreement between the district and the Arlington Professional Firefighters Association, that agreed to switch health care plans.
According to Fire Commissioner Chairman Jim Beretta, this new change decreases the amount of taxes that residents pay while “absorbing the state-mandated cost increases that we have no control over.” According to the Poughkeepsie Journal, the $17.25 million proposed budget that lowers the amount of money taxpayers pay is approximately $85, 000 less than that of last year, and brings “the tax rate per $1,000 of assessed value from $6.27 to $6.19.” The change also allows Arlington to increase its firefighting services to its four stations 24/7 with firefighters who are paid and reduce overtime costs.
According to Jim Berretta, the use of a private ambulance company means “that a patient’s insurance coverage will cover most or part of the cost. The amount covered is going to vary based on a person’s insurance coverage. This is no different than the exposure people have now to the cost of an ambulance, should they need one, in many, may municipalities who use a commercial ambulance service.”
However, paid and volunteer members of the Arlington Fire District will still continue to provide immediate emergency responses to every call in the district.
Brant Abbott. “Arlington Fire District to outsource ambulances.” Poughkeepsie Journal 16 December 2016: 1. Web. 25 January 2017.
Schutzman, Nina. “Arlington Fire plans to cut taxes, outsource ambulances.” Poughkeepsie Journal 17 October 2016:1. Web. 25 January 2017.
By: Eric Lee, Equipment Officer, 2016-2017
For the Halloween of 2016, Vassar College EMS responded to a total of 15 intox calls and required no mutual aid assistance for the calls on campus. The call volume for the night of Halloween has decreased from last years 18 calls.
To prepare this year, all Halloween crews participated in an intox MCI drill geared towards preparing all crew members to split and run calls as a two pair team. The MCI drill was able to give some newer members the experience and guidance from the EMS 1 during an intox or drug call, while allowing crews to become comfortable working with their fellow crew members.
In order to allow crews to focus on calls, Vassar College EMS had a dedicated dispatcher from VCEMS working with Safety and Security to better organize the dispatch of in service crews and keep track of the status of each crew. The dispatcher also worked with one Mobile Life ALS and one BLS standby unit to dispatch appropriate ambulances for patient transport. With two units on standby, this allowed the Arlington Fire District ambulances to continue to serve the surrounding community.
A total of four VCEMS crews were tasked with responding to any calls on campus. One additional crew was tasked with navigating Mobile Life units to the call location. With four crews on call from 10 PM to 2 AM the following morning, VCEMS was able to handle 15 calls over the 4 hour period. Only one crew was required to split to cover all calls in the area. Each responded to about 4 to 5 calls each during the night.
By: Julia Beatini, Assistant Captain, 2016-2017
Patients and EMS agencies alike seek alternatives for the EpiPen, an epinephrine auto-injector used for treating anaphylaxis, after Mylan pharmaceuticals instated a 500% price increase in 2016. Hopefully, up-and-coming generic auto-injectors will provide a much-needed solution in 2017.
Anaphylaxis is an acute life-threatening allergic reaction that affects millions of people each year. When left untreated, it can result in airway obstruction, respiratory failure, shock, and death. However, epinephrine reverses the progression of anaphylactic reactions by constricting blood vessels and opening airways in the lungs, providing patients with nearly immediate relief. Since the 1980s, epinephrine has been widely available to patients, parents, and emergency healthcare providers in the form of auto-injector pens (1). These small, spring-loaded syringes are pre-filled with a dose of epinephrine that can be injected quickly and easily to stop the progression of an anaphylactic reaction.
The EpiPen®, produced by Mylan pharmaceuticals, was one of the first epinephrine auto-injectors on the market. Since their release in 1987, EpiPens have become the leading epinephrine injectors on the market and have received praise throughout the years for their efficiency and reliability (2). However, Mylan pharmaceuticals recently came under fire after 2016 saw a 500% increase in the price of a two-pack of EpiPen. While the price of an individual EpiPen soared from $60 to over $300, experts estimated that the auto-injectors cost only $30 to produce (3). Following a congressional investigation in the fall of 2016, Mylan agreed to pay the government $465 million to settle claims that the company shortchanged consumers (4). In spite of the outcome of the investigation, patients, parents, schools, and emergency medical providers are still struggling to afford the life-saving medication.
For years, EpiPens have been one of the most commonly administered medications in emergency medicine. According to a 2013 study, more than half of patients who have experienced multiple anaphylactic reactions report “calling an ambulance” as their immediate action plan when experiencing symptoms of anaphylaxis (5). The study also indicated that only a third of patients who have experienced multiple anaphylactic reactions carry EpiPens with them, and this number is likely to decrease as fewer patients are able to afford them. This presents a growing need for EMS agencies to carry EpiPens at a time when many agencies lack sufficient funds to keep the auto-injectors on their ambulances. Although VCEMS will continue to carry EpiPens, many other agencies – especially those situated in small rural areas – are seeking alternatives.
To address the issue, some states are pushing for EMTs to manually administer epinephrine syringes instead of the classic auto-injector. The syringe kits would save districts thousands of dollars, as they cost only $20 (6). However, they also require more time to administer and present a higher risk of infection. States would also need to provide EMTs with extra training in order to administer them safely.
Luckily, different drug companies provide EpiPen alternatives that are steadily gaining popularity. Amedra pharmaceuticals offers Adrenaclick, a pre-filled auto-injector priced at $140 for a two-pack (7). Adamis pharmaceuticals and Windgap Medical are also working hard to get their own auto-injectors on the market. They claim that their products will have longer shelf lives than EpiPens, which must be replaced after one year without use, and that they will be available for roughly half of the current market price of an EpiPen (8). Their products are still pending FDA approval, but are set to be released in 2017. CVS pharmacy also plans to release a generic EpiPen alternative later this year, priced at $110 per two-pack (9).
With the growing number of EpiPen alternatives, individual consumers and EMS agencies will continue to carry epinephrine to treat anaphylaxis. However, the new drug options are certain to change the epinephrine market as we know it, ending Mylan’s long-held monopoly on the industry.
By: Lauren Middleton, Captain, 2016-2017
According to the Centers for Disease Control and Prevention (CDC), bioterrorism is defined as “the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants…” These agents are classified into three categories based on their potential risk. Category A contains the highest priority agents that are easily transmissible, result in high mortality, and would cause major systemic disturbances (1). Category A includes anthrax, botulinum, Ebola virus, and plague (2). Since these agents are found in the environment, it can be difficult to distinguish accidents and natural causes from harmful intent.
Bioterrorism is not a new threat. One of the earliest recordings of a major bioterrorist attack was in the 1346 Siege of Caffa in which the Mongols threw bodies infected with plague over the city walls (3). In more recent history, there have been attacks using botulinum, salmonella, and anthrax. Although the 2001 anthrax attack was a relatively small scale event with only 22 cases, 35,000 people were vaccinated against anthrax and smallpox and the government was in turmoil. The stock of smallpox vaccine had been almost depleted because it was considered eradicated in 1980. Since then, larger amounts of the vaccine have been stored (4). Plans have also been put into place on how to respond to bioterrorism and highly infectious diseases such as Ebola and Zika (5).
Rapid identification and response are important elements in limiting the severity of a natural outbreak or attack. Healthcare workers, including first responders, play an important role in minimizing the disease spread. Starting on October 4, 2014, dispatchers asked about any recent travel to Ebola-affected countries for patients complaining of fever. If the patient had travelled to West Africa, a specially trained Haz-Tac team was dispatched rather than the nearest EMS. From December 2014 to February 2015, 3090 EMS responders were trained in putting on and using the appropriate personal protective equipment (PPE). They were also trained in asking about travel to West African countries for patients with symptoms suggestive of Ebola (6). In June 2016, New York implemented training programs for first responders to protect themselves and safely treat patients infected with high risk diseases such as Ebola and Zika (7). Emergency responders can help by identifying potentially infected patients by knowing which symptoms to look for. Training such as in these examples could be used to minimize illnesses and deaths following a bioterrorist attack.
Effective Immediately: Commercial Ambulance Service Now Responsible for Hospital Transports in the Arlington Fire District
Effective 7 AM on January 1, 2017, Arlington Fire District (AFD) will no longer transport patients to the hospital. While EMS providers from AFD will still respond to all EMS calls and provide on-scene treatment, Mobile Life Support Services (MLSS), a commercial ambulance agency, will take over hospital transports. Whereas previously, AFD provided free transportation to area hospitals, MLSS will now bill patients for their services. While many health insurance plans will cover this, it is still possible that the patient will be required to pay a co-pay depending on their specific insurance plan and provider.
The operations of VCEMS will remain the same; when anyone on campus calls the CRC (845-437-7333), VCEMS will be dispatched. In the event that the patient requires transport to the hospital, VCEMS will request an ambulance, but care will now be transferred to MLSS as opposed to AFD. While we understand that this new change may be a financial burden, we still urge all members of the community to call the CRC and request EMS in any instance where emergent medical care is needed.
Arlington Fire District Media Release
By: Lauren Middleton, Captain, 2016-2017
Head Trauma Scenario
By: Eric Lee, Training Officer, 2016-2017
Each time EMS is called to a scene, the EMT on call may be seen writing on a white document. This document is known as a Pre-hospital Care Report (PCR) and is completed for each call VCEMS responds to. The main purpose of a PCR is to record the treatment and care provided by the VCEMS and to ensure that the necessary information is passed on to healthcare providers for the continuation of care.
While on scene, general information such as the patient’s name, age, vital signs, allergies, medications, past medical history, and symptoms are recorded. Typically, at least two sets of vitals will be obtained during a call to be able to accurately assess the patient’s condition during the call. In cases where the patient is transported to the hospital for further care, this information is key in order to provide the proper treatment once care of the patient is transferred from one provider to another. Specifically, for VCEMS, the ambulance crew that arrives to transport the patient is given a copy of the PCR so that they have the necessary information to treat the patient. After the call, a narrative is written up detailing the event of the call, including the assessment and findings the EMTs may have come upon.
Like any medical record, a PCR will only be read or seen by those who are directly involved in patient care. The importance of patient privacy both during and after a call are of utmost importance to VCEMS. This includes allowing only those who are directly involved in the patient’s care to have access to the PCR pertaining to a particular call. A copy of the PCR is given to Baldwin Health Services for a follow up appointment to be certain that the complete treatment is provided for a patient. All EMS agencies, including VCEMS, are not legally permitted to disclose any information regarding the patient to anyone not directly involved in the care of the patient. For example, if an ambulance is called to transport the patient to the hospital, EMS is allowed to update and explain the current situation to the ambulance crew since the new crew will take over the care of the patient; however, if security or police personnel are at the scene and ask EMS for any information, even as general as the patient’s date of birth, EMS will not disclose any information. The patient is of course allowed to disclose any information he/she may choose to security or police personnel.
PCRs help facilitate the effective care of patients from one provider to another. It is critical that the PCR is completed accurately, as it serves not only as a method to transfer important information to other healthcare providers, but also as a legal document detailing the care EMS provided. The importance of patient confidentiality cannot be stressed enough to maintain the trust that must exist between EMS and its patients that allows VCEMS to effectively treat patients.
By: Renata Mukai, Assistant Captain, 2015-2016
Each year, at the end of February, VCEMS members are given the chance to attend the National Collegiate Emergency Medical Services Foundation’s annual conference. Instead of spending a weekend on campus, ten lucky students get to pile into cars and make the drive to a city in the Northeast, spend a couple of free nights in a hotel bed (usually with complimentary breakfast), wear EMS blue, and join the hundreds of other campus EMS providers in attending conference events designed to increase further knowledge of emergency-related information. The conference presents a unique opportunity to network with collegiate EMS organizations from near and far, allowing VCEMS to learn about how other campus teams work and what they do differently. It also allows campus EMS members to be targeted by schools, companies, and gadget designers (in case you’re in the market for an automated CPR compression machine). The convergence of so many EMS organizations at one hotel leads to the expected gear jealousy (who knew an on-the-sleeve pen loop could look so cool) and exchange of ideas (can we get an ambulance?). Most importantly, though, this national event is a place for campus EMS providers to learn.
For especially motivated participants, a crack-of-dawn wakeup time on the first morning of the conference is rewarded with the chance to take part in practical skills labs. These are typically more hands-on trainings, with small signup limits and focuses on developing skills that range from mass-casualty incident drills to tutorials on field usage of a portable ultrasound machine. Spots in these classes are tough to obtain and wait lists for more flashy sessions can be lengthy. Still, the members of VCEMS who managed to get into one of these skills labs generally gave them positive reviews — and the knowledge they gained could plausibly be passed along to the rest of our agency.
Even without the chance to take part in a skills lab, the conference offers plenty of other educational options through classroom- or lecture-style presentations. These can be given by other EMTs, paramedics, nurses, nurse practitioners or physician assistants, or doctors. Plenty of the M.D.s and D.O.s who give talks started out as first responders, and some have even maintained their certifications. The tone of many of the 2016 conference’s presentations, especially those focused on traumas, was ominous though informative due to the no longer uncommon occurrence of campus shootings. Lectures on triage protocols, bleeding management, et cetera pitched preparation for worst-case scenarios through the emergency philosophy of “If you fail to plan, you’re planning to fail” — a phrase repeated by surgeons and state troopers alike during their presentations. Emphasis on collaboration between campus EMS and other agencies, like local police, fire houses, and campus security, was also ubiquitous in these seminars. The subject matter of conference lectures includes a wide range of other topics as well: emergency animal care, YouTube-inspired trauma treatment, advice for special needs patient care, and lessons on pharmaceuticals represent only a small handful of the diverse focuses for hour-long sessions. When chairs ran out last year, some popular lectures were even attended by small crowds standing behind intentional seating. Movement in and out of lectures was somewhat permissible, and allowed for the discovery of common interests with fellow VCEMS members. Participants at the conference can attend any of these sessions, and as many as they wish to, during what is typically a two-night stay. The trip back to Vassar is typically the final Sunday afternoon of the conference, giving the ten members what is hopefully enough time to catch up on homework before classes resume the following Monday.
The next NCEMSF Conference will be held in Baltimore, Maryland from February 24th, 2017 to February 26th, 2017. Participation includes a weekend away from Vassar, some free swag, the chance to meet other EMTs, and the opportunity to broaden your understanding of emergency care, making you an even more knowledgeable member of VCEMS.
By: Lauren Middleton, CPR Coordinator, 2015-2016
Every five years, the American Heart Association (AHA) reviews and updates their protocols on cardiopulmonary resuscitation (CPR). The changes are based on international analysis of new resuscitation research from the past five years. The updates allow CPR providers to give the best care possible using the most recent science. The 2010 update had several pertinent changes. The compression rate was raised from approximately 100 compressions per minute to at least 100. The compression depth was also increased for adults from 1.5-2 inches to at least 2 inches. The major 2010 difference was the change in step sequence from Airway, Breathing, Chest Compressions to Chest compressions, Airway, Breathing.
The 2015 Update continues to emphasize the importance of these changes and make others according to new research. When a bystander finds an unresponsive person, the AHA recommends checking for pulse and breathing at the same time to reduce time before compressions. If CPR is required, the bystander should start by activating the emergency response system (call 911 and get an AED). The new Guidelines include using mobile devices to call for help instead of just shouting for help. This is especially important when there are no other bystanders. The CPR provider does not need to leave the victim to go get help if they can use their cell phone to call. Once 911 is contacted, the phone should be left on speaker-phone so that the dispatcher can give further instructions (performing CPR or identifying agonal gasps). The dispatcher will ask about the quality of the breathing. If the victim is unresponsive and not breathing or only gasping, CPR should be started. The dispatcher can also guide the rescuer through the steps of CPR. At the very least, chest compressions without breaths should be provided.
The rate of chest compressions now has an upper limit of 120 compressions per minute. In general, more compressions increase the chance of survival, but the new limit is based on preliminary data that suggest faster compressions result in an inadequate compression depth. An upper limit to adult compression depth has also been added in the 2015 Update. The depth of at least two inches is now from 2-2.4 inches or 5-6 centimeters. The purpose of the chest compressions is to push blood through the heart to deliver oxygen to the brain and body. Rescuer compressions are often too shallow rather than too deep. The upper limit is based on one small study that found an association between too deep compressions and increased injuries to the victim. The AHA emphasizes that in a 2-rescuer scenario, the person giving chest compressions should not lean on the chest between compressions or when the other rescuer is giving breaths.
The 2015 Update also reviewed and updated protocols for special situations including bystander-administered naloxone and ventilation with an advanced airway in place. If a rescuer has appropriate training, they can administer naloxone to a person with a known or suspected opioid addiction. If there is an advanced airway in place, the patient should be ventilated at a rate of one breath every six seconds. This is a change from one breath every 6-8 seconds. For more information, the 2015 Guidelines and Highlights are available online at: https://eccguidelines.heart.org/wp-content/uploads/2015/10/2015-AHA-Guidelines-Highlights-English.pdf
The full updated guidelines can be found at: