1. University of California San Francisco

2. SFFD EMS SYSTEM 40 dynamically deployed ambulances Shifts starting time from 0500 until 2130 from 1 central station Only SFFD ambulances are participating in RAMPART 8 receiving hospitals participating in study RAMPART implemented 6/19/09 on 10 rigs initially First enrollment 6/27/09 45 enrollments 7 enrollments in 1 week in November Prior PHTSE experience

4. Study Challenges  Continued Paramedic training  Informed Consent  RAMPART boxes/Megabundle management

5. Keeping the medics involved/informed and happy!! And locating them!

6.  RAMPART bulletin board w/FAQs, opt out bracelets, auto injector instructions, recent enrollment info, enrollment #s, coordinator contact info, etc.  Flyers with unit #/medics names for each enrollment  RAMPART FAQs  Contact every crew that enrolls a subject  Flyers with protocol clarifications posted or placed in medic’s mailbox.  Practice with expired auto injectors.  In person review to start in January  Mandatory on line CE for medics with RAMPART included in sz/neuro/AMS module.

7. Protocol Clarifications If patient stops seizing after IM and before IV study drug, they don’t receive IV study drug. No focal seizures. Getting medics to wait 5 min prior to enrollment. Patient must be actively convulsing.

8. Informed Consent Challenges

9. Homeless without any contact info, or marginally housed. With psych/substance abuse issues other seizure threshold lowering lifestyles. Subjects discharged from ED prior to investigator arrival or leave AMA prior to investigator arrival. Addresses not valid with notification letters returned In SF approximately 30% of subjects Language issues Cultural differences/Educational Issues

10. Notification letters left in patient chart and/or mailed out to patient. Call ED prior to investigator arrival Attempt to locate case manager, LAR, psychiatrist, emergency contact or PMD. Make extra hospital visits ED info form given by medics to ED staff

12. Thank you! Jeany Duncan RAMPART EMS Coordinator UCSF duncanj@sfgh.ucsf.edu 415-206-4106