1. A Doctor’s Reflection on Ambulance Design J Brent Myers, MD MPH Director | Medical Director Wake County Dept of EMS J Brent Myers, MD MPH Director | Medical Director Wake County Dept of EMS

6. Source of Response Time Measure

7. De Maio: Ann Emerg Med, Volume 42(2).August 2003.242-250 Proportion of Patient’s Surviving Vs. Response Time of Defibrillator

8. Ultra-Time Critical = BLS Clinical ConditionUltra-time critical treatment BLS or ALS Cardiac arrestCompressions and defibrillation BLS Severe traumaHemorrhage control, reduction of fracture, rapid transport, chest decompression BLS (save for chest decompression today) AnaphylaxisIM EpinephrineBLS AsthmaInhaled beta agonist, IM Epinephrine BLS

9. ALS Response Times that Matter? Severe respiratory distress CPAP (can’t this be BLS?) IV medications for treatment Advanced airway management Chest pain/STEMI Dysrhythmia treatment EKG interpretation Cardiac arrest management Severe respiratory distress CPAP (can’t this be BLS?) IV medications for treatment Advanced airway management Chest pain/STEMI Dysrhythmia treatment EKG interpretation Cardiac arrest management

20. Summary Lighting/conspicuity that is evidence- based Climate control that is appropriate for pharmaceuticals (and pharmaceuticals that are appropriate for the climate) Speed that is measureable and can be monitored as well as attained Safe use of interior spaces Lighting/conspicuity that is evidence- based Climate control that is appropriate for pharmaceuticals (and pharmaceuticals that are appropriate for the climate) Speed that is measureable and can be monitored as well as attained Safe use of interior spaces

21. We succeed only as we identify in life, or in war, or in anything else a single overriding objective and make all other considerations bend to that one objective. - Eisenhower