1. Alerts!!! Edward Hospital EMS System Continuing Education

2. Objectives Strokes Trauma Cardiac

3. Code Stroke

4. … A patient has clinical evidence of a new onset stroke and the stroke team needs to be mobilized… … A patient has clinical evidence of a new onset stroke and the stroke team needs to be mobilized… Code Stroke Code Stroke  When patient is potential candidate ( < 8 hours) Stroke Yellow Stroke Yellow  Evidence of acute stroke greater than 8 hours

5. Code Stroke Stroke Team Stroke Team  N N N NIS/on-call neurologist  C C C CT tech  M M M MRI tech  E E E ED Director, CTU Manager Clinical Leaders, and charge nurse

6. Code Stroke Soooo…. Why not call from the field??? - Needs to be called by RN or MD as witnessed - Resource allocation - Chain of events

7. Trauma Alert

8. … A trauma patient arriving at the ED will be classified into one of three different categories… IIIIII

9. Trauma Alert Category I Category I  Has two types of criteria Severe Mechanism Severe Mechanism Severe Instability (majority reason) Severe Instability (majority reason)  Response Paged out / Overhead Paged out / Overhead Trauma Surgeon in 30 minutes Trauma Surgeon in 30 minutes Who else? Who else?

10. Trauma Alert Category I Criteria Category I Criteria  Sustained hypotension: Systolic blood pressure ≤ 90 (≤ 80 in pediatric patients)  All penetrating injuries to head, neck, torso to include buttocks, groin, shoulder  Respiratory rate 29  Intubation/advanced airway intervention in the field in the presence of significant trauma  GCS≤ 10  Traumatic Arrest-Penetrating

11. Trauma Alert Category II Category II  Varying criteria Response Response  Paged / No overhead  Trauma Doc consult Has to respond within 12 hours Has to respond within 12 hours  Who else?

12. Trauma Alert Category II Criteria Category II Criteria  GCS 11-14  Ejection from vehicle  Motor vehicle crash with a fatality in the same passenger compartment  Falls: Adults >20 feet (one story =10 feet); Pediatric >10 feet or 2-3 times the height of the child  Motor vehicle rollover (>180 degrees)

13. Trauma Alert Category II Criteria Category II Criteria  Motor vehicle crash with intrusion >12 inches and/ or auto deformity >18 inches  Motorcycle crash >20 m.p.h or separation of rider and motorcycle  Pedestrian/ Bicyclist struck, thrown or run over  Combination trauma with ≥ 10% TBSA burn (proximal to wrist/ ankle)  Amputation proximal to wrist or ankle

14. Trauma Alert Category II Criteria Category II Criteria  Limb injury with sensory or motor deficit proximal to wrist or ankle (crushed, degloved or mangled extremity)  Sensory or motor deficit or paralysis (suspected spinal cord injury)  Two or more long-bone fractures  Traumatic Arrest-Blunt  EMS provider judgment

15. Trauma Alert Category III Category III  “This group of patients has sustained injury, but does not meet Category I or Category II criteria based on the initial assessment by the Emergency Department physician or designee. The initial assessment will occur within 10 minutes of arrival to the Emergency department.”

16. Trauma Alert Questions??? Questions???

17. Cardiac Alert

18. …The overall goal of the cardiac alert is to improve patient mortality and morbidity rate associated with suspected myocardial infarction… D2B D2B E2B E2B

19. Cardiac Alert Process Process  Field vs. ED Who’s involved? Who’s involved?  Care Continuum End Result… End Result…  PCI!

20. Movie

21. Cardiac Alert Communication Importance of 12-leads Importance of 12-leads “Painting the picture” “Painting the picture”

22. Cardiac Alert Points of communication… Points of communication…  Interpreting and not reading EKG  Knowing your MI location  2mm or more… in 2 contiguous leads

23. Cardiac Alert But I called for….. But I called for….. False Positives False Positives

24. Cardiac Alert Questions???

25. Remember!!! …Because these functions occur as a chain reaction throughout the hospital, when you call for an alert, it may not happen due to the criteria and circumstances that must be adhered to. Do not get discouraged for next time!!! If you feel an alert is warranted, please exercise due diligence in the best interests of the patient each and every time and recommend the alert. It only harms the patient in the long run if we don’t… If you feel an alert is warranted, please exercise due diligence in the best interests of the patient each and every time and recommend the alert. It only harms the patient in the long run if we don’t…

26. Thoughts? Questions? Complaints? Feel free to contact us in the EMS office… Feel free to contact us in the EMS office…  Shannon Morris 630-527-3332 630-527-3332 smorris@edward.org smorris@edward.org  Stephanie Klavohn 630-527-3341 630-527-3341 Stephanie.Klavohn@edward.org Stephanie.Klavohn@edward.org  Dan Donahoe 630-527-3112 630-527-3112 Daniel.Donahoe@edward.org Daniel.Donahoe@edward.org