Major EMS Systems Paper & Project

E N D O F Y E A R R E P O R T

2 0 1 3 E MS S TA T I S T I C S

C O U N C I L B L U F F S F I R E & R E S C U E

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2 0 1 3 E M S S T A T I S T I C S C O U N C I L B L U F F S F I R E & R E S C U E

OV E RV I E W

This is an overview of the medical services statistics and quality medical care that the citizens of Council Bluffs receive on a daily basis from the men and women of the Council Bluffs Fire Department. The Emergency Medical Services (EMS) system in Council Bluffs is dedicated to increasing survival and reducing disability from out-of-hospital emergencies by providing the highest quality patient care in the pre-hospital setting.

Once again we would like to thank both Mercy Hospital and Jennie Edmundson Hospital for

their continued support of our EMS System, their education, guidance, pharmacy, patient follow up and feedback they continue to offer us on a daily basis. Thank-you to our medical directors, Dr. Chris Elliott and Dr. Tom Masters for their medical direction. Patient outcome feedback has been outstanding and allows providers timely feedback which results in improved patient care.

During 2013 the Council Bluffs Fire Department responded to 7,745 (-1.3%) responses for fire and EMS. Of those requests 6,187 (+0.5%) were EMS related or 80% (+2%).

12 Lead’s continue to play an important role in identifying STEMI patients and helping to reduce

time the patient arrives to the cath lab. In 2013 we performed and transmitted 513 field EKG’s and identified 24 STEMI patients with an average time from 911 call to fax of 15 min.

R U N S TA T I S T I C S

 6,187 (80%) of the total responses resulted in calls for emergency medical assistance and 4,171 (-1.4%) patients were transported to the hospital for continued care. The remaining responses were for fire suppression, hazmat, alarm activation, and other non EMS related responses.

 The daily EMS response average for the year was 16.9 calls per day and 11.6 transports per day. This response average was unchanged from the previous year average.

 The total EMS call volume increased 0.5% in 2013 from the previous year. We have increased in volume by 36.6% over the past 10 years.

 The Fire Department provided 416 crew hours of EMS stand-by for events around the city including Mid-America Center, CB stadium for HS football and IWCC football games.

 Mutual aide or ALS Tier outside the city limits was provided 42 (21%-) times.

 2013 Medic Unit response totals: M3 - 2,380(36.6%) / M2 – 2,159(33%) / M1 – 1,964(30%)

 2013 Patients Transported M3 -1,566(37%) / M1 – 1,339(32%) / M2 -1,319(31%)

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2013 TRANSPORT DESTINATIONS

TRANSPORT TIMES AVERAGES (MINIUTES)

DESTINATION PATIENTS

PERCENT

7:08 Jennie Edmundson 1,612 38%

7:08 Mercy Hospital 2,557 60%

7:55 Creighton Medical Center 32 0.7%

11:35 University Of Nebraska Med Center 37 0.9%

2013 SKILLS AND PROCEDURES

A dramatic improvement of intubation success rates were continued in 2013. ET Intubation success rates improved from 88% to 93%. This may be contributed to the addition of Glyde Scope Fiber Optic airway equipment.

A CO2 monitor was used in 98% of all intubated patients which is an umprovement from 91%. Esophageal Bulb was used in 89% of all intubated patients. Documentation that the emergency room physician confirmed tube placement was documented in 91% of all charts. Our goal for 2011 was to have 100% compliance with our airway confirmation protocol by using the EID bulb, CO2 monitor, and having the ER physician confirm placement on arrival to the ER. We had no unrecognized misplaced intubations in 2013.

2013 MEDIC UNIT SCENE TIME AVERAGE OF 9:62 MINUTES

Individual Scene Time Ave: M1-10:19, M2-9:35, M3-9:34

A L S P RO C E D U R E S TA T I S T I C S

43% OF OUR PATIENTS TRANSPORTED REQUIRED ALS INTERVENTIONS

73 DIABETIC PATIENTS RECEIVED ALS CARE AND REFUSED TRANSPORT

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ALS PROCEDURES PROVIDED

PROCEDURE COUNT SUCCESS RATE

IV PLACEMENT 1,616

75%

FIELD INTUBATION 54/58

93%

CHEST DECOMP 4

NA

DEFIBRILLATION 73 NA

CPAP 26 NA

12 LEAD EKG 513 NA

INTRAOSSEOUS PEDI 2 100%

INTRAOSSEOUS ADULT

39

95%

EXTERNAL PACING 3 NA

KING AIRWAY 5 100%

CARDIOVERSION 1 100%

MOST COMMON MEDICATIONS ADMINISTERED

MEDICATION TIMES USED

MEDICATION TIMES USED

ALBUTEROL 116 VERSED 56

ASPRIN 258 OXYGEN 789

ATROPINE 13 BENEDRYL 10

D50 128 GLUCAGON 12

DUO-NEB 214 GLUCOSE PASTE 12

EPI 1:10,000 121 ADENOCARD 5

MORPHINE 55 AMIODARONE 20

NITRO 317 NARCAN 50

ZOFRAN 145 FENTANYL 167

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CARDIAC ARREST STATISTICS

The following statistics show the changes that have been made in the system the past few years are improving the survival rates in Council Bluffs.

During 2013 there were 50 patients in cardiac arrest. Using the Utsteine template which counts only the victims who were in V-Fib or V-Tach on arrival of EMS, and defining a ‘Save” as a patient who walked out of the hospital without neurological deficits, we can estimate the departments save rate to compare nationally.

The Department had 17 patients that fit into this formula of V-Fib/V-Tach and “had a chance to be saved”. Of these cardiac arrests 8 patients walked out of the hospital and can be counted as “Cardiac Arrest Saves”.

THE NATIONAL AVERAGE IS 6-10%

THE COUNCIL BLUFFS FIRE DEPARTMENT

SAVE RATE FOR 2013 WAS 47%

Most common initial rhythms in cardiac arrests:

 Asystole – 36% / PEA – 30% / VF/VT – 34%