CCAD wins MEMSA 2010 "Service of the Year" award

CCAD proudly accepts the MEMSA "Service of the Year" award. The following is the submitted narrative for the award application:

Chariton County Ambulance District
Emergency Medical Service of the Year

Chariton County Ambulance District (CCAD) was established in 1973 with two bases, in Salisbury and Brunswick. The Salisbury base houses two ambulances and facilitates the daily operations of the district. In 1996, the Brunswick Public Safety Building was established and houses one ambulance and maintains a helicopter landing zone. The population of Chariton County is approximately 7,600 with 758 square miles of coverage. CCAD responded to 1,033 calls in 2009. Chariton County is defined by Medicare as a “super rural” area. Medically, the residents are served by three clinics, a health department and three nursing homes. After 5PM, the only acute medical treatment is provided by the Chariton County Ambulance District. The closest hospitals range from 22 miles to 40 miles, with the average distance per transport of 30 miles. The closest Level 1 trauma center and advanced cardiac and stroke center is 60 miles.
CCAD employs 69 employees, 10 full-time staff, 15 prn staff, and 44 volunteer first responders. The first responders are essential members of our team. In a rural area with long response times, the responders provide quick care and important information to the 911 center and the responding ambulance crew. The paid staff includes three RN’s, twelve EMT-Paramedics, and nine EMT’s and one office assistant. The full-time staff has an average of 20 years of experience with nine of the ten employees born and raised in the county. This year’s EMS week, four employees will be celebrating their anniversary year of employment with two of 10 years, one of 20 years and one of 30 years of service. The employee credentials include; seven BLS CPR instructors, one EVOC instructor, one ACLS instructor, one ITLS instructor, one PALS instructor, four EMS training instructors, four EMS evaluators, one PEEP instructor, and complete NIMS compliance. Over the last 2 years, CCAD has provided three scholarships for employees to complete EMT-P training and one scholarship to continue toward RN completion.
CCAD is committed to continuing education for the staff. The staff is provided with ACLS, PALS and BLS training. The district hosts monthly CEU classes to keep the employees up to date on current medical trends and to meet Bureau requirements for licensure. In 2009, 12 CEU classes were taught with a total of 180 certificates given for 36 hours of training. The training manager has made great effort to bring in outside professionals that are trained in specific areas, such as MoDot for “Incident Traffic Control for Emergency Responders”, MU FD for “First on the Drug Lab Scene: Awareness”, Bob Page for “Capnography and 12-Lead Interpretation”, and SANE nurses for “Sexual Assault Care”. The first responders meet monthly for continuing education classes, also. They meet for quality assurance and feedback on ways to improve care, as well as, keeping up on new medical equipment and medical trends. The paid staff meets monthly with the district’s medical director, Dr. Karl Harmston for QA/QI. Dr. Harmston has been the district’s medical director for 18 years. The medical director knows each employee, reviews emergency transports with the staff, and changes protocols, policies and procedures as medical trends change. All of the patients involved in the emergency transfers are followed-up via telephone contact to assure proper assessments and ensure a high quality of care.
CCAD has purchased equipment over the past year to improve patient care and staff safety. Zoll AutoPulses (mechanical CPR) have shown improved CPR results and improved safety with cardiac arrest transports. EZIO interossous needles have been utilized for vascular access when an IV is unattainable. Power stretchers have reduced injuries with lifting and transferring patients. CCAD began providing 12-lead cardiac transmission ten years ago, but with the recent digital change on cellular phones, were unable to forward the results to the hospitals for several years. New technology has permitted the district to now fax 12-leads to receiving hospitals for early access to cardiac care. The district has also purchased ambulances with higher safety standards and equipment securing devices.
To ensure rapid transport to the appropriate hospital, five air ambulances are utilized, depending on location of the call and availability. CCAD works with the county E911 center to grid 36 zones and provide the appropriate helicopter for the appropriate location. The county has 19 pre-designated helicopter landing zones with GPS coordinates. Early activation of air ambulances has been utilized by CCAD since 2000, when there was only one helicopter service available. The helicopters and services have increased providing even quicker access for the patients to be transported to the appropriate trauma or medical centers. With the E911 center trained in helicopter activation with certain symptoms, the transport time to these centers can be reduced by as much as one hour at some locations.
CCAD considers it a duty and privilege to provide medical education and opportunities to the citizens. The district provides bi-monthly BLS CPR classes to the residents. The CPR instructors also travel all around mid-Missouri providing BLS CPR classes to counties that the service isn’t available. In 2009, CCAD hosted 31 CPR classes and certified 381 students. CCAD’s training entity provides annually either an EMT class or a First Responder class, last year an EMT class with 10 students and a refresher class were taught. The classes are intended to keep medically educated residents available for employment or knowledge to help family and friends. The bonus is a career opportunity. The district works with Red Cross to provide quarterly blood drives. The opportunity to give blood allows the residents to feel the positive effects of helping others and bring the community together. With the district’s open-door policy, many residents frequent the ambulance bases for blood pressure checks. The district, in cooperation with the Public Safety Net, teaches a safety class to the five county school’s third grade classes. The students are provided books to study and are required to write reports on their findings. The superintendent then follows up with a lecture and gives praise on their new personal responsibility achievement. The district has developed a website for the public and employees to track events, board minutes, classes and general district information. Over the last year, the district has participated in two health fairs and provided free 12-lead EKG screenings. The results have been a 27% identification of new onset cardiac changes. Those identifications prompted physician visits and potentially saved a life.
The staff is involved in local, regional and state EMS initiatives. At the local level, the superintendent represents the district in the LEPC, Chamber of Commerce in Salisbury and Brunswick (ambulance base locations), and the Child Fatality Review Board. At the regional level, the superintendent is the EMS alternate at the Troop B Regional Homeland Security Oversight Committee (RHSOC), and a board member of the Central Region EMS Subcommittee. Current employees have worked at or are currently working at five of the local hospitals. This first-hand knowledge of the hospital procedures and staff helps patient continuity of care. At the state level, the superintendent is involved in implementation of the Patient Safety Organization (PSO) and the district will be a pilot program. The district has been recognized by the Pediatric Subcommittee-State Advisory Council on EMS for pediatric equipment and supplies available for emergency needs. Three employees regularly attended the MEMSA EMT and EMT-P practical evaluations in Kansas City and Columbia. The district is a member of the Missouri Ambulance Association and attended all of the MAA conferences in 2009 in order to keep the employees and Board of Directors informed of state and national EMS interests. The superintendent also attends the monthly EMS Legislative Subcommittee and EMS State Advisory Committee meetings, providing input as one of the few rural voices.
Looking into the future, CCAD will continue to provide a safe and thriving atmosphere. In cooperation with the LEPC, the district helped secure funding from private enterprises to establish an emergency notification system. This system is to be up and running by June 2010. It will provide mass notification by phone, cellular phone, email, or text. It will be activated for HazMat situations, boil orders, weather emergencies, or any circumstance that may cause harm to anyone approaching these areas. The district is also in the process of researching all air ambulance transports over the last year. The purpose is to establish financial impact on patients. Over the next year, the district is planning a “First on Scene” lecture for churches and organizations. The purpose is to provide first-hand knowledge, scenarios, and teachings of what to do for those who are there first.
Chariton County Ambulance District doesn’t just bring the patient to the hospital; they bring the hospital to the patient. The legacy of providers is continuing with a new generation of eager and knowledgeable class. Transferring knowledge and experience will keep the district in a class of their own, rural or urban. By the Chariton County Ambulance District winning the Emergency Medical Service of the Year, the employees and residents win recognition as a safe and co-dependent team.