Celebrating EMS, ‘the Real Front Line Heroes’
Hospital emergency departments need to function with life-saving speed and efficiency. But for many patients, their emergency treatment begins even before they arrive, thanks to Emergency Medical Services workers who provide hospital-level care on-scene and en-route.
“People say that front line hospital workers are heroes, but the reality is the EMS workers are the real front lines, and they are the heroes,” says Scott Goldstein, DO, Director, EMS-Disaster Medicine, at Einstein Medical Center Philadelphia. This week, May 17 – 23, is National EMS Week.
Dr. Goldstein says EMS workers have always been heroes, speedily treating life-threatening emergencies where seconds count and transporting patients to the appropriate hospital for the best treatment whether the patient is having a stroke or a heart attack, been injured in an accident or felled by violence.
A New Risk: COVID-19 Exposure
But the COVID-19 pandemic means EMS workers also put themselves at risk of potential exposure whenever they answer a 911 call – and they do so without hesitation.
“They are putting themselves at risk and going into homes and nursing homes where people are sick, going into circumstances where they don’t know what it is until they get there,” says Elizabeth Datner, MD, Einstein’s Chair of Emergency Medicine.
Ryan Overberger, MD, Program Director for Einstein’s new EMS Fellowship, added that medical workers “in the hospital can control many more aspects of the interaction – from environmental controls like doors and ventilation, to restricting visitors, to distancing and contact limitations, but EMS has to go get the patient in their environment where they’ve been coughing, sneezing and breathing. They need to stabilize them, reassure their family and bring them to the hospital, all the while managing their personal protective equipment without the ability to pause to fix their mask or wash their hands. It’s a really challenging environment.”
Between 1,500 and 1,700 ambulances arrive at Einstein Medical Center Philadelphia’s Emergency Department a month. “The initiation of care they provide is absolutely paramount to a patient’s survival,” says Steven L. Chapman, associate vice president of emergency services.
A Smooth Handoff
The EMTs and paramedics radio ahead to the ER with the patient’s symptoms. That enables the hospital to ready the necessary team for immediate intervention – to halt damage from a stroke or heart attack, to stem bleeding from a traumatic injury.
And if the EMS is transporting a COVID-19 patient in respiratory distress, the team is ready to take him or her to a negative pressure room – where air is filtered to prevent virus particles from spreading – so that advanced care can take place with less risk to others.
“Their handoff of a patient is absolutely critical for continued care,” Chapman says. “There are situations in which time is of the utmost importance. When minutes count, we have a team set up based on the ability of EMS to call ahead.”
The public may not realize the pivotal role First Responders play in patient care. “People may think of it more as a route of transportation and a little medical care but it is a lot more medical care,” says Melissa Kohn, MD, who practices emergency medicine at Einstein Medical Center Elkins Park and Einstein Philadelphia. She, Dr. Goldstein and Dr. Overberger are among the six board-certified EMS physicians at Einstein.
At Einstein Medical Center Montgomery, EMS teams have proven flexible and cooperative in response to hospital initiatives to expedite patient care, says Mark Menapace, an emergency medicine nurse who’s the liaison with the county’s EMS teams.
When EMS transports a potential stroke patient, for instance, they’ll take the patient on their stretcher directly to the CT scanner, which is a few feet from the ER, after a quick evaluation by an ER doctor. The scan determines whether the stroke is from a blood clot or bleeding, and dictates what treatment is necessary.
“Getting that answer as quickly as possible is critical,” Menapace says.
While the COVID crisis has highlighted the heroics of First Responders, and this week has been set aside to honor them, their work should always be recognized, Dr. Goldstein says, adding: “They’re heroes every day for their entire careers.”