May 13 to 19 is National Emergency Medicine Services Week. Eric Dickson, MD,   head of the Department of Emergency Medicine and director of Emergency Medical Services at University of Iowa Hospitals and Clinics, talks about emergency medicine:

In the state of Iowa, how many emergency medicine services (EMS) systems are there?

EMS systems start when you pick up the phone and dial 911 to get the dispatcher, they're a critical component. They activate an ambulance system, typically, with first responders, EMT, paramedics; they bring in the ambulance system and then deliver patients to the emergency departments, which are the end of the EMS system. So when the patient is either discharged from the emergency department or admitted to the hospital, that's where EMS ends.

How is UI Hospitals and Clinics emergency medicine treatment and trauma system different from other emergency systems around the country?

I think the two biggest things that we see that are very different from an urban environment are really the distance and time that transports take place. So in Iowa we have a lot of very long transports, critical patients that are much more dependent on our out of hospital providers then what you see in an urban environment where there's a trauma center around every corner. We really need the best possible EMTs and paramedics to provide the care because they're going to be taking care of the patients longer.

The second thing is volunteerism. In most urban systems, you have a professional core of EMTs and paramedics and that is this is their fulltime job. In Iowa, 80 percent of the people providing care in the out of hospital environment are volunteers. They're good men and women who have donated their own time, their own money to get their training and want to give back to their community and serve their community. And that's why it is so important that we have Trauma Awareness and EMS Awareness Week that we give thanks to those people who are really there to take care of us when something bad happens.

A lot of people see the helicopters that land over at UI Hospitals and Clinics quite frequently. Tell us a little bit about that, how that fits into EMS and why it is that you would actually transport somebody via helicopter.

We have a very busy helicopter program here, there's about 2,500 helicopter landings on our rooftop each year, many of those from AirCare, the University of Iowa's helicopter system, which has flown over 20,000 missions and three million miles over the last 25 years. The helicopter, because of the distance that some of the patients have to be transported, even between hospitals to go from a lower acute emergency department to the end of the line - a level one trauma center like we have here - they're a critical part of shortening that time and making that distance seem less. The other part is we have crews that are highly, highly trained so when they get to the scene, be it on the roadside or at another hospital, we bring a higher level of care, often a physician going out from this hospital, providing care someplace else, so it's an extension of the hospital to the people that need us.

A lot of people talk about trying to deliver quality medical care. Talk a little bit about what that means, especially when you look at things within the emergency department, trying to deliver that in an emergency type setting.

When we talk about quality of care, you want to ask yourself the question, what do you really want from an emergency department?   And what people want is state-of-the-art care, without unnecessary delays, and without errors being made. And we have really learned a lot from our AirCare pilots about how to deliver quality. For example, every time we take off from the rooftop, we run a checklist, and I want that pilot running the checklist just to make sure there are no mistakes being made. And it's not a matter of the pilot not knowing what to do, it's an extra check to make sure that our crews and our patients are safe.

In our emergency department, we do the same thing; we run a checklist on people with critical diseases just to make sure, just to make absolutely sure, that they're getting the very best care that they possibly can. Not because we need cookbook medicine, but because we want to put that level of safety in there. The other thing is to use what Toyota has done and make every person who works in the emergency department and quality expert and a chief quality officer. So our staff all feel like they have two jobs: one to take great care of the patients; and two, to constantly find better, higher quality ways to take care of the patients. It's really empowering to them and you end up with much better care and the patients do better.

You do a lot of teaching as well, especially being at UI Hospitals and Clinics. How many emergency medicine students are trained, actually, at UI Hospitals and Clinics?

We see 6,000 students a year within emergency medical services here, and those students range from your basic CPR course, automated defibrillator courses, to our higher level course, which is a paramedic program (half the state's paramedics trained here at the University of Iowa), to an emergency medicine residency. And again, we've used some of the things that we've learned from our pilots about simulator training - a pilot never flies a new aircraft until they've spent a certain number of hours on a simulator working out scenarios. And we do the same thing with our students, intense simulator training before they ever get to see a patient.

You also mentioned that UI Hospitals and Clinics also offers education programs for emergency medicine training for physicians. Is that unique, or how is it that actually works?

We do have the only emergency medicine residency in this state, and it is part of our mission to enhance emergency care throughout the state. The best way to do that is train some physicians focused in emergency medicine so that they can go out and become leaders in their community, support their EMS workers, their ambulance systems, and provide the best possible care in the emergency departments outside of here. So we started our program three years ago and we are graduating our first class just this year, and it's an extraordinary group that will be serving the state of Iowa for a long time to come.

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