The 750,000 plus emergency medical service men and women throughout the U.S. are often the first on the scene of a disaster, a motor vehicle accident, or other dangerous surroundings. They make up the medical frontline emergency teams that provide the day-to-day lifesaving services we've come to expect.
Even more amazing, about 80 percent of Emergency Medical Service (EMS) positions in Iowa are staffed by volunteers - people who spend their own time and money to be trained to return to their local communities to help in the event of a medical emergency.
Eric Dickson, MD, FAAEM, head of the Department of Emergency Medicine at University of Iowa Hospitals and Clinics says than on a typical day in Iowa, EMS dispatchers receive between 400 and 500 calls for help, that's a call every three to four minutes.
"Once a call is received, one of 1,800 EMS systems will be activated," says Dickson. "And 80 percent of those systems are made up volunteers. People who typically work full-time jobs outside of EMS and choose to serve their community by responding to our calls for help. That's why is so important for us to thank them. Without those volunteers and professional EMS workers there really is no one to respond our calls. We owe them our gratitude."
Dickson says the first thirty minutes is absolutely critical and often determines whether a patient lives or dies. "Take cardiac arrest for example, the two things that have the greatest impact on whether a patient lives or dies is when CPR is started and when the first shock is delivered, neither of these things can wait until the patient is loaded into an ambulance; let alone transported to the hospital. Time is absolutely critical in Emergency Medicine."
1. How is it determined who is treated at their local medical centers and who is sent forward to a tertiary center like UI Hospitals and Clinics?
Iowa's comprehensive trauma system is made up of the state's 117 emergency departments. They receive a level designation from the department of public health between 1 and 4. "Level 4 centers play a critical role in initially stabilizing the patient, but have the least capabilities of providing definitive care," says Dickson. "The state's two level 1 centers located strategically at Methodist Hospital in Des Moines and at UI Hospital and Clinics in Iowa City provide the most comprehensive trauma care and are the destination for the most severely injured."
Whether a person survives a severe illness or injury depends on the quality of emergency care they receive and the time it takes to receive definitive care he says. "Our AirCare flight crews are made up of paramedics, nurses, and doctors who not only get the patients to us quicker but begin advance care before they ever leave the scene of an accident. In a rural state like Iowa it is not uncommon for us to be able to take an hour off transport time by flying a patient rather than going by ground ambulance. In a field where we measure life-and-death by minutes, air ambulance transport is a critical link in the chain of survival."
Dickson says the biggest change in emergency medicine is the use of simulators. "It is much like a pilot learning on a ground simulator before they take to the skies. Our trainees spend the early part of their training in a simulator room, learning to take care of patients in the safest environment possible. Today's high-tech simulators, talk, breath ,and have a pulse. We can create scenarios with the simulators that will make the most seasoned emergency physician sweat. It's an incredible teaching tool."
Dickson says engagement and outreach are next on the agenda. "We have some of the best EMS instructors in the country and over the next year we are going to focus on getting those teachers out, providing education and training to as many EMS systems as we can. We are state-institution with an obligation to serve every citizen in Iowa and the best way for us to do that is by supporting Iowa's EMS workforce, so they can support us when we call for their help."
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