Under water escapes, death notifications and wrecked cars all in a weekend's work
Rockport — The parking lot was strewn with smashed-up vehicles and inside The Samoset Resort in Rockport on Nov. 10, a crew of emergency workers administered CPR and worked to determine a diagnosis. On lower floors, red lights flashed and firefighters wandered the halls in full turnout gear and helmets.
However, what appeared to be a massive emergency situation instead was a five-day training conference for emergency services across the state of Maine. During a five-day period — Wednesday through Sunday — classes were offered by Atlantic Partners EMS to allow all types of emergency departments up-to-date training.
Atlantic Partners EMS Director Rick Petrie said the organization is in its second year of hosting the conference, which previously was run by Midcoast EMS. He said the organization works year-round with the mission of helping to educate emergency workers on protocols as well as assure patient care during emergencies is at its best.
"Overall, our job is to be a resource agency for the EMS services," Petrie said, adding there are numerous regulation guidelines that often change from year-to-year. "What [small EMS services] want to do is be there in the community to provide the care. We knock down barriers and help them meet requirements. It's a struggle sometimes."
Atlantic Partners EMS serves nine Maine counties that include 20 hospitals and 148 EMS services, Petrie said. Within those counties — Kennebec, Somerset, Waldo, Lincoln, Knox, Washington, Hancock, Penobscot and Piscataquis — lie a range of EMS services from large cities like Bangor down to volunteer departments like Cushing Rescue, he said. Each EMS service requires training of providers, based on EMT license level, regardless of size. The weekend conference allows a multitude of classes to be offered and smaller services to get the training they need, Petrie said.
"We try to get as much training in as possible," he said.
About Atlantic Partners EMS
The state of Maine in the late 1970s established six regions, each a nonprofit corporation, with the goal of providing education to emergency workers, Atlantic Partners EMS Director Rick Petrie said. Each of the six regions were funded through a federal grant, assigned to a specific geographic region and hospital.
In time, grant funding decreased and several of the 501(c)(3) corporations began to consider combining leadership, Petrie said. By sharing one director, it allowed two regions — Kennebec Valley EMS and Northeast EMS — to hire a full-time education coordinator.
"That program worked well enough that at the end of 2010, we decided to formalize the corporations," Petrie said. "At that time, Midcoast EMS said 'we like what you're doing, can we join?'"
As of July 1, 2011, Atlantic Partners EMS became responsible for three of the original regions. The other three regions remain separate corporations. Atlantic Partners EMS provides services to nine counties — Kennebec, Washington, Somerset, Hancock, Waldo, Penobscot, Lincoln, Piscataquis and Knox.
"The merger is based on the philosophy of stopping the duplication," Petrie said. "Do a better job, more efficiently."
For more information about Atlantic Partners EMS, visit apems.org/about/mission-statement/.
Classes differ each year. This year, offerings included refresher courses needed to maintain different levels of EMT licensing, a class addressing international deployment and battlefield medicine, classes to teach EMS instructors, planning and managing a medical incident during a "mass gathering" (such as a town festival), how to deal with a dog guarding its injured owner, enhancing communications between field rescue crews and the hospital, transporting patients who are obese, how to treat patients who have used new legal and illegal drugs and how to deal with patients experiencing a psychological emergency, among many others.
One class addressed methods for dealing with family members following termination of resuscitation. In January 2012, new guidelines were put in place requiring EMS providers to cease resuscitation efforts after 20 minutes during a cardiac event if other factors indicate the patient's heart will not restart — a non-responsive rhythm —, according to Maine EMS Medical Director Matt Sholl.
“It's pretty common to make [death] notifications,” he said. “We spend a lot of time training providers. This is really one of the most sacred things as EMS providers we can do.”
Sholl said the termination of resuscitation protocol has been in place for many years but setting a time limit for EMS workers of 20 minutes came about because research shows CPR is not as effective when performed in a moving vehicle or on a stretcher.
“High quality chest compressions are most important,” Sholl said. “[EMS workers] can't deliver good compressions when moving.”
He said nationwide policies were taken into consideration before establishing Maine's protocols.
“We had to set boundaries,” he said.
Sholl said the only reason an unresponsive patient suffering from a cardiac episode should be moved before CPR is started is to allow emergency workers more room to maneuver or to remove workers and the patient from an unsafe area.
“It's not the nicest thing for the public to see but it's important,” Sholl said.
He said the new guidelines not only benefit patients with a higher quality of CPR but also EMS workers and the general public because the ambulance isn't traveling to the hospital at a high rate of speed with lights and sirens.
“The important piece for the layperson to grasp is procedures are alarmingly similar. There are no special medicines or therapies at the hospital than on scene,” Sholl said, adding there is a 10 to 15 minute window of time after a heart stops beating during which it's vital to restart it.
He said training for EMS workers regarding notification to family members has been somewhat overlooked in years past.
“We need to be better about offering the skills to notify,” Sholl said. “Families respond well to EMS, firefighters or police breaking the news. They accept it as much as hospital personnel [telling them]. We are more and more trying to bring — or keep — families together, even in the hospital.”
Other classes during the weekend were more hands-on. Throughout the resort, posted on the walls near restrooms, signs jokingly warned attendees to remove vehicles from a particular parking lot or risk being taken apart by hydraulic tools, while outside in the parking lot, previously wrecked vehicles provided by One Steel sat waiting.
When students arrived, clad in turnout gear and helmets, they looked on as instructors demonstrated proper and safe use of the tools — one a spreading tool often referred to as JAWS and the other a cutting tool. Students then split into three groups to try the tools, some for the first time.
In the meantime, another class of students took to the pool outfitted in helmets and regular clothes over swimwear. This class sought to learn how to escape a submerged vehicle. First, students practiced swimming in the pool fully-clothed, some even choosing to keep shoes on. Then, two at a time, they climbed into a simulator and buckled their seat belts. Instructors pointed out where students should place their hands to facilitate escape in a timely manner. Then, into the water and upside down went the students inside the simulator. Instructors wearing swim goggles ducked their heads underwater to monitor the students' progress and occasionally banged on the simulator to create a more realistic underwater experience. Each student in the class was able to escape unaided by instructors to the clapping of the other students.
In another area, students crouched in hallways, working together to make a diagnosis of a patient simulator, performing CPR and asking the instructor questions about the patient's condition. Those not participating in hands-on classes filled the lower level rooms for lectures and group discussions. Vendors also had a space downstairs to showcase everything from clothing to the latest ambulance models.
Throughout the weekend, EMS workers that are also veterans were treated to discounted or free meals and a flag raising took place Sunday morning, Petrie said. Classes concluded Nov. 11 at The Samoset.
Associate Editor Stephanie Grinnell can be reached at 236-8511 or firstname.lastname@example.org.