The Revolution in EMS Care

Intro

There’s a revolution taking place in emergency medical services, and for many, it could be life changing.

From the increasingly sophisticated equipment they carry and the new lifesaving techniques they use, to the changing roles they play in some communities – providing preventive care and monitoring patients at home – ambulance crews today are hardly recognizable from their origins as “horizontal taxicabs.”

Here’s a look at some of the most important changes happening in EMS care around the country – including a few plans in the testing phase still, and the challenges EMS professionals face to bring those to reality.

In Case of Emergency

EMS crews today are better equipped than ever for the worst kinds of emergencies, from cardiac arrests and gunshot victims to car crashes and other life-threatening injuries. These days, more ground and air ambulances include X-ray and ultrasound devices, machines that perform automatic chest compressions for CPR, communications systems that forward electrocardiograms to the emergency room, and equipment for lab tests that can identify dangerous conditions such as a developing septic infection.

Much of the best equipment – including a helicopter equipped as a mobile emergency room or intensive-care unit – can be found at the Mayo Clinic, in Rochester, Minn. Regarded as a leader in sophisticated onboard equipment and communications, Mayo often consults with other medical transport systems to share best patient care strategies, and works with U.S. military physicians to share expertise on how treatment of battlefield wounds might apply to civilian medicine.

Mayo provides increasingly advanced pre-hospital treatment, says Scott Zietlow, a trauma surgeon and medical director of the Mayo One trauma helicopter program. External defibrillators and pacemakers are standard, as are portable analyzers for lab tests and noninvasive devices to determine if a blood transfusion or antibiotics are needed. Because Mayo has its own blood banks, its air ambulances are able to provide a growing array of blood products that most others don’t carry.

In addition to featuring state of the art equipment, Mayo’s emergency medical service has helped test a number of EMS innovations, including capnography, a monitoring device that helps in the placement of breathing tubes and measures the concentration of carbon dioxide in exhaled air. This can guide the effectiveness of CPR chest compressions and gauge the likelihood that a patient can be revived. Mayo Clinic can also transport patients on a machine that does the work of a heart and lungs.

Mayo’s work with the military has led its EMS crews to adopt quick – clotting bandages and tourniquets for blunt trauma and penetrating wounds. A study of 125 patients that Dr. Zietlow co-wrote, published last year in the Journal of Special Operations Medicine, concluded that civilian use of tourniquets and hemostatic gauze is highly effective at stopping bleeding.

Mayo EMS crews also plan to adopt a practice the military uses as an alternative to intravenous lines, particularly when a limb has been lost: sternal intraosseous infusion, in which fluids and medications are administered into the bone marrow directly through the sternum.

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