Special recognition must go to the private EMS services that responded to our requests. Many county-based and municipal units came when we called. Without the ambulances and other means of transport the private sector supplied, there is no possible scenario other than to have brought in FEMA.
We plan to address the issues of the day and their impact on the EMS system in South Carolina. I may reach out to several of you between issues to “pick your brains” and ask what you want and need to know more about how and what is going on across the state.
Since our first column is bumping up against a hard deadline for publication (editors are some sticklers, folks!), I’ve chosen this initial column to welcome you all into our world at the state office and let you know a few of the things we have going on and are coming up in the future. This column is not intended to be a “brag list” of accomplishments for our bureau to pat ourselves on the back; it is to open a window into what has been happening in our world that directly affects yours. If you gain insight on one new idea, program, or project we are working on, I will have done my job.
Bureau of EMS and Trauma
As you know we are just about a year into the Bureau of EMS and Trauma actually being designated as a bureau; having had the Division of EMS and Trauma upgraded, if you will, to a full bureau. It was no small feat and it was only through the EMS community’s feedback and positive words that the leadership of DHEC saw the hard work you do every day and determined that growing us from a division to a bureau was a “need” and not a “want.” We are able to produce so much more for you as an EMS system and access resources that we only dreamed about for the last 30 years. We will not squander this opportunity and the Bureau of EMS and Trauma is here to work for you.
One of the most impactful projects we wrapped up after two years of effort was the updating, review, and legislative approval of our two main regulations 61-116, Trauma Systems and 61-7, EMS. With your help, input, editing, and comment, we were able to have both regulations time out during the last year of the legislative session and both regulations are now in full effect.
Highlights in the Trauma Regulation include:
- Mandatory trauma triage tags on all 911 transport units (DHEC obtained a grant for $275,000 to initially equip the state’s ambulance fleet)
- Transitioning to requiring hospitals to be credentialed as “Trauma Centers” by the American College of Surgeons (ACS) to obtain state designation
- The addition of Level Four Trauma Centers and Level 1 and 2 Pediatric Trauma Centers to the regulation
The EMS regulation, as most of you know, was more than 10 years old! In emergency medicine that is literally a lifetime, and it required a near complete re-write. There are many highlights, but the improved equipment list, new “driver” requirements, a re-vamping of the educational system, special exemptions for volunteer rescue squads, and the major changes to report writing and data managers come to mind. More than 400 changes were incorporated into this regulation revision. We could not have done it without the input and support from all of you.
The South Carolina EMS Community Paramedic (CP) Pilot Program was expanded tenfold this year. The great success of the Abbeville CP pilot program is widely known. As you are aware, the Bureau is intent on making data driven decisions, and DHEC felt that although the CP program could thrive in a rural setting with a single hospital provider, we could not fully release it from pilot status before it could be tested thoroughly in several different models.
We now have more than 10 CP programs spread across the state in urban, rural and even a small section of super rural areas. The community needs assessments for each of these areas was vastly different, and after 12 or 18 months, I believe we will have collected enough data to be able to say the CP programs in South Carolina are modeled correctly and can be released for use across the state. The data thus far suggests that many of your programs are wildly successful! Congratulations.
Protocols and Scope of Practice
EMS Protocols and Scope of Practice are being updated and will be released for comment by the time this column hits the front porch. I hope many of you recognize the hard work and literally hundreds of hours that went in to the Bureau and many of you re-writing the State EMS Protocols and Scope of Practice. We received many positive comments on the newly revised skills list, and I anticipate you will do justice to the Statewide Protocols as well.
The new format did not include any dosage recommendations — except in the mandatory procedures areas — but does have an editable field for each agency to set their dosage requirements. We do not want to determine what dose of what medication to administer; that is between you and your agencies’ Medical Control Physicians (MCP).
In producing the protocols in this manner, we are ensuring each agency’s MCP is deeply involved in individual agency protocol development. Speaking of protocols, DHEC with the approval of the State MCP, recently changed the scope of practice for EMTs to allow for the drawing up and administration of epinephrine for a person having an anaphylactic emergency. This was done in response to overwhelming requests from the field to address the rapidly growing costs of epi-auto injectors. On average these injectors are costing agencies between $600-800 each. The cost of a new “Epi Kit” is $20 or less.
Through the input and consultation with agencies across the state, we were able to partner with DHEC’s Bureau of Drug Control and obtain permission to utilize off-line narcotics administration, a procedure that hadn’t been allowed in South Carolina since before many of our EMS employees were born. One year of data on this project is also suggestive, thus far, that it’s working. Patients are receiving appropriate analgesic pain relief, and there does not appear to be any increase in diversion of controlled substances in the EMS community. Couple that with the addition of Tylenol and Toradol to the formulary, and we predict narcotic use on EMS patients may actually decrease in the next year. Keep up the good work.
The Bureau also has collaborated with several other state and local entities, most notably the S.C. Department of Alcohol and Other Drug Abuse Service (DAODAS) and the S.C. Fifth Judicial Circuit Solicitor’s Office to begin a Law Enforcement Officer Naloxone (LEON) Program. With a newly passed law and some donated naloxone, we began training officers across the state who indicated an interest in the program. Although we had little to no funding, we have been able to train over 800 officers. That training and the heroic efforts of those officers have resulted in more than 10 confirmed saves of overdose patients. Make no mistake, we are at the beginning of an epidemic here in South Carolina. Four years ago we barely cracked 50 deaths and 3,500 EMS administrations of naloxone statewide. In one month this summer we had 30 deaths in one county alone, and if the numbers hold through December we will have more than 7,000 EMS administrations of naloxone across South Carolina. Due to these facts, we jointly applied with DAODAS for a U.S. Department of Health and Human Services grant for overdose prevention in May 2016. DAODAS and the DHEC’s Bureau of EMS were awarded just over $3.2 million for a five year project in which we will train police departments across the state and place in service more than 5,000 naloxone kits in these departments. Virtually any police agency in the Palmetto State will be able to carry this lifesaving tool and be provided the training free of charge.
As I bring this column to a close, I can easily think of 15 more exciting and innovative projects the Bureau has undertaken in the last year, all with your help and encouragement. I would be remiss; however, if I did not close with the efforts put forth by the SC EMS System in response to Hurricane Matthew. When this storm hit Category Five strength and seemed to have the Carolinas in its sights, you all stood ready to assist. More than 3,030 patients and residents of licensed facilities had to be evacuated from the coastal regions to Greenville, Charlotte and beyond.
As we staffed the DHEC Emergency Operations Center, we watched as these patients were efficiently and safely moved inland. As a bureau, we were tasked with the movement of more than 425 of these patients, and you did not disappoint. Despite the interstate being reversed, you sent us everything you had — ambulances, buses, wheelchair vans. No request we made went unfilled. Once more for effect — NO request we made went unfilled at the level for which we requested for nearly six days running. You as a statewide EMS system came to the aid of the citizens of South Carolina and did so in a big way.
Special recognition must go to the private EMS services that responded to our requests. Many county-based and municipal units came when we called. Without the ambulances and other means of transport the private sector supplied, there is no possible scenario other than to have brought in FEMA ambulances at a cost of several million dollars a day to the taxpayers to move these patients across our state. As we say in the bureau “an ambulance is an ambulance is an ambulance.” Without these consummate professionals working side-by-side with you, we would not have weathered this storm.
I hope you’ve gained a little knowledge, or I have piqued your interest to look into some of the projects we have going on in the bureau. We are always looking to collaborate with you on well- researched pilot projects, work through an issue you’re having or just sit down and have a cup of coffee. If you want to check out all the exciting programs we have in the mix, don’t forget to stop by our new portal: SCEMSPORTAL.ORG to find out all you need to know about EMS in South Carolina!
Rob Wronski is the South Carolina Department of Health and Environmental Control (SC DHEC) Bureau Chief of EMS. He has served in many roles since becoming a firefighter paramedic in 1991, culminating with his selection as Chief of EMS for the state where he has served for nearly three years. He has held several executive positions including Assistant Chief of the St. Andrews Fire Department in Charleston, Medical Officer of the Mt. Pleasant Fire Department, and a Shift Commander in the Beach Park (IL) Fire Department. His experience includes working in fire-based EMS, including ALS and BLS first response as well as fire based and county based ALS transport.