by Candi Helseth
In the high desert of northern Nevada, Humboldt General Hospital Emergency Medical Services (HGH-EMS) responds to a motor vehicle accident call. Paramedics quickly perform a trauma exam using a portable ultrasound unit to detect internal bleeding or possible blockages and a handheld blood analyzer that returns diagnostic laboratory results in two minutes. Their conclusion: this critically injured patient needs surgery as quickly as possible. The HGH-EMS ground ambulance heads to a Reno trauma center 150 miles away.
Taking ultrasound and lab out in the field improves patient outcomes in rural areas, HGH-EMS Director Pat Songer said. “When we can reduce decision making time in the field, we can bypass a stop at a Critical Access Hospital to make those determinations. It means trauma patients get to a trauma center and into surgery faster, which means they are more likely to survive.”
Five years ago Humboldt General Hospital, a Critical Access Hospital (CAH) in Winnemucca, Nev., approved an EMS expansion for a critical care paramedic ground system that required major upgrades in ambulances, equipment and staff training. Humboldt County, with only 16,000 residents, covers 10,000 miles with a lot of barren, rough terrain—including sand dunes, dense sagebrush, and unpaved roads—and weather conditions that can quickly turn sour. Using ground ambulance or a combination of ground and helicopter, patient transport times have been reduced to an average of two hours, 15 minutes by ground or ground/air combinations, compared to an average of three hours, 30 minutes by helicopter. The hospital’s transport costs dropped from $7.8 million to $1.4 million a year. (Helicopter transports average $26,000 per trip compared to HGH-EMS’ ground ambulance average of $6,000.) In the last four years, all but two patients have survived the critical care transport to Reno.
By adopting an aggressive community and patient education program, HGH-EMS has also improved patient outcomes. Songer says he knows of at least a dozen people walking the streets who were saved by one of 250 automatic external defibrillation (AED) units that HGH-EMS purchased and placed in public spots such as gold mines, casinos, motels and senior centers. Wherever AEDs have been deployed, community teams have also been trained in their usage.
Additionally, HGH-EMS holds immunization clinics and promotes community safety with programs such as bicycle helmet safety and clinics on correct installation and usage of car seats. Individualized patient education reduces ER visits and hospital readmissions, Songer added. When patients call 9-1-1 to have HGH-EMS take them to the emergency room because they are experiencing adverse symptoms related to poor management of a chronic disease, HGH-EMS staff treat the problem at the site.
“When a patient with asthma calls for help because of misusing medications, for instance, that’s a prime opportunity for our paramedics in the field to educate the patient about correct usage,” Songer explained. “We treat the patient and release the patient home rather than bringing that patient into the hospital for an unnecessary ER visit.”
Earlier this year HGH-EMS added a 32-bed, 2,000-square-foot mobile hospital, which was first used at the annual weeklong Burning Man event held in Nevada’s Black Rock Desert this fall. HGH-EMS staff treated 2,500 patients out of an estimated 48,000 attendees at the on-site mobile hospital.
On average, HGH-EMS has only about 2,000 calls per year in Humboldt County. “So it’s important that we maximize how we use our resources,” Songer said. “One of the ways is to integrate our people into the hospital and to use our community resources as efficiently as we can.”
Local police officers and sheriff’s deputies, trained in first aid and AED use, act as HGH-EMS’ first responders. HGH-EMS staffers also work in the hospital, assisting in ER and as technicians in various areas. Paramedics manage the Cardiac Rehab Department, which is one of very few nationally accredited Cardiac Rehabs in a CAH, according to Songer. HGH is a public entity supported by a hospital tax district, and has also been designated as a federal rural CAH, which allows it a higher reimbursement rate from Medicare/Medicaid.
“Urban ambulance systems are designed around volume but since we’re hospital-based, we want to keep patients out of ER and the hospital unnecessarily,” Songer said. “And we believe there’s no reason you should have to live in a rural area and not get equivalent service to what is expected in urban regions.”
To learn more about HGH-EMS, contact Songer at firstname.lastname@example.org or 775-623-5222 (ext. 260).
Back to: Fall 2011 Issue