University of California San Francisco. SFFD EMS SYSTEM 40 dynamically deployed ambulances Shifts...
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Transcript of University of California San Francisco. SFFD EMS SYSTEM 40 dynamically deployed ambulances Shifts...
University of California San Francisco
SFFD EMS SYSTEM
•40 dynamically deployed ambulances•Shifts starting time from 0500 until 2130 from 1 central station•Only SFFD ambulances are participating in RAMPART•8 receiving hospitals participating in study•RAMPART implemented 6/19/09 on 10 rigs initially•First enrollment 6/27/09•45 enrollments•7 enrollments in 1 week in November•Prior PHTSE experience
Study Challenges
Continued Paramedic training
Informed Consent
RAMPART boxes/Megabundle management
Keeping the medics involved/informed and happy!!
And locating them!
RAMPART bulletin board w/FAQs, opt out bracelets, auto injector instructions, recent enrollment info, enrollment #s, coordinator contact info, etc.
Flyers with unit #/medics names for each enrollment
RAMPART FAQs Contact every crew that enrolls a subject Flyers with protocol clarifications posted or placed
in medic’s mailbox. Practice with expired auto injectors. In person review to start in January Mandatory on line CE for medics with RAMPART
included in sz/neuro/AMS module.
Protocol Clarifications
• If patient stops seizing after IM and before IV study drug, they don’t receive IV study drug.
• No focal seizures.• Getting medics to wait 5 min prior to
enrollment. • Patient must be actively convulsing.
Informed Consent
Challenges
• Homeless without any contact info, or marginally housed.
• With psych/substance abuse issues other seizure threshold lowering lifestyles.
• Subjects discharged from ED prior to investigator arrival or leave AMA prior to investigator arrival.
• Addresses not valid with notification letters returned
• In SF approximately 30% of subjects• Language issues • Cultural differences/Educational Issues
• Notification letters left in patient chart and/or mailed out to patient.
• Call ED prior to investigator arrival• Attempt to locate case manager,
LAR, psychiatrist, emergency contact or PMD.
• Make extra hospital visits• ED info form given by medics to ED
staff
RECE IVIN G ED RAM PA RT IN FOR MA TI ON CA RD
This patient has been enrolled in the RAMPART Prehospital
Seizure Study comparing paramedic treatment with IM Midazolam versus IV Lorazepam.
The patient has received
Adult Dose
Either
10mg Midazolam IM Or
4mg Lorazepam IV
Pediatric Dose
Either 5mg Midazolam IM
Or
The on call investigator will be calling the attending MD within 30 min to find out if the patient was seizing on arrival at the ED.
If you have further questions, please call the RAMPART pager at:
415-443-1500 If the patient is being discharged from the ED, please
call the RAMPART pager prior to discharge.
Thank you!
Adult Dose*
Either 10mg Midazolam IM
Or 4mg Lorazepam IV
Pediatric Dose*
Either 5mg Midazolam IM
Or 2mg Lorazepam IV
Thank you!
Jeany DuncanRAMPART EMS Coordinator
415-206-4106