When Minutes Count
Medical emergencies are never expected, but when they occur, a community’s emergency resources – such as the emergency medical services system or the Froedtert & The Medical College of Wisconsin Emergency Department – are always ready to provide needed care.
Ask area residents what they consider to be their community’s most essential resources, and most would probably produce a long list of assets ranging from neighborhoods to schools, art to sport venues, and shopping to restaurants.
Many would also cite access to quality health care. But few would mention the availability of an emergency department. After all, it’s the one place no one wants to end up. That is, until they absolutely need it. When the unexpected happens – a high fever or allergic reaction, a life-threatening stroke or heart attack – the availability of a first-rate emergency department is quite possibly a community’s most vital asset.
Just ask Hal Boston. At the age of 50, the last thing he expected to experience was a stroke. As a firefighter, emergency medical technician (EMT) and driver for Milwaukee Fire Department’s Engine Company No. 6, Hal worked in a physically demanding job. He also exercised regularly and didn’t smoke. But one morning last January, shortly after arriving home from work, Hal realized he was feeling symptoms of stroke.
“After 25 years as an EMT, I recognized what was happening,” Hal said. “I felt numbness going up and down my left side and I couldn’t move my hand. And then I just fell down.” Hal tried to alert his wife, Lori. With his still-working right hand, Hal even tried to call the house phone from his cell. Fortunately, his wife soon found him and called 911. “All I was able to do was mumble the word stroke,” Hal recalled.
Dual-trained EMT first responders with Engine Company No. 8 responded to Lori’s call. Based on Hal’s symptoms, they immediately decided to rush him to the Froedtert & The Medical College Emergency Department. “While paramedics were transporting me, they told me they were taking me to Froedtert; I had heard the hospital has the best available services for treating stroke,” Hal said.
Minutes count when responding to stroke. That’s why the Froedtert & The Medical College Acute Stroke Team (FAST) is available around the clock. The team provides immediate and experienced stroke expertise to determine if the latest treatments can benefit a stroke patient. The FAST team is the only one of its kind in eastern Wisconsin.
Hal was given intravenous tissue plasminogen activator (tPA), a clot-busting drug that can reverse stroke if given within three hours of the onset of stroke symptoms. He responded well, and after spending six days in intensive care, was released.
Today, Hal continues to receive care for an underlying cardiac condition, possibly caused by a viral infection which was a contributing factor to his stroke. Otherwise, he has no lingering effects. “Froedtert saved my life,” Hal said. “They really knew what they were doing and gave me a big quality of life to look forward to.”
Three Levels of Care“An emergency department is a safety net for the community,” said Michael C. Decker, MD, Medical College of Wisconsin emergency medicine physician. “It’s critical that people with medical emergencies and urgent health issues have immediate access to highly skilled care to address these situations.” According to Dr. Decker, patients can expect to receive that service at the Froedtert & The Medical College Emergency Department, which provides three levels of care. The Emergency Department offers intensive, resuscitative care for critical, life-threatening illness or injury in collaboration with the Froedtert & The Medical College Level I Trauma Center. The Emergency Department also provides general emergency care for urgent medical conditions, such as chest pain, shortness of breath, fractures, dehydration, bleeding and severe pain.
Additionally, the Emergency Department provides minor care for less serious situations, such as an ear infection or broken finger, that can’t wait through the night or until Monday morning to be treated by a patient’s primary care physician. “Many people think of Froedtert & The Medical College as a trauma center,” Dr. Decker said. “In reality, more than 95 percent of our cases are not trauma-related injuries. As a community emergency department serving the region, we take care of the full range of patients.”
Reorganized and ExpandedTo provide the highest efficiency in patient care, the Emergency Department was completely renovated last year. It added 13 exam rooms for a total of 38. Each is private and equipped with ultrasound capability and cardiac monitoring equipment, so services can be provided right in the room. Rooms are grouped within team stations or “pods” for patient care. Each pod consists of six to seven exam rooms and is overseen by a team of nurses, nurse practitioners, physician assistants, technicians and physicians.
When patients arrive at the Emergency Department, their symptoms are quickly assessed to determine their resource requirements. Patients with urgent needs are assigned to a pod dedicated to providing those resources, while patients with less acute needs are treated in the Minor Care pod, minimizing their wait time. Minor Care is located some distance from the trauma area to reduce potential patient anxiety.
The trauma area was enlarged with an open flow plan to maximize staff movement. Four rooms accommodate up to two patients each in the event of an incident with mass casualties.
Other additions to the Emergency Department include an on-site 64-slice volume computed tomography scanner that is available 24 hours a day, and a pneumatic tube (similar to those used at drive-up banks) that extends from the Emergency Department to the laboratory, allowing staff to send blood and tissue samples directly to the lab for faster analysis. Additionally, all staff members wear a Vocera badge that allows instant, real-time communications with staff anywhere in the Emergency Department.
Care Based on ResearchThe Emergency Department’s reorganization was based on the most current research, as are its treatment protocols, according to StephenW. Hargarten, MD, MPH, Medical College of Wisconsin emergency medicine physician and chair of Emergency Medicine.
“We pay constant attention to evidence-based protocols to develop advanced systematic approaches for patient care,” Dr. Hargarten said. “An example is our focus on acute heart attacks. From the paramedics who bring the patient in, to our Emergency Department staff, to the availability of an on-site Cardiac Catheterization Laboratory, the entire pathway of care is integrated and patient-centered. This is important, because time is of the essence.”
Having evidence-based protocols in place can make a difference in critical outcome measures. For example, the Emergency Department’s “door-to balloon time,” which measures how long it takes before a heart attack patient receives often lifesaving balloon angioplasty or coronary intervention, is substantially less than 90 minutes, the standard set by the American Heart Association.
As Dr. Hargarten noted, this integrated system of care extends to the Milwaukee County emergency medical services (EMS) system as well, which serves the Froedtert & The Medical College Emergency Department along with other emergency departments in the area. The EMS system’s dedication to improving care through research was recently cited in a study in the Journal of the American Medical Association. Of 10 regions studied, the Milwaukee County EMS system ranked second highest in survival rates of patients who were in ventricular fibrillation cardiac arrest.
“With these established pathways in place, patients should expect state-of-the-art care and attention the moment they arrive at our Emergency Department,” Dr. Hargarten said.
Source: Froedtert Today
Date: December 2008