Cypress Creek - Unconventional EMS
Cypress Creek Emergency Medical Services has emerged among the most progressive operations across the nation, a trendsetter always reaching to deliver the cutting edge in critical care. “They are well-respected in the industry,” said Ken Bouvier, Past President of the National Association of Emergency Medical Technicians. “They are always looking at how they can improve the quality of life in their community. I’m always looking at what they’re doing.” Staying forward in pre-hospital medicine, said CCEMS Medical Director Dr. Levon Vartanian, simply is a soulful calling for the 35-year-old, $14 million operation, which is funded by public and private monies.
Its team of about 265 staff and volunteers serves some 500,000 residents in a 250-square mile region north of Houston, whose explosive growth over the years has made mention in the likes of the Wall Street Journal.
Cypress Creek has always held its service community close, with many of its workers from the area and a number of them, including some of the brass, having served the organization for decades.
“We believe the community deserves the best,” said CCEMS Medical Director Dr. Vartanian, an emergency physician at nearby Houston Northwest Medical Center. “This is our community. We are in the neighborhood and in people’s homes, we are always asking ourselves, ‘How can we do things better?’ With pre-hospital emergency care developing as rapidly as emergency care in hospitals, we are always looking to stay ahead on the front lines, to do things better and quicker for our patients.”
And to stay ahead, Cypress Creek focuses on staying abreast of the latest in procedures, training staff on cutting-edge care, deploying new technologies and developing and maintaining relationships with all the parties who have a stake in delivering the finest in emergency care.
MATTERS OF THE HEART
Among CCEMS’ highest-profile initiatives – and one that has been used as a model by other emergency services groups - is its program for STEMI patients, launched in 2006.
Paramedics, properly trained in procedures, interpret 12-lead ECG’s, diagnose the problem and determine whether to bypass the emergency department and proceed directly to the catheterization lab.
Field paramedics then activate the cath lab at the “point if illness” and alert staff at the proper destination that there is a patient en route.
Upon arrival, cath lab staff, who also are trained in the system’s protocol, continue the effort to save yet another life.
The program, which has drawn high praise from some area hospitals, indeed seems to be effective.
Self-reported data from a two-year period indicates CCEMS’ effort has reduced its door-to-intervention time to 53 minutes, compared with the American Heart Association’s national standard of 90 minutes.
And while there have been other smaller variables perhaps contributing to the improvement – presenting a challenge in statistically measuring mortality data - CCEMS believes the most significant factor in reducing intervention time is using properly trained paramedics to activate the cath lab.
The program got its start three years ago, when Houston Northwest Medical Center and CCEMS, the hospital’s primary paramedic service, developed the protocol.
Houston Northwest CEO Drew Kahn said while data evaluation is still under way, he is convinced the protocol is promising and “absolutely” would recommend its use.
“We have patients who would not have survived who are surviving,” Kahn said. “We are really pretty astounded by the results.”
Nearby Methodist Willowbrook Hospital is set to deploy CCEMS’ STEMI program next month because, said Medical Director Dr. Patrick Woods, it will reduce the process for STEMI patients by 10 to 20 minutes.
“We were very open to joining Cypress Creek EMS in their STEMI process because we have first-hand knowledge of the high caliber of their paramedics and the quality of their medical and administrative leadership within their organization,” Dr. Woods said. “...We know that we can trust their paramedics when we receive a call that an incoming patient is having a STEMI and are therefore willing to activate the cath lab based on their assessment of the patient and that patient’s EKG. We believe that is the right thing to do for the patient and for expediting their care.”
Also for improved cardiac care, CCEMS uses some of the latest in what technology offers, including the ResQPod, an apple-sized contraption that increases negative thoracic pressure and brings more blood to the heart during CPR by impeding air suction through the mouth during the up-stroke of chest compressions.
Another cardiac arrest device Cypress Creek EMS now uses is the LUCAS Chest Compression System, which is designed to provide mechanical external chest compressions.
HIGH RISK: TACTICS
Another of CCEMS’ visionary initiatives is its tactical team, composed of paramedics who also are certified police officers.
The team, created about 14 years ago and the nation’s first dual trained team, was a response to lessons learned during the Branch Davidian incident in Waco, Texas.
The team works alongside federal and local law enforcement agencies during the likes of high-risk SWAT events and warrant services by providing on-the-spot medical care to anyone at the scene.
IN THE KNOW
Staying educated on current trends is a centerpiece of CCEMS’ goals.
A hot, controversial topic that presently is landing squarely in the lap of paramedics is patients suffering from excited delirium, agitated delirium or exhausted mania – increasingly surfacing amid the use of TASERS by law enforcement, said Wren Nealy, CCEMS’ director of special operations.
Patients with the condition, believed to be associated with chemical shifts in the body perhaps due to chronic drug use, have always been around and presented challenges to law enforcement.
“It used to take 12 to 15 officers to restrain one of these patients,” Nealy said. “If they were restrained with straps, some of those patients would dislocate their wrists trying to free themselves.”
But some of those patients sometimes die or become critically ill after being captured by the TASER, and paramedics must treat them, he said.
So Cypress Creek has learned the latest in treating those patients, responding with chemical sedation, induced hypothermia and sodium bicarbonate – Nealy, working alongside excited delirium expert Jerry Staton, is teaching other organizations those methods.
CCEMS also has learned quite a bit about responding to disasters.
In the wake of Hurricane Rita, CCEMS established a Paramedic Initiated Referral system that allows paramedics to evaluate and treat patients with non-life threatening conditions in the field rather than transporting them to the hospital.
The system was deployed during Hurricane Ike, when emergency centers across the area shut down and large-scale power outages and flooding plagued the region.
As a result of the referral system, ambulances were freed up to respond to patients with critical needs.
Another piece of the plan was “oxygen assist,” a proactive measure where CCEMS staff delivered oxygen tanks to patients who might otherwise have called 9-1-1, further clogging the demand for emergencies.
THE PLAYERS
Cypress Creek EMS maintains that delivering the finest in emergency care depends not just on what you know and what you do with it, but who you know and how well.
“It takes a lot more than knowledge, vision and education to save lives,” said CCEMS Executive Director Bradley England. “To maximize care, you have to know your community and be a part of the community. It’s critical to have strong, healthy relationships with hospitals, administrators, doctors, nurses, community leaders, citizens. There has to be trust and respect. We are lucky we have that, and it’s made a huge difference in our operation.”
Relationships within an EMS organization matter too, England said.
CCEMS leaders believe every member of the team contributes equally in saving lives.
CCEMS Medical Director Dr. Vartanian, who was a paramedic in the 1980s, not only has an open-door approach but often works alongside paramedics out in the field.
Dr. Vartanian credits CCEMS’ paramedics, who, he said, are always reaching, eagerly exploring ways to improve care in the trenches.
“They are always asking questions, ‘…Can we do this…what if we tried that,’” Vartanian said. “And we listen, and say, ‘That might work.’” EMS
