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Civilian training officers grade cityís paramedics (7-28-00)

Five energetic professionals from The University of Texas Health Science Center at San Antonio (UTHSC) are helping to ensure the quality of the cityís emergency medical care. They ride the streets in speeding ambulances with paramedics, evaluating split-second responses to critical care situations as the sirens wail.

"The city is divided into five sections and we change areas quarterly. I am riding with crews in the Southeast Side of town," said Tom Culwell, RN, EMT-P, clinical faculty member with the Department of Emergency Medical Technology (EMT) in UTHSCís School of Allied Health Sciences. He spoke while riding with an ambulance crew to a call.

Culwell is one of the EMT departmentís Civilian Training Officers (CTOs), who evaluate paramedics during ambulance runs and collect on-board data for analysis of emergency techniques and medications. The CTOs also teach continuing education courses for paramedics, paramedic nurses and emergency department nurses.

In a recent seminar at the UTHSC School of Nursing, Wayne Kierce, RN, EMT-P, one of the CTOs, took nurses and paramedics through several stages of care for a simulated patient having a heart attack. The speakers "discussed management of the patient from the pre-hospital setting to the emergency department, the cardiac catheterization lab, the operating room, the intensive care unit and to cardiac rehab," Culwell said. The course was a joint effort between the EMT department, the Emergency Nurses Association, the American Association of Critical Care Nurses and the Association of Operating Room Nurses.

The civilian training officers also teach advanced cardiac life support courses to Health Science Center medical students and coordinate an annual injury accident simulation for third-year medical students. These educators are key links in a chain of care involving physicians, nurses, paramedics, emergency medical technicians, dispatchers and emergency department personnel.

"Emergency Medical Services in San Antonio is about 25 years old, and it is the fastest growing area of health care delivery in our city," said Ann J. Burgardt, M.D., assistant professor in the EMT department. "This is health care delivery outside the hospital setting. People in EMS must have a firm grasp of time and teamwork. CTOs train their colleagues how best to respond to acutely time-dependent medical emergencies, such as heart attacks, drownings and injuries sustained in motor vehicle accidents. Nursing is part of the constant quality control involved in EMS."

Physicians sometimes ride the ambulances to evaluate techniques and care, but the task usually belongs to the CTOs, who bring data for analysis to San Antonioís EMS medical director, Donald J. Gordon, M.D., Ph.D. Dr. Gordon also is professor and chairman of the Health Science Centerís EMT department.

"We are using a new medication, amiodarone, on ambulances to help restart the heart after it has been fibrillating (beating wildly)," Dr. Burgardt said. "Our CTOs describe the situations in which this new medication is used. How old was the patient? What treatment steps were taken? How much of the medication was given?"

The commercial availability of new technologies such as communications satellites and cellular phones has caused an explosion of EMS calls and responses. CTOs evaluate new technologies and determine how they might be used to better advantage. Recently, CTO Terry Eaton, EMT-P, designed a pediatric immobilization board and began using it to treat pediatric patients with traumatic injuries. Joe Lindstrom, CTO supervisor, is involved in setting up computer collection of ambulance run forms. He also works with the state to ensure documentation is current on San Antonio Fire Department paramedics.

"We have 90,000-plus patients a year, of whom 42 percent to 44 percent are transported to area hospitals," Dr. Burgardt said. "CTOs help us evaluate our effectiveness."

Contact: Will Sansom