July 17, 2000
Volume XXXIII, No. 28



EMT faculty evaluate, train city's paramedics

Allied Health

Five energetic professionals from the Department of Emergency Medical Technology (EMT) are helping to ensure the quality of the city's 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; currently I am riding with crews in the southeast side of town," said Tom Culwell, clinical faculty member with the EMT department in the School of Allied Health Sciences. He spoke while riding with an ambulance crew to a call. 

Culwell is one of the EMT department's 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 School of Nursing, Wayne Kierce, one of the CTOs, took nurses and paramedics through the initial 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 CTOs 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 Dr. Ann Burgardt, 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 Antonio's EMS medical director, Dr. Donald Gordon. Dr. Gordon also is professor and chairman of the Health Science Center's 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? What were the patient's other medical problems? Where was the patient found? How much time elapsed until arrival at the hospital?" 

The commercial availability of new technologies such as communications satellites and cellular phones has resulted in an explosion of EMS calls and responses. CTOs constantly evaluate and appraise new technologies and determine how they might be used to better advantage on the street. 

Recently, CTO Terry Eaton designed a pediatric immobilization board and began using it to treat pediatric patients with traumatic injuries. Most backboards are manufactured for adult-sized patients. He published an article on its use in the Journal of Emergency Medical Services. 

Joe Lindstrom, CTO supervisor, is involved in setting up computer collection of ambulance run formsa welcome innovation considering that the CTOs, along with Drs. Gordon and Burgardt, review 6,000 to 8,000 run forms a month. Lindstrom also works with the state to ensure documentation is current on every San Antonio Fire Department paramedic. 

"We have 90,000-plus patients a year, of whom 42 percent to 44 percent are transported to area hospitals. That's a lot of runs," Dr. Burgardt said. "CTOs help us evaluate how well we are doing."