By Samantha Hilker

Gundersen Tri-State Ambulance, a longstanding member of PAAW, is doing some great things in their corner of the world, so we’re shining the spotlight on them!

This past December, conversations about the use of essential oils to support patients experiencing pain, nausea and anxiety started shaping a new program for the La Crosse-based service.  The national opioid crisis is causing many healthcare organizations, and individual providers, to look at the way some conditions, like pain, are addressed.  When Dr. Chris Eberlein, Medical Director for Tri-State Ambulance and ER Physician for Gundersen Health System, started seeing the way essential oils were used to support patients within Gundersen, he wondered if there might be an application for EMS.  “I noticed that many of the patients given small doses of Fentanyl or other narcotic pain medications in the field were not leaving the ER with a prescription for painkillers – they didn’t need it.  I thought there must be something different we can do to support them without administering opiates.  The field providers (and their patients) didn’t have any other options, until now” recalls Dr. Eberlein. 

Essential oils work on the limbic system, the same system that controls our fight or flight response.  When someone breathes in the oil our olfactory nerve cells carry the essential oil into our brain. They bypass the thalamus and enter the limbic system through the cerebral cortex which lies just above it.  Scent is a powerful thing that, for many of us, triggers an immediate and intense response such as memories or nausea; it only makes sense they can have a calming effect on the senses as well.  Dr. Eberlein, Nick Eastman, Operations Supervisor – Clinical Services, connected with Denise Nicholson, Registered and Certified Clinical Aromatherapist, who leads the essential oil program at Gundersen Health System.  Denise is also an RN, BSN, Advanced Care Plan Facilitator and Nursing System Specialist with Gundersen and has studied essential oils extensively; she believes in their benefits and application for use because she has seen the patient response.  Both Gundersen and Tri-State follow the British and German models of use (inhalation and absorption), not the French model (ingestion).  “The oils are delivered by putting a few drops on a cotton ball, then taping that to the patient’s chest or by rubbing a small amount of diluted oil on the pads of a patient’s feet.  Inhalation is the fastest and safest way to deliver essential oils to a patient, but absorption can be beneficial in certain circumstances as well,” Denise explains. 

Tri-State is now carrying six (6) different essential oils on their paramedic units and has a specific procedure for their use.  “I want to make it clear that the oils are an adjunct, not a replacement for standard treatments or medical protocols.  Although we didn’t implement these oils to manage the current narcotic shortages EMS services everywhere are experiencing, we are hoping the use of the oils allows us to support patients without using as many narcotics.  We have also added non-narcotic pain medications to our pain management protocol,” Dr. Eberlein clarifies. 

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Company-wide use at Tri-State has just started and although Gundersen has been using them for some time, they have not done any formal clinical trials.  Anecdotally, however, the results are changing skeptics into believers. 

“We have one long-time paramedic who was part of our pilot group who is a bit of a skeptic.  During his introduction and education on essential oils, he decided to try some for his plantar fasciitis.  He purchased some from Gundersen (available in the hospital gift shops) and applied it to the soles of his feet…within 30 minutes his feet were pain free for the first time in years.  I think it’s safe to say he’s now one of the programs biggest supporters,” Nick Eastman shared. 

It is important to note that any service looking to implement a similar program must do their due diligence and research the use, benefits and safety of essential oils before including them in their supportive measures.  Essential oils are not regulated by the FDA and are not an alternative to standard medical treatments; some can interact with prescription medications.  Any service looking to implement essential oils as a supportive measure should also spend time researching the supplier of any oils they might incorporate into their system.  There are a lot of direct-sales companies selling essential oils these days, and you can even purchase them on Amazon.  Gundersen works with a supplier who only works with healthcare providers and is a certified and registered clinical aromatherapist; the oils go through extensive testing, so the providers and patients can be confident in what they are getting. 

PAAW is proud of the work Gundersen Tri-State Ambulance is doing and their willingness to share their experience with other services across the state – a shining example of how we are stronger together. 

Resources:

• Price, S., & Price, L. (2012). Aromatherapy for health professionals. Edinburgh: Churchill Livingstone.
  
• Buckle, J. (1997). Clinical aromatherapy in nursing. London: Arnold.
  
• Tisserand, R.,& Balacs, T. (1995). Essential oil safety, a guide for health care professionals. Edinburgh: Churchill Livingstone.
  
• Kevelle, K. (1999).  Aromatherapy for dummies. Wiley.
  
• Johnson, S. (2015) Evidence based essential oil therapy: The ultimate guide to the therapeutic and clinical application of essential oils. Johnson
  

Visit the Midwest EMS Expo Facebook page to see photos of last week's expo and educational sessions. 

More information about 2019 coming soon!

Our thoughts go out to the Paramount Ambulance team, whose staff member passed away in the line of duty in Iowa this morning. Our deepest condolences to family, friends, and colleagues.

PAAW is deeply saddened to learn of this morning's tragic helicopter crash. Our hearts are with the families, friends, and colleagues of those who passed away in the line of duty. Our deepest condolences to the Ascension Spirit team.

By Samantha Hilker

Patrick Ryan, co-owner of Ryan Brothers Ambulance and current PAAW board member, worked furiously to correct a problem some services may not have known they even had. 

A few weeks ago, Patrick noticed something strange.  The MTM transfers were being reimbursed at $1.75/mile instead of $5.56/mile, and even more curiously, some were being all out denied.  A deeper look revealed a potential cause of the problem: billing codes.  Typically, BLS and ALS transports are submitted to MTM with the codes A0380 and A0390, respectively, whereas the code reserved for stretcher vans is A0425 with a reimbursement rate of $1.75. 

“On some shorter trips, the difference wasn’t that much and might not be immediately obvious as it would on the long-distance transfers.  Depending on the services typical number of MTM transports and their distance, they may not have even noticed a change in their reimbursement rates for MTM trips.  It was a few long-distance trips that really raised the flag for us.”
—Patrick Ryan 

Patrick started making phone calls to other PAAW members to find out if they had noticed any of the same with their MTM authorizations and claims; sure enough, Patrick wasn’t alone.  He then reached out to MTM and DHS to find out more.  After many phone calls and email conversations, it appears the issue was one of miscommunication and misunderstanding. 

DHS has submission requirements that MTM must follow when submitting claims to DHS.  This is not to say that DHS can, in any way, enforce MTM’s provider submission expectations; so, when DHS made a request to MTM regarding code A0425, it should not have affected how ambulance service providers were being reimbursed from MTM.  As of this morning, PAAW received confirmation that MTM has revised their position on the ambulance codes and will allow providers to submit under codes A0380 and A0390 so they can be paid appropriately for the level of service provided.  MTM will also be pulling all claims that were denied for not being coded as A0425 and will be working to get them corrected and paid.  At this point, it looks as though there will not need to be any action taken on the part of the Ambulance Service Provider, however, you may want to look at your recent MTM transfers to see if you were affected. 

This is a great example of how PAAW benefits its members by building a network of professionals who are willing to step in, take the lead and find the answers; not only for their own service but to the benefit of services across the state.  Way to go, Patrick—PAAW is proud to have you! 

This has been a great week for EMS in Wisconsin, with several key bills signed into law, including AB654 for dispatcher-assisted CPR, and AB872 for EMS and public safety career ed tech grants. PAAW President Dana Sechler attended both signings. Great job to all who collaborated to make this happen!

Staff from several PAAW member organizations, including Bell Ambulance, Paratech Ambulance Service, and Baraboo District Ambulance were selected for AAA's national Stars of Life program. Meet the Wisconsin Stars at http://ems.zone/18WIstars!

Has the current shortage of controlled medications or saline affected your ability to provide high quality care to your patients? 

PAAW is working to collect data on how these, and other, medication shortages impact ambulance services throughout the state of Wisconsin as well as how services are adjusting to meet the needs of their patients. 

Please complete our short survey here► https://www.surveymonkey.com/r/1804paawshortages

View a list of drug shortages on the FDA website.

The open EMS Section Chief and Regional Coordinator positions have been filled.  If your email is up to date in the e-licensing system, you likely received the communications yesterday and today from the EMS Office.  Both Mark and Ela appear to have impressive credentials and valuable experience throughout their EMS careers.  PAAW is looking forward to working with them, once they officially start their positions! 

In case you missed the emails, here are the excerpts:   

EMS Section Chief

We are very happy to announce that Jonathan “Mark” Lockhart has been selected to fill the role of Emergency Medical Services (EMS) Section Chief for the Office of Preparedness and Emergency Health Care, EMS Section. Mark, as he prefers to be known, and his family will be moving to Wisconsin from Virginia, and Mark will begin his new role with the EMS Section on May 29, 2018.

Mark’s professional experience includes 8 years at Stafford County (VA) Fire and EMS, where he served as Deputy Chief and Chief.  Prior to his work in Virginia, Mark spent 23 years at Maryland Heights (MO) Fire District, progressively serving as a firefighter/paramedic, the EMS Officer, Battalion Chief, Deputy Chief, and Chief.  Mark is a Nationally Registered Paramedic, Firefighter I/II, and has held Fire Officer I and Fire Service Instructor certifications.  Mark's experience as an EMS and Fire Instructor includes teaching here in the US, as well as in Mexico, the United Kingdom, and Sweden. Mark has also been a contributing author for several EMT, Paramedicine, and Trauma/Life Support publications. Over his career, Mark has been an active participant in many professional associations, including: NREMT, NAEMT, and the International Association of Fire Chiefs. 

EMS Regional Coordinator

We are very happy to announce that Elizabeth “Ela” Rybczyk will be joining OPEHC as the new EMS Regional Coordinator for Regions 4 and 5 (Western and Southwestern WI).  Elizabeth’s first day in the office will be Monday, May 14, 2018.

Elizabeth, or Ela as she prefers, has a Bachelor of Arts in Health, Behavior, and Society  from the University of Rochester (NY), and a Certificate in Public Health Fundamentals and Principles from the University of Albany (NY).  Ela started her career as an EMT in 2008, and became a certified Paramedic in 2010, serving at several ambulance services in upstate New York.  Ela holds certifications in Remote Medicine for Advanced Providers, Paramedicine, and Critical Care Paramedicine.  She has also served as an Administrative Lieutenant and Training Director for the Greece (NY) Volunteer Ambulance and EMS Service, and as a member of the Monroe-Livingston Regional Patient Safety Committee.  

By Samantha Hilker

I’m not the smartest person in the room, and that is what I love most about my job. 

Being an EMS educator is a tough job; it takes a special person to pour their heart into educating others.  It takes someone who can stand behind their team to celebrate their accomplishments and also support them through mistakes.  A person who will pick up the phone at 3 a.m. to help a crew through a tough call, discuss a protocol, or work through the transport decision trees with dispatch without a second thought.  Someone who is OK with not being the smartest person in the room because they live in constant learning and embrace new challenges. 

I had the good fortune of speaking with several EMS educators about what they really want their clinical team(s) to know.  Here are the highlights:

Mistakes are not the end of the world.

Let’s be real, everyone makes mistakes. EVERYONE. The important thing is that you (1) realize the mistake and take steps to correct or communicate it, (2) learn from your mistake and (3) help others learn from you. Making a mistake once is part of the learning process – making the same mistake twice is foolish.

I am here for you.

Call me. Anytime. I’d honestly rather have you ask a question if you’re unsure of something – or call me right away to discuss a concern than receive a complaint or find something concerning on QA reports a few days or weeks later. A lot of times, the mistakes people think they made really aren’t that big of a deal – especially if we know about them and understand the why right away.

I don’t like doing QA any more than you like me calling you about QA concerns.

While looking at high-level outcome data and trends is interesting, I don’t like having to call you about protocol or documentation compliance issues. QA is necessary – it lets us know how we’re doing, how I’m doing as an educator…but please know that I do not spend time pouring over reports just looking for reasons to call you. Trust that I am looking for every reason not to call you before that phone rings.

It’s not always as exciting as I’d like it to be.

I know the education isn’t always the most exciting and sometimes we repeat things – but sometimes we need to repeat things for the benefit of the whole team. I would love to do exciting, cutting edge, new education all the time…but there is also value in getting back to the basics.

Practice how you play.

It is so important to train how you work…meaning realistic scenarios via simulation or low-fidelity equipment, partner configuration, uniforms and using the tools you use in real life. A lot of what we do in high-stress, time-sensitive situations is done without implicit thought – muscle memory – the more realistic our training the more efficiently we’re able to react in a real situation.

As I write this article, I am about midway through a virtual instructor-led paramedic refresher and never have I been more thankful for the EMS educators that helped shape me through the years, and the services who supported the role of an internal educator.  When education is viewed as a burden or requirement you meet just to maintain your license, it is easy to dismiss the value of a passionate educator providing face-to-face or hands-on transfer of knowledge.  I encourage you to take full advantage of the educators in your life, both formal and informal, especially if you are fortunate enough to work for a service willing to support that role internally. 

A special thank you to the following EMS educators who took time out of their day to contribute to this article:

• Thomas Carpenter, EMS Educator with Gundersen Health
  
• Rick Barton, EMS Educator with Gundersen Health
  
• Nick Romenesko, Clinical and Quality Manager with Gold Cross Ambulance Service, Inc.
  
• Robert Whitton, Education and Quality Assurance Coordinator with Paratech Ambulance
  
• Michael Barrow, Founder/Co-Author CPR Podcast, and Educator with Centura Hospitals