Ep. 57 | Emily Brown, RN, Director of EMS and Trauma Services, SGMC Health

Transcript

- When seconds matter, what happens before a patient reaches the hospital can make all the difference. Welcome to what Brings You In Today, a podcast from SMC health. I'm Kara Brockwell and I'm Erica Bennett, and today we're catching up with Emily Brown, director of trauma and emergency medical services at GMC health. So, Emily, what brings you in today? Well, we're going to talk about EMS and trauma.

Very good. So Emily was actually one of our first guest when we started episode three. So a lot has changed in those two years. A lot of has been achieved by our team. So why don't you tell us a little bit about that? So we are now coming up on our first redesignation for trauma. So we're hitting our three year mark as being a level three trauma center here, about to have our redesignation visit in the next couple of months.

We've done a lot of work in that space, increased our trauma volumes pretty significantly with just, you know, referrals from the region and just the increase in trauma overall in the in our area, in our community. We have really increased our EMS coverage. We have moved into another county. We've we've started coverage over in Brooks County. And that's going really well for us.

We have added trucks to our fleet. We will stand up our our seventh truck in about 30 days. We'll have a new truck to add to our fleet that'll be additional for us. Increased our call volumes. EMS overall, I guess probably one of our biggest things is we've added pre-hospital blood transfusion capabilities to our service. We have expanded our transport service, our inner hospital, inner facility transport services.

We've actually grown that division from the ground up and say we now are running sometimes four and five full time trucks, including a critical care truck for that division. So lots of lots of good things, positive things, lots of growth in both of those spaces. So let's give the listeners just a little bit of background, in case they are not familiar with the team, medical services here at health.

They cover Leonce Lanier, Echols, Echols, and now Brooks, and which is a pretty large, significant geographical region. Yes. So a large area covered by who? What is emergency medical services? So we cover a little over 1600 square miles, which is is a large area over those four counties. Several of those counties are some of the largest counties in the state.

But we provide the 911 emergency services coverage to those four counties. So if you call 911 for an ambulance, SMC health EMS is who's coming. So that's what kind of professionals make up EMS. We have M.T. Advanced and paramedics in our 911 division. And then we have paramedics EMT advanced and M.T. Basics in our inner facility or specialty care transport division.

So advanced EMTs, they they go forward after a basic certification and that's additional schooling. And then a paramedic is actually can you can actually have an associate's degree paramedic degree. And so we have an EMT advance and a paramedic partner on each now and one truck. And then for our specialty care, we sometimes will have two M.T. Basics or an advance in a basic or a paramedic for our critical care transport truck.

We have a critical care credentialed paramedic there, and we have quite a few critical care paramedics within our 91 division as well. And those paramedics have additional education. We send them to University of Florida's critical care paramedic program. And we they have it's about a three month program that they do clinicals, additional hours and clinical hours there. And it really focuses on the critical care, transport and management of severely injured or sick patients.

So we have, I think, about 12 or 14 within our 901 division that are critical care paramedics. That's awesome. Let's talk a little bit about the Prehospital blood program that you mentioned. That's something that we recently launched here. What what kind of problem were you trying to solve and what results have we seen from that? The first 60 minutes after a severe trauma is critical.

And in rural Georgia, that 60 minutes is quickly gone. By the time you've realized there's an accident called 911, an ambulance gets there. You take care of the patient on scene, and then you have to get them back to a hospital. Hemorrhage is the leading cause of preventable death in trauma patients. And so it was really important to us, for us to be able to bring that life saving treatment to the scene, because it really 20, 30 minutes makes a huge difference for a trauma patient that's hemorrhaging.

So this was something that the state has actually been working on for several years. It's not always been within the scope of practice for a paramedic to initiate a blood transfusion, especially on scene. So the state of Georgia Department of Public Health added that into the scope of a paramedic. And you can they can receive post licensure training.

So it's agency specific. Your paramedics at your agency are trained based on what your agency protocols are. We doctor Seaton, our medical director, wrote those protocols and we trained them on that so that we could we could start that service. And so that's been something that we've we've been waiting to happen and working on for probably about five years, 4 or 5 years.

And I think within the last two years, maybe a little longer than that, as how long it's been within the scope of practice. So it was a really lengthy process for us. It took there's a lot of moving parts. You know, blood has to stay at a certain temperature, and whenever you're immobile, you have to come up with ways to be able to keep that blood at the right temperature.

So we have special coolers in our vehicles that have to stay plugged in. And, you know, just things like that. It was just it was a lot of moving parts. And so we're proud of that. We're proud to be able to to offer that. When you have someone that's had a car accident in Echols County on the far side of Echols County, then their way over 60 minutes before you get them to a trauma center.

So us being able to take that blood to the scene and start that transfusion there sometimes will make a difference between whether that patient survives or not. And there was another medication also. They all can distribute on the scene. Correct? I can't remember what it's called, but it was TX. So we've carried TX a I guess a couple of years and that that medication is also important and it's not really something that's going to start the hemorrhage, stop the hemorrhage or replace the blood product immediately.

What does is really strengthens. Like when your body begins to clot, it strengthens that clot. And so it helps you when not to the clot, not to be fragile and break up in the middle of a severe trauma. So we've had that medication for I guess probably about 2 or 3 years maybe. And we we do give that for trauma patients or anybody that's got hemorrhage.

We can give that medication and and give that in or out to the hospital implementation wise. What did it take to launch that program? I know that we had some trainings with our fellow first responders. And what did that look like? It took a lot, I guess, probably gathering up protocols from other agencies that had already done it.

There were Northeast Georgia Health System in Gainesville had already piloted this program. They were the pilot program for the state. And so we worked with them to to get their protocols. There were other agencies. We actually were able to go to Atlanta and ride with Grady EMS and their fly cars to be able to see what their process looked like, to learn how to do it.

That was interesting. So we we did that. We a lot of it was just getting the protocols and, and filtering through what would work for us versus what works for a metropolitan area like Atlanta or Gainesville. So we did that. The cooler bond, the cooler and the supplies, that's not cheap. So we we had to purchase all that.

We had to find the rock cooler. So when it's 100 degrees outside in South Georgia, you've got to make sure that that cooler is going to maintain the correct temperature. And we we did take us a little while to to pick the right stuff, but the training was really intense. We actually trained with we bought fake blood products so that they could actually simulate starting the transfusion and working with, with getting the bags and the equipment set up.

And that's really the biggest thing. When you get on scene, you can usually look at a patient and tell that they're going to need that blood product. But when everything's going on, it's chaotic. Everybody's running around the the just being able to recall how to set all that stuff up, you know, it really is. It depends on muscle memory.

So the training was important. We trained over 200 personnel and that included every fire department within Lowndes County was trained. And so they actually carry the set up on their fire apparatuses. And for certain calls they'll go ahead and have that set up for us when we get there. And then all we have to do is take it and they help us.

Our paramedics come and start the blood transfusion, so that takes a lot of time off of how long it takes to get it set up and how long you can it takes you to get off scene. Our scene times are something we're really proud of here for our level one traumas for patients that have been shot or stabbed, our scene times are like 6 or 7 minutes on average, and that's well below the national average.

And we didn't want to do anything that was going to prolong that, because the goal is to get them to the hospital, get them in front of a surgeon. They need to be at the hospital in surgery where there's other resources available. But but training all of those personnel to give us the information we need before we get there, to know if we need it going ahead and get in the set up.

Done. Go ahead. And being able to start the transfusion as soon as we roll up on scene, that was really important. And and we've worked hard with that and we've done it. We've we've actually done it several times since we went live with this process. And it works. And so we're proud of that. We're I'm probably especially proud that when you get on scene, there are agencies.

You're looking at 3 or 4 different agencies sometimes, and they all know what to do. We're working on the same protocol. So that takes a lot of work. And we're we're proud to be able to to do that and offer our patients care that you you see in metropolitan areas like Atlanta, we do the same thing here. Yeah.

There's several pockets of care that I think about with first responders. You know, you think about the trauma, which we're talking about now, but then you have your heart attacks, you have your strokes, and so much education goes into the first responders to be able to prep those patients before they ever even get to the hospital, so that they can have better results.

So tell us a little bit about what that looks like in regards to Stryker heart. Yeah. So all of our fire departments are they all have certain calls that they go to. And we ask that they automatically respond to high risk calls. So your your chest pains, your stroke patients, diabetic emergencies, respiratory distress, drownings, any kind of high risk call.

They are automatically dispatched along with us and their their fire departments are so concentrated within an area that the majority of the time they beat us to the scene. And so they're able to go and start that assessment and provide us really critical information to let us know that we need extra trucks, you know, do we need to to step it up and get there a little faster?

You know, what needs to happen? They train with us every quarter. So we set up quarterly skills and we focus on different things. So we focus on on stroke. Like we talk about that and we go through how to recognize the signs and symptoms of stroke. They all have access to call our emergency room on their radios so they can call in stroke alerts.

They can call in trauma alerts. They can do those things. And that's another thing that I'm really proud of, that we've worked really hard. And and if you don't have the the collaboration with, with those fire chiefs and those that fire administration, you're not going to see this. But those guys come and they train and with us every quarter.

And so they they work under our same medical protocols so they know how to do an assessment just like our EMS personnel. And it's, you know, just because they work for a different agency, the the level of care that you're getting on scene is the same. That's powerful. Yeah. That's phenomenal. I mean, to think that all of our first responders in our communities have that type of education and that they're all working together, has to make a difference in quality of care ultimately being delivered.

And speaking of our cardiac emergencies, who recently launched our Heart Ready program. So can you talk a little bit about that and how it's preparing other community members for knowing about heart emergencies? Yeah, so we have a Jumpstart a heart through our SMC Health Foundation and any organization, civic organizations or public safety agencies can apply through that grant for advice.

But what we've really seen is an uptick in our civic organizations and our churches and other people in the community that are requesting those ads. So we're able to provide those ads, take it there and provide the training. Anybody can use an ad. You see them when you go to the grocery store, when you go to the mall, the movie theater.

And they're so they're so simple to use. Like you just open them up and it tells you what to do, but it will save a life, you know, when you're calling an ambulance and an ambulance is 20 minutes away and they're someone suffering a cardiac arrest, that AED may save their life. The quicker that you can defibrillator the patient, the the higher the survival rate.

So we're really excited about that program. We're I'm excited to put it in places like churches and and other buildings and organizations, and we provide them with something to put on the outside of their building, their window or whatever, to let us know that, you know, they have an ad in the building. So that's a really that's a great program we actually just provided to ads to two churches over in Thomasville yesterday.

We have another one coming up for a business down in Lake Park that we'll be able to put there. That's a business inside a little shopping center. So we're seeing these ads all over our community. And that's that's great. That's because it's extending your first responders, right? I mean, our first responders take time to get there. But it gives it empowers the community members to as soon as they see something, be able to recognize what it is and take action.

Yes. To provide another link in that treatment train. And your team will also provide like CPR training if that's requested as a part of the program, to not just add training. Absolutely. We have a lot of BLS or first aid instructors. And so depending on the organization, we can provide the the a first aid certification. Or we can do the basic life support where we do the CPR certification as well.

We can do either one based on what they ask. But we always provide a little bit of, hands only CPR instruction whenever we give out the AED. So people will kind of know what to do and feel empowered to do that. But our number one dispatch also, if you call, they'll walk you through that. So they can they can teach you how to do CPR.

When you call 911, they provide those instructions. What's your go to song or to keep you on beat when your performance CPR? I don't I don't sing, I can't and that's just because I guess I'm so OCD. But they say this new Ella Langley song, you can choose the Texas. Yeah, yeah. So I like that song, so I may start using it next time.

That was just, you know, that's all over the social media in our association. Every time there's a new song out there, like, oh, this one is to the beat of what you need. Yeah. She's an a big deal. And so I saw that the other day on like TikTok or something. So I may use that next time. All right.

Your team has earned safe ride champions. What does that mean? So we have special systems that we carry in every ambulance. And it is based on the size and the weight of the child. But it is custom to to their size that we can place on our stretcher so that we can bring them in and they are restrained properly on the way to the hospital.

They it's not safe to secure a car seat to the stretcher. Some of our ambulances have a seat where you can properly secure the car seat if you need to. But a lot of these patients, we need them to be laying on the stretcher so that we can assess them properly and and get vital signs, things like that.

So these systems allow us to be able to do that for kids, babies even, you know, as 5 or 6 pound babies if possible, if we need to. So we can do that safely. That's a big deal. That's, that's really thought about that. Yeah. And the difference in what you would need for that, if you look at a small child and you put them on that stretcher, it's not just using the regular straps, it's not going to secure them properly.

And that's a big thing. I mean, I think we've seen that push over the last several, several years about car seat. We have several car seat technicians within our organization, and we try to teach that to the community. So we too should be responsible for transporting them safely. An emergency doesn't negate safe transport. So yeah, for sure. You helped implement a cadet program for EMTs, right?

Yes. In other work, for other workforce initiatives, what problem is that? Solving for us to have our own cadet program. So I think recruitment and retention over EMS in general is just such a difficult and complex issue on the number of licensed personnel in the state of Georgia. We see that, especially in our region, trend down a little bit every year.

And so we have a lot of paramedics and EMTs that are aging out and not renewing their license. And then, you know, you're not replacing them. You're going to have a recruitment and a and a retention issue. So we wanted to start that cadet program so that we could bring people into the EMS profession. We hire them and they're our employees while they go.

So we they we pay them as they learn and they complete the basic program, and we pay for them to take the registry and get their state license. And then they work a year on our specialty care transport, on our specialty care transport division side, doing inner facility transports. During that year, we will help them go back to the advance through the advanced EMT program if they want to.

And we teach that program in-house, or we utilize Wiregrass program for both of those. And then once they complete that, they're able to transfer over to the 901 side. So we've seen through our cadet program, the very first one, we still have people that completed that program that are still in our agency, and we've watched them filtrate through from the specialty care transport side to the to the 901 side.

In fact, our, you know, we just had our awards banquet this year for EMS week and the paramedic of the year. He started in our first cadet program. He was one of the students there just a couple of months after he graduated high school. And so he has during that time went to Wiregrass Advanced Program, went through their paramedic program, and he's been working on our on our nine on one side, I think since maybe November or December of last year and doing really well, obviously.

So he's paramedic of the year. So we're seeing that work and you're we're seeing we have several people that were in that class that are still within our agency and have come over to the nine one side, some state and the specialty care transport division. And that's, you know, we need personnel for both. So we're excited about that program.

And we have another class that we think will be coming up in August so that we can start, replacing the ones we've got 5 or 6 in the advanced program right now that they're going through, and then we've got 4 or 5 that are that will be in the paramedic program in the fall at Wiregrass. So we're excited about that.

We hope that this continues to staff our 911 division and they can. Speaking of word ceremony, what are their awards. Did they give out? I know there are certain like things that they can achieve as paramedic life safety awards. Tell me tell us a little bit about what those were like. We present pre cardiac Pre-Save awards. And so the criteria for that is that if the patients in cardiac arrest on scene, that they have to get a pulse back before they get back to the hospital and that the patient has to, either be transferred out of our emergency room or go to our ICU, still alive for them to get that, get that award

and then trauma saves, they have to receive some kind of life saving treatment on scene and then come to our hospital and need to go to the operating room, and they have to be discharged from the hospital alive. So we handed out 160 of those awards combined. And then we also recognize our EMT of the year, which was Scott Roberts this year.

And that's a that that award. And the paramedic of the year award is peer voted. So they vote the peers vote on on those two awards. And then we award a Robert Mitchell who was a past captain here for us at EMS. We give a Robert Mitchell Leadership Award and EMS admin decides on that and that this year that was Captain Benny Saddler from our Brooks County division.

Very good. So it's fun to be able to recognize the work that they're doing because truly they are on the front lines, out in our community, serving our patients. So and sometimes probably, yeah, probably feels like a thankless job too, because someone's not thanking you or their in their at their worst very much. Very much so. And you know our community I think does a good job of I get I get people that that probably several times a month that call back or email me or, you know, see me somewhere and talk about the great care they receive.

So I'm proud of that. Our our personnel work hard, you know, for to be able to be recognized. And I think that I think our community does a good job of doing that. So that's you don't see that everywhere. And we have a good, good community that appreciates the service that we provide. I think if there was any kind of advice you could give to the community regarding calling 91112 or just any mids, just what's the number one thing you would want someone listening to to understand or just learn about EMS today?

Everything's not an emergency, even though it feels like it is. But we're coming and we're coming safely, right? So like if you call in and it's something that's not emergent, we're not coming license our into your house. That's dangerous for us. It's dangerous for other people on the road. So we're coming to to assess you. But we may not come like it looks like on TV.

Every time somebody calls 911 and then, you know, for true emergencies, obviously we're coming as safely as we can and as quickly as we can. But I think that I think it's probably a a widespread issue of over utilization of 901 and the emergency rooms. So I think that's something that your hospital systems are not always able to address.

I think there's a lot of, you know, socio economic issues that go along with that. And probably the person calling 901 doesn't always believe they have an emergency, but that is their only pathway to health care. And that's the only way they can get in, you know, to see somebody for health care. So I think it's really complex.

And I think you're you're groups need to come alongside your, your health care organizations to help address some of that. But yeah, it's pretty complex issue. I wish I had an answer for it. Looking ahead a little bit to our new E.R. and trauma center, that's going to be done here at the end of 2026. I know we're all so excited, but what does that mean for for your team and for EMS?

I think it's just a lot more efficiency. I think that obviously we we need the space. We need the the extra beds just from volume increases. So that's going to help us tremendously. On the I'm most excited about being able to drive the ambulance in and not have to back it up, and then you can just drive in and turn around and drive back out.

And that's going to be that's going to be great for me too. Traffic flow. Yes. The traffic flow is going to be great. I think just the space overall. I think it's just something that the community can be proud of. It just shows that we're we're still investing in emergency care and growing and that's important to us. And so I'm we're excited about the the new space and and just being able to kind of spread out a little bit.

Everything won't be sitting up under. You can really see that ambulance bay taking place right now. Yes. Yes, I'm excited about that. Well, is there anything else you want to share with us this morning? No. Oh, I know a question that I get sometimes is people want to know why we're a level three trauma center as compared to a level two or a level one.

Can you explain what the difference is between the levels and why we are a level three? We operate really along the same lines as a level two. There are some just a couple of subspecialties that kind of separate us from a level two, and that would be some of your lesser utilized subspecialties like your maxillofacial, maybe some of your interventional radiology, things like that, that you have to have continuous coverage of to be a level two trauma center.

And so we we don't always have that kind of coverage. But as far as cardiothoracic, vascular, orthopedic care, we we operate a lot and see the same things at a level two, our volumes are that of a level two trauma center. And I think that that's potentially a goal, you know, that we'll set in the next several years as we continue to recruit physicians and continue to build our, our organization and, and health system level ones are going to be that's your academic centers.

That's where you have to have research and you have to have you're really going to see that more at a at a university level, like a teaching hospital. So that's your your Gainesville's and your Emory's, Grady's, that sort of thing. And that's really what separates a level one from a level two. There are some volume guidelines that you have to meet, like you have to admit over a certain number of patients a year to be a level two.

But the biggest thing is going to be the research and just the teaching hospital. Overall, they have all the residents and that you can think of the surgical residents and things like that. So that's that's the biggest difference. Yeah. And as far as trauma prevention, just speaking, because we have members of the general public that listen to this podcast, what's the number one thing that someone can do to prevent coming to the E.R.?

Where your seatbelt where your seatbelt don't know where you're where you're helmets. Pay attention to the because you're going to you have to pay attention to the cars. If you're going to ride a motorcycle, they're not going to pay attention to you. Be safe. Do not ride. Let your children ride golf carts stacked ten deep on the golf cart without being seatbelt it in.

If you're under the age of 16, you shouldn't be driving it. Don't drive it on the roads safe. Drive it safely. We're coming up on summer, so we'll see an uptick in that. That's just irresponsible to let 8 or 10 children on a golf cart, right? Even around the neighborhood, we see that every year where they flip the golf carts, where they're just riding around subdivisions and things like that, where you see golf carts a lot.

But there's a way to do that safely. Well, I think it's easy to get complacent to when you haven't experienced an accident or an injury from that, but you see those every single day in our air. So it is one of those things where it can happen to you. So to prevent that is important. Yes. I do have a question.

I know the entire community wants to know. Has there been an uptick in traffic accidents at the roundabouts? There hasn't actually. I'm surprised. Roundabouts. I think those guys at the furniture store really helped us out with that throughout the community by educating and and everybody wanted to to score a ten. So they were trying to do really good.

They probably went home and research how to drive in a roundabout, but there really hasn't. We've had a couple but but it hadn't been bad. Oh, so you're going slower naturally. So even if you were to get into an accident, it's not going to be a really bad one. I feel like people are slowing down because they have it to the little one lane still, and people are just going slower, so you have more time to react when they open it all up.

I'm not sure that we won't see a little uptick. I will keep our eye on it, but so far it has not been what I imagined it would be. Well that's good. I did see the ambulance go through the roundabout on the furniture stores video and they got a ten. They got a chance. So that was our EMT of the year rather.

Okay. All right. Well I think that wraps us up. Yeah. We don't even have to ask you your favorite food question because we've already done that has a chance unless it's changed. I don't eat over there much anymore since I made my office. You can never beat their breakfast. Their breakfast is the best. Yeah. Okay. Well, thank you for joining us.

We really appreciate it. Lot going on in your world. And we appreciate all you do to make sure that our first responders and our trauma program is where it needs to be to take care of everybody. I certainly feel like we're in safe hands. Thank you. All right, until next time.