A tele-medicine system to recognize heart attacks is improving both the quality and speed of treatment for five or six patients a month in Curry County.

And a similar system is gearing up to provide the same kind of improvement for stroke victims. With the STEMI-Alert program, says Cal-Ore General Manager Joe Gregorio, the partners are “able to determine if a patient is having a true heart attack, get them started on the right medication, and taken to the right facility as quickly as possible.”

In August 2007, Sutter Coast Hospital, Cal-Ore Life Flight and Rogue Valley Medical Center (RVMC) began the system to recognize, treat and transport heart attack victims as quickly as possible. It uses special equipment and training to recognize STEMI (ST-Elevation Myocardial Infarction) victims as soon as Cal-Ore ambulance paramedics can connect patients to a 12-lead EKG.

The STEMI-Alert system has cut more than an hour out of the time it took to get patients to a cardiologist, according to Sutter Coast Emergency Department Director Beth Brown, R.N.

Before STEMI-Alert, a patient had to arrive at Sutter Coast for assessment, then Sutter Coast had to find a cardiologist willing to treat the patient before they could be administer care and transport the patient.

With STEMI-Alert, assessment begins when Cal-Ore paramedics transmit the results of the 12-Lead EKG. Once Sutter Coast has confirmed a STEMI heart attack, treatment can begin, geared toward getting the patient to RVMC – which has agreed to accept STEMI patients – as quickly as possible.

“The goal is to make arrangements to transfer the patient by air ambulance to RVMC within 10 minutes of the patient’s arrival at the Sutter Coast emergency department in Crescent City.

The early treatment usually involves establishing an IV and administering oxygen. The right treatments to assist the heart can decrease pain, control nausea and stop the heart attack so that there is less damage to the heart muscle.

The flight itself, Gregorio says, is 17 minutes. Door-to-door, from Sutter Coast to RVMC, is about an hour.

At RVMC, the team is ready for the STEMI-Alert patient based on the EKG readings and Sutter Coast assessment. Most patients go straight to the cardiac catheterization lab, where the blockage is opened in the clogged artery and a stent is surgically placed.

Most STEMI-Alert patients are out of the hospital in a day or two, rather than a week or more that a larger heart attack would require, according to Sutter Coast officials. Patients are back to normal activities sooner, and have a much better quality of life after returning home.

Gregorio says a similar system of assessment by Cal-Ore, stabilization at Sutter Coast, and rapid transport to specialized treatment is being developed with California Pacific Medical Center for stroke victims.

So far, he reported, six patients have been transported in about three hours’ time.

“The STEMI-Alert program has changed the face of local emergency cardiac care,” says Cal-Ore President Dan Brattain. “Cal-Ore is proud of its role in improving access to high-quality cardiac care for our community.”

In September of 2008, Cal-Ore took delivery of its sixth fixed-wing airplane, a Piper Cheyenne jet-prop. This is the fifth Cheyenne that the company operates.

The airplane started its life at Piper's factory, then immediately left to fly for a corperation in Germany. Following its return to the U.S., the aircraft was owned by a businessman in Carson City, Nevada.

In December, the company took delivery of another new Medix Chevrolet Dura-Max Type II ambulance. This unit was on display in the Medix show booth at the annual American Ambulance Association conference in Las Vegas, Nevada.

Both the airplane and the ambulance are an example of our company's commitment to providing the communities we serve with the best equipment possible.

Cal-Ore Life Flight is pleased to announce that they now participate in the FireMed public-private reciprocal billing agreement with other Oregon ground ambulance membership programs. Each participanting agency agrees to extend the benefit offered to its own members, to members of the reciprocatimg programs who use ambulance service in their area. To date, there are 80 individual agencies participitaing in the FireMed program. (See Coverage Map and List of Participating Agencies).

By participating in FireMed, Cal-Ore Life Flight can extend membership benefits to their members who travel out of Cal-Ore's service area. If a Cal-Ore Life Flight member uses a ground ambulance in one of the reciprocal agencies coverage areas, they are billed in accordance with that ground ambulance company's membership rules.

Cal-Ore President, Dan Brattain said, "By participating in this program, we are adding greater coverage and value for our members at no additional cost."

For more information, call Cal-Ore Life Flight at 541-469-7911.

Southwestern Oregon Community College is partnering with Cal-Ore Life Flight to offer an Emergency Medical Technician Basic class in Brookings beginning Feb. 13.

Before starting the class, students must complete an application process. To be considered, students must be 18 or older, provide a copy of a high school diploma or GED, meet the minimum score requirement on a placement test and provide proof of immunizations as specified on the application.

The two-term EMT Basic class, totaling 10 credits, costs $492 per term, plus the cost of textbooks and supplies. Volunteers at local fire departments or other public safety non-profits may be able to get tuition waivers from their agencies, bringing the cost down to $160 per term. There is no additional charge for out-of-state students.

Class is scheduled from 6 to 9 p.m. on Tuesday and Thursday evenings at the Cal-Ore Life Flight facility on Cove Road in Brookings. Attendance at each session is mandatory to meet the number of instruction hours required by the state.

Those interested are encouraged to pick up an application packet at the Southwestern Brookings Center or Gold Beach Center and return it as soon as possible. The class will only be offered if an adequate class size is met. For more information or to register, those interested can contact the Brookings Center at (541) 469-5017 or the Gold Beach Center at (541) 247-2741.

AGNESS – The Agness Illahe Volunteer Fire Department, possibly the only such fire department in Oregon that is not tax funded, will soon be the only fire department in Curry County that will operate an ambulance service.

"We've been a rescue service all these years, but a rescue service cannot transport," Fire Chief Bill Scherbarth said. "To be able to transport you've got to become an ambulance service."

"When you are an hour from the hospital, you've got to do something," Scherbarth said.

The nearest hospital is Curry General in Gold Beach. Currently, Cal-Ore Life Flight ambulances must go the 30-plus miles along South Bank Rogue River Road to pick up someone needing to get to that hospital.

"If we roll to a scene, being a rescue service we have to sit on the scene. Being an ambulance service we can package that person instead of waiting for Cal-Ore," Scherbarth said. "We can gain an hour plus. It just gets our patients an hour or so quicker to the hospital."

Scherbarth said that in the past it was legal for the rescue service to pick up a patient and go halfway to Gold Beach and meet a Cal-Ore ambulance. But Oregon rules have changed, and that is no longer legal.

"When you live in Agness, you've got to deal with what you've got and get it done," Scherbarth said. "It's got to the point where rules and regulations and liability are such, it's got so we have to do it. So we're going to do it."

That requires emergency medical technicians (EMTs) and a properly equipped ambulance.

The fire department recently purchased an ambulance from Cal-Or, which has helped volunteers complete the certification process that will allow the department to be an ambulance service.

"We're non-tax based," Scherbarth said of the fire department. "We live on donations. This was costing money. We're total volunteers. We're not a fire district. We're probably about the only ones in state of Oregon not a fire district."

"Cal-Ore kicked in half the cost of the ambulance," he said. "That's the only way we survived. We rely on other districts to get fire trucks and that stuff. The city of Coos Bay just donated an attack truck to us. All of our equipment is real old, but it works good and gets the job done."

He said the winter population of the area is about 150.

Fundraising is an ongoing thing for the department without a tax base.

"We put on potlucks and steak feeds. Once a year we go out with a donation letter to landowners and residents of the area. They've been real good," Scherbarth said.

The fire chief says the department now has members who have completed EMT training.

"All volunteers, eight EMTs, 100 percent certified," he said. "We're down to just filling out the forms. Everything else we're done. We've got the machine, we've got the training, the personnel. It's just getting the i's dotted and the t's crossed."

He said the certification as an ambulance service should come in February.

"We have 15 fire department members active and eight of these 15 are EMTs," Scherbarth said.

EMTs are required to take a 50-hour basic course. Additional training will certify them as intermediate EMTs, with more training required to certify them as paramedics.

"I've got three intermediates, five basics. And 99.9 percent of the time we have at least one or maybe two intermediates on board," Scherbarth said.

The department's board of directors made the decision to become an ambulance service because they didn't want a patient to lie beside the road until an ambulance could get there.

"The directors said ‘No. We want to treat and then get them halfway to Gold Beach and meet Cal-Ore.' We could go 15 miles down the road, that much quicker to the hospital," Scherbarth said.

"We'll still continue to transport over to Cal-Ore some place between here and Gold Beach, then we can go back on line and be available for the community," he said.

Cal-Ore Life Flight has become the first ambulance company in the region to have its own Human Physiologic Simulator (HPS) training facility, with the acquisition of an adult HPS (SimMan) and infant HPS (SimBaby) manikin. The latest in advanced training tools for paramedics, nurses, physicians, and other medical personnel

Human Physiologic Simulators (HPS) are high-tech manikins that, through the magic of computers and compressors, can be programmed to breathe, talk, have heart attacks or become critically ill at the click of a mouse!

“Nine of our nurses and medics have undergone instructor training to run and program both manikins. The manikins are already in service training Cal-Ore Life Flight air medical and ground ambulance crews.” reported Joe Gregorio, Cal-Ore Life Flight’s General Manager.

According to Gregorio, the manikins come preprogrammed with patient scenarios that simulate a common problem such as chest pain or difficulty breathing. Because the manikin talks, generates a heart rhythm, breath sounds, and pulses, nurses and medics start with a basic assessment of the manikin, just as they would a real patient. The nurses and medics do not know where the computerized scenario will take them, so they must interact with the ‘patient’ in the moment, making interventions based on their assessment of the presenting complaint and current patient condition. Some scenarios are problematic, with patients developing dire, life-threatening complications.  All scenarios are designed to reproduce on demand those clinical situations that, heretofore, the staff could only see in a real patient. This means the staff can practice intervening for real problems in real patients using their usual medical equipment in a controlled environment, and gain the skills needed to care for the patient before actually having to do it on a real human.
If the nurse or medic does not make the correct intervention, the computer will sense the failure and the ‘patient’ will continue to deteriorate.
 
Skills training can be common skills – like starting an IV or taking blood pressure, or they can be complex, such as shocking a patient out of a lethal heart rhythm with a defibrillator or inserting a breathing tube. In the past, students only had access to training on a live human being at the time the event occurred. With an HPS manikin, a student can practice the skill 100 times before ever seeing it or having to respond to it on a real person.

With SimBaby, the only infant HPS manikin in Del Norte County, the nurses and medics have access to on-demand training in the skills necessary to care for critically ill or injured children, situations not commonly seen in this county.

 “Because of our voluntary accreditation with the Commission of Accreditation for Medical Transport Systems (CAMTS), we have assumed the obligation to train our staff to a standard that surpasses the requirements we previously needed to meet under our Oregon and California licensure. With the purchase of these manikins, we will be able to easily meet these standards.” Gregorio said.

CRESCENT CITY — A local air ambulance company recently received the highest level of accreditation in the industry.

Cal-Ore Life Flight, which keeps its airplanes at the Crescent City and Brookings airports, was granted a three-year accreditation through the Commission on Accreditation of Medical Transport Systems (CAMTS).

All air ambulance companies must meet Federal Aviation Administration, state and federal requirements to fly patients for medical care. The commission's standards are higher than the government's, said Dan Brattain, Cal-Ore president.

This top-most accreditation is optional in California and Oregon, but attaining it ensures a company has met the highest standards in the industry, Brattain said.

"You have to review [CAMTS] standards and not only write new policies, but you have to demonstrate you also live by the guidelines," he said.

Some states now require air ambulance companies to receive this accreditation, he said.

Cal-Ore's five planes pick up patients from small clinics in Humboldt, Del Norte and Curry counties and fly them to facilities with higher-level care.

Of the nearly 500 air ambulance companies in the country, only about 140 have received this top-most accreditation.

"It's not common because it's difficult to achieve," said Darryn Ballance, who does community relations for Cal-Ore.

Cal-Ore applied for the accreditation almost two years ago. The company's staff of 70 worked to meet standards, and after inspection, the commission's board of directors approved Cal-Ore's full accreditation.

To reach the highest standards, Cal-Ore registered nurses went through more training, and satellite phones were installed in all of the planes, Brattain said. Departmental leaders must meet quarterly to improve management and internal coordination, he added.

Reach Michelle Ma at mma@triplicate.com.

Cal-Ore Life Flight recently received air ambulance accreditation through the Commission on Accreditation of Medical Transport Systems (CAMTS).  CAMTS is dedicated to improving the quality of patient care and safety of the ambulance transport environment. An internationally recognized organization, CAMTS is ranked as the leader in establishing air ambulance standards over and above FAA, State and Federal regulations.

Following a two-year preparation process by Cal-Ore, CAMTS surveyors spent two days completing an intensive site inspection of the company’s operations.  A full review by the CAMTS Board of Directors determined that Cal-Ore Life Flight demonstrates their ability to deliver service in compliance with CAMTS high standards and granted a three-year full accreditation.

Of an estimated 500 air ambulance services nationwide, less than 30% are CAMTS accredited.  Cal-Ore Life Flight is now one of the approximately 140 accredited services.

Cal-Ore President, Dan Brattain said, “This is quite an achievement for a small, unsubsidized company like ours. It clearly reaffirms what an outstanding group of dedicated employees we are fortunate to have, and our overall commitment to our patients.”

For more information, log on to camts.com or cal-ore.com.

If Ferrari made an SUV, it would look like the Cal-Ore Life Flight plane.

At least, that's how David Ravetti put it. And he should know -- he's the pilot.

”It's a very fast, very quick airplane,” said Cal-Ore Life Flight President Dan Brattain. And by November, the Piper Cheyenne twin turboprop that serves as an ambulance for Southern Oregon, Del Norte and Humboldt counties, will be stationed at Eureka's Murray Field for the first time.

The plane flies patients from rural hospitals to those in larger areas that can handle more critical patients, such as the UC Davis Medical Center in Sacramento, the UCSF Medical Center in San Francisco, hospitals in Redding, Santa Rosa, and occasionally as far as Portland, Los Angeles and Phoenix.

Of the 25 to 30 medical flights that depart Humboldt County's hospitals monthly, Cal-Ore Life Flight handles between 60 and 70 percent of them, Brattain said. Santa Rosa and Redding-based flight companies take care of the rest, he said.

But the planes that serve Humboldt County currently take off from Crescent City, adding 13 to 14 minutes' time to a trip.

”The health care in Humboldt County is good, so when (patients) are on the plane, they're very sick,” Brattain said. “For them to order the flight, they can't get the care here.”

But taking a sick person in the air, in an area smaller than the back of an ambulance, has its difficulties.

”It's really a challenge because of the altitude and weather,” said Kathleen Peterson, a registered nurse who oversees patients during flights.

Especially the weather, Brattain said. Even if a hospital has a bed for the patient, bad weather can halt the expedition. “The weather's either good enough or not (and) we can either fly or not,” Brattain said.

And pilots must check their emotions at the door and not get pushed into flying under questionable circumstances because of a patient's condition, Brattain said. That and being ready to go at any moment can lead to stressful days.

”If you're on duty, you're on duty,” he said. “You have to be geared and ready to go when that call comes in.”

Most patients need a high-level of care and have brain injuries, are infants or children, or have burns, Peterson said.

But the payoff is well worth it, he said. “It's very rewarding to get someone to a place where they can get the medical care they need,” Brattain said.

Karen Wilkinson can be reached at 441-0514 or kwilkinson@times-standard.com

Cal-Ore recently purchased their 4th Piper Cheyenne II aircraft, bringing the total fleet size to five.

Cal-Ore's President, Dan Brattain, said "This aircraft will greatly assist our growing operations and provide our community with more efficient service. The jet-prop aircraft are a much faster and a more comfortable form of transportation for our air ambulance patients."

The fifth aircraft, formerly owned by celebrity Wayne Newton, has already proven to be a real asset for the company.

As part of an ongoing effort to assist local volunteer agencies, Cal-Ore Life Flight recently donated over $4,700.00 to Curry County Fire departments.

According to Cal-Ore President, Dan Brattain, “Our community is so fortunate to have such a dedicated group of professional and well trained volunteers. These local community members greatly assist our service in providing the highest quality Emergency Medical Services.” Brattain noted that the fire departments play an integral role in assisting with accident scenes, lifting assistance, additional help with critical patients, and first responses.

Cal-Ore Life Flight sent checks to all volunteer agencies in their 911 response areas, which included Harbor Fire, Brookings Fire, Cape Ferello Fire, Pistol River Fire, Winchuck Fire, Gold Beach Fire, Agness Fire, and Ophir Fire.

Joe Gregorio, General Manager of Cal-Ore said, “Many times these volunteers are taken for granted. They leave their jobs, homes, kids birthday parties, and other important functions to respond whenever asked. We truly appreciate all that they do; they do not get nearly enough credit.”

Cal-Ore also provides on-going training to these agencies along with medical supplies and equipment to assist them as needed.

Please contact Darryn Ballance for more information at 541-469-7911 ext 110.