This is a transcript of an interview segment I did with David Reinis at EMS today 2012. David is one of the EMS 10 innovator award winners from last year and he is in Colorado near Denver.
David came up with an innovative way to educate and maintain standards for cardiac care with the paramedics by reviewing cardiac anatomy using pig hearts. Check out this interview with David on how he found a unique way to revisit anatomy and physiology and help folks understand things like STEMI’s, things like acute coronary syndromes, and of course cardiac arrest.
So check this interview out of him for innovations in patient care, sponsored by Physio-Control and EMS Today.
EMS 10 Innovator Interview
JAMIE: We’re here at EMS 2012 for the EMS 10 Awards and I am really excited because of the innovators & the people that have come up with a new way to either educate, to innovate, to provide better care for our patients.
David Reinis is an educator from Centura Health in Denver, Colorado and, David, you have come up with an interesting program to find a way to help EMS professionals visualize and understand what’s going on with a STEMI patient, with a cardiac patient and draw conclusions between what’s going on in the anatomy and physiology directly with what they’re seeing an EKG.
David, tell us a little bit about the program.
DAVID: I’ve been a paramedic for 30 years and what I tried to do is bring a program that would speak to people who learn visually and to put a 3-D model in their hand so that they could understand anatomy on a real level. So I was looking for program and one of the providers to Centura hospital was St. Jude’s and they did a heart dissection so I went to that and it was more geared towards the hospital and heart caths, things like that. I thought what a great idea. Take a 3-D model and get it to the paramedics, bring it to the paramedics on some level that they would under understand and how it related to to cardiac care, STEMI. We could also look at what could go awry with STEMI mimics using a model and dissection.
So I surrounded myself with some really talented people from local hospitals’ Cath Lab. This included people from St. Jude’s medical, they provide pacemakers, and our own medical director Dr. Eby. We found a good model which is a pig heart and brought it out to the paramedics. They did a dissection and we put it down to the field level for them.
JAMIE: What was their initial response? So much of what we learn early on was really book learning as far as your anatomy physiology. There wasn’t a lot of hands-on. It was look at this picture of a heart, memorize this diagram of blood flow and things like that. But so many people are different types of learners. They really need that hands on and that 3-D perspective to really rotate that heart and the pig heart’s the perfect analogue of the human heart.
Pig Hearts Save Human Hearts and Lives
DAVID: It is, it’s so close to the human heart in so many ways. Initially when I brought it up it wasn’t accepted with full-blown enthusiasm as far as “this is what it will cost to bring it out to field,” but my management got behind it and said, “let’s give it a try.”
The first classes going there and see, regardless of their tenure as a paramedic, see their eyes light up and have take a look and say, “I never knew that the tricuspid valve was translucent, it makes so much sense now.” They look at the right versus left side of the heart and why the left is a high-pressure side because it’s two or three times the thickness is a right side. So they could look at the structure and say, “I can see why this would fill under hypertension situations.
JAMIE: And you could see things like words that are just words, like “hypertrophy” but what does that really mean? Or Hypermegally, all these words that mean different things. To be able to look at a heart and say, “I can get a sense of why this would be over-expanded,” or that it’s because the muscle tissues become enlarged and this side of the heart is different because you have been able to handle it and see the differences in the two sides of this two-pump system.
DAVID: And they also are able to, and this is where our heart lab team came in, is one of the ladies, Jennifer Brooks, was extremely talented and they were able to actually bring in the same stuff (cath equipment) that they would utilize on a human and we would heart cath each one of the pig hearts. The guys would get to do that and they began understanding the vessels in what side of the heart is fed and what side of the heart is dominant and how important it is to open up these vessels and to call “STEMI” as quickly as possible because time is tissue.
JAMIE: What’s the aftermath of this program? What’ve you seen, what have you heard back from your providers as they take this class and now gotten the field to apply the knowledge they’ve gained.
DAVID: Well we also have a very high-end QA program. One of last year’s innovators, Ryan Mayfield, does a lot of statistical analysis and he was able to show that the class has increased the calling of cardiac alerts in a positive way. You can call it, but the one thing they need realize is that there are mimics out there that will mimic a cardiac alert in so many different ways. It can be because they’re too cold from Osborne waves or they can have pericarditis from inflammation, drug use. So this also is able to help the paramedics recognize those mimics which increases the percentage of the calls being called correctly and those mimics being thrown out.
JAMIE: Right. That is so important to build confidence with the Cath Lab and EMS services so that they trust you when you call in that STEMI Alert. Especially if you’re not transmitting data because I know not all systems are doing that. So it’s important for you to really become confident and knowledgeable in skills by diagnosing a positive STEMI event.
Improved EMS Education Improves Outcomes
DAVID: Oh, absolutely, being able call it correctly, calling it quickly, all makes a tremendous difference in outcome of the patient. When we first started cardiac alerts, in its infancy, an hour to an hour and a half was what we started with. Now that number is down to 20 min. We’re getting these patients into the Cath lab, get them sterilized and ready to have a cath put in the femoral artery from the time of being called, it’s amazing, an amazing time frame to look at. That all means what sort of outcomes is that patient going to have? If we are saving that much more tissue then that patient will have that much more productive outcome in his life, and live a good productive life rather than be a cardiac cripple.
JAMIE: It is so important to keep innovating like this. I want to thank you and congratulate you on your award of the EMS 10 innovation award. It’s exciting when I see people taking things that are commonplace at the anatomy and physiology sections going on in colleges and places all over the country and pulling that into a paramedic program applying it directly to what we need to know about. It is just really exciting to hear about.
What are your thoughts about EMS 10 program’s type of recognition of the innovators out there.
DAVID: When you think about the other people that were not recognized with you, I’m very humbled by this. Nobody gets this alone. Regardless who you are you didn’t get here on your own. There should be 56 people behind me accepting this award. This was maybe my idea my concept, but to bring this to you took a lot of team work and planning from a lot of dedicated people.
Catch the rest of the news from this week’s show in Episode 292 – David Reinis Advances Cardiac Understanding from the MedicCast.