2021 death of young woman led to trauma level care program for emergency responders
It's July 20. James City EMS trauma program buys time for accident victims. Will York supervisors approve voter referendum for 8% sales tax? African Baptist Meeting House frame raising pictures.
The James City County firemen and paramedics were feverishly working to stabilize a pretend victim trapped inside an attic frame at Fire House 4 when they were interrupted by something more important – a real-life emergency call.
The exercise was just a simulation, an ongoing routine in county fire stations. It’s part of the advanced care paramedic program that allows the James City Fire Department’s Emergency Medical Services team to provide a level of care normally seen only in trauma centers – a level higher than 99% of the nation’s EMS services provide, according to officials.
It all started with the death of a young woman in a motor vehicle accident in 2021.
“Despite all of the equipment and expertise that the fire department had to bring to bear on that day, it was very apparent immediately that the real need for that patient was time,” said Dr. Amir Luca, a VCU emergency room physician who has been the medical advisor for the county EMS services since 2019.
“That’s time to be treated in the field, time to address their injuries, time to sustain their lives, and mostly, time to be transported to a hospital with the necessary resources to manage our most critically ill and injured patients.”
In the young woman’s case, time ran out.
James City County does not have any hospitals with full time trauma services, explained Betsy Sink, the battalion chief who oversees the advanced care paramedic training program with Luca. The nearest full time trauma centers are in Newport News and Richmond, 45 to 60 minutes away from the center of the county depending on traffic.
“Time is the enemy here against bleeding and trauma in general,” Sink said. “We call it the golden hour…you want to have the patient from the time of impact...to the hospital in definitive care within an hour.”
After the 2021 accident, Luca said, he sat down with James City Fire Chief Ryan Ashe to develop a plan to eliminate preventable death due to hemorrhage after an accident.
Within a year the fire department had implemented the first and only pre-hospital blood transfusion program in the region, Luca said. Department fire houses stock refrigerated Type O whole blood that can be administered to victims regardless of their blood type.
Coolers in the ambulances maintain the blood on the road.
Over the past five years nearly 100 patients “who would have almost certainly bled to death...have received lifesaving blood transfusions in the field,” Luca said. The county has reduced the need to use helicopters to transport patients – at costs of up to $50,000 per patient – by 90%.
The program quickly expanded from blood transfusions in the field to ultrasound, tracheotomies and advanced cardiac and airway management treatments, Luca added.
“Patients in cardiac arrest today have nearly double the rate of neurologically intact survival that they had only 5 years ago,” he added.
Sink told us that most of the fire department’s staff chooses to obtain paramedic training, and many go on to take the advanced care paramedic course.
A candidate must be recommended by a commanding officer for leadership and composure, and undergoes more than six months of rigorous training in advanced trauma, pediatric resuscitation and other treatment common to emergency rooms.
Sink said the program began in October of 2022 and has trained paramedics in Newport News, Williamsburg and York County as well.
The advanced care paramedics have an app with medical protocols developed by Luca that can advise on cases they don’t often see. And Luca is on call day and night to consult on video as required, Sink said.
They conduct weekly inventory checks to make sure every emergency vehicle in every fire station has the items needed and in the same place so it can be located quickly.
A dispensary resembling a snack vending machine stores medical consumables. But instead of using money, EMS staff must enter their personal code and the code for the incident they worked to ensure nothing is taken improperly.
The Fire Department’s work earned it the Virginia Association of Counties Achievement Award last month, presented to counties that adopt innovative approaches to public services that other counties can replicate.
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