PILOT PROJECTS
The state EMS Advisory Council has approved several pilot projects for emergency medical services in South Carolina. Pilot projects which are current are the cricothyrotomy pilot project, D50W, Critical Care Paramedic, and the recently approved Prehospital Thrombolytic Therapy. Projects which have been conducted in the past include: aspirin treatment for cardiac patients, the Gusto study, the rectal Valium pilot project, the TPA Thrombolytic Therapy project and EMT-Defibrillator. Recently, Rapid Sequence Induction Intubation was changed from pilot project status to a state approved skill.
Other projects can be approved by review of the Medical Control Committee and the EMS Advisory Council. Pilot projects are approved as a means for a service to perform a skill or administer a drug, not currently approved statewide, and submit information to the Medical Control Committee so that the Committee may determine if this project should be approved for statewide use. Pilot projects are not intended to be conducted on a long-term basis, only long enough for adequate data to be received and analyzed by the Committee.
Cricothyrotomy pilot project: Airway protection is an immediate concern in the management of a critical patient. Airway protection and maintenance can be difficult in patients who have suffered severe maxillo-facial injuries, cervical spine injuries, or anaphylactic reactions. Many EMS systems around the country have trained their personnel to perform cricothyrotomies. A pilot project has been in effect for Spartanburg County, and Meducare to train EMT-P’s to perform cricothyrotomies in those cases where an airway cannot be established by the traditional routes.
The Medical Control Committee is now reviewing cricothyrotomies for adoption as a state-approved skill. Before this can be adopted, the Committee is reviewing all alternative means for airways, including the laryngeal mask airway (LMA). A recommendation on whether to allow cricothyrotomies and/or LMA’s is expected by spring or summer.
D50W: Bishopville Rescue Squad and Lynchburg Rescue Squad in Lee County are conducting a project allowing the use of D50W by EMT-I’s for patients with altered level of consciousness consistent with hypoglycemic states. Although EMT-P’s are allowed to use D50W the project was approved for these squads based on the large number of certifications below the paramedic level, the absence of a hospital or emergency department in Lee County and the run times which are frequently in excess of 30 minutes.
Critical Care Paramedic: Mobile Care Ambulance Service has been approved to begin the process to staff a Critical Care Transport Team, EMT-P’s trained in the Critical Care Paramedic curriculum. Critical Care Transport Teams transport interfacility patients with EMT-P’s trained to perform skills which are currently allowed only by nurses or respiratory therapists. EMT-P’s belonging to the Critical Care Transport Team must first complete the national Critical Care Paramedic course, an intense 80-hour curriculum. If successful, utilization of a Critical Care Transport Team will allow needed health care personnel to remain in the hospital and will allow for more rapid transport of the critical patients.
STEPS FOR APPLYING FOR PILOT PROJECT APPROVAL:
The request for approval of
a pilot project must be submitted in writing by the director of the emergency
medical service, with the signature and approval of the service's medical
control physician.
Letters must be included in the
proposal from hospitals which will be receiving the majority of the patients
treated in the project. These letters must include acknowledgment from the
hospitals that they were contacted in the project planning process and that the
hospitals agree to participate in the project’s quality improvement
activities.
Data from approved pilot projects must be submitted to the EMS Section on a regular basis. Usually, data will be requested every six months, but the Medical Control Committee may choose to require data on a more, or less, frequent basis.
The following requirements must be addressed as separate items in the written request:
1.Brief description of the licensed EMT service
2.Justification of need for the program, including any data available
3.Data on costs and cost effectiveness
4.Description of the equipment and functions
5.Responsibilities of the Medical Control Physician
6.Explain how involved the Medical Control Physician is in this project
7.Name and qualifications of the person assisting the Medical Control Physician with training
8.Outline of the initial curriculum for training
9.Plans and procedures for continuing education
10.Protocols
11.Plans for supervision of activities
12.Record system on pilot project activities, training curriculum, and attendance at training programs
13.Names and qualifications of the EMTs participating in the program
14.Method for evaluation of cases and outcomes
15.Method for handling cases of inappropriate procedures
16.Plans for evaluation of the pilot project after 12 months.
Requests for pilot projects will be considered for approval by the Medical Control Committee. Representatives of the service submitting the request will be invited to attend the meeting.