Advances in Cardiac and Stroke Care

Advances in cardiac and stroke care, electronic data collection, two office moves, the Weber Sim Center, possible consolidation and free‐standing EDs were big news during the Tidewater EMS Council’s fourth decade.

By the mid‐2000’s a number of automated external defibrillator trials had completed and along with updated AHA recommendations this program vastly expanded to first response vehicles and large gathering venues. In 2004 the Eastern Shore EMS Council was awarded a grant to purchase 67 AEDs and the TEMS Council received a donation of 10 AEDs to distribute to EMS agencies. Also that year Virginia Beach widely implemented an AED program in its police department, and the Virginia Beach Emergency Response System was formed linking police, fire, EMS and communications.

New Regional Medical Operations Committee (MOC)

The new regional Medical Operations Committee (MOC), successor of the Prehospital Care Committee, started the decade with “excellent representation from localities and other stakeholder groups.” The group tackled disaster preparedness, ambulance diversion, pandemics, use of simulation in EMS training, 12‐lead and other emerging technologies and practices, and continued its oversight of IV and drug box restocking and EMS training.

Tidewater Center for Life Support Training

The Tidewater Center for Life Support Training annually trained some 17,000 persons in CPR and first aid, ACLS, PALS and ATLS both on campus at EVMS and through its network of community training sites. The program, operated by TEMS on behalf of EVMS, continued to be recognized as one of the most active AHA training centers in the mid‐Atlantic region.

Annual EMS Picnic and Awards Program

Over 800 attended the council’s EMS picnic and awards program in 2004 at the Virginia Zoo in Norfolk, and the council added a $1000 high school senior scholarship to its line‐up of annual EMS awards in 2005. By 2011 the annual picnic was drawing a record crowd of 1400 attendees.

Research and Continuing Education

TEMS support of research projects continued during this decade. The council funded an intraosseous device study in Portsmouth, an alternate EMS transport study in Norfolk, a MRSA study in Norfolk and a comparison of high fidelity simulation versus traditional methods of teaching ACLS. During the mid‐2000’s Norfolk Fire Rescue also studied the use of a blood substitute, PolyHeme.

Western Tidewater EMS Mini-Symposium

In what would become an annual regional EMS continuing education event, in 2005 the Nansemond‐Suffolk Vol. Rescue Squad hosted the first Western Tidewater EMS mini‐symposium called Continuing Concepts in Prehospital Emergency Medicine. The event was co‐sponsored by Emergency Physicians of Tidewater, TEMS and the Virginia Office of EMS. The third mini‐symposium in 2007 featured Roy Mantooth who starred as Johnnie Gage in the NBC TV series “Emergency!” EMS Cartoonist Steve Berry was the headliner in 2008 and again in 2010. Over the years the coordination of the event shifted to TEMS, and it was renamed “EMS Education Expo” in 2010.

On the Move

Growth of the council’s programs and staff prompted a search for expanded office space. In 2005, after 25 years in the EVMS Brambleton Avenue building, the council moved to leased space in the Interstate Commerce Center in Norfolk not far from Sentara Leigh Hospital. The new location nearly doubled office space and provided a large conference room and skill practice break‐out rooms. This new location offered an opportunity for the council to explore and implement high‐tech medical simulation training.

Kent J. Weber Simulation Center

Using funds from the MMRS program, the hospital preparedness program, Rescue Squad Assistance Fund and other grants and contributions, the council established the Kent J. Weber Simulation Center in 2006. For the next five years the council supported various types of education and research using skill trainers and high‐fidelity simulation manikins.

Mobile Simulation Labs

On the horizon was development of an even higher‐tech simulation center by EVMS as well as simulation capabilities by TCC in a new health professions building. By 2011 council committees determined that a mobile simulation lab, such as developed by Chesapeake Fire in 2009, and the EVMS and TCC facilities would meet the majority of EMS simulation needs. EMS agencies were encouraged to utilize the Chesapeake mobile simulation lab and EMS leaders agreed the region would pursue additional mobile sim labs if needed.

Office Moves

Facing increasing rent in 2012 the council again searched for office alternatives. Following a search the Board of Directors decided to purchase a building at 1104 Madison Plaza in Chesapeake. Compared to rent, the council saved more than $30,000 in occupancy costs during its first year after moving to its new building.

Also on the move was the Tidewater Center for Life Support Training, operated for EVMS by TEMS. In 2011 it moved from the Brambleton Avenue location to renovated space in Smith Roger’s Hall, an EVMS building near the Chrysler Museum. That move ended the TEMS connection with 855 West Brambleton Avenue in Norfolk which had lasted 30 years.

Freestanding Emergency Departments

Between 2004 and 2008 the region grappled with the concept of freestanding emergency departments. Both Sentara and Bon Secours proposed and constructed these facilities in Virginia Beach and Suffolk and asked that EMS transport patients there. Previous regional medical protocols prohibited emergency patient transport to anywhere other than a full service hospital in response to various “emergency centers” opening up in the 1980s.

The Operational Medical Directors committee, with input from the EMS community, developed freestanding ED facility and staff expectations that if met would be sufficient to receive a wide range of ambulance patients. Bon Secours at first challenged the expectations—particularly a requirement for staffing by a board certified emergency medicine physician—but eventually agreed. The experience reinforced the concept that the individual EMS agency OMD had the authority to determine ambulance patient destination.

Evaluating Consolidation

In 2008 the Virginia Office of EMS published various maps including one that consolidated TEMS and PEMS as part of a larger effort to implement new EMS council regulations and redesignate council service areas. This led to the formation of a state “Process Action Team” (PAT) that studied the boundaries and programs of all the regional EMS councils.

The TEMS and PEMS executive committees met to discuss consolidation and recommended areas for collaboration but not consolidation.

In 2009 the PAT concluded its work and recommended establishment of seven “service areas” while maintaining all eleven EMS councils. Ultimately, very little changed from that year‐long effort and the General Assembly, through budget language, locked the regional boundaries until some point in the future when regions would agree to change.

Later in 2009 the state issued a process for all regional councils to seek redesignation, and following a lengthy application and review process, all eleven were redesignated in 2010.

BecomeEMS.org

Seeing the success of the Virginia Beach Rescue Squad Foundation’s ongoing media recruitment campaign and resulting increases in membership in Beach rescue squads, in 2010 the council teamed up with PEMS and planned a joint media‐based EMS recruitment campaign aided by a $120K grant from the Virginia Rescue Squad Assistance Fund.

Bruce Nedelka of Virginia Beach EMS volunteered his time as the campaign leader and representatives from both regions served on a steering committee. Several marketing specialists submitted proposals, and the committee selected Rubin Communications to help produce the campaign and purchase the media advertising. WAVY TV‐10 and Sinclair Communications were selected as primary media partners. An internet portal named BecomeEMS.org was developed and the year‐long campaign kicked off during EMS Week in 2010.

Campaign Results

Targeted media messages drove interested people to the BecomeEMS.org web portal where they would find more about volunteer and career opportunities throughout both EMS regions. Over 1400 radio commercials, six TV news stories, and newspaper ads resulted in some 41,200 page views on the BecomeEMS.org site.

Surveys revealed that 37% of those receiving initial training or initially affiliating with an EMS agency during the campaign were influenced by a media campaign. But because both the Virginia Beach LivesNeedSaving.org and BecomeEMS.org campaigns continued during the same period and overlapped media markets, most respondents were unsure of the exact campaign influence. The 19‐page final report made it clear, however, that continuing and well‐delivered media messages were a key to EMS recruitment. The report also pointed out which elements of a campaign were the most significant factors of a person’s influence to get involved with EMS.

End of an Era

The fourth decade of TEMS saw an ending of an era for the TEMS board of directors. The board lost its two remaining charter directors—those who began service on the TEMS board when it was incorporated in 1974.

Dr. Robert J. Robertson's Passing

In 2010 Robert J. Robertson, MD passed away. Dr. Robertson had been a steadfast director and TEMS supporter, and served as the organization’s first president. In the early years he attended federal EMS conferences and helped shape the future direction of TEMS and other councils. He seldom missed a TEMS meeting and always helped guide the board through difficult and challenging decisions.

Robert W. “Rusty” Hundley's Retirement

In 2011 charter director Robert W. “Rusty” Hundley stepped down from the board after 37 years of service. Rusty served as vice president and treasurer and at one time or another was chair of most of the council’s EMS committees. He was a leader of EMS in Suffolk, and a principal in the 1982 start‐up of a private ambulance service that became Medical Transport, LLC. He continues as administrator for Emergency Physicians of Tidewater, the largest ED group in eastern Virginia, and continues service as an EMS provider and member of VA‐1 DMAT.

More Headlines from the 4th Decade

2004

MMRS Healthcare Committee expands to include the Eastern Shore and Northern Neck to mirror the Eastern Region Hospital Preparedness Program; TEMS conducts a second regional Quality improvement retreat featuring national speakers Dave Harrawood and Mike Taigman; Virginia Beach EMS adds 24 career medics; Shock Trauma is converted to EMT‐Enhanced and Cardiac Tech is converted to EMT‐Intermediate; TEMS implements regional ALS preceptor training; the 25th annual Virginia EMS Symposium in Norfolk attracts nearly 1900 attendees.

2005

Norfolk Fire Rescue adds an 11th medic unit; Southampton County installs a new $2.88M communication system; Southampton and Isle of Wight Counties implement “revenue recovery” programs to help offset the cost of daytime EMS coverage; CHEMPACKs arrive in area hospitals; Sentara Norfolk General marks the 25th anniversary of its Level 1 Trauma Center; Tidewater Community College EMS program increases to 10 full time staff plus part time faculty; devastation from Hurricane Katrina prompts deployment of the VA Task Force 2 Urban Search and Rescue Team and repeat deployments of the relatively new VA‐1 Disaster Medical Assistance Team; the Virginia Beach Rescue Squad team wins first place during the International Rescue and Emergency Care Association BLS competition, and does it again in 2006.

2006

TEMS assumes ownership and maintenance of all drug and IV boxes; fire destroys the Bloxom fire station and two ambulances; the MMRS strike team deploys to the Governor’s Inaugural in Williamsburg; Daniel Green succeeds Maryann Fitchett as president of the Eastern Shore EMS Council; Richard Hatch succeeds long-time Eastern Shore EMS OMD Geoffrey Gubb; Susan Boyle succeeds long-time Western Tidewater OMD Sharada Bhandary; concerns rise over a possible “bird flu” pandemic; the TEMS annual Administrator award is named for Bruce W. Edwards; HRSA funding is used to purchase quick set-up tents for all hospitals to increase surge capability; Sentara opens a new Heart Hospital in Norfolk; Wayne Berry joins the state EMS staff as Southeast Virginia Program Representative; Chesapeake Emergency Communications Center earns the state’s Accredited Emergency Medical Dispatch Center designation; All Hands Consulting is awarded a $70K contract to study Accomack County’s fire, EMS and emergency management.

2007

The state again studies regional EMS councils and TEMS is identified as a “star performer”; MMRS funds 4 disaster trailers on the Southside and 4 on the Peninsula; a large-scale radiological MCI drill—Operation Chain Reaction—is conducted at the Virginia Beach amphitheater; Bon Secours and Sentara both propose new hospitals in Virginia Beach; the 9th edition of the regional medical protocols includes “performance indicators”; Jeffrey Flournoy is selected as the Eastern Shore 9-1-1 Center’s first director; a new VHF communication system is added to hospitals to link hospital command posts and governmental resources; hospital campuses begin to go “tobacco free”; Norfolk Fire Rescue obtains EMT-Intermediate training accreditation; Isle of Wight County creates a new Fire and EMS division within its Department of Emergency Services; Virginia Beach Rescue Squad breaks ground for a second station and Isle of Wight Rescue Squad breaks ground for a new station.

2008

TEMS receives a $124K grant for region-wide EZ intraosseous infusion devices; Medical Transport, LLC begins financial support for the newsletter Response; TEMS establishes “Partner in Service” recognition and names Nightingale and Medical Transport, LLC as the first recipients for their support of the Response newsletter; Princess Anne Vol. Fire and Rescue in Virginia Beach celebrates its 50th anniversary; the First Landing Fire and EMS station opens in Virginia Beach; Jennifer Barnes succeeds Daniel Green as president of the Eastern Shore EMS Council; TEMS and Virginia Beach EMS co-sponsor Camp 911 for children of EMS, fire and police; Chesapeake Regional begins $8.4M expansion of the emergency department; Leonard Weireter, MD is named chair of Trauma and Critical Care at EVMS, and medical director of the Trauma Center at Sentara Norfolk General; Virginia Beach Police and EMS dedicate a new helicopter air ambulance; VA-1 DMAT deploys to Hurricane Ike; Eastern Shore 9-1-1 earns EMD accreditation from the Virginia Office of EMS; Bon Secours Virginia and Sentara Healthcare agree to collaborate in developing Sentara Princess Anne Hospital.

2009

Virginia Beach EMS reports efforts are underway to link EMS and hospital outcome data; the Governor appoints Bruce Edwards as the first EMS representative to the state Board of Health; EMS council contracts are amended to include activities related to H1N1 pandemic flu planning and the council hosts a flu summit; EMS STEMI 12-lead work group forms and is chaired by Chris Cannon; Franklin Fire Rescue hosts the annual regional awards program at the Paul D. Camp Workforce Development Center; Riverside Health Services and Shore Health Services announce partnership; MMRS program supports creation of first of eight mass casualty evacuation buses.

2010

OMDs endorse region-wide 12-lead transmission to all hospitals; Virginia Beach EMS starts therapeutic hypothermia; the state Office of EMS phases in Internet-based EMS data reporting; neurologists, hospital stroke coordinators, EMS leaders and others draft the region’s first regional Stroke Triage plan which is approved by the OMD committee and implemented in 2011 but initially rejected by the state Office of EMS due to inclusion of local designation of Acute Stroke Emergency Department; POST form – Physician Order for Scope of Treatment – introduced in the region as an improvement for the Durable Do Not Resuscitate form; five VA-1 DMAT personnel deploy to earthquake damaged Haiti; Bon Secours sponsors an EMS cruise on the Spirit of Norfolk during EMS Week; Riverside Shore Memorial announces the hospital will be relocated to Accomack County in approximately 5 years, replacing the existing 1971 facility; the Center for EMS Training in Portsmouth receives EMT-P training accreditation; Sentara Leigh Hospital completes major ED renovation and expansion; Geoff Miller, a previously named JEMS Magazine Top 10 EMS Innovator, selected to head the new EVMS simulation center.

2011

EMS use of tourniquets comes back in vogue; Bloxom Fire and Rescue moves into a new $1.2M station, replacing the one destroyed by fire in 2006; Sentara and Bon Secours become council’s first Platinum Partners; Norfolk Emergency Communications earns state EMD accreditation; regional STEMI plan is adopted by OMD committee; Eastern Shore develops 12-lead capability; most hospitals in region obtain “primary stroke center” certification; Bruce Edwards elected chair of the Virginia Board of Health; Nightingale christens new Eurocopter EC-145 aircraft; responders reflect on the 10th year anniversary of the 9-11 attack on America; TCC opens a state-of-the-art regional health professions building in Virginia Beach which houses the EMS program; regional EMS surge plan developed (subsequently incorporated in regional MCI response guide); EVMS opens state-of-the-art education and research building which includes a simulation center.

2012

Regional EMS testing is consolidated at the new education and research building at EVMS; several regional protocols renamed to be compliant with state EMS data dictionary; TEMS submits proposal to the Virginia Hospital and Healthcare Association, which is accepted, to house Eastern Region Hospital Preparedness Program and its coordinator; Tangier Fire Department applies for a state EMS permit and Accomack County assigns a full-time medic there; a Navy jet crashes into a Virginia Beach apartment complex; Sentara Leigh breaks ground on a new bed tower; the POST program expands region-wide; groundbreaking is held for a new fire rescue station at the Virginia Beach Town Center and for a replacement station in Chesapeake Beach; VA-1 DMAT deploys to New Orleans to support the federal response to Hurricane Isaac.

2013

Eleventh edition of regional medical protocols published. Hospital Preparedness Program adds a training position, and begins transition to the Eastern Virginia Healthcare Coalition; Sentara Virginia Beach adds 24 inpatient psychiatric beds; TEMS board approves a new grant program to support EMS provider attendance at national EMS conferences; Norfolk Fire Rescue reinstates “Triage Tuesday”; Portsmouth Fire and Rescue develops the CHECKUP program to help prevent recurring EMS calls for at-risk patients; the HRMMRS Strike Team stratifies its response capabilities into 4 operational levels; some 2300 attend the International Air Medical Conference in Virginia Beach; Virginia Beach police add the combat tourniquet; regional community paramedicine workgroup forms.