A Decade of Change and Innovation in TEMS

Advances in Trauma Care and Technology

Advances in trauma care; specifically, whole blood and ultrasound, a global pandemic, and improving pediatric care were big news during the Tidewater EMS Council’s fifth decade. And sadly, we saw the end of an era losing two EMS legends, James Mapp Chandler and Bruce Winston Edwards.

Regional Challenges and Resilience

Various tragedies struck during the fifth decade. From hurricanes to the death of prominent leaders in the Tidewater region to the shutdown of DePaul hospital to sprinkler damage that caused a mass exodus from a healthcare facility, Tidewater had seen it all. In the face of these unprecedented times, Tidewater EMS began to take a look inward to ensure the mental and physical health of the providers was a top priority.

Responding to the Global Pandemic

The Impact of COVID-19

In March of 2020, the world came to a screeching halt as the United States was shut down to help stop the spread of the disease, COVID-19. This changed the way hospitals, grocery stores, ambulances, and many more, did business. Personal Protective Equipment became standard verbiage in all airway-related protocols and the 911 call volume drastically decreased, as people were afraid to go to the hospital for care because they might catch this illness.

The 2020 Tidewater EMS expo was cancelled due to the pandemic, but was swiftly brought back in 2022. The event was co-sponsored by Sentara, TEMS and the Virginia Office of EMS.  The emerging theme in 2022 was provider health and mental wellness. The keynote speaker, Bob Holdsworth, spoke of Wading into Chaos and Dr. Peter Antevy, the pediatric guru who started Handtevy, spoke at the awards ceremony dinner. The 2023 speaker was local legend Mike Barakey. Over the years the name has shifted from “EMS Education Expo” in 2010 to Tidewater Healthcare Expo in 2024.

Financial and Operational Support

TEMS support of research projects continued during this decade. The council launched a whole blood program in October 2022 and started conversations regarding ultrasound training for medics to use in ultrasound technology in the field. The council obtained an RSAF grant to distribute i-GELs to every agency and worked out an agreement for the hospitals to restock.

TEMS was eligible and applied for a small business loan from the CARES-Act’s Payroll Protection Program. With the assistance of Towne Bank, our contract bookkeeper, and office manager, we successfully secured the loan totaling $142,900. Additionally, TEMS qualified for and applied to FEMA’s Public Assistance Program to recover 75% of the costs associated with our response to COVID-19. Through the HRMMRS program, TEMS was able to secure a variety of PPE to supplement many of our local EMS agencies in their response to COVID-19.

EVHC COVID-19 Supplemental Grant – VDH/VHHA advised that the Hospital Preparedness Program (HPP) received supplemental grant funds for response to COVID-19; purchased a large quantity of PPE that will support Long Term Care Facilities (LTCFs) and Dialysis Centers.

Clinical Innovation and Field Advancements

Whole Blood Initiative

Both military and civilian entities have proven that whole blood works. They didn’t always know this though and this lack of knowledge had devastating consequences, especially on the battlefield. The Army Rangers ran into this problem when they tried to perform fluid resuscitation for hemorrhagic shock using only crystalloids. The results turned what little blood soldiers had left into diluted Kool-Aid. Civilian trauma centers also saw this in the 1980s-90s when drug related violence caused large numbers of gunshot wounds. Volume resuscitation using crystalloids led to worse patient outcomes.

Why Whole Blood Matters

Whole blood is compact, easier to use, and improves trauma care outcomes significantly. Despite resistance to change, TEMS proved that field administration of whole blood can give trauma patients a fighting chance, reducing preventable deaths in those under age 46—the leading cause of death in that age group.

Introduction of Ultrasound in EMS

In late 2023, conversations about using ultrasound machines in the field became more of a reality. Virginia Beach had doctors, called MD 2, who brought their own ultrasound machines in a chase car to the scene of any call that sounded like they might be needed and Chesapeake was using the Butterfly ultrasound machine to confirm cardiac standstill on cardiac arrest patients. It was time to start using ultrasound machines to influence patient care decisions. The initial focus was on lung slide, cardiac imaging and FAST exams. The proposed class would be a 3-day course with a multi-day clinical component at the Eastern Virginia Medical School.

Advancing Pediatric Emergency Care

Implementation of Handtevy

In January 2019, the Tidewater EMS Council submitted a contract modification to the Office of EMS to support the implementation of Handtevy – Pediatric Emergency Standard. Handtevy is the premier pediatric healthcare technology company, committed to improving the treatment of critically ill or injured children in emergency settings; specifically, it gives EMS teams rapid access to lifesaving information proven to save lives and reduce errors.  

Chesapeake Fire Department agreed to be the Handtevy beta-test agency for the Tidewater region; subsequently, Chesapeake Fire Department completed a Handtevy Train-the-Trainer course January 22, 2019; 15 members completed the course. Chesapeake Fire Department began department-wide training on Handtevy with a “Go Live” date was February 11, 2019.

Regional Expansion and Results

A Handtevy Train-the-Trainer course was delivered on May 2, 2019 at the 2019 Tidewater EMS Expo (14 students attended); that brings the regional total to 29 Handtevy instructors. The first quarter of data was evaluated and demonstrated that the Chesapeake Fire Department reduced their pediatric medication errors to “zero” while the remaining TEMS agencies had a greater than 30% error rate.

During the calendar year 2020, Handtevy was implemented in all EMS agencies throughout the TEMS region to be used on patients age 17 and younger. Handtevy has made an improvement in the amount of pediatric patients receiving the correct dose of medication of Midazolam, Morphine, Fentanyl, and Epinephrine.

Honoring EMS Legends

The fifth decade of TEMS saw an ending of an era for the TEMS board of directors. The board lost its second and longest-serving Executive Director, and the EMS community lost one of its legends who served tirelessly the City of Virginia Beach, the Tidewater EMS Council region, and the Commonwealth of Virginia.

James Mapp Chandler

James Mapp "Jim" Chandler, 62, of Norfolk, passed away Friday, May 4, 2018 after a brief illness. From an early age, Jim was involved in Emergency Medical Services, volunteering as a teenager as a firefighter and rescue squadsman with the Onancock Volunteer Fire Department. His passion continued as he attended Virginia Tech, and served on their rescue squad. He was a Life Member and Past Captain of the squad. After graduation, Jim worked in the field of Emergency Medical Services, also volunteering with the Campbell County Rescue Squad and the Princess Anne Courthouse Rescue Squad. He began his EMS career as a Field Coordinator for the Eastern Shore Medical Services Council, then on to the Blue Ridge EMS Council as Executive Director. He started out at the Tidewater Emergency Medical Services Council as a Training Coordinator. He served as the Executive Director of the Tidewater Emergency Medical Services Council for 36 years.

Bruce Winston Edwards

Bruce Winston Edwards, 72, passes away Saturday, August 22, 2020. Bruce Edwards joined the Ocean Park Rescue Squad in 1967. In 1973, he became executive director of the Emergency Coronary Care Program of Virginia Beach, Inc., a federally funded program that created the first advanced life support technicians in the state. Between 1975 and 1984, he was the coordinator of the city’s Office of

Emergency Medical Services. After that, he became the chief of the Department of Emergency Medical Services. Chief Edwards served as the department’s chief for 32 years. He continued on as chief emeritus after his retirement in 2016, which allowed him to remain active as an advisor and mentor for the past four years. When he first became chief of the department, EMS responded to about 8,000 calls per year. By 2016, the department was responding to 44,000 calls. Bruce also served on the State EMS Advisory Board in 2006 and as the chairman of the Virginia Board of Health in 2011. Finally, Chief Edwards serves on the Tidewater EMS Council’s Board of Directors for 40-years (1976-2016).

Noteworthy Events and Milestones from the 5th Decade

Emergency Response and Evacuations

2014 - On July 22, 2014, 146 residents of the Harbour Pointe Healthcare and Rehabilitation Center in Norfolk VA had to be emergently evacuated from the facility. Power to the facility had to be shut off due to water damage to the main distribution panel from an overhead sprinkler. Norfolk Fire-Rescue (NFR) immediately notified the Eastern Virginia Healthcare Coalition (EVHC) and requested activation of the Regional Healthcare Coordination Center (RHCC). The RHCC initiated an alert to all of the regional partners (hospitals, air medical, DOH, OCME and nursing home/assisted living facilities) through the Virginia Healthcare Alerting & Status System (VHASS) that this event was occurring and that bed availability was needed. The RHCC assisted with locating beds and reporting that information to the Harbour Pointe administration who was handling the evacuation. NFR participated with the Harbour Pointe administration to safely evacuate the residents. They were able to coordinate the transportation assets of 9 different agencies and direct 71 transports over the course of 12 hours.

2015 – "Taking care of our own" is a goal that has been shared by the Tidewater EMS Critical Incident Stress Management (CISM) Team since its inception approximately 25 years ago. The team has expanded from the original members to a team with over 70 members, who respond to incidents in Hampton Roads and the Eastern Shore.  The team has evolved over the years as a result of experience, training, and the involvement of professionals from the local fire, police, and EMS departments. The Tidewater EMS Council, with the support of an RSAF Grant through the office of EMS, sponsored a conference in February 2015 to provide CISM certification training and stress management education for first responders.

2016 – Bruce Edwards started as a volunteer with the Ocean Park Rescue Squad in 1967, and went on to build on of the most innovative and agile Emergency Medical Services (EMS) in the country. After 49 years with the agency, Chief Bruce W. Edwards retired March 1. Virginia Beach City Manager Dave Hansen appointed Edward Brazle as chief of the Department of Emergency Medical Services, effective June 22; Pulling resources from across the country, Norfolk Fire-Rescue developed a STOP THE BLEED course that can be completed in about an hour.  Students will learn to recognize and treat severe bleeding using various techniques and products developed around the latest science; the Chesapeake Fire Department partnered with the Girl Scouts of the Colonial Coast, Norfolk Fire-Rescue, and the Chesapeake Police Department for the first annual Camp Fury-Chesapeake. This program aimed to increase the diversity of women and minorities in public safety.

2017 – the Tidewater Emergency Medical Services (EMS) Council announced immediate availability of the regional EMS protocol training videos, enabling EMS providers and agencies to begin the rollout

process of the 12th edition of the regional protocols; Kent “Curly” Jules Weber passed away February 24, 2017. After retiring from military service, he earned a Master’s Degree from George Washington University and taught organization and management at Golden Gate university before moving to the Hampton Roads area as a planning associate with the Tidewater Regional Health Planning Council. There he helped establish and was the first Executive Director for the Tidewater Emergency Medical Services Council, an organization he continued to serve for the remainder of his life on its Board of Directors, many committees and as treasurer. “Kent navigated the TEMS council through early days of complicated federal grants and was instrumental in the development of the state's dedicated EMS funding program." The City of Virginia Beach decided to end its local medevac program effective February 27. On February 25th Riverside Shore Memorial Hospital opened the doors to patients in its new building in central Accomack County; VA-Task Force 2 USAR and VA-1 Disaster Medical Assistance Team respond to Harvey - Components of these local FEMA and HHS teams deployed to assist state and local responders in the wake of the devastation in Texas.

2018 – In September the Regional Trauma Triage Plan was revised to include CHKD as the Level I Pediatric Trauma Center, with subsequent approval by the OMD Committee, including language which reflects the pediatric (less than 15 years of age) verbiage and other changes made to reflect the treatment and transport of pediatric trauma patients within the region; The HRMMST was recognized for Outstanding Contribution to EMS Emergency Preparedness and Response;

2019 – The Tidewater EMS Council became a member of the Hampton Roads Chamber of Commerce; TEMS worked to establish a standing Commercial EMS Committee to promote communication and cooperation among the members of the Commercial EMS community and with system partners such as emergency physicians, emergency nurses, critical care personnel, hospital pharmacists, hospital administrators, public health and with the Virginia Office of EMS; Hampton Roads MMRS received the first of 10 Medical Rapid Access Transport (MRAT) units; these units are a small off-road ambulance designed to reach patients that are located in difficult to reach places.

2020 – Due to the COVID-19 Pandemic, the Tidewater EMS Council, Hampton Roads Metropolitan Medical Response System, and the Eastern Virginia Healthcare Coalition began leasing an 11,000 square foot warehouse in the Cavalier Industrial Park located in Chesapeake, Virginia. This warehouse has 2,500 square feet of environmentally controlled space and 8,500 square feet of open-floor warehouse space. This warehouse was quickly filled with personal protective equipment and sanitizing equipment that was used by EMS and healthcare facilities; The Tidewater EMS Council retained the services of Coastal Media & Marketing Group (CMMG) to provide services that included website evaluation, social media use, media training and public information officer services, developing a podcast, and creating video content to enhance services provided by the Council; TEMS established a standing ED Director - Nurse Manager Committee. This committee has a positive impact on regional collaboration between hospitals and EMS agencies, which will serve to strengthen the EMS delivery system in the region; the TEMS Governance Committee amended the bylaws to include a seat on the Board of Directors to represent Allied Health, which may be filled from Long Term Care Facilities, Assisted Living Facilities, Skilled Nursing Facilities, Home Health, Hospice, and Dialysis, which further diversifies the Board; Hampton Roads MMRS received the first of 10 new MCI transport units; these units can carry 10-seated, nine-stretchered, and two-wheelchair patients; To honor Former Chief Bruce Edwards, the Virginia Beach City Council unanimously voted to name the Emergency Medical Services building in his honor. It is now The Bruce W. Edwards Virginia Beach Emergency Medical Services Headquarters and Training Center.

2021 – Dr. Stewart Martin stepped down as Board President after 23 years of service. He was congratulated and THANKED for all that he has done during his tenure; Dr. Martin passed the “gavel” to our incoming president Dr. Lewis Siegel; DePaul hospital closed its doors permanently; TEMS restructured the CISM program with an emphasis on rebranding and additions to the menu of services; specifically, Behavioral and Mental Health Wellness due to rising public safety suicides; additionally, TEMS Strategic Regional EMS Plan was amended to include behavioral and mental health wellness;

2022 – TEMS i-GEL Initiative received an RSAF grant to replace the King supraglottic airway with i-GEL across the 10-jurisdictions and 58 EMS agencies in the Tidewater region; this new supraglottic airway device improves the quality of patient care and outcomes; TEMS and Chesapeake Fire Department in concert with the Virginia Department of Fire Programs and the National Fire Academy delivered a six-day Quality Management course. The class was comprised or 26 performance improvement coordinators from the Tidewater and Peninsulas EMS council regions; TEMS conducted a successful blood drive receiving 54 units of whole blood during its inaugural blood drive. Additional blood drives have been planned in Virginia Beach, Norfolk, Chesapeake, and Suffolk to support the TEMS Whole Blood Initiative; Ed Brazle, Chief of Virginia Beach EMS retired effective December 31, 2022 after serving as the agencies Chief for six-years; Chesapeake Regional Medical Center was certified as a Comprehensive Stroke Center by a nonprofit healthcare commission. The accreditation means the hospital has a neuroscience ICU, knowledgeable medical staff and expertise in treating several serious medical conditions that can accompany strokes.

2023 – The Hampton Roads Metropolitan Medical Strike Team partnered with Joint Base Langley-Eustis and the 633^rd Med Group to provide medical coverage for the Air Power Over Hampton Roads Air Show featuring the Air Force Thunderbirds; The Tidewater EMS Council was recognized by Inside Business – Hampton Roads Business Journal as a Healthcare Hero for Emergency Initiative; TEMS Executive Director David Long was appointed to the Virginia Stroke Systems Task Force as the EMS representative; 2023 Tidewater Healthcare Education Expo had over 190 attendees at this year’s event; TEMS enjoyed the support of over 22 Sponsors and five Partners. This year’s event enjoyed the improvements to the event website and the first offering of an event APP. During the event the Virginia-1 DMAT team held their annual training and awards ceremony. TEMS also conducted the TEMS Regional Awards dinners recognizing 14 awards winners from across the region. The City of Virginia Beach announced that Jason Stroud was appointed as the Chief of the Department of EMS. Garry Windley became chief of Isle of Wight Fire and Rescue.

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