Clay County Fire Rescue (CCFR) has been honored as this year’s prestigious Nicholas Rosecrans Award winner for their exceptional Community Paramedicine Program. This recognition signifies the outstanding achievements of the program in promoting and implementing preventative care, as opposed to the traditional reactive emergency response.

The Nicholas Rosecrans Award, now in its 22nd year, is given to emergency medical service individuals, teams, or organizations that have remarkably demonstrated a commitment to injury and illness prevention. Established in memory of Nicholas Rosecrans, a young boy who tragically drowned in 1996, the award epitomizes the spirit of proactive care. It emerged from the efforts of San Diego paramedics and Nicholas’s mother, Lynn Artz, who united to advocate for EMS-driven prevention initiatives, changing the face of first responder intervention.

The Clay County Fire Rescue Community Paramedicine Program, founded in 2019, is a beacon of such innovation. The program’s initial primary objective was to improve Clay County residents’ independence and quality of life. The program transcends mere medical intervention. It is a system where firefighter paramedics engage with residents, understand their unique needs, and facilitate connections to essential community resources. From durable medical equipment to health education, the program ensures that community members receive care and have the necessary tools and knowledge to maintain a higher quality of life and prevent future emergencies.

Since its inception, the Community Paramedicine Program has continually expanded to meet the data-demonstrated needs of its community. In 2022, the Clay County Fire Rescue team launched the Overdose Prevention and Education Program (OPEP) through their Community Paramedicine Program with the support of a grant from the Substance Abuse and Mental Health Administration. Clay County’s OPEP provides free Naloxone training and distribution, with 2,663 naloxone kits distributed and 590 individuals trained from October 2022 to July 2023 alone. This dedicated approach has significantly contributed to a 27% decline in overdose-related fatalities in Clay County since 2020.

The success of the Clay County Fire Rescue Community Paramedicine Program lies in its community-focused approach and its push for interoperability and collaboration with important Clay County community health and wellness stakeholders. Key partnerships have been pivotal to their delivery of grants from the Center for Disease Control and the Substance Abuse and Mental Health Administration. The Clay County Fire Rescue’s work with organizations such as their regional Opioid Task Force, Clay Department of Health, Clay Behavioral Health Center, The Hanley Foundation, and St. Vincent’s Hospital showcases their commitment to working alongside their community resources.

The Nicholas Rosecrans Award will be conferred to Clay County Fire Rescue during the opening ceremonies at the EMS World Expo on September 20th in New Orleans in front of thousands of EMS professionals and organizations from around the world. Nicholas Rosecrans’ mother, Lynn Artz, will be in attendance to personally acknowledge their immense efforts and commitment. Additionally, Clay County Fire Rescue will lead an EMS World Expo session on injury and illness prevention, introducing attendees to their innovative approach toward community health and safety.

The Nicholas Rosecrans Award is facilitated by the California Paramedic Foundation and the RedFlash Group, in cooperation with EMS World. This year’s award is sponsored by Mission Critical Protocols, a new protocol publishing platform for EMS providers.

 

 

https://caparamedic.org/news-and-events/74329/

October 12, 2022 – Orlando, Florida –  The California Paramedic Foundation has announced the 2022 Nicholas Rosecrans Award Winner—Gerard Carroll, MD of Cooper University Health EMS. Dr. Carroll received the Rosecrans honor in recognition of their first-of-a-kind prehospital buprenorphine program, which has now spread to multiple locales across the country. The California Paramedic Foundation conferred the Award to Dr. Carroll during the opening keynote ceremonies of the 2022 EMS World Expo in front of thousands of EMS industry attendees from around the world.

In 2019, Dr. Carroll and Cooper University Health EMS launched the first EMS-administered buprenorphine program in the United States. Dr. Carroll and his team realized that many opioid use disorder patients in the 9-1-1 system typically refuse transport to local emergency departments that offer buprenorphine and addiction services. In response, they implemented a paramedic-delivered buprenorphine and referral service to reach out-of-hospital patients with a high risk of overdose.

Buprenorphine acts as a bridging medication for individuals battling opioid addiction. The drug works rapidly to reduce withdrawal symptoms by binding opioid receptors and also blocks the actions of opioids like fentanyl and heroin, providing critical time for those facing opioid addiction to seek and receive addiction resources and treatment. The medication has proven to be effective in intervening in opioid addiction and overdose risk.

A recent study authored by Dr. Carroll in the Annals of Emergency Medicine analyzed the effectiveness of the Cooper EMS buprenorphine program. The study found that patients treated in the Cooper EMS program demonstrated decreased opioid withdrawal symptoms and increased outpatient addiction follow-up care following buprenorphine administration and referral.

The Cooper EMS buprenorphine pilot serves as a model to EMS organizations across the country seeking to implement their own EMS-integrated bridging medication programs. To that end, Dr. Carroll has worked nationally to support such initiatives by sharing the Cooper EMS buprenorphine program, implementation best practices, and lessons learned. 

California Paramedic Foundation Director John Ehrhart noted at the ceremonies, “Dr. Gerry Carroll and Cooper EMS are true pioneers in EMS prevention, and their program serves as a model to EMS organizations throughout the United States facing the brunt of the opioid epidemic. Their program is a vibrant example of EMS prevention programs that flip the traditional reactive 9-1-1 system on its head by preventing injury and illness before they occur.”

The Nicholas Rosecrans Award has nationally recognized EMS organizations delivering excellence in injury and illness prevention programming for over 20 years. The Award is named after a young toddler whose tragic drowning spurred EMS injury and illness prevention programs in Southern California. Each year, Nicholas’ mother Lynn Artz attends the EMS Expo to personally award the winner. The California Paramedic Foundation, RedFlash Group, EMS World, and Air Methods Corporation sponsor the Award to raise national attention and support for excellent EMS prevention programs. Information on the history of the Award and its winners can be found at CAparamedic.org/nicholas-rosecrans.

The California Paramedic Foundation is proud to recognize the 2020 Nicholas Rosecrans Award Winner: Dr. Kevin Munjal and the Mt. Sinai Community Paramedic Program (CPP). The Mt Sinai team protect high-risk seniors by ensuring they received timely and necessary care in the safety of their home during the initial onslaught of the COVID-19 pandemic in New York City.

The Mt Sinai team recognized that high-risk seniors often face acute-on-chronic health events in which they cannot wait for important evaluations to rule out significant causes, but if those significant causes are ruled out can often stay at home and avoid unnecessary emergency hospital visits. They also identified that many of these health events resulted in 9-1-1 utilization despite patients being connected with robust primary care teams and networks.

The Mt Sinai team leveraged EMS providers to work ahead of these 9-1-1 calls to provide early assessments and navigate the patients back into their primary care teams. Furthermore, they built their community paramedicine program in a scalable manner with the ability to onboard and train EMS providers in a quick and safe manner. This design choice would prove invaluable during the initial COVID-19 outbreak that faced New York City and dramatically increased the needs of high-risk seniors in their community.

Dr. Munjal at their team have been successful in diverting more than two-thirds of the CPP patients from unnecessary 9-1-1 activation and/or emergency department visits. They have seen lower re-request rates than typical emergency department post-discharge return rates. They have also seen high rates of admission when patients are found in need of a transport to the hospital. All pointing to their accuracy and success as a program. To learn more visit: https://partner.mountsinai.org/web/mspps/initiatives

The novel SARS-Co-2 virus and the COVID-19 illness it causes are rapidly sweeping around the globe. California and the Pacific West have been profoundly impacted by a significant number of cases. EMS has the potential to mitigate or accelerate the spread of the virus. Out-of-hospital providers sit at the front door of the healthcare system. They will be interacting with the sickest of COVID-19 patients, particularly those of at-risk populations like the elderly and persons with chronic, underlying diseases—both communities that utilize EMS with high frequency.

The success or failure of EMS with this novel coronavirus is contingent on a unified, informed, and diligent approach across the state. To that end, the California EMS Authority and its Director Dr. Dave Duncan recently launched the COVID-19 portal. This platform is a one-stop-shop for invaluable information for the state’s EMS practitioners.

The COVID-19 portal site provides unified information on areas familiar to EMS providers, such as appropriate PPE, patient assessment tools, and general infectious disease updates. However, the site also provides crucial information in newly evolving areas of operations, such as alternate destination strategies. These rapidly deploying strategies will be new to paramedics and EMTs, as these programs have only previously existed in regional pilot programs.

It will be increasingly important in the coming months for frontline providers to stay informed on both the state guidance and local operations. The California Paramedic Foundation encourages you to visit the site and review the materials currently available. We also encourage you to create a monthly reminder to check the portal for updated information and guidance.

The California Paramedic Foundation will continue to follow large statewide implementations and make EMS providers aware of new programming as it develops and takes effect.

 

Today we spotlight Air Methods, our partner in education. Air Methods—which operates as Mercy Air and Skylife in California—believes that everyone deserves access to lifesaving care via their highly trained critical care clinicians, without the stress of navigating unreasonable costs after the fact. We support them in this mission and admire their commitment to patient advocacy, education, and research.

EMS providers know that there are times when the difference between life and death is measured in minutes. Multisystem trauma, heart attack, stroke, and neonatal emergencies are just a few of the situations where the use of air-medical transport ensures that patients get the care they need in the timeframe required to save their life. Unfortunately for some patients, this has historically led to high out-of-pocket bills—the result of air ambulance providers typically being out-of-network with insurers.

Some air ambulance services offer membership-based programs. Members of their programs have all costs covered if they require treatment and transport. However, most people do not plan for a car accident, heart attack, or stroke. And yet, these people deserve important lifesaving air-medical care when these emergencies do occur—and without life-changing bills. Adding to the issues of membership programs, patients with Medi-Cal coverage cannot receive a bill for these services and get no benefit from such a program. This redundancy is often not well communicated in air-medical marketing programs.

Enter Air Methods, the national air-medical leader with over 300 bases serving 48 states. Air Methods believes everyone deserves access to lifesaving care, and that no membership should be required to guarantee low out-of-pocket costs. To this end, Air Methods has developed its No Membership Required program and patient advocacy services.

Air Methods’ no membership program has resulted in agreements with large health insurance companies in more than 20 states, with plans to increase these agreements and go in-network in all areas they serve. Patients under these plans see little to no balance bills. For patients that are not yet in-network, the company offers its patient advocacy services, where company representatives help patients and their families work with their insurers to navigate the billing process. Lastly, Air Methods has developed a robust financial assistance program. By fostering community partnerships, Air Methods created a charitable fund designed to offset the portion of emergency medical treatment not covered by a patient’s insurance.

Through their focus on patient advocacy and financial assistance, an Air Methods patient with Medicare pays an average of just $280 in out-of-pocket expenses. Patients with private insurance also see similar levels of cost.

 

This incredibly low cost is impressive in the context of the critical services provided by Air Methods’ excellent clinicians. The company’s standards for initial employment are high, and the company maintains important provider competencies through considerable investment in continuing education and training for all crewmembers throughout their career.

Air Methods clinicians are taught by industry-leading paramedics, nurses, and physicians. The company supports this educational effort with sophisticated facilities equipped with high-fidelity simulation technology. All of this prepares the flight crews to care for infants, pediatrics, high-risk OB patients, as well as standard adult patients at a high level.

Air Methods clinicians also have access to frequent physician-led cadaver labs, empowering flight crews with the confidence to perform lifesaving procedures such as endotracheal intubation, surgical cricothyrotomy, needle thoracostomy, and escharotomy. These investments directly benefit their patients. For example, Air Methods’ first-attempt tracheal tube intubation rate consistently exceeds 90% – nearly 20% better than the average EMS success-rate.

Air Methods further supports its highly-trained clinicians with industry-leading equipment and resources, such as cutting-edge ventilators, balloon pumps, and impella devices. The company also recently launched a blood product program. Currently, 98 bases have the ability to deliver blood products to patients in the field and during transport, an intervention that is critical to survival for patients who have sustained significant trauma.

Air Methods also works to drive the out-of-hospital care industry forward through a dynamic and well-developed quality assurance (QA) and research program. They maintain a 100% QA of patient transports, ensuring active guidance for the clinical team, adherence to national patient care guidelines, and an ability to adapt future clinician practice for better patient outcomes.

Air Methods derives powerful statistical research from its large, nationwide operations. It then uses this data to establish evidence-based best practices that influence clinical decisions throughout the industry. They are the only non-hospital based air medical company to have an Institutional Review Board Accreditation completed and renewed through 2021. With 26 current clinical research projects, Air Methods has established itself as an active participant and leader in evidence-based medicine.

Established in 1980, Air Methods began with a single helicopter and a hospital contract in Colorado. To date, Air Methods conducts over 100,000 patient transports per year and employs over 4,500 team members. Their commitment to safety, education, and patient advocacy make them an industry leader in the air-medical transport arena.

The California Paramedic Foundation is proud to partner with Air Methods and supports their efforts to deliver financially reasonable, top-quality air medical care and transport to patients throughout California.

As the United States continues a hard-fought battle against the current opioid epidemic, many communities around the nation are finding incredible value in the prevention capabilities of their EMS providers. Paramedics and EMTs—who are the frontline responders in many opioid overdose cases—often have unparalleled opportunities to establish relationships with overdose survivors and get them critical preventative resources and assistance. This year, the California Paramedic Foundation recognized just such a program being operated by the Colerain Township Fire and EMS Department.

The Foundation conferred its national Nicholas Rosecrans Award for injury and illness prevention to Colerain during the keynote address at the 2019 EMS World Expo in New Orleans in front of thousands of EMS practitioners and leaders from around the country and world. As part of the awarding, Colerain Fire and EMS presented during the seminar teaching how others might implement successful prevention programming in their region.

Colerain’s incredibly successful program reflects a paradigm shift throughout the country in which EMTs and paramedics—often as a part of multidisciplinary teams—try to prevent 911 incidents before they happen. The Township’s program was born out of the personal experience of Colerain Assistant Chief Will Mueller’s 911 responses to local drug overdoses. During his presentation to attendees, Chief Mueller recalled the final precipitating event leading to his creation of the Colerain program.

“I went on an overdose response for a young woman. I found her curled up in the corner of a room with a friend at her side. This woman was someone’s daughter or sister. It could have been my daughter. The worst part was a friend of the victim was present throughout the whole ordeal and could have activated 911 but was too afraid. I knew we had to do more,” said Mueller, as he shared with the group.

Since that event, Chief Mueller and Colerain Fire and EMS have worked to address the opioid crisis through multifaceted prevention programming. Their efforts include a “Safe Station Program” offering round-the-clock resources at each fire station, educational materials in the hands of frontline EMTs and paramedics, and a multidisciplinary quick response team (or QRT). The QRT consists of a fire-paramedic, a chemical dependency specialist, and a police officer who work together directly with at-risk individuals identified through 911 incidents.

To date, their programming has viewed by many as highly successful. The team has had a 72% success rate in helping more than 350 individuals enter into substance abuse treatment. As a direct result, the Colerain Fire and EMS Department have seen a 70% reduction in 911 requests for opioid overdose.

At the heart of Colerain’s high impact programming is the idea of “meeting patients where they are.” The EMS Agenda 2050, a national document providing a vision for the future, refers to this as people-centered care and has identified it as a transformative idea in the way our country delivers out-of-hospital care.

Hannah Dawes—the Colerain QRT’s chemical dependency specialist—echoed this sentiment when she told the audience, “it is so important to develop a trusting relationship between all members of the team and then with those individuals in need of help wherever they may be. This relationship will serve as the foundation for any subsequent successful action plan and follow-up.”

“Prevention is the future of emergency medical services and paramedicine,” states Paul Maxwell, founder of the Nicholas Rosecrans Award and a Director at the California Paramedic Foundation. “It is flipping traditional EMS on its head with paramedics working ahead of 911 calls to reduce injury and illness in their communities. We are incredibly proud of Colerain Fire and EMS for the impact they have had on their township.”

The Nicholas Rosecrans Award is conferred to individuals and organizations who create EMS-driven injury and illness programming. The award is named after a young toddler whose tragic drowning helped drive critical prevention programming in California. The award is facilitated by the Foundation in partnership with EMS World—the leader in paramedicine meetings, content, and education—and RedFlash Group—the leading EMS consultancy specializing in emergency communications and care professions.

 

Today we spotlight Falck, our partner in education and EMS-driven prevention. Falck, in operation for over 100 years, is the international leader in emergency medical services, rescue, and fire protection. Falck is uniquely rooted in the nonprofit world with its profits benefitting international biomedical research. We believe this charitable mission and belief in innovation is at the heart of Falck’s recent and successful expansion across the US and California.

Falck Group and its subsidiary Falck USA get their namesake from founder Sophus Falck. In 1884, Sophus was witness to a terrible fire in Copenhagen and observed the need for organized rescue and medical response. This experience so impacted him that in 1906, he founded Falck to meet the emergency needs of his community. The company’s first ambulance was also the first automobile ambulance in all of Scandinavia.

As the organization has grown and thrived, its service has expanded from its humble beginnings to offer doctors-on-call, medical clinics, global disaster response, EMS response, roadside assistance, firefighting, and more. It has more than 32,000 employees worldwide, of which more than 18,000 staff ambulance services. It is the largest EMS/fire provider in the world, responding to more than 9 million emergency, medical, and fire incidents in its operations across 46 countries and six continents.

Falck is owned by two prominent European nonprofits— The Lundbeck Foundation and KIRKBI. The Lundbeck Foundation generates annual grants of more than $500 million to support biomedical research in critical areas of science. The Foundation also gives out its yearly Brain Prize, the most prestigious international award in the field of neuroscience. KIRKBI is a family foundation often recognized for its 75% ownership of the LEGO Group and its charitable mission.

It is from this nonprofit leadership that Falck derives its values. Values that significantly differentiate it from its competitors. While the Falck team always aims to be revenue positive akin to other companies, the profits it generates are destined to better the world around us through research grantmaking, not merely bettering an investor’s portfolio. This business model resonates with paramedics who enjoy the pairing of their noble work with an equally noble corporate mission.

Falck’s unique ownership model, corporate partners, and sheer size also provide the organization with an incredible ability to innovate. Falck’s Director of Clinical Operations, Dannie Wurtz, states, “Falck prides itself on being a global leader in healthcare. As such, we invest heavily in innovation, taking an outside-the-box approach to pre-hospital care. With such a strong global presence, we have the unique ability to participate in many diverse EMS models in several different countries.”

This desire to innovate can be seen in Falck’s graduate EMS business program, its staff positions dedicated solely to innovation and design, and even its new drone programs. Their ability to solve problems in new and effective ways is incredibly valuable to California communities seeking increased efficacy and efficiency in their evolving emergency medical services and operations.

It is for all these reasons that Falck has seen such a rapid success across our state and country. The company currently serves 80% of Orange County, 40% of LA County outside of Los Angeles City, and recently won the exclusive 911 contract for Alameda County.  Altogether, their statewide operations serve 6+ million residents in a 911 capacity.

The California Paramedic Foundation is proud to partner with Falck, as we together advance paramedicine and the care of our communities.

In 2017, the National EMS Advisory Council (NAEMSAC) released an advisory recommending fundamental changes to the nomenclature used in emergency medical services (EMS). Following this advisory, the federal government convened a series of national meetings to discuss this topic. Last week, they released a white paper draft summarizing the results of these meetings. Here’s our breakdown on this important issue.

At a high level, nomenclature change aligns with ongoing efforts to increase professionalism in EMS — something advocates identify as crucial to the evolving industry. However, it also works to perform simple housecleaning in a field plagued with acronyms and a myriad of titles. US standards currently recognize four prehospital provider levels: emergency medical responder (EMR), emergency medical technician (EMT), advanced emergency medical technician (EMT-A), and paramedic (formerly EMT-P). Further confusing the landscape is the overarching term of emergency medical services (EMS).

“This is ____. She is an EMT,” says the layperson. “I’m actually a paramedic,” replies the proud clinician. Cue a confused look from the layperson and anyone in earshot. Complicating the issue further is any attempt at describing the activities performed by EMTs and paramedics. Are they practicing EMS, or do they work in an EMS system, or both? Do EMTs and paramedics perform the same work? What about prehospital nurses? Are they nursing or EMSing? And down the rabbit hole, we go.

Advocates argue ‘paramedic’ and ‘paramedicine’ are more straightforward and professional. If this initiative comes to pass, almost all providers would be paramedics, and they would practice paramedicine despite their environment. Practically speaking the levels would become something like emergency medical responder (EMR), basic care paramedic (formerly EMT), primary care paramedic (currently paramedic), and advanced care paramedic (flight, critical care, and community paramedics).

The white paper does highlight concerns voiced during the meetings regarding the removal of EMS, rescue, and other descriptors from local operations. However, it is crucial to note that renaming clinicians and their work does not mandate changing the names of departments or services — no need to repaint the ambulance or engine just yet.

EMS systems, fire rescue departments, mobile integrated health teams, and so on, are names designed to clarify the environment in which the paramedic works. However, the care rendered in each situation can be best described simply as paramedicine. “I am a paramedic. I practice paramedicine. I work in my local EMS system.”

This change mirrors other healthcare professions, such as nursing and medicine. A cath lab nurse, an ER nurse, and a family practice nurse are all nurses practicing nursing. Similarly, physicians across all specialties are practicing medicine. We call their departments, health systems, and teams various things. But the actors themselves are distinct and clear.

While the proposal has many supporters, both the International Association of Fire Fighters (IAFF) and the International Association of Fire Chiefs (IAFC) stand in opposition. They state that each provider level is distinct and warrants a separate name and that there is little evidence justifying the change. However, it is unclear what kind of evidence would be needed to support the move other than a desire by the industry itself and a clear rationale.

Join our newsletter below to follow this issue and more!

This summer, Dr. Howard Backer retired from his post as Director at the California EMS Authority. Over the last nineteen years, he has held numerous prominent positions across California’s Health and Human Services Agency and worked on issues ranging from bioterrorism planning to strategic deployment of emergency resources. In his final role with the Authority, he propelled critical developments such as community paramedicine, health information exchange, and quality improvement processes.

Dr. Backer’s journey through medicine and ultimately into public service was guided by an early desire to work with people. Despite a great interest in science as a teenager, he realized early on that he did not want to spend his life in a laboratory with test tubes and animals. He instead decided to pursue a career in medicine where he could work at the intersection of sciences and humanities.

He was accepted to the University of Michigan, where he studied language, literature and premedical sciences in preparation for medical school. During his undergraduate years, he also traveled abroad to Switzerland. This experience further solidified his love of the outdoors, which would steer some of his career choices later in life.

After finishing at Michigan, Howard was ready to escape the midwest. He sent medical school applications off to both coasts and ultimately chose the University of California at San Francisco, for its strong reputation and proximity to many outdoor destinations. He arrived in the Bay to begin his medical studies during the rise of the Haight-Ashbury and the peak of anti-war protest.

During his studies at UCSF, outside of the emergency department at San Francisco General Hospital, Dr. Backer had limited exposure to emergency medical services and paramedicine—both newly forming areas of health care. He intended to exit medical training as a generalist before further specialization, an accepted practice at that time. Accordingly, he took a rotating internship position at Highland Hospital in nearby Alameda County.

A year later—with just two weeks until internship graduation—Howard’s next career move was still undecided. When he received a fateful phone call from a former Highland Hospital nurse. She asked him if he was interested in a seasonal position at Lake Hospital in Yellowstone National Park. His response: “I’ll be there in two weeks.”

Dr. Backer spent the summer working as a general practitioner responsible for multiple aspects of the hospital and clinic services, including working on the hospital’s ambulance. He worked alongside the park’s rangers who provided rescue services but not emergency medical care. When an incident occurred, a physician and nurse would jump into the ambulance, and a maintenance person would fill in as a driver.

The work was a cross of summer camp and the TV series MASH. The beauty and adventure of the park intermixed with frequent serious emergencies such as cardiac patients at Old Faithful, major trauma from road accidents, thermal pool burns, and wild animal attacks. The typical, non-critical injuries and illnesses (familiar to any paramedic) were also a part of the practice. His career in emergency medicine and EMS had begun.

Dr. Backer went on to work at Yellowstone for the next three years, returning to the Bay Area to work in emergency departments during the off-seasons. It was during one of these off-seasons that he was offered a fellowship position in a newly forming emergency medicine program at San Francisco General Hospital. His considerable experience garnered at Yellowstone allowed him to work with confidence in the urban environment.

Dr. Backer said yes to the fellowship with a caveat. He would like to continue to work at Lake Hospital. Since the program was still evolving and somewhat flexible, they agreed. And so it went. Howard would spend his summers in Yellowstone. Where his experiences demonstrated the skills and training on which to focus his education back in the Bay Area.

Following this training, Dr. Backer joined the faculty at SFGH briefly. Soon after he went back across the Bay to the new Emergency Medicine Residency at Highland Hospital, where he worked alongside well-known EMS leaders such as Drs. Bob Daley, Mike Callaham, and Jim Pointer. In Highland ED, he met his wife Anita and started a family. He also continued to pursue his interest in wilderness and resort medicine with clinical stints in Vail and Tahoe.

After nearly 25 years of practice in various environments, Howard was looking back on a career of beautiful experiences and fascinating medicine. But he also understood that it was hard to sustain a direct care role in emergency medicine. The timing was right for him to pursue other medical interests, one of which was public health.

Dr. Backer initiated his move into public health through a second residency in Preventive Medicine. The unique program included both a Master’s in Public Health (MPH) at UC Berkeley and a project-based externship through Kaiser of Oakland. He then began work in immunization and infectious diseases at the California’s Department of Health Services, which had offices located in Berkeley at the time. Then 9/11 happened.

Howard was quickly tapped to plan for threats of biological terrorism. The first project centered on smallpox vaccination for medical and first responders. He then went on to prepare for medical response to pandemic influenza and anthrax attacks. These projects took Dr. Backer out of the Immunization Branch, instead working with the directorate in the Department of Public Health. He would ultimately be asked to serve as the interim Director of that department on two separate occasions.

Dr. Backer enjoyed this new role of working on developing policy, building programs, and working with public health and medical system stakeholders. Never one for managing in the hospital setting, he found that he rather enjoyed management challenges in a government setting. Howard applied the decision style of an emergency physician—rapid decision-making with limited data with re-evaluation and no shame in changing direction when necessary. This turned out to be a successful approach in public health, as well as emergency medicine.

After working on everything from influenza to radiation to chronic health issues, Dr. Backer was reassigned to a role reporting directly to the Secretary of Health and Human Services Agency. In this role, he was tasked with coordinating emergency and disaster response across the entire Agency.

Dr. Backer’s work was foundational to the development of California’s Emergency Support Functions (ESFs) in the areas of Public Health and Medical and Mass Care and Shelter. Subsequently, during the next gubernatorial transition from Schwarzenegger to Brown, he was appointed as the Director of the EMS Authority.

The Authority had not had much recent stability at the Director level. However, the staff was well experienced, and work at EMSA continued to advance. What Dr. Backer lacked in EMS provider experience, he made up with his strong relationships across the Health Agency and his understanding of the state government process.

Howard quickly identified multiple areas of focus across the California emergency medical services (EMS) landscape. There was a profound lack of usable data being provided to policymakers and EMS agencies. And where information did exist, it was often siloed from other end users. EMS systems lacked comparable quality assurance methods that were well established in other areas of health care. Paramedic treatment protocols were highly variable across the state. And there was clearly a need in California for the newly evolving paramedic roles, such as community paramedicine.

Under Dr. Backer’s leadership, the Authority worked to increase both data creation and reporting by EMS localities. The department funneled millions of dollars in federal grants to initialize health information exchanges connecting paramedics to regional health systems to give patients better continuity of care. Other high-impact programs, such as the Patient Unified Lookup System for Emergencies, or PULSE, were also launched.

The ongoing success of these implementations represents significant technical and bureaucratic achievement. California is now considered a national leader in data and information exchange incorporating EMS providers. This program is actively developing longitudinal data improvements and ultimately, a clearer picture of patient outcomes, which will help steer future practice and policy.

During his tenure, Dr. Backer also pushed local medical directors toward more standardized, evidence-based protocols. The adoption of a unified scope of practice for critical care and flight paramedics, including competency maintenance and demonstration illustrates the collaboration among medical directors and provider agencies.

In the realm of community paramedicine, Dr. Backer’s connections across the Health Agency allowed for multi-departmental support of pilot programs that have shown a great success. This exploratory work is currently awaiting codifying legislation. These efforts will soon make community paramedicine available throughout the state.

Dr. Backer is also recognized for advancing EMS quality assurance and quality improvement. He envisions a system that is aligned more closely to the broader healthcare model with significant transparency, quality improvement, and patient focus. This represents an essential change in prehospital systems that will better integrate EMS and health care systems and support the evolving roles for EMS.

In just eight years, Dr. Backer has significantly advanced California’s EMS systems and successfully moved the goalposts in an industry seeing rapid evolution. His achievements are being continued by a new generation of paramedics, physicians, and administrators who embrace evidence-based practices, advancing technology, and positive change. His departure leaves large shoes to fill at the EMS Authority, but his precedent will undoubtedly help his successor hit the ground running.

This week paramedic Jason Smith, of the California Paramedic Foundation, sat down for an interview with Lynn Artz. Lynn is the mother of Nicholas Rosecrans, a toddler who tragically drowned in 1996 and after whom our award for first responder prevention programming is named. This May, marks the 23rd anniversary of Nicholas’ tragic passing and the 17th Annual Nicholas Rosecrans Award. This year’s award will be conferred at the 2019 EMS World Expo in New Orleans on October 14th.

 

 

Jason – Hi Lynn, thank you for joining us today!

Lynn – Hi Jason, thanks for having me!

Jason – I’d like to start with some background on Nicholas. I understand you were very proactive with Nicholas’ safety. Can you provide some context to the accident?

Lynn – Yes. I took Nicholas’ safety very seriously. When he was younger, I had a dream of him drowning. Upon waking, I went to check on him and found him sleeping peacefully in bed. It was quite scary even though it wasn’t real. We had a pool at the home, and I had it fenced in the day before Nicholas began walking.

Jason – That must have been very scary.

Lynn – Yes! It was.

As a working Mom, I placed him in daycare. I had picked a lovely daycare. A woman had started it at her home. They were incredibly responsive and had a good curriculum for the kids. They even baked their own bread. Nicholas was actually their first attendee, and he loved it there.  Her home-schooled daughters treated him like a little brother. He was so loved. I couldn’t have asked for a better place.

The family that owned and ran the daycare had just moved into the home a few months before Nicholas started there. The home had a hot tub in the backyard, and I discussed my concerns with the owner. They were great and removed the entry stairs, covered the tub, and fenced it in. So, I felt very comfortable with their quick attention to the safety of their children.

Jason – Can you tell me about the morning of May 8th, 1996?

Lynn – On May 8th, I took Nicholas to daycare. I gave him a big kiss and left him playing with a ball and stick. At about 10AM, I received a call while at work from the daycare staff. They told me, ‘Nicholas is alive, the paramedics are with him. He fell into a pool.’

My immediate thought was, ‘What pool?!’ I had never seen a pool on the premises. Well, it turned out the home for sale next door had the pool. There was no fence around the pool. The home didn’t have a permit to have a pool built there in the first place.

I later learned the details of what had happened. Nicholas had been under the supervision of a young man while he and 4 other boys played in a grassy field with lots of trees. They called it ‘the orchard’, and I remember Nicholas had loved to play there. I recall the owner telling me about it and simply thought she had hired staff and was expanding. I was happy for her. By any account a 5 to 1 ratio at a daycare is considered pretty good. It had sounded like things were good.

Well. One of the boys was able to get out by pushing a gate open. As he ran off in one direction, a second boy ran in the opposite direction. The gentleman took off after them. By the time he had gathered the two boys and returned to the orchard, Nicholas had also ran off unbeknownst to the man. By the time, they figured out he was not just hiding among the trees and began looking for him, he had already fallen in the pool.

One of the owner’s daughters provided CPR while they called 911. The paramedics arrived and took over CPR. They were able to get his heart started and stabilize him enough for LifeFlight to  transport him to Children’s Hospital of San Diego. That was when they called me. My office manager drove me first to the daycare, where I screamed Nicholas’ name as I ran up the driveway. An officer met me before I reached him and told me that he was to be transported to the hospital. I was allowed to come close enough to see the paramedics treating him on the porch. I grabbed his sopping wet shoes and clutched them to my chest all the way to the Children’s Hospital to await the helicopter. The smell of chlorine still takes me back to that awful day.

Jason – Can you talk a little bit about the following hours and the tough decision your family faced?

Lynn – Nicholas was placed on life support at the hospital. They had medicated him so that he would tolerate the breathing equipment while they performed tests to evaluate his brain function. After testing throughout the day, they came to us with the terrible results— Nicholas truly had no brain function. All that remained was the very primitive drive to breathe. They gave us the choice of keeping him on life support, with no likely change, or withdrawing care. We made the incredibly tough choice to withdraw care.

At about 10PM, when his sedation medication had worn off, he was removed from life support. I had the staff bring in a rocking chair and Nicholas was put in my arms. I rocked him, kissed him, and sang an Irish lullaby. His gurgling, labored breathing soon stopped. I sat and held him for a long time.

Jason – That is incredibly moving. I’m so sorry for your loss. And you reached out to the paramedics who responded to the incident, correct?

Lynn – That’s right. I had this strong, strong feeling that I needed to thank the first responders and paramedics who came to the daycare. This feeling continued for about a month, so I found out who had been working that day at the San Miguel station. I wrote them all individual letters and thanked them for the extra time they had given me with Nicholas.

Jason – Can you give us some insight into how this tragedy transitioned to the incredible prevention work you have helped support?

Lynn – Well after the event, I was very hopeful that something positive could come from it. I had truly done everything that I could to prevent this kind of tragedy, but it still occurred. I wanted the event to help prevent this from happening to others.

Several months after Nicholas’ drowning, I happened to be the program chair for my sorority alumnae group. We had been looking for programming for our regular meetings. Someone suggested that I speak with Roxanne Hoffman about presenting at a meeting. She was the head of the Safe Kids Coalition in San Diego. The person had heard her presentations were fantastic, and so I asked her to attend our September meeting.

At the September meeting, Roxanne Hoffman and I were chatting and she said ‘So I guess you know Paul Maxwell.’ I replied, ‘No I don’t, who is he?’ Roxanne went on to tell me that Paul was one of the paramedics who responded to Nicholas’ drowning, and that he had been carrying around the letter I had written to him.

She told me that he had actually responded to dozens of drownings that Spring. He had contacted her asking for her help. He was tired of responding to child drownings and wanted it to stop. Paul had started gathering statistics and data from his EMS system, data that was not previously available to the Safe Kids Coalition, to support legislation around pool safety.

Jason – That’s incredible how you met. Were changes to pool safety laws successful?

Lynn – Yes. Laws were created that forced new homes to have safety features like fences. Unfortunately, they grandfathered pools built prior to the law, but it was a great success moving forward.

Jason – Can you tell me about EPIC Medics?

Lynn – Well a few months after the legislation effort, I was contacted by Paul. He wanted to let me know that he had found several other paramedics who were interested in working on child injury prevention. Together they had started the group Paramedics Eliminating Preventable Injury in Children, or EPIC Medics. They were going to create prevention programming around the pediatric injury statistics they had gathered.

Jason – Do you feel paramedics and first responders help injury and illness programming to be more effective?

Lynn – Absolutely. It is a powerful image. These providers are authority figures that the public knows are responding to these incidents first-hand. It works to convey the importance of these issues. These are the people who show up first.

When it comes to prevention these providers know, more than anybody, what types of incidents are causing injury and illness in their communities. They are the ones showing up and treating these problems.

It’s similar to how a firefighter shows up to a fire, then studies how it happened, and then works to prevent that from happening in the future. Paramedics and EMTs are no different. They know what caused the injury or accident. Who better to work on prevention of those things.

Jason – I agree wholeheartedly. Can you tell me how the Nicholas Rosecrans Award got started and your involvement with it?

Lynn – It was Mother’s Day 2002. I had moved from San Diego County to Indianapolis at that point. I received a call from Josh Krimston, a paramedic/founder of  EPIC Medics. He told me they were creating an award to give to paramedics and firefighters who had been working in injury prevention but often never recognized for their actions. He told me they wanted to name it after Nicholas. I was totally on board.

The first award was given out that year, and the winner was quite fittingly a fire chief in Alaska who had created a life vest water safety program called “Kids Don’t Float.” I believe the program continues to this day. Incredibly, the chief was discouraged by critics who did not think the program would be successful and thought life vests would just be stolen. Well, it turned out the community actually donated life vests and he successfully reduced drowning incidents in Alaska by 60%. I thought it was a wonderful program to kick-off the award.

The award has been given out each year since then. Each year I attend the ceremony so that I can physically hand the award to the winners. The act of giving away the award is so meaningful to me. I am so honored and grateful to be given that opportunity to recognize those individuals.

Jason – What does all of this prevention programming from the Safe Kids Coalition to EPIC Medics and the Nicholas Rosecrans Award mean to you?

Lynn – The story of my son has had such an impact. I know my son, at two years old, has saved lives. And that means a lot to me. I had one mother once tell me that she had been reading one of our articles. She came across the words, ‘There is no Splash…’ which prompted her to check on her own child. She actually found him to be underwater, but immediately pulled him out and he was fine. Nicholas’ story saved that life.

It makes me feel like his life and death have purpose. It wasn’t just a random tragedy. There was a reason. It meant something. It means my son didn’t die for nothing. There has been a positive change in his honor.

Jason- Do you have any advice for first responders interested in prevention?

Lynn– Analyze your community. What types of incidents are you getting called to most? What types of things do you see on your incidents that you believe can be changed?

The previous award winners list is a great place to look for ready-made solutions. The Nicholas Rosecrans Award has recognized programs working on everything from pediatric drowning to senior falls and teenage driver safety to drug abuser rehabilitation. Those winners will gladly share their knowledge and information with those looking to start something similar. In fact, it is one of the criteria of the award to share your program with others that wish to replicate your program in their community.

It’s also important to understand that you will face challenges. There are difficulties, such as convincing provider agencies to participate in programming. It takes motivated first responders and a community approach, but it is achievable!

Jason- Thank you so much for your time! We look forward to seeing you at the 2019 EMS World Expo for the next Nicholas Rosecrans Award.

Lynn – Thank you Jason.