RIO RANCHO, N.M. — From a medication that helps stop internal bleeding to home visits to prevent the need for 911 calls, Rio Rancho Fire Rescue Department has been advancing its medical services.
Most of the services are recent additions, while others are expected to come online this summer.
“I would absolutely say that we’re on the cutting edge in New Mexico and beyond,” said department Medical Director Dr. Darren Braude, also a University of New Mexico professor of emergency medicine, EMS and anesthesiology.
Battalion Chief Marc Sandoval said RRFR is the first department in New Mexico to have a telemedicine video-conferencing system that allows emergency medical responders and their patients to talk to doctors during calls.
“It’s basically like a HIPAA-compliant Facetime,” he said.
HIPAA is the Health Insurance Portability and Accountability Act, which mandates privacy in personal medical information.
Braude said crews can usually handle situations on their own, but if they need to consult a doctor, it helps if the doctor can see the patient. Telemedicine also provides a good venue for a doctor to explain concerns to a patient who needs to go to the hospital but is resisting, he said.
The fire department’s telemedicine system operates via laptop. Sandoval said responders first successfully used it in February, although the system has been in place for longer.
Ultrasound for hearts
Paramedic lieutenants have also begun using ultrasound machines to more accurately tell if a cardiac-arrest patient’s heart is pumping.
“There may be a handful of places in the world — not only in the country— where paramedics are able to do that,” Braude said.
Providers in hospitals often use the technique, but it’s recently been introduced to field work, he said.
Sandoval said ultrasound is more accurate than a heart monitor, which may show electrical activity when the heart isn’t compressing, and is an easier assessment than looking for a pulse.
“What we don’t want to do is do chest compressions when the heart is pumping,” he said.
Fire Lt. Jessica Duron-Martinez said the ultrasound also helps crews see if they’ve done everything they can.
Sandoval said Rio Rancho’s three paramedic lieutenants, one working during each shift, have earned state certification for ultrasound and will respond wherever they’re needed in the city, typically coming from Station 1 on Southern Boulevard.
RRFR received approval to use the ultrasound machine in December, joining Albuquerque Fire Department and Albuquerque Ambulance, he said.
Stopping blood loss
In September, the fire department began using tranexamic acid, or TXA, a medicine that helps create clotting agents to stop severe internal bleeding. It’s in all ambulances, and all Rio Rancho emergency medical service providers have been trained to administer it.
Braude said he believed RRFR was the only fire department in the metro area using it. TXA was used in gynecology and obstetrics for decades, and rediscovered for battlefield injuries before entering civilian emergency medicine.
Braude said surgery is the only way to stop internal bleeding, but it could take 30 minutes to get to UNM Hospital from Rio Rancho, depending on circumstances. TXA is important to keep people alive on the way.
RRFR also has a LUCAS device, which does the chest compressions in CPR, freeing one or two members of an EMS crew to do other procedures.
“That’s a lot of hands if you only have a limited number to begin with to do other important things,” Braude said.
Sandoval said the LUCAS compresses the chest to the right depth at the right speed more consistently than a human does.
Braude said if eight or 10 people could respond to a cardiac arrest and take turns doing chest compressions, they might do them as well as the LUCAS. However, RRFR can afford enough staff members to send four or five people, so the device is better.
Also, if someone goes into cardiac arrest in a moving ambulance, he said, it’s much safer and easier for crews to use the LUCAS than manual chest compressions.
Paramedic lieutenants carry the devices. While waiting for the lieutenant, crew members perform manual CPR.
Sandoval said Rio Rancho Fire Rescue was the first agency to get such a device in the metro area two or three years ago. Albuquerque Fire Department and Albuquerque Ambulance have similar equipment now, he continued.
With the LUCAS and ultrasound, Braude said, paramedic lieutenants have the equipment because the department could afford to train and equip that small number of people.
“It made the training easier, and it made the investment easier,” he said.
In the works
RRFR is preparing two more programs Sandoval hopes will begin in mid-July. He expects both to sustain themselves with payments from users’ health insurance.
The Community EMS program will provide case management and home visits for frequent users of ambulance services and other people the department will serve under contracts with health-insurance companies. RRFR is the only fire department in the state with such a service, as far as Sandoval knows.
He said the program will officially begin July 15 with one new position, although a firefighter on temporary light duty provided the services before now.
“She did wonders with that position,” Sandoval said.
Community EMS is meant to prevent emergencies, lessen non-emergency calls, support people after discharge from the hospital and free up crews for other response. Braude said it’s a way to engage the population other than “on the worst day of their lives.”
Help it provides could include building wheelchair ramps, fall-proofing homes, explaining what services people should and shouldn’t seek at the emergency room and helping patients navigate the health-care system.
If someone keeps calling 911 because of loneliness, the habit might lessen because of the provider’s weekly visits, plus information responders already provide about senior programs and the related shuttle.
The Medic Six program will consist of one ambulance dedicated to non-emergency medical transportation between treatment facilities. Braude said the program will provide a needed service without impacting the department’s ability to respond to emergencies. People will be able to schedule service times from 8 a.m. to 5 p.m. Monday through Friday, except for holidays.
Sandoval said the department will repurpose an ambulance and hire two people for the program.
“That’s their whole response,” Sandoval said. “They won’t be firefighters; they’ll be EMS only.”
Braude said RRFR is always making changes to improve.
“We are constantly looking at the evidence and we are constantly re-evaluating our practice and doing what provides the best possible care,” he said.