HomeMy WebLinkAboutJustification Summary10. Justification Summary:
A) Problem description: The City of Miami's Department of Fire -Rescue (MFR) current use of bag -valve -mask
(BVM) on its residents may have a negative impact on Quality Patient Care, which could subsequently increase
the morbidity and mortality rate in the City. MFR cannot adequately and consistently ventilate patients in need of
mechanical ventilation. On many occasions, patients assisted by our Emergency Medical Services (EMS) units
may require mechanical ventilation. Patients develop a condition where the mechanics or ability to breathe is
impaired due to cardiovascular condition, drug overdose, brain trauma, neuromuscular disease, musculoskeletal
defects or respiratory distress syndrome. A direct outcome of this inadequacy is a low 16% save rate (pulse at
hospital) of our 292 cardiac arrest patients for year 2003 (of which most of these never leave the hospital alive).
This results from having to rely upon our present mechanical ventilation device known as the BVM. Recent
studies published by the American Heart Association in 2004 have concluded that BVM ventilation is inferior to
using Emergency Transport Ventilators, and is often "inadequate and potentially dangerous for both intubated
and non-intubated patients." Some of the problematic side effects of using the BVM are: inaccurate (too much or
too little) tidal volumes (air flow) into the lung and esophagus causing insufficient oxygenation of the body.
Another side effect is gastric distention (over inflation) of the stomach, which can result in aspiration of gastric
contents. In addition, BVMs do not provide the necessary control of ventilation or the proper information for our
paramedics to measure the progress on the patient while the procedure is taking place. EMS units' equipment is
very limited in its usage resulting in unappreciated adverse clinical consequences, including hyperventilation and
hypoventilation.
Miami is the poorest large city in the State and the 4th poorest in the US. It continues to be a gateway for poor
immigrants, and its economy relies heavily on tourism. Low-income families and the elderly are the city's most
vulnerable groups. In 2002 Miami's median income was $20,883, and 31% of its residents lived in poverty.
Seventeen percent of its population was aged 65 and older and 40% of them lived in poverty. This group's special
needs routinely puts' heavy demands on MFR's 911 system. Last year, MFR's 54 units (23 ALS Rescues, 1 ALS
Pumper, 4 Supervisors, 16 Fire Trucks and 10 ALS Special Event units) handled 82,393 calls for assistance,
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serving the EMS requests of approximately 365,000 residents, and over 1.2 million people coming to work,
visiting and doing business on an everyday basis within city limits.
B) Present situation: AU of our ALS units are equipped with BVMs to perform mechanical ventilation on patients
that need this procedure. Currently, MFR does not have in place a device that can adequately and consistently
provide the correct pressure and tidal volume necessary for adequate ventilation. Optimal control of patients'
condition suffers as the task of intermittently squeezing the BVM competes with other resuscitation priorities.
This situation May have a negative impact on patient care by having unacceptable inconsistency and inability to
achieve proper ventilation. In addition to not being able to properly measure ventilation, using the BVM takes
additional manpower during critical patient treatment times. The use of the trained paramedics could be better
utilized to administer other treatments. Last year, MFR responded to more than 82,000 calls for assistance. Of
these, 592 required ventilation with the usage of a BVM and 388 required intubated ventilation. MFR
implemented usage of a BVM and an intubation tube on 292 cardiac arrest patients.
C) Proposed solution: The EMS units at MFR desperately need to acquire emergency transport ventilator units.
MFR proposes to equip all of its ALS vehicles with Emergency Transport Ventilators (ETVs), and to train each
Paramedic in its use and importance. In controlled trials ETVs have been shown to deliver efficient ventilation
treatment, providing the correct pressure and tidal volume necessary for adequate ventilation. In addition ETVs
will allow our EMS personnel to concentrate on other critical elements of resuscitation.
D) Consequences if not funded: The lack of this enhanced technology could have significant consequences to
the residents and visitors of the City. MFR will continue to utilize its current practice of solely using BVMs to
ventilate our patients, which may result in improper ventilation, a continued low saved rate (of which most of
these never leave the hospital alive), and limit our EMS personnel from concentrating on other critical elements of
resuscitation.
E) The geographic area to be addressed: This grant will serve the entire 34.5 square miles of the City of
Miami. The City has 365,000 residents, and welcomes over 1.2 million people coming to work, visiting and doing
business on an everyday bases within city limits. Among large cities, Miami is the poorest in the State and the 4th
poorest in the US. Low-income families and the elderly are the city's most vulnerable groups. in 2002 Miami's
median income was $20,883, and 31% of its residents lived in poverty. Seventeen percent of its population was
aged 65 and older and 40% of them lived in poverty. Their special needs routinely puts' heavy demands on
MFR's 911 system, which handled 82,393 calls for assistance in 2004.
F) The proposed time frames: Months 1 to 3: present award to the City commissioners for approval, research
supply, meet with sales representative, write specifications for the equipment to be purchased, equipment
installation plan, and training curriculum. Months 3 to 6: purchase equipment and set up training schedule.
Month 6 to 12: configure and install equipment, begin training, document personnel trained.
G) Data Sources: 2000 U.S. Census data for the City of Miami, 2004 City of Miami Management Information
System, 2004 City of Miami Department of Fire -Rescue Incident Report System, 2002 City of Miami Department
of Fire -Rescue 5 Year Strategic Plan, Hyperventilation -Induced Hypotension during Cardiopulmonary
Resuscitation (published on line before April 5, 2004 by American Heart Association), Concepts and Application
of PreHospital Ventilation by Marvin A. Wayne, MD and University of Washington.
H) Statement attesting no duplication: _The City of Miami MFR project to purchase and install portable
ventilators devices into the entire fleet of Fire Rescue units does not duplicate any previous efforts or activity on
another grant under this grant program.