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HomeMy WebLinkAboutRequest For GrantFLORIDA DEPARTMENT OF HEALTH EMS GRANT PROGRAM REQUEST FOR GRANT FUND DISTRIBUTION In accordance with the provisions of Section 401.113(2)(b), F. S., the undersigned hereby requests an EMS grant fund distribution for the improvement and expansion or continuation of pre -hospital EMS. DOH Remit Payment To: Name of Agency: City of Miami Department of Fire — Rescue Mailing Address: 1151 NW 7 St. 3rd Floor Miami, FL 33136 Federal Identification Number VF 596000375 Authorized Agency Official: Signature Date Robert Ruano, Director of Grants Administration Type Name and Title _ Sign and return this page with your application to: Florida Department of Health BEMS Grant Program 4052 Bald Cypress Way, Bin C18 Tallahassee, Florida 32399-1738 Do not write below this line. For use by Bureau of Emergency Medical Services personnel only Grant Amount For State To Pay: $ Grant ID Code: Approved By: Signature of EMS Grant Officer Date State Fiscal Year: - 0rganization Code E.0, OCA Object Code 64-25-60-00-000 N_ N2000 7 Federal Tax ID: VF Grant Beginning Date: Grant Ending Date: DH Form 1767P, Rev June 2002 1 Kaye,W. et al, JAm Coll. Cardiol 39(5), Suppl A, 2 Cobb, L. et al, JAm Med Assoc 281(1 3):1182 -1188 3 Wigginton, J; The inspiratory Impedance Threshold Device for Treatment of Patients in Cardiac Arrest; Business Briefing: Long Term healthcare 2005 10. Justification Summary: A) Problem description: The objective of CPR is to provide sufficient circulatory support to a patient in cardiac arrest (SCA) to restore spontaneous circulation. The cornerstone of this approach is maintenance of an adequate blood pressure and vital organ perfusion pressure when the heart is incapable of providing the essential cardiac output on its own. In spite of the many advances in medical care, there has not been a significant improvement in the survival rate from cardiac arrest in 30 years. Although survival from sudden cardiac arrest (SCA) in a US hospital is 3 times greater than for patients who suffer an arrest at home, consider that: (1) survival after in - hospital arrest is only 16%'; (2) In the vast majority of cases, the presenting rhythm is not chock -able (VFNT), so drugs and compressions are the only viable treatment. For cardiac arrests where shock is not indicated or defibrillation is delayed, adequate cardiac tissue perfusion and circulation are crucial in providing a successful defibrillation'i. Recent studies have shown that even mildly excessive ventilation rates and incomplete chess wall recoil during CPR can be lethal. Conventional manual CPR is inherently inefficient and provides only marginally adequate coronary perfusion pressures due to the sub -optimal pressure gradient between the aorta, the right atrium and left ventricle in the heart. During the decompression phase of CPR, a small intrathoracic vacuum (relative to atmospheric pressure) develops when each chest wall recoil, promoting blood flood back to the heart. Myocardial perfusion predominantly occurs during this key decompression phase of CPR. The difference between diastolic aortic and the right atrial pressures (CPP) is a critical determinant of CPR efficacy. Much of the potential hemo-dynamic benefit of this intra-thoracic vacuum is lost when respiratory gases enter the lungs during the decompression phase of CPR. As a result, less venous blood goes back into the heart, cardiac preload and cardiac output is decreased reducing blood pressure and limiting vital organ perfusion. The intracranial pressure is higher during the decompression phase of CPR, which combined with decreased cardiac output results in lower cerebral perfusion. In an effort to improve outcomes in cardiac arrest patients a new technology has been developed that rediscovers and works to maximize the most important principles surrounding optimization of blood flow during resuscitation, however, due to fiscal constrains it has proven difficult to Miami Department of Fire Rescue (MFR) to take advantage of this technology and ameliorate working conditions encountered in a cardiac arrest situation. Miami is the poorest large city in the State and the 3rd poorest in the US. It continues to be a gateway for poor immigrants. Low-income families and the elderly are the city's most vulnerable groups. In 2002, Miami's median income was $20,883, well below the national average of $50,046, and 31% of its residents lived in poverty. Seventeen percent (17%) of its population was of 65 years of age or older and 40% of them lived in poverty. This percentage increases dramatically between November and April of each year as older adults known as "snow -birds" migrate down to Florida from colder climates. The lack of preventative health care exacerbates the problem as well. This annually migration causes a significant increase in the amount of EMS calls leaving fewer MFR personnel per capita to respond to EMS/Fire related emergencies. This group's special needs routinely put heavy demands on MFR's 911 system. MFR serves the EMS requests of approximately 365,000 residents, and over 1.2 Ilion people who commute to work, visit and/or do business on an everyday basis within city limits. Last year, MFR's 54 units (23 ALS Rescues,1 ALS Pumper, 4 Supervisors, 16 Fire Suppression units and 10 ALS Special Event units) handled more than 86,000 calls for assistance, of which 621 were classified as possible Cardiac Arrest Calls. MFR attempted to resuscitate 243 patients. B) Present situation: The current method of delivering CPR on our residents may have a negative impact on Quality Patient Care, which could subsequently increase the morbidity and mortality rate in the City. Presently, our EMS personnel deliver CPR by using emergency transport ventilators (ETV) and by homodynamic performance of manual chest compression until a second unit arrives on the scene and a pneumatic chest compression device (Thumper) can be applied. EMS crews need to accomplish many task to effectively resuscitate a cardiac arrest patient (e.g., intubating, IV, medications, defibrillating, packaging, etc). New technologies that will indeed double both blood flow to the heart and increase blood pressures will be much more efficient It will improve the circulation to the brain and significantly increase the chances of survival after an out -of -hospital cardiac arrest, C) Proposed solution: MFR proposes to equip its ALS units with a ResQPOD or equivalent Impedance Threshold Devices (ITD) and train all Paramedic(s)IEMT(s) in its use, This new technology combined with CPR or Active Compression Decompression (ACD CPR) has shown markedly higher blood flow to the heart and brain compared with either method alone. By greatly increasing circulation during CPR, the ITD helps to improve the deliver of vital nutrients to the patient's organs, thus increasing the efficacy of the intravenous vasopressor therapy. The early application of this device complies with the new changes to the CPR guidelines from the America Heart Association (AHA) which emphasizes CPR prior to providing electrical shock, drug and/or intubation therapy of a cardiac arrest patient. As a result of the increased circulatory pressure, the ResQPOD or equivalent device will help to better visualize and palpate veins, thus enhancing the initiation of an IV and improving the circulation of fluids and drugs. D) Consequences if not funded: The lack of this enhanced technology could have significant negative consequences to the residents and visitors of the City. MFR will continue to utilize its current practice of delivering less effective CPR, which may result in a decreased circulatory pressure and decrease the viability of a SCA patient. E) The geographic area to be addressed: This grant will serve the entire 34.5 square miles of the City of Miami. The City hosts 365,000 residents, and welcomes over 1.2 million people daily. F) The proposed time frames: Months 9 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 devices and set up training schedule. Month 6 to 12: equip devices on rescue units; implement training, document personnel trained. G) Data Sources: 1) Kaye,W. et al, J Am Coll, Cardiol 39(5), Suppl A. 2) Cobb, L. et al, J Am Med Assoc 281(13): 1182 —1188 3) Wigginton, J; The Inspiratory Impedance Threshold Device for Treatment of Patients in Cardiac Arrest; Business Briefing: Long Term healthcare 2005 and the 2000 U.S. Census data for the City of Miami, 2005 City of Miami Management Information Systems Department, 2005 City of Miami Department of Fire -Rescue Incident Report System, 2002 City of Miami Department of Fire -Rescue 5 Year Strategic Plan. H) Statement attesting no duplication: The City of Miami MFR project to purchase and install ResQPOD or equivalent 1TDs into rescue units does not duplicate any previous efforts or activities on another grant under this grant program.