Dispatch 061115

JUNE 11, 2015

PINEVILLE SAFETY DAY, AHA GO RED LUNCHEON AND MUCH MORE!

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Welcome to Medic 103...

many more we will need before we are ready to implement a change. The grid below shows what size tests This week, we’ll tackle a somewhat sensitive subject. Per should be performed based on where an organization a previous week’s discussion, change can be difficult. If is; relative to the three concepts that make implementanot managed appropriately, change may lead an orga- tion run smoothly. It is important to note that implemennization to create and implement policies/practices that tation is only listed in one place on that chart. do not net improvement. Here at Medic, we want to improve. Learn. Grow. And to do that, we do small scale Alright, now that we have some concept of the size and testing before implementing a change in our system. scope of tests that we would want to perform and we understand that we do not want to rush into implemenHow does Medic do small scale testing? As we discussed tation we will discuss how to plan your first test. a few weeks ago, we conduct small tests via PDSA cycles. One important part of PDSA testing cycle we need But we’ll do that in 2 weeks... to remember is that they are best conducted as a set of tests. It’s rare that a group will run one PDSA test and As always, if you have any questions, please email Tiffany conclude, “Yep we got it. Let’s implement this practice”. at tiffanya@medic911.com.

One of the biggest threats to successfully implementing change in an organization is a rush to implement. In order to successfully implement change three things need to exist: 1. High organizational commitment 2. High confidence that the change will lead to improvement 3. Small cost of failure.

These three factors work together to help us to decide the size of PDSA cycle we should run, and likely how

Organizational Commitment Low confidence that current change idea will lead to improvement High confidence that current change idea will lead to improvement 2

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Resistant

Indifferent

Cost of failure large Very small scale test Very small scale test Cost of failure small Very small scale test Very small scale test Cost of failure large Very small scale test Very small scale test Cost of failure small Small scale test Small scale test

Ready Very small scale test Very small scale test Very small scale test Small scale test

As previously noted, the latest Performance Pay Tracking Period began on March1st. We are striving to meet the Patient Satisfaction goal of a ≥ 68% rating (experience as “Excellent”).

In order to create a comfortable margin of performance, while continuing to improve the patient experience, we would like to share some feedback from recent patient focus groups.

The two areas that patients value the most are: 1. Communication from the treating crew: “Explain treatment options and procedures” “Provide reassurance and compassionate communication with the patient” 2. Setting clear expectations: “Set transport length expectation” “Set a triage level expectation before arriving at the hospital”

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Please note: This information is being shared with Medic personnel, first responders and law enforcement agencies in Mecklenburg County as a result of a nationwide alert issued by the U.S. Drug Enforcement Agency.

National Forensic Laboratory Information System (NFLIS) has reported an increase in Fentanyl submissions of 3,344 in 2014 up from 942 in 2013. On March 18th, 2015 the DEA issued a nationwide alert in regards to the dangers of Fentanyl exposure.

For more information, please contact Malcolm Leirmoe at malcolml@medic911.com, 704-943-6143.

CHEMISTRY AND PHARMACOKINETICS

Fentanyl is chemically unrelated to Morphine; however, it affects the same opiate receptors within the brain. Fentanyl proves to be 50 to 100 times more potent than Morphine on a weight basis. A 100 microgram dose of Fentanyl is equivalent to a 10 milligram dose of Morphine. Fentanyl also produces muscle rigidity at a greater frequency than other opioids; more specifically when taken in a “rapid push” manner. Fentanyl’s analgesia effects are accompanied with respiratory depression and nausea and vomiting.

Fentanyl also differs from other opiates in that it does not cause drops in blood pressure or cardiac output.

The onset of Fentanyl is immediate. Its effects peak at 3-5 minutes and last in-between 30-60 minutes. The half-life of Fentanyl is 6-8 hours.

Illicit Use:

According to the Drug Abuse Warning Network (DAWN), nonmedical use associated with emergency department visits increased from 15,947 in 2007 to 20,034 in 2011. Studies out of Illinois and Rhode Island both cite large increases in both Fentanyl overdoses and deaths across 2 year spans. The DEA

INTRODUCTION

Fentanyl is a synthetic opioid used in healthcare for pain management and anesthesia. It has been commonly abused in the past due to its analgesic effects. Recently a more potent powdered form of Fentanyl has been found in the possession of illicit users.

History:

Fentanyl was placed into service in a medical capacity in the 1960’s and made it into the illicit market by the 1970’s. It has commonly been abused in the pill and patch form. It has been acquired through theft from pharmacies and nursing facilities, prescription abuse, and via used patches that have been disposed. The routes of use have been oral, mucosal, intravenous, intranasal, inhaled, and even rectally.

Traditionally the illicit IV Fentanyl has been harvested from the patches (new or used). The patches have also been chewed on and placed under the tongue.

Recently, acquisition of Fentanyl has moved into the clandestine laboratory. These labs have started to develop powdered Fentanyl in stronger concentrations.

The Drug Enforcement Administration (DEA) reports that from April 2005 to March 2007 a noted increase in overdoses and deaths occurred. A study out of Illinois noted a drastic increase within the area. The study led to the finding of a clandestine lab out of Toluca, Mexico. During this 2 year time frame, the DEA placed two Fentanyl precursor chemicals under their List 1 chemical designation; making them harder to obtain. The DEA and Center for Disease Control and Prevention (CDC) noted a decrease in Fentanyl deaths after declaring the designation.

In the past two years another spike has been noted in Fentanyl related overdoses and deaths. The

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reports large spikes in nonmedical Fentanyl deaths in New Hampshire, New Jersey, New York, and St. Louis.

Concern is raised in the mixing of Fentanyl with other illicit substances (cocaine, heroin, etc).

The DEA reports numerous seizures of Fentanyl; primarily in the northeast and in California. One seizure consisted of 12 kilograms of Fentanyl. The Fentanyl has been traced to Mexican drug trafficking organizations.

ROUTES OF EXPOSURE

Fentanyl is given medically via Intravenous, Intranasal, Inhalation, Intramuscular, Transmucosal, Orally, and Transdermal routes. Illicit use follows the same routes of delivery. Both the CDC and DEA have issued warnings for potential exposure from Powdered Fentanyl via transdermal absorption. Actual clinical effects would be based on concentration, amount, compound/analogue, and skin integrity  (open wounds, moisture, heat, etc). A study out of Salt Lake City, Utah cited that heat exposure increased the absorption of Fentanyl through the skin.

Therefore, skin exposure after vigorous activity could lead to rapid absorption of the drug.

Protection and Exposure:

When handling powdered Fentanyl, as with any other illicit or unknown substance, personal protective equipment should be used; to include but not limited to eye protection, gloves, face mask, and gown (depending upon risk of skin exposure). Time exposed, proximity, and concentration/amount of the substance are all factors that affect how significant the exposure will be. Avoid handling the substance while perspiring and emitting excessive body heat.

If exposed, seek medical attention immediately. If transdermal exposure, initially brush the powder off the skin, then flush with copious amounts of water and monitor vital signs until definitive treatment can be acquired. If inhalation, injection, ingestion, or transdermal exposure, seek medical attention immediately.

Questions? Please contact: Malcolm Leirmoe Medical Services Dept.

Mecklenburg EMS Agency Office: (704)943-6143 malcolml@medic911.com

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JUN COMPLIANCE We hope you had a great time at this year’s EMS Week!

EMS Week Gift If not, feel free to drop by the PR Office, between 0700 -1700.

The PR Office is located near CMED. Can’t make it during PR Office hours?

Don’t worry... Let Lester or Tiffany know and they’ll be happy to setup a time/delivery for your gift.

Pick up your EMS Week Gift by Jun 26th.

For more info, contact Tiffany at tiffanya@medic911.com, 704943-6178 or Lester at lestero@medic911.com, 704-516-0650.

Wed, Jun 17 Fri, Jun 19 Mon, Jun 22 Wed, Jun 24

0800 - 1200 1200 - 1600 1300 - 1700 0800 - 1200

JUN IN-SERVICE Tue, Jun 16 Wed, Jun 17 Thu, Jun 18 Fri, Jun 19 Mon, Jun 22

Wed, Jun 24

1000 - 1400 1200 - 1600 1000 - 1400 0800 - 1200 1200 - 1600 1800 - 2200 1200 - 1600 1800 - 2200

PLEASE NOTE: If your Annual Performance Review was Dakota Anaya, Jason Barr, Eric Bitler, Scott Blair, Nina in May and you did not attend the May class, you must Bost, Cory Colvin, Dale Cordice, Waldy DeArmas, Mat- contact Amy Broughton to attend a June class. thew Deedrick, Michael Durham, Alan Elam, Robin F arrar, Kelly Flynn, Taylor Gibson, Noah Godbey, Robert INFORMATION UPDATES Graf, Charles Gunter, Eric Hall, Kayla Hough, Donald • Please register for your Corporate Compliance Training session through LMS. Howie, Angela Kaufman, Elizabeth Kennedy, Mark Kern, David Kirchmer, Victoria Layton, Malcolm Leirmoe, Jim • The duration of the Medic Safety & Compliance Training sessions is up to 4 hours.

Lockard, Karim Mahmoud, Zachary Marshburn, Recarla Massey, Milan Merges, Dan Nielson, Robert Parker, Ga- • Attendees will be paid for the total time spent in class. brielle Pegram, Anne Pentland, Justin Rowe, Robin Roy, • Each employee, with an Annual Performance ReBryan Rucker, Brian Shimberg, Christopher Somerset, view within that same month, MUST attend one of Crystal Strong, Jennifer Strout, Angela Tart, Andrew Tinthe available Compliance Training Sessions. son, Shane Walcott, Danielle Walcott, Jennifer White, John White, Scott Wilson, Rebecca Zamagni-Mander • Compliance sessions are held next to the Medic Fitness Center. and Chris Zornow

REQUIRED ATTENDANCE

For more information on Corporate Compliance Class or if you need directions, please contact Amy Broughton at amyb@medic911.com.

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