Carle Regional EMS System

Providing Education and Representation since 1988.

History

Since 1988, The Carle Regional EMS System has provided education and representation for the EMS agencies in Illinois Department of Public Health Region 6. To date, more than 50 fire departments, rescue units, ambulance services and businesses have joined The Carle Regional EMS System to facilitate up-to-date emergency transportation and pre-hospital care for the citizens in their care.

Our Mission

Providing the best patient care through education, quality assurance and a commitment to our system members.

Education

Education is the foundation of any emergency service. It is essential, and is mandated by State regulation, that individuals working for pre-hospital providers maintain a minimum level of annual continuing education units. The Carle Regional EMS System works with individual agencies to provide State approved EMT-B, EMT-I, EMT-P, EMD and flight team courses on an as-needed basis. The System provides continuing medical education on a schedule that best meets the individual agency’s needs. The Carle Regional EMS System also hosts an annual Emergency Response Symposium.

• EMT - Basic In the State of Illinois the EMT-Basic is the minimum level of certification for ambulance personnel. Certification as an EMT-Basic requires successful completion of the U.S. DOT’s EMT-Basic National Standard Training Program, and approval by a state emergency medical services program or other authorized agency. The curriculum for the EMT-B deals with the assessment and care of the ill or injured patient. Carle Regional EMS teaches two EMT-Basic classes per year, one in the spring and another in the fall. Other courses may be added, as schedules will allow.
• EMT - Intermediate This EMT has passed special additional training programs in order to provide some level of advanced life support, such as the initiation of IV (intravenous) lines, advanced airway techniques, and administration of some medications beyond those the EMT-Basic is permitted to administer. This course is taught under the new National Standard EMT-Intermediate Curriculum. Carle Regional EMS may hold one of these courses per year.
• EMT - Paramedic The EMT-Paramedic has successfully completed a training program that meets or exceeds the U.S. DOT’s National Standard Paramedic Curriculum. Paramedics can generally perform relatively invasive field care, including insertion of endotracheal tubes, the initiation of IV lines, administration of a variety of medications, interpretation of electrocardiograms and cardiac defibrillation. Carle is currently working with Parkland Community College to make this program a degree program.
• ECRN The Emergency Communications Registered Nurse monitors EMS telecommunications from pre-hospital providers and acts as a designee of the EMS System Medical Director to collaborate with EMT’s and Paramedics in the field. This ECRN course provides the experienced Emergency Department nurse with the necessary information to perform this extended role competently and confidently. Prerequisites: RN license with two years of Emergency Department experience (or equivalent), ACLS, and Advanced BTLS.

EMS Class Schedule

Agencies that are PRN (scheduled as needed):

• Airlife
• Bismarck Ambulance
• Bondville Fire
• Chrisman Fire
• Elliott Fire
• Hume Fire
• Ivesdale Fire (Trains in Sadorus)
• Metcad
• Metcalf Fire
• Monticello Fire
• Newman Fire
• Pesotum Fire
• Tuscola Fire
• Villa Grove Fire

Physicians Corner

Why is it when we give nitroglycerin to some chest pain patients their blood pressure drops significantly, many times enough to scare the living heck out of us; whereas, most patients with chest pain tolerate the nitroglycerin with no problem at all?

It all depends on where the infarct (cardiac muscle death) is taking place.

If the infarct is taking place anywhere but the right ventricle (most cases), nitroglycerin should have little effect on the patient’s cardiac output and, therefore, blood pressure.  However, when the infarct is large enough and affecting the right ventricle, then we may run into problems with the use of nitroglycerin.  When the right ventricle muscle does not squeeze as well (e.g. due to an infarct), then preload (the amount of blood returning to the right ventricle from the rest of the body) becomes extremely important.  The out put of the right ventricle depends on a good preload, the pressure of which essentially “pushes” the blood along to the lung and subsequent left ventricle.  If you decrease the preload with nitroglycerin (since it is a potent venodilator), right ventricular output can significantly diminish resulting in significant decreased blood pressures as well.  Thankfully, fluid bolus’ help well in this circumstance; so, if this happens to you, a good fluid bolus will usually bring that pressure back up again since it is increasing the preload back to where it was before.

So, how do we know if the patient is suffering a right ventricular infarct?  It is impossible to know for sure with a monitor, but there are clues to tell you whether it is possible or not.  Usually, the monitor is on lead II.  A right ventricular infarct will always have ST elevation in lead II (the segment between the QRS and T-wave).  If this is the case, simply give your nitroglycerin with caution, always with an IV in place, and be ready to give a fluid bolus if necessary.  If you have a 12 lead EKG at your disposal, then you can predict a right ventricular infarct when the ST elevation in lead III is greater than lead II.  If that is the case, then you may very well run into a significant BP drop when nitroglycerin is given.  Be prepared!

--Dr. Thomas Scaggs

For More Information

For more information about the Carle Regional EMS System or its course offerings, please contact one of the EMS staff members:

• Dan Bowton, Coordinator/Manager (Dan.Bowton@carle.com)
• John T. Sollars, Instructor (John.Sollars@carle.com)
• Ashley Runck, Office Coordinator (Ashley.Runck@carle.com)