Beyond EMS

first_imgË™In our first month, we found three people who needed acute interventions right away,Ó he says. Ë™Our physician says that if we hadn_t seen them that day, they would have been [later] hospitalized for one to two weeks, likely in intensive care.Ó He says these health-care workers don_t need to be paramedics. Ë™In fact, they wouldn_t even need to be [from] EMS; but I_d like to use the volunteer EMTs we have, if we can expand their training and get some reimbursement,Ó he adds. Ë™This model has the potential to break down the old EMS paradigm, which could lead to a new reimbursement paradigm.Ó”ž Nova Scotia_s program began as a pilot in 1999 and has proven so successful that it has become a fixture on the islands, inspiring the creation of similar programs in remote areas of Canada. During this phase, which lasted 18 months, Cain says, Ë™The paramedics did a lot of preventative things, and watched for signs and symptoms of something pending.Ó Wingrove aims to create a community paramedicine bachelor_s degree by adding the Nova Scotia models to the Minnesota Community Health Worker college certificate program. Ë™We want these workers to have a broad background in EMS, public health and mental health. Then we can start spreading this degree program across the country. Our goal is to have everyone doing the same thing so that we can create a Âresearch bed_ on the effectiveness of community paramedics,Ó he says. Ë™A county in Nebraska has a recently retired deputy sheriff with a PhD in mental health. He has been the first responder to every mental-health call in that county, so he knows just what EMS people need to know to handle a mental-health event.Ó Wingrove is trying to find $25,000 in federal money for the deputy sheriff to develop this segment of the University of Nebraska curriculum. For the past eight years, paramedics on Long and Brier Islands have provided primary health-care and prevention services to some 1,200 residents (plus summertime visitors), both in a clinic and during home visits. (See Ë™A note on Canada_s ÂParamedics,_Ó above, for an explanation on the country_s provider levels.) The community paramedicine program has also captured the attention and imagination of rural health leaders in the U.S., some of whom are developing a pilot program and a community paramedicine curriculum that can be used to train U.S. EMS providers to provide primary care and prevention services. One patient Ë™who wasn_t comfortable crossing the iceÓ to visit a doctor during the winter had an acute episode of hypertension, Rawson says. Paramedics doing a home check recognized that the patient_s blood pressure was dangerously high and contacted the physician; the doctor changed medications and the paramedics continued to provide daily monitoring. Ë™That patient is now doing well,Ó he reports. Michael McKeage, EHS vice president of clinical operations, noted that, Ë™Not all paramedics will be able to do this; community health takes different skills that they_ll need to learn. And the approach to the patient in the non-emergency situation is unique, so paramedics need to be sensitive to that environment.Ó Misner noted that the community paramedics also work closely with medical first responders from the islands_ three fire departments, participating in monthly first responder training programs that provide lectures followed by skills stations on topics chosen by the first responders. Anyone involved with EMS in the U.S. for at least a decade no doubt remembers the push in the mid ’90s to create Ë™expanded-scope EMS.Ó Although that effort sputtered and appeared to have died, the concept of using EMS personnel as Ë™community paramedicsÓ to provide primary care services when not responding to emergency calls lives on in Canada — and is about to make a comeback in the U.S.”ž When asked what the difference was between these community paramedic programs and the ill-fated, expanded-scope programs (e.g., in Red River, N.M.) a decade ago, Wingrove says, Ë™I consider this more expanded role than expanded scope. Expanded scope leaves you with the impression that EMS is expanding paramedics into the next level of health care, say into the nursing or physician level, but this is simply expanding the paramedic_s role into public health.Ó Gary Wingrove, director of government affairs for the Mayo Clinic_s ambulance service in Minnesota, and Dennis Berens, director of the Nebraska Office of Rural Health, have joined forces to develop a Ë™community healthcare specialistÓ curriculum and conduct a pilot program to show how EMS personnel can fill health-care gaps in rural and frontier areas of the country. To accomplish those goals, they recently developed the Community Healthcare and Emergency Cooperative, a consortium of rural health, EMS and academic organizations in Minnesota and Nebraska. They also secured federal grant funding through their states to get this program under way. Ë™Most of our population is elderly, and the [home-care] nurse was overwhelmed by the acuity and amount of need out here,Ó Rawson says. Ë™Many people were falling through the cracks. So we asked what we could do to help her, and she identified the patients who don_t need a lot of care but need to be seen. Nova Scotia_s EHS also recently gave permission for rural health leaders in the U.S. to use and modify the Canadian curriculum. Cain says Dalhousie University in Halifax, Nova Scotia, has been studying the Long and Brier Islands program and is preparing to submit a paper for publication. An unpublished report on that study found that the Long and Brier project significantly reduced hospitalizations, visits to physician offices and emergency departments, and residents_ travel times and costs. Four other Nova Scotia jurisdictions are interested in adopting the program. Residents of the islands — who are two hours, 20 minutes, and two ferry rides (in good weather) from the nearest hospital in Digby — had asked provincial health officials to station a physician on the islands, which was not feasible. Instead, the province and island residents launched a multiphase pilot project using paramedics (who are stationed on the islands 24/7) to provide many primary care services. According to Misner, community paramedics have also developed collaborative relationships with local home-health services, including Victorian Order of Nurses, a non-profit organization that provides community-based health services for 10 provinces and three territories in Canada. The third phase brought a nurse practitioner (NP) to the islands through a collaborative practice agreement with a physician in Digby. Adding the NP allowed the paramedics (after further training) to perform wound care, blood draws and other types of primary care under the supervision of the NP in both the clinic and the field. They learned to assess patients with congestive heart failure and diabetes, assist with medication compliance, administer antibiotics, assess urine specimens, change dressings, and remove sutures and staples. Rawson reports that between November and July 9, BFNEMS paramedics provided 1,000 home visits, lasting almost 495″ž”ž hours, in addition to handling their usual emergency-call volume (approximately 300 calls a year). Community paramedics do an average of six daily home visits, checking on the same three patients every day and sometimes visiting as many as nine. Wingrove is a founder of the International Roundtable on Community Paramedicine (IRCP), which has a mission to Ë™promote the international exchange of information and experience related to the provision of flexible and reliable health-care services to residents of rural and remote areas using novel health-care delivery models.Ó In 2006, IRCP held a three-day meeting in Nova Scotia, and another in Rochester, Minn. It will hold its third-annual meeting in Australia this month and expects participants from Australia, Canada, Scotland, the U.S. and England. In between those meetings, IRCP has been holding monthly conference calls involving 30Ï50 people involved or interested in community paramedicine.center_img Ë™Every day, we have crews going out doing everything from taking vital signs, doing blood-glucose monitoring, insulin injections, medication compliance and providing an overall view of the community and elder citizens_ health status,Ó he says. He notes that all those skills are within the paramedics_ scope of practice — except for insulin injections, for which the paramedics received a half day of training. Ë™We had to bunker down and treat them in their homes,Ó Rawson says. Ë™They did 12-leads and faxed them to the doctor, who changed their medications. We also have limitations on the prehospital administration of nitro, so we were able to modify that [rule] and allow the paramedics to give more. He notes that in the six months before the community paramedic program started, BFNEMS had transported one elderly couple six times, although none of those transports resulted in a hospital admission. Ë™Since this program started, we visit them daily to check up on them and haven_t transported them once,Ó he says. Ë™[The program_s first phase] had paramedics providing [some primary] care to the community, but only within the scope of things they could do in the back of an ambulance,Ó says Marilyn Pike, former senior director of Emergency Health Services (EHS), Nova Scotia_s EMS system. Ë™But we realized this wasn_t going to be enough. We held many meetings with [residents] to explain what paramedics could do. They expected the paramedics to do everything, including surgery and [obstetrical services], and it took a while to explain that paramedics couldn_t do that,Ó she says. According to Rawson, BFNEMS is now planning to greatly expand treatments this fall to include sterile wound care, suturing and immunizations. The agency also plans to teach the paramedics to do phlebotomies because Ë™it makes no sense to travel three hours for a 10-second prick, [and] many people who should have routine blood work don_t get it.Ó In the second phase, the paramedics began providing such services as flu shots, blood pressure and glucose checks, and home assessments (to detect fall hazards and other dangers). This required EHS to develop new policies, procedures and protocols. The biggest challenge to BFNEMS came on a winter day when two patients with ischemic cardiac disease called in distress within five minutes. Bad weather prevented anyone from leaving the island via snowmobile or air ambulance, leaving a single paramedic crew to handle both cardiac emergencies.”žChristian”žIsland has three ambulances –“žfrontline, backup and first-responder units — so the two-person, on-duty BFNEMS paramedic crew split up and paired with first responders to go to both patients at once. Beginning on June 1, paramedic service became available during the daytime, and in November, those paramedics began providing community care on Christian Island similar to that provided on Long and Brier Islands. The program Ë™borrowedÓ Nova Scotia_s community paramedic curriculum, BFNEMS Manager Douglas Rawson says, and modified it to fit Christian Island residents_ needs. For example, BFNEMS added a module on insulin injections, which Nova Scotia community paramedics weren_t doing. In late 2006, Beausoleil First Nation EMS on Lake Huron_s Christian Island started a program modeled on Nova Scotia_s. (Ë™First NationsÓ is the term Canadians use to refer to Ë™Native Americans.Ó) Christian Island, which is a 25-minute ferry ride from mainland Ontario (or 15 minutes over the ice via snowmobile when the lake is frozen), has roughly 650 year-round residents and about 2,000 more in the summer. Prior to June 1, 2006, a clinic staffed by a community nurse and a home-care nurse, along with a physician who visited once a week, provided the only health care, and volunteer first responders transported emergency patients to an ambulance service on the mainland. The Dalhousie study concluded that the Long and Brier project Ë™has clearly demonstrated the effect of this innovative model on increasing accessibility to a full range of comprehensive primary health-care services along with a high level of resident acceptance and satisfaction with the model of care and the positive impact of the model of care or residents_ health and reductions in health-care costs.Ó Ë™We have a great staff, which has taken a lot of initiative,Ó he adds. Ë™Although home visits were foreign to EMS, they say they like going out and visiting people in their homes.Ó Ë™We need a new model that can serve as the front end of public health, primary care, emergency service, mental health and maybe even dental care,Ó Berens says. Ë™We_re looking at using the EMS model and infrastructure, especially in the Great Plains states, where most of our EMTs are volunteers. We_d like to create some jobs for those EMTs while better caring for the health-care needs of our citizens. In Ontario However, community paramedic proponents insist they_re talking about Ë™expanded roles,Ó not Ë™expanded scope,Ó for EMS providers — a subtle but important difference. Ë™Expanded scope implies that you_re expanding the paramedics_ skills and services, and others in medicine start saying, ÂHey, that_s what we do,_Ó says Nova Scotia_s former Provincial EMS Medical Director”žEd Cain, MD, a leader in the movement that created Nova Scotia_s community paramedicine program. Ë™With expanded-role [EMS], we_re emphasizing that different professionals can do these various competencies, but in these settings, there are no other health-care professionals available to do them.Ó In Nova Scotia In an unpublished report on the project, former coordinator of the Long and Brier Island Community Paramedicine Project Debbee Misner, RN, BScn, said, Ë™The project_s focus dramatically altered the traditional work of the paramedics. Accustomed to quickly responding to emergency calls within a specified period of time, paramedics were now being called upon to, among other things, share a cup of tea with island residents as part of a falls prevention assessment where [they] assessed both residents and their environment for fall hazards.Ó Cain says, Ë™They also created an Âadopt-a-patient_ program. They visit a shut-in on a regular basis and may be the only contact that person has.Ó An abandoned clinic in Freeport where a physician had formerly practiced was renovated to serve as headquarters for the Long and Brier Islands project. The paramedics began holding clinics there, as well as visiting patients in their homes between emergency calls. It would take half a day for a visiting nurse or home-care person from the mainland to visit a patient on the islands, Cain says Ë™so paramedics do home visits.Ó In the”žU.S. This model certainly seems promising for filling the widening health-care gaps in remote parts of the U.S. However, finding the revenues to fund such programs could prove daunting until far-sighted policy makers agree to pay for paramedic treatment separate from transport.Mannie Garza is news director of JEMS and editor of the management newsletter EMS Insider. She has a BA in journalism and has been writing about EMS for nearly 20 years.last_img read more

The Disco Biscuits Close Down PlayStation Theater With Career-Spanning Setlist On NYE [Photos/Full Video]

first_imgLoad remaining images The Disco Biscuits capped off their New Year’s run in spectacular fashion at the PlayStation Theater. All four nights contained stand-out moments, but New Year’s Eve was incredibly special. Billed as their final shows at the theater, the venue became their home in New York City before it officially closed on January 1st.The event was subject to a fair amount of hype and they did not let their fans down. There were no themes or gimmicks. The show was just a well-balanced culmination of their entire career, as the setlist featured songs from every stage of the band’s history, spanning across two and a half decades.It’s pretty obvious that the band and fan base are reinvigorated. The outpouring of creativity in their songwriting and the fans’ reception of their new music is a reflection of that.They opened the night with a standalone version of one of their all-time classics, “Jigsaw Earth”. Right off the bat, their stage presence was through the roof. Each member of the band was feeling every single note.Once they dropped into the first jam, it was off to the races. Keyboardist Aron Magner took them deep into the digital matrix with layers of synth while bassist Marc “Brownie” Brownstein chugged along right behind him. It’s important to note that Jon “Barber” Gutwillig and his guitar tech had his tone dialed in on his Gibson hollow body and his Fender Stratocaster the entire run. He sounded fantastic all night, and it was clear right from the beginning of the show.The drum solo in “Jigsaw” was incredible. Allen Aucoin was playing a new kit and it sounded thunderous. His usage of his entire kit was impressive, from his phrasing on his toms to his cymbals and e-drums. It was nice seeing him get the shine he deserves. Since replacing original drummer Sam Altman after his departure in 2005, he’s contributed a level of tenacious stamina that’s unmatched.Next came one of Barber’s new songs, a ballad titled “Stars in the Sky”. It’s a beautiful song with an emotional arrangement and soulful lyrics. Seeing Gutwillig writing such emboldened songs again inspired the fan base, who are beyond grateful for all of his brilliant contributions over the years. Not only did his Stratocaster sound impeccable, but his voice was also powerful and moved the audience.The jam was airy. It was the musical equivalence of floating through cumulous clouds on a magic carpet ride. All four of them were focused and relaxed. Patient yet continuously pushing forward as they broke out in thumping rock n’ roll. It was the best rendition of the song since they first played it at the Roxian Theater during night one of their winter tour in Pittsburg on November 14th.Magner led the way as they jammed into “Basis for a Day”, switching from one keyboard to the next and stacking sounds like the synth wizard that he is. His ability to fill space is second to none, watching his mind work in real-time never gets old. Once Barber found his place, Allen dropped the backbeat before he built into a massive drop. The venue erupted. They peaked with passion and conviction and slipped back into the end of the song with a fiery fierceness, which made the first set of the night only three songs.That was a good sign of what was to come. Allen cranked the tempo up and Barber followed with a few nasty riffs before they marched into another new fan-favorite, “Anthem”. The song absolutely ripped and gave both Barber and Magner room to express themselves. They both went crazy without stepping on each other’s toes; a difficult task for many. They used it as their countdown song into 2020 and it was perfect. The balloons dropped while they shredded the ending into pieces. It was a glorious moment to witness.One of the highlights of the entire run came next. A colossal “Orch Theme” had the power of the ball drop in Times Square. They dug down into the nuts and bolts of the composition and it got rowdy as they made great use of type 1 improvisation. It’s something that Barber recently mentioned the Grateful Dead doing on his podcast, Touchdowns All Day. They made the Playstation Theater feel like a European arena rave, and it is engraved in the minds of everyone that witnessed it.The jam was extraordinarily hot, like the blue flame of a welder’s blowtorch. Anyone who listens back to the soundboard can confirm that the statement is an objective fact.The transition into “Spacebirdmatingcall” was another prime example of flawless execution. When the Disco Biscuits are locked in it’s hard for them to miss. They brought the crowd from an incredibly blissed-out jam directly into another new song, “4th of July”, which was one of the most skillful feats of the night. Just like “Stars in the Sky”, this was arguably the best rendition of the song since it was debuted earlier this tour. It was majestic and will only continue to grow.With a strong bassline and backbeat, it could be described as space-hop. Barber looked like a teenager that just fell in love with his guitar and it definitely charged the rest of the band up. Allen supplied the backbone and the front three were interlocked as they jammed out of it back into “Spacebird”.  Seeing them nail a sandwich that was made up of a new song and another one of their classics was a thing of beauty.It was now time for the final set of the weekend after a long four nights. “Mindless Dribble” was an awesome choice as it’s pure unadulterated rock n’ roll. Barber’s Stratocaster was singing as Brownie kicked a filthy bassline behind it. The groove was heavy and the jam was snappy. They were looking at each other, nodding their heads in agreement, like “yeah, we’re crushing it”. It went deep into freeform exploration, taking the jazz roots of improvisation and adding their new-age spin to it. It was impossible for fans to stand still.They proceeded to jam into “Helicopters” because it wouldn’t be a new year without the crowd singing, “Happy New Year! Look out below!” They dropped into the jam and Johnny R. Goode cut out the lights perfectly. He provided stellar light shows every night and did so without lasers. Barber used a pedal that made his guitar sound like a synthesizer and it was straight cash. Their capacity to make electronic music with instruments is stunning.Related: Andrew Cass Talks Disco Biscuits, String Cheese Incident, More [Interview]The build into “We Like to Party” was 2.0 Biscuits at their finest. Again, it sounded like a word-class DJ was on stage. Brownie put down his bass and yelled, “New York City, can you hear me!?”, while the crowd went crazy. The contrast between songs like “Mindless Dribble” and “We Like to Party” is what keeps fans coming back for more. With the synth-bass pumping through the speakers and Magner laying chords down, Barber danced all over the fretboard. It was an ’80s dance party of epic proportions.Taking a page out of the Grateful Dead’s book, they flowed into total ambient space before dropping into another one of their “Tractorbeam” segments where they cover an electronic song. They knocked this one out of the park. It was a killer placement and fits perfectly with their trance-fusion sound. They jammed back into the ending of “Helicopters” and ended the final set of the weekend with a bang.All in all, the entire show was a major success for the band and their entire team.But, it wouldn’t be complete without a proper encore, and man oh man, did they provide one. “Frog Legs” > “Run Like Hell” is a classic Biscuits pairing. Everybody grinned from ear to ear. They went deep into the murky waters of Bisco and satisfied the taste of every diehard Biscuits fan that was in the building and watching the stream. You could feel Brownie’s bass line pulsate in your heart.It was an illustrious display of musicianship by one of the best live bands in the world, and the perfect way to cap off one of the most important years in Biscuits history.Well, there’s not much more to say. The Disco Biscuits closed out the Playstation Theater with triumphant performances that spanned across four nights. Fans will unquestionably look back on the underground theater, often referred to as “The Dungeon”, as one of the most important venues in the band’s history.The back half of 2019 brought about their first official tour in ten years and a plethora of new songs. And by the looks of it, they don’t plan on stopping anytime soon. So buckle up and enjoy the ride because set-break is officially over.Enjoy a full-show pro-shot video of The Disco Biscuit’s New Year’s Eve performance at PlayStation Theater below.The Disco Biscuits – PlayStation Theater – New York, NY – 12/31/19[Video: The Disco Biscuits]Below, check out a galleries of photos of The Disco Biscuits performing at PlayStation Theater for the last time courtesy of photographers Andrew Blackstein and Dave Vann.Setlist: The Disco Biscuits | PlayStation Theater | New York, NY | 12/31/19Set One: Jigsaw Earth, Stars in the Sky[1] > Basis For A DaySet Two: Run Like Hell > Anthem[2], Orch Theme > Spacebirdmatingcall > 4th of July > SpacebirdmatingcallSet Three: Mindless Dribble > Helicopters[3] > We Like To Party > Tractorbeam Jam[4] > Helicopters[3]Encore: Frog Legs > Run Like HellNotes:[1] Unfinished[2] w/NYE countdown[3] with NYE lyrics[4] Delorean Dynamite/Strandbar (Todd Terje)The Disco Biscuits | PlayStation Theater | New York, NY | 12/31/19 | Photos: Andrew Blackstein The Disco Biscuits | PlayStation Theater | New York, NY | 12/31/19 | Photos: Dave Vanncenter_img Load remaining imageslast_img read more

Veteran property fund managers trade on their reputations to launch start-ups

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Local support for International Campaign, 16 Days of Action Against Gender Based Violence!

first_imgAddThis Sharing ButtonsShare to FacebookFacebookFacebookShare to TwitterTwitterTwitterShare to LinkedInLinkedInLinkedInThe 16 Days of Action against Gender Based Violence Campaign aims to raise awareness of domestic abuse and other forms of violence which are mainly experienced by women and girls. The campaign runs from 25th November, which is the International Day for the Elimination of Violence Against Women , to 10th December ,which is Human Rights Day.The Domestic Abuse and Violence Against Women Partnership (DAVAWP) is supporting the 16 Days Campaign with the following events:16/11/15 – 07/12/15: On line public vote on DAVAWP Song Writing Competition for Young People www.dumgal.gov.uk/davawp/• 25/11/15: Robert Burns Cinema, 5.30pm: Free community screening of “Do I Sound Gay?” Documentary which addresses issues like gender stereotyping and homophobia.• 02/12/15: Launch of a commitment for Dumfries and Galloway’s work to become a White Ribbon Region• 10/12/15 – Oasis Youth , 7.30pm : DAVAWP Song Writing Competition Awards Ceremony and Anti-Violence Concert• 10/12/15: Launch of DAVAWP and Queen of the South FC joint campaign to promote the White Ribbon Campaign.• Throughout the 16 Days Campaign the DAVAWP will also send updates via social media.DAVAWP Chair, Prof. Hazel Borland said: “Violence against women harms women here in Dumfries and Galloway and across the whole world. The 16 Days Campaign is an opportunity to stand up against these forms of violence by highlighting them and taking a stance against them. I would like to invite the local Residents to support our events and also take part in our song writing competition public vote. ““We are delighted to launch our work to become a White Ribbon Area. The White Ribbon Campaign aims to encourage men to work against violence against women, with the understanding that most men do not commit violence against women. The Campaign gives men the opportunity to sign the pledge to “never commit, condone or remain silent about violence against women.”last_img read more