In Texas, there鈥檚 rarely a dull moment for emergency responders. Consider a few events from just this year.
January 2024: An explosion at the historic Sandman Signature Downtown Hotel in Fort Worth . Windows and walls blew out of the building鈥檚 first and second floors; employees said they鈥檇 as construction occurred throughout the day. One person was hurt critically, four seriously. Responders included the Fort Worth Fire Department and Medstar Mobile Healthcare; patients were distributed across multiple local hospitals.
March 2024: In Bastrop County near Austin, a concrete truck driven by a crossed the center line on State Highway 21 and struck a school bus full of prekindergarten children returning from a field trip. The bus flipped, skidded on its side, then rolled. The accident killed two people 鈥� 5-year-old student Ulises Montoya and the driver of another car traveling behind the bus. Responders came from three counties. Austin-Travis County EMS at the scene. Four patients were flown out, ATCEMS transported six more, and others went with other agencies.
July 2024: The earliest-forming Category 5 hurricane on record, Hurricane Beryl walloped Grenada, weakened a bit before striking Mexico, then landed in the U.S. as a Category 1 near Matagorda, south of Houston. Flooding and wind damage were widespread, and , with associated tornadoes causing more fatalities. More than eight inches of rain fell in Houston, and more than 2.7 million people lost power. The storm impacted 29 regional hospitals, which were besieged by patients and those needing power for medical devices but couldn鈥檛 discharge postoperative patients to homes without power. This led to EMS backups and, by the next day, left just 4% of city ambulances available for calls. The Texas Emergency Medical Task Force coordinated ambulance strike teams to help backfill and support care.
Each of these were messy mass casualty incidents that might have overwhelmed unprepared systems. In Texas, statewide adoption of the system and the well-practiced use of wristbands to identify and track patients gave firefighters, EMS and hospital personnel a common platform that expedited, simplified and improved their care of the injured.
鈥淭he way we advocate these calls happen is for EMS to create their patient channels and send the notification to the hospital ED,鈥� said Corey Ricketson, Pulsara鈥檚 senior vice president for strategic accounts. 鈥淭hat鈥檚 the necessary building block for success.鈥�
Like any tool, though, to be optimally fast, efficient and comfortable with it, you have to use it often 鈥� not just a few times a year at MCIs. Like the most useful tools, however, Pulsara is multipurpose 鈥� and just as suited for regular daily calls as it is for the occasional big ones.
END THE 鈥楾ELEPHONE鈥� CALLS
Texas has embraced the platform on a statewide level, offering it to every provider with the intention that they鈥檒l use it with their normal volume of patients.
鈥淯蝉颈苍驳 as the method to deliver patient reports from EMS to hospitals daily ensures that your organization is using the same tool in an MCI as you are every day,鈥� the state Department of State Health Services .
That鈥檚 Pulsara鈥檚 proposition too: While the company started out by promoting its product around high-stakes time-sensitive emergencies like STEMI and stroke, it demonstrates the same advantages with all-purpose use, and the greater familiarity of daily practice benefits providers and patients alike. A breaking mass casualty event, as any EMS chief knows, is no time to be learning new tools or fumbling with the unfamiliar.
鈥淲ith frequency, you build the muscle memory for success,鈥� said Ricketson. 鈥淲e advocate using Pulsara for every single patient, whether it鈥檚 the toe pain that鈥檚 going to triage or the chest pain that鈥檚 going to the cath lab. Lower-acuity patients are an opportunity to get that practice in, because you鈥檙e under much less stress. Then if you can make it second nature, then you just don鈥檛 have to think about it whenever something big happens.鈥�
The time required to clear scenes and get patients to definitive care suggests that鈥檚 a viable approach. After the Bastrop County bus crash, the scene鈥檚 50-plus patients were processed in . Following the Fort Worth hotel explosion, the scene was , even with victims who needed extrication. Obviously, time to definitive care matters for trauma victims, and Pulsara has also chronicled speed benefits with the platform鈥檚 use around , and more.
Even without repetition, using the platform is quick and simple: Responders give each patient a wristband with a unique barcode and scan it with the app on their personal communication device to start a patient channel. They then use that channel to chronicle all findings and interventions, along with the patient鈥檚 identifying information. Any other responders on the platform, including those at hospital emergency departments (in Texas they also use Pulsara), can access that channel and add to it as they deliver additional care. The same record follows the patient throughout and across organizations, reducing duplication and ensuring accuracy.
This can replace radio reports and phone calls, streamlining the process on both the EMS and ED ends and beyond to specialists, other facilities and anyone else involved in care. Providers can add photos and supporting data like EKGs, and when face-to-face communication is needed, the platform supports video calls.
鈥淕etting on the radio and calling in a report is easy; nobody denies that,鈥� said Ricketson. 鈥淏ut what often happens is that somebody takes that report and then has to try to remember everything you said, or they try to write it down as you鈥檙e saying it and then pass it along. Then as the information changes hands, it degrades, and the story changes. It鈥檚 2024, and we鈥檙e still playing that 鈥榯elephone鈥� game of passing information from person to person.鈥�
FASTER ORDERS MEAN FASTER SERVICE
That streamlined approach brings the same benefits to single patients as it does to multiple. In both cases it helps definitive care occur faster, as ED staff have reliable, actionable information to begin preparations immediately. Odds are, with the old phone or radio report and vague details scribbled down on the nearest scrap, meaningful actions might not really be taken before patients are on premises.
鈥淚magine you walk into McDonald鈥檚 at noon, and the line鈥檚 out the door,鈥� said Ricketson. 鈥淭hen you see that kiosk sitting there, and you鈥檙e really hungry. Are you going to stand in line, or are you just going to walk up to the kiosk and order? Because when you do that, it puts you into the system immediately, and you鈥檙e going to eat sooner.
鈥淚t鈥檚 similar if I call in a radio report for a suspected STEMI and tell the nurse I鈥檒l be there in 10 minutes, they may just wait for me to get there. If I notify them with and attach an EKG, that nurse can press a button that says 鈥榓ctivate,鈥� and now a cardiologist and cath lab personnel and registration personnel are all added in immediately. You鈥檙e in the system, they鈥檙e taking action, and now why even stop at the ED?鈥�
The daily repetition of this process naturally builds speed and comfort when there鈥檚 more than one patient in front of you 鈥� think about how fast baggage professionals at airports can intake, tag and forward along your checked bags among hundreds of others. Time savings come in applying the wristbands and completing patient reports earlier with features like voice-to-text and simple ID scanning to populate personal details.
鈥淚 can do the scanning, photos and voice-to-text with a Pulsara report in about 45 seconds,鈥� said Ricketson. 鈥淏ut I don鈥檛 have to wait for someone to answer the radio or phone, and I don鈥檛 have to repeat myself if there鈥檚 a bad connection. I take the extra 45 seconds before I ever leave, and we have the order in, and now the ED also has an extra few minutes鈥� heads-up.鈥�
That鈥檚 a benefit that scales. After the Sandman explosion, Medstar created an incident in Pulsara, shared it with its local regional advisory council (bodies that oversee trauma care in Texas), and the RAC shared it on to regional hospitals to alert them of the MCI and potential for patients, resulting in a more agile response by their EDs. And in Bastrop County, with even more patients, everyone having a common operating picture of their identities, details and locations expedited reunifications with terrified families.
START SMALL AND BUILD
Other states are moving forward with as well, and now they have a big-state model for success: Start with the basics 鈥� EMS to ED communication 鈥� then grow capabilities with practice.
鈥淚t鈥檚 a lot like running a marathon,鈥� said Ricketson. 鈥淵ou don鈥檛 just hit the pavement and start trying to run 26 miles. You start with something like a 5K and build up. A lot of people never get off the starting blocks when it comes to a project like this because they think it鈥檚 too big to overcome. But the people who have been successful with this are those that don鈥檛 put up those roadblocks. They鈥檙e the ones who say, 鈥榃e鈥檙e going to implement this, and we鈥檒l start with our EMS-to-ED. Then when we get good at that, we鈥檒l start doing some MCI training,鈥� or whatever the case is. And eventually it鈥檚 been a year, and they look back and realize, 鈥榃ow, we鈥檝e come an incredibly long way, and we鈥檙e really good at this now!鈥欌€�
When the next big one happens, their patients will appreciate that.
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