It’s taken two years and $1.2 million to get Rhode Island’s 911 system ready to provide CPR and other medical instructions to callers. The system should be working in June. Rhode Island is the last state in New England to provide this service.
It’s been nearly two years since Rhode Island lawmakers approved funding to train all 911 call takers to provide CPR instructions over the phone, but new data shows no improvement in people’s chances of receiving CPR in the critical minutes prior to the arrival of first responders.
Only about one in five people who went into cardiac arrest in their homes or someplace other than a hospital or health care setting in Rhode Island last year received CPR before police, fire or emergency medical providers showed up, according to data provided to The Public’s Radio by the state Department of Health. The state’s bystander CPR rate has remained between 19% and 21% since 2018.“The needle hasn’t really moved,” said Jason Rhodes, the health department’s chief of emergency medical services.
Originally published in ProPublica
For people who go into cardiac arrest, getting CPR during the first few minutes can mean the difference between life and death. Every minute of delay in performing CPR on people in cardiac arrest decreases their chances of survival by as much as 10%, according to the American Heart Association.Rhode Island’s bystander CPR rate is less than half the national average, according to the nonprofit Cardiac Arrest Registry to Enhance Survival, which collects data on regions that encompass about 40% of the nation’s population. (Rhode Island does not participate in CARES but models its data collection on it.) Rhode Island’s survival rate for out-of-hospital cardiac arrests also remains well below the national average.
Rhode Island’s 911 system was the subject of a 2019 investigation by The Public’s Radio and ProPublica that raised questions about whether the lack of training for the state’s 911 call takers was costing lives. Among the findings: a 6-month-old baby in Warwick died in 2018 after a 911 call taker gave incorrect CPR instructions to the family.
But Rhode Island’s lack of progress is not for lack of trying. The state had to replace its aging computer-aided dispatch system before the 911 center could install the software that would guide its call takers to deliver the appropriate medical instructions.
“I’m becoming a little bit despondent at this point,” said Dr. Joseph Lauro, an emergency room physician and member of the Rhode Island chapter of the American College of Emergency Physicians, which helped lead the push to improve training. “All those efforts and nothing has happened.”
In June 2019, Rhode Island lawmakers earmarked $220,000 in the state’s budget for the 2020 fiscal year, for training and software that would enable 911 call takers to deliver CPR instructions and other medical assistance by phone.
It was expected to be up and running more than a year ago. But Rhode Island’s EMD training began just last month.
Emergency medical calls in every other New England state are handled by people certified in emergency medical dispatch, or EMD.
“We’re frustrated, too,” about the delays, said J. David Smith, director of the 911 center. But he said the extra time was needed to buy and install a new $1.2 million computer-aided dispatch system so the new software can operate properly. “So that when we finally do this,” he said, “it’s going to be the best it can be.”The training includes following carefully scripted instructions to talk a caller or bystander through performing CPR. The system is used in Washington state’s King County, home to Seattle, a national model for prehospital cardiac care. More than 75% of people in King County who experienced out-of-hospital cardiac arrests in 2020 received bystander CPR.
The new software program also will enable the Rhode Island State Police, which oversees the 911 center, to collect data and track its performance in handling 911 calls. Priority Dispatch, a company based in Salt Lake City, Utah, is providing the software and training under a state contract signed in August 2019 for about $150,000, Smith said.
The center is currently completing training for all 911 call takers and supervisors on the new computer-aided dispatch system, Smith said, and vetting the EMD protocols with state health officials. He said the new system is expected to launch in June. Legislation has been introduced in the General Assembly to mandate that all 911 call takers be certified in EMD, which includes being trained to provide CPR instructions over the phone. A bill (H 5629) introduced by Rep. Mia Ackerman, D-Cumberland, the House deputy majority whip, would require that at least one 911 call taker trained in what’s known as telephone CPR be on duty at all times. A companion Senate bill (S 0385) has been introduced by Sen. Maryellen Goodwin, D-Providence.At a March 30 committee hearing on the House bill, Lauro, the emergency medicine physician, said that as medical director for several EMS departments he reviews cases of cardiac arrest patients treated by emergency medical personnel. “One of the most common things that I find in out-of-hospital cardiac arrest is lack of bystander CPR,” he said.
Dr. Catherine Cummings, president of the Rhode Island Medical Society, said most Rhode Islanders assume that 911 callers routinely receive CPR instructions over the phone, and “are surprised to find out that it doesn’t” happen.
Ackerman said the legislation would ensure that 911 call takers continue to receive the training required for them to maintain their EMD certifications. “The law is the only way to assure that it will happen,” she said. “It’s that simple.”
A similar bill she introduced in March 2019 did not make it out of committee.
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After 27 years as an emergency RN and over a year as a frontline nurse in the Covid-19 pandemic, Rhode Islander Timothy Aurelio has seen a lot. But, during the height of last year’s surge, the Nurse of the Week was taken aback when the CDC told hospitals that workers should tote their (suddenly-classed-as-reusable) N95 masks in a brown paper bag. One day, as he arrived at the hospital, Aurelio says he saw “This security guard had his N95 in a brown paper bag, and it was completely crushed. His metal nose bridge was completely flat.”
Rhode Island emergency nurse, Timothy Aurelio, RN, BSN-DC.
There was some logic to the instruction, as a brown paper bag permits the free flow of air around the N95 and should help prevent bacteria from growing inside the mask. However, Aurelio quickly discovered the downside: “With a mask in this integrity, it’s not going to protect you… I saw their masks being stored in their duffel bags, and in their pocketbooks, and hanging from the hook next to the printer Anything from the air is dropping down into their mask.” As he told a local reporter, “Last July… we didn’t have a safe place to store our N95 masks and our masks were getting crushed and soiled, people were leaving them on the desk.” In fact, he added, “This is how I first developed the idea: a security guard had his N95 in a brown paper bag and it was intertwined in his belt. And I said, ‘What is that?'”
This could literally be a matter of life or death, so the RN began to think of a way to create PPE for his PPE. Aurelio’s solution? The N95 Mask Preserver. Designed with the aid of engineers at MassChallenge Rhode Island, RIHub, and Michael Katz of the University of Rhode Island, Aurelio’s PPE protector consists of a hinged case made of medical-grade plastic, which he says is “the same material that’s used for our hospital syringes. It also has an additive called WITHSTAND, which is antimicrobial, anti-fungal, anti-mold, and anti-mildew.” The Preserver also includes a 1/4″ hole so healthcare workers can clip the case to their scrubs so they always have their PPE ready to hand.
Aurelio’s N95 preserver has proved so popular that he now has a patent pending. He told ABC in Rhode Island, “The docs at the ER at my place are wearing them, our nurses are wearing them and using them, and they’re seeing such a difference in the integrity of their mask.”
As he sees it, Aurelio was acting as a nurse more than as an entrepreneur: “I saw that my colleagues were getting sick with Covid,” he said. “If I can eliminate one of those risk factors by having a safe N95 mask that’s in good integrity, that’s why I did this.”
For more on Aurelio’s N95 tote, visit his website.
Most nursing students are eager for opportunities to treat real patients, and sometimes, opportunity knocks much sooner than they might have expected. If you keep your eyes and ears open—and have top-notch study skills like our Nurse of the Week, Warwick, RI BSN-to-be Tiffany Hansen—you might end up acting as a first responder just a few months after starting classes.
Yesterday evening, on Tuesday, March 23, while driving home from school, Hansen told local ABC reporters, “I heard tires screeching. I thought it was just a fender bender or something. I definitely wasn’t expecting someone to be on the ground.” And just like that, she had her very first patient. A 25-year-old motorcyclist had crashed into a car, and was lying in the road, helmetless and severely injured.
Nursing student Tiffany Hansen talks to ABC6 in Rhode Island.
Four months into her nursing school education, if the freshman felt especially fresh at that moment, she certainly approached the scene like a pro. Hansen assessed the situation and mentally scanned her class notes as she went over to her patient to check his breathing and pulse. “I made sure the scene was secure. There were other bystanders, another guy; I had him stop the traffic and call 911, [and] I had another girl help me keep his head and neck aligned.” Thanks to the aid of Hansen and other bystanders, the young man arrived at the hospital in stable condition (and will hopefully reconsider the value of wearing a helmet after his recovery).
Ironically, for Hansen the experience must have resembled a particularly gruesome pop quiz. A few hours ago, in class, “My teacher, she was just talking about how if you see something, not even just as a nursing student, but a person, you stop and do something. Even if it’s just making sure they’re not alone and calling 911.” Hansen, who has a young toddler, added, “I would never want someone just driving by my son if that was my son in the road.”
For more details on this story, visit Rhode Island’s ABC6.
Nursing
students from the University of Rhode Island
(URI) Nurse Practitioner programs are gaining experience with young patients
thanks to a new volunteer opportunity. Taking what they’ve learned in the
classroom into the exam room, the students have spent a few recent Saturday
mornings at the Rhode Island Nursing Education Center performing full physicals
on volunteer children.
These
students are enrolled in the Family
Nurse Practitioner and Psychiatric
Mental Health Nurse Practitioner programs. The children have been recruited
from among friends and family to take part in the exercise where the nursing students
interviewed the patients and their parents to gather a full medical and family
history, then conducted a comprehensive physical exam.
Twenty
URI students took part in the program, which allowed them to apply lessons
learned in the classroom to real-life scenarios. Denise Coppa, associate professor
and director of Advanced Practice for the College, monitored the exams by video
in an adjoining room, allowing her to provide immediate feedback on the students’
performance.
Coppa tells today.uri.edu, “This gives the students great practice on compiling a patient’s history, conducting a physical exam and developing a full assessment of that patient. They benefit from practicing the physical exam as well as working on their communication skills with a patient. It gives the students real-world experience they can take with them.”
To learn more about how
University of Rhode Island nurse practitioner students are gaining real-world
experience with young patients, visit here.
The University of Rhode Island (URI) College of
Nursing recently received a $2.7
million, four-year grant aimed at enhancing the nursing workforce and strengthening
health care in the community. The grant will allow URI Nursing students to get
more hands-on experience, benefiting patients at local community health centers
at the same time.
The
Health Resources and Services Administration (HRSA) has provided the grant in
an effort to fuel its Advanced
Nursing Education Workforce (ANEW) program, which enhances
the academic clinical partnerships between the College and two community health
centers—Thundermist Health Center and Providence Community Health Center. With
help from the grant, URI nursing students in the Adult Gerontology, Psychiatric
Mental Health, and Family Nurse Practitioner programs, based at the Nursing
Education Center in Providence, will be placed in the health centers to provide
primary care and behavioral health services, under the supervision of
professionals in the centers.
The
HRSA grant provides funding for traineeships and will pay the tuition of 14
nursing students in the program each year. Associate Nursing Professor Denisa
Coppa expects 48 to 56 students will be placed in one or both of the centers over
the four-year period, each working two days a week, while maintaining their
studies as full-time students.
Coppa tells today.uri.edu, “This program will give experience to these nurse practitioner students so they are prepared to work in community health centers when they graduate…This project is a huge benefit not just for the students, but for practicing health care providers and the health care system as a whole. We’re increasing and transforming the health care workforce to provide more primary care services for the medically underserved population.”
To learn more about the
$2.7 million, four-year HRSA grant awarded to the University of Rhode Island College of Nursing to help enhance the nursing
workforce and strengthen health care in the community, visit here.
Denise Coppa, associate dean of the College of Nursing graduate programs, tells Today.URI.edu, “We have a huge mental health and addiction crisis across the country. We need more people who are clinically trained and can handle working with mental health patients. The students will come out of the program certified to deliver mental health counseling and therapy, and will be licensed to prescribe psychotropic medications.”
URI’s new nursing program is designed to educate psychiatric mental health nurse practitioners who are capable of providing psychiatric care to individuals and families in a multitude of health care settings. The program is being offered as part of the regular, on-going curriculum in the URI College of Nursing and upon completion of the program, graduates will be eligible to take the American Nurses Credentialing Center certification exam.
The program is based at Rhode Island’s Nurse Education Center in Providence where classes in psychiatric assessment and diagnosis, neuro-psychopharmacology, and integrated treatment for older adults will be offered. Students will also be able to complete their clinical hours in local hospitals, community health centers, and private practice offices.
To learn more about the University of Rhode Island College of Nursing’s new master’s degree program in psychiatric mental health, visit here.
