Welcome, Dr. Rauch! KCEMS is excited to welcome Lindsey Rauch, MD, as our

Assistant Medical Director on July 1, 2021.

Lindsey Rauch, MD is an emergency medicine physician with

Emergency Care Specialists. She is a graduate of Grand Valley

State University and received her medical degree from Michigan

State University College of Human Medicine. She completed her

residency in emergency medicine at Spectrum Health/Michigan

State University in Grand Rapids and her subspecialty fellowship

training in emergency medical services at Western Michigan

University (WMed) in Kalamazoo. She has previously served as the

interim medical director for Calhoun County MCA, Assistant

Medical Director for Kalamazoo County MCA and also as a medical

control physician for Yellowstone National Park EMS in partnership

with WMed. Her clinical, teaching and research interests include

provider education, quality improvement/assurance, disaster preparedness, and administration. Outside of

work she enjoys gardening, fly-fishing, camping, and traveling with her husband and their dog, Nuya. Dr.

Rauch is very much looking forward to returning to the greater Grand Rapids area full time and is excited to

begin with Kent County EMS!

Success Story We wanted to take a moment to share a recent success story. Rockford Ambulance providers Rich Keizer

and Brian Townley responded to an unresponsive patient. As they were packaging the patient for

transport, the patient began to seize. In collaboration with the first responders, the crew immediately began

to protect the patient from harm and draw up Midazolam. After the crew drew up Midazolam they then

completed a MACC. During the MACC, it was identified that the crew initially drew up the IV dose (5mg),

however, an IV was not established yet. The crew then drew up the additional 5 mg for a full 10mg IM

dose and administered it to the patient. Within a short time, the patient’s seizure was broken.

Great job to Rich & Brian for utilizing the MACC and avoiding a medication error!!!

June 2021

KCEMS RoundUp Closing the Loop

Trivia Question 1: A pH of 5 is how much more acidic than a pH of 6?

Quality Improvement Group Updates We would like to take a moment to catch everyone up on some happenings that are

occurring in our Quality Improvement Group meeting. Currently we have

representatives from non-transport, transport and all 3 health system organizations

coming together and meeting every week to improve the patient handoff, or TOT,

reporting process for all transition points (non-transport to transport & transport to

hospital). As we continue to work on this project you may be asked to provide your

feedback on how to make the process better through a QR code linked 5 question

survey. We are asking that if you are asked to provide constructive feedback you

would take a few moments to do so.

First Case of Hantavirus Reported in Michigan From Michigan Health Alert Network:

The Michigan Department of Health and Human Services (MDHHS) is reporting the first case of Hantavirus

Pulmonary Syndrome (HPS) in Michigan, caused by Sin Nombre hantavirus. The patient was hospitalized

with a severe respiratory illness and is recovering. In the weeks prior to becoming ill, the patient was

cleaning out an unoccupied home that had evidence of a rodent infestation.

Michigan healthcare providers are reminded to consider hantavirus when evaluating patients with a febrile

respiratory illness and history of exposure to wild rodents and/or their droppings and nests. Illness caused

by hantaviruses is similar to other respiratory viruses such as COVID-19. The Centers for Disease Control

and Prevention Infographic describes how to differentiate HPS from COVID-19.

Facts About Hantavirus

Seizure and PNES

On one of our case reviews we identified an interesting case and with the

support of one of the local resident programs Dr. Zina Alhaddad created a

recorded PowerPoint presentation to discuss Psychogenic nonepileptic

seizures, or PNES.

As a lead into Dr. Alhaddad’s presentation, PNES can appear outwardly like

epileptic seizures, but their cause is psychological. PNES in most cases

come from a psychological conflict or accompany an underlying psychiatric

disorder. There is currently no known organic or physical cause for PNES, however, there are several

disorders that increase the chance for developing PNES.

Please follow these links to learn more:

https://drive.google.com/file/d/1rbqgHLjFjlxZ1Zxfc1DB4aq01Rv4sLtB/view

https://drive.google.com/file/d/1g3jj0fgWzAKHFmwlePSr24md0wj_fS1b/view?usp=sharing

https://www.youtube.com/watch?v=lwCJvNR0QeM&t=233s

Trivia Question 2: Where would a patient catch a nosocomical infection?

Hospital Visitor Policy Updates

Mercy Health St. Mary’s: Two visitors for inpatients (can be different visitors), one visitor for EDs and outpatient

departments. No visitors for Covid patients unless extenuating circumstances.

Metro Health: Two visitors for inpatients and may rotate. One visitor may stay overnight with all inpatients. Two

visitors are allowed for COVID-19 positive patients and those in enhanced droplet precautions. One visitor is allowed

in ED, Surgical Center and Cancer Center. There will be no restriction on the number of visitors at the NOCs.

Spectrum Health Hospital: Two visitors for inpatients (can be different visitors), one visitor for EDs and outpatient

departments. No visitors for Covid patients unless end of life.

Trivia Question 3: What is the name of the interval during cardiac repolarization when depolariza-

tion cannot occur?

Insightful Information:

Pediatric Trauma Report

Helen Devos Children’s Hospital’s recent annual trauma systems

report included some helpful information, included here, for the

EMS community to be aware of.

Helicopter from

Referring Hospital

5%

Trivia Question 4: What is an AV shunt?

Protocol Updates If anyone has any suggestions for future protocol revisions, please let us know by following the link below.

Protocol Enhancement Request Survey link: https://survey.alchemer.com/s3/6327765/Protocol-

Enhancement-Request

EMS Data - Opioid Response

There were 1,526 more EMS responses for probable opioid overdoses in 2020 compared to the prior year

(an increase of 13.7%). The largest increase in 2020 occurred in May with a relative increase of 33.9%

compared to prior month and a 29.8% increase compared to the same month (May) during 2019.

EMS responses for probable opioid overdoses in 2021 are trending upward since February and are

currently 18.4% higher than Jan-Apr 2020 and 29.1% higher than Jan-Apr 2019

Ambulance Updates From Mark Meijer:

https://abcnews.go.com/Politics/global-microchip-shortage-impacting-ambulance-supply/story?id=77827044

The link above references the ambulance chassis shortage, which is about to have a real impact on

ambulance builders / providers. Mark Van Arnam is the Director of the CAAS / GVS Vehicle Stds group and

retired CEO of AEV, one of the country's custom builders.

Information on Poiseuille’s Law From openanesthesia.org:

Trivia Answers: 1. Ten 2. In a healthcare facility 3. Absolute refractory period 4. A direct connection between the arterial and venous circu-

lations

NECK TRAUMA & STROKE CASE STUDIESYou are invited to attend this free educational program for EMS first responders, providing an interdisciplinary approach of best practices, with special presentations in the treatment of cardiology and trauma patients.

Wednesday, June 16 6:00 – 8:30 pm

Virtual EventAfter registration you will be emailed the link for the virtual event.

YOU’RE INVITEDEric Mitchell, MD

General Surgery

Neck Trauma

Augusto Elias, MDNeurointerventional Radiology

EMS Stroke Update

RSVP by Friday, June 11 Laurie.Popma@metrogr.org or 616.252.7125

Earn 2.0 EMS Continuing Education Credits for attending.

EMS LECTURE SERIES

Speakers

ANNOUNCES OUR NEXT

EVENT & YOU'RE INVITED!

WHEN: June 16

WHERE: The Metro Health

ED ambulance bay

TIMES: 1100-1400 and

2300-0200

WE ARE SO THANKFUL for the work you do and to have you as part of our team!

2021 Michigan EMS Virtual Expo Agenda each session worth 1 – credit in category specified

Thursday, June 17 0730 – 1700 Virtual Exhibit Visits 0800 – 0815 Welcome to Michigan’s EMS Expo 0815 – 0915 Breakout 1 Credit Title and Presenter

Operations Managing Change in Hyper-Turbulent Times, Matt Zavadsky Educational Admin. Ethics in EMS Education, Allison Billiti Medical You Can’t Breathe Through Your Nose While Smiling, Steve Huisman Airway and Vent. Covid Close to Home, Jim Kalinowski 0915 – 0930 Break and Virtual Exhibit Visits 0930 – 1030 Breakout 2

Sponsored by Michigan Association of Air Medical Providers Credit Title and Presenter Medical Wolves in Sheep's Clothing: Sepsis, Chris Ebright Ped. Patient Assess. Pediatric Patient Assessment and Treatment Tips, J. David Feichtner Airway and Vent. Covid Close to Home (repeat), Jim Kalinowski Trauma Plate-over-nail Technique & Early WB'ing in Distal Femur Fractures,

Dr. Blake Miller and Dr. Andrew Fras 1030 – 1045 Break and Virtual Exhibit Visits 1045 – 1145 Breakout 3 Sponsored by Michigan Association of Air Medical Providers

Credit Title and Presenter Preparatory Violence on the Rise in EMS: Jerry Schley & Orlando Blanco

Patient Assessment Human Trafficking-EMS Awareness, Terrie Godde Operations In search of EMS Unicorns, Lance Corey Educational Admin. Trauma Stewardship: Self Assessment, Emily Bergquist

1145 – 1215 Lunch and Virtual Exhibits Visits 1215 – 1315 Breakout 4

Sponsored by ZOLL Medical Credit Title and Presenter

Ops. Em. Preparedness Emergency Preparedness, Jerry Schley Medical Working Toward the “Ideal” Response to Out-of-Hospital Cardiac Arrest,

Stephen Dowker Operations Linking EMS with Hospital Disaster Planning, Sue Andersen

Educational Admin. State EMS Education Update, Terrie Godde 1315 – 1330 Break and Virtual Exhibit Visits 1330 – 1430 Breakout 5 Credit Title and Presenter Medical And the beat goes on…LVAD, Chris Ebright Preparatory Acid Base Derangements, Steve Huisman Ped. Patient Assess. DOSE (Safe Sleep), Terrie Godde Geriatrics Geriatric Nutrition:an Underutilized Assessment Tool, J. David Feichtner 1430 – 1445 Break and Virtual Exhibit Visits 1445 – 1545 Breakout 6

Credit Title and Presenter Operations EMS Finance for 2021 and Beyond, Matt Zavadsky

Medical CHF From the Patient Perspecitve, Sue Andersen Instructional Tech. Command Presence in the Classroom, J. David Feichtner Pediatric Medical Moving Beyond Epiglottis and Croup, Lisa Hill Practical Pediatric Medication Administration, Terrie Godde Limit to 10 people only! 1550 - 1650 Thursday Keynote: Encephalopathy Caused by Restraint: Dr. Werner Spitz, Medical Credit Sponsored by Medstar Friday, June 18 0730 – 1530 Virtual Exhibit Visits 0800 – 0900 Breakout 1

Sponsored by Michigan Center for Rural Health Credit Title and Presenter Medical When a Stroke Really Isn’t A Stroke, Chris Ebright

Measure. and Eval. Everyone Loves M & E, J. David Feichtner Preparatory Organizational Demands, Culture & Stress Gaps: Why We Haven't Always Done It That Way, Andrea Abbas 0900 – 0915 Break and Virtual Exhibit Visits 0915 – 1015 Breakout 2

Credit Title and Presenter Pediatric Medical EMS’s Role in Recognizing Physical Child Abuse, Lisa Hill

Patient Assessment Until All the Pieces Fit, Chris Ebright Ed. Admin./Prepatory Trauma Stewardship: Self Care, Emily Bergquist 1015 – 1030 Break and Virtual Exhibit Visits

1030 – 1130 Breakout 3

Credit Title and Presenter Operations Are “HOT” Responses Worth the Risk?, Matt Zavadsky Medical Emerging Infectious Disease Care, Sue Andersen Instructional Tech. The Funnest Aspect of Teaching EMS, Steve Huisman 1130 – 1145 Break and Virtual Exhibit Visits 1145 – 1245 Friday Keynote: Unexpected Nightmares, Ben Vernon, Trauma Credit Sponsored by Mutual of America 1245 – 1315 Lunch and Virtual Exhibits Visits 1315 – 1415 Breakout 4 Sponsored by Stryker

Credit Title and Presenter Pediatic Trauma Pediatric Burns, Lisa Hill

Medical With names like Disco Biscuit, Goof Balls, and French Fries, what could go wrong?, Steve Huisman

Preparatory National EMS Issues Update, Matt Zavadsky and Kolby Miller 1415 – 1430 Break and Virtual Exhibit Visits 1430 – 1530 Breakout 5

Sponsored by Mutual of America Credit Title and Presenter Operations Seriously? You want to do what?, Lance Corey

Geriatrics EMS Care for Dementia Patient, Kolby Miller Trauma Recognizing Domestic Violence and Sexual Assault, Sam Stiles Practical Pediatric Medication Administration, Terrie Godde Limit to 10 people only!

Thank you to our Expo Sponsor!

Thank you to our Event Platform Sponsor!

www.mipoisonhelp.org

The Michigan Poison Center at the Wayne State University School of Medicine is issuing a warning about

a public health threat related to xylazine abuse.

Xylazine is a drug of abuse and works via central alpha-2 agonism. It is not approved by the Food and

Drug Administration for human use. It is used in veterinary medicine as an animal ‘take-down’ agent and

anesthetic. Xylazine typically causes sedation, anesthesia, muscle relaxation, and slowed respiratory rate

and heart rate. It can be swallowed, inhaled, smoked, snorted, or injected into the muscle or vein.

In humans, xylazine causes significant slowing of heart rate and blood pressure. Xylazine shares many of

the same effects as opioids however, the effects set in quickly and last longer. Xylazine may be

substituted for an opioid such as heroin, or used together with an opioid for additive effects. However,

xylazine does not respond to naloxone to reverse its effects because it is not an opioid.

The Michigan Department of Health and Human Services has been monitoring overdoses related to

xylazine. A series of fatal overdoses have occurred between September and October, 2020 involving

xylazine in several communities on the west side of the state. In Michigan, overdose deaths related to

xylazine have also involved fentanyl.

Fentanyl detection in deaths related to xylazine is very concerning. Fentanyl is a highly potent synthetic

opioid used to treat patients with severe pain who no longer gain relief from other opioids. Users may

not be aware of the presence of fentanyl in the xylazine supply. Both xylazine and fentanyl can place

users at increased risk of toxicity and even death due to their combined effects on the respiratory

system and central nervous system.

Clinicians who suspect cases that may be related to xylazine, fentanyl, or combined use of these

substances should call the Michigan Poison Center. If the case occurred within the last 60 days and you

don’t require medical assistance, report to the Michigan Department of Health and Human Services

Drug Poisoning Surveillance Team at MDHHS-MODASurveillance@michigan.gov.

Michigan Poison Center

800-222-1222

Free, confidential, expert advice

24/7/365