Community health partnership prepares Boca Raton`s EMS system for the future
BY BRUCE ANGIER
Boca Raton Fire Rescue has been the primary responder for medical emergencies in this oceanside community, which has a population of about 69,000, since July 1974. During that time, Boca Raton Fire Rescue Services (FRS) has grown with the community and adapted to its changing health care needs. Today, FRS provides emergency medical services (EMS) from six fire stations. One-hundred fifty firefighters, 93 of whom are also certified paramedics, staff five advanced life support (ALS) paramedic rescue units as well as one basic life support (BLS) and five ALS engine companies. We respond to approximately 8,000 EMS calls a year. Additionally, the department provides a typical array of services associated with modern fire rescue, including hazardous-materials response. Conventional prehospital care provided by Boca Raton Fire Rescue is largely identified with the health care system.
Forming a partnership with Boca Raton Community Hospital in January 1994, we further expanded our role in the community by providing new community health outreach programs. The partnership, an innovative public/private relationship, seeks to improve community health care by combining the resources of both agencies and delivering community-based preventive health care programs.
The Fire-Rescue/hospital Smart Heart partnership sponsors four core programs: cholesterol analysis and blood-pressure screening, community CPR training programs, Safe Kids, and Project Kid Keeper.
COMMUNITY HEALTH COORDINATOR
Boca Raton Fire Rescue has assigned one firefighter-paramedic/ registered nurse full-time to coordinate the Smart Heart and other community health education programs. The objective is to initiate within the community new health programs that will transform our emergency medical services into a more proactive organization–seeking to prevent medical emergencies before they occur. The initiative has the support of Boca Raton Fire Chief Kerry Koen: “I believe that proactive health care and diagnostic programs designed to prevent emergencies will play a significant role in future EMS system design. It just makes sense to minimize the demand for emergency service where we can, both in terms of economics and the preservation of key resources that are needed for critical-care applications. It is a new road to follow, but one that has promise, and it must be traveled.” To facilitate the rapid implementation and delivery of preventive health care programs, the community health care coordinator answers directly to top management.
SMART HEART PROGRAM
National health care research indicates that premature deaths occur because of one of four primary factors: lifestyle (50 percent of deaths, environment (20 percent), heredity (20 percent), and health care system failure (10 percent). The Smart Heart program was launched in response to the community`s potential for a large volume of cardiac-related emergency medical calls.
The program attempts to shift emergency medical services from the reactive state of health care to a proactive role in changing lifestyle risks. By shifting from the health care system role, which affects 10 percent of the premature deaths, to improving lifestyles, which affects 50 percent of the premature deaths, a larger percentage of the community`s health care problem can be addressed. The programs associated with Smart Heart have received national recognition in fire service- and emergency medical services-related publications. Smart Heart was also a finalist in the International Fire Chiefs Association`s 1995 “Fire Service Award for Excellence” competition.
Free cholesterol analyses are offered at the local fire station in targeted geographic regions in which FRS and the hospital believe the risk of heart disease may be most prevalent–typically communities with high populations of the elderly. Fire Rescue paramedics draw the blood for analysis. The hospital nurses screen the blood pressure. Paramedics, nurses, and community volunteers also educate the public about heart disease during the screening process. The volunteers are citizens who had previously experienced a cardiac-related emergency. They provide living proof that healthful lifestyle choices can reduce the risk of heart disease. After analyzing the blood, the hospital mails a letter with the results to the residents. The letter advises those with high cholesterol levels to see their physician. If they do not have a physician, the hospital refers them to one.
So far, approximately 1,850 citizens have had cholesterol screenings through the Smart Heart partnership. Of the first 587 people who had their cholesterol levels checked on February 14, 1995, 80 percent, or 469, had levels higher than 200. A level above 200 is considered to be a significant risk factor for heart disease. The most recent blood cholesterol screening took place on February 14, 1996, in the Boca Teeca neighborhood in Boca Raton, the same neighborhood as the previous year. Of the 1,109 people who had their cholesterol levels checked, 76 percent, or 841, had levels higher than 200. The initial data from the two screenings will be evaluated to determine whether there is a positive correlation between our educational efforts and the improved cholesterol levels. “By identifying their lifestyle risk, residents may take corrective action before an emergency occurs by modifying diet and exercise patterns,” points out Cindy Metcalf, FRS community health coordinator.
The Boca Raton Community Hospital and Boca Raton Fire Rescue combined their CPR training programs, enabling Smart Heart organizers to make more classes available for the general public and to expand the types of CPR training programs offered. The partnership offers American Heart Association Heart Saver, Infant/Child, and Basic Life Support CPR training programs. All classes are taught by Fire Rescue and Boca Raton Community Hospital CPR instructors. The programs are offered at the hospital`s education center as well as at Fire Rescue training facilities.
PROJECT KID KEEPER
Project Kid Keeper, a free one-day child safety workshop, is offered in May or June, to coincide with the beginning of summer vacation for most children. Most pediatric trauma (the leading cause of death among children) cases are seen during the vacation months. The two-part course is offered twice–during the day and at night–to accommodate different schedules. The first half is a workshop that focuses on preventing child emergencies. Educators from the hospital and Fire Rescue cover safety issues such as home, water, and vehicle safety. The workshop is interactive, allowing the participants to ask questions and share ideas. The second half of the program is devoted to a child and infant cardiopulmonary (CPR) class. The participants are divided into groups and are taught by paramedics and nurses at individual instruction stations. Each participant is issued an American Heart Association participation card. This program, originated by Lieutenant Shaun Fix, has been very successful. Approximately 250 area residents have participated in it to date.
The National Safe Kids program is a long-term effort to prevent unintentional injury, the number-one killer of children under the age of 14. Safety instructors from Boca Raton Fire Rescue, Boca Raton Police, and Community Hospital and the American Red Cross participate in the program. Instructors from these organizations teach various safety programs at area elementary schools. Fire Rescue instructors cover topics such as poison control, transportation safety, fire prevention, safety for latchkey kids, “Stranger Danger,” and the appropriate use of 911. The children also learn first aid and rescue breathing techniques. In January 1996, the American Red Cross honored Boca Raton Fire Rescue Safe Kids instructors. A stranger was unsuccessful in his attempts to lure two elementary school girls into a car. The “Stranger Danger” program was credited with averting a possible tragedy.
CPR ON THE MENU
A public education/training program targeting local restaurant employees was started in 1995, in recognition of the fact that we had been responding to frequent calls to local restaurants. Fire Rescue CPR instructors teach restaurant employees how to recognize a medical emergency and how to appropriately activate the 911 system. They are taught basic CPR awareness and the Heimlich maneuver. Classes are held at the restaurants. It is anticipated that educating restaurant employees will increase the probability that restaurant patrons will survive a cardiac event or choking experience. “When the fire department approached me with this training opportunity, I immediately agreed,” remarks Jim Muro, a local restaurant owner who participates in the program. “These new skills enable my employees to be more conscious of their role during an emergency.” Muro added, “Hopefully, the training will help to reassure my customers that my staff is prepared for medical emergencies.” Some 80 restaurant employees at seven area restaurants were trained during the initial program offering.
Fire Rescue and hospital administrators are convinced that these health outreach programs improve the community`s overall health, but it may take many years to accumulate conclusive data. Both partners benefit from the Smart Heart partnership. With an increased level of preventive health care in the community, medical emergencies can be reduced. “The Smart Heart partnership is a great example of working together to promote wellness and prevent disease in our community,” says Betsy Whisman, Boca Raton Community Hospital`s marketing director. Smart Heart benefits Fire Rescue by potentially reducing the risk of emergency medical system overload. The hospital benefits by having more emergency room beds available for critical emergencies.
But Smart Heart does even more than improve community health levels. It builds new, innovative relationships with the community. These relationships, as well as strong community support, will help position emergency medical services providers for success in our evolving, and increasingly competitive, health care system. n
(Left) Restaurant employees practice CPR as part of the “CPR on the Menu” community health outreach program. (Photos by Cindy Metcalf.) (Right) Children learn about smoke detectors as part of the Safe Kids program sponsored by the Smart Heart partnership.
Parents learn CPR as part of Project Kid Keeper at Boca Raton Community Hospital. (Photo by author.)
n BRUCE ANGIER, a nine-year veteran of Boca Raton (FL) Fire Rescue, is a lieutenant and certified paramedic. He has an associate`s degree in fire science technology from Palm Beach Community College and is a senior at Barry University, where he is majoring in public administration.