Pre-Hospital Care of the Mechanical Circulatory Support Device Patient Dennis Rivard MA, CCP Mid-Atlantic Region Pre-Hospital MCS Task Force

Sept 11, 2001

An MCS Coordinator, a Flight Nurse, and a Patient

Meeting of the Minds Advances in medical technology is exceeding the community’s ability to safely manage patients with this technology Decision to set up meeting to work more closely Meetings would be multi-disciplined Goal to create a method of identifying and provide basic management information Bring MCSD centers together to work smarter

MARPH Covers Virginia, DC, and Maryland Meet monthly Core hospitals Virginia Commonwealth University Hospital INOVA Fairfax Hospital Washington Hospital Center Johns Hopkins Hospital University of Maryland Medical Center

Basic Tenets Do not prescribe medicine Not certifying or credentialing any clinicians Compromise Listen to the experts (EMS) Collaborate whenever possible

The Motley Crew

Participants MCS Coordinators EMS providers (ground and flight) ED medical team members Heart Failure Cardiologist Cardiac surgeons

Field Guides Designed to provide consistent and reliable information to first responders Pump systems assigned a color Colors are present on guide, labels, and luggage tags Electronic PDF files Updated annually

Color Guides Coding Dark Blue Heartware Orange Heartmate II Jarvik Lavender VentrAssist Green Thoratec PVAD Light Blue Heartmate XVE Yellow

Guide Design Separate cards for each device Allows for multiple uses Can be separated and used separately Color coding encircles each card Color is printed along the edge Allows to be photocopied Eliminated confusion for color-blind first responders

Field Guides Each a little different in design 10 questions FAQ section Emergency step by step troubleshooting section with pictures Changing batteries Changing controllers Alarms Two sided laminated and bound

Heartware and Heartmate XVE

VentrAssist and Heartmate II

Thoratec PVAD and Jarvik 2000

Guides 10 Questions 1. Can I do external CPR? If not, is there a hand pump to use? If device slows down (or goes into a low flow state), what alarms will go off? How can I speed up the rate of the device? Do I need to give heparin if the pump slows down? Can the patient be defibrillated? If OK to defib, is there anything that must be disconnected prior to defibrillating? Does the patient have a pulse with this device? What are acceptable vital sign parameters? Can this patient be externally paced?

Tags and Labels Label controllers and tag bags Follows same color coding system Information on tag is for specific implant center contact information Tags state: Name of hospital MCS Team contact information Color code of device Type of device

Tags Side one Side two Patient’s identification Implanting hospital Emergency contact info Color code tape Side two Type of pump Written color code

Additional Uses Non-MCSD trained units Emergency Departments Patients Rehabilitation centers Out-Patient Dialysis Centers

Launch of Field Guide Program Multi-state EMS training opportunity Target audience was EMS educators and team leaders 6 stations (one for each pump presented) Patients with specific pumps at each station MCS Coordinator at each station Hands on exposure Used field guides as outline for presentation

Mechanical Circulatory Support Organization (McSO) National organization Multi-disciplined Grant funded Linked to other related organizations

National Training Program If we don’t do it, someone will Expected surge in MCSD patients once DT is an FDA approved therapy Opportunity to provide consistent messages Safe for our patient to travel throughout the US First national launch in San Jose this October Air Paramedic and Nurses National Meeting Offering pre-conference courses

What Does the Future Hold??? Need central resource center Development of national information bank One stop shopping One phone number when placing a MCS patient in their residence Coordinator hot line directory

Questions