1. detroitrampart

2. Detroit Rampart Teams  Emergency Medical Services (EMS) Division, Fire Department of the City of Detroit  WSU Hub  Sinai-Grace Hospital  Detroit Receiving Hospital  Add St. John Hospital  Henry Ford Hospital Hub  Henry Ford Hospital Detroit  Add suburban hospitals

3. Emergency Department

5. Patient Enrollment at WSU as of January 3, 2010  WSU = 54  DRH = 17  Sinai-Grace = 34  Others = 3  Henry Ford Hospital = 20

8. Purple Pin – Sinai Grace Turquoise Pin – Detroit Receiving Green Pin – Henry Ford

9. Why Has it Worked?  Detroit EMS  Started with buy-in from the management  Important to Chief Kelly  Jenny Atas, M.D. ( Medical Director)  THE MEDICS  Working Relationship with the Henry Ford Hospital Hub  Working together - Great teamwork among research coordinators and EMS liaisons!!!  Training sessions

10. Detroit Statistics  Detroit’s population in 2002 was 951,270 (6,845 persons per square mile)  Approximately 10% of Detroiters are > 65 years old  Unemployment rate 17.3% (three times that of the national average)

11. Detroit  Large area  Low density compared to other urban areas

12. Detroit’s low socioeconomic Status

14. Drug and Alcohol Related Problems

15. Detroit EMS Data  911 service to the entire city of Detroit (139 square miles)  24 medic units  300 paramedics and basic technicians  Over 120,000 calls annually  Transporting over 70,000 patients  Last 5-year periods 69% and 63% of total neurological diagnoses were seizures (DRH and SGH respectively)

16. Detroit EMS Commitment  Involved Detroit EMS with initial train the trainers - Dean  EMS took an active role in developing processes for RAMPART  Dedicated administration  Ongoing Training  Combined data on education gaps  Focused retraining efforts

17. Chief James Kesteloot

18. Instructor Sean Larkins and Captain Joe Wilson (not pictured),

19. Supervisors – Can’t say enough! Anna M. Dean-McDonald Michael J. Kearns Kenneth M. Meisel Vincent W. Fourment Marvin D. Messer Jerald K. James James A. DeDeckere James F. Gatteno Dwayne R. Dixon Anthony M. Wade Robert Brown Keith L. Syrkett Melvin Green Angela M. Turner Martha Rademaker Paul M. Edwards Donnella D. James Michael D. Christy John F. Wright Damon K. Sutton

20. THE MEDICS

21. “I won’t enroll any patients in RAMPART” – Anthony Spitznagel now has 9 enrolled

22. Interactions with Medics  Training was attended by HFH & WSU personnel  Had to overcome the “PolyHeme” Effect  Reassure they will not be disciplined  Maintain Visibility and Interactions  Continued contact other than when patient is enrolled  Pizza Night (Oct0ber 13 & 15, 2009)  RAMPART Lunch Bags (December 15 & 17, 2009)

23.  Cooperation with EFIC process  Close communication between coordinators  Coordinated box management and enrollment

24. Friendly competition Receiving vs Ford Detroit EMS #1

25. “The RAMPART girls”  Paula Crouse  LynnMarie Mango  Valerie Mika

29. Secrets – not really  Great EMS agency with dedicated Medics  Excellent teamwork  Focus on positives and system fixes