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Health Resuscitation Outcomes Consortium - paramedis i5u~~ ~<k~ MEMORANDUM April 26, 2005 TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: National Institutes of Health Resuscitation Outcomes Consortium The City of Dubuque paramedic service has been invited to participate in a research project of the National Institutes of Health on out-of-hospital resuscitation. The University of Iowa Hospitals and Clinics has created the Iowa Resuscitation Outcomes Consortium that consists of eleven paramedic ambulance -services and the University. The study's grant period officially began September 1 of last year, and will run nearly five years. Under the tightest of medical control and oversight by physicians and scientists, the City's paramedic teams will be utilizing and testing several new protocols involving drugs, devices and strategies in the area of medical and trauma resuscitation. The grant will cover all needed training, equipment and disposable supplies to carry out the protocols, and the reporting of the results. Emergency Medical Services Supervisor Ric Jones has researched the legalities and liabilities of this undertaking. He advises that the City's Physician Medical Directors, Corporation Counsel, the City's general liability carrier and their underwriters believe that the City assumes no more risk than that which is ordinary in the provision of ambulance service. The City's insurance company and its underwriters advise that the City's professional liability insurance covers the City's participation in this study. In addition, local Institutional Review Boards at Mercy and Finley Hospitals must investigate and sign off on any and all protocols or procedures in the study before they can be used in the field. City staff believes that none of the proposed protocols have potential to harm the patients involved in the study. The focus of this study is to bring to the forefront the very best practices in resuscitative skills, strategies, tools and pharmaceutical agents. Most cardiac arrest patients die despite aggressive efforts to resuscitate them. This study expects to improve the likelihood of surviving cardiac arrest. The City of Dubuque will benefit from its participation in several ways. The top three cardiac monitor/defibrillator manufactures are advancing proposals to provide their latest equipment free of charge to study participants. All needed equipment and training will be provided by the University of Iowa clinical staff. The City will be reimbursed for data collection costs. .. Fire Chief Dan Brown is recommending City Council approval for the City of Dubuque to participate in the Iowa Resuscitation Outcomes Consortium. I concur with the recommendation and respectfully request Mayor and City Council approval. ;1~t ~~0tL Michael C. Van Milligen MCVM/jh Attachment cc: Barry Lindahl, Corporation Counsel Cindy Steinhauser, Assistant City Manager E. Daniel Brown, Fire Chief ~ ~ CITY OF DUBUQUE, IOWA MEMORANDUM April 14, 2005 TO: Michael C. Van Milligen, City Manager FROM: E. Daniel Brown, Fire Chief f DE SUBJECT: National Institutes of Health Resuscitation Outcomes Consortium Our paramedic service has been invited to participate in a research project of the National Institutes of Health on out-of-hospital resuscitation. The National Institutes of Health is the steward of medical and behavioral research for the nation. It is an agency under the U.S. Department of Health and Human Services. Ten centers in North America were selected to participate in this Resuscitation Outcomes Network. University of Iowa Hospitals and Clinics (UIH&C) is one of the centers and at their invitation our paramedic service will be one of the groups in this study. Eleven of Iowa's larger paramedic ambulance services will be participating. We will be among the smallest emergency medical services providers in the nation to participate in this project. University of Iowa Hospitals and Clinics has created the Iowa Resuscitation Outcomes Consortium that consists of the eleven paramedic ambulance services and the University. The base requirement of the study was that a group be able to enroll 500 cardiac arrest cases per year. No system in Iowa is that busy. In our Fire Department we respond to about 40 cardiac arrest calls annually. The consortium of the eleven services exceeds the required number of cases. Our colleagues in Iowa who we hope to join in this undertaking are: Johnson County EMS, Iowa City; Area Ambulance Service, Cedar Rapids; Medic EMS, Davenport; Waterloo Fire Dept. EMS, Waterloo; Covenant/Sartori EMS, Waterloo-Cedar Falls; Des Moines Fire Dept. EMS, Des Moines; West Des Moines Fire EMS, West Des Moines; Dallas Co. EMS, West Des Moines; Siouxland Paramedics, Sioux City; and Henry Co. Health Center EMS, Mt. Pleasant. The study's grant period officially began September 1 of last year, and will run nearly five years. Under the tightest of medical control and oversight by the world's most pre-eminent physicians and scientists in their field, our paramedic teams will be utilizing and testing several new protocols involving drugs, devices and strategies in the area of medical and trauma resuscitation. The grant will cover all needed training, equipment and disposable supplies to carry out the protocols, and the reporting of the results. Emergency Medical Services Supervisor Ric Jones has researched the legalities and liabilities of this undertaking and in meetings with our Physician Medical Directors, Corporation Counsel, the City's general liability carrier and their underwriters we are of the unanimous conclusion' that the City assumes no more risk than that which is ordinary in the provision of ambulance service. Our insurance company and its underwriters assure us that the City's professional liability insurance covers our participation in this study. In addition, local Institutional Review Boards at Mercy and Finley Hospitals must investigate and sign off on any and all protocols or procedures in the study before they can be used in the field. We are confident that none of the proposed protocols have potential to harm the patients involved in the study. Emergency Medical Services agencies utilize their most resources on cardiac arrest and severe trauma patients. In spite of this, survival rates are very low. The focus of this study is to bring to the forefront the very best practices in resuscitative skills, strategies, tools and pharmaceutical agents. Simply put, most cardiac arrest patients die despite aggressive efforts to resuscitate them. This study expects to improve the likelihood of surviving cardiac arrest. One early focus of the study will simply be reinforcement of the basics of providing CPR. Research has changed the way CPR is taught and is quite likely to change it some more. It is now known that the upstroke in the CPR compression cycle is as important as the downstroke in creating a pressure differential within the chest cavity. This pressure differential is what moves blood. Our cardiac monitors will be equipped with devices to help the rescuer evaluate their CPR efforts. This immediate feedback will assure that this important basic skill is consistently accurate and adequate. t The Dubuque Fire Department is honored to be helping to create the science that will save many lives now and in the future. There will be a total of twenty paramedic services in the nation that are invited to be in this study. Eleven of these services are in Iowa, where the first out of hospital defibrillation programs for basic providers were created in the 1970's. Iowa has continued to be a worldwide leader in EMS innovation. The other nine EMS systems are large urban systems in Seattle, Washington; Portland, Oregon; San Diego, California; Dallas, Texas; Pittsburg, Pennsylvania; Birmingham, Alabama; Toronto, Ontario, Canada; Ottawa, Ontario, Canada; and Vancouver, British Columbia, Canada. The City of Dubuque will benefit from its participation in several ways. Right now the top three cardiac monitor/defibrillator manufacturers are advancing proposals to provide their latest equipment free of charge to study participants. All needed equipment and training will be provided by the University of Iowa clinical staff on our premises and accommodating our schedules. The City will be reimbursed for data collection costs. I respectfully request that the City of Dubuque accept the invitation to participate in the Iowa Resuscitation Outcomes Consortium.