This week on the show, I got the chance to sit down and talk with health care social media and video innovators, Ted Setla and Tom Bouthillet. We’ve had Ted and Tom on the show here before talking about their innovative Code STEMI program over at CodeSTEMI.tv. In this week’s show we have part 1 of a two part special segment on their upcoming episodes recorded recently in Wake County, North Carolina. Check it out.

In this first segment with Ted and Tom, I ask them about the logistics of capturing the stories in a dynamic health care setting like a cardiac care system from the EMS responders through the hospital cath lab and into the ICU. Ted and Tom share some insights into capturing these important stories of survival and professionalism and also some thoughts on what other systems might want to look at to capture such stories in their systems.

Make sure you check out all of the projects and things that Ted and Tom are working on. You can catch up with Ted over at SetlaFilms.com and Tom at EMS12Lead.com and their Code STEMI project is available over at CodeSTEMI.tv.

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Jamie Davis:         I’m very excited to be joined again by the illustrious Ted Setla, filmmaker extraordinaire, and, of course, editor-in-chief of EMS12lead.com, Tom Bouthillet and together you may know them as the creators of the just amazing and impressive CODE STEMI web series. Ted, Tom, welcome back to Innovations in Patient Care. So I thought I’d take a little different tack this time, at least, to begin with, and kind of get a little bit of the behind-the-scenes look at what you guys do. Because you’re going into systems of care and looking at things. We talked to you in past episodes here about some of your other CODE STEMI project series. But I thought it might be good since you guys went down to Wake County, North Carolina and anybody that’s been following cardiac care nationally knows that they’re one of the leaders of putting cardiovascular care systems together from the top to the bottom. But I think that that also gives us a unique set of challenges when it comes to trying to capture that in a video form or trying to tell that story. Ted, I guess, I’ll start with you. Because as the director of this project from a video standpoint, you ran into some unique challenges trying to go into a city or an organization and start putting stories together. Tell us a little bit about some of the preliminary things that you have to do to just even begin to put this project together.

Ted Setla:            Sure. Thanks, Jamie, and appreciate the invite to come out and talk. I think one of the first things that Tom and I have done over the, I’d say, the first few months prior to any of these projects taking off, I think – Physio being our partner in this, had played a very important role in pulling together a lot of the individuals who are going to be stakeholders in the success of this while we are on location. So I do want to recognize Eric and Danny who are [unintelligible 0:03:40.8] in helping kind of pull that portion together. Because ultimately the last three months we had multiple conversations with a gentleman by the name of Jeff Hammerstein who ultimately was a caregiver. The gentleman went above and beyond to make sure that whatever we wanted, we would get. To be honest with you, that doesn’t always happen in situations like this because I think most of the systems that we go to do not understand overall what we want to accomplish until we get there. That seemed to be, again, pretty true once we arrived in Wake County and kind of said, “Okay, we’ve had conversations. We said what we wanted.†but ultimately we’re like, “Okay, we know what you want but we’re not so sure how we’re going to overall get all this,†but they did make some preliminary calls to hospital and what not. Once we got there – and this was actually more of the unique situation than anything – but it’s just a true testament. I think to both Tom and I working together, is once we got there, my focus was really to get cameras – when we’re running two cameras on any situation, it’s important to coordinate that in a way that makes sense from the audience standpoint. So my focus was really on that and working with my other camera operator to make that happen. But, Tom, in his – to me, every time we go out, he impresses me even more with knowing what we need now, how we’re going to go about getting it and tactfully take, “This is what we need, how can you help me get this?†He pushes the right buttons. So ultimately, it is, in my mind, a true documentary – you go out and find out what you’re going to get and you only get what you’re willing to – how you’re willing to push the envelope. So that’s kind of the impetus, kind of how we got into this Wake County episode and there were quite a few stories. I definitely let Tom kind of elaborate more on that and how we’re able to capture so much in such a little time.

Jamie Davis:         Yes, Tom. Tell us a little bit about that. Because you capture stories from multiple different angles, where did those stories come, from a system? If somebody is listening to this – physician or a nurse or a paramedic – and wants to do something like this to feature in their system, where do you start gathering these stories?

Tom Bouthillet:  Well, it helps that EMS is often at the crossroads of life-threatening emergencies. So with Ted and I both being paramedics and having participated in life-threatening emergencies and then even me personally having a life-threatening emergency in my immediate family, you definitely realize that any time, any one has experienced a sudden cardiac arrest, it’s a profoundly life-changing and emotional event. We’re always very, very mindful that we don’t want to exploit anyone suffering. So we want to approach it from a highly sensitive and compassionate way. But we also want to confer benefit to the rest of the medical community by going out and identifying best practices so that they can be shared with other communities that maybe aren’t quite as far along as a Wake County EMS or a London ambulance service. I think when we approached it from that standpoint, the family – for example, one of our cardiac arrest survivors from Wake Med, we literally filmed in his room in the ICU when he had been rewarmed but had not regained consciousness yet and, in fact, the man was still intubated and the outcome was unknown. So for his wife to trust us that much to allow us to do that was quite amazing and, in fact, the heroes of this series that we just got done, which I should mention, was not just Wake County EMS, we also went to Guilford County EMS. We kind of filmed two separate locations in one trip. Guilford County EMS I had never heard of before to be quite honest with you but both turned out to be really interesting experiences. But anyway the spouses in both settings – Guilford County and Wake County – are the real heroes of this episode because they just were women of incredible faith. Neither one doubted that their loved ones were going to survive. And it was pretty remarkable having them walk us through, in some cases, the actual resuscitation attempt. I remember one of the women from Guilford County, she basically – I asked her, “My God, you must have been terrified. Your husband hadn’t just agonal breathing and he was in cardiac arrest, did you realize the seriousness of it?†She said that she did. And I said, “Well, it must have been terrifying for you.†And she looked at me with all-conviction and said, “Tom, I believe in a very loving and powerful God.†And she just went on to explain what was in her mind while this was all happening and how one of the paramedics that was walking through the front door to try and resuscitate her husband said, “Ma’am, we’re going to do everything we can,†and she looked at them said, “I know you will.†And I was just blown away by that. So these women were remarkable and it was a real privilege that they allowed us to view these highly emotional and sensitive times in some cases. It was really kind of something we hadn’t done before. It was pretty profound I think for everyone on the set.

Jamie Davis:         Ted, how do you maintain the opportunity as a camera operator to a filmmaker to get in there and get the story while not being obtrusive to the situation on the scene that’s going on in front of you?

Ted:                      Well, I think the first thing that we talked about and my other camera operator may have had some medical background in terms of videos he’s done, but he’s never been involved with this kind of situation either. So what it was was really – it’s a trust thing that ultimately we have to have conversations prior to with a lot of these people. We will usually run cameras, for instance, we were running with – like doing a ride-along – we will run cameras and our focus, this episode is unlike Paramedic 911 or any of those other shows. It’s not about necessarily the call so much as it is the paramedics and the job they’re doing. And, ultimately, what ends up happening is one or two things happens. Either one is we tell why we’re there with the patient, and this happened in London almost on every patient. Once we explained why we’re there, what we’re doing, they were very happy to be involved with the filming of the episode. So we don’t go into it with the idea that we got to get close-ups of the patients right away by any means. Our focus is really showing the type of care, basically, giving an immersive experience of what it’s like to be in that ambulance to be cared for. And once the patients understand our intentions and how we’re affiliated, what our goal is, the whole nine yards, I think that changes their mindset and it allows us to get a much different experience than I think a lot of shows have been.

Jamie Davis:         Tom, do you think that – obviously, the fact that you and Ted are paramedics lends to your ability to read the situation medically about what’s going on, but it also helps you to see some aspects of the story unfold and highlight them, doesn’t it?

Tom:                     Oh, absolutely. If we didn’t realize who the important people were, we wouldn’t know to speak to them in the first place let alone ask them the right questions. And so it’s always a tension between dealing with whatever handler we’ve been assigned who is trying to act as a gatekeeper for wherever we are but in the process of them opening those gates and us meeting people and forming relationships, they might say, “Oh, I know, let me call my buddy who is a critical care intensivist and we’ll find out about this other thing†and it causes a certain amount of anxiety for the media relations types that are trying to keep us contained in a healthcare setting. But in the end, it leads to a much more interesting product and, in fact, almost invariably, and I’m sure Ted would verify this, their anxiety turns to awe by the time – we looked over and one of them was just almost crying or maybe was actually crying by the time we’re interviewing the spouse of one of these people that’s undergoing therapeutic hypothermia. And I think if this happened in London with the gentleman who was there, kind of supervising us from the London Ambulance Service and I think this happened at a couple of different locations at this recent trip to North Carolina, by the end, we opened their own eyes to their own system in a way that they hadn’t appreciated before and I think it blows them away.

Jamie Davis:         Ted, one thing I noticed and I’ve noticed this whenever you go out traveling on shoots, but this time, particularly, maybe because I was just watching for it more, there was a lot of pictures coming out, still photographs that were being posted on Twitter and different social media outlets, what is the response from the organizations that you’re with to your social media reach. Obviously, you have quite a following as Tom, but you bring a lot of attention to their systems.

Ted:                      Well, I think what was beautiful about Wake County this time around, from the very beginning, I think some of the – even from the paramedic to boots on the ground all the way up through the ranks, all of which they have social presence on the web. So I almost feel as if while we’re giving them certain press in terms of the experience we’re having, what we’re seeing and so on, I think the truth is that they have taken a much of what we have posted and have re-posted it themselves because they are a proud system and they should be. Based on what we found, they have every right to be and the more and more we sort of following some of these people online through Facebook or Twitter, whatever, they themselves are posting information and double and triple posting some of the things that we have because they recognize that when somebody from the outside comes in and sees just what they’re doing, I think we’re such a humble group, every one we talked to were so humble about their success that I think it took someone from the outside to come in and shout from the rooftops what they’re doing for them to really get behind it and, to be honest, honored that we had this opportunity.

Jamie Davis:         Tom, what are your thoughts about that? You were involved with this as well and seeing the – I know I was retweeting stuff. There were other people following it. They were retweeting and following on Facebook and it wasn’t just creating hunger for the final product but it really was featuring that system.

Tom:                     Well, sure. Ted mentioned how humble of a system it is. It wasn’t false humility. Jeff Hammerstein, one of their district chiefs, who is also their PIO, that was our main point of contact, has never worked in another system. So all he has ever known is very high-quality and excellence in emergency medical services. And so when we’re blown away by something, he shrugs his shoulders and he’s like, “This is just the way it is here.†He really doesn’t have any frame of reference. He’s not seen it done any different and so he was right there to say, “Maybe you guys should be the one to tell our story.†And so from that standpoint, I found that to be very, very interesting. Especially, after the London Ambulance Service, which was really eye opening in a lot of ways because it’s so unlike anything I’d ever seen before in the United States, I personally wondered if any EMS system in the United States could compare because the entire system is different. One is socialized medicine and one has a healthcare system that is highly complicated. So to be in an EMS system that operates at such a high level and tackles problems that other EMS systems don’t even attempt to tackle and do it so well and, you know, one of the forefathers of Community Paramedicine, their advanced practice paramedic program, which was up and running and doing some pretty spectacular things early on, it was really awesome to see a US EMS system that I would put on par with any EMS system. It just was really, really interesting. I guess to be honest with you, of course, I personally liked social media in Instagram and Facebook and things like that but I’m not a Twitter man like Ted. So I guess I enjoy – they made fun of me for blowing up Instagram the whole time I was there but I was really having fun doing that and they would make fun of me because those two were taking pictures their cameras constantly and I’m taking pictures of the people we’re interviewing. So that’s the difference between the host and the director of photography.

Jamie Davis:         But it really, I think, highlights why you and Ted are such a great team to go in and do this project and others like it is that you bring that multiple viewpoints. Tom, you’re looking to interview and tell the story that they’re wanting to tell you on at that time. Whereas Ted has got an eye towards the entire project and he’s starting to put it together as new footage is coming in to his camera. He’s starting to put this together in his head and see how everything’s going to fit. You guys have come up with such a tremendous product.

Tom:                     Well, a lot of stuff ends up on the editing room floor, God knows. And Ted is a very, very accomplished editor in my opinion. He does a very, very good job not just with the photography but for stitching together the narrative. There is a ton of emails that go back and forth and discussion and long phone calls and sometimes some tears when we work out what the narrative is and how it’s going to go but I think it’s a credit to our respect for one other that we get through it and, at the end of the day, it’s no hard feelings. And I think the product ends up pretty darn good.

Ted:                      Yes, I would agree. Ultimately, this is – the hardest part for me is knowing that if I could edit all of the footage into something and create all of this amazing content, there is so much. We had over – when I got done importing all the content, we had just about 4 terabytes of content that will be shot with two cameras. Actually, it was more than that. We had five cameras at any one time going depending on what situation called for. So it just made – the challenge here at this point is going to be making sure we do justice to a system that we both have respect for.

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That is going to wrap of this segment and episode of Innovations in Patient Care. Stay tuned for more segments from the top health care, EMS and nursing conferences this year as we continue to focus on ways that healthcare professionals just like you are providing innovative care and improving patient outcomes all the time.

Thanks again to Physio-Control for sponsoring this and other episodes of Innovations in Patient Care. Make sure you say thank you to them on Facebook or Twitter for helping me bring you some of the best in health care innovators every year.