This episode is sponsored through the generous support of Physio-Control. Find out more about how they are helping health care professionals innovate and improve outcomes in health care at Physio-Control.com or look for them on Facebook and twitter.

This week on the show, I got the chance to sit down and talk again with health care social media and video innovators, Ted Setla and Tom Bouthillet. This week we pick up with part 2 of the segment we recorded earlier this month. We pick up where we left off earlier this month with part 2 of a 2 part special segment on their upcoming Code STEMI episodes recorded recently in Wake County, North Carolina. You can follow all their previous episodes and be ready to catch their new episodes over at CodeSTEMI.tv. Check it out.

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Jamie Davis:         Ted and Tom, welcome back to Innovations in Patient Care. We spoke last time about some of the logistical things, the behind-the-scenes look of you guys going in and doing a Code STEMI episode in a featured system like Wake County, North Carolina. But I want to talk a little bit about what you picked up because there were some exciting things going on down in Wake County and they really – when you talk about premiere EMS systems in the United States, they are always there in the top five. Anybody mentions them that knows what they are talking about. So I guess you guys really – Ted, you were really, I guess, just honored to be invited to come in and take a look from the inside out.

Ted:                      Well, I want to start with both Jim Albright and Jeffrey Hammerstein, both from Wake and Guilford Counties, both of them, to me, are tributes to what their systems are all about. They have the personalities, that magnetism if you will, to understand that it’s not without a great humility as well as vision that they work the way they do. I applaud both of them for being able to come on camera, tell their story, answer some extremely difficult questions. We drilled them in ways that, to be honest with you, I don’t think you wouldn’t do unless you were a political opponent. Well, we wanted to get the hardcore ideas from them on why their system works so well and what they’re doing to be leaders in a community of which they may not think that they’re doing anything too spectacular but to the rest of the world they are.

Jamie Davis:         Tom, was there something that when you first got there that you were looking for to learn from Wake County and going down to North Carolina for this trip?

Tom:                     Well, I think before we went, I was actually filled with a certain amount of pre-sentiment that I hope I wasn’t let down. I think I had so much respect for Wake County that I was worried that I might have them up on a pedestal and I was wondering if they could live up to my perception when I got there. So I made up my mind that I was going to try and judge them according to their own merits and not try and have unfair expectations and at the same time I think they were trying to keep our expectations low. Either that or they just truly are just extraordinarily humble people. They said many, many times to us, “Guys, we’re just human beings. We are just an EMS system. We put our hands on one leg at a time. Yes, we do some cool stuff but at the end of the day we render emergency treatment to the sick and injured and take them to the hospital just keep that in mind.†And so with that said, they are everything I thought they were and more. I was extraordinarily impressed with both systems, in fact, with Wake County EMS and Guilford County EMS.

Jamie Davis:         It sounds like they made quite an impression on both of you just in the conversations we’ve had just in this segment and the one we did last time. Tell me a little bit, Tom, about how they started you off in the system there? What were you starting to look at as your first segment to start getting up and look at this picture how this system is better than some of the other systems that are around the country?

Tom:                     Well, it’s actually kind of a funny story because our first morning there, we were setting up the first shot and while that happened, Jeff Hammerstein said, “Hey, guys, there’s a sudden cardiac arrest at the North Carolina State Fair, what do you want to do?†And I think his head was spinning because we were breaking down equipment and shoving it in the back of his SUV, so that’s what we want it to do, is go film it. But they, actually, a bike medic got on scene first and then they assembled a greater crew. It’s hilarious because in my department we call that “pit crew CPR.†In Seattle, they call it the “Choreograph model.†They just call it the way they do things. They don’t have fancy titles for it. They just do it. Before we knew it, the patient had the pulse back and had received the 12-lead and it was STEMI and they were on their way to Rex Hospital. So we did a U-turn but the State Fair was so close to Rex that by the time we got to the emergency department, the patient had already gone to the cath lab. So we did a quick down-and-dirty interview with the crew that had been on the call and then we went up to the cath lab and the patient had already been cathetered and was in the ICU. So we went to the ICU and finally found the guy and he was awake in his ICU bed. So that was a pretty spectacular way to spend our first hour. It was like, “My God, it’s a pretty auspicious beginning. We hardly been here and we kicked it off with a cardiac arrest survivor.†It was pretty remarkable.

Jamie Davis:         And that’s a good look at door-to-balloon time because you guys were chasing him all the way through the system.

Tom:                     You got it. Exactly right.

Jamie Davis:         So what can a system outside of Wake County – you said, again and again, they just kept saying that “This is the way we just do things. We’re not anything special†which says to me that there are other places around the country that could be doing the same things and having the same numbers. What are some of the lessons learned that you guys picked up doing the segment?

Tom:                     Well, I’ll let Ted speak to that as well but, I think, first and foremost, it’s many things that you and I have discussed on this podcast before, Jamie. First of all, they’ve made it their explicit goal to offer prompt compassionate and clinically excellent care to the citizens of Raleigh and Wake County. So that is their guiding force and certainly they have a world-renowned medical director and EMS director in Brent Myers who kind of is the coach and kind of sets the strategic goals for his deputy directors. But I’ll tell you what, they really respect their people. So they don’t – if you’re a new medic, they don’t just throw you to the wolves. They give you the after-market education and training that you’d need. They don’t partner you up with another person who’s inexperienced. You have access to advanced practice paramedics and district chiefs out in the field. They really set their people up for success and they have a culture of learning. Whereas, in Guilford County EMS, he flat out said, “We have a no-blame culture here.†So they’re really just out for continuous quality improvement and they spend all their time imagining how they can do it better. And I think it sounds so basic, it should be a no-brainer, I think if more EMS system started there, they also would have excellent results because it’s not a secret. All of these systems, whether it’s the LAS or Wake County or King County or Austin Travis County or Hennepin, you name it, the top EMS systems in the country, if you call them and ask, they’ll tell you how they do it. They’re happy to share their best practices. And so that, being the case, it’s out there for those who seek it. And so Ted and I have the privilege of going in to some of these systems and we don’t have to take anyone else’s word for it. It’s really fun for me. I’m like a kid in the candy store. If I want to know something about how they started double-sequential defibrillation, I’ll just ask Brent Myers on camera. So it’s pretty neat. It’s pretty awesome opportunity.

Ted:                      And I’m also saying that part of – speaking from the top-down, part of what’s – what it’s kind of made it clear as I keep going through the edits here, the interview with Brent Myers was very clear. He said when he went out to basically pitch what his system needed to do, the one thing that rang through for him in this whole system development was that the board members of the city, of Wake County, they get it. They understand that ultimately they’re held to one standard and, that is, to improve patient survival and to take care of patients. And when he delivers that report every year on what they’ve done, the city recognizes, the county recognizes just how much improvement they’re making. They don’t tell him how to spend his money. He even mentioned before that they had to cut back on budgets because money wasn’t coming in. One of the things that they were able to do is reduce ambulance hours without reducing training hours. Through attrition, they were able to do that. Now that, from a system status standpoint, how do you do that without really causing an uproar. I think the true the testament to their system was that the medics, when they were asked about whether or not if they wanted to reduce their training hours, there was a near-uproar in the system, as he put it. And he says that that’s just one area in which having a one-on-one face-time with Dr. Myers, as they all get at least eight hours – I think it’s eight hours every quarter – they come together and they talk about every aspect of what’s going on in the system, challenges they face, things that they may need to do to improve, how they’re prepared or what they’re doing on these calls. And that face-to-face time is invaluable to this people.

Jamie Davis:         It sounds like, as you talk about this system, that it really starts at the top and has this effect of him setting – Dr. Myers’s setting stage for everything else in the system. I assume that that goes well, Ted, not just for the EMS system but there has to be some coordination with the overall healthcare system and hospital system as well.

Ted:                      I certainly would have to say, in all hospital systems, while there is a competitive nature to them, I’m pretty darn impressed with just how much their hospital-based system and there is a doctor in charge of training over there. His name is Graham Snyder of which he has made a significant contribution to not only the training of their residents and everybody in hospital but they bring medics from the field in on these training scenarios and make it as real – the investment into this training, the simulation lab, it’s amazing. Absolutely amazing. And that is his job, is to make sure that the first time that any of these medics and/or doctors see something, it isn’t the first time and they’re very comfortable. I was overall impressed with just how much commitment he has to the overall training of both hospital and pre-hospital.

Jamie Davis:         What about the patients themselves? I know you do a lot of interviews because you give this system-wide picture, taking a look at the whole project. You mentioned in the last segment that there was a wife of a patient that was trusting giving you guys a certain amount of trust that you’re going to represent their story well. But you hear the patients talk about the system that they’re living within. Do they have an understanding of how good the system is when compared to other places or do they just have this blind trust that they’re going to dial 9-1-1 and get the best that they can get?

Tom:                     No. They had no idea. I asked that question a lot and said, “Well, did you guys even realize that you’re being cared for by one of the best EMS systems in the country?†They said, “No. We’re very grateful for what they’ve done but we have no idea.†I thought that was a very poignant thing. Now, Brent Myers wasn’t surprised. He said a couple of times people have no idea. You would think they would. Like I wonder in Seattle they probably know they got King County Medic One although I know they occasionally vote on a ballot to fund it and things like that. So I don’t know. Maybe it’s just one of those things that people know what an EMS system is not doing it right because it’s on the front page of the local rag or if the system is really in shambles or has had a high profile problem or if  someone’s broke the law. But I was pretty surprised how many people didn’t appreciate how awesome EMS was in the city of Raleigh. They were happy to find out. And especially, obviously, once their lives are touched in a very personal way, they’re very grateful. Prior to that, can you think of anybody, Ted, that said, “Yes, I knew we had an all-star system here.â€?

Ted:                      Not one. I think that just us being there trying to explain to them – they had been interviewed by news, some of them by the news. They’ve been telling their story time and time again. I think what really rang true and we sat there going, “My goodness, this is a commercial, was†– the lady, the wife of the man who was still being cooled in the ICU as we were sitting there talking to her, trying to understand what she was going through, just because this happened a couple of days earlier and how her reaction to not only the EMS crew but the hospital crew – she was just a walking billboard of just – “This people just care. They made it very clear that I was a priority.†And just all the things that – what’s the quote? People always remember how they made you feel but they don’t care whether or not what you did for them as long as you made them feel as if you’re number one. Well, Wake County and the whole EMS system did both. It was very evident in that interview because it was so live for her. She was feeling it right then.

Jamie Davis:         So what’s next for Code STEMI? Obviously, we’re waiting for the episodes from Wake County to come out. I know, Ted, you’re working on that. I don’t think people really appreciate the challenges that come with trying to put all of those hours and hours of video footage together and come out with a discreet story that can tell what you saw in some way. Obviously, you still have your eyes on horizon. Are there other cities that you can talk about that maybe coming along its potential destination?

Ted:                      You know what, I direct this mainly towards other filmmakers, other paramedics out there, other system administrators, other chiefs of EMS, medical directors. All of which, I think what Code STEMI has made us realize is that there is so much in an entertainment world where you’re able to go in and kind of get a viewer or an immersive experience of a system based on the personal stories that are developing that system and are frightful of what they built. When you’re able to do that, it changes not only the commitment, I think, from the people within because they understand that their system had been able to achieve certain success but it also tells the world, “Here are certain aspects of what makes our system go well. We would like to share that, so that way the entire EMS and healthcare community can benefit. I implore other systems out there if they are interested in having their system profiled or understanding what it is that we’re doing to contact us. Because I think that there’s an open door here, an opportunity, with other system to make an amazing educational, yet, entertainment-based concept that will help justify what they’re doing for their community. And I think that’s something that we need to kind of let everyone know. It’s not just a one-size-fits-all. It doesn’t matter how big or small your system is, there ultimately a lot of people out there who are anxious to learn how they can improve their own system.

Jamie Davis:         Tom, any final thoughts that you’d like to share with potential future project systems out there, the stories you want to tell in the future?

Tom:                     Well, I think it’s one of those deals, Jamie, where Physio-Control kind of took a leap of faith with Ted and I because when they bankrolled us going out to these system, I’m pretty sure it comes out of their marketing budget. Most of the time marketers want to see what their return-on-investment is. It’s proven to be, I think, a little but elusive or difficult to quantify the return-on-investment for Code STEMI. But, on the other hand, I think it’s important to acknowledge that Physio-Control has really done a tremendous service to the medical community at-large by featuring these best practices and high-performing systems of care, if nothing else. So I don’t know long-term what is going to happen with Code STEMI. Certainly, Ted and I would like it for to continue and we certainly are very grateful for everything that Physio has gone up to this point. So there’s absolutely more systems that we would love to go feature but I think we’re just going to kind of take it one system at a time and make sure that we do justice to the ones that we’ve already been to.

Jamie Davis:         And we can find Code STEMI still over at codestemi.tv, is that correct, Ted?

Ted:                      That’s correct.

Jamie Davis:         I noticed you have a new kind of website set up. You’re over at realhouse.org but you can go to codestemi.tv, it’ll take you right to that page and you can watch the episodes from Code STEMI London and be ready for the new episodes from Wake County when they come out.

Ted:                      Absolutely. Yes, we’re putting out the trailers first in probably the next month and then from there we’re going to have a date set for the release of the episodes.

Tom:                     And Guilford County too, Jamie. They’re doing some awesome things with the LUCAS device there.

Jamie Davis:         Oh, fantastic. Well, we want to thank you guys. We want to, of course, thank Physio-Control for their continued support of Code STEMI and of this program, Innovations in Patient Care, and without them helping us to tell these stories of advanced care and standards of care, we really wouldn’t be able to pass this message on and help everyone improve patient outcomes.

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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.

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.