By KEN LEISER
On July 10, Dr. Kacey Kronenfeld was called early on to the scene of a deadly gas leak explosion in downtown Sun Prairie, Wis., a suburb of Madison. The regional EMS medical director for SSM Health in Wisconsin arrived in a Ford Police Interceptor outfitted with emergency lights, sirens and supplies to treat patients in the field.
Kronenfeld
"They reached out and requested my presence early in the event as the situation unfolded and there were still a lot of unknowns," Kronenfeld said. "Having our specialized vehicle allowed me to quickly and safely respond with a wide range of potentially necessary medical equipment."
Since she stepped into her role in July 2017, Kronenfeld has focused primarily on identifying the most pressing needs in the delivery of prehospital medical care and the education and training of EMS professionals in the south-central Wisconsin region.
To that end, the specially equipped physician response vehicle has served as a mobile education lab for Kronenfeld and her team after its introduction in May. But the vehicle's function has expanded to provide Kronenfeld with the means to respond to emergencies when needed, as well.
Dubbed MEP-1, the acronym serves both of the vehicle's functions interchangeably — Mobile Education Program and Mobile EMS Physician.
First contact
SSM Health in Wisconsin and Madison Emergency Physicians developed the Pre-Hospital Medical Program in partnership. The physicians group is a private practice that staffs seven emergency facilities and one urgent care in southern Wisconsin.
Firefighters and other rescue crews at the perimeter of a July 10 gas leak explosion in Sun Prairie, Wis. The explosion leveled a building and damaged others, ignited a major fire and resulted in the death of a firefighter and injuries to others. Dr. Kacey Kronenfeld, regional EMS medical director for SSM Health in Wisconsin, was called to the site to be resource for first responders. Amber Arnold/Wisconsin State Journal
The organizations sought to improve the quality of care starting from the moment an EMS agency comes in contact with a patient in the field. Kronenfeld's team, which includes Stephanie Lehmann, EMS regional coordinator for SSM Health and Dustin Weber, SSM Health regional EMS education coordinator, is working with three SSM Health hospitals and a freestanding emergency department. Both Lehmann and Weber are licensed paramedics. (SSM Health recently has grown to include four additional hospitals that have not yet been incorporated into the program.)
"It is recognition that patients' care and their management from that first contact with EMS absolutely plays an integral role in the outcomes for that patient," Kronenfeld said.
The EMS Program has several goals, but education and training remain top priorities. Education and training, Kronenfeld said, are among the most powerful tools to influence the level of EMS care the communities receive. With that in mind, Kronenfeld's team are working to develop curriculum and additional training opportunities.
The training includes medical mannequins capable of simulated bleeding, crying and mimicking a seizure; online education modules; and in-person lectures from physician specialists employed by SSM Health. For instance, obstetricians have taught sessions on emergency situations related to childbirth.
Because the service area of the SSM Health system includes rural, suburban and urban markets, EMS service providers include volunteer departments and professional departments where full-time licensed paramedics respond to thousands of calls each year. That reality defies a one-size-fits-all approach to training, Kronenfeld said.
Kronenfeld stressed the importance of being in the field to better understand what is happening on the front lines "with our crews, with our community." Working in the field also helps her team get to know the EMS crews personally so those crews feel more comfortable raising questions or concerns.
Nationally, it is not uncommon for EMS physicians to conduct training in the field, said Rachel Nathanson, communications manager for the National Association of EMS Physicians. Sun Prairie EMS Chief Brian Goff said that in many areas around the U.S., medical directors can come out to the scene. "In this particular area of the country, it is not a very prevalent thing."
Field medicine
In an October 2017 position statement, the EMS physician association recognized that part of the practice of emergency medicine by EMS physicians "can and should include the performance of clinical interventions in the field." Examples include more advanced procedures such as invasive airway management, amputation of an entrapped limb or the performance of an emergency cesarean section at or around the time of the mother's death.
"While these interventions vary in complexity and may not be distinctly unique to the practice of EMS medicine, it must be recognized that the environment in which such interventions are performed is distinct to the practice of EMS medicine," the group said in the statement.
Goff said his agency called Kronenfeld to the scene of the gas line explosion in Sun Prairie to triage victims, make critical medical decisions and ensure one hospital wasn't inundated with patients. The explosion, which claimed the life of a Sun Prairie firefighter, resulted in nearly a dozen injuries and damaged or leveled several buildings. Kronenfeld helped tend to a couple of first responders injured on the scene and functioned as a resource throughout the incident.
Kronenfeld said it is "a rare thing," for her to work in the field alongside first responders, and she expects that will hold in the future. "Really, the goal is to build a system where we are not needed out there," she said.