Pre-Hospital Care of the Mechanical Circulatory Support Device Patient

Dennis Rivard MA, CCPMid-Atlantic Region Pre-Hospital

MCS Task Force

Sept 11, 2001

An MCS Coordinator, a Flight Nurse, and a Patient

Meeting of the Minds• Advances in medical technology is exceeding the

community’s ability to safely manage patients with this technology

• Decision to set up meeting to work more closely• Meetings would be multi-disciplined• Goal to create a method of identifying and

provide basic management information• Bring MCSD centers together to work smarter

MARPH• Covers Virginia, DC, and Maryland• Meet monthly• Core hospitals– Virginia Commonwealth University Hospital– INOVA Fairfax Hospital– Washington Hospital Center– Johns Hopkins Hospital– University of Maryland Medical Center

Basic Tenets

• Do not prescribe medicine• Not certifying or credentialing any clinicians• Compromise• Listen to the experts (EMS)• Collaborate whenever possible

The Motley Crew

Participants

• MCS Coordinators• EMS providers (ground and flight)• ED medical team members• Heart Failure Cardiologist• Cardiac surgeons

Field Guides

• Designed to provide consistent and reliable information to first responders

• Pump systems assigned a color• Colors are present on guide, labels, and

luggage tags• Electronic PDF files• Updated annually

Color Guides Coding

• Dark Blue Heartware• Orange Heartmate II• Jarvik Lavender• VentrAssist Green• Thoratec PVAD Light Blue• Heartmate XVE Yellow

Guide Design• Separate cards for each device– Allows for multiple uses– Can be separated and used separately

• Color coding encircles each card• Color is printed along the edge– Allows to be photocopied– Eliminated confusion for color-blind first responders

Field Guides

• Each a little different in design• 10 questions• FAQ section• Emergency step by step troubleshooting

section with pictures– Changing batteries– Changing controllers– Alarms

• Two sided laminated and bound

Heartware and Heartmate XVE

VentrAssist and Heartmate II

Thoratec PVAD and Jarvik 2000

Guides 10 Questions1. Can I do external CPR?2. If not, is there a hand pump to use?3. If device slows down (or goes into a low flow state), what

alarms will go off?4. How can I speed up the rate of the device?5. Do I need to give heparin if the pump slows down?6. Can the patient be defibrillated? 7. If OK to defib, is there anything that must be

disconnected prior to defibrillating?8. Does the patient have a pulse with this device?9. What are acceptable vital sign parameters?10.Can this patient be externally paced?

Tags and Labels

• Label controllers and tag bags• Follows same color coding system• Information on tag is for specific implant center

contact information• Tags state:– Name of hospital– MCS Team contact information– Color code of device– Type of device

Tags

• Side one– Patient’s identification– Implanting hospital– Emergency contact info– Color code tape

• Side two– Type of pump– Color code tape– Written color code

Additional Uses

• Non-MCSD trained units• Emergency Departments• Patients• Rehabilitation centers• Out-Patient Dialysis Centers

Launch of Field Guide Program

• Multi-state EMS training opportunity• Target audience was EMS educators and team

leaders• 6 stations (one for each pump presented)• Patients with specific pumps at each station• MCS Coordinator at each station• Hands on exposure• Used field guides as outline for presentation

Mechanical Circulatory Support Organization (McSO)

• National organization• Multi-disciplined• Grant funded• Linked to other related organizations

National Training Program

• If we don’t do it, someone will• Expected surge in MCSD patients once DT is an

FDA approved therapy• Opportunity to provide consistent messages• Safe for our patient to travel throughout the US• First national launch in San Jose this October• Air Paramedic and Nurses National Meeting• Offering pre-conference courses

What Does the Future Hold???

• Need central resource center• Development of national information bank• One stop shopping• One phone number when placing a MCS

patient in their residence• Coordinator hot line directory

Questions