CHRISTIAN EMS RECEIVES MEMSA PRESIDENTIAL LEADERSHIP AWARD
Frank Seavert, Kendell Jones, Christopher Wahoski, Aj Ventimiglia, Michelle Moffett, Jen Royer, Karl Parks, Brian Bruemmer, Joe Siegfried, Joshua Malson, Patricio Renner, Nathan LiveLee, Wes Jansson, Ian Breden, Kerri Jansson, Matt Fitzgerald, Nathan Brown, Christopher Jones and Jane Lubiewski.
August 20, 2015 - Christian Hospital EMS
ST. LOUIS COUNTY, MO. - Christian Hospital's EMS team was recently honored with the Missouri Emergency Medical Services Association (MEMSA) Presidential Leadership Award. This award is given out once a year by the MEMSA board president to the recipient of his choice.
Christian Hospital's EMS was recognized with this award for their response to the Ferguson unrest in August and November of last year.
'BROWN' DEMONSTRATIONS POSED CHALLENGE TO FERGUSON EMS AND FIRE
November 17, 2014 - JEMS By Gary Ludwig, MS, EMT-P
ST. LOUIS - EMS providers and agencies attempt to prepare for almost anything, particularly large-scale events and mass casualty incidents (MCIs). But how do you prepare for standing by or responding to the warm or hot zones of rapidly escalating and moving riots and protests? You can prepare for auto crashes, shootings, heart attacks and even mass casualties, but large-scale civil disturbances introduce unusual and highly hazardous obstacles for EMS and fire agencies.
The Ferguson (Mo.) Fire Department (FFD) and Christian Hospital EMS (CHEMS) were confronted with these issues when riots broke out on the afternoon of Aug. 9 after Ferguson Police Officer Darren Wilson shot and killed Michael Brown outside the Canfield Green apartment complex. Brown, an 18-year-old male, was shot six times. Race soon became an underlying foundation for civil disturbances and peaceful protests that lasted three weeks.
Allegedly, Brown was walking in the middle of the street with a friend when Wilson pulled up alongside him and asked the pair to move to the sidewalk. A fight reportedly broke out between Brown and Wilson and initial reports indicated Brown punched Wilson in the face and wrestled for the officer's gun.
Versions of the story vary, and there was no dash camera in the officer's cruiser that could record or document the encounter, which reportedly occurred in and around the vehicle. According to a The New York Times story detailing Wilson's testimony to a grand jury in St. Louis, Wilson's gun was discharged two times in the police car during the struggle.
Another report says Brown ran and Wilson drew his weapon after getting out of his police car in an attempt to stop Brown. Some witness statements had Brown raising his arms to surrender while Wilson shot him.
Police reports indicated Brown turned back to attack Wilson after initially running away. Wilson feared for his life, so he continued to fire his weapon until the threat was neutralized.
The grand jury is still looking into the shooting, but hasn't issued any findings or indictments yet. Regardless of what actually happened, the end result was almost three weeks of civil disobedience, looting and peaceful protests.
EMS & Fire Response
At the core of providing EMS response were FFD and CHEMS. Operating from two fire stations, FFD is the primary fire agency for the city of Ferguson. FFD does first response but not EMS transport - that service is contracted out to CHEMS.
CHEMS is a hospital-based EMS system that's the 9-1-1 provider for eight different fire protection districts and municipalities in north St. Louis County, which holds a population of approximately 250,000 residents. With 22 ambulances and approximately 108 employees, CHEMS is the third-busiest 9-1-1 provider in Missouri, answering approximately 46,000 calls annually.
A CHEMS ambulance crew was transporting a patient nearby the apartment complex when it came across the crime scene. A paramedic crew member got out to see if he could assist Brown, but realized after an assessment there was nothing he could do. The crew called for another EMS unit, waited until it arrived, and continued transporting the original patient.
Because of unrest at the scene, however, the second ambulance was ordered by the police to leave the scene and move to a staging area. The police then kept Brown's body at the scene for approximately four hours while they conducted their investigation, which further agitated crowds as the word spread.
CHEMS Chief Chris Cebollero, NREMT-P, arrived some three hours after the initial shooting as events were escalating. He immediately realized the significance of the situation as the crowd grew to the ambulance staging area.
Using his years of experience, Cebollero emphasized the seriousness of the situation to the young EMS crew and supervisor who were already at the scene. He told them situational awareness was something that should be in the forefront of their thoughts.
Cebollero began looking for another staging area that would provide better safety from the angry crowd, as well as ingress and egress for the crews. According to Cebollero, "The challenge was, where do you set up an EMS staging area when the crowds kept growing and becoming more restless while holding signs that said, "Kill the police' and, 'Stop murdering us'?"
After the body was removed from the scene, the crowds grew in size and became more disobedient, and people began throwing rocks and bottles at ambulances. In some cases, the crowds intentionally blocked fire engines and ambulances from getting to scenes.
The police came out in force the first night and formed lines in an attempt to control the crowds. The CHEMS ambulances were within 10 - 15 feet of these police lines. At this point, Cebollero feared for the safety of his crews and decided to move them to another location.
There were some injuries to police officers and demonstrators the first night. The EMS response to these individuals took about 30 minutes, since it was unsafe to send ambulances into the hot zone areas. Task force protection was required, but the police were busy trying to manage the crowds.
The second night things escalated, and destruction included the burning and looting of several buildings. Fire and EMS crews could see buildings burning from their vantage point, but couldn't respond because fear of violence against them from the crowds was too high.
Importance of Communication
Adding to the confusion during the first four days was the issue of which law enforcement agency was in charge of the operation. It was technically the Ferguson Police Department's municipality, but St. Louis County Police took over the investigation and crowd control because it's a much larger agency.
Missouri Governor Jay Nixon also added to the confusion by sending the Missouri State Highway Patrol in to take control. Much of this information wasn't getting back to fire and EMS, and they couldn't develop tactical plans.
Initially, there was no unified command system in place and planning meetings didn't occur. Interoperability between police, fire and EMS was a challenge because the ability to communicate over radios between was problematic, according to Cebollero.
Ray Kemp, an EMS journalist who was on scene most nights, said, "I was getting most of the information that EMS needed for their operations by following the protestors on Twitter as they tweeted out different messages on what streets they were blocking or other activity."
After several consecutive nights of looting and structural fires, it was apparent civil disturbances weren't stopping, so a joint command post was established.As the situation escalated, CHEMS began staffing five extra ambulances each night for about eight days. All five of these ambulances were staged at the joint command post and deployed as needed.
Even though most of the violent activity occurred at night, there were still areas where CHEMS wouldn't send an ambulance during the day - even on 9-1-1 calls - because of concern for the safety of EMS crews.
CHEMS did have some "force protection," whereby police officers were assigned to respond with ambulances. However, other law enforcement commitments meant this wasn't always available, and when it wasn't, Cebollero had to personally make the tough decision whether to send an ambulance.
As Cebollero describes it, "We had rocks and bottles being thrown all over the area, as well as several gunshots [being fired], and my goal was to make sure our personnel went home at the end of their shift."
Cebollero attempted to acquire body armor to further protect his personnel, but to his dismay discovered it would take six weeks or more for the vital equipment to arrive. Thankfully the St. Louis Police Academy came to his aid and loaned him 30 pieces of body armor for CHEMS personnel to wear.
Despite the added protection, some areas were just too violent to expose EMS personnel to. In several instances, CHEMS wouldn't respond to some of the warm zones and had patients brought to the command post where EMS and fire were staged. Ironically, 9-1-1 calls dropped approximately 20% during the 19-day period of unrest- not only in Ferguson, but in the areas surrounding Ferguson.
Things became so dangerous that, on at least two occasions, protestors began marching toward the command post with the potential of overrunning it. Police fired tear gas in an attempt to disperse the crowds, but in the event the crowd was successful, law enforcement officers gave EMS personnel batons and instructed them to "do the best they could to defend themselves." Thankfully, the police were able to stave off the crowd.
Each morning, CHEMS leaders would hold morning breakfast briefings with the EMS crews, but soon became concerned about the stress the crews were under and their mental well-being. To assist them, mental health counselors were brought in to these morning sessions.
Mutual aid from other surrounding fire districts and municipalities didn't occur until about the ninth or tenth day.
Cebollero said the surreal moment came when he saw President Barack Obama talking on television about Ferguson. "Here's a guy who talks about the economy, terrorists and other things, and now he was talking about Ferguson," Cebollero said. It was at this point where the realization of how big this event was became apparent.
At the end of the initial 19-day period in Ferguson, CHEMS had transported approximately 70 patients. The medical nature of the complaints ranged from gunshot and rubber bullet wounds, stabbings, and hyperventilation to heat exhaustion.
As sensationalized as this event was, Cebollero fears this will become the norm when shootings of this nature occur. He believes EMS personnel should be better prepared on situational awareness issues and that they should perform practice drills well in advance of such events.
CHRISTIAN HOSPITAL EMS TO RECEIVE NATIONAL AWARD FOR EXCELLENCE
September 17, 2014 - EMS WORLD MAGAZINE
CLINTON, MISS. - The National Association of Emergency Medical Technicians and EMS World announced the recipients of the 2014 National EMS Awards of Excellence. We congratulate the following recipients and recognize their outstanding achievements and contributions in EMS:
Christian Hospital Emergency Medical Services (CHEMS), St. Louis, Missouri: 2014 Dick Ferneau Paid EMS Service of the Year, sponsored by Ferno
These awards will be presented at the NAEMT General Membership Meeting and Awards Presentation on Tuesday evening, November 10, in Nashville, TN., and the following morning at EMS World Expo's opening keynote and awards ceremony. The winners will also be profiled in the November issue of EMS World Magazine. Learn more about the 2014 recipients:
Christian Hospital Emergency Medical Services (CHEMS) provides 911 and inter-facility patient transport to the St. Louis area, serving more than 250,000 people and responding to approximately 25,000 calls annually. Its fleet consists of 16 ambulances and two command/triage vehicles staffed by 60 full-time first responders and 40 on-call responders, and seven full-time dispatchers. CHEMS takes a proactive approach to continuing education, offering an array of opportunities for providers to further their education and enhance experience. CHEMS has advanced hospital-based mobile integrated healthcare (MIH) in the community, decreasing emergency department admission of non-emergent patients by 11 percent, and assisting patients to find primary care physicians. In addition, CHEMS focuses public education efforts on teaching children about 911 and emergency situations through its "No Panic Please!" program.
Nominees for the Service of the Year Awards are scored on the following: advances in EMS education and training in the agency; innovations in prehospital care and protocol development implemented by the agency; medical community involvement with the agency; EMS system/program upgrades implemented by the agency; worker safety and well-being programs implemented by the agency; injury- and illness-prevention projects implemented by the agency; and public-education project sponsorships the agency is involved in.
NEW EMS PROGRAM FUNNELING HUNDREDS OF PATIENTS TO PRIMARY CARE
May 6, 2014 - KSDK
ST. LOUIS COUNTY - An important follow-up story to a chronic problem for a local emergency medical system.
Last year, 22 patients used Christian Hospital's 911 system more than 600 times. In February, a new program was put into place to try to reduce the number of repeat callers.
Terrell Jones was one of those callers.
"I was in there a lot," said Jones.
Last year, Jones called Christian Hospital's 911 system almost 50 times. His emergencies were brought on by the pain of sickle cell disease.
"My disease," said Jones, "there's no telling when it will happen."
But in the past three months, he's only needed to go to the emergency room twice. During the time, Jones began working with Christian Hospital Advanced Practice paramedic Derek Mollett.
"It's all about working with the patients," said Mollett.
Where Mollett was once taking patients like Jones to the emergency room, he's now making some house calls. He's connecting patients who don't have regular doctors to primary care.
Christian Hospital calls this the Community Health Access Program, or CHAP for short. Half of the week, paramedic Mollett still runs 911 calls. But the rest of the time, he's following up on those calls, helping his patients to doctor's appointments, reduce stress, even quit smoking. All issues that lead to numerous 911 calls in the first place.
Since the program started in February, hundreds of patients like Terrell have been helped. CHAP has navigated more than 1,800 patients into getting regular medical care. And the progress is measurable.
"We've seen a seven percent decrease in our non-emergent volume in the E.R.," said Chris Cebollero, chief of Christian Hospital's EMS. "We've seen a seven percent decrease in our non-emergent volume to the hospital through our EMS from the field."
And a 22 percent drop in calls from frequent 911 users like Jones. Cebollero was expecting some push-back.
"But we find people coming in saying, 'I don't want to go to the ER, I want to go to that place you've got upstairs,'" said Cebollero.
It's a starting place, where symptoms can be managed before they become a crisis.
"These are people that really need our help," said Mollett.
The Community Health Access Program, CHAP, still doesn't have funding. But a number of insurance companies have reached out since February, asking how they can get involved.
ST. LOUIS COUNTY - If you have a medical emergency, you call 911. But we were shocked to find one woman alone visited Christian Hospital's emergency room 241 times in 2013.
Twenty-two patients went to Christian Hospital's emergency department, called emergency medical services (EMS), 600 times in one year. That's one of the reasons starting Monday, Feb. 3, north St. Louis County will see a huge change in how it gets its emergency medical care.
NewsChannel 5's Kay Quinn took an in-depth look at what it means for you.
THE FUTURE OF HEALTHCARE
When you hear an ambulance siren, you know medical help is on the way. Christian Hospital's EMS covers Black Jack to Ferguson, saving lives over 300-square miles every day.
On a recent Thursday, we rode with Christian Hospital EMS to get a first-hand look at what some of the calls involve. During one call, a young patient ended up being taken to the hospital. She had a true emergency.
But Christian Hospital officials say not all patients who call 911 do. The system is so efficient, the people who run it say it's created a generation used to being taken to the hospital whether they need it or not.
"Since August," said Christian Hospital's EMS Chief Chris Cebollero, "22 patients have come to the E.R., or used EMS, 600 times. And one patient alone, 150 times in a year."
These are shocking numbers that raise an important question: Are the people of north county really getting the best medical care they can get?
Cebollero says when he asked himself that question, his answer was no.
"We're taking care of what's happening right there but we're not following up with their care," said Cebollero. "We're not getting them to the specialists they need."
So starting Monday, Feb. 3, Christian Hospital's EMS and emergency department will undergo a revolutionary change. If you're having a true medical emergency, like the patient we saw, you go to the hospital. If you're not, think of it as paramedics making house calls.
"If you don't have a medical emergency, we're going to see you in the ER now," said Cebollero. "But the next time you come, we may change the focus of how you're getting the care. So I think that's the first thing" patients are going to notice."
Here's how the new system, called mobile integrated healthcare, will work: dispatchers and EMS workers will still triage calls and patients like they normally do. But once EMS arrives, if there's not a true medical emergency, one of three things could happen: a patient could be treated at home, taken that day to one of two health resource centers where their medical concerns can be addressed immediately, or given an immediate appointment with a primary care doctor.
Even transportation issues to future appointments will be addressed.
"We will over time, and I will emphasize, over time, provide them with other resources and break that cycle of coming to the emergency department," said Ronald McMullen, president of Christian Hospital.
And by doing that, Christian Hospital is hoping to create a new cycle of health care.
YEARS OF PLANNING
The mobile integrated healthcare plan has taken years of development. A centerpiece of the plan is the opening of two health resource centers, one at Christian Hospital and one at Northwest Healthcare.
Instead of the emergency room, paramedics can take people who need medical issues addressed to these non-emergency settings. They'll be open from 11 a.m. until 11 p.m., seven days a week. Unlike an urgent care center, walk-up patients won't be accepted, and the plan is to eventually close the health resource centers once the demand declines.
But in the meantime, they will be used to connect people calling 911 with the immediate health care they need.
"We need to take more of a foundational approach to medicine," said Cebollero.
The goal is to treat the underlying health condition that prompts a patient to call 911. For example, a patient who feels short of breath may have few options but to call 911. A paramedic can rush to the patient's home and get them breathing easy again. If that person needs to go to the hospital, EMS would take them.
But if they don't have an emergency, under mobile integrated health care, the paramedic would get that patient to one of the health resource centers, or to a primary care physician who can prescribe a treatment regimen.
Future appointments with that doctor would be scheduled. Taxi vouchers could be given to patients without transportation. All of these steps could begin to cut the chances that patient will experience another terrifying bout of shortness of breath.
Future appointments with that doctor would be scheduled. Taxi vouchers could be given to patients without transportation. All of these steps could begin to cut the chances that patient will experience another terrifying bout of shortness of breath.
We're happy to take care of them at the ER" said Cebollero. "But is that what they really need? And again, we want to look at those numbers and say how can we keep you out of this, out of the ER, and out of being in an ambulance? Make you healthier and enjoy your life? And I think that's what's important about this program."
REACTION FROM THE COMMUNITY
Christian Hospital recently hosted a community forum on mobile integrated health care. During the meeting, stakeholders in north county, including school superintendents, religious leaders and law enforcement learned about the new system.
Captain Troy Doyle, commander of St. Louis County's north precinct, was in the audience. He says he likes what he hears about mobile integrated health care.
"Often times, law enforcement, we have to respond with EMS on some of the calls. Some of the calls are just minor scrapes and scratches," said Capt. Doyle. "But it does take law enforcement out of service for that length of time."
Capt. Doyle says eventually, the new system could reduce the amount of time law enforcement has to respond and be out of service.
Mike O'Mara represents the fourth district on the St. Louis County Council. He's also a Florissant resident and attended the forum. He says he was shocked to hear of the number of people who repeated use 911 in north county.
"If we can whittle those numbers down," said O'Mara, "it's going to be less burden on our hospital system here in north county. I think it's very positive, not just for north county but for the entire Metro area."
But for Chris Cebollero, the chief of Christian Hospital's EMS, the goal is helping the people in north county lead the healthiest lives they can.
"As an EMS provider, I don't want to be there on the worst day of your life, I want to be there to prevent the worst day of your life from happening," says Cebollero
HOSPITAL-OPERATED AMBULANCE SERVICE HAS COMMUNITY'S BACK
August 4, 2013 - St. Louis Post Dispatch
NORTH COUNTY - Christian Hospital is among the few private hospitals in Missouri to operate its own emergency dispatch center and ambulance system.
In addition to providing conventional lifesaving services, its ambulances are first responders to 911 emergency calls in several north St. Louis County areas - standing by to aid firefighters and also supporting police officers when they serve high-risk arrest warrants.
Christian's ambulance fleet also provides a "safe place" for residents who fear domestic violence, gang activity or other forms of bullying.
"The community knows that we're there for them all the time, and not just when they need medical care," said Chris Cebollero, chief of Christian's emergency medical services. "We cheat death sometimes, (but) hopefully we're not just there on the worst days of people's lives. We're an extension of this community's hospital."
The hospital-based ambulance service began in 1978 when the newly opened Christian Hospital Northeast campus collaborated with the nearby Black Jack, Riverview and Spanish Lake fire protection districts to offer 911 emergency services.
Since then, its ambulance fleet has grown to 20 advanced life support ambulances and a staff of 125 paramedics, emergency medical technicians and dispatchers. The ambulances, strategically stationed at local firehouses and the hospital, serve eight North County townships and respond to 46,000 calls a year.
Christian's paramedics and EMTs work 24-hour shifts, and during that time period they are usually running calls 14 to 16 hours a day.
On average, the hospital's ambulance fleet responds to 130 dispatch calls a day, and roughly 70 percent of those calls result in a patient being transported to the hospital. Some patients are taken to trauma centers at Barnes-Jewish Hospital and SSM DePaul Health Center.
Cebollero is exploring new funding models and grant opportunities to begin an innovative program in North County to help patients navigate through the medical system.
Under one of his proposals, Christian would send a "community paramedic" to a person's home, rather than a costly and fully-staffed ambulance - unless immediate emergency transport appears to be warranted. That person would assess the patient's condition, then arrange a follow-up appointment with a primary care physician - and if needed, help arrange transportation for the patient to that doctor's appointment.
"People think that we're at we're at the intersection of gloom and doom," Cebollero said. "The way I see it, we're at the corner of opportunity and success."
CHRISTIAN HOSPITAL EMS PROVIDES AMBULANCE SERVICE TO NORTH ST. LOUIS COUNTY FIRE SERVICES
May 06, 2013 -
NORTH ST. LOUIS COUNTY - Christian Hospital Emergency Medical Services (CHEMS) provides 911 and inter-facility transportation to the St. Louis metropolitan area.
Initially, north St. Louis County was served by the St. Louis County Emergency Medical Services. In an effort to provide more efficient ambulance services, the Spanish Lake Fire Protection District, the Riverview Fire Protection District and the Blackjack Fire Protection District joined forces in the early 1980s to offer an ambulance to Christian Hospital.
Today CHEMS provides primary 911 emergency services to north St. Louis County fire districts and communities serving more 250,000 people, including:
- Blackjack Fire Protection District
- Spanish Lake Fire Protection District
- Riverview Fire Protection District
- Metro North Fire Protection District
- Mid-County Fire Protection District
- Kinloch Fire Protection District
- City of Ferguson
- City of Berkeley
- Backup 911 services to the Florissant Valley Fire Protection District and the city of Hazelwood
There are approximately 25,000 calls for CHEMS annually
CHEMS is the third-busiest 911 provider in the state of Missouri
CHEMS provides inter-facility transfers in and out of Christian Hospital and Northwest HealthCare
Our fleet consists of 16 ambulances and two command/triage vehicles
We employ 60 full-time first responders and 40 on-call responders
There are seven full-time dispatchers providing services for CHEMS and Alton Memorial EMS