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Premier Health Care Services Physician Brad Cotton, MD, Champions Improvements to Pre-hospital Cardiac Care

August 1, 2008– Adena Regional Medical Center Emergency Department and Ross County Volunteer EMTs’ Work Together to Improve Pre-hospital Cardiac Care.

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Left to right: Premier Physician Steve Schneider, MD, Adena ED
Medical Director; Premier Physician Brad Cotton, MD, Ross/Vinton County EMS Medical Director; Bob Newland, EMS Liaison at Adena Regional Medical Center

A revolutionary change that will save lives and shorten door to balloon time for EMS-treated STEMI patients in Ross County and across Ohio was announced by Premier physician and Ross/Vinton County EMS Medical Director Brad Cotton, MD, and Adena Regional Medical Center EMS Liaison Bob Newland at the annual Ross County EMS Breakfast May 17th hosted at Adena in celebration of EMS Week.

The ruling, which went into effect on May 29, changes both the Ohio Administrative Code and the Ohio Revised Code, allows Ohio’s EMT-Basic personnel to acquire and transmit 12 lead EKGs. Prior to this ruling, only EMT-P personnel in Ohio and 48 other states across the nation were allowed to obtain 12 lead EKGs. “The problem,” notes Dr. Cotton, “is that EMT-P personnel are located primarily in metropolitan areas; whereas, over 70% of the EMS personnel in Ohio and across the nation are EMT-Basics in non-metropolitan areas.”

Dr. Cotton and EMS Liaison Bob Newland conducted a study from July 2005-July 2006 involving five volunteer EMS squads in Ross County. A total of 90 EKGs were transmitted via satellite phone to Adena’s ED, where the Premier ED physician interpreted the EKG. Five STEMI patients were identified, and the cardiac catheterization team was activated while the patient was still enroute from the EMS scene. Data demonstrated an average door to balloon time savings of 30 minutes.

The EKGs were also graded for readability and accuracy of lead placement, with scores over 95%. Scene time was recorded, and there was, in fact, a slight decrease in scene time. The study was conducted under the close supervision of the Medical Oversight Committee of the Ohio EMS Board.

Dr. Cotton and EMS Liaison Newland presented the study as a poster presentation at the Society of Chest Pain Centers annual meeting in Nashville, Tennessee in April 2007. Subsequent to this presentation, Wisconsin and North Carolina amended their EMS statutes allowing EMT-B acquisition of 12 lead EKGs.

Dr. Cotton gave an oral presentation at the National Association of EMS Physicians in Phoenix in January 2008, and the abstract was published in Pre-Hospital Emergency Care. Dr. Cotton notes, “We are also working with Dr. Howard Werman of the Ohio State University Emergency Department on submitting our research for peer-reviewed publication. We all recognize the implications of this research. Expanding the ability of EMS personnel to identify STEMI patients in the field will spur the development of regional STEMI systems with designated receiving hospitals and EMS transport protocols.”

Dr. Cotton has served as a Premier ED physician at Adena and EMS Medical Director for Ross County since 1998. Dr. Cotton has also served as an EMT-P for 25 years, from Kent to Cleveland EMS to Circleville, and he was also an ED RN. “It has been great to work with our Ross County EMS personnel; they are happy to have led the nation in this advance of EMS care.” Bob Newland, Adena EMS Liaison, and himself a STEMI survivor from the days of thrombolytics and fly-out notes, says, “Our local EMS personnel, us local volunteer “hillbillies,” as we are sometimes called, really are proud. We are glad we got to make a difference.”

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