EMTs: Online database will benefit patient care
Milton responders concerned about time it takes

By JACQUELINE CAIN | Staff Writer
jackie@miltonindependent.com

An electronic, state-mandated system for recording emergency medical services is coming to every EMS agency in Vermont by 2013. Milton Rescue is one of the first departments to swap its pencils for the web-based Statewide Incident Reporting Network, or SIREN, Chief Don Turner said.

Though some agencies, including Essex Rescue, reported into SIREN as early as 2009, all agencies in Milton’s district – those that primarily transport to Fletcher Allen Health Care in Burlington – implemented it as of October 1, Turner said.

SIREN replaces the hardcopy run sheets emergency medical technicians fill out to document emergency calls. All the information is stored in a protected online database, said Chris Bell, director of EMS and public health preparedness for the Vermont Dept. of Health.

In addition to the obligatory patient information and nature of the emergency, the system still includes a narrative section. EMTs can write it themselves, and they also have the option to turn the boxes checked into the written report, which can make the process easier, Assistant Chief Rod Moore said.

The statewide system was designed to provide the health department with a complete picture of Vermont emergency medical services, the EMS professionals said. The database allows EMTs to look at other agencies’ data, albeit anonymously.

“[With] the paper form which we had before, we couldn’t track anything,” Moore said. With SIREN, for example, “The state can look at the data to see where the flu is … which part of the state is getting hit worst.”

Turner added, “Essentially, [it will provide] better management of patient care and consistency in care.”

Bell said most states use a similar system. An online EMS database has been talked about for at least the 14 years Moore has been on Milton Rescue, he said.

SIREN allows the health department to quantify information, Bell said: “Whereas before we were just trying to do our best based on paper records, this will really provide data to make decisions about patient care and policy,” he added.

Turner, Moore and EMT-Intermediate Chris Burnett all said the online database is a positive change, but with any new technology, there are some bugs to be worked out.

In the few months that Milton has used SIREN, the average time for a call has increased, which is the major concern of Milton EMTs, they said.

“There’s a time period of learning, but right now that’s my major concern: How long the duration of call is, how long an ambulance is out of service,” Turner said.

Prior to implementing SIREN, the average emergency call took Milton responders an hour and a half from the time of the call until they go back in the station, Turner said.

With SIREN, calls have lasted two and a half to three hours, he said. With paper and pencil, EMS crews could work on the run sheet in the ambulance on the way to the hospital, Burnett added.

SIREN makes this a little more difficult. Because it’s a web-based program, SIREN requires an Internet connection to run.

Milton Rescue has one laptop, a hand-me-down Panasonic ToughBook from the Vermont State Police. Milton was fortunate to receive one, Turner said.

But the machine can’t access SIREN driving to the hospital. The state and Fletcher Allen’s doctors prefer EMTs complete the run sheet before they leave the hospital, so the volunteers use computer terminals there, Turner said.

Internet access is also available at computer terminals inside Northwestern Medical Center, the main hospital used by AmCare Ambulance Service, which serves Georgia, St. Albans and Fairfield. Milton Rescue occasionally brings patients there.

AmCare director Walter Krul said his ambulance technicians already use a digital data-entry system; AmCare’s software developer will share the data with the state before the 2013 mandate, he said.

But working at a computer station keeps the EMTs away from Milton an extra hour on average, Turner said. Milton already has one of the longest journeys to the hospital in the county, especially when ambulances need to reach patients off Lake Road, he said.

The state understands Turner’s concern, Bell said.

“Vermont has unique challenges of rural locations,” he said. “As long as the hospital receives the information necessary to continue a patient’s care, it’s acceptable for them to return to their service area so [it] still has ambulance cover available.”

Milton has two ambulances and also relies on Colchester for back-up, Turner said.

He acknowledged that as crews get used to SIREN, it will take less time to fill out the form. But the reality is the digital system requires more resources than paper and pencil, he said.

“If we get [remote access to SIREN] ... it would alleviate some of the concern I have,” Turner said.

Turner hopes to supplement SIREN with a program called FieldBridge, which allows for some data entry on a laptop en route to the hospital.

The program costs $1,400 with an annual $400 licensing fee, Bell said. The cost of FieldBridge as well as an additional ToughBook – $4,500 – is included in the proposed Rescue fiscal year 2013 budget Turner will present to the Selectboard, he said. The rugged laptops are built to withstand some extreme situations in which users like police and rescue agencies might find themselves, but Turner is considering other options because of the price, he said.

The Selectboard will discuss Fire and Rescue’s proposed budgets at a public meeting in early January.

Bell said the state is looking into funding sources for laptops and for FieldBridge. No state money to offset the costs to access SIREN remotely is available, he said.

On a recent Monday inside the Rescue station, EMT Carl Mesick used a personal laptop to type up a run report he handwrote the previous day – the Internet connection at the station wasn’t working.

The progress bar read “97 percent complete” when the program froze.

Fortunately, SIREN automatically saved the report, but Burnett said he has noticed SIREN is prone to crashing when it’s used outside the hospital terminals. He has never lost a report, though.

“It has its drawbacks, but I think it benefits the whole state to have all this information in one place,” Burnett said.

The other EMTs echoed his sentiment.