‘Ready for anything’

Medical Control contract keeps TCFD on the cutting-edge

“Check your own pulse.” That’s the first rule for fire department paramedics arriving at the scene of an emergency. The patient (or patients) requires immediate attention, and first-responders don’t have the luxury of being flustered.

“The more cool, calm, and collected we are, the better care we can provide,” said Shannon Stephens, Assistant Chief for The Colony Fire Department (TCFD).

To that end, The Colony Fire Department is staying on the cutting-edge of medical training by virtue of its current Medical Control contract with Medical City Plano (MCP). Through the affiliation, TCFD paramedics have access to a wide variety of programs and services – computerized training, facility access, ongoing statistical analysis of department operations, on-site training by emergency room physicians, operating-room rotations, ER rotations, and more.

One of the facilities they utilize is a cadaver lab at UT-Southwestern Medical School in Dallas where paramedics and other first-responders can practice hands-on, life-saving techniques. Shift by shift, TCFD has been sending all of its paramedics to the lab to keep their training fresh. A recent trip to the lab emphasized what they call “taking an airway.”

“When we arrive on a scene, one of the first things we’ll assess is if the patient’s airway is at risk through some kind of traumatic injury or medical event like a chronic illness,” Stephens said. “Sometimes patients are just fighting so hard to breath they get exhausted, and they’re not providing adequate ventilation on their own. So we take over for them and assist their respiration through different procedures like an intubation or tracheotomy.”

As the name implies, the cadaver lab provides paramedics the chance to use their tools and techniques on actual cadavers as opposed to mannequins, which not only have a tendency to wear down but simply don’t compare to the real thing, Stephens said.

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The Colony Fire Department paramedics Harrison Stoker, left, and Mike Powers prepare for their lab training by reviewing some of the tools of the trade.

TCFD veteran Mike Powers and newcomer Harrison Stoker were among the recent paramedics to undergo training at the lab. Powers has been in the fire services for 17 years. He said that most often a paramedic may only encounter serious trauma scenes a handful of times in their whole career.

But when that time comes, you have to be confident and let your training kick in. That’s when time spent in the labs really pays off.

“One of the unique things about fire services is that you go from 0 to 100 very quickly. One minute you’re literally sitting there at the table having a cup of coffee then just minutes later you’re at the scene of a horrific car accident, using the Jaws of Life, taking an airway,” he said. “It goes that quick. You don’t know from one minute to the next what you’ll be asked to do so you have to be ready for anything. The lab experience is great so that you’re not going in totally green when those situations arise.”

Then again, there are times when serious incidents come in waves. On average, each paramedic in the department performs about three intubations a year, Stephens said. Stoker, however, has performed five in the last two months alone. Despite those opportunities to put his skills to the test, he’s still appreciative of the lab training.

“I remember the first time I did CPR on someone. It’s totally different than the mannequin,” Stoker said. “At the lab, I definitely learn things to apply for the next time. You get very specific instruction regarding common issues.”

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TCFD paramedics Harrison Stoker, left, and Mike Powers were among the latest department personnel to attend lab training at UT Southwestern Medical School in Dallas.

All lab participants are, of course, very respectful of the cadavers. Those individuals’ last act in life was to donate their bodies for educational purposes so that other lives may be saved.

“The more exposure you get, the more acclimated you are, the better you’ll do. This is a great opportunity,” Powers said, adding that his confidence in his skills was 100-percent restored following the lab work. “When we’re out on a call, we have to be fast. Like the doctor told us, the patient is dying and it’s just you. You have to do something. It’s intense. The more practice, the better.”

In his 20-year career, Stephens has performed many different emergency medical procedures. He remembers well the sensations of those experiences, especially his first chest decompression.

“I was startled because that was the first time I’d ever experienced something like that,” he said. “These types of laboratories take that away. They tone down the excitement level. This is our profession and it’s the patient’s emergency. There’s no room for error.”

TCFD’s Medical Control contract with Medical City Plano began in November 2016. Since that time, MCP has been tracking various department statistics.

“In the beginning, our first-attempt intubations were right at 50 percent, which isn’t really bad. It’s a complex procedure,” Stephens said. “But last month, our first-attempts were at 100 percent. That’s unheard of. It’s a goose-bump moment where you can really see the difference being made by the level of training.”

TCFD is one of only four fire departments in the region partnered with MCP for Medical Control services, along with Plano, Frisco, and Rowlett. The training and communication goes both ways, as well. As part of the program, for example, Emergency Room staff at MCP are instructed to observe the “45-second rule” when receiving a patient. Rather than simply whisk the patient off to a room, this ensures hospital staff members absorb relevant information from the paramedics.

“That rule makes sure the hospital has a clear understanding of what happened at the scene and why we’re bringing in our patients the way we are,” Powers said. “It’s a win-win.”

The ER rotations also give paramedics the chance to develop a better understanding about procedures taking place after they drop off their patients. “Paramedic training opens the door to the medical profession but getting the actual real-world experience in the hospital is different,” Stoker said. “It’s like learning Spanish in school versus living in a Spanish-speaking country.”

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The Colony Fire Department’s contract with Medical City Plano for Medical Control services requires ER staff to observe a ’45-second rule’ when receiving new patients. This protocol ensures paramedics are given ample opportunity to convey important information about the circumstances surrounding the patient’s emergency.

MCP’s program capitalizes on decades of medical, technological, and pharmaceutical advances developed by military medics on the frontlines in Iraq and Afghanistan, Stephens said. Thus, TCFD paramedics assigned to The Colony Police Department’s Special Response Team (most of whom are former military medics already) receive additional training through the program specific to those needs.

“We’ve got four firemen that are embedded on TCPD’s SWAT team as tactical paramedics. They’re not armed; they’re not officers. They’re just assets to the team,” Stephens said. “They have additional training and protocols that they perform. Most of the equipment is the same but they carry a small amount of specific medical equipment for certain traumatic injuries,” like for complex sutures or even dental work.

The way the system is set up, Stephens said, The Colony FD paramedics will always take care of The Colony Police officers. “In the event our SWAT team is making a raid outside the city and a member is injured, there will be a TCFD paramedic providing our level of care all the way to the hospital, regardless of the mode of transport.”

And by “our level of care,” Stephens is referring to what’s called The Colony Way. TCFD prides itself on maintaining a high, consistent level of specific training (like what’s provided at the cadaver lab) in order to create necessary cohesion within the department.

“We’ve all got to be on the same page. That’s The Colony Way,” Powers said. “Whatever the call, you’ve got to multitask and pay attention to the lead paramedic giving instructions. It takes a village to save a person.”

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