Department of Emergency Medicine
Rhode Island Disaster Initiative (RIDI)
Overview
The fundamental role of RIDI was to enhance Rhode Island's ability to prepare for and respond to a disaster through applied research.
RIDI was Transitional
RIDI completed its research between 1999 and 2007. During that time, RIDI successfully elevated Rhode Island's disaster management capabilities and resources. RIDI generated recommendations based on experimental data and led to the insertion and evaluation of technologies that foster improved communication among all disaster response participants. Several current practices, including the Rhode Island Department of Health EMS Major Incident Protocol, the statewide Patient Tracking System / Public Health Emergency Management Suite (which also includes a hospital capacity and diversion dashboard, a chat and calendar function, and statewide EMS electronic patient care reports) all had their inception in RIDI concepts and practices.
RIDI transferred its findings and assets to the community and local operating entities to continue to manage and carry forward the mission. Although RIDI does not continue as an operating entity, the results of RIDI's efforts continue to benefit the EMS and Emergency Preparedness community in Rhode Island and beyond.
Support Role
As an organization, RIDI did not routinely provide first responder support to mass casualty incidents (MCI) but did, during Phase III of the initiative, bring operational technologies to the scene. These tools and technologies were used to improve disaster response, collect data, and beta-test new technology programs. Lifeguard EMS, a paramedic and emergency physician staffed response vehicle with mobile command post and critical care transport capability, provided a role model platform for best practices in response and support.
Filling the Gap
One of RIDI's goals was to fill the gap between ongoing solution efforts and the actual needs of first responders. Formulating a strategic approach based on a documented and thoroughly researched assessment of system and user requirements is a vital component of building successful, long-term solutions. The broad requirements of the disaster response system were determined through research of best practices, technologies and protocols. One example was the finding that traditional triage schemes were rarely used by experienced providers, who instead accurately and efficiently triage patients based on their skills and rapid first impression of need and resource availability. This finding was then incorporated in statewide MCI triage protocols with excellent effect, and is supported by the successful use of "First Impression Triage" in other systems.
Why Rhode Island?
Rhode Island is ideally sized both by population and geography to assess practices and deploy test technologies. With a population of approximately one million surrounding a metropolitan area, it forms a model whose results find applicability in many other states. Senators Jack Reed and Lincoln Chaffee, as well as Representatives Patrick Kennedy and Jim Langevin, were ardent supporters of RIDI and helped make it a reality.
Position
RIDI's place in the disaster response community
Our goal was to collaboratively develop and introduce best practices that prepare emergency responders for large-scale emergency incidents.
By providing needed research in the areas of readiness, technology, and training, RIDI realized its mission of integrating the operations of first responders (EMTs, firefighters, police officers and others) with disaster response tools and techniques. Emergency professionals now respond to incidents with standard protocols, equipment, methods, and material, providing Rhode Island residents and visitors with effective disaster response as a result of RIDI efforts and collaborations.
RIDI participated in many aspects of disaster response management, from readiness improvement to field data collection at incident sites. The sections below provide a visual representation of how RIDI interacted with disaster response organizations:
- Disaster Response: Measured readiness, identified shortfalls and tested solutions to improve the interaction between primary and secondary respondents
- Disaster Preparation: Training activities and resources for emergency professionals
- Responder Operations: Operations designed to assist first responders with technology and protocol development and training
Disaster Response: Improving the way RI reacts to disasters
RIDI initiatives support disaster response through research in the effective usage of technology combined with post-incident data collection serving as input into future research activities.
Technology insertion was a key component of RIDI's mission. These technologies (primarily communications), provide better information flow on the scene and back to hospitals. Logistics, communication, patient tracking and similar real-time information are critical to effective disaster management.
Disaster Preparation: Improving response via preparedness
Effective disaster medical response is predicated on preparedness and effective training leading to readiness. RIDI conducted research on training and the state of readiness within Rhode Island. Additionally, drills and training exercises provided an excellent test bed for communication and monitoring technologies.
Protocol Research. An important area of research was the effectiveness of various protocols and their performance during drill events. The results led to current Rhode Island EMS response protocols.
Responder Operations: Improving response with technology
One of the important lessons learned about disaster management is that tools and procedures are not effective if they are only utilized during a disaster. Effective disaster response results from regular training and daily use of the tools and protocols that will be relied upon during a disaster incident. Daily familiarity produces results on "game day". RIDI addressed this issue by placing technologies and protocols in the hands of first responders for regular, daily use and adapted their efficacy during periods of high stress or full scale disaster.
Protocol research helped determine optimum modes for first responders to interact with other organizations and clarify what information is created or required by specific responders. This work supported criteria for the current Rhode Island EMS Patient Tracking System.
Funding
RIDI was a federal government funded initiative. RIDI Phase II & III funds were administered by the Office of Naval Research.
Phase I
Senators Jack Reed and Lincoln Chaffee, as well as Representatives Patrick Kennedy and Jim Langevin, helped obtain congressional funding to establish and complete the RIDI project. The initial RIDI funds were administered by the Department of Health and Human Services, Office of Emergency Preparedness (DHHS-OEP) as the grant agency. DHHS-OEP contracted with the Chemical Biological Information Analysis Center (CBIAC) to coordinate and accomplish the RIDI Project. As a RIDI partner providing program management and oversight, the Battelle Memorial Institute administered the CBIAC through federal contract. RIDI Phase I was funded at $900,000. These funds were used to establish the organization and perform a statewide hazard, vulnerability and risk analysis, to collate current research in disaster management, to reach out to cross-disciplinary experts and begin the definition work for research carried out in Phase II.
Phase II
The second phase of RIDI also received unanimous support from the Rhode Island delegation, with funding at $1.499 million. Phase II backing flowed through the Department of Defense to the Navy and the Office of Naval Research (ONR). ONR contracted with CBIAC in a manner similar to Phase I to carry out Phase II of the RIDI project. The CBIAC contracted with Rhode Island Hospital's Research Administration Office for Phase II. University Emergency Medicine Foundation (UEMF) physicians continued to run the project.
Phase III
The Rhode Island delegation unanimously supported funding for Phase III at $2 million per year, with two years of funding to total $4 million. Due to fiscal constraints after the 2001 9/11 terror attacks, Congressional funding was limited to $1.2 million for the remainder of the project. Phase III funding was used to disseminate best practices and research findings through a demonstration project, including design and assembly of a specialized response vehicle (Lifeguard EMS), and conferences for first responders and first receivers.
Phase I focused on laying the groundwork for the organization, background research, forming collaborative relationships, and building a strategic plan. Phase I activities established the current state of disaster research and response and applied this information to experimental design during Phase II. The tasks for Phase I are listed below.
Perform a Vulnerability Assessment
RIDI performed a vulnerability assessment of emergency medical disaster response for the State of Rhode Island. This assessment identified limitations in readiness, training and technology used by medical first responders (EMTs, firefighters, police officers and others) and emergency department personnel (doctors, nurses, technicians and others) in their response to a disaster. The range of disasters considered included events stemming from weapons of mass destruction, natural disasters common to Rhode Island and combined events.
Create and Convene Expert Panels
Experts with knowledge and background in disaster response, preparedness and responder operations were invited to join voluntary panels. These panels, which include local experts with knowledge specific to Rhode Island, national and international domain experts, and RIDI staff, helped disseminate RIDI plans and ideas, refine Phase II study designs and develop plans to accomplish Phase III tasks.
Review Medical Literature
Experts reviewed the medical literature, Web references and other sources for information on disaster care and response. This review focused on readiness, training, technology and identification of potential solutions to identified challenges. The annotated review was published in Phase I and was updated in Phase III.
Evaluate and Insert Technology
In Phase I, RIDI investigators began the process of inserting relevant technology for evaluation. For example, the technology reviewers explored Web-based emergency department/agency communications and data gathering systems. Related to readiness, various small projects, including a means to provide automated knowledge of EMS system and emergency department workload, were evaluated. The RIDI team implemented and tested these various technologies in Phase II.
The mission of Phase II was to design and execute experimental programs, collect and analyze the data and prototype new technology.
Design and Execute Experimental Programs
During Phase II, the RIDI team conducted three focused studies and a series of full-scale exercises in the Rhode Island Hospital Medical Simulation Center, a unique facility for training medical personnel that also serves as a laboratory for testing protocols and training techniques.
In one focused study, RIDI researchers compared the ability of health care providers to perform typical triage and intervention tasks both with and without Level C personal protective equipment (PPE). The second focused study tested first responders’ ability to recognize and therefore not enter a dangerous situation involving a hazardous chemical. In the third focused study, RIDI researchers examined whether first responders used the START (Simple Triage and Rapid Treatment) triage system required at the time by RI EMS Protocols, or followed some other triage behavior when entering into a scene with multiple casualties. The results of these focused studies were released at the Society for Academic Emergency Medicine Annual meeting in May 2004, and led to changes in RI EMS Protocols.
Using feedback and post-study analysis of the focused studies, RIDI adjusted the scope, design, range and other parameters to optimize a full-scale exercise that was then conducted 12 times, comparing a control group and a trained group. This novel experimental approach allowed accurate data acquisition during a series of simulated disaster evolutions, comparing the proposed training paradigm to standard practice.
The exercise scenario consisted of a nine-patient disaster in a family clinic attacked with a small improvised explosive device that spread Lewisite throughout the clinic (see video link at right). The victims suffered a combination of trauma and chemical injuries. The severity and type of victim problems were designed to provide a realistic scenario for the test subjects and to also challenge their disaster response capabilities. Important elements measured during the exercise were the scene entry decision, patient triage and care actions, application of decontamination techniques, use of PPE, administration of antidote (if any), and transport priority. Research results from the full-scale exercises helped guide revisions in RI DOH EMS Protocols, and were published in the International Journal of Risk Assessment and Management (Vol 9 No 4, 2008 pp 394-408).
Collect and Analyze Data from Experimental Programs
In addition to collecting and analyzing data from the experimental studies and drills, RIDI researchers also reviewed real-time metrics from responders during actual events. Several small-scale events involving multiple casualties occurred during the study years. Most notably, RIDI investigators reviewed, and several also were involved in, the Station Nightclub Fire response.
The Station Nightclub Fire occurred at 11:12 pm on February 20, 2003 in Warwick, Rhode Island. It ranked as the fourth-deadliest nightclub fire and the ninth deadliest public assembly fire in the United States. The fire consumed the entire building within three minutes. Ninety-six people were killed immediately and hundreds were cared for at area hospitals. Only two subsequent hospital deaths occurred over the next few weeks. No patient perished during triage or EMS care. Triage followed RIDI principles, not the standard paradigm.
Some of the other significant lessons learned from this event relate to communication between the scene and area hospitals and among the hospitals to enable sound decisions related to patient transport.
Prototype New Technology
During Phase II, demonstration and beta technologies were implemented and operated to assess the benefits they offer to the emergency management community. For example, the RIDI team successfully demonstrated an interfacility secure Internet chat capability among Rhode Island Hospitals. RIDI also piloted a web-based Disaster Control Panel that posted hospital diversion status, bed count, and patient arrival rates. The Rhode Island Department of Health, having seen this capability and researched several similar options, created a suite of web-based tools with similar capabilities. This Public Health Emergency Management Suite (PHEMS) includes a patient tracking system (PTS) using bar-coded bracelets from disaster scene through hospital transfer, electronic EMS patient care reports, hospital diversion and bed status integration with the PTS (available bed numbers are updated as PTS records transpot), a calendaring system that encourages drill collaboration, and a chat function. These types of technologies can help hospitals determine the extent of resources necessary to cope with a mass casualty disaster and make information available to the central command center to assist with patient transport decisions.
RIDI Phase III focused on analyzing data collected in Phase II to solidify and validate best practices. Emphasis was placed on the dissemination of best practices through lectures, training and conferences for first responders and first receivers.
The Rhode Island Disaster Responder conferences shared information about disaster planning, preparation, and response resources with local first responders and emergency department staff. Speakers and demonstrations from multiple local, state, and federal response organizations showcased the number of response assets available in the state and region. Presentations and exhibits focused on strengthening interoperability and communication among the region’s response organizations.
More than 100 people attended the first Rhode Island Disaster Responder conference held in May 2005. Participation grew to more than 150 participants at the second Rhode Island Disaster Responder conference held in May 2006.
Phase III also included a demonstration project and vehicle to bring RIDI best practices to the scene of disasters, drills and multiple casualty incidents in Rhode Island. First responders, EMS agencies and others applied the range of best practices identified in Phase II and provided field evaluation to complete the project.
In Phase III, efforts successfully arranged sustaining funds to continue the research and training started in the first three Phases of RIDI, including formation of the LifePACT Critical Care Transport system at Rhode Island Hospital/Hasbro Children's Hospital and multiple STEP (Simulation-based Training in Emergency Preparedness) courses held at the Simulation Center for area first responders and first receivers.
Collaborators
Many organizations and entities throughout the state of Rhode Island collaborated with RIDI in order to generate beneficial return to all the disaster response participants within the state. Some organizations were particularly important because of their participation in disaster response and the extent of their network.
Other organizations were significant in assuring that RIDI's efforts represented an additive, useful component to the work being conducted through multiple federally and state-sponsored activities. A few of the key partners and relationships are described below.
The Hospital Association of Rhode Island consisted of representatives of all the hospitals in the state of Rhode Island. HARI partnered with RIEMA, Rhode Island DOH and others to form committees where issues related to hospital preparedness for disasters, in particular acts of terrorism, are discussed and standard procedures developed, with a focus on readiness and interface with EMS agencies. RIDI was involved in these forums during the project.
The Rhode Island Emergency Management Agency is a leader in disaster preparedness and terrorism-related issues. Through multiple grants, RIEMA has helped hospitals prepare for mass casualty incidents, particularly in the area of personal protection equipment (PPE) and mass decontamination. RIEMA was also instrumental in setting up and maintaining a statewide Nextel phone-based communications network linking all the hospital emergency departments to the EMA and pre-hospital arena, which has since transitioned to a dedicated 800MHz radio system with redundant computer and radio backups. RIEMA has also taken the lead on organizing and conducting realistic exercises to simulate terrorist attacks using various weapons of terror. RIDI was involved in the planning and evaluation phases of these exercises.
The Department of Health has received multiple grants from the federal government to boost preparedness for terrorism-related incidents in Rhode Island, particularly those related to bioterrorism. Efforts included a surveillance system, education and rapid dissemination of information to health care providers in the state, and a robust Incident Command System at DOH. DOH has also significantly improved its laboratory capabilities and has hired staff dedicated to issues concerning terrorism. RIDI coordinated with DOH to prevent duplication of efforts, enhance the surveillance systems proposed by DOH and participate in joint exercises.
The City of Providence Emergency Management Agency (PEMA) was awarded a grant to form a MMRS. Dr. Kenneth Williams serves as the medical director for this system and was involved in the planning and construction of the system, which integrates with statewide disaster preparedness efforts, including communications technology, distribution of force protection pharmaceuticals, distribution of casualty treatment kits, and establishment of a Metropolitan Medical Strike Team (LifePACT serves as this team). In addition, PEMA dedicated an addition to their facility in 2014, including command post, extended operations support, and clinic capabilities -- operated in conjunction with LifePACT / Rhode Island Hospital.
Mission
To measurably improve emergency medical response to disasters through research, training and technology.
The Rhode Island Disaster Initiative (RIDI) began conceptually in 1999 with a meeting of EMS and disaster-oriented emergency physicians and other professionals who recognized the recurring shortfalls in disaster response. With the additional threats posed by terrorist activity, the dangers of secondary devices (intentional explosions that occur after the first responders arrive), hostage situations, and weapons of mass destruction, the RIDI team proposed a research project to address the gaps in medical response to disasters.
The primary objectives of the RIDI project were to:
- Identify vulnerabilities facing emergency medical responders in Rhode Island (and across the United States)
- Design measurable means of assessing care for victims of real and simulated disasters
- Apply resources to identify best practices and insert novel technologies
- Validate the identified best practices through testing
- Assess and communicate the validity of these results through a statewide demonstration project
These best practices were refined and validated during the demonstration phase, culminating in the publishing and distribution of research information enabling other regions to benefit from the RIDI project.
Status
Phase I received funding in early September 2001, and was complete in 2002. Hazard/Vulnerability Analysis, an extensive annotated bibliography, and other deliverables were produced. Many of the RIDI researchers responded with FEMA DMAT team RI-1 to the NYC World Trade Center 9/11 terror attack, gaining valuable practical knowledge.
Phase II was complete in 2004. Phase II included focused and full-scale research drills at the Brown University Health / Rhode Island Hospital Medical Simulation Center, leading to various recommendations for protocol and training initiatives. Development of an objective method for scoring disaster drill performance, and the use of a simulation center to repetitively (12 identical research full-scale disaster drills were completed) assess disaster drill performance were major Phase II accomplishments.
Phase III finished in 2005. Phase III focused on the dissemination of best practices through lectures, training, conferences and the use of a specialized response vehicle.
RIDI established the Lifeguard EMS team to bring research-based, practical disaster response training to first responders in the region. Because effective disaster response results, in part, from daily use of the tools and protocols that are relied upon during a disaster incident, the Lifeguard EMS team operated regularly to provide critical care transport for critically ill and injured adult patients between hospitals and from incident scenes in the Rhode Island area. Lifeguard EMS began preliminary transport operations in October 2004 and gradually expanded operations to 24/7/365 in 2009. Lifeguard EMS began with a RIDI-funded custom ambulance/command post vehicle, adaptable for mobile high-fidelity manikin simulation and disaster support training and operations. Lifeguard EMS merged with the Hasbro Children's Hospital Pediatric Transport Team in 2009 to form LifePACT, now operating two critical care ground ambulances with paramedic/nurse/physician staffing averaging 1500 annual patient transports.
RIDI introduced curricula for two courses that recognize the time limitations of first responders and their leadership. FirstSTEP is simulation-based training in emergency preparedness for first responders. It can be given to a variable number of attendees at the Rhode Island Hospital Simulation Center, at a hospital, or at an EMS station. TopSTEP is simulation-based training for top leadership officials, including EMS officers, fire chiefs, service administrators, training officers, and others. The TopSTEP course is carried out at the Simulation Center with lecture and discussion occupying about half of the day and group simulation sessions and debriefings finishing the program. With supporting funds from the Health Resources and Service Administration through the Rhode Island Department of Health, 20 STEP courses were delivered to hospital first receivers, and FirstSTEP courses were delivered to City of Providence Firefighter EMTs. When available, the Lifeguard EMS ambulance vehicle was integrated into these training courses.
RIDI, Battelle, and the Office of Naval Research sponsored a conference for first responders and first receivers on May 21, 2005 as another means of disseminating RIDI best practices. The Rhode Island Disaster Responder conference shared information about disaster planning, preparation and response resources with local first responders and emergency department staff. There were more than 150 attendees, including Rhode Island Senator Lincoln Chafee and Congressmen Jim Langevin, who provided opening remarks at the luncheon. Featured speakers included Dr. Ken Williams, who discussed RIDI's research results and goals; Dr. Nadine Levick, who presented research on response vehicle safety; and Abigail Williams, managing partner of Abigail Williams & Associates, who helped raise awareness of legal issues in disaster response. Additional speakers from more than 15 local, state, and federal response organizations provided an overview of how to access the resources they provide.
A second disaster responder conference was held in May, 2006, and incorporated drills and exercises in addition to networking and lectures.
RIDI collaborated with the Rhode Island Emergency Management Agency, Providence Emergency Management Agency, Rhode Island Department of Health, and other agencies to sustain the RIDI findings. Research results were incorporated into statewide training, protocols and practices. Further research at the Brown University Health / Rhode Island Hospital Simulation Center continues to support triage, resuscitation, and other EMS activities.
Organization
RIDI was administered and operated by members of the Rhode Island medical community with affiliations at Rhode Island Hospital and the University Emergency Medicine Foundation.
Kenneth A. Williams, MD, FACEP - RIDI Principal Investigator, Project Medical Director
Dr. Williams' career in EMS began in the 1960s with Red Cross courses, followed by EMT and emergency department experience in New Jersey and Massachusetts in the 1970s. Dr. Williams attended Hampshire College in Amherst, MA, where his studies included technology assessment, public policy science, computer models of thermodynamic systems, and a National Science Foundation grant program to teach high school physics through alternative energy projects. He taught CPR and first aid courses during and after college, wrote a first aid textbook for preschool teachers and parents, and received a fellowship grant in exercise physiology.
After graduating from medical school at the University of Massachusetts in 1984, he completed residency in emergency medicine at the University of Pittsburgh in 1987, where he was a Chief Resident and received a resident research award from the Emergency Medicine Foundation. Returning to the University of Massachusetts as faculty in the emergency department, Dr. Williams served as Medical Director for UMASS Life Flight, Chief, Division of EMS, Director of Emergency Medicine Informatics, and received a National Library of Medicine Fellowship in Medical Informatics. He held a faculty appointment as Associate Professor of Clinical Emergency Medicine at the University of Massachusetts.
During his tenure at UMASS, Dr. Williams was also active in regional, national and international emergency medicine organizations, serving as EMS Medical Director for Central Massachusetts and in a variety of positions with the Massachusetts chapter of the American College of Emergency Physicians, the Massachusetts Dept. of Health Office for EMS, the Association for Air Medical Services, the Air Medical Physician Association, the National Association of EMS Physicians, the Alliance for Critical Care Transport, and the MA-2 Disaster Medical Assistance Team. He founded the New England Airmedical Alliance in 1989.
Dr. Williams accepted a position at Brown University and the University Emergency Medicine Foundation in 1997, and holds an appointment as Associate Professor of Emergency Medicine at Brown University and is Director of the Division of EMS and EMS Fellowship at Brown, and Medical Director for the LifePACT Critical Care Transport ambulance service at Rhode Island Hospital. He is also Medical Director for the Rhode Island Department of Health Center for EMS, Past-President of the Air Medical Physician Association (2000-2002), Past-President of the Rhode Island Chapter, American College of Emergency Physicians, and Chair-Elect of the National Association of EMS Officials Medical Director's Council. Dr. Williams, along with other project leaders, began planning for the Rhode Island Disaster Initiative in 1999.
Dr. Williams' research and publications cover a range of topics, including EMS and medical informatics, and include many papers and textbook chapters. He has delivered several hundred lectures as an invited speaker at international, national, and local medical conferences.
Selim Suner MD, MS, FACEP - Principal Investigator
Dr. Suner graduated from Brown Medical school in 1992 after obtaining a degree in Biomedical Engineering in 1988. He then completed an emergency medicine residency program at Rhode Island Hospital and is currently an attending physician at Rhode Island Hospital and a Professor in the Departments of Emergency Medicine, Surgery and Engineering at Brown. Dr. Suner's main research interest is in the areas of disaster and mass gathering medicine.
Dr. Suner served as commander of the Rhode Island Disaster Medical Assistance Team (DMAT) and served during multiple disaster deployments of the Office of Emergency Preparedness, including the Ice Storms in upstate New York, Eqyptair 990 crash off of Massachusetts and the September 11th World Trade Center attacks. Dr Suner also serves as the chair for the emergency preparedness committee at Rhode Island Hospital and participates in many state-level committees working on disaster and terrorism issues. He coordinates the Brown Academies in Emergency Medicine, including a Disaster Fellowship. Dr. Suner is a leader, both nationally and within the state, in training for incidents related to weapons of mass destruction. He teaches in multiple seminars throughout the country as well as a senior medical school seminar on weapons of mass destruction.
Francis Sullivan MD, FACEP - Principal Investigator
Dr. Sullivan received an MD at Medical University of South Carolina in Charleston in 1976. He completed a categorical internship in internal medicine, served on active duty with the USPHS for two and a half years, returning to complete training in internal medicine at MUSC. He completed a year of fellowship training in critical care medicine with Division of Anesthesiology and Respiratory / Critical Care, where he was also involved in cardiac resuscitation research. He has been an attending physician in emergency medicine in the Brown University-affiliated hospital system since 1983, currently predominantly at Rhode Island Hospital. He has been consistently involved in local prehospital care training and issues, now concentrating on their interface with the Brown University Program in Emergency Medicine residency. In addition to being an active member of the Rhode Island Disaster Medical Assistance Team (DMAT), he participated in the World Trade Center deployment as one the first three responding teams.
Charlie Seekell - RIDI Project Manager
Mr. Seekell graduated from the University of Rhode Island with a Masters degree in Marine Affairs. A retired Coast Guard officer, he has participated in the response to numerous major disasters, including the crash of Eygpt Air 900 and World Airways Flight 30. In addition, Mr. Seekell has been involved in the emergency and security planning efforts for a number of large-scale events, such as the Tall Ships visits. Mr. Seekell has also served on the Radiological Emergency Response Plan Commission for the town of Plymouth, Massachusetts. Mr. Seekell was employed by the Battelle Memorial Institute during the RIDI project
Additional Investigators
Greg Jay, MD, PhD
Bert Woolard, MD
Research Staff
The project research efforts and administration were supported by a number of staff affiliated with the Brown University Medical School and UEMF.
Research Assistants
Whit Hill, BA, NREMT-P, CCEMT-P
Flor Trespalacios
Phase I Research Interns
Zachary Litvack
Jordan Bonamo
Lifeguard EMS
Lifeguard EMS embodied the readiness aspects of RIDI through daily critical care transport of patients in Rhode Island and beyond, using a custom ambulance built to serve as a role model for safety, flexibility, and training. LifePACT, as the service is now named (Pediatric and Adult Critical care Transport) sustains the RIDI model and continues to offer critical care transport services for adults and children between hospitals and at incident scenes (upon mutual aid request).
LifeGuard EMS Overview (for historical purposes only, the service has been renamed to LifePACT)
Lifeguard EMS, a critical care transport service, was also available for disaster support and training. Supported by the RIDI Project and organized by the University Emergency Medicine Foundation, Lifeguard EMS was a state licensed ALS ambulance service based at Rhode Island Hospital.
The Lifeguard team was composed of two paramedics and an emergency physician. The ambulance, Lifeguard 1, had specialty equipment including a ventilator, intravenous infusion pumps, adult and pediatric intraosseous devices, and multiple advanced care capabilities.
On site and ready to respond immediately from 8am–8pm weekdays (with expanded hours as the service matured, now 24/7), Lifeguard EMS was ready to transfer critically ill or injured patients between facilities in Rhode Island and/or surrounding communities in Massachusetts and Connecticut.
Scene response for major incidents was available as requested by the incident commander, and training could be arranged with the team.
Transport Criteria
The Lifeguard EMS team transported critically ill and injured patients in Southeastern New England. Physicians, EMTs, or incident commanders with a critically ill or injured patient could request the Lifeguard EMS team. Patients must be accepted by an attending physician prior to transfer between hospitals. The team can be on the way to the patient as acceptance arrangements are made.
Transport Requests
Transport requests for LifePACT (the current critical care transport service at Rhode Island Hospital) can be made through Express Care, the transfer and access center at Rhode Island Hospital by calling:
(401) 444-3000
EMS agencies can request LifePACT using mutual aid radio systems.
In case of medical emergency, dial 911.
Hours of Operation
LifePACT is a 24/7 service, 365 days per year.
The Lifeguard EMS Team consisted of an emergency physician and a paramedic who provide patient care, as well as a paramedic driver.
Kenneth A Williams, MD
Medical Director
kwilliams@lifespan.org
The Lifeguard EMS ambulance was specially designed for optimal safety, in keeping with the research findings of Nadine R. Levick, MD, MPH, a vocal advocate for improved safety standards for emergency medical vehicles and EMS providers. Special design attention was paid to the rear ambulance compartment, which can be a potentially harmful work environment for EMS personnel. All 5 seats had 4-point safety harnesses, all equipment was safely attached, and the patient was secured to a center-mounted cot.
Additional information about vehicle safety is available at http://www.objectivesafety.net
The specially designed and constructed Lifeguard EMS ambulance had equipment for training and disaster support. The high-end transport vehicle served as a mobile classroom, complete with high-fidelity manikins and critical care/disaster support response unit. Through daily transports, area first responders and emergency department personnel became familiar and comfortable with disaster response “best practices” to improve emergency preparedness in Rhode Island.
The Lifeguard EMS team was available to provide support at major incident scenes as requested by an incident commander.
The ribbon cutting ceremony for the Lifeguard EMS ambulance was held on March 13, 2006.
All members of the Rhode Island delegation participated in the event and made formal remarks at the beginning of the ceremony.
The Lifeguard EMS team and ambulance were part of Phase III of the Rhode Island Disaster Initiative, which began in 2001 with unanimous support from the Rhode Island delegation.