Talbot County Has a Heart for Cardiac Care

Jeff Dawson, age 56 from Frederick, MD, a manager with the Environmental Protection Agency (EPA), was trying to relax and de-stress from work by hunting with some friends in Talbot County on December 27, 2018. He had been coming to the area for four years to hunt with Rennie Gay of Tidewater Guide Service. The hunting party had broken for lunch at the Amish Market in Easton, when Dawson fell out of his seat, suffering from a cardiac arrest.

Fortunately, Easton Police Sergeant Pat Sally was nearby and started CPR within a minute. An AED from Sally’s police car was then used to provide an electrical shock to Dawson’s heart. Talbot Paramedics and the Easton Volunteer Fire Department responded to the scene. Dr. Thomas Chiccone, Medical Director for Talbot County Emergency Medical Services (EMS), just happened to be on a ride-along on the ambulance to assist with Dawson’s care.

Dawson was taken to University of MD Shore Regional Health (UMSRH) in Easton where he underwent immediate heart catheterization and PCI or angioplasty by Dr. Jeffrey Etherton, who placed a stent in the artery of Dawson’s heart where earlier, plaque had broken off, causing a blockage to the artery and cardiac arrest. He was discharged from UMSRH on January 1 and started cardiac rehabilitation in Frederick in mid-January.

Dawson, who is now recuperating at home in Frederick, comments, “I was luckier being at that location than at my own home, where it would have taken more time to get the help I needed. My friends in Frederick tell me they want to take me to Vegas because of my luck.”

According to Clay Stamp, Director of Talbot County Department of Emergency Services and Assistant County Manager, the number of cardiac calls is increasing in Talbot County. He comments, “Talbot County has a rich history in staying current with staffing and technology as it relates to our increasingly aging population with cardiac issues. We have been able to provide a continuum of care through the partnership between the Talbot County government, UMSRH, and the Talbot Paramedic Foundation. Together, we have been able to put the pieces in place to effectively save lives.”

Pictured left to right with Life Pack 15 are Paramedic Brian Micheliche, Paramedic Jason Leaman, Dr. Thomas Chiccone, Medical Director for Talbot County Emergency Medical Services; Brian LeCates, Deputy Director of Talbot County Department of Emergency Services; Ken Kozel, President and CEO of UMSRH; Clay Stamp, Director of Talbot County Department of Emergency Services and Assistant County Manager; and Paramedic Keith Dulin. Absent from the photo are Gary Jones, Regional Director of Cardiovascular Services, UMSRH; Wayne Dyott, President of the Talbot Paramedic Foundation; and UMSRH interventional cardiologists, Dr. Jeffrey Etherton, and Dr. Gabriel Sardi.

Gary Jones, Regional Director Cardiovascular Services, UMSRH, was one of a group of five firefighters, Basic Life Support providers, and cardiac rescue technicians in Talbot County who recognized the need for Advanced Life Support services in Talbot County while working in the field in the early 1980s. In 1983, this group of five took training and worked as volunteer ALS providers out of the Easton Fire Department. As the need in Talbot County grew for ALS providers, the number of people trained grew and eventually the ALS Service changed from a volunteer to a paid service provided through Talbot County Emergency Services. UMSRH committed to providing a place for the training to occur, utilizing the Emergency Department for training, providing medical oversight, as well as ongoing continuing education for paramedics. Currently, paramedics across the Shore are trained at Chesapeake College with clinical rotations at UMSRH.

In 2009, the program became part of the Talbot County Department of Emergency Services, which encompasses the 911 Center, Emergency Medical Services, and Emergency Management. “The county’s focus on mitigating and assisting with the treatment of sudden cardiac arrest has focused on community training, paramedic training, 911 Dispatch, and keeping abreast of new technology and techniques,” adds Brian LeCates, Deputy Director of Talbot County Department of Emergency Services.

LeCates adds, “Talbot County pays to train its paramedics and to date has 29 paid paramedics and 15 paid EMTs. This enables the county to have one paramedic and one EMT, at a minimum, on each ambulance at each location in the county, as well as a supervisor on duty 24/7. The five stations in Talbot County include Easton Volunteer Fire Department, Easton Airport, St. Michaels Volunteer Fire Department, Tilghman Volunteer Fire Department, and Trappe Volunteer Fire Department.”

Each February, Talbot County Department of Emergency Services provides its Annual CPR Marathon, providing free CPR and AED training to the public. The event usually draws 200 to 300 people. This year the event is on February 27, from 9 a.m. to 6 p.m. at the Talbot County Community Center in Easton. LeCates states, “The goal of the marathon is to train bystanders so that they can start CPR before trained professionals arrive. It can mean the difference between life and death in the field.”

AED training is also provided that day for any site which has a public access AED. There are approximately 230 AEDs throughout Talbot County in such locations as schools, police cars, businesses, churches, and public spaces. Over the years, AEDs have saved lives at Lowes, the YMCA, the Tidewater Inn, and recently at the Amish Market in Easton. These devices were funded by The Talbot Paramedic Foundation, which just celebrated its 30th anniversary.

The Talbot Paramedic Foundation funded the purchase of AEDs 18 years ago to be used for public access. The AEDs are maintained by Talbot County Department of Emergency Services. Because many of the AEDs are no longer serviceable by the manufacturer, the organization needs to raise $100,000 to replace a portion of them. The plan is to phase the new AEDs in over a period of time. The Foundation’s purchase of the AEDs reduces the cost for users to less than half the actual cost of $1000 each. With underwriting from the Talbot Paramedic Foundation, Talbot County Department of Emergency Services also trains individuals at sites which have AEDs. Sites pay $200 annually for maintenance of their units and a portion of their annual training.

Wayne Dyott, President of the Talbot Paramedic Foundation, explains, “Our organization was originally founded by the same staff who provided ALS in the county. Once the Talbot County government started funding salaries and some of the equipment needed for paramedics, the Talbot Paramedic Foundation supplemented the funds to support the purchase of additional equipment, such as AEDs, Life Packs, and video laryngoscopy, and to provide training for paramedics. Our mission as a nonprofit organization is to help maintain paramedic services at the highest level needed in Talbot County.”

Talbot County received national recognition for their AED Program, “Operation Save Heart,” at the International Fire Chiefs’ Association meeting in Las Vegas, NV as one of the largest rural AED communities in the nation. About six years ago, the Foundation provided upgraded equipment for paramedics, purchasing Life Pack 15. This equipment provides a monitor, a defibrillator, a pulse oximeter, and end-tidal capnography – all industry standard equipment used to handle cardiac events in the field. The units cost $36,000 each and Talbot County needs six of them for its paramedic units. Talbot County government purchased half of the Life Packs and the Talbot Paramedic Foundation purchased the other half. Talbot Paramedic Foundation works with local civic and philanthropic organizations to raise the necessary funds.

Talbot County Emergency Medical Services is always looking for ways to improve the outcomes for cardiac arrest victims. Talbot County’s 911 dispatchers give pre-arrival CPR and AED instructions to callers who call in cardiac arrests, encouraging them to administer CPR and look for an AED if they are in a public building. Talbot County DES Command Staff attended the Maryland Resuscitation Academy in May of 2013 to learn High-Performance CPR, now the industry and State of Maryland standard for resuscitation. In September 2013, paramedics began using the Lucas CPR devices, which allow them to administer High-Performance CPR through a device, enabling them to start other interventions such as IVs, medication administration, and airway management. According to LeCates, “We have seen a spike in survival rates by using this more effective CPR.”

Information is also transmitted differently today. Over the past six years, paramedics have been able to transmit EKGs to hospital Emergency Departments. These general technology improvements help determine next steps for the hospital’s cardiac catheterization lab. In 1991, Dr. Scott Friedman and Gary Jones established diagnostic heart catheterization services and pacemaker defibrillator implant services at UMSRH. At this point in time, patients requiring acute coronary interventions were transferred to the University of Maryland in Baltimore or Peninsula Regional Medical Center in Salisbury for treatment. For a select number of a subset of heart attacks delays in transferring patients were impacting the outcomes for heart attack victims and paramedics were getting tied up with transporting patients to these centers, UMSRH decided to seek Cardiac Interventional Center designation in order to do primary and elective angioplasty in Easton. Jones comments, “Time is muscle, meaning the longer the delay, the greater the possibility of heart muscle damage.”

UMSRH applied to become a Cardiac Interventional Center (CIC) through MIEMSS and recruited two interventional cardiologists, Dr. Jeffrey Etherton, and Dr. Gabriel Sardi, and hired additional cardiac catheterization lab staff, doing elective angioplasties in 2017. In 2018, UMSRH was designated as a CIC and today, paramedics take patients to Easton for interventional services. This past year, in addition to over 300 elective angioplasties, the CIC treated over 70 primary angioplasty patients – a significant increase over the 50 patients they projected – and the demand is increasing every day. UMSRH now has three cardiac catheterization teams and this past year, there were 163 activations of the call team.

Jones comments, “We are very proud of these results. The “door to balloon” target time nationally is 90 minutes. At UMSRH, the CIC can do it 60 minutes or less over 95 percent of the time.  There have been numerous examples where people have had a cardiac arrest in the field, received bystander CPR, received ALS by Emergency Medical Services, and then been transported to UMSRH CIC and patients have walked out of the hospital just like Jeff Dawson. And, like Dawson, patients in our area can receive Cardiac Rehab at our Centers in Easton, Dorchester, and Chestertown following their intervention.”

He adds, “From very humble beginnings, we have developed a sophisticated model of care for the continuum of care here for cardiac patients in Talbot County. It’s a real partnership between government, private funders and the hospital. When all the pieces come together as they have and it works effectively, it’s pretty gratifying.”

Dawson reflects on his experience, “I am super grateful to everyone who cared for me in Talbot County. It’s a debt I can never fully repay. I will try and live a life that’s worth living. It’s a second chance to keep working on things that improve people’s lives.”

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