In Texas, there’s rarely a dull moment for emergency responders. Consider a few events from just this year.
January 2024: An explosion at the historic Sandman Signature Downtown Hotel in Fort Worth injured 21 people. Windows and walls blew out of the building’s first and second floors; employees said they’d smelled gas as construction occurred throughout the day. One person was hurt critically, four seriously. Responders included the Fort Worth Fire Department and Medstar Mobile Healthcare; patients were distributed across multiple local hospitals.
March 2024: In Bastrop County near Austin, a concrete truck driven by a sleep-deprived cocaine user crossed the center line on State Highway 21 and struck a school bus full of prekindergarten children returning from a field trip. The bus flipped, skidded on its side, then rolled. The accident killed two people – 5-year-old student Ulises Montoya and the driver of another car traveling behind the bus. Responders came from three counties. Austin-Travis County EMS evaluated 53 people at the scene. Four patients were flown out, ATCEMS transported six more, and others went with other agencies.
July 2024: The earliest-forming Category 5 hurricane on record, Hurricane Beryl walloped Grenada, weakened a bit before striking Mexico, then landed in the U.S. as a Category 1 near Matagorda, south of Houston. Flooding and wind damage were widespread, and at least 36 people died, with associated tornadoes causing more fatalities. More than eight inches of rain fell in Houston, and more than 2.7 million people lost power. The storm impacted 29 regional hospitals, which were besieged by patients and those needing power for medical devices but couldn’t discharge postoperative patients to homes without power. This led to EMS backups and, by the next day, left just 4% of city ambulances available for calls. The Texas Emergency Medical Task Force coordinated ambulance strike teams to help backfill and support care.
Each of these were messy mass casualty incidents that might have overwhelmed unprepared systems. In Texas, statewide adoption of the Pulsara system and the well-practiced use of wristbands to identify and track patients gave firefighters, EMS and hospital personnel a common platform that expedited, simplified and improved their care of the injured.
“The way we advocate these calls happen is for EMS to create their patient channels and send the notification to the hospital ED,” said Corey Ricketson, Pulsara’s senior vice president for strategic accounts. “That’s the necessary building block for success.”
Like any tool, though, to be optimally fast, efficient and comfortable with it, you have to use it often – not just a few times a year at MCIs. Like the most useful tools, however, Pulsara is multipurpose – and just as suited for regular daily calls as it is for the occasional big ones.
END THE ‘TELEPHONE’ CALLS
Texas has embraced the platform on a statewide level, offering it to every provider with the intention that they’ll use it with their normal volume of patients.
“Using Pulsara as the method to deliver patient reports from EMS to hospitals daily ensures that your organization is using the same tool in an MCI as you are every day,” the state Department of State Health Services noted in a 2023 presentation.
That’s Pulsara’s proposition too: While the company started out by promoting its product around high-stakes time-sensitive emergencies like STEMI and stroke, it demonstrates the same advantages with all-purpose use, and the greater familiarity of daily practice benefits providers and patients alike. A breaking mass casualty event, as any EMS chief knows, is no time to be learning new tools or fumbling with the unfamiliar.
“With frequency, you build the muscle memory for success,” said Ricketson. “We advocate using Pulsara for every single patient, whether it’s the toe pain that’s going to triage or the chest pain that’s going to the cath lab. Lower-acuity patients are an opportunity to get that practice in, because you’re under much less stress. Then if you can make it second nature, then you just don’t have to think about it whenever something big happens.”
The time required to clear scenes and get patients to definitive care suggests that’s a viable approach. After the Bastrop County bus crash, the scene’s 50-plus patients were processed in under 2½ hours. Following the Fort Worth hotel explosion, the scene was cleared in two, even with victims who needed extrication. Obviously, time to definitive care matters for trauma victims, and Pulsara has also chronicled speed benefits with the platform’s use around stroke, STEMI and more.
Even without repetition, using the platform is quick and simple: Responders give each patient a wristband with a unique barcode and scan it with the app on their personal communication device to start a patient channel. They then use that channel to chronicle all findings and interventions, along with the patient’s identifying information. Any other responders on the platform, including those at hospital emergency departments (in Texas they also use Pulsara), can access that channel and add to it as they deliver additional care. The same record follows the patient throughout and across organizations, reducing duplication and ensuring accuracy.
This can replace radio reports and phone calls, streamlining the process on both the EMS and ED ends and beyond to specialists, other facilities and anyone else involved in care. Providers can add photos and supporting data like EKGs, and when face-to-face communication is needed, the platform supports video calls.
“Getting on the radio and calling in a report is easy; nobody denies that,” said Ricketson. “But what often happens is that somebody takes that report and then has to try to remember everything you said, or they try to write it down as you’re saying it and then pass it along. Then as the information changes hands, it degrades, and the story changes. It’s 2024, and we’re still playing that ‘telephone’ game of passing information from person to person.”
FASTER ORDERS MEAN FASTER SERVICE
That streamlined approach brings the same benefits to single patients as it does to multiple. In both cases it helps definitive care occur faster, as ED staff have reliable, actionable information to begin preparations immediately. Odds are, with the old phone or radio report and vague details scribbled down on the nearest scrap, meaningful actions might not really be taken before patients are on premises.
“Imagine you walk into McDonald’s at noon, and the line’s out the door,” said Ricketson. “Then you see that kiosk sitting there, and you’re really hungry. Are you going to stand in line, or are you just going to walk up to the kiosk and order? Because when you do that, it puts you into the system immediately, and you’re going to eat sooner.
“It’s similar if I call in a radio report for a suspected STEMI and tell the nurse I’ll be there in 10 minutes, they may just wait for me to get there. If I notify them with Pulsara and attach an EKG, that nurse can press a button that says ‘activate,’ and now a cardiologist and cath lab personnel and registration personnel are all added in immediately. You’re in the system, they’re taking action, and now why even stop at the ED?”
The daily repetition of this process naturally builds speed and comfort when there’s more than one patient in front of you – think about how fast baggage professionals at airports can intake, tag and forward along your checked bags among hundreds of others. Time savings come in applying the wristbands and completing patient reports earlier with features like voice-to-text and simple ID scanning to populate personal details.
“I can do the scanning, photos and voice-to-text with a Pulsara report in about 45 seconds,” said Ricketson. “But I don’t have to wait for someone to answer the radio or phone, and I don’t have to repeat myself if there’s a bad connection. I take the extra 45 seconds before I ever leave, and we have the order in, and now the ED also has an extra few minutes’ heads-up.”
That’s a benefit that scales. After the Sandman explosion, Medstar created an incident in Pulsara, shared it with its local regional advisory council (bodies that oversee trauma care in Texas), and the RAC shared it on to regional hospitals to alert them of the MCI and potential for patients, resulting in a more agile response by their EDs. And in Bastrop County, with even more patients, everyone having a common operating picture of their identities, details and locations expedited reunifications with terrified families.
START SMALL AND BUILD
Other states are moving forward with Pulsara as well, and now they have a big-state model for success: Start with the basics – EMS to ED communication – then grow capabilities with practice.
“It’s a lot like running a marathon,” said Ricketson. “You don’t just hit the pavement and start trying to run 26 miles. You start with something like a 5K and build up. A lot of people never get off the starting blocks when it comes to a project like this because they think it’s too big to overcome. But the people who have been successful with this are those that don’t put up those roadblocks. They’re the ones who say, ‘We’re going to implement this, and we’ll start with our EMS-to-ED. Then when we get good at that, we’ll start doing some MCI training,’ or whatever the case is. And eventually it’s been a year, and they look back and realize, ‘Wow, we’ve come an incredibly long way, and we’re really good at this now!’”
When the next big one happens, their patients will appreciate that.
For more information, visit Pulsara.
