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Introduction

The Delaware Emergency Medical Services Oversight Council (DEMSOC) annual report
represents an overview of the available information regarding the progress and state of
Delaware‟s EMS system. The inaugural report published in 2000, enabled DEMSOC to establish
a baseline from which to measure the impact of changes and growth in Delaware‟s EMS system.
DEMSOC presents this annual report in accordance with Title 16, Chapter 97, §9703 of the
Delaware Code.

It is DEMSOC‟s vision that Delaware‟s EMS system represents true excellence in out-of-
hospital health care.

As you read the 2011 Annual Report, we are confident that you too will be proud of the State of
Delaware‟s Emergency Medical Services current capabilities, and marvel at the progress that has
been made in the previous 11 years. The DEMSOC members are encouraged by the system‟s
successes, optimistic about the future and are looking forward to continuing enhancements to the
EMS services provided to the State in the years to come.

What EMS Does

The goal of Delaware‟s Emergency Medical Services system (EMS) is to provide the right level
of care at the right place and the right time. This is accomplished through a well-coordinated
tiered system of response that includes many agencies. Each agency has an integral role in
providing the highest level of pre-hospital medical to the citizens and visitors of the 1st State.

EMS in Delaware includes:

Public safety dispatch centers

Ground and air ambulance services
Fire services
County paramedic services
Law enforcement agencies
Local and State EMS agencies
Hospitals and specialty care centers
Training institutions and organizations
Citizen, professional, and technical advisory groups
Other governmental and voluntary organizations

Who We Are:

1080 Certified First Responders

1473 EMT-Basics
260 Paramedics
165 Dispatchers
 7 Medical Directors
67 Regulatory, Managerial & Support Personnel (DEMSOC, OEMS, SFPC, DE State Fire School)

EMS services provided to the State of Delaware include:

There are 56 Basic Life Support (BLS) ambulance agencies comprised of a combination of paid
and volunteer EMS providers. Paramedic Advanced Life Support (ALS) services are provided
state-wide by the three counties while the State Police Aviation Division provides the majority of
911 aero-medical services with assistance from one inter-facility service. Additionally, the state
is serviced by nine BLS inter-facility medical transport services, three ALS inter-facility medical
transport services and one specialty hospital transport service. The units that respond to 911 calls
for service receive their directions from certified dispatch centers located throughout the state.

126 BLS ambulances providing 911 services

100 BLS ambulances providing non-emergency services
19 Full Time & 3 Part Time ALS units providing 911 services
5 ALS Supervisor units
3 Air Medical helicopters providing 911 services
2 ALS agencies providing non-emergency services

The majority of 911, emergency patient transportation is provided by the volunteer BLS fire-
based ambulance services and the Delaware State Aviation Division. ALS services are provided
through a system of chase or intercept paramedic units operated by the three counties. These
ALS units respond in conjunction with the BLS transport units. In 2011, the EMS system in
Delaware responded to the following incidents: (information based on EMS patient care reports)

185085 Statewide Total Run Reports

142189 Medical Incidents
117499 Basic Life Support Incidents
30533 Trauma Incidents
67586 Paramedic Incidents
10120 Pediatric Incidents (0-17yrs)
199 Air Medical Transports
5822 ALS Cardiovascular Incidents
 Delaware Emergency Medical Services Oversight Council
DEMSOC
The Delaware Emergency Medical Services
Oversight Council (DEMSOC) was formed pursuant
to the Delaware Emergency Medical Services
Improvement Act of 1999 (HB332). The council is
charged with monitoring Delaware‟s EMS system to
ensure that all elements of the system are
functioning in a coordinated, effective, and efficient Hon. Lewis Schiliro
Chairman
Robert Stuart
Co-Chairman
manner in order to reduce morbidity and mortality
rates for the citizens of Delaware. It is also charged
to with ensuring the quality of EMS services in
Delaware.

DEMSOC consists of 19 members appointed by the

Hon. Rita Landgraf Robert Ricker Wayne Smith
Governor. The Secretary of The Department of
Safety and Homeland Security, Lewis Schiliro,
serves as the chairman. Also serving on the Council
is the Secretary of Delaware Health and Social
Services, Rita Landgraf. DEMSOC also includes
representatives from the following agencies: the Dr. Jon McGhee Lawrence Tan Colin Faulkner

Governor‟s Office, each county government, the

Delaware State Fire Prevention Commission, the
Delaware Volunteer Firefighter‟s Association and its
Ambulance Committee, the Delaware Healthcare
Association, the Delaware Police Chief‟s Council,
the Delaware Chapter of the American College of Dr. Glenn Tinkoff Dr. Ross Megargel Dr. Ed Alexander

Emergency Physicians, the State Trauma System

Committee, the Medical Society of Delaware, the
Delaware State Police Aviation Section, and the
State EMS Medical Director. There is a
representative for practicing field paramedics and
Sgt. Keith Mark Glenn Luedtke Michael McMichael
there are three at-large appointments for interested
Not Pictured:
citizens, one from each county. The Delaware Office
William Tobin
of Emergency Medical Services provides staff
Robert Coyle, Jr.
support for DEMSOC. The Office of Emergency Gregory Patterson
Medical Services is assigned to Delaware Health and Dr. Steve Murphy

Social Services‟ Division of Public Health and is the Edward Marecki Kenneth Dunn

regulatory authority for the paramedic system and

provides medical oversight to the state‟s EMS
system.

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 Delaware EMS Oversight
Delaware is a frontline leader in prehospital emergency care through comprehensive
coordination, development and evaluation of the statewide emergency medical services system.
The Delaware EMS system is a two tiered EMS delivery system with shared oversight of Basic
Life Support services and personnel by the State Fire Prevention Commission and Advanced
Life Support services and personnel by the Office of EMS within the Division of Public Health
within the Department of Health and Social Services.

The Office of Emergency Medical Services (OEMS) is responsible for coordination of

training, certification, financing, and oversight of the state‟s paramedic system.
EMS Medical Direction is provided by emergency medical physicians that are employed
by the Office of EMS. They provide medical direction to both Advanced Life Support
(ALS) and Basic Life Support (BLS) services.

The Delaware State Fire Prevention Commission (SFPC) oversees Basic Life Support (BLS)
services through the Ambulance service regulations. These regulations address administrative,
operational, and provider requirements. This includes emergency as well as non-emergency
ambulance services.

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 Emergency Medical Services and Preparedness Section (EMSPS)

In December of 2010, the Division of Public Health announced that the Office of Emergency
Medical Services (OEMS) and the Public Health Preparedness Section (PHPS) merged and now
constitutes the new Emergency Medical Services and Preparedness Section (EMSPS). The two
separate offices still exist; they are co-located geographically and have shared oversight. Steven
Blessing was named as the Section Chief overseeing the newly formed section. Nicole Quinn is
the Director of the Public Health Preparedness Office. In early 2011, Diane Hainsworth was
named the Director of the Office of EMS. The merger allows the Division of Public Health to
consolidate resources supporting the two offices and find synergy in the similar missions and
capabilities they possess.

The EMSPS has representation on the following committees:

DEMSOC Traffic Records Coordinating Council "Core Team"
National Association of State EMS Officials DPH Section Chiefs Meeting
Organ and Tissue Donor Awareness Board CODES
National Trauma-EMS Stakeholders Committee EMS Dispatch Committee
Coordinating Council for Children with Disabilities DTCC Paramedic Education Advisory Board
Accreditation of Educational Programs for the EMS DEMSOC Mass Casualty Transport Committee
Professions (CoAEMSP) Atlantic EMS Council
American College of Surgeons‟ Trauma System Priority Medical Dispatch
Consultation -site visit review School Health Commission
Statewide Interpretative and Emergency Communication Risk Watch
New Castle County EMS Advisory Committee NAEMSP Annual Meeting
Sussex County EMS Advisory Council o NAEMSP Public Health Committee
ALS Standards Subcommittee of the Board of Medical o NAEMSP Standards and Clinical Practice
Practice Committee
Delaware Chapter of the American College of Emergency o NAESMP Quality Improvement Committee
Physicians o NAEMSP Air Medical Services Ad Hoc
Delaware Chapter of the Committee on Trauma Committee
Delaware Chapter of the American Trauma Society Christiana Care Emergency Department Research
American Heart Association‟s Delaware Mission Lifeline Committee
Delaware Homeland Security Christiana Care Critical Care Committee
Delaware Medical Reserve Corps Volunteer Meetings State Citizen Corps Council Meetings
Delaware Volunteer Organizations Active in Disasters Delaware Public Health and Medical Ethics Advisory
(DEVOAD) Group
Performance Evaluation and Improvement Workshop Healthcare preparedness Steering Committee
DHSS Disaster Committee Laboratory Preparedness Advisory Committee
Emergency System for Advance Registration of Volunteer (Biological Component)Collaborative Fusion, Inc
Health Professionals (ESAR-VHP) State Coordinators‟
Meetings SHOC Section Meetings
Emergency Services Coordinator Group Senior Advisory Council (SAC)
Advisory Committee for Johns Hopkins Center for Public Governance Board Member, Delaware Information and
The Office of Emergency Medical Services (OEMS)
Health Preparedness Analysis Center (DIAC)
State Hazard Mitigation Council Mid-Atlantic Regional Public Health Preparedness
ASTHO Directors of Public Health Preparedness (DPHP) Council

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 The Office of Emergency Medical Services (OEMS)

The mission of the Office of Emergency Medical Services is to assure a comprehensive, effective, and
efficient statewide emergency medical care delivery system in order to reduce morbidity and mortality
rates for the citizens of Delaware. The OEMS ensures the quality of emergency care services, including
trauma and prehospital advanced life support capabilities, through the coordination and evaluation of
the emergency medical services system, within available resources.

Responsibilities of this agency include:

Advanced Life Support Services (ALS): The OEMS ensures highly trained paramedics are
providing quality emergency care to the citizens and visitors of Delaware. The OEMS is
responsible for coordination of training, certification, financing, and oversight of the state‟s
paramedic system.
Statewide Trauma System: This program is responsible for coordination of hospitals and
provider agencies to ensure optimal care for trauma patients.
Prehospital Patient Care Reports: The EMS Data Information Network (EDIN) system
collects EMS report data electronically on a real-time basis and provides administrators with a
powerful resource management, and research tool. The EDIN system collects, at minimum,
over 130 data points covering demographic, assessment, and treatment phases of an EMS
incident.
EMS Medical Direction: This program is responsible for providing medical oversight of the
statewide EMS system (Advanced/Basic Life Support, and emergency medical dispatch),
review and modification of the statewide standard treatment protocols, oversight of medical
command facilities, conducting research and oversight of the statewide EMS quality assurance
program.
Emergency Medical Services for Children (EMSC): The goal of this program is to improve
emergency care for children in the State of Delaware through specialized activities. The
Special Needs Alert Program (SNAP) and Safe Kids are part of the programs within EMSC.
First State, First Shock Early Defibrillation Program: This program is responsible for
providing data collection, training, and prevention activities in support of initiatives to reduce
cardiac arrest deaths in Delaware.
Crash Outcome Data Evaluation System (CODES): This program analyzes data to gain a
more comprehensive understanding of the causes and impacts, both medical and financial, of
motor vehicle crashes, and is better equipped to develop injury prevention programs with
demonstrated potential for improved outcomes.

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EMS Infectious Disease Exposure Monitoring: The need for an effective infection control
program has always been an essential and integral part of the prehospital practice in Delaware
because there is both the risk of healthcare providers acquiring infections themselves and of
them passing infections on to patients. Preventive and proactive measures offer the best
protection for individuals and organizations that may be at an elevated exposure to these
infectious diseases.
State Regulations promulgated through OEMS:
Delaware Trauma System Regulation: The State Trauma System regulations were first
promulgated in 1997 to add detail to the Trauma System enabling the legislation of 1996.
Subsequent revisions were enacted in 1999 and 2001. The regulations include sections on the
Trauma Center Designation Process, Trauma Center Standards, Triage, Transport, and Transfer
of Patients, and the Trauma System Quality Management Plan.
Air Medical Ambulance Service Regulation: The purpose of this regulation is to provide
minimum standards for the operation of Air Medical Ambulance Services in the State of
Delaware. These regulations intend to ensure that patients are quickly and safely served with a
high standard of care and in a cost-effective manner.
Early Defibrillation Provider Regulation: The purpose of this regulation is to establish the
criteria for training and the right for emergency responders to administer automatic external
cardiac defibrillation in an out-of-hospital environment.
Advanced Life Support Interfacility Regulation: The purpose of this regulation is to permit
the use of paramedics, under the oversight of the Division of Public Health, to manage patients
while in transit between medical facilities or within a healthcare system. It includes approval of
an organization to provide service using paramedics, as well as defining their scope of practice
and medical oversight.
Medical Orders for Life Sustaining Treatment (MOLST): Delaware recognized the need to
update the existing Pre-Hospital Advanced Care Directive (PACD) form and regulations to
address the recognition of advance care directives across all health care settings, including, but
not limited to, hospitals, long-term care facilities, hospices, emergency medical transport, and
home care. Delaware now has an approved Medical Orders for Life-Sustaining Treatment
(MOLST) form. These MOLST/PACD regulations authorize the Division of Public Health in
conjunction with other key groups within the State to develop and implement MOLST/PACD
protocol. These regulations, protocol and form standardize the legal advance care directive
documentation so that EMS and all health care providers have a readily recognizable form which
sets forth the patients preferences regarding provision of life-sustaining treatments. The
MOLST/PACD forms allow EMS and other health care providers both to identify and to honor
an individual‟s wishes to the greatest extent possible and to grant individuals the dignity,
humanity, and compassion they deserve.
Organ and Tissue Donor Awareness Board
The Office of EMS provides staff support to the Delaware Organ and Tissue Donor Awareness
Board. Created by Delaware Code, Title 16, Chapter 27, Anatomical, Gifts and Studies, §2730,
this Governor-appointed board has the responsibility of promoting and developing organ donor
awareness programs in Delaware. These programs include, but are not limited to, various types
of public education initiatives aimed at educating residents about the need for organ donation and
encouraging them to become designated organ donors through the State driver‟s license program.
As of October, 2011, there were 577 Delaware residents waiting for an organ transplant. As of
January 1, 2012 352,413 (46.23%) Delaware drivers have self-designated as organ donors on
their driver licenses.

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 Office of Preparedness
DELAWARE HEALTH AND SOCIAL SERVICES
Division of Public Health
Public Health Preparedness Section

The Office of Preparedness takes the lead and collaborates with partners and the community to
develop, implement and maintain a comprehensive program to prepare for, mitigate against,
respond to and recover from public health threats and emergencies.

Beginning in 2002, Delaware has received funding through the Health Resources and Services
Administration (HRSA), Bioterrorism Hospital Preparedness Program, which is now managed
by the Office of the Assistant Secretary for Preparedness and Response (ASPR) within the US
Department of Health and Human Services (HHS). Public Health Emergency Preparedness
(PHEP) funding is also received from the Centers for Disease Control and Prevention. In
addition, Delaware has also received funding through the U.S Department of Homeland Security
to enhance preparedness and response capabilities to a terrorist incident. Delaware continues to
prepare the Division of Public Health (DPH), hospitals and supporting healthcare systems to
deliver coordinated and effective care to victims of terrorism, disasters and other public health
emergencies.

DPH has well-established Public Health and Emergency Medical response capabilities and
continues to further enhance preparedness efforts as they pertain to Medical Surge Capacities
and Capabilities (MSCC). Through its Modular Medical Expansion System (MMES), DPH can
provide prophylactic medications and/or vaccine for up to 2000 people per hour for dispensing
medications and 600 people per hour for vaccination through its Point of Dispensing; can
accommodate up to 200 people in an Alternate Care Site, which can assist hospitals with
expanding acute care capabilities by 400 patients; and can expand mortuary capacity within the
state by 144 bodies. Other capabilities include, but are not limited to, redundant communications
capabilities using 800 Mhz radios, portable decontamination shelters in every hospital,
stockpiled personal protective equipment, a mobile medical facility, and a statewide hospital
evacuation plan. Throughout DPH‟s preparedness process, it has addressed supplies and
equipment; education and preparedness training, exercises, evaluation and corrective actions; and
the needs of at-risk populations.

DPH has implemented a five year building block approach to its training and exercise program.
DPH will focus its efforts on responding to an anthrax event, continuity of operations, and
hospital readiness and response, scaling up responses year by year. The exercise cycle will begin
in the Fall of 2012.

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 Delaware State Fire Prevention Commission (SFPC)
Submitted by the Delaware State Fire School

The State Fire Prevention Commission is charged with the protection of life and property from
fire for the people of Delaware and to oversee the operation of the Delaware State Fire Marshal‟s
Office and the Delaware State Fire School.

Back Row:
William F. Tobin
Tom DiCristofaro
Bob Ricker
Douglas S. Murray Sr.
Front Row:
David J. Roberts, Chairman
Alan Robinson, Vice
Chairman

Missing from Photo:

Marvin Sharp

The Statutory responsibilities of the Delaware Fire Prevention Commission are to promulgate,
amend, and repeal regulations for the safeguarding of life and property from hazards of fire and
explosion. The Statutory responsibilities of the State Fire Prevention Commission may be found
in Title 16, Chapter 66 & 67 of the Delaware Code and are summarized as follows but not
limited to:

• The Commission consists of seven persons appointed by the Governor.

• They have the power to promulgate, amend and repeal regulations for the safeguarding of
life and property from hazards of fire and explosion.
• Prior to promulgation, they shall hold at least one public hearing on each regulation,
amendment or repealer and shall have the power to summon witnesses, documents and
administer oaths for the purpose of giving testimony.
• They shall appoint the State Fire Marshal and State Fire School Director.
• The Commission shall have power to authorize new fire companies or substations; resolve
boundary and other disputes; prohibit cessation of necessary fire protection services.
• The Commission is empowered to enforce its orders in the Court of Chancery.

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 Delaware State Fire School (DSFS)

Delaware Code, Title 16, Chapter 66, §6613 – 6618, mandates the Delaware State Fire School
to: (1) provide firefighters with needful professional instruction and training at a minimum cost
to them and their employers; (2) develop new methods and practices of firefighting; (3) provide
facilities for testing firefighting equipment; (4) disseminate the information relative to fires,
techniques of firefighting, and other related subjects to all interested agencies and individuals
throughout the state; and (5) undertake any project and engage in any activity which, in the
opinion of the State Fire Prevention Commission, will serve to improve public safety.

New Castle County Division Delaware State Fire School Sussex County Division

In order to comply with the statutory mandate, the State Fire School established a goal “to
provide fire, rescue, emergency care, and related training to members of the fire community,
industry, agencies, institutions, and the general public requiring specific programs and any
program which will serve to benefit the safety of the public”. The primary activities center on
operations at the State Fire Training Center west of Dover. Other activities are consolidated into
in-service fire department training courses, training programs for state agencies, institutions and
industrial facilities, public education programs, and emergency care and first aid courses.
The agency objectives established to achieve that goal are:
To provide firefighters with needful professional instruction and training.
To provide basic life support personnel with needful professional instruction and training.
To provide rescue personnel with needful professional instruction and training.
To certify basic life support personnel as State of Delaware Emergency Medical Technicians.
To inspect and license ambulances that operate within the State of Delaware.
To provide agency, institutional and industrial personnel and the general public with needful
professional instruction and training.
To disseminate information relative to fires, techniques of firefighting, and other related
subjects to all agencies and individuals throughout the state.
To develop new methods and practices of firefighting.
To provide facilities for testing of firefighting equipment.
On July 1, 1972, the State Fire Prevention Commission was also given the mandate under
Delaware Code, Title 16, and Chapter 67, §6708 – 6714, to regulate the ambulance service in
Delaware. The Commission assigned to the State Fire School the added duties of inspecting and
licensing ambulances and the training and certifying of ambulance personnel.
Ambulance Service Regulations – This regulation is to ensure a consistent and coordinated high
quality level of ambulance service throughout the state focusing on timeliness, quality of care

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and coordination of efforts. This regulation addresses BLS Ambulance Service and Non-
Emergency Ambulance Service. It clearly defines the administrative and operational
requirements for such entities.

The State Fire Prevention Commission has adopted, as a regulation, a Statewide Quality
Assurance and Improvement Committee. This committee, under the direction of the State
Medical Director, is responsible for assuring and improving the quality of Basic Life Support
within the EMS systems that serve the State of Delaware. By conducting medical incident
reviews and evaluating patient care statistics, the committee is able to provide constructive
feedback on quality improvement to all EMS professionals within the State of Delaware.

The State Fire Prevention Commission also adopted a BLS regulation that detailed EMS
Educational Program Administrative Standards and Guidelines. This regulation describes the
standards and guidelines for emergency medical services (EMS) educational agencies that
present programs for the First Responders/ EMT-Bs in the State of Delaware. The regulation
was developed to ensure that all students receive the highest quality of training approved by the
State Fire Prevention Commission and the Office of Emergency Medical Services.

Office of the Fire Marshal (OFM)

In 1953, at the urging of the Volunteer Fire Service, the State Legislature created the Office of
the State Fire Marshal and directed that regulations, reflecting nationally recognized standards,
be promulgated to enhance life safety and property conservation for the citizens of Delaware.

The State Fire Marshal's Office functions as an independent state agency under the State Fire
Prevention Commission, which promulgates the State Fire Prevention Regulations, as enforced
by the State Fire Marshal's Office. As the law enforcement agency charged by state statute with
the suppression and investigation of arson, the State Fire Marshal's Office provides the lead role
in fire and arson investigations, statewide. The agency is charged with assisting the Chief of any
fire department on request, inspections and code enforcement in health care facilities,
educational occupancies, public assembly, public accommodations, flammable and combustible
liquids, flammable gases, explosives and fireworks.

The State Fire Marshal's Office is responsible for the comprehensive compliance with the state
statute for the installation of smoke detection devices in all residential occupancies, which will
greatly reduce the likelihood of injuries and deaths from fire.

The objective of the State Fire Marshal's Office is to provide a fire safe environment for the
citizens of Delaware and all who visit and carries out its mandate for Public Service, through the
work of three divisions, Administration, Field Operations & Technical Services.

Number of Fire Fatalities 2

Number of Burn Injuries Investigated by SFMO 54
2011Delaware State Fire Marshal’s Office Data

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 Medical Direction
Medical direction involves granting authority and accepting responsibility for the care provided
by EMS, and includes participation in all aspects of EMS to ensure maintenance of accepted
standards of medical practice. Quality medical direction is an essential process to provide
optimal care for EMS patients. It helps to ensure the appropriate delivery of population-based
medical care to those with perceived urgent needs. (National Highway Traffic Safety Administration)

Structure
Delaware‟s Emergency Medical Services (EMS) responds to and provides medical care to
victims of illness and trauma through a statewide coordinated medical system of EMS
responders. EMS responders include 911 dispatchers, first responders, Basic Life Support (BLS)
providers, paramedics or Advanced Life Support (ALS) providers, and on-line emergency
physicians who oversee individual patient care. All of these EMS responders are medically
coordinated through protocols and training directed and overseen by a select group of Board
Certified Emergency Physicians licensed in Delaware.

Delaware employs emergency physicians to devote part of their professional efforts to the State
EMS system. They include:
State EMS medical director
State BLS EMS medical director
County EMS medical directors (one for each county)
County associate EMS medical directors (one for each county)

The BLS and county medical directors are accountable to the state EMS medical director. The
medical directors meet regularly to review statewide treatment protocols, quality issues, new
medical techniques and equipment in a continuing effort to provide the citizens of Delaware with
the most up-to-date and appropriate EMS care possible. All EMS medical directors are required
to take the National Association of Emergency Medical Services Physicians' (NAEMSP)
Medical Directors course.

Delaware‟s EMS Medical Directors assure quality care to patients through interactions with
other physicians, hospitals, citizen groups, and organizations such as, the American Heart
Association and the Medical Society of Delaware. They review aggregate patient care data from
the providers to determine the effectiveness of the treatment protocols. Retrospective medical
oversight occurs through interactions with EMS personnel at hospital emergency departments
and subsequent to problem case identification. Certain high risk or intensity cases are routinely
identified for automatic medical direction review.

PCR Print Time Report

The Medical Directors are continuing to monitor the issue of the timely delivery of the patient
care report (PCR) to the receiving facilities. The importance of the PCR to the receiving facility
is immeasurable since the PCR often provides the patient‟s initial complaint, initial vital signs,

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initial treatments, medical history, medication list, response to treatments and environmental
factors that may influence patient care and subsequent disposition. A PCR completed greater
than 24 hours after patient arrives in a facility provides no service to that patient nor the
healthcare providers caring for that patient and leads to questions of fraudulent billing when a
PCR is completed so far beyond the time of service. Standing Order for PCRs, for both ALS
and BLS providers, require compliance times of 4 hours or less. The graph below shows the
compliance rates to the standing order of 59% with 41% of all PCRs completed beyond the 4
hour timeframe.

Statewide Print Time Report 2011

80,000 59%
70,000

60,000 41%
50,000

40,000

30,000

20,000

10,000

0
=<4 hrs > 4 hrs

=<4 hrs > 4 hrs

Statewide Reports by Agency Type and Printed Hour 2011

Total Number of Reports

50,000 54%
46%
40,000 86%
30,000

20,000

10,000 14%
0
ALS BLS

=<4 hrs >4 hrs

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2011-2012 Initiatives
Field Providers Work Hours: We are addressing concerns regarding the excessive
continuous work hours that some of the field providers are working without the
opportunity for uninterrupted down time. This happens when providers work for several
provider agencies, moving from one to the other without rest between. These types of
schedules are leading to a number of real and potential problems/liabilities:

o Increased medical errors

o Increased aggressiveness
o Motor vehicle crashes

EMS Funding: EMS funding is a considerable issue within our state. When the ALS
system was developed in our state it was set up that the state would reimburse the county
paramedic services 60% of all operational costs. Unfortunately, with the fiscal
environment today that number as of the start of FY11 has dropped to 30%. As a result,
the county agencies have had to make some difficult decisions as to reductions of service.
Some of those reductions (or proposed reductions) include:
o Reduced administrative support staff
o Reduced Quality Assurance/Quality Improvement (QA/QI) data analysis
o Reduced participation in State EMS planning, QA, protocol development and
training.

Systems of Care Development: Delaware is fortunate to have a well-developed

inclusive Trauma System and an inclusive Pediatric System. The next initiative is the
development of a Cardiovascular System of Care. Currently, our EMS system operates
as if a cardiovascular system of care is already in place. We have developed protocols
that identify the need for transport to an appropriate facility. Emergency percutaneous
coronary intervention (PCI) or angioplasty capabilities in each county have been
identified and are the preferred centers for transportation of patients having a heart attack.
The following are a few major obstacles that have been identified:
o Currently there is no funding for a system coordinator
o Need for development/legislative change for protected peer review
o Need to identify systemic performance measures for QA/QI
o Lacks outside, independent verification

Use of Pre-hospital Continuous Positive Airway Pressure (CPAP): Delaware was

early to indentify the usefulness of pre-hospital CPAP and embrace the use of CPAP
systems for patients in respiratory distress. The use of this type of device continues to
reduce overall healthcare costs for these patients with shorter hospital stays and improved
patient comfort and outcomes. We are continuing the program that allows the use of
these devices in the BLS community with success.

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Sepsis Protocols and Recognition: With recent published information regarding the
early identification of sepsis (patients with life-threatening infections) and survivability,
the state implemented a field testing program through the use of point of care testing for
lactic acid levels by paramedics. This point of care testing is part of an optional ALS
protocol to help identify patients who are likely suffering from sepsis and begin treatment
by pre-hospital care providers. This evidence based protocol is expected to shorten the
time it takes patients with sepsis to receive the appropriate treatment. Research has
shown that the sooner we identify patients with severe infections or sepsis and initiate
antibiotic therapy the more likely they are to survive, and to survive with less morbidity.
In the near future we expect to initiate prehospital IV antibiotic therapy on our septic
patients with longer transport times.

Updated Standing Orders and EMS Safety: In 2011, the EMS medical directors
reviewed the standing orders with the intention of updating them to the new American
Heart Association‟s resuscitation guidelines. Included in this update are modifications to
the trauma and pediatric standing orders. The medical directors have been and continue to
advocate for EMS safety and the standing orders are no exception. From an EMS
medical director‟s perspective, red lights and siren responses, and transports, are an EMS
safety issue for patients, EMS providers and the traveling public. The State Fire
Prevention Commission's regulations currently do not address the use of red lights and
siren during EMS responses. The State Fire Commission has agreed to begin the process
of addressing this issue and has made verbal commitments to address this problem in the
near future. The EMS medical directors continue to advocate for patients, EMS providers
and the public, by reminding field providers, within the standing orders, that for many of
the patients transported to the hospital, red lights and sirens are not indicated.

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 Continuum of Care

The EMS Continuum of Care is the cyclical process used to describe the delivery and constant
improvement of EMS care. An EMS event usually begins with the onset of illness or injury in a
patient and a call to the dispatch center through 911. The call is then triaged and dispatched and
the appropriate providers arrive on scene to provide care. The patient is then delivered to the
hospital, where they receive specialty care (cardiac, trauma, pediatrics) as appropriate and
ultimately may enter rehabilitation if needed. The event is then analyzed and lessons learned are
shared with providers and the public in the form of awareness campaigns and educational
programs in the hope of reducing the potential for further events. Events are analyzed by
looking at the 12 main attributes of an EMS system (Public Access, communications, clinical
care, etc.) so that all aspects of the EMS system benefit from the lessons learned during a given
event. Each modification or improvement to one aspect of the EMS system has an impact on the
rest of the system.

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 System Evaluation

Evaluation is the essential process of assessing the quality and effects of EMS, so that strategies
for continuous improvement can be designed and implemented. (National Highway Traffic Safety
Administration)

The National Association of Emergency Medical Services Physicians (NAEMSP) has identified
three related variables for measuring EMS system performance; clinical performance, response
time reliability and economic efficiency. These variables are interdependent for overall system
success. Focusing the majority of resources on any one variable is done at the expense of
performance potential in the other variables. For example, extreme cost cutting measures will
have a detrimental impact on clinical performance and response time reliability. Also, if a system
places all of its efforts on response time performance there will be a significant increase in costs
as well as a decrease in clinical performance.

28 | P a g e
 Prehospital Patient Care Report

In Delaware, data from the electronic EMS Data Information Network (EDIN) is largely used to
evaluate the EMS system. EDIN collects EMS report data electronically on a real-time basis and
provides administrators with a resource management and research tool. The EDIN system
collects, at minimum, over 130 data points covering the demographic assessment and treatment
phases of an EMS incident. The EDIN system has been online since January 1, 2000. Since its
inception, over one million records have been entered into the system. Currently, all of the
Advanced Life Support agencies in Delaware are using the system on a full-time basis. Of the 58
volunteer Basic Life Support agencies, almost all are using the system on either a full time or
partial basis. This allows DEMSOC a continued review of operational and clinical data for the
ALS and BLS providers.

Update On New Prehospital Patient Care Reporting System:

The new prehospital patient care reporting system will have an open scalable architecture and
support standards, which are key to streamlined processing and data exchange. It will further
provide a secure method of collecting pre-hospital data, extracting existing data, and exporting or
sharing data for strategic planning and process improvement initiatives. By upgrading the
technology used and by utilizing a web based program OEMS will provide higher quality data
collection. Finally, Delaware is looking forward to integration into the National EMS
Information System. The ability to share and benchmark data with other states will be vital for
continued growth and improvement of EMS care in the years to come.

29 | P a g e
 Clinical Performance

EMS systems were originally developed to reduce fatalities from traumatic injuries, especially
from motor vehicle crashes. It was noticed during military conflicts that patients had better
outcomes when injuries were quickly stabilized in the field and the patient was then transported
to a care center. The original EMS system mimicked this with the vast majority of the emphases
placed on traumatic injuries. As the science and practices of prehospital care progressed over the
years, so did the scope of the EMS provider. The evolution of evidence based practices with
cutting edge technologies work in tandem to improve the clinical outcome for all types of
patients. The EMS system is inclusive of many different disciplines; trauma, cardiac care,
medical care, pediatric care, medical transportation, public health and domestic preparedness just
to highlight a few.

EMS provides care to those with perceived emergency needs and, when indicated, provides
transportation to, from, and between health care facilities. Mobility and immediate availability
to the entire population distinguish EMS from other components of the health care system
(National Highway Traffic Safety Administration).

(All data used for this section and throughout the report were, unless noted otherwise,
extrapolated from the EMS Data Information Network (EDIN). Please note for this report,
Advanced Life Support (ALS) and BLS data are reported separately. While reading this report
please do not combine the ALS and BLS data. Doing so would lead to inaccurate totals.)

EMS Usage by Location Type-2011

100%
90%
80%
70% Farm
Education Institution
60% Other
Place of Employment
50% Public Place
Heath Facilities
40% Street or Highway
Home/Residence
30%
20%
10%
0%
New Castle Kent County Sussex County
County

EMS usage by location type:

These graphs show the location of EMS calls which is helpful in designing dispatch protocols, developing
operational systems to assist EMS providers in the rapid location of patients and to develop programs to reach
critically ill and injured patients as quickly as possible with life saving treatments of which the Automatic
Defibrillator program is an example.

30 | P a g e
 Types of EMS Patients by County
2011
4.4% 3.9%
16.5% 15.9%
1.2% 1.9%

0.5% 77.4% 0.2% 78.2% Medical

OB/GYN
New Castle County Kent County Stand by
4.3% 5.8% Trauma
16.8% 26.2% Trauma/Medical

4.0%
0.3% 74.6% 4.0% 64.0%
Sussex County Out of State

Types of patients
Medical patients are those individuals who are suffering from a condition such as chest pain,
heart attacks, respiratory problems, altered mental status, seizures, strokes and infectious disease.
OB/GYN refers to pregnancy and female related medical conditions.
Trauma patients are those who suffer an injury caused by a transfer of energy from some external
source to the human body such as motor vehicle crashes, gunshot wounds, stabbings, industrial
accidents and falls.
Trauma/Medical patients often include patients who had a medical condition that caused them to
suffer a trauma such as an episode of syncope, related to a heart problem that caused the patient
to fall, suffering a serious head injury.
Standby is when EMS personnel wait in readiness, typically at large scale events such as
marathons or concerts.

Gender of EMS Patients-2011

45.7%
Male
Female
54.3%

31 | P a g e
 Most Common Patient Presentation by Primary
Impression, ALS 2011
New Castle County Sussex County Kent County
Number of Patients

5000
4000
3000
2000
1000
0
Cardiac Difficulty General Pain Altered Other
Problems Breathing Malaise Mental
Status

Primary Impression is the EMS provider’s evaluation of the patient based on: signs, symptoms, patient’s chief
complaint and other factors. These graphs do not take into account the type of patient (medical, trauma). The
primary impression of other is defined in the patient narrative and not able to query.

Most Common Patient Presentation by Primary

Impression, BLS 2011
New Castle County Sussex County Kent County

16000
Number of Patients

14000
12000
10000
8000
6000
4000
2000
0
Pain Difficulty General Other No Abdominal
Breathing Malaise Complaint Pain

32 | P a g e
 ALS Receiving Hospital Comparisons 2009-2011
14,000

12,000

10,000

8,000
2009
6,000 2010
2011
4,000

2,000

al
a

l
l

ita
l
ita
a

i ta ra

ita
i ta ia n

i ta o ri
pit

sp ne

p
p

sp

os
s

sp m

os
sp rist

Ho Ge
Ho

Ho
Ho Me
l

H
H
Ho Ch

l
l

on
nt

e
e

cis
d
eb

ok
Ke
-

gt
or

n
R
Be

ic

in
i lf

ra
CE

nt
M

i lm
.F
Na

St

W
Note: Both ALS and BLS charts are based on the total number of patients transported by the specific EMS service.
BLS responds to more patient runs and therefore transports more patients to the hospital. This is noted on the right
hand side of each chart contained on this page.

BLS Receiving Hospital Comparisons 2009-2011

35,000

30,000

25,000

20,000 2009
15,000 2010
2011
10,000

5,000

0
l
na

l
l

ita
l
ita
ta oria
ta

pi era

ita
pi

pi stia

p
p

p
en

os
os

os em

os

os
os ri

H
H

H
ta

H M
H Ch

l
l
ta

on
t

e
be

s
en

pi

ok

ci
os
-

gt
or
ee

an
K
R

tic
H

in
i lf
B

Fr
an
M

i lm
C

t.
N

W
S

33 | P a g e
 ALS and BLS Patient Age Comparison- 2011
All Patients
14000
12000
10000
8000 ALS
6000 BLS

4000
2000
0
Less than 12 to 20 21 to 30 31 to 40 41 to 50 51 to 60 61 to 70 71 to 80 81 to 90 Greater
12 Years Yrs Yrs Years Years Years Years Years Years than 90
Years

ALS and BLS Patient Age Comparison-2011

Trauma Patients
3500
3000
2500
2000 ALS
1500 BLS

1000
500
0
Less than 12 to 20 21 to 30 31 to 40 41 to 50 51 to 60 61 to 70 71 to 80 81 to 90 Greater
12 Years Yrs Yrs Years Years Years Years Years Years than 90
Years

ALS and BLS Patient Age Comparison-2011

Medical Patients
12000

10000

8000
ALS
6000
BLS
4000

2000

0
Less than 12 to 20 21 to 30 31 to 40 41 to 50 51 to 60 61 to 70 71 to 80 81 to 90 Greater
12 Years Yrs Yrs Years Years Years Years Years Years than 90
Years

34 | P a g e
 Time of Day When EMS Incidents Occur-2011

7000

6000

5000

4000
ALS
BLS
3000

2000

1000

0
00
00
00
00
00
00
00
00
00

10 0
11 0
12 0
13 0
14 0
15 0
16 0
17 0
18 0
19 0
20 0
21 0
22 0
23 0
0
0
:0
:0
:0
:0
:0
:0
:0
:0
:0
:0
:0
:0
:0
:0
0:
1:
2:
3:
4:
5:
6:
7:
8:
9:

ALS/BLS Incidents by Month-2011

12000

10000

8000

ALS
6000
BLS

4000

2000

0
1/2011 2/2011 3/2011 4/2011 5/2011 6/2011 7/2011 8/2011 9/2011 10/2011 11/2011 12/2011

35 | P a g e
 Response Time Performance
The Delaware EMS system measures response time performance in fractiles. Fractile response
refers to how the response time is measured against an established performance goal. For
example, if a response goal is 8 minutes, the fractile response time is a percentage of the
responses within that 8 minute goal. A 90% fractile response indicates that 90% of the time the
response time was within 8 minutes or less. Numerous factors affect response time performance
including geography, baseline resource availability, call volume and deployment strategies.
The response time goals for the Delaware EMS system adopted by the EMS Improvement
Committee are based on cardiac arrest survival research. These response goals are nationally
recognized and citied by both NFPA (1710) and the American Ambulance Association
guidelines. It is recognized that these are ideal goals. Response time performance measure is one
of several performance goals and is not a single predictor of the health or success of an EMS
system.
The performance goals for Delaware‟s EMS System recognizes that not all emergencies are life
threatening and do not require maximum resource response. The Emergency Medical Dispatch
system is a systematic approach (protocol) that assists dispatchers in identifying which 911 calls
require maximum response, and identifies calls as:

Alpha – Requires a BLS response. Example is a minor burn.

Bravo – Requires a BLS response. Example is with unknown patient status.

Charlie – Requires ALS and BLS response. Example is burns with difficulty breathing.

Delta – Requires ALS and BLS response. Example is an unconscious burn victim.

Echo – Response type not addressed in the legislated response time goals, but it requires a
maximum response to include available first responders. Example would be a cardiac arrest.

Omega – Response type not addressed in the legislated response time goals. An example of an
Omega response is a dispatcher, while remaining online with the caller, connects to a poison
control center for instructions.

36 | P a g e
 Advanced Life Support Response Time
Compliance for Delta/Echo Responses
January 2011 - December 2011

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Kent County EMS New Castle County Sussex County EMS Delaware
EMS

6 minutes or less 8 minutes or less 10 minutes or less 12 minutes or less

Goal: Each Advanced Life Support (ALS) paramedic agency within the Delaware EMS system provide an
ALS paramedic unit, as defined by recognized state standard, on the scene within 8 minutes of the receipt
of Delta calls on at least 90% of the time. BLS ambulance unit on scene within 10 minutes of the receipt
of Delta calls on at least 90% of the times in urban areas and 70% of the times in rural areas.

Basic Life Support Response Time

Compliance for Delta/Echo Responses
January 2011 - December 2011

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Dover Kent NCC-Urban NCC-Rural Sussex Total

6 minutes or less 8 minutes or less 10 minutes or less 12 minutes or less

37 | P a g e
 Advanced Life Support Response Time
Compliance for Charlie Responses
January 2011- December 2011

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Kent County EMS New Castle County Sussex County EMS Delaware
EMS

6 minutes or less 8 minutes or less 10 minutes or less 12 minutes or less

Goal: Each Advanced Life Support (ALS) paramedic agency within the Delaware EMS system provide an
ALS paramedic unit, as defined by recognized state standard, on the scene within 8 minutes of the receipt
of Charlie calls on at least 90% of the time. BLS ambulance unit on scene within 12 minutes of the receipt
of Charlie calls on at least 90% of the times in urban areas and 70% of the times in rural areas.

Basic Life Support Response Time

Compliance for Charlie Responses
January 2011 - December 2011

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Dover Kent NCC-Urban NCC-Rural Sussex Total

6 minutes or less 8 minutes or less 10 minutes or less 12 minutes or less

38 | P a g e
 Basic Life Support Response Time
Compliance for Bravo Responses
January 2011 - December 2011

100%

95%

90%

85%

80%

75%
Dover Kent NCC-Urban NCC-Rural Sussex Total

12 minutes or less 14 minutes or less 16 minutes or less 18 minutes or less

Goal: BLS ambulance unit on scene within 12 minutes of the receipt of Bravo calls on at least 90% of the
times in urban areas and 70% of the times in rural areas.

Basic Life Support Response Time

Compliance for Alpha Responses
January 2011 - December 2011

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Dover Kent NCC-Urban NCC-Rural Sussex Total

12 minutes or less 14 minutes or less 16 minutes or less 18 minutes or less

39 | P a g e
 Estimate of EMS System Cost
One important factor in evaluating the efficiency of an EMS system is measured in terms of cost.
Delaware continues to refine the process to accurately reflect total EMS system costs. The Basic
Life Support (BLS) Financial form was developed and distributed to all agencies starting in
2002. Additionally, all 911 centers, involving EMS dispatch, have submitted the costs to run
their centers during 2011.

House Bill 332 outlines the requirement for EMS agencies to report cost. “All components
of the EMS system should report revenues and expenses so that the system can be continually
evaluated for its cost effectiveness. Members of the General Assembly, the Governor, the
public and other policy makers should know the costs of Delaware’s EMS system in order to
measure its effectiveness”.

Basic Life Support (BLS) Program Cost

“The Delaware State Fire Prevention Commission recognizes the importance of collecting and
providing financial information with designated agencies. With the adoption of the current
Ambulance Service Regulations this requirement remains an important part of the data reporting
requirements. However, the Commission recognizes that the Ambulance Service Providers have
a number of reporting requirements which are duplicate reports in part. These reporting
requirements include the annual Delaware Volunteer Financial Report, the Annual EMS
Financial Report and the Annual Fire Company Financial Review/Audit Report. The
Commission recently began a review of these requirements and working with the various
agencies will look toward the development of a standard financial reporting form that will meet
the requirements of the various agencies requiring this information.”
~David J. Roberts, Chairman Delaware State Fire Prevention Commission

40 | P a g e
The population figures below for 2011 were obtained from the 2011 Delaware Population
Projections Summary Table. The County Cost Per Capita was obtained by calculating the total
population for 2010 by the expended budget for 2011 for each agency. The cost per square mile
was obtained by calculating the total geographical size by the expended budget for 2011 for each
agency.

Advanced Life Support (ALS) Program Cost

Cost Per
Population County Cost
Area Geographic Size Square
(2010) Per Capita*
Mile
Kent County 162,388 27.10 594 square miles 7,411.29
New Castle County 541,650 24.90 438 square miles 30,801.78
Sussex County 201,238** 55.64** 950 square miles 11,787.98
Delaware 905,276 32.13 1,982 square miles 14,678.13
*Cost per Capita is unavailable for the BLS agencies.
**Please also note that the County Cost Per Capita calculation does not include the visiting population to the state,
including commuters in New Castle, racing fans in Kent, and beach visitors in Sussex.

County ALS Agency Cost, FY 11

$14,000,000
$12,000,000
$10,000,000
$8,000,000
$6,000,000
$4,000,000
$2,000,000
$0
New Castle County, Sussex County,
Kent County, EMS
EMS EMS
Total $13,491,178 $4,402,305 $11,238,578
70% County Contribution $9,443,825 $3,081,614 $7,867,005
30% State Contribution $4,047,353 $1,320,692 $3,371,573

41 | P a g e
 Aviation and Dispatch Center Cost
Delaware State Police Aviation Program Costs

Total Costs: $2,700,000.00

Personnel: $1,750,000.00
Helicopter Maintenance: $700,000.00
Fuel Costs: $250,000.00
Medical Supplies: $15,000.00

Dispatch Center Costs

The costs listed below include the total cost and selected budget lines only

New Castle County 911 Center: (Fire/EMS Only) Sussex County 911 Center:
Total Costs: $4,768,667.00 Total Costs: $1,764,431.00
Personnel: $4,301,621.00 Personnel: $1,600,606.00
Equipment: $451,508.00 Equipment: $105,685.00
Training: $15,538.00 Training: $20,200.00

Kent County 911 Center: Seaford 911 Center:

Total Costs: $1,802,900.00 Total Costs: $557,626.00
Personnel: $1,662,300.00 Personnel: $545,126.00
Equipment: $132,400.00 Operational: $10,800.00
Training: $8,200.00 Training: $1,700.00

Wilmington: Rehoboth 911 Center:

(EMS Dispatch is handled by New Castle County 911 center) Total Costs: $486,034.00
Total Costs: $0.00 $438,258.00 $438,258.00
$46,385.00 $46,385.00
$1,391.00 $1,391.00

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43 | P a g e
44 | P a g e
 Delaware Statewide Trauma System
Introduction

Unintentional injury is the # 1 killer and disabler of Delawareans aged 1 to 44 years, and is
among the ten leading causes of death for the remaining ages of 45 to over 65 years. Intentional
injury, a separate category, is also among the leading causes of death in the 1 to 44 year age
group. Unintentional injuries, homicide, and suicide accounted for 64 percent of all deaths to
Delaware children and adolescents in 2005-2009 (Delaware Health Statistics Center. Delaware
Vital Statistics Annual Report, 2009, Delaware Department of Health and Social Services,
Division of Public Health: 2011).

Unintentional injuries include those caused by highway crashes involving motor vehicles,
bicycles or pedestrians, by falls, and by farm and industrial mishaps. Intentional injury adds
assaults, shootings, stabbings, and suicides to the above statistics. Trauma System Registry
records show that 6,269 citizens and visitors to Delaware were injured seriously enough to
require hospitalization in Delaware hospitals in 2010 and of these, 185 sustained fatal injuries.
In addition, another 105 people were killed immediately in Delaware traumatic incidents in
2010. Because trauma so often involves children and young people, it is responsible for the loss
of more years of life than any other cause of death, both nationally and in Delaware. It robs us of
our most precious resource---our youth.

As seen below, the number of injuries serious enough to require hospitalization continues to rise
in Delaware. Our Trauma System is caring for more patients each year. More resources are
needed to maintain the same level of optimal care for the rising number of injured in our state.

Traumatic injury can occur at any time. It can happen to anyone. Those with critical injuries
need to receive definitive care within a short period of time in order to minimize the risk of death
and disability. The role of a Trauma System is to organize resources and assure their immediate
availability to the injured at all times and in all geographic areas of the system. These resources
include 911 Emergency Communications Centers, Basic and Advanced prehospital providers,

45 | P a g e
multidisciplinary trauma teams in hospital emergency departments, and in-hospital resources
such as operating rooms and intensive care units. Research has shown that the coordination of
these resources which takes place as a Trauma System develops can result in dramatic
reductions, up to 50%, in preventable deaths due to injury (Mann NC, Mullins RJ, MacKenzie
EJ, et al. Systematic review of published evidence regarding trauma system effectiveness. J
Trauma. 1999;47(3 suppl):S25-S33).

June 30, 2011 marked the 15th anniversary of the passage of legislation creating Delaware‟s
Statewide Trauma System. The passage of this enabling legislation was the first step in
systematically improving the care provided to the injured of our state. Today‟s Delaware
Trauma System is comprised of a network of professionals who work together to ensure that
trauma patients receive the appropriate emergency medical care for their injuries. The success of
the statewide Trauma System is the result of much hard work by many people and agencies, led
by the Division of Public Health (DPH) Office of Emergency Medical Services (OEMS). OEMS
is the lead agency and provides oversight of the Trauma System, from the time a traumatic
incident occurs through the full continuum of care. With the guidance of OEMS and the
dedication of many individuals statewide, Delaware has developed one of the nation‟s few truly
inclusive statewide Trauma Systems, in which every acute care hospital participates in the
Trauma System and has met the standards for state designation as a Trauma Center or Trauma
System Participating Hospital. Most importantly, this means that no matter where in the state
people are injured, they enter a system of care that follows the same guidelines, regulations, and
standards and makes sure they are cared for in the facility best able to manage their injuries.
Since July 1996, over 69,300 people have been cared for by Delaware‟s Trauma System.

As shown below, the mortality rate of the most seriously injured patients has dramatically
decreased as our Trauma System matured. The data shown in the slide on the left was discussed
in an article published in the August 2010 Journal of Trauma, with Dr. Glen Tinkoff, Trauma
System Medical Advisor, as lead author. The blue line shows national data for the same group
of patients. Delaware has consistently achieved lower mortality rates in the most seriously
injured patient group than the nation overall.

46 | P a g e
The data below shows the same analysis for seriously injured older patients. The mortality rate
for this group of patients has also declined significantly over the years.

Delaware‟s Trauma System regulations are based on the guidelines of the American College of
Surgeons‟ Committee on Trauma (ACS COT). ACS review teams visit each Level 1, 2, and 3
Trauma Center and report to the Division of Public Health on the facility‟s compliance with the
Trauma Center Standards before a hospital can be designated as a Delaware Trauma Center.
Reviews must be successfully completed every three years in order for a hospital to retain its
state Trauma Center designation status. Trauma System Participating Hospitals are reviewed
every three years by an out-of-state physician consultant and Division of Public Health staff.
Current Trauma Center and Trauma System Participating Hospital designations are:
Regional Level 1 Trauma Center:

Christiana Hospital, Christiana Care Health Services

A Regional Resource Trauma Center has the capability of providing leadership and
comprehensive, definitive care for every aspect of injury from prevention through rehabilitation.

Pediatric Regional Level 2 Trauma Center:

Nemours / Alfred I duPont Hospital for Children

A Pediatric Regional Level 2 Trauma Center has the capability to provide comprehensive
pediatric trauma care for the most severely injured children within its geographic area and is
expected to assume a leadership role in the care for injured children within its local, regional, and
statewide Trauma Systems.

47 | P a g e
Community Level 3 Trauma Centers:

Beebe Medical Center

Kent General Hospital, Bayhealth Medical Center
Milford Memorial Hospital, Bayhealth Medical Center
Nanticoke Memorial Hospital
Peninsula Regional Medical Center (Salisbury Maryland) via reciprocity
A Community Trauma Center is capable of providing assessment, resuscitation, stabilization,
and triage for all trauma patients, arranging for timely transfer of those patients requiring the
additional resources of a Regional Trauma or Specialty Center, and delivering definitive care to
those whose needs match the resources of this facility. Reciprocity means that Delaware‟s
Division of Public Health has accepted the Trauma Center designation conferred by Maryland.
Participating Trauma System Hospitals:

St. Francis Hospital

Wilmington Hospital, Christiana Care Health Services
A Participating Hospital is an acute care facility that may receive, usually by private vehicle,
moderately or even severely injured trauma patients. Participating Hospitals quickly identify and
transfer patients with significant injuries to a Trauma Center after initial resuscitation. When
necessary, this facility may provide care to trauma patients with minor injuries. Participating
Hospitals contribute data to the Delaware Trauma System Registry and Quality Improvement
Program. They do not receive ambulance patients meeting the Prehospital Trauma Triage
Scheme criteria.
2011 Accomplishments

1. Trauma System Registry – PLUS

For the first time, Emergency Department (ED) injury data has been collected from all
Delaware Trauma System hospitals and analysis has begun. This accomplishment was
assisted by a grant from the Delaware Office of Highway Safety which provided funding
to contract with an injury epidemiologist to analyze ED highway injury data. Hospitals
provided data on all ED injury-related visits for calendar year 2010. It is anticipated that
more annual data will be collected in the future. The graphs below demonstrate the age
breakdown for statewide ED visits in 2010 for two major mechanisms of injury –
highway injuries and fall injuries.
As seen in the next graph, ED visits for highway injuries increase sharply in the 15-19
and 20-24 age groups.

48 | P a g e
 Fall-related ED visits are most frequent in the very young and elderly.

2. Delaware Trauma System Registry

Data submitted by all eight Delaware acute care hospitals is compiled into the Trauma
System Registry. Hospital Trauma Registrars gather data from prehospital tripsheets and
hospital medical records to enter into the Collector trauma registry software program.
They submit data on a quarterly basis to the OEMS Trauma System Coordinator. System
reports are then generated on various topics, including types, locations, and persons
involved in trauma occurring throughout the state, as well as Trauma System quality
parameters.
Trauma in the elderly is a significant health problem. Injuries are a leading cause of
hospitalization, long-term care placement, and death in the elderly. As shown in the next
graph, falls are the number one cause of injury in the elderly by far.

49 | P a g e
Violent injuries are also a problem in Delaware. The graph below illustrates the breakdown by
age on assaults that caused injuries requiring hospitalization in Delaware in 2010.

Below is a breakdown of the kinds of assaults resulting in death in Delaware, 2010.

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2012 Challenges

1. Financial support for the Trauma System

Funding support for our Trauma System continues to be a challenge. This issue has
never been pursued to the legislative level. While Delaware hospitals have to date been
motivated to “do the right thing for their communities”, they are facing the same financial
challenges as Trauma Centers across the country---increasing patient volumes (as shown
in the Introduction graph), managed care, lifestyle preferences of physicians that do not
include taking trauma call, malpractice insurance costs, uncompensated care, and
expectations of increasing numbers of physicians for payment to participate in trauma
programs. Some Delaware Trauma Centers are finding a source of reimbursement
through billing for trauma activations and substance abuse Screening and Brief
Intervention programs. A Legislative Team has been formed by the hospital
representatives on the Trauma System Committee to look more closely at this issue.

2. Further development of the Trauma System Quality Program

The Trauma System Quality Program is also an ongoing process. Trauma System
Registry data from all hospitals supports both the Quality and Injury Prevention
programs. Volume indicators are well developed and reported annually. Sentinel cases
are discussed at the Trauma System Quality Evaluation (QE) Committee meetings as well
as system education issues.
Some quality filters that are monitored include:
o Patients with Glasgow Coma Score less than 15 and Injury Severity Score
over 24 who are not transferred to a facility with neurosurgical capabilities
o Initial Emergency Department (ED) length of stay
o Interfacility transport times
o Undertriage (patients meeting triage criteria without a trauma activation)
o Mortality rate by Injury Severity Score
o Patients transferred out immediately following surgery in the initial facility
o Double acute care transfers
o ED deaths of patients transferred to a higher level of care
o Patients transferred directly from Operating Room to Operating Room
o Surgical airways in the field
o Patients transferred with blood running
o Patients that bypass other Trauma Centers and go directly to the Level 1
Trauma Center from the scene (overtriage)
o Delays in transfer leading to adverse outcome
o Missed prehospital triage leading to adverse outcome
Summary

Supporting the statewide Trauma System and its injury prevention programs as part of the state‟s
economic responsibility will yield a substantial return through decreased injury-related deaths
and permanent disabilities with loss of productivity, and will result in a healthier and safer
Delaware. Delaware‟s Statewide Trauma System continues to mature, with the same goal it has
had since it was born……….to save lives.

51 | P a g e
 Delaware Emergency Medical Services for Children

Introduction

In 1997, Delaware was awarded its first Emergency Medical Services for Children (EMSC) grant
through the federal Maternal and Child Health Bureau. The EMSC program is designed to
reduce child and youth mortality and morbidity due to severe illness and injury. Delaware‟s
EMSC program is administered through the State via a contract with Nemours/Alfred I. duPont
Hospital for Children.

Children's heart rates, respiratory rates and blood pressures all change as they grow. Their
airways are shaped differently for intubation, IV sizes are smaller and medications must be
carefully calculated according to weight. One size does not fit all! Emotional reactions to illness
and injury vary by developmental age. Healthcare providers must have the pediatric training and
equipment needed to care for children.

In 1984, federal legislation was enacted to fund Emergency Medical Services for Children
(EMSC) programs in the United States. Children under the age of 18 years account for
approximately 26% of the U.S. population and about 25% of all visits to Emergency
Departments (ED‟s) nationwide. Studies showed that prehospital providers did not always
receive training on how to care for children, and ambulances and emergency departments
sometimes lacked the correct sized equipment needed to care for children.

Photo submitted by
Angie Quackenbush,
DE EMSC Program

52 | P a g e
2011 Accomplishments

In 2011, the State EMSC Advisory Committee and EMSC Program focused on the following
activities:

Statewide Pediatric System

Delaware‟s Division of Public Health (DPH) announced the December 30, 2011 completion of
the initial phase of development of Delaware‟s Statewide Pediatric System through recognition
of Delaware‟s hospitals as Pediatric Emergency Care Facilities. Every Delaware acute care
hospital that treats children voluntarily chose to participate in this new program, which required
them to meet state standards, submit a lengthy application, and be visited by a review team.
Since 2007, DPH‟s Emergency Medical Services for Children (EMSC) Standards Committee, a
group of 19 Delaware clinical emergency care experts, has worked to develop the statewide
Pediatric Emergency Care Facility Recognition Program to standardize emergency medical care
for children in the state.

Development of such a program is a performance measure of the Health Resources and Services
Administration (HRSA) national EMSC program. Delaware‟s Standards Committee relied upon
documents and regulations adopted in other states such as California, Illinois and Tennessee as
models for the Delaware program. The purpose of having statewide pediatric standards for the
emergency departments is to take the first step in organizing a system of emergency care for
children in Delaware.

“We are proud that every Delaware hospital has chosen to be part of this emergency care system
for children,” said Dr. Karyl Rattay, DPH director. “This is an opportunity to recognize their
commitment to excellence in pediatric care. Having an inclusive statewide pediatric system
means that every child will receive the benefit of an entire system of specialized pediatric care if
they should need it.”

Like the Delaware Trauma System, the role of the Pediatric System of care is to organize
resources and assure their immediate availability to the target population at all times and in all
geographic areas of the system. Studies have shown that the coordination of these resources
which takes place as a system of care is developed, can result in dramatic improvements in
patient outcome.

According to the EMSC National Resource Center, Delaware is only the 5th state in the nation to
successfully implement the Pediatric Emergency Care Facility Recognition Program. Delaware
also became the 3rd in the nation to develop an inclusive pediatric system with all acute care
hospitals that see children recognized.

The Honorable Matthew Denn, Lt. Governor, joined Dr. Rattay in recognizing Delaware‟s
hospitals as Pediatric Emergency Care Facilities at an awards ceremony held in the Tatnall
Building on February 21.

The following hospitals were recognized as Delaware Pediatric Emergency Care Facilities:

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Level 1 Nemours/Alfred I. duPont Hospital for Children, Wilmington
The Level 1 facility is capable of providing comprehensive specialized pediatric medical and
surgical care to all acutely ill and injured children. This facility serves as a regional referral
center for the specialized care of pediatric patients.

Level 2 Christiana Hospital, Christiana Care Health System, Newark

The Level 2 facility is capable of identifying and stabilizing pediatric patients who are critically
ill or injured and providing ongoing inpatient care or appropriate timely transfer to a Level 1
facility.

Level 3 Bayhealth - Kent General Hospital, Dover

Bayhealth - Milford Memorial Hospital, Milford
Beebe Medical Center, Lewes
Nanticoke Memorial Hospital, Seaford
St. Francis Hospital, Wilmington
Wilmington Hospital, Christiana Care Health System, Wilmington
A Level 3 facility is capable of identifying and stabilizing those pediatric patients who are
critically ill or injured and providing appropriate timely transfer to a higher level of care. Level
3 facilities have capabilities for the management of minor pediatric inpatient illnesses.

The highlight of the event was the heartfelt comments from parents of a 3-year-old child who
nearly drowned here in June, 2011. They praised the care their son received from the time of the
incident through his discharge from the Level 1 Nemours/Alfred I. duPont Hospital for Children.
This child is alive and well today, thanks to the systems of care that Delaware has developed.
The video of their talk can be found at http://www.wdel.com/story.php?id=40965

The Honorable Matthew

Denn, Lt. Governor, shares
his thoughts on the
importance of the new
Pediatric System for
Delaware’s children and
their families. He is joined
by Dr. Sue Kost, EMSC
Advisory Committee
chairperson, and Dr. Karyl
Rattay, Director of Public
Health.

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EMSC Targeted Issue Grant Research – ‘Evaluation of a Pediatric Emergency Care
Recognition Program on Care of Injured Children’
Delaware is serving as the model for an EMSC Targeted Issue research grant investigating the
impact an implementation of a Pediatric System has on emergency care for children. We are
proud that the national EMSC program has recognized the work our state has done to develop
our Pediatric System. Based on the results of this research, other states may see the value of
developing a pediatric system and utilize the experience of Delaware to take pediatric care in
their states to the next level of excellence.

National EMSC Performance Measures Survey

Delaware‟s EMSC program has completed an analysis of data from the National EMSC
Performance Measure (PM) surveys. The data will be utilized to assess the needs of the EMS
and hospital programs related to pediatric care. The EMSC online survey was distributed to all
licensed BLS and ALS EMS agencies that respond to 911 calls in Delaware and to all acute care
hospitals. The survey and analysis are helping to identify gaps in essential pediatric equipment
for ambulances based on the American Academy of Pediatrics (AAP) guidelines. This
information will be used to help guide the use of EMSC grant funds.

Annual Childhood Injury Prevention Conference

The Delaware EMSC program partnered with Safe Kids Delaware to provide this conference in
June 2011 in Dover. Over 150 injury prevention advocates from across the state attended.

EMSC Program Manager

Delaware has a new EMSC Program Manager, Raj Maskay, is replacing Marie Renzi, who
resigned after serving the program for 13 years. Raj worked for the state of Alaska‟s Division of
Public Health for over 11 years and managed the Alaska EMSC program for four years.

EMSC 2011 Data

Data from the Delaware Trauma System Registry, below, shows that the death rate of the most
seriously injured young people has significantly decreased since the statewide Trauma System
was implemented in 2000. It is expected that the Pediatric System developed through the EMSC
Pediatric Emergency Care Facility Recognition program will help to further reduce the mortality
rate of children and teens in Delaware over time.
EMSC Graph 1: Delaware Trauma System Registry Mortality Rate, Children and Teens

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Delaware EMSC uses the EDIN system to monitor the number and location of pediatric calls, the
most frequent reasons for the calls, and the procedures most frequently performed on children by
prehospital providers. The following graphs provide aggregate data regarding pediatric
emergency incidents in the State of Delaware in 2011.

EMSC Graph 2: 2011 Number of Pediatric ALS and BLS Incidents Ages 0-19 Years

Number of Incidents by Patient Age 0-19 Years

4500
4000
3500
3000
2500 ALS
4321
2000 BLS
1500
1000
1501 1567 1606
1318
500 75 866
34 576 567 513
368
0
1

14

19
to

to

to

to

to

to
0

10

15
s

s
ge

ge

ge

ge

s
A

ge

ge
A

A
Data reflects the number of run reports in the EDIN database for BLS agencies and for ALS
agencies.
EMSC Graph 3: 2011 Ten Most Frequent Procedures by ALS and BLS, Patients Ages 0-19
Years

Vital signs and provision of oxygen were the most frequent BLS procedures on young people in
2011. Vital signs and on-line medical control consultation were the most frequent ALS
procedures for children and teens in 2011.

Other Important Facts:

The majority (74.8%) of 2011 pediatric ALS calls were for medical reasons. Over half (60%)
of all pediatric BLS emergency calls were for medical reasons also.

Trauma calls made up of 21 percent of ALS pediatric calls; and 33.1 percent of BLS
pediatric calls.

56 | P a g e
 Pain and general malaise continued to be the top two primary complaints for BLS encounters
with children ages 0-19, while difficulty breathing continued to be the top primary
complaint for ALS calls for children ages 0-19.

About 5.8 percent of all ALS calls and 9.2 percent of BLS calls for those aged 0 -19 years
were due to motor vehicle crashes in 2011. Both figures are slightly lower than in 2010.

For those aged 15-19 years, about 46.6% of ALS calls and 51.8 % of BLS calls were due to
motor vehicle crashes. This trend has remained almost the same for the last two years.

2012 EMSC Challenges / Goals

Unintentional injuries remain the leading cause of death for Delaware‟s children. In the 5-year
period between 2005 and 2009, unintentional injury, homicide, and suicide accounted for 64.4%
of the deaths of Delaware children between the ages of 1 and 19 years 1. The goal of the EMSC
program is to reduce death and disability of children by improving pediatric emergency care.
There is still much to be done. Injury prevention works to decrease the number and severity of
injuries, while other EMSC performance measures support growth and development of both
prehospital and hospital pediatric programs.

In 2011, Delaware remains dependent upon annual federal grant EMSC funding to support
children‟s needs in our growing EMS System. There is still no official pediatric representation
on DEMSOC. A statewide Pediatric System Quality Program needs to be developed to support
hospital and prehospital pediatric program growth through identification of opportunities for
improvement in all areas of pediatric emergency care. And there is no EMSC legislation to
integrate EMSC priorities into state EMS system statutes and regulations.

Summary

Delaware‟s Statewide Pediatric System has been born! The initial phase of our Pediatric
Emergency Care Facility Recognition Program has been completed successfully. But like a child,
this system needs to grow and mature. The Recognition Program supports a continuous process
aimed toward achieving excellence in prehospital and hospital pediatric care statewide. Its goal
is to maintain a system that is in a constant state of readiness to care for pediatric patients
anywhere in the state. Delaware‟s EMSC program is proud of its many accomplishments over
the 15 years of its existence, and looks forward to continuing its leadership toward future
successes.

1
Delaware Health Statistics Center. Delaware Vital Statistics Annual Report, 2009, Delaware Department of Health and Social Services, Division
of Public Health: 201

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Cardiovascular Care
Out-of-hospital cardiac arrest (OHCA) remains the leading cause of death among adults in the
United States and other developed Western countries. Between 250,000 and 400,000 estimated
deaths occur each year. Cardiovascular disease refers to a multitude of diseases and conditions
affecting the heart and blood vessels and is not limited solely to the heart and great vessels.

Heart disease and stroke remain the two most common cardiovascular diseases in Delaware. A
large majority of these diseases are preventable through public education and awareness.
Reducing the risk factors of cardiovascular disease can be accomplished by creating healthier
individual lifestyles. The combined efforts of multiple agencies in Delaware to continue to place
emphasis on education and awareness will play a major role in reducing the risk factors.

Delaware Paramedics responded to over 6200 patients with cardiovascular related complaints in
2011. Due to declared benefits of retirement in Delaware, there has been a significant influx of
retirees. Delaware also has a native aging population. Due to these two factors a large number of
Delaware hospitals have expanded their cardiovascular care programs. Delaware EMS systems
ensure a continuum of care for patients transported by EMS through integration with these
hospitals.

Cardiac Arrest Registry to Enhance Survival (CARES) Program

Submitted by Robert A. Rosenbaum, MD FACEP, EMS Medical Director, New Castle County and
Timothy Shiuh, MD FACEP, Associate EMS Medical Director, New Castle County

New Castle County EMS (NCC EMS) continues to participate in the Cardiac Arrest Registry to
Enhance Survival (CARES), a surveillance project run through the CDC and Emory University
that follows cardiac arrest patients from dispatch through hospital outcome. NCC EMS is one of
the first 25 agencies (now numbering 68 agencies) from across the country participating in
CARES by sending data from every cardiac arrest patient with presumed primary cardiac
etiology treated by EMS in NCC. Details include time to dispatch; response times;
demographics; initial presentation; treatments by bystanders, first responders and EMS
personnel; and level of function for survivors. All hospitals in NCC send data to the CARES
database creating a seamless picture of the care provided to cardiac arrest patients.
Performance by NCC EMS has been well above the national average of reported cardiac arrest
survival and remains at or above the average of the peer group of other CARES agencies.
Agencies participating in CARES are high performance EMS agencies with established records
for provision of quality care making the achievement of above average results among this group
all the more impressive. NCC entered its 1,000th patient into the database during 2011 and also
added its 100th survivor to the database.

As the number of patients continues to grow, we are able to review broader areas and look for
trends. One clearly identifiable trend is the improvement of survival for patients who have
bystander CPR performed. The odds ratio of survival is doubled for patients in our CARES
database who had bystander CPR. In patients under age 65 who have bystander CPR, the odds
of survival increase by 2.4 times. We continue to see opportunities for improvement in cardiac

58 | P a g e
arrest survival and hope that implementation of several specific initiatives will increase these
numbers:
We have encouraged a far more direct approach from dispatchers to get bystanders to
perform CPR. Our goal is recognition that a patient is in cardiac arrest and for a
bystander to begin CPR within 1 minute of the start of the call.
We are reviewing data that show areas where bystander CPR is more likely and
where it is less likely. Targeted education initiatives in areas with little bystander
CPR could lead to more opportunities for survival from cardiac arrest in these areas.
Rates of bystander CPR in our patient set from all of New Castle County remain at
approximately 20%. This unacceptably low rate further illustrates the need for a
concerted education effort for CPR and AED usage in all communities.
New Castle County EMS continues to provide feedback to first responders from
police agencies that have arrived on scene and begun CPR or applied an AED.
Earlier intervention by any trained provider increases survival likelihood.
Communication from NCC EMS and Medical Direction with case examples provides
positive feedback to the respective departments and involved law enforcement
personnel.
We hope to see greater ROSC in the field through a protocol change in the 2012
Paramedic and BLS Standing orders. The requirement that patients in cardiac arrest
have 3 cycles (6 minutes) of CPR on scene is intended to drive our performance and
rapidly initiate care on site with an emphasis on quality chest compression and de-
emphasizing rapid patient movement. This will require an evolution in EMS practice
to better match current recommendations of the American Heart Association
supported by detailed research on best practices for care of patients in cardiac arrest.

CARES will continue to be utilized by NCC EMS as a valuable resource to identify successful
interventions in care of cardiac arrest patients and to look for areas that can be improved. The
addition of Sussex County EMS to the CARES collaborative effort and the planned addition of
Kent County EMS will provide the opportunity for statewide data collection on outcomes of
cardiac arrest patients in the near future.

STEMI/Stroke Specialty Centers

In the 2004 and 2010 National Highway Traffic Safety Administration's assessments of
Delaware's Emergency Medical System it was recommended Delaware develop and implement
emergency medical care triage and destination policies, as well as protocols for patients requiring
transport to specialty care centers. The specialty care centers recommended were ST Elevation
Myocardial Infarction (STEMI) and Cerebral – Vascular Attack (CVA) STROKE centers.
By aggressively pursuing the development of designated STEMI/STROKE centers, Delaware
has four (4) hospitals offering full-time emergent PCI for STEMI and five (5) hospitals are
currently certified by the Joint Accreditation Commission for Health Care Organizations
(JACHO) as Primary Stroke Centers.

Hospitals currently designated as STEMI centers are:

Christiana Hospital, Newark, DE
St. Francis Hospital, Wilmington, DE

59 | P a g e
 Kent General Hospital, Dover, DE
Beebe Hospital, Lewes, DE

Hospitals currently JACHO certified as primary stroke centers are:

Christiana Hospital, Newark, DE
Wilmington hospital, Wilmington, DE
St. Francis Hospital, Wilmington, DE
Nanticoke Memorial Hospital, Seaford, DE
Beebe Hospital, Lewes, DE

Cardiac Alert/Code

The standard of care for paramedics treating patients with cardiac related complaints or patients
who present with signs and symptoms of acute myocardial infarction AMI/heart attack is 12 lead
EKG analyses. Time is the critical factor for AMI/heart attack patients. The rapid recognition of
AMI/heart attack by paramedics is the first step in a sequence of events which includes rapid
notification of the appropriate care facility and transport to the specialized care facility. By using
this systematic approach for out of hospital AMI/heart attack related emergencies the interval
from time of onset of symptoms to cardiac catheterization has been reduced to less than 30 min.
By using this systematic approach, studies continue to show that patients have a lower mortality
rate and shorter hospital stays.

Prehospital Protocols

The recent addition of the induced hypothermic protocol for patients resuscitated from cardiac
arrest that do not immediately regain consciousness has been shown to improve neurological
function. The data gathered as a direct result of this procedure is showing a better than expected
outcome for these patients.

Stroke

Strokes accounted for 1,366 Paramedic incidents in 2011. Stroke has a very narrow therapeutic
window and these patients require the same systematic approach as for AMI/heart attack
emergencies. Rapid identification, early notification to the appropriate specialty care center, and
rapid transport to a primary stroke center within the therapeutic window, greatly enhances the
patient's chances of survival.
Since EMS personnel must properly identify the signs and symptoms of stroke and initiate the
proper sequence of events, EMTs and paramedics play a vital role in stroke management thus
enhancing the patient's chances of survival.

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 First State, First Shock!
CPR and AED Program

The First State, First Shock Public Access Defibrillation (PAD) program was established in 1999
through support and funding from the Health Fund Advisory Committee. The Office of
Emergency Medical Services is designated the lead agency for the First State, First Shock
program.

The Delaware Office of Emergency Medical Services (OEMS) is charged with “Coordinating a
statewide effort to promote and implement widespread use of semi-automatic external
defibrillators and cardio–pulmonary resuscitation....” (DelCode Title 1, Chap. 97)
The First State, First Shock program has been committed to the following goals:
Decreasing death and disability in Delaware by decreasing time to defibrillation in
cardiac arrest patients
Promoting heart health and early detection of the signs and symptoms of heart attack
Increasing public accessibility to Semi-Automatic External Defibrillators (SAED)
throughout the state
Increasing the number of Delawareans trained in Cardio–Pulmonary Resuscitation and
SAED use
Ensuring First Responders and police vehicles are SAED equipped
Tracking outcome to guide future efforts

The primary goal of the First State, First Shock program is to increase survivability of victims of
out-of-hospital cardiac arrest. Increasing the availability of Semi-Automatic External
Defibrillators by the strategic placement of these devices provides for enhanced accessibility by
the general public.

Key Initiatives For 2011 Were:

Completing the FDA mandated recall and replacement of 488 SAED units by two
manufacturers.
Distribution 184 SAED units, 75 of which were issued to first responders with the
remainder issued through the Public Access Defibrillator program
Thanks to funding from the Health Fund Advisory Committee and Health Resources
Services Administration, the program has been able to place over 3000 SAED units in
service throughout the state to date.

Major challenges to the First State, First Shock! program:

1. There continues to be an increase in over-the-counter sales of SAED's throughout the
state. SAEDs are considered a class III medical device by the FDA which requires a
prescription prior to purchase, however one manufacturer is marketing a device FDA

61 | P a g e
 approved for direct over-the-counter sales, no prescription required. This makes it
extremely difficult to keep track of the number of SAEDs throughout the state.
2. Older units issued at the inception of the program are out-of-warranty, obsolete,
malfunctioning and require replacement. Of the 2661 units still in service only 584 are
within the five year warranty period. This is particularly challenging since monies will
have to be allocated to purchase units to replace older units as they continue to
malfunction.

3. Cardiac arrest is a primary health issue. Current data shows 71% of all cardiac arrests
occur in the home. Strategically placing SAEDs throughout the state and continue
providing CPR/AED training for laypersons and first responders still remains the primary
initiative.

Cardiac Arrest by Location

Home/Residence
Public Place
Care Facility
Street
Other
Work

For victims of cardiac arrest the return to spontaneous circulation rate in Delaware is 36%. Prior
to the placement of SAEDs the prognosis for cardiac arrest victims was poor with an estimated
1% - 5% with return of spontaneous circulation. Delaware has made tremendous strides in
strengthening the early defibrillation link in the Chain of Survival. The OEMS is certain that by
continuing to place SAEDs for general public access and with first responders and continue to
provide CPR/AED training, we will continue to see an increase in the cardiac arrest survival rate
in the State of Delaware.

Year Number of Cardiac Arrests Patients that

experienced a return
of circulation
2004 780 158 (26%)
2005 752 170 (29%)
2006 756 190 (32%)
2007 756 215 (36%)
2008 745 222 (35%)
2009 773 261 (35%)
2010 850 252 (35%)
2011 893 273 (36%)

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 Emergency Department and Hospital Diversion Data
Information provided by the Delaware Healthcare Association indicates there were 394,682
visits to the Delaware acute care hospital emergency departments in 2011. This is an increase of
120,151 hospital emergency department visits (30.44%) statewide from the same period in 2000.
In addition, there were 70,417 patient admissions from the emergency department for 2011, an
increase of 22,405 (31.82%) from the same period in 2000.

There were fewer Emergency Department visits in 2011 than in 2010; however, this trend is not
expected to continue. The decrease is due to a combination of public health publicity for and
availability of the combined seasonal flu and H1N1 flu vaccinations, plus a lighter than normal
flu season. Delaware also has had an increase in walk-in clinics within the state.

Statewide Admissions from the Emergency Departments

of Delaware's Acute Care Hospitals
80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Kent/Sussex Counties Calendar Yea
New Castle County State of Delaware

Admissions from the Emergency Departments of

Delaware's Acute Care Hospitals 2000 to 2011
50,000
40,000
30,000
20,000
10,000
0
A I. duPont Bayhealth Beebe Medical Christiana Care Nanticoke St. Francis
Hospital for Medical Center Center Health Services Memorial Hospital
Children Hospital

In 2011, there were still an average of 23 patients in Delaware acute care hospitals on any given
day that no longer required hospital care, but the patient remained in the hospital awaiting
discharge to post-acute care settings. Also, there was an average of three patients in the Kent
and Sussex Counties hospital emergency departments on any given day awaiting transport to an

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inpatient psychiatric facility. This inability to discharge inpatients results in a shortage of
inpatient beds available for the admission of emergency department patients and the inability to
move the emergency department psychiatric patients until transport arrives reduces the number
of emergency department beds available for new patients. This also has a direct negative impact
on the frequency of hospital diversions and the BLS providers that must take patients to other
hospitals outside of the BLS provider's immediate service area.

Daily Average Number of Hospital Inpatients Awaiting

Discharge to a Post-Acute Care Setting
90
80
70
60
50
40
30
20
10
0
2000
2007
2011

Note: the transfer of emergency department psychiatric patients to inpatient psychiatric facilities does not
seem to be affecting New Castle County hospitals at this time; however, not all of the New Castle County
hospitals are currently tracking transport of emergency department psychiatric patients.

Daily Average Number of Hospital Emergency Department

Patients Awaiting Transfer to a Psychiatric Facility
6

0
Kent/Sussex Counties New Castle County

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 Human Resources and Workforce Development

5% EMS Providers in Delaware

8% 1st Responders
(BLS)

40% EMT-B's (BLS)

47% Paramedic's (ALS)

Emergency Medical
Dispatchers

Above is a graph that shows the percentage of prehospital providers. These are the individuals
that are responsible for “taking the calls”. In addition to the prehospital providers, Medical
Control Physicians are an integral part of the system. The medical control physicians give “on-
line” medical direction to the providers and are the receiving physicians within the emergency
rooms of the state.
Work continued in 2011 on recruitment and retention of EMS providers. There is a national
shortage of EMS providers. Although Delaware is also affected by a shortage of EMS providers,
the agencies across the state have worked hard to improve recruitment and retention,
compensation, work conditions, training and diversity. The demand for EMS services is also
expected to increase as the state‟s population ages. The Delaware Population Consortium
projects that from 2005-2015, Delaware‟s population will increase by 15%, and the number of
residents 60 years and older is expected to increase 27%.
While the aging population is increasing, the volunteer population is beginning to decrease.
Information from the National Registry of Emergency Medical Technicians shows that the
majority of EMS responders nationwide are between the ages of 20-45. Many people within this
age range are finding it more difficult to volunteer their time with increased dual income and
single parent families, and the fact that many people are working longer hours.
DEMSOC created a workforce diversity subcommittee in 2006 to address issues with the
recruiting and retention of a more diverse EMS workforce. As part of this effort, the Office of
Emergency Medical Services is working with technical high schools throughout the state to
develop an EMS program that would increase the availability of training and allow students to
transition to the Delaware Tech program upon graduation.
Increasing demand for services fueled by a rising population and aging baby boomers has placed
many volunteer fire companies into a position of hiring staff to cover basic life support (BLS)
ambulance runs resulting in additional operational costs to maintain existing levels of service.

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 Education and Training
The state of Delaware currently recognizes three (3) levels of Emergency provider. Each level
has a correlating National Registry equivalent, however only paramedic personnel are required to
maintain a National Registry certification as well as a state certification or license. The current
levels are:
First Responder (FR)
o The FR can initiate immediate basic lifesaving interventions.
Emergency Medical Technician- Basic (EMT-B)
o The EMT-B can provide basic emergency medical care and transportation.
Emergency Medical Technician-Paramedic (EMT-P)
o The EMT-P provides the highest level of pre-hospital emergency care.

In accordance with the national standards as published in the EMS Educational Agenda for the
Future and the National Registry of Emergency Medical Technicians, the State of Delaware has
adopted the new standards as outlined in the National Scope of Practice model. These changes
will be implemented over the next 5 years with state wide completion by March 2017.
First responder (FR) becomes Emergency Medical Responder (EMR)
o EMR personnel are certified through the Delaware State Fire Commission
o All First responders will be transitioned by September of 2016
EMT-B transitions to EMT
o EMT personnel are certified through the Delaware State Fire Commission
o All personnel will be transitioned by March 31, 2016
EMT-Paramedic to Nationally Registered Paramedic
o All paramedics in the State of Delaware are required to maintain this National
certification in order to obtain and maintain their Delaware Paramedic License
o All current paramedics will be transitioned by March 31, 2017

EMT-Paramedic
Submitted by Delaware Technical and Community College

EMT-Paramedic (EMT-P) is the advanced life support

(ALS) standard of care for the State Of Delaware.
Delaware Technical Community College offers paramedic
education through a two-year Associate of Applied
Sciences degree program that follows the National EMS
Education Standards. Developing leadership and sound
decision making skills as part of a student‟s clinical
practice is emphasized throughout the Program which
consists of approximately 2,000 hours of classroom,
simulation lab, clinical and field internship experiences. Delaware Tech Paramedic Class 12

In March 2011 the Program was reviewed by the Committee on Accreditation of Educational
Programs for the Emergency Medical Services Professions (CoAEMSP) and recommended for
reaccreditation by the Commission on Accreditation of Allied Health Education Programs

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(CAAHEP). It was reaccredited in October 2011. The Program has continuously maintained
accreditation by CAAHEP since 1999 and is the only accredited paramedic program within the
State of Delaware.
In 2011 the Delaware Tech Paramedic Program graduated its 12th class. A total of 124
paramedics have successfully completed the Program since its inception. One hundred percent of
the Program‟s graduates have successfully passed the National Registry of Emergency Medical
Technicians Paramedic examination.

Delaware Academy of Public Safety and Security (DAPSS)

The Delaware Academy of Public Safety and Security (DAPSS) is a public charter school for
male and female high school students or “Cadets” who want a strong academic foundation for
college and/or careers in law enforcement, firefighting, emergency medicine, and other fields
that keep the public safe and secure. The school is located in New Castle County and opened in
September of 2011 with 9th grade students. The school‟s core curriculum blends traditional
learning with highly motivational career preparedness course work. With help from our public
safety partner, after four years, our cadets will have a wide range of options for continuing their
education or starting their careers in the rapidly expanding field of public safety and security.

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 Domestic Preparedness
Burn Training

The emergency care of patients who are critically burned presents challenges to our experienced
medical responders in Delaware. With the threat of criminal acts of terrorism using energetic
devices as weaponry, our state‟s cadre of care providers needs to be prepared to deal with the
potential of multiple victims of this type of injury.

The American Burn Association offers the Advanced Burn Life Support (ABLS) class. This 8-
hour class is intended for physicians, nurses, paramedics and other advanced care providers who
may be called upon to care for victims of thermal injury. The course is led by instructors who
are experts in burn care. Didactic material is combined with case studies, group discussion and
hands-on training using live victims moulaged to simulate burn patients. The goal is to educate
care providers on the most current guidelines on providing care to burn victims during the first
24-hours post injury.

The Office of EMS working with the Division of Public Health was fortunate to provide this
training to our state‟s health care providers. A class was offered at the Delaware State Fire
School in May. Sixteen students – including physicians, nurses and paramedics – completed the
program. Thanks to funding from a preparedness grant, we were able to offer this program at no
cost to the state‟s providers.

We look forward to offering this extremely valuable and popular program in the future.

Toxmedic Protocols

These protocols were developed to delineate the requirements and responsibilities of various
agencies when providers or patients are exposed to hazardous substances. Patients who have
been exposed to chemicals and weapons of mass destruction often require procedures,
medication and treatments that are not in the scope of a normal field paramedic. Participation in
the Toxmedic program by Delaware paramedic agencies is elective. Each of the state‟s ALS
agencies continues to participate.

Each paramedic identified as a “Toxmedic”, has successfully completed the Advanced Hazmat
Life Support Course (AHLS). AHLS program is a 2-day, 16-hour course sponsored by the
Division of Public Health.

The AHLS program focuses on medical management of people exposed to hazardous materials,
including nuclear, biological and chemical terrorism. Participants are trained to provide rapid
assessment of hazmat patients, recognize toxic syndromes, provide medical management for
hazmat patients, apply the poisoning treatment paradigm and administer specific antidotes.

The state Toxmedic treatment protocols were updated last year to reflect the most current
information related to the treatment of smoke inhalation cyanide exposures and hydrogen sulfide
from chemical suicide calls. While no new protocols were developed, information related to

70 | P a g e
many of the antidote medications was added to the EMS Pharmacology manual. In addition,
work is underway to provide distance learning material to update all Delaware Toxmedics on
current hazmat patient care protocols.

Nerve Agent Antidote Protocols for BLS and Public Safety

The protocol was designed to outline the process by which BLS and Public Safety agencies train,
acquire, maintain, use and discard MARK I nerve agent antidote kits. When responding to an act
of chemical terrorism or a hazardous materials incident, emergency responders may be exposed
to harmful, even fatal doses of nerve agents. In these situations, responders may need to
administer life saving medications to themselves or fellow responders in a rapid time frame. The
decision for an agency to participate in the MARK I program is voluntary; however, those
agencies wishing to participate must comply with the Nerve Agent Antidote protocol outlining
training and quality assurance requirements.

During the first few months of 2011, the Office of Emergency Medical Services, working with
the Homeland Security Terrorism Preparedness Working Group and Public Health Preparedness,
completed a project replacing expired nerve agent antidote kits for state EMS and law
enforcement services. Expired Mark I kits have been replaced by DuoDoteTM autoinjectors.
Autoinjectors that remained after the replacement program were distributed to EMS services that
wished to begin participating in the antidote program.

Technical Assistance

Since 2007, the Office of Emergency Medical Services working with the Office of Public Health
Preparedness and the Delaware State Fire School has contracted a senior paramedic to provide
EMS agencies with technical assistance on domestic preparedness issues. This position entails
continuing a number of projects that assess current preparedness efforts and plan for future
preparedness initiatives.

The goal of OEMS domestic preparedness efforts is to increase the readiness of all Delaware
responders to prepare for an all-risk response. This includes incidents of terrorism, hazardous
materials releases, specialized and technical rescue, severe weather events, mass illness
outbreaks and mass casualty situations. Efforts will be made to increase the interagency
operability between EMS and other state response and preparedness agencies.

Carbon Monoxide Poisoning

There have been many articles published in prehospital medical journals about the dangers of
Carbon Monoxide poisoning. Carbon Monoxide is an odorless, colorless gas produced by the
incomplete combustion of many organic materials. It affects the body by inhibiting the ability of
the blood to transport oxygen to the cells. Patients who are exposed to CO often exhibit very
vague symptoms making it easy to mistake CO poisoning for other problems such as the flu. In
addition to affecting the patient, the presence of CO in a residence may also affect responders
who are sent there to aid the patient.

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EMS agencies throughout Delaware have made increasing use of the pulse co-oximeter to
measure CO levels in their patients. The Delaware State Fire School offers training on CO and
co-oximetry in both their basic EMS classes and department in-service continuing education
programs. In addition, at the 2011 Delaware Volunteer Firefighters‟ Association Conference, a
representative from OEMS presented an educational session on smoke inhalation which included
information on CO and the use of co-oximetry on the fire ground.

Chemical Suicide Awareness

An emerging threat to responders has presented in the form of chemical suicides. Person‟s who
wish to take their own life, are using a variety of household materials to produce a poisonous
chemical reaction. The byproducts of this reaction often include substances such as hydrogen
sulfide or cyanide. Often the victim will choose a location such as a car in order to use the
confined space to produce the most lethal concentration of fumes.

Emergency responders arriving on scene are at risk of secondary exposure, contamination and
illness as a result of any left-over chemicals in the air. In order to make responders aware of the
potential for these situations, OEMS completed two projects related to chemical suicides in
2011.

First was the development of a continuing education program on chemical suicides. This
program was a result of efforts involving both OEMS and the Delaware Department of Natural
Resources and Environmental Control (DNREC) and is intended for firefighters, EMS providers
and law enforcement officers. It reviews the threat of chemical suicides, the dangers involved
and helpful tips to approach suspect vehicles. The program includes video presentations of
model vehicle approaches by various response agencies.

Secondly, the state Toxmedic protocol was revised to include a treatment plan for hydrogen
sulfide exposure in order to treat patients or responders who become affected while on the
incident scene. This treatment plan enabled use of medications already included in the existing
Toxmedic program.

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 EMS Interfacility Transport
Interfacility transport services are an important part of any well designed EMS system. The EMS
system is often thought of as the 911 emergency response service, but the 911 Emergency
Response service is just one part of the whole EMS transport system. The 911 transport system is
not staffed to provide transport services for the non-emergent patients. Interfacility transport
services fill this important role allowing the 911 emergency response units to remain available
for emergent request for service. To date, there are 100 ambulances certified through the State
fire commission to provide these services through nine (9) interfacility transport companies.

There are three types of ground interfacility transport Ambulances in Delaware:

Basic Life Support (BLS):

o Ambulances are staffed with Emergency Medical Technicians (EMT‟s). EMT‟s
provide basic care and patient monitoring including oxygen therapy, bandaging &
splinting, etc.
o Interfacility transport EMT‟s have the same scope of practice as 911 EMT‟s and
utilize the same statewide treatment protocols.
o Delaware has nine Basic Life support interfacility agencies with a total of 100
ambulances licensed and operating in Delaware:
 CFT
 Christiana Care
 Delaware Park
 Hart to Heart
 LifeStar
 Prime Care
 St. Francis
 Transcare
 Urgent

Advanced Life Support (ALS):

o Ambulances are staffed with at least one Paramedic and one EMT. Paramedics
provide advanced life support care and monitoring including ACLS. The EMT
provides support to the Paramedic.
o Interfacility transport paramedics have the same scope of practice as 911
paramedics and utilize the same statewide treatment protocols.
o Delaware has two paramedic interfacility agencies licensed and operating in
Delaware:
 St. Francis
 TransCare

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 Specialty Care Transports:
o Ambulances are staffed with transport team personnel and at least one EMT from
the transport service. The transport team personnel are staffed with specialty care
personnel typically representing at least one Registered Nurse, one Respiratory
Therapist, and may include a Physician.
o The transport team is able to perform procedures and assessments authorized by a
prescribing practitioner and overseen by the medical facility. The EMT provides
support to the transport team.
o Delaware has two hospital based transport teams:
 Christiana Care Health Services
 AI duPont Hospital for Children

Interfacility ambulance services can be used for the following types of Patients:

Facilities requesting non-emergency Home/Hospice Care Facilities

patient transportation
Board and Care Facilities
Skilled Nursing Facilities
Physician Offices Urgent Care Centers

Clinics Custodial Care Centers with a

prescribing practitioner
Acute Care Hospitals including jails, rehabilitation
centers, etc.

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75 | P a g e
76 | P a g e
 2011
Annual
Report

New Castle County Emergency Medical Services Division

OVERVIEW

Introduction

The mission of the New Castle County Emergency Medical Service, as an

essential component of the New Castle County Government, is to provide efficient,
compassionate, and high quality emergency medical care to the visitors and residents
within New Castle County. Our delivery of paramedic service directly impacts the quality
of life for of all who reside, visit, and work in New Castle County.
The New Castle County Emergency Medical Service is a county municipal “third service”
paramedic agency within the County Department of Public Safety. New Castle County
EMS has the distinction of being the “First Paramedic Service in the First State.” In
2010, New Castle County EMS became the first EMS agency in Delaware to achieve
national accreditation from the Commission on Accreditation of Ambulance Services
(CAAS).
New Castle County EMS operates in a “tiered response” configuration, and responds
with basic life support (BLS) ambulances from the volunteer fire service, career fire
departments, private ambulance service providers, and specialized BLS providers, such as
the University of Delaware Emergency Care Unit, a student operated ambulance.
In 2011, New Castle County EMS deployed nine (9) paramedic units during its high call
volume periods, and eight (8) paramedic units during non-peak operating hours. A
Paramedic Sergeant (field EMS supervisor) is on duty during each shift with a second
Paramedic Sergeant augmenting field operations during peak call volume periods. An
EMS Lieutenant serves as the overall shift commander on a 24-hour basis. Both the
Paramedic Sergeant and EMS Lieutenant are equipped as advanced life support
responders.
Our personnel strive to demonstrate our commitment to our motto “Excellence in
Service” each and every day.
Further information regarding the New Castle County Paramedics is available on our
web site at: www.nccde.org/ems.

A NATIONALLY ACCREDITED EMERGENCY MEDICAL SERVICE

77 | P a g e
 OPERATIONS

Paramedic Service Operational Demand

New Castle County EMS has a clearly defined call volume pattern that begins to increase
at approximately 0600 hours each day, reaches a peak at approximately 1100 hours, then
steadily declines until after midnight. Utilization of “power shift” units, such as Medic 9,
provides an opportunity to increase paramedic staffing during high call volume times each
day. Additional paramedic units have been placed in service for special circumstances,
including inclement weather conditions and other events that could potentially impact
paramedic service delivery to New Castle County.

In 2011, the EMS Division deployed eight (8) paramedic units and a Paramedic Sergeant
on a 24-hour basis, seven days a week. A ninth paramedic unit and second Paramedic
Sergeant are added during peak call volume periods on a “power shift” configuration
(0700-1900 hours) seven days a week.

New Castle County EMS

Incidents by Hour
From 01/01/11 to 12/31/11

2000

1800

1600

1400

1200
Total Incidents

1000

800

600

400

200

0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Hour of Day

This chart illustrates the New Castle County paramedic call volume during calendar year 2011 by
hour of day.
Source: New Castle County Computer Aided Dispatch (CAD) System

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New Castle County EMS had a paramedic service response time for all incidents (combined Charlie,
Delta, Echo and stand-by events) of 63.9% reliability within 8:59 minutes or less during calendar year
2011. Response time reliability based on dispatched priority level documented a faster paramedic
response time for potentially life-threatening, time sensitive (“Echo” level) incidents with a response
time reliability of arrival 72.3% within 8:59 minutes or less.

The Emergency Communications Center will prioritize emergency medical incidents in accordance
with a national set of criteria. It is routine for the communications center to reassign paramedic units
from a lower priority incident to a higher priority medical incident.

The New Castle County Paramedics responded to 29,246 incidents during calendar year 2011.
Approximately 3,493 patients required two or more paramedics to accompany them during their
transport to the hospital.

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This map illustrates the number of New Castle County Paramedic incidents that occurred in each fire company
district during calendar year 2011. The New Castle County Paramedics work closely with the fire company
basic life support ambulances on a daily basis. County paramedics augment the basic life support capabilities
of the fire service ambulances by providing out-of-hospital advanced life support care.

Source: New Castle County Computer Aided Dispatch (CAD) System

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 2010 Overall Survival (%) 2010 Overall Survival, by CARES Agency

Annual CARES cases 0-99 Annual CARES cases 100-299 Annual CARES cases 300+

New Castle County Emergency Medical Services (identified as CARES Agency 40) has been participating in the
Cardiac Arrest Registry to Enhance Survival (CARES Registry) since 2009 and has over 1,000 case entries.
The latest survival data released by the CARES Registry indicates that cardiac arrest survival rates in New
Castle County, Delaware are above the national average of the reporting jurisdictions. New Castle County
EMS continues to explore opportunities to further enhance the potential for survival of patients that experience
out-of-hospital cardiac arrest. New Castle County EMS responded to 500 patients that were in cardiac arrest
during calendar year 2011. Approximately 69% of the patients in New Castle County were at home when they
experienced sudden cardiac arrest.

Source: Cardiac Arrest Registry to Enhance Survival (CARES)

New Castle County Paramedics

provide care to the victim of a motor
vehicle collision involving a
motorcycle. County paramedics were
dispatched to 197 crashes involving
motorcycles during calendar year
2011.

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New Castle County Paramedic Unit Activity

PARAMEDIC UNIT 2011

Medic 1 (Wilmington) 3,170

Medic 2 (New Castle) 4,016

Medic 3 (Newark) 3,347

Medic 4 (Brandywine 100) 3,312

Medic 5 (Middletown) 1,805

Medic 6 (Glasgow) 3,081

Medic 7 (Prices Corner) 3,404

Medic 8 (Wilmington) 3,953

Medic 9 (12 hour/day unit) 1,845

Medic 10 (Special Duty) 70

Medic 11 (Special Duty) 32

Medic 12 (Special Duty) 3

Medic 13 (Special Duty) 0

Medic 20 (Special Ops) 22

ALS Bike Team 0

Single paramedic ALS 2,344

responses
TOTAL RESPONSES 30,407

New Castle County EMS Supervisor and Staff Activity

EMS SUPERVISOR/STAFF 2011

EMS HQ Staff (Chief & Asst Chiefs) 110

EMS Lieutenants 774

Paramedic Sergeants 2,966

TOTAL STAFF RESPONSES 3,850

The mission of the New Castle County

Paramedics can take place in a variety of
locations and venues. Here, a county
paramedic unit stands by while fire company
water rescue personnel search the Chesapeake
& Delaware Canal for a vehicle that
reportedly submerged with the driver still
inside. The victim was recovered, and was
pronounced dead at the scene by the
paramedics.

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 ADMINISTRATIVE ACTIVITY

Public Education/Injury Prevention Programs

New Castle County EMS continued to provide a limited number of public education activities to
support its delivery of emergency medical care. Public education is a secondary function within the
EMS Division, and is not supported by a full time assignment. Unfortunately, our agency has had to
reduce its outreach activity as a result of fiscal restrictions throughout state and local government. A
robust public education program can support the delivery and performance of an EMS system by
improving the speed of public access and prompting appropriate bystander response before EMS
arrives on scene. New Castle County has bystander CPR performed during cases of sudden cardiac
arrest at a rate below the national average. In New Castle County, the initiation of bystander CPR
before EMS arrives gives the patient a 2.5 times greater chance of survival.
Public Education Activities

CPR/AED Classes 13 courses conducted with certification of 210 persons

CPR Healthcare Provider 39 courses conducted with certification of over 690
persons
First Aid Classes 1 course conducted with certification of 10 persons
Vial of Life Program Continued collaboration with Christiana Care Emergency
Departments and Visiting Nurse Association, and volunteer
fire service to facilitate ongoing distribution of Vial of Life
kits. Distributed Vial of Life kits at 7 events by paramedics.

EMS Division Displays Staffed 16 paramedic service displays or presentations with 5

EMS Division Honor Guard details and 4 NCC Pipes and
Drums events

9/11 Remembrance New Castle County EMS participated in 5 events that

recognizing the 10-year anniversary of the events of 9/11/01

Open House Paramedic units displayed at 3 fire company open house

events
Teen Driving Awareness 3 events with 55 students to highlight the risks and potential
impact of teen driving decisions

Youth Education 4 presentations to 92 students regarding EMS careers and the

role of paramedics in the emergency medical services system

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 The New Castle County Pipes & Drums is a multi-discipline ceremonial unit that includes
Emergency Medical Services Division, Division of Police and Emergency Communications Division
personnel. The Emergency Medical Services Division also maintains an EMS Honor Guard to
represent the County paramedics at official events, public safety funerals and render honors to
retired members of the service.

ACCOMPLISHMENTS

Continued Participation in National CARES Registry

The New Castle County Paramedics were one of the first 25 agencies to
participate in the national Cardiac Arrest Registry to Enhance Survival (CARES)
program operated by the Centers for Disease Control (CDC), American Heart
Association (AHA) and Emory University. The CARES registry facilitates
uniform collection of EMS response and hospital discharge data for cardiac arrest
patients, and provides a platform for standardized data analysis. There are now
57 EMS agencies nationwide participating in the project.

New Castle County Service Awards

Emergency Medical Services Division

personnel were among those recognized by
County Executive Paul Clark at the annual
New Castle County Service Awards breakfast
on November 30, 2011. The New Castle
County Service Awards event is hosted
annually by the County Executive for
personnel that have been with the county for 20
or more years.

Twelve personnel from the Emergency Medical Services Division were cited for their
outstanding service and dedication to the citizens of New Castle County.

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30 Years: Senior Lieutenant Karl E. Hitchens
Paramedic Sergeant Kenneth N. Dunn
Paramedic Corporal Charles W. O‟Neal
Paramedic First Class James D. McCarnan

25 Years: Paramedic Sergeant Donald M. Kennard

Paramedic Sergeant Dawn E. Gulezian
Paramedic Corporal John P. Lloyd

20 Years: Lieutenant Mark P. Allston

Paramedic Corporal Kenneth M. Sliney
Paramedic Corporal Donald L. Morris
Paramedic Corporal Beth A. Bratton-Heck
Paramedic Corporal Paul G. Bazzoli

2011 EMS Graduation & Appointment Ceremony

New Castle County EMS hosted their

annual Graduation & Appointment
Ceremony in May 2011 during
National EMS Week. The annual
event recognizes the graduating New
Castle County paramedic students, in
addition to those “selective
certification” personnel that transferred
from out-of-state. The 2011 event was
also the first time the ceremony was
streamed live to an international
audience.

Appointed to the Service in 2010

Paramedic Jessica A. Duncan
Paramedic Thomas C. Hobbs
Paramedic Rachel A. Stemerman

New Castle County Paramedic Class of

2008-2009
Paramedic Elizabeth A. Alderson
Paramedic Ashley D. Steil

New Castle County Paramedic Class of

2009-2010
Paramedic Aleksandra N. Campbell
Paramedic Travis N. Duffin
Paramedic Leah Hojnicki
Paramedic Michael E. Pietruczenia

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NCC*EMS Initiates Pre-hospital Sepsis Screening
In July 2011, the New Castle County Paramedics added a new
device to assist in the early recognition and treatment of a
common, but silent killer known as “sepsis.” The Emergency
Medical Services Division issued lactate meters and
thermometers to all county paramedic units to permit the testing
of a patient‟s blood lactate level and obtain a patient‟s body
temperature in the field. Lactate has been identified as a
potential leading indicator of shock and organ failure. Elevated
blood lactate levels with an elevated temperature and other vital
sign changes can indicate the early stages of sepsis. County
paramedics are alerting the receiving hospitals to potential
sepsis patients in an effort to expedite the initiation of care that
can potentially reduce mortality for these patients.
National EMS Week 2011 Activities

EMS Week 2011 included lunch BBQ events at the

Delaware Park Picnic Grove for EMS Division
personnel. The appreciation lunch included a visit
from the FDNY EMS Pipes & Drums, who stopped
by on their way to Arlington, VA to welcome the
participants completing the National EMS Memorial
Bike Ride.

EMS Division personnel rotated through the BBQ,

which featured cooking by some of staff. The lunch
has been used to say “thank you” to those who give
so much of themselves each and every day.

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Middletown Freestanding Emergency Department site to Include Paramedic Station

On November 30, 2011 County Executive Paul Clark

participated in the groundbreaking ceremonies for a
Christiana Care construction project that will place a
freestanding emergency department in Middletown.
The site will include a separate New Castle County
paramedic station that will replace the existing
accommodations for Paramedic Station No. 5, which
is currently located at the NCCPD Southern Patrol
Unit on Broad Street.

Photo courtesy of Christiana Care Health System

NCC*EMS Participates in Preparedness Exercises

The EMS Division participated in a functional

exercise of the state Division of Public Health
Hospital Evacuation Plan on May 10, 2011 at the
Christiana Hospital. The exercise provided an
opportunity for hospital administration to interact
with representatives from state and local
government during simulated conditions that would
require the evacuation of a hospital in Delaware.

EMS Chief Provides Congressional Testimony

On May 12, 2011 Chief Lawrence E. Tan provided

testimony to the Emergency Preparedness, Response
and Communications Subcommittee of the U.S.
House of Representatives Committee on Homeland
Security. Chief Tan delivered testimony on behalf of
the Emergency Services Sector Coalition on Medical
Countermeasures and the International Association of
EMS Chiefs. The Emergency Services Sector
Coalition on Medical Countermeasures consists of
emergency services professional associations, policy
groups and pharmaceutical companies that are
working to promote the development of a national
strategy for protecting emergency services (law
enforcement, fire service and EMS) personnel from a
chemical, biological radiological, nuclear or
explosive (CBRNE) incident.

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NCCo Paramedics Recognized at Public Safety Awards Ceremony

Twenty-five Emergency Medical Services

Division personnel were recognized at the
May 26, 2011 Department of Public
Safety Awards Ceremony for their
accomplishments and exemplary
performance. The following EMS
Division personnel were cited for notable
performance at the event:

Assistant Chief Richard D. Krett

Assistant Chief Daniel G. Seador
S/Lt. Joseph J. Dudley
Lt. Mark P. Allston
P/Sgt. Kenneth N. Dunn
P/Sgt. Dawn E. Gulezian
P/Sgt. Donald M. Kennard
P/Sgt. Mark R. Logemann
P/Cpl. David B. Aber
P/Cpl. Isaac J. Hankins
P/Cpl. Crystal D. DiMauro
P/Cpl. Michael A. McColley
P/Cpl. Richard Moerman, Jr.
P/Cpl. William J. O‟Leary
Paramedic 1/C Stacy T. LeCompte
Paramedic 1/C David J. McKinney, Jr.
Paramedic 1/C Sherri R. Portello
Paramedic 1/C Daryl C. Rollins
Paramedic 1/C Jeffrey R. Russell
Paramedic 1/C Michael C. Schusteritsch
Paramedic 1/C Elizabeth A. Thompson
Paramedic 1/C Autumn M. Tuxward
Paramedic 1/C Jorge H. Vasquez
Paramedic Michael E. Ferrero
Paramedic Dawn M. Longfellow

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NCCo EMS Division Coordinates Special Event Medical Coverage

The New Castle County Emergency Medical Services Division coordinated the medical coverage of several special
events during calendar year 2011. For instance, on May 15, 2011, New Castle County Paramedics worked with
basic life support ambulances from St. Francis Hospital EMS, and bike teams from the Aetna Hose, Hook and
Ladder Company of Newark and University of Delaware Emergency Care Unit to provide coverage to the Delaware
Marathon. The Delaware Marathon involved over 2,500 participants and resulted in twelve (12) requests for
emergency medical assistance that included five (5) patients being transported to area hospitals.

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NCCo Paramedics Recognized by Kiwanis Club of Wilmington

Three New Castle County Paramedics were honored

with Kiwanis Club Awards for the Quarter at a
luncheon held at the Hotel DuPont in Wilmington on
September 21, 2011. Paramedic Sergeant Kenneth N.
Dunn, Paramedic First Class Daryl C. Rollins and
Paramedic First Class Stacey T. LeCompte of the
New Castle County Emergency Medical Services
Division were recognized by the Kiwanis Club of
Wilmington.

The three New Castle County Paramedics were cited

for their teamwork, exemplary clinical expertise and
skill demonstrated during a July 2010 response to a
shooting. The incident involved a male patient who
had sustained a shotgun wound to his face, which
caused severe facial injuries that obstructed his ability
to breathe.

NCCo EMS Produces Public Service Announcement Videos

New Castle County EMS released three

public service videos during calendar year
2011 that have been broadcast over the
cable TV government access channel and
posted to the NCC*EMS web site.

Paramedic Service Video: an

informational video that describes the role
of the New Castle County Paramedics and
the capabilities of the county advanced life
support service within the EMS system.
Link: http://youtu.be/cGiVLWjkODs

Learn CPR!: a brief video that describes

the importance of immediate action during
cases of sudden cardiac arrest. The video
highlights the need for citizens to learn
CPR, but also instructs them to follow the
directions provided by the 9-1-1 dispatcher
in the event of an emergency.
Link: http://youtu.be/IxXPHXau464

Learn CPR! (Spanish Version): the

Learn CPR video was also produced in
Spanish and made available to the Latino
community.
Link: http://youtu.be/O7z7KevLGrs

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NCCo Paramedics Participate in Job Fair

On Monday, April 11, 2011 the New

Castle County Paramedics participated in a
Job Fair hosted by United States Senator
Chris Coons. Over 50 employers were
present at the Chase Center at the
Riverfront in Wilmington for the event.
Lt. Mark Allston, EMS Division
Recruitment Coordinator, and Paramedic
Cpl. Isaac Hankins staffed the EMS
Division display with representatives from
the New Castle County Office of Human
Resources.

NCCo EMS Renders Honors to Fallen NCCPD Officer

On September 16, 2011 the New Castle County Police

Department suffered a tragic loss. Lt. Joseph Szczerba was
fatally stabbed while struggling with a suspect shortly after
midnight. Lt. Szczerba, at age 44, had served with the
department for 18 years.

The New Castle County Paramedics were tasked with

planning and coordinating the medical coverage of the
funeral, which was estimated to be attended by 6,000
people. With the assistance of Kent and Sussex County
EMS and several BLS agencies, New Castle County EMS
provided support to the New Castle County Police
Department that included an EMS Honor Guard, the NCC
Pipes and Drums, medical coverage of the funeral venue,
and maintenance of county-wide 9-1-1 ALS coverage on
the day of the funeral.

New Castle County EMS mourns the loss of NCCPD Lt.

Joseph L. Szczerba.

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Our Mission is Your Life

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 Echo Level Response, NCC EMS
1,000
Number of Responses

800
600
400
200
0
2007 2008 2009 2010 2011
Within 6 minutes Within 8 minutes Within 10 minutes Within 12 minutes Total

Delta Level Response, NCC EMS

Number of Responses

15,000

10,000

5,000

0
2007 2008 2009 2010 2011
Within 6 minutes Within 8 minutes Within 10 minutes Within 12 minutes Total

Charlie Level Response, NCC EMS

20,000
Number of Responses

15,000
10,000
5,000
0
2007 2008 2009 2010 2011
Within 6 minutes Within 8 minutes Within 10 minutes Within 12 minutes Total

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 ALS and BLS Patient Age Comparison-2011
New Castle County
10000

8000

6000
ALS
BLS
4000

2000

0
Less 12 to 20 21 to 30 31 to 40 41 to 50 51 to 60 61 to 70 71 to 80 81 to 90 Greater
than 12 Yrs Yrs Years Years Years Years Years Years than 90
Years Years

Percentage When New Castle County ALS/BLS Arrived On-Scene in

8 Minutes or Less on Delta/Echo/Charlie Level Incidents-2011
100%
90%
80%
70%
60% Charlie
50% Delta
40% Echo
30%
20%
10%
0%
2009 2010 2011 2009 2010 2011
ALS BLS

New Castle County ALS and BLS

35 ,000
62%
30 ,000

25 ,000
90% 38%
20 ,000

15 ,000

10 ,000

5 ,000 10%
0
ALS BLS

= <4 hrs >4 hrs

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 New Castle County
BLS Scratch Report
From 01/01/11 to 12/31/11
Out Of Company
Station In District District Totals Scratches Percentages
Aetna Hose, Hook & Ladder 7534 841 8375 108 1.29%
Belvedere Fire Company 98 222 320 30 9.38%
Brandywine Hundred 1631 527 2158 0 0.00%
Christiana Fire Company 8420 535 8955 4 0.04%
Claymont Fire Company 2987 535 3522 15 0.43%
Cranston Heights Fire Company 1310 881 2191 1 0.05%
Delaware City Fire Company 1001 438 1439 2 0.14%
Elsmere Fire Company 1366 431 1797 0 0.00%
Five Points Fire Company 930 435 1365 1 0.07%
Goodwill Fire Company 1122 372 1494 0 0.00%
Hockessin Fire Company 993 488 1481 0 0.00%
Holloway Terrace Fire Company 923 426 1349 29 2.15%
Mill Creek Fire Company 3699 444 4143 0 0.00%
Minquadale Fire Company 1242 478 1720 4 0.23%
Minquas Fire Company 775 799 1574 0 0.00%
Odessa Fire Company 606 185 791 29 3.67%
Port Penn Fire Company 72 165 237 1 0.42%
Talleyville Fire Company 3164 327 3491 0 0.00%
Townsend Fire Company 485 176 661 49 7.41%
University of Delaware 222 75 297 34 11.45%
Volunteer Hose Company Inc. 2596 223 2819 63 2.23%
Wilmington Manor Fire Company 1626 426 2052 0 0.00%
Totals 42802 9429 52231 370 0.71%

New Castle County BLS Paid Personnel Chart By Company

Agency Name Total Pd personnel Shifts covered
Aetna Hose Hook & Ladder 8 FT - 40 PT 24 hour coverage
Belvedere Fire Co. 30 1FT 15PT 12H
Brandywine Hundred Fire Co. 11 8FT - 4PT 24/7
Christiana Fire Co. 12 8 FT - 47 PT 24/7
Claymont Fire Company 13 9FT - 125 VOL 24/72
Cranston Heights Fire Co. 14 6 FT - 15 PT 24/7
Delaware City Fire Company 15 4FT 24 On ~ 72 Off
Elsmere Fire Co. 16 4 FT - 15 PT 24/7
Five Points Fire Company 17 2 FT - 25 PT 24/7
Goodwill Fire Company 8 FT-10PT 24/7
Hockessin Fire Co. 19 9 FT - 10 PT 24/7
Holloway Terrace Fire Co. 40 PT 24/7
MillCreek Fire Company 21 9 FT - 15 PT 24/7
Minquadale Fire Company 22 8 24/7
Minquas Fire Co. 23 2 FT 30PT 24/7
Odessa Fire Co. 24 41PT 24/7
Port Penn Vol. Fire Co. 29 4 FT - 21 PT 24/7
Talleyville Fire Co. 11FT- 20PT 24/7
Townsend Fire Co. 26 2 FT 10H
Volunteer Hose Company 9 FT 15 PT 24/7
Univ of DE Emer. Care Unit 0 0
Wilmington Fire Department 100 172 24/72
Wilmington Manor Fire Co. 7 FT - 11 PT 24/7

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 New Castle County
Basic Life Support (BLS)
Submitted by various BLS agencies in New Castle County

New Castle County is comprised of 21 volunteer fire companies and one paid fire department,
the City of Wilmington. Every fire company in New Castle County operates at least one basic
life support unit and many fire companies operate multiple BLS units. There are two additional
BLS units, owned by the county, that are used as “loaner” ambulances; these ambulances are
placed into service when a fire company‟s ambulance is placed out-of-service for any period of
time.

Many volunteer fire companies in New Castle County are transitioning from a predominantly
volunteer system to a combination system, which accommodates both volunteer and paid
personnel. During a time when volunteerism is on a decline, fire companies must find alternative
ways to provide a safe, quick, and professional service, while struggling with these personnel
issues. BLS units need to be on-scene within an average of eight minutes of most calls. This type
of time demand, as well as increased call volume has lead many volunteer companies to
transition to paid personnel that work various shifts. The combination departments have shown
to be a great improvement for many New Castle County Companies.

Photos courtesy of Aetna Fire Company

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Notable Events
Odessa Fire Company
Odessa Fire Company receives award for Excellence in Fire Service-Based EMS
Washington, D.C
Thursday, April 7, 2011

President Frank Gant and Ems Supervisor Dave Aber, along with Gov. Markell, Congressman
John Carney, and DVFA President Bill Tobin receive the Award for the Odessa Fire Company at
the CFSI dinner in Washington D.C. The award was for Excellence in the Fire Service-Based
Ems. This was the first year this award has been given for a volunteer fire company at the CFSI
dinner.

Brandywine Hundred Fire Company

Brandywine Hundred Honors Top EMS Responders

Brandywine Hundred is the proud operator of two ambulances, responding to over 2,237
requests for service with 1,683 of these requests resulting in transports. The staffing of the
ambulances is accomplished through a combination of paid staff for the primary unit and the
second ambulance is staffed entirely by volunteer members. We would like to take this
opportunity to congratulate the top responders for their dedication:

Chris Weatherby – 55 calls

Richard Daswick – 18 calls
Doug Horstmann – 14 calls
Tom Fanelli – 12 calls
Ryan Kennard – 8 calls

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 Communication Center
New Castle County
Submitted by David Roberts

The New Castle County 9-1-1 Emergency Center receives 9-1-1 calls through a variety of phone
exchanges and numerous cell towers throughout New Castle County. The total number of 9-1-1
calls processed in year 2011 was 365,048. Another 88,151 non-emergency calls were also
processed by our Emergency Call Operators. The Center dispatched or processed a total
of 125,387 fire/medical incidents and 317,475 police incidents in year 2011. New Castle County
Emergency Communication Center handled over 51.63 % of the 776,891 9-1-1 calls in the State
of Delaware for 2011.

The New Castle County Emergency Communications Center was recognized as an Accredited
Center of Excellence in Emergency Medical Dispatch by the National Academy of Emergency
Medical Dispatch in October 2002 as the 87th agency in the world accredited; and then, re-
accredited in October 2005 , November 5, 2008 and 15, 2011. Additionally, we utilize the
National Academy of Emergency Fire Dispatch protocols and currently working toward our
national accreditation.

The New Castle County Emergency Communications Center operates 24-hours a day on a year-
round basis. We provide Fire/EMS Communications to the City of Wilmington, twenty-one
New Castle County Volunteer Fire Companies, six fire brigades, and the New Castle County
Paramedics. Additionally, we provide Police Communications service to seven police agencies
within New Castle County. The Center is staffed by thirty full and part-time Emergency Call
Operators, twenty-three New Castle County Police Communications personnel, twenty Delaware
State Police Communications personnel, twenty-five full-time Fire/Medical Communications
personnel, and an administrative staff of six personnel.

This agency also operates a state-of-the-art mobile communications van that is capable of taking
over all operations, with the exception of phones, within the 9-1-1 Center at a moments notice.
The New Castle County Emergency Communications Center operates within the New Castle
County Public Safety Building.

New Castle County Delaware 911 Calls

600,000
500,000
Total 911 Calls
400,000
300,000
Calls received
200,000 by Cellular
phone
100,000
0
2008 2009 2010

Picture submitted by NCC 911 Center Data submitted by E911 Board

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Kent County Emergency Medical Services
Submitted by Kent County EMS

Mission
Our mission is to be a leader in meeting the present and future health care needs of the citizens
and visitors in our community through a network of high quality advanced life support services,
education and prevention programs which share common goals and values.

Values
Service: We are committed to help the sick and injured by providing superior service to our
patients and our community with skill, concern and compassion.
Quality: Because our patients are our primary concern, we will strive to achieve excellence in
everything we do.
People: The men and women who are our paramedics, and those associated volunteers,
physicians, nurses and students are the source of our strength. They will create our success and
determine our reputation. We will treat all of them with respect, dignity and courtesy. We will
endeavor to create an environment in which all of us can work and learn together.
Stewardship: Fulfilling our mission requires that we use our resources wisely and with
accountability to our publics.
Integrity: We will be honest and fair in our relationships with those who are associated with us,
and other health care workers as well.

EMS agencies throughout the country have realized the important role of bicycles in the realm of
pre-hospital emergency care. Bicycles are both a cost effective and fun way of delivering any
level of pre-hospital emergency care in any number of venues.

The advantages that paramedics on bikes have are many. Crowd congestion issues are lessened
by the increased mobility of bicycles, they are relatively inexpensive, cost little to maintain, are
able to carry Advanced Life saving equipment, and they offer health benefits to the providers
who are riding. This does not even begin to touch upon the intangible benefits of public relations,
and community educational opportunities afforded by being “on ground level” with the
population you serve. Every child in the area wants to know who you are, what you do, and what
things you have on your “tricked out” bike. In Kent County, we have used this as an on duty
opportunity to do helmet education, and community education on what it is we actually do as
paramedics. Paramedics may be out there to initiate life saving procedures, but many times it is

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the patient contact with the child who needs only a Band-Aid where we make the greatest
impact.
History
Kent County Department of Public Safety, Division of Emergency Medical Services (KCDEMS)
has been utilizing paramedics on bicycles for 13 years. Our utilization has risen from 10 events
our first year to one or more events almost every weekend from March through October.
KCDEMS utilizes our team for everything from Bike Rodeos, where we may teach bike safety
and handling to 10 kids, to race coverage for Dover Downs International Speedway where the
crowd can top 170,000. The flexibility of our high-end aluminum mountain bikes has allowed us
to tailor our programs to the needs of the requesting agency.
Training
Training our members is important for a variety of reasons. First and foremost it helps our
paramedics feel confident in their skills, and it promotes safe and able handling of the bike.
KCDEMS sends all of our All Terrain Medical Response Team (ATMRT) candidates to
International Police Mountain Bike Association (IPMBA) school. This is a comprehensive
program that spans 4 eight-hour days. This school teaches our medics a multitude of skills,
including how to maneuver the bikes, how to safely negotiate obstacles, and also covered are
basic maintenance skills. This training ensures that all of our team members have a foundation of
safe riding skills. In conclusion, paramedics on bicycles are an asset to any agency. We are not
only able to decrease response times by our increased mobility in a crowd, but are able to do
positive public relations and education because of our increased accessibility.

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Kent County EMS Hazardous Materials (HAZMAT) Medic Team
Decon 3

Kent County EMS began to

develop its role as support
agency to Hazmat Responders
early in 1997 with the initiation
of the KCEMS Hazmat Medic
Team. The Administration
identified the goal of offering
technical and functional
support to the Incident
Commander of a HazMat
Scene. The Team's mission
statement defines this task as
"...working with Fire-Rescue
Units and other agencies to effectively minimize health risks to the individual, responders, and
community in the even of a hazardous materials release". The team was assembled with two
Paramedics selected from each shift, one alternate member, and one Administrator to oversee the
project.
The first group of five team members was sent to Delaware State Fire School for the EPA
Hazmat Operations training in April 1997. This core group compiled a great deal of information
while working towards development of operational plans and department SOP's. As the
remaining team members have completed the 40 hour Operations training, the team has
conducted and /or participated in several training exercises involving the volunteer fire and
ambulance services and local industry. The accumulation of equipment has been ongoing and
continues to expand. The arrival of the MCI-Hazmat response trailer to Kent County has added
to the possibilities of the team's potential. Team development continues at a steady pace.

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 SWAT MEDICS
Law enforcement agencies throughout the country have realized the important role of medical
support during SWAT or tactical missions. Utilization of experienced paramedics trained in
tactical operations enhances the team and ensures appropriate and timely emergency medical
care during highly stressful and potentially dangerous situations.

History
Kent County Department of Public Safety, Division of Emergency Medical Services (KCDEMS)
initiated the SWAT/Tactical Medic program in 2007. The first law enforcement agency to
request our services was Smyrna Police Department. Smyrna PD coordinates a consortium
tactical team, the STAR (Special Tactics and Response) team comprised of member of various
departments. Recently, Milford Police Department has requested KCDPS SWAT-Medics
support their SOG (Special Operations Group) tactical team.

Training
Intensive training is required to be proficient and maintenance of skills. SWAT-Medics, in
addition to remaining proficient in emergency medical treatment protocols and procedures, must
also maintain training in tactical operations and weapons. Initial training occurs at the
International School of Tactical Medicine® where specialized emergency medical training is
provided to handle advanced airway management, thoracic and abdominal injuries, orthopedic
stabilization, police K-9 emergency veterinarian care, and much more. This school also certifies
our paramedics as basic and advanced SWAT operators with a proficiency in tactical entry, room
clearing, weapons training, hostage and barricaded subjects training. The team continually trains
on a monthly basis with both the STAR and SOG teams to ensure excellent working relations
and skills maintenance.

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Injury Prevention and Community Outreach
Kent County Department of Public Safety Division of EMS is proactive in our injury prevention
efforts. Throughout the course of the year, we have done a variety of prevention and educational
programs for the public we serve. 2011 was a busy year. As the population of Kent County
grows, the requests for stand-bys and community service increase proportionally. In addition to
the All Terrain Medical response team events listed in the previous section, Kent County
paramedics participated in 12 community events- these events included CPR classes, school
demos, health fairs, and a great number of standbys (where we are on standby due to crowd
estimates, etc.) Kent County Paramedics taught 5 CPR classes last year reaching over 30
people.

2011 marked the 9th year that we have been a recognized NHTSA fitting station. Parents and
caregivers may come by headquarters by appointment and have their car seats inspected, and
checked by our trained technicians. In 2011 we inspected and installed 8 car seats. Our
department now has one NHTSA certified child seat safety technician who has completed the
NHTSA 32 hour course.

In addition to the above, Kent County Department of Public Safety Division of EMS participated
in a number of community outreach and injury prevention programs with the Caesar Rodney
School District, the Kent County Public Library and Dover
Public Library.
In order to accomplish effective communication with our
younger audience, Paramedic Pete was hired and detailed to
cover these events. Pete spoke with the children regarding who
Paramedics are and what to expect if they call 911. Also
discussed were bike safety, anti-bullying campaign, summer /
water safety among other topics. Paramedic Pete and his
assistants, Paramedic John and Paramedic Mike were well
received! EMS has an important role in Injury prevention, and we
believe that we have a responsibility to do all we can to prevent
unintentional injury. We will continue to participate in as many
programs as we can, in order to decrease the morbidity and
mortality that results from preventable injury.

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2011 Improvement Initiatives and Summary Report

Hazmat

ToxMedic

MCI
Homeland
Security Mass Gatherings

KCDPS EOD
Technical

Rescue Special
Operations SORT

Maritime Rehab

Response NEHC

Bikes

ATV

Special Operations Special Operations encompasses the response categories of Mass Casualty
Incident (MCI), Hazardous Materials Incidents (Hazmat), Technical Rescue Operations
(confined space, high angle, trench, collapse), Explosive Ordnance and Tactical EMS Support
(EOD/SORT), Fire Ground Support (Rehab), All-Terrain Medical Response (Bikes & Medic-
Gator), Maritime Operations, and Weapons of Mass destruction (WMD/CBRN) preparedness
and response.

In keeping with the National trends, Special Operations activity within the Department continues
to gain a more “global” or “all-hazards” capability in that equipment, materials, and personnel
are utilized for multiple response strategies with key personnel with more highly focused training
serving as response leaders.

This section of the report will update the current status of each of these response categories as a
result of equipment procurement, training of personnel, and activity over the past year. Further,
an outline of future needs and initiatives will be presented.

Mass Casualty Incident (MCI)

Response: The Department MCI Plan identifies staged levels of response based upon assessed
patient populations. The key operational point identified is early activation of the MCI response.
The plan allows for any component of the system to “make the call”, therefore, Department
Dispatchers, Medics, Supervisors, or Administration can all initiate the MCI Response Plan. The
MCI Response Plan has been presented to and endorsed by the Kent County Fire Chiefs with

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regard to the automatic response levels. The Kent County MCI Plan is consistent with other
County and State MCI Plans.
Equipment: Each Medic Unit carries Triage Kits and limited additional supplies to be used for
patient care. The Supervisor‟s unit (KM5) is equipped with an MCI Command Kit to facilitate
orderly control of the medical branch of the incident. All units have updated contact lists for
local and regional medical facilities. Critical data is kept both in hard copy and electronically in
the unit MDT. The Special Operations trailer is equipped to support triage and treatment of up to
50 patients, has its own electrical power supply, and has additional components of the Treatment
Area Command Kit, TVI Shelter with air heater unit, Chemical Personal Protection Kits (PPE),
and Nerve Agent Antidotes Kits (NAAKs). TANGO-1 may be deployed for additional ALS
resources and initial hazmat/radiological survey. The Decon Support trailer may also be
deployed for further sheltering and electrical supply. The Mobile Command Post may be
deployed for extended operations.
Training: All Medics are trained in START Triage and this skill is supported by monthly
“Triage Days” during which all patients are identified with appropriate triage tags. Medics
continue to train on the MCI Plan which gives Medics guidelines for determining the level of
response necessary and emphasizes the need for the first-on-scene Medic crew to initiate the
MCI response. “Trailer Day” drills continue in which all Medics are annually familiarized with
the response support units and complete hands-on practical evolutions with the equipment.
Activity: There were no MCI incidents which required the deployment of these additional assets.
Units were pre-deployed as required in support of Mass Gathering events.
Needs and Initiatives:
1. Continued refresher training through Triage Days and con-eds will maintain current training
levels. These have been added to the 2012 Training Schedule
2. Further training needs to be accomplished such that all Medics are competent in establishing a
Medical Sector at an MCI (Triage, Treatment, and Transport). During training sessions Medics
who are less experienced with MCI Command roles are tasked with accomplishing such an
assignment. Supervisors are being included in functional and full-scale exercises in compliance
with the NIMS.
3. Dedicated towing vehicles should be established such that no on-duty Medic Unit is diverted
from direct response to the scene in order to transport a support unit. The goal is to expand the
vehicle fleet to provide for 2 spare units.
4. Extended Operation and Re-call of personnel capability needs to be demonstrated through
practical exercise. Medics are issued personal pagers for Call-back and OT notification.

Mass Gatherings

Response: The Department prepares for several Mass Gathering activities each year. Notably,
the NASCAR races at Dover Downs, the Delaware State Fair, the Bike-to-the-Bay, and the
Amish Country Bike Tour present the venues for the largest populations. There are occasionally
other events (VIP appearances, DAFB Air Show, Chicken Festival, etc.) which also require Mass
Gathering preparations. Operations center on pre-positioning assets and adding staff to cover the
particular event. Response may be limited to assigning a Bike Team to the venue or expanded to
establishing an entire communications center with dozens of support units on site.
Equipment: The All-Terrain Medical Response has been expanded with one trailer now
housing the Bikes and one Medic-Gator and a second trailer which houses a second Medic-

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Gator. All trailer units can be pre-deployed in support of larger events. These units include the
Spec Ops, Decon Support, and Medical Resource Unit (MRU) trailers along with the County
Decon Units and TANGO-1. Additional ALS gear sets have been established to support each of
these units. The Mobile Command Post is a self-contained communications center which can be
deployed to any site as needed.
Training: A number of Medics are trained to operate the Bikes and an increasing number
trained to operate the Gator (the primary means of covering large venues). All Medics are
introduced to towing a support trailer.
Activity: The Gator and/or Bikes were used to cover Spring and Fall NASCAR races, Safe
Summer Day, and the Governor‟s Fall Festival. The Spec Ops trailer was pre-deployed for the
State Fair. The County Decon Unit and TANGO-1 were deployed to cover several VIP events
including Return Day.
Needs & Initiatives:
1. Additional medics have completed IPMBA training.
2. A standardized reporting form has been established to address operational needs when
requested to cover a large event.

Maritime Response

Response: Kent County‟s primary response jurisdiction extends well into the Delaware Bay and
includes a busy anchorage. Currently the Medics are taken to vessels via VFD Rescue Boats.
Occasionally the Coast Guard assists with aviation support. DSP has acquired a new helicopter
which will increase the availability of aviation support over marine environments.
Equipment: There is no specialized equipment currently in service to support maritime
response.
Training: The Little Creek FD has a Company specific training available to Medics.
Activity: There has been no maritime response activity.
Needs & Initiatives:
At this time further development of maritime response is tabled as current response efforts have
been sufficient.

Hazardous Materials Response (Hazmat)

Response: The Department‟s response continues to be one component of a multi-agency

response plan. Supported primarily and in depth by the Little Creek VFD, the group response for
hazmat incidents is currently initiated by a responding fire line officer. The mission of the
Hazmat Group remains primarily the provision of decontamination services. Following a request
by DNREC and the support from the Department Chief, an expansion of the mission has been to
develop a limited number of personnel capable of assisting DNREC in entry operations as a
medical component of the entry team.
Equipment: The State of Delaware Hazardous Materials Decontamination trailer, tow vehicle,
and the Decon Support trailer remain housed at Little Creek VFD. TANGO-1 operates from
KCDPS Headquarters.
Training: Regular training sessions are held on the third Tuesday night each month (with few
exceptions). As new equipment arrives it is introduced through these regular training sessions.
Joint exercises have been conducted with DNREC, the 31st CST, and DAFB. These joint

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sessions have met with great approval from all concerned and more are planned for the future.
Currently there are six Medics trained or awaiting training to the Hazmat Technician level which
qualifies them to assist the entry team.
Activity: There were no Decon activations for this period. The unit(s) participated in displays 2
times. The units were pre-deployed in support of the NASCAR races.
Needs & Initiatives:
1. Regular training nights will continue. Joint training evolutions with other response agencies
should be enhanced. The 3rd Tuesday each month has been established as a regular training day
for Medics, as well as the evening session at Little Creek.
2. Due to the continued and superlative support from the Little Creek VFD, there exists a lesser
demand for Medics to operate the Decon Line. Therefore, Medics are focusing more towards the
medical management of hazmat patients and the ToxMedic Protocols have been slightly
expanded.

Technical Rescue

Response: The Kent County Technical Rescue Team is spearheaded by the Cheswold FD with
support from several Kent County FDs. Currently there are 10 Medics training with the team.
Technical Rescue encompasses trench, collapse, confined space, high angle, and swift water
rescue operations along with urban search & rescue (USAR). The primary response area is Kent
County with assisting teams in New Castle and Sussex counties. The “Second Due” area for the
Kent team extends to the Chesapeake Bay including Caroline, Talbot, and Queen Anne counties
in Maryland (dual response with Anne Arundel).
Equipment: The team equipment is based at Cheswold FD and Hartly FD and is comprised of a
custom heavy rescue unit with additional equipment contained in a support trailer. All rescue
operations equipment is compatible with the other two county‟s equipment. Each team member
has a “go bag” with some personalized gear. Some specialized medical equipment has been
placed in service. Hartly FD has placed in service a “Light & Air” unit which has been included
with the initial response of the Team. This unit also tows the Support Trailer for the Team.
TANGO-1 is attached to this team response. Additionally, equipment and supplies are being
acquired towards the establishment of a mobile “Base Camp” to address the logistical needs of
an extended operation.
Training: The majority of active team members are trained to the Technician level for Trench
and Collapse rescue; all are Operations level for all disciplines. Several team members have
completed large animal rescue training.
Activity: There were no team activations. The team participates in annual trench and collapse
weekend exercises.
Needs & Initiatives: As the team increases in number and equipment inventory, continuing
training will have to occur. Exercises testing extended operations and the establishment of a
“base camp” continue.

EOD/SORT Response

Response: Medic Units are routinely dispatched to support EOD/SORT operations. Bomb
Technicians are medically monitored before and after entry evolutions. Medics stand by in safe

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zones for certain law enforcement operations. Tactical Medics operate as integral members of a
Tactical Team.
Equipment: Specialized equipment has been obtained for direct support of SWAT Medics.
Tactical Body Armor, rescue litters, radio microphone equipment have been added to the
inventory. Regular duty body armor and ballistic helmets are standard uniform for all medics.
Training: Four medics completed Basic and Advanced Tactical EMS training and are
embedded with the STAR Team in Smyrna and the Milford PD team. All current Kent County
Paramedics received refresher briefings regarding EOD operations as part of the 2-year refresher
cycle. Medics routinely receive refresher training regarding the assessment and treatment of
blast and burn injuries.
Activity: Monthly training with both teams continues. There was more than 50 hours of
training activity. There were 10 missions for a total of 60 hours.
Needs & Initiatives:
1. SWAT Medics are alerted by alpha pager and/or the STAR / Milford phone tree process.
2. Additional equipment is being obtained to coincide with the expansion of this program.
3. Re-certification training has begun with one SWAT Medic due for this training each year.

Fire Ground Support

Response: Medics are routinely dispatched to multiple alarm working fires and many “occupied
high density residential” locations. Many times this response is merely a stand-by, however it is
not uncommon for the Medics to assist in rehab services or conduct medical assessment and
monitoring of firefighters.
Equipment: Primary Medic units have Cyanokits as part of the ToxBox inventory and now
have a Smoke Inhalation Protocol for fire ground support operations. All of the support trailers
have sheltering, heat, and lighting capability. The Special Operations unit “TANGO-1” is in-
service and offers a “bridge” in support equipment between the Medic Unit and the support
trailers. The Spec Ops trailer has additional IV supplies, cots, sheltering, and heating capability.
Training: Specific training to support the new protocol has been completed. Medics are
capable of deploying shelters and other support equipment.
Activity: Call volume varies from year to year. Some Fire Departments have added Medics to
the initial dispatch for known working building fires or for residential complexes. Weather
continues to be a factor during the extremes of heat and cold.

Needs & Initiatives:

1. The establishment of the “Power Unit” has served to help cover this issue during the daytime
hours.
2. Once full staffing is accomplished, the additional KM10 unit will also help cover these
missions.

All-Terrain Medical Response

Response: The Bikes and Medic-Gator have thus far been pre-deployed to special events.
While the units are capable of emergency response, the application of these assets remains as
support to in-progress incidents. The units are housed in the ATMR trailer which requires
transport to the scene.

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Equipment: The ATMR trailer has been a tremendous improvement in storage and ease of
transport of the units. All response vehicles (Crown Vics excluded) are equipped to tow the
trailer. A solar battery charging system was installed for the Gator. The additional Medic Gator
and trailer are in service.
Training: The Bike Team continues as before with several Medics trained to ride the units.
Gator training has been completed and all medics are familiar with Gator unit operation.
Activity: The Bikes and Gator covered both the Spring and Fall NASCAR races. The Gator
was used at Safe Summer Day, the Governor‟s Fall Festival, and the Amish Country Bike Tour.
Needs & Initiatives:
1. Additional training on Gator operation should be conducted to increase the number of
qualified drivers. Gator driving should be extended to all Department employees and an MOU
should be established to allow VFD personnel to operate the unit under extreme circumstances.
Training is scheduled periodically. VFD personnel can be utilized as needed, much in the way
they assist in transferring Medic Units from the scene when all Medics are committed to patient
care.
2. Further training on trailer operations should be conducted and extended to all Department
employees to increase the number of qualified drivers. Training is scheduled periodically.

WMD / Terrorism Preparedness

Response: General ideology suggests that response units will most likely not know ahead of
time that an incident is an act of terrorism or involves WMD. Therefore, all responders must be
capable of adapting operational modalities in response to information as it is acquired.
Specialized equipment will be utilized as the situation warrants.
Equipment: Personal “Escape Ensemble Kits” are available on each unit which include
chemical protective suits and air purifying respirators. Ballistic helmets, goggles, and NIJ Level
II body armor are now part of the standard uniform. Tox-Boxes are in-service which provide
NAAKs (nerve agent antidote kits) for medics and patients and additional pharmaceuticals for
those medics who can function under the ToxMedic Protocols. Four of the five support trailers
in the department carry additional WMD response equipment and supplies. The First-On-Scene
response guidelines include a “Bomb Response” checklist and related reference materials. Each
Medic Unit is equipped with a radiological response kit and a GammaRAE detector for early
warning of a radiological event. Carbon Monoxide detectors have been added to the Medic
standard equipment. Two RAD 57 carboxyhemoglobin detectors have been put in service and
have proven to be valuable tools in triage of multiple carbon monoxide exposure patients.
Training: “Trailer Days” are included in the annual con-ed schedule in which all Medics
practice with the response support units and complete hands-on practical evolutions with the
equipment. A hands-on training for radiological response has been added. AHLS courses are
made available to all Medics as they are scheduled.
Activity: There was no identified activity in response to WMD / Terrorism. There were several
CO responses in which the arrival of the Medics (and the CO detectors) was the first indication
of potential poisoning.
Needs & Initiatives:
1. Refresher training in the use of PPE and “escape kits” needs to be conducted. Each Medic
should demonstrate proper use of this equipment. Incorporated into “Trailer Day” con-ed
sessions.

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2. Awareness and Operational level concepts and procedures for WMD response should be
revisited through in-service review and printed distributions. This is accomplished through
periodical publications.

Conclusion

Situational Assessment: Incidents involving some form of Special Operations response

continue to occur at a manageable frequency, however primary Medic Units are being committed
to these incidents for longer periods. Several annual event venues present significant challenges
to the department‟s operations. The department has continued response roles both locally and
regionally. The possibility of a disaster, natural or man-made, is as present as ever.
The establishment of TANGO-1, a multi-purpose response unit has enhanced the response
capacity of the Department. This unit is not currently staffed around the clock.
Vulnerability: Training and exercise has increased awareness and response capability as
compared to previous years, thus reducing the vulnerability of the individual responder.
Geographically Kent County remains central to several major metropolitan areas of national
significance. Complacency as a result of low utility presents the greatest controllable risk factor.
A comprehensive Kent County threat/vulnerability assessment needs to be conducted.
Capability: The establishment of a “Special Operations” designation as part of an employee
incentive program has swelled the number of medics intent on participating in some level of
Special Operations. Providing training opportunities to support this interest is challenging.
Resources continue to expand and develop to provide flexible response modalities and increased
capability. A Statewide and Regional capability goal needs to be established.

114 | P a g e
 Number of Responses Echo Level Response, Kent County EMS
250
200
150
100
50
0
2007 2008 2009 2010 2011
Within 6 minutes Within 8 minutes Within 10 minutes Within 12 minutes Total

Delta Level Response, Kent County EMS

Number of Responses

5,000
4,000
3,000
2,000
1,000
0
2007 2008 2009 2010 2011
Within 6 minutes Within 8 minutes Within 10 minutes Within 12 minutes Total

Charlie Level Response, Kent County EMS

5,000
Number of Responses

4,000
3,000
2,000
1,000
0
2007 2008 2009 2010 2011
Within 6 minutes Within 8 minutes Within 10 minutes Within 12 minutes Total

ALS and BLS Patient Age Comparison-2011

Kent County
2400

2000

1600
ALS
1200
BLS
800

400

0
Less 12 to 20 21 to 30 31 to 40 41 to 50 51 to 60 61 to 70 71 to 80 81 to 90 Greater
than 12 Yrs Yrs Years Years Years Years Years Years than 90
Years Years

115 | P a g e
 ALS/BLS Incidents by Month-2011
Kent County
1800

1600

1400

1200

1000 ALS
800 BLS

600

400

200

0
ch

t
Fe y

ov r
ay

ne
ry

ly

r
il

r
us

be

be
e
be
pr
r

Ju
a

ua

ob
ar

Ju

ug
A
nu

em

em
m
M
br

ct
te
A
Ja

ec
ep

D
S
Percentage When Kent County ALS/BLS Arrived On-Scene in
8 Minutes or Less on Delta/Echo/Charlie Level Incidents-2011
100%
90%
80%
70%
60% Charlie
50% Delta
40% Echo
30%
20%
10%
0%
2009 2010 2011 2009 2010 2011
ALS BLS

Kent County ALS and BLS Print Time Report

63%
10 ,000

8 ,000

87% 37%
6 ,000

4 ,000

2 ,000 13%
0
ALS BLS

= <4 hrs >4 hrs

116 | P a g e
 2011 Kent County BLS Scratch Report
Station Total Scratches Scratch Percent
Bowers Sta. 40 293 11 3.8%
Camden-Wyoming Sta. 41 2233 88 3.9%
Carlisle Sta. 42 2549 69 2.7%
Cheswold Sta. 43 1704 85 5.0%
Felton Sta. 48 1257 9 0.7%
Frederica Sta. 49 403 4 1.0%
Harrington Sta. 50 1942 24 1.2%
Hartly Sta. 51 820 10 1.2%
Leipsic Sta. 53 228 22 9.6%
Magnolia Sta. 55 939 8 0.9%
Marydel Sta. 56 462 60 13.0%
Dover AFB Sta. 58 137 0 0.0%
Prime Care Sta. 63 6259 0 0.0%
Smyrna Amer. Legion Sta. 64 2938 163 5.5%
Total 22164 553 2.50%

Kent County BLS Paid Personnel Chart by Company

Agency Name Total Pd personnel Shifts covered
Bowers Fire Co. 40 2 12
Camden-Wyoming Fire Co. 41 6F-19P 24/7
Carlisle Fire Company 42 1F-14P 24/7
Cheswold Fire Co. 43 0F-10P 24/7
Clayton Fire Co. 6 0 0
Felton Community Fire Co. 48 8F 15P 24/7
Frederica Vol. Fire Co. 49 1F 12H
Harrington Fire Co. 50 2F 12H
Hartly Fire Co. 51 1 8H
4EMT 15 Drivers
Leipsic Fire Co. 53 VOL
Magnolia Vol. Fire Dept. 55 15P 24/7
Marydel Fire Co. 56 VOL 7EMT, 6EMR 24/7
Smyrna American Legion 64 6F-6P 12H
South Bowers Fire Company 1F

117 | P a g e
Kent County
Basic Life Support (BLS)
Submitted by various BLS agencies within Kent County

Kent County is comprised of 18 volunteer fire companies and one volunteer ambulance
company, the Smyrna American Legion. The Smyrna American Legion‟s ambulance responds
on BLS runs within the Citizen‟s Hose fire district. Other fire districts, which do not operate BLS
services in Kent County are: Farmington, Houston, Little Creek, South Bowers, and Robbins
Hose. Mutual Aid agreements exist with boarding fire companies to supply ambulance service
to these districts or contracts with private ambulance companies.

Notable Events

Cheswold Fire Company

On April 30, 2011Cheswold was dispatched for an accident with multiple patients at the
intersection of Dupont Highway and Messina Hill Road (south end). Rescue 43 arrived under the
command of Chief Jeff Brown and found two cars with several injured people involved. He
requested two additional ambulances and directed his crews to begin packaging the patients for
transport. Four people were transported to local hospitals and the fire units cleared the scene.

118 | P a g e
Magnolia Volunteer Fire Company
The Magnolia Volunteer Fire Company provides EMS service to 6,000 residents within a 16
square mile bedroom community in central Kent County. The service is staffed with a full crew
of two paid EMTs weekdays from 6AM to 6PM, and half of a paid crew with one staff EMT
during weeknights and weekends. The other half of the crew during nights and weekends is
covered by a volunteer driver or EMT. The 17 staff EMTs and 14 volunteer drivers and EMTs
that comprise the service are scheduled for 6-hour shifts based upon their submitted availability
using an automated scheduling system. The blended model employed by Magnolia allowed for
a fast, efficient, and cost-effective response to 940 EMS calls in 2011, and applies its members'
pride in serving their community as a cornerstone of the service.

Ambulance 55 – 2011 Freightliner M2, Type I Medium Duty, PL Custom Titan. Place in service
June 2011.

Magnolia‟s Volunteer EMS Top Responders for 2011 were recognized and presented with their
awards during the company‟s annual Awards Banquet on March 9, 2012. Pictured from left to
right are Ambulance Captain Rob Leech, President Earle Dempsey, Mark Cockburn, and Adam
Duli

119 | P a g e
 Communication Center
Kent County
Submitted by Kent County 911

The Kent County Emergency Communications Center receives 9-1-1 calls through a variety of
phone exchanges through Kent County, Northern Sussex County and Southern New Castle
County. The total number of 9-1-1 calls processed in year 2011 was 97,247. Another 64,995
non-emergency calls were also processed by our dispatchers. The Center dispatched or
processed 22,164 medical incidents and 6273 fire incidents in year 2011.

The Kent County Emergency Communications Center is recognized as an Accredited Center of

Excellence in Emergency Medical and Fire Dispatch by the National Academy of Emergency
Dispatch. Our next Medical Re-Accreditation renewal date is January 2013. In 2011 through
our Quality Assurance Section we achieved 98.64% on Case Entry; 99.17% for Chief Complaint;
99.46% for Key Questions Processing; 92.30% for Pre-Arrival Instructions; 99.72% for Post
Dispatch Instructions; 98.75% for Final Coding and an overall average score of 99.03%.

The Kent County Emergency Communications Center operates 24 hours a day on a year round
basis. We provide Fire/EMS Communications to 18 Volunteer Fire Companies, 2 EMS
Companies and the Kent County Paramedics. The Center is staffed with 21 Fire/EMS
dispatchers and an administrative staff of 3 personnel.

Monies provided by the State‟s 911 Executive Board funded a new Viper 911 phone system for
Kent County. The phone system is a Next Generation 911 system (NG 911) and when network
protocols are worked out nationally it will be capable of receiving text messaging, streaming
video, photos and telemetry. The upgrade cost $1.3 million using fees collected from telephone
and cell phone users.

One of the biggest challenges Kent County has twice a year is the NASCAR Race. This event
brings over 130,000 people to our County. The race creates a city within a city. Starting on
Thursday of the race week Kent County provided trained dispatchers to answer and dispatch
EMS/Fire calls to the emergency responders that are working the event.

The Kent County Emergency Communications Division also maintains an Incident

Communications Vehicle for on-scene command and control of emergency operations, thus
allowing the County Public Safety Answering Point (PSAP) to continue with normal dispatching
functions. Maintained in a constant state of readiness at the
Kent County Department of Public Safety Building, the
Incident Command Vehicle may be utilized at Fire/EMS and
police emergencies, civil disturbances, natural disasters and
other scenes where emergency & tactical communications are
needed. The Incident Command Vehicle is self-sufficient with
its on-board generator, heater, air conditioner, computer aided
dispatch system, high-band paging system, cellular modem
dial up, cellular telephones, 800 MHz radio communications,
recording capabilities and a radio inter-operability system.

120 | P a g e
121 | P a g e
122 | P a g e
 Sussex County
Emergency Medical Services
Caring People, Quality Service

Overview
In 2011, Sussex County EMS (SCEMS) celebrated twenty years of providing Advanced Life
Support (ALS) Service to the residents of, and visitors to, our community. We provide
paramedic service to an area of nearly 1,000 square miles, including all of Sussex County
and a portion of Kent County (primarily Milford), using eight specially designed ALS rapid
response vehicles, each staffed by two paramedics, and overseen by two District Supervisors.
During the summer tourist season, an additional paramedic unit is placed into service to
assist with the high volume of calls, particularly in the beach areas. Our paramedic staff is
supported by administrative, clerical, technical support, and information systems personnel
to ensure a constant state of readiness throughout the year. We work closely with fire
department-based Basic Life Support (BLS) services, volunteer ambulance services, local
hospitals, state and local police, and private aeromedical services, as well as taking part in
the Delaware Statewide Paramedic Program.

“Caring People, Quality Service” is not only our slogan, but our commitment to the people
of Delaware and to each of our patients.

Mission Statement

Sussex County EMS is:

A nationally recognized leader in mobile health care services committed to improving
your quality of life.

We will accomplish this through:

Quality, compassionate patient care
Continuous quality improvement
Proactive planning
Innovative technologies and procedures
The full spectrum of emergency medical services
Comprehensive education and training for our personnel and the public

We Value:
Kindness
Professionalism in action and in attitude
Respect, dignity & politeness
A supportive, productive work environment
Continuing education for personal and professional growth
Honesty, trust, integrity in all our actions
Individual creativity, initiative, and responsibility
Fiscal responsibility
Public trust and support

123 | P a g e
2011 Accomplishments
Field Operations

Call Volume: After a five percent increase in call volume in 2010, Sussex County EMS
experienced a 1% decrease in responses in 2011. Over the past five years, SCEMS has
experienced an 11% increase in the number of responses to calls for service. Our department has
eight paramedics units in service 24 hours a day strategically positioned throughout the county in
an attempt to minimize response time to calls for service.

2011 Incident Responses

Unit Responses
EMS 100 (Eastern Supervisor) 786
EMS 200 (Western Supervisor) 535
Medic 101 (Lincoln) 1,923
Medic 102 (Laurel) 2,046
Medic 103 (Dagsboro) 1,868
Medic 104 (Lewes) 2,839
Medic 105 (Millville) 1,666
Medic 106 (Long Neck) 2,013
Medic 107 (Bridgeville) 2,264
Medic 108 (Georgetown) 1,608
Medic 109 (summer "Power Unit") 98
Other 129
Total 17,775
Table 1: Incident Responses by Unit (Source: EDIN)

Due in large part to Sussex County‟s status as a summer vacation destination, SCEMS sees a
substantial increase in call volume during the summer months, especially in the beach areas.
Again this year, the roaming power unit, Medic 109, was put in service to help cover higher
demand on summer weekends.

1900
1800
1700
1600
1500
1400
1300
1200
1100
1000
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Table 2: Calls by Month (Source: EDIN)

124 | P a g e
Hurricane Irene: Along with much of the eastern seaboard, Sussex County braced for the
impact as Hurricane Irene was forecast to pass directly over the County as a Category 3
hurricane in late August. Emergency preparedness plans were initiated and the Sussex County
Emergency Operations Center was staffed by members of the emergency preparedness
community, including SCEMS employees, for three days. Although, Sussex County did not
receive the significant damage forecast for Irene, the storm served as an excellent opportunity to
test several of the lessons learned from the snowstorms of early 2009. SCEMS was able to
flexibly deploy units as necessary and placed their Cessation of Response Plans into play,
although the winds never reached a level that prevented response to a 911 call. SCEMS and
Sussex County Public Information Officers made extensive use of social media sites such as
Facebook and Twitter in an attempt to keep the public informed of the approaching storm.

Special Events Coverage: SCEMS provided EMS coverage for numerous special events
including Return Day, Punkin Chunkin, Apple Scrapple Festival and the July Fourth
Celebrations utilizing both traditional crews and paramedic bike teams. The July 4Th weekend is
the busiest weekend of the year for emergency responders in Sussex County. SCEMS deployed
several additional units to cover the numerous holiday celebrations in Rehoboth Beach, Bethany
Beach and Laurel.

Figure 1: SCEMS bike medics complete annual IPMBA training (Source: SCEMS)
Extreme Makeover: Home Addition: In August, the crew of the television show, Extreme
Makeover: Home Edition arrived in Cool Springs outside of Harbeson, DE to build a house for a
local resident. At the build site, hundreds of volunteers worked in the heat to construct several
buildings in one week. SCEMS personnel were on-site throughout the build until its completion
to provide Emergency Medical Services for the people present. Several patients were
transported to the local hospital for treatment during the taping of the show.

Figure 2: Special Events Team deploys resources to Figure 3: Bus arrives back at build site to large
Extreme Makeover: Home Edition build inCool crowds in hot weather prompting several EMS calls
Springs (source: SCEMS) (source: SCEMS)

125 | P a g e
Personnel
Staffing: SCEMS had six paramedic vacancies as of December 31, 2011. Local, regional and national efforts
focused on recruiting Nationally Registered Paramedics from out-of-state. During 2011, SCEMS hired three
student paramedic employees from Delaware Technical and Community College‟s Paramedic Program.
SCEMS did not sponsor any new students in the 2011-2012 paramedic program.

Figure 3: A Shift (source: SCEMS) Figure 5: C Shift (source: SCEMS)

Figure 4: B Shift (source: SCEMS) Figure 6: D Shift (source: SCEMS)

126 | P a g e
Competition Team: Once again, the SCEMS competition team competed in the “JEMS Games”
held in March 2011 during the EMS Today Conference in Baltimore, Maryland. The team
included Paramedics Jeff Cox, Stuart Hensley, Jill Wix and Jessielynn Woolbright. This year‟s
competition included seventeen teams the United States and Australia. During the competition,
the EMS teams were judged on their performance and speed during mock patient care situations
and scenarios. After advancing to the final round of the competition with two other teams, they
were judged on how effectively they triaged and treated multiple victims from a mass suicide.
For their performance, the SCEMS team was awarded a Gold Medal for their first place finish.
In previous years, SCEMS teams have earned both silver and gold medals in the JEMS Games
and placed third in an international EMS competition in Israel sponsored by Magen David Adom
Israel.

Figure 7: SCEMS Competition Team takes Gold Medal

in 2011 JEMS Games (source: SCEMS)

NAEMT Award: In August, the National Association or EMTs presented Sussex County EMS
with the Dick Ferneau Paid EMS Service of the Year. EMS Director Robert Stuart and several
department members attended the ceremony at EMS Expo in Las Vegas to receive this award.

Figure 8: SCEMS is presented the Dick Ferneau

Paid EMS Service of the Year (source: SCEMS)

127 | P a g e
Education and Quality Management

Continuing Education: All SCEMS paramedics attend continuing educations sessions held by
our Education Department covering both medical and operational topics eight months out of the
year. In addition to these didactic sessions, paramedics complete required daily training
delivered via the county intranet.

Simulator Program: After working through several technical issues, SCEMS began their Patient
Simulator program. In this program, all field paramedics will be evaluated using scenarios in the
simulator lab. They have always assessed their paramedics‟ abilities to perform critical skills
(e.g. intubation, surgical airways) but this new program will assist them in assessing their ability
to make critical patient care decisions. Over the last two months, SCEMS has been able to have
a third of its department rotate through the Simulation Lab. The goal is to have all paramedics
be evaluated in the Simulation Lab semiannually.

Cardiac Arrest Resuscitation to Enhance Survival (CARES): In November, SCEMS began to

participate in the CARES registry, joining New Castle County EMS that has been involved since
2009. This is a database maintained by Emory University in cooperation with the Centers for
Disease Control and Prevention in an effort to improve survival from Cardiac Arrest.
Drills and Exercises
Del Tech Disaster Drill: SCEMS participated in drills and exercises with DelDOT, DRBA, local
hospitals and the Delaware Tech Paramedic Student Program. SCEMS provided MCI resources
such as tarps and cones and staff shadowed the EMS participants and provided guidance and
direction during the exercises.
Active Shooter Drill: On June 4, SCEMS participated in Operation School Plan Emergency
Action Response (Operation SPEAR) with the Ocean View Police department and other fire and
police agencies. Held at the Lord Baltimore Elementary School, this exercise simulated the
emergency response to an active shooter in a school setting.
DRBA Drill: On September 21, SCEMS participated in an exercise simulating a fire on the Cape
May – Lewes Ferry. The drill was designed to test the hospital‟s preparedness to handle a
sudden patient surge from a disaster. SCEMS Paramedics, Sussex County Emergency
Operations Command Post, the Delaware State Police Aviation Section and local fire companies
all participated in the event.
Equipment and Logistics
Paramedic Station 106: In late 2011, SCEMS began the search for suitable property to erect a
new paramedic station in the Long Neck area. For many years the current station has been
collocated with the Mid-Sussex Rescue Squad, Station 91. Mid-Sussex has elected not to renew
its lease with the County prompting this search for a new location.
Infrastructure: Through the use of a grant from DEMA, SCEMS installed a bidirectional
amplifier at Headquarters to improve radio and cellular communications throughout the building.
Also, SCEMS installed emergency power generation at Station 103/Special Operations, Station
102 in Laurel and Station 105 in Clarksville.

128 | P a g e
2012 Initiatives

Personnel
Recruiting and Retention: SCEMS entered 2011 with six paramedic vacancies and no
sponsored student-employees in the Delaware Technical and Community College Paramedic
Program. Over the past five years, SCEMS has had a median attrition rate of 6 paramedics per
year. With the cessation of their sponsorship of paramedic students, they‟re increasing recruiting
activities in an effort to hire more out-of-state paramedics needed to offset the existing vacancies
and anticipated annual attrition.
Education of BLS: Since the early 1990s, SCEMS has offered the Medic Assist course to BLS
companies. This course is designed to train EMTs to assist paramedics in the performance their
ALS skills. As examples, the course includes preparing IV bags for use by the paramedic and
correctly placing ECG leads on the patient. SCEMS has recognized that the BLS providers
could benefit from more exposure training so it is beginning to offer several other courses to the
local volunteer fire and EMS departments. These courses are directed primarily towards Mass
Casualty Management and Fire Ground Rehab.
Equipment and Logistics
Cardiac Monitor Replacement: SCEMS will begin a program of replacement for its aging
Physio-Control LifePak 12 Monitor/Defibrillators currently utilized in our department. Many of
these monitors are over ten years old. This model of monitor is no longer manufactured and the
manufacturer will end its support for this monitor over the next several of years. An ad hoc
committee consisting of field paramedics and administration was formed to look for a
replacement for the LifePak 12. Members of this committee traveled to the headquarters of the
three major cardiac monitor manufacturers in an effort to evaluate their products and the quality
of their manufacturing processes. This replacement process will take place over several budget
years.
Paramedic Station 106: SCEMS will be purchasing property and beginning construction of a
new Station 106 in Long Neck.
Infrastructure: SCEMS will be completing its emergency power generation project by installing
generators at Station 101 in Lincoln and Station 104 in Lewes. SCEMS will also be completing
the conditioning of all garage spaces in an effort to maintain medication storage at the proper
temperature range and reduce maintenance costs on vehicle rear climate control units.
Sussex County EMS
P.O. Box 589
Georgetown, DE 19947
302.854.5050
Caring People, Quality Service
http://www.sussexcountyems.com

http://www.facebook.com/pages/Georgetown-DE/Sussex-County-
EMS/151180322526http://www.facebook.com/pages/Georgetown-DE/Sussex-County-
EMS/151180322526

129 | P a g e
 Echo Level Response, Sussex County EMS
400
Number of Responses

300
200
100
0
2007 2008 2009 2010 2011
Within 6 minutes Within 8 minutes Within 10 minutes Within 12 minutes Total

Delta Level Response, Sussex County EMS

Number of Responses

8,000
6,000
4,000
2,000
0
2007 2008 2009 2010 2011
Within 6 minutes Within 8 minutes Within 10 minutes Within 12 minutes Total

Charlie Level Response, Sussex County EMS

Number of Responses

6,000
5,000
4,000
3,000
2,000
1,000
0
2007 2008 2009 2010 2011
Within 6 minutes Within 8 minutes Within 10 minutes Within 12 minutes Total

ALS and BLS Patient Age Comparison-2011

Sussex County
3500
3000
2500
2000 ALS
1500 BLS

1000
500
0
Less 12 to 20 21 to 30 31 to 40 41 to 50 51 to 60 61 to 70 71 to 80 81 to 90 Greater
than 12 Yrs Yrs Years Years Years Years Years Years than 90
Years Years

130 | P a g e
 ALS/BLS Incidents by Month-2011
Sussex County
3200

2800

2400

2000
ALS
1600
BLS
1200

800

400

0
ch

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ay

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S
Percentage When Sussex County ALS/BLS Arrived On-Scene in
8 Minutes or Less on Delta/Echo/Charlie Level Incidents-2011
100%

80%

60% Charlie
Delta
40% Echo

20%

0%
2009 2010 2011 2009 2010 2011
ALS BLS

=
Sussex County ALS and BLS PCR Print Time Report
55%
77% 45%
10,000

8,000

6,000
23%
4,000

2,000

0
ALS BLS

=<4 hrs >4 hrs

131 | P a g e
 2011 Sussex County BLS Scratch Report
Station Total Scatches Scratch Percent
Bethany Beach 608 4 0.7%
Blades 624 44 7.1%
Bridgeville 805 30 3.7%
Dagsboro 465 13 2.8%
Delmar 1335 6 0.5%
Elendale 730 24 3.3%
Frankford 203 11 5.4%
Georgetown 2144 124 5.8%
Greenwood 580 11 1.9%
Gumboro 232 13 5.6%
Indian River 9 0 0.0%
laurel 1605 58 3.6%
Lewes 2391 13 0.5%
Memorial 77 3 3.9%
Mid -Sussex 2003 129 6.4%
Millsboro 1697 153 9.0%
Millville 1283 54 4.2%
Milton 816 18 2.2%
Roxana 683 21 3.1%
Selbyville 347 10 2.9%
Total 18637 739 2.50%

BLS Paid Personnel Chart By Company

Sussex County Total Paid personnel Shifts covered Days/Time Covered

Blades Fire Co. 3FT - 8PT 12H 6am-6pm 7 days

Bethany Beach Fire Co. 8FT - 20PT 24H 24/7
Bridgeville Fire Company 2FT - 15PT 12H 6am-6pm 7 days
Dagsboro Fire Co. 3FT - 15PT 12H 24/7
Delmar Fire Co. 8FT - 8PT 24H 24/7
Ellendale Fire Co. 4FT - 20PT 12H 24/7
Frankford Fire Co. 3FT 12H 24/7
Georgetown American Legion 3FT - 6PT 12H 6am-6pm 7days
Greenwood Fire Co. 1FT - 30PT 12H 6am-6pm 7days
Gumboro Vol. Fire Co. 3FT - 9PT 12H 6am-6pm 7days
Laurel Fire Dept. 7FT - 10PT 24/7
Lewes Fire Dept 9FT - 10PT 24H 24/72
Memorial Fire Co. 1 FT - 4PT 12H 7am–7pm 5 days
Mid Sussex Rescue Squad 10FT - 15PT 24H 24/7
Inc.Fire Co.
Millsboro 6 FT - 10PT 12H 5am-5pm 7days
Millville Vol Fire Company 9FT - 18PT 24H 24/7
Milton Fire Co. 1FT - 7PT 12H 24/7
Rehoboth Beach Vol. Fire Co. 8 FT - 30PT 24H 24/7
Roxana Vol. Fire Co. 2FT (66) : 1FT M-F (84) 12H & 8H
Seaford Vol Fire Co. 8FT - 5PT 24H 24/7
Selbyville Fire Co. 3FT - 8PT 8.5H & 12H 5 days

132 | P a g e
Sussex County
Basic Life Support (BLS)
Submitted by various BLS agencies within Sussex County

Sussex County is comprised of 21 volunteer fire companies and two volunteer ambulance
companies. The Georgetown American Legion responds on BLS calls within the Georgetown
Fire District and the Mid-Sussex Rescue Squad responds on BLS runs within the Indian River
Fire District.

Notable Events

Bethany Beach Volunteer

Fire Company
Training
Twenty five of our EMTs recertified as Nationally Registered and Delaware EMTs in March
2011. This is a two year certification requires a twenty four hour refresher class and a minimum
of forty eight hours of continuing education. Additionally, two members gained certification as
Delaware Emergency Medical Responders.
Eight of the career and volunteer staff attended the Journal of Emergency Medical Services
(JEMS) Conference in Baltimore, Maryland from March 1-5, 2011. This conference is one of
the leading venues of EMS education in the country. Having the latest information available to
our members will allow us to remain a leader in the EMS community.
Four of the career and volunteer staff also attended the FDIC Conference in Indianapolis, Indiana
from March 21-26, 2011. The FDIC conference presents the most current information on
firefighting and rescue techniques.
The BBVFC participated in an MCI (Mass Casualty Incident) drill on June 4th, 2011 at Lord
Baltimore Elementary School. The drill was a simulated school shooting with approximately 12-
15 victims. This drill proved to be a valuable learning experience and tested the MCI plan for
the county. Blades VFC provided EMS coverage for the BBVFC district during the drill.
We are planning a trip and tour of the Dover AFB in April 2012, focusing on the Emergency
Services provided at their facility. Dr. Cowen from Beebe Medical Center in Lewes is scheduled
to come and discuss spinal cord injuries along the Delaware coast. Also, Service Member Dr.
Dan Cowell is scheduled to present the topic of Psychiatric Emergencies. A review of
respiratory emergencies is going to be conducted by Associate Dean and Director of Respiratory
Therapy at Salisbury University, Robert Joyner Jr.
Budget Items

We have purchased four ballistic vests for our personnel when responding to potential violent
situations. Two vests will be carried on each ambulance. These vests will greatly enhance the
safety of our personnel.

133 | P a g e
We are monitoring the progress on the AFG (Assistance to Firefighters Grant) grant for a
mechanical CPR assist device. The cost of the device is approximately $16,000.
We received a $500 donation from both the Bethany Beach Woman‟s Civic Club and the AARP
Southern Delaware Chapter.
DEMSOC Report
The Delaware Emergency Medical Services Oversight Council released its 2010 report in May
of 2011. Bethany Beach is mentioned on pages 124 and 125 of the report in a very positive light.
On page 124, Bethany Beach is identified as the lowest scratch rate in the county at 0.49%. On
page 125, the year end summary and article referencing “Kids Night Out” are highlighted. Once
again, Bethany Beach EMS continues to be a leader in providing quality EMS Service.

Sussex County Emergency Medical Services Awards Banquet

On May 13th, 2011, the Sussex County Emergency Medical Services (SCEMS) held its annual
EMS Awards Banquet. Bethany Beach VFC Emergency Medical Services was well represented
with several members receiving awards. FF/EMT Brice Hickman was awarded the “EMT of the
Year” for Sussex County, FF/EMT Justin Cassell was awarded the “EMT of the Year” for the
Medic 104 district, and EMS Chief Douglas Scott was awarded “EMS Captain of the Year” for
Sussex County.

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 Dagsboro Fire Department
In addition to providing Fire/Rescue services, the Dagsboro Volunteer Fire Department also
provides Emergency Medical Care to their district. The company operates two BLS ambulances
and an EMS Command unit responsible for patient care at emergency scenes. All members of the
EMS branch are either National Registered Emergency Medical Technician Basic (NREMT-B)
or National Registered Emergency Medical Technician Paramedic (NREMT-P). In addition, all
EMS providers are Automated External Defibrillator (AED) certified and are required to take all
the qualifying courses to become a Firefighter and Rescue Technician. This training adds up to
over 1,300 hrs. all of which they take voluntarily. The department pays for all training courses,
however members are not paid for any of their time which is totally voluntary. They have been
trained to spring into action and treat anything from a subject with a minor laceration to life-
saving CPR. We always know and feel we have done all we can to help a patient in need no
matter how serious the call.

Dagsboro’s 2009 Kodiak/Lifeline

Dagsboro’s 2011 –
International/Horton
Laurel Fire Department
On Saturday afternoon March the 19th the LFD, along with SCEMS and Trooper 2, were
dispatched for a MVC with entrapment, on County Seat Highway east of Laurel. Rescue Captain
Jim Brittingham responded and arrived on scene and established command of the incident.
Command advised incoming units of double entrapment. BLS/ALS crews arrive and began
patient assessment. E-4 arrives and crew goes to work stabilizing and putting tools into service.
Rescue 81 arrives and their personnel place into service additional tools. Rescue workers freed
the injured passenger and Laurel EMS transport the patient to PRMC. A short time later the
driver was freed and Blades EMS transported the patient to PRMC. The extrication took
approximately 22 minutes from the time the first engine arrived on scene. Command placed the
incident under control and units were cleared with fire police remaining on scene waiting on
towing company.

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Lewes Fire Department
During the working fire at Drake Knoll Lewes was dispatched for a Vehicle Accident at 5 Points.
While in route to Lewes for a cover up assignment Rescue/Engine 89-2 was on scene quickly. 1
vehicle rolled over after striking a fire hydrant. The driver had minor injuries

Photo courtesy of Lewes Fire Department

Above photos courtesy of Blades Volunteer Fire Company

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Communication Center(s)

Sussex County Emergency Communication Center:

The Sussex County Emergency Operations Center / Fire and Ambulance Callboard employs 20
full time Fire / EMS Dispatchers, 1 Quality Assurance Supervisor, and 1 Assistant Chief
Dispatcher.

The staff here has been busy this year with several special projects. We were hosts to the
Extreme Makeover – Home Edition. While this project was in full swing, a Hurricane, Tornado
and flooding added some excitement to everyone involved.

We held the Sussex County Annual 911 Day. Fifth grade students from all over the county
attend this event. Displays of all Emergency Service groups are on hand to talk with the
students.
Over the year our center also welcomed a delegation from Egypt. The group came to observe the
911 functionalities and facilities. The Egyptians are in the start-up process of implementing a
country-wide 911 system. Director Joe Thomas, County staff as well as the 911 equipment
vendor Verizon, gave a tour of the facilities and showed firsthand how Sussex County is at the
leading edge of 911 “next generation” implementation. This visit is the latest in a series of tours
we have provided of our state of the art facilities since starting our operations at the new facility
location in 2008. This year we also hosted groups from Richmond Virginia, Long Island New
York and Norfolk Virginia.

Fire Service Mobile Project: Working with the CAD vendor to deploy Mobile Data Terminals
to the volunteer fire service in Sussex County that will interface with the CAD system to provide
the latest technology as well as providing the field units more information in the apparatus which
includes driving directions, automatic vehicle location, and touch screen status update. Sussex
now has over 80 units with MDT‟s.

Computer Aided Dispatch System: The Center is also working with the Mapping and
Addressing Department to keep the maps current by doing bi-monthly map updates to the
system. We are also expecting to upgrade to accept the new updates to the Medical Dispatch
software.

Phone System -The Center had a major phone service upgrade this year. Fold-down procedures
were put in place in the event the Center had to transfer calls to a neighboring Center.

EMS Mobile Project: The Center continues to support the Sussex County EMS with Mobile Data
Terminals, which operate in the same function as the fire service mobiles.

Beta Test Site: Sussex County Emergency Operations Center / Fire and Ambulance Call Board,
continues to be a Beta Test Site for TriTech Software Systems. Sussex is also remains a Beta
Test Site for the National Academies of Emergency Dispatch. The site tests protocol changes
and updates along with the testing for new protocols

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Diversion Reports: The Center compiles a diversion report for the three (3) hospitals in Sussex
County as well as the two (2) hospitals in Maryland that border Sussex County.
As of January 01, 2011, the updated statewide Diversion Policy was implemented in Sussex
County.
Re-accreditation: The Center is accredited until 2012. We continue to work towards meeting
the standards set by the National Academy of Emergency Medical Dispatch.
Dispatcher Incentives: “The current Fiscal Budget continues the incentive
program provided to the dispatchers. The amount of the incentive is $375.00, with a maximum of
$750.00 per year. This program provides a reward for dispatchers who meet the National
Academy of Emergency Medical Dispatch (NAEMD) performance level on each of the various
required judged items. This program rewards employees who maintain a high level of
competence in responding to emergency calls, which in turn enables the Sussex County
Emergency Operations Center to maintain its certified status. The current Fiscal Budget again
includes funding for shift differential pay for Emergency Communications Specialists who work
the night shift. This supplemental fee of 75¢ per hour is comparable to what the State of
Delaware offers their dispatchers, as well as that of other counties.”

Regional Training Facility: The Sussex County Emergency operations Center continues to
maintain our status as a regional training facility for the National Academy of Emergency
Dispatch, offering the Emergency Tele-communicator Course (ETC), Emergency Medical
Dispatch (EMD), and other training for the entire region.

Continuing Education: Sussex continues to provide a variety of continuing education classes to

assist the dispatchers with their jobs. The courses are taught by our staff as well as various
agency representatives, physicians, medics, and others that interact with our agency. To assist the
dispatchers with continuing education and pertinent information, we have launched an internal
website which lists current assignments, protocol information, health and fitness information, as
well as many other subjects relative to the dispatcher or their position

Rehoboth Beach
Submitted by Dawn Lynch

The Rehoboth Beach 9-1-1 Communications Center receives 9-1-1 calls through phone exchanges and
cell towers in the Rehoboth area. The total number of 9-1-1 calls processed in year 2011 was 5,315.
Another 30,650 non-emergency calls were also processed by our Telecommunicators. The Center
dispatched and/or processed a total of 2,622 EMS Incidents, 651 Fire Incidents, 4,263 Police Incidents,
and 2,930 traffic stop in year 2011.

The Rehoboth Beach 9-1-1 Communications Center was recognized as an Accredited Center of
Excellence in Emergency Medical Dispatch by the National Academy of Emergency Medical Dispatch on
April 1, 2003 as the 79th agency in the world accredited; and then, re-accredited in August 2010 through
2013. In 2011 the Center‟s overall EMD compliance rate was 96.82%.

The Rehoboth Beach 9-1-1 Communications Center operates 24-hours a day on a year-round basis. We
provide Police Communications to the City of Rehoboth Beach and Fire/EMS Communications to the
territory of the Rehoboth Beach Volunteer Fire Company. The Center is staffed by eight full-time
Emergency Telecommunicators and one Communications Supervisor. The Center falls under the overall
direction of the Rehoboth Beach Police Chief.

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 The Rehoboth Beach 9-1-1 Communications Center operates within the Rehoboth Beach Police Station.
The Center utilizes a Positron Viper 9-1-1 Phone System, Nortel Administrative Phone System, Motorola
Centracom Elite Radio System, Verint Recording System, and New World AEGIS CAD System to
process calls for service.
Major projects for 2011 included implementation of a new recording system to record radio traffic direct
from the 800 MHz CEB instead of from secondary radio units and working the State 9-1-1 Board to
improve GIS Data for the area. We continued to focus on training in 2011 having sent two dispatchers to
the APCO International Conference and seven dispatchers to the APCO MidEastern Training Conference.

City of Seaford Police Department:

Submitted by Anita Bell
The Seaford 9-1-1 Center receives approximately 10,000 emergency calls through various
administration and 9-1-1 lines and is part of a state wide network of 9 PSAP‟s all working in
conjunction with the goal of providing the very best service to our citizens and guests in our
community. During 2011 the center dispatched or processed a total of 3,216 fire/ambulance
incidents and 9,162 police incidents.

The Seaford 9-1-1 Center was initially recognized as an Accredited Center of Excellence in
Emergency Medical Dispatch on August 7, 2003 by the National Academy of Emergency
Medical Dispatch and listed as the 83rd in the world to become accredited. We were re-
accredited in 2006, 2008 and just recently re-accredited on Dec 22, 2011 thru Dec 22, 2014.

Seaford 9-1-1 Center operates 24 hours a day, 7 days a week. We provide Police, Fire, and EMS
communications to the City of Seaford Police Dept and Seaford Volunteer Fire Department and
Seaford EMS. Our Communications Center also handles police administrative calls and after
hour calls for City Hall. The Communications center is staffed with 8 full-time dispatchers, 2
part-time dispatchers and 1 Administrator/EMD-Q.

The Seaford 9-1-1 Center operates within the Seaford Police Department and recently updated
the Communications Center to include 4 dispatch consoles, 1 of which is a fold down station for
the SUSCOM and EOC.

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 Delaware Air Medical Services

Introduction
Delaware‟s Division of Public Health first promulgated regulations for Air Medical Ambulance
Services in 1993. The purpose of these regulations is to provide minimum standards for the
operation of Air Medical Ambulance Services in the State of Delaware. It is the further intent of
these regulations to ensure that patients are served quickly and safely with a high standard of
care. Subsequent revisions in 2001 and 2002 described the air medical service application and
state certification process and resulted in the emergence of a well-developed system of air
medical transportation in the state.

Currently, private air medical services may apply for any of three levels of State of Delaware
interfacility transport certification and/or prehospital certification:

LIMITED STATE CERTIFICATION: Approval granted following satisfactory completion of

the air medical program certification process to an air
medical service wishing to provide one-way transport
to or from Delaware only.

FULL STATE CERTIFICATION: Approval granted following satisfactory completion of

the application process to an air medical service
wishing to provide point to point transport service
within the state of Delaware, in addition to one way
transport to or from Delaware.

911 CERTIFICATION: Approval granted following satisfactory completion of

the application process to an air medical service
wishing to act as a supplemental resource to the
Delaware State Police in carrying out prehospital scene
missions in Delaware. These services may also apply
for full certification to provide point to point transport
service within the state of Delaware and one way
transport to or from Delaware.

The initial certification period is three years. Recertification is required every three years.

Scene response – The Delaware State Police (DSP) Aviation Section has responsibility for
primary scene response throughout Delaware and is certified for full and limited interfacility
transport as a secondary mission when needed. Additionally, the following private air medical
service is state-certified to be dispatched by the Emergency Operations Centers when DSP is not
available to respond to a scene or when more than one aircraft is needed:

Christiana Care LifeNet, Newark and Georgetown DE

The Delaware 911 Air Medical Dispatch Process, which was developed based on proximity of
the aircraft to the incident location, is utilized to determine the next due aircraft to be dispatched.

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Interfacility transfer – State-certified private air medical services are utilized as the primary
transport services for patients who need to be transferred to a higher or more specialized level of
care, either within Delaware or within the region, such as to a Burn Center.

The following private air medical services have full state certification to perform point-to-point
Delaware interfacility transports:

Christiana Care LifeNet, Newark and Georgetown Delaware

JeffSTAT LifeNet, Philadelphia Pennsylvania
PHI for Maryland ExpressCare, Baltimore Maryland
STAT MedEvac, Baltimore Maryland, providing air transport for the Alfred I.
duPont Hospital for Children transport team

The following private air medical services have limited state certification to perform flights
bringing patients either into or out of Delaware:

Christiana Care LifeNet, Newark and Georgetown Delaware

JeffSTAT LifeNet, Philadelphia Pennsylvania
MedSTAR, Maryland and Washington DC
MidAtlantic MedEvac, Pottstown/Doylestown Pennsylvania
PennSTAR, Philadelphia Pennsylvania
PHI for Maryland ExpressCare, Baltimore Maryland
STAT MedEvac, Baltimore Maryland, providing air transport for the Alfred I.
duPont Hospital for Children transport team

The following air medical services are available to our state through Mutual Aid agreements:

Maryland State Police Aviation Section

New Jersey State Police Aviation Section

2011 Accomplishments
Delaware‟s air medical system has matured to include eight air medical services providing 24/7
emergency transportation for patients in need of specialty medical care after becoming injured or
ill, either initially from the scene, or following assessment at a medical facility. The system has
evolved from one part-time service to the current full complement of eight services with the
levels of state certification described above.

Hallmarks of the development of this system include

1985 – Delaware State Police Aviation Section Air Medical Services Program
initiated.
2001 - Christiana Care LifeNet Air Medical Program began.
2004 – Delaware State Police Aviation Program expanded coverage to 24 hours a
day, 7 days a week, 365 days a year.
2006 - Christiana Care LifeNet added a second site and aircraft in Georgetown,
Sussex County.

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 2008 - DSP increased its capacity through purchase of a Bell 412 aircraft, which can
carry more patients and is useful in case of the need for evacuations. It is also used
with the Helicopter Emergency Action Team (HEAT).

Below left, annual trauma scene air transports to tertiary care hospitals Christiana, duPont, or
Peninsula Regional by percentage of flights. Below right, comparison of scene flights and
interfacility transfers.

2012 Challenges
The Trauma System Quality Committee is continuing to work on analyses of data to determine
optimal distribution of patients throughout the Trauma System. This includes methods of
identifying the most seriously injured patients, with utilization of air medical transport to move
them directly to the Level 1 or Level 2 Trauma Centers from the scene, while triaging less
seriously injured patients to the Community Level 3 Trauma Centers. The goal is optimal
utilization of the resources of all level facilities so as to avoid overcrowding of our tertiary care
centers and underutilization of the resources available close to the patients‟ homes in the
Community Trauma Centers.

Safety issues are a continuing priority of the air medical service providers and of the Office of
EMS. All certified air medical services provide updated safety equipment and safety program
and procedures information as part of their recertification process. Regular helicopter safety
inservices for both scene providers and hospital staff are encouraged.

Summary
The scene and interfacility air medical transport services provided for the most seriously injured
patients are an integral part of the Delaware Trauma System. Priorities continue to be safety,
efficient and appropriate utilization, and „Getting the right patient to the right facility in the right
amount of time”.

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 Delaware State Police Aviation Section
2011 DEMSOC Report

MISSION STATEMENT

To Enhance the Quality of life for all Delaware Citizens and visitors by
providing professional, competent and compassionate law enforcement

CORE VALUES

HONOR INTEGRITY COURAGE LOYALTY

ATTITUDE DISCIPLINE SERVICE

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 DELAWARE STATE POLICE
TROOPER’S PLEDGE

Humbly recognize the responsibilities

entrusted to me as a member of the
Delaware State Police,
An organization dedicated to the preservation
of property and human life, I pledge myself
to perform my duties honestly and faithfully
to the best of my ability and without fear, favor,
or prejudice. I shall aid those in danger or distress,
and shall strive always to make my State
and Country a safer place in which to live….
I shall wage unceasing war against crime
in all it’s forms, and shall consider no sacrifice
too great in the performance of my duty
I shall obey the laws of the United States
of America….and of the State of Delaware…. and
shall support and defend their constitutions
against all enemies whomsoever, foreign
and domestic. I shall always be loyal to
and uphold the honor of my organization,
my State and my Country.

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The Delaware State Police Aviation Section provides effective support services to our law
enforcement, medical, and search and rescue communities. As the section‟s mission expands to
encompass the many new demands placed on the Division involving the Homeland Security
front, members have been able to incorporate new technologies, add new equipment, undertake
and excel in new responsibilities such as the search and rescue mission and maintain the 24/7
expanded hours of operation.

The Aviation Section supports State, Federal and local law enforcement by providing aerial
assistance during vehicle and foot pursuits, traffic reconnaissance during large public events and
route security during events involving visiting dignitaries and other important persons. Our
section provides criminal reconnaissance and stand-by medical evacuation during high risk
warrant executions to all law enforcement agencies operating in our state and surrounding area.
The Aviation section also trains with the Special Operations Response Team (SORT), Explosive
Ordinance Disposal for volatile situations that would require a rapid tactical insertion. The
Delaware Department of Natural Resources and Environmental Protection Agencies also utilize
the section for game and environmental violation.

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The Section continues its participation in the Open Water Rescue program, which involves a
partnership between the State Police, the United States Coast Guard, the Delaware Fire Service,
and rescue swimmers from area beach patrols, which is also referred to as the Delaware Air
Rescue Team (DART). Aviation, at EMS request, provides air medical transport for seriously
injured and ill persons. Organ transplant recipients are also transported, at request, by our
section to hospitals within or outside of our State borders.

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Spot Light

The Delaware State Police Unit was honored by being featured in the July 2011 issue of Rotor
& Wing Magazine.

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 NEWS RELEASE
DELAWARE STATE POLICE
Superintendent Colonel Robert M. Coupe
Presented by Public Information Officer Cpl/3 Bruce W. Harris
P.O. Box 430| Dover, DE 19903 | Cell: 302.535.3706 [email protected]

DSP News Release: Victim Hoisted from Ship Following 20 Foot Fall

Location:

Slaughter Beach, Delaware

Approximately 5 miles off the Coast

DATE and TIME:

Tuesday May 3, 2011

Victim(s):

Leovie Cauite-54 Philippines

Oil Tanker:

The Cosmic (Greek tanker)

Contracted by Delaware Valley Marine

Assisting Agencies:

Delaware State Police Trooper 4 Helicopter

State Fire Service
Wilmington Police Department
Slaughter Beach Fire Department
Lewes Fire Department
Sussex County Paramedics
Delaware Bay Launch Service
United States Coast Guard

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Resume:
Slaughter Beach-Today around 11:55 a.m. the Sussex County 911 Center received an
emergency call from an oil tanker approximately 5 miles off the coast of Slaughter Beach
Delaware.

The 911 Center was advised by the ship‟s Captain that a crew member, Leovie Caguite-54 of the
Philippines had fallen some 20 feet down a cargo hole and struck his head.

The Chief of the Slaughter Beach Fire Department immediately activated the Delaware Air
Rescue Team “DART”. DART members consist of Volunteer fire personnel
specifically trained to perform rescues from the rear of Delaware State Police Helicopters.

Rescue agencies consisting of: Delaware State Police Aviation, the State Fire Service,
Wilmington Police Department, Slaughter Beach Fire Department, Sussex County Paramedics,
Lewes Fire Department and the United States Coast Guard all played a hand in today‟s rescue
efforts.

It took approximately 25 minutes for the Delaware Bay Launch Service to transport a Sussex
County Paramedic via boat to the Cosmic, a Greek oil tanker, to assist Caguite with his injuries.
Once on board the Cosmic the Sussex County Paramedic “back boarded” the patient for
transport. Delaware State Police Trooper-4 helicopter then lowered medical personnel from the
Lewes Fire Department to the ship via a hoist.

Once the hoist arrived on the deck of the Cosmic, Caguite and the Lewes Fire Department
personnel were hoisted back to Trooper 4. Trooper 4 then transported the patient to the
Slaughter Beach boat ramp where he was stabilized by Slaughter Beach ambulance personnel for
further transport.

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After being stabilized Caguite was then flown to Christiana Hospital were he is being treated for
head trauma and is listed in critical condition.

Special Events

Throughout the 2011 NASCAR season the Delaware State Police Aviation Section was
contracted to provide Aero Medical Services.

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 Tactical EMS Missions 2011

Special Operation Response Team (SORT)

Explosive Ordinance Disposal (EOD)

Since the commencement of the Tactical/Medic MOU between DSP and WPD, which began in
April of 2008, this year was the busiest to date. There were a total of 210 activations, one
activation every 1.74 days. The previous record was in 2009 with 203 total activations. The
tactical medic‟s busiest single month was September of this year with a total of 35 activations in
30 days. In addition to being the busiest year overall, 2011 was the most violent year for the
special operations teams as a whole when comparing the types of activations and outcomes,

2011 SIGNIGICANT RESPONSES/CRITICAL INCIDENTS

1/14/11- 977 Lochmeath Way, Dover

15 hour EOD call-out with multiple devices and bomb making explosives found in a residence.

3/22/11- 230 N. Harrison Street, City of Wilmington

Barricaded subject in basement of residence
Subject taken into custody after stand-off

5/3/11 - 5 Miles off Delaware Coastline

Aviation SAR mission with critical patient transported to Christiana Hospital where Trooper 4
Heavy was utilized and DART team activated

6/15/11- 6253 Dublin Hill Road, Bridgeville

Domestic barricade incident
2 dead, Murder/Suicide prior to majority of team arrival

6/26/11- 7 Water Street, Greenwood

Shots fired at police/barricade with hostages
1 dead, several wounded, hostages rescued by SORT
Subject arrested after several hour stand-off

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7/25/11- Naamans Road & Marsh Road, Wilmington
Barricaded subject in residence
1 dead, Suicide

8/7/11- 10140 Dogwood Road, Laurel

Barricaded suicidal subject
Subject taken into custody after short operation

9/2/11- 9687 Randall Street, Laurel

Barricaded subject
1 dead, Suicide

9/6/11- Shamrock Motel, 2171 S. Dupont Hwy, Dover

Barricaded robbery suspect
Arrested after several hour stand-off
Explosive breaching utilized

9/11/11- Dutch Inn, 111 S. Dupont Hwy, New Castle

Barricaded subject. Several hour stand-off, subject arrested after gas deployed successfully

11/30/11- 1403 Lochmeath Way, Dover

Several hour EOD call-out where various chemicals and explosive materials were recovered
from a shed behind a residence

2011 SORT/EOD Stats:

TOTAL ACTIVATIONS (SORT & EOD including cancellations and training) = 210.0
MEAN ACTIVATION = 1 call every1.74 days
WPD SWAT (including cancellations) = 97
WPD CALLS MUTUAL AIDED TO DSP = 29
DSP CALLS MUTAL AIDED TO WPD = 39
ALS MEDIC STAND-BY‟S =5

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 2011 DSP Tactical Medic Response Statistics

Medic Response Record

229 635 779 835 907 149 293 429 449 032 1102 Total
January 0 1 0 1 0 3 5 0 2 1 2 15
February 0 2 0 0 0 5 2 2 0 3 1 15
March 0 1 0 0 2 0 8 5 2 3 1 22
April 1 0 0 2 0 3 3 1 0 2 2 14
May 0 0 0 3 0 1 5 2 0 2 0 13
June 0 2 0 4 0 2 3 1 0 0 0 12
July 0 0 0 4 0 0 3 1 2 1 0 11
August 0 3 0 0 0 1 4 0 0 2 4 14
September 0 1 0 6 0 2 5 0 1 5 1 21
October 0 0 0 4 0 3 2 0 1 2 0 12
November 0 0 0 1 0 3 2 1 0 1 0 8
December 0 0 0 1 0 2 1 0 0 0 0 4
1 10 0 26 2 25 43 13 8 22 11 161

Mission Types

Medic High Risk Hostage Dignitary Civil Training / Other

EOD
Warrant Baricade Protection Disturb. Exercise
1102 7 1 0 0 0 2 1
229 0 0 0 0 0 1 0
635 8 2 0 0 0 0 0
835 25 1 0 0 0 0 0
907 2 0 0 0 0 0 0
149 11 3 0 0 7 0 4
293 36 6 0 0 0 1 0
429 10 1 0 0 0 1 1
449 7 1 0 0 0 0 0
779 0 0 0 0 0 0 0
032 18 2 0 0 0 1 1

TOTAL 124 17 0 0 7 6 7

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 Article Submitted by
Wilmington Police Master Sergeant / Paramedic
Adam Ringle

MEMORANDUM

To: Michael J. Szczerba

Chief of Police

From: M/Sgt. Adam B. Ringle 7061

Tactical/EOD Paramedic 1490
B-Platoon Uniformed Services Division

Date: 1 JAN 12

Re: WPD/DSP Paramedic MOU Report 2011

Sir,

This writer is providing this departmental information memorandum to highlight the

success of Paramedic Memorandum of Understanding (MOU) between the Wilmington Police
Department (WPD) and the Delaware State Police (DSP) as well as to outline the Tactical/EOD
Paramedic services provided by this writer throughout the year 2011.

TOTAL ACTIVATIONS (including cancels) = 210.0

MEAN ACTIVATION = 1 call every 1.74 days
WPD SWAT (including cancels) = 97
DSP SORT RINGLE = 30
DSP EOD RINGLE = 7
WPD EOD RINGLE = 3
AVIATION SEARCH & RESCUE RINGLE = 2
WPD CALLS MUTUAL AIDED TO DSP = 29
DSP CALLS MUTAL AIDED TO RINGLE = 39
CALLS WHERE NO MEDIC AT ALL AVAIL = 10
ALS MEDIC STAND-BY’S = 5

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Snapshot Comparison
Since this program began in April of 2008, our busiest year was 2011 with 210 total activations,
one call every 1.74 days. The previous record was 2009 with 203 total activations. Our busiest
single month was September of this year as well with a total of 35 activations in 30 days. In
addition to being the busiest year overall, this year was by far the most violent year for the
special operations teams as a whole when comparing the types of activations and outcomes, for
example, the shear volume of barricaded subjects. The last major critical incident prior to this
year occurred on 10/23/09 at 1524 West 4th Street, City of Wilmington and shared many
similarities of the Greenwood incident that occurred on 6/26/11. A barricaded armed subject,
shots fired, multiple hostages shot, hostages rescued and one killed.

Training
In addition to the above listed calls for service, this writer attended all Paramedic didactic and
clinic training required by the State of Delaware, successfully completed Type I Advanced
SWAT School as required by the Wilmington Police Department, attended several multi-agency
training drills and successfully completed Helicopter Technician System Operator/Rescue
Specialist annual recertification program required by the Delaware State Police Aviation Unit. In
addition, this writer attended several continuing education modules on various topics and
maintained all required instructor credentials in BCLS, ACLS, PALS, ABLS and AMLS.

Special Projects
This writer has been working with Nelson-Kellerman, the manufacturer of Kestrel Pocket
Weather Meters, for the past several years to develop and enhance their product capabilities for
law enforcement. This writer receives new models to test annually and provides feedback
specific to enhance and develop features for EOD and SWAT call outs where weather data is
critical for personnel rehabilitation and hydration guidelines. This writer is currently working
with a new type of product called a “Heat Stress Tracker” to develop guidelines in their software
to track the effects of heat stress on police officers operating in tactical gear and EOD blast
protection suits. This unit provides a mathematical value for the officer‟s ability to offload heat
effectively to track the potential for injury in given conditions. This could potentially prevent
heat overload to officers before it could even occur and this writer possesses the only unit made
as it has not been cleared for full production. This orange colored unit is pictured below along
with the 4500 Bluetooth weather meter we currently use for EOD call-outs.

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Conclusion
The above listed data outlines the significant need for specialized tactical/EOD Paramedic
services for both the Wilmington Police Department and the Delaware State Police alike.
Furthermore, this program has been proven successful and continues to protect our responding
personnel and citizens alike during major and critical incidents. In 2010, this program was
activated once every 1.9 days or 192 times and in 2011 there was approximately an 11% overall
increase in frequency to once every 1.74 days or 210 times. It should further be noted that critical
incidents increased during 2011 almost 150% and several had outcomes resulting in homicide or
suicide by the suspect(s).

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2011 DSP Helicopter Missions
KENT NEW CASTLE OTHER SUSSEX TOTAL
Medical 184 199 13 319 715
Scene 34 61 10 92 197
Negative Transport 150 132 3 226 511
Inter-Hospital 0
Medic Assist 6 1 7
Traffic 6 27 9 42
Search & Rescue 16 62 1 48 127
Reconnaissance 11 1 11 23
Criminal Search 35 184 3 140 362
Surveillance 17 188 93 298
Maint & Testing 9 52 34 95
Training 3 152 1 126 282
Demonstrations 0
Fire Related 3 8 1 6 18
Police Related 2 8 2 12
Public Related 6 14 8 28
Law Enforcement 3 3
Fire Fighting 1 5 6
Other 19 76 6 22 123
TOTAL 301 984 26 823 2134

Trooper-4 Refused 55 calls due to weather

Trooper-2 Refused 62 calls due to weather

2011 DSP Helicopter Flight Hours

KENT NEW CASTLE OTHER SUSSEX TOTAL
Medical 52.3 50.4 8.4 152.5 263.6
Scene 28.8 29.5 6.7 106.8 171.8
Negative Transport 23.5 19.9 1.7 44.2 89.3
Inter-Hospital 0
Medic Assist 1 1.5 2.5
Traffic 3.4 14.5 7.3 25.2
Search & Rescue 10.9 28.5 0.8 21.4 61.6
Reconnaissance 0.3 8.8 0.2 5.6 14.9
Criminal Search 25.4 92.6 2.2 74.9 195.1
Surveillance 12.3 93.6 0.2 57.4 163.5
Maint & Testing 2 33.6 16.8 52.4
Training 3.4 120.9 2.6 116.4 243.3
Demonstrations 11.1 14.2 1.3 6.2 32.8
Law Enforcement 0
Fire Fighting 0.4 1.7 2.3 4.4
Other 13.8 46.8 12.8 16.7 90.1
TOTAL 135.3 505.6 28.5 477.5 1146.9

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2011 AED Deployments
Delaware State Police Aviation Section oversees the divisions AED program. In 2011 Troopers
deployed their Automated External Defibrillator (AED) on 12 occasions, which met the criteria
for download (pads-on-patient). The following is a summary of the utilizations:
9 utilizations where the AED analyzed followed by a “No Shock Advised” prompt. The patient
was subsequently pronounced deceased.
1 utilization where the AED analyzed followed by a “NO shock advised” prompt. Patient care
was subsequently taken over by the paramedics. Upon arrival at the hospital the patient had a
pulse.

1 utilization where the trooper administered 2 shocks followed by CPR. The patient was
subsequently to the hospital where they were pronounced.

1 utilization where the trooper administered 3 shock followed by the patient having a
spontaneous return of circulation (ROC). The patient arrived at the hospital alive.

Infectious Disease Exposures

For the 2011 calendar year the Delaware State Police had a total of 10 confirmed infectious
disease exposures. In addition, there were a total of 10 cases that did not meet the exposure
criteria; however, these incidences were documented and placed in a file.

Of significant Importance: There were two separate incidents this year involving exposure to
scabies. In addition to receiving medical evaluation and treatment for those troopers who were
exposed, both incidents required extensive decontamination of the state police facilities to
include vehicles.

The Delaware State Police Aviation Section is pleased to announce that Cpl/2 Nicole Parton, and
Cpl/1 Shawn Wright successfully completed their flight training and are working as productive
crew members within the section. Cpl/3 Edward Sebastianelli, Cpl/2 Sean McDerby, Cpl/1
Stephen Fausey and Cpl Jennifer Potocki are progressing through the intense 18 month
paramedic training program at Delaware Technical Community College and are expected to
graduate and join the DSP Aviation rank and file in the Fall of 2012. DSP Aviation welcomes
Cpl/1 Steven Rindone, who was recently transferred into the section as a Trooper/Pilot and is
currently undergoing his flight training.

Summary
The Delaware State Police Aviation Section continues to research new aircraft acquisition
options ranging from refurbishment to fleet replacement. In addition, the section continues to
analyze manpower options to support the ever increasing mission and to ensure that we continue
to provide superior service to those that we serve by honoring the Division‟s Core Values of
Honor, Integrity, Courage, Loyalty, Attitude, Discipline and Service.

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 Echo Level Response, DSP

10
Number of Responses

0
2007 2008 2009 2010 2011

Within 6 minutes Within 8 minutes Within 10 minutes Within 12 minutes Total

Delta Level Response, DSP

800
Number of Responses

600

400

200

0
2007 2008 2009 2010 2011

Within 6 minutes Within 8 minutes Within 10 minutes Within 12 minutes Total

Charlie Level Response, DSP EMS

35
Number of Responses

30
25
20
15
10
5
0
2007 2008 2009 2010 2011

Within 6 minutes Within 8 minutes Within 10 minutes Within 12 minutes Total

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Christiana Care/LifeNet 2011 DEMSOC Report

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Chief Flight Nurse
Christiana Care/LifeNet has been proudly providing critical care aviation transport and
emergency services support to Delaware and our surrounding states since the spring of 2001. As
a two aircraft program, with bases in New Castle and Sussex Counties, we have become an
integral part of delivering quality care to those citizens who have become critically ill or injured
and require transfer for definitive treatment.
A highly skilled, and critically educated medical crew, consisting of a flight nurse and
paramedic, are able to maintain or increase the life sustaining treatment initially started for the
patient. By having extensive protocols, readily available medications, critical care monitoring
capabilities, and on line medical direction, patient care is not interrupted during transport.
Christiana Care/LifeNet has been CAMTS accredited since April 2006. This certification
indicates that the aviation and patient care systems have gone through a rigorous site survey and
found to meet or exceed the nationally established standards for medical transport programs. We
are preparing for our third site survey in the coming weeks.

2011 Accomplishments
A total of 484 aviation missions were completed in 2011. Transports were requested from 38
referring hospitals across 4 states and accepted by a total of 22 major hospitals providing
specialty care. 26 scene missions were completed with the highest percentage being in Sussex
County. We were requested to and participated in state and county evacuation drills, and multi-
casualty incident training.
LifeNet 6-1 and 6-4 are popular requests for community programs throughout the tri-state area.
39 outreach educational appearances were provided for local businesses, schools, EMS agency
functions, and scouting organizations. The medical crew and EMS pilots, also provide education
for members of the state‟s EMS and Fire Service programs.

Summary
Christiana Care/LifeNet‟s program director, pilots, mechanics, medical leadership, nurses and
paramedics, strive to provide the most efficient, timely, and highest quality patient care possible.
As part of our dedication to the communities we serve, crew members are involved in emergency
services and patient care committees throughout our catchment area at the state and local levels.

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Who We Are
Safe Kids Delaware, led by the Delaware Division of Public Health, is a member of Safe Kids
Worldwide, the nation‟s first non-profit organization dedicated solely to the prevention of
accidental childhood injury. Safe Kids Worldwide is made up of more than 600 state and local
Safe Kids coalitions in all 50 states, the District of Columbia and Puerto Rico. Safe Kids
Delaware consists of more than 20 community, civic and state organizations. The Coalition‟s
initiatives include classroom-based programs and educational events for families. The Coalition
focuses on promoting child passenger safety, water, pedestrian, fire and bike safety.

What We Do
In the United States, Safe Kids partnerships have contributed to a 45 percent reduction in the
child fatality rate from accidental injury – saving an estimated 38,000 children‟s lives since
1987. Locally, this is done through community partnerships, advocacy, public awareness, and
through distribution of safety equipment and education on proper usage. Safe Kids Delaware
promotes changes in attitudes, behaviors, laws, and the environment to prevent accidental injury
to children.

From January 1, 2011 through October 15, 2011 Safe Kids Delaware participated in:

125 Health Fairs, safety camps, classes and events in area schools, businesses and
communities reaching approximately 22,881 children and their families;
Six (6) Bike Rodeos, distributing 430 bike helmets;
Several Safe Kids Days throughout the state reaching 5,000 children and their families,
Taught 6,989 children to Walk this Way Safely to School.
Checked 2,000 child safety seats and corrected 800 child safety seats with partner assistance.

Think First for Kids reached 3,000 elementary and middle school children. Pre- and post-tests
showed a significant increase in knowledge, change in attitude, and increase in safety behaviors.
Our Annual Safe Kids - EMSC Conference attracted more than 130 professional and para
professionals who were thoroughly impressed with all that the conference had to offer.

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How We Do It
Safe Kids Delaware is committed to making a strong impact on its children and their families.

Increased Family education

Providing additional safety equipment including car seats and helmets to families in
need.
Advocating for better laws to help keep children safe, healthy and out of the
emergency department.

The success of our achieving these goals is heavily dependent on new and current funding
sources. We are continuing to seek resources and pursuing development of new partnerships
that will contribute to the ongoing efforts of Safe Kids Delaware and its mission.

Summary
The goal of Safe Kids Delaware is to raise awareness of preventable injury issues in our state,
educate individuals in vital injury prevention strategies, and motivate them to participate in our
vision of an injury-free life for all children.

New Castle County Safe Kids Day

Safe Kids Bike Rodeo

Seaford Central Elementary School, Safe Kids Walk

This Way Pedestrian Safety Program

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 Special Needs Alert Program (SNAP)

Introduction

The Special Needs Alert Program (SNAP) assists responders in providing emergency care for
children with special health care needs. SNAP can improve care by facilitating the transfer of
medical information from parents to EMS to the hospital. SNAP alerts providers to look for
medical information even when a parent is not present during an emergency. Completed SNAP
enrollment, emergency medical information and consent forms are entered into a secure SNAP
electronic database. The child‟s medical information is given to the 911 dispatch center, the
county based paramedic service, and the local fire company and is made accessible to responding
units through secure methods.

2011 Accomplishments

In April of 2011, the SNAP Program became part of the nation‟s first statewide electronic system
for citizens who have special needs, the Delaware Emergency Preparedness Voluntary Registry.
Parents or guardians may now enroll in the electronic registry and begin their SNAP enrollment
process online at www.de911assist.delaware.gov .
Currently, there are over 245 children enrolled in SNAP; 138 in Kent County, 63 in New Castle
County, 44 in Sussex County, and 15 dual enrollees. There are another 68 enrollments in
progress through the electronic Delaware Emergency Preparedness Voluntary Registry. Over
half of the SNAP electronic enrollments coincided with the dates of Hurricane Irene.

2012 Challenges/Goals

Increasing outreach and enrollment opportunities is a challenge and key component to continued
program growth. Working with existing partners and building new avenues of outreach through
trainings and information-sharing with the public school system, professional medical
organizations, disability groups, and parent organizations will facilitate increased enrollment.

Summary

SNAP continues to work with emergency response agencies and families with children with
special health care needs to increase the medical information available at the time of a 911
emergency call.

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 Crash Outcome Data Evaluation System (CODES)
CODES Project is a collaborative effort between the OEMS, the Delaware State Police, the
Delaware Health Statistics Center and the Delaware Office of Highway Safety. From these
agencies, OEMS collects many types of data (e.g., demographic, injury severity, hospital charge,
etc.) that are linked, analyzed and publicized. Resulting data allow state agencies, policymakers
and the public to understand the causes and impacts of motor vehicle crashes.

2011 Accomplishments
Linked 2008 CODES data, generated fact sheets, and prepared motor vehicle crash
hospitalization data for National Highway Traffic Safety Administration (NHTSA) and
Delaware Office of Highway Safety (OHS)
Participated in Single Unit Truck Crashes Study using 2006-2008 linked data for
National Transportation Safety Board (NTSB) and NHTSA
Linked 2007-2009 crash to trauma registry data to support the OHS sub grant-
„Epidemiologic Analyses: Risk-Taking Driving Behaviors, Crash Characteristics, and
Severity of Injury‟
Provided 2003-2007 data for Wilmington University to conduct the follow up study of
Delaware Graduated Drivers License (GDL) program
House Bill No. 95 proposed to repeal the law that requires every person operating or
riding on a motorcycle to have a safety helmet in their possession. These law encouraged
helmet usages by ensuring helmets are available to all riders who may choose to use
them. On June 14, a Delaware Crash Outcome Data Evaluation System (CODES)
analyst attended the committee meeting with the Deputy Cabinet Secretary of Safety and
Homeland Security and the Governor‟s office via conference call. CODES provided
Delaware‟s Office of Highway Safety with the estimated medical costs of helmeted vs.
unhelmeted motorcyclists to support the current law
Attended the OHS Impaired Driving Assessment
Presented the report of Delaware CODES Application at NHTSA Region 3 Training
Webinar
Presented the report of “Injury Analysis of Alcohol Impaired Driving Crashes” at the
2011 CODES Network Annual Program and Technical Assistance Meeting
Displayed the poster of trauma injury and CODES information at the 2011 Statewide
Highway Safety Conference

Goals
Complete linking 2009 crash report, EMS, and hospital discharge files
Continue responding to NHTSA and Delaware OHS data requests in the format requested
and in a timely manner
Continue participating Single Unit Truck Crashes Study using 2009 linked data for NTSB
and NHTSA
Continue linking crash, EMS, and trauma data to support OHS sub grant- Analyses of
Trauma System Emergency Department Data and CODES-Trauma Data Linkage

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Delaware Motorcycle Injury Cost
Facts
Presented by the Crash Outcome Data Evaluation System (CODES)
Project

Helmets Save Lives and Costs

In Delaware, motorcycle National Highway Traffic Safety

operators and passengers up Administration (NHTSA) estimates
to age 19 are required to the use of motorcycle helmets saved
wear helmets. It could save 1,829 lives in 2008. If all
more lives and costs if all motorcyclists had worn helmets, an
motorcycle operators and additional 823 lives could have been
passengers wear helmets. saved.
Crash and Injury Outcomes from Statewide Crash and Hospital Discharge Data

Average Medical Costs1 by Body Part Injuries, 2003-2007

Motorcyclists Other

For all of the body region injuries, the average medical costs for motorcyclists were higher than
the costs for the people injured in other traffic related crashes.

1. Blincoe L, Seay A, Zaloshnja E, Miller T, Romano E, Luchter S, et al. The Economic

Impact of Motor Vehicle Crashes, 2000. Washington (DC): Dept of Transportation (US),
National Highway Traffic Safety Administration (NHTSA); 2002.
Medical costs include emergency room and inpatient costs, follow-up visits, physical
therapy, rehabilitation, prescriptions, prosthetic devices, and home modifications.

Delaware Crash Outcome Data Evaluation System (CODES)

represents a collaborative effort among the Office of Emergency
Medical Services, Delaware State Police, Delaware Health
Statistics Center, and the Office of Highway Safety. The facts
and figures presented here were derived from 2003 to 2007
CODES linked database. For more information, please call (302)
223-1350.

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 Infection Disease Control
The infectious control program for Delaware includes pre-hospital care providers (EMTs,
paramedics, and first responders), firefighters, and law enforcement personnel. Delaware is one of
the few states that conduct mandatory source testing

.
The need for an effective infection control program has always been an essential and integral part
of the pre-hospital practice because there is both the risk of healthcare providers acquiring
infections themselves and could result in passing infections on to patients. Preventive and
proactive measures offer the best protection for individuals and organizations that may be at risk
for an elevated exposure to these infectious diseases. Since 1993, Delaware has reviewed 179
potential exposures forms reported by the pre-hospital setting and in 2011 reviewed 31. The table
below represents the type of exposures reported in 2010.

Type of Exposure for 2011 Reports

Inhalation: coughing, sneezing, confined proximity 14

Ingestion: splash/spray, hand-to-mouth contact, mouth-to-mouth contact, ect. 7

Percutaneous: medical sharp, hollow-bore needle, bite, ect. 3

Mucocutaneous: Nasal, Oral, Ocular. 3

Cutaneous: non-intact skin, intact skin with large fluid volume 4

Infection control refers to policies and procedures used to minimize the risk of spreading
infections and reduce the occurrence of infectious diseases. These diseases are usually caused by
bacteria or viruses which can be spread by:
human to human contact
animal to human contact
human contact with an infected surface
airborne transmission through tiny droplets of infectious agents suspended in the air
such common vehicles as food or water
Protection from the threat of infectious disease is an urgent matter due to constant changes in
lifestyles and environment, which result in new diseases to which people are susceptible. The
required equipment lists for ambulances in Delaware also offers assistance to pre-hospital
providers to receive immunizations against hepatitis, flu, tetanus and tuberculin skin testing.

Education and training is required yearly by all agencies to update pre-hospital personnel on
infectious disease policies and universal precautions. Increased emphasis is being placed on the
educational process to reinforce these issues with pre-hospital medical providers as well as
industrial and police agencies. During this training, agencies are given an overview of common
diseases that have a potential for transmission.

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DELAWARE EMS SAFETY INITIATIVES

The EMS field has been identified as a high-risk industry and safety impacts more than just EMS
personnel. Safety in EMS affects our patients, EMS responders, and the public. EMS providers
are more than two and a half times more likely than the average worker to be killed on the job,
and their transportation-related injury rate is five times higher than average.

Following the tragic events of 2008 in which Sussex County Paramedic Stephanie Callaway and
Delaware City EMT Michelle Smith were killed in the line of duty, several initiatives were
taken, aimed at increasing the awareness of the risks associated with the EMS profession and
how to reduce those risks. In the past year, the following steps have been taken:

Delaware‟s EMS community participated in the development of the National Association

of EMT‟s (NAEMT) “EMS Safety Course” which was introduced at the EMS Today
Conference in Baltimore in March of 2011
“EMS Safety Course” was presented at the Delaware State Fire School (DSFS), during
which a number of Delaware providers were certified as instructors
DSFS has since established a schedule that will offer the course at their facilities
throughout the state
The “EMS Safety Course” will be presented at the Delaware Volunteer Firefighters‟
Association conference in September of 2012
a number of individual agencies have conducted courses for their members, and other
courses are scheduled throughout the state
changes in statewide treatment protocols aimed at reducing the number of patients
transported with the use of warning lights and sirens

Delaware is also represented on a committee established by the National Fire Protection

Association (NFPA) to establish a new standard for the design and construction of ambulances.
This new standard, known as NFPA 1917, replaced the existing KKK-1822 standard established
by the National Highway Traffic Safety Administration (NHTSA) as a bid specification
document. Already under revision, NFPA 1917 seeks to incorporate automotive engineering
design, ergonomics, and new technologies to create a safer ambulance.

A member of the Delaware Emergency Medical Services Oversight Council (DEMSOC)

Committee also serves on the steering committee for the National EMS Culture of Safety
Strategy Project. The project is a three-year cooperative agreement between the National
Highway Traffic Safety Administration (NHTSA), with support from the Health Resources and
Services Administration‟s (HRSA) EMS for Children (EMSC) Program, and the American
College of Emergency Physicians (ACEP) and brings together representatives from national
EMS and fire organizations to develop a national EMS “Culture of Safety” Strategy. This
Strategy is intended to change the status quo and chart a new course that will support the
emergence of a culture of safety in EMS.

These efforts, and others yet to come, are all intended to produce one common outcome….when
the call is over, everyone goes home.

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 Thank You

The Delaware Emergency Medical Services Oversight council (DEMSOC) would like to express a sincere thank you
to all the agencies that submitted photos, data and text for this year’s DEMSOC report.

Office of EMS, Office of Preparedness, Department of Safety and Homeland Security, SFPC, DSFS, State Fire
Marshal’s Office, Delaware Technical and Community College, New Castle County EMS, Kent County EMS, Sussex
County EMS, Delaware State Police, Delaware Healthcare Association, E911 Board, Emergency Medical Services
for Children, DE Trauma Committee, NCC Dispatch, KC Dispatch, SC Dispatch, Rehoboth Dispatch, Seaford
Dispatch, CCHS LifeNet, Bethany Beach Fire Co, Cheswold Fire Co, Lewes Fire Co, Blades Fire Co, Laurel Fire
Co, Brandywine Hundred Fire Co, Aetna Fire Co, Magnolia Fire Co, Dagsboro Fire Co.