ER Doc Keeps Paramedics Primed

Those unfortunate enough to need the services of our local paramedics assume they're in good hands - an ambulance ride wouldn't exactly be a good moment to find out otherwise.

But for Marin County paramedics to be ready for any emergency that awaits them, they are constantly taking classes, training and learning about the latest practices and information in their field.

That's where Medical Director Mark Bason-Mitchell comes in.

“It’s really keeping a handle on the whole system,” said Bason-Mitchell.

Marin General Hospital and the Marin County Fire Department made a deal last summer in which Marin General assists the county’s emergency medical services and funds the position of Medical Director for the Marin County Fire Department, the Ross Valley Paramedic Authority, and Southern Marin Emergency Medical Paramedic System.

Bason-Mitchell, an emergency room doctor at Marin General for the last 10 years and the community liaison for the hospital, was the “perfect fit” for the job, said Mike Giannini, the Marin County Fire Department’s Emergency Medical Services Battalion Chief. 

Bason-Mitchell conducts regular training sessions with paramedics around the county. On a recent training day, he hit four of the fire departments he oversees – stretching from the Mill Valley station out to Tomales Bay – to go over treating basic poisonings and overdoses. He’ll repeat the talk twice more this month for two other shifts. Last month, he acted out cardiac arrest procedures with the paramedics.

At each station last week, the paramedics and EMTs gathered to go over the top 10 fatal poisons and overdoses: aspirin, Tylenol, tricyclics (a type of antidepressent), cardiac drugs, iron, hydrocarbons like gas or furniture polish, caustics and corrosives like drain cleaner and batteries, opiates, and insecticides and phosphates.

Bason-Mitchell touched on each poison, symptoms, dosages and what the paramedics can expect or should do. Tylenol is lethal at about 40 pills for an average-sized man and many people don’t realize they’re doubling up when they take Vicodin or Percocet as well, Bason-Mitchell told the 20 paramedics assembled in Mill Valley. He warned them to decontaminate patients who are doused in gases, cleaners or insecticides before treating them.

Throughout the session, Bason-Mitchell went over changes in procedure or important scientific advances. It’s no longer considered wise to force kids to throw up, he told them, since many used to simply choke or inhale the poison into their lungs, causing more problems.

The EMTs and paramedics gathered in the informal setting asked questions, made jokes, and recounted cases they had and what they could do differently. The setting - in a break room at Mill Valley's main station and a living room of the San Anselmo station - encourages people to ask questions and be willing to learn, Bason-Mitchell said.

“I try to be less of a doctor,” said Bason-Mitchell.

Previously, the three paramedic agencies funded the medical director position themselves, but budget cuts put the job of medical director - and the ongoing education and medical study vital to paramedics that comes with it - in jeopardy, Giannini said. 

Marin General now covers the $60,000 bill “as a way to improve care and build relationships with our personnel and the hospital staff,” said Giannini. 

With so many Marin emergency and trauma patients going to Marin General, it made sense for the hospital to work with emergency personnel, he said. Continuity of pre-hospital care and communication helps ensure better outcomes for the hospital and the patients.

In Marin, the paramedics are based out of the fire departments. Mill Valley, Tam Valley, Sausalito, and Tiburon-Belvedere are served by the Southern Marin system. The Ross Valley Paramedic Authority covers all of Ross Valley except Corte Madera. And the unincorporated Marin stations, like Woodacre and Tomales, have their own paramedics.

Although there are not transport units or ambulances at every station (Ross Valley’s only emergency transport unit is stationed on Sir Francis Drake Boulevard in Ross), every firefighter is also an EMT and some at each station are additionally paramedics.

This creates an overlapping paramedic system with built-in back-ups, all of which Bason-Mitchell tries to make sure is up to date and up to speed.

In addition to the education aspects, Bason-Mitchell also oversees the continuous quality improvement, a system of checks and balances to ensure everything runs smoothly. In heart attack cases, if the paramedics can perform an EKG in the field and alert the catheterization lab at the hospital, the time to getting those blood vessels opened can be greatly minimized. But, what if the EKGs are being read wrong or the lab is being called in too frequently for incorrectly-read cases, wasting resources?

Marin General actually has some of the best times in the state in terms of getting the blood vessels reopened after a heart attack and many other hospitals don’t even have EKGs in the field yet. But it’s all a balancing act that Bason-Mitchell helps insure runs smoothly.

“I really like the job,” he said.

The best part is that since he still works a number of shifts in the emergency room at Marin General, he’s able to take patients directly from the paramedics he works with regularly. They can then check in with him on what happened to those patients and how things turned out. And he brings those experiences to his next training visit to a group of paramedics.

“That connection extends directly to the emergency department," Giannini said. "When we bring patients to Mark, there is a better continuum of care and additional opportunities for our paramedics to learn about medicine."