St. Michael Medical Center and Kitsap EMS can solve the ER crisis

In 1974, the CBS newsmagazine 60 Minutes called Seattle the best place to have a heart attack in America because survival rates were the best in the country. And by 2019, victims of cardiac arrest were nearly 5 times more likely to survive in King County compared to other cities in America.

Why? Because back in 1968, a visionary cardiologist, Leonard Cobb, and an equally pioneering fire chief in Seattle, Gordon Vickery, tried working together. Known as the Medic One Experiment, these two men had one goal: to create a rapid mobile response system using firefighters as paramedics in combination with a responsive medical team at the emergency department inside Harborview Medical Center. Ultimately, their innovative approach pushed survival rates for cardiac arrest in King County to the highest in the world.

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Their success depended on a fearless leader to set the bar higher for emergency care than it had been set before. Someone who demanded perfection out of everyone. And who got it? Someone who listened to the incoming cases on a scanner at home. Someone, who — when the emergency department got crazy on New Year's Eve — came in on his night off to make sure healthcare got done right. For many years, every paramedic, medical student and resident working in the only Level I trauma center in the state was trained by one man: A balding, stocky neurologist, wearing black-rimmed glasses and a sweater vest, named Dr. Michael Copass.

Back in 1997, Harborview emergency department was managed by a second-year resident (not yet a practicing physician) and about a dozen medical students in collaboration with top-notch paramedics and firefighters. I spent six weeks there, beginning on Thanksgiving Day and ending after the New Year's holiday, learning more than I ever imagined. Dr. Copass taught medical students and residents to think like paramedics. And he taught paramedics to think like medical students and residents. But most importantly, he taught us that emergency care is not accomplished in a vacuum. It requires, actually demands, collaboration and coordination between EMS and hospitals.

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Copass lived by two rules. Number one, that every patient, no matter their medical condition, color of their skin, or socioeconomic background, deserved the best possible care delivered in the most respectful way, and number two, that time is always of the essence. Uncomplicated patients should be in and out of the emergency department in three hours or less. Minutes mattered. He wanted the emergency department always at the ready to receive new emergencies so EMS personnel could get back on the road after delivering patients.

And every morning, students lined up in the radio room to watch as Copass reviewed our clinical notes from the night before. He held us accountable for every decision we made, whether right or wrong. In every patient and student encounter, Copass saw room for improvement. Like the time I evaluated a man who sustained a superficial gunshot wound to his leg.

The man told me he had been cleaning his gun on a quiet Saturday night at home. Copass asked if I actually believed that story. I nodded, too naïve to know better. I had cleaned up the wound, given a tetanus shot and discharged the man without realizing there might be more to the story.

That's when Copass pulled out the police report and filled in the blanks. The paramedic who responded to the call recognized there might be more than met the eye and notified law enforcement. It turns out the man was shot by his own weapon. The part he left out was that while he was trying to retrieve his gun from his ex-girlfriend's house, he had been shot by her new boyfriend. In fact, they had traded gunfire and both men were injured. Without EMS personnel, I couldn't see the whole picture. Hospitals have to work with fire departments in order to provide exceptional emergency care. Otherwise, minutes become hours and patients suffer.

Which brings me back to problem with ambulances stacking up in the parking lot at St. Michael Medical Center in Silverdale, waiting to bring sick patients to the emergency department. This problem is not the result of just one bad day or one gigantic pandemic. Emergency care is akin to "a room with a view" into a healthcare system. Underfunding public health increases preventable injuries, food-borne illness, and vaccine-preventable disease. Patchy primary care overwhelms emergency department waiting rooms. Poor staffing decisions made by tone-deaf hospital administrators leads to rooms and hallways overflowing with ill and injured patients.

Dr. Copass knew that without collaboration the system would disintegrate. He was right. Today, St. Michael Medical Center is one of the busiest emergency departments in the Washington State — busier than Harborview Medical Center, according to the Washington State Hospital Association. As the Medic One experiment proved, when hospitals work together with fire chiefs the community wins.

It shouldn't be better to have a heart attack in King County than it is in Kitsap County. As the lone hospital facility in Kitsap County, St. Michael is obligated to provide timely emergency care to those who need it. It seems to me that the local fire chiefs are searching hard for solutions to the routine backups at our only local ER. Now, hospital administrators need to meet EMS leaders at the table. And if they refuse to do so, then our community needs a second facility to step in and share the load.

Dr. Niran Al-Agba is a pediatrician in Silverdale and writes a regular opinion column for the Kitsap Sun. Contact her at [email protected].