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


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

Why? Because in 1968, a visionary cardiologist, Leonard Cobb, and an equally pioneering fire chief in Seattle, Gordon Vickery, tried to work 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 in the emergency department at Harborview Medical Center. Ultimately, their innovative approach pushed cardiac arrest survival rates in King County to the highest in the world.

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Their success depended on a fearless leader who set the bar for emergency care higher than it had been before. Someone who demanded perfection from everyone. And who got it? Someone listening to incoming cases on a scanner at home. Someone who, when the ER went crazy on New Years Eve, came in on his night off to make sure the health care was done right. For many years, every paramedic, medical student and resident working in the state’s only Level I trauma center was trained by one man: a bald, stocky neurologist, wearing black-rimmed glasses and a pullover, named Dr. Michael Copass.

In 1997, the Harborview Emergency Department was staffed by a second-year resident (not yet a practicing physician) and a dozen medical students in conjunction with paramedics and top-notch firefighters. I spent six weeks there, starting on Thanksgiving Day and ending after the New Years holidays, 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. Most importantly, he taught us that emergency care does not happen in a vacuum. This requires, in fact requires, collaboration and coordination between EMS and hospitals.

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Copass lived by two rules. First, that every patient, regardless of health condition, skin color or socio-economic background, deserves the best possible care delivered in the most respectful manner, and second, time is always running out. Uncomplicated patients should be in and out of the emergency department in three hours or less. The minutes counted. He wanted the emergency department to be always ready for new emergencies so that EMS personnel could get back on the road after delivering patients.

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

The man told me he cleaned his gun on a quiet Saturday night at home. Copass asked me if I actually believed this story. I nodded, too naive to know more. I had cleaned the wound, taken a tetanus shot, and fired 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 acknowledged there might be more than expected and notified law enforcement. It turns out the man was shot by his own gun. The part he left out was that while he was trying to get his gun back from his ex-girlfriend, he was shot by his new boyfriend. In fact, they had exchanged gunfire and both men were injured. Without the EMS staff, I couldn’t see the whole picture. Hospitals must work with fire departments to provide exceptional emergency care. Otherwise, minutes become hours and patients suffer.

Which brings me back to the problem of ambulances piling up in the parking lot at St. Michael Medical Center in Silverdale, waiting to bring sick patients to the ER. This problem is not the result of a single bad day or a gigantic pandemic. Emergency care is like “a room with a view” of a health system. Underfunding of public health increases preventable injuries, foodborne illnesses and vaccine-preventable diseases. Uneven primary care overwhelms emergency department waiting rooms. Poor staffing decisions made by deaf hospital administrators lead to rooms and hallways overflowing with sick and injured patients.

Niran Al Agba

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 Washington state — busier than Harborview Medical Center, according to the Washington State Hospital Association. As the Medic One experience has proven, when hospitals work with fire chiefs, the community wins.

It shouldn’t be any better to have a heart attack in King County than in Kitsap County. As Kitsap County’s only hospital facility, St. Michael’s is committed to providing timely emergency care to those in need. It seems to me that the local fire chiefs are intensely looking for solutions to routine backups in our only local emergency room. Now, hospital administrators must meet EMS leaders around the table. And if they refuse to do so, 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]


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