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Why This Series Exists

• Even internal team members discover new Institute programs (example: “Safe Cities”/community safety initiative in Ashtabula County funded via grant money and running “on autopilot”).

• Key point: UH EMS Institute is more than a hospital medical control line—it’s operations, integration, education, specialty service coordination, and system-level problem solving.
  
  

UH System Overview: Hub-and-Spoke, Community Hospitals, and “Two Personalities” Downtown

“The Mothership”

• UH Cleveland Medical Center (CMC) = Level 1 Trauma + Comprehensive Stroke + tertiary specialty services.
  
  

• Includes Rainbow Babies & Children’s (functionally a separate hospital under the same umbrella).
  
  

• Internal “sub-hospitals” noted: Seidman (cancer), MacDonald (women’s health), etc.
  
  

• Houses high-acuity resources:
  
  

  • ECMO center (including ED eCPR)
    
    

  • High-risk neonatal/peds capabilities
    
    

  • Deep bench of subspecialists and consult access
    
    

Community hospital model (common pattern)

• Many UH community hospitals are discussed as Level 3 trauma + stroke/STEMI capability, with system transport resources supporting the model.
  
  

Facility Walkthrough (UH + Partners)

The group “runs the map,” emphasizing how each facility fits into the system and how EMS care changes based on services available.

UH Hospitals Discussed

• Ahuja (Beechwood): Full service; STEMI + stroke; not a trauma center; OB presence; multiple med directors.
  
  

• Conneaut Medical Center: Critical access; frequent transfers; part of the “outer spoke” model.
  
  

• Lake Health:
  
  

  • Lake West: Recently became a trauma center; positioned as an east-side trauma hub; STEMI + stroke.
    
    

  • TriPoint (Concord Twp): Primary stroke; no STEMI; some OB services.
    
    

• Portage (Ravenna): Level 3 trauma; Primary stroke; STEMI; no OB (moved due to low volume/quality + safety considerations).
  
  

• Samaritan (Ashland County): Primary stroke; limited PCI (non-emergent/daytime only); no OB due to volume; rural transport challenges (Amish population mentioned); medical command covers multiple counties.
  
  

• Elyria: Stroke + STEMI + Level 3 trauma; only trauma center in Lorain County now; community ECMO CPR program started; also supports field blood for high-risk circumstances via a “zero waste” model.
  
  

• Geauga: Level 3 trauma; PCI; STEMI; “well-oiled” STEMI program (Dr. Stefano’s home base).
  
  

• Parma: Level 3 trauma; stroke + STEMI; high volume; noted as likely next expansion target for advanced programs.
  
  

• St. John (Westlake): Level 3 trauma; STEMI; primary stroke; high-volume west-side catchment.
  
  

Partner Hospitals Discussed

• Western Reserve (Cuyahoga Falls): Level 3 trauma; Primary stroke; no STEMI; neurosurgery capability; runs same EMS protocols/drug boxes.
  
  

• Aultman System: Canton (Trauma 2, STEMI, OB, peds, primary stroke), plus Alliance, Orrville, Massillon (freestanding ED noted/uncertain); Alliance described as “tenecteplase only” with transfer-out after administration.
  
  

• Southwest: Trauma 3; STEMI; primary stroke; OB; aligned protocols/drug boxes.
  
  

• Firelands (HVI support): Trauma 3; STEMI; primary stroke; OB; more EMS-agency support emphasis.
  
  

Geographic Reality + Coverage Footprint

• Discussion of large service areas and long transports:
  
  

  • Samaritan medical command spans Ashland/Wayne/Richland + parts of Crawford.
    
    

  • Portage coverage extends broadly (Portage, Trumbull, Summit, Mahoning, Columbiana, Harrison, into Jefferson; plus parts of Stark/Carroll).
    
    

• Big operational implication: loss of OB services in rural facilities increases prehospital delivery risk and shapes how EMS must triage/transport.
  
  

“Level 3 Works” — Why Community Trauma Matters

• Story example: trauma patient crashing in a community ED, stabilized surgically, then transported—likely would not have survived a direct long transfer.
  
  

• Emphasis: coordinated community trauma system prevents avoidable deaths.
  
  

ECMO CPR Expansion: Community eCPR is a Big Deal

• Elyria is positioned as a community test site for eCPR/eCMO cannulation (cath lab, cardiac intensivists).
  
  

• Vision: expand ECMO receiving capability outward to shorten time-to-pump and improve arrest outcomes.
  
  

• Survival framing:
  
  

  • Standard ACLS survival ~10% (discussed)
    
    

  • ECMO CPR can raise survival to ~30%+ (and CMC reportedly better)
    
    

• Reinforces: this takes many moving parts—prehospital triggers, transfer center, perfusion, transport, cath lab readiness, protocols, and coordination.
  
  

The QB Concept: ED Quarterback (and Transport Quarterback)

ED Quarterback (EMS Institute paramedic role)

• Dedicated EMS “navigator” in the ED—not an ED nurse role, not a rotating assignment.
  
  

• Helps with:
  
  

  • Receiving EMS reports and understanding protocols/OneDose logic
    
    

  • Activating service lines (trauma/stroke/STEMI)
    
    

  • Managing real-time issues: wall times, equipment problems, escalation, patient offload to get ambulances back in service
    
    

  • Building relationships with crews (“it’s the same person, every time”)
    
    

Transport Quarterback + Transfer Referral Center (TRC)

• Dispatch/transport coordination co-located with the hospital transfer center.
  
  

• Orchestrates:
  
  

  • Bed placement + specialist conferencing
    
    

  • Movement logistics: critical care air/ground, specialty resources
    
    

• Big theme: system integration is the only way advanced programs (eCPR, blood, trauma network) run reliably.
  
  

Activation Platform: LifeNet (“Striker” style)

• Used for daily and program-level activations.
  
  

• Critical in complex pathways like eCPR (paging perfusionists, transfer center, transport QB, etc.).
  
  

• Mentioned: ongoing work toward a new LifeNet version, with EMS Institute deeply involved.
  
  

EMS Institute “Team Behind the Curtain”

• EMS coordinators/managers: agency-facing, system-level communication, change management (e.g., construction impacts, helipad changes, diversion messaging).
  
  

• Medical directors: not “one doc decisions” — group decision-making based on shared experience + data.
  
  

• Internal + affiliated specialty input:
  
  

  • Trauma, cardiology, neuro/stroke, neonatal/peds, critical care/ventilation expertise
    
    

• Repeated point: providers may see one physician, but the system is a composite product.
  
  

Protocol Development: Regional, Collaborative, Standardized

• Northeast Ohio regional protocol described:
  
  

  • Voting members = coordinator + medical director per system
    
    

  • Heavy specialty involvement (example: OB updates included specialists from major systems)
    
    

• Benefit: cross-system standardization so crews from different agencies can work seamlessly together with similar drug boxes/protocol flow.
  
  

OneDose: The Institute’s Decision Support + Communication Backbone

Why UH chose it (origin story)

• Came from a cold call (initially about a cot), passed along; recognized as a powerful prehospital/out-of-hospital decision support platform.
  
  

Key wins highlighted

• Rapid protocol updates pushed instantly to pockets (example: scope change allowing Advanced EMTs to give IV Zofran—live in ~12 minutes).
  
  

• Notifications to reach line clinicians (not just chiefs/coordinators) with real-time operational updates (diversion, facility status).
  
  

• Shift in philosophy: PDF is for printing; the app is the source of truth.
  
  

Decision support tools discussed

• Medication math (weight + concentration aware; emphasizes mL volume safety)
  
  

• EMS calculators: Apgar, Shock Index, GCS (incl. pediatric), maintenance fluids, RASS, Rule of 9s, etc.
  
  

• Checklists: RSI, post-ROSC optimization, high-risk procedure support (with time stamps)
  
  

• CPR Assist: cycle timing prompts, meds, pulse checks—designed to help in short-staffed environments
  
  

• EMAC medication scanning (phone-based):
  
  

  • Verify right med + syringe + volume
    
    

  • Flags out-of-concentration situations and recalculates
    
    

  • Claimed as first-in-country early adopter / beta work in this context
    
    

“Next up” features teased

• AI trained on local protocol content (answers with protocol links, calculators, documents)
  
  

• Knowledge/document center (ERG, device manuals, “what does this error light mean?”)
  
  

• Expanding access to dispatch centers for system-wide messaging
  
  

Contacts feature (surprise “big deal”)

• Searchable contacts with service tags (EDs, medical directors, capabilities)
  
  

• Translation services accessible via the same platform
  
  

• Goal: unify communications across agencies using different ePCR platforms.
  
  

Tone Moments / Quotes Worth Pulling

• “It’s this understood product that the rest of the world should immediately understand.”
  
  

• “It just happens for them—they don’t see what goes on in the background.”
  
  

• “Med math is hard. Division gets everybody.”
  
  

• “Slicker than snot.”
  
  

• “We’re not spamming you—we’re trying to give you only what you need.”
  
  

Operational Takeaways for Listeners

• UH EMS Institute is built around integration: hospitals, transport, service lines, medical direction, education, and technology.
  
  

• Community hospitals are not “lesser”—they are essential nodes that extend specialty care outward.
  
  

• eCPR and prehospital blood are examples of “new frontiers” requiring coordination, training, and reliable activation workflows.
  
  

• OneDose is positioned as the single platform for:
  
  

  • protocols,
    
    

  • decision support,
    
    

  • notifications,
    
    

  • contacts,
    
    

  • and future AI knowledge retrieval.

From The Episode