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May/ June 2001 

Orange County Emergency Medical Services

405 W. Fifth Street, Suite 301A 

Santa Ana , CA 92701

(714) 834-3500

Volume 2, Issue 3 Editor: Barb Andrade, RN

Inside this Issue

1 OCEMS Director Retires Under Construction

2 Code Triage QI Corner

3 EMS Staff June-July calendar 

4 EMS Week Celebration 

5 EMS Week Celebration Pictures "All our dreams can 

   come true if we have the courage to pursue them." -Walt Disney

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OCEMS Program Director Retires By Barb Andrade, RN 

May 31, 2001 CeCe Waite, RN, OCEMS Program Director, retired. We here at OCEMS wish CeCe and Nick Waite the best of luck as they travel to and from Idaho and Arizona. The Waite's plans are to sell their house in Orange, and begin moving essential things to Challis, Idaho. They will be building a barn in Idaho this summer, then will return to Quartzite, Arizona to "Hunker" down for the winter.

The following was a short letter written by CeCe to the EMS community; "It is with both sadness and happiness that I end my career with OCEMS. I have been involved with OCEMS since 1975. Thirty years were spent at Hoag Memorial Hospital as an emergency room nurse— twenty-one of these as an MICN, next as the neuro-resource nurse and finally as the Prehospital Care Coordinator. It was very exciting to have such an active role in the evolution of EMS. It was a more forgiving time – we all made mistakes and learned together. The system has grown immensely over the years. These last five years, spent with the County, have been a refreshing and challenging job change. In my role as EMS Program Director, I have expanded my working relationships to all areas of Orange County which have afforded me the opportunity to meet and work with some very talented and dedicated individuals. I take with me all of the things that you have taught me. It has been both professionally and personally fulfilling for me to help contribute to the EMS System in Orange County. I leave in your very capable hands the difficult decisions to make for the future!"

E mergency M edical S ervices Health Care Agency's

Idaho or Bust OCEMS is in the process of remodeling the front office area. We are still open for business. Just follow the signs to our new entrance. This remodel will help us serve you more efficiently. For questions please call (714) 834-3500. 

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Code Triage By Paul Russell, RN 

Exercise Mania There are more opportunities to test the medical disaster response system than ever before. All three Orange County Multi-Agency Disaster (OCMAD) Nets are in the process of planning an exercise. Plans are also under way for three fall exercises; San Onofre Nuclear Generating Station, John Wayne Airport and the November 15 th Statewide EMS Authority Exercise. There is no lack of a chance to test the system you participate within. However, there is a lack of volunteers for some of these exercises. Orange County is somewhat unique in that it stages many exercises that involve the use of live role-players to simulate casualties. This adds to exercise realism and depth of play. But, it also adds to the challenge of staging a drill. All participating agencies benefit from the mass casualty exercises. Therefore, all participants need to make efforts to solicit volunteers to play the role of ill and injured. Be involved and contribute to the planning process.

MIFEPREX® By Ken Miller, MD 

There has been considerable debate over the ethics and practice of early first trimester pregnancy termination by pharmacologic means. In September 2000, the FDA approved mifepristone (Mifeprex®), formerly called RU-486, for elective termination of early first trimester pregnancy by qualified physicians. It is approved for use in terminating pregnancy of 49 days (7 weeks) or less and is used in combination with misoprostol (Cytotec®).

Mifepristone has both anti-progesterone and prostaglandin effects on the uterus. These effects combine to stimulate uterine contractility and shedding of endometrium. Misoprostol is a prostaglandin analog and has an added effect on uterine contractility. Once pregnancy has been diagnosed by urine test and clinical examination or pelvic ultrasound has ruled out ectopic pregnancy, mifepristone is given orally during an office visit in a single dose. This is followed by another office visit 3 days later. If vaginal bleeding and abortion has not occurred misoprostol is given orally in a single dose. A third office visit about 2 weeks later is scheduled to verify termination of pregnancy. This combination of drugs is effective in terminating early intrauterine pregnancy in up to 97% of women. The drug regimen is expensive (about $300 for the drugs plus office visits). Other dosage regimens are under study. The expected effects of this regimen are the onset of vaginal bleeding and crampy pelvic pain. Bleeding can last about 9-16 days and has been described as slightly more than a heavy menstrual period. Occasionally (about 8% of patients) bleeding can last up to 30 days. Rarely patients have needed a transfusion and about 1% will require curettage to control bleeding. Other common effects are nausea, vomiting, diarrhea and headache. 

EMS Implications: Available clinical information on mifepristone/ misoprostol so far does not indicate a need for change in out-of-hospital approach to calls involving women with abdominal pain, pelvic pain, vaginal bleeding in early pregnancy or vaginal bleeding from other causes. Pharmacologic elective termination of pregnancy is one more differential diagnosis in causes for vaginal bleeding in early pregnancy. Clinical symptoms and signs of hemorrhagic hypovolemic shock should be managed using oxygen and IV saline infusion to correct hypoperfusion. It is important to point out that mifepristone/ misoprostol will NOT terminate an ectopic pregnancy. If ectopic pregnancy is not identified before the drug regimen is initiated, the same risks of hemorrhagic hypovolemic shock from tubal rupture exist. Suspicion of ectopic pregnancy should be managed with the same urgency regardless of other factors.

Keep Your Eyes Open An automatic, noninvasive, glucose monitoring device GlucoWatch Biographer-Cygnus) has been approved for marketing by the FDA. The manufacturer states that it is not meant to replace a regular blood glucose meter.

THE DEVICE-The Biographer is worn on

Schedule of Upcoming Mass Casualty Exercises... By Paul Russell, RN South/ Yellow Net June 27, '01 OCFA Explosion event Metro/ Blue/ North Green Nets Exercise Nov. '01 City of La Habra Unknown

San Onofre Nuclear Generation Station (SONGS) Aug. 8, '01 & Sept. 12, '01 Operational Area (Orange County) Power plant incident

John Wayne Airport Exercise October '01 JW Airport Aircraft accident Statewide Hospital Exercise Nov. l5 '01 All Hospitals Unknown There are a variety of SONGS training classes that are now being offered by the Sheriff's Emergency Management staff at the Emergency Operations Center. Contact Linda Bomberg at (714) 628-7018 to receive a class schedule.

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