Yale Medicine physicians working with Yale New Haven Health serve a greater metropolitan region of about 400,000 residents. As part of an academic medical center, the Yale Medicine Department of Emergency Medicine does far more than receive patients, says emergency medicine specialist David Cone, MD.

Its expertise guides EMS teams, innovating treatment protocols to ensure the best care for patients from the moment they dial 911 to the day they return home from a hospital visit.

Yale Medicine serves as a link between its physicians and the 23 regional EMS agencies that support New Haven and 11 surrounding towns. Its team is responsible for ensuring the quality of medical care provided by close to 1,000 emergency workers. “We do a lot of teaching for the paramedics, and assist the agencies with the quality management,” says Dr. Cone. “That makes for a better, stronger system.”

When a call comes to 911, a local dispatcher will send an ambulance to provide on-site treatment and, if needed, take the patient to the closest Yale New Haven Health center. Once the paramedic and patient enter the emergency department, the information exchange begins. “The paramedic will say, ‘I’m pretty sure this is what’s happening,’ ” says Dr. Cone.

From there, a “verbal handoff” starts. “Most of the time, emergency physicians meet EMS staff and run the show,” he says. But if a condition needs specialty attention—if it may be a stroke, for example—then the relevant multidisciplinary teams will be called to the emergency department.

“Most of the research that drives big and sophisticated changes in emergency treatment comes out of academic medical centers like ours,” says Dr. Cone.

An example is continuous positive airway pressure (CPAP) treatment, a procedure to keep airways open that was once used only in the hospital, but is now used by paramedics in the field. “We never used to use CPAP for respiratory problems in the field,” he says.

EMS technicians now also use such mechanical CPR devices as the LUCAS chest compression device, which Dr. Cone says “do a better job at CPR than people.”

Yale Medicine also pioneered the approach of taking patients suspected of having heart attacks directly to the cardiac catheterization laboratory—where interventions can be performed to reverse a heart attack—rather than to the emergency department. “We started doing that in May of 2010,” Dr. Cone says. “It’s now a widely accepted practice.”

Yale Medicine’s prehospital emergency medical services participate in Yale New Haven Health’s SHARP (Sponsor Hospital Area Response Physician) Team program. The only physician response team in the state of Connecticut, SHARP has two response vehicles, six physicians, and two physician assistants who can respond to a serious event.

The team provides expert guidance in such serious or large-scale events as a plane crash, a trench collapse, or a terrorist attack. While most people will never see the team, SHARP is a backstop for the EMS teams in times of crisis. "Usually by the time we get there, the local EMS responders have solved the problem,” Dr. Cone says. “But they may want us to look at the patient, ride in the ambulance, or provide general advice.”

SHARP provides opportunities for EMS teams and new doctors to learn by doing, Dr. Cone says. “Most fellowship training programs have some field response program like this,” he says. “We are training the next generation of EMS physicians.”

While all emergency department physicians interact with EMS teams, at Yale Medicine the approach is atypically collaborative, says Dr. Cone. "The physicians that provide the medical oversight are more involved in the EMS system—more directly hands on,” he says. “We want to make sure that the medical direction is really helping the system.”