In an emergency, advanced training and equipment can mean the difference between life and death. Penn Medicine Lancaster General Health’s (LG Health) new Physician Response Vehicle brings high-tech equipment and medical expertise directly to the scene, with a mission to save the lives of more patients.
Penn Med 1 is a large sport utility vehicle equipped with the same life-saving equipment and supplies as a medical helicopter. It also carries medical expertise: Its driver, Brendan Mulcahy, DO, PHP, is medical director of LG Health Emergency Medical Services (EMS) and an emergency medicine physician.
Mulcahy works collaboratively with Lancaster County EMS personnel to provide advanced therapy to patients at the scene of an emergency. Since May, he and Penn Med 1 have responded to vehicle accidents, cardiac arrests, overdoses, construction site accidents and a serious fall.
Chief Medical Officer of LG Health, Michael Ripchinski, MD, MBA, CPE, said Penn Med 1 reflects LG Health’s long-standing commitment to the community and providing advanced care before patients even reach the hospital. The vehicle is owned and operated by LG Health and is provided as a community service.
“With Penn Med 1, we are essentially bringing hospital care to where our patients need us,” he said. “Our goal is to raise the level of prehospital care available in Lancaster County and improve survival and outcomes for our patients.”
Mulcahy, who joined LG Health in early 2023, trained in the subspecialty of emergency medical services. He is a faculty member in the EMS Fellowship Program within the Department of Emergency Medicine at the Perelman School of Medicine at the University of Pennsylvania.
In addition to his medical training, he has been actively involved in emergency medical, fire and rescue services since the age of 18, first as a volunteer firefighter and paramedic in his hometown. He currently serves in the Pennsylvania National Guard, serving as the 328th Senior Medic.e Brigade Support Battalion.
Penn Med 1 brings advanced care directly to the patient
Typically, when an emergency occurs, fire and rescue personnel first extract a patient who may be trapped – for example, a person trapped under debris during a building collapse – and deliver them to staff emergency services on site for treatment, Mulcahy said. When Penn Med 1 is dispatched, it takes a different approach, called a “physician-led rescue.”
He works alongside EMS staff and they make decisions regarding patient care together. His experience and specialized training allow him to initiate treatment without first moving the patient, even if this means entering a collapsed building or other confined space.
“We found that providing earlier and more aggressive care directly to the patient can significantly improve outcomes for that patient,” he said. “As an EMS-trained emergency physician, I can perform many of the specialized procedures performed by our trauma surgeons, except in austere environments. »
For example, Mulcahy has the training to perform a field amputation or emergency cesarean delivery when the mother has died but the child may still survive. Penn Med 1 carries advanced life support equipment, a hospital grade ventilator and a LUCAS machine for mechanical chest compressions. It also carries two units of whole blood for on-site transfusions, which are not typically available on EMS vehicles.
Additional features include a “doctor bag” with chest tubes, arterial and central lines; an ultrasound unit; a safe for storing controlled substances; a heart monitor; and equipment specifically designed for pediatric patients. A pop-up whiteboard is available when establishing an incident command becomes necessary. Mulcahy has witnessed several cardiac arrests in which advanced therapies available in the vehicle, such as ultrasound, changed the way on-site providers managed the patient’s care.
“When we all work together, we save lives”
In addition to field response, Mulcahy uses Penn Med 1 to provide training to local police, fire and emergency medical services providers. While teaching tourniquets and bleeding control, it also demonstrates the vehicle’s capabilities.
Edward T. Dickinson, MD, director of EMS field operations for Penn Medicine, said that while Penn Med 1 is impressive, Mulcahy’s wisdom and skills are a greater asset in an emergency than any piece of equipment.
“The biggest benefit is having expert hands, eyes and ears to assess the scene and support the EMS team,” he said. “When you call an EMS medic on scene, there’s nothing they can’t do to help you.”
Mulcahy is trained to handle a difficult intubation or triage the injured during a mass casualty event. But it can also encourage an exhausted paramedic to take a break or comfort a distraught team after a difficult loss.
Dickinson, who is also director of Penn Medicine’s new EMS Fellowship, one of only a handful of such programs in the country, said Penn Med 1 is just one piece of a comprehensive approach to improving pre-hospital care throughout the health system. How this care is delivered varies based on local geography, patient populations, and EMS resources, among other factors.
A medical response vehicle is ideal for a community like Lancaster County, where there is often a need for rapid access to rural areas and a more dispersed population. Similar vehicles could be added elsewhere in the health system, if they are determined to be a valuable support to that particular community’s EMS system, he said.
“Wherever an emergency occurs, Penn Medicine EMS medics are there to use our training and expertise to support and work collaboratively with the local EMS community,” Dickinson said. “There is no doubt that when we all work together, we save lives. »
