Emergency Medicine by Alexandros G. Sfakianakis: Απριλίου 2016

Σάββατο 30 Απριλίου 2016

When the fan leaves the shit... Norway: detached rotor blades spin in air...

Total loss, 11 found, 2 corpses missing. Time to redo that EC225 Gearbox/Main rotor shaft, i think... R.I.P. Grounded, again ( Norway, U.K. ( World wide i hope... )) ( SAR machines can still fly, on life saving missions ) Airbus FIX IT, OR KILL IT ..! You can better then this ! Why let this machine ( SuperPuma 225 ) ruin your exelent rep. ? ExEMTNor

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When the fan leaves the shit... Norway: detached rotor blades spin in air...

Medical Staff Associate - CSL Plasma

CSL Plasma is seeking FT Paramedics to join our Medical Staff Associate Team in our Oklahoma City facility. We offer competitive salary, great benefit package which includes medical, dfental, 401K, career advancement opportunities, tuition reimbursement, and 3 weeks vacation the first year. Apply on line at CSLPLASMA.COM

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When the fan leaves the shit... Norway: detached rotor blades spin in air...

Total loss, 11 found, 2 corpses missing. Time to redo that EC225 Gearbox/Main rotor shaft, i think... R.I.P. ExEMTNor

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Ohio responders get lesson in American Sign Language

Some of the words included pain, where, doctor, medicine, breathe, stop, yes, no, hospital, emergency, firefighter and ambulance

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Παρασκευή 29 Απριλίου 2016

Braun Ambulances Debuts First Rollover Ambulance Crash Test

Braun Industries teamed up with CAPE Testing to conduct the Fire/EMS industry's first rollover ambulance crash test. They crashed a 10 year old unit in a test that most closely compares to the anticipated SAE J3057. The test focused on the modular body and roll impact loading, or how well the box holds up in the event of a rollover.

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Braun Ambulances Debuts First Rollover Ambulance Crash Test

EMS OFFICER I-Paramedic - Durham County EMS

Performs responsible work in rendering emergency and non-emergency medical care and life-saving measures to critically ill or injured persons of all ages on basic and advanced life support levels. Requires successful completion of the North Carolina State Emergency Medical Services training program or an equivalent training program. Employment is contingent on passing a assessment center, physical agility ...

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Inside EMS Podcast: Why EMS needs to get back to helping people

Download this podcast on iTunes, SoundCloud or via RSS feed

In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson talk about the week's news, including EMS employees claiming an ambulance company took their paychecks, a dispatcher that obtained patient information and allegedly assaulted that patient and workplace bullying and harassment after firefighter-paramedic Nicole Mittendorff died by suicide.

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Quick Clip: Bullying and workplace harassment in EMS

Download this quick clip on iTunes, SoundCloud or via RSS feed

In this week's Quick Clip, co-hosts Chris Cebollero and Kelly Grayson discuss the subject of bullying and workplace harassment after Nicole Mittendorff, a firefighter-paramedic with Fairfax County Fire and Rescue, died by suicide. The news comes on the heels of concerns that she was a victim of bullying.

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500lb Patient Calls Big Lake Texas EMS Over 30 Times for Lift Assistance

Big Lake, TX: The Situation: An obese 62 y/o male patient exhibited all the classic signs of needing professional care, but refused to leave the comforts of his home. As a result, he suffered from poor hygiene and lacked the ability to get up on his own after falling. There were days when he would call Big Lake EMS multiple times for lift assistance. “We have some pretty strong guys that work ...

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Parents want CPR training to be mandatory for Michigan students

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Inside EMS Podcast: Why EMS needs to get back to helping people

Download this podcast on iTunes, SoundCloud or via RSS feed

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What is the appropriate discipline for driving 17 mph above the speed limit?

The news of an ambulance caught speeding on an interstate highway points to another unwinnable situation for field providers. Is it reasonable to expect any ambulance crew to drive with due regard, rapidly deliver a patient, quickly return to the service area, not rack up overtime and perfectly represent the agency"

The video of the ambulance driving on Interstate 24 toward Nashville appears to be filmed by an opportunistic news crew from WKRN. The reporter uses the video to play a game of "gotcha" with the county EMS director.

As I watch the video, I see an ambulance moving through moderate traffic on a multi-lane highway on dry roads, with clear sky overhead and being passed by some passenger vehicles while passing others.

After viewing the video and analyzing the vehicle data, the EMS agency suspended both crew members without pay for an unreported amount of time.

Do you think the crew members are bad people caught in the act of a bad behavior"

I don't think so. Just culture leads me to believe that they are good people making decisions based on the systems and culture within which they work.

What we don't see or hear in the news report are possible explanations for the ambulance being driven up to 87 miles per hour. I am not excusing the behavior, but four unanswered questions quickly came to mind.

Are there organizational forces at play that lead personnel to believe it is OK to drive 15 to 20 miles per hour above the speed limit"
Was the crew being held over their shift end time and driving fast to complete a long distance transfer so they could start their time off"
What was the call volume in their response area and were they feeling urgency or pressure to complete the transfer so they could support their colleagues"
What is the department's policy for lights and sirens use on the freeway" Some departments don't use red lights and sirens on the freeway.

I also have a question for the news crew. Did they call 911 to report the speeding ambulance" If the ambulance posed a danger to civilians on the road, the news crew's first obligation should be to the safety of its audience — not trying to get a scoop.

Discipline needs to exist on a continuum with consequences appropriate to the infraction, consistently applied and communicated through training and policies. Were all of the personnel of this agency aware that driving 17 miles per hour over the speed limit punishable with an unpaid suspension" Or is this incident in the "they should have known better" category"

I haven't driven 115 miles per hour since I was 16 and I have been driving slower ever since. My speed decreased as my knowledge, experience and awareness of others increased. As you operate any emergency vehicle, remember as the vehicle's speed increases you have less time to react, vehicle stability decreases and it takes more road to slow or stop.

I want to hear from you in the comments. Is this a punishable offense" Explain why or why not. And how would you have handled this media-driven caught in the act incident"

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ASSISTANT CHIEF-CLINICAL AFFAIRS - Durham County EMS

As one of North Carolina’s fastest growing EMS agencies, we are seeking an experienced paramedic clinician and educator for the position of Assistant EMS Chief – Clinical Affairs. The successful candidate will be responsible for leading the department’s clinical improvement and enhancement efforts, and will provide significant input and leadership to our in-house education and training ...

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Parents want CPR training to be mandatory for Michigan students

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Parents want CPR training to be mandatory for Michigan students

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Mich. lawmakers urged to make CPR training mandatory for high school students

Thirty-one states have already passed laws requiring students to learn CPR before they graduate

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Editorial: Newborn's death reveals dispatcher shortage

Parents of a 3-day-old baby, bitten by the family dog, drove their baby to the hospital themselves after two 911 calls went unanswered

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Parents want CPR training to be mandatory for Michigan students

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Πέμπτη 28 Απριλίου 2016

Instructions for Authors

Publication date: May 2016
Source:The Journal of Emergency Medicine, Volume 50, Issue 5

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Endovascular Therapy Is Effective and Safe for Patients With Severe Ischemic Stroke

Publication date: May 2016
Source:The Journal of Emergency Medicine, Volume 50, Issue 5
Author(s): Jennifer Zhan

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Association Between Use of Oral Fluconazole During Pregnancy and Risk of Spontaneous Abortion and Stillbirth

Publication date: May 2016
Source:The Journal of Emergency Medicine, Volume 50, Issue 5
Author(s): James M. Tsahakis

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Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis

Publication date: May 2016
Source:The Journal of Emergency Medicine, Volume 50, Issue 5
Author(s): Jacob Nacht

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Oral Fluoroquinolones and the Risk Of Uveitis

Publication date: May 2016
Source:The Journal of Emergency Medicine, Volume 50, Issue 5
Author(s): Jacob Nacht

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Family Perspectives on Aggressive Cancer Care Near the End of Life

Publication date: May 2016
Source:The Journal of Emergency Medicine, Volume 50, Issue 5
Author(s): Allison Ashley Harris

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Brugada Phenocopy or Unmasked Brugada Syndrome? Relevance of the Provocation Test

Publication date: May 2016
Source:The Journal of Emergency Medicine, Volume 50, Issue 5
Author(s): Usama Boles, Adrian Baranchuk

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The Emergency Physician's Role in Differentiating Brugada Syndrome from Brugada Phenotype

Publication date: May 2016
Source:The Journal of Emergency Medicine, Volume 50, Issue 5
Author(s): Jason Ondrejka, Gary Giorgio

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Fat Emboli Syndrome in a Child with Duchenne Muscular Dystrophy After Minor Trauma

Publication date: May 2016
Source:The Journal of Emergency Medicine, Volume 50, Issue 5
Author(s): Loretta Stein, Richard Herold, Andrea Austin, William Beer
BackgroundFat embolism syndrome is the result of systemic manifestations of fat emboli in the microcirculation. Duchenne muscular dystrophy is a condition that increases the risk of fracture resulting in fat emboli.Case ReportWe describe a patient with Duchenne muscular dystrophy who exhibited cardiopulmonary, neurologic, and ophthalmologic sequelae consistent with fat emboli syndrome after minor trauma.Why Should an Emergency Physician Be Aware of This?Fat embolism syndrome is a rare but important consideration with significant morbidity and risk of mortality in patients with Duchenne muscular dystrophy after even minor trauma. Early recognition and aggressive resuscitation are crucial to positive clinical outcomes.

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What it takes to be an EMT

In the first episode of this small online series, we meet Gabe. Learn how Gabe went from a small town volunteer EMT to a Navy Corpsman and emergency dispatcher. What journey will you take?

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Ambulance rollover crash test video

What it takes to be an EMT

Ambulance rollover crash test video

Is adding paid staff to a volunteer agency the beginning of the end or the start of a new future?

Is adding paid staff the beginning of the end for your volunteer agency"

Or is it an opportunity to make your service better, stronger, faster and smarter"

The answer to these questions depends on how the decision to integrate career personnel into your organization is arrived at and managed. What may initially seem overwhelming or an admission of defeat is in reality the opportunity to build a stronger, better, faster, smarter volunteer EMS agency with the capability to provide reliable and excellent medical response to your community.

Commitment to the community
If your agency is considering supplementing volunteer EMT and paramedics with paid EMS providers, chances are good that you already recognize one or more of these problems:

The schedule is not filled for every shift, every day.
You are passing calls or abusing mutual aid agreements.
Multiple tones are needed to scramble a crew resulting in response delays.
The core group of responders is getting discouraged, resentful and burned out.
Members have begun to rationalize that occasional failed responses are OK or normal because the surrounding towns have the same problem.

If any of these are true for your department, it is time to get help with staffing.

Failure to do so because of pride, tradition or fear of outsiders staffing the ambulance does not excuse a volunteer service from failing to provide the safety net it has committed to providing the community.

Taking responsibility for employees and the community
Many volunteer ambulance agencies and rescue squads began generations ago with little or no formal planning. Often bylaws, policies, leadership roles and culture have developed piecemeal over the years.

As a result, the organizational structure has likely been built on personalities and emotion rather than sound business principles. The informal, often clannish nature and sometimes questionable operating practices of some agencies may have worked 80 or even 20 years ago with the respect and support of a grateful public, but the world and EMS has changed dramatically. EMS will continue to change at light speed.

As your volunteer agency moves forward with adding paid staff, it needs a clearly defined mission statement, vision statement or strategic plan for the near and distant future. These documents are a foundation that must now be in place to effectively run a modern EMS organization.

Your agency will from now on be in the business of saving lives and providing for the livelihood of EMTs who have chosen to make EMS their vocation. This is a responsibility not to be taken lightly, and the groundwork needs to be in place to manage this change successfully.

Making the transition to paid staff successful
The first step is to hold a special meeting of your members with mandatory attendance. Insist on polite and respectful discourse and stick to the facts:

There must be scheduled coverage 100 percent of the time.
Adding paid staff is the morally and ethically responsible thing to do for the community when volunteer participation alone cannot accomplish this.

To achieve buy in, every member must have a voice. If decisions about major changes, including staffing, are made by officers or a board of directors without the input of the membership, there is exactly zero hope of successfully implementing those changes, and likely no hope of salvaging the organization as a volunteer effort for any length of time. Resentment, conflict — a hostile us versus them environment — and the continued attrition of volunteer members is the probable result.

"The most important thing in communication is to hear what isn't being said."
— Peter Drucker

A new beginning for the department
This is a perfect opportunity to reimagine, rethink and redesign your volunteer agency. Strong leadership will be needed to guide the conversation towards focusing on the positive. Ask, "What do we want for the future"" not on, "How do we avoid what we don’t want""

Ask your members to answer the following questions:

In a perfect world, how will your volunteer squad operate"
What is preventing a perfect vision from happening today"
What is the department's role — 911 response, education and prevention, community outreach — in the community"
What traits and characteristics are you seeking in new paid staff, as well as new volunteers"
What qualifications are required for paid position applicants"
Who should lead the new paid staff" Why"
How can the department take advantage of the opportunity provided by bringing experienced and career-oriented EMS providers in-house to help make those changes"

Focus on creating a partnership
Bringing in the right people is critical to the future success and stability of your squad, regardless of pay status. Be thoughtful, focused and deliberate with the job description and interview process. Look for applicants who will have the patience and experience to mentor new recruits and bring confidence to part-time volunteer members.

Consider hiring a crew chief or operations manager who can provide shift coverage and take care of day-to-day administrative functions including scheduling, inventory management, equipment checks, in-service training and chart review for continuous quality improvement. Having the daily operations taken care of will take a big load off of the volunteer members who have been running the business part-time, and allow those members to focus on the patient care aspect that they originally signed up for.

Be proactive in adding paid staff
Make the decision to add paid staff before being forced to by a sentinel event. Panic hiring just to put meat in the seat because a response failure resulted in a poor outcome or death of a patient, will send your department down a rabbit hole of chaos, shame, resentment and possibly financial ruin.

Managing the change deliberately with a positive outlook, and the support of the membership and community will prevent the division, morale issue and human resource problems that can plague this initiative. Intentionality also honors your department's commitment to the safety of the community.

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Scheduling EMS personnel: 5 best practices for paramedic chiefs and HR managers

The shift schedule for EMS personnel is one of the most important, vital and often overlooked aspects of EMS operations. It determines an agency’s ability to effectively provide service, it sets call receiver and dispatcher expectations of resources available to respond and it has a direct impact on the morale of providers.

In order to make the most out of your agency’s schedule to benefit the organization, the patients it serves and the providers, here are five best practices for scheduling EMS personnel.

1. Clearly communicate the schedule
While communication plays a vital role in everything that we do, clearly communicating the schedule is essential. The schedule should be accessible to agency management, operation supervisors and especially the providers so that they actually know when they are expected to be on shift.

The easiest way to accomplish across the board accessibility to the schedule is to use an online scheduling application. There are many systems available, some geared specifically for the EMS industry and others that are more generic.

If your agency continues to do scheduling via spreadsheet programs or by hand, communicating that schedule is both harder and time-consuming but must still be done. Make sure to follow a consistent and predictable schedule to announce the schedule, accept change requests, grant schedule changes and to announce the final schedule.

Although tedious and time-consuming, this will ensure that your schedule has been communicated, that your providers know what is expected of them and most importantly that everything has been documented should an issue arise down the road.

2. Have the schedule ready in advance
Having a schedule available in advance has benefits for both the agency and the provider’s planning purposes. An agency can plan for resource management, such as the number of vehicles needed on any given day and time, which allows vehicles to be scheduled for preventive maintenance and downtime. A provider can plan for childcare, class schedules or some much-needed sleep.

How far in advance the schedule can be set and available to providers depends on agency operations. Agencies with hyperdynamic scheduling, where every week is different than the week before, will at best be able to schedule a week in advance. Agencies that divide their scheduled resources between core always available units and flex units to dynamically cover special events or peak demand times will be able to schedule their core units two weeks or more in advance and add the flex units as needed. Agencies that have a set schedule with few changes can schedule a full month or more in advance.

3. Consider provider preferences
Provider preferences play a large role in both the ability to provide service and the quality of that service. Managers should be looking to make things easier, not harder, for everyone involved.

Knowing your provider’s preferences will make scheduling easier for you, makes their ability to balance the things outside of work easier for them, and that makes coming in for their shift more enjoyable for everyone. Not taking their preferences into consideration can lead to poor morale, a negative disposition towards the agency, more work for the scheduler and directly result in a poor quality of service that they provide.

Shift trading is a common occurrence in EMS. If your agency allows shift trades, make sure to approve or deny the trade as soon as possible. The same applies to when someone requests time off. There is a reason they are requesting the time off or looking to trade the shift. Not knowing whether a request has been approved can result in both unnecessary anxiety for the provider and a harder time covering the shift from the operational end.

In a hyperdynamic scheduling model, it is important to set the deadline for the submission of provider availability. Make sure this deadline and what is expected of it is clearly communicated to everyone. Provide friendly weekly reminders of the deadline. Once that deadline is set, stick to it and make the schedule available on time.

4. Prioritize agency needs
The needs of your agency must be prioritized. Is it more important to cover a shift or manage overtime" Can two providers from last week’s orientation class work together or are experienced providers being paired with new providers for a certain length of time or hours"

Once you fully understand what your agency has as the main priority, you can better adjust the schedule to ensure those priorities are met. Create a scheduling priority matrix or flowchart and communicate it to operational staff and management. This will help provide consistency in scheduling during all hours by the operational team.

Deciding par levels of unit resources will also help to establish the base number of resources your agency needs. Define what the levels are and at what point going below those levels triggers an agency-wide alert. This internal state of emergency can result in a number of actions to help rectify the situation, including mandating employees to stay past their scheduled shift end time.

If you find that you are mandating your employees to stay past their scheduled end time greater than 10 percent of the time, this is perhaps an indicator that you need to revisit your base schedule and make adjustments. While mandating is an option, it should be used sparingly since doing so often results in lower morale, frustration, and general anger from the providers who it affects. Low morale can manifest as sub-standard customer service, higher absentee rates and a lack of efficiency.

5. On-call lists
Life happens, even to EMS providers. Sickness, doctor appointments, court dates, childcare issues and sudden situational emergencies will happen over the course of time. When they happen at an EMS agency the effect can be disastrous in terms of being able to meet response times and other metrics that measure the agency’s performance.

To fill vacancies quickly, maintain an on-call list of personnel who are not scheduled to work, but able to cover a shift if needed. The list should be accessible to anyone on the operational end to utilize.

What are your best practices for EMS provider scheduling" Share your ideas and questions in the comments.

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Scheduling EMS personnel: 5 best practices for paramedic chiefs and HR managers

Follow these scheduling practices to improve provider morale, patient care and operational efficiency

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What it takes to be an EMT

Ambulance rollover crash test video

What it takes to be an EMT

Ambulance rollover crash test video

Medical supply inventory management systems for EMS

Today’s complex EMS environment requires administrators to constantly juggle issues like tightening budgets, drug shortages, strict governmental regulations and a highly engaged and connected staff — all while operating in a litigious society. Using yesterday’s approach to inventory management and supply and logistics is no longer an acceptable practice [1].

There are several significant aspects to automated inventory control and management for today’s EMS agencies, in both the public and private sectors. Having a reliable, effective and efficient inventory management system can help an organization reduce costs, limit waste, improve employee relations and limit liability. It can also positively impact patient care by having the right supplies and drugs available when needed [1].

For some time now, private-sector EMS agencies have used automated solutions to improve their fiscal bottom line by reducing costs and limiting waste. Increasingly, public-sector EMS agencies are seeing a similar need as their local funding from government or donations from stakeholders have declined or remained stagnant.

EMS agency leaders cannot continue to rely on emotional appeals to their stakeholders to justify their fiscal needs. The trend in local governments is for transparency and accountability to show taxpayers where and how their money is being spent [1].

EMS agencies across the board are also facing more demanding requirements for reimbursement from medical insurance companies, Medicare and Medicaid for the supplies and drugs used when rendering patient care. The health care environment is rapidly changing with reduced reimbursements, new government regulations and an increased focus on compliance. This added complexity makes managing billing and coding in house much more challenging [2].

Inventory control and management software benefits
Current and developing technologies in ICM can enable EMS agencies to improve both their efficiency and effectiveness in a variety of ways including, but not limited to [3]:

Preventing medical inventory from expiring or being overstocked
Centralizing inventory control among departments and vehicles
Improving EMS medical staff productivity and performance
Ensuring that every ambulance is fully equipped with life-saving medications and devices
Logging the movement or usage of medical inventory

Inventory control to prevent narcotics diversion
Diversion is the theft of any pharmaceutical to be sold or traded for personal gain. Resale of narcotics is not limited to common street crime but also can involve Medicare fraud, theft from other providers, organized crime and a host of other crimes [4].

In its simplest form, detection of the loss of pharmaceuticals is a basic inventory control function. The three variables are replenishment of warehouse or central inventory, documented usage, and replenishment of in-station or in-ambulance inventory. Depletion of inventory is fairly predictable over time and can therefore be forecast as well [5].

Here is a common sense, simplistic example of monitoring inventory: You order what you use. There is no reason to order anything more than at the rate you use it and by using percentages of increase, the variances become highly recognizable. Use percentages because in drug inventories, units may not raise a flag [5].

For example, an increase of 10 units of morphine in this months requested inventory for Station #6 may not seem out of line compared to the stations ordering history, but if those 10 additional units of morphine represent a 15 percent increase over what’s previously been ordered each month that might be cause for a closer look.

Electronic tracking of supplies
Barcoding has become the basis for the majority of ICM systems on the market today. A barcode-based system streamlines the process by enabling an agency to track the life-cycle of any item: from the initial receipt of an item at the warehouse; the distribution of the item into the supply chain such as sending it to a specific EMS station; use of the item for patient care. Key inventory management and control functions that lend themselves to barcoding include [5]:

1. Managing Inventory of Standard Medical Consumables
Keep it simple by barcoding and tracking standard inventory items by location, number and quantity. Track a variety of standard stock inventory like bandages, gauze, and more.

2. Tracking Medication Inventory
Categorize medication using batch-lot numbers to efficiently and effectively keep track of expiration dates. Having an accurate picture for medication ins and outs, as well as on-hand quantity and reorder levels, can ensure that each EMS vehicle has the right medication inventory on board when an emergency strikes.

3. Serialized Inventory Tracking
Track chemicals and oxygen tanks individually using serial numbers to meet government mandated requirements, and to better prepare yourself when serialized inventory items are needed.

Electronic medication dispensing systems
Cart-mounted electronic medication dispensing systems, also known as med carts, have been a fixture in most medical facilities, such as hospitals and nursing homes, for many years and are now making their way into the EMS realm. Keeping medications under lock and key is an inventory security control measure for sure, but it’s not an effective strategy for managing and controlling how those medications are used.

Electronic medication dispensing systems provide benefits for both EMS providers and managers. Providers benefit from:

Secure, automated access to narcotics and supplies
Better adherence to controlled substance policies
Intuitive and easy-to-use software to accurately and completely document usage
Integration of usage into the patient care/billing report

The management/ownership benefits of an electronic medication dispensing systems include improved:

Compliance with state and DEA regulations for medication storage and dispensing
Inventory control and dispensing of narcotics
Control of EMS provider access rights
Inventory tracking and documentation of drugs used in patient care
Billing accuracy for medications used in patient care

Biometric security
One of the top components of inventory control and management is biometric security, which uses an individual’s biometric finger print to verify all transactions. This prevents someone from making false transactions or supervisors or managers having to make sense of illegible paper signatures. For added speed and security the biometric reader can also be used to login to inventory control software.

Beyond paper-based data collection and information management
In addition to inventory control and management, today’s electronic information management systems for EMS operations can include a host of other data collection and reporting features that improve an EMS agencies efficiency and effectiveness. One example is performing vehicle inspections with an electronic check sheet. If the inspection check sheet is integrated with inventory management and fleet maintenance software it can greatly enhance an agency’s operational intelligence. By replacing time-consuming paper check sheets crew members can be more accountable for supplies and equipment. All information captured during the inspection processes can be used to manage and report on an agency’s operations performance and needs [6,7].

Another example is the use of a web-based inventory check sheet to conduct inventory of on-hand supplies. Expiration dates on medical supplies are also captured to ensure that inventory is safe and ready for administration. On-hand inventory is balanced against par stocking levels to automatically generate supply requests. Optimally those supply requests are sent electronically to the supply room and processed based on an agency’s operational procedures.

Asset verification
The equipment used by EMS providers to provide patient care, particularly biomedical equipment such as defibrillators and medication pumps, represent a significant financial investment by the agency. Keeping track of that equipment as it moves through the operation is a critical risk management activity.

Electronic asset tracking enables end users to verify that equipment checked out to a station or vehicle is indeed at the location or report the missing equipment. If equipment is subsequently located, they can add it to their inspection and automatically transfer ownership to the new location or vehicle allowing missing assets and assets in motion to be recovered. If an asset requires maintenance the user can also record the maintenance while in the field using the check sheet.

Logging supplies by call
Using electronic reporting also enables the EMS provider to capture the supplies used on a per call basis. Crew members can enter the run number or ePCR number and enter the supplies used on the call. Once completed, the vehicle's inventory is updated and a supply request is created. These electronic call records can later be used to report on supply usage and matched up with an agency’s ePCR records for quality assurance reviews.

General inspection questionnaires
Electronic reporting programs on the market today enable an agency to create customized questionnaires for any type of location or equipment inspection. These questionnaires are a basic element to any inspection process and provide supervisors and fleet managers with timely alerts on anything from narcotics usage to vehicle mileage and repair orders.

Fleet management integration
Fleet managers can receive information from electronic reporting check-sheets that will provide them with vehicle mileage, operating hours and any repair orders in real time. This makes planning scheduled maintenance and handling off-schedule repairs much easier.

Before you get started
Before purchasing any software vendor's product, it is useful for an agency’s leadership to conduct a self-assessment to answer some key questions.

Why do we need to collect and analyze data"
What data should, or must, be collected"
Who will be responsible for entering the data"
How will the responsible parties enter the data"

These are important internal assessment questions. Far too often software purchasing decisions are made by those in leadership or technology positions within an organization without much thought about one of the most important components in any automated system: the end user who needs to integrate use of the software with their primary mission of patient care.

A majority of the data that most EMS agencies need to collect and analyze for their ICM originates at the level in the organization where the services get delivered. The earlier in the process that an agency’s managers gain input from these stakeholders, the greater the chance that whatever reporting software is eventually chosen will be the right one.

References

1. 4 ways to better manage EMS inventory http://ift.tt/1lsIMUO

2. Avsec, R. 5 steps to buying fire department reporting software. FireRescue1.com http://ift.tt/1zEy4G7

3. McKesson. EMS Medical Billing & Revenue Cycle Management. http://ift.tt/1SvEeQV

4. ASAP Systems. Barcode Inventory System for Fire Rescue & EMS. http://ift.tt/24mRbAr

5. nMed. Prescription Drug Theft & Pharmacy Security. http://ift.tt/1SvEgIr

6. ASAP Systems. Barcode Inventory System for Fire Rescue & EMS. http://ift.tt/24mRbAr

7. OperativeIQ. Electronic Check-sheets. [Available on-line] http://ift.tt/24mR9Zz

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Pharmaceuticals in EMS: Are you compliant?

Today EMS agencies EMS agencies purchase pharmaceuticals from a variety of sources [1]. Whether you purchase/ obtain your pharmaceuticals through a hospital, wholesaler/ distributor or other entity, it’s important to know your responsibilities in ensuring the integrity of the pharmaceutical supply chain as well as ensuring you are in compliance with State and Federal Regulations.

Before 2013, EMS services were not considered part of the pharmaceutical supply chain and were generally beyond the radar of the U.S. Food and Drug Administration. However, due to the Drug Supply Chain Security Act requirements, EMS entities are now considered an accountable part of "dispenser-to-first-responder transactions" and subject to DSCSA requirements [2,3]. Although EMS can continue to purchase drugs and supplies from most of their previous vendors, certain track-and-trace documents need to be maintained.

The Affordable Care Act has mandated numerous pharmaceutical-related regulatory changes that affect EMS and the Medicare ambulance community. These changes include [4,5,6,7]:

State-driven Medicaid requirements
Increased monitoring of ambulance billing suggested by the Office of the Inspector General at the U.S. Department of Health and Human Services
Ambulance claims processing changes from the Centers for Medicare Services
Requirements of Drug Quality and Security Act and the Drug Supply Chain Security Act
Requirements of the International Statistical Classification of Diseases and Related Health Problems or ICD-10 diagnosis codes

Implementing the DSCSA requirements likely remains a challenge for many EMS agencies. Conveniently, some components of the required DSCSA provider-level documentation correlate with the recent ICD-10 diagnostic code documentation recommendations, which also affect EMS reimbursement.

What is the DSCSA"
On November 27, 2013, the Drug Quality and Security Act became law. Title II of the DQSA, the Drug Supply Chain Security Act mandates new definitions and requirements related to pharmaceutical product tracking and tracing [5,8,9]. Product tracing includes identifying transaction information for each drug while tracking includes keeping records for six years of those entities that have been in possession of the drug starting with the manufacturer to wholesale distributors to dispensers including EMS services [5,8,9].

The intent of the law is to enhance the FDA's ability to protect consumers from exposure to drugs that may be counterfeit, stolen, contaminated, or otherwise harmful by improving detection and removal of potentially dangerous drugs from the drug supply chain to protect patients. The development of the system will be phased in with new requirements over a 10-year period [5]. The market has responded by offering many software programs to help all parties in the pharmaceutical chain achieve compliance.

How can EMS agencies maintain DSCSA compliance"
EMS agencies can only accept ownership of a prescription drug if the previous owner — wholesale supplier or distributor — provides an official transaction report. These transaction reports must be maintained for six years. In most cases when an EMS entity purchases a medication, the wholesale supplier will provide the transaction report in the shipment. Since the supplier must also keep copies of the report, if an EMS agency misplaces a report they should be able to contact the supplier for another copy. This mandate may be problematic for EMS agencies with limited administrative capacities or financial resources.

Details required to be provided on a transaction report include the:

Proprietary or established name or names of the
Strength and dosage form of the product
National Drug Code number of the product
Container size
Number of containers
Lot number of the product
Date of the transaction
Date of the shipment, if more than 24 hours after
Date of the transaction
Business name and address of the person from whom ownership is being transferred

In addition to the transaction report a transaction statement is a paper or electronic form which documents that that the entity transferring ownership in a transaction:

Is authorized as required under the Drug Supply Chain
Received the product from a person that is authorized as required under the Drug Supply Chain Security Act
Received transaction information and a transaction statement from the prior owner of the product, as required under section 582
Did not knowingly ship a suspect or illegitimate product;
Had systems and processes in place to comply with verification requirements under section 582
Did not knowingly provide false transaction information; and
Did not knowingly alter the transaction history.

EMS services can only purchase prescription drugs from a supplier that has a federal and state license. Drug suppliers must be licensed in the states that they ship into. A supplier holding a license in their home or headquarters state doesn’t necessarily mean the supplier can ship drugs into other states.

Before purchasing medications from a supplier verify the supplier's licenses. License verification, by state, is available on the FDA Verify Wholesale Drug Distributor Licenses website.

Also, each EMS agency must also have on file a copy of their medical director's Drug Enforcement Administration license to purchase drugs and a vast array of other drug administration related supplies from the licensed vendor. This requirement affects all training entities. If a training entity, such as a college, university, or private school, wishes to purchase intravenous supplies, simulated medications, or even normal saline for the sole purpose of education, they must produce for the vendor the same required documentation.

EMS agencies should carefully order only the pharmaceuticals they need. Although it is near impossible to use all stored medications before they expire, ordering more than is needed is costly. Due to the DSCSA requirements, most suppliers are expected to not allow returns of prescription drugs [8]. Returning unused medications may be allowable for hospital-based EMS systems in which drugs are obtained from the hospital's own pharmacy service.

However, regardless of the EMS system, a tracking system must be in place to trace where the drug went once it was received from the distributor. In most cases the drugs will either be in a storage room, on an ambulance, or in another vehicle such as a supervisor's vehicle. Although some of the DSCSA requirements remain unclear, many EMS agencies are also preparing to track the administration data of each drug, such as who administered the drug, when — date and time and to whom it was administered, and from what ambulance it was dispensed.

The role of the field care provider
EMS field providers can assist with drug tracking-and-tracing by implementing medication documentation standards and by strictly adhering to their established EMS agency restocking, storing, and administration policies. As previously mentioned some components of the required DSCSA provider-level documentation correlates with the recent ICD-10 diagnostic code documentation recommendations. Therefore, adhering to medication documentation and administration standards will improve compliance with both DSCSA and ICD-10 code requirements while improving your service's opportunity to maximize reimbursement [10].

Document with DSCSA and ICD-10 codes in mind
Field care is rarely mentioned when national clinical practice guidelines and professional standards are developed. However, when it comes to DSCSA and ICD-10 code requirements, EMS is held to the same standards as other health care providers [10,11]. Here are some important documentation considerations.

1. Document medication orders and administration in the following format: Drug, dose, route, frequency [12,13,14,15].
For example, contacting Medical Command might be necessary for analgesia when caring for a patient with acute abdominal pain. The order should be documented as "Contacted Dr. Langenkamp who ordered Morphine Sulfate 5 mg intravenous push every 30 minutes". If offline medical direction permits analgesia without direct medical control, simply documenting the procedure as "Morphine Sulfate 5 mg administered intravenous push" is sufficient.

2. Avoid nonmedical or slang terms when documenting medication administration.
For example, while the phrase "Hung bag of NS KVO" is understandable to most field providers, this type of documentation does not meet any documentation standards.

3. Avoid confusing and vague terms of fluid administration such as keep vein open (KVO), to keep open (TKO), and wide open (WO).
Since 1998, professional standards have called for all intravenous therapy fluid orders to contain a specific infusion rate [15,16,17,18,19]. A common infusion rate for KVO is 25 mL/hour, but this may vary. An example of a properly documented IV infusion would be "Intravenous 0.9% normal saline infusion at 25 mL/hour " or "IV 1 liter bolus 0.9% normal saline infusion at 1000mL/hour initiated".

In addition, your administration practice should also represent sound medication safety by using an IV pump or a simple rate flow device. There are many safe low cost products on the market.

5. Document why certain medications were not given.
For example, not all patients with ischemic chest pain symptoms can receive nitroglycerin. Perhaps the patient took tadalafil (Cialis®), vardenafil (Levitra®), sildenafil (Viagra®), or another medication for erectile dysfunction in the past 48 hours. Document why the medication was not given because of the patient meeting exclusion criteria in the chest pain treatment protocol.

Certain states have implemented time critical diagnosis programs that require EMS documentation to be more specific for conditions such as stroke, STEMI, and trauma. For example, if a TCD process for the treatment of Non ST elevation myocardial infarctions (NSTEMI) includes heparin and clopidogrel (Plavix®), carefully document why these medications were given, the inclusion criteria, or not given.

6. Document reassessment findings after treatments.
Reassessment after medication administration should always include objective and subjective findings. This is important because it measures and evaluates the therapeutic value of the medication. For example, after administering albuterol 5 mg by nebulizer, objective findings would include post treatment work of breathing, respiratory rate, pulse, blood pressure, lung sounds, pulse oximetry, and waveform capnography. The patient reports the subjective data by describing his interpretation of the therapy, such as "breathing easier now".

Both components of your reassessment are important findings to support DSCSA requirements, ICD-10 codes and CMS reimbursement. If there was no change in the patient's condition, or if the condition worsens, these too must be reported.

7. Perform serial physical exams and diagnostic tests as applicable.
For example, the patient who received the albuterol treatment would most likely need several lung sound assessments. The patient who received sublingual nitroglycerin for chest pain would most likely receive another 12-lead ECG when his chest pain resolves or becomes worse. Performing and documenting all appropriate reassessments assists EMS agencies in satisfying DSCSA and ICD-10 code requirements.

Implementing the DSCSA requirements will no doubt remain a daunting task for EMS administrators, medical directors, and field professionals. Although some of the requirements are clear, they may elicit more questions than answers. Successful compliance with the requirements, as well as billing for services, likely requires an open and frequent dialogue with reliable legal counsel with specific knowledge of your EMS agency and its protocols. You can also submit questions to the FDA through the FDA's DSCSA website.

References

1. The Kaiser Family Foundation. (2005, March). Follow the pill: Understanding the U.S. pharmaceutical supply chain. Retrieved from http://ift.tt/1SvEeAu

2. Barlas, S. (2011). Track-and-trace drug verification: FDA plans new national standards, pharmacies tread with trepidation. Pharmacy and Therapeutics, 36(4), 51-68. doi:10.1201/b18697-5

3. Ducca A. (2012, October). Re: Determination of system attributes for the tracking and tracing of prescription drugs. (docket no. FDA-2010-n-0633). Fed. Reg. 2011 January 7;1182:76. Retrieved from http://ift.tt/24mR9Zn.

4. Centers for Disease Control and Prevention (CDC). (2016). International Classification of Diseases, tenth revision, clinical modification (ICD-10-CM). Retrieved from http://ift.tt/1mro1sj

5. U.S. Food and Drug Administration (FDA). (February 2016). Requirements for transactions with first responders under section 582 of the Federal, Food, Drug, and Cosmetic Act—Compliance policy guidance for industry. http://ift.tt/1VQYFHc

6. Government Health Administrators. (2016). Ambulance providers ICD-10 CM planning and preparation. http://ift.tt/1SvEeQK

7. Centers for Medicare & Medicaid Services (CMS). (2015, October). Medicare claims processing manual: Chapter 15—Ambulance. Retrieved from http://ift.tt/1ypWu2W

8. Brennan, Zachary. (2016, February 29). New FDA guidance for first responders as track-and-trace requirements take effect. Retrieved from http://ift.tt/1SvEeQM

9. U.S. Food and Drug Administration (FDA). (2013). Drug Supply Chain Security Act (DSCSA). Retrieved from http://ift.tt/1qNzwSf

10. American Pharmacists Association (Apha). (2015). Apha Policy Manual. Retrieved from http://ift.tt/1eMJnwU"ids=p-929421&tids=t-929417

11. American Medical Association (AMA). (2017). CPT 2017 Professional Edition. Washington, DC: AMA.

12. Institute for Safe Medication Practices (ISMP). (2011). ISMP acute care guidelines for timely administration of scheduled medications. Retrieved from http://ift.tt/24mRbk6

13. Institute for Safe Medication Practices (ISMP). (2011, February). Preventing medication errors during codes. Retrieved from http://ift.tt/1SvEeQR

14. Institute for Safe Medication Practices (ISMP). (2015). ISMP safe practice guidelines for adult IV push medications. Retrieved from http://ift.tt/24mRbka

15. Institute for Safe Medication Practices (ISMP). (2016). 2016-2017 medication safety best practices for hospitals. Retrieved from http://ift.tt/1SvEgIl

16. Infusion Nurses Society. (2006). Infusion nursing specialty practice. Journal of Infusion Nursing, 29(Supplement), 1s, S18. doi:10.1097/00129804-200601001-00005

17. Infusion Nurses Society. (2006). Infusion nursing specialty practice. Journal of Infusion Nursing, 29(Supplement), 1s, S35-36. doi:10.1097/00129804-200601001-00005

18. Hadaway, L. C. (2004). Closing the case on the keep-vein-open rate. Nursing, 34(8), 18. doi:10.1097/00152193-200408000-00015

19. Infusion Nurses Society. (1998). An infusion of independence. Journal of Infusion Nursing, 21(1), 1st ser., S1-S91. doi:10.1097/00000446-199804000-00015

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Medical supply inventory management systems for EMS

Inventory control and management enables EMS agencies to improve efficiency and effectiveness

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Pharmaceuticals in EMS: Are you compliant?

The Drug Supply Chain Security Act mandates pharmaceutical tracking, tracing and documentation for EMS agencies

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PARAMEDIC & EMT-B - COMPASS AMBULANCE SERVICES

We are looking for Paramedics and EMT-B's who are committed to making a difference and who want a positive place to work. Paramedics will be required to provide advanced and basic life support for emergent and non-emergent transports. EMT-B will be required to provide basic life support for emergent and non-emergent transports.

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Mich. paramedic saves own daughter's life

Jeffrey Ballard's 8-year-old daughter, who suffers from asthma, stopped breathing and became unconscious in the car

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Employees say ambulance company took their paychecks

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Employees say ambulance company took their paychecks

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Employees say ambulance company took their paychecks

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Employees say ambulance company took their paychecks

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Fla. paramedic saves man's life on plane

This is the second time firefighter-paramedic Austin Bleiweiss has helped save someone's life while on a plane

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The painful truth: The documentation burden of a trauma surgeon

The Journal of Trauma and Acute Care Surgery

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Snakebite by the Shore Pit Viper (Trimeresurus purpureomaculatus) Treated With Polyvalent Antivenom

Wilderness & Environmental Medicine

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Self-rated expectations of suicidal behavior predict future suicide attempts among adolescent and young adult psychiatric emergency patients

Depression and Anxiety

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A prospective study of platelet function in trauma patients

The Journal of Trauma and Acute Care Surgery

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Objective and self-reported physical activity measures and their association with depression and satisfaction with life in persons with spinal cord injury

Archives of Physical Medicine and Rehabilitation

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The contribution of anterior deltoid ligament to ankle stability in isolated lateral malleolar fractures

Injury

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Repetitive transcranial magnetic stimulation as an alternative therapy for dysphagia after stroke: A systematic review and meta-analysis

Clinical Rehabilitation

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Pulley ruptures in rock climbers: outcome of conservative treatment with the pulley-protection splint—a series of 47 cases

Wilderness & Environmental Medicine

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Decade long trends (2001-2011) in duration of pre-hospital delay among elderly patients hospitalized for an acute myocardial infarction

Journal of the American Heart Association

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A comprehensive approach for the ergonomic evaluation of 13 emergency and transport ventilators

Respiratory Care

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An analysis of neurosurgical practice patterns and outcomes for serious to critical traumatic brain injuries in a mature trauma state

The Journal of Trauma and Acute Care Surgery

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Changing demographics and injury profile of new traumatic spinal cord injuries in the United States, 1972-2014

Archives of Physical Medicine and Rehabilitation

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High-intensity interval training and moderate-intensity continuous training in ambulatory chronic stroke: a feasibility study

Physical Therapy

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Transitions in the embodied experience after stroke: a grounded theory study

Physical Therapy

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Impact of healthcare-associated sepsis on mortality in critically ill infants

European Journal of Pediatrics

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Emergency cerclage: outcomes, patient selection, and operative considerations

Clinical Obstetrics and Gynecology

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Responsiveness of the balance evaluation systems test (BESTest) in people with subacute stroke

Physical Therapy

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Helicopters and injured kids: improved survival with scene air medical transport in the pediatric trauma population

The Journal of Trauma and Acute Care Surgery

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Low homoarginine levels in the prognosis of patients with acute chest pain

Journal of the American Heart Association

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Τετάρτη 27 Απριλίου 2016

Team of Teams or Team of Rivals.

No abstract available

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Resilience.

No abstract available

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Suction Evacuation of Hemothorax: A Prospective Study.

Introduction: Though tube thoracostomy is a common procedure following thoracic trauma, incomplete evacuation of fluid places the patient at risk for retained hemothorax. As little as 300-500cc of blood may result in the need for an additional thoracostomy tube or, in more severe cases, lung entrapment and empyema. We hypothesized that suction evacuation of the thoracic cavity prior to tube placement would decrease the incidence of retained late complications. Methods: Patients requiring tube thoracostomy within 96 hours of admission were prospectively identified and underwent suction evacuation of the pleural space (SEPS) prior to tube placement. These patients were compared to historical controls (CON) without suction evacuation. Demographics, admission vital signs, laboratory values, details of chest tube placement and outcomes were collected on all patients. Multivariable logistic regression was utilized to compare outcomes between groups. Results: 199 patients were identified, consisting of 100 retrospective controls and 99 SEPS patients. There were no differences in age, gender, admission injury severity score or chest abbreviated injury score, admission laboratory or vital signs or hospital length of stay. Mean volume of hemothorax in SEPS patients was 220cc (SD 297); with only 48% having a volume greater than 100cc at time of tube placement. 3 patients developed empyema and 19 demonstrated retained blood; there was no difference between SEPS and CON patients. SEPS was significantly protective against recurrent pneumothorax following chest tube removal (OR 0.332; 95% CI 0.148, 0.745). Conclusion: Preemptive suction evacuation of the thoracic cavity did not have a significant impact on subsequent development of retained hemothorax or empyema. SEPS significantly decreased incidence of recurrent pneumothorax following thoracostomy removal. Though the mechanism is unclear, such a benefit may make this simple procedure worthwhile. A larger sample size is required for validation and to determine if preemptive thoracic evacuation has a clinical benefit. Levels of Evidence: Level III (Therapeutic, Care Management) (C) 2016 Lippincott Williams & Wilkins, Inc.

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Initial Safety and Feasibility of Cold Stored Uncrossmatched Whole Blood Transfusion in Civilian Trauma Patients.

Background: The transfusion of cold stored uncrossmatched whole blood (WB) has not been extensively utilized in civilian trauma resuscitation. This report details the initial experience with the safety and feasibility of using WB in this setting after a change of practice at a level 1 trauma center was instituted. Methods: Up to two units of uncrossmatched group O positive WB that was leukoreduced using a platelet sparing filter from male donors were transfused to male trauma patients with hypotension secondary to bleeding. Hemolytic marker haptoglobin and reports of transfusion reactions in these patients were followed. Additionally, transfusion volumes and outcomes were compared to a historical cohort of male trauma patients who received at least 1 red blood cell (RBC) unit, but not WB, during the first 24 hours of admission. Results: There were 47 WB patients who were transfused with a mean of 1.74 (+/-0.61) WB units. The median haptoglobin concentration on post-WB transfusion day 1 was 25.1 mg/dl (+/-9.3) in 7/30 non-group O recipients. No adverse reactions in temporal relation to the WB transfusions were reported. There were 145 male historical control patients identified who were resuscitated with component therapy; the median volume of incompatible plasma transfused to the WB vs. component therapy group was not significantly different (1000 ml vs. 800 ml, respectively, p=0.38); the mean plasma:RBC (0.99+/-0.47 vs. 0.77+/-0.73, respectively, p=0.006) and platelet:RBC (0.72+/-0.40 vs. 0.51+/-0.734, respectively, p

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Evaluation of Role 2 (R2) Medical Resources in the Afghanistan Combat Theater: Initial Review of the Joint Trauma System R2 Registry.

Background: A Role 2 registry (R2R) was developed in 2008 by the US Joint Trauma System (JTS). The purpose of this project was to undertake a preliminary review of the R2R to understand combat trauma epidemiology and related interventions at these facilities to guide training and optimal utilization of forward surgical capability in the future. Methods: A retrospective review of available JTS R2R records; the registry is a convenience sample entered voluntarily by members of the R2 units. Patients were classified according to basic demographics, affiliation, region where treatment was provided, mechanism of injury (MOI), type of injury (TOI), time and method of transport from point of injury (POI) to R2 facility, interventions at R2, and survival. Analysis included trauma patients aged >=18 years wounded in year 2008 to 2014, and treated in Afghanistan. Results: A total of 15,404 patients wounded and treated in R2 were included in the R2R from February 2008 to September 2014; 12,849 patients met inclusion criteria. The predominant patient affiliations included 4,676 (36.4%) US Forces, 4,549 (35.4%) Afghan Forces, and 2,178 (17.0%) Afghan civilians. Overall, battle injuries predominated (9,792; 76.2%). TOI included 7,665 (59.7%) penetrating, 4,026 (31.3%) blunt, and 633 (4.9%) other. Primary MOI included 5,320 (41.4%) explosion, 3,082 (24.0%) gunshot wounds, and 1,209 (9.4%) crash. Of 12,849 patients who arrived at R2, 167 were dead (1.3%); of 12,682 patients who were alive upon arrival, 342 died at R2 (2.7%). Conclusions: This evaluation of the R2R describes the patient profile and common injuries treated at a sample of R2 facilities in Afghanistan. Ongoing and detailed analysis of R2R information may provide evidence-based guidance to military planners and medical leaders to best prepare teams and allocate R2 resources in future operations. Given the limitations of the dataset, conclusions must be interpreted in context of other available data and analyses, not in isolation. Study Type/Level of Evidence: Descriptive study; Level of Evidence VI (C) 2016 Lippincott Williams & Wilkins, Inc.

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Influences of Limited Resuscitation with Plasma or Plasma Protein Solutions on Hemostasis and Survival of Rabbits with Non-Compressible Hemorrhage.

Background: Plasma infusion with or without RBC is the current military standard of care for prehospital resuscitation of combat casualties. We examined possible advantages of early and limited resuscitation with fresh plasma compared with a single plasma protein or crystalloid solutions in an uncontrolled hemorrhage model in rabbits. Methods: Anesthetized spontaneously breathing rabbits (3.3+/-0.1 kg) were instrumented and subjected to a splenic uncontrolled hemorrhage. Rabbits in shock were resuscitated at 15 min with Plasma-Lyte (PAL; 30 ml/kg), PAL+ fibrinogen (PAL+F; 30ml+100mg/kg), fresh rabbit plasma (PLS; 15ml/kg), or 25% albumin (ALB; 5 ml/kg) solution; all given in two bolus IV injections (15 min apart) to achieve a MAP of 65 mmHg, n=8-9/group. Animals were monitored for 2 hrs or until death and blood loss was measured. Blood samples and tissues were collected and analyzed. Results: There were no differences among groups in baseline measures and their initial bleeding volume at 15 min. At 60 min post-injury, MAP was higher with albumin than with crystalloids (PAL or PAL+F), but shock indices were not different despite the large differences in resuscitation volumes. Fibrinogen addition to PAL only increased clot strength. Plasma resuscitation increased survival rate (75%) without significant improvement in coagulation measures. Albumin administration replenished total plasma protein, and increased survival rate to 100% (p<.05 vs. crystalloids no histological adverse events were identified in the vital organs. conclusion: fibrinogen administration added to a compatible crystalloid did not improve hemostatic outcomes. plasma resuscitation increased survival rate however its effects differ from those obtained with albumin at of volume. advantage was consistent our previous findings which used volume equal plasma. benefit for may be mostly due content rather than coagulation proteins. lippincott williams wilkins inc.>

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Managing the surge in demand for blood following mass casualty events. Early automatic restocking may preserve red cell supply.

Background: Traumatic hemorrhage is a leading preventable cause of mortality following mass casualty events (MCEs). Improving outcomes requires adequate in-hospital provision of high volume red blood cell (RBC) transfusions. This study investigated strategies for optimizing RBC provision to casualties in MCEs using simulation modeling. Methods: A computerized simulation model of a UK major trauma centre (TC) transfusion system was developed. The model used input data from past MCEs, civilian and military trauma registries. We simulated the effect of varying on-shelf RBC stock hold and the timing of externally restocking RBC supplies on TC treatment capacity across increasing loads of priority one (P1) and two (P2) casualties from an event. Results: 35,000 simulations were performed. A casualty load of 20 P1&2s under standard TC RBC stock conditions left 35% (95% CI 32-38) of P1s and 7% (4-10) of P2s inadequately treated for hemorrhage. Additionally, exhaustion of type O emergency RBC stocks (a surrogate for reaching surge capacity) occurred in a median of 10 hours (IQR 5->12). Doubling casualty load increased this to 60% (57-63) and 30% (26-34) respectively with capacity reached in 2hours (1-3). The model identified a minimum requirement of 12U of on-shelf RBCs per P1/2 casualty received to prevent surge capacity being reached. Restocking supplies in an MCE versus greater permanent on-shelf RBC stock holds was considered at increasing hourly intervals. T-test analysis showed no difference between stock hold versus supply restocking in terms of overall outcomes for MCEs up to 80 P1&2s in size (p

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Tube Thoracostomy: Increased angle of insertion is associated with complications.

Introduction: Tube thoracostomy (TT), considered a routine procedure, has significant complications. Current recommendations for placement rely on surface anatomy. There is no information to guide operators regarding angle of insertion relative to chest wall. We aim to determine if angle of insertion is associated with complications of TT. Methods: We performed a retrospective review of adult trauma patients who necessitated TT at a level I trauma center over a 2 year period (January 2012 - December 2013). TT performed intraoperatively or using radiological guidance were excluded. Thoracic anteroposterior (AP) or posteroanterior (PA) radiographs were reviewed to determine the angle of insertion of TT relative to the thoracic wall. A previously validated classification method was utilized to categorize complications. Descriptive and univariate statistics were used to compare angle of insertion and complicated vs uncomplicated TT. Results: Review identified 154 patients who underwent a total of 246 TT placed for emergent trauma. All patients had a post-procedural chest x-ray. We identified 90 complications (37%) over the study period. 144 of the TT's reviewed had an angle of insertion less than 45 degrees of which there were 27 complications (19%). 102 of the TT's had an angle greater than 45 degrees and 63 complications (62%), P

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Underage drinking, brief interventions, and trauma patients: are they really special?.

Background: While the relationship between underage drinking and injury has been well established, few studies have examined whether presenting for an acute injury moderates the efficacy of a brief intervention (BI) on alcohol misuse. Method: Patients (aged 14-20) in the emergency department screening positive for risky drinking (AUDIT-C score) completed a baseline assessment, were randomized to conditions [a stand-alone computer-delivered BI (n=277), a therapist-delivered BI (n=278), or a control condition (n=281)], and completed a 3-month follow-up. This secondary analysis of Project U connect examined regression models (controlling for baseline values) to examine the main effects of injury, and the interaction effects of injury by BI condition, on alcohol consumption and consequences. Results: Among 836 youth enrolled in the randomized controlled trial (mean age = 18.6, 51.6% male, 79.4% Caucasian), 303 (36.2%) had a primary complaint of intentional or unintentional injury. At baseline, injured patients were more likely to be male (p

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Risk of Recurrence After Surviving Severe Sepsis: A Matched Cohort Study.

Objectives: To examine the risk of recurrence in adults who survived first-episode severe sepsis for at least 3 months. Design: A matched cohort study. Setting: Inpatient claims data from Taiwan's National Health Insurance Research Database. Subjects: We analyzed 10,818 adults who survived first-episode severe sepsis without recurrence for at least 3 months in 2000 (SS group; mean age, 62.7 yr; men, 54.7%) and a group of age/sex-matched (1:1) population controls who had no prior history of severe sepsis. All subjects were followed from the study entry to the occurrence of end-point, death, or until December 31, 2008, whichever date came first. Interventions: None. Measurements and Main Results: Primary end-point was severe sepsis that occurred after January 1, 2001 (the study entry). Relative risk of the end-point was assessed using competing risk regression model. During the follow-up period, severe sepsis and death occurred in 35.0% and 26.5% of SS group and in 4.3% and 18.6% of controls, respectively, representing a covariate-adjusted sub-hazard ratio of 8.89 (95% CI, 8.04-9.83) for the risk of recurrence. In stratified analysis by patient characteristics, the sub-hazard ratios ranged from 7.74 in rural area residents to 23.17 in young adults. In subgroup analysis by first-episode infection sites in SS group, the sub-hazard ratios ranged from 4.82 in intra-abdominal infection to 9.99 in urinary tract infection. Conclusions: Risk of recurrence after surviving severe sepsis is substantial regardless of patient characteristics or infection sites. Further research is necessary to find underlying mechanisms for the high risk of recurrence in these patients. Copyright (C) by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Professional Sports Drug Testing Collector (Nationwide) - Comprehensive Drug Testing (CDT)

CDT is seeking qualified candidates with a background in law enforcement, emergency medical response, or laboratory science/toxicology for a unique part-time opportunity as a Professional Sports Drug Testing Collector. ABOUT US CDT, Inc. (Comprehensive Drug Testing, Inc.) manages drug-testing programs for several major professional sports organizations. Administering a nationwide drug-testing program ...

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Professional Sports Drug Testing Collector - Comprehensive Drug Testing (CDT)

Incidence and outcome of cardiac injury in patients with severe head trauma

Although cardiac injury has been reported in patients with various neurological conditions, few data report cardiac injury in patients with traumatic brain injury (TBI). The aim of this work is to report the i...

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An exploration of the views of paramedics regarding airway management

Paramedics are a skilled group of clinicians with expertise in airway management. Our research group has completed a trial comparing supraglottic airway devices with tracheal intubation during out of hospital ...

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Effect of private versus emergency medical systems transportation in trauma patients in a mostly physician based system- a retrospective multicenter study based on the TraumaRegister DGU®

The effects of private transportation (PT) to definitive trauma care in comparison to transportation using Emergency Medical Services (EMS) have so far been addressed by a few studies, with some of them findin...

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Coma of unknown origin in the emergency department: implementation of an in-house management routine

Coma of unknown origin is an emergency caused by a variety of possibly life-threatening pathologies. Although lethality is high, there are currently no generally accepted management guidelines.

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Effect of prehospital notification on acute stroke care: a multicenter study

The sooner thrombolytic therapy is given to acute ischemic stroke patients, the better the outcome. Prehospital notification may shorten the time between hospital arrival and brain computed tomography (door-to...

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Paramedic $5,000 sign on bonus and relocation contact HR - Champion EMS

Champion EMS, based in Longview, TX we are a non-Profit, 501(c) 3 organization and we are seeking highly skilled Paramedics in the East Texas area. Champion EMS provides EMS through a coordinated system utilizing 24 stations and 34 on duty paramedic units positioned throughout east Texas. Champion EMS is committed to providing high quality pre-hospital medicine in our urban/rural and super rural communities ...

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The survival impact of plasma to red blood cell ratio in massively transfused non-trauma patients

Abstract

Purpose

High ratios of Plasma to Packed Red Blood Cells (FFP:PRBC) improve survival in massively transfused trauma patients. We hypothesized that non-trauma patients also benefit from this transfusion strategy.

Methods

Non-trauma patients requiring massive transfusion from November 2003 to September 2011 were reviewed. Logistic regression was performed to identify independent predictors of mortality. The population was stratified using two FFP:PRBC ratio cut-offs (1:2 and 1:3) and adjusted mortality derived.

Results

Over 8 years, 29 % (260/908) of massively transfused surgical patients were non-trauma patients. Mortality decreased with increasing FFP:PRBC ratios (45 % for ratio ≤1:8, 33 % for ratio >1:8 and ≤1:3, 27 % for ratio >1:3 and ≤1:2 and 25 % for ratio >1:2). Increasing FFP:PRBC ratio independently predicted survival (AOR [95 % CI]: 1.91 [1.35–2.71]; p < 0.001). Patients achieving a ratio >1:3 had improved survival (AOR [95 % CI]: 3.24 [1.24–8.47]; p = 0.016).

Conclusion

In non-trauma patients undergoing massive transfusion, increasing FFP:PRBC ratio was associated with improved survival. A ratio >1:3 significantly improved survival probability.

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Firefighter - Lebanon Fire District

LEBANON FIRE DISTRICT 1050 WEST OAK STREET LEBANON, OREGON 97355 Updated: April 27, 2016 Job Classification: Firefighter Lebanon Fire District is currently hiring for Firefighter. All testing through National Testing Network (NTN) must be completed May 20th, 2016 at 5:00 pm PDT. Salary Information: $4739 - $5960 monthly plus incentives (Effective July 1, 2016) Benefit Information: Health, dental and ...

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Issue Information - Ed Board

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Issue Information - TOC

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911 Call: Kid Rock's Personal Asst. Killed In ATV Accident

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911 Call: Kid Rock's Personal Asst. Killed In ATV Accident

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911 Call: Kid Rock's Personal Asst. Killed In ATV Accident

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911 call: Tiger attack at Palm Beach Zoo

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911 Call: Kid Rock's Personal Asst. Killed In ATV Accident

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911 call: Tiger attack at Palm Beach Zoo

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911 call: Tiger attack at Palm Beach Zoo

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911 call: Tiger attack at Palm Beach Zoo

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Acute kidney injury observed during phase 1 clinical trials of a novel xanthine oxidase/URAT1 dual inhibitor PF-06743649

Clinical Rheumatology

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Loss of health related quality of life following low-trauma fractures in the elderly

BMC Geriatrics

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Effect of a multidisciplinary approach for the management of patients with atrial fibrillation in the emergency department on hospital admission rate and length of stay

The American Journal of Cardiology

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UBC study finds psychedelic drugs may reduce domestic violence

The University of British Columbia Health News

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Demographic parameters related to 30-day readmission of patients with acute myocardial infarction: Analysis of 2,371,867 hospitalizations

International Journal of Cardiology

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Prolonged intermittent renal replacement therapy

Advances In Chronic Kidney Disease

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Patient journey after admission for acute heart failure: length of stay, 30-day readmission and 90-day mortality

European Journal of Heart Failure

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Yellow fever vaccination essential for Angola, WHO reminds travellers

WHO news

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Investigation of a rise in obstetric acute renal failure in the United States, 1999–2011

Obstetrics and Gynecology

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Comparison of short-term clinical outcomes between ticagrelor versus clopidogrel in patients with acute myocardial infarction undergoing successful revascularization; from Korea Acute Myocardial Infarction Registry—National Institute of Health

International Journal of Cardiology

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Swallowing disorders in severe brain injury in the arousal phase

Dysphagia

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Infectious complications in obese patients following trauma

Journal of Surgical Research

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Modified fixations for distal femur fractures following total knee arthroplasty: A biomechanical and clinical relevance study

Knee Surgery, Sports Traumatology, Arthroscopy

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Immediate consequences of acute kidney injury: The impact of traditional and nontraditional complications on mortality in acute kidney injury

Advances In Chronic Kidney Disease

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Paediatric cervical spine injures: Nineteen years experience of a single centre

International Orthopaedics

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Evidence for the value of health promotion interventions in natural disaster management

Health Promotion International

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Restricted activity and persistent pain following motor vehicle collision among older adults: a multicenter prospective cohort study

BMC Geriatrics

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Leicester doctor reducing asthma admissions

University of Leicester News

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An Asian perspective on improving outcomes for nasal bone fractures by establishing specific treatment options

Clinical Otolaryngology

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Are money problems and violence related?

The University of Iowa Health News

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Aorto-caval fistula and celiac artery transaction after gunshot wound.

No abstract available

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Direct oral anticoagulants: a practical guide for the emergency physician.

The direct oral anticoagulants (DOACs) are the mainstay for stroke prophylaxis in nonvalvular atrial fibrillation and treatment of acute venous thrombosis. They are attractive alternatives to warfarin because of their efficacy, ease of prescription and safety profile. The emergency department has gained expertise in the management of DOAC bleeding complications, but has been slower to adopt prescription decisions. Emergency clinicians are in a unique position to identify patients who are prescribed DOACs and are at high risk of impending bleeding. This is a practical guide for the emergency clinician on how to prescribe DOACs, the red flags for DOAC patients in the emergency department and advances in the treatment of bleeding. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Τρίτη 26 Απριλίου 2016

EMT (EMT, EMT-Advanced, EMT-Intermediate) (Non-Firefighting) - Klamath County Fire District No. 1

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EMS Positions (non-firefighting) - Klamath County Fire District No. 1

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Paramedic Firefighter - City of Columbus NE

The City of Columbus is establishing a list of qualified candidates for Firefighter/paramedic for an immediate opening. If you are interested in this opportunity or know someone who might be, please have them plan on participating in the testing on Friday, May 6, 2016. Applications can be downloaded from the City website, www.Columbusne.us and mailed to me, faxed to my attention at 402-563-1380 or emailed ...

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Zico's New Z-Shlammer Tool Combines Power and Utility

YARDLEY, PA — Ziamatic Corp. (Zico) introduces the new Z-Shlammer tool—and it's guaranteed to be a pure beast on the fire scene. The Z-Shlammer breaks up concrete, drywall, wood, and more with its 6 lb. hammer, but adds in the multi-functionality of a pentagonal hydrant wrench and a 5-1/2" steel pry hook too. All this on a 1200 lb. rated, 32" fiberglass handle with 3-3/4" ...

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Nonoperative Management of a Large Extrapleural Hematoma after Blunt Chest Trauma

Publication date: Available online 25 April 2016
Source:The Journal of Emergency Medicine
Author(s): Luis Gorospe, María Ángeles Fernández-Méndez, Ana Ayala-Carbonero, Alberto Cabañero-Sánchez, Gemma María Muñoz-Molina
BackgroundAn extrapleural hematoma (EH) is an uncommon and potentially life-threatening condition defined as the accumulation of blood in the extrapleural space between the parietal pleura and the endothoracic fascia. EH usually occurs after blunt thoracic trauma causing fractures of the sternum and ribs, which can tear the intercostal or internal mammary vessels. Typical radiological findings of EH are a biconvex opacity on the involved hemithorax and the so-called displaced “extrapleural fat sign.”Case ReportWe present a case of a 36-year-old man with an isolated scapular fracture after a high-energy blunt chest trauma complicated with a large contralateral EH that was successfully managed nonoperatively with transcatheter arterial embolization (TAE) and image-guided drainage with a pig-tail catheter. To the best of our knowledge there is only one previous report describing a large EH after blunt thoracic trauma without rib fractures. Only two previous cases of large EHs have been treated initially with TAE, but both patients ultimately required open surgery.Why Should an Emergency Physician Be Aware of This?Patients with EH can present with respiratory distress and hypotension, so early identification is important to facilitate proper treatment. EH has characteristic radiological findings, and contrast-enhanced computed tomography is not only the best imaging tool for confirming an EH, but also the best technique for detecting the source of the bleeding and other serious thoracic complications that may not be evident on chest x-ray studies.

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An Electronic Emergency Triage System to Improve Patient Distribution by Critical Outcomes

Publication date: Available online 25 April 2016
Source:The Journal of Emergency Medicine
Author(s): Andrea Freyer Dugas, Thomas D. Kirsch, Matthew Toerper, Fred Korley, Gayane Yenokyan, Daniel France, David Hager, Scott Levin
BackgroundPatient triage is necessary to manage excessive patient volumes and identify those with critical conditions. The most common triage system used today, Emergency Severity Index (ESI), focuses on resources utilized and critical outcomes.ObjectiveThis study derives and validates a computer-based electronic triage system (ETS) to improve patient acuity distribution based on serious patient outcomes.MethodsThis cross-sectional study of 25,198 (97 million weighted) adult emergency department visits from the 2009 National Hospital Ambulatory Medical Care Survey. The ETS distributes patients by using a composite outcome based on the estimated probability of mortality, intensive care unit admission, or transfer to operating room or catheterization suite. We compared the ETS with the ESI based on the differentiation of patients, outcomes, inpatient hospitalization, and resource utilization.ResultsOf the patients included, 3.3% had the composite outcome and 14% were admitted, and 2.52 resources/patient were used. Of the 90% triaged to low-acuity levels, ETS distributed patients evenly (Level 3: 30%; Level 4: 30%, and Level 5: 29%) compared to ESI (46%, 34%, and 7%, respectively). The ETS better-identified patients with the composite outcome present in 40% of ETS Level 1 vs. 17% for ESI and the ETS area under the receiver operating characteristic curve (AUC) was 0.83 vs. ESI 0.73. Similar results were found for hospital admission (ETS AUC = 0.83 vs. ESI AUC = 0.72). The ETS demonstrated slight improvements in discriminating patient resource utilization.ConclusionsThe ETS is a triage system based on the frequency of critical outcomes that demonstrate improved differentiation of patients compared to the current standard ESI.

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Importance of Pelvic Radiography for Initial Trauma Assessment: An Orthopedic Perspective

Publication date: Available online 25 April 2016
Source:The Journal of Emergency Medicine
Author(s): Diederik O. Verbeek, Andrew R. Burgess
BackgroundMany institutions have abandoned the routine for selective pelvic x-ray (PXR) for initial imaging in blunt trauma patients undergoing computed tomography (CT) scanning.ObjectiveOur aim was to examine the association between selective use of PXR and time to diagnosis of (major) pelvic fractures, as well as prioritization of key immediate interventions (including hip reduction and pelvic arterial embolization).MethodsWe conducted a 1-year review of early management of pelvic fracture patients undergoing pelvic CT scanning. Time interval and sequence of initial imaging and key immediate interventions were recorded.ResultsOf 218 pelvic fracture patients, 79 (36%) had no initial PXR, and instead had an initial CT scan. Time to first pelvic imaging in those patients was 48 min (standard deviation [SD] = 47 min vs. 2 min [SD = 6 min] with PXR; p < 0.001). Of 40 hip dislocations, 15 (38%) were detected first on CT scan. Overall, 22 (55%) required a second CT scan after reduction in the emergency department. No initial PXR was performed in 42 of 120 (35%) pelvic ring fracture patients and in 16 of 61 (26%) unstable pelvic ring fractures. Time to pelvic arterial embolization was longer in 4 patients without initial PXR than in 14 patients with PXR (296 min [SD = 206 min] vs. 170 min [SD = 76 min], respectively, p = 0.038).ConclusionsSelective PXR was associated with a significant delay in recognition of (major) pelvic fractures, including those with associated hip dislocations and (potential) pelvic bleeding. PXR remains a useful screening tool to rapidly determine the need for immediate interventions and to allow early planning before CT scanning.

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Gum-Elastic Bougie Efficacy for Tracheal Intubation During Continuous Chest Compression in Infants—A Crossover Simulation Trial

Publication date: Available online 25 April 2016
Source:The Journal of Emergency Medicine
Author(s): Takashi Cho, Nobuyasu Komasawa, Kazuo Hattori, Ryosuke Mihara, Toshiaki Minami
BackgroundRecent guidelines for infant cardiopulmonary resuscitation emphasize that all rescuers should minimize interruption of chest compression, even for endotracheal intubation.ObjectiveWe compared the utility of application of a gum-elastic bougie (GEB) plus Miller laryngoscope (Mil) with the Mil alone during chest compression on an infant mannequin.MethodsSixteen anesthesiologists with more than 2 years of experience performed tracheal intubation on an infant mannequin using the Mil or Mil plus 6Fr GEB, with or without chest compression. Intubation success rate, intubation time, and subjective difficulty scores of laryngoscopy and tube passage through the glottis were measured.ResultsIn Mil trials, none of the participants failed without compression, whereas four failed with compression (p = 0.03). In Mil-plus-GEB trials, all participants succeeded regardless of chest compression. Intubation time was significantly longer with chest compression in both Mil and Mil-plus-GEB trials (p < 0.001). The intubation time during chest compression was significantly longer in Mil than in Mil-plus-GEB trials (p < 0.001). Difficulty of operation on a visual analog scale (VAS) for laryngoscopy did not significantly differ between Mil and Mil-plus-GEB trials during chest compression, whereas the VAS for tube passage through the glottis was significantly higher in Mil than in Mil-plus-GEB trials.ConclusionsGEB use shortened the intubation time and improved the success rate of infant tracheal intubation during chest compression by anesthesiologists in simulations.

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What level of ballistics protection do EMS providers need?

Body armor continues to be a heated topic of discussion in light of the daily threats responders' face

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Why a normal ECG has five visible waveforms

Each portion of a heartbeat produces a different deflection on the ECG. These deflections are recorded as a series of positive and negative waves. On a normal ECG, there are typically up to five visible waveforms: P wave, Q wave, R wave, S wave, T wave.

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Can your EMS director pass the physical ability test?

Wake County EMS Director Jose Cabanas completing the EMS Physical Ability Test.

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How labeling a patient's problem 'impaired consciousness' keeps me objective

Alcoholism affects people from all walks of life. There is no escape from its clutches for those afflicted with the disease. The rich, the poor and everybody in between has their share of alcoholic persons.

Responding to calls to treat intoxicated persons is frustrating, time consuming and has the potential to be the undoing of any well-meaning EMT or paramedic.

Remembering that a 911 call for an intoxicated person is the same thing as a call for a person with an impaired consciousness helped me keep things in perspective, and not judge the people entrusted to my care. When I learned to stop hearing the "intoxicated person" message from dispatch and replaced to words I heard to "impaired consciousness" my frustration diminished greatly.

Ultimately, people suffering from alcoholism deserve the same level of professionalism as everybody else.

Not so healthy
Fleas flutter around the sleeping man, land on his face, his hands, bite him, then fly off.

"Rubin!" I said, crouching down.

He was sixty, looked seventy, wrinkled, tired and just about done.

Sixty years. That’s longer than most street people last. They don’t have longevity.

Tonight, Rubin is inside, lying on a flea-infested air mattress at one of the state’s largest homeless shelters. He considers the place his home. It’s where he lays his head at the end of long days spent wandering the streets of Providence. They let him stay here, tucked away in the corner of the day room, along with anywhere from ten to 100 other homeless folks.

At six or seven in the morning, they are all shown the door, left to their own devices for the day. For some, that means looking for work. For most, it means looking for a high: booze, heroin, crack, pills; whatever works. Rubin depends on vodka in little half pints.

"I’m sleeping," Rubin said. "Leave me alone."

"They’re kicking you out."

"Why""

"Because you are intoxicated."

He’s nearly always intoxicated.

I watch as he closes his eyes and falls back asleep. The fleas return to his face. I brush them off, he swipes at my hand, thinking I’m a giant flea. He misses.

I pull a sleeping bag over his face and leave him where he lies.

The girl at the desk apologizes for calling us, but also lets us know that she’s not going to be responsible for him if he gets sick. Or seizes. Or dies.

I tell her to call us back if he wakes up and walk back to the truck.

Rubin returns to his dreams.

Wealthy
At the end of the road, fifty yards from the river on the front steps of a well-maintained home, sits a 60-year-old woman. Her brother stands close by, apologetic and concerned.

"We tried to get her to go, but she won’t budge."

The woman stayed seated, defiant. She knew what little control was hers was about to be taken away, and she had no intention of giving it up willingly.

A little dog scurried over. I knelt and scratched behind his ears as the intoxicated woman looked on.

"She’s been drinking for 10 days. Says she wants to drink herself to death. My sister is inside getting some things."

I looked her in the eye while petting her dog.

"We’re taking you to the hospital."

"Bullshit," she slurred.

One of the firefighters who was on scene before us chimed in.

"We can do this the easy way or the hard way, it’s up to you."

I never was a fan of the strong-arm tactic.

"In five minutes we are going to be at the ER. I know you don’t want to go but I am required by law to intervene if family members present a strong case that you may harm yourself. And, you are intoxicated, so I can’t leave you here."

She tried to rationalize, claim her freedom was being compromised, get up and run, be a rock and simply not cooperate.

Years ago, I would have called police and let the firefighters help me wrestle her and tie her to the stretcher and drag her away from her home. Today, I let go of the dog, took hold of her arm, had my partner take the other and lifted her to her feet. We walked to the stretcher, put her on it and fastened the seat belts. The struggle lasted about 20 seconds.

Then the crying began. She cried all the way to the hospital, taking a break now and then to glare at me, but her resolve was broken, along with her spirit. She did make one desperate lunge for the rear door, but before the seat belt was undone I had her back down.

As I walked out the door of the ER, the woman’s sister who had accompanied us in the back of the rescue stopped me. She took my hand and looked me in the eye.

"I want to thank you for being so kind."

She held the gaze for a moment, her eyes filled up and she turned and walked away.

I quickly wiped my own eyes and got back in the truck.

Alcoholism is a crafty, evil disease.

A little too wise
Monday she was drunk at home, a concerned friend called 911 to have strangers check on her well-being. I guess it is easier to call the fire department when a friend is in need than getting up and doing something yourself.

We found her inside her apartment, empty beer cans littering the floor, highly intoxicated. There is no law against being drunk at home, but our patient clearly needed some help.

After a small brawl, we talked her into going to the hospital for detox, hopefully eventual rehab.

Wednesday she was home again, drunk. This time she called 911 for a ride to the hospital because she wanted to go to detox. Apparently, rehab wasn’t in the cards on Monday.

Saturday we got a call for an intoxicated person at an address on Broad Street. Our friend, drunk again, this time at an acquaintance’s place. He was tired of her, wanted us to get rid of his problem guest.

By now I thought we had become friends with the woman. It’s a short trip to the emergency room, but a bond quickly forms between patient and caregiver, especially a frequent customer.

Monday we got a call for a person down in the bushes. I saw a hand rise from some hedges in front of one of the high-rise buildings where the elderly and disabled residents of Providence reside. Walking closer, I saw my newest old friend, drunk again, unable to extricate herself from where she fell.

She fought for a while, learned quickly that a 60-year-old former prostitute is no match for five firefighters sent to help her. "I have a knife," she said, enraged now that we had her out of her nest.

You would think that after all of these years I would learn never to let my guard down. Because familiarity sets in by no means diminishes the potential threat on every call.

To the patients we are sent to treat, we are no more than a blur, a momentary diversion from their otherwise dreary existence. Once we part ways we are forgotten, the next person who enters their lives more important than the last.

She ripped open the front of her coat and brandished a 12-inch butcher’s knife. Her eyes were wild, full of hate.

Before she had a chance to hurt herself, or us, we disarmed her, put her on the stretcher and took her to the hospital. There was no real malice once the knife was out of her hands, but for one moment, when she was capable of murder, she could have altered a lot of lives.

These three 60-year-old people have one thing in common. They call it alcoholism.

For me to remain objective, I call it impaired consciousness.

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Πληροφορίες

Σάββατο 30 Απριλίου 2016

Παρασκευή 29 Απριλίου 2016

Πέμπτη 28 Απριλίου 2016

Τετάρτη 27 Απριλίου 2016

Abstract

Purpose

Methods

Results

Conclusion

Τρίτη 26 Απριλίου 2016

Δημοφιλείς αναρτήσεις