Emergency Medicine by Alexandros G. Sfakianakis: Αυγούστου 2016

Τετάρτη 31 Αυγούστου 2016

Presentations to an urban emergency department in Switzerland due to acute γ-hydroxybutyrate toxicity

γ-Hydroxybutyrate (GHB) is a drug of abuse with dose-dependent sedative effects. Systematic data on the acute toxicity of GHB from emergency department (ED) presentations over a long period of time are current...

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Now Available from theEMSstore: The Exclusive Blue Leatherman Raptor

The Exclusive Blue Leatherman Raptor, specifically designed with the input of special-operations medics, EMTs, and fire professionals with knowledge of standard medical shears, is a 6-in-1 multi-tool with all the necessary features that uniformed medical professionals require to safely and quickly go to work in an emergency situation. The Raptor features a perfect balance of multi-purpose tools for ...

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Crestline: 1st manufacturer with a BNQ standard certified ambulance, Summit 150 - Type 3

QUEBEC, Canada — Crestline is proud to announce we are the first manufacturer to have certified our product, the Summit 150 - Type 3 Ambulance to the new BNQ-1013-110-2014 standard for the province of Quebec, Canada. The certification process was started at the beginning of the year and culminated with the Certificate of Conformity being issued on July 27, 2016. The BNQ 1013-110 standard sets ...

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Fire Rescue Technician (firefighter/medic) - James City County Fire Department

Progressive fire department offering exciting opportunities for a career in firefighting and emergency medical services! We are accepting applications beginning September 2 to fill current vacancies and to create a hiring pool of eligible applicants to fill future vacancies. Job description can be found on the James City County Career Center at http://ift.tt/2bCvTvI.

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Army reports survival rates improving for soldiers wounded in combat

By David Vergun

WASHINGTON — About 92 percent of Soldiers wounded in Iraq and Afghanistan have made it home alive, according to Lt. Gen. Nadja Y. West.

That's the highest percentage in the history of warfare, despite the rising severity of battle injuries from increasingly lethal weapons, said West, Surgeon general of the Army and commander of Army Medical Command. She spoke on Thursday, Aug. 18, to the Defense Writers Group.

The survival rate in Vietnam was around 75 percent, she told her audience.

Contributing factors
There are a number of reasons for improved survival rates, West said.

Soldiers, not just medics, are receiving much better training in lifesaving techniques, and Army medicine has continued to advance, she said. Another reason is that casualties are transported swiftly back to hospitals and receive excellent care en route.

Other contributing factors are less obvious, she said, like improved communication from the point of injury.

For example, a video teleconference line has been established between forces deployed in Afghanistan and Iraq back to Landstuhl Regional Medical Center, Germany, which is usually the first stop for casualties, she pointed out.

Communications channels have also been established with follow-on treatment centers, including Walter Reed National Military Medical Center, Maryland; Naval Medical Center San Diego; and the Army's burn center at Joint Base San Antonio.

During a recent video teleconference, West recalled, physicians in the U.S. were able to see that a Soldier's head wound was causing inter-cranial pressure and advise medical staff to address while still in theater.

Open communications channels also mean that medical staff stateside can better prepare for an incoming casualty, West added.

Future survivability
While battlefield survival rates continue to improve, Soldiers in future conflicts may not be so fortunate, West said.

In the conflicts in Iraq and Afghanistan, the U.S. forces had the luxury of air superiority and could evacuate casualties almost at will, she said.

A Soldier with a head wound in Afghanistan could arrive from the point of injury to Bethesda Naval Medical Center where the medical specialist was standing by within 24 hours of being wounded, she said.

"That's unprecedented," she said.

But in a conflict with a near-peer enemy U.S. forces cannot count on that level of air superiority, West said. So Army medicine is looking for alternative ways of treatment.

For one, the Army will be asking a lot more of its medics in the future. That could mean teaching them sophisticated techniques and procedures that they currently don't perform. First responders, those non-medics in the fight, will also be asked to do more, she said.

Advances in telehealth will also play a vital role, she said. Telehealth, employing telecommunications technologies to deliver virtual medical services, has already come a long way.

In the near future, a Soldier could be fitted with medical sensors that collect and relay medical data to an intensive care specialist, or a vascular surgeon in the U.S. could instruct a medical provider in theater to do a relatively complex procedure on a blood vessel.

"It won't make that person a trauma surgeon," West said. "But that reach-back could help when needed."

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Recovery from a possible cytomegalovirus meningoencephalitis-induced apparent brain stem death in an immunocompetent man: A case report

Journal of Medical Case Reports

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Examining how the perception of health can impact participation and autonomy among adults with spinal cord injury

Topics in Spinal Cord Injury Rehabilitation

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Effects of 14 versus 21 days of nimodipine therapy on neurological outcomes in aneurysmal subarachnoid hemorrhage patients

Annals of Pharmacotherapy

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Comparing the effects of aromatherapy massage and inhalation aromatherapy on anxiety and pain in burn patients: A single-blind randomized clinical trial

Burns

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Impact of the 2013 ACC/AHA cholesterol guidelines on the prescription of high intensity statins in patients hospitalized for acute coronary syndrome or stroke

American Heart Journal

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Effects of mobility training on severe burn patients in the BICU: A retrospective cohort study

Burns

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A multicentre observational study of inter-hospital transfer for post-resuscitation care after out-of-hospital cardiac arrest

Resuscitation

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EpiPen's pricing debacle and its impact on patients, insurers

Northeastern University News

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Comparing fracture healing disorders and long-term functional outcome of polytrauma patients and patients with an isolated displaced midshaft clavicle fracture

Journal of Shoulder and Elbow Surgery

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Systematic review of complications and outcomes of diabetic patients with burn trauma

Burns

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Is retrograde intubation more successful than direct laryngoscopic technique in difficult endotracheal intubation?

The American Journal of Emergency Medicine

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The effect of massive transfusion protocol implementation on pediatric trauma care

Transfusion

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Early access to vocational rehabilitation for inpatients with spinal cord injury: A qualitative study of patients' perceptions

Topics in Spinal Cord Injury Rehabilitation

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Perceptions of shared decision making among patients with spinal cord injuries/disorders

Topics in Spinal Cord Injury Rehabilitation

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Posttraumatic stress symptoms among spinal cord injury patients in trauma: A brief report

Topics in Spinal Cord Injury Rehabilitation

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Early extracorporeal membrane oxygenation for cardiovascular failure in a patient with massive chloroquine poisoning

The American Journal of Emergency Medicine

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Investigation of oxidant and antioxidant levels in patients with acute stroke in the emergency service

The American Journal of Emergency Medicine

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Safe-opioid prescribing working group details success in AAMC journal Academic Medicine

University of Massachusetts Medical School News

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Hospital Volume and Mortality in Mechanically Ventilated Children: Analysis of a National Inpatient Database in Japan.

Objectives: To evaluate the relationship between annual hospital volume of mechanical ventilation in children and mortality. Design: A retrospective analysis. Setting: Japanese hospitals (n = 641) in the Japanese Diagnosis Procedure Combination database from July 2010 to March 2013. Patients: Patients 15 years old or younger receiving mechanical ventilation during hospitalization. Interventions: None. Measurements and Main Results: A total of 26,981 mechanically ventilated pediatric patients were identified. They were categorized into four subgroups based on the quartiles of mean annual hospital volume of mechanical ventilation in children. Multivariable logistic regression analyses were performed to examine the effects of hospital volume on 30-day mortality, with adjustment for patient and hospital characteristics. Compared with the low volume group (= 166) volume groups were 0.63 (0.50-0.79), 0.56 (0.42-0.74), and 0.57 (0.50-0.79), respectively. Subgroup analyses of surgical and nonsurgical patients showed similar trends. Conclusions: In mechanically ventilated pediatric patients divided by hospital volume quartiles, all three higher volume groups had lower mortality than the lowest volume group. (C)2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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Τρίτη 30 Αυγούστου 2016

Lateral Firefighter/EMT - Snoqualmie Fire Department

SNOQUALMIE, CITY OF, FIRE DEPARTMENT 37600 SE SNOQUALMIE PARKWAY SNOQUALMIE, WASHINGTON 98065 Updated: August 24, 2016 Classification: Lateral Firefighter/EMT The City of Snoqualmie is currently building an eligibility list for Lateral Firefighter/EMT. The Department is anticipating one (1) vacancy in the near future and hopes to fill it in late 2016 / early 2017. This position requires FireTEAM through ...

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Are EMTs resilient enough?

Improving resiliency through regular exercise and smart nutrition is essential to helping EMS providers cope with traumatic stress.

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Are EMTs resilient enough?

By Bryan Fass

While even normal people outside of public safety experience job-related stress as a fact of life, it seems like ours is much worse. Those of us who've in the business for a while can remember a time where the topic of stress and stress management were never discussed. Thankfully, EMS has taken a great leap forward bringing to light the depth and severity of our mental health.

Stress can be good and bad. Exercise induced stress is good. It forces our body to grow, heal and improve. The stress you experience prior to a protocol test increases your mental acuity.

The trouble starts when the stress response is constant and your body has no time to reset and rebalance. As call volumes have increased, so have resiliency issues for EMS providers.

As a paramedic and as a strength coach I have often wondered what has changed.

Why has the rate of suicide and mental health issues increased"
Is it the call volume, is it the type of calls or have we changed"

Next read these questions. I want to spark a conversation. Share your answers with me in the comments or send me an email. Together, we can hopefully steer the profession in a healthier direction.

Is our inability to handle stress because we have lost the ability to separate from the job"
Have we lost the ability for physical outlets to help manage the stress"
Are we poisoning ourselves with a toxic combination of overtime, poor eating habits and reliance on stimulants"

I can recall as a green medic running my first pediatric traumatic arrest. Sure, I had read about it, studied it and even did hours of training in the NICU. Yet having to manage the scene, intubate the child while en route, start compressions, start an IO and then carry a child I knew was deceased into the emergency department was very foreign to me.

I recall standing there as the trauma team worked the child, being expected to calmly and accurately give a report and then go write my patient care report. I had no training for that and no way to manage those emotions. Yes, that call weighed on me the rest of the shift, but I pushed on.

Exercise to increase resiliency
However as soon as my shift ended I drove right to the gym and hammered myself with an epic workout; that was and is my outlet, my relief valve. Studies show that exercise, any exercise, calms the mind and releases endorphins that help promote wellness [1, 2, 3].

Exercise is by far the best medicine for building resiliency. The data is clear. Any exercise is beneficial with cardiovascular exercise shown to be slightly superior. As I have said in multiple EMS1 columns move well and move often but just move.

Another issue is our addiction to technology. When I was a street medic you were connected only if you had a Nextel phone (the walkie talkie phone). Now there is an app for constant communication. I often wonder if after a series of difficult calls when an EMT should disconnect from the stressor and find an outlet if the news feeds, photos, texts and instant messages that flood in slowly elevate the long-term stress response.

Disconnect from the world and get after it. The stronger you are and the more fit you are, the less pain you experience. Exercise will boost your resiliency and help to improve your sleep and nutrition.

Let’s face it: the EMS diet is not so good. Not only do you have to contend with the call volume and missed meals; bringing your food with you will fix that. We also have to deal with stress eating and fatigue eating. There is a reason that you crave the foods that are bad, and understanding why is the first step.

Eat better to improve resiliency
The overconsumption of sugars and caffeine plus a diet devoid of beneficial nutrition when tied into the over stimulation of the stress response throws the serotonin, cortisol, adrenalin response and more importantly the recovery process so far out of whack that we are essentially poisoning ourselves and making ourselves vulnerable to the cumulative dangers of bad stress [4]. Soldiers that died by suicide were 62 percent more likely to have extremely low levels of DHA (the good fat in fish and chia/flax that helps your brain) then soldiers that did not attempt suicide [5].

On top of that, too many first responders are self-medicating with alcohol and drugs. This destroys the allostatic balance leading responders into a deep, dark hole.

A key to boosting resiliency in EMS requires that EMT’s have a physical outlet for their stress. Tie in good nutrition that heals, and you can boost your resiliency and wellness at the same time.

References

Perspectives in Rehabilitation. Exercise therapy improves both mental and physical health in patients with major depression. DOI: 10.3109/09638288.2014.972579. Knapen, Davy Vancampfort, Yves Moriën and Yannick Marchal. Pages 1490-1495
Exercise and well-being: a review of mental and physical health benefits associated with physical activity Penedo, Frank J; Dahn, Jason R
http://ift.tt/2bzVlli
http://ift.tt/1GsrWTc
Lewis, Michael et.al. "Suicide of active duty us military and omegs-3 fatty acid status. The Journal of Clinical Psychiatry 72.12 (2011): 1585.

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My children don’t know their father before PTSD

By Lea Farrow, Uniform Stories Contributor

It has been almost five years since my husband was diagnosed with PTSD. In a lot of ways, it feels like a lifetime. And for our children, it has literally been their lifetime.

I knew my husband for nine years before his official diagnosis. However, I really only knew my husband for five years before the signs of the disorder started to show.

My husband has been a paramedic for 15 years. His PTSD didn't arrive overnight. It was an insidious process after years of answering extremely traumatic calls, and receiving very little support or education through the service about ongoing stress management.

Many of the jobs that led to my husband's PTSD were pediatric calls. The job that triggered his major collapse was a horrific pediatric death. At the time, we had two small children of our own, our daughter was almost 3 and our son was not yet 1.

The day my husband came home from work a broken man, he fell to pieces in the kitchen. It wasn’t that I hadn’t seen him cry before, but we could have both drowned in his tears that night.

Although I tried my best, I couldn’t protect our children from every episode that ripped through our house. Sometimes the pain would burst out of my husband so suddenly and ferociously, that all I could do was huddle my kids until the storm passed. Our daughter would ask, “Mommy, what’s happening" Daddy is really scaring me…”

I had to accept the reality that my children were not safe alone with their father. One day I was torn away from work by a desperate phone call, and rushed home to a find a shattered man, only barely holding on. I often ask, do our children remember that day" Do they remember the raw anguish coursing wildly out of their father, who scarcely had enough strength left to direct it away from us" I sure do.

We found new ways to manage as a couple and as a family. I helped my husband begin to earn back the trust from his children and he found help for his PTSD (when he was ready to accept it). We have come a long way in the years since, but PTSD is still very much with us. It’ll be with us always. And our children sadly bear witness to some of its worst moments. They don’t know a life without PTSD overshadowing it.

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EMS needs planning, preparation to mitigate the effects of terrorist attacks

In June 2016 the National Academy of Medicine released a discussion paper that looked at the challenges of an EMS response to a major terror attack. In the paper, "Health and Medical Response to Active Shooter and Bombing Events," members of the National Academies of Sciences, Engineering, and Medicine’s Forum on Medical and Public Health Preparedness for Catastrophic Disasters described potential best practices on how to respond effectively to sudden, dramatic mass casualty events, based on data gleaned from recent attacks in Europe and the U.S.

Most of us are still relatively complacent about what we would do in case of a Boston or Aurora style attack in our community. Indeed, chances are very remote that such attacks will occur.

However, in such cases, the actions of dispatch centers and field personnel may play a critical role in the victims’ chances of survival. It is common sense that EMS, fire and law enforcement personnel should jointly prepare and train for a variety of sudden mass casualty events.

Work together, train together
As the National Academy of Medicine discussion paper implies, a variety of political, fiscal and bureaucratic barriers exist to hinder the development of such plans. Both government and private sector agencies charged with public safety and public health must put aside territorial differences and work together to determine who will respond, how teams will operate and where patients should be transported, all in a very short operational period.

Bleeding control is a major priority when managing large numbers of injured patients after an attack. In many situations, direct pressure bandages and tourniquets can rapidly control bleeding, and free up field providers to provide care to other injured victims.

Unfortunately, ambulances and engine companies often do not carry enough trauma supplies to handle more than a few victims simultaneously. Disaster caches or trailers can be helpful, but only if they can be rapidly moved to the scene within minutes of the initial dispatch.

Rural and remote areas
Rural regions face especially difficult challenges in a mass casualty response. Underfunded agencies and scattered resources can hinder an adequate response.

One simple solution is to have policies in place that initiate mutual aid from neighboring agencies automatically at the initial response, rather than waiting precious minutes for the first responding units to arrive. This would include air medical services, volunteer organizations and even agencies that are a fair distance away from the incident, but would be expected to respond in large scale events.

The delay in sending an appropriate response level can result in lives lost. Dispatch protocols should be developed that result in an adequate number of units and personnel being sent to initial reports of a major event, similar to fire service alarm assignments.

This can reduce the human judgment factor during dispatch and improve the chances of getting off on the right foot early in the incident. If it turns out that the incident is smaller than reported, no harm is created in downgrading the response.

Cooperation with receiving facilities
Emergency departments and hospitals will not be immune to the effects of a large scale event. Not only do such facilities have to be able to rapidly scale up their internal disaster response, they must also work in cooperation with each other to spread the multitude of patients around the region.

While field operations may perform the initial sorting and destination decisions, resources such as staff, blood products and equipment may be rapidly depleted, necessitating a rapid region-wide response by other facilities and organizations. Again, interagency agreements, policies and procedures should be in place to facilitate complex decision making processes.

No one wants to think about a major violent event happening in their community. As EMS providers, we have to prepare for the worst, and hope for the best. As the National Academy of Medicine paper points out, continuous planning and preparation will be the major tools used by field providers and agencies alike in mitigating the effects of a terror attack.

Health and Medical Response to Active Shooter and Bombing Events

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Are EMTs resilient enough?

By Bryan Fass

Stress can be good and bad. Exercise induced stress is good. It forces our body to grow, heal and improve. The stress you experience prior to a protocol test increases your mental acuity.

The trouble starts when the stress response is constant and your body has no time to reset and rebalance. As call volumes have increased, so have resiliency issues for EMS providers.

As a paramedic and as a strength coach I have often wondered what has changed.

Why has the rate of suicide and mental health issues increased?
Is it the call volume, is it the type of calls or have we changed?

Next read these questions. I want to spark a conversation. Share your answers with me in the comments or send me an email. Together, we can hopefully steer the profession in a healthier direction.

Is our inability to handle stress because we have lost the ability to separate from the job?
Have we lost the ability for physical outlets to help manage the stress?
Are we poisoning ourselves with a toxic combination of overtime, poor eating habits and reliance on stimulants?

Let’s face it the EMS diet is not so good. Not only do you have to contend with the call volume and missed meals; bringing your food with you will fix that. We have to deal with stress eating and fatigue eating. There is a reason that you crave the foods that are bad and understanding is the first step.

Eat better to improve resiliency
The overconsumption of sugars and caffeine plus a diet devoid of beneficial nutrition when tied into the over stimulation of the stress response throws the serotonin, cortisol, adrenalin response and more importantly recovery process so far out of whack that we are essentially poisoning ourselves and making ourselves vulnerable to the cumulative dangers of bad stress [4]. Soldiers that died by suicide were 62 percent more likely to have extremely low levels of DHA (the good fat in fish and chia/flax that helps your brain) then soldiers that did not attempt [5].

On top of that too many first responders are self-medicating with alcohol and drugs. This destroys the allostatic balance leading responders into a deep, dark hole.

A key to boosting resiliency in EMS requires that EMT’s have a physical outlet for their stress. Tie in good nutrition that heals, and you can boost your resiliency and wellness at the same time.

References

Perspectives in Rehabilitation. Exercise therapy improves both mental and physical health in patients with major depression. DOI: 10.3109/09638288.2014.972579. Knapen, Davy Vancampfort, Yves Moriën and Yannick Marchal. Pages 1490-1495
Exercise and well-being: a review of mental and physical health benefits associated with physical activity Penedo, Frank J; Dahn, Jason R
http://ift.tt/2bzVlli
http://ift.tt/1GsrWTc
Lewis, Michael et.al. "Suicide of active duty us military and omegs-3 fatty acid status. The Journal of Clinical Psychiatry 72.12 (2011): 1585.

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My children don’t know their father before PTSD

By Lea Farrow, Uniform Stories Contributor

It has been almost five years since my husband was diagnosed with PTSD. In a lot of ways, it feels like a lifetime. And for our children, it has literally been their lifetime.

I knew my husband for nine years before his official diagnosis. However, I really only knew my husband for five years before the signs of the disorder started to show.

The day my husband came home from work a broken man, he fell to pieces in the kitchen. It wasn’t that I hadn’t seen him cry before, but we could have both drowned in his tears that night.

I had to accept the reality that my children were not safe alone with their father. One day I was torn away from work by a desperate phone call, and rushed home to a find a shattered man, only barely holding on. I often ask, do our children remember that day? Do they remember the raw anguish coursing wildly out of their father, who scarcely had enough strength left to direct it away from us? I sure do.

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Effect of high-frequency oscillatory ventilation on esophageal and transpulmonary pressures in moderate-to-severe acute respiratory distress syndrome

High-frequency oscillatory ventilation (HFOV) has not been shown to be beneficial in the management of moderate-to-severe acute respiratory distress syndrome (ARDS). There is uncertainty about the actual pres...

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Association between off-hour presentation and endotracheal-intubation-related adverse events in trauma patients with a predicted difficult airway: A historical cohort study at a community emergency department in Japan

A reduction in medical staff such as occurs in hospitals during nights and weekends (off hours) is associated with a worse outcome in patients with several unanticipated critical conditions. Although difficult...

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EMS needs planning, preparation to mitigate the effects of terrorist attacks

A recent National Academy of Medicine discussion paper describes best practices for EMS and hospital responses to active shooter, bombing and terror attacks.

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Impax Provides Update on Epinephrine Injection, USP Auto-Injector

HAYWARD, CA., Aug., 2016 /PRNewswire/ -- Impax Laboratories, Inc.(NASDAQ: IPXL) today provided an update and additional information to patients, physicians and customers on its epinephrine injection, USP auto-injector, 0.15 mg and 0.3 mg., the authorized generic of Adrenaclick®. Epinephrine injection, USP auto-injector (also called epinephrine auto-injector) is an emergency injection (shot) of ...

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New director named for NHTSA's Office of Emergency Medical Services

WASHINGTON — The National Highway Traffic Safety Administration has announced the appointment of emergency physician Dr. Jon Krohmer as the Director of the Office of Emergency Medical Services (OEMS).

Chosen from a field of more than 30 candidates, Krohmer has been actively involved in EMS for over 30 years, first in his home state of Michigan, and then at the national level as an active member of the American College of Emergency Physicians (ACEP) and president of the National Association of EMS Physicians (NAEMSP).

Krohmer’s federal service began in 2006 when he started working for the Department of Homeland Security. He went on to become the Director of the Health Services Corps for Immigration and Customs Enforcement (ICE) at DHS, and has provided medical expertise to the U.S. Coast Guard for the past year.

Krohmer will start at the NHTSA on September 6.

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The Efficacy of Case Management on Emergency Department Frequent Users: An Eight-Year Observational Study

Publication date: Available online 29 August 2016
Source:The Journal of Emergency Medicine
Author(s): Casey A. Grover, Elizabeth Crawford, Reb J.H. Close
BackgroundCase management is an effective short-term means to reduce Emergency Department (ED) visits in frequent users of the ED.ObjectivesOur study aimed to assess the long-term efficacy of intensive case management in frequent users of the ED.MethodsThis was an observational study of ED usage conducted at a community hospital that has an ED case management program in which frequent users of the ED are enrolled and provided with intensive care management to reduce ED use.ResultsWe identified 199 patients that were enrolled for 6 or more years. Patients averaged 16 visits per person per year in the year prior to enrollment. Patients averaged the following number of visits per person per year after enrollment: year 1 (7.1), year 2 (4.1), year 3 (3.1), year 4 (3.3), year 5 (3.1), year 6 (2.0), year 7 (2.1), and year 8 (1.9), all statistically significant compared to the year prior to enrollment. Twenty-nine patients, despite case management, continued their frequent use, and required a revision to their plan of care. Five patients required a second revision to their plan of care secondary to recurrent ED usage. Persistent use despite case management was primarily due to prescription medication misuse and chronic pain.ConclusionCase management of ED frequent users seems to be an effective means to reduce ED usage in both the short and long term. Patients with prescription drug misuse or chronic pain may continue to demonstrate frequent use despite case management, and may require revisions to their plan of care.

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Patient Insurance Profiles: A Tertiary Care Compared to Three Freestanding Emergency Departments

Publication date: Available online 29 August 2016
Source:The Journal of Emergency Medicine
Author(s): Erin L. Simon, Gregory Griffin, Kseniya Orlik, Zhenyu Jia, Dave Hayslip, Daniel Kobe, Nicholas Jouriles
BackgroundIt has been speculated that freestanding emergency departments (FEDs) draw more affluent, better-insured patients away from urban hospital EDs. It is believed that this leaves urban hospital−based EDs less financially secure.ObjectiveWe examined whether the distribution of patients with four types of insurance (self-pay, Medicaid, Medicare, and private) at the main ED changed after opening three affiliated FEDs, and whether the insurance type distribution was different between main ED and FEDs and between individual FEDs.MethodsA retrospective analysis of insurance status of all patients presenting to our EDs from July 2006 through August 2013. Insurance was divided into self-pay, Medicare, Medicaid, and private insurance across three time periods, which reflect the sequential opening of each FED. Insurance types for each facility were compared for individual time periods and across time periods. χ² was used to analyze the data.ResultsIn the three studied time frames (periods B, C, and D), there were less privately insured patients and more self-pay, Medicaid, and Medicare patients at the main than at each FED (p < 0.001). Insurance types were significantly different between each of the three FEDs and the main ED (p < 0.001) and between each of the three FEDs (p < 0.001).ConclusionsThere were less privately insured patients and more self-pay, Medicaid, and Medicare patients at the main ED compared to the FEDs. Privately insured patients decreased at both the FEDs and main ED during the study. Insurance distribution was significantly different between the main ED, and three FEDs, and between individual FEDs.

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Analysis of Gastric Lavage Reported to a Statewide Poison Control System

Publication date: Available online 29 August 2016
Source:The Journal of Emergency Medicine
Author(s): Jimmy Donkor, Patil Armenian, Isaac N. Hartman, Rais Vohra
BackgroundAs decontamination trends have evolved, gastric lavage (GL) has become a rare procedure. The current information regarding use, outcomes, and complications of GL could help refine indications for this invasive procedure.ObjectivesWe sought to determine case type, location, and complications of GL cases reported to a statewide poison control system.MethodsThis is a retrospective review of the California Poison Control System (CPCS) records from 2009 to 2012. Specific substances ingested, results and complications of GL, referring hospital ZIP codes, and outcomes were examined.ResultsNine hundred twenty-three patients who underwent GL were included in the final analysis, ranging in age from 9 months to 88 years. There were 381 single and 540 multiple substance ingestions, with pill fragment return in 27%. Five hundred thirty-six GLs were performed with CPCS recommendation, while 387 were performed without. Complications were reported for 20 cases. There were 5 deaths, all after multiple ingestions. Among survivors, 37% were released from the emergency department, 13% were admitted to hospital wards, and 48% were admitted to intensive care units. The most commonly ingested substances were nontricyclic antidepressant psychotropics (n = 313), benzodiazepines (n = 233), acetaminophen (n = 191), nonsteroidal anti-inflammatory drugs (n = 107), diphenhydramine (n = 70), tricyclic antidepressants (n = 45), aspirin (n = 45), lithium (n = 36), and antifreeze (n = 10). The geographic distribution was clustered near regions of high population density, with a few exceptions.ConclusionsToxic agents for which GL was performed reflected a broad spectrum of potential hazards, some of which are not life-threatening or have effective treatments. Continuing emergency physician and poison center staff education is required to assist in patient selection.

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The Impact of the 2008 Council of Emergency Residency Directors (CORD) Panel on Emergency Medicine Resident Diversity

Publication date: Available online 29 August 2016
Source:The Journal of Emergency Medicine
Author(s): Dowin Boatright, Java Tunson, Emily Caruso, Christy Angerhofer, Brooke Baker, Renee King, Katherine Bakes, Stephanie Oberfoell, Steven Lowenstein, Jeffrey Druck
BackgroundIn 2008, the Council of Emergency Medicine Residency Directors (CORD) developed a set of recruitment strategies designed to increase the number of under-represented minorities (URMs) in Emergency Medicine (EM) residency.ObjectivesWe conducted a survey of United States (US) EM residency program directors to: describe the racial and ethnic composition of residents; ascertain whether each program had instituted CORD recruitment strategies; and identify program characteristics associated with recruitment of a high proportion of URM residents.MethodsThe survey was distributed to accredited, nonmilitary US EM residency programs during 2013. Programs were dichotomized into high URM and low URM by the percentage of URM residents. High- and low-URM programs were compared with respect to size, geography, percentage of URM faculty, importance assigned to common applicant selection criteria, and CORD recruitment strategies utilized. Odds ratios and 95% confidence limits were calculated.ResultsOf 154 residency programs, 72% responded. The median percentage of URM residents per program was 9%. Only 46% of EM programs engaged in at least two recruitment strategies. Factors associated with higher resident diversity (high-URM) included: diversity of EM faculty (high-URM) (odds ratio [OR] 5.3; 95% confidence interval [CI] 2.1–13.0); applicant's URM status considered important (OR 4.9; 95% CI 2.1–11.9); engaging in pipeline activities (OR 4.8; 95% CI 1.4–15.7); and extracurricular activities considered important (OR 2.6; 95% CI 1.2–6.0).ConclusionLess than half of EM programs have instituted two or more recruitment strategies from the 2008 CORD diversity panel. EM faculty diversity, active pipeline programs, and attention paid to applicants' URM status and extracurricular activities were associated with higher resident diversity.

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Point of Care Echocardiography in an Acute Thoracic Dissection with Tamponade in a Young Man with Chest Pain, Tachycardia, and Fever

Publication date: Available online 29 August 2016
Source:The Journal of Emergency Medicine
Author(s): Kristin Carmody, Michael Asaly, Uché Blackstock
BackgroundAlthough thoracic aortic dissections are uncommon in young patients, they must be considered in the differential diagnosis in the presence of chest pain and abnormal vital signs. Although computed tomography angiography is the test of choice for thoracic dissection in the emergency department, point of care (POC) transthoracic echocardiography has a high specificity in the diagnosis of this disease. It is especially helpful in patients with proximal ascending dissections in the presence of a pericardial effusion.Case ReportThis case report illustrates a young patient presenting with chest pain, persistent tachycardia, and fever with a presumed upper respiratory infection who had an ascending thoracic dissection with tamponade discovered on POC echocardiography.Why Should An Emergency Physician Be Aware of This?POC echocardiography should be an important part of the algorithm in young patients presenting with chest pain and abnormal vital signs that do not improve with supportive measures. Definitive care in patients who present with a thoracic aortic dissection in the presence of cardiac tamponade diagnosed on POC echocardiography should not be delayed in order to wait for other imaging methods to be performed. POC echocardiography may expedite care and treatment in young patients presenting with this deadly disease.

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Repeated Thrombosis After Synthetic Cannabinoid Use

Publication date: Available online 29 August 2016
Source:The Journal of Emergency Medicine
Author(s): Amer Raheemullah, Thomas N. Laurence
BackgroundSynthetic cannabinoids are swiftly gaining popularity and have earned a reputation of being relatively safer than other illicit drugs. However, there is a growing body of literature associating thromboembolic events with their use.Case ReportA 32-year-old woman presented on four separate occasions with a new thromboemoblic event after smoking synthetic cannabinoids. She had no medical history, and over the span of 9 months she developed two kidney infarcts, pulmonary emboli, and an ischemic stroke. Each of these events occurred within 24 hours of smoking synthetic cannabinoids. During periods of abstinence, she remained free of thrombotic events.Why Should an Emergency Physician Be Aware of This?This report shows that an association between thrombosis and the use of synthetic cannabinoids is reproducible and involves both venous and arterial thrombosis, suggesting activation of coagulation or inflammatory pathways. As the popularity of this drug continues to grow, we can expect to see a growing number of these cases. Synthetic cannabinoid use should be included in the differential diagnosis of young patients with no risk factors who present with venous or arterial thrombosis.

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Predictors of Repeated Visits to a Pediatric Emergency Department Crisis Intervention Program

Research Articles
P. Cloutier, N. Thibedeau, N. Barrowman, C. Gray, A. Kennedy, S.L. Leon, C. Polihronis, M. Cappelli
Canadian Journal of Emergency Medicine,FirstView Article(s), 9 pages

Abstract

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Orthostatic Symptoms of Transient Ischemic Attack – Revised

Case Report
Ariel Hendin, Lisa M Fischer, Jeffrey J Perry
Canadian Journal of Emergency Medicine,FirstView Article(s), 3 pages

Abstract

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Prevalence and associated factors of occupational injuries among municipal solid waste collectors in four zones of Amhara region, Northwest Ethiopia

BMC Public Health

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Effectiveness of phosphodiesterase 5 inhibitors in the treatment of erectile dysfunction in patients with spinal cord trauma: Systematic review and meta-analysis

Urologia Internationalis

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Sex differences in mortality following isolated traumatic brain injury among older adults

The Journal of Trauma and Acute Care Surgery

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Shorter times to packed red blood cell transfusion are associated with decreased risk of death in traumatically injured patients

The Journal of Trauma and Acute Care Surgery

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Cardiac arrest during recovery after tilt-induced vasodepressor syncope in a 76-year old man

Journal of Acute Medicine

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Elderly taiwanese's intrinsic risk factors for fall-related injuries

International Journal of Gerontology

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Analysis of fluid resuscitation in critically injured patients—A central role of saline solutions

Journal of Acute Medicine

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Evaluation of a new community-based curriculum in disaster medicine for undergraduates

BMC Medical Education

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Influence of fluid balance on morbidity and mortality in critically ill patients with acute kidney injury

Iranian Journal of Kidney Diseases

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Operative management versus non-operative management of rib fractures in flail chest injuries: A systematic review

European Journal of Trauma and Emergency Surgery

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Hepatotoxicity due to red bush tea consumption: A case report

Journal of Clinical Anesthesia

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Prehospital intubation for isolated severe blunt traumatic brain injury: Worse outcomes and higher mortality

European Journal of Trauma and Emergency Surgery

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Septic sternoclavicular arthritis, osteomyelitis and mediastinitis

Journal of Acute Medicine

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Device and Medication Preferences of Canadian Physicians for Emergent Endotracheal Intubation in Critically Ill Patients

Research Articles
Robert S. Green, Dean A. Fergusson, Alexis F. Turgeon, Lauralyn A. McIntyre, George J. Kovacs, Donald E. Griesdale, Ryan Zarychanski, Michael B. Butler, Nelofar Kureshi, Mete Erdogan
Canadian Journal of Emergency Medicine,FirstView Article(s), 12 pages

Abstract

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Asteroid Hyalosis: A Mimic of Vitreous Hemorrhage on Point of Care Ultrasound

Case Report
Charles E.A. Stringer, Justin S. Ahn, Daniel J. Kim
Canadian Journal of Emergency Medicine,FirstView Article(s), 4 pages

Abstract

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Apelin Compared With Dobutamine Exerts Cardioprotection and Extends Survival in a Rat Model of Endotoxin-Induced Myocardial Dysfunction.

Objective: Dobutamine is the currently recommended [beta]-adrenergic inotropic drug for supporting sepsis-induced myocardial dysfunction when cardiac output index remains low after preload correction. Better and safer therapies are nonetheless mandatory because responsiveness to dobutamine is limited with numerous side effects. Apelin-13 is a powerful inotropic candidate that could be considered as an alternative noncatecholaminergic support in the setting of inflammatory cardiovascular dysfunction. Design: Interventional controlled experimental animal study. Setting: Tertiary care university-based research institute. Subjects: One hundred ninety-eight adult male rats. Interventions: Using a rat model of "systemic inflammation-induced cardiac dysfunction" induced by intraperitoneal lipopolysaccharide injection (10 mg/kg), hemodynamic efficacy, cardioprotection, and biomechanics were assessed under IV osmotic pump infusions of apelin-13 (0.25 [mu]g/kg/min) or dobutamine (7.5 [mu]g/kg/min). Measurements and Main Results: In this model and in both in vivo and ex vivo studies, apelin-13 compared with dobutamine provoked distinctive effects on cardiac function: 1) optimized cardiac energy-dependent workload with improved cardiac index and lower vascular resistance, 2) upgraded hearts' apelinergic responsiveness, and 3) consecutive downstream advantages, including increased urine output, enhanced plasma volume, reduced weight loss, and substantially improved overall outcomes. In vitro studies confirmed that these apelin-13-driven processes encompassed a significant and rapid reduction in systemic cytokine release with dampening of myocardial inflammation, injury, and apoptosis and resolution of associated molecular pathways. Conclusions: In this inflammatory cardiovascular dysfunction, apelin-13 infusion delivers distinct and optimized hemodynamic support (including positive fluid balance), along with cardioprotective effects, modulation of circulatory inflammation and extended survival. Copyright (C) by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Δευτέρα 29 Αυγούστου 2016

How to apply a tourniquet

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How to apply a tourniquet

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How to apply a tourniquet

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Faces of an emergency

EMS artwork by Daniel Sundahl. Check out more of his work here.

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How to apply a tourniquet

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Faces of an emergency

EMS artwork by Daniel Sundahl. Check out more of his work here.

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Faces of an emergency

EMS artwork by Daniel Sundahl. Check out more of his work here.

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Faces of an emergency

EMS artwork by Daniel Sundahl. Check out more of his work here.

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PulmCrit- The siren’s call: Double-coverage for ventilator associated PNA

sirens2.gif?resize=750%2C288

Some theories are so attractive that they are nearly irresistible. No matter how many times they are disproven, these theories still seem compelling. One example is double-coverage for pseudomonas. Recently, the IDSA recommended this for ventilator-associated PNA (VAP), despite openly admitting that RCTs found it to be ineffective.

EMCrit by Josh Farkas.

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Firefighter/Paramedic - Umatilla County Fire District #1

UMATILLA COUNTY FIRE DISTRICT #1 320 SOUTH 1ST STREET HERMISTON, OREGON 97838 Updated: August 24, 2016 Job Classification: Firefighter/Paramedic Umatilla County Fire District #1 anticipates hiring 6-8 Firefighter/Paramedics in early 2017. We will be requesting the list of applicants in mid -October 2016 and candidates moving forward to the interview steps will be provided additional information. Oral ...

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Louisiana floods: How a USAR task force responded to social media inquiries

By Catherine R. Counts and Ruel Douvillier

During the week in mid-August that saw seven trillion gallons of rain fall on southern Louisiana, the Louisiana Task Force 1 Urban Search and Rescue Team (LATF-1) received over half a dozen requests for aid or information via Facebook Messenger.

Given that more than 20,000 people were rescued from rising flood waters over the course of that same week, half a dozen requests may seem like a drop of rain in the ocean, but to those individuals, LATF-1 was a governmental entity that could help, and in many cases, it was the only one responding via social media.

Calls for help or information
We were activated on August 13th and deployed on August 14th for water-based search and rescue missions, joining the hundreds, if not thousands, of other boats filling Louisiana’s flooded roadways to make sure our neighbors were not trapped by the rising waters. That mission evolved into a search and recovery mission as the week progressed.

After the first message was received LATF-1 leadership made the decision to respond to all messages as they were received. Since we only ever received second hand information from worried families and friends we had no way of knowing the accuracy or reliability of the information we were passing on. We passed each call for assistance on anyway, directly to the Operations Section Chief of the Incident Management Team.

We thanked the messenger with a text response and let them know we had forwarded the request to the "appropriate authorities." In all cases we received a reply message of thanks, and sometimes even an update once the flood victims had been rescued.

Although the Facebook Safety Check was activated during the flooding, given the large geographic area, varying timelines of the flooding and a lack of data coverage in the effected areas, it was a less than reliable source for accurate information on an individual’s safety.

In some cases, we had no way of knowing whether or not we played any part in the rescue of these individuals, while in others we were informed of the victim’s rescue before the Incident Management Team could even deploy a response team. But we do know that we played a role in the trust that the citizens of Louisiana place in governmental agencies. In that moment, they felt their voice had been heard.

Armchair responders
Given past false alarms we try to intentionally delay alerting social media about our deployments until they are already underway. However, in this case, a real deployment happened and we didn’t tell our followers until four days in to the response phase.

Once we posted something, most Facebook page fans simply liked or shared the post, with a select few sending comments of prayer and well wishes.

To our surprise, we did receive one comment to the effect of "what took you so long?" This comment likely mirrored the growing frustration with the lack of national media coverage surrounding the flooding.

Rather than delete the comment or block the commenter we choose to respond as diplomatically as possible. Simply stating that we had been deployed since the weekend prior and had been unable to post an update.

The comment was almost instantly deleted by its author.

When being diplomatic doesn’t work
As a search and rescue team we are first and foremost responsible for the care of people. Although we have a canine team, many of whom were also deployed, we only assist with an animal rescue should we encounter one in the course of regular operations. We are not trained, nor expected, to seek out rescues geared towards pets, livestock, or other four-legged living beings.

But not everyone knows that.

Once the waters started to recede, two individuals reached out, both attempting to rescue the same group of neglected dogs. Although the dogs weren’t in a flooded area, it was obvious they needed help, and these women had taken the initiative — independent of one another — to provide food and water while seeking out an organization that could formally take on the animals.

That’s when they found us. And for the next two days we messaged back and forth, explaining that we worked within a structured response system and couldn’t "break ranks" to rescue these dogs. At times their frustration with our inability to assist was so apparent they asked for the name of the Operations Section Chief, something we weren't able to provide.

It took a phone call from one of our canine handlers explaining our model of response as well as recommending a number of animal groups conducting rescues in the area to reach a mutual understanding that we weren’t the appropriate group. The concerned individuals thanked us for the information and never contacted us again.

A week later we determined that the dogs had been rescued by the original messenger and personally transported to a nearby no-kill shelter. No official rescue groups, animal or human, had been involved in their care.

Lessons learned
Our USAR task force is extremely lucky to have an overwhelmingly supportive group of social media followers. Not only do they include our first responders and their family members, but also strangers from every corner of the globe. That level of support was mirrored during this recent activation from most, if not every, follower.

However, given the similarities that this disaster shared with Hurricane Katrina, both in scope and size, as well as a lack of national media attention and a polarized political response, many of the negative emotions we were facing weren’t necessarily directed at us.

But that doesn’t mean we shouldn’t have been prepared to respond. Because the last thing we want to do is discourage any requests for help.

We now know that managing our Facebook page during this activation would have been significantly less stressful had we incorporated the following:

Designate one person to handle all social media responses and postings.
Ensure that no personal contact information is available on the public page.
Pre-identify contact information that the public can use to request aid.
Alert our followers to an activation within 24 hours.
Have an automatic response to Facebook messages.
Pre-script responses for requests for aid, with the next steps delineated depending on the type of request received.
Develop a mechanism for determining the timeliness of a second-hand request for aid to avoid any false alarms.

As demonstrated by the thousands of private citizens, better as known as the Cajun Navy, that deployed their boats into the flood waters looking to help with rescues, the people of Louisiana are more than willing to step into action when they feel that the government isn’t doing enough. But a lack of responsiveness on social media should never be deemed as the reason why they feel the need to launch out on their own.

We are proud to have been active on social media during the recent flooding and we will continue to improve our utilization of this modern day communication platform to reflect our recent experiences. We owe it to those individuals we have sworn to serve.

About the authors:
Ruel Douvillier spent 20 years in the Army, serving as a medic, infantryman and paratrooper. He spent five years as a paramedic with New Orleans Emergency Medical Services, and 14 years with the New Orleans Fire Department, most of that time with their heavy technical rescue squads. He has also served with private ambulance services and volunteer and combination fire departments. He has extensive experience as an instructor. Ruel is presently the Task Force Leader of the State and Regional USAR team, Louisiana Task Force 1 and the Operations Manager for SAR Specialists, an emergency response training company.

Catherine R. Counts is a doctoral candidate in the department of Global Health Management and Policy at Tulane University School of Public Health and Tropical Medicine where she also previously earned her Master of Health Administration. Counts has research interests in domestic health care policy, quality and patient safety, organizational culture and prehospital emergency medicine. She is a member of AcademyHealth, Academy of Management, the National Association of EMS Physicians, and National Association of EMTs. In her spare time, Counts serves as one of the Canine Managers of the State and Regional USAR team, Louisiana Task Force 1.

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Louisiana floods: How a USAR task force responded to social media inquiries

By Catherine R. Counts and Ruel Douvillier

Once we posted something, most Facebook page fans simply liked or shared the post, with a select few sending comments of prayer and well wishes.

To our surprise, we did receive one comment to the effect of "what took you so long"" This comment likely mirrored the growing frustration with the lack of national media coverage surrounding the flooding.

The comment was almost instantly deleted by its author.

But not everyone knows that.

But that doesn’t mean we shouldn’t have been prepared to respond. Because the last thing we want to do is discourage any requests for help.

We now know that managing our Facebook page during this activation would have been significantly less stressful had we incorporated the following:

Designate one person to handle all social media responses and postings.
Ensure that no personal contact information is available on the public page.
Pre-identify contact information that the public can use to request aid.
Alert our followers to an activation within 24 hours.
Have an automatic response to Facebook messages.
Pre-script responses for requests for aid, with the next steps delineated depending on the type of request received.
Develop a mechanism for determining the timeliness of a second-hand request for aid to avoid any false alarms.

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Firefighter - Burlington Fire Department

BURLINGTON FIRE DEPARTMENT 350 SHARON AVE BURLINGTON, WASHINGTON 98233 Updated: August 26, 2016 Classification: Full-Time Firefighter Burlington Fire Department is currently accepting applications for 1 full-time Firefighter. All testing through National Testing Network must be completed by close of business September 17, 2016. Salary Information: $4,670.91 - $5,838.63 per month (2016 Salary Schedule) ...

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Louisiana floods: How a USAR task force responded to social media inquires

By Catherine R. Counts and Ruel Douvillier

Once we posted something, most Facebook page fans simply liked or shared the post, with a select few sending comments of prayer and well wishes.

The comment was almost instantly deleted by its author.

But not everyone knows that.

But that doesn’t mean we shouldn’t have been prepared to respond. Because the last thing we want to do is discourage any requests for help.

We now know that managing our Facebook page during this activation would have been significantly less stressful had we incorporated the following:

Designate one person to handle all social media responses and postings.
Ensure that no personal contact information is available on the public page.
Pre-identify contact information that the public can use to request aid.
Alert our followers to an activation within 24 hours.
Have an automatic response to Facebook messages.
Pre-script responses for requests for aid, with the next steps delineated depending on the type of request received.
Develop a mechanism for determining the timeliness of a second-hand request for aid to avoid any false alarms.

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Louisiana floods: How a USAR task force responded to social media inquires

By Catherine R. Counts and Ruel Douvillier

Once we posted something, most Facebook page fans simply liked or shared the post, with a select few sending comments of prayer and well wishes.

The comment was almost instantly deleted by its author.

But not everyone knows that.

But that doesn’t mean we shouldn’t have been prepared to respond. Because the last thing we want to do is discourage any requests for help.

We now know that managing our Facebook page during this activation would have been significantly less stressful had we incorporated the following:

Designate one person to handle all social media responses and postings.
Ensure that no personal contact information is available on the public page.
Pre-identify contact information that the public can use to request aid.
Alert our followers to an activation within 24 hours.
Have an automatic response to Facebook messages.
Pre-script responses for requests for aid, with the next steps delineated depending on the type of request received.
Develop a mechanism for determining the timeliness of a second-hand request for aid to avoid any false alarms.

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10 tips for successful online anatomy and physiology instruction

By Dan Limmer

There are some EMT and paramedic education topics, like anatomy and physiology, that we have trouble picturing or conceptualizing how to best teach online. Anatomy and physiology brings to mind long, detailed lectures and labs on things like osmosis and facilitated diffusion.

I believe that many complex topics, including anatomy and physiology, can be taught online or in a hybrid format. Some of the key considerations for effective online instruction include:

1. Make the path and outcomes clear
Students won’t know exactly how to learn the A&P material unless you give them a guide. They won’t know the depth you want them to learn unless you give them examples.

2. Make it relevant
Relevance supports learning. While certain parts of A&P are largely memorization, most things can be helped along by clinical relevance and balancing facts and figures with a bit of pathophysiology.

3. Offer audio and video resources
Reading and looking at A&P images alone isn’t enough. Quick audio podcasts with salient points and short, relevant videos are key to effective instruction. Avoid the temptation to load up on too many videos, GIFs and slide decks. There’s a lot out there, and students will have trouble sorting through what is important when time is short.

4. Offer classroom or online follow-up
Students learning this material on their own will need a human safety net. They’ll need to bounce things off their peers and an instructor to make sure they are on track. Everyone appreciates having a safety net.

5. Sequence exercises from easy to complex
Consider the cognitive domain when choosing online exercises and assignments, just as you would in the classroom. Start the process with simpler assignments and wrap up an online learning module with more complex assignments and tests. Instructors go wrong by either staying in the middle with instruction of moderate difficulty all the time, or by not matching the assignment with the student’s current level of cognitive learning.

Through experience, I believe there are five levels of exercises for online A&P learning:

1. Simple start/refresher
You may think it is too simple to do an exercise in which a student matches a disease to an organ or system, but this eases students in and allows you to see where they stand. Another easy starting exercise would be to ask students to make a crude drawing of the organs in each abdominal quadrant or to label the long bones of a skeleton.

2. Provide a list of diseases and conditions
Give students a list of diseases and have them identify the causative organ or organ system for each disease. Start with some grounders like myocardial infarction and emphysema. Move on to diabetes. Then get a bit more challenging with esophageal varices and cor pulmonale. Your goal should be to have them need to research some of the answers on their own.

3. Facilitated research and note-taking
In this case you are providing the students a list of bullet points and having them fill in the blanks. Do this to guide the students into what they should be learning. You can collect these as assignments if you choose. Students get to research, take notes and get feedback from you, all while creating a lasting study tool. A facilitated research topic might be listing the different components in the immune response (antibody, antigen, mast cells, basophils, histamine, leukotrienes, etc.) and asking your students to describe the role of each of those components.

4. Clinical integration
Add case studies into the mix at this point. This allows students to integrate the first two types of exercises with patient assessment and treatment. Using the immune exercise, give scenarios in which the student would have to predict the chemical mediator or mediators responsible for a patient’s signs and symptoms. A potential pitfall would be getting too deep into teaching the immunology portion of the course, but some instruction is OK. Too much takes a lot of time and muddies the waters. A problem-based learning or case-based instruction approach would incorporate more of the immunology at this point.

5. Comprehensive online examinations
Many instructors agonize over whether students use their books when taking online exams. I just assume they do, so I make the questions tougher. As my friend and paramedic educator Joe Mistovich says, "If you want your students to learn comprehensively, you have to test comprehensively." If your test questions are fluff, students won’t learn. Testing is more than measurement. It sets the tone for what you want your students to learn and how hard they need to work in all aspects of the course.

My last bit of advice is to get in there and try online A&P instruction. Take a chance. Create some online activities. You’ll learn from your first try and improve for the next class.

I’d love to see any specific exercises or hear about your experiences with online A&P. Educators and students may have good and bad experiences to share with me and others in the comments.

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NAEMT accepting nominations to donate to 5 injured EMTs

CLINTON, Miss. — The National Association of Emergency Medical Technicians and a corporate partner are accepting nominations for an injured EMT to receive a financial donation. Nominations close Sept. 5.

The EMS community is encouraged to tell the story of a first responder who was injured in the line of duty in a way that seriously impacted their ability to do their original job. The injury may have occurred at any time during the EMT’s career, but they must still be alive and living with the effects of their injury.

Five EMS practitioners who were injured during their career will be considered for a donation.

The practitioner must be willing to share their story through various communications including print, online and social media. In case the EMT is unable to make the decision, a family representative may speak for them.

The head of the recipient’s EMS agency must also agree to sharing their story.

Nominations may be submitted by anyone associated with the nominee, such as a fellow EMT, EMS supervisor, a family member or the injured practitioner themselves.

Eligibility for the nomination is open only to emergency responders in U.S. agencies. Local, state and federal responders, as well as career and volunteer responders are eligible.

The following information must be submitted in order to be eligible for the nomination:

EMT contact info
Agency contact info
Supporting information: 700-word narrative about the EMT’s injury and up to 3 supporting documents

The deadline for submission of nominations is Labor Day, Monday, Sept. 5. To submit a nomination, complete the online nomination form here.

from EMS via xlomafota13 on Inoreader http://ift.tt/2bMnTG0

Πληροφορίες

Τετάρτη 31 Αυγούστου 2016

Τρίτη 30 Αυγούστου 2016

Δευτέρα 29 Αυγούστου 2016

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