A while ago, I posted videos of the method I use to change an intubating laryngeal airway (AirQ, Igel, etc.) for an endotracheal tube. But what if there is a non-intubating laryngeal airway or one with a crossbar in place? Well if you have a disposable bronch, then you can use this method from Erik […]
EMCrit by Scott Weingart.
OBJECTIVE: Acute aortic dissection (AAD) is one of the most frequent aortic emergencies, which occurs to the vascular specialist. Endovascular reconstruction of the true lumen using minimally invasive stent grafting or stenting has become increasingly popular and widespread among institutions. The aim of this paper is to report a case series composed by twenty-eight patients, who underwent endovascular intervention for acute type B aortic dissections complicated by rupture using thoracic endovascular aortic repair (TEVAR).
PATIENTS AND METHODS: All patients with type B-AAD were admitted to the surgical intensive care unit and initially managed with a standing protocol for medical management of AD and observed for evidence of visceral or extremity malperfusion.
RESULTS: No major complications or adverse reactions occurred during the immediate postoperative period. Two patients died in the first three months of the study; both developed a cerebral ischemia. Three patients were lost at follow-up, the remaining twenty-three had a mean follow-up of 41.12±3.55 months (range: 36-58). CT scans were routinely performed at 3 months, 6 months, and yearly after the intervention for all patients.
CONCLUSIONS: Endovascular repair is developing as a strong alternative to surgery and may eventually evolve as a superior method for definitive treatment for patients with appropriate indications, such as complicated dissections. AD rupture may be more common in arch stent-graft patients with an ascending aortic diameter >4 cm and with a multi-stents placement.
L'articolo Aortic rupture of acute aortic dissection type treated with thoracic endovascular aortic repair (TEVAR) sembra essere il primo su European Review.
By EMS1 Staff
SURRY COUNTY, N.C. — North Carolina paramedics have begun conducting blood transfusions, a procedure that could potentially save lives in near-death situations.
When responding to trauma calls with a lot of blood loss, Surry County EMS Director John Shelton said the first hour in treating a patient is critical.
“That 60-minute time frame, from the time the person is injured to when we can get them to a trauma center, is very strong and significant in what the outcome is going to be,” Shelton told WFMY.
Since the procedure was implemented this month, paramedics have already had two situations in which blood transfusions were ready to take place.
“Being able to administer blood in the field is going to significantly improve their chances of survival with the types of injuries that we run on a daily basis,” Shelton said.
During calls where paramedics and EMTs think a transfusion may be necessary, they will contact their supervisor or police, who will retrieve the needed blood from a local hospital.
First responders in Surry County are the first in the state to administer blood transfusions, and Shelton said the only other EMTs they know of also doing them are in Texas.
A while ago, I posted videos of the method I use to change an intubating laryngeal airway (AirQ, Igel, etc.) for an endotracheal tube. But what if there is a non-intubating laryngeal airway or one with a crossbar in place? Well if you have a disposable bronch, then you can use this method from Erik […]
EMCrit by Scott Weingart.
Download this podcast on iTunes, SoundCloud or via RSS feed
In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson are joined by Deputy Secretary of Health for the State of Pennsylvania Ray Barishansky. Barishansky began his career as a volunteer EMS provider and worked his way up to the Department of Health. He shares his experiences, career, influences and gives his tips on having a great EMS career and growing to the next level.
Download this quick clip on iTunes, SoundCloud or via RSS feed
In this week's Quick Clip, co-hosts Chris Cebollero and Kelly Grayson are joined by Ray Barishansky, Deputy Secretary of Health for the State of Pennsylvania. Barishansky shares his tips on having a great EMS career and growing to the next level.
Download this podcast on iTunes, SoundCloud or via RSS feed
In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson are joined by Deputy Secretary of Health for the State of Pennsylvania Ray Barishansky. Barishansky began his career as a volunteer EMS provider and worked his way up to the Department of Health. He shares his experiences, career, influences and gives his tips on having a great EMS career and growing to the next level.
By EMS1 Staff
Maybe you’re not working as an EMT, but you’d still like to give back to your community in a very real, necessary way. Depending on where you live, dedicating a few hours a month as a volunteer could be the way to do that.
Whether you’re brand new to EMS or just taking a break from working full-time, here’s how to volunteer for an EMS service.
In many of our nation’s rural areas, call volume is so low that it’s not profitable for private companies to establish offices with full-time employees. In these towns, EMS is a volunteer service provided by neighbors and community members.
EMS is still a young profession, so even just 30 years ago it was far less regulated than it is now. Almost anyone with minimal training could sign up to drive with a local ambulance service, or ride along with a rescue team.
While it’s great thing that our care providers are gaining more certifications and becoming more educated in the process, the higher barrier to entry keeps out volunteers who aren’t certified. It’s more difficult to find enough people to cover the schedule, and especially difficult to find people to volunteer to become EMTs.
Individual requirements will vary based on the service and state requirements, but you will probably have to earn some kind of certification, whether it is CERT, EMR, or EMT.
Even to become a volunteer, your EMT certification course could take anywhere from an intensive two-week course to a whole semester at a community college.
You need a high school diploma, and to be in reasonable health. There’s no athletic requirement to become a volunteer EMT, but being able to safely load and unload patients into the ambulance will make you better at your job.
Once you find a volunteer service that's willing to take you, be kind, respectful, and ready to learn.
Sure. Some universities even have volunteer EMT opportunities on campus, like Tulane University’s TEMS organization.
EMT work is actually a great job for students. In between calls, you’ll probably be allowed to study for other classes or complete coursework. Many organizations are willing to work with your schedule, and your hours of clinical experience may be recorded for PA or medical school, if that’s your chosen route.
You can still volunteer as an auxiliary member of a rescue squad or fire department, working as someone who takes photos, organizes fundraisers, and raises publicity for the organization.
You maybe even sign up for ride-outs with a local ambulance service.
Check to see if your town has a Citizen’s Fire Academy. In many areas, fire departments have become the main provider of EMS. Many citizen’s fire academy organizations allow participants to ride out with firefighters, so you may get to see a medical call or two on your way out.
Otherwise, there are several national organizations that provide training and certification so that you can be ready to respond in a disaster. Check out your Medical Reserve Corps, Fire Corps, and local Red Cross to see how you can get involved.
No matter how you choose to volunteer your time in EMS, it’s a valuable, unforgettable experience that will allow you to serve your community.
Ambulance response to staging and egress from a mass casualty incident is critical for an effective EMS response.
Early photos and reports of a commuter train that had crashed into and through a station in Hoboken, N.J. made it clear that there were likely to be lots of patients. Initial radio calls likely requested all available ambulances and an activation of regional response plans for additional ambulances and mass casualty transport buses.
This short video shows the ambulance staging area.
#JerseyCity police say this is the medical staging area for the NJ Transit train crash in Hoboken. #Hoboken #NJtransit http://pic.twitter.com/6cvVqQ48Io
— NJ.com (@njdotcom) September 29, 2016
The video showcases best practices for ambulance staging at an MCI. Here is what I saw being done well and additional ideas on how to implement these practices at any MCI response.
1. Keep calm and quiet
It is remarkable how quiet the staging area is. There are no sirens and no one shouting commands.
2. No sirens
It is worth repeating that no vehicles have their sirens activated in the staging area and there are no sirens heard in the distance. Siren noise increases the stress of all responders and complicates communication between responders. Limit siren use to transport of high-priority and critical patients from the incident. Or don't use sirens at all.
3. Red lights optional
Some of the units have their red lights activated in the staging area. During the daytime, running the ambulance lights is fine but likely unnecessary while parked or moving up in the staging area.
At night time, carefully consider the use of rotating lights, especially strobes. The intermittent flashing of lights in a staging area is likely unnecessary and potentially distracting.
4. Stay with your vehicle
In the video, most responders are in or near their vehicles. Orders to move up could come at any time. Don't let an unattended vehicle block other vehicles from egress, which could complicate or compromise the EMS response.
5. Be ready to move
While staging, be attentive to radio, voice and visual commands to move up in line or to exit the staging area. Allowing the engine to idle, especially in a large parking lot, makes sense for easy and rapid ambulance move up.
6. Secure the staging area
Parked ambulances near a major incident are a beacon for the worried well, media and other bystanders. At a known or suspected terrorist incident, ambulances are a potential target. Restrict vehicle and pedestrian access to the staging area, ask non-uniformed people to leave the staging area and if law enforcement resources are available create a secure perimeter around the staging area.
7. One-way and egress
The staging area traffic pattern for ingress or entry into the staging area, as well as parking and egress, needs to be established as soon as possible. It is critical that the earliest arriving units to the staging area be mindful to the traffic pattern and direct later arriving units into the staging area that allows ambulances to continually move up and exit staging to retrieve a patient as quickly and efficiently as possible. Movement in the staging area should be like a smooth flowing river, not like a game of Jenga.
8. Incident safety
Responder adrenaline can be the biggest safety risk during an MCI response. Maintain situational awareness through constant scanning, wearing high-visibility apparel, staying next to or in your ambulance and acting only when ordered to move by a staging officer.
In an unsecured staging area, you are especially likely to encounter bystanders unfamiliar with emergency vehicles. If your ambulance needs to be reversed, make sure to have a spotter in voice and visual contact with the driver.
9. Prepare for patients
Use your time wisely in the staging area. As you become aware of the incident mechanism — train derailment, collapse structure, explosive detonation, or multiple vehicle collision — anticipate patient injuries you are likely to encounter and prepare equipment. For a train versus building, I anticipate blunt trauma injuries, especially to the head, face and chest.
Patients may require extrication, airway management, spinal motion restriction, pain management and fluids. While waiting in the staging area, prepare a backboard, check airway equipment and spike a bag of saline.
Further into the incident, EMS providers are more likely to care for patients with less severe injuries. Treatment might be limited to reassurance, minor bleeding control and splinting unstable long bone and joint injuries.
Don't relax if your ambulance is at the end of the line. When your turn comes, you might receive the critical patient that took an hour to extricate.
10. Know your resources
The staging officer needs to know the resources that are available. In some jurisdictions, it might make sense to have two staging areas to divide BLS ambulances from ALS ambulances.
The video also shows the County of Hudson EMS Task Force medical ambulance bus. Knowing when to release the bus from staging and how to best use it should be pre-determined based on local protocols, previous incident experiences and training exercises.
Finally, visualize a successful staging area from other types of mass people movement.
At the Las Vegas airport taxi stand, dozens of cabs enter the passenger loading area in a smooth, simultaneous one-way flow. In less than 90 seconds, passengers are loaded and another wave of taxis enter from taxi staging to passenger loading. This is a sharp contrast to the privately owned vehicle loading and unloading area at any major airport. POVs are parked two deep, sharply angling toward the curb and potentially blocking traffic for several minutes.
Watch the N.J. video and share your tips for ambulance staging at an MCI in the comments.
Addiction knows no boundaries. At any time, anyone given the right circumstances can develop an addiction. From having that first cigarette or cup of coffee in the morning, to spending every penny of one's savings on methamphetamine or alcohol, addiction is an illness that can be both physically and psychologically devastating.
Medical associations, such as the American Medical Association and the American Psychological Association, have framed addiction as a medical condition, requiring intensive medical and psychiatric treatment to drive it into remission. Recovering addicts will say that addiction is a lifelong affair, a daily battle to stay sober.
Addiction is so common it's almost a fashion statement. Think alcohol during prohibition; tobacco in the 50s; cocaine in the 70s and meth in the 90s.
Opioids, in the form of heroin, were chic in the 1980s among fashion models, musicians and entertainers. Heroin is back again, often mixed with other stronger narcotics like fentanyl that is causing soaring overdose death rates.
The rate of narcotic addiction has also risen with the increasing rate of prescriptions as medical providers try to relieve patients' pain. Opioid overdoses, in most states, are the leading cause of accidental death, even exceeding motor vehicle collision deaths.
Complex problem requiring a complex solution
Despite the complexity of the problem, legislators, regulators and the uninformed continue to look at addiction as a "choice," a "lifestyle," and apparently something very simple to stop. There is a growing backlash and opinion that by increasing access to naloxone that somehow the community is condoning narcotic addiction, that naloxone enables addicts to live their "chosen lifestyle."
EMS providers know all too well that nothing could be further from the truth. Most of us have seen the devastating effects of addiction. Consider the emphysema patient who continues to smoke or the patient in liver failure as a result of alcoholic cirrhosis who continues to drink alcohol. Neither of these patients chose to become addicted. And we spend billions of dollars annually treating these diseases of addiction. Is narcotic addiction that different from these diseases"
There is no evidence to support the enablement of addiction by increasing access to naloxone. Research points to the contrary. Rapid access to naloxone for overdosed patients has gained acceptance as a stop gap measure to help addicts into therapy. This can be ironically verified by the rapid onset of a major naloxone shortage in this country.
As for the frustrations cited in the article, let's look at them a little more closely. For example, for every image of an addict behaving badly, there are hundreds, probably thousands, more who are struggling to quit their addiction. Most states give drunk drivers a chance to enter therapy and sober up before sending them to prison. Most law enforcement agencies offer immunity for turning in firearms to protect their communities. But substitute heroin or prescription narcotics for any of these terms and somehow it's different.
Just to be clear, I offer no simple solution to the current crisis. It's too complex of a problem to offer a pithy response. Legalization is no panacea — tobacco and ethanol show the results of legalizing consumption. But denying medical patients to a lifesaving drug is not the answer.
The first-year findings from the State of EMS report set a foundation to track change in EMS and ignite discussion among EMS leaders and field providers about our future. We asked EMS1 editorial advisors, columnists and contributors to review, react to and reflect on State of EMS 2016 data. The panel includes:
1. Which State of EMS 2016 finding surprised or interested you most"
Dr. James MacNeal: It is interesting that such a large percentage of respondents think paramedics should have an associate’s degree as a minimum requirement. These same respondents reported an extremely low number of associate’s degree-prepared paramedics working for them.
It will be interesting to follow this trend over time as the next generation of paramedics enters the profession. While the associate’s degree may seem to be a surrogate for achieving professional status for paramedics, it causes me some concern. Is it fair to ask an entry-level paramedic to take on two years of college debt to enter a career that pays less than minimum wage in some areas"
The perpetual chicken-or-egg situation is occurring here. Do we get the degree to justify better pay, or offer better pay so providers get the degree" My guess is that it will be a slow combination of both that will ultimately lead to a larger proportion of associate’s degree-trained paramedics.
Sean Caffrey: I also found it most interesting that almost two-thirds (64 percent) of respondents believe that paramedics should hold at least an associate’s degree; however, less than 8 percent of organizations actually required that of their applicants. This is a clear disconnect that actually represents our own organizations holding us back as professionals.
It’s also interesting to note we’ve been concerned about 24-hour shifts, and longer, for many years. We also have recent evidence that 12-hour shifts may, however, be among the worst of all in terms of fatigue and recovery. Interestingly, almost 40 percent of services report shift lengths of 24 hours or more, while half of all services surveyed use 12-hour shifts.
We have much work to do to better understand shift length and fatigue, including the research published in Prehospital Emergency Care, "Recovery between work shifts among Emergency Medical Services clinicians."
Chris Cebollero: It was interesting to see the differences in how systems are conducting clinical care. More than half the agencies involved in the cohort are using an AutoPulse or LUCAS device. You can argue that these systems are trying to be on the cutting edge of care and trying to increase their cardiac arrest survival rates. But only a quarter of reporting agencies are using the impedance threshold device. This seems to be a disconnect in using resources in concert with each other to achieve a high rate of ROSC. If you decided to go with a mechanical CPR device, take the next steps and use the ITD to ensure maximum effectiveness.
Rob Wylie: The survey finding that surprised me the most was the lack of consistency in medical care practices. I realize that there is and always will be a significant divide in the service area types — for example, rural versus urban — but with the advent of available technology, such as software for patient tracking outcomes, along with increased grant availability and more professional certification and education requirements, I would have thought that the gaps would narrow. There will always be outliers, but I expected a more homogeneous prehospital health care system.
I was also surprised by the disparity in clinical measures being utilized by different agencies. With the widespread distribution of best practices, I expected more agreement on critical clinical measures that all agencies should track as a standard.
Catherine R. Counts: Two things stood out to me. First, almost half of the organizations were able to implement hypothermia protocols, which is a relatively quick uptake of a new clinical procedure versus other interventions. Note that the 2015 AHA guidelines do not recommend prehospital initiation of therapeutic hypothermia.
Second, I am surprised that nearly half of respondents are surveying patient satisfaction – although I think we need to define the word "survey" to better understand the effort to collect and analyze satisfaction data.
2. Which additional finding was either most affirming or most concerning"
Sean Caffrey: I was pleased to see a very diverse list of organizations surveyed, an uncommon occurrence. Overall it shows that while we often pride ourselves on variation, we are generally similar as organizations and as a profession, dealing with similar issues and seeing similar trends. Despite the variation in agency type and geography, little in the survey was particularly surprising.
James MacNeal: The funding issues continue to concern me. As health care becomes more integrated, are we placing increasing demand on some of the lowest-paid members of the health care team with the least amount of training in care management and long-term care"
This is unfortunate, but it might also prove a huge opportunity for EMS to step into a role that no other provider can assume in such a rapid fashion. Mobile integrated health care needs to be properly funded before we can expect our agencies to continue to pursue it as a viable care option. Expecting EMS to develop training programs, educate providers and provide care is a lot to ask when there is no dedicated funding stream.
Chris Cebollero: It was interesting that there is still so much reliance on response times as a component of an effective EMS system. This old way of measuring system effectiveness has to finally be debunked and replaced. The EMS systems of today need to also focus on outcome measures, including measurement of patient satisfaction.
First responders are getting on-scene on average in four minutes. Care is at the patient's side faster today than when response time compliance was put into place decades ago. The clock should then stop and the team needs to deliver the best patient care possible, focusing on outcomes, navigating the patient to the most appropriate treatment facility and ensuring that patients feel they received excellent care.
Rob Wylie: The most affirming finding was the overwhelming agreement by the respondents that EMS services are becoming more integrated with the overall health care system. The complexity of the regulatory environment, coupled with the pace of clinical change in medicine in general, dictates that we have a cohesive, comprehensive and symbiotic relationship between EMS response agencies, hospitals and the medical education system.
Catherine R. Counts: It is affirming that clinical measures are being used by agencies to measure appropriate application of care, but the amount of variation is worrisome.
3. How do the findings of the first year align with other trends in EMS and health care"
Catherine R. Counts: It makes sense to me that there is variation in how "success" and "good care" are measured. The U.S. health care system as a whole can’t agree on what constitutes good care, so it’s no surprise that EMS can’t either.
James MacNeal: The likely increase in patient satisfaction scores tied to EMS reimbursement is a very scary prospect. Patients are often most anxious and least likely to understand the care that is being provided to them in the first minutes of their emergency. Poor experiences in the emergency department and in the hospital may translate to lower patient satisfaction scores for EMS by the time the patient receives the survey. In a model where EMS providers must have pancake breakfasts, fish fry dinners and bingo night (to raise needed funds), it is very scary thinking that if their patient satisfaction isn’t good, their reimbursement might be lowered more than the barely afloat level it is at already.
Chris Cebollero: It seems to me that the status quo is alive and well in EMS. The adage, "that's the way we have always done it" comes to mind when looking at the first year of data. We now have the opportunity to challenge our processes, determine what the EMS systems of tomorrow will look like and transition to new models. Health care is changing daily. It is time for EMS to be in the forefront of change to help patients get healthier.
Rob Wylie: The findings of the first year point in a couple of directions. First, patient outcome-centered care. As we see the growth of community paramedicine to prevent patients who could otherwise be treated at home by highly trained medics — supervised by doctors, physician assistants or nurse practitioners/APRNs — from returning to the hospital.
Second, we have an opportunity to refocus more of the services we provide to be patient-centric. Why do we transport diabetics who return to a normal (blood sugar level) after treatment" Why are COPD patients transported when all they may need is an adjustment in their medications" Home-based care is less expensive, less invasive and in many instances more than adequate.
Sean Caffrey: The variation in clinical care was not particularly surprising. As with any medical practice, the level of care being provided and the adoption of new treatment modalities occur at various speeds throughout the health care system.
It was also interesting to see some clearly outdated items still around while some newer therapies had gained substantial adoption. This is comforting in the sense that it represents that we advance in a similar way to our colleagues throughout health care and that removing therapies is perhaps harder than adding them.
4. What specific actions, based on State of EMS 2016 findings, do you recommend to EMS leaders"
Chris Cebollero: It is always a best practice to benchmark your system, processes and clinical care with the career field. This project lets EMS leaders look into the EMS mirror and gauge how successful their EMS system truly is. As leaders, we need to meet, exceed or set the standards for others to follow and hopefully come to some consensus on how "gold standard" EMS systems should operate. This is going to be a long road, but it begins with the sharing of data.
James MacNeal: Engage with your local hospitals now. Mobile integrated health care is not a right of EMS. Many hospitals don’t even know EMS providers can do these things. By getting in on the front end of this, EMS will be in a better position to control their destiny. Engage your medical director for EMS activities as well as hospital liaison duties. Integration is paramount to all of our success, but if you are not a full partner, bundled billing will be your nemesis.
Catherine R. Counts: Recognize that no EMS organization is an island, while at the same time no two organizations are exactly alike. Protocols and procedures can have variation across organizations, but said variation must come from a place of good intentions.
EMS is a changing field, but different organizations have the capacity to change at various rates. Don’t try a new idea just because a famous EMS agency or service did it. Do your own research and come to a decision that is best for your organization’s economic and cultural situation.
Rob Wylie: I am reminded of the adage, the only two things emergency response agencies hate are change and the way things are. We need to focus on best practices, evidence-based medicine and clinical measurements that truly gauge the value of the service we provide. "We’re too small" or "We’ve always done it this way" are crutches and excuses that do not hold water.
Look around at those that are doing it right. Educate your community and its leaders as to the kind of service your customers deserve and that those services cost money. Adopt evidence-based clinical measures that show the great work you are doing, not just how fast you are leaving the station after a 911 call.
Sean Caffrey: The IHI's "Triple Aim" will continue to be the rallying cry of health care moving forward. We know health care is too expensive, far less effective than it should be and very disconnected from the patient.
EMS leaders must do a better job of measuring from the customer’s perspective. Obscure metrics, such as measuring response time intervals from the time of dispatch, something no patient would care about or benefit from, puts us in a position of peddling self-serving nonsense that will likely come back to haunt us. We must also do a much better job of measuring and providing good customer service. It won’t be long until we can read about ourselves in a Yelp or similar-style review.
5. What else would you add to the discussion"
James MacNeal: EMS providers need to be active learners and participants in the EMS system. Encourage your medical directors, nurses, emergency physicians and law enforcement personnel to spend time with you. You need to carry the torch of your profession and spread the word of our undying commitment to saving lives and serving our communities.
Chris Cebollero: As EMS leaders we often talk about how splintered the EMS career field is, or we wonder when some person or agency is going to unite all of EMS so we finally get the recognition and respect our career field deserves. It is through efforts such as this that will bring recognition to common care and operational practices.
Sean Caffrey: An overwhelming majority of respondents want paramedics to have a degree, many EMS organizations invest over half their budgets on staff and we claim to be very concerned with their safety. Our actions, or perhaps our need to get trucks on the street at any cost, however, show that we are not yet aligning our practices with our preaching – issues which are squarely under our control as EMS leaders.
Catherine R. Counts: The fact that Fitch, EMS1 and NEMSMA teamed up to do this report is fantastic. Although prior attempts at surveying EMS organizations have been made, the long-term goals of this survey set it apart from those efforts. By committing to seek out responses from the same organizations year after year (and with such a large response rate), this survey will only become more valuable both within and outside the EMS industry.
Concepts like mobile integrated health care and community paramedicine, paired with the continued focus on ensuring that health care is effective while being patient-centered, noted in this report and subsequent surveys will ensure that EMS is able to keep pace with the trends, changes or alternative markets coming our way.
Rob Wylie: I would recommend that all EMS leaders become involved in professional associations and organizations such as the National EMS Management Association, the International Association of Fire Chiefs, and the National Association of EMS Physicians (you don’t have to be an MD to join!).
Most of all, I would encourage leaders and their personnel to look hard at what their communities expect from them now, and then educate them as to what is possible with a collaboration and support in the future.
Find the need and create the solution! Become the "agency of first resort" in your community.
The Panel
James MacNeal, MPH, DO, NRP, began his career in emergency medicine as a paramedic. He holds an American Board of Emergency Medicine/Emergency Medical Services certification and completed an EMS fellowship at Yale University. He is the MercyRockford Health System’s EMS medical director.
Chief Rob Wylie has been in the fire service for 29 years, serving first as a volunteer firefighter and then as a career firefighter, rising through the ranks to become the fire chief of the Cottleville FPD in St. Charles County, Missouri, in 2005. During his tenure, he has served as director of the St. Charles/Warren County Hazmat Team and as president of the Greater St. Louis Fire Chiefs Association. Wylie has served as a tactical medic and TEMS team leader with the St. Charles Regional SWAT team for the last 19 years and serves on the Committee for Tactical Casualty Care guidelines committee. Chief Wylie is a member of the Fire Chief/FireRescue1 Editorial Advisory Board.
Chris Cebollero is a nationally recognized emergency medical services leader, author and advocate. He is a member of the John Maxwell Team and available for speaking, coaching and mentoring. Currently he is the senior partner for Cebollero & Associates, a medical consulting firm, assisting organizations in meeting the challenges of tomorrow. Cebollero is a member of the EMS1 Editorial Advisory Board.
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’s degree in 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.
Sean Caffrey, MBA, CEMSO, NRP, currently serves as the EMS programs manager for the University of Colorado School of Medicine, Pediatric Emergency Medicine Section. He has been certified as a paramedic since 1991 and has worked in volunteer, private, hospital-based, fire-based and third service EMS systems in roles from provider through department head. Caffrey currently works in conjunction with the state EMS office in Colorado, is the vice president of the EMS Association of Colorado, is a board member of the National EMS Management Association and a member of NAEMT, NASEMSO and NAEMSP. His interests include EMS system design, pediatrics, public policy, professional development and research.
By Allison G. S. Knox, EMT-B, Faculty Member at American Military University
It isn’t rare for newborn babies to have trouble with jaundice in the days after their birth. The condition is usually recognizable by an orange coloring of the skin, which is caused by a high level of bilirubin in the blood. Most of the time the baby’s liver will rid the body of bilirubin, but in rare cases, the bilirubin level rises so quickly that their body simply cannot recover, resulting in devastating effects.
When the level is high enough, bilirubin crosses the blood-brain barrier and leaves a stain on the brain that causes brain damage, a condition called kernicterus. Untreated severe hyperbilirubinemia can also cause auditory neuropathy spectrum disorder, ranging from mild to complete hearing loss, and cerebral palsy, which leaves a child unable to walk. Many of these children are forced into wheelchairs for life. For some, severe hyperbilirubinemia can even result in death. Once caused, the damage from hyperbilirubinemia cannot be reversed, but the cognitive parts of the brain are often left intact. For the family of a child with kernicterus, it can be devastating to see their child who was perfectly healthy at birth suddenly suffer from a debilitating illness.
Changing medical policies
To effectively manage jaundice and detect hyperbilirubinemia in newborn babies, healthcare policies are in urgent need of change. Because potentially devastating levels of bilirubin are so rare, many doctors don’t necessarily look out for the signs and symptoms that can arise in the first few days of a newborn’s life. As a result, a child who could be helped is often left untreated. If bilirubin levels were regularly checked through physician-ordered tests, fewer babies would suffer from kernicterus.
Full Story: Medical changes that could prevent brain damage in infants
