IL-6 rs1800795 polymorphism is associated with septic shock-related death in patients who underwent major surgery: a preliminary retrospective study

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, being the primary cause of death from infection, especially if not recognized and treated promptly. The aim o...

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Impact of random safety analyses on structure, process and outcome indicators: multicentre study

To assess the impact of a real-time random safety tool on structure, process and outcome indicators.

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How EMS, patients benefit from rapid technological changes

Technological progress will continue to transform how we connect with our community, one patient at a time

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How EMS, patients benefit from rapid technological changes

Communicating information remotely has undergone a revolution of sorts. Letters carried by humans have been around for a millennium, first on foot, then followed by animals, boats, trains, automobiles and planes. Today, a mailed letter can arrive halfway around the world in two days, compared to the many months that it would have taken less than 200 years ago. The introduction of the telephone in the late 1800s shifted the focus of communication from reading to hearing information in real time.

Digital technology has continued that progress in ever faster cycles. It's hard to imagine that the dawn of the internet age was a mere 40 years ago. The digitalization of information changed the paradigm of what it means to communicate. Not only is it just words; it includes images, sounds, video and other forms of data crucial to banking, security and research.

We've experienced this information revolution as EMS providers. Most of us now digitize our patient care records and upload them to a server for processing and retention. We transfer information from our monitors wirelessly to our PCR tablets or laptops. Radios, cellphones and mobile data terminals operate on digital communication systems. Many of us receive our continuing education online (including our own EMS1 Academy). Telemedicine with physicians is improving the diagnostic capability of the field provider on the scene of a medical incident.

Technology is also contributing to a network of emergency care information for the community. The public can watch videos online to learn critical skills such as chest compressions, naloxone administration and tourniquet use.

Consumer products, like the Amazon Echo, provide critical, just-in-time information about CPR, heart attacks and stroke. Mobile apps, like PulsePoint, alert citizens with medical training to respond to nearby critical incidents and locate an AED if needed.

Emergency response activation

For all of these great technological developments, we're still lagging at where it might be most crucial, the activation of an emergency response. Despite present day technology, we continue to rely on the verbal descriptions provided by victims and eyewitnesses as to what's occurring on the scene.

Most, if not all of us, have had the experience of being dispatched to an incident that turned out to be nothing like what was reported. While not a panacea, having live video could be helpful in the initial triaging of 911 activations.

Tech-driven medical alert systems could provide information about a patient's history and current vital signs to the communication center. Widespread use of texting can enable the nearly one million people in the United States who are deaf or hard-of-hearing to communicate quickly in an emergency.

Certainly the issues of data security is huge. I suspect that more than a few of us have had some private information compromised. I also believe that this is a transient issue that will be resolved in the long term. Personal liberties may also be involved, but a well-informed consumer can make a decision of what information to make available to emergency responders.

The pace of technology has made profound changes in how we communicate in our personal and professional lives. When it comes to EMS, technological progress will continue to transform how we connect with our community, one patient at a time.

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Pre-hospital ct diagnosis of subarachnoid hemorrhage

Subarachnoid hemorrhage (SAH) is associated with higher mortality in the acute phase than other stroke types. There is a particular risk of early and devastating re-bleeding. Patients therefore need urgent ass...

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Development of the major trauma case review tool

As many as half of all patients with major traumatic injuries do not receive the recommended care, with variance in preventable mortality reported across the globe. This variance highlights the need for a comp...

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The number of displaced rib fractures is more predictive for complications in chest trauma patients

Traumatic rib fractures can cause chest complications that need further treatment and hospitalization. We hypothesized that an increase in the number of displaced rib fractures will be accompanied by an increa...

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REV Group announces partnership with Ferno on revolutionary new ambulance design

REV Group, a $2+ billion manufacturer of industry-leading motor vehicle brands, and Ferno, the global leader in emergency pre-hospital patient handling equipment, are announcing the launch of a groundbreaking and innovative patient and crew-centric ambulance design. This design will allow EMS providers to experience improved patient & medic safety, operational flexibility, and system efficiency ...

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Platinum Educational Group offers third round of scholarships for EMS, nursing and allied health students

GRAND RAPIDS, Mich. — Platinum Educational Group, the Testing, Scheduling, and Skills Tracking Experts, understands the struggles and obstacles that are presented to students obtaining higher education in the healthcare industries. In 2015, Platinum Educational Group launched its inaugural scholarships program geared at EMS students. In 2016, the company has expanded its product line to include ...

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Hospital debuts pediatric-specific ambulance

The ambulance, which features blue skies and white clouds on the interior ceiling, will be outfitted with specialized equipment

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Building a strong EMS team: Overcoming conflicts

When team members do not mesh well, it can add stress to an already stressful environment

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How community paramedics use point-of-care devices

SALT LAKE CITY — Point-of-care testing is a tool for community paramedic patient assessments in the out-of-hospital setting that is convenient for the patient and providers, easy to use, leads to a more prompt field diagnosis and results in more timely treatment. Desiree Partain, clinical program manager with MedStar Mobile Health, introduced how community paramedics are using handheld, portable blood analyzers in a presentation at EMS Today.

Partain discussed the benefits and drawbacks to consider, as well as the regulatory hurdles, involved in implementing point-of-care testing. Much of the presentation was based on the lessons Partain and MedStar has learned through implementing its point-of-care testing program

Memorable quotes on point-of-care testing by community paramedics

Partain repeatedly emphasized the importance of first defining the department's goals for a community paramedicine program. The program goals, along with the target patient population, should drive the decision to purchase a handheld blood analyzer. Here are three memorable quotes from Partain's presentation.

"The important thing is identifying the needs of your specific (community paramedic) program. Truly define what is important to your agency. What patient populations are you going to be treating""

"Get the right equipment to meet the needs of your program and the patients you are trying to serve."

"If we are giving paramedics point-of-care devices, we need to give them information on how to use the data."

Top takeaways of point-of-care testing

Partain's presentation was a helpful introduction to point-of-care testing and how it has been implemented by MedStar mobile integrated health care personnel. Here are the top three takeaways:

1. Benefits of point-of-care testing

The benefits of point-of-care testing include speed, portability, convenience, connectivity and quality assurance. A portable blood analyzer allows community paramedics to provide more information to physicians than they could do with vital signs and a physical exam.

2. Understand regularity requirements

EMS clinical managers need to review and understand the Clinical Laboratory Improvement Amendment (CLIA) waiver requirements. A CLIA waiver is most likely to be granted when there is low risk for incorrect results, such as blood glucose testing or a CHEM 8 which is chemistry, electrolytes, hematology and blood glasses.

3. Treatment goals come first

Partain described a post-discharge heart failure patient and how a field diagnosis with point-of-care testing led to earlier intervention for the patient. The treatment, provided in the patient's home, was quicker and more convenient for the patient than transport and treatment at the hospital.

A point-of-care testing program needs to driven by goals for specific patient populations. The testing needs to be articulated in specific patient protocols, such as a heart failure protocol. The MedStar protocol directs both the use of an iSTAT device and what to do with the data the iSTAT returns.

Learn more about point-of-care testing

Partain discussed the importance of initial and ongoing education. Here are several articles about prehospital conditions which might benefit from handheld, blood analyzer data.

• A salty tale: What EMS personnel need to know about electrolyte disorders
• 6 useful sepsis assessment and treatment tips
• 4 things paramedics need to know about capnography and heart failure
• 4 steps to prepare for prehospital antibiotic administration
• Drunk versus diabetes: How can you tell"
• Remember 2 Things: How to avoid common glucometer mistakes
• Remember 2 Things: How to best obtain a glucometer blood sample
• How to get an accurate glucose reading for diabetic patients
• Blood glucose test for altered mental status

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SC ambulance transporting patient struck by truck

The ambulance had its lights and sirens activated when a FedEx truck failed to yield to the rig

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Pediatric sepsis: 10 things paramedics need to know

Use this information and the SEPSIS mnemonic to improve EMS recognition, assessment and treatment of pediatric sepsis

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Clinical outcome after alternative treatment of scaphoid fractures and nonunions

Abstract

Purpose

Achieving stable fixation of scaphoid fractures and nonunions continues to be a challenge. Compression screw fixation has been the current standard surgical procedure. However, in some cases, bone healing cannot be achieved and requires further revision. Recent series reintroduced volar plating as valid option for stable fixation. The aim of the study was to review clinical outcome of alternative scaphoid treatment.

Methods

From 2011 to 2014, nine patients with scaphoid fracture were treated by Headless Compression Screw (HCS) and seven patients with scaphoid nonunion by HCS or volar mini condylar plate with bone graft. The average age was 34.4 years and the average time to follow-up was 19.3 months. From 1996 to 1998, 38 patients with scaphoid nonunion were treated using compression screw (S-group) or volar mini condylar plate (P-group) with bone graft. The average age was 39.6 years and the average time to follow-up was 26.2 months.

Results

The union rate was 100%. For scaphoid fractures, the mean Modified Mayo Wrist Score (MMWS) was 94.1 and the DASH score 7.4. From 2011 to 2014, the MMWS was 87.9 and the DASH score 7 in scaphoid nonunions. In the period between 1996 and 1998, the MMWS was 67.2 in the P-group and 58.6 in the S-group, and the DASH score 16.8 and 28.2.

Conclusions

Our study demonstrated that appropriate application of the HCS was able to produce very satisfactory results in scaphoid fractures and nonunions. In our opinion, however, the method of scaphoid plate osteosynthesis can achieve a higher degree of stability, particularly rotational stability, in case of multifragmentary avascular scaphoid nonunions.

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Top 5 pediatric medical care questions

DALLAS — Peter Antevy, MD, a pediatric emergency medicine physician best known for his development of the Hantevy Method for pediatric medication administration, gave a number of interesting talks at the 2017 Gathering of Eagles.

On the second day of the conference, Antevy was awarded the Ron J. Anderson Award for the significant impact his work within the field of pediatric EMS has had on the industry. Afterward, he presented on the top five challenges in prehospital pediatric medical care. His session, streamed on Periscope, was chock full of information including the following memorable quotes and key takeaways.

Memorable quotes on pediatric care

"If you have a BVM, chest rise, good saturation and you think you’re ventilating the patient OK, stick with that."

"It’s really hard to screw the King tube up, you just shove it in and it goes in the right spot."

"At the end of the day, BVM is still king."

"There is going to come a day where if you document a pain score greater than '5' and don’t give a dose of a pain medication, then you won’t get paid."

"With morphine … the pain finally goes away after you transfer care and the doctor gets all the credit. We don’t want to do that."

"Why shouldn’t we all use D10 cradle to grave""

Key takeaways on pediatric care

Antevy’s talk was well organized and able to address the following questions:

1. What’s the best pediatric airway option"

A BVM with good placement and vitals is the best option; however, if necessary, Antevy is also a fan of supraglottic airways including the LMA, King LT and iGel. He uses all three across the various EMS systems he provides medical direction to.

2. What should EMS use for pediatric pain control"

Antevy's first focus was the growing trend toward meaningful use. EMS agencies should expect to provide medication to children complaining of pain regardless of how far away the receiving facility is located. Otherwise, they will eventually pay a financial penalty.

Most agencies likely use morphine, fentanyl, dilaudid or ketamine. Antevy argues that fentanyl and ketamine are the leaders for pediatric pain control since morphine takes 25 minutes for the patient’s pain levels to decrease.

Antevy reminded the audience of the dead space that exists in the MAD device when administering nasally which traps 0.1 mL of medication, which can significantly impact the volume of medication a pediatric patient receives.

3. What should EMS use for pediatric seizure control"

Most agencies now use midazolam over lorazepam and diazepam because it’s fast, can be used via any route of administration and has very few active metabolites. That said, recent research suggests, and Antevy agrees, that intramuscular administration is preferred over IV or rectal.

4. How should EMS treat hypoglycemia"

Another recent publication out of Oregon suggests that hypoglycemia protocols vary widely by agency. Antevy received a round of applause when suggesting that everyone use D10 for all patients, regardless of the patient's age.

5. Should EMS withhold fluids in kids"

A single NEJM article on children with malaria in sub-Saharan African recommended against bolusing children that are not in shock. Most other research suggests that there is no benefit to withholding fluids, something Antevy agrees with.

Learn more about pediatric assessment

Antevy recently discussed these five questions and other pediatric assessment and care topics on the Inside EMS podcast:

• Inside EMS Podcast: Why EMS providers should treat children as adults

After listening to the podcast, check out these articles on EMS1:

• Pediatric IOs: 5 things I didn’t learn in paramedic school
• How to use OPQRST as an effective patient assessment tool
• Pediatric patient ABCs: 7 tips for EMTs and paramedics
• EMS leader’s 8-step guide to excellent pediatric care
• 3 things paramedics need to know about seizures and respiratory compromise
• How well do you know pediatrics"
• The critical pediatric patient: Test your knowledge
• Pediatric trauma assessment and treatment tips

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Medical directors share their most discussed questions, concerns

DALLAS — Officially known as the EMS State of the Sciences Conference, the Gathering of Eagles happens each year during the third weekend in February. But for the other 51 weeks of the year, the Eagles, who are the medical directors for the 40 or so largest EMS systems in the United States, use a systematic email list server to ask questions, share ideas and consolidate the types of discussions that will likely dominate the next Gathering.

Jim Augustine, MD, FACEP, the Eagles Librarian and Associate Medical Director for Atlanta Fire Rescue Department, presented a summary of the types of discussions the Eagles have been having over the last year. 

Memorable quotes

Augustine moved quickly through his synopsis, here are some quotes on themes that stuck out:

"Develop better all-hazards response, because we never know what the next threat is going to be."

"We have an industry that has guaranteed business for many more years into the future."

"Regardless of what patch you have on your shoulder, everyone needs to look at what we can be doing to improve things for the community."

"I encourage all of you to form your own eagles, form a network for sharing information and best practices."

Key takeaways from Eagles electronic correspondence

The 80 discussions the Eagles have had over the past year centered on the following themes, here are my takeaways from each:

1. How is staff working?

Employee safety is continuing to gain prominence in the EMS industry. This comes from an increase in our understanding of the dangers of lack of sleep and fatigue as well as recent high profile attacks on EMS providers in the field.

2. Products and medications for patients

The Eagles adopt new products and medications with the same types of questions and concerns that every EMS service faces. This year, the conversations centered on interventions like supraglottic airways and intraosseous vascular access systems as well as medications like ketamine and epinephrine. 

3. Transport, non-transport and hospital interface

An increasing number of hospitals are becoming certified destinations for specific conditions such as stoke, sepsis and cardiac arrest. But not all certified centers are created equal. Less traditional destinations are also receiving more attention due to the increasing diversification of what services EMS agencies provide.

4. Increase in technology

The use of capnography during cardiac arrest, the expectation that dispatchers provide CPR instructions prior to EMS arrival and even drones were topics of discussion for the Eagles over 2016. The technology topics are only expected to increase every year.

5. Major incident management

Given the growing number of high profile active shooter incidents, the need for cohesive and comprehensive communication across coordinating agencies has never been more apparent. This concern includes both the actual event and the subsequent responses, vigils and outreach that occur after the fact.

6. Impact of Wingspread VI

Wingspread is a conference of fire service leaders that meet once every 10 years. They met in June 2016 and recently released the Wingspread VI report. Of significance to EMS agencies was the decision to change the name of the report to "Statements of National Significance to the United States Fire and Emergency Services."

Learn more about Eagles' top topics

Read more about these topics on EMS1.

• Orlando Pulse nightclub shooting lessons for EMS response to MCIs
• LVO stroke: How to improve EMS response and patient survival 
• How to improve stroke patient triage, assessment, care and transport 
• Tips for assessing and treating stroke victims 
• Pediatric IOs: 5 things I didn’t learn in paramedic school 
• 10 best sepsis assessment and treatment tips, articles and videos 
• 6 useful sepsis assessment and treatment tips 

Read the full 2016 Wingspread VI Report

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Va. EMS to use mobile ultrasound to better treat patients

EMS providers will be able to email photos or videos to hospital officials before arriving

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Predictors of posttraumatic stress symptoms and association with fear of falling after hip fracture

Journal of the American Geriatrics Society

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Current management practices for patients presenting with low back pain to a large emergency department in Canada

BMC Musculoskeletal Disorders

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'Biggest Loser' host Bob Harper suffers heart attack

AP

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Acute kidney injury in elderly intensive care patients from a developing country: Clinical features and outcome

International Journal of Nephrology and Renovascular Disease

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Sharp vision: New glasses help the legally blind see

AP

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Intravoxel incoherent motion diffusion-weighted imaging of bone marrow in patients with acute myeloid leukemia: A pilot study of prognostic value

Journal of Magnetic Resonance Imaging

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Sharp vision: New glasses help the legally blind see

AP

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Can body mass index predict clinical outcomes for patients with acute lung injury/acute respiratory distress syndrome?: A meta-analysis

Critical Care

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Relationship between therapeutic effects on infarct size in acute myocardial infarction and therapeutic effects on one-year outcomes: a patient-level analysis of randomized clinical trials

American Heart Journal

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Cervical spine imaging for young children with inflicted trauma: Expanding the injury pattern

Journal of Pediatric Surgery

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Percutaneous edge-to-edge mitral valve repair for the treatment of acute mitral regurgitation complicating myocardial infarction: A single centre experience

International Journal of Cardiology

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The dirty dozen: UN issues list of 12 most worrying bacteria

AP

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Epidemiology of emergency department visits for anxiety in the United States: 2009–2011

Psychiatric Services

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Intracerebral hemorrhage location and outcome among INTERACT2 participants

Neurology®

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Can vestibular rehabilitation exercises help patients with concussion? A systematic review of efficacy, prescription and progression patterns

British Journal of Sports Medicine

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Combination of BTrackS and Geri-Fit as a targeted approach for assessing and reducing the postural sway of older adults with high fall risk

Clinical Interventions in Aging

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Management of anticoagulation with rivaroxaban in trauma and acute care surgery: Complications and reversal strategies as compared to warfarin therapy

The Journal of Trauma and Acute Care Surgery

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Recurrent obstetric anal sphincter injury and the risk of long-term anal incontinence

American Journal of Obstetrics and Gynecology

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Low adverse event rates but high emergency department utilization in chest pain patients treated in an emergency department observation unit

Critical Pathways in Cardiology

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ADHD and nonsuicidal self-injury in male veterans with and without PTSD

Psychiatry Research

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Building a strong EMS team: Overcoming conflicts

By Allison G. S. Knox, American Military University

Working in emergency medical services can be extremely stressful for responders. To provide the best service to patients under such conditions, it’s critical that EMS teams be comprised of a group of trusted people.

However, building a strong team is easier said than done. When team members do not mesh well, it can add stress to an already stressful environment. It is important for those in EMS to know how they fit into the team environment and contribute to the overall team effort. Individuals must also know how to effectively diffuse and overcome any challenges that may arise within the team.

Some scholars argue that individuals come together with the “forming, norming, storming, performing” framework. According to researcher Judith Stein, under this framework, people essentially need to figure each other out and work out their differences. After doing so, they are much better able to effectively perform as a team.

DISCUSS ISSUES OPENLY

In all teams, it is inevitable that there will be conflicts among members, which can make it difficult to work together. When this situation arises, it is important for team members to talk out their differences directly. It does not help the situation or the team performance to turn the situation into gossip. When team members discuss their differences openly, they are often able to come to a resolution.

TURN TO MEDITATION

There may be times when team members cannot work out their differences. When this happens, mediation can often be an effective solution. In EMS, it is important to discuss these issues with the chief or another person in a managerial position. The goal is not to get someone into trouble but rather to come to a mutual understanding and compromise over the issue at hand.

Especially in EMS, it is important to have strong and collaborative teams. Ultimately, each team member is responsible for his or her role in the team and must figure out how to work together and to iron out differences before it becomes an issue. Speaking to each other about these issues in a civilized fashion is ideal, but mediation may be needed if initial discussions are not constructive.

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Stryker EMS - More power to you

Stryker is bringing more power to EMS professionals around the globe with our Powered System.

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Stryker EMS - More power to you

Stryker is bringing more power to EMS professionals around the globe with our Powered System.

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Listen: EMS1’s columnists share passion, origins of joining EMS

By EMS1 Staff

RALEIGH, N.C. — In a recent podcast episode, Kelly Grayson and Chris Cebollero, EMS1 columnists and hosts of Inside EMS, shared their journey to becoming EMS providers. 

Grayson and Cebollero each sat down with Steve Cohen on the Medic2Medic podcast to discuss their origins in EMS and where they see its future heading.

Cebollero’s career in EMS began in the 1980s with the U.S. Air Force. He said he was transporting a military patient when a woman got out of her vehicle and handed him her 3-month-old baby who was not breathing.

“It was that night that I realized that this woman didn’t care who I was, where I was from, only that I was in the ambulance and I had all the answers to take care of her most precious gift. It was that night I realized that if I wasn’t on top of my game as a paramedic, somebody would die and it would be my fault,” Cebollero said. 

He then spent the next 30 years training, educating and studying in EMS.

“It wasn’t until I was pushed into the craft until I realized how important it really was,” Cebollero said. “One of the biggest lessons I’ve learned, is that you have to go after what you want, you can’t just sit on the bench and wait for it to come.”

Grayson joined EMS around 23 years ago. While waiting to enroll in a nursing program, Grayson became an EMT, and “has been doing that ever since.”

In the past, EMS1 Editor-in-Chief Greg Friese and Kris Kaull, the founder of EMS1, sat down to talk on the podcast.

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Stryker EMS - More power to you

Stryker is bringing more power to EMS professionals around the globe with our Powered System.

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Stryker EMS - More power to you

Stryker is bringing more power to EMS professionals around the globe with our Powered System.

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Volume replacement during trauma resuscitation: a brief synopsis of current guidelines and recommendations

Abstract

Introduction

Intravascular volume and fluid replacement are still cornerstones to correct fluid deficits during early trauma resuscitation, but optimum strategies remain under debate.

Methods

A synopsis of best current knowledge with reference to the following guidelines and recommendations is presented: (1) The European Guideline on Management of Major Bleeding and Coagulopathy following Trauma (fourth edition), (2) S3 Guideline on Treatment of Patients with Severe and Multiple Injuries [English Version of the German Guideline S3 Leitlinie Polytrauma/Schwerverletzten-Behandlung/AWMF Register-Nr. 012/019 sponsored by the German Society for Trauma Surgery/Deutsche Gesellschaft für Unfallchirurgie (DGU)], and (3) S3 Guideline Intravascular Volume Treatment in the Adult [AWMF Register-Nr 001/020 sponsored by the German Society for Anesthesiology and Intensive Medicine/Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)].

Results and conclusions

Volume replacement at a reduced level in severely injured and bleeding trauma patients is advocated (permissive hypotension) until the bleeding is controlled. ATLS principles with Hb, BE, and/or lactate can assess perfusion, estimate/monitor the extent of bleeding/shock, and guide therapy. Isotonic crystalloid solutions are first-line and specific recommendations apply for patients with TBI.

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Contemporary damage control surgery outcomes: 80 patients with severe abdominal injuries in the right upper quadrant analyzed

Abstract

Background

Damage control laparotomy (DCL) is a well-established surgical strategy in the management of the severely injured abdominal trauma patients. The selection of patients by intra-abdominal organs involvement for DCL remains controversial. The aim of this study was to assess the injury to the abdominal organs that causing severe metabolic failure, needing DCL.

Methods

Severely injured abdominal trauma patients with a complex pattern of injuries were reviewed over a 52-month period. They were divided into DCL and definitive repair (DR) group according to the operative strategy. Factors identifying patients who underwent a DCL were analyzed and evaluated.

Results

Twenty-five patients underwent a DCL, and 55 patients had DR. Two patients died before or during surgery. The number and severity of overall injuries were equally distributed in the two groups of patients. Patients who underwent a DCL presented more frequently hemodynamically unstable (p = 0.02), required more units of blood (p < 0.0001) and intubation to secure the airway (p < 0.0001). The onset of metabolic failure was more profound in these group of patients than DR group. The mean Basedeficit was − 7.0 and − 3.8, respectively, (p = 0.003). Abdominal vascular (p = 0.001) and major liver injuries (p = 0.006) were more frequently diagnosed in the DCL group. The mortality, complications (p < 0.0001), hospital (p < 0.0001), and ICU stay (p < 0.009) were also higher in patients with DCL.

Conclusion

In severely injured with an intricate pattern of injuries, 31% of the patients required a DCL with 92% survival rate. Severe metabolic failure following significant liver and abdominal vascular injuries dictates the need for a DCL and improves outcome in the current era.

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Man tries to steal ambulance with patient, crew inside

Crews said they were treating a patient in the back of an ambulance when the man jumped into the driver’s seat

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EMS provider cited after ambulance crash

The ambulance was not responding to an emergency call when the crash occurred and there were no patients on board at the time

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NJ ambulance transporting patient rear-ends vehicle

The ambulance had its lights and sirens activated when it rear-ended another vehicle, whose driver said they did not hear the sirens

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Paramedics find, revive patient’s turtle after crash

By EMS1 Staff

VAIL, Colo. — You aren’t dead unless you’re warm and dead — at least that much is true for Turtle the turtle.

Eagle County Paramedic Services responded to a vehicle crash Sunday; all victims were transported to the hospital. While there, one of the youngest patient’s told paramedics he lost his pet turtle.

Crews with the Vail Fire Department returned to the scene of the crash and were able to find Turtle. However, he was frozen solid due to cold morning temperatures. 

Crews were able to revive Turtle after setting him in the sun for half an hour before reuniting him with his owner. 

 

At 0930 this morning, Eagle County Paramedic Services, Vail Fire Department, and Colorado State Patrol responded to a...

Posted by Eagle County Paramedic Services on Sunday, February 26, 2017

 

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How community paramedics use of point-of-care devices

SALT LAKE CITY — Point-of-care testing is a tool for community paramedic patient assessments in the out-of-hospital setting that is convenient for the patient and providers, easy to use, leads to a more prompt field diagnosis and results in more timely treatment. Desiree Partain, clinical program manager with MedStar Mobile Health, introduced how community paramedics are using handheld, portable blood analyzers in a presentation at EMS Today.

Partain discussed the benefits and drawbacks to consider, as well as the regulatory hurdles, involved in implementing point-of-care testing. Much of the presentation was based on the lessons Partain and MedStar has learned through implementing its point-of-care testing program

Memorable quotes on point-of-care testing by community paramedics

Partain repeatedly emphasized the importance of first defining the department's goals for a community paramedicine program. The program goals, along with the target patient population, should drive the decision to purchase a handheld blood analyzer. Here are three memorable quotes from Partain's presentation.

"The important thing is identifying the needs of your specific (community paramedic) program. Truly define what is important to your agency. What patient populations are you going to be treating""

"Get the right equipment to meet the needs of your program and the patients you are trying to serve."

"If we are giving paramedics point-of-care devices, we need to give them information on how to use the data."

Top takeaways of point-of-care testing

Partain's presentation was a helpful introduction to point-of-care testing and how it has been implemented by MedStar mobile integrated health care personnel. Here are the top three takeaways:

1. Benefits of point-of-care testing

The benefits of point-of-care testing include speed, portability, convenience, connectivity and quality assurance. A portable blood analyzer allows community paramedics to provide more information to physicians than they could do with vital signs and a physical exam.

2. Understand regularity requirements

EMS clinical managers need to review and understand the Clinical Laboratory Improvement Amendment (CLIA) waiver requirements. A CLIA waiver is most likely to be granted when there is low risk for incorrect results, such as blood glucose testing or a CHEM 8 which is chemistry, electrolytes, hematology and blood glasses.

3. Treatment goals come first

Partain described a post-discharge heart failure patient and how a field diagnosis with point-of-care testing led to earlier intervention for the patient. The treatment, provided in the patient's home, was quicker and more convenient for the patient than transport and treatment at the hospital.

A point-of-care testing program needs to driven by goals for specific patient populations. The testing needs to be articulated in specific patient protocols, such as a heart failure protocol. The MedStar protocol directs both the use of an iSTAT device and what to do with the data the iSTAT returns.

Learn more about point-of-care testing

Partain discussed the importance of initial and ongoing education. Here are several articles about prehospital conditions which might benefit from handheld, blood analyzer data.

• A salty tale: What EMS personnel need to know about electrolyte disorders
• 6 useful sepsis assessment and treatment tips
• 4 things paramedics need to know about capnography and heart failure
• 4 steps to prepare for prehospital antibiotic administration
• Drunk versus diabetes: How can you tell"
• Remember 2 Things: How to avoid common glucometer mistakes
• Remember 2 Things: How to best obtain a glucometer blood sample
• How to get an accurate glucose reading for diabetic patients
• Blood glucose test for altered mental status

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Rapid response: Spotting senior abuse on EMS runs

What we know: This week CNN released a jarring investigative report on rape and sexual abuse taking place in nursing homes and assisted living facilities. CNN cites Administration for Community Living, a branch of the U.S. Health and Human Services Department, statistics that there have been more than 16,000 reported cases of sexual abuse in these facilities since 2000.

It’s reasonable to believe there are many more cases that went unreported.

The attacks on patients are most often carried out by someone on the facility’s staff. Many attacks went unpunished or lightly punished. In at least one case, a facility executive was accused of covering up sexual attacks.

Why it matters: The Centers for Disease Control and Prevention says that in 2014 there are 15,600 nursing homes in the United States. The 16,000 reported attacks doesn’t mean each facility has had one, but the number is big enough that such attacks could happen anywhere.

According to a NASEMSO study, there were nearly 37 million calls for EMS service in 2009; of those, 28 million resulted in transport.

I found no hard data on what percentage of our annual runs are made to these sites. But those with nursing homes and assisted-living facilities in their jurisdictions know that they account for many of their EMS runs.

We know from our own dark history that sexual predators will disguise themselves as caregivers. EMS is often the first outsider to encounter a long-term care patient.

The CNN report highlights the importance of knowing what to look for and what to do if things don’t look right. And frankly, there are more questions than answers at this point.

Two big questions

1. What to look for"

The CNN report showed that this type of sexual assault often goes unreported and is only later discovered. That discovery may come when the person is seen for something like difficulty breathing.

If there’s little or no family contact, firefighters may be the first trustworthy person these patients see from the world outside their facility. Patients may describe the attack to medics in the safety of an ambulance or medics may observe injuries not related to the nature of that particular call.

Either way, departments that run EMS with one or more long-term care sites will need to think through how to teach medics what signs of abuse to look for on these calls.

2. What to do"

There’s an abundance of protocol information for law enforcement on how to handle sexual abuse cases. That’s not true for fire-based EMS.

Fire departments will need to develop procedures to communicate this information to police and emergency department doctors — especially if police do not routinely respond to medical emergencies at these sites.

Firefighters and medics will also need to learn what to say to patients who confide in them that they are abuse victims. This takes skill and can be made harder when that patient’s physical and mental capacities are diminished, as with dementia patients.

They’ll also need to teach responders the proper way to preserve evidence and document the call when abuse is suspected. In one case CNN reported, a victim saved her abuser’s semen in her bra, but was unable to hand that over until three weeks following the attack.

Further reading

• Pocket Guide for Police Response to Sexual Assault
• Treating geriatric patients: 5 tips for EMTs and paramedics

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Allina Freedom House Recruit Video

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Allina Freedom House Recruit Video

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Diverse EMS workforce is good for business

SALT LAKE CITY — Recruiting and employing a diverse workforce strengthens an EMS agency and improves relationships with the communities the agency serves. Brian LaCroix, President/EMS Chief of Allina Health EMS, explained the business case for diversity and the efforts his agency is undertaking at the EMS Today conference.

Diversity is a critical challenge as EMS agencies struggle to recruit talented personnel across all socioeconomic levels, including those that may not know enough about EMS to consider it as a career. Several short videos, filmed by LaCroix, featured EMTs and paramedics from racial and ethnic groups not typically represented in EMS. Those EMS providers are inspiring other people in their communities to consider an EMS career.

Memorable quotes on diversity in EMS

LaCroix emphasized the business case for diversity, as well as the realities of changing demographics Allina Health EMS is facing throughout his presentation. Allina is the largest ambulance and transport service in Minneapolis and St. Paul, Minn. About 600 staff serve 1.1 million people, about 20 percent of the state's population. Here are four memorable quotes from the LaCroix.

"There is a strong business case to look at diversity from a recruitment and retention view."

"We have people in our community who are socioeconomically depressed and one of their biggest challenges is jobs. We (Allina Health EMS) have jobs."

"We need more paramedics than Minnesota will produce. We (Allina Health EMS) need to look for paramedics where we have not looked for them in the past."

"It's my experience, particularly with the Somali community in Minnesota, that they want to serve their community as much as anyone else."

Top takeaways on recruiting a diverse EMS workforce

LaCroix made an objective argument for the business and service benefits of a diverse EMS workforce. He also stressed the importance of doing the right thing to grow the profession and serve the diverse populations in the 122 communities Allina Health EMS serves. Here are the top three takeaways from LaCroix's presentation for other EMS leaders.

1. Make intentional efforts to change EMS workforce diversity

LaCroix explained that when EMS agencies don't reflect the makeup of the community they serve, they are too often greeted with skepticism and even hostility, making it more difficult to provide effective patient care and improve population health. Until recently, Allina’s staff was a mostly white, male organization in a region that was rapidly becoming more diverse.

Allina first sought to understand its current workforce and then to make intentional efforts to improve diversity to better reflect the communities Allina serves. LaCroix shared that Allina's workforce is a mix of staff from three generations — baby boomers, generation X and millennials, who are the largest cohort. Twenty-five percent of the Allina workforce has more than 15 years of experience. In the last five years, Allina's workforce has changed from 98 percent Caucasian to 81 percent Caucasian through intentional efforts to train, recruit and employ a diverse workforce

2. Business case for diversity in EMS

LaCroix emphasized the business case for diversity throughout the presentation. Several of the top business reasons he shared are:

• Diversity drives growth in the national economy.
• A diverse business can capture a greater share of the consumer market.
• Recruiting from a diverse pool of candidates means a more qualified workforce.
• A diverse and inclusive workforce helps business avoid employee turnover costs.
• Diversity fosters a more creative and innovative workforce through thinking differently and novel approaches to problems.
• Diversity is a key aspect of entrepreneurialism.
• Diversity in leadership is needed to leverage a company's full potential.

LaCroix challenged attendees to imagine how the business case for diversity can be applied to EMS challenges and opportunities.

3. Freedom House has a high return on investment

The Allina Health EMS’s Freedom House EMT Academy has introduced new EMTs to the Allina workforce, which is benefiting patients, other EMS providers and the Minnesota communities Allina serves.

The cost for the Freedom House EMT academy is $25,000, which is a significant investment for Allina. But the return on investment of broadening and diversifying the applicant pool is significant.

Allina Health EMS has calculated that the organization spends $75,000 to recruit and onboard a single EMT or paramedic in the new provider's first year. Those costs include employee training, third rider time, uniforms and more, but don't include pay and benefits. Growing its own applicants is helping Allina lower recruiting and onboarding costs, creating jobs for people from socioeconomically depressed communities and delivering outstanding patient care to all who are in need.

Learn more about EMS workforce diversity

Watch a video about the Allina Health EMS Freedom House EMT Academy and read these articles to learn more about recruitment, retention and diversity.

• Why diversity matters in EMS
• Why EMS must seek out diversity
• EMS agency launches diversity training program
• EMS leaders must promote a workplace free of harassment
• Minneapolis offers paid EMS training to diversify department  
• Understanding cultural and gender differences is essential for EMS managers
• EMS volunteer recruitment and retention: 6 ways a volunteer EMS agency is getting it done
• Prioritize EMS volunteer recruitment and retention  
• Why your EMS action film is recruiting the wrong people
• EMS volunteer recruitment never stops
• How Pittsburgh’s ‘Freedom House’ shaped modern EMS systems
• How Freedom House Ambulance Service became a national EMS model 

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Allina Freedom House Recruit Video

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Allina Freedom House Recruit Video

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White Shirts: Uniform care 101

See all of Jessie Senini's comics.

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Active shooter response: Equip your team to save more lives

Download this free e-book to learn what training and supplies you need to prepare for a successful response to a mass casualty incident

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Emergent versus delayed lithotripsy for obstructing ureteral stones: A cumulative analysis of comparative studies

Urolithiasis

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2 Alabama doctors convicted in pill mill case

AP

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Long-term outcome of allogeneic cultivated limbal epithelial transplantation for symblepharon caused by severe ocular burns

BMC Ophthalmology

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Former House speaker Boehner predicts 'Obamacare' won't be repealed

AP

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Hospitalized asylum seeker returned to detention center

AP

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Outcomes associated with resuming warfarin treatment after hemorrhagic stroke or traumatic intracranial hemorrhage in patients with atrial fibrillation

JAMA Internal Medicine

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MRI vs. Ultrasound as the initial imaging modality for pediatric and young adult patients with suspected appendicitis

Academic Emergency Medicine

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Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure: A meta-analysis of randomized controlled trials

Canadian Medical Association Journal

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A review of the epidemiology and treatment of orthopaedic injuries after earthquakes in developing countries

World Journal of Emergency Surgery

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Baseline adiponectin concentration and clinical outcomes among patients with diabetes and recent acute coronary syndrome in the EXAMINE trial

Diabetes, Obesity and Metabolism

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Frequency and prognosis of acute pancreatitis associated with fulminant or non-fulminant acute hepatitis A: A systematic review

Pancreatology

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A double-blind, randomized, comparative study of the use of a combination of uridine triphosphate trisodium, cytidine monophosphate disodium, and hydroxocobalamin, versus isolated treatment with hydroxocobalamin, in patients presenting with compressive neuralgias

Journal of Pain Research

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Association of mutations in TLR2 signaling genes with fulminant form of hepatitis B related acute liver failure

The Journal of Infectious Diseases

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Predicting risk for portal vein thrombosis in acute pancreatitis patients: A comparison of radical basis function artificial neural network and logistic regression models

Journal of Critical Care

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The traumatic experience of first-episode psychosis: A systematic review and meta-analysis

Schizophrenia Research

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Assessment of hydration status using bioelectrical impedance vector analysis in critical patients with acute kidney injury

Clinical Nutrition

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Risk factors for injuries associated with damage claims following groin hernia repair

Hernia

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Predictors of major depression and posttraumatic stress disorder following traumatic brain injury: A systematic review and meta-analysis

The Journal of Neuropsychiatry & Clinical Neurosciences

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Introduction of Tele-ICU in rural hospitals: Changing organisational culture to harness benefits

Intensive and Critical Care Nursing

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PulmCrit- Killer resuscitation: Abdominal hypertension as an occult driver of multiorgan failure

Introduction with a clinical conundrum A 66-year-old man is transferred from an outside hospital due to inability to be liberated from the ventilator.  He presented a week earlier with pneumonia and sepsis.  He received six liters of fluid initially, and has been running net positive 1-2 liters daily since then (for a total of about […]

EMCrit by Josh Farkas.

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Prone positioning in acute respiratory distress syndrome after abdominal surgery: a multicenter retrospective study

The recent demonstration of prone position’s strong benefit on patient survival has rendered proning a major therapeutic intervention in severe ARDS. Uncertainties remain as to whether or not ARDS patients in...

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Prospective evaluation of the Eppendorf–Cologne Scale

Objectives: Early diagnosis of traumatic brain injury and reliable prediction of outcome are essential for determining treatment strategies and allocating resources. This study re-evaluates the Eppendorf–Cologne Scale (ECS) and its predictive accuracy for outcome compared with the Glasgow Coma Scale (GCS). Methods: A prospective cohort analysis of severely injured trauma patients registered in the Trauma Registry of the German Society for Trauma Surgery from 2012–2013 was carried out. Only directly admitted patients alive on admission with complete data on GCS, ECS and outcome in terms of survival to hospital discharge or death were included. The predictive accuracy in terms of the outcome of the ECS and the GCS was modelled using area under the receiver operating characteristic (AUROC) curve analysis. Results: A total of 17 616 patients fulfilled the study inclusion criteria. The ECS outmatched the predictive accuracy of the GCS for outcome (AUROC, 0.853, 95% confidence interval, 0.831–0.854; and AUROC 0.836; 95% confidence interval, 0.825–0.848, respectively; P=0.062). An ECS score of 8 was associated with a 25-fold higher mortality compared with an ECS score of 0. Patients who had an ECS score of 8 had a 1.5-fold higher mortality compared with patients allocated a GCS score of 3. Conclusion: The ECS shows a higher accuracy for prediction of outcome compared with the GCS and enables further differentiation within the critical GCS 3 collective.

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Commence, continue, withhold or terminate?: a systematic review of decision-making in out-of-hospital cardiac arrest

When faced with an out-of-hospital cardiac arrest patient, prehospital and emergency resuscitation providers have to decide when to commence, continue, withhold or terminate resuscitation efforts. Such decisions may be made difficult by incomplete information, clinical, resourcing or scene challenges and ethical dilemmas. This systematic integrative review identifies all research papers examining resuscitation providers’ perspectives on resuscitation decision-making for out-of-hospital cardiac arrest patients. A total of 14 studies fulfilled the inclusion criteria: nine quantitative, four qualitative and one mixed-methods design. Five themes were identified, describing factors informing resuscitation provider decision-making: the arrest event; patient characteristics; the resuscitation scene; resuscitation provider perspectives; and medicolegal concerns. Established prognostic factors are generally considered important, but there is a lack of resuscitation provider consensus on other factors, indicating that decision-making is influenced by the perspective of resuscitation providers themselves. Resuscitation decision-making research typically draws conclusions from evaluation of cardiac arrest registry data or clinical notes, but these may not capture all salient factors. Future research should explore resuscitation provider perspectives to better understand these important decisions and the clinical, ethical, emotional and cognitive demands placed on resuscitation providers.

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Copeptin improves the sensitivity of cardiac troponin in patients 70 years or older, but not enough to rule out myocardial infarction at emergency department presentation

Objectives: We aimed to evaluate the diagnostic performance of the combination of cardiac troponin (cTn) and copeptin in a population older than 70 years of age to rule out non-ST-elevation myocardial infarction (NSTEMI) at emergency department (ED) presentation. Methods: Among 885 analyzed patients with acute chest pain presenting to the ED, 218 (25%) were aged at least 70 years. Results: Patients with elevated copeptin values at presentation were more often aged at least 70 years and had higher blood pressure. Patients at least 70 years without NSTEMI more frequently had elevated copeptin values than younger counterparts (42 vs. 25%, P

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A system-wide approach from the community to the hospital for improving neurologic outcomes in out-of-hospital cardiac arrest patients

Objective: In the present study, we aimed to determine the effects of a system-wide approach from the community to the hospital in improving the neurologic outcomes in out-of-hospital cardiac arrest (OHCA) patients within Sungbuk in Korea. Methods: This study used a before–after design. In 2011, compression-only cardiopulmonary resuscitation (CPR) for citizens, a state-wide standard dispatcher assisted-CPR protocol, medical control for regional emergency medical service (EMS), provision of high-quality advanced cardiac life support (ACLS) with capnography and extracorporeal CPR, and the standard postcardiac arrest care protocol were implemented in the system-wide CPR program. CPR provision and outcomes were compared between the 2009–2010 and the 2012–2013 periods. A multivariate logistic regression model for good outcome of OHCA was used to identify interventions with a significant impact. Results: In total, 581 adult nontraumatic OHCA patients who received resuscitation attempts from 2009 to 2013 were selected for the analysis of CPR provision and outcomes. CPR provision improved significantly, as indicated by the following results from 2009–2010 to 2012–2013: from 15.9 to 50.4% for bystander CPR (P

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Frequent users of the emergency department services in the largest academic hospital in the Netherlands: a 5-year report

Objective: To investigate the demographic and service characteristics, motive for consultation, and disposition of adult frequent users (FUs) of the largest academic hospital in the Netherlands over a 5-year period. Patients and methods: This retrospective study included all patients aged 18 years and older visiting the emergency department (ED) during a 5-year period (2009–2013). Frequent ED use was defined as having four or more visits to the ED during a year. Patient and service characteristics, motive for consultation, and disposition were explored. Results: Frequent ED users represented 2% of all patients who visited the ED during 2009–2013 (8% of all ED consultations). On average, each FU visited the ED five times per year. Compared with nonfrequent users (NFUs), FUs were significantly less often self-referred, less frequently transported to the hospital by ambulance, received a lower urgency code upon arrival to the ED, and more often admitted to hospital than NFUs. Complaints related to the digestive system (19%), general complaints such as fever (18%), respiratory (10%), or cardiovascular problems (10%) were the main motive for consultations of the frequent ED users. Two percent of the FUs were serial FUs (FUs during 3 or more consecutive years). Conclusion: Frequent use of the ED has been depicted as inappropriate use of these services. However, our study shows that FUs consist of a relatively small number of patients and that FUs suffer from chronic, and often, severe somatic illnesses that require specialized medical care.

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Prehospital thoracostomy in patients with traumatic circulatory arrest: results from a physician-staffed Helicopter Emergency Medical Service

Objective: Until recently, traumatic cardiac arrest (tCA) was believed to be associated with high mortality and low survival rates. New data suggest better outcomes. The most common error in tCA management is failing to treat a tension pneumothorax (TP). In the prehospital setting, we prefer thoracostomies for decompressing a potential TP in tCA cases; however, interventions can only be recommended with adequate information on their results. Therefore, we reviewed the results of thoracostomies performed by our Helicopter Emergency Medical Service. Methods: Our Helicopter Emergency Medical Service database was reviewed for all patients who underwent a single or a bilateral prehospital thoracostomy in tCA. We evaluated the incidence of TP, the return of circulation in tCA, the incidence of infections, the incidence of sharps injuries and patient survival. Results: A total of 267 thoracostomies were performed in 144 tCA patients. Thoracic decompression was performed to rule out TP. TP was identified in 14 patients; the incidence of TP in tCA was 9.7%. Two of the tCA patients survived and were discharged from the hospital; neither had clinical signs of TP. No infections or sharps injuries were observed. Conclusion: The outcomes of patients with tCA who underwent prehospital thoracostomy were poor in our group. The early identification of TP and strict algorithm adherence in tCA may improve outcomes. In the future, to reduce the risk of unnecessary thoracic interventions in tCA, ultrasound examination may be useful to identify TP before thoracic decompression.

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Reviewing papers for publication: privilege, pain, or perhaps a responsibility

No abstract available

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Effects of a media campaign on resuscitation performance of bystanders: a manikin study

Objective: Cardiac arrest is associated with a poor outcome if cardiopulmonary resuscitation (CPR) is delayed. Nevertheless, CPR performance by laypersons in witnessed cardiac arrest is frequently poor. The present study evaluated the effect of a media campaign on CPR performance. Participants and methods: CPR performance of 1000 individuals who did not have any medical background was evaluated using a resuscitation manikin. The media campaign consisted of flyers, posters, and electronic advertisement. Five hundred individuals were evaluated before the media campaign and 500 individuals after the media campaign. Age and male/female ratio were comparable within each of the groups. Premedia campaign performance was compared with postmedia campaign performance with respect to chest compressions and ventilation metrics. Results: Chest compression depth and total compression work were significantly higher after the media campaign: median depth 51 mm postcampaign versus 45 mm precampaign (P

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SODAS: Surveillance of Drugs of Abuse Study

Objective: Novel psychoactive substance (NPS) as a form of recreational drug use has become increasingly popular. There is a paucity of information with regard to the prevalence and clinical sequelae of these drugs. The aim of this study was to detect NPS in patients presenting to the emergency department with suspected toxicological ingestion. Patients and methods: The prospective study was performed in a large emergency department in the UK. During a 3-month period 80 patients were identified by clinicians as having potentially ingested a toxicological agent. Urine samples were analysed using liquid chromatography high-resolution mass spectrometry, and basic clinical data was gathered. Results: Eighty patients with a history of illicit or recreational drug consumption had urine screenings performed. Forty-nine per cent (39) of the patients undergoing a screen had more than one illicit substance detected. Twenty per cent (16) of the patients tested positive for at least one NPS. Conclusion: Almost half of the presented patients revealed ingestion of multiple substances, which correlated poorly with self-reporting of patients. Developing enhanced strategies to monitor evolving drug trends is crucial to the ability of clinicians to deliver care to this challenging group of patients.

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Which adverse events should be reported in an emergency department? A Delphi study

Objective: The aim of this study was to determine if emergency medicine specific triggers for completing an incident form could be agreed and if a common definition for contributory factors could be achieved. Such definitions could be used to improve safety within the emergency department (ED) and share learning across the specialty. Participants and methods: One hundred and fifteen ED safety leads in the UK and Ireland were invited to participate in a Delphi study. This process took 1 year to complete. In the first round, participants listed 20 events that should be reported as an adverse event and 20 contributory factors that could contribute to risk or harm. An 80% concordance level was sought for both aspects. Results: Eighty-four per cent of safety leads participated in the first round, although this decreased over subsequent rounds to 43%. Four hundred and eighty-five triggers were initially suggested; eventually, 27 triggers that should always or usually be reported achieved 80% concordance. Sixty-eight contributory factors were initially identified with eventual agreement being reached on 27 remediable contributory factors. Conclusion: The process demonstrated agreement amongst emergency physicians in the UK and Ireland on the type of events that should be formally reported. The lists emerging from this process should not be viewed as exhaustive; rather they should be used to encourage the reporting of incidents and designing safer systems and processes within the ED.

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Associations between perceived discrimination and health status among frequent Emergency Department users

Objective: Frequent Emergency Department (ED) users are vulnerable individuals and discrimination is usually associated with increased vulnerability. The aim of this study was to investigate frequent ED users’ perceptions of discrimination and to test whether they were associated with increased vulnerability. Methods: In total, 250 adult frequent ED users were interviewed in Lausanne University Hospital. From a previously published questionnaire, we assessed 15 dichotomous sources of perceived discrimination. Vulnerability was assessed using health status: objective health status (evaluation by a healthcare practitioner including somatic, mental health, behavioral, and social issues – dichotomous variables) and subjective health status [self-evaluation including health-related quality of life (WHOQOL) and quality of life (EUROQOL) – mean-scores]. We computed the prevalence rates of perceived discrimination and tested associations between perceived discrimination and health status (Fischer’s exact tests, Mann–Whitney U-tests). Results: A total of 35.2% of the frequent ED users surveyed reported at least one source of perceived discrimination. Objective health status was not significantly related to perceived discrimination. In contrast, experiencing perceived discrimination was associated with worse subjective health status (P

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Use of checklists improves the quality and safety of prehospital emergency care

Objectives: High-level emergency medical care requires transfer of evidence-based knowledge into practice. Our study is the first to investigate the feasibility of checklists in improving prehospital emergency care. Materials and methods: Three checklists based on standard operating procedures were introduced: General principles of prehospital care, acute coronary syndrome and acute asthma/acutely exacerbated chronic obstructive pulmonary disease. Subsequent to prehospital care and immediately before transport, information on medical history, diagnostic and therapeutic procedures was obtained. Data of 740 emergency missions were recorded prospectively before (control group) and after implementation of checklists and compared using the χ2-test (significance level P

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ECG interpretation in Emergency Department residents: an update and e-learning as a resource to improve skills

Objective: ECG interpretation is a pivotal skill to acquire during residency, especially for Emergency Department (ED) residents. Previous studies reported that ECG interpretation competency among residents was rather low. However, the optimal resource to improve ECG interpretation skills remains unclear. The aim of our study was to compare two teaching modalities to improve the ECG interpretation skills of ED residents: e-learning and lecture-based courses. Participants and methods: The participants were first-year and second-year ED residents, assigned randomly to the two groups. The ED residents were evaluated by means of a precourse test at the beginning of the study and a postcourse test after the e-learning and lecture-based courses. These evaluations consisted of the interpretation of 10 different ECGs. Results: We included 39 ED residents from four different hospitals. The precourse test showed that the overall average score of ECG interpretation was 40%. Nineteen participants were then assigned to the e-learning course and 20 to the lecture-based course. Globally, there was a significant improvement in ECG interpretation skills (accuracy score=55%, P=0.0002). However, this difference was not significant between the two groups (P=0.14). Conclusion: Our findings showed that the ECG interpretation was not optimal and that our e-learning program may be an effective tool for enhancing ECG interpretation skills among ED residents. A large European study should be carried out to evaluate ECG interpretation skills among ED residents before the implementation of ECG learning, including e-learning strategies, during ED residency.

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Is It Okay To Ask: Transgender Patient Perspectives on Sexual Orientation and Gender Identity Collection in Healthcare

Abstract

Objective

The National Academy of Medicine and Joint Commission recommend routine documentation of sexual orientation (SO) and gender identity (GI) in healthcare to address LGBT health disparities. We explored transgender patient-reported views on the importance of SO/GI collection, their willingness to disclose, and their perceived facilitators of SO/GI collection in primary care and Emergency Department (ED) settings.

Methods

We recruited a national sample of self-identified transgender patients. Participants completed demographic questions, survey questions, and free response comments regarding their views of SO/GI collection. Data were analyzed using descriptive statistics; inductive content analysis was conducted with open-ended responses.

Results

Patients mostly self-identified as Male gender (54.5%), White (58.4%), and sexual orientation other than Heterosexual, or LGB (33.7%; N=101). Patients felt it was more important for primary care providers to know their GI than SO (89.1% vs. 57%; p<.001); there was no difference among reported importance for ED providers to know the patients’ SO versus GI. Females were more likely than males to report medical relevance to chief complaint as a facilitator to SO disclosure (89.1% vs. 80%; p=.02), and less likely to identify routine collection from all patients as a facilitator to GI disclosure (67.4% vs. 78.2%; p=.09). Qualitatively, many patients reported medical relevance to chief complaint and an LGBT-friendly environment would increase their SO/GI disclosure willingness. Patients also reported need for educating providers in LGBT health prior to implementing routine SO/GI collection.

Conclusions

Patients see the importance of providing GI more than SO to providers. Findings also suggest that gender differences may exist in facilitators of SO/GI disclosure. Given the under-representation of transgender patients in healthcare, it is crucial for providers to address their concerns with SO/GI disclosure, which include LGBT education for medical staff and provision of a safe environment.

This article is protected by copyright. All rights reserved.

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EMS, fire, police practice rescue task force

Spokane responders practice rescue task force training.

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EMS, fire, police practice rescue task force

Spokane responders practice rescue task force training.

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EMS, fire, police practice rescue task force

Spokane responders practice rescue task force training.

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IAED’s Brett Patterson lauded as JEMS’ EMS10 Innovator at EMS Today

SALT LAKE CITY—The International Academies of Emergency Dispatch® (IAED™) is pleased to announce that Brett Patterson, IAED Chair of the Medical Council of Standards and Academics & Standards Associate, received the Journal of Emergency Medical Services’ EMS10: Innovators in EMS Award Feb. 22 at JEMS annual EMS Today Conference & Exposition, held this year for the first ...

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EMS, fire, police practice rescue task force

Spokane responders practice rescue task force training.

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EMT wrests knife from stabbing suspect before aiding victim

By Manuel Gamiz Jr
The Morning Call

ALLENTOWN, Pa. — The cellphone video shows a group of men surrounding a man lying on the street, one of them with his foot on the man's right bicep. The man on the ground is struggling, and there's shouting.

A woman hovering near the man pleads with him in Spanish and English: "No te mueves, don't move."

An EMT dressed in blue runs over, uses his knee to pin the man's right leg and grabs for his right wrist. Within seconds, a small knife flies out of the man's hand and lands in the street.

The video, obtained from a witness to Wednesday afternoon's stabbing at the intersection of Hamilton and 24th streets, then pans to the right, showing a woman lying on the street writhing in pain, her beige coat soaked with blood.

Allentown police identified the woman as Melissa Mercado-Santini, and on Thursday they charged her father-in-law with attempted homicide and other counts in the attack at the intersection in west Allentown, where Mercado-Santini had stopped her car for a red light.

Police said Jose Santini Feliciano, who was in the front passenger seat, repeatedly stabbed his daughter-in-law and also stabbed his wife, Lucina Santini, who was in the back seat of the car and tried to grab the knife.

The attack, police said, happened "for unexplained reasons."

Several people in traffic behind Mercado-Santini's car, including two emergency medical technicians and an off-duty Allentown police officer, witnessed the attack and jumped into action to help subdue Santini Feliciano and help the victims until police arrived.

The cellphone video — taken by a driver going west on Hamilton Street — pans from left to right, showing the group of men holding down Santini Feliciano, who still appears to be wriggling around.

The EMT dressed in blue in the video, Giovanni Grella with the Philadelphia-based Romed Ambulance, can be heard yelling to some of the men to move so he could get in a better position to grab hold of Santini Feliciano's hand.

Within seconds, Grella and another man wrestle the knife away from Santini Feliciano, the video shows.

With the suspect disarmed, Grella moves over to help Mercado-Santini, asking her, "Where are you stabbed?" As the video ends, Grella is kneeling over Mercado-Santini yelling out to his partner to "grab a jump kit" — an emergency supply bag used by first responders.

Allentown police closed off Hamilton Street for several hours as they investigated. Evidence of a vicious attack included a bloodied purse inside the car, and bloody rags and towels used to treat the victims lying on the street between the car and Grella's ambulance.

Police Capt. Bill Reinik said it was fortunate the paramedics and other passers-by jumped into action.

"He was in the process of stabbing her when the ambulance guys pulled up and stopped him," Reinik said Wednesday. "They're our heroes of the day."

In addition to attempted homicide, Santini Feliciano, 57, of the 1000 block of West Walnut Street in Allentown, is charged with two counts each of aggravated assault and simple assault. He remains in Lehigh County Jail on $750,000 bail.

Court records give no motive for the attack, saying "for unexplained reasons, Mr. Santini Feliciano began to stab Ms. Mercado-Santini about the body with a knife."

In charging documents, Allentown police say they received several 911 calls about the stabbing around 3 p.m.

Police said Mercado-Santini suffered numerous stab wounds, including two to her neck and others to her stomach, chest and arms, and had to undergo emergency surgery to control internal bleeding. Doctors told investigators Mercado-Santini's injuries were "significant."

Santini Feliciano's wife suffered a laceration to her hand, authorities said, and needed several stitches.

Allentown police recovered a folding knife at the scene, court records state.

On Wednesday, Grella said he was behind Mercado-Santini's car stopped in traffic and noticed something was wrong with her car, thinking it might be an accident. As he approached her car, he saw a man attacking a woman.

Copyright 2017 The Morning Call 

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How to develop confident EMS volunteers

SWOT analysis gives volunteers the opportunity to participate in the development of an action plan for training, increased competence and success

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Hawaii council OK's city-wide AED mandate

The bill will also shield people who use AEDs to help save someone in cardiac arrest from liability

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Ill. ambulance transporting patient skids, veers into ditch

The ambulance was in the process of passing a semi truck when a gust of wind caused the ambulance to overcorrect

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Why social networks are crucial for the care of high EMS utilizers

SALT LAKE CITY — High EMS utilizers often have a limited social network that increases their vulnerability to personal health problems, natural disasters and other day-to-day turmoil. Michael Baker, Chief of EMS with the Tulsa (Okla.) Fire Department, described the health care system as complex and non-linear, which is increasingly difficult to navigate, and how crucial social networks are to the health care of high EMS utilizers in a presentation at EMS Today.

Baker began the presentation with a story about a patient who became increasingly isolated secondary to chronic disease, depression and addiction. The patient alienated herself from her friends and family social network and rebuilt a network with food delivery and taxi companies who were willing to bring her food, cigarettes and alcohol. The lack of a social network made the attempts at providing social services and community paramedicine futile to changing the patient's outcome.

The key function of a social network is provision of social support, which is one of the main ways social networks influence physical and mental health status.

Memorable quotes on social networks

Baker studied social networks for high EMS utilizers for his master's thesis, which he drew on this research. Here are several memorable quotes from Baker's presentation.

"Social networks, not social media."

"Understanding the social networks for the people we are treating is really important for us (EMS)."

"If you don't have a social network, who do you call for help""

"Birds of a feather flock together. We want to be with people like us. If we can work within social networks, we might be able to slow the obesity epidemic"

"A social network is a third vital sign."

Top questions on social networks for high EMS utilizers

Everyone has a social network, but their importance to EMS patients is not well understood. Baker defined social networks and how EMS providers might apply this information. Here are the answers to the top questions on social networks.

What is a social network"

A social network is not social media, like Twitter or Facebook. Social networks are connections between actors — individuals and organizations — and the ties that bring those actors together. Patients, friends, family, EMS providers, social services, hospitals and churches are just a few examples of actors. The pattern of connections, as well as the strength, between actors are often more important than the individuals who are part of the social network.

How does EMS map a patient's social network"

Social networks begin at birth and expand through life experiences. Most people are limited to about 100 social connections. It's those connections where we can share emotions, shape courses for action and create social pathways for interactions.

The patient's social network, which is a map of connections, is invisible to the EMS provider. The network structure is dynamic and connections reveal opportunities for targeting interventions to change behaviors.

Baker described a survey process to map a social network. With questions like:

• Who are the adults you discuss important matters with"
• Who do you socialize with" When" Where" What"
• What influences do these people have on your health"
• Are any of your connections doing anything to improve their own health (i.e. quitting smoking, making it to doctor's appointments or losing weight)"

What happens when a patient loses social connections"

Patients who lose connections to a spouse, family and friends often shift their support requests to public safety. This shift puts the burden on EMS providers to lift patients off the ground, change a commode, transport a patient to doctor's appointments or monitor chronic disease conditions. A community paramedicine or mobile integrated health care program can help patient's re-form social connections with family or create new social connections to better assist with their long-term health care needs.

Losing social connections, like the death of a spouse, adds stress to the surviving spouse's health. Many EMS providers are probably familiar with stories of a wife who died a few days after her husband's death. Social isolation increases the risk of stroke. Isolation is also linked to poorer outcomes from stroke and a higher risk of mortality and morbidity.

How can EMS promote social networks"

Baker recommended several strategies to strengthen social networks. For example, neighbors checking on neighbors, especially before a severe weather emergency, can strengthen connections. A volunteer telephone care program reaches out to socially isolated individuals through regular phone calls. EMS providers, walking through a neighborhood, can distribute health, safety and disaster preparedness actions.

During the patient assessment process, EMS providers can assess a patient's living conditions, access to services and other factors which influence social networks. Promoting connections, which already exist, or creating new connections will be valuable to the patient's overall health.

An EMS provider may not always have the time, knowledge or resources to immediately solve a patient's problems from lack of social network connections. Baker recommended a three-step process.

1. Identify: Take the time on scene to understand the problem.
2. Report: Follow existing procedures to report the problem to social services or resources within the agency.
3. Refer: Enable and encourage in-depth follow-up once the field providers identify and report the problem, to refer the patient to the best resources.

Learn more about social networks

In the presentation, Baker recommended a book, an app and an example of how public safety personnel become a connection in the social network of many older adults.

Baker recommended "Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives," which is an in-depth exploration of social networks by one of the foremost experts on the topic.

The Person-Centered Network app is used to screen a patient and connect the patient with available community resources. The app can map the current social network and recommend an ideal network with other actors — individuals and organizations — to assist the patient.

Baker shared the example of two police officers who made pasta dinner for a lonely elderly couple. Identifying this couple early, connecting them to other human beings can have significant long-term impacts on the couple's health.

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Answering the call: A paramedic's 10 days at Standing Rock

I spent 10 days on the Standing Rock Indian Reservation, North Dakota, in late December 2016 caring for the people drawing attention to the construction of the the Dakota Access Pipeline. The challenge of providing medical assistance in a remote location with severe weather conditions was well-suited to my life experiences and skills as a paramedic. But my decision to participate in this medical mission was confusing to some friends and family and also controversial to others.

I went to the Standing Rock Indian Reservation after a lot of research and discussion with friends and family. I grew up in a small town in Alaska where I did not have running water for the first few years of my life. I worked at fire and EMS agencies with transport times of one to two hours or more. I also worked for the Alaska Interagency Wildland Fire Medic Program, which provided medical services on wildland fires, and I worked as a medic in the oil fields on the North Slope.

Living and working with limited modern resources and in extreme environments are not new experiences for me. Had I not had the experiences that I did I likely would not have gone to Standing Rock. Part of the reason I felt compelled to go is because I knew I had the experience and skills to tolerate the environment and treat the types of medical complaints that were likely to be common.

The Dakota Access Pipeline is a oil pipeline that is being constructed to transport crude oil from the Bakken fields in western North Dakota to refineries in southern Illinois. It travels along an existing pipeline route that would take it under Lake Oahe, near the current borders of the Standing Rock Indian Reservation. The Standing Rock Sioux Tribe has objected to the construction of the pipeline on the grounds of treaty violations, the presence of sacred sites and the potential for irreparable environmental damage. In April 2016, a member of the Standing Rock tribe set up a camp on the edge of the reservation closest to the pipeline’s planned route. People flocked to the camp to show solidarity with the Standing Rock tribe, and additional camps have been constructed in the area.

Legality of providing paramedic care

The legality of providing medical care in the camps was an issue that was raised multiple times when discussing the trip with friends. Because Native American reservations are considered sovereign nations, the tribal government is allowed to set their own rules for EMS licensure. Having a state license is not required unless the tribe chooses to require it. Part of the vetting process included submitting copies of my identification and national registry certification. I was also warned to make sure I brought a photo ID and my national registry card with me so that my identity could be verified once I arrived in camp.

I also made arrangements with my parents to bail me out of jail in the event that I was arrested. While I did not anticipate being arrested for being a caregiver, I wanted to make sure my bases were covered.

Volunteering for the Medic Healer Council

I’m a full-time college student and I knew that with the poor internet service in the camps I would not be able to go until winter break from classes, which would put me in camp over Christmas. I was OK with that since there would likely be people who would want to head home at least temporarily and so it would be a good time for me to provide reinforcement. 

I submitted a volunteer application with the Standing Rock Medic Healer Council and was contacted by a volunteer coordinator who interviewed me and provided me with information about some of the cultural guidelines I would be expected to follow. I was asked to learn and follow the Seven Lakota Values of:

1. Prayer
2. Respect
3. Compassion
4. Honesty
5. Generosity
6. Humility
7. Wisdom

I spoke with several people who had been in the camps, including other medical providers, about what to expect. I drew upon my Alaska work experience to know what to pack and also consulted with some of my more outdoorsy friends. Here is a list of the supplies I brought with me.

My idea was to plan for the worst case scenarios for traveling to Standing Rock and staying in camp. Even knowing that many supplies have been donated to the camps, I did not want to assume any items would be available for me to use.  

I borrowed much of the equipment I took with me, which helped keep my costs down and allowed me to avoid buying gear that I would likely never use again since winter camping is not exactly something I planned on making a habit of. My packing list was nearly perfect. I used or gave away about 95 percent of the things I brought with me, while also not discovering anything I needed but didn’t bring.

Getting to Standing Rock

From my house to the camps is almost exactly 1,000 miles. I planned for two days to drive to North Dakota and three days to drive home. I planned for an extra day on the way home just in case I ran into bad weather I would have extra time to get back before I had to be in class and at work. My departure from Washington was delayed due to bad weather in Montana that closed the interstate, but once I got on the road the drive was fine and I arrived in North Dakota on Dec. 20, 2016. I spent the night in Bismarck before heading to camp the next morning, which was the first of my 10 days at Standing Rock.

Arriving in camp

I checked into camp on the morning of Dec. 21, 2016 and attended an orientation to camp life that covered everything from how to use the composting toilets to how to dress appropriately when attending a sweat lodge. After orientation I was directed to one of the other camps on the reservation that was in need of additional staff. I was warmly greeted by the people working in the medical yurt who were happy to have the additional help.

Providing medical care

The main medical team for the camp I was in consisted of an RN and apprentice herbalist, both of whom had been onsite for a couple of months. There was also another RN who was spending a couple of weeks at the camp and a resident physician was shared with the other camps.

Providing medical care in an environment like the camps at Standing Rock is dissimilar to providing medical care on an ambulance. Much of it falls into the primary care category; with things like sprains, strains, colds and coughs. Burns and respiratory issues were two of the most common chief complaints, which was exactly what I was expecting after working in the wildland fire camps in Alaska. We were able to treat the majority of the medical complaints on site and when necessary we would refer people to a clinic or hospital in Bismarck. We provided integrated care, using both Western, or conventional medicine, and herbal medicine, and the medic yurt also served as a healing space for people who needed to talk or recuperate. 

We always had to be prepared for any possible injuries from conflicts between the residents of the camps and law enforcement and the DAPL employees. This meant being prepared for patients with pepper spray exposure and inhalation, hypothermia and traumatic injuries.

One of the other responsibilities of the medics is sweeping the camps before every storm to make sure people are prepared and also sweeping the camps after the storms to make sure everyone made it through OK. The medics also help ensure the general health and safety of camp residents, such as making sure everyone had a carbon monoxide detector in their sleeping space.

Living in camp

Daily camp chores included making sure there was adequate firewood, boiling water and doing dishes, cleaning the medical space, and evaluating our inventory levels. The firewood situation was the most frustrating part of living in camp. Most of the wood that had been donated was either wet or green or both, which means that it did not burn very easily. On days when we had extra medical staff, I helped work on insulating and preparing a new, larger yurt that was going to be the new medical space. 

Most of the nights I was in camp I slept in my tent.


Inside the tent. (Photo/Ann Marie Farina)

The heater I had was too powerful for the tent, so I only ran it briefly while getting ready for bed or when waking up in the morning. Even without a heater, I was able to sleep comfortably by putting my 20 F sleeping bag inside my 0 F sleeping bag. It was even warmer in the tent after the blizzard due to the snowpack.

The blizzard was one of the more intense things I experienced while at Standing Rock. On Dec. 25, we were hit with a blizzard that dropped 12-15 inches of snow in 24 hours and had wind gusts of up to 60 mph. Due to the wind, I couldn’t unzip my tent door without it becoming filled with snow, so I packed up my spare sleeping bag, my cooking equipment and my blizzard supplies and moved into one of the new yurts I had been helping insulate. I stayed there for two nights with the members of the yurt building crew.

Pre-blizzard. The propane canisters made excellent anchors. The canvas tarp was tied to itself with rope going under the tent. (Photo/Ann Marie Farina)


Post-blizzard. (Photo/Ann Marie Farina)

Our camp primarily used solar power for electricity, which was supplemented by generator use when there wasn’t enough sun. Many days we didn’t have to run the generator at all, which was great since many days the generator didn’t want to run (I’m probably being unfair to the generator here. It is a perfectly good machine. We just didn’t hit it off very well). There was a community center located in a large military tent where breakfast and dinner were served daily, and where elders would tell stories and there was almost nightly drumming and singing. 

Gratitude

I’m glad that I went to Standing Rock and I wish I had been able to stay longer. I met many incredible people while I was there, from around the United States and also from Canada and overseas. A diverse number of languages and cultures were represented, with the one thing we all had in common was that we felt compelled to go to Standing Rock.

During my 10 days there, I saw the Northern Lights dance for the first time in 10 years. I fell asleep listening to drumming and singing and the owls and the coyotes. I now have a Cuban abuela and a Lakota unci (pronounced oon-chi) — grandmothers — who are two of the strongest (and most stubborn) women I have ever met.

Going to Standing Rock enabled me to get in touch with my roots as a paramedic. My experience was also a good reminder that there are many ways to help people as a paramedic that aren’t tied to working in a traditional EMS setting or working on an ambulance.

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