National Registry Evolution Builds Momentum
NREMT Executive Director Bill Seifarth. Since its founding in 1970, the National Registry of EMTs (NREMT) has offered the nation assurance that the men and women providing emergency treatment in the out-of-hospital setting are capable of providing the care that patients and their loved ones deserve. Following the interim direction of Drew Dawson, the NREMT named Bill Seifarth as its new executive director in August 2018. An EMS industry veteran, Seifarth brings more than 20 years of experience to the position, including leadership at both the state and federal levels, along with a background of managing several comprehensi...
Source: JEMS Special Topics - January 16, 2019 Category: Emergency Medicine Authors: Ryan Kelley, NREMT Tags: Exclusive Articles Administration and Leadership Source Type: news

Stop the Burn and Churn of Turnover and Burnout Through Resiliency Science
Several years ago, while sitting in a critical incident debriefing, I noted how little was understood about the impact of high-intensive exposure to the complexity of humanity. The incident debrief concerned a murder of one individual for their unborn baby. Both mother and infant died from the action of another. As the healthcare responders, we were dealing with the high emotional load of what we saw and how it impacted us. According to the Oxford English Dictionary, the definition of the word “resilience” is: “the capacity to recover quickly from difficulties, toughness … the ability of a substanc...
Source: JEMS Special Topics - January 16, 2019 Category: Emergency Medicine Authors: Martie L. Moore, RN, MAOM, CPHQ Tags: Exclusive Articles Administration and Leadership Source Type: news

Motivational Interviewing: A New Therapeutic Approach for Community Paramedics
One of the most challenging obstacles community paramedics face is trying not to fix all of their patients' problems. For many, EMS is a desirable industry because it offers the ability to help others in need. But what do you do when you are faced with a patient who doesn't want help, is resistant, or is ambivalent to change? Motivational interviewing is a therapeutic approach that moves an individual away from uncertainty and toward positive decisions based on accomplishing established goals. It allows the community paramedic the ability to empower their patients to make changes in order to ensure program success through ...
Source: JEMS Special Topics - January 15, 2019 Category: Emergency Medicine Authors: Desiree Partain, CCP-C Tags: Training Exclusive Articles Mobile Integrated Healthcare EMS Today Source Type: news

Austin-Travis County EMS Ambulances Offer Eye-catching, Effective Locations & Intersection Clearance
When leaving the National Association of EMS Physicians annual conference this weekend, I got a chance to scout out one of the Austin-Travis County EMS (ATCEMS) ambulances on a call at Austin's airport. (I tried to take home some souvenir EMS equipment but their alert crew—and vehicle design—locked up all doors and compartments!) Although you may not be a fan of their color scheme, it is effective, and particularly eye-catching from a distance. I especially like their use of all-exterior storage space and side-door step extrusion. One of the most impressive design features of these Wheeled Coach vehicles ...
Source: JEMS Special Topics - January 14, 2019 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT-P Tags: Exclusive Articles Ambulances & Vehicle Ops Source Type: news

Not Just Acid Reflux: The Need to Think Worst First
A previously healthy, well-appearing 42-year-old female living in a modern, high-rise apartment in downtown Los Angeles calls 9-1-1 at 5:30 am complaining of worsening of a burning, epigastric pain she had been experiencing for the last three days. She reports associated nausea and non-bloody, non-bilious vomiting, and that she couldn’t manage to get comfortable in bed until she finally decided to call for help at daybreak. During her 9-1-1 call, she reports “pain, like heartburn, that just woke me up again and I had to throw up, … and then I was sweating so much.” Using the Los Angeles Tiered Disp...
Source: JEMS Special Topics - January 13, 2019 Category: Emergency Medicine Authors: Stephen Sanko, MD, FACEP Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news

Former Homeland Security Director Reunited with Rescuers at NAEMSP Keynote
Former Pennsylvania Governor and Homeland Security Director Tom Ridge coded in his JW Marriott hotel room in Austin, Texas, in 2017. He was successfully resuscitated by crews from Austin-Travis County EMS and Fire and is one of among many cardiac arrest survivors grateful for the contributions of America’s EMTs and paramedics. Ridge was the opening keynote speaker yesterday at the annual meeting of the National Association of EMS Physicians, being held this week at the same JW Marriott in Austin where Ridge experienced his “life incident.” During his address, Secretary Ridge reviewed his history with EMS....
Source: JEMS Special Topics - January 11, 2019 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT-P Tags: Cardiac & Resuscitation News Exclusive Articles Administration and Leadership Source Type: news

Ohio ’s Statewide Rescue Task Force Initiative
A normal day at work is abruptly changed when you are informed of an active shooter incident (ASI) at a school in a cozy, normally peaceful suburb. The initial report indicates that there are at least three adults and four children injured as you scramble to activate mutual aid and secure the manpower and medical resources for care of these patients with the possibility of more victims. Seventeen years later, shots ring out the high school of another serenely peaceful suburb. The gunman’s shower of bullets leaves three students dead, one paralyzed, and another injured with a guarded chance for a full recovery. As you...
Source: JEMS Special Topics - January 10, 2019 Category: Emergency Medicine Authors: Carol A. Cunningham, MD, FAAEM, FAEMS Tags: Exclusive Articles Terrorism & Active Shooter Operations Source Type: news

The Side-by-Side Lift and Carry
This article marks the debut of an innovative new article delivery method. It's presented as a narrated article and, below that, as a downloadable read-only PowerPoint presentation and a printable PDF. We hope you enjoy this new article type, and we welcome your suggestions for enhancement and improvement at jems.editor@pennwell.com. Download as a read-only PowerPoint presentation. Download as a printable PDF.   (Source: JEMS Special Topics)
Source: JEMS Special Topics - January 8, 2019 Category: Emergency Medicine Authors: Michael Meoli, EMT-P, TP-C, NAEMT-AF Tags: Exclusive Articles Operations Source Type: news

EMS Today 2019: A Sneak Peak
Join AJ, Ryan and Bobby along with their special guests in a special Google Hangout where they discuss EMS Today 2019 and the incredible classes, events and workshops that will take place over three incredible days at the incredible Gaylord Resort in National Harbor, Maryland. Along with talking about the educatiopnal offerings, the group will talk about some of the challenges and opportunities that the medic community faces in the coming year. You can watch live at 1:00pm (Eastern); 12:00pm (Central); 10:00am (Pacific) on Tuesday, January 8th. If you can't join us live, the event will be archived here soon after it is bro...
Source: JEMS Special Topics - January 3, 2019 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT P Tags: Exclusive Articles Administration and Leadership EMS Today Source Type: news

Salute to Littleton Fire Rescue
January 1st was not just the start of a new year in Colorado. It was a big change day for the men and women of Littleton Fire Rescue (LFR), as their fire department is dissolved and their staff and facilities are absorbed and integrated into the massive South Metro Fire Rescue, the second-largest fire department in Colorado. The tragedy at Columbine High School on April 20, 1999, resulted in me traveling to the beautiful city of Littleton to personally meet and interview the men and women of LFR and their mutual aid neighbors. I walked through the bullet-riddled entranceways and hallways of Columbine with senior staff and ...
Source: JEMS Special Topics - January 2, 2019 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT P Tags: Exclusive Articles Columns Administration and Leadership Source Type: news

Closing Out the Year and Looking to the Future
As 2018 ends and 2019 approaches, I wanted to first thank all our readers, authors, columnists, photographers and editorial board members for following and contributing to our work throughout 2018. It was a year of change for JEMS, moving to an all-electronic platform and working to enhance our electronic delivery systems and methods. Change takes time, so we thank you for your patience and promise you that more great innovations are on the way to make your receipt and use of important articles and information easier to read, print out and share on all your devices. We appreciate our audience and do not take your trust in ...
Source: JEMS Special Topics - December 22, 2018 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT-P Tags: Exclusive Articles News Administration and Leadership Source Type: news

The Weaponization of Narcan
Narcan, the trade name of the opiate antidote naloxone, has become a part of the modern lexicon. It can even be found in the Urban Dictionary. Although initially a noun, it is now a widely used verb as in, “I Narcanned that patient,” or, “I Narcanned your Honor Student.” Narcan is so effective that we have even dreamed up imaginary clinical situations to administer it. YouTube is full of videos of police officers giving themselves or colleagues Narcan for suspected “fentanyl exposure.” A popular video shows a police officer giving Narcan to another officer after exposure to what was late...
Source: JEMS Special Topics - December 21, 2018 Category: Emergency Medicine Authors: Bryan Bledsoe, DO, FACEP, FAEMS Tags: Airway & Respiratory Exclusive Articles Columns Source Type: news

The Brutal Math of Drug-Seeking Behavior in Prehospital Care
Dallas Fire-Rescue Medical Director Marshal Isaacs, MD, calls them "prime numbers." He’s referring not only to drug-seekers—although many of them belong to the population of patients who "fall off the grid" in between encounters with the healthcare system, and therefore pose a major challenge to being tracked over time. These patients can be transients or migrant workers; they can be living in short-stay accommodations like motels, and therefore moving frequently around a region; they can be suffering from mental illness or addiction and moving among rehabilitation centers; or they...
Source: JEMS Special Topics - December 19, 2018 Category: Emergency Medicine Authors: Jonathon S. Feit, MBA, MA Tags: Exclusive Articles Documentation & Patient Care Reporting Columns Source Type: news

Rethinking ALS Intercepts and Mutual Aide Agreements
This article focuses on the EMS standard operating procedure (SOP) known as the advanced life support (ALS) intercept.1 In the seven rural Midwest and Mountain West states in which the authors work it’s common for ambulance services to be staffed by volunteers with basic life support (BLS) training. These dedicated first responders have varied levels of NREMT credentialing including: EMT-Basic, Advanced EMT, and EMT-Intermediate (EMT-B, AEMT and EMT-I, respectively).2 All EMTs complete coursework in human anatomy, physiology, pathophysiology, emergency skills and patient assessment. The more advanced the EMT (e.g., a...
Source: JEMS Special Topics - December 19, 2018 Category: Emergency Medicine Authors: Ralph Renger, PhD Tags: Exclusive Articles Operations Source Type: news

Mental Health, Sleep Deprivation and Career Stress in EMS and Fire
The human brain is a marvelous, yet complicated system. Researchers spend entire careers studying what makes the brain act or react to certain experiences. A mental health issue stemming from life’s experiences has culturally been seen as a sign of weakness, but actually is part of a very complex architecture that’s unique from person to person. In order to gain an understanding of how stress plays a role in the lives of first responders, we need to start answering some hard questions: What leads to burn-out? What’s associated with PTSD? How is lack of sleep affecting the mental health states of first res...
Source: JEMS Special Topics - December 13, 2018 Category: Emergency Medicine Authors: Morgan K. Anderson, MPH Tags: Exclusive Articles Resiliency Operations Source Type: news

Clinical Performance Measures that Matter —Are You Ready?
This article has been revised since it was originally posted on 12/11/2018. Figures 3 and 4 were not correct in the previous version and were replaced on 12/14/2018 at 6:00pm PST. No changes have been made to the text of the article. Ask EMS professionals to define “quality in EMS” and you may get a tip of the head and an answer like, “Well, I’m not sure, but I know it when I see it.” In today’s healthcare environment, demonstrating quality is crucial. Payers are increasingly linking payment to outcome and quality, and becoming less interesting in paying for services that don’t add...
Source: JEMS Special Topics - December 11, 2018 Category: Emergency Medicine Authors: Wayne C. Harbour, NRP Tags: Exclusive Articles Operations Administration and Leadership Source Type: news

Global Differences in Out-of-Hospital Cardiac Arrest Reporting
Conclusion Large disparities exist surrounding OHCA patients among three different high-income countries. In addition to this, there are significant gaps in capturing, reporting, sharing and analyzing OHCA data across regional and national borders. Uniformity of reporting standards continue to hinder the epidemiological evidence base for OHCA. Much about OHCA epidemiology is still unknown in many regions of the world, including countries with regional OHCA surveillance in place. These findings present considerable challenges not only nationally, but globally for evaluating the global burden of out-of-hospital cardiac arres...
Source: JEMS Special Topics - December 6, 2018 Category: Emergency Medicine Authors: Michael Schulz, MS, NRP Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news

Look Up From Your Screen
One of the best things about being in the emergency services is the freedom we enjoy from a traditional office setting. Increasingly, though, our mobile devices are infiltrating our space and chewing up our time and attention. We can be sitting in the cab of an emergency vehicle anywhere, but still be tethered by our phone and tablets, unless we make a conscious choice not to be ruled by techno-diversions. As a member of the healthcare world, why not set an example to others and choose to heed the advice of experts to look up from the screens to which we all seem addicted? Here are three good reasons: 1. ...
Source: JEMS Special Topics - December 4, 2018 Category: Emergency Medicine Authors: Kate Dernocoeur, NREMT Tags: Exclusive Articles Columns Operations Source Type: news

Patient's Elevated Airway Pressure Puzzles Providers
Discussion Whether they’re “sensed” through difficulty in ventilating a patient manually via a bag-valve mask or noted because of a ventilator alarm, elevated airway pressures present a risk of harm to the patient. Many ventilators are set to not only alarm at certain airway pressures, but to alter the inspiratory flow delivered to a patient in order to avoid further elevations in airway pressure. This may result in a reduction in the tidal volume delivered to the patient and/or reduced minute ventilation, both of which may result in hypoventilation and resulting hypercapnia. This adjustment, which ventil...
Source: JEMS Special Topics - November 29, 2018 Category: Emergency Medicine Authors: John Freese, MD Tags: Airway & Respiratory Exclusive Articles Source Type: news

Carrying and Administering Lifesaving Prehospital Blood
When New Hanover (North Carolina) Regional Medical Center’s AirLink teams began carrying prehospital blood in September 2017, patients experiencing hemorrhagic shock gained the ability to receive lifesaving oxygen-carrying red blood cells while being transported to the trauma center. Prehospital blood transfusions are known to increase 24-hour survival while also decreasing the total amount of blood needed during hospitalization, but are only available on about half of the EMS helicopters in the United States. In a testament to the need for prehospital blood transfusions, the first patient to receive this lifesaving ...
Source: JEMS Special Topics - November 28, 2018 Category: Emergency Medicine Authors: Kevin Collopy, BA, FP-C, CCEMT-P, NRP, CMTE Tags: Trauma Exclusive Articles Source Type: news

ECG Educational Standards for Prehospital Providers
Conclusion As the role of evidence-based medicine becomes more prominent in the field of emergency medicine, a clear view of the current state of ECG education and platform from which to implement uniform standards becomes increasingly essential; especially as research expands into the prehospital setting. Further research into EMS education may identify both strengths and weaknesses in basic ECG interpretation appropriate for first responders. Implementing minimum ECG interpretation standards for EMS personnel nationwide is one potential option to ensure prehospital educational institutions stay responsive to current scie...
Source: JEMS Special Topics - November 27, 2018 Category: Emergency Medicine Authors: Jonathan Barney, BA, EMT, MS3 Tags: Training Exclusive Articles Cardiac & Resuscitation Source Type: news

EMS Encouraged to Comment on Opioid Crisis National Roadmap
The NHTSA Office of EMS is encouraging members of the EMS community to comment on a draft report developed by the Fast Track Action Committee (FTAC) on Health Science and Technology Response to the Opioid Crisis. Under the White House Office of Science and Technology Policy, NTSC convened the Opioid FTAC as a response to the opioid crisis to identify (1) research and development (R&D) critical to addressing key gaps in knowledge and tools, and (2) opportunities to improve coordination of Federal research and development essentials to combating the opioid crisis. The draft report, "Health Research and Development t...
Source: JEMS Special Topics - November 21, 2018 Category: Emergency Medicine Authors: NHTSA Office of EMS Tags: News Administration and Leadership Mobile Integrated Healthcare Source Type: news

Recruitment and Retention: A Perennial Problem in EMS
Conclusion We can interpret from these studies and the information they provide that our industry’s turnover rate sits at an average nationally of 20–30%. Further, about 10–15% of our staff leave our employment to retire, which is something we probably can’t, and shouldn’t, attempt to change. Of the remaining 15% that voluntarily resign each year, we can implement some workplace changes that could substantially reduce this number, and this does not necessarily require increasing their salaries significantly. References 1. Perkins BJ, DeTienne J, Fitzgerald K, et al. Factors associated with wor...
Source: JEMS Special Topics - November 20, 2018 Category: Emergency Medicine Authors: Vincent D. Robbins, FACPE, FACHE Tags: Columns Exclusive Articles Administration and Leadership Source Type: news

First Combination Bachelor of Nursing Degrees/EMT-Intermediate Certifications Conferred in Austria
The first cohort of students have completed the Bachelor of Nursing Science program at Austria's University of Applied Sciences in St. Pölten. Some students also graduated as Emergency Medical Technician-Intermediate. The six-semester program offers a regular Austria Nursing Law Bachelor and an “academic program for prehospital care and nursing,” according to the Austrian Paramedic Law. Related JEMS Article: Austrian University Adds EMS Training to Bachelor of Nursing Degree Nurse paramedics are quite common in European countries such as Spain, Norway, Netherlands, Sweden and Finland. In Austr...
Source: JEMS Special Topics - November 20, 2018 Category: Emergency Medicine Authors: Christoph Redelsteiner, DrPhDr, MSW, MS, EMT-P Tags: Training News Exclusive Articles Source Type: news

Reflecting on Pennsylvania's EMS Issues from 2,300 Miles Away
My sister-in-law in Eastern Pennsylvania, sent me this great descriptive article published in the Times News from the six-county EMS region in Eastern Pennsylvania where I was director from 1975–1992. It presents a great update and facts on age-old issues that volunteer, BLS and low-volume services have. I wish I wrote it. Most of the issues are decades old and existed when I was the region's EMS Council Director, but now these issues are catching up with small services and choking them—financially and emotionally—to death. From 1975–1987, the Commonwealth of Pennsylvania's EMS law allowed (by ...
Source: JEMS Special Topics - November 19, 2018 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT-P Tags: Exclusive Articles Columns Administration and Leadership Source Type: news

Between a Stethoscope and a Gavel
In late 1959, a young firefighter candidate was given a welcome break from the “grinder”—an affectionate term for the training academy of the Los Angeles County Fire Department (LACoFD). The young firefighter had been told his “contractual duty is to fight fire”1 and had spent the prior weeks drilling on the techniques of the profession under the Southern California sun. However, today would be different. Instead of pulling hose and lifting ladders, his afternoon would be spent in a classroom taking a course called “first aid.” At best, the course was marginal; lasting less than tw...
Source: JEMS Special Topics - November 15, 2018 Category: Emergency Medicine Authors: Jameson Karns Tags: Exclusive Articles Administration and Leadership Source Type: news

Amid Drug Crisis, Spiritual First Responders Hit the Streets
Sidewalk prayers near shoot-up spots. Sunday sermons in the back of a bar. Pleas to struggling souls to surrender to God. Funerals for members of their flock who didn't make it. Clergy members have become spiritual first responders in the opioid crisis, often leaving the pulpit to minister on the streets. They can be reverends, rabbis, priests or pastors. Though their faiths differ, they invariably approach people with addiction as equals. No Bible-thumping, no blaming. Quite a few are in recovery themselves. Despite some signs of a slowdown, the nation's all-time deadliest drug overdose epidemic endures. Opioids were invo...
Source: JEMS Special Topics - November 13, 2018 Category: Emergency Medicine Authors: Michael Hill, Associated Press Tags: News Mobile Integrated Healthcare Source Type: news

Safety is Third, Not First, and We All Know It Should Be
Conclusion In educational opportunities, train like you plan to fight. Since there may not be an actual patient, the “benefit” in the risk-benefit analysis may be lesser. However, taking no risks in training ensures you’ll be less prepared to take risks—even R+ risks—in actual operations. For example, you don’t stop patient care because it’s raining, so don’t stop your training simply because it’s raining. Also, during your education, fight the idea that we can ever say “the scene is safe.” Accept that our work is done in an imperfect environment where safet...
Source: JEMS Special Topics - November 13, 2018 Category: Emergency Medicine Authors: Christopher Davis, MD, NRP, FAWM Tags: Exclusive Articles Operations Source Type: news

Firefighting and On-Duty Cardiac Deaths
Conclusion Using autopsy data from on-duty fatalities that occurred over a 15-year period, the underlying cardiac pathological conditions associated with sudden cardiac death were investigated among firefighters. Our data suggest a need for updated and improved medical screening for firefighters. Particularly, screening for CHD and cardiac enlargement should be incorporated into a firefighter’s routine screening. Given the important role of EMS in ensuring both civilian and firefighter safety, EMS personnel should be alert to the potential to encounter either sudden cardiac arrest or a myocardial infarction in firefi...
Source: JEMS Special Topics - November 12, 2018 Category: Emergency Medicine Authors: Denise L. Smith, PhD, FACSM Tags: Training Exclusive Articles Source Type: news

St John Ambulance Bicycle Team Turns 20 Years Old
They say necessity is the mother of invention. In 1998, two years prior to the Sydney 2000 Olympics, necessity reared its head in the form of the realisation that one of the world’s biggest events would soon challenge the very way St John Ambulance Australia (NSW) supports events. With its large crowds, big venues, security and access challenges, the Olympics like no other event would test traditional approaches to major event coverage. St John Ambulance Australia (NSW) would need to think of new more innovative ways of responding to incidents, often across significant distances whilst navigating dense crowds and se...
Source: JEMS Special Topics - November 9, 2018 Category: Emergency Medicine Authors: Didier Moutia Tags: Exclusive Articles International Operations Source Type: news

Thousand Oaks, Calif., Bar Shooting Underscores Several Points for EMS to Consider
The shooting at Borderline Bar & Grill, a country music bar in Thousand Oaks, Calif., the second-largest city in Ventura County, highlights several key areas EMS/Fire/Rescue/police agencies should consider during similar incidents. 1. Formal mass casualty incident triage may be delayed. According to the FBI, most shootings are over in five minutes. First-arriving EMS crews must be ready to take on, triage, treat and transport patients immediately upon arrival. Therefore, crews coming in minutes later may be the ones required to set up formal triage, patient collection and treatment areas. This image made from aerial ...
Source: JEMS Special Topics - November 8, 2018 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT-P Tags: Training Exclusive Articles Terrorism & Active Shooter Source Type: news

The Critical Role EMS Plays in Fighting the Flu
Influenza has been impacting public health on a global scale since the beginning of recorded history. Influenza, also known as the “flu,” has numerous organizations committed to public health research, developing vaccines, and educating on best practices to prepare for the upcoming flu season. By gaining an understanding of the flu through history, virology, and how it impacts our society, we can have a better appreciation for the commitment that’s involved with combating the flu. What Is Influenza (and What’s Not)? The eyes of an epidemiologist can twitch for a variety of reasons, one of them being...
Source: JEMS Special Topics - November 8, 2018 Category: Emergency Medicine Authors: Morgan K. Anderson, MPH Tags: Exclusive Articles Operations Source Type: news

Brownsville, Texas, Kickstarts New Program to Help Reduce Non-Emergency 9-1-1 Calls
  BROWNSVILLE (KRGV) – A growing number of non-emergent 9-1-1 calls have one Rio Grande Valley city looking to reduce those calls. Brownsville Fire Chief Jarrett Sheldon says a new program will be able to identify the people who frequently call for non-emergency situations. “We’ll get a patient – an elderly patient who falls a lot. The goal of this program is, basically, go in their home, find out why are they falling, you know, why are we responding three times a week, four times a week to these homes,” he explains. Read more at KRGV. (Source: JEMS Special Topics)
Source: JEMS Special Topics - November 7, 2018 Category: Emergency Medicine Authors: Cecilia Gutierrez (KRGV) Tags: News News Videos Mobile Integrated Healthcare Source Type: news

Raising the Intubation Bar is Noble, But Not Practical
We thank Mr. Wood and Mr. Podsialdo for their insightful comments regarding the Pragmatic Airway Resuscitation Trial (PART) results.  With regards to their comment of prior studies finding better outcomes with intubation than supraglottic airways, one must bear in mind that these prior studies were biased by their retrospective designs; the airway was selected by paramedic choice and may have been influenced by a range of factors such as the patient’s condition, anatomy, the physical environment or the practitioner’s level of comfort. Meta-analysis or systematic reviews of these retrospective studies ...
Source: JEMS Special Topics - November 6, 2018 Category: Emergency Medicine Authors: Shannon W. Stephens, EMT-P Tags: Airway & Respiratory Exclusive Articles Source Type: news

It ’s About Paramedic Intubation Skill Maintenance, Not ETI vs. SGA
Conclusion The PART study’s aim was to demonstrate that SGA is superior to SETI. Whether this is true or not remains to be seen. That doesn’t mean this study doesn’t have value. It clearly demonstrated that an important, time-honored and gold standard skill in resuscitation isn’t being practiced effectively by paramedics. The solution should not be to abandon the procedure. The solution is that we need to fix the problem. We need to enhance education, provide more opportunity for skills maintenance and develop systems that ensure that paramedics are regularly practicing these advanced skills. It is ...
Source: JEMS Special Topics - November 6, 2018 Category: Emergency Medicine Authors: Stephen P. Wood, MS, ACNP-BC Tags: Airway & Respiratory Exclusive Articles Source Type: news

Pediatric Extremity Hemorrhage and Tourniquet Use
Conclusion Current evidence suggests that direct pressure, commercial tourniquets and improvised tourniquets can adequately control pediatric extremity hemorrhage. Being prepared for an emergency requires dedicated and recurrent training. Practice bleeding control by applying direct pressure, a commercial tourniquet, and a cravat on a simulated (yet human, i.e., standardized) small patient. Take a moment to share the information you gained from this article, and from your own practice, with colleagues. Your knowledge, and the knowledge that you impart to others, will save lives. Back to the Call You take a deep breath and ...
Source: JEMS Special Topics - November 1, 2018 Category: Emergency Medicine Authors: Erica Simon, DO, MHA Tags: Trauma Exclusive Articles Source Type: news

Executive Institute (XI) Convenes in Hershey, Pennsylvania
EMS leaders convened in “Chocolatetown USA”—also known as the town of Hershey, Pennsylvania—on Monday, Oct. 22, 2018, for the Page, Wolfberg and Wirth (PWW) Media XI Leadership Conference at the Hershey Lodge. The Executive Institute (XI) is a one-day interactive workshop with sessions tailored for EMS industry executives, chiefs, top-level managers, owners and leaders interested in high-level views and discussions about reimbursement, compliance, privacy, leadership and human resource management. Well-known industry leader, Mike Taigman, kicked off the morning with an eye-opening keynote. Taig...
Source: JEMS Special Topics - October 27, 2018 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT P Tags: Exclusive Articles Administration and Leadership Source Type: news

abc360 Conference Offers Treasure Trove of New Information
The Page, Wolfberg and Wirth (PWW) abc360 Conference kicked off on Tuesday, Oct. 23, at the Hershey Lodge in Hershey, Pennsylvania, offering a robust audience a treasure trove of new information on several key EMS administrative areas. Up first were the reimbursement, compliance and privacy updates from PWW partners Doug Wolfberg, Steve Wirth and Ryan Stark, which was packed with the latest about what’s going on with the Centers for Medicare and Medicaid Services cost data collection requirements, Medicare appeals, and some interesting air ambulance news. “We aim to not only inform attendees about the latest in...
Source: JEMS Special Topics - October 26, 2018 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT P Tags: Exclusive Articles Administration and Leadership Source Type: news

Pennsylvania Passes Epic Ambulance Non-Transport Payment
  Video from WNEP-TV. Barrar's bill to reimburse ambulance companies heads to governor WEST CHESTER, Pa.–Legislation drafted by state Rep. Steve Barrar, R-160, that would require ambulance companies to be reimbursed for providing medical treatment, even if the patient is not transported to a hospital, was successfully voted on concurrence by the House. Read more at Daily Local News Mobile Integrated Healthcare Editor Matt Zavadsky's Take:   A very logical step being taken by the Pennsylvania legislature!   And, one that is currently in place for payers such as Anthem and the Medicaid ...
Source: JEMS Special Topics - October 26, 2018 Category: Emergency Medicine Authors: Matt Zavadsky, MS-HSA, EMT Tags: News Mobile Integrated Healthcare Source Type: news

Pennsylvania Agency Reveals ‘Fallen Hero’ Ambulance
Commonwealth Health EMS headquartered in Scranton, Pennsylvania, revealed an ambulance with a special meaning on Tuesday, October 23. The “Fallen Hero” ambulance pays tribute to members of the emergency services and military community from Northeastern Pennsylvania who have paid the ultimate sacrifice in the line of duty. The families and friends of many of the fallen heroes immortalized on this tribute ambulance were on hand for the unveiling ceremony. The event was also attended by representatives from Scranton Fire Department, Scranton Police Department, the Pennsylvania State Police, the Pennsylvania Army N...
Source: JEMS Special Topics - October 25, 2018 Category: Emergency Medicine Authors: Julian P. Watras, NRP, CIT Tags: Exclusive Articles Ambulances & Vehicle Ops Source Type: news

Ditch the Machine to Improve Accuracy in Blood Pressure Measurement and Diagnostics
Conclusion For the patient in this case, the decision to forego the convenience of a machine in favor of the skills of a knowledgeable paramedic was lifesaving. Much like the comparison often drawn between the old-fashioned barbell and more sophisticated exercise machines, newer, more complex, and more expensive might make a process more comfortable, but doesn’t always equate to superior results. As we surrender more and more of our hands-on skills to the ease of automated technology, we risk more than the loss of the aptitudes that form the foundation of sound patient assessment—we place our patients in jeopar...
Source: JEMS Special Topics - October 24, 2018 Category: Emergency Medicine Authors: Mark Rock, NRP Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news

Taking a Manual Blood Pressure: Techniques & Pitfalls
Follow the steps below in order to get the best results from use of the aneroid sphygmomanometer when measuring a patient’s blood pressure, taking care to avoid some common errors. 1. Properly expose the patient. The blood pressure should be measured during the secondary examination, which begins with exposing the patient. This will ensure that the cuff is placed on the skin. The blood pressure cuff should never be placed over clothing, as doing so will increase pressure on the cuff and produce an inaccurate reading. 2. Properly position the patient. The patient should be seated comfortably, with the legs uncrossed. ...
Source: JEMS Special Topics - October 24, 2018 Category: Emergency Medicine Authors: Mark Rock, NRP Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news

Managing the Toxic Chemical Release that Occurs During a Crush Injury
Conclusion Remember, crush injuries are a different form of trauma that require a very different mindset and approach to patient care. Local physiologic deterioration can begin very quickly, but systemic effects aren’t seen until the external pressure on the extremity or body part is released. The presentation of crush injuries can also be very clandestine, as in automobile accidents, due to local or central sensory neurological interruption and damage. Therefore, it’s essential to insist upon earliest possible access to the patient to assess the possible/probable extent of any crush injury and prepare/monitor ...
Source: JEMS Special Topics - October 22, 2018 Category: Emergency Medicine Authors: Andrew Parrish, MD, EMT-P Tags: Trauma Exclusive Articles Source Type: news

The Opportunity & Need for a Nuanced View of Prehospital Information
On the final day of the 2018 North Carolina EMS Expo, Stephen J. Howell, NRP, the EMS captain and coordinator at New Hanover Regional EMS, gave a talk audaciously titled “How Data Drives Success.” Having seen many such presentations over the years—many of which have fallen short of innovative or anything more than platitudes about the “need” to chart patient care for legal coverage, and a pining, fruitless, frankly overblown and never-really-explained desire to gain unfettered access to hospital-side electronic health records—I was curious. Mr. Howell offered a sophisticated overview of ...
Source: JEMS Special Topics - October 18, 2018 Category: Emergency Medicine Authors: Jonathon S. Feit, MBA, MA Tags: Columns Exclusive Articles Mobile Integrated Healthcare Source Type: news

The Agenda is Set ... Now What?
In September, Jon Krohmer, MD, FACEP, marked the end of his second year as director of the National Highway Traffic Safety Administration (NHTSA) Office of EMS. His tenure has included major initiatives, such as EMS Agenda 2050 and a revision of the National EMS Model Scope of Practice, as well as continued efforts to support state and local EMS organizations battling the opioid crisis and addressing other public health issues.Krohmer has a long career in EMS, starting as an emergency physician and EMS medical director in Michigan. He served in national organizations, including a stint as president of the National Associat...
Source: JEMS Special Topics - October 17, 2018 Category: Emergency Medicine Authors: Ryan Kelley, NREMT Tags: Exclusive Articles EMS Insider Administration and Leadership Source Type: news

Variabilities in the Use of IV Epinephrine in the Management of Cardiac Arrest Patients
Discussion The results show a lack of standardization in epinephrine dosing across large EMS systems around the world, in spite of the existence of standard guidelines such as the 2015 AHA CPR and ECC Guidelines.5 Dosing maximums, epinephrine drip use, dosing amount and frequency, and dosing distinction for rhythms not being more consistent across the board shows the current state of uncertainty that epinephrine administration is in at this time. The AHA ECC Guidelines don’t specify dosing maximums or about distinguish between v fib and other rhythms.5 In those two categories, responding agencies showed a lack of sta...
Source: JEMS Special Topics - October 15, 2018 Category: Emergency Medicine Authors: Nidhish Lokesh, NREMT Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news

Prepping For Situations That May Never Happen
I looked over as my partner drove the first-in ambulance up the exit ramp to the elevated portion of I-70, and gasped. “There must be 60 cars over there,” I told him. Black ice had formed on the road (when the wrecks were counted, there were 59 vehicles). The good news was that our 400+-pound dispatcher who had been on his way to work was up and walking, gingerly, on the slippery roadway. The bad news was that the incident command system (ICS) was still evolving in the minds of Alan Brunacini and others. Unified command, a coherent staging process, and radio frequencies in common didn’t yet exist in the e...
Source: JEMS Special Topics - October 11, 2018 Category: Emergency Medicine Authors: Kate Dernocoeur, NREMT Tags: Major Incidents Exclusive Articles Columns Source Type: news

Coordinated Response Delivers Specialized Medical Resources During Hurricane Florence
Conclusion Overall, this coordinated response during the most intense portion of Hurricane Florence was an incredible success due to the careful planning of all of the public safety personnel in Wilmington. It’s important that anytime EMS responds to a high-intensity and low frequency call that an after-action review be completed and that both highlights and opportunities for improvement are identified. (Source: JEMS Special Topics)
Source: JEMS Special Topics - October 11, 2018 Category: Emergency Medicine Authors: Kevin Collopy, BA, FP-C, CCEMT-P, NRP, CMTE Tags: Rescue & Vehicle Extrication Exclusive Articles Source Type: news

Tulsa's Multiagency Crisis Response Team Stops Woman from Taking Her Own Life
  TULSA, Oklahoma - A new team in Tulsa helped prevent a woman from taking her own life on Tuesday. Officers say she was standing outside the guardrail on the Peoria bridge over the BA Expressway for several hours. A police officer, a paramedic, and a therapist make up the unique 3-person team known as the Crisis Response Team or CRT. The goal is to keep people out of the hospital and out of jail and instead get them the help they really need. Read more at Tulsa News on 6. (Source: JEMS Special Topics)
Source: JEMS Special Topics - October 11, 2018 Category: Emergency Medicine Authors: Ashley Izbicki (Tulsa News on 6) Tags: News News Videos Mobile Integrated Healthcare Source Type: news

Ambulance Crew Configuration: Are Two Paramedics Better Than One?
Conclusion Understanding ideal crew configuration is vital to maintain EMS systems. There’s a lack of evidence demonstrating the need for a second ALS provider on a general ALS response. Implications of overstaffing may result in more patient care errors and draining of financial resources which could be spent on additional state-of-the-art medical equipment or number of units resulting in better system performance and patient care. References 1. Robbins V: History of ambulance services and medical transpoortation systems in the United States. In JT Lindsey (Ed.), Management of ambulance services. Pearson: Boston, pp...
Source: JEMS Special Topics - October 8, 2018 Category: Emergency Medicine Authors: Vincent D. Robbins, FACPE, FACHE Tags: Exclusive Articles Operations Source Type: news