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 the pati...
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 the value of prehospital...
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 standar...
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 early 1980s. ...
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. 27...
Source: JEMS Special Topics - October 8, 2018 Category: Emergency Medicine Authors: Vincent D. Robbins, FACPE, FACHE Tags: Exclusive Articles Operations Source Type: news

Disruption Is on the Horizon, Are You Ready?
Conclusion As I end this issue of EMSOLOGY, I glimpse into our future and see that the EMS and healthcare landscape looks massively different: The traditions, methods and practices of today are memorialized and honored by providers and forgotten by our patients of tomorrow; Technology reduces service demand and automates supply side service delivery; Patient behaviors are always aligned with the most effective, efficient and, therefore, the most appropriate preventive and reactive care pathway; Medicine is custom-delivered to the patient; Going out of the home to receive care is no longer needed; and The capacity bubble c...
Source: JEMS Special Topics - October 5, 2018 Category: Emergency Medicine Authors: Jonathan D. Washko, MBA, NRP, AEMD Tags: Columns Exclusive Articles Administration and Leadership Source Type: news

Airway, Breathing or Consequences: Medical-Legal Consequences of Airway Mismanagement
Conclusion Although practice may not make perfect, it certainly can make proficiency. And when it comes to airway management, for every tube, every time, every age, everywhere ... capnographic (or at least capnometric or colorimetric) verification of proper initial and ongoing placement is the standard of care. If being the subject of a serious medical malpractice lawsuit is among the things you strive to avoid, get in habit of using your tools and trusting the technology. (Source: JEMS Special Topics)
Source: JEMS Special Topics - October 4, 2018 Category: Emergency Medicine Authors: Scott DeBoer, RN, MSN, CEN, CPEN, CCRN, CFRN, EMT-P Tags: Airway & Respiratory Exclusive Articles Source Type: news

Airway, Breathing or Consequences: Use Your Tools and Trust the Technology
Conclusion Ongoing confirmation of proper placement of an airway device is critical. Whether by a colorimetric device, capnometry, or, ideally, capnography, the tools should always be available and always be used. Note that there’s no mention of when this confirmation should take place. That’s because it’s essential to ensure that the tube is in the right spot and stays in the right spot. Each time, every time, all the time! As a healthcare provider, it’s essential to know your equipment, its uses and its limitations. You’re responsible for understanding not only how and why these tools work, but also how and why...
Source: JEMS Special Topics - October 1, 2018 Category: Emergency Medicine Authors: Scott DeBoer, RN, MSN, CEN, CPEN, CCRN, CFRN, EMT-P Tags: Airway & Respiratory Exclusive Articles Source Type: news

A Duty to Act at 30,000 Feet
Andrew King Needum was raised in the small rural town of Celina, Texas, where he grew up working on his grandfather’s farm spending many years tending to the cattle and helping manage crops. Needum went to college at Tarleton State University where he received a Bachelor of Science in agriculture service and development in 2006. In 2007, he married his wife, Stephanie, and began serving on the Weston Volunteer Fire Department, in Weston, TX. After a year as a volunteer firefighter, Needum knew that the fire service was where he needed to be. He enrolled in the Collin College Fire Academy and graduated as an EMT with a St...
Source: JEMS Special Topics - September 27, 2018 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT P Tags: Exclusive Articles Operations Source Type: news

Firefighter/Paramedic Recalls Springing Into Action on Southwest Flight 1380
Editor's Note: On April 17, 2018, Jennifer Riordan, a 43-year-old vice president of community relations for Wells Fargo bank and mother of two children from Albuquerque, N.M., was pulled halfway out of an airplane window on Southwest Flight 1380 after the windows was hit by shrapnel from a failed engine just 20 minutes into the flight. The seatbelt around her waist kept her from being completely sucked away, and it was through heroic efforts by a handful of brave passengers risking their own lives that Jennifer was pulled back into the plane so resuscitation attempts could begin. What follows is the firsthand account from ...
Source: JEMS Special Topics - September 26, 2018 Category: Emergency Medicine Authors: Andrew Needum, NRP Tags: Exclusive Articles Operations Source Type: news

Reuniting and the Bonds of Trauma After Flight 1380
This is the story about a “family” I never knew that I had until a tragic and traumatic event brought us together. Following the incident that occurred on Southwest Airlines Flight 1380, a cohesive bond was formed among all of us directly involved.   The Immediate Aftermath Immediately following our offloading of the plane, several buses were lined up to transport us to the Philadelphia airport terminals from the tarmac. It just so happened that my family was on the same bus as Peggy Phillips, the nurse who assisted me in the performance of CPR on Jennifer Riordan. My parents and Peggy began to converse ab...
Source: JEMS Special Topics - September 26, 2018 Category: Emergency Medicine Authors: Andrew Needum, NRP Tags: Exclusive Articles Resiliency Operations Source Type: news

Standardization of EMS Simulation Activities Improves the Learning Experience
Conclusion Standardization is an essential consideration for any simulation activity. The level of standardization must be specifically chosen and incorporated into the design to ensure that each simulation is appropriate and useful. It’s not acceptable to simply place the manikin on a table, or throw the manikin down into the mud and recreate a patient encounter that was “cool” from the last shift. Standardization within simulation activities improves quality and the experience for learners. It also enhances the efforts of proper simulation design, execution and debriefing making the effort of evidence-based practic...
Source: JEMS Special Topics - September 25, 2018 Category: Emergency Medicine Authors: Aaron Dix, NRP, MBA, CHSE, NCEE, CP-C Tags: Training Exclusive Articles Columns Source Type: news