New research has just uncovered a simple maneuver that can possibly save your life or the life of someone you know.  Take a look at this video:
http://www.wjactv.com/news/news/paramedic-killed-ambulance-rollover/nPKxd/

If you believe that the simple act of riding in the ambulance somehow negates the need to wear a seatbelt, then you are almost assuredly mistaken.  Technology exists to allow all EMS personnel to be restrained while performing any task, including CPR.  With the availablity of high-tech restraints and automated paient care devices, there is little excuse to remain unsecured while in transit with a paient and no reason to be un-seatbelted while returning to quarters.

We preach the need for seatbelts to our friends and family members because of what we, as EMS providers, see on a daily basis.  Our reluctance to take our own advise should never be the reason to mourn the unnecessay death of a squad member.

The simple answer is: "when it is incapable of restraining the patient".  What is not made abundantly clear is that the straps sold to you (the EMS Provider) with your cot were specifically designed to hold your patient safely, in conjunction with the floor mount, in the event of a motor vehicular accident.  The only way to make sure that this remains true is to replace your cot straps (when necessary) with straps of the same "break-strength".  Otherwise, we are weakening the crash-restraint system or in effect, we become responsible for making the vehicle/stretcher combination less crash-worthy.  While replacing straps on other devices (stair chair, scoop, backboard) with easier-to-clean (lighter-duty) styles is not an issue, the simple act of putting a less-than-adequate strap on the rolling stretcher should not be done without considering the consequences;  shifting the liability from those that made and constructed the cot and floor mount into the hands (and pocketbooks) of the organization that failed to adequately maintain the integrity of the system (thats you - the EMS provider).

What do you use to acquire a patient's temperature on a routine call?  This question comes up frequently in my discussions with EMS providers.  Thermometers vary widely in their type and usefulness in EMS.  I would like to take a moment to discuss these types and their operating characteristics.

The Oral Thermometer.  With the elimination of  the use of Mercury, we are left with oral thermometers that display temps by either electronic digital display or (non-electronic) visual display.  Electronic display units are all basically reusable and require a sheath or probe cover to prevent cross-contamination.  The non-electronic visual display thermometer is always single use and relatively inexpensive.  In either case, the cost per use is low and reading is relatively reliable under almost any condition.

The Tympanic (Ear) Thermometer.  I would have to say that these are the most misunderstood thermometers available to EMS personnel.  They work by reading the heat coming off the membrane inside the ear.  Using these correctly is a little tricky and requires some basic training.  They also use a low-cost probe cover, however, that is where similarity ends.  This style of  thermometer requires the unit be stored and used at a stable ambient temperature of about 70 degrees farenheit or an erroneous reading will likely result.  'Nuff said.

The Temporal (Forehead) Thermometer.  These units work by reading the surface temperature emanating from the forehead.  Like the ear thermometer the instructions on the most popular forehead unit state that they require a stable ambient temperature (60-104 degrees) to operate properly and also should not be used where oxygen is being administered(?).  On the positive side, they do not require a sheath or cover.  On the negative side, they should not be used if the patient is sweating (a common problem where fever is present).

Now that we are familiar with the different types of thermometers let's take a look at what thermometers do for us as EMS providers.  Most EMS call reports ask for patient skin condition (temperature, moisture and color).  Even though the exact temperature may not be required, it could be inserted in the narrative, if necessary.  Most EMT courses teach the manual method of determining skin temp; Cool, Normal or Warm to touch.  Pre-hospital EMS protocols never (as far as we can find) tie BLS treatment to the determination of an absolute temperature, however, there are references to treatment of patients who have, or are suspected of having, an elevated temp.

There are special conditions in EMS (i.e. Rehab at fire scenes, Stand-By at mass gatherings, etc.) where actual temperature measurement may be required.  EMS agencies should evaluate their use of thermometry to determine which type best suits their individual needs.

It is becoming a common occurence to hear "What brand of tape do you sell?"  Our most common response is "Why do you ask?".  Our customer then say "Because the stuff made in Durkastan doesn't stick".   Apparently, in a world where so many products come out of other countries (China?), we succumb to the lure of price over quality.  It seems that in the constant push to reduce our spending, we fall into the trap of buying products that do not work as expected.  Worse yet, the crews using these lower quality items either fail to complain or give up complaining to their supervisors because they don't believe anyone is listening.  This is particularly disturbing when it comes to EMS supplies.  The common occurance of getting tape that just doesn't have the "sticky-ness" of the "Made-in-USA-stuff" is second only to the possibility of getting such things as a BVM that doesn't inflate or gloves that rip way to easily!  Don't let sub-par products have a negative affect on patient care or your safety. We need to realize that using twice as much tape to stabilize a head is not a cost saving manuever and the need to re-glove in the middle of a call is both expensive and puts providers at risk.

In the battle of the Latex vs the Nitrile Glove one basic fact is indisputable.  Latex is inherently stretchy and Nitrile is not.  The debate over which glove is best for EMS will rage on as long as glove-wearing is a universal precaution however, understanding what to look for in a glove will lead to making a smart glove choice.  With latex gloves becoming more expensive and with worries about latex allergies ever-present, it becomes more important to understand the characteristics of Nitrile with respect to glove fit and durability.  As Nitrile does not inherently stretch as easily as latex, gloves made of Nitrile tend to fatigue the hand, especially if the Nitrile is thick.  As Nitrile gets thinner (and easier to stretch) the glove becomes easier to break.  So glove manufacturers will continuously try to find a Nitrile formulation that is both stretchy (thin) and strong, a very tough job to say the least.  As EMS providers we must protect ourselves from disease while wearing gloves that will allow us to do our job.  ALS providers need to start lines while BLS providers immobilize and extricate the same patient.  Is the same glove right for both jobs?  Maybe, however it should not be ruled out that the ALS provider be given a thinner glove for IV starts while a thicker, more durable glove be available for the rigors of BLS.  Ultimately, the right glove for any job in EMS is the one with the strength to stay intact and thereby protect both the patient and caregiver.

Recall Class: Class I

Date Recall Initiated: January 13, 2012

Products:

• Cardiac Science Powerheart, CardioVive, and CardioLife Models of AEDs
• GE Responder and Responder Pro AEDs
• Nihon-Kohden AEDs

Affected Models: Powerheart 9300A, 9300E, 9300P, 9390A, and 9390E; CardioVive 92532, 92533; CardioLife 9200G and 9231; GE Responder and Responder Pro; and Nihon-Kohden AEDs

Go to Serial Number Search to determine if an AED is affected by this recall. Enter one or more serial numbers, located on the back of the AED, in the box provided on the firm’s webpage.

These AEDs were manufactured and distributed from July 1, 2011 through December 30, 2011.

Use: This product is used for emergency treatment of victims showing symptoms of sudden cardiac arrest who are unresponsive and not breathing.

Recalling Firm:
Cardiac Science Corporation
3303 Monte Villa Parkway
Bothell, Washington 98021

Distributors:
GE Healthcare, LLC
3000 N Grandview Blvd
Waukesha, Wisconsin 53118-1615

Nihon Kohden Corporation
1-31-4, Nishiochiai Shinjuku-ku
Tokyo, 161-8560, Japan

Reason for Recall: The affected AEDs contain a component that may fail unexpectedly due to a defect. If the component were to fail during a rescue attempt, the AED may not deliver defibrillation therapy causing serious adverse health consequences, including death. The unit’s self test may not detect the failure or impending failure of the component.

Public Contact: Customers may contact the firm at 1-888-402-2484 (in the U.S.) and +1-425-402-2482 (outside the United States) or by email at aed210@cadiacscience.com.

FDA District: Seattle

FDA Comments: On January 13, 2012, the firm sent all affected customers an URGENT-Voluntary Medical Device Recall letter. The letter describes the product, problem, and actions to be taken by the customers.

Affected customers are advised to contact the firm to arrange for delivery of shipping materials for animmediate return of their AEDs for repair. The affected devices will receive a hardware correction, and the same serial number device will be returned to the customer in most cases. All affected AEDs will be corrected at no charge to the customer.

Customers and distributors can also visit www.cardiacscience.com/aed210 for more information about the AEDs affected by this recall (including Frequently Asked Questions).

Class I recalls are the most serious type of recall and involve situations in which there is a reasonable probability that use of these products will cause serious adverse health consequences or death.

Health care professionals and consumers may report adverse reactions or quality problems they experienced using these products to the MedWatch: The FDA Safety Information and Adverse Event Reporting Programeither online, by regular mail, by telephone, or by FAX.

Additional Information:
Firm Press Release

Many times I will be asked by a service if they should switch from the standard Laryngoscopes they have been using for years to the Fiberoptic Laryngoscopes that are generally perceived as "brighter and better".  Without taking either side, I believe it is time to examine the benefits (or lack thereof) of each type of system to allow that decision to be made on a more intelligent level.

Standard handle and blades ("the old standby") - Used by paramedics who were originally taught with these and continued to use them because of their high reliability and ease of storage and disinfection (?).  These handles usually contain 2 ordinary "C" batteries (small handles contain "AA") and will light any blade that has a working bulb.  The standard blades found in many sets have small incandescant bulbs that put out a yellowish/white light when engaged.  Each blade has its own bulb and can be replaced when it gets dim or stops lighting.  If a blade fails to light because of a bad bulb, a different blade will light from that handle.  (We will save the numerous other blade options that are available for another discussion).    

Fiberoptic handles and blades ("next generation laryngoscopes") - Like their standard counterparts, the Fiberoptic handle also contains 2 appropriate size batteries but unlike the standard handle, the fiberoptic bulb exists at the top of the handle and lights only when the blade comes in contact with, and pushes down on, the bulb housing.  Because the bulb is located within the handle, should the bulb fail to light, NO blades will light until the bulb is replaced. For this reason the need for a second (back-up) handle is critical when using a fiberoptic system.

Stay tuned for a discussion on Disposable vs Reusable laryngoscope blades.

Recently someone asked me about getting Tourniquets for their service to stay compliant with the new protocols set up by New York State Department of Health.  They wanted to know if they could buy the "little stretchy ones" the medics use to start an I.V.  I realized at that point that we have been using the wrong name for these for so long that the concept has been compromised.  These "little stretchy ones" are actually Venous Constricting Bands (VCB) and are only designed to constrict venous return to make a vein easier to catheterize.  The Tourniquets in the new protocols are ARTERIAL constricting tourniquets designed to stop arterial flow.  Even though the names seem trivial, I have to wonder how many EMS agencies may have confused these concepts????

Q: why do all portable suction units crap-out during cardiac arrests?
A: they don't.  They actually failed weeks ago and nobody noticed !!!!.

Something that hospitals learned many years ago is that electronic
equipment require a technician to check and maintain them so they
will work when called upon.  many EMS systems spend endless money
on maintaining their expensive defibrillators and even their stretchers but
don't think twice about their battery-operated suction units.

simple maintenance and battery replacement on a regular schedule can
avoid the trauma of having your suction unit code on your next arrest.

nuff said.

You are driving to a call and find yourself behind a car that will not pull to the right, opposing traffic is heavy so you think " hey, I can just zip by him on the right!". Freeze that thought for a second and think back to Charley Brown, he is all psyched up to kick that football that Lucy is holding and you sit there wanting to yell at him!. You know what is going to happen.....

yep, Charley Brown falls for it again.

Well folks that car is Lucy and if we pass on the right that is the second in time that driver will finally wake up and swerve to the right.

Check out this video to see what I am talking about.

Dashcam_ambulance_crash_getvideo.aspx

Good Grief, just don't pass to the right!!!