Robert Vroman, M.Ed., BS NREMT-P

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EMS1 Daily News

13th body pulled from snow in Everest avalanche

As soon as the avalanche occurred, rescuers, guides and climbers rushed to help, and all other climbing was suspended

Medic cleared of terror threat charge at Texas school

"I'm very truly sorry if I scared or frightened anyone; that was not my intention," medic Ron Miller said

Pet cat attacks Calif. family; 3 taken to hospital

The cat clawed the face of its owner's sister, as well as the arms and legs of its owner's mother; it caused deep gashes on the legs of it's owner's 10-year-old brother

Photos of the Week for April 18, 2014

West, Texas honors 15 killed in 2013 explosion

A moment of silence at 7:51 p.m. marked the exact time of the leveling blast in a town that is recovering but still has a long way to go

Off-duty EMT saves life of fellow softball player — again

Teammate Terry Backman was there to save him, on the same field in the same park, when he collapsed from a heart attack last summer, and again last Sunday

Crash victim applauds medical flight for saving her life

The use of air transport can be controversial, but a 17-year-old survivor says without it, she wouldn't be alive

Man ate pot candy before shooting wife on phone with 911

It was purchased from a legal Denver dispensary; the dispatcher is on paid leave during an investigation into whether officers responded quickly enough

Naked yelling man spits in Pa. medic’s face

The medic was at a hospital on an unrelated call when the man charged from his room screaming obscenities, and spit in his eye

Missing morphine found in Calif. medic's home

Investigators searched her home for a case involving stolen cars, and arrested her for the stolen narcotics
Top

EMS1 Topic Articles

13th body pulled from snow in Everest avalanche

As soon as the avalanche occurred, rescuers, guides and climbers rushed to help, and all other climbing was suspended

Medic cleared of terror threat charge at Texas school

"I'm very truly sorry if I scared or frightened anyone; that was not my intention," medic Ron Miller said

Pet cat attacks Calif. family; 3 taken to hospital

The cat clawed the face of its owner's sister, as well as the arms and legs of its owner's mother; it caused deep gashes on the legs of it's owner's 10-year-old brother

Photos of the Week for April 18, 2014

West, Texas honors 15 killed in 2013 explosion

A moment of silence at 7:51 p.m. marked the exact time of the leveling blast in a town that is recovering but still has a long way to go

Off-duty EMT saves life of fellow softball player — again

Teammate Terry Backman was there to save him, on the same field in the same park, when he collapsed from a heart attack last summer, and again last Sunday

Crash victim applauds medical flight for saving her life

The use of air transport can be controversial, but a 17-year-old survivor says without it, she wouldn't be alive

Man ate pot candy before shooting wife on phone with 911

It was purchased from a legal Denver dispensary; the dispatcher is on paid leave during an investigation into whether officers responded quickly enough

Naked yelling man spits in Pa. medic’s face

The medic was at a hospital on an unrelated call when the man charged from his room screaming obscenities, and spit in his eye

Missing morphine found in Calif. medic's home

Investigators searched her home for a case involving stolen cars, and arrested her for the stolen narcotics
Top

EMS1 Columnist Articles

Inside EMS Podcast: Airway management, how to cope with PTSD and depression

Download this week's episode

​In this week's Inside EMS podcast, hosts Chris Cebollero and Kelly Grayson discuss how emergency medical personnel need to shift their thinking in terms of tactical EMS in light of a recent high school stabbing in Pennsylvania.

They also talk about airway management in the clinical issue segment of the podcast and their thoughts on medics intubating patients in the field.

"We've gotten so far away from what this was really meant to do," Chris said. "We don't spend enough time training it, growing that skill and I think that we allow our ego to get in the way."

Chris and Kelly interview Kyle Norris, public information officer with the Code Green Campaign, in their guest table segment about how to assist responders that suffer from PTSD or depression.

If you have any topics or items you would like to hear discussed on Inside EMS, let us know in the comment section below.

Here are links to some of the articles and other items mentioned on the show:

3 dead, gunman arrested in shootings at Jewish centers

4 students seriously hurt in Pa. school stabbings

10 killed when truck, bus carrying students collide

Witnesses describe panic, fear at scene of fatal Calif. bus crash

2 medics injured in Tenn. ambulance rollover

Medic, parking officer get into fight at convenience store

Emergency dispatchers suffer from symptoms of PTSD, study reveals

The Code Green Campaign

Tactical EMS: An overview

New take on emergency care: Christian hospital using paramedics to reduce 911 calls

How to sell your story in grant applications

When tackling online grant application forms like the one used for American Fire Grants or most foundation grants, it’s easy to get the impression that funding decisions are based on “just the facts, ma'am, just the facts.”

Seemingly endless “fill in the blank” fields can lull you into a false sense of security. You’ve done your job as a grant writer when you’ve checked every box, right"

No matter how tedious the fact gathering and reporting may feel, it goes without saying that it is a crucial step in the process. Your agency’s application may already be scrutinized for eligibility and completeness before it even reaches an official funding decider.

However, getting your application to the top of a committee’s “maybe pile” is determined by your story. How you sell your story will be the deciding factor as to whether your facts are considered at all.

Here’s a general look at how it works:

Step One: The reviewer asks: Why do they want the funding"

Step Two: The reviewer reads your application narratives.

Step Three: The reviewer says: Now that I am persuaded, inspired and/or motivated, let’s see if the agency’s facts support the stated need.

Step Four: The reviewers check your facts and figures to determine whether or not the facts support your persuasive declaration of need.

Step Five: If there’s more than one reviewer, they discuss your agency’s predicament and urgency of your need, and come to a consensus.

Persuasive writing doesn’t tell a grant reviewer how to think about your situation. It paints a picture that helps the reviewer come to his or her own conclusion about your agency’s worthiness to receiving the funding you requested.

How to sell your story

Sell your story the same way a film documentarian presents a concept or idea. Use compelling anecdotes within your grant application narratives. Illustrate the gravity of your need by describing a past EMS call where the funding you’re asking for would have saved time, alleviated patients’ discomfort or prevented an employee’s on-the-job injury.

Help reviewers feel the weather and experience the road conditions of your EMS service area. Then present facts that justify receiving the money by using quotes from letters of support from community leaders.

Include photos and video clips to show your EMS employees in action, along with pictures of the outdated equipment that needs replacing. It boils down to putting a face on the people who will benefit from the new equipment or gear, and distinguish your agency by using third party awards or accreditations to bolster the authenticity of your facts.

Mentioning accreditation from the Commission on the Accreditation of Ambulance Services, state, and regional EMS awards, and community service awards, can favorably position your agency’s contributions and demonstrate your agency’s importance to your community’s health care delivery system.

Don’t think for one moment that grant application reviewers will somehow just look at all your statistics and intuit that your EMS agency is the one most deserving of the precious dollars over which they have control.

While the facts are crucial, you really must sell your story. While the ultimate funding decision rests in your agency presenting valid facts, grant application reviewers will use those facts and figures to justify their personal and subjective opinions about your need.

Reviewers are human, so appeal to their emotions.

How not to incriminate yourself at breaking news scenes

In what can only be described as a horrific confluence of unfortunate timing and rotten luck, two fire engines collided enroute to an emergency call, sending a multi-ton fire truck through a window and into a restaurant full of diners.

Fifteen patients were transported to the local trauma center and other area hospitals; among the injured were six firefighters.

Dozens more EMS personnel from neighboring agencies responded to the chaotic scene and made fast work of rescuing victims and sorting out what had happened. The specific cause of this terrible accident remains under investigation.

When the dust settles, I am sure there will be lessons learned followed by steps taken to prevent similar incidences. We must learn from tragedy to become better.

However, there are vital teachings we can take away immediately.

Later down the road the excitement and drama will fade and lawsuits by those in desperate need to find fault — and recompense — will likely just be coming to life. An army of investigators will leave no stone unturned for any trace of evidence, so make sure you’re not in the spotlight.

Here are three things that every EMS provider should remember and follow in the wake of such critical events:

1. Stay off your phone

Who called whom and what did they say" You have incriminated yourself or someone else. The person you called easily just became a witness too. The same holds true for text messaging.

2. Don’t take pictures

Don’t take out your phone to snap photos, either. It may be a spectacular shot, but taking pictures potentially violates confidentiality laws, and taking or sharing images from the scene and possibly compromises the investigation.

3. Remain silent

Do not speak about any aspect of the incident with reporters, civilians, or anyone else who is not directly part of the crew on the scene. After the fact, do not speak to anyone who is not a superior officer of your agency assigned to manage one or more aspects of the incident. Everything you say can be used against you or misconstrued against the truth.

The closer you are to the epicenter of the incident, the more vital — and precious — your right to remain silent and your right to counsel.

With a full understanding of the critical nature of the investigation, and an absolute willingness to cooperate with it, do not speak with law enforcement investigators until after you have consulted with an attorney who can quickly assess your criminal liability exposure and advise you accordingly. It’s a good idea to have such an attorney on standby who can respond to the scene for just such incidents.

Of course, more often than not, the facts will bear out that there is no actual or probable criminal liability for you.

However, you do not want to be the one who forfeited the right to silence and lost everything because your description of events was "misinterpreted."

What Billy Joel taught me about EMS career satisfaction

During high school and college, I worked at several radio stations and was lucky enough to interview several famous musicians. One was the Piano Man himself, Billy Joel.

He shared some advice that some 20-plus years later still resonates with me: “Figure out what you’re good at, and do that. Otherwise, you’re just wasting your time.”

That memory was recently triggered by a phone call from a peer that I highly respect seeking some advice.

About a year ago he quit his job at a TV news station after feeling burned-out. He launched a new business, which is doing well. But he admitted he was considering returning to his former career because he missed the passion he used to have for his work.

Good vs. passionate

It got me thinking. Being good at something isn’t the same as being passionate about it.

In EMS, there are many ways we can incorporate our passion into our day job.

If you care about animals, find a way to fund pet oxygen masks for the ambulances in your department.

If drunk driving, a medical condition like a stroke, or a disease a family member suffers from are important to you, sell media on stories that connect your profession with your passion – your pitch will be that much more compelling.

EMS touches on many different issues, and our role as public relations professionals is to recognize the passion within ourselves, our organization and our peers.

Then, we need to tell those human interest stories to create memorable images and positive public awareness for our companies.

A lesson from finance

Here’s an example. A financial advisor I know had a passion to ensure that his personal investments were not “terror-infested.”

No mutual fund existed that screened out U.S. companies operating in terror nations like Iran, Syria and North Korea — so he created his own. He combined his talent with his passion. It’s not easy, but it’s fulfilling and personally rewarding.

So to update Billy Joel’s quote, “Figure out what you’re good at and passionate about, and do that. Otherwise, you’re just wasting your time.”

Failure to change is the root of DCFEMS problems

The DCFEMS chief can’t seem to catch a break. Every attempt Chief Ken Ellerbe has made to revamp the department’s operation to better respond to the community’s needs has been met with resistance — and at times, total disdain.

His latest proposal to shut down a neighborhood fire station to increase on-duty medics during peak call times is no exception.

Yet, given a rancorous relation with labor and an ever-increasing distrustful city council, it’s not very likely that such a Band-Aid gesture would even make much of a difference for the department.

It continues to suffer from poor performance and poor public perception.

Kicking cans down the road

On one hand I can’t lay all of the blame on the current chief. He inherited decades of a poorly managed public safety organization, with each prior chief kicking a bunch of proverbial cans down the road.

It points to the greater issue of not having a plan.

The department’s own civil committee released a report in 2013 that said as much. It determined there was no coherent, logical approach to staffing an appropriate level of EMS resources by the department. It seemed leadership at the time didn’t even know how many ambulances could be available on any given day.

But even this report doesn’t capture the full extent of the issue.

Like many large urban EMS departments, DCFEMS has not evolved since the 1970s. Revised construction codes and enforcement has led to fewer fires over the past 40 years, but staffing levels have not dropped in response.

At the same time, the demand for EMS has risen due to changing demographics, an aging population and poorly distributed health care availability. Add in the mind-numbing intricacies of reimbursement and the medical-legal environment and you have a situation that would be difficult for any department to adapt to.

It’s about mindset

But many fire departments have done just that, managing to incorporate the evolving needs of their communities, while maintaining operational effectiveness for existing ones.

What they have in common is a long-term strategic mindset that looks at needs not just in one year, but three, five or 10 years down the road. They consider the financial, operational and cultural barriers to overcome, as well as who needs to be involved in the planning.

In many ways DCFEMS is the case study for how a department fails in the face of change. Without leadership and vision from all levels of the organization, it’s not likely things will improve anytime soon.

How do paramedics get over the guilt of failed rescue after patients pass away?

I've been an EMT for nearly 10 years and I have unfortunately had people die in my arms, but the answer to your question greatly depends on the situation.

For example an 80-year-old person who has a heart attack and dies generally does not affect a professional EMT or Paramedic as its the natural course of life. Yes we would like to save all of our patients, but sometimes its just not possible and elderly deaths are just part of the job.

On the other hand if I lose a young person it can be very difficult to get over.

While most people in Emergency Services have "seen it all" anybody who has a young person die in their ambulance is usually affected by it ... sometimes deeply. To get over it we talk to our crewmates and sometimes to professional counselors, depending on the severity of the call. Personally, when I lose a young patient I tend to hug my wife and kids a little more than normal, but it can take me months to stop thinking about those failed rescues.

5 errors that are giving you incorrect blood pressure readings

Controversy erupted this year when revised guidelines increased thresholds for diagnosing and treating hypertension[1].

Nurses and physicians often argue over differences between arterial line and non-invasive blood pressure (NIBP) cuff readings. To make the best use of blood pressure monitoring equipment, it is helpful to have an insight into how the equipment works and the likely sources of error that can affect readings.

Here’s what many of us do wrong when taking BP, and how to get it right:

1. You’re using the wrong-sized cuff

The most common error when using indirect blood pressure measuring equipment is using an incorrectly sized cuff. A BP cuff that is too large will give falsely low readings, while an overly small cuff will provide readings that are falsely high. The American Heart Association (AHA) publishes guidelines for blood pressure measurement,[2] recommending that the bladder length and width (the inflatable portion of the cuff) should be 80 percent and 40 percent respectively, of arm circumference. Most practitioners find measuring bladder and arm circumference to be overly time consuming, so they don’t do it.

The most practical way to quickly and properly size a BP cuff is to pick a cuff that covers two-thirds of the distance between your patient’s elbow and shoulder. Carrying at least three cuff sizes (large adult, regular adult, and pediatric) will fit the majority of the adult population. Multiple smaller sizes are needed if you frequently treat pediatric patients.

Korotkoff sounds are the noises heard through a stethoscope during cuff deflation. They occur in 5 phases:

  • I – first detectable sounds, corresponding to appearance of a palpable pulse
  • II – sounds become softer, longer and may occasionally transiently disappear
  • III – change in sounds to a thumping quality (loudest)
  • IV – pitch intensity changes and sounds become muffled
  • V – sounds disappear

In their 1967 guidelines, the AHA recommended that clinicians record the systolic BP at the start of phase I and the diastolic BP at start of phase IV Korotkoff sounds. In their 1981 guidelines, the diastolic BP recommendation changed to the start of phase V, a standard that remains in the most recent (2005) recommendations2.

2. You’ve incorrectly positioned your patient’s body

The second most common error in BP measurement is incorrect limb position. To accurately assess blood flow in an extremity, influences of gravity must be eliminated.

The standard reference level for measurement of blood pressure by any technique (direct or indirect) is at the level of the heart. When using a cuff, the arm (or leg) where the cuff is applied must be at mid-heart level. Measuring BP in an extremity positioned above heart level will provide a falsely low BP whereas falsely high readings will be obtained whenever a limb is positioned below heart level. Errors can be significant — typically 2 mmHg for each inch the extremity is above or below heart level.

A seated upright position provides the most accurate blood pressure, as long as the arm in which the pressure is taken remains at the patient’s side. Patients lying on their side, or in other positions, can pose problems for accurate pressure measurement. To correctly assess BP in a side lying patient, hold the BP cuff extremity at mid heart level while taking the pressure. In seated patients, be certain to leave the arm at the patient’s side.

Arterial pressure transducers are subject to similar inaccuracies when the transducer is not positioned at mid-heart level. This location, referred to as the phlebostatic axis, is located at the intersection of the fourth intercostal space and mid-chest level (halfway between the anterior and posterior chest surfaces.

Note that the mid-axillary line is often not at mid-chest level in patients with kyphosis or COPD, and therefore should not be used as a landmark. Incorrect leveling is the primary source of error in direct pressure measurement with each inch the transducer is misleveled causing a 1.86 mmHg measurement error. When above the phlebostatic axis, reported values will be lower than actual; when below the phlebostatic axis, reported values will be higher than actual.

3. You’ve placed the cuff incorrectly

The standard for blood pressure cuff placement is the upper arm using a cuff on bare skin with a stethoscope placed at the elbow fold over the brachial artery.

The patient should be sitting, with the arm supported at mid heart level, legs uncrossed, and not talking. Measurements can be made at other locations such as the wrist, fingers, feet, and calves but will produce varied readings depending on distance from the heart.

The mean pressure, interestingly, varies little between the aorta and peripheral arteries, while the systolic pressure increases and the diastolic decreases in the more distal vessels.

Crossing the legs increases systolic blood pressure by 2 to 8 mmHg. About 20 percent of the population has differences of more than 10 mmHg pressure between the right and left arms. In cases where significant differences are observed, treatment decisions should be based on the higher of the two pressures.

4. Your readings exhibit ‘prejudice’

Prejudice for normal readings significantly contributes to inaccuracies in blood pressure measurement. No doubt, you’d be suspicious if a fellow EMT reported blood pressures of 120/80 on three patients in a row. As creatures of habit, human beings expect to hear sounds at certain times and when extraneous interference makes a blood pressure difficult to obtain, there is considerable tendency to “hear” a normal blood pressure.

Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mmHg or more, or diastolic blood pressure decrease of 10 mmHg or more measured after three minutes of standing quietly.

There are circumstances when BP measurement is simply not possible. For many years, trauma resuscitation guidelines taught that rough estimates of systolic BP (SBP) could be made by assessing pulses. Presence of a radial pulse was thought to correlate with an SBP of at least 80 mmHg, a femoral pulse with an SBP of at least 70, and a palpable carotid pulse with an SBP over 60. In recent years, vascular surgery and trauma studies have shown this method to be poorly predictive of actual blood pressure[3].

Noise is a factor that can also interfere with BP measurement. Many ALS units carry doppler units that measure blood flow with ultrasound waves. Doppler units amplify sound and are useful in high noise environments.

BP by palpation or obtaining the systolic value by palpating a distal pulse while deflating the blood pressure cuff generally comes within 10 – 20 mmHg of an auscultated reading. A pulse oximeter waveform can also be used to measure return of blood flow while deflating a BP cuff, and is as accurate as pressures obtained by palpation.

In patients with circulatory assist devices that produce non-pulsatile flow such as left ventricular assist devices (LVADs), the only indirect means of measuring flow requires use of a doppler.

The return of flow signals over the brachial artery during deflation of a blood pressure cuff in an LVAD patient signifies the mean arterial pressure (MAP). While a normal MAP in adults ranges from 70 to 105 mmHg, LVADs do not function optimally against higher afterload, so mean pressures of less than 90 are often desirable.

Clothing, patient access, and cuff size are obstacles that frequently interfere with conventional BP measurement. Consider using alternate sites such as placing the BP cuff on your patient’s lower arm above the wrist while auscultating or palpating their radial artery. This is particularly useful in bariatric patients when an appropriately sized cuff is not available for the upper arm. The thigh or lower leg can be used in a similar fashion (in conjunction with a pulse point distal to the cuff).

All of these locations are routinely used to monitor BP in hospital settings and generally provide results only slightly different from traditional measurements in the upper arm.

5. You’re not factoring in electronic units correctly

Electronic blood pressure units also called Non Invasive Blood Pressure (NIBP) machines, sense air pressure changes in the cuff caused by blood flowing through the BP cuff extremity. Sensors estimate the Mean Arterial Pressure (MAP) and the patient’s pulse rate. Software in the machine uses these two values to calculate the systolic and diastolic BP.

To assure accuracy from electronic units, it is important to verify the displayed pulse with an actual patient pulse. Differences of more than 10 percent will seriously alter the unit’s calculations and produce incorrect systolic and diastolic values on the display screen.

Given that MAP is the only pressure actually measured by an NIBP, and since MAP varies little throughout the body, it makes sense to use this number for treatment decisions.

A normal adult MAP ranges from 70 to 105 mmHg. As the organ most sensitive to pressure, the kidneys typically require an MAP above 60 to stay alive, and sustain irreversible damage beyond 20 minutes below that in most adults. Because individual requirements vary, most clinicians consider a MAP of 70 as a reasonable lower limit for their adult patients.

Increased use of NIBP devices, coupled with recognition that their displayed systolic and diastolic values are calculated while only the mean is actually measured, have led clinicians to pay much more attention to MAPs than in the past. Many progressive hospitals order sets and prehospital BLS and ALS protocols have begun to treat MAPs rather than systolic blood pressures.

Finally, and especially in the critical care transport environment, providers will encounter patients with significant variations between NIBP (indirect) and arterial line (direct) measured blood pressure values.

In the past, depending on patient condition, providers have elected to use one measuring device over another, often without clear rationale besides a belief that the selected device was providing more accurate blood pressure information.

In 2013, a group of ICU researchers published an analysis of 27,022 simultaneous art line and NIBP measurements obtained in 852 patients[4]. When comparing the a-line and NIBP readings, the researchers were able to determine that, in hypotensive states, the NIBP significant overestimated the systolic blood pressure when compared to the arterial line, and this difference increased as patients became more hypotensive.

At the same time, the mean arterial pressures (MAPs) consistently correlated between the a-line and NIBP devices, regardless of pressure. The authors suggested that MAP is the most accurate value to trend and treat, regardless of whether BP is being measured with an arterial line or an NIBP. Additionally, supporting previously believed parameters for acute kidney injury (AKI) and mortality, the authors noted that a MAP below 60 mmHg was consistently associated with both AKI and increased mortality.

Since 1930, blood pressure measurement has been a widely accepted tool for cardiovascular assessment. Even under the often adverse conditions encountered in the prehospital or transport environment, providers can accurately measure blood pressure if they understand the principles of blood flow and common sources that introduce error into the measurement process.

References:

1. James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. (Available at: http://jama.jamanetwork.com/article.aspx"articleid=1791497)

2. Pickering TG, Hall JE, Appel LJ, et al. AHA Scientific Statement: Recommendations for blood pressure measurement in humans and experimental animals, part 1: blood pressure measurement in humans. Hypertension. 2005; 45: 142-161. (Available at: https://hyper.ahajournals.org/content/45/1/142.full)

3. Deakin CD, Low JL. Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study. BMJ. 2000; 321(7262): 673–674. (Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27481/)

4. Lehman LH, Saeed M, Talmor D, Mark R, Malhotra A. Methods of blood pressure measurement in the ICU. Crit Care Med. 2013;41:34-40.

Why your EMS action film is recruiting the wrong people

We’ve all seen it, and most of us have felt it: Job fatigue, burnout, stress — whatever we want to call it.

We have witnessed it in colleagues, friends, bosses, and sometimes in ourselves: EMTs who once loved their jobs complaining every time dispatch sends them on another run. Firefighters angry to be on the scene of another “BS” call. Paramedics who think BLS care is below them.

At the Pinnacle EMS conference last summer, former Toronto EMS Deputy Chief Alan Craig spoke about “compassion fatigue.” He emphasized the need to be aware of compassion fatigue, its signs and symptoms, and how to cope with it. He also said we must teach compassion, not take it for granted. These are all important skills for any EMS leader. But what stood out was Chief Craig’s discussion of matching expectations with reality for new members of our profession.

Look at the EMS and fire department recruiting videos on YouTube. Think about the brochures you’ve sent in the mail, the posters you’ve seen displayed at conferences, and the pitches that your recruiters give to potential employees.

EMS expectations vs. reality

Do those videos show EMTs getting up in the middle of the night for a patient whose stomach hurts" Do they show paramedics feeding someone’s dog, helping a woman back into bed, or contacting social services to arrange extra help for an elderly man who can’t take care of himself"

Chances are they don’t. Like departments where I have worked and volunteered, your videos probably have fast-paced rock music in the background, footage of ambulances racing through the night with lights and sirens, and videos of technical rescues, tactical medics, and raging fires.

Your recruiting pitch probably includes phrases like “Every day our paramedics save lives” and “Thousands of times each year, people call on us when a life is on the line.”

Fire-based EMS agencies are probably guiltier than others — how many fire departments have recruiting materials that spend more time or space showing fires and swift water rescues than EMS care" Even when EMS is portrayed, the patient is often lying on a backboard with a crushed car nearby, or paramedics are intubating and performing CPR.

Next time an EMS provider you know complains about running a 911 call that is not a life-threatening emergency, think about how we have set him up to fail — before you chastise him. Did he grow up watching Emergency!, like so many of my mentors did, and expect every call for help to be a life or death situation" Did he watch videos on YouTube, like so many of my contemporaries did, and expect every day to be filled with cardiac arrests, vehicle entrapments, and house fires" Or did he listen to our recruiting pitches, like so many of our newest candidates, and expect to be performing RSI and responding to active shooter events during their first shifts"

EMS and the fire service should not stop telling potential employees and volunteers that our profession is exciting, or that they’ll have the chance to save lives. But we also need to align their expectations with reality to ensure that we attract the right people.

Tell applicants that we impact people’s lives every day, sometimes by pulling them from burning cars or defibrillating them, but more often simply by holding their hands, listening to their stories, or reassuring them that everything will be okay.

Until we match expectations to reality, we only have ourselves to blame when our newest volunteer or our veteran employee spends more time complaining about their job than they spend actually doing it.

First-aid training: An opportunity to educate the public about EMS

By Allison G. S. Knox, American Military University
InPublicSafety.com

Throughout the United States, many individuals receive first aid training so they know how to handle very basic emergencies. It is beneficial, for example, that the average person understands how to effectively manage significant bleeding from an injury or provide assistance during cardiac arrest. Ultimately, very basic first aid skills can save lives and allow an individual to render care while waiting for trained medical personnel to arrive.

First aid classes are extremely beneficial for training the public about emergency care. In addition to such training, it is also important for first aid and CPR instructors to take the opportunity to explain the overall structure of Emergency Medical Services (EMS) and the emergency system as a whole to these students.

EMS is, unfortunately, a widely misunderstood system. Many ambulance companies and jurisdictions have numerous issues with individuals calling 9-1-1 for non-emergent calls. This happens on a regular basis because most individuals in local towns and cities do not have a strong grasp of the specifics of EMS. First aid courses are a great time for instructors to highlight the overall hierarchical structure of EMS and explain how protocols affect EMS in various jurisdictions.

Read full story: First Aid Training: An Opportunity to Educate the Public about EMS

Military tech becomes integrated critical care system

At the EMS State of the Sciences Conferences held in Dallas, Texas, a new technology on display caught my eye. It is a joint collaboration between Impact Instrumentation and Bio-Nexus, supported by a grant from the Office of Naval Research, to develop an integrated critical care system (ICCS). This partnership has stunning potential and means new applications in the civilian sector are coming soon.

Bio-Nexus is a nearly four-year-old software company with the mission of designing a mobile workflow engine, dubbed the E.L.A.D. System, to securely transfer mission-critical data in a mobile environment. The company has integrated their sophisticated software with a heads-up display and a headset as well as a portable wireless computer.

The initial focus of the E.L.A.D. System was on military use. The system was designed to save wounded soldiers on the battlefield by guiding a paramedic’s actions in emergency conditions, proving situational pictures for paramedical staff, reporting the status of the injured and more.

What makes it innovating is that the ICCS software now supports applications run over the E.L.A.D. ICCS provides physiologic monitoring and life support of critically ill or injured patients using an interface software that monitors the patient and controls devices in the field. It also provides real-time guidance on what type of actions need to be taken based on clinical practice guidelines.

Imagine being able to control and monitor critical-care equipment without interrupting patient care. The Bio-Nexus E.L.A.D system can do just that.

This is not a fancy Google Glass. This is a U.S.-based company building the military-grade hardware and medical software of tomorrow — a company that has created durable, functional medical devices for at least three decades.

The system has speech recognition for hands-free capabilities as well as interactive menus on the display. This facilitates adherence to protocols and rapid documentation. The system also offers hands-free voice recognition algorithms and displays. It works with vital signs monitors, IV Pumps and Impact’s 731 Series Ventilators (AEV® and EMV+®).

In the field, the system will let a paramedic monitor and control medical devices while documenting every change and treatment. This was demonstrated at the conference where the company showed how fast and easy it was to change ventilator settings while monitoring critical parameters and documenting patient care.

Technologies like those from ICCS and Impact also create a road to widespread adoption of electronic medical record systems as all information can be shared in real time or downloaded for later access. At the same time, the ICCS software provides secure communications at the bedside and remotely.

ICCS technology also meets commercial and military medical transport standards and facilitates rapid workflow processing in the field.

The partnership will provide an end-to-end digital medical platform and create a pathway to a full EMR. More importantly, it will streamline patient care.

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EMS1 Tips

Active shooter response: Are you physically ready?

Normally, I am strong believer that paramedics are at their best when they saunter into a scene, slowly walking and looking for clues and risks. But an active shooter incident is going to require repetitive bursts of significant physical activity.

Energy-saving tips for your station

Earth Day 2012 takes place this Sunday, with events planned held worldwide to increase awareness and appreciation of the Earth's natural environment. So, it's a good time to see what you can do at your agency to save both resources and money.

How this video can "Keep Yourself Safe"

Consider using this PPE safety video in your EMT Basic or Refresher Class.

CPR class instruction: 5 ways to make it great

My most recent healthcare provider recertification was memorable for all of the things the instructors did well.

Patient assessments: How to avoid free-for-alls

Substantial cajoling and adult guidance from mom in a Santa hat was required to initiate an orderly process of taking turns, appreciating a gift after it was opened, and taking occasional pauses for a meal or to welcome additional relatives.

Patient assessment: A non-linear process

On a skill sheet, patient assessment is presented as a linear process: First size up the scene, then complete the primary assessment followed by the secondary assessment.

Blood pressure reading tips and tricks for EMS

One of the things I'm most often asked by students and rookie EMTs is, "Kelly, how am I supposed to hear a blood pressure in the back of the rig?"

How to use Slideshare for EMS

Slideshare is an online community and tool for sharing presentations.

How to get optimal battery life from your devices

The batteries in your wireless cell phone, tablet or laptop are probably not the same old Duracells you used in your childhood walky-talkies.

U-turn for the OB patient

If you have an OB patient about to deliver, do a U-Turn and put the patient backwards on the gurney. By placing their head at the "foot" of the gurney, this allows you to work out of the captain's chair and gives you more room. The hardest part of doing this is getting your partner to place the patient in this position. Old habits are hard to break and it may feel odd, but once in the truck ...
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