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

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EMS1 Daily News

Rapid Response: Medics stealing narcotics happens with distressing regularity

Narcotic theft, often by the people entrusted to secure and administer those drugs, is damaging to providers, agencies and communities

Spotlight: Binder Lift found a safer, simpler, easier way to lift patients

Company Name: Binder Lift Signature Product: The Binder Lift Original Website: Intro: The Binder Lift attaches 19-25 handles to the patient’s torso for caregivers to grasp when providing lift assistance. These handles enable caregivers to team lift while using proper lifting ergonomics. The first Binder Lift was first created by Dan Binder to prevent his wife’s back ...

Missing paramedic found dead at NM hiking location

Bryan Conkling, 40, was found in a steep rocky area a quarter-mile from the La Luz Trail three days after being reported missing

Calif. EMS educator run over by her own car

Phylicia Hassapis, 49, died trying to stop her car from rolling down her driveway

School casualty kits might expand nationwide

More than 3,000 school personnel have been trained on simple techniques that will stop a person from bleeding to death before EMTs arrive

India ambulance workers fight with swords for transport

One of the men was seriously injured in the swordfight over the job to drive a deceased person to another city

Ambulance Design: What needs to be fixed or added?

EMS1 LinkedIn members suggest safety and comfort improvements to the patient care and driver compartments, ambulance exterior and more

Woman charged in heroin death of 14-month-old daughter

The child ingested a lethal dose of heroin and fentanyl after the mother brought her with her to a drug house

No ambulance, D.C. fire engine transports dying infant

Paramedics began transporting a critically ill 5-month-old aboard the engine because an ambulance was unavailable; the boy did not survive

Bolt falls from NFL stadium roof, 3 fans injured

Just before half time of the Indianapolis Colts game at Lucas Oil Field a bolt sheared and fell from the retractable roof

EMS1 Topic Articles

How to be the best EMS professional you can be

Conference presentation to define tenants of professionalism and its need in the dynamic world of EMS

Rapid Response: Medics stealing narcotics happens with distressing regularity

Narcotic theft, often by the people entrusted to secure and administer those drugs, is damaging to providers, agencies and communities

Missing paramedic found dead at NM hiking location

Bryan Conkling, 40, was found in a steep rocky area a quarter-mile from the La Luz Trail three days after being reported missing

Calif. EMS educator run over by her own car

Phylicia Hassapis, 49, died trying to stop her car from rolling down her driveway

School casualty kits might expand nationwide

More than 3,000 school personnel have been trained on simple techniques that will stop a person from bleeding to death before EMTs arrive

India ambulance workers fight with swords for transport

One of the men was seriously injured in the swordfight over the job to drive a deceased person to another city

Ambulance Design: What needs to be fixed or added?

EMS1 LinkedIn members suggest safety and comfort improvements to the patient care and driver compartments, ambulance exterior and more

Woman charged in heroin death of 14-month-old daughter

The child ingested a lethal dose of heroin and fentanyl after the mother brought her with her to a drug house

No ambulance, D.C. fire engine transports dying infant

Paramedics began transporting a critically ill 5-month-old aboard the engine because an ambulance was unavailable; the boy did not survive

Bolt falls from NFL stadium roof, 3 fans injured

Just before half time of the Indianapolis Colts game at Lucas Oil Field a bolt sheared and fell from the retractable roof

EMS1 Columnist Articles

Rapid Response: Medics stealing narcotics happens with distressing regularity

What Happened: We regularly share news about medics caught stealing narcotics from their agency, patients, hospitals or other facilities that store and distribute narcotics. This week was no different, with two separate incidents.

In Missouri an EMT and a casino security guard were caught on film removing hydrocodone from a locked cabinet in the casino's EMT room. A Florida medic was charged with multiple counts of theft and possession for removing fentanyl, presumably from vials, and replacing it with an unknown liquid. It is not clear from the reporting if the vials had already been opened for administration to patients and the medic was stealing the remainder or if the vials were put back into stock for potential administration to patients.

Why it’s Significant: Reports of narcotics theft are damaging on many levels. First, the career, livelihood and future ambitions of these medics have been destroyed by their theft, presumably driven by an addiction.

Second, the alleged thefts erode the public's trust. EMS providers enter the homes of the sick and injured. For EMS to succeed, the citizens we serve need to trust us to enter their private spaces and potentially have access to their most treasured belongings and valuables .

Third, systems for securing narcotics are vulnerable to an addict who is willing to take great risk to obtain something of great value. The ubiquity of cameras in a casino should be well understood by an EMT and a security guard in that workplace.

Top Takeaways: Anywhere there is the administration and storage of narcotics the risk of theft is significant. We may worry about the unknown criminal breaking and entering to obtain narcotics or a thief lifting a med bag from the ambulance while a crew is on scene, but the real risk is from the people entrusted with those drugs.

These are my top takeaways about the most recent news of medics caught stealing narcotics:

1. Control, limit and monitor access to narcotics

The safeguards that are currently in place – locked cabinets, two-person access, tamper-proof containers – are not adequate to the risk medics are willing to take to access narcotics.

2. Act on your hunches and suspicions

When a drug-diversion is exposed and reported there are almost always co-workers that come forward to say they were suspicious, had a hunch or saw some clues that something was amiss with their now arrested and terminated co-worker. Workplaces need to have systems to report suspicions, but in a way that does not lead to reprisal if the suspicions turn out to be unfounded. But when something seems to be amiss it is almost always amiss. Trust your instincts.

3. Make it safe to acknowledge and treat the addiction

A medic is likely to be praised if they share in the day room that they are entering a tobacco cessation program or attending "meetings" about drinking. But if that medic were to report they are getting help for their narcotics addiction they would likely be put on the fast-path to suspension and termination. For treatments and interventions to succeed through employee-assistance programs medics need to be safe to access those programs without fear of reprisal.

What’s Next: How do medics become addicts"

I want to understand what is leading medics to become addicted to narcotics. I read news that some narcotics addicts were healthy and employed professionals before an illness or injury. And when the pain pills are cut off or no longer available those addicts turn to theft or illegal narcotics, like heroin, to satiate their addiction.

I also, like many of you, know medics that are off the job because of back injuries from patient lifting and movement. We have an obligation to help prevent lifting-related injuries and to see our colleagues through appropriate treatment, which may include narcotic pain management, and to a successful return to work.

Is there a clear line that can be drawn from a lifting-related back injury to narcotics theft" I don't know, but it sure would be worth investigating because if we can prevent the back injury we might also be preventing a cascade of other terrible outcomes for our providers, our agencies and the patients we serve.

Further Reading :

Why EMS managers must plan for narcotic thefts

Police: Ambulance employee stole prescription pads to buy drugs

Inside EMS Podcast: The 5 food evils

Download this week's episode on iTunes , SoundCloud or via RSS feed

In this week's Inside EMS podcast, hosts Chris Cebollero and Kelly Grayson take a seat at The Guest Table with Fit Responder President Bryan Fass to discuss nutrition.

Fass talks about the five food evils; foods that have no nutritional value and actually cause us harm. These foods, according to Fass, should be erased from our diets.

"Food should heal, not harm," Fass says.

The first food evil is white bread.

"We, as Americans, are addicted to sugar," Fass says. "We have been programmed by society to do that." And white bread gives us the sugar rush we crave.

Can you guess what the other food evils are"

The good news is that all of them can be easily substituted with similar foods.

Cebollero, Grayson and Fass also talk about snacks. What are the best snacks you can find at a convenience store"

When you are working a night shift, your food choices might be limited. Convenience stores are not the best places to find healthy food, but sometimes they are the only option.

"There’s a whole convenience-store diet," Fass says. "If it’s in a bag, it has to have oils and sugar and stabilizers, which are all chemical-based."

Fass recommends bringing your own food, but when you can’t, avoid candy and try to find unprocessed nuts and seeds or granola bars.

"That’s the challenge with the convenience-store diet," Fass says. "If you don’t bring it with you, you are forced to make the best of the bad decisions."

What snacks do you eat during your shifts"

What will fix an EMS system under stress?

An EMS system is a living, breathing organization. When it flourishes, great things happen. When it is under stress, the organization will attempt to accommodate and adjust, but at some point compensatory mechanisms fail and things begin to fall apart.

What’s happening at Austin-Travis County EMS can happen anywhere. This high performance system is experiencing small, but significant changes and issues of high turnover, mandatory holdovers and worsening morale.

An agency experiencing these issues has to tackle it head on. Both management and labor leadership must set aside daily differences to focus on immediate solutions that control the bleeding, followed by long-term plans that identify the core issues of subpar staffing and creating solutions that address them on a more permanent basis.

No two situations are alike

Local workforce availability, regulatory issues, political concerns, labor-management relations, and competition are factors in recruiting, hiring and retaining personnel. An EMS agency has to take the time to deeply investigate root causes and resolve those in order to achieve long lasting changes in staffing.

Sadly, most agencies tend to look only at the superficial issues and throw short-term solutions at them. Salary might attract folks to an organization, but its workplace satisfaction that keeps them there, year after year.

I’ll bet many of you, like me, remember working for organizations because we were treated like family or felt like we were valued and heard. We felt like we contributed, not only to our agency’s bottom line, but to our community. When that feeling of contributing to the community goes away there’s not much left that will keep us around.

Solutions are not always resource intensive. Sometimes a change in structure or culture is what’s needed to bring an organization back to its fighting weight. It just takes a little courage for its leaders to make those changes.

5 reasons you should NOT become an EMT

For a job with typically long hours and relatively low pay, you rarely hear about EMS agencies having a shortage of willing applicants. In fact, some might argue that the seemingly endless supply of young, eager EMTs is part of what fuels the low wages and long hours that are often endemic to our job.

The EMS workforce is an interesting bunch. We attract our share of smart, dedicated individuals who are looking to start a career in emergency services or elsewhere in medicine.

We also tend to attract our share of disenchanted nay-sayers. Newly certified EMT’s who quickly transition from wide-eyed newbies to jaded do-nothings, punching the time clock and sleeping through the minimum continuing education requirements.

There are good reasons to enter the EMS workforce and there are some really bad reasons. How can you tell if you are on the road to a long and successful EMS career or on a short trip to frustration and burnout"

Are you trying to decide if a career in EMS is right for you" Here are five perfectly good reasons to NOT become an EMT.

1. You think you’ll look good in the uniform

Some folks get caught up in the image of being an EMT. They can often be spotted by the medical supplies that adorn their uniform belts and the stickers on the backs of their cars. Do you like the idea of being an EMT more than you like the work of being an EMT"

The job of an EMT isn’t about being something. It’s about doing something. An EMT’s work is about service to individuals in need. EMTs who are most successful have an outward focus, not in inward focus.

Doing the work of an EMT often requires a great deal of humility. We often serve people who are angry, drunk and violent. We serve in all kinds of places, at all times of the day and night, when we’re tired, frustrated, and hungry. Regardless of the circumstances, we kneel in front of the patient and ask how we can serve.

When you imagine the job of an EMT, make sure you are focusing on doing the work of an EMT, more than you are focused on being an EMT.

2. You met an EMT at a party and he had the best stories

War stories can be fun. The best war stories give people a unique perspective into the often bizarre world in which we live and work. Sharing the worst war stories is disrespectful to our patients and unprofessional. If we’re not careful, they can even become illegal disclosures of our patients’ private health information.

Understand that war stories often represent the most interesting few minutes of an individual’s career. When we tell our stories, we select the most entertaining and unusual things that we’ve encountered, often giving the impression that our job is filled with non-stop hilarity and adventure.

In truth, our job can be mundane and routine. Nobody ever tells a war story about taking a nursing home patient to a dialysis treatment or waking up at 2 a.m. to help a drunken person vomit into a bucket or help someone’s grandmother back into bed.

The bulk of our duties aren’t exciting or entertaining. They are, however, deeply meaningful to the people whom we serve. If you don’t find meaning in mundane acts of service, this work might not be for you.

3. You want to drive fast

Hollywood movies and TV shows love to portray EMS personnel racing to the scene of an emergency. Our TV counterparts are prone to squealing tires and white-knuckle cornering on their way to scripted emergencies.

Driving an emergency vehicle with lights and sirens operating is quite a bit less thrilling than the big screen makes it seem. Real emergency vehicles are only allowed to exceed the speed limit in specific circumstances and always with due regard for the safety of others.

Emergency vehicle operators are never allowed to demand the right of way or drive in a manner that requires others to act ideally by moving to the right, not pulling into the intersection, and leaving room for us to turn right or left. If EMS personnel do get into an accident with lights and sirens running, they are almost always at fault.

EMTs also learn that the few seconds saved by driving fast are rarely, if ever, meaningful to the patient’s outcome, but the consequences of a single bad decision while driving emergent can ruin a whole career.

4. You think 16 weeks of school is better than four years of college

EMT certification is significantly shorter than the training required for most other jobs in the healthcare industry, making it a popular entry-level position for a variety of medical jobs. But that doesn’t mean that EMT training is a cake walk. Many EMT students quickly realize that they are required to comprehend and retain a larger volume of information than they have been exposed to in the past and they’re required to learn it in a faster time frame than they had imagined.

Everything being taught in EMT certification is in the 'essential' category and there are no trophies for participation. You learn the information and skills or you don’t pass the certification tests. Many students have to repeat the class two or three times before achieving a passing grade.

EMT training also isn’t over when class is over. Being a good EMT requires a greater discipline for self-directed learning than most jobs in medicine. Your EMT class will give you the bare minimum of knowledge to help you understand the many injuries and illnesses you’ll encounter. The rest of the learning will be up to you and it never ends. If you’re going to be good, you’ll want to keep learning more than the minimum CE requirements.

5. You want to save lives

The idea of "saving lives" is one of the most overused concepts in our industry. Very little of what we do could honestly be categorized as "lifesaving." The big problem with all the noise about being "life savers" and doing lifesaving work is that people get the idea that saving people is what our work is about and it’s not.

If your motivation for becoming an EMT has anything to do with a desire to regularly be thrown into a life or death struggle, where your actions and decisions are the critical factor in determining if someone lives or dies, you’re almost certainly going to burn out fast.

Most of the medical emergencies that EMTs manage aren’t life-threatening and many aren’t even time-critical. If you are coming to EMS to save lives, ask yourself if you will be satisfied applying Band-Aids, preventing dehydration, managing diabetes, protecting people from their own addictions and reckless behavior and giving them rides from where they are to where they need to be.

If you still want to be an EMT, drop the idea of saving lives and get accustomed to the idea of managing people's healthcare needs. To be successful you’ll need to be an advocate for safety (including driving) and a constant learner. You’ll need to forget about the being and master the doing. And when the day is done, have the discretion to only tell the good stories.

But there’s an advantage: If you’re one of those rare individuals who are willing to do all of those things, you’ll find a lifetime of rewarding service in this field. For everything that you have to let go of to be successful, the job will pay you back tenfold in excitement, challenge and reward. You will have to sacrifice and give, but you will witness some of the most precious and sacred moments in our human existence. I wish you luck.

EMS Artwork: A routine procedure can be terrifying


About a week ago I went for a “routine” procedure. When I arrived at the specialist’s office I followed my directions, I stripped naked from the waist down, laid on the table and left my baby maker out in the open for the world to see. I wasn’t uncomfortable with the procedure until this very moment. About 10 minutes later 2 women entered, the one who was going to perform the procedure was a student. For the next 30 min I was handled, squeezed and examined. All of a sudden this routine procedure turned very invasive.

I started thinking of all the times I’ve had patients in the back of my ambulance whom I started 12 leads, IVs or intubated, all routine procedures. When most of us go to work we’re going to start more IVs than people will have cups of coffee that day. My point is what seems routine to us may be a terrifying experience for our patients. I think it’s important to maintain a level of compassion for our patients. It may be the 5th IV you’ve started that day but the first ever for your patient.

I’ve been wanting to do a Flight Nurse and Medic piece for a long time and this image illustrates my point very well. Imagine on top of the IV, 12 lead, medications and the initial injury or medical condition you will now be flying in a helicopter or small plane. Flying alone can be terrifying for many people.

Thank you everyone for your continued support. Be safe and take care of each other.

Dan Sun Photos Routine

How Mich. responders triple breached an absolute duty to respond

Michigan responders took nearly two hours to arrive and locate a driver – who was in the driver seat, of all places – after a witness made three 911 calls to report the car accident. I am almost too dumbfounded to provide legal analysis about the incident.

The calm – perhaps too calm – demeanor of the 911 operator is understandable; to be effective, a 911 operator cannot be stirred – visibly – by the calls to which they must respond. I get the calm response.

But I cannot comprehend how 10, 20, and 30 minutes pass with no response at all to the incident. How does that happen" This incident – unfortunately not entirely unique to the State of Michigan (recall the Detroit EMT who refused to respond to an infant in cardiac arrest ) – takes negligence to a new, uncharted level.

Breach of duty to respond

Most significantly, this case shines a glaring spotlight on the "breach" element of negligence.

A breach of a duty , in this case, the duty to respond, exists where one owes the duty, a reasonable provider with the same level of training and experience in the same locale would act on that duty, but the actual duty-holder fails to do so.

Here, a caller activated 911, an operator took the call and nobody responded to the incident. The civilian called again and nobody responded. The civilian called a third time and still, nobody responded. That is a triple-breach of duty to respond!

What makes this story even more egregious is the fact that – allegedly – an ambulance did respond to the scene –– and the crew did not locate the driver who was later found by another ambulance crew in the driver’s seat !

I have been on calls myself where vehicle occupants were not where I expected them to be; wedged up under the steering console, for example. But we found those patients by looking.

If an ambulance crew did, in fact, arrive on the scene without locating the driver, it is clear that they did not do an adequate or appropriate assessment of the scene.

Using a negligence analysis, the ambulance crew had an absolute duty (see Wright v. City of Los Angeles and Zepeda v. City of Los Angeles ) to get out of the ambulance and thoroughly examine the wreckage, open the doors, check the passenger compartment thoroughly, look under the vehicle, and check the close surrounding area for evidence of an injured person who may have fled the scene, like blood or personal belongings.

In this case, it seems that they did not get out of the ambulance.

Let this be a lesson to any EMS provider who thinks that something is nothing; everything is something until you assess and prove that it’s nothing.

Law enforcement officers as medical first responders can save lives

For many medical and trauma emergencies, law enforcement personnel are the true first responders, arriving on scene before EMS providers. Although the law enforcement skill set is highly specialized to safeguard lives and property, and protect individuals in the communities they serve, many cops have not received extensive training in emergency medical care.

The utilization of law enforcement officers as first responders during medical emergencies has the potential to decrease the time it takes for a patient to receive lifesaving care. Patients who experience a sudden cardiac arrest, an opiate overdose, or significant trauma may benefit greatly from programs that equip and prepare law enforcement for immediate medical intervention.

Sudden cardiac arrest: AED deployment in law enforcement vehicles

The first three links in the American Heart Association’s Chain of Survival are early access to the emergency response system, early CPR, and early defibrillation. Each year, over 350,000 Americans experience an out of hospital cardiac arrest and only 41 percent of those patients receive bystander CPR.[1] Equipping law enforcement vehicles with automated external defibrillators and ensuring that officers are trained in CPR and AED use allows lifesaving interventions to be delivered as quickly as possible.

Training in AED use can be completed in a matter of hours with a high degree of success[2], and many areas in the U.S. have already equipped law enforcement with AEDs. Studies suggest that deployment of AEDs in law enforcement vehicles significantly decreases the time from the initial 911 call to the delivery of the first defibrillation attempt, and increases survival to hospital discharge rates.[3]

Implementing a law enforcement AED program is not without challenges. The effectiveness of equipping law enforcement with AEDs may be directly related to the number of first responding fire department vehicles that also have an AED.

An early study in an urban area of Ohio saw no significant changes in out of hospital cardiac arrest survival after equipping law enforcement with defibrillators, however in the test area all fire department vehicles were also equipped with AEDs.[4] Response times for law enforcement and fire resources were similar in the study area, meaning that an AED usually arrived on scene early regardless of law enforcement response. This suggests that AED programs for law enforcement may have the most impact in areas where response times for EMS are notably longer than for law enforcement.

A study of widespread deployment of AEDs to law enforcement in Miami-Dade County in the late 1990’s revealed the importance of officer support and comprehensive education prior to initiating an AED program. The study found that the average response time for police to a cardiac arrest event was just over six minutes, while response time for all other events was significantly faster at just over four minutes.[5] The study suggests possible factors for the delay as lack of comfort with AED use, and concern over liability.

Another study in a Pittsburgh suburb showed similar results. Although law enforcement consistently arrived on scene before EMS resources, defibrillation was only used in 69 percent of cardiac arrest situations.[6] Factors contributing to the inconsistent AED use included the expected imminent arrival of EMS personnel, failure to bring the AED to the patient, and excessively lengthy patient assessments.

These studies indicate that best practices for AED use by law enforcement include comprehensive education of officers prior to AED deployment. Comfort level of individual personnel with the use of an AED, and commitment to program implementation directly relate to rates of survival for cardiac arrest patients. Officers must be knowledgeable about the impact their AED can have, and be ready to respond to cardiac arrest situations appropriately.

AEDs may be most effective when deployed in areas where law enforcement response times are shorter than those of EMS, however given the effectiveness of early defibrillation on cardiac arrest patients it may be true that deploying more AEDs into a given community is a net plus, regardless of agency response times.

Opiate overdose: Naloxone administration by police

More than 220 law enforcement agencies in at least 24 states currently equip officers with naloxone for emergency administration to opiate overdose patients.[7] Overdose deaths are not isolated to intravenous drug users. The availability of potent opiate-based analgesics makes opiate overdose a concern for patients in virtually all demographics. Death from prescription drug overdose has increased steadily in recent years, and overdoses in heroin users doubled between 2010 and 2012.[8]

Opioid abuse and overdose causes significant respiratory depression. Death from opiate use occurs subsequent to hypoxia, and can occur very rapidly in some cases.[9] The medication naloxone displaces opioids from the receptors in the brain, effectively reversing respiratory depression. Naloxone has been used for decades to reverse opiate induced respiratory depression, can be administered easily via an intranasal atomizer, and has no potential for abuse.[10] The effectiveness of naloxone has prompted the development of community programs that provide naloxone and training in its administration to individuals who use drugs or know someone at risk of overdose.[11]

Given the effectiveness of naloxone, and its successful use by otherwise untrained lay persons, it would seem that equipping law enforcement officers with the medication would provide significant benefit.

One such program, in Quincy, Mass., had great success after supplying officers with intranasal naloxone kits. Officers responded to 191 suspected overdose incidents, and successfully reversed 182 opiate overdoses.[12] That same program identified an unexpected benefit, in that drug users’ perception of law enforcement became more positive once it was understood that lifesaving medication was available.

There are several barriers to successfully supplying law enforcement with naloxone. First, naloxone is a prescription medication and must be administered with some medical oversight. In Michigan and Pennsylvania, law enforcement operates under EMS protocols for naloxone administration and is therefore under the oversight of the EMS agency medical director. The other 22 states, at the time of this writing, that allow law enforcement administration of naloxone have statutes or regulation authorizing its use.[13] Although these precedents are in place for regulation and oversight, organizing and implementing such statutory changes takes time and may hinder other states adoption of naloxone administration by law enforcement.

Legal liability may also be of concern for law enforcement agencies considering naloxone use, however these concerns would be unfounded. There are no records of any lawsuit relating to naloxone use through community programs or law enforcement administration.[14] The use of naloxone for opiate overdose reversal is well established, and the risks of administration are very low. It would seem that concern over liability relating to naloxone use has little merit and would not be reason to delay implementing a law enforcement naloxone program.

The cost of naloxone is relatively low, approximately $60-$80 per two-dose package, but costs may be rising to match the increased demand for the drug. The administration of the drug in its intranasal form is simple and easy.[15]

Law enforcement use of naloxone continues to grow. The prevalence of overdose deaths make the deployment of naloxone to law enforcement justified, as does the time sensitive nature of an opiate overdose emergency. First responding officers carrying naloxone have the ability to provide a life-saving reversal of respiratory depression prior to EMS arrival, allowing the patient to receive more definitive care in a timely manner.

Tourniquets and hemostatic dressings: Police treatment of severe bleeding

In recent years the U.S. has seen an increase in the number of large scale incidents involving penetrating trauma or blast injuries. Active -shooter incidents present an environment that resembles combat, with multiple patients located in a hot-zone environment that may not be safe for EMS personnel. The provision of tourniquets to law enforcement officers can allow for the rapid triage and treatment of individuals, including other officers, at risk of death from severe hemorrhage.

In the early 1990’s the United States military began developing and implementing tactical combat casualty care, or TCCC. A significant component of TCCC is the control of severe bleeding during a traumatic event. Exsanguinating hemorrhage is the leading cause of death from injuries sustained during combat, and the proper application of tourniquets and hemostatic dressings has been shown to increase survivability of penetrating trauma and blast injuries in the military setting.[16]

The benefit of tourniquet use among EMS providers is well recognized, as is the controlled use of hemostatic dressings in the prehospital environment. Military personnel use tourniquets and hemostatic dressings on a daily basis, yet the use of these lifesaving devices in the civilian setting has not yet been widely adopted.

The events of the Boston Marathon bombing highlight the potential benefit of equipping law enforcement with tourniquets. During that incident, it was identified that the rapid application of a tourniquet resulted in multiple individuals surviving who might otherwise have died from exsanguinating hemorrhage.[17]

News reports from recent active-shooter incidents describe patients bleeding heavily, suggesting that tourniquets and hemostatic dressings may have been useful in those cases.[18,19]

Commercially manufactured tourniquets and hemostatic dressings are simple to use, relatively inexpensive, lightweight, and require minimal training to be used effectively. Providing these lifesaving devices to law enforcement allows officers to protect the victims of violent crimes quickly and effectively.

Law enforcement officers are often the first public service providers to arrive at the scene of an emergency. The research in support of AEDs, naloxone, and bleeding control methodssupports the training of officers to provide immediate and life saving care for patients experiencing cardiac arrest, overdose and traumatic injury.


  1. Alan S . Go, MD et. al. "AHA Statistical Update." Circulation (2013): n. pag. Web. 11 Aug. 2015.
  2. Kooij, Fabian O., et al. "Training Of Police Officers As First Responders With An Automated External Defibrillator." Resuscitation 63.1 (2004): 33-41.
  3. Hess, Erik P., and Roger D. White. "Optimizing Survival From Out-Of-Hospital Cardiac Arrest." Journal Of Cardiovascular Electrophysiology 21.5 (2010): 590-595.
  4. Sayre, Michael R., et al. "Providing Automated External Defibrillators To Urban Police Officers In Addition To A Fire Department Rapid Defibrillation Program Is Not Effective." Resuscitation 66.2 (2005): 189-196.
  5. Myerburg RJ, Fenster J, Velez M, et al. Impact of community-wide police car deployment of automated external defibrillators on survival from out-of-hospital cardiac arrest. Circulation. 2002; 106: 1058–1064.
  6. Mosesso VN, Davis EA, Auble TE, et al. Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest. Ann Emerg Med. 1998; 32: 200–207.
  7. Davis, Corey S., et al. "Engaging Law Enforcement In Overdose Reversal Initiatives: Authorization And Liability For Naloxone Administration." American Journal Of Public Health 105.8 (2015): 1530-1537.
  8. Centers for Disease Control and Prevention. 2013 drug overdose mortality data announced [press release]. Atlanta, GA: January 12, 2015.
  9. Mouillon T, Bruhn J, Roepcke H, Hoeft A. “Opioid-induced respiratory depression is associated with increased tidal volume variability”. Eur J Anaesthesiol. 2003; 20(2):127---133
  10. Chamberlain JM, Klein BL. “A comprehensive review of naloxone for the emergency physician”. Am J Emerg Med. 1994;12(6):650---660.
  11. Clark AK, Wilder CM, Winstanley EL. “A systematic review of community opioid overdose prevention and naloxone distribution programs”. J Addict Med. 2014; 8(3):153---163.
  12. "ONDCP And SAMHSA Release Opioid Toolkit, Promote Naloxone." Alcoholism & Drug Abuse Weekly 25.34 (2013): 4-5.
  13. Davis, Corey S., et al. "Engaging Law Enforcement In Overdose Reversal Initiatives: Authorization And Liability For Naloxone Administration." American Journal Of Public Health 105.8 (2015): 1530-1537.
  14. Davis, Corey S., et al. "Engaging Law Enforcement In Overdose Reversal Initiatives: Authorization And Liability For Naloxone Administration." American Journal Of Public Health 105.8 (2015): 1530-1537.
  15. Davis, Corey S., et al. "Engaging Law Enforcement In Overdose Reversal Initiatives: Authorization And Liability For Naloxone Administration." American Journal Of Public Health 105.8 (2015): 1530-1537.
  16. Joseph M. Galante, MD, et. al., “Identification of Barriers to Adaptation of Battlefield Technologies into Civilian Trauma in California”, Military Medicine, (2013) 178, 11:1227
  17. "Tourniquet Use at the Boston Marathon Bombing: Lost in Translation." NCBI. U.S. National Library of Medicine. Web. 8 Aug. 2015.
  18. Keneally, Meghan. "Aurora Shooting Trial: Cop Gets Emotional About Moment He Found Dead 6-Year-Old." ABC News. ABC News Network. Web. 8 Aug. 2015.
  19. "Two Women, Ages 21 & 33, Killed in Louisiana Movie Theater Shooting." Fox4kccom. 23 July 2015. Web. 14 Aug. 2015.

How to buy an ePCR system

Investing in an electronic patient care reporting (ePCR) system is no small undertaking. The result definitely has its advantages ─ an efficient method of documentation that provides insight into local and national EMS trends. The process of identifying the right vendor to meet your agency’s needs, at the right price, takes research and time.

In November 2014, the National Association of State EMS Officials (NASEMSO) developed a guide for agencies that outlines questions to consider when purchasing ePCR . It covers important topics such as assessing the needs of your agency or department, compliance with state requirements, hardware, updates and technical support.

One of NASEMSO’s recommendations is to contact other EMS providers and find out what their experience has been with ePCR. Jim Bratcher, EMS chief of Peoria (Ariz.) Fire Department, shared lessons learned about the development of their program that has been in place for five years. Peoria completes approximately 14,000 records per year. When implementing ePCR in a department or agency with a high call volume, there are critical factors to consider.

What Bratcher emphasized is the support that is required within the agency to maintain ePCR.

"In order to get full utilization of the product in a large department, you need to have someone dedicated to the system," Bratcher explained.

One of the benefits of having ePCR is the amount of qualitative and quantitative data that can be extrapolated from the reports, such as the number of calls for a specific patient’s chest pain complaint, the medications given, or response times. The information that is available to EMS providers who use electronic charting is phenomenal. However, the data is only useful if you have someone who can interpret it, which can take time if you are running reports on thousands of records.

Another reason to have dedicated staff for ePCR is ongoing maintenance and training. Bratcher urged EMS providers to "understand the time and effort it takes to maintain the software."

When budgeting for a department’s ePCR program, the total cost must include maintenance and technical assistance, such as upgrades and the availability of a vendor support line. In a large department or agency, someone also needs to be available to serve as a subject matter expert inside the agency.

The vendor may provide the first round of training, but there will be new employees who need to be trained. Even after extensive field-testing, a new software program will have bugs. A single point of contact for personnel to notify with issues and questions and subsequently, receive answers and updates from, simplifies the flow of information. Even after five years, Peoria continues to monitor and adjust their system on a regular basis.

Bratcher also discussed the importance of thoroughly field-testing the product. Talking to a vendor’s current customers about the performance of a product or seeing a demonstration is a start, but it’s not the same as installing the software on a tablet or laptop and having personnel enter information while they are in the field.

Staff can provide feedback on what works and what does not, whether it is the training they receive, the flow of information, or the reports available. Determine what changes the vendor can make to design a program that is right for your agency. Trade-offs may have to be made, but finding a balance between cost, performance, compliance with state requirements and compliance with the National EMS Information System (NEMSIS) is the ultimate goal. NEMSIS is a national collection of standardized EMS data used to establish standards of care, identify areas for improvement, and prioritize educational needs.

Field-testing is a good opportunity to introduce into the system a point of contact, or liaison, for department personnel. Establishing an internal network to support ePCR early in the implementation process gives the vendor, administration and field personnel confidence that they are well supported to establish an effective ePCR program.

Consider what your agency needs:

  • What is your agency’s call volume"
  • Who will be responsible for interpreting the data and reports"
  • How many department personnel will be using the program"
  • Who is the point of contact in your agency for those people" With the vendor"
  • How much time are you planning to allocate to ePCR each week" Each day"
  • What field-testing should be done"

Saving the dying agency: The value of transformational leadership in EMS

By Dr. Shana Nicholson and Scott Crouch

Maintaining strong leadership within Emergency Medical Services (EMS) has always been a challenge, particularly for agencies in rural areas that depended heavily on volunteers. Today those leadership challenges have shifted, as the need for continual care coverage rises and paid crews are increasingly necessary. As these paid EMS agencies have taken root around the country, volunteers have dramatically faded.

​When an organization transitions to an all-paid staff, the financial burden is immense and, without strong leadership, an agency can bleed money like a patient in hemorrhagic shock. In addition, morale often plummets and the organizational structure can buckle.

Shifting to a Transformational Leadership Style
So how do you turn an agency around when it’s circling the financial drain" The answer is transformational leadership. When a new administrator takes over a financially challenged organization, an initial assessment of the agency’s personnel, apparatus, equipment, finances, and care protocols should take place.

Full story: Visit the In Public Safety blog

Medic finds tranquility on the Pacific coast

In 1984, when Doug Baier was a 29-year-old firefighter with the Livonia, Michigan fire department, he was drawn to a Detroit-area institution that attracted many young people in the ‘80s: Madonna.

No, not that Madonna; Madonna College – now Madonna University. "Some of my coworkers actually thought it was named after her," says Baier (pronounced "Buyer").

The 60-year-old Navy veteran, who’d become an EMT in 1982 because "it was the only way you could get into the fire service," discovered he enjoyed the patient-care part of his job enough to attend Madonna’s paramedic program. He graduated in 1984 and began working as a dual-role medic – with Livonia until 1990 and the Bremerton (Washington) Fire Department ever since. Along the way, he noticed a fundamental change in EMS.

The evolution of EMS

"When I started, it was Emergency Medical Services," says Baier. "Our goal seemed to be saving hearts that were too young to die.

"At some point, though, we became ‘prehospital care,’ which meant the standard of care shifted from intervention in acute events to doing what the hospital did, but out of the hospital. Now we’re actually flirting with post -hospital care.

"I don’t know if I’ve kept up. I find myself on calls when I’m not really sure what the objective is."

Baier thinks new EMS providers need to embrace the industry’s evolution and develop realistic expectations about the impact they’ll have in the field.

"One of my heroes, Dr. Gregory Henry, calls emergency medicine ‘the occasional application of scientific principles to meet human needs,’" says Baier. "What he means is, if you’re thinking you’ll be saving lives all the time, you’re wrong; you’re going to be meeting patients’ basic needs, whether they’re social, psychological or whatever. Occasionally, you’ll do something medical, but mostly you’ll be helping citizens through crises whenever they decide they’re having one.

"That’s what I remind myself: Even though most calls aren’t too exciting, maybe I can still help somebody today."

One aspect of rescue that hasn’t changed is the territoriality of neighboring districts.

"We have strictly geopolitical boundaries," Baier says. "Literally across the street from one of our stations is another jurisdiction. We wouldn’t be dispatched to a call there.

"If I could wave a magic wand and change the system, I’d start by making sure the closest ambulance is sent to each call."

Firefighter or medic"

Baier enjoys the call variety inherent in his dual role.

"Firefighting is a nice distraction when the tones go off," he says. "It’s a relief to have something other than routine EMS calls.

"My job is sort of like the movie Groundhog Day ; I pretty much know who I’m going to see during each 24-hour shift. We’ve been doing a lot more social services for the ‘EMS loyalists’ in our community."

Despite the 80-20 mix in favor of EMS calls, Baier says firefighting is still the priority at Bremerton.

"We just hired a new paramedic. His whole first year, the emphasis is going to be on development of fire skills, even though his job will be mostly medical. I think that’s pretty standard throughout the industry."

The focus changes for medics after their first year, though.

"Take King County, right across the water from us," says Baier. "They are officially the Seattle Fire Department and their paramedics are dual-role, but it’s kind of a nod and a wink.

"The medics aren’t expected to do any firefighting while they’re assigned to medical units. They have turnout gear, but they’ll probably only wear it once a year when they’re assigned to engine companies for refresher training."

Staying sharp

A bigger issue for paramedics than firefighting skills, Baier says, is maintaining proficiency in their primary occupation.

"My old department, Livonia, went from having no practicing paramedics to 95 of them. I see this sort of trend everywhere.

"Our county (Kitsap) has even more medics than Seattle does. How can we all expect to get enough practice"

"Circumstances are changing in our industry. I used to go to work and not be surprised when I got an intubation. Now I hardly ever get to try one. I don’t know if it’s part of the aging process, but I actually started to get timid with airway management because I wasn’t doing it often enough."

Seeking quality of life

When Doug is off duty, he and his wife of 36 years, Ann, usually choose a good movie.

" Goodfellas and Casino are two of my favorites," Baier says. "I could feed you a few lines, but you probably couldn’t print any of them.

"My coworkers tease me because this is a great place for outdoor recreation, yet Ann and I are indoors watching movies."

With only five years until Doug’s retirement, the Baiers are beginning to think about life after EMS.

"We’ve never felt disappointed about our decision to move here," says Baier of the Pacific Northwest. "Sometimes we think about heading back east, but we’re pretty happy where we are. We might just stay."


EMS1 Tips

7 ways to best use, or avoid, capnography in the field

EMS1 readers shared their suggestions on how to get the most out of the method

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.

3 energy-saving tips for your EMS station

Earth Day, or any day, is a good time to see what you can do at your agency and home to save both resources and money.

How this video can "Keep Yourself Safe"

Consider using this PPE safety video in your EMT course or refresher class

CPR class instruction tips: 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 is 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 education and training

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.

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