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

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EMS1 Daily News

2 killed, 8 critically injured in Ariz. car crash

Investigators are probing whether drugs or alcohol played a role in the crash

FDNY EMT sworn in as U.S. citizen, ends 11-year fight to stay in country

He was nearly deported in 2003 when he voluntarily registered with the federal government under a post-9/11 special registration security program

Police: 3-year-old girl beaten to death in NYC

The girl was found unconscious and unresponsive in an apartment; she was rushed to the hospital and later died

30 injured in riot at N.H. college pumpkin festival

One group of college students threatened to beat up an elderly man, and another resident heard someone threatening to kill police officers

City, fire department reach agreement on medic program

The agreement establishes job classifications for fire engineer/medic and firefighter/medic, which will bring a 5 percent pay increase

Healthcare worker isolated on cruise ship over possible Ebola contact

The woman poses no risk because she has shown no signs of illness for 19 days and has voluntarily self-quarantined on the cruise ship

'Fastest ambulance in the world' unveiled in Dubai

The car is able to race to injured people at 185 mph and will be used by 50 specially-trained paramedics

Baby dies after left in car for 6 hours in Oregon

Firefighters and medics attempted to revive the infant, but were not successful

Inside EMS Podcast: Does EMS need cameras in ambulances?

Hosts Chris Cebollero and Kelly Grayson discuss the pros and cons of putting cameras the back of rigs, and debate ALS vs. BLS systems

Off-duty Ind. medic killed in crash with gas tanker

Officials say he crossed the center line and crashed into the tanker, which then hit two other cars

EMS1 Topic Articles

EMT quits over social media 'booty dancing' video

Two EMTs were goofing off during a late night shift and posted a video on Snapchat; the service deletes content once it's posted but someone recorded it

Kan. gets regional air ambulance in hospital partnership

The air medical transport service will also provide ground transport for critically ill and injured patients in southwest Kansas

Man arrested for defacing 9/11 memorial in NY

White paint was used to deface the memorial to fallen first responders

Ga. EMT honored for response to man struck by lightning

The rain was so heavy EMTs had to wade through ankle-deep water and follow the man's voice; Jessica Galvin sized up the situation and treated him on the scene

43 in Dallas declared 'Ebola free'

The first group of people who had contact with the first U.S. Ebola patient have been cleared after 21 days of monitoring

CDC to revise Ebola PPE protocol

New guidelines will require "no skin showing," and a "buddy system;" a 30-person support team will also assist civilian medical professionals

2 hurt after police chase of LAFD stolen ambulance

A man being treated by medics drove off in the ambulance and led police on a chase that ended when he crashed into a truck at an intersection

2 killed, 8 critically injured in Ariz. car crash

Investigators are probing whether drugs or alcohol played a role in the crash

FDNY EMT sworn in as U.S. citizen, ends 11-year fight to stay in country

He was nearly deported in 2003 when he voluntarily registered with the federal government under a post-9/11 special registration security program

Police: 3-year-old girl beaten to death in NYC

The girl was found unconscious and unresponsive in an apartment; she was rushed to the hospital and later died

EMS1 Columnist Articles

Inside EMS Podcast: Does EMS need cameras in ambulances?

Download this quick clip on iTunes, SoundCloud or via RSS feed

In this week’s Inside EMS Podcast, hosts Chris Cebollero and Kelly Grayson discuss a medic accused of fondling a woman in the back of an ambulance, and how EMS can both defend itself against these types allegations and make them less likely to happen.

“I can’t help but think cameras in the back of the rig might be the nuclear response to this sort of thing,” Grayson said.

Cebollero says it sounds like it’s being introduced as a form of punishment, but contends there’s nothing wrong with that thought.

“Is there really a negative"” he asked. “I think it could be very helpful.”

Grayson said he would like to think EMS doesn’t need “the all seeing eye of Big Brother,” but Cebollero suggests it makes sense to put ambulances in the back of the ambulance, and then even use that technology to send patient information to the ER.

“On the face of it, it sounds like a great idea,” Grayson said. “I just also think it’s ripe for abuse and unforeseen consequences that we may not grasp as of yet.”

They also debate whether more EMS providers are becoming involved in misconduct destroy the public’s trust. Grayson stands by his position that it’s not more prevalent than it has been in the past, it just appears more in the news. But he acknowledges that “perception is reality.”

“What’s it going to take to clean up our image"” Grayson asks.

They also talk about response time problems in San Francisco, and relate it to a story a Md. department that improved response times by 27 percent by adding more BLS ambulances and cutting back on dispatch protocol questions before assigning a unit.

“Hold on to your hats San Francisco,” Cebollero said. “They did it by adding more ambulances to the fleet. Image that. It’s like witchcraft.”

In the clinical issue, they debate the idea of putting more BLS providers on the street in order to move ALS providers to more of a community role, running ALS interception if it’s needed.

Cebollero brought up the problem that advanced-level providers are often not available for calls where their needed, such as cardiac and respiratory calls, or to do 12-lead interpretations.

“You know why we’re not having them there" Because they’re too busy running calls that do not require their unique knowledge and skill set,” Grayson said. “We need more BLS providers, and let the ALS providers do ALS things.”

Guest Tom Bothillet also joins the show to talk about the importance of ECG knowledge and 12-lead interpretations. He discusses some common mistakes, and provides resources to improve our education.

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

How to deliver the perfect EMS apology

Here is a secret about being an EMS leader: We make mistakes.

Not many people know or acknowledge this, but it's real and something you will encounter in your leadership career. And because we make mistakes, there may be the need to apologize for your actions.

I recently found myself in the situation where my emotions got the better of me, and I found myself in the position of having to say I’m sorry. The perfect apology in a business setting can be a bit more involved than what's required in your personal life, where friends and family usually forgive us for transgressions.

In business, colleagues and peers can chose to hold a grudge, thus affecting your professional abilities and effectiveness. With this in mind, delivering the perfect business apology can be slightly more complex.

Yet whether it's written or verbal, there are five basic components of a good apology.

  • A sincere apology opens the doors to communication with you and the other person.
  • It displays your willingness to admit to your mistakes.
  • It helps restore dignity to the person hurt or insulted.
  • It displays your remorse for your actions.
  • It shows you acknowledge your actions had a negative impact on the other person.

The perfect apology in four steps

1. Convey remorse

This first step is the most important because it shows that your words are honest, sincere and authentic. In addition to starting with "I'm sorry," or "Please forgive me," you should also add the reason for the apology, as in, "I'm sorry for reacting the way I did, and I feel embarrassed for acting unprofessionally."

You should also convey an apology as soon as you realize you wronged someone. Being real is the key here; if you have an ulterior motive it may be transparent and minimize your apology's effectiveness.

2: Take responsibility

During your apology, you may be tempted to explain your actions away. Even though you think it may be helpful, making excuses can actually weaken your apology. Don't pass the blame onto someone or something else.

Instead, you need to empathize with the person and demonstrate that you realize your mistake and regret the action. Try not to make assumptions about how they felt, but putting yourself in their shoes and picturing how you would have felt in the same situation can help deliver a strong message.

3. Make amends

Making amends means taking the necessary actions to make the situation right again. A simple statement like, "If there is anything I can do to make up for this incident, please ask," goes a long way.

You also need to be prepared to follow through, and not just make your statement an empty promise.

4. Promise it won't happen again

This is a vital step because you need to reassure the person you will change your behavior, and begin rebuilding trust in your ability to fixing the relationship. With that said, once you promise to change the behavior, if you don't follow through you will do irreversible damage to your reputation and your trustworthiness.

Once you have apologized, you should also not expect instant forgiveness. It may take folks different lengths of time to process the information and feel comfortable enough to forgive you.

The person you are apologizing to may even become angry and give you an earful in return. You should allow him to vent, and at the end of the rant give a final apology.

In your daily responsibilities as an EMS leader, we deal with tons of different situations that may lead to the need for an apology. On a final note, if your behavior could result in legal action or possible liability against you or your organization, delay your apology and seek the advice of your legal council.

Why EMS leaders should embrace healthy conflict

By Steve Knight, Ph.D.

In EMS and the fire service, teamwork is the essence of much of our successes. Whether deployed on firefighting apparatus with multiple personnel or a single EMS unit with two personnel, nearly all work is accomplished through the deployment of teams.

However, there are times when our team's social and cultural norming processes may serve to diminish innovation and cause us to resist change — and that can happen when we avoid conflict.

Conflict can be defined as disagreement, opposition, and variance. For many of us, our natural tendency is to avoid conflict, especially in the workplace. But since conflict is a natural occurrence in relationships, our efforts to eliminate conflict come at the cost of candor, honesty — and accountability.

Artificial harmony

If not careful, our desire for harmony can be more appropriately identified as a lack of trust in a team where dissenting voices can be heard without reprisal. If you want to test whether your team has a trust problem, observe the degree of consensus in a formal meeting, and then compare that to the informal meetings afterward at the water cooler, at lunch or behind closed doors.

Management guru Patrick Lencioni identifies this phenomenon as artificial harmony. Over time, low candor and conflict-avoidance behaviors will result in team mediocrity.

In emergency services, accountability is most often formally viewed as a function of discipline; that is, whether or not the team members are following a bureaucratic set of policies and procedures. One of the first and most glaring problems with this approach is that few policies and procedures have any correlation to team performance of the mission.

Informally, accountability is more rightly viewed as discipline for the team members for any actions or beliefs outside of the group culture, such as shunning, distancing, or marginalizing the member that is outside of the cultural norm.

However, in most instances, and I believe the EMS mission handles this better than the fire mission, accountability has little to do with performance of the mission. In a low-accountability environment, mediocrity will reign and eventually employees will begin to serve themselves, rather than the team or the mission, because they perceive their performance as having little value.

Why conflict is healthy

A certain degree of conflict is necessary for the health, success, and continued pursuit of excellence in an organization. Hefitz and Linksy identify it as disequilibrium. Jack Welch calls it candor. John Kotter refers to it a sense of urgency.

This healthy conflict is good for teams and organizations because it challenges the status quo, forces the teams to consider different points of view, and ultimately results in a high accountability environment.

Leaders must ensure that a team environment is created where all members are provided an opportunity to share their thoughts and beliefs in a safe and respected environment. Leaders must learn how to allow the conflict to rise and create some disharmony in the group, but know when to move toward resolution.

Far too often, our "fix it" team mentality does not tolerate conflict so we address it immediately rather than letting the process work itself out. At times, leaders must be the ones to generate some conflict if it is needed to get dissenting opinions — and to show that there is no payback for not always agreeing with the boss.

Of course, ground rules must be established for what healthy conflict looks like, and respect and professionalism must be upheld. Healthy conflict furthers the depth and breadth of innovation and change, but ultimately, a decision must be made.

Consensus in the decision is not the ultimate goal of the process (other than those rare occasions where everyone truly agrees). Paramount to success and accountability is the understanding and belief that the team's ultimate decision is a result of open, honest and candid dialogue.

About the author:

Dr. Steve Knight, a Fitch & Associates consultant, brings more than 25 years of fire and EMS experience to the firm. He served for nearly 17 years as assistant fire chief for the City of St. Petersburg, Fla. He has been a subject matter expert for both the National Fire Academy and the Center for Public Safety Excellence (CPSE), a nonprofit corporation that serves as the governing body for the organizations that offer accreditation, education, and credentialing services to the first responder and fire service industries.

Knight has also served as team leader and assessor for the Commission on Fire Accreditation International and has held multiple faculty appointments in Fire Science and EMS. Prior to coming to Fitch, he served as senior manager of a consulting team within the Center for Public Safety Management.

How an ambulance crash defined an EMS agency’s care

When the leadership team of Minnesota-based Allina Health EMS was awakened in the early-morning hours of Jan. 18, with the news that one of their ambulances had been involved in a devastating head-on collision they knew how they would respond.

Their actions were guided by a deep understanding of what matters to them, a desire to show how they cared in a big way, and a determination to stay ahead of storytelling about the event.

Just after 1 a.m. the ambulance was transporting without lights and siren a stable medical patient on a rural, two-lane highway when it collided head-on with an SUV. The impact ripped apart the SUV and destroyed the ambulance.

The lone occupant of the SUV suffered multiple traumatic injuries. The attending paramedic was unresponsive with a severe head injury. The lower extremities of the EMT driving were crushed.

The only uninjured person — the medical patient on the stretcher — placed a desperate call for help with the injured paramedic's cell phone.

Other ambulances quickly responded. By the time the leadership team learned of the event, the driver of the SUV and ambulance crew were on their way to area hospitals.

'We'll show you how much we care'

Allina Health EMS is the medical transportation arm of a $3.4 billion not-for-profit hospital and clinical corporation headquartered in the Twin Cities. Allina's EMS operations serve more than 100 communities throughout Minnesota, with 570 employees responding to more than 90,000 calls per year.

Regional Director of Operations Kevin Miller received the initial call and immediately headed for the hospitals where the critical patients had been transported. On the way he contacted other team members.

Their top priorities were:

  • Ensuring the injured were getting the best possible care and support.
  • Notifying and informing families.
  • Assuring the rest of the Allina staff were informed and enlisted to help as needed. Allina EMS President Brian LaCroix was in Arizona at the National Association of EMS Physicians’ conference and immediately prepared to return to Minnesota.

Miller started notifying families of the injured and convened a leadership team conference call to make certain that Allina's response was coordinated, honest, transparent, generous, and reflected how much the organization truly cares about its employees and its patients.

Five months earlier, during a two-day leadership retreat, the Allina EMS team had wrestled with what distinguishes their organization and them as leaders. In sorting through the usual litany of lofty corporate values, they had recognized that a deep sense of caring was really at the soul of their organization.

They noticed that the highest levels of inspiration, motivation, and satisfaction came when field staff and leaders had opportunity to demonstrate caring.

Their discussion at the retreat led them to talk about the myriad of uncontrollable factors in emergency medical work, including the nature of the call, the severity of a patient's clinical presentation, the location of a patient, the socio-economics and politics of health care, and the challenges facing their large hospital-oriented parent company.

The discussion also touched on how much Allina could control, such as how they treated employees, patients, families and communities. They wanted all their relationships to be characterized by an overt demonstration of caring.

Toward the end of the retreat, Twin Cities Operations Director Jeff Czyson summarized what mattered in a single declarative phrase, "We'll show you how much we care." The phrase stuck and as the retreat concluded, the team committed to living out that declaration in the coming year.

Whatever it takes

In the immediate aftermath of the crash, Allina's leadership team had ample opportunity to demonstrate caring in a big way. They ensured the injured were supported, providing practical support to families in terms of companionship, medical information, accident information, emotional support, transportation, food, lodging and simple errand-running.

"We decided to do whatever it took," LaCroix said. "We didn't know the details about what had caused the accident and that wasn't our first concern. We wanted everyone to know we were there to help. Cost wasn't a primary concern."

The team offered support and full information to the family of the SUV driver who was in critical condition and later died. The family of paramedic Brian Nagel, also in critical condition, needed to travel from another part of the country. Czyson, Miller and other Allina staff stayed with Nagel until family arrived.

In addition, Allina provided a uniformed EMS provider to stay at the hospital for as long as was needed to be available to support and assist the family in any way. Allina helped Nagel's family publicize a Caringbridge website that brought thousands of wishes of support and prayer from around the world.

EMT Tim Daly's lower extremity injuries were severe and would confine him to a wheelchair for months. In addition to supporting Daly and family during his hospital stay, Allina employees immediately began helping Daly's family prepare his home for a wheelchair. Ordinary tasks like transportation, medical equipment, meals and encouragement became an organization-wide project.

News of the crash was quickly reported by local media, but not before the leadership team helped to guide the story to be about the injured and their need for support.

Contrary to the common corporate practice of saying little about an event until all the facts are known and public relations and legal departments have been consulted, LaCroix took a risk and within hours of the accident began providing information about the event to his entire staff through public Facebook postings.

The initial posting spoke frankly about the crash. Nagel was unconscious and in intensive care and his prognosis uncertain. Nagel's family wanted people to know what was going on, that Nagel was in need of support and prayer, and they wanted LaCroix to get the word out.

Rather than wait for the usual corporate news release, he moved quickly and communicated from the heart through Facebook. When local media picked up the story, they quoted from LaCroix’s posts. The quotes helped focus the story on the care and support of those who were suffering, which Allina has continued throughout the year.

Neither of the crew members have returned to full duty. After five days in a coma Nagel woke up, and has continued to make progress in recovering from a severe TBI. Daly has had several surgeries and is regaining use of his legs and feet.

"This has been a team effort," LaCroix said "Everyone in our organization has stepped up. It's been amazing to see how much people really care."

What are some misconceptions TV has taught you about EMS?

Emergency! Chicago Fire. Sirens. Bringing out the Dead.

These are just a handful of the EMS shows and flicks we’ve all fallen prey to watching. While entertaining, they also have their teaching-moment downfalls.

We asked our fans on Facebook to share some inaccuracies they’ve seen while watching a TV show or movie about EMTs and paramedics. Here are some of their responses.

Have something else to add" Post it in the comment section.

"Disregard scene safety, just run in!" — Ana Silva

"Traffic always gives emergency vehicles the right of way." — Michelle Battey

"Screw c-spine. Just get that guy in the truck!" — Kory Smith

"Yelling 'C'mon!' or 'Stay with me!' always brings the patient back to life.' — Georgie Pirie

"All EMS workers are thing and neat." — Amanda Barber

"CPR is only performed for a few seconds before you dramatically say, 'We lost em.'" — Jessica Byrd

"That doctors wait outside the hospital in the rain for the ambulance to arrive, and help move the patient from the ambulance stretcher to the hospital stretcher." — Kathy Merchant-Kliwinski

"The great pay. Everyone lives in a beautiful home and never stresses over which bills to pay." — Michael Reigner

"That you can shock asystole and bring someone back." — Chelsea Taylor

"We get to sit down and eat meals like normal people. We never get splattered with blood, puke, urine or feces." — Bob McGee

Blauer's new boots are put to the test

I’ll be honest; I’m a boot snob.

I recently received a pair of Blauer's new Clash Boots to evaluate. I really did not think fancy lacing and rugged lightweight comfort could sway me from my go-to brand, but boy was I wrong.

My current boots have a fairly loose, flat heel. The first few minutes in the Clash brought immediately improved heel control and balance. By also being a little more on the balls of my feet, I discovered it was easier to keep my footing and maintain forward-momentum hiking.

This became glaringly obvious when I went off-road in them. On a breaking shale hillside, I always felt in control. It was also noticeable coming down steep hills when the improved posture kept me more upright on a tight descent. They even have fence-climbing grooves in the toe.


The construction materials are also exceptional. Full-grain leather provides real strength and protection, while the nylon panels offer ventilation.

The end result is a rugged, protective boot that is surprisingly light. An oil and slip-resistant rubber sole, with hybrid traction tread pattern, give you grip on and off the pavement in rain, snow or shine.

Blauer’s waterproof membrane enhances waterproof leather, suede and nylon materials, blocking water from coming in, while still letting perspiration out.

I went outside after a summer pop-up rain shower and stood in a puddle about 1 to 1.5 inches deep to test the waterproofing around the main seams. As I was standing there waiting for telltale signs of moisture, my wife walked out onto the porch.

“What are you doing standing in a puddle"” she asked.

“I’m testing a pair of boots, honey,” I replied. Without hesitation, the retort: “Well, you look pretty stupid.” I suffered this embarrassment without one drop of water entering the boots.


I really like the extra cushioning in the sole, particularly in the heel area. It’s very shock absorbent, and is radiused to enhance driving comfort on a long shift.

I spent my first day in the Clash almost exclusively on my feet. The firm lacing system and bouncy heel led me to try a few low test PLF’s off a wall. These boots are amazing jumpers. They would be great for a paratrooper or in a pararescue situation.

The flexible compression-molded EVA midsole and PU foam heel cushion also helped provide long-lasting impact absorption. The antibacterial and moisture-wicking lining kept them comfortable and dry.

I was also surprised that absolutely no break-in period was required. I had brought a back-up pair in case the break-in got rough, but I never needed them. The Clash was comfortable from the start to finish of a very long day.

Easy on, easy off

The BOA lacing system is astonishing, and my favorite feature of the boot.

For those that have not seen it yet, it combines the speed of a zipper with the support of a lace. It’s quickly becoming popular in sports footwear, and ski boot companies even use it.

BOA provides you a quick in-and-out of the boot, and is engineered for comfort and performance. The system has a braided stainless steel cable for long-lasting durability.

I quickly grew to love the BOA system. Twist and pull, and off the boots come. A quick twist or two, and you are tightly laced for maximum ankle support.

The other thing I like it the flexibility where you need it. The lacing gaps are strategically placed so that some flexibility, like foot extension, is useful. I just can’t get over how cleverly this boot combines rigid ankle and forefoot support with a surprising range of motion.

Blauer makes the Clash in a variety of styles. They have both 6- and 8-inch-tall versions and waterproof, non-waterproof and insulated models. Whether you work in the desert or the mountains, you can find a model suited to your specifics needs. Prices range from about $130 to $170.

Use this analysis tool for a better EMS grant proposal

Building a strong argument for your grant proposal is not an easy task, but using a cause-and-effect analysis to determine which areas to focus on can make the process a lot easier.

First, determine what problem are you trying to solve. For some agencies this could be quicker response times, increasing cardiac arrest survivors, or reducing injuries for on-duty personnel.

When constructing a grant proposal, be mindful of every facet of the problem and how it affects your agency and the community you serve. There are many ways to accomplish this task; one that I find very useful is the fish-bone diagram.

This technique helps identify many possible causes for a problem, and can lead to great brainstorming for an individual or a group.

For example, here’s an example of the fish-bone diagram showing a problem of missed free throws in basketball.

As you can see, the diagram lists the possible causes that have led to the effect of missed free throws. The example above does a great job providing a broad range of specific causes, and this is exactly how you must approach a grant proposal.

Cause: Poor cardiac arrest outcomes

For our example, let’s say an EMS agency is experiencing poor outcomes for out-of-hospital cardiac arrests. What factors could be contributing to these poor outcomes"

Was bystander CPR done" Were AEDs available and used" What was the response time of EMS" How far was the incident from the nearest hospital"

Take a moment to construct your own fish-bone diagram and submit it in the comments below.

Effect: Poor cardiac arrest outcomes

Now that we have an excellent idea of what causes our problem, how do we develop this information into a grant proposal"

Through your fish-bone diagram, you concluded one cause was poor AED availability. To break this down even further to get to the root cause, we could do another fish-bone diagram for just poor AED availability. However, in this article we are going to keep it simple.

We will use this information for an extremely common grant application question: summarize the purpose of this request. In this case, the purpose of requesting funding for AEDs would be to improve out-of-hospital cardiac arrest for your community.

This is a clear and concise opening statement that leads the way for a great grant proposal.

The fish-bone diagram is a useful tool to dissect your problem and better highlight root causes of a problem that often have financial implications and can be addressed through grant funding.

Spotlight: Vitalboards provides an accessible spot for EMTs to access emergency info

Company Name: Vitalboards
Headquarters: O’Fallon, Missouri

Vitalboards’® mission is to bring its lifesaving program to every community within the continental United States.

The product features an 8 ½ x 11-inch magnetic memo board with a pen and clip that mounts to a refrigerator door. The reverse side includes an area for each homeowner to list their vital health information and aims to be easily accessible to EMS responding to in-home emergencies.

It also includes a free Vital ICE app that can be custom-branded for responders. Departments can send out push-notifications to users and connect users to local safety campaigns and other community information.

Where did your company name originate from"
We decided on the name based on its simplicity and literal meaning. ‘Vital’ is defined as “absolutely necessary or important; essential,” and ‘boards’ is indicative of the memo board component of our program, which features an area on the reverse side for homeowners to list their vital health information.

What was the inspiration behind starting your company"
Not many people are conscious of ‘what if’ emergency scenarios involving themselves or a loved one; most of us avoid thinking about it. We thought if we could provide EMS and other first responders with patient-provided medical information on the backbone of products that people actually can use, making everything easily accessible in an emergency situation, we would have something truly unique.

Why do you believe your products are essential to the EMS community"
We’ve received numerous reports from EMS stating that historically, they have struggled with locating patient medical information while on emergency house calls. According to those surveyed, existing medical information programs fail in this area due to the fact that they can seldom locate the information card, likely because homeowners can’t utilize them for any other purpose so they don’t keep them somewhere where they’re easy to find. And quite frankly, they are often poorly designed and aren’t the nicest things to post on the refrigerator door.

To further complicate the issue, many people are purchasing stainless steel refrigerators today, which don’t accept magnets often used for mounting vital information cards. Therefore, most homeowners relegate them to a drawer somewhere, where it does neither the patient nor the responding EMTs any good.

Vitalboards® not only provides an aesthetically-pleasing, lifesaving product that can adhere to stainless steel refrigerators, it also features a free Vital ICE app for iOS and Android which will be unveiled in November 2014. The app is an extension of the Vitalboard® while the homeowner is outside of the house, and contains information that emergency personnel need. The app can be custom branded for EMS agencies and fire departments, and features a back office site where they can send out push notifications to Vital ICE users, making the app a powerful, much-needed emergency communication tool.

What has been the biggest challenge your company has faced"
As a startup of less than two years, there have been obvious challenges that come with a smaller company, such as identifying the key customer base, getting our marketing/branding in place, and establishing distribution channels. The biggest challenge of all has been identifying the key customer base. Given the fact that Vitalboards® can be utilized by nearly any business or organization as an effective, lifesaving community outreach program, it was difficult to focus on one single customer base.

What makes your company unique"
Vitalboards® is not just a one-trick pony. We not only feature a lifesaving memo board product that homeowners love and actually use, but also a lifesaving mobile app that doubles as an emergency communication platform for participating EMS and fire departments.

What do your customers like best about you and your products"
Homeowners love our memo board product because it’s a useful, free, everyday communication tool for family members. EMS and first responders like the product because they can see the homeowner’s vital information on the back of the board, in a location they can easily find. The upcoming release of Vital ICE is garnering nationwide attention already, mostly due to its emergency push-notification feature.

What is the most rewarding part of serving the first responder community"
We are proud to be a part of saving lives. We have already received numerous accounts of our program in action, and how it also goes on to bring much-needed free PR to local EMS and fire departments across the country. Having a program that represents a solution to a nationwide challenge is truly rewarding.

Do you support any charitable organizations within public safety"
Yes, our charity of choice is the National Fallen Firefighters Association, which has received 5 percent off all proceeds for each order since our inception. We are also open to diverting these funds to a more local cause within each community, based on the department’s wishes.

Is there any fun fact or trivia that you d like to share with our users about you or your company"
We love our Cardinals baseball here in St. Louis!

What s next for your company" Any upcoming new projects or initiatives"
The Vital ICE app (currently in beta testing) will be unveiled in the upcoming 2014 EMS World Expo in Nashville, where we are a finalist in the nomination for the Innovation Award. Feel free to stop by our booth for a quick demo and see how it could benefit your department. Version two of Vital ICE is already in design for 2015, and will further redefine what an ‘In Case of Emergency’ app can do.

Concerns with EMS dispatch need to be documented

After reading this editorial a few times, I’m pretty sure that I don’t get what the problem is regarding the absence of the EMS communication department within the combined dispatch center.

The writer implies that with the EMS center a mile away from the “main” dispatch, it somehow makes the center an “obstruction” to efficient operations. How is this obstruction being measured" Are there documented delays in the dispatch of EMS units"

Three Rivers Ambulance Authority is accredited by the Commission on Accreditation of Ambulance Services and an Accredited Center of Excellence by the International Academies of Emergency Dispatch. I would imagine that these accrediting agencies might take a look at communication efficiencies as part of their process.

EMS communication has evolved into a sophisticated operation, allocating thin resources appropriately and maximizing the effectiveness of the system. It’s an integral part of an overall EMS operation. In this case, this center receives no subsidy from taxpayers for its operations, which I suspect is not the case with the consolidated dispatch center.

This sounds more like some unhappy or envious officials who are making waves and trying to consolidate control. If there are issues, then they should be clearly stated, well documented and supported by a level of evidence that outweighs the cost of moving centers.

Otherwise, what’s the sense"

Clinical solution: 8-year-old at school with trouble breathing


According to the Centers for Disease Control, reports of food allergies have been on the rise over a 10-year period. It is unclear if this change is due to increasing rates of allergy or simply increased awareness and better reporting.

Regardless, it is currently estimated that food allergy affects approximately 4 percent of children under the age of 18 in the United States. Eight foods account for nearly all reported allergic reactions: milk, eggs, peanuts, tree nuts (almonds, walnuts, etc.), fish, shellfish, soy and wheat.[1]

Severity of allergic reaction can vary depending on the patient as well as the particular food. Reactions can be localized or may result in anaphylaxis.


When responding to a patient having an allergic reaction it is important to determine how severe the reaction is. Generally, it is sufficient to differentiate between three levels: allergic reaction, anaphylaxis and anaphylactic shock.

1. An allergic reaction (regardless of severity) occurs when an antigen enters the body. An antigen is a substance that triggers the immune system to respond. Immunoglobulin E binds to the antigen and provokes the release of histamine and other chemicals, which promote inflammation in the body; how broadly this inflammation occurs influences the classification of the reaction.

A simple allergic reaction will often present with hives, redness and itching on the skin. These symptoms are generally limited to the area of the body which was exposed to the antigen. An example of an allergic reaction would be redness and watering of the eyes from exposure to pollen.

2. Anaphylaxis occurs when histamines and other immune chemicals result in effects throughout the body. These effects can include dilation of the blood vessels, leaking of fluid from blood vessels and contraction of the muscles that surround the air passages in the lungs.

Anaphylaxis should be suspected when a patient presents with hypotension or respiratory distress after exposure to a known or suspected antigen.

3. Anaphylactic shock occurs if anaphylaxis progresses and hypotension becomes significant.

Treatment of patients with a simple allergic reaction is largely supportive. Many EMS systems indicate that diphenhydramine be used for such cases. When a patient is experiencing anaphylaxis or anaphylactic shock, however, epinephrine is the treatment of choice.

Despite some teaching to the contrary, there are no absolute contraindications to the use of epinephrine in anaphylaxis. EMS providers may be hesitant to aggressively use epinephrine on a conscious patient, preferring instead to give diphenhydramine or adopting a wait-and-see attitude. This is a risky decision.

The mechanisms of action for diphenhydramine and epinephrine can be thought of like a sink filling up with water. In this example, the water represents the histamines and other immunologic chemicals in the body. Diphenhydramine works by competitively binding to the receptor sites in the body that are normally bound by histamines.

In our example of the sink, giving a patient diphenhydramine is like opening up the drain to allow water to flow out. While opening the drain will help to empty the sink, there is still water flowing in from the faucet.

Epinephrine works to counter an anaphylactic reaction by constricting blood vessels, relaxing smooth muscle in the lungs and decreasing the release of histamine. Giving epinephrine to an anaphylaxis patient is like turning off the faucet filling up the sink.

Many patients with a history of anaphylaxis or other serious allergies are often prescribed epinephrine auto injectors. These devices deliver a dose of medication by the intramuscular route and are intended to be used by patients or bystanders in case of exposure to an antigen.

EMS protocols may allow for providers to either carry auto injectors or use a patient's auto injector to deliver this medication.


Based on Stephen’s history and presentation, it is apparent that he is suffering an anaphylactic reaction after exposure to peanuts.

You ask the staff if Stephen has an epinephrine auto injector prescribed to him. After consulting his emergency forms, they tell you that he does and the injector is brought to the room.

You ask Stephen if he feels that he can administer the injector himself. He shakes his head "no." Based on your protocols, you elect to administer the epinephrine yourself.

After checking that Stephen’s name is on the auto injector and that the medication is not expired, you remove it from its packaging and press the injector down on Stephen’s outer thigh, holding for 10 seconds.

Shortly after administering the medication, you notice that Stephen’s breathing is noticeably improved. He starts answering your questions and your engineer is able to obtain a set of vital signs.

You radio an update to the responding ALS unit and continue to monitor for any changes in his status.


Centers For Disease Control And Prevention. "Food Allergy Among U.S. Children: Trends in Prevalence and Hospitalizations." MCHS Data Brief. Centers For Disease Control And Prevention, Oct. 2008. Web. 10 Sept. 2014.


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