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

EMSA is updating the vehicles with new patient loading and restraint systems

Bulgrarian government reports 175 attacks on medics in 2014 when responding to impoverished Roma community

City officials want the fire department to add EMS, but a private ambulance company says it would put people out of work without bringing in as much revenue as projected

Officials hope to implement the service by July 1

Arrowhead EMS conference attendees sought out the best EMS products to improve patient care and enhance provider safety

Hosts Chris Cebollero and Kelly Grayson discuss the importance of keeping complete and accurate records

Hosts Chris Cebollero and Kelly Grayson discuss a threat by an Ariz. ambulance company to go on strike over pension pay

One hopes that a show like this will build empathy for its firefighters and medics and spread to the larger first-responder community

A 10-year-old noticed the victim of a car crash appeared to be deaf, and ran over to help medics communicate with the injured woman

For a week she debated: 'candy or pets,' and raised additional funds for the fire department and ambulance service to purchase two kits

EMSA is updating the vehicles with new patient loading and restraint systems

Bulgrarian government reports 175 attacks on medics in 2014 when responding to impoverished Roma community

City officials want the fire department to add EMS, but a private ambulance company says it would put people out of work without bringing in as much revenue as projected

Officials hope to implement the service by July 1

Arrowhead EMS conference attendees sought out the best EMS products to improve patient care and enhance provider safety

Hosts Chris Cebollero and Kelly Grayson discuss the importance of keeping complete and accurate records

Hosts Chris Cebollero and Kelly Grayson discuss a threat by an Ariz. ambulance company to go on strike over pension pay

One hopes that a show like this will build empathy for its firefighters and medics and spread to the larger first-responder community

A 10-year-old noticed the victim of a car crash appeared to be deaf, and ran over to help medics communicate with the injured woman

For a week she debated: 'candy or pets,' and raised additional funds for the fire department and ambulance service to purchase two kits

At the Arrowhead EMS conference in Duluth, Minn., I joined paramedics and EMTs from across the state and northern Wisconsin seeking out EMS products that aim to improve provider safety, patient care, and EMS operations. Several products caught my attention and I was able to learn more about those products from representatives at the show.

1. UCapIt: Better dispense supplies and medications

The UCapIt Controlled Access Pharmaceutical Dispenser was the most prominent item in the BoundTree Medical booth. Although we shared a good laugh about the frequency with which exam gloves need to be restocked during deer hunting season at EMS agencies in the north country, the careful and intentional distribution of medical supplies, along with medications, is important for agencies of any size.

With the UCapIt, supplies from the mundane, like gauze pads, to the controlled, like narcotic medications, can be securely dispensed. Two-person authentication can be programmed for specific items. All dispensing information is electronically reported so managers know when restocking is necessary and for monitoring usage. Learn more about the UCapIt Controlled Access Pharmaceutical Dispensers.

2. Airspace CO monitor: Always on

A call for "sick person" or "flu-like symptoms" could be caused by many things, including carbon monoxide (CO). The odorless, invisible gas probably is the cause of more illnesses than we realize and a danger to EMS providers unless we are monitoring for it on every call.

The Airspace CO monitor, assembled in Wisconsin, is portable, easy-to-use, and gives audio and visual alarms. Attach the compact CO monitor to the jump bag (first-in kit) to make it part of every patient contact. Learn more about the Airspace monitoring systems.

3. EMMA capnograph: Real-time and accurate ventilation monitoring

The EMMA capnograph is a neat little bit of whiz bang that packages big waveform capno monitoring features in a finger-sized package. By now we should know the importance of capnography, but we continue to hear stories about missed intubations or patients that were poorly ventilated because capnography was not utilized. EMMA, easily attachable to an airway, quickly generates a high quality and viewable waveform where you are looking – at the BVM and airway.

When the Moore Medical rep exhaled into a KingLT with an EMMA attached, I was impressed at how quickly the capno waveform appeared and how easy it was for me to view the normal waveform. Learn more about the EMMA Mainstream Capnometer.

4. Whelen V23 V-Series lights: Don’t take changes on roadside visibility

I'll be honest. At most EMS tradeshows, I make a wide pass around the pulsing, bright lights that many vendors display for emergency vehicles. Squinting through my fingers, I tentatively approached the Whelen lighting booth because day or night I am committed to making the roadside, one of the most dangerous EMS work environments, safer for all responders and reducing the risk of secondary collisions.

I’m glad I braved my photophobia to learn about recent enhancements in warning lightheads for ambulances and other emergency vehicles. Almost all lighting for new vehicles or being retrofitted to existing vehicles uses LED technology. Of special interest to me were lights in the V23 V-Series that offer 3-in-1 combination lighting with 180 degree wide-angle visibility. These multi-function lights provide warning notification when activated, as well as flood lighting when programmed, to the opening of a door or compartment. Combination lights also mean fewer lights need to be mounted on the ambulance and a cleaner overall look for the vehicle. Learn more about V23 V-Series and other Whelan warning lightheads.

5. Ferno x-frame cot: Now in production

First quietly, and then publicly, Ferno has been demonstrating prototypes of its INX patient cot, which is a component in the Ferno Integrated Patient Transport and Loading System. The innovative cot is now in production at FERNOs Ohio manufacturing facility.

The new cot is designed to be part of an integrated system and complicate the use of a stair chair, like the Ferno PowerTraxx, to extricate a patient from their house or 3rd story apartment. Experienced providers have long known that the stair chair is the optimal tool for moving patients from difficult-to-reach locations and the cot, regardless of its weight, is not well-suited for lifting or carrying over any distance or obstacle.

Each time I caught a glimpse of the FERNO, booth attendees were gathering around for demonstrations of how the INX cot eliminates lifting patients. Learn more about the Ferno EMS integrated patient transport and loading system.

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 discuss the challenges in documentation – from spelling errors, to not taking pride in your record.

“No one wants to believe they’re poor at documentation,” Grayson said. But being cross examined in court is not the right time to discover you don’t have a good chart, he said.

Cebollero discussed the challenges that come with being told false information by patients, but also pointed out that documentation is what leads to funding.

“This is what pays the bills,” he said. “This is where we get the money in.”

In the news portion, they talk about a Mich. ambulance service that shut down to avoid bankruptcy.

“You have to ask, what’s the cost of doing business"” Grayson said. “What’s the cost of providing quality medical care to your community" Apparently they think $75,000 a year is too much.”

They also discuss a threat by Arizona’s Southwest Ambulance to go on strike over pension pay.

By law the company would have to give Rural/Metro 10 days’ notice, and the parent company says it has a contingency plan in place.

“It’s not about a contingency plan,” Cebollero said. “It’s getting back to the table and giving workers the feeling you’re listening to what they’re saying.”

Grayson points out the EMS union is not asking for money, but rather $8 million in pension funds – which helps ensure workers make a career out of EMS and retire from the industry

“You’d think they could sit together and hash out their differences,” Grayson said.

They also talk about Sioux Falls, S.D., which won an appeal to contract with Paramedics Plus, and discuss an ambulance rollover that injured three people in Ohio when the driver veered into the median for unknown reasons.

"Nightwatch" is a first-responder show for first responders. There's grittiness, failure, triumph, sensitivity and everything that falls in between. It even touches on the mundane, routine aspects of the job — a welcome and refreshing surprise.

I know this is an invitation for angry comments and letters, but I don't like "Chicago Fire." The limited number of episodes I watched were long on action and short on authenticity.

By that, I mean the human authenticity. Firefighters and medics watching "Nightwatch" can pick out technical and tactical things they should be doing differently. If it were perfect, it would be a training video. Life is not perfect.

There were times when the New Orleans responders' dialogue and actions seemed heavily influenced by the camera's presence. But there were more times when the real responders came out — flaws and all. And it is that human authenticity I hope drives the show's future episodes.

Yes, authentic characters will make for better entertainment. But more importantly, people develop empathy for authentic characters — they begin to see life through others' eyes.

And in a perfect world, this empathy for a small handful of characters will have a carryover to the larger firefighter and EMS community. Any spike in public opinion will help us on the day-to-day fire and medical calls, in the annual municipal budget battles and when state and national legislation affecting us come up for votes.

That's why I'm far more excited to see a show like "Nightwatch" than one with unbelievably perfect looking characters with unbelievably complicated life stories.

If you missed the premiere, you can watch it here.

Allow me to throw a few numbers at you today:

51 - 63 - 13 - 14 - 4

While you could play these numbers for your next attempt to win the lottery, there’s meaning behind them. In order, they represent a quick snapshot of the gender and ethnic breakdown of our country’s population, based upon the U.S. Census data: 51 percent female; 63 percent white, of nonhispanic background; 13 percent black; 14 percent Latino; 4 percent Asian.

Let’s compare that with the best known set of similar data for EMS providers.

29 - 81 - 8 - 9 - 1

A quick comparison reveals that our staffing doesn’t line up with the general population. Frankly, in my travels across the country the numbers are even more skewed in favor of a young, white, male dominated industry.

There’s also another number.

According to the National Health Statistics Reports, about 1.8 percent of males identify as being gay. That number may be higher, as many in the study chose not to disclose their sexual identity. In other words, it’s you can expect that in most mid-to-large departments, at least a few staff will be homosexual.

I have no idea how many of the allegations are true in this story about a medic who filed a discrimination lawsuit saying he was fired for being gay. I also don’t know the perception or misinterpretation by parties on both sides of this lawsuit. Yet as best as I can tell, being gay, black, brown or female has no bearing on the ability to perform the work.

To let internal biases and stereotypes color the ability for someone to be a productive worker is insensitive and self-serving. It’s difficult to imagine how EMS can approach culturally ingrained scene dynamics in a sensitive way, when the majority of us don’t come from that background. The lack of inherent understanding and perspective can produce unnecessary tension and misunderstanding, and a misinterpretation of what is said and done by both patient and provider.

Moreover, it creates a greater sense of mistrust between the community and its government-provided services, which was demonstrated recently in Ferguson, Mo. Not actively recruiting EMS providers from the community means not tapping into a potent workforce that is capable of providing excellent care.

Here’s the real issue: We actively resist making these changes.

Most of this is unconscious. We blame the school system, the cultural barriers, and the nature of the work as reasons why females and minorities are not attracted to the profession.

What we fail to grasp is the dynamic that the “other side” sees – a white, male, middle class dominated workforce that has little interest in understanding the cultural subtext that surrounds medical, psychological and social issues that are present at any EMS scene.

We have to be proactive in researching root causes for the barriers that exist to protect the status quo, and engage in ways to tie the local community to its safety services. Our nation will continue to diversify even more rapidly than it has before. EMS must be reflective of that change, for its own good.

The upcoming EMS on the Hill Day is the perfect time to advocate for The Field EMS Bill, which redefines EMS in the federal government, establishes grant programs and helps determine how funding is delegated.

The National Association of Emergency Medical Technicians (NAEMT) will host the 6th annual EMS On The Hill Day in Washington, D.C. on April 28-29.

The Field EMS Bill is sponsored in the House by Indiana Rep. Larry Buschon and championed by NAEMT as an advocate for their members and EMS professionals around the country.

“In many areas of the nation, EMS services are highly fragmented, poorly equipped and insufficiently prepared for day-to-day operations, let alone natural or man-made major disasters,” said Melissa Trumbull, Industry Relations Manager for NAEMT.

This, in part, has to do with the legal designation of EMS under the Department of Transportation. The bill addresses the 2006 Institute on Medicine Report, Emergency Medical Services: At a Crossroads, that identified systematic problems in EMS including: funding, training, research, and national coordination of quality improvement metrics.

Consequences if the EMS Field Bill fails

• Increased difficulties with access to care due to increased response times, inadequate staffing, and insufficient equipment
• Stifled progression of EMS
• Closing of agencies due to financial constraints

NAEMT believes that EMS is the gateway to the public health system and has a significant impact on the crucial initial moments of a patient inside the health care system. The EMS Field Bill designates essential funding that is necessary to sustain the quality of care we give our patients, but also has the opportunity progress to preventative programs like community paramedicine.

While some providers feel that this bill does not do enough or will have no impact on EMS, NAEMT challenges those sentiments stating, “The bill contains specific remedies to the issues identified in the IOM report.” Additionally, the EMS Field Bill continues to educate the public about what EMS is and has opened a dialogue with Congress about field emergency medical care and its impact upon the greater health care system.

Learn more about joining NAEMT for EMS on the Hill Day.

On July 17 2014 Eric Garner died after briefly resisting arrest. The most glaring mistake was the failure of both EMS and law enforcement to recognize a life threatening situation and take immediate action.

Video of the incident has been seen by thousands of people. In the footage, EMS providers arrive and appear to do nothing more than check a pulse and eventually place the patient on their stretcher. Bystanders are angry, police are unsure what to do, and even the EMTs are indecisive in their actions. The footage was bound to go viral.

I’m sure you have a pet peeve when EMS providers are shown inaccurately on TV or in movies. One of my major irritations is when EMS is depicted as doing nothing more than placing an oxygen mask and driving the patient to the hospital (where presumably the real medical care occurs). I'm sure you know that our role is so much more than that. We bring high quality medical care to wherever the patient is. We are more than an expensive taxi ride. In this case, the failure of EMS to immediately provide quality medical care is disappointing.

Cause of death

In August, a New York City medical examiner found that pressure on the chest and neck caused the death of Garner. Notwithstanding this finding, death as a result of positional asphyxia is a relatively common phenomenon.

First coined in the 1970s by a King County Seattle medical examiner, positional asphyxia and the exact way in which it causes death has been debated ever since. Several studies on the effects of being restrained while prone have been conducted. Some show a 25 percent reduction in forced vital capacity, the amount one is able to forcefully exhale after maximum inhalation, and used to measure the maximum volume in the subject’s lungs.[1]

Several other studies evaluated the immediate metabolic effects one may experience as a result of lying prone after a short period of anaerobic exercise. Those studies found no significant effect to the end tidal CO2, stroke volume, or blood pressure. One should quickly note that all of these studies were done using young healthy subjects with no know health risks. Obviously more research on the subject is needed. In either case, the effect of violent restraint and the weight of several people on the back of a subject, even for a brief period, should not be underestimated. EMS providers need to be vigilant and rapidly assess any person for which law enforcement summons our services.

In this unfortunate event there is plenty of blame to go around, but rather than placing the majority of the blame on individual providers, let's evaluate the system as a whole to determine what actions need to be taken. What can we learn" What can be improved" From simply viewing the footage[1] , I think we can identify several potential areas of improvement.

Public safety relationships

In some locations the relationship between different branches of public safety is a tense one. EMS providers may want to avoid a confrontation, and in so doing, they may not adequately assess the patient. In other cases, EMS providers may be intimidated by law enforcement. This is particularly common with newer EMTs. EMS providers need to be confident and kind enough to seamlessly work with law enforcement to avoid making a bad situation worse. Working at the management level to improve inter-agency relationships should be a priority.

Provider safety

EMS providers may feel uncomfortable if there are loud or angry bystanders. In this case, bystanders were frustrated with law enforcement. In the end, they also became frustrated by the apparent failure of EMS to intervene. Plenty of law enforcement officers were on scene, and when the scene is as safe as it can be, it's time for us to go to work. If EMS provides quality care, it will often further de-escalate the situation.

Respiratory assessment

It is unclear from the cellphone video footage if Garner was breathing. Some of the law enforcement officers can be heard saying that he was, but of course there is a difference between gasping, agonal respirations and normal breathing. Rapidly distinguishing between the two is important, and should be repeatedly practiced.

Pulse assessment

We've all felt our own pulse pounding during a stressful event. Attempting to palpate the presence or absence of a faint pulse can be difficult, but it should be done in a rapid manner taking no longer than 10 seconds. If you are unsure if you are feeling your patient’s pulse, consider attaching a pulse oximeter with plethysmographic waveform which can provide objective proof that the patient does indeed have a pulse.

Of course one should be able to assess the patient’s pulse with no more than their fingers, but it is good to be aware of all the tools at your disposal. In any case, if you are unsure if a pulse is present or not, immediately begin CPR and apply defibrillation pads.

Patient positioning

When caring for pediatric patients, we know that a quality assessment means removing, or at minimum looking, under their clothes. In the case of Garner, his position on the ground facing away from the provider could have had a negative impact on the assessment. Level of consciousness can be difficult to assess when you are not able to clearly view the patient's face. Position yourself or your patient in a manner that allows a quality assessment. If this means removing handcuffs, quickly do so with the assistance of law enforcement.

Bring your tools to the patient

The ability of EMS to deliver medical care to the location of the patient is arguably the reason for our existence. In this case, no obvious medical care was provided until the patient was moved from the scene. After speaking with a source close to the event, EMTs moved Garner to the ambulance where paramedics were called and care was rendered. In a field where we are fond of saying 'seconds count,' the failure of EMTs to rapidly render aid is concerning. Make sure when you arrive at the patient's side, you are able to provide at least basic medical care. Bring your equipment with you.

EMS provider bias

Preparing yourself for a patient based on dispatch information can predispose you to look for whatever it is you thought you’d find. Often EMS providers expect to find a patient in police custody to be looking for an escape from an immediate trip to jail. Don’t allow your preconceptions to cause you to see only what you want to see. Evaluate every patient as if there is almost no chance they are lying to you.

The goal

When a mistake occurs, there are always many contributing factors. Taking a hard look at the system design and process leading up to the incident has the potential to ensure the mistake does not happen again. Often managers take a punitive approach, which of course doesn’t actually solve the problem. Through dissecting the mistakes contributing to the death of Garner, we as a profession can better ourselves. We should never miss an opportunity to learn, and let’s not allow the lessons from this unfortunate incident to pass us by. Let’s learn what we can, change what we can, and emerge better for it.

InPublicSafety.com
By Dr. Shana Nicholson

Fire departments across the country are struggling to recruit and retain volunteer firefighters. Small departments in rural areas are especially dependent on volunteer firefighters to serve and protect their communities.As a firefighter with Shinnston Volunteer Fire Department in Shinnston, W. Va., our department has emphasized a family-oriented approach in order to recruit volunteers. This approach has resulted in far less personnel turnover than the average volunteer department as well as a strong camaraderie within “The Ten House.” This legacy of service extends through multiple generations, with parents passing their knowledge, dedication, and passion for the fire service to their children.

How does “The Ten House” make It work"

In 2014, Shinnston Volunteer Fire Department responded to 642 alarms. These alarms ranged from structure fires and medical calls to vehicle accidents with injuries and entrapments. The department, which serves about 10,000 residents for initial response and mutual aid, is fortunate to have more than 40 volunteer members, many of whom are legacy firefighters. It is only possible to have this many volunteers because the department has the support of families and community members.

The Shinnston Fire Department actively involves the families of its volunteer firefighters so individuals can more easily balance personal lives with serving their community. There is a certain social aspect of a small rural fire department that includes cook outs, holiday celebrations, birthdays, weddings, and even football games.

Read full story: Involving Families Is a Valuable Recruiting Tool for Fire Departments

In 2011, U.S. emergency departments saw 486,000 burn patients, accounting for 0.4 percent of all ED visits.[1] Burns are grouped based on the layer of tissue the burning extends into and are divided into four main classifications known as “degrees”.[2]

Classification of burns by depth and breadth

First-degree burns involve only the outermost layer of the skin, known as the epidermis (“epi” is Greek for “on” or “over”). A common example of a first degree burn is a sunburn, where the outer layer of skin turns pink or red.

A second-degree burn is split into two categories, “partial thickness” and “full thickness.” The thickness indicates how far down into the skin tissue (dermis) the burn has gone. A partial thickness burn will present with blisters on the surface and significant skin redness and pain.

A full thickness burn extends through the whole depth of the dermis. These burns are red or white in color and may present with decreased sensation depending on the level of nerve damage the patient has sustained.

Another way to differentiate between full and partial thickness burns is the speed at which they blanch, or turn white, when pressed on or when the burned area is moved. A partial thickness burn will blanch normally while a full thickness burn will blanch slowly. You can think of blanching like checking capillary refill in reverse. You are looking for the speed at which the skin turns white rather than the speed at which the color returns to normal.

Third-and-fourth-degree burns are those which have moved through all of the layers of skin and into the fatty tissue (third degree) and muscle and bone (fourth degree) below. Patients with these burns generally do not have any pain at the site of worst injury because the nerves in the dermis have been destroyed. Burns will be black or white and there will be no blanching when the wound is pressed on.

It is important to note that with thermal burns, a burn may be surrounded by burns of lesser severity. For example, a third-degree burn will often be ringed by second and first-degree burns depending on how concentrated the heat source was.

General treatment for thermal burns

The initial goal of treatment in burn care is to stop the burning process. First ensure the patient is removed from the heat source. Then consider dousing the area in cool (but not ice) water.

Immediate cooling of a thermal burn with tap-temperature water has been shown to be an effective means of reducing the temperature of the wound and can speed also speed tissue recovery.[3] It is important to note, however, that cooling large burns (> 10 percent total body surface area) may actually result in poorer patient outcomes.

The skin serves to assist in temperature regulation and damage to large areas of tissue can compromise the ability of the body to thermoregulate. In these circumstances cooling can overcome the body’s compromised ability to maintain homeostasis.[3]

After cooling the burned area, the wound should be covered with sterile dressings. Local practice may differ on when to use dry and wet dressings, be sure to refer to your local protocols or consult your medical director. Patients meeting burn criteria based on local protocols may be transported to a specialty burn center.

Treatment for cook's burned hands

Based on your clinical findings during Carl’s assessment, you determine that he has partial thickness second-degree burns. This determination is made as a result of the destruction of the epidermis (skin sloughing or sliding off the wound from ruptured blisters) as well as the consistent amount of pain across the burn indicating that there is probably not extensive nerve damage. Since the burn occurred approximately 10 minutes before your arrival, you have Carl place his hands under cool running water. While allowing the water to run, you carefully remove Carl’s wedding ring in anticipation of his fingers swelling. As the ALS transport unit pulls up on scene you apply a sterile dressing to the burn.

After listening to your report, the ALS crew starts an IV and begins to administer fluid and provide narcotic pain management. Carl is assisted to the gurney and moved to the ambulance. The crew follows local trauma triage guidelines and transports Carl to the regional burn center because the burn involves his hands and will require specialty care.

References

1. Centers for Disease Control and Prevention. (2011). National Hospital Ambulatory Medical Care Survey: 2011 Emergency Department Summary Tables. Retrieved from: http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2011_ed_web_tables.pdf

2. (n.d.). Burn classification. Retrieved from University of New Mexico Hospitals website: http://hospitals.unm.edu/burn/classification.shtml

3. Prehospital Trauma Life Support Committee Of The National Association Of Emergency Medical Technicians In Cooperation With The Committee On Trauma Of The American College Of Surgeons. (2014). Burn injuries. In PHTLS: Prehospital trauma life support - eighth edition (pp. 406-428). Burlington, MA: Jones & Bartlett Learning.

NHTSA research into ambulance (and emergency vehicle) driving operations and driver training is long overdue.

Not because vehicle-related incidences account for a significant number of actions against emergency vehicle operators – which they do – but because the lack of consistency in standards and training leaves the vehicle operators vulnerable.

Unfortunately, like much that is “organized” by the federal government, I am not optimistic about the outcome of this NHTSA investigation.

Gathering information is one thing. The breadth and quality of the information is another; as is the usability of the information.

To be useful, the information gathered will need to identify the specific causes of “negative incidents” involving emergency vehicles and, more importantly, it will need to show a causal link between the incident, the outcome, and the impact of training – or the lack thereof on both.

To be valuable, the aforementioned data will need to be translated into a training curriculum that addresses and prevents (or at least reduces the number of) negative incidents involving emergency vehicles.

To be meaningful, the curriculum will need to be supported by enforceable standards for compliance.

To be impactful, emergency vehicle operations from coast to coast will need to accept, implement, and follow-through.

As you can see, this will be a monumental task. Without the proper support and follow up, simply gathering the information will be nothing short of a waste of time and energy.

On the other hand, if the project is completed such that the information is useful, valuable, meaningful, and impactful, then emergency vehicle operators will enjoy a level of protection never before seen in EMS. More importantly, the public will benefit from the ever-improving delivery of EMS.

I have two CDs I keep up in the front of the ambulance to play on the way to calls.

For most calls, I play action songs – things like the Rocky theme song, The Final Countdown, and Eye of the Tiger. On the way to a working code I play Stayin' Alive and Another One Bites The Dust - the two songs that are the right tempo for giving CPR. That helps me get in the zone and also puts the right tempo in my head.

Whatever you listen to, don't forget to pay attention to where you're going and what's in front of you, and make sure you can hear your communications center.

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

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.

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

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

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

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.

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.

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?"

Slideshare is an online community and tool for sharing presentations.

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