news for ems professionals · the focus of this issue of lights & sirens will be preparation....
TRANSCRIPT
The “Prepper” Issue
Greetings everybody! It’s been a long winter and everybody is by
now deeply entrenched in planning for warm weather activities.
That crazy groundhog in PA didn’t see his shadow this year, which
allegedly means no more “Bad” winter. I have always been
skeptical about the groundhog day thing and seeing as how we just
saw some of the quickest snow accumulation all winter in recent
weeks, I think I’m in the right for a change!
The focus of this issue of Lights & Sirens will be preparation.
Preparing for warm weather, for certain types of EMS calls, and
for upcoming education offerings.
As we enter
spring of
2013, plans
for the new
G e n e s i s
M e d i c a l
Center are
on track
and EMS
f i g u r e s
heavily into
the design
from traffic flow to parking accommodations at the ED. The new
lounge will be spacious, if not palatial and the entire layout will
certainly be state-of-the-art. Plans are done. Acton will soon begin
and its an exciting time to be involved in EMS.
As technology figures more and more heavily into the delivery of
healthcare, computers are penetrating front-line EMS and not only
at paid services, but also in the Fire Service based Municipal and
Volunteer EMS agencies. Computer based documentation offers
not only the promise of increased quality through expanded
charting, but also increased capture of demographic information,
which is crucial to timely reimbursement of service fees. In the
past, I witnessed much resistance to computer technology among
the more seasoned of our profession (read: “the old people”), but
now I see more and more of these same opponents of technology
now embracing it with open arms.
So indeed, the word “Preparation” fits here, and so let’s get on
with the good stuff!
New Patient inflow planned for Good Samaritan Campus
Beginning April 15th, EMS transports to Genesis will become
simpler due to the onset of construction at the Bethesda Campus.
On that date, EMS will no longer be transporting any patients to ,
Bethesda except for O.B. patients in labor, those patients will be
transported directly to Labor & Delivery on 2 West. This is in
preparation for the construction of the new Medical Center facility
to begin. Meanwhile, Genesis Good Samaritan Campus will be
seeing a renovation to expand the patient treatment area of it’s ED
and improve patient flow from triage to admission or discharge.
Volume 3 • Issue 2 March/April, 2013
News for EMS Professionals
Lights & Sirens is a monthly publication for EMS providers
in the Muskingum County and surrounding areas. To submit
an article for inclusion, please contact Joel Dickinson,
EMS Consultant at Genesis HealthCare System,
(740) 454-7657 or at [email protected]
There will be a lot of support for this initiative to succeed and
EMS will be a critical part of helping this transition to go
smoothly.
EMS Preplanning: Making our jobs easier
The Fire Service is known for developing pre-plans for various
scenarios, facilities and potential disasters. The purpose, obviously
is to develop an organized approach to solve a problem at hand.
The upshot is that it also tends to make our jobs easier. The
following is a guest article written by Joshua Tilton, NREMTP on
just such a method:
EMS Preplanning
Does your department “EMS Preplan”? Of course it would
be impossible to know every single one of your patients, where
they live, and medical history but what about those with special
needs? One thing that I have always been very proactive about and
have done now for a few years is “EMS Preplanning.” We are
excellent about fire preplanning buildings. We know which ones
we will be offensive or defensive attack styles, where all the
hazards are, and where everyone should generally be between
night and day shift. But when it comes to EMS how many times
have you responded to a SOB call just to arrive and find out that
yes they are having trouble breathing, but they have a tracheotomy
and are vent dependant?
Usually when these patients move into an area they are told
by the social worker to please inform the fire department that they
are there. This is usually just a quick little note that says “Hi my
name is and I have Blah.” These little notes are great with the
exception that numbers get transposed and papers can never been
found when needed. One thing to consider is a home visit. Now I
know that we don’t usually make house calls unless something is
burning or it’s a bad day, but it could become more prevalent in
the very near future. Suppose the home was on fire? If you have
already preplanned you know which area of the house this person
is usually in and if there are any special considerations (may
favorite is the 15 oxygen tanks next to the bed warming on the
duct work).
Preplanning is one of
those things that could take a
few minutes but could gain you
so much in the end. It doesn’t
need to be a novel but some of
the things that I like to include
are, the patients actual medical
condition, what are the patients
d e p e n d e n c i e s , b a s i c
information, current med lists, current allergies, special equipment,
where are they in the house, and special considerations otherwise.
Then once all of this information is gathered and a look around the
house has been established the information is invaluable. Go back
and create a computerized record of the information, if the patient
requires special equipment make sure you train your staff on it.
Ventilators seem to be one of the biggest that readily come to
mind. Ventilators are in the scope of practice for a Paramedic and
such if you have a special needs patient dependant on one it is
much easier for the patient to go on their equipment as opposed to
being bagged.
The other thing this is handy for is disasters. Recently we had
the misfortune of being hit pretty hard by the storms. We were
able to fall back on our EMS preplans and to prioritize patients
that needed to be checked on. We have several that are ventilator
dependant and we were able to successfully evacuate them first
into a facility that had been pre arranged with the logistics
coordinator at our EMA.
In the ever expanding role of the fire and EMS services and
with “Community Paramedicine” and “Advanced Practice
Paramedic” programs on the horizon and difficult economic times,
we seem to be encountering more and more home managed
patients. Things that we aren’t used to seeing on an emergency
basis are starting to become regular calls. Through a combination
of EMS preplanning and education the next time we get called to
an “Alert Home” for a displaced trach tube hopefully we will be
ready.
Joshua Tilton is a Nationally Registered Paramedic who holds CCEMTP and EMS
CE -Instructor certifications who works for MedFlight and M&M Fire Department.
He currently lives in North Zanesville with his fiancée, Susy. He can be reached at
EMS: One Mission, One Team
That is this year’s EMS week theme. We love that because the
motto of Genesis Emergency and Trauma Services is One Team!
This year’s Genesis EMS Appreciation Conference will be held on
May 18th at the Genesis HealthPlex. This will avoid the conflict
with Memorial Day Weekend and serve to give EMS Week a very
special kick off! A flyer will be coming to all departments very
shortly and we have some special events in store for this year’s
attendants. Topics will be announced in the flyer and all promise
to be interesting and engaging with several hands-on learning
events..
We will again be teaming up with MedFlight and Air Evac
LifeTeam to present a top shelf conference with door prizes and
good food and best of all; The Conference is STILL FREE to EMS
Providers! Please join us to celebrate you, the EMS providers of
our area!
Registration will be the same as in the past; simply complete and
mail-in the registration slip on the flyer, call Stephanie at the
Trauma Services Office at 740-455-7670, or email registration
information including your name, Department Affiliation, Provider
level and call back number/email address to
News for EMS Professionals March/April, 2013 Page 2
Medication Alert: Epinephrine for allergic reactions.
Please share this information with all clinical staff at your
respective departments.
Adrenalin, or Epinephrine as it’s also known, is commonly used in
the treatment of allergic reactions and anaphylaxis. Administration
of the proper dosage of adrenalin is crucial to proper treatment and
is also a consideration in patients above the age of 40, or at any
age with known heart disease.
The target of adrenalin in allergic reaction is vascular leakage at
the capillary level which leads to angio-edema; the condition
which causes the airway to swell shut in severe cases of allergy.
Peripheral vaso-constriction is a Beta II effect of adrenalin, the
other benefit, broncho-dilation is also a beta II effect. In
combination they both work to alleviate the swelling around the
airway and allow air to pass more freely in and out of the lungs.
The common dosage for allergic reaction is 0.3 to 0.5 mg of
1:1,000 concentration “epi”, administered subcutaneously, which
also thankfully corresponds to 0.3 to 0.5 ml of the drug. Adrenalin
comes packaged most commonly for EMS in 1.0 milliliter glass
ampoules although it also comes packaged in 30 ml vials
(Remember the days of high-dose cardiac epi?).
The mistake most commonly made in any emergency setting (Not
just EMS) is that the caregiver draws the entire contents of the
ampoule and then proceeds to, you guessed it, administer the entire
amount of drug.
The next most common mistake is when this drug is given by the
IV route. Yes, Epinephrine is indicated for use via the IV route for
severe anaphylactic shock, but is not indicated for routine
treatment of allergic reactions.
What’s the difference you
ask? In an allergic reaction
the patient presents with
itching, hives, red skin and
possibly wheezes, but the
patient is not in a shock state
as evidenced by an altered
level of consciousness and
shocky vital signs! The
vascular collapse is what
leads to hypotension and the
altered mentation of the
patient. If your patient is
conscious and not exhibiting
s i g n s o f i mp e n d i n g
respiratory failure, you want to use the SQ route for the adrenaline.
It will be absorbed in a much more tolerable fashion as not to
cause the degree of tachycardia and cardiac workload that a shot
straight into the IV will.
Some tips to help providers avoid giving adrenaline in the wrong
dosage or by the wrong route include:
Only draw the desired dose. Set aside the remainder of the vial or
carry multiple ampoules. Epi is cheap so don’t be thrifty.
Patients use Epi Pens thousands of times a day without having to
have an IV in place first. Recognize the issue and treat it, then an
allergic reaction can’t evolve into full-blown anaphylaxis!
Also, it is arguable that Benadryl, the other component of pre-
hospital allergy care is much more effective when administered IM
than IV due to it getting a longer trip to peak effectiveness and
therefore a longer half-life than an IV dose. This is similar to
giving anti-emetic IM; it takes a few minutes longer to work, but
the patient remains comfortable and vomit-free for a much longer
period of time.
Reminder: New Geriatric Triage Guidelines
As a reminder to all agencies, the age for Geriatric patients has
decreased from older than 69 to 65 and above. This means that
anybody 65 or older who has had a standing height fall must be
brought to Genesis Good Samaritan ED for a full Trauma
evaluation.
Another reason for a patient to be categorized as a trauma patient
is if they are currently taking any kind of medication that thins the
blood. Some of the more common drugs are:
Coumadin
Plavix
Dabigatron, or Pradaxa
Xarelto or Rivaroxoaban
AND INCLUDING ASPIRIN!!!
Documentation Notes:
Keep up the great work of charting time on the backboard. This is
helpful not only to the program, but to the patients! All times are
critical so please remember to record them when doing your run
sheets.
Please make sure to give your PCR copies to the nurse taking care
of your patient. This is to improve capture of data and make sure
each specialty service can access PCR information. The boxes will
be coming out very soon! ~ Thanks!
News for EMS Professionals March/April, 2013 Page 3
All new EMS Protocol and Procedure Guidelines are coming
June, 2013
Tested
Provider Approved
State-of-the-art
Championed by Physicians
Compliant
Progressive
Educator & Training Officer Friendly
Upcoming EMS Week Functions EMS Week Appreciation Conference
Topics to include:
Less than Lethal Police Interventions
Trauma Point/Counter-Point
Trauma Case Study: You make the call
Hands-on Airway competition and learning stations
Crazy, off-the-wall patient presentations
Neurosurgical emergencies
And much more!
In addition, Genesis ED’s will be serving treat trays and giving out
EMS week gifts to crews visiting the ED that week, so come and
see us!
Community Ambulance Service Monday, May 20th, 2013
CAS is sponsoring a Public Safety Breakfast for all area Public
Safety personnel, Police, Fire and EMS are all invited to come
mingle and share an excellent home-cooked breakfast! The event
starts at 8 am and runs until 10 am and location is Community
Ambulance Service, 952 Linden Avenue in Zanesville.
Friday, May 24th, 2013
Friday is the date for CAS’ traditional Public Safety Cookout. The
time for this event will be from 11 am to 1 pm. Come join us for
excellent cookout fare and a chance to visit with our public safety
brothers and sisters. Same location as Breakfast on Monday that
week.
Upcoming Educational Opportunities:
Mid-East Ohio Career & Technology Center
Emergency Medical Technician Course
June 4th - August 24th, Tuesday & Thursday 6:00-10:00, Includes
3 Saturdays and 1 Sunday. Includes all materials and up to two
NREMT exams.
Advanced Emergency Medical Technician Course
August 1st – December 10th, Tuesday & Thursday 6:00-10:00
Includes 4 Saturdays. Includes all materials and up to two NREMT
exams
Paramedic Course
July 9, 2013 - June 26, 2014, Tuesday & Thursday 6:00-10:00
Includes Saturdays and Sundays. Includes all materials and up to
two NREMT exams. Applications accepted until June 24, 2013.
Financial Aid Available
Fire and EMS Instructor Course
May 2nd—June 8th
Must pass the Firefighter II, EMS Assessment exam or passed the
NREMT exam within 3 years of class start date.
All Classes will be held at Mid-East Career and Technology
Center for Adult Education, 920 Moxahala Ave., Zanesville, OH
43701
For questions contact: Paula Moore, Public Safety
Coordinator, 740-455-3111 Ext. 328
Central Ohio Technical College
COTC and CTEC will be hosting a variety of EMS courses from
EMT class in Newark (CTE) to a Paramedic class in Pataskala.
Both Summer classes begin in May.
Anyone interested in our programs should first complete a COTC
college application https://apply.cotc.edu/ and then contact
Gateway @ Pataskala: 740-964-7090 or Knox: 740-392-2526 or
Newark: 740-366-9222 or Coshocton: 740-622-1408 or
[email protected] to schedule COMPASS testing or
review transcripts prior to beginning the EMS Application packet
that is attached.
Classes start soon, so hurry!
Ohio State’s Center f o r E M S 1 0 t h Anniversary and Local Heroes Week 2013
Join Ohio State’s Center for EMS for our annual conference April 15-21. Monday 8 am—5pm Keynote Address, Variety of topics
Tuesday 8 am—5 pm Geriatrics for EMS
Wednesday 8 am—5pm Advanced Stroke Life Support
Thursday 8 am—5 pm Operation: Street Smart (Drugs) and
Operation: Street Smart for a New A.G.E. (Adult Gang Education)
Friday 8 am—5 pm Why Teens Kill
Saturday and Sunday 8 am—5 pm Emergency Pediatric Care
Provider Course
All Registration opens at 7 am each day, locations differ.
To register, please visit centerforems.osu.edu
News for EMS Professionals March/ April, 2013 Page 4