Spring is in the air!
Greetings EMSers! We have survived another winter, albeit the
mildest one in recent memory. Weather has a huge impact on our
activity. Everybody I know comments that the slightest bit of snow
brings out the poor driver lurking beneath the surface of most of
those on behind the wheel. It seems like the amount of snow
required to achieve the highly coveted “snow day” has fallen from
an all-time high (when each of us were children) to a mere glazing
of the sidewalks, but we know the school systems have the safety
and well being of our children at heart.
Weather impacts us indirectly as well. While a snow squall can
bring on a rush of backboard shuffles, warm weather can have an
even greater effect on more people. Look out your window; No,
not at the rapidly growing lawn you need to attend to, at the trees
and flowers. They are blossoming and casting their spores to the
winds. This makes spring a wonderful season of renewal for some,
but it can be a pretty miserable time for others.
Pollen, mold and ragweed. All words that mean tough times lie
ahead for those with seasonal/environmental allergies and reactive
airway disease. At best, it’s a minor inconvenience. At worst, it
means constant hacking, sneezing and trouble catching one’s
breath. As we age, most of us will become more sensitive to our
allergies. Those born with sensitivity to environmental allergens
generally become more tolerant of the illnesses as they occur
through repeated exposure; rather than getting better, these people
become accustomed to dealing with the fallout of springtime and
year-round exacerbations of their condition. The bottom line is to
keep your allergy medications handy and use them at the first sign
of trouble; sneezing and itchy, watery eyes shouldn’t be a part of
life. Get your meds of preference and use them; heal thyself!
Watch the Kids.
Warm weather brings kids out in droves. Being cooped up for a
long, cold winter was one of life’s greatest tortures as a child and
though I did find plenty of ways to occupy my time both indoors
and out, nothing beats a mild, sunny day
outdoors. Be cautious and look for all the
learners in your neighborhood; youngsters
learning how to get out and about on
everything from tricycles to bikes and
motorcycles. Most kids aren’t focused on
their surroundings as they enjoy riding and
this leads to several “designer” injuries as a
result of those lapses.
In urban areas, kids tend to dart between parked vehicles, shooting
into traffic without looking for what’s about to hit them. Take note
of the size of the vehicle that struck the child and look for
corresponding injuries. Keep in mind that young bones don’t break
completely, nor do they offer the best protection to underlying
organs such as the liver, spleen and spinal cord. Children with
blunt, traumatic injury should always receive full spinal
immobilization (and the time the equipment was placed recorded).
Out in the country (and some suburban areas), kids tend to grow
up on dirt bikes and ATV’s more commonly. These machines
while fun, are where designer injuries originated because the type
and frequency of certain injures are attributable to riding. ATV’s
have a nasty tendency to “grab onto” the rider in a way that during
a tip-over accident, the machine does more injury to the rider than
contact with the ground. ATV rollovers are responsible for a high
number of spinal injuries. While floor boards on ATVs have all
but eliminated lower extremity trauma, heavy landings continue to
Volume 2 • Issue 4
News for EMS Professionals
The Lights & Sirens is a monthly publication of
Genesis HealthCare System for EMS providers
in the Muskingum and surrounding Counties. To
sumbit an article for inclusion in a future issue,
send e-mail to [email protected] along with
the writers credentials.
Happy Easter!
be a source of facial and neck trauma despite helmet use as the
rider’s head makes contact with the handle bars upon bottoming
out the suspension. Wheel-to-wheel contact on-track is another
cause of crashes. When wheels spinning at different speeds or in
opposite directions touch, the result is that one of the vehicles will
“climb” onto the other, or both with be violently repelled, causing
the rider to lose control.
Dirt bikes are a source of more predictable injuries. “Casing”, or
landing on the peak of a second jump or landing area causes the
suspension to bottom abruptly leading to broken ankles and axial
loading of the spine. Two wheelers do tend to be a little safer for
the rider than ATV’s in that once the rider is separated from the
bike, they tend to part ways. One other thing motorcycles have
more of than their ATV counterparts is altitude. Everybody loves
big air and getting it under you brings your
worst enemy into play; gravity. The old saying
goes: “Sky/ground/sky/ground, brace up, this
is going to hurt!”
A “low-side” is a type of slide in which the
rider lays the bike down, minimizing injury
to the rider and damage to the bike. A “high-
side” is a loss of control in which the bike initially slides, but the
tires suddenly grip, catapulting the rider into the air; this is
obviously the more dangerous and painful of the two. “Tank
slapper” is a motocross term for the loathsome straddle injury. If
you’ve ever been to a motocross race, you have seen first hand that
these riders occasionally crash their brains out, hop on and go
riding again. They are tough people from peewee to vet class, it
takes a hit to get a rider to actually stop and sit still to be
evaluated; it usually involves something that’s broken or otherwise
not working the way it should.
Something to keep in mind with the peewee crowd is their
helmets. With racers barely past their 5th birthday and riders
younger than that, it’s important to keep C-Spine front and center
in your care for these little ones. Those big heads on kids require
an equally large helmet to protect them. I get a kick out of seeing
the micro mini riders out there mixing it up, but be mindful that
those big helmets put some big torsional forces on those little
necks. Immature spinal columns and neck muscles don’t provide a
lot of protection from injury, so plan on boarding any youngster
that hits his head of had a witnessed fall.
“I bound him the way I found him”
It takes a lot to convince racers of any kind that they need to go to
the hospital. As stated above, generally the only way to get them to
go is if something is rendered out of order. For that reason, once
you get permission to take the rider to the hospital, you also have
to sell him on the idea of spinal immobilization precautions.
It’s critical for these patients to be splinted in the position found.
Remember: movement and time does not negate an injury, nor
does an injury have to fully manifest at the time it occurs. These
are tough people in terms of sustaining crash injuries and pain
tolerance and they very likely have much worse injury than what
they are letting on. Abdominal tenderness should be considered
internal bleeding until its ruled out. Pneumos are difficult to detect
in the field until they reach 20% collapse, never mind all the other
bikes going in the background. Use witnesses as a source for
determining Mechanism of Injury. The way a rider is struck and/or
strikes objects is a good predictor of that person’s injuries.
After reading all of that, you might think I’m anti-motorcycle/
ATV but nothing could be farther from the truth. I am a rider
with 40+ years of experience in both doing it right and learning
from my mistakes. I believe that if a rider has information and
understanding of the risks they are taking, it will help them to
survive both on and off-road. Wear your helmet, watch the
other guy and be safe!
Pharmacy Notes
Below is a list of drugs used by area EMS agencies and their
estimated back-in-stock dates.
Diazepam Injection 5mg/2 ml carpuject or vial (Hospira)
Est. Delivery Date: Late April, 2012
Etomidate Injection, 2 mg/ml 20 ml vial (Hospira)
Est. Delivery Date: June, 2012
Alternate sources: American Regent and Pfizer: In stock
Fentanyl Citrate Injection, 0.5 mg 2 ml amp/vial (Hospira)
Est. Delivery Date: May, 2012
Magnesium Sulfate Injection, 50% 20 ml vial (Hospira)
Est. Delivery Date: April, 2012
Midazolam Injection, 1 mg/ml 5 ml vial (Hospira)
Est. Delivery Date: April, 2012
Ondansetron Injection 2 mg/mL, 2 ml Syringe (Hospira)
Est. Delivery Date: April, 2012
Procainamide HCL Injection, 100 mg/ml 10 ml vial
(Hospira)
Est. Delivery Date: May, 2012
Promethazine Injection, 25 mg/ml 1 ml vial (Hospira)
Est. Delivery Date: 2013
Alternate Source: West-Ward (accelerated to March-April 2012)
Sodium Bicarbonate Injection, 1mEq/ml 50 ml Abboject
Est. Delivery Date: April, 2012
Vasopressin Injection, 20 u/ml, 1 ml vial (Hospira)
Est. Delivery Date: Late April, 2012
Vecuronium Injection, 20 mg vial
Temporarily Suspended
Alternate Source: Sagent Pharmaceuticals (Available now)
For more information see:
http://www.fda.gov/Drugs/DrugSafety/DrugShortages
News for EMS Professionals 4/2012, Page 2
Code STEMI Activation Update Cathy Huggins, MSN, RN, CNL, CCRN Chest Pain/Heart Failure Coordinator, Genesis HealthCare System
On February 28th, 2012, Dr. Albirini met with the ED Physicians
to discuss Code STEMI activation protocols. We were hoping to
be further along with 12 lead EKG transmissions, but that has been
held up waiting on grant funding. As the Paramedic scope of
practice includes 12 lead EKG interpretation, the ED Physicians
are willing to activate the Code STEMI response based on the
Paramedic’s radio report. The more information that you provide,
the more confident the ED physician will feel in activating the
Code STEMI. However, if it is a short transport, they may still
wait to visually examine the EKG before activation.
Here are some pointers for radio report that will help the physician
determine if they need to activate the Code STEMI team:
Chief Complaint and History of Present Illness: “This is a
55 year old male who called complaining of 8/10 chest pain
that radiates to the left arm and jaw. Patient states the pain
began approximately 30 minutes ago and was not relieved
with rest or nitroglycerine x 3. The pain is described as sternal
pressure and is constant.”
Associated symptoms: “He is also experiencing diaphoresis,
nausea, and shortness of breath.”
Pertinent medical history: “He is a diabetic with hypertension
and has a history of cardiac stents.”
Vital Signs: “His blood pressure is 102/50, heart rate is 46,
and respirations are 24, O2 sat is 94% on room air.”
Treatments performed: “He has had 4 baby aspirin, oxygen
is on at 2 liters per nasal cannula, and 1 IV has been
established.”
12 lead EKG findings: “The 12 lead EKG shows ST
elevations in leads II, III, and aVf with reciprocal changes in
v2, v3, and v4.” Be specific with what you see.
If a Left Bundle Branch is seen, ask the patient if they
have a history of previous LBBB and relay this with the
report.
ETA: “We have just left the scene and will be arriving in
approximately 20 minutes.”
A quality EKG tracing is much easier to interpret and leaves less
chance for false activations. Literature recommends that the 12
lead EKG be obtained in the patient’s home prior to loading in the
squad. A 12 lead EKG is more likely to have artifact if it is
performed in the back of the squad.
Early notification to the ED is helpful. If you have an extended
transport time, this will allow for earlier activation of the STEMI
team.
EKG’s that can be misleading include pacemaker rhythms, old
bundle branch blocks and pericarditis. If you feel that you would
like an EKG refresher course, Genesis Healthcare System
Education Services Department offers a Basic 12 Lead EKG and
an Advanced 12 Lead EKG Class free of charge. Each class lasts
about 3 hours and CEU’s will be awarded. If you are interested,
please contact the Education Services Department at 740-586-6550
to register.
The Genesis Shining Star of EMS award On Saturday May 26th, one deserving
nominee from each provider level, First
Responder through Paramedic will receive a
special recognition in honor of their
commitment to excellence in EMS. In order
to nominate a candidate, please include the
nominee’s name, provider level, department
affiliation and a brief narrative detailing why this person should be
considered for the award. Once completed, either drop the paper in
the run sheet box at Good Sam or Bethesda, or e-mail to
[email protected]. The winners will be selected on May 18th
and awards will be presented at the EMS week Conference at the
Genesis HealthPlex. Deadline for entry is May 18th at midnight.
Good luck!
Spring is safety season!
Spring is the time a lot of departments put on injury prevention
campaigns to promote community awareness of traumatic injury
and accidental death. Statistics show that preventable deaths
decline when outreach training is made available to the
community. Increasing your visibility as a guardian of public
health really helps with levies come election day. An excellent
topic this time of year is always helmets.
More children between the ages of 5 and 14 present to ED with
injuries from a bicycle crash than any other activity. Sturdy,
lightweight bicyclist helmets help to guard against head injury
while the light weight reduces torsional forces on the cervical
spine and immature neck
muscles. Some communities
supply helmets to kids in need
and while that’s a great idea, it’s
not always economically
feasible. Another possible source
is grant funding. Many well-off
programs look to give at the
community level and donations
are of course, tax deductible.
Regardless of whether you are
able to buy helmets or not, there are still things that can be done
for no cost; consider teaming up with a local non-profit
organization like the Red Cross chapter, or Jaycee's for a helmet
safety and fit check day. Here are a couple of tips for properly
fitting helmets:
A damaged helmet should never be trusted to save a live; it
has already done it’s job. Advise the family to get a new
helmet.
“If you have a ten dollar head, go ahead and put it in a ten
dollar helmet.” Otherwise, shop for quality and never buy a
helmet that’s too big so a child can “grow into” it. An
improperly fitting helmet can’t be depended upon to do it’s
job.
Educational Opportunities:
Thursday, April 12th EMSAC Meeting Muskingum County EMA, 6-6:30 pm
Baby Abandonment. Presented by Brady Johnson, EMT-P, Falls
Twp. Fire Department.
Wednesday, April 18th Hand and Microsurgery Associates 1210 Gemini Place, Columbus, Ohio 43240
The Physicians and staff of Hand and Microsurgery Associates
will be hosting an EMS Open House and presenting a
complimentary Continuing Education offering. This event is
located at the group’s new facility near Polaris The event begins at
6:30 pm with a guided tour of the new facility and the presentation
commences at 7:00 pm. Food and drinks will also be provided.
Don’t miss this rare opportunity to see this state of the art facility.
To register, RSVP to Mary Mazik at [email protected]
or call 614-800-5930 by April 13th as space is limited.
Saturday, April 21st Lifelink Spring Update
Hugenberger Auditorium—Grant Medical Center
With a variety of topics and speakers update always brings many Central Ohio EMS providers together for education and a great Saturday with friends. The event runs from 9 am to 4 pm and cist is $25. To RSVP, email [email protected], include your
name, EMS certification level, address, phone number,, and e-mail
address, or you can call (614) 566-9111, option 1. For more
details, visit www.grantlifelink.com/
Saturday, May 26th, 2012 EMS Week Conference Genesis HealthPlex
2800 Maple Ave., Zanesville, OH 43701
Please join us for a day of Education and Appreciation of the hard
work done by the EMS providers of southeastern Ohio! You truly
are the best and we hope you let us show it.
Save this date for the best EMS conference we’ve put on to-date.
We will be hosting speakers from the local and regional medical
communities. We will have vendors showing the latest in state-of-
the-art patient care and we will serve lunch, all at zero cost in
honor of all that you do for your community! Spread the word to
fellow EMSers, On-duty crews and Nurses are welcome as well.
There will be free items, door prizes and health screenings specific
to EMS providers. Vendors/exhibitors include Finley Fire
Apparatus, Physio-Control, Zoll, Air Evac Lifeteam and
MedFlight and more. To RSVP, send e-mail to
[email protected] or call the trauma office at (740) 455-
7670. Come join us for a great time on May 26th!
Trauma Notes Stuart Chow, D.O., Medical Director, Acute Trauma Services
The more things change, the more they stay the same. Case in
point being tourniquet use. Constricting bands were created for
limiting hemorrhage on the battlefield and it’s use blossomed in
WW I and II before falling aside in favor of other methods. The
tourniquet became a necessary evil as it was thought that
tourniquet use caused loss of tissue viability at the onset of the age
of limb reattachment.
Since 2004, tourniquet use on the battlefield is once again in favor
to the point of integration into battle dress uniforms and recent
published summaries of lessons learned from battlefield trauma
surgery states that use of a narrow tourniquet does not contribute
to loss of limbs when used for hemorrhage control. Trauma bags
today should contain at least two of the military specification
Combat Application Tourniquets and several packages of
hemostatic agent to manage the worst hemorrhage.
Congratulations From Trauma Services Lori Cody, RN, MSN, Trauma Program Manager
We are proud to announce that our very own Joel Dickinson has
been chosen to receive the “Frank Giampetro Distinguished EMS
Educator Award” as part of the 14th Annual EMS Star of Life
Awards. This award recognizes a dynamic educator who has made
notable contributions to the Emergency Medical Services system
thus improving the quality of care delivered to the citizens of
Ohio.
Joel has been the valuable link in the chain that connects our EMS
community to Genesis Healthcare System. Joel serves as the chair
of EMSAC and has been instrumental in bringing numerous
educational offerings to these monthly meetings. Joel has
resurrected this newsletter, offering informational and educational
topics. Joel also continues to be an ACLS and PALS instructor.
Joel has been actively involved in assisting Genesis Healthcare
System to obtain numerous accreditations and verifications,
including Level III Trauma Center, STEMI Accreditation, Heart
Failure Accreditation, and A-Fib Accreditation. So please join us
in congratulating Joel!
News for EMS Professionals 4/2012, Page 4