How is Your EMSWeek?

Elsewhere on social media this week I have seen a call to “protest EMS Week 2023”. The logic suggests that the free meals and cheap trinkets are far less than the long-suffering and under-paid providers deserve. While I whole-heartedly agree, “we” have made EMS Week what it has become, not what it was intended.

The EMS Week 2022 proclamation reads “I call upon public officials, doctors, nurses, paramedics, EMS providers, and all the people of the United States to observe this week with appropriate programs, ceremonies, and activities to honor our brave EMS workers and to pay tribute to the EMS providers who lost their lives in the line of duty.” I read nothing in there about free drink coosies and pizza. While there is nothing wrong with a “company BBQ” to get together outside the ambulance, we are wasting the opportunity we were given as a national spotlight. It feels good to bask in that glow for the moment, but we could be grabbing the microphone while we’re there.

EMS Week was designed with a daily focus on service, not just for accolades to passive providers, but as a chance at the microphone to tell our individual stories. Unlike our brothers and sisters in law enforcement and fire protection, we are generally not considered “essential” because the public has not yet seen our value. We can’t point the finger at them and say they need to wake up and look harder, it is up to us to proclaim and demonstrate that value. That doesn’t happen when our mouths are full of free food, only when we provide the free “food” of empowerment to others. So, why aren’t we teaching free classes that build community awareness?

Face it, we suck at coordinated political action. We can’t agree on educational requirements, collective bargaining, titles, or even whether you can provide good care from a red truck. Most of us still honor personal anecdote over research and blame volunteers or federal reimbursement for low pay. We all have different ideas to solve the mess. However, we do share a common power and it is in the personal interactions that we are best at demonstrating our medical knowledge and concern for the welfare of individuals. The same individuals that we are asking to fund us with their taxes.

We could be using this week in service above and beyond instead of using it as a chance to rest. Empowering the public is the best way to gain trust. Show what we know and ask for help in improving outcomes. We need their help to keep a cardiac arrest patient viable until we can arrive and resuscitate them. Make them a part of the team, not outsiders. Learn to install a car seat and help new parents prevent an accident. Build the relationships that use our strength when people are in distress and they will see us as a necessary component of the community, not an add-on.

Many of the pieces of the puzzle to fix EMS are beyond our immediate personal control, but if we actively make the community a partner, they will support us and even demand change on our behalf. Don’t protest the monster we created, tame it for our better purposes.

Advice From an FTO

As we begin to wind down on the pandemic-level of constant 911 calls and the endless hours waiting on a room in the ED, we find ourselves in a time to reflect a little before our next call. Like so many services, we have a new influx of eager young professionals. Recently, a new student asked me, “how do you guys keep doing this day after day?” Not an unusual thing to ask lately, and my reply was this:

“determination and our perseverance to make sure our patient gets the definitive care and treatment they need.”

COVID-19 has really stretched us thin, not just with staffing, but with supplies, training, willpower, and people who actually WANT to learn. Training new hires and students can be tedious and frustrating if you don’t have the opportunity to learn and adapt along with them in addition to teaching them what they need to know. You must become extremely patient and place yourself into their boots. If you don’t empathize, you risk placing yourself in the position of doing harm. Not only to your student, but to the patient, and most likely our profession as well. We need to be resilient and steadfast, showing them the ropes and thoughtfully placing them into the patient care position supported with good proctoring and mentorship.

Improving EMS Deployment Performance

I work regularly with agencies that are looking to improve aspects of their operations. Some casual readers may be surprised to know that the focus of those discussions is not always about cutting response times. While response is a simple and common measure, it clearly does not evaluate EMS well and certainly fails to encapsulate many of its complex needs and values. Still, I feel the necessity to address the time objective briefly before going on to other important aspects.  

Examining the 2020 Vision of EMS

The NHTSA Office of EMS released a significant document last year called the EMS Agenda 2050 that was carefully crafted to set a bold vision for the next 30 years of paramedicine by clearly differentiating the focus of care from its original definition in the 1996 EMS Agenda for the Future. Now, after just a few months of a COVID-19 pandemic, we have seen these modern precepts being challenged. As with any such vision of the future, a bit more perspective then just the immediate quarter is required. Before stepping toward the future, it is important to know exactly where we are today. To provide that update, NASEMSO released a new National EMS Assessment this past April to provide a measure of emergency medical response personnel and their agencies in this pivotal year of 2020. Although the latest survey is only updating the original work of a decade ago, there have been such dramatic changes that direct comparisons, even over this relatively short time frame, are difficult. To help bridge that gap for comparison, the folks over at ZOLL did a quick blog to reflect on the evolution of the EMS industry since 2011. Still for many, a little more context on how we got this far may be helpful before we can truly understand the significance of these most recent discussions regarding the future of EMS.

It was only back in 1960, that President John F. Kennedy made the statement that “traffic accidents constitute one of the greatest, perhaps the greatest, of the nation�s public health problems.” The automobile was well entrenched in the new American dream by this point as ribbons of smooth highway were unrolling across the country that facilitated speeds of travel much greater than the safety aspects of the car would afford. Yet it wasn’t until 1966 that the National Academy of Sciences ‘white paper,’ officially titled “Accidental Death and Disability: The Neglected Disease of Modern Society,” that ambulances began to transform from a side business at funeral homes into our modern Emergency Medical Systems of today. This initial milestone report, delivered during the Vietnam War, stated that �if seriously wounded � chances of survival would be better in the zone of combat than on the average city street.� So, the signature of President Lyndon Johnson provided federal funding through the National Highway Safety Act of 1966 that not only provided for the establishment of EMS programs, but thoughtfully placed the system within the federal Department of Transportation. Although the Omnibus Budget Reconciliation Acts of the 1980’s under President Ronald Reagan transformed direct federal EMS funding into state preventive health and health services block grants, federal guidance remained within the National Highway Transportation Safety Administration.

The numbers 9-1-1 were added to the American experience by AT&T in 1968 and it grew slowly across the nation as more communities demanded Emergency Medical Services. The most effective recognition of out-of-hospital care throughout the 1970’s came as the result of a television show simply called “Emergency!” This drama highlighted the results of efforts by early cardiologists like Drs. Lown, Zoll and Pantridge in having developed portable devices capable of disrupting the lethal dysrhythmias of v-fib effectively parlaying paramedicine from a focus primarily on trauma to include chronic medical conditions within the home as well. Pediatric trauma would not be officially recognized until 1984 with an Emergency Medical Services for Children study leading to a report finally published in 1993. The patchwork quilt of EMS continued to grow with increasing interest and even more piecemeal funding. Economist Jack Stout led a revolution in economic modeling of EMS systems during the 80’s and 90’s in response to the imbalance of demand and financing that had already fractured EMS into a kaleidoscope of models from fire-based, public safety to “third-service” public utility models to for-profit integrated healthcare businesses. 

It is certainly no accident that our industry has ended up in the position we are today. As W.E. Deming has taught the world, “every system is perfectly designed to get the results it gets.” And we proudly embrace the philosophy that states “when you’ve seen one EMS, you’ve seen one EMS” because we still believe that each service knows the particular unique expectations of their individual community while allowing insurance companies to dictate reimbursement rates. As a result, there is little federal standardization beyond a minimum national level of competency and few local agencies that are funded as “essential services”  even though the NAEMT has advocated this position for years. 

Today, it is heart disease that has overtaken the American consciousness as waistbands expand across the countryside demanding more from our organs than the body was designed to provide. In addition, we face new biological and socio-economic challenges for delivering healthcare in the field. We’ve needed a new road map like the EMS Agenda 2050, but we can’t just sit back and wait for it to happen. As professionals, we all need to educate ourselves on topics like Emergency Triage, Treatment, and Transport (ET3) and health information exchanges that are being piloted at select services. We must be the change we want to promote. 

 

Better Lifting for Better Care

Anyone who has been to a national EMS conference in the last few years has probably seen Rick Binder in the exhibit hall. If that name is not familiar, you may be more likely to remember his life-size teddy bear wearing a vinyl vest surrounded with brightly colored handles. While we are friends now, I have absolutely no financial interest to disclaim. In fact, I had initially avoided both him and the product that his dad had developed whenever I saw the booth at trade shows. Personally, I just didn�t see the need for it since I was a master with a hospital sheet and had acquired a wide repertoire in the many ways to use it. But there are times that peer pressure can be a good thing. Other teammates from my service had visited with him at EMS Today and appeared to be impressed. Curiosity got the better of me and I wanted to learn what I might have overlooked, so I took Rick up on his free offer to field test the device. It was because of my own experience with the Binder Lift that I was finally sold.

I have learned that there are many lifting situations where this device will be an incredible asset to me as well as my patients. The slogan, �because people don�t come with handles� initially led me to think that the use of the Binder Lift was directed primarily at the bariatric patient who requires only a simple lift assist to return them to an upright condition where they can sign my refusal form. While it is certainly useful in such cases, it is definitely not limited only to that situation.

In my first example of these many unique cases, the patient was over six-foot-tall and had been discovered unconscious, but breathing, on his front porch by a third-party caller. I had been to that address before and knew he had a history of stroke that had previously left him unable to drive. We had three responders available and knew we needed to get him to the hospital quickly. After a rapid initial assessment, the patient was rolled to his side so we could apply the Binder Lift. Once secured, one person grabbed his feet while my partner and I were able to grab different handles to balance our height difference and eased his lanky frame down the steps to our stretcher. This movement was much easier on our backs and proved safer for the patient compared to our other options that day.

The simplicity with which we were able to transport this patient made me think back to a previous visit here. I only wish I had had this device when this same patient had been helping his elderly father get to the bathroom toilet. I can only imagine the mishap that led to his naked father falling on top of him – pinning him to the bath tub wall. Then, whether it was due to the fall or just the wait for us to arrive, his dad had defecated quite a lot. The waste had eventually made its way over both of the men. Finding a firm handhold on the slippery gentleman was a challenge made even more difficult by his son being entrapped beneath him. The vinyl construction of the Binder Lift would have made the extrication job much easier to accomplish and also simpler to clean up afterwards. It may have even prevented the need to change my uniform that evening.

In another memorable example, it was about 2AM when the tones dropped for a fall with injury. The husband of a 62-year-old female found his wife on the ground in front of their porch. She had stumbled and fallen forward about a two-foot drop. Unfortunately, she had braced herself for the landing with a stiff arm before reaching the ground. Her primary complaint was pain in the right shoulder which, although closed, did exhibit deformation (a probable dislocation. She denied any other pain along her spine, but as a precaution against a distracting injury, we placed her in a cervical collar per protocol.) Getting the patient to a seated position was accomplished only with significant coaxing and some obvious pain. There was no option of lifting her from beneath her arms and her loose pajamas gave little hope of bearing the weight of her hips to lift her. So after placing her right arm in a sling, we were able to place the Binder Lift around her torso and helped her move her legs into a crouched position without any further aggravation. The patient was then easily lifted upright and the stretcher maneuvered behind her allowing her to simply sit down. The Binder Lift was also helpful in orienting her on the cot. Finally, the slick vinyl material of the vest and straps was easily removed to leave her comfortably in a high Fowler’s position on the stretcher.

In short, the Binder Lift allows for better body mechanics when lifting that not only help to raise the patient safely but can be effective in extending the careers of medics that might otherwise be forced into premature retirement due to back injury. If you don�t try a Binder Lift for your patients, at least do it for yourself. I still carry an extra hospital sheet for many situations, but it always lays right on top of my Binder Lift.

Learn more at http://binderlift.com.

tl;dr but commenting anyway

I’ll try to be brief. As an EMS blogger, I have always believed in the potential that social media possesses to change the dynamics of how we interact and grow professionally. The promise of the democratization of information and the timely access to news and research on-demand should only be making us better at our prehospital jobs. It is my experience, though, that we have simply become more efficient at sharing opinions than we are at actually communicating useful information. Worse yet, many individuals continue to abuse social media resulting in a stifling of their own professional development. Dave Statter terms this phenomenon as “Social Media Assisted Career Suicide Syndrome” (with plenty of examples.) But probably most disturbing is that we, as healthcare professionals, are hardly any more progressive in our knowledge or use of social media than the general public.

As author Stephen Covey has aptly pointed out, “the biggest communication problem is we do not listen to understand. We listen to reply.� Like the responder who keys the microphone before thinking through the data that needs to be transmitted, many of us share a stream of thought from our beliefs in place of observing facts that may serve to lift the conversation. What becomes all too apparent in the rush to comment is the lack of depth in our training instead of the width of our understanding. It amazes me how many readers of an article will post comments based on the title of the piece without reading the text itself. The acronym “tl;dr” sums up the very problem at its heart because the person writing the comment is admitting the post was “too long; didn’t read.” 

To prove that this is not simply an opinion letter, I’ll submit a Pew Research Center study from earlier this year that demonstrates how differently various age groups receive their news. Hardly anyone younger than a Baby Boomer will dirty their fingers by thumbing through an actual newspaper any longer as social media finally edges out this traditional printed news in popularity. Even digital newspaper websites are declining in readership while television manages to retain its lead as the most popular medium (also propped up in large part by older generations.)  It is apparent that, independent of its source, more Americans prefer watching stories to actually reading the news. In fact, the most interesting insight from the survey is that the top two platforms for news among the college-aged crowd is Facebook and Snapchat.

My greatest fear has now become the “democratization of information” because of how much of the internet is fake. Not just “fake news,” but fake businesses, fake metrics, and even fake people. Artist Donny Miller, known as much for his typographic-based prints as his politically astute comments, noted that �We don’t communicate anymore. We just talk.� He is also the one who popularized the quote: �In the age of information, ignorance is a choice.� However, the internet has become much less than we thought it could be. And even using it becomes more of a challenge to mine information than simply find information.

As a sign of the decline of printed news in the prehospital arena, PennWell Corporation discontinued printing the Journal of EMS earlier this year and has opted for a digital approach to disseminating news. Whether JEMS, or its competitors at EMS1 and EMSWorld, can navigate the new reality of news is still to be seen. But it is clear that “readers” are demanding more interactive content that includes engaging visual infographics and flashy videos. One of the bright spots on the web to me as a professional has been the appearance of FOAM (the Free, Open Access Medical educational resources.) But this collective has many challenges as well. Some of the ethical issues that need to be analyzed and resolved are outlined in this article which also posted this handy summary graphic.

 

A few years ago, someone posted a question to a Reddit forum pondering, “If someone arrived from 50 years in the past, what thing would you have the hardest time explaining?” George Takei shared the reply of a very astute observer of society who answered, “I possess a device, in my pocket, that is capable of accessing the entirety of information known to man. I use it to look at pictures of cats and get in arguments with strangers.”

Although I am not fan of New Year’s resolutions, my personal plan for this coming year is to continue to educate myself (going beyond the bare minimums of ConEd classes) by actually reading more research and commenting my opinions on the news less often. We will have to see what happens to this blog as well as my Facebook and Twitter pages as a result. Happy New Year. 

Christmas Responders

A special Christmas poem for first responders…

Body Cameras in EMS

EMS professionals are known for having opinions, but one topic that is sure to bring out their thoughts is the idea of bringing cameras into their world. Whether expressed as a fear of HIPAA violations or a worry of punitive measures against their own actions, the idea of being recorded can cause many to bristle. But our world is changing, and we are being recorded more often than we might appreciate. Sometimes it is the media reporting news, other times it may be the public trying make the news. Still other recordings happen with our own equipment. From the telemetric monitoring of our driving to the recording of audio being synchronized with the acquisition of vital statistics by the monitor at the cardiac arrests we work, we are already being watched. So, what is fundamentally different about video capture?

The concern over HIPAA does not pertain to the collection of data itself, but ultimately how it is used; or even more importantly, how it might inadvertently be made available to those not responsible for the direct care of a patient. On the other count, how managers choose to use any potential recordings will determine whether it becomes a tool for professional development or a weapon directed against paramedics. And we constantly see footage of events being captured by dash cams and body cams including the actions earlier this year when an EMT attacked a restrained patient in the back of her rig. This broadcast event became a reminder for all leaders to discuss not only how we respond to provocations but to consider the value of body-worn cameras to capture the EMS point-of-view during patient encounters. An article by EMS1 editor Greg Friese asked some interesting questions that are still largely unanswered by the community.

The service where I work in North Carolina recently began using a popular fleet management application utilizing GPS to track basic telematics during vehicle operations. Not long after the pilot project began gathering data, an unfortunate incident happened that automatically required law enforcement to investigate. During the probe, the medic operating the ambulance was cleared of any potential violations specifically because of the details that were recorded around the time of the incident. Similarly, a progressive EMS operation in the state of Texas began piloting a program with Axon (a bodycam provider formerly known as Taser.) In this case, the recording was made with a bodycam in the patient compartment of the ambulance during a transport. The male paramedic was later accused by a female patient of inappropriate touching. The video was produced from the Axon system resulting in the charges being dropped and a career likely being saved. While these are only two anecdotes, they show the very positive side of EMS actions being recorded. Another interesting study in progress is by a major EMS provider in Minnesota that has seen a lot of negative press for being pressured by law enforcement to administer sedatives to suspects. The intent here is to document the decisions of their paramedics through the use of body worn cameras. It is significant to note from experience at Axon that more LEO have been saved by being able to reproduce and evaluate actions than have been punished through administration review of bodycam video.

Another way to use video recordings captured during calls for service is as a record of assessments or treatments. Through voice recognition, or artificial intelligence, actions of the crew can be automatically transcribed for the PCR documentation. This could be a significant value as studies have shown up to a 40% increase in the accuracy of reports when the option to review recordings of what had happened are utilized. Depending on how quickly supervisors access the recordings, they can also be used for near real-time review and critique of procedures in the field to eliminate unnecessary skills training or professional assessments. There are many other potential uses that are far less invasive into our daily work. Many agencies routinely videotape training simulations for review with the objective to improve patient care. Some are even looking to turn that idea around by placing the camera on the patient and recording how the clinician interacts with the patient from the perspective of the patient.

A rural Tennessee EMS agency partnered with another body camera manufacturer, Wolfcom, back in 2016 to request donations through their bodycameradonations.com website saying that �it would help our crew members to validate situations we encounter and record and preserve critical video evidence.” The fact is that many times EMS is the first on the scene and often sees important evidence that may be trampled or moved while helping patients and victims. Body cameras can capture that critical video evidence from the moment we arrive on the scene. The county went on to argue that with body cameras, there is video proof of a patient refusing treatment adding that �in cases where patients refuse service and later on develop medical problems or die from their injuries, with body cameras we would have video evidence of them refusing the treatment.�

Consent is a potential legal issue with recording a patient/care-giver interaction, but again my home state of North Carolina is somewhat unique in that only one party in a conversation needs to acknowledge consent for the interaction to be recorded. Consent in other states could be handled differently. For instance, recordings could be limited to the interior of the patient compartment where notification could be posted of the recording in progress.

Preventing the violation of patient privacy is the objective of HIPAA. The federal act itself does not attempt to preclude the collection of patient data although the penalties of any breach of that trust can be severe enough for agencies to self-limit the recording of any non-essential patient data. Walking into a hospital with a camera recording everything observable to the staff could also provide significant challenges in how that video is accessed and may be a legitimate concern to the hospital administration charged with protecting the privacy of its patients in the ED.

It is important to recognize that the recordings made through the Axon system are backed up to the cloud where they can be automatically linked with other cameras that recorded at the same time nearby the scene to add additional perspectives. The web interface that is used in this application is called evidence.com and has been designed specifically to maintain the chain of custody for critical evidence by documenting the details of any access to recorded information. This security is very different than the application of a personal GoPro camera that is used frequently by firefighters, but where the Chief has no recognizable control over the viewing of the video that is captured or how it might be distributed.

How video recordings are ultimately used in EMS will be determined by our reaction to it. That is not to say we will control it, but we will influence how it is applied. If it becomes a tool for us to learn and improve our practice in relation to patients, it will be because we have embraced it. If it becomes something that is used against us as professionals, it will be a result of our attempts to circumscribe the terms under which it is utilized.

"So God made an EMT"

Editors Note: To celebrate EMS Week last week, my good friend Eric Garton wrote a poem in the style of Paul Harvey and recorded his narration. It has touched many people so I asked him to share the words here along with a link to the YouTube version. Feel free to share them further, but please give the credit to Eric for his hard work and creativity.

 

“So God Made an EMT”

by Eric Garton   (c) 2018, All rights reserved.

 

And on the ninth day, God looked down on the world he worked hard to create and said,

�I have doctors and nurses in hospitals and clinics. Now I need a caregiver in the field.�

So God made an EMT.

 

God said, �It must be someone who gets up early in the morning, checks their truck off, scarfs

down breakfast, run a cardiac arrest, run two hospital transfers, skips lunch, finish paperwork,

run another transfer, command a horrible car wreck, restock, clean truck, run three sick calls

and hopes for at least four hours sleep before the end of their shift.�

So God made an EMT.

 

God said, �It must be someone who can work continuous CPR on an infant knowing they have

died, and while holding back tears console the family and tell responders on scene, �Good

teamwork everyone. Maybe next time.� �

So God made an EMT.

 

God said, �It must be someone who can manage a patient�s airway while upside down in a

wrecked vehicle. Someone who can calm a ten year old girl and her parents, while splinting her

fractured arm. It must be someone who can aggressively recognize and treat medical

emergencies, yet has the compassion to hold an elderly lady�s hand who fell at nursing home

telling her, �I am here for you. Everything will be OK.� �

So God made an EMT.

 

God said, �It must be someone who is selfless. Someone who will respond to an emergency

without a second thought. Someone who can handle the blood, the guts, the vomit, the broken

bones and give one hundred percent to all their patients. It must be someone who believes in

teamwork and respects all services involved. It must be someone who performs acts of

heroism, yet never calls themself a hero. It must be someone who praises victory, yet not

ashamed to admit defeat. It must be someone who can look the Grim Reaper right in the eye

and say, �Not this time.� �

So God made an EMT.

 

God said, �It must be someone who is loyal to their community. Someone who will put their life

on the line with the hope of saving a complete stranger. Someone who cares more about the

lives they save than the money they make in a year. Someone who will educate themselves,

and willing to share their knowledge with others. Someone who will remain professional and

caring, no matter how minor or major the emergency may be. Someone who can bring their

coworkers together as a family and see them as fellow brothers and sisters.�

 

�Someone who will reply with a smile on their face and a tear in their eye when their child says

they want to spend their life �doing what you do.� �

So God made an EMT.

 

From Eric: I want to thank all for the support and kindness from everyone who has listened and shared my poem. Many of you have requested a written version of it for yourselves or to share. I hope all of you enjoy reading this to others as much as I have enjoyed reading it to you. Thank you for all that you do.

Download a PDF version here: SoGodMadeanEMT

EMS Today 2018 Highlights

The EMS Today conference is always filled with interesting content both in the classrooms as well as the show floor. My live Twitter feed during the conference referenced highlights of the educational sessions I attended ranging from the Operational category to Advanced practice and even some Basic courses. The complete experience shared by everyone is permanently archived with the official #EMSToday hashtag. 

I traveled the exhibit hall several times last month looking for innovative and practice-changing technology. There was plenty to be found and the “best” will always be subjective. While these are some that I felt were worth sharing, others may have found significant gems I missed. If you were also there, please feel free to use the comment section below to add your own impressions of what you see as important in changing the practice of our field of EMS. 

One of my favorite sessions at any national EMS conference is when you can find a gathering of even a small number of “Eagles” (the top Medical Directors from around the country.) The lightning round of “The Eagles Unplugged” presentations in Charlotte was on February 22, just a week before the huge international Gathering of Eagles in Dallas. One of the first topics requested by the audience was on “spinal immobilization” (or in deference to my friend Rommie Duckworth, the proper term should arguably be “spinal stabilization”.) There was certainly no love in that packed room for most techniques or devices currently in use. In fact, the emphatic consensus statement was that there is simply no literature that shows any benefit to current spinal motion restriction while there are plenty of documented complications. 

In regards to spinal stabilization, everyone in the room agreed that the long spine board is gone and immobilization currently consists of just a collar. However, there was no consensus on what that collar should look like while there was no shortage of complaints for what is currently on the market. One of the JEMS “Hot Products” from EMS Today in 2017, however, was the SIPQuik vacuum cervical splint from Care 2 Innovations which I only got to play with this year. Basically, it is a collar-shaped bag filled with tiny styrofoam beads and a generous velcro strap. It has several advantages in that it fits a wide variety of patients and will conform closely to the shape of the neck to provide gentle support in any position. Unlike rigid collars that require the head to be placed in the neutral position for stabilization, the SIPQuik can wrap around the neck and be secured comfortably snug with the strap before the collar is molded to support the head while the air is vacuumed from the collar. The beads are held tightly in place to provide support that minimizes the possibility of further injury. Removing the manual pump without locking the air tube will allow air to reinflate the collar for easy removal. 

Several sessions, and exhibitors, included discussions of safety for care providers while working on the road. In America, we tend to love the large square box we call the patient compartment in our Type I and Type III transport vehicles. The size of the box and position of supplies and equipment requires a significant range of motion and most providers roam about unrestrained. Traditional safety belts are already available in every seat, however, they are just too cumbersome to apply and too restrictive to be used. At least this was my thinking until I placed by arms into the new 6-point “Back Pack” belting system on the EVS2160BPB from Emergency Vehicle Seating, Ltd. Unfortunately, the Back Pack system is not advertised on their website yet, but if you are interested, they will know what you are asking about if you contact them. 

The shoulder straps were as easy to apply as simply slipping my arms through the loops.  But the range of motion was incredible and allowed me to stand up fully and reach clear across my imaginary patient to where I would expect cabinets to be on the other side of the room – while still wearing the shoulder straps and even the lap belt! As I return to the seat the straps automatically tighten and should the vehicle have an accident, the belts would immediately tighten to prevent my head from crashing into those same cabinets across my patient. This quick and easy seat belt access is certified to meet all safety standards of FMVSS and SAE while providing maximum flexibility for the care of my patient. Two EVS1790 captain’s style chairs in place of the typical bench seat also allows comfortable and safe crew seating or can be rotated and tilted forward to allow the transport of a second patient on the non-skid back surface of the seats. Clearly, EVS has been giving plenty of thought to where we put our butts.

Another one of the hottest topics in prehospital treatment of trauma has to be the use of tourniquets and binders. I really thought that the poplar military-style tourniquet had not changed significantly from the belt and windlass configuration of decades ago, but there have been innovations here as well.

The S.T.A.T. Tourniquet is probably the greatest revolution in design. It comes in both a pediatric and adult size, but immediately conjures up the ubiquitous zip tie. It is wrapped around the limb above the injury and the end is inserted and pulled as tight as needed (in 2mm increments) to easily adjust. Although it looks like a zip tie, it is anything but what you find in the hardware store however. It is a wider design to prevent cutting into the skin and the material is a stretchier rubber to hold fast and evenly to secure blood flow. It also has a simple timer that can be activated when applied to measure half hour increments up to a max of 2 hours. Like the common zip tie it resembles, it can be used in combination to create a larger band or used in a series for splinting too. One major difference from the traditional zip tie is that this model also has a release tab to remove the tension. The simple design and lower cost compared to a traditional windlass system makes it ideal for public use in an MCI situation as part of a hemorrhage control kit. S.T.A.T. Medical Devices even sells them preloaded on a carabiner in a quantity of 25 tear-off tourniquets.

 

In case that style of tourniquet design is just too revolutionary, the folks over at SAM Medical have evolved the traditional tourniquet design by adding TRUFORCE Buckle technology to auto-lock the tourniquet during application. Slack in the tourniquet is the main cause of application failure requiring extra time twisting the windlass or even restarting the application. The SAM XT is designed to

require 33 pounds of force to engage two pegs that hold the strap before it is Velcro-ed together and the windlass can be engaged to stop the bleeding. This makes application easier and quicker. They also have a junctional tourniquet to stop pelvic hemorrhage. And my favorite model is the SAM Pelvic Sling II to comfortably apply the correct force to stabilize pelvic fractures. The design looks similar to the SAM XT tourniquet, but uses a patented AUTOSTOP buckle instead that ensures that the optimal compressive force is reached to confirm correct application. It is more expensive than a hospital sheet, but it provides confidence and comfort in a professional design.

I was also impressed by the Water-Jel Burn Dressings which provides a cooling gel (that is water-based, bacteriostatic and biodegradable) that actually stops the burn progression by actively cooling the skin and relieving pain rather than simply covering the wound to protect against airborne contamination. These dressings come in several different sizes and have a shelf-life of 5 years. The other great feature of these dressing is that each dressing has a Total Body Surface Area (TBSA) icon that indicates approximate total body surface area covered with the use of that particular dressing to improve your estimates of the body area covered.

Finally, to reduce medication calculation errors in pediatric patients, CertaDose provides syringes printed with color bands that match the Broselow tape used with younger patients. These syringes are clinically proven to reduce critical dosing errors by labeling the correct dosage directed on syringes labeled by the medication to be administered. Simply select the correct drug, match the color zones according to the Broselow tape and draw up the correct dosage.

I should also mention StethoSafe as another highlight from the floor of the show because I rely on their product to protect my stethoscope, but I did a whole other blog on the StethoSafe earlier.

Leave a note about what you found most interesting.