NOVEMBER 2015 | VOL. 44, NO. 11 $7 · 2020-03-10 · WEMT Clinical Education Coordinator, VitaLink/...

How a prevention program reduced employee injuries p. 20

Designing a safety management system for your agency p. 26

International MIH-CP Programs p. 32

Search and Rescue on the Border p. 42

October 3–7, 2016 | New Orleans, LAEMSWorldExpo.com#EMSWorldExpo

NOVEMBER 2015 | VOL. 44, NO. 11 $7.00

Visit us online at EMSWorld.com

AGITATED PATIENTS p. 14 AUTOMATED CPR DEVICES p. 35 PRODUCT REVIEWS p. 50

Introducing Metris—the new mid-size commercial van from Mercedes-Benz. The spacious cargo model offers 186 cubic feet of storage space and an impressive 2,502-lb payload, while the passenger model seats up to eight people. Both are equipped with advanced safety features like ATTENTION ASSIST®1 and Crosswind Assist2 for industry-leading protectability. From customizeability to garageability to affordability, Metris gives your business endless possabilities. Visit MBVans.com

GIVES YOUR BUSINESS ENDLESS POSSABILITIES.THE ALL-NEW METRIS

Starting at only $28,950.*

©2015 Mercedes-Benz USA, LLC. *Excludes all options, taxes, title, registration, transportation charge, and dealer prep fee. 1 Driving while drowsy or distracted is dangerous and must be avoided. ATTENTION ASSIST may be insufficient to alert a fatigued or distracted driver and cannot be relied on to avoid an accident or serious injury. 2 Crosswind Assist engages automatically when sensing dangerous wind gusts at highway speeds exceeding 50 mph. Performance is limited by wind severity and available traction, which snow, ice, and other conditions can affect. Always drive carefully, consistent with conditions.

For More Information Circle 11 on Reader Service Card


PARTNERS

ADVISORY BOARD

4 NOVEMBER 2015 | EMSWORLD.com

For more information contact your dedicated Account Manager or call 800.533.0523.

Professionally Approved

800.533.0523 www.boundtree.com

The Assure® Prism multi Blood Glucose Meter, designed exclusively for multi-patient use, needs only a small 0.5 µL, sample size and the strip points away from you when acquiring the blood. The meter features a backlight, 5 second test time and a strip ejection mechanism to eliminate the cost and cross-contamination risk of removing the strip with your gloved hand. Optional orange EMS carrying case is also available. A value-packed portfolio designed just for the EMS professional!

New FDA cleared Meter for Professional Use!

Peter Antevy, MDCEO & Founder, Pediatric Emergency Standards, FL

James J. Augustine, MD, FACEPMedical Advisor, Washington Township Fire Department, Dayton, OH; Clinical Associate Professor, Department of Emergency Medicine, Wright State University, Dayton, OH; Director of Clinical Operations, Emergency Medicine Physicians, Canton, OH

Raphael M. Barishansky, MPH, MS, CPMEMS/Public Health Preparedness Consultant, West Hartford, CT

Eric Beck, DO, NREMT-PAssociate Chief Medical Officer, American Medical Response

Bernard Beckerman, MD, FACEPAssociate Professor, School of Health and Behavioral Sciences, York College (CUNY), Jamaica, NY

Tom Bouthillet, NREMT-PCaptain, Town of Hilton Head Island (SC) Fire & Rescue Division

Kenneth Bouvier, NREMT-PDeputy Chief of Operations, New Orleans EMS; NAEMT President 2004–2006

Elliot Carhart, EdD, RRT, NRPAssistant Professor, Emergency Services Program, Jefferson College of Health Sciences, Roanoke, VA

Chris Cebollero, NREMT-PSenior Partner, Cebollero & Associates, St Louis, MO

Will Chapleau, EMT-P, RN, TNSDirector of Performance Improvement, American College of Surgeons

Kevin T. Collopy, BA, FP-C, CCEMT-P, NREMT-P, WEMTClinical Education Coordinator, VitaLink/AirLink, Wilmington, NC; Lead Instructor, Wilderness Medical Associates

Michael W. Dailey, MDAssistant Professor, Dept. of Emergency Medicine, Albany Medical College, NY

Thom DickEMS Educator, Brighton, CO

William E. Gandy, JD, LPEMS Educator and Consultant, Tucson, AZ

Erik S. Gaull, NREMT-P, CEM, CPPMaster Firefighter/Paramedic, Cabin John Park (MD) Volunteer Fire Department

Troy M. Hagen, MBA, NREMT-PCEO, Care Ambulance, Orange, CA; President, National EMS Management Association

Martin Hellman, MD, FAAP, FACEPAttending Physician, Children’s Hospital of Pittsburgh, Pittsburgh, PA

Tim Hillier, Advanced Care ParamedicDirector of Professional Development, M.D. Ambulance, Saskatoon, SK Canada

Lou Jordan PIO, Fire Police Officer, Union Bridge (MD) Fire Department

C.T. “Chuck” Kearns, MBA, EMT-PEMS Consultant

G. Christopher Kelly, JDAttorney at Law, Atlanta, GA; Chief Legal Officer, EMS Consultants, Ltd.

Skip Kirkwood, MS, JD, EMT-P, EFO, CMO Director, Durham County (NC) EMS

Sean M. Kivlehan, MD, MPH, NREMT-P International Emergency Medicine Fellow, Brigham & Women’s Hospital, Harvard Medical School

William S. Krost, MBA, NREMT-PAdjunct Assistant Professor of Emergency Medicine, The George Washington University

Ken Lavelle, MD, FACEP, NREMT-P Clinical Instructor and Attending Physician, Thomas Jefferson University Hospital, Philadelphia, PA

Rob Lawrence, MCMIChief Operating Officer, Richmond (VA)Ambulance Authority

Todd J. LeDuc, MS, CFO, CEMAssistant Fire Chief, Broward Sheriff Fire Rescue, Ft. Lauderdale, FL

Mark D. Levine, MD, FACEPAssistant Professor, Dept. of Emergency Medicine, Washington University School of Medicine; Medical Director, St. Louis (MO) Fire Dept.

Tracey Loscar, NREMT-PTraining Supervisor, UMDNJ - University Hospital EMS, Newark, NJ

Craig Manifold, DOEMS Medical Director, San Antonio Fire Department and San Antonio AirLIFE; Assistant Professor, University of Texas Health Science Center at San Antonio

Paul M. Maniscalco, MPA, EMT-PSenior Research Scientist & Principal Investigator, The George Washington University Office of Homeland Security

Richard W. Patrick, MS, CFO, EMT-P, FFDirector, Medical First Responder Coordination, Office of Health Affairs–Medical Readiness, U.S. DHS

Tim Perkins, BS, EMT-PEMS Systems Planner, Virginia Office of EMS, Virginia DOH, Glen Allen, VA

Michael E. Poynter, EMT-PExecutive Director, Kentucky Board of Emergency Medical Services

Vincent D. RobbinsPresident & CEO, MONOC, Monmouth-Ocean Hospital Service Corporation, Neptune, NJ

Mike RubinParamedic, Nashville, TN

Angelo Salvucci Jr., MD, FACEPMedical Director, Santa Barbara County & Ventura County EMS, CA

Scott R. Snyder, BS, NREMT-PFaculty, Public Safety Training Center, Emergency Care Program, Santa Rosa Jr. College, CA

Matthew R. Streger, Esq. Executive Director, Mobile Health Services, Robert Wood Johnson University Hospital; Fitch and Associates, LLC, New Brunswick, NJ

Dan Swayze, DrPH, MBA, MEMS Vice President/COO, Center for Emergency Medicine of Western Pennsylvania, Inc.

Cindy Tait, MICP, RN, PHN, MPHPresident, Center for Healthcare Education, Inc., Riverside, CA

John Todaro, BA, NRP, RN, TNS, NCEEEMS/CME Academic Department Coordinator, St. Petersburg College, St. Petersburg, FL

William F. Toon, EdD, NREMT-P EMS Training Manager, Loudoun County (VA) Fire, Rescue and Emergency Management; Battalion Chief - Training (ret.), Johnson County (KS) EMS: MED-ACT

David Wampler, PhD, LPAssistant Professor, Emergency Health Sciences, University of Texas Health Science Center, San Antonio, TX

Paul A. Werfel, MS, NREMT-PDirector, Paramedic Program, Clinical Asst. Professor of Health Science, School of Health Technology & Management, Asst. Professor of Clinical Emergency Medicine, Dept. of Emergency Medicine, Health Science Center, Stony Brook University, NY

Katherine West, BSN, MSEd, CICInfection-Control Consultant, Infection Control/Emerging Concepts, VA

Gerald C. Wydro, MD, FAAEMChief, Division of EMS, Temple University School of Medicine, Philadelphia, PA

Matt Zavadsky, MS-HSA, EMTDirector of Public Affairs, MedStar Mobile Healthcare, Ft. Worth, TX

ADVISOR IN MEMORIAM Norman E. McSwain Jr., MDDepartment of Surgery, Tulane University School of Medicine, New Orleans, LA


PUBLISHERScott Cravens, EMT-B800/547-7377 x1759 [email protected]

ASSOCIATE PUBLISHER - CENTRAL & MIDWESTDeanna Morgan901/[email protected]

EDITORIAL DIRECTORNancy Perry800/547-7377 x1110 [email protected]

SENIOR EDITORJohn Erich800/547-7377 x1106 [email protected]

ASSISTANT EDITORLucas Wimmer800/547-7377 [email protected]

PRODUCTION MANAGERLuAnn Hausz 800/547-7377 [email protected]

ART DIRECTOR Julie Whitty 800/547-7377 [email protected]

AUDIENCE DEVELOPMENT MANAGERSharon Haberkorn800/547-7377 [email protected]

BUSINESS DEVELOPMENT MANAGER - NORTHEAST Sandy Domin847/454-2712 [email protected] DEVELOPMENT MANAGER - WEST COAST John Heter 503/889-8609 [email protected] DEVELOPMENT MANAGER - SOUTHEASTAnn Romens800/547-7377 x1366 [email protected]

ADMINISTRATIVE ASSISTANTMichelle Lieffring 800/547-7377 x1612 [email protected]

LIST RENTALSElizabeth Jackson847/492-1350 [email protected]

REPRINT SERVICESFor reprints and licensing please contact Brett Petillo at Wright’s Media 877-652-5295 ext. 118 or [email protected]

EMS World Magazine1233 Janesville Ave., Ft. Atkinson, WI 53538800/[email protected]

ONLINE:EMSWorld.comFacebook.com/EMSWorldfansTwitter.com/EMSWorldnews

LETTERS TO THE EDITOR: All letters must include the writer’s name, address and daytime phone number, and may be edited for clarity or space. E-mail [email protected]: Queries, manuscripts, story suggestions, press releases and news items are welcome. E-mail [email protected] OR BACK ISSUES: Select back issues are available for $10. E-mail [email protected]: E-mail requests to [email protected]/ADDRESS CHANGES: Phone 877/382-9187 or 847/559-7598, fax 800/543-5055, write to EMS World, P.O. Box 3257, Northbrook, IL 60065-3257, or e-mail [email protected].

Chris Ferrell, CEO

Ed Tearman, CFO

Blair Johnson, C00

Scott Bieda, EVP, Public Safety & Security

Ed Nichols, VP, Public Safety Events

Curt Pordes, VP, Production Operations

HOW TO CONTACT US

STAFF

E M S W O R L D O N L I N E


The work you do every day not only saves lives, it transforms them. You

continuously sacri�ce your back because your patient’s safety matters

more than your own. Listening to and working together with medics,

we built iN∫X with an independent X-Frame design that ALLOWS

YOU TO NAVIGATE OBSTACLES WITH YOUR THUMB AND NOT YOUR

BACK. You could say, we’ve got your back.

TOGETHERWE CAN OVERCOME

ANY OBSTACLE.

FERNOEMS.COM/INX/KNOWLEDGECENTER | 877.733.0911FOR LIFE™

© 20

14 FE

RNO-

WAS

HING

TON,

INC.

*READ THE WHITEPAPER AT

iN∫X™ INTEGRATED PATIENT TRANSPORT & LOADING SYSTEM™


facebook.com/emsworldfans twitter.com/emsworldnews www.linkedin.com/groups?gid=1853412

SPONSORED BY:

MOULAGE OF THE MONTH

NEW

PODCASTSWORD ON THE STREET: ECCU PREVIEWIn a series of podcasts, host Rob Lawrence chats with key faculty who will be presenting at the Emergency Cardiovascular Care Update (ECCU) 2015 Conference, scheduled for December 7–11 in San Diego, CA. Find out why ECCU is one of the most important EMS conferences of the year. Guests include: • Ed Stapleton, AAS, EMT-P, will review why EMS professionals and

educators need to be at ECCU 2015;• Dr. Tom Rea will review The Resuscitation Academy High Performance

CPR Program at ECCU 2015; • Dr. Vinay Nadkarni will discuss how ECCU is unique in educating people to

the nuances of the new 2015 Resuscitation Guidelines;• Dr. Paul Pepe will review the latest research discussed at the Gathering

of Eagles conference; • Dr. Ben Bobrow will present cutting-edge initiatives EMS providers and

systems can take in relation to cardiac arrest management.See EMSWorld.com/podcast.

WHEN IS A CARD NOT A CARD?There is a recurring theme that surfaces whenever the topic of EMS continuing education comes up, and that is the value of the card courses. Regardless of where you stand on the topic, there is very little else offered in the way of options for a majority of the country. As a course coordinator, therefore, what are some steps you can take to improve your product? See EMSWorld.com/12122436.

SHOULD AN AMBULANCE BE A BILLBOARD?Advertising in EMS is rarely a topic of discussion among patients and care providers unless it involves telling people to call 9-1-1. However, with recent economic changes, decreases in property tax revenue, cost shifting and declining reimbursements, is it time we look at the feasibility of placing advertisements on ambulances? See EMSWorld.com/12122585.

MEDIA GALLERY: EMS SAFETY COMPETITIONSee a selection of images from the sixth annual AMR Safety Competition held at Aurora (CO) Community College in August. See EMSWorld.com/12122591.

FEATURES

Bobbie Merica continues her guide to simulating injuries and illnesses through effective use of moulage. This month: Industrial response, impaled eye. See EMSWorld.com/12122433.

ReelDx, a pioneer of real-patient video in medical education, and EMS World have partnered to publish real-patient video case studies designed to educate EMS practitioners.Visit EMSWorld.com/12081461 to see each week’s new case. Previous cases featured include: • 34-year-old with hematemesis; • 5-year-old in respiratory distress; • pediatric poisoning; • pediatric diving accident.

VIDEOS

EMSWORLD.com | NOVEMBER 2015 11

We believe in knowing emergency medical services so deeply that we’ve created the smartest customized suite of insurance products and risk management services in the industry, bar none.

That’s because our team of experts doesn’t just write policies for emergency services—we partner with our clients for the long haul. ESIP and ASIP give you the advantage of mitigating risk and preventing losses before they happen, saving time, money and resources while delivering the ultimate benefit: peace of mind.

Mark Harrington (L) ASIP Program Manager

EMS Industry Specialist

EMERGENCY SERVICES INSURANCE BY EMERGENCY SERVICES EXPERTS

25 YEARS OF LEADERSHIP IN SPECIALIZED INSURANCE

We are who we insure

Find out how we can help protect your business.

mcneilandcompany.com/ems (800) 822-3747 ext. 380

Dave Denniston (R) Director of Risk Management

Past Chief, Cortlandville Fire District

Protecting Patients and Providers – Decreasing Operational Costs

E very EMS agency has a responsibility to create a culture of safety—both to protect patients and

members and to proactively reduce risk to the organization.

McNeil & Co. is a specialized insurance company that has set itself apart by offering deep expertise in emergency services and a hands-on approach to managing risk. Its ESIP and ASIP programs—for volunteer and private EMS organizations—provide comprehensive insurance coverage along with loss control measures to help prevent accidents before they can occur.

Dave Denniston is key to that effort as Director of Risk Management. Having served previously as Chief of Cortlandville Fire Department and currently as a Regional Director for the Association of Fire Districts of the State of New York, he brings more than 20 years of EMS and fire experience to the company.

McNeil & Co. focuses on helping clients to remedy common sources of accidents or losses, and Denniston offered insights on the top three most common causes of claims within the EMS industry:

Motor Vehicle Incidents: A significant number of claims result from vehicle accidents or incidents.

“They either collide with another vehicle, rear end someone or sideswipe a vehicle due to inattention or a high rate of speed,” Denniston says. “They might not stop at stop signs or red lights. Most states have an exemption allowing EMS vehicles to proceed past stop signs and red lights when responding to a true emergency, but there needs to be a proper driver training program in place at the agency so that providers understand state laws and the limitations of their vehicles.”

Patient Handling: These claims generally involve patients not properly belted or dropped.

“Very few agencies use the manufacturer-installed shoulder strap because it limits their access to the patient, so if there is an accident, the patient gets dislodged and injured,” Denniston says. “Someone might not be properly secured on a stretcher and you hit a bump or a rock on the sidewalk and the stretcher falls sideways, causing the patient to fall.”

Documentation: Improper, incomplete or missing documents can put an organization at risk.

Denniston says that all agencies should establish a protocol to create detailed records, which are critical in the event of an accident or dispute. Many claims, however, are filed long after an incident occurred.

“We do see claims being filed as the statute of limitations approaches,” says Denniston. “Patients might wait a year to say that one of the first responders misdiagnosed them, gave them the

wrong medication, didn’t properly secure them or dropped them. Without proper documentation, it becomes difficult to say that the first responder did everything they should have done. A year later, it can be extremely difficult to defend the claim.”

McNeil & Co. helps EMS-based agencies develop preventive rather than reactive safety strategies to reduce these and other risks, and therefore decrease insurance claims and costs.

“We analyze every claim so we can see what should have been done to make it preventable,” Denniston says. “We use that information to help other agencies identify risks and be proactive in preventing future claims. We can help them do driver training

programs, look at drivers’ history, do patient handling training and implement clear policies and procedures.”

McNeil & Co. also offers its E-Learning training system free to all clients. The tool offers online, mobile-friendly training and performance tracking with the ability to assign courses to staff. Among the hundreds of courses offered are EMS driver safety, first aid, patient transport, bloodborne pathogens, Ebola prepared-ness and accident documentation.

Denniston says that McNeil & Co. encourages clients to ask questions about safety and works closely with them to help improve operations. “The more of our resources that they use, the better their odds to reduce losses and keep their rates in check,” Denniston says. “The message about safety has to be sent to every individual, from leadership to training officers to the frontline responders.”


FROM THE EDITOR By Nancy Perry

EMSWORLD.com | NOVEMBER 2015 1312 NOVEMBER 2015 | EMSWORLD.com

THE 2015 EMS WORLD EXPO, held September 15–19 in Las Vegas, NV, attracted nearly 5,000 attendees from 38 countries for five days of education, networking and product debuts.

Following two days of workshops and the fourth annual World Trauma Symposium, the core conference program kicked off Thursday, September 17, with the recipients of the 2015 National EMS Awards of Excellence recognized.

The winners, commended for their outstanding achievements in the field of EMS, included Calvert Advanced Life Support from Prince Frederick, MD, the 2015 Volunteer EMS Service of the Year, sponsored by ZOLL, and Richmond Ambulance Authority from Richmond, VA, the 2015 Dick Ferneau Career EMS Service of the Year, sponsored by Ferno.

Also presented was the second annual Mike Smith Memorial Scholarship Award to Stephanie Gilbert.

The opening keynote was delivered by Brent Myers, MD, MPH, FACEP, who provided a glimpse into the future of EMS in his compelling presentation that focused on how mobile integrated healthcare and community paramedi-cine are transforming prehospital operations.

Looking to the next few years, Myers says 60%-80% of Medicare payment will not be fee for service, but instead will focus on if the patient received adequate care. This is where community paramedicine programs could step in to improve patient care while helping ease congestion in hospitals.

Immediately following the keynote was the opening of the EMS World exhibit hall. This year’s exhibition featured

EMS World Expo Hits the Jackpot in Las VegasLargest EMS conference in North America delivered cutting-edge education and the latest technologies transforming prehospital care

353 exhibitors showcasing the latest products, services and technologies transforming the delivery of prehos-pital care.

The exhibit hall offered many additional educational opportunities for attendees. EMS World Expo faculty pre-sented free 30-minute sessions in the Learning Center, the Sim Lab walked participants through various simula-tion scenarios using the latest high-fidelity simulators, and, new this year, the active shooter simulation enabled groups of attendees to walk through sift-and-sort pro-cedures.

Mark your calendar for the 2016 EMS World Expo and NAEMT Annual Meeting, October 3–7 in New Orleans, LA. Visit EMSWorldExpo.com for more information.

First-Time Attendee Shares Valuable Lessons Learned at EMS World Expo 2015Despite it being my first time in Las Vegas, the content at EMS World Expo 2015 was more than enough to keep me off the strip and in the convention center.

While the effect of stress on the long-term health of EMS providers has got-ten more attention lately, we often ignore the impact stress has on our day-to-day decision making during emergency incidents.

In a fascinating and standing-room-only session, Maine EMS educator Dan Batsie presented evidence showing that our ability to function is hindered by the stress that naturally occurs on critical incidents. Some of that stress comes from the expectation—from ourselves, our peers and the community—that we will be able to help in every situation. The need to act sometimes compels people to act without thinking through the consequences.

“I think these are the most dangerous words in EMS: ‘Just do something’,” Batsie says. “This is when accidents happen. This is when people get hurt.” Batsie described the physiological changes that occur during stressful situa-tions, such as critical incidents. Decreased fine motor dexterity, tunnel vision, reduced cognitive processing abilities and auditory exclusion are just some of the evolutionary adaptations that help humans escape dangerous situations but harm us when we are trying to treat patients and stay safe on scenes. Batsie argued that EMS education needs to more realistically mimic some of these stressors, so we can learn to adapt to them. Methods of dealing with this stress include teamwork and crew resource management, checklists, and breathing exercises.

Another way to prevent stress from causing medical errors was presented by Kevin Collopy, a paramedic and educator from North Carolina, in his session on taking a “time-out” prior to rapid sequence intubation (RSI). The time-out approach is similar to what is happening in operating rooms in order to prevent wrong-site surgeries and other medical errors. For an RSI, Collopy suggested taking just 30 seconds to pause and go over a checklist with the entire team prior to starting the procedure. The checklist included ensuring someone was keeping an eye on the patient’s pulse oximetry levels, having suction and alternative airways ready, and other important preparations.

In the airport, waiting for my flight back to Washington, I overheard an attendee mention how energized he was to return home and implement changes based on what he had learned. While getting your CE hours and having a little fun are both great bonuses, this is what EMS World Expo 2015 is all about: sharing new ideas and inspiring leaders at all levels to improve EMS systems.

Michael Gerber, MPH, NRP, is an instructor, author and consultant in Washington, DC.

2015 Volunteer EMS Service of the Year: Calvert Advanced Life Support

2015 Dick Ferneau Career EMS Service of the Year: Richmond Ambulance Authority

Brent Myers


IT SOUNDS PRETTY CLICHÉ TO SAY “PRACTICE what you preach.” It’s easy to say, but how hard is it to put into effect?

One thing I preach is that if you are an EMS lead-er, you are coach and mentor to your subordinates. Disciplining an employee when they do something wrong is not necessarily a form of coaching and men-toring. However, some EMS leaders think when an employ-ee errs, the answer is to punish them regardless of the circum-stances. I preach against that since I have seen how you can sour a good employee when they have not done anything wrong intentionally.

Employees do things wrong for three reasons: 1. They make an honest mistake. Whatever they did

wrong, they did not do purposefully, but they made a simple and honest error.

2. They make an at-risk decision. They have multi-ple choices to make in a situation and, based upon their education, experience and training, they choose what they think is the best course of action. Unfortunately it turns out to be wrong.

3. They intentionally and deliberately choose to violate a policy, rule or regulation. In some cases there may not be a rule, policy or regulation, but if you lined up 100 other employees and asked if they would do the same thing, none of them would because they know it’s wrong.

What I preach is that EMS leaders should not dis-cipline employees who make an honest mistake or choose wrongly when making an at-risk decision. Instead we should take these opportunities to mentor and coach our employees. We should help them grow professionally and embrace mistakes so they do not get repeated. If it was an honest mistake and other employees have erred similarly, maybe there is a sys-tem problem that needs to be fixed.

Unfortunately, some EMS leaders feel that discipline is always the fix when something is done wrong. They think this will ensure the mistake never happens again. I do believe that if an employee does something wrong with intent, knowing it is wrong, they should be dis-ciplined. Discipline should be a tool to correct bad behavior. But just because an employee does some-

thing wrong does not mean they did it intentionally.This is what I preach, and I had to practice it recently.

It wasn’t easy.On September 11, we held a 9/11 memorial service

in my town of Champaign, IL. It was a short ceremony of about 20 minutes at the fire and police memorial in a city park. There were speeches and an invoca-

tion from our chaplain, and our honor guard presented the colors and rang the bell in remembrance of those who lost their lives.

Being the fire chief, I take tre-mendous pride in my depart-ment and its firefighters. These are symbolic events that also

demonstrate the professionalism of our department. As part of this ceremony, we raised the ladders on two trucks and hung a large American flag between them. I stressed before the ceremony that I wanted a picture of the two ladder trucks with the name Champaign on the sides of the ladders and the flag hanging between them.

Later in the day I went to the captain responsible for taking the pictures. I asked if he got the picture of the flag between the ladder trucks. He told me he did not because he forgot the camera on the seat of his car. I was furious. How do you forget the camera on the seat of the car? I said nothing and walked out of his office. He told me later that’s how he knew I was mad.

I thought about it over the weekend. I realized he did not do it intentionally. It was an honest mistake. My anger subsided. On Monday morning I walked into his office and closed the door, and we talked about it. He said he just forgot the camera among the other things he was doing to make sure it was a nice and reverent ceremony. I accepted that. I told him it was not the end of the world, and we’d get another picture sometime in the future. He continued to apologize. No apology was necessary—it was an honest mistake.

I also need to practice what I preach. How can I dis-cipline this captain for an honest error? He learned from it. I did too. Our department will survive. Maybe we’ll put backup photographers in place in the future to make sure we get that picture we want.

If you’re an EMS leader, you’ll lose credibility if you preach one thing and do the opposite.

ABOUT THE AUTHOR

Gary Ludwig, MS, EMT-P, is chief of the Champaign (IL) Fire Department. He is a well-known author and lecturer who has successfully managed large, award-winning metropolitan fire-based EMS systems in St. Louis and Memphis. He has a total of 37 years of fire, rescue and EMS experience and has been a paramedic for over 35 years.

Practice What You PreachMistakes happen—don’t let anger shape your reaction to them

EMS leaders should not discipline

employees who make an honest mistake.

LUDWIG ON LEADERSHIP By Gary Ludwig, MS, EMT-P

ABOUT THE AUTHOR

Debbie Vass is the director of quality initiatives for Paramedics Plus, which operates Sunstar Paramedics in Pinellas County, FL. She is a certified paramedic and licensed nurse in the state of Florida.

INJURY PREVENTION

EMTs and paramedics are taught to treat injuries and respond to medical emergen-cies, and many are actively involved in their communities to raise awareness about injury prevention. Yet thousands of EMS

workers are injured on the job every year.An estimated 10% of EMS employees miss work on

any given day due to an injury sustained on the job.1 The daily routines of EMTs and paramedics—lifting stretchers, kneeling next to patients, delivering CPR compressions—involve repetitive motions that can be damaging to the body, especially the back, knees, shoulders and neck. The leading cause of EMS injuries, lifting a patient, is a critical component of the job.

When an EMT or paramedic lifts an object heavier than 50 lbs., he puts tremendous stress on his joints and can begin to cause muscle damage. Unfortunately for EMTs and paramedics, many transports require lifting a patient who weighs much more than 50 lbs. and often needs to be lifted directly from the ground.

The physical demands of the job won’t change. However, EMS providers are finding ways to prevent on-the-job injuries.

Sunstar Paramedics in Pinellas County, FL, is teach-ing methods and techniques to its EMTs and para-medics to help them prepare for physically demand-ing tasks and prevent injuries. The Fit Responder program changed the way Sunstar employees lift and move patients and how they think about preparing for their shifts.

Any EMS provider can reduce employee injuries by selecting and implementing programs to help EMTs, paramedics and other in-the-field employees learn how to prepare for their physically demanding jobs and use techniques that create less stress on their bodies.

Selecting an Injury Prevention ProgramInjury prevention programs vary widely in how they’re approached. Each EMS organization should identify its needs and select a program that addresses its goals.

“Sunstar Paramedics has a strong training pro-gram that teaches our employees the fundamentals of lifting stretchers and moving patients,” says John Peterson, the service’s chief administrative officer. “As we analyzed our internal programs, we realized a more advanced biomechanics program could improve employee safety.”

Shortly after this realization, Sunstar’s manage-ment team attended a conference presentation by Fit Responder creator Bryan Fass and started researching his techniques and methods to see if the program might be a fit for Sunstar.

Fass conducts scientific testing to ensure his teach-ings use the muscles correctly and address the needs of EMTs and paramedics. His methods for moving, lifting and stretching fit the type of advanced biome-chanics Sunstar Paramedics’ employees needed, yet the methods were simple enough that they would not require advanced flexibility or fitness levels.

The next step is deciding if the investment and bene-fits align. EMS providers should consider potential cost savings when evaluating injury prevention programs.

“We looked at the program costs and weighed them against what we were paying in workers’ com-pensation, plus paying staff overtime or hiring new employees to cover missed shifts,” says Peterson. “In the end we decided the Fit Responder program would be beneficial in the long run and we would see a strong return on investment.”

Implementing the ProgramThe Fit Responder program teaches lifting and move-ment techniques, as well as stretches and exercises to reduce injuries.

Lifting patients is the most dangerous activity for EMTs and paramedics, and Fit Responder teaches lifting techniques that can prevent muscle strains. One exam-ple of a lifting technique is the “linebacker” position, where an employee has his legs shoulder-width apart and lifts with his head up and shoulders pulled back.

How to Start an Injury Prevention ProgramBetter techniques and stretching can reduce employee injuriesBy Debbie Vass

20 NOVEMBER 2015 | EMSWORLD.com EMSWORLD.com | NOVEMBER 2015 21

Ambulances are used in part of the pre-shift stretch routine.

INJURY PREVENTION

“One of the best ways to avoid injury is by keeping the spine and neck straight,” says Fass. “The ‘linebacker’ stance automatically puts your body in that position and allows

you to focus on the patients while still keep-ing your body safe.”

To avoid lifting patients, Fass showed new and creative ways to use Graham Medical

MegaMovers to slide patients while still maintaining patient safety. These movement techniques help reduce back strain injuries in the field. Sunstar already had MegaMovers in

stock, so there were minimal overhead costs with implementing the changes.

The third component of the Fit Responder program is stretching. Many muscle strains occur when the muscles aren’t properly warmed up before strenuous activity. Employees can prevent injuries by doing simple stretches before, during and after each shift.

Two keys to the stretches: They’re easy to learn and can be done anywhere, includ-ing inside the ambulance. In addition, ten-nis balls and foam rollers are used to help muscles heal by massaging painful knots that can form in muscle tissue, which often lead to pain and eventually injury.

To help employees remember to stretch before and after each shift, Sunstar set up stretching areas with instructional posters, tennis balls and foam rollers at its headquar-ters and two hub locations. Similar stretch-ing areas were set up inside employee break areas in Hospital Corp. of America hospitals

to facilitate stretching during shifts. Each employee carries a tennis ball in their bag to promote muscle healing throughout the day.

Employee AdoptionInitially employees may be hesitant to change. They’ve been doing their job in a certain way, and it can take time to embrace new techniques.

EMS providers should create a plan for helping employees adopt an injury preven-tion program. For Sunstar Paramedics, the shift supervisors and field training officers were a key to implementation.

Fass taught a four-day “train the trainer” course to familiarize Sunstar’s supervisors and field training officers with the new lift-ing techniques, stretches and exercises. The course equipped the trainers to teach their teams how to implement the new procedures, answer questions about techniques and serve as program ambassadors who are excited about the changes.

When it was time to introduce the pro-gram to all of Sunstar Paramedics’ employ-ees, the supervisors and FTOs assisted Fass in teaching the techniques and stretches. Fass presented the program overview, and employees split into groups to learn the types

Pre-shift stretches using a table at Sunstar Paramedics’ headquarters in Largo, FL.

Paramedics use tennis balls to target painful nodules that may form in muscle tissue.


MACS is Making Ambulance Crews Safer with the Mac’s Bariatric Ambulance Lift. With a 1,300 lbs. weight capacity the lift is prepared for any job you can roll on it. The platform is universal and will accommodate whatever equipment you choose to use. The Bumper Stow Technology makes the lift available to the ambulance crew at all times and functions as a bumper and step.

Don’t Strain Your Back...Go See Mac!

MACS is Making Ambulance Crews Safer with the Mac’s Bariatric Ambulance

With a 1,300 lbs. weight capacity the lift is prepared for any job you can roll on it. The platform is universal and will accommodate whatever equipment you choose to use. The Bumper Stow Technology makes the lift available to the ambulance crew at all times and functions as a bumper and step.

Don’t Strain Your Back...

800-795-6227 [email protected] www.macsliftgate.com

the ambulance crew at all times and


The Right Tool for the Job…

[email protected] | 855-239-5438

STOP unsafe improvising!

Sheets are for sleeping….

Tarps are for transferring…

www.BinderLift.comTo Receive FREE demo, visit….

Binder Lift is for lifting.


Sunstar Paramedics education and training coordinator Trevor Jackson uses a foam roller to massage muscle tissue in his leg.

INJURY PREVENTION

(nine months after launching the Fit Responder program), and it’s on track to meet or exceed the goal.

To help meet that goal, Sunstar Paramed-ics set an objective of 100% employee adop-tion. Use of the new techniques was added to employee evaluation sheets, and super-visors offer guidance on proper techniques throughout shifts.

“We understand that everyone won’t immediately adopt the preferred lifting tech-nique or always remember to stretch,” says Peterson. “But with the help of our super-visors and field training officers, we can encourage the lessons from the Fit Responder program and continue toward companywide implementation.”

REFERENCE1. Studnek JR, Ferketich A, Crawford JM. On the job illness and injury resulting in lost work time among a national cohort of emergency medical services professionals. Am J Ind Med, 2007 Dec; 50(12): 921–31.

of lifts, such as moving a patient from bed to bed or down stairs without lifting.

“We are seeing more and more employees adopt the new techniques every week,” says Josh Hoover, employee support and devel-opment coordinator at Sunstar. “I think the employees who are still hesitant will see the benefits their coworkers are getting from the program and embrace the changes.”

In addition, Sunstar modified new-hire orientation trainings to incorporate the Fit Responder program and teach the stretches and techniques to newly hired EMTs and paramedics.

EvaluationWhile the overall goal of any injury preven-tion program is increased employee safety, each EMS provider will have different objec-tives for measuring the effectiveness of an injury prevention program.

Sunstar Paramedics set a goal to decrease employee injuries by 20% by January 2016

Josh Hoover coaches Sunstar Paramedics team members on using biomechanic techniques to practice safely moving a patient from the ground, which is a move that places great stress on joints and muscles. ©Steve Berry


Gainful employment information available at ColumbiaSouthern.edu/Disclosure.

EMERGENCY MEDICAL SERVICES

PROFESSIONAL DEVELOPMENT OPPORTUNITIES IN

TO HELP YOU GAIN

NEEDED FOR SUCCESS.THE KNOWLEDGE AND SKILLS

CSU OFFERS

ADVANCE YOUR CAREER AND TAP INTO YOUR POTENTIAL TODAY!

TO LEARN MORE ABOUT OUR TRAINING, WORKSHOPS, CEUs AND ONLINE DEGREES, VISIT

ColumbiaSouthern.edu/EMSworld or call 877.258.7153

BACHELOR’S IN EMERGENCY MEDICAL SERVICES ADMINISTRATION

TEXTBOOKSINCLUDED


• History - 7 years proven track record

• Open channel design allows complete patient access from the airway to the waist without un-restraining the child.

• The restraint tightens into the mattress of the stretcher not into the child preventing any additional injury to the patient.

• Compact packaging, the ACR-4 fits into its own

10 x 10 custom bag taking up less room in the

back of an ambulance.

• ACR-4 replaces the need to carry multiple

devices to accomplish the task of restraining

all size patients

• ACR-4 has been fully crash tested under

the strictest of standards

•

Machine washable

The Ambulance Child Restraint provides the safe and effective transport of infants and children in an ambulance, covering weight ranges from 4lbs to 99lbs.

It’s so comforting to know my baby will be transported safely

L44-99lbs

M22-55lbs

S11-26lbs

XS4-11lbs

NEXT GENERATION

Ambulance Child Restraint

T: 516.321.9494E: [email protected] W: www.quantum-ems.com

3000 Marcus Avenue, Suite 3E6, Lake Success, NY 11042-1012


SAFETY SYSTEMS

EMS agencies have protocols and policies in place to ensure proper care and safety of patients. Agencies can also include programs that make EMS providers more mindful of their own safety and the

behaviors that impact that safety. Developing a safety management system (SMS) can assist field providers and their supervisors in being proactive, and possibly even predictive, instead of reactive, to the hazardous situations they face in the field.

The creation of an SMS can become an integral part of the agency’s operational procedures, but it takes a commitment from leadership to administra-tive staff says Ron Thackery, senior vice president of professional services & integration for American Medical Response (AMR).

During the recent EMS World Expo held Septem-ber 15–19 in Las Vegas, NV, Thackery and others presented ways to create an SMS as part of the EMS Safety Officer workshop that debuted this year.

According to Thackery everyone in an agency must understand the role of safety in order to implement and manage a program. He cautions, however, that one size does not fit all. Leadership, with strong input from employees, must analyze individual agency needs and prioritize based on what is realistic to implement. “You can’t boil the ocean,” says Thack-ery. “You might have a list of 10 things you want to do but realistically, you can’t do all of them. You have to boil it down to something manageable. Agencies have to pick their top needs and be committed to implementing the most important ones.”

Being proactive and predictive, instead of reactive, is key to successBy Susan E. Sagarra

26 NOVEMBER 2015 | EMSWORLD.comWILDLAND FIRES I FIRE DYNAMICS I ACTIVE SHOOTERS I FIRE BASED EMS I STRATEGIES & TACTICS I LEADERSHIP I PLUS MORE

January 31 – February 4, 2016San Diego Convention Center • San Diego, CA

GOING GLOBAL

TRAINING WITHOUT BARRIERS OR BORDERS

What’s New in 2016 at Firehouse World:• More than 80 conference sessions and moderated panels, featuring U.S. and international instructors• Exclusive Esperanza Staff Ride and a Leaders Recon Program at the site of the 2003 Cedar Fires• Big Room Sessions focusing on U.S. and International Tactics, Fire Dynamics and the Modern Fireground, Baltimore Riots, and the Fatal Houston Southwest Inn Fire• 250+ exhibitors featuring the latest tools and technologies• Firehouse Fitness Showcase and circuit workouts• Special Burn Survivors Benefit Program FirehouseWorld.com

#FHWorld16SAVE UP TO

$100 WHEN YOU

REGISTER TODAY!

The annual AMR Safety Competition simulates situations EMS professionals encounter every day.

SAFETY SYSTEMS

Thackery says that the message needs to be changed on a regular basis: “People might become numb to the message. Some organizations update the photos every six months or every year. I try to push people to have something personal and to update with new photos all the time. And really, people who are committed will keep updat-ing it, and leadership must make sure it happens.”

Thackery says the aviation industry implemented safety management systems in the 1970s. The EMS industry is mim-icking the aviation industry’s research and policies for its programming.

“It became popular in the EMS profes-sion in the past decade because the air-med side kept having crashes,” says Thackery. “We decided we needed to have a frame-work with a tie to EMS. Agencies have a process and policies, a way to manage their dispatching, billing, etc. It makes sense to include a program and policies for safety. When they do it, it just becomes a part of the overall way they run the agency.”

The concept is rooted in behavior-based safety and relies heavily on Herbert Hein-rich’s Pyramid of Safety. Heinrich was an industrial safety pioneer from the 1930s who worked for Travelers Insurance Co. Heinrich’s research is claimed as the basis for the theory of behavior-based safety, which holds that as many as 95% of all workplace accidents are caused by unsafe acts. Heinrich came to this conclusion after reviewing thousands of accident reports.

According to Thackery, changing behav-iors to create a culture of safety in the EMS industry requires a commitment to improve provider safety, which results in improved patient safety and, ultimately, improved community safety. The foundation of an SMS includes fostering a culture of safety, coordinated support and resources, safety data, education initiatives, safety standards and requirements for reporting and investi-gating incidents that affect safety.

An SMS should examine how paramed-ics are lifting patients, driving ambulanc-es, fatigue levels (analyzing hours of ser-vice), infection control protocols, hazmat responses, machinery operations and work-space ergonomics. Thackery also says an

Thackery and his colleagues at AMR have extensive knowledge in integrating safety into every aspect of providers’ duties. Thackery is responsible for risk manage-ment and safety, with previous executive oversight for f leet administration and clinical services. He serves on the board of directors for the National Safety Coun-

cil and chairs the Professional Standards and Research Committee of the American Ambulance Association.

“There are four components to a safety management system,” says Thackery. “The three primary ones are safety risk manage-ment, safety leadership and safety assur-ance. The fourth is safety promotion, which

is the glue that holds it all together. That part is how you communicate to the people in the field to behave safely. If you remember the TV show Hill Street Blues, at the end of every roll call they were told, ‘Let’s be care-ful out there.’ That built a culture of safety in every show. That kind of culture can be built within any agency.”

Thackery says the message can vary. In some places the chief or board president signs a mission statement or pledge that the agency is committed to safety. Others may have the entire staff sign the pledge. The statement may be framed and placed in a heavily traveled area of the agency.

“It’s a pledge saying, ‘This is why I work safe,’” he says. “Another idea is to have the staff provide photos of whatever is impor-tant to them in life–a spouse, kids, a pet. It sends a message that they are committed to work safely because of the reminders that are posted. It helps build a culture among the staff because people also learn things about each other. Then it is up to leadership to develop policies and programs of what they expect them to do to behave safely.”

36” or 48” long track

Emergency Vehicle Seating

Did you know that 74% of EMS worker deaths are transportation-related?*

Don’t let your staff become part of the statistic. Protect them with safety seating from EVS, Ltd. Since 1993, we’ve produced more safety seating products than anyone in the EMS industry, through investing in research and development and dynamic testing.

What are you doing to keep your medical staff safe? Specify EVS seating in your next vehicle.

Our only business is seating safety for the EMS industry!

(800)364-3218 · International (574)233-5707E-mail: [email protected] · www.evsltd.com

EVS 1769 Seat with Mobility 1 Tracking System

• Seamless seat with 3-point belting system

• Tracking system allows access to equipment and patient while belted

• Available in 36” or 48” long track

• Seat attachment to base may be offset to gain additional space

*According to the National Association of EMS Physicians.

Tilt-forward to transport a second patient or flip-up when not in use

SEAT OPTIONS


Code #72657

Move with Speed & SafetyThe MegaMover® Select™ Goes Where Stretchers Can’t

800.558.6765GrahamMedical.com

• Transfer, transport, and rescue patients that can’t be reached by stretchers

• 14 multi-positioned handles provide ergonomic lifting

• Pull straps for situations when pulling a patient is safer than lifting

• Durable, nonwoven design holds up to 1000 lbs.

• Light, space-saving, and portable

NEW EMS Products from Graham Medical



“A LOT OF AGENCIES MANAGE SAFETY IN A REACTIVE MODE; BUT THEY CAN DEVELOP SYSTEMS TO BE PRO-ACTIVE OR EVEN PREDICTIVE.” —Ron Thackery

100%of providers have

knowledge of safety issues;

74%of supervisors have

knowledge of safety issues;

4%of top management have

knowledge of safety issues.

In most agencies:

SAFETY SYSTEMS

SMS can focus on environmental sustain-ment, contractor safety, off-duty safety, fit-ness for duty, physical agility testing, drug/alcohol testing and medical monitoring (of employees, but also communicable diseases

in the community, such as Ebola).Thackery says there are three approaches

to managing safety issues:1. Reactive (past): Respond to events that

have already occurred, such as incidents and accidents;

2. Proactive (present): Actively identify hazards through the analysis of the orga-nization’s processes;

3. Predictive (future): Analyze system processes and current environment to identify potential future problems.

“A lot of agencies manage safety in a reac-

tive mode,” says Thackery. “An employee gets injured and the agency reacts. But they can develop systems to be pro-active or even predictive.”

However, that requires leadership to be more in tune with what is affecting safety within the agency. Thackery says that in most agencies, the paramedics and EMTs have 100% knowledge of problems and safety issues; supervisors have 74% knowl-edge; mid-level management has just 9% knowledge; and top management has just 4% knowledge.

So how does an EMS agency go about analyzing its needs and then implement-ing and maintaining a safety management system? Thackery said agencies should fol-low the ideas in the four pillars of an SMS:

Safety Policy: Establishes senior management’s commit-ment to continually improve safety, defining the methods, processes and organizational structure needed to meet

safety goals. It requires:• Commitment of the team to achieve

high standards and compliance. This also involves ethical decision-making and pro-moting a culture of safety.

• Transparency in managing safety.• Documented policies/processes.• Open reporting.• Any policy, program or initiative must

pass two tests: Will it mitigate risk if used as designed, and will the system adversely impact productivity, safety, efficiency and privacy?

Safety Risk Management: Determines the need for, and adequacy of, new or revised risk controls. The agency must identify hazards and assess, analyze and control the risks.Safety Assurance: Evaluates the continued effectiveness of implemented risk control strategies and supports the identification of new hazards. This ensures results meet

expectations and compliance, and facili-tates information gathering (via audits/evaluations, employee reporting and data analysis). Periodic assessment of the system is required.

Safety Promotion: Includes training, communication and other actions to create a posi-tive safety culture within all levels of the workforce. This phase is the glue that “bonds”

all safety activities. It involves advocating for a strong safety culture; communica-tion (includes awareness, lessons learned, social media); training and education; and eliciting input, ideas and feedback from everyone.

“The four categories give agencies the ability to put together their own SMS,” says Thackery. “They need to think about what they want to do in their own agencies. They also have to build a process so that people are willing to come forward about things they see and get employees to become engaged in order for it to work.”

Patient falls are a regular part of the working day in a healthcare environm

ent and perform

ing a safe lift is vital for both the wellbeing of the fallen person

and the EMS professionals. Injuries am

ong EMS professionals can be costly

not only to employers and em

ployees but also can negatively impact the

quality of care that a patient may receive.

Consequences of injury

worker

disorders

Consequences to the w

orker are:

• Ongoing pain

disorder

• The loss

• Time off required

resulting in reduced earnings

Moving fallen people is a regular part of the working day but the repetitive

nature of the work can cause serious back injury. The Mangar ELK & Camel

inflatable lifting cushions provide a safe lift from the floor to a chair or

stretcher, whilst minimising the risk of back injury to workers.

Inflatable lifting cushions are proven to:

• Reduce risk of back injury • Protect workers

• Reduce costs • Maintain patient dignity

Emergency services in the UK, Australia, Canada and

the USA are using lifting cushions. To find out why

and for a free demonstration, please call

804.405.5706 or email [email protected]

mangarusa.com

SAfE PATIEnT LIfTIng

MangarLiftingCushionsEMSmangarint

Lifts up to

1,000lbs

MAKE SURE yoUR nExT LIfT ISn’T yoUR LAST62% of EMS workers’ back injuries are as a result of patient lifting.


ABOUT THE AUTHOR

Susan E. Sagarra is a writer, editor and book author based in St. Louis, MO.


AMR holds an annual event in Denver where providers compete in a safety and skills competition that simulates situations EMS professionals encounter every day. “The AMR National Safety Competition is not only a very prestigious event for our caregivers, it also instills a culture of safety and an emphasis on clinical excellence,” says Thackery. “The competition includes a timed driving course that measures their abilities to safely and efficiently operate an ambulance, two very difficult patient encounters and a clinical skills section.” While the crews have a lot of fun and truly enjoy the competition, they also understand the importance of focusing on safety and clinical excellence. “The crews all take home something they have learned and then they pass it on to the other team members in their local operation,” says Thackery. “It’s that type of commitment to learning and excellence that ensures our crews provide outstanding patient care every day.”


Does the evidence demonstrate a true benefit to ACCDs with cardiac arrest victims?By Philip Chan, MD, Hawnwan Philip Moy, MD, & Rob Lawrence, MCMI

It was a typical night for Michael Snyder, Jr. as he settled into his third-floor apartment with a few friends. Little did he know that later that evening, he would succumb to a cardiac arrest. When it happened his friends immediately called 9-1-1.

Within minutes of EMS’ arrival, paramedics realized performing hands-on CPR would hinder Michael’s removal. The only way to maintain uninterrupted CPR while moving him from his third-floor walkup to the ambulance would be with mechanical help.

Fortunately Michael’s local EMS system had the foresight to equip every paramedic unit with an

automatic chest compression device (ACCD). The paramedics applied the ACCD and transported him down three flights of stairs. Their ACCD performed its lifesaving intervention throughout and during the entire transport to the hospital.

To the credit of the paramedics for their quick think-ing, the EMS system’s progressive planning and invest-ment in technology, and the ACCD, Michael Snyder, Jr. survived without any neurologic deficits. But beyond a unique case like this, does the evidence demonstrate a true benefit to ACCDs with cardiac arrest victims on a larger scale? Are they worth the investment?

ZOLL Medical Corporation

The new 2015 AHA guidelines for CPR/ECC were released in October. For updates, see www.emsworld.

EVIDENCE-BASED EMS: Automated Chest Compression Devices

EMS1505



AUTOMATED CPR

ably cause a pause in manual chest compres-sions, but in reality this time is minimal, especially given that providers are trained to seamlessly integrate the device into their

resuscitation with a “pit crew” approach. A study looking at a load-distributing band CPR device found that providers could reli-ably deploy the device in under 60 seconds.4

Once the device is in place, there will be additional room around the patient where the provider performing chest compressions would have been. In simulations, having an ACCD in place and operating does increase the time needed for intubation, but by less than 10 seconds.5

Percutaneous coronary intervention can even be performed while an ACCD is in place, as demonstrated by a 2014 Journal of Emergency Medicine case report in which the patient achieved ROSC after the pro-cedure.6

With the continued evolution of newer devices, rhythm analysis and shock delivery will be possible in the future, further aug-menting resuscitative efficiency.

Do ACCDs improve patient outcomes? Currently there is no robust data to support that ACCDs improve measurable patient outcomes in prehospital cardiac arrest. This is despite the fact that ACCDs have

Automated Chest Compression Devices (ACCDs)Good chest compressions remain an inte-gral part of the resuscitation of a pulseless patient, but challenges frequently inter-rupt or compromise their quality. This is especially true in the prehospital setting, where personnel may be limited and other critical procedures such as airway man-agement, intravenous access, medication administration and transport may com-pete with good compressions. In addition, rescuer fatigue can often set in well before arrival at a hospital.1

In principle, a device that delivers auto-mated chest compressions could reduce interruptions, ensure appropriate depth and frequency, and free up personnel and space to perform other tasks. But should they be implemented universally? A number of questions need to be addressed before coming to a conclusion.

Are ACCDs safe and reliable?One of the issues with using an automated device is the potential for injury to the patient.

Trauma such as rib fractures and pneu-mothoraces are known complications from

manual CPR, but there are no studies com-paring the incidence of these complications between manual and automated CPR. How-ever, cardiac arrest survivors will regularly testify that they would rather be alive with a broken rib than dead and uninjured.

Additionally, for extremely obese patients, an ACCD may not be able to accommodate their large chest circumfer-ence, though devices are rated for weight and providers are trained to understand the uses and limitations of the devices prior to deployment.

Reliability has been integral to the imple-mentation of ACCDs, and there is one nota-ble case report where an ACCD was placed on a hypothermic drowning patient for 5 hours and 20 minutes, allowing initiation of cardiopulmonary bypass.2

When should ACCDs be used? Another clear advantage of using an ACCD is the ability to provide prolonged periods of effective chest compressions without con-cern for provider fatigue as well as freeing up personnel to perform other important tasks.

With use of ACCDs, compressions do not stop when the patient is being transported to a stretcher, into an ambulance, out of

the ambulance or to the receiving hospital stretcher. One case study in 2011 docu-mented a patient with a suspected splenic hemorrhage who went immediately to the OR, where he arrested. He was placed on an ACCD for 40 minutes before return of spon-taneous circulation (ROSC), which allowed for source control with a splenectomy and recovery without neurologic deficits.3

In addition to maintaining circulation in the pulseless patient with an extended period of prehospital transfer, ACCDs, once integrated as part of the community’s EMS CPR chain of survival, free up first respond-ers and EMS providers to perform other critical procedures, an obvious benefit.

Additionally, there is new evidence to suggest that performing chest com-pressions while the patient is placed in a 30-degree reverse Trendelenburg posi-tion may improve outcomes [EMSWorld.com/12088616]. The only effective way to deliver such an intervention with effec-tive compressions is via an ACCD and an elevated backboard.

Will an ACCD hinder resuscitation while it’s getting set up or in use? Deploying an ACCD on a patient will invari-

We are currently accepting abstracts for consideration for the EMS World Expo 2016, scheduled for October 3–7 in New Orleans, LA.

We are looking for timely, thought-provoking and educationally sound topics that are relevant to EMTs, paramedics, critical care providers, emergency nurses, educators, administrators and managers.

Proposed sessions are evaluated based on: ✔ Relevance to the EMS community; ✔ Practical applications of material; ✔ Timeliness of the topic;✔ Speaker qualifications.

Top consideration is given to new, high-quality and/or timely topics not previously presented at EMS World Expo, and to presentations that focus on solutions for both field providers and EMS management. Submit online at EMSWorld.com/12124170.

DEADLINE FOR SUBMISSIONS: DECEMBER 15, 2015. QUESTIONS? E-MAIL [email protected].

Phys

io-C

ontro

l

Call or visit us online for your FREE demo.

Looking for an easy, flexibletraining solution for EMScontinuing education andfirefighter development?

Go online with 24-7 foreasy access to individuale-learning and classroomdelivery options throughunlimited-use membershipsor single course credits.Assign, track, and report ondepartment-wide training.

1530

-000

9

GET TRAINING AS SERIOUS AS YOUR JOB

888-240-4911www.24-7ems.com


EMS1511S



AUTOMATED CPR

ever, each system must also weigh the cost of an ACCD against the importance of freeing up personnel to perform other important tasks. Finally, given the few case reports of positive outcomes, there may be an important role for ACCDs in select patients.

REFERENCES1. Duchateau FX, Gueye P, Curac S, et al. Effect of the AutoPulse automated band chest compression device on hemodynamics in out-of-hospital cardiac arrest resuscitation. Intensive Care Med, 2010 Jul; 36(7): 1,256–60.2. Michalski T, Gottardi R, Dunser MW. Extensive soft tissue trauma due to prolonged cardiopulmonary resuscitation using an automated chest compression (ACC) device. Emerg Med J, 2014 May; 31(5): 431.3. Dumans-Nizard V, Fischler M. Intraoperative use of an automated chest compression device. Anesthsiology, 2011 May; 114(5): 1,253–5.4. Ong ME, Annathurai A, Shahidah A, et al. Cardiopulmonary resuscitation interruptions with use of a load-distributing band device during emergency department cardiac arrest. Ann Emerg Med, 2010 Sep; 56(3): 233–41.

5. Agostinucci JM, Catineau J, Jabre P, et al. Impact of the use of an automated chest-compression device on airway management during out-of-hospital cardiopulmonary resuscitation: the PLAINT study. Resuscitation, 2011 Oct; 82(10): 1,328–31.6. Forti A, Zilio G, Zanatta P, et al. Full recovery after prolonged cardiac arrest and resuscitation with mechanical chest compression device during helicopter transportation and percutaneous coronary intervention. J Emerg Med, 2014 Dec; 47(6): 632–4.7. Hallstrom A, Rea TD, Sayre MR, et al. Manual chest compression vs use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest: a randomized trial. JAMA, 2006 Jun 14; 295(22): 2,620–8.8. Hock Ong ME, Fook-Chong S, Annathurai A, et al. Improved neurologically intact survival with the use of an automated, load-distributing band chest compression device for cardiac arrest presenting to the emergency department. Crit Care, 2012 Aug 3; 16(4): R144.9. Ong ME, Mackey KE, Zhang ZC, et al. Mechanical CPR devices compared to manual CPR during out-of-hospital cardiac arrest and ambulance transport: a systematic review. Scand J Trauma Resusc Emerg Med, 2012 Jun 18; 20: 39.

been shown to increase mean systolic and diastolic pressure in patients compared to manual chest compressions.1

A randomized multicenter trial consist-ing of 767 patients demonstrated that use of an ACCD resulted in a delay of two minutes

to defibrillation, and survival to hospital discharge in the ACCD group was 5.8%, compared to 9.9% in the manual CPR group (p=0.04). In addition, Cerebral Performance Category (CPC) scores were higher in the manual CPR group. This data suggests the

use of an ACCD results in worse patient outcomes.7

However, a later study with 1,011 patients found that in the emergency department setting, implementation of an ACCD showed a trend toward better survival to discharge and neurologic outcome.8 A more recent review in 2012 found insufficient evi-dence to support or refute the use of ACCDs in out-of-hospital cardiac arrests, and while ACCDs provide more consistent compres-sions, they may in fact worsen neurologic outcome.9

Bottom Line: Worth the Cost?ACCDs can easily cost over $10,000 for a single unit, and disposable components for the units (e.g., straps, suction cups) must be purchased separately. To equip an EMS sys-tem with these devices on every ambulance could be cost-prohibitive, and for this rea-son ACCDs may not be ready for widespread implementation in prehospital care. How-

Grant Monies Fund Device DeploymentMINNESOTA TO PLACE LUCAS SYSTEM IN AMBULANCES STATEWIDELast year, the Minnesota Department of Health announced an initiative to place Physio-Control’s LUCAS 2 Chest Compression System into ambulance services and hospitals across the state. The Leona M. and Harry B. Helmsley Charitable Trust is funding the project with a $4 million grant. The project will include the necessary training for using the devices and will be coordinated by the health department.

FLA. EMS AGENCY GETS AUTOMATED CPR DEVICESManatee County EMS bought eight ZOLL AutoPulses; half of the cost was covered by a state grant funded by traffic tickets. The other half came out of the capital expense budget for EMS. Steve Krivjanik, chief of Manatee County Emergency Medical Services, said he’s hoping to have all 18 county ambulances stocked with one by 2017.

ABOUT THE AUTHORS

Philip Chan, MD, is a third-year emergency medicine resident at the Washington University School of Medicine/Barnes-Jewish Hospital. He has an interest in prehospital medicine in addition to medical education and, in his free time, he contributes to Everyday EBM, a resident-run blog focused on emergency medicine.

Hawnwan Philip Moy, MD, is an assistant medical director of the St. Louis Fire Department and emergency medicine clinical instructor and core faculty of the EMS Section of the Division of Emergency Medicine at Washington University in St. Louis, MO. He completed his emergency medicine residency at Barnes-Jewish Hospital/Washington University in St. Louis and his EMS fellowship at the University of North Carolina in Chapel Hill.

Rob Lawrence, MCMI, is chief operating officer of the Richmond Ambulance Authority. Before coming to the USA in 2008 to work with RAA, he held the same position with the English county of Suffolk as part of the East of England Ambulance Service. He is a graduate of the Royal Military Academy Sandhurst and served in the Royal Army Medical Corps.

WE´RE COMING TO NEW ORLEANS

SAVE THE DATE October 3 – 7, 2016Ernest N. Morial Convention Center | New Orleans, LA

EMSWorldExpo.com #EMSWorldExpo

ED

UCATION

What People Are Saying about EMS World Expo*

NETW

OR

KIN

G

I was able to make connections withmany di erent EMS companies.

It was a fun learning experience with lots of educational and networking opportunities.

Outstanding, I always get good info and make good contacts.

EX

HIB

IT HALL

A good value for the dollar. This trade show is second to none.

The exhibit hall was packed with innovative products.

Awesome show. Better than others I have been to.

I learned so much. The speakers were amazing. I’m taking back a ton of information!

Quality of learning content was excellent. Probably the best conference I’ve attended.

It is extremely important to be up-to-date on the latest research to provide the best care. The conference provided great information on new and emerging changes in EMS.

* Attendee comments from EMS World Expo 2015

EMS World® ISSN 1946-9365 (print) and ISSN 1946-4967 (online) is published monthly by Cygnus Business Media, 1233 Janesville Ave., Fort Atkinson, WI 53538. The publisher reserves the right to reject nonqualified subscribers. One-year subscriptions for nonqualified individuals: U.S. $50; Canada and Mexico $70; all other countries $100. Payable in U.S. funds drawn on a U.S. bank. Periodicals postage paid at Fort Atkinson, WI, and additional mailing offices. Printed in

U.S.A. POSTMASTER: Please send change of address to EMS World, P.O. 3257, Northbrook, IL 60065-3257. Canada Post PM40612608. Return undeliverable Canadian Addresses to: EMS World, PO Box 25542, London, ON N6C 6B2. CHANGE OF ADDRESS notices should be sent promptly. Provide old mailing label as well as new address; please include ZIP code. Allow 2 months for change to take effect. GST #842773848.

The views and opinions in the articles herein are not to be taken as

official expressions of the publishers, unless so stated. The publishers do not warrant, either expressly or by implication, the factual accuracy of the articles herein, nor do they so warrant any views or opinions offered by the authors of said articles. © Copyright 2015 by Cygnus Business Media. All rights reserved. No part of this publication may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from EMS World.

FE AT UR ES

32 The International Roots of Community Paramedicine What we can learn from programs in Australia and CanadaBy Gary Wingrove, Peter O’Meara, PhD, & Michael Nolan, MA, Dip. Ed., CCP(F)

35 Evidence-Based EMS: Automated Chest Compression Devices Does the evidence demonstrate a true benefit to ACCDs with cardiac arrest victims?By Philip Chan, MD, Hawnwan Philip Moy, MD, & Rob Lawrence, MCMI

42 Search and Rescue on the Border The elite BORSTAR search and rescue team provides care for all in needBy Joseph J. Kolb, MA

50 Product Applications from the Field Interviews with end users of EMS products, technologies and services

ContentsNOVEMBER 2015 VOL. 44 | ISSUE 11

COV ER R EP ORT

COLUMNS14 CASE REVIEW

Restraint of an Agitated PatientBy James J. Augustine, MD, FACEP

19 LUDWIG ON LEADERSHIP

Practice What You PreachBy Gary Ludwig

58 LIFE SUPPORTDisparate MeasuresBy Mike Rubin, BS, NREMT-P

DEPARTMENTS 8 EMS World Online12 From the Editor56 Advertiser Index57 Classified Ads

DOWNLOAD the FREE

EMS World tablet editionapp to access

exclusive EMS World

content.

DOWNLOAD the FREE

EMS World tablet editionapp to access

exclusive EMS World

content.

DOWNLOAD the FREE EMS World tablet edition app to access exclusive EMS World content.

20 How to Start an Injury Prevention Program

Better techniques and stretching can reduce employee injuriesBy Debbie Vass

26 Steps to Designing a Safety Management System

Being proactive and predictive, instead of reactive, is key to successBy Susan E. Sagarra

EDITOR’S NOTE: We are relaunching our continuing education content in 2016. E-mail [email protected] to be notified when content is available.

ON THE COVER: Sunstar Paramedics team members use biomechanic techniques to practice safely moving a patient from the ground.


42

50

26


20

BORDER RESPONSE

In late December a seriously injured man was found on the side of a 7,000-foot cliff in a treach-erous mountain range south of Tucson. Hovering above the victim was a Black Hawk helicopter with agents from the elite U.S. Border Patrol

Search, Trauma and Rescue (BORSTAR) team. After

the rescuers fast-roped in to render aid, high winds and low visibility forced the chopper to return to base.

With no choice but to wait until the morning to evacuate him, agents stayed overnight with the now-stabilized patient, who was later identified as a scout for drug smugglers. In the morning he and the agents

were hoisted onto a Black Hawk, and the patient was eventually transported to Tucson Medical Center.

Typically the sound of the U.S. Border Patrol arriv-ing sends illegal immigrants and drug smugglers scurrying to avoid being detained and returned to their country of origin, but on this particular mis-sion, like thousands of times before, the helicopter carrying BORSTAR agents arrived with the primary mission of saving a life, regardless of its motive in entering the U.S.

BORSTAR was created in 1998 in response to two things: 1) a need to provide emergency care and evac-uation to injured Border Patrol agents in remote areas along the border, and 2) increasing deaths among migrants crossing into the U.S. from the elements and violence at the hands of fellow migrants and traf-fickers (human and drug).

The need for a unit such as BORSTAR is at least partially a consequence of U.S. border security policy. In 1993 Operation Hold the Line in El Paso, followed by Operation Gatekeeper in San Diego, created a fun-nel effect where individuals hoping to cross the border illegally were forced from the urban areas into more rural and inhospitable deserts and mountains. This was exacerbated by the construction of some 700 miles of border fence, pushing migrants further into remote areas.

In 1998 the Border Patrol reported 263 migrant deaths. This number jumped significantly to 492 in 2005. At the end of fiscal year 2014, there had been 307 deaths reported along the southwestern border. The majority of these were due to exposure to the elements, but violence among narcotic and human smugglers is always a factor.

The elite BORSTAR search and rescue team provides care for all in needBy Joseph J. Kolb, MA

BORSTAR works to stay ahead of these daunting numbers. Its teams were called out 1,079 times in 2014; 1,793 times in 2013; and 1,431 times in 2012. For rapid response along the border, there are 9 special detachments with an average of 20 BORSTAR agents found in each sector from San Diego to Brownsville, TX, with the Special Operations Group working out of the El Paso headquarters. In recent years the BOR-STAR team from the Brownsville Sector in South Texas has been the busiest, especially with the recent flood of immigrants coming to the U.S. from Central America.

Violence against Border Patrol agents has been a regular tactic used by drug smugglers desperate to get their products into the U.S. This further validates the need for BORSTAR to be able to treat its own.

Assaults against Border Patrol agents have decreased over the last four years, from 666 in 2011 to 366 in 2014, but are no less serious. A common tactic is for migrants and smugglers to pelt agents with rocks, which are readily available weapons in the desert. Many of these rock incidents have resulted in serious injuries. The majority of serious injuries and deaths to Border Patrol agents, however, are from vehicular accidents, to which treacherous terrain,


Phot

os co

urte

sy U

.S. C

usto

ms a

nd B

orde

r Pro

tect

ion

BORDER RESPONSE

factors playing key roles in determining if a candidate can handle providing care under pressure situations.

The grueling course leaves many candidates on the sidelines. Munoz estimates some 75 candidates will pass the preselection criteria at their sector and start the STC course in El Paso, but fewer than 20 will ulti-mately complete it and earn the coveted BORSTAR tab worn on the right BDU sleeve above the circular Border Patrol patch.

Upon completion of the STC, eligible agents receive additional specialized training in numerous areas: emergency medical; tactical medicine; technical rope rescue; paramedic; austere medic; load planner; heli-copter rope suspension training; rescue watercraft/boat operator; cold-weather operations; personnel recovery; small unit tactics; tactical combat casualty care; opera-tions management and planning; and advanced dive, swiftwater and technical rope rescue operations.

Care for AllBORSTAR enhances the level of compassion toward border crossers. That can escape the media’s and pub-lic’s perception of the Border Patrol, which is often

criticized by both supporters of greater border secu-rity and advocates for those caught crossing. This criticism doesn’t affect the agents or the job they do, because they see the reality.

weather and poor lighting have all been contributing factors. Then there is the ever-present threat of attack with weapons. In October 2012 Agent Nicholas Ivie was shot to death by drug smugglers, as was Agent Brian Terry in December 2010.

“I initially joined BORSTAR in 2004 to help injured Border Patrol agents,” says Cdr. Jesse Munoz, from the unit’s El Paso headquarters at Fort Bliss, TX. “But regardless of your political views or views on immi-gration, people should not be dying in the desert.”

Munoz says the training and organization of BOR-STAR have changed over the years to meet the austere and challenging environments of most of its calls and potential tactical incidents.

Unlike civilian EMS crews, who are instructed to stand by until a scene is safe, BORSTAR agents enter scenes with the expectation they’re unsafe. There are numerous unknowns when arriving at a scene, and often agents respond with an M4 rifle at the ready. Munoz says there have been no known attacks on BORSTAR agents responding to emergencies, but many agents have been fired upon or attacked on patrol.

“We need to hone our skills in tactical medicine because of attacks on agents,” Munoz says.

The mission extends beyond the border. Agents

have been used for domestic emergencies such as hurricane and tornado search and rescue as well as providing standby medical assistance at the Super Bowl and training foreign agencies in search and rescue and tactical combat casualty care. Training operations, most of which average 4–6 weeks, have been conducted for border-patrol agencies in Africa, Belize, Costa Rica and Iraq.

Becoming an AgentBecoming a BORSTAR agent is not easy. The quali-fication and training curriculum resembles that of military special forces units.

BORSTAR consists of experienced Border Patrol agents who must have at least two years’ experience patrolling the “line.” They must pass a prequalifi-cation physical fitness and swim test at their refer-ring sector to attend and successfully complete the five-week BORSTAR selection and training course (STC). The STC is a physically and mentally demand-ing course in which candidates are evaluated and trained in various search and rescue techniques, tactical medicine, technical rescue, land navigation, communication, swiftwater rescue, air operations and the ability to work in a cohesive unit. Course days last as long as 16 hours, with sleep deprivation and stress


ABOUT THE AUTHOR

Joseph J. Kolb, MA, has a 20-year history as an EMT and currently serves with the New Mexico Task Force 1 urban search and rescue team. He designed and teaches a self-defense curriculum for EMS workers through Global One Defense Solutions in Albuquerque. Reach him at [email protected].

Real-time fleet telematics • Manage video from anywhere • Instant driver feedback

ALL of your digital video on ONE platform!

www.digitalallyinc.com • 800-440-4947 • [email protected]


Arizona RescueOne recent example of a BORSTAR operation occurred in December in the Baboquivari mountain range in Arizona, where an undocumented male was discovered at the bottom of a deep ravine after fall-ing off one of the range’s treacherous cliffs.

Agents from the Tucson Sector responded in a UH-60 Black Hawk helicopter equipped with a hoist. “When agents arrived on scene, they discovered the victim at the bottom of a deep ravine on very treacherous terrain,” says Air Enforcement Agent Rafael Madrigal, who was among the Black Hawk’s crew. “The victim needed to be brought up and treated quickly.”

Emergency responders con-sider mountain rescues high-risk given the altitude—6,000 feet in this case—and rugged terrain.

An onboard hoist operator lowered an Office of Air and Marine EMT and a BORSTAR paramedic onto the mountain. The duo climbed down the

ravine to reach the victim while the hoist operator lowered a lit-ter near him. Agents then carried the man to the litter. Once he was secured, the hoist operator lifted the EMT, paramedic and patient up to the helicopter for transport to Ryan Airfield for advanced medical care.

The victim was stable but complained of injuries to his head and legs and said he had lost consciousness.

“One of the toughest cases I’ve responded to,” says Munoz, “was two men, one naked and the other in his underwear, in dis-

tress so severe they made a pact: If nobody found them that night, they were going to kill themselves. We were able to resuscitate

them and get them evacuated.”While providing medical care to the

people they’ll be apprehending may seem

*For terms and conditions please visit www.buyemp.com/customer-service.htmlBuyEMP.com You order. We ship (free).* It’s that simple.

Introducing eSeries Transport Ventilators from O-Two Medical Technologies

• Compact & Lightweight

• Easy To Use

• Quick Patient Setup

• Live Monitoring Screen

• 18+ Hour Battery Life

• Budget Friendly

• 2 Year Manufacturer’s Warranty

Built for EMS

Contact EMP for more details800.558.6270



Your ONE-STOP destinationfor exceptional gifts, now at

exceptionally low prices!

Gift-giving ideas this holiday season

to pose a moral dilemma, the humanitarian mission comes first. Law enforcement issues can wait until the patient has recovered.

“It doesn’t matter who the person is, we will provide care for them,” says Supervisory Agent Thomas Hermosillo, a technical rope specialist with BORSTAR for nine years. “A lot of the people we treat crossing the border are really bad guys.”

Hermosillo is referring to drug traffickers. Agents will treat their wounds and evacuate them for definitive care.

Supervisory Agent Patrick Limbaugh has no problem with his combined role as an emergency care provider and law enforce-ment agent.

“You know you’re doing the right thing by providing care, but you still have to do the job of apprehending people who enter the country illegally,” Limbaugh says.

In these cases, Munoz says, an agent will stay with the patient throughout their recovery in the hospital. When they are medi-cally cleared, the deportation or incarceration process will begin.

The agents take particular issue with the coyotes who abuse and manipulate vulnerable migrants who may pay as much as $5,000 to cross into the U.S.

“The smugglers are notorious for lying to groups of migrants,” Munoz said. “They may point them in a direction and say the road is only a mile away while it really is 20.”

That’s when migrants can get into trouble. But since word got around the migrant camps south of the border that BORSTAR is available if they get into trouble, many coyotes, and even drug smugglers, now carry cell phones in case of medical emergency.

Munoz has confronted groups as large as 85 by himself and 150 with other agents.

Tales of the BorderHermosillo says it’s not uncommon to be called out for a drug smuggler who is unresponsive because of heat exhaustion. When agents arrive on scene, they will find the smuggler in one spot and the drugs often concealed not far away.

“It’s kind of amusing that after we treat them with an IV and they come to, they tell us everything, even where the drugs are,” Her-mosillo says. “We then have to take the individual into custody.”

What agents find most challenging is locating people who call for help but have no idea where they are along the nearly 2,000-mile border. Munoz says when 9-1-1 calls come in, there are skilled operators who have perfected triangulation and area description techniques to better lead BORSTAR to the patient.

Aiding in finding patients are emergency beacons placed throughout high border-crossing traffic areas. Essentially these are panic buttons people can activate for BORSTAR to respond. Munoz says they’ve been a double-edged sword.

“We may get a call that winds up being a diversion to pull agents from another area to respond,” Munoz says. “It gets frustrating that people will take advantage of our compassion for criminal purposes.”

BORDER RESPONSE


888-458-65463121 Millers Lane Louisville, KY 40216 Tel: 502-775-8303 Fax: 502-772-0548

S A F E T Y A P P L I A N C E C O M P A N Y

www.junkinsafety.com

PROUDLY MANUFACTURED IN THE USA

JSA-400

Aluminum Break-Apart Stretcher

SpecificationsDimensions: 66 ¼" L x 17 ½" W x 2 5⁄8" HFolded Length: 49 ½"Folded Depth: 3 ½"Adjustable to: 80"Load Capacity: 400 lbs.Shipping Weight: 21 ½ lbs.

Designed to gently maneuver stretcher under

patient without rolling or lifting.

The center of the Junkin Aluminum Break-Apart

Stretcher can be opened to allow the patient to

be X-rayed while secured on the stretcher.

Features sturdy, lightweight aluminum

construction with an adjustable length and

three patient restraint straps. Folds for easy

storing and separates in half during

application and removal.

JSA-400

JSA-400_qtr_pg.indd 1 11/4/09 2:57:25 PM



THE NEW 2015 RESUSCITATION GUIDELINES: TRANSLATING SCIENCE INTO SURVIVAL

JOIN US IN SAN DIEGO!

Calling all EMS Instructors and Providers: ECCU 2015 with the new 2015 Guidelines on CPR and ECC is for You!

• Be among the first to learn from the experts who developed the new Guidelines on CPR and ECC. Attend Official Instructor Updates.

• Learn the latest resuscitation techniques and systems from the “Eagles,” consisting of EMS Medical Directors from the most successful EMS systems in the United States under the leadership of Dr. Paul Pepe.

• Practice with the Seattle Resuscitation Academy team including Drs. Thomas Rea and Michael Sayer along with their EMS leadership to “perfect perfusion.”

• Fine-Tune your airway management skills with Colby Rowe and other experts in simulation and management of the difficult airway using the latest innovations.

• Network with other EMS and in-hospital providers while learning best practices for instruction and implementation.

Hear first hand from ECCU faculty about what to expect at ECCU. Watch podcasts at http://www.emsworld.com/podcast

Conference December 8-11 • Pre-Conference December 7-8Manchester Grand Hyatt, San Diego, California

Conference & Exposition

Plan now to attend. Register at www.eccu2015.com

Presented by the Citizen CPR Foundation in cooperation with:

A D V E R T O R I A L

A Simple Change to Save MoneySometimes savings can be as easy as chang-ing a defibrillator pad.

Scott Hicks, director of operations and administration for Medstar Ambulance in Detroit, learned this lesson when his com-pany switched to Bound Tree Medical’s Medstorm Multi-Function Defibrillator Pads about four years ago.

Hicks says the service had previously used manufacturer pads, but decided to make the switch as a cost-saving measure. They have used Bound Tree’s pads since.

“The biggest advantage has been cost sav-ings, and the pads function the same as the manufacturer pads did,” Hicks says.

The pads encompass a radiotransparent and radiotranslucent system that allows them to stay with the patient as they move through different care environments.

The ease of use helped make the imple-mentation of the new pads as easy as letting employees know the change was happening, Hicks says.

The pads come with a variety of features that make them easier to use, including a color-coded packaging system, a 60-inch

lead wire that allows for more room to work, easy-to-read instructions and warn-ing labels throughout the packaging, peel-pouch and tear-notch packaging to allow for easier access while wearing gloves, and a checklist printed directly on the release liners.

“There was no learning curve at all, and implementation was seamless,” Hicks says. “We simply sent a picture of the new prod-uct out and advised our employees they would be seeing the pads soon.”

The latex-free pads come with a polymer adhesive gel that allows for great contact and offers uniform current distribution so defibrillation and pacing is effective.

To learn more about Bound Tree Medi-cal’s Medstorm Multi-Function Defibril-lator Pads or their other products, visit boundtree.com.Circle 38 on the Product Information Card

An Emphasis on EducationContinuing education in any profession is a solid way to further a career and foster success.

Columbia Southern, an online university based in Orange Beach, AL, helps EMS and fire professionals advance their education through its Bachelor of Science degrees in EMS administration, healthcare adminis-tration with an EMS management focus, and fire administration.

Vera Morrison, battalion chief of DeKalb County, GA, Fire Rescue, received her Bachelor of Science in Fire Administra-tion from CSU. Morrison was working for a fire department while pursuing a nursing degree, but decided to further her career in the fire industry. She says her experience was great.

“The coursers were challenging but intriguing,” Morrison says. “They made you think about what you were actually doing.”

It took Morrison five years to get her degree, as she took a year off during her time at Columbia Southern. She says that while she needed to take a break, university edu-cators were helpful even during that time.

Columbia Southern is geared toward providing education in specialized areas for adult learners, and has trained its faculty in assisting students as much as possible.

Morrison says she would recommend the university to anyone looking to further their education.

“Whether you’re registering for the first time or trying to get information, there are always people who will help you out,” Mor-

rison says. “It’s something everybody should know about.”

To learn more, visit columbiasouthern.edu.Circle 37 on the Product Information Card

Easier Lifting and Loading of PatientsEMS poses a lot of injury risk to the people who deliver it, and the employees of Colo-rado’s Grand County EMS aren’t an excep-tion. Loading patients had contributed to a number of rotator cuff injuries among its providers.

When Chief Ray Jennings, Jr. and his staff discovered a safer way, they didn’t hesitate to bring it to their service. This year they’ve added Ferno’s iN∫X Patient Transport & Loading System to several new trucks.

“When we actually had the opportunity to evaluate it,” Jen-nings says, "we knew it was the right device for us.”

The iN∫X functionally elimi-nates lifting, with an independent x-frame design that automates raising, lowering, loading and unloading of patient loads up to 700 lbs. Its load height can be programmed to match the ambulance. High-speed exten-sion and retraction speeds the process, and dual powered actuators maximize stability to protect against tips.

Grand County will work toward outfit-ting its entire fleet.

“It’s been handy for us on a number of occasions,” says Jennings. “It’s made it very

efficient and easy to load and unload every patient, and it works especially well when you get to the heavier patients. You don’t have to have four or six people to try to lift the stretcher. I think it’ll be a great wellness device for our providers.”

For more: www.fernoems.com/inx.Circle 40 on the Product Information Card

Education at Your Own PaceSeeking education can be hard in the emer-gency services. Work and family demand so much time; how do you fit in school?

That was the dilemma Taylor Rowan faced. A young firefighter with Dawson County Fire/Rescue in Georgia, he wanted to get his paramedic certification knocked out now, so he could spend more time with his kids as they grow up. Lenoir Community College provided the solution.

“I looked into their program and really liked the way it was set up,” says Rowan, 24. “It’s a work-at-your-own-pace type of schedule where they give you the work once

a week and you can access it anytime. That let me work when I had the opportunity.”

It’s a faster program than many, taking less than a year from day one to completion, and a fraction of the cost of other paramedic programs in the area. Lenoir is also one of only two distance education paramedic programs in the U.S. accredited by CAA-HEP; that makes its graduates eligible for the National Registry credentialing exam.

Now a paramedic, Rowan will have that time he wanted to spend with his kids, as well as improved career prospects.

“Being a paramedic, you’re more valuable to your department, and it really opens up a lot more opportunities in the job world—everything from riding an ambulance to working in an emergency room or dispatch,” he says. “It really opens up the market.”

For more: www.lenoircc.edu/public safety/.Circle 41 on the Product Information Card

Interviews with end users of EMS products, technologies and services

Product Applications from the Field

Sim Package Keeps Students in the MomentTraining manikins can help teach students needed skills in a realistic way, but they’re expensive in an area where budgets are perennially tight.

The National EMS Academy found a solution in the ALSi medical simulation package from iSimulate. Based around a pair of common iPads, ALSi provides an advanced simulation platform with five training screens, including monitor, defi-brillator and AED capabilities. The pack-age is more affordable than traditional training manikins.

“I find it engages the students in a way that really puts them into the environment of the simulation,” says Greg Mullen, who oversees paramedic training at nine Acad-emy locations. “It’s a step into the realism that we want them to be comfortable with when they actually start to take care of patients. This allows that, and expense-wise it’s more realistic.”

ALSi’s monitor iPad is displayed in a case to resemble a cardiac monitor. Once the student is set up, the instructor’s iPad can be used to wirelessly control the dis-play as the simulation progresses. Changes to patient condition can be timed or action-based, and vital signs trend realistically either on the fly or as programmed. ALSi can be used on any manikin, live role-play-er or as a stand-alone educational tool in a classroom presentation setting.

For more see www.isimulate.com/alsi/.Circle 39 on the Product Information Card

P RO D U C T A P P L I C AT I O N S

EMSWORLD.com | DECEMBER 2015 7776 DECEMBER 2015 | EMSWORLD.com


Lifting Made EasierCurrently trending upward are the age of volunteer rescue squad members and the number of obese patients these squads must treat and transport. Mac’s Lift Gate has created the Bariatric Lift Unit to combat the negative effects of these trends.

The hydraulic-powered platform lifts up to 1,300 lbs. and can fit any cot an agency currently uses.

Mathews (VA) Volunteer Rescue Squad President Judy Buis says the squad purchased its first Bariatric Lift Unit in 2014 and has been extremely satisfied with the results. MVRS is located in a rural county and responds to about 1,300 calls per year, and Buis says they use the lift about twice a week.

“The Mac’s Lift Gate units are easy to operate and definitely a back saver,” Buis says.

The unit is flexible, and MVRS has even raised the unit to the level of a home deck to load on patient onto an ambulance, Buis says.

“If a patient is not too heavy, we can load them easily without ever pulling the lift out,” Buis says. “But if the need arises, we can have the unit ready to operate in less than 60 seconds.”

For more: www.macslift.com.Circle 43 on the Product Information Card

Lightweight, Durable CPR ManikinIllinois has around 700,000 high school students. Illinois Heart Rescue is trying to get them all trained in CPR.

That’s a huge task, as you can imagine, but one made easier with the help of Prestan’s new Ultralite Manikins, which the group’s program director, Teri Campbell, discovered at EMS World Expo 2014.

“They were the solution to the problem I had,” says Camp-bell, RN. “The manikins we were using were great, but they were intended for one-time use.

I needed a product I could use repetitively, and that was going to withstand the rigors of teen-agers and kids and adults doing CPR many times a week, many times a month.”

Prestan’s Ultralite Manikins come in four-packs that helped ILHR assemble CPR instruction kits it passed out to the state’s regional educa-tion offices, which manage their use by high schools. Each kit includes 16 stackable training manikins, two AED trainers, a

training DVD and educational support materials.

Ultralite Manikins are compact and lightweight, with

a true-to-life feel and ana-tomically correct design. They allow realistic compressions to a depth of two inches and are compatible with AED trainer pads. The four-pack comes with four manikin torsos, four heads, four compression pistons and 50 face-shield lung bags in a specially designed, convenient carry bag.

For more, see www.prestan-products.com/ultra lite.html. Circle 44 on the Product Information Card

More Realistic Cric TrainingMost EMS providers don’t do a lot of cricothyrotomies in the field. If and when the need arises, then, they better have gotten some good practice reps in their training.

Providers in Keller, TX, are getting those since the Keller Fire-Rescue Department won a Life/form Cricothyrotomy Simulator from Nasco in a recent contest. The device has vastly increased the realism of its providers’ cric practice.

“With most of your older simulators, you cut through a layer, and then you’re automatically in the trachea. That’s not realis-tic,” says firefighter/paramedic Bobby Goolsby. “Once you cut the skin, then you have to cut the membrane and everything around the trachea. That’s what the simulator requires. It’s a much more realistic experience.”

The Life/form simulator (LF00994U) was developed for learning and practicing the techniques of both needle and surgical cricothy-rotomy procedures. It includes anatomically accurate landmarks, palpable through lifelike skin, and a hyperextended neck that lets the user determine the right incision site. The upper neck is made from a soft core material reusable for repeat trainings. The airway passes fully through from top to bottom, and its trachea is replace-able, which allows checking the stylet and obturator placement after cutting. Ties hold the obturator in place, and inflation of the simulated lung signals proper placement.

The kit comes with a base, six replaceable neck skins, six adult trachea inserts (four rigid, two soft), six child trachea inserts (four rigid, two soft), a pair of simulated lungs and a carrying case.

The providers at Goolsby’s station have been exploring the simu-lator’s attributes during their regular airway training; once they’ve mastered it, it’ll likely move on to the central fire HQ. “That way everybody can train on it, and we can use it in scenarios,” says Goolsby. “It’s the closest thing to a person you can practice on.”

For more: www.enasco.com/product/LF00994.Circle 45 on the Product Information Card

Putting Child Safety FirstWhen children are involved, it’s important to be able to focus on both their clinical needs and their safe transportation. With Quan-tum EMS’ ACR-4, that task becomes simple.

The ACR-4 is a child harnessing system that fits children from 4–99 pounds. The system includes a quick-release chest strap and is made from a breathable fabric.

John Kloss, executive director of the Eastern Pennsylvania EMS Council, recently took shipment of 249 ACR-4 units for use by EMS agencies within the six-county region the council serves. So far the reviews have been nothing but positive, Kloss says.

“Literally one day after distribution, we received a message from a county EMS agency saying the product had been used, the ease of use was incredible and they felt very comfortable using it,” Kloss says.

The system allows for rapid transition from sitting to flat, and can be used with the stretcher back rest in the raised position.

“Overall, I have nothing but positive things to say about this product,” Kloss says.

To learn more visit quantum-ems.com.Circle 42 on the Product Information Card

The Proof Is in the VideoVideo inside of EMS vehicles has become more and more common for a number of reasons. Whether it is to ensure insurance claims are correctly handled or to reduce vehicle damage, maintenance and insurance costs, recording systems are becoming more and more important.

Digital Ally provides that and more with its FleetVu Suite. The suite includes an app for driver login and inspections, user-friendly cloud interface for real-time analysis and management of your fleet, and incident video playback with causality data and interactive route maps.

Priscilla Burgi, director of safety and risk with California service ProTransport-1, currently uses the Digital Ally FleetVu Suite with new vehicles in its fleet of ambulances.

Burgi says deployment of the product went smoothly, and the benefits showed very quickly.

“So far we have used two of the Digital Ally recordings to show we were clear of accidents,” Burgi says.

Burgi says there have been some unexpected benefits to using the system too. She has noted that the EMTs and other drivers have improved their driving skills and are more aware of their driving habits because of the video system. One of Burgi’s favorite features is the ability to set company parameters on things such as driving speed, so if the driver goes over a certain speed, a video recording is triggered.

“Being able to determine what parameters work best for your organization is a huge benefit,” Burgi says.

Another benefit is how quickly the videos are available to view.Burgi says other features, such as the back-up camera, have

already decreased the number of incidents the fleet has had.“With the customer service paired with the end product, this

will make a big difference for the safety of any fleet,” Burgi says.To learn more about Digital Ally’s FleetVu Suite, visit digital

allyinc.com.Circle 46 on the Product Information Card




After more than 40 years of making ambu-lances, Braun’s a known quantity in the world of EMS. You know when purchasing a Braun truck that it’s a quality product assembled from quality components.

That includes its seats. For years now Braun has turned to EVS Ltd. for its seating.

“We’ve been using their seats for as long as I can remember, in all our models and a variety of applications,” says Chad Brown, Braun’s vice president of sales and mar-keting. “They work hand in hand with our engineering and sales force in designing the right seat for the right application.”

A three-time winner of EMS World Inno-vation Awards, EVS offers a range of stan-dard and advanced options for ambulances, including captain’s chairs and attendant and child seats, as well as cushions/head-ers, belting/accessories and base options.

All EVS seats meet or exceed pertinent federal motor vehicle safety standards and are seamless to comply with Triple-K and

OSHA standards for removal of bloodborne pathogens. The com-pany uses heavy-duty upholstery-grade vinyl with an advanced medi+GARD protective finish that’s also available for door panels and cabinet trim. Bodily f luids are cleanable with a 10% bleach solution. Testing is done by independent certified facilities, with results available upon request.

As Braun’s custom-ers sometimes have more specialized requirements, EVS also works with them on specific requests.

“When we get into a custom situation, they’re very easy to work with, designing around the customer’s needs and wants with a variety of different faces, seat backs and restraint systems,” says Brown. “That

Less Painful Lifting for Patient and ProviderLifting patients can be a tricky task. Lifting them while keeping them comfortable can be even trickier.

For Ben Speidel, a paramedic and fire-fighter with the Chagrin Falls Fire Depart-ment in Ohio, the Binder Lift Original helped him achieve this goal.

They had responded to a woman who was found uninjured and in the seated position, and she needed help getting to her feet.

Speidel says she was visibly anxious and even tearful because she had bad shoulders, and she said people had separated them try-ing to lift her before.

“We deployed the Binder Lift and assisted her up without issue,” Speidel says. “She told us multiple times how grateful she was that

this piece of equipment is available.”Speidel says the event could have easily

turned into a trip to the ED were it not for the Binder Lift.

The product is easy to use and simple enough in design that seeing it used once is enough to know how to use it forever, Speidel says.

He has had access to the product for about two months now, and has used it a handful of times. Speidel says one of the best parts of the Binder Lift is that it cre-ates secure handles on the patient in easily accessible locations.

“This decreases back strain by prevent-ing rescuers from being forced to crouch down behind a seated patient and reach

under their arms,” Speidel says.To learn more about the Binder Lift,

visit binderlift.com.Circle 49 on the Product Information Card

A Safer Way to Lift PatientsA growing concern in the EMS and fire pro-fessions is the long-term health and safety of employees.

To foster growth in this wrinkle of the job, Graham Medical has developed the MegaMover Select.

A new twist on an old classic, the Mega-Mover Select provides its users with more handles and more options for hand place-ment, making it easier to lift patients.

Stephen Rawson, captain of the health and wellness division of the City of Renton Fire and Emergency Services Department in Renton, WA, says the product can have a big impact on the fire and EMS industries.

“In fire services, we’re in crowded homes sometimes, encountering tight conditions and big patients,” Rawson says. “When you have to lift someone through areas that are tight, it’s tough and people can get hurt.”

Rawson says the MegaMover Select makes that task simpler. The various

handles positioned throughout the prod-uct make it more versatile and help avoid heavy lift-and-twist situations when going through doorways. People can be positioned in different spots on the transport unit, such as having someone in front pulling while people behind lift, to avoid being squished in tight quarters.

The MegaMover Select’s handles are scal-able and allow people to lift from different positions. Instead of straining to lift one side higher, the users can switch to one of the handles higher up on the product.

Rawson says the product has been test-ed in a number of different environments, including by police, firefighters and para-medics. There was very little pushback from the 345 police officers and paramedics who tested the product, and most appreciated the new design.

Along with creating a safer workplace, the product can save departments money, Rawson says.

“It lessens the cost on fire services for on-the-job injuries, along with helping members have healthy retirements,” he says.

To learn more about the MegaMover Select and other products, visit graham medical.com.Circle 48 on the Product Information Card

Tools Help Save Cardiac Arrest VictimFor a guy who had a cardiac arrest, Steve Dunn got pretty lucky.

With his heart racing after an overam-bitious 2008 workout, he drove himself to a nearby hospital moments before losing consciousness. When he crashed in its parking lot, a nearby police officer was next to him within seconds. EMS person-nel arrived and quickly got CPR started. And that Oshkosh (WI) Fire Department crew was that week trialing a combination of the ResQPOD impedance threshold device (ITD) and ResQPUMP active compression-decompression CPR (ACD-CPR) device, both now available from ZOLL.

Those are all key ingredients to improv-ing cardiac resuscitation, and in this case they came together to help save Dunn, PhD, who was back teaching business at the Uni-versity of Wisconsin–Oshkosh 10 days later.

“It was a sequence of events that led to me being saved,” Dunn says. “There were paramedics there, they got to me quickly, they happened to be testing the ResQCPR system, I happened to get it, and it worked as designed. I’m coming up now on eight years’ survival, so I feel incredibly lucky.”

The ResQPOD and ResQPUMP jointly constitute ZOLL’s ResQCPR system, which helps regulate pressure in the chest to enhance perfusion in states of low blood flow. The ResQPOD ITD helps negative intrathoracic pressure by preventing the influx of unnecessary air through the

open airway during chest wall recoil; the ResQPUMP allows the compressor to actively re-expand the chest with a suction cup to further enhance the negative pres-sure that helps refill the heart. In a clinical trial, use of the ResQCPR system increased one-year survival by 49% compared to patients who got conventional manual CPR.

Other data shows that using an ITD dur-ing ACD-CPR lowers intracranial pressure (thus improving cerebral perfusion pres-sure), increases blood flow to the brain and improves the likelihood of survival.

And, in fact, Dunn actually awoke dur-ing CPR. “They told me later I didn’t have a pulse or anything,” he says, “so of course they flipped out because they said they’d never had a guy who was basically dead talking to them.

“I attribute that to the ResQCPR system. Without it, I don’t know that I would have survived and been able to go back to work. Obviously, as a professor, I need my brain to work. So I’m completely convinced it played a large role in me being who I am today.”

For more, see www.zoll.com/ResQCPR.Circle 50 on the Product Information Card

Timeless Emergency Vehicle Seating

gives us the ability to offer our customers a variety of options. It’s a high-quality prod-uct, and they’re easy and responsive to do business with.”

For more, see www.evsltd.com/.Circle 47 on the Product Information Card




Lifting More ComfortablySafety is one of the biggest concerns in EMS when handling a patient.

Making sure the patient is comfortable is another focal point.Mangar International’s Elk Lifting Cushion helps providers cover

both of those areas.The compact, battery powered cushion inflates with the push of

a button to help patients reach a seated position, making it easier for them to stand.

Chris Mulberry, assistant chief paramedic of Platte Valley Ambu-lance Service, says his agency has been using the lifting cushion and is satisfied with the results.

“The nice part is that it’s not big and it’s not heavy,” Mulberry says.The cushion only weighs about 8 pounds, and is applicable for

use on patients of any age.Mulberry says the cushion is especially useful when handling

older patients.“With elderly people, some have

more fragile skin because they’re on certain medications,” Mulberry says. “You could go in and just pick them up, but a fair amount of time you’re causing some skin tearing. The cushion makes it more safe and more comfortable, and makes it so you’re not just grabbing or yanking.”

Prior to using the Elk Lifting Cush-ion, Mulberry says his agency just lifted patients manually.

The cushion, designed for either indoor or outdoor use, makes it so providers can shimmy or roll a patient onto the cushion, and get them to a standing position without having to lift them manually.

Mulberry also says the device is durable.

“When you see the pictures, it doesn’t look too rugged,” Mulberry says. “EMS people are hard on equipment, but this product stands up to any EMS use.”

Mulberry says a representative from Mangar gave his agency training on how to use the product as well.

To learn more about the Mangar Elk Lifting Cushion or other products, visit mangarusa.com.Circle 50 on the Product Information Card

Saving Lives Through TechnologyYou never know when you might be needed to save a life.

Bill Eck, Zoning/Code Officer with Kingstown Township and nearly 40-year fire service veteran, learned that lesson a short time after installing Active911.

Eck says he installed the software in September of 2013 at around 2 in the afternoon. Around 8 o’clock that night, Eck was alerted by the software that his neighbor’s three-year-old child was in danger, and ended up saving his life.

“As far as I’m concerned, it’s paid for itself a thousand times over,” Eck says.

Active911 is a digital messaging system that alerts users to emer-gencies in their area. During an emergency, alarms, maps and other critical information are sent to user’s phones.

Eck says the product is convenient because it allows him to be alerted to emergencies in the area without the use of a scanner or similar product.

Eck says he likes that he can get silent alerts with Active911, so

during meetings he can still be alerted to emer-gencies without the noisiness that usually comes with a scanner. Being able to change tones for dif-ferent alerts is a valuable feature as well, he says.

Old scanners and pagers that are worn on belts are the closest thing he has used to Active911, but they don’t necessarily compare, Eck says.

“There’s really nothing out there like this that I can remember,” Eck says.

One of Eck’s favorite features is the display. Having the information about the location of the emergency sent directly to your device makes for easy use, he says.

“Unlike a scanner, if you a miss a house number or something, you can see it again,” Eck says.

Eck says Active911 is great, and he would absolutely recommend it to anyone thinking about trying it.

For more information on Active911 or to set up an account, visit


EMSWORLD.com | DECEMBER 2015 83For More Information Circle ?? on Reader Service Card

LIFE SUPPORT By Mike Rubin


Disparate MeasuresWhat’s the best way to evaluate performance and help workers improve?

I’M WHAT YOU CALL A SELF-EMPLOYED PERSON. I’ve been that way since I left my last clinical job in 2013.

Self-employed people have a few perks: We often work out of our homes, tailor work hours to our lifestyles and don’t have bosses in the conventional sense.

We rely on customers—in my case, you and my edi-tor—to tell us how we’re doing. That feedback is always appreciated and usually helpful, but it lacks a quantita-tive component that would allow us to judge our long-term performance and spot trends.

If those of you who work for healthcare companies ever get letters from patients, you know what I mean. Consider this note received by Jimmy, an AEMT and good friend, from the daughter of one of his patients:

I have worked in the ER for the past 20 years, and sel-dom have I seen such an impressive medical response… I very much appreciated his calm skills in the midst of a life-threatening situation… He is a wonderful profes-sional who makes the world a better place.

Way to go, Jimmy! Such praise should count in some positive way when his employer evaluates him, but Jimmy’s supervisor faces the same problem with customer comments that I do: There isn’t a good way to com-bine qualitative feedback, like compliments, with other per-formance measures to yield all-inclusive evaluations. Nice let-ters are hard to beat for instant gratification and are much more fun to receive than anything from a law firm, but they don’t really tell us enough about the quality of our work.

I’m betting Jimmy gets graded at least annually on some sort of scale. You know the kind I mean: On a scale of 1–5, with 5 the highest, how would you rate the employee’s effort/attention to detail/dedication to world peace?

If so, is Jimmy’s letter worth a “+1,” or will it just show up as a memo entry? Does he have to be perfect to get a 5 or just excellent? Is 3 average or not very good? Would your boss answer those questions the same way as his boss? Where’s the consistency, the fairness?

Simply adding a comment about Jimmy’s letter to his evaluation—perhaps as a statement support-ing a generally favorable numerical assessment—is hardly an ideal solution. Such prose would likely be interpreted differently by Jimmy’s current and future

managers. I don’t think it’s possible to set standards for combining words with numbers.

In the absence of policy on this matter, what if some supervisors raised Jimmy’s score to accommodate his nice letter and others didn’t? I faced that sort of unpre-dictability when I was employed by someone other than “self.” A few of my reviews catalogued and coded spe-cific aspects of my performance, but one simply graded my smile. I earned near-perfect scores marginalized by negative observations and average scores buoyed by effusive compliments. That’s because numerical ratings are often meaningless—nothing more than subjective appraisals force-fit onto arithmetic scales.

In the words of noted vocalist and part-time philoso-pher Dionne Warwick, “What’s it all about, Alfie?”

First, I think our industry has to decide what we should be rated on. I’m a big believer in focusing on results, rather than effort or affect. If I were running an EMS agency, I’d want to know how well my medics were recognizing manageable conditions, like acute bron-chospasm or hypoglycemia, and then treating them.

Second, we need quantitative ways to evaluate out-comes. Customer feedback is nice to have, but it’s almost impossible to merge well-meaning prose into the kinds of performance appraisals that can be compared. We have to be able to do that—compare

and judge individuals objectively—or we’ll never know what’s above or below average.

Third, after we review documented weaknesses with employees, we should seek improvement in their per-formance. That doesn’t mean negative reinforcement is all that matters; we just have to recognize that evaluation strictly for evaluation’s sake won’t close the QA/QI loop.

There are ways to quantify and compare clinical out-comes meaningfully. Just ask me if you want to know more. I’m not sure most people in our business have thought much about measuring quality that way. It’s harder work than reading letters.

Thank-you notes are nice. If you get one, enjoy the moment, but understand that quality improvement comes from constructive changes based on compre-hensive, measureable results. Getting there requires much more than nice letters.

ABOUT THE AUTHOR

Mike Rubin is a paramedic in Nashville, TN, and a member of the EMS World editorial advisory board. Contact him at [email protected].

Reliability is important. At Stryker, our products are manufactured to the highest standard and tested to validate performance, safety, and effectiveness. We complete life cycle tests, electrical safety tests and tests to simulate product use and abuse over a lifetime.Products that stand up to the rigors of their environment are necessary in the life-saving world of EMS. That is why we go above and beyond the call of duty for our EMS line of products. 20 years. And our shift has only just begun.

For more information call 800 784 4336 or visit ems.stryker.com

1 On Power-PRO™ XT and Performance-PRO™XT Cots

Copyright © 2015 Stryker Mkt Lit-1128 27 APR 2015 Rev A.3

PROVEN STRONG

Maneuver Securely

142,000 cycles of torture track testing simulate varied terrain to ensure

functionality in rough environments.1

Lift Confidently Simulated ambulance loading and unloading

is performed 113,000 times during Power-LOAD® fastening system testing.

Roll Safely31,000 cycles, or 737 miles,

of wheel and caster testing ensures integrity on our casters.

I think our industry has to decide what we

should be rated on.


CASE REVIEW By James J. Augustine, MD, FACEP


ABOUT THE AUTHOR

James J. Augustine, MD, FACEP, is an emergency physician and the director of clinical operations at EMP in Canton, OH. He serves on the clinical faculty in the Department of Emergency Medicine at Wright State University; as an EMS medical director for fire-based systems in Atlanta, GA; Naples, FL; and Dayton, OH; and on the EMS World Editorial Advisory Board. Contact him at [email protected].

L E N O I R C O M M U N I T Y C O L L E G EEMERGENCY MEDICAL SCIENCE

E A R N Y O U R D E G R E E O N L I N E !

231 Hwy. 58 South • Kinston, NC

www.lenoircc.eduContact a program specialist at

252-527-6223, ext. 115 or [email protected]

Paramedic Certification (Hybrid Program)• Fully CAAHEP Accredited

• Different course options that allow currently credentialed EMTs, AEMTs, or individuals with no certification to train for their Paramedic certification.

• Hybrid Paramedic program offered through LCC Continuing Education Department. Only four on-site visits required for skills training and evaluations. All coursework is done online. Tuition is $360.

• Clinicals can be completed in your area. Contact LCC regarding available areas.

• Graduates are eligible for the NCOEMS Paramedic exam and the National Registry Paramedic exam.

Associate Degree in Emergency Medical Science — Bridging • All degree classes offered 100% online.

• Currently credentialed state and national Paramedics earn up to 45 credits toward their degree just for being certified!

• Designed for demanding EMS work schedules. Complete the degree at your own pace!

THE ELDERLY MAN TOOK A BIG SWING AT the social service worker. Fortunately he missed, but that was the last event that would be tolerat-ed for the evening, so the worker and accompa-nying police officer called for EMS to transport the man to the hospital.

Attack One is dispatched on a report of a vio-lent male, with police officers already on scene and the scene secure to approach. The response is to be without lights and siren, so the crew has time to prepare to immobilize an uncooperative patient.

On arrival they find an elderly man sitting in his front room with two police officers and the social worker. One of the officers asks the Attack One paramedic to meet with him in the kitchen for an explanation of the situation. The two EMTs remain with the patient, and the female EMT takes the lead in talking to him. The patient does not want anyone to touch him, so there is initially no attempt to take vital signs or perform a physi-cal assessment.

The EMT pulls up a chair and sits down about six feet away from the patient, introduces herself and asks if the man needs anything to make him more comfortable, like maybe a drink of water. She has the male EMT step back to the front door and take all the medical equipment out onto the front porch. She speaks nonthreateningly, in simple, short sentences the patient can easily understand.

After a short time the patient asks, “Do you know why they took my wife away?”

Without looking to the social worker, the EMT replies, “No—why don’t you tell me what you know about it?”

He looks down, and the EMT takes the opportu-nity to exchange a glance with the social worker. The EMT is going to be in the position of being a friend and rescuer to the patient, because it is obvious the social worker was somehow involved in an activity the patient is unhappy about. The paramedic in the other room is receiving the details of how earlier in the day, an adult protective services worker completed a monthlong evaluation and found the man’s elderly wife in conditions that were dangerous to her. They had a younger relative come into the home to trans-

Restraint of an Agitated PatientAn EMT’s rapport is key when an elderly patient becomes upset

fer her to a skilled nursing facility. A family member had stayed with the elderly husband until 1800 hours, but when he left and the sun set, the man became angry and hostile. A police officer arrived and called the social worker to assist. Neither was able to calm the man.

The female EMT works to befriend the man, who appears to be in good physical condition, has no smell or appearance of intoxication and sits with his fists clenched on his couch. He will not make eye contact.

“I really would like to hear about your wife,” she asks. “Would you please tell me?”

The man begins to speak and talks about his wife being ill but still able to take care of herself and him. He explains he can’t see well, and his wife did all the functions in the house that required reading, and could do so from her wheelchair as he moved her around. He did not believe she should be removed

Copyright granted for this article for department use only up to 20 copies.

Initial AssessmentA 78-year-old male, uncooperative and agitated, not oriented to time.

❯ AIRWAY: Patent.

❯ BREATHING: No distress.

❯ CIRCULATION: Brisk capillary refill in hands.

❯ DISABILITY: Pupils midsize and reactive. No focal findings. Short-term memory impaired, and upset his wife was taken to a nursing home earlier in the day. He has a history of dementia, and agitation in the nighttime hours.

❯ EXPOSURE OF OTHER MAJOR PROBLEMS: No injuries.

VITAL SIGNS

TIME HR BP RRPULSE

OX.

2015 72 180/100 24 95%

2025 72 170/80 20 99%

SECONDARY ASSESSMENT, APPROPRIATE TO PRESENTING CONDITIONNo change. Demeanor more peaceful. Remains oriented only to person, place and event, which is likely his baseline.


CASE REVIEWCASE REVIEW


crew an opportunity to relate a positive choice to the patient.

The patient remains calm en route to the hospital. The EMT is the primary caregiver and communicator in the patient care area.

Hospital CourseThe patient is peaceful as he enters the emergency department, and the nursing staff evaluates him. At that point the patient again gets very agitated and threatens the nurses and staff. Staff members try again to deescalate things, but the noise, bright lights and smell of the facility cause him to call for his wife and disregard requests from the staff. The staff then consider both physical and chemical restraints.

Instead the female EMT comes back into the room where the patient is being treated and succeeds in talking with him until the hospital-based counselor arrives and assumes responsibility. The patient is admitted, and his eyesight is improved by

cataract removal and a new set of glasses. He is found to have a degree of dementia but is counseled to his best level, then dis-charged to his family.

Case DiscussionThere are many reasons why a person may become agitated. Some are medi-cal causes that include illnesses, hypoxia, head injury, drug/alcohol ingestion, or a combination of the above. Other causes are an aging brain and underlying mental health problems.

Persons who are agitated and have per-formed criminal actions are primarily the responsibility of law enforcement, although in some jurisdictions EMS may assist in transporting them for medical evaluation or treatment. Those patients will have their method of restraint selected by the officer. EMS personnel cannot remove civil liberties and restrain persons unless there is a medi-cal reason to do so.

For persons with agitation caused by medical reasons, there are three methods of providing treatment and transportation that’s safe for the patient and the EMS staff. A great reference for EMS providers is the NAEMSP position paper published in 2002.1

Options for EMS restraint of agitated patients include:

• Verbal restraint—Any verbal commu-nication from a prehospital provider to a patient utilized for the sole purpose of limit-ing or inhibiting the patient’s behavior.

• Physical restraint—Any method in which a technique or piece of equipment is applied to the patient’s body in a manner that reduces the subject’s ability to move his arms, legs, head or body.

• Chemical restraint—Any pharmaceutical administered by healthcare providers specifi-cally for the purpose of limiting or controlling a person’s behavior or movement.

There are certain situations, like patients with uncontrolled behavior related to sub-

from the house, “but these bad people came and had a nephew take her away.”

The social worker gives a quick motion with his hand that indicates to the EMT that some of the details of the story are correct, but some probably are not.

The short story from the man gives the EMT enough opportunities to build some trust. She begins by confirming how impor-tant it is that couples work together to get important jobs done, just like the crew members here to help him today. She asks for some details on what his wife would read, and he starts into stories of their life together. The female EMT motions for the other EMT to go get a cup of water for the patient. “He sounds a little dry,” she says, “and might want a drink.”

The atmosphere in the room is becom-ing friendlier, and even the social worker is able to enter the conversation and laugh when the man asks about adding some gin to the water.

However, things grow tense again when the paramedic and police officers reenter the room, and it is clear to the man that the police are insisting he be taken to the hospital for evaluation, since he physically threatened the officer and social worker.

At this point the man reaches behind him and, out of the back of his pants, pulls out a knife about eight inches long. “I want you people to bring my wife back, or I’m going to leave and get her myself,” he warns, bran-dishing the knife. “Nobody try to stop me!”

The female EMT is still closest to the patient, and she remains seated and calm.

“That won’t help your wife or you,” she tells him, “so please just hand it to me, and let’s talk about how we can help her.”

She manages to open a conversation with him, almost one on one, and he hands the knife to her.

Over a few minutes of dialogue, the patient is convinced that his best option is to ride in the ambulance to the hospital, talk to the patient assistance team there, have a warm meal and let the doctors there check his eyes to see if they can be improved. The hospital will also be able to get the best information on his wife. The paramedic defers to the EMT for all interac-tion with the patient, including getting vital signs and making sure the patient has no further weapons on him.

The paramedic moves away to the front yard to contact medical control by phone and receives agreement to transport the patient to the hospital for evaluation of his overall health and his eyes. This gives the

Learning PointEMS personnel must be capable of using appropriate restraint when an agitated patient must be treated and/or trans-ported. Verbal restraint is an option where the patient is unlikely to be uncooperative and violent.

HOSTED BYREGISTER FOR EMS ON THE HILL DAYApril 20, 2016 (briefing April 19), Washington, D.C. | naemt.org

It has never been more important for EMS professionals to speak out on behalf of our patients’ needs and on issues that impact our ability to provide quality medical care.

HELP DRIVETHE FUTURE OF EMS

For More Information Circle 17 on Reader Service Card For More Information Circle 18 on Reader Service Card

CASE REVIEWCASE REVIEW


stance abuse and excited delirium, that must proceed quickly to both physical and chemical restraint. These usually involve law enforcement personnel and some use of law enforcement materials.2 Every EMS provider needs a physical restraint protocol that’s written in cooperation with local men-tal health and chemical dependency treat-

ment organizations, approved by medical direction and understood by every EMT.

Many situations that result in agitated pre-hospital patients can be resolved by simple conversation and direction by EMTs. But patients with the potential for uncontrolled violence must be restrained to protect them-selves, crews and bystanders. Treatment and

transportation decisions must be based on what can be done safely. That may also involve chemical restraint protocols for medi-cations administered by paramedics.

Verbal restraint is the first option for man-agement of an agitated patient. Its objec-tives are to ensure the safety of the patient, staff and others in the area; help the patient manage his/her distress and regain control of his/her behavior; avoid the use of other restraints if possible; and avoid coercive interventions that may escalate agitation (like application of physical restraints).

“Talking someone down” is a process many EMTs may be comfortable with due to their underlying personality, the train-ing they’ve received or experience seeing other emergency personnel display excel-lent methods of verbal deescalation. There are written educational programs that pro-vide EMTs with deescalation training, and some in-person training programs will do the same. A 2012 article by Janet Richmond is particularly detailed on methods used for verbal restraint in the emergency setting.3

If verbal communication is not effective, physical restraints are typically employed, using a variety of devices applied to the extremities and torso or using law enforce-ment techniques and procedures. Once the patient is restrained, one EMT must main-tain constant supervision en route to and at the hospital, until the patient is safely turned over.

Even in these difficult agitated-patient incidents, there is an opportunity for good customer service. The use of verbal dees-calation is usually obvious to family and bystanders. The use of physical restraint may require an explanation if they are pres-ent. Done in a professional and nonjudg-mental fashion, the action can be explained in such a way that the crew appears patient-focused and caring.

REFERENCES1. Kupas DF, Wydro GC. Patient Restraint in Emergency Medical Services Systems. NAEMSP, http://www.naemsp.org/Documents/Position%20Papers/POSITION%20PatientRestraintinEMSSystems.pdf.2. Augustine JJ. Arms and ‘The Man.’ EMS World, www.emsworld.com/12005057.3. Richmond JS, et al. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BEAT De-escalation Workgroup. West J Emerg Med, 2012 Feb; 13(1): 17–25.


1 In adult patients with cardiac arrest from cardiac etiology. ResQCPR System Summary of Safety and Effectiveness Data submitted to FDA.

2 Lurie et al. J Med Soc Toho Univ 2012;59(6):305-315.

The ResQCPR System is intended for use as a CPR adjunct to improve the likelihood of survival in adult patients with non-traumatic cardiac arrest. Risk information: Improper use of the ResQCPR System could cause ineffective chest

compressions and decompressions, leading to suboptimal circulation during CPR and possible serious injury to the patient. The ResQCPR System should only be used by personnel who have been trained in its use. The ResQPUMP

should not be used in patients who have had a recent sternotomy as this may potentially cause serious injury. Improper positioning of the ResQPUMP suction cup may result in possible injury to the rib cage and/or internal organs,

and may also result in suboptimal circulation during ACD-CPR.

49-0879-000, 01

The ResQCPRTM System is a CPR adjunct comprised of two synergistic devices – the ResQPOD® ITD 16

and the ResQPUMP® ACD-CPR Device. Used together, these devices increase blood flow to the brain

and vital organs, as well as increase the likelihood of survival.2

Better Blood Flow. Improved Survival.

For more information, please visit www.zoll.com or call 877-737-7763.

A major clinical study showed a

49%in one -year survival from

cardiac arrest.1

increase


NOVEMBER 2015 | VOL. 44, NO. 11 $7 · 2020-03-10 · WEMT Clinical Education Coordinator, VitaLink/...

Documents

Transcript of NOVEMBER 2015 | VOL. 44, NO. 11 $7 · 2020-03-10 · WEMT Clinical Education Coordinator, VitaLink/...