Tuesday, December 23, 2008

Emergency personnel should get drugs during pandemics

Reuters reported on a DHHS guidance memorandum advising hospitals and emergency services employers stock up on antiviral drugs for their workers.

Health, emergency staff get drugs 1st in pandemic

It seems Avian flu is the big concern. While according to the article there have only been 390 people infected worldwide--246 of those have died. The big question, and one not to figure out after it is too late: Are we a mutation or two away from trouble?

I am guessing that most employers will take some time to get this plan up and running--and that the antiviral drugs will have a significant cost attached. A quick check at drugstore.com shows a price of about $100 for a ten day supply (prophylactic dose) of the medication.

Has anyone seem preparedness efforts such as this in their agency or area?

Friday, December 19, 2008

So much for the Good Samaritan Law

California's Supreme Court just gave the concept of helping one another a slap in the face with their recent ruling (link from the LA Times):

California Supreme Court allows good Samaritans to be sued for nonmedical care

The article summarizes:

The California Supreme Court ruled Thursday that a young woman who pulled a co-worker from a crashed vehicle isn't immune from civil liability because the care she rendered wasn't medical.

The divided high court appeared to signal that rescue efforts are the responsibility of trained professionals. It was also thought to be the first ruling by the court that someone who intervened in an accident in good faith could be sued.

Of course the ruling has some significant legal and factual issues, mostly whether the action (allegedly pulling the woman from the wreck "like a rag doll") was negligent and the cause of the injuries. The fact that alcohol was involved certainly muddies the waters.

The dissenting opinion from the court seems reasonable to me:

Justice Marvin R. Baxter said the ruling was "illogical" because it recognizes legal immunity for nonprofessionals administering medical care while denying it for potentially life-saving actions like saving a person from drowning or carrying an injured hiker to safety.

"One who dives into swirling waters to retrieve a drowning swimmer can be sued for incidental injury he or she causes while bringing the victim to shore, but is immune for harm he or she produces while thereafter trying to revive the victim," Baxter wrote for the dissenters. "Here, the result is that defendant Torti has no immunity for her bravery in pulling her injured friend from a crashed vehicle, even if she reasonably believed it might be about to explode."

Yet the constitutional scholars believe the court ruling has merit:

Both opinions have merit, "but I think the majority has better arguments," said Michael Shapiro, professor of constitutional and bioethics law at USC.

Shapiro said the majority was correct in interpreting that the Legislature meant to shield doctors and other health care professionals from being sued for injuries they cause despite acting with "reasonable care," as the law requires.

Noting that he would be reluctant himself to step in to aid a crash victim with potential spinal injuries, Shapiro said the court's message was that emergency care "should be left to medical professionals."

While I agree that yanking someone from a car when there is no real hazard may cause injury, does this ruling keep people from stopping and helping those who really need it? In the bigger picture, does this ruling take us back a step in civilization by making well-meaning citizens reluctant to help another human being in a time of need and ignore the greater good? I think so on both counts.

I also think that the next time I need help on the side of the road I hope a constitutional scholar isn't the one driving by. I could be there for a while.

Thursday, December 18, 2008

Florida sun charges ambulance batteries

Sunstar ambulance in Florida mounted solar panels on the roof of two ambulances to charge batteries in monitors, stretchers and other devices.

From an article on Tampabay.com

People looked at Terence Ramotar like he was crazy last spring, he said, when he suggested putting a solar panel on the roof of an ambulance.

The idea is now a reality. On Monday, Sunstar Emergency Medical Services will roll the first of its two solar-powered ambulances into service in what appears to be the first such project in the nation.

The solar panels do not power the vehicle, but rather supply power to recharge the batteries for various life-saving devices.

Whether this will work has yet to be determined. I have certainly seen crazier ideas. But when Sunstar has a full-time person assigned to shuttle batteries out to crews in the field, the $4,000 price tag doesn't seem so crazy--plus a hint of environmental responsibility is always a good thing.

Definitely worth keeping an eye on.

How can you tell if your patient is stable?

According to an article in the Canadian Press the ability to send a text message is a sign of stability. Apparently this is used at "packed to the max music concerts" in the UK as a method of determining whether a patient is ready to get back to the concert. From the article:

"The main point is when you've got, mainly at music festivals, a band playing that is very popular amongst teenagers, you have to expect a lot of them to faint, get panic attacks in the crowd, get stressed and want medical attention, when they're otherwise uninjured," Sinclair said Wednesday from a ski holiday in Chamonix, France.

"And when you get inundated with hundreds coming in in an hour, you need some means of getting them out and back to enjoying themselves quickly. And we found the texting sign is very useful for that."

Looking at it, texting shows fine motor function and mentation. Judging by the way younger people text it could also be said they have their sense of purpose back.

I wonder what would happen if we noted a "positive texting sign" on our run report here?

I love quotes...

These came up today on my Google homepage.

Everyone's a hero in their own way, in their own not that heroic way.
- Joss Whedon, Zack Whedon, Maurissa Tancharoen, and Jed Whedon

I have not failed. I've just found 10,000 ways that won't work.
- Thomas A. Edison

The stupid neither forgive nor forget; the naive forgive and forget; the wise forgive but do not forget.
- Thomas Szasz

Monday, December 8, 2008

More on volunteers: Delaware

The News Journal of Delaware published an article on the volunteer EMS and fire services in the state: When Every Second Counts.

The article looks at response times noting several larger scale incidents and comparing Delaware's response times to NFPA and other standards. As with many article like this it didn't take long for the comments to pour in using the newspaper's comment feature attached to the article.

It is clear that there is both a strong voice from the volunteers in Delaware (many of whom I met while at their conference last year) and support from the public as well.

If you read the EMS magazines (one I read recently had several editorials on how volunteers fit into the emerging professionalism of EMS) the paid vs volunteer service certainly is a hot topic.

The topic extends into more than professionalism. Volunteerism was at the core of society but has taken hits from shrinking available time and the shrinking economy. Yet could a municipality today say, "Next year we are doing away with volunteers." and find the budget to hire the staff that would be required to cover that jurisdiction? I think not.

I've been posting quite a few news pieces without commentary recently. Here are my thoughts on this issue of volunteer vs paid in the United States:

I believe the answer relies in setting a standard, then using resourcefulness and collaboration to meet the standard. And not a reduced or varied standard.

I believe that a family traveling down the East Coast (or anywhere) shouldn't receive varied levels of care. Not just whether it is BLS or ALS, but the actual quality of the system and providers should not vary based on the type of system.

I believe we focus too much on paramedic services when an EMT or EMT-I service with a shared paramedic response will meet that standard in many (but not all) communities.

I believe that a territorial attitude and competition sometimes seen in the volunteer services must cease in order to meet these standards and assure fiscal responsibility. I came from a system in which there were 3 truck companies (each with 100+ ladders) in a 6 mile stretch of highway. (This has since changed.) There are times crews and apparatus decisions must be done cooperatively between adjoining districts for the good of those we protect.

We need to get out of the box and put service first--first over paid or volunteer. We need to create quality, cooperative training and emergency response. Those who are hired to supplement volunteer organizations should be carefully chosen to "fit" well with the call force. Paid personnel should receive training in mentoring and teamwork.

Volunteer services aren't going anywhere. No municipal budget has the ability to just "go paid." Rather than get into arguments about what is best when we have no ability--and in many cases no desire--to change is senseless.

Why do senseless things? Lets make what we do and who we are better. Every person. Every agency. Better.

Start today.

Thursday, December 4, 2008

Another bad week for EMS news

A quick round-up of stories that show the challenges of EMS on the street.

According to the Washington Post, more trouble in a troubled city:

Man Dies at Home After Paramedics Diagnose Acid Reflux

In Albuquerque:

Ambulance worker arrested on scene

And in a bit of good news, Maryland is working to get its flight program on the right track. Most agree that the business-driven model of air medical transport seen in many areas results in unnecessary flights. (Maryland is run by the State Police) In an interesting quote from a Baltimore Sun editorial:

Data from the Maryland Institute for Emergency Medical Services Systems also has shown that 43.7 percent of patients flown to trauma centers are released within 24 hours, a statistic that critics said suggested the choppers were used too often.

Here is the editorial: Support for medevacs. I look at this as a well balanced editorial. It is refreshing to see that a newspaper (The Sun) looked at the issues and was constructive rather than taking a sensationalist approach--especially in the wake of a tragic crash. Their point is correct. Give an amazing system a tune-up and keep it going.

For all of these reports remember that there are two sides to the story. This combination of stories highlights a common theme I teach: EMS is about decision making and people.