tag:blogger.com,1999:blog-30595453381650023222024-03-04T23:00:47.588-05:00Emergency CareA blog for EMS students, practitioners and educators.Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.comBlogger156125tag:blogger.com,1999:blog-3059545338165002322.post-33838994984593739022010-10-27T09:33:00.002-05:002010-10-27T09:43:51.127-05:00New BlogI have moved my blog to:<br /><br /><a href=http://emtreview.com/blog>The EMS Classroom</a><br /><br />Please follow me there!<br /><br />Thanks.<br />Dan Limmer<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-8037375778152515382009-07-15T14:10:00.002-05:002009-07-15T14:55:52.940-05:00Dave Page strikes againDave Page is one of the brightest stars in EMS today. He is smart, talented, focused, visionary and an amazing educator. My EMS news feeds picked up this story today:<br /><br /><a href=http://www.kare11.com/news/health/takekare/takekare_article.aspx?storyid=819502&catid=20>Students get paid to learn to be lifesavers</a><br /><br />It is win/win/win when we train people for careers, offer a hand to those who might not be able to afford it and expand diversity in EMS. I applaud Dave and his colleagues for his efforts in the Emergency Medical Services Academy.<br /><br />I post this coinciding with the confirmation hearings of Sonia Sotomayor for a reason. There is no place for discrimination of any kind--reverse, forward or otherwise in EMS. I would hate to see the issues surrounding the New Haven firefighters having a negative impact on any qualified individual in choosing to follow their passion into the emergency services.<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-27797997758219818882009-02-12T09:44:00.007-05:002009-02-12T10:38:27.950-05:00Memories of Love and WarYou'll see in my profile that I also wear the hat of a journalist. No one in EMS has only one job, right?<br /><br />I had an idea which began percolating years ago as I was in the back of an ambulance with an 80-year-old woman during a 30 minute ride to the hospital. I had a precautionary line started and 12-lead done with 25 minutes to go. <br /><br />This is where many of the excitement-driven medics would languish, longing for the next glimpse of major trauma or cool invasive procedures. Me, I figured we had time to chat.<br /><br />It turns out this woman was a nurse in World War II. She didn't say specifically, but alluded to coming from a wealthy family in Manhattan. In the 1940s women had certain programmed career choices. She became a nurse. A poster in the hospital said the Army needed nurses stateside for 1 year. What the poster didn't say was after a year and one day she would be headed overseas.<br /><br />She enlisted and ended up in North Africa seeing battlefield casualties. She spoke little of that; her generation guards their military experience with an iron clad stoicism that has spanned 60 years. I could see between her words, in the pauses where memories remain cloistered, that there was more. I regret never going back to see her. To talk more about that time, listening to more of the memories, even if for my own selfish desire.<br /><br />While I may have saved a patient or two in my days in EMS, I look back at my time with her as one of the best and most profound experiences in 30 years riding in the back of an ambulance. I think about it often.<br /><br />I recently returned to the assisted living facility where I met the World War II nurse several years ago. My chance to talk again with her had passed. Knowing this, my goal was to gather more of these memories before they were lost forever. It wasn't an original idea. Many have written and photographed projects before me. It was a personal quest. <br /><br />I pitched the series to our local weekly newspaper and they went for it. Today's installment brings this blog post full circle. The link below is to an article I did for the Valentine's day edition of the paper. I interviewed three fascinating people about their half-century relationships and how they were affected by war. It is called:<br /><br /><a href=http://www.seacoastonline.com/articles/20090212-NEWS-902120385>The Generations Project: Memories of love and war</a><div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-49631671494316233442009-02-05T09:58:00.003-05:002009-02-05T10:03:22.203-05:00More for the educators...I'm in awe. After looking at the video in the previous post I wanted to know more about this classroom and professor. I found a video which gives a better idea about the man and his methods.<br /><br />It is something to aspire to. Imagine your EMS students considering their education a journey rather than a hurdle to get "the card." Imagine probing questions, discovery and insight being part of that journey...and your classroom.<br /><br />Imagine your students feeling like this:<br /><br /><object width="425" height="344"><param name="movie" value="http://www.youtube.com/v/hBmDgMFAZTI&hl=en&fs=1"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/hBmDgMFAZTI&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="344"></embed></object><div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-21471965450394077232009-02-05T09:18:00.004-05:002009-02-05T10:16:01.575-05:00One for the educators...I taught an instructor CE class on online learning last Friday (to a great group in Bangor, Maine). One of the statements I made was that our educational system in EMS uses the worst possible methods for the students--and the best for us--or at least the one that makes us feel best and most secure. If you haven't guessed, I am talking about lecture.<br /><br />Everyone is angry at the AHA for going to the video-driven classes but the AHA is right. We talk too much. Students don't practice and apply enough. Listening to the instructor is one of the worst ways to learn. I'm sorry but war stories have a limited value and only when short and in context. Students need to think, apply and problem solve.<br /><br />In Maine there are many who oppose online classes (better termed asynchronous learning). When I suggested a hybrid online/classroom-based EMT-I class two years ago you'd think I kicked Johnny and Roy right in the nuts. <br /><br />My opinion: asynchronous learning can provide better learning than we offer in the traditional classroom when done right...and make it easier for us to reach more people. Doing it right involves well constructed classes, choosing appropriate topics and providing active student/instructor participation.<br /><br />I believe students text and Facebook in class because they are bored. Students are tech savvy and have outgrown our fascination with PowerPoint long ago (which seems to drain interactivity right out of the classroom unless it is done properly).<br /><br />My sister-in-law (a teacher and school board member) recently posted a youtube video on her facebook page. It gives an interesting glimpse into the lives of students and some shocking realities for the classroom. Please take a look.<br /><br /><object width="425" height="344"><param name="movie" value="http://www.youtube.com/v/dGCJ46vyR9o&hl=en&fs=1"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/dGCJ46vyR9o&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="344"></embed></object><div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-27075915136143908542009-01-19T10:29:00.003-05:002009-01-19T10:35:23.050-05:00Emergency Care in JapanI picked up this <a href=http://search.japantimes.co.jp/cgi-bin/ed20090119a2.html>article</a> from The Japan Times on my daily EMS news feeds.<br /><br />It seems like Japan is having hospital diversion issues similar to the US--and the rest of the world. From the article:<br /><br /><blockquote>The deterioration of emergency medical services has become a nationwide worry. In October, a pregnant woman transported by ambulance was refused admission to eight hospitals in Tokyo and died after giving birth. In December, an elderly woman seriously injured in a traffic accident died after she was refused admission to six hospitals in Fukushima and Ibaraki prefectures.<br /><br />The Fire and Disaster Management Agency's 2008 white paper says that, in 2007, an ambulance took an average of seven minutes to pick up a patient — 0.4 minute more than in 2006 — and 26.4 minutes to take the patient to a medical institution that accepted him or her — one minute more than in 2006. Both times were the worst ever. The 26.4 minutes to transport a patient was 6.5 minutes longer than 10 years ago.</blockquote><div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-16650906468632018032009-01-09T17:20:00.004-05:002009-01-09T17:46:15.624-05:00Medics, muscle cars and MargolisScott Snyder out at the San Francisco Paramedic Association sent me a link thinking it would be good "blog fodder." He was right:<br /><br /><a href=http://www.jems.com/news_and_articles/news/09/paramedics_get_muscle_cars.html>Paramedics get muscle cars</a><br /><br />There are two things I find interesting. First is the "muscle car" reference. It doesn't seem to fit with my thinking on EMS. And lets be real, we could all drive 4 or 6 cylinder vehicles but we'd beat the crap out them and they wouldn't last 18 months. Couldn't take the beating.<br /><br />I just hope nobody crashes one. The lawsuit will certainly bring out that headline in a negative light.<br /><br />OK, stereotypes dealt with, I then noticed the reference to advanced practice paramedics. You may recall how that was initially one of the levels proposed in the early EMS Scope of Practice drafts. It was considered impractical, before it's time and taken out relatively quickly.<br /><br />I remember presentations given by Gregg Margolis about the process and the advanced practice paramedic. We also had personal conversations. I had the good fortune to work for Gregg at The George Washington University. Gregg was an advocate for the APP. I think that it is important to note that the advanced practice paramedic concept has resurfaced.<br /><br />I think most changes in EMS will be evolutionary, not revolutionary. Gregg was looking for a revolutionary change. One that would have given EMS increasing professionalism, more training and responsibility and perhaps most importantly, a career path.<br /><br />Gregg worked on a revolution and didn't get it the first try. But when someone tries for something lofty but worthy, people notice. It is like planting a seed. The APP concept in Raleigh likely isn't the full scope of the original concept, but it is a sprout from the seed Margolis (and others) planted.<br /><br />I just thought it was important to mention this evolutionary step toward a revolutionary vision. Good happens slowly. Sometimes imperceptibly. But it seems to be happening here.<br /><br />Thanks, Gregg. You are good for EMS. Revolution or not.<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-2016625151681602552009-01-07T11:01:00.002-05:002009-01-07T11:03:46.917-05:00EMS in top 5 worst jobsI was watching CNN on the plane this morning (Go JetBlue!) and saw a report on the best and worst jobs. You'll be happy to know that EMS landed at number 5 in the top 10...WORST JOBS.<br /><br /><a href=http://www.careercast.com/jobs/content/JobsRated_10WorstJobs>10 worst jobs</a><br /><br />Well, at least we aren't lumberjacks...<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-17934948322225715452009-01-06T09:58:00.005-05:002009-01-06T10:32:21.190-05:00EMS lost a friendJohn Pryor, MD, a Major in the Army Reserve was killed in Iraq on Christmas day. His funeral service was yesterday in Philadelphia.<br /><br />I don't call this out because we lost a soldier or because a family lost their father--although this is certainly and painfully the case. I call this out because EMS lost a true friend and advocate.<br /><br />I first heard of this through the <a href=http://www.ncemsf.org/>National Collegiate EMS Foundation</a>. I lurk on their Facebook page because I feel it is an important organization. They sent out an email immediately after Dr. Pryor's death. It seems Dr. Pryor heard of the NCEMSF and "adopted" them.<br /><br />I really can't begin to post a eulogy here but I'll provide a few links that do. Please take a moment to look these over and pay respect to a man who gave so much--even before he gave his life.<br /><br /><a href=http://www.philly.com/inquirer/front_page/20090106_HUP_surgeon_buried_with_Army_honors.html>Philadelphia Inquirer</a><br /><a href=http://www.ncemsf.org/news/shownews.ems?item=104>National Collegiate EMS Foundation</a><br /><a href=http://www.uphs.upenn.edu/surgery/faculty/jpp.html>Dr. Pryor's faculty profile at Penn</a><br /><br />And finally, <a href=http://www.philly.com/philly/opinion/20070808_An_Army_surgeon_tells_of_war_on_our_own_turf.html>An editorial in Dr. Pryor's own words</a>.<br /><br />Theodore Roosevelt, our 26th President, delivered a speech which became known as "The Man In The Arena"<br />at the Sorbonne in Paris, France on April 23, 1910. It is my favorite of all time. The part of this speech that many of us in the emergency services relate with is most appropriate at times such as this. <br /><br /><blockquote>It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.<br /></blockquote><br /><br />In Memoriam and Honor of<br />John P. Pryor, M.D. 1966-2008<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com1tag:blogger.com,1999:blog-3059545338165002322.post-76008639590807422822009-01-05T10:51:00.005-05:002009-01-05T11:45:29.692-05:00Happy New Year!I hope your holidays were happy and your New Year is filled with hope and opportunity.<br /><br />No resolutions here--I'm going to continue my efforts to be more active in blogging.<br /><br />A few bits and pieces for the New Year:<br /><br />The New York Times agrees with my thought on California's recent interpretation of the Good Samaritan Laws:<br /><br /><a href=http://www.nytimes.com/2009/01/03/opinion/03sat2.html?_r=1>I'll have to call my lawyer</a><br /><br />There have been some changes to the NIMS. Nothing I would call sweeping but it might be helpful to take a look:<br /><br /><a href=https://www.fema.gov/pdf/emergency/nims/NIMS_core.pdf>NIMS Changes 2008 (PDF download)</a><br /><br />2008 was the big EMS social networking year with several sites popping up including two by the EMS magazines:<br /><br /><a href=http://connect.jems.com/>JEMS Connect</a><br /><a href=http://www.emsunited.com>EMS United</a><br /><br />And you can now find almost everyone (including me) on <a href=http://www.Facebook.com>Facebook</a><br /><br />Bryan Bledsoe posted his Top 10 EMS research papers on jems.com recently. These are definitely worth a look:<br /><a href=http://www.jems.com/news_and_articles/columns/Bledsoe/bledsoe_top_10_ems_studies.html;jsessionid=F5EC2093A5AED46A91B7A2FAD855F77F>Bledsoe's Top Ten</a><br /><br />Now, for those of you that know me, I have not only been in EMS for 31 years, I also spent quite a bit of time in police work. I am including this photo of yours truly as a rookie police officer in 1984 for the obvious laugh factor, to point out the benefit of Explorer Posts (I was a member of a police and fire post prior to getting on both jobs) and to remember the close friends and wonderful experiences I had as a police officer in Colonie, NY. Here I am with Neil Leach, a great friend for over 30 years.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjK6Y4HLnfJQ9pI55hcus3mYNdnEzIlh7CMKptP_fUiHsA2YxNPcp_v8pT7d010wL7CYM-qvi8l5OXG3mtaGrWwJ5NAGL41YIgppCCjvq9pRoJM1aT_5odIwp69_uBcPJ_ELzhgAGu8BtE/s1600-h/dan+and+neil+1984a-c.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 239px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjK6Y4HLnfJQ9pI55hcus3mYNdnEzIlh7CMKptP_fUiHsA2YxNPcp_v8pT7d010wL7CYM-qvi8l5OXG3mtaGrWwJ5NAGL41YIgppCCjvq9pRoJM1aT_5odIwp69_uBcPJ_ELzhgAGu8BtE/s320/dan+and+neil+1984a-c.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5287850709856994098" /></a><br /><br />I sincerely hope that your experiences in the emergency services are as rich and wonderful as mine have been over the past 31 years.<br /><br />Happy New Year!<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com1tag:blogger.com,1999:blog-3059545338165002322.post-16646533678769887042008-12-23T11:19:00.002-05:002008-12-23T11:56:21.899-05:00Emergency personnel should get drugs during pandemicsReuters reported on a DHHS guidance memorandum advising hospitals and emergency services employers stock up on antiviral drugs for their workers.<br /><br /><a href=http://www.cnbc.com/id/28268505>Health, emergency staff get drugs 1st in pandemic</a><br /><br />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?<br /><br />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 <a href=http://www.drugstore.com/pharmacy/prices/drugprice.asp?ndc=00004080085&trx=1Z5006>drugstore.com</a> shows a price of about $100 for a ten day supply (prophylactic dose) of the medication.<br /><br />Has anyone seem preparedness efforts such as this in their agency or area?<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com1tag:blogger.com,1999:blog-3059545338165002322.post-36184167533051339292008-12-19T08:56:00.002-05:002008-12-19T09:12:27.460-05:00So much for the Good Samaritan LawCalifornia'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):<br /><br /><a href=http://www.latimes.com/news/local/la-me-good-samaritan19-2008dec19,0,4033454.story>California Supreme Court allows good Samaritans to be sued for nonmedical care</a><br /><br />The article summarizes:<br /><br /><blockquote>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.<br /><br />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.</blockquote><br /><br />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.<br /><br />The dissenting opinion from the court seems reasonable to me:<br /><br /><blockquote>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.<br /><br />"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."</blockquote><br /><br />Yet the constitutional scholars believe the court ruling has merit:<br /><br /><blockquote>Both opinions have merit, "but I think the majority has better arguments," said Michael Shapiro, professor of constitutional and bioethics law at USC.<br /><br />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.<br /><br />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."</blockquote><br /><br />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.<br /><br />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.<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-81388402515671438382008-12-18T13:42:00.003-05:002008-12-18T13:50:22.055-05:00Florida sun charges ambulance batteries<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdxEaxL54W2S8E27G1YC92hiuD6aZNtlEtNg1_flrvUFWMF3TAcKNg3LKYu3qiQCjO-OoTp3ZwdfoXmQDCPZMCxrcuDV6j99ScX4wpH3qIosP9gEg1xwJGTGh6WCApBii15WkusQdUZzg/s1600-h/npn_clwambulance121_49961c.jpeg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 320px; height: 241px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdxEaxL54W2S8E27G1YC92hiuD6aZNtlEtNg1_flrvUFWMF3TAcKNg3LKYu3qiQCjO-OoTp3ZwdfoXmQDCPZMCxrcuDV6j99ScX4wpH3qIosP9gEg1xwJGTGh6WCApBii15WkusQdUZzg/s320/npn_clwambulance121_49961c.jpeg" border="0" alt=""id="BLOGGER_PHOTO_ID_5281203440212063282" /></a><br />Sunstar ambulance in Florida mounted solar panels on the roof of two ambulances to charge batteries in monitors, stretchers and other devices.<br /><br />From an article on <a href=http://www.tampabay.com/news/publicsafety/article941559.ece>Tampabay.com</a><br /><br /><blockquote>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.<br /><br />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.<br /><br />The solar panels do not power the vehicle, but rather supply power to recharge the batteries for various life-saving devices.</blockquote><br /><br />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.<br /><br />Definitely worth keeping an eye on.<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-77309304251083589552008-12-18T13:07:00.002-05:002008-12-18T13:20:12.063-05:00How can you tell if your patient is stable?According to an <a href=http://www.google.com/hostednews/canadianpress/article/ALeqM5i5wdg2ssiJIiq9xvOnPufqb8Thvg>article</a> 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:<br /><br /><blockquote>"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.<br /><br />"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."</blockquote><br /><br />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.<br /><br />I wonder what would happen if we noted a "positive texting sign" on our run report here?<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-18225236049665080992008-12-18T09:50:00.001-05:002008-12-18T09:52:24.510-05:00I love quotes...These came up today on my Google homepage.<br /><br />Everyone's a hero in their own way, in their own not that heroic way.<br /> - Joss Whedon, Zack Whedon, Maurissa Tancharoen, and Jed Whedon<br /><br />I have not failed. I've just found 10,000 ways that won't work.<br /> - Thomas A. Edison<br /><br />The stupid neither forgive nor forget; the naive forgive and forget; the wise forgive but do not forget.<br /> - Thomas Szasz<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-40685331005950842072008-12-08T10:44:00.002-05:002008-12-08T11:50:51.659-05:00More on volunteers: DelawareThe News Journal of Delaware published an article on the volunteer EMS and fire services in the state: <a href=http://www.delawareonline.com/apps/pbcs.dll/article?AID=/20081207/NEWS/812070352>When Every Second Counts</a>.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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:<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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. <br /><br />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.<br /><br />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.<br /><br />Why do senseless things? Lets make what we do and who we are better. Every person. Every agency. Better.<br /><br />Start today.<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-46776698479049395022008-12-04T13:11:00.002-05:002008-12-04T13:30:46.586-05:00Another bad week for EMS newsA quick round-up of stories that show the challenges of EMS on the street. <br /><br />According to the Washington Post, more trouble in a troubled city:<br /><br /><a href=http://www.washingtonpost.com/wp-dyn/content/article/2008/12/03/AR2008120303696.html?hpid=sec-metro>Man Dies at Home After Paramedics Diagnose Acid Reflux</a><br /><br />In Albuquerque:<br /><br /><a href=http://www.krqe.com/dpp/news/crime/crime_krqe_albuquerque_ambulance_worker_arrested_200811292305_rev1>Ambulance worker arrested on scene</a><br /><br />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:<br /><br /><blockquote>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.<br /></blockquote><br />Here is the editorial: <a href=http://www.baltimoresun.com/news/opinion/editorial/bal-ed.chopper28nov28,0,3837063.story>Support for medevacs</a>. 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.<br /><br />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.<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-18297681060574414772008-11-20T10:36:00.002-05:002008-11-20T10:55:39.835-05:00More on EMS in crisis<a href=http://www.bryanbledsoe.com/>Bryan Bledsoe</a> forwarded an <a href=http://www.menshealth.com/cda/article.do?site=MensHealth&channel=health&category=doctors.hospitals&conitem=7933ba9f6197d110VgnVCM20000012281eac____>article from Men's Health</a> about EMS in crisis. The article takes a look at Philadelphia and New Jersey EMS systems as an example of problems such as system abuse, fatigue among providers and provider shortage.<br /><br />Melissa Alexander called out a <a href=http://kob.com/article/stories/S661228.shtml?cat=10134>similar EMS piece from the Albuquerque, New Mexico area</a>.<br /><br />I believe we'll be seeing more and more of these stories. Unfortunately EMS has many crises these days. Perhaps the most important ones are those involving identity and value of the EMS system and the providers that serve in it. Many of the problems we face seem to have roots in these basic issues.<br /><br />I should note that Bryan Bledsoe was named one of Men's Health magazine's Heroes of Health and Fitness as well as one of ACEP's Heroes of Emergency Medicine. Bryan was an early voice in the air medical transport issue. <a href=http://www.emsresponder.com/web/online/Industry-Wire---Business-News/Dr-Bryan-Bledsoe-Named-a-Hero-of-Health-and-Fitness-by-Mens-Health-Magazine/14$8443>emsresponder.com reports on this story</a>. Congratulations, Bryan.<br /><br />Stay tuned...<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-37203312472876932322008-11-17T11:52:00.002-05:002008-11-17T12:03:25.267-05:00Editorial calls for EMS reform in NJI have mentioned the EMS system in NJ several times in my blog. It seems to be at the critical intersection of funding crisis, identity issues, big population numbers and the decline of volunteers seen throughout the country.<br /><br />This <a href=http://blog.nj.com/njv_editorial_page/2008/11/reform_emergency_services.html>editorial in the Star Ledger</a> provides an overview of the issues in NJ.<br /><br />What most outsiders don't realize is the impact of transition from older models steeped in tradition to newer models. I believe there is a benefit, both fiscally and for the age old concept of neighbors helping neighbors, in keeping a volunteer presence in communities when it can be maintained with quality and consistency.<br /><br />Unfortunately the psychology of maintaining that balance can be more elusive than finding 14 million dollars to implement reform.<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-50285060077403431562008-11-16T09:48:00.003-05:002008-11-16T10:07:21.376-05:00Google predicts flu outbreaks faster than CDCCould it be true? It makes sense. Based on search terms, <a href=http://www.google.org/flutrends/>Google Flu Trends</a> can predict flu outbeaks, and do it well. According to a <a href=http://www.cnn.com/2008/HEALTH/conditions/11/11/google.flu.trends/?iref=mpstoryview>CNN article</a>:<br /><blockquote>In the 2007-08 flu season, Google accurately estimated current flu levels one to two weeks faster than published CDC reports in each of the nine U.S. surveillance regions, Google said in a statement.</blockquote><br />This shouldn't be a big surprise when in the past, according to the same article, trends were determined by:<br /><blockquote> ...physicians' reports of patients with flu-like symptoms, lab reports of influenza from nasal and throat swabs, and death certificates.</blockquote><br />I suspect this will also send up early flags in the event of chemical or biological terrorist attacks as well.<br /><br />Go Google! And kudos to the CDC for collaborating and seeing the potential in non-traditional epidemiology.<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-73392507228452911692008-11-13T09:41:00.003-05:002008-11-13T14:09:56.784-05:00Coming soon: Tele-EMSA company called <a href=http://www.swiftmd.com/>SwiftMD</a> has been contracted by a Montana "Preserve" to deliver "emergency medical services, via the phone, Internet or bi-directional video, to all residents and Ameya Preserve employees and their families."<br /><br />I found this article (essentially a press release) on <a href=http://www.marketwatch.com/news/story/SwiftMD-Provide-Telemedicine-Services-New/story.aspx?guid=%7B7F27184D-937E-4027-941C-907E0397AAC6%7D>Marketwatch.com</a> as part of my daily searches of EMS news. From the article:<br /><br /><blockquote>SwiftMD, the revolutionary telemedicine firm, today announced that it has been selected by Ameya Preserve in Bozeman, Montana, to be the sole telemedicine supplier for each of the 300 new homes built in its development. Under the terms of the agreement, the first of its kind in the United States, the company will provide emergency medical services, via the phone, Internet or bi-directional video, to all residents and Ameya Preserve employees and their families. Each home will be equipped with all necessary technological components for the service - an important feature as the nearest healthcare facility is 45 minutes away. The homes are expected to be completed in 2011.</blockquote><br /><br />Does anyone else think this is as huge as I do?<br /><br />From the <a href=http://www.swiftmd.com/individual-plans/conditions-we-treat>"Conditions we treat"</a> section of the SwiftMD site:<br /><blockquote>For most members, SwiftMD is they first call they make at the onset of illness or injury. If it could be treated by a routine office visit or a trip to an urgent care center, SwiftMD is an excellent choice. In fact, the majority of routine and urgent care cases can be safely treated by a SwiftMD physician over the phone.<br /><br />Our services are appropriate for most people from 3 to 69. To ensure patient safety we do not treat other age groups or people with some conditions, including pregnancy-related problems and psychiatric disorders.<br /><br />When you call our toll free number you will answer a few questions to determine whether or not a telemedicine consultation is appropriate for your condition. If not, you will be advised to visit a doctor for a physical exam, or call 911 if it’s a life-threatening problem. Otherwise we’ll schedule an appointment and you’ll be talking to a SwiftMD doctor within an hour.</blockquote><br /><br />It is rare to find me relatively speechless. Quite frankly I am not sure whether to sign up and see if I can buy stock in this company--or wonder about the quality and direction this takes medicine in...<br /><br />What do you think?<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-30036236373708455342008-11-12T20:28:00.002-05:002008-11-12T20:49:20.649-05:00If you like lights and sirens you'll love thisMake way for the Howler.<br /><br />EMSA, an EMS service in Oklahoma, held a press conference today to announce they were installing Howler sirens in their ambulances.<br /><br />According to an <a href=http://ap.google.com/article/ALeqM5jQOqopRzDG9_R2zb65yR3xRf-HewD94DB2L01>Associated Press article</a>:<br /><blockquote><br />"The most frequent thing motorists say to us is they didn't see the ambulance coming," Wells said at a Tuesday news conference, where the new technology was demonstrated.<br /><br />During the demonstration, two ambulances were parked near each other. A plastic stepladder with three glasses of liquid on top was placed in between the vehicles.<br /><br />The ambulance without the Howler sounded its siren and produced its familiar wail. Then, the Howler, which produced booms that sounded like a 1980s video game played at an earsplitting level. The liquids in the three glasses rippled. Wells jokingly said the new sirens sounded like "a vacuum cleaner on steroids." </blockquote><br /><br />The <a href=http://www.whelen.com/details_prod.php?head_id=9&cat_id=68&prod_id=415>Howler</a> is sold by Whelen whose literature on the product recommend hearing protection.<br /><br />"a vacuum cleaner on steroids..." I'm guessing that hearing protection is more than just a good idea.<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com1tag:blogger.com,1999:blog-3059545338165002322.post-85902408921525906422008-11-10T07:48:00.002-05:002008-11-10T08:04:42.307-05:00It is National Collegiate EMS WeekCongratulations to all those providing EMS on college campuses around the country. The event, sponsored by the <a href=http://www.ncemsf.org>National Collegiate EMS Foundation</a>, recognizes the hard work and dedication of campus EMS providers.<br /><br />The purpose of the foundation (from their Facebook page):<br /><br /><blockquote>Founded in 1993, NCEMSF is a 501(c)(3) non-profit professional organization committed to scholarship, research and consultancy activities and to creating a safer, healthier environment on college and university campuses. Comprised of approximately 200 college campus based emergency medical service (EMS) agencies trained to respond within minutes and provide care tailored specifically to campus emergencies, NCEMSF's purpose is to support, promote, and advocate EMS on college and university campuses nationwide. In addition to providing for the acquisition of medical knowledge, campus based EMS allows student participants to develop certain life skills including leadership, communication, and decision making. NCEMSF provides a forum for communication and creates an environment where ideas can be exchanged and problems can be solved.</blockquote><br /><br />I have a special place in my heart for the college services. When I couldn't take an EMT course because I was too young (many, many years ago) I enrolled in a Red Cross Advanced First Aid course taught by members of the Five Quad Volunteer Ambulance at SUNY Albany. What a dynamic and talented group of college students.<br /><br />I have no doubt that the passion those students showed toward EMS is one of the reasons I am still here today doing EMS.<br /><br />Happy National Collegiate EMS Week. Remember all you can do. Know the difference you make. We need a new generation...a future...for EMS. You are that future.<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-41616723228272003162008-11-09T09:56:00.003-05:002008-11-09T10:03:50.511-05:00An unexpected cause of hypoglycemiaThe FDA recently announced a recall of syringes:<br /><br /><blockquote>The U.S. Food and Drug Administration is notifying health care<br />professionals and patients that Tyco Healthcare Group LP (Covidien) is<br />recalling one lot of ReliOn sterile, single-use, disposable, hypodermic<br />syringes with permanently affixed hypodermic needles due to possible<br />mislabeling. The use of these syringes may lead to patients receiving an<br />overdose of as much as 2.5 times the intended dose, which may lead to<br />hypoglycemia, serious health consequences, and even death.<br /><br />The recall applies to the following lot number and product information:<br /><br />-- Lot Number 813900<br />-- ReliOn 1cc, 31-gauge, 100 units for use with U-100 insulin</blockquote><br /><br />We think of many reasons for hypoglycemia when working a diabetic call...but this one wouldn't even be on the radar screen.<br /><br />The full article:<br /><br /><a href=http://www.fda.gov/bbs/topics/NEWS/2008/NEW01911.html>FDA Reports Nationwide Recall of Mislabeled ReliOn Insulin Syringes</a><div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0tag:blogger.com,1999:blog-3059545338165002322.post-91321258872912805502008-10-31T05:03:00.002-05:002008-10-31T05:23:32.389-05:00Differing opinions are healthyA Colorado state senator from Denver wrote a <a href=http://www.denverpost.com/headlines/ci_10838470>very interesting letter</a> to the Denver Post recently.<br /><br />This ex-medic and politician makes some points which seem to be supported by recent literature--that more medics on the street may not be the answer. Denver is struggling with response times. The letter is a bit long to post here in its entirety. Here is a highlight:<br /><br /><blockquote>But I have to tell you, I would rather wait ten minutes for a skilled<br />paramedic who can start the process of saving my life than have one by my<br />side in three minutes who does not have the necessary skill or experience.<br /><br />I know there is controversy. I know there is currently an audit in process.<br />I spent nine years as a CPA, so I understand the auditing and accounting<br />procedures well. Unfortunately, you are on a path to lower the quality of<br />your emergency medical service because, I submit, you are counting the wrong<br />beans.<br /><br />Response time is important, but it is only one component. Making decisions<br />based on response times alone is irresponsible. Look at the whole system.<br />Look at the amount of time spent on the scene. Look at the save rates for<br />viable patients.</blockquote><br /><br />I think this is a very positive letter. I don't know enough about the issues in Denver to form an opinion, but I do like the fact that someone will look at things differently. This is how we grow. It is essential to stop reactive, emotional, non-research based opinions to move EMS forward in both practice and professionalism.<br /><br />It is important to read the whole article. It seems that there are other intertwined issues--such as the fire department taking over EMS--so it is equally important to get get all the facts. Senator Morse concludes:<br /><blockquote><br />You have one of best trauma systems in the country. Rely on the experts who<br />work there, not the auditors and the politicians who know nothing of trauma<br />care.<br /><br />One more thing,, be wary of those who would move the paramedic response to<br />the fire department.<br /><br />That solution would nearly double the cost and significantly reduce the<br />quality because each fire paramedic would see hundreds fewer patients every<br />year and their skills would atrophy-paramedic skills are perishable.<br /><br />Keep them fresh even if you have to wait an extra minute or two for them to<br />arrive.</blockquote><br /><br />Several years ago in Kennebunk I unpopularly argued that clinically competent, community-based EMT-Intermediates may be better for the system overall than bringing in out-of-town per diem medics.<br /><br />I had a bit of a flashback here...<div class="blogger-post-footer">http://feeds.feedburner.com/emergencycare</div>Dan Limmerhttp://www.blogger.com/profile/11666279767120682672noreply@blogger.com0