The Brutal Math of Drug-Seeking Behavior in Prehospital Care
Dallas Fire-Rescue Medical Director Marshal Isaacs, MD, calls them "prime numbers." He’s referring not only to drug-seekers—although many of them belong to the population of patients who "fall off the grid" in between encounters with the healthcare system, and therefore pose a major challenge to being tracked over time. These patients can be transients or migrant workers; they can be living in short-stay accommodations like motels, and therefore moving frequently around a region; they can be suffering from mental illness or addiction and moving among rehabilitation centers; or they might b...
Source: JEMS Special Topics - December 19, 2018 Category: Emergency Medicine Authors: Jonathon S. Feit, MBA, MA Tags: Exclusive Articles Documentation & Patient Care Reporting Columns Source Type: news
Rethinking ALS Intercepts and Mutual Aide Agreements
This article focuses on the EMS standard operating procedure (SOP) known as the advanced life support (ALS) intercept.1 In the seven rural Midwest and Mountain West states in which the authors work it’s common for ambulance services to be staffed by volunteers with basic life support (BLS) training. These dedicated first responders have varied levels of NREMT credentialing including: EMT-Basic, Advanced EMT, and EMT-Intermediate (EMT-B, AEMT and EMT-I, respectively).2
All EMTs complete coursework in human anatomy, physiology, pathophysiology, emergency skills and patient assessment. The more advanced the EMT (e.g., advan...
Source: JEMS Special Topics - December 19, 2018 Category: Emergency Medicine Authors: Ralph Renger, PhD Tags: Exclusive Articles Operations Source Type: news
Mental Health, Sleep Deprivation and Career Stress in EMS and Fire
The human brain is a marvelous, yet complicated system. Researchers spend entire careers studying what makes the brain act or react to certain experiences. A mental health issue stemming from life’s experiences has culturally been seen as a sign of weakness, but actually is part of a very complex architecture that’s unique from person to person.
In order to gain an understanding of how stress plays a role in the lives of first responders, we need to start answering some hard questions: What leads to burn-out? What’s associated with PTSD? How is lack of sleep affecting the mental health states of first responders? The...
Source: JEMS Special Topics - December 13, 2018 Category: Emergency Medicine Authors: Morgan K. Anderson, MPH Tags: Exclusive Articles Resiliency Operations Source Type: news
Clinical Performance Measures that Matter —Are You Ready?
Conclusion
The future will belong to those who can prove value. The use of a clinical performance dashboard and comparisons to national data will help to ensure that when the payers come knocking on our doors looking for "proof" that what we do enhances patient care and improves patient outcome, we’ll have an answer!
This is the first in a yearlong series of articles developed by the Academy of International Mobile Healthcare Integration (AIMHI).The AIMHI article series is developed in partnership with JEMS to help educate EMS agencies on the hallmarks and attributes of high-performance/high-value EMS system de...
Source: JEMS Special Topics - December 11, 2018 Category: Emergency Medicine Authors: Wayne C. Harbour, NRP Tags: Exclusive Articles Operations Administration and Leadership Source Type: news
Global Differences in Out-of-Hospital Cardiac Arrest Reporting
Conclusion
Large disparities exist surrounding OHCA patients among three different high-income countries. In addition to this, there are significant gaps in capturing, reporting, sharing and analyzing OHCA data across regional and national borders. Uniformity of reporting standards continue to hinder the epidemiological evidence base for OHCA. Much about OHCA epidemiology is still unknown in many regions of the world, including countries with regional OHCA surveillance in place. These findings present considerable challenges not only nationally, but globally for evaluating the global burden of out-of-hospital cardiac arres...
Source: JEMS Special Topics - December 6, 2018 Category: Emergency Medicine Authors: Michael Schulz, MS, NRP Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news
Look Up From Your Screen
One of the best things about being in the emergency services is the freedom we enjoy from a traditional office setting. Increasingly, though, our mobile devices are infiltrating our space and chewing up our time and attention. We can be sitting in the cab of an emergency vehicle anywhere, but still be tethered by our phone and tablets, unless we make a conscious choice not to be ruled by techno-diversions.
As a member of the healthcare world, why not set an example to others and choose to heed the advice of experts to look up from the screens to which we all seem addicted? Here are three good reasons:
1. ...
Source: JEMS Special Topics - December 4, 2018 Category: Emergency Medicine Authors: Kate Dernocoeur, NREMT Tags: Exclusive Articles Columns Operations Source Type: news
Patient's Elevated Airway Pressure Puzzles Providers
Conclusion
In this case, the patient’s high airway pressures continued even after she was removed from the ventilator, as evidenced by the difficulty with manual ventilation. Thus, the problem wasn’t with the ventilator or its tubing.
The endotracheal tube was properly placed, as evidenced by the presence of bilateral breath sounds, its depth and placement as visualized on chest X-ray. And the tube didn’t appear to be kinked or otherwise obstructed based upon the ability to easily pass an endotracheal suction catheter.
Given the wheezing heard on auscultation—and even though the patient had no history of pulmonary ...
Source: JEMS Special Topics - November 29, 2018 Category: Emergency Medicine Authors: John Freese, MD Tags: Airway & Respiratory Exclusive Articles Source Type: news
Carrying and Administering Lifesaving Prehospital Blood
When New Hanover (North Carolina) Regional Medical Center’s AirLink teams began carrying prehospital blood in September 2017, patients experiencing hemorrhagic shock gained the ability to receive lifesaving oxygen-carrying red blood cells while being transported to the trauma center.
Prehospital blood transfusions are known to increase 24-hour survival while also decreasing the total amount of blood needed during hospitalization, but are only available on about half of the EMS helicopters in the United States. In a testament to the need for prehospital blood transfusions, the first patient to receive this lifesaving serv...
Source: JEMS Special Topics - November 28, 2018 Category: Emergency Medicine Authors: Kevin Collopy, BA, FP-C, CCEMT-P, NRP, CMTE Tags: Trauma Exclusive Articles Source Type: news
ECG Educational Standards for Prehospital Providers
Conclusion
As the role of evidence-based medicine becomes more prominent in the field of emergency medicine, a clear view of the current state of ECG education and platform from which to implement uniform standards becomes increasingly essential; especially as research expands into the prehospital setting.
Further research into EMS education may identify both strengths and weaknesses in basic ECG interpretation appropriate for first responders.
Implementing minimum ECG interpretation standards for EMS personnel nationwide is one potential option to ensure prehospital educational institutions stay responsive to current scie...
Source: JEMS Special Topics - November 27, 2018 Category: Emergency Medicine Authors: Jonathan Barney, BA, EMT, MS3 Tags: Training Exclusive Articles Cardiac & Resuscitation Source Type: news
EMS Encouraged to Comment on Opioid Crisis National Roadmap
The NHTSA Office of EMS is encouraging members of the EMS community to comment on a draft report developed by the Fast Track Action Committee (FTAC) on Health Science and Technology Response to the Opioid Crisis. Under the White House Office of Science and Technology Policy, NTSC convened the Opioid FTAC as a response to the opioid crisis to identify (1) research and development (R&D) critical to addressing key gaps in knowledge and tools, and (2) opportunities to improve coordination of Federal research and development essentials to combating the opioid crisis.
The draft report, "Health Research and Development t...
Source: JEMS Special Topics - November 21, 2018 Category: Emergency Medicine Authors: NHTSA Office of EMS Tags: News Administration and Leadership Mobile Integrated Healthcare Source Type: news
Recruitment and Retention: A Perennial Problem in EMS
Conclusion
We can interpret from these studies and the information they provide that our industry’s turnover rate sits at an average nationally of 20–30%. Further, about 10–15% of our staff leave our employment to retire, which is something we probably can’t, and shouldn’t, attempt to change. Of the remaining 15% that voluntarily resign each year, we can implement some workplace changes that could substantially reduce this number, and this does not necessarily require increasing their salaries significantly.
References
1. Perkins BJ, DeTienne J, Fitzgerald K, et al. Factors associated with workforce retention amo...
Source: JEMS Special Topics - November 20, 2018 Category: Emergency Medicine Authors: Vincent D. Robbins, FACPE, FACHE Tags: Columns Exclusive Articles Administration and Leadership Source Type: news
First Combination Bachelor of Nursing Degrees/EMT-Intermediate Certifications Conferred in Austria
The first cohort of students have completed the Bachelor of Nursing Science program at Austria's University of Applied Sciences in St. Pölten. Some students also graduated as Emergency Medical Technician-Intermediate. The six-semester program offers a regular Austria Nursing Law Bachelor and an “academic program for prehospital care and nursing,” according to the Austrian Paramedic Law.
Related JEMS Article: Austrian University Adds EMS Training to Bachelor of Nursing Degree
Nurse paramedics are quite common in European countries such as Spain, Norway, Netherlands, Sweden and Finland. In Austria, the combined p...
Source: JEMS Special Topics - November 20, 2018 Category: Emergency Medicine Authors: Christoph Redelsteiner, DrPhDr, MSW, MS, EMT-P Tags: Training News Exclusive Articles Source Type: news
Reflecting on Pennsylvania's EMS Issues from 2,300 Miles Away
My sister-in-law in Eastern Pennsylvania, sent me this great descriptive article published in the Times News from the six-county EMS region in Eastern Pennsylvania where I was director from 1975–1992.
It presents a great update and facts on age-old issues that volunteer, BLS and low-volume services have. I wish I wrote it.
Most of the issues are decades old and existed when I was the region's EMS Council Director, but now these issues are catching up with small services and choking them—financially and emotionally—to death.
From 1975–1987, the Commonwealth of Pennsylvania's EMS law allowed (by interpretation) ...
Source: JEMS Special Topics - November 19, 2018 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT-P Tags: Exclusive Articles Columns Administration and Leadership Source Type: news
Between a Stethoscope and a Gavel
In late 1959, a young firefighter candidate was given a welcome break from the “grinder”—an affectionate term for the training academy of the Los Angeles County Fire Department (LACoFD).
The young firefighter had been told his “contractual duty is to fight fire”1 and had spent the prior weeks drilling on the techniques of the profession under the Southern California sun.
However, today would be different. Instead of pulling hose and lifting ladders, his afternoon would be spent in a classroom taking a course called “first aid.”
At best, the course was marginal; lasting less than two hours, it was wedged betwe...
Source: JEMS Special Topics - November 15, 2018 Category: Emergency Medicine Authors: Jameson Karns Tags: Exclusive Articles Administration and Leadership Source Type: news
Amid Drug Crisis, Spiritual First Responders Hit the Streets
Sidewalk prayers near shoot-up spots. Sunday sermons in the back of a bar. Pleas to struggling souls to surrender to God. Funerals for members of their flock who didn't make it.
Clergy members have become spiritual first responders in the opioid crisis, often leaving the pulpit to minister on the streets.
They can be reverends, rabbis, priests or pastors. Though their faiths differ, they invariably approach people with addiction as equals. No Bible-thumping, no blaming. Quite a few are in recovery themselves.
Despite some signs of a slowdown, the nation's all-time deadliest drug overdose epidemic endures. Opioids were invo...
Source: JEMS Special Topics - November 13, 2018 Category: Emergency Medicine Authors: Michael Hill, Associated Press Tags: News Mobile Integrated Healthcare Source Type: news
