ems help grant dying mans last wish

EMS Help Grant Dying Man’s Last Wish

Near death, he wanted to be near nature

EMS personnel know too well the frustration and heartbreak that typically attend the last hours of a victim’s life. So it was a welcome change for EMS with the Snohomish County Fire District when they were called in to help grant a dying man his last wish and one last measure of joy.

According to a story by A.J. Willingham on HLNTV.com, the patient had been a forest ranger until illness cut short his career. Eventually he ended up at Evergreen Hospice Center in Kirkland, WA, where, as he sensed his end, he confided in the chaplain his dying wish to be among nature one last time.

ems help grant dying mans last wish

To ensure the safety and comfort of the patient, the hospice center contacted the local fire department to see if they would be able and willing to help with the man’s request. Soon enough, the man — known only as Ed — was being carefully transported to some nearby woods in the back of an ambulance.

The EMS team was kind and compassionate in completing its mission. According to a post on the Evergreen Hospice Volunteers page, “Together, the group took Ed up and down the trails, bringing him the scents of the forest by touching the fragrant growth and bringing their hands close to Ed’s face.”

The post also noted that, “People sometimes think that working in hospice care is depressing. This story … demonstrates the depths of the rewards that caring for the dying can bring” — rewards that EMS can identify with.

hlntv.com

are house calls key to future of ems

Are House Calls Key to Future of EMS?

Paramedicine represents new revenue source

The role of EMS has traditionally been pretty straightforward: respond to emergencies, stop the bleeding, convey to the nearest hospital. But over the past few years that paradigm has evolved as ambulance companies have begun to make inroads into the business of home health care.

are house calls key to future of ems

An article on bostonglobe.com reports how EasCare, a Massachusetts ambulance company, is just one of many companies nationwide that are redefining the paramedic’s role to include home-based treatment and prevention. Under a pilot program set to launch this summer, paramedics would treat patients with infections, minor wounds, injuries from falls, and problems associated with chronic diseases like diabetes and congestive heart failure.

“We really do believe this is the house call of the future,” said EasCare CEO George Gilpin.

As the government and insurers implement policies to discourage visits to the emergency room, home care could represent an important new revenue stream for ambulance companies trying to offset the loss of business. American Medical Response of Greenwood Village, CO, the largest ambulance company in the U.S., has been using paramedics to provide home care since 2010, according to the Globe. It runs programs in more than a dozen cities and has plans to expand into Massachusetts.

The service model varies. EasCare paramedics will rely on referrals from its partner, Commonwealth Care Alliance, which answers patient calls at night. The paramedics will travel in SUVs carrying medications and equipment not found in a regular ambulance, like a blood-testing kit, and will have access to electronic medical records. A regular doctor would be consulted before a plan of care began.

“This really changes the whole way EMS is going to approach patients,” said Greg Davis, project manager at EasCare. “Sometimes we wondered if we really needed to take them to the hospital. Is there something we could have done for them in their home? This will give us that opportunity.”

bostonglobe.com

combatting traumas lethal triad

Combatting Trauma’s Lethal Triad

Although trauma care has come a long way over the past 30 years, trauma is still one of the leading causes of death in any age group, writes Ryan Gerecht, MD, CMTE in the April, 2014 issue of the Journal of Emergency Medical Services. A common cause of death in patients with traumatic injuries is what Gerecht terms “the lethal triad” of hypothermia, acidosis, and coagulopathy.

combatting traumas lethal triad

Better education on the lethal triad could improve outcomes for millions of people injured annually, Gerecht asserts. “At the end of the day,” he says, “recognition and prevention of this lethal triad can be more effective than treatment. A variety of seemingly simple but truly significant actions and inactions by EMS at both the scene and during transport can directly prevent or slow the progression of the lethal triad.”

Even mild hypothermia in a trauma patient can wreak havoc, notes Gerecht. “Of particular concern is the effect of hypothermia on the coagulation system,” he says. “The coagulation system is a temperature- and pH-dependent series of complex enzymatic reactions that result in the formation of blood clots to stop both internal and external hemorrhage.” Coagulopathy is the impaired ability of the coagulation system to synthesize blood clots.

Acidosis is broadly defined as below-normal blood pH; in trauma patients, the major cause of acidosis is poor perfusion to the tissues. A shortage of blood forces the body’s cells to utilize anaerobic metabolism instead of normal aerobic metabolism to make functional energy. Lactic acid is a byproduct of this process. One of the most harmful effects of acidosis on trauma patients is that their coagulation system becomes severely impaired.

Hypothermia, acidosis, and coagulopathy thus form a deadly cycle that results in continued hemorrhage, which can quickly spiral out of control and lead to death.

Gerecht offers 16 steps that providers should follow to battle the lethal triad, including:

  • Find and stop the bleeding.
  • Continue to search for sources of bleeding, as others may exist.
  • Always assume your patient’s temperature is dropping – because it is.
  • Limit crystalloid infusion as much as possible.

Read the full article at: jems.com

emt aids classmates in school stabbings

EMT Aids Classmates in School Stabbings

A 16-year-old student at Franklin Regional High School in Murrysville, PA stabbed 21 students and a security guard last month. None of the victims died from their wounds — and some can thank the actions of classmate Alex Pasculle, an 18-year-old senior and certified EMT.

According to Ashlie Hardway of WTAE in Pittsburgh, Pasculle knew an emergency was developing when he heard the fire alarm sound during homeroom.

Although he was told not to go downstairs, Pasculle saw that someone had been stabbed and ran to his car to retrieve his first aid bag. A police officer told Pasculle there was an attacker in the building.

emt aids classmates in school stabbings

“I parked my car and ran up front to start triaging people,” Pasculle said. “There was actually so much blood that [the school nurse] fell getting up and then I fell getting up, too,” Pasculle said.

Pasculle said that he has been working in emergency services since he was 14 and became a certified EMT about a year ago. For the past five months he has worked for Murrysville Medic One. Little did Pasculle know when he went to school that day that his emergency training might end up saving lives.

A makeshift dressing he created to slow the bleeding of one teen’s deep abdomen probably meant the difference between living or dying, Pasculle believes. “From the bleeding, from the amount of blood. Just simple wound pressure on something saved a life.”

Sources: wtae.com

Obamacare Changing the Future of EMS

Patient experience impacts all in healthcare system

“We’re arguably at the most pivotal time in our young profession,” write Doug Hooten and Matt Zavadsky in an article on jems.com, the website of the Journal of Emergency Medical Services. “The ACA [Affordable Care Act] has provided EMS an unprecedented opportunity to become a part of the healthcare system, a move that many of us have dreamed about for decades.”

The authors argue that the ACA (a.k.a. Obamacare), by attaching financial incentives to the notion of patient-centered care, is forcing hospitals to pay closer attention to all the links in the healthcare delivery system — including EMS. Under the ACA, hospitals are now rewarded or penalized based, in part, on feedback gathered from patients after they have been discharged.

obamacare changing the future of ems

Hooten and Zavadsky predict that ambulance companies will be held to a higher standard by hospitals for service delivery and “customer service” — if they aren’t already — because EMS plays such an important role in the overall patient experience. A bad trip to the hospital can leave a lingering negative impression that could end up impacting the hospital’s bottom line.

The authors cite several reasons why EMS providers should pay attention to this important sea change in the healthcare system:

  • Our patients care about what (and how) we care for them.
  • Our payers now care about what we do (and what we say) to the patients.
  • Our healthcare stakeholders (the sending or receiving hospitals) care.
  • It may be one of the only quality metrics we have.
  • We need to bend the perception curve.

Sources: jems.com

new sitcom on emts gets thumbs-up

New Sitcom on EMTs Gets Thumbs-up

Balance, good writing bring ‘Sirens’ to life

A new sitcom on USA Network about three Chicago EMTs shows promising signs of life, writes paramedic Mike Rubin in EMSWorld.com.

new sitcom on emts gets thumbs-up

Produced by Dennis Leary, Sirens is an adaptation of a 2011 British series about London’s ambulance service. The program debuted on March 6, and Rubin was relieved to find that Sirens was not “Rescue Me with an extra helping of bathroom jokes.”

“Sirens is unique among EMS-themed sitcoms,” Rubin writes, “– engaging and subtly funny, without underlying sensationalism or pathos.“ The characters, plot lines, and clowning around evidenced in the program’s first night are standard comedic fare (although Rubin notes that “obligatory references to, and comparisons of, male genitalia are less gratuitous than they might have been”), but Rubin believes the show manages to balance the requirements of situational comedy with an appreciation for the professional challenges faced by EMTs.

Yet, Rubin writes, “None of this means Sirens is occupationally accurate. We never see CPR when the crew responds to a cardiac arrest, and we wonder how Johnny can spend several minutes on scene, post-arrest, chatting with his girlfriend while his patient awaits transport.”

Despite the liberties taken with the realities of emergency medical services, Rubin believes that “Hollywood has no obligation to portray our industry accurately. It’s hard to imagine how any attempt to do so would be entertaining enough to sustain corporate sponsorship. On-the-job scenarios we insiders find funny often involve tragedy trumped by absurdity — a hard sell to Nielsen audiences raised on laugh tracks. Plus there are too many times when we’re not doing anything.”

Sources: emsworld.com

no call too distant for global rescue

No Call Too Distant for Global Rescue

Ready to respond at the Sochi Olympics

Imagine you’re on call. Except the call might come from France, Russia, or any other spot on the globe.

That is the level of response promised by Global Rescue, a private crisis-response firm based in Boston. Global Rescue was in Sochi, ready to come to the aid of any members of the U.S. ski and snowboard teams, with whom Global Rescue has worked since 2006.

no call too distant for global rescue

According to an an article in USA Today, Global Rescue had up to five aircraft on standby in the event that any of the 375 athletes, staff, and guests it was hired to serve encountered a medical or security emergency. (During the Arab Spring, the company whisked more than 200 people out of Egypt.)

Two suicide bombings near Sochi in the months leading up to the games put security concerns in the spotlight. Russia implemented a $2 billion “ring of steel” — a fortified perimeter stretching from the Black Sea to the Caucasus Mountains. Global Rescue CEO Dan Richards called Sochi a “unique challenge.”

“Our advance preparations are dramatically enhanced for Sochi, particularly considering planning for potential mass evacuation involving dozens or hundreds of people,” Richards said. “Our medical evacuation, in contrast, is typically (for) just one or a few people.”

Sources: USA Today

binge drinking at uc berkeley strains ems system

Binge Drinking at UC Berkeley Strains EMS System

The latest accessory worn by more and more students at UC Berkeley is not something you can pick up at the university bookstore or the local fashion boutique. “Barf Bibs,” as they are called, are used by the city’s paramedics to prevent drunk patients from vomiting all over the inside of the ambulance during transport. The bibs are one symptom of a campus-wide drinking problem; another, more alarming symptom is the strain the problem is having on the city’s emergency services.

binge drinking at uc berkeley strains ems system

Dan Noyes, chief investigative reporter for ABC7 News in San Franscisco, CA, reported that on Sunday, Aug. 25, there were 18 calls to transport drunk students to the hospital. The fire department’s seven fire engines, two ladder trucks, and three ambulances were so busy a call had to placed to surrounding communities for mutual aid. The emergency room at the hospital nearest the Berkeley campus, Alta Bates, was so full of drunken students that ambulances had to be diverted to other hospitals.

“As we would respond to one group to the campus for one patient, another call would come in,” Berkeley Fire Deputy Chief Avery Webb said.

Karen Hughes, manager of the [email protected] program, suggested that the increase in call activity might be an indication that outreach efforts to educate students to call 911 if they see a friend in trouble are working.

One possible solution to reducing the strain on hospitals is for schools to extend hours of operation at campus health centers, so drunk students could be treated there instead of the emergency room.

Sources: abclocal.go.com

hand-washing rates low among ems providers

Hand-Washing Rates Low among EMS Providers, Study Finds

It seems like a no-brainer that the healthcare professionals who make first contact with a patient requiring immediate medical care would be conscientious about washing their hands. But a new study by the Robert Wood Johnson Hospital in New Brunswick, NJ, found that only 13 percent of emergency medical providers reported cleaning their hands before patient contact.

“What we found was a little concerning,” said Dr. Josh Bucher, a resident at Robert Wood Johnson Hospital and one of the study’s authors.

hand-washing rates low among ems providers

As reported on cbsnews.com, the study found that only one-third washed their hands after performing invasive procedures. Just 52 percent said they wore gloves with every patient contact although, as Bucher notes, “Gloves and hand-washing are supposed to be combined.” According to Bucher, hand-washing should occur prior to touching a patient, after touching a patient, after contact with bodily fluids, and before and after invasive procedures — essentially, anytime a provider touches anything or anyone at all.

According to the Centers for Disease Control and Prevention, about one in every 20 hospital patients develops a healthcare-associated infection (an infection acquired while a patient is receiving care for other conditions), some of which lead to death.

The study, which is considered preliminary since it has not yet been published in a peer-reviewed journal, was administered through an online survey and distributed via email to national and emergency medical organizations. Nearly 1,500 people responded.

The study also found that:

  • Women and older EMTs are more likely to wash hands
  • Only 10 percent of respondents received blood-borne pathogens training
  • Having soap in an ambulance did not affect hand hygiene

Sources: cbsnews.com

emt saves patient while both have heart attacks

EMS Excellence Sprouts – in the Heart of the Desert

For one week each year, the third largest “city“ in Nevada is Black Rock City, home to the Burning Man Festival, a weeklong, free-spirited gathering of approximately 68,000 people. The event takes place in the middle of Black Rock Desert outside of Reno — a remote location with no existing infrastructure or services. And yet, a first-class EMS system offering free, high-quality healthcare is available to serve participants; this year, about 3,500 people were treated. How does that happen?

emt saves patient while both have heart attacks

An expanded role for paramedics is a big part of the answer.

According to an article by Jason Busch in emsworld.com, for the past three years medical care at the Burning Man Festival has been delivered primarily by EMS providers from Humboldt General Hospital EMS Rescue, led by director Pat Songer, ASM, EMT-P. Bryan Bledsoe, DO, FACEP, FAAEM, medical director of MedicWest Ambulance and a professor at University of Nevada School of Medicine, has provided medical direction. What this team has been able to accomplish offers a model for EMS delivery that has implications for other, less exotic environments.

Because of the event’s distance from established healthcare facilities – the closest hospitals are 150 miles away — Bledsoe says the EMS team decided to take a more global approach.

“Instead of just placing ambulances and first aid stations everywhere we decided we would develop an integrated emergency healthcare system that ranged from first aiders to board-certified emergency physicians,” says Bledsoe. “We specifically wanted to use paramedics in an expanded role because they are already accustomed to the austere environment, independent thought, and the general mindset of the event medical and EMS leaders. As emergency physicians we saw the capability to safely expand their scope of practice to meet the needs of Burning Man.”

The integrated system, which includes a fully functional emergency department with facilities for minor care, emergency care, and extended care, enables the EMS team to handle a high volume of patients. More than 600 patients were treated on the event’s last day, making the Burning Man EMS one of the busiest emergency departments in the country that day.

“I think what I have learned from Burning Man — and I have been in EMS and healthcare for almost 40 years — is that the current healthcare system is broken,” says Bledsoe. “At Burning Man we have looked beyond the constraints of conventional thought and protocol and tried to develop a healthcare system that is truly integrated from the first responders to the physicians. We have taken down numerous barriers between healthcare providers and eliminated turf battles. We try to ensure the patient gets to the level of provider most capable of managing their problem — and that is not always a physician.”

Adds Mendiola, ““Our system has demonstrated that paramedics and other levels of EMS providers can effectively serve as physician extenders, helping to deliver appropriate care in a much more sustainable manner — while still being physician-led.”

Sources: emsworld.com