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April is Autism Awareness Month: Now Let’s Go Farther

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Since sometime in the 1970s the month of April has been recognized as “Autism Awareness Month” with April 2nd being “World Autism Awareness Day”. It’s a time dedicated to increasing awareness of this disorder that is affecting an increasing amount of the population. While just how many people may be affected is up for debate, the prevalence is growing. So much so that last I heard, 1 in 50 kids are born with a varying degree of the disorder.

You’ll hear different statistics out there than the 1 in 50 I just quoted since there is disagreement between various camps in the Autism Community. Understanding, diagnosing, and much more so treating autism is difficult by the fact that “Autism” is a blanket term covering the many manifestations of “Autism Spectrum Disorder” (ASD). ASD covers a complex array of conditions, symptoms, and behaviors that someone diagnosed as being “Autistic” can display. People “on the spectrum” can be minimally affected, or “high functioning” or can be “low functioning” if they are profoundly affected.  I can’t claim to understand it myself and I’ve been as immersed in it as I’ve ever been over the last few years.

Yesterday was “World Autism Awareness Day” and I’m posting this article on April 3rd. You may be wondering why I didn’t post this up yesterday instead of the recap of the fake “news” stories I posted for April Fools’ Day. I waited for two reasons: one being that while Autism affects my life and my family it is still important to show that life goes on every day. Humor is a big part of our family life out of both fun and necessity. Another reason is that I believe there isn’t anyone reading this that isn’t “aware” that autism is a thing that exists. I can’t imagine there is an EMS professional out there who isn’t aware of autism but if you’re not, here’s a link to the Wikipedia page on it, and here’s a link to the Autism Society of America. Go read and become aware. In fact, it’s probably a good idea to go read and understand more about ASD anyway. There is a lot to know. ASD is challenging and complex and even the so-called (and especially some of the self-proclaimed) “experts” may not know as much about it as they claim to. I’m no expert by far and I want to stay out of the politics of the debate so I’ll just say this. If you’ve seen one person with “autism” you’ve seen one person with autism. Every person is an individual and there is no one right way to think about how every person will manifest their symptoms.

So since you’re all aware of autism now, let’s get to the point of this post: increasing acceptance, understanding, and respect. I’m glad that we’re all aware that autism is a thing, as would most parents of children who are somewhere on the spectrum as well as the people who are on the spectrum themselves. However, I’m sure they would be even happier if they could simply run an errand with their child without having to fear the reaction of other people in public. I’m sure they would really appreciate people not reacting to them or their child out of fear and ignorance should the child manifest typical behaviors or make noise when they go into a restaurant to eat a meal. As a paramedic, I can say that we would really appreciate not having to live in fear of calling 911 and having the responders have absolutely no clue of how to behave towards our son. That’s what I’d say people whose lives are affected by autism really want. While “awareness” is super-neat and all, let’s move on to the next step of making life a little less hard for everyone. Chances are that nobody reading this blog is going to be capable of finding an effective treatment, but everyone reading this can do their part to make the disorder less of a bad thing by working on their own behaviors towards people on the spectrum.

As you may know, my girlfriend Amy has been a huge blessing in my life. Her son, Connor, has some special needs, one of which is being on the autism spectrum, specifically diagnosed as PDD/NOS or Pervasive Developmental Disorder/Non Other Specified. Living with Connor has changed my life in many ways and has taught me more about myself than I thought I could learn. I’m different now, and hopefully it’s for the better. ASD is very complex and I’m as aware of it as I think I can be but I wasn’t always this way.Amy has shown me a lot that I didn’t know I didn’t know. When Amy and I were early in our relationship, she used to come and ride with me on the ambulance on a somewhat regular basis. EMS was as new of a world to her as her world was to me and while never really got anything all that complex while she was riding with me, we did have one call that stands out.

We were the 911 service for a smaller city where everyone knew everyone and the public safety community all hung out together. It was normal for the police, EMS, and firefighters to eat their meals together and we all listened in to each other’s radio frequencies. So one day when I heard the police get called to the local supermarket for “A child wandering the parking lot alone who appears to have autism.” We decided to head over there ourselves with the ambulance to see if we could lend a hand. Amy was with us and she was very interested, and I was the shift officer and approved of us jumping the call.

When we arrived, we found the police out with a male child who couldn’t have been more than 10. He was very afraid of the police, appeared to be non-verbal, and was walking away from them whenever they approached him. When we arrived, he was walking back into the store. I walked up to the police sergeant and offered our assistance. I told them that our ride-along had a child with autism herself. That seemed to be enough for them. They parted like the Red Sea and let Amy take charge without knowing her from anyone. We followed the kid through the store keeping a respectable distance and watched him as he searched the aisles. Finally, the boy walked up to a man who was perusing the frozen foods section and got uncomfortably close to him. Being “official” like I was in my EMS uniform, I stepped between them until Amy grabbed me. “That’s his dad Chris, chill out.”

It was his dad and he was not aware of the fact that two paramedics, three police officers, and a ride-along were very concerned about what his child was doing wandering the aisles and parking lot of a grocery store. The kid hadn’t done anything wrong and neither had his father, but we were all highly aware of the fact that we were uncomfortable dealing with a situation that was normal for the father of the child. Sure, he probably should have been watching the kid more closely, but how often would the parents of a typically developing child let their 10 year old walk alone in a grocery store. I’m not overprotective and I know that my 9yo step-daughter is capable of fending off kidnappers should I let her go pick out a box of cereal while I look for a gallon of milk… should this father be condemned for the same?

This event got me thinking that I really didn’t know as much about autism or the world of special needs children, but an event Amy and I shared later really hit home for me. We were watching Annie, the girl-child, play a little league game in a local park when I saw a man mowing his lawn which was adjacent to the ball field. He mowed row after row of grass all with a teenage boy following him in lock step about 3 feet behind. Back and forth they walked together silently, the man mowing and the boy following. I thought it was odd but Amy’s perspective snapped me into focus, “He must not be able to leave his son alone in the house while he mows his lawn. I used to have to mow my lawn at night when the kids were in bed because I couldn’t leave Connor alone for that long.”

At that moment, I realized that there was a whole world I didn’t know about. Even though I had been a paramedic for years and thought that I knew some things, I was ignorant to how the special needs community lives and gets through daily events that are easy and normal for most. I was ashamed. I realized that the reason the police and both my partner and I were so quick to let Amy handle the little boy with Autism in the grocery store was because we were scared. We didn’t know what to do with something we didn’t understand. Give us a car accident, a robbery, a cardiac arrest and we’d be fine working as a team… but give us a small boy that didn’t understand that we were there to help him and couldn’t communicate back with us and we failed.

As a paramedic, I live in fear of the day that I have to call 911 for my step-son. I know most of the EMS people that would respond to a call for help in most of the jurisdictions that we travel in and while darn near all of them are top-notch, I’m still scared. I’m scared because I would be scared of the medic that I was just two years ago. Sure, I was “aware” of autism as being a thing, but I had absolutely no understanding of what it meant. I had no idea of how to manage behaviors from a person with ASD, and I really didn’t know how to manage my own behavior towards them. I had awareness without understanding. Even though now I’m much more well-versed in my behavior towards people with ASD and other special needs, I’m still not as good as I want to be. The subject is complex and requires a lot of study and personal growth. One day I might be as good as I want to be but today’s not that day. I still have a lot to learn.

As I said before, “Awareness” is super-neat and all and as the step-dad of someone with ASD I thank you for knowing that autism exists. Now I ask you to take the next step and give us all a little acceptance and understanding. Nobody here is probably going to find the next revolutionary therapy but we all can stop being rude when we see someone with ASD having a meltdown in public. We can give a little understanding and courtesy when someone with ASD is being themselves in a way that isn’t quite within the social norm because we understand they cannot help it. As caregivers, we can react with kindness and patience when we realize that someone’s communicative needs and thoughts on the situation at hand aren’t what we may expect them to be.

So you can go blue for autism. You can proudly display your puzzle-pieces. Heck, you might even put a ribbon on your car. However all I’m asking is that you give people a little leeway to be themselves and just be nice to people. Not everyone is the same and we all need your respect and maybe even a little help sometimes. That’s what would be really nice.

So in honor of all of those with Special Needs and also the people who love them, Happy Autism Month y'all.

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If you’re looking for training for your police, fire, or EMS agency on Autism, I recommend this group: http://autismalert.org/

If you’re looking for a window on understanding the world of families with children who have special needs, I recommend the “Imperfect community” at: www.ShutUpAbout.com

Posted by on April 3, 2013 • Filed under: Command & Leadership, Emergency Medical Services, EMS, EMS ethics, EMS Health & Safety, EMS Topics, Fire Rescue Topics, new perspective, News, Paramedic, paramedic education, Patient Management, Training, Training & Development

EMS Fights the Flu – The 2013 influenza epidemic

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It’s hitting early, it’s hitting hard, and it’s no joke. This year’s flu season is filling up the nation’s emergency departments, urgent care centers, hospitals, and ambulance run sheets fast. In the US a majority of states are under “widespread” or “intense” flu conditions. No state is currently reporting low levels of flu activity and all states are affected.  According to both Google flu trends and the Centers for Disease Control and Prevention (CDC), the US is right in the throes of an intense and widespread flu season that is sickening many people all over our country. The US flu season generally occurs in winter when people tend to congregate indoors, and this year’s locally cold winter is helping the flu spread quickly.

The “flu” is an abbreviation for the disease “Influenza” which is caused by the various incarnations of the influenza virus. The disease has become such a part of our culture that people call almost any minor illness a touch of the “flu.” People say things like “I have the stomach flu” when they have a case of gastroenteritis, or say that they have the flu when they’re feeling a tad under the weather. This causes a lot of misconceptions about what influenza actually is and can cause us to let our guard down about treating the disease and protecting ourselves from it. Make no mistake that the actual flu is a serious illness that can make even an otherwise healthy person incredibly ill. While the symptoms of the disease themselves can seem relatively minor, the intensity of those symptoms and the complications they can lead to are quite serious and can even be fatal.

Influenza is a viral infection that causes symptoms similar to the common cold. However, the symptoms are markedly more severe with the flu than with a cold. The flu brings intense fever, exhaustion, and severe body aches. Influenza is a respiratory illness though it sometimes brings gastrointestinal symptoms like, nausea, vomiting, and diarrhea. The flu can lead to complications such as dehydration, secondary infections, pneumonia, electrolyte imbalances, cardiac symptoms and exacerbations of asthma and COPD. While most influenza-related fatalities are in vulnerable populations such as the very young, older adults, and in those with compromised immune systems, this is not always the case. In the Spanish Flu pandemic of 1918, the Russian Flu pandemic of 1978, and the possible 2009 H1N1 pandemic, most of the fatalities were in the young adult age range.

While modern medical practices do tend to lessen the impact of a flu pandemic in contemporary times, they are still very worrisome as even seasonal influenza epidemics can overwhelm existing medical facilities and cause an estimated 3,000 to 43,000 deaths in this country each year. The CDC cannot accurately count morbidity and mortality from confirmed influenza infections as medical facilities are only required to report deaths from Influenza or “influenza-like-illnesses” (ILIs) in children, however their estimates over the last decade show an average of 30,000 deaths in the US per year. In comparison, in 2009 the CDC estimates that 17,774 people died from HIV/AIDS.

Influenza has caused pandemics, or global infections, throughout human history. While most countries experience epidemics of influenza at regular intervals, the influenza virus occasionally mutates into a particularly virulent strain and spreads quickly throughout the globe. In the 1918 Spanish Flu pandemic it is estimated that between 1% and 3% of the total global population died with an estimated 600,000 deaths in the United States alone. In more remote areas of the country the mortality count was higher with some villages in Alaska being completely decimated. The “Hong Kong Flu” pandemic in 1968-1969 is said to have killed over one million people worldwide with over 33,000 fatalities in the US. The last official pandemic influenza was in 1978-1979, the “Russian Flu” affected mostly the younger population. In the 21st century, the World Health Organization is attempting to ascertain if the 2009 worldwide outbreak of “H1N1” influenza classifies as a pandemic, with epidemiologists still conducting research. Recently, the CDC has estimated that the 2009 virus killed between 171,000 and 574,000 people worldwide.

Clean your equipment! Don't let your truck be a vector for the spread of disease

The flu is no joke and EMS providers need to practice prevention and infection control. First off, get your flu shot. Ignore the myths about the vaccine and just get it. Immunized healthcare workers are less likely to get sick themselves, are less likely to spread the flu amongst their patients, and are less likely to bring the virus home to their families. EMS providers need to thoroughly clean and sanitize their ambulances and patient care equipment. Hand washing is extremely important, as is the use of proper PPE. All patients exhibiting symptoms of an influenza-like-illness such as a cough, fever, and/or gastrointestinal symptoms should be asked to wear a mask. EMS providers should wear a surgical mask when treating these patients as well. Influenza is spread through droplets that are aerosolized when coughed or sneezed up by an infected person. These droplets settle onto surfaces via gravity and are spread via personal contact or through contact with the droplets while they are airborne. The CDC estimates that the influenza virus can remain viable on external surfaces anywhere from between 2 to 8 hours exposed to the environment. This is more than enough time to cross contaminate your next patient or your coworkers on the next shift. The virus can be killed on surfaces with commonly available disinfectants and regular cleaning and it can be killed on your hands with soap and water or alcohol-based hand sanitizers; However, once a person is infected, the virus cannot be killed with any medical treatment. It can only be slowed down or allowed to run its course.

Protect yourself, protect your patients, and protect your community. Be serious about preventing the spread of the flu. EMS providers are the first line of defense against this insidious disease. Remember that if you are sick, stay home. A person remains infectious for around 7 days after symptoms first appear. Stay home from work until you are at least 24 hours free from fever. Flu prevention is truly an area where EMS is at the intersection of Medicine and Public Health. As with many things, an ounce of prevention can go a long way in the fight against flu.

 

 

 

A comparison of Symptoms between the Common Cold and the Flu

 

Common Cold

Flu

Symptoms

Cold symptoms appear gradually and include sneezing, cough, stuffy nose and sore throat. Fevers are very rare and fatigue is mild. Headaches sometimes occur.

Flu symptoms appear quickly (within 3-6 hrs) and include fever, chills, severe aches and chest discomfort.

Severity:

Usually does not cause severe health problems.

Serious health problems, such as pneumonia, bacterial infections, or hospitalizations can occur.

Fever:

Rare

Usually present

Fatigue:

Mild

Moderate to severe

Chills:

Rare

Common

Sneezing:

Common

Rare

Chest pain:

Mild to moderate

Often severe

Coughing:

Hacking, productive cough

Dry, unproductive cough

Headache:

Rare

Common

Stuffy nose:

Common

Rare

Aches:

Slight, but only headaches

Usual and often severe, affects the entire body.

Sore throat:

Common

Rare

Treatment:

There is no cure for the common cold. Cough syrup and other cold medications are available to ease some of the symptoms and make the patient feel a little better. Tea and nasal drops also sometimes help.

Sometimes antiviral medication helps control the flu but often patients simply wait for their body to fight the virus and overcome the disease. Medication is also available to ease patient comfort.

Duration of illness:

Symptoms typically peak two to three days after infection onset, and usually resolve in seven to ten days.

In children, the cough lasts for more than ten days in 35–40% of the cases and continues for more than 25 days in 10%. Adults usually feel better in seven days.

Seasonal?

Not seasonal (occurs throughout the year)

Seasonal (in winter). In the U.S., flu season is generally October to May and peaks in February.

Vaccine?

No

Yes

Causative Organism:

adenoviruses, coronaviruses, rhinoviruses (most common cause), respiratory syncytial virus, parainfluenza virus, influenza virus

Influenza virus

 

Posted by on January 8, 2013 • Filed under: Emergency Medical Services, EMS, EMS Health & Safety, EMS Topics, Fire Rescue Topics, infection control, News, Patient Management, sanitize, swine flu, Training, Uncategorized

Prehospital Pain Control

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“We must all die. But that I can save a person from days of torture, that is what I feel is my great and ever-new privilege. Pain is a more terrible lord of mankind than even death itself.’’   - Albert Schweitzer

It has been observed that pain is part of the presenting symptoms of up to 70% of all EMS patients. One study has even suggested that over 20% of EMS patients are experiencing severe to extreme levels of pain. As EMS providers, it is our duty to routinely recognize and aggressively treat our patients’ pain as it is one of the biggest things we fight against in our professional practice.

In the not-too-distant past, pain was not aggressively treated by EMS. This was partially due to lack of training on the part of responders but was also due to a lack of availability of proper measures for pain control. Since then, more medications have been made available for field use and more medical directors have become open to the prospect of allowing providers to aggressively treat pain. Quite a few respected national organizations have weighed in on the subject and it continues to gather a lot of attention. Prehospital pain control is a complex issue with many factors to consider on all levels of the EMS spectrum. Field providers need the tools to effectively manage their patient’s pain as well as the education to recognize and treat it; medical directors need to provide these tools and education to their field providers in a way that allows them to trust their use of them; and our overall attitudes towards pain control need to be changed. Large national studies have shown that rates of pain control measures taken in differing patient populations decrease on some disappointing criteria, including gender and patient income level. While numbers specifically reflecting our area are hard to come by, it can be assumed that our area may loosely follow the wider trends.

The old adage “Pain never killed anybody” used to be thrown around by some people in healthcare. To them it means that any pain patients may suffer in the name of their more expedient care is reasonable.  I disagree. Patients may not die due to severe pain but it has lasting effects upon a person’s long-term physical and psychological health. Pain is what our bodies use to teach us lessons on how to avoid noxious stimuli and dangerous injuries. By its very nature, pain makes a lasting impression on us. We need to accept that our patients have more pain than we may realize or expect that they do and provide aggressive and adequate relief for them. While assessing pain is difficult, accepting that people tend to have individualized perceptions of and reactions to pain is important for prehospital providers. It is not acceptable for a healthcare provider to judge a patient’s pain based upon their own personal opinion of how they themselves would tolerate it.

In our contemporary EMS toolbox we have a number of methods for achieving analgesia, which is the control of pain without causing a loss of consciousness. Analgesia can be achieved by many methods available in the field. While paramedics have medications such as Fentanyl, Dilaudid, Morphine, Ketamine, and Versed available to administer to patients, all levels of EMS providers have effective pain management tools. Proper splinting and patient packaging techniques, ice and/or heat packs, padding and elevating extremities, and even techniques such as guided imagery, breathing exercises, and psychological support have been shown to achieve pain control. It is always a good idea to use a range of techniques when managing a patient in severe pain in order to achieve good control and not just to rely on one technique or medication. For example, no narcotic in any amount will completely control the pain of a badly fractured and angulated extremity if the extremity is allowed to move freely or is improperly splinted. The combination of the splint and the medication must be used in tandem. Paramedics must consider the use of medications together for severe pain, such as by combining a narcotic with a sedative such as a benzodiazepine or Ketamine. While benzodiazepines (Versed, Valium, Ativan, etc) and/or Ketamine do not provide analgesia in of themselves, they work in conjunction with pain medications to potentiate the effect and maximize pain control. Ketamine can also be used to achieve “dissociative analgesia” in higher doses, where the patient’s level of consciousness is decreased to the point where they are no longer conscious of the pain they are experiencing.

Selecting the proper technique or medication for each patient is not always an easy task as no method is a one-size solution. However, it is obvious that fractures should be splinted and supported as appropriate and that patients should be packaged in a position of comfort. For patients requiring spinal immobilization, padding voids on the backboard is appropriate as is the use of a Back-Raft or other approved backboard padding device. Offer ice or heat packs to patients with musculoskeletal injuries and be sure to keep patients warm during care. Talk to them about their pain and provide psychological first-aid as you are able. BLS and ILS providers may consider calling for an ALS intercept for pain control medications in some cases as appropriate.

For ALS providers, choosing the right medication is not always an easy choice. Having knowledge of the characteristics of each medication you carry makes it easier to utilize clinical judgment. Fentanyl is a popular choice for prehospital pain control as it is fast-acting and has a shorter time of duration than other pain medications. Fentanyl also has less risk of hemodynamic instability when compared to other narcotics. Dilaudid, another option in our toolbox is a longer-lasting pain med that is good for patients with chronic breakthrough pain, or for patients with obviously fractured extremities. There is little risk in the prehospital setting of developing dependence in your patients with episodic use of narcotic analgesia for acute pain control.

Perhaps the biggest part of the job of every healthcare provider is alleviate the suffering of the sick and injured and a lot of that is reducing physical pain. Be proactive and aggressive in managing pain for your patient and become comfortable taking with your patients about their pain. We may not be able to eliminate all pain in the prehospital setting, but we can make a big difference in making this world a less painful place.

Posted by on October 3, 2012 • Filed under: Ambulance, Emergency Medical Services, EMS, EMS Topics, EMS training, Paramedic, paramedic education, patient care, Patient Management, Training, Training & Development

Dirty Wet Wipes, Millions of Dollars, and the Coming Changes to EMS

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It was quickly turning out to be one of those mornings. The ER was hopping and everyone was busy. We had been taking in a lot of ambulances since the start of the day shift and everyone was trying to muddle through the increasing patient load. While I was in-between tasks, I noticed that one of the nurses had left a backboard in the hallway outside of a patient room. I figured that I had a few spare moments and took it out to the ambulance garage to clean it and throw it in the cabinet. A mundane task wrapped up into a hectic day.

I have to tell you that I wrote and rewrote that first paragraph four times because I couldn’t seem to write it in a way where it sounds interesting. Cleaning a backboard in an ER isn’t all that exciting, right? Why would I write about something like that?

Because after I wiped the board down with the disinfectant towelettes, I was absolutely horrified with what I found.

The handful of disinfectant wipes I used to wipe the thing off with came out filthy. They were mostly black but were speckled with orange-ish brown spots that come from wiping up drops of blood. The board looked a tad dirty when I started and even smelled faintly of pee but I never expected it to be as dirty as it was. It was absolutely disgusting. What makes it all the worse is that there was no way the blood, dirt, and pee came from the patient who was most recently put on the board. That patient wasn’t bleeding, hadn’t peed, and was well dressed from a clean environment. The patient had been placed on this festering petri-dish of a medical tool by the (hopefully) well-meaning ambulance crew who had responded to the call for help. They had put her on this thing and happily whisked her off to the ER for treatment.

So why, you ask, is this important enough for me to write about. Why would I write about one single backboard carrying one single patient brought in by a small ambulance service to a small hospital? Why is that worthy of wider attention?

I’ll tell you why:  This one incident epitomizes a coming tsunami of liability, headaches, and hardship for EMS providers around the US that is going to completely blind-side EMS. A few years back the Centers for Medicare and Medicaid (CMS) quietly stopped paying for things considered to be “preventable medical errors” including hospital acquired infections. They believed that they could save substantial amounts of money by not paying for injuries and illness caused by the hospitals that were treating the patients they were financially responsible for. You might have guessed that Healthcare Acquired Infections (HAIs) happen to be the largest group of these preventable medical errors and hospitals have gone in to full battle mode to combat them.

It is estimated that one in twenty patients will contract a HAI during their hospital stay. It is also estimated that around 98,000 patients die each year from them. HAIs are the most common complication in hospital care of patients costing the US healthcare system around $45 Billion annually.

Hospitals have to take care of patients who contract HAIs in their facility; they’re just not paid to do it. There are estimates out there that say it costs an individual hospital between $10,000 and $25,000 (or more) for every instance of an individual patient contracting a HAI while in their facility. That’s not small change and hospitals are spending money like crazy to fight germs. Infection control departments are being fully staffed and well-funded, housekeeping and environmental services workers are sitting through hours upon hours of training, policies and procedures for cleaning and disposing of potentially contaminated items are being written and enforced by the truckload and they’re just getting started.

And we in EMS are largely oblivious to this fact.

Think of this. If this patient would have been admitted and found to have a HAI, who would have been at fault? Think hard, because tens of thousands of dollars are on the line per each individual patient. Is it the hospital, which has an army of environmental services staff, a battalion of infection control nurses roaming the hallways, and a forest of policies and procedures in place regarding meticulous cleaning practices? Or the EMS agency that brought in a patient on the backboard that was as clean as those wet wipes showed us it was?

To my knowledge, no hospital in the United States has ever sued an ambulance service or otherwise attempted to collect from one due to non-payment related to a HAI. But it’s coming. It’s coming sooner than you think it will come and if you’re not ready it will blind-side you and potentially bankrupt your service. If you think that I’m mistaken, fine… however when Millions of dollars are on the table locally and Billions are on the table nationally… I don’t think that I am.

Clean your stuff. Wash your hands. Write policies regarding cleaning and infection control, enforce them, and document their continuous use. It’s not a small issue. This is one of those things where EMS must act now or someone will act for us.

Oh, and on that note, have you heard about Medicare’s new concept of paying for patient outcomes? This is where hospitals that have better results for their patient care will get more money than hospitals that have poorer results for their patient care? That’s coming too. What do you think it will do to ambulance services when the hospitals start to identify services that consistently bring in patients who do poorly as opposed to services who consistently bring in patients who do better? Right now, nobody knows… but that issue is coming too. Believe me, the hospitals are tracking it. It’s time to get to work.

Here’s some light reading for you as well as my references.

http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf – CDC analysis paper on cost of HAIs and benefits of prevention.

http://www.huffingtonpost.com/glenn-d-braunstein-md/hospital-acquired-infections_b_1422371.html – Good article with statistics from about hand-hygiene

http://www.medicalnewstoday.com/articles/80074.php – Medicare to stop paying for HAIs

http://www.hfma.org/Templates/InteriorMaster.aspx?id=22142 – Article about pay-for-performance and pay for patient outcomes

Posted by on September 27, 2012 • Filed under: Administration & Leadership, ckemtp rants, Command & Leadership, disinfection, Emergency Medical Services, EMS Health & Safety, EMS Topics, Fire Rescue Topics, Funding & Staffing, infection control, Patient Management, Training, Training & Development

Tracking Traction – When Traction Splints Should Pull Their Weight

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“What’s that mailbox say?” You ask your partner, “14338 Hansen Road? Good, we’re here. Your partner calls “on scene” to dispatch as you pull into the gravel driveway of the farmhouse you’re responding to. It’s set some distance from the road, but as you pull up you’re met by two teenagers who are waving you towards the gate to a field. You stop and ask them where they’re directing you.

“He’s out in the field!” They both exclaim at once. You ask the older of the two what’s going on. “Our dad was trying out our new dirt bike and he fell! He’s about a quarter of a mile out in the pasture! He’s hurt real bad! We think his leg’s broke! He’s yelling a lot. You’ve got to go help him!”

Judging by the amount of rain your area has had in the last few weeks, the dirt lane out into the pasture doesn’t look all that friendly for your ambulance to travel down. Luckily, the guys from the station are following you in Utility 984 which is a 4-wheel-drive pickup truck. They arrive shortly after you get out of the ambulance and pull out the gear you need. You take a backboard, the c-collar bag, your trauma kit, the drug box, and on a whim you dust off the traction splint and take it with you. As the utility unit pulls up, you throw all of your gear in the back and ask them to give you a lift down to the patient.

After about a 3 minute ride you find the patient, an adult male in his late 40s. He’s lying in a kind of fetal position on his left side holding onto his right thigh very tightly with both hands. He’s pale, cool, and diaphoretic and even though he’s trying to be brave for his sons, you can tell that he is in extreme amounts of pain. You introduce yourself to the patient and ask him what happened while your partner attempts to protect his c-spine. He seems to be conscious and alert but has trouble getting the words out. Through the story told by him and his sons, you find that he was turning sharply on the new dirt bike and had stuck out his leg to help him keep his balance. Apparently he must have caught something with his foot because he felt a terrible pain in his thigh and flew off of the bike at a fairly high rate of speed. On assessment, you find a few superficial abrasions to the patient’s arms and one on his forehead, but no other injury other than to his obviously deformed leg. You ease the patient to a supine position and can see that the leg is shortened and rotated. Then you expose the patient and see that his right thigh is swollen to about twice the size of the left one. He has no pain to palpation to his head, neck, back, chest, abdomen, pelvis, arms, left leg, or right ankle… but that deformed, shortened, rotated, and swollen left thigh suggests a mid-shaft femur fracture, and a painful looking one at that.

Since you’re working a paramedic truck, you have your partner pop in a large bore IV line while you get out the drug box. The patient’s going to need a line anyway as people can lose a huge amount of their total blood volume into their thigh without spilling a drop externally and he could probably use some pain control before you move him. You choose to give him 50mcg of Fentanyl and have the rest drawn up to give him after you see his tolerance to the medication. While you’re doing this, you‘re thinking about how lucky you are that you remembered to grab the traction splint. You’re also desperately hoping that you remember how to put it on. It’s been… a while since you put one on a patient last and you think you were sick that last skills review day where you were supposed to practice it. Your partner wasn’t however and you put the patient on the traction splint together. Once you pull the traction, you see the relief spread over your patient’s face as the bone is pulled back into alignment and his muscles stop spasming. His pain drops markedly and his blood pressure is actually up a bit since you last took it. You give him a repeat dose of Fentanyl to prepare him for the bumpy ride back in the pickup truck and package him the rest of the way on the long-board for spinal precautions.

The femur is one of the strongest bones in the body and is said to be able to withstand forces of up to 15-30 times a person’s body weight before breaking. It does this because it is surrounded and supported by the powerful muscles within the thigh that contract around it to provide reinforcement. Femurs are connected proximally to the pelvis through the femoral neck or acetabulum, and are connected distally at the knee joint. When the femur is fractured, the muscles of the thigh spasm and contract, pulling the jagged ends of the newly fractured femur past each other, shortening the leg and causing great pain and damage to the internal tissue as the bones lacerate and damage the structures around it. The damage from an improperly splinted femur fracture can be worse than the injury from the trauma taken to break the bone in the initial injury. In fact, due to its proximity to the femoral artery and vein, a patient can completely exsanguinate from an isolated femur fracture. It is of vital importance to stabilize and realign a femur fracture as soon as possible after an injury in order to prevent further damage and potential other complications.

Traction splints are required by law to be carried in most ambulances in the United States. They come in three popular varieties, the Kendrick Traction Device, The Hare Traction Splint, and the Sager Splint. All of them are designed to perform the same function for a wide cross section of patients however their design and application vary greatly. They serve to pull distal force along the leg to lengthen it back to its normal length. The traction applied by the splint pulls the femur back into normal alignment and the splint then serves to immobilize the leg. The traction and immobilization stop the muscle spasms and realign the bone, preventing further injury and greatly reducing pain. It is amazing the first time a provider sees a traction splint being properly applied to a femur fracture and realizes the amount of immediate pain relief the splint provides. While EMS providers don’t tend to use traction splints very often, once they do they consider them to be extremely valuable pieces of equipment.

A traction splint is indicated for a mid-shaft femur fracture with no pelvic involvement and no injury distal to the femur on the involved leg. Mid-shaft femur fractures present with a history of an injury from a specific force, such as the story above or from a front-end vehicle accident, but can also occur from incidents of lower energy transfer. Femur fractures will be present with shortened, rotated extremities with swollen, painful thighs in the affected leg. Be sure to check distal pulses before and after application of the splint.

Get to know your traction splint and pull it out to play with it every so often. When you need it, you’ll *really* need it and it’s good to know how to use it. Your patients will thank you.

Posted by on September 25, 2012 • Filed under: Emergency Medical Services, EMS, ems education, EMS Topics, EMS training, Paramedic, paramedic education, Patient Management, scenario, scenario based training, Training, Training & Development

FIrefighter Pre-Hydration – Fight Fire like a Marathon Runner

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Has anybody else noticed that it’s sweltering outside? There’s no other way to describe the oppressive heat we’ve been facing without trotting out the word “sweltering.” The word itself is almost fun to say. I recommend that you work it into as many conversations as you are able these days while you toil outside in the intense heat. It won’t keep you any cooler, but at least you’ll be adding to the vocabularies of the other sweaty people working around you. It sure beats asking them if it’s “Hot Enough” for ‘em. That gets annoying.

In the last few weeks here in Southern Wisconsin we’ve been having some terrible fires requiring response from multiple area departments. Some of them have been heat related and some of them have just come at a bad time, but all of them have had one common denominator. They’ve all been dangerously hot. Not just the fires themselves, but the oppressive, dangerous, and potentially deadly heat on the fire ground due to the weather conditions has contributed to multiple firefighter injuries. Thankfully, most of the injuries have been minor and heat-related but some of them have been worse. I don’t know if the heat contributed to all of the injuries suffered by those brave firefighters, but it certainly couldn’t have helped.

In times like these, all firefighters need to remember the fact that active firefighting activities are nearly the same as competitive sporting events. Firefighters working on active fire grounds have the same or higher demands put upon their bodies as do athletes on the playing field. It is of extreme importance to remember that fact and take appropriate action to keep yourself and your brothers and sisters safe. Extreme weather is a great equalizer. It affects all of us no matter our station in life. Everyone on the scene has the responsibility to recognize the risk they’re taking by exerting themselves outside in these conditions and take appropriate steps to protect themselves. Nobody wants to see their fellow firefighters fall ill and even less than nobody wants to be the firefighter who goes down themselves.

By design, firefighting personal protective equipment provides an effective barrier to thermal energy. This becomes a problem in hot weather because it doesn’t allow for the shedding of excess body heat and raises the core temperature of the wearer quite sharply. While after years of promoting rehab, even the staunchest believer in their own invincibility can usually be coerced or threatened enough to go to rehab after heavy work on the fire ground, rehab is of even more importance during hot weather because it allows the firefighter to shed his or her PPE and allow that body heat to escape. However, it is important to remember in times of extreme hot weather like we’re facing now that rehab after working is not enough to keep you safe from heat-related injuries and illness. It’s simply too hot for normal people to work effectively without prior planning and preparation. Athletes spend days preparing themselves before competing in physical events by resting adequately, storing up calories and carbohydrates, and pre-hydrating. We should as well.

While it is important to keep yourself nourished with healthy food, I don’t recommend that firefighters load up on calories and carbohydrates before every shift like runners before a race. I do recommend pre-hydration. To pre-hydrate is to drink water before you need it and it is important to realize that one should drink water before they are thirsty to maintain normal hydration. While the adequate daily intake of water for healthy adults varies due to temperature conditions, levels of activity, and other factors, the Institute of Medicine (IOM) recommends that adult males take in 3 liters of water per day and adult females take in 2.2 liters. The water doesn’t need to come only from drinking water, and can come from water stored in food we eat. The IOM says that if a human is producing around 1.5 liters of pale yellow to clear urine per day and is urinating at least once every 3-4 hours they are at close to normal hydration levels. However, many factors affect our hydration and it is easy for a person to become dehydrated without realizing it. Dehydration leads to fatigue, headaches, tachycardia, low blood pressure, and other nastier symptoms that greatly affect firefighting performance and safety. It has been stated that it is not uncommon for firefighters to lose two liters of water through sweat while working on the fire ground in full PPE. If you start to sweat that much when you are already dehydrated, you will not be effective for very long.

Pre-hydration is all about keeping your water tank full before you respond and is as simple as drinking water throughout the day and maintaining your hydration levels. Since fighting a fire in full gear can be compared to running a marathon, we may want to emulate their guidelines. Marathon runners are taught to drink 20 to 32 ounces of water 2 to 3 hours before running and then to drink 8 to 10 ounces of water every 20-30 minutes before they run. While actually running, they are advised to drink 8-10 ounces of water every 20-30 minutes as well. It is not advisable to intake a large amount of water before engaging in strenuous activity because it takes time for the water to move from the stomach to the large intestine and be absorbed into the blood stream. Too much water in the stomach at once can lead to nausea and vomiting during periods of strenuous activity. Sports drinks with electrolytes like Gatorade, Power-ade, and others like them should be consumed occasionally to replace any electrolytes lost through sweating however there is no need to pre-load yourself with them as the body does not store more electrolytes than it needs and excretes any excess quite rapidly. Replacing lost electrolytes through food is of great value, and most can be replenished by eating fruit like a banana. In addition, avoid soda pop, carbonated beverages, or beverages that contain high amounts of caffeine and/or sugar as these drinks can actually contribute to dehydration by acting as diuretics.

It is easy to encourage pre-hydration among your crews. People need to drink water before they feel thirsty, and should continuously drink small amounts of water through the day. Place water in conspicuous areas throughout the station and the living quarters. Water that is out of sight is out of mind and can be forgotten. By placing water right in the line of sight of everyone, they are reminded of the need to have a glass or two. You can make the drink more attractive by adding commercial flavorings like lemonade, crystal light, or Mio mixes that add taste without adding too much sugar. Another trick is to place the bottles of water in the engine next to every staffed seat and encourage every firefighter to drink a bottle during any response to a working incident.

By pre-hydrating, you will ensure that you and your fellow firefighters hit the fire ground with full water tanks and can perform at peak levels in this oppressive heat. Keep yourself hydrated and stay safe out there. We’ve sickened and injured too many firefighters lately and I don’t want it to keep up. Turn the tide and drink up. You’re worth it.

Posted by on July 9, 2012 • Filed under: Administration & Leadership, Command & Leadership, EMS Health & Safety, fire, Fire Rescue Topics, Firefighter Safety & Health, Firefighting Operations, Training, Training & Development, training-fire-rescue-topics

Pericarditis for EMS – A Short and Sweet Case Review

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“Man it’s hot!” you think to yourself while cleaning the back of your rig in the hospital ambulance bay. Those glass garage doors they put on here might make the garage look pretty, but they sure heat the place up in the summer time. You convince yourself that it was nice of them to install a sauna for the EMS crews and let the thought sustain you as you mop the floor of the truck. You and your partner have been running steady since you came on shift this morning, and the noontime sun is really blazing down out there. As the tones come across your radio and the dispatcher calls your unit, you realize that you’re not getting a break anytime soon.

Your partner comes out from the report room as you check the address on the map book. You’ve been called for the 47yo male patient complaining of chest pain. It’s not too far away and you arrive within a few minutes of the call. The patient’s wife lets you in to the house.

“He’s been sick in bed all day, really sick” she tells you as she leads you inside to the back bedroom of the house. “He’s been running a fever and having trouble breathing. I told him I was going to call you when he started telling me that his chest hurt.”

You find the patient sitting on the side of his bed leaning slightly forward and crossing his arms across his chest. His skin is flushed and warm to the touch. He’s breathing slowly and carefully, wincing slightly as he finishes every inhalation. You introduce yourself to the patient and ask him how he’s doing. He answers that his chest is killing him and that it’s been becoming progressively more painful to breathe. He denies feeling short of breath but states that it’s just too painful to get enough air in. He indicates with his hand that the pain is sub-sternal, and that it radiates to the bottom part of his left shoulder blade. He describes the pain as intense, “sharp and raw” and constant. He says that it’s worse when he lies down and when he moves.

Your partner checks the patient’s vital signs while you continue your assessment. You notice what you think may be a little bit of jugular venous distension when you look down at him but it’s hard to see in the light. His lung sounds are clear, His abdomen is soft and non-tender, and His recent history includes a slight fever and chills with progressive upper respiratory illness over the last two days. He adds that he’s been sick since he came home from his dentist’s office after having a cavity filled the other day and he’s wondering if the numbing medicine the dentist gave him had anything to do with it. Your partner tells you that his vital signs are: Pulse 112 and slightly irregular, BP 106/74, respiratory rate 18 with a pulse-ox of 98% on room air. Your partner said that something seemed strange when he listened for the patient’s blood pressure and he had to check it a few times. He says it was almost like the systolic pressure disappeared when the patient took a breath in.

Your partner places him on 4-litres of oxygen via nasal cannula as you strap the patient on the cot. He seems very uncomfortable when you try to lay him down and asks to be sat almost completely upright. You wheel him out of the house and put him in the rig. You decide to place the patient on the monitor, both the 5 lead and to acquire a 12-lead although you’re pretty sure that the patient’s complaint isn’t cardiac in nature. Your partner starts an IV with Normal Saline and you decide to transport the patient to his hospital of choice. You choose to follow the chest pain protocol just to be safe, and administer 4 baby aspirin and one nitro-tab sublingually. Then you look at the 12-lead and are horrified to see all of the changes. The patient has flipped T-waves and ST-segment changes in nearly every lead. This just got serious, and you ask your partner to flip on the lights and sirens as you transmit the 12-lead to the ER.

So what do you think this is?

We all know that not all chest pain is a heart attack and that many conditions that can lead to a patient feeling pain in their chest. This patient describes his pain as increasing with motion and respiration and as feeling “sharp” and “Raw” with radiation to his back under his scapula and states that the pain is relieved by sitting up and leaning forward. As any chest pain can be a symptom of a myocardial infarction or pulmonary embolism, it’s important to look at the total picture and try to rule out immediately life threatening conditions as best as possible. The medic in this fictional case followed protocols and “treated for the worst while hoping for the best” but even he was surprised to see the changes on the 12-lead.

The heart is contained in a tough, fibrous sac called the “Pericardium” which encases and protects the heart inside the chest. This sac positions the heart properly within the chest and keeps it from rubbing directly against any other structures within the thoracic cavity as it moves. Usually, the sac contains a small amount of fluid for lubrication. When the sac becomes inflamed, it is called “pericarditis”. This condition causes pain and other symptoms as described above, which include:

  • Diffuse pleuritic chest pain that tends to lessen with sitting upright and leaning forward but increases with breathing and lying flat. The pain is worsened by movement, but not necessarily by exertion. It does not decrease with administration of nitroglycerine.
  • The patient may present with a fever, or a cough. Usually the patient has the pain for hours or days before presenting for care.
  • The presence of diffuse EKG changes is usually associated with pericarditis, showing non-specific T-wave inversions and ST segment changes in multiple leads as shown on a 12-lead EKG. This is caused by the inflammation of the pericardium and the vasculature of the heart rather than a blockage in the arteries. However, occasionally a coronary artery can spasm and cause classic MI symptoms.

Pericarditis has many causes, including a bacterial or viral infection, an autoimmune response, or inflammation following a heart attack. While there may be a possible link between the condition and dental procedures, research has not yet discovered a direct link. However, some dentists prefer to place their patients on prophylactic antibiotics prior to an invasive procedure to help prevent infective pericarditis and/or endocarditis, which is a rare but serious infection within the inner chambers of the heart.

Field treatment for pericarditis includes judicious use of the system’s chest pain protocols. Place the patient on oxygen and administer aspirin and nitroglycerine as per protocol. Pain may be relieved with opiates but is not generally reduced with nitroglycerine. Acquire and transmit a 12-lead EKG early in the treatment so that the patient can go to an appropriate destination for care.

Posted by on June 25, 2012 • Filed under: Emergency Medical Services, EMS, ems education, ems scenario, ems scenario based education, EMS Topics, EMS training, paramedic education, Patient Management, scenario, scenario based training, Training, Training & Development

Heat Emergencies for EMS – The Summer Time Blues

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It’s just about here! Summer time is awesome in where I live. It almost makes those long winter months seem worth it. Almost. With the warm weather close upon us it’s time to review some of the common complaints that EMS providers seem to see more of in the summer time. Gone are the days of frostbite and hypothermia and here are the days of heat stroke and bee stings. It pays to brush up on these complaints because we’ll be seeing them before we know it.

Heat Emergencies

We humans are a fickle bunch. Get us too cold or too hot and we tend to get sick as the dog days of summer. Since there’s little chance of hypothermia coming in the summer, a review of the hotter side of environmental emergencies couldn’t hurt. In emergency care, heat emergencies are generally classified into three levels in terms of severity. These are:

  • Heat Cramps
  • Heat Exhaustion
  • Heat Stoke

It’s important to remember that these classifications aren’t absolute and are harder to pin down when combined with concurrent medical conditions and other factors such as age, gender, and physical health. It’s also important to realize that some physical conditions, caffeine and alcohol consumption, and prescription medications can diminish a patient’s capacity for thermoregulation and precipitate heat injury.

Heat Cramps – Generally occurring in athletes or those undergoing physical exertion in a hot environment, heat cramps are muscle spasms that mostly occur in the abdomen or extremities. (Core temp 99.1-101.3)

Treatment for Heat Cramps includes general medical care, removing the person from the hot environment, providing oral fluid replacement, and cooling them gently.

Heat Exhaustion – Characterized by Fatigue, weakness, anxiety, intense headaches, profuse sweating, nausea/vomiting, and decreased urine output, heat exhaustion is caused by inadequate fluid intake and excessive fluid loss through sweating. It is essentially hypovolemia caused by hyperthermia and may be the result of several days of inadequate fluid replacement and dehydration. (Core temp 99-104)

Treatment includes much the same as the treatment for heat cramps. Do not give oral fluids to patients with a decreased level of consciousness. If your level allows, start an IV and consider a fluid bolus. Begin active cooling with ice packs to the axilla and groin. Monitor the patient’s vitals closely and watch for cardiac arrhythmias. BLS providers should consider an ALS intercept for fluid replacement.

Heat Stroke – This is a true medical emergency and aggressive treatment is warranted. It is characterized by a decreased level of consciousness, increased pulse and respiratory rates, and hypotension. Skin color, temperature, and moisture findings are not reliable but are generally hot and dry. It is becoming shown that patients that suffer near-fatal cases of heat stroke have a strikingly high 1 year mortality rate. (Core temp >105)

 

Treatment for Heat Stroke includes aggressive cooling with ice packs, evaporative cooling, and IV fluids. BLS providers should request an ALS intercept. Rapid transport is warranted. Manage the airway and other complaints such as arrhythmias as per protocol.

Watch your coworkers too. Make sure that your fellow EMS people are staying cool on incident scenes, especially when they may be wearing turnouts or other protective gear. When you're not actively performing tasks that require protective gear, strip it off to allow yourself to adequately cool. Push them to drink plenty of fluids and go to rehab when they need to. Be safe out there and watch each other’s backs. We need you out there.

Posted by on April 16, 2012 • Filed under: ALS Intercept, Emergency Medical Services, EMS, ems education, EMS Health & Safety, EMS Topics, EMS training, Firefighter Safety & Health, Paramedic, paramedic education, Patient Management, Training, Training & Development

12-lead EKG tips for EMS – Making the most of the squiggly lines

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The 12-lead EKG is one of the most fantastic advances in EMS treatment since the invention of the bandage. The movement of this powerful diagnostic tool from the confines of the hospital to the streets has been nothing short of revolutionary. It has given EMS professionals a wealth of information on how to best care for our patients and has driven hospital care and the development of medical care practices by providing clear and critical data that physicians had rarely before seen.

Did you realize that by moving this tool to the field, EMS has almost made heart attacks into a minor medical complaint that can be effectively treated if caught early? EMS has changed healthcare with that. We’re catching things that used to go uncaught and have vastly improved the lives and qualities of life for countless patients who pass through our care. Kudos to the visionaries that helped drive this change. No matter the level of the service, be it ALS, ILS, or BLS, a 12-lead EKG is an essential EMS tool and should be the standard of care.

Proper acquisition of the 12-lead EKG is paramount to getting the most out of this tool. An improperly acquired 12-lead does not provide diagnostic quality information and can render the tracing mostly useless. Here are a few tips to making sure that you get it done right:

Lead Placement

Traditionally, the limb leads go on the limbs, and while it’s acceptable to move them closer if you have to, try to avoid placing the leads over bony prominences or overly fatty areas. Look for a generally flat, clean, intact area of skin with muscle generally underneath.

The V-Leads go on the chest in a specific pattern. Leads V1 and V2 go in the 4th intercostal spaces (between the ribs) on either side of the sternum. To find these, go about 3 finger widths up from the xyphoid process, or bottom of the sternum. V1 is on the patient’s right, V2 is on the left.

V4 should be placed next, it goes one rib down in the 5th intercostal space, on the mid clavicular line. Place V3 in between V2 and V4.

V5 goes in the anterior axillary line (front of the arm pit) and V6 goes in the mid-axillary line. They go in the same horizontal line as V4.

Skin preparation

It is important to prepare the skin by cleaning it with an alcohol prep and by abrading it with a cloth towel to remove dead skin cells. You may need to wash the area with saline and dry it. Remove excess body hair by shaving. For females, place the leads under the breast tissue. You may need to lift and clean the skin underneath the breast to get a clear tracing.

Baseline

A quality 12-lead EKG has a smooth, flat baseline (called the isoelectric line). Baseline wander, or the vertical motion of the EKG line can mask important findings in the EKG tracing and result in a non-diagnostic EKG. The patient should remain motionless and lay as close to supine as possible for the acquisition of the tracing and the ambulance should be stopped and not moving during the process. It sometimes takes a few minutes for the EKG tracing to normalize and you should wait for it to do so. The goal is to be able to see the entire cardiac waveform clearly and be able to measure accurate ST segment levels. Skin prep is important to reduce artifact. A tracing with artifact or baseline wander can mask serious EKG findings and may cause a patient to be misdiagnosed.

Multiple EKGs

One EKG is a spot-check of the patient’s heart. Two EKGs are a trend of their condition. Try to obtain a symptomatic tracing of the patient before treatments like oxygen, nitroglycerine, or aspirin are given. While you shouldn’t  delay treatment, it has been shown that ST segment elevation can normalize quickly with EMS treatment and an EKG obtained afterwards that does not show ST segment changes can mask a STEMI that should be emergently treated by a cath lab. The 2 or 3 minutes you spend taking the symptomatic EKG can save the patient hours or days going without definitive treatment for their underlying condition.

A good rule of thumb is to capture a 12-lead EKG tracing at the patient’s side where you find them symptomatic, then again when you load them in the truck, and then before you arrive at the ER.

Conditions Requiring an EKG

A 12-lead isn’t just for chest pain.Acquiring one never hurts any patient and may help catch the odd presentation of a serious but vague condition. Obtain a 12-lead for possible strokes, altered levels of consciousness, weakness, dizziness, fatigue, palpitations, and otherwise vague medical complaints. Remember that diabetic patients, younger women, and various ethnicities often have atypical presnetations and may have “Silent MIs.” Be vigilant. You may just save a life.

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Posted by on April 9, 2012 • Filed under: Emergency Medical Services, EMS, ems education, EMS Topics, EMS training, Paramedic, paramedic education, Patient Assessment, patient care, Patient Management, STEMI, Technology & Communications, Training, Training & Development, Uncategorized
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