Saturday, May 25, 2024

EMS Research - Chest Decompressions: The Driver of CPR Efficacy


The study aims was to optimize cardiopulmonary resuscitation (CPR) efficacy by investigating the relationship between key CPR metrics: compression rate, depth, and recoil velocity.

The goal was to model the impact of these variables on CPR effectiveness, particularly through their influence on end-tidal carbon dioxide (ETCO2), which is a marker of perfusion.

The study emphasizes the crucial role of chest recoil in CPR effectiveness. The findings suggest that CPR guidelines should prioritize maximum chest recoil to improve hemodynamics and increase the chances of survival during cardiac arrest.

The research advocates for an increased focus on chest recoil in CPR training and guidelines, potentially leading to improved outcomes in cardiac arrest scenarios by enhancing the quality of perfusion during resuscitation efforts.
Further Reading:
Chandran, K., AlgazeGonzalez, I.M., Wang, S., & Davis, D.P. (2024) Chest Decompressions - the Driver of CPR Efficacy: Exploring The Relationship Between Compression Rate, Depth, Recoil Velocity & End-Tidal CO2. Taylor & Francis Online. https://www.tandfonline.com/doi/full/10.1080/10903127.2024.2364058? Accessed May 25, 2024

Thursday, May 23, 2024

EMS Celebration - History of EMS Week


President Gerald Ford established the first National Emergency Medical Services Week in 1974, and since then it has been celebrated on the third week of May every year. 

The goal of EMS Week was to raise awareness and pay tribute to the crucial work EMS professional do, often times risking their own safety and well-being in the pursuit to provide care to others. 

As it has evolved, we now celebrate it with various events that honor the achievements of EMS professionals, highlight the importance of EMS in healthcare, and advocate for the challenges and issues faced by the EMS community.

For the full article follow the link below: 

https://emsweek.org/2024/03/21/history-of-ems-week/

Further Reading:

Woodyard, D.R. (2023) EMS in the United States: Fragmented Past, Future of Opportunity. Colorado: Donnie Woodyard

Tuesday, May 21, 2024

EMS Week - What is EMS today?


Is it what you see on TV or in movies? EMS started as an improvement to service to transport you to a hospital, with treatment and care along the way.

For the first time we brought care to you – but only in an emergency. It was an enormous step up from a stretcher in a hearse supplied by a funeral home (because they had the vehicles).

From the extremes of defibrillating a cardiac patient in a marathon to assisting a senior citizen with her or his prescriptions for cancer treatment or congestive heart failure: is EMS an emergency service, a health care service or a preventive medical service?

The answer to that depends on who you ask, as EMS still has several delivery models and philosophical approaches.

Are we a community service in the continuum of healthcare or just the angels of 3:00 AM? We are balancing the original-and-since-improved, yet cobbled-together, EMS system as an essential service with the changing needs of healthcare for our citizenry.

Further Reading:

Woodyard, D. R. (2023) EMS in the United States: Fragmented Past, Future of Opportunity. Colorado: Donnie Woodyard

Sunday, May 19, 2024

EMS Celebration - EMS Week 50th Anniversary


“EMS Week celebrates all EMS providers who diligently care for their patients and communities in times of crisis,” states NAEMT President Susan Bailey, MSEM, NRP.

'Honoring Our Past, Forging Our Future’ reflects on the proud history and contributions of EMS practitioners. We must remain focused on evolving, innovating, and ensuring EMS has the necessary support to respond to the public's call for help effectively.

This year, marking the 50th anniversary of National EMS Week, we pay tribute to those who paved the way, challenging norms and setting higher standards.

Simultaneously, we anticipate the future, leveraging their work to shape a path for the next generation of EMS professionals dedicated to community service.

Activities:
Sunday, May 19: Health, Wellness & Resilience Day

Monday, May 20: EMS Education Day

Tuesday, May 21: EMS Safety Day

Wednesday, May 22: EMS for Children Day

Thursday, May 23: Save-A-Life Day (CPR & National Stop the Bleed Day)

Friday, May 24: EMS Recognition Day

Saturday, May 25: EMS Remembrance Day

Further Reading:

Woodyard, D.R. (2023) EMS in the United States: Fragmented Past, Future of Opportunity. Colorado: Donnie Woodyard

Friday, May 17, 2024

EMS Emergencies - Pediatric Patients


EMS providers need to be well-prepared to handle pediatric emergencies as they require specialized knowledge and skills due to the unique needs of children.

Here are some key points they should know:

  1. Respiratory Distress: Children commonly present with respiratory distress due to conditions such as asthma, bronchiolitis, or croup. EMS providers should be proficient in assessing respiratory status, administering oxygen, and managing airway obstructions.

  2. Febrile Seizures: Febrile seizures are common in young children and are often frightening for caregivers. EMS providers should know how to assess and manage febrile seizures, including ensuring adequate ventilation and preventing injury during the seizure.

  3. Trauma: Children are at risk for various types of trauma, including falls, burns, and motor vehicle accidents. EMS providers should be skilled in assessing and managing pediatric trauma, including immobilization techniques and pain management.

  4. Sepsis: Sepsis can be challenging to recognize in children, as symptoms may be nonspecific. EMS providers should be vigilant for signs of sepsis, such as fever, tachycardia, and altered mental status, and be prepared to initiate early treatment.

  5. Anaphylaxis: Allergic reactions, including anaphylaxis, can occur in children due to food allergies, insect stings, or medications. EMS providers should be trained in recognizing anaphylaxis and administering epinephrine as needed.

  6. Dehydration: Children are at increased risk for dehydration due to factors such as vomiting, diarrhea, or fever. EMS providers should be skilled in assessing hydration status and administering fluids as needed, especially in cases of severe dehydration.

  7. Seizures: Seizures can occur in children due to various causes, including epilepsy or febrile illnesses. EMS providers should know how to assess and manage seizures, including protecting the child from injury and administering appropriate medications if necessary.

  8. Poisoning: Accidental poisoning is a common pediatric emergency. EMS providers should be familiar with common toxins and their effects on children, as well as appropriate decontamination and treatment measures.

  9. Cardiac Arrest: While less common in children than in adults, cardiac arrest can still occur due to various causes, including congenital heart defects or respiratory failure. EMS providers should be proficient in pediatric CPR and advanced life support techniques.

  10. Communication & Family Support: Effective communication with caregivers is essential in pediatric emergencies. EMS providers should be skilled in providing clear and compassionate communication, as well as offering support to families during stressful situations.

By being knowledgeable about these common pediatric emergencies and having the necessary skills to assess and manage them effectively, EMS providers can play a crucial role in providing optimal care for children in emergency situations.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

Wednesday, May 15, 2024

EMS Emergencies - Geriatric Patients


EMS providers should be well-versed in managing common geriatric emergencies, as elderly patients often present with unique challenges due to age-related physiological changes and comorbidities. Here are some key points EMS providers should know:

  1. Recognition of Geriatric Syndromes: Understand common geriatric syndromes such as delirium, falls, urinary incontinence, and frailty. These may not present as typical medical emergencies but can significantly impact the overall health and well-being of older adults.

  2. Comprehensive Assessment: Perform a thorough assessment, considering the potential for atypical presentations of illness. Geriatric patients may not exhibit classic signs and symptoms of illness, so a high index of suspicion is crucial.

  3. Polypharmacy: Recognize the impact of polypharmacy on geriatric patients. Elderly individuals often take multiple medications, increasing the risk of drug interactions, adverse effects, and medication non-compliance.

  4. Dementia & Cognitive Impairment: Be prepared to manage patients with dementia or cognitive impairment. Communicate effectively, use clear and simple language, and involve family members or caregivers in the assessment and decision-making process.

  5. Mobility & Functional Status: Consider the patient's mobility and functional status when assessing and managing emergencies. Reduced mobility and functional limitations can affect the patient's ability to participate in care and may require adaptations in treatment approaches.

  6. Fall Prevention: Assess for fall risk factors and implement appropriate fall prevention strategies. Falls are a leading cause of morbidity and mortality in older adults and can result in serious injuries such as fractures, head trauma, and soft tissue injuries.

  7. Cardiovascular Emergencies: Be vigilant for cardiovascular emergencies such as myocardial infarction, heart failure, and arrhythmias, which are common in the elderly population. Older adults may present with atypical symptoms, so consider a broad differential diagnosis.

  8. Respiratory Emergencies: Recognize respiratory emergencies such as pneumonia, exacerbations of chronic obstructive pulmonary disease (COPD), and pulmonary embolism. Aging-related changes in the respiratory system can predispose older adults to respiratory infections and other pulmonary conditions.

  9. Sepsis: Be aware of the increased susceptibility of geriatric patients to infections and sepsis. Early recognition and prompt initiation of treatment are crucial to improve outcomes in this population.

  10. End-of-Life Care: Provide compassionate end-of-life care when appropriate. Understand the patient's wishes regarding resuscitation and advanced directives, and involve palliative care services as needed to ensure optimal symptom management and support for both the patient and their family.

By incorporating these considerations into their practice, EMS providers can effectively assess, manage, and optimize outcomes for geriatric patients experiencing emergencies.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

Monday, May 13, 2024

EMS Equipment - Mechanical Chest Compression Devices

EMS providers should be familiar with the LUCAS (Lund University Cardiopulmonary Assist System) device and similar mechanical chest compression devices as they can significantly impact the management of patients in cardiac arrest. 

Here are some key points regarding both advantages and disadvantages:

Advantages:

Consistency: Mechanical chest compression devices like LUCAS can provide consistent and uninterrupted compressions, ensuring that the quality and depth of compressions are maintained throughout resuscitation efforts. This consistency is often challenging to achieve with manual compressions, especially during prolonged resuscitation attempts.

Reduced Fatigue: Manual chest compressions can quickly lead to provider fatigue, resulting in decreased effectiveness over time. Mechanical devices alleviate this issue by delivering continuous compressions without fatigue, ensuring that high-quality compressions are maintained for extended periods.

Standardization: Mechanical devices offer standardized compression rates and depths, reducing the variability that can occur with manual compressions performed by different providers. This standardization helps optimize perfusion during cardiac arrest and improves outcomes.

Safety: Mechanical devices reduce the risk of injury to EMS providers during transport and resuscitation efforts, particularly in challenging environments such as moving ambulances or confined spaces where manual compressions may be difficult to perform safely.

Multitasking: By automating chest compressions, EMS providers can focus on other critical aspects of patient care, such as airway management, medication administration, and team coordination, without compromising the quality of compressions.

Disadvantages:

Cost: Mechanical chest compression devices like LUCAS can be expensive to purchase and maintain, potentially limiting their availability in some EMS systems. The initial investment in these devices and ongoing maintenance costs should be considered when evaluating their implementation.

Training Requirements: Proper training is essential for EMS providers to effectively use mechanical chest compression devices. Training should include device operation, troubleshooting, and integration into resuscitation protocols to ensure optimal patient outcomes.

Device Limitations: Mechanical devices may not be suitable for all patients, particularly those with certain anatomical characteristics or injuries. EMS providers must be aware of the device's limitations and know when manual chest compressions may be more appropriate.

Interruptions: Although mechanical devices aim to provide continuous compressions, interruptions may still occur during battery changes, device malfunctions, or transfer between care providers or settings. EMS providers should be prepared to quickly address and minimize these interruptions to maintain effective resuscitation efforts.

Patient Considerations: Some patients may experience discomfort or injury from mechanical chest compressions, such as rib fractures or skin abrasions. EMS providers should assess each patient's condition and adjust device settings or techniques accordingly to minimize potential harm.

Overall, mechanical chest compression devices like LUCAS offer several advantages in the management of patients in cardiac arrest, including consistency, reduced provider fatigue, standardization, safety, and the ability to multitask. 

However, EMS providers must also be aware of the associated disadvantages, such as cost, training requirements, device limitations, interruptions, and patient considerations, to ensure appropriate and effective use in clinical practice.

Further Reading:

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Frascone, R. J. (2014) The Risk Versus Benefit of LUCAS: Is It Worth It? Anesthesiology 120: 797–798

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

Vitali (2022) The Lucas Device Explained  https://www.vitalipartners.com/blog/2022/08/the-lucas-device-explained-chest-compression-system/ Accessed May 12, 2024

Saturday, May 11, 2024

EMS Particular Patient Populations - Spina Bifida


When responding to patients with spina bifida, EMS providers should be aware of the following key points:

  1. Understanding Spina Bifida:

    • Spina bifida is a congenital condition characterized by incomplete closure of the spine during fetal development. It can result in varying degrees of spinal cord and nerve damage, leading to physical and neurological impairments.
    • There are different types of spina bifida, including spina bifida occulta (mild, hidden form), meningocele (meninges protruding through a spinal defect), and myelomeningocele (most severe form, with the spinal cord and nerves protruding through an open spinal defect).
  2. Neurological Impairments:

    • Patients with spina bifida may experience neurological impairments such as paralysis or weakness in the lower limbs, loss of sensation, bladder and bowel dysfunction, and hydrocephalus (build-up of fluid in the brain).
    • Assess the patient's neurological status, including motor function, sensation, and reflexes, and be prepared to manage any associated complications, such as urinary retention or neurogenic shock.
  3. Skin Integrity:

    • Patients with spina bifida, particularly those with myelomeningocele, are at increased risk of skin breakdown and pressure ulcers due to impaired sensation and mobility.
    • Inspect the patient's skin for signs of pressure injuries, and provide appropriate padding and positioning to prevent further skin damage during transport.
  4. Bladder & Bowel Management:

    • Bladder and bowel dysfunction are common complications of spina bifida, requiring ongoing management and monitoring.
    • Be prepared to address urinary retention, urinary tract infections, and fecal incontinence, and provide appropriate interventions, such as catheterization or bowel management techniques.
  5. Orthopedic Considerations:

    • Orthopedic deformities, such as scoliosis (curvature of the spine), clubfoot, or hip dislocation, may occur in patients with spina bifida and may require surgical correction or orthotic devices.
    • Be aware of any orthopedic issues that may affect the patient's mobility and positioning during transport, and provide appropriate support and accommodations as needed.
  6. Hydrocephalus Management:

    • Hydrocephalus is a common complication of spina bifida, resulting from impaired cerebrospinal fluid (CSF) circulation and absorption.
    • Monitor the patient for signs and symptoms of increased intracranial pressure, such as headache, vomiting, or changes in consciousness, and provide timely interventions, such as ventricular shunting or CSF drainage, if necessary.
  7. Psychosocial Support:

    • Living with spina bifida can have a significant impact on the patient's emotional well-being, as well as on their family members and caregivers.
    • Provide emotional support and reassurance to the patient and their caregivers, and connect them with appropriate community resources and support networks as needed.
  8. Collaboration with Healthcare Providers:

    • Communicate with the patient's primary care provider or specialists, such as neurosurgeons, orthopedic surgeons, urologists, or rehabilitation specialists, to obtain relevant medical history and treatment information.
    • Provide a detailed report to the receiving healthcare facility to ensure that the patient's ongoing medical needs are addressed and that appropriate follow-up care is arranged.

By being knowledgeable about the unique challenges and needs of patients with spina bifida, EMS providers can deliver compassionate and effective care that supports optimal outcomes and enhances the patient's overall well-being.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell