EMS Airway Management - 7 Es of Advanced Airway Management Education

The article by Terry Riddle, FP-C, emphasizes a structured approach to training in advanced airway management for medical professionals.

The "7 Es" framework includes the following key components:

1. Education - Focusing on foundational knowledge.
2. Evaluation - Regular assessment of skills.
3. Experience - Gaining practical, hands-on experience.
4. Environment - Understanding the importance of a conducive learning and working environment.
5. Equipment - Familiarity with and access to the right tools.
6. Errors - Learning from mistakes to improve practice.
7. Excellence - Striving for the highest standards in patient care and professional development.

This approach aims to ensure comprehensive, high-quality training that prepares healthcare providers for the complexities of airway management in various clinical settings.

For more information, access the article link here.

EMS Equipment - The Power Paradox

Despite powered advancements in patient movement, the initial ground lift remains a manual task for EMS providers.

The attached JEMS article addresses a critical issue in EMS that despite heavy investments in advanced power stretchers and other power-assisted patient handling devices, the initial task of lifting a patient from the ground remains manual and risky. 

This inconsistency, termed the "power paradox," exposes EMS Providers to significant musculoskeletal injuries, with nearly half of EMS workers experiencing such injuries due to manual patient handling.

While EMS agencies have invested significantly in technologies like power stretchers, power loads, and power stair chairs, they often overlook the necessity of power patient lifts.

The lack of a comprehensive power-assisted patient handling approach leads providers to use makeshift solutions like bedsheets, increasing the risk of injuries to both the patient and the provider. 

Statistics from the National Institute for Occupational Safety and Health (NIOSH) highlight that nearly half of all EMS workers suffer from work-related musculoskeletal injuries, underscoring the need for a complete and integrated approach to patient lifting.

The solution lies in incorporating power patient lifts, which are affordable compared to the costs of potential injuries and liabilities. These lifts can significantly reduce the physical strain on EMS providers and enhance patient safety. 

The article emphasizes that EMS agencies need to prioritize injury prevention by embracing a holistic approach to powered patient handling. 

By doing so, they can protect their personnel, improve patient care, and mitigate liability risks, ensuring the sustainability and effectiveness of EMS operations​.

Journal of Emergency Medical Services 2024 

For more information, access the attached article link.

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

EMS Equipment - Traction Splints

Traction splints are devices used in prehospital settings to provide stabilization and immobilization for certain types of fractures, specifically femur fractures.

Their purpose is to help alleviate pain, reduce bleeding, and prevent further damage to surrounding tissues.

Some common brands of traction splints include the HARE traction splint, Sager traction splint, and Thomas traction splint.

These brands have variations in design and application method, but they all serve a similar purpose.

Recommendations for using traction splints typically include cases where there is a suspected or confirmed mid-shaft femur fracture.

The use of traction splints can help align the fractured bone ends and provide relief by reducing muscle spasm and restoring limb length.

Femur fractures are serious injuries that we often encounter in the field.

Recognizing Femur Fractures: Look for signs like severe pain, swelling, deformity (leg may appear shorter or rotated), inability to move the leg, and sometimes, bruising.

High-Impact Injuries: Remember, the femur is the strongest bone in the body. A fracture usually results from high-impact trauma, like motor vehicle accidents or significant falls.

Check for Complications: Be vigilant for potential complications such as bleeding (femoral artery damage), fat embolism, or shock, especially in high-impact traumas.

Immobilization is Key: Stabilize the leg with a traction splint if indicated. Proper immobilization reduces pain, bleeding, and the risk of further injury.

Monitor Vitals: Keep a close eye on the patient’s vital signs. Femur fractures can cause significant pain and shock, which may lead to changes in pulse, blood pressure, and respiratory rate.

Transportation Considerations: Handle with care during transport. Smooth movements and careful handling can prevent further injury and pain.

Communication with Hospital: Inform the receiving facility about the nature of the injury, your interventions, and the patient's response to treatment.

However, there are certain contraindications and situations where traction splints should not be used.

These include:

Proximal or Distal Femur Fractures: Traction splints are designed for mid-shaft femur fractures and may not be effective or appropriate for fractures closer to the hip or knee joint.

Pediatric Patients: Traction splints are generally not recommended for pediatric patients due to differences in bone anatomy and the risk of causing additional injury.

Inability to Apply Properly: If the EMS provider is unable to properly apply or use the traction splint, it should not be used. In such cases, alternative methods of immobilization will need to be considered.

Therefore, it is important to note that the decision to use a traction splint should be based on the specific circumstances of the patient and the availability of appropriate resources.

EMS providers should consider factors such as the mechanism of injury, the location and type of femur fracture, and the patient's overall condition.

It's always advisable for EMS providers to adhere to local protocols and guidelines, as they may vary depending on the region and specific healthcare system.

These protocols are typically established based on current evidence, best practices, and expert consensus to ensure optimal patient care.

EMS Equipment - Shock Pants

EMS providers should be aware of the following key points regarding Military Anti-Shock Trousers (MAST) and Pneumatic Anti-Shock Garment (PASG):

1. Purpose: MAST and PASG are devices used to manage hemorrhagic shock and hypovolemia. They help stabilize patients by applying external pressure to the lower extremities, which helps redirect blood to vital organs and increase blood pressure.

2. Mechanism of Action: MAST and PASG apply circumferential pressure to the legs and lower abdomen. This pressure compresses the blood vessels, reducing blood pooling in the lower extremities and promoting blood flow back to the heart and brain.

3. Application: MAST consists of a pair of inflatable trousers, while PASG is a single-piece garment that wraps around the patient's lower body. They are typically applied to patients with suspected or confirmed hemorrhagic shock or hypovolemia. The garments are inflated using a manual or automatic pump until a specific pressure is achieved.

4. Considerations: EMS providers should be cautious when applying MAST or PASG, as these devices may have contraindications and potential complications. It is essential to follow proper application techniques and adjust the pressure according to the patient's condition and vital signs. Regular reassessment of the patient is crucial to ensure adequate perfusion.

5. Limitations: MAST and PASG are considered adjuncts to other resuscitative measures and should not replace definitive interventions or delay transportation to a medical facility. They are not suitable for patients with certain injuries or conditions, such as fractures, burns, or abdominal trauma.

6. Training and Familiarity: EMS providers should receive appropriate training on the correct application, monitoring, and potential complications associated with MAST and PASG. Familiarity with local protocols and guidelines is crucial for safe and effective use.

Remember, the use of MAST or PASG should be based on specific protocols, medical direction, and individual patient assessment. Always consult local guidelines and medical control when considering the use of these devices.

Additional Reading:

https://www.ncbi.nlm.nih.gov/books/NBK534783/

https://www.hmpgloballearningnetwork.com/site/emsworld/article/10325078/ems-myth-1-medical-anti-shock-trousers-mast-autotransfuse-significant-amount-blood-and-save-lives