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Thank You to My Readers on the 14th Anniversary of 9/11!

September 7, 2015 2 comments

“How Did I Move Forward From the Loss of “That Day?”

I appreciate my subscribers to http://www.ParamedicMastery.com.  This week reminds me of the great people I have worked with in EMS, many of which are still good friends.  As this week starts our brothers and sisters are changing their Facebook Profile pictures to flags and eagles.  It is great to see that people remember and will not forget.  EMS is really about the community and those we work with.

We should care as much for the person next to us,as the patient on the stretcher.

September 11, 2001 was a huge disaster which stopped New York City, the United States and most of the world for a few days. The magnitude of the disaster was huge; 7 buildings, 2 airliners, 10 EMTs and paramedics, 343 fire department members, 79 police officers and some 3,300 civilians. When the disbelief turned to acceptance the struggle was to understand the parts the stories, the events and the whys.

Especially for me the information was important.  I went down to the World Trade Center at 1:00 pm on 9/11/01 and did not go home until 3:00 pm on 9/13/2001.  We were in news blackout working hour to hour, bucket to bucket, hope to hope. In the years since I have transitioned from understanding to asking myself, “How do we move forward, not forgetting, but not stuck in the moment.  I vividly remember nights at Ground Zero with the American Flag hanging above the Pit.

Call to action: Please leave your American flag out the night of 9/11, well lit, to honor the emergency responders and military who have given so much on 9/11 and in the years since.

I enjoy doing acts of kindness and generosity in the name of EMTs that died on 9/11.  Somehow, this helps me and makes me feel good about the loss on 9/11.

I have been giving a presentation that called, “After The Siren Stops, Taking Care of our Own.”  I have received excellent feedback on this lecture.  As many of you know I have written the only EMS Book about September 11, 2001 in the world. The Downwind Walk: A USAR Paramedic’s Experience’s after the Terrorist Attacks of 9/11.

I will continue to teach EMS the lessons of 9/11 and how to take care of our own. I plan on speaking at conferences next year and doing book signings.

To show my appreciation to my subscribers I plan to do the following:

  • Ground Zero Tours: I am available for tours around Ground Zero and New York City for EMT’s and Paramedics who are visiting The City. E-Mail me for details.
  • I am planning on recording a book reading this week about what it was like on 9/11/01 to 09/12/01 at Ground Zero, excerpts from my book. I will post this on my web site. http://www.paramedicmastery.com for free.
  • I will be scheduling lectures around the country and world in the next couple of years as we approach the 20th anniversary of 9/11 to share the EMS lessons of 9/11, the great people we lost and how to take care of our own going forward.

Please e-mail me @ StevenKanarian@Gmail.com  if you are interested in a tour in The City or sponsoring a book reading/ signing.

Have a great week as we approach September 11 2014.  Honor those EMTs and paramedics we have lost through your caring and professionalism.   Do something in name of a person who died on 9/11, through you they will live on.

Travelling Is My Passion

Well travelling is one of a my passions at least. I  love living, dining and travelling.  In a nutshell I enjoy living life and experiencing the world.  Through travel we can meet new people and see interesting things.  Sometimes travel gives us a break from everyday life, other times travel gives us a comparison so we may appreciate what we have.  Often i feel travel gives us perspective on our lives and helps us see what is really important.I want to start this blog so I may highlight the great people I meet on the road and the best experiences I find so you too may enjoy  life and all the treasures the world offers.WP_20150325_15_16_22_Pro

Fit For EMS Bit By Bit

January 22, 2015 1 comment

http://youtu.be/bKmbPu3UfXM

Like many EMS professionals I have struggled with getting in shape.  Hell, it is hard even to set a routine for exercise when you are doing s shift work and overtime.  Our eating habits are not always the best either. How many times have you brought food only to succumb to the smell of fried food when tired or stressed out?  True there are those that set aside time to run, lift weights and eat right, but they are in the minority in EMS and the general population.

I can remember those times I was exercising or bike riding and found the job more enjoyable.  Above all EMS providers need to have tone to lift people and a diet that keeps our blood pressure at acceptable levels.

After being threatened by my doctor and him listing the risks of being overweight,  bought a Fit Bit for myself this Christmas.  I am pleased to see how much activity I get during the day walking around from location to location at work.  By walking for 45-90 minutes a day I have been racking up 4 to 5 miles and feeling more fit.

There is more to getting in shape than walking. What successes or challenges have you had getting in shape while working in EMS?

How To Become A flight Paramedic, Interview with Jason Hums, MPH

EMS Preparing To Care For Ebola Patients: What You Need To Know.

The first case of Ebola has been diagnosed in the United States and transported by EMS.  Dallas Texas Fire Department paramedics transported the Ebola patient to Texas Health Presbyterian Hospital of Dallas http://www.cnn.com/2014/09/30/health/ebola-us/index.html This patient had travelled from West Africa to the United States before exhibiting symptoms. Upon exhibiting symptoms the patient called EMS for transport and treatment. The crew transported the patient and were quarantined to ensure they did not contract the Ebola Hemorrhagic fever. http://www.nbcdfw.com/news/health/Case-of-Ebola-Confirmed-in-the-US-CDC-277648611.html

EMS Has Dealt With Disease Outbreaks And Hazardous Exposures Safely Before.

The Ebola epidemic in Africa makes people apprehensive about the Ebola disease. I can remember responding to AIDS patients in the early 1980’s and how EMTs and paramedics where so paranoid about the spread of AIDS.  We wore hospital gowns, masks and wrapped the patient in blankets.  In time we became more comfortable managing the risk of AIDS exposure, understanding that the disease was spread by bodily fluids and exposure to blood.  In 2001 EMS was faced with Anthrax powder responses in New York City.  We responded to these calls and wore our personal protective equipment (PPE) while Haz Mat techs assessed the hazards and identified the powder.  By protecting ourselves with masks, gloves and appropriate PPE we managed this risk.

PArtners are important in EMS

What The CDC Says About The Spread of Ebola

CDC recognizes that even a single case of Ebola diagnosed in the United States raises concerns. Knowing the possibility exists, medical and public health professionals across the country have been preparing to respond. CDC and public health officials in Texas are taking precautions to identify people who have had close personal contact with the ill person and health care professionals have been reminded to use meticulous infection control at all times.

We know how to stop Ebola’s further spread: thorough case finding, isolation of ill people, contacting people exposed to the ill person, and further isolation of contacts if they develop symptoms. The U.S. public health and medical systems have had prior experience with sporadic cases of diseases such as Ebola. In the past decade, the United States had 5 imported cases of Viral Hemorrhagic Fever (VHF) diseases similar to Ebola (1 Marburg, 4 Lassa). None resulted in any transmission in the United States. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/united-states-imported-case.html

Symptoms of Ebola include

  • Fever (greater than 38.6°C or 101.5°F)
  • Severe headache
  • Muscle pain
  • Weakness
  • Diarrhea
  • Vomiting
  • Abdominal (stomach) pain
  • Unexplained hemorrhage (bleeding or bruising)

Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.

What Precautions Do We Take When Facing Ebola Patients

Standard PPE and Universal precautions enable us to protect ourselves from the fluid exposure of Ebola.  Ebola is a hemorrhagic fever that is transmitted through body fluid exposure. Precautions to reduce exposure to body fluids help protect EMS providers.

Precautions for EMS providers”

  1. Wear BBP rated PPE when responding to calls with difficulty breathing, fever and body fluids exposed.
  2. Inquire with patient if they have recently travelled from a foreign country or had contact with someone who  has traveled reduce bleeding or fluid drainage.
  3. Bandage wounds
  4. Wrap the patient in blankets to cover exposed wounds
  5. Follow your department’s procedures for decontamination of the ambulance and exposure documentation policies.

For more information about Ebola: http://www.cdc.gov/vhf/ebola/about.html

Comment below: How do you feel about responding to patients with Ebola?

Read about EMS on September 11, 2001…

GPS for EMS: Global Positioning or Global Problems?

Be sure to comment below: What features would you like to see on GPS?

images gps phone

Technology has infiltrated all aspects of our society making our lives more efficient. Emergency medical services’ use technology in all phases of our jobs. Patients call for 9-1-1 assistance using text or cell phones.  Emergency calls are received by operators who use computer aided dispatch to prioritize and dispatch calls. We use electronic monitors to measure a patients ECG, oxygen saturation and capnography readings.

Ambulances are using global positioning systems to locate the call or best route to the hospital.  Each link of the EMS system is vital in getting rapid care to the patient an emergency and must be reliable to save lives. Our dependence on technology is underscored during disasters or blackouts where we lose communications. Technology is used to benefit the patient but not a replacement for experience and common sense.

Lately I have been questioning how reliable GPS is for EMS use.  GPS is definitely a nice tool to have in our arsenal when traveling in an unfamiliar area during a transport. But how reliable is GPS when depended on for rapid responses in life threatening emergencies?

GPSI personally have experienced problems with GPS not recognizing a town or village, not having a street entered into the database or taking an out of the way route because of programming glitches. Some GPS units require the user to enter the specific neighborhood of a town or city to accurately enter the street. Most recently GPS sent me around in circles because there was a new bridge in Arlington, VA that had not been entered in the GPS database.   Miscommunications between crew members can also result in ambulances going to the wrong hospital.  “I thought you meant Columbia on Broadway?”

I grew up in EMS using maps.  There is always a street you have not heard of in your area or you can get sent our of your service area or town. You should always carry a map. A map offers a second source of information and a source for direction when GPS fails.

As an EMS supervisor I have seen problems affecting response times and patient care.  A common problem causing extended response times occurs when a crew member verbally enters an address into a cell phone which brings the unit to the same street but in the next town.  The EMS system is also open to variable results from GPS when each provider is using their own cell phone or GPS unit to guide them to a call.  I am alarmed to see crews that operate with no map as a back-up to GPS.  What do you do if GPS service is not available or the GPS unit freezes? In the end the patient suffers.

GPS will locate the call location providing you enter the information in correctly and their is satellite communication available.  GPS data must be confirmed when receiving the information from the dispatcher, when entering the info into the GPS unit and again while responding to the location. Similar to the 5 Rights of Medication Administration GPS data must also be confirmed and verified. A benefit of GPS is the ease of navigation when it is a location we respond to often and you can recall the location from past destinations.  GPS will also take into account traffic conditions which may affect our response times.  Is it best for us to go through the traffic area using lights and sirens or bypass the location? Does your service have policy for using GPS or bypassing the most direct route? Clearly the best solution is to know your service area to ensure the quickest response times. We need research looking at the reliability of GPS under emergency response conditions.

An experienced EMT or Paramedic knows his or her response area well. They have taken the time to learn shortcuts and best routes to the hospitals.  What is the rookie to do? The best solution is to have your partner look up the location on a map while your are entering the location in GPS.  Using your brain to determine the best route into the call area is safest, then depend on GPS for the turn by turn location of the call address.  If you are working solo in a response units the stress of responding quickly and both using GPS and looking the address up on the map can cost precious time.

A danger of our technology based world is that we turn our brains off and think of other things while we are driving or providing patient care. We are trained not to blindly trust the ECG monitor or pulse oximetry, we have to critically look at the GPS route and trust our instincts to question the route.

The recent air india crash in San Francisco clearly underscores the problem with depending on technology while performing our jobs. Asiana Air 214 Lee Gang Guk told investigators after the crash that he found the approach “very stressful” and “difficult to perform” with such a large plane and the absence of an electronic system that tracks a plane’s glide path, which was down for maintenance, according to the report. http://www.usatoday.com/story/travel/news/2013/12/11/ntsb-asiana-airlines-fatal-crash/3891213/

Although EMS mistakes are usually one patient at a time this plane crash dramatically shows us what happens when decision makers depend on technology and particularly when the technology is not available.

Solutions when using GPS

  • Update your GPS unit software with the latest updates
  • Make sure the address is correct when acknowledging the call location
  • Ensure the address is entered into GPS correctly
  • Have your partner look up the location on a map and guide you to the response area
  • Keep focused on the response and question GPS instructions that do not seem correct
  • Document area specific problems with your agency to avoid re-occurrence.
  • Submit inaccuracies to GPS mapping services to increase accuracy of GPS maps.

Each year, you can expect roads to change as much as 40 percent — that’s new roads, closed roads, lane changes, you name it

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Bad satellite signals and signal interference are some of the most common glitches and happen when something gets in the line of sight between your GPS device and the satellite network. Without a clear and strong signal, your device can’t accurately establish your location. Tall buildings, dense foliage, mountains and even reflective objects can cause such a problem.

To correct mapping problems such as an incorrect address, or to request a change to the address for a business or home, or to add an address, please submit your corrections to these websites: http://mapinsight.teleatlas.com/mapfeedback/index.php and https://mapreporter.navteq.com/ .

Epinephrine Research

I was reading an article on research By Dave Page of Inver Hills Community College Paramedic Program. In this article Dave Page reviews a Epinephrine study ( Hagihara A, Hasegawa M, Abe T, Nagata T, Wakata Y, Miyazaki S. Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest.  JAMA. 2012;307(11):1161-1168)
This study consisted of a review of 417,188 cardiac arrests in a Japanese cardiac arrest database.  The study found that 18.5 % (2,786 of 15,030) of patients with epinephrine administration survived while  4,7 % did not get epinephrine survived, and 2.2% had good neurological outcome.

Dave Page stated “We must be careful drawing inferences from this study because effective outcome -driven cardiac arrest management is multi-factorial.”  What Dave Page means is when studying the process of cardiac arrest management we begin by looking at each link in the survival chain.  The outcome of hospital discharge is our ultimate goal, but the process and all its components contribute to the outcome.

Dave Page is a intelligent EMS professional who uses good judgement and understands the nature of research and improving resuscitation, step by step.  Our ulitmate goal of research is increased survival and better patient care.

Research Caveats:

1) Be careful not to make broad assumptions based on one or two studies you read

2) Registry data may have limitations and is used out of context.

3) Always read more into the study and understand the possible areas of variation (i.e.what kind of CPR being done, skill level of provider, length of time perfoming skills).

4) look at the number or patients studied and how this study applies to your system (i.e. a study in a rural EMS system may not pertain to an urban system)

Remember what I always say, Research is the process of shining a light into a dark room to study a problem.  The problem grows  when looking into a dark room with a flashlight , we don’t know if the leg we see is of a table, a chair or a patient.

Additional points to review: 1) Registry sources for research, process management.

Steven Kanarian, MPH, EMT-P

Excited Delirium: Improving Our Care Of The Agitated Patient by David Aber

Paramedic Mastery

I would like to welcome David Aber to Paramedicmastery.com as a contributor. Dave has been involved in the EMS service for over 20 years and is a passionate educator and conference speaker. While still working full time as a paramedic for an all 911 service he also serves as the Training and Education Coordinator. Dave believes that EMS does an amazing job but can do much better for our systems, co-workers, and most of all our patients. Follow him on Twitter @EMSDifference or read his blog at www.EMSDifference.com

Imagine being dispatched to a call for unknown emergency for a male reportedly walking up a street screaming and punching out car windows. You arrive simultaneously with the police and find the subject now sitting along the street curb with bloodied hands. He has rapid respirations and is profusely sweating.  As you and the police approach the patient he becomes more agitated…

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Paramedic class – Are you ready to make the difference?

Paramedics save lives and make the difference every day.  Now that you have decided to take the next step in your EMS career what concerns do you have about paramedic education?  Are you concerned about finding the time for class?  Maybe you have been out of school for a while and want to know how to get conditioned for the challenge of medic school.  Subscribe to my blog and learn how to prepare for medic class from the Medic Mentor.      Leave a comment to let me know what concerns you about medic class.

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