JEMS: Journal of Emergency Medical Services -- Current Issue
JEMS: Journal of Emergency Medical Services RSS feed: Current Issue.
Journal of Emergency Medical Services (JEMS) , the most respected journal in the field of emergency services, is published
for paramedics, emergency medical technicians (EMTs), instructors, administrators, nurses and physicians. JEMS reports on the
issues that most affect the EMS work environment, such as life-support topics, management concerns and system design, legal questions
and new product and book/video reviews. For more than 30 years, JEMS has set the standard for news, information and education
in prehospital care.
To order this journal, and for more information, go to
http://www.jems.com
Updated: 50 min 10 sec ago
Healing the Wounds: 2010 National EMS Memorial Service
This month's column is an important call to action for EMS agencies to support the National EMS Memorial Service and, more specifically, the families of those who have lost their lives while performing EMS duties.
Miracle or Luxury?
Is continuous positive airway pressure (CPAP) a modern miracle or a luxury? This month, readers respond to JEMS.com columnist Guy Haskell's article, “CPAP Works Wonders: The best thing since sliced bread … with peanut butter.” One agrees, but another wonders if it's a necessity. Also this month, Keith Wesley and Marshall J. Washick's JEMS.com review of a recent study generates a discussion on proper pain management protocol.
Miracle or Luxury?
Before sliced bread, people just sliced it themselves. Likewise, before CPAP, a bag-valve mask was used to provide positive pressure ventilation assistance. At least, I hope it was. I agree that CPAP is fantastic, but I consider it a luxury and hope we haven't forgotten the art of bagging patients. After all, it's how we teach airway management. Shouldn't it be how we practice as well?
Miracle or Luxury?
CPAP has made a real difference in the rural setting as well. Out here in the boondocks, we're farther away from everything. Having CPAP has improved our patient outcomes and reduced the amount of time they stay in the hospital. The type of CPAP we use allows us to start treating our patients in their homes, if needed. I agree; CPAP is the greatest thing for EMS since the pocket on a shirt.
Pain Protocols
Kudos to the study authors and to Dr. Wesley and Paramedic Washick for reviewing [“Are Fentanyl and Morphine Equals?”]. I agree with Washick that both agents are appropriate for EMS use, but as others have also said, one must know which to use when. It's imperative that medics have a thorough knowledge of any drug used. Although there's no excuse for failing to manage pain adequately, there's also no excuse for medical directors and state EMS systems restricting their medics from adequately managing pain by limiting protocols. If the fear is inadequate education in pain management, then educate your medics.
Corrections
The formula for ethanol is incorrect in Steve Berry's article, “Duh: Don't underestimate human stupidity” (June 2010 JEMS). The correct formula is C2H5OH. The article, “New CCR Technique Proves Successful,” (June 2010 JEMS) incorrectly reported the cooling temperature for normal saline solution. The temperature should be 40° F.
> Petrol Perils: Identifying toxicity presentation from Gulf oil spill
Various federal agencies have teamed together to ensure the safety of oil spill responders include the U.S. Occupational Health and Safety Administration (OSHA), the Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security (DHS), which recently released guidelines for those working in Gulf Coast clean-up response at www.DeepwaterHorizonResponse.com.
Better Standardization
In the U.S., we've defined immediate access to EMS, police protection and fire department assistance as the expectation. We've designated one of the few three-digit telephone extensions as the universal means to access these services in the vast majority of the country. And when you dial 9-1-1, you almost unfailingly get the initial assistance you need. With that call, the meter starts running. If you are in an accident or are very ill, the cost of health-care treatment can ultimately be in the tens of thousands, or even hundreds of thousands of dollars.
‘S’ is for … Implement these seven ‘s’ components to transform your agency
Have you ever noticed that some EMS organizations seem to click together just fine, but other organizations languish in constant turmoil, with one problem after another, invariable turnover and dysfunction? Why is that? It may be because there's a gap between where they are and where they should be.
Leading the Pack: Correctly interpreting ECG data
Although a shortage of sound EMS field research remains in some areas, the fundamental EMS philosophy of doing the “right thing” continues to guide providers and medical directors alike to seek out better prehospital treatment options. These two groups have worked collaboratively with their hospital counterparts to identify assessment strategies and interventions to improve patient care in this unpredictable practice arena. One of the key changes to EMS practice that can improve patient care is the early identification and treatment of acute myocardial infarction (AMI).
‘We've Got Ya’ Getting people past their fear
Everybody's scared of something, sometime. It turns out that's not a bad thing, Life-Saver. Of course, some people are irrationally fearful. But for most, fear is more like good sense. It prompts them to moderate their contact with everything from tall, shaky ladders to wrong-way traffic.
Toxic Temptations: Treating pediatric patients with hydrocarbon poisoning
Engine 57 and Medic 507 are dispatched to a child who's short of breath and “sleepy.” En route, the dispatch center advises there's a slight language barrier. Upon arrival, a 4-year-old child is found having difficulty breathing. Oxygen is applied with a non-rebreather mask, and the child tolerates the placement of the mask on his face.
What Current Studies Mean to EMS
Merchant RM, Abella BS, Abotsi EJ, et al. Cell phone cardiopulmonary resuscitation: Audio instruction when needed by lay rescuers: a randomized, controlled trial. Ann Emerg Med. 2010;55:538–543.
The Trauma “A” Team: Advanced trauma life support training enhances ED & hospital trauma decisions and care
In February 1976, Jim Styner, MD, FACS, an orthopedic surgeon, crashed his small airplane in rural Nebraska. One of his children had only minor trauma, but three were critically injured. Styner's wife was killed instantly, and he was severely injured. They all received inadequate care at the receiving hospital, stemming from the lack of proper education of the receiving emergency department (ED) staff regarding early trauma management.
Pay Back Time: Health-care reform to boost transport reimbursements
Ambulance billing might not be the most exciting topic in EMS, but it could be the most important for cash-strapped departments. At this year's Fire-Rescue Med conference, Oceanside (Calif.) Fire Department Battalion Chief Peter Lawrence stressed two major trends to watch for in the upcoming months: changes as a result of health-care reform and a renewed effort from private ambulance services to capture a larger piece of the EMS pie.
Alternate Route: The humerus bone—A viable option for IO access
Intraosseus (IO) has long been an important method to access the central circulation in cases of difficult peripheral IV access. The first widespread use of IO was to treat hemorrhagic injuries during World War II. Now, IO access has become the standard of care for pediatric resuscitation.
On the Same Page: Making transitions between EMS & urgent care centers smooth
Medic 25 is called to a local urgent care center to a chief complaint of a possible heart attack at 8:45 p.m. On their way there, one of the medics tells his partner they've been getting multiple calls to this facility at about the same time each evening, so they can “unload” their patients before it closes at 9 p.m. He says it's usually for minor complaints and seems to be more for the convenience of the urgent care center staff than for any true emergencies.