Note: I realize the videos are not working. I hope to have it fixed later today.

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Unnecessary stress is bad. I don’t like it, and try to do everything I can to lessen its presence in my life. EMS is full of stress, much of it unnecessary. I hope to do a short series on ways to reduce EMS stress from your life. Here’s post # 1. Flight of McFerrin

I usually don’t drive. I believe the paramedic should sit in the shot gun seat so when we arrive on scene, I can hop out and get to work. I don’t have to bother with all the parking details. I jump out, grab my gear from the side door and go to work.

But when I precept, which I have been doing a lot lately, I drive and my preceptee sits in the shot gun seat. I do enjoy driving, but sometimes it can be stressful. Blasting the sirens and air horn, cars not pulling over, not stopping, turning in front of you. I find myself cussing and expressing disgust at the other driver’s ignorance and stupidity.

My old partner Arthur used to get so...

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Darkness. Cold. Reflection of fire in the water. Hoses on the ground. Onlookers. The stretcher, pulled by my partner and a firefighter, races through the scene to the the unknown victim carried out of the building. Behind them my feet are up in the air. I am three feet above the ground, suspended parallel, my arms wide out. A snapshot in time. I land hard on the black ice. I lay there. I am fifty-five years old. I do a body assessment. Still have feeling in my hands and toes. No acute pain. I didn’t hear any cracks. I get to my feet and take a few tenuous steps, and then move quicker, Moments later I am at the patient’s side, giving commands, Still a working paramedic.

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This past week our Regional Medical Advisory Committee voted unanimously to suspend our prehospital therapeutic hypothermia guidelines in light of two recent studies.

The first, Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial, published in the January 2014 Journal of the American Medical Association, showed that while there was no difference in neurologically intact survival between those patients who were cooled prehospitally and those who were cooled in the hospital, those who were cooled prehospitally were more likely to rearrest and more likely to suffer side effects such as pulmonary edema.

The second study, Targeted Temperature Management at 33 degrees C versus 36 degrees C, published in the December 2013 New England Journal of Medicine, showed that there was no difference in survival between those patients who were cooled to 33 degrees Centigrade and those who were kept normothermic at 36...

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In the aftermath of Hurricane Katrina in 2005, I was deployed to Gulfport, Mississippi for a week to assist with 911 operations. I witnessed firsthand the destruction caused by the storm, and witnessed the great resilience of the Gulf Coast people. Most of the news coverage at the time focused on the flooding of New Orleans. I remember reading subsequently that a doctor and some nurses in a New Orleans hospital were charged with murder in hastening the deaths of some infirm patients who were unable to be evacuated. I remember being outraged by the gall to charge health care providers who were no doubt doing their best under extraordinary circumstances, and I remember being glad to hear the charges were subsequently, dropped.

With this background in mind, I was interested to read a new book Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, an account of what happened at Memorial Hospital during Hurricane Katrina and its aftermath. The New York Times selected the book as one of the ten best of the year.

I was...

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In the aftermath of Hurricane Katrina in 2005, I was deployed to Gulfport, Mississippi for a week to assist with 911 operations. I witnessed firsthand the destruction caused by the storm, and witnessed the great resilience of the Gulf Coast people. Most of the news coverage at the time focused on the flooding of New Orleans. I remember reading subsequently that a doctor and some nurses in a hospital there were charged with murder in hastening the deaths of some infirm patients who were unable to be evacuated. I remember being outraged by the gall to charge health care providers who were no doubt doing their best under extraordinary circumstances, and I remember being glad to hear the charges were subsequently, dropped.

With this background in mind, I was interested to read a new book Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, an account of what happened at Memorial Hospital during Hurricane Katrina and its aftermath. The New York Times selected the book as one of the ten best of the year.

I was...

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Three sets of footprints in the snow. Two with fully defined treads. Mine barely register. I’m twelve years older than the two of my partners combined. This is my fifth pair of boots and the soles have gone smooth. I walk carefully. We do a call and I can’t make it up the icy driveway. I keep slipping down the incline. I have to hike up through the snow to get to the door. I have had this pair of Fort Lewis’s seven years, and they have stood me well. I order a new pair that night and they arrive on Christmas eve. I put them under the tree so I it will look like there are even more presents when my daughter awakes in the early hours and checks to see if Santa has come. In life we give way to youth, all of us do. We fade away. But I hope this new pair of working boots won’t be my last. I have more earth to tread on, more inclines to climb.

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Looking to improve your 12-lead reading skills, this was a great webinar on STEMI imposters, given by Dr. Marcin Dada of Hartford Hospital as part of the Mission Lifeline STEMI Accelerator Project in Hartford, CT.

It is now available for on-demand viewing.

Webinar recording: STEMI IMPOSTERS

Don’t stop there, check out these webinars/slide shows on the EMS 12-Lead blog, taught by Tom Bouthillet.

STEMI Mimics and Imposters

STEMI Recognition: Beyond the Basics

And if you have a handy $4.99, try Tom’s 12-Lead ECG Challenge application. Here’s a product review of it. I bought it the other day and have been enjoying it, and learning quite a bit. It’s great to play with while waiting in the triage line or on a standby.

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Here in Connecticut, we await the final day of spinal immobilization (to a long backboard). The new spinal motion restriction guidelines have been approved by the state EMS Medical Advisory Committee and the State EMS Board. We are just waiting on the completion of the educational training program and the Commissioner of Public Health’s final approval.

I recently was sent this video documenting what is soon (hopefully) to be an extinct practice — at least in our state.

Enjoy!

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In the late 1980s when I was first going to EMT School there were very few true life EMS books out there. What ones there were I devoured. I specifically recall Paramedic by Paul Fischer and EMT: Beyond the Sirens by Pat Ivey. There was only one novel I was aware of — Street Dancer by the late Keith Neely. Like many of the books that followed in subsequent years they all followed the same pattern. Newbie takes an EMT class, gets certified, starts working, overcomes their fears and clumsiness and become competent, while encountering a variety of archetypes along the way. The books were great for someone like me looking for what the life was really like.

For many years, even after I had been working for a long time, I continued to read each new EMS book as I discovered them. After awhile, I got a little tired of the same stories, and stopped reading unless I heard something special.

Occasionally other authors have reached out and asked me to read and review their works and I have always done so if they sent...

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Greater Hartford Mission: Lifeline Webinar

STEMI Imposters

Tuesday, December 3, 2013

Noon – 1 pm

Presented by: Marcin Dada, MD
Associate Director of the Chest Pain Center
Hartford Hospital

Moderator: Raffaella Coler, RN, MEd, Paramedic
Director, EMS Education
Hartford Hospital

Registration in advance is required in order to receive the sign-on info:

Register Here

Everyone is invited. I have seen the slides and it is a great show. 45 minute presentation and 15 minutes for questions.

Good for 1 Hour CME

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