Archive for December, 2009

Search for the ultimate EMS-related Android app

December 14th, 2009 Sean

*****Update******

Since I wrote this post, I have done several reviews on EMS-related Android apps. Check them out under my “Reviews Section”.

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Being the geek that I am, I am constantly on the lookout for digital alternatives to things like calendars, checkbooks, and paramedic field-guides. Of course, being the not-so-wealthy-EMS-salary guy leaves me looking for cheap, if not free solutions.

My search for EMS-related applications started when I bought my Motorola Droid phone last week. After downloading the metal-detector (yes metal-detector) and internet radio applications, I began searching for apps that would be useful to an EMT or Paramedic.

I did my initial search was done using the built in app-market app that comes with Android. I searched various keywords like “EMS”, “Paramedic”, “Paramedic field guide”, “ALS Field Guide”, etc. I came up with 2 applications, however the results are not so good.

Here is a rundown of what I found.

BLS Drug Profiles:

The application comes with 6 drug profiles (Aspirin, EPI Auto-Injector, Activated Charcoal, Albuterol Inhaler, Nitro, Oral Glucose). While the information seems to be accurate, it’s not a very useful application for in-field use. I guess if you somehow forgot your doses or contraindications, then this might might be of some help. This app has been removed from my collection.

USA Drug Reference:

At first glance, this seemed like an extremely useful application. It’s basically an electronic version of a PDR or Nurses drug reference book. It has a really neat scrolling feature that makes flipping through the different drugs a breeze. It seemed like the perfect drug reference. That is until I actually tried looking at the information on the individual drugs. The majority of the categories are empty or have missing information. The program is solid, but the information is definitely lacking. This is quite a shame as the app has huge potential.

There are some applications out there that cost money. Skyscape’s “Rapid Paramedic” reference is basically a digital version of their hard copy pocket guide. I guess I would spend the money if I didn’t already own the pocket guide. Unfortunately, Epocrates does not have an android version of their program. It is available for Blackberries, iPhones and Palm phones. This, of course, is a major bummer. Hopefully they will come out with a compatible version soon.

The built-in GPS navigator is far superior to any GPS device that I have ever purchased. It utilizes Google Maps, which means that it updates constantly. I suppose it could be used to route yourself to calls, however I would check to make sure you aren’t violating any policies before you do so. I happen to work for an ambulance service that prohibits using personal gps devices. However, I have looked up random addresses in my area and compared the recommended routing given by Google Maps and my personal preferred routing by just looking at a map. I must say that I am quite impressed.

I must say that I am a bit disappointed in the lack of EMS-related apps for Android, being that the platform has been around for a while now. I will certainly keep my eyes out and post when I find any. If anyone knows of any that I missed, please let me know!

Posted in Android, Reviews Tags: , , , , View Comments

Privates to the Rescue!

December 11th, 2009 Sean

Budget cuts, layoffs, and public criticism are all nightmares of nearly every public agency or department. In times of financial crisis and a near economic meltdown, public entities are getting desperate for an answer. The big question is, what happens when your government can’t afford to provide life saving services like EMS? The answer lies within the foundation of the American Dream. Private enterprise.

In a very large portion of the country, private business is already providing these life saving services at no cost to the tax payers. With so many cities and counties operating in the red, I’m left to wonder why more areas aren’t being serviced by private companies. By switching to a private or pay-per-service system, municipal governments can save a truck load of money. That is money that can be used to fund or improve critical services like law enforcement, roads or fire suppression.

There are certainly valid arguments, none of which are financial, that oppose such systems. Many people feel that emergency medical services is a responsibility of the government, and therefore should be operated by the government. Some more arguments against private EMS include:

  • Stability

  • Oversight

  • Accountability

  • Quality of care

I can certainly understand a fear that a private ambulance can “go under”, leaving an area with no coverage. However, during these tough times, there is hardly any stability with any branch of the government. Layoffs and budget cuts are forcing public agencies to decrease personnel and number of units available. The risk is equal on both sides of the fence. For every ambulance service that goes out of business or loses a contract, there are several financially sound companies waiting for opportunities to expand. If we trust privately run hospitals to service communities, then why can’t we trust private ambulance service?

The argument about oversight, accountability and quality of care with private ambulance services is weak. In reality, there is more government oversight when it comes to contracted services then there is when the city or county runs their own service. Private ambulance services have to follow strict guidelines in order to maintain a contract. With no contract, the company can’t operate, which translates to no business. Contracts call for response time compliance, number of units available, quality assurance programs and complaint resolution. When fire or third-service based systems are in place, all the governing boards typically care about is amount of money they spend. Which, by the way is usually over the top.

Private business has to earn their money and manage it. If they don’t generate enough revenue, then they can’t operate. Sound familiar? If you are a working person supporting a family then it probably does. Government agencies don’t have to worry about generating income. They just spend the money and ask for more when they run out. It sounds harsh but it’s true. Next time you get behind on your car payment or mortgage, try asking your boss for more money and tell me how it goes.

In conclusion, I feel that private business is just as capable if not more capable of providing efficient and quality emergency medical care. As always, I welcome all questions and comments. You can e-mail me at sean@medicmadness.com or simply comment below.

Have a great week.

Posted in Opinion, Politics Tags: , , View Comments

Intubation – A high or low priority?

December 11th, 2009 Sean

IntubationCurrent2_tcm16-210658A common theme around hospitals and the latest ACLS guidelines suggest that intubation should no longer be considered a high priority. Instead it is now recommended that high-quality CPR and early defibrillation take priority over all other ALS interventions. I for one feel differently when it comes to pre-hospital care.

According to the American Heart Association, other procedures like IV access and medication adminstration can be performed before intubation if adequate ventillations are taking place by means of a bag-valve-mask. While I certainly agree with the concept, I do not feel that it is very practical for situations when EMS is involved. Unlike hospital settings, EMS workers have to deal with bumpy roads, tight corners, environmental factors and limited room in most ambulances. It can be extremely difficult to maintain a good seal and adequately ventilate a patient in those conditions.

Early intubation frees up hands, limits the amount of time suction is needed and allows paramedics to focus on interventions like chest compressions, defibrillation and medication adminstration.

I am not saying that I completely dissagree with the new ACLS guidelines. I simply feel that pre-hospital care was not taken into consideration when they were released. I would be interested to see how much of the Heart Association’s research was done on pre-hospital cases.

As always, feel free to e-mail me with any questions or comments.

Posted in Field Medicine, Opinion Tags: , , , , , , View Comments

Good Health – A Must for EMS Providers

December 11th, 2009 Sean

Good morning readers. Today I am going to discuss the importance of good health when working in the EMS field. Good health is something that is often ignored amongst many EMT’s and Paramedics. The truth is, we need to stay healthy to truly perform our jobs effectively. Regular exercise and good nutrition will ultimately equate to more energy, better concentration, more strength and will lower your risk for injuries.

For the purpose of this article, I am going to focus on nutrition. Having worked in EMS for many years, mostly on night shifts, I certainly understand the difficulties in finding healthy food while working the streets. I have been guilty of late night 7-11 chili dogs, “Big Gulp” sodas and large bags of chips. It almost seemed like healthy food disappeared when the sun went down. I have since learned to tone it down on the artery clogging snacks.

Meal planning is going to be the first step to your nutrition plan. I plan on 5-6 small meals a day. This helps to kick the urge to snack. Eating 6 small meals a day also helps to maintain a faster metabolism, which translates into less fat retention. Target and other major stores offer many decent sized coolers from 20-50 dollars that would easily fit all of your meals and drinks for a shift.

Eating 6 meals a day is great, but it wont do you much good if you aren’t eating the right stuff. We all know that fresh fruits and vegetables are good for you. I could write a book on the importance of eating fruits and vegetables. But the truth of the matter is, if you don’t like it, you probably aren’t going to eat it. I personally enjoy eating apples, carrots, oranges and salads. They can be filling and have a good source of natural sugars for energy. Try browsing around your local grocery store for healthy foods to eat. You might be surprised at how much is out there that you will actually enjoy eating. A good rule of thumb is to consume no more than 2,000 calories a day. You be the judge, find what you like and keep it below the 2,000 mark. Remember, you can’t go wrong with fresh fruits, vegetables and whole grain foods.

Try to avoid foods and drinks with high sugar content. While sugar is important, excess amounts will lead to less energy and more fat retention. Try drinking more water and diet sodas instead of regular sodas. Diet sodas are good, but they contain a decent amount of sodium, which wont do you any good if you consume an excess amount. It doesn’t take a genius to figure out that candy and sweets can be bad, however a treat every now and then isn’t going to hurt anything.

Ever since I started to focus on healthy eating I have truly improved my job performance. I require less sleep, have more energy and I am able to concentrate better than before. Good health isn’t the only upside to a good nutrition plan. You will also save a substantial amount of money. Nutrition planning doesn’t have to be rocket science. Most people know whats healthy and whats not. Don’t try to over-complicate things. Experiment around a little and find a nutrition plan that works for you. As always, have a great week and please feel free to e-mail me with any questions or comments.

Posted in Health and Fitness Tags: , , , View Comments

Is EMS Recession Proof?

December 11th, 2009 Sean

Hello readers. Today I am going to discuss the impact of a downward economy on EMS and the medical field in general. Until recently I actually believed that the medical field was immune to the economy. Like many others, I thought that since people can’t control when they get sick, that EMS and medical facilities would never suffer. That idea is absolutely wrong. Many things factor into financial hardships for medical facilities and EMS agencies during a recession. High unemployment rates and government cutbacks are just a couple examples.

Many American Citizens receive private health insurance as a benefit from their employers. When establishments are going out of business and people are frequently laid off, the number of insured patients significantly decreases. This can affect the medical field in general because people will not typically see a family physician for non life-threatening conditions, as they have no means to pay for it. While this may not affect the emergency call volume for EMS providers, it can certainly affect reimbursement. As it already stands, government provided insurance like Medicaid and Medicare already reimburse at an alarmingly low rate. In California, the average reimbursement rate is 14 percent. That means for every dollar that an ambulance service bills, they will only receive 14 cents. Even without a recession, this is still a huge obstacle for ambulance providers to overcome. With more and more people losing jobs, the amount of non-payers and government-assisted payers goes up.  Sounds bad enough right? It only gets worse.

When businesses collapse and people lose jobs, the government also suffers. People not working means people aren’t paying taxes. This equates to higher taxes and government cut backs. Medicaid and Medicare programs across the nation are tightening their belts, making reimbursement more difficult. Some states are even going as far as to delay payments. In addition to the decrease in cash flow, the state and federal government tend to place higher taxes on businesses, making daily operation even more difficult.

Despite all the doom and gloom that goes along with a recession, many agencies will prevail. Good financial planning, cutting overtime expenses and eliminating wasteful spending will be the key to success during these times of financial crisis.

As always, feel free to e-mail me with any comments or questions.

Posted in Opinion, Politics Tags: , , View Comments

Motorcycle Medics to the Rescue

December 11th, 2009 Sean

Good morning readers. Today I am going to discuss what is nearly every EMS workers dream. Motorcycle paramedics. Sounds like a blast right? Absolutely! Many countries like England, Japan and Italy, already use this type of first-response. Heavy traffic, narrow roads, and long ambulance response times have prompted some U.S. cities to deploy motorcycle paramedics as well.

The idea behind the program is to cut response times. This is made possible by the motorcycle’s ability to “slice” through traffic and maneuver through city streets.

Most systems deploy the responders in pairs of two. One bike can carry the ALS supplies and the other can carry the BLS supplies. In some areas, all of the supplies are stored on one motorcycle, with the exception of a backboard. Side compartments are specially designed to carry a heart monitor / defibrillator, medications, oxygen, airway kits, IV kits and BLS supplies.

In 2004, Miami Florida became the first major metropolitan area to deploy motorcycle paramedics. They claim that since the deployment, their response times have been nearly cut in half. Other areas in the United States that utilize motorcycle paramedics include Daytona Beach, Nantucket and Cheltenham.

Countries all over Europe have been using motorcycle paramedics for many years. As the population continues to grow and traffic continues to be become more of an issue, it is likely that we will see more motorcycle rescue programs throughout the United States. As it currently stands, metropolitan areas like New York City and Los Angeles would most likely benefit from a motorcycle program. This has left many people wondering, “why don’t we have it already?”

The cost to operate a motorcycle rescue program is quite expensive as the insurance rates are through the roof. The United States utilizes more private ambulance services than most of the world. First-responder units do not generate revenue, so many private providers may be reluctant to implement such a program.

Hopefully in the near future we will see more pilot programs for motorcycle responders. Quicker response times will translate to better patient care. Not to mention how cool it would be work on one.

I hope everyone has a great week. As always, feel free to e-mail me with any questions or comments.

Posted in Misc Tags: , , View Comments

Are we over-responding to emergencies?

December 11th, 2009 Sean

Good evening readers. Watching the news recently has left me wondering about the amount of resources that we dedicate to emergency response. A recent clip about a vehicle that drove through a glass door at an urgent in the Los Angeles area was nothing short of amazing. When the news story started, the live feed showed several emergency vehicles surrounding the building. 13 to be exact. By the time the story was done airing, I counted 19 emergency vehicles between fire and ambulances.

Being that 6 people were transported to the hospital, I can certainly understand the additional ambulances. However, I have a hard time making sense of nearly 20 response crews. I am not an expert in fire operations by any means, but I’m confident that this incident could have been handled with less resources. The image displayed on TV’s nation-wide showed some crews treating the victims, and at least 12 people standing around outside the building.

A good comparison to this incident would be the Mojave Air and Spaceport explosion in 2007. 4 critical patients who suffered from blast injuries were transported via air ambulance to a trauma center. 2 patients died at the scene. The total response included 3 fire engines, 3 air ambulances and 2 ground ambulances. The ground ambulances were canceled once the airships arrived on scene.

Obviously Mojave, CA does not have anywhere near the resources that Los Angeles does. However, the incident was run with an adequate number of personnel to ensure scene safety, proper patient care, and expedient transport.

In times of financial hardship, businesses and goverment agencies around the nation are doing what they can to cut costs. In the response to the current budget crisis, Police officers, correctional officers, state employees and even some fire agenices in California are mandating 2 unpaid days off a week for all employees. Many government workers are getting their walking papers, leaving departments understaffed and over worked. Not wasting money on “over-responding” to these incidents is certainly a way that we can work to overcome these hard times.

As always, feel free to e-mail me with any questions or comments.

Posted in Opinion, Politics View Comments

EMS Dispatchers now telling patients to take aspirin

December 11th, 2009 Sean

Many EMS systems across the nation are starting to implement a new dispatch protocol. Now when patients experiencing chest pain call 911, they will be instructed to self-administer aspirin prior to the arrival of the ambulance. The long time standard has been that dispatchers would advise all patients to take nothing by mouth while they wait for paramedics to arrive. This is a big step in a new direction for our nations EMD systems.

Studies by the Nation Academies of Emergency Dispatch have shown that the new aspirin protocol will decrease scene times and possibly improve the outcome for patients experiencing cardiac episodes.

The dispatchers will not instruct patients to take the aspirin if they are a minor, disoriented, have a known allergy or have a known bleeding disorder.

This protocol is already in place in Kern County, California. I personally have responded to several incidents where patients have taken the aspirin before my arrival. So far it appears that the protocol is effective. I have yet to run into any issues.

If this turns out to be a success, then I think we will start to see more “prior to arrival” interventions being implemented. I’m glad to see more being done in an effort to decrease the amount of cardiac related deaths.

As always, if you have any questions or comments, please feel free to e-mail me.

Posted in Field Medicine Tags: , , , View Comments

Professionalism – A much needed trait for EMS providers

December 11th, 2009 Sean

Good morning readers. Today I am going to talk about professionalism in the EMS field and in the everyday workplace. In my years as a paramedic I have seen both ends of the spectrum. I have worked in environments where EMT’s and Paramedics were allowed to wear pretty much whatever they want. I have also worked with companies where all crew members were required to wear the same uniform, and keep it up to a strict standard. Obviously the stricter of the two produces better confidence with the patients that we serve as well as with members of other branches of public safety.

Now you might be wondering why this article is titled “professionalism” and all I keep talking about is appearance. Well I can tell you that appearance, attitude, courtesy and competence all go towards professionalism. For instance, if you have a sloppy appearance, you will most likely have a sloppy attitude as well.

Unfortunately, many (not all) fire and EMS agencies tend to be quite lax towards a good uniform policy. On a standard medical-aid call, you might have 2 people in turnout pants with a t-shirt, 1 person wearing uniform pants and a sweater, 1 person wearing a jump suite, and someone wearing a polo. While this may meet all of the responders comfort needs, it doesn’t instill much respect with the patient and the general public.
Law enforcement agencies typically have very strict uniform polices and almost always present themselves in a professional manner. It’s pretty rare to find several officers from the same agency wearing different jackets or shirts. I have always been of the impression that law enforcement sets a great example when it comes to professionalism.

I understand that many rural volunteer departments have no choice but to “come as you are” in order to cut down on response times. I respect that.

Now in conclusion I will say that the cops probably set the best example, but there are obviously exceptions out there. Looking your best, being knowledgeable in your duties, and treating the patients like they were your grandmother, will make you shine in your job as an EMS professional.

As always, if you have any questions, please feel free to e-mail me.

Posted in Opinion Tags: , , , , , , View Comments

Socialized Medicine – Good or Bad for EMS?

December 11th, 2009 Sean

GM071002HillarysMedA popular topic often debated in political races and amongst health care providers is the need for nationalized medical coverage (socialized medicine). Various other countries like Canada, England and Australia utilize such services. A popular argument for nationalized health care is availability of insurance for all citizens regardless of their financial situation. On the surface, the idea sounds reasonable, but in a nation run by private enterprise it can cause more problems then it’s worth.

Insurance coverage provided by both the state and federal government has proven itself to be inadequate and bad for business. As it already stands government funded health insurance reimburses pennies on the dollar for both emergency and non-emergency medical care. Many hospitals, private doctors offices, and medical facilities are turning away these patients because of a significant lack of compensation.

EMS providers are in a bad position as they don’t have the option of turning away non-payers or government-funded payers. This leaves ambulance services and emergency departments relying on private insurance companies to make up for the significant losses caused by government-funded insurance. Switching to a nationalized health care plan would be sure to place most private providers out of business.

The loss of private EMS services would require state and local governments to pick up the slack and provide the service at the cost of the tax payers. This of course would significantly increase income and property taxes to pay for the insurance and the services provided in place of private medical operations.

Sure, having more government jobs could result in retirement plans and good benefits, but the amount of jobs available could rapidly decrease. Budget cuts and increasing cost of doing business would either result in raising taxes or cutting jobs. Once government bureaucracy comes into play, you can be assured that the number of ambulances on the streets will decline. Local police agencies are a prime example. It is hard to find a police department that claims to have adequate staffing or funding. Socialized medicine would leave EMS agencies in the exact same situation.

Our health care system in the United States is far from perfect. Abuse on the system, lawsuits and uninsured patients are constantly increasing the cost to provide medical care. Work needs to be done to resolve this issue, but not at the expense of the tax payers.

If you have any questions or comments, please feel free to e-mail me.

Posted in Opinion, Politics Tags: , View Comments
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