Archive for the ‘Field Medicine’ Category

Turn your Android phone into an EMS tool – Part 1

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Welcome to part 1 of my new series on “turning your Android phone into an EMS tool”. The goal of these tutorials are to help place the power of technology in the hands of EMS professionals. I have always been of the belief that being intelligent isn’t necessarily knowing everything, but knowing where to find information. Technology and the internet have empowered us as healthcare providers to be more productive and efficient all while providing exceptional patient care.

If there is one thing that I make sure I have before every shift, it is my Android phone. I use it to  look up drugs, research medical conditions, review protocols, translate foreign languages, identify pills, do math, take notes and make base contact. Ever since I bought my “Droid” a year ago, I have constantly been working to customize it to the point that it has truly become my personal EMS assistant. This guide will take you through easy steps towards customizing your own phone to help you in your everyday roll as an EMS professional.

So lets move on to the good stuff shall we?

Introduction

This tutorial will no require NO additional applications. I am going to show you how you can modify your phone to help make your job easier. Nothing that I show you will void your warranty or cost you any money. As a matter of fact, this entire series will show you how to transform your phone into your EMS assistant without spending a dime.

Step 1 – Setup your “EMS Screen”

Having multiple screens is just one of the cool features that comes with Android phones. In this section we are going to clear out one of those screens to be your “EMS Screen”. I typically make mine the one on the very right. This of course can be changed to your liking. If you really want to get fancy, you can install the “Helix Launcher” from the app market. This app allows you to add up to 7 screens on your Android phone. This is optional and something that can always be done at a later time.

Now that you have a clear desktop to be used as your “EMS Screen”, we need to start unpacking and decorating. To begin, lets place a really simple app on your screen that comes pre-installed. The calculator. I am a firm believer that no paramedic should be without one. To do this, you need to scroll to your EMS screen, press and hold your finger on the desktop until you see a menu box pop up labeled ”Add to Home Screen”. From here you will need to select “shortcuts”, then “applications” and finally select the app you want to add to your screen. In this case we will select “calculator”. Remember this method can be used to add any application you want to your EMS screen (or any screen for that matter). You can move the calculator icon around by pressing and holding it until unlocks, then you can move it about as you wish. I prefer to keep my calculator on the top right of the screen, you can find a place that works for you. Now repeat this process and add “Maps” as well. This will come in extremely handy when locating calls.

Now we need to make a couple folders that will be used to place contact numbers in. To add a folder, simply press and hold on the screen (just like the previous step) and select “folders”. From here you need to select “new folder”. Now that the folder is on your desktop, we need to change the name to better organize our contacts. Do this by opening the folder, then pressing and holding the title bar until a screen pops up that allows you to rename your folder. Input the desired name and hit OK. I typically have 2 folders on my EMS screen, “base” and “dispatch”. I use these folders to store dispatch and base hospital phone numbers. You can add as many as you like, but be careful not to take up too much room. There is a lot more to come and we will need all the space we can get. (Side Note – These folders can also be used to store shortcuts to applications)

Now the final thing to add in this step is our Google Search Bar. Having quick and easy access to Google’s powerful search engine may be the most useful feature that we add to our EMS screen. You should already have a google search bar on your home screen. You can either move that one to your EMS Screen or just make a new one. For the purpose of this article, we will just make a new one. To do this, press and hold your EMS Screen and select “Widgets”. From here we need to select “Search”. Once the search widget is in place, then you can move it to wherever you like. I prefer to keep mine on the bottom of the screen. Do what works for you.

Below is a picture of what our EMS Screen should look like so far.

Step 2 – Set up your contacts

This may seem like an obvious task to you, but you would be surprised how many paramedics don’t take advantage of even the most basic cell phones out there. As EMTs and Paramedics we have tons of phone numbers that should be accessible at all times. The simple steps that we cover here will also come into play as we cover some more advanced Android features later in this lesson.

There are various types of phone numbers that we need to keep. These of course may differ based on the area that you work, but here is a good starting point.

  • Dispatch (EMS, Fire, Police, etc)
  • Base Contact (Both core numbers and ER numbers)
  • Poison Control

I personally like to keep these numbers grouped together as it makes finding them much quicker. We will do this by creating new contacts and placing their respective category in front of the contact name. For example, when entering a phone number for your EMS dispatch, your contact name should look something like “Dispatch – EMS”. Likewise, your fire dispatch should be “Dispatch – Fire”. This way they will show up next to each other on the contact list. Below is an example of an organized contact list.

After creating the name of your contact, you will now want to add custom phone number fields. This will prove to be handy when adding phone numbers for the local hospitals. I typically like to add a number for making base contact and the general ER number. You can properly label these numbers by changing the default label from “home” to “custom”. This will bring up a window asking you to input the name that you wish to use for the label. You can then add as many more numbers as your wish using the “+” button. Below is an example of creating a custom label.

Continue these steps until you have all your desired contacts added.

Step 3 – Place Your Contacts in Folders

Now that we have added all of our contacts, it is time to put them all in their respective homes. We are going to do this by pressing and holding the EMS Screen , selecting “Shortcuts”, then selecting “Contact”. Now simply select the desired contact and it will be placed on your EMS Screen. Next we need to move it into the desired folder by pressing and holding the contact shortcut, then dragging it into the folder. Repeat this step until you move all of your contacts into their respective folders. Now when you need to dial one of your saved numbers, simply select the folder and select the desired number.

Below is an example of how you utilize the contacts saved in your folders.

Coming in Part 2

This tutorial was designed to get you started and lay the foundation for your new EMS tool. Part 2 of the series will feature some of the following:

  • A list of free useful apps that can be used in the pre-hospital setting.
  • More tips and tricks for adding different kinds of shortcuts to your EMS Screen.
  • A tutorial on how to place your protocols directly on your EMS Screen.
  • A guide and demonstration on how to put it all together.

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

Hyperventilation and the number game

I would like to share with you all a trick that I learned a little while back for dealing with patient’s that are hyperventilating. I’m sure you have all had that patient who is breathing 28 times a minute after their boyfriend dumped them or had some type of stressful event. This usually leads to Carpopedal Spasms which often leads to even more anxiety. Getting your patient to slow down and regulate their breathing pattern can be very difficult. The technique that I am going to explain has proven to be helpful to me, but it isn’t perfect as it requires your patient’s participation.

Before I get into this technique, please remember to assess your patients properly. Always try and rule out other causes of rapid breathing before assuming that your patient is just hyperventilating because of stress or anxiety.

When I encounter patients that are hyperventilating I try to get them to follow a normal breathing pattern by having them take a deep breath and then telling them to count to 10 slowly without taking a breath. It’s OK if they can’t make it to 10. You can can start low and work your way up. Once they finish counting, let them take one more deep breath and then do it again. Continue doing this until they regulate their breathing.

Like I said before, it’s not a perfect technique as the patient has to be willing to participate. I have had it work plenty of times but have also found it to be useless on some patient’s too. Please let me know if you have success with this strategy. Also, if you have any other tips for treating hyperventilation, feel free to comment below!

I hope you enjoyed this quick tip.


Next generation EMS

So there I was, sitting in the back of the ambulance cleaning up after running a combative patient that was under the influence of meth-amphetamines. My partner and I were wading through the wreckage that this outstanding citizen caused. Kind of like people do when their homes get demolished by tornadoes. I looked at my partner – who happens to be brand new – and told him that he did a good job on the call. He looked up at me with a confused stare and replied, “are you being scarcastic?” I explained to him that he stayed calm and did a great job with getting the restraints placed on the patient in a timely manner.  ”Um….thanks, nobody ever gives me feedback so I don’t really know if I’m doing a good job or not”, he replied.

After speaking with him for a while, I realized that he is afraid to ask any senior medics or EMT’s for advice. This really troubles me for many reasons. For starters, the majority of my family lives in this town and if a new EMT wants to better himself and learn from the more experienced medics, then I want that opportunity to be available to him. If he runs my family, I want him to be competent and comfortable with his skills.

Back in my night-shift days – before giving in to the call to promote to middle management – we used to all sit around the crews quarters and talk about our calls while finishing up our PCRs. Everyone talked about scenarios, asked questions and offered advice to the new guys. Nobody was afraid of being perceived as an idiot or a bad medic. We were all there to learn from each other and grow as professionals.  Nobody was out to be the “best medic”.

We owe to our newcomers to flood their brains with tips and information, whether they ask for it or not. Every time I see a teaching opportunity, I jump on it. Likewise, I take advantage of every learning opportunity that comes my way. Just remember, in time our “FNG’s” will become the senior providers. At some point in time, my health will get the best of me and I will require EMS. The same “new guy” that nobody wanted to bother with may end up coming to my aid. I don’t know about you, but I want him to have the benefit from learning from all our years of experience.

Short term memory loss and head injuries

I had a discussion with a fellow employee a couple days ago regarding assessments of patients with suspected head trauma. One thing that was brought up was acute short-term vs long-term memory loss as a result of a head injury. I would like to share a quick tip for assessing memory loss in these cases.

Patients with short-term memory loss may present themselves as a GCS of 15 if only asked the standard questions. Answering the month, day, president or even a simple math question correctly doesn’t necessarily mean the patient doesn’t have an altered mental status. Detecting the presence of short-term memory loss can help the hospital staff to diagnose a concussion or a hemorrhage.

One obvious sign of short-term memory loss is repetitive questioning. However this doesn’t always occur. My favorite assessment strategy is to give the patient a number or word to remember (something easy). Make sure they know that it is important that they remember the number or word as you will be asking them what it is later. Wait a couple minutes and ask them to repeat what you told them. If they can’t remember, you can always try it again to make sure. If they do remember, then their short-term memory is most likely still in tact.

If you have any questions or suggestions for assessing short-term memory loss, please comment below or e-mail me.

Dextrocardia and proper lead placement

Dextrocardia is a condition where the heart is located on the right side of the body, as opposed to the left. This condition is typically the result of a birth defect and doesn’t usually cause any problems. Patients with Dextrocardia are often undiagnosed until they receive their first chest x-ray or ECG. Depending on the person’s health history, they may go until early adulthood without knowing. Knowing that your patient has Dextrocardia will alleviate a lot of headache and confusion both in the pre-hospital setting and in the ER.

Below is an example of a chest x-ray of a patient diagnosed with Dextrocardia

When you encounter patient with Dextrocardia, it is important to place the ECG leads backwards. For example, the left-limb leads should be placed on the right side. If the leads are placed in their traditional location, the ECG will show inverted P and T waves.

Below are 2 ECG’s revealing Dextrocardia (The leads are in their traditional locations)

There is a lot documentation out there that suggests that defibrillator paddles / pads should be placed on the opposite side when defibrillating patients with Dextrocardia. However, there are also studies that show that paddle / pad placement doesn’t make much of a difference. If in doubt, contact your medical director and ask for guidance before being confronted with this situation.

Dextrocaria can be detected in a 12-lead ECG. An alerting sign is a P and QRS inversion in lead 1. If you encounter this, first check your limb leads to assess proper placement, then contact medical control to relay your findings. Do not assume that the patient has the defect if they have not been diagnosed by a physician.

Other than ECG placement and defibrillation, your treatment of patients with Dextrocardia doesn’t change.

If you have any questions, or have any more information, please comment below or e-mail me.

Why my daughter doesn’t play with balloons

I was en route to a call for a child choking. We are typically canceled on these calls before we arrive on scene as the parents either relieve the obstruction, or they realize that kid wasn’t really choking. Not this time. We made it all the way across town and arrived on scene to see a firefighter waving us into the house.

My partner puts the ambulance in park and gives our “on scene” traffic as I walk around to the back to get the gurney out. The firefighter walks up and says “Sean, the kids really choking…..not sure on what but we can’t get it out”. We get our equipment and head inside, doing our best to stay as calm as we can.

Sure enough, an 8 month old girl is on the floor with firefighters trying desperately to relieve the obstruction. They inform me that they are unable to ventilate with a BMV and back blows and chest thrusts are not working. I take a second to assess the child and realize that the kid now has no pulse. I quickly grab my laryngoscope and magill forceps and insert the blade to try and spot the foreign body that has deprived this poor child from oxygen. Seeing nothing but emesis, I grab the portable battery-powered and suction the airway. I go back in a see a blue object in the child trachea. I manage to grab the object on the first attempt and remove it. I place an ET tube and begin ventilating the child.

It was a balloon. A blue balloon that the child was biting before it popped, being sucked into the child’s airway as she probably gasped from being frightened.

The child is placed on our gurney, secured, and we are off to the nearest hospital. A quick look for IV access appears hopeless so I place an IO. After 1 round of EPI and Atropine, the child’s pulses return. No spontaneous movement, no spontaneous respirations…..just a pulse.

We get to the ER and the child is placed on a ventilator. Before clearing the hospital, I hear that the kid is now starting to breathe on her own. The ER staff was able to get a stable blood pressure and subsequently flew the child out to the nearest children’s hospital. I called that hospital every day for a week in hopes to hear good news. Unfortunately she died after a week of ICU.

Balloons are an infants worst enemy. They are possibly the worst thing a kid could possibly swallow. BLS methods of relieving balloons that are stuck the airway are next to useless. Unfortunately the parents of this child learned this the hard way. This is quite possibly the most mentally draining call that I have ever run.

If you have an infant or a toddler, be very careful when letting them have balloons. Please keep an eye on them, or just keep balloons away from them. Remember, we can’t all carry laryngoscopes around with us at all times.

H2S Suicide Warning – Please Read!

This warning came through my local EMS authority and was distributed amongst all of our employees. It is really an eye opener as it shows a good example of how approaching the unknown could cost you your life.

Please read through the attached document and pay attention to the details of the chemical used.

The document outlines a story about a young man that committed suicide by mixing chemicals to make a deadly gas. He was found in his car on the side of the road. Fortunately, he posted papers on his windows warning people not to open the door without calling hazmat and using proper protective equipment. Had he have not done that, the rescuers could have been killed or severely disabled with one breath.

Please read this and pass along the information so this doesn’t harm anyone. The next attempt might be so nice as to post warnings. Also, be warned that photos of the scene including the dead body are included.

H2S suicide warning

A few tips for passing National Registry

I recently received an e-mail asking me about study material for the National Registry exam. It has been a number of years since I tested, but I would like to share some tips I learned while studying for the test.

Written Exam

The written is probably the most stressful part of the whole thing. At least now you get your results within a day or two. I had to wait 2 weeks for my results! Anyway, on to my advice….

I used “Barron’s Nation Registry Study Guide” for pretty much all of my studying. The book comes with a bunch of practice tests that are very similar to the National Registry questions. As a matter of fact, I remember quite a bit of them being nearly the same as the questions I came across on the test. I would take the practice tests, grade them, and then highlight the areas I either missed or had to guess on. I would take notes on the subjects that I needed to brush up on and then go back and study them in my textbook. Worked like a charm. I passed on my first try!

The book is a great tool to ensure success on the first try but you need to remember a few things. The test isn’t as complicated as people make it out to be. I hear people say crap like “if you see oxygen as one of the answers, pick it”. That’s 100% BS. Go with the answer that you KNOW is correct. I also remember someone telling me “if you see mast pants as an answer, pick it”. More BS. Yes I saw a couple questions with mast pants and an option, but I know for a fact one of them was absolutely wrong. Carefully read the questions and answer accordingly.

Pay attention to the wording on the questions as some people will read the question too quick and get the answer wrong because they misunderstood. For example; if they say things like “initial treatment”, it probably refers to a BLS treatment (BLS before ALS!). If they say something like “priority treatment”, it’s probably referring to something more definitive like intubation. Read the question twice to make sure you didn’t skip over words like “not” or “don’t”.

I used to tell people to go back and read over the test and answers again to make sure they didn’t skip any questions or mark on the wrong spot. This of course changed with computer-based testing. Just remember, pick the answer you KNOW is correct.

Skills Testing

I HATED practicing for skills tests. It feels redundant and boring. Trust me it’s worth it. All those stupid things like “c-spine” and “scene safety” WILL make a difference. Practice with some other paramedic students, and some seasoned paramedics. Memorize those skills sheets. Remember your proctor will be following one while you make a fool of yourself trying to get your license.

Something to consider is what kind of people are doing your test. Do some research and find out what kind of system the proctors work in. Read up on their protocols and try to get into their mindset. Remember, what works for you may seem stupid to others. You are in their playground. Adjust accordingly. I know a bunch of people are going to e-mail me telling me that I’m stupid because regardless of their local protocols, the testing remains the same. I agree. However, they are humans and think and act like humans. They are naturally going to respond to what they are comfortable with. Run your scenario just like they would run a call in real life. Trust me, it will work wonders.

As always I welcome suggestion, comments, hate mail and questions. I hope this post can be of use to someone. Please let me know if you have any other advice to offer!

Have a great week everyone.

Marriages and Heart Blocks

The title will make sense soon……I promise.

I figured I would share with you all something I made up while I was in paramedic school learning ECGs. It’s an easy way to memorize the different heart blocks and how to recognize them. It all revolves around a story about a couple named “P” and “QRS” (clever huh?). Different stages of their relationship will represent the blocks.

Normal Sinus

P and QRS are in the honeymoon phase of their marriage. They are always together and never leave each others sight. Life is good for P and QRS!

First Degree AV Block

P and QRS are getting irritated with each other. While they still remain true to the relationship, they are keeping their distance for now.

Second Degree AV Block (Type I)

P and QRS have entered the viscous cycle of breaking up and getting back together. They get together, they start fighting and keeping their distance, and they break up again.

Second Degree AV Block (Type II)

P and QRS have decided to get back together again. However, P is still quite disgruntled and has decided to go out every night or two and fool around on QRS. You can probably imagine what comes next!

Third Degree AV Block

As you probably saw coming, QRS caught P cheating and moved out. They have filed for divorce and are completely separated. There is absolutely no relationship between P and QRS now.

The End

And that’s why I do this job

I just finished reading a great post on Jeramedic’s Blog about his first true save in the field. The whole time I was reading it, I couldn’t help but remember my first. Fortunately Jeremiah got to see the save right before his eyes. I had gotten pulses back in the field, but I knew (or thought) the downtime was to long for her to have any real neuro activity. I actually left the hospital sure that she wasn’t going to make it. That’s where this story gets good.

I was teaching an EMT class at the local college one night. The semester had just started and I having the students introduce themselves and explain why they want to become an EMT. After 20 minutes of the usual “I need this for my job” or “I want to be a firefighter”, a student asked to share a story if I didn’t mind. I encouraged him to take all the time he needs.

He walked up front and told the story of how he witnessed his mom collapse and go into cardiac arrest. He talked about how he didn’t know what to do and how scared he was. Then he started to explain what happened once the ambulance showed up. As his story went on, I started paying closer attention. This sounded familiar…..very familiar. After he told his story, I excused myself from the class for a minute and called a break. I made a call to my dispatch center and asked to reference the last name and see if any patient’s were run for a cardiac arrest in the last year. Just as I suspected, I ran his mom a little over a year ago. I was the paramedic that he was talking about.

Not quite sure how to approach this, I asked to speak to him in private. I thanked him for sharing the story and broke the news. He immediately teared up and gave me a big hug and thanked me over and over again. He went back in the class and announced to everyone that I was paramedic that saved his moms life. Everyone clapped for a good few minutes. I was full of emotion and didn’t really know how to act at that point. He went on to tell everyone that this is the very reason he wanted to become an EMT and eventually become a paramedic. I couldn’t believe it. I had inspired someone to do this job without even knowing.

He asked if I would be willing to share my side of the story, to which I did. I started from the point where we were dispatched an explained the series of events up until we reached the hospital. I watched tears come to everyones eyes and it wasn’t until that point that I truly understood why I do this job.

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