Good Old Days of EMS

From StJoeNews.com:

Ambulance service was a raucous endeavor in the late 1960s and early 1970s.

It was a time when funeral homes — which for years had provided emergency services — gave the job to privately owned ambulance companies.

As you can imagine, the competition was fierce. At the time it was even humorous, as movies such as the 1976 “Mother, Jugs and Speed” spoofed these ambulance wars.

In St. Joseph, it was humorous and sometimes pretty dangerous. Here, rival ambulance companies often got involved in fist fights, gunplay and pulling false alarms on each other. Getting them at your home for an emergency could sometimes be a crapshoot, too. Most drove ill-equipped 1960 Buick Electra model ambulances. And the drivers had little more than a Red Cross citizen’s emergency training.

“One ambulance service would call the other one and say, ‘We need an ambulance up here at Krug Park place,’ or some other remote place, they’d chase up there and the other service would be sitting do

Emergency room volunteer serves up companionship, stat!

From FtMcMurrayToday.com:

Vilia Tosio is a friend of the emergency department.

She spends a few hours a week keeping patients waiting to be treated at the Northern Lights Regional Health Centre comfortable and comforted.

“There might be the perception out there that volunteering at a hospital is not so pleasant — that it may be yucky, but it’s not,” she said. “It’s about companionship, making people feel less scared. It’s being a friend; it may be something as simple as chatting with an elderly person who may have forgotten their glasses preventing them from reading a magazine.”

Tosio has been involved with the local hospital’s Friends of the Emergency Department program for a little more than a year, six months after she first moved to Fort McMurray with her husband.

Tosio, who is originally from South Africa, has also lived in Holland and New Zealand.

“I’ve always done volunteer work,” said Tosio. “Whether it is fundraiser for an orphanage in Turkey, collecting clothes for people in Romania and Africa or The Nelson Mandela Children’s Fund from South Africa … Ghandi once said that we must be the change we want to see.”

Tosio volunteers at the hospital once a week for an average of three to four hours.

“Even if you can give someone 15 minutes, that 15 minutes of interaction in an eight-hour day of waiting can make a difference,” she said. “Just imagine a mother who has a sick child and maybe she has other children with her too. Having kids in a confined space for up to eight hours is not easy.”

Tosio called volunteer work a rewarding experience.

“It’s always appreciated but you may not always see the results right away,” she said. “But somewhere down the line it’s going to make a difference.”

Tosio then showed Today an email sent to her last month from a woman she helped in 1998 who thanked her for her support at that time.

Jillian McIntosh, volunteer services co-ordinator at the Northern Lights Regional Health Centre, said volunteers at the hospital help relieve a lot of the stress and anxiety patients may feel.

“Isolation is a big thing with people who are in the hospital,” she said. “The reality is that staff can’t give their undivided attention to a single person and sit and chat with each patient for an hour or they would never get their work done. I think a lot of the families who have family members here are comforted knowing that we have great people who are here just volunteering their time to spend with their loved one. They really appreciate the fact that somebody who doesn’t even know their family member is taking the time to get to know them.”

McIntosh said the No. 1 quality the health centre looks for when selecting volunteers is “a genuine desire to help people.”

“It’s a great way to get to know their community, especially for newcomers to the city,” said McIntosh. “It’s also a great way to gain skills or develop ones that they already have.”

McIntosh said volunteers must also have Alberta Health Care coverage, go through a criminal record check, have references and even go through an interview process.

Along with the Friends of the Emergency Department program, the hospital also has volunteer opportunities for continuing care, pet therapy and a youth program.

Wisc. Dept. Debates Paramedics vs EMTs

From JEMS:

Members of the Big Bend Vernon Fire Department presented the fire board with two medical scenarios to demonstrate the difference between basic EMT care and paramedic care at the Aug. 17 fire board meeting.

Although all of the board members stayed to hear the first presentation on EMT care, two board members got up and walked out before the second presentation. Patrick Hays, Deputy Chief in charge of EMS for the BBV Fire Department, led the presentation, in which one scenario of a male patient with chest pain and shortness of breath, and who stops breathing and loses a pulse, was handled in two different ways.

In the first presentation, the patient received EMT basic level care without a paramedic. In the second presentation, the patient received care from an EMT basic, an intermediate IV tech and a paramedic. “People around the whole country have the impression that there are ambulance drivers and there are paramedics,” he said. “We wanted to show the different levels of EMS care.” During the first presentation, EMTs showed up to the scenario and took the patient’s vital signs, put him on oxygen, started CPR and transported the patient to the hospital.

Hays explained that if a patient has their own nitroglycerin, the EMT can assist the patient with it, but they cannot treat the patient with nitro. An EMT is also not authorized to give out any medications accept for aspirin, he said.

All of the fire board members listened to the presentation, but when it came time to present the paramedic scenario, Hays said board members Sue Fischer and Ellen Cole got up and walked out of the room. They completely left the building and stood outside until the presentation was done, he said. The two then returned to the meeting room once the presentation was complete. Hays said after the meeting he overheard the two tell one of the paramedics that it was nothing personal but that they “didn’t get paid for this.”

Hays said that the eight members on the fire board represent the 9,500 residents covered by the department and felt they owed it to the residents of the community to hear both presentations. “To me, this was the most amount of disrespect I have ever felt in my life,” he said. “It showed me they feel it’s not important to be educated about the fire department they are responsible for and that they don’t want to know what we do.”

Fire Board President Carol Shae said she was very pleased with the department’s presentation and learned a lot about paramedics that she never knew. “I was not aware they were going to do that (leave the meeting) and I consider it very unprofessional,” she said.

Rural Emergency Medicine: Patient Volume and Training Opportunities

From The Journal of Emergency Medicine:

Background: A paucity of board-certified Emergency Physicians practice in rural Emergency Departments (EDs). One proposed solution has been to train residents in rural EDs to increase the likelihood that they would continue to practice in rural EDs. Some within academic Emergency Medicine question whether rural hospital EDs can provide adequate patient volume for training an Emergency Medicine (EM) resident.

Study Objectives: To compare per-physician patient-volumes in rural vs. urban hospital EDs in Oklahoma (OK) and the proportion of board-certified EM physicians in these two ED settings.

Methods: A 21-question survey was distributed to all OK hospital ED directors. Analysis was limited to non-military hospitals with EDs having an annual census > 15,000 patient visits. Comparisons were made between rural and urban EDs.

Results: There were 37 hospitals included in the analysis. Urban EDs had a higher proportion of board-certified EM physicians than rural EDs (80% vs. 28%). There were 4359 vs. 4470 patients seen per physician FTE (full-time equivalent) in the rural vs. urban ED settings, respectively (p = 0.84).

Conclusions: Patient volumes per physician FTE do not differ in rural vs. urban OK hospital EDs, suggesting that an adequate volume of patients exists in rural EDs to support EM resident education. Proportionately fewer board-certified Emergency Physicians staff rural EDs. Opportunities to increase rural ED-based EM resident training should be explored.

Rocuronium vs. Succinylcholine in the Emergency Department: A Critical Appraisal

From Emergency Medicine Journal:

Background: Two methods of paralysis are available for rapid sequence intubation (RSI) in the emergency department (ED): depolarizing agents such as succinylcholine, and non-depolarizing drugs such as rocuronium. Rocuronium is a useful alternative when succinylcholine is contraindicated. Contraindications to succinylcholine include allergy, history of malignant hyperthermia, denervation syndromes, and patients who are 24–48 h post burn or crush injury. Non-depolarizing drugs have the advantage of causing less pain due to post-paralysis myalgias.

Clinical Question: Can rocuronium replace succinylcholine as the paralytic of choice for RSI in the ED?

Evidence Review: Four relevant studies were selected from an evidence search and a structured review performed.

Results: For the outcomes of clinically acceptable intubation conditions and time to onset, the two agents were not statistically significantly different. Succinylcholine seems to produce conditions that have higher satisfaction scores.

Conclusion: Succinylcholine remains the drug of choice for ED RSI unless there is a contraindication to its usage.