Is the scene safe? Well rescue goes tragically awry…

From Fox 59:

The 911 caller is talking to dispatcher and Eric Dalton, a 40 year-old experienced plumber from Anderson who was using muriatic acid to loosen up pipe fittings.

Caller: “He is not breathing well. Get somebody to come here quick I have got two of them of them down there. They just passed out.”

Two volunteer firefighters from Liberty Township climbed into the pit also, but both Brian Buck and Rick Compton Sr. also collapsed from the fumes. All four were left slumped on top of each other in a dark pit.

Maryland Firefighter Delivers Baby in Station Lot

From JEMS:

A Montgomery County mother says she knew she wouldn’t make it to the hospital to give birth, so she had the baby in a fire station parking lot.

Erin and Christian Presley’s son was due on Monday, but then he couldn’t wait any longer. On the way to Shady Grove Adventist Hospital on Thursday, Erin Presley says she knew she had to push, so they pulled over into the Gaithersburg Volunteer Fire Department at 3 a.m.

Christian Presley says he rang the doorbell, but no one answered, and then he called 911. Firefighter Michael Skidmore woke up and helped deliver the infant in the parking lot.

Telemedicine for Stroke Diagnosis

From the State-Journal:

Louisville Health Care offers advanced options for stroke patients.

It’s a robot hospital staff call “NELSON” for Neurological Evaluator for Lowering Stroke Outcomes Nationwide.

It operates on a secured wireless broadband Internet connection and allows neurological specialists at UofL to provide care to patients in Frankfort from miles away.

“I see these patients all the time, but I’m no replacement for a board certified expert,” said Dr. Michael Presley, medical director of Frankfort Regional’s Emergency Department, at a press conference Thursday.

NELSON, 5 feet 6 inches tall, rolled into the room alongside physicians. A screen at the top projected the face of UofL stroke team leader Dr. Kerri Remmel.

Emergency responders may have faked certificates

From CNN:

More than 200 emergency medical technicians, firefighters and police officers in Massachusetts and New Hampshire may have to surrender their licenses after an investigation into falsified EMT course completion certificates, state officials say.

First responders must complete recertification courses every two years, but the investigation found that although some of them had been awarded certificates, they had not attended all the required classes, said Jen Manley, spokeswoman for the Massachusetts Department of Public Health.

Nurses in Minnesota and California set strike dates

From the AP, via Google:

Thousands of nurses in Minnesota and California on Friday announced plans to walk off the job for a single day next month if they don’t reach contract agreements with hospitals.

The nurses — 12,000 in the Minneapolis area and nearly 13,000 at hospitals across California — both set June 10 as a strike date. The walkout stands to be the largest in U.S. history.

Nurses in California say low staffing levels are their main concern. In Minnesota, nurses cited that along with pay and pension issues in authorizing a strike last week. On Friday, the Minnesota nurses said filing notice of intent to strike was necessary to get the hospitals to move on negotiations.

Emergency Docs Say BlueCross BlueShield Is Wrong About Unnecessary ED Visits

From HealthLeaders Media:

A national group of emergency room doctors and its New York chapter yesterday blasted this week’s Excellus BlueCross BlueShield report that says in Upstate New York, two out of five non-overnight visits to hospital emergency departments are unnecessary.

“There are serious and profound methodological flaws in the Excellus study,” said Gerard Brogan, MD, president of the New York American College of Emergency Physicians.

“Using the final discharge diagnosis rather than the presenting symptoms, ignoring that the patient with low back pain could have just as easily had a rupturing aortic aneurysm, as well as eliminating all the patients that were admitted to the hospital from the ER due to the severity of their illness, unfortunately, significantly weakens this analysis and calls into question its validity.”

Sandra Schneider, president-elect of the American College of Emergency Physicians, added that the report “does not capture all the data necessary to analyze whether an emergency visit was appropriate, and it leads to false conclusions.”

Immediate Defibrillation or CPR First?

From Resuscitation:

Delayed versus immediate defibrillation for out-of-hospital cardiac arrest due to ventricular fibrillation: A systematic review and meta-analysis of randomised controlled trials

Human studies over the last decade have indicated that delaying initial defibrillation to allow a short period of cardiopulmonary resuscitation (CPR) may promote a more responsive myocardial state that is more likely to respond to defibrillation and result in increased rates of restoration of spontaneous circulation (ROSC) and/or survival. Out-of-hospital studies have produced conflicting results regarding the benefits of CPR prior to defibrillation in relation to survival to hospital discharge. The aim of this study was to conduct a systematic review and meta-analysis of randomised controlled trials comparing the effect of delayed defibrillation preceded by CPR with immediate defibrillation on survival to hospital discharge.

Methods

A systematic literature search of key electronic databases including Medline, EMBASE, and the Cochrane Library was conducted independently by two reviewers. Randomised controlled trials meeting the eligibility criteria were critically appraised according to the Cochrane Group recommended methodology. Meta-analyses were conducted for the outcomes of survival to hospital discharge overall and according to response time of emergency medical services.

Results

Three randomised controlled trials were identified which addressed the question of interest. All included studies were methodologically appropriate to include in a meta-analysis. Pooled results from the three studies demonstrated no benefit from providing CPR prior to defibrillation compared to immediate defibrillation for survival to hospital discharge (OR 0.94 95% CI 0.46–1.94). Meta-analysis of results according to ambulance response time (≤5min or >5min) also showed no difference in survival rates.

Conclusion

Delaying initial defibrillation to allow a short period of CPR in out-of-hospital cardiac arrest due to VF demonstrated no benefit over immediate defibrillation for survival to hospital discharge irrespective of response time. There is no evidence that CPR before defibrillation is harmful. Based on the existing evidence, EMS jurisdictions are justified continuing with current practice using either defibrillation strategy.