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I’d heard about waveform analysis of ventricular fibrillation before, but it wasn’t until I happened to read this article that I actually realized there are approved defibrillators out there that will do so.  (For a demo of the first one I found, a Phillips model, click here; that machine is actually undergoing a trial.)  In other words, some types of V-fib are more responsive to a shock than others, and a machine can be programmed to tell the difference.

Granted, this is useful only on the first shock in the patient with an unknown down time.  Witnessed V-fib, or second and subsequent shocks, could still be shocked manually, so manual defibrillation won’t go away any time soon.  However, this is an example of a bit of technology that could help customize resuscitations for each patient, instead of treating all cardiac arrests in a manner so formulaic.

Filed under: EMS
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I know that times are tough, and state money is hard to come by, but I still believe there are probably certain things a medical school trying to raise a buck should be above.  Case in point:

*sigh*

Filed under: Medical School
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With the AHA making a big deal about door-to-balloon time for MIs, it’s only natural that hospitals have been scrambling to find ways to reduce that time.  One way to reduce that time is to get prehospital ECGs transmitted to the hospitals to allow the ED docs to call for the cath lab to be opened, and hospitals have been trying to encourage EMS providers to send in patients’ ECGs.  One solution has been to spring for new gear; just this month, one large facility bought the EMS service I volunteer for a set of cables that allow our monitors to fax an ECG via cell phone.  Other services have upgraded their monitors with Bluetooth for the same purpose.

However, there is a cheaper way.  Unfortunately, I had food in my mouth when I read the following lines, which I find completely hysterical:

Our out-of-hospital personnel use their personal cell phones to take a picture of a 12lead EKG which they believe represents ST segment elevation myocardial infarction and transmit it to a hospital e-mail account.  Upon notification by the out-of-hospital provider, the e-mail picture is then accessed by the emergency physician.

The authors thoughtfully provide a login which allows you to access a sample image.  As I expected, the image quality is sufficient for the viewer to diagnose MIs so obvious the machine can read them, but doesn’t seem quite good enough for subtle ECGs.  However, I do have to give them points for style and creativity.

Filed under: EMS, Emergency Medicine
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I always wanted to be an evil scientist growing up; although, technically, I’m a Psycho Vigilante.  Now, there’s a website that will help quell my unnatural urges.

Filed under: Sunday Silliness
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There are many, many studies which are criticized for studying the obvious.  If you read the conclusion reached by this study, you would be forgiven for thinking that it is one of those:

Conclusions. The out-of-hospital intubation environment is significantly different from that of in-hospital providers. Paramedics frequently have a poor physical operating environment and encounter significant distractions while trying to perform endotracheal intubation.

Actually, the study isn’t really that much more than putting a handle on the obvious.  Yes, it’s obvious that prehospital intubations have fundamentally different conditions than intubations in the hospital (where you can control patient position, lighting, temperature, etc).  What was most entertaining was not the conclusion, but what proportion of calls had which distraction:  bystanders 14.1%, unsafe scene 0.2%, weather 1.5%, other 4.6%, none 79.5%.

What was also interesting was that more than half the intubation attempts were done kneeling at the patient’s head, which (at least as I see it) would give a less-than-optimal view for patients on the floor.  Perhaps I just need to spend some time playing to figure out exactly what they’re doing.

Filed under: EMS Research
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Plenty of companies have started selling units that will keep EMS medications at a constant temperature, based on some earlier studies showing some breakdown of meds from heat.  However, the picture isn’t really all that clear; other studies have shown no difference.

In an effort to resolve the discrepancy (and to test a much broader range of meds), a team from Missouri exposed 23 drugs to a temperature that cycled from -6°C to 54°C–temperatures that are certainly possible over the course of the year.  Eight of the meds dropped to less than 90% of their original concentration by the end of the 28-day study, important ones all:  lidocaine, diltiazem, dopamine, NTG, ipratropium, succinylcholine, haloperidol, and naloxone.

Some of these were no surprise–diltiazem and succinylcholine are supposed to be refrigerated.  Worse yet, there was no room-temperature storage control to compare.

However, in some regions of the country, this study might actually underestimate the damage done by letting your drug box fry.  I would think that having the low temperature half the time (as done in this study) would tend to preserve the drugs; if you’re in a less-busy service in most places in the US, you might very well have your drugs baking at that upper limit better than half the time, and not necessarily cooling down during the occasional call.  By the same token, a busy service might find its ambulances assuming environmental temperatures less frequently, giving more stability.

So what does this mean to actual EMS practice?  Probably not much.  I’d be much more interested in checking the levels of drugs actually carried on an ambulance.  That’s the real test–how these things work in the field.  After all, if we find that meds are getting used before they degrade, or that the actual temperature changes of the medications themselves isn’t as great as we thought, those climate-control boxes might not be necessary–but they’ll still be great for keeping that D50 from hitting 40 degrees in the winter.

Filed under: EMS Research
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One man’s cougar is another man’s MILF.

I made that up, and Google tells me no one else has said it, so I’m going to copyright it right now.  You may use it, but must give me some credit. 

Filed under: Sunday Silliness
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Most of my attitudes towards EMS were formed by my personal experiences with EMS services and systems which are pretty much formed in ways which fight against the provision of high-quality care.  Therefore, I nearly choked when I stumbled across an article entitled, “EMS Sex Ed Program Reduces Rural Pregnancy Rate,” primarily because I couldn’t trust probably half of the people I’ve worked with to provide such a program without making a some of the students uncomfortable (i.e. I couldn’t trust some of them not to use the word faggot, and I couldn’t trust others not to be trying to screw the high school girls), to say nothing of the actual knowledge of sex and reproduction among those colleagues (which is not necessarily their fault–my medical assistant students had a longer sex & reproduction section than the EMT-P curriculum).

Granted, the article isn’t a research article, but some small problems jump out at me.  Right in the first two paragraphs, the author notes that the school district involved had 12 pregnancies in the year before the EMS sex-ed lectures.  Then, “[a]fter only two sex ed classes taught by paramedics, the number of teen pregnancies fell to four, and in 2003, fell again to only one.”

This would be remarkable.  However, since there are no historical data in the article, there’s no way of knowing whether the 12 pregnancies in 2001 was a typical number or a mere statistical aberration.  After all,  terrorist deaths in the US in 2002 and 2003 dropped compared to 2001–does this statistic show the effectiveness of our counterintelligence agencies, or is it just a return to baseline after an unusual year?  (Hint:  look up the data for the preceding few years.)

The other question is one of curriculum development, which the article glosses over–it simply describes the program as “fact-based program that presents statistics and information.”  While there may have been very good research and input into this program (which the medics seem to have cooked up themselves–after all, the health department educator is described as being “unable to offer a program”), it’s not exactly a topic covered in paramedic school.

Most disturbingly, this article was published by a journal that calls itself Best Practices in Emergency Services.  How can this be described as a “best practice” when the article presents the level of proof that I would expect out of a USA Today article?

While I certainly welcome the day when paramedic-level providers will be commonplace outside the ambulance, I don’t know that this is a place I expect them to end up.  Maybe that’s just because I see the profession as having started out dealing with emergencies, and expect it to continue dealing with emergencies and urgencies.

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I just filled out waiver forms that would allow me to use my wife’s health care benefits instead of being charged by my school for personal benefits.  Last year, I filled out a form and turned it in to the registrar’s office with a copy of my card; the registrar’s office made a decision as to whether my wife’s benefits were good enough, and my bill was changed within a week.

This year, I filled in essentially the same form electronically.  The difference is, this year the equivalence decision will be made by the insurance company that provides student health benefits.

Hmmm, I wonder which way the decision will go this year.

Filed under: Medical School
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The FDA says it’s ready to review the new drug application of a company that’s created in injectable form of acetaminophen.  This would seem useful if we didn’t already have a readily available, cheap way of getting Tylenol (which is not exactly a life-saving drug, incidentally) into people who are unable to swallow:  the suppository!

Filed under: Emergency Medicine
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