Due to Flash problems, use these links: Home Blog Links Contact More info
I’ve always harped on the importance of proofreading, though I admit it’s really easy to let some things slide, such as missing words (especially really short ones in a long message). Some are a bit more tough to let go, such as this attempt at a compliment coming from our state EMS officials:
With numbers like these, there is doubt you are “Always There All The Time”
Sometimes, “no” is the most important word of all.
From the always-entertaining Failblog:
Whew! What a day! It’s taken me a couple days to have a few minutes in front of the computer to really put my thoughts together regarding this event.
First of all, NAEMT considers the event a success–not a surprise, given that they thought they might be able to get 30-40 people to this, and ended up with 3 times that upper number. I saw a pretty decent cross-section within that group: people representing city, county, and private EMS agencies, some that were fire-based, some hospital-based, some independent.
Pennsylvania, I must say, had a decent showing: 9 of us. (It should have been 15, but there were some last-minute cancellations.) Notably absent (given their proximity) was anyone from Philadelphia, but at least we had a decent variety: from big-city EMS (Pittsburgh) to smaller-city EMS (Allentown) to the suburbs (Ambler) to the more rural (Quakertown), plus the executive director of NAEMSE, and some dopey resident physician.
Monday was a quick evening briefing on what to expect and what to talk about (this year’s requests listed here, complete with links to the actual handouts we had). Tuesday started later than I expected, with our first meeting at 9:30am.
Tuesday was a hectic whirlwind of a day. As delegation leader, I ended up at all of the meetings I could get to, which meant hitting 6 of the 8 meetings, but I think half the delegation came to just as many meetings as I did. It doesn’t sound like a lot of work to get to 6 meetings between 9:30 and 3pm, until you realize that few of them were in the same office building–which meant, say, leaving one of the House buildings south of the Capitol, walking past the Capitol to the Senate office building, taking out all the metal in our pockets to clear security, having the meeting, then heading back past the Capitol for another House meeting. Nevertheless, we were only 2 minutes late to a single meeting, which I consider a victory.
The meetings varied a bit, though all were with staffers. We did run into Sen. Robert Casey on his way to a caucus meeting, and he was gracious enough to pose for a picture with us.
The shortest meeting was about 10 minutes; once or twice, we had 30 minutes with the staffer. We never really had to deal with anyone who seemed really resistant to our ideas, but it’s always tough to tell if anything useful will actually come out of these. Of course, you have to try–if you don’t, someone else will happily bend the ears of our elected officials.
Today I leave for EMS on the Hill Day, which is tomorrow. I will try to post some updates if anything interesting happens (and a summary blog post if nothing does). If you’re feeling motivated enough to write your Senator or member of Congress a letter about an EMS issue, today would be the day, and fax it to them–that way, they’ll have plenty of supporting constituent letters when we show up at their offices.
The unfortunate thing about global commerce is that company names that aren’t problematic in, say, German, can become offensive or silly in other languages. Would you buy from Assmann Electronics?
Over my EMS career, I’ve only had extensive experience with 2 tripsheet programs. One was programmed poorly and quite buggy; the other was clearly designed for flight nurses, not ground paramedics. However, both of them would at least produce a report that would give useful data to someone reading it.
In PA, electronic documentation is the law, and few places in this side of the state use handheld computing to any degree, so it’s rare to get a tripsheet on a patient while they’re still in the ED. Nevertheless, I’ve occasionally referred to EMS documentation on my floor rotations, so tripsheets aren’t entirely worthless–unless they look like this:
Looking down, some of it looks fairly intuitive–when area A is assessed as “Patent” and B gets “Normal Respirations,” this starts to look like the standard ABCs–until you get to C, which get the remark “Neuro Intact.” And what, pray tell, is area U? Granted, it’s pretty easy to figure out that this is a basically benign exam (although I seem to remember a bruise or abrasion on this gentleman’s face; it’s tough to tell without my admission H&P in front of me as I admitted him at the beginning of April), but if there were an abnormality, would it be obvious where it was to the casual reader?
I understand that at trial, or back at the station, there’s a key that you can pull out to put these things together. But to those of us without the magic decoder ring, it’s a total mystery. How this program meets Pennsylvania standards, I’ll never know.
(Incidentally, I hit the offending agency’s website to let them know that their current program is horrible, but they don’t list an email address or have a comment submission form on their website.)
Just a note: for those of you who didn’t already know this (and I know there are at least 2 of you), if a patient tells you he had TB ten years ago and has had clear chest X-rays every 6 months since, he doesn’t have TB. Since he doesn’t have TB, you don’t need to wear your N-95 masks, and you most certainly don’t need to call ahead to the hospital and ask for an isolation room, which will invariably have someone in it when you ask, setting off a flurry of activity as we try to move the patient who doesn’t need a negative pressure room to make way for…a different patient who doesn’t need a negative pressure room.
So for future reference, if you ask about medical problems and someone says they have/had TB, make sure you clarify whether they have TB right now or not.
I don’t know how much things have improved in more than a decade, but my paramedic text (circa 1997) has exactly 2 references to sepsis or septic shock in its index. One is a single sentence (not totally correct, though not totally incorrect either, emphasis in original): ”Septic shock, for example, is caused by the release of an endotoxin from several Gram-negative bacteria.” The other reference leads to a full page of information, half of it bullet points…in the “Pediatric Medical Emergencies” section. There is not a single direct reference to adult sepsis in the entire book. In addition, I’ve not seen any paramedic agencies with sepsis protocols, although they undoubtedly exist.
Recent research might someday change this. A recent small study looked at just 52 ambulance-delivered patients with severe sepsis; just under half got fluids. (In case you’re wondering how it took 2 years to get just 52 study patients, the study only looked at patients with severe sepsis–963–then cut out those not brought in by ambulance–down to 216–and further cut out those who didn’t receive “early goal-directed therapy” (EGDT). Of those final 76, 4 had no EMS tripsheets (!), and 20 were brought in by BLS ambulance, and couldn’t properly be studied for comparison.)
Important bit of information for background purposes: EGDT is a bundle of treatments intended to be performed early in the patient’s hospital course, with specific treatment goals in mind including blood pressure, central venous pressure, and central venous O2 saturation.
While the numbers were too small to achieve statistical significance, patients receiving prehospital fluid tended to be more likely to achieve these goals within 6 hours of arrival; the data were strongest for the BP goal. This is despite the fluid group having an average initial SBP 20 points lower, both on-scene and on arrival at the ED. (Appropriately, then, the apparently sicker fluid group had a higher mortality–but again, not a statisically significant number.)
So is it appropriate for an EMS agency to develop sepsis protocols? Certainly. Is it going to help anybody? Well, this isn’t proof, but a very suggestive hint that it just might.
Bonus links: the Surviving Sepsis campaign. A model state protocol I intend to submit to PA.
For those of you bored at work and stationed on a street corner somewhere, with only a Crackberry or other mobile phone to access this series of tubes, I’ve thrown up a plugin to make my blog a mobile-friendly site. It should automatically detect that you’re using a phone rather than a desktop.
The definitive guide to being a prehospital medical director is probably the 4-part series put out by the NAEMSP, although ACEP’s guide is probably a close second (plus cheaper and more portable to boot). However, if you really felt that the government needed to duplicate what’s already been done, how would you arrange it? Would you put it under EMS’ traditional federal home, the NHTSA? Perhaps coordinate with NAEMSP to be the lead organization?
No, of course not. Instead, you’d put it under the Department of Homeland Security, because that’s where the US Fire Administration ended up. Instead of getting a physician group to take charge of a document meant for physicians, you’d toss this responsibility to the International (!) Association of Fire Chiefs.
Disclaimer: Despite these misgivings, I’ve agreed to be on the committee that puts this document together…as the NAEMT’s representative. I hope they have NAEMSP and ACEP reps on the committee–I wouldn’t expect much buy-in from physician groups without it.
Subscribe to this site's RSS feed.