dr-exmedic.com

This year’s EMS Week theme is “Anytime. Anywhere. We’ll be there.”  Just in case you were interested and hadn’t noticed.

Filed under: EMS
2 Comments »

There is a whole string of riddles that ask “How do you hide a hundred-dollar bill from” a particular type of physician.  There’s pretty much the whole array of them here, but what I can’t seem to find right now is a discussion on some board somewhere about the proper answer regarding an ED doc.  The best answer of the group, I thought, was:  ”Stuff it in a tie.”  However, I think I’ve come up with something better (although of course someone has probably beaten me to it).

Q:  How do you hide a $100 bill from an ED doc?  A:  Anywhere out of plain sight–it’s not like they have the attention span to look for it.

Filed under: Sunday Silliness
2 Comments »

It drives me nuts to see the wrong conclusions taken from fairly simple data.  The latest example is in the popular press, which seems to universally believe that talking on the cell phone while driving is a huge evil.  (I’m not convinced it’s safe, but thus far, I remain unconvinced that it’s any worse than talking to the person next to you, eating, shaving, applying makeup, reading paperbacks, or any of the other distracting things I see other drivers doing, or have done myself.)  Note the lede to this story:

A very small percentage of the population can safely drive while talking on their cell phones, but chances are high that you’re not one of these “supertaskers.”

So what data brings the reporter to the conclusion that so few people can “safely drive” while doing complicated math problems?  Well, during simulated drives during a cell phone conversation

It took [drivers] 20 percent longer to hit the brakes when needed, and following distances increased 30 percent

So if you’re on the phone and allow more following distance because you know your reaction time is worse, that’s somehow “unsafe”?  To me, that’s a brilliant example of how people can adapt to what they’re doing, not a cause for alarm.

Keep in mind too that they were asking people do do math over the phone, not chat about the weather and what to pick up at the store–but that’s the fault of the study asking a non-real-world question, not the fault of the reporter.

Filed under: General
No Comments »

A recent study looked at the health characteristics of a group of people recertifying through NREMT, and I don’t think any of the conclusions were particularly surprising:  only 1 in 4 exercised at recommended levels (with the highest percentage being among those in the military, though still only 42%), just over a quarter had a weight in the government’s “normal” range (BMI 20-25) and a quarter met the “obese” category, and there were quite a few smokers (particularly among the women).

What was less surprising, but infinitely amusing, was a study in the exact same issue of Prehospital Emergency Care. The study itself was moderately informative (abstract here), particularly the part which described the subjects, who were South African paramedic students:

All subjects had been taking part in structured physical training…since beginning their studies in the department.  This physical training involved a 5-kilometer run once a week, at a pace of approximately 6 min/km, general training involving upper and lower body exercises (push-ups, sit-ups, squats, calf-raises, and so forth) lasting 20 minutes once a week, and informal ball sports for 30 minutes once a week.

Now, this isn’t very much, and certainly less than what you’d do at a comparable police or fire academy, but given the strain on the body of a paramedic (you too have probably seen Stryker’s “By the time his career is half over, he’ll have lifted 500 tons” ads), don’t you think it’s time that physical fitness became part of the curriculum?

Or, as the paramedic curriculum lengthens, are we better off letting the medics do the heavy mental lifting, and let EMTs do the physical stuff?

Filed under: EMS Research
No Comments »

There are some things you do that you just shouldn’t admit to in public, such as urinating in a shower that other people use, or singing along to Erasure’s greatest hits.  To wit:

I am ONLY getting rid of this phone because I am going back to a blackberry (simply becasue its easier for me to text).  I work for an ambulance service and its hard for me to text on the droid while I am driving to calls, which I have to do often to alert other crews of situations.

Emphasis mine.

And to think I only stumbled across this because I wanted to know how much it’s going to cost to replace my phone should it not start back up after it’s done drying out….

Filed under: EMS
3 Comments »

Just for the record, so there’s absolutely no doubt about this:  expressive aphasia (even if mild) is a deficit.  Since speech is controlled by the neurological system, expressive aphasia is a neurological deficit.  Since there is a single place (or “focus”) in the brain responsible for speech, expressive aphasia is a focal neurological deficit. And if this happens suddenly, you have what is called a “sudden-onset focal neurological deficit,” which, the last time I checked, was one of the leading symptoms of CVA, also known as a stroke.

Which means that if you have a patient in your ambulance with sudden onset expressive aphasia, you really, really need to call it in as a stroke alert.  Not that there’s anything that’s happened recently that made me think of this….

(I will grant you that technically such a patient would be negative on the Cincinatti Prehospital Stroke Scale.  Allow me then a shameless plug for the talk I’m giving at the region’s annual EMS conference, which is properly titled “Beyond the CPSS” but is essentially how to do a cranial nerve exam in about a minute–and the brochure lists my lecture’s subtitle.  If you happen to be in Western PA later this month, stop by and pretend to learn!)

Filed under: EMS
No Comments »

Since I’m an advocate of open government in general, and especially since Pittsburgh EMS employees are paid in large part by my tax dollars, I like to see people making public documents such as this, which is the full medical director’s investigation into an incident that happened during our big snowstorm a few weeks ago.  (If you aren’t already familiar with the incident, a local man died after crews couldn’t reach him despite making 3 separate attempts; each time, they asked if he could walk to the ambulance but appear to have made no alternate efforts to reach the patient.)

Filed under: EMS
No Comments »

Ah, the Android version of Epocrates is finally available….

Filed under: Other random stuff
No Comments »

Research on the composition of ambulance crews is always fun to critique, in part because it’s generally pretty meaningless, and frequently raises more questions than it answers.  That makes it great to have come across a new study, which examined cardiac arrest survival rates in Milwaukee County, for patients treated by 2, 3, or 4 (or more) paramedics.

The authors looked at 12 years of cardiac arrest data, and were able to correlate EMS cardiac arrests to hospital patients, in order to accurately track not only ROSC but survival to hospital admission and discharge.  (From this aspect, at least, that makes this one of the higher-quality crew composition studies I’ve seen.)  The raw numbers gave roughly similar survival-to-discharge rates for crews with 2, 3, or 4+ medics (8.7, 8.7, and 8.4% respectively).  However, the percentage of each group responding to shockable rhythms was lowest in the 2-medic group (40.7%), higher in the 3-medic group (49.9%), and higher still in the 4-medic group (59.8%).  Given that the shockable patients are the most savable, the 4-or-more group should have had the highest save rates…but they didn’t.  This became very obvious when the researchers controlled for things known to make a survival difference (presenting rhythm, for example, or whether the arrest was witnessed):  patients treated by crews with 4 or more medics had 2/3 the odds of surviving to discharge of those treated by only 2.

One explanation the researchers suggest is somewhat plausible–perhaps all those medics being present and looking for something to do result in more ALS interventions being performed, resulting in less CPR (and we all now know how important quality CPR is).  Personally, I expected even the adjusted save rates to be perfectly identical, so my money is on another possibility:  that there’s some other factor that causes high mortality, but happens to be associated with having more medics on scene.

For example, survival has been shown to be lower in poorer people, who are also more likely to live in an urban area–exactly the kind of place you’d expect to get a response with more medics than you need.  This would mean that more medics don’t give worse care than fewer, but that their abundance is a marker for something about the individual, in the same way that ice cream sales and rape rates correlate almost perfectly–not because they are related but because they are related to some third thing (which, in the case of ice cream sales and rape rates, would be temperature).

Filed under: EMS Research
No Comments »

It turns out that, in addition to the national poison control center number (800-222-1222), there is a National Button Battery Ingestion Hotline.  I knew that swallowing a button battery can be bad; I didn’t think it warranted its own number.  Fun factoids:

• Nearly 25% of batteries are swallowed because they are mistaken for medicines or pills.
• Adults and older children often think of the mouth as a “third hand”, holding the battery there while working.

I guess that means that many of these ingestions are Darwinian in nature…pretty much everyone but the little kids.

Filed under: Emergency Medicine
No Comments »