dr-exmedic.com

If you pay taxes for a government service, it only makes sense that you should be able to see how well your money is being spent, right?  In that spirit, one man has thoughtfully compiled what little publicly-available data there is on various EMS systems on a website entitled EMSCompare.

If you have data not already up there, Mr. Clemans’ email is right at the top of that page.  I have to imagine he’d welcome any additional numbers to flesh out his site (but didn’t ask).

One of the mantras I’ve heard, from my EMT class on, is that “too much oxygen never hurt anybody.”  It makes some sense at a gut level, and it’s resulted in the treatment of many, many patients with oxygen–far more than will ever be treated with it in the ED.  I know I’m not the only person who’s given oxygen to patients with abdominal pain, for example.

However, that’s one of the EMS truisms that needs to be erased from our collective memory.  While not proof of the concept that too much of anything can be bad for you, a new study in JAMA is certainly very suggestive.  I barely need to say very much if I just include the key table:

As you can see, among almost 3600 cardiac arrest victims, the mortality was lowest in the group with normal oxygen levels (45%), lower than both the hypoxic group (57%) and–more significantly–the hyperoxic group (63%), which actually had the highest mortality.  Even worse, the hyperoxic group was also less likely to be discharged home after surviving.

Now, the study itself was not structured to prove that too much oxygen is proven to harm:  it was just using observed data, not testing anything, so the best we can see is an association–not a cause.  However, it’s consistent with experimental data (mostly in pigs) suggesting that high levels of oxygen after ROSC can be harmful.

This is the sort of data that won’t change EMS practice overnight (unless you happen to already have a portable blood gas analyzer in the back of your ambulance–in which case, I’m extremely jealous).  However, it should help decrease our willingness to claim that “more is better.”

I’m very sorry that I missed the IIHS 50th anniversary crash when it happened–a perfect example of modern injury-reduction technology (a 2009 Malibu) versus what we used to have (a 1959 Bel Air).

Fortunately, they didn’t pick any sort of car that I have any attachment to–it would have been a waste of a perfectly good classic car.

I don’t know if this is an error of the dictator or of the transcriber, but I ran across it and it made me laugh, in a sick sort of way, because I’m quite certain that it was incorrect:

The patient`s family succumbed to complete cardiopulmonary collapse

I doubt that one very much–it was certainly the patient himself who expired.

Courtesy of security expert  Bruce Schneier, a link to SnapScouts, an Android program for “crowd sourcing crime prevention.”

If you have any doubt as to what point the website owners are making, their company is called “MiniTru.”

Engadget is mostly a consumer electronics site, so it’s kind of odd that they would have a brief blurb about the Lifepak 15–but at least they came up with a great title for it:

Medtronic’s LIFEPAK 15 defibrillator for extreme conditions, or extremely clumsy paramedics

My employer is handing out T-shirts with this logo for EMS Week, rather than using the official slogan.  I think this one is much more appropriate, don’t you?

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.