ICPDM Tactical Operational Medical Support
Dates: October 19th through October 23rd, 2009
Location: REMSA Training Center
Fee: $1450 ($200 deposit required to reserve class spot with remaining $1250 due at least 30 days prior to class). 20% discount for REMSA employees and education allowance may be applied towards registration fee.
NOTES:
Class size limited to 15 students.
No refunds within 7 days of class. Deposit refundable with cancellation 30 days or more prior to class.
Registration: ICPDM.ORG
Street Level Drug Awareness
REMSA Education and Training and Sparks Police Department Drug Recognition Experts will provide education on the newest and most commonly abused street and prescription drugs in the area as well as assessment and management of patients under the influence of these substances. Topics include:
- Commonly abused street drugs in the area
- Recognition and treatment of side effects associated with drug abuse
- Overview of abused prescription drugs
- Identification of drugs and potential safety concerns associated with them
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| Dates | Day | Start Time | End Time | Location | Fees | |
|---|---|---|---|---|---|---|
| 08/07/2009 | Fr | 01:00 PM | 05:00 PM | 230 – REMSA Education West Room |
$40.00 | |
| 08/10/2009 | Mo | 01:00 PM | 05:00 PM | 230 – REMSA Education West Room |
$40.00 | |
| 08/13/2009 | Th | 01:00 PM | 05:00 PM | 230 – REMSA Education West Room |
$40.00 |
MEDICATION AND OTHER ERRORS IN EMS
When we review charts and Occurrence Reports we find that there are many different types of errors made as we care for patients. Happily, errors do not happen every day and not all errors result in harm to the patient; but then you also have to wonder how many errors are made that we never catch? The most important thing to remember is that most errors are preventable.
Some common errors in EMS that have resulted in legal action across the nation are:
• Delays in patient care because of an inability to find the patient’s location
• Equipment that doesn’t work or a lack of knowledge on the provider’s part of how it works
• Medication errors
• Esophageal intubation
• Vehicle crashes
• AMA of a patient that is not competent
What can we do as EMS providers to prevent errors?
• Look at your map book and know traffic patterns for different times of the day. If you can’t find a location, call into dispatch early and get help.
• Occupy your downtime productively: Having nothing to do produces boredom or anticipation. Both boredom and anticipation are exhausting and exhaustion can lead to errors.
• Check your vehicle and all of your equipment before you start your shift: Is everything there? Does it work? Do you know how to use it? If you have questions on equipment, ask a supervisor, or the education department.
• Maintain your knowledge base and competency: Attend the monthly CE programs, subscribe to journals, research current trends on the internet and use your education money to attend conferences. Check your mailbox for updates and changes in protocols and equipment.
• Always use the five rights when giving a medication (right patient, right drug, right dose, right time, right route). Don’t rely on the fact that every medication container will always be in the same spot in your med box; look at the label and the strength EVERY time you give a medication. Verify patient medication allergies; check medication name on package; check medication name on container (syringe, vial, ampule, bottle); check/validate expiration dates; check total container quantity; draw the correct dosage and verify the drawn dosage. If you are uncertain about a drip calculation or a dosage calculation, have your partner check and verify your math. Don’t ever give a medication that someone else has drawn up.
• Use multiple methods of confirming tube placement but ALWAYS rely on the best: ETCO2. Secure the tube well, continuously monitor the patient’s cardiac and SPO2 status and immobilize the patient so the patient doesn’t dislodge the tube. Frequently reassess your tube and patient and recheck tube placement after every patient move.
• Take care of yourself and your partner: Fatigue, hunger, thirst, illness, preoccupation and complacency can all lead to errors. It is your responsibility to know when you can no longer perform optimally.
• Document all of the aspects of competency and capability of the patient to make the decision to refuse care. This is one protocol you should know inside and out and never skimp on documentation. You want to document on each of the seven points in the protocol and if the patient refuses to sign or walks away, be sure you document that action. Before allowing any patient to sign AMA be sure you have checked for and documented any possible organic reason for his refusal or that would make him incompetent to sign AMA (hypoglycemia, intoxication, dementia, head injury, hypotension, etc.)
• Work as a team: Teamwork can decrease certain types of errors. Acting alone or without support can lead to patient care problems on a number or levels.
• Communication is key to making positive differences: Confirm medication orders, reaffirm protocols, and repeat information back to the patient to be sure it was heard correctly. If you are ever unsure of your treatment or want further advice with a patient, don’t hesitate to contact a base station physician.
Every error of any magnitude should be reported. Reporting an error immediately protects you and the organization. Sentinel events are errors that have a higher likelihood of causing harm to a patient, attracting media coverage, going on up the chain of command as a complaint, or ending in litigation against the organization and/or the care provider.
In the words of the African American poet, Nikki Giovanni, “Mistakes are a fact of life. It is the response to the error that counts.”
Diane Rolfs, MS RN
Mt. Rose Ski Patrol ALS Pilot Project
Mount Rose Ski Tahoe Resort has presented a challenge to EMS providers over the years. When severe weather, severe injury or illness and remote patient location are combined, definitive patient care can be significantly delayed and compromised. We all know that the Mt. Rose Ski Patrol is one of the best patrols in the industry and although the Rose professional ski patrol employs many paramedics, EMT-Basic care can only be provided according to laws and the insurance carriers. After researching the subject of ski patrol ALS care, we found that there were a few areas in the U.S. that provide advanced care. In those cases, a special paramedic district was formed or the county EMS agency actually assigned medics to the area as Vail does. Our Medical Director, Dr. Ryan, was open to a proposal that could improve patient care at the Resort using current resources. There were 10 paramedics that worked for various ALS agencies, but 7 were under Dr. Ryan’s direction at North Lake Tahoe Fire (Incline) and REMSA. Over the summer and fall of 2008, the proposal was presented to all the agencies that would be involved. The management and legal counsel of Mt. Rose, REMSA and North Lake Tahoe Fire Protection District worked together as a team, with the goal of providing the best patient care in the Sierras. The plan allows NLTFPD and REMSA paramedics who are working as Pro Ski Patrollers at Mt. Rose, to provide ALS care when needed according to their respective protocols. The Medic would be required to notify the EMS dispatch agency that they were “on-scene” to be able to provide ALS as would be required if they were to roll up to say, an accident scene in their POV. After numerous meetings and discussions the plan was set and all we needed was snow to get the Mt. Rose ALS Pilot Program launched. All of the supplies and equipment came from REMSA stock and Phillips generously loaned us 2 MRX monitors for the season.
So far we have treated 25 ALS patients, the majority were provided pain management for trauma but we have also treated an ACS patient and various medical complaints. There have been a lot of assessments done by the Patrol EMT-Basics with the Medics being “consulted” but ALS care was deemed unnecessary. A key benefit of the ALS assessment has been a better utilization of Care Flight for appropriate patients. A survey of patrollers revealed that they felt working with paramedics on calls helped deepen their knowledge base and gave them reassurance that their patients were getting the best possible care immediately and also felt that they were a part of that process. In a nutshell, the Pilot program appears to be a success so far. As the ski season comes to a close, there will be a comprehensive review of the program to evaluate the effectiveness and make any changes that are needed. We hope that the Mt. Rose Patrol ALS Program will be continued for many seasons in the future. To quote our first ALS patient who had to be extricated from a pile of granite with a femur fracture, “I know I’m hurt pretty badly but I was really afraid that moving me would hurt me even worse…it wasn’t so bad actually” (might have had something to do with the nitrous/fentanyl). There are many people involved in the development and success of the program but here are a few names to mention…Mike Ferrari Patrol Director, Paul Senft General Manager Mt. Rose, Patrick Smith, Dr. Joe Ryan, Chief Mike Brown, Mike Williams, Jim Gubbels, Diane Rolfs, Evan Schwartz, Russell Barnum, Bruce Hicks, Nathan Johnson, Tim Egan, Mike Schwartz, Kevin Romero, Paulette Schneider, Asst. Patrol Director, REMSA “Ski Car” Crews and Dispatch Center Staff and the Entire Mt. Rose Ski Patrol.
If you have any questions regarding the ALS pilot or are interested in being a Ski Patrol Medic contact Charlie Tabano, Program Coordinator. ctabano@remsa-cf.com, or call at 775-741-0772.
Charlie Tabano
Mount Rose Ski Patrol Paramedics