Congestive Heart Failure Management
Congestive Heart Failure, CHF, Pump Failure, Corpulmonale, Cardiac Asthma, Right-sided Heart Failure, Left –sided Heart Failure: What do all of these conditions mean? Are they just different names for the same thing or is there a difference in diagnosis and management?? In this class, Dr. John Swanson, M.D., Renown Emergency Physician will be discussing Conges-tive Heart Failure diagnosis and prehospital and emergency treatment. Learn about the latest science behind current treatments and therapy.
Course Faculty: Dr. John Swanson
Course Dates: September 21, 2009, 14:00—17:00, October 1, 2009, 14:00—17:00
Course Cost: $30, Free to REMSA / Care Flight Employees (employees must call to register)
Audience: Course is open to EMT’s, Paramedics, RN’s, Other Medical Professionals
Registration: 775.858.5700 Ext 4168 or www.remsaeducation.com
Continuing Education Units Information: Approved for 3.0 Hours
CA EMS #94-0104 / BRN CE Provider #NV030198-1
Have a Ball Miniature Golf Tournament
Hello Safe Kids Supporters,
We have scheduled the first Have a Ball Miniature Golf Tournament to benefit Safe Kids Washoe County on October 10 at Wild Island Golf Course!
Attached is a flyer with participant information as well as a sponsorship flyer. Please post, distribute and spread the word! Additionally, I have full color brochures if you would like any to distribute!
Your support is critical to our success! Sign up with your friends and family. Ask a business you know to sponsor a hole! Create a great costume for you and your team!
This will be a great fun-filled event for everyone involved! Thanks for your help!
Have a Ball Flyer
Have a Ball Sponsor Package
SFPA Conference With TNCC and FCCM Preconference Workshops
14 CE hours will be awarded to EMS personnel and nurses who attend the conference
This two-day conference will provide cutting-edge and thought-provoking topics on the continuum of care from the pre-hospital setting to the emergency department. Enjoy this opportunity to network with friends and colleagues and see state-of-the art equipment and technology.
Location: Saint Mary’s Conference Center, 1111 Gough St, San Francisco, CA 94109-6686
Dates: September 24 & 25, 2009
Preconferences: September 22 & 23
Conference Sponsors:
Medtronic Physio-Control
Philips Healthcare
Zoll Medical Corp.
Download PDF flier here
Barton University Wilderness EMT Course
Challenge your urban EMT skills in the wilderness and learn to treat backcountry injuries.
DESIGNED FOR:
❖ Outdoor enthusiasts
❖ Ski Patrol
❖ EMT’s
❖ Backcountry skiers
❖ Paramedics
❖ Fire ghters
❖ And many other professions
Cost: $650, five-day course
Earn: 45 EMS CE’s, CME’s or CE’s
How Safe is a Safety Harness?
You are dispatched to a priority 2 fall at UNR. Dispatch informs you that there is a building under construction and the patient fell from a third floor and is hanging from a safety harness. You arrive to find a construction worker hanging from a support beam by his safety harness approximately 25 feet above the ground. You are able to talk to the man and he says that he isn’t hurt but his legs are starting to “go to sleep”. The jobsite foreman informs you that he fell approximately 6 minutes ago and that he fell about 5 feet until his harness stopped him. RFD arrives within moments but is unable to reach him with their equipment. They call for a ladder truck to respond to the scene. You are fairly certain that this will be an AMA since there doesn’t seem to be any injuries. While awaiting the RFD ladder truck someone yells out “I think he’s unconscious!” You look up to see the man hanging lifeless in his harness. His coworkers are yelling to him but he doesn’t respond. You are helpless, awaiting the arrival of the ladder truck. The ladder truck arrives within minutes and sets up to rescue the man but it takes 4 minutes before they reach him. They carry down a lifeless patient to you and your partner. Your initial assessment reveals a man in his early 30’s that is unconscious and unresponsive. He is pulseless and apneic. You immediately start CPR and move into the ambulance. You do the usual treatments and procedures in route to Renown but to no avail. You hand the patient off to the physician at Renown and he is pronounced dead several minutes later.
What happened? Why did this young and seemingly healthy man die from such a short fall? Suspension trauma is a rare but we should be aware of the dangers associated with safety harness use. Death or injury secondary to the use of a safety harness is called, “suspension trauma.” The cause of death or syncope from suspension trauma is “orthostatic intolerance.” Orthostatic intolerance can be caused by several things. A common cause of orthostatic intolerance is standing with the knees locked for long periods of time. When the knees are locked there is not much need for the leg muscles to remain tight so they relax. This allows blood to pool in the legs and thus resulting in hypotension and syncope. When this occurs, the person will quickly become supine and blood is returned to the heart and the symptoms are resolved.
There are several types of safety harnesses out there but most of them support the majority of the person’s weight with leg straps. When a person falls and is suspended by the harness, the body is usually in an upright position with the legs hanging below. The legs become relaxed and the harness impedes venous return to the inferior vena cava. This results in a large amount of blood pooling in the lower extremities which lowers the amount of circulating blood to a potentially lethal level and also creates a relative “compartment syndrome.” When a person’s blood pressure falls, creating an unconscious state it would normally result in a supine position. When hanging in a harness, this doesn’t happen. Instead, the body is suspended upright with no way to correct the situation. There have been many documented cases of death from suspension trauma however not all of them occur while the person is still suspended. There is another potentially lethal situation here called “post rescue death.” Because of the relative “compartment syndrome” the blood in the person’s legs is deoxygenated and may also be contaminated with very high levels of sodium and potassium. If the person is brought to the ground and immediately moved to a supine position, the rush of “bad” blood from the legs can cause cardiac arrest.
So what does this mean for us? Well if you are the lucky one that gets this call there are a few things you can do. If the person is still conscious but hanging in a harness you can instruct them to pump their legs up and down or ride an imaginary bike which will cause the muscles to contract and squeeze the blood out of their legs. If the person is unconscious they need to be rescued quickly (probably by fire). According to OSHA 29 CFR 1926.502 employers are required to provide for “prompt rescue of employees in the event of a fall or shall assure that employees are able to rescue themselves.” This may be by calling 911 or the employer may have a “Fall Rescue Team.” If this is the case, work with the team as they probably know more about harness safety and rescue than we do. After the initial rescue the patient needs to be handled very carefully. If they still have a pulse, some experts advise not moving the patient to a supine position immediately to deter a rush of “bad blood” into the central circulation. However other experts advise that if the patient is hypotensive, the brain may not be perfused requiring the need for positioning in trendelenburg. You may elect to transport with the head up and the patients legs hanging over the sides of the gurney if you feel it is appropriate. If the person doesn’t have a pulse or at any time during the rescue develops cardiac arrest they should be promptly placed in a supine position and CPR initiated. Regardless of how the person presents to you after rescue, transport is necessary to rule out damage to the heart, kidneys, lungs and brain as even in the absence of symptoms, damage could occur.
Eric Bridges EMT-P
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
Chili’s in Reno Sponsoring Safe Kids Washoe County
On July 29, Chili’s in Reno, Sparks and Carson City is sponsoring Safe Kids Washoe County!
10% of all sales all day – in-restaurant, take out and gift cards – will be donated to SKWC to support injury prevention programs and keeping kids safe in Washoe County.
Stay out of your kitchen and let Chili’s do the cooking! Beat the heat meet for girls’ or guys’ night out after work. Take your office to lunch!
You must bring the attached flier to any local Chili’s (addresses on the flier) on July 29. Please forward this email or copy the flyer and distribute to as many people as you can to support Safe Kids!
What’s in it for you?
Win a Prize!
Besides the great perks listed above ~ Safe Kids Washoe County will sweeten the deal ~
The group with the largest total of sales at Chili’s will receive a party catered by Chili’s (just write the name of your group, i.e., “Such N’ Such business” on the flier)!
Co-workers not interested? Then take 50 of your closest friends! The individual with the largest total of sales will receive a $50 Chili’s Gift card (again, write your name on the flier).
See you at Chili’s on July 29!