Spring is in the air!

Greetings EMSers! We have survived another winter, albeit the

mildest one in recent memory. Weather has a huge impact on our

activity. Everybody I know comments that the slightest bit of snow

brings out the poor driver lurking beneath the surface of most of

those on behind the wheel. It seems like the amount of snow

required to achieve the highly coveted “snow day” has fallen from

an all-time high (when each of us were children) to a mere glazing

of the sidewalks, but we know the school systems have the safety

and well being of our children at heart.

Weather impacts us indirectly as well. While a snow squall can

bring on a rush of backboard shuffles, warm weather can have an

even greater effect on more people. Look out your window; No,

not at the rapidly growing lawn you need to attend to, at the trees

and flowers. They are blossoming and casting their spores to the

winds. This makes spring a wonderful season of renewal for some,

but it can be a pretty miserable time for others.

Pollen, mold and ragweed. All words that mean tough times lie

ahead for those with seasonal/environmental allergies and reactive

airway disease. At best, it’s a minor inconvenience. At worst, it

means constant hacking, sneezing and trouble catching one’s

breath. As we age, most of us will become more sensitive to our

allergies. Those born with sensitivity to environmental allergens

generally become more tolerant of the illnesses as they occur

through repeated exposure; rather than getting better, these people

become accustomed to dealing with the fallout of springtime and

year-round exacerbations of their condition. The bottom line is to

keep your allergy medications handy and use them at the first sign

of trouble; sneezing and itchy, watery eyes shouldn’t be a part of

life. Get your meds of preference and use them; heal thyself!

Watch the Kids.

Warm weather brings kids out in droves. Being cooped up for a

long, cold winter was one of life’s greatest tortures as a child and

though I did find plenty of ways to occupy my time both indoors

and out, nothing beats a mild, sunny day

outdoors. Be cautious and look for all the

learners in your neighborhood; youngsters

learning how to get out and about on

everything from tricycles to bikes and

motorcycles. Most kids aren’t focused on

their surroundings as they enjoy riding and

this leads to several “designer” injuries as a

result of those lapses.

In urban areas, kids tend to dart between parked vehicles, shooting

into traffic without looking for what’s about to hit them. Take note

of the size of the vehicle that struck the child and look for

corresponding injuries. Keep in mind that young bones don’t break

completely, nor do they offer the best protection to underlying

organs such as the liver, spleen and spinal cord. Children with

blunt, traumatic injury should always receive full spinal

immobilization (and the time the equipment was placed recorded).

Out in the country (and some suburban areas), kids tend to grow

up on dirt bikes and ATV’s more commonly. These machines

while fun, are where designer injuries originated because the type

and frequency of certain injures are attributable to riding. ATV’s

have a nasty tendency to “grab onto” the rider in a way that during

a tip-over accident, the machine does more injury to the rider than

contact with the ground. ATV rollovers are responsible for a high

number of spinal injuries. While floor boards on ATVs have all

but eliminated lower extremity trauma, heavy landings continue to

Volume 2 • Issue 4

News for EMS Professionals

The Lights & Sirens is a monthly publication of

Genesis HealthCare System for EMS providers

in the Muskingum and surrounding Counties. To

sumbit an article for inclusion in a future issue,

send e-mail to EMS@genesishcs.org along with

the writers credentials.

Happy Easter!

be a source of facial and neck trauma despite helmet use as the

rider’s head makes contact with the handle bars upon bottoming

out the suspension. Wheel-to-wheel contact on-track is another

cause of crashes. When wheels spinning at different speeds or in

opposite directions touch, the result is that one of the vehicles will

“climb” onto the other, or both with be violently repelled, causing

the rider to lose control.

Dirt bikes are a source of more predictable injuries. “Casing”, or

landing on the peak of a second jump or landing area causes the

suspension to bottom abruptly leading to broken ankles and axial

loading of the spine. Two wheelers do tend to be a little safer for

the rider than ATV’s in that once the rider is separated from the

bike, they tend to part ways. One other thing motorcycles have

more of than their ATV counterparts is altitude. Everybody loves

big air and getting it under you brings your

worst enemy into play; gravity. The old saying

goes: “Sky/ground/sky/ground, brace up, this

is going to hurt!”

A “low-side” is a type of slide in which the

rider lays the bike down, minimizing injury

to the rider and damage to the bike. A “high-

side” is a loss of control in which the bike initially slides, but the

tires suddenly grip, catapulting the rider into the air; this is

obviously the more dangerous and painful of the two. “Tank

slapper” is a motocross term for the loathsome straddle injury. If

you’ve ever been to a motocross race, you have seen first hand that

these riders occasionally crash their brains out, hop on and go

riding again. They are tough people from peewee to vet class, it

takes a hit to get a rider to actually stop and sit still to be

evaluated; it usually involves something that’s broken or otherwise

not working the way it should.

Something to keep in mind with the peewee crowd is their

helmets. With racers barely past their 5th birthday and riders

younger than that, it’s important to keep C-Spine front and center

in your care for these little ones. Those big heads on kids require

an equally large helmet to protect them. I get a kick out of seeing

the micro mini riders out there mixing it up, but be mindful that

those big helmets put some big torsional forces on those little

necks. Immature spinal columns and neck muscles don’t provide a

lot of protection from injury, so plan on boarding any youngster

that hits his head of had a witnessed fall.

“I bound him the way I found him”

It takes a lot to convince racers of any kind that they need to go to

the hospital. As stated above, generally the only way to get them to

go is if something is rendered out of order. For that reason, once

you get permission to take the rider to the hospital, you also have

to sell him on the idea of spinal immobilization precautions.

It’s critical for these patients to be splinted in the position found.

Remember: movement and time does not negate an injury, nor

does an injury have to fully manifest at the time it occurs. These

are tough people in terms of sustaining crash injuries and pain

tolerance and they very likely have much worse injury than what

they are letting on. Abdominal tenderness should be considered

internal bleeding until its ruled out. Pneumos are difficult to detect

in the field until they reach 20% collapse, never mind all the other

bikes going in the background. Use witnesses as a source for

determining Mechanism of Injury. The way a rider is struck and/or

strikes objects is a good predictor of that person’s injuries.

After reading all of that, you might think I’m anti-motorcycle/

ATV but nothing could be farther from the truth. I am a rider

with 40+ years of experience in both doing it right and learning

from my mistakes. I believe that if a rider has information and

understanding of the risks they are taking, it will help them to

survive both on and off-road. Wear your helmet, watch the

other guy and be safe!

Pharmacy Notes

Below is a list of drugs used by area EMS agencies and their

estimated back-in-stock dates.

Diazepam Injection 5mg/2 ml carpuject or vial (Hospira)

Est. Delivery Date: Late April, 2012

Etomidate Injection, 2 mg/ml 20 ml vial (Hospira)

Est. Delivery Date: June, 2012

Alternate sources: American Regent and Pfizer: In stock

Fentanyl Citrate Injection, 0.5 mg 2 ml amp/vial (Hospira)

Est. Delivery Date: May, 2012

Magnesium Sulfate Injection, 50% 20 ml vial (Hospira)

Est. Delivery Date: April, 2012

Midazolam Injection, 1 mg/ml 5 ml vial (Hospira)

Est. Delivery Date: April, 2012

Ondansetron Injection 2 mg/mL, 2 ml Syringe (Hospira)

Est. Delivery Date: April, 2012

Procainamide HCL Injection, 100 mg/ml 10 ml vial

(Hospira)

Est. Delivery Date: May, 2012

Promethazine Injection, 25 mg/ml 1 ml vial (Hospira)

Est. Delivery Date: 2013

Alternate Source: West-Ward (accelerated to March-April 2012)

Sodium Bicarbonate Injection, 1mEq/ml 50 ml Abboject

Est. Delivery Date: April, 2012

Vasopressin Injection, 20 u/ml, 1 ml vial (Hospira)

Est. Delivery Date: Late April, 2012

Vecuronium Injection, 20 mg vial

Temporarily Suspended

Alternate Source: Sagent Pharmaceuticals (Available now)

For more information see:

http://www.fda.gov/Drugs/DrugSafety/DrugShortages

News for EMS Professionals 4/2012, Page 2

Code STEMI Activation Update Cathy Huggins, MSN, RN, CNL, CCRN Chest Pain/Heart Failure Coordinator, Genesis HealthCare System

On February 28th, 2012, Dr. Albirini met with the ED Physicians

to discuss Code STEMI activation protocols. We were hoping to

be further along with 12 lead EKG transmissions, but that has been

held up waiting on grant funding. As the Paramedic scope of

practice includes 12 lead EKG interpretation, the ED Physicians

are willing to activate the Code STEMI response based on the

Paramedic’s radio report. The more information that you provide,

the more confident the ED physician will feel in activating the

Code STEMI. However, if it is a short transport, they may still

wait to visually examine the EKG before activation.

Here are some pointers for radio report that will help the physician

determine if they need to activate the Code STEMI team:

Chief Complaint and History of Present Illness: “This is a

55 year old male who called complaining of 8/10 chest pain

that radiates to the left arm and jaw. Patient states the pain

began approximately 30 minutes ago and was not relieved

with rest or nitroglycerine x 3. The pain is described as sternal

pressure and is constant.”

Associated symptoms: “He is also experiencing diaphoresis,

nausea, and shortness of breath.”

Pertinent medical history: “He is a diabetic with hypertension

and has a history of cardiac stents.”

Vital Signs: “His blood pressure is 102/50, heart rate is 46,

and respirations are 24, O2 sat is 94% on room air.”

Treatments performed: “He has had 4 baby aspirin, oxygen

is on at 2 liters per nasal cannula, and 1 IV has been

established.”

12 lead EKG findings: “The 12 lead EKG shows ST

elevations in leads II, III, and aVf with reciprocal changes in

v2, v3, and v4.” Be specific with what you see.

If a Left Bundle Branch is seen, ask the patient if they

have a history of previous LBBB and relay this with the

report.

ETA: “We have just left the scene and will be arriving in

approximately 20 minutes.”

A quality EKG tracing is much easier to interpret and leaves less

chance for false activations. Literature recommends that the 12

lead EKG be obtained in the patient’s home prior to loading in the

squad. A 12 lead EKG is more likely to have artifact if it is

performed in the back of the squad.

Early notification to the ED is helpful. If you have an extended

transport time, this will allow for earlier activation of the STEMI

team.

EKG’s that can be misleading include pacemaker rhythms, old

bundle branch blocks and pericarditis. If you feel that you would

like an EKG refresher course, Genesis Healthcare System

Education Services Department offers a Basic 12 Lead EKG and

an Advanced 12 Lead EKG Class free of charge. Each class lasts

about 3 hours and CEU’s will be awarded. If you are interested,

please contact the Education Services Department at 740-586-6550

to register.

The Genesis Shining Star of EMS award On Saturday May 26th, one deserving

nominee from each provider level, First

Responder through Paramedic will receive a

special recognition in honor of their

commitment to excellence in EMS. In order

to nominate a candidate, please include the

nominee’s name, provider level, department

affiliation and a brief narrative detailing why this person should be

considered for the award. Once completed, either drop the paper in

the run sheet box at Good Sam or Bethesda, or e-mail to

EMS@genesishcs.org. The winners will be selected on May 18th

and awards will be presented at the EMS week Conference at the

Genesis HealthPlex. Deadline for entry is May 18th at midnight.

Good luck!

Spring is safety season!

Spring is the time a lot of departments put on injury prevention

campaigns to promote community awareness of traumatic injury

and accidental death. Statistics show that preventable deaths

decline when outreach training is made available to the

community. Increasing your visibility as a guardian of public

health really helps with levies come election day. An excellent

topic this time of year is always helmets.

More children between the ages of 5 and 14 present to ED with

injuries from a bicycle crash than any other activity. Sturdy,

lightweight bicyclist helmets help to guard against head injury

while the light weight reduces torsional forces on the cervical

spine and immature neck

muscles. Some communities

supply helmets to kids in need

and while that’s a great idea, it’s

not always economically

feasible. Another possible source

is grant funding. Many well-off

programs look to give at the

community level and donations

are of course, tax deductible.

Regardless of whether you are

able to buy helmets or not, there are still things that can be done

for no cost; consider teaming up with a local non-profit

organization like the Red Cross chapter, or Jaycee's for a helmet

safety and fit check day. Here are a couple of tips for properly

fitting helmets:

A damaged helmet should never be trusted to save a live; it

has already done it’s job. Advise the family to get a new

helmet.

“If you have a ten dollar head, go ahead and put it in a ten

dollar helmet.” Otherwise, shop for quality and never buy a

helmet that’s too big so a child can “grow into” it. An

improperly fitting helmet can’t be depended upon to do it’s

job.

Educational Opportunities:

Thursday, April 12th EMSAC Meeting Muskingum County EMA, 6-6:30 pm

Baby Abandonment. Presented by Brady Johnson, EMT-P, Falls

Twp. Fire Department.

Wednesday, April 18th Hand and Microsurgery Associates 1210 Gemini Place, Columbus, Ohio 43240

The Physicians and staff of Hand and Microsurgery Associates

will be hosting an EMS Open House and presenting a

complimentary Continuing Education offering. This event is

located at the group’s new facility near Polaris The event begins at

6:30 pm with a guided tour of the new facility and the presentation

commences at 7:00 pm. Food and drinks will also be provided.

Don’t miss this rare opportunity to see this state of the art facility.

To register, RSVP to Mary Mazik at mmazik@handandmicro.com

or call 614-800-5930 by April 13th as space is limited.

Saturday, April 21st Lifelink Spring Update

Hugenberger Auditorium—Grant Medical Center

With a variety of topics and speakers update always brings many Central Ohio EMS providers together for education and a great Saturday with friends. The event runs from 9 am to 4 pm and cist is $25. To RSVP, email lifelink@ohiohealth.com, include your

name, EMS certification level, address, phone number,, and e-mail

address, or you can call (614) 566-9111, option 1. For more

details, visit www.grantlifelink.com/

Saturday, May 26th, 2012 EMS Week Conference Genesis HealthPlex

2800 Maple Ave., Zanesville, OH 43701

Please join us for a day of Education and Appreciation of the hard

work done by the EMS providers of southeastern Ohio! You truly

are the best and we hope you let us show it.

Save this date for the best EMS conference we’ve put on to-date.

We will be hosting speakers from the local and regional medical

communities. We will have vendors showing the latest in state-of-

the-art patient care and we will serve lunch, all at zero cost in

honor of all that you do for your community! Spread the word to

fellow EMSers, On-duty crews and Nurses are welcome as well.

There will be free items, door prizes and health screenings specific

to EMS providers. Vendors/exhibitors include Finley Fire

Apparatus, Physio-Control, Zoll, Air Evac Lifeteam and

MedFlight and more. To RSVP, send e-mail to

sdinan@genesishcs.org or call the trauma office at (740) 455-

7670. Come join us for a great time on May 26th!

Trauma Notes Stuart Chow, D.O., Medical Director, Acute Trauma Services

The more things change, the more they stay the same. Case in

point being tourniquet use. Constricting bands were created for

limiting hemorrhage on the battlefield and it’s use blossomed in

WW I and II before falling aside in favor of other methods. The

tourniquet became a necessary evil as it was thought that

tourniquet use caused loss of tissue viability at the onset of the age

of limb reattachment.

Since 2004, tourniquet use on the battlefield is once again in favor

to the point of integration into battle dress uniforms and recent

published summaries of lessons learned from battlefield trauma

surgery states that use of a narrow tourniquet does not contribute

to loss of limbs when used for hemorrhage control. Trauma bags

today should contain at least two of the military specification

Combat Application Tourniquets and several packages of

hemostatic agent to manage the worst hemorrhage.

Congratulations From Trauma Services Lori Cody, RN, MSN, Trauma Program Manager

We are proud to announce that our very own Joel Dickinson has

been chosen to receive the “Frank Giampetro Distinguished EMS

Educator Award” as part of the 14th Annual EMS Star of Life

Awards. This award recognizes a dynamic educator who has made

notable contributions to the Emergency Medical Services system

thus improving the quality of care delivered to the citizens of

Ohio.

Joel has been the valuable link in the chain that connects our EMS

community to Genesis Healthcare System. Joel serves as the chair

of EMSAC and has been instrumental in bringing numerous

educational offerings to these monthly meetings. Joel has

resurrected this newsletter, offering informational and educational

topics. Joel also continues to be an ACLS and PALS instructor.

Joel has been actively involved in assisting Genesis Healthcare

System to obtain numerous accreditations and verifications,

including Level III Trauma Center, STEMI Accreditation, Heart

Failure Accreditation, and A-Fib Accreditation. So please join us

in congratulating Joel!

News for EMS Professionals 4/2012, Page 4