The “Prepper” Issue

Greetings everybody! It’s been a long winter and everybody is by

now deeply entrenched in planning for warm weather activities.

That crazy groundhog in PA didn’t see his shadow this year, which

allegedly means no more “Bad” winter. I have always been

skeptical about the groundhog day thing and seeing as how we just

saw some of the quickest snow accumulation all winter in recent

weeks, I think I’m in the right for a change!

The focus of this issue of Lights & Sirens will be preparation.

Preparing for warm weather, for certain types of EMS calls, and

for upcoming education offerings.

As we enter

spring of

2013, plans

for the new

G e n e s i s

M e d i c a l

Center are

on track

and EMS

f i g u r e s

heavily into

the design

from traffic flow to parking accommodations at the ED. The new

lounge will be spacious, if not palatial and the entire layout will

certainly be state-of-the-art. Plans are done. Acton will soon begin

and its an exciting time to be involved in EMS.

As technology figures more and more heavily into the delivery of

healthcare, computers are penetrating front-line EMS and not only

at paid services, but also in the Fire Service based Municipal and

Volunteer EMS agencies. Computer based documentation offers

not only the promise of increased quality through expanded

charting, but also increased capture of demographic information,

which is crucial to timely reimbursement of service fees. In the

past, I witnessed much resistance to computer technology among

the more seasoned of our profession (read: “the old people”), but

now I see more and more of these same opponents of technology

now embracing it with open arms.

So indeed, the word “Preparation” fits here, and so let’s get on

with the good stuff!

New Patient inflow planned for Good Samaritan Campus

Beginning April 15th, EMS transports to Genesis will become

simpler due to the onset of construction at the Bethesda Campus.

On that date, EMS will no longer be transporting any patients to ,

Bethesda except for O.B. patients in labor, those patients will be

transported directly to Labor & Delivery on 2 West. This is in

preparation for the construction of the new Medical Center facility

to begin. Meanwhile, Genesis Good Samaritan Campus will be

seeing a renovation to expand the patient treatment area of it’s ED

and improve patient flow from triage to admission or discharge.

Volume 3 • Issue 2 March/April, 2013

News for EMS Professionals

Lights & Sirens is a monthly publication for EMS providers

in the Muskingum County and surrounding areas. To submit

an article for inclusion, please contact Joel Dickinson,

EMS Consultant at Genesis HealthCare System,

(740) 454-7657 or at EMS@genesishcs.org

There will be a lot of support for this initiative to succeed and

EMS will be a critical part of helping this transition to go

smoothly.

EMS Preplanning: Making our jobs easier

The Fire Service is known for developing pre-plans for various

scenarios, facilities and potential disasters. The purpose, obviously

is to develop an organized approach to solve a problem at hand.

The upshot is that it also tends to make our jobs easier. The

following is a guest article written by Joshua Tilton, NREMTP on

just such a method:

EMS Preplanning

Does your department “EMS Preplan”? Of course it would

be impossible to know every single one of your patients, where

they live, and medical history but what about those with special

needs? One thing that I have always been very proactive about and

have done now for a few years is “EMS Preplanning.” We are

excellent about fire preplanning buildings. We know which ones

we will be offensive or defensive attack styles, where all the

hazards are, and where everyone should generally be between

night and day shift. But when it comes to EMS how many times

have you responded to a SOB call just to arrive and find out that

yes they are having trouble breathing, but they have a tracheotomy

and are vent dependant?

Usually when these patients move into an area they are told

by the social worker to please inform the fire department that they

are there. This is usually just a quick little note that says “Hi my

name is and I have Blah.” These little notes are great with the

exception that numbers get transposed and papers can never been

found when needed. One thing to consider is a home visit. Now I

know that we don’t usually make house calls unless something is

burning or it’s a bad day, but it could become more prevalent in

the very near future. Suppose the home was on fire? If you have

already preplanned you know which area of the house this person

is usually in and if there are any special considerations (may

favorite is the 15 oxygen tanks next to the bed warming on the

duct work).

Preplanning is one of

those things that could take a

few minutes but could gain you

so much in the end. It doesn’t

need to be a novel but some of

the things that I like to include

are, the patients actual medical

condition, what are the patients

d e p e n d e n c i e s , b a s i c

information, current med lists, current allergies, special equipment,

where are they in the house, and special considerations otherwise.

Then once all of this information is gathered and a look around the

house has been established the information is invaluable. Go back

and create a computerized record of the information, if the patient

requires special equipment make sure you train your staff on it.

Ventilators seem to be one of the biggest that readily come to

mind. Ventilators are in the scope of practice for a Paramedic and

such if you have a special needs patient dependant on one it is

much easier for the patient to go on their equipment as opposed to

being bagged.

The other thing this is handy for is disasters. Recently we had

the misfortune of being hit pretty hard by the storms. We were

able to fall back on our EMS preplans and to prioritize patients

that needed to be checked on. We have several that are ventilator

dependant and we were able to successfully evacuate them first

into a facility that had been pre arranged with the logistics

coordinator at our EMA.

In the ever expanding role of the fire and EMS services and

with “Community Paramedicine” and “Advanced Practice

Paramedic” programs on the horizon and difficult economic times,

we seem to be encountering more and more home managed

patients. Things that we aren’t used to seeing on an emergency

basis are starting to become regular calls. Through a combination

of EMS preplanning and education the next time we get called to

an “Alert Home” for a displaced trach tube hopefully we will be

ready.

Joshua Tilton is a Nationally Registered Paramedic who holds CCEMTP and EMS

CE -Instructor certifications who works for MedFlight and M&M Fire Department.

He currently lives in North Zanesville with his fiancée, Susy. He can be reached at

jtilton@mmfireems.com

EMS: One Mission, One Team

That is this year’s EMS week theme. We love that because the

motto of Genesis Emergency and Trauma Services is One Team!

This year’s Genesis EMS Appreciation Conference will be held on

May 18th at the Genesis HealthPlex. This will avoid the conflict

with Memorial Day Weekend and serve to give EMS Week a very

special kick off! A flyer will be coming to all departments very

shortly and we have some special events in store for this year’s

attendants. Topics will be announced in the flyer and all promise

to be interesting and engaging with several hands-on learning

events..

We will again be teaming up with MedFlight and Air Evac

LifeTeam to present a top shelf conference with door prizes and

good food and best of all; The Conference is STILL FREE to EMS

Providers! Please join us to celebrate you, the EMS providers of

our area!

Registration will be the same as in the past; simply complete and

mail-in the registration slip on the flyer, call Stephanie at the

Trauma Services Office at 740-455-7670, or email registration

information including your name, Department Affiliation, Provider

level and call back number/email address to

sdinan@genesishcs.org.

News for EMS Professionals March/April, 2013 Page 2

Medication Alert: Epinephrine for allergic reactions.

Please share this information with all clinical staff at your

respective departments.

Adrenalin, or Epinephrine as it’s also known, is commonly used in

the treatment of allergic reactions and anaphylaxis. Administration

of the proper dosage of adrenalin is crucial to proper treatment and

is also a consideration in patients above the age of 40, or at any

age with known heart disease.

The target of adrenalin in allergic reaction is vascular leakage at

the capillary level which leads to angio-edema; the condition

which causes the airway to swell shut in severe cases of allergy.

Peripheral vaso-constriction is a Beta II effect of adrenalin, the

other benefit, broncho-dilation is also a beta II effect. In

combination they both work to alleviate the swelling around the

airway and allow air to pass more freely in and out of the lungs.

The common dosage for allergic reaction is 0.3 to 0.5 mg of

1:1,000 concentration “epi”, administered subcutaneously, which

also thankfully corresponds to 0.3 to 0.5 ml of the drug. Adrenalin

comes packaged most commonly for EMS in 1.0 milliliter glass

ampoules although it also comes packaged in 30 ml vials

(Remember the days of high-dose cardiac epi?).

The mistake most commonly made in any emergency setting (Not

just EMS) is that the caregiver draws the entire contents of the

ampoule and then proceeds to, you guessed it, administer the entire

amount of drug.

The next most common mistake is when this drug is given by the

IV route. Yes, Epinephrine is indicated for use via the IV route for

severe anaphylactic shock, but is not indicated for routine

treatment of allergic reactions.

What’s the difference you

ask? In an allergic reaction

the patient presents with

itching, hives, red skin and

possibly wheezes, but the

patient is not in a shock state

as evidenced by an altered

level of consciousness and

shocky vital signs! The

vascular collapse is what

leads to hypotension and the

altered mentation of the

patient. If your patient is

conscious and not exhibiting

s i g n s o f i mp e n d i n g

respiratory failure, you want to use the SQ route for the adrenaline.

It will be absorbed in a much more tolerable fashion as not to

cause the degree of tachycardia and cardiac workload that a shot

straight into the IV will.

Some tips to help providers avoid giving adrenaline in the wrong

dosage or by the wrong route include:

Only draw the desired dose. Set aside the remainder of the vial or

carry multiple ampoules. Epi is cheap so don’t be thrifty.

Patients use Epi Pens thousands of times a day without having to

have an IV in place first. Recognize the issue and treat it, then an

allergic reaction can’t evolve into full-blown anaphylaxis!

Also, it is arguable that Benadryl, the other component of pre-

hospital allergy care is much more effective when administered IM

than IV due to it getting a longer trip to peak effectiveness and

therefore a longer half-life than an IV dose. This is similar to

giving anti-emetic IM; it takes a few minutes longer to work, but

the patient remains comfortable and vomit-free for a much longer

period of time.

Reminder: New Geriatric Triage Guidelines

As a reminder to all agencies, the age for Geriatric patients has

decreased from older than 69 to 65 and above. This means that

anybody 65 or older who has had a standing height fall must be

brought to Genesis Good Samaritan ED for a full Trauma

evaluation.

Another reason for a patient to be categorized as a trauma patient

is if they are currently taking any kind of medication that thins the

blood. Some of the more common drugs are:

Coumadin

Plavix

Dabigatron, or Pradaxa

Xarelto or Rivaroxoaban

AND INCLUDING ASPIRIN!!!

Documentation Notes:

Keep up the great work of charting time on the backboard. This is

helpful not only to the program, but to the patients! All times are

critical so please remember to record them when doing your run

sheets.

Please make sure to give your PCR copies to the nurse taking care

of your patient. This is to improve capture of data and make sure

each specialty service can access PCR information. The boxes will

be coming out very soon! ~ Thanks!

News for EMS Professionals March/April, 2013 Page 3

All new EMS Protocol and Procedure Guidelines are coming

June, 2013

Tested

Provider Approved

State-of-the-art

Championed by Physicians

Compliant

Progressive

Educator & Training Officer Friendly

Upcoming EMS Week Functions EMS Week Appreciation Conference

Topics to include:

Less than Lethal Police Interventions

Trauma Point/Counter-Point

Trauma Case Study: You make the call

Hands-on Airway competition and learning stations

Crazy, off-the-wall patient presentations

Neurosurgical emergencies

And much more!

In addition, Genesis ED’s will be serving treat trays and giving out

EMS week gifts to crews visiting the ED that week, so come and

see us!

Community Ambulance Service Monday, May 20th, 2013

CAS is sponsoring a Public Safety Breakfast for all area Public

Safety personnel, Police, Fire and EMS are all invited to come

mingle and share an excellent home-cooked breakfast! The event

starts at 8 am and runs until 10 am and location is Community

Ambulance Service, 952 Linden Avenue in Zanesville.

Friday, May 24th, 2013

Friday is the date for CAS’ traditional Public Safety Cookout. The

time for this event will be from 11 am to 1 pm. Come join us for

excellent cookout fare and a chance to visit with our public safety

brothers and sisters. Same location as Breakfast on Monday that

week.

Upcoming Educational Opportunities:

Mid-East Ohio Career & Technology Center

Emergency Medical Technician Course

June 4th - August 24th, Tuesday & Thursday 6:00-10:00, Includes

3 Saturdays and 1 Sunday. Includes all materials and up to two

NREMT exams.

Advanced Emergency Medical Technician Course

August 1st – December 10th, Tuesday & Thursday 6:00-10:00

Includes 4 Saturdays. Includes all materials and up to two NREMT

exams

Paramedic Course

July 9, 2013 - June 26, 2014, Tuesday & Thursday 6:00-10:00

Includes Saturdays and Sundays. Includes all materials and up to

two NREMT exams. Applications accepted until June 24, 2013.

Financial Aid Available

Fire and EMS Instructor Course

May 2nd—June 8th

Must pass the Firefighter II, EMS Assessment exam or passed the

NREMT exam within 3 years of class start date.

All Classes will be held at Mid-East Career and Technology

Center for Adult Education, 920 Moxahala Ave., Zanesville, OH

43701

For questions contact: Paula Moore, Public Safety

Coordinator, 740-455-3111 Ext. 328

Central Ohio Technical College

COTC and CTEC will be hosting a variety of EMS courses from

EMT class in Newark (CTE) to a Paramedic class in Pataskala.

Both Summer classes begin in May.

Anyone interested in our programs should first complete a COTC

college application https://apply.cotc.edu/ and then contact

Gateway @ Pataskala: 740-964-7090 or Knox: 740-392-2526 or

Newark: 740-366-9222 or Coshocton: 740-622-1408 or

cotcadmissions@cotc.edu to schedule COMPASS testing or

review transcripts prior to beginning the EMS Application packet

that is attached.

Classes start soon, so hurry!

Ohio State’s Center f o r E M S 1 0 t h Anniversary and Local Heroes Week 2013

Join Ohio State’s Center for EMS for our annual conference April 15-21. Monday 8 am—5pm Keynote Address, Variety of topics

Tuesday 8 am—5 pm Geriatrics for EMS

Wednesday 8 am—5pm Advanced Stroke Life Support

Thursday 8 am—5 pm Operation: Street Smart (Drugs) and

Operation: Street Smart for a New A.G.E. (Adult Gang Education)

Friday 8 am—5 pm Why Teens Kill

Saturday and Sunday 8 am—5 pm Emergency Pediatric Care

Provider Course

All Registration opens at 7 am each day, locations differ.

To register, please visit centerforems.osu.edu

News for EMS Professionals March/ April, 2013 Page 4