Any kid who has ever drank a Slurpee too fast on a warm day, and found themselves shivering and chilled, knows that cold fluids can be remarkably effective at cooling the human body. I had this leason reinforced while I was working as a consultant for a bio-tech company. The company was looking for methods to induce and maintain therapeutic hypothermia.
I can disclose much about the different methods and results that the engineering team experimented with, but I will tell you this, if you want to drop someones core temperature fast, nothing is quite as effective as a quick, two litter bolus of cold saline. This is why most therapeutic hypothermia protocols begin by inducing hypothermia, not with some fancy cooling blanket or external cooling device, but an infusion of 37 degree saline.
With that thought in mind, how important should it be to keep the saline we infuse into our patients whom we want to keep warm at something close to body temperature? I hadn’t really given the question much thought until I got an email from Scott.
Scott’s one of those SWAT medic types. He works with his local SWAT team to provide on site medical interventions if the need arises. Scott had an interesting experience with an accidental infusion of ice cold saline. I’ll let Scott take it from here:
Pssst. Quick tip. If you’re a Facebook user and you enjoy FireRescue1, this is your chance to get in on a nice giveaway. This page explains it all. But it isn’t that tough.
Don’t worry, I’m not going to launch into a big discussion about single tier vs. two tier ambulance deployment or fire based vs. private ambulance service. I believe that different systems across the nation require different deployment models and, unless you are very familiar with the system you’re talking about, it’s really tough to say which model is ideal for that system.
Put briefly, Chicago Fire can figure out what model of response is going to work best for them.
What really burned me about this article though were the quotes from Pete Houlihan, EMS director for the Chicago Firefighters Union. Houlihan implies that EMT level providers are untrained medical personnel and he likens sending them on medical calls, unassisted by paramedics, as “playing Russian Roulette” with the citizens.
If I were an EMT working in Mr. Houlihan’s system that would piss me off. I’m not an EMT (Basic) and I don’t work in Chicago and it still pisses me off. I know I shouldn’t get to riled up about anything politicians say, but for the record, I’d like to correct a few of the misleading statements in this piece.
I worked for some great EMS organizations through the years. I’ve worked for some really awful ones along the way as well. Finding the right EMS organization and contributing to them in a positive way can be tricky. Sometimes, the struggle can be deciding whether to stay and help make things better or move on and plant your awesomeness elsewhere.
If your current EMS employer doesn’t value and respect you, there are plenty of organizations out there that will. If you are in a toxic work environment, it may be hard to imagine that there are places out there where respect, dignity and good patient care are the norm. Good organizations are out there and, as you might imagine, there are many common elements to their success.
Are you wondering if your being treated the way you should be? Let me help you answer the question of whether you’re working in a top-notch company or scraping the bottom of the EMS-service barrel. Here’s a list of some of the positive attributes of well run EMS organizations.
Best in class EMS organizations:
1. Value 2-way performance evaluation and are open to employee feedback.
Some EMS organizations prefer to give no feedback what-so-ever to their employees. (Unless someone screws up.) There are no scheduled performance reviews and supervisors say very little about job performance on a day-to-day basis. Most companies provide some sort of formalized performance review, though they may do it out of the misguided perception that it protects them from liability. (It doesn’t.)
The very best EMS organizations give generous real-time feedback to their workforce, both good and bad. Feedback is received in a timely manner, when it is most relevant and appropriate. But they don’t stop there. They also seek out feedback and create channels for employees to evaluate their leaders and their workplace. They encourage feedback and then they do something amazing with it, they listen and respond.
My latest Remember Two Things video is up over at EMS1. At EMS World last year I gave a 90 minute presentation about sepsis for EMS providers. This video answers the most essential question from that lecture in about four minutes.
The question: What can EMS providers really do to reduce mortality rates in sepsis patients?
A few days ago, EMS1 reported that a Tennessee paramedic had been demoted for administering an incorrect medication to a patient. I have mixed feelings about this and I’d like to know your thoughts.
My first thought is that we can’t race to judge if the discipline was warranted or appropriate in this specific circumstance. As always, in incidents like this, only a rare few people actually know the whole story. None of us can speak to the paramedics experience, his thought process, his history within the organization or his reputation. It is unlikely that any of us will ever know whether this was an isolated event or a problematic trend.
Having said that, I always have reservations about punitive responses to honest medical errors. I just think that they aren’t the right way to solve these types of problems. Human beings error. As long as humans carry out the work of medicine there will be errors. They are indeed inevitable.
Once we make peace with this idea, we can go about the real business of reducing errors to an acceptable minimum and always striving to reduce the number of occurrences and the harm done with each error. That’s easy for me to say. And it’s probably easy for a lot of folks to believe, until a paramedic makes a high profile error like this one and the family’s, facilities and media are clamoring for a response. Then discipline seems like a good idea.
Here’s the rub. Dicipline doesn’t seem to do anything to reduce or prevent the next error. In fact…discipline may make the problem worse.
It’s an interesting dilemma. I’d like to hear what you think.
Sam Abell is a photographer. He works for National Geographic. Your first thought might be, “What can a photographer teach me about being a good EMT?” Well, as it turns out, quite a bit. Sam is a world class photographer for a million complex reasons and one simple one. Let’s start with the simple one.
He has passion.
In this video Sam describes the year long process of taking a single photograph of a bison skull on the American plains. Watch the video and listen to Sam’s story, then I’d like to make a few observations.
While listening to this interview, I had several ideas about what makes Sam Abell a great photojournalist. As he relates his experience, he gives us clues into what it takes to be really good at what you do. Here’s what I got from his story:
Those who perished ten years ago today gave their lives in the name of freedom. They didn’t ask to stand in the name of justice and democracy. They didn’t volunteer to play a momentous and tragic role in our history. But they gave their lives just as surely as any soldier who ever fought for our country. We owe it to them to look back and remember the horrible price they paid for our country and our way of life.
We owe it to them to stand vigilant against those that wish us ill.
The EMT Spot needs your tips and tricks! I’m collecting the very best tips and techniques for nailing the IV every time. What have you got to add? What are your very best techniques for making sure you get the IV started when it counts? What’s the best IV starting advice you ever received? Now that you know, it’s time to help your fellow EMS brethren on their way to IV mastery.
Send me your contribution and, if you make the final cut, you’ll see your advice immortalized right here in a future post. This is your chance to contribute to the ever-growing database of EMS knowledge that is The EMT Spot. I’d love to put your name right here, along side many of the industry’s top educators and EMS practitioners.
Send your IV starting advice to steve@theemtspot.com, send me a tweet @SteveWhitehead or click on the comments section and add your advice right here and now.
This post won’t be awesome without you. What are you waiting for?
Chances are, you’ve probably heard about the new trend in synthetic cannabis products either from your local news media or from your ongoing EMS education. Over the past few years, these products have been increasing in prevalence around the US and in Europe. But what are these products anyway? Are they cannabis or not? Are they legal to posses? Are the effects similar to traditional marijuana?
Here’s a quick rundown of what EMS folks should know about this new and growing trend in street pharmacology.
Synthetic cannabis products have a variety of street names including Spice, K2, Herbal Incense, Potpourri, Barely Legal and Kronic. It is frequently sold under the classification of an “herbal smoking blend” and some head shops and online retailers have attempted to skirt the ongoing tide of new regulations by selling the products as legitimate potpourri or plant food with the warning, “Not for human consumption.”
What is it really?
These products are all various dried organic (plant) compounds that are laced with a synthetic cannabinoid chemical that is designed to mimic the effects of cannabis in the body. Many of the products claim that they are a natural blend of legal herbs and spices that combine to give the user a legal and cannabis free high. Investigations into the contents of the products reveal that most of the herbs listed on the product packaging are not truly present in the product and that the often unidentified organic material in the product is laced with one of five common synthetic cannabinoids. (While there are over a hundred known synthetic chemical cannabinoids, these products tend to contain cannabicyclohexanol, JWH-018, JWH-073, CP-47,497 or HU-210.)
The company was looking for methods to induce and maintain therapeutic hypothermia.
