Game Changing; The Best SGA’s for Resuscitation

Last week an important article hit the internet, written by Dr. Joe Holly. I’ve met him and his conclusions should be taken in high regard. This guy is no industry shill. He cannot be bought or sold. He conducts his research with unassailable integrity.

He has been doing cutting edge studies on resuscitation for a long time. He typically spends months if not years, developing models of evaluation which can never be called into question.

In this important article he concludes, “All SGAs aren’t equal. The King and Combitube should be avoided if the goal is to both maintain and allow for the generation of the negative intrathoracic pressure during the recoil phase of CPR.”

It’s really this simple. If you want to improve save rates, don’t hitch your wagon to an old donkey.

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Compassion and Contempt Are Mutually Exclusive

Contempt is an insidious disease that steals your heart and corrodes your soul. It happens quietly when you aren’t looking. It starts with seemingly harmless generalizations about the patients that are your privilege to serve. I know how it happens because it once happened to me.

The real cause of contempt is the one-sided nature of EMS work. We don’t see people at their best. We mostly see them at their worst. Recovering alcoholics don’t have much need for an ambulance. But you see folks active in their additions every day. This makes it only too easy to generalize about them negatively.

The same can be said for people from a certain geography or ethnic group. When you run calls in a tough neighborhood nobody ever calls 911 to say, “Hey, nobody on this block has called an ambulance all year.” But those blocks do exist just a stones throw from your busiest response area.

Here’s the rub. Compassion and contempt cannot exist in the same heart at the same time. They are mutually exclusive. If you are genuinely compassionate towards all, contempt cannot enter your soul. So too if you have lost your heart to burn out, real compassion will elude you. Now you are just faking it.

I’ve recently been exposed to some caregivers that are total burnouts. The contempt they feel for their patients dripped from their skin like cold sweat. Those few who were consistently compassionate stood out like rare gemstones. I concluded this was a conscious choice they made every day. I think I know why.

Because being compassionate makes life easier. Contempt is like a corrosive chemical that degrades all goodness. It steals your humanity away one stupid comment at a time. Flowers don’t grow in an acid bath. Caring is just a more natural human condition.

These angels of mercy stand out like brilliant lights in the fog. Everyone they touch feels better for the exposure. They have no room for hate because they are filled with love and gratitude. They are genuinely grateful for the opportunity to be of service.

If you catch yourself going along with someone who is filled with emotional poison know this, your soul is in mortal danger. If you merely smile and refuse to agree or acknowledge the poison, then it can’t hurt you. All it takes is a smile. Then you will be bulletproof. There will be room in your life for joy and fulfillment.

Ever notice how the worst burnouts have the unhappiest lives? Their marriages suck, their children are little monsters, and they are always broke. I’m not sure exactly why this is true but I suspect it starts with the little things. Unhappiness is a choice.

My suggestion is to make the choice to care when you put on your service uniform. Put that commitment into action by being compassionate to everyone. Be even more compassionate towards those that others might not. It will change everything for you. Your world will be brighter and more filled with joy. Your family will love you more. Life will cut you a break once in awhile.

Try it. Prove me wrong.

 

 

 

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Finegan Lights Kickstarter Project

Finegan Lights are a patented illumination retrofit kit designed to be attached to ground ladders. The retrofit kit does not alter the structural integrity of a ladder and does not affect NFPA certification.

Finegan Lights are the brainchild of Bill Finegan, a respected career Lieutenant with the Philadelphia Fire Department. His outstanding safety innovation has already benefitted from years of testing and careful development. The company is ready to go.

Firefighting is inherently dangerous work and the danger increases exponentially in the dark. A ladder that is capable of illuminating itself and the immediate area is a game changer. Ladders with our lights will be able to illuminate the foundation, exterior walls and windows of a structure, enhancing firefighter safety and offering improved situational awareness at night.

The Finegan Lights will add vastly expanded functionality to a tool you already use. The applications are limited only by your imagination. It’s perfect for portable scene lighting in an MCI. It can be used for lighting up MVA scenes or confined space rescues. Drop four ladders on the edge of a field and you have just demarcated a helicopter-landing zone. The Finegan Lights easily adapt to many different operational requirements.

But most importantly the Finegan Lights will help rescuers see beyond or under a ladder and more easily locate the ladder itself when seconds matter most.

For full product details and participation options see https://www.kickstarter.com/projects/1911005247/finegan-lights-for-firefighter-ladders?ref=537120&token=e5a6ed31

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The ClearVue Video-Laryngoscope

The ClearVue Video Laryngoscope from Infinum combines many of the best features available at a value price. It’s a premium quality second-generation hand held video-laryngoscope for EMS. It can be used for either direct laryngoscopy or video-laryngoscopy.

The disposable blades are low profile for ease of insertion, even in a tight mouth opening. They are also available in five different sizes to accommodate a full spectrum of patients. The blade size range meets many state requirements, so you really don’t need to carry a heavy laryngoscope set anymore. Ongoing costs are reduced with the disposable blades and the initial investment is less than most comparable devices.

The high definition 640 x 480 screen is a generous 3.5”. It tilts for glare and swivels for more convenient storage. The screen is reinforced with anti-shatter protection and the blades feature an anti-fog lens. The 2.0 megapixel camera provides a full 66-degree field angle view. ClearVue has a rechargeable 3,200mAh Lithium battery with a working time over 200 minutes. Rather than eating up batteries during shift change equipment checks, ClearVue just needs occasional recharging.

The overall design is compact, ergonomic and weighs less than 350gm. It has a natural balanced feel in the hand. The construction is rugged and it’s built right here in Florida. You can record and export an image or video of the tube placement. The high-resolution view of the glottis will enhance first-attempt success while minimizing any chance of a complication during the intubation process.

Today video-laryngoscopy is quickly becoming an ALS standard of care. You would be hard pressed to find a medical helicopter without one. ClearVue offers an unrivaled combination of quality, value and performance. You don’t have to compromise with the ClearVue EMS solution.

 

 

 

 

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Pediatric Skills in EMS

Here is yet one more excellent example of a paper from Australia that highlights the need for better pediatric Paramedic training. No surprise. Paramedics get scant few hours to either train or work on kids. Its a double whammy.

You don’t get trained to do it, and don’t get much experience doing it. So neither of the two typical learning pathways are available. But when they are needed, that’s when everyone expects you to be an expert.

This article focuses on trauma, which I frankly think should be child’s play (no pun intended) http://www.tandfonline.com/doi/full/10.1080/20008198.2016.1273587

For a more elaborating user experience here in the States I suggest Dr. Peter Antevy’s class.  Take it Twice. https://www.facebook.com/Handtevy/

When I committed to really learning about MCI Management I took AJ Heightman’s MCI class. Then I took it a second time and realized what and how much I missed. Sometimes doing the same thing twice proves well worth the effort, especially when it’s about a skill set you will rarely if ever be called upon to use. http://www.jems.com/articles/print/volume-36/issue-5/major-incidents/aj-heightman-offers-easy-triag.html?c=1

Sometimes the skills we need most are those we use the least.

 

 

 

 

 

 

 

 

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Growing Need For Video-Laryngoscopy

I have not blogged in a long time. I wasn’t really free to do so in my most recent position. But as the wise sage Keanu Reeves once said, “Yah, I’m thinking I’m back”.

I’d like to share a few thoughts about a critical new role for video laryngoscopy. With the rapid growth of supraglottic airways as a primary means of securing an airway on cardiac arrests, paramedics are getting fewer opportunities to intubate. This was already a bad situation.

Many parts of the country already have a difficult time maintaining airway skills. In some regions paramedics only get three or four intubations a year. They often have difficulty getting OR training time. These challenges can play in factor in skill deterioration.

Now think about what the impact might be when we move to rescue airways and intubations drop from 3 or 4 to .03 or .04 per year. That does not at all mean the skill is not required anymore. Far from it.

Some specific indications for an advanced airway often occur with breathing patients. One example is airway burns. I want the largest tube I can get in, instantly. Another is frank pulmonary edema with high inspiratory pressures being required to ventilate. A third might be a witnessed asthma arrest. These are all potential walking home saves.

That’s why I think it has become high time everyone had a video laryngoscope. It’s a responsible and cost effective way to prevent DL skill erosion from costing lives that might otherwise be saved.

 

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Physio-Control and Aircraft Medical Launch Strategic Partnership

Physio-Control and Aircraft Medical have entered a strategic partnership that will include Physio-Control distributing the McGRATH® MAC EMS Video Laryngoscope to Emergency Medical Services (EMS) customers throughout the United States.

The McGRATH® MAC EMS Video Laryngoscope combines direct and indirect view laryngoscopy, offers a bright, clear video image to assist paramedics during difficult intubations and supports traditional Macintosh laryngoscope training and techniques. Full details here http://www.jems.com/articles/2015/07/physio-control-and-aircraft-medical-launch-strategic-partnership.htmld

I really like this device and I’ve written about it a few times. It is very compact, rugged and easy to use. https://phillydan.wordpress.com/2013/02/19/new-mcgrath-mac-ems/

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