JEMS: Journal of Emergency Medical Services RSS feed: Current Issue. Journal of Emergency Medical Services (JEMS) , the most respected journal in the field of emergency services, is published for paramedics, emergency medical technicians (EMTs), instructors, administrators, nurses and physicians. JEMS reports on the issues that most affect the EMS work environment, such as life-support topics, management concerns and system design, legal questions and new product and book/video reviews. For more than 30 years, JEMS has set the standard for news, information and education in prehospital care. To order this journal, and for more information, go to http://www.jems.com http://www.jrnlemergencymedicalservices.com/?rss=yesElsevier Inc.en © 2012 Elsevier Inc. All rights reserved. JEMS: Journal of Emergency Medical Services0197-2510372February 2012 © 2012 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jrnlemergencymedicalservices.com/article/PIIS019725101270030X/abstract?rss=yes Harnessing the power of the sun. That's what Southwest Ambulance in metropolitan Phoenix is doing with the installation of solar panels on 40 ambulances. Find out how the solar panels have helped this EMS agency keep medications at the correct temperatures (even during hot, desert days), and reduce use of electricity.Connect with JEMS.com10.1016/S0197-2510(12)70030-XJEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Load & Go77http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700311/abstract?rss=yes Jersey City (N.J.) Medical Center EMS personnel work to resuscitate a seizure patient who lapsed into respiratory arrest on scene. The patient had a long-standing and well-known seizure disorder secondary to a space-occupying lesion on his brain. He presented to BLS and ALS crews actively seizing. Medical command ordered 5 mg intramuscular midazolam with a repeat 5 mg dose. The patient continued to seize after both doses were administered, and a patent IV in the patient's antecubital fossa was ripped out by the patient's movement. A correctly sized nasal airway was placed, and bag-valve mask ventilations were timed with the patient's respirations. After multiple unsuccessful attempts to obtain peripheral IV access, the paramedic established an external jugular IV when the patient began to have intermittent periods of apnea. The patient was stabilized and transported to the emergency department postictally, with all vital signs within normal limits. He received further treatment and follow-up evaluation and was released from the hospital the next day.Combative Seizure10.1016/S0197-2510(12)70031-1JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5EMS in Action1213http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700323/abstract?rss=yes This issue features an in-depth profile of the Jersey City (N.J.) Medical Center EMS (JCMC EMS) system—a high-call volume system that was in need of redesign and optimization seven years ago; one that had not advanced its equipment and processes with the times. Its dedicated crews provided the best care possible with the equipment and resources they had in America's most ethnically diverse city, but they knew they could do better and accepted massive changes implemented in their system.The Crews Are Key! Specialized EMS team deployment yields best resultsA.J. Heightman10.1016/S0197-2510(12)70032-3JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5From the Editor1414http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700335/abstract?rss=yesThe Federal Aviation Administration (FAA) is requiring pilots to get 10 hours of rest between flights before going airborne, and some EMS experts say the emergency medical profession should do the same.> Sleep Deprivation: FAA releases new guidelines about fatigueRichard Huff10.1016/S0197-2510(12)70033-5JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Priority Traffic1616http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700347/abstract?rss=yes“Because we have always done it that way.” Sound familiar? I know I've heard it countless times in my career—especially in the fire service, which is steeped in tradition. Did you know that the width between two railroad tracks in the U.S. is 4′ 8.5″? According to legend, that's the exact measurement between the railroad tracks in England, and it was English railroaders who first started building the American railway system. England came up with that measurement because the pre-railroad tramways were that same width, and the people who built the tramways also built wagons with the same tools; wagons also happened to have the same width.Stuck in a Rut: EMS has opportunity for system redesignGary Ludwig10.1016/S0197-2510(12)70034-7JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Leadership Sector2020http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700359/abstract?rss=yesWe've suffered some grief over the label “ambulance drivers.” Especially since the TV series, Emergency!, in the late '60s and early '70s, which portrayed transport crews as acerebral, mute livery lackies. Nor did Raquel Welch or Bill Cosby do us any favors in 1976 with their roles in the pathetic flick Mother Jugs and Speed. That film demeaned and de-minded us for years in the public's memory.Little Things: Stuff we can learn from ‘ambulance drivers’Thom Dick10.1016/S0197-2510(12)70035-9JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Tricks of the Trade2222http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700360/abstract?rss=yesEarly in my EMS career, while I was an undergraduate student just getting my feet wet, I remember being mesmerized the first time I saw a portable monitor/defibrillator. I can still picture my chief at that time showing me the monitor and telling me that this machine was capable of ECG monitoring and transmitting 12-lead ECGs to the local hospitals. My mouth hung open in pure amazement. Ever since those early days, I've attributed prehospital ALS to that of a “curb-side cardiologist.”Easy as E-C-G: Teach 12-lead interpretation in 3 easy phasesRobert P. Girardeau10.1016/S0197-2510(12)70036-0JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Higher Learning2424http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700372/abstract?rss=yesIt's 10 a.m. on Monday: the first day of the week for most people but the second day of your tour. You and your paramedic partner are dispatched to assist a 62-year-old male complaining of chest pain. As the ambulance heads in the direction of the call, the causes of chest pain parade through your head. Myocardial infarction (MI) is toward the top of the list, but there are several other causes of chest pain that must also be considered.More than Chest Pain: Providers treat patient with thoracic aortic dissectionDennis Edgerly10.1016/S0197-2510(12)70037-2JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Case of the Month2828http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700384/abstract?rss=yesPatterson PD, Weaver MD, Frank RC, et al. Association between poor sleep, fatigue and safety outcomes in emergency medical services providers. Prehosp Emerg Care. 2012;16(1):86–97.Sleep Saves: Fatigue a leading cause of medical errors in the fieldDavid Page10.1016/S0197-2510(12)70038-4JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Research Review3233http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700396/abstract?rss=yesEvolution or Revolution: EMS industry faces difficult changessMichael Ragone10.1016/S0197-2510(12)70039-6JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-53439http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700402/abstract?rss=yes In 2005, Christopher Rinn, then-director for the Jersey City (N.J.) Medical Center EMS (JCMC EMS) Division, contacted Washko and Associates looking for assistance with improving their EMS system. Back then, things were dramatically different from where they are today. Rinn had recently taken over the EMS system, which was gasping for air, losing money at every turn, the fleet on its last leg and equipment that had been “ridden hard and put away wet” day after day.EMS Royal Flush: Jersey city Medical Center EMS reinvents itself & achieves five major national EMS recognitionsJonathan D. Washko, A.J. Heightman10.1016/S0197-2510(12)70040-2JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-54049http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700414/abstract?rss=yesNo Pulse? Check for a left-ventricular assist devicePaul Satterlee, Nader Moazami, David Hildebrandt, K. Hryniewicz, Jessica Boughton, David Page10.1016/S0197-2510(12)70041-4JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Continuing Education5050http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700426/abstract?rss=yesSome large wounds can be difficult to manage in the field. Finding a way to apply an occlusive dressing to an abdominal wound or closing a large laceration can involve some rather creative bandaging techniques to contain hemorrhage and keep dirt and debris out. The Combat Wound Seal from FastTrack Medical Solutions was developed by combat physicians and paramedics with military backgrounds and extensive trauma experience. It uses the same adhesive as the FastBreathe Thoracic Seal (see January's “Hands On” column on jems.com/journal), which aggressively bonds to the skin without damaging the surface on removal. I think of the Combat Wound Seal as an extra-large, rectangular butterfly bandage.Bigger & Better than Band-AidsFran Hildwine10.1016/S0197-2510(12)70042-6JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Hands On5858http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700438/abstract?rss=yesWe often try to change night scenes into day with illumination. However, sometimes that isn't possible or practical. And searching for a missing person or victim at a scene before the rescue truck arrives could be lifesaving. Until recently, night-vision devices were expensive and usually the domain of the military, SWAT teams and other high-end users. The NV 351 and NVD Mini from Minox provide an economical choice in night-vision devices. The NV 351 allows noise-free and discreet observations with a compact, handheld device. The shock- and impact-resistant NVD Mini uses an innovative infrared digital technology to amplify residual light frequencies. Its infrared sensor reproduces the image on the monitor in the viewfinder. And, contrary to conventional tube night-vision devices, the NVD Mini isn't sensitive to bright light sources, so it can be used in daylight as well. This product's lightweight, weatherproof design performs in a wide range of conditions and temperatures. The eyepiece is designed to give eyeglass wearers a full field of view, and there's a tripod socket for extended viewing. This looks like a great device to be carried in EMS supervisor vehicles and rescue trucks.Night Vision10.1016/S0197-2510(12)70043-8JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Hands On5858http://www.jrnlemergencymedicalservices.com/article/PIIS019725101270044X/abstract?rss=yes Bariatric patients provide many challenges for EMS. Aside from their weight and girth, another factor is the shift in the normal center of gravity when carrying and moving these patients that can make them feel unsecured and add unexpected weight stress to the rescuers moving them. A normal or slightly overweight adult has a center of gravity just behind the belt buckle. A morbidly obese/bariatric patient has a pendulous abdomen that shifts; it pulls their center of gravity forward, making it easier to tip an ambulance stretcher. The B.E.A.R. (bariatric equalizing abdominal restraint) from Beariatrics Inc. quickly attaches to an ambulance stretcher with eight 1½” nylon straps and buckles (four on each side) or to a backboard with conveniently spaced Velcro straps. A strong nylon mesh band and three 2” straps allow you to package and contain the patient on the stretcher or backboard. The nylon mesh band increases the surface area of the straps as it wraps and stabilizes the abdominal mass.Bariatric Equalizing Abdominal Restraint10.1016/S0197-2510(12)70044-XJEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Hands On5858http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700451/abstract?rss=yesWith diaphoretic or combative patients, burned skin, long transports and cramped working areas, securing an IV line in the field can be a real challenge. And one of Murphy's Laws of EMS is, “the harder the IV is to start, the easier it is dislodged.” Paramedics have a variety of ways to keep the IV in place. Whether it's a sticky commercial product or the use of bandaging material to wrap the area, they'll use anything short of staples to secure the line. But the new StedLine IV Sleeve from REDpoint International Medical Innovations is an easy-to-use wrap that secures the IV line without adhering to the patient's skin. After starting the IV and securing the insertion site, you simply loop the special StedLine IV Sleeve feature over the patient's thumb and wrap the rest of it around their arm, over top of the IV line. You then wrap the IV line one full turn around each of two attached plastic discs and secure the Velcro closures. The IV line won't put any tension on the insertion site—even if a 1 L bag of fluid drops from the ambulance ceiling to the floor.Secure that IV10.1016/S0197-2510(12)70045-1JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Hands On5959http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700463/abstract?rss=yes Across the U.S. and around the world, a large portion of EMS service is provided by volunteers. One way to maintain a professional appearance when responding to a call from home or on the road is to cover your jeans and T-shirt with a jumpsuit. The Taclite EMS Jumpsuit from 5.11 Tactical incorporates the most popular features of their EMS pants and uniform shirts with a lightweight, rip-stop fabric that's ideal for any climate. The fabric is treated with Teflon to help liquids roll off. A two-way front zipper, expandable waist and side seams make this jumpsuit easy to get on and off. It has adjustable belt loops, double-reinforced knees and cargo pockets with internal dividers.Lightweight Jumpsuit10.1016/S0197-2510(12)70046-3JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Hands On5959http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700475/abstract?rss=yesTreating acutely ill pediatric patients before the “Broselow Tape” often involved a call to medical command to confirm doses and delaying treatment. With the advent of the “Broselow Tape” in 1986, paramedics had a fast and accurate way of determining the proper dose in pediatric emergency treatment based on the patient's length. It was a critical advancement because missing a decimal point could be the difference between 4.5 mg and 45 mg. Because most adult medications have standard doses, this problem rears its ugly head with the use of weight-based dosing when treating pediatric patients. The SafeDose EMS app from eBroselow.com lets you compare (in seconds) almost any order for pediatric oral and/or parenteral medications with the massive, pre-calculated Artemis database. This app is like having a pediatric pharmacist (and Dr. Broselow) looking over your shoulder and helping you ensure the dose you give to a child is accurate.Pediatric App10.1016/S0197-2510(12)70047-5JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Hands On5959http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700487/abstract?rss=yesA recent focus of hospital patient care treatment continuity and safety improvements has been the patient handoff report. Poor patient outcomes (i.e., patients have died) may occur when the person taking over care of the patient in the field or ED misses an important part of the patient's history or treatment in the handoff report. Some regions are moving to a short form, written patient handoff document to be left with the receiving facility to bridge the gap until the full, usually electronic, EMS chart is written. FieldSaver, a new Android app from fieldsaver.com, provides a means to quickly capture on your smartphone the demographic and patient history data required for a well-documented patient handoff. Services that subscribe to FieldSaver can have EMTs and paramedics quickly enter a “short report” containing patient demographics, allergies, medications, past medical history and treatments, which can be printed or transmitted to the receiving facility immediately after the verbal bedside handoff report. The data entered into the short report remains in the database so it doesn't need to be re-entered when the provider completes the full electronic patient care report that contains all of the required National EMS Information System data points.Smartphone ePCR10.1016/S0197-2510(12)70048-7JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Hands On5959http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700499/abstract?rss=yesI was driving to the airport after speaking at a conference and hearing Dr. Ed Racht's lecture. ED (Emergency Department) Ed, as I like to call him, is a renowned speaker at national EMS and healthcare conferences and is ED (Extremely Dedicated) toward teaching ED (Emergency Didactics), including such topics as ED (Excited Delirium), ED (Erectile Dysfunction), ED (Explosive Diarrhea), ED (Ethanol Discourse), ED (Epidermal Detachment), ED (Eelworm Disentanglement), ED (Earwax Dialysis), and last but not least, ED (Edematous Duodenums).Glottic Passage Steering: A little airway assistanceSteve Berry10.1016/S0197-2510(12)70049-9JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5The Lighter Side7272http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700505/abstract?rss=yes In an effort to reduce binge drinking at parties around Dartmouth University, a group of students came up with a plan. They thought it would be beneficial for student EMTs to visit such parties to determine whether an intoxicated person needed medical attention—because apparently this condition is so difficult to identify. We say the friends of the said intoxicated individual should be responsible enough to assess this condition and handle it on their own instead of wasting the valuable time and energy of student EMTs who could be out saving lives.Last Word10.1016/S0197-2510(12)70050-5JEMS: Journal of Emergency Medical Services 37, 2 (2012)2012-02-01JEMS: Journal of Emergency Medical Services2012-02-01372S0197-2510(12)X7002-5Last Word7474