Posted on April 21st, 2008 by admin
April 21, 1878: Firefighter George Reid, of Engine Company 21 in Chicago, is busy unloading hay for the horses that pull their fire engines. As the story goes, he was on the third floor when an alarm rang, and rather than dashing down the flights of stairs, he took the easiest way: down a binding pole that had been set vertically. Inspired, forward-thinking Captain David Kenyon, of the same company, convinced the Chief of Department later that year to allow for the installation of a permanent 3″ diameter pole made of Georgia pine. Needless to say, they were the first-due engine for many calls after that.
Image courtesy of the Hulton-Deutsch Collection/Corbis
Since then, however, because of stringent safety concerns, installations have been stopped and existing ones removed, as per NFPA recommendations. Single-story firehouses are now more and more common, and the once staple of the firehouse image — that and the dalmatian — are now part of the beautiful and long-gone past.
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Filed under: On the Fire Side, That Was Then
Posted on March 31st, 2008 by admin
Hands, not mouths, are more important for bystanders who perform cardiopulmonary resuscitation, the American Heart Association says.
In a scientific update issued yesterday, the association said chest compressions, or “hands-only CPR,” save as many sudden cardiac arrest victims as the combination of chest compressions and mouth-to-mouth rescue breathing.
Because people are less willing to do mouth-to-mouth, the update should prompt more people to choose to aid those who collapse from cardiac arrests.
“Don’t be afraid to try it,” said Dr. Michael Sayre, chairman of the association’s Emergency Cardiovascular Care Committee and author of the statement published in Circulation: Journal of the American Heart Association. “We are sure many lives will be saved if the public does hands-only CPR for adult victims of sudden cardiac arrest.”
The association said 310,000 adults in the United States die each year from sudden cardiac arrests that occur outside hospital settings. Bystanders who see someone collapse should call 911, then immediately start chest compressions. Without immediate and effective CPR from a bystander, a person’s survival chances decrease 7 percent to 10 percent per minute.
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Filed under: EMS
Posted on January 11th, 2008 by admin
One of the easiest ALS tools to use, but often one of the most neglected, is the glucometer. Gone are the days of putting drops of blood on a chemical test strip and staring at it intently, trying to figure out which color it had changed to. Today’s provider has accurate test results in as little as five seconds. But three challenges are commonly faced by the ALS provider using a glucometer:
» Not using the glucometer on the correct type of patient;
» Poor use and maintenance of the glucometer;
» Inaccurate readings.
Too often we think of using the glucometer only on those patients in whom we elicit histories of diabetes or who present with the common initial findings of hypoglycemia (confusion/unconsciousness, diaphoresis, medical alert bracelets, etc.). The reality is that the glucometer can provide a quick check of any patient with an altered level of consciousness, unexplained fall or lethargy. As with many medical conditions, signs and symptoms can be indicative of more than one thing; hyper- and hypoglycemia are not limited to those who suffer from diabetes. I have yet to meet an experienced ALS provider who has not been fooled by this at some point in their career.
According to the FDA, there are currently more than 25 approved portable glucose testing devices available. Although these may have different buttons or steps to take, the procedure for using them is roughly the same.
1. Prepare your equipment and, when possible, explain the procedure to the patient and gain consent for the test.
2. Cleanse the site of the puncture to obtain your blood sample.
3. Next, obtain a drop of blood (glucometers use minute amounts of blood for the test, measured in microliters) and apply it to the test strip. Some machines require the blood to be applied to the test strip before it’s inserted into the device, while others have the test strip inserted first (which generally turns the machine on) and the blood then applied to the end. The machine will begin analyzing the sample while you apply a sterile adhesive bandage to the site (as it is a potential site of infection).
4. Properly dispose of your supplies, and continue your treatment and assessment of the patient.
From EMSResponder.com
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Filed under: EMS, Proper Practices
Posted on January 5th, 2008 by admin
The Coast Guard Cutter Sundew’s firefighters undergo some extremely harsh training at the Maritime Academy of Toledo, Ohio. Note they use OBAs, which are smaller and are worn in front of the firefighter unlike SCBAs. Because of space constraints on ships their equipment seems considerably less redundant than the ones I use.
The video continues with episodes 2 and 3 here.
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Filed under: Fighting Fire
Posted on January 4th, 2008 by admin
At approximately 1530 hours, Rescue 24 responds to a person complaining of chest pain. Upon arrival, the crew performs an initial assessment. It reveals a patient in moderate distress, diaphoretic and with cool skin, but alert, oriented and cooperative. The patient, an overweight 64-year-old male, informs the crew that he was watching television when he began to experience epigastric discomfort and became nauseous.
The crew completes a head-to-toe assessment, obtains vital signs (BP 88/50, pulse 94, respiratory rate 18), administers 100% oxygen via a non-rebreather mask, applies an ECG monitor and performs a 12-lead ECG, attaches an SaO2 monitor, assesses blood glucose (125 mg/dL) and initiates two intravenous lines of normal saline. They administer a 500cc fluid bolus and note improvement in the patient’s blood pressure to 142/86 mmHg.
What would you do next ?
Upon arrival at the emergency department, the patient experiences a generalized seizure and goes into cardiac arrest-the ECG monitor displays ventricular fibrillation.
Now what?
Read more about this scenario.
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Filed under: Case Studies
