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| Wednesday, August 26, 2009

For Whom the Road Tolls
After close to a decade of planning and building, a multi-million dollar toll bridge opened in July in southern Louisiana. A few weeks before the opening, an overlooked issue surfaced: The bond documents exempted only police vehicles from the toll. Fire and EMS vehicles would have to pay.

It appears existing state law exempts fire vehicles and supersedes the bond documents. But EMS vehicles will still be automatically billed each time they cross.

Brady Daigle, operations manager for Lafourche Ambulance, estimates this could cost his agency thousands of dollars a year. He was told Lafourche Ambulance may be able to dispute the tolls, but that would take time and cost money.

Mark Lambert, communications director of the Louisiana Department of Transportation and Development, says there have been discussions about how to add EMS vehicles to the exempted category, but "it's always complicated when you start rewriting rules and regulations." He also says there's another toll road in New Orleans, and as far as he knows, the ambulance companies set up accounts and pay tolls.

At press time, planners had about three weeks to resolve the situation before the scheduled toll collection began. Lambert says, "We want to do what's best for the community." JEMS wants them to do what's right and fair for EMS.

EMT Recovers from 'Brain Attack'
In December 2005, Justin Kelley was just like any other 25-year-old EMT. But then something happened that was very out of the ordinary.

"I was on my way to work and began swerving on the road and passed out. Next thing I knew, I woke up in a hospital bed," Kelley says.

Doctors at Alvarado Hospital in San Diego discovered Kelley had cerebral arteriovenous malformations (AVMs). These abnormal connections between the arteries in the brain usually form before birth and occur in less than 1% of the population. Due to the AVMs, Kelly suffered multiple intracranial bleeds.

Kelley's loss of memory and motor skills left him at a second-grade level. It took him years to relearn how to speak, walk, read and write, and during that time, his EMT certification expired.

Because he didn't remember enough from his initial EMT training, he had to start over. He says that he remembers the first time around, his instructors told him he was so sharp he should consider becoming a paramedic. This time, it wasn't so easy. But his perseverance eventually paid off. In December 2008, after his third time through the class and taking the exam, he was once again certified.

Today, he's working as an EMT for Rural/Metro and says his experience has made him a better first responder. "I never understood why anyone would have a DNR [do not resuscitate order], but now I can."

First Shift, First Save
Some EMTs wait years for their first save; Alex Su didn't even wait a whole shift. About two hours into his very first shift, working the Boston University commencement ceremony May 17 (he had been hired two days prior), Kevin Fieldƒfather of one of the graduates collapsed and went into cardiac arrest. Su and fellow EMT Elizabeth Snow made their way across the arena and found Field with no pulse. When initial CPR attempts failed, Su delivered a shock using an AED, followed by more CPR. By the time paramedics arrived, Field was breathing on his own and talking. At the hospital, a pacemaker was placed and he was released. First saves often have more to do with opportunity than skill, but whether it happens on the first or five-hundredth shift, it's nice to know you're the right person for the job.

Clocked Out
Patients might want to think about not getting ill or injured on or half past the hour in northeast England, where an ambulance driver with North East Ambulance Service is being investigated for allegedly going back to the station May 18 and clocking out with a Category A (life-threatening) patient in the compartment.

The paramedic and advanced technician responded at 3:57 p.m., five minutes after receiving the call that 69-year-old Ali Asghar had collapsed with a potential stroke. But the father of four didn_t make it to the hospital until 30 minutes later an interval that included an estimated four-minute delay caused by the changeover after the driver complained of being 15 minutes past shift. Asghar deteriorated quickly and died of a suspected heart attack soon after reaching the hospital's accident and emergency unit.

The service has suspended both providers from duty pending a thorough investigation, saying, "Patient care is our number one priority and we treat any action which falls short of the high standard expected of our staff extremely seriously."

Minutes were precious to this paramedic, but more so to his patient. As Asghar's son, Mohammed, said, "The time he took to detour could have saved my father's life." JEMS

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