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From the October 2008 Issue | Wednesday, October 8, 2008


Safety Warnings

Ferno Cot Concerns

If your service uses Ferno 35X PROFlexX stretchers, take a look at their frames for cracks, deformities, metal shavings or bent support arms in the X-frame area. Ferno advises customers with 35X PROFlexX cots with serial numbers between 06-002156 and 07-054091 (showing they were manufactured between Jan. 17, 2006, and Aug. 16, 2007) to discontinue the use of any cot showing such signs and to contact the company. (Current Ferno model 35X production units are not affected.)

Ferno released the advice Aug. 11, four days after Massachusetts EMS issued an ˙urgent alertÓ to EMTs and paramedics in that state reporting that some Ferno cots had suffered ˙metal fatigue and breaking of the telescoping legs.Ó Massachusetts EMS Director Abdullah Rehayem advised EMTs and paramedics to keep both hands firmly on the stretcher at all times while moving a patient because ˙at least one cot leg break occurred as the EMTs wheeled a patient toward the ambulance.Ó

˙It_s unlikely that most stretchers will experience any problems,Ó says Ferno Regulatory Affairs Director Dorothy Deaton, ˙yet, given our desire to produce only the finest quality equipment, Ferno would like to ensure this issue does not affect its customers by offering courtesy leg replacement kits.Ó

Ferno asks customers with ˙an identified stretcherÓ to contact Ferno Technical Support by calling 866/987-3776 or sending an e-mail toquality.products@ferno.com for instructions on how to inspect the PROFlexX cot and/or to make arrangements for a free leg replacement kit.ƒMannie Garza

Clenbuterol in Street Drugs

In 2005, the Centers for Disease Control and Prevention issued a warning about heroin contaminated with clenbuterol, a long-acting beta agonist used by body builders and in veterinary settings. But the North Carolina College of Emergency Physicians recently warned that several patients had been treated in that state after using cocaine adulterated with clenbuterol.WakeCounty (N.C.) EMS Chief Skip Kirkwood notes that such patients ˙complain of tachycardia, anxiety and an intense sensation unlike their previous highs.Ó

He warnsEMS responders not to give these patients sodium bicarbonate because the clenbuterol ˙forces potassium into the cell,Ó making the patient extremely hypokalemic. ˙Given the magnitude of this outbreak, we must assume all patients with drug abuse and tachycardia have been exposed to the contaminated drug,ÓKirkwood says. For more information, seeKirkwood_s article ˙Alert: Clenbuterol Outbreak in NCÓ atwww.jems.com.ƒMG

Meth Lab Dangers

EMTs and paramedics are increasingly encountering methamphetamine labs. The Department of Homeland Security (DHS) recently warned first responders about an incident in which police discovered a meth lab that housed 16 cylinders containing highly explosive anhydrous ammonia gas, as well as a ˙probableÓ explosive device.

But even labs that aren_t booby-trapped contain volatile and toxic chemicals, which DHS notes can even ˙potentially seep through cracks in chemical-protection suits worn by hazmat teams.Ó

DHS warns that when dealing with illicit labs containing any type of chemical, responders shouldnever:

>Taste, touch, smell, pour or shake anything;

>Smoke or introduce any ignition devices in the area;

>Operate light switches or plug or unplug anything electrical;

>Rub their eyes, nose or mouth;

>Forget to search for booby traps;

>Remain longer than absolutely necessary; or

>Hesitate to call a hazmat team to a meth lab scene.

In addition,EMS may find children living in homes with these illicit labs. The U.S. Drug Enforcement Administration estimates that some 14,000 children in theU.S. were exposed to meth labs from 2002Ï2007. Many of these children test positive for drugs and may require transport to a hospital for evaluation.

Pro Bono> Are you Liable in a Disaster?

After Hurricane Katrina, theLouisiana attorney general accused a physician and two nurses of allegedly using morphine and sedatives to kill several seriously ill elderly patients in aNew Orleans hospital during the disaster.Criminal charges were later dropped against the nurses, and a grand jury refused to indict the physician.But the accusations prompted a public outcry in support of these professionals who had been working under extremely difficult conditions.

On July 14, Louisiana Governor Bobby Jindal signed several bills into law to protect medical personnel (includingEMS providers) in future disasters. This legislation includes limitations on civil liability and damages that can be sought by a patient and extends the state_s ˙Good Samaritan LawÓ to protect medical personnel from lawsuits for actions during a declared state of emergency. These laws will likely prompt other states to re-evaluate their immunity protections forEMS providers to expand legal protection in times of disaster.

Meanwhile, here are a few key points to remember about legal immunities and responding in other states:

If you_re officially deployed to another state during a declared disaster, the requesting state provides liability protection. The Emergency Management Assistance Compact (EMAC) is aCongressionally ratified interstate mutual aid compact that provides a legal structure by which states affected by catastrophe may request emergency assistance from other states. EMAC member states have agreed to accept the licensure and certifications of individuals from member states.

Individuals deployed through EMAC are considered agents of the requesting state for tort liability and immunity purposes. For example, ifyour state has entered into an EMAC compact with a requesting state and yourEMS agency has an agreement with your state to be part of an EMAC response, the requesting state would recognize your certification while you were functioning there. In addition to the liability protections EMAC provides, any liability protections available in that state (like the ones signed into law inLouisiana) should apply to you during the response.

You are not protected in a disaster response unless you_re part of a formal approved response. If you ˙self-deployÓ without being requested by your state through EMAC or through a specific federal contract your agency has with the Federal Emergency Management Agency or its contractor, you have no legal protection. If you ˙freelanceÓ and go out of state without being requested, your certification won_t be valid either. Resist the urge we saw in response to 9/11 and Katrina to go it alone. If you do, it could spell disaster for your agency and your individual certification.

Always function within your level of certification.When properly responding to a disaster in another state, that state will recognize your certification. But this means you must continue to function within the scope ofpractice established by your home state. Don_t be tempted to do things you haven_t been trained to do and/or are not certified to do in your state.

For more information on EMAC, visitwww.emacweb.org.

Pro Bono is written by attorneysDoug Wolfberg andSteve Wirth ofPage, Wolfberg & Wirth LLC, a national EMS-industry law firm. Visit the firm_s Web site atwww.pwwemslaw.com formoreEMS law information.

Shocking Statistics On Chest Compressions & AEDS

AsEMS systems worldwide increase their emphasis on minimizing interruptions to chest compressions during resuscitation attempts, questions arise about whether to suspend compressions during defibrillation. ˙It usually takes seven seconds [for the AED to analyze and three to four seconds to shock, so there_s likely a 15Ï20 second delay if they shock right away, and in some cases, [more than] 20 seconds that the hands would be off the chest,Ó says Paul Pepe, MD, MPH, director of Dallas (Texas) Medical Emergency Services. ˙There_s evidence that not doing compressions during that time could be harmful, so we_ve been doing compressions during analysis. As soon as it says Âshock advised,_ we do another round of 30 compressions, then take our hands off, push the button and go right on with chest compressions.Ó He notes that most defibrillators hold a charge for at least 30 seconds, but cautions that ˙some machines dump the charge,Ó so an EMS agency should check with the manufacturer before instituting such a policy.

In the future, however, your protocols could call for continuing chest compressions even during shock.EmoryUniversity researchers recently measured the ˙leakageÓ voltage and current during defibrillation on 39 patients and found a rescuer with a gloved hand pressed into a patient_s chest couldn_t even perceive the shocks. (Lloyd MS, Heeke B, Walter PF, et al: ˙An analysis of electrical current flow through rescuers in direct contact with patients during biphasic external defibrillation.Ó Circulation. 117[19]: 2510Ï2514, 2008.) ˙The present findings support the feasibility of uninterrupted chest compressions during shock delivery,Ó the authors conclude.ƒMG

Action Alert

Push Congress for Fuel-Tax Relief

TheU.S. media ran numerous stories this summer on how the cost of fuel is creating new problems forEMS agencies, especially those staffed by volunteers. In response, Rep. Jim Ramstad, R-Minn., introduced a bill in theU.S. House of Representatives June 11 that would amend the federal tax code to exempt ground and air ambulances from the federal motor fuel tax through 2012.

The fuel-tax exemption in that bill (H.R. 6243) would save ambulance services only 24.4 cents on each gallon of diesel fuel (18 cents for non-diesel), ˙which is not enough, but would help,Ó says American Ambulance Association (AAA) Senior Vice President for Government Affairs Tristan North. He adds that Senator Gordon Smith, D-Ore., is ˙eagerÓ to introduce a similar bill in the Senate.

The AAA encourages theEMS community to lobby federal lawmakers on behalf of this measure. And such lobbying is clearly needed: As of Sept. 10, no other members of Congress had signed on as co-sponsors.

Meanwhile, another bill designed to help volunteer fire departments with the cost of fuel has started gathering co-sponsors in both the House and Senate.

In early July, three senators and three representatives introduced the Supporting America_s Volunteer Services Act (H.R. 6461/S. 3237). The˙SAVES ActÓ would require the Federal Emergency Management Agency to reimburse eligible volunteer fire companies 75% of the excess they spent for gas and diesel fuel above the average cost of fuel in 2007. The legislation notes that between June 2003 and June 2008, regular gasoline prices rose 171% and diesel prices soared 229%.

Find more information on these bills online atThomas.loc.gov, and then let your lawmakers know what you think they should do.

EMS Agency Abducted from Mars

According to an Aug. 10 article in the Pittsburgh Post-Gazette, the mayor of Mars,Pa., is imploring the city council to investigate the abrupt disappearance of the city_s primary ambulance service earlier this year. The council, however, refused, citing the fact that the non-profit Mars Emergency Services Inc. was completely private and received no annual funds from the borough. Meanwhile, long-time rival service Quality EMS has been responding to emergency calls and the mayor_s phone rings ˙off the hookÓ with people inquiring as to what happened to Mars EMS. However, this is one mystery that may never be solved: No one formerly affiliated with the service will talk about what happenedƒlet alone explain how the services_ two ambulances seemingly vanished into thin air.

West Point Cadets Train with FDNYEMS

West Point graduates are going to Iraq or Afghanistan after they receive their commissions in the U.S. Army, and this summer, 72 future Army officers got a taste of what they may face on the battlefield by running at least two eight-hour shifts with Fire Department of New York EMS. Benjamin Zederbaum, founder and director of the Cadet Medical Intensive Training program atWest Point, coordinated the project with contacts from his earlier career in NYC EMS. Although these future officers won_t serve as field medics, their experiences will impact medical care on the battlefield, he says. ˙If a medic comes up to one of our lieutenants and says, ÂIf we don_t get a medevac for this solider, he_s going to die,_ that lieutenant is going to understand. ÂThis guy has a pneumothoraxÚ I get it._ Lives will be saved because of this,Ó says Zederbaum.ƒAnn-Marie Lindstrom

For more information about the program, contact Benjamin Zederbaum atemtbenz@yahoo.com.

>Controversy

Should Feds Investigate Fatal Ambulance Crashes?

Some ambulance-safety leaders have asked the federal National Transportation Safety Board (NTSB) to investigate fatal ground ambulance crashes just as it does air ambulance crashes. The hope is that NTSB investigations would result in changes in ambulance design and operation that could better protect patients and providers in ambulance compartments. But not everyone in theEMS community agrees about involving the NTSB. What do you think? Let us know atwww.jems.com.

Quick Takes

James Augustine, MD, a nationally recognized EMS medical director (and JEMS editorial board member), became interim medical director for the District of Columbia Fire and EMS (DCFEMS) Aug. 29 after the department_s former medical director, Michael Williams, MD, resigned. DCFEMS Chief Dennis Rubin, who was formerly Atlanta_s fire chief, convinced Augustine to leave his post as medical director of the Atlanta Fire Department earlier this summer to become the DCFEMS deputy medical director. Augustine was also first chair of the Ohio EMS Board.

"I am looking forward to taking emergency medical services within the fire department to the next level," Augustine said. "Magnificent progress has aleady been made through the Mayor_s EMS Task Force, and I look forward to sustaining and augmenting the success seen so far."

Soldiers Now Use EPCRS

The U.S. Army_s Medical Communications for Combat Casualty Care (MC4) could be called an electronic patient care report (ePCR) on steroids. Battlefield medics enter data on handheld devices, and field-hospital physicians can access that information on laptops and can track the patient_s treatments and other medical informationƒeven years later.

Additional system components allow personnel to order supplies and maintain inventories, show geographic trends in illnesses and injuries, provide reference documents (including environmental risks in specific areas) and display the best facility for a particular illness or injury.

More than 5 million medical care records have been entered at more than 250 facilities in 14 countries since the system was deployed in 2003. The Army recently announced that the system is now deployed throughout all branches of the U.S. military. For more information about MC4, visitwww.mc4.army.mil.JEMS




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