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JEMS Reveals Top Stories of 2011


By now you know the top 10 stories for JEMS.com in 2011. Here’s the complete list:

1. “2010 CPR Guidelines: A Summary

2. “New Drug Has Dangerous Potential for Patients & Providers

3. “EMS Should Train like Navy SEALs

4. “Know the Signs and Symptoms of Traumatic Asphyxia

5. “Nurse Defends Paramedics & ETI

6. “Prehospital IVs & Trauma Patients

7. “Prehospital Intubation & Cardiac Arrest Survival

8. “EMS System Abuse

9. “EMT or Paramedic?

10. “Identifying Diseases that Mimic Strokes

As we count down to the start of 2012, we thought it would interesting and educational to look back through the hundreds of non-news articles we published on jems.com in 2011 and review the Top 10 most popular articles with you.

Looking at the most widely read articles will give you a good idea of what was on the minds of EMS providers in 2011 and, perhaps, what interested or concerned them the most.

After reading all the articles on our Top 10 list, plus the tremendously popular 9/11 10-year anniversary four-part supplement, “Out of the Darkness,” you’ll see several common threads.

First and foremost is that we have to be consistent in our approach to patients and their care. If we fail to be consistent, people can and will die.

We have to maintain chest compressions at all costs, or patients won’t be resuscitated and leave the hospital.

EMS providers have to be vigilant and consistent in their approach to penetrating and crush injury trauma. The old adage “All bleeding will eventually stop” is true in relation to patients with crush injuries, traumatic asphyxia and penetrating wounds. Staying at the scene trying to start an IV may cause your patients to slip into irreversible shock and die.

The same holds true for endotracheal intubation. Most people in the know accept the fact that it’s “better to bag than brag about getting a tube on the third try.” If I’m lying unconscious and not breathing, please bag me with a bag-valve mask (BVM) and tube me later if you can do it in one attempt that lasts no longer than 10 seconds. I have a few good brain cells left so I want to maintain the ones I have—for as long as I can.

Last, but not least, the top stories on JEMS.com point out the need for solid, constant training and simulation, an emphasis on preparing for the unknown and watching out for our safety and the safety of our partners—you (and they) are the most precious commodity we have in EMS. Now let’s take a look at all your favorite stories from this year.

No. 10
In March, 2011, JEMS publishing an outstanding article, “Identifying Diseases that Mimic Stroke” about the difficulty of assessing patients with less than obvious symptoms of stroke, written by Bill Raynovitch, NREMT-P, EdD, and Richard Walker, MD, FACEP, FAAEM, appeared on JEMS.com. It was one of the most popular articles of the year.

You know the patients that I’m talking about, the ones who talk but don’t make much sense. Sure, I could be describing one of your recent EMS partners, but I’m not. I’m describing that 13-year-old who fell and hit his head last night, went to bed and then woke up presenting rambling sentences that his mother can’t understand.

Read this important clinical article and pass it along to your friends. It may make the difference between life, death or permanent disability for someone you treat in the next few days, weeks, months or years.

No. 9
This popular article, “EMT or Paramedic?” was written by Skip Kirkwood, MS, JD, EMT-P, EFO, CMO. It drew a lot of attention because it addressed the identity crisis (or complex) we have in EMS. The public and the news media really don’t know what we do or what to call us. They either think we’re all paramedics or get confused when a fire engine, ambulance and “EMS supervisor” shows up when they call 9-1-1.

Kirkwood makes some excellent points in his popular article. Read it and reflect on it.

Personally, I don’t care what the patient, their family or the news media calls me as long as they realize I was sincere, acted professionally and worked hard to address their needs.

No. 8
In this popular article, “EMS System Abuse” by Bryan E. Bledsoe, DO, FACEP, FAAEM, reflects on his decades of EMS involvement and the ever-present problem of EMS System Abuse.
The insightful Bledsoe points out that we can’t really solve the issue of EMS system abuse until we solve society’s ills: poverty, homelessness, mental illness, substance abuse, domestic abuse, lack of primary care and education.

Read this outstanding article by Dr. Bledsoe and pass it along to all your friends and co-workers this holiday season. It may change their attitude toward Aunt Millie when she calls them out at 2 a.m. on Christmas because she’s simply lonely and depressed.

No. 7
This past February, popular EMS author and educator, Keith Wesley, MD, FACEP, and his fellow educator, Marshall J. Washick, BAS, NREMT-P
reviewed, debated and discussed research that had been published in Academic Emergency Medicine on the association between prehospital endotracheal intubation (ETI) attempts and survival to hospital discharge among out-of-hospital cardiac arrest patients in “Prehospital Intubation & Cardiac Arrest Survival.”

It turns out that the researchers found that individuals with no ETI attempt were 2.33 times more likely to have ROSC compared with individuals with one successful ETI attempt, and individuals with no ETI attempt were 5.46 times more likely to be discharged from the hospital alive.

This is compelling research that you should read and think about before you throw that BVM aside in favor of that laryngoscope and tube.

No. 6
David Page, MS, NREMT-P, and popular author of the JEMS Research Review column, revisits an epic topic in EMS: Should we “load and go” with trauma patients and start IVs en route to the trauma center or “stay and play” at the scene?

His article, “Prehospital IVs & Trauma Patients” on this subject, or the recent book Rawhide Down, on the attempted assassination of President Ronal Reagan, you know that Reagan and many other penetrating trauma victims have been saved by rapid transport with treatment given along the way.

No. 5
Maybe this article’s title, “Nurse Defends Paramedics & ETI
was what captured the attention of plenty of field providers—because it referenced a nurse discussing ETI by paramedics. But Tony Garcia, BS, BSN, RN/EMT-P, is much more than a nurse. He’s a field provider who’s passionate about prehospital care and proper airway management.

His article nicely details the issues involved with the training and monitoring of ETI in the field. He also offers advice and suggestions for improvement in this critically important aspect of EMS. Read it and pass it along.

No. 4
The ever-popular Bryan E. Bledsoe, DO, FACEP, FAAEM, and his colleagues Ross. P. Berkeley, MD, FACEP, FAAEM, and Troy Markus, DO , wrote this popular article on rarely encountered, but frequently deadly, traumatic asphyxia, “Know the Signs and Symptoms of Traumatic Asphyxia.”

It’s well worth your time to read this article, particularly their teaching points on the thoracic crush injury described in the article and summary. Your rapid assessment and high degree of suspicion when you encounter a rollover or crush condition will often make the difference of life or death for these patients.

No. 3
JEMS Editorial Board member and popular EMS historian William Atkinson, PhD, MPA, EMT-P, wrote this popular article, "EMS Should Train like Navy SEALs” in June. It compares the work and training by the Navy SEALS with efforts by EMS providers to be prepared for things that will confront them in the field.

The President and Chief Executive Officer of WakeMed Health & Hospitals—one of the nation’s largest and progressive medical centers—Atkinson points out that in this world of instant media and social networking, “not everything is always as it first appears, and the need to clarify your understanding and make modifications is required for an appropriate and effective response.”

Atkinson believes that every single element of training can and does make a difference in mission outcomes. And in the case of emergency services and medicine, training can mean the difference between life and death.
This article is well worth the read.

No. 2
In August, Jon Nevin, NREMT-P, MBA, did a great job of succinctly defining the issue of bath Ssalts for EMS providers in his article, “New Drug Has Dangerous Potential for Patients & Providers.” He explains what EMS providers will and have been seeing on calls involving the use of this drug.

Despite legislative effort to criminalize the sale of bath salts, it appears bath salts will be seen frequently in the field and pose a danger to patients and providers.

because no direct antidote to bath salts toxicity exists, Nevin pointed out the need for symptomatic treatment with attention to sedation (often repeatedly) for agitation, cardiovascular monitoring and awareness of the hyperthermic potential that can easily place the patient at a heightened risk for fatal consequences.

He also noted that Rhabdomyolysis is possible and can lead to renal failure and death. Therefore, the presentation of tea-colored urine, muscle pains, confusion and/or gastrointestinal symptoms, should lead to high suspicion of this condition. Treatment ranges from aggressive fluid challenges and sodium bicarbonate administration to emergency dialysis.

Read this article and pass it along so others are ready for the consequences (and dangers) of bath salts to patients and the EMS crews that are dispatched to manage them.

No. 1
Surprise! Or is it? The top non-news story of 2011 on JEMS.com was the synopsis prepared by JEMS to assist you in understanding the EMS Implications of the 2010 American Heart Association Guidelines for CPR: “2010 CPR Guidelines: A Summary.”

This short article was an encapsulated version of the detailed editorial supplement published by JEMS in January of 2011, “Evolution in Resuscitation” to present the essential EMS aspects of the 2010 Guidelines. Sponsored by the AHA, Laerdal, Michigan Instruments, Philips, Physio-Control, Vidacare and ZOLL, the supplement was a “must read” because it outlined changes with regard to compressions, ventilation, intubation and confirmation of a patient airway.

As we move into 2012, take the time to re-read this important summary and ensure you’re performing your resuscitations in accordance with the AHA standards.

The JEMS staff has enjoyed presenting you with the top 10 JEMS.com articles of 2011. We hope you enjoyed them as well. Best wishes for a safe a happy holiday season!

—A.J. Heightman, JEMS editor-in-chief





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