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I had started reading the December 2007 JEMS supplement, "Lethal Exposure 2," but had not finished it when an incident happened in my plant earlier this year.
I_m an EMT-I working part time with an ambulance service and volunteering as a firefighter. I also work full time in a corn processing plant as a supervisor. On Feb. 10, we had a lethal release of carbon monoxide in a laboratory that killed two of my co-workers and hospitalized 16 others.
As a member of the EMS community, I thought I knew all there was to know about CO poisoning. But after the incident, I read the supplement three times to better understand CO poisoning and its effects on the body. I also gave it to my plant manager and other personnel who had been affected by the poisoning.
Each person who read the supplement thanked me for bringing it in, saying it helped explain what happened. It really provided insight on the deadliness of this silent killer and how quickly it spreads. The levels our people were exposed to, according to the article and judging by how quickly some of our people went down, exceeded 6,700 ppm. This incident and your supplement increased my plant personnel_s awareness of CO poisoning.
Edward Hunter, EMT-I
As an avid reader of JEMS, I look forward to "Last Word every month. Most of the time, I completely agree with what_s determined to be a Thumbs Up or Down. However, I have to disagree with "True EMS Horrors" (April). The downward thumb is misdirected.
If you carefully read the Men_s Health request for comment and the actual article that ran, you would see that the editors were looking to show how EMS lacks the resources it needs to do a more efficient job. Almost every single response from paramedics addressed the issue of misuse of the EMS system (calling for a toothache, hunger, etc.) that plagues our communities, further delaying patient care for those who truly need it. In conclusion, I request that you take a minute to revisit the article and reconsider your vote.
Brad Chernock, BS, NREMT-P, CCEMT-P
Newark, New Jersey
I have the following thoughts on April_s "Research Review." The article reads, "Assuming that all ear bleeding is from a basal skull fracture necessitates that the patient undergo an extensive workup." Prehospital care providers are unable to tell if a mechanism of injury is substantial enough to result in a basal skull fracture. The test of collecting exsanguinations from the ear canal and waiting 20 minutes does not rule out a skull fracture even if the sample clots. A sound prehospital conclusion to this study, therefore, would be that if you think a patient_s injury warrants running the test, then it warrants your treating the patient as if they have a basal skull fracture. Just my opinion.
Jim Miller, EMT-P
New Bern, North Carolina
In "Triage for WMD Incidents" (May), the SLUDGE mnemonic on p. 64 indicates that M stands for "Meiosis." This should be "Miosis." Meiosis is the process of cell reduction division in which the number of chromosomes per cell is cut in half. Miosis is excessive smallness or contraction of the pupil. Also, the SLUDGE mnemonic has all but been abandoned in the recognition and medical management of cholinesterase inhibitor toxicity. The "new and improved" mnemonic is DUMBELS
The SLUDGE mnemonic fails to account for the three "killer Bs." Overall, the article is very good.
Brandon F. Johnson, Firefighter/NREMT-P
Assesing Your Assessment
The article, "Documentation: Basically Very Important," was great. It shows what makes or breaks a good medic, especially in the eyes of our allied health teams within the hospital. In 20 my years, I can honestly say I√ve made huge gains for my patients. I've seen patients continually go through the system with the same problems and leave the hospital undiagnosed. But by doing my assessments, I get a bigger picture and can bring that to the doctor and get the patient the help they need. When you have the right information, you shine like a professional. We need to get beyond being glorified first-aiders. In essence, we're like Sherlock Holmes trying to solve a mystery with a medical team and looking out for the interests of the patient.
Arne Larsen, BLS/AED/CPR Instructor
Barrie, Ontario, Canada
The URL for Jones and Bartlett in "2008 JEMS Hot Products" (June, p. 46) should have readwww.jbpub.com.
The article "Death by Polonium-210," will appear in a special supplement in November JEMS, not August, as indicated in July, p. 30.We regret the misprints.