Ask Feds to Investigate Ambulance Crashes
Any loss of life or serious injury in our response or delivery of EMS care is a terrible tragedy. This has been a concern of a number of EMS leaders and researchers over many years, with serious ambulance crashes and„EMS roadside tragedies occurring every day.

National resources exist to investigate these tragic events and to assist EMS in improving safety. The primary organization that can bring this expertise to EMS is the National Transportation Safety Board (NTSB).

The NTSB has a team of engineers, transport crash analysts and other experts with the technical skills to investigate a complex crash scenario, and also the power to generate national recommendations. Unfortunately, the NTSB hasn’t investigated an ambulance crash since 1979, and, since then, there have been an estimated 1,600 fatalities related to ambulance crashes.

Unlike commercial vehicles, there’s no national database for ambulance crashes that result in serious and fatal injuries and/or in substantially damaged or destroyed ambulances. There are also no technical crashworthiness standards for the rear compartment of our ambulances.

The EMS community knows there’s a problem. But, until we have data to analyze, track and trend probable causes, we can’t make sound recommendations to address equipment failure or unsafe practices that wesuspectare the cause of loss of lives and livelihoods, and leave communities at risk for limited emergency response.

An ad hoc group of EMS professionals recently assembled to address concerns about ambulance crashes after a July 20, 2007, crash occurred in Antwerp,„Ohio. The collision killed five occupants in the ambulance and left the community with only 50% of their EMS fleet, tragically killing one-third of their„EMS responders. This ad hoc groupƒnow known as the Ambulance Transportation Safety (ATS) Task Forceƒis petitioning the NTSB to assist„EMS, as it does for commercial and other vehicles.

A position paper, petitioning the NTSB to assist EMS with data analysis and technical resources, can be found atwww.objectivesafety.net/Policyinfo.htm. This paper calls for NTSB action.

Many of us have been involved in a crash personally, or have a friend or relative who has been involved in or failed to survive an ambulance crash. You can help by carefully reading the ATS Task Force position paper, writing to your lawmakers and sending your concerns directly to the NTSB. We need your help.
„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„ – Eileen Frazer, RN, CMTE, CLNC

Members Chosen for New National„EMS Advisory Council
The U.S. Department of Transportation (DOT) has announced the names of the first 25 individuals selected to sit on the new National EMS Advisory Council (NEMSAC).

˙The purpose of NEMSAC is to provide advice and counsel to the [DOT] on national emergency medical services initiatives, while offering a forum for the non-federal deliberation of national EMS issues,Ó wrote Drew Dawson, director of the DOT/NHTSA Office of EMS, in an e-mail to the chosen individuals.

NHTSA Associate Administrator Marilena Amoni says it was ˙quite challengingÓ for DOT officials to evaluate more than 400 nominations and choose 25 individuals to represent all„EMS stakeholder groups.

The DOT chose people to represent each type of service model and to fill specific slots listed in the Dec. 18, 2006,Federal Registernotice that the DOT would create the NEMSAC.

Here’s a list of who will serve the first two year terms on NEMSAC, followed by the constituency they represent:

Charles Abbottƒstate highway safety directors;Dia Gainor,MPAƒstate EMS directors;Kyle Gorman,MBA, EMT-Pƒfire-based EMS;Joseph Heck,DOƒcity/county councils, state legislatures;Kenneth R. Knipperƒvolunteer EMS;Kurt M. Krumperman,MSƒfor-profit ambulance services;Patricia Kunz Howard,PhDƒstate EMS training coordinators;Thomas Judgeƒair medical;Baxter Larmon,PhD, MICPƒEMS researchers;Jeffrey T. Lindsey,PhDƒEMS educators;Daniel E. Meisels,MPAƒhospital-based;Robert Oenningƒ9-1-1 call takers/dispatchers;Aarron Reinertƒcombination volunteer/paid department;John Sacra,MDƒemergency physicians;Ritu Sahni,MD, MPHƒEMS medical directors;Jose SalazarƒEMS educators/training officers;Jeffrey P. Salomone, MD, FACSƒtrauma surgeons;Richard A. Serinoƒmunicipal third service;Linda K. Squirrelƒtribal EMS;Kevin Staley,MPAƒpublic-utility model system;Matthew Tatumƒemergency managers;Chris D. Tilden,PhDƒpublic health;J. Thomas Willis;Gary L. Wingroveƒhospital-based EMS; andJoseph Wright,MD, MPHƒpediatric emergency physicians.

NEMSAC meetings will be open to the public and announced in theFederal Register. ƒMannie Garza

James O. Page Collection to be Archived at UCLA Library
The works of the late Jim Page, founding publisher ofJEMSand one of the most influential EMS and fire leaders in America, will soon have a permanent home in the History and Special Collections Division at a UCLA library.

Bill Atkinson, PhD, chairman of the James O. Page Foundation, says arrangements have been finalized with UCLA’s Louise M. Darling Biomedical Library to archive more than 40 cartons of Page’s articles, speeches, reports, manuscripts, memorabilia, personal correspondence, audio files and videos in the James O. Page Collection. The library will carefully catalog these materials, scanning those to be made available online, and storing all documents to ensure their preservation. The project is being made possible through donations received by the James O. Page Foundation.

Beginning later this year, a catalog of all documents and audio-visual files will be available, with printed copies available for a small fee. Several documents and files will also be accessible for free on the library’s Web site. Anyone can request to visit the library and access originals from the collection.

˙Jim was not only a prolific writer but a great one,Ó says Atkinson, president of WakeMed Healthcare and Hospitals. ˙Whether speaking or writing,Ó he adds, ˙Jim had a way of telling a story that made issues and history come alive.Ó

˙Jim’s history is intertwined with the Los Angeles County Fire Department and Squad 51,Ó says Doug Wolfberg, one of Jim’s partners in the law firm Page, Wolfberg and Wirth LLC. ˙Having his collection at UCLA is a fitting and prestigious honor.Ó

In addition to Jim’s writings, the James O. Page Collection is designed to be a hub for many other audio-visual and written materials that are important -„or interesting- of EMS. The library plans to invite other„EMS pioneers or luminaries to donate their collections. However, anyone who has materials related to Jimƒwhatever form they might take, including personal lettersƒare invited to share copies or originals for potential inclusion in the archive. For more information about how to share these important documents and memories, go towww.jamesopage.org.

˙We see the Collection as a touchstone to Jim’s legacy and an inspiration for generations of EMS and fire personnel to come,Ó says A.J. Heightman,JEMSeditor-in-chief. ˙It will be a central collection and conversation point, bringing together the people and events that shaped this industry. As far as we know, the James O. Page Collection will be the first of its kind.Ó Jim kept and catalogued an incredible depth of EMS history in his files.

On July 30, 2008, The James O. Page Foundation will hold a benefit dinner aboard the historicU.S.S. Midwayaircraft carrier in„San Diego, in cooperation with the Pinnacle EMS Leadership Conference.„EMS leaders and friends of Jim from throughout the country are expected to attend. Proceeds will help fund the endowment for the James O. Page Collection. More information about the event is available atwww.pinnacle-ems.com.

-Keith Griffiths, founding editor ofJEMS,member of the James O. Page Foundation Board

QUICK TAKES
Ambulance Manufacturer Declares Bankruptcy
On Jan. 28, American LaFrance, one the nation’s oldest manufacturers of ambulances and fire apparatus announced it had ˙filed a petition for relief under Chapter 11 of the U.S. Bankruptcy Code.Ó Although the company reports it will resume the production of fire apparatus, likely by sometime in March, it said it would close its Sanford, Fla., manufacturing plant and ˙will discontinue the manufacturing of ambulances.Ó For more information, visitwww.americanlafrance.com, click on News and then on Press Releases.

Contour TS Blood Glucose Test Strips Recalled„
Bayer Diabetes Care issued a recall for test strips used in the Contour TS Blood Glucose Meter on Dec. 21, 2007. The recall statement says the strips could give blood glucose readings 5%Ï17% higher than the actual blood glucose. Bayer faults new equipment and says it has fixed the problem.

They stress the problem is only with the test stripsƒnot the meters themselvesƒand only with Contour TS strips. The Web sitewww.fda.gov/medwatch/safety/2007/contourTS_recall.htmlists the affected lots, andwww.bayerdiabetes.comgives product codes and article numbers for the recalled test strips.

First Female EMS Chief for Philadelphia FD
After more than 270 years,„Philadelphia has a female„EMS chief. Diane Schweizer is now the chief of EMS Operations. According to the story in thePhiladelphia Inquirer,Schweizer had been an EMT while in high school in„New Jersey. She joined the department in 1995 as a paramedic after graduating from the University of Scranton, Pa., with a math degree and received a master’s in EMS from Hahnemann University in Philadelphia. Schweizer oversees 300-plus paramedics with 45 ambulances.

New BrunswickCreates Province-Wide Ambulance Service
The Canadian„province of„New Brunswick has consolidated more than three dozen ambulance services with 50 separate contracts into the public company Ambulance New Brunswick, according to a CBC News story. The single system is seen as an opportunity to standardize levels of service, as well as provide consistent pay scales throughout the province.

˙Primary care paramedicÓ is the new entry-level position for the system, with training offered to„EMS personnel who don’t already have that certification.

The system will also introduce something„New Brunswick hasn’t had beforeƒstandardized response times. The targets are nine minutes in urban areas and 22 minutes in rural areas 90% of the time.

PRO BONO:Changing & Rewriting A PCR
Sometimes, after a patient-care report (PCR) is completed for a call, it’s later found to contain errors or to be incomplete. Other times, although less common, a PCR in its entirety can be lost or misplaced, or if done electronically, inadvertently erased or deleted before it was saved. In these instances,„EMS providers may be asked by their organizations to amend or modify their PCR, or perhaps even recreate it entirely. What are the legal parameters regarding such practices?

First, be sure to check your state or local„EMS requirements to see if they speak to this subject. Most do not, but it’s important to comply with any such regulations, protocols or directives that may be in place in your„EMS system that may address the modification or replacement of PCRs.

If no such state or local directives exist, then there are a few general principles to keep in mind. Chiefly, at no time should an organization ask EMS providers to ever falsify, misrepresent or embellish their documentation for any reason, whether to support a claim to Medicare or another insurer, make the patient care look better or more complete than it really was, or to cover up some error, protocol deviation or poor outcome. Equally important, no„EMS provider should ever agree to change or rewrite a PCR for any such reason. Among other laws, the federal False Claims Act could impose substantial penalties upon individuals or organizations that do so.

Nevertheless, there are legitimate reasons a PCR might require modification or rewriting. It could later be determined that important information was omitted or stated inaccurately. It’s certainly permissible to amend a PCR to correct mistakes or omissions. When such changes are necessary, they should be made by the original author of the PCR whenever possible. In addition, changes made after the original PCR was written should be made as soon as possible, and should be signed and dated so it’s clear that the changes weren’t part of the original PCR. Some electronic PCR programs will track changes automatically.

If a PCR is lost or deleted, and needs to be rewritten, it’s important to ensure that information is documented accurately. If the provider can’t recall details, such as vital signs, specific treatments provided, the precise nature of the patient’s complaint or other key facts, they shouldn’t be guessed or made up for documentation purposes. There might be other sources to glean information from, such as notes from the time of the call, or perhaps even a tape recording of patient information being relayed to the receiving facility. But a note should be made whenever a PCR is recreated using these external sources of information.

If a PCR can’t be recreated because the necessary information simply can’t be accurately recalled or reliable information can’t be obtained from other sources, the organization may wish to write an incident report or other such note indicating that the PCR was lost and the circumstances under which that occurred, so there’s some documentation of that fact in the event records are later subpoenaed or requested in a lawsuit.

This update is provided bySteve WirthandDoug WolfbergofPage, Wolfberg & Wirth LLC(www.pwwemslaw.com), a national„EMS, ambulance and medical transportation industry law firm.„

Don’t Swallow That Aspirin
By now, a lot of people know to swallow an aspirin if they think they’re having a heart attack. If Improvita Health Products has its way, that will change. They’ve developed Faspirinƒan uncoated, 81-mg aspirin that dissolves in the mouth.

Improvita President Tom Klamet says, ˙Faspirin was developed by a physician who saw the many benefits of an aspirin that could be administered quickly and effortlessly.Ó Not only does Faspirin get into the system faster, but it dissolves on the tongue, which makes it easier to administer to someone who has trouble swallowing.

Faspirin was introduced to the retail food and drug markets last summer. Improvita is planning a secondary launch to medical professionals later this year after an efficacy study is completed. Ohio Northern University is conducting the clinical study to compare absorption speed and bioavailability between Faspirin and other low-dose aspirins, including Bayer and„St. Joseph’s.

Klamet says, ˙Right now, we assume Faspirin gets into the blood system within three to five minutes. Absorption through mucosal tissues is much faster than going through the stomach and liver.Ó Traditional aspirin can take as long as 30 minutes to get into the bloodstream, says Klamet. And enteric-coated aspirin can be eliminated before all its dosage makes it into the system, he adds.

The study results are expected in April, with peer-review publication by late summer or early fall. After they have scientific data to share, Klamet says they’ll be ready to target the medical community.

More information is atwww.faspirin.com.„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„„ ÏAnn-Marie Lindstrom

Know Your Patients:Young Diabetics Give Up Medic Alert Jewelry for Tattoos„
Some young people with diabetes are getting tattoos that identify their medical condition, according to an ABC News story. The idea is controversial. On one hand, a Medic Alert bracelet or pendant can disappear, while a tattoo is forever. On the other hand, there’s concern about health risks from tattoos. ˙Diabetics are known not to be the best healers and [a tattoo] is a trauma to the body,Ó says Todd Soard, president of the Florida Association of Professional EMTs and Paramedics. As an answer to those problems, the company MEDAWARE offers glow-in-the-dark, temporary tattoos that identify the wearer as having diabetes. If the trend hasn’t hit your area yet, hang on Ú it may be coming.