Administration and Leadership, Airway & Respiratory, Patient Care, Training

Modern Miracle or Luxury?

Issue 8 and Volume 35.

Miracle or Luxury?
Is continuous positive airway pressure (CPAP) a modern miracle or a luxury? This month, readers respond to JEMS.com columnist Guy Haskell’s article, “CPAP Works Wonders: The best thing since sliced bread … with peanut butter.” One agrees, but another wonders if it’s a necessity. Also this month, Keith Wesley and Marshall J. Washick’s JEMS.com review of a recent study generates a discussion on proper pain management protocol.

Before sliced bread, people just sliced it themselves. Likewise, before CPAP, a bag-valve mask was used to provide positive pressure ventilation assistance. At least, I hope it was. I agree that CPAP is fantastic, but I consider it a luxury and hope we haven’t forgotten the art of bagging patients. After all, it’s how we teach airway management. Shouldn’t it be how we practice as well?
D. Klein
Via jems.com

CPAP has made a real difference in the rural setting as well. Out here in the boondocks, we’re farther away from everything. Having CPAP has improved our patient outcomes and reduced the amount of time they stay in the hospital. The type of CPAP we use allows us to start treating our patients in their homes, if needed. I agree; CPAP is the greatest thing for EMS since the pocket on a shirt.
Michael J. Mallo, EMT-P
Spencer, Indiana

Pain Protocols
Kudos to the study authors and to Dr. Wesley and Paramedic Washick for reviewing [“Are Fentanyl and Morphine Equals?”]. I agree with Washick that both agents are appropriate for EMS use, but as others have also said, one must know which to use when. It’s imperative that medics have a thorough knowledge of any drug used. Although there’s no excuse for failing to manage pain adequately, there’s also no excuse for medical directors and state EMS systems restricting their medics from adequately managing pain by limiting protocols. If the fear is inadequate education in pain management, then educate your medics.
Gene Gandy, JD, LP, NREMT-P
Via jems.com


CORRECTIONS
The formula for ethanol is incorrect in Steve Berry’s article, “Duh: Don’t underestimate human stupidity” (June 2010 JEMS). The correct formula is C2H5OH.

The article, “New CCR Technique Proves Successful,” (June 2010 JEMS) incorrectly reported the cooling temperature for normal saline solution. The temperature should be 40° F.
We regret the errors. JEMS

This article originally appeared in August 2010 JEMS as “Letters: In Your Words.”