Major Incidents, Mass Casualty Incidents, Operations

Readers Share Feedback on Nutrition Article and Sandy Hook Shooting

Issue 1 and Volume 38.

Challenges to ‘Eating Healthy’
This month, JEMS readers and Facebook fans chime in with additional suggestions and feedback on a December JEMS article by nutrition columnist Elizabeth Smith, MS, RD, LDN, EMT-B, “Eating Healthy on an EMS Budget: 8 tips to stretch your budget, not your waistline.” Also, our Facebook fans respond to news posts about the tragic school shooting at Sandy Hook Elementary School in Newtown, Conn., on Dec. 14, 2012. We were touched by their words of love and support for the Newtown Volunteer Ambulance Service, Newtown Fire and Rescue, and the community’s other first responders. We echo their thoughts and sentiments to all who have been touched by this terrible tragedy.

I’m fortunate to have a vacuum sealer. Sunday is a big cooking day in my house. I make stuff that could be, but doesn’t necessarily need to be, reheated.
Scott H.
Via Facebook

I’ve been around for quite a few decades and still cannot figure out what a “serving size” is. We deal with things like ounces, grams, etc. When is someone going to put things in terms we use?
Derek M.
Via Facebook

Author Elizabeth Smith, MS, RD, LDN, EMT-B, responds: You’re right, Derek; serving sizes are often labeled in ounces and grams, and it is much easier if you can think of servings in terms of everyday things. Here are a few for reference:

>> One serving of fruit or vegetables is the size of your fist.
>> One serving of pasta is the size of an ice cream scoop.
>> Three ounces of meat, fish or poultry is the size of a deck of cards.
>> One serving size of potato is the size of a computer mouse.
>> An appropriately sized bagel is the size of a hockey puck.
>> One serving of cheese is the size of a pair of dice.

There are a lot of great visual aids along these lines available online as well.

Sounds great in theory, but the bottom line is that in busy systems it does not work. With turnaround times less than 10 minutes at the hospital, being scheduled for 12 hours but working 16 hours and it’s against Occupational Safety and Health Administration (OSHA) regulations to eat in an ambulance or even store food in an ambulance, you cannot prepare your meals for the week. What you are describing may be the norm in your area but in most services good luck with being able to do this on a daily basis. Your intentions are good but the real factor is that you need time to stop and eat and that just does not happen.
Trent S.
Via Facebook

Author Elizabeth Smith, MS, RD, LDN, EMT-B, responds: I believe the OSHA regulation you are referring to is the prohibition of eating and drinking in the workplace, part of 29 CFR 1910.1030, Occupational Exposure to Bloodborne Pathogens. This regulation has been interpreted in the OSHA Bloodborne Pathogens Exposure Control Plan for ambulance companies specifically to define the patient area as the workplace and the cab section of the ambulance as permissible for food and drink, provided that the company has a policy in place for employees to clean contaminated clothing. So you are allowed to carry food and eat in the truck, just keep it in the front and away from the patients.

Tragedy in Newtown, Conn.
We in EMS who responded will be forever changed for what we could not do at the scene. There was nobody to transport, and that was devastating. Nothing breaks an EMT’s heart more than not being able to do anything but move the dead. May we find strength in each other and in our profession. God bless, from a Newtown resident and AEMT.
Melissa M.
Via Facebook

I was there at the [Newtown] High School gym [working with American Red Cross Disaster Mental Health], where I got to talk with the EMS folks. We don’t have words to express the deep loss they feel.
Philip B.
Via Facebook

I’ve been in EMS nearing 23 years; I don’t think I’d be able to work another day for a while after all that happened there. After all the years, it is the young’uns that still haunt my dreams and thoughts …
Scott M.
Via Facebook

As I began my shift today, I was shocked at the tragic news of this senseless act. I feel sad for those struck by this devastating situation. Through the sadness comes pride in my fellow EMS/fire/law enforcement brothers and sisters that ran toward this scene today. Stay safe and continue with courage and strength. Hug your family a little tighter when you get off duty.
Scott W.
Via Facebook

In the time to come, may strength, compassion, selflessness and service guide your way. And when it is your turn to take care of each other and yourselves, may you have the healing that you need.
Cassandra D.
Via Facebook

This is what makes me so passionate about my job in the EMS field. All of us have to endure so many scenes like this. We have to put our feelings aside at that moment to help the people in need. I take my hat off to all EMS medics and salute you for what you do for patients. Thank you to all you guys what you do for your fellow man. I’m so proud of you even though I don’t know you. It’s a cruel world out there. Good luck to all of you.
Lizelle P.
Via Facebook

MCI Management Tips
I am assembling some of the items you mentioned in your great article on MCI planning in the November issue of JEMS (“Incident Management: 10 tips to help gear up for MCIs” by A.J. Heightman, MPA, EMT-P).  Do you have any checklists you have used in the past to assist me in large event planning?  Thank you for the insight on this very important topic.
Troy Willrick
Daytona Beach, Fla.

Editor’s Note: Thank you, Troy, for the kind words. We recommend reading the article “MCI Magnifiers: Many factors can complicate an incident of any size” by Editor-in-Chief A.J. Heightman which appeared in the September issue of JEMS. This article, and many more resources for management of major incidents, can be found online at