Meet...Todd Rosenhaus

Meet... Todd Rosenhaus

Todd has been an instructor with Emergency Care Programs since ___ and is happy to share his EMT history with our students. Let us know if you have any questions for Todd ?

When did you decide you want to become an EMT?
It all started because of the TV show "EMERGENCY" that I watched (and still watch) when I was growing up.

What 1 event (good/bad/ugly) in life factored into your decision to save lives and become an EMT?
Knowing First aid has always been in my family, so I was taught early before becoming an EMT. It was always important to know I had the potential to save a life. Becoming an EMT has just given me more tools to work with.

Did you volunteer / intern as an EMT before you made it your career?
I have been a volunteer for over 30 years. EMS is an unpaid career for me. I do it to give back to the community.

Tell me the best way to find an EMT job?
You need to work hard and do your leg-work, every ambulance company is different. You need to be confident.

What is your Level of Certification? EMT/Paramedic/Lab Instructor/Lead Instructor
I am an EMT and a Senior Instructor (CIC). I also hold a National Registry EMT certificate.

How challenging is it being an EMT?
It's only challenging if you do not put time into your class. Everything is not going to be handed to you on a "Silver Platter". You need to study, practice, and not be afraid to ask questions.

How do you keep sharp in your own skills?
Besides performing my skills on the ambulance, every time I talk to students about a skill, or demonstrate hands on about a skill, I keep sharp.

How is your family life affected – are they supportive of your job?
They always support me; they understand why I do it so maybe they will follow.

What is your most inspirational "save"?
Any save that a person is able to survive is inspirational.

What was your greatest "loss" on the job and how did it affect you?
The greatest loss is that my best friend cannot work with me anymore, He was hurt while working on 9/11 and because of his injuries, and he cannot work. So for awhile it was hard to talk to him about EMS but it has been getting better.

How's the comradery on the job with your fellow EMTs?
It's a second family.

What advice can you give others who want to become an EMT?
You need to want it not just for a job but to care that you will make a difference.

Why do you enjoy teaching your students?
I love knowing that I am teaching people who want to make a difference.

How do you encourage others to follow this career path?
I tell them the truth: you are going to have good, bad and ugly days and you need to take it one day at a time. But just think! You will be making a difference to someone.

Words of wisdom for our students / future-EMT's?
Practice, Practice, Practice

CPR in the workplace. Why you want to train your employees.

According to the American Time Use Survey, put out by the Bureau of Labor Statistics, Americans spend approximately 8 hours a day working at their jobs. The next largest chunk of time is spent sleeping at approximately 7.8 hours. Most jobs are conducted in an environment with other players, whether they are your office mates, partners, team or group.

A good way to break out of the mold of everyday work activities is to conduct a CPR Training Class at your work environment. Besides being a welcome change of pace, it stimulates thoughts on healthy living and saving lives. Is there a better way to spend a few hours?

Most CPR classes include a discussion on heart healthy living habits vs. unhealthy ones. This is included to emphasize the fact that individual's who have more than one unhealthy habit, have a much higher risk of developing cardiac and vascular damage than people who follow prudent heart living. This information on unhealthy habits has been slow to reach the public because of many years of advertising lies. They claim tobacco, soft drinks, fast food and breakfast cereals (cigarettes, sugar, salt) are part of the American lifestyle and you MUST have it in your homes and consume large quantities of it. They not only convince you to buy it, but your children as well. It has taken years for the government to put restrictions on the advertising and sale of tobacco products. Unfortunately, much too late for my parents, aunts and uncles who were persuaded that smoking was the thing to do in the roaring 20's. (1920's that is) They died long painful deaths from every kind of cancer. We need to, absolutely, learn what can hurt us, how to prevent it, and what to do if it does. All office or corporate workers can easily learn 'hand's only CPR'. Add in choking (the Heimlich Maneuver) and the use of a public access AED and you have a complete CPR Class.

To be able to recognize the warning signs of heart attacks is knowledge worth having for everyone:

1. Uncomfortable pressure, tightness or squeezing in the chest area.
2. Sweating, nausea or shortness of breath.
3. Back pain or pain moving down the arm or up to the jaw.
4. Skin might be pale, cool and wet.

Encourage your manager or boss to arrange a CPR class for your organization. And when the CPR Instructor arrives at your place of work with the manikins, pay attention and ask questions. Don't worry; they will make it interesting and fun. Just wear clothing that will be comfortable when kneeling over a manikin.

After cardiac problems, the second leading cause of death in Americans is stroke. (A clot or bleed in the brain instead of the heart)

We need to know those warning signs also because FAST transport to a stroke center is the only thing that can reverse permanent disability and death. Here are the Stroke (brain attack) warning signs:

1. F =Facial drooping
2. A =Arm weakness
3. S =Speech difficulties
4. T =Time to call 911

The more people that know CPR, AED and the Heimlich maneuver, then the more people we can keep alive until the ambulance arrives. Knowing CPR is knowledge and knowledge is definitely power.

Meet....Karen Fiorello

Karen has been an instructor with Emergency Care Programs for over a decade and is happy to share her EMT history with our students. Let us know if you have any questions for Karen :)

When did you decide you want to become an EMT?
I actually took the class in high school but was unable to take the state exam due to some personal issues but I loved it. Since then, I became a police officer and then was able to find the time later on to go back and take another original class. I passed with flying colors and I decided that I also wanted to teach people how to save a life.

What 1 event (good/bad/ugly) in life factored into your decision to save lives and become an EMT?
I delivered a baby as a police officer and I knew then I needed to get my EMT Certification. The baby was fine.

Did you volunteer / intern as an EMT before you made it your career?
I volunteered and I still volunteer. I give back to my community in Long Island by volunteering for my local fire house.

Tell me the best way to find an EMT job?
Perseverance and coming to the realization that all jobs are important whether you are doing transport or 911. So apply to many places and understand that no matter who you work for , your job is to save lives.

What is your Level of Certification? EMT/Paramedic/Lab Instructor/Lead Instructor
EMT/CLI/ CIC Lead Instructor

How challenging is it being an EMT?
It's very challenging. You never know what your next call is going to be and no two calls are ever the same. They might be similar but each person is an individual - treat them as such and with respect.

How do you keep sharp in your own skills?
I keep sharp by volunteering and keeping myself out there. Also when I teach I practice my skills as well as teach them.

How is your family life affected – are they supportive of your job?
Sometimes it's hard when you get calls in the middle of the night or stuck on snow standbys but the family supports my decision and is very proud if me

What is your most inspirational "save"?
I have had many but I guess saving my great aunt when she went into respiratory arrest she was 85. She is now 88 and is wonderful- she teaches tap dancing to 3 classes and takes the train from Brooklyn to the city for ballroom dancing .

What was your greatest "loss" on the job and how did it affect you?
9/11 as an EMT and a police officer I will never be the same there are no words to describe how I feel and how badly it has affected me.

How's the comradery on the job with your fellow EMTs?
Working with other EMT's and paramedics is interesting to say the least. Most have a good sense of humor and joke around when the time is right. I think this is kind of a coping mechanism to help deal with the sadder aspects of the job. Most everyone knows when it's time to be serious though.

What advice can you give others who want to become an EMT?
We are a family with both ups and downs but we always have each other's back and will be there when anyone of them needs help. They are your family.

Why do you enjoy teaching your students?
I love being able to give information that may one day save a person's life , I love when they are enthusiastic ... the joy of seeing students so excited when they pass and knowing that I had a hand in it and maybe one day seeing them out in the field.

How do you encourage others to follow this career path?
I encourage them by letting them know they need a passion for this job and that the rewards when you save someone will be so worth it.

Words of wisdom for our students / future-EMT's?
Treat everyone like they are your family members. Practice like the EMT'S you want to come to your house to take care of your family members. Have a sense of humor; if nothing affects you any longer and you have empathy or compassion talk to someone... but never let it get that far.


Stop the Bleed

The world has changed drastically in the last 30 some years. Even our language has evolved. No longer do we use terms like; pay phones, rotary dials, transistor radios, beepers, cassette recorders. We also, no longer use that technology. We are now somewhere between self-driving cars and booking tickets to Mars.
Healthcare has also changed with the times, and some diseases once in circulation have been eradicated. Unfortunately though, new strains of 'not so good stuff' have come into the present.

EMS is trying its best to keep up. One of the things we have to look forward to is a discussion on whether or not to train EMT's in scenes of ASHE (active shooter/hostile event). If you are interested in this topic, EMSWORLD magazine (March 2017 / Vol. 46, NO. 3) has excellent articles on the subject. One is a roundtable discussion with 4 top experts and I strongly encourage you to find the publication and read the article.

One of the first questions they ask of these experts is whether or not EMS should be more proactive in assisting casualties in mass shootings? Some of the experts in this article say scene safety might be an illusion. The questions they bring up must cause us to think. No one can truly say that a scene is absolutely safe until you are far from it, in the safety of your ambulance, driving away. They will not be asking EMT's to go into the line of fire but all of them agree that the emergency system needs a solution.

Another question brought up in this article is weather it is feasible to expect the police to help with the medical stabilization of patients. E. Reed Smith, MD states, " the law enforcement officer who is no longer stopping the killing can very quickly switch over to stopping the dying." He goes on to say that the scope of practice for the police would be very much the same as a current lay-person's knowledge: bleeding control, tourniquet use, compression only CPR, public-access defibrillation, and maintaining body temperature.

What I found enlightening is that some of these experts are advocating for hemorrhage control kits to be displayed right beside AED's in public places. In fact there is a program out there called Stop the Bleed. The goal of the Stop the Bleed program is to make training in bleeding control as common as CPR training and Combat Application Tourniquets (C-A-T's) publicly available, with enough pressure bandages to treat 8 patients, mounted alongside your public-access AED. The article states, "The recommendation to train citizens and all first responders to stop bleeding came out of the Hartford Consensus." "This committee was formed in direct response to the 2012 mass shooting at Sandy Hook Elementary School in Newtown, CT, which left 20 children and 6 staff members dead."

Ed Racht, MD, sums it up and says that an important part of the strategy of responding to ASHE's is preparing law enforcement and other responders for aggressive hemorrhage control. "If law enforcement-which has the training and expertise to go deeper into the uncontrolled hot zone –can rapidly identify and control significant bleeding and bring patients to safety, they can have a significant impact on patient outcome and loss of life." The question is, will they want to?

A similar thing took place when many fire departments strongly encouraged the fire fighters to become CFR's (Certified First Responders), which is the level below EMT. A very large amount of fire fighters I have come across clearly stated to me that all they wanted to do was fight fires. Maybe this narrow tunnel thinking needs to change to a much broader vison and training in the present world of violence and terrorism. www.dhs.gov/stopthebleed

Meet...Jason Rabinowitz

Jason has been an instructor with Emergency Care Programs for a very long time and is happy to share his EMT history with our students. Let us know if you have any questions for Jason :)

When did you decide you want to become an EMT?
I decided to become an EMT in 1992. It was kind of a "second" career for me. I was originally an electronics/camera salesman.

What 1 event (good/bad/ugly) in life factored into your decision to save lives and become an EMT?
No real one event factored into my decision to become an EMT. Another salesman I worked with told me he was taking the class and said I should take it with him, so I did. The rest is history lol.

Did you volunteer / intern as an EMT before you made it your career?
I actually was volunteering as soon as I was cpr certified which took place in the very beginning of the EMT class. I started off learning how to dispatch and in a few weeks, I was riding on the ambulance with my cpr certification, assisting the EMT's on the ambulance. Once class ended, I took the EMT exam with on-site scoring on a Thursday night, which I passed. I went to a private ambulance company the next day to apply for a job. The following Sunday night I received a phone call from that company asking if I can report to work the next morning (Monday) I was lucky, I had a full time EMT position within 3 days of taking my state exam.

Tell me the best way to find an EMT job?
Most of the private ambulance companies have a pretty high turn over rate, so that's probably a good place to start. After working at the "privates" for a few months or longer, I recommend applying for FDNY and hospital based 911 ambulance positions

What is your Level of Certification? EMT/Paramedic/Lab Instructor/Lead Instructor
I am a paramedic, and a CIC.

How challenging is it being an EMT?
Being an EMT has many different challenges. Everything from making split second, potentially life-saving decisions, to an adrenaline rush responding to a "hot" call. There are also many times where things can get quite mundane like treating a patient for minor bruise or a head cold. This job will expose a person to different cultures, standards of living and let you see "what goes on behind closed doors"

How do you keep sharp in your own skills?
I don't have a problem keeping my skills sharp, since I am an instructor and also work as a supervisor at a private ambulance company.

How is your family life affected – are they supportive of your job?
My wife isn't always happy with the hours I work, but she understands that I don't work a Mon-Fri 9-5 job. My kids (ages 8 and 14) love it and are always asking me if anything interesting happened during my day.

What is your most inspirational "save"?
I have had several pre-hospital "saves" over my career. One that stands out the most was at a concert I was working. An elderly woman and her daughter were sitting in the front row and waiting for the show to start. Her daughter decided she wanted to take a "selfie" with her mom with the stage in the background. As she was about to take the picture, her mom suddenly collapsed onto the floor of the arena beside her. An EMT we had stationed next to the stage was summoned and immediately began cpr. I as a paramedic was stationed upstairs in our main first aid office. I responded, along with my partner to the scene. We continued cpr with the EMT while placing the patient on a stretcher and began ALS care for her. We started an IV, gave medications and defibrillated the patient. She regained a pulse while in the ambulance on the way to the hospital. Approximately 2 weeks later she was discharged and walked out of the hospital.

What was your greatest "loss" on the job and how did it affect you?
No one likes dealing with children. Unfortunately I have been on several calls involving children. One of my earliest calls of my career involved a 12 year old boy who was having a severe asthma attack and passed out in the lobby right in front of the apartment he lived in with his family. We did CPR and performed other life saving measures, but he did not survive.

How's the comradery on the job with your fellow EMTs?
Working with other EMT's and paramedics is interesting to say the least. Most have a good sense of humor and joke around when the time is right. I think this is kind of a coping mechanism to help deal with the sadder aspects of the job. Most everyone knows when it's time to be serious though.

What advice can you give others who want to become an EMT?
Like I tell my new students on the first day of class, being an EMT isn't the most financially rewarding job one can have, but it is definitely one of the most gratifying jobs you can have.

What advice can you give others who want to become an EMT?
Like I tell my new students on the first day of class, being an EMT isn't the most financially rewarding job one can have, but it is definitely one of the most gratifying jobs you can have.

Why do you enjoy teaching your students?
I enjoy teaching because I can combine the course materials with some of my real life experiences. In addition, I like answering questions from students and explaining the "why's and how's" of being an EMT.

How do you encourage others to follow this career path?
By telling them it's not a difficult job most of the time, but there are times when you will be called upon to help another person while everyone else is just standing around wondering what to do next. It's a great feeling to have helped someone who is sick or injured and especially a great feeling knowing you just saved someone's life. I also encourage them to choose a career path based on teaching EMT's if they feel they have gotten tired of being on an ambulance all the time and want to try something a little different but related to being an EMT.

Words of wisdom for our students / future-EMT's?
I got through my original EMT course and my paramedic course by looking at those who were already in the profession and saying to myself "if he/she can do it, so can I" It takes time, dedication, determination, and a willingness to learn new things to become an EMT. Like I mentioned earlier, you will not become moniterally rich from working as an EMT, but it will definitely reward you spiritually.


PTSD in EMS

One of the most important considerations in EMS today should be the mental health of our first responders and care providers. With traumatic situations at an all-time high, EMS providers, along with all uniformed first responders, are seeing an increase in horrific situations. The end result of these visual images, in addition to the pain and suffering of fellow human beings becomes the perfect recipe for PTSD.

The most significant contributor to PTSD is not only what you see and hear but also denial of the impact of these memories that become imprinted in our brains. Our EMT Courses teaches us the importance of CISM (Critical Incident Stress Management) but is it really out there and readily available? And if it is, what about the social stigma related to our "strong & brave" going for mental help?

"We suffer what I call cultural brainwashing," says Jeff Dill, a captain at the Palatine Rural Fire Protection District in Illinois. "Once we put this uniform on, we're expected to act a certain way: Be strong. Don't show weakness. Don't be the weak link of the company – we can handle problems on our own.....We forget we're human beings first....

Preventing burnout in the EMS System can also help with keeping PTSD at bay.

One study found that the top causes of emergency services burnout are:

  • Abuse of the 9-1-1 system

  • Extensive time shift length

  • Extended length of service

  • High call volume

  • Sleep deprivation

  • Lack of administrative support

If you find that you are experiencing any of the signs & symptoms below:

  • Flashbacks

  • Nightmares

  • Hopelessness

  • Loss of interest in normal activities

  • Loss of interest in normal activities

  • Irritability and anger

  • Insomnia

  • Difficulty concentrating

  • Difficulty making decisions

  • Overuse of alcohol

  • Misuse of drugs

It might be time to take action. The newest weapon in the fight against PTSD is called First Response Resiliency Curriculum Training. Take some time and do a little research. It just might be time to invest in YOU. Find a program near you that offers CISM or First Response Resiliency Training. One of the best methods of releasing the trauma of PTSD is being able to talk to people who also work in the same field and have similar experiences. You are worth it!

Delayed EMS Responses – Causes and Solutions

Will you survive a life threatening medical emergency in the US?
Depends on where you live.
Collapse in Seattle from cardiac arrest – you're guaranteed defibrillation within minutes. Collapse in Washington? Call a cab.
In the fifty largest US cities, about 9,000 people collapse from cardiac arrest caused by a short circuit in the heart. This is a very treatable issue – all it needs is a shock from an AED machine. Yet only about 10% are saved.
Something is clearly wrong. True; in a large percentage of EMS calls, a longer response time will not cause harm to the patient. But what about all the other times, when every second counts?

Let's take a deeper look at the problem.

1) Insufficient Ambulances

Before we get into all the complicated issues, let's get down to the most obvious problem – lack of ambulance units. As populations in different areas grow and change, the need for ambulances changes as well – but EMS systems are not evolving enough.
Recently, Mayor Martin J. Walsh of Boston announced that Boston Emergency Medical Service had begun training a new class that would increase their EMS count by 24 employees.
It's time for other cities and towns to follow their lead and ramp up the number of ambulances.

2) Dispatch Errors

Last year, two young siblings, Ayina and Jai'Launi Tinglin, were killed in a Far Rockaway fire. EMS did not reach the scene until 20 minutes after the call was received.
The cause? Personnel errors preceding the dispatch.

Why the errors? Not enough training, says Jack Tanski, a telecommunicator for the Colony Police Department in Latham, NY, and a former paramedic.

Much more funds and effort needs to be invested in training and overseeing EMD. At the moment, in many agencies the management uses the communications center as a "dumping ground" for women who are on maternity leave or employees on light duty.

The outcome?
A dispatch center full of improperly trained employees who don't even want to be there. Like every other part of the EMS system, EMD needs a clear protocol and oversight. "EMD is like the kid in the family who gets the hand-me-downs," said Jeff Clawson, MD, owner of Medical Priority Consultants, Inc., in Salt Lake City, UT, "EMS buys all the fire engines, helicopters and equipment, but balks at buying a protocol that may cost $300-about the same as a battery for a defibrillator and half as much as the chair a dispatcher traditionally sits in."
In addition, personality needs to be assessed when hiring dispatchers. A good dispatcher must have good interpersonal skills and a calm, reassuring manner.

3) Lack of Teamwork Between the EMS System and the Fire Department

The fact is that firefighters today are more likely to respond to medical emergency calls than to actual fires. Yet the culture doesn't yet reflect that. Firefighters went into their careers expecting to fight fires, and not to plug in AEDs – so it is unsurprising that it is often difficult for them to respond properly.
In one city, firefighters median response time to a dumpster fire – which requires donning protective boots, pants, coats and breathing apparatus – was faster than their response to a cardiac arrest call. And this is understandable. Medical treatment was not what they signed up for. It is not what they were trained for.
In addition, infighting and turf wars between fire departments and ambulance services cause deadly delays.
Maybe it is time for firefighter recruiting and training to be changed to reflect the new reality. Let's develop a new culture of partnership between EMS and fire departments.

4) Inability to Find Location of Emergency

Paper maps are basically extinct, right?
Wrong.
Many city's ambulances have high priced GPS systems – but their paramedics still use time consumer paper maps. Why?
Because those GPS systems are only there to let the dispatchers keep track of the ambulances, not to provide direction to the drivers. Although this does cut 30-plus seconds off response time, there's no reason the EMS responders themselves shouldn't have GPS to help them navigate the streets.
The FDNY says that it isn't so necessary since most EMTs work in the same areas each day. But even in an area that's basically familiar, a GPS can go a long way in helping to locate a specific address and the best route to get there.

5) Calls Coming During a Shift Change

From his apartment window, Jonathan Agronsky saw Julia Rusinek on the ground. He rushed to the firehouse less than a block from where she fell – the firefighters there said a fire engine from another station farther away was on the way. Why couldn't they come? Their ambulance crew was going off duty.
Last December, a paramedic was dispatched to a report of a cardiac arrest at 6:01 – but his shift had ended at 6. What did he do? He drove back to his firehouse to go off duty, and firefighters performed CPR on the victim for 25 minutes until the new paramedic crew drove to the scene.
It is not certain if such scenarios take place often, but it is definitely an issue that should be address, perhaps by offering a significant financial incentive for post-shift calls.

EMTs continue to be devoted to their jobs and saving lives. Putting some of the above changes into practice can go a long way towards increasing efficiency and making things easier for EMTs everywhere.

Responding to Violent Protests

Especially after the protests following the recent election of Donald Trump, you may be getting a feeling that you're reliving the days of the 1960's Civil Rights Movement. Many of these protests have unfortunately turned into full-scale violent riots – including pepper spraying, effigy burning and window smashing.

Unfortunately, EMS responders have been the targets of bricks, bottles and even Molotov cocktails when responding to such situations. In light of this, it's a good time for EMTs to brush up on how to best respond to emergencies at the site of a violent protest, especially in places like New York, where protests are a frequent occurrence.

Anticipating the Violence

The first step to proper response is always preparation – and part of that is recognizing when events are likely to turn violent. Some of the most common are:

  • Peaceful demonstrations

  • Planned political conventions (interrupted by activists)

  • Racially charged events (i.e. police shooting of a minority)

  • College campus sporting events

Advance Preparation

Though management planning is not an EMT requirement, you can approach the management at your agency before such events and double check to make sure they're prepared with:

  • Extra staffing and equipment

  • Method of communication with other agencies that would be involved

In many cases, your agency may create task forces to ensure proper coordination and safety for everyone involved.

EMT Personal Preparation

What you can do on your own is prepare yourself, your ambulance and your equipment for the special circumstances.

  • Make sure you have a helmet and a clearly marked EMS jacket at all times

  • Remove any axes, hooks or poles that are accessible to outsiders

  • Remove scissors or sharp instruments from your pockets and equipment bags

  • Place duct tape on the windows of your vehicle in an "X" shape

  • Expect to see many patients with abrasions, sprains, lacerations, tear gas exposures and breathing difficulties. Prepare your equipment appropriately.

Responding

Once the violence has begun and calls start coming in, never respond before making sure you'll be safe.

  • Make sure your dispatcher has confirmed with police that the area is secure.

  • Once on the scene, seek out a law enforcement individual to confirm that you are in a safe zone.

  • Do not enter the scene if there are no law enforcement agencies around

  • Feel free to request police assistance if worried that a patient will turn violent

  • Be prepared to abandon the scene at the first sign of danger

  • Move in and out quickly – only basic patient assessment. More thorough assessments will have to wait until you and the patient are both secure.

No matter how passionate you are about saving lives, never forget to put your own safety first. It's not worth risking your life to treat someone's broken leg or burn.

Election 2016: What EMTs Want to Know

Every group looks to the presidential candidate that will address the issues they care about most. But what about EMTs? What candidate would be best for us? With Election Day almost here, it is interesting to ponder what each of the candidates would do about several hot issues currently affecting EMTs. Yes, health care is often discussed by both candidates, but it is usually just a general back and forth about the state of Obamacare. But though the average voter may not know much about these more specific topics that concern EMTs, they are affecting hundreds of thousands of people every day and deserve to be addressed.

Here are four questions the candidates should answer:

  • What steps will you take to reverse the opioid overdose epidemic?

  • How can you alleviate the funding strain caused by the low payment for ambulance transportation for Medicaid/Medicare patients?

  • Will you support the creation of a federal body for EMTs to increase productivity and efficiency?

  • Will you place restrictions on the price increases of common, life-saving drugs that are basic EMT requirements, such as the EpiPen?

Opioid Overdose Epidemic

Guess what? More people die from opioid overdose each year than from motor vehicle collisions! In 2014 alone, there were 47,055 deaths from drug overdose, 2/3rds from opioids. The opioid overdose epidemic should be a big concern for anyone considering EMT training, because opioid addicts are highly likely to be repeat patients.

EMT's responding to an opioid overdose use Naloxene a synthetic drug, similar to morphine, that blocks opiate receptors in the nervous system and can reverse the effects of opioid overdoses. But because the use of naloxone has skyrocketed together with the rate of overdoses, the price, once about a dollar per dose, has increased by 1000% or more, adding more strain to the underfunded EMS system. Repeat patients and overpriced medicines all contribute to reduced EMT salaries.

What a future president can do:

  • Institute strict legislation on the administration of OxyContin (oxycodone).

    Why? Until the mid 1990's, opioids were used only for patients with truly significant chronic pain, such as cancer patients. Then OxyContin came onto the market. And the creators of OxyContin downplayed the addictive qualities of the drug and marketed it aggressively to doctors. Money is the be all and end all, right? The result? An increase in sales of OxyContin from $45 million in the first year to nearly $3 billion a decade later – along with an equally severe increase in addiction, overdose and death from opioids.
    There are already several models of drug restriction the federal government can follow. In Pennsylvania, for example, there is a strict limit on the number of opioids a patient can receive after an ER visit. There is also an electronic prescription drug monitoring program that allows prescribers of controlled substances to prevent patients from going from doctor to doctor to get more opioid prescriptions. By placing similar federal guidelines on the use of oxycodone as a pain reliever, the next president could be preventing hundreds of thousands of innocent patients from inadvertently becoming opioid addicts.

  • Mandating long-term intervention for any patient brought in for an opioid overdose.

    When a patient is brought in for major trauma from a car accident, vast resources are invested to reduce the rate of death and disability from their injuries. A severely injured accident victim will probably spend weeks in the hospital and then rehab. What resources are invested into opioid overdose patients? A short period of observation and then a discharge right back into the environment that caused them to overdose to begin with! There are better ways. In Toms River, NJ, the RWJ Barnabas Health system created a program where recovery specialists are sent to Emergency Rooms whenever an opioid overdose patient is admitted. The specialists offers the patient immediate access to an inpatient recovery unit or up to eight weeks of long-term follow-up in the community. The Barnabas Health IFP program has seen its success rate of getting addicts into recovery rise from 20% of patients to 80%.

Therefore, the next president can encourage legislation requiring:
a) Recover specialists on site in every emergency room
b) A mandatory admission to an addiction recovery unit for any overdose patient

Insufficient Ambulance Reimbursement for Medicaid/Medicare Patients

There are several problems with the current mode of payment by Medicaid and Medicare for ambulance transport.

  • The fact is that the insurance coverage provided by Medicare and Medicaid for ambulance transport does not cover the cost of service – and these patients account for more than three quarters of all ambulance transport patients.

  • EMS agencies do not get paid for the cost of medical care delivered to patients who decline transport to the hospital. The result? EMS agencies have an incentive to transport all patients to the hospital, even if unnecessary, so at least some of their costs get reimbursed.

At the moment, this shortfall is usually addressed by subsidies from local governments. But this is not a long term solution. The next president must set up some sort of federal funding for EMS systems so they can continue to operate in an efficient manner.

Creating a Federal Body for EMS Services

When it comes to national disasters such as major terror attacks, or virus epidemics, the local EMS service model doesn't work very well. Because there is not central body to coordinate, it is hard for EMS from different locations to work well together. In addition, if the data from all the EMS agencies was consolidated, it would allow for better national disease surveillance and national disease prevention programs. The formation of a single Federal "home" for EMS would promote equipment standardization, national emergency response coordination, and central training guidelines. It would allow EMS to improve our EMS system's ability to respond daily and during disasters.
Will the next president make this a priority?

Overpriced Drugs

Yes, there are alternatives to the EpiPen. But, come on – they aren't truly solutions.
Imagine entering your child's school nurse office and finding a collection of generic medical supplies – syringes and vials – rather than a stock of neatly-packaged EpiPens. Which makes you feel more secure?

Auto injectors are easy to store, easy to use, and don't require much training. Other injection methods are a lot messier – but that is what EMTs are using these days as the price of EpiPens skyrocketed. Why? Well, "because it's cheaper". Should that be a reason for potentially endangering patients?

The same applies to the sharp price rise in Naloxine. The next president needs to institute some federal guidelines restricting the unnecessary price rise of lifesaving drugs.

EMT's and Crime Scenes

The streets are buzzing with talk of the recent New York and New Jersey bombings and the arrest of the suspect, Ahmad Khan Rahami.

Now what does this have to do with an EMT blog?
A lot
Take this excerpt from a New York Times article:

"Mr. Rahami, blood pouring from a wound in his shoulder and splattered on his face, was loaded onto a stretcher and taken to University Hospital in Newark."

This is just one of the many instances when emergency medical care and the criminal justice system collide. You may shy away at the thought – treating a deadly criminal? Why should you waste your energy, skills, and good medical equipment, on a man who tries to kill?

But the truth is, by saving a criminal's life, you may be helping his victims. And in a case such as this, where it is an act of terror, you may play a role in preventing similar incidents in the future. If the criminal is alive and in stable condition, he can be questioned by law enforcement agencies and the court. The information they gain through this is usually highly valuable.

Approaching a Crime Scene

When you approach the crime scene, as an EMT, your job remains the same – to save lives and give appropriate medical care. However, there are several other things you'll need to be aware of.

1) Don't Become a Victim!
Before anything, you need to make sure that you are not in danger of becoming a victim yourself. Unless you were trained as a tactical EMT, you are not required to enter a "hot" or "warm" zone (where there is still active violence or a chance of violence.)
Only once the scene was given the all-clear and the criminal is neutralized should you enter and begin triage and treatment.

2) Be Aware
The patient was lying on the couch? Take note. You moved a table to get to him? Remember where it was originally.
In one instance, investigators wasted a lot of time because they thought a witness had moved things around after the crime. In reality, the paramedic had moved some items to gain access to the victim, but had not informed anyone of this. (Journal of Emergency Medical Services, Crime Scenes: Documenting Assessment and management of crime victims.)

3) Document Everything
You may be so preoccupied with giving care that you give just a perfunctory documentation of the event. Don't do that.
Especially if you were one of the first at the scene, chances are, you'll be called in as a witness. In addition, because the defense will be looking for a way to get the criminal off the hook, they can even try to shift the blame onto you!
So make sure you recall every detail and document it as soon as you can. Especially take note of anything you moved on or near the patient's body, anything the patient or bystanders say to you, and what treatments you administered.

4) Record Facts
Only write down things that are objective – not the conclusions you drew. For example, don't write if it was a knife or bullet wound; just describe the way the wound looked. Don't identify a person as "intoxicated"; just describe his behavior and the smell of his breath. Leave the conclusions to the court.

You may feel that EMT's are not police – and you're right. Your primary responsibility as an EMT will always be to care for your patients. But by coming to the rescue at a crime scene and following protocol, you can help the truth be uncovered and play a vital role in assisting victims beyond their medical needs.

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