JEMS: Journal of Emergency Medical Services RSS feed: Current Issue. Journal of Emergency Medical Services (JEMS) , the most respected journal in the field of emergency services, is published for paramedics, emergency medical technicians (EMTs), instructors, administrators, nurses and physicians. JEMS reports on the issues that most affect the EMS work environment, such as life-support topics, management concerns and system design, legal questions and new product and book/video reviews. For more than 30 years, JEMS has set the standard for news, information and education in prehospital care. To order this journal, and for more information, go to http://www.jems.com http://www.jrnlemergencymedicalservices.com/?rss=yesElsevier Inc.en © 2012 Elsevier Inc. All rights reserved. JEMS: Journal of Emergency Medical Services0197-2510371January 2012 © 2012 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700013/abstract?rss=yes JEMS.com columnist Skip Kirkwood, MS, JD, EMT-P, EFO, CMO, talks about the need EMS has for better training about scene safety. No longer is “scene safe, BSI” acceptable. Read about his proposal at jems.com/training. Or you can read more in this month's Priority Traffic section on p. 18.Connect with JEMS.com10.1016/S0197-2510(12)70001-3JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Load & Go77http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700025/abstract?rss=yes Providers from Southwest Ambulance, Gilbert (Ariz.) Fire Department and Gilbert Hospital Native Air Omniflight work to attempt to resuscitate a 6-year-old drowning victim. According to Mike Connor, spokesman for the Gilbert Fire Department, a father called 9-1-1 after his two sons didn't come home from a bike ride. He went out searching and noticed their two bicycles next to a canal near their home in Gilbert. A bystander pulled the boys out of the water. Jean Machnicki, a Gilbert Fire Department community services coordinator, said there have been 25 water-related incidents in 2011 in Maricopa County and hopes this year will be different. Pediatric resuscitation is a critical training and operation component of every EMS system.Aggressive Response10.1016/S0197-2510(12)70002-5JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3EMS in Action1213http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700037/abstract?rss=yes A BLS ambulance from an EMS service in a financially distressed rural area responds to a 48-year-old morbidly obese patient who collapsed in his third floor bedroom with congestive heart failure.Year of Advancement: 2012 to bring federal EMS lead agency & discharge data to EMSA.J. Heightman10.1016/S0197-2510(12)70003-7JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3From the Editor1414http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700049/abstract?rss=yes An October JEMS training article by Keith Widmeier, NREMT-P, CCEMT-P, EMSI, AAS, (“Hold Still: Teaching pediatric immobilization techniques”) spurred a discussion on proper spinal immobilization techniques for children. Also, a reader comments on a November clinical education article on the different types of diabetes by Donald A. Locasto, MD, FACEP; Dustin J. Calhoun, MD; Robbie J. Meek, CCEMT-P, CICP, PNCCT-P, NREMT-P, EMS-I & Thomas W. Trimarco, MD, (“Distinguishing Diabetes: Differentiate between Type 1 & Type II DM).Car Seat SafetyTheresa Remsberg10.1016/S0197-2510(12)70004-9JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Letters1616http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700050/abstract?rss=yesIf a patient deserves and warrants transport to a hospital via ambulance, I believe that patient deserves our unique attention to detail and a full head-to-toe assessment. This cannot be accomplished if the pediatric patient is left in a car seat. Also, if something happens, such as a seizure, then the car seats out there today don't keep the patient in a good airway position. In fact, in addition to little or no shoulder blade support, there is slight cervical flexion and therefore, it's difficult to neutralize the patient's airway.Car Seat Safety10.1016/S0197-2510(12)70005-0JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Letters1616http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700062/abstract?rss=yesAuthor Keith Widmeier, NREMT-P, CCEMT-P, EMSI, AAS, responds: Would being padded and taped be the most comfortable position for a child? Probably not. However, they are used to their car seat, and they are used to padding around their head. As a CPS Tech, you are aware that many rear-facing infant seats come with padding around the head to assist infants because of the lack of sternocleidomastoid muscle tone.Car Seat Safety10.1016/S0197-2510(12)70006-2JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Letters1616http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700074/abstract?rss=yesThis is an excellent article that achieved its purpose. I did notice that in the discussion of treatments for hypoglycemia, the authors went as far as mentioning rectal glucose but left out an important one: intranasal glucagon.Diabetes DiscussionMax Drucker10.1016/S0197-2510(12)70007-4JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Letters1616http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700086/abstract?rss=yesThe December JEMS Research Review column (“Debating Detox: Providers' predictions about transporting inebriated patients”) contains an error. In the “Watch Box” section, a study from the Emerg Med J by Schmidbauer W, Ahlers O, Spies C, et al., was mistakenly included in this section. This particular study was not actually reviewed in the column. We regret the error.Correction10.1016/S0197-2510(12)70008-6JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Letters1616http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700098/abstract?rss=yesEMS personnel need to make personal safety a priority, or they face becoming a grim statistic, say experts concerned about violence against medical workers. In recent months, there have been several states that have reported EMS workers being beaten or worse while doing their job of providing patient care. In many cases, the incidents expose a key area of unpreparedness in the field.> On Target: Are EMS providers trained for dangerous patients?Richard Huff10.1016/S0197-2510(12)70009-8JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Priority Traffic1821http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700104/abstract?rss=yesIt's interesting to watch how high-profile individuals deal with an image crisis. I watched as U.S. Representative Anthony Weiner tried to wiggle his way out of a tweet of himself wearing briefs that he had accidentally sent to all of his Twitter followers, instead of his intended target. What was usually a private message between two individuals turned into a public distribution.Ahead of the Crisis: Break the story yourselfGary Ludwig10.1016/S0197-2510(12)70010-4JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Leadership Sector2222http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700116/abstract?rss=yesLife ain't easy for a trained observer. Ever noticed how that works, Life-Saver? You can't help wondering about stuff the average person would likely never even notice. Like the guy sitting in your favorite coffee shop an hour before dawn with a pair of sunglasses on his head. Or a lady in a late-model pick up, who's about to make a right turn onto a high-speed country roadway from a side street while chatting at a stop sign with a neighbor in another vehicle. Normally, she wouldn't have caught your attention, but the lady in the truck has her arm around a smiling, shirtless 2-year-old, who looks like he's standing on her lap. The child is waving its arms through the driver's open window.Bumpers: Is your equipment talking smack about you?Thom Dick10.1016/S0197-2510(12)70011-6JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Tricks of the Trade2424http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700128/abstract?rss=yesOn a warm spring night, MedicWest ambulance and the Clark County (Nev.) Fire Department are dispatched to a difficulty breathing call in a low-income neighborhood east of the Las Vegas strip. On arrival, they encounter an 8-year-old girl with difficulty breathing. The mother reports that the child has a history of asthma but has been out of her albuterol inhaler for approximately two weeks.Late-night Wheezer: Providers respond to pediatric asthma patientBryan Bledsoe, Kely BuchanNan, Ryan Hodnick10.1016/S0197-2510(12)70012-8JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Case of the Month2626http://www.jrnlemergencymedicalservices.com/article/PIIS019725101270013X/abstract?rss=yesAt 2205 hours, Rescue-102 is called to a private residence for a young female complaining of abdominal pain. On arrival, the EMS providers determine that the patient is 24 weeks pregnant and is having contractions. She's conscious, alert and oriented.Breech Birth: Not your average call for abdominal painChad Brocato10.1016/S0197-2510(12)70013-XJEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Case of the Month3031http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700141/abstract?rss=yesFive recent studies on intraosseous (IO) will help ring in the New Year. Each of these has something unique to add to our knowledge and practice, but together they tell a more powerful story.Intraosseous Intrigue: Studies examine success rates on pediatric, adult & obese patientsDavid Page10.1016/S0197-2510(12)70014-1JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Research Review3233http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700153/abstract?rss=yes Until now, even the most basic information about EMS has been unknown or inaccurate. How many EMS agencies and EMS professionals are there in the U.S.? How many 9-1-1 responses do they run annually? For the most part, any information on a national scale was a guesstimate at best.And the Survey Says: NASEMSO analysis provides snapshot of EMS industryTeresa McCallion10.1016/S0197-2510(12)70015-3JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-33435http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700165/abstract?rss=yes Pediatric patients constitute approximately 13% of EMS transports. This is generally a good thing and demonstrates how rare pediatric emergencies are, as well as how injury prevention and vaccination programs have ensured a healthy pediatric population. An unintended consequence is that EMS doesn't have the same familiarity with pediatric emergency medical care as it does with adult emergency medical care. In addition, the clinical component in some paramedic programs can lack substance in pediatrics.Standardized Simulations: Live pediatric patients increase paramedic student familiarityJay MacNeal10.1016/S0197-2510(12)70016-5JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-33638http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700177/abstract?rss=yesE-Linkage at Last: EMS crews linked to hospitals & discharge diagnosisFrank Zanka10.1016/S0197-2510(12)70017-7JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-34040http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700189/abstract?rss=yes Very few of us ever know the effect we have on others. We pass each other in stores and on the street, whiz by each other at shift change and chat casually at a cocktail party, but we don't know how anyone receives us beyond our cursory impressions of the moment. We also seldom realize what affect we have—how we've changed a good day into a bad one or vice versa. It's said that it takes time to see how pebbles tossed into water ripple out and what the resultant waves come to bear on the shoreline. New Mexico attorney and paramedic W. Ann Maggiore, JD, NREMT-P, has spent much of her personal and professional life focused on EMS issues, individuals and agencies, and more importantly, has thrown out thousands of pebbles. Woman with a Mission: EMS attorney, paramedic/firefighter represents EMS in the field & courtroomJudith Acosta10.1016/S0197-2510(12)70018-9JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-34651http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700190/abstract?rss=yes A respected practice is a method or technique that has consistently shown positive results compared with other practices, and thus, has been used as a benchmark. A “respected” practice can evolve to become even more effective as improvements are discovered. EMS systems often develop their own respected—or best practices—over time. These may include clinical interventions that have been made into protocols by forward-thinking medical advisory groups or medical directors, operationally sound strategies for making the most of scant resources or even training on a unique piece of equipment a system uses.Striving to Thrive: How to implement the ‘best’ for your agencyRaphael Barishansky10.1016/S0197-2510(12)70019-0JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-35255http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700207/abstract?rss=yes EMS is dispatched to a residence for an “unresponsive child.” On arrival, a frantic mother is waiting at the door and directs the crew to the living room. EMS providers find an 8-year-old male who's only responsive to deep pain. While one paramedic assesses the patient, their partner obtains a history from the mother. The mother states her child was complaining of a headache for the past week, and says it worsened earlier today. He's an otherwise healthy child. A full primary survey reveals that airway breathing and circulation (ABCs) are intact. The patient's vital signs are a heart rate of 60, respiratory rate of 8, blood pressure of 160/120 and oxygen saturation of 90%. An IV is established, and a glucose check is administered, revealing a blood sugar of 95. The patient will only respond to deep, sternal rub. Clear the Fog: The challenges of altered mental status in childrenMark Meredith, Lee Blair, Eric Clauss10.1016/S0197-2510(12)70020-7JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Continuing Education5661http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700219/abstract?rss=yesEMTs and paramedics use tape every day. The standard 1” medical tape is used to secure dressings, IV lines, endotracheal tubes and splints. Many providers like to keep a roll handy by securing it to their stethoscope. Unfortunately, this handy roll of tape may bump against your stethoscope when you're trying to assess blood pressure, lung sounds and heart sounds, making patient assessments more difficult. The S3 Stat Tape Holder from Statgear incorporates a plastic set screw to quietly secure a 1” roll of tape to your stethoscope for easy use. The tape roll spins easily and can be removed or replaced quickly.Stat Tape HolderFran Hildwine10.1016/S0197-2510(12)70021-9JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Hands On6262http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700220/abstract?rss=yesPenetrating thoracic trauma can create several life-threatening conditions. Patients can't breathe when air is coming through the chest wall and not the trachea. Sealing the wound often fixes only part of the problem. Closing an open pneumothorax can cause an even deadlier tension pneumothorax. The FastBreathe Thoracic Seal (FTS) from Fastrack Medical Solutions LLC has a low-profile, one-way valve that allows air to be expelled with minimal pressure. A unique adhesive creates an occlusive seal, which bonds aggressively to wet, bloody and dirty skin without damaging the skin when it's removed. The adhesive is so unique that the FTS can be removed and reapplied with complete adhesion to the skin.Signed, Sealed & Breathing10.1016/S0197-2510(12)70022-0JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Hands On6262http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700232/abstract?rss=yesA patient with a STEMI needs to get to a cardiac cath lab as soon as possible. If your system is primarily BLS, you may not be always be able to depend on ALS to be available to interpret a 12-lead ECG. This may cause your service to miss patients with STEMIs who should be transported to a cath lab. The ReadyLink 12 from Physio-Control Inc. provides BLS services with the means to identify STEMIs in the field and ensure transport to a STEMI center. BLS providers need to be trained in lead placement and 12-lead acquisition, but the final interpretation is left up to a physician connected to Physio-Control's LIFENET System. The ReadyLink 12 unit has a keyboard and display for patient data entry, but the screen doesn't display the ECG.12 Leads for BLS10.1016/S0197-2510(12)70023-2JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Hands On6262http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700244/abstract?rss=yesEMS is frequently tasked with providing coverage in unique venues and situations. Large public gatherings present a challenge to responders trying to maneuver through the crowd so they can get help to where it's needed. Regular ambulances are hard to maneuver through a crowd, golf carts are frequently under-powered and too low to the ground, and bicycles can leave the crew winded if the venue is large or hilly. The Sentinel PMV from Xtreme Green Products Inc. is a three-wheeled, electric stand-up chariot that's designed to move you through crowds easily and is designed to fit through a standard width doorway. And if the futuristic, stealth fighter-esque profile doesn't attract enough attention, the Sentinel PMV is outfitted with flashing LED emergency lights and a full-power siren to move the crowd out of your way.Part the Masses10.1016/S0197-2510(12)70024-4JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Hands On6363http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700256/abstract?rss=yesPaper or plastic, boxers or briefs, old school or new school, printed field guide or smartphone app? These are some of the choices EMS workers deal with every day. Back in the day, lots of EMTs and paramedics carried an Informed printed pocket guide as a reference for common patient medications, treatment algorithms and pharmacology. As technology has improved, so have the resources available to field providers, such as the electronic version of the Pocket Guides by Informed. The latest updates to this popular product line also bring them into compliance with the “2010 American Heart Association Guidelines for CPR & ECC” for both the printed and smartphone app versions. In addition to medications, pharmacology and algorithms, the new versions include a revised Spanish section, clear ECG rhythm images and updated pediatric medications.Control Your Destiny10.1016/S0197-2510(12)70025-6JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Hands On6363http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700268/abstract?rss=yesAfter spending all those years being told to sit still, be quiet and listen in class, it's now become popular to play games in the classroom. “Jeopardy” has been a popular model to use for reviewing didactic information for years with the host writing the answers and the students tasked with buzzing in first and responding with the appropriate question. The Eggspert Wireless 2.4 gHz from Educational Insights provides the EMS educator with a fun and high-tech way to educate and entertain their students. It features a color-coded display for up to six participants, six egg-shaped buttons and a remote to reset the board. The first student to “ring in” causes the corresponding light to blink and locks out the other buzzers. A switch on the teacher remote sets the time to answer from five to 30 seconds. A “Wheel of Fortune” mode on the control also allows the instructor to “spin” the lights to pick a random student. A series of switches on the teacher remote actually allows the teacher to “pick” which color the “random” spin will stop on providing the opportunity to keep all students engaged.Classroom Game Play10.1016/S0197-2510(12)70026-8JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Hands On6363http://www.jrnlemergencymedicalservices.com/article/PIIS019725101270027X/abstract?rss=yes This textbook is designed to facilitate easy location and review of key topics related to emergency medicine. The 50 chapters are presented in appropriate order related to topic and importance of information, and they chapters address key components in emergency medicine that introduce the topic, explain important learning points in subcategories, emphasize rationale for procedures and understanding of concepts and include a summary where appropriate.Current Diagnosis & Treatment Emergency Medicine (7th ed.)David L. Sullivan10.1016/S0197-2510(12)70027-XJEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Hands On6464http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700281/abstract?rss=yes Paramedic: I call it a wandering arterial pacer with variable conduction and bundle branch block.Rite of P-Wave Passage: The art of interpreting the ECGSteve Berry10.1016/S0197-2510(12)70028-1JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3The Lighter Side7272http://www.jrnlemergencymedicalservices.com/article/PIIS0197251012700293/abstract?rss=yesThe Fire Department of New York (FDNY) EMS recently opened a new station in the former St. Vincent Hospital area, contributing to keeping the residents of Manhattan safe. Serving the communities that encompass Manhattan's west side, Station 7 contains supply areas for advanced and basic life support, a vehicle supply room, oxygen storage area and a decontamination bay. With more than 3,600 square feet of space, the new station can house nine units and staff 21 ambulance tours per day.Last Word10.1016/S0197-2510(12)70029-3JEMS: Journal of Emergency Medical Services 37, 1 (2012)2012-01-01JEMS: Journal of Emergency Medical Services2012-01-01371S0197-2510(12)X7001-3Last Word7474