Pre-Hospital Blog

EMS can be better

We need to catch up

with one comment

When responding to a call, I have found that it is simpler to map it with my iPhone than with our dusty old map books. The iPhone is fast, accurate, and easy.

The highest tech systems in emergency vehicles involve an in-vehicle computer that links up with dispatch to get automatic call routing and other information. These systems cost thousands of dollars per unit, not including infrastructure costs, and setting them up is fraught with bugs and implementation is no cake walk (I an in the process of implementing this for my agency. It’s no joke).

Why does my $400 consumer product offer easier access to this information than my $3000 tablet?

Written by ben

April 12th, 2010 at 9:50 am

Posted in questions

No really, your paperwork is imoprtant.

with 15 comments

I’ve told my crews hundreds of times that “your paperwork is just as important as any other part of the call and you must complete your paperwork before returning to service.”

I am a hypocrite.

Ambulance services constantly tell their crews how important it is to complete paperwork and that there is no way they should ever return to service before turning in a run sheet at the hospital. Then, when it gets busy, dispatch tones a crew that has just gone out at the hospital with another call.

Let’s stop this.

Run sheets are important. They’re our legal record of care given to a patient, they (sometimes) provide valuable insight about a patient’s condition to hospital personnel, and they’re how we get paid. But they’re never as important as you are if you’re the only ambulance in the system that is even remotely close to returning to service.

Next time, I’m going to tell my crews this: It is important to get our paperwork completed in a timely fashion, but not as important as providing ambulance service to the next customer in the community we are committed to serving. I insist that you complete your paperwork at the hospital whenever you can, but understand it is expected that you will break off if you have to run a call.

Written by ben

December 24th, 2009 at 8:08 pm

Posted in rants

A Better Place to work

with 2 comments

There’s a great post up at on the culture at some of the “Top Places to Work” and how they differ from the norm and the worst.

In particular, the authors mention that “many organizations are bastions of dysfunction, where overwork and stress fuel negative and aggressive behaviors.” This rang true to me as the norm at least half the places I have worked in EMS.

We all talk about the need to show people respect and keep people motivated but I think many of us are at a loss as to how to do this day to day. There are some good pointers in the post, check it out.

Written by ben

December 14th, 2009 at 8:44 am

Posted in leadership,links

Mechanism of injury

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Rogue Medic has a great post up on trauma triage criteria, leading into some harsh criticism of mechanism of injury as a treatment criteria.

Treatment based on mechanism needs to go the way of bloodletting and alchemy. I recall being trained to assess a patient based on signs and symptoms, not the vague possibility that they might at some point have sustained some hypothetical injury.

A good example of this is vehicle crashes. It is not uncommon to arrive on scene of a rough looking crash at highway speeds and see a patient who appears lucid and uninjured being encouraged to get down on a backboard, despite his protests that “I feel fine. No, my neck doesn’t hurt. Stop that.” Modern vehicles are designed to be destroyed in a crash. The vehicle will be subjected to far greater forces than the occupants. So when you see a car that’s crunched up like a pop can and a guy sitting on the curb, there’s not necessarily a need to toss him on a back board and run him emergent to the ED while you place bilateral 14′s and cut off all of his clothes. He needs assessed and treated based on his signs and symptoms, not those of the vehicle.

I am prepared to make the bold, unsupported claim that treatment based on mechanism is lazy medicine that creates unnecessary ambulance rides for a lot of “patients.”

Pop on over and check out Rogue Medic’s post. It’s worth your time.

Written by ben

December 9th, 2009 at 12:00 pm

Posted in links,rants

They don’t make ‘em like they used to.

with 3 comments

Whenever I am talking to non-EMS folk about what it is I do for a living, the conversation inevitably turns to a question like “you must see some pretty bad car wrecks.” And my response is usually to say “You’d be surprised. Cars are really safe nowadays.” People seem to walk away from crashes that would have killed everyone and probably some bystanders 20 years ago.

Now, I can show them video. The International Institute for Highway Safety, in celebration of their 50th anniversary, crashed a 1959 Chevrolet Bel Air into a 2009 Chevrolet Malibu and the results are stunning.

I’ll take the 2009 any day.

Check out the video on the site. It’s pretty stunning.

Via Slashdot.

Written by ben

September 27th, 2009 at 11:56 am

Posted in Uncategorized

Supportve care for asthma attacks

with 5 comments

In addition to beta agonists, steroids, epi, mag, etc, etc in treatment of asthma, you might also consider coaching your patients to breathe slower.

Eurekalert has a study from Southern Methodist University showing that asthma patients who were taught to slow their breathing during an attack can decrease the severity of attacks.

During an attack, sufferers tend to hyperventilate, breathing fast and deep against constricted airways to fight an overwhelming feeling of oxygen deprivation.

Unfortunately, this makes the problem worse by lowering the body’s carbon dioxide levels, which restricts blood flow to the brain and can further irritate already hypersensitive bronchial passages.

Patients who “overbreathe” on a sustained basis risk chronic CO2 deficiencies that make them even more vulnerable to future attacks. Rescue medications that relieve asthma symptoms do nothing to correct breathing difficulties associated with hyperventilation.

Written by ben

September 20th, 2009 at 9:16 pm

Posted in research

’nuff said

with 8 comments

Yes, it’s that simple.


Written by ben

September 17th, 2009 at 6:58 pm

Posted in funny,ideas,links


without comments

The initial numbers are indelible: 8:46 a.m. and 9:02 a.m. Time the burning
towers stood: 56 minutes and 102 minutes. Time they took to fall: 12
seconds. From there, they ripple out.

  • Total number killed in attacks (official figure as of 9/5/02): 2,819

  • Number of firefighters and paramedics killed: 343
  • Number of NYPD officers: 23
  • Number of Port Authority police officers: 37
  • Number of WTC companies that lost people: 60
  • Number of employees who died in Tower One: 1,402
  • Number of employees who died in Tower Two: 614
  • Number of employees lost at Cantor Fitzgerald: 658

  • Number of U.S. troops killed in Operation Enduring Freedom:

  • Number of nations whose citizens were killed in attacks: 115
  • Ratio of men to women who died: 3:1
  • Age of the greatest number who died: between 35 and 39
  • Bodies found “intact”: 289
  • Body parts found: 19,858
  • Number of families who got no remains: 1,717

  • Estimated units of blood donated to the New York Blood Center:

  • Total units of donated blood actually used: 258

  • Number of people who lost a spouse or partner in the attacks:

  • Estimated number of children who lost a parent: 3,051

  • Percentage of Americans who knew someone hurt or killed in the attacks:

  • FDNY retirements, January–July 2001: 274
  • FDNY retirements, January–July 2002: 661

  • Number of firefighters on leave for respiratory problems by January
    2002: 300

  • Number of funerals attended by Rudy Giuliani in 2001: 200
  • Number of FDNY vehicles destroyed: 98
  • Tons of debris removed from site: 1,506,124
  • Days fires continued to burn after the attack: 99
  • Jobs lost in New York owing to the attacks: 146,100
  • Days the New York Stock Exchange was closed: 6

  • Point drop in the Dow Jones industrial average when the NYSE reopened:

  • Days after 9/11 that the U.S. began bombing Afghanistan: 26

  • Total number of hate crimes reported to the Council on American-Islamic
    Relations nationwide since 9/11: 1,714

  • Economic loss to New York in month following the attacks: $105

  • Estimated cost of cleanup: $600 million
  • Total FEMA money spent on the emergency: $970 million
  • Estimated amount donated to 9/11 charities: $1.4 billion

  • Estimated amount of insurance paid worldwide related to 9/11: $40.2

  • Estimated amount of money needed to overhaul lower-Manhattan subways:
    $7.5 billion

  • Amount of money recently granted by U.S. government to overhaul
    lower-Manhattan subways: $4.55 billion

  • Estimated amount of money raised for funds dedicated to NYPD and FDNY
    families: $500 million

  • Percentage of total charity money raised going to FDNY and NYPD
    families: 25

  • Average benefit already received by each FDNY and NYPD widow: $1

  • Percentage increase in law-school applications from 2001 to 2002:

  • Percentage increase in Peace Corps applications from 2001 to 2002:

  • Percentage increase in CIA applications from 2001 to 2002: 50

  • Number of songs Clear Channel Radio considered “inappropriate” to play
    after 9/11: 150

  • Number of mentions of 9/11 at the Oscars: 26

  • Apartments in lower Manhattan eligible for asbestos cleanup: 30,000

  • Number of apartments whose residents have requested cleanup and
    testing: 4,110

  • Number of Americans who changed their 2001 holiday-travel plans from
    plane to train or car: 1.4 million

  • Estimated number of New Yorkers suffering from post-traumatic-stress
    disorder as a result of 9/11: 422,000



Written by ben

September 11th, 2009 at 8:30 am

Posted in Uncategorized

Evolution of an ego: best case scenario

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The top curve never descends for some folk

Written by ben

September 9th, 2009 at 6:51 pm

Posted in random

Annals of Medicine: The Cost Conundrum: Reporting & Essays: The New Yorker

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Annals of Medicine: The Cost Conundrum: Reporting & Essays: The New Yorker

A great New Yorker article on skyrocketing healthcare costs.

Written by ben

June 10th, 2009 at 2:58 pm

Posted in links