Product Applications from the Field: November 2011

Airon Device Proven to Save Lives

It’s only a year that Magnolia Hospital EMS in Corinth, MS, has been using CPAP for its most severe respiratory distress patients, but, according to EMS Director Mike Lutz, it’s already proved to be a lifesaver. “One incident that stands out was a call for a lady with oxygen saturation in the 70s at a local pulmonology clinic,” he recalls. “She was on 2 liters of oxygen and in severe respiratory distress. When we came in, we told the pulmonologist we had CPAP available, and he said, ‘Let’s use it.’ By the time we arrived at the hospital, the lady pulled the mask aside and told the crew, ‘Thank you for saving my life.’”

A year ago, CPAP was a completely new technology for his system, says Lutz, but they wanted to provide the best care for their patients and knew CPAP was the way to go. “We nixed the disposable devices really quickly,” he says. “Then we looked at oxygen consumption, ease of use and benefit to the patient and chose the Airon model. We have six ambulances and there’s one on each ambulance. I just looked at my database, and we’ve used CPAP 30 times in 11 months, mostly in the winter and fall because the COPD and emphysema patients have more trouble when the weather gets colder.”

There was very little learning curve, says Lutz. A rep from D&D Medical, who sold the device, held an in-service for all of the paramedics and the hospital education department, which will train new paramedics on it. “It’s simple to operate and makes a world of difference,” Lutz says. “More than anything, patients are arriving here in much better shape than they were in the past. Normally, patients with severe respiratory distress would be intubated and put on a ventilator upon arrival to the ER. Now, even before they go upstairs, they’re often off CPAP and on regular oxygen. All of our medical control doctors, and everyone else, are really excited about this technology, and we look forward to using it because we know we can make such a big difference with our patients’ outcome.”

Visit https://aironusa.com.

Warm Fluids a Must for Patients in Cold Conditions

Some things are best served cold. Blood isn’t one of them.

California Shock Trauma Air Rescue (CALSTAR) Chief Flight Nurse Bryan Pond sees a lot of cold conditions operating in South Lake Tahoe. And cold patients. Which is why he’s a fan of the Thermal Angel fluid warming device available from Bound Tree Medical.

“It becomes a matter of needing to get these patients warmed up, especially when we’re on the ski slopes, people have had an accident and they’ve been on the snow for a little bit,” Pond says. “They can be rather cold by the time we pick them up. So we need a way to [actively] warm them up as opposed to simply relying on passive re-warming. And this is a really good product for doing that.”

The Thermal Angel is an in-line, battery-powered disposable, lightweight and completely portable blood and IV fluid warming device, capable of intravenous application and irrigation warming. Notably, the Thermal Angel can be used to help prevent fluid-induced hypothermia.

“We’re able to give warm blood [and IV fluid] products to patients during transfer which is huge, as opposed to [just saying], ‘Here’s a bunch of cold blood, I hope it doesn’t screw you up too bad,’ ” Pond explains.

Pond says the Thermal Angel is extremely effective, allowing him to administer fluids to hypothermic patients who may be in rigor or shaking because they’re so cold. He can give them warm fluid and they begin to relax and feel much better almost immediately.

Since the Thermal Angel is elegantly simple, there are no knobs, settings or switches. An experienced user can set up the Thermal Angel in a matter of seconds. And because the Thermal Angel is a portable, battery-powered single patient device, there are no additional costs due to patient movements throughout the continuum of care.

Visit www.boundtree.com.

Nothing Beats a Demers Ambulance

When New York-based Mohawk Ambulance’s Vice President Jim MacPartlon finds an ambulance he likes, he sticks with it for a long time. That’s been the case for almost nine years, says MacPartlon, who has nothing but good things to say about Demers’ vehicles.

“Our drivers love them,” he says. “They like the design, and they know they’re a high-quality, safe ambulance to work in. We’ve also been pleased with the low maintenance costs because of the way they’re built. We estimate that we’ve gained 10% to 12% fuel efficiency with these vehicles.”

Mohawk was one of the first New York agencies to purchase ambulances from Canadian manufacturer Demers, says MacPartlon.
“They’re an easy company to work with,” he says. “We asked for a few minor changes, and they were very receptive to making those changes. They did it right the first time.”

Visit www.demers-ambulances.com.

Navigate Tight Spaces Quickly with Graham Medical's Alternative Transport Chair

EMTs and paramedics responding to a scene can often be assured of one thing: The patient will be located someplace that’s inconvenient for transport to the ambulance, be it up or down stairs, in a tight space, amidst obstacles or sometimes all of the above.

Enter the MegaMover® Transport Chair from Graham Medical. Steve McAdoo, firefighter/paramedic and public information officer for Clackamas Fire District #1 in Oregon, says the MegaMover, “speeds up response time. No running back to the vehicle for a stretcher or stair chair. It’s right there in our kit.”

The MegaMover isn’t meant to replace existing patient-transport methods. Instead, it’s a portable alternative option. The patient’s weight is distributed across eight nylon-reinforced handles, allowing up to four people to share the load. The disposable chair, made of a nonwoven, latex-free material with a sanitary fluid barrier, weighs only 10 ounces, rolls to the size of a water bottle and can transport up 350 pounds. It’s ideal for carrying patients in areas of limited space, narrow hallways or down stairs.

“It fits in anybody’s kit–on an ambulance, on a fire engine, we’re able to get it and always have it with us,” says McAdoo. “In dealing with a regular stair chair, that’s not typically something we bring into a scene with us. That’s something we figure out we need and then somebody has to go back out and get it, unbuckle it–it’s time consuming. The MegaMover transport chair is already with us. As soon as we discover that’s what we need, it’s (as simple as) reaching into a bag, grabbing it and doing it. It’s much quicker (and) saves us a lot of time on scenes.”

Visit www.grahammedical.com.

Informed's Smartphone Field Guides Keep Latest Information at Fingertips

A field guide should be a lot of things: portable, packed with relevant information and easy to use. Informed Publishing’s EMS Advanced Life Support (ALS) interactive application is all of that and much more.

Of particular note, says Rick Russotti, RN, EMTP and a retired battalion chief from Greece, NY, who currently serves as a paramedic educator with Monroe Ambulance/Transportation in Rochester, NY, and is the author and host of Mitigation Journal, a blog which offers “unique perspectives on civil preparedness and emergency response,” are the top notch graphics on the app. “I spent a good bit of time evaluating this product for its graphic capabilities and I found that other products just really didn’t show you what they needed to show you. I didn’t find that to be the case with Informed. You tap on the graphic, it enlarges and shows you what you need, and it also gives you easy navigation to and from different topics. It’s really easy during critical situations for me to pick out the information that I need.”

Russotti also notes that the price–between $6-$8, depending on the platform, with free updates–is a bargain for the information available at his fingertips. Having used Informed’s hard-copy field guides since the late 1980s, when he purchased an iPod Touch a few years ago he discovered Informed’s apps. “For a while I carried both products, the paper copy and the app on my iPod, but gradually the paper copy didn’t get used and went by the wayside. One of the biggest features I like about the app is the automatic self-updating, so (I don’t have to) wait for next year’s edition to come out to catch up on medicine or protocol changes.”

The EMS ALS app provides fast, easy access to vital assessment information, medications and drug doses; quick interpretation of 12-Lead EKGs; and the latest CPR and ACLS algorithms from the American Heart Association (AHA). The app is available on the iPhone and Droid platforms.

Visit www.informedguides.com.

Intra's Laryngoscope Video Adapter Offers a Better Look Down

When you’re developing a new product for the EMS market, it makes sense to get input from EMS providers. So when Cincinnati-based Intra, which makes advanced imaging products for medical uses, set out to develop its Swift 3000 laryngoscope video adapter, it turned to some local experts with the Blue Ash Fire Department.

“They approached us to get our opinion on what was out there and what kind of avenues to possibly look at,” says Assistant Chief Chris Theders. “We did almost like market-testing for them—they’d come to us with a demo unit and give a presentation, and we’d let all three crews look at it, then come back with, ‘This will work’ or ‘This won’t work.’ They wanted to talk to people in the field, because we’re the ones who are going to use it on a daily basis.”

The resulting product was solid enough that Blue Ash put one on both of its first-out units to facilitate intubations. The Swift 3000 converts a traditional laryngoscope into an advanced ETI tool that delivers images, the company says, comparable to the stationary endoscopic equipment of hospital ORs.

The Swift 3000’s video probe attaches to the laryngoscope blade with a simple clip and delivers a 100º view with a depth of field up to 300 mm. It has its own single white LED and a convection heating system to prevent fogging. The monitor weighs less than 2 oz. and provides a 2.5-inch display, and can be mounted on the scope handle or an included wristband.
Blue Ash providers found the system easy to use, Theders says, and no more time-consuming than a normal intubation.

“When you practice with it, you really start to get a feel for what you’re looking at,” he says. “Everybody’s been very excited about it. It’s another tool we can have available for difficult intubations or difficult lighting, and I think it probably lets us get a higher percentage of quality intubations.”

For more, visit www.intra-llc.com.

iTec Manufacturing's Multi-Grip Head Immobilizer Is Quietly Reliable

With 117 ambulances on the road running 160,000 calls a year, silence is golden. That is to say, if leaders of a service as large as East Texas Medical Center EMS aren’t hearing gripes about their equipment from the front lines, it probably means things are working pretty well.

That’s certainly been the case for ETMC with iTec Manufacturing’s Multi-Grip Head Immobilizer, which it’s used for years.

“The best thing is, we don’t hear about it from the guys in the field,” says Andrew Petty, the service’s director of education and clinical services. “Any manager will tell you that’s a good thing, because they very rarely call you to say, ‘Hey, this did great!’ What you usually hear is, ‘This thing doesn’t work!’”

Designed by a firefighter, the Multi-Grip is a complete disposable head immobilization system that’s compatible with all cervical collars and backboards. It holds the head across the forehead and below the chin with easy-peel tape straps that secure to a pair of foam cylinders to hold the head in place. It comes in adult, child and infant sizes, the latter of which fits in a car seat.

A key benefit is the flexibility the Multi-Grip allows in immobilizing patients.

“It’s easy to position on the patient once they’re on the board,” says Petty. “Sometimes you have to be creative with the padding when you place a patient, and this device allows you to extend that creativity to the head blocks. You can cut it and make it two separate blocks, similar to the old towel rolls, if you have to, and the fact that it’s not adhered to the board allows you more flexibility with where and how you place your patient.”

Besides its ease of use and no-news-is-good-news reliability, the Multi-Grip is favorably priced for budget-conscious times, and iTec offers a program by which interested services can trial it for free.

Visit www.itecmfg.com.

Mac's Lift Gate Offers Lift Assistance

Across the U.S., patients are getting bigger, and posing an increased risk of injury to the EMTs and paramedics who lift and carry them. Smart services have responded by taking measures to protect their personnel, and in Boston that’s included outfitting a special bariatric ambulance with an automated lift from California-based Mac’s Lift Gate.

With the lift, providers need no longer hoist their largest patients into ambulances manually. They’re instead positioned on a lift platform and raised hydraulically at a simple touch.

“One of the most common long-term injuries we were losing members to was back injuries,” says Tony O’Brien, a leader with the union that represents Boston’s personnel, the EMS Division of the Boston Police Patrolmen’s Association. “We tried a couple of different ways of easing the loads we lift and carry, and from a union standpoint, this thing is far beyond. It’s the best thing we’ve found for our members to prevent back injuries.”

The regular Mac’s Ambulance Lift can raise and lower up to 750 lbs. and will accommodate most isolettes and cots.
For more power, Mac’s offers a Bariatric Lift that can elevate up to 1,300 lbs. Both stow under the bumper and are easily pulled out and unfolded for use. The lifts fit Type I (bariatric) and Type III (cot and isolette) ambulances and are designed for all bariatric cots.

Boston EMS rolled out its lift in January, and while no one’s yet examined back injury rates before and after, those charged with protecting worker safety think it’s a benefit.

“We don’t have actual numbers, but it seems like kind of a no-brainer,” says O’Brien, also an EMT with the Special Operations Division, which handles Boston’s bariatric transports.

“I mean, you can tweak your back lifting a 100-pound person if you don’t do things right. But the real risk is with the larger ones, and this thing has to have taken that away. Obviously, every time you’re not lifting that kind of weight, you’re preventing a possible injury. So from the members’ point of view, it’s an invaluable piece of equipment.”

Visit www.macsliftgate.com

Learn by Doing with Simulators and Manikins

As president of Emergency Medical Consultants, Inc. and captain for Boca Raton Fire-Rescue in Palm Beach, FL, Shaun Fix, PMD, NREMT-P, recognizes that adults learn by doing. He relates that when adults are told how to do a certain task, they’ll remember about 10% of the procedure. If they see it, they can recall about 20%. “But if they hear how to do it, see how to do it, then practice how to do it, they’ll retain about 80%,” he says.

Medical procedure training manikins and simulators are an important part of Fix’s “learn by doing” approach. And Nasco Life/Form CPR manikins and Airway Management Trainers are his trainers of choice. Fix utilizes eight infant, six child and 18 adult Airway Management Trainers, including several advanced “Airway Larry” trainers that give him the ability to create various scenarios for patient evaluations. CPaRlene manikins for CPR training are also included in his inventory.

“A lot of our training involves advanced procedures,” he says. “We’ve been using Nasco products for about 15 years, and we appreciate their mobility, flexibility and affordability.”

The trainers are very lightweight and highly mobile, he notes. “That’s important because a lot of what we do requires that we take them on the road,” he says. “One whole Nasco manikin may only weigh 20 to 30 lbs. compared to other manikins which can weigh up to 100 lbs.”

Being able to add advanced anatomy, such as lungs, stomachs, torsos, arms, etc., enhances flexibility and affordability by providing a “build-as-you-go” process. “The ability to add advanced parts is unique,” he says. “You can initially purchase a plain CPR manikin, or you use one you already have, then add an intubation head, EKG and defibrillation chest, and IV and blood pressure arms.”

Visit www.enasco.com and click on Health Care.

Saving Lives, Safer Rides with Automated-Chest Compressions from Physio-Control

For EMTs and paramedics, automation can allow them to focus on other aspects of patient care and help save more lives. The LUCAS Chest Compression System from Physio-Control is no exception.

As one of the first adopters of the LUCAS device, Kevin Traynor, senior clinical supervisor for Cypress Creek EMS in Spring, TX, says his agency saw an opportunity for paramedics to focus on other things in the resuscitation effort besides compressions.

“We (initially) deployed it with our supervisors on all cardiac arrests and we saw some tremendous results. Not only does it free up our paramedics’ hands, it also provides better compressions than anybody could do manually, and that ultimately equates to better perfusion of the vital organs and increases our potential for getting that patient back from cardiac arrest.”

Seeing such remarkable perfusion, Traynor explains, CCEMS started to measure end-tidal CO₂ rates, blood pressures and SpO₂ readings on patients in cardiac arrest. They actually observed normalizing end-tidal CO₂ rates, blood pressures and SpO₂ in cardiac arrest patients, and with the application of the LUCAS device CCEMS have seen a 10% appreciation in ROSC rates.

Following a trial period, CCEMS deployed the LUCAS device to every truck in their system. They also opted to transition from the LUCAS 1, which operates pneumatically via compressed air cylinders and requires no electrical supply, to the LUCAS 2, which runs off of lithium-ion polymer battery technology, has a long shelf life and requires no test-cycle maintenance.

And one big advantage for the medics, Traynor says: Being a hands-free device, the LUCAS Chest Compression System allows medics to stay strapped in during transport. “That’s a huge challenge when you’re talking about a cardiac arrest you’re transporting to a hospital. The LUCAS device allow us to do good, high-quality compressions on the way to the hospital, and our crews in the back are seated and a whole lot safer.”

Visit www.physio-control.com.

Redpoint Helps Reduce IV Failures During Transport

Keith Hughes is a specialist in safely transporting patients.

Over the past 10 years, Hughes has worked in 9-1-1 trauma and patient transportation roles with private emergency services firms in Washington, Arizona and Texas.

He knows first-hand the importance of the “Golden Hour” of care following a medical event and the “Platinum Ten” where first responders must move quickly in unpredictable environments.

He also knows the frustrations surrounding that care. At the top of his list is the accidental unseating of IVs, costing valuable time to reseat them.

“I could give you 200 instances where an IV line was ripped out, rolled over, snagged on an ambulance door or IV pole, stepped on, or otherwise dislodged. It just happens during transport even when people are being careful.”

So when he saw a sample of a new Stedline IV Sleeve from Redpoint International, Inc., he immediately took note.

The Stedline IV Sleeve is a primary tubing IV stabilization device made of a soft, disposable material that is specially engineered to reduce the risk of failures due to movement. Using no tapes or adhesives, the sleeve itself absorbs yanks and tugs that cause IV catheters to fail. “It works really well,” says Hughes. “The IV line will stretch or rip before the line is pulled out of the patient’s arm. I’d much rather fix a line tear than reseat an IV catheter.

“As soon as I experienced it in the field, I purchased a box and have continued to order them,” Hughes continues. “I expect to have them with me wherever I work. The last thing you can afford is the time to reseat IVs, especially if you’re the first on the scene and have multiple patients.”

Visit www.redpointcorp.com.

StatBand Patient Tracking Solution

For disaster preparedness and response groups like the Belgium Red Cross, finding a fast, easy, and simple-to-use emergency patient tracking system can be a challenge; however, by capitalizing on the latest technologies and products available, emergency preparedness and response professionals can maximize positive outcomes in the event of an emergency or planned drill.

The Belgium Red Cross was able to do just that during a drill they conducted at Ostend Airport. After a long search, they selected StatBand Rapid ID and StatBand Triage Tags to manage patient tracking. According to Belgium Red Cross Intervention Manager Hugo Geuvens, responders were not told ahead of time about the new method of registration using the wristbands.“Users were not familiar with StatBand wristbands; however, all the users automatically adapted to the easy-to-use solution,” he says.

Geuvens explained how the Belgium Red Cross used StatBand wristbands for patient tracking during the drill. “The smaller evacuation/Rapid ID wristbands have peel-off labels that were used to ‘track’ the movements of people in a fast and easy way, even without any IT tools available. This was an important requirement for our Red Cross unit. Using IT in emergency cases is nice, but should not hinder a fast rollout and usage. A label was collected from the StatBand wristbands and simply stuck to a piece of paper at an entry or exit point. The barcodes were later used for fast electronic recollection of information. We also wrote down the identity of victims or civilians and placed a label on a paper registration document to uniquely ID that document. This linked the person and document together so that we could instantly track all ‘patients.’ StatBand wristbands were fast, easy, and simple to use, and we are quite happy with our decision to use them.”

Visit www.statband.com.

SMART STAT Patient Simulator Next Best Thing to Live Patients

With budget cuts commonplace for many hospitals and EMS agencies, finding a training tool that’s cost effective is imperative. And if that training tool also happens to offer more bells and whistles than comparable, higher priced products, all the better.

“We decided to use the SMART (Scenario-based Medically Advanced Resuscitation Trainer) STAT (patient simulator) due to the significant cost savings compared to other high fidelity simulators,” says Nurse Clinician Jennifer McDermitt, RN, BSN, Department of Nursing Education and Professional Development at Hurley Medical Center in Flint, MI. “It has a lot of the same features as other higher priced simulators, such as cardiac rhythms, lung function, CPR, urinary catheterization, etc. It also has many features that the higher cost simulators just don’t have, such as cyanosis, tearing eyes, runny nose and foaming mouth.”

McDermitt acknowledges additional advantages, including that its wireless, battery operated (with the option to connect to an outside power source) and self-contained. She adds that the simulator is heavy, so her hospital uses a stretcher to transport the device, and while its condition can improve, remain stable or deteriorate depending on operator instructions, it does not automatically deteriorate based on interventions that a user does–or doesn’t–perform.
The SMART STAT, from Simulaids, is also user-friendly and efficient as a training tool, explains McDermitt. “We were up and running in little time. We also purchased the optional software scenarios that work great and have saved our education department tons of time.

“We use it within out facility for mock codes or other procedural type scenarios,” McDermitt continues. “I had a nurse from our Ortho unit state that they had a code and how smooth it went because they had just practiced code scenarios using the SMART STAT.”

Visit www.simulaids.com.