EmergencyTech.org

Years ago I was fortunate enough to attend one of the first CONTOMS tactical medic classes in Bethesda, MD. Everything about the class was amazing and, surprisingly, the stuff that stuck with me the longest was some of the training that seemed most mundane at the time. Since the course, I’ve used skills learned there to treat a broken tooth, manage hydration, and even store pee in a ziploc bag.

You see, in CONTOMS they taught us that the best way to store urine is to put some silica gel (that stuff that comes in packages) in a ziploc bag. When you urinate into the bag, the gel solidifies the urine and you can store it for later disposal. This is invaluable when you’re on a long deployment and can’t just sneak off into the bushes to do your business.

A German company has developed a commercial version of this idea with their new roadbag device. Designed for long car trips (as far as can be gleaned from the Google translation), perfect for long hours spent at a corner post with no bathroom (as nearly every EMT understands) this is exactly what every EMT-T should have come up with during class.

Via Medgaget.

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Remote controlled simulation mannequins are nothing new to medical training. In EMS we’ve been using them for years and each iteration comes with a host of new features. The military’s new Medi-Man dummies, however, sound like they really hit the mark when it comes to accuracy:

The dummies are remotely controlled by the instructors to simulate particular injuries. Some have gaping belly wounds or spray blood – actually a red fluid that can be chemically tweaked to reflect different injuries – from severed limbs. Others might be breathing irregularly, their pump-activated chests rising on just one side. “A trainer can change a dummy’s behavior according to trainees’ actions,” says Staff Sergeant Glenn Gonzalez, noncommissioned officer in charge of the facility.

That’s only the beginning, though. The real breakthrough may be in the intensity of the scenarios. Over at Fort Bragg, it sounds like these dummies are getting the snot beaten out of them on a daily basis while the Army’s 82nd Airborne Division trains for deployments in Iraq.

Teams of six trainees race down a path in Fort Bragg’s forest. They must treat and carry any “casualties” they encounter along the way – usually two per team. Obstacles include barbed wire, trenches and holes filled with mud. Instructors throw training grenades to keep the medics’ heads down. “I guarantee you they’re exhausted by the time they reach this point,” Gonzalez says, standing near the barbed-wire obstacle. The idea, he says, is to make sure medics can make smart decisions about treating casualties even while scared and tired. Gonzalez and his fellow instructors have trained around 1,800 medics and doctors in the past year.

So, when these things make their way into the private-sector end of medical education they will have been well tested and, hopefully, most of the durability issues will have been worked out. The only people I know who beat on training equipment more than EMS folks? Military folks.

The proof, perhaps, is in the numbers:

“There have been around 2,400 soldiers killed in Iraq due to enemy action,” says Captain Earnhardt, division spokesman. “The reason that’s 2,400 and not 10,000 is this training.”

Via War is Boring

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Oh, those Canadians are at it again with all of their inventing and politeness. Well, this has nothing to do with politeness, unless your idea of “polite” is ensuring effective chest compression rate and depth during CPR.

Two engineering students from McMaster University have invented what they believe is the solution: the CPR Glove. They have entered a prototype of their innovative device in this year’s Ontario Engineering Competition for university students being held in Ottawa from Feb. 9 to Feb. 11. They are part of a 17-member team competing from McMaster.

The black, one-size-fits-all CPR Glove features a series of sensors and chips that measure the frequency and depth of compressions being administered during CPR and outputs the data to a digital display.

To be effective, compressions must be given at the rate of 100 per minute and at a depth of four to five centimeters.

A study measuring retention of CPR training published in the Journal of the American Medical Association showed that 59 per cent of the time, compressions were applied at the rate of only 80 per minute. Thirty-seven per cent of the time, the compressions were too shallow. CPR administered at these levels is not likely to save a person in cardiac arrest.

What I find particularly interesting about this is that it seems effective in many different ways: as a training adjunct, as a real-time indicator of compression effectiveness, and as an interface device for AEDs designed for bystander-use. Think of the effectiveness of cues like “deeper” or “harder” . . . well, you get the point.

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I know this is a bit dated, but I’m cleaning out the old “Stuff to Blog” folder.

Two rocket scientists EMS workers over at the London Ambulance Service have, rightly, become laughing stocks after their recent attempt at circumnavigating the British Isles because their on-board GPS moving map display told them to:

The crew had been tasked with taking the male patient 12 miles across Essex from King George Hospital in Ilford to Mascalls Park Hospital near Brentwood - a 12 mile journey which should have taken about 30 minutes.

But a fault in the ambulance’s on-board satellite navigation system sent the London Ambulance Service crew on an eight-hour round trip to Manchester.

A spokesman for the ambulance service said the crew set off in the early hours of Tuesday morning. They didn’t reach Mascalls Park Hospital until the early afternoon.

He said the crew hadn’t been to Mascalls Park before and only realised they were heading in the wrong direction when they reached the outskirts of Manchester.

Sure, the crew blames it on a problem with the technology, but we all know what really happened. Didn’t these fine fellows ever learn the old saw, “treat the patient, not the monitor?” And, if so, don’t they think that the same might hold true for other pieces of equipment?

(Reminds me of the old “Mondi Map Display” I used to have when I worked in Cheektowaga. -ed.)

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File this one under “you must be kidding me”:

For years services have re-used single use devices like cervical collars, head-immobilizers, and tourniquets in an effort to reduce waste keep costs down. The theory was, “a few squirts or disinfectant and they’re good as new.” Historically durable stainless steel surgical devices like forceps and spreaders have been steam autoclaved or otherwise sterilized before reuse. It is prohibitively expensive for facilities to just throw away durable equipment after a single use but they are designed to be used over and over unlike fragile tracheal and endotracheal tubes which are made of plastic or other soft materials.

This is the first that I have heard of sterilizing and reusing single-use invasive medical devices like endotracheal tubes.

Reprocessed devices are soaked in sterilizing solutions, disassembled, blasted clean with a fine powder, reassembled and inspected, then packaged, sterilized and resealed. On average, they’re reused three to six times.

Today, the AP reports on federal legislation that will address the increasing use of “reprocessed medical devices” and the medical and ethical complications that arise such as those suffered by Sean Van Duyn after an Orlando hospital placed a reprocessed single-use only tube in his tracheal stoma. There is also the issue of informed consent as Van Duyn’s parents, for example, were never told that the devices labelled “single use only” were in fact used on other patients, up to six other patients.

Federal regulators say reprocessing is safe, but original device manufacturers say they can’t guarantee recycled products will work correctly — and that they are wrongly blamed for malfunctions and patient harm caused by reprocessing.

A federal law taking effect Tuesday, requiring reprocessors to put their company name on recycled devices as well as the packaging, could help determine who’s at fault when problems occur. For devices too small to mark, detachable stickers could be transferred to the patient’s chart.

“That’s like a ‘Sue Me!’ sticker,” and may not be used much, said Josephine Torrente, a lawyer and biomedical engineer who consults for device manufacturers.

The practice, that reportedly saves hospitals 50% over purchasing new equipment, has become so prevalent that there is even a professiona organization that represents the reprocessing companies, the Association of Medical Device Reprocessors. Their position is that the, “products are totally safe because each item is inspected before being shipped.”
The argument has, however, extended past the bounds of ethical medical practice and solid patient advocacy and has become one of copyright.

Johnson & Johnson subsidiary Ethicon Endo-Surgery is suing the biggest reprocessor, Ascent Healthcare Solutions, for trademark infringement over reprocessing its single-use devices.

“It is impossible to reuse them,” said Robert O’Holla, J&J’s head of regulatory affairs for medical devices, because they are not designed to be taken apart for cleaning. Yet J&J gets complaints from customers about problems with devices showing excessive wear or bleach on them — signs of reprocessing.

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