Letter from Chair

Growth is happening....the difference is being noticed....

I had the privilege of recently attending the EMS Today national conference in Baltimore, Maryland, and was pleased to see the overwhelming interest in ECSI programs among the many EMS providers, educators, and administrators in attendance. We added 11 new ECSI Educational Centers and an even larger number of new instructors in just two days.

I also had the opportunity to visit the EMS Educators Conference in Seven Springs, Pennsylvania. Although it was a different forum than the EMS Today conference, I spent most of my time there speaking with instructors who were excited to discuss our products and expressed their happiness with our programs. It is obvious that ECSI has a very strong presence in Pennsylvania.

Now is the time we need to continue to move forward stronger than ever. I would like to congratulate all of those working toward making ECSI's programs the preferred programs for all agencies and instructors. I would also like to remind everyone promoting ECSI that the quality of our products, the pricing, the administrative ease, and customer service we provide through delivery of the programs remain our strengths. Our pride in ECSI makes other instructors want to make the change and "Experience the ECSI Difference!" This slogan could not be any truer. Sell our strengths as an organization. We can stack up and come out on top against any other organization.

Craig Spector
2007 National Advisory Chairperson

The Big Picture

2007 continues to bring more positive advancements to ECSI. We are pleased to announce a new partnership with LifeSafe Services, as the ECSI National Contracts Training Provider. LifeSafe Services is affiliated with SOS Technologies, providing supplemental oxygen equipment and AEDs along with quality training to businesses and industries across the USA (See Educational Center Spotlight). Since this partnership was formalized last month, many of the other SOS Technologies locations across the United States joined with LifeSafe Services to provide ECSI training. Working at a national level, ECSI and LifeSafe Services will be responding to national and regional requests for proposals (RFPs) from government, businesses, and schools. Depending on the locations of the required training, we will be contacting other SOS Technologies locations and other ECSI Educational Centers to assist in satisfying local training needs under the terms of the RFP. This will further enhance ECSI name recognition and growth on the national level.

ECSI has also been busy securing a few remaining regulatory office approvals. With the assistance of our medical partners, the American College of Emergency Physicians (ACEP) and the American Academy of Orthopaedic Surgeons (AAOS), we have recently been in contact with select entities who provided us with verbal program approval, but failed to send the official letter, or have undergone recent change of personnel and have not yet responded. We expect to have these few loose ends tied up shortly.

"Airway, Airway, Airway"
Submitted by Jaime S. Greene
Safety Associates, FL

In the mid 1980’s there was a quote on airway management that advocated the following: "Oxygen is good, blue is bad, air must go in and out". While I am aware of the recent studies advocating compressions–only CPR (which really isn’t a new concept), I wanted to take a look at airway management. I know that there has been what appears to be a downplaying of airway and ventilation versus compressions, but that’s just a poor perception of the true story. One needs only to go back and look at the origin of the word breath from the Greek, pneuma, and you will find that it means "life."

We have known for quite some time that we have been overventilating our patients. Back to the 2000 ECC/ILCOR Guidelines and up to present there has been much discussion about airway and ventilation being properly managed. Instructors such as I were taught and carried on the tradition of big, forceful breaths—and lots of them. However, what is really needed is adequate breaths delivered with good, quality chest compressions. A couple of years ago I attended an all day conference on pre-hospital medicine where several of the emergency department physicians of that locale came and spoke. Consistently they each said that if EMS would bring the patients to them with adequate airways and proper ventillation they could solve the rest of the patient’s problems. As one doctor said, "I can’t do much with blue and dead."

So, let's look at the delivery of ventilations. A recommended order of delivery is as follows: mouth to mouth, mouth to mask, alternative/advanced airways, and bag valve mask.

Mouth-to-Mouth: While there are obvious health implications for the rescuer, this is still the best way to ventilate the nonbreathing person. Why? Because if you haven’t properly opened the airway you will know it immediately when you give your first breath. It is like placing your mouth against the palm of your hand and blowing. It doesn't go anywhere. Yes I have done actual mouth-to-mouth, yes I know it’s not the prettiest thought or image one could have of themselves, but it worked and people can be resuscitated by this means of ventilation. In addition to having the airway properly opened you will also be able to tell if breaths are getting more difficult to administer or if the patient is starting to regain breathing on their own more quickly by this means.

Mouth-to-Mask: This is our second choice for ventilation delivery. For the healthcare professional the use of "resuscitation pieces" is required by OSHA (not a small town in Wisconsin). Specifically, OSHA says that they are to be "provided by the employer and readily available at all times." I asked an OSHA representative what readily available meant and that person said, "Within arm's reach." In EMS we teach personal safety comes first. Thus I would encourage folks to carry a mask with them at all times, not just at work. You don't leave your CPR skills at work, do you? Ideally, the mask should be transparent, with a cushioned cuff and a one-way valve. Some masks will come with an O2 inlet. If oxygen is available it should be applied, via the inlet, at 10-12 liters per minute. It is also recommended that if a rescuer is going to be giving mouth-to-mask for a prolonged period of time then a nasal cannula should be applied to the rescuer flowing at 3-5 liters per minute.

Alternative Airways: There are more and more of these coming to the market all the time but few if any have clinical studies to support their use or value. We really do need to become an industry that is driven by research and not by personal preference. The two alternative airways mentioned in the ECC/ILCOR Guidelines are the Laryngeal Mask Airway (LMA) and the Combitube. (My experience has been with the LMA which is where I will go here). The LMA has over 2,000 peer reviewed research articles, 120 of which focus on pre-hospital care. This is more than any other device on the market today. It is easily placed (97% correct placement 1st attempt) and on average takes no more than 15 to 20 seconds to place. Specifically Guidelines says, "This is a more secure and reliable means of ventilation than the face mask." Further, it says, "…regurgitation is less likely with the LMA than with the bag-valve mask and aspiration is uncommon." The LMA is considered a BLS device and is easily taught and learned. In the case of the LMA one of the intents behind its design is to move the mask from the face to the tracheal opening, thus better directing the breath to the nonbreathing patient. For lay rescuers, while the skill is easily taught and learned it may not always be practical to implement. It should be noted, too, that "Once an alternative/advanced airway is placed we no longer perform cycles of CPR but rather should give continuous chest compressions of 100 per minute without pauses for ventilation." The breaths are to be interspersed with 8 to 10 breaths delivered per minute. (2005 ECC/ILCOR Guidelines)

Bag-Valve Mask: There are as many variations on this device as you can imagine. While this is the device we tend to gravitate toward, it's not that high on the list of choices. It takes quite a bit of practice to learn how to use it properly; ideally it should take two rescuers to use it (see the ECC/ILCOR Guidelines) and thus doesn't always perform well because of the awkwardness in operating the device. Don't get me wrong, it definitely has its place in the resuscitation of patients, but it's not the do all, end all. Additionally, one size does not fit all. There are bag-valve masks for each age group and the proper sized BVM should be used on the patient being cared for by health care personnel. Remember it's a tool in the resuscitation of patients, not the only one.

So we have discussed the various delivery means of ventilations to the nonbreathing patient. While the current emphasis is on compressions-only CPR, this is meant only for those cases where there is witnessed arrest or the rescuer has no barrier device available and is unfamiliar with the victim. The means of delivering those breaths is contingent on both the level of training of the individual and their commitment to use the skills they have obtained, whether for employment purposes, personal satisfaction or both. Remember, "Oxygen is good, blue is bad, and air must go in and out."

Educational Center Spotlight
Submitted by LifeSafe Services
Jacksonville, FL

The value of safety is always greater than the cost of assuring it. LifeSafe Services is here to provide that feeling of safety on a national basis with training classes offered throughout the U.S.

LifeSafe Services is a single-source provider for emergency safety and related training needs. We provide emergency oxygen equipment and supplies; automated external defibrillators and supplies; and CPR, AED, First Aid, Bloodborne Pathogens, Oxygen and OSHA training classes.

LifeSafe Services is a part of the SOS Technologies national network of exclusive distributors of the Oxygen Therapy Institute unique emergency oxygen system. As a member of the SOS Technologies network of companies, LifeSafe Services has been both a pioneer and a leader in the area of emergency oxygen for more than 30 years.

Interested in convenient, practical training programs at competitive prices? LifeSafe Services has the classes you're looking for. We deliver performance-oriented, cost-effective training to small businesses, as well as corporate, government, and education customers. With a network of educated professionals, such as fire fighters, paramedics, EMTs, and nurses, we have more than 150 educators across the country. These educators bring real life stories to the classrooms and help make the learning experience more interesting, which helps maximize knowledge and improve skill retention. We are an authorized training center for ECSI.

LifeSafe switched to ECSI this year because of the impressive quality of videos, professional books, quick response time, and the National Certification Program. Our instructors have been thrilled with the change, and our clients have noted the value of the programs.

Another aspect of LifeSafe is the LifeKit division, which specializes in survival kits. You never know when tornadoes, hurricanes, earthquakes, or blizzards will strike and you have to be well prepared for when the unexpected arrives. You must be prepared to support yourself and those around you until help arrives. LifeKit, a subsidiary of LifeSafe Services, has the emergency and disaster supplies that you will need to survive. We also supply more advanced supplies such as trauma kits, triage kits, large first aid kits, search and rescue kits, and kits for auto, schools and commercial businesses. Visit our Web site, http://www.lifekit.com/, and get one step closer to being prepared.

In the News
Submitted by Alton Thygerson

Cleveland, OH – A woman whose father died in a house fire bought 560 smoke alarms to help Cleveland firefighters with a new public safety campaign. The woman used $2,885 from insurance on her father's house to purchase the alarms. The devices will be donated to the Vanguards, a group of black Cleveland firefighters whose goal is to install free smoke alarms in every home. Although his home had smoke detectors, the father died of a heart attack six months ago while trying to put out an electrical fire.
Source: Associated Press, January 2, 2007.

New York, NY – A 50-year-old man, while waiting for a downtown train, saw a 19-year-old man fall onto the train tracks. The man jumped down to the tracks and rolled with the young man into the trough between the rails as a train came into the station. The train's operator saw someone on the tracks and put on the emergency brakes. Before the train came to a stop, two cars passed over the men—with about two inches to spare.
Source: Associated Press, January 4, 2007.

Hot Springs, AR – A city inspection found 123 violations at a motel where a 42-year-old woman died of carbon monoxide poisoning. A loose pipe allowed the gas to enter two guest rooms.
Source: Associated Press, January 19, 2007.

Zephryhills, FL – A 68-year-old skydiver from Lakeland who had made more than 1,000 jumps apparently suffered a heart attack or stroke after leaping from a plane. The man's reserve chute deployed as designed, but he was dead when he reached the ground.
Source: Associated Press, January 23, 2007.

Bartlesville, OK – Two firefighters plunged into the freezing water of a frozen-over pond to rescue a 17-year-old girl who had fallen through the ice. Rescuers said the girl was attempting to cross the pond at the time. Firefighters were able to tow the girl thorough11-foot deep water to a boat. The girl was in the water for eight minutes and the firefighters for about five minutes. All escaped serious injury.
Source: Associated Press, January 25, 2007.

San Francisco, CA – A 65-year-old woman saved her 70-year-old husband's life by clubbing a mountain lion that had the man’s head gripped in its jaws until the animal let go. She smashed the cat in the snout with a large branch and stabbed it with a pen to fend off the attack.
Source: Associated Press, January 26, 2007.

Minneapolis, MN – A 29-year-old man survived a 16-story fall at the Hyatt Regency Hotel. He was horsing around with friends when he crashed through a window on the hotel's 17th floor.
Source: Associated Press, January 29, 2007.

Provo, UT – An ice climber fell 200 feet to his death near Bridal Veil Falls in Provo Canyon. The man was with two other climbers when he fell from the upper tier of an ice formation. The other climbers reached him after the fall, but were unable to revive the victim.
Source: Associated Press, January 31, 2007.

Medical Journal Articles

Fatal Animal-Vehicle Collisions in the United States
Both fatal and nonfatal injuries from animal-vehicle collisions are a significant public health problem. As the human population expands and encroaches upon natural areas for wildlife, the likelihood of an animal-vehicle collision increases. During a 10-year time period, 1995-2004, an average of 165 deaths occurred each year. Most deaths occurred in rural areas, during the fall months, on straight roads, and in clear weather. Various methods to reduce such collisions were described, with fencing appearing to be the most effective. The use of personal restraints, such as seat belts in vehicles and helmets for motorcycle and all-terrain-vehicle riders, may decrease fatalities during a collision.
Source: Wilderness and Environmental Medicine, 17(4):229-239 (2006).

Mandatory Reporting Laws and the Emergency Physician
Mandatory reporting laws, which vary by state, impose requirements on physicians to report certain conditions or suspected conditions to local authorities for further action. The first laws dealt with infectious disease control and by 1925 all states had some form of infectious disease mandatory reporting law. This article examined two conditions: impaired driving and abuse-related laws. Six states have laws governing patients with epilepsy. Both the American Medical Association and the Epilepsy Foundation have opposed these laws. Abuse is witnessed in the ED throughout the entire range of the lifespan, from infants to the elderly. Each of these groups has its own set of unique issues of which emergency physicians should be aware. Three years after the first case of child abuse was reported in the medical literature in 1962, all states had implemented relevant mandatory reporting laws. Elder abuse ("granny battering") was first in the medical literature in 1975. Currently, 43 states have elder abuse mandatory reporting laws. An estimated 2 to 6 million women per year are victims of intimate partner violence. Almost 1 million women are physically assaulted yearly, and half of these assaults result in injury. Recently, men have also been recognized as victims of intimate partner violence. Currently, 42 states have mandatory reporting laws for injuries resulting from firearms, knives, or deadly weapons.
Source: Annals of Emergency Medicine 49(3):369-376 (2007).

Injuries and First Aid Training Among Canyoneers
The sport of canyoneering involves a combination of various outdoor skills including rappelling and anchor building, hiking, swift water swimming, and rock climbing. Often no alternative exit exists until the end is reached, making emergency evacuations difficult. Zion National Park in Utah is one of the most popular canyoneering areas in the United States. A survey found that minor wounds and orthopedic injuries are common, but fortunately do not often require outside assistance. More significant injuries are less common and usually involve orthopedic trauma or environmental exposure. A first aid curriculum for canyoneering should cover stabilization of fractures and evacuation techniques, as well as minor wound care.
Source: Wilderness and Environmental Medicine, 18(1):16-19 (2007).

Injuries and Illnesses of Big Game Hunters in Western Colorado
In the western United States big game hunting for meat and recreation continues to be a popular activity. Northwestern Colorado is lightly populated, and the Memorial Hospital in Craig, CO, is the only hospital in the county. A survey found 725 ED visits during a nine-year period involved the prime hunting months of September to November. Forty-five percent of the visits were for trauma, 31% for medical illnesses, and 24% were labeled "other." The most common medical visits (105) were for cardiac signs and symptoms, and all of the ED deaths (4) were attributed to cardiac causes. The most common trauma was laceration (151), the majority (113) of which came from unintentional knife injuries, usually while the hunter was field dressing big game animals. Gunshot wounds (4) were rare. Hunters should consider a thorough cardiac evaluation prior to big game hunts. Hunter safety instructors should consider teaching aspects of safe knife use.
Source: Wilderness and Environmental Medicine, 18(1):20-25 (2007).

Work-Related Eye Injuries and Illnesses
More than 65,000 work-related eye injuries and illness are reported in the U.S. annually. More than one half of work-related eye injuries occur in the manufacturing, service, and construction industries. This article describes medical care. Key recommendations are given. Eye pain after a trauma caused by a foreign body, rubbing, or a scratch suggests a corneal abrasion. Patching is ineffective for corneal abrasions and is not recommended. Chemicals burns of the eyes make up a significant percentage of work-related eye injuries and require rapid treatment. Alkalis (pH greater than 10) are more dangerous than acids (pH less than 4), with the exception of hydrofluoric acid, because they may penetrate the cornea for an extended period. Persons with a chemical eye burn should receive copious fluid irrigation. Ninety percent of work-related eye injuries are preventable with adequate eye protection. OSHA mandates that employers provide workers with adequate eye protection.
Source: American Family Physician, 75(7):1017-1026 (2006).

Upcoming Conferences for ECSI/Jones and Bartlett Publishers

Top

About our ECSI Connections Sponsor