Paramedic Blog

We received our first shipment, just in time for introduction at EMS Today next week in Baltimore. The new AllMed® Hi-Viz Rescue Vest combines comfort with function. This deluxe load bearing EMS vest features 5 deluxe equipment pockets, a radio carrier, a pen pocket, and a double entry cervical collar pouch across the back. It even has inside pockets for personal items. The vest is intended to give you instant access to everything you need in the first few minutes of care. Manufactured of rugged 500-denier nylon, with a heavy-duty liner, and durable poly-coil zippers, this vest stands up to the abuse of rescue and extrication.  Water repellant Hi-Viz yellow with highly reflective trim, this vest can easily be seen at night in harsh weather. 

To give credit where it's due, this vest is not my original design. It's very similar to the vest first sold by Pacific Emergency, probably designed by Drew Roberts or Brad Field. Another version is a similar vest made by Ferno. My only contribution was to take this street-proven design, and make it safer. By combining high-visibility and rapid care, this vest offers a whole new take on the idea of a personal trauma kit. The latest version of our Hi-Viz Rescue Vest is Certified ANSI 107-2004 Class 2 Compliant Available in only Hi-Viz Yellow sizes: Small-Medium, Medium-Large, and Large-X-Large

The Federal Highway Administration has established a policy for high-visibility safety apparel. This new Part in title 23, Code of Federal Regulations requires the use of ANSI certified Class 2 or Class 3 garments by workers who are working within the right of ways of Federal-aid highways. The rule is not an unfounded mandate; it is a requirement or standard applicable to highways that receive Federal-aid, no different from other requirements or standards applicable to these highways.

The final rule is effective November 24, 2008 “by which time States and other agencies shall comply”. According to the rule, “all workers who are within the right-of-way of a Federal-aid highway who are exposed either to traffic or construction equipment within the work area shall wear high-visibility safety apparel”.

Specific issues regarding the compliance of EMS workers were extensively referenced by the Rule. The rule establishes that the ANSI 107-2004 Class 2 and Class 3 Standards are the minimum apparel performance standard. It leaves open the opportunity for additional garment design features and functions that might benefit emergency responders as potentially allowable in the future.

I just noted this morning on respondersafety.com that Public Safety Vests (ANSI 207-2006) meet the requirements of Federal Regulation 23 CFR 634 according to a letter to the CVVFA Emergency Responder Safety Institute from Jeff Paniti Associate Administrator for Operations at the Federal Highway Administration (FHA), US Department of Transportation.

The decision clears the confusion highway responders faced in preparing to comply with the Rule that goes into effect on November 24, 2008. ANSI labeled garments Class II and Class III are referenced in the rule. In his letter Mr. Paniti stated " we reviewed the ANSI ISEA 207-2006 public safety vest standard very carefully and found this standard compatible with the ANSI/ISEA Class II requirements for night-time visibility."

So EMS Agencies have 3 basic choices; ANSI 107 Class 2 Vests, Class 3 Coats or Ensembles (Class 2 Vest or Coat with Class E Pant), or ANSI 207 Vests. The later 207 Standard, is on a vest design that is held together with hook and loop fastener at the shoulders and sides. The idea is that if a motorist snags you by the vest it will tear-away. The downsides are that by design these are very lightweight garments, and probably not suitable for load bearing or radio carrying. For those applications, you can still use a Class 2 Vest.

The new AllMed Rescue is a premium quality extrication glove I’ve been working on. The Rescue is a highly sophisticated design, manufactured with 7 different materials.

The gloves are constructed mainly of Neoprene and synthetic leather, for a great fit and long wearing durability. They have reflective trim on the fingers, so that rescue tool operators can see exactly where they are. They have polycarbonate knuckle protectors to reduce abrasion injuries. The AllMed Rescue features polymer coated Kevlar pads to protect your palm and fingertips. They also have rubber traction pads across three fingers and distal palm, to enhance gripping power when using patient handling equipment.

The AllMed Rescue features a tapered cut to the fingers, and is made in 5 different sizes for a superior fit. They are also very fast to put on and remove. The AllMed Rescue Gloves are available in both Royal Blue and Black colors. Glove keeper strap for belt carry is included. The idea was an extrication style glove, with a design more specialized to EMS. The first batch should be done by March, in time for EMS Today.

It’s getting cold here in the Midwest for the first time this year. We have been lucky, with lots of warm fall weather. Now that the snowflakes are falling it’s time to review the different ways to keep EMS patients warm. We run on a hundred thousand dollar truck, carrying half again that much in medical equipment, and yet often can’t find a warm blanket for our patients.

Emergency Rooms know the huge value of a warm blanket and a smile. These are the things that really make a difference to a sick patient. They are already scared and feeling terrible, being cold and sick too is a lot to ask. But on many ambulances today keeping patients warm is largely an afterthought. I suggest you take some of your ambulance blankets home, and next time you get a little chilly try them out. See what actually works and use the information to put a smile on somebody’s face today.

The cheapest blankets ambulances frequently use are the low-end disposables. Maybe the most well known is the old silver space blanket. These things do work, a little. But they blow around like crazy. Their best application may be as a blanket liner, to help keep your primary cover clean while enhancing performance. Their biggest advantage is the compact size, making them a top choice for emergency kits.

The tissue and poly-foam disposables just don’t offer much warmth if you ask me. Their greatest advantage is being cheap. There are foam backed plastic and tissue backed plastic, with the first offering slightly better performance.

The next level up, so to speak is the old Cotton Blanket. Hospitals use these a lot, and as a direct result so do many ambulances. Hospitals like them because they launder pretty well, and with low capital costs and fairly durable construction are actually the cheapest way to go. We used to use these a lot in the old days, again as liners with our red wool winter blankets. The cheap 5-finger price and keeping the wool blanket clean had big advantages. This combination is also about one the cheapest combinations to keep people warm in real cold weather.

The next is of course is wool or wool-blend blankets. These are rugged, warm, and some can be used as a fire blanket. They really don’t wash well, so frequently cleaning is an issue. But boy do they work when it’s cold. Cot quilts are even a better choice. There are a few on the market, made especially for ambulance use. They lie under the cot mattress, and then fold around the patient. They secure around the patient with hook & loop fasteners, so you can access a limb. They work extremely well, and if you are in the Northern States you really need to have a look. 

One newer blanket I really love is the simple nylon/fleece combination. These blankets are under 20$ yet really perform astonishingly well. They trap body heat between the nylon and fleece layers. This insulating air space creates a high-performance thermal barrier. I keep one on my sofa, and one in my car at all times. These are probably the best blankets for the money you can buy.

Another new type of blanket is the active heating disposables. These are something I think everybody should keep around for weather emergencies. They work rather mysteriously, combining oxygen, iron filings, and vermiculite inside a polypropylene cover. They work like those instant hand warmer that hunters like to use. When you open the package and let air hit the blanket, they heat up in about 10 minutes. They are pretty expensive for daily use, but really can be a lifesaver in a disaster big or small. They stay warm for up to 8 hours too. If you think there is even any chance of getting caught out all night in bad weather, these blankets are a must have.

One of my favorite new products from the EXPO this year is new Comfort Zone Blanket Warmer. The Comfort Zone is a durable hard case that contains and heats a standard blanket. You just leave it plugged into a DC outlet in the ambulance, to keep a blanket ready and warm all the time.

Your local weather, costs, and performance are all important considerations when choosing a blanket. Just please don’t make your patients suffer in cold weather. We need to be respectful and responsible when addressing the most basic care needs of our patients. A warm blanket and a smile are an important part of doing just that.

I was at the Colorado EMS Conference at Keystone Resort last week. This is maybe the prettiest little Conference Center I’ve ever seen, up in ski country. While there I got a chance to see the latest version of the Hartwell CombiCarrier, the CombiCarrier II.

The original CombiCarrier was a great idea, and with this latest redesign it’s finally going to get the attention it deserves. The CombiCarrier II combines the construction of a plastic spine board, with the versatility of a scoop stretcher. It opens at both ends like a scoop, but unlike a scoop rarely “binds up” thanks to the robust locking mechanism. The circular plate steel lock has a lot more contact area, so both connecting it and taking it apart are much faster and easier than a scoop.

Many thought the first CombiCarrier somewhat heavy and thick. But the newest CombiCarrier feels even lighter than most plastic boards. It’s also much slimmer and easier to use. Not matter how good your log rolling technique, nothing beats a scoop for minimizing patient movement. Construction details include quick connect pins and carbon plastic reinforcing rods. These rods are located inside the handholds, so you have a tight lockup of reinforcement rod to plastic sidewall. This is a detail only used on the very strongest plastic boards like the Prolite XT. The CombiCarrier II combines the best aspects of both scoop stretcher and back board, with the weaknesses of neither.

It will accommodate a CID that they are developing for it now. The CombiCarrier II also has a unique advantage for those that loose a lot of boards in the ER. You don’t have to move the patient at all to take them off the board. Then you can just take it with you when you go. The CombiCarrier II should be available in about a month.