The new AllMed Nighthawk Intubation Kit is a compact and versatile deployment system for the innovative TruLite Disposable Laryngoscope. It holds 2 TruLite Laryngoscopes, and two SwiftGrip ETT Kits. It’s the most versatile, compact, high-performance intubation kit on the market. It also uses the lightest weight and brightest disposable steel-bladed laryngoscope in the world. 

The Nighthawk Intubation Kit can be used as a separate hand-held kit, has a hidden loop for belt-carry, or can even be mounted to a load-bearing Molle tactical vest with four Lift-The-Dot snap-loops.

The TruLite Laryngoscope is a completely disposable, integrated handle and blade combination. The blade and handle are permanently attached together. Every blade has it’s own power supply from 2 AA batteries in it’s own compact and lightweight handle. They are offered in color-coded Mac 2, 3, and 4 sizes, and soon in Miller 1, 2, and 3 sizes.  

• Compact 11" x 6" x 1.5" Size
• Weighs Only 1.2 Pounds
• Forged Stainless Steel Blades
• Super-Bright, blue-white LED illumination
• No Cleaning Cost

The Swiftgrip ETT kits include the ET Tube, rapid Swiftgrip ETT Holder, a polished aluminum stylet, and even a syringe. Everything is packaged completely assembled and ready for instant use. The innovative Swiftgrip ETT Holder is the only commercially available device that can be applied blindfolded. It is also the only one already loaded on the ETT when you open it, and leaves the pharynx available for inspection and/or suctioning.

Each Nighthawk Intubation Kit will automatically come with a size 7 and 8 Swiftgrip, and a #3 and #4 Macintosh TruLite Laryngoscopes. We will allow for individual clinician preference in substituting other TruLite blade sizes or styles.

The Nighthawk Intubation kit is manufactured from rugged waterproof; 500-denier black nylon polyurethane coated fabric and features a durable double-pull YKK zipper. It offers both patient range and complete equipment redundancy, yet weighs only 1.2 pounds stocked.

I received a copy of an interesting survey by Leflein Associates, of about 150 Paramedics and 150 EMT's (sponsored by Zoll). It reveals a lot about EMS provider's attitudes regarding the current consent degree under which Physio Control is producing defibrillators. Under the terms of the current consent decree, if you want to buy a Physio-Control defibrillator you must sign a letter which:

1. Describes “…the nature and immediacy…” of your need, and
2. Certifying that you “…have previously standardized on Physio Control defibrillators…” and
3. “…Need the Physio Control defibrillators to provide adequate emergency care to patients…”

Some of the key findings in the Leflein Associates report include:

• 60% of those surveyed agree that the consent decree will affect the ability of EMS agencies that use Physio-Control products to deliver proper pre-hospital care. This includes 56% of those who currently use a Physio product.
• 56% of those surveyed think EMS Agencies that use Physio-Control should switch to another brand as a result of the consent decree. Among current Physio owners, 45% agree.
• Only 36% of EMTs and Paramedics were aware of the consent decree before this survey. There was a higher awareness (50%)  among those planning to purchase Physio-Control next. 
• Respondents ranked reliability (92%), durability (85%) and functionality (80%) as the most important factors in an AED or Manual ALS External Defibrillator.
• Things like price (36%), previous experience with the brand (36%) and brand reputation (38%) rank lowest.
• But curiously, when those who were planning to purchase their next defibrillator from Physio-Control were asked why - their responses largely reflected the brands cost, reputation, and their previous experience.

For a pdf of this report, just send me your request and I'll reply with a copy attached. Most of the big companies do these kinds of consumers’ surveys all the time. This one, while no more objective than most of its type - is still very interesting.

To me it says there is a big disconnect between what we say we do, and why we really do it. Even the most carefully considered equipment-purchasing decisions are still largely driven by emotion. In other words, the feelings still count a lot more than the facts. This is not necessarily bad thing, but it certainly is a human thing.

Three important issues have only recently been addressed by the EMS uniform and apparel industry. The first is the fundamental style of most EMS uniforms. They are really just police uniforms, evolutions of military designs, sometimes with only a change in fabric color from what local law enforcement officers wear. Most EMS uniform shirts have scalloped pockets, button down square epaulets, permanent creases, and all the other design features of police wear. I think we place our EMS staff at high risk by wearing these style garments. The drug crazed patient does not care you wear light blue while the police in your community wear dark blue. He reacts to the visual styling cues and will often mistake you for a cop in the first few seconds. In many parts of the world this is no big deal, but in any modern American big city it can get you killed.
 
The second problem is that we work in a very physically demanding profession. We often compound heat stress by wearing older style polyester fabrics. We really need comfortable garments that give us complete freedom of movement to efficiently do our very physical type of work. We are also in dirty outside work environments, and are frequently exposed to different sources of fabric stains. We need uniforms that both repel fluids and wick perspiration away.

We still frequently wear dark colors that cannot be easily seen at night. You might have noticed that in recent years, many in the construction and roadway work industries are now wearing high-visibility tee shirts on the job site. We have the new Federally Mandated ANSI compliance deadline driving the purchase of safety vests and coats. But the big unanswered question is, will EMS staff wear the new safety vests? Most are cheap and fit poorly, and truthfully make you look like a whacker. I think the only answer is good looking high visibility uniforms, like what has been the norm in much of Europe for years. If we had great looking hi-viz shirts and coats, no matter the season or circumstance we would be safer. If the uniform itself is visible, we don't have to worry about putting a separate garment on over it. The challenge will be to create professional, functional, and great looking hi-viz uniforms for EMS providers.
 
Many of these concerns have now been recently mitigated in the sports apparel business. There have been many new developments in fabric manufacturing and fabric coating/treatment technology, which can provide our industry valuable new benefits. Most of these features were first seen on golfing apparel and other high performance outdoor sports apparel. Some of the first of these new technologies to make it to our market have been recently introduced by companies such as Spiewak and Sons, Alanco, Perfection Uniforms, and 511 Tactical. One of the most significant developments is the new high performance polyester fabric. These are not the old polyester fabrics you know. Polyester uniforms have always been hot and sweaty permanent press sauna suits. Not these new polyester fabrics, the new generation synthetics often have wicking properties and are now much more breathable.
 
Spiewak recently introduced their leading edge SPDU, Spiewak Performance Duty Uniforms. These advanced technology uniforms have over 30 advanced features. They are manufactured from new performance polyester material, which has mechanical stretch properties. It also features a nanotechnology coating, which makes these unusually comfortable uniforms virtually impervious to stains and highly fluid resistant. I watched the company president pour a cup of coffee on the of the SPDU white shirts, move it around, let it sit for 10 minutes, and then blot it completely away without a sign of it having been there. Of all the new synthetic fabrics, this stuff is by far the most impressive. The only thing I don’t like about it is the law enforcement style, which to be fair is what they are intended for. These are pure police uniforms, but with a downright dressy cut and a rich feel to the hand. They brought many new desireable features to market with this exploration of what best in class can be.

Alanco has recently introduced a new 24-7 line of performance uniforms with the Truspec brand label. They’re new 24-7 Series brand 60% cotton, 40% performance polyester polo shirt is breathable and wicks moisture away. These new performance polyester fabrics have amazing comfort compared to fabrics of the past. I tested a white one, and found it one of the most comfortable shirts I’ve ever worn. The material has a incredibly rich, natural feel and amazing breathability. I sent it to the laundry to wash on the hot cycle and it come back fitting exactly the same. The collar stayed crisp and it looked almost like it had been pressed, despite having only been folded and not hung. 
 
Perfection Uniforms also has a new Eclipse Series performance polyester polo shirt. This shirt also introduces a whole new uniform look. The styling details do not share one design line with police apparel. I think this shirt represents an important styling breakthrough in EMS apparel. The shirt features epaulets more like a race car drivers suits than a police shirt. The pockets, pen holder, microphone clip and all the subtle styling details subliminally create an official professional uniform appearance that is markedly different than a cop. I think looking good but different could help keep EMS professionals alive. The material is the latest 100% polyester performance fabric. The heavier weight of the material gives the Eclipse Polo a real rugged and long wearing feel. Like other modern fabrics of this type, the shirt is much more comfortable and wicks perspiration away from your skin so it can more easily evaporate it to keep you cool. They are have some great new EMS pants.

Several manufacturers have introduced new EMS trousers, like the new pants from Perfection Uniforms and 5-11 Tactical. They share some specific features growing in popularity with the growing American waistline. One is an expanding elasticized waistband. Some others are a generous thigh cut, reinforced crotch and double hook clasps to help make them more comfortable and stay secure. What is new in EMS pants is that they are being made for much bigger Medics. But the really big news in uniforms is the fabrics.
 
These new high performance polyester fabrics promise to keep us cleaner, drier, and much more comfortable while doing a difficult and physically demanding job. Some like the style of the new Perfection Eclipse, even hold the promise of helping to make us safer. These are the features and garment technologies that are likely to drive EMS market demand in the very near future. I predict that the next big trend will be incorporating high-visibility compliance in a performance polyester blend fabric polo shirt.

Medtronic said it would reduce its workforce by 1,100 positions on March 3^rd, 2008. A company spokeswoman said, "Yesterday's announcement does not impact Physio-Control employees." Medtronic took the reigns when it merged with Physio-Control in 1998. The Physio-Control brand name is one of the best-recognized names in the EMS product Industry. Founded in 1955, it is also one of Redmond Washington’s largest employers. Most of the very first portable defibrillators widely used in EMS were developed and manufactured by Physio-Control. But today times must be tough at Physio-Control.

Physio-Control’s parent company Medtronic, Inc. and their two top executives signed a consent decree of permanent injunction related to Automatic External Defibrillators (AEDs) manufactured by Physio-Control, Inc. on April 30^th, 2008. The consent decree prohibits the manufacture, distribution, and export of specified AEDs at or from Physio-Control's facility in Redmond, Wash., until the devices and facilities have been shown to be in compliance with the Food and Drug Administration's (FDA) current Good Manufacturing Practice (cGMP) requirements, as set forth in the Quality System regulation for devices.

My first defibrillator as a new Paramedic was the reliable but heavy Lifepak 4. Once it flew out of the unlatched door of my moving ambulance. When we pulled over to pick it up and checked it out, it still worked fine. Physio-Control durability became the standard by which other EMS products were judged. They also produced the first truly portable EMS defibrillator/cardiac monitor, the Lifepak 5. Tens of thousands of these rugged little devices were sold. In some cases, they gave decades of reliable life-saving performance. Physio-Control then set another new standard with the first integrated 12-lead capable portable cardiac monitor/defibrillator, the Lifepak 12. With each new accomplishment, Physio-Control successfully partnered with EMS clinicians to meet our rapidly evolving product needs.

When Physio-Control Inc. suspended shipments of its LIFEPAK defibrillators in January 2007; the company cited vague issues with its quality-control systems (read that story here). A few weeks later, it eliminated 300 jobs, or about 30 percent of its work force. The FDA's recent injunction against Medtronic and Physio-Control cites 11 violations, reported by FDA inspectors during a 2006 visit. Previous FDA inspections in 2000, 2003 and 2005 showed similar violations. FDA issued warning letters after the 2000 and 2005 inspections, citing the cGMP violations (Read the injunction here).

Medtronic said a year ago that it would spin off Physio-Control into an independent public company by October 2007. However, those plans were put on hold when manufacturing process problems were reported in January. In recent filings with the Securities and Exchange Commission, Medtronic reported that it still plans to pursue the spin-off. Over the six-month period that ended Oct. 26, Physio-Control operated at a $30 million loss before interest and income taxes. They will report financial results for the fourth quarter and fiscal year, which ended April 25, 2008, on Tuesday, May 20, 2008. It is unclear exactly how long it will take Physio-Control to comply with the injunction agreement, at which point it will again be able to sell its defibrillators. However, if Physio-Control does not comply with the agreement it will have to pay a fine of $15,000 per day, in addition to $15,000 per day for each violation.

The company continues to support EMS customers without interruption. Physio-Control has been paying the sales, service, customer care, and all mission-critical staff salaries required to maintain a strong supporting presence in the EMS market. The brand was built on service, and this commitment has been maintained despite recent challenges. Many in our industry are closely watching this evolving situation with growing concern. Only this last weekend, I saw a law firm advertising on television for clients in a class action suit against Medtronic for alleged faulty internal defibrillators. Medtronic Physio-Control has been a vital partner to EMS for over 30 years, and recent news highlights the growing risk to this longstanding relationship. 

We were also very favorably impressed with the Safety Site. We were able to break it with our throw test, but only the replaceable lens. It continued to operate and we found that it performed remarkably well.  It did not appear likely to survive being run over. We were impressed with the light intensity and long-range visibility.  It features a high performance light reflector that permits visibility at over 2 miles.

The Safety Site has the brightest bulb, a Super Bright Luxeon made by Whelen, a leader in emergency lighting. Over the last 2 years they have had only 10 returned, most after having been run over by drunk drivers. A case can be made that if the flare is brighter, it should get hit less often. It also offers the best battery life of one hundred hours.

Turboflare was perhaps the first electronic flare and is physically the largest. But it was not as bright or visible as either the Safety Site or Powerflare.  They offer a wide variety of accessories like flags, triangles, and cones to help make it more conspicuous. When we threw it against the wall, it switched off but came right back on. When we ran over it, we broke the legs off. The Turboflare comes in two versions, Yellow for pedestrian use and Orange for commercial or industrial use.  The difference is the battery life and durability. The orange one can take more abuse and has a battery life of 30-hours. It offers a fair balance of performance and durability.

We believe the Safety Site and Powerflare offer the best combination of price, performance, and durability. AllMed will offer both options for our customers’ consideration when choosing a safer alternative to burning road flares. We will offer both the brightest flare, and the most durable flare.

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 in 5 different sizes.

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.