Paramedic Blog

The Ultimate Tactical Intubation System

Wed, 23 Jul 2008 08:08:20 GMT

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.

Defibrillator User Survey

Fri, 18 Jul 2008 19:37:13 GMT

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:

Describes “…the nature and immediacy…” of your need, and
Certifying that you “…have previously standardized on Physio Control defibrillators…” and
“…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.

What's New in EMS Uniforms

Sat, 21 Jun 2008 10:36:01 GMT

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.

We have recently seen some innovative hi-viz shirt styles at Ergodyne and Occunomix. But the real hot idea if you ask me is great looking high-visibility polo’s made in high-performance fabrics, like those from the Australian company Originality Uniforms. These attractive color-blocked designs give a hint of what could and should be done next. While not manufactured to ANSI Standards 107, these shirts easily could be. Now if we could only combine the modern high visibility patterns of the Originality shirts, with the styling details of the Perfection shirts, in the fabric of the Truspec shirts - now that would really be something special.

For more on what’s new in EMS apparel, check out the latest EMS1.com article on the subject. There is more valuable information on Uniforms Magazine, and the Fashion Incubator.

Hard Times at Physio-Control

Mon, 02 Jun 2008 14:00:44 GMT

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.

Battery-Operated Road Flares

Tue, 20 May 2008 13:33:52 GMT

We recently evaluated several different electronic battery-operated road flares. All them offer a much safer alternative to burning road flares, that is also reusable. The State of California recently outlawed the use of burning road flares for good reason. They needlessly cause fires and expensive roadway damage. Modern LED technology now can provide us with battery-operated flares that are both highly visible and very durable. What follows is a comparison of three different flares we evaluated. Thanks to David Dunham who did all the great work on this project!

The Powerflare is the most durably constructed of the battery-operated flares we tested. It has a case that will stand up to almost anything. We threw it against a cement wall, and ran over it with both a car and a fire truck. It did not break or fail to operate. It works very well at night and has two different light pulse settings. It lights up a traffic cone well when put underneath it, or when placed on the top. It uses a CR123 battery with a 20-hour battery life. The Powerflare offers unmatched durability but is not as visible as the Safety Site.

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.

AllMed Vendor Fair 2008

Tue, 08 Apr 2008 13:19:38 GMT

We held our annual meeting and trade show last weekend. The event was at beautiful Tan-Tar-A Resort, on the Lake of the Ozarks. We had over 30 vendors showing all of their latest products. We also get a chance to see some future innovations in this private venue. We literally shut the company down for the day, so everyone could see all the exhibits. Then we put on a great dinner and danced to Cold Blue until we couldn't walk.

EMS Today 2008

Thu, 03 Apr 2008 20:40:02 GMT

We introduced the Trulite Disposable LED Laryngoscope from Truphatek at EMS Today in Baltimore last week. ALS providers commented that the quality and performance easily justified the price. Several agencies thought it would be a more easily carried "first in" laryngoscope. Some pointed out it's potential to impact quality assurance in a positive way.

We also launched our new AllMed Rescue Gloves; our new ANSI certified Hi-Viz Rescue Vest, and fielded lots of questions about our prototype Ultra-X Class E Pants.

EMS Today has long been known as one of two annual events that are attended by EMS Professionals from around the world. One big reason why is because this is the place to see the latest EMS Product innovations. It provides attendees a unique peek into tomorrow’s technology today. It was a great show this year, with attendance up and more time to see the exhibits. Stay tuned to EMS1.com, for more details on some of the exciting new EMS products I found at EMS Today!

For me the highlight of the event was when Walt A. Stoy, PhD, EMT-P, CCEMTP and Baxter Larmon, PhD, MICP came over and modeled our latest AllMed Safety Apparel designs. Both are pictured here wearing our AVC Helmet. Walt is wearing the new Hi-Viz Rescue Vest while Baxter shows his style in an Ultra-X Coat.

A bunch of Medics from Iceland showed up and I could not resist getting my picture taken with them. In many parts of the world, good looking and functional high visibility gear are commonplace. It was the only time during the show that I blended into a crowd.

New Disposable LED Laryngoscope

Sat, 22 Mar 2008 10:47:13 GMT

We are going to soon get a very impressive new disposable laryngoscope. It's called TruLite™, manufactured by Truphatek® in Israel. Truphatek® has long been the manufacturer of most Rusch® brand laryngoscopes. They have made some of the finest EMS airway products of the last 20 years. The Rusch Lite™ Blades, Rusch GreenLite™, FOCS™ Snap-Light™ Blades, and even the Viewmax blades now followed by the Rusch Truview ™ EVO, are all Truphatek® products.

I got a first look at the TruLite™ novel system back at last November EMS Expo. It will be the first product to carry the Truphatek® brand name in the USA, and AllMed will be it’s first EMS Distributor.

TruLite™ is a very different approach to laryngoscopy. Each stainless steel blade is permanently attached to it's own handle. At first this sort of threw me, but I believe it could solve some tough problems. What happens if your laryngoscope handle or blade doesn't work? Well, then it could be valuable to have a totally independent back-up system.

And then there is also the astonishing performance of the system. This is the brightest light of any scope I've ever seen. The LED illumination is simply stunning. It gives a very slight bluish white color that is within the spectrum now recognized as ideal for enhancing the viewing of tissues and for providing best conditions for intubation.

The beautifully finished steel blade has a real forged lip, it's not just a stamped out blade. The compact lightweight handle holds two AA batteries. The whole thing is surprisingly small and light, weighs just 120gram(0.27lb) inclusive of the two AA batteries. It replaces a typical full intubation system? Maybe not, and at $15.95 list some may see it at as too expensive. But I can see some unique applications and advantages.

It is the perfect system for a Tactical Medic or Military Medic. Put a TruLite™ and a Swiftgrip™ in a thigh pocket holster and you are good to go. Frankly, with a Miller #2 and Mac #4, what else do I really need? Maybe I could just leave the big tube kit in the truck, since this combination in my first-in bag would give me both range and redundancy. It might also be a real hit with training institutions. Each student could get intimately familiar with his or her own training scope. For any duty where space and weight issues rule it would have real advantages, such as for Wilderness and Mountain Rescue Teams and Urban Search & Rescue.

The first three sizes will be the Mac #2, #3, and #4 and each size has a color-coded sleeve. We expect the Miller #1, #2, and #3 by late Spring. These curved blades are E-Macs, not American Macs. They are flatter with a lower profile, and greatly reduced flange. They are far more versatile than the Mac you know. Basically, you insert them into the posterior pharynx to use it just like a straight blade or if you are an OR trained Mac guy, just follow the tongue and you will wind up in the valecula. Either way, this one blade can do it all. I’m going to be showing them for the first time at EMS Today next week.

The reality is most clinicians use only one blade size/style on >90% of their intubations. Why carry around a whole lot more?

New ANSI Certified Rescue Vest

Fri, 21 Mar 2008 15:22:13 GMT

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.

Federal Worker Visibility Rule Deadline Approaches

Sat, 16 Feb 2008 11:50:59 GMT

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 small, shorter length vest design. tear-away features are optional for both 107 and 207 vests. These are vests which are 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 2 107 Vest.

If anybody wants a Powerpoint on this new standard, send an e-mail request to phillydan@hotmail.com, & I'll reply with a copy.

Rescue Gloves

Thu, 03 Jan 2008 16:00:47 GMT

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.

A Warm Blanket and Smile

Fri, 07 Dec 2007 16:05:33 GMT

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.

Hartwell CombiCarrier II

Wed, 14 Nov 2007 17:40:01 GMT

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.

New Pediatric Transport Seat

Mon, 01 Oct 2007 19:19:53 GMT

How much does it matter how advanced our clinical skills, if we can’t safely transport a sick child to the hospital? The new Safeguard Transport is a simple restraint system for safely transporting sick children on any brand of ambulance stretcher.

This device is only intended for use on your stretcher. Think of it as a car seat adapter to make your stretcher a specialized pediatric transport platform. No it is not for other purposes; it cannot be used a spine board and cannot be used as a regular car seat. But for what it is intended, it's simply outstanding. The quality of construction and design is evident with every detail.

The Transport can be used on kids from 22 to 100 pounds. It articulates with the head-end of the stretcher. It's fast to attach to your stretcher with just two simple clip straps. It's also very easy to put on the child, with a single take-up for strap positioning convenience.
Maybe most importantly, it is very intuitive. Sometimes pediatric equipment can be difficult to use, we use it so infrequently. I'm confident an average Joe could put this thing on right, even never having seen it before.

The Safeguard Transport is very strong, and rigorously tested. This company does all their own testing in house. They also design and manufacture many other different types of automotive restraint systems, so they have considerable experience. The have a video online that demonstrate the performance of the Safeguard Transport in an accident. They also have one that shows exactly what happens to a child when transported on the stretcher alone.

Nothing I’ve seen before for this purpose, matches the elegant simplicity of the Safeguard Transport. I predict half the ambulances in America will have one in 3 years.

Don't Be a Hero

Sat, 22 Sep 2007 12:55:32 GMT

It’s the craziest coincidence. For some reason I’ve been thinking lately about my experiences during the Plaza Flood in Kansas City. I Googled it, and found out to my surprise that it happened exactly 30 years ago.

September 12^th, 1977 it rained like the sky was a giant fire hose. I was on duty downtown, with a nice little card game getting started. We really liked bad weather since it tends to keep people inside out of harms way. Back then we ran all the emergencies, transfers, and even picked up the deceased for the local funeral homes. Anything that could get us a respite was welcome. It didn’t seem fair when the tones dropped. We backed out the downstairs garage in our trusty Cadillac to discover ourselves in a small river. My partner driving floored it, and a wave came over the hood. Astonishingly, we came up out of the water with the engine still running. A bit rattled we headed out to the call.

As we went in toting our now antique gear, water was everywhere. We came in to see an enormous lady, soaking wet and in full arrest. We got down to business, and I got the tube, line, and hooked her up to find fine V-fib. I got ready and called clear to shock and my partner Bob asked if I could wait a sec. Then he went out on the porch.

That gave me my first clue I was in trouble. Bob had real good horse sense. I most always followed his lead, but I was in my code groove. So I carefully wiped my feet on my pants legs, got up on tiptoes and hit the button on the Lifepak 4. A blue flame went across her massive chest. I almost wet my pants. Another round of drugs, and I try to decide about shocking again. Then we learn she was found out on the porch this way at least 15-20 minutes ago, and pulled inside. Bob peeks his head in the door and asks, “Uh, you aren’t going to push that red button anymore are you”? "No", I respond sheepishly, realizing I had just gotten real stupid and lucked out. He cautiously entered and then we wrapped up to go.

Twenty-five people died in the flood, some trying to get their cars out of underground parking garages. I wasn't the only person that had a bad case of stupid that night.

The moral of the story is don’t try too too hard to be a hero, it’s dangerous and rarely makes a difference in the outcome.

My New Boots

Wed, 05 Sep 2007 19:25:16 GMT

I got a new pair of boots today. It’s my fourth pair of Redbacks, but by far the nicest. I first tried their famous slip-on Station Boot. It was so incredibly durable and comfortable. The soles looked nearly new, after two years of constant wear. You can move your toes around, and stand or walk for hours pain-free. Just don't try climbing in them when they are wet, when the slip-on convenience gets real inconvenient. Once in desperation at a trade show when my feet were killing me, I slipped on the boots and my feet quit hurting. So next I bought two pairs of casual dress Redbacks, and was once again delighted.

My new Redback Rescue boots are simply the best boot I’ve ever worn, and I’m kind of a shoe snob. They are built like a tank with triple stitched full-leather uppers, full leather lined, center zip, and even ANSI steel toes. My initial impression early this morning was, "If the sky falls today I'll have the right boots on". By the end of the first day, they felt like old friends on my feet and ready to go anywhere.

Both my father and grandfather were funny about shoes. They both lined up all their favorites along one side of their bed, as do I. Nothing cheap, everything built to be re-soled until you die. I am much the same way. Until recently I wore only Alden and Johnson Murphy dress shoes, and Redwing Boots. But Redwings aren’t what they once were, having given in to the market pressures to import and sell cheap.

Redbacks are not built to sell cheap. They are manufactured in Australia, of the thickest and most durable leathers I’ve ever seen. The soles and mid-soles are high-tech composites, and they don’t start breaking down before you get them broke in. They are also extremely waterproof; you basically have to fully immerse them to get your feet wet. I admit they spoiled me with comfort. No other shoe or boot even comes close. I will surely be wearing Redbacks as long as they keep making them. Yes, there are a few other great boots on the market including Danner and Haix. Yes, there are plenty of cheaper boots available too. But best in class is always worth a little extra money, at least to me.

Amazing Courage

Thu, 16 Aug 2007 22:11:09 GMT

I saw a well-known local Paramedic last week at a conference. He has been a Paramedic and EMS Instructor Coordinator for over 30 years. He is widely respected as a leader in EMS and about to retire. When I say Hello he has to turn his whole body to answer, because his neck won’t move. Worse, he walks around bent way over, all the time. I don’t know why and I’m not comfortable asking. But every time I see him I wonder how it must hurt, and Thank God for my good health.

He has two sons currently serving in Iraq. At the EMS Conference he simply stunned me when he shared that he had just gotten back from Afghanistan. He did a tour of duty for the State Department as a Medic, serving up EMS for American and Afghani Police. He was driving down booby-trapped roads with little or no military support, treating the injured under wartime conditions. This guy is probably 56 years old and can’t even walk around standing up! He found a way to go serve without a Medical, and then did it.

Is a hero a guy doing his job, when the sky falls on him? Or is a real hero a guy like this, that knows the risks and does it anyway? I wish I could have said something intelligent. I was struck speechless as I listened to his tales. I still can’t wrap my mind around a disabled guy, older than me, running around dodging bullets. Both of his sons lives are on the line so what does he do? He volunteers to risk his life to equal their contributions. These are the actions of one amazing American.

AllMed AVC Helmet

Thu, 02 Aug 2007 13:37:08 GMT

Ambulance Vehicle Crew Helmet

Field professionals from around the country provided lots of ideas for how we could make the AVC Helmet better, and we listened. The latest AllMed AVC Helmet is now available in four different shell sizes. The benefit of more sizes is a better fit, and a very compact profile. Built to the DOT FMVSS 218 Standard, the AllMed AVC Helmet is designed to protect the wearer in a mobile medical, motor-vehicle work environment. The DOT standard is endorsed by the Consumer Product Safety Commission for all “Wheeled, Large Motor” vehicle activities*. It’s the only CPSC endorsed standard for this application that permits access to the ears, vital for diagnostics and communications.

Our AVC Helmet shell is a high-pressure ballistic Kevlar and aerospace Carbon Fiber composite. Having exactly the right amount of resin versus fiber controls laminate structure. With a typical wet lay-up hand laminated helmet, the best resin versus fiber volume is 50%. By injecting the resin under high pressure, we achieve a 40% resin to 60% fiber ratio that is optimum for helmet shells. But that is not where the expanded list of new features ends;

1. New exclusive Gel-Coat chromed carbon fiber finish resists scratches much better than a painted shell.

2. New steel quick-release buckle, several times the strength of a plastic buckle.

3. New Star of Life die cut crown pad, with a Reflective Star of Life front decal.

4. New detachable sweatband can be easily removed and cleaned. Plus, with each AVC Helmet you get two additional thickness sweatbands for a near custom fit.

5. New polycarbonate visor with a very compact ratchet mechanism. The new visor offers smooth, one-handed operation. It's also truly field replaceable.

6. New high impact vinyl edge guard offers extra protection if the helmet is dropped.

7. New impervious “wipe-down”, patent-pending expanded polyurethane impact liner makes it easy to keep clean.

8. New optional TX-1 LED Helmet Light. The light is safely breakaway mounted, and it swivels. It is heat resistant and waterproof, and features 3 super-white LED’s.

The AllMed AVC Helmet has all the features Medics love including;

§ Easy access to the ears, for use of stethoscope and communications equipment

§ “Blackout” Reflective trim for a professional look and 360° enhanced visibility

§ It’s still the thinnest DOT compliant EMS Crew helmet on the market

Most other so-called EMS helmets are simply ANSI compliant safety helmets. They are not designed for use where you work, in a moving motor vehicle. The new AllMed AVC Helmet offers EMS providers a true EMS Helmet, designed for use in a mobile medical work environment.

*http://www.cpsc.gov/cpscpub/pubs/349.pdf

Our AVC™ Helmets are designed to be a snug fit and are very form fitting. It is crucial to for a good fit that you take the time to measure your head carefully. Face straight forward, and have someone else measure the circumference of your head. Measure ½” above the ears. Our AVC™ Helmet comes in 4 different sizes. Each helmet is supplied with three different thickness sweatbands.

SMALL fits 21”- 22”

MEDIUM fits 22 1/8” – 23”

LARGE fits 23 1/8” – 24”

X-LARGE fits 24 1/8” – 25”

More Here Ambulance Vehicle Crew Helmet

AllMed Ultra X EMS Coat

Wed, 01 Aug 2007 20:56:25 GMT

The world’s first armored all-season EMS Coat.

The new AllMed^® Ultra-X Coat is a 500-denier nylon all-season EMS Coat, with removable EVA foam protective pads in the elbows and shoulders. The shoulder pads make carrying a heavy defibrillator on a shoulder strap more comfortable. Combining the technical features EMS professionals asked for, the AllMed^® Ultra-X Coat is innovative, rugged, and great looking. Constructed of the same type materials as most Trauma Bags, it can handle extreme conditions. It’s built to take all the abuse you can throw at it.

It has a removable; heavy-duty fully quilted 200gm-insulated liner that zips out of the torso and sleeves separately. The outside shell is fully lined and the sleeves are also removable. The new AllMed^® Ultra-X is perhaps the most versatile EMS duty coat ever made.

Wear it as a fully insulated winter coat,
Remove the sleeve insulation only (or armor pads) for enhanced mobility,
Remove the sleeves and wear it as an insulated vest,
Remove the insulation and wear as non-insulated vest,
Or even as a non-insulated jacket.

The AllMed^® Ultra-X Coat is built to perform under the most adverse conditions. It’s not just a modified Police or Firefighter Coat. It was designed to the demanding expectations of real EMS Professionals.

Additional features include a cell phone pocket, fleece lined collar and hand-warmer pockets, hook & loop badge and patch holders, microphone clip, extra wide elastic waistband, and snap wrist cuffs. The Ultra-X also offers an unprecedented value, priced where high-volume municipal agencies, private ambulances or even individuals can afford to buy it.

The AllMed^® Ultra-X Coat is available in fluorescent Yellow with Blue Trim, or fluorescent Yellow with Red trim, in sizes S, M, L, XL, XXL, XXXL, XXXXL

Note: We have added a 5X and 6X size, expected to arrive the first week of December 07.

The Ultra-X is certified ANSI 107-2004 as both Class II Coat and Class I Safety Vest

Better Safety Standards in EMS

Tue, 31 Jul 2007 13:30:31 GMT

I think we need to establish a new standards group for introducing safety standards into the EMS field. The existing standards groups have a limited understanding about safety issues in EMS. I don't believe that NFPA has developed useful standards that have brought much value to EMS providers.

I’ve been working for about a year on a new EMS Coat. I got tired of over-priced, over-engineered raincoats that don’t hold up. They offer little resistance to abrasion, tears, punctures, and no impact protection at all. That’s why we went a totally different direction. I looked back at the things that have happened to me during my 30 years of EMS. Then I designed a new coat that could take this kind of abuse. After I got the first prototype, we took it to EMS providers and listened to what they did and did not like about it. We took their ideas, and then made the changes people wanted.

We need a high-visibility coat that has protective armor padding, and is very resistant to tears and abrasion. We need a garment that will hold up crawling around in the muck and mire of real ambulance calls. So that’s what I did, basically crossing a Trauma Bag with a Motocross Armored Jacket. More on that project very soon. But what standards should we design the coats performance around? Should we pay thousands that gets passed on to customers, to comply with various standards including some that don't make any sense?

For years now we have been buying coats to meet standards that provide no real protective value to the wearer. For example, the ridiculous NFPA blood borne pathogen standard. Can anybody cite me even one actual case of a Medic or EMT that ever caught a communicable disease transmitted by blood that went through a coat? Can anybody give me even one piece of scientific data that shows this NFPA standard has reduced any actual risks? I seriously doubt it, but eagerly await hearing about it. What this standard did do is nearly double the price of a decent EMS coat. Now they cost around 250$, a pretty steep price for a 10$ an hour EMT to pay.

Does anybody really think it's worth another hundred bucks per coat to certify that it reduces a non-existent risk?