PAX Centurion - Spring 2019

Page 28 • PAX CENTURION • Spring 2019 617-989-BPPA (2772) is the cause of 78 percent of the compensation paid for lost productivity” (White). One of the innovations that is aimed to reduce some of these injuries is power stretcher technologies. This allows for lowering and raising of patients utilizing hydraulics rather than brute force, potentially reducing the chance for back injuries. While powers stretchers alone aren’t the answers to all of our patient extrication issues they certainly are a step (accompanied by an audible crack in your lower back and pain shooting down both legs) in the right direction. Prehospital Ultrasound is an emerging technology that is making its way into the prehospital setting. This device, once only available in the Emergency Department, is now being deployed to ground and flight EMS units to guide patient care. This treatment modality can be used to guide or assist with lifesaving interventions being done in the field by prehospital providers. It can provide valuable information and shave time off of definitive care by addressing the needs of the patient before the ambulance arrives at the hospital. This innovation has the ability to improve patient outcomes and reduce mortality. Could this device prove useful in a busy urban EMS system such as Boston? Video Laryngoscopy has provided prehospital providers with another valuable tool at their disposal. While many veteran providers may have a few choice words to say about this new technology, it does serve a purpose and can aid in difficult intubation scenarios. While providers should be competent in standard laryngoscopy (placing a metal/plastic blade into the mouth of a patient to view vocal cords and pass a breathing tube through) , video does serve a purpose. Being able to view the airway anatomy of a patient that may be obstructed by blood, trauma, vomit or a host of other factors may be the difference between life and death. These devices prove useful in confined spaces or difficult patient access that prehospital providers are often faced with. Video scopes allow others to see what the practitioner is seeing simply by looking at a screen smaller than a cell phone. This screen can allow a large audience to view the airway of a patient that at one time only the practitioner performing the skill could see. The ability to provide high definition views of a difficult airway to multiple sets of eyes is (Photo: ems1.com/Greg Frieses) (Photo: Scott Weingart/EMC Project) ( Photo:Trumbulltimes.com ) (Photo: Stryker.com) an innovation that has greatly impacted the care our patients receive in the streets of Boston. Cardiac arrests are some of the most labor-intensive medical calls we can be faced with; from arriving at the patient, moving the patient to an area spacious enough for all hands to work and the actual performance of CPR. Our agencies often work very well together to provide the best care to these patients but we often take “one step forward and two steps back” when it comes to these patients during extrication and transport. The LUCAS device is a battery powered CPR device that solves a multitude of problems commonly encountered during out-of- hospital cardiac arrests. It addresses a simple issue: human fatigue. With some resuscitations lasting upwards of an hour in the prehospital setting, continuous CPR for long durations is laborious. When providers become fatigued during long periods of CPR, the quality of compressions decreases along with the patient’s chance for survival with a good neurological outcome. LUCAS allows providers that would once be performing CPR to complete other tasks such as: seeking information about the events leading up to the cardiac arrest from family/bystanders, gathering medications and past medical history potentially providing a cause for the cardiac arrest, placing advanced airway management, establishing IV/IO access, administering cardiac medications and clearing a path to extricate the patient. This device allows for UNINTERRUPTED chest compressions during extrication and patient transport. These are critical times and ones that are usually the most difficult for responders to deliver effective compressions. This device reduces the chance for injuries to EMS providers who are forced to stand in the back of a moving ambulance to provide CPR enroute to the hospital. Studies have proven that compressions provided in the back of a moving ambulance are subpar in quality. With one provider managing the airway enroute to the hospital, the other provider is left with balancing chest compressions and administering cardiac medications. The LUCAS device could free up hands that would once be providing inadequate chest compressions to provide life- saving medications. Numerous studies have proven this device to reduce injury, provide continuos high-quality chest compressions and increase the number of neurologically-intact cardiac arrest survivors. Could this device provide better patient care to residents and visitors to our city? Not all new innovations to hit the streets have been in the form of a fancy new electronic gadget. Some innovative medications and protocols have been developed due to large scale studies and trials. New medications once only seen in the hospitals or on the battlefield have begun to make an appearance in the drug box of EMS providers. These new medications have allowed for better prehospital care and reduced the delay in which patients receive it. Continued knowledge-sharing and large scale trials are providing innovative ways for patients to receive better care. TranexamicAcid (TXA) was originally designed by Japanese Researchers Shosuke and Utako Okomoto in the 1960’s. “It was first Responding to change… From EMS Change on page 26