Still, a great many others believe that the world will undergo a drastic change late this year, either through a great spiritual transformation or an apocalyptic cataclysm. And if you don't have a plan in place, you're either going to die when the comet hits or be one of the unlucky survivors left eating feral housecats and picking through the rubble.

People engage in all sorts of risky behavior when they believe the end is near. They go skydiving. They go Rocky Mountain climbing. They go 2.7 seconds on a bull named Fu Manchu.

They tell their supervisors what they really think of them.

So it got me to thinking: If we knew this were the last EMS Week ever, how would we promote EMS if political correctness and long-term consequences weren't a concern" Here are my top 10 suggestions. Chime in with your own in the comments, but adopt them at your own risk… just in case the Mayans were wrong.

Hold a mass oxygen therapy seminar for nursing home nurses. It works just like a mass CPR training event but is much simpler. Divide your nurses into teams of two, and issue each team a soft, fluffy pillow. Have team members take turns holding the pillow over their partners' faces while paramedics with megaphones roam the crowd, barking, "This is what it feels like to your hypoxic patients when you administer oxygen via face mask at two liters per minute!"

Sponsor an EMS cultural exchange program between your communications center and the local cable company. Think of the possibilities here: Not only could cable subscribers get an installer dispatched right now and have EMS to thank for it, but certain 911 callers could be told, "You have an infected toenail" And it's been bothering you for a month" We'll have the paramedics right out to you, ma'am… a week from Tuesday between the hours of 11:00 am and 6:00 pm."

Sponsor free health screenings for all your system abusers. Check their blood pressure, blood glucose and cholesterol. Set up referrals for substance abuse, psychiatric counseling and homeless shelters. And most important, issue cards that contain all that information... and are also fitted with RFID tags that broadcast their location at all times. "Dispatch to Rescue 7, we have a man down call at the corner of Park and 7th Avenue, with multiple callers reporting. Also, be advised that Benny's chip has been broadcasting from that location for the past 15 minutes, and we tracked him from the liquor store on Park and 9th."

Partner with Home Depot and your local homeowners associations in sponsoring a "Find Your House at Night" seminar. Put all attendees in a darkened room. Then, without warning, play a recording of an ambulance siren at ear-splitting volume, and disorient them with the blinding glare of a million-candlepower spotlight. Then, turn on the lights and thank them all for coming. Tell them you'll be taking your show on the road to each of their neighborhoods in the coming months… unless they'd like to use the discount coupons so generously provided by their sponsors to purchase reflective numbers for their houses and curbs.

Partner with a NASCAR team to promote your new "pit crew CPR" protocols. Get the pit crew to show you how to lift an obese patient onto a spine board with a floor jack and fit an EZ-IO adapter onto an air wrench. Solicit sponsorship from equipment and supply vendors, and charge laypeople for "pit passes" to watch you practice megacode scenarios at your next ACLS class. Fastest megacode with the least amount of hands-off time wins the 2012 Physio Control Resuscitation Cup.

Hold a bystander training seminar. We all know that bystanders can be either a blessing or a curse, depending on how helpful they are. Well, here's our chance to train them up the right way. Suggested topics:

• Status Dramaticus: We Can Tell Your Loved One Is Faking a Seizure, and Now You Can, Too!
• Time Compression and 911: No, You Didn't Call 20 Minutes Ago
• Extrication 101: If You're Going to Pull the Victim from the Car before We Arrive, at Least Bring Him to the Side of the Road so We Don't Get Our Boots Muddy
• Cold Water and Junkies: It Just Results in Hypothermic Junkies
• The Paramedic Mosey: Waving Frantically and Shouting "Hurry Up!" Just Makes Us Walk Slower

Hold a cookout for staff from the local emergency departments. Serve and seat your favorite triage nurses immediately. For your, umm… "less-favored" triage nurses, tell them you're too busy to seat them right away and to just find an empty spot along the wall until you can get to them. When they point out that there are plenty of empty tables in plain sight, pretend you didn't hear them, or haughtily inform them that those tables are reserved for trauma nurses. Or telemetry nurses. Or obstetrical nurses. Any excuse will do.

"Bring Your Medical Director to Work" Day. I know many of us have never met that vague and mysterious figure who writes those absurdly restrictive protocols. Here's your chance to get to know him or her and show off your capabilities. So bring your medical director down to the station. Give a tour of the communications center. Invite him or her for a meal with the crews. Then go for a ride in one of the rigs… with your medical director strapped to a spine board and driving Code 3 down the roughest streets in your district. And if he or she complains that it's too painful, say that you're only allowed to give him 2 mg of morphine every 15 minutes, and even then only after obtaining permission from medical control at the receiving hospital. After all, it's protocol.

Goodbye, lights and sirens; hello, water-cooled machine guns and snowplow bumpers! Sure, it's a little harsh, but think of the educational and deterrent potential! When you get that guy in the Prius in front of you, pressing a cell phone to his ear and staring at you in the rearview mirror like a duck in thunder, just put a short burst into his gas tank and push him off the road. After driving past a few smoking hulks in the ditch, other drivers will learn to slow down and pull to the right. It'll be smooth sailing for every ambulance on the road right up until December 21, baby! And the best part is the apocalypse will probably happen before any of the lawsuits ever get to court!

Hold a picnic for your supervisors… in the parking lot of the local 7-11. Feed them bitter gas station coffee and frozen burritos, and right before they start to eat, announce that the picnic has been moved to the parking lot of another 7-11 ten blocks away. Do this every time they start to take a bite, and be sure to have 7-11 lock all the bathrooms. When they complain, explain that you're only trying to run the most efficient picnic possible, and remind them that plenty of other people want their jobs.

ROANOKE, Va. — A medical transport helicopter had a close call with three military jets Thursday night in Rockbridge County, just north of Lexington.

A pilot and three crew members were on board the Carilion Clinic craft. They were returning after dropping off a patient at Carilion Roanoke Memorial Hospital, according to Carilion spokesman Eric Earnhart.

The incident happened as the helicopter approached its helipad. An alarm sounded, alerting the pilot that an aircraft was within 1,000 feet.
"The pilot and crew scanned the area and saw three military aircraft in the vicinity," Earnhart said. "As a precaution, the pilot took evasive action and the helicopter landed safety."

Carilion reported the incident to the Federal Aviation Administration and the military, Earnhart said.

Medevac helicopters do not typically file flight plans, as they usually fly below radar, said Sherry Wallace, spokeswoman for Roanoke Regional Airport. Still, the helicopter crew routinely calls the Roanoke control tower to make it aware of flights, Wallace said.

It's unclear at what altitude the incident occurred or how fast the aircraft were traveling. Typically, medevac pilots maintain an altitude between 5,000 and 10,000 feet, Earnhart said.

It was not clear Friday which branch of the military was involved, but military jets are known to make training flights in the region.

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All Rights Reserved

BUFFALO, N.Y. — Police say a woman who stole an ambulance at a New York hospital led them on a chase that reached almost 100 mph before she crashed.

Buffalo police tell local media the woman got into the ambulance at the Erie County Medical Center and took off at about 6:30 a.m. Sunday.

They say she was chased by medical center police and narrowly missed pedestrians and other vehicles as she sped through intersections, lost control and hit a parking lot wall.

Authorities say 37-year-old Heather Sullivan, a patient at the hospital, is being held Monday at the Erie County jail. She's facing reckless endangerment, grand larceny, criminal possession of a stolen vehicle and other charges.

Jail officials couldn't be reached to determine if she has a lawyer.

WATERTOWN, N.Y. — Named for a north country Emergency Medical Technician (EMT) who was shot to death in Cape Vincent five years ago, a bill passed by the state Senate Tuesday would increase the penalties for killing a first responder.

Mark's Law passed the Senate 59 to 0. The bill would make killing an emergency responder such as a firefighter or EMT first degree murder.

The law is named for Mark Davis, an EMT who was shot to death while responding to a call in Cape Vincent in 2009.

Christopher Burke of Cape Vincent was sentenced to 16 years in state prison for the crime.

Davis' family was in the Senate chambers Tuesday. The family says the vote is a step in the right direction.

"He would be very honored," said Davis' sister, Maricia Astafan.

"It's a good way to remember him and a way to protect other people and to know this will not be tolerated if this happens again," she said.

Astafan is following in her brother's footsteps by studying to be a paramedic.

She says the law will protect her colleagues in the line of duty.

The one thing you can deal with because it's out there that it's not tolerated to do something to you - you know, EMTs, firefighters and first responders - that they're not going to get away with it," Astafan said.

This bill still needs to pass the state Assembly and be signed by the governor before it becomes law.

Davis' family hopes it won't stop there. They would like to see other states adopt similar laws.

Reprinted with permission of 7 News WWNYTV

Treatment Uses — Relief of moderate to moderately-severe pain. Has been used as an antitussive (cough suppressant: an effect of the hydrocodone component) and is as effective and possibly a more potent antitussive than codeine. Hydrocodone is a centrally acting analgesic used to provide additive pain relief when non-narcotic analgesics are ineffective. Acetaminophen (abbreviated APAP) is a peripherally acting analgesic agent found in many combination products and also available by itself.

APAP is also an antipyretic (fever lowering) agent. This combination product emphasizes a commonly overlooked principal in pain management. While narcotics may offer greater analgesia than non-narcotic agents, combinations of the two nearly always produce better pain control than either agent alone. In EMS systems without access to narcotics, protocols often call for administration of acetaminophen or other non-narcotic analgesic agents to patients with pain. While non-narcotic agents are unlikely to be effective in severe pain, they will always provide additional effectiveness for narcotics given later during the course of patient care. Every algorithm for pain management emphasizes continuation of non-narcotic agents when escalating to stronger (usually narcotic) drugs. Dose strengths of hydrocodone/APAP start with the number of milligrams of hydrocodone and follow with the acetaminophen dose. The most commonly prescribed strength of hydrocodone/APAP is 7.5/500.

Dosing and Administration — For moderate to moderately-severe pain in adults, initial oral dosing is one 7.5/500 tablet of hydrocodone/APAP every four to six hours as needed, not to exceed eight tablets in any 24-hour period. Alternatively, one or two 5/500 tablets can be given every four to six hours as needed, also not to exceed eight tablets over 24 hours. Dose adjustment is based on pain severity and patient response. The limiting factor is the APAP — healthy adults should not ingest more than 4 grams (4,000 milligrams) of acetaminophen per day.

Although not commonly prescribed, there is a liquid preparation of hydrocodone/APAP available in a standard strength of 7.5 milligrams of hydrocodone and 500 milligrams of APAP in each 15 milliliters of elixir. Pediatric dosing using the elixir for children between 2 and 13 years old is 0.27 milliliters per kilogram (weight) given orally every four to six hours as needed up to a maximum of six doses per day. This equates to 0.135 milligrams per kilogram of hydrocodone and 9 milligrams per kilogram of acetaminophen. Children 14 years of age and older can be given an adult equivalent dose of 15 milliliters orally every four to six hours, up to six doses per day. The 15 milliliter dose provides 7.5 milligrams of hydrocodone and 500 milligrams of APAP. It is very important to measure liquid doses exactly. Household teaspoons and tablespoons are not adequate measuring devices. To deliver exact dosages, use a calibrated measuring cup or syringe. There are no published dosing data for children under 2 years old. Similar dosing is recommended for adults and children when used as an antitussive.

Taking hydrocodone/APAP with food decreases the absorption rate of the acetaminophen component although this effect appears most significant when taken with food high in carbohydrates. Many patients find it necessary to take hydrocodone/APAP with food or milk to minimize gastric irritation. For rapid relief of pain, taking on an empty stomach or with food low in carbohydrates would provide fastest absorption.

There are strong suggestions in medical literature that patients with liver dysfunction (hepatic insufficiency) and patients who consume three or more alcoholic drinks per day should lower daily use of acetaminophen. How much less they should take is unclear, although most studies demonstrate harm in the form of liver damage and increased risk of gastrointestinal bleeding to this patient population at daily doses above 2 grams (2,000 milligrams). Therefore wise practitioners limit APAP to 2 grams daily for patients who consume three or more alcoholic drinks per day or have hepatic insufficiency. One of the most startling and compelling studies of APAP dangers came from the Acute Liver Failure Study Group in 2005. Researchers reported APAP poisoning is now the most common cause of acute liver failure requiring liver transplant in the United States. The majority are unintentional poisonings and the drug most often implicated is — you guessed it — hydrocodone/APAP.

Dosage adjustments are not specifically recommended in older patients although caution is warranted in older or debilitated patients because to the central nervous system depressant effects of hydrocodone.

Overdoses of hydrocodone/APAP are potentially lethal polydrug overdoses. Activated charcoal is particularly effective at binding acetaminophen. Hemodialysis is helpful in removing the drug from the body. Consultation with a poison control center should be used to guide patient management. Nalaxone can reverse the respiratory depression and coma associated with narcotic (hydrocodone) overdose. If the acetaminophen dose exceeds 200 milligrams per kilogram or 7 grams total of APAP (whichever is lower), acetylcysteine should be administered promptly. Serum acetaminophen levels obtained four or more hours following ingestion help to predict toxicity, but should not delay initiation of treatment. Clinical and laboratory evidence of liver toxicity may not become apparent until 48 to 72 hours post-ingestion. Of note, significant liver damage is rarely reported with acute overdoses under 10 grams, and fatalities rarely seen with less than 15 grams in healthy adult patients. Significantly smaller overdoses have killed patients with preexisting liver dysfunction.

Pharmacology/Pharmacokinetics/Stability — After oral administration of hydrocodone/APAP, peak concentrations are reached in the bloodstream at 1.3 hours and remain active for 3.8 hours. The liver metabolizes nearly all each hydrocodone/APAP dose, and about 85 percent of the broken down drug components appear in the urine within 24 hours of an oral dose. Small quantities of acetaminophen are excreted in breast milk. however acetaminophen is considered compatible with breastfeeding by the American Academy of Pediatrics. Hydrocodone passage into breastmilk is theoretically expected based on molecular weight. While risks to a nursing infant cannot be ruled out, they are likely small with occasional use by a nursing mother at recommended doses. Monitoring the infant for sedation, changes in feeding patterns, or gastrointestinal symptoms associated with centrally acting narcotic use are recommended. Oddly, and despite being the most commonly prescribed medication in the United States, the exact mechanisms of action for both APAP and hydrocodone remain unknown. APAP is thought to lower fever by acting on the hypothalamic heat regulating center and exert analgesic effects by inhibiting prostaglandin synthesis. Hydrocodone has an action similar to codeine which mostly involves activation of opiate receptors in the central nervous system and smooth muscle.

Hydrocodone/APAP tablets vary considerably in appearance and strengths between manufacturers. They should be stored at room temperature between 59-86 F and protected from light and moisture using a tight, light-resistant container.

Cautions and Warnings — Like any narcotic, physical and psychological dependence can occur with long term use. Particular caution should be directed at keeping this medication away from small children. Hydrocodone/APAP should be used with caution in patients with preexisting kidney or liver disease; kidney and liver function should be monitored regularly. The sedative properties of hydrocodone/APAP make it inadvisable for patients taking this medication to drive or operate heavy machinery. Although uncommon at therapeutic doses, hydrocodone does produce dose-related respiratory depression.

Important Side Effects and Interactions — The most common side effects of hydrocodone/APAP are constipation, nausea and vomiting. Skin rash and itching are also reported, as is urinary retention in males. Lightheadedness and sedation occur in some patients. Patients should be observed for respiratory depression induced by the hydrocodone component of this drug. Confusion and hallucinations have occasionally been reported. Rarely, serious liver and/or kidney damage have occurred in patients taking hydrocodone/APAP, most often in those with preexisting renal or hepatic disease.

Seventy-one drugs are reported to interact with hydrocodone/APAP. Of these, the most significant involve other drugs also known to be liver or kidney toxic. Combinations of these drugs with hydrocodone/APAP are inadvisable. Additionally, drugs with central nervous system depressant effects may produce profound sedation and/or additive respiratory depression when combined with hydrocodone/APAP. These include barbiturates, benzodiazepines, muscle relaxants, and alcohol (ethanol). While the evidence is weak at best, at least three studies have suggested that hydrocodone/APAP may increase plasma concentrations of oral contraceptives (OC’s) while simultaneously decreasing plasma levels of APAP. There have been no significant reports of food-drug interactions with hydrocodone/APAP.

Average Costs — U.S.
5/500 tablet and 7.5/500 tablet (generic)
Patient cost: $ 0.25 and 0.26 each*
Large Hospital cost: $0.04 and 0.05 each
*(Wal Mart® and Target don’t include this med in their $4/month programs)

References:
1. MICROMEDEX® Healthcare Series: Thomson Micromedex, Greenwood Village, Colorado (accessed April, 2008).
2. Albany Medical Center Pharmacy, Albany, New York.
3. Larson AM, Polson J, Fontana RJ, Davern TJ, Lalani E, et al. Acetaminophen-Induced Acute Liver Failure: Results of a United States Multicenter, Prospective Study. Hepatology. 2005;42 (6):1364-1372.