Related Resource: The EMS1 2008 Year in Review special coverage
That dude has ice water in his veins.
For an increasing number of EMS systems, that phrase has been more descriptive of the patient than the intrepid lifesaver who resuscitated him.
In recent years, post-resuscitation cardiac care has been turned on its ear by the revelation that neurological cellular death doesn’t begin at the four- to six-minute mark as we once believed; instead, cellular death cranks into overdrive only after we have restored perfusion and oxygenation. Researchers have since studied ways to mitigate that cascade of destructive cellular events, and the research has resulted in data compelling enough to make post-resuscitation cooling of comatose patients with ROSC one of the bigger advances in prehospital care.
Dozens of EMS systems around the country are doing it. Boston EMS implemented a therapeutic hypothermia protocol in the spring. Austin/ Travis County EMS will adopt it soon. FDNY is doing the same. Many more are developing protocols. Wake County EMS, an early adopter of therapeutic post-ROSC hypothermia, has tweaked their protocols to include continuous esophageal temperature monitoring.
Remember ten years ago, when we used to say things like, “You don’t have a dead body until it’s a warm dead body?” Who would have figured that we’d now be doing just the opposite, and even inserting esophageal temperature probes to monitor our effectiveness in doing so?
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Many more EMS systems in 2008 have adopted CPAP therapy for their patients in respiratory distress. CPAP helps prevent atelectasis and recruits formerly collapsed alveoli, and helps stave off intubation in many of our sickest CHF patients. In fact, many of the services who have adopted CPAP protocols have seen a precipitous decline in the number of intubations they perform on those patients.
As any respiratory therapist who has ever struggled to wean a vent patient will tell you, this is a good thing.
Sophisticated, yet easy-to-operate systems like the Emergent Portovent and the low-cost Boussignac system have made CPAP available to the EMS masses, and our patients have reaped the benefits.
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Of course, any discussion of the events of 2008 would be incomplete without mentioning the election of Barack Obama as our 44th President. Whether you are an Obama supporter who believes he is the Chosen One to lift our nation from its malaise, or whether you are convinced that he’s determined to make America a socialist country, there is no denying that changes are in store.
For one thing, we now have a President who has declared that healthcare is a right, not a privilege. Whether that means that millions of uninsured Americans will soon have affordable avenues to health care or that EMS and hospital emergency departments will soon collapse under the weight of the entitlement mentality run amok, remains to be seen.
Personally, I’m skeptical. For one thing, as one prominent blogger has pointed out, the U.S. government couldn’t even make money selling sex. I don’t hold out much hope for them managing something as intricate as health care.
I fear the result may be exactly what another prominent EMS blogger has predicted:
National Health Care: All the efficiency of FEMA, with the compassion of the IRS.
Best wishes for 2009, folks!
