The National EMS Management Association, along with eight other national EMS and fire organizations, sent a letter to Congress in April asking it to take quick action on the nationwide shortage of generic injectable drugs. “To date, very little attention has been focused upon the negative impact that this national health and preparedness crisis has had on EMS systems and our patients,” the letter reads. “While the drug shortages may be an urgent issue for hospitals and healthcare facilities, a crisis level has already been breached for EMS systems and the patients they serve.”
Nearly half of the drugs on a U.S. Food and Drug Administration shortage list are routinely used by EMS to save lives, including medications to treat heart arrhythmias and seizures. The letter warns that not only does EMS have few or no alternatives to those drugs, but frequently changing drugs also increases the risk for errors.
Read the letter to the House and Senate at nemsma.org.
In another development, the U.S. Department of Health & Human Services Office of the Assistant Secretary for Preparedness and Response held a meeting for EMS organizations and federal officials to discuss the impact of drug shortages on EMS on April 16 in Washington, D.C.
CDC Urges EMS to Get Severely Injured Patients to Trauma Centers
Since the U.S. Centers for Disease Control and Prevention (CDC) issued updated field triage guidelines earlier this year, Richard Hunt, M.D., director of the division of injury response at the CDC’s National Center for Injury Prevention and Control, has been working to get the word out about the importance of following them.
The guidelines, of course, are a series of steps and tests that EMS should use to identify and assess patients severely injured in car crashes, falls and other everyday occurrences.
Hunt says the importance of getting severely injured patients to a Level 1 trauma center—or, if one isn’t accessible, to the highest level of trauma care in the system—can’t be overstated. “If you’re severely injured and are cared for at a Level 1 trauma center, your chance of death goes down by 25 percent,” he says.
Written by an expert panel that reviewed more than 2,000 recent papers on treating trauma patients, the updated guidelines haven’t changed all that much since the last version was issued in 2006. “It turns out when you look at those articles, most reaffirmed what the 2006 expert panel came up with,” Hunt says.
Still, there are some exceptions, including:
Patients should be transported to a trauma center if they have a Glasgow Coma Score of less than or equal to 14. Under the old guidelines, the criterion was less than 14.
Patients should be transported to a trauma center if they need ventilatory support.
For motor vehicle crashes, patients whose vehicles have intrusion into the roof should go to trauma centers. “Roll-over crashes by themselves don’t necessarily mean you have severe injury, but if you’re in a roll-over crash and there is roof intrusion, that is an additional sign you may be severely injured,” Hunt says.
The guidelines are endorsed by more than 30 national physician and EMS organizations and the Federal Interagency Committee on EMS. View the “Guidelines for Field Triage of Injured Patients: Recommendations of the National Expert Panel on Field Triage, 2011,” at cdc.gov/mmwr/preview/mmwrhtml/rr6101a1.htm?s_cid=rr6101a1_w.
Head Injuries on the Rise?
At the EMS Today conference in early March, one of the hottest items at the Centers for Disease Control and Prevention’s (CDC’s) National Center for Injury Prevention and Control booth were the “Heads Up Concussion in Youth Sports” materials, says Richard Hunt, M.D., director of the division of injury response.
The question is: Are traumatic brains injuries on the rise? The statistics suggest they are. A recent CDC study looked at all non-fatal traumatic brain injuries (TBI) in kids and teens younger than 19, including skull fractures and bleeding in the brain, presented at 66 emergency departments between 2001 and 2009. Researchers found that the rate of head injury increased from 153,000 in 2001 to 248,000 in 2009. But another explanation is that awareness about the seriousness of TBI is increasing, Hunt says.
“There are two areas regarding TBI where there has been a huge amount of attention. One is on TBI that have occurred in the military, and the other area is in sports concussions,” he says. “At EMS Today, our awareness materials were very hot items. It’s reached a level of awareness for the EMS provider.”
According to Hunt, responders should make sure they’re following CDC recommendations for TBIs. “They are based on the best science available,” he says. “They make a big difference, and we need to implement them.”
There are two major things to watch out for with brain-injured patients, according to Hunt. “You need to make sure patients don’t become hypotensive,” he explains, “as hypotension means the brain doesn’t have enough oxygenated blood to continue to function well. The second component is avoiding hyperventilation. No hypotension and no hyperventilation. Those are the big ones.”
View the guidelines at cdc.gov/concussion/clinician.html.
No Kissin’: British Soccer Star-Turned-Actor Promotes Hands-Only CPR
To get the word out about hands-only CPR, the British Heart Foundation has enlisted the help of Vinnie Jones, a soccer player-turned-actor who stars in a seriously funny instructional YouTube video. Jones plays a Cockney-accented, cashmere-clad thug who comes across (or perhaps creates) a cardiac arrest victim and is preparing to start compressions. “No kissin’,” he admonishes, as two of his henchmen groove to the Bee Gees’ “Stayin’ Alive” in the background. “You only kiss your missus on the lips.” Check it out at youtube.com/watch?v=ILxjxfB4zNk.
