Nearly 70 percent of rural volunteer EMS services are struggling to recruit and retain volunteers and one-fifth believe the problem is getting worse, a report by the Rural Health Research & Policy Centers has found. EMS-only agencies report having more difficulty recruiting volunteers than fire-based agencies (72 percent vs. 65 percent). The report, “Rural Volunteer EMS: Reports From the Field,” is based on interviews with 49 directors of all-volunteer rural EMS services in 23 states.
Why are volunteers in short supply? Directors blame a small population base; a lack of employment options that force residents to seek work elsewhere, making them unavailable to answer calls in their communities; and competing demands on time because of family obligations, especially on weekends.
To improve recruitment and retention, directors suggest that decreasing the time and burden of training, offering incentives for employers to allow employees to answer calls during work hours and improving a service’s visibility in the community would help. Another fix cited by directors is paying volunteers.
In fact, about half of the agencies surveyed already offer some pay for their volunteer workforce, most often by paying per run. Because of the generally low call volume—the average rural EMS agency surveyed answers 163 calls a year, or about one every other day—it’s cheaper to pay EMTs or paramedics for an individual run than to maintain a full-time paid staff, according to the report.
In addition to workforce issues, maintaining adequate funding is an ongoing struggle, according to the report. About 83 percent of rural agencies rely on multiple sources for financial support, including billing revenues, regular fundraising events, local or county support, and one-time state, local or grant funds.
Among those with a single source of support, half are supported by fundraising and donations alone. Others receive only tax dollars or only billing revenue, according to the report.
Despite the challenges, the majority of rural volunteer EMS directors are optimistic about their ability to maintain their service in the future, while 20 percent are uncertain and 8 percent are pessimistic. Read the entire report at shepscenter.unc.edu/research_programs/rural_program/pubs/report/FR99.pdf.
Users of Synthetic Marijuana Heading to EDs
If you haven’t yet encountered the drug known as K2, you may soon. Synthetic marijuana, often sold under the name K2, is sending some of those who smoke it to hospital emergency departments with racing heart beats, extreme anxiety and hallucinations, according to reports from poison control centers nationwide. The drug is still legal throughout much of the United States, although many states and some counties are rushing to pass legislation prohibiting it.
Since the start of 2010, the American Association of Poison Control Centers has received nearly 2,000 reports of people who became ill, sometimes seriously, after smoking K2. That compares to only about a dozen such reports in 2009. Though popular in Europe for years, K2 seems to have caught on here only recently, toxicologists say.
K2 is often sold in packets of herbs laced with synthetic marijuana and marketed as incense at “head shops,” gas stations, convenience stores and online for about $30 to $40 per 3-gram bag. The drug also goes by other names, including Spice, Spice Gold, Spice Diamond, Yucatan Fire, Solar Flare, K2 Summit, Genie, PEP Spice, and Fire n Ice, according to the U.S. Drug Intelligence Center.
While people typically smoke K2 expecting relaxation and euphoria, some experience the opposite: extreme agitation, anxiety, tachycardia and frightening, disturbing hallucinations, says Anthony Scalzo, M.D., medical director of the Missouri Poison Center and chief of toxicology at St. Louis University, who first sounded the alarm bell about K2 a few months ago. In some cases, the drug also causes vomiting, tremors and seizures, according to federal drug abuse agencies.
K2 was developed for study purposes in the mid-’90s in the lab of John Huffman, a Clemson University chemist, who was conducting National Institute on Drug Abuse-supported research on cannabinoids. The chemical makeup of the drug, which he called JWH-018 and JWH-073, was similar to tetrahydrocannabinol (THC), the active ingredient in marijuana—but considerably more potent.
While still legal under federal law, several states—including Kansas, Iowa, Missouri, Arkansas, Kentucky, Alabama, Michigan and Illinois—banned K2 in recent months. Bills to outlaw K2 are pending in other states, including Nebraska, North Dakota, Ohio, New York, New Jersey and Louisiana.
If EMS personnel come across people who say they have smoked K2, treat them with fluids and benzodiazepines, Scalzo advises.
More Evidence of the Value of Checklists
Two new studies show the value of checklists for reducing medical errors. Though both studies were done in hospitals, experts say EMS could take a lesson from hospitals’ experiences.
The first study, in the Oct. 20 issue of the Journal of the American Medical Association, found that checklists, along with pre- and post-surgical debriefings, at 108 Veterans Administration hospitals nationwide reduced deaths by 18 percent.
In the second study, six hospitals in the Netherlands implemented a series of 11 checklists that covered every aspect of surgical care from the moment the patient arrived at the hospital until discharge. Hospitals that implemented checklists saw all surgical complications reduced by one-third, while in-hospital deaths were cut in half, according to the study, which appeared in the Nov. 11 issue of the New England Journal of Medicine (NEJM).
When considering the use of checklists, one common question is, “what items should be included in the list?” Interestingly, it may matter more that you’re using some type of checklist rather than any specific line item, says John Birkmeyer, M.D., a surgeon and director of the Center for Healthcare Outcomes and Policy at the University of Michigan Ann Arbor, who wrote an editorial accompanying the NEJM study.
In the Netherlands, the incidence of all types of complications dropped—not just those that were targeted by the checklist—suggesting that the enhanced communication that checklists promote is what’s most critical. “EMS is the type of setting that seems like it would be ideal for a checklist. Things are happening fast. There is a high level of chaos in the field, and care is delivered by a wide range of personnel varying in both skill and training,” Birkmeyer says. “Checklists are designed for just that sort of thing.”
Malfunctioning Defibrillators Prompt FDA Warning
After receiving thousands of reports of malfunctioning defibrillators, the U.S. Food and Drug Administration has launched an initiative to improve the safety of the life-saving devices by improving design and manufacturing practices.
During the past five years, the FDA’s Center for Devices and Radiological Health (CDRH) has received more than 28,000 medical device reports about defibrillators that failed to operate properly, while manufacturers have issued dozens of recalls involving hundreds of thousands of the devices, according to an FDA news release.
Many of the problems include engineering, design and manufacturing practices, including quality control of components bought from other suppliers, according to the FDA. At least one malfunctioning defibrillator may have caused a patient’s death. “These devices play an important role in health care,” said CDRH Director Jeffrey Shuren, M.D., in a statement. “The purpose of our initiative is to improve these technologies so we can save more lives.”
As part of the “External Defibrillator Improvement Initiative,” the FDA will work with manufacturers and other industry stakeholders and experts to not only improve the safety of current defibrillators, but to also promote the development of next-generation defibrillators.
The initiative kicked off with a public meeting held Dec. 15–16 at the FDA headquarters in Silver Spring, Md. The FDA is also collaborating with the University of Colorado’s Department of Emergency Medicine to determine what types of changes will improve ease of use and outcomes, including a multi-city pilot that will connect AEDs with EMS so that when an AED is used, EMS is rapidly dispatched. Read more at the FDA’s website: fda.gov/NewsEvents/Newsroom/Press
Announcements/ucm233827.htm.
Traffic Fatalities Continue to Drop
About 33,808 people died due to traffic crashes on the nation’s highways in 2009—a record-breaking, nearly 10 percent decline from 2008 and the fewest deaths since 1950, according to updated figures from the National Highway Traffic Safety Administration (NHTSA). The decline in traffic fatalities occurred even though estimated vehicle miles traveled increased by 0.2 percent year over year.
The number of people injured in motor vehicle crashes in 2009 also declined for the 10th year in a row, dropping 5.5 percent from 2008, according to NHTSA.
Fatalities declined in all categories of vehicles—including motorcycles, which saw fatalities also dip slightly from 2008, halting 11 years of annual increases. Alcohol-related driving fatalities declined by 7.4 percent in 2009 to 10,839, compared to 11,711 in 2008.
New Physician Specialty: EMS
The American Board of Medical Specialties (ABMS) is offering physician certification in a new subspecialty: emergency medical services. The ABMS Board of Directors and Assembly Representatives approved the new subspecialty at its September 22–23 meeting, bringing the total number of subspecialties to 149. The certification will be administered by the American Board of Emergency Medicine (ABEM). The EMS subspecialty was developed to “standardize physician training and qualifications for the delivery of medical care in the pre-hospital setting,” an ABMS news release states.
“The certification of EMS physicians will accelerate improvements in the care of the acutely ill and injured patient while being stabilized on the scene and transported to the hospital,” said Mark T. Steele, M.D. president of ABEM, in a news release. “The impact of the early provision of initial care will increasingly save lives and improve health care delivery.”
Read more at the ABMS’ website: abms.org/News_and_Events/Media_Newsroom/Releases/release_TwoNew
Subspecialties_11042010.aspx.
