Hyperthermia Deaths to Children Left in Unattended Vehicles

Dr. Lou Romig shared this link to information on Hyperthermia Deaths to Children Left in Unattended Vehicles.

Hyperthermia leading to heat stroke is a life threatening emergency. A child either because of young age, functional motor skill development, or restraint in a child passenger seat is unable to self-extricate if unintentionally left inside a vehicle.

EMS professionals can play a role in preventing this tragic emergency by:

1. Educating parents and children about the rapid rise in a vehicles interior temperature

2. Reminding parents of the importance to look before they leave the car

3. Keeping your eyes open for children left unattended inside a hot vehicle. Don’t assume an adult will return to the vehicle quickly. If in doubt call 911 and take appropriate steps to extricate the child from the car if you suspect a heat emergency.

Treat heat stroke by removing the child from the dangerous environment, beginning immediate active cooling, managing ABC life threats, and transporting to the most appropriate receiving facility.

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The EMS Magazine CE Article for September is High School Sports Injuries. I co-authored this article with Kevin Collopy. We have been receiving lots of reader questions and comments about this article. One sign that an article is resonating with people is that they ask questions.

Read the article.

Take a quiz at RapidCE.com to earn CE credit.

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In just a year the EMS Boot Camp project has built an archive library of over 22 hours of recorded EMT and Paramedic continuing education webinars. The multimedia CE lessons cover many important aspects of EMS. Each EMS Boot Camp webinar includes:

• Recorded video and audio of the session that you can watch anytime online right from your computer.
• Download MP3 of the audio that you can listen to via your IPod or other MP3 player or even burn to a disc.
• Transcripts of the session that may include question and answer sessions, chat logs or exclusive resources discussed during the live session.
• Printable handout and or outline of the session that you can present to your training officer or Medical Director for CE credit.
• Written transcripts of selected sessions.
• Plus a printable Certificate of Completion for each session.

The educators and their titles in the EMS Boot Camp archives include:

Steve Whitehead:

• The Art of Patient Rapport
• Conquering The National Registry Cognitive Exam
• Conquering The National Registry Skills Stations

Buck Feris:

• Medical Math in 3D
• Uncovering the Autonomic Nervous System

Lisa Hollett:

• Child Abuse Recognition in EMS
• Critter Catching 101 – OB Emergencies
• Trauma for Tw0 – Trauma in Pregnancy

Joseph F. Clark:

• A Google Search is Not Research

Plus there are sessions from Greg Friese, Jim Hoffman and Jamie Davis:

• Conquering Medical Control
• Pediatric Assessment Essentials and Case Studies
• IV Complications in EMS
• MCI Response for EMS
• Diabetic Patients – What Your Instructor Left Out
• EMS Exam Boot Camp
• EMS Training Preparation
• EMS Career Development

For unique and useful EMS training you can start using right now visit EMSBootCamp.com for complete details on each session.

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The nurse’s instructions were simple. “You two guys just wait here until Amanda gets back.”

Then she handed me the other guy and walked out of the room. There I was holding, Michael, my newborn son. He and I were together and totally alone. And that is when it all came together.

First Bath

About 10 minutes earlier I watched, photographed, and cried as the nurses confidently washed and swaddled Michael. His full head of black hair stood straight up off his skull like a mad muppet. In one hand the nurse capably balanced Michael and with the other she washed his hair. “They usually don’t have this much hair,” she said mostly to herself. I was surprised too. I just thought, for no particular reason, that babies came out bald.

Cut Right Here

Just before the bath the doctor showed me where to cut the umbilical cord, “Just between these two clamps.” I hesitated for a moment and he said “Go for it.” So I did. I was hoping for a cleaner and more authoritative cut.  Instead I hacked through the cord like a lefty using scissors in art class. Fortunately, the jagged cord was destined to fall off a few days later.

Clear the Airway

Before I cut the cord I watched as the pediatrician expertly guided an endotracheal tube into Michael’s trachea for a bit of deep suctioning. Lots of goo, but nothing too concerning came out. At that point I didn’t know what I should be doing. Lamaze class didn’t mention anything about what dad does after delivery – at least that I could remember. I also realized that the only book I read during 9 months of gestation was by Alan Thicke – the dad from the 80s comedy growing pains. Probably could have done some better preparation. What was supposed to happen next was a complete mystery to me.

Get em’ in the Boat

Before being whisked into the warming bed and the waiting hands of the pediatrician everyone in the operating room began to breathe, smile, and talk again. As a medic student I had been in the OR. The atmosphere was always light, music was playing, and OR staff made idle chit chat in the down moments. This OR was much different. Three physicians, with another one in the room next door waiting for Michael, several nurses and tech, and me on a stool sitting next to Amanda’s head barely exhaled. Once the c-section surgery began hardly a word was spoken until the assisting OB doctor announced, “This one is a keeper!” In case you don’t fish, a keeper is a fish that is big enough to keep for dinner.

Sure enough Michael was a keeper. When the doctor lifted him out of the womb; the room sighed, smiled, and cheerfully laughed. Michael was 10 pounds, 8 ounces, with a full head of long black hair.

It’s Never Like TV

We had both looked at each other. This was not the birthing process we had in mind, but we knew it was time to opt for the c-section with general anesthesia. Due to some anatomical fluke Amanda’s epidural would not hold bilaterally. She needed to be intubated. We were not going to have one of those made for TV births with yelling, swearing, pushing and crying. Instead she laid still on the table, sedated and paralyzed, with a tube coming out of her mouth. Her eyes were taped shut and I watched her chest gently rise with each mechanical ventilation. I sat next to her wondering and waiting.

Exhaustion

More than eighteen hours of labor had taken its toll on Amanda. She was physically and mentally exhausted. The epidural was intermittently failing, contractions were not increasing in intensity and frequency, and the monitor was showing fetal heart rate decelerations. Something was wrong. It was shift change and the new day’s on-call doctor came in. He said, “Let’s take a look.” I also looked as he looked. The pad Amanda was sitting on was soaked with a lot of bright red blood. That is not right.

At the time I was seven months into a nine month paramedic program. The week before we had finished pediatric advanced life support and neonatal advanced life support. I knew just enough about OB emergencies to get really worried. Was the baby OK? Was Amanda at risk? “Have you thought about a c-section,” the doctor asked? We hadn’t so he started to lay out the options. The choice was obvious to Amanda and me.

Pit Crew Jumps the Wall

The next few minutes were like being on pit row at a NASCAR race. The doctor poked his head out the door and said, “We are doing a c-section now.” Staff flooded into the room. In minutes Amanda was moved into another bed, had a second IV placed, a urinary catheter inserted, and her gown changed. Things were happening fast. The joyous phone call I had planned to announce the baby’s birth changed from “We had a baby” to “Amanda is going to surgery right now.”

—

For forty-five minutes I sat in a rocking chair and simply held Michael. He was pretty tired from a stressful few hours so he made things easy for me. His umbilical cord had been over his shoulder. With each contraction his cord was compressed against Amanda’s pelvis which caused the heart rate decelerations. He wouldn’t have gotten out on his own with his size and cord entanglement.

Now Michael is a healthy, happy, athletic, and smart five-year old. I can’t be prouder of him and more grateful to my wife for what she went through to bring him into this world. I will always treasure the forty-five minutes he and I spent together while Amanda was being sewn up because that is when it all came together.

—

Author note: this is my submission to the May 2010 edition of the Handover Blog carnival hosted by Steve Whitehead at theEMTSpot.com. This month’s theme was “When It All Came Together”. Steve will be compiling all submissions into blog post. Thanks to Steve for hosting and I am looking forward to reading the other submissions.

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During the EMSBootCamp.com session a participant asked if there was an iPhone app for calculating the APGAR score of a newborn. I found these three with some help from my Twitter friends:

1. APGAR iPhone App
2. APGAR Droid App
3. Medical Calculator for Blackberry

Have you used any of these apps for training or an actual field delivery? Does an app seem unnecessary or inappropriate for labor and delivery?

The archived EMSBootCamp.com session, Critter Catching 101, is available in the archives. The two-hour session included a review of labor and delivery A & P, stages of labor, and childbirth emergencies. The presenter, Lisa Hollet, answered audience questions well past the scheduled end time. Check it out to meet your CE requirements for OB/Pediatrics.

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Everyday EMS Tips readers often tell me pediatric patients are the most challenging to assess and treat. This is often a function of inexperience and nervousness. Also a crying child (or even a worse a silent child) will raise anyone’s anxiety level. Recently Dr. Mike Pitt, aka Magic Mike, was the featured guest on the EMSEduCast.

Magic Mike is finishing his pediatric’s residency at Children’s Memorial Hospital in Chicago. During the EMSEduCast episode Mike talked about how he uses magic and other techniques to build rapport with children and put them at ease during assessment and treatment procedures. Mike shared some specific ideas as well as general principles.

Listen to EMSEduCast Episode 39 with Dr. “Magic” Mike Pitt.

Also watch this video featuring Magic Mike. (note this is a screen capture with a video camera)

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Two children in my son’s preschool class were diagnosed with H1N1 last week. Both children had been at school for the days preceding their diagnosis. Both are now at home with high fevers, malaise, coughs, and sore throats. While my first thought on hearing the diagnosis should have been, I hope they feel better soon, I immediately thought, I hope my son doesn’t get sick!

Panic Attack: Do I pull him out of his preschool for the next week so that the teachers can disinfect and ensure a temporary end to the spread of germs? Do I insist that he wash his hands at every sink we pass throughout our day? Do I isolate him at home for the rest of the flu season? Do I have a total panic attack?

Passive Resistance:No, I can’t pull him out of school every time other children are sick. I can’t expect the school to shut down. And, obviously, I can’t have a panic attack just thinking of the possibility of my child becoming ill.

Instead I teach my son how to stay healthy. We follow the recommendations provided by the Centers for Disease Control and Prevention (CDC).

1. Cover your nose and mouth and use a tissue when you sneeze and cough. Throw the tissue into a trash can.

2. Wash your hands. Use soap and water.

3. Try not to touch your eyes, mouth, or nose.

4. Stay home when you are sick.

Chances are high that my son will get a cold sometime during the winter. However, I will not panic, nor will I be passive. We will follow precautions and recommendations, and we will stay informed.

Visit the CDC’s website on H1N1 for more information, http://www.cdc.gov/h1n1flu/

H1N1 (Swine Flu)

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School is now in session. Kids are walking, cycling, and riding to school in privately owned vehicles and school buses. All drivers need to refresh back-to-school vehicle safety tips. I wrote nine tips in this Everyday EMS Tips column at EMS1.com. Use the comments area to submit a 10th tip for me to add to the list.


Summary of the Everyday EMS Tips column:
1. When responding emergently, avoid routes that pass directly by a school.
2. Avoid any situation that requires backing up.
3. Stop far enough away from a school bus loading or unloading kids.
4. Wait with younger children at the school bus stop.
5. Turn on hazard flashers while waiting for a school bus to load or unload.
6. Remind children about the importance of seatbelt use and wearing a properly fitting helmet for biking and skating.
7. Make sure your children understand basic traffic safety laws.
8. Don’t talk or text on your phone while driving.
9. Be a role model and demonstrate important traffic safety behaviors.

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