Today is worldwide suicide prevention day. You can find more information from the CDC’s Suicide Prevention Website.

Also check out this post in the Everyday EMS Tips archives about talking to patients in crisis.

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During this session of Office Hours, Jim Hoffman and I discussed what seems to be an increase of stolen ambulances and how following some simple rules can prevent you from uttering the words “I thought I parked it right here”. Listen below and check out the links under the player.

• Boot review
• Ambulance stolen with patient inside
• Police kill ambulance thief
• Stolen ambulance in Chicago area

EMS Boot Camp

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Importance of Falls Prevention

Falls prevention among geriatric patients takes a coalition of EMS professionals, public health officials, injury prevention specialists, hospital staff, patient personal physicians, pharmacists, exercise specialists, and more. I recently discussed prevention and program design with Colleen Campbell, Senior Injury Prevention Coordinator for the Alameda County Public Health Department Emergency Medical Services.

Ms. Campbell described the multiple efforts of the Alameda County Public Health Department to reduce falls by seniors in a large and densely populated county. After working on falls prevention related programs for more than twelve years she explained that it is “most important to incorporate fall prevention into services that already exist.”

Make Fall Prevention part of Existing Services

An EMS agency that wants to make an immediate impact after receiving a fall prevention funding grant may want to charge into the community and start making a difference immediately with a new program, but Ms. Campbell advises a long-term approach that will help the fall prevention program survive. She said, “The development is slower, but that leads to sustainability for the fall prevention program.”

EMS agencies can help create or join existing coalitions of community organizations that focus on older adult injury prevention. A broader based focus will include senior safety while driving, other types of injury prevention like food safety, and preparation for natural disasters that are community or region specific. In Wisconsin older adults need to be prepared for winter weather. Older adults in Alameda County need to be prepared for earthquakes.

Fall prevention can and should be integrated into many existing services. Does your community have a regular meal schedule at a senior center or other community building? The Alameda County falls program invites pharmacists to deliver presentations at congregate meal sites. Older adult attendees bring a “brown bag” or list of their medications to have them reviewed by a pharmacist. After reviewing the medications the pharmacist can advise the older adult on medication precautions and the need to check with their personal physician about potential medication interactions that could increase falls risk or cause other problems.

By maintaining the general health of the older adult with programs that include staying physically active, proper nutrition, and medication management EMS agencies and coalition partners can impact older adult’s overall health and prevent falls. Ms. Campbell explained, “4,000 people over age 60 are hospitalized in California each year just from medication mismanagement.” Medication mismanagement is a significant fall risk factor.

Innovative Fall Prevention Program

EMS professionals routinely transport geriatric patients from the hospital to home. On these discharge runs the patient is well enough to go home, but to sick and or lacking the friend or family support or resources for a ride in a private vehicle or other type of transport. Unfortunately, the patient is usually returning to the same home that has the same fall and safety hazards that existed before they left for the hospital. Many of those hazards may now be exacerbated because the patient has reduced or impaired mobility, is taking more medications and or new medications, and is being cared for by a spouse or friend that is now at risk of a fall while assisting to the patient.

An innovative program in Alameda County recognizes the problem of falls prevention and engages EMS professionals to talk about falls prevention with patients and their caregivers at the time of discharge. The BLS hospital to home program is a collaboration of the Alameda County EMS Senior Injury Prevention Program (SIPP) and the BLS ambulance providers in the county. Colleen Campbell of Alameda County Public Health and Lauri McFadden of American Medical Response, along with other coalition partners, launched the program when they realized the tremendous opportunity for EMS providers to assist with falls prevention at this critical point in patient care.

Every BLS ambulance in Alameda County has a one-page script for the EMS professionals to review the contents of a large red folder with the patient and their caregivers. The script is used to describe these folder contents:

• Existing community services for older adults
• Local transportation options for older adults
• Fall prevention manual with information on medication management, behavior modification, nutrition, and home safety checklist
• Medication management form

The most comprehensive portion of the scripted conversation is about medication management. The EMT explains the hazards of taking multiple medications, documenting all medications on a medication form, and bringing that medication form to every physician appointment. The form includes recommended questions for the patient to ask their physician about their medications.

The script and red folder contents take ten to twenty minutes for the EMT to review with the patient. Since the inception of the program packets have been distributed to several hundred patients. EMTs enjoy doing this because they know they are potentially preventing a future call and many of them have older adult friends and relatives that have been injured from a fall. Lauri McFadden, Alameda County Operations for AMR shared this quote from EMT Cary Shelby, “We arrived at the patient’s residence where all his family members were eagerly awaiting his arrival. We took advantage of the moment and began to explain the information in the packet, which had all the answers to the questions that they asked. The packet contained all the information that the family needed to build their confidence on how to better take care of their sick family member.”

Alameda County has made their BLS Hospital to Home Discharge program resources available to other EMS professionals and agencies:

1. Preventing Falls for Sixty Plus Adults – PDF document link
2. BLS Provider Hospital to Home Discharge Script – Word document link
3. Medication List with Questions for my Doctor and Pharmacist – Word document link

For additional information browse to Alameda County EMS Senior Injury Prevention Program

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Today is World COPD Day. Everyday EMS Tips frequently encounter patients with respiratory distress or failure secondary to Chronic Obstructive Pulmonary Disease (COPD). This is from the CDC MMWR report, “The aim of World COPD Day is to raise awareness about COPD and improve COPD care throughout the world.”

To celebrate World COPD try some of these Everyday EMS Tips:

1. If you smoke stop. Smoking is the most significant risk factor for COPD. CDC quit smoking page.

2. If you know someone that smokes encourage them to quit.

3. Go outside and enjoy some fresh air. Expand your lungs and use your heart on a walk, run, bike, swim, or ski.

4. Review your local COPD treatment protocols and the medications and interventions you are authorized to use.

5. If you don’t have CPAP yet for your ALS or BLS service send a friendly email to your service director and medical director and ask when CPAP will be part of your protocols for respiratory distress.

6. Prepare and deliver a COPD prevention program. Find education resources and more from the COPD Learn More Breathe Better Campaign.

7. Imagine what life would be like on a 30 foot oxygen tubing tether. Quit smoking.

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More kids die while riding ATVs (All Terrain Vehicles) than bicycles. Many more kids are injured riding ATVs. Have you responded to an ATV accident yet? If you haven’t it is probably just a matter of time. Read article about pediatric ATV deaths at EMS1.com.

My friend Rocco shared these general tips for pediatric assessment treatment and transport, as well as pediatric injury prevention.

1. MOI is often misleading, use it for guidance, but perform a good assessment.
2. Remove helmets with face protection early in anticipation of airway problems.
3. Remove helmets early in anticipation of difficulty spine stabilizing the already large head of a child.
4. Follow local protocols and regularly receive hands-on training focusing on helmet removal in different situations.
5. Have a DVD player or iPod with cartoons on it to play for kids to distract them from pain or a IV start.
6. Partner with local shops to get the message out about ATV safety, helmet use and preventing kids driving without responsible adult supervision.

Rocco Altobelli is a flight medic and Wilderness Medical Associates lead instructor. He lives and works in northwest Montana.

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This week, October 19-25, is National Lead Poisoning Prevention Week. According the CDC web page about lead, “Lead is a highly toxic metal that at one time was an ingredient in many household products, including lead-based paints manufactured before 1978. The primary source of lead exposure among U.S. children is the lead-based paint and lead-contaminated dust and soil found in and around old, deteriorating buildings.

Today, childhood lead poisoning is considered to be the most preventable environmental disease of young children, yet an estimated 310,000 U.S. children have elevated blood lead levels. A simple blood test can prevent a lifetime spoiled by the irreversible damage caused by lead poisoning.”

EMS Professionals have a unique position among all healthcare workers in that they see patients and their families in their homes. Just like we can play a role in fall prevention we can also play a role in lead poisoning prevention. Lead was used in paint in homes built before 1978. This paint and lead contaminated dust are top hazards for children. Lead poisoning prevention tips are available from the CDC.

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In central Wisconsin, the ice and snow season logically leads to an increase in the number of “elderly patient has fallen, possible broken hip” calls. When responding to patients with a suspected broken hip, remember these tips:

1. The patient is often already in a relative position of comfort. Wait to move the patient until you have a plan and resources to make the move. This will also minimize your risk of injury.

2. Geriatric patients have decreased thermoregulatory responses. The patient is likely conducting heat into a cold floor. Covering the patient does not stop the downward conductive heat loss. Move the patient on to a warm blanket(s) and/or padded backboard to minimize the heat loss.

3. If authorized, follow your local protocols to begin pharmacological pain management before moving the patient. If IV access is difficult due to the patient’s position on the ground or cramped quarters consider IM administration.

4. Minimize movement of the patient’s injured leg and hip by using available materials like pillows and draw sheets to buddy splint the patient’s legs together.

5. When it is time to move the patient, assign one person to focus on stabilizing the injured hip and not participate in the lift.

What do you do to minimize pain and improve comfort for a patient with an unstable hip injury from a fall?

Do you see an increase in fall during the winter?

How is your service involved in fall prevention programs?

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October 19-25 is Drug Free Work Week. Special resources are available and promoted this week to help businesses effectively address drug and alcohol problems in the workplace. Obviously every week should be drug free work week.

Have you ever suspected that a co-worker is intoxicated? Has a co-worker boasted to you that they left the bar just a few hours before their shift started? The consequences of an intoxicated employee can be deadly to the person, your patients, and to you.

This is what I have done when I suspect a co-worker is intoxicated or under the influence and we are not providing patient care.

1. Immediately contact my supervisor by phone or face-to-face report. Without delay since we might be paged to a call at any moment.

2. After contacting my supervisor for our unit to be out-of-service until I ask the supervisor for advice on what, if anything, I should say to my co-worker.

3. Fill out documentation provided by supervisor/HR department about the incident. Remember to document behaviors you observed and statements your co-worker made.

Fortunately,  I have not been in a situation where we were traveling to a call, caring for a patient, or transporting a patient with an intoxicated co-worker. Have you? I would like to think that would be a very rare situation that I will never encounter. If I was in this situation this is what I would do.

1. Immediately relieve the co-worker of any patient assessment or care duties. If out of the vehicle, I would ask the co-worker to return to vehicle to wait for me.

2. Request assistance from other emergency responders on-scene to continue to assist with patient care.

3. Contact a field supervisor and/or my agency dispatch center as soon as practically possible.

4. Consider my options for transporting the patient. At this point we would not have a complete crew. I would request advice from the supervisor for guidance on initiating transport with a police or firefighter driver and a single paramedic on board or waiting for another transport unit.

What would you do? Talking and thinking through what-if situations like this will help prepare you for incidents that we hope are unrealistic, but tragically do happen.

No related posts.

A fun image for Friday afternoon made with wordle.net. Click the image for a larger view. As you can see much of the focus of EverydayEMSTips.com is on safety and prevention. Have a fun and safe weekend.

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Visit the US Health and Human Services YouTube channel to vote for the best flu prevention public service announcement. Finalists are competing for a $2500 prize.

This is my favorite video. I think I was my hands more than the average person to begin with, but I needed to wash my hands – twice – after watching this video. Do me a favor and wash your hands before and after eating, after using the bathroom, after any patient contact, after sneezing, and just more often thanks. Which of the videos is your favorite and Why?

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