Issue 5, December 2010
Northeast Ohio‟s “Green” Newsletter for Prehospital Care Providers
HOW TO TELL A WINNER FROM A LOSER
Special points of
Interest

Who‟s a Winner?

One hour continuing education offering by Dr.
Garlisi on Burns

Safe Communities

Safe Kids

Christmas Tree
Fire Stats

Ohio Certifications
A Winner says, “Lets find out.” A
loser says, “Nobody knows.”
A Winner learns from his mistakes A
Loser tries not to make mistakes by
not trying anything different.
When a Winner makes a mistake, he
says. “I was wrong.” When a Loser A Winner says, “I‟m good but not as
makes a mistake, he says, “It
good as 1 ought to be.” A Loser says
wasn't my fault.”
“I‟m not as bad as a lot of other
people.”
A Winner works harder than a Loser,
and has more time. A Loser is
A Winner feels responsible for more
always “too busy” to do what is than his job: A Loser says “I only
necessary.
work here!'
A Winner goes through a problem; a
Loser goes around it and never gets
past it.
A Winner stops talking when he has
made his point; A Loser goes on until
he has blunted his point.
A Winner makes
commitments. A Loser makes
promises.
A Winner in the end gives more
than he takes. A Loser dies
clinging to the illusion that
winning means taking more
than you give.
A Winner listens. A Loser
just waits until it is his turn to
talk.
A Winner says, “There ought to
be a better way to do it.” A
Loser says „That‟s the way its
always been done here."
A Winner respects those who are
superior to him and tries to learn
something from them. A Loser
resents those who are superior to
him, and tries to find chinks in
their armor.
A Winner says, AND remembers: “A Winner never quits
and a Quitter never wins”
Article submitted by Robert David
EMS Jane Still Available!
Don’t forget to use EMS Jane at www.emsjane.com. The Institute has
renewed the subscriptions. Any problems? Email us.
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A word from Cuyahoga
County Safe Communities
What is Safe Communities all about?
Every year, thousands of people are injured in traffic crashes in Cuyahoga
County. Safe Communities is a community-based program designed to create
awareness and prevent injuries caused by traffic crashes. Cuyahoga County Safe
Communities, funded by the Ohio Department of Public Safety, is a cooperative
effort of law enforcement agencies, prosecutors, local governments, health care
personnel, and other interested parties that work together to achieve safer,
healthier communities in Northeast Ohio and to reduce the costs associated with
traffic-related injuries and fatalities.
Programs offered by Safe Communities:
• Traffic Safety– Seat belts are the single most effective way to
reduce death and injuries due to crashes. Safe Communities promotes the Click
It or Ticket campaign and leads efforts to decrease reckless and
aggressive driving.
• DUI Reduction– Cuyahoga County DUI Task Force members are also members
of Safe Communities. Their efforts are focused around the
Over the Limit, Under Arrest campaigns s well as DUI checkpoints and
efforts to reduce driving under the influence.
• Motorcycles– Since motorcycle crashes are increasing, Safe
Communities works with a Motorcycle Safety Committee to educate
motorcyclists about visibility and helmet use.
• Teen Traffic Safety– With teen drivers leading the statistics in
crashes, Safe Communities educates new teen drivers about distracted driving
and graduated drivers licenses.
The Greater Cleveland Safe Kids/Safe Communities Coalition
meets six times a year.
More information available at www.injurypreventioncenter.com or
contact Heidi Dolan at [email protected] or 216.983.1110
You’re invited!
The Rainbow Injury Prevention Center is always looking for
new partners in the effort to keep Northeast Ohioans healthy and safe and invites
you to come a Safe Kids/Safe Communities meeting to see what the Coalition can
offer your agency and your community. Reaching families through education and
intervention is one of the easiest and most effective ways to prevent injuries and
deaths. Please consider joining us for our next meeting on January 11 from 9:30
am to 11 am. Lunch will be served. The meeting will be held at the Beachwood
Community Center located at 25225 Fairmont Blvd. As an added incentive, we
will be raffling off several Firefighter Heroes framed photographs to fire
departments which send representatives. Call 216-983-1110 for details or to RSVP.
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3
A Word From Safe Kids of
Greater Cleveland
What is Safe Kids all about?
Safe Kids is a global network of organizations whose mission is to prevent unintentional injury,
which is a leading killer of children 14 and under. A large part of injury prevention involves
educating parents, caregivers, and children about the simple ways to prevent needless injuries.
The coalition works to get safety information to the public through low-cost or free educational
programs and materials. Safe Kids Greater Cleveland brings together health and safety experts,
educators, corporations, government agencies, and volunteers to educate and protect families in
the Greater Cleveland area.
Programs offered by Safe Kids:
• Bicycle safety- Safe Kids has an active bicycle safety program that teaches children about the
importance of helmets, using hand signals, what to do at stop signs, and more. Kids engage in
participate in activities and demonstrations that help them remember the rules of the road. Safe
Kids also offers bicycle helmets at a discounted price.
• Child Passenger Safety- UH Rainbow Babies & Children’s Hospital offers free car seat inspections.
Safe Kids also offers certification and recertification classes for those interested in
becoming CPS technicians.
• Fire Safety– Safe Kids leads a carbon monoxide awareness campaign and offers discounted
carbon monoxide detectors to low-income families. Rainbow also offers programs focusing on fire
and burn safety, and Injury Prevention Technicians teach children throughout Greater Cleveland
about fire prevention and escape through interactive presentations and activities.
• Pedestrian Safety– Safe Kids offers pedestrians safety programs for children of all ages. It also
organizes the Walk to School Day each year, and schools throughout Greater Cleveland
participate.
Poison Prevention– With support from the Northern Ohio Poison Control Center at UH Rainbow
Babies & Children’s Hospital, Safe Kids hosts events educating children and adults on the dangers
of poisons in homes and the harm in prescription drugs.
Contact Mandy Thomas at [email protected] or 216.983.1110 for more information
WATER THAT CHRISTMAS TREE
What's a holiday party or even the traditional Christmas morning scene
without a beautifully decorated tree? If your household, like more than
33 million other American homes, has a natural tree, take to heart the
sales person's suggestion—―keep the tree watered!‖ Christmas trees
cause 250 fires annually, resulting in 14 deaths, 26 injuries, and more
than $13.8 million in property damage. Shorts in electrical lights or open
flames from candles, lighters, or matches typically start tree fires.
Well-watered trees are not a problem, but dry and neglected trees can
be.
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Geneva Symposium–
A Huge Success
“Huge success” is an understatement in describing the 2010 Geneva Symposium. 134 people
attended and heard Randy Mantooth— Johnny Gage from the classis hit TV show
“Emergency”— speak. Randy Mantooth is said to have inspired many of today‟s fire and EMS
workers to seek service professions. The symposium also included many informational classes
that attendees could attend and participants had the opportunity to network with professionals
from throughout Northeast Ohio.
The institute has already scheduled three symposiums for next year. Beachwood, Geneva, and
Twinsburg are scheduled to host the symposiums. More may be scheduled at a later date.
The pictures below and on page 8 are from the Geneva Symposium. As can be seen, the event
was well-attended and offered a great educational opportunity for all participants.
PAGE
New F/R, EMT & EMSI Re-Certification Rules
It‟s official. The often talked about “One Card” State of Ohio certification will become a reality on
January 1, 2011. With this comes many changes every First Responder, EMT, Paramedic, and EMS
instructor need to know about. This change doesn‟t simply include moving expiration dates to birthdays.
Along with the expiration date change, the amount of required continuing education will change.
The amount each person will need will depend on whether his/her recertification cycle gets shorter
or longer. For example, if a person‟s current expiration date is February 3, 2011, and that person‟s
birth date and new expiration date is October 10, his or her recertification cycle is lengthened by
about nine months. Under the current rule, no additional continuing education is needed if the recertification cycle is lengthened. However, if an EMT has a current expiration date of December 15,
2011, and his or her birth date is January 4, the recertification cycle as of January 1st will be shortened by more than eleven months, and s/he will have from January 1st to 4th to re-new. Since it is a
shorter cycle though, less continuing education will be needed, but the education must be earned in
all the same categories, and Trauma Triage is still a mandate.
Also entering into the mix is whether or not the EMS certified individual also has a Firefighter and/
or Fire Safety Inspector certification. If so, the First Responder, EMT, Paramedic, and EMS Instructor expiration dates will all move to the individuals‟ firefighter certification expiration date. All renewed certifications will then be good for three years.
Each department should have a person designated to learn these new rules and teach the department‟s members how to comply in order to avoid any lapse in certification (and pay). Ultimately,
however, by Ohio law certification and certification renewal is the individual certificate holder‟s
sole responsibility and his/her agency has no authority or responsibility to any individuals certifications.
Here are a couple of links to help:
 This first link is to check expiration dates. Enter the social security number or certification number and check out the expiration dates. Calculate your new recertification cycle (in months)
from the EMS card dates, fire card dates or birth date, whichever apply.
 This second link is the link right to the rule (4765-8-06). This contains the exact language of the
rule and includes the required continuing education based on the number of months in your individual certification cycle as identified by dates mentioned above.
If you have questions, you can call ODPS at 800-233-0785 and speak to one of the certification
staff. Patience is key as they will undoubtedly be busy. The rule is in effect as of January 1, 2011 so
ask ahead about any questions regarding your certification. -Jim Thomas, UH EMA
5
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Newsletter Continuing Education
CON ED
October 18, 2010
Andrew Garlisi, MD
The wet smoke drifted skyward – blending in with the pre-dawn grey winter sky. The two
story cape cod-style home, now reduced to smoldering rubble, had been consumed quickly
by the fire. Scott Jeffers had returned to the scene after transporting the only survivor, to the
ED. Jeffers, a 19-year veteran of Oak County EMS, had never in all his years of service experienced a call
as gut-wrenching and grisly as this. The family of 6 was now reduced to one—fighting for her life in the
Burn Unit at Clayton Memorial Medical Center, 60 miles away.
Jeffers, stood staring at the home as if hypnotized by the charred remains of the home. The fire engine
and two additional tankers had responded, but the blaze had virtually engulfed the house by the time
they had arrived. The searing flames and thick smoke had impeded efforts to gain entrance and the
rescue team had prepared for the worst.
All the victims were upstairs. Three young children had died in their beds. One child and the two
parents were lying in the hallway. All victims were severely burned, including the mother who was still
alive. Jeffers had carried her out to where the EMS team was ready. She was barely breathing but had a
pulse. An ambu bag was applied for assisted ventilations as the EMTs struggled to find a vein for IV
access. Her face was charred and swollen. Jeffers knew that intubation would be difficult, if not
impossible. The skin on her arms blistered in some areas, and was whitish in others.
―Let me take a quick look,‖ Jeffers said. The EMT removed the face mask and Jeffers inserted the
laryngoscope blade. The tongue and pharynx was swollen. Carbonaceous material had accumulated in
the throat.
―Give me some suction,‖ Jeffers barked. ―I can’t see a damn thing, continue to bag her and grab the
King Airway.‖
The paramedics rushed her to the local community hospital five miles away. The emergency physician, a
semi-retired moonlighter, was unable to access a central vein. One of the nurses had accessed a foot
vein and Ringer’s Lactate was initiated. The patient’s oxygen saturation was reasonable with the King
Airway, so the physician decided not to remove it to attempt a difficult intubation. The helicopter had
been called prior to EMS arrival and ETA was ten minutes. When the flight crew arrived, the patient was
hypotensive, tachycardic and her oxygen saturation was drifting downward.
BURN INJURIES
Perhaps one of the most devastating and complex of all emergencies, severe burn injuries continue to be
a major cause of human suffering and disability. Although deaths from burn injuries have declined in the
past two decades, approximately 1.4 million persons in the United States suffer from burn injuries yearly.
Of these, approximately 180.000 are hospitalized and 5% of hospitalized patients die as a result of their
burn injuries. In structural fires, one half of burn victims die of smoke inhalation or carbon monoxide
poisoning before reaching the hospital.
There are several burn categories, including chemical, electrical, scalds and fire. Serious burn injuries
occur most often in young adult males, followed by children younger than 9 years old. For children
under 2 years old, liquid scalds and hot surface burns account for nearly all serious burn injuries.
Burn injuries are extremely complex and invoke metabolic, anatomic, and physiologic changes involving
virtually all major organ systems. In addition, for victims of structural fires, there are compounding and
complicating factors, including traumatic injury, carbon monoxide poisoning, cyanide toxicity, smoke
inhalation, and substance abuse. Knowledge of these physiologic and complicating factors will improve
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Severity of burn injury depends on the extent and location of the burn, age of the patient, presence of
inhalation injury, pre-existing medical conditions, and presence of intoxicants such as alcohol.
Depth of burn injury can be described based upon classification by degree. First degree burns
(superficial) cause minor damage to the epidermal skin layer. Clinical signs include redness, tenderness
and pain. Sensation is intact and no blistering occurs. An example of a first degree burn injury is sunburn. Second degree burns involve the epidermal and the dermal layers. Blisters are common. These
burns are tender and if they involve the deeper dermal layer, sensation can be impaired and scarring
can occur. Third degree (full thickness) burns totally destroy the epidermis and dermis, as well as the
blood supply to the dermis. The skin is numb and has a leathery, whitish appearance.
The “rule of nines” is the time-honored method of estimating extent of total body surface area (TBSA) of
burns. For the adult, the rule allots 9% of TBSA to the head and neck, and to each upper extremity, 18%
each to the anterior and posterior thorax, 18% to each lower extremity and 1% to the genitalia and perineum. The area of the patient’s palm represents 1% of the total body surface area and can be used for
estimation of burn size. The infant patient has a relatively larger head (18%) and proportionately smaller
legs (14% each), compared to the adult.
Burns are further classified as Minor, Moderate, and Severe (Major). Major burn injury victims should be
transported to a Burn Center. Major burns include:
 Full thickness (3rd degree) burns involving more than 10% of TBSA
 Partial thickness burns involving more than 25% of TBSA in adults or 20% in children
 Burns of the face, eyes, ears, hands or perineum (functional and/or cosmetic impairment)
 Burns associated with major trauma or smoke inhalation
 Burns in high risk patients
Field management of the burn victim necessitates that the EMT is aware of the clinical signs and symptoms of impending airway failure as well as the multitude of associated co-existing complications that
often occur in conjunction with the burn. Smoke inhalation is a lethal condition that causes upper airway
and lung damage. Signs of inhalation injury include carbonaceous sputum, singes nasal hairs, burns of
the mouth and nose and shortness of breath. Patients who suffer from airway injury should receive
endotracheal intubation early, before edema makes intubation difficult or impossible.
For those patients with stable airways, high-flow humidified oxygen should be provided via a
nonrebreather apparatus.
Hypovolemic shock (“Burn Shock”) can occur due to loss of intravascular fluids into the tissues
adjacent to the burn wound. The damaged skin can no longer retain water, and fluid losses can be large
and devastating. Venous access in a burn victim can be quite difficult, even under the best of
circumstances. Transfer of the burn victim should not be delayed by a prolonged search for IV sites.
Fluid resuscitation is best guided by achievement of normal urinary output (30 to 40 mls per hour in an
adult and one ml per kg per hour in children younger than 2 years). The Parkland formula is a widely
used guide for initial fluid administration. This formula recommends Ringer’s Lactate at 4 ml/kg/% TBSA
burned. One half of the fluid is given in the first 8 hours from the time of the burn, with the other half
administered over the next 16 hours.
For pediatric fluid administration, the Galveston formula has been recommended, utilizing D5RL at
5000ml/m² of TBSA burned, plus 2000 ml/m² administered in the first 24 hours. One half is instilled in the
first 8 hours, the other half given over the subsequent 16 hours. (Dextrose is provided in children because they have smaller glycogen stores than adults).
Morphine has been the traditional narcotic used to manage the burn victim’s pain. The doses can be titrated upward as needed and there is little protein binding.
On Behalf of all of us here at the University Hospitals
EMS Training & Disaster Preparedness Institute, we
extend our best wishes to all of our partners for a Happy,
Safe and Healthy Holiday season. We‟re looking forward
to working with you in 2011!
~University Hospitals EMS Training & Disaster Preparedness Institute Staff
Institute Contact Info
University Hospitals EMS Training & Disaster Preparedness Institute
Toll Free– 1.877.754.SAVE (7283)
Fax line– 1.440.735.3822
Dan Ellenberger, Director
Pager: 216-464-8410 PIN-35165
E-mail: [email protected]
Judy Gau, CQIA, EMS/Quality Assistant
Phone: 440-735-3513
Pager: 440-270-0154
E-mail: [email protected]
Jim Thomas, Website Manager/Online Continuing Education
[email protected]