By: Kate Pula, Training Officer, 2014
There may be a new way to treat victims of internal hemorrhaging. It’s a new technology called polyurethane polymer foam that forms inside a patient’s body after being injected in two liquid phases (which upon mixing create the foam).
The mixed liquid expands 30 times its original volume and conforms to the surfaces of the injured tissue and other organs. Then the liquid becomes solid foam capable of providing resistance to blood-loss and has minimal blood absorption.
This new technology was developed by military research and has resulted in 72% survival rate at three hours post-injury in testing based on swine injury model data; compared to the 8% survival rate in the controls. The foam is designed to be administered in the field by a combat medic and can be easily removed by doctors during surgery. In tests, removal of the foam took less than one minute following incision by a surgeon.
This new form of hemorrhaging treatment is to be instituted for military use soon. And hopefully, as many new life saving techniques have done in the past, will eventually transition to civilian EMS techniques.
By: David March, Training Officer, 2014
An often forgotten aspect of note taking during EMS calls is the important role that time plays. Anyone with a fair amount of field experience is familiar with the difference that five minutes can make on a patient’s condition. Patients that were having some difficulty catching their breath can slowly sink into unconsciousness as their body shuts down. Intoxicated patients who had been having difficulty sitting up might find their legs and start wandering around the room. Time is critical.
Yet, many EMTs note changes in patient’s condition with little consideration for the timeline. Of course it’s most important to note that the patient started off unable to determine where they were, and later worked up to a full understanding of their situation, but the time it took them to do so is also relevant. The time that vitals are taken is always recorded to help monitor trends, but more subjective findings such as patient responsiveness can be just as important to predict what is happening with the patient.
Noting the time throughout the call can help you, and those who will read your report further down the line, make sense of the story of the patient’s night. Since you have to wear a watch, might as well make use of it.
By: Kate Pula, Training Officer, 2015
ABC stands for Airway, Breathing, and Circulation; these life signs are the first thing to check after approaching the patient. These are a very important part of every patient assessment no matter what type of call it is and should be checked before the start of patient assessment. It’s important to remember to check ABCs for every patient, although many patients are responsive and talking with us. In addition, any life threats that are found when checking life signs should be treated immediately: assist breathing, administer oxygen, stop life-threatening bleeding, etc.
Finally when checking life signs on an unresponsive patient, the pulse (circulation) should be checked first. If no pulse is found, then proceed with CPR. If a pulse is found, then proceed with the nor- mal ABCs. So with an unre- sponsive patient the order is CAB – Circulation, Airway, and Breathing.
By: David March, Training Officer, 2014
David Bridgman-Packer graduated last year with a major in Physics. When he was at Vassar, David was very involved with VCEMS and equipment officer his senior year. We caught up with David, who is working with Doctors Without Borders in New York City:
VCEMS: What made you decide to join VCEMS and what did you enjoy most?
David Bridgman-Packer: After my sophomore year at Vassar, I started to become interested in medicine, and I saw EMS as a first stepping stone into the field. It introduced me to practices, mindset, and personalities found in medicine, and it allowed me to break out of the passivity of academia to actively assist and engage with my community. My favorite memories involve working with the other EMTs, getting to know the Vassar security team, and making pancakes after late-night calls.
V: How has your experience volunteering with VCEMS influenced your current work or future career plans?
D: Working with VCEMS helped me to focus my interests in medicine and apply them while still in College. After graduating, I spent six months working in the outpatient clinics at Memorial Sloan-Kettering Cancer Center in New York. I am now working in the New York Office of Doctors Without Borders, and I will be starting medical school in the fall.
V: Any funny stories?
D: Well there was that one time that I got a call in the middle of the night and left my TA without pants. Most people think we sleep in our uniform.
V: Any words of alumni wisdom?
D: Keep your friends close when you leave Vassar. The real world can be big and intimidating. Everything is better when you have a supportive group of friends.
V: It would seem to have become a peculiar tradition of ours, so please, what’s your spirit animal?
V: Anything else you would like to add?
D: If you’re interested in medicine, global health, or New York City, I’m always available to talk about life after Vassar and the path toward medical school. You can find me on Facebook or get in touch with me through the exec board. VCEMS did a lot for me and I’d love to give back as much as I can.
By: Jess Metlay, Captain, 2013
As EMTs we do not provide official diagnoses for our patients but in EMS care it is important to differentiate between call types. In this spirit, each month I’ll present a short scenario and either ask you to provide a treatment plan or tell me what’s wrong. So, without further ado…
You receive a dispatch on a Sunday afternoon for a 20 year old female patient with abdominal pain. Sounds simple enough. When you arrive on scene you find your patient sitting up on the sofa in her living room. Your patient arrived home yesterday morning for spring break. When you ask her to describe her pain, she tells you that she is actually feeling a lot better at the moment. The pain started two days during her last midterm with a mild pain by her bully button, which she originally attributed to nerves and a lack of sleep. However, that night she woke up to a sharp pain in her lower right abdomen and vomited. She reports experiencing waves of mild to moderate nausea since then. The pain persisted all throughout yesterday and even radiated to her back, “I spent all of yesterday lying in bed. Everything hurt: eating… drinking… moving. But by the far the worse was right after I accidentally pressed down on my abdomen.”
You perform a focused physical assessment by palpating the patient’s abdomen. Her lower right quadrant is extremely rigid; she even flinches when you apply pressure (“I guess the pain hasn’t really gone away”– patient). The rest of your physical exam is unremarkable and vitals are normal. Your patient does have a low grade fever of 100°F. The patient’s parents are also on scene and mention that she had a fever of 101°F yesterday, as well as the fact that she barely touched her dinner last night or breakfast this morning (“It was her favorite!”).
You are concerned about the continued rigidity and fever, so you ask some additional questions: “when did the pain get better?” and “did you take any medications or do anything in particular to improve the pain?”
“That’s the weirdest part” she says, “I woke up this morning to by far the absolute worst pain since this all started. It felt like I was being stabbed. I basically passed out from the pain and then when I came to, I told my parents and they called 911. But I actually feel a lot better now”
Not the answer you wanted to hear; immediately concerned, you rush her to the ER where she is scheduled for an emergency surgery.
What was wrong with your patient? Send your thoughts to email@example.com.
Congratulations to Sharon Lee for solving last month’s puzzle! Your EMS partner had hyperglycemia or high blood sugar. The question you asked was if he had diabetes (which he did). Left untreated hyperglycemia can develop in diabetic ketoacidosis, which is likely what happened to your partner.
By: Sarah Mincer, Assistant Captain, 2015
Gastroenteritis or food poisoning is most likely the cause. Food poisoning is caused by consuming contaminated food or drink, and gastroenteritis can be caused by a viral infection, bacteria, toxins, or parasites. Although the symptoms can be very similar, there are some differences between the two. Both can cause nausea, vomiting, and diarrhea, which in turn can lead to dehydration. Gastroenteritis can also lead to a bloated abdomen, fever, and additional aches and pains. Although these symptoms may be uncomfortable for your patient, they are usually not life threatening.
If you respond to a call where the patient is complaining of stomach pain, you should always ask the seemingly obvious questions first: was there any trauma or did they eat anything that they may be allergic to. If they answer yes to either of these, the situation may be a little more serious and transport may be the best option. If the answer was no to both of these questions, you can move onto the rest of your assessment.
Some things that can be indicators of a more serious problem are blood in the stool or in their vomit, a high fever, symptoms lasting more than three days, or prolonged vomiting that prevents intake of any liquids. Another important thing to look out for is dehydration, especially if they have been vomiting. Severe dehydration can cause dry mouth, decreased urination, dizziness, fatigue, or an increased heart or breathing rate. If any of these things are present, it may be a good idea to transport the patient, but you can play it by ear if the symptoms are not too severe. Another quick thing to do in your assessment is a palpation of the abdomen. You should palpate the four quadrants of the abdomen, and it should be soft when pressing down firmly.
There are a few things you can recommend to your patient when they decide that the hospital is not the route they want to take. At Vassar, you can always tell them that they can go to Baldwin if their symptoms persist or if they get too uncomfortable. They also have the option of driving to the hospital, taking a taxi for medical transport, or calling EMS again. The important thing to remember with vomiting and diarrhea is that they have to stay hydrated. Gatorade is a great way to stay hydrated and replace electrolytes. Juice, ginger ale, broth, and tea are also good options; small but frequent sips are best when drinking these. They shouldn’t eat until the vomiting and nausea subsides, and when that happens they should try to eat more bland foods such as saltines, bananas, rice, or bread. Make sure they get plenty of rest, and symptoms should clear up on their own. If their symptoms last more than a few days, tell them to visit a doctor, either at Baldwin or elsewhere.