When a gunman opened fire on a crowd of concertgoers in Las Vegas in October 2017, Capt. Philip Taurisano of the Utica (N.Y.) Fire Department knew it was time to accelerate the long-standing discussion of acquiring ballistic protection for his personnel into reality.
Approaching his chief with the thought of reallocating funds that had been earmarked for an emergency ATV, Taurisano was determined to convince decision-makers that keeping his crew members safe on the job was a wiser spend for his department, which runs 10,000 EMS calls a year. After tenacious market research, Taurisano decided on ballistic plates built by Veterans Manufacturing to keep his personnel safe in unpredictable situations.
“We wear them like turnout gear,” explains Taurisano, meaning that as soon as a call comes in, the decision is made based on the circumstance of the call whether to don the vest over the provider’s uniform. Personnel are not sent into any scenarios or situations they hadn’t responded to previously, so no additional risk is taken on. It’s simply an added measure of protection, says Taurisano.
Each riding position in the department’s five ambulances is equipped with a vest. Taurisano decided to go with armor plates and one-size-fits-all vests from Veterans Manufacturing because of the 10-year guaranteed shelf life, comfortable, lightweight design, responsive customer service, and ability to carry shears, tourniquets, hemostatic agents and other lifesaving tools in the vest’s pockets. Providers can also don helmets at their discretion.
“I can’t see not justifying the cost of this equipment at your agency,” says Taurisano, who is looking to acquire 20 more vests. “We don’t ever want to say after something happens, ‘We wish we’d done something earlier.'”
When it comes to saving lives, quick vascular access is vital. Every second lost trying to find a usable vein puts the patient at increased risk. The longer it takes to find the vein and start delivering blood, IV fluids, or life-saving medicine, the more time patients spend in physical decline.
Even in the best of working conditions, it can be difficult for an EMS provider to find a patient’s vein. And often, providers find themselves trying to find veins in the worst of conditions—when it’s dark and the weather is bad, or in a remote location where the light is poor and the patient’s skin is covered in blood and dirt.
James G. Vretis II, DO, medical director for the Center for Tactical Medicine in Carlsbad, Texas, and medical director for the San Angelo Fire Dept., understands the challenges of vascular access in crisis situations. “I’ve been an emergency physician in trauma medicine for the last 38 years,” he says. “There are times when you just can’t find a vein on a patient; such as a renal failure patient who has had so many IVs that you just can’t identify a usable vein.” And time matters, because every second an unconscious diabetic patient with low blood sugar goes without a vascular sugar infusion, the closer they get to irreversible harm and death.
This is why Vretis is a big believer in intraosseous vascular access— Piercing the bone to access the bone marrow space to create a vascular pathway quickly and reliably.
The Arrow® EZ-IO® Intraosseous Vascular Access System from Teleflex is a hand-held pistol-style device whose power driver and needle/catheter drill into the proximal humerus, proximal/distal tibia, or distal femur* to connect an IV needle/catheter directly into the patient’s bone marrow.
“This device allows EMTs to get fast vascular access on a patient that you can’t find veins on,” says Dr. Vretis. “If I wanted to give someone IV fluids in a hurry and they’re in shock, instead of digging around for a vein for critically important minutes, I can just do the intraosseous approach. Quite literally in seconds, I can get a line started where we can give fluids or meds, or whatever.”
The Arrow® EZ-IO® System comes with three different needle/catheter length options (15/25/45 mm) for patients of different ages and body sizes.
Insertion is as straightforward as selecting the appropriate needle/catheter length and attaching it to the Arrow® EZ-IO® Driver. “You then put the device to the patient’s proximal humerus, push the needle until you hit the bone, pull the trigger on the driver to drill into the bone, and 1–2 seconds later, you’re in the marrow cavity of the humerus,” says Vretis. “You can then connect a line to the catheter and start pushing fluids into the patient.”
The Arrow® EZ-IO® System procedure is very easy to learn, he added. “The training to use the EZ-IO® System usually only takes about an hour per person, at most.”
To learn more, go to www.teleflex.com/ezio.
*Distal femur insertion site for the EZ-IO® System is only indicated for use in pediatric patients. James G. Vretis is not a paid consultant of Teleflex.
Streamlined Security for Controlled Substances
If your crews are fed up with keeping track of multiple key sets for controlled-substance lockboxes and keeping records of user access, Tec Solutions may have the streamlined security system your department needs. Tec Solutions specializes in wireless access control, providing EMS and fire departments reliable systems that ensure controlled substances and patient records are only accessible to those meant to access them.
Larry Baumgart, EMT-P, operations manager of Mercy EMS (N.Y.), says Tec Solutions was the best fit for his agency. The company installed its NarcLocks, which are electronic wireless access-control locks, in the controlled-substance safes in all agency ambulances, fly cars, helicopters, and building safes. “Ease of installation, size, and no need for a power source were major factors” in choosing Tec Solutions, says Baumgart.
“Tec Solutions’ programming hubs and chargers are also at each building, which allows us to utilize a minimal number of keys for the maximum number of employees,” says Baumgart. “The fact that the locks require no external power enabled us to also use them on our portable lockboxes.”
The NarcLock stores the last 1,100 authorized and failed access attempts in its memory, while the key fobs store the last 12,000, allowing administrators to produce detailed monthly audit reports of user access through an online management system. Because it’s web-based, admins can access this information from anywhere at any time. The platform allows users to assign keys to personnel (the locks can only be unlocked by authorized smart keys), view crew members’ access activity, and even make customized access schedules.
Another advantage of the access control system is its ability to retrofit a department’s existing lockboxes, so if your department is hesitant to make the switch for the sake of saving money and avoiding inconvenience, Tec Solutions has you covered.
“We were able to retrofit many of our existing lockboxes with very little modification and additionally added a NarcLock as a secondary lock to our wall safes,” says Baumgart. “Financially it was far less expensive to retrofit or modify than to purchase new safes, especially for the buildings. Retrofitting the NarcLocks was no more difficult than changing any standard cam lock.”
Baumgart says this is particularly beneficial to his department because it provides secure access control for both of its patient transportation services: “As Mercy includes both ground and air transport, we were able to use the administration software to ensure various levels of security and access were met.”
How many times have you sustained a back injury after lifting a patient? Chances are at least once, if you’re part of the unlucky half of EMS providers who fall in this category. To prevent these career-ending injuries from impacting more providers, the Binder Lift was invented and has since become an essential tool for many EMS professionals who lift and handle patients on a regular basis.
The Binder Lift is outfitted with features to ensure providers lift ergonomically. It has 19–25 handles so multiple crew members can assist in a lift, including removable leg straps for increased flexibility. And whether you purchase the nylon or vinyl lifts, both materials are 100% impervious to bodily fluids, making them easy to decontaminate with sanitary wipes.
Mark Nelson, an EMT and fire captain with the St. Louis Park Fire Department (Minn.), says his colleagues have experienced multiple advantages since purchasing the device.
“The Binder Lift encourages proper lifting technique, increasing our level of safety and stability,” says Nelson. “We have been able to achieve multiple lifts on the same patient, from floor to chair or bed, then to transport cot. This device provides multiple grab handles to utilize instead of using the patient’s underarms.”
Nelson says his department made the purchase after one of its firefighters told colleagues about the Binder Lift, which he’d used at another department where he works.
“We evaluated the lift, deployed two, and then expanded to six, one for each frontline apparatus,” says Nelson. “There was another lifting device we tried, but ultimately it was discarded due to complexity of use and other significant issues regarding patient comfort.”
Nelson’s department has learned the Binder Lift has improved the patient’s experience as much as that of the providers lifting them. Features facilitating this improved comfort include a cushioned top edge and a torso wrap that’s designed to offer stability to the patient while decreasing the risk of bruising, skin tears, or fractures.
Nelson’s crews most often use the regular (MX)-size lift, but they also use the XLT+ for bariatric patients, which lets them use more personnel to safely lift and provide an added level of comfort.
“We have experienced very positive feedback from our patients on how comfortable it is for them,” Nelson says, noting he would recommend the product to other departments. “The most important improvement has been patient comfort when lifting them.”
Violence struck close to home for Houston firefighters in January when four of their law enforcement counterparts were shot while serving a drug warrant. It more than justified the Houston Fire Department’s recent decision to obtain ballistic protection for its personnel in the field.
“We hope we never need to test the ballistic capability, but that was a perfect example of why we need the protection,” says Executive Assistant Fire Chief Richard Mann. “Those situations are chaotic in their early stages, and we need to provide our members with all the protection we can as they do their jobs.”
After field-testing some options, the department chose the F1 UFC (Universal Fire Carrier) ballistic vest from Covert Armor, along with optional hard armor plates (it comes with Level II/IIIA soft plates) and tactical helmets. It will distribute these to every frontline riding position—869 in total across all ambulances, fire apparatus, and other response vehicles.
A unique one-size-fits-all design will enable the full spectrum of providers to wear the F1s and negates the need for individual fitting, sizing, and customized design.
“I’ve literally put one on one of our largest individuals and one of our smallest, and the same vest can accommodate both of them,” says Mann. “Regardless of who’s in those positions every day, the vest will fit them. That’s a unique feature of it, and at the same time, regardless whether it’s a big or small person, it provides a minimum level of protection for each of them.”
Policy for wearing the vests is still in development, but they’ll likely be required for certain call types. One type that seems certain is more mass shootings. As the department evolves with current trends away from staging at such incidents and toward EMS penetration into warm zones, its personnel can do so with a bit more security.
“Clearing those scenes can take time, and a lot of lives have been lost in those incidents that were savable,” says Mann. “So the shift has been to get us in there quicker, to take care of people more rapidly. To do that safely, we need to provide our personnel the right equipment, and that includes ballistic protection.”