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Patient Care

Product Applications From the Field: March 2020

Combat Medical

Rugged Solution to Traumatic Bleeding

When you have a patient with severe hemorrhaging of an extremity, you want a reliable, tried-and-true tourniquet to stop the bleeding.

Combat Medical’s Tactical Mechanical Tourniquet (TMT) is designed with just that in mind, combining safety and effectiveness. 

“The TMT was developed to address the shortcomings of currently fielded tourniquets as a response to reports from military operations,” says David Saxman, clinical training manager at Combat Medical.

Based on research conducted by the U.S. Army Medical Research and Development Command (formally known as the U.S. Army Medical Material Development Agency) on the use of tourniquets in the battlefield, the TMT was developed to ensure efficacy when applied to yourself or your partner.

This encompassed meeting or exceeding the list of minimal essential characteristics (MECs) established by the Army’s Joint Tourniquet Working Group.

According to Saxman, the user will achieve better occlusion at a lower pressure due to the TMT’s width being double that of other common tourniquets’ internal bands. This also allows the patient to be more comfortable, and pressure loss and slippage are avoided by a locking mechanism in the torsion bar.

Constructed out of copolyester resin supplemented by UV and IR protection, the TMT is long-lasting and capable of enduring harsh conditions. 

Users may find other tourniquets less effective than the TMT because of its integrated speed buckle, which allows easier one-handed application. Saxman says,

“That allows it to be applied faster than most tourniquets and makes it intuitive to use and easy to operate in a high-stress environment," he says.

Additionally, the Junctional Hemorrhage Control Plate is slated to be released soon as a supplement to the TMT. “This added capability will provide an undeniable lifesaving advantage over all other tourniquets on the market,” says Saxman. 

Columbia Southern University  

Online Education to Prepare Tomorrow's EMS Leaders

Columbia Southern University's degree programs in emergency medical services administration are designed for EMS professionals who are seeking a leadership or administrative position in the EMS field.

Taught by industry experts, these educational programs cover several areas of EMS systems, including leadership, planning and development, risk management, and administration.

“The flexibility of the program around current professional and personal life was the driver for choosing CSU,” says Daniel Tyk, who earned his Bachelor of Science in Emergency Medical Services Administration with CSU in 2017.

“Moreover, the reputation for effective and economic education offerings made CSU an obvious choice. Their partnerships with organizations like my fire department make it easy for career-driven individuals to pursue further education.”

Tyk is currently captain, EMS manager, and public information and community relations officer for North Shore Fire-Rescue in Whitefish Bay, Wisc. He recommends CSU educational programs to any EMS professional looking to advance their personal and professional life.

“I believe in being a lifelong learner,” says Tyk. “The programs offered at CSU allowed me to meet my goals in my personal life (being present for my family), while still allowing me to achieve excellence and education in my professional life. In a world where technology and information are ever-changing, I believe continued education is essential to professional and personal growth and success.”

CSU is geared toward providing education in specialized areas for adult learners and has trained its faculty in assisting students as much as possible.

“I've found ways to apply what I have learned both in my career and at home,” comments Tyk. “These lessons are invaluable and are lessons I have not found at other educational institutions. CSU faculty has been overwhelmingly responsive and helpful when I had questions. I would recommend CSU to anyone currently in a career but looking for advancement in knowledge and skill.” 


An Equal Learning Experience

The Sacramento Fire Department recently switched between makers and models of popular monitor-defibrillators. That entails a certain reeducation curve, as crews, supervisors, and trainers all learn the new devices. 

A big piece of its resuscitation training will adjust very simply, though: Scenarios posed to newcomers during their field evaluations can replicate the new hardware with the push of a button. 

That’s one key feature of the REALITi360 platform from iSimulate, which the department recently acquired and will deploy in coming months: It can mimic the appearance and function of proprietary monitors and defibrillators from a range of popular makers, including ZOLL, Physio, Philips, and corpuls.

Based on two iPads, the REALITi system provides a patient simulator, CPR feedback, and video. Additional modules add CPR feedback, live video streaming, and simulated patient records. Ectopic beats, arrthymias and artifacts can be added to any waveform, and the whole package is wireless, battery-driven, and portable enough to go in an ambulance. 

It will let evaluators craft and preload scenarios to suitably challenge their students and new hires, as well as create and change them on the fly. In this way they can ensure everyone they’re evaluating gets calls worth judging. 

As it is, one new provider might get multiple codes during those first shifts, while another gets nothing worse than a skinned knee. 

“You never know what you’re going to get in the field,” says Capt. Rob Walters, who oversees the department’s EMS training. “We’ve had times when instructors felt they couldn’t properly evaluate a rookie because they didn’t get any calls that required critical thinking or ALS-level care. But you’re rendering the same evaluations to people and trying to decide whether they’re ready to be paramedics with the department.”

What this does is make the playing field level: New providers will take the same tests, so to speak.  

“We’ll create and load up these scenarios and send them out with the instructors,” says Walters, “and they can initiate the evaluation at the beginning of the shift with this device, run through evaluation of the standardized scenario, and then run the rest of the shift and see how things go.”  

North American Rescue 

Blood and Fluid Warmer Is Light, Powerful, and Easy to Learn

Carrying whole blood products is becoming a reality for many EMS systems. And for those, it is a life-saving intervention service leaders count on to get severely injured or ill patients help before they lose critical perfusion.

“We are quite rural and far away from a trauma center,” says Stephen Rahm, NRP, chief of the Office of Clinical Direction and co-chair of the Centre for Emergency Health Sciences (cEHS), a Spring Branch, TX-based biomedical education and research facility that enables providers to practice emergent procedures on human cadavers. Rahm’s office works closely with Bulverde Spring Branch Emergency Services (BSBES), investigating the newest innovations on the market and assisting in designing agency protocols.

After investigating other systems, Rahm decided on the Quantum Blood & Fluid Warming System from North American Rescue. The Quantum consists of thermal administration sets with dynamic sensing elements to ensure constant normothermic fluid delivery. It has an operational weight of just 22 total ounces, yet it can deliver one unit of warm whole blood in approximately 5 minutes. After a warm up period of less than 30 seconds, the output temperature of the blood is approximately 100.4°F. A fully charged battery will allow for the transfusion of two units of blood.

“The warmer is in the tubing itself, which was very appealing,” says Rahm, adding that the unit’s small size and portability were other selling points. 

The learning curve isn't steep, says Rahm—start an IV and simply plug it into the system’s tubing, which is connected to a battery. Training videos break down the steps. At BSBES, one unit of blood is carried by the battalion chief in a quick response vehicle. Protocols are established by the system’s medical director, and parameters such as blood pressure, heart rate, and shock index determine if a transfusion is indicated. If the blood is not used in a two-week period, it's sent to a level 1 trauma center to minimize waste. 

Instituting whole blood requires an entire system to come together, says Rahm, adding there is published research supporting blood transfusion in the military setting, and emerging evidence in the civilian setting. “As an agency, we’d like to offer this precious commodity to our patients,” he says. 


Safely Secure Portable Medical Devices  

Space in the back of an ambulance is limited. Paramedics often have to reach over patients to grab items. Medical devices are on the floor and could easily be stepped on. Sometimes equipment is placed on the stretcher. All of this creates an unsafe environment. Technimount Solutions offers a safer way to transport devices without affecting crews’ work.

The Stretcher Safety Arm mounting system for Stryker stretchers allows users to securely position medical devices such as defibrillators directly on the stretcher. Not only is it out of the way, but it can easily be transported from place to place.

Justin Reed, EMS chief for the Cy-Fair Volunteer Fire Department in Texas, was immediately sold on the device after watching a demo on YouTube. 

“We needed a solution to get the monitor off the floor and onto somewhere it would be secured,” he says.

Technimount representatives met with Reed at Pinnacle 2017 in Boca Raton, Fla., to demonstrate the Safety Arm in person. Cy-Fair ultimately purchased the device for its entire fleet of 20 ambulances. 

“The device has been a game-changer for our crew. They don’t even notice it’s a new piece of equipment because it’s so functional,” says Reed. “Having that arm there to get the monitor out of everyone’s way helps us in every single aspect.”

For the patient, he explains, it places the monitor in front of them, allowing the paramedic to better engage in dialogue with the patient about what is happening. 

“With that monitor front and center, you can also show the patient their blood pressure and heart rate,” he says. “In addition, the real estate in an ambulance is prime, and having the monitor out of the way opens up the square footage we need. It’s out of the way—out of sight and out of mind.” 


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