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 EMS Call for help - For safety sake; know when to ask for lifting or scene support!
DATE: January 2010
Many Wheelchair, paratransit drivers, EMTs and paramedics are injured every year because they attempt to lift or move patients improperly. Or, when circumstances warrant, without help. It is important that you know when to call for assistance. The need for additional support can vary depending on the patient's condition and the environment in which they are found.

In his article titled “Lift With Your Head” (August 2006, EMS Magazine) Dick Blanchet suggests the following examples of when to consider calling for additional help:

1. When the patient must be carried up a flight of stairs. Moving a heavy weight up is more difficult than moving it down. A stair chair is helpful, but a single caregiver at the bottom will not be able to maintain a good lifting position.

2. When you must carry the patient on a stretcher down three or more steps. A stretcher's wheels will usually span two steps. The weight of the stretcher can be borne by the back wheels as the front end is lifted, then by the front wheels as the back end is lifted.

3. When the terrain to traverse has obstructions. There might be debris in the way, or a steep slope.

4. When you must carry the patient out of the house on a backboard, such as after a fall. Lifting a heavy patient on a backboard from floor level can be high-risk for everyone. The patient is often frightened and can suddenly reach out, throwing your balance off.

5. Depending on the experience level of you and your partner. If my partner is well trained in lifting and we know each other's strengths and limitations, it will help guide our decision to request a lift assist. If you've never worked together before, additional hands are prudent.

6. With a heavy patient. By itself, this is not reason for a lift assist (if, for example, you do not have to lift the patient). However, a heavy patient who cannot move from the bed to the stretcher on their own should be a red flag. What is a heavy patient? That's in the eye of the beholder.

7. For patient comfort. An additional crew member can help minimize pain by providing support to the legs or head in a non-urgent transfer.

Mr. Blanchet points out, “just because additional help has arrived doesn't mean it will be used effectively”. It is critical that you take the time to brief your fellow caregivers on the patient's injury and your lifting plan. He also notes, you should “discuss the route you'll be using to take the patient out of the house and to the vehicle.

Janel Scarbrough EMT-P

Accidental needlesticks or cuts can lead to hepatitis B virus infections or HIV: Don’t Take Your Work Home with You
DATE: February 2010
According the New England Journal of Medicine, a victim of a needle stick single has a 2% to 40% chance of contracting Hepatitis (chances of Hepatitis C are 2.7% - 10% and HIV are 0.2% - 0.44%). We’ve learned that most needlesticks can be easily avoided. However, needlestick injuries are far too common. Available statistics probably underestimate the severity of the problem because many EMS and healthcare workers do not report their injuries.

The majority of needlestick injuries occur during the following procedures: IV insertion, blood collection, IM/SQ injections, and sharps disposal. It’s important to ALWAYS be considerate of others when exposing a needle. Dispose of all used needles and sharps in the appropriate containers.

Most importantly, expect the unexpected. Be extra careful during emergent situations. Always keep exposed needles pointed down and away from yourself and others. Alert co-workers when you have a needle or sharp in your hand.

To prevent needle stick injures:
· Be careful when handling needles, scalpels, and any other sharp objects.

· Do not put the cap back on a used needle; do not bend or break a needle by hand, and do not take the needle off a disposable syringe.

· Put all sharp objects in a special holder that only contains sharp items.

· Always wear gloves when you touch anything that has blood or other body fluids on it.

If you stick yourself with a needle used on a patient, report it immediately. Both you and the patient should be tested for hepatitis and HIV infection. Contact the office as soon as possible. Always wash well with soap and water. We will get you an appointment with a doctor for exam or if none are available, we will send you to the ER for evaluation. Always wright up an incident report.

Janel Scarbrough EMT-P

Aggressive driving: Avoid the challenges or confrontations of an aggressive driver
DATE: March 2010
According to Road and Travel Magazine, “fully one-half of drivers who are subjected to aggressive driving behavior on the road respond with aggression of their own, thus risking a more serious confrontation.” The National Highway Traffic Safety Administration (NHTSA) defines aggressive driving as "the operation of a motor vehicle in a manner that endangers or is likely to endanger persons or property". Examples also include speeding or driving too fast for conditions, improper lane changing, tailgating and improper passing. This type of behavior often escalates into Road Rage. In the U.S., approximately 6 million vehicle crashes occur each year as a result of aggressive driving. Nationally, each year Road Rage kills and injures thousands of motorists for seemingly trivial reasons.

Not surprisingly, the best way to avoid an incident with an aggressive driver is to keep your cool in traffic, be patient, and correct unsafe driving habits that are likely to antagonize or provoke other motorists. Be the bigger person…. Drive away safely without endangering your patient, your partner or yourself. Safety always comes first. And remember, even when going "lights and sirens" you still have to ask permission for the right of way, stop at all yield signs, intersections, and stop signs. Always use due regard. Always travel at a safe speed, and take into consideration weather, road conditions, and traffic.

Janel Scarbrough EMT-P

Pedestrian and Bicyclist Safety

DATE: April 2010
This month our safety campaign illustrates Pedestrian and Bicyclist Safety.
The following represents pedestrian and bicycle accident statistics for the United States according to the National Highway Traffic Association and the Insurance Institute for Highway Safety.

· Pedestrian fatalities account for 11% of motor vehicle fatalities, comprising the second largest category of motor vehicle accident deaths following occupant deaths.

· Bicyclists accounted for 14% of all non-occupant traffic fatalities

· Over 180,000 pedestrians have been killed in motor vehicle accidents since 1975

· On average, a pedestrian is killed in a traffic accident every 111 minutes.

· About 53,000 bicyclists have died in traffic crashes in the United States since 1932.

Each year, more than 500,000 people in the US are treated in emergency departments, and more than 700 people die as a result of bicycle-related injuries. Children are at particularly high risk for bicycle-related injuries. Children 15 years and younger normally account for 59% of all bicycle-related injuries seen in US emergency departments. And, unlike adults, they do not have the experience of driving themselves and may not understand the rules of the road such as stop signs. Use particular caution when you see children on bicycles.

All of us agree it’s important to pay careful attention and avoid accidents involving pedestrians or bicyclists. Regardless of the importance of any transport, always drive cautiously when pedestrians or bicyclists are near because they may cross your path. Even when driving under emergency conditions, respect the right-of-way of pedestrians.

Janel Scarbrough EMT-P, PA-C, FF

Roadway Construction Diversions and Work Zone Safety
DATE: May 2010
It’s orange barrel season again. Each year, over 8oo deaths occur from motor vehicle crashes in U.S. road construction work zones. The people who work each day in roadway construction sites are often at the mercy of drivers. Roadway construction sites offer relatively little protection for police officers, utility workers and construction workers who call the “work zone” their office.
As a professional driver in the medical transportation industry, you need to help set the tone for safe driving in work zones. Besides paying attention to the orange diamond-shaped warning signs or electronic message boards in a road construction project, you should:

· Minimize distractions. Avoid changing radio stations, using a cell phone, etc. while driving in a work zone

· Drive carefully and slowly through the construction site; at the posted speed limits

· Watch closely for the work zone flaggers

* Stay alert. Dedicate your full attention to driving

· Most importantly, watch for stopped or slowing traffic. Do not tailgate. Unexpected stops and tailgating are two of the leading causes of injuries in work zones.

· This summer, keep an eye out for construction workers, their equipment and vehicles. Let them go home to their families after a day at the office!

Janel Scarbrough EMT-P

Staying Focused While Driving
DATE: June 2010
A moving vehicle equates to thousands of pounds of moving mass and velocity. As a driver, you are responsible for the safety of the people in your vehicle, those sharing the road and yourself. It is up to you to make sure your vehicle does not injure or kill others, or damage their property. Consistently paying attention makes it possible for you to see, recognize and avoid the hazards of the road. The primary attribute for a safe driver is alertness. The ability to pay attention, even in routine driving situations is one of the most important driving tasks.

When you drive… try concentrating solely on the driving task. Think of nothing else. Unfortunately it’s not easy. Paying attention while you drive must become a “habit”. In his book Defensive Driving Rule #1: Pay Attention, Bob Schaller points out, “Paying attention can become a habit, but you have to work at it.” According to Mr. Schaller, you must “make conscious, persistent choices NOT to eat while driving, or whatever you do that takes your attention off where your moving vehicle is pointed”. This is called maintaining "situational awareness."

Inattentive driving is extremely dangerous. The discipline of driving deserves your full attention.

Janel Scarbrough EMT-P

Dialysis patients... You make a life-changing difference!
DATE: July 2010
Dialysis transports can sometimes be perceived as routine. However, nothing could be more dangerous for a Dialysis Patient than complacency on the part of the caregiver. Please consider the following:

· When it comes to Dialysis Patient’s, infection control is a primary concern. This begins with caregiver hand washing prior to any contact with a Dialysis Patient. During a so-called “routine transport” there are many opportunities for the spread of infectious agents. Make sure you are current on the company infection control policies and practices.

· Dialysis Patients are especially prone to hypotension, thus likely to sustain falls when left unattended. Dialysis Patients deserve exceptional attention to detail, especially in regard to their personal safety.

Lastly, please do your best to help provide timely transportation to Dialysis Patients. Patients receiving dialysis treatment can be susceptible to depression. Waiting over long periods of time for transportation to arrive can be agonizing.

Janel Scarbrough PA-C, EMT-P

You Work in a Dangerous Place…scene safety is your top priority
DATE: August 2010
As EMS providers we sometimes fail to appreciate the serious hazards routinely faced while providing patient care on the roadside. Unfortunately any roadside accident scene has the makings of a “secondary incident”, putting you and your co-workers at risk.
Preplanning is fundamental to effective roadside safety and scene management. For example, as you arrive at a scene, account for possible use of traffic detours. If law enforcement has not arrived, assign someone to manage traffic flow.
To minimize the potential of a secondary incident, scene communication and cooperation is essential. Also, make certain your vehicle is visible to oncoming traffic by properly positioning your vehicle, using warning lights and immediately deploying safety cones and reflectors. And, always wear a Class II Reflective Safety Vest at every roadside scene!

Janel Scarbrough EMT-P

Excessive Speed - A tool of inexperienced, over-eager drivers
DATE: September 2010
Every year throughout the United States, there are numerous emergency and non-emergency medical transportation vehicle accidents which occur due to excessive speed. According to the National Highway Traffic Safety Administration (NHTSA), “Speeding is one of the most prevalent factors contributing to traffic crashes…. The economic cost to society of speeding-related crashes is estimated by NHTSA to be $40.4 billion per year. Speeding is a contributing factor in 30 percent of all fatal crashes”.

Some EMS drivers often speed to reduce response times. However, the experienced driver understands the absurdity of exceeding the limits of safety to arrive a moment earlier. There is no sound reason for putting a patient, your co-workers, or the public at risk.

In the old west there was a saying… “No matter how good you think you are, if you get in enough gun fights, you’ll eventually lose”. The same can be said for drivers who routinely resort to excessive speed; you will eventually lose and someone can get hurt.

If the potential for needlessly injuring another person does not get the attention of speeding drivers, maybe the liability is worth considering. When an injury accident occurs as the result of excessive speed, it’s also likely a personal injury lawsuit will be filed. Aside from the liability to the medical transportation or EMS organization, the speeding driver faces the potential of being charged with a crime. This could result in enormous legal bills for the driver to defend him or herself in a criminal prosecution.
Janel Scarbrough EMT-P

Take out your Trash
DATE: December 2010
Ambulance and medical transportation crews are expected to ensure that their vehicles are always clean and serviceable. However, in our daily routines in which we literally “live” in our vehicles…trash happens. Clutter begins to collect between calls, sometimes papers and wrappers end up in every possible pocket or under seats. We sometimes forget that trash is also an unsafe and potentially harmful element. Continuously removing trash and debris from your vehicle throughout your shift reduces the chance of injury and the spread of infection.

Simple as it seems, keeping an ambulance clean prevents a lot of debris from settling into hard to reach places. This can make decontamination efforts more successful, lessening the hazard for both patients and crews. Trash and debris can also get caught under the brake or gas pedal causing a crash hazard.

As the weather turns colder, trash seems to pile up faster in our vehicles. For the sake of your patients, your fellow employees, and yourself, please be vigilant about vehicle cleanliness.

Squad check, cleaning and daily maintenance should be preformed at the start of your shift (regardless of what time you come in- example 8am, noon, 5pm). Due to the drain issues we have to wash the squad quickly outside and then placed in the garage before they freeze.

Remember that keeping crew areas, garage and supply areas are important as well.

Also- plug in squads after each run and bring in medic equipment and IV supplies so they don't freeze.

Life Line Medical

7 Things to never say to your Boss:
Karen Burns, On Wednesday March 17, 2010, 11:19 am EDT
A big part of maintaining the boss-employee relationship is to never allow a boss to think you dislike your work, are incapable of doing it, or--worse--consider it beneath you.These sound like no-brainers, but many statements heard commonly around the workplace violate these basic rules. Looking for an example? Here are seven heard in workplaces all the time. They may seem ordinary, even harmless. But try reading these from your boss's point of view. You'll see right away why it's smart to never allow these seven sentences to pass your lips:

"That's not my job."
You know what? A lot of bosses are simple souls who think your job is to do what's asked of you. So even if you're assigned a task that is, indeed, not your job, refrain from saying so. Instead, try to find out why your boss is assigning you this task--there may be a valid reason. If you believe that doing the task is a bad idea (as in, bad for the company) you can try explaining why and suggesting how it could be better done by someone else. This may work, depending on the boss. In any case, remember that doing what's asked of you, even tasks outside your job description, is good karma.

"It's not my problem." When people say something is not their problem it makes them look like they don't care. This does not endear them to anybody, especially the boss. If a problem is brewing and you have nothing constructive to say, it's better to say nothing at all. Even better is to pitch in and try to help. Because, ultimately, a problem in the workplace is everyone's problem. We're all in it together.

"It's not my fault." Yet another four words to be avoided. Human nature is weird. Claiming that something is not our fault often has the result of making people suspect it is. Besides, what's the real issue here? It's that something went wrong and needs to be fixed. That's what people should be thinking about--not who is to blame.

"I can only do one thing at a time." News flash: Complaining you are overworked will not make your boss feel sorry for you or go easier on you. Instead, a boss will think: (1) you resent your job, and/or (2) you aren't up to your job. Everybody, especially nowadays, feels pressured and overworked. If you're trying to be funny, please note that some sarcasm is funny and lightens the mood. Some just ticks people off.

I am way overqualified for this job." Hey, maybe you are. But the fact is, this is the job you have. You agreed to take it on and, while you may now regret that decision, it's still your job. Complaining that it's beneath you only makes you look bad. Plus, coworkers doing similar jobs may resent and dislike you. And guess what? Bosses will not think, "Oh, this is a superior person whom I need to promote." Nope, they'll think, "What a jerk."

"This job is easy! Anyone could do it!" Maybe what you're trying to convey here is that you're so brilliant your work is easy. Unfortunately, it comes off sounding more like, "This work is stupid." Bosses don't like hearing that any work is stupid. Nor do they really like hearing that a job is easy peasy. It belittles the whole enterprise. If a task is simple, be glad and do it as quickly as you can. Even "stupid" work needs to get done.
"It can't be done." Saying something can't be done is like waving a red flag in a boss's eyes. Even if the thing being suggested truly is impossible, saying it is can make you look ineffectual or incapable. Better to play detective. Why is the boss asking you to do whatever it is? What's the problem that needs to be solved? What's the goal? Search for doable ways of solving that problem or reaching that goal. That's what bosses really want. Most of them do not expect the impossible.Last words: When in doubt, remember that silence really is golden.Karen Burns is the author of the illustrated career advice book The Amazing Adventures of Working Girl: Real-Life Career Advice You Can Actually Use, recently released by Running Press. She blogs at

Required Reading:
Posted July 2010

Back To Basics: “True Emergency” And “Due Regard”
Emergency Vehicle Operations
Michael Wilbur, Firehouse® contributing editor (April 2003)

What is a "true emergency" and how does it affect me as an emergency vehicle operator?

Most states’ vehicle and traffic laws define emergency operations this way: "The operating or parking of an authorized emergency vehicle when such vehicle is engaged in transporting a sick or injured person; transporting prisoners; pursuing an actual or suspected violator of the law; or responding, working or assisting at the scene of an accident, disaster, police call, alarm of fire,
actual or potential release of hazardous materials or other emergency. Emergency operations shall not include returning from such service".

If an accident occurs, an emergency vehicle operator is likely to be judged in this way: "Did you have reasonable grounds, based on dispatch information and personnel experienced to believe that you were responding to a TRUE EMERGENCY?"

What is a TRUE Emergency?

According to the U.S. Department of Transportation (DOT) Emergency Vehicle Operators Course Instructor's Manual, "a TRUE EMERGENCY is a situation in which there is a high probability of death or serious injury to an individual or significant property loss, and action by (you) an emergency vehicle operator may reduce the seriousness of the situation."

If you are involved in an accident or property damage, injury or loss of life occurs, your actions will be evaluated and judged by your department and the citizenry you serve. In most cases, your actions will be judged in the court of law, whether it is a civil court or criminal court, or both. A court will judge your actions from at least two aspects: Was the situation a TRUE EMERGENCY? And did you exercise DUE REGARD for the safety of the others?

According to the DOT manual, "Due Regard is based on circumstances". In judging "DUE REGARD," the principal criteria used are: Was there "enough" notice of approach to allow other motorists and pedestrians to clear a path to protect themselves? If you do not give notice of your approach until a collision is inevitable, you have probably not satisfied the principal of due re-
gard for the safety of others.

In determining whether an emergency vehicle operator was exercising due regard in the use of signaling equipment, for example, the courts will consider, the following points:

A. Was it reasonably necessary to use the signaling equipment, given the circumstances?
B. Was the signaling equipment actually used?
C, Was the signal audible and/or visible to motorists and pedestrians?

A widely accepted way of determining "due regard" is, "A reasonably careful man performing similar duties and under the same circumstances, would act in the same manner."

How many of your calls are true emergencies? The answer very few, ironically whether you are a career firefighter in New York City, Bowling Green, Kentucky, or Phoenix, Arizona, or a volunteer firefighter in Fuller Road, Lansing, Bethpage, Middle Hope, Howells or Otisville, the percentage of true emergency calls is the same, on average about 2% to 5%. Generally, career depart-
ments do far more runs than their volunteer counterparts; however, the percentage of true emergency calls is the same regardless of where you are performing those firefighting duties.

So, one would ask the question why are the fire trucks, police cars and ambulances using their lights and sirens almost 100% of the time, when true emergencies make up only 2% to 5% of the total call volume? Why are emergency vehicle operators consis-
tently abusing the privilege (yes it is a privilege) of using emergency lights, sirens and air horns on non emergency runs?

When asked these questions as I teach around the country, the answers are pretty much the same: I am safer using the warning equipment when I drive, the apparatus is not covered by insurance unless we use the warning equipment, it's not really a call if we don't use the warning devices, it's not really a fire truck without the lights and sirens on, we are in a hurry to get back to the
station to eat, I have to get back home in a hurry, it's not thrilling enough, I can't get my adrenaline fix without the lights and sirens, I'm a volunteer firefighter and nobody can tell me how to drive, I have to beat the other companies in, I'm first due, response time isn't everything it's the only thing, etc.

The excuses are many and as varied as the firefighters who drive fire apparatus, but NONE of the excuses are valid, not one. The reality is that with lights and sirens on you are statistically four times more likely to get into an accident and that there is a 10 times more likelihood of serious injury and/or death within the confines of that accident, perhaps even firefighters. Apparatus
operators should embrace and be relieved every time they respond without lights or sirens.

Moreover, it is a fact that drugged, drunken and fatigue drivers aim for and run into red flashing lights (visit the website for more information on struck by incidents), so the idea of being safer with the red or white flashing lights is simply NOT true. Instead, you and your apparatus become a target.

Another excuse that I often here is, "the apparatus will not be covered (insured) without the lights and sirens on." Again, this is simply not true. All of the major fire apparatus insurance companies have programs that highlight dangers of over-responding (sending apparatus that is not needed), the abuse of lights and sirens and offer recommendations on proper response procedures.

Next time, we will offer recommendations on proper response policies that are in line with the definition of a true emergency. For more information on emergency vehicle driving, aerial apparatus placement or apparatus consulting visit our web site at

Remember Life Line Medical can provide First Aid Classes, Health Care Provider CPR, and Heartsaver CPR for your group, club, or organization. 3 person minimum. Click Here for more information.

*If you want your info/Continued Education posted onto our website please email me at

Happy EMS Week!!