Tuesday, April 27, 2021

At the CPR Demonstration at DSCC We Learned the Survival Rate for Sudden Cardiac Arrest in Dolan Springs is Near Zero and What WE CAN Do.

Dolan Springs Needs AED’s

We learned a lot at the recent first aid film and CPR demonstration at the DSCC. We discussed the survival rate for cardiac arrests and it’s not good, only 3% to 10% nationwide and closer to zero here.


Again It’s NOT the Fire Districts Fault.

It’s because we decided to live in a rural area with long response times. BUT teaching CPR to increase th
e availability of effective CPR and early defibrillation by citizens using an AED can improve this situation.
If you suffer a sudden cardiac arrest the ONLY thing that will save your life is the rapid use of an AED, and you don’t have a lot of time 5-10 minutes.

Timeline...
If someone collapsed at the DSCC from a sudden cardiac arrest it would take 1-2 minutes for someone to recognize the problem and make the decision to call 911. Hopefully someone would start CPR at this point.

It would take another 1-2 minutes for 911 to answer the call and transfer you to fire dispatch. There it would take another 1-2 minutes for you to explain the problem. We're at 3-6 minutes...

Fire dispatch would alert the crew, it takes 1-3 minutes to get the door up and the ambulance in route. 
We're at 4-9 minutes as they leave the station.

The Crew is Just Leaving the Station


It's three miles from Station 41 to the DSCC, so it would take the ambulance about 4 minutes to arrive at the DSCC and 1-2 minutes to offload equipment. 

That's 9-15 minutes for the ambulance to arrive at a call only three miles from the fire station. 

That's why we need to teach everyone effective CPR and place AED's at the DSCC and other local businesses. 
Again It’s NOT the Fire Districts Fault.








Saturday, April 24, 2021

First Responders and Rugged Phones - Who Ya Gonna Call With a Broken Phone?

I shake my head when I see people using their phone with cracked screens, but I cringe when I see first responders with using one. 

First responders need phones that work anytime and every time, so they need a rugged case or a rugged phone.

I'm hard on phones and tablets. I broke two phones and a tablet in a week, so we buy rugged phones now. it's just less expensive. 

I carry a Sonim XP8. It's a rugged phone and I can attest to that because I've dropped it so many times. 

I love this XP8 review they say "We put the Sonim XP8 through the wringer. We dropped it on concrete several times, jumped on it, skipped it across a small pond, and it only suffered a couple of scuffs". 

I know most Androids are not water resistant, but there are Android based rugged phones that are water proof. iPhones 7 and later models say they're splash proof. Splash proof?

There are many rugged Android phones on the market but only rugged cases are available for iPhones. Like the Xciel has rugged iPhone cases that are water proof and drop resistant but spending $725 for a case for a $1000 iPhone is out of my price range.

The Blackview BV9900 Pro rugged phone is $500 but has FLIR for firefighters. 

The Sonim XP8 is $699 at AT&T or around $200 used on eBay AT&T is the FirstNet service provider. 

In day to day operations if a firefighter breaks a phone they get a new one the next day. In a disaster if a firefighter breaks a phone it may be days to weeks to get a new phone. 

So First Responders Please STOP Buying Breakable Phones 

This is a Uniden UV350 Mobile Android Phone on FirstNet it's made for first responders with external antennas for phone and GPS for extended range in rural areas where first responders work on the fringe of cellular coverage.



The New Uniden UV350 Smartphone/Radio blurs the line between two-way radios and smartphones with GPS and it's Bluetooth PTT Push-to-Talk microphone and PoC Push-to-Talk over Cellular service it's the future of first responder communications.







Wednesday, April 14, 2021

Studies Show survival to hospital discharge was greater in those treated by BLS

I see on the LMRFD minutes Larry Tennant was demanding a paramedic in Meadview.. WHY 

Studies show Paramedic vs EMT Survival Rate Your chances may be better with an EMT and rapid transport...

Over 80% of calls are EMS calls and 80% of those BLS calls. 

Truth is There is little difference between the survival rate of patients treated by an EMT using Basic Life Support or a Paramedic using Advanced Life Support.'

If fact the study says you have a 2.51-fold increased odds of dying if treated with ALS care rather than BLS

Cardiac Arrest Survival 

The findings from the OPALS trial are consistent with those of an observational cohort study of a sample of Medicare beneficiaries who experienced OHCA done by Sanghavi et al. from 2009 – 2011 

[7]. The authors found that survival to hospital discharge was greater in those treated by BLS (13.1% v 9.2%) [7]. Ninety-day survival (8.0% vs 5.4% ) and neurologic function among hospitalized patients (21.8% vs 44.8%) were also found to be greater in the BLS group [7].

MAJOR TRAUMA

They found no substantial difference in survival to hospital discharge between BLS an ALS care (81.8% for BLS v 81.1% for ALS). In fact, in those with GCS <9 ALS care increased mortality (60.1% v 51.2%).
The reasoning for this may be due to delayed hospital transport while ALS interventions are performed on scene or complications of endotracheal intubation. A meta-analysis by Lieberman et al performed before the publication of the OPALS trauma study came to the same conclusion – there is no benefit to on-site ALS intervention for patients with major trauma [12].

The authors also postulate that the delay in definitive care to perform ALS interventions on scene is the underlying cause of the findings. A more recent study by Rappold et al evaluated survival in patients with penetrating trauma in an urban environment who were transported via ALS, BLS or police [13]. Their findings are consistent with previous data. They found the overall adjusted OR identified a 2.51-fold increased odds of dying if treated with ALS care. The outcomes of these studies emphasize that definitive care for severely injured trauma patients is most likely to be in the operating room rather than on the side of the highway.

Additionally, as our knowledge evolves about the effect of permissive hypotension in trauma patients, the findings supporting BLS care as optimal make more and more sense [14,15].

TAKE HOME POINTS ON ALS VS. BLS CARE

The standard of EMS care has evolved over time towards ALS level care in many communities around the world. To justify the cost of maintaining this level of care and skill for providers there should be considerable improvements in patient-oriented outcomes, such as neurologically intact survival after out of hospital cardiac arrest and decreased morbidity and mortality after major trauma.

The results of several large studies question the benefit to ALS interventions when BLS care is optimized. Review of the literature suggests that an understanding by EMS systems and providers of what interventions lead optimal outcomes is more complex than just the distinction between BLS and ALS care.

Some patients will benefit from advanced interventions such as fluid resuscitation and dysrhythmia management, while others require rapid transport to definitive care in the operative suite. While the issue of what level of care is best for each individual patient is far from settled, it is clear that the prehospital phase of care for all patients is critically important for outcome.


BLS is more than basic, it’s fundamental to good care              

MAIN OUTCOMES AND MEASURES

Survival to hospital discharge, to 30 days, and to 90 days; neurological performance; and incremental medical spending per additional survivor to 1 year.

Survival to hospital discharge was greater among patients receiving BLS (13.1% vs 9.2% for ALS; 4.0 [95% CI, 2.3–5.7] percentage point difference), as was survival to 90 days (8.0% vs 5.4% for ALS; 2.6 [95% CI, 1.2–4.0] percentage point difference). Basic life support was associated with better neurological functioning among hospitalized patients (21.8% vs 44.8% with poor neurological functioning for ALS; 23.0 [95% CI, 18.6–27.4] percentage point difference). Incremental medical spending per additional survivor to 1 year for BLS relative to ALS was $154 333.

Just My Opinion

The ability to rapidly transport patients to definitive care has a lot to do with survivability. Waiting an hour or calling a medical helicopter because we lack resources isn't right. 

Why should a taxpayer in the LMRFD pay a $25,000 medical helicopter bill because their ambulance was transporting a dehydrated hitchhiker at milepost 5 on US93?

It would be better to have several backup ambulances staffed by paid volunteer EMTs and EMRs with good Basic Life Support skills who can do rapid transport to KRMC.

If a patient has trauma and needs a Level I Trauma Center, call a medical helicopter. But KRMC can handle respiratory, heat stroke, cardiac, stroke, and most other calls not requiring a trauma surgeon right now.

Rapid Transit $2500 vs Medical Helicopter $25,000

Dolan Springs to KRMC is 38 miles, it would take 28 minutes to get to KRMC at 80mph

Meadview to KRMC is 58 miles, it would take 49 minutes to get to KRMC at 70mph.

In Dolan Springs paramedics routinely call for a medical helicopter with a 30 minute flight time from Vegas for calls KRMC can handle. Then they load the patient in the ambulance and drive to the fire station where they sit and wait for 30 minutes. 

When the helicopter gets there it takes10-15 minutes to land, shutdown the helicopter, load the patient, and take off. 

Then it's another 30 minutes flight time back to the hospital where it takes 5 minutes to land and off load the patient. 

That's 75 minutes rather than 28 minutes to get to definitive care. 

LINKS to More Info  

The Ontario Prehospital Advanced Life Support (OPALS) Study – a must read for EMS, investigates cardiac arrest, major trauma and respiratory distress




Sunday, April 11, 2021

Why Would Anyone Annex Into the LMRFD Raising Their Property Taxes by Hundreds of Dollars if They Get the SAME Services NOW?

Why Would Anyone Annex Into the LMRFD

Every time we talk about raising property taxes by a few dollars, people say no. 

So what are the chances of getting people to voluntarily raise their property taxes by hundreds of dollars? My guess is slim to none.

Be Honest, would you annex into the fire district and raise your property taxes by $200 to $400 a year, if you get the same services now at no cost? 

You see they get the same services for free, unless they have a fire or call the ambulance, they pay nothing.... 

If the fire district wants people to annex into the fire district we need to offer them something for the hundreds of dollars of increased property tax? 

Did you know in other fire districts if you call 911 for a medical emergency you get fire paramedics and private ambulance. If the fire paramedics do something like a breathing treatment and you refuse the ambulance ride, it cost you nothing.

In the LMRFD when you call 911 for a medical emergency you get fire paramedics in a private ambulance and it costs you $2200

Things need to change... If you live in the LMRFD and pay property taxes you should be able to get .....................

The LMRFD is 144 square miles while the ambulance CON, the area the LMRFD ambulance is 2200 square miles. The main part of the fire district is made up of two main parts, Dolan Springs and Meadview. The area between the two communities is confusing at best, it's outside the fire district but inside the CON.


The Meadview area especially Meadview City is made up of a checkerboard of parcels in and outside the fire district. If there were two fires at the same time one in and one outside of the fire district, firefighters would have no way to know. The fire district worries about liability with volunteers, where's the liability if they go to the wrong house and someone dies?



In Meadview some parcels just blocks from the fire station are not in the fire district,

If the fire district wants people to annex into the fire district we need to either offer them something for their tax dollars or reduce the CON and let them call someone else..


FirstNet the Stand Alone Network Built for First Responders is Now in Dolan Springs and US93

The First Responder Network Authority also known as FirstNet is the federal entity charged with overseeing the creation and delivery of the FirstNet network.

Housed within the Department of Commerce, National Telecommunications and Information Administration, the agency’s role is to ensure AT&T delivers on the terms of its contract and creates a network that meets the needs of public safety now and into the future.

FirstNet's Band 14 is available in Dolan Springs and it looks like they're working on getting better coverage on US93. I hope FirstNet will soon have service in Meadview.

WHY FIRSTNET?
1. It’s our nation’s public safety wireless broadband network
2. Federally regulated by the First Responder Network Authority
3. There’s no throttling for FirstNet subscribers anywhere in the             country
4. FirstNet has the only physically separate network core in the            country dedicated entirely to Public Safety, First Responders, and     entities who support them
5. 24x7x365 priority and preemption for first responders
6. Faster than any commercial network
7. Highly-secure core and available end-to-end encryption
8. Dedicated deployables for service continuity and disaster                 recovery, to quickly address coverage extension demands                 triggered by natural or man-made disasters, and for special events      planned in advance.

FIRSTNET ELIGIBLE USERS

Primary Users are Public Safety Entities that act as first responders, the agencies who are at an emergency scene first. This includes law enforcement, fire protection services, emergency (911) call dispatching and government Public Safety Answering Points, emergency planning and management offices, and ambulance safety services. 

Extended Primary Users are those agencies, organizations, non-profit or for-profit companies that provide public safety services in support of Primary Users. They provide mitigation, remediation, overhaul, clean-up, restoration, or other such services during or after an incident.

Friday, April 9, 2021

Reduce Inappropriate Helicopter Utilization in EMS KRMC in Kingman can handle most patients

When local EMT's call for a Medical Helicopter rather than drive the 38 minutes to KRMC in Kingman it can costs you an $25,000 and can take over an hour....

If you have serious trauma that requires a Trauma Center with 24/7 Surgeons a Medical Helicopter is a good call. 

If you are having heat stroke, heart attack, seizure, or stroke, KRMC is 38-40 minutes away and can handle most patients

Every patient transported to Las Vegas when a trauma center in not required KRMC and the local economy looses thousands of dollars.


Using a Medical Helicopter simply because our local ambulance is underfunded or inadequately staffed isn't an acceptable solution 

The article below is about how and when a helicopter should be called. I hope it answers some questions. 

Reduce Inappropriate Helicopter Utilization in EMS

Monday, April 5, 2021

Thanks to Chief Bonnee the First Round of Scheduled Covid Vaccinations Were Canceled

Chief Bonnee found a problem with the first set of scheduled Covid vaccinations, people were signing up from as far away as Las Vegas and New York City...

So Chief Bonnee worked with the department of health to cancel the first round of appointments and change some of the wording on the questions for the second round of online appointments. For the second round of shots you were required to answer several questions including if you lived in the local area. 

On April 1st the second round of Covid vaccinations went off without a hitch and many locals got their shot...

Thanks Chief Bonnee

Sunday, April 4, 2021

FREE First Aid, CPR, and Preparedness Training at DSCC

Are You Prepared? 
If Not Coming Every Saturday in April & May  there will be FREE Preparedness Training at DSCC 15195 N Pierce Ferry Road...

Who Ya Gonna Call When the SHTF?




 

Saturday, April 3, 2021

Watch for Upcoming Training on Various Topics Here's a Great Article on Why We Should All be Preppers

We have some upcoming training on various subjects related to preparedness so I thought I would post this article "Why We Should All Be Preppers"

Chances are you have a neighbor who was ready for this pandemic. And if you knew they were stockpiling before the disaster, you likely thought they were weirdos. I know I did, even as I traveled the world writing a book about them. Not anymore. Although preppers have long been the subject of ridicule, I imagine many of us will take on some of their habits, or at the very least make space in our closets and garages for nonperishables.

"Why We Should All Be Preppers"

https://www.theatlantic.com/ideas/archive/2020/05/we-should-all-be-preppers/611074/