X-cs: From: Self To: wilderness-emergency-medicine@list.pitt.edu Subject: (Fwd) Stuff... Reply-to: kconover@pitt.edu Date: Wed, 3 Jan 1996 16:16:42 ------- Forwarded Message Follows ------- Date: Wed, 3 Jan 1996 9:52:06 -0500 (EST) From: Arthur Laurent (alaurent@npr.org) To: KCONOVER@pitt.edu Subject: Stuff... Talk to you later. 'Bout time we woke up the WEM list after the holidays. Art (alaurent@npr.org) -- End -- X-cs: From: Self To: wilderness-emergency-medicine@list.pitt.edu Subject: BLS kit for car for SAR team EMT? Reply-to: kconover@pitt.edu Date: Wed, 3 Jan 1996 16:18:42 ------- Forwarded Message Follows ------- From: Self To: Arthur Laurent (alaurent@npr.org) ,ALAURENT@npr.org Subject: Re: WEMT address change Reply-to: kconover@pitt.edu Date: Tue, 2 Jan 1996 12:01:29 On 2 Jan 96 at 9:11, alaurent@npr.org wrote: > When you get around to it (how'd you do on your certification test?), Got a 92 (just got my score day before yesterday); passing's 75. Now I have to take the orals in Chicago in May or October (they'll tell me which in a few weeks). > could you send me recommendations for what BLS medical stuff to carry in > my car. Thanks! Sorry to put you off before. Well, now that I have a little time, let's get started. We might think about broadening the discussion a bit -- perhaps even carrying on this discussion on the wilderness-emergency-medicine list, if you're willing -- since you're a member of a SAR team, you should probably slant your car BLS kit both towards on-the-road emergencies _and_ out-in-the-boonies problems. So, first, let's create some broad overall categories. And for the Personal Safety Equipment I'll list what I (think I) carry in my car now. Personal Safety Equipment - misc + headlamp + flagging tape to mark route away from road to patient (in SAR pack) - water: + life vest; can use spare tire if no room for life vest - cliff etc. + rope for belay - road + flares + red or blue strobe light for top of car + safety vest with Scotchlite on it - body fluid exposure + gloves + surgical face masks with eye protection + disposable protective gown? (don't carry one myself; rips too easily) + squirt bottles of peroxide/chlorine bleach for blood spills in the boonies? (Don't carry these but now that I think of it may add.) - communications equipment + VHF/Ham 2 meter radio + cell phone Diagnostic/Recordkeeping/Reference Immobilization Dressings and Bandaging Supplies (incl. irrigation) Airway/Ventilation Medications (even at BLS level you want to carry some common OTC meds, etc.) What do you think of this as an outline? And do you want to continue this on the wilderness-emergency-medicine list? Thanks. --Keith -- End -- X-cs: From: Self To: wilderness-emergency-medicine@list.pitt.edu Subject: BLS kit for car for SAR team EMT? Reply-to: kconover@pitt.edu Date: Wed, 3 Jan 1996 16:19:10 ------- Forwarded Message Follows ------- Date: Wed, 3 Jan 1996 9:52:06 -0500 (EST) From: Arthur Laurent (alaurent@npr.org) To: KCONOVER@pitt.edu Subject: Stuff... Talk to you later. 'Bout time we woke up the WEM list after the holidays. Art (alaurent@npr.org) -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Wed, 3 Jan 1996 11:34:04 -0500 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Wed, 3 Jan 1996 11:34:03 -0500 (EST) Received: via switchmail; Wed, 3 Jan 1996 11:34:03 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 3 Jan 1996 11:32:31 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Wed, 3 Jan 1996 11:31:38 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from mail.unicall.be (MAIL.UNICALL.BE [193.210.154.4]) by list.srv.cis.pitt.edu with SMTP (8.7.3/cisls-2.4) ID for ; Wed, 3 Jan 1996 11:31:16 -0500 (EST) Message-Id: <199601031631.LAA07130@list.srv.cis.pitt.edu> Received: from [193.210.154.82] by mail.unicall.be (NTMail 3.00.11) id va028361 Wed, 3 Jan 96 16:29:40 +0000 (GMT) Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Date: Wed, 3 Jan 1996 18:41:10 +0100 To: wilderness-emergency-medicine@list.pitt.edu From: Pierre_malfait@unicall.be (Pierre Malfait) Subject: new trauma list Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 TRAUMA-LIST Welcome to the Trauma mailing list. This list exists to provide a forum for alpersons involved in the management of the injured patient. Trauma care is still a new and rapidly advancing field, and the Interneprovides a medium for providers of trauma care that can match the pace of succhanges. Trauma spans the globe, and trauma care systems are evolvindifferently in different countries, in different states, different cities andifferent hospitals. The Internet provides the perfect opportunity for conference, debate, dicussion and argument between these groups, and thus disseminateand extend knowledge of trauma care throughout the planet. The TRAUMA-LIST mailing list is based, moderated and archived at Trauma.orgTrauma.org aims to provide a receptacle for educational materials, sources oinformation, details of forthcoming events and eventually original articlescontibutions and papers relating to the field of trauma care. It should brintogether the knowledge and experience of doctors, nurses, paramedics, researchers and all groups directly and indirectly related to trauma management. How to subscribe --------------- Send an email message to majordomo@ftech.net with subscribe trauma-list as the first line in the body of the message. How to send a message to the TRAUMA-LIST conference --------------------------------------------------- Send your email message to : trauma-list@ftech.net How to unsubscribe ------------------ To unsubscribe you should collect the form Z9TY-865-FXFXFX from the small huthat is 1.6 kilometers north-northeast of the hallowed Yawon tree of Papua NeGuinea. Fill this out in triplicate and exchange it for a piebald llama fro'El Pepe's llama store and novelty shop' in the Andes. Journey with the Llamto the ancient (and lost) Mayan city of Qwertyzcoatl. Having unlocked thsecret to the great pyramid, descend into its depths to find the ancient VT22terminal. From here you can send an email message to majordomo@ftech.net with unsubscribe trauma-list as the first line in the body of the message. TRAUMA.ORG ---------- To access Trauma.org's web pages point your World Wide Web Browser to : http://www.trauma.org/ To send a message to Trauma.org email : trauma@trauma.org Dr. Karim Brohi email : Karim@trauma.org ====================================================================== Dr. Karim Brohi Trauma Surgery & Critical Care Email : karim@trauma.org Extreme Environments Medicine Snail : 72 Ladbroke Grove Notting Hill John Radcliffe Hospital,Oxford London ----------------------- Dr.Pierre Malfait, M.D. Vredelaan 5 B- 8370 Blankenberge Belgium Tel.:++ 32 50 41 60 84 e-mail : Pierre_Malfait@unicall.be -- End -- X-cs: From: Self To: Chris ,wilderness-emergency-medicine@list.pitt.edu Subject: Re: BLS kit for car for SAR team EMT? Reply-to: kconover@pitt.edu Date: Wed, 3 Jan 1996 22:01:53 On 3 Jan 96 at 14:04, Chris wrote: > > + headlamp > > A flashlight would be good as well. I tend to prefer Maglite's since they > have quite a reputation for being durable, and you can buy whatever size > meets your preference. Any sort of flashlight would do, really. Possibly > even a headlamp that doubles as a hand-held flashlight, though many now > do that. Aah, but you can't use both hands while holding a flashlight. Yes, a flashlight is good, but _not_ a substitute for a good headlamp. P.S. The new Petzl Duo lamp with Energizer AA lithium cells is a dynamite headlamp. > > + red or blue strobe light for top of car > > This would lend attention if you were en route to help or if you just put > it on your car after arriving on a scene, but would this cause any sort > of problems of a legal type? ie: Aren't laws in place to prevent misuse > of this sort of emergency strobe light? ie: blue for police cruisers and > vehicles, red for ambulances or fire vehicles, yellow for service > vehicles, etc? Just who decides who can use these, and in what cases they > can be used? Seems that in this day and age you really have to CYA, even > when your intent is to help, even to the point of saving a life. Well, each state has its own rules. In most states around here, any member of a volunteer EMS agency (including SAR teams in many states) can use a single strobe or rotating light beacon for responses. In PA, blue; in VA or WV, red (not sure about MD). But the main reason I think it's good is for when you have to stop in the middle of the road to "block" an accident scene so someone plows into your car instead of you. But with a nice bright strobe, maybe they don't even hit your car! > > Since you are making a kit for being able to do rapelling and the like, > would it make sense to just pack in a helmet with a face shield or > something along those lines? Just a matter of personal preference? Good point -- I personally keep my SAR pack in the car at all times so my helmet's there all the time. > I'm sorry to say I'm still learning about radios and the various > frequencies. I assume this would include the CB frequencies on it? Nope. I think CB radios aren't worth the $$ or the room they take up in your car. A poor alternative if you're in a very rural area and not a member of an EMS agency or SAR team. Thanks for the comments. -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Wed, 3 Jan 1996 17:06:01 -0500 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Wed, 3 Jan 1996 17:05:59 -0500 (EST) Received: via switchmail; Wed, 3 Jan 1996 17:05:59 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 3 Jan 1996 17:05:53 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Wed, 3 Jan 1996 17:04:24 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from ucs.orst.edu (root@ucs.orst.edu [128.193.4.5]) by list.srv.cis.pitt.edu with SMTP (8.7.3/cisls-2.4) ID for ; Wed, 3 Jan 1996 17:04:21 -0500 (EST) Received: from bison.RANGE.ORST.EDU by ucs.orst.edu; (5.65v3.2/1.1.8.2/24Sep94-1201PM) id AA25684; Wed, 3 Jan 1996 14:04:20 -0800 Received: by bison.RANGE.ORST.EDU (4.1/SMI-4.1) id AA25248; Wed, 3 Jan 96 14:04:12 PST Date: Wed, 3 Jan 1996 14:04:11 -0800 (PST) From: Chris To: kconover+@pitt.edu Cc: wilderness-emergency-medicine@list.pitt.edu Subject: Re: BLS kit for car for SAR team EMT? In-Reply-To: <199601032123.QAA07864@post-ofc02.srv.cis.pitt.edu> Message-Id: Mime-Version: 1.0 Content-Type: TEXT/PLAIN; charset=US-ASCII Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 35127424 0 On Wed, 3 Jan 1996, Keith Conover, M.D. wrote: Please keep in mind while reading this that I am not an EMT certified to any degree. I am a Premedicine student heavily interested in this field, so I thought I would throw in my two cents here. Please feel free to reply to the list, in private, or however you see fit. Naturally, these are just ideas, so don't hold me liable if you use one of them and something goes wrong ;) Good luck! -Chris Kuivenhoven Atlanta, GA [I deleted a bit here in the name of bandwidth :-] > Personal Safety Equipment > - misc > + headlamp A flashlight would be good as well. I tend to prefer Maglite's since they have quite a reputation for being durable, and you can buy whatever size meets your preference. Any sort of flashlight would do, really. Possibly even a headlamp that doubles as a hand-held flashlight, though many now do that. > + flagging tape to mark route away from road to patient (in SAR > pack) > - water: > + life vest; can use spare tire if no room for life vest > - cliff etc. > + rope for belay > - road > + flares > + red or blue strobe light for top of car This would lend attention if you were en route to help or if you just put it on your car after arriving on a scene, but would this cause any sort of problems of a legal type? ie: Aren't laws in place to prevent misuse of this sort of emergency strobe light? ie: blue for police cruisers and vehicles, red for ambulances or fire vehicles, yellow for service vehicles, etc? Just who decides who can use these, and in what cases they can be used? Seems that in this day and age you really have to CYA, even when your intent is to help, even to the point of saving a life. > + safety vest with Scotchlite on it > - body fluid exposure > + gloves > + surgical face masks with eye protection Since you are making a kit for being able to do rapelling and the like, would it make sense to just pack in a helmet with a face shield or something along those lines? Just a matter of personal preference? > + disposable protective gown? (don't carry one myself; rips too > easily) > + squirt bottles of peroxide/chlorine bleach for blood spills in > the boonies? (Don't carry these but now that I think of it may add.) > - communications equipment > + VHF/Ham 2 meter radio I'm sorry to say I'm still learning about radios and the various frequencies. I assume this would include the CB frequencies on it? > + cell phone > > Diagnostic/Recordkeeping/Reference > > Immobilization > > Dressings and Bandaging Supplies (incl. irrigation) > > Airway/Ventilation > > Medications (even at BLS level you want to carry some common OTC > meds, etc.) > [More deleted here, just conversation.] > --Keith -Chris Kuivenhoven chris@bison.range.orst.edu -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Wed, 3 Jan 1996 19:33:50 -0500 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Wed, 3 Jan 1996 19:33:48 -0500 (EST) Received: via switchmail; Wed, 3 Jan 1996 19:33:48 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 3 Jan 1996 19:32:49 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Wed, 3 Jan 1996 19:31:05 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from dowjones.com (gauntlet.dowjones.com [143.131.189.4]) by list.srv.cis.pitt.edu with SMTP (8.7.3/cisls-2.4) ID for ; Wed, 3 Jan 1996 19:30:55 -0500 (EST) From: David.Copeland@cor.dowjones.com Received: by dowjones.com; id TAA08282; Wed, 3 Jan 1996 19:31:09 -0500 Received: from unknown(143.131.184.108) by gauntlet1.dowjones.com via smap (g3.0.1) id sma008278; Wed, 3 Jan 96 19:31:00 -0500 Received: by world.dowjones.com (1.38.193.4/16.2) id AA01138; Wed, 3 Jan 1996 19:30:36 -0500 Received: by cor.dowjones.com via Worldtalk with X400 (3.0.4/1.64) id WT28991.111; Wed, 03 Jan 1996 19:30:36 EST Date: 3 Jan 96 19:29:20 -0500 To: wilderness-emergency-medicine@list.pitt.edu Subject: SAR volunteer- with own gear! Ua-Content-Id: 468 P1-Recipient: wilderness-emergency-medicine@list.pitt.edu P1-Message-Id: US*mci*dj;cp1 0000001900000468 Original-Encoded-Information-Types: IA5-Text X400-Trace: US*mci*dj; arrival 960103192920-0500 deferred 960103192920-0500 action Relayed converted (IA5-Text) X400-Trace: US*MCI*DJ; arrival 960103193034-0500 deferred 960103193034-0500 action Relayed Message-Id: <468*/PN=David.Copeland/OU=cp1/O=dowcor/PRMD=dj/ADMD=mci/C=US/@MHS> P1-Content-Type: P2 Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 33554560 0 Hello all, After figuring out my local mail problems, I have a question, namely: I live in Monson, MA and I'd like info on what SAR teams are in my area that could use a SOLO certified Wilderness First Responder, AHA Basic Life Support certified/ARC "Community CPR" certified, and National Ski Patrol Winter Emergency Care certified volunteer with 10+ years of heavy duty hiking and backcountry trekking experience. Even some contact people who could then direct me accordingly would help. I've got all this training, but it's going to waste because I don't live near any big mountains... All info appreciated. Happy New Year y'all! David Copeland david.copeland@cor.dowjones.com -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Thu, 4 Jan 1996 19:59:47 -0500 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Thu, 4 Jan 1996 19:59:47 -0500 (EST) Received: via switchmail; Thu, 4 Jan 1996 19:59:47 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 4 Jan 1996 19:57:51 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Thu, 4 Jan 1996 19:54:07 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from JEFLIN.TJU.EDU (jeflin.TJU.EDU [147.140.128.114]) by list.srv.cis.pitt.edu with SMTP (8.7.3/cisls-2.4) ID for ; Thu, 4 Jan 1996 19:54:04 -0500 (EST) Received: from JEFLIN.TJU.EDU by JEFLIN.TJU.EDU with SMTP; Thu, 4 Jan 1996 19:53:04 -0500 (EST) Date: Thu, 4 Jan 1996 19:53:00 +0000 From: "Jack T. Grandey" X-Sender: GRANDEYE@ To: "Wilderness Emergency Medicine@" Subject: Re: BLS kit for car... Message-ID: MIME-Version: 1.0 Content-Type: TEXT/PLAIN; charset=US-ASCII Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 > > > + red or blue strobe light for top of car > > > > This would lend attention if you were en route to help or if you just put > > it on your car after arriving on a scene, but would this cause any sort > > of problems of a legal type? ie: Aren't laws in place to prevent misuse > > of this sort of emergency strobe light? ie: blue for police cruisers and > > vehicles, red for ambulances or fire vehicles, yellow for service > > vehicles, etc? Just who decides who can use these, and in what cases they > > can be used? Seems that in this day and age you really have to CYA, even > > when your intent is to help, even to the point of saving a life. > > Well, each state has its own rules. In most states around here, any > member of a volunteer EMS agency (including SAR teams in many states) > can use a single strobe or rotating light beacon for responses. In > PA, blue; in VA or WV, red (not sure about MD). But the main reason > I think it's good is for when you have to stop in the middle of the > road to "block" an accident scene so someone plows into your car > instead of you. But with a nice bright strobe, maybe they don't even > hit your car! If the purpose of the strobe is for scene protection as opposed to response, the overwhelming results of the literature says: AMBER. (Forgive me Harvey)I don't have the references handy, I have to look them up (never mind, you'd have to know) but many studies show a significant reduction idn scene accidents when stopped vehicles display amber instead of red, blue, purple, etc. They offer lots of theories, including red indicates cope, ie. something interesting, wheras, amber says street crews, tow trucks...yawnnn. In any case, if that's your purpose, yeloow's your color. JTG Jack T. Grandey, NREMT-P Continuing Education Coordinator Operations Director Albert Einstein Medical Center Wilderness EMS Institute -- End -- X-cs: From: Self To: wilderness-emergency-medicine@list.pitt.edu Subject: Malpractice Coverage Reply-to: kconover@pitt.edu Date: Sun, 7 Jan 1996 19:01:11 Several people have asked about malpractice coverage for wilderness emergency medicine work. Since my hospital and group support my work in this field as an extension of my regular emergency medicine activities, I ask my chairman for a letter every few years recognizing that wilderness activities are part of my job, and thus they will be covered under my malpractice insurance. Here's the text of the latest letter: (Mercy Hospital Letterhead) January 5, 1996 Keith Conover, M.D. Director, Wilderness Mecidine Emergency Medicine Association of Pittsburgh 13 Pride Street Pittsburgh, PA 15219 Dear Dr. Conover: I am writing in recognition of your work with search and rescue teams. In particular I would like to note your work with the Wilderness EMS Institute, the National Cave Rescue Commission, and the Appalachian Search and Rescue Conference. By teaching members of these organizations, by providing medical direction for their search and rescue team members, and by participating with them in the field, you help fulfill one of the expectations for Emergency Department staff at Mercy Hospital -- participation in community medical affairs. Such community involvement is integral to the role of the Mercy Hospital of Pittsburgh and its Emergency Department, and I and the Emergency Department support and encourage your efforts in these areas. Thank you. Sincerely Bruce A. MacLeod, M.D., FACEP Chairman, Department of Emergency Medicine Hope others find this useful. -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Mon, 8 Jan 1996 11:10:17 -0500 Received: from local (daemon@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Mon, 8 Jan 1996 11:10:17 -0500 (EST) Received: via switchmail for kconover+@pitt.edu; Mon, 8 Jan 1996 11:10:17 -0500 (EST) Received: from netcom5.netcom.com (pturner@netcom5.netcom.com [192.100.81.113]) by post-ofc02.srv.cis.pitt.edu with SMTP (8.7.3/cispo-2.0.1.1) ID for ; Mon, 8 Jan 1996 11:03:53 -0500 (EST) Received: by netcom5.netcom.com (8.6.12/Netcom) id IAA05939; Mon, 8 Jan 1996 08:00:34 -0800 Date: Mon, 8 Jan 1996 08:00:34 -0800 (PST) From: Patton M Turner Subject: Re: BLS kit for car for SAR team EMT? To: kconover+@pitt.edu cc: Chris , wilderness-emergency-medicine@list.pitt.edu In-Reply-To: <199601040305.WAA29716@post-ofc02.srv.cis.pitt.edu> Message-ID: MIME-Version: 1.0 Content-Type: TEXT/PLAIN; charset=US-ASCII X-PMFLAGS: 34078848 0 On Wed, 3 Jan 1996, Keith Conover, M.D. wrote: > Well, each state has its own rules. In most states around here, any > member of a volunteer EMS agency (including SAR teams in many states) > can use a single strobe or rotating light beacon for responses. In > PA, blue; in VA or WV, red (not sure about MD). But the main reason > I think it's good is for when you have to stop in the middle of the > road to "block" an accident scene so someone plows into your car > instead of you. But with a nice bright strobe, maybe they don't even > hit your car! Actually yellow is far better than red or blue for this. People do too much rubbernecking with red and blue lights and impared drivers tend to steer towards red lights. My opinion, but confirmed by several studies. Also make sure the light won't drain your battery over a several hour period. The strobe are OK, but some beacons are a problem. Here LEOs are blue, FD/EMS/Ambulance/Hazmat/CD are red, but CAP and other SAR groups are yellow. I guess it is a "yeilding right of way issue" Warning Triangles are nice to have also and make good turnmarkers on rural roads. Much safer than flares. Pat -- End -- X-cs: From: Self To: Patton M Turner ,Chris , wilderness-emergency-medicine@list.pitt.edu Subject: Re: BLS kit for car for SAR team EMT? Reply-to: kconover+@pitt.edu Date: Tue, 9 Jan 1996 09:59:01 On 8 Jan 96 at 8:00, Patton M Turner wrote: > Actually yellow is far better than red or blue for this. People do too > much rubbernecking with red and blue lights and impared drivers tend to > steer towards red lights. My opinion, but confirmed by several > studies. Also make sure the light won't drain your battery over a > several hour period. The strobe are OK, but some beacons are a problem. I think the best is to have a combination: a single light with different color lenses. Leave yellow on for if you need to stop at a scene. Switch to red or blue for a response to a scene if needed (depending on state). > Warning Triangles are nice to have also and make good turnmarkers on > rural roads. Much safer than flares. I have a set. But they're so big and bulky and heavy (at least the ones I have, with heavy sand-filled bases) that I took them out of the car and just rely on the (not so good but lighter and smaller) flares. I just couldn't find a place to put the triangles in the car where they would be easy to access, whereas I used some Velcro strapping to attach the flares just below my fire extinguisher in the back of the Range Rover. Oh, that's another piece of equipment to add to the list: fire extinguisher (Art, are you keeping the master list so once it's done you can post it to the list?) Thanks for the reply. -- End -- X-cs: From: Self To: "Roy L. Alson, PhD, MD, FACEP" Subject: Re: Malpractice Coverage Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover+@pitt.edu Date: Tue, 9 Jan 1996 10:09:45 On 8 Jan 96 at 14:10, Roy L. Alson, PhD, MD, FACEP wrote: > Keith, > > I personally think that the letter from you chair does not go far enough. > I think it should state that these activities that you perform are > considered part of your academic and medical responsibilities as a member > of the staff and faculty. > > As your chair's letter is worded, I believe that the instituion has the > flexibility to interpret "support" in many ways, including bailing out of > covering you for malpractice. > > Several years ago, I had my chair send me a letter stating that my EMS, NDMS > and SAR activities are part of my duties and responsibilities as our > deparatment's EMS coordinator. The deliniation of these activities as part > of my "duties" was felt by our legal eagles to obligate the institution to > provide my malpractice coverage in these operations. > > Just my thoughts. > > > Roy > ========================================================== > Roy L. Alson, PhD, MD, FACEP > Emergency Medicine > Assistant Professor of Emergency Medicine > Medical Director, NC Baptist AirCare > Bowman Gray School of Medicine > ralson@isnet.is.wfu.edu > 910-716-2193 fax: 910-716-5438 > Roy, could you find the text of that letter and post to the list? I think others would like to see it. I know I would. Thanks! -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Fri, 12 Jan 1996 19:12:02 -0500 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Fri, 12 Jan 1996 19:12:01 -0500 (EST) Received: via switchmail; Fri, 12 Jan 1996 19:12:01 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 12 Jan 1996 19:10:38 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Fri, 12 Jan 1996 19:09:48 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from mail02.mail.aol.com (mail02.mail.aol.com [152.163.172.66]) by list.srv.cis.pitt.edu with SMTP (8.7.3/cisls-2.4) ID for ; Fri, 12 Jan 1996 19:09:46 -0500 (EST) From: BBASON@AOL.COM Received: by mail02.mail.aol.com (8.6.12/8.6.12) id TAA04847 for wilderness-emergency-medicine@list.pitt.edu; Fri, 12 Jan 1996 19:09:16 -0500 Date: Fri, 12 Jan 1996 19:09:16 -0500 Message-ID: <960112190912_114762295@mail02.mail.aol.com> To: wilderness-emergency-medicine@list.pitt.edu Subject: Ketoprofen Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 33554560 0 I asked for information about Orudis KT and this is what I got. Thanks Kevin ____________________________________________________ Subj: ketoprofen Date: 96-01-12 10:10:40 EST From: KevinMTC To: BBASON File: KETPRFN.RTF (36482 bytes) DL time (2400 baud): < 4 minutes Ketoprofen is a non-steroidal anti-inflammatory drug (NSAID) in the same class as ibuprofen (Motrin, Advil, Nuprin, etc.) and Naproxen (also available OTC). It has the same uses (pain, arthritis, etc.) and side effects (GI irritation, ulcers, GI bleeds, renal failure in hypovolemic/dehydrated patients, and increased bleeding). It is expensive (as is Naproxen). Since ibuprofen is available as a generic I would suggest using it instead as it is considerable cheaper. Naproxen does last longer, but this is of uncertain advantage. The most important things to know is you should use them cautiously, avoid exceeding the recommended doses, take with food and/or milk, stop if you get abdominal pain, do not use in head injury, do not use with aspirin or other NSAIDs, do not use in trauma patients (due to possibility of inhibiting platelets and probably more importantly, the risk of renal failure increases) and take plenty of fluids when using. There are reports of climbers popping a few too many Advil on a long route with out enough water and ending up in renal failure. All this aside, I would consider one of these (probably ibuprofen) indispensable in the back country. Take Tylenol as well, it works very well for muscle-skeletal pain and avoids the GI toxicity. Attaches is a RTF document from the STAT-Ref! library (CD-ROM) containing some of the major excerpts. If you need further information talk with your local pharmacist or ER physician. Kevin Coonan M.D. -- End -- X-cs: From: Self To: BBASON@aol.com,grandeye@jeflin.tju.edu Subject: Re: Fwd: WEMSI courses Reply-to: kconover+@pitt.edu Date: Sat, 13 Jan 1996 16:03:38 On 10 Jan 96 at 15:45, BBASON@aol.com wrote: > Kieth, > > Would you be able to email this guy future courses. Also, CC: with the list. > > Thanks, > > Brad > > --------------------- > Forwarded message: > From: CPT_Kevin_Coonan@ftdetrck-ccmail.army.mil > To: BBASON@aol.com > Date: 96-01-10 09:37:51 EST > > I am a physician in Frederick, MD. I would be interested in future > WEMSI courses. > > Thanks > > Kevin Coonan M.D. > > > I've already emailed him (and everyone else on the w-e-m list) the schedule below. And I mailed him about 5 lbs. of material. --KC Schedule of WEMSI-Recognized Wilderness EMT and Wilderness Command Physician Classes Revised 12/31/95 Prerequisites: - for WEMT classes: + EMT training or better + outdoor equipment and condition to participate fully in field exercises + basic wilderness SAR certification or equivalent (N.B. some providers offer SAR training prior to the WEMT class that will meet this requirement for those lacking SAR training.) - for WCP classes: + licensed physician + qualified to provide medical direction to EMS personnel, or wilderness rescue medical personnel, in home jurisdiction + experience at providing medical direction to prehospital personnel + outdoor equipment and condition to participate fully in field exercises -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=- WHO: - Center for Emergency Medicine of Western PA WHERE: - at Camp Soles (near Seven Springs in SW PA mountains) WHEN: - Basic Wilderness Rescue (MEETS SAR PREREQUISITE): + will be held on a weekend prior to each class (exact date TBA) + not needed for ASRC or VA GSAR FTMs or higher, or equivalent) - WEMT: two days one weekend, three days another weekend + April 21 & 22 and May 3, 4 & 5. + WEMT: October 19 & 20 and Nov 1,2 & 3. - Wilderness Command Physician (two days): + November 1-2 (Friday-Saturday COST: - TBA CONTACT: - Pam Westfall, Administrative Asst. Center for Emergency Medicine 230 McKee Place, Suite 500 Pittsburgh, PA 15213-4904 412-578-3203 email: Pam Westfall -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=- WHO: - QUEST and Bloomsburg State University and Geisenger Medical Center WHERE: - Bloomsburg State University, Northcentral PA WHEN: - June 5-9 COST: - $110 (text+class fee) - plus food and lodging. The food/lodging costs will be approx. $15.00/day/pers. for lodging and approx. $16.00/day/pers. for food. Lodging will be in campus dorms and the food will be at the cafe. Students will be allowed to make other arrangements if they wish but will be very strongly advised to stay and eat on campus. CONTACT: - Tom Burkiewicz (QUEST) 717-389-4342 or Bradford Bason 307 E. Market St. Danville, PA 17821 717-271-1314 (H) 717-326-8185 (W) 717-271-1339 (Bason Rescue Equipment Voicemail) email: Brad Bason -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=- WHO: - Maryland Institute for Emergency Medical Services System, Region I WHERE: - Western Maryland WHEN: - in the spring COST: - TBA CONTACT: - Steve Meyer HCR 1, Box 177-A Barton, MD 21521 301-463-5881 (H/W) email: MIEMSS Region I--David Ramsey -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=- WHO: - National Cave Rescue Commission, Eastern Region WHERE: - Near Elkins, WV WHEN: - June (22-30), as part of the East Region National Cave Rescue Commission weeklong training college (MAY ATTEND FIRST WEEKEND AND OBTAIN NCRC BASIC CAVE RESCUE ORIENTATION CARD WHICH WILL MEET SAR PREREQUISITE) COST: - TBA CONTACT: - John Appleby, ER-NCRC Regional Coordinator 899 Kulp Rd. Perkiomenville, PA 18074 1-215-541-4994 (H) email: John B. Appleby -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=- WHO: - Irish Mountain Rescue Association WHERE: - Dublin, Ireland WHEN: - in September, before the UK/Irish National Mountain Rescue Conference COST: - TBA CONTACT: - Joe O'Gorman, Training Officer Irish Mountain Rescue Association 9 Kingston Heights Ballinteer Rd. Dublin 16 Ireland 00353 1-298-9719 email: Gerard Butler -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=- There is also talk about a WEMSI WEMT course in Virginia but nothing more definite at present. CONTACT: - Rob Christie, Medical Officer Appalachian Search and Rescue Conference 1604 Trap Road Vienna, VA 22182 703-319-1479 (H) 703-370-4101 (W) email: Rob Christie <75714.1425@compuserve.com> -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=- N.B.: the class, previously announced to tentatively be held in the Philadelphia area will not be held in 1996, and probably not in 1997, but may be held at some later date. -- End -- X-cs: From: Self To: Raj Lakhanpal Subject: Re: MedConnect : New CME and Cases of the Month Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover+@pitt.edu Date: Sat, 13 Jan 1996 21:14:54 On 14 Jan 96 at 2:32, Raj Lakhanpal wrote: > Dear Colleagues > > All our cases are up for January. Believe it or not, we are heavily [snip] > Cases of the month in Toxicology and Pediatrics have very interesting > cardiologic > manifestations and the case in Primary Care presents complications of HIV > disease. Please > participate in the discussions. Your participation will greatly encourage > us and enrich > these discussions. > > Pediatric/Medical News at your Desktop will be published soon. Please > register so that > we can e-mail you the titles of the abstracts discussed on medconnect. If > you are interested > in contributing to any of these innovative programs, do contact us. Pardon me, but can you explain the relevance of this message to the _wilderness_ _emergency_ medicine list? If not, you are spamming, and I request you stop it. Thanks. (list owner) -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Sat, 13 Jan 1996 14:34:21 -0500 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Sat, 13 Jan 1996 14:34:21 -0500 (EST) Received: via switchmail; Sat, 13 Jan 1996 14:34:21 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Sat, 13 Jan 1996 14:34:06 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Sat, 13 Jan 1996 14:32:53 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from tigger.jvnc.net (tigger.jvnc.net [128.121.50.145]) by list.srv.cis.pitt.edu with SMTP (8.7.3/cisls-2.4) ID for ; Sat, 13 Jan 1996 14:32:52 -0500 (EST) Received: from t1-186.texel.com by tigger.jvnc.net with SMTP id AA07445 (5.65c/IDA-1.4.4 for wilderness-emergency-medicine@list.pitt.edu); Sat, 13 Jan 1996 14:32:49 -0500 Message-Id: <30F8DBB6.20DE@medconnect.com> Date: Sun, 14 Jan 1996 02:32:22 -0800 From: Raj Lakhanpal Organization: Med connect X-Mailer: Mozilla 2.0b3 (Win95; I; 16bit) Mime-Version: 1.0 To: wilderness-emergency-medicine@list.pitt.edu Subject: MedConnect : New CME and Cases of the Month Content-Type: text/plain; charset=iso-8859-1 Content-Transfer-Encoding: 8bit Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 35127424 0 Dear Colleagues All our cases are up for January. Believe it or not, we are heavily dependent on Federal Express to deliver our cases and the blizzard in Northeastern United States put a damper on their flying activities. The CME Program features an excellent presentation The Modern Work Up of Blunt Abdominal Trauma-CT vs. DPL vs. Ultrasound. A Review. Cases of the month in Toxicology and Pediatrics have very interesting cardiologic manifestations and the case in Primary Care presents complications of HIV disease. Please participate in the discussions. Your participation will greatly encourage us and enrich these discussions. Pediatric/Medical News at your Desktop will be published soon. Please register so that we can e-mail you the titles of the abstracts discussed on medconnect. If you are interested in contributing to any of these innovative programs, do contact us. You can also post/view any upcoming meetings, conferences in the Medical Community section of medconnect. Medconnect is requesting submissions for Joke of the week, Interesting medical photographs/slides and a photograph, slide of the month/wk-on the lighter side of life. e.g. your recent trip to Kenya, Australia, etc. All material which is published will be acknowledged. Send your suggestions/comments at reply@medconnect.com Thank you All staff at medconnect Internet : http://www.medconnect.com Email : reply@medconnect.com -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Mon, 15 Jan 1996 15:31:24 -0500 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Mon, 15 Jan 1996 15:31:22 -0500 (EST) Received: via switchmail; Mon, 15 Jan 1996 15:31:21 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 15 Jan 1996 15:29:24 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Mon, 15 Jan 1996 15:27:32 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from pop.cc.nih.gov (pop.cc.nih.gov [137.187.120.140]) by list.srv.cis.pitt.edu with ESMTP (8.7.3/cisls-2.4) ID for ; Mon, 15 Jan 1996 15:27:30 -0500 (EST) Received: from [128.231.80.74] ([128.231.80.74]) by pop.cc.nih.gov (8.7.3/8.7.3) with SMTP id PAA08144; Mon, 15 Jan 1996 15:27:03 -0500 (EST) X-Sender: dlanducci@pop.cc.nih.gov Message-Id: Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Date: Mon, 15 Jan 1996 15:28:53 -0500 To: BBASON@aol.com, wilderness-emergency-medicine@list.pitt.edu From: Dante_Landucci@NIH.gov (Dante Landucci, MD) Subject: Re: Orudis KT Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 >I would like to know more about Orudis KT. It is an OTC analgesic that I >have recently seen TV. I have not looked for it in the stores. Orudis belongs to a class of agents known as non-steroidal anti-inflammatory drugs (NSAIDs). There are a large number of other compounds in this group, including Ibuprofen (Motrin) and plain old aspirin. Looking at large populations, the drugs all cause essentially the same adverse reactions, and, if taken in the appropriate doses, give roughly the same level of relief. Individual people have different responses to each agent, though, and it pays to try out several different ones to see which one seems to give the best result at the lowest cost. Bear in mind that all NSAIDs increase the risk of bleeding after injury by impairing proper function of platelets. NSAIDs also affect kidney function. Plenty of liquids should be consumed when they are taken. Except under the supervision of a physician, they should not be administered to individuals with kidney disease or high blood pressure. In the wilderness setting, where trauma my have occured, acetaminophen (Tylenol) is the agent of choice for analgesia. It does nothing for inflammation. It also does not increase the risk of bleeding. For these and many other reasons, read the package inserts carefully before taking or dispensing any medication. -- End -- X-cs: From: Self To: Dante_Landucci@NIH.gov (Dante Landucci, MD) Subject: Re: Orudis KT Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover+@pitt.edu Date: Tue, 16 Jan 1996 13:53:42 On 15 Jan 96 at 16:36, Dante Landucci, MD wrote: > >I've been toying with the idea of switching the NSAID in the WEMSI > >Medkit from ibuprofen to naproxen. > > Why have NSAIDs in the typical wilderness setting? The risk of > administration to trauma patients with subsequent increase in bleeding > seems significant. Even when I was in the most desolate area of Utah, > rescues were effected within time spans that made the potential benefit of > an anti-inflammatory agents inconsequential. Unless someone is heading for > truly isolated or technolgically deprived areas (such as the subarctic or > tropics), why not just settle for uncomplicated analgesia with > acetaminophen and/or opiates? > A good question, indeed. I agree that NSAIDs should not be given to major trauma victims as analgesia in the acute wilderness setting. But: The reasons that I believe a NSAID should be in a standard WEMSI medical kit are: 1. good for pain that Tylenol won't touch (will take care of pain that is about twice as intense). 2. good for problems in team members, such as minor twisted ankles, eyestrain headaches, etc. 3. unlike equipotent analgesics such as hydrocodone or codeine, NSAIDs have little if any effect on the CNS; so people can still belay, climb, etc. after taking them. 4. Popular demand: how often does a team member approach a WEMT (or other members of the team) and say: "Have you got any Advil or Nuprin? I ache all over after that task." And there is some evidence that a single dose of NSAID after excessive muscular activity (such as SAR) does much to alleviate next-day soreness. The reference is buried somewhere here. -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Wed, 17 Jan 1996 11:29:57 -0500 Received: from local (daemon@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Wed, 17 Jan 1996 11:29:56 -0500 (EST) Received: via switchmail for kconover+@pitt.edu; Wed, 17 Jan 1996 11:29:56 -0500 (EST) Received: from pop.cc.nih.gov (pop.cc.nih.gov [137.187.120.140]) by post-ofc02.srv.cis.pitt.edu with ESMTP (8.7.3/cispo-2.0.1.1) ID for ; Wed, 17 Jan 1996 11:24:15 -0500 (EST) Received: from [128.231.80.72] ([128.231.80.72]) by pop.cc.nih.gov (8.7.3/8.7.3) with SMTP id LAA08425 for ; Wed, 17 Jan 1996 11:24:14 -0500 (EST) X-Sender: dlanducci@pop.cc.nih.gov Message-Id: Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Date: Wed, 17 Jan 1996 11:26:07 -0500 To: kconover+@pitt.edu From: Dante_Landucci@NIH.gov (Dante Landucci, MD) Subject: Re: Orudis KT X-PMFLAGS: 34078848 0 >But: > >The reasons that I believe a NSAID should be in a standard WEMSI >medical kit are: > >1. good for pain that Tylenol won't touch (will take care of pain >that is about twice as intense). Can you substantiate that claim? >2. good for problems in team members, such as minor twisted ankles, >eyestrain headaches, etc. To my knowledge, there is no evidence that it would be better than acetaminophen. >3. unlike equipotent analgesics such as hydrocodone or codeine, >NSAIDs have little if any effect on the CNS; so people can still >belay, climb, etc. after taking them. Good point. >4. Popular demand: how often does a team member approach a WEMT (or >other members of the team) and say: "Have you got any Advil or >Nuprin? I ache all over after that task." And there is some >evidence that a single dose of NSAID after excessive muscular >activity (such as SAR) does much to alleviate next-day soreness. >The reference is buried somewhere here. I agree with your belief that NSAIDs help prevent exertional muscular pain. I don't concur that it's the responsibility of a WEMT to be providing such medication for others. Each member is responsible for those necessities that make the expedition, whether for pleasure or rescue, more tolerable. There is collaboration on the major points, such as food and shelter. But, for example, I doubt WEMTs carry toothpaste for all. Members may choose to draw it from a common pool, but they still need to assume that responsiblity. In the case of NSAIDs, a common pitfall is to focus on the high benefit:risk ratio and the relatively large therapeutic window. The more important issue is that, when adverse reactions occur, they can be very serious. Given the frequency with which these drugs are used, side effects are remarkably common. I consider it undesirable for one individual to assume that degree of responsibility for his/her companions when they can do so for themselves. I have contemplated this matter at length during my various travels. Finally, I've decided to always carry aspirin (not a good choice for many reasons, but it works very well for me). If someone wants it, I share it; not as a HCW, simply as an associate. I make it clear it's their decision whether to use it or not. -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Thu, 18 Jan 1996 10:55:09 -0500 Received: from local (daemon@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Thu, 18 Jan 1996 10:55:08 -0500 (EST) Received: via switchmail for kconover+@pitt.edu; Thu, 18 Jan 1996 10:55:08 -0500 (EST) Received: from inet.ed.gov (inet.ed.gov [192.239.34.1]) by post-ofc03.srv.cis.pitt.edu with SMTP (8.7.3/cispo-2.0.1.1) ID for ; Thu, 18 Jan 1996 10:54:15 -0500 (EST) Received: from cc:Mail by ed.gov id AA821991097; Thu, 18 Jan 96 10:52:47 EST Date: Thu, 18 Jan 96 10:52:47 EST From: "peter mccabe" Encoding: 20 Text Message-Id: <9600188219.AA821991097@ed.gov> To: kconover+@pitt.edu, SalazarJ@USA.RED-CROSS.ORG, wilderness-emergency-medicine@list.pitt.edu Subject: Re[2]: WMS Wilderness First Aid Course -Reply -Reply X-PMFLAGS: 33554560 0 Jose and Keith I think Jose from the Am Red Cross in KC is indicating that the Responding to Emergencies course is probably the multi-media 8 hour Red Cross course. Keith, as you know we put all of our people in Maryland Search & Rescue (ESAR-616) through what used to be called Advanced First Aid (now called Emergency Response) with the American Red Cross. We found the new Emergency Response 40 hour training course superior to the the DOT First Responder training. We do, however, understand there is a new DOT First Responder course coming down the road in the coming months. In Maryland, we are fortunate that with successful passing of the Red Cross Emergency Response training our folks can challenge the Maryland First Responder test. Most do, and most pass to become Maryland First Responders. We still like the Red Cross training though. And, the old 12 hour CPR training for Professional Rescuers is taught in the Red Cross Emergency Response course. -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Thu, 18 Jan 1996 11:01:11 -0500 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Thu, 18 Jan 1996 11:01:09 -0500 (EST) Received: via switchmail; Thu, 18 Jan 1996 11:01:08 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 18 Jan 1996 11:00:26 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Thu, 18 Jan 1996 11:00:05 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from inet.ed.gov (inet.ed.gov [192.239.34.1]) by list.srv.cis.pitt.edu with SMTP (8.7.3/cisls-2.4) ID for ; Thu, 18 Jan 1996 11:00:03 -0500 (EST) Received: from cc:Mail by ed.gov id AA821991453; Thu, 18 Jan 96 10:55:30 EST Date: Thu, 18 Jan 96 10:55:30 EST From: "peter mccabe" Encoding: 4 Text Message-Id: <9600188219.AA821991453@ed.gov> To: Wb7qni@aol.com, wilderness-emergency-medicine@list.pitt.edu Subject: Re: Litter system... Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 33554560 0 I may be seeing folks from the Mtn Rescue Council (Seattle) at the winter meeting of the Mountain Rescue Association (MRA) in Stowe, VT this weekend. I will ask about the unit you are interested in if they are there. -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Thu, 18 Jan 1996 11:51:33 -0500 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Thu, 18 Jan 1996 11:51:32 -0500 (EST) Received: via switchmail; Thu, 18 Jan 1996 11:51:32 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 18 Jan 1996 11:50:02 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Thu, 18 Jan 1996 11:49:49 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from mail11.digital.com (mail11.digital.com [192.208.46.10]) by list.srv.cis.pitt.edu with SMTP (8.7.3/cisls-2.4) ID for ; Thu, 18 Jan 1996 11:49:48 -0500 (EST) Received: from us2rmc.zko.dec.com by mail11.digital.com (5.65v3.2/1.0/WV) id AA04424; Thu, 18 Jan 1996 11:40:50 -0500 Received: from xdelta.enet by us2rmc.zko.dec.com (5.65/rmc-22feb94) id AA07348; Thu, 18 Jan 96 11:37:26 -0500 Message-Id: <9601181637.AA07348@us2rmc.zko.dec.com> Received: from xdelta.enet; by us2rmc.enet; Thu, 18 Jan 96 11:37:26 EST Date: Thu, 18 Jan 96 11:37:26 EST From: Steve Hoffman 18-Jan-1996 1137 To: wilderness-emergency-medicine@list.pitt.edu Cc: hoffman@xdelta.ENET.dec.com Apparently-To: wilderness-emergency-medicine@list.pitt.edu Subject: Immobilization of Fractured Clavicle Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 33554560 0 :Many years ago, the recommended treatment was to use a figure-of-eight :bandage behind the shoulders to exert rearward traction on the shoulders and :so to seperate the broken ends of the clavicle, thus preventing further :injury. This proceedure is no longer used, presumable for the comfort of :the patient. The EMS (wilderness and street) training classes I've attended indicated an incorrectly applied figure-of-eight could result in sub-clavicular artery lascerations, and that this had occured and that the death was directly attributed to the clavicular fracture treatment with the figure-of-eight bandaging. Unfortunately, I can not cite sources in any medical literature. (I do hope this is not an EMS `urban legend' I am here propogating.) Steve Hoffman, NR-EMT-Intermediate, WEMT -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Thu, 18 Jan 1996 09:43:23 -0500 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Thu, 18 Jan 1996 09:43:20 -0500 (EST) Received: via switchmail; Thu, 18 Jan 1996 09:43:19 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 18 Jan 1996 09:41:13 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Thu, 18 Jan 1996 09:38:21 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from sun1.tcd.ie (sun1.tcd.ie [134.226.1.29]) by list.srv.cis.pitt.edu with ESMTP (8.7.3/cisls-2.4) ID for ; Thu, 18 Jan 1996 09:38:18 -0500 (EST) Received: from pc97.mee.tcd.ie (pc97.mee.tcd.ie [134.226.86.97]) by sun1.tcd.ie (8.7.1/8.6.10) with SMTP id OAA20274 for ; Thu, 18 Jan 1996 14:38:14 GMT Date: Thu, 18 Jan 1996 14:38:14 GMT Message-Id: <199601181438.OAA20274@sun1.tcd.ie> X-Sender: gbutler@mail.tcd.ie X-Mailer: Windows Eudora Light Version 1.5.2 Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" To: wilderness-emergency-medicine@list.pitt.edu From: Dr Gerry Butler Subject: Immobilization of Fractured Clavicle Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 Currently, the guidelines for field treatment of a fractured clavicle is to place the arm in a sling and immobilize to the body with a swathe. Many years ago, the recommended treatment was to use a figure-of-eight bandage behind the shoulders to exert rearward traction on the shoulders and so to seperate the broken ends of the clavicle, thus preventing further injury. This proceedure is no longer used, presumable for the comfort of the patient. This may be effective if the patient is being transported by ambulance, or on a short walk over flat ground. However, in a wilderness setting, the patient may have to walk for a considerable distance over rough ground which may lead to considerable movement of the shoulder/upper thorso. Such movement, affecting the clavicle, may then lead to further injury, particularly of the bloodvessels and nerves in the immediate vicinity of the fracture. At a recent meeting of my Mountain Rescue Team, the question of whether the "old treatment" was the best was raised. Any comments on this would be much appreciated. Gerry Dr Gerry Butler (gbutler@tcd.ie) TELTEC Radio Propagation Group Electronics Dept, Trinity College Dublin, Ireland Dublin+Wicklow Mountain Rescue, EMT-D, EI0CH -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Thu, 18 Jan 1996 09:55:33 -0500 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Thu, 18 Jan 1996 09:55:32 -0500 (EST) Received: via switchmail; Thu, 18 Jan 1996 09:55:32 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 18 Jan 1996 09:54:02 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Thu, 18 Jan 1996 09:53:47 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from emout06.mail.aol.com (emout06.mail.aol.com [198.81.10.43]) by list.srv.cis.pitt.edu with SMTP (8.7.3/cisls-2.4) ID for ; Thu, 18 Jan 1996 09:53:46 -0500 (EST) From: BMannix@aol.com Received: by emout06.mail.aol.com (8.6.12/8.6.12) id JAA19202 for wilderness-emergency-medicine@list.pitt.edu; Thu, 18 Jan 1996 09:53:15 -0500 Date: Thu, 18 Jan 1996 09:53:15 -0500 Message-ID: <960118095314_200173598@emout06.mail.aol.com> To: wilderness-emergency-medicine@list.pitt.edu Subject: Re: Immobilization of Fractured Clavicle Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 33554560 0 As one who has experienced a fractured clavicle (very common in bicycling), I would want to have the figure-eight bandage if I had to walk or be transported any distance. I found that the bandage can be very uncomfortable when it is too tight, and even when it is just tight enough. In a first-responder situation, I would suggest applying a relatively loose bandage, using the patient's feedback as a guide to the right tension. Keep in mind that there is an artery under the bone, and excessive movement may pose a risk to it. Brian Mannix BMannix@aol.com -- End -- Received: from post-ofc01.srv.cis.pitt.edu (post-ofc01.srv.cis.pitt.edu [136.142.185.10]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Thu, 18 Jan 1996 11:23:45 -0500 Received: from local (daemon@localhost) by post-ofc01.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Thu, 18 Jan 1996 11:23:42 -0500 (EST) Received: via switchmail for kconover+@pitt.edu; Thu, 18 Jan 1996 11:23:42 -0500 (EST) Received: from USA.REDCROSS.ORG (usa.redcross.org [162.6.2.21]) by post-ofc01.srv.cis.pitt.edu with SMTP (8.7.3/cispo-2.0.1.1) ID for ; Thu, 18 Jan 1996 11:15:36 -0500 (EST) Received: from NHQ-Message_Server by USA.REDCROSS.ORG with Novell_GroupWise; Thu, 18 Jan 1996 11:13:12 -0500 Message-Id: X-Mailer: Novell GroupWise 4.1 Date: Thu, 18 Jan 1996 11:12:22 -0500 From: Jose Salazar To: peter_mccabe@ed.gov, kconover+@pitt.edu Subject: Re[2]: WMS Wilderness First Aid Course -Reply -Reply -Reply X-PMFLAGS: 33554560 0 Peter, Just to clarify. The Responding to Emergencies course is our college level course that is appx. 23 hours. It has more information. However, the actual skills taught are Adult, child, infant, CPR, bleeding, and splinting. The new edition will have a chapter on delayed care such as wilderness. Regarding Emergency Response, I am glad that you are using that program. I do agree that this program is better for S&R. Just to let you know. We will be revising our program to meet the new first responder curriculum. (Please don't ask me for a time frame..yet) However, we are not looking at dropping any information we now have. We are also looking at getting National Registry approval so that students can take the registry exam upon completion of our program now that the Registry is giving the FR test. If you need more info. please let me know. Jose >>> peter mccabe 01/18/96 10:52am >>> Jose and Keith I think Jose from the Am Red Cross in KC is indicating that the Responding to Emergencies course is probably the multi-media 8 hour Red Cross course. Keith, as you know we put all of our people in Maryland Search & Rescue (ESAR-616) through what used to be called Advanced First Aid (now called Emergency Response) with the American Red Cross. We found the new Emergency Response 40 hour training course superior to the the DOT First Responder training. We do, however, understand there is a new DOT First Responder course coming down the road in the coming months. In Maryland, we are fortunate that with successful passing of the Red Cross Emergency Response training our folks can challenge the Maryland First Responder test. Most do, and most pass to become Maryland First Responders. We still like the Red Cross training though. And, the old 12 hour CPR training for Professional Rescuers is taught in the Red Cross Emergency Response course. -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Thu, 18 Jan 1996 11:49:55 -0500 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Thu, 18 Jan 1996 11:49:54 -0500 (EST) Received: via switchmail; Thu, 18 Jan 1996 11:49:54 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 18 Jan 1996 11:48:57 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Thu, 18 Jan 1996 11:48:40 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from pop.cc.nih.gov (pop.cc.nih.gov [137.187.120.140]) by list.srv.cis.pitt.edu with ESMTP (8.7.3/cisls-2.4) ID for ; Thu, 18 Jan 1996 11:48:38 -0500 (EST) Received: from [128.231.80.97] ([128.231.80.97]) by pop.cc.nih.gov (8.7.3/8.7.3) with SMTP id LAA28198 for ; Thu, 18 Jan 1996 11:48:32 -0500 (EST) X-Sender: dlanducci@pop.cc.nih.gov Message-Id: Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Date: Thu, 18 Jan 1996 11:50:26 -0500 To: wilderness-emergency-medicine@list.pitt.edu From: Dante_Landucci@NIH.gov (Dante Landucci, MD) Subject: Re: Immobilization of Fractured Clavicle Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 Dr Gerry Butler wrote: >Many years ago, the recommended treatment was to use a figure-of-eight >bandage behind the shoulders to exert rearward traction on the shoulders and >so to seperate the broken ends of the clavicle, thus preventing further >injury. This proceedure is no longer used, presumable for the comfort of >the patient. I do not concur that use of figure-eight bandages is out of favor. Traction is required to appropriately appose the fractures ends. If done too rapidly, this can be anguishing for the patient. If applied gradually, though, the procedure can often be tolerated without administration of any analgesics. The advantage is that it reduces the incidence and degree of malunions. Although individuals seem capable of adapting well to malformed clavicles, it seems optimal to restore their anatomy as close to baseline as possible, all the more so given the low risk of complications from the corrective procedure. I know of no data but find it hard to believe that either method offers superior immobilization and, thus, pain control during evacuation. I believe no data about post-immobilization complicationswith either modality is available. For these reasons, I continue to use figure-eight binding for uncomplicated clavicular fractures. Brian Mannix wrote: >...Keep >in mind that there is an artery under the bone, and excessive movement may >pose a risk to it. Of equal or greater importance is the proximity of a large neural bundle. The presence of these structures is the other factor that predicates gradual application of traction. -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Thu, 18 Jan 1996 14:05:08 -0500 Received: from local (root@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Thu, 18 Jan 1996 14:05:06 -0500 (EST) Received: via switchmail; Thu, 18 Jan 1996 14:05:06 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Thu, 18 Jan 1996 14:04:22 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Thu, 18 Jan 1996 14:01:49 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from pop.cc.nih.gov (pop.cc.nih.gov [137.187.120.140]) by list.srv.cis.pitt.edu with ESMTP (8.7.3/cisls-2.4) ID for ; Thu, 18 Jan 1996 14:01:42 -0500 (EST) Received: from [128.231.80.97] ([128.231.80.97]) by pop.cc.nih.gov (8.7.3/8.7.3) with SMTP id OAA07265 for ; Thu, 18 Jan 1996 14:01:34 -0500 (EST) X-Sender: dlanducci@pop.cc.nih.gov Message-Id: Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" Date: Thu, 18 Jan 1996 14:03:29 -0500 To: wilderness-emergency-medicine@list.pitt.edu From: Dante_Landucci@NIH.gov (Dante Landucci, MD) Subject: Re: Immobilization of Fractured Clavicle Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 > The EMS (wilderness and street) training classes I've attended indicated > an incorrectly applied figure-of-eight could result in sub-clavicular > artery lascerations, and that this had occured and that the death was > directly attributed to the clavicular fracture treatment with the > figure-of-eight bandaging. Although the literature about clavicular fractures and their complications is scant, this seems a very possible, albeit uncommon, scenario. Following clavicular fracture, patients have experienced: arterial injury/compression venous injury/compression brachial plexopathy forearm compartment syndrome Most of these injuries are from complicated fractures (<= 20 % of cases). The typical site of injury to the clavicle (>= 75% of cases) is in the middle third. In the absence of extreme displacement of the bone fragments, which is generally the cause of additional injury, these are considered uncomplicated. Additional trauma can occur form excessive or unnecessarily rough movement. Anyone with a fractured clavicle FIRST should be carefully examined for evidence of neurologic or vascular compromise in the ipsilateral extremity. If none is noted, immobilization can be performed with care. If there is evidence of damage to neurovascular structures, if the fracture occurs proximally or distally, or if there is a concommittant dislocation or other severe trauma the most important consideration is getting the patient to medical attention as quickly as possible with minimal manipulation of the fracture site. Obviously, for complicated extrications, some sort of immobilization is necessary. The following references present a good perspective on the handling of clavicular fractures. Newer references devote much more attention to surgical intervention for complicated cases; the older references may be more relevant to this discussion. 1. Post M. Current concepts in the treatment of fractures of the clavicle. Clin Orthop 1989(245):89-101. 2. Neviaser JS. Injuries of the clavicle and its articulations. Orthop Clin North Am 1980;11(2):233-7. 3. Heppenstall RB. Fractures and dislocations of the distal clavicle. Orthop Clin North Am 1975;6(2):477-86. 4. Taylor AR. Some observations on fractures of the clavicle. Proc R Soc Med 1969;62(10):1037-8. -- End -- X-cs: From: Self To: REBURR@aol.com Subject: Re: Frostbite questions... Reply-to: kconover@pitt.edu Date: Fri, 19 Jan 1996 09:27:37 On 19 Jan 96 at 3:18, REBURR@aol.com wrote: > Keith: Did you get my followup post to you in which i described my > conversation with Bill Doolittle (the PI) about the Bassett dextran "study". > If not' I'll send it along again. It is important in understanding this > issue. Bob Burr. Indeed. I can't find it right now but I'm sure I've got it filed here somewhere. It's very different than what Murray told me. Maybe you could ask Murray if he can explain why he thought dextran was great and should probably be the standard of care, pending new investigation? That's why it's in our recommendations. Thanks very much. --Keith -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Fri, 19 Jan 1996 09:37:47 -0500 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Fri, 19 Jan 1996 09:37:46 -0500 (EST) Received: via switchmail; Fri, 19 Jan 1996 09:37:46 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Fri, 19 Jan 1996 09:36:13 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Fri, 19 Jan 1996 09:32:36 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from opsarg.sld.ar ([200.12.154.33]) by list.srv.cis.pitt.edu with SMTP (8.7.3/cisls-2.4) ID for ; Fri, 19 Jan 1996 09:32:28 -0500 (EST) Received: by opsarg.sld.ar (/\==/\ Smail3.1.25.1 #25.9) id ; Fri, 19 Jan 96 11:32 ARG Received: from hsmdla by sspn.sspn.sld.ar id aa07398; 19 Jan 96 10:49 ARG Received: by hsmdla.sspn.sld.ar (PcCorreo 4.2) with UUCP; Fri, 19 Jan 96 10:36:23 ARG Date: Fri, 19 Jan 96 10:36:23 ARG From: "parada@hsmdla.sspn.sld.ar" Message-ID: <810ao071@hsmdla.sspn.sld.ar> X-Mailer: PcCorreo 4.2 / (c) Fernando Lopez Guerra. To: wilderness-emergency-medicine@list.pitt.edu Subject: Inmobilization of fractured clavicle Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 33554560 0 The most important aspect of field treatment should be to reduce further injury and provide enough comfort so the patient can be evacuated or selfevacuated quickly. I have not seen any complication such as vascular or nerve bundle damage due to figure of 8 inmovilization of fractured clavicle allthough there is a potential to produce this I would say that it is very very unlikely to damage vascular or nerve structures if the backward traction on the shoulders is done gently and gradually so the injured patient can relax and permit further traction which eventually leads to proper inmovilization. For field inmovilization I would use a 10-15 cm elastic bandage in a figure of 8 and add a sling on the afected side. The elastic bandage is stiff enough to provide inmovilization and is more confortable than a rigid inmovilization (cast) to walk or move over rough ground and can be trimmed to fit better after some time of use. Marcelo Parada MD parada@hsmdla.sspn.sld.ar ARGENTINA -- End -- X-cs: From: Self To: Wb7qni@aol.com Subject: Frostbite studies/backcountry fluids Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover@pitt.edu Date: Sat, 20 Jan 1996 22:59:33 On 20 Jan 96 at 21:58, Wb7qni@aol.com wrote: > I've always thought rural ambulances (including SAR ground troops) should > carry 3% saline, dextran, or (as I used to do with my contacts) a good water > filter plus sterile salt and some reusable sterile solution IV bags (for > reconstituting your own). I've actually got recipes for making LR and NS in > the bush hospital. We were all told to travel in similar blood type pairs, so > if we got bad malaria we could transfuse each other. Only trouble is pyrogens -- you can get an anaphylactic reaction unless you ultra-filter the water through a _very_ good filter. NASA has developed such, with prepackaged salts for IV fluid, but the filter requires lots of pressure and lots of time. > > The Yearbook reference you wanted follows this. (quote carets removed for clarity --KC) --------------------------------------------------------------- Experimental and Clinical Observations on Frostbite. Heggers JP, Robson MC, Manavalen K, Weingarten MD, Carethers JM, Boertman JA, Smith DJ Jr, Sachs RJ. (Wayne State Univ, Detroit; Detroit Receiving Hosp Burn Ctr) Ann Emerg Med 16:1056-1062, September 1987. ABSTRACT: Research on frostbite blister fluid in humans suggested that thromboxane (TxA2) and prostaglandins play a role in the pathogenesis of frostbite. The experimental clinical applications of these principles were incorporated into a protocol designed to determine whether a specific topical inhibitor of TxA2 - Aloe vera - and a systemic antiprostaglandin agent would be beneficial in treating frostbite. Twenty New Zealand white rabbits were divided into 5 groups. Treatment groups received antiprostanoids, methylprednisolone, and aspirin combined with antithromboxane agents A. vera and methimazole. The control group received no therapy. The classic frostbite rabbit ear model was used. There was no tissue survival in the control group. Methimazole treatment produced 34.3% survival; A. vera, 28.2%; aspirin, 22.5%; and methylprednisolone, 17.5%. A modified frostbite protocol using ibuprofen was then compared with other therapeutic modalities in 154 patients treated for frostbite. Fifty-six patients were treated with a combination of a systemic antiprostanoid and a topical antithromboxane. For all degrees of frostbite in this protocol group, 67.9% healed without tissue loss, 25% healed with partial tissue loss, and 7% required amputation. Of the 98 patients treated with other modalities, 32.7% healed without tissue loss, 34.6% healed with tissue loss, and 32.7% required amputation. The therapeutic approach used in this study to prevent progressive dermal necrosis from frostbite was designed to inhibit the localized production of TxA2 and systemically control prostanoid production. Ibuprofen was used instead of aspirin because aspirin irreversibly inhibits cyclooxygenase activity, which is needed for prostaglandin E2 (PGE2) and prostaglandin F2a (PGF2a) production. A steady-state or equilibrium relationship between PGE2 and PGF2a to maintain normal cell function and cell integrity was substantiated (Fig 4-13). The protocol led to a reduced hospital stay and less morbidity when compared with other therapeutic modalities. COMMENT: The article represents a nice blend of basic science and animal and clinical research. Previously, emergency physicians were discouraged from surgical debridement of blisters. The authors of this article recommend removal of clear blisters and application of the topical agents they have studied to prevent TxA2-induced tissue injury. Nonblistered, frostbitten tissue may be saved and should not be debrided early. - M.M. McDonald, M.D. -------------------------------------------------------- [ end of non-careted citation --KC] The cited animal study is interesting but of limited clinical application. If you use methimizole you develop myxedema coma as your frostbite recovers :-) (methimizole has both NSAID and antithyroid actions) The human "study" had massive selection bias and basically no controls. Look at their "protocol." They compared treatment of those with frostbite admitted to their burn service with those with frostbite admitted to other services. The severity and distribution of frostbite in the two groups was _very_ different. There was no control or randomization over whether patients were admitted to the burn service or another service, or any discussion of the potential comorbidity of patients, presumably with other problems, admitted to other services. You can justify NO CONCLUSIONS WHATSOEVER based on their human data. Worse, you can't even get an _inkling_ of whether there was any benefit from ibuprofen in this study because of massive methodological flaws. Their ":study" sounds like an ex-post-facto argument for treating frostbite the way they already do in the burn unit, rather than a scientific study. It's total garbage, a poorly-done descriptive study masquerading as a controlled clinical trial. The editors who let this into Ann Emerg Med should be shot. (Sorry, am I getting a little hot under the collar here? It's just that people cite this "study" all the time as support for ibuprofen. I suspect ibuprofen is good, and recommend it, but not based on this study.) I hope you don't mind my sharing this with with the w-e-m list. Thanks! -- End -- X-cs: From: Self To: wilderness-emergency-medicine@list.pitt.edu,Dante_Landucci@NIH.gov (Dante Landucci, MD) Subject: Re: Orudis KT Cc: EMED List Reply-to: kconover@pitt.edu Date: Sun, 21 Jan 1996 22:23:54 On 17 Jan 96 at 11:26, Dante Landucci, MD wrote: > >But: > > > >The reasons that I believe a NSAID should be in a standard WEMSI > >medical kit are: > > > >1. good for pain that Tylenol won't touch (will take care of pain > >that is about twice as intense). > > Can you substantiate that claim? See below. > > >2. good for problems in team members, such as minor twisted ankles, > >eyestrain headaches, etc. > > To my knowledge, there is no evidence that it would be better than > acetaminophen. > > >3. unlike equipotent analgesics such as hydrocodone or codeine, > >NSAIDs have little if any effect on the CNS; so people can still > >belay, climb, etc. after taking them. > > Good point. > > >4. Popular demand: how often does a team member approach a WEMT (or > >other members of the team) and say: "Have you got any Advil or > >Nuprin? I ache all over after that task." And there is some > >evidence that a single dose of NSAID after excessive muscular > >activity (such as SAR) does much to alleviate next-day soreness. > >The reference is buried somewhere here. > > I agree with your belief that NSAIDs help prevent exertional muscular pain. > I don't concur that it's the responsibility of a WEMT to be providing such > medication for others. Each member is responsible for those necessities > that make the expedition, whether for pleasure or rescue, more tolerable. > There is collaboration on the major points, such as food and shelter. But, > for example, I doubt WEMTs carry toothpaste for all. Members may choose to > draw it from a common pool, but they still need to assume that > responsiblity. > > In the case of NSAIDs, a common pitfall is to focus on the high > benefit:risk ratio and the relatively large therapeutic window. The more > important issue is that, when adverse reactions occur, they can be very > serious. Given the frequency with which these drugs are used, side effects > are remarkably common. I consider it undesirable for one individual to > assume that degree of responsibility for his/her companions when they can > do so for themselves. > > I have contemplated this matter at length during my various travels. > Finally, I've decided to always carry aspirin (not a good choice for many > reasons, but it works very well for me). If someone wants it, I share it; > not as a HCW, simply as an associate. I make it clear it's their decision > whether to use it or not. > Force me to dig into my file cabinet, will you? {This may be of interest to those on the emed-l list, so I'll post this reply there, too. The background is a discussion of whether to put a NSAID in a Wilderness EMT's personal medical kit or not. I've wanted for several years to review these articles and synthesize my reasoning in written form, so don't be surprised at the detail!} I will leave for someone else to discuss: the idea that some pain is severe enough that acetaminophen and other mild analgesics will have no significant effect on it. And I won't discuss the methodology of the studies except that they all seemed adequate, except for possibly some drug company funding. OK, I found that most of the evidence supported the ideas that: * NSAIDs control pain that is about twice as severe as the most severe pain that aspirin (ASA) or acetaminophen (paracetamol, Tylenol) , and * NSAIDs will do about twice a good a job of controlling pain as will ASA or acetaminophen for pain of a severity for which they both will have some effect. ------------------------------------------------------------------- * First, let me dispose of what might be seen as dissenting evidence. There is a single study that suggests that ASA 600 mg + caffeine 60 mg works as well as ibuprofen 200 mg in a dental pain model. However, the caffeine may well have potentiated the effect of the ASA so I discount this study. 1. [Habib S, Matthews RW, Scully C, Levers BGH, Shpherd JP. A study of the comparative efficacy of four common analgesics in the control of postsurgical dental pain.Oral Surg Oral Med Oral Pathol 1990;70:559-63.] ------------------------------------------------------------------- * Next, there are studies that confirm that ASA and acetaminophen are about equipotent for mild pain (and, roughly, as are most common oral narcotics). And, that narcotics and acetaminophen or ASA have additive effects. This article also points out that oxycodone (as in Percocet) is stronger than hydrocodone (as in Vicodin), which in turn is stronger than codeine (as in Tylenol #3). And it also shows that Darvon isn't very good. 2. [Beaver WT. Aspirin and acetaminophen as constitutents of analgesic combinations. Arch Intern Med 1981;141:293-300.] This study also shows that shows that acetaminophen and a narcotic such as hydrocodone or oxycodone are about equipotent for mild pain, but that the combination of the two is additive. (Interestingly acetaminophen 500 mg was superior to oxycodone 5 mg!) ------------------------------------------------------------------- * If you look carefully at Table 4 in this next study, you can see that naproxen (e.g., Naprosyn, Aleve) works for worse pain than ASA, as well as providing better pain relief for milder pain. 3. [Sindet-Pedersen S, Petersen JK, Go/tzsche PC, Christensen H. A double-blind, randomized study of naproxen and acetylsalicylic acid after surgical removal of impacted lower third molars. Int J Oral Maxillofac Surg 1986;15:389-94.] ------------------------------------------------------------------- * Next, you can confirm ibuprofen is superior for surgical pain, too. 5. [Slavic-Svircev V, Heidrich G, Kaiko RF, Rusy BF. Ibuprofen in the treatment of postoperative pain. Am J Med 1984; July 13:84-6] (This one also rated 400 mg ibuprofen better and longer than one acetaminophen + codeine tablet.) ------------------------------------------------------------------- * and headache: 6. [Diamond S. Ibuprofen versus aspirin and placebo in the treatment of muscle contraction headache. Headache 1983;23:206-10.] ------------------------------------------------------------------- * There is a direct trial that showed that naproxen was about the same as acetaminophen + codeine for surgical pain: 7. [Oullette RD, Feinberg A, Laraga R, Rothernberg RE, Welch GW. Naproxen sodium vs acetaminophen plus codeine in postsurgical pain. Curr Ther Res 1986;39(5):839-845.] ------------------------------------------------------------------- So the logical arguments go like this: Argument 1: acetaminophen = aspirin [2] naproxen > aspirin [4] ibuprofen = naproxen (I'll not cite any evidence, but if you think it's stronger you'll have to cite some evidence to prove it!) therefore, ibuprofen > acetaminophen Argument 2: acetaminophen = aspirin [2], and ibuprofen > aspirin [5,6] therefore, ibuprofen > acetaminophen Argument 3: naproxen = acetaminophen + codeine [7] acetaminophen + codeine > acetaminophen [2] ------------------------------------------------------------------- Finally, there were direct trials of ibuprofen vs acetaminophen. Still unbeaten is the champ, ibuprofen! 8. [Cooper SA. Five studies on ibuprofen for postsurgical dental pain. Am J Med 1984; July 13:70-7.] ------------------------------------------------------------------- Q.E.D. -- End -- X-cs: From: Self To: Frank Sherman Subject: Re: Orudis KT Cc: "Charles P. Kollar" , wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover@pitt.edu Date: Tue, 23 Jan 1996 06:32:24 On 22 Jan 96 at 15:13, Frank Sherman wrote: > I have tried repeatedly to get off this list please help me. FRANK Send unsubscribe wilderness-emergency-medicine to majordomo@list.pitt.edu If you are subscribed under an address different than the one that appears under your header, you must send unsubscribe wilderness-emergency-medicine and this will have to be approved by one of the list owners. -- End -- X-cs: From: Self To: Dante_Landucci@NIH.gov (Dante Landucci, MD) Subject: Re: Orudis KT Cc: wilderness-emergency-medicine@list.pitt.edu,Dante_Landucci@NIH.gov (Dante Landucci, MD) Reply-to: kconover@pitt.edu Date: Tue, 23 Jan 1996 06:51:13 On 22 Jan 96 at 11:08, Dante Landucci, MD wrote: > >So the logical arguments go like this: > > > >Argument 1: > >acetaminophen = aspirin [2] > >naproxen > aspirin [4] > >ibuprofen = naproxen > > (I'll not cite any evidence, but if you think it's stronger you'll > > have to cite some evidence to prove it!) > >therefore, ibuprofen > acetaminophen > > > >Argument 2: > >acetaminophen = aspirin [2], and > >ibuprofen > aspirin [5,6] > >therefore, ibuprofen > acetaminophen > > > >Argument 3: > >naproxen = acetaminophen + codeine [7] > >acetaminophen + codeine > acetaminophen [2] > > > >------------------------------------------------------------------- > >Finally, there were direct trials of ibuprofen vs acetaminophen. Still > >unbeaten is the champ, ibuprofen! > > 8. [Cooper SA. Five studies on ibuprofen for postsurgical dental > > pain. Am J Med 1984; July 13:70-7.] > >------------------------------------------------------------------- > > > >Q.E.D. > > Thank you for the detailed exposition. I'm glad to have been forced to > reconsider my position. > > On additional issue needs clarification. When citing studies of Naproxen, > are you talking about the compound, or its sodium salt? I believe there is > convincing evidence the latter is more potent, probably due to > bioavailability, than the former. I also believe it may have been found to > be more potent an analgesic than Ibuprofen, though less convincingly. > > Thanks again, > > Dante > Interesting point, and I'd always assumed the differences were trivial. In my previous references, Oulette used the sodium salt, Sindet-Pedersen used the base compound. -- End -- X-cs: From: Self To: Eduardo Novaes Ramires ,wilderness-emergency-medicine@list.pitt.edu Subject: Electric Shock for Snakebite Reply-to: kconover+@pitt.edu Date: Wed, 24 Jan 1996 12:11:12 On 24 Jan 96 at 14:14, Eduardo Novaes Ramires wrote: > Hello, > > I don't know if I am writing to the right list. I heard about > shock treatment for snake, scorpions, and possibly, spider bites. The > technique was developed by Dr. Ron Guderian, now at Quito, Equador. It > seems that he is aplying this technique with success. > Well, here in Brazil we have more or less 10,000 snake bites and > 5,000 or more spider and scorpion bites. Does anybody know of detailed > information about the effectiveness/costs/people working with this > technique? Can this be applied on the field? > Thanks, > > Eduardo Novaes Ramires > Instituto Butantan, Lab. Artropodes > CP 65, CEP 05503-900 > Sao Paulo, SP > Brasil > Here is some information, a brief quote from our soon-to-be released textbook: Electric Shocks for Snakebite Electric Shock treatments for snakebites are useless. The few studies that showed positive effect are flawed.[1] There are now good studies that show electric shocks useless.[1,2,3] As some lecturers put it: "Electric shocks were tried on snakebite back when electricity was first discovered. [Franz Anton Mesmer tried it --KC] It didn't work then, and it doesn't work now." 1. Guderian RH, Mackenzie CD, Williams JF. High voltage shock treatment for snake bite. Lancet 1986;2(8500):229. 2. Howe NR, Meisenheimer JLJ. Electric shock does not save snakebitten rats. Ann Emerg Med 1988;17(3):254-6. 3. Davis D, Branch K, Egen NB, Russell FE, Gerrish K, Auerbach PS. The effect of an electrical current on snake venom toxicity. J Wild Med 1992;3(1):48-53. -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Wed, 24 Jan 1996 13:35:07 -0500 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Wed, 24 Jan 1996 13:35:06 -0500 (EST) Received: via switchmail; Wed, 24 Jan 1996 13:35:06 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Wed, 24 Jan 1996 13:33:10 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Wed, 24 Jan 1996 13:31:05 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from mail1.new-york.net (mail1.new-york.net [165.254.2.54]) by list.srv.cis.pitt.edu with ESMTP (8.7.3/cisls-2.4) ID for ; Wed, 24 Jan 1996 13:31:02 -0500 (EST) From: grenard@herpmed.com Received: from herpmed.com by mail1.new-york.net (PMDF V4.3-10 #5880) id <01I0E21MV9CG00BMEB@mail1.new-york.net>; Wed, 24 Jan 1996 13:27:36 -0500 (EST) Date: Wed, 24 Jan 1996 14:00:56 -0800 (PST) Subject: RE: Electric Shock for Snakebite To: Eduardo Novaes Ramires , wilderness-emergency-medicine@list.pitt.edu, kconover+@pitt.edu Message-id: MIME-version: 1.0 X-Mailer: Chameleon - TCP/IP for Windows by NetManage, Inc. Content-type: TEXT/PLAIN; charset=US-ASCII Content-transfer-encoding: 7BIT Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 34078848 0 If I recall the original Lancet letter (not a study, not an article ... just a letter) correctly, Guderian reported on the use of an outboard motor sparkplug wire applied to a snakebite with a good result. This report was highly anecdotal. Many snakebites are blanks, many snakebites are by non-venomous snakes....so there may be a good result when there is nothing else to have but a good result. In the U.S. this report was picked up by the media as well as by the herpetological community. Makers of stun guns jumped on the band-wagon and outdoor magazines did likewise. Except for possibly cauterizing the wound (not a good idea if you wish to use extraction) non-lethal amounts of electricity cause pain and burns. It has absolutely no effect on the toxicity of the venom and, contrary to the belief of some, does not cause a molecular re-arrangement of the venom constituents rendering them harmless in situ. Low voltage electricity is being investigated as a means to enhance passage of topical peptides systemically and may, in fact, have a highly deleterious result in a genuine venomous snakebite. This subject is explored in some detail along with other new and/or non-traditional means of treating snakebite in "Medical Herpetology" (http://www.xmission.com/~gastown/herpmed/medherp.htm). ------------------------------------- Steve Grenard E-mail: grenard@herpmed.com http://www.herpmed.com/ POB 40825 - Staten Island NY 10304-0825 USA Telephone/Fax/Messages: 1-718-4476144 ------------------------------------- -- End -- Received: from post-ofc02.srv.cis.pitt.edu (post-ofc02.srv.cis.pitt.edu [136.142.185.11]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Fri, 26 Jan 1996 19:49:48 -0500 Received: from local (daemon@localhost) by post-ofc02.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Fri, 26 Jan 1996 19:43:29 -0500 (EST) Received: via switchmail for kconover+@pitt.edu; Fri, 26 Jan 1996 19:43:29 -0500 (EST) Received: from JEFLIN.TJU.EDU (jeflin.TJU.EDU [147.140.128.114]) by post-ofc02.srv.cis.pitt.edu with SMTP (8.7.3/cispo-2.0.1.1) ID ; Fri, 26 Jan 1996 19:39:31 -0500 (EST) Received: from JEFLIN.TJU.EDU by JEFLIN.TJU.EDU with SMTP; Fri, 26 Jan 1996 19:37:30 -0500 (EST) Date: Fri, 26 Jan 1996 19:37:28 +0000 From: "Jack T. Grandey" X-Sender: GRANDEYE@ To: "Wilderness Emergency Medicine@" cc: Baxter Larmon , Gregg Margolis , Keith Conover , Walt Stoy Subject: Paramedic Curriculum Revision Project Message-ID: MIME-Version: 1.0 Content-Type: TEXT/PLAIN; charset=US-ASCII X-PMFLAGS: 34078848 0 This is just a final notice to make sure tha I've heard from all who would be interested in serving on the Environmental Emergencies workgroup for the paramedic curriculum revision project. If I've heard from you, you do not need to re-send. If you're interested & I haven't, this is your last chance. A reminder: I only have four (4) positions available for writers. We need people /c outdoors knowledge/interest, but these are primarily writing positions. If you have expertise, but limited time, please contribute as a peer reviewer. There will be MANY opportunities for your input. Thanks all, for your interest. JTG Jack T. Grandey, NREMT-P Continuing Education Coordinator Operations Director Albert Einstein Medical Center Wilderness EMS Institute Author - Environmental Emergencies workgroup, Paramedic Curriculum Revision Project -- End -- X-cs: From: Self To: Thomas Smith Subject: Re: softer rides in a truck Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover@pitt.edu Date: Sat, 27 Jan 1996 23:29:56 On 27 Jan 96 at 20:44, Thomas Smith wrote: > We are currently setting up an evacuation system for a group of villages > and an exploration base camp in the Andes. Fortunately, we have found a > Porter STOL aircraft about an hour away on the coast of Peru and are in > the process of preparing a primitive but adequate landing strip on some a > plateau. However, there are some very, very bumby roads to overcome to > get to the site. We have a couple of double cabin pick-ups in the area > and have volunteered them for moving injured to the strip. I was > wondering if anyone knew of proven procedures for rigging the pick-ups > for litters so the bumps and grinds of the "road" don't needlessly > aggravate any injuries. I imagine some form of improvised suspension can > be made to ease the trip. Any leads would be greatly appreciated, and we > can guarantee the advice will be put to good use. > PS For some reason the Internet clips part of my address when sending. > Please send replies to tsmith@amuate.rcp.net.pe > Thanks > Tom Smith A common technique is to place a litter on top of several large partly-inflated truck inner tubes. I've done this a couple of times and it helps some. Not ideal, but cheap and workable. P.S. you ought to change your "reply-to" address in your email program. I see that you can get mailings from the w-e-m list, but your "reply-to" address is tsmith@amauta and that just isn't enough for you to get direct email replies; it generates an error message because there isn't enough domain addressing after your name. -- End -- X-cs: From: Self To: wilderness-emergency-medicine@list.pitt.edu Subject: WECC-First Responder Equvalency Reply-to: kconover@pitt.edu Date: Mon, 12 Feb 1996 14:52:19 To those interested in DOT First Responder equvalency for those who have completed the Ski Patrol WECC (Winter Emergency Care Course). As of December, 1995, Pennsylvania EMS has adopted the PA Emergency Health Services Council (PEHSC) Vote to Recommend (VTR) #94105: "The Department recognizes The National Ski Patrol (Outdoor) Winter Emergency Care Course as being equivalent to the U.S. Department of Transportation's First Responder Course. Action: The Department adopted this recommendation and will allow the students completing this course to take the Department's First Responder certification test. This may be of use for Ski Patrols in other states, to persuade your state EMS to grant similar equivalence. -- End -- X-cs: From: Self To: wilderness-emergency-medicine@list.pitt.edu Subject: WEMT neurological examination Reply-to: kconover@pitt.edu Date: Mon, 19 Feb 1996 09:44:02 I'm posting this to get informed opinions as to the neurological examination that Wilderness EMTs should be taught. Readers of the list will probably not need to be told _why_ WEMTs should be able to do a bit more of a neuro exam than a "street" EMT or paramedic -- though that would also make an interesting discussion thread, too. Instead, I'd like to focus on the specific elements that make up the WEMTs neuro exam. Criteria for inclusion would be, I think: * provides useful information either the WEMT at the scene, or for a remote medical command physician on the radio/field phone * can be done adequately without excessive WEMT training time WEMSI currently teaches a neuro exam similar in organization to a medical student's exam, abbreviated as often done in the ED. Here is an outline: WEMSI Wilderness EMT Quick Reference Card Version 1.01 June 16, 1995 -------------------------------------------------------------- Emergency water disinfection: _ if dirty, flocculate (alum or white campfire ash) _ 8 drops Betadine(r)/L for 30 minutes; use more or leave longer if dirty or very cold water _ 4 cc of Clorox(r) 5% bleach for 40 L (10 gallons) overnight; double if have to use in an hour -------------------------------------------------------------- "Clearing the C-Spine": Only in wilderness _ totally alert, not intoxicated _ no painful "distracting" injury _ no neck pain _ no neck tenderness _ no numbness, tingling, weakness _ normal motor/sensory exam of extremities _ painless full range of motion of neck -------------------------------------------------------------- Shoulder Dislocations - Check and document distal NVI incl. "patch area" and forearm. - Can pt. bring affected hand to opposite shoulder? If so, unlikely is shoulder dislocation. - Palpate for deformity: AC sprain? Humerus fx? - pain medications, muscle relaxants, suggestion, or hypnosis; ask patient to relax muscles - Stimson method: face down on ledge/table, padding under shoulder at edge; attach weight to elbow or wrist and monitor for neurovascular impairment from weight; use other method if no results in 30 minutes. - Milch technique: traction upwards. -------------------------------------------------------------- Neurological Exam: Mental Cases Sometimes Make Deepdish Casserole: MCSMDC + Mental Status + Cranial Nerves: "How many fingers?" [CN II, optic: vision] "Look up, look down, look right, look left." EOMI (ExtraOcular Motions Intact) [CNs III, IV, VI, oculomotor, trochlear, abducens: move eyes in all directions] "Close your eyes and say `now' when you feel a touch." {forehead, cheek, chin}) [CN V, trigeminal: bilateral face sensation] "Smile; raise your eyebrows." [CN VII, facial: bilateral face strength] "Which side do you hear the sound on?" {rub fingers next to ear, then other} [CN VIII, auditory: hearing] "Hold your shoulders up." {press down on shoulders} {alternate: have patient turn head against resistance} [CN XI, accessory: elevates shoulders, turns head side to side] "Stick out your tongue" {tongue in midline?} [CN XII, hypoglossal: protrudes tounge] Not tested: CN I, olfactory: smell; CN IX, glossopharyngeal: sensation back of throat; CN X, vagus: parasympathetic to internal organs + Sensory: light touch, pinprick + Motor: strength + Deep Tendon Reflexes: forearm [brachioradialis], elbow [biceps], knee jerk [patellar], ankle jerk; also response to stroking lateral sole ("Babinski": normal down > 1 yr. old. + Cerebellar: "finger -> nose" "heel -> shin" Gait ("Walk a straight line, heel to toe.") However, in his lectures and in the Neurological Examination chapter of Tintinalli's EM textbook, Greg Henry argues for a different neuro exam as a screening exam for the ED. I won't reproduce that entire chapter here, but will summarize the exam he proposes below. (The Tintinalli textbook, fourth edition, should be available in every ED in the country, and the chapter's only four pages long.) Table 191-1. Neurologic Screening Exam Area Test -------------------------------------------------------------------- Mental status Normal orientation, speech, global affect Cranial nerves Funduscopic, extraocular movements and pupillary response, visual fields, corneal reflexes, and facial muscle strength Motor Basic muscle groups, tone, drife, heel-and toe walking Sensory Cold and vibration on areas indicated by patient or on distal extremities Coordination (gait) Observation of gait, and finger-to-nose testing Reflexes Deep tendon--knees, ankles, elbows, and wrists; degenerative reflexes--Babinski's signs, snout, grasp, and root. -------------------------------------------------------------------- A few quotes from this chapter: "Evaluation of mental status is performed simply by speaking with the patient. In the ED detailed tests for hemispheric function are not necessary in a patient who is conversing normally, is making reasonable responses to questions, and is well-oriented." "Mass lesions that cause pressure either directly or indirectly on the diencephalon can alter the visual fields and pupillary response to light. Insidious tumors of the cerebral hemispheres, which may have very few gross neurological findings, can cause early changes in the visual fields." "The extraocular muscles are innervated by the third, fourth, and sixth cranial nerves. The nuclei for these nerves cover a large area in the pons and midbrain, making them good indications of brainstem function." "The corneal reflex is often affected in hemispheric disease long before general facial sensation or the muscles of mastication are involved." "The eighth cranial nerve rarely requires testing in the ED." "Tests for the ninth, tenth, eleventh and twelfth cranial nerves are generally not important in the ED. There are no acute diseases that will manifest themselves with findings only in these areas, and in a rapid neurologic screening exam they are of little value." I'd be very interested in the list's responses. Thank you. -- End -- Received: from post-ofc03.srv.cis.pitt.edu (post-ofc03.srv.cis.pitt.edu [136.142.185.39]) by shadow-blue.cis.pitt.edu with ESMTP (8.7.3/cispop-1.6.1.3) ID for ; Mon, 19 Feb 1996 11:46:27 -0500 Received: from local (root@localhost) by post-ofc03.srv.cis.pitt.edu (8.7.3/cispo-2.0.1.1) ID for kconover@pop.pitt.edu; Mon, 19 Feb 1996 11:46:27 -0500 (EST) Received: via switchmail; Mon, 19 Feb 1996 11:46:27 -0500 (EST) Received: from list.srv.cis.pitt.edu via qmail ID ; Mon, 19 Feb 1996 11:44:51 -0500 (EST) Received: from local (majordom@localhost) by list.srv.cis.pitt.edu (8.7.3/cisls-2.4) ID ; Mon, 19 Feb 1996 11:44:20 -0500 (EST) X-Authentication-Warning: list.srv.cis.pitt.edu: majordom set sender to owner-wilderness-emergency-medicine using -f Received: from aehn2.einstein.edu (root@aehn2.einstein.edu [205.245.103.237]) by list.srv.cis.pitt.edu with SMTP (8.7.3/cisls-2.4) ID for ; Mon, 19 Feb 1996 11:44:11 -0500 (EST) Received: from novix (ipservice.einstein.edu [205.245.102.1]) by aehn2.einstein.edu (8.6.12/8.6.9) with SMTP id LAA14992; Mon, 19 Feb 1996 11:43:49 GMT Date: Mon, 19 Feb 1996 11:43:49 GMT Message-Id: <199602191143.LAA14992@aehn2.einstein.edu> X-Sender: burtonb@aehn2.einstein.edu X-Mailer: Windows Eudora Light Version 1.5.2 Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii" To: kconover+@pitt.edu From: Barry Burton Subject: Re: WEMT neurological examination Cc: wilderness-emergency-medicine@list.pitt.edu Sender: owner-wilderness-emergency-medicine@list.pitt.edu Precedence: bulk X-PMFLAGS: 35127424 0 Keith At 09:45 AM 2/19/96 +0000, you wrote: >I'm posting this to get informed opinions as to the neurological >examination that Wilderness EMTs should be taught. > Instead, I'd like to focus on the specific elements >that make up the WEMTs neuro exam. Criteria for inclusion would be, >I think: > >* provides useful information either the WEMT at the scene, or for a >remote medical command physician on the radio/field phone Agreed > >* can be done adequately without excessive WEMT training time Agreed2 > >WEMSI currently teaches a neuro exam similar in organization to a >medical student's exam, abbreviated as often done in the ED. Here is >an outline: > Agreed, as one of the instructors, that I'm not sure that all of what we've taught is necessary. >WEMSI Wilderness EMT Quick Reference Card >Version 1.01 June 16, 1995 >-------------------------------------------------------------- >snip >-------------------------------------------------------------- > "Clearing the C-Spine": Only in wilderness > _ totally alert, not intoxicated > _ no painful "distracting" injury > _ no neck pain > _ no neck tenderness > _ no numbness, tingling, weakness > _ normal motor/sensory exam of extremities > _ painless full range of motion of neck >-------------------------------------------------------------- > > Neurological Exam: Mental Cases Sometimes Make > Deepdish Casserole: MCSMDC >However, in his lectures and in the Neurological Examination chapter >of Tintinalli's EM textbook, Greg Henry argues for a different neuro >exam as a screening exam for the ED. I generallylike the concept of a more focused, meaningful exam that will actually help make decisions, rather than show off what I can do. > I won't reproduce that entire >chapter here, but will summarize the exam he proposes below. (The >Tintinalli textbook, fourth edition, should be available in every ED >in the country, Why? Why quote a review textbook, rather than a scientific text or articles? I hate learning from "prep" books. (I admit ver 4 is better than ver 3, and that I own one, for the 'residency', but I hate quoting from it!) >Table 191-1. Neurologic Screening Exam > >Area Test >-------------------------------------------------------------------- >Mental status Normal orientation, speech, global affect >Cranial nerves Funduscopic, extraocular movements and > pupillary response, visual fields, corneal > reflexes, and facial muscle strength >Motor Basic muscle groups, tone, drift, heel-and > toe walking >Sensory Cold and vibration on areas indicated by > patient or on distal extremities >Coordination (gait) Observation of gait, and finger-to-nose testing >Reflexes Deep tendon--knees, ankles, elbows, and wrists; > degenerative reflexes--Babinski's signs, snout, > grasp, and root. >-------------------------------------------------------------------- Orientation, if done with a mini mental state instrument and _true_ orientation checks is great. Conversant confused individuals are not uncommon (not counting crazed light deprived mammal seeking speleothem loving confused/dazed sleep deprived cave rescuers) Even corneal reflex has some application in the field for protective measures, in select cases. I like tone/drift combined with walking /finger nose. Very QUick general motor exam, and captures all major roots. NOT sure vibration is practical (cary another piece of gear, with only one purpose? Grandey'll have a fit) when position testing should get at the same tracts. >A few quotes from this chapter: > >"Evaluation of mental status is performed simply by speaking with the >patient. In the ED detailed tests for hemispheric function are not >necessary in a patient who is conversing normally, is making >reasonable responses to questions, and is well-oriented." Excellent > >"Mass lesions that cause pressure either directly or indirectly on >the diencephalon can alter the visual fields and pupillary response >to light. Insidious tumors of the cerebral hemispheres, which may >have very few gross neurological findings, can cause early changes in >the visual fields." > Good reason to test by confrontation "The extraocular muscles are innervated by the third, fourth, and >sixth cranial nerves. The nuclei for these nerves cover a large area >in the pons and midbrain, making them good indications of brainstem >function." > >"The corneal reflex is often affected in hemispheric disease long >before general facial sensation or the muscles of mastication are >involved." > >"The eighth cranial nerve rarely requires testing in the ED." > >"Tests for the ninth, tenth, eleventh and twelfth cranial nerves are >generally not important in the ED. There are no acute diseases that >will manifest themselves with findings only in these areas, and in a >rapid neurologic screening exam they are of little value." Only as far as swallowing function, for PO feeding would be concerned. Pratically, I'm still not quite sure what situation would idctate management strategy based soley on a loss, or asymmetry, of DTR's, as well. > >I'd be very interested in the list's responses. > >Thank you. > >Keith Conover, M.D. (NSS 12893, WD4PSY) >- Information Systems Coordinator, Dept. of EM, Mercy Hospital >- Clinical Assistant Professor, Dept. of Emergency Medicine, > Univ. of Pittsburgh (EM Residency and Center for Emergency Medicine) >- Medical Director, Wilderness EMS Institute > (http://www.pitt.edu/DOC/95/30/32686/Wemsi.html) > (for a WEMSI-sponsored list, send "subscribe > wilderness-emergency-medicine" to Majordomo@list.pitt.edu) >- Eastern Region, Natl. Cave Rescue Comm./Appalachian SAR Conf. > Just my two cents worth. Echo, Echo...Drip, Drip. See you at NCRC Barry (N3VOW) Barry J. Burton, D.O. EMS Fellowship Director Department of Emergency Medicine Albert Einstein Medical Center Philadelphia, PA 19141 -- End -- X-cs: From: Self To: EMED-L@ITSSRV1.UCSF.EDU Subject: Re: Rural prehospital Discontinuation of Treatment Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover+@pitt.edu Date: Mon, 19 Feb 1996 18:46:35 [Regarding the emed-l thread] For those who are wrestling with the problem of discontinuing CPR in the rural setting: you may want to look at the wilderness literature on this point. True, in the wilderness, continuing CPR is often not possible during evacuation, unlike the back of a rural ambulance, so there are some differences. Here is what WEMSI protocols say on the point: "Always start CPR in a pulseless victim well away from a road unless one of the following contraindications is present: - If cardiac arrest is due to trauma; - If a drowning victim has been immersed for more than an hour, even in cold water; - If Advanced Cardiac Life Support is more than an hour away; - In cases of unwitnessed cardiac arrest, when there is no way of knowing when it began; - Persons who appear dead because of: - Rectal temperatures that are the same as that of the environment; - Rigor mortis or dependent lividity; but, only in a non-frozen patient; or - Lethal injuries, such as decapitation, massive head or chest injuries, severed trunk. In the backcountry, discontinue CPR if, after 30 minutes of effort, you can detect no evidence of spontaneous pulse or respirations, and if CPR cannot be continued throughout the evacuation. For cer tain situations, the possibility of resuscitation with Basic Cardiac Life Support is high, so continue CPR for more than half an hour: - Cold water immersion less than an hour (hypothermia and possibly the mammalian diving reflex tend to slow metabolism) - Avalanche burial; - Arrest after known hypothermia; - Lightning or arrest secondary to electric shock." --------------------------------------------------- NAEMSP (National Association of EMS Physicians) has Clinical Guidelines for Delayed/Prolonged Transport including discontinuing CPR, and the Wilderness Medical Society has a set of Practice Guidelines addressing the topic of discontinuing CPR. NAEMSP 230 McKee Place, Suite 500 Pittsburgh, PA 15213-4904 1-412-578-3222; 1-800-228-3677 Wilderness Medical Society P.O. Box 2463 Indianapolis, IN 46206 1-317-631-1745 -- End -- X-cs: From: Self To: Ed Werzyn Subject: Re: Wilderness Med kit Cc: wilderness-emergency-medicine@list.pitt.edu Reply-to: kconover@pitt.edu Date: Tue, 20 Feb 1996 21:56:07 On 20 Feb 96 at 15:59, Ed Werzyn wrote: > I saw your Wilderness Med kit and had a few questions. I am taking > an EMT-Basic level course now and was curious about some of the > items contained within the Basic Med kit. > > Maybe I should start off by asking does the Wilderness EMT have more > latitude in providing medical care in the field as does a "regular" > EMT- Basic? Here in Arizona, EMT-Basic can only administer 3 > "drugs"; oxygen, oral glucose, and activated charcoal. They can > also administer 3 additional drugs, if the patient has them on hand; > nitroglycerine, a bronchiodilator, and epinephrine. > > Does going through the Wilderness EMT expand the available drugs > that an EMT-Basic can administer? Of course I'm assuming that the > Med kit is carried by a Wilderness EMT, which has a minimum of an > EMT-Basic training. I assumed this since the "advanced" Med kit > contains endotracheal tubes, which require EMT-Intermediate or > Paramedic training. In short: no. Taking a continuing education course doesn't allow you to administer drugs. Having a license to practice medicine, or having direction from someone who does, is what you need to be able to administer such "expanded" drugs. Laws differ from state to state. In Colorado, an EMS medical director can "add" drugs to the list a paramedic (? if this applies to EMTs) can give. In PA, an EMS Medical Director can't do this. But a physician medical director for a SAR team can, outside the EMS regulations, use the state's delegated practice provisions to direct Wilderness Medics to give drugs that the same person, acting as an EMT-Basic on the street, can't give. Even if the person's medical training is EMT-Basic + WEMT, the person "changes hats" in the wilderness and acts as a non-EMS medical provider. Each state is different. For Arizona, talk to Ken Iserson at the University's ED; he works closely with Arizona SAR teams and I'm sure knows what's up in AZ. > I am part of a Search and Rescue team, which is the reason for > taking the EMT course. I plan on continuing to take a Wilderness > EMT course as well. There was one given here last year that was > sponcered by one of the whitwater rafting companies and I'm trying > to find out if others will be given this year. (The company that > sponcered it last year is basically out of business this year). Any > information on Wilderness EMT courses would be appreciated. > Thanks!! > > > Sincerely, > +---------------------------------------+ Edward A. Werzyn, Jr > | O "Take a Hike!" | Longbow Apache > System Administrator | []|-| Grand Canyon rim-to-rim | > McDonnell Douglas Helicopter | / \| and back again! > | 5000 E. McDowell Road > +-----------------------------