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From: "Keith Conover, M.D., FACEP" <kconover+@pitt.edu>
To: rey_funez <eyekunstler@eee.org>,
        wilderness-emergency-medicine@list.pitt.edu
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On 28 Aug 98, at 13:43, rey_funez wrote:

> i was wondering what emOx is. i saw an ad but the phone was busy so i went
> to net and found you talking about it. please informe. -rEy
> 

emOx is/was a system to produce oxygen from two dry powders and 
some water.  It is a lot lighter than carrying oxygen cylinders, though 
we found some problems (the bottle tended to tip over, pouring a 
nontoxic but yecchy slurry into the patient's oxygen mask).  It 
originated in South Africa.  The company seems to have 
disappeared, I haven't heard anything from them in a while, and last 
I checked the Web site was gone.  Promising, but not quite usable 
for SAR, at least the evaluation unit I got.

--Keith Conover, M.D., FACEP
  http://www.pitt.edu/~kconover
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On 28 Aug 98, at 13:43, rey_funez wrote:

> i was wondering what emOx is. i saw an ad but the phone was busy so i went
> to net and found you talking about it. please informe. -rEy
> 

emOx is/was a system to produce oxygen from two dry powders and 
some water.  It is a lot lighter than carrying oxygen cylinders, though 
we found some problems (the bottle tended to tip over, pouring a 
nontoxic but yecchy slurry into the patient's oxygen mask).  It 
originated in South Africa.  The company seems to have 
disappeared, I haven't heard anything from them in a while, and last 
I checked the Web site was gone.  Promising, but not quite usable 
for SAR, at least the evaluation unit I got.


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i was wondering what emOx is. i saw an ad but the phone was busy so i went
to net and found you talking about it. please informe.
-rEy


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Date: Mon, 17 Aug 1998 17:13:41 -0400 (EDT)
From: Jonnathan Busko <jmbst85+@pitt.edu>
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Subject: Re: W-EMED WEMT- Disinfecting cloths?...
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Linda,

On Sat, 15 Aug 1998 Mkeowl@aol.com wrote:

> Boy, do YOU ever reply fast...

Nothing like a morning off to do that.

> 
> Actually, some of the particulars -- one of the gowning situations is MERSA
> (?) or an air-borne contagious agent where it is in the air or gets on things
> during a sneeze. Dunking my jumpsuit in Hperoxide after I degown is not
> practical 8 hours before my shift ends. 

Actually, as long as you aren't picking your nose after picking a
patient's nose, MRSA shouldn't be all that big a deal (actually, what this
really means is watch where you put your hands after airway management).
Airbornes will be pretty much killed with standard washing regimens;
again, if you have suspicions of a patient's status, watch where you put
your hands.  If you're gowned up and you don't get anything specific on
your jumpsuit, just do what we all should do but occasionally fail to do;
wash your hands before you eat, don't stick anything (pens, tripsheets,
etc.) in your mouth, and wash your uniforms and yourself after each shift.

> I'm refering to both viral, baterial, and ? that we encounter. I run my EMT
> shift with the local Vol. RS and cannot change after every nasty call. Don't
> panic if it is REALLY bad I will change. Scrubs would be easlier but, not
> practical for a local RS.

Yeah, scrubs would be nice.  I once ran at a squad where we wore scrub
shirts and BDU pants.  Boy, was that nice.

> What are the soaking times?

Actually, if I'm just generally worried about the ick to which I'm
exposed, I just wash my clothes with a standard detergent;  sometimes I'll
throw in a hospital laundry disinfectant pack if I'm washing a whole pile
of "patient ick" clothes.

If I get something specific on my uniform (blood and what-not), I take off
that uniform piece, and do a series of 5 minute H2O2 soaks alternating
with first cold water washes (to keep the protein in the blood from
denaturing and permanently staining the uniform) and then hot water rinses
until the ick is gone.  Longer than that and I think the material weakens
and then a bleaching effect occurs.

I also always carry a spare uniform with me.  I've had to shower and wash
uniforms midshift, and it helps if you're still on duty to have a spare
jumpsuit around.


Jonnathan

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From: "Jack T. Grandey" <grandey+@pitt.edu>
To: <wilderness-emergency-medicine@list.pitt.edu>
Subject: RE: W-EMED Status of WEMT courses given by WEMSI??
Date: Sun, 16 Aug 1998 08:52:22 -0400
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The only class that was in question is/was the Fall class sponsored by the
CEM.  That class has  been cancelled.  To the best of my knowledge, all
others are firm as planned.

JTG


Jack T. Grandey, NREMT-P
    Operations  Director
   Wilderness EMS Institute   
    http://www.wemsi.org
                



-----Original Message-----
From: owner-wilderness-emergency-medicine@list.pitt.edu
[mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of
nigel dyson-hudson
Sent: Saturday, August 15, 1998 21:52
To: wilderness-emergency-medicine@list.pitt.edu
Subject: W-EMED Status of WEMT courses given by WEMSI??


I just cruised over to the web site, http://www.wemsi.org/classes.html, and
found out that WEMT classes seem to be up in the air.

1. I am definately interested in October in PA or Spring in Lancaster.

2. I have put up a mail server and DNS for some other projects I am working
on so I can host a mailing list if someone needs to create a new one.

nigel dyson-hudson
nigel dyson-hudson
"mad dogs and Englishmen" and I am both!

MCNE & Internet Fundi
InternetSmiths, Inc.
10 Slators Ln
Newfield, NY 14867-9737
607-564-7983, FAX 607-564-7993
ndh@InternetSmiths.com

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I just cruised over to the web site, http://www.wemsi.org/classes.html, and
found out that WEMT classes seem to be up in the air.

1. I am definately interested in October in PA or Spring in Lancaster.

2. I have put up a mail server and DNS for some other projects I am working
on so I can host a mailing list if someone needs to create a new one.

nigel dyson-hudson
nigel dyson-hudson
"mad dogs and Englishmen" and I am both!

MCNE & Internet Fundi
InternetSmiths, Inc.
10 Slators Ln
Newfield, NY 14867-9737
607-564-7983, FAX 607-564-7993
ndh@InternetSmiths.com

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Boy, do YOU ever reply fast...

Actually, some of the particulars -- one of the gowning situations is MERSA
(?) or an air-borne contagious agent where it is in the air or gets on things
during a sneeze. Dunking my jumpsuit in Hperoxide after I degown is not
practical 8 hours before my shift ends. 

I'm refering to both viral, baterial, and ? that we encounter. I run my EMT
shift with the local Vol. RS and cannot change after every nasty call. Don't
panic if it is REALLY bad I will change. Scrubs would be easlier but, not
practical for a local RS.

What are the soaking times?

Thanks,

Linda in VA
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Date: Sat, 15 Aug 1998 10:54:36 -0400 (EDT)
From: Jonnathan Busko <jmbst85+@pitt.edu>
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Subject: Re: W-EMED WEMT- Disinfecting cloths?...
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I find that immediate application of hydrogen peroxide helps to get the
?>?<?>>>?!!? out fairly well without much bleaching.


Jonnathan

Jonnathan M. Busko, NREMT-P
MS III, University of Pittsburgh School Of Medicine.

-_---__----___-----____------_____-------______--------_______---------_______-
				Primum Non Nocere
-_______---------_______--------______-------_____------____-----___----__---_-


On Sat, 15 Aug 1998 Mkeowl@aol.com wrote:

> For those of us that get exposed to the ?>?<?>>>?!!? in EMT work (infectious
> agents that we gown for but, still have to wear our regular coveralls for the
> rest of the shift... or lots of body fluids...) what/how would you recommend I
> clean and disinfect my clothes without bleaching them white?
> 
> Thanks,
> 
> Linda R. Uihlein, SAR, EMT, WEMT in VA
> Do not reproduce without author's express permission.
> To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine"
> as the body of a message (no subject) To: Majordomo@list.pitt.edu
> Submissions To: wilderness-emergency-medicine@list.pitt.edu
> 

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For those of us that get exposed to the ?>?<?>>>?!!? in EMT work (infectious
agents that we gown for but, still have to wear our regular coveralls for the
rest of the shift... or lots of body fluids...) what/how would you recommend I
clean and disinfect my clothes without bleaching them white?

Thanks,

Linda R. Uihlein, SAR, EMT, WEMT in VA
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Date: Sat, 15 Aug 1998 09:37:15 +0000
To: wilderness-emergency-medicine@list.pitt.edu
From: The Tates <tates@tenforward.com>
Subject: Re: W-EMED WEMT- Disinfecting cloths?...
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We bought some stuff at the local cleaning supply place that works well
although there is probably better stuff now. Try them and see what they
have. BTW the application times depend on the bug you want to kill (HIV is
fast, HBV takes a little while.)

I will find out the name of the place if you need me to.

David Tate




At 11:15 AM 8/15/98 EDT, you wrote:
>Boy, do YOU ever reply fast...
>
>Actually, some of the particulars -- one of the gowning situations is MERSA
>(?) or an air-borne contagious agent where it is in the air or gets on things
>during a sneeze. Dunking my jumpsuit in Hperoxide after I degown is not
>practical 8 hours before my shift ends. 
>
>I'm refering to both viral, baterial, and ? that we encounter. I run my EMT
>shift with the local Vol. RS and cannot change after every nasty call. Don't
>panic if it is REALLY bad I will change. Scrubs would be easlier but, not
>practical for a local RS.
>
>What are the soaking times?
>
>Thanks,
>
>Linda in VA
>Do not reproduce without author's express permission.
>To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine"
>as the body of a message (no subject) To: Majordomo@list.pitt.edu
>Submissions To: wilderness-emergency-medicine@list.pitt.edu
>
>

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Date: Sat, 15 Aug 1998 01:29:50 -0400
To: wemsi-staff@list.pitt.edu
From: Bernie Roche <broche@titan.tcn.net>
Subject: W-EMED A Lovely Dog Needs a Good Home
Cc: wilderness-emergency-medicine@list.pitt.edu
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Hi, all:

A lady in Ohio has Multiple Sclerosis, and is unable to care for her
4-yr.-old short-haired Golden Retreiver.  The dog is purebred, has its
papers, has had all its shots, etc.  I'm told it's a very loving,
mild-mannered dog.

We are trying to find a loving owner for this dog.  Even better, it would
be nice if we could find a temporary home, so that she might have the dog
back if she should become able to care for it in the future.

If you would like to take this dog, on a temporary or permanent basis,
please e-mail me.  I can arrange for the dog to be at Old Timers Reunion on
the Labor Day weekend, for pickup, if this is convenient.  If not, the lady
lives in mid-Ohio, and arrangements can be worked out.




Best Wishes,

Bernie Roche, RN, BScN, W-EMT, OSJ
WEMSI Web Site Administrator

http://www.wemsi.org/
broche@tcn.net
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From: Sol Roter <roter@istar.ca>
To: "'wilderness-emergency-medicine@list.pitt.edu'"
	 <wilderness-emergency-medicine@list.pitt.edu>
Subject: RE: W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)
Date: Tue, 28 Jul 1998 17:47:39 -0400
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Please, no flame wars. Other lists have been seriously ruined by them.

Thanks

-----Original Message-----
From:	Deborah M Gessner [SMTP:pcrs242@Juno.com]
Sent:	Monday, July 27, 1998 12:32 AM
To:	wilderness-emergency-medicine@list.pitt.edu
Subject:	W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)


On Sat, 25 Jul 1998 14:02:21 -0400 Bernie Roche <broche@titan.tcn.net>
writes:
>At 07:26 AM 25/07/98 -0700, you wrote:
>
>>REPLY TO 07/24/98 21:01 FROM 
>wilderness-emergency-medicine@list.pitt.edu:
>>W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)
>
>>Please feel free to reproduce.
>
>>Best wishes,
>>Bob Norris
>
>
> $   (But remember to practice Safe Sex if you do.)...
>
><VERY BIG GRIN>
>
>
> 
>
>Best Wishes,
>
>Bernie Roche, RN, BScN, W-EMT, OSJ
>WEMSI Web Site Administrator
>
>http://www.wemsi.org/
>broche@tcn.net
>Do not reproduce without author's express permission.
>To unsubscribe, send the text "unsubscribe 
>wilderness-emergency-medicine"
>as the body of a message (no subject) To: Majordomo@list.pitt.edu
>Submissions To: wilderness-emergency-medicine@list.pitt.edu
>


The comment maked with the $ sign was uncalled for as a professsional
in the EMS field

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Date: Mon, 27 Jul 1998 20:17:07 -0700
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Subject: Re: W-EMED Re: Seeing through the fog?
References: <199807272221.QAA29502@preytor.ecentral.com> <19980727.155135.10622.24.ray_waugh@juno.com>
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Friends,
    Please forgive me as I did not get this original message, but I believe
that the originator of this strand was correct about this device.  Anyone
hear of a thermal imaging camera?  These can see through fog, smoke, and snow
and give a real image (albeit black and white).  The fire service uses these
when doing search in burning buildings.  The also use them getting to the
scene through heavy smoke and fog, though I'm not familiar with the
range/distance the device is capable of seeing.
    Check out some of the fire sevice journals.  Several manufacturers
advertise these devices there.
Hope this helps,
E. Scheiderer, EMT-P, RN
Mechanicsburg EMS

Raymond W Waugh wrote:

> RADAR does not really "see" through fog.  It sends out a radio frequency
> pulse and receives the reflections (generally from metal surfaces),
> recording the distance and bearing of the reflection.  Depending upon the
> frequency of operation, it may obtain reflections from rock or other
> non-metallic surfaces.  In any event, the typical RADAR display does not
> permit you to distinguish shape or "see" in the conventional
> understanding of the word.
>
> ------------------------------------
>           ray_waugh@juno.com
> ------------------------------------
>
> On Mon, 27 Jul 1998 16:21:54 -0600 "Howard M. Paul" <hmpaul@ecentral.com>
> writes:
> >I remember that it was developed during WWII. Believe it's called
> >RADAR.
> >
> >At 08:04 AM 7/27/98 -0400, you wrote:
> >>FAA question for you.  One of the staff from the Mt. Washington
> >>weather observatory in the White Mouontains of New Hampshire
> >>was giving a talk at the Wilderness Medical Society tonight.  He
> >>said that he thinks that the FAA has a device that can see through
> >>fog.
> >______________________________________
> >H o w a r d  M.  P a u l   <hmpaul@ecentral.com>
> >EMS Director, Alpine Rescue Team, Evergreen, Colo.
> >Public Affairs Mgr., Colorado SAR Board
> >ASTM Committee F32 on SAR
> >                        ______________
> >
> >"You can't teach people to rescue in the mountains
> >until they have learnt to climb...   ...It is a number of
> >small points which have little significance individually
> >that, considered together, spell danger to the
> >experienced rescuer."  -- Hamish MacInnes
> >
> >Do not reproduce without author's express permission.
> >To unsubscribe, send the text "unsubscribe
> >wilderness-emergency-medicine"
> >as the body of a message (no subject) To: Majordomo@list.pitt.edu
> >Submissions To: wilderness-emergency-medicine@list.pitt.edu
> >
>
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From: David Kovar <kovar@webnexus.com>
Message-Id: <199807272312.QAA13103@dalmatian.webnexus.com>
Subject: Re: W-EMED Re: Seeing through the fog?
To: wilderness-emergency-medicine@list.pitt.edu
Date: Mon, 27 Jul 1998 16:12:36 -0700 (PDT)
In-Reply-To: <199807272221.QAA29502@preytor.ecentral.COM> from "Howard M. Paul" at Jul 27, 98 04:21:54 pm
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Yea, radar will do it, but I also saw the beginnings of a special report
on some station last week that allowed the pilot to visually see through
fog. I presume it was something akin to a FLIR camera, but I didn't
catch the details. The film clip they showed looked like a normal
cockpit view, only slightly degraded by fog.

Wish I'd caught the full report.

-David

> 
> I remember that it was developed during WWII. Believe it's called RADAR.
> 
> At 08:04 AM 7/27/98 -0400, you wrote:
> >FAA question for you.  One of the staff from the Mt. Washington 
> >weather observatory in the White Mouontains of New Hampshire 
> >was giving a talk at the Wilderness Medical Society tonight.  He 
> >said that he thinks that the FAA has a device that can see through 
> >fog. 
> ______________________________________
> H o w a r d  M.  P a u l   <hmpaul@ecentral.com>
> EMS Director, Alpine Rescue Team, Evergreen, Colo.
> Public Affairs Mgr., Colorado SAR Board
> ASTM Committee F32 on SAR
>                         ______________
> 
> "You can't teach people to rescue in the mountains
> until they have learnt to climb...   ...It is a number of 
> small points which have little significance individually 
> that, considered together, spell danger to the 
> experienced rescuer."  -- Hamish MacInnes
> 
> Do not reproduce without author's express permission.
> To unsubscribe, send the text "unsubscribe wilderness-emergency-medicine"
> as the body of a message (no subject) To: Majordomo@list.pitt.edu
> Submissions To: wilderness-emergency-medicine@list.pitt.edu
> 

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Date: Mon, 27 Jul 1998 15:51:35 -0700
Subject: W-EMED Re: Seeing through the fog?
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RADAR does not really "see" through fog.  It sends out a radio frequency
pulse and receives the reflections (generally from metal surfaces),
recording the distance and bearing of the reflection.  Depending upon the
frequency of operation, it may obtain reflections from rock or other
non-metallic surfaces.  In any event, the typical RADAR display does not
permit you to distinguish shape or "see" in the conventional
understanding of the word.

------------------------------------
          ray_waugh@juno.com
------------------------------------

On Mon, 27 Jul 1998 16:21:54 -0600 "Howard M. Paul" <hmpaul@ecentral.com>
writes:
>I remember that it was developed during WWII. Believe it's called 
>RADAR.
>
>At 08:04 AM 7/27/98 -0400, you wrote:
>>FAA question for you.  One of the staff from the Mt. Washington 
>>weather observatory in the White Mouontains of New Hampshire 
>>was giving a talk at the Wilderness Medical Society tonight.  He 
>>said that he thinks that the FAA has a device that can see through 
>>fog. 
>______________________________________
>H o w a r d  M.  P a u l   <hmpaul@ecentral.com>
>EMS Director, Alpine Rescue Team, Evergreen, Colo.
>Public Affairs Mgr., Colorado SAR Board
>ASTM Committee F32 on SAR
>                        ______________
>
>"You can't teach people to rescue in the mountains
>until they have learnt to climb...   ...It is a number of 
>small points which have little significance individually 
>that, considered together, spell danger to the 
>experienced rescuer."  -- Hamish MacInnes
>
>Do not reproduce without author's express permission.
>To unsubscribe, send the text "unsubscribe 
>wilderness-emergency-medicine"
>as the body of a message (no subject) To: Majordomo@list.pitt.edu
>Submissions To: wilderness-emergency-medicine@list.pitt.edu
>

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I remember that it was developed during WWII. Believe it's called RADAR.

At 08:04 AM 7/27/98 -0400, you wrote:
>FAA question for you.  One of the staff from the Mt. Washington 
>weather observatory in the White Mouontains of New Hampshire 
>was giving a talk at the Wilderness Medical Society tonight.  He 
>said that he thinks that the FAA has a device that can see through 
>fog. 
______________________________________
H o w a r d  M.  P a u l   <hmpaul@ecentral.com>
EMS Director, Alpine Rescue Team, Evergreen, Colo.
Public Affairs Mgr., Colorado SAR Board
ASTM Committee F32 on SAR
                        ______________

"You can't teach people to rescue in the mountains
until they have learnt to climb...   ...It is a number of 
small points which have little significance individually 
that, considered together, spell danger to the 
experienced rescuer."  -- Hamish MacInnes

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Subject: W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)
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On Sat, 25 Jul 1998 14:02:21 -0400 Bernie Roche <broche@titan.tcn.net>
writes:
>At 07:26 AM 25/07/98 -0700, you wrote:
>
>>REPLY TO 07/24/98 21:01 FROM 
>wilderness-emergency-medicine@list.pitt.edu:
>>W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)
>
>>Please feel free to reproduce.
>
>>Best wishes,
>>Bob Norris
>
>
> $   (But remember to practice Safe Sex if you do.)...
>
><VERY BIG GRIN>
>
>
> 
>
>Best Wishes,
>
>Bernie Roche, RN, BScN, W-EMT, OSJ
>WEMSI Web Site Administrator
>
>http://www.wemsi.org/
>broche@tcn.net
>Do not reproduce without author's express permission.
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>wilderness-emergency-medicine"
>as the body of a message (no subject) To: Majordomo@list.pitt.edu
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>


The comment maked with the $ sign was uncalled for as a professsional
in the EMS field

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With regard to the use of cold on snake bites... Iwas once told that the anti-
venin dosage was in some way based on the amount of swelling and therefore
using a cold compress would interfere with this. Any truth to this? 

Jonathan Silver, WEMT

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At 07:26 AM 25/07/98 -0700, you wrote:

>REPLY TO 07/24/98 21:01 FROM wilderness-emergency-medicine@list.pitt.edu:
>W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)

>Please feel free to reproduce.

>Best wishes,
>Bob Norris


But remember to practice Safe Sex if you do....

<VERY BIG GRIN>


 

Best Wishes,

Bernie Roche, RN, BScN, W-EMT, OSJ
WEMSI Web Site Administrator

http://www.wemsi.org/
broche@tcn.net
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Date:     Sat, 25 Jul 98 07:26:25 PDT
From: "Robert Norris"   <Bob.Norris@Forsythe.Stanford.EDU>
To: wilderness-emergency-medicine@list.pitt.edu
Subject:  Re: W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)
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REPLY TO 07/24/98 21:01 FROM wilderness-emergency-medicine@list.pitt.edu:
W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)

Please feel free to reproduce.

Best wishes,
Bob Norris

To:  wilderness-emergency-medicine@list.pitt.edu
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To: wilderness-emergency-medicine@list.pitt.edu
Cc: Bob.Norris@Forsythe.Stanford.EDU
Date: Fri, 24 Jul 1998 23:54:28 -0400
Subject: W-EMED Re: WE-EMBED Snake-Bite (Was: Communications Info)
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From: pcrs242@Juno.com (Deborah M Gessner)
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I would like permission to reproduce this that Robert(BOB)Norris wrote
about snake bites for my SAR classes we have to much argument over snake
bites and what to do.
Thank You
Deborah M. Gessner   242
Pulaski County Life Saving Crew
Dublin  Va.



On Mon, 20 Jul 98 13:04:21 PDT "Robert Norris"  
<Bob.Norris@Forsythe.Stanford.EDU> writes:
>REPLY TO 07/17/98 09:33 FROM 
>wilderness-emergency-medicine@list.pitt.edu: Re:
>W-EMED Snake-Bite (Was: Communications Info)
>
>re: the use of ice in pit viper venom poisoning:
>
>There's really two separate issues here:
>1. the use of ice in the form of "cryotherapy" - packing the
>extremity in ice for hours to days to somehow allow the body to
>deactivate the venom in situ
>   - this was practiced in the 50's and 60's and clearly resulted in
>worsened outcomes (more tissue loss/amputations)
>   - it is now clearly condemned by anyone knowledgable in the
>management of these bites
>
>2. the use of ice for "first aid" (local ice pack)
>   - the recommendations here are less rooted in fact/experience
>   - Dr. Jacob Dubnoff did some preliminary, unpublished work using
>radio labelled venom components, and found that they were driven
>deeper into the tissues when the bitten part was cooled (cited by
>Findlay Russell in his text "Snake Venom Poisoning") - obviously
>this needs further work...
>
>The exact time when POSSIBLE beneficial effects from local
>cooling (decreased pain, maybe slight decreased enzymatic function)
>gives way to DEFINITE deleterious effects (decreased local blood
>flow, increased tissue damage) occurs is unknown and that is why
>most authorities recommend avoiding any cooling measures.
>
>Best wishes,
>Bob Norris, MD
>Emergency Medicine
>Stanford University
>
>
>
>
>To:  wilderness-emergency-medicine@list.pitt.edu
>cc:  VENOM(VENOM-L@ICOMM.CA)
>Do not reproduce without author's express permission.
>To unsubscribe, send the text "unsubscribe 
>wilderness-emergency-medicine"
>as the body of a message (no subject) To: Majordomo@list.pitt.edu
>Submissions To: wilderness-emergency-medicine@list.pitt.edu
>

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Date:     Mon, 20 Jul 98 13:04:21 PDT
From: "Robert Norris"   <Bob.Norris@Forsythe.Stanford.EDU>
To: venom-l@icomm.ca, wilderness-emergency-medicine@list.pitt.edu
Subject:  Re: W-EMED Snake-Bite (Was: Communications Info)
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REPLY TO 07/17/98 09:33 FROM wilderness-emergency-medicine@list.pitt.edu: Re:
W-EMED Snake-Bite (Was: Communications Info)

re: the use of ice in pit viper venom poisoning:

There's really two separate issues here:
1. the use of ice in the form of "cryotherapy" - packing the
extremity in ice for hours to days to somehow allow the body to
deactivate the venom in situ
   - this was practiced in the 50's and 60's and clearly resulted in
worsened outcomes (more tissue loss/amputations)
   - it is now clearly condemned by anyone knowledgable in the
management of these bites

2. the use of ice for "first aid" (local ice pack)
   - the recommendations here are less rooted in fact/experience
   - Dr. Jacob Dubnoff did some preliminary, unpublished work using
radio labelled venom components, and found that they were driven
deeper into the tissues when the bitten part was cooled (cited by
Findlay Russell in his text "Snake Venom Poisoning") - obviously
this needs further work...

The exact time when POSSIBLE beneficial effects from local
cooling (decreased pain, maybe slight decreased enzymatic function)
gives way to DEFINITE deleterious effects (decreased local blood
flow, increased tissue damage) occurs is unknown and that is why
most authorities recommend avoiding any cooling measures.

Best wishes,
Bob Norris, MD
Emergency Medicine
Stanford University




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From: "Christopher Magro" <cjm@walrus.com>
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Subject: W-EMED ice + snakebiteeeee
Date: Mon, 20 Jul 1998 11:43:31 -0400
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It is important to note the reason why treatment with ice is strongly =
condemed:
the venom of some snakes(ie. the pit viper for one) is designed to not =
only immobilize and kill the prey but also to digest it (see Mosby's =
Paramedic Textbook).  Therefore, because the tissue is being digested =
and killed the application of ice may further tissue damage and could =
easily cause frostbite.

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<DIV><FONT size=3D2>It is important to note the reason why treatment =
with ice is=20
strongly condemed:</FONT></DIV>
<DIV><FONT color=3D#000000 size=3D2>the venom of some snakes(ie. the pit =
viper for=20
one) is designed to not only immobilize and kill the prey but also to =
<EM>digest=20
</EM>it (see Mosby's Paramedic Textbook).&nbsp; Therefore, because the =
tissue is=20
being digested and killed the application of ice may further tissue =
damage and=20
could easily cause frostbite.</FONT></DIV></BODY></HTML>

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Subject: RE: W-EMED Re: Backboards -- the ATLS 2-hour rule
Date: Mon, 20 Jul 98 11:08:27 -0000
x-mailer: Claris Emailer 1.1
From: Ropes That Rescue <ropes@sedona.net>
To: "SteveK" <stevek@spectralogic.com>,
        "\"'wilderness-emergency-medicine@list.pitt.edu'\"	" <wilderness-emergency-medicine@list.pitt.edu>,
        <kconover+@pitt.edu>, <EMS-L@listserv.ACNS.NWU.EDU>
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Dear Steve,

I read with interest, you comments on the full body vacuum splint being 
used in the metal stokes litter. 

We have been doing a number of power utility courses where the partially 
or totally hanging trauma patient is packaged high off the ground by 
using just such a means on transmission lines.  There (and in similar 
vertical environments), we have used a "litter scoop" technique in 
conjunction with the full body Hartwell "evac-u-splint" secured in the 
stokes type litter. The lifting effort can be supplied by the 
rescuer/attendant or, more preferably, by the team on the ground. The 
litter is first positioned at the angle that the patient is found hanging 
depending on where their FAS is attached to the harness. 
By coming from below the patient with this combined retrieval adjunct, we 
are able to gently scoop while gently raising as well. The air is 
vacuumed out either up on the tower (either end has an orifice for this 
purpose) or once the patient reaches the ground. 
What is interesting is that this technique outperforms other techniques 
we have used in the air when dropping to the ground is not possible. This 
"rescuer-based" and "team-based" litter scoop with vacuum splint is only 
a tool which needs constant practice. Anyway, thought you might like some 
input. Nothing too deep here.

All the best,

Reed Thorne
Ropes That Rescue Ltd.
eMail: ropes@sedona.net

Web Site:  www.sedona.net/ropes
" T h e  A R T  o f   C l e a n  R i g g i n g "

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From: "Jack T. Grandey" <grandey+@pitt.edu>
To: "WEM" <wilderness-emergency-medicine@list.pitt.edu>
Subject: RE: W-EMED NJ con-ed credit for WEMT
Date: Sun, 19 Jul 1998 11:22:50 -0400
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Thanks for the information, and as I said, I'm happy to work with NJ or any
other state for con-ed credits.  I believe the first issue, though (for the
list) is to find out whether there is sufficient demand to make it worth the
trouble.

If there are enough NJ EMTs and medics that would like the course taught in
NJ, or would like credit for the course, taken elsewhere, we'll pursue it.

Please let me know, directly, not to the list.

JTG
Jack T. Grandey, NREMT-P
     Operations Director
 Wilderness EMS Institute
   http://www.wemsi.org/

> -----Original Message-----
> From: JSilver374@aol.com [mailto:JSilver374@aol.com]
> Sent: Saturday, July 18, 1998 10:52
> To: Jack T. Grandey
> Subject: Re: W-EMED PA con-ed credit for WEMT
>
>
> In a message dated 07/18/1998 09:21:15 AM Eastern Daylight Time,
> grandey+@pitt.edu writes:
>
> > I'd certainly be happy to submit it, if someone can let me know the
> >  necessary process.
> >
> >  JTG
> >
> >  > -----Original Message-----
> >  > Any thought to getting New Jersey OEMS to recognize WEMSI's WEMT
> >  > course? They
> >  > already grant CEUs for SOLO's course. Shouldn't be too hard
> to get 'em on
> >  > board.
> >  >
> >  > Jonathan Silver, WEMT
> >  > Highland Park, NJ
> >
>
> You will need to submit a course curriculum, written exams,
> copies of handouts
> and any visual aids to plus the usual forms. As I recall you also need to
> submit your instructor credentials.
> Contact:
>
> New Jersey Department of Health and Senior Services
> Office of Emergency Medical Services
> PO Box 360
> 50 East State Street
> Trenton, NJ 08625-0360
> Phone: 609-633-7777
> Fax: 609-633-7954
> EMS Education Coordinator: Robert Dinetz
>
> It's not so much for the CEU's that this would be helpful. Most
> local squads
> pick up at least part of the cost for CEU courses.
>
> Thanks,
> Jonathan Silver
>

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From: "Jack T. Grandey" <grandey+@pitt.edu>
To: <wilderness-emergency-medicine@list.pitt.edu>
Subject: RE: W-EMED PA con-ed credit for WEMT
Date: Sat, 18 Jul 1998 09:18:36 -0400
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I'd certainly be happy to submit it, if someone can let me know the
necessary process.

JTG

> -----Original Message-----
> Any thought to getting New Jersey OEMS to recognize WEMSI's WEMT
> course? They
> already grant CEUs for SOLO's course. Shouldn't be too hard to get 'em on
> board.
>
> Jonathan Silver, WEMT
> Highland Park, NJ

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In a message dated 07/16/1998 07:34:59 PM Eastern Daylight Time,
grandey+@pitt.edu writes:

> I am pleased to announce that the PA Dept of Health has granted continuing
>  education credit for WEMSI's WEMT program as follows:
(snip, snip)

Any thought to getting New Jersey OEMS to recognize WEMSI's WEMT course? They
already grant CEUs for SOLO's course. Shouldn't be too hard to get 'em on
board.

Jonathan Silver, WEMT
Highland Park, NJ
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Subject: Re: W-EMED Snake-Bite (Was: Communications Info)
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Every source I've seen says this is a BAD idea.  What is the controversy on your
other listserv?

Seth Collings Hawkins
Carolina Wilderness Medicine
UNC-Chapel Hill School of Medicine

On Fri, 17 Jul 1998 09:34:13 EDT RivrChik@aol.com wrote:

>Would those of you who are responding to this query regarding snakebites
>please address the use of ice on the affected extremity, it seems to be a
>controversial issue with another listserver I am currently involved in.
>Do not reproduce without author's express permission.
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From: "Jack T. Grandey" <grandey+@pitt.edu>
To: <wilderness-emergency-medicine@list.pitt.edu>
Subject: RE: W-EMED PA con-ed credit for WEMT
Date: Fri, 17 Jul 1998 13:16:47 -0400
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Yup.  dat's de way de system works, now.  I'd put the hourse in & suggest to
those who feel they;re not getting their due, to lobby through their EMS
council.

JTG
    -----Original Message-----
    From: owner-wilderness-emergency-medicine@list.pitt.edu
[mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Bob
Cooney
    Sent: Thursday, July 16, 1998 21:06
    To: wilderness-emergency-medicine@list.pitt.edu
    Subject: RE: W-EMED PA con-ed credit for WEMT


    Jack,

    The amount of credit is substantial, however ALS providers need 18/
year, EMTs 24/3 years and First Responders 16/3years.  You may have
individuals who feel they do not get all the credit since they cannot spread
the hours over two periods of certification;

    Bob Cooney
        -----Original Message-----
        From: owner-wilderness-emergency-medicine@list.pitt.edu
[mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Jack
T. Grandey
        Sent: Thursday, July 16, 1998 7:34 PM
        To: WEM
        Cc: WEMSI
        Subject: W-EMED PA con-ed credit for WEMT


        I am pleased to announce that the PA Dept of Health has granted
continuing education credit for WEMSI's WEMT program as follows:

        First Responder:        30.0  hr.s
        EMT :                       50.0  hr.s
        Medic/PHRN:           51.5  hr.s

        This applies to all programs taught using the WEMSI curriculum, and
conducted in accord with the policies and procedures specified in the EMS
Continuing Education Manual.

        JTG

        Jack T. Grandey, NREMT-P
        Institute for Quality & Medical Management
Operations Director
                 UPMC Health System
Wilderness EMS Institute
                 http://www.upmc.edu/
http://www.wemsi.org/


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<DIV><SPAN class=3D950031217-17071998><FONT color=3D#0000ff =
face=3D"Times New Roman"=20
size=3D3>Yup.&nbsp; dat's de way de system works, now.&nbsp; I'd put the =
hourse in=20
&amp; suggest to those who feel they;re not getting their due, to lobby =
through=20
their EMS council.</FONT></SPAN></DIV>
<DIV><SPAN class=3D950031217-17071998><FONT color=3D#0000ff =
face=3D"Times New Roman"=20
size=3D3></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D950031217-17071998><FONT color=3D#0000ff =
face=3D"Times New Roman"=20
size=3D3>JTG</FONT></SPAN></DIV>
<BLOCKQUOTE=20
style=3D"BORDER-LEFT: #0000ff solid 2px; MARGIN-LEFT: 5px; PADDING-LEFT: =
5px">
    <DIV class=3DOutlookMessageHeader><FONT face=3D"Times New Roman"=20
    size=3D2>-----Original Message-----<BR><B>From:</B>=20
    owner-wilderness-emergency-medicine@list.pitt.edu=20
    [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]<B>On =
Behalf=20
    Of</B> Bob Cooney<BR><B>Sent:</B> Thursday, July 16, 1998 21:06=20
    <BR><B>To:</B>=20
    wilderness-emergency-medicine@list.pitt.edu<BR><B>Subject:</B> RE: =
W-EMED PA=20
    con-ed credit for WEMT<BR><BR></FONT></DIV>
    <DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
    size=3D3>Jack,</FONT></SPAN></DIV>
    <DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
    size=3D3></FONT></SPAN>&nbsp;</DIV>
    <DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
    size=3D3>The amount of credit is substantial, however ALS providers =
need 18/=20
    year, EMTs 24/3 years and First Responders 16/3years.&nbsp; You may =
have=20
    individuals who feel they do not get all the credit since they =
cannot spread=20
    the hours over two periods of certification;</FONT></SPAN></DIV>
    <DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
    size=3D3></FONT></SPAN>&nbsp;</DIV>
    <DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
    size=3D3>Bob Cooney</FONT></SPAN></DIV>
    <BLOCKQUOTE=20
    style=3D"BORDER-LEFT: #0000ff solid 2px; MARGIN-LEFT: 5px; =
PADDING-LEFT: 5px">
        <DIV class=3DOutlookMessageHeader><FONT face=3D"Times New Roman" =

        size=3D2>-----Original Message-----<BR><B>From:</B>=20
        owner-wilderness-emergency-medicine@list.pitt.edu=20
        [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]<B>On =
Behalf=20
        Of</B> Jack T. Grandey<BR><B>Sent:</B> Thursday, July 16, 1998 =
7:34=20
        PM<BR><B>To:</B> WEM<BR><B>Cc:</B> WEMSI<BR><B>Subject:</B> =
W-EMED PA=20
        con-ed credit for WEMT<BR><BR></FONT></DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3>I am pleased to announce that =
the PA Dept=20
        of Health has granted continuing education credit for WEMSI's =
WEMT=20
        program as follows:</FONT></SPAN></DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3></FONT></SPAN>&nbsp;</DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3>First=20
        Responder:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 30.0&nbsp;=20
        hr.s</FONT></SPAN></DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3></FONT></SPAN><SPAN=20
        class=3D300421923-16071998><FONT color=3D#000000 face=3D"Times =
New Roman"=20
        size=3D3>EMT=20
        =
:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20
        50.0&nbsp; hr.s</FONT></SPAN></DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3></FONT></SPAN><SPAN=20
        class=3D300421923-16071998><FONT color=3D#000000 face=3D"Times =
New Roman"=20
        =
size=3D3>Medic/PHRN:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;=20
        51.5&nbsp; hr.s</FONT></SPAN></DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3></FONT></SPAN>&nbsp;</DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3>This applies to all programs =
taught using=20
        the WEMSI curriculum, and conducted in accord with the policies =
and=20
        procedures specified in the EMS Continuing Education=20
        Manual.</FONT></SPAN></DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3></FONT></SPAN>&nbsp;</DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3>JTG</FONT></SPAN></DIV>
        <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
        face=3D"Times New Roman" size=3D3></FONT></SPAN><FONT =
color=3D#000000=20
        face=3DArial size=3D2></FONT>&nbsp;</DIV>
        <DIV><FONT color=3D#000000 face=3DArial size=3D2>Jack T. =
Grandey,=20
        NREMT-P</FONT> <BR><FONT color=3D#000000 face=3DArial =
size=3D2>Institute for=20
        Quality &amp; Medical=20
        =
Management&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;=20
        Operations Director</FONT> <BR><FONT color=3D#000000 =
face=3DArial=20
        size=3D2>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; UPMC =
Health=20
        =
System&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20
        Wilderness EMS Institute</FONT> <BR><FONT color=3D#000000 =
face=3DArial=20
        size=3D2>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <A=20
        href=3D"http://www.upmc.edu/"=20
        =
target=3D_blank>http://www.upmc.edu/</A>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;=20
        <A href=3D"http://www.wemsi.org/"=20
        target=3D_blank>http://www.wemsi.org/</A></FONT> </DIV>
        <DIV>&nbsp;</DIV></BLOCKQUOTE></BLOCKQUOTE></BODY></HTML>

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Would those of you who are responding to this query regarding snakebites
please address the use of ice on the affected extremity, it seems to be a
controversial issue with another listserver I am currently involved in.   
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To: wilderness-emergency-medicine@list.pitt.edu
Subject: Re: W-EMED Snake-Bite (Was: Communications Info) 
In-reply-to: Your message of "Fri, 17 Jul 1998 09:34:13 EDT."
             <1346279b.35af52d6@aol.com> 
Date: Fri, 17 Jul 1998 09:28:10 PDT
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>Would those of you who are responding to this query regarding
>snakebites please address the use of ice on the affected extremity,
>it seems to be a controversial issue with another listserver I am
>currently involved in.  

*Don't* Do it!!!

I know of no good reference to support that treatment and several
which *strongly* condemn it (eg. _Medicine for Mountaineering_,
Forgey's _Wilderness Medicine_.)  I've never heard a physician
recommend it, all I am aware of strongly recommend against it.

Get a good reference, such as the above, and post information from
that.  If the guys suggesting ice still won't believe you ask them
to provide a medically acceptable reference for their position.

One thing I've not yet seen recommended on this thread is the Sawyer
extractor.  At least on crotalid bites this has been shown effective
if used within the first few minutes of the bite, before the venom
has a change to disperse.

The other missing element in this discussion is *prevention*.  As
far as I'm concerned there is no good excuse for a rescuer to get
bitten by a venomous snake.  Learn the habits of snakes in your
area, let them know you are comming, don't reach into places where
they hide etc.  Our knowledge of treating snake bite should be
reserved for the subjects we help, we should never need it for
ourselves.

The rec.backcountry newsgroup has what I think is a pretty good FAQ
on this.  (I'm not prejudiced at all of course, just because I was
the original author.)  You might check that out.
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From: "Rob Thomas" <ROBERT@medinfo.iplan.co.za>
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Date:          Fri, 17 Jul 1998 08:22:34 GMT+2
Subject:       Re:W-EMED Snake-Bite (Was: Communications Info)
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Greetings all,

In reply to "David C. Kovar" <kovar@webnexus.com> I would like to add
what I have been recently taught regarding Southern African snakes. 

>WMA's Wilderness First Responder Course teaches:
>
>1) Antivenin - A specific treatment, limited to a hospital setting as it
>can cause allergic reaction in rare cases. Most effective during first four
>hours.

SA: Polyvalent Antivenin effective for most Cytotoxic snakes (primarily 
adders) and Neurotoxic snakes (primarily mambas & cobras). Monovalent 
antivenin for Boomslang (Tree-snake - Haemotoxic). No antivenin available 
for twig or vine snake. For Black Mamba bite up to 8 ampoules may be 
administered immediately within the hospital setting. 

>2) Transport - To the hospital, for antivenin. Walking the patient out is
>reasonably safe unless severe systemic signs and symptoms occur. The
>thought being that this will be significantly faster than a carryout. Split
>the affected part if possible.

If this is a neurotoxic snake bite, prepare for possible CPR. People have 
been known to arrest in relatively short periods after a Mamba or Cape 
Cobra bite. Even a Forest Cobra or Egyptian Cobra can have a fast effect 
on a susceptible person (child, elderly, infirm). 

>3) Expect swelling - Remove constricting items.
>
>The underlying belief is that you cannot field treat a venomous snakebite.
>Non-venomous snakebite should be treated as a puncture wound.

>Medicine for Mountaineering suggests wrapping the bitten extremity 
>snugly,
>splinting it and keeping it at the level of the heart. The victim should be
>transported as quickly as possible with as little effort on their part. The
>underlying belief is that this immobilizes the venom at the site. They
>caution that wrapping should not be undertaken unless you are certain that
>the envenomation is known to be moderate or severe - inflicted by large
>snake, pain and swelling appear at once - AND a hospital is many hours or
>days away.

In the South African setting, a fair number of the snake-bites are 
neurotoxic. There is relatively little immediate pain, redness or 
swelling. The first SSS tend to be affection of the cranial and 
respiratory nervous system. For haemotoxic bite, the first SSS can take up 
to 48 hours. In this case there is bruising in the joints and over the 
kidneys and liver. Prepare to administer LOTS of blood (in hospital).

The current orthodox treatment calls for the distal-to-proximal 
bandaging of the affected limb at approx 50mm/hg constriction with a pad 
over the bite. I would recommend this only for neurotoxic and haemotoxic 
snakes. Applied in Cytotoxic snakes this tends to lead to severe localised 
damage. If you like I can provide the exact text from the South African 
Institute for Medical Research's document on snake-bite treatment 
published 1996.

>In short, get them to a hospital as quickly as possible. I'd trade off
>immobility for speed, following WMA's instruction.

Ditto, while still taking cognisance of the differing possible scenarios. 

The problem with getting this to hospital (in this country) is that 
occasionally the medical personnel at the hospital need to be instructed 
in the correct treatment of snake-bite. I have an anecdotal story of a 
handler bitten on the left hand at the ?Nelspruit? snake park and the 
doctors at the hospital wanted to amputate the arm as a preventative 
measure. Apparently they didn't take the refusal of consent too well. Two 
months later the handler had regained full use of his hand. I believe this 
happened during the last 18 months - it was told to me during a course on 
snake identification and snake-bite treatment by the curator of said snake-
park. 

Just my 2c worth, which in South African rands, is bugger all.

Regards

Rob



Rob Thomas

(robert@medinfo.iplan.co.za)

Phone : 450-2957 (Work), Pretoria (012), South Africa (+27)
Cell:   082-652-2540

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From: "Bob Cooney" <Bobcems@epix.net>
To: <wilderness-emergency-medicine@list.pitt.edu>
Subject: RE: W-EMED PA con-ed credit for WEMT
Date: Thu, 16 Jul 1998 21:06:19 -0400
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Jack,

The amount of credit is substantial, however ALS providers need 18/ year,
EMTs 24/3 years and First Responders 16/3years.  You may have individuals
who feel they do not get all the credit since they cannot spread the hours
over two periods of certification;

Bob Cooney
    -----Original Message-----
    From: owner-wilderness-emergency-medicine@list.pitt.edu
[mailto:owner-wilderness-emergency-medicine@list.pitt.edu]On Behalf Of Jack
T. Grandey
    Sent: Thursday, July 16, 1998 7:34 PM
    To: WEM
    Cc: WEMSI
    Subject: W-EMED PA con-ed credit for WEMT


    I am pleased to announce that the PA Dept of Health has granted
continuing education credit for WEMSI's WEMT program as follows:

    First Responder:        30.0  hr.s
    EMT :                       50.0  hr.s
    Medic/PHRN:           51.5  hr.s

    This applies to all programs taught using the WEMSI curriculum, and
conducted in accord with the policies and procedures specified in the EMS
Continuing Education Manual.

    JTG

    Jack T. Grandey, NREMT-P
    Institute for Quality & Medical Management
Operations Director
             UPMC Health System
Wilderness EMS Institute
             http://www.upmc.edu/
http://www.wemsi.org/


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http-equiv=3DContent-Type>
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</HEAD>
<BODY bgColor=3D#ffffff>
<DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
size=3D3>Jack,</FONT></SPAN></DIV>
<DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
size=3D3></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
size=3D3>The amount of credit is substantial, however ALS providers need =
18/ year,=20
EMTs 24/3 years and First Responders 16/3years.&nbsp; You may have =
individuals=20
who feel they do not get all the credit since they cannot spread the =
hours over=20
two periods of certification;</FONT></SPAN></DIV>
<DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
size=3D3></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D860420401-17071998><FONT color=3D#0000ff =
face=3D"Arial Black"=20
size=3D3>Bob Cooney</FONT></SPAN></DIV>
<BLOCKQUOTE=20
style=3D"BORDER-LEFT: #0000ff solid 2px; MARGIN-LEFT: 5px; PADDING-LEFT: =
5px">
    <DIV class=3DOutlookMessageHeader><FONT face=3D"Times New Roman"=20
    size=3D2>-----Original Message-----<BR><B>From:</B>=20
    owner-wilderness-emergency-medicine@list.pitt.edu=20
    [mailto:owner-wilderness-emergency-medicine@list.pitt.edu]<B>On =
Behalf=20
    Of</B> Jack T. Grandey<BR><B>Sent:</B> Thursday, July 16, 1998 7:34=20
    PM<BR><B>To:</B> WEM<BR><B>Cc:</B> WEMSI<BR><B>Subject:</B> W-EMED =
PA con-ed=20
    credit for WEMT<BR><BR></FONT></DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3>I am pleased to announce that the =
PA Dept of=20
    Health has granted continuing education credit for WEMSI's WEMT =
program as=20
    follows:</FONT></SPAN></DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3></FONT></SPAN>&nbsp;</DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3>First=20
    Responder:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 30.0&nbsp;=20
    hr.s</FONT></SPAN></DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3></FONT></SPAN><SPAN=20
    class=3D300421923-16071998><FONT color=3D#000000 face=3D"Times New =
Roman"=20
    size=3D3>EMT=20
    =
:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20
    50.0&nbsp; hr.s</FONT></SPAN></DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3></FONT></SPAN><SPAN=20
    class=3D300421923-16071998><FONT color=3D#000000 face=3D"Times New =
Roman"=20
    =
size=3D3>Medic/PHRN:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;=20
    51.5&nbsp; hr.s</FONT></SPAN></DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3></FONT></SPAN>&nbsp;</DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3>This applies to all programs =
taught using the=20
    WEMSI curriculum, and conducted in accord with the policies and =
procedures=20
    specified in the EMS Continuing Education =
Manual.</FONT></SPAN></DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3></FONT></SPAN>&nbsp;</DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3>JTG</FONT></SPAN></DIV>
    <DIV><SPAN class=3D300421923-16071998><FONT color=3D#000000=20
    face=3D"Times New Roman" size=3D3></FONT></SPAN><FONT =
color=3D#000000 face=3DArial=20
    size=3D2></FONT>&nbsp;</DIV>
    <DIV><FONT color=3D#000000 face=3DArial size=3D2>Jack T. Grandey, =
NREMT-P</FONT>=20
    <BR><FONT color=3D#000000 face=3DArial size=3D2>Institute for =
Quality &amp;=20
    Medical=20
    =
Management&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;=20
    Operations Director</FONT> <BR><FONT color=3D#000000 face=3DArial=20
    size=3D2>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; UPMC =
Health=20
    =
System&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20
    Wilderness EMS Institute</FONT> <BR><FONT color=3D#000000 =
face=3DArial=20
    size=3D2>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <A=20
    href=3D"http://www.upmc.edu/"=20
    =
target=3D_blank>http://www.upmc.edu/</A>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;=20
    <A href=3D"http://www.wemsi.org/"=20
    target=3D_blank>http://www.wemsi.org/</A></FONT> </DIV>
    <DIV>&nbsp;</DIV></BLOCKQUOTE></BODY></HTML>

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