Here are some websites focused on saving lives through early defibrillation:

National Center for Early Defibrillation
www.early-defib.org

AED Instructor Foundation
www.aedinstructorfoundation.org

Kids Endangered Now
www.kenheart.org

Louis J. Acompora Memorial
www.la12.org

Chad Foundation for Athletes and Artists
www.chadfoundation.org/index.shtml

Welcome to the winter edition of the ECSI Newsletter!

The past 3 months have been very busy. Here is a brief overview of the activities:

Regulatory Affairs
We have been hard at work securing program approvals at the state and national levels, as well as through national organizations. To assist with this task, we are pleased to introduce Mr. David Weliver. David is responsible for contacting regulatory affairs personnel and maintaining our rapidly expanding database of approval letters.

Instructor Development Course
In just a few weeks we will release our Instructor Development Course (IDC), which will be posted on the secured Members area of our website. Now those of you looking to train more instructors can do so with these easy-to-use materials.

Changes to the Website
You may have already noticed the new look of the ECSI website, including the new URL: ECSInstitute.org. Explore the new website today! It is easier to navigate and locate the items most important to you. We are currently adding more items to the secured Members area, including marketing flyers that you can download for free to help you market your training.

New Programs/Products
We are pleased to announce the release of our academic-level first aid, CPR, and AED program designed specifically for high schools and colleges/universities. Read all about this program in What's New From ECSI.

Many Thanks
We wish to thank Dr. Alton Thygerson from Brigham Young University for his continued contributions to many sections of ECSI Connections. We also welcome first time contributor Michael O. McLeieer, of E.S.C.A.P.E., Inc. for his featured article in this edition.

Advisory Council
We are pleased to introduce the following members of our new Advisory Council:

Sara Becker, EMT-I
Webster, NH

Joel Demers, EMT
Westbrook, CT

Michael S. Estep, EMT-D, PhD
Shingle Springs, CA

Hudson Garrett, RN, MSN, MPH
Columbus, GA

Al Kalbach, EMT-P
Allentown, PA

Michael McLeieer, FF, EMT-B
Kalamazoo, MI

Bob Nixon, EMT-B, MBA
Auburn, MA

Catharine Shaner, MD, FAAP
Allentown, PA

Alton Thygerson, Ed.D
Provo, UT

Sandy Waggoner, EMT-P, FF, EMSI
Milan, OH

Garrie Wright
Toronto, Ontario, Canada

As discussed in the fall edition of ECSI News, the ECSI Advisory Council members will help shape the future of ECSI. Our first meeting with this group is scheduled for February.

On the National Front

Actual Causes of Death
Modifiable behavioral risk factors are the leading causes of death in the United States.

Causes                        Number       % 
Tobacco                      435,000      18.1
Poor diet/inactivity       400,000       16.6
Alcohol                         85,000        3.5

Other actual causes of death were microbial infections (75,000), toxic agents (55,000), motor vehicle crashes (43,000), firearms (29,000), sexual behaviors (20,000), and illicit use of drugs (17,000).

While smoking remains the leading cause of death, poor diet and physical inactivity may soon overtake tobacco as the leading cause of death. These findings, along with escalating health care costs and an aging population, argue persuasively for a need to establish a more preventive orientation in the U.S. health care and public health systems. Source: Journal of the American Medical Association. 291(1), March 10, 2004:1238-1245.

States Reporting In

Houston, TX - A woman who fled from a burning apartment re-entered the building and died trying to save her son, not knowing that he had escaped. The 45-year-old woman believed that her 6-year-old was inside the unit.
Source: Associated Press, December 21, 2004.

Wauwatosa, WI - Doctors successfully treated a teenager with a usually fatal case of rabies by using a novel combination of drugs. They induced a coma in a 15-year-old girl to stave off the rabies infection. Only five people in the world had been known to have survived rabies after the onset of symptoms. Rabies, which attacks the brain and nervous system, is considered untreatable once the symptoms appear. Symptoms include fever, headache, anxiety, and loss of consciousness.
Source: Associated Press, November 24, 2004.

Hollywood, FL - A 14-year-old boy died after tackling another player during the second-half kickoff of a youth football league game. The victim plowed into another player and crumpled on the field. He died before paramedics could get him to a hospital.
Source: Associated Press, November 9, 2004.

Las Cruces, NM - A junior at New Mexico State University died after his 21st birthday celebration led to alcohol poisoning. Fraternity members called for help after finding the victim unconscious and not breathing.
Source: Associated Press, November 20, 2004.

Liberty, SC - Two men died after a 400-pound tire exploded as they tried to install it on a truck. They had put ether and motor oil on the tire and ignited it so it would expand and adhere to the rim. The tire exploded and debris landed on top of them.
Source: Associated Press, September 30, 2004.
 
Salt Lake City, UT - Backcountry avalanches have killed four men in three days and in three separate incidents. One victim was skiing near the Brighton and Solitude Ski Resorts, another was snowmobiling, and two were snowshoeing. Utah has a yearly average of four avalanche-related deaths.
Source: Deseret News, December 13, 2004.

Langdon, ND - A farmer died after he was trapped in a bin with nearly 18,000 bushels of grain. The 44-year-old man was storing grain on his farm when the incident happened. After neighbors volunteered to help empty the bin, the victim was found inside.
Source: Associated Press, October 19, 2004.

Yellowstone National Park, WY - A tourist who wandered off a trail broke through fragile ground in a thermal area that covers water near or above the boiling point. The scalding caused second-degree burns on his legs up to his knees.
Source: Associated Press, October 10, 2004.

With the inquiries we continue to get regarding the use of AEDs, ECSI asked Dr. Thygerson to provide some timely journal articles that would answer some of these questions.

Teaching Public Access Defibrillation to Lay Volunteers---A Professional Health Care Provider is Not a More Effective Instructor Than a Trained Lay Person
Source: Resuscitation. 2004 Dec; 63(3):305-10.

Survival improves in witnessed out-of-hospital cardiac arrest if the victim receives bystander-initiated cardiopulmonary resuscitation and rapid defibrillation (BLS/AED). The European Resuscitation Council has a simple program to teach these lifesaving skills, which require no previous experience with automated external defibrillators (AEDs). To be able to widely implement the use of AEDs, many instructors are needed, and therefore lay persons may also be used as trainers. This randomized study compared lay volunteers trained by a lay person with those trained by a health care provider. No statistical difference was present between the two groups of lay volunteers. All were able to use the AED and follow instructions. They identified victims with ventricular fibrillation and cardiac arrest, but had difficulties identifying cases with imminent cardiac arrest. The control group of trained first aiders performed significantly more effectively than the newly trained lay persons. Conclusions: No significant benefit exists in the trainer being a health care professional, but thorough training and subsequent rehearsing of the skills learned are crucial.

The Acquisition and Maintenance of Defibrillation Skills by Lay First Responders
Source: Resuscitation. 2003 Jan;56(1):77-82.

Nontraditional and lay first responders increasingly are being trained in the skill of defibrillation. With the simplification of new devices, there is a need to determine optimal first responder selection and training and maintenance of this important skill. This study found that first responders with higher training levels were more likely to acquire the skill of defibrillation successfully. However, once the skill was acquired, it was easily maintained by all (98%). The researchers concluded that, for first responders proficient in cardiopulmonary resuscitation (CPR), the skill of defibrillation with an AED is readily acquired and maintained. While less experienced persons may be less likely to acquire the skill initially, once acquired, the skill is equally maintained by all.

Training of Police Officers as First Responders with an Automated External Defibrillator
Source: Resuscitation. 2004 Oct;63(1):33-41.

A short and effective training program is an essential prerequisite in learning how to use automated external defibrillators (AED) by EMS providers and first responders. This study evaluated a 3-hour AED course. All police officers (823 officers; 76% male, average age 36 years) were trained in the region of Amsterdam, the Netherlands. An assessment was made at the beginning of the course and at the end as to whether BLS can be improved in a 3-hour AED course. Through a combined BLS and AED assessment at the end of the course, the researchers found that BLS improved significantly. After training, 89% of the students were able to use an AED safely and effectively. Self-confidence and motivation improved from 12% and 73% to 99% and 94% over the course. Independent student characteristics influencing the success of the AED course were: previous BLS training, motivation before the course, and resuscitation experience that dated back for more than 12 months. The researchers concluded that the majority of police officers can be trained to use an AED safely and effectively within a 3-hour AED course. Also, during this course, they improve on their BLS skills.

Winter's Here!
By Michael O. McLeieer, of E.S.C.A.P.E., Inc

Cold winter weather is upon us in much of the United States, and with it comes a variety of health and safety hazards affecting people both indoors and out. To help ensure families and workers stay safe and warm this season, Michael O. McLeieer, President of New England based E.S.C.A.P.E., Inc., a new ECSI Educational Center, has provided some cold weather safety tips.

Driver Safety
Snow, ice, and extreme cold can make driving treacherous. In 1998, 131,000 motor vehicle crashes occurred during sleet and snowy conditions in the U.S. Before the onset of winter weather, make sure your car is ready for the season with a tune-up, snow tires or tires with good tread, a charged battery, and sufficient antifreeze.

• Keep emergency gear in your car, including a cell phone, flashlight, jumper cables, sand or kitty litter, ice scraper/snow brush, small shovel, blankets, and warning devices. For longer trips, take food, water, extra blankets, and required medication.
• If you must travel in bad weather, drive slowly and let someone know your route and anticipated arrival time.
• Try to get to the store before a storm hits.
• Carbon monoxide kills. Don't sit in a parked car with the engine running unless a window is open. Don't warm up your car in the garage. If your car is outside, make sure the exhaust pipe and the area around it are free of snow.
• If you are stopped or stalled, light two flares and place them outside, one at each end of the car. Stay in your vehicle and open a window slightly. Wrap yourself in blankets. Run your heater for a few minutes every hour to keep warm.

Pedestrian Safety
Ice- and snow-covered roads and walkways can be serious safety hazards.

• Walk on sidewalks, if possible. If they are icy and you must take to the streets, walk against the flow of traffic and as close to the curb as you can.
• Wear a bright piece of outer clothing if you have to walk in the street or road. Dark winter colors are often hard for motorists to see.
• Don't wear a hat or scarf that blocks your vision or makes it hard for you to hear traffic.
• Ice and snow can alter road conditions, making it hard for vehicles to stop or slow down. Before you step off the curb¾even at a stop sign or traffic light¾make sure approaching vehicles have come to a complete stop.
• Be aware that snowdrifts can turn familiar territory into an alien landscape, covering curbs and other potential hazards.
• Bending your knees a little and taking slower, shorter steps can greatly reduce your chances of falling.

Dress for the Cold
Walking in a winter wonderland won't be so wonderful if you aren't prepared for the weather. Not dressing properly can lead to hypothermia, a serious condition in which your body temperature cools down to abnormal levels.

• Wear several layers of loose-fitting, lightweight clothing, and wear mittens instead of gloves. Trapped, insulating air warmed by body heat is the best protection from the cold.
• Wear a hat and make sure shoes or boots have nonskid soles.
• Change out of wet clothes as soon as possible.

Snow Shoveling
While snow shoveling can be good exercise, it can also be dangerous for optimists who take on more than they can handle.

• Dress warmly, paying special attention to feet, hands, nose, and ears.
• Avoid shoveling snow if you are out of shape. If you have a history of heart trouble, do not shovel snow unless your doctor approves.
• Pace yourself and don't work to the point of exhaustion. Shoveling can raise your heart rate and blood pressure dramatically. Take frequent breaks.
• If possible, push snow in front of you. If you have to lift it, pick up small amounts and lift with your legs bent, not your back. Do not toss snow over your shoulder or to the side.
• Don't drink alcohol before or while shoveling snow and don't smoke while shoveling.

Snow Blower Safety
Snow blowers or throwers aren't toys. These machines may help you efficiently remove snow from driveways and sidewalks, but they also cause thousands of emergency room visits each year.

• Make sure you understand your owner's manual safety procedures thoroughly.Be sure you have good visibility or light.
• Walk, never run.
• Keep the area clear of pets and people, especially kids.
• Clear the area of all obstacles that can clog the chute.
• Never put your hand in the snow blower to remove snow or debris. Turn it off and wait a few seconds, then use a stick or broom handle.
• Never leave the snow blower unattended and don't let kids operate it.
• Dress properly for the job. Wear boots that give you good footing on slippery surfaces and avoid loose fitting clothes that can get caught.
• Don't attempt to clear steep slopes.

Home Heating
Colder weather means it's time to turn on your furnace or other heating device. But take care---winter months result in the most home fires, and heating devices are often the culprit. With proper precautions you'll be safe and warm this season.

• Install a smoke detector and carbon monoxide alarm near your bedrooms and on each floor.
• Know the symptoms of carbon monoxide poisoning: headache, fatigue, nausea, dizziness, and shortness of breath.
• Have your heating system tuned up each year. If you heat your home with a wood stove, have the chimney connection and flue checked each year and make sure the stove is placed on an approved stove board to protect your floor from heat.
• Your wood-burning fireplace should have a sturdy fire screen in place. Make sure your chimney and flue are inspected each year and cleaned, if needed. Burn only untreated wood. Never burn paper or pine branches: pieces can float out the chimney and ignite your roof or your neighbor's, as well as nearby trees.
• Do not use gas appliances such as ovens, ranges, or clothes dryers to heat your home.
• If you use a kerosene heater, never use gasoline, which can cause a fire or explosion. Use only water-clear 1-K grade kerosene. Never refuel the heater inside your home or fuel it when it is hot or in operation. Do not fill the tank above the "full" mark. Keep a door open to the rest of the house or open a window slightly to reduce the risk of carbon monoxide buildup.
  

Student Pairs

This technique involves learning in pairs where two students alternate asking and answering questions on an assigned topic. Where can questions come from? The students could ask the questions found in the ECSI student manuals. Another method is to turn the topical headings into a question. Students can be randomly assigned to pairs and they can mutually agree as to who will ask the first question or use a coin-flip to do so. After having answered and perhaps having been corrected or given additional information, the second student puts a question to the partner. Again, the students alternate asking each other questions. The instructor goes from pair to pair, giving feedback and asking and answering questions.

A variation of this technique is to ask students to think about a problem for a minute, write for a minute, and then share their thoughts with a neighbor (Think-Pair-Share). Pairing can also be used for discussing an issue, analyzing a case or problem, or summarizing an instructor's presentation.

This edition of Technicians Tips comes from Tom Garcia, MD, FACEP. Dr. Garcia's best-selling books on ECG interpretation provide a wealth of information for paramedics, nurses, and physicians in a teaching manner that is unsurpassed. If you are a provider who is looking for a few ECG clarification tips from a pro, try these:

• A "cardiac rhythm" refers to the cadence or sequence of how cardiac complexes occur.
• An "arrhythmia" refers to a cardiac rhythm that is pathological in nature, transmitted differently than the normal process.
• "Artifacts" are false abnormalities of the baseline present on an ECG due to sources other than the patient's bioelectric impulses.
• "Premature complexes" are those that arrive ahead of schedule. The complex occurs early compared to where it should have occurred along the ECG strip.
• An "escape complex" is almost the opposite of a premature complex. It occurs late in the cadence.
• "Aberrancy" relates to electrical impulses that travel along non-established pathways in order to depolarize the heart. These are seen as wide complexes different from those that have gone through the normal impulse.
• "Atrial flutter" refers to a very rapid, regular atrial tachycardia occurring at rates between 200 and 400 beats per minute. The atrial complexes appear in a saw-tooth pattern that is only found in this rhythm.
• "Ventricular tachycardia" is simply the presence of three of more ectopic ventricular complexes in a row with a rate above 100 beats per minute.
• "Second degree AV blocks" are characterized by both the presence of P waves and intermittently dropped QRS complexes. Mobitz I second-degree AVB is more common and usually benign. Mobitz II second-degree AVB is less common and more life-threatening.

You can learn much more about ECGs, including 12 lead interpretation, by visiting: http://www.emszone.com/catalog/0763722464/

Programs & Products: Just Released by the Emergency Care and Safety Institute (ECSI):

First Aid, CPR, and AED, Fourth Edition
ISBN: 0-7637-3016-5 · Paperback · © 2005

The cornerstone of an integrated teaching and learning system, the Fourth Edition combines comprehensive content with dynamic features, design, and technology to better support instructors and to prepare students for any emergency.

The text has been updated to include:

• Updated dental emergencies and injuries information
• Updated poisoning information, including:
  • Eliminated syrup of ipecac
  • Revised Poison Control Center contact information
• Updated snake bite information, including:
  • Eliminated extractor
  • Revised pit viper emergency care
• A new chapter on disaster preparedness, which includes:
  • Natural Disasters (Earthquake, Flood, Heat Wave, Hurricane, Landslide, Tornado, Tsunami, Volcano Eruption, Wildfire, Winter Storm)
  • Technological Hazards (Hazardous Materials Incidents, Nuclear Power Plants)
  • National Security Emergencies (Terrorism, Chemical and Biological Agents, Nuclear and Radiological Weapons)
• Updated AED information to cover pediatrics

The teaching and learning system has been updated to include:

• A choice of VHS Videos or DVDs!
• New administration information incorporated into the Instructor's Resource Manual
• Combined CPR and AED Instructor Resource Manuals into one for use with the First Aid, CPR, and AED, CPR and AED, and AED programs allowing CPR and AED users to share the supplements between both programs
• Revised Instructor Toolkit (ITK) CD.

The ECSI offers the most comprehensive and accurate safety training materials available. Some of the exclusive benefits ECSI programs include:

• Approval from two nationally recognized medical organizations
• More affordable, innovative products
• Ease of administration through one-time online registration, quality customer service, and one-stop shopping for all of your emergency care training program needs
• No hidden costs
• Free supplements for qualified instructors
• Free course completion cards and instructor cards
• Continuity with AAOS' market-leading Emergency Medical Services programs

To become an ECSI Educational Center or Instructor or to just learn more about ECSI and its programs and products visit us at www.ECSInstitute.org!

Educational Centers and Instructors are invited to contact their Public Safety Specialist at 1-800-832-0034 to request a review copy or to purchase a copy of this essential new text without risk today.

If you are interested in our broader list of Public Safety programs, visit http://www.EMSzone.com

Coming Soon!

Wilderness First Aid
Watch for the announcement of the release of this program.

In this edition of ECSI Connections, we spotlight one of our newest ECSI Education Centers, Safety Watch, Inc. This is a unique Educational Center providing both for-profit and not-for-profit divisions that meet the needs of many communities.

Safety Watch, Inc. was incorporated in 1996, and has formed an alliance with training centers and individuals that provide quality first aid, CPR, AED, emergency care, and safety training. Safety Watch, Inc. is also prototyping franchises in PA, OH, and FL.

Al Kalbach, founder, has been a firefighter-paramedic since 1973, and has been an instructor since 1975. He states: "We work closely with our offices and affiliates across the United States and look forward to adding more affiliates that teach the ECSI programs. Our goal is to provide comprehensive first aid and emergency care training, services, and products that are sensible and based on each facility needs, saving the customer time and money. That's why we have made the switch to ECSI."

Al started as a private contractor in 1992 to provide a single resource for medical facilities and emergency services for OSHA compliance regulation needs, emergency care and CPR. Al now manages comprehensive first aid, safety, and emergency care services for a wide variety of businesses and industry. Al also wrote AED, emergency oxygen, and other texts for other national curricula.
Safety Watch, Inc. has a nonprofit division called the Lifesaving Road Tour™ (LSRT), which is designed to provide emergency care awareness, training, and services. LSRT has over 100 CPR manikins and over 20 AED trainer units that allow it to provide mass training anywhere it is needed. This unique program is available for community projects, businesses, and organizations.

"LSRT's mission is to foster the development and implementation of community emergency preparedness and response programs that enable citizens to respond to any emergency, and provide coordinated care and services with local professional emergency responders," states Kalbach, who completed a cross country tour in May of 2004 with Medtronic. This tour, called "Let's Keep the Beat," visited 12 cities and trained over 1200 people in CPR and AED. "We utilize local instructors to do these mass trainings, and look forward to working with ECSI and its training centers to provide more training in 2005."

Kalbach states LSRT works with national companies and the government to obtain grants for AEDs and emergency response training. "We are interested in hearing from ECSI centers that feel they have a need that can be met with our help."

For more information visit http://www.safetywatchinc.com, and http://lifesavingroadtour.org, or contact Al Kalbach: al@safetywatchinc.com.

Some of the key conferences/meetings that ECSI and Jones and Bartlett Publishers will be attending this quarter include:

• American Society for Law Enforcement Training, Jacksonville, FL
• California Parks and Recreation Expo, Sacramento, CA
• EMS Today, Philadelphia, PA
• National Association of EMS Physicians, Naples, FL
• National Association of Parks and Recreation - Aquatic Conference, Las Vegas, NV
• Texas Association of Fire Educators, San Antonio, TX

For a comprehensive list of upcoming conferences please visit: http://www.emszone.com/company/conferences.htm