Letter from Chair

Submitted by Dave Magruder, 2009 National Advisory Council Chairperson

Warm summer greetings,

In the last newsletter, I described a statement about Quality written by Mike Love. At the time he wrote it, he was the Assistant Chief for the Montgomery County Fire and Rescue Service in Rockville, Maryland. In this newsletter, I'd like to focus on just three sentences from what Mike wrote:

"Quality is a sustained desire and effort to produce the best possible service. This desire has to be shared by everyone who either directly or indirectly affects the service. The root of Quality will be on constantly looking for ways to improve the service and actually making those improvements."

There are now well over 1800 ECSI Education Centers. All Education Centers and Instructors play major roles in ensuring that ECSI's Quality is second to none. Your ECSI Advisory Council is constantly looking for ways to improve, but it needs your input. We need to hear from you. If you are doing something that you feel the rest of us could benefit from, let us know. If there is something that you think should be changed, let us know that too. Your Advisory Council is the voice for tens of thousands of ECSI instructors. I can tell you that the volunteers on your Advisory Council, along with the great staff at ECSI, are constantly looking for ways to improve the service and are actually making those improvements.

Please let any of the Advisory Council members know if there is anything we can do to assist you. Feel free to email me with any comments that you would like us to hear.

Be safe.

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News and Announcements

Boy Scouts of America release new Wilderness First Aid guidelines The Boy Scouts of America (BSA) has announced a new Wilderness First Aid Curriculum and Doctrine Guidelines to be implemented in all Boy Scout classes after March 1, 2010. This curriculum, which is available for download in the Member's Area of the ECSI website, was written by the BSA Health and Safety Support Committee and Wilderness First Aid Task Force. ECSI will be developing materials to assist BSA instructors in meeting these new guidelines.

New promotional flyers available New and improved course promotional fliers are now available in the Member's Area of ECSI's website. The new flyers allow you to edit your contact information before printing to provide a more professional look. New Sports First Aid and Injury Prevention and Oxygen Administration course flyers are also available.

Save on Save A Life Cards Approved ECSI Educational Centers and Instructors can save 50% off the standard list price of the Save A Life Card 100 packs. Simply call 1-800-541-5691 to order, and reference this newsletter offer to receive your 50% discount. This offer expires on September 15, 2009.

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In the News

Submitted by Alton Thygerson, FAWM

Pamplona, Spain—A bull gored a young Spaniard in the neck, causing the first fatality in nearly 15 years at Pamplona's running of the bulls. The victim was killed almost instantly as he scurried for cover under a wooden barrier, sliding under it feet-first. Had he dived headfirst, this experienced bull runner would probably still be alive. At least nine people were injured in the fourth of eight planned runs. Two were Americans in their 60s, one of whom suffered a blow to the chest. The party went on despite the death, the 15th since record-keeping began in 1924. The running of the bulls—made famous by Ernest Hemingway's novel "The Sun Also Rises"—has never been suspended just because someone has died in the mad, half-mile dash from a holding pen to the city's bull ring.
Source: Associated Press, July 11, 2009

Oxford, FL—A 12-foot pet Burmese python broke out of a terrarium and strangled a 2-year-old girl in her bedroom. The snake's owner, who is the boyfriend of the girl's mother, discovered the snake missing from its terrarium and went to the girl's room, where he found it on the girl. The girl also had bite marks on her head. The owner did not have a permit for the snake.
Source: Associated Press, July 2, 2009

Sturgis, KY —The body of an 8-year-old boy was found with his head pinned in a church elevator as his family was cleaning up after his grandmother's wedding reception.
Source: Associated Press, June 16, 2009.

New York, NY—When an 11-year-old sitting on bleachers with his Little League team grabbed his head and started crying, his family thought he had been whacked by a ball. Hours later, they learned he had been struck by a stray bullet. Doctors removed the bullet, which lodged between the boy's skin and skull.
Source: Associated Press, June 9, 2009.

Clovis, NM—A 7-year-old girl survived a crash that killed her father who had been ejected out of the family's vehicle and drove the damaged vehicle to get help. Police said that the girl realized her father was dead and drove for about three miles until a passing motorist spotted her.
Source: Associated Press, May 28, 2009.

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Medical Journal Abstracts

Submitted by Alton Thygerson, FAWM

Medical Training in Mountain Rescue in America and Europe

This study evaluated medical training of mountain rescuers in countries associated with the International Commission of Mountain Emergency Medicine. First aid topics taught most often are hypothermia and cold injuries (32 of 33 organizations); avalanche rescue, first aid kit of rescuer, cervical collar (31 of 33); hemorrhagic shock, wound dressing (30 of 32); and heat injuries and SAM SPLINT (29 of 32). CPR manikins are used in 32 of the 33 organizations. The authors recommend standardization of medical training conducted on a yearly basis.
Source: High Altitude Medicine and Biology. 2009 Summer;10(2):195-200.

Anaphylaxis in the Community: Learning from the Survivors

This study focused on survivors of anaphylaxis and their experiences in using, or not using, an epinephrine autoinjector for first aid treatment. Of the 1,885 participants, 500 (27%) were epinephrine users, and 1,385 (73%) were nonusers. Epinephrine users were more likely to report symptoms; to report peanut, fish, or insect sting triggers; to be asthmatic; and to have taken or been given asthma medication on the day of the episode. Epinephrine users reported problems in deciding whether to give the injection, repeat the dose, and/or go to an emergency department. Nonusers reported not injecting epinephrine for various reasons, such as no prescription for epinephrine and/or a mild anaphylaxis episode.
Source: Journal of Allergy and Clinical Immunology. 2009 Jun 21.

Four Rabies Jabs Sufficient

The number of doses of rabies vaccine recommended following an animal bite or other exposure has been reduced from five to four to ease an ongoing vaccine shortage. The new recommendation will become official when it is published in an upcoming issue of Morbidity and Mortality Weekly Report.
Source: Medpage Today, June 26, 2009.

Subway Defibrillators Save Lives

The use of automated external defibrillators (AEDs) in public places such as subways can save lives, new research from Germany shows. During the study of over 7.5 years, AEDs were used on 17 victims. Of 14 people having hearts attacks, 12 (86%) were resuscitated and admitted to a hospital. Three victims suffered other causes for collapse, and in two, the device delivered no shock.
Source: Heart Rhythm 2009, May 13, 2009.

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Featured Articles

Student EMTs Save a Life

Submitted by Raymond Levy—Boston University

Alex Su's first shift as an EMT was at the psychology department convocation on Commencement Sunday at Walter Brown Arena. He'd been hired by Boston University's (BU) Emergency Medical Services just two days earlier.

"I figured I'd just be handing out Band-Aids or something," says Su. About halfway through the ceremony, he and fellow EMT Elizabeth Snow noticed a commotion across the arena. Then the announcer stopped reading names and called for a physician. The pair rushed over with their first aid kit, oxygen tank, and automated external defibrillator (AED). The father of a graduate had collapsed.

A Boston University police officer, a physician who happened to be attending Commencement, and the man's family were on the scene. "The patient was lying down, unresponsive," Su says. "I checked for a pulse and he didn't have one. We immediately identified it as cardiac arrest." Snow radioed for an ambulance, and Su and the doctor began CPR.

"In these situations, everyone else was panicking—so even though you're nervous, you have to stay calm and think on your feet," Su says. "Everyone is looking toward you to do something." One of those people was the man's daughter, Heather Field, who was graduating that day. "I had just lost my mom a year and a half ago," she says. "I actually thought I was going to lose my other parent."

Snow fired up the AED, and the physician applied the pads, or "paddles" that many of us have come to recognize as part of an emergency responder's apparatus. The machine analyzed Field's heart function and recommended a shock to help restore normal rhythm. Su administered it, and the team continued with CPR. Within a minute, Mr. Field's pulse returned, and he began breathing on his own. By the time paramedics had arrived and he was strapped into the stretcher, he was talking. He was taken to Brigham and Women's Hospital, where surgeons later implanted a pacemaker and released him one week later.

Each year more than 300,000 Americans experience sudden cardiac arrest, and 95% of them die, most within minutes. For every minute that CPR is not provided, a victim's survival rate is reduced 7 to 10%.

"Most of the stories I hear about people doing CPR usually end with the patient not making it," says Su, who took the EMT course at FitRec last year and recertified this past January. "It was a big sigh of relief—for all of us, for the family members. It was pretty chaotic. When we saw that he was going to make it, it was a pretty good feeling."

Snow, who has worked for Emergency Medical Services for a year and covered last year's Commencement, says the most serious condition she'd ever faced as an EMT was a possible fractured ankle.

"To go from that to someone who's not breathing and doesn't have a pulse was a big jump," she says. "I was definitely kind of panicking on the inside, but just tried to do what I was trained to do. I felt prepared. It was good reinforcement that this does work and I'm doing it for a reason. To have such a positive outcome is fantastic."

As for Su, she has nothing but praise for the newbie. "He was so calm and handled it so well. I don't know what I would have done if this was my first patient ever. I probably would have really freaked out. He was pretty much a rock star in all this."

A Professional Rescuer CPR Recertification class was done through ECSI at Boston University and their training was instrumental in their preparedness and response.

Summer Safety

Submitted by Michael McLeieer, E.S.C.A.P.E.

Summer is here, and that means lots of outdoor recreational activities, as well as a host of safety hazards that go along with this time of the year!

During the summer months, more and more people across the country will be enjoying the outdoors. Unfortunately, sun, heat, and fair-weather activities such as swimming, biking, picnicking, and lawn mowing also present their share of hazards. Here are some tips to help ensure that everyone community enjoys a safe summer.

General Sun and Heat Concerns

Overheating can cause muscle cramps, chills, nausea and dizziness, among other symptoms. At its worst, it can lead to heat stroke, a medical emergency.

• Drink plenty of water before and during hard or strenuous work in the heat. You'll often need to drink more water than your thirst indicates. Taking frequent small drinks is more effective than gulping down large amounts at once.
• When possible, schedule heavy work for the cooler hours of the day, such as early morning or late evening. When possible, start with less strenuous work and gradually build up the intensity so you can acclimate yourself to the heat. Rest frequently as well.
• Never leave children alone in a car during the summer—even for a few minutes with the windows rolled down.
• Protect yourself from the sun's ultraviolet (UV) rays. Overexposure can lead to eye problems, sunburn, and even skin cancer.
• Use UV protective sunscreens with a protection factor of at least 15 whenever you are in the sun for long periods. Remember that even on cloudy days, UV rays can get through.
• Minimize your exposure from 10:00 AM to 4:00 PM, when the sun's rays are the strongest. Wear wide-brimmed hats in the sun; baseball caps don't cover enough of your face and neck.
• Choose sunglasses that block 99 to 100% of UV light. Wraparound glasses are best.
• Always keep babies less than 6 months old out of direct sunlight.

Swimming

The Centers for Disease Control reports that drowning is the second leading cause of injury-related death among children 1 to 14 years old. Keep these tips in mind:

• Never leave kids alone while they are in or near a pool, even if they can swim.
• Don't swim if you are chilled, tired, overheated, immediately after eating, or in storms.
• Alcohol and swimming don't mix.
• Obey "no diving" signs. It means the area is unsafe for headfirst entries.
• Always check the depth before entering the water. Check for submerged obstacles.
• Always dive with your hands in front of your head.
• Surround your pool on all sides with a sturdy 6-foot fence. Make sure young kids can't reach the gate latch.
• Keep rescue equipment (life preserver, long pole with a hook on the end) near your pool.
• Slips and trips are common on slippery surfaces. Discourage running in a pool area.
• Don't body surf in waves bigger than 3 feet, on sloped beaches, or near sandbars.

Fireworks

Every year, thousands of people—most of them children—are treated in emergency rooms for serious injuries related to fireworks. Fireworks (sparklers and firecrackers included) are not toys and should only be used only by trained professionals. The only safe way to enjoy fireworks is at a distance. If you still plan on using fireworks and/or sparklers, heed these warnings:

• Read and follow all instructions on the label and follow all state laws regarding their use.
• Light fireworks outdoors away from houses and flammable materials. Be sure people are out of range.
• Keep a bucket of water handy.
• Don't try to re-light or handle malfunctioning fireworks. Soak them with water and throw them away.
• Never ignite fireworks in a container, especially one made of glass or metal.
• Store fireworks in a dry, cool place.

Biking and Riding

It's important to wear a protective helmet while bike riding. The American Medical Association reports 75% of cycling deaths are caused by head injuries. Always wear a protective helmet when biking, in-line skating, and using scooters and follow these guidelines:

• Ride near the curb, single file, and in the same direction as traffic.
• Keep to safer, less-traveled routes.
• Don't do stunts—they can lead to serious injury.
• Be alert to road hazards such as potholes, rocks, and glass that can cause you to lose control.
• Make yourself visible. Wear bright clothing during the day, and wear a reflective vest or use reflective tape on clothes at night. Never ride at dusk without a headlight and red taillight or large reflector in the back.

Lawn Mowers and Gasoline Trimmers

Summertime also means gasoline-run tools, from lawn mowers and trimmers to weed-eaters and saws.

• Use an approved safety container with a self-closing lid so vapors cannot escape—and never bring gasoline inside your living quarters.
• Don't smoke while handling gasoline, and don't use gasoline near sparks, flames, hot surfaces, and sources of static electricity. Never use gasoline to start a fire.
• Before you mow, clear the yard of rocks, sticks, and anything else the mower might fling.
• With a riding mower, mow up and drown the slope so you're less likely to tip.
• Keep kids and pets away while you're mowing.
• Never refuel a mower or trimmer while it's hot.
• Never mow or trim in bare feet or sandals. Wear heavy-duty shoes with non-slip soles.

E.S.C.A.P.E., Inc. is a nonprofit charity, headquartered in Kalamazoo, Michigan, with a branch office in Merrimac, Massachusetts, that works full time to teach children and adults techniques in fire prevention, CPR, and first aid.

AED Training Meets with Great Success

Submitted by Dave Bianco—CPR Simplicity, PA

On Thursday evening, March 19, 2009, a woman who just turned 60 was here in the northern part of Pittsburgh visiting from North Carolina. She and her husband were moving to Connecticut, so he went ahead while she stopped here to visit friends and family. They attended dinner in Cranberry, where she didn't eat much because, she stated, she didn't feel very well. On the drive back from Cranberry, the woman started to feel worse and asked the driver to pull over. As the driver was doing so, the woman collapsed from sudden cardiac arrest.

The other two women began to panic, called 911, and were yelling for help outside the vehicle. An unknown female stopped her vehicle to render assistance. The two women in the car didn't know CPR, but this stranger knew to push on the chest, so she began doing so in the vehicle. The police arrived very quickly and witnessed the stranger attempting CPR in the vehicle. They quickly took over after removing the woman from the vehicle and placing her on a blanket on the ground. They continued CPR while one of the officers opened the AED and applied the electrodes. The AED advised shock, and they delivered the first defibrillation and continued CPR for another two minutes, at which point they administered a second shock. The EMS service arrived at this point, and with the police's assistance continued CPR, placed her on the stretcher, and lifted her into their unit. The woman was defibrillated twice more on the scene, until the responders were able to obtain a pulse and transport her to a local hospital's emergency department.

This episode marked the 66th successful pre-hospital resuscitation involving personnel and an AED from the PULSE program. It is very fortunate for this visitor to our city that she happened to be traveling through an area covered by the St. Margaret Foundation PULSE Program.

Pet Points

Submitted by Lani Byrd, ECSI National Membership Director

With the joys of being outdoors and relishing the sunshine during the summer months, it's important to be aware that our furry friends can be extremely sensitive to heat. Please pay attention to the following warnings and tips:

• Recognize warning signs of heat stroke. Symptoms of heat stroke in dogs include excessive panting, drooling, rapid pulse, and fever. Panting in cats is not normal, and if it lasts more than a few minutes, can be a sign of serious distress.
• Cool your pet. Immediately get your pet out of the heat and run cool (not ice cold) water over the animal and wrap with damp towels. Try offering your pet ice cubes to lick to begin to re-hydrate.
• If you are taking your dog for a summer walk, slip off your shoes and check the heat of the pavement. If the pavement is too hot for your feet, it is too hot for your dog as well. Unlike the soles of your shoes, the pads of a dog's feet are sensitive. They can easily burn on hot pavement.
• Dogs and cats can get sunburned. If you are planning to be outside in the sun with your dog or cat, especially ones with light fur or pink noses and ear tips, ask your veterinarian about pet-friendly sun block. Zinc oxide can be especially effective in preventing sunburn.
• Never leave a pet in a car on a hot day. On an 85-degree day, the temperature inside your car can reach 102 degrees in 10 minutes. According to veterinarians, a pet can only withstand a higher body temperature for a very short time before suffering irreparable brain damage or even death. Cracking windows on a hot day isn't enough to keep your pet cool. And don't assume your air conditioning will keep your pet cool while you leave the vehicle unattended—the system could malfunction and start blowing warm air.

Remember—keep it safe and have a happy and enjoyable summer!

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Educational Center Spotlight

Submitted by Jerry Buffman, Dummies on the Run

My name is Jerry Buffman, owner of Dummies on the Run—a mobile CPR & First Aid Instruction company. Almost every day, you will find me traveling the highways of southeastern Michigan providing on-site instruction to child and adult care facilities, churches, schools, and non-profit organizations. My goal is to create a positive, understandable and enjoyable class and teach people to understand the hows and whys of CPR and first aid.

The path to becoming a CPR instructor is rarely direct, and few kids grow up wanting to be a CPR teacher. I certainly did not, but after traveling a circuitous path that took me through nursing school, working for the Forest Service in Idaho, the Burn Unit in Seattle's King County (Harborview) Hospital, and a Coronary and Intensive Care in a hospital in Anchorage, Alaska, I ended up opening a daycare center and had an experience that changed everything.

My personal pivotal experience occurred when a toddler looked at me while shoving a deviled egg in her mouth and began to turn purple. I watched as her eyes rolled back and she fell on the floor in a seizure. I cleared her airway obstruction with a couple abdominal thrusts, and the seizure was over in a few seconds.

At this time, daycare providers were not required to be certified. I talked to a few fellow daycare providers who said they would take a class, and decided I would start teaching. One class a month become 4, then 10, and before long, Dummies on the Run grew to be a nice little business with a steady clientele.

As my business has grown over the years, I have come to pick up some tricks of the trade that I am always happy to share with others. Here are few things that make my life easier:

• Working with ECSI and, in particular, Denise Howard! I have worked with all the major agencies and have found ECSI to be the most helpful and accommodating. No matter what strange question I ask, she always goes right to the source and gets back to me quickly. If a particular group is not familiar with ECSI, she is on it!
• I use ACTARS—adults and infants—which are pricey, but worth it. Every person has a dummy, so you don't have down time and have everyone focused on the same thing. No one is doing their grocery list or balancing their checkbook.
• I recently have begun using CPR EZY, which provides great feedback on compression depth as well as body mechanics. I always get at least one "Wow! I never realized!" with every class.
• I do all my card printing in class using a mini lap top and a Canon portable printer.
• I entered a contest last year for small businesses and won a Ford Transit Connect, which I highly recommend for small business owners! Ford Motor Company has a new vehicle targeted for small businesses. I set it up with storage units so that everything has a secure place. The best thing of all is the inventory system that comes with Ford Work Solutions. I can label everything with a tag, which the vehicle's onboard computer reads every time you turn the key. I know when I need to order more supplies or if something I need for the day is not on board. The van is really perfect for what we do—just the right size to drive and park. Life is good!

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International Spotlight

Submitted by Nigel Bachoo, Carisafe Medical Services Limited

Our years in the West Indies spent on ambulances assisting the ill and injured made us realize that there was a need to not only provide persons with proficient and efficient medical services, but also to empower our fellow citizens by bridging the gap that existed between the phone call and the arrival of an ambulance. Thus, Carisafe Medical Services Limited was born.

Carisafe was established in 2007 with the vision of providing a series of high-quality services, ranging from air medical evacuation, occupational safety and health consultancy, and pre-hospital care training. Training has indeed become a core part of our business and has captured the interest of both the general public and the corporate industry. All of our methods of our training are carefully designed and coordinated by our team of EMS professionals and our Medical Director. One of our main focuses is ensure that our clients' training needs are met and that customer satisfaction is maximized.

To say ECSI has assisted us is an understatement. Through the constant communication with ECSI's Caribbean Director, Mr. Allister Taylor, Carisafe has been able to make purchases and receive items on short notice simply by making a phone call or sending a an email. ECSI has placed no limitation on the minimum number of texts that can be purchased at any particular time, making it easy for small- and medium-size businesses to facilitate contracts of any size and thus grow from strength to strength. All training material from ECSI has continuously exceeded our clients' expectation and feedback has always been exceptional.

Carisafe continues to strive for excellence throughout all areas of the pre-hospital care field and sees ECSI as a life long partner in establishing an unprecedented reputation in this arena.

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Conferences

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