Letter from Chair
Submitted by Craig Spector, ECSI National Advisory Council Chairperson

Summer greetings to all!

I would like to welcome all of our new instructors and training centers to the ECSI team. For these new team members, I would like to review the role of the ECSI National Advisory Council. We are here to be resource consultants for all of ECSI's Instructors and Educational Center Coordinators. Our goal is to enhance the growth of ECSI, uncover opportunities for new programs, review new materials, and to help field any questions or concerns from the field.

The following members represent this year’s Advisory Council: Bob Barr, Dave Bianco, Colleen Campbell, JR Dietl, Sue Lockhart, Dave Magruder, Shannon Miller, Todd Soard, Terry Timmins, and Greg West.

Feel free to contact me via email. I will share your ECSI questions or ideas with the other members of the Advisory Council and bring these issues before ECSI staff.

I would also like to be sure you are aware of the merchandise that promotes ECSI. This includes wallet-sized emergency action cards, shirts, patches, business cards, and more.

I, along with others on the Advisory Council, just attended and represented ECSI at the ECCU conference in Las Vegas, June 12-14th. For those of you that stopped by the booth to say hello, it was great to speak with you!

Remember these summer safety tips—seat belts, sun screen, sun glasses, and sipping.

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The Big Picture
Submitted by Dr. Larry Newell, ECSI National Executive Director

Featured Article

An AED—It’s not just a box on the wall…or is it?
Submitted JR Dietl, Contemporary Lifesaving Training

As CPR and First Aid instructors, we have to ask ourselves if we are really doing everything we can when we organize and instruct our courses in the fight for survival against sudden cardiac arrest.

When we look back on the history of CPR and automated external defibrillator (AED) use, we cannot help but think, "Why do we only have a 5 to 6 percent save rate for sudden cardiac arrest in the United States?" CPR has always definitively consisted of both chest compressions and breathing. This combination was first seen in the 1962 training video entitled "The Pulse of Life" created by James Jude, Guy Knickerbocker, and Peter Safar. Jude and Knickerbocker, along with William Kouwenhouen, had recently discovered the method of external chest compressions; in parallel, Safar worked with James Elam to establish the effectiveness of artificial respiration. The combined findings of these two research teams were presented at the annual Maryland Medical Society meeting on September 16, 1960 in Ocean City, Maryland. The response was overwhelming and gained rapid widespread acceptance in the following decade. This was reinforced by the video and speaking engagements undertaken by the team. In 1957, Peter Safar wrote the book ABC of Resuscitation which served as a promotional tool for public education in the 1970s.

Studies have shown that immediate CPR followed by defibrillation within 3 to 5 minutes of sudden ventricular fibrillation (VF) improves survival rates. In cities such as Seattle, where CPR training is widespread and defibrillation by EMS personnel follows quickly, the survival rate is near 30 percent. In cities such as New York City, without those advantages, the survival rate is strikingly low at only 1 to 2 percent.

Since no single agency accurately collects information on how many patients receive CPR, how many do not receive CPR when required, number of CPR trained individuals, etc. there are no reliable national statistics on CPR. Many studies have examined CPR in specific communities. While they show varying rates of success, all are consistent in showing benefits from early CPR (American Heart 2007).

The history of the AED is nothing short of amazing. In 1947 Claude Beck performed the first successful human defibrillation on a 14-year-old boy who succumbed to VF during elective chest surgery. The defibrillator used on this patient was designed and manufactured by James Rand, a friend of Beck. It was an alternating current (AC) unit with silver paddles the size of large tablespoons. Rand made two defibrillators in that first year: one can be found in the Smithsonian, and the other in The Bakken's collections. Nine years later (1956) Paul Zoll used a more powerful unit to perform the first closed-chest defibrillation.

Work completed by Lown et al in the early 1960s demonstrated the superiority and safety of direct current (DC) over AC defibrillation. In 1967, Pantridge and Geddes demonstrated that using a mobile, battery-powered DC defibrillator could save lives. Later that decade, an implantable defibrillator was introduced by Dr. Michael Mirowski. When the first AED was designed it weighed over 30 lb. Both internal and external defibrillators were redesigned in the 1970s to automatically detect VF. As improvements in electronics and computers became available, they were adapted to defibrillators (Emedicine 2006)

In Belfast, Ireland, ambulance-transported physicians first achieved prehospital defibrillation in 1966. Defibrillation by Emergency Medical Technicians (EMTs), without the presence of physicians, was first performed in Portland, Oregon, in 1969; however, this was not reported until late 1972. In 1980, the AED was introduced. It was equipped with sensors that are applied to the chest to determine whether VF is actually occurring. If detected, the device calls out instructions to deliver an electrical shock to the patient (Emedicine 2006).

In the future, defibrillators will continue to be improved and become safer and more efficient. Manufacturers are improving the electrode design to reduce the chances that the device operator will be shocked. A recent patent issued in the United States describes an electrode system that uses a Y shaped cable for just this purpose. Advances in the fabrication of integrated circuits will also make the devices easier to use and more compact and lightweight.

More and more states are enacting laws mandating AEDs and their placement. Currently AEDs are being placed in locations such as schools, physical fitness facilities, airports and churches. Federal law requires all airlines with flight attendants to have AEDs onboard. On June 4th of 2006 American Airlines celebrated their 50th save—out of 80 cardiac arrests in the air—since they incorporated AEDs on their fleet in 1999.

When looking at CPR training, AED placement and overall save rates, the systems seems to show a positive trend where AEDs are accessible. When comparing Chicago Airports, Las Vegas casinos, and other facilities that have incorporated readily accessible AED programs, the save rates again show a more positive trend than facilities without such programs. Training is imperative and makes a difference; however, areas that have the units prominently displayed for any and all to access are experiencing significantly higher save rates than other areas that have AEDs and trained personnel but no ready access to them. It is common to hear from students that they have been trained in the use of AEDs, but are unfamiliar with their placement. We know that the combination of CPR and the use of AEDs is the best fight against sudden cardiac arrest. Therefore, when instructing classes, an emphasis should be placed on AED placement and communicating the location of the units. The student who attends your training must realize the importance of the AED, communicate to others the location of the AED, access it, and thus help to increase the save rate–our ultimate goal. In resuscitation the equation is simple, the faster the shock, the lower the damage, and the greater the chance of complete recovery. We are all trying to achieve these results and hopefully National CPR/AED week will be the beginning of greater success in saving lives.

Tech Tips
PowerPoint—Less is More!
Submitted by Bill Kimball, ECSI Distance Education Manager

If I had a dime for every bad PowerPoint (PPT) I've created, I’d be sipping margaritas on my own private beach. Fortunately, I've learned to simplify my presentations, embrace the concept of "less-is-more", and adhere to a few "rules." Hopefully this Zen-like enlightenment, and the lessons I’ve learned along the way, will help you avoid "Death by PowerPoint."

KISS = Keep It Simple & Supportive
Your audience wants to hear from the expert directly. If they wanted someone read verbatim off a screen, they’d be at a karaoke bar. You want to design slides that support, not replace you.

With regard to pictures, limit yourself to three or less per slide and steer clear of "cartoonish" images. The clip art collection in PPT contains photo quality images which you can view by checking the "Photographs" box in the "Results should be" menu, when inserting a clip art image.

Rules of the Road
These tips may not work in all situations; however, they may help streamline your presentations:

Optimize to Reduce File Size
Using images can quickly create monster-sized PPT files, which only serve to hog your PC's resources. Anyone who has ever been in front of a classroom when PowerPoint has failed to launch knows this pain. Optimizing your images reduces the overall file size without any loss of quality. To do this, follow these steps:

Resources
Developing effective PowerPoint slides requires more than what can be covered here, so I've put together a few helpful resources for you:

In Conclusion
PowerPoint is one of those products we love to hate, or is it hate to love? Either way, presentation applications are here to stay. Whether you use Microsoft PowerPoint, OpenOffice's Impress, or Apple's Keynote, the same prevailing principles can be applied. In essence, you as the instructor should always be the centerpiece of the presentation.

If you take nothing else away from this article, try to remember the acronym KISS = Keep It Simple & Supportive. Your audiences will thank you.

Educational Center Spotlight
Commercial EMS—The Inception of a New Division
Submitted by Marlene Kenney, VP of Operations, Commercial EMS

With the advent of automated external defibrillator (AED) technology, Commercial EMS was developed to extend a new level of protection to new and current Commercial clients nationwide through AED sales, comprehensive turnkey AED program management, and CPR/AED training.

Commercial EMS is the newest division under the umbrella of Commercial Services, Inc. It is the sister company to Commercial Fire and Commercial Kitchen Exhaust Cleaning (KEC). Celebrating over 20 years of service excellence, Commercial Services is a nationwide integrator of fire suppression and kitchen exhaust cleaning performing these services for many of the largest restaurant and retail chains in the United States. Commercial Services' unique business philosophy is to develop and maintain long-term partnerships not only with nationwide and regional customers but also with affiliate partners.

With the blend of unsurpassed customer service, customized service programs, cost competitive pricing structures, state of the art information management, and continuous honest communication—Commercial Services, Inc. offers its clients "The Commercial Advantage."

Commercial Services, Inc. employs the services of over 800 affiliates, providing its current customer base with the true nationwide coverage they seek. Keeping with this scenario, Commercial EMS will be working with AED manufacturers, CPR/AED instructor affiliates across the nation, and the ECSI to educate and prepare the general public on the important role we can all play in sudden cardiac arrest.

Education Center Spotlight – International
Trinidad and Tobago – It was a hard job, but someone had to do it
Submitted by Dr. Larry Newell, ECSI National Executive Director

Spending time outside of the United States can be challenging in unexpected ways. How do you tell your colleagues or your family that you are actually stranded on an incredibly beautiful island right after you completed many long days of work? Would your friends and family believe you? Well, I was stranded on Tobago due to bad weather… and I enjoyed every minute of it!

Getting an international operation up and running can be exciting and challenging. But I am pleased to announce that Mr. Allister Taylor, our new Director of ECSI—Caribbean Operations, is up for all challenges. As both a medical clinician and EMS operations chief, Allister brings a diverse background. And as a native to Trinidad he is well-versed in the needs of businesses, industries, and the general population of Caribbean islands.

While in Trinidad and Tobago we worked with EMS, fire, and police agencies, medical and nursing colleges, hospitals, community training centers, businesses, and government regulatory authorities.

Their commitment to establishing an outstanding EMS system is really still in its infancy. In 2003 the Health Department in Trinidad decentralized government owned and operated EMS. High on the list of goals now is an appropriately tiered response, community education (in Trinidad) to the newly established 8-1-1 emergency number, the ability to secure the best instructors to educate healthcare personnel, and EMS program accreditation.

To all our new friends in Trinidad and Tobago, I want to say thanks for the hospitality and for your interest in, and support of, ECSI. I can't wait until my next opportunity to be stranded.

Special thanks to:
Nigel Bachoo, Carisafe Medical Services
Lester Frederick, Tobago EMS
Glenda Charles-Harris, COSTAATT
Dr. Helmer Hilwig, North Central Regional Health Authority
Adita Maharaj, National Training Agency
Brent Murphy, GMR, Trinidad and Tobago
Karla Reid-Pierre, Emergency Training Institute, Trinidad and Tobago
Kurt Pierre, Emergency Training Institute, Trinidad and Tobago
Dr. Jean Richard, Tobago EMS
Camille Yates, YIATES Healthcare

In the News
Submitted by Dr. Alton Thygerson

McLean, VA – A high school rowing coach emptying his luggage after a team trip to South Carolina was bitten by a small rattlesnake that had somehow gotten into his bag. The coach told authorities he felt a sharp pain on his hand when he reached into his luggage after returning from the road trip. He then saw the nearly foot-long snake.
Source: Associated Press; March 26, 2008

Deming, NM – About 179 snakes, nearly half of them venomous, were removed by game officers from the home of a man who died after being bitten by one of them. A canebrake rattlesnake bit the 37-year-old man on his right thumb while he was alone in the mobile home. Authorities said he did not have the required permits to possess or sell snakes.
Source: Associated Press; February 1, 2008

Albany, NY – A postal worker is credited with saving a 1-year-old girl by catching her after she fell out of a second-story window. The postal worker was delivering mail when she noticed a baby in an open window above the front door. Paramedics checked the baby and found no injuries.
Source: Associated Press; April 23, 2008

Lexington, KY – An eighth-grader has been charged with wanton endangerment after allegedly putting crumbled peanut butter cookies in the lunchbox of another student with a known severe peanut allergy. The student did not eat the cookies.
Source: Associated Press; April 21, 2008

Provo, UT – A newspaper photographer was struck by a javelin at the Utah high school track and field championships. The javelin struck just below the knee but did not hit any bone. The javelin was cut off, leaving the tip inside the leg so EMS personnel could transport the victim. Event judges said that the victim crossed into the javelin area while shooting photos of the discus competition.
Source: Associated Press; May 16, 2008

Bloomington, IL – A teenage bull rider was seriously injured at a Professional Championship Bullriders event. The 17-year-old broke seven ribs and suffered a collapsed lung at the event. The rider fell off the bull and the animal stepped on his back.
Source: Associated Press; April 29, 2008

Medical Journal Articles
Submitted by Dr. Alton Thygerson

First Aid on the Internet—The Internet is becoming an important source of health-related information. One concern is that though there is a large volume of information, the quality, accuracy, and completeness of the information is questionable. A research team used the phrase “first aid for burns” and compiled the first 25 hits from several search engines. After an analysis for technical accuracy, the team found that only one web site was in the excellent category and three were judged as being very good. This study found that the technical information provided is inadequate and that the sites include a significant amount of grossly inaccurate information. The few sites that contain excellent technical information make up a very small proportion of what is available. Therefore, the average Internet user may not encounter these; instead they may gain knowledge from questionable sites.
Burns. November 2006. 32(7):897-901.

Cooling a Burn—There are conflicting reports as to the best temperature to use for cooling a burn. A study found that cooling a burn with tap water is an effective method of minimizing the damage sustained during a burn, and such water is usually available. Even when cooling was delayed beneficial effects occurred. This study also found that ice water cooling is associated with an increase in tissue damage.
Burns. November 2007. 33(7):917-22.

Hands-Only (Compression-Only) CPR—Laypersons witnessing a sudden collapse of an adult should call the EMS (usually 9-1-1) and provide quality and continuous chest compressions in the middle of the victim’s chest by pushing hard and fast. This technique is for laypersons who are unable or unwilling to provide rescue breaths. It is also recommended for dispatcher-assisted instructions for untrained bystanders.
Circulation. March 31, 2008. 117:2162-2167.

Emergency Care for the Elderly—Emergency department (ED) crowding is an increasing problem. The CDC identified that individuals 65 years and older comprise the group with the highest rate of increased ED visits. If the trend continues, ED visits for the 65- to 75-year-old group could nearly double by 2013. Therefore, it seems apparent that first aiders and EMS personnel will also be caring for more elderly than in the past.
Annals of Emergency Medicine. June 2008. 51(6):769-773.

Death After an ED Visit for Syncope—A common condition known as syncope (a brief loss of consciousness caused by a sudden drop in blood pressure and also known as fainting) often causes emergency department (ED) visits by victims. While syncope is common, deaths related to it are low among those making ED visits.
Annals of Emergency Medicine. May 2008. 51(5):585-590.

Transient Ischemic Attack May Indicate Future Stroke—Transient ischemic attacks (TIAs) are often warning signs of an impending stroke. Unfortunately, it is unclear when the stroke might occur. This study found that about 1 in 20 patients with a TIA will have a stroke in the next 48 hours and that risk increases slightly during the next week. If the person happens to be one of those who have a stroke, there is a 15% chance that it will be fatal and a 60% chance that there will be some long-term disability. The researchers recommended that an ED physician tell the victim to take an aspirin and receive immediate tests to see if the cause of the TIA needs additional treatment. Usually hospital admission is necessary and there is an advantage of being in a hospital where “clot buster” fibrinolytic therapy is available.
Annals of Emergency Medicine. March 2008. 51(3):322

Upcoming Conferences for ECSI/Jones and Bartlett Publishers

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