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Times they are a-changin’

The past 12 months saw a number of things happen that impacted EMS

If you asked Santa for a new EMT card, you’d better let go of that idea lest you join the 207 Massachusetts EMTs who thought they had recertified their cards without really trying.

That was, uh, until the Department of Public Health caught on. Not so good for them, and really bad for all of us who now contend with a very suspicious public and curious government officials. “No,” I’ve said a hundred times, “I can’t recert my paramedic card with two box tops from Kellogg’s Raisin Bran.”

Apparently these Bostonians weren’t the only folks trying to pull the wool over our eyes. Clear across the globe, or the “pond” as some would say, the World Health Organization (WHO) was accused of exaggerating the dangers of H1N1 in collusion with drug companies to (gasp) increase their profits.

Some accused the WHO of making up the whole H1N1 Pandemic. “What, what, what…" you say? Well hindsight is 20:20; H1N1 gave us one of the mildest flu seasons we’ve ever seen — I’m not so sure that was entirely predictable.

Excepting a nasty predilection for kids, we’re in for what promises to be another lightweight influenza season this year. H1N1 is definitely here to stay; hopefully you got your flu shot this year. WikiLeaks might spill the beans on WHO someday.

Health Care Reform was big on the 2010 agenda and it looks like some trickle down will hit us on New Year’s Day 2011. That’s right; EMS will ring in the New Year by recording loaded ambulance transports in tenths of a mile. Oh, and that’s not all. Medicare ambulance fees will decrease annually as a “productivity adjustment” due to the wonderful efficiencies afforded by Health Care Reform. Get me some Zofran!

The FAA finally answered multiple wake up calls from the NTSB, proposing a slew of safety requirements affecting air medical providers. On the subject of transportation, the NFPA 1917 Standards for Automotive Ambulances squeaked under the wire after a series of false starts to push out a draft document for public comment (which closed December 15).

The committee will meet in February 2011 to review, revise, and respond to comments. If all goes well, we may see this document in 2012, at which point the feds will drop their KKK purchasing spec.

While you were out getting your flu shot, Emergency Cardiac Care (ECC) Guidelines 2010 rolled off the presses. As I predicted last year, procainamide is back! Truthfully, if you keep abreast of resuscitation research, nothing in Guidelines 2010 should have surprised you. 2010 saw the rollout of a brand spankin’ new EMS Education Agenda, now gaining steam and slated to appear in textbooks publishing early 2011.

Despite all the supposed “efficiencies” afforded by Health Care Reform, EMS medications were in incredibly short supply during 2010. Many services ran out of preload epinephrine, 50% dextrose, naloxone, sublingual nitroglycerine, and several others.

The FDA is reporting that many shortages continue, and because shortages reached a seeming all time high with considerable disruption to patient care across the health care spectrum, four leading health care groups met in November with the FDA, manufacturers, and suppliers to discuss solutions. More to come on that front.

AED failures also peaked in 2010, prompting the FDA to call a special meeting this month with manufacturers to address the problem. Let’s hope that Physio-Control, Philips and Zoll put their heads together with the rest of the manufacturers and strategize some industry standards that put an end to surprises like dead batteries, missing pads, and outright AED failures.

Fire equipment is designed and maintained to work when consumers need it to; AEDs should be no less battle ready than sprinklers, smoke detectors, and fire extinguishers.

So, what’s in store for 2011? Well, firstly, you can dispense with all the overblown hype we were cajoled into believing was needed to protect against H1N1. Yup, the CDC finally acknowledged the science that clearly showed N-95 masks offered no benefits over simple surgical masks. Their whole infection control strategy was realigned to be more realistic:

Unless you live in California, where either the germs are unique or lawmakers don’t do science. Tantamount to a giant leap backwards, California implemented strict new requirements that not only fly in the face of science, but force Fire and EMS agencies to literally flush money down the toilet: Be afraid; be very afraid…the backers of this bizarre legislation may well bring it elsewhere!

Next, EMS is getting its own version of an airport TSA full body scanner: ultrasound. That’s right, portable ultrasound is finally making the leap from ED and ICU to the ambulance. Watch for this incredibly useful tool to play a big role in hypotension, cardiac arrests, line placement, trauma, fractures, OB and more.

I’m also betting that 2011 will see some decent prehospital data validating the accuracy of SpCO, the pulse oximeter used to measure blood carbon monoxide (CO) levels. The device, marketed by Masimo Corporation (Irvine, Calif.) has come under heavy attack in the blogosphere after a single in-hospital study reported differences between the device and blood gas measurements. It’s amazing how quick some folks are to bash new technologies. CO is a major public health problem; SpCO is a new technology that can save lives when used properly. Nuf’ said.

“Can you hear me now?” may be back for reruns in 2011. I’m betting thousands of public safety radio users will keep their heads in the sand for one more year until they wake up disconnected on January 1, 2013. The FCC has announced narrow banding until the cows come home. If your department hasn’t started moving there, expect to be out of touch in 2013. Last call — literally.

Finally, we all have an obligation in 2012: remember September 11th. This year marks the 10th anniversary of the brutal attack on America. It is our responsibility as emergency responders to make sure the memory remains in the hearts and minds of all Americans.

Take a moment to visit the National September 11 Memorial site at The education tab links to some awesome resources for the classroom. Make certain that your schools are helping us to always remember 9/11. Happy New Year!

Mike McEvoy, a leader in the EMS world, shares his expertise on issues effecting the jobs and lives of firefighter paramedics. Read, ‘Fire Medicine,’ McEvoy’s FireRescue1 column, to learn about first responder stress, the criminalization of medical errors, current epidemics, and more.