Monday, November 27, 2006

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Sunday, November 26, 2006

Star Of Life History

DEPARTMENT OF FIRE RESCUE
HISTORY OF THE RESCUER'S STAR OF LIFE

by Arline Zatz

Each of the six "points" of the star represents an aspect of the EMS System. They are:

  • Detection
  • Reporting
  • Response
  • On Scene Care
  • Care in Transit
  • Transfer to Definitive Care

The staff on the star represents Medicine and Healing.

Just as a pharmacists have the mortar and pestle and doctors have the caduceus, Emergency Medical Technicians have a symbol, its use is encouraged both by the American Medical Association and the Advisory Council within the Department of Health, Education and Welfare. The symbol applies to all emergency medical goods and services which are funded under the DOT/EMS program.

We see the "Star of Life" constantly, whether it be on ambulances or uniforms. But, how many realize what this symbol represents and how it was born? Not too many, judging from the random survey I conducted after having realized I had no idea myself.

Designed by Leo R. Schwartz, Chief of the EMS Branch, National Highway Traffic Safety Administration (NHTSA), the "Star of Life" was created after the American National Red Cross complained in 1973 that they objected to the common use of an Omaha orange cross on a square background of reflectorized white which clearly imitated the Red Cross symbol. NHTSA investigated and felt the complaint was justified.

The newly designed, six barred cross, was adapted from the Medical Identification Symbol of the American Medical Association and was registered as a certification mark on February 1, 1977 with the Commissioner of Patents and Trade-marks in the name of the National Highway Traffic Safety and Administration. The trademark will remain in effect for twenty years from this date.

Each of the bars of the blue "Star of Life" represents the six system function of the EMS, as illustrated below: The capitol letter "R" enclosed in the circle on the right represents the fact that the symbol is a "registered" certification.

The snake and staff in the center of the symbol portray the staff Asclepius who, according to Greek mythology, was the son of Apollo (god of light, truth and prophecy). Supposedly Asclepius learned the art of healing from the centaur Cheron; but Zeus - king of the gods, was fearful that because of the Asclepius knowledge, all men might be rendered immortal. Rather than have this occur, Zeus slew Asclepius with a thunderbolt. Later, Asclepius was worshipped as a god and people slept in his temples, as it was rumored that he effected cures of prescribed remedies to the sick during their dreams.Eventually, Zues restored Asclepius to life, making him a god.

Asclepius was usually shown in a standing position, dressed in a long cloat, holding a staff with a serpent coiled around it. The staff has since come to represent medicine's only symbol. In the Caduceus, used by physicians and the Military Medical Corp., the staff is winged and has two serpents intertwined. Even though this does not hold any medical relevance in origin, it represents the magic wand of the Greek deity, Hermes, messenger of the gods.

The staff with the single serpent is the symbol for Medicine and Health and the winged staff is the symbol for peace. The Staff with the single serpent represents the time when Asclepius had a very difficult patient that he could not cure, so he consulted a snake for advice and the patient survived. The snake had coiled around Asclepius's staff in order to be head to head with him as an equal when talking. The Winged staff came about when Mercury saw two serpents fighting,and unable to stop them any other way placed his staff between them causing them to coil up his winged staff.

The Bible, in Numbers 21:9, makes reference to a serpent on a staff: "Moses accordingly made a bronze serpent and mounted it on a pole and whenever anyone who had been bitten by a serpent looked at the bronze serpent, he recovered.

Who may use the "Star of Life" symbol? NHTSA has exclusive rights to monitor its use throughout the United States. Its use on emergency medical vehicles certifies that such vehicles meet the U.S. Department of Transportation standards and certify that the emergency medical care personnel who use it have been trained to meet these standards. Its use on road maps and highway signs indicates the location or access to qualified emergency care services. No other use of the symbol is allowed, except as listed below:

States and Federal agencies which have emergency medical services involvement are authorized to permit use of the "Star of Life" symbol summarized as follows:

1. As a means of identification for medical equipment and supplies for installation and use in the Emergency Medical Care Vehicle-Ambulance.

2. To point to the location of qualified medical care services and access to such facilities.

3. For use on shoulder patches worn only by personnel who have satisfactorily completed DOT training courses or approved equivalents, and for persons who by title and function administer, directly supervise, or participate in all or part of National, State, or community EMS programs.

4. On EMS personnel items - badges, plaques, buckles, etc.

5. Books, pamphlets, manuals, reports or other printed material having direct EMS application.

6. The "Star of Life" symbol may be worn by administrative personnel, project directors and staff, councils and advisory groups. If shoulder patches are worn, they should be plain blue "Star of Life" on a white square or round background. The function, identifying letters or words should be printed on bars and attached across the bottom separately. The edges of the basic patch and functional bars are to be embroidered.

Special function identification and physical characteristics must be adhered to when applying the "Star of Life" to personal items, as follows:

a) Administrative and dispatcher personnel must use a silver colored edge, and the staff of Asclepius should be with a silver colored serpent. These items do not need a white background.

b) The shoulder patches and other EMS patches may be displayed on uniform pockets and the symbol can also be placed on collars and headgear.

This article was taken from Rescue-EMS Magazine, July-August 1992.

Do We Need Paramedics On Fire Engines?

Twilley, 71, was in cardiac arrest.
He was lucky. He was one of an estimated 165 Americans who collapse each day in the most saveable form of sudden cardiac arrest — most saveable because it can be reversed by a shock from a defibrillator, and because it happens in public, where bystanders can summon emergency help.

Twilley was saved, but not by paramedics. He was saved by Conway's cardiopulmonary resuscitation and by firefighters who arrived before the paramedics and shocked his heart back to normal.

There was no paramedic on the fire engine. In fact, there are no paramedics in the Jenks Fire Department at all, and no plans to hire any. At a time when more cities are trying to put a paramedic on every fire engine — often the first vehicle to reach a medical emergency — Tulsa, which provides emergency medical services to Jenks, is limiting the number of its paramedics.
Yet Tulsa's emergency medical system is considered one of the nation's best as measured by the EMS "gold standard," the survival rate of its saveable cardiac arrests. Tulsa's survival rate is 26%. The national average is an estimated 6% to 10%.
The city's EMS philosophy — and Twilley's story — illustrate the findings of a USA TODAY study of emergency medical data from 12 of the nation's biggest cities that suggest that victims of cardiac arrest are more likely to be revived in cities that spend fewer taxpayer dollars on paramedics. (Related: Six minutes to live or die)
Cities with the highest survival rates, the data suggest, train firefighters and citizens to respond first with defibrillators and CPR, sending in a smaller, closely supervised corps of paramedics minutes later to give advanced care.

This is the great divide in emergency medicine. Should a paramedic be on every fire truck, even though most of the calls are not matters of life or death? Or should paramedics be a smaller, more skilled corps that arrives to take over a few minutes after firefighters who just have basic emergency medical training?

Most cities opt for more paramedics, despite the expense and evidence that the approach does not necessarily save more lives.
Of the cities studied by USA TODAY, Seattle saves more cardiac arrest patients — 45% — with 1.48 paramedics per 10,000 residents. Boston has the second-highest survival rate — 40% — and the lowest paramedics ratio at 0.86.

Many of the other cities have substantially lower survival rates and markedly higher numbers of paramedics per 10,000 population. Nashville, for example, has an 8% survival rate with a 3.33 paramedics ratio. Omaha has the highest ratio at 4.70 with a 16% survival rate.
Fewer paramedics

Seattle, Boston and Tulsa represent cities with fewer paramedics. They believe that a paramedic who rides a fire engine to every call doesn't get enough practice providing skilled care because so few calls are real medical emergencies.

So firefighters in these cities are trained in rapid response and basic medical care. They save many victims of cardiac arrest with a shock from an automated external defibrillator (AED).
Paramedics, rescuers with more training, experience and medical oversight, typically arrive in an ambulance minutes later. They provide advanced life support — administering drugs through IVs and inserting a breathing tube — to stabilize patients before transporting them to the hospital.

These cities put a premium on having no more paramedics than their medical director can closely monitor. "We have a small group of people who are highly experienced and trained, who work only in their specialty," says William Hepburn, assistant Seattle fire chief.

Seattle also teaches its citizens CPR. "Most people equate EMS with paramedics," Hepburn says. "EMS should be an integrated system of trained citizens, first responders, paramedics and hospitals. Quick and effective CPR first saves lives."
Twilley's case in Jenks is a perfect example: While a waitress at the diner dialed 911, Conway dropped to his knees and began CPR.
The firefighters arrived, applied their AEDs and shocked Twilley once, five minutes after the 911 call was made. He was waking up when the paramedics arrived four minutes after that. He was asking for his cap before they wheeled him out.
In Boston, the focus is on giving paramedics more opportunities to practice both their technical and clinical judgment skills. "We don't believe in sending our paramedics on every call," says Boston EMS chief Rich Serino. "We want to have highly trained paramedics who utilize their skills often so there is minimal skill deterioration."

In Tulsa, Emergency Medical Services Authority (EMSA) medical director John Sacra was instrumental in persuading Tulsa officials to keep a smaller, more skilled and more supervised corps of paramedics.

"The more paramedics you put into the system, the more medics that are doing fewer procedures," Sacra says. "It's a problem."

Tulsa stands on the opposite side of this great theoretical divide from Oklahoma City, which is increasing its paramedics corps.

The two cities, 100 miles apart, save about the same percentage of cardiac arrest victims — 26% in Tulsa and 27% in Oklahoma City. But their fire departments have different views on how many paramedics they need.
In Tulsa, each resident spends $3.29 per year in taxes for 128 paramedics. In Oklahoma City, residents each pay $11.40 for 226 paramedics.
In Tulsa, five of 30 fire engines have paramedics. In Oklahoma City, almost half of its fire engines have paramedics — 17 of 35.
More paramedics

Omaha and Nashville represent cities with more paramedics. Their philosophy: Fire engines are almost always first on the scene of an emergency, and a paramedic on the engine means the most trained rescuer arrives first.
So they continue to hire, train and employ more paramedics to ride on fire engines.
Nashville fire officials put paramedics on seven of the department's 39 fire engines, and reduced the time it takes for a paramedic to reach a victim by 21% to 25%.

There have been no scientific studies showing that this approach saves more lives. But it consistently appears to be what the public and most politicians want.
"In my experience, response times, response times, response times are of greatest concerns to those we serve," says Stephen Halford, Nashville's fire chief.
Robert Dahlquist, Omaha's fire chief, says paramedics are the best way to provide emergency medical services to his community. "I'd like to have more paramedics," he says.
James Love, Omaha's assistant fire chief, says 42% of the EMS calls require advanced life support. "This is the reason that we staff the paramedic coverage that we do. We continue to strive for 100% paramedic engine coverage," Love says.
Los Angeles is an anomaly because it has both a low survival rate — 6% — and a low paramedic ratio per 10,000 population at 1.55.
But in raw numbers it has the most paramedics of any city studied, boosting its paramedic force from 594 to 730 in the past year. "We have so many calls and so many sick patients," says Marc Eckstein, the city fire department's medical director. "I live in the city. I want a paramedic at my neighborhood fire station."

But Eckstein acknowledges he can't keep track of all his paramedics and their skill levels.
"If you have 500 paramedics spread out over 500 square miles going to 60-some-odd receiving hospitals, it is clearly impossible to get a handle on how well the medics are performing," he says.

Corey Slovis, Nashville's EMS medical director, who oversees 196 paramedics, agrees. "If you have 50 or 60 paramedics, you are able to tell which ones are great, which ones are mediocre and which ones need to come in and get checked out," he says.
"Between 80 and 100, you can't keep track of them all."
What's next?

After considering the USA TODAY findings, a number of fire and EMS officials say that a national, scientific study should be undertaken to determine how paramedics should be deployed in big cities.

"Fire departments have been (adding more paramedics) because they think it's going to make a positive difference," says John Sinclair, a fire chief and former paramedic who heads the EMS section at the International Association of Fire Chiefs. "Maybe we do have a problem. It's not really counterintuitive if you look at it. The more medics, the fewer that are taking care of really sick people."

U.S. Surgeon General Richard Carmona, a former paramedic and EMS medical director, says cities must look at their paramedic deployment and ask, "What did a paramedic add to this call to reduce pain or morbidity?"

"It's not a matter of right or wrong, but how can we do this better?" he says. "Fire chiefs and police chiefs and EMS directors should always say, 'Show me the science. Show me how this will benefit my citizens.' The idea is to do better with meager resources."
For 25 years, Slovis says, he has believed that having a paramedic on every fire engine was the best way to save more lives.

"Now I realize that the best systems may be the ones with the limited number of paramedics who are elite — highly trained," he says. "I have completely changed."

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Friday, November 24, 2006

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