Continuous Positive Airway Pressure (CPAP), is the
technology used by more and more patients for the treatment of sleep apnea at
home, but in ambulances CPAP is used in cases of Acute Pulmonary Edema
where fluid(s)
in the lungs prevent oxygen from getting to the blood (PAP ventilation is also
commonly used for critically ill patients in hospital with
respiratory failure, and in newborn infants).
PAP ventilation can prevent the need for endotracheal intubation in many patients. Putting a tube into someone's throat carries risks, so the advent of disposable, portable CPAP masks give Paramedics a new treatment option. There are advances in PAP technology almost weekly, so there are numerous types of masks and PAP therapy.
Without getting complicated, CPAP in the "pre-hospital setting" uses oxygen pressure to help push fluids out of a patient's lungs and help keep the air sacs in the lungs open at the same time. The pressure of CPAP can also help keep the patients upper airway open if they are unconscious (keeping the upper airway open during sleep is how CPAP helps patients with sleep apnea).
For a much more technical explanation of CPAP, click here. Just know that TIERS has this cutting-edge technology on board to help people who need it.
For years, Paramedics have used
Intraosseous Infusion (I/O), as a way of getting fluids and
medications
directly to the blood supply of infants because infants' veins are too tiny to
enter with a needle. A special needle is used to go through the soft spot in the
bone just below the knee so that fluids can be introduced into the blood marrow.
The
intraosseous space is a specialized area of the vascular system where blood
flow is rapid and continues even during shock. Drugs and fluids infused via the
intraosseous route reach the central circulation as quickly as those
administered through standard IV access.
I/O
is used less frequently in adult cases due to greater difficulty penetrating
denser adult bone. The development of hand held battery powered devices provide
fast, safe and controllable I/O access within seconds. Basically, a special
catheter is drilled into adult bone. Usually, a specific site on the
tibia is used as
it lies just under the skin and can easily be palpated and located; spots on the
femur and the on the pelvis are other sites that can be used.
Research has also increased the number of medications that can be introduced via I/O has caused adult I/O to become more common.
KEEP IN MIND: I/O in adults is normally used only if regular needle-in-the-arm IV access fails. I/O in infants is more common because of their tiny, tiny veins.
Thanks to the Children's Miracle Network at Samaritan Medical Center, TIERS does have specialized equipment for infants and children in our Pedicatric ALS Bags (see below).
Pediatric ALS Bag
Our
Pediatrics Advanced Life Support bags help rescuers in one of the most
crucial areas of emergency care--the resuscitation of an infant or child.
These were provided to TIERS
through
the generosity of the Children's Miracle Network of Northern New York at Samaritan Medical Center.
The Broselow®/Hinkle Pediatric Emergency System is featured in our special Pediatrics ALS bags. The system matches the right sized equipment, the correct procedures, and the right dosages of emergency medications by one simple measurement--the height of the child--to help Paramedics deliver emergency care without having to rely on memory or making tricky dosage calculations when under stress. The same system is used in hospital emergency departments worldwide.
Once the height of the child is measured, the Paramedic uses the enclosed guidebook to determine which color range the child fits into. The correct area of the chart (left), has vital information for treating respiratory, cardiac, and seizure emergencies, and the correct emergency drug dosages for that size. These types of emergencies in children are extremely rare for emergency care providers, so they may have little recent practical experience to draw from in making their decisions; the Broselow®/Hinkle Pediatric Emergency System makes treatment fast and accurate.
The next step is to grab the appropriately-colored pack from inside the ALS bag. Each pack has four "procedure modules" inside: Oxygen Delivery, Intubation, IV Delivery, and Intraosseus (for delivering medications into the bone marrow in children with veins too small for IV drug delivery), all with the right size equipment for the size of child. There are also two bag-valve-mask set-ups, a special blood pressure kit with three different-sized cuffs, and a special pediatric stethoscope.
Shown Below: Contents of the Yellow pack; the artificial airways shown range from Adult to Pediatric small sizes. Infant BVM shown compared to Adult BVM. Blood pressure gauge connects to one of three cuffs, depending on childs' size. Pediatric stethoscope compared to regular stethoscope.
Lifepak 15® Lifepak 12® Cardiac Monitor/Defibrillators
The Medtronics Lifepak
15® and Lifepak
12® are the most advanced cardiac units on the market, capable of 12-lead electrocardiagrams, which show Paramedics a much better picture of the heart's
electrical functions in the field. They also measure and record the patient's
blood pressure and pulse, and monitors their oxygen saturation as well, have capnography monitoring capability which lets the Paramedic monitor the
oxygen/CO2
transfer of an intubated patient to see developing problems quickly, and can
transmit real-time images of all data to the emergency room doctor instantly for
more accurate diagnosis and over-the-air orders.
The Lifepak 15® and Lifepak 12® can also be used as an infant/child defibrillator.
Pediatric Extrication "Pappoose"
Another
gift from the Children's Miracle Network of Northern New York at
Samaritan Medical Center were three of these
Dyna Med®
Pediatric Immobilization and Transport System®
units. They are designed to provide safe, secure and comfortable immobilization
for scared kids. Built-in handles help rescuers in moving the child, even in
awkward situations
like a
vertical lift.
HDX Backboards
"All Plastic" may not sound like a great product description, but for backboards "all plastic" is not only lighter and stronger, but it can also be used in water rescues, has no slivers like a well-used wooden backboard may, and absolutely no metal parts means that emergency department doctors can leave the patient immobilized on the backboard while X-rays are being taken, and even during a CT scan ("cat scan").
EMS Helmets
Just like firefighters' protective helmets, but in EMS blue. The face mask protects the eyes and face during dangerous auto extrications, and there is also a neck cover to keep out flying debris and for cold-weather comfort.
AED Trainer
The Automatic External Defibrillator (AED),
gives first responders, EMTs, and now the general public a valuable
tool to help save a life in the event of a cardiac emergency. When its used
correctly, an AED reads the heart's rhythm and determines if the AED can be used
to correct the heartbeat.
At the same time, the AED gives loud verbal instructions to the operator on what the machine is doing ("ANALYZING HEART RHYTHM"), and what rescuers are to do ("DO NOT TOUCH PATIENT" or "START CPR").
As easy as is sounds, there is still training needed to apply and use the device. TIERS has a Lifepak 500T Training System to allow hands-on practice whenever it's needed.
