N E W S	EMS DISPATCH
LETTER
Vol. VIII No. 2 Summer 2001	Southern Tier Regional EMS Council

Table of Contents	Mechanism of Injury
Mech. of Injury  Page 2 EMS Day  Page 2 Meth Labs  Page 3 PCR Inservice  4 EMS Awards  Page 5 Council News  Page 6
Send us news of your agency: information about what you are doing, or about people - someone who should be recognized for exceptional service or caring, someone who deserves a pat on the back. Send it to EMS Dispatch at STREMS.
EMS DISPATCH Published quarterly by STREMS, Inc. 315 West Water Street, Elmira, NY 14901 Robert W. Nowlan, President; Maryann Sweely, Vice President; James J. Cummings, Treasurer; Ronald H. Kintz, Secretary; Robert C. Rajsky, Council Chairperson; Bernadette Josbeno-Oakes, Council Vice-Chairperson
Sponsors: Chemung County, Schuyler County, Steuben County, Arnot Ogden Medical Center, Corning Hospital, Ira Davenport Memorial Hospital, Schuyler Hospital, St. James Mercy Hospital, St. Joseph's Hospital.
INSTRUCTIONAL AIDS The STREMS office has all kinds of teaching tools to be loaned out to EMS personnel. Check out our web site www.strems.org or call us at 732-2354.

Contact us STREMS, Inc. 315 West Water Street Elmira NY 14901 (607) 732-2354 In New York State only: 1-800-343-1311

E-mail us: STREMS@stny.rr.com

Page 2 Mechanism of Injury, EMS Day Page 3 Meth Labs Page 4 PCR Inservice Page 5 EMS Awards Page 6 Council News Previous Articles Back to homepage

Mechanism of Injury -by Vanessa Jewett

You sit there in class listening to the instructor talk about the things that you need to think about before you even arrive at the scene of the incident. We teach you the importance of knowing if the scene is safe, how many patients, is there ALS back up on the way? We also teach you to look at the nature of the illness or the mechanism of injury. When you arrive at the scene of the accident you start to think about what has happened to the parties involved in the crash. Where are the vehicles, where is the damage to the vehicles, what outside forces were involved in the destruction of the vehicles?

All of these factors come into play to figure out the injuries that may be present with the victims.

When you see the vehicles at a crash scene, we should automatically think of scene safety to ourselves, the victims and the bystanders. We then evaluate the mechanism of injury, what forces were placed on the victims when the incident occurred.

We have many outside forces and variables that come into play with a crash or any type of trauma. There is a transfer of energy when trauma occurs, and we see the effects of that transference of energy. Many of the crash scenes that we respond to are due to the deceleration forces, the force that stops or decreases the velocity of the moving victim. The photo included with this article shows the deceleration aspects quite well, in these photos you will see the inside of the drivers side of a vehicle (SUV).

When you looks closely at the vehicle you will see that there is a remarkable amount of damage to the inside of the passenger compartment. This damage was caused by the victims body striking the inside of the vehicle. The immovable object that this vehicle struck was a tree that was three foot in diameter, and then the "3 crashes" began. The first crash was the vehicle striking the tree, the second crash was the occupant striking the inside of the vehicle, and the third crash was the organs of the victim striking and tearing inside the body. When these crashes occur, the speed that the vehicle was traveling and whether or not they are wearing a seatbelt makes many variables in the crashes. Sometimes, as in this crash shown, the variables were all against the victim. This victim impacted the tree at a high rate of speed and when we arrived on the scene he had already been removed to the transporting ambulance and was sped away to the medical facility.

At the scene we examined things a little closer. There was a great deal of intrusion into the passenger compartment. The engine was pushed through the firewall between the engine compartment and the passenger compartment. The impressive detail, that I saw immediately was that there was very little blood loss in the vehicle. I then looked at the steering wheel. The steering wheel had been severely damaged, the ring that you place your hands on was completely distorted and the steering column was pushed into the driver's area. The vehicle impacted the tree and then the victim impacted the steering column and his organs were damaged when they impacted inside his body. When that occurred, there was major damage and the bleeding that occurred was minimal, his heart was no longer beating, no pulse and no respirations were present when the first rescuer arrived on the scene, only minutes after the crash.

The transference of energy was documented very well, with the intrusion into the passenger compartment and the injuries to the victim. We surveyed the scene and looked at it closer and then we could understand why the victim lost so little blood at the scene, and why the impact was so deadly to the victim.

So when you arrive on the scene of a crash, take the time to look at the variables that are right there for you to observe, and remember that when a crash happens, you see the outside effects of the crash, but you need to think about what has happened to the victim when they are stopped suddenly by a solid object, thrown around the inside of a vehicle (or worse yet ejected); what could their injuries be and how can you give the best care available.

EMS Day at the Mall: May 26, 2001

STREMS & Erway Ambulance	Steuben County, Chemung Sheriff, AOMC AMS	Beaver Dams Fire Department

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Page 3 Meth Labs
Page 4 PCR Inservice
Page 5 EMS Awards
Page 6 Council News
Previous Articles
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The Hazardous Substances Emergency Events Surveillance system has revealed first responders face significant dangers in meth labs. The HSEES system complied data on meth-associated events from five state health departments (Iowa, Minnesota, Missouri, Oregon and Washington) from 1996 to 1999. Of the 112 cases involving meth labs that these states reported, 155 people were injured. Of those injured, 79 were first responders - 55 were police officers, nine were EMTs, eight were firefighters, and seven were hospital employees. The Crime and Violence Preventions Center of the California Attorney General's Office cautions: Whether in their raw form or after they've been 'cooked' into finished drugs, touching these chemicals or just breathing their fumes can cause fainting, sickness or permanent injury. In short, the chemicals used to make meth can damage the central nervous system, liver and kidneys, and burn o irritate the skin. Long-term exposure can cause cancer, short-term and permanent brain damage, and immune and respiratory system problems

Signs of a Meth Lab: A lab's main requirements are: water, ventilation and electricity. But when couriers utilize the cold-cook method, the need for electricity may be eliminated. Strong odors, similar to fingernail polish or cat urine, tend to be one of the more obvious signs of a lob. In many cases, the first indication of a lab's presence is citizens complaints about noxious odors. Law enforcement often encounters meth labs in motel rooms, rental properties, vehicles and open areas. Dealers like to use vehicles because they can create the drug in different steps and move the processes around to avoid detection. For example, they may perform part of a cook in a motel room, then do the main process in an open field, and move the product to another location for the final step.

A Team Effort: Meth labs require law enforcement to partner with the local fire department and EMS. When executing a raid on a known meth lab, fire fighters and paramedics must know that it's a meth lab, what the structure is like inside, what chemicals may be present, and how many people they may be dealing with, so they can come prepared. "We have trained at length with our fire department," Major Johnny Kuhlman, commanding officer of the Narcotics Unit in the Oklahoma City Police Dept. says. "if we're going to run a search warrant on a suspected lab, we have them with us, in case there is an explosion or a fire. They also help us decontaminate people." Often officers enter these labs wearing tyvek suits and latex gloves, believing they provide adequate protection. But neither item offers much protection in a meth lab.

What to do: While officers may be aware of the chemicals the process began with, they may not know what stage the cook is in and what chemicals they are dealing with now. What they have is an unknown hazmat spill, and that's exactly how it must be dealt with. "Anytime you're dealing with a lab it's a hazmat situation." If a patrol officer comes upon a lab while responding to a call, Colin Comer, an instructor for the Law Enforcement Training Institute, University of Missouri at Columbia, advises getting out and trying to get the occupants to leave as well. "Find a way to dupe the suspects outside, arrest and drag them out, but get out. The risk of explosion, fire and contamination is just too great." Officers also should not use their weapons or flash-bangs, or even flick on the lights. Doing any of these things in a lab might trigger an explosion or cause a fire to erupt. Comer reminds officers not to touch anything either . If an officer runs his hand along a couch in a lab, then rubs his eyes, he's contaminated. Officers should not interfere with a cooking operation, unless they've been trained to do so. Some people believe that if they turn things off in a hot lab, the situation becomes safer and the chemicals less volatile. But that's not always the case. Some things get worse as the chemicals cool. The cardinal rule is: Turn nothing on, turn nothing off. If you interfere with the process, you may be prompting an explosion or fire.

Other sources of information:
Cleaning up Former Methamphetamine Labs
Methamphetamine Labs Sprouting
Methamphetamine Labs Community Risks and Public Health Responses
Illegal Methamphetamine Labs General Information
Recognizing clandestine meth labs
More on meth labs
Smart Choices Methamphetamine: METH fires, METH Enviroment, METH kills, METH hurts, METH Lies, METH facts, The Meth Test, More METH Labs

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Page 2 Mechanism of Injury
Page 4 PCR Inservice
Page 5 EMS Awards
Page 6 Council News
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PCR Inservice

As we receive PCRs from the different agencies, we review them to make sure they have all the information that the state requires. We have found some common problems with some of them, so we thought we could do a short inservice in the newsletter to help correct some of these problems.

INFORMATION REQUIRED BY THE STATE

1. Date of the call. Make sure it is the correct date. We find the most common mistakes are the wrong month or year.
2. Agency code. Some of the agencies codes are very close numerically. The wrong number could mean your PCR is being credited to a different agency.
3. Location code.

INFORMATION REQUESTED BY THE STATE

1. Patient name and address. This may be different from the location address.
2. Kind of location. Residence, Health Fac.,Farm etc.
3. Patient Date of Birth and age if you can get it.
4. Sex of patient. You can't always tell by the name.
5. Type of call. Emergency, Non-Emer. or Stand-By

HINTS FROM US

1. Remember that these forms are carbonless copies. Please press hard to go through to all the copies.
2. Because they are carbonless copies anything you do on top of these forms will go through all the copies, even if you are on a separate sheet of paper.
3. Do not write in the margins of the PCR forms. If you need more room use a continuation form. If you don't have any, contact this office and we will gladly send some to you.
4. Any time you have patient contact a PCR form must be filled out, even if they refuse treatment. If you are stand-by at some event, a PCR must be filled out for stand-by and if you treat a patient, a separate PCR must be filled out for the patient.
5. Please remember that "Good Cap Refill" is not an approved blood pressure reading.
6. Any information concerning the patient's vitals, their assessment or treatment cannot be changed later.
7. You can review a PCR and make sure the info for the state is on it. You have from the 1 st of the month to the 1 Oth of the month to review the previous months PCRs before you send them to us.
8. PCRs do have patient information on them and fall under patient confidentiality. Please be careful with them. You do not take them home. You do not pass them around for other people to read. You do keep them in a safe and secure place until you send them to STREMS.
9. Remember the PCR that you fill out on a patient is your documentation on what procedures you did. Think of it as your insurance policy. Make sure you write down everything you did, It's called covering your butt.
10. Please write as legibly as possible, we know you are writing in a hurry and there is a lot going on, but we need to be able to read these.

Thank you

If you are interested in taking a class or a refresher course, call this office and we will put your name -on a list. As soon as a class is scheduled we will contact you so you may sign up for it. There will be no classes scheduled for the summer months. They will start again in the fall. A tentative fall course schedule will be available by the end of July. Check our website.

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Page 3 Meth Labs
Page 5 EMS Awards
Page 6 Council News
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EMS AWARDS

Physician of Excellence	EMS Communications Specialist of the Year
Dr. Michael Seaman	David Sullivan
Dr. Seaman is an Emergency Physician who has been a member of STREMAC since 1995 and Vice-Chair as long as Dr. Huffner can remember. He also has been a member of the STREMS Council since 1996. He is always willing to listen to EMTs questions and concerns. He always asks the providers if the protocols work in the "real world". In the fall of 1999 he took it upon himself to participate in seminars that were hosted by the Department o Defense on Domestic Terrorism Preparedness. He then brought back the knowledge and started volunteering his time to ensure that all the EMS and Hospital providers within the region have received proper instruction and training in Domestic Terrorism Preparedness.	David is an active EMT-D with the Elmira Heights Fire Dept. and a nationally certified Emergency Medical Dispatcher through Medical Priority. Acting as an Emergency Medical Dispatcher at the Chemung County Communications Center, David, through prompt and efficient issuance of pre-arrival instructions to the caller, was instrumental in the successful resuscitation of a patient. Through his actions, David has shown that Emergency Medical Dispatch principles and procedures do work and can make a positive difference and contribution in the area of pre-hospital emergency care.

Murphy's Laws:
If anything can go wrong-- it will.
It is impossible to make anything foolproof because fools are so ingenious.
If there is a possibility of several things going wrong, the one that will cause the most damage will be the first one to go wrong.
If you perceive that there are four possible ways in which something can go wrong, and circumvent these, then a fifth way unprepared for, will promptly develop.
Everything takes longer than you think.

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Page 3 Meth Labs
Page 4 PCR Inservice
Page 6 Council Notes
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Notes from the Council

The Council observed a moment of silence for the death of Mr. Bill Connors, CEO of St. James Mercy Hospital and a member of the STREMS Board of Directors.

The DOH is now sending out notices of any EMTs through Paramedics that are fined or suspended or lose their certification. The Council has received several notices and have read the names into the minutes at the last two council meetings.

The Council has recommended the following for Certified Lab Instructors: Brian Brantner, Jill Drake, Mike MacCoy, Becky Franklin, Loreen Sassaman, Debbie Zimmer, and Curtis Mason.

The Council also discussed the "hot" issues in New York Legislature of restocking ambulances and of Trauma Funding. These are issues that the Council will remain on top of and will report any news on them. The 1998 PCR data was finally received from the State and will be reviewed and reported on at a later date. Several Legislation bills were reported on- Bill 11269-5 year recertification of emergency services personnel. Assembly bill 706 cell phone charges for 911 calls be submitted to the counties not the State Police now that counties have 911 dispatchers. Assembly bill 1615 is to connect all ATM machines to 911. This would alert 911 if the machines were being robbed or if someone in the vicinity is in trouble.

A full report on each Council meeting is available at the Council page

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Page 4 PCR Inservice
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