CPR123 Newsletter, December 13, 2011

From the editor:
The EMS field changes every day. We're lucky to be witness to technological breakthroughs that support our medical decisions and lifesaving procedures; the information available to us on the internet; the guidance of GPS to help us get to our patients faster; and the shrinking size of machines that make them portable and affordable.

This week we wanted to highlight some history of things we value (like defibrillators), as well as some medical ideas that are now considered quackery. Don't you wonder which of our modern breakthroughs will astound people a century from now? 

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New technology guides first responders

By Greg Latshaw, USA TODAY

Navigating backcountry roads in places like Hawkins County, Tenn., can be a challenge for ambulance drivers, even if they know the territory.

That's why since March 31, Global Positioning System (GPS) devices, purchased locally for $200 each, have been in use in the county's five ambulances, says Chris Christian, with the Hawkins County Emergency Medical Service (EMS).

The rural squad is one of a growing number of first-responder organizations small and large across the USA equipping vehicles with satellite navigating and vehicle-tracking technology, says Ed Plaugher, director of national programs for the International Association of Fire Chiefs.

While no national statistics are available on how many first responders use satellite navigating devices, their use of automatic vehicle location (AVL) systems — which build on GPS technology to transmit a rescue vehicle's location to a command post — has increased more than 20% per year since 2000, says Clem Driscoll, president of C.J. Driscoll and Associates, a marketing consulting firm in Palos Verdes Estates, Calif.

Nationwide, about one-fourth of ambulances, 15% of fire vehicles and 10% of police cars are equipped with AVL systems, he says.

"It's no longer just about finding the address," Plaugher says. "It's also about finding the closest vehicle."

High price tags and slow political processes have caused some larger city departments to lag in adopting the technology, says Theodore Collins, president and chief executive officer of InterAct Public Safety Systems, a North Carolina company that provides AVL and dispatch software. Read the entire article here.

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The History of the Defibrillator

By Mickey Scott, eHow Contributor

A fibrillation of the heart, if untreated, can lead to cardiac arrest and death. The defibrillator, if used as soon as possible, is an effective means of neutralizing the fibrillation. Used externally or internally, defibrillators have been used by paramedics for over 60 years. They are relatively easy to use, and are accessible in many public places. Countless lives have been saved because of them.

History
The defibrillator was invented in 1899 by psychologists J. L. Prevost and F. Battelli. They discovered that while a weak electrical stimulus could fibrillate a heart, a stronger one could undo it. Initially tested on dogs, the defibrillator was not used on a human until 1947, by American surgeon Claude Beck. He restored the fibrillating heart of a 14-year-old boy. This success paved the way for widespread clinical acceptance of the procedure.

Types
The external defibrillator utilizes two paddles that are applied to the patient's upper right pectoral and lower left rib. These are the kind often seen on television. Implantable cardioverter defibrillators (ICDs) are smaller and implanted within the chest itself. They are connected to the heart and detect irregularities in rhythms and correct them accordingly, outputting an electric shock if necessary. Transvenous defibrillators are similar to ICDs, except they apply the shock to the middle cardiac vein rather than the heart itself.

Dangers
Manual defibrillators should not be used on persons still registering a pulse, as the disruption to a heart's rhythm could be fatal. The paddles should also not be placed directly upon a woman's breast or over a pacemaker. Burns to the patient are common, and blood clots may form. Additionally, those who accidentally come in contact with a live paddle risk electric shock.

The Packer Whacker
Defibrillators in Australia are colloquially known as Packer Whackers, named after media mogul Kerry Packer. In 1990 Packer suffered a heart attack and was clinically dead for six minutes. Few ambulances carried defibrillators at the time, though it happened that the one carrying Packer did. Successfully revived, Packer donated a large sum of money to the New South Wales ambulance service to ensure every ambulance carried a defibrillator. Read the entire article here.

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Outdated Medical Treatments

Man is always seeking to tame what it can never fully understand. The same is true with medicine. While we can never fully come to terms with the throes and devastations we are dealt by the natural world, that doesn’t stop us from trying to mount a saddle on the very worst of it. Along the way to a closer understanding of virtual infinity, there have been stubborn and idealistic, if not necessary, shots in the dark with the hopes of an eventual hit, a glimpse of enlightenment. Here are some of medical science’s best bloopers and outtakes.

Read the entire article here for more about the following topics.

• Radiated Water
• Barber-Surgeons
• Cocaine
• Insulin Shock Therapy
• Smoking
• Lobotomies

Leeches
Even while leeches are still used to this day, it’s not often you go to the doctor complaining of a sore throat and he pulls out a juicy leech as a remedy. Barber-surgeons relied on this natural blood-letter to fix virtually every medieval ailment, thinking it could drain all impurities in a really good suck session. While it sounds barbaric, leeches do have true medical merit; they are used in some kinds of reconstructive surgery to prevent clotting, as the leeches produce a special anti-coagulant enzyme (called hirudin) in their saliva for that very purpose.

Blood-Letting
Blood-letting stems back to an ancient Greek tradition, where in which blood would be drained from an afflicted individual in order to balance the bodily “humors” which were thought to be the determining factors of one’s health. This practice was kept up in medieval Europe as barber-surgeons would drain blood to rid toxins. Read the entire article here.

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A brief history of electrocardiography

From the CPR123 newsletter editor: These are just a few interesting excerpts from this article. See the full article here.

1775
Abildgaard shows that hens can be made lifeless with electrical impulses and he could restore a pulse with electrical shocks across the chest. "With a shock to the head, the animal was rendered lifeless, and arose with a second shock to the chest; however, after the experiment was repeated rather often, the hen was completely stunned, walked with some difficulty, and did not eat for a day and night; then later it was very well and even laid an egg." 

1872
Mr Green, a surgeon, publishes a paper on the resuscitation of a series of patients who had suffered cardiac and / or respiratory arrest during anaesthesia with chloroform. He uses a galvanic pile (battery) of 200 cells generating 300 Volts which he applied to the patient as follows "One pole should be applied to the neck and the other to the lower rib on the left side." 

1872
Guillaume Benjamin Amand Duchenne de Boulogne, pioneering neurophysiologist, describes the resuscitation of a drowned girl with electricity in the third edition of his textbook on the medical uses of electricity. This episode has sometimes been described as the first 'artificial pacemaker' but he used an electrical current to induce electrophrenic rather than myocardial stimulation.

Read the entire article here.

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Ambulance History

By Mary Bellis

During the Crusades of the 11th Century, the Knights of St John received instruction in first-aid treatment from Arab and Greek doctors. The Knights of St John then acted as the first emergency workers, treating soldiers on both sides of the war of the battlefield and bringing in the wounded to nearby tents for further treatment. The concept of ambulance service started in Europe with the Knights of St John, at the same time it had also become common practice for small rewards to be paid to soldiers who carried the wounded bodies of other soldiers in for medical treatment.

The Surgeon-in-Chief of the French Grand Army, "Baron Dominiquie Larrey" created the first official army medical corp. in 1792. Trained attendants with equipment moved out from the field hospitals to give first-aid to the wounded on the battlefield and/or carried them back by stretcher, hand-carts and wagons to the field hospitals.

Motorized ambulance vehicles have been in use since the beginning of the 20th century. In the 1950s the United States pioneered helicopter-ambulances during the Korean War. In 1968, St Vincent's Hospital in New York City started the first mobile coronary care unit. Read the entire article here.