New equipment recently acquired by the Barry-Lawrence Ambulance District has expanded the capabilities of the staff. Jim Liaromatis, operations manager, reported that new innovations regularly improve emergency medicine.
The combat application tourniquet (CAT), for example, has been developed from the U.S. military experience in Iraq. Tourniquets went out of fashion in recent decades because narrow binding straps tended to cause tissue damage. However, in military settings, a tourniquet has proven effective in surviving roadside bombing attacks.
Designed with a wider band, the combat application tourniquet can be put on the wound by the victim himself. Liaromatis showed how the simple device comes with a built-in plastic rod to twist, reaching the proper pressure, and a brace to lock the rod in place. CAT units have been known to stay in place for five hours without causing problems, Liaromatis said.
Technical improvements have also made it possible for the crews to have the easy continuous positive airway pressure (CPAP) machines on ambulances. For patients short of breath or having other respiratory distress, the CPAP machine will give a patient air with four times the pressure of normal breathing. A patient can put on a mask and get relief or receive medicine that needs to be inhaled quickly.
In the past, crews have borrowed CPAP machines from local hospitals if needed for a patient transfer. One machine used to cost $1,200. Liaromatis said he has been able to buy a dozen easy CPAP machines for less than $100 each. Crews are now getting the credentialing needed to use the machines, which will be added on ambulances soon.
An ongoing challenge facing emergency crews is getting an intravenous line hooked up on a patient with poor veins. An innovation for this problem is the interosseous machine. Liaromatis said this device will insert a port for an IV line directly into the bone.
Working like a hand drill, the interosseous can insert a connection directly into a flat surface in the knee or shoulder. An IV line can be hooked directly to the inserted connection and quickly start medicine that will enter the body through the bone marrow. A shoulder connection provides a fast way to reach the heart, Liaromatis said.
"With this tool, we are never without access. It's a great tool," he said.
While it appears that inserting the interosseous connection would be painful, Liaromatis said reports indicate it may be less painful than poking to establish an IV connection.
Another improved tool is the fast track laryngeal mask airway (LMA) machine. Patients that have difficulty breathing because of a constricted throat may need to have a tube inserted in the throat. The process of intubation can be tricky, and the patient faces the danger of vomit aspirating into the lungs.
The fast track LMA machine quickly inserts a tube into the throat. The tube is then inflated, opening the airway. The unit's design allows for the easy insertion of a tube to provide air to the lungs. The inflated portion stays in place and helps prevent aspiration. Liaromatis said the airway mask comes in different sizes, depending on the patient.
"With this device, we're never without vascular access or a secured airway," Liaromatis said.
Recently the ambulance district initiated the statewide Help Protocol with the Monett Police Department, which provides dispatching for the Barry-Lawrence Ambulance District. If an emergency call indicates a stroke or heart attack situation, an air ambulance is immediately ordered into the air.
Liaromatis said four different helicopters are rotated through the system to respond to calls, bringing critical aid faster to the Monett area.