First Aid

I'm kind of an odd duck in the EMS world. I like to see studies that support what we think we already know (just like I enjoy studies that debunk what we think we know).

For years, I and Those-Who-Think-Like-Me have been saying that women don't feel chest pain like men do. Now there's a good pile of evidence that we were right.

A study published in JAMA shows that 2 out of 5 women having heart attacks didn't feel chest pain. Worse, women were more likely to die in the hospital while having a heart attack. The younger they were, the more likely they would die.

It makes sense. First, we've been conditioned for years to think of men when we think of heart attacks. Second, we think of age when we think of heart attacks. Third, we think of chest pain when we think of heart attacks.

A young woman not experiencing chest pain might just have cardiac arrest as her first sign of a heart attack. Not because she wasn't feeling some sort of discomfort, but because we healthcare providers were conditioned to look for other causes of her discomfort.

I hope more research is on its way to help us recognize heart attacks. Chest pain is a good standby and I still say if you have chest pain to call 911 instead of your doctor. Still, that doesn't mean there aren't other symptoms besides chest pain that could indicate a heart attack, especially in a pattern we haven't learned to recognize yet.

It has taken us decades to figure out that women have heart attacks. Years after that before we figured out that women's heart attacks don't always feel the same as men. Hopefully we can open our minds to new ideas about heart disease and that just might lead to quicker recognition and more lives saved.

Association of Age and Sex With Myocardial Infarction Symptom Presentation and In-Hospital Mortality, February 22/29, 2012, Canto et al. 307 (8): 813 -- JAMA.

| Twitter | Facebook | Newsletter Signup |

Researchers at the Mayo Clinic have developed a new diagnosing process that found lots more brain injuries in a group of patient charts from 1987-2000. These were brain injury diagnoses that weren't found using the CDC's method. A large number of the missed brain injuries went to the ER for treatment and more than half had symptoms of brain injury.

What does it mean? Well, healthcare providers haven't always caught on when somebody hit his noggin hard enough to damage the noodle. Did that mean people were dying in the streets from undiagnosed brain injuries? Maybe.

Then again, maybe not.

Read More...

A class of popular heartburn drugs might lead to severe diarrhea, according to the FDA.

Clostridium difficile (C. diff to its friends) is a bacteria that causes really severe diarrhea (among other things). We sometimes get exposed to it, but the good bacteria in our guts often called the healthy flora (a really cool term if you ask me) competes with C. diff and keeps it under control.

Most of the time, C. diff is unleashed by antibiotic use. The antibiotics kill most bacteria, including the stuff we want to keep. Without competition, C. diff is allowed to flourish and cause a serious infection.

Proton Pump Inhibitors (PPI's) are the type of heartburn drug associated with a greater chance of C. diff infection. PPI's are those drugs that stop heartburn before it starts by decreasing stomach acids rather than trying to neutralize acid like other heartburn medications do.

Nobody quite knows why PPI's lead to more C. diff infections. But the evidence suggesting a link is growing.

For now, the FDA is recommending caution especially in those folks who use proton pump inhibitors a lot.

• Diarrhea Treatment
• Symptoms of C. diff in Children

Using mobile apps to save lives seems a bit lofty sometimes. The apps aren't always the panacea their marketing folks claim they are, but every once in a while an idea comes along that really makes sense.

Flashy signs are definitely better than hiding an AED in the closet
(c) Tim Boyle/Getty Images

MyHeartMap is that kind of idea. Using a social network connected by apps for multiple smart phone platforms, MyHeartMap is mapping AED's for use in emergencies. There's no way to really know where all AED's are located right now -- nobody has an easily updated registry that we could tap into in an emergency.

This idea is different. The AED's in this registry aren't submitted by the owners; they're submitted by the public. What if we had an AED registry that could be accessed on your smart phone when an emergency occurs? You could click on a single button that says "Find Nearest AED" and have your smart phone give you directions to the nearest known AED complete with a picture of it so you can find it easier.

I've been collecting photos of AEDs for years here at About.com. My goal is to show how different AED placards and colors can be around the country and around the world. Something like this would be one way to help fight those discrepencies.

Right now this whole idea is in the research phase. Indeed, there isn't an app...yet. University of Pennsylvannia is conducting a challenge to find as many AED's as possible in Philadelphia County. Participants find AED's and snap a picture, then send it to UPenn. Whoever finds the most AED's (team or individual) gets $10,000.

Ten grand! I think I need to go to Philly.

The contest is already underway. For more information, go to www.MyHeartMap.org.

Want to see pictures of AED's so you know what to expect? Visit the AED Picture Gallery. You can also share an AED picture of your own.

A study published in the journal Microbiology is touting the antimicrobial properties of manuka honey. Honey has long been known to be an antiseptic agent but this particular study looked at honey's ability to fight strep infections, a hardy adversary for sure.

Manuka honey is made from bees that get their nectar from the manuka tree. Is it any different than other types of honey? I don't know, but I doubt it's significantly different.

Does this mean you should slather honey all over your next cut? Well, maybe. Ancient cultures did it. I would do it if I got a cut out in the wilderness -- assuming I packed honey. Of course, it makes total sense to pack honey if you go hiking into the woods, considering you can eat it if you get hungry or use it to protect you from infection if you get hurt.

I'm a science guy and I truly believe we should be testing our theories. On the other hand, there's nothing I like to see more than science supporting a practice that ancient healers figured out long before they had the ability to do double-blind trials.

• Honey for Coughs
• Bee Sting Treatment (in case you're into harvesting your own honey)

A fourth grade student in Utah showed how important it is to keep a cool head and respond appropriately in an emergency. The Daily Herald reported that Carter Helt is a hero after performing the Heimlich maneuver on his best friend, Gary Anderson.

Gary was choking on a jawbreaker he received as a reward for being a good student. Carter saw his friend choking and spun him around. Carter wrapped his arms around Gary and pushed up on his friend's diaphragm, twice. On the second push, the jawbreaker popped out.

Besides showing how competent a 10 year old can be, this story illustrates another important point: people don't do the "universal choking sign" as advertised by first aid organizations everywhere.

If you've ever taken a CPR class, you learned the Heimlich maneuver (also known as abdominal thrusts) as a way to treat someone with a foreign object stuck in the airway. One of the things you were likely taught -- especially if your class included a video portion -- was that choking victims will give the universal choking sign (both hands to the throat).

I say there's no such thing.

One of my daughters choked on a piece of food at dinner one night. She was about 7 or 8 years old. When she couldn't breathe she got scared and started hopping up and down. Her face turned blue nearly immediately. Before I could react she dislodged it on her own. The whole thing lasted only a few seconds, but it was really frightening.

In this story, Gary reacted the same way to having a jawbreaker in his throat. He started banging on the table and his face turned colors. It's a good thing Carter was there.

Think your kid is too young to learn CPR? I doubt it. All it takes is to keep your head and react like Carter. Any age can save a life. He's a perfect role model for kids and adults alike. Great job Carter!

• Teaching CPR to Kids
• Heimlich Maneuver
• Before You Take a CPR Class
• Fourth-grader saves friend's life with Heimlich -- Daily Herald

I ran a 5k with two of my kids last night at Disneyland. It was fun and the entire route stayed within the theme parks. If a medical emergency had happened, there were plenty of staff members (cast members, that is) and spectators along the entire route who could get help.

But what if you went down nobody knew who you were? In a half marathon through my home town not too many years ago, a man collapsed in sudden cardiac arrest. Other runners started CPR and an ambulance responded from its post at the 6th mile marker. The man survived to run again.

He was alone on the course. No one knew his name.

On the backs of most running bibs like this there is a medical information form. It contains the essential information needed for the hospital to begin treatment and contact family. Everyone should fill out that form.

The very definition of an emergency is that it's an unexpected event. Most distance runners feel like they're in pretty good shape, but the reality is that anything can happen. In distance events around the country every year runners get hit by cars, suffer head injuries, break bones, fall into rivers, develop heat stroke...the list can go on indefinitely.

Those are just the healthy runners. What about the folks with heart disease, diabetes or dozens of other chronic conditions? They can run but have just a bit more chance of something going wrong.

I don't carry anything when I run. I don't have ID or money. I don't even take my cell phone. If I collapse (and I certainly don't count out the possibility) I'd better have someone who knows me running right by my side or else I'd better have some identifying information written on the back of my bib.

ER nurses and paramedics take note: If you treat a runner from an event, look on the back of the bib. A smart runner will have information you may need written there.

• Ways to Carry Medical Information
• Important Medical Information
• Is It an Emergency?

I've been thinking about getting my parents a first aid kit. It's kind of silly that their son, paramedic and first aid author, hasn't even put together a little bag of goodies for life's little emergencies.

I should have done this for my mom's recent birthday or made it a gift from the kids. My daughter could decorate Grandma's first aid kit with some psychedelic tie-dyed crosses and maybe even bedazzled it. I could stuff it full of all the gear I can be sure my mom would never buy for herself.

My mom isn't the type to buy special bandage scissors or even special bandages. She's the type who uses every washcloth until it falls apart then finds other uses for the scraps. She can sew dresses from scratch and grow all kinds of yummy veggies in her backyard garden (it's not entirely fair to compare Mom & Dad's veggie patch to everyone else because my parents live on a farm -- the backyard is like 40 acres).

My dad can build anything (he once copied a complicated hay rake from pictures I took at a farm show -- even painted it to match). Neither of them is happy unless they're working and active. Even so, they're both a little less spry than they used to be and a first aid kit with certain specialty items is probably overdue. Perhaps next week I'll make Grandma a sparkly new first aid kit.

• First Aid Supplies for the Elderly: What Seniors Should Keep in Their first aid kits
• Treatment of Skin Tears

| Twitter | Facebook | Newsletter Signup |

News reporters are all talking about it: walking around with your mp3 player on might get you killed. It's official according to recent research. But what does the research really say?

A study published January 16, 2012 in the journal Injury Prevention reports that incidents involving pedestrians struck by vehicles while wearing headphones tripled from 2004 to 2011. Authors searched several databases for incidents involving pedestrians struck while wearing headphones (and presumably earbuds) and found 116 cases from 2004 to 2011. Since they could only find 16 cases in 2004-05 but were able to find 47 examples in 2010-11 they concluded that the incidence of pedestrian accidents with headphones on had tripled.

The whole media machine is now reporting how dangerous headphones are, assuming of course that the presence of headphones in all these cases actually caused -- at least in part -- the pedestrian to get hit.

I'm not so sure about that.

For one thing, isn't everybody wearing an iPod or cell phone earbuds these days? It used to be easy to tell the truly psychotic schizophrenic homeless people from the simply unshaven, but now everybody has a bluetooth thingy in their ear so you can't be sure they're not actually talking to another human on the other line. Even I have fallen victim to the lure of mp3 players and hands-free headsets.

To test the assumptions of my media colleagues I did a little research project of my own for 2009, the latest year all these statistics were easily researched. I didn't search out every year of this study because I'm a busy guy and because I'm proving a point, not a thesis. This is what I found:

• 5,219 pedestrians were killed by moving vehicles (planes, trains, automobiles, forklifts, bicycles, Big Wheels, whatever) in 2009
• 4,092 of the pedestrians were killed by cars, trucks, buses or motorcycles (in the study, 55% of the cases were hit by trains?)
• 1,408 of the pedestrians killed in 2009 were drunk (they had .08 or higher blood alcohol content)
• Neither of the official government databases I looked at (CDC or NHTSA) reported whether the pedestrians were wearing headphones or not and the idea that only 116 people mowed down by trains or cars were wearing headphones in a 7 year stretch from 2004 to 2011 seems extremely unlikely to me.

My scientifically dubious research into the whole issue of pedestrian fatalities leads me to conclude two things:

1. You're much safer wearing earbuds while walking home from work sober than you are walking home from the bar after 9 shots of tequila -- with or without earbuds. And...
2. My colleagues in the media could use a statistics lesson.

Maybe it isn't headphones that are causing an increase in pedestrian fatalities. Here's my theory: the number of people wearing headphones and earbuds tripled from 2004 to 2009, including among those who got thrown under the bus (or train or whatever).

I'm a believer in backing up our assumptions with evidence. Indeed, I'm always the guy who defends all those studies that seem to back up common sense. You know what I'm talking about; the studies that leave you saying, "They should've saved their money and asked me. I could've told them that."

This may seem like one of those studies. Let's see, wearing headphones could lead to stepping in front of the train you didn't hear coming. It makes sense, but what does this study really say? The authors were able to find more examples of pedestrian victims wearing headphones - there's just nothing to suggest that the headphones are actually causing any harm.

The only way the authors could actually suggest that headphones are dangerous would be to compare the percentage of pedestrians who wear headphones to the percentage of pedestrian victims who wear headphones. For example, if they could tell me that 15% of all folks on the street had music blasting in their ears, but 50% of all pedestrians hit by trains had music in their ears, I'd be singing a different tune (quietly, you know, so I wouldn't distract anybody trying to play Frogger on a real street).

What research does show is that about 35% of pedestrians killed by motor vehicles are liquored up. Since I'm fairly certain that 35% of us aren't stumbling around completely sauced all the time, that's a pretty good indicator that getting plowed before you leave the bar on foot is a pretty good way to end up getting plowed down the street.

Until proven otherwise, I recommend watching where you're going whether you listen to headphones or not. Oh, and if you get drunk, call a cab.

A cool head under pressure: that's what most folks want in their surgeons, paramedics, police officers, firefighters, soldiers and captains. We don't pay any of these people for the routine, mundane activities that make up most of their careers. Instead, we want them to be prepared for the moment when everything goes horribly wrong.

Rescuers look for survivors aboard the sinking Costa Concordia.

(c) Laura Lezza/Getty Images

Looking at how things were handled differently between Captain Francesco Schettino of the Costa Concordia and Captain Chesley "Sully" Sullenberger of US Airways Flight 1549 really illuminates why we expect so much of the folks we put in charge when things go wrong. When Flight 1549 lost power after hitting a flock of birds -- completely unavoidable, I might add, which we'll talk about in a moment -- Sullenberger kept his calm and guided the plane into the Hudson River. It was a beautiful landing considering he had to skim the airliner along on its belly sans landing gear or a runway. No one was killed aboard Flight 1549, nor was anyone seriously injured.

Read More...