Tag Archive | "Glidescope"

IAFC Recognizes Fire Departments with Heart Safe Community Awards

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The International Association of Fire Chief’s EMS Section recognized two local fire departments with the annual Heart Safe Community Awards.

Hilton Head Island (SC) Fire & Rescue and Howard County (MD) Department of Fire and Rescue were honored at the opening session of this week’s Fire-Rescue Med conferences for their outstanding achievement in developing creative approaches to implement and maintain systems to prevent and treat cardiac-related diseases.

The Heart Safe Community Award, co-sponsored by the IAFC EMS Section and Physio-Control, examines communities holistically and how they have integrated their systems to work symbiotically.

“These departments are doing great work in cardiac care in their community; but, they are also doing something more,” said Chief Al Gillespie, IAFC president and chairman of the board. “These fire departments are demonstrating the level of innovation and collaboration that is critical in today’s environment if we want to raise the bar on community health and safety. ”

Agencies must demonstrate improved quality of out-of-hospital resuscitation through bystander CPR; AED deployment (PAD programs); out-of-hospital 12-lead ECGs; 12-lead ECG advanced notification to the receiving hospital; or other continuous quality resuscitation improvements. The award honors departments representing small communities with populations under 100,000 and large communities with populations over 100,000.

2012 Winner – Small Community

Hilton Head Island Fire & Rescue
Hilton Head Island, South Carolina

Over the past 3 years, Hilton Head Island Fire & Rescue, partnering with Hilton Head Hospital, developed a Comprehensive Emergency Cardiovascular Care Program. In addition, they formed a multi-disciplinary STEMI and Therapeutic Hypothermia Steering Committee as a forum for stakeholders to address concerns, identify opportunities for improvement, and share data that validates the success of their programs and improves continuing education with feedback to emergency personnel. Through the STEMI Committee, they obtain DICOM DVDs of the patients’ angiograms on request and develop case studies for paramedics to sharpen their 12-lead ECG interpretation skills and enhance education with the entire department. With the CARES Registry, they monitor every resuscitation attempt, strengthening the chain-of-survival in our community.

Winner – Large Community

Howard County Department of Fire and Rescue
Howard County, Maryland

In 2011, the Howard County Department of Fire and Rescue created new innovations as well as a new community program in Bystander CPR. Partnering with Howard County General Hospital, they produced a STEMI program to minimize heart damage for patients with a model education system and detailed patient feedback to the ALS provider who treated the STEMI patient.

They also developed a program and increased training to improve neurologically intact survival for patients experiencing out-of-hospital Sudden Cardiac Arrest (SCA). At the request of their County Executive, they have created a community Hands-Only CPR program with the goal to train all Howard County residents and employees in CPR. In addition, partnering with St. Agnes Hospital, they started a pilot protocol to study and improve performance on endotracheal intubation with Glidescope training and deployment.

The Heart-Safe Community awards received many nominations. The IAFC EMS Section and Physio-Control congratulates all nominees for their continued efforts in making CPR/AED training, PAD awareness programs, sudden cardiac arrest awareness and STEMI management a priority in their communities.

About the International Association of Fire Chiefs (IAFC)
The IAFC represents the leadership of firefighters and emergency responders worldwide. IAFC members are the world’s leading experts in firefighting, emergency medical services, terrorism response, hazardous materials spills, natural disasters, search and rescue, and public safety legislation. Since 1873, the IAFC has provided a forum for its members to exchange ideas, develop professionally and uncover the latest products and services available to first responders.

About the IAFC Emergency Medical Services Section
The IAFC EMS Section is a forum that addresses EMS issues for the leadership of America’s fire and emergency service, provides guidance and direction to the IAFC board and membership and represents fire-based EMS issues to the federal government and other EMS partners.

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GlideScope Video Laryngoscope Celebrates 10th Anniversary

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BOTHELL, Wash. — The GlideScope video laryngoscope, invented by Canadian vascular surgeon Dr. Jack Pacey and manufactured in Vancouver, B.C. is celebrating its tenth anniversary in 2011. A celebration was held on April 21st at the company’s new state of the art manufacturing facility in Burnaby, B.C.

Since its introduction, the GlideScope brand has forged the path for an entirely new category of airway devices; the video laryngoscope (VL) class. A widely used “go to” device for Anesthesiology, Critical Care, Emergency, EMS and Military health care providers, the GlideScope provides a consistently clear view of the airway, enabling quick intubation.

Unlike a direct laryngoscope (DL) which may not always provide a clear airway view, resulting in a “blind” procedure, the GlideScope consistently provides a clear picture of the larynx and vocal cords on the display monitor, offering visual control of the endotracheal tube (ETT) in its trajectory toward the airway. With an integrated camera and anti-fogging mechanism providing an excellent viewing range, and “blades” in multiple patient sizes, in both reusable and single-use forms, the GlideScope facilitates fast, accurate ETT placement.

“We’re extremely gratified that the GlideScope has helped save lives over the past ten years,” stated Dr. Jack Pacey, President of Verathon Medical Canada and inventor of the device. “And we’re very proud that our Canada employees and operations have been at the center of this major innovation in airway management worldwide.”

Traditional direct laryngoscopes have been widely used since WWII. However, they frequently require “line of sight” maneuvers which can induce neck flexion, head extension, laryngeal depression and other stress related movements. In late 1999, Dr. Pacey, in his capacity as a vascular surgeon, recognized a clear need for improvement in anesthesia intubations.

In his basement workshop, Dr. Pacey integrated imaging technology with laryngoscopy, to provide reliable visualization and procedural access space to aid in the intubation of difficult airways. The pioneering work of Dr. Pacey and his team in Canada resulted in the introduction of the innovative GlideScope video laryngoscope in 2001.

With the extensive adoption of this significant innovation in the field of airway management, video laryngoscopy has now become a routine practice in health care facilities around the globe. In addition to Anesthesiologists and Intensivists, it is actively used by EMS and military teams worldwide. It also has been featured in the well know television show, “ER” (NBC) and “Royal Pains” (USA Network).

Dr. Pacey continues to lead a dynamic team in Burnaby, including manufacturing the popular GlideScope and engineering new healthcare solutions.

About Verathon Inc
Verathon designs and manufactures reliable, state-of-the-art medical devices and services that offer a meaningful improvement in patient care to the health care community. The company’s noninvasive BladderScan instrument is a standard of care for portable ultrasound bladder volume measurement. The brand is found in over 60 countries in Urology and Primary Care practices, as well as Acute and Extended Care facilities. With the acquisition of Saturn Biomedical Systems in Vancouver, Canada, Verathon entered Anesthesiology, Critical Care and Emergency markets with the GlideScope video laryngoscope brand. Verathon is headquartered in Bothell, Washington and operates as a subsidiary of Roper Industries. For more information, please visit verathon.com.

Click here for video interviews of Dr. Pacey and tips for using the Glidescope.

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An Introduction to Video Laryngoscopy

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The GlideScope Ranger in use by Dr. David Cannell, during a medical mission in the Philippines. Photo Verathon

“…video laryngoscope provided excellent laryngeal exposure in a patient whom multiple experienced anesthesiologists had repeatedly found to be difficult or impossible to intubate using direct laryngoscopy.”(1)

Let me put my view of video laryngoscopy right up front. Video laryngoscopy is better than direct laryngoscopy. It reliably provides a better view and requires less force than direct laryngoscopy. There’s less trauma to the patient. First-pass intubation success rates are higher and require less time than direct laryngoscopy. Video laryngoscopy is better for our patients and should be the standard of care for oral tracheal intubation.

Wow, Charlie, those are pretty bold statements! I make these statements based on five years of experience with a variety of video laryngoscopes in the field, the operating room (OR) and cadaver labs. I have these views based on the scores of journal articles and studies I’ve reviewed. I have these beliefs from conversations EMS, anesthesia and emergency medicine professionals from the U.S., Canada, Europe, Australia and Asia. Ask anyone who has ever used a video laryngoscope and you’ll find very few who don’t agree with most of my statements. Yep, I’m pretty comfortable with my point of view, but this wasn’t always my position.

I’m a tightwad. Just ask my wife and anyone I’ve worked with. I hate spending money, especially my own. Also, I am a skeptic. I look at new technology with a suspicious eye. I see no reason to change for the sake of change. Imagine my thoughts back in 2006 when I first saw a video laryngoscope. Wow! That’s a lot of money for a camera and some lights. I’ve done just fine intubating patients for over twenty years with my metal sticks, why should I change? It took me at least a year of working with the instrument before I started to believe there was a better way to intubate my patients.

Direct laryngoscopy has changed very little since its implementation in medicine over a century ago. The early ’90s saw several developments in the anesthesia world. In operating rooms, flexible and rigid fiber optic devices were used to place endotracheal tubes in patients with difficult airways. Even seasoned professionals needed extensive practice with these devices.(2) It was incredibly rare for these instruments to find their way to an emergency department, let alone in the hands of EMS providers.

I’d like to tell you that anesthesiologists used fiber optic instruments as the springboard to video laryngoscopy, but I can’t do that. Video laryngoscopy truly had its birth in the profession of surgery; specifically laparoscopic surgery. The earliest patent I could find for a video laryngoscope was issued to Dr. Jonathan Berall in 1998.(3) The first commercially available video laryngoscope was designed by Canadian surgeon, Dr. John Allen Pacey and introduced in 2001.

I have to make a disclosure here. Dr. Pacey is one of my EMS heroes. He’s a soft-spoken man, but vigorously passionate in caring for his patients and developing new technologies. I’ve known Dr. Pacey for years and I’m honored and humbled to call him my friend. Earlier this year, I was privileged to interview him for this website. During the interview, he told the story of how he developed the GlideScope. I’ve heard the story countless times, but each time it’s told, I listen with wonder. Watch the video interview and see what I mean.
It took me a while to understand that video laryngoscopes are not traditional laryngoscopes. I was routinely frustrated and typically unsuccessful because I tried to apply direct laryngoscopy skills. My epiphany came when I finally realized it isn’t a laryngoscope, it’s a camera! With that paradigm shift, I became proficient. It’s the function of every video laryngoscope to place a miniature camera and light in the supraglottic region and transmit the image to a monitor.

A number of instruments are on the market, and they differ in the location of the viewing monitor, shape of the blade and method of inserting the endotracheal tube. Monitors are either attached directly to the laryngoscope handle or at the end of a cable that is connected to the handle. Attached monitors are compact and typically take up less room in gear bags. When you adjust the handle with an attached monitor, you also have to move your head to stay in front of the screen. Detached monitors provide a larger viewing screen and don’t require you to move your head when you adjust the handle.

I’ve seen three blade shapes; a modified Macintosh, an L shape and the proprietary angle of the GlideScope. Remember, the blade is the vehicle used to place the camera and lights in the supraglottic area using the least amount of force. I’ve found the greatest success by using my thumb and two fingers to manipulate the blade; it just doesn’t take much pressure to obtain a view. If you have to apply significant force to obtain a video view, you need to perfect your technique or try different shaped blade.

Two of the L shaped instruments I’ve used with monitors attached to the handles have an endotracheal tube channel on the right side of the blade. Once you have a clear view of the glottis, advance the tube through the channel into the glottis. The other method of placing a tube is manually placing the tube with your right hand. Some of my European friends prefer to place the tube without a stylette, but I’ve had much greater success using one.

Each device offers other features such as video and still recordings, disposable or reusable blades, battery type, air worthiness certificates, ruggedness, size and monitor size. The best way to determine which video laryngoscope is best for you is to put one in your hand. Try as many as possible. Start with manikins, and then move to the cadaver lab and patients. I’ve used pretty much everyone out there, so let me know if you have any questions.

Let’s talk about the elephant in the room; cost. I’ve met very few folks who weren’t impressed with the view, ease of use, and superiority of video laryngoscopes over direct laryngoscopy. I’ve met very few folks who didn’t hesitate when they saw the price tags and I was one of them. While I am still a card carrying tightwad, I do believe you get what you pay for.

How many of you old timers remember using a Porta-Power and Come-Along for vehicle extrication? When Ed Curtrell showed us a new fangled hydraulic tool, a Model 32 spreader, he wanted $5,000 for the system. Show me a rescue unit today without a high pressure hydraulic tool; it’s the industry standard. Last year, the State of Maryland required every ALS unit to have cardiac monitors with 12-lead ECG capabilities. How much did you pay for your most recent monitor? It’s the standard of care.

With all of the recent literature, articles, and editorials questioning EMS providers’ competency to provide endotracheal intubation, I just don’t understand why folks aren’t running to this proven technology. End-tidal carbon dioxide capnography isn’t cheap, but we embraced it and made it a standard of care. Because of adverse court settlements involving direct laryngoscopy, the attorney for a community based emergency physicians group proactively recommended the group drop direct laryngoscopy by its emergency physicians. The group now either intubates in the emergency department via video laryngoscopy or places a supraglottic airway.

The two operational medical directors who have had the greatest impact on my EMS career are Frank M. Yeiser, Jr., MD and Douglas Floccare, MD. Both of these men taught me that same thing; just do what’s best for your patient. Friends, video laryngoscopy is what’s best for your patients.

Take care and be safe.
Charlie

References
1. Richard M. Cooper, Can J Anesth. 2003;50:6, 611-613.
2. Clifford Boehm, MD Assistant Professor of Trauma Anesthesiology, R Adams Cowley Shock Trauma Center. Personal communication, 2008.
3. Jonathan Berall, US Patent 5,827,178, www.uspto.gov.

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Charlie Eisele, BS, NREMT-P

Charlie Eisele, BS, NREMT-P has been active in EMS since 1975. After 22 years of service, he recently retired from the Maryland State Police, Aviation Command where he served as a State Trooper, flight paramedic, instructor, flight operations supervisor, director of training, and tactical paramedic.

For over 25 years, Charlie has been a collegiate level educator and curriculum developer. He has served numerous programs including the University of Maryland, and its R Adams Cowley Shock Trauma Center, College of Southern Maryland, Grand Canyon National Park, Marine Corps Base Quantico, Virginia Department of Fire Programs, and Maryland State Police.

Charlie is the co-developer of the internationally delivered advanced airway program at the R Adams Cowley Shock Trauma Center. He is the Airway and Cadaver Lab Course manager for the University of Maryland critical care emergency medical transport program. He’s the co-developer of the EMS Today airway and cadaver lab program. Charlie has been recruited nationally to provide airway management curriculum and education for a variety of private, federal, state and local organization.

Charlie is an Eagle Scout and a published author. He serves on the Journal of Emergency Medical Services Editorial Board and is a member of the program board for the EMS Today Conference & Exposition.

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EMS Airway Clinic is a new site offering best practices in airway management and education for EMS professionals and educators, featuring:
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    Featured Airway Products

    Providing emergency patient care on the ground or in the air is complex and challenging. That's why the tools used by paramedics and EMTs must be adaptable in a constantly changing clinical situation — quickly operational, rugged and easy to use. Learn more about EMS airway management.

    GlideScope Ranger

    The GlideScope Ranger video laryngoscope delivers consistently clear airway views enabling faster intubations in EMS settings. Available in reusable or single-use configurations.

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    GlideScope Cobalt AVL

    GlideScope Cobalt AVL

    The GlideScope Cobalt AVL video laryngoscope offers airway views in DVD-clarity, along with real-time recording. On its own or when combined with the GlideScope Direct intubation trainer, the Cobalt AVL is an ideal tool to facilitate instruction of laryngoscopy.

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    GlideScope AVL Reusable

    GlideScope Cobalt AVL

    The GlideScope AVL Reusable video laryngoscope offers airway views in DVD-clarity, along with real-time recording. On its own or when combined with the GlideScope Direct intubation trainer, the AVL is an ideal tool to facilitate instruction of laryngoscopy.

    See more products …

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