New App – Rampart BLS

A new app has been submitted to Google Play and should be appearing shortly.

Rampart-BLS is a BLS  scenario emulator.  PLEASE have one of the many fine, natural-sounding voices (such as IVONA or SVOX) installed on your Android device!

In this app, you are the ED doc or OMD.  Your EMT-B is calling from the scene and requesting medical direction.  Tell him (or her, depending on the Android Voice – installed separately) what to do:  Get vitals, splint, hold c-spine, etc.

The app is designed for EMT-B students, to give practice in acquiring SAMPLE, OPQRST, and DCAP-BTLS information, as well as head-to-toe assessments and vital signs.  There are 29 scenarios by default, and a built-in scenario editor so you can change things or even add your own – no limit.  An optional Debrief mode will provide feedback at the end of the scenario, letting you know how you did.  The app runs in standard phone mode or speakerphone mode.

The full help file (available in-app) is reprinted below.

 
A simple little scenario operator for EMT-B students.


Quick Start


Start the app right away by pressing the “Play” button on the main screen, OR you can change things around first.

You can pick a scenario by:

  • Tapping the Scenario # box and selecting a scenario;
  • Swiping across the main screen, left (next scenario) or right (previous scenario);
  • Selecting Menu -> Previous or Menu -> Next;
  • Selecting Menu -> Random;

Once you have a scenario selected:

  • Use the sliders on the screen to control how fast the EMT-B speaks, and how many seconds you have until a response is required. You can adjust these at any
    time, and they take effect with the next sentence.
  • Tap “Debrief” in the upper right corner to toggle post-scenario debriefing.

Once you’ve clicked the Start Scenario (Play) button, guide the EMT-B on the phone through his emergency. He’ll explain the situation and ask for orders. Tapping the
“pause” button will pause the scenario after the EMT finishes speaking. Long-press pause to interrupt the EMT and pause immediately.

Your EMT won’t do anything you don’t order. In general:

  • Consider the chief complaint;
  • Order immediate interventions, if necessary;
  • Have the EMT-B get SAMPLE information;
  • For medical situations, have the EMT-B get OPQRST information;
  • For trauma scenarios, request DCAP-BTLS information;
  • Direct the EMT to apply secondary interventions (O2, splint, etc.) as appropriate;
  • Direct the EMT to transport the patient

There are certain criteria common to every scenario:

  • Some patients may have prescriptions (Epi-pen, nitro, etc.) but NO patient will have taken medication prior to the EMTs arrival;
  • If you order activated charcoal, for scenario purposes you have already spoken with Poison Control and that is the correct action;
  • All patients will agree to be transported;
  • Don’t forget Scene Safety and isolation precautions!

Telling the EMT to transport the patient will end the scenario.

This app is meant to reinforce good BLS skills. As such, you are required to do things a bit differently from “real life”. For instance,
if the patient in the scenario is a stabbing victim, you can’t just ask, “Where is he stabbed?” or “Is he bleeding anywhere?”. Instead, you should conduct
a proper head to toe examination of the patient. You can’t ask, “What are his vital signs?” but must instead request BP, heart and respiration rates,
breath sounds, etc.


Debriefing


At the end of a scenario, if Debrief=On, you can press the Play button and get a screen which roughly shows how you did. If there was information
you remembered to check (ostensibly by following SAMPLE, OPQRST, and DCAP-BTLS) it is green; stuff you missed is red, and stuff you didn’t ask about
but was blank anyway will be greyed out. Debriefs are not stored, but you can “long-press” anywhere on it and bring up a share dialog, allowing you to
email it (to yourself, if you like) or send it elsewhere.


I need more time!


After the EMT speaks, a countdown timer appears (controlled by the “Your Reply in…” slider). If you need more time to think for this particular moment,
at the beep tell the EMT to “Wait”. If you continually need more time, adjust the slider to the right or say, “Slower”.

If for a particular exchange you don’t want to wait until
the countdown has elapsed, just tap the timer and the EMT will be ready for your input immediately. You can say “Faster” at the next beep or adjust the
slider to the left, too. You can change the default countdown time in Menu -> Prefs.

Tapping the “Pause” button or saying “Stop” will put the EMT on hold, without a timer. Take your time and consider your next move. Tapping “Play” again resumes the scenario.
If only a minute or two has gone by, the EMT will immediately listen for your next command. If it’s been longer than that the EMT will repeat the
scene size-up as a refresher.

Saying “Restart” will clear everything you’ve done and restart the scenario from scratch. This is useful if you pause the scenario, make changes,
and want to test them out.

If you’re using this as a group to augment training with a manikin, you can easily control the volume with voice commands. Saying “Louder” will raise
the volume; the command “Softer” will lower the volume. The command “Shout” will set the volume to your device’s maximum (this might be too much on
some devices – use cautiously). Your normal hardware controls will also adjust the volume.


Everybody’s Staring


Tap the Speaker icon to the left of the Play button to toggle between speakerphone and regular phone mode. That is, you can run the app
with your device laying on the table, or you can hold it to your ear for more privacy. Sometimes, especially in noisy environments, using phone
mode results in better speech comprehension.


Premise


On the American TV show Emergency! (1972-1979), the intrepid paramedics Roy and Johnny would be toned out for a call.
Arriving on scene, they would invariably remove their
trusty BioPhone and call up Rampart Hospital, where the on-call doc would guide them through the process of starting an IV
D5W and transporting the patient.

This app is for the budding EMT-B. It places you in the position
of the Rampart docs. Your EMT-B is calling from the scene and asking for instruction.

Your EMT can be ordered to:

  • Confirm scene safety;
  • Assess the patient (area-by-area);
  • Take vital signs (BP, pulse, etc.);
  • Check blood sugar;
  • Start CPR;
  • Provide oxygen;
  • insert OPAs or NPAs as needed;
  • Use an AED;
  • Ventilate with BVM;
  • Control C-spine;
  • Immobilize extremities (splint) or patient (backboard);
  • Assist the patient with Nitro, Epi-pen, or MDI;
  • Administer oral glucose;
  • Administer activated charcoal;
  • Control bleeding;
  • Transport the patient

Note that this app assumes a rather strict list of interventions appropriate to the EMT-B level – your protocols may allow you to do things this app will not,
out of the box. You can add stuff, though – we’ll get to that later.


Hearing Voices


Your EMT’s sex and age is dependent on the voices installed on your Android device, and which voice is “default”.

Complete instructions for adding, removing, updating or changing your device voices is beyond the scope of this app or help file, and varies
with the version of Android your device is using. Consult expert web assistance to add or change voices.

The app was developed and tested using SVOX Victoria UK English, SVOX Grace US English, and IVONA Amy UK English, but other voices are out there and should
work as well.


Them’s Fightin’ Words!


One of the permissions required by the app is Network permission, so the voice recognition in Android can communicate with Google. It is
Google which returns what you said (or what it thinks you said).

If the app doesn’t understand something, it may sometimes ask, “Sorry did you just say…” and read back what Google supplied.
What Google supplies is sometimes WAY off the mark, and can at times be offensive. Just puttin’ that out there, it wasn’t us, honest.


Sample Play Dialogue


(Player hits the PLAY button)

  • Medic 52 here. We’re at a household where a mother suspects her toddler of eating cleaning agents. What are your orders?
  • Hold old is the patient?
  • The patient is 3 years old.
  • Is this patient male or female?
  • The patient is male.
  • Is the patient awake or alert?
  • He’s alert and oriented times 3.
  • What’s his pressure like?
  • BP 120/80
  • How about breath rate?
  • He’s breathing 30 times a minute
  • Okay. Put him on oxygen using a non-rebreather at 10 liters per minute.
  • Okay, he’s on oxygen. What next?
  • Check the patient’s heart rate, please.
  • Pulse is 80
  • Is he allergic to anything?
  • He has no known allergies.
  • Does he take any medications?
  • He was taking Tylenol last week for a fever, but no current medications.
  • Listen to his lung sounds, please.
  • Breath sounds are clear.
  • Check the patient’s abdomen
  • His abdomen is unremarkable
  • Okay. Well, go ahead and bring him to the hospital.
  • Okay, see you in 10 minutes.

Menu stuff


Newer devices are moving away from
actual keys. If your device has a menu button, it should work, or you can use
the icon. Here you have alternate ways to go to the next or
previous scenario (you can also do this by swiping left/right on the main screen), select a random scenario, or edit the current scenario.

Doing Things Your Way


This app will work “right out of the box”, with about 30 scenarios ready to go.

The Edit area allows you to add new scenarios or change existing; you cannot delete scenarios from here. If you really don’t like a particular scenario,
just overwrite it. Make as many changes as you like. Go nuts.

Pressing Menu -> Edit brings up the current scenario for editing.
On the left are the key values. Since real-life scenes can get weird, very little data validation is done during data entry. For instance, no
attempt is made to validate a blood pressure. You can set it to “120/80″, “50 over palp”, or “He’s dead, Jim.” It’s all good.

All changes are made
to a “sandbox”. When you’re done editing, you need to press Menu -> Save to actually save the changes. If you wish, you can exit the Edit menu
and run through the scenario with your changes first to see if you like them.
Most items on the edit screen are self-explanatory, except perhaps BGS (background sounds, and now it’s clear.)

So, you’ve got scenario #1, female abdominal pain. She’s 36 years old, but you want to make her 99. Menu -> Edit, tap the age, enter your
desired number, click OK. This puts your change into a sandbox. Back out and hit PLAY to try it out, or not. Menu -> Save to keep the change.

If you leave heart rate blank, your EMT will report “no pulse found”. A blank BP will get you some variant of “blood pressure is unobtainable.” Take
a moment to look through any scenarios you edit or it could get confusing when your alert-and-oriented patient has no heartbeat. That being said, most
items can be left blank, and the app will fill in a suitable answer.


Revealing Patient Problems


When editing certain fields you’ll find a button near the bottom of the screen, “Reveal…”. Clicking this presents you with a list of problems the patient
might have. You can add one or more of these to any field, such that the problem is revealed, and can be dealt with only after the user gets information from
this item.

For example, if you have an assault victim, perhaps he’s bleeding. Bloody clothes, etc. However, it would be “cheating” for the player to just tell the
EMT to “control the bleeding” as soon as he knows it’s an assault. You haven’t found the bleeding yet. In Edit mode, let’s say you tap EXAM_HEAD.
Tap the “Reveal…” button and select “BLEEDING”. Now, the player has to explicitly check the patient’s head before he’s allowed to “find”
the bleeding. Trying to control bleeding before finding it won’t work.

For those situations where a problem is fairly obvious, put the Reveal item in the scene size-up field, SCENE, which is automatically
spoken at the beginning of each scenario. That is, if the SCENE field tells the player that this is a car-crash, put “SPINAL” right there,
so that taking c-spine precautions is allowed right off the bat. Follow good EMT-B rules of judgement when disclosing Reveal items in the SCENE field.
Rule of thumb: If an intervention would be obvious when you roll up or walk in the door, it should go in SCENE.


Background Sounds


The BGS field allows you to place background sounds in a scenario. Editing this field will bring up a file selection dialog. You can select any sound
on your device. The background sounds available from the app are:

airport nightclub
construction site office cubicle
department store opera intermission
grocery store restaurant, crowded
gym/indoor pool shopping mall
highway, dry sports event
highway, wet train station
hotel lobby TV on, cartoons
nature trail TV on, gameshow

Look, Ma, I’m a programmer!


The built-in editor gives you a handy way to make modifications to each of the scenarios, or to create your own from the ground up.

The Prefs menu item allows you to set certain things to a default startup value of your choice.

If you’re feeling adventurous, you can do more. You’ll need one of the many fine, free SQL editors available in the Play store.

With an SQL editor you can customize this app. The scenarios, the recognized words, the commands your EMT can follow, almost everything is located
in an SQL database, “dtsemt_emtb.db”. You don’t need a lot of skill to make changes.

Depending on your device, your memory card, and permissions it could be in one of several places, but
a likely location is on the external card, in /Android/data/com.dtsemt.rampartb/files. You do not need root access to change this file.

Opening this file with an SQL editor gives you access to almost everything, and a little look-around in it should show you how. Sort the records
alphabetically by key and the instructions for making changes precede each section.

If you completely trash the file, no worries – just uninstall the app and reinstall from Google Play.


Suggestions


Disclaimers and all that jazz is on the Menu -> About page.

Comments made on the app Ratings area are NOT automatically forwarded to the author!

This is Betterware; if you can think of any way to make it better, please send suggestions to DTsEMT@gmail.com.

Clicking an ad link once in a while helps to keep this app free.

Thanks!

New App

… in the Google Play store.  DTsEMT Menu allows you to remove any shortcuts you might have to other DTs (Medics of Anarchy) titles and replace them with a single shortcut to the Menu app, freeing up screen space.

The app scans your device on launch and creates a menu of all DTsEMT titles – building, well, a menu.

It does NOT check the Play store for new DTsEMT titles.

Absolutely free, like all MoA apps.

ACK! Mea culpa maxima

Version 1.1 of the drip rate calculator was broken, and replaced the working copy (1.0) for everyone who upgraded.  BUT, (and “everyone I know has a big ‘but’” – PwH) it is fixed, and version 1.12 seems to be stable.  Boring bit: compiler update now only allows lowercase identifiers; Apps market didn’t recognize the drip calc app as an upgrade unless the name matched exactly, which included uppercase; hilarity ensued.  The fact that it installed locally to my device meant that the problem went undetected (by me) for at least a day.

Apologies.  Procedures are now in place to sooner catch this sort of thing if ever it happens again.  Thanks to all who submitted bug reports!

Mods to the Drip Rate calculator

“JS” had a nice idea – how about the gtts/min for folks who don’t have a ml/hr pump?  It’s now there, and I took the opportunity to make the navigation less clunky.  Well, at least /I/ think it’s less clunky.  Version 1.1 and should update automatically for folks who already have it installed.

PLEASE let me know if you find any problems!  Thanks.

 

Another day, another app…

The latest is the DTsEMT RSI Calculator – enter a patient category (adult or peds), enter the weight, and see the drugs.  Allows you to deselect drugs you don’t carry to get them out of the way, and lets you enter patient health concerns (ICP, hypotension, pregnancy, etc) after which it will color-code the drugs.  Choose the green ones for best result ;-)

Absolutely free, no guarantees, blah blah blah.  Android only, je me regret, and tested on a bigger screen – HTC Evo.  Let me know of any problems, please.  Thanks!

 

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