Quick update…

A second EMS tool, Drip Rate Calculator, is now freely available from the Android Market. This is version 1.0, so once again, anyone using it, please feel free to suggest improvements.  I’ll get to ‘em as time permits.

Just to say, I wrote this because I wanted a calculator that was a) free, and b) quicker to load than those embedded deep in Epocrates or programs of that sort.  No fuss, no muss.

Thanks!

Re-Written Android App

App Inventor was a lot of fun, but is being discontinued 12/2011.

I’ve since re-written the Drip Timer app so it’ll still be available. The good news is that the app went from 3.89 MB (App Inventor) to 320KB (native). If you’ve already installed it from here, please Menu -> Settings -> Applications -> Manage Apps and de-install it. Reinstall from the Market, or:

https://market.android.com/details?id=com.DTsEMT.DripTimer&feature=search_result#?t=W251bGwsMSwyLDEsImNvbS5EVHNFTVQuRHJpcFRpbWVyIl0.

Free*3 (no purchase, no ads, no fee)

Thanks!

DTs

Calls and Classes and Android Oh My.

I’ve written a couple of Android applications, which various folk have expressed interest in using, so here they are.  Absolutely free, tell your friends, etc. blah yadda.  Each comes with absolutely no warranty, use at your own risk, warning: choking hazard, and all that good stuff.  If you find an error, comment here to let me know and I’ll address it ASAP (which may not be all that S, be patient.)  These were written for and tested on my HTC Evo 4G.  Your screen may look slightly different if the aspect ratios are very much different.

The first Android app I wrote was Oxygen.  This allows you to enter PSI on the tank and the flow rate in LPM.  Press “Done” on your keyboard to move it out of the way, then tap the tank size you’re using.  The time remaining for the tank is calculated.  PSI is automatically reduced by 200 prior to calculation because most consider 200 PSI the “safe residual pressure” – at which point you should be looking for that new tank.  If you tap “Countdown” a counter will appear and you can put your phone away.  It’ll start buzzing when the tank nears empty.

The other “Hey-that’s-kind-of-neat-let-me-have-it” program is DripTimer.  Instead of watching the IV drip chamber and your watch, and losing count and all of that fun stuff, just run DripTimer.  Tap the upper portion of the screen each time a drop falls into the chamber.  I made the tap area quite large so you can hit it without having to look at it.  Tap  “10″ if you’re using a 10-drop set, or “60″ for a microdrip set.  Sorry, 15-drip-guys, I didn’t have room.  The ML/Min and ML/Hr is displayed.  Two or three drip-taps work, obviously the more actual drops you count the more accurate the calculation will be.  If you’d like to use it to count Breaths or Heartbeats (useful for tapping out neonate heart rates), tap “Breath” instead of “10″ or “60″.  The display changes from “Gtts/min” to “Breaths/min” and you should ignore the ml/hour numbers, of course.  Maybe next version I’ll just blank those…

Unfortunately, WordPress does not allow the hosting of files and mine own host, alas, no longer provides this service.  The files are small enough that I feel no guilt or shame.  I was however forced to rename the files as DOC files so WordPress would allow the upload.

Windows users:  Right click either Driptimer or Oxygen and select “Save link as”.  For the file name, change the extension from “.DOC” to “.APK” (capitalization is unimportant.)

Next, you may either email the file to your Android device as an attachment, or connect the phone via USB and copy it to your SD card.

Finally, you’ll need a free file explorer program (like Astro, available in the Market) to open the file.  Android knows what to do with APK files and will install the program for you.   Since my program isn’t coming from the Market, though, you’ll need to first press [Menu button] Settings -> Applications -> Unknown Sources and make sure there’s a check mark in the box.

Have fun, leave comments if you find bugs, etc.  Again, I have other things on my plate at the moment and can’t promise features/bugfixes right away but I would appreciate any feedback.

Statistical Stuff for 2010

Huzzah!  It’s time again for the DTs Correlation Does Not Equal Causation Festival!

In 2010, DTs ran a total call volume:  775 calls, of which 379 were deemed BLS, 360 were ALS, and 17 were CCT (the CCT numbers should increase in 2011, for DTs is now running such calls since mid-December 2010.)  A mere 31 calls were “lights & sirens” at the request of the sending facility.  We were placed in service prior to patient contact on 35 occasions.  Average number of calls per day, around 7, with a maximum during a single calendar day of 12.  Note that a shift spans two calendar days (eg 06am 12/1 to 06am 12/2) so the actual numbers are probably higher, but I’m too lazy to figure that one out this time.

DTs and his Merry Crew ran 369 male, and 406 female patients.  This is typical; guys don’t tend to go to hospital as often, and the ladies are still living longer.

The average age of all patients was 54 years, with a minimum age of 1 hour (actually probably less than an hour, but my tracking software goes all the way down to “1″) and our oldest patient was 102 years.

Total patient weight – welcome to America – was 42,281kg (or 93,018lbs, or 46.51 tons o’ patient.)  Total weight of all males was 28,165kg making the average male weight 76.32 kg, while the average female patient weighed 66.9kg.

Of our patients who spoke NO English whatsoever, 27 spoke only Spanish; 4 spoke Arabic, 4 Farsi, 3 Korean, 3 French, 2 Urdu/Hindi, and 2 Vietnamese, and one… Greek.  Did not see that coming.

As usual, Chest Pain leads the chief-complaint pack by 2:1 over the next most common complaint, abdominal pain.  The breakdown is:

Chest pain	74
Abd pain	36
AMS	25
Pneumonia	25
Dyspnea	23
Suicidal ideation	21
CVA	20
Dr appointment	16
Appendicitis	14
CHF	14
Fever	11
UTI	11
Fall	10
Atrial fibrillation	9
Malaise	9
Respiratory failure	9
Seizures	9
Backache	8
Premature birth	8
Psychosis	8
Syncope	8
Bleed – GI	7
COPD	7
Injury – head	7
Overdose, suicidal	7
Pancreatitis	7
Asthma	6
Bleed – intracranial	6
Cellulitis	6
FX – hip	6
Hypotension	6
Pulmonary embolism	6
Respiratory abnormality	6
Small bowel obstruction	6
(empty)	5
Dehydration	5
TIA	5
Vomiting	5
Epistaxis	4
Gastroenteritis	4
Hematuria	4
Renal failure	4
Respiratory distress	4
Sepsis	4
Subdural hematoma	4
Abnormal labs	3
AMI	3
Bleed – head	3
Burn	3
Cardiac catheterization	3
Cholecystitis	3
Contusion	3
Croup	3
Depression	3
DKA	3
G-tube replacement	3
Headache	3
Hyperkalemia	3
Hypertension	3
Kidney stones	3
Mass – chest	3
MVA	3
Pain – leg	3
Pain – limb	3
Post-surgery	3
Pyelonephritis	3
Renal insufficiency	3
Tachycardia	3
Weakness	3
Abscess	2
Amputation	2
Anemia	2
Bleed – rectal	2
Bleed – vaginal	2
Bradycardia	2
Bronchiolitis	2
CAD	2
Cardiac dysrhythmia	2
Cath replacement	2
Cerebral palsy	2
Colitis	2
Complications – trach	2
Constipation	2
Dementia	2
Diverticulitis	2
Fatigue	2
FX – ankle	2
FX – arm	2
FX – femur	2
FX – foot	2
Hernia	2
Injury – ankle	2
Injury – face	2
Laceration – lip	2
Leukemia	2
Necrotizing fasciitis	2
Overdose, accidental	2
Pacemaker malfunction	2
Paresthesia	2
Pulmonary insufficiency	2
Stridor	2
Suicidal attempt (non-OD)	2
Surgical consult	2
Tumor, brain	2
Ulcer, skin	2
Vertigo	2

In the transport gig patient pickup is usually from a facility, rather than from residence or roadside. 240 patients were picked up at a single standalone ED, with 176, 106, and 104 patients taken from the big three area hospitals.

As to where they’re taken, 116 went to a general hospital, 110 to a level 1 trauma center, and 73 to a specialty rehab facility. The rest are sprinkled into nursing homes, specialty hospitals (eg Childrens Hospital, or the MedStar Burn Unit), and 45 to residences.

Apropos Veterans Day

In the past month – a normal month for DTs, by the way – I have met:

a Cold War submarine commander;

an original  Tuskegee airman;

a soldier/POW from the Battle of the Bulge;

a tanker from Patton’s Third Army;

at least three infantrymen who saw France – beginning D-Day;  a couple more who toured Europe via the scenic Italian route;

an Air Force officer who served in Vietnam;

a young man on leave who is still serving our country…

Folks are right, there are heroes to be found when one is in the Fire/EMS gig, and it’s our privilege to serve them.

In Which We Contemplate Speech Patterns

I’ve been observing “us” for a while now – we EMS folk – and to non-ems folk it may seem, based on our speech patterns,  that we don’t transport patients at all.

I do not mean that we disavow the people we’ve cared for; that is, we don’t deny picking people up from Bad Situation, and taking them to hospital.  Nor do we in Transport Gig deny that we also take them from standalone EDs to definitive care, or from definitive care to rehab, or from rehab to home… or wherever.

Instead, what I find in our speech patterns is that we seem to transport chief complaints.

“I had this chest pain,” one might begin.  “We ran this auto accident.”  “They toned us out for an arm pain, but it was really a hip fracture.”

It isn’t usual for us to begin “I had a guy with chest pain,” or “I had a lady with leg pain.”  Indeed, unless there is a need for this kind of knowledge, differential diagnosis information inherent in the patient themselves, we don’t mention it.  For instance, “I had a lady with abdominal pain” WILL be stated.  Women have much more that can be going on, abdominally.

And that in itself I find interesting.  We will, in telling our stories to each other, include any and all information which will allow our audience, other Bambulance Folk, to follow along at home down the diagnostic path.  “So, at 02:30 we found a 69-year old male prone, unresponsive, in the kitchen wearing slippers” – this we toss in because stocking feet tend to slip and slide – “with a bottle of orange juice on the floor near his hand” – this we include because OJ is, (as ever), a clue.

“Aha!” our audience exclaims.  “What was his glucose?”  And yes, they got it.  The stories, you see, are never really about People.  Rather, they seem like stories about Problems, And How We Solved Them.

I’ve been thinking about this, and I believe it’s because we’re all about The Data.  Give me What I Need To Take Care of My Patient.

You will not, at the station, hear this:

“I transported a young new mother, flaxen haired.  Her blue eyes: now distant with worries of tomorrow, now sparkling with merriment at the thought of today. Her smile flashed brightly, in joyous competition with those eyes, and…”

Nah.  Our stories to each other don’t work that way.  They follow the cut-and-dried approach of a patient care report. Although I have been tempted to begin a PCR with the immortal, “It was a dark and stormy night,” or, “Lounging at the station, my Medic Sense began tingling moments before the tones dropped.  We leapt into action.”

BUT – and this is the whole point of this – we seem only to tell our stories to each other to Find Things Out.  “This is what I saw, this is what I found,” and the unspoken, Did I miss something?  Or, What could I have done better?  Or, what else should I have checked?  We constantly seek feedback.

Not for every call.  Just once in a while, there IS a call where one’s Medic Sense tingled, and we want to know, Why?

Listening to us talk, I find we never bring up the calls where our Medic Sense didn’t tingle – we don’t tend to brag about the calls where we did everything right, and know it.  We constantly seek peer review and aren’t afraid to draw it out.

Which I find to be uber-cool.  Regardless of how well the patient contact turned out, and even if everything went fine, the fact is that we through these stories turn to each other and, in essence, say, “Help me to be better for next time.”

Poor Impulse Control?

Watch it, folks, these things tend to repeat:

From the Chicago Sun-Times, http://www.suntimes.com/news/24-7/2787746,ambulance-taken-100910.article

“October 10, 2010

BY ROSEMARY SOBOL Staff Reporter/rsobol@suntimes.com

A man who “thought he could get to the hospital quicker” jumped behind the wheel of an ambulance and took off Saturday while his ailing family member and two paramedics were inside, authorities said.

Jimmy McCoy, 27, of the 4800 block of West Superior, “probably thought he was helping” when he took the wheel as a relative was being treated for a diabetic episode, Fire Department spokesman Larry Langford said.

» Click to enlarge image

Jimmy McCoy

McCoy was arrested and charged with felony unlawful possession of a stolen motor vehicle.

Ambulance No. 23 was stopped in the 4300 block of West Wilcox at 11:30 a.m. while paramedics were treating the relative in the back, Langford said.

The male and female paramedics immediately radioed in, saying: “This is ambulance 23. Our ambulance has been stolen, and we are in the back with a patient,” according to Langford.

The paramedics were “somewhat agitated” but handled the situation professionally, he said.

McCoy allegedly began driving northbound on Kostner.

Fire Truck No. 26, which had gone on the medical run with ambulance No. 23, stopped the ambulance about three blocks away, Langford said.

Truck No. 26 “made a U-turn and made it to the intersection of Madison and Kostner, where it blocked the ambulance,” Langford said.

Police surrounded the ambulance and arrested McCoy.

Police said McCoy, who has been arrested 32 times before, allegedly told officers he “thought he could get to the hospital quicker” than the paramedics.

The patient was taken by another ambulance to the hospital, fire officials said.

No one was injured, officials said.”