The Lunch Break Workout

http://nsca-lift.org/TSAC/TSAC_Report_15.pdf

This workout is designed to fit into a 45-minute lunch period or can be done immediately before or after a shift. The workout itself will take about 35 minutes. You can adjust the workout length by either increasing or decreasing the number of cardio time periods. It is designed for work on a piece of cardio equipment such as a treadmill, stationary bike or elliptical machine. That is not to say that it couldn’t be done while skipping rope, jogging in place or doing some other form of cardio exercise that doesn’t require a machine. It is designed to break up some of the boredom associated with machine-based cardio training.


You can take the heart rate measurement yourself by taking your pulse for 10 seconds and multiplying it by six, or use the heart rate feature on the piece of equipment you are using. Use 7%0 or your MHR as your initial target. As you become fitter you can slowly increase the percentage. The second step is to pick four exercises that consist of a vertical push, a vertical pull, a horizontal push, and horizontal pull. Whatever exercises you choose, make sure they allow you to “bailout” if unable to complete the reps. For example, a barbell bench press is a poor choice for this workout as fatigue may put you into a dangerous situation in which the bar could trap you or injure you. Pushups or a dumbbell bench press would be the better choice. Now to begin, pick your preferred piece of cardio equipment (I strongly suggest that you rotate through different pieces of equipment through the week if your facility is so outfitted). Start off at an easy pace for one minute. Progressively increase either the speed or the resistance every minute for the next five minutes in a manner that will allow you to reach your training heart rate by the end of the fifth minute. Once you have reached the end of the fifth minute, stop the machine and immediately move to the exercise you have chosen for that day. If it is a weight lifting movement, make your first set about three-quarters of what you plan on using for a working weight (If you elected to do dumbbell standing presses with 40lbs, do your first set at 30lbs). This will act as a quick warm-up. As soon as you are done with that set, get back on the piece of cardio equipment you were

using and check your pulse rate. It should be still within the target heart rate range if you worked hard enough. It may be higher depending upon the exercise you performed. Now depending on your level of conditioning and what emphasis you are putting on your training, you can determine how much time to take between sets. You can progress from longer periods of time to shorter periods of time (10mins to 8mins to 5mins to 3mins). The shorter the cardio periods, the greater the number of sets and higher volume of work will be performed. The last five minutes of the routine should consist of gradually decreasing the intensity or pace on the cardio machine as a cool down period. Keep your repetitions in the 5 – 8 range. For push-ups/pull-ups you can make the reps higher but try to keep them fewer than 20. To stay at this rep limit, you may externally load your body to perform the exercise. I have found that reps under five are too heavy to be performed correctly while in a fatigued state. For a four on, two off work schedule, perform this workout every day you work. Do only one exercise per day following this format:

day 1 – horizontal push,

day 2 – vertical pull,

day 3 – vertical push,

day 4 – horizontal pull.

You will note that there are no lower body exercises in the workout format. Lower body exercises such as squats and deadlifts, due to their technical nature and high heart rates they produce in this format, are generally not used. I believe this format could be used with an extremely well conditioned athlete but I still believe the subject should become familiar with this type of training before including any lower body work. In the interim, I would recommend that some form of lower body exercise such as squats be performed using a more traditional strength routine such as the 5x5 format on either one of the “off days” or scheduled in the middle of the week in lieu the aforementioned training. The athlete should always take at least one full day off and it may be prudent at the start of this program to follow a two days on, one day off schedule. There are several different options you can experiment with using this workout. If you are interested in trying more than one exercise per day, alternate a push movement, cardio, a pull movement, cardio etc. I would recommend you only do this when you are training in a manner that the cardio sessions are shorter to allow enough time to get in sufficient volume for both exercises. If you do train this way, I also recommend that you do not train back to back days in this manner but either take a day off or keep the day in between as a light cardio, recovery day. This workout is quick and simple and has a lot of room for variation. Change the exercises every few weeks. Keep track of progression by increases in weight used, number of sets performed, increases of total repetitions for the entire workout or distances covered while on the cardio equipment.


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References:


Barry Charewicz, CSCS "NSCA TSAC REPORT, ISSUE 15" Originally Posted: October 2010. Full Article Available Online: http://nsca-lift.org/TSAC/TSAC_Report_15.pdf

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TACTICAL MEDICINE—COMPETENCY-BASED GUIDELINES

http://www.coalitiontacticalmedicine.org/about/news-events/


Background: Tactical emergency medical support (TEMS) is a rapidly growing area within the field of prehospital medicine. As TEMS has grown, multiple training programs have emerged. A review of the existing programs demonstrated a lack of competency-based education.

Objective: To develop educational competencies for TEMS as a first step toward enhancing accountability.

Methods: As an initial attempt to establish accepted outcome-based competencies, the National Tactical Officers Association (NTOA) convened a working group of subject matter experts.

Results: This working group drafted a competency-based educational matrix consisting of 18 educational domains. Each domain included competencies for four educational target audiences (operator, medic, team commander, and medical director). The matrix was presented to the American College of Emergency Physicians (ACEP) Tactical Emergency Medicine Section members. A modified Delphi technique was utilized for the NTOA and ACEP groups, which allowed for additional expert input and consensus development. Conclusion. The resultant matrix can serve as the basic educational standard around which TEMS training organizations can design programs of study for the four target audiences.

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References:

Richard Bruce Schwartz, MD, John G. McManus, Jr., MD, MCR, John Croushorn, MD, Gina Piazza, DO, Phillip L. Coule, MD, Mark Gibbons, Glenn Bollard, MD, David Ledrick, MD, Paul Vecchio, E. Brooke Lerner, PhD "TACTICAL MEDICINE—COMPETENCY-BASED GUIDELINES" Originally Posted: 09/24/2010 Full Article Available Online: http://www.coalitiontacticalmedicine.org/wp-content/uploads/file/TEMS%20Competency%20Paper%20published.pdf

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Ideas for SOP's/SOG's

Modeled after the Fire Drill of the Week format, each month we will feature in .pdf format a template for department’s to utilize in developing their own policies and SOG’s.  With an emphasis on critical firefighter safety topics, we hope that this new series will be a valuable resource for our readers.

Each policy/SOG template will include:

• Color coding using the red-yellow-green system
• The Gordon Graham risk and frequency classification
•  A link to a custom report related to firefighter safety developed by the National Firefighter Near Miss Reporting System
• References and resources

Red-Yellow-Green color coding

One method of classifying department policies and SOG’s is the red-yellow-green color coding system.  The color code can either be at the top of the document, the color of the paper (although red is a tough color to read from) or the color of the tabs in the policy manual.  Examples of what would be in each category include:

• Red – includes emergency operations, emergency vehicle operations, civilian evacuation, roadway safety, MAYDAY, SCBA, RIT and related topics.  Essentially anything that during an emergency could get a firefighter or a civilian injured or killed.
• Yellow - these are the tasks that we do a lot (high risk and high frequency) and the ones that are high risk and low frequency but give us time to think.  Personnel policies including drug testing, sexual harassment, and report writing would be in this category.
• Green (or white)- these are the tasks that create a low opportunity for any of the above areas of concerns or exposure. Examples include the uniform or grooming policy, shift scheduling, or daily station duties. Round figures, 80% of your fire departments policies will be on white paper.
  

Risk and Frequency classification

Anyone familiar with FFCC’s co-founder Gordon Graham will also be familiar with his risk and frequency classification system.  Basically it organizes any task or in this case policy/SOG topic into one of 4 classifications:

•  High Risk/High Frequency
•  High Risk/Low Frequency
•  Low Risk/Low Frequency
•  Low Risk/High Frequency

A good introduction to this system can be found at: http://www.gordongraham.com/pdfs/GREFS_NPCCR.pdf

National Firefighter Near Miss Reporting System

Each policy/SOG template related to firefighter safety will have a link to a custom   near-miss report on that topic.  This great additional resource is being developed by the great folks at the National Firefighter Near Miss Reporting System.

References and Resources

Each template will also include appropriate references such as NFPA and OSHA standards and other resources for you to use in developing your own policies.  Several outstanding resources exist on the internet through fire departments and other organizations placing their policies and SOGs on line.

Click the link bellow for the full article including the Resource Links and Downloadable Templates.
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References:

www.firefighterclosecalls.com "FFCC Policy & SOG Program" Full Article Available Online: http://www.firefighterclosecalls.com/sopsog.php

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Automatic Crash Notification’s Role in Triage

The optimal way to reduce the consequences of injuries is to prevent them. When injuries do occur, however, EMS providers must transport patients to the most appropriate health-care facility for the management of their injuries. Determining the destination facility can have a profound effect on the patient’s morbidity and mortality.

Determining the best destination hospital for an injured patient in an appropriate time frame (“right patient, right place and right time”) is the primary goal of successful field triage. This is also an area in which vehicle telematics and Advanced Automatic Collision Notification (AACN) can play a significant role.

Automatic Notification
Vehicle telematics is the integration of wireless communication into a vehicle’s electrical architecture, which allows a vehicle and its occupants to interact and communicate with other vehicles, the road, public safety answering points (PSAPs) or telematics service provider call centers. A component of vehicular telematics, AACN, is the successor to Automatic Crash Notification (ACN) and is found in an increasing number of motor vehicles.

When a vehicle’s AACN system detects a crash (as determined by vehicle sensors, airbag deployment or seatbelt pretensioners), either an urgent message is directly relayed to the local PSAP or the vehicle’s Global Positioning System (GPS) location and crash-related data—change in velocity (delta-V), principal direction of force, airbag deployment, multiple collisions and rollover determination—are automatically sent by emergency wireless call to a telematics service provider.

These methods allow injured occupants to communicate in real-time with PSAPs or the telematic service provider emergency call centers without having to initiate the call.

With a wide range of vehicle manufacturers and telematics service providers transmitting AACN information, collaboration is essential to ensure standardization. Continued cooperation is critical to ensure consistent information is being transmitted to emergency care systems and personnel. Further study, including pilot projects and research, is necessary as AACN continues its integration in our nation’s vehicles.

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References:

Bob Bailey, MA, Scott Sasser, MD, FACEP "Automatic Crash Notification’s Role in Triage - How Advanced Automatic Collision Notification can assist in the early response, triage & care of injured patients" Originally Posted: 01/01/2011 Full Article Available Online: http://www.jems.com/article/trauma-patients/automatic-crash-notification-s 

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Related Links:

• A copy of the Field Triage Decision Scheme accompanies this month’s JEMS. Also, it and the Advanced Automatic Collision Notification protocol are at www.jems.com/crashsensors

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Measurement and Feedback Tools - Monitoring CPR Quality in Real Time

Sudden cardiac arrest (SCA) continues to be a leading cause of death in the United States, claiming the lives of more than 300,000 people each year, with half of those cases occurring out of hospital. Despite advancements in defibrillation equipment and increased attention on CPR, only 5–10% of SCA victims leave the hospital alive. These bleak statistics illustrate the urgency for improving and implementing the chain of survival in order to increase the rate of survival to hospital discharge for cardiac arrest patients. The good news: Over the past few years, we have begun to see real improvements in survival rates in many communities.

Following SCA recognition and bystander assistance, EMS arrival and assumption of care becomes the most critical link in sustaining the life of a cardiac arrest victim. It cannot be overemphasized that high-quality CPR performance is essential for successful resuscitation.

In an attempt to improve performance, CPR measurement and feedback systems, such as the Philips HeartStart MRx with Q-CPR*, monitor performance and provide real-time feedback to the caregiver. Such devices measure compression rate, depth and ventilation characteristics in order to ensure high-quality CPR performance during an actual cardiac arrest. Recent studies in both EMS and hospital care have shown improved rates of pulse restoration with the use of these devices.

As CPR quality initiatives continue to grow, the practice of using real-time measurement and feedback during the resuscitation, combined with regular debriefing sessions using the data captured during patient events, has shown promising early results. Research has shown that debriefing with data obtained from measurement and feedback tools can increase subsequent CPR performance and improve outcomes from in-hospital SCA.

Strengthening the links within the cardiac chain of survival has the potential to significantly improve outcomes of cardiac arrest victims. SCA survival statistics demonstrate how detrimental a weakness can be in any one of the critical links involved in this sequence.


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References:

Benjamin S. Abella, MD, MPhil and Emily C. Esposito, BA "Strengthening the Chain of Survival Incorporating real-time quality measures improves cardiac arrest outcomes" Posted: 09/30/2009 Full Article Available Online: http://www.jems.com/article/patient-care/strengthening-chain-survival

*Q-CPR is a registered trademark of Laerdal Medical

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Advancing quality and access to emergency care in remote locations - South Tyrol, Italy

The Weisses Kreuz provides special training for a group of paramedics, nurses, and physicians to have this group better prepared to operate under extreme weather conditions that from time to time occur in the high Alps. The top paramedics undergo the following program:

• 260 hours of theoretical training
• A minimum 160 hours of practical training
• Annual refresher training and recertification within specific disciplines

To enable continuous skill improvement and to ensure safe and optimal patient care, Weisses Kreuz introduced Q-CPR (quality CPR); a concept that, via sensors placed onto the patient’s chest, provides Italian Resuscitation Council compliant feedback on the quality of compressions delivered during resuscitation. Thanks to this new technology, Weisses Kreuz is now able to ensure quality treatment within yet another field.

Projects aiming to increase chance of survival

In addition to providing EMS to the local population of South-Tyrol, Weisses Kreuz is also concerned with the millions of tourists who visit the area every year. A sincere ambition to promote safety and improve clinical outcomes spurred the organization to launch the following project:

• Dissemination of CPR training in the population and
• Dissemination of First Aid knowledge

A minimum of 4000 school children will annually be using the self-directed MiniAnne/CPRAnytime program to learn and practice CPR. This endeavour will be followed up with research conducted by Professor Uwe Kreimeier, MD; Associate professor at the University of Munich Hospital, and his team.
                       
To encourage more people in the general population to gain First Aid knowledge, Weisses Kreuz introduced a free-of-charge smart First Aid guide for the iPhone and/or iPod Touch. The application, also compatible with other smart-phones, comes in German, Italian and English. So far the application has been downloaded more than 250 000 times worldwide.

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References:

Weisses Kreuz EMS, South Tyrol, Italy "Advancing quality and access to emergency care in remote locations" Full article available online: http://www.laerdal.com/UserStories/43276803/Advancing-quality-and-access-to-emergency-care-in-remote-locations

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Manikins and on-the-fly scenarios help emergency responders meet increased demands for services

National EMS Academy (NEMSA), Louisiana, USA:

At the National EMS Academy (NEMSA), classes accommodate learners’ work schedules and accelerated paramedics attend training paid sessions. “We got together with the business and academic communities and identified a chronic need for paramedics and basic-EMT workers,” said Director Gifford Saravia. “Now, 175-200 students start each semester and within four months, those who complete basic-EMT training can work full time while continuing their paramedic training. In a typical college setting, you complete core courses, then specialize; we reversed that model.”

During Hurricane Katrina, Saravia assisted with evacuations and rescue operations. “It was eye-opening, a huge undertaking.” Not surprisingly, NEMSA favors on-the-fly scenarios. “As a medic, you have to be prepared for anything, and we rely heavily on simulation so students can make – and learn from – their mistakes. Most EMT training programs use simulation these days; those that don’t are missing a huge opportunity.”

“With students and instructors scattered all over Louisiana, our jobs are made a lot easier because of Laerdal technology,” Saravia said. “Our mass casualty incidents (MCI) and trauma simulations are where the rubber really meets the road.” Twice yearly, 40-50 paramedic students come to Lafayette where basic-EMT students and manikins are patients for plane crashes, school shootings or vehicle crashes into a crowd. “We bring in helicopters, fire and police departments, and the media for interagency activity. Students enjoy it – and learn – because it gives them a sense of scale and added realism.”


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References:

National EMS Academy (NEMSA), Louisiana, USA "Manikins and on-the-fly scenarios help emergency responders meet increased demands for services" Available Online: http://www.laerdal.com/us/UserStories/48061987/Manikins-and-on-the-fly-scenarios-help-emergency-responders-meet-increased-demands

 

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