In Field Use

For the first couple shifts, I had trouble remembering that I had the field guide with me. I was used to using my nurses drug reference, a medical dictionary and my Android phone. Once I started to get the hang of it, I actually found myself turning to the field guide before using any of my other resources. While the guide simply can’t compete with the volume of the nurses drug reference, I had no trouble finding any of my patient’s home medications in the field guide. Not to mention the fact the drug guide in the back is simple and to the point. I don’t have to read through 2 pages of information to get what I’m looking for. Definitely EMS friendly.

I tried out the Radio Report sheet found on the first page of the guide a couple times. I found it to be pretty handy but I ended up using my custom one that I have printed out on a 3×5 card. This wasn’t at the fault of the field guide, I’m just used to using my own format. One thing that was really neat was the ability to reuse the page by wiping it down with an alcohol prep. I wrote on it with a standard ball-point pen and had no trouble wiping off what I had wrote. The content never completely wiped away, but it didn’t bother me as the writing was so faded that it didn’t get in the way. Here are some before and after pictures.

The 2nd picture demonstrates how it looks after wiping it down with a single alcohol prep.

One section that I found to be the most useful was the poisons. While this certainly couldn’t replace calling poison control, I did find it to be really handy. I basically lists several different types of poisons and then explains recommended treatments (given that your protocols permit) and tells you what symptoms to expect. I can honestly say that this is my favorite section in the whole guide. I found more use out of this than I did anything else.

Other features not tested in the field

There is tons of great information in this book, however I did not test all of it in the field. In some cases this was because I simply didn’t run any calls that could apply to those sections. In other cases, it was because I don’t believe in relying on guides for doing things like ACLS.

The emergency medications listed in the book are pretty handy, but I think it should be used more as a study guide / refresher and not necessarily something that you turn to before administering a medication. I firmly believe that this information should be drilled into our heads so that we don’t lock up when we leave our field guide at home. Having said that, we are humans (well most of us) and we do forget things from time to time. Especially when we don’t use the knowledge on a regular basis. So having the information in your back pocket could save you from doing harm.

The pediatric medication chart looks extremely promising. It’s like a Broselow tape but only a fraction of the size. This is something that I actually would use in the field if given the opportunity. While I still believe in knowing your doses, I think having the ability to check your work is extremely important when it comes to weight-based doses. I typically do the math, draw up the med then, quickly check my guide / Broselow Tape to make sure that my dose is correct. This way I’m confident that I’m giving the right amount of medication, and yet not screwed when I forget my field guide.

I found absolutely no in-field use for the ACLS section. However I did find myself refreshing my memory while sitting on street corners or while sitting in quarters (given the Dodgers weren’t playing).

The MCI / Multiple patient section is pretty cool as well. When responding to an MCI (especially if you are the first unit in) it would be great to review the algorithms and refresh on the unit leader rolls before getting on scene. The information is brief and to the point. My only suggestion for this section would be to add a spreadsheet of some sort to keep track of multiple patients. I realize that in an ideal situation, I would be “that guy” standing around with a clipboard and radio while everyone else works. However I typically have to assist with packaging and loading patients being that our resources are limited, so something that I can keep in my pocket would be worth it’s weight in gold.

Conclusion

I can honestly say that this guide will be permanently added to my arsenal of resources that I use in my daily responsibilities as a Paramedic. It’s small size is ideal for EMS responders and the information packed into the guide is priceless. I realize that there are smart-phone versions of this guide (which I plan on buying) but I would still recommend having this guide. Phones lose reception, batteries die and they are fragile. While I do consider myself to be a proponent of high-tech gadgets, I still enjoy the old-school reliable method of having a paper copy when it comes to this kind of valuable information.

If you don’t have this guide, I would highly recommend buying it. It’s inexpensive and you will be glad you did.

You can order it from Amazon or find it at your local book store.

Please feel free to contact with any questions or comments.

Click here to view the video on YouTube.

If you work in EMS and own an Android phone, then you have probably searched for EMS-related applications with little success. I wrote a blog post a little while back on the subject. Like most people, I have had little success finding useful applications for EMS professionals. However, with the recent release of Epocrates for Android, this has changed.

Before I get into the actual review I am going to talk about the phone and operating system used to test this software. All of my testing was done on a Motorola Droid from Verizon. I currently have Android 2.1 installed with the latest version of Epocrates. Your experience may vary with different cell networks and phones. If you have a different experience, please let me know!

Installing:

Epocrates for Android is available in the App Market. The quickest way to install it is to just do a search, but it can be found under the health section as well.

Putting it to use:

This app has several different features that can be extremely useful in the field. The “Pill ID” features is great for drug overdoses or identifying pills that belong to patients who cannot communicate. You simply identify the pill by matching a number of different variables like color, shape, markings, etc. It then shows a list of matches with pictures and you select the pill that you have. It then shows you details about the medication.

My favorite feature on the app is the “Interaction Check”. It gives you the ability to select multiple medications and see if they interact with each other. For example, we all know that if you administer Nitroglycerin to a patient who recently took Viagra, that it can cause an unsteady drop in blood pressure. If you enter those 2 medications into the interaction check, it will tell you that there is a contraindication and list details on the reaction. You can enter as many meds as you want. I suppose you could put all of a patient’s medications into the checker, but it would be time consuming.

Epocrates for Android also comes with a drug reference guide, which can come in handy for looking up a patient’s medications to get a better idea of their medical history. Another neat feature is the “tables”. This is basically a list of algorithms for all types of medical situations. It contains sections for ACLS, Emergency Medicine, Cardiology, etc. I could see this being handy for study material or as a refresher, but not so great in the field. This kind of stuff should be pulled from our brains on scene of a call, not a phone. But that’s just my opinion.

One more feature is the “Med Math”. This is probably handy for nurses or doctors working in longer care environments. It is basically a bunch of medical calculators. There were a couple neat ones that could be handy in the field like a “Dosing Calculator” and a “Pregnancy Wheel”.

Possible areas for improvement

I would like to see more medical calculators that are relevant to work in a pre-hospital setting. Some quick drip rate calculators like Dopamine or Epi would be really handy. I know that there are paid versions of Epocrates software that contains more features. I haven’t had a chance to review the paid versions so I don’t know if it exists there. Other than that, I really don’t have any gripes about the program. It’s stable, fast and free. Can’t beat that.

Conclusion

After testing Epocrates at home, and having the opportunity to use it on a couple calls, I feel that it is a must for EMS professionals. I would definitely add this to my list of essential EMS apps. I do know that the software is available for iPhone, Windows Mobile and Blackberry as well.

If you have any questions or comments, please voice them below or e-mail me. Thanks!

I heard many people argue that field guides or “cheat sheets” are crutches. I can certainly understand how someone could become dependent on having the information in their back pocket. I have heard plenty of stories of medics flipping out after getting on scene only to realize that they forgot their field guide.

I will say that I have been that guy. The first time I forgot to pack my guide, I ran an infant cardiac arrest. Even though I got nervous, I was still confident that I knew my dosages. I treated the kid without delay and the call ran as smooth as it would have if I did have it.

Even if you carry a guide, it shouldn’t replace your core knowledge. You should have no problem figuring out a dosage or doing drug math. Carrying the guide should be a way to double check your work. You shouldn’t have to rely on it 100%.

The popular field guides that are on the market now have tons of useful information. Poison information and prescription drug information are just 2 examples of things that are nearly impossible to accurately keep in your memory bank. Having the information in your back pocket will be extremely beneficial.

My personal favorite guide is the “ALS EMS Field Guide” by Infomed. I never leave home without it. I also carry a nurses drug reference book and a medical dictionary in my backpack. If nothing else, they can be used to research a patient’s medical history and medications during long transport times and learn something new.

In conclusion, I feel that the field guides are a great tool, but can easily turn into a crutch if you don’t stay on top of your core knowledge. The guides should be used to add to your existing knowledge, not replace it.

If anyone knows of any good field guides that I didn’t mention, please let me know. I’m always looking for new tools to use at work.

Since I wrote this post, I have done several reviews on EMS-related Android apps. Check them out under my “Reviews Section”.

Being the geek that I am, I am constantly on the lookout for digital alternatives to things like calendars, checkbooks, and paramedic field-guides. Of course, being the not-so-wealthy-EMS-salary guy leaves me looking for cheap, if not free solutions.

My search for EMS-related applications started when I bought my Motorola Droid phone last week. After downloading the metal-detector (yes metal-detector) and internet radio applications, I began searching for apps that would be useful to an EMT or Paramedic.

I did my initial search was done using the built in app-market app that comes with Android. I searched various keywords like “EMS”, “Paramedic”, “Paramedic field guide”, “ALS Field Guide”, etc. I came up with 2 applications, however the results are not so good.

Here is a rundown of what I found.

BLS Drug Profiles:

The application comes with 6 drug profiles (Aspirin, EPI Auto-Injector, Activated Charcoal, Albuterol Inhaler, Nitro, Oral Glucose). While the information seems to be accurate, it’s not a very useful application for in-field use. I guess if you somehow forgot your doses or contraindications, then this might might be of some help. This app has been removed from my collection.

USA Drug Reference:

At first glance, this seemed like an extremely useful application. It’s basically an electronic version of a PDR or Nurses drug reference book. It has a really neat scrolling feature that makes flipping through the different drugs a breeze. It seemed like the perfect drug reference. That is until I actually tried looking at the information on the individual drugs. The majority of the categories are empty or have missing information. The program is solid, but the information is definitely lacking. This is quite a shame as the app has huge potential.

There are some applications out there that cost money. Skyscape’s “Rapid Paramedic” reference is basically a digital version of their hard copy pocket guide. I guess I would spend the money if I didn’t already own the pocket guide. Unfortunately, Epocrates does not have an android version of their program. It is available for Blackberries, iPhones and Palm phones. This, of course, is a major bummer. Hopefully they will come out with a compatible version soon.

The built-in GPS navigator is far superior to any GPS device that I have ever purchased. It utilizes Google Maps, which means that it updates constantly. I suppose it could be used to route yourself to calls, however I would check to make sure you aren’t violating any policies before you do so. I happen to work for an ambulance service that prohibits using personal gps devices. However, I have looked up random addresses in my area and compared the recommended routing given by Google Maps and my personal preferred routing by just looking at a map. I must say that I am quite impressed.

I must say that I am a bit disappointed in the lack of EMS-related apps for Android, being that the platform has been around for a while now. I will certainly keep my eyes out and post when I find any. If anyone knows of any that I missed, please let me know!