Administrative Brief
COMMISSION INFORMATION MEMORANDUM
VOL. 26, NO. 36
November 19,2004
ADMINISTRATIVE BRIEF FROM JOE KNOTT:
In August 2003 and again in September 2004, the EMS Division, Salina Fire Department
purchased new loll "M" Series monitor/pacer/defibrillators. The "M" series are replacing the
older loll PO 1400 that have been in service with the department for the past 14 years.
Developing technology has allowed loll Medical to manufacture what I consider the most
advanced monitor/pacer/defibrillator on the market today.
Non-Invasive
Pacemaker
loll "M" Series
12 Lead ECG Monitor
Biphasic Defibrillator
Synch ron ized
Card ioversion
loll offers the "M" series with 12 lead EGG, non-invasive blood pressure monitor, oxygen
saturation monitoring and end tidal GO2 monitoring.
The two (2) new loll "M" series used by the department are equipped with 12 lead EGG with
interpretive capabilities. This will allow crews to print a 12 lead EGG in the field and transmit
that 12 lead along with an interpretation of the EGG directly to the Emergency Room
physician via cell phone. This will insure that treatment provided by department Paramedics
and EMT's are appropriate for that patient.
The "M" series provide hands free defibrillation via the use of defibrillation electrodes, while
monitoring a regular 4 or 12 lead EGG. These units also provide the ability to capture the
heart rate to increase (non-invasive pacing) or overdrive the patient's heart rate and then
lower the heart rate back into a normal range. All this is accomplished with the minimum of
discomfort to the patient.
The department will be budgeting to replace the remaining 5 loll PO 1400 with loll "M" series
over the next five years.
-over-
CIM
Page 2
Biphasic vs Monophasic Defibrillation
Monophasic technology / waveform defibrillator, has been the standard of care over the past
40 years, provides a shock with current flow in one direction (from one electrode or paddle
to the other). Biphasic technology / waveform defibrillators incorporate two - way current flow
in which electrical current first flows in one direction, then reverses and flows in the opposite
direction.
It is well known that extremely high levels may cause damage to the heart cells and, for a
defibrillator shock, peak current indicates the highest current level. Fortunately, even
monophasic technology / waveforms which have a higher peak currents have not been shown
to cause damage to the heart at traditional energy levels. Since biphasic technology /
waveforms have a lower peak current than monophasic technology / waveforms, the risk of
injury is less with biphasic defibrillation.
Monophasic defibrillation settings for a cardiac arrest patient in ventricular fibrillation start at,
200 J for the first attempt at defibrillation. If not successful the second attempt is made at 300
J. If the second attempt is not successful a third defibrillation of 360 J is attempted. All
recurrent attempts at defibrillation are at the 360 J level, throughout the remainder of the
arrest. With biphasic defibrillation the initial attempt at defibrillation is 120 J, second attempt
at 150 J, third attempt at 200 J.
Zoll Preventive Maintenance Program
The EMS Division contract with loll medical for biannual maintenance for 5 loll PO 1400 and
the 2 "M" series. These biannual inspections check the operation of the monitors, pacers and
the defibrillation capacities of each unit, to insure that they are within manufacture
specifications. All of these inspection and operation checks are conducted on site.
Therefore, all units can be inspected and operational checked without leaving the department.
If a unit fails to meet specification, loll Technical Services are notified and a loner unit is sent
to the department within 24 hours. The unit that fails its inspection is then returned to loll for
.
repairs.
MONDA V'S MEETING:
1. Enclosed are other items on the agenda. If any Commissioner has any questions or
cannot attend the meeting, please contact me.
2. Let's begin the study session at 2:30 p.m. An agenda is attached.
Dennis M. Kissinger
City Manager