Migraine
By Anna Smith, RN, Coordinator, Stroke Center, Valley Hospital

The medical community has not treated the migraine as a disease, but rather a psychological disorder controlled by the migraine sufferer. However, with improved technology and communication from sufferers, we have begun to understand migraines as a debilitating disease. Despite the advances in understanding migraine disease, many dangerous and outdated myths have not yet been dispelled.

Migraine disease is a serious health and disability problem that affects approximately 32 million Americans, most of whom are women, and up to 38 million Americans have the genetic propensity for migraines. There is no known cure for migraine disease, only treatments for the symptoms. Furthermore, such treatments are not always effective and migraine sufferers may show a diminished tolerance to a variety of medications, treatments and pain management regiments.

"There is no condition of such magnitude that is as shrouded in myth, misinformation and mistreatment as is this condition [migraine], and there are few conditions which are as disabling during the acute attack," claims Dr. Joel R. Saper, MD, FACP, director of the Michigan Head-Pain & Neurological Institute.

Not only are migraines disabling, they can be life-threatening. More people died from migrainous strokes last year than were murdered with handguns.

The National Migraine Association has identified the following myths about migraines:

Myth: A migraine is just a bad headache.

Fact: Migraine is a disease; a headache is only a symptom. What causes migraine pain is different than what causes a "regular" headache.

Myth: Migraine is caused by psychological factors, such as stress and depression.

Fact: Migraine is a neurological disease, not a psychological disorder.

Myth: Migraine is not life threatening, just annoying.

Fact: Migraine can be life threatening by inducing such conditions as stroke and coma.

Myth: Any doctor will recognize and properly treat migraine.

Fact: Migraine is one of the most misdiagnosed, mistreated and least understood diseases.

Migraine is typically characterized by severe, recurring head pain, usually located on one side of the head and one or more of these associated symptoms: nausea, vomiting, and increased sensitivity to light, sound and smell. Other symptoms may include lightheadedness, diarrhea and scalp tenderness. Migraine symptoms vary for each individual sufferer, making diagnosis—the key to an effective treatment program—complicated.

To gain a better understanding of types of migraine and treatment options, visit the National Migraine Association’s website at www.migraines.org.

Health district receives grant to plan for EMS response during mass casualty events
By Mary Ellen Britt, RN, Trauma Coordinator, EMS and Trauma System Office

The Southern Nevada Health District Office of Emergency Medical Services and Trauma System (OEMSTS) and other leaders in the emergency medical care and emergency management communities share a concern that Southern Nevada is vulnerable to a terrorist act or mass casualty event. This concern is based on the large population, significant visitor volume and relative geographic isolation from any other major urban area. To better serve the community, OEMSTS submitted an application and was awarded a "Terrorism Injuries: Information, Dissemination and Exchange" (TIIDE) grant. The grant is funded through a cooperative agreement between the U. S. Department of Health and Human Services and Centers for Disease Control and Prevention for a three-year period, which began Sept. 1, 2007.

OEMSTS plans to develop a comprehensive, evidence-based and integrated strategic plan to strengthen the daily operations of the EMS and trauma system and enhance our ability to respond appropriately to a mass casualty incident producing numerous victims with traumatic injuries.

Recent events worldwide have demonstrated that terrorism and mass casualty events have the potential to seriously impact public health systems and emergency response capability. In addition, these events present unique triage, diagnostic, treatment and surge capacity issues. The goals and objectives of the OEMSTS TIIDE grant project are designed to enhance our community’s ability to assess the current EMS and trauma system resources and plan for future needs; to link existing data sources to provide meaningful information to our emergency care and emergency management partners; to assist in the revision and coordination of existing emergency management plans and to ensure the trauma system plan is fully integrated into community-wide mass casualty planning; to strengthen daily operations of the EMS and trauma system and identify strategies to adapt daily operations to manage a large influx of injured patients resulting from a mass casualty incident.

Systematic data management and dissemination of information to the emergency care community is essential in promoting more coherent evidence-based actions within agencies and organizations and to improve the community’s ability to respond appropriately. In order to predict surge capacity, an emergency care system assessment will be conducted to include identification of current resources and the capacity and capability of the EMS agencies, hospitals and trauma centers to handle multiple victims with traumatic injuries. To prepare healthcare providers, OEMSTS plans to facilitate trauma care training opportunities utilizing existing trauma care courses.

One of the most important objectives of the TIIDE program is to engage new partners in the public health, emergency care and emergency management communities while maintaining and reinforcing existing relationships. The ability to share meaningful information about EMS transport and emergency care of victims suffering traumatic injuries, with community partners will greatly enhance our ability to strengthen the daily operations of the existing emergency medical care and trauma system. It will also help to develop evidenced-based plans to effectively and efficiently manage a mass casualty event and thereby reduce the incidence of morbidity and mortality. We welcome your participation.

EMS Week in Review

This year, the Southern Nevada Health District planned two events in honor of National EMS Week: EMS Day and the Responder of the Year award ceremony.

EMS Week Kick Off Event featured demonstrations and continuing education opportunities for EMS professionals. Co-sponsored by Mercy Air, the event drew 70 EMS participants who heard from local professionals on topics such as cerebral vascular accidents, helicopter safety, burns and blast injury education.

Demonstrations, which were open to the public, included Las Vegas Fire and Rescue’s bomb squad and CBRNE Unit, Clark County Fire Department’s Heavy Rescue, Las Vegas Motor Speedway’s Safety Truck and equipment, Petty Race Car display, MedicWest Ambulance’s Critical Care Paramedic equipment and American Medical Response’s bariatric unit.

The health district demonstrated its mobile command center and staff members from the Office of Public Health Preparedness distributed planning resources for families and pets. Sunrise Children’s Hospital fitted and gave away free bicycle helmets for children. In addition, Mercy Air held a raffle for helicopter rides for seven lucky EMS personnel. Pictures of the event are available on our website at www.southernnevadahealthdistrict.org.

During the annual Responder of the Year award ceremony, the health district recognized professionals from eight licensed EMS agencies in Clark County.

The following individuals were recognized for their demonstration of excellent patient care, clinical skills, exemplary professionalism and exceptional contributions and commitment to the success and advancement of emergency medical services:

• John Torgerson, EMT-Basic, Las Vegas Fire and Rescue
• Paul Stepaniuk, Paramedic, Henderson Fire Department
• Ginger Nehrbass, Paramedic, American Medical Response
• Nels Eastgaard, Paramedic, Clark County Fire Department
• Nick Robison, Paramedic, North Las Vegas Fire Department
• Michael Cheney, Paramedic, MedicWest Ambulance
• James Gleeson, Paramedic, Mesquite Fire and Rescue
• Steve Kreps, EMS RN, Mercy Air

Pictures of the event are available on our website at www.southernnevadahealthdistrict.org

How Old Are You – REALLY?
By Ted Milano, certified personal trainer, NREMT – I

Did you know there may be a significant difference between your chronological age (how old you are in calendar years) and your "real" age (your biological age or how old your body is based on lifestyle, medical history and genetics)?

If you continually support an unhealthy lifestyle, you may be relatively young chronologically, but your body may look older and perform slower. Not to mention that you most likely run a higher risk of disease and shortened life span.

On the other hand, if you have a relatively "clean" lifestyle, you may look much younger than your driver’s license reflects. Additionally, you may be able to ward off disease, thus adding years to your life.

How many of us believe the myth that if we live fast and play hard in our younger years, we can put ourselves back together later on in life? It no more works that way than if you buy a new car, neglect the scheduled oil changes, fill it with bad gas, crash it into parked cars, and then 10 years down the road, expect it to perform as it did when you drove it off the lot. Conversely, an older (or classic) car can keep up with the newest vehicles on the road if it is properly maintained with care.

Supporting this theory, the website — www. Realage.com — invites you to take a short quiz about your lifestyles, medical history and physical statistics. Once submitted, the information will be evaluated and calculated. An email is then sent with your confidential "real age", along with a detailed list of what you’re doing right and what you may need to improve upon.

Lately, I have been approached by more and more employees interested in averting or reversing their current unhealthy lifestyle. As I’ve been known to say, "Look at your medical patients, folks." How did they buy that one way ticket to the hospital in the back of your rig? Are you at risk of being on the receiving-end of some of those nasty devices you love to stick into them? Start using your daily experiences with these patients to motivate yourself to care for your body like a cherry '68 Ford Mustang before you end up in the salvage yard with the few remaining Yugos of the world.

Ted Milano is the Employee Health and Physical Education Coordinator for Medic West Ambulance-Las Vegas. He is also a certified personal trainer specializing in strength, conditioning and injury prevention. If you have a question about health and wellness in Emergency Medical Services, contact him at: Ted.Milano@gmail.com

Ted Milano is the Employee Health and Physical Education Coordinator for Medic West Ambulance-Las Vegas. He is also a certified personal trainer specializing in strength, conditioning and injury prevention. If you have a question about health and wellness in Emergency Medical Services, contact him at: Ted.Milano@gmail.com

EMS News Reel

The Medical Advisory Board (MAB) meets the first Wednesday of each month at 11 a.m. in the Clemens Room at the Ravenholt Public Health Center, 625 Shadow Lane. Following is a summary of the meeting on May 7, 2008.

• The board discussed a new Nevada statute that requires a driver of an ambulance, advanced emergency medical technician or other person providing medical services licensed or certified to practice in this state to report as soon as reasonably practicable but not later than 24 hours after the person knows or has reasonable cause to believe that an older person has been abused, neglected, exploited or isolated.
  
  Board members expressed concern about having paper copies of the Report of Suspected Abuse form on the units. They agreed the best solution is for medics to enter the information on the Department of Health & Human Services website and obtain confirmation of receipt. Rory Chetelat offered to speak with Richard Whitley, director of the Health & Human Services, to discuss the Board's recommendations.



• Dr. David Slattery reported that the ultimate goal of the Stroke Destination Task Force is to improve stroke care for patients by developing a stroke system in Southern Nevada with minimal impact on stakeholders. The plan is to model the stroke system after the trauma system. He added that the health district has sent out invitations for anyone who is interested in serving on the Stroke System Development Steering Committee.



• Chetelat reported that the Transfer of Care Committee has been formed. The committee has met several times and is working on issues to get the data reporting corrected by cleaning up the exceptions list and defining a data dictionary.

Ask the EMS Office

I am currently endorsed as a Preceptor. What are the requirements for endorsement as a Secondary Instructor?

You must successfully complete a bridge course approved by the Southern Nevada Health District’s Office of Emergency Management & Trauma System by Dec. 31, 2009. See "District Procedure for Bridging EMS Preceptors to Secondary EMS Instructors" on page 17 in the EMS Procedure Manual.

Are there specific requirements to become an EMS Instructor?

Yes. See "District Procedure for Secondary EMS Instructor Training" on page 18 in the EMS Procedure Manual.

Can I take the National Registry exam in Clark County even if I don’t plan to get certified in Nevada?

Yes, National Registry open testing is available in Clark County on a space available basis throughout the year. Information on future open testing dates is available at www.nremt.org.

Under what circumstances may an EMT apply for an extension for recertification?

If you are unable to complete the recertification requirements within the allotted time due to circumstances beyond reasonable control, then you may apply in writing for a late renewal. You must submit the request for an extension to the SNHD-OEMSTS before your certificate expires.

Valid reasons include military service, deployment and personal or family illness. A late renewal fee will apply (refer to the EMS Fee Schedule).

Is there a grace period on expiration dates for EMT certification?

No, you must recertify with SNHD-OEMSTS on or before your certification period expires.

We Welcome Your Submissions

The editors of the EMS Advisor welcome submissions related to the EMS profession. If accepted, the editors reserve the right to edit all copy for length, style and clarity without prior notification to authors. All submissions must be submitted electronically via email to EMSAdvisor@snhdmail.org. Photographs must be at least 300 dpi and require a signed consent form.