This is a message from the Palo Alto Fire Department. Palo Alto firefighters will be hosting a community pancake breakfast benefiting Project Safety Net this Saturday, Oct. 12, from 9 a.m. to 1 p.m. at Rinconada Park, located at 777 Embarcadero Road. The event will include a simulated automobile rescue using the Jaws of Life and a live landing of Life Flight’s helicopter. For additional information, please find us on Facebook and Twitter or visit Project Safety Net at www.psnpaloalto.com.

Some residents claim this was a misuse of the emergency notification system because they believe it was primarily sent as a way to market the fire department’s charity pancake breakfast. In the fire department’s defense, Chief Nickel states the notification was not intended as a way to market the event, but instead it was sent out of concern that residents would flood the 9-1-1 dispatch system when they saw the Life Flight helicopter landing in town. Citizens are naturally curious when they see emergency personnel and apparatus, so the fire department wanted to ensure the community was aware this was a simulated event and not an actual emergency. [Read the full story at EMS World]

• Handling and restraining
• Resuscitation
• Determining heart rate and respiratory rate

The fire department was provided with a kit to restrain animals and medical tools for treatment. [Read the full story at The Norman Transcript]

The table below shows the most common medical abbreviations that are used for documentation.

A / B / C / D / E / F / G / H / I / J / K / L / M / N / O / P / Q / R / S / T / U / V / W / X / Y / Z

The SINCIAPCPDDD acronym serves as a guideline for emergency personnel during hazmat tactical operations. The table below shows which tactics each hazmat response level is able to conduct. Most EMT’s are only trained at the level of First Responder Awareness (FRA) and therefore can only participate in the SIN portion of tactical operations.

	Tactic	FRA	FRO	IC	Tech / Spec
S	Safety
I	Isolate and deny entry
N	Notifications
C	Command and management
I	Identification and hazard assessment
A	Action planning
P	Protective equipment
C	Containment and control
P	Protective actions
D	Decontamination and cleanup
D	Disposal
D	Documentation

A junctional rhythm is a protective heart rhythm that occurs when the atrioventricular node (AV node) takes over as the heart’s pacemaker. To fully understand a junctional rhythm, let’s first take a look at the cardiac conduction system and see how it operates in a normal, healthy heart.

Cardiac Conduction System

The SA node is the heart’s natural pacemaker and is located in the right atrium. The SA node generates an electrical impulse at a rate of 60-100 bpm and sends it to both atria by way of the internodal tracts. This causes both atria to contract simultaneously and force blood into both ventricles. The electrical impulse then continues down to the AV node, which is located between the atria and the ventricles. The AV node slows down and regulates the impulse, then sends it through the bundle of His to the left and right ventricle. From the bundle of His, the impulse travels through the Purkinje fibers, which are inside the ventricular muscle, causing the ventricles to contract and pump blood throughout the body.

Junctional Rhythm

A junctional rhythm occurs when the AV node takes over as the primary pacemaker because either the SA node failed or the AV node blocked the atrial impulse. The AV node only generates an electrical impulse at a rate of 40-60 bpm, so you typically see a much slower heart rate. There are some circumstances, however, where the AV node develops an abnormal automaticity and exceeds the SA node rate. This is defined as either an accelerated junctional rhythm or junctional tachycardia, depending on the rate. A junctional rhythm is protective — the AV node serves as a backup for the SA node — so it should not be suppressed. The reason being is it would be more dangerous for a lower pacemaker site, such as the bundle of His, to assume the role of pacing the heart. Generally, the lower or more distal the pacemaker site, the less reliable and effective the pacing is.

How to Identify a Junctional Rhythm

A junctional rhythm can be identified by having a regular R-R interval and one of the following P wave characteristics:

• Absent P Waves: This occurs when the AV node sends an electrical impulse to the atria and ventricles at the same time.
• Inverted P Waves: This occurs when the AV node sends an electrical impulse to the atria first.
• Post QRS P Waves: This occurs when the AV node sends an electrical impulse to the ventricles first.

The absence or change of the P wave indicates the primary pacemaker has shifted from the SA node to the AV node.

Junctional Rhythm Types

• Junctional Rhythm: The AV node is the primary pacemaker with a rate of 40-60 bpm.
• Accelerated Junctional Rhythm: The AV node is the primary pacemaker with a rate of 60-100 bpm.
• Junctional Tachycardia: The AV node is the primary pacemaker with a rate > 100 bpm.

Visit the Junctional Rhythms page to learn more about the different types of junctional rhythms.

Junctional Rhythm Symptoms

Junctional rhythms can be completely asymptomatic or accompanied by any of the following:

• Palpitations
• Fatigue
• Dyspnea
• Lightheadedness
• Dizziness
• Syncope

Junctional Rhythm Causes

• Sick sinus syndrome
• Digoxin toxicity
• Ischemia of the AV node
• Acute inflammatory process that may involve the conduction system (e.g., acute rheumatic fever, lyme disease)
• Diphtheria
• Drugs that can cause bradycardia (e.g., beta-blockers, calcium blockers, antiarrhythmic agents)
• Metabolic states with increased adrenergic tone
• Isoproterenol infusion

As an EMS provider, one of the quickest ways to end your career is with a back injury, which unfortunately happens more frequently than you may think. A survey conducted by the National Association of Emergency Medical Technicians (NAEMT) showed that 47% of EMS personnel have sustained a back injury while performing EMS duties. Scary — right? Although this percentage is quite high, it’s important to realize this is a preventable injury and you don’t have to become part of the statistic. Here are four basic principles of body mechanics that will save your back and put you in a position to have a long and healthy career.

Four Basic Principles

• Keep the weight of the object as close to your body as possible: The likelihood of sustaining a back injury greatly increases the further you have to reach for the object.
• Use your leg, hip, gluteal and abdominal muscles to lift: These muscles can generate a lot of lifting power with minimal risk. Notice how your back muscles, which are drastically weaker, were not included.
• Think “stacking”: Try to picture your shoulders stacked on top of your hips and your hips stacked on top of your feet. Once everything is properly aligned, move them as a unit.
• Reduce the height or distance the object needs to be moved: This is where the phrase, “work smarter, not harder” comes into play. Sometimes this can be as simple as moving the gurney as close to the patient as possible.

The next time you’re moving a patient or equipment, make sure to incorporate these four basic principles. Your back will thank you — trust us.