I posted a question on my Facebook page asking my followers what they felt the “most innovative change” was that they have seen during their career in EMS.  To date, I have gotten 26 responses of varying degrees of seriousness but the most common one that I have seen is prehospital CPAP.  In fact, one nurse even weighed in with that answer.  I decided to do some research and see what else I could find out about the topic.

I remember being an EMT in New Jersey home for the summer back in 1999 and watching the LIFE paramedics pull out a large bag with their CPAP setup out of the trunk of their unit.  It was admittedly an intimidating piece of machinery to me.  CPAP in my home system in Massachusetts was as foreign as prehospital 12-Lead EKG’s were at that time.  We did not get LP-12’s until 2002 or 2003.

When I did a Google search for prehospital CPAP, I found an article from EMS World written in 2005 by my good friend Bob Sullivan outlining its use, why it is effective, and why it is so important to start CPAP sooner rather than later.  Some of his references in the article date back to as early as 2000.  The proof has been in the pudding for years, CPAP works.

A simple "Set it and forget it" CPAP Device. Photo taken from

Why then did it take a special project waiver and two years of evaluations to get it approved for use by paramedics in Massachusetts?  Randy Cushing, a paramedic with the Agawam Fire Department was one of the leaders in the push for prehospital CPAP and his efforts finally paid off in 2010 when the change went through in the state protocols giving paramedics standing orders for prehospital CPAP.  Eleven years after I was seeing it used in New Jersey.  Five years after the article, one of many, was posted about its effectiveness in prehospital care.  This leads me to make the broad conclusion that in 2013, there are still probably some systems out there that don’t use it, or haven’t gotten full approval to use it yet.

This makes me think about studies such as the one that compared usage of IM Versed with IV Lorazepam for seizures.  Rogue Medic does a great five part write up of this, the first part of which can be found here.  The evidence is there, IM Versed works both for the patient, and is a safer route of administration for providers as well.  For the time it takes to establish an IV, especially on a seizing patient, and the risks of needle sticks which might be less with safety needles but still exist, I’d gladly go for an IM to the thigh or some other easily accessible spot.

It makes me wonder though, with as long as it took systems to adopt things like CPAP or 12-Lead EKG’s, how far off are other innovative revolutionary patient care techniques for prehospital providers?  Also, why does it take so long?  Why has it become necessary for each system and each state to seek out their own proof when the work has already been done for them?

We work in a field, the medical field, that is constantly evolving and changing.  We, as providers of care, need to do a better job of embracing those changes, and driving that evolution.  We are not talking about sterile surgical techniques here.  CPAP is non-invasive.  And every medic in the field should be able to give an IM injection or use an auto injector.  Proven simple treatments that have proven profoundly beneficial results.  These should be the sort of treatments that we, as prehospital providers, hang our hats on.