Michigan Continuing Education Updates

The State of Michigan is changing some of their requirements for continuing education.  Their goal is to improve pediatric outcomes, and as such the following changes are being put into place.

All licensure levels 1 credit lecture or practical:

  • Pediatric Airway
  • Pediatric Medical
  • Pediatric Trauma
  • Pediatric Assessment

Specialist and Medics 1 practical credit:

  • Medication Administration

Additionally all levels will be required to have one credit in Operations for Emergency Preparedness.

Chits must be clearly identified for the topic being covered.

The State is in the process of updating their Pre-Approved Standardized CE listings to reflect changes to their new credit requirements.

These changes will affect individuals whose licenses expire December 31, 2016.  These changes went into effect on 5-Dec-2014.


For more information please refer to the State of Michigan website.

Training Portal Updates

Our training portal is currently in the process of being updated.  The new system should be more responsive.  All new classes starting in September will be on this site.

The old training portal will be left online until the current courses are completed.

If you are currently enrolled in a course, you will continue to log into the old training portal.

Online CE Provider Reminder

There are still providers attempting to use Emcert as a source of online credits in Michigan.  The state released a memo dated June 19, 2013 removing Emcert as an approved source for online education.  If you visit the the Emcert website you will be informed that they have moved to Medic-CE.  Medic-CE is also not listed as an approved online provider for Michigan.

To further complicate things the State of Michigan has the following statement on their website “(3)   Any EMS program approved by CECBEMS shall be considered a Michigan-approved continuing education program. “  Of course this isn’t accurate because the courses at Medic-CE are CECBEMS approved.

If you dig around in the Medic-CE website you will eventually find the following statement “Michigan only accepts continuing education offered by an approved Michigan continuing education provider. At this time, Medic-CE is not an approved provider.”

As for CECBEMS courses.  In past conversations with the state about these credits it seems that there are numerous opinions about how these are to be applied.  I will paraphrase the states response – If you have met all of your mandatory requirements with state approved CE classes, i.e. it has a Michigan CE chit attached with it and a category code, then  you can use CECBEMS for supplementary credits.  My interpretation of this is – CECBEMS credits are more or less worthless in the State of Michigan.  There has been some changes at the state since this conversation occurred so maybe things have changed, but it has been my experience that getting a straight answer from the state can at best be difficult.

Skills Day Review

I don’t have the opportunity to get out to as many conferences as I would like, there are just too many other fires burning.   I did however make my way out to the Homer Township Fire Station for the Midland County Annual CE day.  This year was the 14th anniversary of the event and is put on by MidMichigan EMS.

According to Scott Schaffer, the person primarily responsible for this event, the first CE day was held in the basement of the hospital.  The first CE day had about 10 participants and it has since grown to having around 100 participants.

This years CE appeared to have been a great success.  About 90 participants were in attendance and the day started out with two hours of practical sessions.  The sessions were kept fresh by breaking them into half-hour increments and rotating to a new instructor.

After the practical session was over the crowd returned to their seats and a guest speaker from the Michigan State Police gave an excellent presentation on methamphetamines and other street drugs.  This was followed by a working lunch of hamburgers, chips, and soft drinks.  The lunch was cooked fresh on location by the Homer Township Fire Department.

As the crowd returned to the main classroom a presentation was provided on mental health and pediatrics.  This was followed with a series of case studies as presented by Dr. Grieg, who is also the county PMD.

The day wound down with 2 additional hours of practical sessions.

MidMichigan EMS has been using this format for the last three years and has had great success with it.  According to Joe Thomas, who is also instrumental in this event, next years event will be set up differently and hopefully will be more engaging.

Feedback analysis of the event was very positive.

If you are a provider in Midland County or respond into this county for mutual aid, and you are not taking advantage of this excellent opportunity for CE, you are missing out.

We are looking forward to see what changes are planned for next years 15th anniversary.

A Horse of a Different Color

Its a hot humid July day, and you have been dispatched to the entrance road of Burksdale Woods.

Burksdale Woods is a popular site for horseback riding.  Over the last few years you have been here numerous times for horse related incidents, several of them had bad outcomes, and you are not looking forward to the dispatch information.

Dispatch advises you that a  22-year-old female was thrown from her horse.   No other information is available.  The call was dropped and dispatch could not reestablish contact.

En route to the call you and your partner discuss possible scenarios.  Thoughts of spinal injury, head trauma, and airway maintenance come quickly to the forefront.

As you arrive on scene you find your patient sitting on the ground, holding her right leg which is extended in front of her.  The patient is rocking back-and-forth, and is in obvious pain.

Your partner takes cervical spine precautions and you begin assessing the patient.  The patient states that she was walking the horse after finishing her ride.  She tells you something “spooked” the horse, it reared up, and came down on her leg.  She denies falling off the horse or loosing consciousness.  She explains that when the horse hit her leg she didn’t even fall.  She says, “It hurt, bad!  I hopped around for a few seconds and then sat on the ground.”

You kneel down next to the patient and explain that you need to look at her leg and then begin cutting away her pants.  As you work on exposing the patient’s leg your partner obtains a set of vitals.  You find that the patient’s leg is discolored, swollen, and feels somewhat firm.  You ask the patient to rate her pain on a 1 to 10 scale and she tells you its “off the scale”.  Your partner has obtained an order for pain medications.  You establish an IV,  the leg is splinted, and transport is initiated.

During the trip to the hospital the patient tells you that the pain meds are not helping much.  You re-examine the leg and find that it feels firmer than before and the distal pulse is weak.  As you continue to evaluate the patient’s leg you begin thinking that you have seen worse looking injuries that didn’t produce as much pain as your patient is portraying.  Given the magnitude of the pain and the mechanism of the injury you begin to suspect compartment syndrome.

Upon arrival at the ED you express your concerns to the receiving physician, provide a turn over report, and depart.  Later, you return to the ED and the physician informs you that it was compartment syndrome along with a tib/fib fracture.  He further tells you the patient is in surgery now and should make a full recovery.

 Compartment Syndrome

Compartment Syndrome

Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.

Acute compartment syndrome is usually caused by a severe injury. Without treatment, it can lead to permanent muscle damage.


Compartments are groupings of muscles, nerves, and blood vessels in your arms and legs. Covering these tissues is a tough membrane called a fascia. The role of the fascia is to keep the tissues in place, and, therefore, the fascia does not stretch or expand easily.


Compartment syndrome develops when swelling or bleeding occurs within a compartment. Because the fascia does not stretch, this can cause increased pressure on the capillaries, nerves, and muscles in the compartment.  Blood flow to muscle and nerve cells is disrupted. Without a steady supply of oxygen and nutrients, nerve and muscle cells can be damaged.

In acute compartment syndrome, unless the pressure is relieved quickly, permanent disability and tissue death may result.

Compartment syndrome most often occurs in the anterior (front) compartment of the lower leg (calf). It can also occur in other compartments in the leg, as well as in the arms, hands, feet, and buttocks.


Acute compartment syndrome usually develops after a severe injury, such as a car accident or a broken bone. Rarely, it develops after a relatively minor injury.

Conditions that may bring on acute compartment syndrome include:

  • A fracture.
  • A badly bruised muscle. This type of injury can occur when a motorcycle falls on the leg of the rider, or a football player is hit in the leg with another player’s helmet.
  • Reestablished blood flow after blocked circulation. This may occur after a surgeon repairs a damaged blood vessel that has been blocked for several hours. A blood vessel can also be blocked during sleep. Lying for too long in a position that blocks a blood vessel, then moving or waking up can cause this condition. Most healthy people will naturally move when blood flow to a limb is blocked during sleep. The development of compartment syndrome in this manner usually occurs in people who are neurologically compromised. This can happen after severe intoxication with alcohol or other drugs.
  • Crush injuries.
  • Anabolic steroid use. Taking steroids is a possible factor in compartment syndrome.
  • Constricting bandages. Casts and tight bandages may lead to compartment syndrome. If symptoms of compartment syndrome develop, remove or loosen any constricting bandages. If you have a cast, contact your doctor immediately.


The classic sign of acute compartment syndrome is pain, especially when the muscle within the compartment is stretched.

  • The pain is more intense than what would be expected from the injury itself. Using or stretching the involved muscles increases the pain.
  • There may also be tingling or burning sensations (paresthesias) in the skin.
  • The muscle may feel tight or full.
  • Numbness or paralysis are late signs of compartment syndrome. They usually indicate permanent tissue injury.


Acute compartment syndrome is a surgical emergency. There is no effective nonsurgical treatment.

An incision is made to cut open the skin and fascia covering the affected compartment. This procedure is called a fasciotomy.

Sometimes, the swelling can be severe enough that the skin incision cannot be closed immediately. The incision is surgically repaired when swelling subsides. Sometimes a skin graft is used.


Prehospital care

Care for prehospital providers should include:

  • Immobilization of the injury site – immobilization should be closely monitored to ensure that continued swelling and the splinting device does not further compromise circulation.
  • Cooling of the site
  • Pain management
  • Fluid therapy to maintain a systolic pressure of 90 – 100 mmHg in cases of suspected shock.
    • Some studies suggest running an IV wide open on patients not showing signs and symptoms of shock.  These studies claim that the fluid helps to protect the kidneys by prevening clogging of the renal tubules of myoglobin.  Myoglobin accumulates in the bloodstream as a result of the injury.  If can be found in high concentrations in the event of compartment syndrome or crush injury.  If IV fluids are run wide open, closely monitor the patient for fluid overload.
  • Reassuring the patient
  • Management of any other injuries or conditions that relate to airway, breathing, circulation

In cases of isolated injury early recognition, transport to an appropriate facility, along with advanced notification to the receiving facility will produce the greatest benefit to the patient.

It’s Pumpkin Time

Fall is rapidly approaching and few things go as well with the changing of the season as the variety of pumpkin and Octoberfest beers.

Many healthcare providers believe beer if consumed in moderation, one 12 ounce beer per day for women and two for men, may provide some key health benefits.

1.  Stronger bones – 

Beer contains high levels of silicon, which is linked to bone health. In a 2009 study at Tufts University and other centers, older men and women who swigged one or two drinks daily had higher bone density, with the greatest benefits found in those who favored beer or wine. However, downing more than two drinks was linked to increased risk for fractures.  Pale ale typically has the highest amounts of silicon, while white lagers and non-alcoholic beers have the least.

 2.  A healthier heart –

A 2011 analysis of 16 previous studies involving more than 200,000 people, conducted by researchers at Italy’s Fondazion di Ricerca e Cura, found a 31% reduced risk of heart disease in those who consumed about a pint of beer daily.

It should be noted that higher amount of alcohol from any source caused a rise in risk for heart disease.

More than 100 studies also show that moderate drinking trims risk of heart attacks and dying from cardiovascular disease by 25% to 40%, Harvard reports. A beer or two a day can help raise levels of HDL, the “good” cholesterol that helps keep arteries from getting clogged.

3.  Its good for the kidneys –

study in Finland singled out beer among other alcoholic drinks for lowering the risk of kidney stones by as much as 40%.  One theory is that beer’s high water content helped keep kidneys working, since dehydration increases kidney stone risk.

It’s also possible that the hops in beer help curb leeching of calcium from bones; that “lost” calcium also could end up in the kidneys as stones.

4. Beer is good brain food – 

A beer a day may help keep Alzheimer’s disease and other dementia at bay.

A 2005 study tracking the health of 11,000 older women showed that moderate drinkers (those who consumed about one drink a day) lowered their risk of mental decline by as much as 20 percent, compared to non-drinkers. Older women who consumed a drink a day scored about 18 months “younger,” on average, on tests of mental skills than the non-drinkers.

5. Reduced cancer risks – 

A Portuguese study found that marinating steak in beer eliminates almost 70% of the carcinogens, produced when the meat is pan-fried. Researchers theorize that beer’s sugars help block the carcinogens from forming.

Scientists also have found that beer and wine contain about the same levels of antioxidants, but the antioxidants are different because the flavonoids found in hops and grapes are different.

6. Its makes a great multi-vitamin – 

A Dutch study, performed at the TNO Nutrition and Food Research Institute, found that beer-drinking participants had 30% higher levels of vitamin B6 levels in their blood than their non-drinking counterparts, and twice as much as wine drinkers. Beer also contains vitamin B12 and folic acid.

7. It helps reduce the chance of stroke – 

Researchers at the Harvard School of Public Health found that moderate amounts of alcohol, including beer, help prevent blood clots that block blood flow to the heart, neck and brain—the clots that cause ischemic stroke, the most common type.

8.  Guards against diabetes –

A 2011 Harvard study of about 38,000 middle-aged men found that when those who only drank occasionally raised their alcohol intake to one to two beers or other drinks daily, their risk of developing type 2 diabetes dropped by 25%. The researchers found no benefit to quaffing more than two drinks. The researchers found that alcohol increases insulin sensitivity, thus helping protect against diabetes.

9. Lower Blood Pressure 

A Harvard study of 70,000 women ages 25 to 40 found that moderate beer drinkers were less likely to develop high blood pressure than women who sipped wine or spirits. 

10. Longer Life 

In a 2005 review of 50 studies, the U.S. Department of Agriculture (USDA) reported that moderate drinkers live longer. The USDA also estimates that moderate drinking prevents about 26,000 deaths a year, due to lower rates of heart disease, stroke, and diabetes.

These benefits appear to apply in other countries as well, with an earlier study reporting that, “if European beer drinkers stopped imbibing, there would be a decrease in life expectancy of two years—and much unhappiness.”

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