Training day: 3 Waveform capnography scenarios

Training day: 3 Waveform capnography scenarios

By Jake Mellor

A previous article provided five training scenarios to help BLS providers better understand common capnography waveforms and how this information can lead to more adequate treatment for a patient.

Below are three more scenarios, which will spur discussion about more complex yet still common conditions that providers may encounter in the pre-hospital setting. In each scenario, students will see how waveform capnography can be vital to a quicker diagnosis and better patient care.

Waveform capnography is a tool that EMS providers at any level can use. (Photo/USAF)
Waveform capnography is a tool that EMS providers at any level can use. (Photo/USAF)

The goal for students completing these scenarios should be to recognize a few more common and distinct waveforms, as well as next treatment steps.

Waveform Capnography Scenario 1: Congestive heart failure

EMS arrives on scene to find a 68-year-old male patient with a chief complaint of difficulty breathing. Patient is situated in a tripod position, and vital signs are quickly obtained:

HR: 122
BP: 160/100
RR: 24 and labored
SpO2: 88 percent
ETCO2: 30 mmHg
Lung sounds: Rales, bilaterally

Show students this waveform: a shorter, rounded arch found to be specific to CHF patients.

EMS1 image

It’s important for students to know that this waveform will not appear in every CHF patient, but if it is present, it will work in conjunction with other findings to confirm CHF.

Waveform Capnography Scenario 2: Curare cleft

Two paramedics have intubated a patient with full-thickness burns on 40 percent of his body via rapid-sequence intubation. EMTs are present to assist during transport to a burn center. Vital signs post-RSI are as follows:

HR: 134
BP: 84/52
RR: assisted
SpO2: 100 percent on ETT
ETCO2: 41 mmHg
LS: Clear bilaterally

Provide the students with this waveform, a clear example of curare cleft.

EMS1 image

Explain to students what is going on during each brief downward spike in the alveolar plateau of phase III. For a patient intubated via RSI, this cleft is very likely an indicator that the neuromuscular blockade is wearing off, and the patient is now trying to breathe on his own against the tube.

Make it clear that now is not the proper time for extubation, even though the patient wants to breathe on his own, and that another dose of paralytic medications is what this patient needs. Although EMT students will not be familiar or trained in giving these drugs, being able to recognize curare cleft and alerting the paramedics will greatly increase the efficacy of the intubation and help patient comfort.

Waveform Capnography Scenario 3: CPR and ROSC

Have students simulate running a code.

CPR has been in progress for 10 minutes, providers have placed an oropharyngeal airway and are ventilating with a BVM that has inline capnography, and after two defibrillation attempts, the patient is still in ventricular fibrillation.

After another round of CPR and administering a third shock, give students this capnography waveform.

EMS1 image

When a patient reaches ROSC, the CO2 that had been building up during insufficient peripheral perfusion is suddenly washed out as blood begins moving more effectively again, resulting in a sudden spike on the waveform.

Ensure that students know that if they see this spike, they should alert the rest of their crew and perform a pulse check to verify ROSC. While this condition is certainly an improvement, students should know that patients in ROSC could easily re-arrest. Patients going back into cardiac arrest will have a decline in ETCO2 that is just as significant as the original ROSC spike.

Waveform capnography is a tool that EMS providers at any level can use. Even if the intervention that the waveform demands is beyond the scope of practice of a provider, recognition of a pattern and communication with other members of the crew can be the difference for a critical patient.

About the author

Jake Mellor is a firefighter/paramedic student intern with the Town of Madison (Wis.) Fire Dept.  

Apple Watch’s heart monitoring feature now live

Apple Watch’s heart monitoring feature now live

By EMS1 Staff

CUPERTINO, Calif. — The Apple Watch’s latest update includes an ECG app that monitors heart rate and checks for irregular rhythms.

Digital Trends reported that the electrocardiogram app, which is now available for Apple Watch Series 4 users, includes a pair of electrodes built into the back of the watch to check for irregular heart rhythms.

The Apple Watch’s latest update includes an ECG app that monitors heart rate and checks for irregular rhythms. (Photo/Apple)
The Apple Watch’s latest update includes an ECG app that monitors heart rate and checks for irregular rhythms. (Photo/Apple)

According to TechCrunch, the app passively monitors the wearer’s heart in the background, and another feature requires the user to complete the circuit by placing a fingertip on the edge of the watch’s digital crown.

If the app detects a skipped or rapid heartbeat, a notification will be sent to the user’s watch screen.

When a notification is received, the user is supposed to open the ECG app and rest their arm on a flat surface while holding a finger to the digital crown. At that point, a real-time graph of the user’s heart rhythm will be displayed until the app finishes its measurements. 

The feature is not meant to replace a doctor, but to simply monitor for complications. The signup process warns users that the app cannot detect a heart attack, blood clots or a stroke.

ABC News reported that Richmond, Virginia, resident Ed Dentel was testing the app after updating his watch when he was alerted that he might be experiencing atrial fibrillation.

“The application on the launch sounded off right away with atrial fibrillation — not something I’ve ever heard of, but since I’m in pretty decent health and never had a problem before, I didn’t give it much thought. I figured something was glitchy, so I set everything down turned in for the night,” he said.

Dentel said he put his watch back on the next morning and received the same alert.

“Right away: AFib. So I shut everything down and turned it back on and tried it again. Same result, same result, same result,” he said.

Dentel added that he gave the watch to his wife to see if she received the same alert, and it came back normal.

“I put it on my left wrist, on top, AFib. I put it on my left wrist, on the bottom, AFib. I switch to my right wrist. Same thing. So, I started to get a little bit alarmed.”

Dentel went to the doctor and was given an EKG, and the diagnosis was confirmed.

“I was dealing with a case of atrial fibrillation that I never knew I had and probably wouldn’t have known anytime soon,” he said.

Still, doctors said they’re taking a wait-and-see approach with the app.

“It is potentially helpful in these small instances,” Dr. Michael Cho, a cardiologist at Crystaln Run Healthcare, said. “The incidence is higher as you get older — if you had Apple Watches on 80-year-olds, you’d have a high incidence of AFib. If you have mostly 20-, 30- or 40-year-olds, you’re not going to see that much.”


Lume Cube adds DJI Mavic 2 drone lighting kit to current lineup

Lume Cube adds DJI Mavic 2 drone lighting kit to current lineup

Allows drone users to light up the sky for multiple applications, including search and rescue

CARLSBAD, Calif. –  Lume Cube, the world’s most versatile light for content creators, announced today pre-orders for the Lume Cube Lighting Kit for the DJI Mavic 2 Drone. Dubbed as the go-to portable drone, the DJI Mavic 2, when paired with the Lume Cube Lighting Kit, provides pilots with a powerful solution for capturing content in both creative and commercial applications.

“As the leading provider of drone lighting solutions for both casual and professional pilots around the world, we are proud of our continued innovation, offering solutions for every quadcopter that hits the market,” said Riley Stricklin, co-founder at Lume Cube. “With DJI as the market leader, the popularity of the recently announced Mavic 2 has led to many requests for us to create a lighting solution specifically for this drone. We’re proud to announce that Mavic 2 pilots can now pair lighting with their drones, allowing their creativity to reach new heights and use their Mavic 2 for a variety of new applications.”

Constructed from the original DJI Mavic mount design, the new Lume Cube Lighting Kit is the first and only custom lighting solution on the market for the DJI Mavic 2 that incorporates continuous light and strobe capability for FAA Night Flight regulation, as well as wireless Bluetooth control. Not only is the new lighting kit an incredible tool for creative drone users, but it also provides public safety officials with a solution for anti-collision lighting, commercial surveillance, Search & Rescue, and a variety of inspection services. Additionally, when off the drone, the Lume Cube can be used as a standalone device on any smartphone, camera or even underwater with a GoPro.

Lume Cube Lighting Kit – DJI Mavic 2 Features:

  • Powerful Light Quality & Light Weight – Packed with 3,000 Lumens of light, the DJI Mavic 2 Lighting Kit offers high quality lighting with a continuous lighting option, seven different strobe speeds and the ability to illuminate anything within an 11-mile flight range. With a lightweight, nine-ounce design – which has minimal impact on the flight time – the Lume Cube Kit’s features prove to be unmatched against existing drone lighting solutions.
  • Kit Design & Custom Lens – The custom designed Fresnel lens gives off high-quality LED light with a 60° beam angle, 360° adjustability and no hot spots, which is a win-win for Mavic 2 content creation. Mounts are made with injection molded thermoplastic and finished with over molding to help maximize durability and longevity, while maintaining a lightweight mount design.  
  • Anti-Collision Lighting & Sensors – Keeping the Mavic 2 within line-of-site is a requirement for safe drone operation. With visibility from over three miles away, Lume Cubes meet FAA Guidelines and ensure the Mavic 2 is qualified to fly at any time of the day or night. Lume Cubes also help illuminate the surroundings of the Mavic 2, allowing its 10 anti-collision sensors to work effectively.
  • Run Time & Bluetooth Connection – From the ground, users can operate the Lume Cubes within 100 feet via Bluetooth on any iPhone or Android smartphone through the Lume Cube App. When on half power, they have a two+ hour run time and at full power while flying, have a 30-45+ minute run time.
  • Durability – The Lume Cubes are made with an aluminum shell and are waterproof and drop proof, making the Kit highly durable and built to last.

The Lume Cube Lighting Kit allows for a variety of applications, both creative and commercial:

  • Unique Lighting Effects in the Sky – To capture the most creative photographs and videos, the Lighting Kit can be used in a variety of ways to produce studio quality content. Whether hovering the Mavic 2 over a subject to illuminate it from above, or light painting the sky using the waypoint feature and a camera’s long exposure, the possibilities are endless.
  • Security, Surveillance and Inspections – The Lume Cube Lighting Kit illuminates what the Mavic 2 can’t see – a crucial part to any surveillance or inspection. Even during the day, the Lume Cubes can eliminate shadows and silhouetting from the sun. From law enforcement surveillance to routine inspections of solar panels, crops, wind turbines, power lines and more, the Lighting Kit ensures the Mavic 2 captures clear footage through its Hasselblad camera. 

The Lume Cube Lighting Kit for DJI Mavic 2 includes two mounts, two Lume Cubes and a custom zipper case for $189.99. It is available now for pre-order sale at and will soon be available through retailers in time for the holidays!

Visit for more information on Lume Cube and the Lume Cube Lighting Kit for DJI Mavic 2 Drone. 

About Lume Cube

Founded in 2014 with headquarters in Carlsbad, Calif., Lume Cube manufactures is the world’s most versatile lights for content creators offering multiple lighting options and accessories for photography, video, drone and smartphone use. Having recently launched throughout Best Buy and Apple stores nationwide, Lume Cube is the essential tool for casual and professional creatives looking to capture epic photos and videos in every environment.

Bound Tree Medical partners with EMSGrantsHelp to offer free grant assistance for opioid response products

Bound Tree Medical partners with EMSGrantsHelp to offer free grant assistance for opioid response products

Bound Tree Medical, part of the Sarnova family of companies, and the leading national specialty distributor of emergency medical products in the emergency medical services (EMS) market, has partnered with EMSGrantsHelp to provide grants support to EMS agencies seeking grants for the purchase of opioid response products like naloxone and opioid overdose kits.

Bound Tree is proud to offer 1:1 unlimited, personalized grant consulting through EMSGrantsHelp to help your agency research and find grants, review grant narratives and applications, and provide 50% off grant writing services as needed.

To start the process, visit Bound Tree’s grant program page at and submit your request for assistance. The grant expert team will maintain contact with your department as grants are pursued, and until a suitable grant is found.

About Bound Tree Medical
Bound Tree Medical is one of the largest specialty distributors of emergency medical equipment, supplies, pharmaceuticals and product expertise in America. Customers include Emergency Medical Services (EMS) professionals who provide pre-hospital, emergency care, including first responders, EMTs and paramedics. Bound Tree supports the public safety community with a team of EMS-experienced sales and support representatives, backed by strong vendors and a national distribution network. From everyday disposable items to extensive capital equipment, Bound Tree offers thousands of quality products from leading manufacturers to help our customers save lives.

For more information, visit

About Sarnova:
Sarnova, one of the largest, privately held companies in Columbus, is the leading national specialty distributor of healthcare products in the emergency medical services (EMS) and acute care markets. The company is comprised of four major business units:  Bound Tree Medical, DXE Medical, Emergency Medical Products and Tri-anim Health Services. Together, they distribute more 100,000 clinically differentiated medical products and supplies to thousands of hospitals and emergency care providers across the country. Sarnova is uniquely positioned as one of the industry’s only distributors that can offer customers a comprehensive portfolio of products supported by clinical expertise and refurbishment / repair services. Sarnova is a company of Water Street Healthcare Partners, a strategic investor focused exclusively on the health care industry.

For more information, visit

Polaris Launches Industry-Leading Work Utility Vehicle: PRO XD™

Polaris Launches Industry-Leading Work Utility Vehicle: PRO XD™

All-new diesel UTV line-up engineered for durability, serviceability and safety with industry-leading payload and towing for any jobsite

MINNEAPOLIS – Polaris® Commercial has designed a breakthrough line of utility task vehicles (UTVs) purpose-built for work: the all-new PRO XD. The PRO XD line from Polaris offers three diesel-powered models built to withstand the tough duty cycles and usage on the worksite, boasting industry-leading payload and towing capabilities and unmatched durability, serviceability and safety tailored to the commercial working customer.  

“Polaris Commercial is lazer-focused on delivering best-in-class capability, durability, serviceability, and safety to drive increased productivity for commercial work needs, missions, and markets. We listened, learned, and leveraged our nearly 65 years in this business and now we’re delivering the absolute best new UTV optimized for work,” said John Olson, vice president and general manager of Polaris Commercial. “These new vehicles will deliver huge value to our hard-working customers in the rental, construction, commercial and government sectors.”

EMS1 image

The PRO XD provides industry leading payload of 1,930 lbs, towing of 2,500 lbs, and world-class mobility that’s expected from a world leader like Polaris. Extensive research with rental, government and construction industry leaders showed that customer productivity and profitability in work environments who use UTVs are driven by vehicle durability, serviceability and safety — which is exactly what the PRO XD provides. The vehicle models are the two-passenger PRO XD 2000D, which is available in either two-wheel drive or all-wheel drive, and the four-passenger PRO XD 4000D available in all-wheel drive.

“Our expansive commercial and military customer base operate Polaris vehicles in the harshest environments around the world,” said Sean Cheatham, vice president of product development, strategy, and marketing at Polaris Commercial. “And we have incorporated their feedback into the development of the PRO XD.”


The Polaris PRO XD is engineered with industry-leading, long-lasting and robust components. Durability drives productivity and profitability by decreasing downtime, lowering the cost of replacement parts, and reducing maintenance labor.

–           Kubota industrial diesel engine

–           All-new rigid chassis design for industry-leading payload and towing capacities

–           Rust-free and dent-resistant composite bed, large enough to fit a full-size pallet

–           Heavy-duty, sealed driveline components to increase resistance from corrosive conditions

–           Reinforced seat base and heavy-duty seat material for the industry’s most puncture- and tear-resistant seat

–           Industry-first, 26-inch, non-directional jobsite tire designed for puncture resistance and longer life on hard-packed surfaces



The ability to easily identify issues and conduct simple service tasks on a vehicle at the jobsite is critical to keeping the machine running efficiently and delivering a better return on investment. The Polaris PRO XD is designed to increase vehicle lifespan and optimize uptime.

–           Engine maintenance intervals doubled to 200 hours — Polaris is the only vehicle brand to offer this standard on a diesel UTV — the result is less time and money spent on oil changes and extended use time

–           Improved vehicle fault alarms to notify users of potential issues that could cause serious damage to the vehicle. Alarms include low oil pressure, parking brake engagement, belt burn, and engine overheat

–           Relocated dipstick and air filter for easiest service maintenance through side access without the need to raise the bed

–           Front air intake for clean air ingestion, improved air filter life, consistent engine power and durability

–           Two-seat, two-wheel drive offering for driveline service simplicity

–           Polaris PULSETM Connector simplifies the process of adding electronic accessories like lights and radios to the vehicle’s power source, simplifying accessory installation and enhancing upfit possibilities


Safety is a major focus on jobsites to prevent losses and enhance effectiveness. Reducing accidents and injuries, avoiding mishaps, and enhancing situational awareness are key focus areas for our Polaris Commercial customers. That’s why the Polaris PRO XD incorporates safety features to stay at the forefront of jobsite compliance.

–           Industry-first orange seat belts and vehicle decals to improve vehicle visibility to surrounding workers and jobsite supervisors

–           Backup alarm, horn and parking brake standard

–           Vehicle starts only in Park with brake enabled

–           Industry’s widest foot wells to easily enter/exit vehicle with real work boots and gear

–           Speed limited to 26 miles per hour for jobsite compliance, with additional speed limiting capabilities down to 15 miles per hour for slower jobsite requirements driven by safety critical operations

–           Engine Braking System (EBS) for slow decent down hills

–           Fully sealed cab to prevent dust ingestion. This also makes the cab quieter thereby reducting noise hazards and fatigue.

Produced in Polaris’ state-of-the-art Huntsville, Alabama manufacturing facility, the PRO XD work vehicle is engineered to handle any construction jobsite, commercial work environment or government application, including operations and maintenance support, personnel transport, and emergency response. The Polaris PRO XD is sold and supported as part of the Polaris Commercial and Polaris Government & Defense portfolio of brands and encourages customization solution requests for improving work and mission productivity and safety at jobsites around the world.

Customers can visit the Polaris Commercial website for more information, or to request a quote.

Editor Note: For high-resolution images, video and data sheets, please visit our online media kit at or contact Katie Paulson,


About Polaris Commercial

Backed by more than 60 years of Polaris Industries innovation, Polaris Commercial offers a comprehensive line of durable, versatile and customizable work vehicle solutions for transporting people and hauling equipment in urban environments and industry applications. GEM®, PRO XD, Taylor-Dunn® and RANGER® vehicles are engineered with the customer’s needs in mind to be dependable, safe, sustainable and to increase productivity. The dedicated and specialized employees of Polaris Commercial provide end customers with simple purchasing processes based on individual needs, dedicated customer support and a worldwide network of dealers for localized service.

Polaris Commercial | Built for Work |

About Polaris® Government and Defense

Polaris Government and Defense vehicles are forged from more than 60 years of off-road innovation and leadership. The commercial prowess and innovative culture of Polaris Industries are leveraged to deliver unique value to government entities and military forces worldwide. This dedicated division provides highly capable, simple to use, and affordable mobility platforms and vehicles that are readily available through easy procurement channels and supported through lifecycle training, service and maintenance from Polaris – the original equipment manufacturer.

About Polaris

Polaris Industries Inc. (NYSE: PII) is a global powersports leader that has been fueling the passion of riders, workers and outdoor enthusiasts for more than 60 years. With annual 2017 sales of $5.4 billion, Polaris’ innovative, high-quality product line-up includes the RANGER®, RZR® and Polaris GENERAL™ side-by-side off-road vehicles; the Sportsman® and Polaris ACE® all-terrain off-road vehicles; Indian Motorcycle® mid-size and heavyweight motorcycles; Slingshot® moto-roadsters; snowmobiles; and pontoon, deck and cruiser boats. Polaris enhances the riding experience with parts, garments and accessories, along with a growing aftermarket portfolio, including Transamerican Auto Parts. Polaris’ presence in adjacent markets globally includes military and commercial off-road vehicles, quadricycles, and electric vehicles. Proudly headquartered in Minnesota, Polaris serves more than 100 countries across the globe. Visit for more information.

3 Questions to ask when buying ambulance equipment mounts

3 Questions to ask when buying ambulance equipment mounts

Patient and provider safety is our No. 1 concern when it comes to ambulance transports, yet we traditionally overlook a simple way of providing a safe working environment inside our ambulances: securing our equipment.

Let’s take a look at three questions we should ask ourselves when retrofitting a current ambulance, purchasing a new ambulance or creating a new interior design to accommodate our safety needs (not just concerns).

1. Do I need to access it from the inside?

To combat the risk and tradition of standing (or remaining un-belted) in the patient compartment, manufacturers are turning to better ergonomically-designed mounts and ambulance design systems in order to promote safer practices. (Photo/USAF)
To combat the risk and tradition of standing (or remaining un-belted) in the patient compartment, manufacturers are turning to better ergonomically-designed mounts and ambulance design systems in order to promote safer practices. (Photo/USAF)

Loose equipment is a potential projectile.

Blood pressure cuffs, splints, radios, flashlights, wheel chocks and cardiac monitors are all items that you see carried on an ambulance, but that doesn’t necessarily mean that they all need to be carried inside of one.

External compartments are a great option for carrying (and securing) items that aren’t typically needed inside of an ambulance during transport and patient care. Mounting brackets, dividers, slide-out shelves and securing straps can all be used in an external compartment storage design.

Each of the pieces of equipment stored in an outside compartment certainly holds a purpose, just not one that requires immediate accessibility inside of the ambulance, .and certainly not one that warrants them becoming a potential projectile hazard in the event of a collision or hard stop.

2. Can I reach it standing up?

While standing during transport is not an advocated practice, it does happen. Securing necessary equipment to walls or counters, keeps it accessible, yet secured.

Sliding-door cabinets can keep loose items like bandaging supplies and IV bags well secured, but newer track systems and mounting brackets can also be integrated into your ambulance interior design to help keep cardiac monitors and other bagged or contained equipment in stow.

An important consideration to keep in mind for standing-access equipment is whether or not a provider can still hold onto a handrail while accessing secured items. Simple-lever designs and push-release buttons have helped to facilitate this access consideration.

3. Can I reach it sitting down?

Sitting (while properly seat belted) has become the gold safety standard within our industry during the course of patient transport.

Limited access to equipment, nevertheless, has always been the argument against this recommended practice.

To combat the risk and tradition of standing (or remaining un-belted) in the patient compartment, manufacturers are turning to better ergonomically-designed mounts and ambulance design systems in order to promote safer practices.

Wall mounts secured to sliding tracks have been introduced into ambulances, just like sliding track seats. Brackets are secured to stretchers to hold cardiac monitors in place, while still allowing for patient movement and full-body access.

Safety has finally become the focus of many manufacturers, which has transitioned into a source of innovation. What was once loose on a counter is now secured (within reach) on a shelf. The number of potential projectiles inside of our ambulances has been greatly decreased through mounts and brackets, and the safest method of provider transportation (in a seated, secured position) has now become the objective.

So, the next time you’re purchasing a new ambulance – or if you’re simply looking to integrate some more safety features into your current design – ask yourself these three simple questions.