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You can lay them flat, or in trandelenburg if safe to do so and have them turn their head to the side, again if safe to do so. Sometimes you can have them puff out their cheeks like blowing up a balloon and that can help create a backflow in the EJ and make it more visible. Again, all of these techniques are only used if allowed and won't harm the patient. You can also place firm pressure against the clavicle and sometimes that will help as a "tourniquet", EJ's take a lot of practice as a lot of times you won't get a regular flash like you do on other peripheral IV's, it'll be small and you just have to know what you're feeling. Also something to keep in mind, a lot of ER's don't even allow their RN's to do EJ's and you have to have special training to perform them since there is increased risks associated with the procedure.

It's important to use these events as reminders. There's probably a lot of fellow rural folks on here. This could happen anywhere, maybe not on such a large scale, but the potential is there if you look around. We're trained to observe stuff. So, do that, look at what is in your backyard. Farms? Ammonium Nitrate and Anhydrous Ammonia. Probably every large farm, or ranch has some of this stuff. Some have excessive amounts. I've turned out to a lot of barn fires in the past sixteen years. Anyone that has been to one either with EMS, or as a firefighter knows that you're probably going to be there a while. The longest I recall, we were on scene over 25 hours. Aside from the attack being a royal PITA, the overhaul, mop up; and finding a tractor big enough to get the pumper, which is beached frame deep at nearest pond; they're exhausting, massive, dangerous fires. Plants have MSDS lists, and sometimes the fire dept. has one.. Barns don't. You have no idea wtf farmer john has stored in there. Propane heating, fertilizers, pesticides, paint, cleaning products... So, while you're trying to be a safe firefighter, and a good neighbor by getting the animals out.. There could be a cocktail that could level a country block brewing above your head. Typically, we'll do any animal rescues first, if safe; before we start lobbing hundreds of thousands of gallons of water into the flaming mass. B/c The fertilizers usually react extremely violently when they're burning and you apply water. There is no way in hell ANY fire company, short of an airport carries enough dry chemical; and you'd need a truck load of foam. I can't think of anyone locally that carries more than five, 5gal. pails. Shit goes quick when you're flowing high pressure and and using an eductor. And anyone with fire training knows that if you want good foam cover with Class A; you're going to have to be closer, than say if you were just spraying a light mix with a hand line. We have a really good foam system, with all these ethanol cars and such; and if you want a blanket to pile up, you're gonna need to be at least with in 50'. Too close if something explodes. IMO, viewing the video, it looking like a tank BLEVE. But it could have been a combination of water getting somewhere it shouldn't have. Who would expect that to happen? They were probably trying to cool the tanks, or getting set up to do that, when... That's just something you can't plan for; they were evacuating people, and even though a lot of people were injured; not a lot of civilians were killed. They did their job, and they did it well, unfortunately, they didn't get to go home after it was done. We lowered our station flag in honor of them, hard not to choke up a bit; even a thousand miles apart, we're right beside them.

How about we move beyond n=1 anecdote? What does the evidence suggest? http://www.ncbi.nlm.nih.gov/pubmed/19586701