On this month's episode, we chat with Matt Smith about wilderness medicine.

As we shift from a high resource to a low resource setting, there are 3 main concepts to consider:

- Ideal to real

- High risk to low risk

- Stable to unstable

These concepts are important as we shift our practice and prepare ourselves.

For this patient context, we need to focus on the things we can't replace, and learn to manage that.

Our approach to these patients need to be algorithmic, and focus on doing the basics well. Two mnemonics (H-E-M-P; A-B-C-D-E) are presented to help with our approach.

Lastly, hypothermia assessment and management is discussed.

On this month's episode, we discuss acute coronary syndrome (ACS) with Dr. Jess McLaren

We define ACS, we cover pathophysiology, and some common causes. Importantly we discuss the assessment of this patient population - paying attending to both objective and subjectives signs and symptoms. We spend some time talking about electrocardiograms, and perhaps most importantly, we chat about the management of this patient.

On this episode, we're joined by Dr. James Gilbertson with the Ottawa Hospital, and Cst. Caroline Gallant with The Ottawa Police Marine, Dive and Trails (MDT) Unit.

We take a dive into drowning and cover:

• What drowning is
• The scale of the problem
• Drowning pathophysiology
• The medical management of drowning patients
• Prognostication

Lastly, we speak to drowning prevention

In British Columbia 7 people per day are dying as a result of a highly contaminated toxic supply of drugs. Since the announcement of the public health crisis related to illicit drug toxicity deaths in 2016 over 12,000 people have lost their lives.

Despite previous misconceptions that the toxic drug crisis is confined to Vancouver's lower mainland and the downtown east side, Jen is sounding the alarm that not a square inch of the province of BC has been unaffected by the crisis. Working on the frontlines of a provincial organization means every patient and every paramedic is being affected, and as a service provider the organization is burdened with the monumental task of meeting the demand for emergency health services in rural communities that otherwise have never required such a response.

Jen emphasizes the importance of the paramedic role given the frequency at which they interact with people who use drugs. She proffers that paramedics are uniquely positioned to offer alternative models of care that aim to reduce harm, but that the window of opportunity to offer these tools is narrowing.

In this episode Jen speaks to some of the things paramedics can be doing to reduce harm in their approach, and in pathways that their organizations can be offering to patients. You can learn more about what the literature is saying about the paramedic role in caring for people who use drugs in Jen's scoping review.

You can contact Jen on twitter at @jlynnbolster or e-mail her directly at [email protected]

"No statistical difference"

On today's episode of Critical Levels, we chat with Dr. Ken Milne of the Skeptics' Guide to Emergency Medicine (https://thesgem.com; @thesgem).

We start with a high-level discussion and literature and evidence, and then apply these concepts to 'lyse' and 'bust' some of the predominate prehospital myths.

Find links to the primary literature on our website.

We examine:

2:00 - The importance of primary literature

4:10 - Why?

10:10 – Literature, critically appraising articles, & levels of evidence

13:20 – Evidence Based Medicine

17:30 – Guidelines & Protocols

22:22 – Epinephrine in Cardiac Arrest

28:30 – Sodium Bicarbonate in Cardiac Arrest

32:10 – Advanced Airways

36:10 – "Treat the patient, not the monitor"

42:05 – TTM (Targeted Temperature Management)

48:22 – "Be Skeptical"

51:15 – TBI Management/TXA

61:05 – Final Thoughts

Paramedics receive little education on grief and bereavement. As paramedicine integrates palliative approaches to care, it has become very apparent paramedics are under-prepared for the crucial role they play in supporting patients and families in grief and recognizing and responding to their own grief reactions.

In this episode we talk to Cheryl Cameron and Tyne Lunn about how paramedicine is evolving to include the provision of palliative care. We start by defining palliative care and talk about how paramedics are well positioned to support patients with palliative care needs, already seeing this patient population in our routine 911 caseload, but needs to do better to align the care we provide with people's wishes.

· MyGriefToolbox as one strategy and tool to address gaps in education/supports for paramedics

· Scale and spread of this approach across Canada

· Importance of person, family and caregiver centered approach

· Psychosocial support, system navigation, and compassion can be provided by all levels of paramedics

· De-bunking some myths about providing palliative care

They'll introduce us to MyGriefToolbox, a set of free resources that have been developed in collaboration with Canadian Virtual Hospice to support paramedics as we provide a palliative care approach and psychosocial support to grieving individuals, families, and caregivers.

On today's episode, we carry on last month's conversation about cardiac arrest management and care.

Recorded at the Paramedicine Across Canada Expo (PACE) Conference in Saskatoon in September 2022, we're sitting down with Mike Humphrey and Adam Perrett of Lethbridge Fire and Emergency Services to talk about how they've revolutionized the care provided to the citizens of Lethbridge, Alberta.

We walk through how they train, evaluate, and feedback data with respect to cardiac arrests; how they use a culture of excellence to deliver high performance CPR leading to improved ROSC rates; and they use real time data to track opiate overdoses in their community.

On today's episode, we chat with Dr. Sheldon Cheskes, principal investigator of the landmark DOSE VF trial.

In this study, published in the New England Journal of Medicine, Dr. Cheskes and his team wanted to evaluate DSED and VC defibrillation as compared with standard defibrillation in patients who remain in refractory ventricular fibrillation during out-of-hospital cardiac arrest.

In this episode, we walk through the study design, methodology, results, and perhaps most importantly, critically appraise the study to see how it works in the real world!

Timestamps:

02:48: Dr. Cheskes Intro

06:15: Study Intro

16:45: Patients

18:18: Intervention – Vector Change

25:45: Intervention – DSED

37:12: Comparison/Outcome

40:23: Results

54:15: Critical Appraisal

Pain is a condition that we often see in the prehospital world, yet for a variety of reasons, we're bad at treating it.

On today's episode with pain expert Dr. Samina Ali, we go through what pain is, pain assessment, barriers to providing analgesia, and then discuss how we actually treat pain, using both non-pharmacologic and pharmacologic interventions