The JEMS Report

Hear an important JEMS Talk on ethics in emergency medical services and mobile medicine.

Items Discussed

• The belief that field clinicians can/should be trusted to make ethical and moral decisions.

• Are we educating clinicians on how to make such assessments, or are we training clinicians to paint by number/practice by rote protocol?

• Are “thinking” vs. a scientifically informed, protocolized approach mutually exclusive—or can they inform one another?

• Are we training clinicians to develop their moral compasses?

• What happens when science suggests that the moral or ethical thing to do is the suboptimal choice (and by what yardstick is that judged)?

Panelists

Christopher Colwell, MD; chief of Emergency Medicine at Zuckerberg San Francisco (CA) General Hospital and Trauma Center

Michael Dailey, MD; director of Prehospital Care Services & Education at Albany (NY) Medical Center

Abby Dotson, PHD; executive director at the National POLST Collaborative, director of the Oregon POLST Registry

Jonathon Feit, MBA; co-founder and chief executive of Beyond Lucid Technologies, Inc.

Keep the conversation going by using #JEMSTalk on social media.

Paramedics in a rural setting respond to a young man who is unresponsive, barely breathing, has pinpoint pupils and has fresh needle marks along his arm veins. Recognizing this as an opiate overdose they assist ventilations and attempt to administer IV naloxone, but have difficulty starting an IV line.

They heard about nasal naloxone, so they squirt a vial of naloxone into the patient’s nose with a syringe (1 ml of 0.4 mg). It does not have any effect but they manage to establish an IV and administer another 0.4 mg IV. The patient awakens. Based on this experience, they decide nasal naloxone does not work and resist adoption of the concept during future discussions.

Read the full article here.

Congenital syphilis is a severe and often life-threatening infection seen in infants whose mothers were infected.

Firefighter/Paramedic Kate Freshman joins the Not A-Fib Podcast to discuss providing care while being recorded live on "Live Rescue" on A&E, and how she became involved with Women in Fire, which led her to create "Fire Up St. Louis.”

They also discuss her work on a peer support committee, working to channel members to the right resources to address mental health issues before they are in crisis.

This podcast reviews RSI research related to paramedics with nurse anesthetist Penny Chiasson. She is also a hypnotherapist with Genesis Hypnosis.

Article discussed: Alzaatreh, M. Y., Alsadi, M. R., Alkhsealat, Y., Alhemedi, M., & Alrabab’a, M. H. (2022). Pre-hospital rapid sequence induction by paramedics: A scoping review. Journal of Emergency Medicine, Trauma & Acute Care (5) 40.

Connections: If you want to connect with Penny Chiasson you can reach her at [email protected] and to connect with the show, reach out through www.ProfessorBram.com.

Eric Chase and Asbel Montes share stories of grace. Accountability still exists and grace allows for forgiveness. Pursue excellence from a place of grace.

Manual ventilation is a basic skill that every emergency medical services (EMS) responder is expected to perform proficiently. Improper manual ventilation may result in significant morbidity; however, there is no feedback mechanism or method of control for the volume, pressure, or frequency during manual ventilation. In this study, we aimed to quantify the ventilation parameters of manually delivered breaths using a simulated lung.

Read the full article here.

This podcast discusses the latest research in EMS bleeding control with Will Chapleau who is a paramedic, nurse, educator and writer.

Article discussed: IPMI. (October 1, 2023). International Prehospital Medicine Institute Literature Review, October 2023. Journal of Emergency Medical Services. https://www.jems.com/patient-care/international-prehospital-medicine-institute-literature-review-october-2023/

Eric Chase talks with Daniel Sundahl in a wide-ranging conversation, which includes post-traumatic growth.

Respiratory distress is one of the most common emergencies resulting in a 911 call. Whether it be an asthma attack, chronic obstructive pulmonary disease (COPD) exacerbation or complication of pneumonia, difficulty breathing is a symptom that prehospital providers encounter quite frequently.

Most patients that call for emergency medical services for breathing problems have known-disease pathologies that are respiratory in nature. For example, patients with asthma, an obstructive pulmonary disorder, often present with chest tightness, wheezing and difficulty breathing.

Nebulized albuterol and supplemental oxygen are normally first-line interventions for the typical asthma attack. Providers understand the mechanism of action for those medications since they aim to correct the impaired respiratory processes as a result of disease.

Read the full article here.