The JEMS Report

Is there a cultural difference between first responders and hospital staff? Hear from Amy and Herb Campbell and their perspectives on relationships, culture and their personal struggles with mental wellness throughout their careers.

How did curiosity and unanswered questions lead to the founding of a business and a passionate emergent leader? Find out on this week's Emergent Leadership episode with Julianne Stevenson of Sterling Credentials, LLC.

Where I'm coming from (compared to most of my colleagues):

• Master's in Public Health with a concentration in Health Policy from Yale Medical School.

Flu vaccine is bad example, most vaccines are ~80% effective

• One dose of the MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella. Two doses of MMR vaccine are 97% effective against measles and 88% effective against mumps. MMR is an attenuated (weakened) live virus vaccine.

2004

10%

2005

21%

2006

52%

2007

37%

2008

41%

2009

56%

2010

60%

2011

47%

2012

49%

2013

52%

2014

19%

2015

48%

2016

40%

2017

38%

2018

29%

2019

45% est

https://en.wikipedia.org/wiki/Influenza_vaccine#:~:text=A%202012%20meta%2Danalysis%20found,24%20months%20(66%20percent).

https://www.cdc.gov/vaccines/vpd/mmr/public/index.html#:~:text=One%20dose%20of%20MMR%20vaccine%20is%2093%25%20effective%20against%20measles,(weakened)%20live%20virus%20vaccine.

https://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html#:~:text=The%20vaccine%20is%2080%25%20to,receive%20the%20complete%20vaccine%20series.

https://www.cdc.gov/pertussis/about/faqs.html#:~:text=CDC%20estimates%20that%20in%20the,4%20years%20after%20getting%20Tdap.

Time to Develop Vaccine?

• Fastest time to develop vaccine: four years https://www.nytimes.com/interactive/2020/04/30/opinion/coronavirus-covid-vaccine.html

Historical Vaccine Problems?

• Cutter Incident (1955): Active polio administered to 200,000, with 200 cases of polio, and 10 deaths. This was a live vaccine, compared to the Pfizer and Moderna COVID vaccines that are Messenger RNA (mRNA) which is just a set of instructions that tells your body to make the protein that resembles part of the Coronavirus...(but not a Recombinant DNA vaccine like I said.)

https://www.cdc.gov/vaccinesafety/concerns/concerns-history.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1383764/

https://www.cnbc.com/2020/12/08/pfizer-moderna-covid-vaccine-side-effects-trials.html

COVID vaccine

• Does it work? Yes, it appears to work pretty well.  But no way is it going to be 95% effective in the real world....

What we don't know: 

• How many of the people in the study were exposed to the COVID virus?

What we do know: 

• You need two shots, and you're going to be sick after your second shot...."The most common solicited adverse reactions were injection site reactions (84.1%), fatigue (62.9%), headache (55.1%), muscle pain (38.3%), chills (31.9%), joint pain (23.6%), fever (14.2%); severe adverse reactions occurred in 0.0% to 4.6% of participants, were more frequent after Dose 2 than after Dose 1, and were generally less frequent in participants ≥55 years of age (≤ 2.8%) as compared to younger participants (≤4.6%).”  https://www.fda.gov/media/144245/download

What's the priority for EMS clinicians?

CDC COVID-19 vaccination program interim playbook

Jurisdictional considerations for Phase 1 subset groups may include, for example:

https://www.cdc.gov/vaccines/imz-managers/downloads/COVID-19-Vaccination-Program-Interim_Playbook.pdf

CISA guidance on essential critical infrastructure workers (explicitly listed in both categories)

Guidance on the Essential Critical Infrastructure Workforce: Ensuring Community and National Resilience in COVID-19 Response

Health/Public Health

--Emergency medical services workers including clinical interns.

--Prehospital workers included but not limited to urgent care workers.

Law Enforcement/Public Safety/Other First Responders

-Public, private, and voluntary personnel (front-line and management, civilian and sworn) in emergency management, law enforcement, fire and rescue services, emergency medical services (EMS), and security, public and private hazardous material responders, air medical service providers (pilots and supporting technicians), corrections, and search and rescue personnel.   

https://www.cisa.gov/publication/guidance-essential-critical-infrastructure-workforce

American College of Emergency Physicians supports EMS Clinicians being included in Category 1A

https://www.acep.org/corona/COVID-19-alert/covid-19-articles/acep-statement-on-ems-professionals-priority-access-to-the-covid-19-vaccine/

American Paramedic Association and the National EMS Managers Association supports EMS Clinicians receiving a COVID-19 vaccination "as soon as possible."  

https://www.nemsma.org/resource/resmgr/covid-19/covid-19_vaccination_conside.pdf

EMS included in Category 1A from AIPC and CDC, states may vary.

New York: "ICU, EMS, ED top priority" (other first responders were Phase 2)

https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/NYS_COVID_Vaccination_Program_Book_10.16.20_FINAL.pdf

New Jersey: "Who are "healthcare personnel" in Phase lA? Healthcare personnel are paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials. This includes any type of worker within a healthcare setting. Examples include, but are not limited to...personnel with variable venues like EMS, paramedics, funeral staff, and autopsy workers."

http://nj.gov/health/legal/covid19/12-10-20_PopulationPrioritizationPOD_memo.pdf

What should we do:

• Taking the vaccine is your individual choice based on your own circumstances

This week, the hosts of the EMS Handoff Podcast are joined by Ed Moreland, NRP. They cover a variety of topics, including advocating for the patient, profession and self.

Ed is a Metro Washington, DC native, a veteran of the United States Marine Corps and PA Army National Guardsman who has been actively engaged in EMS since 1990 when he ran his first EMS call as a volunteer in Montgomery County, PA. A Nationally Registered Paramedic, Ed has worked in a variety of EMS models, including non-profit, for-profit, hospital-based and rural systems.  He has served as a paramedic, supervisor, regulator, deputy chief and chief. He is currently working in senior leadership with a national medical transportation provider.  

Explore the stress of a California firefighter during strike teams and the different dynamics during deployment. Hear the optimistic perspective of Darnell Dodson II and how he keeps mentally, spiritually, emotionally and physically well.

"When you are at work, engage.... Learn your partners, even the one you don't get along with." -Darnell Dodson II

Join Brett Lyle as she speaks with emsimprov.com's founder and chief facilitator, Eric Chase, as they discuss how improv and creativity can be used as a tool for combating the everyday challenges EMS, first responders, law enforcement and healthcare providers face. They talk resilience, emotional and mental barriers, and Eric shares a few exercises he and his team employ to transform teams into communities of support.

In this week’s episode of the EMS Handoff, the crew talks with Wes Ogilvie, MPA, JD, NRP, LP, as he addresses the “lawyer boogeyman” issue, as well as documentation tips you can use today to improve your practice.

He also discusses Emergency Medical Treatment and Labor Act and its impact on patient care, specifically in stroke and heart attack cases. Being a patient advocate is of supreme importance and has implications medically, legally and ethically for your patient. 

Refusals are an often source of medical liability and it's all about consent. Wes discusses best practices for legal consent and the importance of capturing present mental capacity. 

Wes wraps up with scene safety considerations, including restraints and excess of force. 

Wes is a practicing attorney for the state of Texas. He has been in EMS since 2004 and a paramedic since 2007. His experience has been primarily volunteer with a variety of agencies in Central Texas and the Houston area, both suburban and rural.  

Wes is currently a paramedic/field training officer with West EMS and a paramedic with Huffman EMS. He has taught both initial and continuing education EMS courses. Throughout his career, he has been published in several EMS periodicals and co-authored the Medical-Legal chapter of Paramedic Care: Principles and Practice. In addition to both chasing and driving ambulances, he’s an active blogger. Visit his blog at www.theambulancechaser.com.

Effect of Out-of-Hospital Pediatric Endotracheal Intubation on Survival and Neurological Outcome: A Controlled Clinical Trial by Gausche, M et. al.

Paramedic Self‐efficacy and Skill Retention in Pediatric Airway Management by Youngquist, S.T. et. al.

Gausche Study: Criticism

1. Good study design, bad application and interpretation

-Intent to Treat Model, when 115 of 420 “Treat” patients had no intervention attempted at all, drives difference between groups to the null hypothesis.

Except that, of course, this was exactly what the study was about!

2. It is the system, not the clinician!

It is the system, not the clinician!: Endotracheal Intubation: Factors for Success:

Experience2

Prehospital ETI cannot automatically be compared to ETIs performed in the emergency department or in the operating theatre, for two main reasons. Firstly, the majority of prehospital ETIs are done in CA patients or after major trauma in challenging settings, while the majority of in-hospital ETIs are done in a controlled environment. Secondly, prehospital ETIs are challenged by a number of environmental factors that may influence the failure rates and increase adverse events, including....

-Restricted patient access

-Suboptimal patient and operator positioning

-Limited equipment 

-Difficult or hazardous operating environments

Equipment3,1

Physician median (range) ETI success rates were 0.991 (0.973, 1.000) (all had RSI)

A large recent study reported a doubling of the odds of intubation failure where no drugs were used.1

But they still used biased language, not comparing apples-to-apples for tools (let alone experience or exposure)...

"When comparing physicians to non-physicians, the corresponding median (range) ETI success rates were 0.991 (0.973, 1.000) versus 0.849 (0.491, 0.990)." 

Resources

1. The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis. https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1603-7.

Hear Chad Casons' story about his approach to mental wellness as a drill instructor and his perspective as a suicide prevention instructor.

Brett Lyle chats with Mountain Lakes EMS Council (NY) Executive Director Travis Howe about his path to leadership.

Welcome to Emergent Leadership where we connect with passionate leaders who just have to share their stories, perspectives, and most importantly, lessons learned.

The need is urgent, the events are critical, and the you of tomorrow is just an episode away!

Join the conversation: If you have a leadership topic, experience, or lesson learned you would like to share or hear more about, send an email at [email protected] or use and follow #emergentleadership to join the conversation. You can also connect to Brett directly through LinkedIn or follow her journey on YouTube.