The Overrun

Summary

In this conversation, Amy Eisenhauer discusses the qualities of a good leader in EMS and the importance of mentoring. She emphasizes the need for leaders to care about their people and listen to their needs and goals. Amy also highlights the value of having a mentor and a board of directors to support and guide one's career. The conversation touches on the challenges of leadership in EMS, including the difficulty of balancing the demands of the job and taking care of oneself. The importance of self-awareness, emotional intelligence, and work-life balance is emphasized. In this conversation, Amy Eisenhauer discusses the film 'Bringing Out the Dead' and its impact on the EMS community. She also talks about substance use disorder among firefighters and the need for leadership to address mental health issues. The conversation highlights the importance of education, support, and a culture of compassion in EMS. The hosts emphasize the need for effective leadership and the development of leadership skills at all levels of EMS. They also discuss the challenges of high turnover and the importance of investing in the well-being of EMS professionals.

Summary

In this episode, Dr. Zaf Qasim discusses advances in medical resuscitation and the future of cardiac arrest care. The conversation covers topics such as compression-only CPR, the controversy surrounding head-up CPR, the use of band and piston-driven devices, and the potential of extracorporeal cardiopulmonary resuscitation (eCPR). The importance of good dispatch and patient selection is emphasized as key factors in improving outcomes. The episode concludes with a discussion on the need for a paradigm shift in how we approach cardiac arrest care. Then, Dr. Zaf Qasim discusses updates in trauma resuscitation. The focus is on the use of whole blood in trauma resuscitation, the importance of meaningful intervention in the pre-hospital setting, the role of ultrasound in trauma resuscitation, and the use of ketamine and fentanyl in RSI and trauma scenarios. Dr. Qasim emphasizes the need for resuscitation before intubation and the importance of controlling bleeding and restoring volume. He also highlights the potential of technology, such as ultrasound and sending real-time information to the trauma team. The conversation ends with a call for hope in the future of pre-hospital medicine.

Takeaways

Advances in medical resuscitation have focused on basic life support (BLS) interventions, such as compression-only CPR and early defibrillation.
The effectiveness of head-up CPR in improving outcomes is still under debate, and more research is needed to determine its role in human resuscitation.
While band and piston-driven devices have shown variable results in improving outcomes, they can be useful logistically in certain situations.
Extracorporeal cardiopulmonary resuscitation (eCPR) shows promise for refractory ventricular fibrillation patients, but its implementation requires system-wide changes and good patient selection.
Good dispatch and patient selection are crucial in improving cardiac arrest care and should be prioritized in system design and protocols.
A paradigm shift is needed to move from a one-size-fits-all approach to cardiac arrest care to a more individualized approach based on patient outcomes and preferences.

The use of whole blood in trauma resuscitation is gaining traction and has shown to improve outcomes.
Meaningful intervention in the pre-hospital setting, such as giving blood and controlling bleeding, is crucial for improving trauma outcomes.
Ultrasound can provide valuable information in trauma resuscitation, including assessing the heart and identifying pericardial effusion.
Ketamine is still a great drug for RSI in trauma, but dosage and patient physiology should be considered.
Technology, such as ultrasound and real-time information sharing, has the potential to enhance trauma resuscitation.
There is hope for the future of pre-hospital medicine, with a focus on improving pre-hospital interventions and outcomes.

In this episode, Dr. Ken Milne discusses two studies related to emergency medicine. The first study examines the use of small adult ventilation bags in out-of-hospital cardiac arrest. The study found that small bags were associated with a lower rate of return of spontaneous circulation (ROSC) compared to standard bags. However, this was an observational study and more research is needed to draw definitive conclusions. The second study explores the use of nitroglycerin in right ventricular myocardial infarctions (MIs). Traditionally, nitroglycerin has been contraindicated in these cases, but the study found no significant difference in adverse events when nitroglycerin was used. Again, more research is needed to confirm these findings. Overall, these studies highlight the importance of evidence-based practice and the need for further research in emergency medicine. 

A Block

Dr. Tristan Glenn discusses diversity, equity, and inclusion (DEI) in the context of EMS. He emphasizes the importance of understanding and valuing individual identities and lived experiences. Microaggressions are explored as harmful behaviors that communicate negative appraisals of individuals. The lack of diversity in EMS is highlighted, and the need for purposeful recruitment and community engagement is discussed. Dr. Glenn suggests embedding DEI principles throughout the entire organization and utilizing technology, such as mixed reality simulations, for training. Overcoming resistance to DEI initiatives requires cultivating a consciousness of the impact each individual has on creating an equitable and inclusive environment.

Takeaways

DEI involves understanding and valuing individual identities and lived experiences.

Microaggressions are harmful behaviors that communicate negative appraisals of individuals.

Recruitment and community engagement are essential for increasing diversity in EMS.

Embedding DEI principles throughout the organization and utilizing technology can support DEI initiatives.

Overcoming resistance to DEI requires cultivating a consciousness of the impact each individual has on creating an equitable and inclusive environment.

B Block

Dr. Alicia Rouff joins the podcast to discuss diversity, equity, and inclusion (DEI) in emergency medicine and EMS. The conversation explores the current state of DEI in the field, the challenges faced by underrepresented groups, and the need for proactive change. The importance of recruitment and creating opportunities for people of color in EMS is highlighted. The discussion also emphasizes the importance of cultural understanding and respect when interacting with patients from diverse backgrounds. The episode concludes with a message of showing up as your authentic self and promoting kindness in healthcare.

Takeaways

DEI in emergency medicine and EMS is an ongoing challenge that requires proactive change.

Recruitment and creating opportunities for people of color in EMS is crucial for increasing diversity in the field.

Cultural understanding and respect are essential when interacting with patients from diverse backgrounds.

Showing up as your authentic self and promoting kindness in healthcare can make a positive impact.

Summary

Dr. Mike Berkenbush joins the podcast to discuss the challenges in EMS education on differentiating chest pain. The conversation highlights the need for a broader approach to chest pain, beyond just focusing on heart attacks. The importance of field impression and open-ended questions in assessment is emphasized. The discussion also explores the physiological differences in chest pain presentation and the potential mimics of chest pain, such as pericarditis and aortic dissection. The role of honesty and patient education, as well as the potential value of point-of-care troponin testing and AI in EKG interpretation, are also discussed.

Takeaways

EMS education should focus on a broader approach to chest pain, beyond just heart attacks.

Field impression and open-ended questions are crucial in assessing chest pain.

Physiological differences and potential mimics of chest pain should be considered.

Honesty and patient education are important in managing patient expectations.

Point-of-care troponin testing and AI in EKG interpretation have potential value in pre-hospital care.

Chapters

00:00 Introduction and Background

00:42 The Problem with EMS Education on Chest Pain

03:03 Recognition of Pre-Hospital Care in Cardiac Cases

04:01 Focus on Time-Sensitive Interventions

05:00 The Need for a Broader Approach to Chest Pain

06:07 The Challenge of Teaching Differential Diagnosis

07:03 Guiding EMTs in Assessing Chest Pain

08:13 The Importance of Field Impression

09:00 The Dangers of Casting a Wide Net

10:16 Physiological Differences in Chest Pain Presentation

11:19 Mimics of Chest Pain: Pericarditis and Aortic Dissection

12:25 Other Mimics: Cholecystitis and Pneumonia

13:00 Differentiating Chest Pain from Other Conditions

14:14 The Importance of Describing Types of Pain

16:11 The Role of Open-Ended Questions in Assessment

18:07 The Challenge of Teaching Assessment Skills

19:06 The Impact of EMS Communication on Patient Expectations

20:28 The Importance of Honesty and Patient Education

22:43 The Potential Value of Point-of-Care Troponin Testing

25:28 The Role of AI in EKG Interpretation

26:49 The Potential for BLS Providers to Perform 12-Lead EKGs

27:11 Conclusion

https://www.sciencedirect.com/science/article/pii/S2773232023000081

https://www.sciencedirect.com/science/article/pii/S0735675721000279

Then, Ed and Dan discuss the challenges and considerations surrounding the assessment and treatment of chest pain by BLS providers. They explore the tendency to over-triage chest pain cases and the need for a more nuanced approach. They emphasize the importance of field provider information in guiding patient care and highlight the role of EMS in the overall healthcare system. The conversation also touches on the need for ongoing learning and skills development, as well as the value of knowing the receiving facility. The episode concludes with final thoughts on the topic.

Takeaways

Avoid over-triaging chest pain cases and consider a more nuanced approach to differential diagnoses.

Field provider information is crucial in guiding patient care and can make a difference in the patient's trajectory through the emergency department.

EMS providers should recognize their role in the healthcare system and the importance of their assessments and findings.

Continued learning and skills development are essential for providing better care to patients.

Knowing the receiving facility and building relationships with the staff can improve patient outcomes.

Balancing the fear of litigation with effective assessment is important, and acting in the best interest of the patient is key.

BLS providers are expected to know more and do more in the evolving healthcare landscape.

Choosing the right center for patients based on their needs and available resources is crucial.

A thorough assessment, understanding the patient's story, and considering associated symptoms are essential in evaluating chest pain cases.

Dr. Peter O'Meara discusses the concept of paramedic practitioners and the need for higher education and professional recognition in the field. He compares paramedic practice in the US and Australia, highlighting the similarities in patient populations and the importance of a unified profession. The attrition rates and lack of a career ladder in the US are identified as issues that can be addressed through education and professional development. The role of NEMSAC and previous recommendations for degree programs are discussed, as well as the opposition from organizations like NAEMT. The importance of having a voice and separating paramedics from agencies and the need for modernization in EMS is emphasized. The conversation concludes with discussing paramedic terminology in Australia and the significance of publishing and discussing these topics.

The concept of paramedic practitioners and the need for higher education and professional recognition in the field

Comparison of paramedic practice in the US and Australia, highlighting similarities and the importance of a unified profession

The attrition rates and lack of career ladder in the US can be addressed through education and professional development

The importance of having a voice for paramedics and separating paramedics from agencies

Then, 

In this conversation, Louis Imperatrice, the National Manager of Clinical Excellence for DACA, discusses the absence of a clinical ladder and degrees in paramedicine, which he believes is detrimental to the field. He highlights the limitations of EMS and the lack of upward movement, leading to the loss of professionals. The fragmented nature of EMS systems and the need for change are also discussed. Imperatrice emphasizes the need for federal funding and lobbying in EMS, as well as the importance of modern-day leadership and education. He suggests the implementation of clinical and management tracks in EMS education to improve the industry.

Takeaways

The absence of a clinical ladder and degrees in paramedicine is detrimental to the EMS field, leading to a lack of upward movement and the loss of professionals.

EMS systems are fragmented, and there is a need for change and standardization.

Federal funding and lobbying are necessary to support EMS and promote necessary changes.

Modern-day leadership and education are crucial in improving the EMS industry.

Dr. O'Meara's Paper

Louis Imperatrice's Papers

Summary

In this episode, Ed and Dan discuss several topics related to medicine and EMS in 2023. They start by reviewing a study on the use of nitroglycerin in acute pulmonary edema and congestive heart failure, highlighting its positive effects on blood pressure and oxygenation. They then move on to a comparison of succinylcholine and rocuronium in rapid sequence intubation (RSI), concluding that the choice of paralytic agent may not significantly impact outcomes. They also discuss a case in which a paramedic impersonated a doctor in Louisiana, highlighting the need for patient advocacy and responsible clinical practice. They conclude by expressing excitement for future episodes and inviting listeners to share their stories.

Takeaways

Nitroglycerin can be effective in improving outcomes in acute pulmonary edema and congestive heart failure.
The choice between succinylcholine and rocuronium in RSI may not have a significant impact on first pass success rates.
Patient advocacy and responsible clinical practice are crucial in preventing incidents of impersonation and ensuring patient safety.
Hindsight is 20-20, and it is important to learn from past mistakes and continuously evolve in the field of medicine and EMS.

Chapters

00:00 Introduction
00:26 Discussion of Nitroglycerin in Acute Pulmonary Edema Link Link
11:22 Comparison of Succinylcholine and Rocuronium in RSI Link
22:34 Case Study: Elijah McClain Case Link
31:04 Case Study: Paramedic Impersonates Doctor in Louisiana Link
36:01 Conclusion and Future Plans

Dan Gerard is the president of the International Association of EMS Chiefs, who authored a position statement in August of 2023 supporting the use of whole blood as the standard of care for hemorrhagic injury. IAEMSC joins a growing list of national and international organizations that support this change. In this interview, Ed and Dan talk to Dan Gerard who explains the rationale behind the position statement and the change they hope to make with the position statement.

IAMESC Paper can be read here

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This episode was recorded on October 30, 2023.

Drs. Mike and Mike join Ed to discuss updates in prehospital stroke care. Are we using the right stroke scale for our patients? Are we taking them to suitable hospitals? The gang discusses stroke care in 2023 and where we can go from here.

From the episode notes:

Treatment of LVO patients

Thrombolytics (tPA, tenecteplase)

Mechanical thrombectomy discussion

a)  NNT 2.5

b)  NNT= # needed to treat (how many people receive medicine before there is a benefit)

Aspirin NNT is 64

Benefits of mechanical thrombectomy

a)  Significantly reduced mRS

b)  Longer treatment window (up to 24 hours)

c)  Net monetary benefit $95-175 million USD(1) Discuss net monetary benefit(2) tPA alone $72-135 million USD

d)  Gained quality of life years 2

Potential Harms

a)  New intracranial hemorrhage

b)  Access site problems

c)  New embolization

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Jason Patton is a firefighter with 17 years of experience that discusses EMS and Firefighting misadventures on his Tiktok channel (@firedepartmentchronicles). Jason joins Ed, Jess, and Kevin to discuss how we can use social media to advance the message of EMS and improve the industry.

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