The Overrun

Summary

In this episode of the Overrun Podcast, Ed and Dan engage with Judyth Brown, an experienced instructional designer, to discuss the challenges and opportunities in EMS education. They explore the differences between instructing and educating, the importance of effective instructor training, and the need for a focus on entry-level competence. Judyth emphasizes the significance of integrating real-life experiences into teaching and the detrimental effects of standardized testing on education quality. The conversation also highlights the critical need for documentation training and the role of social-emotional learning in preparing EMS professionals for the field. This conversation delves into the challenges and opportunities in EMS education, focusing on the importance of social-emotional learning, the application of Bloom’s Taxonomy, and the need for a shift towards quality education over quantity. The speakers discuss the role of instructors in fostering a supportive learning environment and the necessity of adapting teaching methods to better prepare students for real-world challenges in emergency medical services.

Keywords

EMS education, instructional design, adult learning, teaching methods, entry-level competence, standardized testing, documentation training, social-emotional learning, instructor training, critical thinking, education, social-emotional learning, Bloom’s taxonomy, EMS training, instructor development, emotional intelligence, teaching methods, professional values, effective learning, instructor ego

Chapters

00:00 Introduction to EMS Education Challenges

03:03 The Role of Experience in Teaching

05:52 Identifying Effective Instructors

09:10 Defining Entry-Level Competence

12:07 The Impact of Standardized Testing

14:57 The Importance of Documentation Training

17:57 Addressing the Dumbing Down of EMS Education

21:02 Social-Emotional Learning in EMS

24:00 Conclusion and Future Directions

24:24 Overcoming Fear in Education

29:18 The Importance of Social-Emotional Learning

35:07 Understanding Bloom’s Taxonomy

43:10 Quality Over Quantity in Education

49:15 The Need for Change in EMS Education

Takeaways

The difference between instructing and educating is crucial in EMS. Instructors often lack training on how to teach effectively. Real-life experiences should be integrated into EMS education. Standardized testing can detract from meaningful learning. Entry-level competence should focus on practical skills and critical thinking. Documentation is a vital skill that is often overlooked in training. Social-emotional learning is essential for effective patient interactions. Instructors should define what they want to see in graduates. The EMS education system needs to evolve beyond outdated practices. Investing in instructor training is key to improving EMS education. Lowering the effective filter in education enhances learning. Gamification and challenging scenarios can improve engagement. Instructors must overcome their ego to facilitate learning. Social-emotional learning is crucial for professional development. Teaching values is essential for ethical decision-making in EMS. Bloom’s Taxonomy helps structure the learning process effectively. Rote memorization is insufficient for real-world application. Quality of education should be prioritized over duration. Instructors need to be aware of their own shortcomings. Change in EMS education is necessary for better outcomes.

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Summary

In this episode of the Overrun Podcast, Ed Bauter, Dan Schwester, and Dr. Michael DeFilippo discuss the recent advancements in dual sequential defibrillation for refractory ventricular fibrillation (VFib). They explore the importance of understanding the nuances between refractory and recurrent VFib, the significance of patient history in cardiac arrest situations, and the latest findings from the DOSE-VF trial. The conversation emphasizes the need for operational readiness, effective communication among medical teams, and the physics behind defibrillation techniques. The episode concludes with a discussion on the protocols for terminating resuscitation efforts and addressing concerns about equipment damage during advanced life support procedures.

Takeaways

Chapters

00:00 Introduction to Dual Sequential Defibrillation

02:36 Understanding Refractory VFib and Its Treatment

05:21 The Importance of Defibrillation Techniques

07:59 Literature Review on Defibrillation Strategies

11:01 Key Findings from Recent Studies

13:50 Implications for Practice and Future Research

20:00 Understanding Defibrillation Mechanics

25:19 Optimizing Cardiac Arrest Response

34:49 Determining Resuscitation Termination

Keywords

Dual Sequential Defibrillation, Refractory VFib, Cardiac Arrest, Resuscitation Science, Defibrillation Strategies, DOZ-VF Trial, Emergency Medicine, Pre-Hospital Care, Medical Protocols, Patient Outcomes

Paper available at: https://www.airmedicaljournal.com/article/S1067-991X(25)00002-1/fulltext

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TT: The Overrun

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Summary

In this year-end special episode of The Overrun podcast, Ed Bauter, Dr. Mike DeFilippo, and Dr. Michael Stone discuss five significant papers from the year that impact emergency medical services (EMS). The conversation covers non-invasive ventilation for pre-oxygenation during intubation, the early administration of adrenaline in out-of-hospital cardiac arrest, and the effectiveness of different routes of drug administration in cardiac arrest scenarios. The discussion emphasizes the importance of adapting practices based on new research findings and the need for further studies to validate these practices in various EMS settings. In this conversation, the speakers discuss multiple aspects of EMS practices, focusing on cultural differences in emergency medical services, the debate between IV and IO access during cardiac arrest, the cost-effectiveness of whole blood in trauma care, and strategies to improve cardiac arrest survival rates through training and system-level changes. They emphasize the importance of evidence-based practices and the need for ongoing education and adaptation in EMS protocols.

Takeaways

Non-invasive ventilation can reduce hypoxemia during intubation.

Practice changes in EMS can take time to implement.

Patient selection is crucial in emergency medicine.

The route of drug administration can impact survival rates.

Bundled care approaches may improve cardiac arrest outcomes.

Research findings should be adapted to local EMS practices.

Timely access to medications is critical in cardiac arrest.

Epinephrine’s role in cardiac arrest management is still debated.

Innovative studies can lead to significant changes in practice.

Cognitive aids can help guide emergency medical procedures. Cultural differences in EMS practices can impact patient outcomes.

The debate between IV and IO access in cardiac arrest is ongoing and complex.

Whole blood may offer significant cost savings and improved patient outcomes in trauma care.

Training and simulation are crucial for improving cardiac arrest survival rates.

Collaboration among different emergency services can enhance training effectiveness.

Cost-effectiveness is a key factor in implementing new EMS protocols.

Regular CPR skills assessments can lead to better patient outcomes.

Data-driven decisions are essential for EMS protocol development.

Engaging administrators with financial data can facilitate changes in EMS practices.

Continuous education and adaptation are necessary for improving EMS effectiveness.

Chapters

00:00 Introduction to Year-End Review

01:09 Non-Invasive Ventilation and Pre-Oxygenation

09:32 Early Administration of Adrenaline in Cardiac Arrest

20:24 Routes of Drug Administration in Cardiac Arrest

23:48 Cultural Differences in EMS Practices

27:41 The Debate: IV vs. IO in Cardiac Arrest

28:32 Cost-Effectiveness of Whole Blood in Trauma Care

38:57 Improving Cardiac Arrest Survival Rates

47:29 Conclusion and Future Directions

Keywords

EMS, non-invasive ventilation, pre-oxygenation, cardiac arrest, adrenaline administration, drug routes, medical research, practice change, emergency medicine, EMS, cardiac arrest, IV, IO, whole blood, trauma care, survival rates, cost-effectiveness, training, CPR

Papers: 

PREOXI: https://pubmed.ncbi.nlm.nih.gov/38869091/

Route of Administration: https://pmc.ncbi.nlm.nih.gov/articles/PMC7616768/

Cardiac Arrest Survival with Practice: https://pubmed.ncbi.nlm.nih.gov/38837166/

Cost Savings- Whole Blood: https://pubmed.ncbi.nlm.nih.gov/38591174/#full-view-affiliation-1

IM Epinephrine: https://pubmed.ncbi.nlm.nih.gov/38857847/

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Summary

 In this conversation, Dr. Devin Dromgoole discusses the evolving role of ultrasound in emergency medical services (EMS). He highlights the feasibility, cost, and training required for EMS providers to effectively use ultrasound in pre-hospital settings. The discussion covers practical applications of ultrasound, including its use in trauma, undifferentiated shortness of breath, and vascular access. Dr. Dromgoole also addresses the resistance to adopting new technologies in EMS and emphasizes the importance of advancing practices for better patient care. Takeaways Ultrasound is becoming more accessible and affordable for EMS.

Advancements in EMS practices are crucial for improving patient care. Then:  Dr. Garrett Cavaliere discusses critical topics in emergency medicine, focusing on aortic dissections and traumatic cardiac arrest. He emphasizes the challenges in diagnosing aortic dissections, the importance of recognizing atypical presentations, and the need for aggressive pain management. The discussion transitions to traumatic cardiac arrest, where Dr. Cavaliere critiques standard resuscitation protocols, advocating for alternative interventions such as early blood administration and avoiding chest compressions in certain scenarios. He also addresses operational challenges in implementing whole blood transfusions in pre-hospital settings, highlighting the logistical and financial considerations that impact emergency care. Takeaways Aortic dissections are frequently misdiagnosed in various medical settings. Recognizing atypical presentations of aortic dissections is crucial for timely diagnosis. Aggressive pain management is essential in treating aortic dissection patients. Standard chest compressions may be harmful in traumatic cardiac arrest cases. Early blood administration is critical in traumatic arrest situations. Whole blood transfusions can significantly improve patient outcomes in trauma care. Operational challenges exist in implementing whole-blood protocols in EMS. Avoiding normal saline in trauma resuscitation can prevent further complications. Effective airway management is vital in traumatic cardiac arrest cases. Understanding the physiological impacts of resuscitation strategies is key to improving outcomes. 

Then:  Ed and Dan discuss their experiences at the National Conference on EMS in Atlantic City. They highlight the inspiring talks, particularly from Chief John Moon, and the importance of networking and learning opportunities at such events. They also address the challenges of conference structures, including scheduling conflicts and the need for better dissemination of information among attendees. Takeaways The conference featured strong educational presentations and inspiring talks. Networking is a crucial yet often overlooked aspect of conferences. Access to data and information is vital for EMS providers. Conferences should aim to provide a comprehensive learning environment. The ethical considerations of patient care were discussed in depth. Ultrasound and whole blood use in EMS are emerging topics. Attendees often face scheduling conflicts that limit their learning. Recording talks for later access could enhance educational benefits. Organizational representation at conferences can improve information sharing.

Overall, the conference was a positive experience with room for improvement. 

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Summary

In this episode of the Overrun Podcast, the hosts discuss the importance of EMS education, the role of conferences, and the impact of misinformation in the field. They critique the Stand and Deliver program and address the need for evidence-based practices while navigating biases in EMS. The conversation emphasizes the importance of mentorship and affirming the humanity of patients in pre-hospital care.

Takeaways

CPR training can save lives and anyone can learn it.

Conferences provide essential networking and educational opportunities for EMS professionals.

The Stand and Deliver program allows new speakers to present at conferences.

Misinformation in EMS can lead to poor patient care.

Toxic heroism in EMS can negatively impact provider mental health.

Evidence-based practice is crucial for effective patient care.

Navigating biases is essential for improving EMS education.

Mentorship is key to developing the next generation of EMS providers.

Affirming the humanity of patients is a vital part of EMS work.

The future of EMS education requires a shift in mindset towards healthcare provision.

Keywords

EMS, education, conferences, Stand and Deliver, toxic heroism, misinformation, CPR, paramedic, healthcare, patient care

Chapters

00:00 Introduction to EMS World Conference Experiences

00:43 The Value of Conferences in EMS

03:19 Networking and Knowledge Exchange at Conferences

06:14 The Unique Crash and Learn Conference

09:34 Challenges of Quality Control in EMS Education

32:07 Controversial Figures in EMS Education

35:02 The Impact of Misinformation in EMS

37:35 Addressing Biases in EMS Education

40:40 The Role of Humor in EMS

43:30 Hope and Progress in EMS Education

01:08:33 Introduction to Jenna and the EMS Discussion

01:09:48 Concerns About Misleading Educational Materials

01:13:16 The Impact of Generational Attitudes in EMS

01:15:45 Addressing Toxic Attitudes in New Medics

01:18:06 The Importance of Accurate Patient Assessment

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Summary

In this conversation, Dan Schwester interviews Dan Gerard, a senior medic, about the generational divide in EMS and the importance of learning from experienced medics. They discuss the need for mentorship and the transfer of knowledge from senior medics to younger generations. They also highlight the importance of interpersonal dynamics, observational skills, and physical exam techniques in patient care. The conversation emphasizes the value of understanding the ‘whys’ behind protocols and the need to break down barriers between different generations of medics. In this conversation, Dan Gerard discusses the importance of physical examination in paramedicine and the value of learning from senior medics. He then delves into his article on emergency medical services (EMS) as a human right. He argues that EMS should be recognized as an essential service and a public good, and that it should be publicly financed to ensure equal access for all. He emphasizes the need for transparency and accountability in the delivery of EMS and highlights the importance of providing high-quality care to every individual in the community.

Keywords

EMS, generational divide, mentorship, transfer of knowledge, interpersonal dynamics, observational skills, physical exam, protocols, paramedicine, physical examination, senior medics, EMS, emergency medical services, human right, essential service, public good, publicly financed, transparency, accountability, high-quality care

Takeaways

There is a generational divide in EMS between older and younger medics, but it is not representative of the entire profession.

Experienced medics have valuable knowledge and skills that can be passed on to younger generations through mentorship.

Interpersonal dynamics, observational skills, and physical exam techniques are important aspects of patient care that younger medics can learn from senior medics.

Understanding the ‘whys’ behind protocols and procedures is crucial for providing effective and efficient care.

Breaking down barriers between different generations of medics can lead to a more collaborative and cohesive EMS community. Physical examination is an essential part of paramedicine and can provide valuable insights into a patient’s condition.

Learning from senior medics can offer valuable clinical pearls and improve clinical practice.

EMS should be recognized as an essential service and a human right, ensuring equal access for all individuals.

Public financing of EMS can help ensure quality care and accountability.

Transparency in the delivery of EMS is crucial for the community to understand the value they are receiving.

Providing high-quality care to every individual in the community is essential for positive outcomes.

Sound Bites

“There is definitely a dichotomy between the younger generations and the older generations.”

“Every new EMT, every new paramedic should have a mentor.”

“Establishing rapport with patients and other first responders is critically important.”

“You should have good perfusion down there. Now, this might be an ongoing problem, you know, like your feet are always cold, you know, but like if they’re like a little mottled or cyanotic, that’s kind of telling me that you have like a circulation issue that’s going on here.”

“Talk to your senior people, go get a cup of coffee, go get a soda, iced tea, whatever. Sit around with them, identify the ones that you know that are actually doing the job and enjoy doing the job, and talk to them.”

Chapters

00:00 Introduction and Background

03:07 The Generational Divide in EMS

09:33 The Importance of Interpersonal Dynamics

13:07 Enhancing Observational Skills

18:07 Understanding the ‘Whys’ Behind Protocols

23:12 Breaking Down Barriers in the EMS Community

27:20 The Importance of Physical Examination in Paramedicine

30:46 Learning from Senior Medics

36:08 EMS as a Human Right: Recognizing the Essential Service

41:43 Public Financing of EMS: Ensuring Equal Access and Quality Care

49:53 Transparency and Accountability in the Delivery of EMS

Paper: 

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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.

Keywords

EMS leadership, mentoring, qualities of a good leader, listening, career development, work-life balance, emotional intelligence, Bringing Out the Dead, EMS, substance use disorder, mental health, leadership, education, compassion, turnover, investment

Takeaways

A good leader in EMS cares about their people and listens to their needs and goals. Having a mentor and a board of directors can provide guidance and support in one’s career. Leadership in EMS requires self-awareness, emotional intelligence, and the ability to balance the demands of the job with personal well-being. The importance of work-life balance and taking care of one’s mental, social, and emotional health is crucial for leaders in EMS. The film ‘Bringing Out the Dead’ resonated with EMS professionals as it depicted the realities of their work and the challenges they face. Substance use disorder is a significant issue among firefighters and EMS providers, and it is essential to address it through education, support, and treatment. Effective leadership is crucial in EMS, and leaders should prioritize the well-being of their staff and create a culture of compassion and support. Investing in the development of leadership skills at all levels of EMS is necessary to improve organizational longevity and address the challenges faced by the industry.

Sound Bites

“A good leader in EMS cares about their people.” “Having a mentor and a board of directors can provide guidance and support.” “Leadership in EMS requires self-awareness and emotional intelligence.” “Somebody sees the work we’re doing.” “This is our life now.” “Alcohol use disorder among firefighters”

Chapters

00:00 Introduction and Discussion on Leadership in EMS 01:09 Qualities of a Good Leader 04:19 Self-awareness and Emotional Intelligence in Leadership 05:18 Balancing Work and Personal Well-being 26:37 Fatigue and Substance Use Disorders in EMS 35:17 The Impact of ‘Bringing Out the Dead’ 37:28 Addressing Substance Use Disorder 38:29 The Importance of Effective Leadership 42:16 Investing in the Well-being of EMS Professionals

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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.

Summary

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.

Takeaways

Small adult ventilation bags may be associated with a lower rate of return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest, but more research is needed to confirm this finding. The use of nitroglycerin in right ventricular myocardial infarctions (MIs) may not be as contraindicated as previously thought, but further research is needed to determine its safety and efficacy. These studies highlight the importance of evidence-based practice and the need for more high-quality research in emergency medicine. Clinicians should consider the limitations of observational studies and use their clinical judgment when interpreting and applying the findings. Discussion and collaboration among healthcare professionals are crucial for updating protocols and guidelines based on emerging evidence.

Then, Ed and Dan discuss two recent studies. The first study examines the use of small bags in cardiac arrest resuscitation, while the second study explores the use of nitroglycerin in right ventricular myocardial infarction (RVMI). The hosts analyze the findings of these studies and discuss their implications for clinical practice. They emphasize the importance of conducting further research and encourage EMS providers to get involved in research projects. The hosts also highlight the need for open communication with medical directors and other healthcare professionals to drive positive change in protocols and treatment approaches.

Chapters

Introduction and Overview Reevaluating the Use of Nitroglycerin in Right Ventricular Myocardial Infarctions

Introduction and Discussion of Small Bags in Cardiac Arrest Resuscitation

The Importance of Research and Collaboration in EMS

Keywords small bags, cardiac arrest resuscitation, nitroglycerin, right ventricular myocardial infarction, RVMI, research, clinical practice, EMS providers, medical directors, protocols, treatment approaches, emergency medicine, cardiac arrest, ventilation bags, nitroglycerin, observational study, myocardial infarction, evidence-based practice

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7234703/

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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.