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.
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
Follow The Overrun on TikTok @TheOverrun
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.
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.
Follow The Overrun on IG: @OverrunProductions
Follow The Overrun on TikTok: @TheOverrun
Follow The Overrun on Youtube: Youtube.com/theovverun
Follow Jason Patton on Tiktok: @Firedepartmentchronicles
Saying Goodbye to Rookieworld: Thoughts after Recertification
Recertification cycles where I’m from occur every three years. To some, three years may seem like a long time, but to an EMT like me, those three years flew by.
When I first got my certification, the US was between waves of a pandemic. My first patients went into cardiac arrest after EMS arrival. I’ve served multiple different communities in my state, and have had to adapt to their customs and languages.
I’d be lying if I said this was an easy thing to do.
But, on the upside, it definitely gets easier. You get into your flow with your partner of how you manage a scene, and everything else that we’re taught starts to become second nature. When I get on a scene, I have a job to do, which is to provide the best care I can. But I also have to self-acknowledge that I’m a human with emotions. It’s a weird feeling after a pronouncement where you, your partner, and the paramedics know that you did everything you could. After that, you walk away, mentally resetting before your next job, and yet, the family is screaming at you to keep trying, to bring them back, to do more.
These calls were the ones I’ve struggled with, even from the very beginning.
In Rookieworld, I talked about my first cardiac arrest and what changed between my first truly critical patients, where I was conflicted about showing my emotions. Am I allowed to cry after a bad call, or after a call that goes wrong? How will other people in this job view me if I do?
Now, when I see a critical patient, I still feel those emotions, but not to the extent that I did when I first started.
Is it possible to be sympathetic in these situations while still remaining professional? I think so.
But sometimes in these instances I feel like I’m losing the part of me that cares. No matter what, I’m still giving my patient the best care I can. But is that enough? What more can I do?
I’ve been lucky in having a great support system in other EMTs, paramedics, and even doctors that have been in my shoes before. They’ve always been able to give me good advice, especially when I’m feeling like this. They highlight my compassion, while also acknowledging that it’s human nature to feel upset on a tough call. They can also acknowledge times when they’ve felt that same way. Also at times when I start to feel this way, I find myself turning to my hobbies (reading, trying new recipes, or working out), or spending time with my friends. All of these things have made me realize that there’s more to life than just being an EMT, and that no matter what, you’re not alone and always have people to support you.
Also in Rookieworld I’ve discussed how hard it was being a legacy in EMS, and how the start of my EMS journey was plagued by many different people comparing me to my dad. It’s been a little bit easier since I now work primarily in a different county than he does. But since then, I’ve had to make a name for myself and prove not only to the medics, but to my partners as well that I know what I’m doing and that I belong on a 911 ambulance in a busy system.
My confidence has grown immensely since I’ve moved. Many of my coworkers who first knew me as the shy, quiet girl are now so surprised that I can speak up for myself and have a little bit of an attitude. I feel more confident in my ability to make a decision, and my partners (and most of the time, the medics) are able to trust me, but also give me guidance when I need it and ask for it. I’ve also begun to meet some of the different doctors and nurses in our hospital systems and have been able to establish a relationship with them, which is helpful. I’ve learned that these relationships are very valuable to me and it’s always helpful to see a familiar face on a call, or in the hospital when I’m bringing in a patient. For example, I always appreciate it when I bring in a very sick patient and the doctor tells me that we’ve done a good job taking care of the patient on the way to the trauma center. It gives me reassurance that I’m doing the right thing.
In some cases, I’ve also amazed myself. Not only am I more confident in my ability to think critically, I’m (slightly) more confident in my ability to communicate with my patients who may speak a different language than I do. While my ability to speak and comprehend is far from perfect, I am able to get my point across to my patients and have them understand me. Every shift, I find myself learning a few more words that I can add to my vocabulary in order to better communicate with my patients. I’ve found that it eases their apprehension a bit, and they are grateful that I am trying to communicate with them in their primary language. Patient encounters like these have inspired me to learn the languages of the communities that I serve in order to help make them feel more at ease when they call for an ambulance.
Being an EMT for only three years may not seem like a long time.
Truthfully, it really isn’t.
But I’ve surprised myself with how much I have grown in both my critical thinking ability and my confidence. It means a lot that the people I work with also have that same confidence in me that I have in them. Some of the partners I’ve worked with over the years, even the ones who have helped teach me how to be the EMT I am today, are now some of my best friends. And while I still doubt myself sometimes, I’m able to get reassurance that I’m on the right track and doing the right thing to help my patient.
After these past three years, EMS is something I’ve fallen in love with (much to the dismay of my father). I love the chaos, and I love the unpredictability of what a shift can bring. It’s something I’m passionate about, and something that will benefit me as I plan on applying to medical school next cycle. Being an EMT has made me realize that I want to do more for my patients, and help them get the care that they need. I believe that I can do that as a future emergency medicine physician.
EMS has taught me so much, both about the field and medicine in general, and about myself.
Don’t worry, I’m not going anywhere just yet! I’m still going to continue to blog about all the cool things I’ve been up to in the past few years, including how important research is to EMS and beyond, founding a simulation team (that placed in the top 3 at a competition!), and more.
So here’s to the next three years… and beyond!
Dr. Mike DeFilippo talks about acute psychiatric emergencies and what we can do to help.
The status quo has changed.
Surely, we’ve all heard that from one healthcare organization in some form. “Here at Jimmy’s House of Medicine our brand of medicine is different” and we’ve all heard the classic trope of “We’re not co-workers, we’re family.” I can say for the duration of my career I’ve heard my various employers parrot the same empty rhetoric about how the way they do things is “moving medicine forward” or extending another platitude that their system or service is superior to the other by using some tired wordplay like “Moving at the speed of life.” We use these recruiting tools to bring people into our hospital systems, and then we expose them to the same exhausting, short-staffed, long-hours, toxic work environments that we’ve all gotten used to. Then a new generation of employees come in, and the cycle perpetuates. We often talk about the need for things to change, but then we never act on it. I submit that this lack of change is often to do a systemic lack of will. That is, organizations writ large are fearful of change so they elect to do nothing and offer non-answers as solutions. Of course, this is done while saying the organization will always do whatever it can to stay current.
What do we do now as clinicians? How is the end of Roe v. Wade going to impact us?
Should EMS clinicians be allowed to purchase and use recreational marijuana? If you haven’t been aware of this controversy, it will probably be coming to your area sooner than you think.
How can EMS education take these positives, these negatives, and the pandemic and mold it into a brand-new form of EMS education? An education system where we can feel somewhat prepared for the possibilities that we are coming into? EMS education owes it to the future paramedics and EMTs to teach us these skills AND how to mentally prepare ourselves.