All in Interview

Episode 111: Amy Eisenhauer on Leadership, Fatigue, and Use Disorders

Episode 111: Amy Eisenhauer on Leadership, Fatigue, and Use Disorders

Ed Bauter
FOAMed, Mental Health, Interview, Health and Safety

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.

Episode 110: EMS WEEK with Dr. Zaffer Qasim

Episode 110: EMS WEEK with Dr. Zaffer Qasim

Ed Bauter
Cardiac Arrest, FOAMed, Interview, Trauma

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.

Episode 109: Dr. Ken Milne, Small BVMs, and Nitroglycerine

Episode 109: Dr. Ken Milne, Small BVMs, and Nitroglycerine

Ed Bauter
Chest pain, FOAMed, Interview, Medicine

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. 

Episode 108: DEI in EMS with Dr. Tristan Glenn and Dr. Alicia Rouff

Episode 108: DEI in EMS with Dr. Tristan Glenn and Dr. Alicia Rouff

Ed Bauter
Controversy, Interview, Medicine, Mental Health

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.

 

Episode 107: Cardiac and Non-Cardiac Chest Pain with Dr. Mike Berkenbush

Episode 107: Cardiac and Non-Cardiac Chest Pain with Dr. Mike Berkenbush

Ed Bauter
Interview, Chest pain

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.

 

Episode 106: EMS Career Ladders

Episode 106: EMS Career Ladders

Ed Bauter
Interview

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.

Episode 104: Dan Gerard and Whole Blood

Episode 104: Dan Gerard and Whole Blood

Ed Bauter
FOAMed, Interview, Trauma

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.

Episode 102: Jason Patton from Fire Department Chronicles

Episode 102: Jason Patton from Fire Department Chronicles

Ed Bauter
Interview

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

Episode 101: Death Notifications with Steph Leather

Episode 101: Death Notifications with Steph Leather

Ed Bauter
Cardiac Arrest, FOAMed, Interview

We're bad at notifying families what's happening during a cardiac arrest event. We're even worse on ourselves. The average person may see 3 or 4 dead people in their lives and EMS workers often see that many in a shift. The Overrun's new team member Steph Leather, a national speaker on death notifications and a director of a clinical psychology practice takes us through the steps to make death notifications easier on ourselves and on families of our patients.

Episode 100 (!): Dr. Mark Merlin on Where We've Been and Where We're Going

Episode 100 (!): Dr. Mark Merlin on Where We've Been and Where We're Going

Ed Bauter
FOAMed, Interview, MD1

For our 100th episode, we sat down with a friend of the show Dr. Mark Merlin of MD1 to discuss how far EMS has come in the last 5 years and where EMS might go in the next 5 years. Dr. Merlin talks about his 2009 study using the MAR method to estimate blood loss as well as the recent Emergency Medicine Match dilemma. Take a listen and let us know what you think. Has EMS gotten better in the last 5 years? What can we do to improve our practice over the next 5 years?

Episode 98: Kate Bergen and the Rosies

Episode 98: Kate Bergen and the Rosies

Ed Bauter
Interview, Mental Health

Kate Bergen is a paramedic and artist that appeared on the show in 2020 to discuss how art therapy helped her get through Covid-19. Since then, her art has been featured in national news pieces and she has been featured in national magazines raising awareness of art therapy in our modern world. Her work earned her the EMS10 award in 2020. Now with a new book in the works, she returns to show to discuss how art therapy has helped her manage her mental health since Covid, and how it has helped other people she has met along the way.

Episode 96: Chief John Moon and Freedom House EMS

Episode 96: Chief John Moon and Freedom House EMS

Daniel Schwester
Interview

We had an amazing talk with Chief John Moon, (ret) of Pittsburgh EMS and Freedom House Ambulance, one of the first paramedics in the United States.

If you don't know the story of Freedom House, you should. Before Seattle, Miami, and yes, even Squad 51, Freedom House was providing bleeding-edge care to the citizens of the Hill and greater Pittsburgh, in a world where they were not regarded as equals in emergency services or healthcare.

With the guidance of Dr. Peter Safar and Dr. Nancy Caroline, (yes, THAT Dr. Caroline) Freedom House showed that timely EMS intervention contributed to improved outcomes.

We owe them all a debt that cannot be repaid.

Buy the book here:

https://www.amazon.com/American-Sirens-Incredible-Americas-Paramedics/dp/0306926075/ref=sr_1_1?crid=3K2DH5O0LSFHY&keywords=american+sirens&qid=1676859470&sprefix=american+sirens%2Caps%2C96&sr=8-1

Episode 95: Haney Mallemat and Medicine in Social Media

Episode 95: Haney Mallemat and Medicine in Social Media

Ed Bauter
Cardiac Arrest, Controversy, Interview

Dr. Haney Mallemat (@criticalcarenow) joins Dan to discuss how social media can influence medicine and how recent medical events have shined a light on CPR and bleeding control.

In a matter of a few days, the world was shocked to hear that actor Jeremy Renner had been traumatically injured while on vacation in Nevada and Buffalo Bills player Damar Hamlin experienced a cardiac arrest on the field. These two tragic events have shown the world, albeit briefly, how important early CPR and bleeding control are to survival.

Episode 92: American Sirens with Kevin Hazzard

Episode 92: American Sirens with Kevin Hazzard

Daniel Schwester
Interview

Kevin Hazzard is a paramedic and author who wrote the book A Thousand Naked Strangers, detailing his time as a ground paramedic in Atlanta. He's back with a new story, one that you absolutely need to read.

American Sirens: The Incredible Story of the Black Men who Became America's First Paramedics is the story of a handful of Black men from Pittsburgh who were chosen to become paramedics. It's a story about perseverance, grace under pressure, and dignity that every EMS clinician should read. We were lucky to have Kevin on to speak about the book and his experience in telling the story, and why it matters.

Episode 89: A Thriving Wage with Greg Friese

Episode 89: A Thriving Wage with Greg Friese

Ed Bauter
Controversy, Interview

Greg Friese is the Editorial Director of EMS1.com among other things. He brings a very interesting view of how EMS providers should be compensated for the work they do. In January of 2022, he wrote a piece discussing the importance of EMS providers not just receiving a living wage, but rather for EMS workers to make much greater than a living wage. He recently wrote about the dismal raise that Austin EMS providers received to provide a voice to workers who felt voiceless.

Greg's Bio

Episode 87: Abortion, Roe, and EMS medicine with Natalie Zink

Episode 87: Abortion, Roe, and EMS medicine with Natalie Zink

Ed Bauter
Controversy, FOAMed, Health and Safety, Interview, WTAF?!

Natalie Zink is a paramedic and medical student in Georgia who speaks extensively on women's rights and the medical treatment of abortion. Her work can be found in EMSWorld and in other publications. This episode, recorded May 22, 2022 discusses the leaked Supreme Court brief suggesting the overturn of 1973's Roe v. Wade and 1992's Casey v. Planned Parenthood. Ed and Natalie discuss what field providers can expect and how to treat abortions in the field. This episode is wide-ranging from the logistics of certain legislation to how it effects healthcare providers. Countries such as Poland have attempted similar legislation to no avail. Abortion is a safe and (currently) legal intervention that will occur regardless of the current laws. It is important that EMS and pre-hospital providers know how to treat these patients and what they can expect moving forward should this case become law.

Episode 84: So, You Want To Be A MIlitary Medic?

Episode 84: So, You Want To Be A MIlitary Medic?

Caroline Schwester
Interview, Medicine

If you've been anywhere in this world the last few weeks, you know what's been going on in Ukraine. Once again, military medicine has taken front row. But what actually is military medicine about? What are some of the misconceptions? And what can we as civilians take away from our colleagues in service?

On this episode, Dan and Ed are civilians talking medicine in the military to Dr. Andrew Fisher, MAJ USA, and the namesake of the Saint Fisher Church of Evidence Based Medicine; and our good friend Peter D'Antuono, who served in combat as a medic with the 173rd Airborne Brigade. We get to shine a light on something not many civilians get to hear about...and why it's important.

Check out the Church here:

https://sfcebm.com

https://www.facebook.com/SaintfisherChurchofEBM/

Episode 83: Fundamentals of Bag Mask Ventilation with Rommie Duckworth

Episode 83: Fundamentals of Bag Mask Ventilation with Rommie Duckworth

Daniel Schwester
Airway Management, FOAMed, Interview

One of the most misunderstood pieces of equipment we have is the bag valve mask. Easy to operate, but hard to master, it’s one of the fundamental skills we need to master.

Rommie Duckworth is a nationally-known paramedic and educator in Connecticut who is truly passionate about education and ventilation, and Dan gets to pick his brain and talk about what really matters when we have to breathe for our patients who can’t do it for themselves.

Check out Rommie here:

https://romduck.com

If we’re talking airway or ventilation, Dr. Jim DuCanto isn’t far from the discussion. We talk about his method of BVM grip in the episode, and you can learn more here:

https://www.hmpgloballearningnetwork.com/site/emsworld/original-contribution/edge-there-better-grip-face-mask-ventilation

Here’s a paper Dan did with some colleagues showing smaller sized BVMs gave a more physiologically appropriate tidal volume and pressure:

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

The Refresh 2021 program is still available until March 31…..EMTs and Paramedics should jump on this, it’s totally FREE!

https://www.prodigyems.com/refresh2021

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