EMS Nation

James Boomhower, BS, FP-C, NR-P, has been involved in EMS for nearly 15 years in a variety of health systems throughout New England. He currently functions in the role of Critical Care Transport Specialist-Paramedic/ Lead Peer Support Director with Boston Medflight of Bedford, Massachusetts, and Crisis and Peer supporter for the ECHO FAST team. James’ passion for EMS education is realized through his position as an instructor for Distance CME’s online continuing education program. His desire to bring mental health awareness to the EMS arena has spurred him to create the Fit for Duty platform. Visit our website for more podcast episodes on Evidence-Based Medicine: http://emsnation.org/ Like us on Facebook: https://www.facebook.com/PrehospitalNation Follow us on Twitter: https://www.twitter.com/EMS_Nation  

Ashley Voss-Liebig, RN, BSN, CCRN is the Division Chief for Clinical Performance and Education in Travis County Texas. She is a senior flight nurse and helicopter rescue specialist with STAR Flight. Her research interests include Medical Education, POCUS, Human Performance. She is @ashleyliebig on Twitter

A lecture by Rachel Liu, MD FACEP on the ResUScitation in Critical Care during the 2nd Annual ResusCon 2019 at the Grandview, September 4, 2019 @VassarCME @VBMCEMS @2019ResusCon

A lecture by Shalin Patel, MD FACC on the Mechanical Circulatory Support for Cardiogenic Shock during the 2nd Annual ResusCon 2019 at the Grandview, September 4, 2019 @VassarCME @VBMCEMS @2019ResusCon

A lecture by Timothy P. Collins, DO, FCCP on the Innovations in the Treatment of Shock during the 2nd Annual ResusCon 2019 at the Grandview, September 4, 2019 @VassarCME @VBMCEMS @2019ResusCon

Evie Marcolini, MD is an Assistant Professor of Emergency Medicine and Neurocritical Care.  She has clinical appointments in the Department of Emergency Medicine and the Department of Neurology; and is core faculty in the Emergency Department as well as the Division of Neurocritical Care and Emergency Neurology at Yale. She has board certifications in Emergency Medicine and Neurocritical Care, and is fellowship-trained in Surgical Critical Care from the R Adams Cowley Shock Trauma Center in Baltimore, Maryland.   Evie is Medical Director for the SkyHealth Critical Care helicopter transport service that is shared between Yale-New Haven Health System and Northwell Health. She is a Fellow of the American College of Critical Care Medicine, American Academy of Emergency Medicine (AAEM) and American College of Emergency Physicians (ACEP), and is a member of the Board of Directors for AAEM. She is the past Chair of the Critical Care Section of ACEP, and active in all three societies, with a goal of bringing emergency physicians to the forefront of critical care in all realms. Evie is an active educator and speaker, with an interest in neurocritical care topics as they relate to emergency medicine and bioethics as it relates to emergency medicine and critical care patients. She has, and continues to lecture nationally and internationally, and has won the ACEP Junior Faculty Teaching Award. Evie is very active in bioethics, as a member of the Yale-New Haven Health Ethics Committee and the Society for Critical Care Medicine (SCCM) Ethics committee, and teaches ethics seminars in the ethics of neuroscience and of emergency medicine annually for the Sherwin B. Nuland Summer Institute in Bioethics at Yale. She has been awarded the Grenvik Family Ethics Award from SCCM. Evie is a co-editor of the textbook: Emergency Department Resuscitation of the Critically Ill, which is now in its second edition, is a co-author of an upcoming book on mechanical ventilation in emergency medicine. She has been active as faculty for Wilderness Medical Associates International since 1992, and teaches wilderness medical courses to medical students, residents, faculty and allied health professionals nationally and internationally, as well as having served as Faculty Advisor to wilderness medicine interest groups at the University of Maryland and Yale. When not involved in academic pursuits, Evie loves to spend her time running and skijoring with her two Siberian Huskies. Please leave us your thoughts and comments, we'd love to dig further into this topic.  Make sure to leave @EMS_Nation a 5 star review wherever you listen to podcasts and to share the episode with friends and colleagues to pass along this #FOAMed resource. Checkout the blog at EMSNation.org and say hello to Dr. Faizan H. Arshad on Twitter and Instagram @emscritcare. Wishing everyone a safe tour!

Dr. Mark Merlin Chair of the NJ EMS Council. He is the Founder of the of the New Jersey EMS Fellowship. He is the Medical Director of Medway Air Ambulance which has 10 fixed wing planes transporting hundreds of medical patients each month throughout the world. He has authored over 100 peer-reviewed manuscripts and abstracts in Emergency Medicine and EMS. Dr. Merlin is the CEO of MD1 which provides Emergency Medical Services in a mobile Emergency Department/Operating Room at no charge to citizens of New Jersey.   https://md1program.org/   Please leave us your thoughts and comments, we'd love to dig further into this topic.  Make sure to leave @EMS_Nation a 5 star review wherever you listen to podcasts and to share the episode with friends and colleagues to pass along this #FOAMed resource.  Checkout the blog at EMSNation.org and say hello to Dr. Faizan H. Arshad on Twitter and Instagram @emscritcare. Wishing everyone a safe tour!    

Perseverance, or more simply stated, Grit, is a common trait amongst EMS providers.  It grants us the ability to endure in the face of hardship when others may consider quitting or failing.  In regards to COVID 19, we are all playing the long game, it is a marathon (unfortunately) rather than a sprint.  We must stay united as a group and stay true to our mission of supporting and protecting our communities despite the pandemic.  That is not to say that we are not human ourselves.  While perseverance is one of the characteristics I value most in EMS providers, another virtue I’d care to juxtapose it to is vulnerability. In any situation that presents a threat — be it physical or emotional — our natural instinct is to protect ourselves. That's just basic survival. We try to defend, hide or deny our own insecurities and weaknesses. Being vulnerable involves letting yourself feel all things — the good, the bad and the not-so-pretty — and then also letting someone else see it all. Trying to be invulnerable can be exhausting, as much as we’d like to be super heroes protecting the population from medical maladies we must also acknowledge our own humanity.  This is not easy and it’s okay to express that and seek support.  When we numb feelings like fear, embarrassment and pain, we also numb excitement, hope, gratitude and happiness. Allowing vulnerability into our lives can rejuvenate our senses and actually foster, build and restore our community and make us more connected. I’m including the link to Brene Brown’s TED talk on vulnerability that has nearly 50 million views. Thank you all again for always being in service and a very happy EMS Week.   https://www.ted.com/talks/brene_brown_the_power_of_vulnerability   Today’s episode brings us 2 EMS physicians from Stanford on the topic, “Where have all the STEMIs gone?” where we dive into the literature and statistics on cardiac arrest, dying at home, emergency department volume and numerous other items related to COVID19. Interestingly both domestically and abroad there has been a dramatic reduction in heart attacks, strokes and traumas that have been presenting via EMS to the ED.  We discuss potential hypotheses into this phenomenon and also explore other salient details related to COVID.    Bryan David Sloane, MD – Is the current EMS fellow at Stanford University.  He did his residency at Harbor UCLA where he lived out his EMERGENCY! Dreams.  He was an EMT in LA for 6 years before medical school and considers himself an EMT first and a physician second.  He hopes to take an attending position at Kaiser South Sacramento where he will also be working on many local EMS initiatives.   Gregory H. Gilbert, MD - Clinical associate Professor of Emergency Medicine at Stanford University. Medical Director of San Mateo County and EMS Fellowship Director at Stanford University. He grew up in New York State and received his MD, from SUNY Downstate with distinction for investigative scholarship. He completed his emergency medicine training in Atlanta, Georgia at Emory University and is dual boarded in EM and EMS.  Please leave us your thoughts and comments, we'd love to dig further into this topic.  Make sure to leave @EMS_Nation a 5 star review wherever you listen to podcasts and to share the episode with friends and colleagues to pass along this #FOAMed resource.  Checkout the blog at EMSNation.org and say hello to Dr. Faizan H. Arshad on Twitter and Instagram @emscritcare. Wishing everyone a safe tour and a "happy" EMS Week!     

Unfortunately due to the current situation and ongoing pandemic, it's difficult for us to wish you a "Happy" EMS Week, nevertheless, thank you to all the pre-hospital professionals for always being in service.  Today's episode is with EMS Chief Juan Cardona, from the Coral Springs - Parkland Fire Department in Florida.   He explores the operational and logistical challenges in responding to an out of hospital cardiac arrest during the age of COVID19 starting from issues related to dispatch, PPE, the ideal location of BLS/ACLS, How to interact with the family, Infection control maneuvers and also the psychological impact on families and providers to have their loved ones pass during the pandemic. Please leave us your thoughts and comments, we'd love to dig further into this topic.  Make sure to leave @EMS_Nation a 5 star review wherever you listen to podcasts and to share the episode with friends and colleagues to pass along this #FOAMed resource.  Checkout the blog at EMSNation.org and say hello to Dr. Faizan H. Arshad on Twitter and Instagram @emscritcare. Wishing everyone a safe tour and a "happy" EMS Week! 

This episode is a wrap up covering the highlights from the Tactical Trauma international conference on pre-hospital critical care and trauma. This conference emphasizes tactical medicine, with a panel of experts speaking throughout the 2 days. 0:10 – Introduction to day 2 wrap up 0:40 – Introduction of the panel 1:15 – Mike Abernethy wraps up his session as a moderator on Day 2. Takeaways include Michael Lauria’s discussion on the preoccupation with protocols and guidelines. 2:45 – Three basic concepts include speed, simplicity, and coordination of care. Tactical medicine boils down to how efficiently one can perform these three tasks using evidence based medicine. Take the lessons learned from the military medicine, and a lot of them can be applied to civilian EMS and in-hospital care. 5:30 – One thing to add, is being able to do the basics very well. These basic skills will lay the foundation for new advanced technologies and interventions. 7:00 – Discussion on Mike Klumpner’s talk on medical best practices at MCI’s. The phrase “Just because you can, doesn’t mean you should” is discussed among the panel members. Being able to look at these mass casualty events, their injuries, and intervention with simplistically is the key. An example here includes an anecdote regarding a vascular neck injury, and the ability to ask “Am I making a difference, or am I delaying definitive care?” 9:30 – The panel discusses the criticism of triage in an MCI setting during day 2. One example given is that during most MCI’s, the triage tags were not used including the Boston Marathon bombing, where triage had to ‘go out the door’. Another example is the way the walking wounded are huddled into a corner and sometimes forgotten, while they may be gravely injured as evidenced in the Manchester bombing. 11:40 – FDNY’s new triage protocols include any penetrating injuries between the clavicle and the pelvis are immediate red tags. 12:15 – Breakout sessions with LEO’s who discussed the medical care of the K9’s. 13:30 – The point on situational awareness with the K9 colleagues is discussed. This includes muzzling them early if gravely injured and in danger. 13:45 – Anesthesiology talks about how dogs have a fenestrated chest cavity, and its importance with a tension pneumothorax. The end result is that the resulting obstructive shock may be worse in dogs. 15:00 – Ketamine takes a hit when it comes to pain control with K9’s for multiple physiologic reasons. Morphine IM 30-50mg was preferred for K9 pain control. 15:35 – Currently, it is a felony in the USA to provide ALS to animals if you are not a veterinarian. Propositions for exclusions for EMS workers trained in animal care are in the works right now. One anecdote is during a NC MCI, kid pools were filled with ice for the explosives K9’s, drawing a parallel to firefighter rehabilitation. 18:05 – Psychosocial aspects when providing medical care is discussed along with PTSD learning points. While feelings of anger and hostility towards your patient may be natural, providers must be able to accept that and continue to give medical care. 19:35 – Learning points in PTSD. One interesting finding was that those with minor injuries who received early intervention developed worse PTSD when compared to those with severe or no injuries. This raises questions on mandatory Critical Incident Stress Management, and how it should always be voluntary. 21:05 – Best practices after tough calls in EMS. Debriefing, assessing for safety, and assuring readiness for the next job are the top priorities. Being able to spend time with your colleagues, who have been through similar experiences versus mandatory CISM is discussed as well. 23:15 – The longer people stay in lockdown during MCI’s, the more likely they are to develop PTSD. Data coming out is showing that school lockdowns are causing PTSD in pediatrics. 24:50 – ‘Just culture’ is discussed, as is the importance of making system level changes to prevent errors. Most of the time, it is organizational culture that leads to mistakes, and not just individual mistakes. 26:10 – No non-discoverable mistakes exist in EMS, as opposed to hospital-based medicine. 26:55 – Takeaways from afternoon lectures including penetrating trauma with Dr. Tom Koenig, tactical medicine in mass casualty events with Dr. Matthew Lengua, OB trauma, and blast injuries. 27:30 – Resuscitative hysterotomies in Finland, and other advanced procedures done quickly and in austere environments. Discussing the decision gap, which the is the time from when the decision to perform a critical procedure is made until when that procedure is performed. 33:30 – Advances in resuscitative hysterotomies and thoracotomies, and there are now clear indications for both. However, this does not mean that Top Cover should be eliminated. 34:00 – Takeaways from blast injuries and penetrating trauma, specifically to the head and neck region. Major points include how EMS Physicians can treat some of these patients in the warm zone with critical interventions. 36:00 – Learning points from the lecture on burn care, and the unpredictability of the burn patient. One takeaway is that due to the current school of thought, providers are over-intubating patients with harm. Studies have also shown that escharotomies performed outside of burn centers are often performed incorrectly and incompletely. 39:30 – Use of vehicles as a weapon of mass destruction has become more common recently. A takeaway is that the extent of injury tends to be worse when the attack is intentional, whether using vehicles or other weapons. Logistically, the scene tends to be complex as it generally encompasses are large area. The discussion is brought up again about how as medical personnel, we can empower and train the general public to help. 48:55 – Next steps include teaching our communities the basic skills that have been proven to save lives, and working together to minimize these threats in the future. 49:15 - Conclusion

This episode is a wrap up covering the highlights from the Tactical Trauma international conference on pre-hospital critical care and trauma. This conference emphasizes tactical medicine, with a panel of experts speaking throughout the 2 days.   0:10 - Introduction of the conference 0:45 – Introduction of the expert panel 1:25 – Reflecting on the Las Vegas Shooting. Description of the original triage station which was not setup for an MCI with major trauma. Severely injured patients were kept on scene for approximately 45 minutes, due to unknown location of gunshots being fired. 2:45 – A big takeaway from this session is to assign a civilian to each patient, as many are willing to help. This way there is someone watching every patient who could report on their overall status (ie. Doing well vs deteriorating), freeing up medically trained resources for the most critical patients. Included in this talk was a discussion in how to involve and empower bystanders, as the first responders may not be on scene within minutes. 4:30 – The concept of an “immediate threat vacuum” is discussed, and defined as a period of time where victims are not being treated by EMS. Currently, this remains an opportunity for improvement. 5:00 – Military success rests on the fact that everyone is trained on tactical casualty care, thus allowing that vacuum to be filled. 5:45 – Hemorrhage control for the bystander needs to continue to be emphasized. A major campaign in America is Stop the Bleed, which emphasizes basic bleeding control techniques for the general public. This has also raised awareness for bleeding control kits, which are now readily available in certain public locations (ie. Schools, airports) Link: https://www.stopthebleed.org 6:15 – Studies into casualties were not done until quite recently, where experts were able to analyze drills and incidents to create real timelines for casualties. It was found that victims were not surviving with current protocols, indicating a need for change. There is now widespread access to data regarding specific wounds and their prognostic factors. 7:15 – A reflection of the Pulse nightclub shooting shows that there may have been fatalities due to decisions that came under fire, as there was previously not much data available to study and prepare adequately. 8:00 – A quick discussion on how pre-hospital providers must be prepared for anything that can occur out of hospitals. There is a quick reminder that not all hot-zones are created equal, therefore every environment is different and professionals must train and adapt to this. 8:35 – Some internet searches have revealed that terrorists are using response tactics to learn and improve their terror plans. 9:30 – Brief reminder on how expanding on experience can come in the form of extensive training, along with length of service. 10:00 – Summary of Michael Lauria’s presentation on Emergency Action Drills. This is adapting the way we train to optimize response and link that to subsequent patient outcomes. One way is to look at how other fields train for high risk scenarios, such as the military and the aviation industry. This presentation looked at the medical side of training, and the opportunity for improvement in training 11:00 – Discussed here are the steps for developing ERADs. 1. Identifying time sensitive threats that need to be addressed first (ie. Massive exsanguination, difficult airway). 2. Looking to literature, and coming up with solutions to these threats. 3. Engraining those steps in our mind during training. This has worked well for other professions in their high-risk trainings (aviation, military combat). This shows the importance of training like you fight, so you can fight like you trained when it comes time for that initial reaction. 15:30 – Wrap-up of Mark Forrest’s preventable deaths by exsanguination. The presentation revisited the topics that had no research, including Hydrogel technology and others that need further research. The bottom line takeaway is stopping the bleed with basic techniques has been proven to save lives, while other technologies may be in the horizon. 17:12 – iTClamp use in head and neck trauma has been shown to be fairly effective in studies, while it performed poorly compared to CAT Tourniquet in the lower extremities. However, 7.5% of military wounds are above the neck and result in very high mortality. The iTClamp has shown success in these situations. One link to a study on animal models: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3786550/ 18:05 – Brief update on Junctional hemorrhages. Multiple devices have been shown to be effective in the lab, however their field application has been limited by weight, time, training. SAM has seemed to be the most popular anecdotally. Wound packing and close monitoring is likely the most effective method at the moment. 18:50 – Dr. Kate Prior’s presentation on leadership in a team-based setting with Inclusive Leadership practice. A deeper anecdotal discussion regarding inherent bias in the team environment is discussed here as well. 21:30 – Discussion on the timing of intubation in hypotensive poly-trauma patient. Two main reasons prevailed, the instability that comes with induction, and the negative effects of ventilation. 22:10 – Discussion on the resuscitation of the bleeding pediatric patient. Using the adult knowledge in the pediatric patient, just changing based on weight has more evidence behind it now. 22:55 – Discussion on Damage Control Resuscitation. This depends highly on the setting, and resources available in that setting. Examples of this include consistent hypotension prior to trauma surgery, the use of whole blood, and following the blood pressures being less ideal than signs of perfusion and blood flow using ultrasound. One key point is that each person has a different shock tolerance, and predicting this is virtually impossible. 25:45 – Conclusion of Day 1 Wrap-up.

As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth. It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.    

As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth. It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth. It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth. It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth. It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth. It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth. It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth. It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth. It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth. It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth. It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth. It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth. It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth. It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

The second iteration of FlightBridgeED's prehospital conference does not disappoint.  The second day brought thought provoking concepts and a great review of critical syndromes that we don't often encounter.  The challenging topics of shame in EMS and process improvement were also tackled.   For more information on this year's conference check out the website: https://www.flightbridgeed.com/index.php/fast-19 @FlightBridgeED #FAST19   Per usual, we assembled an all star panel to discuss the highlight's of the day's event. The panel included:   Michael Perlmutter @DitchDoc14 Cynthia Griffin @CMGrffn Samuel Ireland @ireland_sam1 Billie Sell @flight_sell  And your guest host, Andrew Merelman @amerelman     Please subscribe to the podcast on your favorite podcast platform, iTunes, Spotify, Google Play, etc.   Check out the website at www.emsnation.org and follow us on Twitter @EMS_Nation   If a topic or idea you heard on the podcast ignited some curiosity or deeper thought we'd we'd love a 5 star review on iTunes to help spread our mission of EBM in EMS!

The second iteration of FlightBridgeED's prehospital conference does not disappoint.  The first day was filled with not only thought provoking lectures on the bleeding edge of prehospital medicine but also insightful discussions about mental health, peer support and decision fatigue.    For more information on this year's conference check out the website: https://www.flightbridgeed.com/index.php/fast-19 @FlightBridgeED #FAST19   Per usual, we assembled an all star panel to discuss the highlight's of the day's event. The panel included:   Rebekha Spratt (aka Bex) @medibrat Michael Perlmutter @DitchDoc14 Andrew Merelman @amerelman Michael Brown @FireMedicFPC   And your host, Faizan H. Arshad @emscritcare     Please subscribe to the podcast on your favorite podcast platform, iTunes, Spotify, Google Play, etc.   Check out the website at www.emsnation.org and follow us on Twitter @EMS_Nation        

In dealing with the critically ill, some will require an advanced airway.  Many of these patients will be challenging to oxygenate and ventilate and also have underlying pulmonary pathology and physiologic shunt.  The ideal approach to pre-oxygenation and denitrogenation has been controversial. Using standard equipment in parallel to optimize our patients’ hemodynamics has also been controversial (eg. Nasal Canula + BVM with separate oxygen sources as part of pre-oxygenation protocol) and not universally accepted.  In addition, apneic oxygenation with a nasal canula at high flow rates has not been universally adopted despite advocacy by emergency airway experts.  This year, the ENDAO trial – EmergeNcy Department use of Apneic Oxygenation Versus Usual Care During Rapid Sequence Intubation: A Randomized Controlled Trial - showed no difference in lowest mean oxygen saturation between the two groups.  To quote the authors, “application of AO during RSI did not prevent desaturation of patients in this study.”  Despite this, many continue to recommend the use of AO for emergent airways.  In this lecture we will review the protocols, various application techniques , study the objective evidence behind these practices and discuss best practices for our patients to optimize the airway prior to laryngoscopy.   Presentation Objectives: The Definition of Pre-oxygenation and Denitrogenation The various means to achieve ideal pre-oxygenation: Ventilator with BVM Mask, Oxylator with BVM Mask, BiPap Machine with BVM Mask, BVM with PEEP Valve and Pressure gauge Review of the ENDAO and Fellow Trials Ultimate understanding of out-of-hospital best practices for approach to the hypoxic patient requiring advanced airway    

An in depth and personal interview with Brian LaCroix, president of Allina health who has helped develop the EMSgrit.org website.  Bringing a toolkit to mental health and helping develop the core attributes of Resilience and Self care while mitigating social stigma.

Join us as we dig into this controversial conversation on paramedic degree programs.  This is a joint position statement from the National Association of EMS Educators, The National EMS Management Association, and the International Association of Flight and Critical Care Paramedics.  Please find the position paper here:   https://www.emsworld.com/sites/emsworld.com/files/2018-10/joint_position_statement_on_.pdf

EMS Nation and crew wrap up the World Trauma Symposium's dynamic speaker panel and take away lessons for you to integrate into your medical response today!   #NAEMT #EMSWorldExpo18 #EMSNation

https://ampa.org/   Join our distinguished Panel Discuss the Highlights of Day 2!   @CMGrffn Dr. Cynthia Griffin @87MD1 Dr. Chris Fullagar @MattRoginski Dr. Matt Roginski @ALatimer13 Dr. Andrew Latimer @ChuckSheppard Dr. Chuck Sheppard @LuigisDad Sam Matta RN, East Coast Heli Ops  @UCAirCareDoc Dr. Bill Hinckley @Crit_Care_Excel Michael C. Berrier NRP, FP-C, NPT, AAS @AshleyLiebig Ashley Liebig (all around badass) Dr. Damon A. Darsey AND your Host @EMSCritCare Dr. Faizan H. Arshad   Hosted by @AmpaDocs #CCTMC18     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

https://ampa.org/   Join our distinguished Panel Discuss the Highlights of Day 1!   @87MD1 Dr. Chris Fullagar @ktcollopy Kevin T. Collopy, BA, FP-C, CCEMT-P, NRP, CMTE   @UCAirCareDoc Dr. Bill Hinckley @CMGrffn Dr. Cynthia Griffin @LuigisDad Sam Matta RN, NRP @AshleyLiebig Ashley Liebig (all around badass) @EMSCritCare Dr. Faizan H. Arshad   Hosted by @AmpaDocs #CCTMC18     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

The World Trauma Symposium:  https://www.naemt.org/events/world-trauma-symposium NAEMT:  http://naemt.org/ EMS World Expo: http://www.emsworldexpo.com/   Episode #66 Latest on Pelvic Binders from Both Military and Civilian Perspectives #WTS17 #PHTLS #EMSWorldExpo17 with Col. Stacy Shackelford, MD Col. Shackelford is the chief of performance improvement at the Joint Trauma System Defense Center of Excellence for Trauma Joint Base in San Antonio, Texas.  She is also an attending trauma surgeon at the San Antonio Military Medical Center. Col. Shackelford is a member of the Committee on Tactical Combat Casualty Care, led the TCCC guideline review and update for pelvic binders, and has deployed four times as a combat surgeon and as the director of the Joint Theater Trauma System.  Col. Shackelford was commissioned through the U.S. Air Force Academy, attended medical school at Tulane University and general surgery residency at the University of Utah.  After completing a Trauma and Critical Care fellowship at the University of Southern California, Col. Shackelford was assigned as Director of Education at the Air Force Center for Sustainment of Trauma and Readiness Skills at the R. Adams Cowley Shock Trauma Center.  She is an instructor for the Defense Institute for Medical Operations.   Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org  

The World Trauma Symposium:  https://www.naemt.org/events/world-trauma-symposium NAEMT:  http://naemt.org/ EMS World Expo: http://www.emsworldexpo.com/   Episode #65 Controversies in Needle Decompression #WTS17 #PHTLS #EMSWorldExpo17 with Julie Chase, MSED, FAWM, TP-C @ISDMedic   Julie Chase is a tactical medicine instructor in Berryville, Va.  She has worked in public and private venues as a firefighter, paramedic, educator and administrator, and has taught in many countries, assisted with remote clinics and emergency services and is a National Disaster Medical System Response Team Member.  She was an operational and tactical medicine instructor at a federal agency, a curriculum developer, contributing author, and reviewer for publication and accreditation organizations.  Julie holds a Master in Postsecondary and Adult Education, a Bachelor in Paramedicine, and an Associate in Applied Arts and Sciences in Fire Science.    Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org  

The World Trauma Symposium:  https://www.naemt.org/events/world-trauma-symposium NAEMT:  http://naemt.org/ EMS World Expo: http://www.emsworldexpo.com/   Ep #64 Nuances and Challenges to Modern Day Disaster Triage #WTS17 #NAEMT #EMSWorldExpo17 with Brad Newbury, MPA, NRP, I/C @nmetc911   Brad Newbury is the founder, president and CEO of the National Medical Education & Training Center in Massachusetts.  He has been involved in EMS for over 30 years as a volunteer firefighter, paramedic and instructor.  He has taught for the Massachusetts Fire Academy and lectured nationally.  Brad managed the application process for full national accreditation of NMETC’s paramedic program and developed a hybrid paramedic program, which educates and trains students from around the world.  He has worked as a faculty educator, content writer, and has been published by a national journal.  He is also a principle author and speaker for NAEMT’s All Hazards Disaster Response course.  Brad hold a Bachelor’s Degree in Fire Science and a Master’s Degree in Public Administration.    Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org  

The World Trauma Symposium:  https://www.naemt.org/events/world-trauma-symposium NAEMT:  http://naemt.org/ EMS World Expo: http://www.emsworldexpo.com/   ATLS 10th Edition Updates and the Implications of Prehospital Care and PHTLS v9 with Dr. Andrew Pollak @AndyPollak   Dr. Pollak is the James Lawrence Kernan Professor of Orthopedics and chair of the Department of Orthopedics at the University Of Maryland School Of Medicine.  He also serves as Chief of Orthopedics for the University of Maryland Medical System and was previously at the University of Maryland R. Adams Cowley Shock Trauma Center. Dr. Pollak has extensive experience in prehospital emergency care as a volunteer firefighter/EMT, EMS flight physician and fire surgeon.  He serves as medical director of the Baltimore County Fire Department, Special Deputy US Marshal, and Commissioner for the Maryland Health Care Commission, and as an editor of EMS publications.  Dr. Pollak has served on the American Academy of Orthopedic Surgeons Board of Directors, Orthopedic Trauma Association and the Maryland Orthopedic Association.     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org  

Join our all star international panel as we discuss the highlights of the Day 2 program from the first ever Tactical Trauma 2017 conference recorded live in Sundsvall, Sweden. The conference was hosted by Dr. Fredrik Granholm @TotalResus Link to the Tactical Trauma Website: http://www.trippus.se/web/presentation/web.aspx?evid=quLLWDJBkBKybOhXZJmj8Q==&ecid=MPeU8Z0GCzdyw+SuQMe9Ng==&ln=eng&view=category&template=Desktop   Panel Participants: Dr. Mark Forrest @ObiDoc Dr. Rick Dutton @TraumaDinosaur Dr. Kasia Hamptom @KasiaMD Professor Susan Brundage @TraumaMasters Dr. Leilani Doyle @DoyleLeilani Mike Lauria @ResusPadawan Dr. Andy Johnston @armycritcare   And your host Dr. Faizan H. Arshad @emscritcare     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

Join our all star international panel as we discuss the highlights of the day's program from the first ever Tactical Trauma 2017 conference recorded live in Sundsvall, Sweden. The conference was hosted by Dr. Fredrik Granholm @TotalResus Link to the Tactical Trauma Website: http://www.trippus.se/web/presentation/web.aspx?evid=quLLWDJBkBKybOhXZJmj8Q==&ecid=MPeU8Z0GCzdyw+SuQMe9Ng==&ln=eng&view=category&template=Desktop   Panel Participants: Dr. Kate Prior @doctorwibble Dr. Leilani Doyle @DoyleLeilani Mike Lauria @ResusPadawan Dr. Mark Forrest @ObiDoc Matt Libby @MatLibby Dr. Thomas D @thomas1973 And your host Dr. Faizan H. Arshad @emscritcare     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

Continue along for the New York State Collaborative Protocol series with Dr. Chris Fullagar @87MD1 as he reviews the indications, ideal pre-oxygenation strategies, laryngoscopy techniques, confirmation of tube placement as well as guidelines for post-intubation sedation for prehospital providers operating in New York State.   Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1   Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

https://www.smacc.net.au/   Anne Creaton – An Emergency Physician & retrievalist HQ’d in Melbourne Australia. She spent the last 4 years in Fiji establishing emergency medicine training in a low resource environment while building capacity in pre-hospital care and disaster response. While living in Fiji she experienced Cyclone Winston first hand and was part of the in-country response. She is an educator in mass gathering medicine and the MIMMS system and was part of the instructor team for a multiagency tabletop simulation of a multi-site terrorist attack in Melbourne.    Lionel Lamhaut – An anesthetist with critical care and emergency training and an associate professor of the SAMU de Paris (excuse my French - Service d'Aide Médicale Urgente), Dr. Lamhaut is not only a disaster response physician but an academician of the highest caliber with recent publications on the prospective deployment of ECPR for refractory cardiac arrest in the Paris area with a multicenter study well underway.  He responded directly to the deadly terror attack of Charlie Hebdo and was instrumental in the after action analysis in the coordinated multi-site terror attack that struck Paris on Friday the 13th of 2015.   Raed Arafat – Put a warm round of applause together for the Secretary of State and Minister of Internal Affairs of Romania! Tasked with development of emergency medical care in the country, he is the founder of SMURD – the Mobile Emergency Service for Resuscitation and Extrication. In his current position he leads the Department for Emergency Situations including fire and rescue, civil protection, prehospital emergency medical services, air rescue as well as emergency departments.  Ladies and gentleman… a Knight and Grand Officer of the National Order of Merit in Romania, he has overcome both politics and prejudice in his sterling career as a champion of the highest quality prehospital care.   Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

https://ampa.org/   Happy Friday of #EMSWeek2017! https://emcrit.org/wp-content/uploads/push-dose-pressors.pdf    Resuscitation - beginning from initial patient contact to the emergency department to the intensive care unit is a continuun of care - though the first few minutes of patient contact with a critically ill patient can have tremendous repercussions on the patient's ultimate outcome.  Whether in critical care transport or in 911 emergency response, patient's may require a medication in small aliquots immediately that would be either unfeasible or cumbersome to administer via infusion on a dedicated pump.  While circumstances in which a patient needs a push dose medication may be uncommon, the administration of these drugs can be potentially lifesaving.  There are two prehospital scenarios in which the paramedic carries the necessary medication in their armamentariam and with appropriate instruction and training can safely reconstitute into an appropriate dose for use in out-of-hospital resuscitation for the critically ill patient.  Push dose pressors are often employed in profoundly hypotensive patients that will require endotracheal intubation.  Rapid Sequence Intubation and Positive Pressure Ventilation are both associated with hypotension, thus in the patient that requires advanced airway and is hypotensive upon EMS arrival, push dose pressors may be employed to effectively "resuscitate before you intubate".  Typically Epinephrine is diluted to an appropriate dose and adminstered in small aliquots (10mcg/ml) for inotropoic support to optimize hemodynamics prior to RSI or intubation.  There is also anaesthesia literature supporting the use of neosynephrine as well as phenylephrine for this purpose, though these medications are less readily available prehospitally.  Even brief episodes of relative hypotension can cause effects seen days later; in critically hypotensive patients these may be even more pronounced.  By using push dose pressors, a field provider can safely and effectively resuscitate their patient in order to mitigate the risks associated with endotracheal intubation prior to securing an advance airway. Conversely, a separate and distinct class of patients who suffer from decompensated heart failure may present with respiratory distress due to volume overload with pathophysiology associated with marked systemic hypertension. While CPAP is the mainstay of therapy for these patients prehospitally and has significantly reduced intubation of the CHF patient over the past several years, IV Lasix and topical Nitroglycerin play little role in the EMS management of the decompensated heart failure patient.  Nevertheless, these patients often require preload and afterload reduction to manage their symptomatology; it is common to initiate nitroglycerin infusions in critical care transport as well as in the emergency department for management of this hypertension.  Nitroglycerin lowers preload via venous vasodilation at low doses and lowers after load via arterial vasodilation at higher doses, making the patient's vascular container larger lowering the systemic pressure. Aggressive, high dose NTG paired with the recruitment of the alveoli using CPAP & PEEP make up the mainstay of pre-hospital treatment of APE and decompensated heart failure. Bolus doses as high as 2 mg (2000 mcg) of nitroglycerin have been given safely and effectively in previous studies.  In emergent resuscitations we need to focus on bolus dose medications in the acute phase versus starting and titrating critical care infusions while a patient is in extremis. The goal is to achieve clinical end points of treatment faster with bolus dosing at the bedside and then begin maintenance infusions once resuscitation goals are met and the hemodynamics are stable.  Similar to push dose pressors in the acutely hypotensive EMS patient requiring resuscitation, patients with decompensated heart failure may benefit acutely with push dose nitroglycerin, a potent vasodilator.   @AmpaDocs #CCTMC17 Mark your calendars for #CCTMC18 April 9-11th 2018 Wyndham Riverwalk - San Antonio Texas     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

https://ampa.org/   Happy Thursday of #EMSWeek2017!   David Olvera, AAS, FP-C, EMT-P LinkedIn: https://www.linkedin.com/in/david-olvera-36048a1b   World Health Organization Human Factors PowerPoint- www.who.int/patientsafety/activities/technical/who_mc_topic-2.ppt   Glucometer that monitors blood sugar via phone- https://www.dexcom.com/   Checklist Articles:  Development of a standard operating procedure and checklist for RSI in the critically ill.( Scandinavian journal of trauma, resuscitation, and emergency medicine, Sept 11th 2014) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172951/   A pre-procedural checklist improves the safety of emergency department intubation of trauma patients. (Academic Emergency MedicineAug, 2015) https://www.ncbi.nlm.nih.gov/pubmed/   Greater Sydney Area HEMS Checklist- https://nswhems.files.wordpress.com/2013/01/prehospital-emergency-anaesthesia-checklist-3-1-final.pdf   Failed Attempts at Intubation Associated With More Adverse Events http://www.anesthesiologynews.com/Clinical-Anesthesiology/Article/02-17/Failed-Attempts-at-Intubation-Associated-With-More-Adverse-Events/40210/ses=ogst?enl=true       @AmpaDocs #CCTMC17 Mark your calendars for #CCTMC18 April 9-11th 2018 Wyndham Riverwalk - San Antonio Texas     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

https://ampa.org/   Happy Wednesday of #EMSWeek2017! Definitive airway management in the prehospital sphere for critically ill patients is often forced upon EMS providers especially when encountering failure of traditional challenging airway algorithms.  Failure to ventilate and intubate a patient can results in immediate sphincter tightening for providers.  Being facile with a surgical airway based on one's specific kit and armamentarium is paramount for providers in whom the surgical airway falls within their scope of practice.  Adequate training and skills maintenance are perpetual challenges in this HALO (high acuity low occurrence) procedure.   His Bio & Credentials: Kevin T. Collopy, BA, FP-C, CCEMT-P, NR-P, CMTE, WEMT, is an educator, e-learning content developer and author of numerous articles and textbook chapters. He is also the clinical education coordinator for AirLink/VitaLink in Wilmington, NC. Contact him at ktcollopy@gmail.com. LinkedIn: https://www.linkedin.com/in/ktcollopy   Kevin's #CCTMC16 Podcast: Taking a "Time Out" before Initiating RSI Improves Patient Safety and First Pass Success http://emsnation.libsyn.com/ep-30-taking-a-time-out-before-initiating-rsi-improves-patient-safety-1st-attempt-success-with-kevin-collopy-ktcollopy   NYS Collaborative Training Video for Surgical Airway: http://emsnation.libsyn.com/ep-48-surgical-cricothyroidotomy   @AmpaDocs #CCTMC17 Mark your calendars for #CCTMC18 April 9-11th 2018 Wyndham Riverwalk - San Antonio Texas     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

  Checkout EMS Today 2018! http://www.emstoday.com/index.html    Happy Tuesday of #EMSWeek2017! You've asked and you shall receive... Optimizing your patient's airway prior to pulling the trigger for RSI.  Delayed Sequence Intubation in the prehospital realm to prevent Rapid Sequence Death.  Dr. Jeff Jarvis, a paramedic from Williamson County Texas turned EMS Medical Director of Williamson County Texas challenges traditional thought processes to bring the best possible medical care to 911 patients.  "It's medical decision making that saves lives... not a plastic tube through the trachea!!!!" Here is story from conception of the idea, to education and roll out, to challenges experienced interfacing with local emergency departments as well as preliminary results for prospectively collected data. His Bio & Credentials: https://www.wilco.org/Departments/EMS/Leadership/Jeff-Jarvis (Williamson County) http://www.sw.org/Dr-Jeffrey-L-Jarvis (Baylor Scott & White)     @EMSToday #EMSToday2017 Mark your calendars for #EMSToday2018 February 21-23, 2018 Charlotte, NC Convention Center Registration Link: http://www.emstoday.com/register.html     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

https://ampa.org/ http://www.atacc.co.uk/   Happy Monday of #EMSWeek2017! Roll up your sleeves and mentally prepare for getting your hands dirty.  Chief Flight Physician of University of Wisconsin MedFlight, Dr. Mike Abernethy @FLTDOC1, gives an honest assessment of the current state of discongruity in EMS in America.  An honest assessment of the intricacies of American Prehospital Care and efforts we can take to improve outcomes for all our patients. His Bio & Credentials: http://www.emed.wisc.edu/content/mike-abernethy-md   @AmpaDocs #CCTMC17 Mark your calendars for #CCTMC18 April 9-11th 2018 Wyndham Riverwalk - San Antonio Texas     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

https://ampa.org/ http://www.atacc.co.uk/   Join our distinguished Panel Discuss the Highlights of Day 2!   @MedFlightDoc Dr. Ryan Wubben @BritFltDoc Dr. David Hindle @DrewCathers Dr. Andrew Cathers @CMGrffn Dr. Cynthia Griffin @TotalResus Dr. Fredrik Granholm @MikeSteuerwald Dr. Mike Steuerwald @87MD1 Dr. Chris Fullagar @UCAirCareDoc Dr. Bill Hinckley @FLTDOC1 Dr. Mike Abernethy @emeddoc Dr. Zaf Qasim @MattRoginski Dr. Matthew Roginski @EMSCritCare Dr. Faizan H. Arshad   Sponsored by @AmpaDocs #CCTMC17     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

https://ampa.org/   Join our distinguished Panel Discuss the Highlights of Day 1!   @MedFlightDoc Dr. Ryan Wubben @DrewCathers Dr. Andrew Cathers @CMGrffn Dr. Cynthia Griffin @TotalResus Dr. Fredrik Granholm @MikeSteuerwald Dr. Mike Steuerwald @87MD1 Dr. Chris Fullagar @UCAirCareDoc Dr. Bill Hinckley @FLTDOC1 Dr. Mike Abernethy @EMSCritCare Dr. Faizan H. Arshad   Sponsored by @AmpaDocs #CCTMC17     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org