Prehospital Paradigm Podcast

In this 3rd part of the team's discussion of adult trauma care with Dr. Glen Tinkoff, System Chief, Trauma and Acute Care Surgery at University Hospitals, the continuation of trauma center designation criteria continues. On-scene times and the use of ground and air transport methods are discussed which leads into a discussion of what will “kill” a trauma patient?

Ray, Caleb and Dr. Hill continue with Dr. Glen Tinkoff, System Chief, Trauma and Acute Care Surgery at University Hospitals.  The discussion of having a defined Level 4 Trauma Center designation starts this episode and then the group discussion the changes in prehospital trauma care based .. i.e. tourniquets, lactated ringers and cervical collars that has been based on data collection.

Ray Pace takes the lead this month as the crew talks adult trauma topics with, Dr. Glen Tinkoff, System Chief, Trauma and Acute Care Surgery at University Hospitals.  In this first episode of the series, Dr. Tinkoff reflects on how he came to find Trauma Surgery as a specialty including his early life as a first responder. The group discusses the varied capabilities of trauma center levels and the Golden Hour.

In this insightful episode of The Pre-Hospital Paradigm Podcast, Dr. John Hill and co-host Scott Wildenheim dive deep into the evolving world of blood transfusion medicine with special guests Vicki Cary, Manager of Transfusion Medicine, and Matt Howlett, System QA Coordinator for Blood Banks. Together, they explore the critical role of blood and blood products in EMS and trauma care, the challenges of maintaining blood supplies, and recent advancements expanding paramedic scope of practice in Ohio. #prehospitalparadigmpodcast

As Dr. Hill, Scott, Vicky and Matt start to wind up the discussion regarding transfusion medicine for EMS, i.e. using blood products in the prehospital setting, they discuss the proper storage requirements necessary for products and the costs of maintaining the blood collection, storage and distribution process. What's being considered before implementing blood products into the streets.

Scott and Dr. John Hill continue with their guests from the UH blood bank. The discussion continues regarding the emergent useage of blood products before and after the type and screening which can be done with 10 minutes or less depending on the type of testing equipment. They also move on to educating EMS professionals regarding being a part of the collection/donation process.

This month, the crew gets together with, Victoria Cary and Matt Howlett, members of the UH system's blood bank to talk about the progress of transfusion medicine becoming within the practice scope of EMS.  The information is based on rules, regulations and laws of the state of Ohio.  In Part 1, the crew and guests reviews the A, B, Os basics of “blood science.”

From a cardiology standpoint, what can be done by a basic level EMS provider vs. an advanced level provider? How can technology be utilized to expand the BLS scope of practice? The basis of this discussion is the Ohio EMS Scope of Practice

In this month's episode, our guest, Brian Abbott, and the team discuss one of the most important topics for first responders - mental health. Thanks to the UH Portage Paramedic Program for having the team back in the classroom for this episode.

As the team prepares for the next live show, of course, the topic being the mental health of EMS and firefighting professionals, they wind up the in-studio conversation with local firefighter, Brian Abbott who has rebounded to the fire services after treatment for mental health issues related to being in the EMS/fire service.

Peer support, changing the stigma of the culture within the firefighter/EMS population is how Ray, Caleb, Dr. Hill and our guest, Brian Abbot start this episode. Showing signs of mental health issues can be seen as a sign of weakness. However, personal vulnerability needs to be recognized and encouraged. It builds trust in the team and between the officers/leadership and the front line providers.

In Scott's absence, Ray leads the team of Caleb, Dr. Hill and our special guest firefighter Brian Abbott, currently with the City of Elyria Fire Department. PTSD is higher in firefighters: 14.6% to 22%, compared to 6.8% in the general population. Depression is also higher in firefighters: 11% in firefighters, compared to 6.7% in the general population.  Firefighter thoughts of suicide are nearly double those in the general population, with estimates reaching up to 47%. Source: The Ruderman White Paper on Mental Health and Suicide of First Responders

The crew traveled to Caleb's home department, Munson Fire, Department, to bring closure to the recent discussion of caring for neonate patient in the EMS setting.  Thank you Dr. Olicker for joining us this month!

The crew and Dr. Olicker start to put a close on this additional series regarding caring for neonate patients in the EMS environment.  Pediatric cardiology kicks this segment off and then the crew discusses “delivery head trauma” and wraps up with correcting developmental milestones for specific neonate patients.

Neonates with fevers start this discussion as we are still with Arielle Olicker, MD a clinician educator in the division of Neonatal-Perinatal Medicine at U.H. We then go on to discuss vaccination differences between cultures and how to calm the parents/caretakers once EMS arrives.

The crew is back with Arielle Olicker, MD a clinician educator in the division of Neonatal-Perinatal Medicine at U.H. In no particular order, this episode reviews the neonate patient born into an opioid dependent situation as well as patients born with physical and/or mental impairments and appropriate sedation agents an dosages.

In this month's episode, we discuss EMS Pharmacy with our guest, Derek Frost, a system EMS pharmacist. We explore the challenges of managing medications in the field, how to prevent errors, and the best practices for ensuring patient safety. #prehospitalparadigmpodcast 

As the team starts to wrap up the the discussion of demystifying EMS pharmacology, they discuss, what it means to "lock up" the controlled substances and what the potential realistic ramifications might be of not doing that properly. They also dig into the challenges of calculating the varied pediatric dosages within the EMS scenario.  What steps have been taken with the UH EMS system, over 1000 standardized drug boxes to prevent errors and waste?  There are over $600 wirth of drugs within the UH EMS system's drug box.

The team continues the pharmacology discussion with UH Portage's pharmacy manager, Derek Frost.  Remember kicking around trade/brand names vs. generic name in your day?  What steps have YOU taken to reduce confusion? What drugs constitute "controlled substances?" How can we improve automated decision-making support of potentially conflicting medications?

The team gathers with Derek Frost, UH Portage pharmacy manager, to talk about all things pharmacology including trying to analyze and simplify the science behind pharmacology. In Part 1, the team digs right in and talks about medication errors evaluation and elimination there of.

In Part 3 we discuss the best of SANE and sexual assault patients, field termination and DOA, air medical care, neonatal resuscitation, event medicine and access routes, capnography, MCI and the new procedures, and ECPR.

In Part 2 we discuss sports medicine and the hyperthermic patient, importance of EMS documentation, anaphylaxis in pediatric care, dosing, shock, RSI, cardiac arrest care, STEMI care and EMS, and patient capacity in psychiatric emergencies

We take a look back at the best five minutes of our early episodes. In part 1 we discuss CPAP and better hand off care, the use of ketamine in assisted airways, toxicology, stroke, tactical medicine, innovations in resuscitation, steroids, and speak with a cardiac arrest survivor.

As the final installment to this topic, the crew hit the road to Shaker Heights.  You will appreciate the open discussion.

The crew continues with Dr. Frank Ford and Dr. Colin McCluskey further discusscussing EMS professionals utilizing ECMO CPR. They continue define how to spread the reach and implementation of this new CPR treatment technology.

Dr. Frank Ford and Dr. Colin McCluskey join the Caleb and Scott to further discuss EMS providers performing ECMO CPR. In part 2, we discuss application parameters such as a BLS-only crew, DNR patients, the age patients and geographical factors.  

Dr. Frank Ford and Dr. Colin McCluskey join the Caleb and Scott to discuss EMS providers performing ECMO CPR. It's not really that new of a concept. But new to EMS within the UH EMS Institute medical direction system. Exciting updates.

The crew and special guest, Don Zimmerman, wind-up the discussion about the new approaches to MCI's in this live show. Special thanks to Chardon Fire for hosting us!

In Part 3 of the "new" MCI episode, we are talking about changing the "paradigm" no pun intended) of planning, and on-scene thinking.  From tags, to staging, to determining accessibilty, all of it is changing and will continue to change by reviewing other agency's after-action reports.

The team is still talking with Don Zimmerman, MCI subject matter expert and instructor.  In this, part 2 of the New MCI episode, the group discusses what Don calls, “silly rules!”  For example, does the first ambulance really have to be the ambulance that stays at the MCI?

In this month's episode, the team discuss the evolving strategies in handling mass casualty incidents (MCI). They are joined by Don Zimmerman, an expert with extensive experience in fire service, paramedicine, and education. The episode dives deep into the traditional and modern approaches to managing MCIs, particularly in the context of active shooter events and other dynamic situations.

In this episode, the crew dives into the critical and high-stakes world of surgical airway management. The discussion focuses on needle cricothyrotomy, cricothyrotomy kits, and the essential skills and protocols for performing surgical cricothyrotomy. They explore the scenarios where these techniques become necessary, the tools required, and the step-by-step procedures. The expert panel shares their experiences, best practices, and the importance of proper training and preparation.

The podcast team goes "back to school," i.e. the Portage County Paramedic Class to record this live session. We're closing out the End Tidal CO2 session!  Thenk you to the class for having us!

What do Sponge Bob, sharks and the direction that sharks are swimming have to do with simplifying the interpretation of End Tidal CO2 for EMS? The pod crew brings the discussion of simplifying the use of End Tidal CO2 for basic and advanced level providers.

The crew continues to explain the theory and some practical, applicable knowledge related to the use of End Tidal CO2 for patient care.  They simplify how End Tidal CO2 is used to assess and tell  "the patient's clinical story" and emphasizes why it should be a day-to-day patient care standard.

End Tidal CO2 is not just an ALS skill. It is a "live feed" of the patient's ongoing condition. The capnograph is relatively easy to read and, at minimum, monitor changes to be reported to an ALS partner or medical control physician. The pod crew takes time to work backwards, explaining the fundamentals of CO2 production.

Where else would the crew go, other than to an event, to wrap up the event medicine episode? For this month's live session, the gang went live at the Canfield Fair. Thanks again to University Hospitals of Cleveland's Manager of EMS and Community Outreach, Laura Frost, RN. Thanks also to retired Chief Frost for the welcoming us.

For Part 3 of our event medicine podcast, University Hospitals of Cleveland's Manager of EMS and Community Outreach, Laura Frost, RN continues to discuss resources.  The key topic is, how do you get in touch with your supplemental resources when you need them? And stay tuned for our live episode...it will be from the Canfield Fair!

University Hospitals of Cleveland's Manager of EMS and Community Outreach, Laura Frost, RN continues to discuss the logistics of preparation and planning of event medicine. This includes familiarizing all of the event medical staff with how to access primary drugs and equipment as well as how to access supplemental support such as transportation and law enforcement. 

University Hospitals of Cleveland's Manager of EMS and Community Outreach, Laura Frost, RN joins the full crew to discuss event medicine planning and execution. From small community picnics to high school graduations to large national events, planning is the key. This month's discussion emphasizes pre-event assessment, logistical planning and patient care.

As you already know, in the months when we have a 5th Monday, we have an extra airway series episode.  This month, the team is talking Laryngoscopy. Be sure to head to our Prehospital Paradigm Podcast YouTube channel to see the team demonstrate each of the skills discussed on this extra episode.

This is the final episode of our "Neonatal Resuscitation for EMS" series. We were joined by Arielle Olicker, MD. Thanks to the Willoughby Fire Department for hosting this month's live show.  If you would like to host one of our live shows, message us! In addition to providing clinical care in the NICU, Dr. Olicker is part of the team providing follow-up care to our NICU graduates at the Neonatal Extended Outpatient Clinic. Dr. Olicker serves as the medical director for Neonatal Critical Care Transport and is the neonatal director of the Synagis administration program at UH Rainbow.

The crew and Dr. Olicker continue the conversation of undersstanding the neonatal patient, equipment, protocols and emotions. They start to wrap up the discussion in Part 3 as they prepare for the live podcast!

Dr. Olicker is still with the team for Part 2.  The team discusses the decision of transporting a neonate patient to the closest hospital vs. a facility with inhouse neonatal specialty care services as well as complications with the ductus arteriosus as well as the difficult decision of determining a the viability of a neonatal patient's viability for EMS.

Dr. Ariel Olicker, the medical director for Neonatal Critical Care Transport, joins the team for some practical conversation about understanding and being more comfortable with neonatal patients. Since traditional EMS doesn't encounter these patients regularly, the goal is to simplify understanding this patient category.

This month, we were live from the Chagrin Valley Fire Department.  We discussed air medical care with Kyle Schnarrs, Flight Nurse, and Nathan Brazytis, Flight Paramedic, from the UH AirMed critical care transport system. We talk how to become a flight paramedic/nurse, day-in-the-life, as well as just how much goes on in preparation for flight, plus so much more! 

In Part 3 of our discussion with crew members of UH AirMed, They wind up the recorded sessions discussion catching up on loose ends of the discussion, cricothyrotomy, laryngoscopy, the various drugs the helicopter carries and the use of blood on the aircraft.

UH MedAir's Kyle Schnarrs, Flight Nurse and Nathan Brazytis, Flight Paramedic continue to talk about the airmedical transport system.  First, they address the medical brief that can be helpfu to the communications specialists and the flight crew, distinctions between VFR flying and IFR flying for the crew, patients needing LVAD transportation as well as the most recent billing rules.  What is practical?

This month, we welcome Kyle Schnarrs, Flight Nurse and Nathan Brazytis, Flight Paramedic from the UH AirMed critical care transport system. In the first of a 4-part series, they discuss how to become a flight paramedic/nurse as well as answer many questions about air medical transport including a day-in-the-life-of!

This month we discuss field termination and DOA situations with Dr. Donald Spaner. We will dive into what the medical control physician is looking to hear from the field provider's report, the importance of the care of the family members on scene, and DNRs. Recorded at the Madison Township Fire Department.

In this 3rd part of our discussion of field termination of care and DOA situations, the crew and Dr. Spaner talk about the Do Not Resuscitation situations. DNR does NOT mean do NOTHING! Anything that gives the patient comfort can be utilized on a patient under a DNR order.