Podcasts about ems physicians

Ready for the latest insights in prehospital care? Improving health and safety in our communities starts with a commitment to equity. We explore how systemic disparities in Emergency Medical Services (EMS) affect patient care, outcomes, and trust. Join our guests - Remle Crowe, Andra Farcas, and Ameera Haamid - as we unpack the National Association of EMS Physicians' recommendations for making equity a strategic priority, published in Prehospital Emergency Care Journal, Volume 28, Number 6.  Hear how EMS agencies can leverage improvement science, community engagement, and quality monitoring to ensure that all patients receive high-quality, respectful care—regardless of who they are or where they live. This is more than a conversation; it's a call to action. Don't miss this important discussion. Also available for CE Credit!  Check out PEC Podcast Episode 149 today! Available now on your favorite podcast platform.   As always THANK YOU for listening. Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems) Maia Dorsett MD PhD (@maiadorsett) Lekshmi Kumar MD, MPH(@Gradymed1) Greg Muller DO (@DrMuller_DO) Ariana Weber MD (@aweberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaelkim_md) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD

PEC Podcast Episode 146: Consensus Statement of the National Association of EMS Physicians International Association of Fire Chiefs and the International Association of Chiefs of Police: Best Practices for Collaboration Between Law Enforcement and Emergency Medical Services During Acute Behavioral Emergencies

This week Dr. Joe Holley drops in after attending the NAEMSP (National Association of EMS Physicians) annual meeting in Austin, Texas. The leadership of our EMS docs discussed a multitude of important topics for the prehospital care environment. Here is one of the topics Dr. Joe shared on this week's Disaster Podcast.

This episode of Spinal Cast features the extraordinary world of emergency services and two heroes who save lives every day. Dr. Gregg Jones and Dr. Aaron Robinson are EMS Physicians with Hennepin County Emergency Medical Services. They share valuable insights into their challenging field of work and discuss the causes of many critical calls, including those that result in spinal cord injury. Learn some life-savings tips and discover how you can be a hero too in those critical moments when experts are not immediately available.Gregg A. Jones, MDDr. Gregg Jones currently serves as Medical Director of Public Safety and Special Operations at Hennepin EMS, EMS Fellowship Program Director, Assistant Medical Director, Hennepin Emergency Medical Services, and Medical Director for Minneapolis Fire Department. Dr. Jones also serves as Medical Director for MN Task Force 1 Urban Search and Rescue Team. He completed medical School at Oregon Health and Science University and Emergency Medicine Residency training at Hennepin County Medical Center in 2018 and EMS fellowship in 2019. Prior to going to school, Dr. Jones served in the US Army, which included two combat tours to Afghanistan. His current medical interests include medical directing for large-scale events, mass casualty incident planning, paramedic education, provider wellness and the interface between prehospital medicine and law enforcement.Aaron Robinson, MD, MPHDr. Aaron Robinson is an Emergency Medicine and EMS Physician at Hennepin County Medical Center and Hennepin EMS in Minneapolis, Minnesota. He is indigenous and from the Menominee Tribe of Wisconsin. He attended undergrad at the University of Wisconsin Oshkosh before earning his MD at University of Wisconsin. He also earned an MPH from the University of Minnesota. Dr. Robinson completed his residency in Emergency Medicine at Hennepin County Medical Center and stayed to complete a fellowship in Prehospital (EMS) Medicine. His professional interests include out of hospital cardiac arrest, critical care, and health disparities. Thank you again to both Gregg and Aaron for joining us on today's podcast! This production is a collaborative effort of volunteers working to create a quality audio and visual experience around the subject of spinal cord injury. A special shout out of appreciation to Clientek for providing studio space and top-notch recording equipment. Most importantly, thank YOU for being part of the Spinal Cast audience!Interested in watching these episodes?! Check out our YouTube playlist! https://youtube.com/playlist?list=PL40rLlxGS4VzgAjW8P6Pz1mVWiN0Jou3vIf you'd like to learn more about the MCPF you can visit our website - https://mcpf.org/Donations are always welcomed - https://mcpf.org/you-can-help/

This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. In this edition of the EMS One-Stop podcast, Host Rob Lawrence speaks with Dr. Maia Dorsett and Paramedic Nikki Little to discuss the NAEMSP Quality Improvement and Safety Course, an exciting year-long course that provides EMS physicians and quality improvement leaders with the knowledge and skills necessary to lead QI and patient safety initiatives in their region, system or agency. Participants will develop an in-depth understanding of how to apply QI tools and strategies to their local needs to affect the care of patients. Dr. Dorsett and Little identify that the program will take participants on a journey to improve the quality of care and safety in their system through a multi-modal approach in sessions led by expert faculty, who will discuss key aspects of quality improvement. TOP QUOTES FROM THIS EPISODE “I think one of the things I love about this course is half the faculty are not physicians. There is a fair percentage of NAEMSP membership that are not physicians and the quality course especially is very deliberate. It has faculty from different backgrounds.” — Dr. Dorsett “Your system is complex; all of the policies and procedures and processes that you have set up for the folks to work in them, they don't always work as designed.” — Nikki Little “Once a month, and even more often than that, because you meet with your mentees, you get to really collaborate idea-wise and work together with a group of people who are all there committed to making improvements in their system.” — Dr. Dorsett “So many quality leaders are still stuck in this in this moment, where they're looking at 50% in May and 52% in June, and we're just comparing these two numbers and making massive strategic decisions about things that might be seasonal or have abnormal variation and we could be really making some really dumb mistakes if we're not looking at our data over time.” — Nikki Little EPISODE CONTENTS 02:00 – Introduction – Nikki Little 2:25 – Introduction – Dr. Maia Dorsett 02:40 – Description of the course 03:30 – Quality Course origin story 05:30 – Little's experience as an inaugural participant 0745 – Month-by-month syllabus 10:00 – PDSAs and brevity in QI 13:00 – Capstone and results presentation 15:20 – Little's course highlights 17:29 – Dorsett's course highlights 21:25 – This course is not just for physicians 23:10 – Course overall timeline 24:30 – Cohort presentations at the annual meeting and poster presentations 26:20 – Class sign-up details ADDITIONAL RESOURCES ON THIS TOPIC  NAEMSP Year-Long Quality Improvement and Safety Course ABOUT OUR GUESTS Maia Dorsett, MD, PhD, is an emergency medicine and EMS physician and educator. She completed her EMS fellowship at Washington University before moving to Rochester, New York, where she now serves as the medical director for EMS education at Monroe Community College and is the associate regional medical director for education and quality for the Monroe-Livingston Region. She is also the medical director for Gates Volunteer Ambulance as well as Prodigy EMS. Nationally, she serves on the board of the National Association of EMS Physicians and the National Registry of EMTs. She is involved in quality improvement implementation and education, serving as the co-course director for the NAEMSP Quality and Safety course. Nikki Little, FAEMS, has fulfilled many roles as a paramedic, including advanced care paramedic, district chief of paramedic operations, 911 communication supervisor, and quality and patient safety officer in almost 30 years in EMS. She has a passion for patient-centered quality improvement of systems and has advocated for policy advances in the areas of patient safety, team communication and opioid overdose. She has dedicated countless hours to improve the quality and safety of patients with non-transport dispositions, (especially elderly and at-risk persons) and to improve the care for patients experiencing acute coronary syndromes (with particular focus on gender disparities in care). She has also contributed through committee work by way of the Paramedic Chiefs of Canada and the Manitoba Chapter of the Canadian Women's Heart Health Alliance. In the area of quality improvement and paramedic education, she is in her sixth year as faculty of the National Association of EMS Physicians (NAEMSP) Quality and Safety Year-Long capstone course and preconference workshop. Her dedication to furthering the educational mission of the organization, and skill in teaching patient safety and improvement science to paramedic professionals and EMS physicians was duly recognized when she was named co-director. CONNECT WITH OUR GUESTS Maia Dorsett Nikki Little

This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. Ginny Renkiewicz, PhD, is an assistant professor of healthcare administration in the College of Health Sciences and Human Services at Methodist University, Fayetteville North Carolina. Dr. Renkiewicz has been involved in EMS for 21 years as a credentialed paramedic, administrator and leader. Her specific research interests include defining predictors and profiling traumatic stress syndromes in EMS personnel and she recently had two papers published in the U.K. and U.S. on subjects related to her research interests. In this edition of EMS One-Stop, Rob Lawrence and Dr. Renkiewicz discuss her publications, “Secondary trauma response in emergency services systems (STRESS) project: quantifying and predicting vicarious trauma in emergency medical services personnel,” which discusses the emotional countertransference that occurs between the clinician and patient, and “Maladaptive Cognitions in EMS Professionals as a Function of the COVID-19 Pandemic,” which analyses how the coronavirus disease pandemic has profoundly affected EMS professionals. TOP QUOTES FROM THIS EPISODE “I don't think we will ever go back to normal; this is kind of like 911. There was before 9/11, and there was after 9/11, and this is going to be before COVID, and after COVID.” “Vicarious trauma is emotional counter, transference; essentially, you are feeling what the patient feels when they're experiencing a traumatic event. Example being, if you had a call, for example, a stillbirth, you may for the following weeks or months have this weird aversion to children or things in which infants are involved and you may have a stress response to those situations in the same way that the patient would have.” “Post traumatic stress injury is not the only stress disorder that exists out there. It is the one that I think most frequently cited by educators and administrators, because we don't know all of the other more insidious stress disorders, of which vicarious trauma is one.” “A predictor of having vicarious trauma as an EMS professional; my hypothesis is that if your parents or whomever your caregivers are do not teach you how to appropriately and emotionally cope with anything in any situation, it becomes very difficult for you to know how to do it properly in your adult life and so you overcompensate, and so vicarious trauma occurs in that population.” EPISODE CONTENTS 1:12 – Introduction: Dr. Ginny Renkiewicz 1:55 – Ginny's academic career 3:00 – The development of research on EMS 4:50 – Paper discussion – secondary trauma response 09:00 – Education on stress disorders 11:24 – Therapy dog program 12:30 – Next steps/further work on resilience training 1530 – Maladaptive cognitions 17:20 – Getting published in the SOM Journal 19:00 – Learning, conclusions and takeaways 23:00 – The new normal 24:18 – Call to action for leaders 26:13 – NHTSA Listening Group on wellness, resilience and peer support programs 27:30 – Getting involved in research 31:00 – NAEMT Lighthouse leadership program ADDITIONAL RESOURCES ON THIS TOPIC Secondary trauma response in emergency services systems (STRESS) project: quantifying and predicting vicarious trauma in emergency medical services personnel “Maladaptive Cognitions in EMS Professionals as a Function of the COVID-19 Pandemic” ABOUT OUR GUEST Dr. Ginny Renkiewicz is an assistant professor of healthcare administration in the College of Health Sciences and Human Services Methodist University, Fayetteville, North Carolina. She has been involved in EMS for 21 years as a credentialed paramedic and Level II paramedic instructor. She has spent 17 years as a program director, division chair or department head and has been recognized for her contribution to the EMS profession as a Fellow of the Academy of Emergency Medical Services (FAEMS) through the National Association of EMS Physicians. She has won several national and international awards, including National EMS Educator of the Year and the global EMS10 Award for innovation in the field of EMS. She holds an Associate of Applied Science in Sign Language Interpreting degree from Wilson Community College, a Bachelor of Science in Emergency Medical Care with a concentration in EMS management and a Master of Health Science in EMS education (both from Western Carolina University), and a Ph.D. in Health Science with a concentration in Respiratory Care from Rush University. Dr. Renkiewicz is a reviewer for several peer-reviewed journals; serves as executive director of the Foundation for Prehospital Medicine Research; and is enthusiastic about research, innovation and student mentoring. She is also the vice chair of the North Carolina Association of EMS Educators. Her specific research interests include defining predictors and profiling traumatic stress syndromes in EMS personnel. CONNECT WITH OUR GUEST Email: drginnyrenkiewicz@outlook.com Twitter: @DrKrankyPants LinkedIn: www.linkedin.com/in/ginnyrenkiewicz RATE AND REVIEW THE EMS ONESTOP PODCAST Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

EMS One-Stop Show Notes - National EMS Museum This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. In this episode of EMS One-Stop, Host Rob Lawrence discusses the National EMS Museum (NEMSM) with President Dave Zaiman; Museum Director, Kristy Van Hoven; and Jon Krohmer, MD, immediate past-secretary and "We are EMS" coordinator. The National EMS Museum is a volunteer-led organization that collects, preserves and shares the history of emergency medical response in the United States in hopes of inspiring future professionals to take up the call. The National EMS Museum organization operates a virtual museum and produces traveling exhibitions that tour the country every year. The Collections at the National EMS Museum house over 300 years of history that cover the development of prehospital care in the United States, North America and around the world. TOP QUOTES FROM THIS EPISODE “We are here to educate the future. We are here not only to document the legacy, but here to provide a foundation and an education that EMS as a profession, as we move forward is respected, is understood, and maybe in a small part this museum can play a part in improving EMS altogether.” EPISODE CONTENTS 03:05 – Origins of the NEMSM 05:04 – The style and model of the NEMSM 07:00 – Changes underway – recruiting individuals with experience in museum activities 11:50 – President Dave Zaiman 13:20 – Getting EMS into the community 15:00 – Favorite artifacts 16:30 – From MAST pants to blood transfusion 17:20 – Fundraising effort in order to take the museum on the road 20:30 – Developing a traveling mobile “We are EMS” museum project 23:40 – How to book a traveling exhibit ADDITIONAL RESOURCES ON THIS TOPIC The National EMS Museum California Ambulance Association Siren special edition: Fifty Years of Wedworth-Townsend ABOUT OUR GUESTS Dave Zaiman Dave is currently Sales VP - Midwest at Pulsara.  For over 30 years, Dave has been working in healthcare – both as an EMS professional as well as holding several leadership roles in the healthcare technology industry. Based in Minnesota, Dave spent his first 15 years working in the field as an EMT and paramedic in the Twin Cities metro area for both Allina and Hennepin County Medical Center. Kristy Van Hoven Kristy is the museum director for the National EMS Museum and PhD candidate at the University of Leicester. Over the last 3 years, Kristy has worked with the National EMS Museum's Board of Trustees to develop and implement engaging e-volunteer opportunities and community programs that reach their digital audience. In addition to her work with the EMS Museum, Kristy volunteers at several local museums in Toronto, Ontario. Jon Krohmer, MD Dr. Krohmer served as the director of the NHTSA Office of EMS before his retirement in November 2021.  During his tenure as director, Dr. Krohmer oversaw several milestones for the profession, including the creation of EMS Agenda 2050; major revisions to the National EMS Scope of Practice Model and the National EMS Education Standards; and improvements in the collection and use of EMS data through the expansion of the National EMS Information System. Soon after the onset of the COVID-19 pandemic, Dr. Krohmer was tapped to lead the prehospital/911 team as part of the Federal Healthcare Resilience Task Force. Prior to joining NHTSA, Dr. Krohmer had decades of experience as a local EMS medical director, initially in his home state of Michigan. His EMS career began as an EMT with a volunteer rescue squad. Like many EMS professionals, he was inspired by the television show “Emergency!” and by the emergence of the relatively new field of emergency medicine. He entered medical school at the University of Michigan knowing he wanted to make EMS his career. After becoming involved in EMS at the state and national level, he also served as president of the National Association of EMS Physicians from 1998 to 2000. In 2006, he came to Washington to serve as the first deputy chief medical officer for the Department of Homeland Security Office of Health Affairs and served in several other DHS roles before joining NHTSA in 2016. RATE AND REVIEW THE EMS ONE-STOP PODCAST Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. This week, Host Rob Lawrence welcomes back, Alexander Isakov, MD, MPH, professor of emergency medicine at Emory University School of Medicine, executive director of the Emory Office of Critical Event Preparedness and Response (CEPAR), and EMS lead for the National Emerging Special Pathogens Training and Education Center (NETEC). Returning guest, Dr. Isakov provides an update on the current emerging pathogens, diseases, outbreaks and fevers that have featured recently in the news. Candida auris, Marburg virus disease, avian influenza, Nipah virus are discussed as well as recaps on Ebola, COVID-19, polio and seasonal influenza. TOP QUOTES FROM THIS EPISODE “What's concerning CDC officials and experts is there is a multi-drug resistant strain of Candida auris that is really picking up in their surveillance programs.” “While no one wants to be exposed to a multi-drug-resistant Candida auris, it's really the ominous compromised patient that's going to be likely most affected by it, so that means elderly patients or patients that are getting chemotherapy and have some immunosuppression consequence of that or people that are taking immunosuppressant drugs, they are the ones really at greatest risk.” “The likelihood that EMS personnel are going to encounter somebody with Marburg virus disease in the U.S. during routine operations is extremely low, but good to be vigilant about it and identifying that someone might have been exposed, and understanding their travel history, if someone is ill, has a fever or myalgia, GI complaints and has travelled within the last 21 days to equatorial Guinea or Tanzania, then it would raise suspicion.” ADDITIONAL RESOURCES ON THIS TOPIC CDC: Infection prevention and control for Candida auris CDC: Information for infection preventionists NETEC: Situation report: Marburg cases rise in equatorial Guinea and Tanzania NETEC: EMS guidelines for Marburg virus disease ABOUT OUR GUEST Alexander Isakov, MD, MPH, is a professor of emergency medicine at Emory University School of Medicine. He is certified by the American Board of Emergency Medicine in both emergency medicine and emergency medical services (EMS). Dr. Isakov is the director of the Section of Prehospital and Disaster Medicine whose faculty provides medical oversight for 911 communications centers, and ground and air EMS responders in metropolitan Atlanta. He is also the executive director of the Emory Office of Critical Event Preparedness and Response (CEPAR), which serves as the center for Emory enterprise-wide planning for and coordinated response to catastrophic events. Dr. Isakov has provided leadership in emergency medical services and disaster preparedness locally and nationally. He serves as the medical director for the Sandy Springs Fire Department and Air Life Georgia. He is the founding medical director for the Emory-Grady EMS Biosafety Transport Program. He is the EMS lead for the National Emerging Special Pathogens Training and Education Center (NETEC) and is a designated Subject Matter Expert for the Assistant Secretary for Preparedness and Response, Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE). Dr. Isakov is also on the American College of Emergency Physicians Epidemic Expert Panel and is a member of the EMS sub-board for the American Board of Emergency Medicine. He previously served on the National Association of EMS Physicians board of directors and the Technical Expert Panel for NHTSA's EMS Agenda 2050. Dr. Isakov has an MD from the University of Pittsburgh and an MPH from Boston University. He completed his emergency medicine residency training at the University of Massachusetts Medical Center and his EMS fellowship with Boston EMS. Dr. Isakov has lived and worked in Atlanta for 20 years. He practices clinically in the emergency department of Emory University Hospital. RATE AND REVIEW THE EMS ONE-STOP PODCAST Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

Dangers of lights and sirens. Who is EMS? Dispatcher assisted CPR. Intubation video review. And more! Last week was the annual conference for the National Association of EMS Physicians. For 2 1/2 days experts in the field of EMS medical direction gave insights to a whole range of topics. I had the pleasure of getting to see some of them. Check out this recap to learn more. 

EMS providers pride themselves on the great care we deliver, but is that care equitable for all our patients? Join us for this second special edition PCRF journal club with the Diversity, Equity, and Inclusion committee of the National Association of EMS Physicians. Dr. Andra Farcas and the panel of authors will discuss their recent systematic scoping review on disparities in EMS care. After screening thousands of abstracts, the authors analyzed over 145 articles. It is time to act on the information they uncovered!To view the video, please visit: https://youtu.be/g7XOQD5v_bM

Dr. Joe Holley from Paragon Medical Education Group is featured in today's episode. He talks about his recent trip to the NAEMSP (National Association of EMS Physicians) conference in southern California. During the conference they focused on building more understanding between prehospital and hospital medical professionals. What do people in the hospital need to know about how first responders do their jobs and manage disaster situations.

A discussion about prehopsital physicians in the US and volunteer EMS: the good, the bad, and the ugly. Please don't listen to this if you are easily offended. You were warned. This podcast is hosted by ZenCast.fm

On this week's episode of The EMS Handoff, Tennessee EMS Medical Director Dr. Joe Holley, and Dr. Todd Heffern, emergency department director, EMS medical director and president of the Tennessee Chapter of the National Association of EMS Physicians, discuss the role of the EMS physician medical director in 2021 and beyond.  * The "Active" Medical Director * ASEP Position Statement * NAEMSP Position Statement * Pilot programs and new drugs * Sparse data and medical decisions * Medical director as conscience of EMS agency * It's tough to a CQI process * Top errors in EMS * Most important approach for ANYONE in the field * Abnormalities and notation * Paint the picture of your decision making * Difference between a clinician and technician * Acronym courses as continuing education * Bringing training from Okay to Great * Patient Outcomes vs. Administrative Outcomes

Welcome to our first episode of "But Why?" A podcast dedicated to providing education to prehospital clinicians in an entertaining conversation with EMS Physicians, Paramedics, and some good old fashion humor.  This podcast is brought to you by Washington University and NAEMSP.  Our first episode explores why a Tour De France Cyclist, Tom Simpson,  (Tom Simpson) and high school football player, Max Gilpin, died competing in the sports they loved. 

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

The Heat is here!  While you're inside trying to stay cool or floating around in the pool, why don't you catch up with the latest Prehospital Emergency Care Podcast Episode 65!  In this episode, your PEC podcast team highlights the Prehospital Emergency Care Journal Volume 23 Number 3.  We cover topics like:  Feasibility of Out-of-Hospital Cardiac Arrest Ultrasound by EMS Physicians To a fascinating study on the utility of Drones in mass gathering events!   And so much more! So click here to download today! We hope you enjoy this podcast and THANK YOU for listening! Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio DO (@PEMems)

Isabel talks with Dr. Mike Barnum, an emergency medicine physician in Las Vegas. They discuss how evidence informs practice, the different types of evidence, and how to integrate sound data into your center. For Your Information: AMR Las Vegas: https://www.amr.net/locations/operations/nevada/las-vegas/las-vegas-event-medical American College of Emergency Physicians: https://www.acep.org/ American Academy of Emergency Medicine: https://www.aaem.org/ National Association of EMS Physicians: https://naemsp.org/ Want to get involved in a study? Have a question? Email us at dispatchindepth @ emergencydispatch (dot) org

Isabel talks with Dr. Mike Barnum, an emergency medicine physician in Las Vegas. They discuss how evidence informs practice, the different types of evidence, and how to integrate sound data into your center.   For Your Information: AMR Las Vegas: https://www.amr.net/locations/operations/nevada/las-vegas/las-vegas-event-medical American College of Emergency Physicians: https://www.acep.org/ American Academy of Emergency Medicine: https://www.aaem.org/ National Association of EMS Physicians: https://naemsp.org/ Want to get involved in a study? Have a question? Email us at dispatchindepth @ emergencydispatch (dot) org

Todos los servicios de emergencias médicas deben contar con un Director Médico. La figura del Director Médico del Servicio de Emergencias Médicas es fundamental, según Juan Cardona, quien nos concedió una muy interesante entrevista para este episodio. Juan Carlos Cardona es el Jefe de División de Servicios de Emergencias Médicas del Coral Springs - Parkland Fire Department, en Florida, Estados Unidos de América. Dónde buscar al Director Médico del Servicio de Emergencias Médicas En este episodio, el Jefe Cardona nos relata cómo su departamento realizó la búsqueda de candidatos a Director Médico del Servicio de Emergencias Médicas, y por qué deseaban buscar a un médico de alto calibre para que los ayudara a mejorar su sistema hasta convertirse en un sistema de alto rendimiento. La búsqueda resultó en la contratación del Dr. Peter Antevy, quien los ha ayudado no solamente en las actualizaciones de sus protocolos para incluir procesos novedosos como al intubación en secuencia retrasada, sino que también ha logrado mejorar las estadísticas de sobrevivencia al paro cardiaco de un 8% inicial a un 38%. Preparación del Director Médico del Servicio de Emergencias Médicas El Curso de Director Médico del Servicio de Emergencias Médicas de la National Association of EMS Physicians va a ser ofrecido durante la siguiente edición del Congreso EMS World Americas. Juan Carlos Cardona puede ser contactado a través de www.coralsprings.org.

SPECIAL SMALL BATCH EPISODE The National Association of EMS Physicians (@NAEMSP), the American College of Emergency Physicians (@EmergencyDocs @ACEPEMSDP), and the American College of Surgeons-Committee on Trauma (@ACSTrauma) have published a position statement titled:  Spinal Motion Restriction in the Trauma Patient – A Joint Position Statement The PEC Podcast team interviewed NAEMSP President Dr. Brent Myers (@bmyersmd) regarding the utility of EMS Backboards and the PASSION of EMS providers about this very position statement. Click here to listen now! We hope you enjoy this podcast and THANK YOU For listening! Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio DO (@PEMems)    

What is SCAPE? For this podcast, we're discussing the acute pulmonary edema presentation. This patient is hypertensive (SBP >140mmHg), severely dyspneic, with diffuse rales and clearly anxious. The "no-shitter, drowning-before-your-very-eyes" type of pulmonary edema.  This is the SCAPE patient. SCAPE = Sympathetic Crashing Acute Pulmonary Edema. Patho Quick Hits The core causative factor in the SCAPE patient is an acute increase in left ventricular filling pressure. There are a myriad of causes for a sudden increase in LV pressure, but the end result is a redistribution of fluid into the lungs. 1) Acute increase in LV filling pressure. 2) Fluid redistribution into the lungs and alveolar space. 3) Hypoxia ensues. 4) Catecholamine production and increase in SVR. 5) Activation of the RAAS. It's important to remember that the majority of these patients are not volume overloaded. This is a fluid distribution problem due to increased LV pressure. As the RV continues to pump fluid into the pulmonary circulation, the LV cannot move that fluid forward because of the increased afterload. This creates a pressure gradient that transmits that pressure back into the pulmonary capillaries. 5 Major Causes of SCAPE - Exacerbation of chronic LV failure - Acute myocardial ischemia or infarction involving 25% or more of the myocardial mass - Severe systemic hypertension - Left sided valvular disorders - Acute tachydysrhythmias and bradysrhythmias Treatment In the out of hospital realm, the core treatments are Non Invasive Positive Pressure Ventilation (NIPPV) via CPAP or BiPAP, coupled with nitroglycerine as a first-line medication. For the "regular guy" toolbox, the treatment pathway looks a little like this: 1) Treating the underlying cause if evident. 2) NIPPV 3) NTG 4) More NTG 5) More NTG 6) More NTG  Do not delay NIPPV to see if other therapies (like a NRB) will work first. In the awake patient maintaining their own airway presenting with SCAPE, have a low threshold to apply your NIPPV mode of choice. These patients need PEEP: they generally have an oxygenation problem, and not a ventilation problem. To that point, most prehospital disposable CPAP systems do not deliver 100% FiO2. The O_two and Pulmodyne O2-MAX systems we generally use are either fixed FiO2 or provide a titration of FiO2 based on oxygen flow. The O_two system will provide between 59% and 77% FiO2 at oxygen flow rates between 8L/min and 25 L/min respectively. The Pulmodyne O2-MAX system provides 30% FiO2 regardless of PEEP, or with an additional adapter may provide 30%, 60%, or 90% FiO2 independent of the set PEEP. Nitrogylcerin If sublingual NTG is all you have, give it. Often, too. Lifting up the CPAP mask for 20 seconds is highly unlikely to cause clinically relevant harm. If you have the option of IV NTG, that should be your go-to. Standard dosing strategies for IV NTG of 5-40mcg/min are likely ineffective, and there is literature to support higher dosing strategies. Consider that we bolus 400mcg of SL NTG, and that the bioequivalence of SL NTG is comparable to around an IV NTG dose of 60-80mcg/min, so rapid titration of IV NTG even up to 100mcg/min is not entirely unreasonable and largely supported by current literature. Bibliography Dec, G. W. (2007). Management of Acute Decompensated Heart Failure. Current Problems in Cardiology, 32(6), 321–366. https://doi.org/10.1016/j.cpcardiol.2007.02.002 Mosesso, V. N. J., Dunford, J., Blackwell, T., & Griswell, J. K. (2003). Prehospital therapy for acute congestive heart failure: state of the art. Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 7(1), 13–23. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med4&NEWS=N&AN=12540139 Aguilar, S., Lee, J., Castillo, E., Lam, B., Choy, J., Patel, E., … Serra, J. (2013). Assessment of the addition of prehospital continuous positive airway pressure (CPAP) to an urban emergency medical services (EMS) system in persons with severe respiratory distress. The Journal of Emergency Medicine, 45(2), 210–9. https://doi.org/10.1016/j.jemermed.2013.01.044 Levy, P., Compton, S., Welch, R., Delgado, G., Jennett, A., Penugonda, N., … Zalenski, R. (2007). Treatment of Severe Decompensated Heart Failure With High-Dose Intravenous Nitroglycerin: A Feasibility and Outcome Analysis. Annals of Emergency Medicine, 50(2), 144–152. https://doi.org/10.1016/j.annemergmed.2007.02.022 Mebazaa, A., Gheorghiade, M., Piña, I. L., Harjola, V.-P., Hollenberg, S. M., Follath, F., … Filippatos, G. (2008). Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes. Critical Care Medicine, 36(Suppl), S129–S139. https://doi.org/10.1097/01.CCM.0000296274.51933.4C Agrawal, N., Kumar, A., Aggarwal, P., & Jamshed, N. (2016). Sympathetic crashing acute pulmonary edema. Indian Journal of Critical Care Medicine, 20(12), 719. https://doi.org/10.4103/0972-5229.195710 Mattu, A., Martinez, J. P., & Kelly, B. S. (2005). Modern management of cardiogenic pulmonary edema. Emergency Medicine Clinics of North America. https://doi.org/10.1016/j.emc.2005.07.005 Scott Weingart. EMCrit Podcast 1 – Sympathetic Crashing Acute Pulmonary Edema (SCAPE). EMCrit Blog. Published on April 25, 2009. Accessed on September 11th 2018. Available at [https://emcrit.org/emcrit/scape/ ].

Prehospital Emergency Care Podcast  Episode XXIII Happy EMS Week to all our first responders, EMS providers, and EMS Physicians.  Thank you for all you do! To celebrate, we have been working hard on a fantastic episode for you!   We've reviewed some of the most thrilling and coolest manuscripts from the March/April Prehospital Emergency Care Journal.       Right click here to download now!   We've also had some outstanding conversations with our cutting edge authors.   In this episode we interview:   Do Pediatric Teams Affect Outcomes of injured Children Requiring Inter-hospital Transport? [9:48] Julie Leonard MD, MPH Prehospital Glucose Testing for Children with Seizures: A Proposed Change in Management [18:18] Marianne Gauche-Hill MD   Katherine Remick MD       NAEMSP Position Statement Team [37:02]  John Gallagher MD     John Lyng MD   Please enjoy this podcast episode and stay tuned for our small batch episode next month in June.  Happy EMS week everyone and be safe! Hawnwan Philip Moy MD Scott Goldberg MD, MPH Jeremiah Escajeda MD, MPH Joelle Donofrio DO

Dr. Roger White of Mayo Clinic is the Co-Medical Director of the Mayo Clinic Medical Transport System and overall medical game-changer. Dr. White is re-writing history with the countless lives he is saving and cutting edge changes to the medical community.   While on vacation in Italy, White received a phone call in the midst of dinner. It was emergency medical services calling from Rochester Minn., about a patient in cardiac arrest. Without hesitation, White leapt into action and began directing the paramedics on what to do next. (Something he does anytime his Bat phone rings) In this show, we get an exclusive look into the life of a great American hero, Dr. Roger White.   More about Dr. Roger White Roger D. White, M.D., FACC, is Professor of Anesthesiology, Mayo Clinic College of Medicine, and a consultant in the Department of Anesthesiology as well as Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN.  He is the Medical Director of the City of Rochester and Olmsted County Early Defibrillation Program. He is also Co-medical Director of Gold Cross/Mayo Clinic Medical Transport and Principal Investigator with the Mayo Clinic Therapeutic Hypothermia Program. He was chair of the Board of Directors of the National Registry of Emergency Medical Technicians in 1983 and again in 1994.  Dr. White is a member of the National Association of EMS Physicians, American College of Cardiology, American Society of Anesthesiologists, and the Minnesota Society of Anesthesiologists.  He is a reviewer for Resuscitation, Annals of Internal Medicine, Critical Care Medicine, Mayo Clinic Proceedings, and Circulation.   He is a fellow of the American College of Cardiology.  In 2004 Dr. White received the Hans Dahll Award at the Emergency Cardiovascular Care Update Conference.  On-going clinical research includes assessment of patient outcomes following cardiac arrest, evaluation of performance of biphasic waveforms in clinical settings, and therapeutic hypothermia after cardiac arrest. Dr. Roger White's bibliography includes 327 publications, the majority pertaining to emergency cardiac care.

Ep #33 Double Sequence Defibrillation - A Journey through the Literature with Dr. Phil Moy @PECPodcast   Check out Dr. Phil Moy weave this elegant tale on the evolution of prehospital double sequence defibrillation.  He interviews 3 different author groups who recently published their work in Prehospital Emergency Care, the journal of the NAEMSP (National Association of EMS Physicians). PEC Podcast: http://pecpodcast.libsyn.com/ PEC Journal: http://naemsp.org/Pages/pecjournal.aspx NAEMSP Website: http://naemsp.org/Pages/default.aspx   Also find my friends and fellow prehospital physician podcasters on Twitter: Joelle Donofrio @PEMEMS Jeremiah Escajeda @JerEscajeda Scott Goldberg @EMS_Boston     Sponsored by @PerfectCPR Apple Watch App with Audio and Haptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR Delivery PerfectCPR.com     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  

Traumatized children need your full attention. Protocols work well for adults, but trauma in children requires that we exercise our clinical muscles just a bit more.   Two main reasons:  Children have specific injury patterns  Their physiologic response to trauma is unique.   Crash course in pediatric anatomy and physiology in trauma When you think of trauma in children, think of Charlie Brown. Large head, no neck, his chest and abdomen form an underdeveloped, amorphous shape. Alternatively, think of children as apples – they are rounder than they are tall, with a large increased surface area. Apples don’t have a hard shell or thick rind to protect them. If you drop them, you may not see any evidence of damage to the outside, but there can be considerable bruising just under the surface. A child has thin skin, less subcutaneous deposits than an adult, and a non-calcified, pliable thorax that deforms more than it protects or shields. The child’s abdominal muscles are not yet developed. There is less peritoneal fat to cushion a blow, and so traumatic forces transmit readily into internal organs, often without external bruising. The child’s large surface area also causes him to dissipate heat more quickly. He may be wet from urine or blood, and in a major trauma, this faster cool-down predisposes him to coagulopathy. Case A 5-year-old boy who was playing with his older brother in front of their home when the ball rolled into the street. He ran after it, and was struck by a sedan going approximately 30 mph. This is the so-called Wadell’s triad that occurs in a collision of auto versus pedestrian or auto versus bicycle. The initial impact is the greatest, and will vary depending on the child’s height and what part of his body reaches up to the bumper of the car. Depending on the height of the child and the height of the car, the initial impact will cause a femur fracture, a pelvic fracture, or direct abdominal trauma. The second impact happens as the child is flung onto the grill or the hood of the car, causing usually thoracic trauma. The third impact can be the coup de grace – to add insult to major injury, the child is then propelled forward, worsening the two previous impacts’ injuries and adding a third – severe blunt head trauma. Intubation Pearl #1: If your patient has any subtle change in mental status, intubate early. In pediatric trauma, we need to be proactive. Hypoxia is our enemy. Intubation Pearl #2: Thankfully cervical spine injuries in children are uncommon, and when they do occur, they typically occur at the child’s fulcrum, which is at C2. Compare this with an adult’s injury pattern with our fulcrum at C7. Be careful and minimize manipulation of the cervical spine, but do what you must to visualize the chords and place the tube. Keep the neck midline, and realize that the child’s usual decrease respiratory reserve is even more affected by trauma. Preoxygenate and pass that tube quickly. Chest Tube Pearl #1: Chest tube sizing in pediatrics is straightforward if we remember that the traditional chest tube size is 4 x the ETT size. Chest Tube Pearl #2: Try using a pigtail catheter. Safety Triangle Lateral edge of the pectoral muscle Lateral edge of the latisimus dorsi Line along the fifth intercostal space at the level of the nipple. It’s roughly where you would put on a generous dose of deodorant. Insertion here minimizes the risk of damage to nerves, vessels and organs. Resuscitative Thoracotomy in Children In a 40-year review of ED thoracotomy, Moore et al. analyzed 1,691 patients who received ED thoracotomy. Overall all-cause adult survival was 6.1%. In children ? 15 years of age, overall all-cause survival was considerably less, at 3.4%. In a large case series and review of the literature for pediatric ED thoracotomy, Allen et al. found a survival rate in penetrating trauma of 10.2%, with a much lower survival rate in blunt pediatric arrest, at 1.6%. Adolescents had more penetrating injuries, and younger children had more blunt trauma. To synthesize, the rarity of ED thoracotomy in children is due to the fact that: Traumatic full arrest in children is uncommon. It is most often blunt trauma. Blunt traumatic arrest in children is mostly non-survivable. REBOA If you have access to resuscitative endovascular balloon occlusion of the aorta or REBOA, this may be an option to temporize the child to get him to the relative control of the operating room. REBOA involves accessing the common femoral artery, passing a vascular sheath, floating a balloon catheter to the appropriate section of the aorta, and inflating the balloon to occlude blood flow. Brenner et al. described a case series of 6 patients from two Level I trauma centers. They used REBOA for refractory hemorrhagic shock due to either blunt or penetrating injury. After balloon occlusion, blood pressure improved sufficiently to take the patient either to interventional radiology or to the OR. Four patients lived, two died. The AORTA trial is underway to investigate its use in trauma. Summary: Children are like Charlie Brown – large head, no neck, amorphous, underdeveloped and unprotected thorax and abdomen. Or, if you like, they’re like, apples – they have a large surface area and are easily internally bruised, often without overt signs of external bruising. Chest tubes for children are very similar to the adult procedure – the traditional chest tube size is 4 x the child’s ETT size. Try to use smaller pigtail catheters, available in commercial kits, whenever possible. They’re easy, safe, and effective. Resuscitative thoracotomy is for penetrating trauma with signs of life wthin 10-15 minutes of arrival. Find the correctable surgical cause of the arrest. Resuscitative thoracotomy for blunt trauma has a dismal prognosis in children. Selected References Allen CJ, Valle EJ, Thorson CM, Hogan AR, Perez EA, Namias N, Zakrison TL, Neville HL, Sola JE. Pediatric emergency department thoracotomy: a large case series and systematic review. J Pediatr Surg. 2015 Jan;50(1):177-81. American College of Surgeons Committee on Trauma; American College of Emergency Physicians Pediatric Emergency Medicine Committee; National Association of Ems Physicians; American Academy of Pediatrics Committee on Pediatric Emergency Medicine, Fallat ME. Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest. Pediatrics. 2014 Apr;133(4):e1104-16. Holscher CM, Faulk LW, Moore EE, Cothren Burlew C, Moore HB, Stewart CL, Pieracci FM, Barnett CC, Bensard DD. Chest computed tomography imaging for blunt pediatric trauma: not worth the radiation risk. J Surg Res. 2013 Sep;184(1):352-7. Moore HB, Moore EE, Bensard DD. Pediatric emergency department thoracotomy: A 40-year review. J Pediatr Surg. 2015 Oct 19. Scaife ER, Rollins MD, Barnhart DC, Downey EC, Black RE, Meyers RL, Stevens MH, Gordon S, Prince JS, Battaglia D, Fenton SJ, Plumb J, Metzger RR. The role of focused abdominal sonography for trauma (FAST) in pediatric trauma evaluation. J Pediatr Surg. 2013 Jun;48(6):1377-83. Stannard A, Eliason JL, Rasmussen TE. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. J Trauma. 2011 Dec;71(6):1869-72. Pediatric Trauma on WikEM   This post and podcast are dedicated to Dr Al Sacchetti, MD, FACEP. Thank you for promoting the emergency care of children and for spreading the message that you don’t need subspecialty training to take good care of acutely ill and injured children. Powered by #FOAMed — Tim Horeczko, MD, MSCR, FACEP, FAAP

What’s happening SecondShift-ers? It’s another exciting week around the FBE podcast studios! Mike and Eric welcome special guest, Dr. Ritu Sahni to the podcast! He’s got an impressive list of credentials as medical director of several services, immediate past president of NAEMSP, and finds time to save the sick and the dead at Portland Providence in Oregon. The guys discuss the EMS subspecialty of EMS Physicians, the start of football season, and the usual entertaining drivel that you have come to expect and love from our (future) multiple award-winning SecondShift podcast!

Hi all,  Get ready for an awesome episode to be published soon starring Dr. Ricky Kue, Assistant Medical Director of Boston EMS, reviewing his manuscript "Tourniquet Use in a Civilian Emergency Medical Services Setting: A Descriptive Analysis of the Boston EMS Experience" Right click here to download.   Thanks for listening and feel free to contact us at pecpodcast@gmail.com or twitter us @pecpodcast for any suggestions for future podcast episodes or any comments you have.  Who knows?  You may be the next star on Prehospital Emergency Care Podcast!   Stay tuned for the next Episode! Cheers, Phil Moy MD Scott Goldberg MD Jeremiah Escajeda MD Prehospital Emergency Care National Association of EMS Physicians, NAEMSP