Podcasts about ems world

During EMS Week, it's important to recognize dedicated EMS providers as well as spotlight ways they can move forward in their careers. To that end, the fire and EMS degree programs offered by Columbia Southern University were designed with busy professionals in mind. Keith Padgett, MS, EFO, a 45-year veteran of the fire service, serves as academic program director for the fire and emergency medical services programs at CSU. In our latest EMS World podcast, host Mike McCabe sits down with Padgett to learn more about the career-expanding options available to today's hardworking first responders. Sponsored by Columbia Southern University. Follow EMS World on social media at EMSWorldOFCL

Lic. Carlos Casillas Cuéllar, Jefe del Centro Regulador de Urgencias Médicas (CRUM) y Héctor Enríquez colaborador del mismo, nos platican sobre el logro del personal del CRUM al obtener el primer lugar en la EMS WORLD.

Mobile integrated healthcare and community paramedicine continue to evolve daily. And these rapid advancements often lead to questions and confusion. EMS World's Mike McCabe sits down with Jeanine Newton-Riner, EdD, MHSA, RRT, EMT-P, CP-C, lead faculty for fire and emergency medical services for Columbia Southern University, to gain some clarity and guidance around getting yourself fully prepared to offer optimal MIH-CP services to your community. Follow EMS World on Facebook, X, and Instagram at @EMSWorldOFCL

Though measles was declared eliminated in the U.S. decades ago, outbreaks do still happen here, and in other places it's much more common. Before vaccines were widely available, it killed an estimated 2.6 million people worldwide each year. Research: "Measles cases rising alarmingly across Europe: WHO." IANS, 24 Jan. 2024, p. NA. Gale OneFile: Health and Medicine, link.gale.com/apps/doc/A780229341/GPS?u=mlin_n_melpub&sid=bookmark-GPS&xid=624cac48. Accessed 13 Feb. 2024. "The Medical Influence of Rhazes." Science and Its Times, edited by Neil Schlager and Josh Lauer, vol. 2, Gale, 2001. Gale In Context: World History, link.gale.com/apps/doc/CV2643450171/WHIC?u=mlin_n_melpub&sid=bookmark-WHIC&xid=5ed3d18a. Accessed 13 Feb. 2024. Associated Press. “Measles deaths worldwide jumped 40% last year, health agencies say.” 11/16/2023. https://apnews.com/article/measles-epidemic-children-who-cdc-bb62da7Measles%20deaths%20worldwide%20jumped%2040%%20last%20year,%20health%20agencies%20say Berche, Patrick. “History of measles.” La Presse Médicale. Volume 51, Issue 3, September 2022. https://www.sciencedirect.com/science/article/pii/S0755498222000422 Carson-DeWitt, Rosalyn, MD, et al. "Measles." The Gale Encyclopedia of Public Health, edited by Brigham Narins, 2nd ed., vol. 2, Gale, 2020, pp. 675-680. Gale In Context: Environmental Studies, link.gale.com/apps/doc/CX7947900178/GPS?u=mlin_n_melpub&sid=bookmark-GPS&xid=5cb0c749. Accessed 13 Feb. 2024. Centers for Disease Control. “Measles History.” https://www.cdc.gov/measles/about/history.html Conis E. Measles and the Modern History of Vaccination. Public Health Reports. 2019;134(2):118-125. doi:10.1177/0033354919826558 Düx A, Lequime S, Patrono LV, Vrancken B, Boral S, Gogarten JF, Hilbig A, Horst D, Merkel K, Prepoint B, Santibanez S, Schlotterbeck J, Suchard MA, Ulrich M, Widulin N, Mankertz A, Leendertz FH, Harper K, Schnalke T, Lemey P, Calvignac-Spencer S. Measles virus and rinderpest virus divergence dated to the sixth century BCE. Science. 2020 Jun 19;368(6497):1367-1370. doi: 10.1126/science.aba9411. PMID: 32554594; PMCID: PMC7713999. Home, Francis. “Medical facts and experiments.” London, 1759. https://archive.org/details/b30785558/ Manley, Jennifer. “Measles and Ancient Plagues: A Note on New Scientific Evidence.” Classical World, Volume 107, Number 3, Spring 2014, pp. 393-397. https://doi.org/10.1353/clw.2014.0001 Panum, Peter Ludwig. “Observations made during the epidemic of measles on the Faroe Islands in the year 1846.” Gerstein - University of Toronto. https://archive.org/details/observationsmade00panuuoft Papania MJ, Wallace GS, Rota PA, et al. Elimination of Endemic Measles, Rubella, and Congenital Rubella Syndrome From the Western Hemisphere: The US Experience. JAMA Pediatr. 2014;168(2):148–155. doi:10.1001/jamapediatrics.2013.4342 Patel, Minal K. et al. “Progress Toward Regional Measles Elimination — Worldwide, 2000–2019.” Morbidity and Mortality Weekly Report, November 13, 2020, Vol. 69, No. 45 (November 13, 2020). Via JSTOR. https://www.jstor.org/stable/10.2307/26967781 Rāzī, Abū Bakr Muḥammad ibn Zakarīyā. “A treatise on the small-pox and measles.” Translated by William Alexander Greenhill. 1848. https://archive.org/details/39002086344042.med.yale.edu/mode/1up Sydenham, Thomas. “The works of Thomas Sydenham, M.D.” London, 1848. https://archive.org/details/b33098682_0002 The College of Physicians of Philadelphia. “Measles.” History of Vaccines. https://historyofvaccines.org/history/measles/timeline West, Katherine. "THE RETURN OF MEASLES: With modern vaccine skepticism, the once-eliminated disease is surging in the U.S." EMS World, vol. 48, no. 6, June 2019, pp. 44+. Gale General OneFile, link.gale.com/apps/doc/A711878059/GPS?u=mlin_n_melpub&sid=bookmark-GPS&xid=8d0bb2cb. Accessed 13 Feb. 2024. See omnystudio.com/listener for privacy information.

Contributor: Meghan Hurley MD Educational Pearls: What is ATLS? Advanced Trauma Life Support (ATLS) is a systematic and comprehensive approach to the evaluation and management of trauma patients It was developed by the American College of Surgeons (ACS) The key components include the Primary Survey ("ABCDE"), the Secondary Survey, Definitive Care, and Special Considerations What are the issues with ATLS? ATLS relies on many algorithms and rules-of-thumb, which might be helpful for individuals with basic skills and training but might actually present obstacles for those with higher levels of training. Dr. Hurley cites several examples. Example 1: ABC approach to trauma patients ABC stands for Airway, Breathing, and Circulation but focusing on the airway first is not always the best decision. Immediate attention may need to be applied to massive hemorrhage. Intubating a patient that is hemodynamically unstable may cause cardiac arrest. A more helpful phrase might be “Resuscitate before you intubate.” Example 2: C-spine precautions Cervical collars may impede the likelihood of first-pass success when intubating. The risk of complications from a failed airway may often outweigh the risk of causing a spinal cord injury. Example 3:Cutting clothes off. The E of ABCDE stands for exposure which means fully undressing the patient to look for missing injuries. This often involves cutting their clothes off. This practice might be too broadly applied and leave low-risk trauma patients without any clothes to wear when discharged home. Example 4: Digital rectal exam A rectal exam can be a useful tool in the evaluation of patients with abdominal or pelvic injuries. It can help screen for rectal bleeding, pelvic fractures, and neurological function However, the rectal exam is not a sensitive test. A retrospective study from the Indian Journal of Surgery found that a rectal exam missed 100% of urethra injuries, 92% of spinal cord injuries, 93% of small bowel injuries, 100% of colon injuries, and 67% of rectal injuries in trauma patients. Example 6: Pushing on pelvis for pelvic injuries Pushing on the pelvis to check for instability can cause further damage to an unstable pelvis. Imaging the pelvis is far more important than pressing on it if a pelvic fracture is suspected.  Example 7: FAST exam A FAST exam, which stands for "Focused Assessment with Sonography for Trauma," is a rapid ultrasound examination used to assess trauma patients for signs of internal bleeding or organ damage in the abdomen and chest. These can be very useful as an initial test to tell a trauma surgeon where to start looking for internal bleeding in an unstable blunt traumatic injury If a patient is stable and likely going to get a CT scan whether the FAST is positive or negative then the test is unnecessary References ATLS Subcommittee; American College of Surgeons' Committee on Trauma; International ATLS working group. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013 May;74(5):1363-6. doi: 10.1097/TA.0b013e31828b82f5. PMID: 23609291. Bloom BA, Gibbons RC. Focused Assessment With Sonography for Trauma. 2023 Jul 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29261902. Brown R. Oxygenate and Resuscitate Before You Intubate. Common pitfalls to avoid when managing the crashing airway. EMS World. 2016 Jan;45(1):48-50, 52, 54-5. PMID: 26852546. Chrimes N, Marshall SD. Attempt XYZ: airway management at the opposite end of the alphabet. Anaesthesia. 2018 Dec;73(12):1464-1468. doi: 10.1111/anae.14361. Epub 2018 Jul 11. PMID: 29998563. Docimo S Jr, Diggs L, Crankshaw L, Lee Y, Vinces F. No Evidence Supporting the Routine Use of Digital Rectal Examinations in Trauma Patients. Indian J Surg. 2015 Aug;77(4):265-9. doi: 10.1007/s12262-015-1283-y. Epub 2015 May 19. PMID: 26702232; PMCID: PMC4688269. Groeneveld A, McKenzie ML, Williams D. Logrolling: establishing consistent practice. Orthop Nurs. 2001 Mar-Apr;20(2):45-9. doi: 10.1097/00006416-200103000-00011. PMID: 12024634. Morgenstern, J. The FAST exam: overused and overrated?, First10EM, August 30, 2021. Rodrigues IFDC. To log-roll or not to log-roll - That is the question! A review of the use of the log-roll for patients with pelvic fractures. Int J Orthop Trauma Nurs. 2017 Nov;27:36-40. doi: 10.1016/j.ijotn.2017.05.001. Epub 2017 May 10. PMID: 28797555. Sapsford W. Should the 'C' in 'ABCDE' be altered to reflect the trend towards hypotensive resuscitation? Scand J Surg. 2008;97(1):4-11; discussion 12-3. doi: 10.1177/145749690809700102. PMID: 18450202. Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma. 2014 Mar 15;31(6):531-40. doi: 10.1089/neu.2013.3094. Epub 2013 Nov 6. PMID: 23962031; PMCID: PMC3949434. Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII  

This episode is an interview with Catherine Musemeche who wrote a fascinating biogrpahy on Mary Sears, titled: Lethal Tides: Mary Sears and the Marine Scientists Who Helped Win World War II. It tells the story of how the U.S. Navy was unprepared to enact its island-hopping strategy to reach Japan when World War II began and how oceanographers came to the rescue. Our efforts were severely hindered in that there was inadequate data on  tides, planning for coral reefs, etc. - to enact effective amphibious landing. Mary Sears, an overlooked oceanographer with untapped talent who, along with her team, became instrumental in turning the tide of the war in the United States' favor. Episode Markers (in mins:secs)Introduction (0:0)Start of Interview (2:12)Early Education (5:13)History of Woods Hole Oceanographic Inst. (7:45)Mary Sears Life in 1941 (11:30)Return to Woods Hole (15:50)Difficult Island Landings(Pacific) & Tarawa Island (19:36)Using Data from Mary Sears Reports (27:06)Mary Sears - becoming a Naval Officer (37:35)Recognition of Mary Sears (40:42)Inspiration for Book (45:16)This book is far more than a biography, and it weaves the multiple story lines – of our war efforts in the Pacific, the efforts of these scientists to bring about the critical victories and of course the incredible life of Mary Sears.Amazon Link to BookBook reviews - Kirkus & Barnes and NobleAs mentioned in this episode, Kate will be speaking at a December WW2 conference (at this link). Catherine “Kate” Musemeche is a graduate of the University of Texas McGovern Medical School in Houston, Texas and the University of Texas School of Law. Musemeche's first book, Small, was longlisted for the E.O. Wilson/Pen American Literary Science Award and was awarded the Texas Writer's League Discovery Prize for Nonfiction in 2015. Her second book, Hurt, was named one of the top ten EMS books of the decade. She has also contributed to Smithsonian Magazine, the Wall Street Journal,  New York Times' “Motherlode” blog, KevinMD.com, Creative Nonfiction magazine and EMS World. She lives in Austin, Texas. Website: https://peoplehiddeninhistory.comDirect linkWebsite with all Podcast Episodes/All PlatformsContact PageTwitter(X)/Instagram: @phihpod

Leading up to EMS World Expo 2023, we are releasing never-before heard episodes from EMS World Expo 2022 in Orlando. As always, the EMS World podcast team will be busy bringing you the most current conference coverage with key speakers and dignitaries from the 2023 event in New Orleans. If you can't join us in person, these podcasts are the next best thing to being there! In this episode from 2022, Mike McCabe sits down with Matthew Levy, DO, MSc, FACEP, FAEMS, NRP, associate professor of emergency medicine at Johns Hopkins University School of Medicine and president of the Stop the Bleed Coalition, to learn more about this campaign that has made a significant impact in training the civilian population on lifesaving techniques related to exsanguination. Follow EMS World (EMSWorldOFCL) on Twitter, Facebook, Instagram, and LinkedIn.

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 edition of the EMS One-Stop podcast spotlights the popular online education series Reel Emergency, which uses real bodycam footage to illustrate various types of medical emergencies. The footage is then discussed in a live broadcast by very well-known emergency medicine physicians, Drs. Peter Antevy, Mark Piehl and David Spiro. Reel Emergency offers free continuing education credit on the day of the Prodigy EMS based broadcast (you must be in the live audience to receive CE) and is then made available via YouTube for all to view and use as part of their clinical education.  Reel Emergency has now produced 15 episodes and has been viewed tens of thousands of times as both individuals and departments benefit from the content, the expert analysis and commentary, as well as subject matter expert guests. In this podcast, Rob Lawrence chats with Reel Emergency's regular host Hilary Gates, director of educational strategy for Prodigy EMS; and Zach Dunlap, clinical education specialist from 410 Medical. Zach also previously worked for an agency that pioneered the use of body-worn cameras in EMS and offers insight into their adoption and use.  TOP QUOTES FROM THIS EPISODE “These real patient videos actually show what's happening on a call. Where else do you get that? You can't get that anywhere else and there's something to be said for doing scenarios and having standardized patients or mannikins, but nothing beats watching the actual call itself because you also have all of the other elements of the call that are really hard to recreate in the classroom. You have all of the emotions all of the bystanders, all of the equipment, the communication aspects you have to worry about, and you have real human reactions” — Hilary Gates “If you are an educator, and you are teaching a certain topic – anatomy, physiology, scene management, all operations, whatever it is – and there is a way to illustrate that, you should be required to illustrate it with a video – there's just no better way to do it.” — Hilary Gates “It should almost be a requirement at this point, the main reason people don't want body cameras in EMS is because it's grossly misunderstood.” — Zach Dunlap EPISODE CONTENTS 1:00 – Introductions 01:35 – REEL Emergency 02:20 – Everyone knows Drs. Spiro, Antevy and Piehl 4:00 – Using video for education 6:10 – Gaining free CE and watching on-demand 07:20 – Using body-worn cameras on the street 08:23 – Using BWCs for performance improvement 11:25 – Suggesting that BWC eventually become the standard of care 12:50 – Where does Reel emergency get its videos from? 14:00 – Filming the Falmouth Road Race and heat emergencies 15:20 – How to view Reel Emergency? ADDITIONAL RESOURCES ON THIS TOPIC Current Reel Emergency topics include sessions on HP CPR, heat emergencies, peds emergencies, junctional hemorrhage, ped airways, anaphylaxis, intracranial emergencies, delirium, end of life care, GSWs and altered mental status. Following are additional resources on incorporating body-worn cameras: Promoting transparency and accountability with BWCs Three outdated paradigms holding EMS back Leadership's role in keeping our workforce safe How to buy body-worn cameras (eBook)   ABOUT OUR GUESTS Zach Dunlap began his EMS career as a paramedic in Amarillo, Texas. After working in Oklahoma City, he returned to the Texas panhandle, where he worked as a flight paramedic for several years. Zach now resides in Houston, and has served as a flight paramedic and clinical director for a progressive 911 system. Currently, he is a clinical education specialist for a national medical company educating and training clinicians across the country on volume resuscitation. Zach obtained his bachelor's in emergency health sciences and has always focused on providing excellent patient care through innovative approaches. Zach enjoys sports and spending time with his two children, Brogan and Brynlee, and their Goldendoodle, Claire. Zach is also the assistant treasurer of the Board of Commissioners of Harris County ESD11 in northern Houston. Hilary Gates, MAEd, NRP, is the director of educational strategy for Prodigy EMS and a volunteer paramedic in the Alexandria (Virginia) Fire Department. She is also a faculty member of the School of Education at American University in Washington, D.C., and teaches Introduction to Community Health in the EM Program at University of Pittsburgh. Beginning her career as a volunteer EMT with the Bethesda-Chevy Chase Rescue Squad in Montgomery County, Maryland, Hilary became a full-time paramedic, EMT instructor and FTO at AFD, and then served as senior editorial and program director for EMS World. She implemented AFD's MIH/CP program in 2017 and has extensive experience as an EMS educator, symposium presenter and quality improvement trainer. ABOUT THE REEL EMERGENCY PANEL Dr. David Spiro is a pediatric emergency physician and professor at University of Arkansas Medical System, and he is chief medical officer of Reel Dx. Dr. Peter Antevy is a nationally recognized lecturer and expert in the field of prehospital pediatrics and cofounder of Handtevy Pediatric Emergency Standards. He currently serves as the EMS medical director for multiple fire and rescue departments in Florida. Dr. Mark Piehl is a board-certified pediatrician and pediatric intensivist at WakeMed Hospital in Raleigh, North Carolina, and co-founder of 410 Medical. CONNECT WITH OUR GUESTS Hilary Gates: Linkedin Twitter Zach Dunlap: Linkedin Twitter 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.

Links from the show:* Lethal Tides: Mary Sears and the Marine Scientists Who Helped Win World War II* Connect Catherine* Rate the show* Never miss an episodeAbout the show:Catherine “Kate” Musemeche is a graduate of the University of Texas McGovern Medical School in Houston, Texas and the University of Texas School of Law. Musemeche's first book, Small, was longlisted for the E.O. Wilson/Pen American Literary Science Award and was awarded the Texas Writer's League Discovery Prize for Nonfiction in 2015. Her second book, Hurt, was named one of the top ten EMS books of the decade. She has also contributed to Smithsonian Magazine, the Wall Street Journal, New York Times' “Motherlode” blog, KevinMD.com, Creative Nonfiction magazine and EMS World. She lives in Austin, Texas.Lethal Tides: Mary Sears and the Marine Scientists Who Helped Win World War II tells the story of how the U.S. Navy was unprepared to enact its island-hopping strategy to reach Japan when World War II began and how oceanographers came to the rescue. Anticipating tides, planning for coral reefs, and preparing for enemy fire was new ground for the navy, and with lives at stake it was ground that had to be covered quickly. They turned to Mary Sears, an overlooked oceanographer with untapped talent who, along with a team of colorful and quirky marine scientists, became instrumental in turning the tide of the war in the United States' favor. Sears and her team helped the navy “solve the ocean” by guiding them to optimal landing sites in the Pacific and by identifying thermoclines, temperature gradients in the ocean, where U.S. submarines could hide from the enemy. Get full access to Dispatches from the War Room at dispatchesfromthewarroom.substack.com/subscribe

Frank Abagnale is famous for being a confidence man, a thief and is convicted of bank fraud. Before being caught he allegedly passed the Georgia bar exam, served as a Doctor and most famously logged millions of miles posing as a Pan Am pilot needing a ride from town to town. Of course in each town he made and cashed fraudulent checks and committed other crimes, many of which are now in question, but the claims are monumental. His story was told in the motion picture "Catch me if you can" featuring Leonadro DiCaprio as Abagnale, Christopher Walken as his father, Charlie Sheen as his prospective father in law and little known actor Thomas Hanks as the FBI agent tracking Abagnale's cons and schemes through the 1960s.So why is this mentioned on WYE? Well, because a recent story broke about a man impersonating a Paramedic and we just LOVE drama here. And a good flick.From WOWK comes a story of mystery, intrigue, and a couple of Volunteer Fire Departments a little too quick to take someone at their word. Apparently Christopher Lee Lin (or as he apparently referred to himself to remain incognito, Christopher Beckinsale, no apparent relation to the movie star) wandered into a West Virginia Volunteer Fire Department and mentioned he was a Paramedic from elsewhere. The Chiefs gave him gear, including, a $15,000 breathing apparatus, and then found out later...well...maybe he isn't who he claims to be.This week we ponder:How does one fake being a Paramedic?How does one not ask around or perhaps ask for proof of said Paramedic certs?Exactly what does a $15,000 breathing apparatus look like?If the real Frank Abagnale made up many of his exploits, does that make him a better con man in the end?BOLOPicard Season 3 on ParamountThe Southern Book Club's Guide to Slaying Vampires by Grady HendrixSupport the showJoin our Facebook Community!Buy us a beer!Email Us! (Justin or Jason)Thanks for listening and please share the show!

Voices of EMS #10. The limited series of Voices of EMS (VOEMS) continues this week with Valerie Bestland and Avi Golden. Valerie tells us a few stories that you will enjoy and learn. Valerie talks a little bit about the organization that she founded. Avi rejoins me and talks about his stroke and how his aphasia takes him all over the world to educate the medical community. VOEMS lets me revisit some of the Medic2Medic Podcast guests for them to tell one more story.

Derek O. Hanley is a long-time paramedic and disabled veteran combat medic, author, published photographer, multi-instrumentalist, noted video producer, and is the founder of DOHP. Derek served an active-duty tour in the U.S. Air Force as a paramedic and instructor, assigned to the 59th Medical Wing and stationed in the emergency department of the USAF level-one trauma center Wilford Hall Medical Center, where he received several awards and medals for his service. Following this, Derek worked as a civilian paramedic in New York and served a tour with the Army National Guard as a combat medic and instructor with the 42nd Infantry Division, also receiving several commendations, including the Army Achievement medal, and a nomination for division soldier of the year.  After moving to California, he was co-founder of a boutique commercial video production company in Oakland, producing and editing dozens of videos, while working with professional athletes, musicians, and CEOs. Concurrently during this time, Derek became an EMT program director, teaching hundreds how to save lives, before starting his own business. He has feature-length film credits for cinematography, photography, and sound for his work on the independent film When the Man Went South, the first film to be shot on the island nation of Tonga completely in the Tongan native language.  Derek's pictures are heavily published in EMS World magazine, garnering the center spread with his photos from the front lines of the COVID-19 pandemic, and twice his images from the field have been selected for the cover. You can purchase hos book here: https://amzn.to/3vQOtbw          

Episode 266 is Dekek Hanley. Derek is a long-time paramedic and disabled veteran combat medic, author, and published photographer. His new forthcoming book, Photos from the Front Line: A Year on the Streets of Alameda County lands on December 1, 2022. We talk about his US Air Force career, EMS, his disability, and his interest in photography. We learn how the book came about and his experience riding for a year. Derek's photos have also been heavily published in EMS World Magazine.Links for the bookDOHP.net/books and Instagram:@thatsdohp

A new video series titled “One for the Road” will soon begin rolling out on EMS World's website. Sponsored by Hartwell, these short educational videos will take on a wide range of topics in the prehospital ecosystem and provide simple, practical tips you can take with you on your next shift. Firefighter-paramedic Steve Whitehead hosts the videos and discusses the new series and what it will accomplish with EMS World's podcast host Mike McCabe. Follow EMS World (EMSWorldOFCL) on Twitter, Facebook, Instagram, and LinkedIn. EMS World Expo is Oct. 10–14, 2022 in Orlando. 

What is community risk reduction, how can EMS providers become involved in it, and what should they understand about education to do so? These are big questions, but the answers can lead us toward safer and healthier communities. In our latest EMS World original podcast, host Mike McCabe explores with Columbia Southern University's Aaron Rhone, PhD, MPA. Sponsored by CSU.  Follow EMS World (EMSWorldOFCL) on Twitter, Facebook, Instagram, and LinkedIn. EMS World Expo is Oct. 10–14, 2022 in Orlando. 

Smith, Mike. (2012). Analysis Paralysis. EMS World. https://www.hmpgloballearningnetwork.com/site/emsworld/article/10526554/analysis-paralysis Van Horne, Riley. "Left of Bang" This podcast is hosted by ZenCast.fm

Bystanders often play a key role in successful outcomes for out-of-hospital cardiac arrest, and among our jobs is raising their awareness and reducing their fear so they can act when needed. In this special EMS World original podcast, cardiac arrest survivor Mike Papale, community relations manager for Defibtech, discusses progress, challenges, and measures we can take to educate and empower lay responders in cases of SCA. Sponsored by Defibtech.  Follow EMS World (EMSWorldOFCL) on Twitter, Facebook, Instagram, and LinkedIn. EMS World Expo 2022 is October 10–14 in Orlando! 

@offload_delay LIVE podcast - Time to Lighten the Mood! After several necessary heavy-hitting shows in a row... the podcast pivots and features 5 seasoned medics sharing a glimpse with us into the "lighter side" of the EMS world. Nancy (IG thegingermama_) makes her debut and joins returning guests Kenny (@iplantpeople), Randy (@Reluctant_Prez) , Troy (FB Troy Boy Ward) & host Brad (@bradhopper14) for an informative and entertaining "roundtable" discussion. Learn more about your ad choices. Visit megaphone.fm/adchoices

The January 9 high-rise fire at the Twin Parks North West Site 4 apartment complex in the Bronx killed 17 people, including eight children, and produced 32 critical patients among the 64 hurt. FDNY Deputy Chief Farooq Muhammad was among the first emergency personnel on scene and commanded the response's medical branch.  In the latest EMS World original podcast, Muhammad reviews the harrowing experience—the deadliest fire in New York City in three decades—with host Mike McCabe.  Follow EMS World (EMSWorldOFCL) on Twitter, Facebook, Instagram, and LinkedIn. EMS World Expo 2022 is October 10–14 in Orlando! 

Interested in the medical field? Curious about life as an EMS worker? This episode is for you! Abe sits down with three Unbounders in the EMS world to discuss what got them into the field, their stories, and the life lessons they've learned along the way. Sign up for a free video series about decision making: www.beunbound.us/navigate

Fewer cops, more crime, and an increasingly dangerous environment for EMS providers—it's a changed world out there, and being one of the "good guys" won't always protect you. What will? Is it time to make body armor routine for EMS? North American Rescue's David Rice, a longtime medic and law enforcement officer, joins host Mike McCabe to discuss the question in our latest EMS World original podcast.   Sponsored by North American Rescue.  Follow EMS World (EMSWorldOFCL) on Twitter, Facebook, Instagram, and LinkedIn. EMS World Expo is live and in person Oct. 4–8, 2021 in Atlanta—and start planning now for EMS World Expo 2022, October 10–14 in Orlando! 

Let's get together, live and in person! EMS World Expo is returning to a live format for its 2021 event, Oct. 4–8 in Atlanta, with lots of new and exciting content. In this episode host Mike McCabe talks with HMP Global VP and EMS World boss Josh Hartman, MBA, NRP, about innovating 2020's COVID-driven virtual show, this year's return to a more traditional format, and all that's awaiting attendees. Register and learn more at www.emsworldexpo.com.  Follow EMS World (EMSWorldOFCL) on Twitter, Facebook, Instagram, LinkedIn, and YouTube.     

Tom Bouthillet is Battalion Chief of EMS for Hilton Head Island (SC) Fire Rescue.  Currently, he is a member of NREMT's Continued Competency Agenda Steering Committee, NEMSMA's EMS Quality Improvement Committee, and NENA's Telecommunicator CPR Working Group. He is also a member of the Editorial Advisory Board for EMS World and a Content reviewer for the British Paramedic Journal. Previously, he was a member of NHTSA's High Performance CPR Working Group, director of the South Carolina Resuscitation Academy, co-producer of the Code STEMI web series, content expert for the 12-Lead ECG Challenge smartphone app, and editor of EMS12Lead.com.  Tom is interested in process improvement, system performance, human factors, crew resource management and evidence-based performance measures for time-sensitive diagnoses.

EMS providers often have uneasy relationships with their infusion pumps. How can they be better? In the latest EMS World podcast, host Mike McCabe speaks with L.J. Relle, a veteran paramedic and clinical consultant for Eitan Medical, about the attributes needed in a pump that's truly EMS-friendly. Sponsored by Eitan Medical.  Follow EMS World (EMSWorldOFCL) on Twitter, Facebook, Instagram, and LinkedIn. EMS World Expo is live and in person Oct. 4–8, 2021 in Atlanta! 

A&E's first responder favorite, Nightwatch, is back in the Big Easy for a new season that premieres March 25. In this special EMS World podcast, New Orleans EMS cast veterans Titus Tero and Holly Sherman join host Mike McCabe to discuss how filming has gone, the challenges of fame, and their role as EMS ambassadors. Share their insights before you catch the show! Sponsored by Braun Ambulances.    Follow EMS World (EMSWorldOFCL) on Twitter, Facebook, Instagram, and LinkedIn. EMS World Expo is live and in person Oct. 4–8, 2021 in Atlanta! 

The back of a moving ambulance remains a dangerous place to make your living. But as awareness of the risks grows, progressive departments and manufacturers are taking proactive steps to help protect their patients and crews. In this latest EMS World podcast host Mike McCabe speaks to Horton Emergency Vehicles VP/GM Lance Randolph and Violet Township (Ohio) Fire and EMS Assistant Chief Jim Paxton about their collaboration and attempts to grow and reinforce the EMS safety culture.  Follow EMS World (EMSWorldOFCL) on Twitter, Facebook, Instagram, and LinkedIn. EMS World Expo is live and in person Oct. 4–8, 2021 in Atlanta! 

COVID-19 survivor Scott Cohen tells his incredible story about being on a ventilator and losing his father to the disease.  Cohen, a retired paramedic from Nassau County, New York, was profiled in this Sept. EMS World story about long haulers.  Have you or a loved one survived COVID-19? Check out Survivor Corps for support and information about clinical trials.Follow EMS World on Twitter, Facebook, Instagram, and LinkedIn. EMS World Expo is Oct. 4–8, 2021 in Atlanta! 

We commonly hear the phrase "resuscitate before you intubate." My question is - how do you know when your patient is resuscitated enough to follow through with intubation? Last weekend I gave a talk at EMSWorld called "The Sound of Silence." At the end of the talk Sam and I had a discussion on how do you know when a patient is resuscitated enough to allow intubation. In true Tyler fashion, I misread how long my talk was suppose to be and had to cut out the ending. This is the discussion portion of that talk and I think you will especially enjoy the ending.

Back in January 2000 EMS World (then Emergency Medical Services Magazine) asked prominent industry experts to foretell the future of EMS. They obliged (find their responses here), not knowing we'd circle back 20 years later to review how they did. Supplementing that September 2020 cover story, the USFA's Rick Patrick—a contributor to that package in 2000—shares his take here on how the industry has evolved and what we all got right and wrong. Join Host Mike McCabe as he goes back to the future with Rick.Follow EMS World on Twitter, Facebook, Instagram, and LinkedIn. EMS World Expo Virtual is Sept. 14–18! 

COVID-19 patients have been found to be hypercoagulopathic: how should EMS providers consider this condition when treating patients? Host Mike McCabe dives into the pathophysiology with Tjasa Hranjec, MD, the co-author of a recent article on the topic published in the August 2020 issue of EMS World magazine.Follow EMS World on Twitter, Facebook, Instagram, and LinkedIn. EMS World Expo Virtual will be held Sept. 14–18, 2020!

Should EMS providers wear a body cam during patient encounters? Cypress Creek EMS (CCEMS) says yes.  Join Clinical Training Coordinator Zach Dunlap from CCEMS as he discusses with Senior Editorial & Program Director Hilary Gates the clinical, safety and training benefits of body-worn cameras in EMS.  Interview follows the article readaloud from the August 2020 issue of EMS World magazine. Follow EMS World on Twitter, Facebook, Instagram, and LinkedIn. EMS World Expo Virtual will be held Sept. 14–18, 2020!

First responders often receive little training or experience with emergency childbirth in the field. A new partnership between UT Health San Antonio and local EMS agencies is bringing medical students with an interest in OB/GYN to fire and EMS services to teach paramedics and EMTs about the intricacies of field deliveries. EMS World’s Jonathan Bassett speaks with Nicholas Stansbury, recent graduate of UT Health San Antonio Medical School and one of the co-authors of “Emergency Deliveries in the Field,” about the background of the program and how it’s helping keep EMS responders trained and ready for unplanned births and the health emergencies that can arise. A readaloud of the full article, which appears in the June 2020 issue of EMS World, follows.

EMS World is asking first responders and healthcare workers who have been diagnosed with COVID-19 to talk about their experiences battling the virus.  Associate Editor Valerie Amato speaks with ER nurse Emily Cornpropst, who treated one of the first COVID-positive patients in the state of Indiana at Franciscan Alliance in Indianapolis. After fighting and recovering from the virus, Emily shares her advice for other front line providers facing the COVID-19 crisis.Check out other stories from the series “When COVID-19 Hits Home.” Here, a pediatric EM physician shares his harrowing experience being hospitalized for COVID-19 complications. An EMS provider reports on their roller coaster of life-threatening symptoms fighting this invisible enemy, and another EMT recounts what it takes to counter fear during the course of her illness.If you or someone you know in the field has a story to share about contracting COVID-19, email us at editor@emsworld.com. Your story will remain anonymous if you so choose. 

COVID-19 testing and availability, accuracy, turnaround time and sampling dominate the news cycle. What does it mean for EMS? What tests are proven to be reliable and how should EMS leaders and medical directors incorporate testing within their systems? Join Drs. Antevy and Pescatore as they explore this hot-button issue and provide updates and recommendations for the EMS community  This is an audio-only version of an EMS World webinar, which you can find here.  Thanks to our sponsor, Bound Tree.Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas! 

The pandemic has turned EMS education programs upside down. Listen to UCLA education experts explain how programs have shifted to remote learning environments and implemented innovative solutions for psychomotor learning and evaluation when students cannot attend classes in person. From EMT and paramedic programs to continuing education, there are insights here for all educators. This is an audio-only version of an EMS World webinar, which you can find here.  Thanks to our sponsor, Bound Tree.Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas! 

For the critical care provider, ventilator management is top-of-mind. When you are at the controls of mechanical ventilation with a COVID-19 patient, what are the best practices, techniques and latest science? Join Eric Bauer and Tyler Christifulli as they take you through a three-round match of ventilator pitfalls and knock-outs to avoid.  This is an audio-only version of an EMS World webinar, which you can find here.  Thanks to our sponsor, Zoll.Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas! 

EMS students still need realistic patient simulations, but providing these online is challenging. Join Dr. Meg Carman as she explains how to engage students in time-sensitive, moderate-to-high risk decision-making in the prehospital, emergency, or critical care environment.  This is an audio-only version of an EMS World webinar, which you can find here.  Thanks to our sponsor, iSimulate.Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas! 

The EMS stories coming out of hard-hit cities like Seattle, New York and New Orleans seem unreal. Increased 911 calls, patients in severe respiratory distress, constant protocol changes: what is it really like for EMTs and paramedics in these cities? Hear it from three providers on the COVID-19 frontlines. This is an audio-only version of an EMS World webinar, which you can find here.  Thanks to our sponsor, Zoll.Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas! 

EMS providers now face additional challenges to our well-being. Along with COVID-19, we face long shifts, odd hours, sleep deprivation, and trauma exposure. Listen and learn healthy relationship and communication skills for coping during the pandemic. EMS experts Rhonda Kelly and Jonathan Dickerson will provide effective ways to manage stressors and mitigate negative impacts on relationships in this novel world.  This is an audio-only version of an EMS World webinar, which you can find here.  Thanks to our sponsor, McKesson.Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas!  

The coronavirus pandemic has strained the healthcare system, 911 communication centers, EMS systems and hospitals. Listen as Jonathan Washko, Assistant Vice President of the Center for EMS at Northwell Health gives advice, tips and innovative workarounds for EMS agencies and PSAPs to create alternatives like telehealth and nurse navigation.  This is an audio-only version of an EMS World webinar, which you can find here.  Thanks to our sponsor, McKesson.Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas! 

Coronavirus (COVID-19) is also redefining how we deal with many issues in the EMS workplace. Join the nation’s top EMS legal experts from the American Ambulance Association and Page, Wolfberg & Wirth as they address topics such as patient privacy, workplace safety, staff shortages, pay practices, worker’s comp and leave, discipline practices, liability and more. This is an audio-only version of an EMS World webinar, which you can find here.  Thanks to our sponsor, Zoll.Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas! 

Do you know everything you should about COVID19 best practices? Join Drs. Levy and Margolis for expert answers to your biggest COVID-19 questions on the topics of PPE, decon, and transport; special conditions and invasive maneuvers; and parameters for screening employees and returning to work. This is an audio-only version of an EMS World webinar, which you can find here.  Thanks to our sponsor, BoundTree.Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas! 

COVID-19 is redefining how EMS approaches prehospital airway management: what are best practices and what do we need to change on-the-fly as new recommendations are made? Join Drs. Rob Dickson and Casey Patrick as they address modified approaches to ALS and BLS airway management. This is an audio-only version of an EMS World webinar, which you can find here.  Thanks to our sponsor, Ambu.Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas! 

Episode 204 is Dr. Peter Antevy and Captian Adrian Castro. Peter and Adrian join me this week to talk about how EMS can help bring closure to a family of a child who has died. The topic stems from an article and podcast this past January from EMS World. Adrian talks about a call that he and his Palm Beach County Florida crew responded to were Adrian had to make a decision not to resuscitate a child. What he did that day made the world of difference to the parents. Peter explains the rationale and reasons that the decision Adrian made was right. Adrian takes through his thought process and the discussion he had with his crews after the call. Peter also talks about the results of a study that asks what parents want after the death of their child. The answers may surprise you. Peter is a Pediatric Emergency Medicine physician and the Associate Medical Director for several South Florida agencies. Peter is also the creator of the Handtevy APP used by numerous EMS organizations. Adrian is Captain and EMS Supervisor for Palm Beach County Florida. 

Mecklenburg EMS Agency (Medic), which operates the busiest agency in North Carolina out of its Charlotte headquarters, recently engaged in an innovative project to redesign the agency’s ALS ambulances, including moving to a new chassis and redesigning the driver and the patient compartments. In this episode, Medic Deputy Directors Jeff Keith and Jonathan Studnek take EMS World through the process of overhauling the vehicle fleet of a large-scale EMS service, in addition to shedding some light on how the coronavirus pandemic has hit the Charlotte area.  Read the article here.Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas!

Metro EMS of Little Rock, Ark., has adapted its protocols to include head elevation for cardiac arrest patients.  A crew utilized their new resuscitation bundle in August to help save 44-year-old Darlene Skogen, whose story is profiled in January’s EMS World magazine. Here MEMS paramedic Jesica Hunter, who was part of that crew, quality manager Mack Hutchison, and associate medical director Wendell Pahls, MD, discuss with Senior Editor John Erich their evolving approach and its benefits.Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas!

Albuquerque Fire Rescue is the first EMS agency in North America to perform ECMO in the field.  How did they do it? With a specially-equipped ambulance, a pop-up tent and a specially-trained team of paramedics, physicians and cannulators.  AFR EMS Chief Chris Ortiz and Dr. Darren Braude of UNM Hospital share their knowledge in treating 2 cardiac arrest patients in late 2019.  Click here to read the accompanying article on EMS World's website.  Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas! 

Palm Beach County Fire Rescue's Captain Jessica Banks, EMT-P, RN is proud of the medication-assisted treatment (MAT) program that is helping those with substance use disorder. Listen as she discusses delivering patient care as a community paramedic, how a mobile integrated health program benefited the department’s relationship with the community, and how you, too, can implement a medication-assisted treatment program in your own community.  Read more about their program from Assistant Editor Valerie Amato on the EMS World website here.Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas! 

Når man snakker om masseskyderi har der altid været lagt stor vægt på blødningskontrol, specielt med tournique i fokus ved massive ekstremitetsblødninger, grundet de erfaringer man har fra krig. Men hvordan ser skadesmønstret egentligt ud i et civil setting? Kan man sammenligne de skader man har set i krig, med dem der er sket i det civile? Vi var til et oplæg om dette på EMS World expo i New Orleans. Lyt med og hør hvordan det umiddelbart ser ud ved civile masseskyderier. Abonner eller hent via iTunes, Podbean, TUNE IN, Spotify, StitcherRadio, Soundcloud eller hvor du henter dine podcast. The profile of wounding in civilian public mass shooting fatalitiesIncidence and Cause of Potentially Preventable Death after Civilian Public Mass Shooting in the USWounding Patterns Based on Firearm Type in Civilian Public Mass Shootings in the United StatesComparison of the Causes of Death and Wounding Patterns in Urban Firearm-Related Violence and Civilian Public Mass Shooting Events Studiet omhandlende overlevende er endnu ikke at finde. Det kommer på bloggen så snart det er udkommet og kan findes. (characteristics of survivors of civilian public mass shooting events: an EAST multicenter study) Støt FOAMmedics arbejde med 5 eller 10 kr pr. podcast. Hvis du har lyst til at støtte vores arbejde med at lave lækker lyd og skrift så klik ind på 10er.dk og støt os med 5,10 eller 15 pr. podcast-episode, så bliver vi så sindsygt stolte og glade. Eller klik på 10'er logo her under og en pop-up løsning kommer frem.

La metodología de la aula invertida no es nueva. Sin embargo, ahora es que está ganando más popularidad entre los educadores progresistas con conocimiento en pedagogía. Este artículo de la revista EMSWorld nos muestra los principios del aula invertida. ¿Qué es el aula invertida? El aula invertida significa intercambiar las actividades que se hacen en el salón de clase por las que se hacen en la casa, y vice versa. En el modelo tradicional, el estudiante recibe una charla o conferencia en el salón de clase y luego completa una asignación en la casa que busca que ponga en práctica lo aprendido en el salón de clase. Una de las desventajas del modelo tradicional es que no se puede adaptar a las necesidades de cada estudiante. El modelo tradicional trata a todos los estudiantes como si fueran iguales y busca que todos se beneficien igualmente de una sola forma de enseñanza que, aunque a muchos va a ayudar, pudiera no ser suficiente o adecuada para una cantidad (quizás significativa) de personas. Este breve video muestra qué es el aula invertida: https://youtu.be/ojiebVw8O0g El aula invertida se adapta a las necesidades del estudiante y del maestro No hay nada malo con el modelo tradicional de educación siempre y cuando usted acepte que no va a poder atender las necesidades particulares de todos sus estudiantes ni tampoco va a retar suficientemente a todos los que el nivel actual no es suficientemente estimulante. Algunos estudiantes comprometidos y motivados necesitan más atención directa. Si tiene a 10 ó 30 estudiantes en un salón, es muy difícil (o imposible) hacerlo porque tiene que prestarle atención a todos. Por otro lado, algunos estudiantes comprometidos y motivados son sobresalientes sin mucho esfuerzo. Tienen un buen potencial para ser excelentes si se les canaliza ese potencial para que lleguen más lejos. Algunos necesitan más motivación o más estímulo. Algunos están aburridos, o peor aún, están en el programa por las razones equivocadas. Un estudiante me dijo una vez una frase que nunca se me olvida: "'Profe', la salvación es individual". Solo que en ese momento estaba tratando a todos por igual sin tener mejores herramientas para individualizar la atención dentro de un grupo, a pesar de que siempre nos han hablado de las bondades de esto. Más oportunidad para innovar. No es solamente más tiempo para hacer lo mismo. El problema de algunos maestros es que ahora no saben qué hacer con el tiempo presencial y revierten a lo que saben: dar más conferencias. Aunque esto es importante a veces, especialmente cuando en realidad no hay tiempo suficiente, el objetivo es lograr poder realizar otro tipo de actividades que no envuelvan tener a los estudiantes sentados en un pupitre observando y escuchando, sino todo lo contrario. Más tiempo El aula invertida provee más oportunidades que el modelo actual porque maximiza el rendimiento en el salón de clase. El tiempo es el factor limitante en la educación. La mayoría de los maestros dirán que no tienen suficiente tiempo para explicar los temas. El maestro, profesor, y/o instructor ahora tiene más tiempo porque cuenta con una cierta cantidad de tiempo extra fuera del salón de clase. ¿Y quién tiene mucho tiempo "libre"? Tenemos que tener en cuenta que solamente porque el estudiante no está en el salón de clase no significa que está en su casa sin hacer nada. Muchos estudiantes, especialmente los adultos, trabajan mientras estudian. Por lo tanto, es importante tener en cuenta que las actividades a hacer en el "hogar" tienen que tener en cuenta que el tiempo "libre" es limitado. Algunos estudiantes tienen empleos que les proveen cierta oportunidad. Por ejemplo, un respondedor a emergencias pudiera tener algo de tiempo "libre" entre un caso y el otro. Por lo tanto, es importante tener en mente, a la hora de diseñar el contenido, dónde es que el estudiante estaría consumiéndolo. Cada vez es más común que el acceso a internet ocurre solamente, o en su mayoría, a través de dispositivos móviles tales como teléfonos y tabletas. Esto tiene implicaciones a la hora de crear el contenido. Por ejemplo, una presentación que tenga muchas letras pequeñas quizás pudiera verse bien en la pantalla grande de una computadora portátil, pero no en una pantalla pequeña de un teléfono. Construir contenido que se ajuste a un formato móvil va más allá de un formato que se ajuste al tamaño de la pantalla, sino también considerar qué el estudiante va a estar haciendo mientras lo oye. Hay podcasts que incluyen notas del episodio, como el ECCpodcast, sabiendo de que muchas personas no van a tomar notas mientras lo oyen porque están haciendo otras cosas (gimnasio, conduciendo, etc.) mientras lo escuchan en sus dispositivos móviles. Otro ejemplo y consejo es crear contenido en bloques o módulos de corta duración. Aunque uno siempre puede detener o pausar el contenido mientras lo oye y reanudarlo más tarde todas las veces que sea necesario hasta completarlo, a veces es conveniente poder presentar una idea completa en un mismo bloque de tiempo. Yo le llamo a esto un bloque funcional, o el tiempo que la persona razonablemente puede dedicarle a atender su contenido en línea. Por lo general, en mi experiencia personal (anécdota, n=1), una pieza de contenido de más de 1 hora siempre acaba siendo dividida en uno o más días. Un audio de 15-30 minutos puede ser escuchado de camino al trabajo o a la casa. ¿Cuánto tiempo es razonable exigir? Los estudiantes tienen que entender que hay cierta expectativa de que haya un estudio en la casa. Entender es fácil, pero aprender toma horas de estudio. Una gran medida del éxito anticipado depende de cuántas horas tenga el estudiante disponible para dedicarle al programa. Desafortunadamente el programa académico no se puede dar el lujo de ajustarse al denominador común de tiempo más bajo porque de lo contrario no va a cumplir con el currículo. Más supervisión del profesor a la hora de ponerlo en práctica. A veces no es hasta que se intenta poner en práctica donde las dudas salen. No hay que esperar al día siguiente. El profesor puede ayudarle en ese preciso momento. O mejor aún, un compañero(a) puede ayudarle en ese mismo momento. El trabajo en colaboración es una excelente oportunidad para aprender. Se dice que cuando uno enseña, dos aprenden (tanto el estudiante como el maestro). El modelo del aula invertida permite al profesor esa colaboración entre estudiantes bajo supervisión directa, de forma tal que se estén cumpliendo los objetivos, se esté aprovechando el tiempo y se estén aclarando las dudas realmente. A veces el maestro va a tener que intervenir para aclarar una duda. Ya hay tecnología en todos lados. Una de las peores frases o excusas que usted puede escuchar a alguien decir es: "es que yo no soy muy tecnológico(a)". La mayoría de las cosas hoy día revuelven alrededor de la tecnología. Dependemos de computadoras, tabletas y teléfonos móviles para comunicarnos, entrar datos, obtener datos, ejecutar acciones que antes hubieran dependido de la memoria, e inclusive utilizamos la tecnología en la educación. La persona que no tenga la destrezas de ser funcional alrededor de cierta tecnología módica entonces no va a tener una destreza fundamental para el mercado laboral de hoy día y del futuro. Entonces, esa frase debe desaparecer, y quien la profese debe reconsiderar qué está haciendo para sentirse cada vez más cómodo(a) con la realidad actual. Con mucha probabilidad, sus estudiantes hoy día usan redes sociales y plataformas como YouTube. Entonces, no hay excusa de que no hay acceso a tecnología. El reto es aprender a usarlas para la educación. En otras palabras, los maestros tenemos que aprender a enseñar. La pedagogía en carreras técnicas Uno de los problemas de las carreras técnicas es que solamente un experto en la materia puede enseñarlo, indistintamente que sea un estudioso de la pedagogía. Entonces, cometemos errores de pedagogía por ignorancia. Aunque cada vez hay más profesionales de la salud que deciden cursar estudios paralelos en carreras en educación, las necesidades del servicio y de la educación hacen que todavía la mayoría de los maestros seamos simplemente expertos en alguna u otra materia, con buenas intenciones y muchos deseos de enseñar. Pero esto debe cambiar. Las instituciones deben comenzar a exigir cierta preparación formal en educación, especialmente en las metodologías de aula invertida, y/o proveer los mecanismos para que su facultad se desarrolle en las áreas de interés para la institución. De lo contrario, las instituciones que compran simuladores de alta fidelidad y gastan altas sumas de dinero en invertir en un laboratorio de simulación solo ven a su facultado utilizándolos simplemente como maniquíes de tareas individuales en vez de maximizar su potencial. Conclusión El aula invertida permite a los profesores enseñar el contenido de formas innovadoras, promueve la interacción en el salón de clase y motiva al estudiante al darle acceso a un mundo de información. Referencias https://www.emsworld.com/article/1223532/los-fundamentos-del-aula-invertida  

This episode felt like some of the first episodes of Medic Mindset. I had a few things on my mind that I wanted to ask him but we also just let the conversation ebb and flow wherever it pleased for an hour. The purpose in sitting down together was to discuss his performance in the EMS World clinical challenge but we ended up talking about all kinds of things like career longevity and advice he would give new medics. His name is Andrew Azelton and he has been in EMS for 18 years and you will hopefully hear what I heard in his voice. He was engaged and happy to talk shop and he seemed just generally peaceful and happy in his work and life. I left the conversation with more energy than when we started and I hope he will have that effect on you as well.  Shownotes at medicmindset.com Follow Medic Mindset on Twitter Facebook Instagram

This episode felt like some of the first episodes of Medic Mindset. The purpose in sitting down together was to discuss his performance in the EMS World clinical challenge but we ended up talking about all kinds of things like career longevity and advice he would give new medics. His name is Andrew Azelton and he has been in EMS for 18 years and you will hopefully hear what I heard in his voice. He was engaged and happy to talk shop and he seemed just generally peaceful and happy in his work and life. I left the conversation with more energy than when we started and I hope he will have that effect on you as well. Go to medicmindset.com for bonus material.

Assistant Editor Valerie Amato sits down with current and former collegiate EMS providers to hear about their unique experiences. She also reads an excerpt of Barry Bachenheimer’s article “Back to School: Another Look at College-Based EMS” from the November 2019 issue of EMS World. Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas!

Medic Mindset host Ginger Locke chats with Dr. Jeff Jarvis about his article “The Perils of Peri-Intubation Hypoxia” from the January 2019 issue of EMS World. He explains how disregarding the fundamentals of airway management induces hypoxia more often than providers realize. Dr. Jarvis also does a read-aloud of his article in this episode.Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas!

Senior Editorial and Program Director Hilary Gates interviews OTEMS Director Kelly Deal about their move to smaller van-style ambulances.  OTEMS’ commitment to patient and provider safety during transport resulted in job applicants who applied to work for them specifically because of the ambulance redesign.  Hilary also does an article readaloud of her EMS World article for September, “Selling Smaller.” Check out the article here on the EMS World website. Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas!

Episode 190 is Dan Cohen. Dan has been with Williamson County EMS for 14 years. He produces distributive education and manages media. His EMS journey began like many of his generation, watching "Emergency". Dan takes an unusual path into EMS as becoming a photojournalist first for Time, Forbes, and BusinessWeek. Dan is blending videography and Paramedicine to tell the story of EMS in Central Texas. Dan and I discuss his path into EMS, Williamson County EMS, and the interesting article he wrote about "Silos" and the impact they have both personally and in EMS. 

EMS World Assistant Editor Valerie Amato interviews GMR Chief Medical Officer Ed Racht about the biggest threats EMS agencies face in the event of a large-scale natural disaster and how to adequately prepare for them. Valerie also does an article readaloud of her EMS World side bar for August, “TARMAC Attacks: 10 Things to Know.” Check out the article here on the EMS World website.Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas!

EMS World Senior Editor John Erich interviews Harney District Hospital EMS Paramedic Travis Lock about his experiences running calls in one of the least-densely populated counties in America.  John also does an audio long read of his EMS World cover story for July, “Alone on the Range.”  Check out the article here on the EMS World website. Follow EMS World on Twitter, Facebook, LinkedIn, and Instagram. EMS World Expo will be held Sept. 14–18, 2020 in Las Vegas!

Shock the System (an EMS World Collaboration) by Ginger Locke

Join the well respected Blogger, Educator, and EMS Provider Amy Eisenhauer and I as we discuss the societal perceptions of substance abuse and mental health in the EMS world. Amy Eisenhauer is a dynamic presenter at Emergency Medical Services (EMS) conferences nationwide, raising awareness on topics such as provider suicide, response to hoarding events, and career development for EMS professionals. As a Certified Emergency Medical Technician, she has served the New Jersey Emergency Medical Services community as a volunteer and career provider since 1995. In addition to providing high quality medical care, Amy has taken on challenging roles as an EMS educator and training officer. Most notably, Amy is a contributing author for EMS World magazine and also hosts an interactive blog on EMS at TheEMSsiren.com, committed to improving the EMS community as a whole. https://theemssiren.com/

In this episode, Alicia Lutman ’99, OTD, shares her journey from TMI into occupational therapy. She talks about her passion for research and developing programs for first responders and school resource officers in interacting with children and adults with autism or mental health conditions. She shares some tips for both caregivers and first responders for emergency situations such as: Reminding people that individuals with autism are on a spectrum; some are able to communicate with you and some are not. We need to be careful about our word choices and understand that the more upset they become, the harder it is to keep the situation under control. Anxiousness and depression, especially in boys and men, can often manifest as anger and aggression. Caregivers can be proactive in providing an information sheet to 911 dispatchers. Dr. Lutman talks about involving Shenandoah University students with the research and continuing to develop and expand on the program for first responders. She also shares her involvement during her time at TMI, her best memories, and offers some advice for our graduating seniors.   Alicia Lutman, OTD, MS, OTR/L, ATC Associate Professor of Occupational Therapy, Shenandoah University B.S., Exercise Science, Concordia CollegeM.S., Occupational Therapy, Shenandoah UniversityOTD, Occupational Therapy, University of St.Augustinehttps://www.su.edu/faculty-staff/faculty/alicia-lutman/ https://www.policeone.com/videos/originals/training/191745519-How-SROs-can-help-develop-socially-acceptable-behavior-in-kids/ Lutman, A.(2017) Autism Awareness for First Responders. EMS World. 46(11)38-41.http://emsworld.epubxp.com/i/890710-nov-2017/38? Lutman, A. (2016) School Resource Officers. Journal of International Law Enforcement Educators and Trainers Association. 6(2) 24- 27. Lutman, A. (2016 March) Supplemental Training for School Resource officers. Journal of International Law Enforcement Educators and Trainers Association. 6(1)65 - 66 Lutman, A. (2015 Dec) Designing an autism awareness program for Law Enforcement. Journal of International Law Enforcement Educators and Trainers Association 23-27. Lutman, A. (2014, April 14). Autism awareness training program for first responders. OT Practice.  12-13.

Episode 137 is Hilary Gates. Have you attended an EMS National Conference? Did you ever wonder how one is put together or how the conference chooses the city to hold the conference? Hilary Gates is the Program Director for EMS World Expo. She is also a volunteer paramedic in Alexandria, VA, where she began the department’s community paramedic program. She is an EMT Instructor and teaches in the School of Education at American University. She began her career as a volunteer EMT with the Bethesda-Chevy Chase Rescue Squad in Montgomery County, MD. Hilary will answer the above questions and tells us what is like for her a few days before EMS World Expo starts. We also discuss what led her to EMS World, community paramedicine and what EMS in 2018 will bring.

Nate Andrews is a paramedic student whose research project in PEA cardiac arrest garnered him an invite to speak at EMS World Expo 2017. Innovative young minds are imperative for the growth of EMS.  EMS World is partnering with UCLA’s Prehospital Care Research Forum (PCRF) to bring original science and research to readers of EMS World and attendees of EMS World Expo. 

Sigurd Blix is an EMT and medical student from Norway who researched the need for more training in wound packing and penetrating trauma. The size and scope of Expo, he says, has him excited to do more research and come back. EMS World is partnering with UCLA’s Prehospital Care Research Forum (PCRF) to bring original science and research to readers of EMS World and attendees of EMS World Expo. 

David Wampler, PhD, speaks on the efficacy of long backboards as a spinal immobilization and transport device. His research found that patients secured on a stretcher mattress without a long spine board had less cervical spine motion than those secured to a long spine board. EMS World is partnering with UCLA’s Prehospital Care Research Forum (PCRF) to bring original science and research to readers of EMS World and attendees of EMS World Expo. 

Experience matters when it comes to obtaining ROSC in cardiac arrest patients. Jenna Tuttle presented research at EMS World Expo on the effect of a provider's case volume on the likelihood of obtaining ROSC in cardiac arrest patients. EMS World is partnering with UCLA’s Prehospital Care Research Forum (PCRF) to bring original science and research to readers of EMS World and attendees of EMS World Expo. 

Justin Saunders' research involves a predictive model to compare expected rates of ROSC with actual success rates so EMS services can better understand what they're doing right (and wrong) during cardiac arrest calls. Saunders is one of numerous students from Western Carolina University's paramedic bachelor's degree program invited to present at this year's EMS World Expo. EMS World is partnering with UCLA’s Prehospital Care Research Forum (PCRF) to bring original science and research to readers of EMS World and attendees of EMS World Expo. 

Jeff Jarvis, MD, Medical Director for Williamson County EMS in Texas, conducted research on prehospital airways and explains that while intubating our patients we can sometimes let our ego get in the way of patient outcomes.  EMS World is partnering with UCLA’s Prehospital Care Research Forum (PCRF) to bring original science and research to readers of EMS World and attendees of EMS World Expo. 

En este episodio conversamos con el Dr. Victor Pimentel sobre el curso Emergency Pediatric Care que se llevará a cabo en la ciudad de Bogotá, Colombia el 21 y 22 de septiembre del 2017. Para más información acerca del curso, visite www.emsworldamericas.com  https://youtu.be/4-5k7V7XCJE

Episode 101: Faces of EMS is a project that was created by Paul Falavolito, Chief of White Oak EMS in Western Pennsylvania. Paul created a wall of EMS practitioners by taking their portraits and displaying these portraits and Faces of EMS was born. Paul joins me to talk about this project. The project is being launched to celebrate the 43rd Annual National EMS Week that runs from May 21-27, 2017. Faces of EMS is being featured on the cover of EMS World Magazine, NAEMT's website and other areas of EMS as part of the #EMSstrongcampaign.This podcast is dedicated to all those those who are involved in EMS. Medci2Medic Podcast wishes you a happy and safe EMS Week.

Episode 91: Scott Cravens is the the Group Publisher SouthComm Communications, which publishes EMS World. Scott entered the EMS world after 20 years in a different role in publishing. Scott also sits on the board of the National EMS Museum Foundation. This museum is dedicated to memorializing and commemorating the history of EMS and the people and organizations that provide emergency care. We discuss why Scott got involved in EMS and why he felt that he needed to become and practice as an EMT. We also discuss the competition in today's world of EMS publishing and information.

Amy Eisenhauer started her EMS career in 1995. Her entrance into EMS is unusual and a good story. Amy is contributing author for EMS World magazine and has an interactive blog on EMS at TheEMSSiren.com. She speaks nationwide on subjects like hoarding, career development and provider wellbeing. We talk about all of the above and how her blog and writing started (another interesting story). Amy likes to teach and educate on different EMS subjects. Amy will be a Speaker at the North Carolina EMS State Conference this October.

En este episodio hablamos con Daniela Melgar quien tiene un interesante recuento de lo que aconteció en las competencias nacionales de extricación en México. Daniela escribió un artículo en la edición de mayo de la Revista EMS World. Enlaces adicionales www.wrecue.org https://www.facebook.com/ExtraccionVehicularMexico/ https://www.facebook.com/asociacionlatinoamericanaderescatevehicular/ https://www.facebook.com/ERUMVoluntariosCDMX/?fref=ts http://www.frems.com http://www.facebook.com/FREMScom

Uno de los temas más controversiales sobre el manejo de un paro cardiaco es cómo decidir terminar los esfuerzos de resucitación. Como profesionales de la salud tenemos un deseo innato de intentar resucitar a todo paciente en paro cardiaco, pero la vida es eventualmente finita. Una vez aprendí, y nunca he olvidado, que en la medicina tenemos el honor de presenciar dos de los eventos más significativos de un ser humano...su nacimiento y su muerte. Cuando las circunstancias se dan para que estos dos momentos ocurran, van a ocurrir indistintamente de lo que nosotros hagamos para evitarlo. Es nuestro deber honrar este proceso natural. La muerte no siempre representa el fracaso de nuestros esfuerzos, sino el fin de un proceso natural. Las Guías 2010 y 2015 de la American Heart Association proveen mucha información sobre los aspectos éticos a considerar a la hora de discutir el tema de detener la resucitación. La intención de este episodio no es discutir los aspectos éticos, aunque hay algunos aspectos que es inevitable considerarlos. No obstante, no es la intención de este artículo discutirlos todos, por lo que los invito a visitar la página de la AHA para las Guías 2015, disponibles gratuitamente en http://eccguidelines.heart.org. El tiempo no es relevante El tiempo del intento de resucitación no es el factor principal en la toma de decisiones. Debemos dejar de usar el tiempo para decidir si hemos intentado mucho o poco la resucitación. El uso del tiempo como factor exclusivo denota desconocimiento de los objetivos de la reanimación. ¿Debo mencionarlo nuevamente? El tiempo es un elemento muy subjetivo. La subjetividad del tiempo El tiempo es objetivo. Lo medimos con un reloj...segundos, etc... de eso no cabe duda. Podemos medirlo con precisión atómica. Lo que varía es nuestra percepción del tiempo. Aunque parezca irónico, la percepción del tiempo es una de las cosas más subjetivas que hay. Haga usted la prueba... cuando usted quiere que el tiempo corra rápido, toma una eternidad. Viceversa, cuando quiere que el tiempo se detenga, pasa todo muy rápido. Es común oir frases como "esto acaba de ocurrir ahora mismo"...pero ya van unos 10 minutos. Por otro lado es posible oir "la ambulancia está tardando una eternidad". pero solo han pasado 2 minutos y 35 segundos desde que terminó la llamada al 9-1-1. ¿Cuándo no iniciar la resucitación? En muchos casos no es apropiado ni siquiera iniciar la resucitación. Tiempo de resucitación = 0 minutos. No se intentó la resucitación. Algunos ejemplos son: Situaciones donde intentar realizar la resucitación pondría al rescatador en peligro Directriz avanzada, testamento u orden de no resucitar (DNR) Signos obvios de muerte irreversible (decapitación, rigor mortis, descomposición, etc.) En estos casos, desde el inicio, se sabe que el intento de resucitación va a ser inconsecuente y futil. Cabe señalar que el no iniciar la resucitación y el dar por terminado los esfuerzos de resucitación son ambos éticamente equivalentes. Ante la duda, saluda Ante ausencia de alguna buena razón para no comenzar (ver anterior), siempre que creamos que podemos resucitar al paciente, debemos fallar a favor del paciente e intentar la resucitación. Pero si fuera así, todavía estaríamos intentando resucitar a los padres de la patria. Tiene que haber una forma para decidir detenerse. DNR A veces la mejor forma de detener la resucitación es una forma (formulario) indicando las intenciones del paciente. Nunca es demasiado temprano para comenzar una discusión, en el momento oportuno, con un paciente sobre sus deseos al final de la vida. Es nuestro deber encontrar ese momento oportuno. Esta página ayuda a las familias a comenzar esta discusión de la manera correcta: http://deathoverdinner.org/ Pero cuando esto no ocurre, el médico debe hacerlo. El programa POLST provee unos fundamentos para lograrlo: Conversación entre el paciente, profesionales de la salud, y familiares cercanos Toma de decisión compartida entre el paciente y su profesional de la salud acerca de el cuidado que el paciente desea recibir al final de su vida Asegurar que los deseos del paciente se cumplan, documentándolo en un formulario Tenemos que mejorar nuestro conocimiento de cuidado de fin de la vida. Cuidado paliativo no es retirar el cuidado...es proveer comodidad al final de la vida. De igual manera, tenemos que aprender a manejar ese cuidado paliativo una vez se comenzaron a realizar medidas avanzadas, tales como la intubación endotraqueal y ventilación mecánica. El no saber extubar a un paciente en etapa terminal resulta en preguntas erróneas tales como "¿desea que lo intuben"? en vez de "¿desea que lo resuciten?". El National Institute for Health and Care Excellence del Reino Unido publica sus guías de fin de la vida para adultos, disponibles aquí. En adición, aquí hay un ejemplo de un protocolo de cuidado para la extubación terminal de un paciente: http://www.aacn.org/WD/Palliative/Docs/terminal_weaning_st_thomas.pdf Como siempre, siga sus protocolos locales. Los hospitales que miden tazas de sobrevivencia se benefician de tener órdenes de DNR debidamente firmadas ya que estos pacientes terminales entonces no entrarán a los registros de intentos de reanimación. A veces la evidencia de una orden DNR llega luego que la reanimación ha comenzado. En el caso de los proveedores fuera del hospital, se debe seguir el protocolo local. Si no existe un protocolo de cómo proceder en estos casos, se debe consultar al control médico para detener la resucitación. El objetivo final debe ser respetar los últimos deseos válidos y legítimos del paciente. Protocolo de Terminación de BLS en paro cardiaco fuera del hospital American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 3: Ethical Issues. ECCguidelines.heart.org. En términos generales, la RCP se realiza hasta que: Retorno de circulación espontánea Transferencia de cuidado a un equipo que provea soporte vital avanzado (en cuyo caso la resucitación puede continuar, pero bajo el control de los nuevos proveedores) El rescatador no puede continuar debido a cansancio o riesgo a su seguridad. Se cumplen criterios confiables de muerte cerebral irreversible, se identifican criterios de muerte obvia, o criterios para terminar la resucitación. A nivel de profesionales de BLS, los criterios incluyen: El paro cardiaco no fue presenciado por el primer respondedor o proveedor del SEM No hay retorno de circulación espontánea luego de 3 rondas de RCP y análisis del DEA El DEA no emitió ninguna descarga Es importante que la decisión se consultada con el médico para detener la reanimación a nivel de BLS. Los proveedores deben ser instruídos acerca de cómo comunicarse con la familia durante este momento de crisis.   https://eccguidelines.heart.org/wp-content/uploads/2015/10/ACLS-Termination-of-Resuscitation.png American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 3: Ethical Issues. ECCguidelines.heart.org. https://eccguidelines.heart.org/wp-content/uploads/2015/10/ACLS-Termination-of-Resuscitation.png El paro cardiaco no fue presenciado por el primer respondedor o proveedor del SEM. Ningún testigo realizó RCP No hubo RCE (retorno de circulación espontánea) luego de un intento completo de resucitación en la escena. El AED no recomendó ninguna descarga. El paciente vive o muere en la escena La única oportunidad de sobrevivencia del paciente en paro cardiaco es que se obtenga retorno de circulación espontánea en la escena. Las Guías 2015 de la AHA recomiendan que el paciente sea atendido en el lugar donde se encontró. Es más conveniente, en términos generales, atender al paciente en la misma escena que dentro de la ambulancia ya que en la escena comúnmente hay más espacio y comodidad que en espacio cerrado de la ambulancia. El paciente que no obtiene retorno de circulación espontánea en la escena tiene 0.7% de sobrevivencia, a diferencia del que sí obtiene RCE, cuya posibilidad de sobrevivencia asciende a un 17.2%. (Prehosp Emerg Care. 2012 Oct-Dec;16(4):451-5) La RCP durante el transporte es pésima. No produce ningún flujo sanguíneo significativo, pone a los proveedores en riesgo de accidentes, y no está asociado a aumento en sobrevivencia. No se debe realizar RCP en movimiento. ¿Cómo resucitar a un paciente? Paso 1: Proteger al cerebro mediante compresiones cardiacas Paso 2: Tratar la causa del paro ¿Por qué su paciente está en paro cardiaco? Los pacientes en paro cardiaco se pueden dividir, según el algoritmo, en dos tipos: los que tienen un problema de ritmo [arritmias como fibrilación ventricular (FV) y taquicardia ventricular (TV) sin pulso] vs los que no tienen un problema de ritmo. Identificar esto es fácil si se tiene un monitor cardiaco. Una simple revisión rápida del ritmo nos provee esta respuesta. Todo paciente en paro cardiaco recibe el siguiente tratamiento: Compresiones de alta calidad, con la menor cantidad de interrupciones. Análisis del ritmo cardiaco inicialmente y cada dos minutos. Si el ritmo es desfibrilable, se desfibrila, si el ritmo no es desfibrilable, no se desfibrila. Epinefrina 1 mg cada 4 minutos (3-5 minutos) Tratar las causas reversibles probables. (si es una arritmia, se administra un antiarrítmico) Causas Reversibles Las causas reversibles son: "Heart" (arritmias del corazón) - desfibrilación + antiarrítmicos Hivolemia - líquidos y sangre Hipoxia - oxígeno Hidrógeno (acidosis) - bicarbonato si estaba acidótico antes del paro Hipotermia - calentar al paciente Hipoglucemia (especialmente en pediátricos) - dextrosa Hipo/hiperpotasemia - calcio, bicarbonato, dextrosa + insulina Toxinas - antídoto (naloxona si es un opioide, o lo que recomiende el Centro de Envenenamientos 1-800-222-1222) Tension, pneumotórax - descompresión Tamponada cardiaca - descompresión Trombosis coronaria - reperfusión Trombosis pulmonar - reperfusión Volvamos al Paso 1: Proteja al cerebro Primum non nocere (primero no cause más daño). En este caso, esto significa que no causemos más anoxia al cerebro. Si usted interrumpe las compresiones, pierde perfusión cerebral. Tenemos que volvernos una máquina perfecta de perfusión cerebral... ya sea manual o mecánica. De la forma en que yo lo veo, tenemos un problema (cualquiera de las H's y T's mencionadas anteriormente), y tenemos una solución. Entre medio del problema y la solución, tenemos un obstáculo: la pobre perfusión al cerebro está acabando con el cerebro rápidamente. En otras palabras, tenemos que actuar rápido. El problema es que algunas de las soluciones requieren TIEMPO. Es fácil y rápido descomprimir un pneumotórax a tensión, pero hacer una embolectomía por una embolia pulmonar, o una intervención coronaria percutánea toma más tiempo del que usualmente tenemos. Tenemos una solución a esto... RCP mecánico. Existe mucha controversia sobre el rol del RCP mecánico... pero si se decide que el paciente requiere un cuidado definitivo que va a durar más tiempo, no hay duda que las máquinas que proveen compresiones continuas tienen esa ventaja: proveer compresiones por largo tiempo. Lea este artículo de EMSWorld: qué hacer cuando su paciente en RCP mecánico recupera conciencia durante las compresiones. Sin leer el artículo, deducimos que la perfusión al cerebro fue tan buena que el paciente recuperó conocimiento durante las compresiones. Pero lo más importante de esto, en mi opinión, es que si podemos mantener el cerebro con buena perfusión infinitamente, tenemos un tiempo infinito para tratar de corregir la causa que tiene el paciente. Antes no nos enfocábamos mucho en la calidad de las compresiones. Las compresiones eran malas (y siguen siendo malas en muchos sitios) y esto provocaba que no hubiera buena perfusión cerebral. A su vez, esto provocaba daño cerebral en poco tiempo. Por lo tanto, antes, el tiempo era importante porque estaba asociado a muerte cerebral. Debido a las pobres compresiones, en pocos minutos empezaba a ocurrir acidosis respiratoria y era necesario tratar la acidosis. Ahora, la acidosis respiratoria se corrige gracias a las buenas compresiones. Ahora, si podemos perfundir perfectamente al paciente, hemos quitado la barrera. El tiempo no es el problema. El verdadero problema ahora es entender si hay algo que podamos hacer por el paciente. Si existe la posibilidad de hacer algo, se intenta. Si no existe la posibilidad, entonces es momento de suspender el esfuerzo. No es un asunto de tiempo, es un asunto de entender qué tiene el paciente y cuáles son las opciones reales. Es decir, el tiempo era el factor limitante. Si podemos perfundir perfectamente al paciente, hemos quitado la barrera. Escuchen este podcast sobre la embolia pulmonar que sufrió el Dr. Joseph Ornato, MD FACEP FACC FAHA. El Dr. Ornato es uno de los principales investigadores sobre el uso de oxigenación por membrana extracorporea (ECMO) durante paro cardiaco para realizar embolectomías. ¡Resulta que él fue uno de sus propios pacientes en su propio estudio! Óigalo contar su historia, la cual incluyó ECMO, compresiones cardiacas, hipotermia terapéutica por 1 semana, y una recuperación neurológica completa. Las guías 2015 de la AHA recomiendan que la RCP extracorpórea (ECPR) puede proveer tiempo adicional para tratar causas reversibles del paro cardiaco (tales como síndrome coronario agudo, embolia pulmonar, fibrilación ventricular refractaria, hipotermia extrema, intoxicación por drogas, y otras causas más). Lea más sobre ECPR en este website: http://edecmo.org/ El tiempo no es el factor determinante de cuándo detenemos la resucitación. Se detiene el esfuerzo cuando se han intentado las cosas que razonablemente se pueden intentar y no ha habido una respuesta. Se detiene la RCP cuando no hay más nada que hacer. Paro cardiaco por trauma Analicemos un caso hipotético: Los paramédicos llegan 8 minutos luego de que se reporta un serio accidente. Cuando llegan, el paciente está inconsciente, sin signos de vida. ¿Qué posiblemente le pudo haber pasado a este paciente? Probablemente una o varias de las siguientes: Lesión traumática cerebral Hipovolemia por un sangrado masivo Hipoxia Pneumotórax a tensión Tamponada cardiaca ¿Cuánta RCP y epinefrina va a resolver estos problemas anteriores? NINGUNA! Si su paciente se desangró, le administraron líquidos IV, sangre, no ha respondido y está en asístole, ¿cuál es el objetivo de realizar RCP por 20, 30, 60 minutos? De seguro usted realizó estas intervenciones mucho antes de 20 minutos. Si usted ya ha determinado que no hay respuesta y está en asístole... ¿cuánta RCP es necesaria? Probablemente ninguna. Si alguien necesita darle RCP por 30 minutos... pues que lo haga hasta que se sienta que "hizo todo lo posible". En un futuro, los libros de historia de la medicina mirarán esta época y contarán que: En el siglo 21 tuvimos una especie de "ritual de paso" para declarar a una persona muerta y dejarla descansar en paz. En este "ritual" le brindámanos epinefrina y ceremonialmente contábamos mientras comprimíamos el pecho rítmicamente y danzábamos alrededor del paciente realizando diferentes procedimientos como desfibrilación, intubación, canalización, etc., hasta que por fin decidíamos, por diferentes y siempre cambiantes razones, que debíamos parar. En cambio, si usted decide hacer algo, ¡realice intervenciones significativas! ¿Qué son intervenciones significativas? Las "intervenciones significativas", según John Hinds, son aquellas que directamente arreglan algo. Son intervenciones o acciones específicas. En momentos de crisis, donde el tiempo y los recursos pueden ser limitados, es críticamente importante que todas las personas envueltas no pierdan tiempo en cosas que no sean intervenciones significativas. Según el Dr. Hinds, las intevenciones significativas en el paciente de trauma son: Intubación usando un "bougie" y capnografía de onda Toracostomía digital (con el dedo) bilateral Colocar una faja pélvica (SAM Splint) Enderezar fracturas de huesos largos Administrar bolos de fluído (administrar sangre si está en el hospital) Luego de realizar esto, entonces analizan cuál es el estatus del paciente y cuáles son los problemas que se han descubierto para decidir cuáles son las alternativas (ver abajo más info sobre toracotomía de emergencia y sobre REBOA). (Nota: El Dr. Hinds falleció en un accidente de motora este año. Vea un tributo aquí). Pero dejemos que sean las propias palabras del fenecido John Hinds que describan lo que él mismo llamó "intervenciones significativas".                   Paro cardiaco por trauma... toracotomía de emergencia Si usted entiende que su paciente tiene un sangrado masivo, la mejor forma de estabilización es detener el flujo pinzando la aorta. Si usted está decidiendo resucitar al paciente de trauma y se va en paro cardiaco frente a usted... este es el momento. De lo contrario, recuerde que las compresiones cardiacas y la(s) epinefrina(s) son completamente inútiles en este momento.       La toracotomía de emergencia está asociada a mortalidad excesivamente altas. El problema no es solamente encontrar la aorta, sino resolver lo que uno encuentre. Si usted no va a hacer esto, y su paciente requiere un control inmediato de un sangrado masivo abdominal, entonces considere si es útil continuar los esfuerzos. REBOA: una opción en el futuro cercano         Donación de órganos En lugares que tengan un sistema de captación inmediata de órganos y un programa preparado para implementarlo efectivamente, los pacientes que no logran RCE podrían ser candidatos para donar hígado y riñones. Corazones muy buenos para morir A todos nos corre la adrenalina por las venas cuando llegamos a un paro cardiaco. La mejor satisfacción es ver a un equipo verdaderamente coordinado realizando un esfuerzo genuino e inteligente por corregir la causa. Aunque el obtener el pulso (retorno de circulación espontánea, o RCE) NO es el objetivo final (el objetivo final es lograr el egreso del hospital neurológicamente intacto o viable), el RCE es un paso importante en el progreso del paciente. A los que nos apasiona ese juego entre la vida y la muerte, saben que una de las mejores emociones es saber que puedes revertir el paro cardiaco, intentarlo, y luego de esforzarte, obtener ese retorno de circulación, sentir el pulso y ver una presión sanguínea en el monitor. A los que me conocen y han trabajado conmigo, saben que usualmente mi frase favorita es "¡buen trabajo mi gente... estamos en cancha todavía!" Conclusión...memento mori Recuerde que todos vamos a morir algún día, y si hacemos las cosas correctamente, la muerte puede ser tan digna como la vida. Referencias American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 3: Ethical Issues. ECCguidelines.heart.org.

This week we will be having a conversation with Angelo Salvucci, Jr., MD, FACEP. He is the medical director for the Santa Barbara County and Ventura County (CA) EMS agencies and a member of the EMS World editorial advisory board. … Continue reading →

In his 3 part education series, Eric presents ventilator management approaches and strategies with regard to different patient presentations. We also apply the pathophysiology we learned in part 1 and 2, bringing it all together to form an easy to understand strategy for ventilator management.

In his 3 part education series, Eric presents ventilator management approaches and strategies with regard to different patient presentations. We also apply the pathophysiology we learned in part 1 and 2, bringing it all together to form an easy to understand strategy for ventilator management.See omnystudio.com/listener for privacy information.

In this 3 part education series, Eric Bauer discusses ventilator management in the critical care environment and the different modes of ventilation.See omnystudio.com/listener for privacy information.

In this 3 part education series, Eric Bauer discusses ventilator management in the critical care environment and the different modes of ventilation.

In this 3 part education series, Eric Bauer discusses ventilator management in the critical care environment. We look closely at cellular respiration and the different terminology as it relates to ventilator management.

In this 3 part education series, Eric Bauer discusses ventilator management in the critical care environment. We look closely at cellular respiration and the different terminology as it relates to ventilator management.See omnystudio.com/listener for privacy information.