Podcasts about prehospital

At a motorcycle track, a middle-aged man suffers a massive crash off a jump. Byt the time our team arrives on scene, the man is inflating like a balloon suffering from massive structural-distorting subcutaneous emphysema. The massive air pockets completely obliterated his normal anatomy, leaving them to guess: Do we blindly plunge decompressing needles into his chest where the landmarks have completely vanished or do we prioritize and secure the airway using advanced focused techniques? Listen in as our team learns in real time that ego has no place beside the patient. How does this case turn out? Listen in!   Interested in obtaining CE credit for this episode? Visit OnlineAscend.com to learn more. Listeners can purchase individual episode credits or subscribe to the Critical Care Review Bundle and gain access to all episode CE Credits.    We are joined by:   Clint Pusey, BSN, RN, CFRN     William W. Wright, FP-C   Click here to download this episode today! As always thanks for listening and fly safe! Hawnwan Moy MD FACEP FAEMS John Wilmas MD FACEP FAEMS Nyssa Hattaway, BA, BSN, RN, CEN, CPEN, CFRN

Program notes:0:37 Prehospital resuscitation with whole blood1:37 Compared with blood components2:35 Easier to store 3:19 Azithromycin in wheezing kids4:19 Treated for five days5:26 Name change from PCOS to PMOS6:26 Consensus build7:28 Improved accuracy of pathophysiology8:30 Adjust policy, change international classification9:15 Biomarkers to direct lung cancer screening10:15 Participants from several countries11:15 What are barriers to those with a smoking history12:24 End

Join the JEMS Podcast as we celebrate EMS Week 2026 with Dr. C. Ryan Keay and Chief Christopher Wray. They cover the frontline issues shaping modern prehospital care: sustainability and stewardship of whole blood programs; rural supply-chain challenges and drone delivery ideas; rapid adoption of point-of-care ultrasound; growth of treatment-in-place and mobile integrated health; AI for documentation and decision support; and legal/operational considerations for body-worn cameras. Dr. Keay and Chief Wray share practical examples, federal policy priorities, and how reimbursement and community partnerships can sustain clinical advances. This episode honors paramedics, EMTs, dispatchers, flight crews, educators, and leaders while offering actionable insights for agencies planning new programs, quality review, and cross-sector collaboration.

Dr. Jonathan Warren discusses practical uses, evidence, and implementation challenges for prehospital ultrasound. We cover lung ultrasound for acute heart failure and B line quantification, trauma FAST exams, cardiac arrest applications including focused pulse checks and transesophageal echocardiography, and how prehospital transfusion and early diagnostics change diagnostic momentum on ED arrival. Dr. Warren also outlines real-world barriers to sustained uptake—cost, training, tech issues, clinical workflows—and describes a national survey from the ACEP prehospital/austere ultrasound subcommittee aimed at identifying why adoption often dwindles after initial implementation.

In today's conversation, we move beyond the idea of simply recording numbers in the cardiac arrest patient. Instead, we explore how physiological data can be used to guide real-time resuscitation, helping clinicians understand what is happening inside the patient, how interventions are working, and where care should go next. Joining us as the guest to discuss this is Mark Faulkner. Mark is an Advanced Paramedic for Hampshire and Isle of Wight Air Ambulance (HIOWAA), where he provides clinical leadership through his critical care practice. His work spans frontline practice, education, quality improvement, and the development of clinical pathways that shape the delivery of advanced pre-hospital care. This is the reading list associated with the episode:Barreto, A. et al. (2020) ‘Diastolic blood pressure and survival in cardiac arrest', Resuscitation, 155, pp. 1–8.Bernard, S.A. et al. (2024) ‘Physiology-guided resuscitation in cardiac arrest', Journal of Clinical Medicine, 13(12), p. 3527.Brede, J.R. et al. (2019) ‘Prehospital REBOA in cardiac arrest', Resuscitation, 140, pp. 136–143.Butterfield, E. et al. (2024) ‘Prehospital arterial monitoring in cardiac arrest', Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 32(1).Kruit, N. et al. (2025) ‘Prehospital ECPR (PRECARE study)', Resuscitation, 188.Nolan, J.P. et al. (2021) ‘European Resuscitation Council Guidelines', Resuscitation, 161, pp. 98–114.Perkins, G.D. et al. (2018) ‘Epinephrine in OHCA', New England Journal of Medicine, 379(8), pp. 711–721.Rubertsson, S. et al. (2014) ‘LINC trial', JAMA, 311(1), pp. 53–61.Sutton, R.M. et al. (2014) ‘Hemodynamic-directed CPR', Resuscitation, 85(3), pp. 397–402.Yannopoulos, D. et al. (2020) ‘Advanced reperfusion strategies', Circulation, 141(10), pp. 784–796.Rees, P. et al. (2023) ‘Prehospital arterial blood pressure monitoring and outcomes in cardiac arrest', Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.Barrett, J. et al. (2023) ‘Diastolic blood pressure and ROSC in OHCA', Resuscitation.VitalStream from BHA Medical sponsors this podcast: Closing the Haemodynamic Blind Spots in Acute and Pre-Hospital CareVitalStream is a wireless, wearable, non-invasive haemodynamic monitoring platform designed to deliver continuous, real-time physiological data, so you're not relying purely on intermittent cuff readings when patients are unstable, moving, or in non-traditional care environments.Using AI-driven analytics and patented Pulse Decomposition Analysis, it provides continuous blood pressure alongside advanced haemodynamic parameters such as cardiac output, stroke volume, systemic vascular resistance, and fluid status. The aim is simple but critical: to help clinicians understand not just what the blood pressure is, but why, and whether a patient is fluid responsive or in need of a different intervention.BHA Medical's VitalStream solution focuses on integrating this level of monitoring into acute care workflows, streaming real-time data to a centralised platform, supporting earlier recognition of deterioration and more informed clinical decision-making.In corridor medicine, where patients are often managed outside traditional monitored spaces, the challenge is missed deterioration between spot checks. Continuous trending helps reduce those “blind spots,” enabling earlier identification of haemodynamic decline and better prioritisation when systems are under pressure.And in pre-hospital care, the value is in maintaining a clear physiological narrative from first patient contact through to hospital handover. VitalStream is designed for rapid deployment, applied, calibrated, and delivers data within around 90 seconds, using a low-pressure finger sensor that allows teams to follow trends in real time, rather than relying on isolated snapshots.For more information, visit: https://www.bha-medical.com/vitalstream-patient-monitoring

Listener discretion is advised: language, adult themes Reference: Boland, Hokanson, et. al. (2016). Prehospital lactate measurement by EMS in patients meeting sepsis criteria. Western J. EM (17)5.

    Welcome to the Prehospital Emergency Care Podcast! In this episode, hosts Jeremiah Escajeda, Greg Muller, and Ariana Weber discuss four of the sixteen articles from the Prehospital Trauma Compendium. In 2025, the Prehospital Trauma Compendium introduced crucial guidelines and insights regarding the management of traumatic injuries in prehospital settings. This episode summarizes four significant articles that focus on the use of blood products, vasopressors, tranexamic acid, (TXA), and care for patients in traumatic cardiac arrest. If you're an EMS professional or a medical provider involved in trauma care, these insights are vital for improving patient outcomes.   Featured Articles Brown, J. B., Yazer, M. H., Kelly, J., Spinella, P. C., DeMaio, V., Fisher, A. D., … Guyette, F. X. (2025). Prehospital Trauma Compendium: Transfusion of Blood Products in Trauma – A Position Statement and Resource Document of NAEMSP. Prehospital Emergency Care, 1–10. https://doi.org/10.1080/10903127.2025.2476195 Orpet, R. E., Barrett, W. J., Kaucher, K. A., Colwell, C. B., & Lyng, J. W. (2024). Prehospital Trauma Compendium: Vasopressors in Trauma – a Position Statement and Resource Document of NAEMSP. Prehospital Emergency Care, 1–7. https://doi.org/10.1080/10903127.2024.2437656 Barrett, W. J., Kaucher, K. A., Orpet, R. E., Campion, E. M., Goodloe, J. M., Fischer, P. E., … Lyng, J. W. (2025). Prehospital Trauma Compendium: Tranexamic Acid in Trauma – A Joint Position Statement and Resource Document of NAEMSP, ACEP, and ACS-COT. Prehospital Emergency Care, 1–8. https://doi.org/10.1080/10903127.2025.2497056 Breyre, A. M., George, N., Nelson, A. R., Ingram, C. J., Lardaro, T., Vanderkolk, W., & Lyng, J. W. (2025). Prehospital Trauma Compendium: Prehospital Management of Adults with Traumatic Out-of-Hospital Circulatory Arrest – A Joint Position Statement and Resource Document of NAEMSP, ACS-COT, and ACEP. Prehospital Emergency Care, 1–15. https://doi.org/10.1080/10903127.2024.2428668   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 (@michaeljukim) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD

A man in a high speed, rollover motor vehicle crash experiences a multitude of symptoms including hemorrhagic shock and profound respiratory distress. As our team assesses him, they attempt multiple needle decompressions to relieve pressure and improve breathing. None are successful. Having recently received training and approval to do a finger thoracostomy, they talk with their lead clinician and decide that is the best course of action. Listen in as we hear from the team on the ground, experience their decisionmaking, and find out what happens.    Interested in obtaining CE credit for this episode? Visit OnlineAscend.com to learn more. Listeners can purchase individual episode credits or subscribe to the Critical Care Review Bundle and gain access to all episode CE Credits.    We are joined by:   Matthew Corban NRP, FPC Air Methods Float Paramedic      Jacqlyn Murray - Flight Paramedic / RN, FP-C , CFRN   Click here to download this episode today! As always thanks for listening and fly safe! Hawnwan Moy MD FACEP FAEMS John Wilmas MD FACEP FAEMS Nyssa Hattaway, BA, BSN, RN, CEN, CPEN, CFRN

Prehospital blood programs that allow emergency responders to administer blood at the scene to trauma victims are drawing increased attention from state lawmakers. A technique with origins on the battlefield, these military methods have made their way to civilian EMS programs. Research suggests a significant number of lives can be saved with this approach, especially in car crashes.  On the podcast to discuss these programs are Jonathan Morrison, the administrator of the National Highway Traffic Safety Administration or NHTSA; Randi Schaefer, a former career Army trauma nurse who has helped set up programs around the country; and Aneesa Turbovsky, who tracks EMS-related legislation for NCSL.  Morrison discussed why these programs are a priority for NHTSA and how these programs could reduce the approximately 40,000 traffic crash fatalities in the U.S. each year. Schaefer reviewed some of the challenges in setting up prehospital blood programs and the role state lawmakers can play. And Turbovsky went into detail on the steps legislatures are taking to make it possible for paramedics to administer blood and how lawmakers can bring together the various parties needed to make these programs work. Resources EMS Legislation Database, NCSL Prehospital Blood Transfusions Give EMS Crews a Lifesaving Option, NCSL State Legislatures News Office of EMS Prehospital Blood Transfusion, NHTSA   Office of EMS Prehospital Blood Transfusion Infographics, NHTSA    Prehospital Blood Transfusion Coalition   Prehospital Blood Coalition Scope of Practice Map "Removing the Barrier to Prehospital Blood: A roadmap to success,"Journal of Trauma and Acute Care Surgery Funding Stat! States Secure Timely Support for EMS Systems, NCSL  

In this episode of Transmission Interrupted, host Jill Morgan leads a compelling conversation with leading experts at the intersection of air transport and high-consequence infectious disease (HCID) care. The panel includes Vance Ferebee, former Medical Division Director and Chief Flight Nurse for Phoenix Air Group; Wade Miles from Emory's Office of Critical Event Preparedness and Response; Ben Tysor of Omaha Fire and Rescue; and Alex Isakov, Executive Director of Emory's Office of Critical Event Preparedness and Response. Together, they break down the realities, challenges, and lessons learned from transporting infectious disease patients both internationally and domestically. The discussion includes behind-the-scenes stories from landmark missions, including patient transports during the West Africa Ebola outbreak. Listeners get an inside look at what it really takes—from specialized airborne containment systems to the intricate handoffs between fixed-wing and ground teams—to safely move critically ill patients across continents while protecting both patients and providers. The conversation explores technical hurdles such as maintaining ICU-level care in the air and managing security and privacy concerns, as well as the importance of relationships, protocols, and practice in ensuring smooth operations. The experts emphasize the value of preparation, collaboration, and adaptable risk assessment in facing future outbreaks and ensuring that health systems are ready to respond—whether for major events like the World Cup, another global crisis, or unexpected threats closer to home. Tune in for a fascinating look at the journey from runway to ICU—and what it takes to keep both patients and transport teams safe. Questions or comments for NETEC? Contact us at info@netec.org. Visit Transmission Interrupted online at netec.org/podcast. Guests Vance Ferebee, BSN Vance Ferebee is the former Medical Division Director and Chief Flight Nurse for Phoenix Air Group. He served as the Director from 2007-2025 and was co-lead on the team that developed the Airborne Biological Containment System (ABCS) utilized for patient transport during the West Africa Ebola outbreak of 2014-2015. He lead the team that developed and implemented the follow on infectious disease transport unit, the Containerized Biological Containment System (CBCS) utilized during the initial COVID outbreak, transporting over 100 patients from Japan, California and Africa back home to Europe and the US. Alex Isakov, MD, MPH Alex Isakov is the founding executive director of the Office of Critical Event Preparedness and Response (CEPAR) and a professor of emergency medicine at Emory University. He directs CEPAR's initiatives to enhance disaster resilience at Emory and in the broader community. He is also the director of Emory's Section of Prehospital and Disaster Medicine and leads Emory EMS. Alex serves as a co-lead for NETEC's EMS Workgroup. Wade Miles, NRP Wade Miles is the Operations and Training Manager for the Emory Office of Critical Event Preparedness and Response (CEPAR). Wade is responsible for the development, management and delivery of educational programs. In addition, he works with the CEPAR team to help develop and coordinate drills and exercises for the University. Miles also serves as the Training Manager for the Section of Prehospital and Disaster Medicine. Wade also serves as a co-lead for NETEC's EMS Workgroup. Ben Tysor, NPR Ben Tysor is Captain and Paramedic of Emergency Medical Services Quality Assurance at Omaha Fire & Rescue. Ben has over 20 years of experience in fire and emergency medical services. He is a member of the Omaha Fire & Rescue high consequence infectious disease transport team and was instrumental in the transport of patients with confirmed Ebola Virus Disease who were cared for at the Nebraska Biocontainment Unit. Host Jill Morgan, RN Emory Healthcare, Atlanta, GA Jill Morgan is a registered nurse and a subject matter expert in personal protective equipment (PPE) for NETEC. For 35 years, Jill has been an emergency department and critical care nurse, and now splits her time between education for NETEC and clinical research, most of it centering around infection prevention and personal protective equipment. She is a member of the Association for Professionals in Infection Control and Epidemiology (APIC), ASTM International, and the Association for the Advancement of Medical Instrumentation (AAMI). Resources NETEC Emergency Medical Services (EMS) Featured Resources ASPR TRACIE EMS Infectious Disease Playbook Phoenix Air Group Transmission Interrupted Podcast NETEC Resource Library NETEC's YouTube channelAbout NETEC A Partnership for Preparedness The National Emerging Special Pathogens Training and Education Center's mission is to set the gold standard for special pathogen preparedness and response across health systems in the U.S. with the goals of driving best practices, closing knowledge gaps, and developing innovative resources. Our vision is a sustainable infrastructure and culture of readiness for managing suspected and confirmed special pathogen incidents across the United States public health and health care delivery systems. For more information visit NETEC on the web. NETEC Consultation Services Assess and Advance Your Readiness for Special Pathogens with Free, Expert Consulting. NETEC offers free virtual and onsite readiness consulting to help health care facilities and EMS agencies prepare for special pathogen events. Our targeted support services are delivered by experts selected and assigned to each inquiry based on the unique needs of your organization. Have a question? Ask a NETEC expert. For more information visit NETEC's Consulting Services.

 In this episode, Peter Antevy, MD, FAEMS, Emergency & EMS Physician, Founder & Chief Medical Officer, Handtevy, Prehospital Research, Speaker & Educator, shares how a critical medication error inspired a technology-driven solution to improve real-time care. He also discusses pediatric readiness, EMS innovation like prehospital blood delivery, and the importance of data-driven leadership in healthcare.

LISTENER DISCRETION IS ADVISED! ADULT THEMES. LANGUAGE. References: Smith, J. E., Cardigan, R., Sanderson, E., Silsby, L., Rourke, C., Barnard, E. B. G., Basham, P., Antonacci, G., Charlewood, R., Dallas, N., Davies, J., Goodwin, E., Hawton, A., Hudson, C., Lucas, J., Keen, K., Lyon, R. M., & Nolan, B. (2026). Prehospital whole blood in traumatic hemorrhage — a randomized controlled trial. The New England Journal of Medicine. https://doi.org/10.1056/nejmoa2516043 Dr. Antevy's Discussion Thread on LinkedIN: https://www.linkedin.com/posts/peter-antevy-md-faems-a9b11726_the-swift-trial-just-published-in-nejm-group-activity-7440071242285625344-1HZP?utm_source=share&utm_medium=member_desktop&rcm=ACoAAF6Ls6YBtNzvNfxmvsyVNOMy6QNK6Bc_pj4

On this episode of AMPED, when our team arrives on scene for a pediatric head trauma case in a 10-month old, everything at first seems normal and under control. But in that calm, something feels off to one of our clinicians and he believes our patient faces imminent peril. Does he defer to the doctor on scene who has given assurances that everything is fine, or does he listen to his intuition and communicate his concerns to his partner in order to take action? Listen in and find out how this case unfolds, and hear how this particular case affected our clinicians greatly after the fact.    Interested in obtaining CE credit for this episode? Visit OnlineAscend.com to learn more. Listeners can purchase individual episode credits or subscribe to the Critical Care Review Bundle and gain access to all episode CE Credits.    We are joined by:   Holly Prather, RN, CEN, CFRN, CTRN     JM Walker Click here to download this episode today! As always thanks for listening and fly safe! Hawnwan Moy MD FACEP FAEMS John Wilmas MD FACEP FAEMS Nyssa Hattaway, BA, BSN, RN, CEN, CPEN, CFRN

As this episode, and in-depth look into the City of Cleveland's EMS system, the crew talks about their handling of the opioid issues within the city and the handling of Narcan. They also discuss the challenges faced by the agency which includes fleet maintenance, road conditions of the city and internal training challenges for such a large, high-volume service. In the future, they hope to have initiatives that handle the frequent callers that may not need an ambulance but still need a clinical interface individual such as community paramedicine.

The crew continues their discussion about the City of Cleveland's EMS agency.  From blood administration in the prehospital setting to CPAP and BiPAP to multiple way to secure airways and oxygenation... the ladies discuss the clinical operation which includes Paramedics and Basic EMTs.

  Welcome to the Prehospital Emergency Care Journal Podcast! In this Deep Dive episode, host Maia Dorsett speaks with Aaron E. Robinson, Sarah K. S. Knack, and Michael C. Perlmutter about their paper, Trends in Prehospital First-Attempt Use of Supraglottic Airways in Non-Cardiac Arrest Patients: A Descriptive Study. The conversation explores how airway management in EMS may be evolving, including growing interest in supraglottic airways as a first-line approach rather than solely a rescue device. The authors discuss key airway concepts—such as RSI, DSI, and rapid sequence airway—and review what their national dataset reveals about current practice patterns. Along the way, they examine variations in medication strategies, including the continued use of sedation-only approaches and airway placement without neuromuscular blockade or medications. The discussion raises important questions about how EMS clinicians balance speed, safety, and skill maintenance when managing critically ill airways in the field.   Featured Article Robinson, A. E., Knack, S. K. S., Driver, B. E., Prekker, M. E., Perlmutter, M. C., Bunting, A. J., … Puskarich, M. A. (2026). Trends in Prehospital First-Attempt Use of Supraglottic Airways in Non-Cardiac Arrest Patients: A Descriptive Study. Prehospital Emergency Care, 1–8. https://doi.org/10.1080/10903127.2025.2593579   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 (@michaeljukim) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD

Out-of-hospital cardiac arrest remains one of the most emotionally complex and ethically challenging events in pre-hospital care. Families can transition from normality to devastating loss within minutes, while clinicians must make rapid, high-stakes decisions that often leave a lasting emotional impact. Traditionally, EMS practice has centred on the moment of “termination of resuscitation”, a clinical decision that often results in abrupt death notifications and limited family involvement. But a growing body of work challenges this model, suggesting that it may unintentionally amplify trauma for both families and providers.In today's episode, we're joined by Dr Darren Braude, Paramedic, Director of the Centre for Prehospital Resuscitation and ECMO, Chief of the Division of Prehospital, Austere and Disaster Medicine. Dr Braude is one of the leading voices behind a powerful reframing: viewing the end of resuscitative efforts not as termination, but as the withdrawal of life support.Borrowing principles from ICU end-of-life care, this approach centres families, promotes clearer communication, and acknowledges that CPR and ventilation are themselves forms of life support. Today, we explore how this model can transform the way EMS navigates death, grief, and humanity in the field. You can read the article this interview is based on here: https://pubmed.ncbi.nlm.nih.gov/40928306/This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

The final episode regarding addiction care wraps up the convo.  We were live at Amherst Fire Department.  If you missed the last 3 episodes, we definitely suggest going back in the timeline.  This episode may challenge your "veteran thoughts" on addiction care.

When our crew is dispatched to an extremely rural location, they find our patient has fallen off an a-frame ladder and been impaled in the chest by a large piece of rebar on the ground. We know that in dealing with impalements, removal or jostling of the object can cause a host of problems for the patient, so the team must take great care in transporting him to a location where removal and treatment can occur in a safe and controlled environment. Listen in as our team coordinates with other first responders, readies their equipment mise en place, and communicates to ensure the best outcome for our patient. You'll find he is simultaneously very unlucky, and extraordinarily lucky in his unusual case.    Interested in obtaining CE credit for this episode? Visit OnlineAscend.com to learn more. Listeners can purchase individual episode credits or subscribe to the Critical Care Review Bundle and gain access to all episode CE Credits.    We are joined by:   Jennifer A. Beckett NREMT-P AAS      Cole Diercks BSN, RN, CFRN     Steven Johnson NREMT-P    Click here to download this episode today! As always thanks for listening and fly safe! Hawnwan Moy MD FACEP FAEMS John Wilmas MD FACEP FAEMS Nyssa Hattaway, BA, BSN, RN, CEN, CPEN, CFRN

As the crew starts to wind up this topic, the discussion of the process of opioid withdrawal continues including inducing a more intense, or higher, level of withdrawal to help the patient's recovery progression. The guys discuss the Clinical Opiate Withdrawal Scale (COWS) score, its use and the interpretation of. KEEPER NOTE: What words should we NOT be using to define these patients with "opiate disease disorder."

This episode is an absolute cracker! And we can say that as we've got outsider help... We've all been involved with patients where securing the airway with a prehospital anaesthetic feels intuitively right; the patient with a severe head injury after a fall from height, the unrestrained driver in a high-speed collision with devastating chest injuries, or the patient with significant maxillofacial trauma following assault. In these situations, advanced airway management appears clearly beneficial. What remains a bit ambiguous is the effect of that intervention. Does it play out into a mortality benefit and if so how should we redesign systems to meet a 24 hour need for this (with many prehospital critical care services not being available fully around the clock), bearing in mind competing financial priorities for optimum health care. Maybe it's okay that for some patients the anaesthetic is delayed to the Emergency Department? Worldwide, trauma accounts for an estimated 4.4 million deaths annually and carries a substantial economic burden. Despite decades of improvements in trauma systems, medications such as tranexamic acid, and the development of prehospital critical care teams, some key aspects of trauma care remain really difficult to study well. Prehospital emergency anaesthesia is a prime example. It is time-critical, ethically complex, highly operator dependent and almost impossible to study using conventional randomised trial designs. As a result, clinicians have largely been forced to rely on observational studies, despite the well-recognised problems of bias and confounding that accompany them. In this episode, we explore the existing evidence base and then focus on a landmark new study published in The Lancet Respiratory Medicine. This paper applies machine-learning techniques to a large UK trauma dataset to address the question; does prehospital intubation improve survival in patients who are predicted to need early airway intervention? We walk through how the authors developed a predictive model to identify high-risk patients, how doubly robust estimation was used to move beyond simple association, and how survival and health-economic outcomes were assessed. The results suggest a clinically meaningful reduction in 30-day mortality for selected high-risk trauma patients who receive prehospital intubation. And we're then joined by two of the study's authors, Amy Nelson and Julian Thompson. Together, we explore what these findings may mean for the future of prehospital emergency anaesthesia, how we should think about evidence in complex emergency care environments, and whether this type of analytical approach could reshape trauma research more broadly. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

Dr. Singer continues to talk to the PPP crew regarding Project DAWN (Deaths Avoided With Naloxone), an Ohio-based network of opioid overdose education and naloxone distribution programs (OENDP) coordinated by the Ohio Department of Health.    Should EMS squads add Buprenorphine to the drug box in the long term? KEEPER NOTE: The Narcan administration is just the beginning of the patient's opportunity to enter a recovery process. 

A.J. and Dr. Hill join Scott this month, to chat with Dr. Jordan Singer from the UH EMS Institute. What is long-term addiction care?  It's more than just showing up, treating the patient's symptoms, i.e., Narcan, and ending the patient's care once they are resuscitated. The crew digs into the norms and what the future might be including, leaving Narcan behind with family members or the patients. KEEPER NOTE: If a 20-year-old overdoses once, there is a 1 in 10-20 chance that they will be dead in 1 year.

In resuscitative trauma surgery every second counts. Can time and lives be saved by moving interventions closer to the point of injury? In this episode, we discuss a recent journal article on prehospital resuscitative thoracotomy as a treatment for traumatic cardiac arrest. Opening the chest on the street, who should do it, why should we do it, and for whom?• Hosts:  Mr Prashanth Ramaraj. General Surgery trainee, Edinburgh rotation. @LonTraumaSchool Dr Roisin Kelly. Major Trauma Junior Clinical Fellow, Royal London Hospital.  Mr Max Marsden. Resuscitative Major Trauma Fellow, Royal London Hospital. @maxmarsden83 Mr Christopher Aylwin. Consultant Trauma & Vascular Surgeon, Royal London Hospital and Co-Programme Director MSc Trauma Sciences at Queen Mary University of London. @cjaylwin Mr Zane Perkins. Consultant Trauma & UGI Surgeon, Royal London Hospital and Prehospital Surgeon at London's Air Ambulance. @ZBPerkins  • Learning objectives: A)    To be aware of the steps of a resuscitative thoracotomy (RT)B)     To understand the rational for prehospital (PH) trauma interventions.C)     To understand the timelines required to optimise success in PH RT.D)    To be familiar with the training governance for clinicians undertaking PH RT.E)     To recognise that PH RT is predominantly an intervention for cardiac tamponade.F)     To understand the contexts in which PH RT might be successful as a standardised intervention.• References: Perkins ZB, Greenhalgh R, Ter Avest E, Aziz S, Whitehouse A, Read S, Foster L, Chege F, Henry C, Carden R, Kocierz L, Davies G, Hurst T, Lendrum R, Thomas SH, Lockey DJ, Christian MD. Prehospital Resuscitative Thoracotomy for Traumatic Cardiac Arrest. JAMA Surg. 2025 Feb 26;160(4):432–40. doi: 10.1001/jamasurg.2024.7245. PMID: 40009367; PMCID: PMC11866073. https://pubmed.ncbi.nlm.nih.gov/40009367/ ter Avest, E., Kocierz, L., Alvarez, C. et al. Improving decision-making for prehospital Resuscitative Thoracotomy in traumatic cardiac arrest: a data-driven approach. Crit Care 29, 485 (2025). https://doi.org/10.1186/s13054-025-05705-z. https://pubmed.ncbi.nlm.nih.gov/41233917/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Our crew was dispatched to a high energy, rollover MVC with a patient ejection, which usually demands aggressive trauma protocols. But what happens when the patient is equipped with a HeartMate II, a Left Ventricular Assist Device (LVAD) that pumps blood for failing hearts. The irony is that this extremely sophisticated medical device that keeps our patient alive, also precludes our team from gathering regular vital signs, like a palpable pulse or traditional blood pressure measurements. How does the team manage a trauma resuscitation when the patient's circulation is a continuous flow rather than a beat? The trick is going to back to the basics of trauma care. Listen in and find out how this case unfurled.   Interested in obtaining CE credit for this episode? Visit OnlineAscend.com to learn more. Listeners can purchase individual episode credits or subscribe to the Critical Care Review Bundle and gain access to all episode CE Credits.    We are joined by:   Chelsea Putman, FP-C     Robert Steele, RN   Click here to download this episode today! As always thanks for listening and fly safe! Hawnwan Moy MD FACEP FAEMS John Wilmas MD FACEP FAEMS Nyssa Hattaway, BA, BSN, RN, CEN, CPEN, CFRN

We discuss the shift to prehospital blood to treat shock sooner. Hosts: Nichole Bosson, MD, MPH, FACEP Avir Mitra, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Prehospital_Transfusion.mp3 Download Leave a Comment Tags: EMS, Prehospital Care, Trauma Show Notes Core EM Modular CME Course Maximize your commute with the new Core EM Modular CME Course, featuring the most essential content distilled from our top-rated podcast episodes. This course offers 12 audio-based modules packed with pearls! Information and link below.  Course Highlights: Credit: 12.5 AMA PRA Category 1 Credits™ Curriculum: Comprehensive coverage of Core Emergency Medicine,  with 12 modules spanning from Critical Care to Pediatrics. Cost: Free for NYU Learners $250 for Non-NYU Learners Click Here to Register and Begin Module 1 What is prehospital blood transfusion Administration of blood products in the field prior to hospital arrival Aimed at patients in hemorrhagic shock Why this matters Traditional US prehospital resuscitation relied on crystalloid ED and trauma care now prioritize early blood Hemorrhage occurs before hospital arrival Delays to definitive hemorrhage control are common Earlier blood may improve survival Supporting rationale ATLS and trauma paradigms emphasize blood over fluid National organizations support prehospital blood when feasible EMS already manages high risk, time sensitive interventions Evidence overview Data are mixed and evolving COMBAT: no benefit PAMPer: mortality benefit RePHILL: no clear benefit Signal toward benefit when transport time exceeds ~20 minutes Urban systems still experience long delays due to traffic and geography LA County median time to in hospital transfusion ~35 minutes LA County program ~2 years of planning before launch Pilot began April 1 Partnerships: LA County Fire Compton Fire Local trauma centers San Diego Blood Bank 14 units of blood circulating in the field Blood rotated back 14 days before expiration Ultimately used at Harbor UCLA Continuous temperature and safety monitoring Indications used in LA County Focused rollout Trauma related hemorrhagic shock Postpartum hemorrhage Physiologic criteria: SBP < 70 Or HR > 110 with SBP < 90 Shock index ≥ 1.2 Witnessed traumatic cardiac arrest Products: One unit whole blood preferred Two units PRBCs if whole blood unavailable Early experience ~28 patients transfused at time of discussion Evaluating: Indications Protocol adherence Time to transfusion Early outcomes Too early for outcome conclusions California collaboration Multiple active programs: Riverside (Corona Fire) LA County Ventura County Additional programs planned: Sacramento San Bernardino Programs meet monthly as CalDROP Focus on shared learning and operational optimization Barriers and concerns Trauma surgeon concerns about blood supply Need for system wide buy in Community engagement Patients who may decline transfusion Women of childbearing age and alloimmunization risk Risk of HDFN is extremely low Clear communication with receiving hospitals is essential Future direction Rapid national expansion expected Greatest benefit likely where transport delays exist Prehospital Blood Transfusion Coalition active nationally Major unresolved issue: reimbursement Currently funded largely by fire departments Sustainability depends on policy and payment reform Take-Home Points Hemorrhagic shock is best treated with blood, not crystalloid Prehospital transfusion may benefit patients with prolonged transport times Implementation requires strong partnerships with blood banks and trauma centers Early data are promising, but patient selection remains critical National collaboration is key to sustainability and future growth Read More

On this show we have espoused the general guiding principal of "when you hear hoofbeats, think horses, not zebras." Sometimes the hoofbeats actually are those of zebras. But what if sometimes there not even zebras, they're unicorns? On this episode of AMPED, our patient has been bitten by a Jameson's Mamba, one of the deadliest snakes in the world. Thankfully, he is an expert herpetologist who is able to talk our team through the steps needed to save his life. But what our team learns is that sometimes that which seems extremely rare results in care that isn't rare at all.    Interested in obtaining CE credit for this episode? Visit OnlineAscend.com to learn more. Listeners can purchase individual episode credits or subscribe to the Critical Care Review Bundle and gain access to all episode CE Credits.    We are joined by:     Samuel Hall MD (Picture)     Jim Harrison (patient) and Kristen Harrison     Courtney Martin NREMT-P   Sarah Crabrtree RN   Kristen Wiley   Kentucky Reptile Zoo Links:    Official site Facebook Instagram   Youtube channel Click here to download this episode today! As always thanks for listening and fly safe! Hawnwan Moy MD FACEP FAEMS John Wilmas MD FACEP FAEMS Nyssa Hattaway, BA, BSN, RN, CEN, CPEN, CFRN

Blogpost asociado  https://ecctrainings.com/te-atreverias-a-dar-tromboliticos-prehospitalarios-para-embolia-pulmonar-lo-que-revela-el-nuevo-estudio-y-como-prepararte-con-acls/" Referencia del estudio original: Harjola, J., Holmström, P., Sane, M., Hartikainen, J., & Harjola, V.-P. (2025). Prehospital fibrinolysis in high-risk pulmonary embolism – Observational data on clinical picture and outcome. Prehospital Emergency Care, 29(7), 1–8. https://doi.org/10.1080/10903127.2025.2582671 Recordatorio rápido: embolia pulmonar de alto riesgo Definición sencilla: EP de alto riesgo / masiva → se manifiesta como shock obstructivo o paro cardiaco. Fisiopatología en pocas palabras: Trombo grande en circulación pulmonar → aumento de poscarga del ventrículo derecho → falla del VD → colapso hemodinámico. Por qué es tan letal: Deterioro muy rápido, ventana terapéutica corta. Frecuentemente se presenta como paro fuera del hospital. Conectar con ACLS: La EP masiva está dentro de las "T" (tromboembolismo) en las causas reversibles del paro. Las guías ACLS contemplan el uso de trombolíticos cuando se sospecha fuertemente EP como causa del paro. ¿Cómo se ve clínicamente un paciente con EP de alto riesgo? Disnea súbita, dolor torácico, síncope, hipotensión, antecedentes de riesgo trombótico. Resumen del estudio de Harjola et al. Objetivo principal del estudio Explorar supervivencia y complicaciones hemorrágicas del uso de trombolíticos prehospitalarios para embolia pulmonar de alto riesgo. Diseño Datos de EMS del área metropolitana de Helsinki + hospital universitario. Periodo aproximado: 2007–2019. Inclusión: Pacientes con EP de alto riesgo sospechada clínicamente. Tratados con fibrinolisis intravenosa prehospitalaria. Diagnóstico de EP confirmado posteriormente por imagen o autopsia. Grupo comparador: Pacientes con EP de alto riesgo que no recibieron fibrinólisis prehospitalaria. Resultados clave Total de pacientes con EP de alto riesgo: 60. Grupo con trombolíticos prehospitalarios para embolia pulmonar: n = 23. 44% mujeres. Edad media: alrededor de 57 años. 74% se presentaron en paro cardiaco. 26% en shock obstructivo. Mortalidad: Mortalidad prehospitalaria aproximada: 35%. Mortalidad intrahospitalaria: alrededor de 27% de los que llegaron vivos. Mortalidad total combinada: cerca de 52%. Todas las muertes en este grupo fueron en pacientes que llegaron en paro cardiaco. Complicaciones: 2 pacientes con sangrado mayor. Ningún sangrado fatal. Supervivencia a 12 meses: Los pacientes trombolizados que salieron vivos del hospital seguían vivos a los 12 meses. Grupo sin trombolisis prehospitalaria: n = 37. Más añosos (edad media cercana a 72 años). Mayor proporción de paro cardiaco. Mortalidad a 12 meses más alta (≈ 76%, tendencia, p alrededor de 0.06). Comentario para desarrollar: Es un estudio observacional, con n pequeño, no podemos concluir causalidad, pero sí hay "señales" interesantes de posible beneficio. ¿Qué nos dice realmente este estudio? Mensajes principales La EP de alto riesgo fuera del hospital tiene una mortalidad muy alta aun con intervenciones agresivas. En este contexto crítico, los trombolíticos prehospitalarios para embolia pulmonar: Parecen relativamente seguros (pocas hemorragias mayores, ninguna fatal). Podrían ofrecer un beneficio en supervivencia, especialmente en pacientes seleccionados. Limitaciones para mencionar Serie de casos; no es ensayo aleatorizado. Número pequeño de pacientes trombolizados. Posible sesgo de selección: Pacientes más jóvenes y potencialmente con menos comorbilidades recibieron trombólisis. No responde preguntas como: Detalle exacto del protocolo. Diferencias entre equipos. Tiempos exactos desde el colapso hasta la trombólisis. Idea clave: No es un "permiso" para trombolizar a todo el mundo, pero sí una invitación seria a considerar que, en EP de alto riesgo, la inacción también tiene un costo muy alto. El reto práctico: decidir trombolisis en el campo Barreras en la vida real Diagnóstico presuntivo sin imagen: Dependemos de clínica, antecedentes, ECG, quizás eco focal. Miedo al sangrado: Especialmente hemorragia intracraneal. Falta de protocolos claros: Muchos sistemas de EMS no contemplan todavía trombolíticos prehospitalarios para embolia pulmonar. Falta de entrenamiento específico: No todos se sienten cómodos con indicaciones, contraindicaciones, dosis. Cómo ayuda ACLS aquí ACLS bien aprendido: Te obliga a pensar en H y T, no solo en adrenalina y ciclos. Te muestra dónde se colocan los trombolíticos prehospitalarios para embolia pulmonar dentro del algoritmo. Te entrena para liderar un equipo y tomar decisiones bajo presión. Conectar con los cursos de ECCtrainings: En nuestros ACLS discutimos escenarios de paro por EP masiva. Practicamos cómo tomar la decisión de administrar o no trombolítico. Simulamos la comunicación con el hospital receptor después de trombólisis. Caso clínico narrado Propuesta de caso Varón de 48 años. Disnea súbita, dolor torácico, antecedente de inmovilidad o TVP reciente. Hipotenso, taquicárdico, saturación baja, signos de shock. En la ambulancia entra en PEA. El equipo evalúa H y T → EP masiva muy probable. Protocolo local permite trombolíticos prehospitalarios para embolia pulmonar: Se administra el medicamento durante la RCP. Después de varios ciclos recupera pulso. Llega vivo al hospital, se confirma EP por imagen y sobrevive. Puntos a resaltar Valor de: reconocer el patrón clínico, tener protocolos, estar entrenado en ACLS. Conectar con la serie de Helsinki: "Son justamente este tipo de pacientes los que aparecen en la serie: altísimo riesgo, pero con posibilidad real de supervivencia si somos agresivos." Cómo prepararte tú y tu sistema Pasos sugeridos para líderes, educadores y clínicos de EMS Revisar la evidencia Usar este estudio como punto de partida para la discusión sobre trombolíticos prehospitalarios para embolia pulmonar. Evaluar la realidad local ¿Disponibilidad del medicamento? ¿Quién puede prescribir y administrar? ¿Qué soporte hospitalario hay (UCI, hemodinamia, ECMO)? Desarrollar protocolos claros Criterios de inclusión y exclusión. Algoritmo que integre ACLS y trombólisis. Entrenamiento formal No basta con escribir el protocolo; hay que entrenarlo en simulación. Cursos ACLS con escenarios específicos de EP. Simulaciones y revisión de casos Simulacros periódicos con roles definidos. Morbimortalidad / debriefing de casos reales o simulados. Comunidad: seguir la conversación en ECCnetwork ECCnetwork: Comunidad en línea para profesionales de emergencias, cuidado crítico, medicina táctica, etc. Espacios para discutir artículos, casos, protocolos, dudas. Invitar a que compartan: ¿Su sistema consideraría trombolíticos prehospitalarios para embolia pulmonar? ¿Qué barreras ven? ¿Experiencias que puedan comentar? Recursos adicionales y blogpost Recordar el blogpost: URL:

Recently, some paramedics, obstetricians, and EMS medical directors were locked in a room and produced some fantastic collaborative prehospital guidelines for managing post-partum hemorrhage, eclampsia, and pre-eclampsia. Have a listen, take a look at the guidelines (links below), and we'll all take better care of our pregnant/post-partum patients. REFERENCES 1. https://naemsp.org/news/now-available-new-ems-obstetric-emergency-guidelines/

Happy Turkey Day! Join host Dr. Phil Moy as we dive straight into a topic that has "stirred up more conversation than a potluck dinner at an EMS station": the prehospital management of spinal injuries. We are here to highlight the critical manuscript "Prehospital Management of Spinal Cord Injuries, an NAEMSP Comprehensive Review and Analysis of the Literature", a pivotal document within the Prehospital Trauma Compendium. To discuss this hot topic, Dr. Moy welcomes two very special guests. First, we have Dr. John Gallagher, an emergency and EMS physician from Kona, Hawaii, and one of the authors of this comprehensive review. Second, we are thrilled to welcome Dr. Ken Milne, recognized as the podcaster from The Skeptic's Guide to Emergency Medicine. Our goal is to provide an objective discussion about the pros and cons of this manuscript so that you, our EMS clinicians and NAEMSP audience, can make your own informed decisions based on the facts. Featured Article: Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries – A NAEMSP Comprehensive Review and Analysis of the Literature: https://www.tandfonline.com/doi/full/10.1080/10903127.2025.2541258 Link to The Skeptic's Guide to EM review of this paper: SGEM#493: You Can't Hold Me Down with Spinal Motion Restrictions: https://thesgem.com/2025/11/sgem493-you-cant-hold-me-down-with-spinal-motion-restrictions/ 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 (@michaeljukim) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the November 2025 Emergency Medicine Practice article, Diagnosis and Management of Emergency Department Patients With Alcohol Withdrawal SyndromeEpidemiology & Background Rising ED visits related to alcohol use. Mortality rates and spectrum of patient presentations. Importance of high suspicion and complexity of cases.Pathophysiology & Mechanisms Alcohol metabolism and neurochemical changes. Differential diagnosis: Conditions that mimic alcohol withdrawal.Prehospital & EMS Considerations Role of EMS in triage and initial management. Use of sobering centers vs. ED transport. Prehospital administration of benzodiazepines (IM midazolam).History & Risk Assessment Key questions to assess risk for alcohol withdrawal syndrome. Importance of patient history, medication use, and comorbidities. Discussion on patient honesty and rapport.Physical Exam & Scoring Systems DSM-5 criteria for alcohol withdrawal. Use of CIWA-AR, BAWS, and PAWSS scoring systems. Importance of objective measurement for monitoring and disposition.Complications & Special PresentationsComplicated alcohol withdrawal: Hallucinosis, seizures, delirium tremens. Diagnostic workup: Labs, imaging, and co-ingestions. Special populations: End-stage liver disease, pregnancy, intubated patients.Treatment Strategies Mainstay: Benzodiazepines (types, dosing, and protocols). Phenobarbital: Indications, dosing, and evidence. Adjunctive therapies: Thiamine, glucose, magnesium. Alternative/adjunct medications: Gabapentin, ketamine, dexmedetomidine, baclofen.Clinical Pearls & Practice Changes Early, aggressive therapy to prevent complications. Symptom-based vs. fixed-schedule treatment. Gabapentin as an alternative or adjunct. Anti-craving medications for relapse prevention.Disposition & Protocols Use of scoring systems for safe discharge, observation, or admission. Importance of protocolized approaches and community resources.Summary & Take-Home Points Five key practice-changing points. Clinical pathway.Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

A brutal incident where a woman gets hit by a truck leaves her with a multitude of injuries, most notably both of her legs bent into a position best described as "frog legs." She's in good spirits and her vitals are good, but her legs bent at that angle means that she cannot fit into our team's helicopter. How does our team get her legs back into place without causing further trauma or risking her stable vitals? Complicating factors is the extremely uneven ground because they're in a cow pasture and the risk of infection is extremely high because the team and the patient are surrounded by cow patties. There is no training for this exact scenario, so how does our team adapt and apply the training they have to this unique situation? This episode of AMPED digs in.   Interested in obtaining CE credit for this episode? Visit OnlineAscend.com to learn more. Listeners can purchase individual episode credits or subscribe to the Critical Care Review Bundle and gain access to all episode CE Credits.    We are joined by:   Aaron Botzow, NRP, FP-C     Drew Gill, BSN, RN, CEN     Michael Eastman DO   Click here to download this episode today! As always thanks for listening and fly safe! Hawnwan Moy MD FACEP FAEMS John Wilmas MD FACEP FAEMS Nyssa Hattaway, BA, BSN, RN, CEN, CPEN, CFRN

In an incredible twist of irony, this month's case focuses on our flight crew loading into their helicopter to be dispatched to... a patient who has fallen out of a helicopter. From a height of approximately 40 feet and at a speed of 30 knots, our patient has an abundance of injuries, which requires our team to remember their axiom: "Slow is smooth, and smooth is fast." This episode also introduces an important question: How do we intervene in different kinds of shock? Our patient had three different kinds: Hemorrhagic, neurogenic, and obstructive shock. Listen in as our guest, along with our panel, deconstructs one of the rarest cases in AMPED history.    Interested in obtaining CE credit for this episode? Visit OnlineAscend.com to learn more. Listeners can purchase individual episode credits or subscribe to the Critical Care Review Bundle and gain access to all episode CE Credits.    We are joined by:   Matthew Habbe NREMT-P.   Click here to download this episode today! As always thanks for listening and fly safe! Hawnwan Moy MD FACEP FAEMS John Wilmas MD FACEP FAEMS Nyssa Hattaway, BA, BSN, RN, CEN, CPEN, CFRN

Prehospital EMS capabilities and why paramedic-staffed ALS ambulances make a difference in the early identification & treatment of STEMI and stroke.The chain of survival for a cardiac emergency and stroke.ALS ambulances are staffed with paramedics who have training in ACLS skills.Why EMS Destination Protocols for suspected stroke and STEMI make a difference.ACLS's timed benchmarks for:point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center.Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.**American Cancer Society (ACS) Fundraiser This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.I hope you'll consider contributing.Every donation makes a difference in the fight against breast cancer! Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylorTHANK YOU for your support! Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Other ACLS-related resources: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

“It's 5pm and your Consultant (attending) has headed off home. A patient arrives in the resuscitation room blood spurting from a stab wound in the armpit. Join Roisin – a junior Major Trauma fellow, Prash – a surgical trainee, Max – a senior trauma surgery fellow, and Chris – a Consultant trauma surgeon, as we talk through decision making from point of injury to aftercare in this challenging trauma surgical case”. • Hosts: Bulleted list of host names, including title, institution, & social media handles if indicated 1.     Mr Prashanth Ramaraj. General Surgery trainee, Edinburgh rotation. @LonTraumaSchool 2.     Dr Roisin Kelly. Major Trauma Junior Clinical Fellow, Royal London Hospital.  3.     Mr Max Marsden. Resuscitative Major Trauma Fellow, Royal London Hospital. @maxmarsden83 4.     Mr Christopher Aylwin. Consultant Trauma & Vascular Surgeon and Co-Programme Director MSc Trauma Sciences at Queen Mary University of London. @cjaylwin • Learning objectives: Bulleted list of learning objectives. A)    To become familiar with prehospital methods of haemorrhage control in penetrating junctional injuries. B)     To recognise the benefits of prehospital blood product resuscitation in some trauma patients. C)     To follow the nuanced decision making in decision for CT scan in a patient with a penetrating junctional injury. D)    To describe the possible approaches to the axillary artery in the context of resuscitative trauma surgery. E)     To become familiar with decision making around intraoperative systemic anticoagulation in the trauma patient. F)     To become familiar with decision making on type of repair and graft material in vascular trauma. G)    To recognise the team approach in holistic trauma care through the continuum of trauma care. • References: Bulleted list of references with PubMed links. 1.    Perkins Z. et al., 2012. Epidemiology and Outcome of Vascular Trauma at a British Major Trauma Centre. EJVES. https://www.ejves.com/article/S1078-5884(12)00337-1/fulltext 2.    Ramaraj P., et al. 2025. The anatomical distribution of penetrating junctional injuries and their resource implications: A retrospective cohort study. Injury. https://www.injuryjournal.com/article/S0020-1383(24)00771-X/ 3.    Smith, S., et al. 2019. The effectiveness of junctional tourniquets: A systematic review and meta-analysis. J Trauma Acute Care Surg. https://journals.lww.com/jtrauma/abstract/2019/03000/the_effectiveness_of_junctional_tourniquets__a.20.aspx 4.    Rijnhout TWH, et al. 2019. Is prehospital blood transfusion effective and safe in haemorrhagic trauma patients? A systematic review and meta-analysis. Injury. https://www.injuryjournal.com/article/S0020-1383(19)30133-0/ 5.    Davenport R, et al. 2023. Prehospital blood transfusion: Can we agree on a standardised approach? Injury. https://www.injuryjournal.com/article/S0020-1383(22)00915-9. 6.    Borgman MA., et al. 2007. The Ratio of Blood Products Transfused Affects Mortality in Patients Receiving Massive Transfusions at a Combat Support Hospital. J Trauma Acute Care Surg. https://journals.lww.com/jtrauma/fulltext/2007/10000/the_ratio_of_blood_products_transfused_affects.13.aspx 7.    Holcomb JB., et al. 2013. The Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study. Comparative Effectiveness of a Time-Varying Treatment With Competing Risks. JAMA Surgery. https://jamanetwork.com/journals/jamasurgery/fullarticle/1379768 8.    Holcomb JB, et al. 2015. Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 Ratio and Mortality in Patients With Severe Trauma. The PROPPR Randomized Clinical Trial. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2107789 9.    Davenport R., et al. 2023. Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury. The CRYOSTAT-2 Randomized Clinical Trial. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2810756 10.   Baksaas-Aasen K., et al. 2020. Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial. ICM. https://link.springer.com/article/10.1007/s00134-020-06266-1 11. Wahlgren CM., et al. 2025. European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Vascular Trauma. EJVES. https://esvs.org/wp-content/uploads/2025/01/2025-Vascular-Trauma-Guidelines.pdf 12. Khan S., et al. 2020. A meta-analysis on anticoagulation after vascular trauma. Eur J Traum Emerg Surg. https://link.springer.com/article/10.1007/s00068-020-01321-4 13. Stonko DP., et al. 2022. Postoperative antiplatelet and/or anticoagulation use does not impact complication or reintervention rates after vein repair of arterial injury: A PROOVIT study. Vascular. https://journals.sagepub.com/doi/10.1177/17085381221082371?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this episode of the Pre-Hospital Paradigm Podcast, Dr. Jon Hill and Scott Wildenheim are joined by Tony Crino, a registered respiratory therapist and paramedic. They continue the discussion of the growing role of advanced ventilator management in EMS. Tony Crino brings both respiratory therapy and paramedic perspectives, breaking down the essentials of ventilator physiology, modes, patient-ventilator synchrony, and how these advanced tools can elevate prehospital care.

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the September 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Status Epilepticus Topic IntroductionFocus: Status Epilepticus in AdultsReference to recent pediatric episodeArticle authors: Dr. Marquez, Dr. Kaur, Dr. LayWhy Status Epilepticus MattersTeaching value and clinical challengeTeam-based care and multidisciplinary involvementGuidelines and EvidenceReview of major guidelines (International League Against Epilepsy, Neurocritical Care Society, American Epilepsy Society)Key trials: EcLiPSE, ConSEPT, ESETTUpdated definition of status epilepticusClassification and DiagnosisConvulsive vs. non-convulsive statusImportance of repeated neurologic examsDiagnostic challenges and mimics (e.g., syncope, psychogenic seizures)Etiology and WorkupAcute vs. non-acute causesCommon triggers: medication noncompliance, metabolic issues, infections, traumaImportance of sleep patterns and ammonia levelsThe NORSE acronym (new onset refractory status epilepticus)Prehospital and ED ManagementAirway, breathing, circulation prioritiesEarly pharmacologic intervention (IM midazolam preferred in prehospital)Gathering history and medication informationPositioning and airway protectionDiagnosticsLaboratory workup: glucose, CBC, metabolic panel, drug levels, pregnancy testImaging: non-contrast CT, MRI, ultrasound, lumbar punctureEEG: spot vs. continuous monitoringTreatment ApproachFirst-line: Benzodiazepines (lorazepam, midazolam)Second-line: Levetiracetam, valproate, fosphenytoin, phenobarbital, lacosamideThird-line: Continuous infusions (midazolam, propofol, pentobarbital, thiopental, ketamine)Dosing pearls and importance of rapid escalationSpecial PopulationsPregnancy (eclampsia: magnesium as first-line)Substance-induced status epilepticus (e.g., isoniazid toxicity and pyridoxine)Brief mention of pediatric management and the PD stat appRisk Management PitfallsNon-convulsive status is common and easily missedImportance of weight-based dosingNeed for formal EEG in ambiguous casesDon't assume non-adherence is the only cause in known epilepticsAlways consider higher level of care for status patientsClinical PathwayStepwise approach to medication and escalationEmphasis on having a pathway/checklist for these high-stress casesConclusionRecap of key pointsThanks to authors and listenersReminder to visit ebmedicine.net for CME and resourcesEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

A common aphorism in the medical community comes from Dr. Theodore Woodward who said in the 1940s, "When you hear hoofbeats behind you, think of horses, not zebras." It's a way of reminding medical practitioners that the most common explanation is usually correct. In other words, Occam's Razor is usually correct. But what happens when the most common explanation isn't correct? What happens when you turn around and find a zebra looking at you? In this month's episode, our team finds a pediatric patient who seems to have had a stroke. Stroke is very uncommon in children, but that doesn't mean it never happens. Listen in as our team starts with the basics, analyzes the feedback, and arrives at their conclusion.   Interested in obtaining CE credit for this episode? Visit OnlineAscend.com to learn more. Listeners can purchase individual episode credits or subscribe to the Critical Care Review Bundle and gain access to all episode CE Credits.    We are joined by:   Maria Milagros Galardi, MD     William McCray, RN   Click here to download this episode today! As always thanks for listening and fly safe! Hawnwan Moy MD FACEP FAEMS John Wilmas MD FACEP FAEMS Nyssa Hattaway, BA, BSN, RN, CEN, CPEN, CFRN

Extreme weather once again plays an important factor in this month's case where our team comes upon a car accident victim who has a litany of injuries that make care extremely challenging, even in optimal conditions. Featuring a pilot for the first time ever in AMPED history, we hear from our clinicians about how to give our patient the best shot at survival, and from our pilot about the many considerations he has to make in order to expedite his arrival at a care facility. Hear these unique insights in this fascinating episode of AMPED.   Interested in obtaining CE credit for this episode? Visit OnlineAscend.com to learn more. Listeners can purchase individual episode credits or subscribe to the Critical Care Review Bundle and gain access to all episode CE Credits.    We are joined by:   Danica Mainridge RN, BSN, CEN, CPEN, CCRN, CFRN     Megan Thompson, RN, MSN, MBA, CEN, CFRN, TCRN, TNS, CES-A    Mikaele Kerner Helicopter PIlot Click here to download this episode today! As always thanks for listening and fly safe! Hawnwan Moy MD FACEP FAEMS John Wilmas MD FACEP FAEMS Nyssa Hattaway, BA, BSN, RN, CEN, CPEN, CFRN

If a person suddenly develops symptoms such as weakness, slurred or garbled speech, loss of balance, or a massive & severe headache; it's possible they could be having a stroke.The Cincinnati Prehospital Stroke Scale.There are several conditions that can mimic a stroke.Identification & Treatment of hypoglycemia or hyperglycemia.Identification & Treatment of hypoxia using a pulse oximeter.Some seizures, electrolyte imbalance, sepsis, brain tumors, and Bell's Palsy can also mimic a stroke.Prehospital providers should transport suspected stroke patients to a stroke center following their local protocols.Hospital providers should active their stroke team to ensure rapid assessment and treatment.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vipPass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

A severely ill Flu A patient, fully intubated, and fighting for every breath requires the AMPED team for transport for possible ECMO. Under even the best of circumstances, this type of patient requires extensive care and presents many challenges. But what happens when extreme weather causes problems with the team's equipment, making care even more challenging? Find out how our team dealt with and overcame these challenges to help ensure our patient's recovery and survival.   Interested in obtaining CE credit for this episode? Visit OnlineAscend.com to learn more. Listeners can purchase individual episode credits or subscribe to the Critical Care Review Bundle and gain access to all episode CE Credits.    We are joined by:   Matt Johnson, NRP Flight Paramedic     Anna Schmick, BSN, RN, CFRN Flight Nurse    Click here to download this episode today! As always thanks for listening and fly safe! Hawnwan Moy MD FACEP FAEMS John Wilmas MD FACEP FAEMS Nyssa Hattaway, BA, BSN, RN, CEN, CPEN, CFRN

The podcast crew takes on the topic of prehospital analgesia. What pain medication do we choose when facing a complex patient with all analgesics available? Are there better options for hypotensive patients? What about pregnancy and the elderly? On this episode, we'll walk through our MCHD pain medication options, take a moment for a BLS reminder, and discuss some specific situations where certain medications are the best fit. REFERENCES 1. McArthur, R., Cash, R. E., Rafique, Z., Dickson, R., Crocker, K., Crowe, R. P., Wells, M., Chu, K., Nguyen, J., & Patrick, C. (2024). Intravenous Acetaminophen Versus Ketorolac for Prehospital Analgesia: A Retrospective Data Review. The Journal of emergency medicine, 67(3), e259–e267. 2. McArthur, R., Cash, R. E., Anderson, J., De La Rosa, X., Peckne, P., Hogue, D., Badawood, L., Secrist, E., Andrabi, S., & Patrick, C. (2025). Fentanyl versus nebulized ketamine for prehospital analgesia: A retrospective data review. The American journal of emergency medicine, 89, 124–128. 3. Powell, J. R., Browne, L. R., Guild, K., Shah, M. I., Crowe, R. P., Lindbeck, G., Braithwaite, S., Lang, E. S., Panchal, A. R., & Technical Expert Panel (2023). Evidence-Based Guidelines for Prehospital Pain Management: Literature and Methods. Prehospital emergency care, 27(2), 154–161. 4. Aceves, A., Crowe, R. P., Zaidi, H. Q., Gill, J., Johnson, R., Vithalani, V., Fairbrother, H., & Huebinger, R. (2023). Disparities in Prehospital Non-Traumatic Pain Management. Prehospital emergency care, 27(6), 794–799.

Contributor: Aaron Lessen, MD Educational Pearls: Prehospital seizures are typically managed with intramuscular midazolam (Versed) Seizures theoretically involve the NMDA pathway, and ketamine is a potent NMDA antagonist A recent retrospective cohort study analyzed a Florida EMS protocol that uses ketamine in seizures refractory to midazolam One group received two doses of midazolam for seizure control The other group received a dose of midazolam followed by a dose of ketamine After matching, 82% of the midazolam-only group patients had resolution of convulsions prior to ED arrival 94.4% of patients in the midazolam + ketamine group experienced resolution Absolute difference between groups was 12.4% (95% CI 3.1% to 21.7%) Limitations to the study include its prehospital setting and limited long-term follow-up References Zitek T, Scheppke KA, Antevy P, et al. Midazolam and Ketamine for Convulsive Status Epilepticus in the Out-of-Hospital Setting. Ann Emerg Med. 2025;85(4):305-312. doi:10.1016/j.annemergmed.2024.11.002 Summarized & Edited by Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/  

Dr. Dan Ackerman and Drs. Luuk Dekker and Jasper D. Daems discuss the analysis of various aLVO stroke detection scales to determine which one is the most useful for prehospital triage. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213570 

Dr. Dan Ackerman talks with Drs. Luuk Dekker and Jasper D. Daems about analyzing various anterior-circulation large-vessel occlusion (aLVO) stroke detection scales to determine which one is the most useful for prehospital triage. Read the related article in Neurology®.  Disclosures can be found at Neurology.org.   

A car accident on the highway sees the vehicle rollover nine times and ejects our patient out of the vehicle with a multitude of life threatening injuries. Our team refers to our patient as the sickest trauma patient any of them had ever seen. The outlook is very bleak, but our team perseveres and gives every effort to help increase the patient's odds of survival. While not ultimately successful, this episode provides critical insight and valuable lessons learned from our team about how important providing the very best care is, even when the cause appears lost.    Interested in obtaining CE credit for this episode? Visit OnlineAscend.com to learn more. Listeners can purchase individual episode credits or subscribe to the Critical Care Review Bundle and gain access to all episode CE Credits.    We are joined by:   Mark Fowler NRP, FP-C    Click here to download this episode today! As always thanks for listening and fly safe! Hawnwan Moy MD FACEP FAEMS John Wilmas MD FACEP FAEMS Nyssa Hattaway, BA, BSN, RN, CEN, CPEN, CFRN

Lindsey Ewing (IG's The Prehospitalist) joins us to discuss updates and questions surrounding the EMS management of traumatic arrest. Sure, we must address the "reversible" causes, but what about ACLS/compressions/epinephrine? Which patients are exceptions to the rules? Lindsey had a tough case, asked some hard questions, and will provide solid answers—our favorite recipe for a jam-packed educational session. REFERENCES 1. Witt, C. E., Shatz, D. V., Robinson, B. R. H., Campion, E. M., Shapiro, M. L., Bui, E. H., Meizoso, J. P., & Dorlac, W. C. (2025). Epinephrine in Prehospital Traumatic Cardiac Arrest-Life Saving or False Hope?. Prehospital emergency care, 1–9. 2. Breyre, A. M., George, N., Nelson, A. R., Ingram, C. J., Lardaro, T., Vanderkolk, W., & Lyng, J. W. (2025). Prehospital Trauma Compendium: Prehospital Management of Adults with Traumatic Out-of-Hospital Circulatory Arrest - A Joint Position Statement and Resource Document of NAEMSP, ACS-COT, and ACEP. Prehospital emergency care, 1–15. 3. https://www.anzcor.org/assets/anzcor-guidelines/guideline-11-10-1-management-of-cardiac-arrest-due-to-trauma-253.pdf

A motorcycle accident leaves our patient with a litany of serious injuries and severe bleeding, yet he remains alert and talking to the team... but that's not the only one he talks to. Our patient puts his life in the hands of a higher power and our Air Methods crew as they work to address his numerous injuries and ailments and get him to a hospital. Hear from the patient himself through this harrowing experience.   Interested in obtaining CE credit for this episode? Visit OnlineAscend.com to learn more. Listeners can purchase individual episode credits or subscribe to the Critical Care Review Bundle and gain access to all episode CE Credits.    We are joined by:   Sarah Baker, RN, PHRN, CEN, CCRN, CFRN   Jesse Weller, NRP, FPC   Kyle Hoover     Here is everyone reunited as our patient continues his recovery. Click here to download this episode today! As always thanks for listening and fly safe! Hawnwan Moy MD FACEP FAEMS John Wilmas MD FACEP FAEMS Nyssa Hattaway, BA, BSN, RN, CEN, CPEN, CFRN

On today's episode, we're lucky to have a couple of special guests to discuss prehospital transcutaneous pacing. Medics turned medical students and EMS researchers, Josh Kimbrell and Judah Kreinbrook recently published a case series decsribing EMS pacing capture. Like many of our favorite topics this came from a paramedic asking a clinical question with loads of dogma and little evidence. What they found should motivate us all to be skeptical when it comes to determining if TCP is actually working. REFERENCES 1. https://www.mchd-tx.org/wp-content/uploads/2025/03/TCP-Podcast-Figures.pdf 2. Kimbrell, J., Kreinbrook, J., Poke, D., Kalosza, B., Geldner, J., Shekhar, A. C., Miele, A., Bouthillet, T., & Vega, J. (2024). False Electrical Capture in Prehospital Transcutaneous Pacing by Paramedics: A Case Series. Prehospital emergency care, 28(7), 928–936. 3. https://www.ems12lead.com/post/tcp-in-transit-part-i 4. https://www.ems12lead.com/post/transcutaneous-pacing-part-2 5. https://www.ems12lead.com/post/transcutaneous-pacing-part-3