Podcasts about Prehospital Emergency Care

We covered a paper in episode 81 that suggested treating atrial fibrillation with rapid ventricular response in the field could lower mortality. But it also drops BP a bit. Could pretreating these patients with calcium lower the risk of hypotension? Dr Jarvis puts on his nerd hat and uses Bayesian analysis to assess a new randomized, placebo-controlled study that looked at just this thing. Why is he going off on this Bayes thing? Because he's been reading a couple of book on it and wanted to take it for a spin.  Tables:  Charts: Bayesian Distributions: Citation: 1.     Az A, Sogut O, Dogan Y, Akdemir T, Ergenc H, Umit TB, Celik AF, Armagan BN, Bilici E, Cakmak S: Reducing diltiazem-related hypotension in atrial fibrillation: Role of pretreatment intravenous calcium. The American Journal of Emergency Medicine. 2025;February;88:23–8.2.     Fornage LB, O'Neil C, Dowker SR, Wanta ER, Lewis RS, Brown LH: Prehospital Intervention Improves Outcomes for Patients Presenting in Atrial Fibrillation with Rapid Ventricular Response. Prehospital Emergency Care. doi: 10.1080/10903127.2023.2283885 (Epub ahead of print).3.     Kolkebeck T, Abbrescia K, Pfaff J, Glynn T, Ward JA: Calcium chloride before i.v. diltiazem in the management of atrial fibrillation. The Journal of Emergency Medicine. 2004;May 1;26(4):395–400.4.     Chivers T: Everything Is Predictable: How Bayes' Remarkable Theorem Explains the World. Weidenfeld & Nicolson, 2024.5.     McGrayne SB: The Theory That Would Not Die. how Bayes' Rule Cracked The Enigma Code, Hunted Down Russian Submarines & Emerged Triumphant From Two Centuries of Controversy. New Haven, CT, Yale University Press, 2011. FAST25 | May 19-21, 2025 | Lexington, KY

  In this episode, we are joined by Dr. Amelia Breyre, the lead author of Multidisciplinary Lessons from Palliative Extubations at Home, to discuss the complexities and collaborative efforts involved in facilitating palliative extubations at home. Dr. Breyre shares insights from two remarkable cases, highlighting how multidisciplinary coordination between critical care, palliative care, EMS, and hospice teams made it possible for patients to return home for end-of-life care. This conversation offers important lessons for EMS clinicians and physicians committed to improving patient-centered care at the end of life. Featured Article Breyre, A. M., Grammatico, M., Policastro, A., Ingram, C. J., Prsic, E., Sussman, L. S., & Couturier, K. (2024). Multidisciplinary Lessons from Palliative Extubations at Home. *Prehospital Emergency Care*, 1-4.

Ready for the latest insights in prehospital care? In this episode, we're diving into an eye opening question in emergency medicine: could giving just a single dose of epinephrine during cardiac arrest be more effective than the standard approach? This topic isn't just about changing a drug protocol—it challenges the way we think about resuscitation itself. We're spotlighting a new study that's sparking important conversations in the field, and it's part of a broader theme in the latest issue of Prehospital Emergency Care, which also features articles on pediatric emergencies, compelling case studies, and new insights into cardiac arrest care. Join Niko and Michael as they speak with authors Dr. Tyler George and Dr. Nick Ashburn about their study - you don't want to miss it.  Check out PEC Podcast Episode 149 today! Available now on your favorite podcast platform.   As always THANK YOU for listening. Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems) Maia Dorsett MD PhD (@maiadorsett) Lekshmi Kumar MD, MPH(@Gradymed1) Greg Muller DO (@DrMuller_DO) Ariana Weber MD (@aweberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaelkim_md) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD

Wrapping up a series of 5 episodes, Dr Jarvis finishes his discussion of mechanical CPR devices (MCDs) talking about papers from Utah, Vienna, Anchorage, and Cincinnati and then gives his take on how to interpret the literature and put it into practice.Papers discussed:1)    Youngquist ST, Ockerse P, Hartsell S, Stratford C, Taillac P: Mechanical chest compression devices are associated with poor neurological survival in a statewide registry: A propensity score analysis. Resuscitation. 2016;September;106:102–7.2)    Zeiner S, Sulzgruber P, Datler P, Keferböck M, Poppe M, Lobmeyr E, Van Tulder R, Zajicek A, Buchinger A, Polz K, et al.: Mechanical chest compression does not seem to improve outcome after out-of hospital cardiac arrest. A single center observational trial. Resuscitation. 2015;November;96:220–5.3)    Levy M, Yost D, Walker RG, Scheunemann E, Mendive SR: A quality improvement initiative to optimize use of a mechanical chest compression device within a high-performance CPR approach to out-of-hospital cardiac arrest resuscitation. Resuscitation. 2015;July;92:32–7.4)    Morgan S, Gray JJ, Sams W, Uhl K, Gundrum M, McMullan J: LUCAS Device Use Associated with Prolonged Pauses during Application and Long Chest Compression Intervals. Prehospital Emergency Care. 2023;March 9;28(1):114–7.5)    Grunau B, Reynolds J, Scheuermeyer F, Stenstom R, Stub D, Pennington S, Cheskes S, Ramanathan K, Christenson J: Relationship between Time-to-ROSC and Survival in Out-of-hospital Cardiac Arrest ECPR Candidates: When is the Best Time to Consider Transport to Hospital? Prehospital Emergency Care. 2016;September 2;20(5):615–22.  FAST25 | May 19-21, 2025 | Lexington, KY

Title: Remembering Freedom House: A Legacy in EMS Join us for a special episode of the Prehospital Emergency Care (PEC) Podcast as we delve into the rich history and enduring legacy of Freedom House. In alignment with our commitment to Diversity, Equity, and Inclusion, we're honored to welcome two distinguished guests: Chief John Moon from Freedom House and Dr. Ameera Hamid, EMS physician at the University of Chicago. Chief John Moon Dr. Ameera Haamid In this powerful conversation, we'll take a nostalgic journey back to the origins of Freedom House, exploring its groundbreaking contributions to the world of Emergency Medical Services. Chief Moon and Dr. Hamid will share their personal insights and reflections, highlighting the pivotal role Freedom House played in shaping modern EMS. This episode is more than just a history lesson; it's a tribute to the pioneers who broke barriers and paved the way for a more inclusive and equitable EMS system. Listen as we celebrate the remarkable story of Freedom House and its lasting impact on prehospital care. Key Topics: The historical significance of Freedom House. Personal stories and reflections from Chief John Moon and Dr. Ameera Hamid. Freedom House's impact on diversity, equity, and inclusion in EMS. The enduring legacy of Freedom House in modern prehospital care. Listen Now: https://traffic.libsyn.com/pecpodcast/Ep._147_Chief_Moon_Dr._Haamid.mp3 Learn More: Achieving Equity in EMS Care and Patient Outcomes Through Quality Management Systems: A Position Statement American Sirens (Chief Moon's book)   As always THANK YOU for listening. Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems) Maia Dorsett MD PhD (@maiadorsett) Lekshmi Kumar MD, MPH(@Gradymed1) Greg Muller DO (@DrMuller_DO) Ariana Weber MD (@aweberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaelkim_md) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD

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

We know the literature on mechanical CPR devices on mortality in out of hospital cardiac arrest (we DO know this literature, right?), but what about in-hospital arrest? Dr. Jarvis reviews a recent paper that uses the AHA Get With The Guidelines - Resuscitation registry to assess the association between MCDs and mortality. Citations1. Crowley C, Salciccioli J, Wang W, Tamura T, Kim EY, Moskowitz A: The association between mechanical CPR and outcomes from in-hospital cardiac arrest: An observational cohort study. Resuscitation. 2024;May 1;198.2. Rubertsson S, Lindgren E, Smekal D, Östlund O, Silfverstolpe J, Lichtveld RA, Boomars R, Ahlstedt B, Skoog G, Kastberg R, et al.: Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: The LINC Randomized Trial. JAMA. 2014;January 1;311(1):53–613. Hardig BM, Lindgren E, Östlund O, Herlitz J, Karlsten R, Rubertsson S: Outcome among VF/VT patients in the LINC (LUCAS IN cardiac arrest) trial—A randomised, controlled trial. Resuscitation. 2017;June;115:155–62.4.  Perkins GD, Lall R, Quinn T, Deakin CD, Cooke MW, Horton J, Lamb SE, Slowther A-M, Woollard M, Carson A, et al.: Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial. The Lancet. 2015;385(9972):947–55.5.  Wik L, Olsen J-A, Persse D, Sterz F, Lozano M, Brouwer MA, Westfall M, Souders CM, Malzer R, Van Grunsven PM, et al.: Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial. Resuscitation. 2014;June;85(6):741–8.6. Bonnes JL, Brouwer MA, Navarese EP, Verhaert DVM, Verheugt FWA, Smeets JLRM, Boer M-J de: Manual Cardiopulmonary Resuscitation Versus CPR Including a Mechanical Chest Compression Device in Out-of-Hospital Cardiac Arrest: A Comprehensive Meta-analysis From Randomized and Observational Studies. Ann Emerg Med Annals of emergency medicine. 2016;67(3):349-360.e3.7. Gonzales L, Oyler BK, Hayes JL, Escott ME, Cabanas JG, Hinchey PR, Brown LH: Out-of-hospital cardiac arrest outcomes with “pit crew” resuscitation and scripted initiation of mechanical CPR. The American Journal of Emergency Medicine. 2019;May;37(5):913–20.8. Koster RW, Beenen LF, Van Der Boom EB, Spijkerboer AM, Tepaske R, Van Der Wal AC, Beesems SG, Tijssen JG: Safety of mechanical chest compression devices AutoPulse and LUCAS in cardiac arrest: a randomized clinical trial for non-inferiority. European Heart Journal. 2017;October 21;38(40):3006–13.9. Primi R, Bendotti S, Currao A, Sechi GM, Marconi G, Pamploni G, Panni G, Sgotti D, Zorzi E, Cazzaniga M, et al.: Use of Mechanical Chest Compression for Resuscitation in Out-Of-Hospital Cardiac Arrest—Device Matters: A Propensity-Score-Based Match Analysis. JCM. 2023;June 30;12(13):4429.10. Youngquist ST, Ockerse P, Hartsell S, Stratford C, Taillac P: Mechanical chest compression devices are associated with poor neurological survival in a statewide registry: A propensity score analysis. Resuscitation. 2016;September;106:102–7.11.  S, Sulzgruber P, Datler P, Keferböck M, Poppe M, Lobmeyr E, Van Tulder R, Zajicek A, Buchinger A, Polz K, et al.: Mechanical chest compression does not seem to improve outcome after out-of hospital cardiac arrest. A single center observational trial. Resuscitation. 2015;November;96:220–5. 12. Morgan S, Gray JJ, Sams W, Uhl K, Gundrum M, McMullan J: LUCAS Device Use Associated with Prolonged Pauses during Application and Long Chest Compression Intervals. Prehospital Emergency Care. doi: 10.1080/10903127.2023.2183294 (Epub ahead of print).13.  Levy M, Yost D, Walker RG, Scheunemann E, Mendive SR: A quality improvement initiative to optimize use of a mechanical chest compression device within a high-performance CPR approach to out-of-hospital cardiac arrest resuscitation. Resuscitation. 2015;July;92:32–7.14.  Li H, Wang D, Yu Y, Zhao X, Jing X: Mechanical versus manual chest compressions for cardiac arrest: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med. 2016;December;24(1):10.15.  Sheraton M, Columbus J, Surani S, Chopra R, Kashyap R: Effectiveness of Mechanical Chest Compression Devices over Manual Cardiopulmonary Resuscitation: A Systematic Review with Meta-analysis and Trial Sequential Analysis. WestJEM. 2021;July 19;22(4):810–9.16.  Wang PL, Brooks SC: Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database Syst Rev The Cochrane database of systematic reviews. 2018;20;8:CD007260.17.  Zhu N, Chen Q, Jiang Z, Liao F, Kou B, Tang H, Zhou M: A meta-analysis of the resuscitative effects of mechanical and manual chest compression in out-of-hospital cardiac arrest patients. Crit Care. 2019;December;23(1):100.

We've reviewed several papers in the past that suggest there might be an advantage to using IV access compared to IO access for medications in cardiac arrest. Is that really a thing? Wouldn't it be great if we had some randomized controlled trials to help answer the questions?  Funny you should mention RCTs. Dr Jarvis reviews three (THREE!) new RCTs that compare IV to IO access in out of hospital cardiac arrest to try to shed some of that bright light of science on this question!Citations:1. Vallentin MF, Granfeldt A, Klitgaard TL, Mikkelsen S, Folke F, Christensen HC, Povlsen AL, Petersen AH, Winther S, Frilund LW, et al.: Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest. N Engl J Med.2. Smida T, Crowe R, Jarvis J, Ratcliff T, Goebel M: A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehospital Emergency Care. 2024;28(6):1–23.3. Nielsen N: The Way to a Patient's Heart — Vascular Access in Cardiac Arrest. N Engl J Med. doi: 10.1056/NEJMe2412901 (Epub ahead of print).4. Ko Y-C, Lin H-Y, Huang EP-C, Lee A-F, Hsieh M-J, Yang C-W, Lee B-C, Wang Y-C, Yang W-S, Chien Y-C, et al.: Intraosseous versus intravenous vascular access in upper extremity among adults with out-of-hospital cardiac arrest: cluster randomised clinical trial (VICTOR trial). BMJ. doi: 10.1136/bmj-2024-079878 (Epub ahead of print).5. Kudenchuk PJ, Brown SP, Daya M, Rea T, Nichol G, Morrison LJ, Leroux B, Vaillancourt C, Wittwer L, Callaway CW, et al.: Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2016;May 5;374(18):1711–22.6.Daya MR, Leroux BG, Dorian P, Rea TD, Newgard CD, Morrison LJ, Lupton JR, Menegazzi JJ, Ornato JP, Sopko G, et al.: Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Circulation. 2020;January 21;141(3):188–98.7. Nolan JP, Deakin CD, Ji C, Gates S, Rosser A, Lall R, Perkins GD: Intraosseous versus intravenous administration of adrenaline in patients with out-of-hospital cardiac arrest: a secondary analysis of the PARAMEDIC2 placebo-controlled trial. Intensive Care Medicine. doi: 10.1007/s00134-019-05920-7 (Epub ahead of print).

PEC Podcast Episode 145: Quick Hits from Prehospital Emergency Care Journal Get ready for a rapid-fire review of the latest prehospital research! In Episode 145 of the PEC Podcast, we dive into the original research section of the Prehospital Emergency Care Journal (Volume 28, Number 3). Join our expert panel as we dissect key findings and discuss the implications for EMS practice. This episode covers manuscripts like: Challenges Locating the Scene of Emergency: A Qualitative Study of the EMS System in Rwanda Prehospital Validation of the Assessment of Blood Consumption (ABC) Score Evidence for Use of Validated Sepsis Screening Tools in the Prehospital Population: A Scoping Review ...and more! Tune in for a concise and informative discussion that will keep you up-to-date on the latest advancements in prehospital care. Click here to download today! As always THANK YOU for listening. Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems) Maia Dorsett MD PhD (@maiadorsett) Lekshmi Kumar MD, MPH(@Gradymed1) Greg Muller DO (@DrMuller_DO) Ariana Weber MD (@aweberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaelkim_md) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD Elijah Robinson MD

The PEC podcast team covers the Prehospital Emergency Care Journal Volume 28 Number 2. We talk about engaging manuscripts in this journal like: A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation & Comparison of the Scope of Practice of the Army Combat Medic Specialist and Civilian National EMS Certification Levels Click here to download it today! 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 (@weberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaelkim_md) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD Elijah Robinson MD

Como todos los artículo, este artículo es mi opinión personal y no necesariamente representa la opinión de ninguna de las instituciones a las que pertenezco... aunque pudieran coincidir. ¿Pueden y/o deben los enfermeros operar una ambulancia? Respuesta corta: Sí. Respuesta larga... Mi opinión es que sí. De hecho, si por mi fuera, pudiéramos médicos especialistas operando una ambulancia. El tema a en cuestión es el alcance de la práctica. Voy a regresar a esto al final. Aclaraciones Los nombres de profesiones aquí descritos corresponden a títulos universitarios en Puerto Rico y los Estados Unidos de América. Muchos países usan los mismos títulos profesionales y requerimientos académicos, mientras que en otros países varía considerablemente. Algunas jurisdicciones han codificado en ley la disposición de qué título debe poseer un profesional de la salud para poder trabajar. Tampoco voy a discutir cuánto se le debe pagar a los proveedores de atención prehospitalaria o si esto va a depender de su grado de formación. En este artículo NO voy a discutir si una ley está bien o si requiere ser enmendada. Ocupación versus profesión Aunque una ocupación envuelve tareas específicas, existen 5 atributos esenciales de una profesión (Greenwood, 1957): Cuerpo de conocimiento Una profesión tiene que tener un cuerpo de conocimiento propio y, aunque tenga paralelos con otras profesiones, es único e independiente. Es más que saber hacer procedimientos. Incluye principios abstractos que requieren una instrucción formal. Requiere preparación y experiencia práctica. Este cuerpo de conocimiento no es estático y puede cambiar según nueva evidencia, lo que provoca que el cuerpo de conocimiento aumente. Autoridad Una profesión tiene autoridad sobre la naturaleza y extensión de sus servicios. Sanción comunitaria Una profesión requiere que un organismo decida el proceso de certificación y licenciamiento. Código de ética Una profesión tiene un código de ética que establece lo que se considera ser profesional. Cultura La cultura establece que el servicio ofrecido es tan valioso a la comunidad que se hace necesario regular para prevenir que personas no cualificadas la realicen. La profesión del proveedor de atención prehospitalaria La frase "proveedor de atención prehospitalaria" es una frase genérica para incluir a todos los nombres usados (paramedico, técnico de emergencias médicas, técnico de atención prehospitalaria, técnico en urgencias médicas, técnico superior en urgencias médicas, técnico superior en atención prehospitalaria, técnico en....... etc.) Aunque existen otros niveles, en los Estados Unidos existen cuatro niveles básicos según el Registro Nacional de Técnicos de Emergencias Médicas: Emergency Medical Responder (EMR) Emergency Medical Technician (EMT) Emergency Medical Technician - Advanced (EMT-A) Paramedic Muchas jurisdicciones han adoptado la nomenclatura de "paramédicos" para referirse a todos los integrantes del sistema, aunque hayan diferencias internas. De igual manera, todos los enfermeros son enfermeros, aunque existen enfermeros prácticos, graduados, especialistas y otras designaciones de práctica avanzada como Nurse Practitioner, entre otros. Indistintamente de la ley local del país que aplique, la profesión del proveedor de atención prehospitalaria está establecida desde el punto de vista académico. La profesión del paramédico está claramente establecida no por el lugar donde se practica sino por los conocimientos y las destrezas que tiene. Es decir, un paramédico no es un enfermero que practica en la calle, o un enfermero no es un paramédico que trabaja una sala de emergencias. De la misma manera, un ginecólogo no es cualquier médico que atiende un parto, o un emergenciólogo es cualquier médico que trabaja en una sala de emergencias. ¿Puede un paramedico trabajar en una sala de emergencias? ¡Sí! De hecho, en el pasado era relativamente común, y en el presente existen muchas jurisdicciones que tienen sistemas de emergencias médicas basados en hospitales, que emplean a paramédicos como técnicos de sala de emergencia porque el alcance de la práctica (conocimientos y destrezas que poseen) les resulta útil y/o conveniente. Nuevamente, no voy a discutir si la ley lo permite o no ya que esto es algo muy local y, en ocasiones, las leyes son creadas para proteger intereses obrero-patronales y como protección de empleo. Aunque eso es importante, en este artículo solamente estoy discutiendo el alcance de la práctica. Alcance de la práctica Según la Asociación Médica Americana, el alcance de la práctica se refiere a las actividades que una persona licenciada a ejercer como profesional de la salud puede ejercer. Este alcance de la práctica está influenciado por estatus legales de la legislatura de cada jurisdicción, así como las reglas adoptadas por las agencias con jurisdicción. Entonces, la decisión de qué capacidades debe tener el personal se debe basar en cuáles son las competencias que debe dominar para hacer sus funciones. Niveles de educación y salario El nivel de educación no debe ser el único determinante del salario sino el efecto que tiene el nivel de educación en el resultado clínico del paciente. Esta es la razón por la cual es posible tener profesionales con un nivel técnico en ciertas tareas. Aunque yo creo en que los paramédicos deben tener un grado asociado, hay mucha controversia si esto se traduce a un mejor cuidado clínico. La ausencia de data no significa data de ausencia, pero corresponde a los proponentes de la idea el demostrar que su modelo es efectivo desde el punto de vista de los resultados clínicos del paciente (no desde el punto de vista de si "puede aprende a hacerlo o no"). Hoy día no existen muchos escenarios donde te "paguen por lo que sabes, no por lo que haces". La mayoría de los sistemas requieren demostrar que benefician al paciente para poder luchar por los reembolsos cada vez más limitados. El hecho de que alguien sea médico, o enfermero, no significa que le van a pagar igual como si trabajara dentro del hospital simplemente porque los modelos de reembolso actuales (especialmente en Puerto Rico) no proveen para un reembolso mayor. Médicos en ambulancias y helicópteros En muchas jurisdicciones europeas y australianas, los sistemas de emergencias médicas basados en helicópteros son operados por médicos especialistas que hacen un entrenamiento adicional en atención prehospitalaria. El currículo de medicina general, incluyendo las rotaciones clínicas, no incluyen consideraciones ni temas sobre el manejo prehospitalario de los pacientes. Algunas escuelas de medicina tienen electivas médicas en sistemas de atención prehospitalaria para estudiantes de medicina interesados. Inclusive, aunque algunas especialidades clínicas, como medicina de emergencia, incluyen todo el currículo de condiciones clínicas, no necesariamente incluyen los aspectos operacionales de un servicio de cuidado prehospitalario. Subsanable? Definitivamente sí. Pero no es algo automático o de facto. Subespecialidad de EMS dentro de la especialidad de Medicina de Emergencias Existe una subespecialidad de EMS dentro de la especialidad de Medicina de Emergencias en los Estados Unidos. El hecho de que hay una subespecialidad demuestra que existe un cuerpo de conocimiento separado al de la medicina de emergencia y otras ramas. Inclusive existen equipos de respuesta a emergencias médicas que responden desde el hospital a la escena a atender situaciones particulares (amputaciones en la escena y ECMO son dos escenarios que me vienen a la mente). El ser médico o enfermero no confiere ningún privilegio para trabajar fuera del hospital a no ser que se posea ese cuerpo de conocimiento adicional. Enermeros en transporte crítico En los mismos Estados Unidos y Puerto Rico, la mayoría de los sistemas de transporte aeromédico cuentan con enfermeros que tienen un entrenamiento adicional para entender las complejidades de un vuelo de escena, o de un transporte interhospitalario desde una facilidad de atención primaria que carece de equipo básico. Los vuelos interhospitalarios se benefician de tener un enfermero debido a la complejidad de algunos pacientes de cuidado crítico. Prueba de esta complejidad es las certificaciones como paramédico de especialidad del International Board of Specialty Certification como Certified Flight Paramedic y Certified Critical Care Paramedic. El punto medio En un ambiente donde exista una abundancia de enfermeros y una carencia de paramédicos, y que hayan enfermeros que deseen trabajar por el salario que trabaja un paramédico y estén dispuestos a completar el/los adiestramiento(s) que los entes rectores establezcan, puedo ver como pueden haber diferentes niveles de proveedores de atención prehospitalaria. Conclusión Mi opinión es que las ambulancias, salas de emergencia y cualquier lugar que atienda pacientes con una emergencia médica debe tener a personas adecuadamente certificadas, licenciadas y credencializadas para llevar a cabo el diagnóstico y tratamiento oportuno y efectivo. Dependiendo de las funciones técnicas específicas, una persona puede estar sobrecualificada o subcualificada. Es posible diseñar un currículo que nivele los conocimientos y destrezas necesarias para llevar a cabo el trabajo, ya sea para los enfermeros, terapistas respiratorios, médicos generales, médicos emergenciólogos, médicos anestesiólogos, médicos intensivistas, médicos cirujanos, etc. Las métricas del resultado clínico del paciente es lo que define si un sistema es efectivo o si necesita mejoras. Es difícil defender el status quo donde no hay métricas asociadas a resultados. https://scasjobs.co.uk/roles/ambulance-nurse Referencias Cohen, M., DeVivo, R., Gausche-Hill, M., & Schlesinger, S. A. (2024). Development and Deployment of a Pre-Planned Hospital Emergency Response Team (HERT) for EMS Augmentation: Case Report and Program Review. Prehospital Emergency Care, 1–8. https://doi.org/10.1080/10903127.2024.2365333 Greenwood, Ernest. "Attributes of a Profession." Social Work, Vol. 2, July 1957, pp 45-55

Description:There is evidence that clinician experience with intubation is associated with improved success rates and evidence that missed intubation attempts are associated with worse survival, at least in cardiac arrest. The recent Airway EBG paper recommends EMS agencies with low intubation proficiency should use SGAs instead of intubation in cardiac arrest. This all begs the question of whether agencies who intubate more often have higher success rates than those who do not. That's exactly the question a new paper from Annals of Emergency Medicine attempts to answer. Join Dr. Jarvis for a discussion of the paper and his thoughts on how to integrate its findings into practice.Citations:1.        Jarvis JL, Panchal AR, Lyng JW, Bosson N, Donofrio-Odmann JJ, Braude DA, Browne LR, Arinder M, Bolleter S, Gross T, et al.: Evidence-Based Guideline for Prehospital Airway Management. Prehospital Emergency Care. 2024;28(4):545–57.2.        Murphy DL, Bulger NE, Harrington BM, Skerchak JA, Counts CR, Latimer AJ, Yang BY, Maynard C, Rea TD, Sayre MR: Fewer Tracheal Intubation Attempts are Associated with Improved Neurologically Intact Survival Following Out-of-Hospital Cardiac Arrest. Resuscitation. 2021;July 13;167(Oct 2021):289–96.3.        Crewdson K, Lockey DJ, Røislien J, Lossius HM, Rehn M: The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis. Crit Care. 2017;December;21(1):31.4.        Thomas J, Crowe R, Schulz K, Wang HE, De Oliveira Otto MC, Karfunkle B, Boerwinkle E, Huebinger R: Association Between Emergency Medical Service Agency Intubation Rate and Intubation Success. Ann Emerg Med. Published online: January 2024. doi: 10.1016/j.annemergmed.2023.11.005 (Epub ahead of print).5.        Carlson JN, De Lorenzo R: Does Practice Make Perfect, or Is There More to Consider? Ann Emerg Med. Published online: January 2024. doi: 10.1016/j.annemergmed.2024.04.019 (Epub ahead of print).

Description: Let's say you were looking for a safe and effective BLS option for analgesia. Something other than oral acetaminophen or ibuprofen. You want the Green Whistle (methoxyflourane) but you can't get the Green Whistle (thanks FDA!). How about sub-dissociative ketamine by nebulizer? Sounds great, but you're worried about your colleagues getting stoned, aren't you? Admit it, you are. Fortunately, there are breath actuated nebulizers. Maybe those things will work? Dr Jarvis reviews a recent paper that compares the effectiveness of nebulized ketamine compared with IV ketamine. And he gives a quick review of some other papers that paved the way for this one. Citations:1. Nguyen T, Mai M, Choudhary A, Gitelman S, Drapkin J, Likourezos A, Kabariti S, Hossain R, Kun K, Gohel A, et al.: Comparison of Nebulized Ketamine to Intravenous Subdissociative Dose Ketamine for Treating Acute Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind, Double-Dummy Controlled Trial. Annals of Emergency Medicine. (2024) May 2.2. Motov S, Mai M, Pushkar I, Likourezos A, Drapkin J, Yasavolian M, Brady J, Homel P, Fromm C: A prospective randomized, double-dummy trial comparing IV push low dose ketamine to short infusion of low dose ketamine for treatment of pain in the ED. Am J Emerg Med. 2017;August;35(8):1095–100.3. Motov S, Rockoff B, Cohen V, Pushkar I, Likourezos A, McKay C, Soleyman-Zomalan E, Homel P, Terentiev V, Fromm C: Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med. 2015;September;66(3):222-229.e1.4. Motov S, Yasavolian M, Likourezos A, Pushkar I, Hossain R, Drapkin J, Cohen V, Filk N, Smith A, Huang F, et al.: Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med. 2017;August;70(2):177–84.5.Dove D, Fassassi C, Davis A, Drapkin J, Butt M, Hossain R, Kabariti S, Likourezos A, Gohel A, Favale P, et al.: Comparison of Nebulized Ketamine at Three Different Dosing Regimens for Treating Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind Clinical Trial. Annals of Emergency Medicine. 2021;December;78(6):779–87.6.Patrick C, Smith M, Rafique Z, Rogers Keene K, De La Rosa X: Nebulized Ketamine for Analgesia in the Prehospital Setting: A Case Series. Prehospital Emergency Care. 2023;February 17;27(2):269–74. FAST24 | June 10 - 12, 2024 | Wilmington, North CarolinaFAST24 is our annual conference for pre-hospital and critical care transport professionals, including nurses, paramedics, and other disciplines. It features engaging workshops, talks by industry leaders, and focused sessions on air and surface critical care transport medicine. The event also offers a unique vendor experience, special guest appearances from notable talent in the industry, catered lunches, as well as relaxing and entertaining networking and social opportunities. Tickets are limited so don't wait! Visit fbefast.com for more information.

Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehospital Emergency Care. February 2024. Date: April 25, 2024 Guest Skeptic: Missy Carter is a PA working in an ICU in the Tacoma area and an adjunct faculty member with the Tacoma Community College paramedic program. She […] The post SGEM#438: Bone, Bone, Bone, Tell Me What Ya Gonna Do – for IO Access Location? first appeared on The Skeptics Guide to Emergency Medicine.

What value does EtCO2 have when it comes to predicting survival from cardiac arrest? We all know a sharp spike in EtCO2 is associated with ROSC, but what about persistently elevated levels? What does this mean for decision making when it comes to termination of resuscitation? Join Drs. Jeff Jarvis, Remle Crowe, and Heidi Abraham for the first episode of “Between Two Nerds”, a subgenre of the EMS Lighthouse Project podcast suggested in episode 82 by Dr. CJ Winckler, as they run through a new paper that may shed some light on this question. Citation:1. Smida T, Menegazzi JJ, Crowe RP, Salcido DD, Bardes J, Myers B: The Association of Prehospital End-Tidal Carbon Dioxide with Survival Following Out-of-Hospital Cardiac Arrest. Prehospital Emergency Care. 2024;April 2;28(3):478–84.2. Levine RL, Wayne MA, Miller C: End-Tidal Carbon Dioxide and Outcome of Out-of-Hospital Cardiac Arrest. N Engl J Med. 1997;337:301–6.3. Page, J. The Magic of 3 AM. PennWell Books. Tulsa, OK. 2017  FAST24 | June 10 - 12, 2024 | Wilmington, North CarolinaFAST24 is our annual conference for pre-hospital and critical care transport professionals, including nurses, paramedics, and other disciplines. It features engaging workshops, talks by industry leaders, and focused sessions on air and surface critical care transport medicine. The event also offers a unique vendor experience, special guest appearances from notable talent in the industry, catered lunches, as well as relaxing and entertaining networking and social opportunities. Tickets are limited so don't wait! Visit https://fastsymposium.com for more information.

How involved in education is the medical director for your paramedic program? If you answered, "Not very much," you are not alone.  Join us as we interview research authors Michael Kaduce and Jonathan Powell, who recently published a paper in Prehospital Emergency Care titled: Medical Directors, Facilities, and Finances: Resource Deficiencies in Accredited Paramedic Programs. Their objective was to evaluate US paramedic program resources and identify common deficiencies that may affect program completion. A lack of medical director engagement in educational activities, inadequate facility resources, and a lack of available financial resources affected the educational environment.  They surveyed those who are directly affected: paramedic students. Guests: Michael Kaduce Jonathan Powell The EMS Educator will publish on the first Friday of every month! Be sure to turn on your notifications so you can listen as soon as the episode drops! This podcast is sponsored by EMS Gives Life.  Would you consider becoming a living organ donor? For more info visit www.emsgiveslife.org Check out the Prodigy EMS Bounty Program! Earn $1000 for your best talks! Get your CE at www.prodigyems.com  Follow @ProdigyEMS on Twitter, FB, YouTube & IG.

Atrial Fibrillation with rapid ventricular response is a common cause of EMS activations and ED visits. It is associated with chest discomfort, palpitations, and hypotension. Treatment is aimed at either rhythm control or rate control with rate control being the most common first line approach. EMS has the potential to treat this condition with medications such as diltiazem, metoprolol, or amiodarone. For those patients with hemodynamic instability, EMS can provide synchronized cardioversion. The question for this podcast, however, is does it matter if EMS treats A Fib or not. Dr. Jarvis recorded this episode in front of a live audience at the State of Jefferson conference in beautiful Ashland, Oregon with Mike Verkest, and special guest Dr Maia Dorsett.  Citation:Fornage LB, O'Neil C, Dowker SR, Wanta ER, Lewis RS, Brown LH: Prehospital Intervention Improves Outcomes for Patients Presenting in Atrial Fibrillation with Rapid Ventricular Response. Prehospital Emergency Care. doi: 10.1080/10903127.2023.2283885 (Epub ahead of print).

For much of the world, there's no reliable way to call for help in an emergency. In Mwanza, Tanzania, local doctor Marko Hingi decided that wasn't acceptable. Working with local motorcycle taxi drivers, Dr. Hingi built an emergency medical system from scratch, and in this episode he shares exactly how he did it.To learn more or get in contact with Dr. Hingi and the Tanzania Rural Health Movement (TRHM), visit their website.Follow Tanzania Rural Health Movement:Facebook | YouTube | Instagram | LinkedIn – – – – – Show ContentsBackground to the Tanzania Rural Health Movement (00:20)Building an Emergency Response System From Scratch (04:05)Training Emergency Motorcycle Responders (08:16)Branding and Marketing the Services and Motorcycle Responders (16:20)Building Infrastructure with Response Times as the Main Goal (20:15)What Happens When a Motorcycle Won't Work for Transport (24:30)Goals and Challenges in the Future (28:55)How to Connect with TRHM (33:55)Support the show-- -- -- -- --HOST Jason Friesen is the Founder and Executive Director of Trek Medics International, a 501c3-registered nongovernmental organization (NGO) dedicated to improving access to emergency response networks in communities across the globe through innovative mobile phone technologies.Learn more about Trek Medics International by visiting their website, and for more info on the Beacon Crisis Response Platform visit here. Follow Trek Medics on: Instagram | Facebook | Twitter | LinkedInTheme song: "Happy Feliz" by ¡Big Grande! (used with permission).

Y'all know I have thoughts on epinephrine in cardiac arrest. And perhaps might have heard me say epinephrine “saves the heart at the expense of the brain”. I've also said I don't have an issue with any epinephrine in arrest, just how we give it currently and have wondered if less epi might do the trick. We review the One and Done paper recently published from North Carolina that looks at this question. Citations 1.      Ashburn NP, Beaver BP, Snavely AC, Nazir N, Winslow JT, Nelson RD, Mahler SA, Stopyra JP: One and Done Epinephrine in Out-of-Hospital Cardiac Arrest? Outcomes in a Multiagency United States Study. Prehospital Emergency Care. 2022;September 26;27(6):751–7. 2.      Fernando SM, Mathew R, Sadeghirad B, Rochwerg B, Hibbert B, Munshi L, Fan E, Brodie D, Di Santo P, Tran A, et al.: Epinephrine in Out-of-Hospital Cardiac Arrest. Chest. 2023;August;164(2):381–93.

ComMed is a non-profit community-based emergency medical response service operating in Johannesburg, South Africa. ComMed's aim is to provide life-saving services to those in need, to those who do not have access to private services, to those who need an emergency medical intervention or to those who simply need support. In this episode, Neil Van Der Merwe discusses the unique role they fill in South Africa's EMS system, and how they fulfill their mission of "All Mission, Non-Profit". To learn more about ComMed visit their website.To get in touch directly you can email info@commed.org.za Follow ComMed: Facebook | Instagram – – – – – Overview of ComMed's services (00:25)Intermediate vs Advanced Life Support in South Africa (04:00)Types of calls ComMed responds to (10:20)How ComMed reaches those in need (13:40)How ComMed managed a successful launch during Covid (16:40)Level and methods of training for volunteers (23:15)ComMed's mission, vision and values (27:15)Advice for those wanting to launch a similar service (30:45)Support the show-- -- -- -- --HOST Jason Friesen is the Founder and Executive Director of Trek Medics International, a 501c3-registered nongovernmental organization (NGO) dedicated to improving access to emergency response networks in communities across the globe through innovative mobile phone technologies.Learn more about Trek Medics International by visiting their website, and for more info on the Beacon Crisis Response Platform visit here. Follow Trek Medics on: Instagram | Facebook | Twitter | LinkedInTheme song: "Happy Feliz" by ¡Big Grande! (used with permission).

For paramedics, click HERE for CAPCE credits! The next frontier in Prehospital medicine is prehospital blood use.  The AABB (formerly the American Association of Blood Banks) is an international authority on transfusion medicine and tissue banking. The Trauma, Hemostasis and Oxygenation Research (THOR) Network is an international multidisciplinary network of civilian and military providers.  Together AABB-THOR has been working to achieve the dream of utilizing prehospital blood.  In our June Deep Dive, we discuss the manuscript:  THOR-AABB Working Party Recommendations for a Prehospital Blood Product Transfusion Program  with guest authors Christopher Winckler MD & Mark Yazer MD Click here to download it today! 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 (@Gradymed1) Greg Muller DO (@DrMuller_DO) Works Discussed Newberry, R., Winckler, C. J., Luellwitz, R., Greebon, L., Xenakis, E., Bullock, W., ... & Mapp, J. (2020). Prehospital transfusion of low-titer O+ whole blood for severe maternal hemorrhage: a case report. Prehospital Emergency Care, 24(4), 566-575. https://www.tandfonline.com/doi/abs/10.1080/10903127.2019.1671562 THOR (Trauma Hemostasis and Oxygenation Research Network Website: https://rdcr.org/ Zhu, C. S., Pokorny, D. M., Eastridge, B. J., Nicholson, S. E., Epley, E., Forcum, J., ... & Jenkins, D. H. (2019). Give the trauma patient what they bleed, when and where they need it: establishing a comprehensive regional system of resuscitation based on patient need utilizing cold‐stored, low‐titer O+ whole blood. Transfusion, 59(S2), 1429-1438. https://onlinelibrary.wiley.com/share/ZCET9NGYI2GRV8ZF8WNH?target=10.1111/trf.15264

En este nuevo episodio os traigo la aplicación de los push dose en emergencias. Espero que sea de utilidad. La bibliografía que he utilizado es: - Nawrocki, P. S., Poremba, M., & Lawner, B. J. (2020). Push dose epinephrine use in the management of hypotension during critical care transport. Prehospital Emergency Care, 24(2), 188-195. doi:10.1080/10903127.2019.1588443 Singer, S., Pope, - H., Fuller, B. M., & Gibson, G. (2022). The safety and efficacy of push dose vasopressors in critically ill adults. The American Journal of Emergency Medicine, 61, 137-142. doi:10.1016/j.ajem.2022.08.055 Weingart, S. (2015). Push-dose pressors for immediate blood pressure control. Clinical and Experimental Emergency Medicine, 2(2), 131-132. doi:10.15441/ceem.15.010 - Scott Weingart, MD FCCM. EMCrit 6 – Push-Dose Pressors. EMCrit Blog. Published on July 10, 2009. Accessed on June 11th 2023. Available at [https://emcrit.org/emcrit/bolus-dose-pressors/ ].

Happy EMS Week!!! PEC Journal Volume 27 Number 2 In this episode, the PEC podcast team brings you sprint podcast #2 of 3 for EMS week.  This episode covers the Prehospital Emergency Care Journal Volume 27 Number 2. We talk about engaging manuscripts in this journal like: Medication Errors in Pediatric Patients after Implementation of a Field Guide with Volume-Based Dosing & Epidemiology and Prehospital Care of Pediatric Unintentional Injuries Among Countries with Different Economic Status in Asia: A Cross-National, Multi-Center Observational Study Click here to download it today! 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 (@Gradymed1) Greg Muller DO (@DrMuller_DO)  

Happy EMS Week!!! PEC Journal Volume 27 Number 1 In this episode, the PEC podcast team brings you sprint podcast #1 of 3 for EMS week.  This episode covers the Prehospital Emergency Care Journal Volume 27 Number 1. We talk about engaging manuscripts in this journal like:  Impact of Prehospital Pain Management on Emergency Department Management of Injured Children & Characteristics and Outcomes of Prehospital Tourniquet Use for Trauma in the United States Click here to download it today! 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 (@Gradymed1) Greg Muller DO (@DrMuller_DO)  

We interviewed Tanner Smida in episode 69 about his very interesting paper using the ESO dataset looking at the association between survival from out of hospital cardiac arrest and type of SGA used (iGel vs KingLT). He found 36% higher odds of survival with iGel. The ink was barely dry on that paper before he published a follow up paper looking at the same association but with a different dataset, this time CARES, and national US registry of OHCA. Citations: 1. Smida T, Menegazzi J, Scheidler J, Martin PS, Salcido D, Bardes J. A retrospective comparison of the King Laryngeal Tube and iGel supraglottic airway devices: a study for the CARES surveillance group. Resuscitation. Published online April 2023:109812. doi:10.1016/j.resuscitation.2023.109812 2. Smida T, Menegazzi J, Crowe R, Scheidler J, Salcido D, Bardes J. A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehospital Emergency Care. Published online January 18, 2023:1-13. doi:10.1080/10903127.2023.2169422See omnystudio.com/listener for privacy information.

PEC Journal Volume 26 Number 6 In this episode, the PEC podcast team brings in the Prehospital Emergency Care Journal Volume 26 Number 6. We talk about the engaging manuscripts in this journal like:  “House Calls” by Mobile Integrated Health Paramedics for Patients with Heart Failure: A Feasibility Study Association of GPS-Based Logging and Manual Confirmation of the First Responders' Arrival Time in a Smartphone Alerting System: An Observational Study Please join us in welcoming the PEC team:  Dr. Greg Muller! We are happy to have you join us! Click here to download it today! 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) Greg Muller DO  

Happy Women's day PEC Podcast listeners! In this Deep Dive episode of the PEC podcast, Dr. Maia Dorsett discusses the Prehospital Emergency Care Manuscript titled Characteristics and Experiences of Women Physicians and Professionals in NAEMSP with the authors:  Kathy Staats MD FACEP kstaats@ucsd.edu   Anurhada Luke MD Luke.Anuradha@mayo.edu Click here to download it today! 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) Lekshmi Kumar MD (@Gradymed1) Maia Dorsett MD PhD (@maiadorsett)  

Date: March 8, 2023 Reference: Smida et al. A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehospital Emergency Care 2023 Guest Skeptic: Dr. Chris Root is a third-year resident physician in the Department of Emergency Medicine at the University of New Mexico Health Sciences Center in Albuquerque, NM. […] The post SGEM#396: And iGel Myself, I'm Over You, Cus I'm the King (Tube) of Wishful Thinking first appeared on The Skeptics Guide to Emergency Medicine.

The cage match you've all been waiting for! iGel vs King LT in cardiac arrest. Which is associated with higher survival? Airways-2 was an RCT of iGel vs ETI in OHCA and found no difference. PART was an RCT of King LT vs ETI in OHCA and found a slight difference favoring King LT. How about in those patients just getting a SGA... how does the iGel compare to King LT? Dr. Jarvis interviews the amazing young researcher and medical student Tanner Smida about his new paper using the ESO dataset to answer just this question. Citation: 1. Smida T, Menegazzi J, Crowe R, Scheidler J, Salcido D, Bardes J. A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehospital Emergency Care. Published online January 18, 2023:1-13.See omnystudio.com/listener for privacy information.

Hello PEC Podcast listeners! In this episode of the PEC podcast, we cover the Prehospital Emergency Care Journal Volume 26 Number 5 with our original PEC Podcast crew; Phil Moy, Scott Goldberg, Jeremiah Escajeda, and Joelle Donofrio-Odmann!  We discuss such articles as:  Secondary Traumatic Stress in Emergency Services Systems (STRESS) Project: Quantifying and Predicting Compassion Fatigue in Emergency Medical Services Personnel & EMS Experience Caring and Communicating with Patients and Families with a Life-Limiting-Illness Click here to download it today! 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)  

Dr. Maia Dorsett joins us again! You may remember her from the Thinking: Lift Assist episode. This time she shares what she knows about the process of death notification. It's a passion-topic for her because she knows how important these conversations are for the loved ones of patients who have died... and for us. She frames a death notification as a procedure that can be taught, learned and practiced. NAEMSP Article Bite #33: Is Death Notification Training associated with decreased burnout among EMS professionals This YouTube video was made by the Monroe-Livingston EMS Region at the beginning of the COVID-19 pandemic in anticipation of the rise of out-of-hospital death. Paper outlining The GRIEV_ING algorithm in the Prehospital Emergency Care journal.

In 2020, the Commission on Accreditation for Prehospital Continuing Education (CAPCE)  reported a 179% increase in course completions compared to the two prior years, as well as a 185% increase in online distributive learning.  Live/in person education represented just 1% of CAPCE-accredited refresher completions in 2020.  What does this say about the future of EMS education? How does this trend away from live courses toward online education affect student retention, skills and evidence-based education? Is this the "new normal"? Hosts Rob Lawrence and Maia Dorsett join the host of the PEC Podcast, Hawnwan Philip Moy, MD, FACEP, FAEMS to discuss these impressive numbers with the authors of the study: Juan March, MD, FAEMS, FACEP, Chief, at ECU Division of EMS, CAPCE Board of Directors; Nicole Camarillo, Data Coordinator at CAPCE and Stephen Taylor, MHS, FAEMS, EMS Specialist at ECU Division of EMS. PEC paper discussed on this episode: March, J. A., Scott, J., Camarillo, N., Bailey, S., Holley, J. E., & Taylor, S. E. (2022). Effects of COVID-19 on EMS refresher course completion and delivery. Prehospital Emergency Care, 26(5), 617-622. This podcast is sponsored by EMS Gives Life.  Would you consider becoming a living organ donor? Visit emsgiveslife.org for more info. Check out the Prodigy EMS Bounty Program! Earn $1000 for your best talks! Get your CE at www.prodigyems.com.  Follow @ProdigyEMS on Twitter, FB, YouTube & IG.

Happy New Years! In the LAST episode of 2022, the PEC Podcast team joins up with Dr. Maia Dorsett and Rob Lawrence of the EMS Educator Podcast To discuss the manuscript Effects of COVID-19 on EMS Refresher Course Completion and Delivery with the authors:  Dr. Juan March, MD FAEMS FACEP, Chief of the Division of EMS, CAPCE Board of Directors Nicole Camarillo, Data Coordinator at CAPCE & Stephen Taylor MHS FAEMS EMS Specialist at ECU Division of EMS  Click here to download today! 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)

Happy Thanksgiving! As you slowly recover from stuffing yourself with turkey and getting ready for Christmas, check out this latest PEC podcast where we cover the Prehospital Emergency Care Journal Volume 26 Number 4.  In this episode we cover manuscripts like:  Comparison of Four Methods of Paramedic Continuing Education in the Management of Pediatric Emergencies & A Standardized Formulary to Reduce Pediatric Medication Dosing Errors: A Mixed Methods Study Click here to download today! 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)

PEC podcast Deep Dive Series! Happy Halloween  PEC podcast listeners.  While Halloween is all about fright, let's talk about the thing that scares a majority of prehospital clinicians, pediatrics.  To be more specific, kids who are having seizures.  To help assuage some of your fears the PEC podcast team (and guest interviewer) delve into the manuscript:  The Effectiveness of Intranasal Midazolam for the Treatment of Prehospital Pediatric Seizures: A Non-inferiority Study with the author Denise Whitfield MD MBA & guest podcast interviewer Joseph Finney MD Podcast host of NAEMSP's Pediatric EMS Podcast Click here to download it today! 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)

Fall is here! While you're enjoying the brisk morning walks, check out our latest podcast where we cover the PEC journal Volume 26 Number 3.  In this episode, we cover fascinating manuscripts like Assessment of Fall-Related Emergency Medical Service Calls and Transports after a Community-Level Fall-Prevention Initiative Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services Responses Click here to download today! 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)

References: Karl A. Sporer, Nicholas J. Johnson, Clement C. Yeh & Glen M. Youngblood (2008) Can Emergency Medical Dispatch Codes Predict Prehospital Interventions for Common 9-1-1 Call Types?, Prehospital Emergency Care, 12:4, 470-478, DOI: 10.1080/10903120802290877 Torlén, K., Kurland, L., Castrén, M. et al. A comparison of two emergency medical dispatch protocols with respect to accuracy. Scand J Trauma Resusc Emerg Med 25, 122 (2017). https://doi.org/10.1186/s13049-017-0464-z PMID: 29223194, 22824188, 18256298, 18584494, 19189610

It's hot outside! While you're cooling off inside, check out our latest podcast where we cover the PEC journal Volume 26 Number 2.  In this episode we cover fascinating manuscripts like Utility of Glucose Testing and Treatment of Hypoglycemia in Patients with Out-of-Hospital Cardiac Arrest Implementing a Patient Tracking System in a Large EMS System Non-transport after Prehospital Naloxone Administration Is Associated with Higher Risk of Subsequent Non-fatal Overdose Click here to download today! 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)

The PEC Podcast with host Dr. Maia Dorsett brings you our Deep Dive Series with:  Daniel Joseph MD Kevin Burns EMT-P, PA-C Aman Shah MD who discuss their manuscript: STEMI Equivalents and Their Incidence during EMS Transport Click here to download today! 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)

La National Association of EMS Physicians (NAEMSP) publicó un compendio de posiciones oficiales sobre el manejo prehospitalario de la vía aérea. Esta es la primera vez que se publica un documento que sirva como referencia para la creación de protocolos. Existen muchos estudios sobre el manejo prehospitalario de la vía aérea. Este documento refleja las mejores prácticas a esta fecha, basados en la totalidad de los estudios. Destreza definitoria de la resucitación El manejo de la vía aérea es una de las destrezas que definen nuestra práctica de resucitar un paciente que no protege su vía aérea o que no tiene una respiración adecuada, indistintamente de su causa (paro cardiaco, de trauma, de sepsis, de un accidente cerebrovascular, etc.) A pesar de lo importante que es, las estadísticas presentan una imagen poco alentadora sobre la consistencia y eficacia de los sistemas de atención prehospitalaria. En otro momento discutiremos los beneficios versus los riesgos del manejo básico versus el manejo avanzado. Este artículo del compendio de manejo prehospitalario de la vía aérea se concentra en cómo enseñamos esta importante destreza. ¿Cargar y llevar o quedarse y jugar en el manejo prehospitalario de la vía aérea? Fuera del hospital existen dos tipos de pacientes: los que necesitan atención inmediata y los que necesitan transporte inmediato. A veces es fácil reconocer cada uno, pero a veces la situación puede ser difícil. Hay pacientes que necesitan ser intubados inmediatamente. Por ejemplo, hay pacientes que tienen traumas maxilofaciales tan severos que ya no pueden ventilar. Posiblemente inclusive pueda ser que necesiten una vía aérea quirúrgica. Por otro lado, hay pacientes que todavía están respirando espontáneamente pero están en fallo respiratorio. Está bien el pedir ayuda. Con pocas variaciones en el mundo, usualmente una ambulancia es operada por dos proveedores. Eso no significa que todas las condiciones pueden ser atendidas por dos personas. Inclusive en el hospital hay emergencias que requieren la presencia de al menos otro médico, y/o otros profesionales de la salud (enfermería, terapia respiratoria, etc.) Hay veces que la ayuda tiene que llegar al paciente y hay veces que el paciente llega a la ayuda. Hay limitaciones y hay circunstancias extremas... en ocasiones. Practica el escenario ideal. No es raro ver el instructor de manejo prehospitalario de la vía aérea simulando un escenario catastrófico donde un paciente está en un espacio confinado, con poca luz, poco espacio, difícil de remover del lugar, en una posición incómoda y bajo la lluvia. Si aprendemos de inicio a improvisar, empezamos a degradar el estándar de calidad. Luego comenzamos a improvisar la improvisación, y se sigue degradando aún más el estándar hasta que todo se reduce a simplemente un laringoscopio, un tubo endotraqueal y fuerza bruta. Debemos comenzar a pensar en el escenario ideal. El escenario ideal es la forma correcta de hacer el procedimiento bajo las circunstancias ideales. Por ejemplo, una intubación endotraqueal normal, común y corriente puede tomar 15-20 minutos desde que comienza la intubación hasta que se asegura el tubo. Hay demasiadas cosas que hacer para evitar que el paciente se deteriore por culpa de la intubación. Las recomendaciones buscan dos cosas: la seguridad del paciente y la mayor posibilidad de éxito. Si usted empieza a desviarse del "escenario ideal", comienza a aumentar la posibilidad de que algo malo le suceda al paciente. Cuando el escenario ideal no es posible, debemos pensar que "debemos hacerlo lo más ideal posible", y eso a veces puede tomar tiempo... y está bien que tome tiempo porque esa es la forma correcta de hacerlo cuando el paciente así lo necesita. "Yo trabajo en el hospital, esto no me aplica a mi." El paciente intrahospitalario tiene el beneficio teórico de que puede ser atendido por múltiples expertos. Algunos pacientes son intubados en sala de operaciones, bajo condiciones ideales, e inclusive utilizando recursos que se encuentran comúnmente en la calle (por ejemplo, fibra óptica). Aunque esto es cierto, ¡no siempre es así! Todos sabemos que el manejo de un paciente a las 10:00 am no es el mismo que a las 10:00 pm en muchos sitios. En muchos hospitales, hay menos recursos disponibles fuera de horas laborables. Esto tiene implicaciones serias ya que la definición de una "vía aérea fallida" es usualmente tres intentos por el operador más experimentado disponible. Lamentablemente a veces el operador disponible no necesariamente sería el mejor si hubiesen otros recursos disponibles. Los hospitales pequeños, que tienen pocos recursos, En el extremo opuesto del nivel de preparación, existen muchos hospitales (usualmente centros académicos) que tienen la misma capacidad de respuesta a las 2:00 am que a las 2:00 pm. Debemos prepararnos siempre para lo que va a ocurrir cuando un paciente necesita una vía aérea un sábado a las 2:00 am. Si pensamos en el peor escenario, lo demás es más fácil. Existen hospitales que, en determinado momento, tienen pocos recursos para atender lo que ciertamente es un paciente crítico. Entonces, quizás muchos proveedores de atención intrahospitalaria también pueden beneficiarse de repasar este documento. La prioridad es el paciente, no el procedimiento El objetivo del manejo prehospitalario de la vía aérea no es realizar un procedimiento, sino el resultado final del manejo del paciente. En la Sala de Operaciones comúnmente se intuba al paciente ante la necesidad de realizar un procedimiento. Fuera de la Sala de Operaciones se intuba el paciente comúnmente porque no puede proteger su vía aérea o no puede respirar adecuadamente. La frase "la intubación endotraqueal es el estándar de oro en el manejo de la vía aérea" ha hecho que muchos educadores y proveedores se enfoquen en el procedimiento como el objetivo. La intubación endotraqueal puede tener complicaciones adversas. Por ejemplo, el manejo de la inestabilidad hemodinámica y desaturación asociada a la intubación endotraqueal antes, durante y después del procedimiento es tan importante como la laringoscopía misma. El artículo nos invita a pensar en las siguientes preguntas: ¿Cuál destreza de la vía aérea le daría a este paciente la mejor oportunidad de sobrevivencia? Práctica deliberada en el manejo prehospitalario de la vía aérea La NAEMSP recomienda que las prácticas de manejo de la vía aérea estén basadas en práctica deliberada. ¿Qué es práctica deliberada? El esfuerzo continuo por ser mejor que ayer. ¿Cuál es el nivel de competencia deseado? Según el artículo, la toma de decisión de qué situaciones requieren manejo de la vía aérea es un diferenciador clave entre una competencia minima versus un dominio de la competencia. Los autores detallan que, aunque no existe un camino específico definitivo para lograr el dominio, el desarrollo de niveles más avanzados de competencia en el manejo completo de la vía aérea "requiere un esfuerzo consciente no solamente de las destrezas, sino de los modelos mentales incrementalmente más sofisticados que incorporan las complejidades de la fisiopatología, dinámicas de equipos y la evidencia, para permitir tomas de decisiones de orden superior. Idealmente la educación inicial debe lograr más que el desarrollo de las competencias mínimas." Competencia mínima versus dominio de la competencia Desde el punto de vista de educación, el problema no es identificar los criterios usar técnicas avanzadas. El verdadero reto es validar que la persona es competente. Cuando hablamos del nivel de competencia, no nos referimos al nivel de la destreza en términos de soporte vital básico o avanzado. Se refiere al grado de proficiencia a la hora de ejecutar la destreza. Se trata de practicar no solamente hasta que se logra hacer bien, sino hasta que se es consistentemente efectivo en diversos tipos de escenarios de forma segura para el paciente. Nuevamente, cuál es el nivel de destreza necesario? Que pueda hacerlo efectivamente y seguramente. El artículo señala que el uso de simuladores de la vía aérea y maniquís de baja fidelidad solamente permiten lograr un dominio de las competencias de soporte vital básico solamente. Las destrezas de soporte vital avanzado tienen otros elementos que requieren que el alumno reciba retroalimentación no solamente en un entorno de alta fidelidad, sino también de laboratorios con cadáveres y pacientes reales. Según el artículo, la realidad es que la mayoría de los sistemas que proveen educación van a tener acceso a poder lograr un dominio de la competencia de destrezas básicas. Sin acceso consistente a esas otras oportunidades más complejas antes mencionadas, es muy difícil esperar que un sistema pueda probar que ha logrado la competencia necesaria (dominio de la competencia) para realizar intervenciones que sean potencialmente peligrosas para el paciente. Destrezas básicas son destrezas fundamentales El objetivo es que el paciente tenga una vía aérea patente y esté ventilando. Cómo usted lo logra dependerá de las circunstancias de los proveedores, el lugar, y el paciente. Entonces, es importante enfocarse en aquellas destrezas que sí podemos lograr un nivel de dominio: las destrezas básicas. Toma de decisiones en el manejo prehospitalario de la vía aérea El pensar cómo es que tomamos las decisiones que tomamos. El artículo habla de la importancia de la "metacognición", o el "pensar sobre lo que pensamos". El por qué se tomó la decisión que se tomó quizás es más importante que resumir si una decisión fue correcta o no. El analizar el por qué permite entender mejor cuándo tomar la misma decisión, o cuándo no. Credencialización La credencialización es el proceso del patrono de determinar que una persona está lista para realizar un procedimiento específico. La credencialización es un proceso independiente del licenciamiento. Una persona puede tener una licencia en su jurisdicción de trabajo, pero no estar credencializado en un lugar de empleo. El director médico es la persona responsable dentro del servicio de emergencias médicas de credencializar al personal. La credencialización no es simplemente una charla, sino la validación (o revalidación de las destrezas). El proceso de credencialización no es un solo evento al principio, sino un proceso continuo. En adición, debe incluir todos los aspectos psicomotores, cognitivos y afectivos que se han descrito anteriormente. En otras palabras, la credencialización no puede ser solamente una charla y no puede ser solamente realizar una (o varias) intubaciones en un maniquí. Es importante señalar que la credencialización no tiene que ser solamente para destrezas de soporte vital avanzado. Si la vida del paciente depende de que el proveedor pueda tener un dominio absoluto de las destrezas cognitivas, afectivas y psicomotoras del manejo básico de la vía aérea, es importante que la simulación y credencialización esté dirigida a ese nivel básico también. Evolución de los adiestramientos Los adiestramientos de manejo (¿avanzado?) de la vía aérea tienen que evolucionar también. El objetivo del adiestramiento inicial debe ser lograr una competencia mínima. Sin embargo, el objetivo final no puede ser quedarse ahí solamente. El objetivo tiene que ser lograr el dominio de la competencia (al nivel que se quiera llegar) para entonces lograr la credencialización. Los adiestramientos tienen que evolucionar. Yo diría que muchos de los adiestramientos que tomamos están basados en la mejor evidencia disponible y así lo reflejan. Sin embargo, somos nosotros los instructores los que tenemos que actualizar los libretos que cada uno tenemos cuando hablamos de estos temas. No es raro todavía ver clases de Soporte Vital Cardiovascular Avanzado (ACLS) enfatizando la intubación endotraqueal cuando desde hace mucho estamos hablando de que esto no necesariamente debe ser el caso del manejo de la vía aérea en el paro cardiaco. Conclusión El manejo de la vía aérea es una de las destrezas fundamentales y definitorias de la resucitación de un paciente. Para lograr ser seguros y efectivos en estas destrezas, tenemos que incorporar muchos otros elementos en el proceso continuo del desarrollo de los conocimientos y destrezas. Referencias Maia Dorsett, Ashish R. Panchal, Christopher Stephens, Andra Farcas, William Leggio, Christopher Galton, Rickquel Tripp & Tom Grawey (2022) Prehospital Airway Management Training and Education: An NAEMSP Position Statement and Resource Document, Prehospital Emergency Care, 26:sup1, 3-13, DOI: 10.1080/10903127.2021.1977877

EMS Week: Rising to the challenge As EMS week comes to a close, NAEMSP, the PEC podcast, and the But Why EMS podcast would like to highlight a NAEMSP member who has Risen to the Challenge of the war in Ukraine.  Dr. Kasia Hampton (@kasiahamptonmd) & her medical student daughter Livia Van Humbeeck (@doclivia) have been helping their home country Poland and their neighbor Ukraine during this horrendous time in history.  We talk to Dr. Hampton and Livia about their initial experiences and their continued plans to aid Ukraine. Click here to check it out today! 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)

For paramedics, click here for CAPCE credits.  Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time, Ouch-less Pediatrics Happy EMS Week: Pediatrics Day! The But Why EMS Podcast team would like to highlight NAEMSP's newest podcast to our family  The Pediatric EMS Podcast In their first episode, hosts Dr. Joseph Finney and Dr. Joelle Donofrio-Odmann talk about Safely and effectively managing pain in our pediatric patients. Medical directors and prehospital clinicians must be able to identify gaps in pediatric pain management and provide the necessary QA/QI to close those gaps. In this episode, we focus on exactly that, with several experts in EMS joining us to offer their knowledge and critical appraisal of the evidence in order to identify and close the gaps in the management of pain in children. Click here to check it out today! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P Please subscribe and review our podcasts on: Apple Amazon Google Podcast Stitcher   Disclaimer The Emergency Medical Services for Children Innovation and Improvement Center is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award (U07MC37471) totaling $3M with 0 percent financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.     To learn more about the Emergency Medical Services for Children Innovation and Improvement Center visit https://emscimprovement.center   Email km@emscimprovement.center Follow on Twitter @EMSCImprovement   Sources: International Association for the Society of Pain Subcommittee on Taxonomy  WT Zempsky NL Schechter 2003 What's new in the management of pain in children Pediatrics Rev 24 10 337 347 16  SJ Weisman B Bernstein NL Schechter 1998 Consequences of inadequate analgesia during painful procedures in children Arch Pediatrics Adolescent Med 152 2 147 149 17  JT Pate 1996 Childhood medical experience and temperament as predictors of adult fu Educational Module on Prehospital Pain Management in Children (Targeted Issues Grant): http://www.youtube.com/watch?v=Tn3MF_4-9iQ&feature=youtu.be Lorin R. Browne, Manish I. Shah, Jonathan R. Studnek, Daniel G. Ostermayer, Stacy Reynolds, Clare E. Guse, David C. Brousseau & E. Brooke Lerner (2016) Multicenter Evaluation of Prehospital Opioid Pain Management in Injured Children, Prehospital Emergency Care, 20:6, 759-767, DOI: 10.1080/10903127.2016.1194931

Ouch-less Pediatrics For CAPCE Credit click here! Happy EMS Week: Pediatrics Day! The PEC Podcast team would like to highlight NAEMSP's newest podcast to our family  The Pediatric EMS Podcast In their first episode, hosts Dr. Joseph Finney and Dr. Joelle Donofrio Odmann talk about Safely and effectively managing pain in our pediatric patients. Medical directors and prehospital clinicians must be able to identify gaps in pediatric pain management and provide the necessary QA/QI to close those gaps. In this episode, we focus on exactly that, with several experts in EMS joining us to offer their knowledge and critical appraisal of the evidence in order to identify and close the gaps in the management of pain in children. 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) Disclaimer The Emergency Medical Services for Children Innovation and Improvement Center is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award (U07MC37471) totaling $3M with 0 percent financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov To learn more about the Emergency Medical Services for Children Innovation and Improvement Center visit https://emscimprovement.center Email km@emscimprovement.center Follow on Twitter @EMSCImprovement Sources: International Association for the Society of Pain Subcommittee on Taxonomy  WT Zempsky NL Schechter 2003 What's new in the management of pain in children Pediatrics Rev 24 10 337 347 16  SJ Weisman B Bernstein NL Schechter 1998 Consequences of inadequate analgesia during painful procedures in children Arch Pediatrics Adolescent Med 152 2 147 149 17  JT Pate 1996 Childhood medical experience and temperament as predictors of adult fu Educational Module on Prehospital Pain Management in Children (Targeted Issues Grant): http://www.youtube.com/watch?v=Tn3MF_4-9iQ&feature=youtu.be Lorin R. Browne, Manish I. Shah, Jonathan R. Studnek, Daniel G. Ostermayer, Stacy Reynolds, Clare E. Guse, David C. Brousseau & E. Brooke Lerner (2016) Multicenter Evaluation of Prehospital Opioid Pain Management in Injured Children, Prehospital Emergency Care, 20:6, 759-767, DOI: 10.1080/10903127.2016.1194931

PEC Podcast Episode 112 is here! In this episode, we cover Volume 26 Number 1 of the Prehospital Emergency Care Journal.  We highlight such manuscripts like: Overdose Receiving Centers – An Idea Whose Time Has Come? & Initial Prehospital Rapid Emergency Medicine Score (REMS) as a Predictor of Patient Outcomes Click here to download today! 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)  

March Madness is here! To help distract you from the craziness of college basketball, the PEC Podcast team is happy to discuss the Prehospital Emergency Care Journal Volume 25 Number 6 where we cover manuscripts like:  Ketamine for Prehospital Pain Management Does Not Prolong Emergency Department Length of Stay & Child Abuse Recognition Training for Prehospital Providers Using Deliberate Practice Click here to download today! 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)    

On this episode of the Standard of Care Podcast, Nick and Samantha take a look at some of the liability issues surrounding the use of red lights and sirens.  What does the law allow the driver of an emergency vehicle to do?  What is “due regard”, anyway?  Are shorter response times making drivers more unsafe?  How does a plaintiff prove his or her case against the driver of an emergency vehicle, and what can you as the driver do to protect yourself?  Please like, comment, and subscribe!      Links:  Epps, K. (2019, May 04). EMT sentenced to 1 year in jail for fatal ambulance wreck. Retrieved November 19, 2020, from https://www.ems1.com/ambulance-crash/articles/emt-sentenced-to-1-year-in-jail-for-fatal-ambulance-wreck-o70N1PhOFiuyvdBK/ Janofsky, M. (1993, December 22). Domino's Ends Fast-Pizza Pledge After Big Award to Crash Victim. Retrieved November 19, 2020, from https://www.nytimes.com/1993/12/22/business/domino-s-ends-fast-pizza-pledge-after-big-award-to-crash-victim.html Jarvis, J. L., MD, MS, EMT-P, FACEP, FAEMS, Hamilton, V., MA, EMT-P, Taigman, M., MA, &  Brown, L. H., PhD. (2020). Using Red Lights and Sirens for Emergency Ambulance Response: How Often Are Potentially Life-Saving Interventions Performed? [Abstract]. Prehospital Emergency Care. doi:10.1080/10903127.2020.1797963, from https://www.tandfonline.com/doi/full/10.1080/10903127.2020.1797963 Jarvis, J. L., MD, MS, EMT-P, FACEP, FAEMS & Verkest, M., A.A.S, CCP-C, FP-C, C-NPT, Paramedic. (2019, August 7). The EMS Lighthouse Project: A Dangerous Proposition: Use of Red Lights and Sirens Study [Audio blog post]. Retrieved 2020, from https://www.flightbridgeed.com/index.php/emslighthouseproject-podcast/13-ems-lighthouse-project-podcast/468-a-dangerous-proposition-use-of-red-lights-and-sirens Kupas, D.F., MD, EMT-P, FAEMS, FACEP, et al., (2022, February 14).  Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses, Retrieved 2022, from https://www.nvfc.org/wp-content/uploads/2022/02/22Feb-Joint-Statement-on-Red-Light-and-Siren-Operations.pdf Kupas, D. F., MD, EMT-P, FAEMS, FACEP. (2017, May). Lights and Sirens Use by Emergency Medical Services (EMS): Above All Do No Harm [Pdf]. Washington DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, Office of Emergency Medical Services (EMS), from https://www.ems.gov/pdf/Lights_and_Sirens_Use_by_EMS_May_2017.pdf LLP, A. (2018, June 30). Louisiana Jury Awards $117 Million to Woman Injured in Ambulance Accident While Pregnant. Retrieved November 19, 2020, from https://www.prnewswire.com/news-releases/louisiana-jury-awards-117-million-to-woman-injured-in-ambulance-accident-while-pregnant-164761026.html Mikkelson, D., & Mikkelson, D. (2011, April). Do Mail Trucks Always Have the Right of Way? Retrieved November 19, 2020, from https://www.snopes.com/fact-check/four-play/ See omnystudio.com/listener for privacy information.

Happy February from the PEC podcast crew! Even though Punxsutawney Phil's shadow predicted another 6 weeks of winter, the PEC podcast team is happy to keep you company while you're keeping warm.  In this episode, we cover the Prehospital Emergency Care Journal Volume 25 Number 5 where we cover manuscripts like: Impact of a Standardized EMS Handoff Tool on Inpatient Medical Record Documentation at a Level I Trauma Center Documentation of Child Maltreatment by Emergency Medical Services in a National Database Clinical Care and Restraint of Agitated or Combative Patients by Emergency Medical Services Practitioners Click here to download today! 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)  

Article reviewed: Farcas AM, Zaidi HQ, Wleklinski NP, Tataris KL. Implementing a Patient Tracking System in a Large EMS System. Prehospital Emergency Care. 2021 Feb 4:1-9. Abstract Objective Accurate tracking of patients poses a significant challenge to prehospital and hospital emergency medical providers in planned and unplanned events. Previous reports on patient tracking systems are limited primarily to descriptive reports of post incident reviews or simulated exercises. Our objective is to report our experience with implementing a patient barcode tracking system during various planned events within a large urban EMS system. Methods In 2018, representatives from the Chicago Department of Public Health, Chicago Fire Department EMS, private EMS agencies, and 27 hospitals in the Chicago EMS System were trained on the use of a web-based patient tracking system using barcoded triage tags and wristbands to monitor triage category and hospital destination during an event. The tracking system was used on two planned operational days and three pre-planned mass gathering events. The primary outcome was the percent of patients initially scanned by EMS that were scanned by the hospital. Descriptive statistics were collected. Barriers to patient tracking system use were identified. Results Each event was reviewed for the number of patients assigned a barcode identifier and scanned by EMS that were then scanned by the hospital. In the first planned operational day, 57% (359/622) of patients initially scanned by EMS were scanned by the hospital. In the second planned operational day, 88% (355/402) of EMS scanned patients were scanned by the hospital and 37% (133/355) were assigned a final disposition. At three city mass gathering events, there were 79% (50/63), 95% (190/199), and 82% (46/56) of EMS scanned patients also scanned by hospitals. Logistical and technological challenges were documented. Conclusions Use of a web-based system with barcode identifiers successfully tracked patients from prehospital to hospital during planned operational days and mass gathering events. Percent of scanned patients increased after the first operational day and remained consistent in subsequent events. Limitations to the patient tracking system included logistical and technological barriers. Similar patient tracking systems may be implemented to assist with event management in other EMS systems. Key words: EMS; patient tracking system; mass gathering event; prehospital; barcode

For paramedics, click here for CE credits.  Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time, this episode covers the complex nature of traumatic arrests. ,  Do we treat it the same as a medical arrest?  Do we have different treatment and decision priorities for these traumatic patients?  What makes caring for these patients in the prehospital environment so unique and how does that affect our care of these patients?  We discuss these questions and more with our special guest: Dr.  Rawan Safa @rawansafa93 Emergency Medicine Resident at Washington University Click here to check it out today! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P Noah Bernhardson MD References Millin MG, Galvagno SM, Khandker SR, Malki A, Bulger EM, Standards and Clinical Practice Committee of the National Association of EMS Physicians (NAEMSP)., Subcommittee on Emergency Services–Prehospital of the American College of Surgeons' Committee on Trauma (ACSCOT). J Trauma Acute Care Surg. 2013 Sep; 75(3):459-67. Lockey, D, Crewdson, K, Davies, G. Traumatic cardiac arrest: who are the survivors? Ann Emerg Med 2006; 48:240-244. Russell, RJ, Hodgetts, TJ, McLeod, J, Starkey, K, Mahoney, P, Harrison, K. The role of trauma scoring in developing trauma clinical governance in the Defense Medical Services. Phil Trans R Soc B 2011; 366:171-191. Morrison, JJ, Poon, H, Rasmussen, TE, Khan, MA, Midwinter, MJ, Blackbourne, LH. Resuscitative thoracotomy following wartime injury. J Trauma 2013; 74: 825- 829. Kouwenhoven, WB, Jude, JR, Knickerbocker, GG. Closed-chest cardiac massage. JAMA 1960; 173: 1065-1067. Luna, GK, Pavlin, EG, Kirkman, T, Copass, MK, Rice, CL. Hemodynamic effects of external cardiac massage in trauma shock. J Trauma 1989; 29:1430-1433. Leis C. Traumatic cardiac arrest: should advanced life support be initiated?. Journal of Acute Care Surgery. 2013;74:634-638. Keith J Roberts. The role for surgery in pre-hospital care. 2015; 18(2): 92-100. Escott ME, Gleisberg GR, Kimmel K, Karrer A, Cosper J, Monroe BJ. Simple thoracostomy. Moving beyond needle decompression in traumatic cardiac arrest. 2014 Apr; 39(4): 26-32. Martin M, Satterly S, Inaba K, Blair K. Does needle thoracostomy provide adequate and effective decompression of tension pneumothorax? Journal of Trauma and Acute Care Surgery. 2012; 73(6): 1412-1417. Stevens RL, Rochester AA, Busko J, et al. Needle Thoracostomy for Tension Pneumothorax: Failure Predicted by Chest Computed Tomography. Prehospital Emergency Care. 2009; 13(1): 14-17. Inaba K, Ives C, McClure K, et al. Radiologic evaluation of alternative sites for needle decompression of tension pneumothorax. Arch Surg. 2012 Sep; 147(9): 813-8. Ball CG, Wyrzykowski AD, Kirkpatrick AW, et al. Thoracic needle decompression for tension pneumothorax: clinical correlation with catheter length. Can J Surg. 2010 Jun; 53(3): 184-8. Brian Wernick, Heidi H Hon, Ronnie N Mubang, et al. Complications of needle thoracostomy: A comprehensive clinical review. Int J Crit Illn Inj Sci. 2015 Jul-Sep; 5(3): 160–169. Smith JE, Rickard A, Wise D. Traumatic cardiac arrest. J R Soc Med. 2015;108(1):11-16. Leis CC, Hernández CC, Blanco MJ, et al. Traumatic cardiac arrest: Should advanced life support be initiated? J Trauma Acute Care Surg. 2013;74(2):634-638. Jørgensen H, Jensen CH, Dirks J. Does prehospital ultrasound improve treatment of the trauma patient? A systematic review. Eur J Emerg Med. 2010;17(5):249-253.  

¿Cuál es la mejor forma de manejar la vía aérea fuera del hospital? El estudio "Prehospital Airway Management: A Systematic Review", publicado en la revista Prehospital Emergency Care el 20 de julio del 2021 analiza la evidencia hasta el momento acerca del manejo de la vía aérea en la medicina prehospitalaria. El estudio puede ser cualitativo (describir la situación) o cuantitativo (medir resultados y compararlos con un control). Está claro que hay pacientes que necesitan manejo avanzado de la vía aérea fuera del hospital. Sabemos que el tubo endotraqueal y un dispositivo supraglótico pueden funcionar. Resultados: éxito al primer intento y sobrevivencia al egreso. La selección depende usualmente de la severidad y circunstancias de la situación Lo que sí sabemos sobre sobrevivencia No hay diferencia en sobrevivencia si se usa un tubo endotraqueal, un dispositivo supraglótico o un dispositivo de ventilación bolsa-mascarilla. En términos de función neurológica luego de paro cardiaco pediátrico, no hay diferencia entre bolsa-mascarilla versus tubo endotraqueal, y entre supraglótico entre tubo endotraqueal. En adultos en paro cardiaco, no hay diferencia entre dispositivo bolsa-mascarilla versus tubo endotraqueal, pero sí hubo diferencia entre bolsa-mascarilla o tubo endotraqueal sobre supraglótico. No hubo diferencia en retorno de circulación espontánea en pacientes en paro cardiaco con uso de bolsa-mascarilla versus tubo endotraqueal o supraglóticos en adultos y pediátrico, o supraglótico versus tubo endotraqueal en pediátrico. Hubo un más retorno de circulación espontánea en pacientes adultos con un supraglótico que con tubo endotraqueal. Lo que sí sabemos sobre éxito en el primer intento Hubo mejor éxito al primer intento con un supraglótico versus el tubo endotraqueal excepto en pacientes adultos con problemas médicos (no hubo diferencia). No hubo diferencia en éxito general entre el uso de un tubo supraglótico versus tubo endotraqueal en adultos. Lo que no sabemos Alcance de la práctica incluye la intubación endotraqueal. Cuál es el nivel de práctica de los participantes? En participantes fuera de los EEUU, cuál es su nivel de acreditación? IPR La disponibilidad de medicamentos Equipo disponible La disponibilidad de videolaringoscopía La taza de éxito en el primer intento El nivel de entrenamiento óptimo Cómo llegar ahí. Qué hacer para llegar ahí. Cuánto tenemos que practicar. Cómo tiene que ser esa práctica Referencia Carney N, Totten AM, Cheney T, Jungbauer R, Neth MR, Weeks C, Davis-O'Reilly C, Fu R, Yu Y, Chou R, Daya M. Prehospital Airway Management: A Systematic Review. Prehosp Emerg Care. 2021 Jul 20:1-12. doi: 10.1080/10903127.2021.1940400. Epub ahead of print. PMID: 34115570.