The Butterfly Effect

    LEVEL ZERO – The Movie from Thaddeus @Setla on Vimeo. Yesterday marked the four year anniversary of this blog, and what a ride it has been, and sitting here in a completely different system in a different state with different friends and colleagues around me, I cannot help but reflect back at how crazy this journey has been.  For me it all started with a trip to California provided to me by AMR, and a few conversations out there with a few paramedics about a little movie called Level Zero that I had stumbled across on the internet. For those of you who have read through the posts of this blog, you know where it went from there.  I started writing.  I connected with Ted Setla and Justin Schorr.  The EMS 2.0 logo and pin were created.  I came out of my shell and found a love for teaching and now, four years later, I am still at it. The road has not been without bumps, and times have not always been easy but ultimately I could not be happier about where I landed.  I wonder sometimes what i would be doing had Mike Taigman not reached out to the east coast for help, or had I not gotten a ride down to one of the southern hospitals in the county from one of their Clinical Specialists.  Any little turn in that road could have changed everything.  I was lucky though.  I have come out of this four year rollercoaster with some great friends who I would not trade for anything.  I have had a little hand in sparking change in my old system in Springfield, and still love following their accomplishments even now, over a year after I left.  I’ve sung Karaoke with people from EMS World and EMS Today.  I’ve sat down and interviewed a man who someday I hope to have a shred of his ability to lead.  Justin Schorr’s number is in my phone, although I don’t talk to him nearly as much as I’d like.  I’ve lobbied on Capitol Hill.  I’ve hosted a podcast that I used to listen to and wish that maybe someday I would...

Some Thoughts on EMS Today

Now that I got my charger fixed for my Netbook I can finally share this post that I wrote on my train ride back from EMS Today 2014.  Enjoy!! Here I sit on the train ready to head back home after another series of adventures at EMS Today.  Although the vibe at this year’s conference was different than years passed, the one factor that remains constant is there are a number of people who are extremely motivated to do more than just spend their 40 hours on a truck, collect a paycheck, and go home.  For the most part, the people who attend these conferences are doing so in the hopes that they become better clinicians both for themselves as well as their patients. Lines were drawn in the sand at this year’s EMS Today conference and the goals and direction was apparent from the get go.  The major focus of many of the classes was what some call community paramedicine which others have termed mobile integrated healthcare.  There were  a number of classes about branding, data, attitudes, and expectations that should be important to a service as well as a paramedic as they prepare themselves to provide care outside of the traditional “emergency” environment so many of us are active in today.  While the classes and churiculum are great, however, I want more. This year’s conference marked the 8th major one that I have attended dating back to EMS World EXPO in Dallas in 2010.  I have seen a number of fads come and go.  I remember just a few years ago when the exhibit hall was full of venders looking to sell everyone on the importance of their products when it came to prehospital ultrasound, something that a lot of us thought might have a practical use in the field.  For the past two or three conferences, community paramedicine has been showing up more and more.  I remember last year, when NAEMT’s EMS on the Hill Day was canceled, Chris and Anne Montera (then known as Anne Robinson) along with a team from MedSTAR in Texas lead by Matt Zavadsky held a half day workshop for the NAEMT delegates to talk about...

The Silver Lining of Epi

I was out with some coworkers for some frosty beverages last night in celebration of a friend’s birthday, and of course, predictably, the conversation turned to our profession.  We got talking about how we handle and respond to cardiac arrests, and mainly the medications that we give.  While we are all proud of our 40% ROSC rate, one of my friends made a bold, and not complete unexpected comment, “I think we need to get rid of epinephrine.” It is an argument that has been made by numerous people, including my friend the Rogue Medic, and it is one that is not completely unfounded.  Patients who receive epinephrine in cardiac arrests have worse outcomes.  To me, that is not completely surprising.  Personally, I feel that patients who we save with epi are people we would have not gotten back without it.  That statement might be slightly confusing, but as far as I am concerned, people with better outcomes without epi have those improved outcomes because their cardiac arrest was intervened with sooner, and the underlying cause was one that made them an easier save. So now we have these ROSC patients who end up with poor long term outcomes and some who might not even make it out of the hospital.  We are saving people only to put them in a vegetative state, or only prolong their lives for a short time, right?  One might think so. . . Then I looked a couple of seats down at the bar, and the whole purpose of epi, and the entire argument became clear to me.  We were joined that night by and celebrating the birthday of, a former paramedic who gave up her career to go into organ procurement and transplantation.  When we brought in one of these patients that was expected to have a poor or short outcome, which is when her company got involved.  They match donors to transplant recipients and get the ball rolling with screening and dealing with a family.  Her company and profession have saved countless lives over the years. If our documented ROSC rate tells us we are “saving” four of out every ten cardiac arrests, let’s say, for...