The Podcast

Podcast Episode 17: The Medicast

Posted by on Sep 9, 2014

We took the week off last weeks or Labor Day and this week the podcast is back with a short interview that I did on Jamie Davis’ The Medicast where we talk about the show and what it is all about.  Regular shows will be back next week!  Enjoy! To download the show in MP3 format, follow this link!  Otherwise check the show out below:     Share...

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For Leadership

The Ambulance of the Future

Posted by on May 12, 2017

Roughly twelve years ago, AMR and AEV’s Safety Concept Vehicle made its way to Springfield for us to take a look at.  It included a number of interesting features like an expanded harness setup to allow providers to move a little more freely around the box while still being anchored.  There were mounting brackets for cardiac monitors, and video cameras to monitor both the rear of the truck for backing up, and the passenger side to check for traffic before opening the curbside door. The vehicle itself contained a lot of positives that have been adopted over the years.  I see more cameras used in emergency vehicles and I’m a a fan of the checkered or striped patterns on the backs of trucks to make them more visible to oncoming traffic.  I have also seen a few more monitor brackets.  But where is everything else?  When is that ambulance of the future going to get here? Year after year at conference after conference, there will undoubtedly be some ambulance parked on the exhibit hall floor touting itself as the “ambulance of...

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For the Field

Posted by on May 22, 2017

In my defense, there are two videos posted below. These are the first two EMS Week videos created by a department that is very near and dear to my heart. Watch. Enjoy. Share...

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Lessons to Learn

Cross Promotion and CPR

Posted by on May 9, 2017

The biggest barrier to many systems’ CPR survival rates skyrocketing is the pubic’s lack of willingness to perform CPR before a rescuer gets on scene.  Those roughly five minutes might be the most important five minutes in a patient’s chance for survival.  Many systems have tried to teach more hands only CPR, or perform “flash mob” trainings as a way to get the word out there about the importance of CPR.  Frequently, the top two concerns that I’ve heard expressed by the public are the perceived legal issues, or the “what if I do it wrong?” attitude, and the fear of giving mouth to mouth to a stranger.  In reality though, neither of these factors truly come into play anymore with good Samaritan protecvtion laws and a new found focus on compression only CPR. This morning I read a news story shared by EMS1 about a woman who nearly lost her son who now hosts “CPR parties” and it got me thinking.  My girlfriend has a problem, and I know that she is not alone.  On an almost weekly basis, our mailbox...

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Recent Posts

The Evolution of Cardiac Arrest Care

As we start to dive down the rabbit hole of what makes an effectively run cardiac arrest, it is important to understand the roots of what we are actually doing.  Personally, I could go back some 23 years to 1993 when I received my first CPR card.  I learned the importance of opening the airway.  Looking, listening and feeling.  If the patient was not breathing, and I could not give a rescue breath, I had to reposition the airway.  Simply put, until the patient had a patient airway, and was effectively being ventilated or breathing on their own, not a single compression was done. If I had somebody with me, for every five compressions that were done, a ventilation was given.  If it was just me, it would be 15:2.  Sometimes I am amazed that we saved anyone at all following that.  In the system that I started in, I feel like we were ahead of the curve.  CPR calls were commonly not transported to the hospital.  We would work them at home and leave them at home. Fast forward now seven years to my time as a paramedic student and my early days as a paramedic.  Not much from that airway focus had changed.  ROSC was rare.  Survival to discharge was even more rare.  Every workable cardiac arrest was transported to the hospital regardless of rhythm or downtime. The success and failure of the care provided rested on two factors: whether the patient was turned over to the emergency room staff intubated, and whether or not the call time was short.  We would walk away from a code high fiving each other for delivering a dead body to the ER in 30 minutes or less, like we were some glorified Dominos delivery drivers. Throughout my career, my views on EMS and the impact that we have on the general public has swung to both ends of the spectrum.  I’ve felt that we were completely necessary for the well being and survival of every single person that we encountered, and I’ve felt used and abused by the system.  As I enter my 16th year as a paramedic though, I can without a doubt say...

Comfort in Change

One of the things that amazes me about this field is how tightly we hold on to our beliefs.  It does not matter if it has to do with oxygen management or medication administration, or even C-Spine.  People always seem to revert back to how they were taught the first time that they learned something presumably because it is uncomfortable.  Maybe it is time to get comfortable with being uncomfortable.  Make it is time to make change a way of life. It has been my experience that people seem to base a lot of decisions that they make off of one negative experience in their career over a more frequent positive one.  We balk at giving pain medications to some patients because we believe that they are lying to us thanks to that one addict that we feel pulled a fast one on us in the early days in our career.  Or we put the nitro aside on an inferior MI because this one time a medic that you met told you about a medic that they knew who dumped the pressure on a patient who then coded on them.  The truth is though that the person in pain, regardless of their background, could benefit from that fentanyl, and chances are, that person having the MI will maintain their pressure and could greatly benefit from the treatment that you are so reluctant to give them. Or take response times as another example.  Despite evidence to the contrary, and despite studies that have been conducted, there is little correlation between response times and mortality in a majority of the emergencies that we as EMS providers respond to.  I happen to know of one rather large service that despite having an excellent ROSC rate they see a lower percentage of CPR saves in the more densely populated section of their service area with considerably lower response times than they do in the more suburban or rural areas.  While the difference in miniscule, it is further proof that despite the fact that somebody gets on scene more quickly than in other areas, speed alone does not constitute more lives saved. I have always found the concept of...

Knee Jerk Management

Your department has a policy that they send two ambulances to reported cardiac arrests.  On one particular busy night two of your trucks are dispatched to a person reportedly not breathing.  The first truck gets on scene and finds a patient beyond help.  Before they can cancel the second ambulance, they are involved in an intersection accident.  In response to this incident the next morning your director releases a memo stating that second ambulances will no longer be dispatched to cardiac arrests. In a labor management meeting, an employee suggests development of an “emergency code” for field personnel to report to dispatch that they are in trouble to help activate a large law enforcement response to assist them at their location.  Your boss says that this will not happen because they think field crews will abuse it.  A week later, a paramedic is seriously assaulted by a psychiatric patient.  The dispatcher on the other side of the radio was unable to make out their calls for help.  Your boss then revisits the policy. Your division uses a non-disposable laryngoscope blades.  A supervisor goes to your boss and suggests following the industry trend and shifting to disposable ones to reduce the risk of infection for patients.  Your boss decides against this since your company has never been sued by someone receiving an infection from this means of transmission.  You are convinced that the only way this policy will change is through some sort of tragedy. All three of these incidents are loosely based on actual events that I have either been part of or have heard about from friends of mine working in different systems throughout the United States.  They are all evidence of the same though, change driven by catastrophe.  We have all experienced it at some point in our career.  We have all been sitting around in a conversation with our friends and coworkers and had somebody utter the words, “Nothing is going to change until somebody gets hurt.”  Some of this attitude from leadership is because of a generalized disconnect from the field.  Some of it is because of the kneejerk, reactive nature of EMS that seems to carry on with people...

Why Rhode Island is Getting It Right

Why Rhode Island is Getting It Right

Apr 24, 2017

As I said in last week’s article about Bob Harper, I am kind of playing catch up with a lot of topics, this being one of them.  In late 2016, the State of Rhode Island announced publicly that on March 1 of this year, there would be a significant protocol change to their cardiac arrest protocols.  Crews would be expected to remain on scene for 30 minutes prior to being transported. Topically, I applaud Rhode Island’s Department of Health for being as public and transparent as they were about this change.  Anybody who has been in the field for even a modest amount of time has been on a scene where they were asked “why aren’t you just taking them to the hospital?”  In some cases, there is some merit to that.  In some cases there is very little that we as paramedics and EMTs can do for a patient on a scene.  Cardiac arrest is not one of those emergencies. I saw some pushback online from some who consider themselves experts on the topic, but that’s neither here nor there.  One common complaint that I saw revolved around scene safety.  Obviously, scene safety trumps all.  If I am coding someone in the middle of a street with an aggressive or growing crowd, I am going to think about moving.  But on these calls are the exception to the rule, and on the vast majority of runs, even in the worst areas of someone’s coverage area, communication with families goes a long way. “We are doing everything for them right here that they would get in the emergency room.  It is their best chance to survive.”  That’s the common statement that I have made a number of times to families of patients in cardiac arrest. Maybe those dissenters failed to read the protocol, it states “Regardless of proximity to a receiving facility, absent concern for provider safety, or traumatic etiology for cardiac arrest, resuscitation should occur at the location the patient is found.”  Emphasis is mine.  Most of the write ups that I read from the online blogging community were written on or around the month of December.  It is certainly possible that the...

Surviving Cardiac Arrest

Surviving Cardiac Arrest

Apr 21, 2017

I’ve been out of this writing game for a bit, so you are all going to have to forgive as I play catchup to some stories that might be just a little older.  I assure you that they still carry relevance. In my time “away” from writing, I’ve been doing a lot with the Resuscitation Academy.  Yes, that Resuscitation Academy.  I teach its concepts, and some of my colleagues and I have completely drank the Kool-Aid.  I will talk more about that at a later date, but I point it out here because I’ve become very passionate about all things cardiac arrest care which brings me to today’s story. Some of you might have read the story about Biggest Loser trainer Bob Harper who, while at Cross Fit in February, suffered a sudden cardiac arrest.  In the article posted by CNN, Harper talks about how “. . . the fact there were doctors in the gym when I had the attack saved my life.”  He talks about how the doctors did CPR on him, and the doctors pulled the AED off of the wall and used it on him. Mr. Harper is right, the almost immediate CPR and early defibrillation saved his life, there is absolutely no doubt about that, but the fact that the two people who provided care to him were doctors is completely irrelevant.  It wasn’t two doctors who saved his life, it was two people who were willing to act instead of just waiting for someone else to do something.  In this case, their occupation is not important.  I do not want to diminish the heroics of this event but had the story could have been an incredibly powerful vessel had it been told a different way. The message that people need to hear in this case is that they need to learn CPR, some kind of CPR.  They do not need an AHA card in their pocket but understanding the fundamentals of hands-only CPR, for example, a skill that can been learned in 15 minutes or less, is one that can save a life.  Knowing where the AED’s are in the gym where you work out, or having the...