Dan sits down with flight paramedic Dave Aromin to discuss the amazing state of Alaska, and the challenges of providing emergency and retrieval care to the largest state. We discuss the logistics involved in his area, the unique clinical practice involved, and the people who take on this role in one of the most unforgiving environments in the United States and the world.
The EMS community in Alaska suffered a huge blow with the loss of a Guardian Flight fixed-wing crew on January 29, 2019, when their aircraft crashed and all aboard, including a patient were lost. There has been memorial and scholarship funds established for the families of the Guardian Flight crew, and they can be found at the following links:
This episode is presented in the memories of:
Pilot Patrick Coyle
Flight Paramedic Margaret Langston
Flight Nurse Stacie Rae Morse
and the patient who they were caring for on their last mission.
Our resident flight crew member Kevin Mazza takes the lead in our discussion about helicopter use in EMS (HEMS).
What goes on when we call for a helicopter, why does it take time, and what can we do as a team to work together and maximize the use of this expensive (and risky) resource for our patients? Kevin breaks it down for the gang and gives us insight on what HEMS can (and can't) do.
Using the FALTER mnemonic:
The costs of air ambulance use:
Using a standardized handoff method and MIST:
The National Air Medical Memorial:
This episode deals with a call where the system and clinicians failed a patient. What makes it different is that a police body camera recorded the encounter, and was released to the public.
There's a lot to unpack here. We talk about the providers' failure to care for their patient, and we discuss how it possibly got to this point.
There is a lot of shared blame here. We want to present this as a way to stimulate discussion and self-examination, and maybe we can avoid these types of things in the future.
The video from www.ems1.com:
The gang looks at the idea of ALS crew configuration. Is a two paramedic system better for patient care? Is one medic with an EMT better? Does more equate to better, and how do we measure it?
We look at the benefits and downsides, look at some of the (sparse) evidence, and talk about some of the things that may help us figure it out!
OPALS Study for OHCA:
Classic Journal Review: The OPALS Study
This includes an excellent breakdown by our friends at www.rebelem.com!
OPALS study for trauma:
The Rapid Emergency Medicine Score and the potential for EMS:
Don't forget to like and rate us on your favorite podcast outlet!
The gang discusses the controversies and challenges over paramedic degrees. We look at the IAFC position statement, and discuss why fire science is a degree, but paramedicine isn’t.
The gang goes back to mental health, and post-traumatic stress. Anna takes the lead in discussing the FIRST program for clinicians to address and work with stress on the job.
We discuss the idea of heroism, the concept of "toxic heroism", and maybe how we should look at honor, rather than being a "hero" as a way to move forward in the profession.
There's also random comments about being generally maladjusted, as only we can do...
Check out Yoga for First Responders here:
On January 17, 2019 NYC mayor Bill DeBlasio stated that EMTs and Paramedics in the City of New York earn less money than Police and FireFighters because “The work is different.” Since that statement, the hashtag #TheWorkISDifferent has become popular on social media. FDNY Local 2507 Vice President Micheal Greco joins Ed for an exclusive interview to discuss how this effects NYC EMS professionals, how it effects EMS in general, and what we can all do to further our profession.
Tyler Christifulli from Flightbridge and FOAMfrat joins Ed to discuss the “Millennial problem”, if that’s even a thing. Millennials are making up more and more of the workforce, and a constant question from management is how to retain and maintain a workforce of people who often look forward to the next thing. Listen in as Ed and Tyler work to dispel falsehoods and unpack some of the perceived problems of “this generation”
Deep Work by Cal Newport
Kevin and Dan go to NYC for the EMCrit Conference! What happened? Find out!
The gang rings in the new year with a small list of things that grind our gears. There’s a list of things that make our profession “less than professional” and that we can, and should change. Crack open a cold one, sit back, and listen in to the gang air their grievances.
As we end 2018 and head into the New Year, Dan shares what he’s learned about moving into a command-level position…and what the pitfalls are for those of us who choose to take the path.
We’ve all been there. The cardiac arrest that may or may not have a positive outcome depending on what we do as providers. We know that walking into an arrest, our goal is to help the patient in any way that we can, and to get them to walk out of the hospital and home to their family. On paper, this is an easy thing to do. Hell, it’s our job. It’s what we do every day. But with the mountain of data that’s been coming out over the past year or so, it can be difficult to know what “the right thing” actually is. Sure, we always tryto do the right thing, but how can we be sure? What if I intubate someone and find out a week later that it wasn’t the right intervention? When do we use an endotracheal tube, or a supraglottic airway? What about a BVM? Should I RSI this patient? What about a DSI? If I do either of those and I fail, what’s my back up? These are all questions that are certainly valid and worth exploring. Let’s dive in.
We’ve all been in those classes where we phone it in. Someone is going to stand in front of the class, power point slides glowing behind them, and preach about a topic we haven’t heard about since our initial classes. The slides will be lightly animated, maybe there will be a video clip that highlights the point of the lecture (like salt makes sugar taste a little sweeter but in a weird way), and the bullet points will be read out word for word. You don’t even have to make the effort to read. Someone in the back of the room is balancing a checkbook, the co-worker who has been there for 20+ years is knitting a baby blanket, the rest are on their phones in a group chat trying to figure out where to go and get a drink at lunch. The class is required, and man does it feel that way.
Why should you spend your hard-earned money and time off at a conference? Dan breaks down why he goes, and why you should, too.
The current role of mostprehospital stroke care for a majority EMS providers is a rapid diesel bolus or an IV line, with the occasional intubation if the patient is imminently ill. With the recent podcast discussing what the current stroke care is out there and the differences in what we can do better, we wanted to ask the question: where is stroke care going, especially for us out in the field? I think this question is best answered by three major literature advances within the last year!
“Empathy is a requirement, sympathy is the price we pay.”
Let’s dissect that statement here. Empathy, specifically affective empathy, is what we need to possess in order to properly and completely care for out patients. “’Affective empathy’ refers to the sensations and feelings we get in response to others’ emotions; this can include mirroring what that person is feeling, or just feeling stressed when we detect another’s fear or anxiety.” In order to treat the whole patient, and not just the monitor, we need to be able to sense their pain, fears, and anxiety. They teach this in nursing school, often called a holistic approach, and it’s something we do not do a good job teaching pre-hospital providers.
Thomas Jefferson wore the first pedometer
Yes, that Thomas Jefferson. While walking through the streets of Philadelphia, and later at his home in Monticello, Thomas Jefferson never stopped his pursuit of knowledge. Jefferson was someone who loved to measure things. So, after the tools were available to make a measurement device to track his steps, Jefferson went about making the first pedometer. He took so much pleasure in this device that he sent one to James Madison in 1788 with instructions on how to customize it.
This series so far has focused on clinical applications and knowledge gaps between the classroom and the application of medicine in the pre-hospital environment. Certainly, these are important topics, and it’s something we at The Overrun will continue to explore; but I wanted to take a slightly different approach to this entry. I’m going to take about the social aspects, and indeed the life changing aspects that medic school had for me.
On this first installation of The Overrun’s What I Wished I Learned in Medic School, I’m going to discuss topics I was introduced to during my Obstetrics and Gynecology clerkship in medical school, or those that were refreshed from my medic school time. I chose topics that I think can either have a direct impact on your prehospital care, or that you can recognize and understand what is going on in your patient while you’re with them before you transfer care at the Labor and Delivery unit or the ED. I tried to steer clear of topics that are normally covered routinely during classes or refreshers (except a couple) – to give you all something new and exciting!
“We could fist fight in the parking lot of a “coffee with an officer” event and then wonder why no one takes us seriously…”