Episode 46: CROSSOVER with Pin The Q Podcast!

For this episode, we joined up with Frank Melillo and the Pin The Q podcast! Frank is a fire officer and former volunteer and career EMT, and his show takes a close look at the culture and tradition of the fire service, which got us thinking: Why DON'T we have culture and traditions in EMS?

If you're looking for the typical Fire vs. EMS slamfest; you're not going to find it on this episode. You may take away an idea, you might find something that changes how do you things in the future, you may get a new perspective. But you won't be bored, that's for sure.

Frank also tells us about the great stuff Next Rung is doing for emergency services peer support, and why you should have Next Rung in YOUR gear bag.

You can find Pin The Q at:

https://pintheq.com

Insta: pintheq_podcast

YouTube: PintheQ Podcast

FB: PintheQ

Next Rung can be found at:

https://www.nextrung.org

Episode 45: POLST and End of Life in Prehospital Care

Anna and Dan sit down with attorney and former paramedic Margaret Keavney to discuss end-of-life issues in EMS. How do we honor patient wishes, and the law? What is our standard, and how does our culture and training sometimes work against us?

We don't get great initial training in the end of life, although EMS is present at the majority of these events. Check it out!

Keavney-Streger Law Firm can be found here:

https://keavneystreger.com

OPALS study on cardiac arrest termination of care:

https://jamanetwork.com/journals/jama/fullarticle/182615

https://www.nejm.org/doi/full/10.1056/NEJMoa052620

New Jersey's POLST:

https://www.nj.gov/health/advancedirective/polst/

About the late Dr John Hinds and his mission to bring advanced care to the patient:

http://www.delta7hems.com

#DoBetter

Episode 44: Our Cric Show

We talk about a wide variety of all things cricothyroidotomy: mental prep and training, the difference in the techniques that are out there, which one might work better, and lots of other stuff. We also shoutout to a LOT of other resources that will help you to really understand this low frequency, but critical procedure.

If this is in your scope of practice; or possibly in a situation where a clinician will use this; you need to know about this to be able to care for your patient.

Dr. Rich Levitan’s website:

https://www.airwaycam.com

Dr. Scott Weingart’s website:

https://emcrit.org

The EMCrit podcast can be found on iTunes (just like us!)…it’s one of the best around with literally hundreds of topics!

SMACC was an amazing prehospital/emergency/and critical care conference that changed how many of us looked at conferences and learning. Check out their stuff here:

https://smacc.net.au/blog/

New England Journal of Medicine paper on comparing cric techniques:

https://www.jwatch.org/em200503300000002/2005/03/30/open-cricothyroidotomy-vs-seldinger-technique

Here’s the case study about the NG tube going into the spinal column…

https://www.sciencedirect.com/science/article/abs/pii/S0196070911000755

Episode 42: Dr. Peter Antevy's Pediatric Pearls

Dr. Peter Antevy joins Ed to discuss a few pearls about pediatric care and resuscitation in the field. Dr. Antevy wears many hats in EMS and has served as the medical director for Davie fire rescue, Coral Springs-Parkland Fire Rescue, Palm Beach County Fire Rescue. Additionally, he is the President of the Greater Broward EMS Medical Directors’ Association, the 2018 NAEMT Medical Director of the Year, a JEMS top-ten innovator of 2015, and an attending pediatric emergency physician at Joe Dimaggio Children’s Hospital in Hollywood, FL.

Are kids just small adults? How do we handle a pediatric cardiac arrest scene? How involved should parents be in the care of the acutely ill child? Is Ketamine safe to use on children (Spoiler: yes.) These and many more questions are discussed.

Dr. Antevy’s videos and protocols can be found here

2008 Pediatric Emergency Care- Ketamine study

Ideal Ketamine Dosage for Pediatric Sedation

Pediatric Consideration in Clinical Microbiology

Episode 41: Fluids and Pressors

Ed, Mike and Dan get nerdy again talking about IV fluids and vasopressors! What works, why, and what do you need to know about the stuff we put into patients…and why it may be hurting more than helping!

2008 JAMA article on fluid resuscitation:

Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults

R Bellomo, C Hegarty, D Story, L Ho, M Bailey – Jama, 2012 – jamanetwork.com… “Normal” 0.9 per cent salt solution is neither “normal” nor physiological. JAMA … The
biochemical effects of restricting chloride-rich fluids in intensive care. Crit Care Med … Crit
Care Resusc. 2008;10(3):225-23018798721PubMedGoogle

Cochrane Review on colloids or crystalloids:

Colloids or crystalloids for fluid replacement in critically people …

https://www.cochrane.org/…/INJ_colloids-or-crystalloids-fluid-replacement-critically-…

Costs involved in using colloids:

Albumin Use Guidelines and Outcome in a Surgical … – JAMA Network

https://jamanetwork.com/journals/jamasurgery/fullarticle/401980

ATLS 10th edition changes:

ATLS 10th edition offers new insights into managing trauma patients



Episode 40-Buprenorphine and New Jersey Paramedics: Perfect Together?

The State of New Jersey, in the throes of an enormous opioid epidemic, has unveiled allowing their Mobile Intensive Care Units (Paramedics) to administer buprenorphine as a part of an optional formulary.

What does this mean? Paramedics and EMTs can rescue patients with naloxone, but are we the right avenue to start people toward recovery? Trail-blazing tactics change in a battle we’ve been losing, or just another windmill to tilt at?

We’re going to discuss buprenorphine, what it does, (and doesn’t), how it can be implemented in the field, and what the potential pearls and pitfalls are for clinicians.

It’s a radical idea. But, just maybe, radical is what we need in this fight.

Check out New Jersey Office of EMS:

https://www.state.nj.us/health/ems/

National statistics from the Center for Disease Control:

https://www.cdc.gov/drugoverdose/data/statedeaths.html

New Jersey’s statistics on a county level:

https://www.state.nj.us/health/populationhealth/opioid/opioid_deaths.shtml

Federal summary of the New Jersey situation:

https://www.drugabuse.gov/opioid-summaries-by-state/new-jersey-opioid-summary

Journal of Substance Abuse paper on initiating outpatient buprenorphine in high-risk populations:

https://www.ncbi.nlm.nih.gov/pubmed/31229187

Reuben Strayer is an emergency physician in NYC, and is doing amazing work on this topic. If you get a chance to hear him speak, do it. You can find him on Twitter: @emupdates and on the internet at www.emupdates.com. He also has several podcasts on the SMACC podcast.

https://emupdates.com/helpcard-and-opioid-misuse/



Episode 39: The National Registry

The National Registry…what is it, and why should it matter to you? As the only national organization of credentialing in the USA, the guidelines and structure they use has a huge impact on your license or certification.

We dig into the Overrun vault to find this episode….let us know what YOU think!

Is NREMT the be-all, end-all solution; or can it be improved to be a truly national licensing standard? We look at the strengths and weaknesses, and what we would like to see from the NREMT!

The National Registry of EMTs is at:

https://www.nremt.org/rwd/public

Episode 38: REBOA

Does absence of evidence indicate evidence of absence? Resuscitative Endovascular Balloon Occulsion of the Aorta (REBOA) is a hot topic in prehospital care, especially with London’s Air Ambulance using it in the field.

What does it require? Are we ready for this? And what’s the benefit to the patient?

We break it down for you in this episode…and you’ll be surprised!

London HEMS can be found at:

https://www.londonsairambulance.org.uk

Paris SAMU is another program you should look at:

https://www.jems.com/articles/print/volume-42/issue-12/features/how-physicians-perform-prehospital-ecmo-on-the-streets-of-paris.html

The Knick was a cable series about turn of the century medicine:

https://www.cinemax.com/the-knick

Original Journal of Surgery paper on REBOA:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249899/

REBOA at the R. Adams Cowley Shock Trauma Center:

https://www.ncbi.nlm.nih.gov/pubmed/29190256

The latest study on REBOA:

https://journals.lww.com/jtrauma/Citation/2016/09000/The_AAST_AORTA_registry_and_data_on_REBOA.33.aspx


SPECIAL EPISODE-RECAP of the EMS/MD1 Fellowship Conference!

Dan recaps the MD1 EMS Conference and shares what he learned from a room full of EM/EMS physicians speaking to EMS clinicians! If you saw the Facebook Live and Instagram streams from this show; you know there was an enormous amount of knowledge being put out!

Check out Dr. Mark Merlin on Twitter at : @ccareanywhere

The NJ EMS and Disaster Medicine Fellowship can be found at: www.emsfellowship.com

The MD1 physician response program: www.md1program.org

Dr. Qasim is on Twitter at: @emeddoc

Dr. Callelo: @DrDianeC, @njpoisoncenter, also at @ToxAndHound

The COMBAT trial for prehospital plasma:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31553-8/fulltext

The PAMPHER trial:

https://www.nejm.org/doi/full/10.1056/NEJMoa1802345

BOKUTOH criteria study:

https://www.jem-journal.com/article/S0736-4679(17)30471-7/pdf

PARAMEDIC2 study of Epinephrine in OHCA:

https://www.nejm.org/doi/full/10.1056/NEJMoa1806842

Pediatric airway management in cardiac arrest:

https://www.ncbi.nlm.nih.gov/pubmed/30862528

Heads up CPR in OHCA:

https://www.jems.com/articles/supplements/special-topics/state-of-the-future-of-resuscitation/head-up-cpr-may-improve-neurologically-intact-survival-rates.html

And, why it may NOT be ready for EMS use, yet…..

https://www.ems1.com/ems-products/cpr-resuscitation/articles/393699048-Why-heads-up-CPR-is-NOT-ready-for-out-of-hospital-cardiac-arrest-care/

Ultrasound in Cardiac Arrest:

https://www.cureus.com/articles/18740-does-point-of-care-ultrasound-use-impact-resuscitation-length-rates-of-intervention-and-clinical-outcomes-during-cardiac-arrest-a-study-from-the-sonography-in-hypotension-and-cardiac-arrest-in-the-emergency-department-shoc-ed-investigators


Episode 37-Pip and 555 Fitness

The gang let Anna handle this episode, and she crushed it! Anna talks with Robert (Pip) Piparo, firefighter, paramedic, and driving force behind the 555 Fitness team, bringing physical fitness to public safety professionals!

We ask why, if we're so smart as clinicians, why do we do things we KNOW are bad for us, and why we absolutely have to Do Better.

And here's an easy way to start: Anna and Pip created The Overrun Challenge! All you have to do is commit to walk ONE mile every day for 30 days. That's it! If you commit to the Challenge, let us know on social media and send pics at Day 1 and Day 30! We will share your success and commitment with our audience!

555 Fitness website:

http://www.555fitness.org

The 555 Fitness APP!

https://itunes.apple.com/us/app/555-fitness-wod/id1067233204?mt=8

Episode 36-Sepsis and Prehospital Care

Ed, Jess, and Dan discuss where we've been with sepsis, where we are, and maybe where we're going. Fluids, pressers, scoring....there's a LOT of information out there, and we try to sort through it for you

The Early Goal-Directed Therapy paper from 2001:

https://www.nejm.org/doi/full/10.1056/NEJMoa010307

Listen to Dr. Weingart (@emcrit) tale with the author himself in a two-part interview:

Podcast 054 – Dr. Rivers on Severe Sepsis – Part I

https://emcrit.org/emcrit/rivers-sepsis-i/

Copy and paste this URL into your WordPress site to embed

Podcast 055 – Dr. Rivers on Severe Sepsis – Part II

https://emcrit.org/emcrit/rivers-sepsis-ii/

Center for Disease Control sepsis information:

https://www.cdc.gov/sepsis/clinicaltools/index.html

Dutch PHANTASi trial:

https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(17)30469-1.pdf

Episode 35-The Last Frontier with Dave Aromin

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:

https://www.customink.com/fundraising/guardianflightalaska


https://www.echoheliops.org/stacie-morse-education-scholarship

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.

Episode 34-HEMS

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:

https://www.ems1.com/air-medical-transport/articles/1589630-How-to-decide-when-to-call-an-air-ambulance/

The costs of air ambulance use:

https://www.npr.org/sections/health-shots/2018/09/25/647531500/taken-for-a-ride-doctor-injured-in-atv-crash-gets-56-603-bill-for-air-ambulance

Using a standardized handoff method and MIST:

http://www.naemsp-blog.com/emsmed/2017/7/27/the-ems-ed-handoff-a-critical-moment-in-patient-care

The National Air Medical Memorial:

http://www.airmedicalmemorial.com

Episode 33-When EMS Fails


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:

https://www.ems1.com/suspension/articles/393632048-Video-Man-struck-killed-by-car-after-EMTs-mocked-released-him/



Episode 32: One Medic, or Two?

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:

https://www.nejm.org/doi/full/10.1056/NEJMoa040325

Classic Journal Review: The OPALS Study

This includes an excellent breakdown by our friends at www.rebelem.com!

OPALS study for trauma:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2292763/

The Rapid Emergency Medicine Score and the potential for EMS:

https://www.jems.com/articles/2018/08/using-the-rapid-emergency-medicine-score-to-zero-in-on-ems-quality.html

Don't forget to like and rate us on your favorite podcast outlet!

Episode 30-Mental Health and Heroism

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:

www.yogaforfirstresponders.org

Episode 29- The Work IS Different with Michael Greco of FDNY EMS

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.

Episode 28: Managing Millennials with Tyler Christifulli

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

T: OverrunEMS

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