Episode 108: DEI in EMS with Dr. Tristan Glenn and Dr. Alicia Rouff

Episode 108: DEI in EMS with Dr. Tristan Glenn and Dr. Alicia Rouff

Ed Bauter
Controversy, Interview, Medicine, Mental Health

A Block

 

Dr. Tristan Glenn discusses diversity, equity, and inclusion (DEI) in the context of EMS. He emphasizes the importance of understanding and valuing individual identities and lived experiences. Microaggressions are explored as harmful behaviors that communicate negative appraisals of individuals. The lack of diversity in EMS is highlighted, and the need for purposeful recruitment and community engagement is discussed. Dr. Glenn suggests embedding DEI principles throughout the entire organization and utilizing technology, such as mixed reality simulations, for training. Overcoming resistance to DEI initiatives requires cultivating a consciousness of the impact each individual has on creating an equitable and inclusive environment.

 

Takeaways

 

DEI involves understanding and valuing individual identities and lived experiences.

Microaggressions are harmful behaviors that communicate negative appraisals of individuals.

Recruitment and community engagement are essential for increasing diversity in EMS.

Embedding DEI principles throughout the organization and utilizing technology can support DEI initiatives.

Overcoming resistance to DEI requires cultivating a consciousness of the impact each individual has on creating an equitable and inclusive environment.

 

B Block

 

Dr. Alicia Rouff joins the podcast to discuss diversity, equity, and inclusion (DEI) in emergency medicine and EMS. The conversation explores the current state of DEI in the field, the challenges faced by underrepresented groups, and the need for proactive change. The importance of recruitment and creating opportunities for people of color in EMS is highlighted. The discussion also emphasizes the importance of cultural understanding and respect when interacting with patients from diverse backgrounds. The episode concludes with a message of showing up as your authentic self and promoting kindness in healthcare.

 

Takeaways

 

DEI in emergency medicine and EMS is an ongoing challenge that requires proactive change.

Recruitment and creating opportunities for people of color in EMS is crucial for increasing diversity in the field.

Cultural understanding and respect are essential when interacting with patients from diverse backgrounds.

Showing up as your authentic self and promoting kindness in healthcare can make a positive impact.

 

Episode 107: Cardiac and Non-Cardiac Chest Pain with Dr. Mike Berkenbush

Episode 107: Cardiac and Non-Cardiac Chest Pain with Dr. Mike Berkenbush

Ed Bauter
Interview, Chest pain

Summary

 

Dr. Mike Berkenbush joins the podcast to discuss the challenges in EMS education on differentiating chest pain. The conversation highlights the need for a broader approach to chest pain, beyond just focusing on heart attacks. The importance of field impression and open-ended questions in assessment is emphasized. The discussion also explores the physiological differences in chest pain presentation and the potential mimics of chest pain, such as pericarditis and aortic dissection. The role of honesty and patient education, as well as the potential value of point-of-care troponin testing and AI in EKG interpretation, are also discussed.

 

Takeaways

 

EMS education should focus on a broader approach to chest pain, beyond just heart attacks.

Field impression and open-ended questions are crucial in assessing chest pain.

Physiological differences and potential mimics of chest pain should be considered.

Honesty and patient education are important in managing patient expectations.

Point-of-care troponin testing and AI in EKG interpretation have potential value in pre-hospital care.

 

Chapters

 

00:00 Introduction and Background

00:42 The Problem with EMS Education on Chest Pain

03:03 Recognition of Pre-Hospital Care in Cardiac Cases

04:01 Focus on Time-Sensitive Interventions

05:00 The Need for a Broader Approach to Chest Pain

06:07 The Challenge of Teaching Differential Diagnosis

07:03 Guiding EMTs in Assessing Chest Pain

08:13 The Importance of Field Impression

09:00 The Dangers of Casting a Wide Net

10:16 Physiological Differences in Chest Pain Presentation

11:19 Mimics of Chest Pain: Pericarditis and Aortic Dissection

12:25 Other Mimics: Cholecystitis and Pneumonia

13:00 Differentiating Chest Pain from Other Conditions

14:14 The Importance of Describing Types of Pain

16:11 The Role of Open-Ended Questions in Assessment

18:07 The Challenge of Teaching Assessment Skills

19:06 The Impact of EMS Communication on Patient Expectations

20:28 The Importance of Honesty and Patient Education

22:43 The Potential Value of Point-of-Care Troponin Testing

25:28 The Role of AI in EKG Interpretation

26:49 The Potential for BLS Providers to Perform 12-Lead EKGs

27:11 Conclusion

 

https://www.sciencedirect.com/science/article/pii/S2773232023000081

 

https://www.sciencedirect.com/science/article/pii/S0735675721000279

 

 

Then, Ed and Dan discuss the challenges and considerations surrounding the assessment and treatment of chest pain by BLS providers. They explore the tendency to over-triage chest pain cases and the need for a more nuanced approach. They emphasize the importance of field provider information in guiding patient care and highlight the role of EMS in the overall healthcare system. The conversation also touches on the need for ongoing learning and skills development, as well as the value of knowing the receiving facility. The episode concludes with final thoughts on the topic.

Takeaways

  • Avoid over-triaging chest pain cases and consider a more nuanced approach to differential diagnoses.

  • Field provider information is crucial in guiding patient care and can make a difference in the patient's trajectory through the emergency department.

  • EMS providers should recognize their role in the healthcare system and the importance of their assessments and findings.

  • Continued learning and skills development are essential for providing better care to patients.

  • Knowing the receiving facility and building relationships with the staff can improve patient outcomes.

  • Balancing the fear of litigation with effective assessment is important, and acting in the best interest of the patient is key.

  • BLS providers are expected to know more and do more in the evolving healthcare landscape.

  • Choosing the right center for patients based on their needs and available resources is crucial.

  • A thorough assessment, understanding the patient's story, and considering associated symptoms are essential in evaluating chest pain cases.

 

Episode 106: EMS Career Ladders

Episode 106: EMS Career Ladders

Ed Bauter
Interview

Dr. Peter O'Meara discusses the concept of paramedic practitioners and the need for higher education and professional recognition in the field. He compares paramedic practice in the US and Australia, highlighting the similarities in patient populations and the importance of a unified profession. The attrition rates and lack of a career ladder in the US are identified as issues that can be addressed through education and professional development. The role of NEMSAC and previous recommendations for degree programs are discussed, as well as the opposition from organizations like NAEMT. The importance of having a voice and separating paramedics from agencies and the need for modernization in EMS is emphasized. The conversation concludes with discussing paramedic terminology in Australia and the significance of publishing and discussing these topics.

  • The concept of paramedic practitioners and the need for higher education and professional recognition in the field

  • Comparison of paramedic practice in the US and Australia, highlighting similarities and the importance of a unified profession

  • The attrition rates and lack of career ladder in the US can be addressed through education and professional development

  • The importance of having a voice for paramedics and separating paramedics from agencies

Then, 

In this conversation, Louis Imperatrice, the National Manager of Clinical Excellence for DACA, discusses the absence of a clinical ladder and degrees in paramedicine, which he believes is detrimental to the field. He highlights the limitations of EMS and the lack of upward movement, leading to the loss of professionals. The fragmented nature of EMS systems and the need for change are also discussed. Imperatrice emphasizes the need for federal funding and lobbying in EMS, as well as the importance of modern-day leadership and education. He suggests the implementation of clinical and management tracks in EMS education to improve the industry.

Takeaways

  • The absence of a clinical ladder and degrees in paramedicine is detrimental to the EMS field, leading to a lack of upward movement and the loss of professionals.

  • EMS systems are fragmented, and there is a need for change and standardization.

  • Federal funding and lobbying are necessary to support EMS and promote necessary changes.

  • Modern-day leadership and education are crucial in improving the EMS industry.

Episode 105: 2023 Year in Review

Episode 105: 2023 Year in Review

Ed Bauter
Drugs, FOAMed, Medicine, WTAF?!

Summary

In this episode, Ed and Dan discuss several topics related to medicine and EMS in 2023. They start by reviewing a study on the use of nitroglycerin in acute pulmonary edema and congestive heart failure, highlighting its positive effects on blood pressure and oxygenation. They then move on to a comparison of succinylcholine and rocuronium in rapid sequence intubation (RSI), concluding that the choice of paralytic agent may not significantly impact outcomes. They also discuss a case in which a paramedic impersonated a doctor in Louisiana, highlighting the need for patient advocacy and responsible clinical practice. They conclude by expressing excitement for future episodes and inviting listeners to share their stories.

Takeaways

Nitroglycerin can be effective in improving outcomes in acute pulmonary edema and congestive heart failure.
The choice between succinylcholine and rocuronium in RSI may not have a significant impact on first pass success rates.
Patient advocacy and responsible clinical practice are crucial in preventing incidents of impersonation and ensuring patient safety.
Hindsight is 20-20, and it is important to learn from past mistakes and continuously evolve in the field of medicine and EMS.

Chapters

00:00 Introduction
00:26 Discussion of Nitroglycerin in Acute Pulmonary Edema Link Link
11:22 Comparison of Succinylcholine and Rocuronium in RSI Link
22:34 Case Study: Elijah McClain Case Link
31:04 Case Study: Paramedic Impersonates Doctor in Louisiana Link
36:01 Conclusion and Future Plans

Episode 104: Dan Gerard and Whole Blood

Episode 104: Dan Gerard and Whole Blood

Ed Bauter
FOAMed, Interview, Trauma

Dan Gerard is the president of the International Association of EMS Chiefs, who authored a position statement in August of 2023 supporting the use of whole blood as the standard of care for hemorrhagic injury. IAEMSC joins a growing list of national and international organizations that support this change. In this interview, Ed and Dan talk to Dan Gerard who explains the rationale behind the position statement and the change they hope to make with the position statement.

IAMESC Paper can be read here

Follow The Overrun on TikTok @TheOverrun

This episode was recorded on October 30, 2023.

Episode 102: Jason Patton from Fire Department Chronicles

Episode 102: Jason Patton from Fire Department Chronicles

Ed Bauter
Interview

Jason Patton is a firefighter with 17 years of experience that discusses EMS and Firefighting misadventures on his Tiktok channel (@firedepartmentchronicles). Jason joins Ed, Jess, and Kevin to discuss how we can use social media to advance the message of EMS and improve the industry.

Follow The Overrun on IG: @OverrunProductions

Follow The Overrun on TikTok: @TheOverrun

Follow The Overrun on Youtube: Youtube.com/theovverun

Follow Jason Patton on Tiktok: @Firedepartmentchronicles

Episode 101: Death Notifications with Steph Leather

Episode 101: Death Notifications with Steph Leather

Ed Bauter
Cardiac Arrest, FOAMed, Interview

We're bad at notifying families what's happening during a cardiac arrest event. We're even worse on ourselves. The average person may see 3 or 4 dead people in their lives and EMS workers often see that many in a shift. The Overrun's new team member Steph Leather, a national speaker on death notifications and a director of a clinical psychology practice takes us through the steps to make death notifications easier on ourselves and on families of our patients.

Episode 100 (!): Dr. Mark Merlin on Where We've Been and Where We're Going

Episode 100 (!): Dr. Mark Merlin on Where We've Been and Where We're Going

Ed Bauter
FOAMed, Interview, MD1

For our 100th episode, we sat down with a friend of the show Dr. Mark Merlin of MD1 to discuss how far EMS has come in the last 5 years and where EMS might go in the next 5 years. Dr. Merlin talks about his 2009 study using the MAR method to estimate blood loss as well as the recent Emergency Medicine Match dilemma. Take a listen and let us know what you think. Has EMS gotten better in the last 5 years? What can we do to improve our practice over the next 5 years?

Episode 98: Kate Bergen and the Rosies

Episode 98: Kate Bergen and the Rosies

Ed Bauter
Interview, Mental Health

Kate Bergen is a paramedic and artist that appeared on the show in 2020 to discuss how art therapy helped her get through Covid-19. Since then, her art has been featured in national news pieces and she has been featured in national magazines raising awareness of art therapy in our modern world. Her work earned her the EMS10 award in 2020. Now with a new book in the works, she returns to show to discuss how art therapy has helped her manage her mental health since Covid, and how it has helped other people she has met along the way.

Episode 97: 2023 Resuscitation Update

Episode 97: 2023 Resuscitation Update

Ed Bauter
Cardiac Arrest, FOAMed

The gang gets back together and discusses new resuscitation data from 2022.

Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest

Question and Methods: double-blind RCT out of Denmark whether high or low arterial blood-pressure targets would be superior in preventing death or severe anoxic brain injury in comatose survivors of OHCA. Enrolled 789 patients

RePHILL Study

Question and Methods: Multicenter RCT out of the UK that investigated prehospital resuscitation using PRBCs and plasma versus normal saline to improve tissue perfusion or mortality in adult trauma patients with hemorrhagic shock.

Mike's favorite study about Refractory VFib

Question and Methods: Shock-refractory VFib remains a common occurrence during OHCA → does dual sequential defib and vector-changing defib improve outcomes in patients with refractory VF? Primary outcome measure was survival to hospital discharge; secondary outcomes termination of VF, ROSC, good neurologic outcome at hospital discharge

Head and thorax elevation during cardiopulmonary resuscitation using circulatory adjuncts is associated with improved survival

Question and Methods: Does the use of a head up device as part of a CPR bundle improve survival from OHCA?

Episode 96: Chief John Moon and Freedom House EMS

Episode 96: Chief John Moon and Freedom House EMS

Daniel Schwester
Interview

We had an amazing talk with Chief John Moon, (ret) of Pittsburgh EMS and Freedom House Ambulance, one of the first paramedics in the United States.

If you don't know the story of Freedom House, you should. Before Seattle, Miami, and yes, even Squad 51, Freedom House was providing bleeding-edge care to the citizens of the Hill and greater Pittsburgh, in a world where they were not regarded as equals in emergency services or healthcare.

With the guidance of Dr. Peter Safar and Dr. Nancy Caroline, (yes, THAT Dr. Caroline) Freedom House showed that timely EMS intervention contributed to improved outcomes.

We owe them all a debt that cannot be repaid.

Buy the book here:

https://www.amazon.com/American-Sirens-Incredible-Americas-Paramedics/dp/0306926075/ref=sr_1_1?crid=3K2DH5O0LSFHY&keywords=american+sirens&qid=1676859470&sprefix=american+sirens%2Caps%2C96&sr=8-1

Episode 95: Haney Mallemat and Medicine in Social Media

Episode 95: Haney Mallemat and Medicine in Social Media

Ed Bauter
Cardiac Arrest, Controversy, Interview

Dr. Haney Mallemat (@criticalcarenow) joins Dan to discuss how social media can influence medicine and how recent medical events have shined a light on CPR and bleeding control.

In a matter of a few days, the world was shocked to hear that actor Jeremy Renner had been traumatically injured while on vacation in Nevada and Buffalo Bills player Damar Hamlin experienced a cardiac arrest on the field. These two tragic events have shown the world, albeit briefly, how important early CPR and bleeding control are to survival.

Episode 94: Better CPR at the end of the year with Josh Lupton and Ken Milne

Episode 94: Better CPR at the end of the year with Josh Lupton and Ken Milne

Ed Bauter
Cardiac Arrest

We end the year with 2 great interviews about cardiac arrest. Josh Lupton is a physician in Oregon who found in 2021 that there might be an ideal number of rescuers for OHCA. Hint: It's more than you think.

Then Ken Milne joins us from the Skeptics Guide to Emergency Medicine to discuss whether heads-up CPR with a commercial device is ready for prime time.

This is our last episode of the year and we wanted to thank everyone for listening. Check out the website, subscribe to the podcast, and keep an eye out during 2023. Lots of more exciting stuff coming!

Episode 93: Hanging with The EMS Avenger

Episode 93: Hanging with The EMS Avenger

Daniel Schwester

If you watch TikTok, and let's be honest, you all do; you know The EMS Avenger from his short posts on evidence-based medicine and all around being a good egg as a clinician.

Dan got to sit down with him (aka: Jimmy Apple) and got to talk about social media in EMS, likes and dislikes, and the role of social media like TikTok in making clinicians better, not just passing time while posted!

Episode 92: American Sirens with Kevin Hazzard

Episode 92: American Sirens with Kevin Hazzard

Daniel Schwester
Interview

Kevin Hazzard is a paramedic and author who wrote the book A Thousand Naked Strangers, detailing his time as a ground paramedic in Atlanta. He's back with a new story, one that you absolutely need to read.

American Sirens: The Incredible Story of the Black Men who Became America's First Paramedics is the story of a handful of Black men from Pittsburgh who were chosen to become paramedics. It's a story about perseverance, grace under pressure, and dignity that every EMS clinician should read. We were lucky to have Kevin on to speak about the book and his experience in telling the story, and why it matters.

Episode 89: A Thriving Wage with Greg Friese

Episode 89: A Thriving Wage with Greg Friese

Ed Bauter
Controversy, Interview

Greg Friese is the Editorial Director of EMS1.com among other things. He brings a very interesting view of how EMS providers should be compensated for the work they do. In January of 2022, he wrote a piece discussing the importance of EMS providers not just receiving a living wage, but rather for EMS workers to make much greater than a living wage. He recently wrote about the dismal raise that Austin EMS providers received to provide a voice to workers who felt voiceless.

Greg's Bio

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