Podcast — The Overrun

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

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/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.

Jan 23

Jan 23 Episode 106: EMS Career Ladders

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.

Nov 5

Nov 5 Episode 104: Dan Gerard and Whole Blood

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.

Aug 22

Aug 22 Episode 102: Jason Patton from Fire Department Chronicles

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

Jul 18

Jul 18 Episode 101: Death Notifications with Steph Leather

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.

Jun 21

Jun 21 Episode 100 (!): Dr. Mark Merlin on Where We've Been and Where We're Going

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?

Apr 12

Apr 12 Episode 98: Kate Bergen and the Rosies

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.

Feb 19

Feb 19 Episode 96: Chief John Moon and Freedom House EMS

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

Jan 6

Jan 6 Episode 95: Haney Mallemat and Medicine in Social Media

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.

Oct 31

Oct 31 Episode 92: American Sirens with Kevin Hazzard

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.

Oct 14

Oct 14 Episode 91: Racism in EMS with Dr. Jamie Kennel

Conference, Controversy, Interview

Dr. Jamie Kennel is a paramedic and EMS educator in Oregon that focuses on the role of racism in EMS. His researchrecently won the Research Award at the 2022 EMSWorld and has important insights into our unconscious biases in the field. Take a listen and let us know what you think. Do our biases work against us?

Aug 22

Aug 22 Episode 89: A Thriving Wage with Greg Friese

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

Jun 27

Jun 27 SPECIAL: 100,000,000 Little Things (with GLAM)

Anna Ryan

GLAM Crossover, WTAF?!, Interview

GLAM is back, taking on the aftermath of Roe v. Wade. Jess, Anna, and their guest Judyth Brown have a multigenerational conversation about women’ health and rights, where we go from here, and how we can get involved.

Jun 6

Jun 6 Episode 87: Abortion, Roe, and EMS medicine with Natalie Zink

https://www.facebook.com/SaintfisherChurchofEBM/

Controversy, FOAMed, Health and Safety, Interview, WTAF?!

Natalie Zink is a paramedic and medical student in Georgia who speaks extensively on women's rights and the medical treatment of abortion. Her work can be found in EMSWorld and in other publications. This episode, recorded May 22, 2022 discusses the leaked Supreme Court brief suggesting the overturn of 1973's Roe v. Wade and 1992's Casey v. Planned Parenthood. Ed and Natalie discuss what field providers can expect and how to treat abortions in the field. This episode is wide-ranging from the logistics of certain legislation to how it effects healthcare providers. Countries such as Poland have attempted similar legislation to no avail. Abortion is a safe and (currently) legal intervention that will occur regardless of the current laws. It is important that EMS and pre-hospital providers know how to treat these patients and what they can expect moving forward should this case become law.

Apr 11

Apr 11 Episode 84: So, You Want To Be A MIlitary Medic?

Caroline Schwester

Interview, Medicine

If you've been anywhere in this world the last few weeks, you know what's been going on in Ukraine. Once again, military medicine has taken front row. But what actually is military medicine about? What are some of the misconceptions? And what can we as civilians take away from our colleagues in service?

On this episode, Dan and Ed are civilians talking medicine in the military to Dr. Andrew Fisher, MAJ USA, and the namesake of the Saint Fisher Church of Evidence Based Medicine; and our good friend Peter D'Antuono, who served in combat as a medic with the 173rd Airborne Brigade. We get to shine a light on something not many civilians get to hear about...and why it's important.

Check out the Church here:

https://sfcebm.com

Mar 21

Mar 21 Episode 83: Fundamentals of Bag Mask Ventilation with Rommie Duckworth

https://www.hmpgloballearningnetwork.com/site/emsworld/original-contribution/edge-there-better-grip-face-mask-ventilation

Airway Management, FOAMed, Interview

One of the most misunderstood pieces of equipment we have is the bag valve mask. Easy to operate, but hard to master, it’s one of the fundamental skills we need to master.

Rommie Duckworth is a nationally-known paramedic and educator in Connecticut who is truly passionate about education and ventilation, and Dan gets to pick his brain and talk about what really matters when we have to breathe for our patients who can’t do it for themselves.

Check out Rommie here:

https://romduck.com

If we’re talking airway or ventilation, Dr. Jim DuCanto isn’t far from the discussion. We talk about his method of BVM grip in the episode, and you can learn more here:

Here’s a paper Dan did with some colleagues showing smaller sized BVMs gave a more physiologically appropriate tidal volume and pressure:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7234703/

The Refresh 2021 program is still available until March 31…..EMTs and Paramedics should jump on this, it’s totally FREE!

https://www.prodigyems.com/refresh2021

Jan 16

Jan 16 Episode 81: Staying Cool When the Heat is On with Dr. Mike Lauria

If you were at the National Association of EMS Physicians Conference this past week, you would have been able to see Dr. Michael Lauria speak. Mike is a USAF veteran, Pararescueman, flight paramedic, and currently an emergency medicine physician in the US. He has appeared on the EMCrit podcast and numerous others to talk about stress and managing it in the field of medicine.

Dan got to sit with him and discuss how keeping cool on scene in stressful situations actually is better for you and your patients, some simple techniques to use, and why we need to incorporate stress inoculation into all our EMS training.

The stuff we talked about is proven to help you think more clearly and function better when things are going into the weeds....it's definitely worth the time!

Jul 6

Jul 6 Episode 74: The FDNY*EMS Struggle with Michael Greco