Épisodes

  • Episode #100 Decision Fatigue

    Episode #100 Decision Fatigue
    Mar 31 2021

    Ashley Voss-Liebig, RN, BSN, CCRN is the Division Chief for Clinical Performance and Education in Travis County Texas. She is a senior flight nurse and helicopter rescue specialist with STAR Flight. Her research interests include Medical Education, POCUS, Human Performance. She is @ashleyliebig on Twitter
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    26 min
  • Episode #92 TacticalTrauma19 Wrap-Up Episode Day 2

    Episode #92 TacticalTrauma19 Wrap-Up Episode Day 2
    Oct 12 2019
    This episode is a wrap up covering the highlights from the Tactical Trauma international conference on pre-hospital critical care and trauma. This conference emphasizes tactical medicine, with a panel of experts speaking throughout the 2 days. 0:10 – Introduction to day 2 wrap up 0:40 – Introduction of the panel 1:15 – Mike Abernethy wraps up his session as a moderator on Day 2. Takeaways include Michael Lauria’s discussion on the preoccupation with protocols and guidelines. 2:45 – Three basic concepts include speed, simplicity, and coordination of care. Tactical medicine boils down to how efficiently one can perform these three tasks using evidence based medicine. Take the lessons learned from the military medicine, and a lot of them can be applied to civilian EMS and in-hospital care. 5:30 – One thing to add, is being able to do the basics very well. These basic skills will lay the foundation for new advanced technologies and interventions. 7:00 – Discussion on Mike Klumpner’s talk on medical best practices at MCI’s. The phrase “Just because you can, doesn’t mean you should” is discussed among the panel members. Being able to look at these mass casualty events, their injuries, and intervention with simplistically is the key. An example here includes an anecdote regarding a vascular neck injury, and the ability to ask “Am I making a difference, or am I delaying definitive care?” 9:30 – The panel discusses the criticism of triage in an MCI setting during day 2. One example given is that during most MCI’s, the triage tags were not used including the Boston Marathon bombing, where triage had to ‘go out the door’. Another example is the way the walking wounded are huddled into a corner and sometimes forgotten, while they may be gravely injured as evidenced in the Manchester bombing. 11:40 – FDNY’s new triage protocols include any penetrating injuries between the clavicle and the pelvis are immediate red tags. 12:15 – Breakout sessions with LEO’s who discussed the medical care of the K9’s. 13:30 – The point on situational awareness with the K9 colleagues is discussed. This includes muzzling them early if gravely injured and in danger. 13:45 – Anesthesiology talks about how dogs have a fenestrated chest cavity, and its importance with a tension pneumothorax. The end result is that the resulting obstructive shock may be worse in dogs. 15:00 – Ketamine takes a hit when it comes to pain control with K9’s for multiple physiologic reasons. Morphine IM 30-50mg was preferred for K9 pain control. 15:35 – Currently, it is a felony in the USA to provide ALS to animals if you are not a veterinarian. Propositions for exclusions for EMS workers trained in animal care are in the works right now. One anecdote is during a NC MCI, kid pools were filled with ice for the explosives K9’s, drawing a parallel to firefighter rehabilitation. 18:05 – Psychosocial aspects when providing medical care is discussed along with PTSD learning points. While feelings of anger and hostility towards your patient may be natural, providers must be able to accept that and continue to give medical care. 19:35 – Learning points in PTSD. One interesting finding was that those with minor injuries who received early intervention developed worse PTSD when compared to those with severe or no injuries. This raises questions on mandatory Critical Incident Stress Management, and how it should always be voluntary. 21:05 – Best practices after tough calls in EMS. Debriefing, assessing for safety, and assuring readiness for the next job are the top priorities. Being able to spend time with your colleagues, who have been through similar experiences versus mandatory CISM is discussed as well. 23:15 – The longer people stay in lockdown during MCI’s, the more likely they are to develop PTSD. Data coming out is showing that school lockdowns are causing PTSD in pediatrics. 24:50 – ‘Just culture’ is discussed, as is the importance of making system level changes to prevent errors. Most of the time, it is organizational culture that leads to mistakes, and not just individual mistakes. 26:10 – No non-discoverable mistakes exist in EMS, as opposed to hospital-based medicine. 26:55 – Takeaways from afternoon lectures including penetrating trauma with Dr. Tom Koenig, tactical medicine in mass casualty events with Dr. Matthew Lengua, OB trauma, and blast injuries. 27:30 – Resuscitative hysterotomies in Finland, and other advanced procedures done quickly and in austere environments. Discussing the decision gap, which the is the time from when the decision to perform a critical procedure is made until when that procedure is performed. 33:30 – Advances in resuscitative hysterotomies and thoracotomies, and there are now clear indications for both. However, this does not mean that Top Cover should be eliminated. 34:00 – Takeaways from blast injuries and penetrating trauma, specifically to the ...
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    50 min
  • Episode #91 TacticalTrauma19 Wrap-Up Episode Day 1

    Episode #91 TacticalTrauma19 Wrap-Up Episode Day 1
    Oct 12 2019
    This episode is a wrap up covering the highlights from the Tactical Trauma international conference on pre-hospital critical care and trauma. This conference emphasizes tactical medicine, with a panel of experts speaking throughout the 2 days.   0:10 - Introduction of the conference 0:45 – Introduction of the expert panel 1:25 – Reflecting on the Las Vegas Shooting. Description of the original triage station which was not setup for an MCI with major trauma. Severely injured patients were kept on scene for approximately 45 minutes, due to unknown location of gunshots being fired. 2:45 – A big takeaway from this session is to assign a civilian to each patient, as many are willing to help. This way there is someone watching every patient who could report on their overall status (ie. Doing well vs deteriorating), freeing up medically trained resources for the most critical patients. Included in this talk was a discussion in how to involve and empower bystanders, as the first responders may not be on scene within minutes. 4:30 – The concept of an “immediate threat vacuum” is discussed, and defined as a period of time where victims are not being treated by EMS. Currently, this remains an opportunity for improvement. 5:00 – Military success rests on the fact that everyone is trained on tactical casualty care, thus allowing that vacuum to be filled. 5:45 – Hemorrhage control for the bystander needs to continue to be emphasized. A major campaign in America is Stop the Bleed, which emphasizes basic bleeding control techniques for the general public. This has also raised awareness for bleeding control kits, which are now readily available in certain public locations (ie. Schools, airports) Link: https://www.stopthebleed.org 6:15 – Studies into casualties were not done until quite recently, where experts were able to analyze drills and incidents to create real timelines for casualties. It was found that victims were not surviving with current protocols, indicating a need for change. There is now widespread access to data regarding specific wounds and their prognostic factors. 7:15 – A reflection of the Pulse nightclub shooting shows that there may have been fatalities due to decisions that came under fire, as there was previously not much data available to study and prepare adequately. 8:00 – A quick discussion on how pre-hospital providers must be prepared for anything that can occur out of hospitals. There is a quick reminder that not all hot-zones are created equal, therefore every environment is different and professionals must train and adapt to this. 8:35 – Some internet searches have revealed that terrorists are using response tactics to learn and improve their terror plans. 9:30 – Brief reminder on how expanding on experience can come in the form of extensive training, along with length of service. 10:00 – Summary of Michael Lauria’s presentation on Emergency Action Drills. This is adapting the way we train to optimize response and link that to subsequent patient outcomes. One way is to look at how other fields train for high risk scenarios, such as the military and the aviation industry. This presentation looked at the medical side of training, and the opportunity for improvement in training 11:00 – Discussed here are the steps for developing ERADs. 1. Identifying time sensitive threats that need to be addressed first (ie. Massive exsanguination, difficult airway). 2. Looking to literature, and coming up with solutions to these threats. 3. Engraining those steps in our mind during training. This has worked well for other professions in their high-risk trainings (aviation, military combat). This shows the importance of training like you fight, so you can fight like you trained when it comes time for that initial reaction. 15:30 – Wrap-up of Mark Forrest’s preventable deaths by exsanguination. The presentation revisited the topics that had no research, including Hydrogel technology and others that need further research. The bottom line takeaway is stopping the bleed with basic techniques has been proven to save lives, while other technologies may be in the horizon. 17:12 – iTClamp use in head and neck trauma has been shown to be fairly effective in studies, while it performed poorly compared to CAT Tourniquet in the lower extremities. However, 7.5% of military wounds are above the neck and result in very high mortality. The iTClamp has shown success in these situations. One link to a study on animal models: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3786550/ 18:05 – Brief update on Junctional hemorrhages. Multiple devices have been shown to be effective in the lab, however their field application has been limited by weight, time, training. SAM has seemed to be the most popular anecdotally. Wound packing and close monitoring is likely the most effective method at the moment. 18:50 – Dr. Kate Prior’s presentation on leadership in a team-based setting with ...
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    26 min
  • Episode #90 2019 NYS ALS Collaborative Protocol Update

    Episode #90 2019 NYS ALS Collaborative Protocol Update
    Sep 8 2019

    As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth.


    It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves.

    New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better. 

    Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

     
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    43 min
  • Episode #76 Wrap-up Day 2 #FAST19 @FlightBridgeED

    Episode #76 Wrap-up Day 2 #FAST19 @FlightBridgeED
    May 9 2019

    The second iteration of FlightBridgeED's prehospital conference does not disappoint.  The second day brought thought provoking concepts and a great review of critical syndromes that we don't often encounter.  The challenging topics of shame in EMS and process improvement were also tackled.

     

    For more information on this year's conference check out the website: https://www.flightbridgeed.com/index.php/fast-19

    @FlightBridgeED #FAST19

     

    Per usual, we assembled an all star panel to discuss the highlight's of the day's event. The panel included:

     

    Michael Perlmutter @DitchDoc14

    Cynthia Griffin @CMGrffn

    Samuel Ireland @ireland_sam1

    Billie Sell @flight_sell 

    And your guest host, Andrew Merelman @amerelman

     

     

    Please subscribe to the podcast on your favorite podcast platform, iTunes, Spotify, Google Play, etc.

     

    Check out the website at www.emsnation.org and follow us on Twitter @EMS_Nation

     

    If a topic or idea you heard on the podcast ignited some curiosity or deeper thought we'd we'd love a 5 star review on iTunes to help spread our mission of EBM in EMS!
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    44 min
  • Episode #75 Wrap-up Episode #FAST19 Day 1 @FlightBridgeED

    Episode #75 Wrap-up Episode #FAST19 Day 1 @FlightBridgeED
    May 8 2019

    The second iteration of FlightBridgeED's prehospital conference does not disappoint.  The first day was filled with not only thought provoking lectures on the bleeding edge of prehospital medicine but also insightful discussions about mental health, peer support and decision fatigue. 

     

    For more information on this year's conference check out the website: https://www.flightbridgeed.com/index.php/fast-19

    @FlightBridgeED #FAST19

     

    Per usual, we assembled an all star panel to discuss the highlight's of the day's event. The panel included:

     

    Rebekha Spratt (aka Bex) @medibrat

    Michael Perlmutter @DitchDoc14

    Andrew Merelman @amerelman

    Michael Brown @FireMedicFPC

     

    And your host, Faizan H. Arshad @emscritcare

     

     

    Please subscribe to the podcast on your favorite podcast platform, iTunes, Spotify, Google Play, etc.

     

    Check out the website at www.emsnation.org and follow us on Twitter @EMS_Nation

     

     

     

     
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    1 h et 15 min
  • Ep #73 EMS Grit- Resilience, Stigma & Self Care in Prehospital Medicine #EMSWorldExpo2018

    Ep #73 EMS Grit- Resilience, Stigma & Self Care in Prehospital Medicine #EMSWorldExpo2018
    Jan 31 2019

    An in depth and personal interview with Brian LaCroix, president of Allina health who has helped develop the EMSgrit.org website.  Bringing a toolkit to mental health and helping develop the core attributes of Resilience and Self care while mitigating social stigma.
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    39 min
  • Ep #72 Paramedic Degree Programs - Propelling the Profession into the Future #EMSWorldExpo2018

    Ep #72 Paramedic Degree Programs - Propelling the Profession into the Future #EMSWorldExpo2018
    Jan 31 2019

    Join us as we dig into this controversial conversation on paramedic degree programs.  This is a joint position statement from the National Association of EMS Educators, The National EMS Management Association, and the International Association of Flight and Critical Care Paramedics.  Please find the position paper here:

     

    https://www.emsworld.com/sites/emsworld.com/files/2018-10/joint_position_statement_on_.pdf
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    50 min