This episode is a follow-up to our last episode about the 2025 AHA updates. Our guest is Remle Crowe, one of the authors of section 4 of the 2025 AHA updates, which specifically addresses systems of care. The conversation delves into the complexities of resuscitation practices in emergency medical services, highlighting the stark reality that many resuscitations do not yield favorable outcomes. It emphasizes the importance of evidence-based practices while also addressing the emotional burden placed on EMTs when delivering difficult news to families. The discussion encourages a holistic view of patient care that considers both clinical evidence and the human impact of medical decisions.

Takeaways

Many resuscitations do not have a favorable outcome.Best practices suggest resuscitating in place.EMTs face emotional challenges in delivering bad news.Training often glosses over difficult scenarios.Ignoring uncomfortable topics does not make them go away.Evidence-based practices can still lead to harm.Communication is key in challenging situations.The emotional toll on EMTs is significant.Real-life scenarios often differ from textbook cases.Holistic patient care must consider emotional impacts.

Keywords

resuscitation, EMT, best practices, emotional impact, patient outcomes, evidence-based medicine, termination on scene, communication, healthcare challenges, trauma care

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 Are we performing CPR on people we know will not benefit—and is that causing more suffering than saving?

With new evidence, emerging ethical dilemmas, and shifting expectations around end-of-life care, this episode forces us to examine long-held assumptions and look at CPR through a more honest, patient-centered lens.

 Link to the official AHA 2025 summary:https://cpr.heart.org/-/media/CPR-Files/2025-documents-for-cpr-heart-edits-posting/Resuscitation-Science/252500_Hghlghts_2025ECCGuidelines.pdf?sc_lang=en

• CPR is not universally life-saving—and often causes devastating harm in the wrong populations.
• Ethical medicine requires avoiding meaningless interventions that prolong suffering.
• Patients with severe dementia, frailty, terminal illness, or irreversible decline see almost no benefit from CPR.
• Age, cognitive status, and functional baseline must influence our decisions.
• The culture of “CPR for everyone” is being replaced by evidence-driven, compassionate care.
• EMS providers must balance clinical realism with patient autonomy and dignity.
• The new AHA updates demand a dramatic shift in how clinicians communicate and act during cardiac arrest.

If this conversation challenged your thinking, share it with a colleague.Then join us for: Monday Afternoon Journal Club on YouTube Leadership & clinical education at OverrunEMS.com Weekly EMS insights on TikTok, Instagram, and LinkedIn @OverrunEMS

In this episode of the Overrun Podcast, hosts Ed Bauter and Dan Schwester engage with Josh Kimbrell and Judah Kreinbrook to discuss their recent research on cardiac arrest, focusing on the critical delays in defibrillation and chest compressions. The conversation explores the implications of these delays, the phenomenon of rearrest, and the importance of a tactical pause in emergency medical services (EMS) to optimize patient care. The discussion emphasizes the need for quality improvement in pre-hospital care and the potential for future research to enhance outcomes for patients experiencing cardiac arrest.

Takeaways

Delays in defibrillation and chest compressions are significant.A substantial percentage of patients may rearrest during transport.Tactical pauses can optimize patient care before moving them.Quality improvement in EMS is essential for better outcomes.Understanding the factors leading to rearrest is crucial.Monitoring and measuring patient responses during transport is vital.The research highlights the fragility of patients post-ROSC.Engaging with medical directors can lead to better protocols.The need for further research in pre-hospital cardiac arrest care is evident.Awareness of the risks associated with patient movement is critical.

Sound bites

“We have to admit there is a problem.”“We should consider a bundle of care here.”“We need to pay attention to our patients.”

Keywords

cardiac arrest, defibrillation, chest compressions, rearrest, EMS, patient care, emergency medicine, quality improvement, pre-hospital care, medical research

Chapters

00:00 Introduction to the Study and Participants01:08 Exploring Post-Arrest Care and Delays04:14 Analyzing Rearrest Patterns and Defibrillation Delays11:37 Understanding Movement and Its Impact on Rearrest17:32 Practical Implications and Future Directions19:02 Understanding Physiological Instability in Patients19:57 The Importance of Tactical Pauses21:53 Exploring the Role of Technology in Patient Monitoring23:46 Optimizing Patient Care Post-ROSC25:32 Navigating ECMO Guidelines and Patient Transport Decisions28:10 The Need for Research in EMS Practices30:50 Quality Improvement in Emergency Medical Services34:26 Final Thoughts on Patient Monitoring and Care

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Paper: https://pubmed.ncbi.nlm.nih.gov/40850145/

In this episode of the Overrun Podcast, hosts Ed Bauter and Dan Schwester engage with Scott Weingart to discuss critical topics in emergency medical services (EMS). The conversation covers the importance of whole blood in prehospital care, the logistical challenges of blood supply, and strategies for overcoming resistance to change within EMS systems. They also delve into advancements in defibrillation techniques, the use of pressors, and the significance of addressing burnout among EMS professionals. The episode concludes with a discussion on the potential role of ultrasound in EMS, emphasizing the need for effective tools in critical care settings.

Keywords

EMS, whole blood, defibrillation, push dose pressors, burnout, ultrasound, blood supply, logistics, critical care, emergency medicine

Takeaways

Whole blood is essential for critically ill trauma patients in the field.Logistical challenges hinder the effective use of blood in EMS.Evidence-based practice is crucial for implementing changes in EMS.Dual sequential defibrillation shows promise in resuscitation efforts.Dopamine should be phased out in favor of norepinephrine.Push dose pressors should be used judiciously and not repeatedly.Burnout is a significant issue in EMS that needs addressing.Self-care and mental health are vital for EMS professionals.Compassionate care can help combat cynicism in the field.Ultrasound technology has potential benefits for EMS, especially in IV access.

Sound bites

“Whole blood is just the ideal product.”“Stop using dopamine in EMS.”“Ultrasound should be on the buses.”

Chapters

00:00 Introduction to the Overrun Podcast03:03 The Importance of Whole Blood in EMS07:42 Logistical Challenges in Blood Supply08:35 Overcoming Resistance to Change in EMS12:13 Advancements in Defibrillation Techniques19:32 Pressors in EMS: What Works Best?25:33 The Role of Push Dose Pressors30:47 Addressing Burnout in EMS36:53 The Future of Ultrasound in EMS

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In this episode of the Overrun Podcast, Ed Bauter and Dan Schwester welcome Anthony Christian, known as Badge502, to discuss the impact of social media on EMS and medicine. They explore Badge502’s journey from EMT to social media influencer, the importance of humor and mental health in the EMS community, and the challenges of navigating social media policies. The conversation also touches on the balance between humor and professionalism, the significance of anonymization in social media posts, and the positive influence of social media on aspiring EMS professionals. Additionally, they address the issue of misinformation in the field and the phenomenon of shadow banning on social media platforms.

Keywords

social media, EMS, mental health, humor, influencer, education, policies, misinformation, shadow banning, community engagement

Takeaways

Social media has a significant impact on EMS and medicine.Humor can be a vital tool for mental health in high-stress environments.It’s essential to be mindful of social media policies in EMS.Anonymization is crucial when sharing content related to patient care.Social media can inspire new generations to pursue careers in EMS.Misinformation can spread easily on social media, requiring vigilance.Shadow banning can affect content visibility on social media platforms.Using social media for good can enhance community engagement.Balancing humor and professionalism is key in EMS content creation.It’s important to foster a supportive and positive online community.

Chapters

00:00 Introduction to Social Media in EMS01:07 The Journey of Content Creation03:30 The Impact of Humor on Mental Health08:05 Navigating Social Media Policies11:33 The Balance of Humor and Professionalism16:07 Anonymization and Ethical Considerations20:07 The Importance of Education in Emergency Response22:59 The Role of Social Media in EMS Education25:00 The Impact of Content Creation on Future Generations26:39 Navigating Misinformation in the EMS Community30:36 The Challenges of Shadow Banning and Social Media Algorithms31:43 Agency Mandated Training and Its Necessity33:07 Respecting Patient Privacy in the Digital Age36:12 Understanding Shadow Banning in Social Media

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In this episode of the Overrun Podcast, Dr. Andrew Fisher discusses the implications of using whole blood in emergency medical services (EMS), particularly in relation to trauma care and sepsis. The conversation explores the benefits and complications of whole blood transfusions, the financial challenges faced by EMS systems, and the importance of community engagement in supporting these programs. Dr. Fisher emphasizes the need for ongoing research and adaptation in EMS practices to improve patient outcomes, including the potential role of freeze-dried plasma as an alternative to whole blood.

Keywords

whole blood, EMS, sepsis, trauma care, hemorrhagic injury, freeze-dried plasma, blood transfusion, emergency medicine, patient outcomes, community engagement

Takeaways

Whole blood is a significant advancement in trauma care.There is a 4% increase in sepsis risk with each unit of whole blood.EMS should focus on treating immediate patient needs.Financial sustainability is a major concern for whole blood programs.Community support is essential for the success of EMS initiatives.Freeze-dried plasma may revolutionize pre-hospital care.EMS must take ownership of hemorrhagic control practices.Research should guide changes in EMS protocols.The cost of blood products can impact patient care decisions.Ongoing education and adaptation are crucial for EMS professionals.

Titles

The Future of Whole Blood in EMSSepsis Risks and Whole Blood: What You Need to Know

Sound bites

“We have to lobby for better EMS funding.”“Freeze-dried plasma could be a game changer.”“The evolution of EMS practices is ongoing.”

Chapters

00:00 Introduction to Whole Blood in EMS02:52 Understanding Sepsis and Whole Blood Complications05:43 The Role of Whole Blood in Trauma Care08:28 Financial Implications of Whole Blood Use11:12 Alternatives to Whole Blood in Emergency Care13:37 Future of Hemorrhagic Trauma Treatment16:10 Community Engagement and Support for EMS19:01 Conclusion and Future Directions

In this episode, Dr. Peter Antevy discusses the critical role of EMS in the early treatment of sepsis, challenging the traditional view that sepsis is solely a hospital issue. He emphasizes the importance of data-driven approaches, early intervention, and the need for EMS to adopt effective treatment protocols. The conversation highlights the potential for EMS to significantly impact patient outcomes and reduce hospital burdens by providing timely care in the field. In this conversation, Peter Antevy discusses the innovative treatment of sepsis using spray-dried plasma, emphasizing its potential to improve patient outcomes. The dialogue explores the importance of data collection in recognizing and treating sepsis, the challenges faced in implementing evidence-based practices in EMS, and the need for transparency in healthcare data. Antevy highlights the role of clinicians in bridging the gap between research and practice, advocating for progressive protocols in EMS, and the necessity of adapting to the evolving landscape of healthcare.

Takeaways

Sepsis is often misunderstood as a hospital-only issue.EMS can and should be involved in sepsis treatment.Data is crucial for demonstrating the effectiveness of EMS interventions.Early treatment of sepsis can drastically improve patient outcomes.Protocols for sepsis management in EMS are essential.The healthcare system needs to recognize the value of EMS.Fluid resuscitation and antibiotics are critical in the field.The role of EMS can alleviate pressure on emergency departments.Understanding the business side of healthcare is important for EMS.Future advancements in EMS will include more comprehensive treatment options. Spray-dried plasma could revolutionize sepsis treatment.Data collection is crucial for recognizing and treating sepsis.There is a gap between clinical practice and research.RCTs are essential for validating new treatments.High-performance CPR is a cost-effective improvement.EMS must adapt to changes in healthcare delivery.Data transparency can drive improvements in EMS.Innovative treatments require rigorous research and validation.Small agencies can implement progressive protocols without high costs.The future of EMS lies in proactive patient care beyond 911 calls.

Chapters

00:00 Introduction to Sepsis and EMS03:11 The Role of EMS in Sepsis Treatment05:47 Data-Driven Approaches to Sepsis09:05 The Importance of Early Intervention12:00 Protocols and Practices in Sepsis Management14:54 The Future of EMS in Sepsis Care26:29 Innovations in Plasma Treatment for Sepsis28:08 The Importance of Data in Recognizing and Treating Sepsis30:21 Bridging Clinical Practice and Research33:20 The Future of EMS Research and Data Collection39:06 Challenges in Implementing Evidence-Based Practices43:18 Navigating Resources in EMS for Progressive Protocols46:55 The Need for Data Transparency in EMS

In this episode of the Overrun Podcast, Ed Bauter speaks with Greg Clopp, a former paramedic turned nurse anesthetist, about the evolution and nuances of Rapid Sequence Intubation (RSI) in emergency medicine. They discuss the importance of understanding patient needs, the role of various medications, and the shift towards Delayed Sequence Intubation (DSI) as an alternative to RSI. The conversation also touches on the challenges faced by EMS professionals, the importance of patient assessment, and the potential for career growth within the industry. Greg shares insights on how to navigate the EMS landscape and the importance of having diverse options in medication protocols.

Takeaways

RSI is taken more seriously in modern practice.One size doesn’t fit all in patient care.Aggressive treatment is necessary in emergency settings.Career opportunities in EMS are limited on the East Coast.Understanding patient needs is crucial for effective treatment.Video laryngoscopy has its limitations, especially with cervical spine injuries.Push dose pressors can be beneficial in fragile patients.Diverse medication options are essential for effective care.Patient assessment should guide treatment decisions.Career pathways in EMS can lead to advanced practice roles.

Chapters

00:00 Introduction to RSI and Its Evolution03:09 The Nuances of RSI in Practice05:59 Exploring Alternatives: DSI vs. RSI09:01 The Role of Medications in RSI11:56 The Disconnect Between Field and Hospital Practices14:59 Video Laryngoscopy: Benefits and Risks18:10 Career Pathways in EMS and Nursing20:58 Final Thoughts on EMS and Career Growth

In this episode of the Overrun Podcast, Ed and Dan welcome intensivist Eddie Joe Gutierrez to discuss the use of vasopressors in emergency medical services (EMS). The conversation covers the challenges of peripheral IV access, the importance of early vasopressor administration in hypotensive patients, and the evolving understanding of fluid resuscitation in sepsis. Eddie emphasizes the significance of norepinephrine as a first-line vasopressor and compares it to phenylephrine, while also addressing the complexities of managing cardiogenic shock in the pre-hospital setting. In this conversation, Eddy Joe Gutierrez discusses critical aspects of managing shock and trauma in pre-hospital settings. He emphasizes the importance of understanding different types of shock, the role of vasopressors, and the challenges pre-hospital teams face. The discussion also covers the use of whole blood in trauma care and the growing interest in point-of-care ultrasound. Ultimately, the key takeaway is the urgency of restoring perfusion to patients as quickly as possible, with norepinephrine being the preferred vasopressor in many situations.

Takeaways

• Peripheral vasopressors are essential in pre-hospital settings.
• Doing nothing in critical situations is not an option.
• Fluid resuscitation has its limits; vasopressors may be necessary.
• Norepinephrine is preferred due to its dual action on alpha and beta receptors.
• Early administration of vasopressors can lead to better outcomes.
• The traditional approach of flooding patients with fluids is being reconsidered.
• Understanding hemodynamics is crucial for effective treatment.
• Phenylephrine may not be suitable for all patients due to its effects on cardiac output.
• Patient history is often limited in pre-hospital care, complicating treatment decisions.
• The focus should be on stabilizing the patient, regardless of the specific vasopressor used. Understanding the nuances of shock is crucial for effective management.
• Norepinephrine is often the first choice for vasopressor therapy.
• Whole blood administration can be beneficial in trauma cases.
• Point-of-care ultrasound is gaining traction but requires training.
• Pre-hospital teams face unique challenges without advanced tools.
• Restoring perfusion is the primary goal in critical care.
• The choice of vasopressor should be based on the patient’s condition.
• Effective communication between pre-hospital and hospital teams is essential.
• Training in ultrasound and other skills is evolving in medical education.
• The focus should always be on patient outcomes and safety.

Chapters

00:00 Introduction to Vasopressors in EMS02:49 Peripheral IV Access and Vasopressors05:54 Early Use of Vasopressors in Hypotensive Patients09:04 Fluid Resuscitation vs. Vasopressors in Sepsis12:00 Understanding Norepinephrine and Its Mechanism14:58 Comparing Vasopressors: Norepinephrine vs. Phenylephrine17:57 Cardiogenic Shock and Its Management20:21 Understanding Shock: A Clinical Perspective24:07 Trauma Management and Whole Blood Administration26:56 Point-of-Care Ultrasound in Pre-Hospital Settings29:13 Vasopressors: Choosing the Right Agent36:52 Restoring Perfusion: The Key Takeaway

Eddy Joe’s work can be found on Instagram @eddyjoemd

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In this episode of the Overrun Podcast, Ed Bauter and Dan Schwester engage with immigration attorney Matthew Hartnett to discuss the complex interactions between EMS professionals and ICE agents. The conversation delves into the rights of EMS workers and patients, the legal boundaries of ICE’s jurisdiction, and the importance of maintaining patient privacy under HIPAA during emergencies. Hartnett emphasizes the need for EMS workers to understand their rights and responsibilities when encountering ICE, especially in sensitive environments where medical care is provided. The discussion highlights the evolving landscape of immigration enforcement and its implications for public safety and patient care.

Takeaways

EMS workers have specific rights when interacting with ICE agents.The right to privacy under the Fourth Amendment is crucial for patients.ICE cannot enter a home without a judicial warrant.Public spaces have different privacy expectations compared to private spaces.Emergency medical situations require a delicate balance of rights and responsibilities.HIPAA regulations must be upheld even in the presence of ICE.Communication with ICE should focus on patient care and privacy.Understanding the legal framework surrounding ICE is essential for EMS professionals.The landscape of immigration enforcement is changing and may impact EMS operations.Maintaining patient confidentiality is paramount in all interactions.

Chapters

00:00 Understanding the Intersection of EMS and ICE18:02 Navigating Rights and Responsibilities in Emergency Situations

In this episode of the Overrun Podcast, Ed and Dan engage with Judyth Brown, an experienced instructional designer, to discuss the challenges and opportunities in EMS education. They explore the differences between instructing and educating, the importance of effective instructor training, and the need for a focus on entry-level competence. Judyth emphasizes the significance of integrating real-life experiences into teaching and the detrimental effects of standardized testing on education quality. The conversation also highlights the critical need for documentation training and the role of social-emotional learning in preparing EMS professionals for the field. This conversation delves into the challenges and opportunities in EMS education, focusing on the importance of social-emotional learning, the application of Bloom’s Taxonomy, and the need for a shift towards quality education over quantity. The speakers discuss the role of instructors in fostering a supportive learning environment and the necessity of adapting teaching methods to better prepare students for real-world challenges in emergency medical services.

Keywords

EMS education, instructional design, adult learning, teaching methods, entry-level competence, standardized testing, documentation training, social-emotional learning, instructor training, critical thinking, education, social-emotional learning, Bloom’s taxonomy, EMS training, instructor development, emotional intelligence, teaching methods, professional values, effective learning, instructor ego

Chapters

00:00 Introduction to EMS Education Challenges

03:03 The Role of Experience in Teaching

05:52 Identifying Effective Instructors

09:10 Defining Entry-Level Competence

12:07 The Impact of Standardized Testing

14:57 The Importance of Documentation Training

17:57 Addressing the Dumbing Down of EMS Education

21:02 Social-Emotional Learning in EMS

24:00 Conclusion and Future Directions

24:24 Overcoming Fear in Education

29:18 The Importance of Social-Emotional Learning

35:07 Understanding Bloom’s Taxonomy

43:10 Quality Over Quantity in Education

49:15 The Need for Change in EMS Education

Takeaways

The difference between instructing and educating is crucial in EMS. Instructors often lack training on how to teach effectively. Real-life experiences should be integrated into EMS education. Standardized testing can detract from meaningful learning. Entry-level competence should focus on practical skills and critical thinking. Documentation is a vital skill that is often overlooked in training. Social-emotional learning is essential for effective patient interactions. Instructors should define what they want to see in graduates. The EMS education system needs to evolve beyond outdated practices. Investing in instructor training is key to improving EMS education. Lowering the effective filter in education enhances learning. Gamification and challenging scenarios can improve engagement. Instructors must overcome their ego to facilitate learning. Social-emotional learning is crucial for professional development. Teaching values is essential for ethical decision-making in EMS. Bloom’s Taxonomy helps structure the learning process effectively. Rote memorization is insufficient for real-world application. Quality of education should be prioritized over duration. Instructors need to be aware of their own shortcomings. Change in EMS education is necessary for better outcomes.

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In this episode of the Overrun Podcast, Ed Bauter, Dan Schwester, and Dr. Michael DeFilippo discuss the recent advancements in dual sequential defibrillation for refractory ventricular fibrillation (VFib). They explore the importance of understanding the nuances between refractory and recurrent VFib, the significance of patient history in cardiac arrest situations, and the latest findings from the DOSE-VF trial. The conversation emphasizes the need for operational readiness, effective communication among medical teams, and the physics behind defibrillation techniques. The episode concludes with a discussion on the protocols for terminating resuscitation efforts and addressing concerns about equipment damage during advanced life support procedures.

Takeaways

• Dual sequential defibrillation is gaining renewed attention in emergency medicine.
• Refractory VFib requires a distinct approach compared to other cardiac arrest rhythms.
• Understanding the patient’s history is crucial in managing cardiac arrest.
• Defibrillation strategies should be tailored to the individual patient.
• The DOZ-VF trial highlights the effectiveness of dual sequential defibrillation.
• Operational readiness and teamwork are essential for successful resuscitation.
• The physics of defibrillation can impact patient outcomes significantly.
• Initial pad placement should prioritize anterior-posterior positioning.
• Communication among team members can enhance the effectiveness of resuscitation efforts.
• Concerns about defibrillator damage are minimal compared to the potential benefits.

Chapters

00:00 Introduction to Dual Sequential Defibrillation

02:36 Understanding Refractory VFib and Its Treatment

05:21 The Importance of Defibrillation Techniques

07:59 Literature Review on Defibrillation Strategies

11:01 Key Findings from Recent Studies

13:50 Implications for Practice and Future Research

20:00 Understanding Defibrillation Mechanics

25:19 Optimizing Cardiac Arrest Response

34:49 Determining Resuscitation Termination

Keywords

Dual Sequential Defibrillation, Refractory VFib, Cardiac Arrest, Resuscitation Science, Defibrillation Strategies, DOZ-VF Trial, Emergency Medicine, Pre-Hospital Care, Medical Protocols, Patient Outcomes

Paper available at: https://www.airmedicaljournal.com/article/S1067-991X(25)00002-1/fulltext

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In this year-end special episode of The Overrun podcast, Ed Bauter, Dr. Mike DeFilippo, and Dr. Michael Stone discuss five significant papers from the year that impact emergency medical services (EMS). The conversation covers non-invasive ventilation for pre-oxygenation during intubation, the early administration of adrenaline in out-of-hospital cardiac arrest, and the effectiveness of different routes of drug administration in cardiac arrest scenarios. The discussion emphasizes the importance of adapting practices based on new research findings and the need for further studies to validate these practices in various EMS settings. In this conversation, the speakers discuss multiple aspects of EMS practices, focusing on cultural differences in emergency medical services, the debate between IV and IO access during cardiac arrest, the cost-effectiveness of whole blood in trauma care, and strategies to improve cardiac arrest survival rates through training and system-level changes. They emphasize the importance of evidence-based practices and the need for ongoing education and adaptation in EMS protocols.

Takeaways

Non-invasive ventilation can reduce hypoxemia during intubation.

Practice changes in EMS can take time to implement.

Patient selection is crucial in emergency medicine.

The route of drug administration can impact survival rates.

Bundled care approaches may improve cardiac arrest outcomes.

Research findings should be adapted to local EMS practices.

Timely access to medications is critical in cardiac arrest.

Epinephrine’s role in cardiac arrest management is still debated.

Innovative studies can lead to significant changes in practice.

Cognitive aids can help guide emergency medical procedures. Cultural differences in EMS practices can impact patient outcomes.

The debate between IV and IO access in cardiac arrest is ongoing and complex.

Whole blood may offer significant cost savings and improved patient outcomes in trauma care.

Training and simulation are crucial for improving cardiac arrest survival rates.

Collaboration among different emergency services can enhance training effectiveness.

Cost-effectiveness is a key factor in implementing new EMS protocols.

Regular CPR skills assessments can lead to better patient outcomes.

Data-driven decisions are essential for EMS protocol development.

Engaging administrators with financial data can facilitate changes in EMS practices.

Continuous education and adaptation are necessary for improving EMS effectiveness.

Chapters

00:00 Introduction to Year-End Review

01:09 Non-Invasive Ventilation and Pre-Oxygenation

09:32 Early Administration of Adrenaline in Cardiac Arrest

20:24 Routes of Drug Administration in Cardiac Arrest

23:48 Cultural Differences in EMS Practices

27:41 The Debate: IV vs. IO in Cardiac Arrest

28:32 Cost-Effectiveness of Whole Blood in Trauma Care

38:57 Improving Cardiac Arrest Survival Rates

47:29 Conclusion and Future Directions

Keywords

EMS, non-invasive ventilation, pre-oxygenation, cardiac arrest, adrenaline administration, drug routes, medical research, practice change, emergency medicine, EMS, cardiac arrest, IV, IO, whole blood, trauma care, survival rates, cost-effectiveness, training, CPR

Papers: 

PREOXI: https://pubmed.ncbi.nlm.nih.gov/38869091/

Route of Administration: https://pmc.ncbi.nlm.nih.gov/articles/PMC7616768/

Cardiac Arrest Survival with Practice: https://pubmed.ncbi.nlm.nih.gov/38837166/

Cost Savings- Whole Blood: https://pubmed.ncbi.nlm.nih.gov/38591174/#full-view-affiliation-1

IM Epinephrine: https://pubmed.ncbi.nlm.nih.gov/38857847/

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 In this conversation, Dr. Devin Dromgoole discusses the evolving role of ultrasound in emergency medical services (EMS). He highlights the feasibility, cost, and training required for EMS providers to effectively use ultrasound in pre-hospital settings. The discussion covers practical applications of ultrasound, including its use in trauma, undifferentiated shortness of breath, and vascular access. Dr. Dromgoole also addresses the resistance to adopting new technologies in EMS and emphasizes the importance of advancing practices for better patient care. Takeaways Ultrasound is becoming more accessible and affordable for EMS.

Advancements in EMS practices are crucial for improving patient care. Then:  Dr. Garrett Cavaliere discusses critical topics in emergency medicine, focusing on aortic dissections and traumatic cardiac arrest. He emphasizes the challenges in diagnosing aortic dissections, the importance of recognizing atypical presentations, and the need for aggressive pain management. The discussion transitions to traumatic cardiac arrest, where Dr. Cavaliere critiques standard resuscitation protocols, advocating for alternative interventions such as early blood administration and avoiding chest compressions in certain scenarios. He also addresses operational challenges in implementing whole blood transfusions in pre-hospital settings, highlighting the logistical and financial considerations that impact emergency care. Takeaways Aortic dissections are frequently misdiagnosed in various medical settings. Recognizing atypical presentations of aortic dissections is crucial for timely diagnosis. Aggressive pain management is essential in treating aortic dissection patients. Standard chest compressions may be harmful in traumatic cardiac arrest cases. Early blood administration is critical in traumatic arrest situations. Whole blood transfusions can significantly improve patient outcomes in trauma care. Operational challenges exist in implementing whole-blood protocols in EMS. Avoiding normal saline in trauma resuscitation can prevent further complications. Effective airway management is vital in traumatic cardiac arrest cases. Understanding the physiological impacts of resuscitation strategies is key to improving outcomes. 

Then:  Ed and Dan discuss their experiences at the National Conference on EMS in Atlantic City. They highlight the inspiring talks, particularly from Chief John Moon, and the importance of networking and learning opportunities at such events. They also address the challenges of conference structures, including scheduling conflicts and the need for better dissemination of information among attendees. Takeaways The conference featured strong educational presentations and inspiring talks. Networking is a crucial yet often overlooked aspect of conferences. Access to data and information is vital for EMS providers. Conferences should aim to provide a comprehensive learning environment. The ethical considerations of patient care were discussed in depth. Ultrasound and whole blood use in EMS are emerging topics. Attendees often face scheduling conflicts that limit their learning. Recording talks for later access could enhance educational benefits. Organizational representation at conferences can improve information sharing.

Overall, the conference was a positive experience with room for improvement. 

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In this episode of the Overrun Podcast, the hosts discuss the importance of EMS education, the role of conferences, and the impact of misinformation in the field. They critique the Stand and Deliver program and address the need for evidence-based practices while navigating biases in EMS. The conversation emphasizes the importance of mentorship and affirming the humanity of patients in pre-hospital care.

Takeaways

CPR training can save lives and anyone can learn it.

Conferences provide essential networking and educational opportunities for EMS professionals.

The Stand and Deliver program allows new speakers to present at conferences.

Misinformation in EMS can lead to poor patient care.

Toxic heroism in EMS can negatively impact provider mental health.

Evidence-based practice is crucial for effective patient care.

Navigating biases is essential for improving EMS education.

Mentorship is key to developing the next generation of EMS providers.

Affirming the humanity of patients is a vital part of EMS work.

The future of EMS education requires a shift in mindset towards healthcare provision.

Keywords

EMS, education, conferences, Stand and Deliver, toxic heroism, misinformation, CPR, paramedic, healthcare, patient care

Chapters

00:00 Introduction to EMS World Conference Experiences

00:43 The Value of Conferences in EMS

03:19 Networking and Knowledge Exchange at Conferences

06:14 The Unique Crash and Learn Conference

09:34 Challenges of Quality Control in EMS Education

32:07 Controversial Figures in EMS Education

35:02 The Impact of Misinformation in EMS

37:35 Addressing Biases in EMS Education

40:40 The Role of Humor in EMS

43:30 Hope and Progress in EMS Education

01:08:33 Introduction to Jenna and the EMS Discussion

01:09:48 Concerns About Misleading Educational Materials

01:13:16 The Impact of Generational Attitudes in EMS

01:15:45 Addressing Toxic Attitudes in New Medics

01:18:06 The Importance of Accurate Patient Assessment

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In this conversation, Dan Schwester interviews Dan Gerard, a senior medic, about the generational divide in EMS and the importance of learning from experienced medics. They discuss the need for mentorship and the transfer of knowledge from senior medics to younger generations. They also highlight the importance of interpersonal dynamics, observational skills, and physical exam techniques in patient care. The conversation emphasizes the value of understanding the ‘whys’ behind protocols and the need to break down barriers between different generations of medics. In this conversation, Dan Gerard discusses the importance of physical examination in paramedicine and the value of learning from senior medics. He then delves into his article on emergency medical services (EMS) as a human right. He argues that EMS should be recognized as an essential service and a public good, and that it should be publicly financed to ensure equal access for all. He emphasizes the need for transparency and accountability in the delivery of EMS and highlights the importance of providing high-quality care to every individual in the community.

Keywords

EMS, generational divide, mentorship, transfer of knowledge, interpersonal dynamics, observational skills, physical exam, protocols, paramedicine, physical examination, senior medics, EMS, emergency medical services, human right, essential service, public good, publicly financed, transparency, accountability, high-quality care

Takeaways

There is a generational divide in EMS between older and younger medics, but it is not representative of the entire profession.

Experienced medics have valuable knowledge and skills that can be passed on to younger generations through mentorship.

Interpersonal dynamics, observational skills, and physical exam techniques are important aspects of patient care that younger medics can learn from senior medics.

Understanding the ‘whys’ behind protocols and procedures is crucial for providing effective and efficient care.

Breaking down barriers between different generations of medics can lead to a more collaborative and cohesive EMS community. Physical examination is an essential part of paramedicine and can provide valuable insights into a patient’s condition.

Learning from senior medics can offer valuable clinical pearls and improve clinical practice.

EMS should be recognized as an essential service and a human right, ensuring equal access for all individuals.

Public financing of EMS can help ensure quality care and accountability.

Transparency in the delivery of EMS is crucial for the community to understand the value they are receiving.

Providing high-quality care to every individual in the community is essential for positive outcomes.

Sound Bites

“There is definitely a dichotomy between the younger generations and the older generations.”

“Every new EMT, every new paramedic should have a mentor.”

“Establishing rapport with patients and other first responders is critically important.”

“You should have good perfusion down there. Now, this might be an ongoing problem, you know, like your feet are always cold, you know, but like if they’re like a little mottled or cyanotic, that’s kind of telling me that you have like a circulation issue that’s going on here.”

“Talk to your senior people, go get a cup of coffee, go get a soda, iced tea, whatever. Sit around with them, identify the ones that you know that are actually doing the job and enjoy doing the job, and talk to them.”

Chapters

00:00 Introduction and Background

03:07 The Generational Divide in EMS

09:33 The Importance of Interpersonal Dynamics

13:07 Enhancing Observational Skills

18:07 Understanding the ‘Whys’ Behind Protocols

23:12 Breaking Down Barriers in the EMS Community

27:20 The Importance of Physical Examination in Paramedicine

30:46 Learning from Senior Medics

36:08 EMS as a Human Right: Recognizing the Essential Service

41:43 Public Financing of EMS: Ensuring Equal Access and Quality Care

49:53 Transparency and Accountability in the Delivery of EMS

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In this conversation, Amy Eisenhauer discusses the qualities of a good leader in EMS and the importance of mentoring. She emphasizes the need for leaders to care about their people and listen to their needs and goals. Amy also highlights the value of having a mentor and a board of directors to support and guide one’s career. The conversation touches on the challenges of leadership in EMS, including the difficulty of balancing the demands of the job and taking care of oneself. The importance of self-awareness, emotional intelligence, and work-life balance is emphasized. In this conversation, Amy Eisenhauer discusses the film ‘Bringing Out the Dead’ and its impact on the EMS community. She also talks about substance use disorder among firefighters and the need for leadership to address mental health issues. The conversation highlights the importance of education, support, and a culture of compassion in EMS. The hosts emphasize the need for effective leadership and the development of leadership skills at all levels of EMS. They also discuss the challenges of high turnover and the importance of investing in the well-being of EMS professionals.

Keywords

EMS leadership, mentoring, qualities of a good leader, listening, career development, work-life balance, emotional intelligence, Bringing Out the Dead, EMS, substance use disorder, mental health, leadership, education, compassion, turnover, investment

Takeaways

A good leader in EMS cares about their people and listens to their needs and goals. Having a mentor and a board of directors can provide guidance and support in one’s career. Leadership in EMS requires self-awareness, emotional intelligence, and the ability to balance the demands of the job with personal well-being. The importance of work-life balance and taking care of one’s mental, social, and emotional health is crucial for leaders in EMS. The film ‘Bringing Out the Dead’ resonated with EMS professionals as it depicted the realities of their work and the challenges they face. Substance use disorder is a significant issue among firefighters and EMS providers, and it is essential to address it through education, support, and treatment. Effective leadership is crucial in EMS, and leaders should prioritize the well-being of their staff and create a culture of compassion and support. Investing in the development of leadership skills at all levels of EMS is necessary to improve organizational longevity and address the challenges faced by the industry.

Sound Bites

“A good leader in EMS cares about their people.” “Having a mentor and a board of directors can provide guidance and support.” “Leadership in EMS requires self-awareness and emotional intelligence.” “Somebody sees the work we’re doing.” “This is our life now.” “Alcohol use disorder among firefighters”

Chapters

00:00 Introduction and Discussion on Leadership in EMS 01:09 Qualities of a Good Leader 04:19 Self-awareness and Emotional Intelligence in Leadership 05:18 Balancing Work and Personal Well-being 26:37 Fatigue and Substance Use Disorders in EMS 35:17 The Impact of ‘Bringing Out the Dead’ 37:28 Addressing Substance Use Disorder 38:29 The Importance of Effective Leadership 42:16 Investing in the Well-being of EMS Professionals

Find Amy: theemssiren.com

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In this episode, Dr. Zaf Qasim discusses advances in medical resuscitation and the future of cardiac arrest care. The conversation covers topics such as compression-only CPR, the controversy surrounding head-up CPR, the use of band and piston-driven devices, and the potential of extracorporeal cardiopulmonary resuscitation (eCPR). The importance of good dispatch and patient selection is emphasized as key factors in improving outcomes. The episode concludes with a discussion on the need for a paradigm shift in how we approach cardiac arrest care. Then, Dr. Zaf Qasim discusses updates in trauma resuscitation. The focus is on the use of whole blood in trauma resuscitation, the importance of meaningful intervention in the pre-hospital setting, the role of ultrasound in trauma resuscitation, and the use of ketamine and fentanyl in RSI and trauma scenarios. Dr. Qasim emphasizes the need for resuscitation before intubation and the importance of controlling bleeding and restoring volume. He also highlights the potential of technology, such as ultrasound and sending real-time information to the trauma team. The conversation ends with a call for hope in the future of pre-hospital medicine.

Takeaways

Advances in medical resuscitation have focused on basic life support (BLS) interventions, such as compression-only CPR and early defibrillation.The effectiveness of head-up CPR in improving outcomes is still under debate, and more research is needed to determine its role in human resuscitation.While band and piston-driven devices have shown variable results in improving outcomes, they can be useful logistically in certain situations.Extracorporeal cardiopulmonary resuscitation (eCPR) shows promise for refractory ventricular fibrillation patients, but its implementation requires system-wide changes and good patient selection.Good dispatch and patient selection are crucial in improving cardiac arrest care and should be prioritized in system design and protocols.A paradigm shift is needed to move from a one-size-fits-all approach to cardiac arrest care to a more individualized approach based on patient outcomes and preferences.

The use of whole blood in trauma resuscitation is gaining traction and has shown to improve outcomes.Meaningful intervention in the pre-hospital setting, such as giving blood and controlling bleeding, is crucial for improving trauma outcomes.Ultrasound can provide valuable information in trauma resuscitation, including assessing the heart and identifying pericardial effusion.Ketamine is still a great drug for RSI in trauma, but dosage and patient physiology should be considered.Technology, such as ultrasound and real-time information sharing, has the potential to enhance trauma resuscitation.There is hope for the future of pre-hospital medicine, with a focus on improving pre-hospital interventions and outcomes.

In this episode, Dr. Ken Milne discusses two studies related to emergency medicine. The first study examines the use of small adult ventilation bags in out-of-hospital cardiac arrest. The study found that small bags were associated with a lower rate of return of spontaneous circulation (ROSC) compared to standard bags. However, this was an observational study and more research is needed to draw definitive conclusions. The second study explores the use of nitroglycerin in right ventricular myocardial infarctions (MIs). Traditionally, nitroglycerin has been contraindicated in these cases, but the study found no significant difference in adverse events when nitroglycerin was used. Again, more research is needed to confirm these findings. Overall, these studies highlight the importance of evidence-based practice and the need for further research in emergency medicine.

Takeaways

Small adult ventilation bags may be associated with a lower rate of return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest, but more research is needed to confirm this finding. The use of nitroglycerin in right ventricular myocardial infarctions (MIs) may not be as contraindicated as previously thought, but further research is needed to determine its safety and efficacy. These studies highlight the importance of evidence-based practice and the need for more high-quality research in emergency medicine. Clinicians should consider the limitations of observational studies and use their clinical judgment when interpreting and applying the findings. Discussion and collaboration among healthcare professionals are crucial for updating protocols and guidelines based on emerging evidence.

Then, Ed and Dan discuss two recent studies. The first study examines the use of small bags in cardiac arrest resuscitation, while the second study explores the use of nitroglycerin in right ventricular myocardial infarction (RVMI). The hosts analyze the findings of these studies and discuss their implications for clinical practice. They emphasize the importance of conducting further research and encourage EMS providers to get involved in research projects. The hosts also highlight the need for open communication with medical directors and other healthcare professionals to drive positive change in protocols and treatment approaches.

Chapters

Introduction and Overview Reevaluating the Use of Nitroglycerin in Right Ventricular Myocardial Infarctions

Introduction and Discussion of Small Bags in Cardiac Arrest Resuscitation

The Importance of Research and Collaboration in EMS

Keywords small bags, cardiac arrest resuscitation, nitroglycerin, right ventricular myocardial infarction, RVMI, research, clinical practice, EMS providers, medical directors, protocols, treatment approaches, emergency medicine, cardiac arrest, ventilation bags, nitroglycerin, observational study, myocardial infarction, evidence-based practice

thesgem.com

SGEM#428: Don’t Worry, Be Happy – The Safety of Nitroglycerin Administration in RVMI

SGEM#426: All the Small Things – Small Bag Ventilation Masks in Out of Hospital Cardiac Arrest

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

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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.