All in FOAMed

Episode 111: Amy Eisenhauer on Leadership, Fatigue, and Use Disorders

Episode 111: Amy Eisenhauer on Leadership, Fatigue, and Use Disorders

Ed Bauter
FOAMed, Mental Health, Interview, Health and Safety

Summary

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.

Episode 110: EMS WEEK with Dr. Zaffer Qasim

Episode 110: EMS WEEK with Dr. Zaffer Qasim

Ed Bauter
Cardiac Arrest, FOAMed, Interview, Trauma

Summary

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.

Episode 109: Dr. Ken Milne, Small BVMs, and Nitroglycerine

Episode 109: Dr. Ken Milne, Small BVMs, and Nitroglycerine

Ed Bauter
Chest pain, FOAMed, Interview, Medicine

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. 

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 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 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 88: Ceribell and Advancing Seizure Care with Dan Gerard

Episode 88: Ceribell and Advancing Seizure Care with Dan Gerard

Ed Bauter
FOAMed, Medicine

Dan Gerard is a man of many hats. He is the current President of the IAEMSC as well as the EMS Coordinator for Alameda county in California. He has spent his lengthy EMS career pursuing new advancements in pre-hospital medicine and is currently piloting a program in Alameda county that may be a game changer when it comes to recognizing and treating seizures in the field. Ceribell is a device that wraps around a patient's head like a headband and produces real-time EEG tracings that can be interpreted by an EMS clinician with little to no training. The best part about this system is that it is already FDA approved and is being used in hospitals with encouraging results. Take a listen and let us know what you think!

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

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

Ed Bauter
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.

Episode 83: Fundamentals of Bag Mask Ventilation with Rommie Duckworth

Episode 83: Fundamentals of Bag Mask Ventilation with Rommie Duckworth

Daniel Schwester
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:

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

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

Episode 76: A begrudging semi-annual Covid update

Episode 76: A begrudging semi-annual Covid update

Ed Bauter
Controversy, FOAMed, Health and Safety, Medicine

We know. We hate it too.

SARS-CoV-2 is still rampant in the United States, and with the emergence of the Delta variant, and the FDA approval of the Pfizer/BioNTech vaccine we thought it would be a good time to update the data.

What medications work? Are steroids useful? Dr. Antevy jumps in to discuss how to manage kids with Covid.

Give a listen, let us know what your shop is doing to keep their sanity during this time.

CDC Tracker

State of NJ Covid Data

Johns Hopkins updates

Recovery (Dexamethasone Study)

Let us know how you're doing: @OverrunEMS

FB/IG: Overrunproductions

Episode 70: Pediatric Cardiac Arrest and Improving Outcomes with Dr. Peter Antevy

Episode 70: Pediatric Cardiac Arrest and Improving Outcomes with Dr. Peter Antevy

Daniel Schwester
Conference, FOAMed, Interview

For most places in EMS, how we treat cardiac arrests in adults is drastically different than how we do it in pediatric patients. And the results show it.

Ed and Dan sit down with Dr. Peter Antevy and talk about how we can do better with pediatric arrests. Dr. Antevy’s programs in Florida have dramatically improved their pediatric survival from cardiac arrest, by focusing on the basics, staying on scene to resuscitate before moving to the hospital, and by engaging parents with WHY we are doing what we do on scene.

This is a critically important topic that we don't talk about. But we need to prepare for these low-frequency, high-stress events to give out patients every possible chance to survive.

On another note, go to https://www.prodigyems.com/refresh2021 to see the talk that inspired this episode. This is some of the best paramedic level training out there today, and it’s NREMT approved, and FREE!

Check out Dr. Antevy’s stuff at:

https://www.handtevy.com

Early epinephrine administration improving outcomes:

https://www.ahajournals.org/doi/epub/10.1161/JAHA.119.014330

We talk about the AHA PALS guidelines for 2020, here they are:

https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000000901

The Polk County study on pediatric OHCA:

https://pubmed.ncbi.nlm.nih.gov/30412719/

Time on scene in pediatric arrest matters:

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.116.023821


Episode 65: Bringing Battlefield Care to the Street with Dr. Andrew Fisher

Episode 65: Bringing Battlefield Care to the Street with Dr. Andrew Fisher

Daniel Schwester
Trauma, FOAMed, Interview

On this episode, Dan gets to sit down virtually with Dr. Andrew Fisher, otherwise known as “Saint” Fisher, of the Saint Fisher Church of Evidence Based Medicine. He’s been an EMT, Paramedic, PA, surgical PGY-1, Army Ranger, and author of a lot of what works in trauma care, especially in prehospital environments.

This is long episode, but there’s a TON of information…everything from tourniquets, pain management, blood vs. crystalloid, “scoop and run”, and much, much more. We also talk about education, and how The Church is looking to educate while still having a laugh or two.

Dr. Fisher’s Twitter feed:

https://twitter.com/fisherad1?lang=en

Kotwal, et al. study on the 75th Ranger Regiment:

https://pubmed.ncbi.nlm.nih.gov/21844425/

the PAMPER trial on prehospital plasma:

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

Fisher on ketamine:

https://pubmed.ncbi.nlm.nih.gov/25399363/

Ketamine and PTSD:

https://pubmed.ncbi.nlm.nih.gov/18376165/

Stop the Bleed information:

https://www.stopthebleed.org

https://www.dhs.gov/stopthebleed

https://community.fema.gov/until-help-arrives

Episode 55: Outbreak EMS

Episode 55: Outbreak EMS

Daniel Schwester
Airway Management, Controversy, FOAMed, Health and Safety, MD1

Dan and Ed sit down on short notice to get some information together about what we as EMS clinicians are up against with the arrival of novel coronavirus.

This is a totally off-label discussion about personal protective equipment, airway management, patient assessment, and items that we are seeing on social media and the FOAMed world.

Please follow your local policies and guidelines, and involve your medical director and leadership with any modifications to your practice.

Follow us at Overrun Productions' YouTube channel, and the MD1 Program YouTube channel for daily updates and practice tips. Leave us questions in the comments section, and we can have our medical director, Dr. Mark Merlin, share his answers on them!

The Overrun is on YouTube at:

https://www.youtube.com/channel/UCGqDBcqJl3B0HLigT5Wl9AA

MD1 Program on YouTube:

https://www.youtube.com/channel/UC93VE2Sr9AC3sMCN0W7uLQA

We're using the Johns Hopkins University Coronavirus Resource center for our data:

https://coronavirus.jhu.edu/map.html

Twitter has been a good resource for FOAMed lately; here's some of the experts we're following:

Minh LeCong: @ketaminh

Salim R. Rezaie, MD:@srrezaie (www.rebelem.com)

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