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About Justin:
Justin is an Advanced Care Paramedic and researcher with Peel Regional Paramedic Services, a member of the Department of Family and Community Medicine at the University of Toronto, and a Scientist with the McNally Project for Paramedicine Research. His work focuses on psychological health and safety among paramedics. Justin is the research lead of the External Violence Against Paramedics (EVAP) program and co-leads the Violence Against Paramedics project with Dr. Donnelly. Connect with Justin on LinkedIn, follow him on Twitter, or see more of his work on ResearchGate.In this episode, we discuss the unacceptable nature of violence against paramedics and shed light on how it affects their mental health and job performance. The conversation explores the efforts made by paramedics like Mandy Johnston and researchers to gather data, understand the prevalence of violence, and implement effective risk mitigation strategies. The program delves into the impact of reporting violence, changes in organizational culture, and the importance of mental health resources. Hear about the personal experiences that led to this crucial research, the training initiatives to de-escalate violent situations, and the ultimate goal of creating a safer and more supportive environment for paramedics.
Support Justin:
https://www.protectparamedics.com/the-team
Chapters:
00:00 Introduction: Addressing Violence Against Paramedics
01:01 Personal Motivations and Research Beginnings
02:16 Documenting and Measuring Violence
03:12 Barriers to Reporting and Cultural Change
04:57 Impact of Reporting and Training
06:52 Mental Health Studies and Personal Stories
09:45 Challenges in Paramedic Mental Health
14:31 Systemic Issues and Resource Allocation
24:03 Historical Context and Physical Injuries
25:38 The Reality of Early Career Paramedics
26:10 Role Identity and Paramedic Identity Mismatch
26:54 Building Resilience: Individual and Organizational Strategies
28:34 The Swiss Cheese Model and Mental Health Screening
References:https://pubmed.ncbi.nlm.nih.gov/24830544/https://pubmed.ncbi.nlm.nih.gov/35206301/https://www.researchgate.net/profile/Paige-Masonhttps://www.protectparamedics.com/the-teamhttps://www.insighthealthsolutions.com/launch-of-peel-region-paramedic-services-partnership-with-thp-for-mental-health-services/https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/2019-ctn-pln-ptsi/index-en.aspx?wbdisable=true#ems #science #paramedic #emergencymedicine #prehospitalcare
#paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife
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In this episode, we delve into the best practices for intubation and the administration of epinephrine during emergency scenarios. Our discussion focuses on avoiding the use of epinephrine through the ETT, the importance of IV and IO routes, the benefits of video laryngoscopy, and the significance of preparation and teamwork. We also touch on airway management challenges, especially in cases with potential C-spine injuries, and emphasize the importance of setting up a systematic and well-coordinated approach to maximize patient outcomes.
Chapters:
00:00 Introduction: Epinephrine Administration Dilemma
00:45 Optimizing Intubation Success
01:51 Video Laryngoscopy and Airway Management
04:07 Preparation and Team Approach
09:21 Debriefing and Continuous Learning
20:47 Conclusion and Final Thoughts
#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife #ROSC #post-arrest #resuscitation #resuscitationsReferences:https://www.ahajournals.org/doi/10.1161/CIR.0000000000001194https://www.ilcor.org/publicationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC8951653/https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf
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In this podcast episode, we dive deep into pre-hospital management strategies for drowning incidents, focused on both adult and pediatric patients. We explore the critical differences between drowning in cold and warm water, the impact of these factors on patient outcomes, and key considerations for initial resuscitation. The discussion covers scene safety, airway management, the effectiveness of PEEP and CPAP in treating pulmonary edema, and the role of epinephrine in these emergencies. The hosts also share best practice guidelines, evidence-based approaches, and practical tips to optimize patient care and improve outcomes.
Chapters:
00:00 Introduction and Overview
00:56 Understanding Drowning: Cold vs Warm Water
01:22 Pediatric Drowning: Unique Considerations
05:10 Initial Resuscitation Steps
06:27 Airway Management Techniques
11:33 The Role of PEEP and CPAP
20:00 Hemodynamic Resuscitation
#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife #ROSC #post-arrest #resuscitation #resuscitations
References:
2024 American Heart Association and American Academy of Pediatrics Focused Update on Special Circumstances: Resuscitation Following Drowning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care | Circulation - American Heart Association Journals, accessed April 4, 2025, https://www.ahajournals.org/doi/10.1161/CIR.0000000000001274Prehospital Cross-Sectional Study of Drowning Patients Across the United States - PMC, accessed April 4, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC9052871/2024 American Heart Association and American Academy of Pediatrics Focused Update on Special Circumstances: Resuscitation Following Drowning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care | Pediatrics, accessed April 4, 2025, https://publications.aap.org/pediatrics/article/154/6/e2024068444/199870/2024-American-Heart-Association-and-AmericanDrowning resuscitation Special considerations for prehospital management - ResearchGate, accessed April 4, 2025, https://www.researchgate.net/publication/374738312_Drowning_resuscitation_Special_considerations_for_prehospital_managementhttps://www.anzcor.org/home/new-guideline-page-3/guideline-9-3-2-resuscitation-in-drowning/downloadpdfHighlights of the 2020 ILCOR Guidelines Update - SaveaLife.com, accessed April 4, 2025, https://nhcps.com/highlights-of-the-2020-ilcor-guidelines-update/European Resuscitation Council Guidelines 2021: Systems saving lives, accessed April 4, 2025, https://www.erc.edu/assets/documents/RESUS-8901-SSL.pdfA systematic review of interventions for resuscitation following drowning - ResearchOnline@JCU, accessed April 4, 2025, https://researchonline.jcu.edu.au/79100/1/79100.pdfA systematic review of interventions for resuscitation following drowning - PMC, accessed April 4, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10323217/https://journals.physiology.org/doi/full/10.1152/physiol.00002.2015https://www.anzcor.org/assets/anzcor-guidelines/guideline-9-3-2-resuscitation-in-drowning-275.pdfhttps://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2020.00524/fullhttps://journals.sagepub.com/doi/abs/10.1177/0883073811415269
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In this comprehensive episode, we delve into the nuances of post-arrest care, focusing on the role of epinephrine, the importance of 12-lead ECG timing, and understanding false positives. The discussion covers essential post-resuscitation strategies, optimizing patient outcomes, and effective communication during patient handover. We also explore the ongoing changes in post-arrest care, including recommendations for paramedics to improve patient safety and outcomes. Key takeaways include the importance of slowing down after ROSC, thorough assessment, and detailed reporting to receiving hospitals.
Chapters:00:00 Introduction and Anecdotes
00:37 Medication Strategies Post-ROSC
00:51 Importance of 12-Lead ECG
02:19 Study on False Positives in ECG
06:18 Neurological Outcomes Post-Arrest
12:04 Patient Handover Best Practices
16:32 Evolving Field of Post-Arrest Care
References:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10455131/https://www.sciencedirect.com/science/article/pii/S1755599X21000355file:///Users/ryancichowski/Downloads/AmbulancetoEDstaffhandover-Pre-publicationfinalversion.pdfhttps://academic.oup.com/eurheartj/article/41/Supplement_2/ehaa946.1851/6005196#google_vignette https://www.ahajournals.org/doi/10.1161/CIR.0000000000001163https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001163?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org
#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife #ROSC #post-arrest #resuscitation #resuscitations
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In this episode, Jakob and I dive into the complexities of managing post-arrest patients. We discuss the critical shift in mindset required once a pulse is regained and emphasize the importance of preventing secondary injuries before transport. Key topics include the priorities in post-arrest care, the role of vital signs, the use of dopamine for treating hypotension, and the ideal oxygen saturation and end-tidal CO2 levels for optimizing patient outcomes. We also explore the challenges of pre-hospital care and share practical tips for ensuring the best possible results for post-arrest patients.
Chapters:00:00 Introduction and Initial Thoughts
00:38 Post-Arrest Patient Management
01:11 Prioritizing Patient Stabilization
05:49 Addressing Hypotension and Fluid Responsiveness
08:51 Dopamine Use and Considerations
18:06 Oxygenation and Ventilation Strategies
20:23 End-Tidal CO2 Monitoring
25:08 Conclusion and Final Thoughts
References:
https://www.bmj.com/content/384/bmj-2023-076019https://pmc.ncbi.nlm.nih.gov/articles/PMC8152988/https://pmc.ncbi.nlm.nih.gov/articles/PMC7703417/https://pubmed.ncbi.nlm.nih.gov/32286900/https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00152-3/fulltexthttps://www.ahajournals.org/doi/10.1161/CIR.0000000000001163https://cprguidelines.eu/assets/guidelines/European-Resuscitation-Council-and-European-Societ.pdf
#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife #ROSC #post-arrest #resuscitation #resuscitations
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In this episode, Jakob and I discuss handling pediatric patients in shockable rhythms, including calculating defibrillation dosages—2 joules per kilogram for the first shock and 4 joules per kilogram for subsequent shocks. We delve into antiarrhythmic medications, highlighting that amiodarone and lidocaine are considered equivalent and outlining their dosages. The importance of family presence and communication during resuscitation efforts is stressed, with evidence suggesting it aids in their recovery from traumatic events. A recent trial on standardized intramuscular epinephrine injections to mitigate delays in administration is also explored. Lastly, the episode touches on the impact of socioeconomic factors on pediatric cardiac arrests and emphasizes the role of community paramedicine.
Chapters:
00:00 Introduction to Shockable Rhythms
00:05 Dosage Calculations for Defibrillation
00:56 Antiarrhythmic Medications
02:17 Family Involvement During Resuscitation
04:12 The PRIME Trial
05:55 Pediatric Cardiac Arrest Statistics
07:10 Key Takeaways
References:https://pubmed.ncbi.nlm.nih.gov/28009655/https://caep.ca/periodicals/Volume_16_Issue_6/Vol_16_Issue_6_Page_497_-_501_Motillo.pdfhttps://media.emscimprovement.center/documents/familypresencecpg3eaabb7cf0414584ac2291feba3be481_36JegLp.pdfhttps://www.thrasherresearch.org/grant/01695?lang=enghttps://pmc.ncbi.nlm.nih.gov/articles/PMC10423885/
#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife
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In this episode, Jakob and I delve into essential aspects of pediatric cardiac arrest management. Key topics include the importance of on-scene resuscitation, differences in pediatric versus adult cardiac arrest causes, optimal treatment strategies, and best practices for airway management. We'll also discuss the significance of early epinephrine administration and the current evidence on supraglottic airways and intubation. Additionally, we touch on the importance of caregiver communication, the PRIME trial, and the impact of social determinants of health on pediatric outcomes.
Chapters:
00:00 Introduction to Pediatric Cardiac Arrest
00:59 Key Differences Between Pediatric and Adult Cardiac Arrest
02:23 Respiratory Causes and Their Impact
07:23 Airway Management Strategies
16:47 Effective CPR Techniques
17:42 The Role of Epinephrine in Cardiac Arrest
19:36 IV vs. IO Access in Pediatric Resuscitation
21:41 The Handtevy Method and Medication Safety
24:31 Using Apps to Reduce Cognitive Load in Pediatric Care
25:35 Cross-Referencing with Partners for Best Practices
26:01 Handling High-Stress Pediatric Emergencies
27:01 Preferred Routes for Cardiac Epi in Pediatrics
27:38 IO Access in Pediatric Patients28:37 Reevaluating the Scoop and Run Approach
29:55 Managing Pediatric Cardiac Arrest on Scene
31:11 Dealing with Drowning and Airway Management
#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife
References:
https://www.ahajournals.org/doi/10.1161/circulationaha.116.023821https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/article/paramedics-success-and-complications-in-prehospital-pediatric-intubation-a-metaanalysis/B6A2D22EE46D2E713E1394F913786391https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.723327/fullhttps://pmc.ncbi.nlm.nih.gov/articles/PMC4540668/
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This video explores the critical aspects of pre-hospital airway management, emphasizing the importance of oxygenation and the variables affecting intubation success. The discussion covers systematic reviews, the pros and cons of endotracheal tubes versus SGAs in managing brain injuries, and the latest recommendations from medical guidelines. It highlights the benefits of simulation training in improving first-pass success rates and delves into the logistics of intubation positions, tools, and techniques. Expert insights are shared on the complexities of achieving better procedural outcomes and the importance of a multimodal approach in education and practice. Finally, the video outlines actionable steps and recommendations for enhancing both individual and systemic practices in paramedicine.
Chapters:
00:00 Introduction and Importance of Oxygenation
00:17 Intubation in Pre-Hospital Settings
01:11 SGA vs. Endotracheal Tube
03:24 Challenges in Pre-Hospital Intubation
05:01 Improving First Pass Success Rates
06:30 Education and Training for Better Outcomes
09:20 Future of Simulation in Airway Management
11:36 Global Best Practices and Lessons Learned
13:03 Conclusion and Final Thoughts
https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-021-00533-0
https://pubmed.ncbi.nlm.nih.gov/36106283/
https://www.sciencedirect.com/science/article/pii/S0007091222004287#:~:text=In%20this%20systematic%20review%2C%20the,benefit%20in%20mortality%20and%20morbidity.
https://sjtrem.biomedcentral.com/articles/10.1186/s13049-022-01049-7#Sec9
https://www.bjanaesthesia.org/article/S0007-0912(24)00061-8/fulltext
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In this episode, we delve into Jakob's master thesis comparing the first pass success rate and overall success rate of laryngoscopy with video laryngoscopy for intubation by ACPs. The discussion covers the importance of advancing airway management, the challenges faced by paramedics in pre-hospital settings, educational and systemic interventions to improve first pass success rates, and the future of simulation in airway management training. Join us for an in-depth conversation on improving patient outcomes in paramedicine.Chapters:00:00 Introduction to the Master's Thesis00:27 Motivation Behind the Research03:17 Challenges in Pre-Hospital Intubation04:58 Improving First Pass Success Rate07:15 The Role of Bougies in Intubation10:02 Video Laryngoscopy vs. Direct Laryngoscopy14:36 Techniques and Tools for Successful Intubation22:49 Training and Mental Preparation24:27 Cross-Training and Teamwork31:28 Video Laryngoscopes and Quality Assurance31:59 Reducing Airway Trauma with Visual Laryngoscopy
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Join us as Jakob and I delve into the complexities of pediatric sepsis in this informative podcast episode. We cover essential topics, including the mean arterial pressure targets for fluid and vasopressor administration, the appropriateness of vasopressors in pre-hospital settings, and the impact of socioeconomic status on sepsis outcomes. Learn about the critical differences between sepsis and septic shock, the main causes of mortality, and the importance of timely antibiotic treatment. We also discuss practical approaches to fluid administration, key clinical signs to look out for, and the role of early warning scores in improving patient outcomes. This episode is packed with valuable insights for healthcare professionals looking to enhance their understanding and treatment of pediatric sepsis.
Chapters:
00:00 Introduction to Pediatric Sepsis
01:15 Understanding Sepsis and Septic Shock
02:30 Mortality Rates and Socioeconomic Factors
03:46 Immune Response and Analogies
06:06 Age Groups and Vulnerability
08:15 Clinical Manifestations in Newborns and Infants
09:58 Common Signs and Symptoms in Older Children
15:30 Differentiating Sepsis from Other Conditions
20:57 Pre-Hospital Interventions and Early Recognition
22:56 Streamlining Sepsis Response
24:40 The Role of Fluids in Pediatric Sepsis
27:31 Administering Fluids Safely
29:18 Vasopressor Therapy Considerations
33:28 Dopamine vs. Epinephrine Debate
38:36 Addressing Hypoglycemia in Sepsis
40:01 Demographics and Risk Factors
42:28 Communicating with Families
43:17 Empowering Paramedics
44:36 Conclusion and Next Episode Preview
