Greg Friese from EMS Educast invited me to guest cohost on episode 67. On the show was David Page from the St. Paul EMS Academy.
Make sure to go check it out.
Thanks for stopping by,
Adam Thompson, EMT-P
ClinCon 2010
07/02/2010 by 2 Comments
Hello to all of our loyal readers. It’s Adam here and I am sorry for the long periods of nothing to read. It was that time of year again, and I was preparing for the ClinCon conference. If you are unfamiliar with it, head over to their WEBSITE.
The reason this takes up so much of my time is because I am part of my agency’s ALS competition team. We compete in these scenario-based competitions. It’s somewhat of a game. Imagine the worst possible call you could ever run, and multiply that by five. That tends to be the types of scenarios the sadist that come up with the challenges think up.
This was my fourth year competing at ClinCon and my team had remained winless. There are two days of competitions with some of the best teams in the country competing. On the first day is the preliminary round, which every team competes in. A team is made of three crew members, and one alternate whom usually holds the video camera.
Preliminary scenario
Bus crash:
- The first five minutes was a START Triage scenario which required each team to go through a number of cards that included patient type and vital signs. Each card had a number and you had to assign a color (red, yellow, green, or black) to the corresponding numbers.
- We are then rushed in, to what is deemed the yellow treatment area. Within this area was a mother holding a baby, and a patient complaining of burning eyes.
- A good sample history and assessment uncovers the cause of the burning eyes which is chlorine. The patient also presented with wheezing.
- The baby was who was actually a green, was not suppose to be re-triaged, but kept with mom instead.
- The mother ends up having hypertension, and then postpartum eclampsia. Her seizures would persist until Magnesium was administered.
- At about the ten minute mark, another patient presents. He is nearly unresponsive, and shows signs of a cardiac contusion and cardiac tamponade.
Treatments they were looking for:
- Rapid full-body assessments on every patient.
- Re-triage all patients red.
- Flush eyes of chlorine exposed patient
- Treat wheezing with bronchodilator
- Once wheezing subsides rales present – treat with Lasix or CPAP
- Treat Eclampsia with Magnesium Sulfate
- Recognize pericardial tamponade
Treatments we did:
- Got 100% of the assessments
- Flushed eyes of chlorine exposure
- Provided high-flow O2, then albuterol, the nebulized Sodium Bicarbonate.
- Recognized the low acuity of the baby and kept it with mom
- Treated mom with benzodiazepines then Mag.
- Recognized Beck’s triad & electrical alternans (cardiac tamponade) and performed a pericardiocentesis.
So we didn’t do exactly everything that they were looking for. Even though we completely resolved the tamponade, there were no points for the percardiocentesis because they said “no one does that”. Um, we do. In fact, all arrest thought to be due to blunt force thoracic trauma receives three needles in their chest. One of them in the heart.
We were concerned that the other 40 teams would have done better and we wouldn’t make it into the top five this year. This concern subsided once we saw the results. We got second over all and made it into the finals once again. Even though, this is just a scenario-based competition and not a real sport, there is a lot of pride. These teams that compete in these challenges take it very seriously and are impressively good. We were thrilled to have done so well.
The Finals
Political rally:
The bus that crashed in the preliminaries was to be headed to a political rally that set the scene for the finals. The finals are performed in front of a live audience at the venue. Prior to entering the scenario, each team was shown a video. It is of the political rally, and portrayed a possible explosion.
- Three initial patients.
- A room filled with picket signs and full bottles labeled dihydrogen monoxide
- A single black box about the size of a shoe box was present in the middle of the room.
- First patient was in V-fib arrest, and had a dialysis shunt. CPR was being poorly performed by a distractor.
A distractor is any actor in the scenario that is not a patient. Dihydrogen monoxide = water.
- Second is a patient with an avulsed eye from a possible explosion.
- Third patient presented with an open mandibular fracture and signs of traumatic asphyxia.
- At about 4 minutes, a fourth patient presented. He was yelling and deaf. He had signs of bilateral perforated tympanic membranes, or eardrums. He was yelling that his neck hurt.
- At about five minutes three more patients walked in with burning eyes from being maced.
Sounds easy right? Well in twelve minutes it is a very stressful and high paced incident.
Treatments they were looking for:
- Scene control
- Assessments for every patient
- V-fib arrest patient is to be defibrillated into a PEA
- After PEA is present they expected you to determine hyperkalemic cause and administer sodium bicarbonate and/pr calcium chloride.
- The eye avulsion only required BLS care
- The traumatic asphyxia required a cricothyrotomy within five minutes.
- Obtain SAMPLE history from deaf guy by writing it down
- Flush the eyes of the maced individuals
- DON’T OPEN THE BLACK BOX
If you opened the box, you became exposed to chlorine gas and had to flush your eyes before you could do anymore treatments. I am not going to go into the details of how every team performed or what exactly we did. All I am going to say is WE WON.
That’s right, Lee County EMS, my team, got first place this year. So bragging rights are ours for the year, and then we will return for the competition once again. There are many other similar competitions to this throughout the country and I will be on EMS Educast this month to talk about them a little more.
So I am back and will be getting back to posting more often. You may have noticed the new look of the site. Tell me what you think. I am hoping to make the move soon to FIRE-EMS Blogs.
Journal Club 3: Episode 53
03/28/2010 by 1 Comment
Of the two podcasts I had the opportunity to be on this week, this one is more to my liking, due to my desire to increase the use of research-based treatments. Having the lead author of one of the studies on the show was another positive. Greg Friese hosts Journal Club 3: Episode 53.
There is a much more thorough discussion of these papers on the podcast.
The papers covered are:
Resuscitation on television: realistic or ridiculous? A quantitative observational analysis of the portrayal of cardiopulmonary resuscitation in television medical drama.
Harris D, Willoughby H.
Resuscitation. 2009 Nov;80(11):1275-9. Epub 2009 Aug 20.
PMID: 19699021 [PubMed - indexed for MEDLINE].
Presented by Rob Theriault.
This study raises a lot of interesting questions about the way that people learn about making end of life decisions, what they anticipate the outcome of resuscitation will be, and even how medical professionals may respond to skills presented in TV medical dramas.[1]
Dismissing TV dramas as trivial ignores the effect that they may have on members of the audience, up to and including doctors.
The Canadian prehospital evidence-based protocols project: knowledge translation in emergency medical services care.
Jensen JL, Petrie DA, Travers AH; PEP Project Team.
Acad Emerg Med. 2009 Jul;16(7):668-73.
PMID: 19691810 [PubMed - indexed for MEDLINE].
Presented by Joe Clark.
This is a study that deserves several posts to cover, so I will not even start here. As with the other studies, this paper is discussed on the podcast.
My impression is that this resource is wonderful. If you know of a relevant paper that they do not cover on the site, send them a link to it. As with all of science, this will always be a work in progress, but that is certainly not a bad thing.
Canadian Prehospital Evidence Based Protocols.
Effectiveness of paramedic practitioners in attending 999 calls from elderly people in the community: cluster randomised controlled trial.
Mason S, Knowles E, Colwell B, Dixon S, Wardrope J, Gorringe R, Snooks H, Perrin J, Nicholl J.
BMJ. 2007 Nov 3;335(7626):919. Epub 2007 Oct 4.
PMID: 17916813 [PubMed - indexed for MEDLINE].
Presented by Bill Toon.
In the US, we have studies that show an inability of the medics (at least the medics in US studies) to be able to safely direct patients to alternative destinations, such as an appointment with a general practitioner. Is the basic EMS education difference, between the US and the UK, the reason?
This study does show that specially trained experienced paramedics can identify stable patients and safely direct these patients to more appropriate resources than the Emergency Department (Accident & Emergency in the UK).
This is an education program that appears to focus on critical judgment, rather than protocol adherence. If done the right way, this should be good for patients, and therefore good for EMS and hospitals.
The full text PDFs of the three papers discussed on the podcast are available for free (until the next EMS EduCast Journal Club) at the Journal Club page of the EMS Educast.
Special guests on the show are Joseph F. Clark, PhD of JosephFClark.com and Jan Jensen of the Canadian Prehospital Evidence Based Protocols.
Footnotes:
^ 1 Positioning prior to endotracheal intubation on a television medical drama: perhaps life mimics art.
Brindley PG, Needham C.
Resuscitation. 2009 May;80(5):604. Epub 2009 Mar 18. No abstract available.
PMID: 19297069 [PubMed - indexed for MEDLINE]
Inadequate positioning of the head and neck was especially prevalent prior to intubation attempts, and improving this was seen as a simple but important first step.
As part of ongoing nationwide efforts to ensure basic resuscitation skills5 we explored all potential causes for the inadequate positioning, and this included trainees’ prior experiences. Many trainees reported limited supervision or hands-on training. Remarkably, however, when asked how they had therefore learned, after “trial and error”, a surprising number answered that television medical dramas had been an important influence.
Of the remaining 22, none (0/22) achieved more than one, let alone all three, components of optimal airway positioning. In terms of individual components, the lower cervical-spine was flexed in 0/22, the atlanto-occipital joint extended in 1/22, and the ears level with the sternum in only 3/22 cases.
While few would suggest that medical dramas can be held responsible for physician performance, it has been previously suggested that they can significantly influence beliefs.6, 7
This does show that ignoring the effect of medical dramas has the potential to be harmful to patients.
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