Cypress Creek EMS Podcast Cypress Creek

In this episode, Steven and Samuel sit down with Dr. Jason Ausman, the current EMS fellow, to discuss COVID-19. Topics covered include:


What’s changed with COVID-19, including the new UK and South African virus variants.
Long term effects of COVID-19.
How we can reduce the spread of this disease.
COVID-19 vaccinations.

Resources mentioned in this episode:


New England Journal of Medicine COVID-19 Vaccine FAQs: https://www.nejm.org/covid-vaccine/faq
Inside the B.1.1.7 Coranavirus Variant https://www.nytimes.com/interactive/2021/health/coronavirus-mutations-B117-variant.html

Death and Dying Part 1

A topic that is not often discussed, death and dying are an inherent reality for the EMS provider. This conversation between Lynne, Samuel and Steven addresses how to deal with grief. There's a huge expectation that first responders should intrinsically understand how to move through the sadness and difficulty of losing a patient, whatever that may look like.

This podcast looks at the stages of grief and how they relate to first responders; it is important to be healthy in processing the death of patients, especially when it is traumatic or sudden. Our increased exposure to the end of life means that we should be aware of the emotions associated with it so that we can move through them and continue…the best job in the world.

The Kubler-Ross Grief Model:

https://www.psycom.net/depression.central.grief.html

Acceptance in Grief

https://jamanetwork.com/journals/jama/fullarticle/205661

These changes go into effect on July 4th, 2020 at 7am.

In this episode, we are joined by our medical director, Dr. Levon Vartanian, along with our assistant medical director Dr. Ziherl and discuss protocols to reduce ED overcrowding during this pandemic. We talk about Paramedic Initiated Referral, COVID-19 Non-Transport, and transport to freestanding EDs. 

Download our protocol app or visit Creekshare.org to download copies of these protocols and the patient handout brochures that go along with them. ———————— 

General PIR: 

Purpose 

What kinds of patients can be referred 

Who cannot be 

Why a consult is required 



Prehospital discharge instructions 

COVID-19 non-transport

 Purpose 

Criteria 

Process 

Handout 

Scripting 

Recommendations for testing/treatment at home/etc. 

Freestanding ED 

What they are 

What they have 

What kinds of patients should go there 

What kinds of patients should not

Following the ESD 11 meeting on June 9th, ICPs Chris Conn and Megan Spearman sit down with UO Steven Beesley to articulate their thoughts. These field staff providers share their perspective about the latest development in the CCEMS/ESD relationship. This format is being tested for bringing information to the field staff…please let us know what you think!

One note about recent "news"; be mindful that CCEMS is your best source of information. While you may find opinions and statements elsewhere online, sensationalism and propaganda is widespread. Please allow us the chance to provide information before spreading something that you "heard". We are so thankful for your loyalty to CCEMS and in turn, we are committed to keeping you informed.

Stay tuned for a question and answer session with Wren Nealy releasing next week on the CCEMS podcast!

In this episode, we discuss airways with Dr. Rachel Ely, who is doing a rotation with CCEMS as an Assistant Medical Director as part of the military's EMS and Disaster Medicine Fellowship based at Brooke Army Medical Center in San Antonio. Dr. Ely has a background in EMS and actively worked as a paramedic for a few years before and during medical school. Passionate about all things "airway", Dr. Ely outlines some of her "must-dos" for a successful advanced airway while providing insight from her years of experience.

Before the call:


Visualization and mental rehearsal
Physical rehearsal: have a plan, and a backup, and a backup, and practice all of them
Location of equipment is key

Airway preparation

During the call:


Pre-oxygenate early. Once you decide they need an advanced airway, give all the oxygen.
Resuscitate before you intubate, Laryngoscope as a Murder Weapon (Scott Weingart)
Hypotension
O2/Hypoxemia
pH/acidosis.  The apneic period can be deadly in certain patients. Recognizing this is trickier in EMS because you don’t have all the data (like blood gases).  Fear this in the DKA patient, the septic shock patient, any metabolic acidosis
Position the patient: it is worth your time to try do this right.
The donut works, sometimes towels/pillows are needed, but just having a FF lift the head off of the floor will give you a 100% better view.
Head off stretcher works for some, but may actually make things worse as the angle of oropharynx to glottis becomes more steep (glottis more anterior).
Neck flexed, head extended gives optimal alignment

In this episode, Steven Beesley, Christy Stermer, Alex Moore, and Samuel Kordik sat down to discuss aerosol-generating procedures, PPE requirements, and how to find answers to your questions during COVID-19.

If you have questions, needs, or just would like someone to talk to, here's a list you can start with. Everyone on here cares deeply about you and would be happy to help:

Samuel Kordik

Elizabeth Breaux

Casey Pile

Zach Dunlap

Lynne Singleton

Ryan Jones

References:

K., T., K., C., M., S., C., P.-S., & J., C. (2011). Aerosol generating procedures (AGP) and risk of transmission of acute respiratory diseases (ARD): A systematic review. BMC Proceedings.

Heinzerling, A., Stuckey, M. J., Scheuer, T., Xu, K., Perkins, K. M., Resseger, H., Magill, S., Verani, J. R., Jain, S., Acosta, M., & Epson, E. (2020). Transmission of COVID-19 to Health Care Personnel During Exposures to a Hospitalized Patient - Solano County, California, February 2020. MMWR. Morbidity and Mortality Weekly Report, 69(15), 472–476. https://doi.org/10.15585/mmwr.mm6915e5

Loeb, M., McGeer, A., Henry, B., Ofner, M., Rose, D., Hlywka, T., … Walter, S. D. (2004). SARS among Critical Care Nurses, Toronto. Emerging Infectious Diseases, 10(2), 251–255. https://doi.org/10.3201/eid1002.030838

Orman, R., & Weingart, S. (2020). COVID-19: Weingart Q & A on Airway, Vents, Tubes, Lungs, ECMO, and CPAP. Retrieved from https://ercast.libsyn.com/covid-19-weingart-q-a-on-airway-vents-tubes-lungs-ecmo-and-cpap

Raboud, J., Shigayeva, A., McGeer, A., Bontovics, E., Chapman, M., Gravel, D., … Green, K. (2010). Risk factors for SARS transmission from patients requiring intubation: A multicentre investigation in Toronto, Canada. PLoS ONE, 5(5). https://doi.org/10.1371/journal.pone.0010717

Teleman, M. D., Boudville, I. C., Heng, B. H., Zhu, D., & Leo, Y. S. (2004). Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore. Epidemiology and Infection, 132(5), 797–803. https://doi.org/10.1017/S0950268804002766

Links to Help with mental stress

https://pca.st/nini28vt The Boiling Point of Stress - Stimulus (FOAM education)

https://medicmindset.com/2019/11/28/antifragile/ Antifragile - Medic Mindset

https://www.artofmanliness.com/articles/beyond-sissy-resilience-on-becoming-antifragile/ Blog post explaining the antifragile concept.

https://disasterassets.org/events/ Zoom meetings (Healthcare workers - free)