February, 2025

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Evidence Based Guidelines for Fatigue Risk Management in Emergency Medical Services

Irish College of Paramedics

Workplace fatigue is a common complaint among shift workers. Emergency Medical Services (EMS) personnel work shifts and deliver emergent health care to the acutely ill and injured on the roadside, in patients homes, and other environments. They must deliver this care while under significant time pressure and stress. Fatigue is a threat that is often overlooked by EMS leadership and personnel as just part of the job.

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More trials from TBS 2025. (part 2)

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed This blog post provides concise summaries of recent critical care trials, including HEMOTION, PREOXI, BLING III, CLASSIC, EVIDENCE, VICTOR, and PARAMEDIC-3. Each trial is examined for its key findings, strengths, limitations, and practical implications for clinical practice. The post aims to inform healthcare professionals about the latest evidence-based practices in critical care.

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How to Treat Strokes

Unitek EMT

A guide for EMTs and Paramedics in identifying and managing stroke cases in the field. According to guidelines published by the American Heart Association and American Stroke Association, before 2008, public education campaigns used the “5 Suddens” (sudden weakness, speech difficulty, vision loss, dizziness, severe headache) to help identify a stroke.

EMT
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Journal Feed Weekly Wrap-Up

EMDocs

We always work hard, but we may not have time to read through a bunch of journals. Its time to learn smarter. Originally published at JournalFeed , a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: New Meta-analysis Metoprolol vs Diltiazem for A-Fib with RVR Spoon Feed This systematic review of 13 studies found slightly higher rates of adverse events after administration of diltiazem versus metoprolol, when t

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Episode 165 Fish Tongue Parasite: Parasite Appreciation Hour

This Podcast Will Kill You

Okay everyone, think about your tongue. Maybe move it around a bit, check in with it, consider what it means to you. Now imagine that your tongue suddenly shriveled up and fell off and that in its place is a tongue-sized isopod aka rollie pollie aka pillbug. Just there, hanging out, forever. How are you feeling? Horrified? Disgusted? Hey, we get it.

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NRHA | Community Paramedicine Framework

American Ambulance Association

National Rural Health Association December 2024 Policy Paper Bridging the gap: A policy framework for sustainable community paramedicine in rural America Authors: Katie Gorndt, Kimberly Haverly, Tom Syverson The post NRHA | Community Paramedicine Framework appeared first on American Ambulance Association.

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Prehospital Care Research Forum Abstracts – ICoP members

Irish College of Paramedics

World Caf-Mediated Contribution of Prehospital Practitioners in Ireland to the First Official National Guidance Regarding Continuous Professional Competence Author: Shane Knox, PhD, MSc HDip, Advanced Para, MCPara, Assoc. CIPD Associate Authors: Suzanne Dunne, PhD, Colum P. Dunne, PhD IntroductionThere was no regulatory requirement for prehospital practitioners in Ireland to provide evidence of competence, or any link between competence and registration to practice.

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3 Medical Suction Training Scenarios for EMS Professionals

SSCOR

As you approach your patient, you hear him snoring and notice the familiar sound of gurgling coming from his mouth. You immediately know you will be working to manage his airwayall within seconds of looking at, listening to, speaking with, and touching the patient. Remember: The first few seconds when you approach your patient will likely give you the most clinical information about your patients condition, bombarding you with information rapidly, sometimes instantaneously.

EMS
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Single-Dose vs. Multi-Dose Epinephrine

Emergency Medicine Education

A pre-post study conducted in North Carolina compared multi-dose epinephrine with single-dose epinephrine in adult non-traumatic out-of-hospital cardiac arrest (OHCA) patients. The authors concluded that patients with bystander CPR and a shockable rhythm who received only a single dose of epinephrine had a higher survival rate to hospital discharge compared to those who did not receive bystander CPR and had multiple doses of epinephrine.

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The 5 Basic Steps of CPR

Unitek EMT

A complete guide to life-saving CPR on adults, children, and infants Every second counts when someone experiences cardiac arrest, and the actions of a bystander can make all the difference. CPR or cardiopulmonary resuscitation can double or triple a persons chance of survival. According to a September 2018 article by the American Heart […] The post The 5 Basic Steps of CPR appeared first on Unitek EMT.

CPR
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Recruiters: Can You Answer These Common Volunteer Firefighter & EMS Questions?

NVFC

By Walter Campbell Recruiting in the volunteer fire and EMS world is no small task. While youre asking your prospective recruits about their motivations, time commitments, and whether they can tell the difference between a Halligan bar and a crowbar, theyre interviewing you just as much. Potential volunteers want to know if your departments culture, opportunities, and leadership align with their passions and priorities.

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The Use of CPAP in Prehospital Care

Irish College of Paramedics

An accurate assessment maximizes CPAP's effectiveness By Kenny Navarro Arguably, airway management is one of the most important interventions provided by emergency medical service personnel. Despite the allegiance to endotracheal intubation as a gold standard of airway control, endotracheal tube placement during acute exacerbation of various respiratory conditions comes with a significant increase in complications and mortality (Keenan, Sinuff, Cook, & Hill, 2004).

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New Toolkit to Advance the Development of Partnerships between GEDs and Value-Based Care Organizations

GEDC

A new toolkit from the West Health Institute aims to equip clinical and operational leaders with the tools to partner with local value-based care organizations (VBCOs) in order to provide additional dispositions for older adults. Traditional paths of admission, discharge, or observation limit the scope of disposition choices to those that may not be optimal to address the patients acute needs and goals of care.

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Podcast – Monthly Round Up December 2024 – Chest trauma, IO access, AI and more

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed This months St Emlyns podcast wraps up Season 11 with a review of key emergency medicine topics. We cover new evidence on chest trauma management, intraosseous access safety, pediatric imaging updates, AI in medicine, toxic alcohol poisoning, and airway management. Plus, insights from major conferences like EUSEM 2024.

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Syncope and a short pause on event monitor

Dr. Smith's ECG Blog

Written by Willy Frick A middle aged man was inspecting the food in his (closed) oven when he felt a few moments of light-headedness. He subsequently woke up on the ground, unsure how long he had been unconscious. He presented for evaluation where inpatient workup including monitoring on telemetry was unremarkable. He was discharged with an event monitor and electrophysiology follow up.

ALS
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Annals ECG of The Month

ACEP Now

Emergency medical services (EMS) were called to the home of a 22-year-old woman after a syncopal episode and seizure-like activity. The patient reported consuming plant needles obtained online in a suicide attempt several hours prior. On EMS arrival, the patient was alert, pulse was fluctuating between 40 and 130 beats/min, and manual systolic blood pressure was 60 mmHg.

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Posttraumatic Stress Disorder (PTSD) and Police Officers

First Responder Wellness

by: Nancy Ryba Panza, PhD, ABPP At First Responder Wellness we specialize in the treatment of Posttraumatic Stress Disorder (PTSD). PTSD is diagnosed when someone has been exposed to an incident (or incidents) that involve actual or threatened death, injury, or sexual violence and then develops impairing symptoms after that exposure. Given the high propensity for police officers to be exposed to such events, it is not surprising that we see a higher rate of PTSD in officers than in the general p

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Prehospital Management of the Pregnant Patient

Irish College of Paramedics

by Chris Colwell, MD; Paul Murphy, MA, MSHA; & Tamara Bryan, BS, EMT-P On Mar 1, 2004 A variety of anatomic and physiologic changes occur during pregnancy. In most cases, there is minimal impact on the mother's health. However, there is the possibility that EMS providers will be called to assist a pregnant female.1 Managing the pregnant patient can present unique challenges.

EMT
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Kangaroos, Simulation & Cardiac Arrest

Medic Mindset

Alex (Sandy) MacQuarrie , PhD and Paramedic, reflects on his move from Canada to Australia, principles of simulation in medical education & his personal experience with cardiac arrest. Topics discussed: Constructivism in education Organic versus mechanistic approach to learning Difference between feedback and debriefing Socratic method versus Advocacy-Inquiry model Peer-to-peer feedback Psychological safety in the classroom Emotional Seriousness in simulation NHET-SIM Certification Prebriefi

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Confirmation Hearing for Secretary of Labor Nominee to be Held on February 19

NVFC

The Senate Committee on Health, Education, Labor, and Pensions will hold a confirmation hearing for Secretary of Labor nominee Lori Chavez-DeRemer on February 19 starting at 10am ET. If confirmed by the Senate, Chavez-DeRemer would oversee the Occupational Safety and Health Administration (OSHA) and the ongoing development of their proposed Emergency Response Standard.

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Podcast – Skills Fade with Nathalie Pattyn at Tactical Trauma 24

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed Emergency medicine demands constant practice, yet many clinicians experience skills fade due to lack of exposure. Nathalie Pattyn explores how this decline occurs, why its a systemic issue rather than an individual failure, and what changes are needed to maintain competency. The post Podcast – Skills Fade with Nathalie Pattyn at Tactical Trauma 24 appeared first on St.Emlyn's.

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Ep. 147 Freedom House with Chief Moon and Dr. Haamid

Prehospital Emergency Care Podcast

Title: Remembering Freedom House: A Legacy in EMS Join us for a special episode of the Prehospital Emergency Care (PEC) Podcast as we delve into the rich history and enduring legacy of Freedom House. In alignment with our commitment to Diversity, Equity, and Inclusion, we're honored to welcome two distinguished guests: Chief John Moon from Freedom House and Dr.

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The Patient Perspective: EMS’s Best Teacher

The EMS Educator

What if the best EMS educators werent clinicians, but patients themselves? In this episode, hosts Hilary Gates and Maia Dorsett welcome sudden cardiac arrest survivor Nova McCarthy and medical director Alicia Bond for an insightful discussion on how patient experiences can enhance EMS education. Nova describes her experience as a keynote speaker and explores the power of patient-centered learning.

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Cardiac Arrest at the Finish Line

Irish College of Paramedics

Two Dublin paramedics, running in Rays Half Million half marathon recently, didnt expect to be faced with a cardiac arrest at the finish line. But thats just what happened when father of three Peter Carolan collapsed and almost died after completing the Ray DArcy Half Million Half Marathon on Good Friday. This morning, Peters wife Alice joined Ray DArcy in studio to thank the two men who saved her husbands life.

CPR
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‘NSTEMI’ or reperfused OMI? And which lesion is the culprit?

Dr. Smith's ECG Blog

Written by Jesse McLaren An 80 year old with a history of CHF, ESRD on dialysis, and multiple prior cardiac stents presented to the emergency department with 3 days of intermittent chest pain and shortness of breath that resolved after nitro, which felt like prior episodes of angina. The patient was pain free on arrival, and below are the prior and new ECG.

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NVFC Mourns Passing of Director Bill Betts

NVFC

The NVFC is deeply saddened by the passing of past chief Willard Bill Betts, Jr., who served as an NVFC director from Delaware since 2020. Betts was also on the NVFCs OSHA Task Force, helping to advocate the volunteer fire services concerns about proposed new standards. Betts served nearly 60 years with the Frederica (DE) Volunteer Fire Company and was actively involved with the Delaware Volunteer Firefighters Association.

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Clinical Conundrum: Do I Have to Replace the Nail After an Avulsion?

REBEL EM

Bottom Line Up Top: Replacing the nail into the eponychial fold doesnt appear to be critical to nail regrowth and cosmetic outcomes of finger injuries with nail avulsion. Clinical Scenario: A 6-year-old boy presents to the Peds ED with an injury to their left 2nd digit. The finger was caught in a car door, injuring the nail and nail bed. On presentation, the patient has a linear laceration the full length of the nailbed and the nail has been avulsed.

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Leucodepletion in Bordetella Pertussis

Don't Forget the Bubbles

Two-month-old Isla presents to their local hospital following a prolonged apnoea at home. They had a two-day history of reduced feeding. Their clinical examination is unremarkable: normal heart sounds, palpable femoral pulses bilaterally, and no rashes, bruises, or signs of injury. They have a soft anterior fontanelle and no focal neurology. Because of their worsening respiratory acidosis, they were intubated in the ED, The initial chest-x ray shows a right-sided consolidation, in keeping with b

ALS
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ToxCard: Radiation-Induced Skin Injury

EMDocs

Authors: Ahmed Mashal (Emergency Medicine Resident, Atrium Healths Carolinas Medical Center); Ann-Jeannette Geib, MD (Emergency Medicine Attending, Medical Toxicologist, Atrium Healths Carolinas Medical Center) // Reviewed by: Christopher Counts, MD (Medical Toxicology Fellow, Rutgers New Jersey Medical School, Newark, NJ); Cynthia Santos, MD (Emergency Medicine Attending, Medical Toxicologist, Rutgers New Jersey Medical School); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case: A

ALS
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Assessing the Eyes

Irish College of Paramedics

BY WILLIAM E. "GENE" GANDY, JD, LP AND STEVEN "KELLY" GRAYSON, NREMT-P, CCEMT-P ON APR 5, 2011 It has been said the eyes are the windows to the soul. In emergency medicine, much can be learned from a routine eye examination. This article will review both techniques and evaluation of findings. Scenario You arrive at a local nursing home to care for a patient who has become unresponsive.

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Potassium 6.2 with narrow QRS: any indication for calcium?

Dr. Smith's ECG Blog

Written by Jesse McLaren An 80 year old patient with diabetes/hypertension/ cirrhosis had a recent increase in candesartan for their hypertension, and was also on spirolactone and nadolol. They presented to a hospital clinic for routine paracentesis, after which they developed nausea and syncope attributed to a vasovagal episode from the procedure. Labs showed a non-hemolyzed potassium of 6.2, normal glucose, and mild acute on chronic renal failure (Creatinine from 140 to 170 umol/L), and the fo

ALS
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National Fire Organizations Set to Advocate for Legislation in DC Later this Week

NVFC

The Congressional Fire Services Institute (CFSI) will hold its annual Fire and Emergency Services Symposium and Dinner on February 12-13 in Washington, DC. CFSI is a consensus organization for the nations fires service that advocates for policies that have been approved by its National Advisory Committee, which consists of over 30 national fire service organizations including the National Volunteer Fire Council (NVFC).

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IVC Distensibility Index vs Collapsibility Index: Using the Correct Index

REBEL EM

Background In 1979, Hiroshi Natori was the first to appreciate the sonographic changes that occur in the inferior vena cava (IVC)s diameter with ventilation in spontaneously breathing patients, mechanically ventilated patients, and those with carcinogenic and tuberculoid cardiac tamponade. 1 They noticed how spontaneously breathing patients had their IVC collapse with inspiration; and ventilated patients had their IVC dilate during positive pressure ventilation.

ALS
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SGEM#468: Wide Open Monocytes – Using MDW to Diagnose Sepsis

The Skeptics' Guide to EM

Reference: Agnello et al. Monocyte distribution width (MDW) as a screening tool for early detecting sepsis: a systematic review and meta-analysis. Clinical Chemistry and Laboratory Medicine 2022; 60(5):786-792 Clin Chem Lab Med. 2022 Date: February 21, 2025 Guest Skeptic: Dr. Aaron Skolnik is an Assistant Professor of Emergency Medicine at the Mayo Clinic Alix School of Medicine and Vice Chair of Critical Care Medicine at Mayo Clinic Arizona.

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EM@3AM: CSF Leak

EMDocs

Authors: Caleb Graham, MD (EM Resident Physician, UTSW/ Dallas, TX); Colin Danko, MD (EM Faculty Physician, UTSW/ Dallas, TX) // Reviewed by: Sophia Grgens, MD (EM Physician, BIDMC, MA); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics.

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Keep Your Eye on the Ball: Assessing & Managing Eye Injuries in the Field

Irish College of Paramedics

Bruce Evans, MPA, NREMT-P | From the August 2008 Issue | Sunday, August 17, 2008 JEMS Couse Objectives >>Review the anatomy and physiology of the eye. >> Describe the prehospital assessment and management of eye injuries. >> Discuss injury prevention as it relates to the eye. Engine 94 and Rescue 94 respond to a popular sports complex known for housing large softball tournaments.

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Podcast – GoodSam App Update with Mark Wilson at LTC

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed Discover how the GoodSAM app is revolutionizing emergency response, from cardiac arrest alerts to real-time video triage and crime prevention. Learn how you can get involved today. The post Podcast – GoodSam App Update with Mark Wilson at LTC appeared first on St.Emlyn's.