Shock

Inadequate tissue perfusion Recognition - "Signs of End-Organ Dysfunction" Liver - Low platelets (<150) and high bilirubin (>1.2) Heart - MAP <70 mmHg, bradycardia (<45 bpm) Brain - AMS, delirium Kidney - Increased Cr, oliguria (<0.5ml/kg/hr) Metabolism - Lactate >4 Eval BMP, Ca, Mg, Phos, LFTs CBC, PT/INR CRP, Lactate Blood cultures, sputum culture, UA …

Transport Destinations

EMS Critical Competency: Navigate the patient to the most appropriate care. In an ideal world, what options would prehospital providers have as transport destinations? Emergency Department Specialty Center - Trauma, Burn, Hand, Eye, Stroke, Cardiac, Geriatric, Pediatric... Urgent Care Mental Health Urgent Care Sobering Center More to come...

Headache

  History: Severity, chronologic pattern and associated symptoms Location? Unilateral or bilateral? Positional changes? Severe with sudden onset, like a thunderclap? Intensifying over minutes or hours? Steady or throbbing? Continuous or intermittent? Episodic? Chronic or recurring? Is the headache "typical" or is there something different? Changes in pattern? Is there an aura? Changes in vision? Weakness …

EMS Imperatives

“Better a Railing at the Top of the Cliff than a Hospital at the Bottom!” - Edward Lear Several truisms in patient care. Proactive rather than reactive Function over anatomy Doctoring over doctors Subjective experience over objective Findings coupled with outcomes True measures over substitutes and proxies Experience over certifications To be continued...

Recommendations to Reduce the Misuse of EMS and Delays in Patient Transfers

"The ER is for Emergencies." - State of Washington The following recommendations were proposed by the District of Columbia Task Force on Emergency Medical Services in its report released on September 27, 2007.  The Task Force, known as the "Rosenbaum Task Force," which was created in response to the January 6, 2006 death of New York …

Competitive Advantage

"Strategy is about making choices, trade-offs; it's about deliberately choosing to be different." - Michael Porter During business school, the professors often discussed the successful companies and organizations in terms of "competitive advantage" - the attributes that allow an organization to outperform its competitors - usually in terms of cost advantage or differentiation. For Amazon, …

Measuring Performance

EMS was established in 1966 by the US Department of Transportation through the Highway Safety Act to reduce death and disability in the pre-hospital setting. EMS executes this objective through ex ante steps, such as training and community education, and ex post steps, such as patient stabilization and transport. With such an important mission, we all have an …

EMS as a Referral Service

Patient Navigation in the Setting of Unscheduled Care I used to ask my patients "if they would like to go to the hospital?" Now I ask them "what hospital would you like to go to?" Imagine if we were no longer limited in patient transport destinations to hospitals, but could help navigate patients to the …

EMS Innovation

"If you can’t fly then run, if you can’t run then walk, if you can’t walk then crawl, but whatever you do you have to keep moving forward.” Driven mostly by the needs of the community, EMS, in its roughly 40 years of existence in the United States, has evolved substantially. From Cadillac ambulances and the …

Welcome

Whether it's 3 pm or 3 am, complete strangers open up their doors and invite us into their homes. We're supposed to be there to aid the sick, provide comfort, and help solve medical problems.  However, more often than not, you're really there because the situation is outside of the scope of what that person …