Inside EMS

Unraveling the complexities of heart blocks

Heart blocks present a significant challenge to EMTs and paramedics, demanding a high level of expertise and precision in both diagnosis and treatment. Understanding the nuances of different types of heart blocks is crucial for effective patient management. The ability to accurately recognize and differentiate between various heart blocks, such as bifascicular, trifascicular and other types, is not just a matter of academic understanding but a vital skill in the fast-paced environment of EMS.

In this episode of the Inside EMS podcast, cohosts Chris Cebollero and Kelly Grayson discuss how to train EMTs and paramedics to recognize, differentiate and treat heart blocks.

Memorable quotes

"Some of the drugs that we give are sometimes cause many problems as they solve." — Kelly Grayson

"The best way to make an arrhythmia go away is to be prepared for the arrhythmia." — Kelly Grayson

“One of the things that we're talking about here is pacing. And I don't think that that's two things that we do very well in EMS. Paramedics don't pace and paramedics don't cardiovert. And one of the things that you've got to be able to remember is when those patients need both.” — Chris Cebollero

Key takeaways

• Understanding heart blocks, Chris Cebollero and Kelly Grayson delve deep into the recognition and differentiation of heart blocks. Grayson emphasizes the challenge EMTs face in distinguishing between various heart blocks, such as bifascicular and trifascicular blocks, highlighting the need for thorough training and understanding.
• Treatment approaches. The podcast hosts discuss the traditional and contemporary treatment approaches to heart blocks, focusing on medications like atropine, lidocaine and procainamide. Grayson points out the delicate balance between treating the arrhythmia and avoiding exacerbating the patient's condition.
• Electrical therapy preference. Both hosts advocate for the use of electrical therapy ("the Edison medicine") in critical cases of arrhythmias. They stress the importance of pacing in cases of bradycardia and cardioversion in tachycardia, especially when the patient is hemodynamically unstable.
• Patient-centric care. A recurring theme is the importance of treating the patient, not just the monitor readings. This includes understanding when to apply treatments and recognizing when a wait-and-see approach might be more beneficial.
• Educational insights. Grayson shares his teaching methods, including the use of analogies and the "AV block cheat sheet" to simplify complex concepts for EMTs and paramedics in training.

This episode of the Inside EMS Podcast is sponsored by LogRx. Learn a better way to track your narcotics at LogRx.com. 

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Emphasizing patient advocacy in EMS education

Critical insights into the implications of recent court rulings on EMS practice and patient care

This episode of Inside EMS is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

In this episode of the Inside EMS podcast, hosts Chris Cebollero and Kelly Grayson delve into the complex and ever-evolving legal and ethical dimensions EMS. This episode comes in the wake of a significant court ruling in which two paramedics were found guilty of criminally negligent homicide in the Elijah McClain case. The hosts discuss this judgment's far-reaching implications for EMS professionals, emphasizing the heightened legal scrutiny and accountability now present in the field.

Memorable quotes

"More and more, we are starting to see prosecutors making examples of paramedics, EMTs, who are not doing the right thing, or them thinking they're not doing the right thing, and our peers are now starting to get connected with murder and manslaughter charges, and it's something that we have to be very, very cognizant of." — Chris Cebollero

"I think that where this case went off the rails is that both paramedics involved forgot that they were first and foremost patient advocates and were acting as law enforcement." — Kelly Grayson

"We're doing our job with ego and this isn't about you. This is about the people that call for our help, and we've got to break that habit, because our poor interactions with people are leading to those national calls when these folks die." — Chris Cebollero

"What could be the worst day of somebody's life ... that's powerful, right? People forget what a privilege that is. But we have to be able to remember that our ego is not good for medicine." — Chris Cebollero

"You should train and educate yourself enough that you're not in doubt very often, but you should be conservative and call someone for, for consultation. That's what medical control is for." — Kelly Grayson

Key takeaways

Cebollero and Grayson discussed the growing legal scrutiny faced by EMS professionals, with the following takeaways:

• Importance of accurate medication dosage. The conversation emphasized the criticality of correctly estimating a patient’s weight for administering weight-based medications. Misjudgment in dosage, as seen in the McClain case, can lead to severe consequences.
• EMS education and training needs. The podcast underscored the need for continuous education and situational awareness among EMS practitioners. The hosts debated how such high-profile cases could influence EMS practices and potentially lead to overly cautious behavior, which might not always be in the patient's best interest. Cebollero and Grayson stress the necessity for precise patient assessment, a skill that goes beyond technical expertise to encompass a deep understanding of the patient's condition and needs. Their discussion points to a growing need for EMS education and training to adapt and address these challenges, ensuring that EMS practitioners are equipped to make informed decisions in high-stakes situations.
• Patient advocacy and interaction. Another key aspect of the conversation is the role of paramedics as patient advocates. The hosts argue that EMS professionals should prioritize their medical responsibilities over any perceived obligation to law enforcement. This episode critically examines the ethical considerations in EMS, particularly in scenarios involving mental health or police involvement. By sharing personal experiences and insights, Cebollero and Grayson highlight the delicate balance EMS providers must maintain between following protocol, ensuring patient safety and navigating complex legal landscapes.

Read for more: The EMS system failed McClain and the justice system failed the paramedics]

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Catch a new episode every Friday on Apple Podcasts, YouTube, PodBean, Amazon Music, Stitcher, Spotify, and RSS feed.

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Inside EMS: Challenges and opportunities for EMS in 2024

This episode of Inside EMS is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

The first episode of Inside EMS in 2024, hosted by Chris Cebollero and Kelly Grayson, offered valuable insights into what’s needed to overcome the challenges for EMTs, paramedics and EMS agencies in the year ahead.

Memorable quotes

• "We need to take charge and, and steer our profession, and generally we don't – as a profession, we tend to be reactive rather than proactive." — Kelly Grayson
• "We have to be worthy of [trust and respect]. And that's what we're trying to do here. So be better than the people you've seen." — Kelly Grayson
• "You don't let the people around you dictate your professionalism." — Chris Cebollero
• "Patient assessment is the most important skill a paramedic, EMT has." — Chris Cebollero

Key takeaways

• 2024 EMS Trend Survey. The hosts highlighted the importance of the What Paramedics Want in 2024 annual EMS trend survey focusing on recruitment, retention, safety, health, wellness, technology adaptation and career development.
• [Insert Promo module linking directly to the survey: https://www.surveymonkey.com/r/2024WPW-EMS1]
• Future of EMS system design. The podcast touched on the issues faced by volunteer and rural EMS agencies, emphasizing the need for innovative solutions and cooperation among various squads. The discussion focused on evolving EMS, particularly the potential shift from paramedic/EMT teams to dual EMT teams with paramedics in chase vehicles, to enhance the use of EMT capabilities.
• Advocating proactivity in EMS. Grayson stressed the importance of being proactive rather than reactive in shaping the EMS profession, especially in education and practice standards. Both cohosts underscored the importance of ongoing personal and professional development, advocating for a culture of continual learning and improvement in EMS.
• Enhancing education and professional standards. The conversation delved into the challenges of EMS education, particularly in teaching comprehensive patient assessment and encouraging paramedics to expect more of themselves. Grayson shared experiences from teaching paramedic classes, focusing on the need for instructors to balance high expectations with realistic goals for entry-level paramedics. The goal for 2024, as expressed by Grayson, is to produce a new wave of competent paramedics, challenging existing educational norms to improve overall EMS quality.
• Importance of patient assessment skills: The cohosts also emphasized the critical role of patient assessment in EMS, advocating for more thorough and continuous assessment throughout patient care.

Read more. Rapid Response: Scene safety trumps patient care but does not replace duty

The episode provided valuable insights into the current state and future directions of EMS, highlighting challenges and opportunities. These discussions are vital for EMTs and paramedics as they navigate their careers in 2024.

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Voluntary AEMT accreditation: A ’game-changer’ in EMS education

CoAEMSP’s Executive Director, George W. Hatch Jr., discusses the EMS accreditation journey

This episode of Inside EMS is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

The Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) plans to launch a voluntary programmatic accreditation for Advanced Emergency Medical Technicians (AEMTs) by January.

In this episode of Inside EMS1, cohost Chris Cebollero sits down with George W. Hatch Jr., EdD, LP, EMT-P, FAEMS, CoAEMSP’s executive director, to discuss the program.

Top takeaways

• AEMT is not just an EMT with additional skills; it requires a broader skill set, including understanding pathophysiology and critical thinking.
• The decision to introduce voluntary accreditation for AEMT programs wasn't preplanned but came about due to discussions within the EMS community.
• This accreditation process is voluntary, and programs that choose not to pursue it can continue operating as they do currently.
• Accreditation will help standardize AEMT programs, improve pass rates on the national registry exam, and enhance the quality of EMS education.
• The process involves benchmarking programs against a set standard, and programs must satisfy sponsorship requirements.
• While there is no plan to extend this accreditation to EMT programs at the moment, it may be considered in the distant future if deemed necessary.
• Accreditation is part of the journey to elevate EMS to a profession and should be supported by those in the field.
• It's essential to stop complaining about the state of EMS education and start actively contributing to its improvement.

Memorable quotes

• "It's about a process of improvement, a continual process of improvement." — Dr. Hatch
• "EMS may or may not be the choice that a lot of people want to make. We have to make it attractive and say, this is what you have to do to be in our profession." — Dr. Hatch

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Complacency kills: A critical look at EMS incidents and policy in 2023

This episode of Inside EMS is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

In this year's Inside EMS year-in-review episode, our cohosts, Chris Cebollero and Kelly Grayson, take a critical look at the major incidents that defined EMS in 2023. Together, they tackle:

Paramedics behaving badly

The episode begins with a focus on the troubling trend of subpar patient care and missteps. The hosts emphasize the importance of delivering compassionate and professional care on every call. They discuss the case in which EMS providers faced charges of first-degree murder after a patient died due to positional asphyxia, underscoring the need for accountability in the profession.

Violence against providers

Next, the hosts address the increasing incidents of violence against EMTs, including stabbings and assaults. They highlight the need for better safety measures and policies to protect EMS personnel.

Criminalization of medical errors

Shifting gears, the hosts delve into instances of medical errors, such as administering the wrong drug. They stress the critical importance of delivering high-quality patient care on every call, regardless of the nature of the complaint.

Focus on CPR

The discussion then turns to a dramatic moment in the NFL when Damar Hamlin went into cardiac arrest after a hit during a game. The hosts commend the quick response of athletic staff and paramedics, emphasizing the significance of well-executed resuscitation efforts.

The demise of ET3

Finally, Chris and Kelly address the unexpected premature end of the ET3 model, a pilot program aimed at improving EMS care and reimbursement. The hosts express disappointment in CMS's decision and question the rationale behind it.

In conclusion, this year-in-review podcast provides valuable insights into the challenges and triumphs of the EMS field in the past year. It highlights the need for accountability, safety measures and ongoing efforts to improve patient care and EMS policies.

Memorable quote:

"Every single call that we run has to be done with the utmost dedication, commitment, professionalism, as if it was the last or maybe even the first EMS call we've ever run. Complacency is what kills there."

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‘Keepers of the flame’: Reflecting on the role of preceptors

This episode of Inside EMS is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

In this episode of Inside EMS, hosts Chris Cebollero and Kelly Grayson delve into the crucial role of preceptors in EMS training and the impact they have on shaping the future of the profession. They emphasize the significance of preceptors as the "keepers of the flame" who pass on traditions and knowledge to new generations of EMS providers.

Memorable quotes

• "Preceptors have a fundamental understanding of their role in shaping the future of the profession." — Kelly Grayson
• "Legacy. The keepers of the flame are not the instructors. They're not the officers. Officers come and go, but the preceptors are the keepers of the flame and pass on the traditions." — Kelly Grayson
• "Preceptors are probably the most important component of EMS education." — Kelly Grayson

The hosts discuss the challenges and responsibilities of being a preceptor, emphasizing the need for preceptors to understand their role in shaping the future of EMS. They also touch on the importance of legacy and how preceptors play a pivotal role in maintaining and passing down the profession's traditions.

Grayson underscores the value of preceptors, highlighting that they are the individuals who can guide and mentor new EMS providers, ultimately affecting the lives of countless patients. He emphasizes the importance of recognizing preceptors as vital contributors to EMS education.

Listen to next: ‘You don’t know everything there is to know about EMS’

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Transforming EMS leadership: Beyond buzzwords to real change

This episode of Inside EMS is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

In this episode of the Inside EMS podcast, the discussion centered on the practical application of leadership in EMS. The conversation highlighted the gap between commonly used leadership buzzwords and their real-world implementation.

Key points

• Employee engagement and empowerment. The need for genuine engagement and empowerment in the workplace was stressed. Kelly Grayson shares an example of providing discounted meals for employees during hectic schedules as a concrete example of servant leadership.
• Leadership by buzzwords. Our cohosts raise concerns about leaders in EMS who rely on buzzwords without understanding their practical implications. They suggest many EMS leaders are caught up in an "ego vortex," focusing more on authority and titles rather than service and care.
• Personal leadership journey. Chris Cebollero shares his personal journey from being a "horrible leader" to understanding the essence of effective leadership. He emphasizes the importance of emotional control and viewing challenges as solutions.
• Systemic issue in EMS leadership. The discussion highlights a systemic problem in EMS leadership, pointing out the lack of formal training and understanding of the art and science of leadership. Our cohosts stress that success in leadership should be measured by the engagement, satisfaction and productivity of the workforce.
• The Peter Principle. The conversation touches on the Peter Principle, where individuals are promoted to their level of incompetence. They note often, leaders are not equipped with the necessary tools and training for their roles.
• Difference between managers and leaders. A distinction is made between managers and leaders. Managers are described as those who enforce policies and procedures, whereas leaders are seen as doing the right thing and then justifying it officially.

Learn more: Visit the EMS Leader Playbook

Memorable quotes:

• "The true measurement of leadership success is how engaged, satisfied and productive the workforce is. Nothing else matters." — Chris Cebollero
• "Leadership is both an art and a science. You've got to know and understand the science before you can paint the portrait of organizational success." — Chris Cebollero

This episode underscores the need for a paradigm shift in EMS leadership, moving away from traditional authoritative styles to a more engaged, empathetic and service-oriented approach.

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Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the Inside EMS team at theshow@ems1.com to share ideas, suggestions and feedback, or if you’d like to join us as a guest.

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Chick-fil-A vs. the duty to act

This episode of Inside EMS is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

In this episode of Inside EMS, hosts Chris Cebollero and Kelly Grayson discuss an incident that sparked fierce debate within the EMS community. The incident in question occurred on October 27, 2023, when a Washington, D.C., firefighter/EMT was dismissed for stopping at a Chick-fil-A before responding to an ALS call. The hosts discuss the ethical implications of this decision, emphasizing the duty to act in emergency services.

Cebollero and Grayson, while acknowledging the challenging landscape of working in EMS, stressed that personal needs and comfort should never compromise the responsibility to respond to emergencies. They shared personal experiences of missing meals due to service calls. The hosts stress how the duty to act commitment to help others should always outweigh personal needs in emergency services.

The discussion also centered on the commendable actions of D.C. Fire and EMS in addressing the incident. Grayson was firm in his belief that the action taken by the D.C. firefighter/EMT was unequivocally unethical and damaging to the public trust. The hosts underscored the importance of upholding the greatest standards of ethics and responsibility, even when not in the public eye.

Memorable quotes

• "Ethics are how you behave when no one is looking. There's not a whole lot of gray area in ethical situations." — Kelly Grayson
• "The whole point of 911 and the honor of what we do is, you call, we come: no question." — Kelly Grayson
• "I can’t count the number of times I have been waiting in line for food and I've been dispatched to a call. I've had to get out of line. I've had to lose my money. I didn't get a chance to eat that day." — Chris Cebollero
• "We have a duty to act. We have to be able to respond as we need to respond, regardless of our own personal needs." — Chris Cebollero

Read next: Duty to act, assess, treat and transport. A legal refresher for EMS providers

RATE AND REVIEW

Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the Inside EMS team at theshow@ems1.com to share ideas, suggestions and feedback, or if you’d like to join us as a guest.

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Pioneering paramedicine: How SCCAD tackles substance use disorders

This episode of Inside EMS is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

In this episode of Inside EMS, hosts Chris Cebollero and Kelly Grayson discuss innovative approaches in EMS with guests Chief David Lewis and Kyle Gaines from the St. Charles County Ambulance District in Missouri. The district's unique approach to paramedicine, specifically in terms of substance use disorders, opioid use disorders and behavioral health, forms the crux of the conversation.

Lewis shares how the escalating number of overdose cases necessitated a novel approach to community paramedicine. Starting as a passion project to save lives, the St. Charles County Mobile Integrated Healthcare Network was born from a need to tackle the overdose epidemic more effectively.

Initially adopting a model from Ohio that involved paramedics, social workers and law enforcement officers responding to overdoses, they soon realized patients were reticent to engage when law enforcement was present. This led to the evolution of the program, with paramedics being specially trained to handle sensitive conversations, helping patients access treatment.

Gaines discusses how educating their team members about addiction was instrumental in overcoming initial resistance to the program and ensuring its success. In the years since its inception, the program has grown and has proven to be effective, with about one in four patients they encounter eventually sitting in front of a treatment counselor.

Read more: $1.5M grant allows SCCAD’s expansion of substance abuse program

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Navigating EMS assessments: A dive into best practices

This episode of Inside EMS is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

In this episode of Inside EMS, hosts Chris Cebollero Kelly Grayson delve into the intricacies of patient assessments in emergency medical situations. They dissect the value of thorough assessments versus focused evaluations, highlighting the critical role of differential diagnosis and the dire need for feedback in honing EMS skills.

The duo debate whether a detailed head-to-toe assessment is always necessary or if a focused assessment based on the chief complaint suffices. Chris opines that a thorough examination provides a fuller picture, vital in cases where patients may not have seen a healthcare professional in years. Kelly, on the other hand, advocates for a focused approach, emphasizing efficiency and relevancy to the primary complaint, especially in high-pressure emergency scenarios.

The dialogue unveils a significant challenge in EMS education and practice – the delineation between a medical and trauma assessment, and the traditional versus a more systems-based approach to patient evaluations. They both acknowledge that the nature and depth of assessments could vary based on the patient's ability to participate in the examination.

One eye-opening anecdote from Chris revealed a situation where a misdiagnosis by a doctor led to a critical oversight in patient care, underscoring the importance of independent assessments and differential diagnosis in EMS practice. Chris shares a valuable lesson from this experience, emphasizing the need to "talk oneself into the diagnosis" rather than accepting a preliminary diagnosis at face value.

Kelly also addressed a fundamental challenge in EMS – the lack of feedback, which stifles the opportunity for professionals to refine their assessment skills and knowledge base. He asks, "how difficult it is to improve the art of assessment and your skills if you don't get feedback?"

The hosts encourage EMS professionals to share their insights and best practices, acknowledging the collective effort required to enhance patient assessment methodologies and ultimately, patient care. They wrap up the discussion with an invitation for listener feedback, fostering an ongoing dialogue to advance EMS practice.

The episode serves as a catalyst for a broader conversation on patient assessment best practices, urging EMS practitioners to continually evaluate and refine their approach towards patient care, thereby enhancing the overall quality and efficacy of emergency medical services.

RATE AND REVIEW

Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the Inside EMS team at theshow@ems1.com to share ideas, suggestions and feedback, or if you’d like to join us as a guest.

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