Today I sit down with Dr. Joseph Martin, (IG: @JaTXerd) a Family Practice and Addiction Specialist who is now an EMS physician, to talk about mental health in our first responders. Spoiler alert: it has a lot to do with sleep deprivation, uncertainty, community, and organizational support.Di Austin-Travis County EMS System Office of the Chief Medical Officer

Cold weather incoming! This is just a quick review of carbon monoxide poisoning treatment options, as well as what differentiates cold water immersion from regular drowning. We anticipate an increase in the number of Carbon Monoxide (CO) related calls in the system as people use charcoal grills and generators for heating. Symptoms include headache,…

Sometimes a small dose of epinephrine or norepinephrine can keep a patient from becoming hypotensive during intubation, or may help bridge the patient to a continuous infusion. Dr. Pickett talks about simple methods for mixing and administering push doses of these pressors and how to administer the infusion. NOTE: It is ASSUMED you already know the…

Like Starsky and Hutch, like peanut butter and jelly, like Riggs and Murtaugh, the inseparable duo is back together for Medic Mindset for an episode of the Thinking Series, this time on abdominal pain. Feast your ears, ladies and gentlemen, boys and girls. The audio is like butter. Available on YouTube, iTunes, Google Play, and Feedburner! https://…

Snakebites are a common patient encounter for #EMS here in Texas, though virtually all states have venomous snakes of one kind or another. Dr. Spencer Greene (@ToxSpencer) walks us through some pearls and pitfalls of caring for these patients. TL;DW: “Dry bites” are very uncommon. Most victims are not drunk young males that are intentionally messin…

YES I KNOW THE THUMBNAIL HAS EPISODE 4 and it’s episode 49. But we have a YouTube channel now so that’s why we have different episode numbers. It’s less confusing than renumbering everything. ANYwhomst, this is our takedown of the week long winter weather event that crippled the region starting around Valentine’s Day. The impacts to EMS were many a…

Vaccines are finally available. I’m getting mine, and you should too. How do they work? Are they safe? What are the side effects? What are the particulars of administration?Di Austin-Travis County EMS System Office of the Chief Medical Officer

Bamlanivimab is a monoclonal antibody for treating mild to moderate COVID-19. You’ve probably heard of it as it has rolled out here in Texas in force. What does it do and how is it given?Di Austin-Travis County EMS System Office of the Chief Medical Officer

Operation Warp Speed is a public-private partnership that has helped speed development of vaccines and treatments for COVID-19. But what does that mean for safety of these treatments? TL;DR: The program does not cut safety corners. It supports industry to rapidly develop capability without the financial risk usually associated with experimental the…

This study looks at an intriguing concept: What happens when you give an acutely suicidal patient ketamine in the ED? This study intrigued me so I thought I’d cover it. This study will not change your practice but will hopefully interest you in participating in research on the topic. TL;DR/TL;DL: DON’T START DOING THIS YET. IT NEEDS MORE STUDY. But…

The Health Data Exchange allows the flow of information between EMS charts and the hospital chart, helping us to easily look at outcomes and how EMS care has affected the patient. The best way to check your own knowledge and understanding of prehospital care is to know how the patient turned out. Was your diagnosis right? Did they decompensate afte…

“What if” can be anxiety provoking and can send you down a rabbit hole of undesirable futures. But it can also be a powerful tool for the clinical preceptor and the clinician who is looking to improve their performance.Di Austin-Travis County EMS System Office of the Chief Medical Officer

I don’t know if this is particularly profound, but I just wanted to offer some words of encouragement.Di Austin-Travis County EMS System Office of the Chief Medical Officer

We talk about a whole bunch of different interventions that have been recommended or not recommended and discussed our logic behind them here.Di Austin-Travis County EMS System Office of the Chief Medical Officer

Are there better ideas for managing cardiac arrests in this pandemic? We talk about modifying response (don’t), calling it early (maybe if we have good info), airway management (you’ve got some choices here), and limiting provider exposure (always).Di Austin-Travis County EMS System Office of the Chief Medical Officer

Here we talk about the tests that are available. How they work, when they work, and why we don’t have a good one to get us out of quarantine early.Di Austin-Travis County EMS System Office of the Chief Medical Officer

There are a myriad of task forces in the response to COVID in Austin and Travis County. Here we talk about ones inside the Medical Branch.Di Austin-Travis County EMS System Office of the Chief Medical Officer

What happens when we reach surge capacity at the hospitals? Where do patients go if they don’t have a home where they can safely quarantine? What about our nursing home patients? In this episode, we detail the plans for all of these patients.Di Austin-Travis County EMS System Office of the Chief Medical Officer

SUPER short one today about COVID and ACE inhibitors (-pril) and Angiotenstin Receptors Antagonists, like Angio Recept Antag. Maybe ang rec ant. Or artan. Artans yeah, that’s it.Di Austin-Travis County EMS System Office of the Chief Medical Officer

We talk about some of the things you’ve seen in the news lately about treatments that might help COVID. AND WHAT DO THEY MEAN I CAN’T TAKE IBUPROFEN? *sad Army Doc noises*Di Austin-Travis County EMS System Office of the Chief Medical Officer

I hate you. So, you caught the COVID. You have endured the fever, cough, sore throat, diarrhea, and abject boredom of being home. When can you be let out of this prison? In this micro episode we talk about the return to work criteria. BLUF: No, you don’t have to be in quarantine forever.Di Austin-Travis County EMS System Office of the Chief Medical Officer

This little jerk right here. Covid is now a pandemic, the real kind, the not-the-zombie-kind. In this episode we talk about what the Office of the Medical Director, Austin Public Health, and Austin/Travis County EMS is doing to respond to what is now a declared disaster.Di Austin-Travis County EMS System Office of the Chief Medical Officer

Buy in from the workforce is necessary to bring any useful change to an organization. While unions and leadership are often set against each other, the things they can accomplish when they work together far exceed those they can accomplish when moving in different directions. The union can give the MD valuable feedback on wants and barriers to impl…

Some causes of headache are benign, but the EMS provider would be wise to consider carefully some “bad actors” that cause headache. Here we will talk too about how to manage these patients in the prehospital setting. Photo by Alexander Dummer on Pexels.com https://atcomd.files.wordpress.com/2019/12/ep-31-headache.m4a…

Jessica Sasser, RN, is one of the amazing staff at our public safety wellness division which supports the physical and mental health of Austin/Travis County EMS and Austin Fire Department. In this episode she discusses meditation and how it can be useful to the first responder. Hint: it doesn’t just make you feel better, it makes you better. Please…

Its estimated that up to 20 % of strokes involve what is called the posterior circulation of the brain. The significance of this fact is these strokes are not picked up or scored well on the NIH stroke scale and many other stroke scales because those scales are looking for larger territory anterior and middle cerebral artery strokes. Posterior circ…

https://atcomd.files.wordpress.com/2019/04/ep-29-medic-to-pa-or-md.m4a Combat medic, paramedic, PA, and now medical student Andy Fisher talks about his journey. If you’ve thought about making the leap from #EMS, don’t miss this episode.Di Austin-Travis County EMS System Office of the Chief Medical Officer

https://atcomd.files.wordpress.com/2019/04/ep-28-andy-fisher-talks-blood.m4a In patients with hemorrhage, nothing else can take the place of #blood. Andy Fisher talks about why, and how, you can bring #blood to your #EMS system.Di Austin-Travis County EMS System Office of the Chief Medical Officer

https://atcomd.files.wordpress.com/2019/05/ep-27-syncope.m4a Syncope, or fainting, is an incredibly common complaint seen by #EMS providers. This short episode discusses some of the exam findings and considerations. The Epsilon wave: https://litfl.com/epsilon-wave-ecg-library/ Wolff Parkinson White syndrome: https://www.youtube.com/watch?v=K098rnvq…

If you are not using #EtCO2 during airway management and monitoring, then you are wrong. Fix yourself. Dr. Pickett tells you why. #EMS #Prehospital #Paramedic #maybeifIsqueezethisbagashardandfastasIcanthepatientwillgetbetter #morewavylines #butIjustlearnedEKGs #Isawthetubegothroughthecords #sodideveryonewhoevermisplacedanETtube https://atcomd.files…

https://atcomd.files.wordpress.com/2019/01/ep-25-tracheostomy-disasters.m4a Do you get nervous when you are faced with a patient with a tracheostomy tube? This short episode covers common problems and how to troubleshoot them. Be nervous no more. #paramedic #EMS #prehospital #criticalcare In this episode, I make reference to a couple of great YouTu…

https://atcomd.files.wordpress.com/2019/01/ep-24-new-clinical-operating-guidelines.m4a We undertook the unenviable task of revising our clinical operating guidelines to make them more usable, more manageable, and easier to read. We want to foster a clinician mindset and embrace the clinical flexibility medics need to take care of our patients in a …

https://atcomd.files.wordpress.com/2019/01/ep-23-flight-rules.m4a Today we are covering some of the flight rules for those studying for their #FP-C exam. #paramedic #EMS #prehospital #HEMSDi Austin-Travis County EMS System Office of the Chief Medical Officer

https://atcomd.files.wordpress.com/2019/01/ep-22-flight-physiology-part-3.m4a Today we are covering a bit of #flight physiology for those studying for their #FP-C exam. We broke this episode into 3 parts to make it a bit more manageable. #paramedic #EMS #prehospital #HEMSDi Austin-Travis County EMS System Office of the Chief Medical Officer

https://atcomd.files.wordpress.com/2019/01/ep-21-flight-physiology-part-2.m4a Today we are covering a bit of #flight physiology for those studying for their #FP-C exam. We broke this episode into 3 parts to make it a bit more manageable. #paramedic #EMS #prehospital #HEMSDi Austin-Travis County EMS System Office of the Chief Medical Officer

https://atcomd.files.wordpress.com/2019/01/ep-20-flight-physiology-part-1.m4a Today we are covering a bit of #flight physiology for those studying for their #FP-C exam. We broke this episode into 3 parts to make it a bit more manageable. #paramedic #EMS #prehospital #HEMSDi Austin-Travis County EMS System Office of the Chief Medical Officer

Epinephrine has been one of the mainstays of cardiac arrest management since the early days of cardiac arrest management. The recently published PARAMEDIC2 trial examined patient outcomes, and more importantly neurologic outcomes, in out of hospital cardiac arrest comparing epinephrine with placebo. Tune in for the surprising results that question …

Ketamine received some negative press last summer (2018) as I’m sure most of you have seen. With ketamine being used more frequently in prehospital medicine for the agitated patient, we wanted to provide a brief review of ketamine use in the setting of the agitated patient. The Medical Director Minute podcast, hosted by Jeff Myers, DO, is a high yi…

In this episode, we discuss the modified Sgarbossa criteria used to identify STEMI equivalents in patients who have an existing or not known to be old left bundle branch block (LBBB). identifying a STEMI in the setting of a LBBB can be challenging because there are ST segment deviations that can be normal in LBBB. We discuss the modified Sgarbossa …

This is the second part of a two part episode reviewing the decision rules that form the base of selective spinal immobilization protocols. In order to properly apply a rule and identify those patients at low risk for spinal injury who do not require spinal motion restriction (SMR). Part two covers the application of the decision rules to our indiv…

This is the first part of a two part episode reviewing the decision rules that form the base of selective spinal immobilization protocols. In order to properly apply a rule and identify those patients at low risk for spinal injury who do not require spinal motion restriction (SMR). Part one covers the two decision rules that many protocols are base…

https://atcomd.files.wordpress.com/2018/06/ep-19-heat-illness1.m4aHeat illness ranges from the benign and temporary to the life-threatening. We dive into management of heat cramps, heat syncope, heat exhaustion, and heat stroke. Rule #1: Stay on scene to cool them down.Di Austin-Travis County EMS System Office of the Chief Medical Officer

In person and on the radio, make the most of your concise patient report. https://atcomd.files.wordpress.com/2018/06/ep-18-trauma-reports1.m4aDi Austin-Travis County EMS System Office of the Chief Medical Officer

If you felt the need to put a #cardiac monitor on at any point in the patient interaction, it should stay on as you walk into the ED. #EMS #paramedic #prehospital https://atcomd.files.wordpress.com/2018/06/ep-17-cardiac-monitor-stays-on1.m4aDi Austin-Travis County EMS System Office of the Chief Medical Officer

We dug into our QA data and the literature to bring you some pearls on #prehospital #airway management. #EMS #paramedic https://atcomd.files.wordpress.com/2018/06/ep-16-airway-pearls.m4aDi Austin-Travis County EMS System Office of the Chief Medical Officer

750,000 Americans will suffer from sepsis this year. Early recognition and treatment are key. Here we go into the field recognition of sepsis and treatment priorities. https://atcomd.files.wordpress.com/2018/06/ep-15-sepsis.m4aDi Austin-Travis County EMS System Office of the Chief Medical Officer

This is a short episode on the response to and care for bombing victims for #EMS, #Firedepartement and #Police. A longer episode will follow that covers #prehospital care in detail, but this is the initial response and considerations. #packagebombmurders #austinbombings @ATCEMS @Austin_police @austinfiredepartment @TxDPS @TravisCoSheriff @Committee…

https://atcomd.files.wordpress.com/2018/02/ep-13-cannabis-hyperemesis-syndrome.m4a Neither rare nor mysterious, Cannabis Hyperemesis Syndrome causes pain and vomiting that can be difficult to treat. Marijuana use is growing for medical purposes and recreational abuse. With this has come a rise in Cannabis Hyperemesis Syndrome which is marked by rec…

https://atcomd.files.wordpress.com/2018/02/ep-12-trauma-resuscitation.m4a Fluid resuscitation, blood, acidosis, coagulopathy, hypothermia, TXA, intubation, push dose pressors! All the greatest trauma lit for your naughty bits.Di Austin-Travis County EMS System Office of the Chief Medical Officer

In this episode we sat down with Dr. Steven Warach the Director of the Clinical Research Institute and Vascular Neurologist from Dell Seton Medical Center to talk about acute MRI for stroke and how we might be able to reduce the time to treatment. 3 questions comprise the safety screen: Do you have any implanted electronics like a pacemaker or defi…