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August 6, 2015 / jeffmedic

2015 NAEMSE Symposium- The Night Before

Tomorrow morning I am heading up to Nashville for the 2015 NAEMSE Symposium.  This summer has been very busy for me with a lot of time away from my family.  I spent most of today with them trying to make up for being gone this weekend.

I made a point of not taking any CoAEMSP sponsored classes this time so that hopefully I will be able to control my blood pressure. I am looking forward to hearing more about the NREMT Portfolio and Scenario Based testing.  I have signed up for some other interesting looking classes also.

I hope I will be able to meet many new friends and reconnect with old ones.

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January 20, 2014 / jeffmedic

Fall 2013 Commencement

I am currently serving as the president of the faculty senate at my school. BY tradition, I was asked to speak at the Fall semester commencement this. Here is the text from my speech. I ended up speaking a grand total of three minutes. I had intended to take 5.

Delivered on December 18, 2013.

For many years we have been told that “a mind is a terrible thing to waste.” As we sit here in this temple of the mind, I hope we have been listening to this admonition.

The human mind represents everything that separates us from the other inhabitants of this world. We have the ability to learn not only from our mistakes but those of others. We have the ability to create beautiful works of art or world-changing discoveries of science.

The mind allows us to see the world as it is and ask why, but more importantly our minds allow us to see the world as it could be and ask why not?

Let us discuss a few ways that we waste our minds. The first way that we waste our mind is by not filling it. Modern communications technology has opened a world of knowledge to us. Its as if we walked into a buffet that contained every type of food imaginable. There are new things to learn everywhere.

Institutions of higher education like BPCC bring you experts in a wide range of subjects to help provide you with knowledge and and train your mind in how to use it. This, more than anything else, is what makes this such a special place.

Learn all you can, everywhere you can. Unlike the buffet of food I mentioned, this buffet of knowledge will never fill you up or make you sick. You might, however, have some interesting dreams after feasting

Second, it is a waste when the products of our minds do not lead to action. An active mind should lead to dirty hands. Every occupation requires thought to be successful. You cannot separate thought from action.

At the wedding of a friend, industrialist Francisco d’Anconia was challenged about his views on money and production. He said

“Take a look at an electric generator and dare tell yourself that it was created by the muscular effort of unthinking brutes. Try to grow a seed of wheat without the knowledge left to you by men who had to discover it for the first time. Try to obtain your food by means of nothing but physical motions- and you’ll learn that man’s mind is the root of all goods produced and of all wealth that has ever existed on earth.”

Whatever you choose to do with your life, put your mind as well as your back into it.

The third way we waste our minds is by not living and acting with a purpose. If an activity is worth our time then we should devote our minds to it as well. Do not let life happen to you. Wake up each morning determined to chart your own destiny.

There is no area of your life where it is sufficient to coast and let other people think for you. Your career, your relationships with your loved ones, your spiritual life, all of these require active participation and thought.

If you put your mind to use in every area of your life, you have a much greater chance of ending up someplace you want to be.

In closing, I plead with you. Use your mind to live a life that has meaning and brings you fulfillment. You have been given an incredible gift, please do not waste it.

April 15, 2013 / jeffmedic

2013 Gathering of Eagles- Day Two and Three

Woke up at about 0500 and couldn’t go back to sleep.

Dr. Corey Slovis gave his usual talk about the Most Important EMS Articles of 2013 that we should know. The most interesting article, in my opinion, was from Scott Weingart and Rich Levitan about preoxygenation and the prevention of desaturation. This article was that first time I was introduced to the concept of apneic oxygenation. The idea is that you can place a patient that you are intubating of a high flow nasal cannula

Here is a link to the slides from the presentation. Here is a link to the article from Annals of Emergency Medicine. Here is a link to a podcast by Dr. Weingart about the article.

The other presentation that I particularly enjoyed was by Dr. Jeffery Goodloe of Oklahoma City and Tulsa, Oklahoma. His talk was titled The EMS Praxis for Anaphylaxis. This issue of Ems and anaphylaxis has been receiving a lot of attention lately. There was an article in the Oct-Dec 2012 issue of Prehospital Emergency Care that questioned whether paramedics were competent at recognizing and treating anaphylaxis. The results were not encouraging.

Here is a link to Dr. Goodloe’s slides. The file is about 48 megabytes.

The rest of the conference was filled with many other excellent presentations. The only complaint I have is that they do not record the lectures so you can listen again. I look forward to next year!

February 25, 2013 / jeffmedic

2013 Gathering of Eagles- Day 1

My annual trip to the Gathering of Eagles has begun on a very positive note. I rode to Dallas with my friends Brian and Amanda. We left Bossier City under cloudy skies but by the time we hit Tyler, Tx the sun was out in force. It turned out to be a beautiful day. We arrived at the Sheraton in Dallas at about 1500 which means we missed rush hour. A definite bonus for this non-city-dweller! As usual there was lively conversation all the way.

While we were waiting for the rest of our Bossier Parish crew to gather for dinner, I got to meet the new director of the NREMT Severo Rodriguez. I spoke to he and Rob Wagoner for a few minutes. Mr. Rodriguez seemed like a very impressive individual but I don’t envy him in that he has very large shoes to fill following after Bill Brown. Mr. Wagoner is also first rate. I have been up to the Registry twice to write test items and I have seen first-hand how dedicated they are to EMS.

Dinner was at the Hoffbrau Steaks, our usual Eagles Thursday night haunt. Then we came back to the conference center to check in and visit with the vendors. I don’t remember them doing this before but I enjoyed getting to mingle. I ran into some old friends and met some new ones. I also got to check out the vendor booths.

 

December 24, 2012 / jeffmedic

Ipratropium Bromide and Peanut Allergies

Here is an article that I wrote for the newsletter of a local EMS agency.

3 years ago one of my students came to class after a ride out shift and told me that their preceptor had told them that Ipratropium Bromide was contraindicated in patients with an allergy to peanuts. This caught my interest because I had never heard of that issue. Ipratropium was not a drug commonly used in EMS when I trained as a paramedic so I wondered if I wasn’t as familiar with it as I should be.

I broke out my trusted ALS Field Guide and sure enough it says the Ipratropium is contraindicated in patients with peanut allergies. Then I looked at the pharmacology text that we use in my paramedic program to verify what I had found. The text also listed peanut allergy as a contraindication for giving Ipratropium. It really worried me that I had not known that before. I am confronted by things I didn’t know every day in my job but this one seemed too basic and too important to have missed.

Because it bothered me so much I started researching why Ipratropium was contraindicated. I checked to see if this contraindication applied to Ipratropium’s cousin Atropine, it didn’t. I also looked up the package insert for the Ipratropium that we used at the EMS agency I work at. There was nothing in the package insert identifying such a contraindication.

Then I turned to Dr. Google. Besides finding out that I almost certainly have cancer, I also found several sites that discussed this issue. Some of them confirmed what I had already found but a few also mentioned a substance called soy lecithin. Soy lecithin is related closely enough to peanuts that people with an allergy to peanuts can have an adverse reaction to it. Digging a little deeper I discovered that soy lecithin is an emulsifying agent that is used in a wide variety of food products and some medications. In particular, soy lecithin is used in Combivent and Atrovent Inhalation Solution metered dose inhalers.

This finding was important because I had not considered that the issue might be one of the inert ingredients of the medication and not the drug itself. I went back to the package insert for the Ipratropium and did not find mention of soy lecithin anywhere in it. Then I went back to the internet and found the package insert for Combivent. Sure enough, soy lecithin was listed as an ingredient and peanut allergy was listed as a contraindication.

I had now reached the point of diminishing returns as far as the internet was concerned. To confirm my findings I called Nephron Pharmaceuticals, the maker of the Ipratropium I used at work. I was put in contact with someone who was able to confirm that their Ipratropium does not contain soy lecithin. He also emailed me several documents related to this issue.

So after all of that, here is my conclusion. Nebulized Ipratropium Bromide is NOT contraindicated in patients with peanuts allergies. Inhaled Ipratropium Bromide delivered by metered dose inhaler under the brand names Combivent and Atrovent IS contraindicated because it contains soy lecithin. Soy Lecithin is in these preparations as a part of the delivery mechanism and not because of the medication itself. As long as EMS continues to use nebulized Ipratropium and not metered dose inhalers this should not be an issue.

Y’all stay safe out there.

October 20, 2012 / jeffmedic

Feedback

This is an article I wrote for a local EMS agency’s newsletter.

Giving effective feedback is an essential skill for an EMS provider. We are all teachers at one time or another and one of the best ways for an adult to learn is by receiving feedback on their performance. This feedback can come from a partner, other members that were on the call, a supervisor, hospital personnel or even the patient. Being open to giving and receiving feedback is one of the characteristics of a serious professional.

For our feedback to be effective there are a few things we should keep in mind. First, always deliver good news in public and bad news in private. Berating someone for poor performance will not induce that person to change if you do it in front of their friends or worse, the patient. Criticizing people in public turns a teaching moment into a confrontation. Better to pull them aside and discuss it privately or perhaps with a small group so that the recipient of the feedback does not feel as threatened.

If the feedback is positive, shout it from the roof tops. When someone does a good job, make sure that everyone involved knows it. This will encourage better performance in all who are involved. It will also, lay the groundwork for when you do have to provide corrective feedback when a mistake is made. It is a lot easier to take correction from someone who has praised you in the past.

Second, make sure that you separate principle from preference. A principle is something that has to be done, a preference is something that could be done. Sometimes it is hard to separate the core principles of a task from our preferences on how to do it. There are often many ways to perform a task and you will work with people that do things differently. This is particularly true when precepting a student or new hire. You are undoubtedly very good at your job and have a routine in place. Allow the student or new hire to come up with their own routine. You are there to ensure that the principles are adhered to. It is unfair to evaluate them based on your preferences.

Third, if you have been chosen to guide a student or new hire that means that you have been identified as someone who has mastered your job. That mastery took time and a lot of work. It is unreasonable to expect a newbie to come out of the gate functioning at anywhere close to your level. They will make many mistakes and do things that you don’t agree with. It is vital that you do not bombard them with feedback about every little thing they did wrong after a call. Pick a small number of the most important things and focus on those until they are corrected. Then pick a few more. This will make the improvement manageable for the learner.

Last but not least, make your feedback as specific as possible. Telling someone to “do better” doesn’t spur anyone to change. The recipient needs specific feedback on what went wrong and why it went wrong. Once you have explained these things to them ask them to come up with a way to correct it. Then compare their solution to what you would do. Having them think through the problem will set the stage for long term improvement.

I hope this discussion of feedback is helpful to you. I would love to hear about ways that you have found to give effective feedback. Stay safe!

August 11, 2012 / jeffmedic

Quicksand

This is an article I wrote for the internal newsletter of a local EMS agency. I’d love to hear how y’all handle quicksand.

There is a scene in the movie The Replacements where Coach McGinty asks the team to name their greatest fear. After several ridiculous answers the quarterback, Shane Falco, responds “quicksand.” The team could quite understand what he meant so he explained it to his teammates this way.

You’re playing and you think everything is going fine but then one thing goes wrong and then another, and then another. And you try to fight back the harder you fight, the deeper you sink until you can’t move. You can’t breath because you are in over your head. Like quicksand.

This description applies to EMS as well. We have all been on calls where things didn’t go as smoothly as we would like. It usually starts with something small. You leave a key piece of equipment in the truck. The previous crew didn’t replace a small but important part on the suction or the monitor. Anything to break your rhythm.

Then you miss an IV and maybe another. Now you forget the list of questions that you had for the patient. You start to get snippy with the other team members on scene. They respond in kind and now intra-team communication suffers. Finally you give up trying to have the call go well and you focus on just getting through it.

I hope this isn’t a common occurrence for you but I’ll bet you have all experienced something similar, especially early in your career. I hope the following suggestions will help when you confront quicksand.

The first step in avoiding quicksand is to be prepared. Come to work able to focus on patient care. Check your truck thoroughly making sure to look over the little but vital stuff like the suction system. Spend a little time every shift studying your profession and preparing for the next patch of quicksand that you encounter.

Second, take a deep breath. You cannot control what comes your way on a call but you can control how you respond to it. If you allow your sympathetic nervous system to take over, your ability to think will be inhibited. You can help this by taking some deep breaths and giving your mind a second or two to refocus on the problem in front of you.

Third, learn from your mistakes. When you encounter quicksand, do your best to work through the problem and then when the call is over and the paperwork is done, go think about something else for a while. Once the emotion of the call has left, sit down and analyze what went right about the call and what went wrong. Identify ways that you could prevent the situation from happening again. Be brutally honest with yourself. Don’t be afraid of being wrong the first time you are presented with a problem. Be afraid of being wrong the next time you are presented with the same situation.

EMS providers are surrounded by chaos. Our job is to bring order to that chaos and get the patient to the hospital in the best condition possible. Identifying, overcoming, and/or bypassing quicksand will minimize the chaos encountered during calls.