MedicCast Recap

I recently had the pleasure of chatting with Jamie “PodMedic” Davis on the MedicCast about my EMS World article, What Your System Should Deliver.  We covered a number of topics, and here are some of the highlights:

1. Response time is one thing that services should track, but it is not the most important thing.  Besides CPR and defibrillation within five minutes for cardiac arrest,  the quality of care delivered after help arrives matters much more than how long it takes for paramedics to get there.  As long response time is tracked, it should be measured the same way in every community.  The clock should start when the phone rings and stop when help reaches the patient’s side.

2. No more excuses.  If a patient seizes all the way to the hospital without receiving a benzo, is in pulmonary and does not get CPAP,  or  has a STEMI that goes undetected, their system failed.  We know better now, and patients who do not receive these interventions from their EMS system suffer long-term consequences.

3. Pain management is important. I first realized how important after reading Peter Canning’s post, Time to Pain Management, which he discussed on the EMS Educast.  Jamie dove into how untreated acute pain leads to chronic pain.  So why would ever not medicate a hip fracture patient before moving them?  Why do we send people on those calls who are not equipped with any?  We have no excuse for not managing pain anymore either.

4. Staying current on research can affect your practice tomorrow, even within existing protocols.  I used to start an IV and give nitro to STEMI patients in their house before moving them.  Since learning that time to aspirin and time to the cath lab are what matter most for them, now I treat them similar to trauma patients.  I give them aspirin right away, move them to the ambulance as quickly as possible, and do as much as I have time to on the way to the right hospital.

5. In some ways I’m glad to be disappointed about the 2010 AHA ECC guidelines.  Jamie pointed out how if you follow the research, you generally know what they are going to be before they get published.  Doing that, I was disappointed that the AHA still recommends the 30:2 compression to ventilation ration.  I have still not gotten a good answer about why we must still pause for ventilation with the resuscitation numbers in systems that use cardio-cerebral resuscitation or ventilate during compressions.

Alas, I am excited about the fact that street medics are having these discussions, and have the knowledge base to criticize the mighty AHA’s guidelines instead of just blindly following them.  We are taking baby steps towards creating a body of EMS-specific research, which will allow us to control our destiny.

Jamie and I could have gone on for hours, and I hope our paths cross in person soon.  You can also hear about a hospital not far from Jamie and I cutting its EMS program, a book and movie about a Sydney paramedic, and an fire/EMS summer camp by watching the podcast here.



  1. Bob, it was a pleasure having you on the show and I, too, hope our paths cross again soon.


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