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Non-invasive Ventilation (CPAP) and Avoiding Intubation: Emphasis on the importance of early CPAP to reduce the need for intubation, thereby decreasing ICU stay and reducing risks like ventilator-associated pneumonia.

Improving EMS-to-ER Handoffs: Discussing issues with inconsistent care during handoffs from EMS to emergency room staff, including scenarios where patients on CPAP were prematurely removed from ventilation. Emphasis on effective communication to maintain continuity of care.

Empowerment in EMS Provider Communication with Physicians: Encouraging paramedics and EMTs to confidently communicate with ER physicians about their treatment decisions to promote patient advocacy and continuity of care.

Medication and Airway Management in Critical Care: Considerations around the use of drugs like ketamine and Versed for sedation during intubation, managing chemical-assisted versus RSI (rapid sequence intubation), and understanding medication effects, especially in cases involving head injuries and hypotension.

Documentation in EMS: Importance of precise, factual reporting in patient care records, highlighted with examples of legal and operational impacts of documentation accuracy.

Pediatric Airway and Medication Administration: Differences in pediatric airway anatomy, syringe use for precise dosing, and drug choices like cuffed versus uncuffed ET tubes and medications to ensure safe pediatric care.

Anaphylaxis and IV Epinephrine Use: Importance of rapid response to anaphylaxis in the field, including the timely use of IV epinephrine in critical cases, especially when there's evidence of multi-system involvement.

EMS Protocols for Hyperthermia and Heat Stroke: The first 30 minutes are crucial, with protocols advocating for immediate cooling, such as ice baths, in-field temperature management, and preparation for sports or high-heat environments.

Combat Medicine’s Influence on EMS Protocols: Drawing from military protocols, particularly around hemorrhage control, tension pneumothorax management, and basic airway techniques in high-threat situations.

Trends in Cardiac Arrest Protocols, Including Heads-up CPR: Highlighting recent shifts toward heads-up CPR and the bundle approach to improve survival rates, including timing of devices like Lucas CPR and specific medication protocols.

Educational Strategies for High-Risk, Low-Frequency Calls: Emphasis on practice drills for precise medication dosing and preparation for pediatric and critical cases, with a focus on accurate syringe use and drug table references.

Avoiding Intubation and Early CPAP:CPAP is emphasized for preventing intubation, reducing ICU stays, and minimizing ventilator-associated pneumonia risks. Early CPAP use decreases the likelihood of intubation by 65% and shortens hospital stays by several days.

Improving Patient Handoff from EMS to ER: Discusses common issues in patient handoff where EMS stabilizes patients only for ER staff to alter treatments, sometimes resulting in rapid patient decline. Effective communication between EMS and ER, including involving respiratory therapy early, is crucial.

EMS Empowerment and Advocacy: Encourages EMTs and paramedics to confidently communicate with ER staff and advocate for the patient’s ongoing treatment plan. It highlights the role of EMS as physician extenders.

Airway Management and RSI (Rapid Sequence Intubation): Emphasis on preparing for failed intubation and using tools like the bougie and supraglottic devices, with cricothyrotomy as a last resort. Planning and careful oxygenation are key to successful field RSI.

Field Cardiac Arrest Management: Advocates for performing most resuscitative efforts on scene instead of during transport, as extrication limits the ability to perform high-quality CPR and advanced care. ROSC (return of spontaneous circulation) and neuroprotective outcomes are prioritized over transportation speed.

Medication in Field Care: Highlights the importance of administering solumedrol in the field for COPD patients to reduce hospital admissions. Emphasizes proactive EMS medication administration to prevent potential future emergencies.

Documentation and Legal Considerations: Reinforces thorough and factual EMS documentation, including the value of direct quotes from patients and witnesses. Proper documentation supports legal cases and serves as essential records for medical continuity.

Mental Health, Capacity, and Restraint Protocols: Clarifies criteria for determining patient capacity, when to use pink slips, and the safe use of chemical and physical restraints. Med control’s involvement is essential when decision-making about patient transport or restraint is unclear.

EMS’s Role in Evidence Collection and Patient Care: Outlines EMS’s role in preserving evidence, particularly in cases of domestic violence or sexual assault, while prioritizing patient treatment. Advises EMS to guide patients to bring additional clothing for after evidence collection.

Specialized EMS Equipment Use: Education on advanced devices like Impella and balloon pumps used for cardiac support and how EMS should understand their functions and emergency protocols.

 Pediatric and Neonatal Resuscitation: Discusses protocols for oxygen administration and airway management in neonates, focusing on gentle ventilation and capnography’s role in verifying airway placement.

Dynamic vs. Static Triage in Mass Casualty Events: Differentiates between static events (e.g., car accidents) and dynamic events (e.g., active shooter situations), each requiring distinct triage methods. Dynamic events often lead to patient self-evacuation, which can challenge traditional EMS protocols.

Communication and Scene Management at Public Events: Highlights the importance of strategic EMS staging and communication for managing events like parades and public gatherings to ensure timely responses and effective patient evacuation.

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