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Episode Overview

In this episode, the team dives deep into the growing role of advanced ventilator management in EMS. As more municipal and transport services encounter ventilated patients in nursing homes, LTACs, and home-care settings, EMS providers face new challenges. Guest expert Tony Creno brings both respiratory therapy and paramedic perspectives, breaking down the essentials of ventilator physiology, modes, patient-ventilator synchrony, and how these advanced tools can elevate prehospital care.

Key Topics Covered

1. Why Advanced Ventilation Matters in EMS

• The shift from crude, gas-powered transport ventilators to ICU-level portable ventilators.

• Increasing prevalence of ventilated patients outside the hospital—especially in long-term and skilled nursing facilities.

• The risks of mismatching advanced patients to outdated equipment.
  
  

2. Ventilator Basics for Paramedics

• Ventilators as "electronic Ambu bags"—squeezing with either a set volume or pressure.

• Key difference: in volume control, volume is fixed but pressure varies; in pressure control, pressure is fixed but volume varies.

• COPD case examples showing how the wrong mode choice can worsen air-trapping and hyperinflation.
  
  

3. Patient-Ventilator Synchrony

• Challenges of desynchrony: patients fighting the vent, variable tidal volumes, and risks of patient harm.

• Importance of monitoring waveforms, compliance, resistance, and alarms to understand patient-vent interactions.

• Why fine-tuning the ventilator to the patient—not sedating the patient to fit the vent—is critical.
  
  

4. Education and Training Needs

• Paramedic curriculum provides only basic exposure—advanced ventilation requires significant ongoing training.

• Parallels with the rollout of 12-lead EKGs: new technology demands higher-level education.

• The importance of developing well-written, protocol-driven guidelines for prehospital ventilator use.
  
  

5. Ventilator Modes and Nomenclature

• Common modes explained: AC/VC, CMV, SIMV, and pressure support/CPAP.

• How different manufacturers label similar functions differently, creating confusion.

• Practical tips for translating modes across devices.
  
  

6. Alarms and Troubleshooting

• High peak pressure alarms: causes include kinking, biting on tubes, mucus plugs, or bronchospasm.

• Plateau pressures: more important for assessing alveolar stress and preventing lung injury.

• Compliance and resistance as bedside pulmonary function indicators.
  
  

7. Special Populations

• Pediatric considerations: often trached, smaller tidal volumes, and subject to scope-of-practice restrictions for EMS.

• LTAC vs nursing home patients: LTAC patients often present with more complex and exotic ventilator modes.
  
  

8. Noninvasive Ventilation (CPAP/BiPAP)

• Benefits of advanced ventilators that can provide both invasive and noninvasive modes.

• Risks of indiscriminate CPAP use—especially in CO₂-retaining patients.

• Advantages of BiPAP/bi-level support for certain respiratory failure presentations.
  
  

Takeaway Message

Advanced ventilator management in EMS isn’t just about having the latest machine—it’s about education, protocols, and clinical judgment. Matching the vent to the patient, understanding basic ventilator physiology, and training providers to troubleshoot are essential steps in safely raising the standard of care.

From The Episode