Josh Kimbrell

#EMIMCC #EMSsky#EMsky#Medsky

We'd love to hear your thoughts and ideas for future research.

Thanks to all of the rockstar co-authors on this study and more importantly the paramedics and EMTs who provide high-quality clinical care to our communities.

Sankey diagram shows the transitions between ROSC and rearrest before, during, and after transport.

Main takeaway:
- Delays to defibrillation and chest compressions due to unrecognized prehospital rearrest may contribute to decreased survival outcomes, and patient movement could play a role.

Violin plot demonstrates the delays described in the post.

- Nearly 50% experienced prehospital rearrest.
- Of 10 w/ rearrest rhythm of asystole, 6 had a CPR delay > 10s with a median delay of 18s.
- Of 16 w/ rearrest rhythm of VF, 12 had a defibrillation delay > 10s and 3 were never defibrillated.

We aimed to:
- Calculate the time interval from rearrest to initiation of chest compressions and defibrillation for those with a rearrest rhythm of asystole or VF
- Use a novel methodology to infer when patient movement began and ended in the context of rearrest

We identified 235 patients with out-of-hospital cardiac arrest on-scene ROSC from an EMS network with multiple divisions with 9-1-1 and emergency airport response from 2021 to 2023.

We used cardiac monitor files to investigate rearrest treatment delays and patient movement.

I'm excited to share that our study on Delays to Chest Compressions and Defibrillation during Prehospital Rearrest was just published in the American Journal of Emergency Medicine. Free link to read: authors.elsevier.com/a/1lf2W2dHVQ...

The Journal is proud to announce its inaugural special issue, The Future(s) of Paramedicine.

This collection features contributions from the United Kingdom, Canada, USA and Australia, exploring what paramedicine might become, or perhaps what it ought to become.

Available: paramedicinejournal.org

Near Sonic velocity

Approximately the speed of sound

Mojo

📢 Check out our study in Academic Emergency Medicine:Systematic review of +32K patients in US EDs finds:
⚠️ 52% of females with STI undertreated
💊 64% of males without STI overtreated
Sex-based disparities in treatment highlight the need to improve ED care for STIs!📎 doi.org/10.1111/acem...

Wow 😳

Compression-only CPR is good for VT/VF arrest, b/c the lungs & blood have some O2 in them.

In opioid-induced cardiac arrest, lung/blood O2 is *gone* by the time arrest occurs. So probably need assisted ventilation along w/ compressions. Pushing around deoxygenated blood doesn't work. #EMIMCC

Very pleased to share short report just published in #EMAJournal
@emajournal.bsky.social

Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service

onlinelibrary.wiley.com/share/author...

No wonder knowledge translation is so delayed!

@EMSsky

Please consider joining us for a grand rounds on transcutaneous pacing tomorrow, Thursday, at 1pm ET. No need to register, just log into the Zoom here:
buffalo.zoom.us/j/9848537719...

Episode 179 - Transcutaneous Pacing Pearls and Pitfalls MCHD Paramedic Podcast · Episode

Why is Transcutaneous Pacing so difficult, and how can we do it better?

It was great to chat with Casey Patrick and my colleague Judah Kreinbrook on the MCHD Paramedic Podcast after being a long-time listener. Check it out!

#EMSSky

open.spotify.com/episode/2rji...

Great book!

Loved this. Paramedicine seems hellbent on improving the quality of paramedic research.

We offer a registry-compatible definition to improve future observation OHCA research examining IAT.

This has profound implications, as this measurement bias calls previous studies of IAT using this definition into question.

Measuring Intra-Arrest Transport in Out-of-Hospital Cardiac Arrest: A Methodological Study of Registry-Compatible Definitions For out-of-hospital cardiac arrest (OHCA) with refractory arrest, transport to hospital with ongoing cardiopulmonary resuscitation (CPR)—“intra-arrest…

We tried to validate studies of intra-arrest transport by comparing the previous definition (lack of ROSC prior to transport) to a direct measurement of CPR at transport time. This definition mis-classified 104 (22%) because of a rearrest.

#EMSsky #emimcc

www.sciencedirect.com/science/arti...

Prehospital Cricothyrotomy for Emergency Airway Management

We published a short paper in CHEST this past week looking at paramedic crycothyrotomies using NEMSIS 2022-2023.

- 72% male
- 66% 60y or younger
- 47% in cardiac arrest at EMS arrival
- 83% documented successful

www.sciencedirect.com/science/arti...

#EMSsky #EMIMCC

If you have a patient arrive with a STEMI who took their daily 81mg aspirin that morning, how much more do you give them?

I know I don’t have the followers & can’t do an easy poll here quite like the former app. But for any of you in EM who see this plz reply/repost
#Pharmsky #EMsky #Medsky

Study: Only 25% of pulse oximeters tested for skin-tone bias post-FDA guidance These devices, crucial for measuring blood oxygen levels, have shown discrepancies in accuracy when used on darker skin, leading to potential health risks for non-white patients, the study states

Voluntary guidance not leading to much progress on a persistent issue. www.ems1.com/research/stu... #EMSSky #MedSky

#emimcc

In another project, we aimed to improve ECG acquisition for "atypical" ACS symptoms from 25-80%. We used iterative PDSA cycles with targeted education and awareness and found improvement.

We also used iterative PDSA cycles to improve pain management with a health equity lens. We identified any patients with pain 5+/10 and paramedics on scene and aimed to improve pain management rates from 25-50% and eliminate the racial disparity.

In this quality project, we used iterative PDSA cycles to improve management of pain for injured patients with a pain score of 5+/10.

We used a novel approach, including splinting and ice pack adm as pain management. Through training, champions, and awareness, we saw sustained improvement.

Poster shows mentioned research findings

We investigated variability in EMS Transcutaneous Pacing protocols.

- 41% don't mention pad placement
- 37% describe electrical capture
- 11% describe false electrical capture
- 56% recommend confirming capture by pulse palpation
- 11% do not mentioned sedation or analgesia

Poster shows mentioned findings

We looked at rearrest using defibrillator files to identify delays and a potential relationship with patient movement.

- 44% of ROSC pts rearrested
- 59% of rearrest occured immediately before or after movement
- 16.2% of rearrest had a delay in recognition > 10s
- Median recognition delay: 48s