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News, updates and commentary on the world of emergency medical services powered by JEMS.
Episodes
Wednesday Dec 23, 2020
Wednesday Dec 23, 2020
Topic #1: Paramedic Lauren Kwei and OnlyFans
Sexy brings readers in, but the point is that medics are not paid enough to survive in NYC
Not just EMS....
Nursing and Only Fans
https://www.buzzfeednews.com/article/otilliasteadman/pandemic-nurses-onlyfans-sex-work
Med Student and Only Fans
https://vt.co/lifestyle/medical-student-makes-over-70000-a-year-selling-pictures-of-her-feet-online
The poster child for the paramedic pay gap - Sexy gets them in the door, then they will hear the underlying point....
Bess Meyerson was the only Jewish Miss America and a heroine to the Jewish community, where "she was the most famous pretty girl since Queen Esther."
https://en.wikipedia.org/wiki/Bess_Myerson
FEMEN
https://en.wikipedia.org/wiki/Femen
Topic #2: Paramedics with Guns
https://www.arkansasonline.com/news/2020/dec/17/pine-bluff-man-fatally-shot-after-shooting-paramed/
-Should be able to carry legal weapons
-It depends on the culture
As State EMS Director, I made the commitment to go to court with every EMT and paramedic that has been assaulted, so that our county prosecutors (district attorneys) knew that State OEMS was paying attention and wanted to see people charged accurately. Because the criminal justice system is overwhelmed and wants to plead everything down.
N.J.S.A. 2C:12-1 Assault.
2C:12-1. Assault. b. Aggravated assault. A person is guilty of aggravated assault if he:
(5)Commits a simple assault as defined in subsection a. (1), (2) or (3) of this section upon:
(c)Any person engaged in emergency first-aid or medical services acting in the performance of his duties while in uniform or otherwise clearly identifiable as being engaged in the performance of emergency first-aid or medical services; or
NY Consolidated Laws, Penal Law §120.08 Assault on a peace officer, police officer, firefighter or emergency medical services professional.
A person is guilty of assault on a peace officer, police officer, firefighter or emergency medical services professional when, with intent to prevent a peace officer, police officer, a firefighter, including a firefighter acting as a paramedic or emergency medical technician administering first aid in the course of performance of duty as such firefighter, or an emergency medical service paramedic or emergency medical service technician, from performing a lawful duty, he or she causes serious physical injury to such peace officer, police officer, firefighter, paramedic or technician. Assault on a peace officer, police officer, firefighter or emergency medical services professional is a class C felony. (3.5-15 years)
Three NJ EMS Clinicians were just suspended this week for punching a patient
https://www.ems1.com/violent-patient-management/articles/nj-emts-accused-of-punching-patient-in-ambulance-say-it-was-self-defense-Veew7de6yOYvMexe/
https://www.state.nj.us/health/ems/documents/reg-enforcement/actions/2020-0109V.EMT.SummarySuspension.Bonvenca.RED.pdf
https://www.state.nj.us/health/ems/documents/reg-enforcement/actions/2020-0108V.EMT.SummarySuspension.Han.RED.pdf
https://www.state.nj.us/health/ems/documents/reg-enforcement/actions/2020-0107V.MICP.SummarySuspension.Piro.RED.pdf
ONLY two EMS Clinicians have ever been shot in NYC history:
- Kings County Hospital Ambulance Attendant Hannah Callahan was shot and killed by an EDP in December 1954.
- Ambulance Surgeon Thomas Garvey was shot in the shoulder by a drunk Swede in the back of the ambulance on the way to the hospital in Spanish Harlem in September 1894.
- No EMT or Paramedic in NJ to date has ever been shot by somebody else since 1874.
N.J.A.C. 8:40-4.11 (b) Crewmembers shall not wear or carry any weapons or explosives while on duty. For the purpose of this chapter, the terms "weapons" and "explosives" include not only offensive weapons, but also defensive weapons such as stun guns, stun batons, air tasers, pepper spray, mace defensive spray and/or telescopic steel batons.
N.J.A.C. 8:41-3.5 Physical behavioral restraints (d) Crewmembers shall not wear or carry any weapons or explosives while on duty. For the purpose of this chapter, the terms "weapons" and "explosives" include not only offensive weapons, but also defensive weapons such as stun guns, stun batons, air tasers, pepper spray, mace defensive spray and/or telescopic steel batons.
- Should engage in self-defense
- Should be able to carry legal weapons
- Should be punished for going overboard
Tuesday Dec 22, 2020
Tuesday Dec 22, 2020
On this week’s episode of The EMS Handoff Podcast, Eric, Bradley and David talk with Tom Herron, associate professor and clinical coordinator at Roane State Community College, about the hidden fears of EMS. Tom is an advocate for EMS and seeks to empower EMS professors to seek help for the injuries and scars that go unseen through experiences with prehospital providers' clinical experience. To reach out to Tom, you can email at reboot.tom865@gmail.com.
Wednesday Dec 16, 2020
Wednesday Dec 16, 2020
In this episode of the EMS Handoff Podcast, Eric, David and Bradley are joined by Kevin Collopy to discuss clinical errors in EMS. Kevin is the clinical outcomes and compliance manager for NHRMC AirLink/VitaLink Critical Care Transport where he oversees the program's research, education, risk management and quality assurance programs.
Kevin regularly speaks across the United States and has taught emergency and wilderness medicine on three continents. He's an author of over 150 articles and book chapters including 12 peer-reviewed research abstracts and papers. Additionally, Kevin serves on several national and international advisory boards, is a past president of the IAFCCP, teaches the paramedic program at Cape Fear Community College and is pursuing a Master's in Healthcare Leadership. He can be contacted via LinkedIn and Twitter (@ktcollopy).
Tuesday Dec 15, 2020
Tuesday Dec 15, 2020
Is there a cultural difference between first responders and hospital staff? Hear from Amy and Herb Campbell and their perspectives on relationships, culture and their personal struggles with mental wellness throughout their careers.
Monday Dec 14, 2020
Monday Dec 14, 2020
How did curiosity and unanswered questions lead to the founding of a business and a passionate emergent leader? Find out on this week's Emergent Leadership episode with Julianne Stevenson of Sterling Credentials, LLC.
Monday Dec 14, 2020
Monday Dec 14, 2020
Where I'm coming from (compared to most of my colleagues):
- Master's in Public Health with a concentration in Health Policy from Yale Medical School.
- FT Faculty at GWU School of Medicine & Southern Connecticut State University MPH Program, and long-time adjunct faculty at NYMC MPH program in Health Policy.
- Assistant Commissioner of Health at the NYC Department of Health & Mental Hygiene during the first SARS outbreak.
- Served as State EMS Director, Consultant to Public Health Canada, Connecticut Department of Public Health, Local Health Departments.
- (So in other words, I'm not a vaccine expert, but I'm pretty well versed in this stuff)
Flu vaccine is bad example, most vaccines are ~80% effective
- One dose of the MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella. Two doses of MMR vaccine are 97% effective against measles and 88% effective against mumps. MMR is an attenuated (weakened) live virus vaccine.
- The Hepatitis B vaccine is 80% to 100% effective in preventing infection or clinical hepatitis in those who receive the complete vaccine series.
- TDAP vaccines is 80-90% effective after fifth dose, but this decreases to 30-40% after four years.
- Flu efficacy in the US, by year:
|
2004 |
10% |
|
2005 |
21% |
|
2006 |
52% |
|
2007 |
37% |
|
2008 |
41% |
|
2009 |
56% |
|
2010 |
60% |
|
2011 |
47% |
|
2012 |
49% |
|
2013 |
52% |
|
2014 |
19% |
|
2015 |
48% |
|
2016 |
40% |
|
2017 |
38% |
|
2018 |
29% |
|
2019 |
45% est |
Time to Develop Vaccine?
- Fastest time to develop vaccine: four years https://www.nytimes.com/interactive/2020/04/30/opinion/coronavirus-covid-vaccine.html
- Average time to develop vaccine: 10 years https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31252-6/fulltext
Historical Vaccine Problems?
- Cutter Incident (1955): Active polio administered to 200,000, with 200 cases of polio, and 10 deaths. This was a live vaccine, compared to the Pfizer and Moderna COVID vaccines that are Messenger RNA (mRNA) which is just a set of instructions that tells your body to make the protein that resembles part of the Coronavirus...(but not a Recombinant DNA vaccine like I said.)
https://www.cdc.gov/vaccinesafety/concerns/concerns-history.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1383764/
https://www.cnbc.com/2020/12/08/pfizer-moderna-covid-vaccine-side-effects-trials.html
COVID vaccine
- Does it work? Yes, it appears to work pretty well. But no way is it going to be 95% effective in the real world....
- What does 95% efficacy mean? Eight out of 18,198 vaccinated with two doses of vaccine got symptoms and a positive COVID test from seven days after their second vaccination through November 14th, 2020. One hundred and sixty-two out of 18,325 vaccinated with placebo got symptoms and a positive COVID test from seven days after their second vaccination through November 14th, 2020.
What we don't know:
- How many of the people in the study were exposed to the COVID virus?
- If people who got the vaccine can be asymptomatic spreaders?
What we do know:
- You need two shots, and you're going to be sick after your second shot...."The most common solicited adverse reactions were injection site reactions (84.1%), fatigue (62.9%), headache (55.1%), muscle pain (38.3%), chills (31.9%), joint pain (23.6%), fever (14.2%); severe adverse reactions occurred in 0.0% to 4.6% of participants, were more frequent after Dose 2 than after Dose 1, and were generally less frequent in participants ≥55 years of age (≤ 2.8%) as compared to younger participants (≤4.6%).” https://www.fda.gov/media/144245/download
- 2020 Flu vaccine will probably be even less effective because there was not much flu in Australia to base the vaccine on. But get the flu vaccine anyway this year, because you don't want to get the flu and COVID at the same time....https://www.cdc.gov/flu/season/faq-flu-season-2020-2021.htm#Flu-Vaccine
- Emergency Authorization isn't the same as regular approval....they are going to continue to gather data. https://www.fda.gov/vaccines-blood-biologics/vaccines/emergency-use-authorization-vaccines-explained
What's the priority for EMS clinicians?
CDC COVID-19 vaccination program interim playbook
Jurisdictional considerations for Phase 1 subset groups may include, for example:
-Phase 1-A: Paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials
-Phase 1-B: People who play a key role in keeping essential functions of society running and cannot socially distance in the workplace (e.g., emergency and law enforcement personnel not included in Phase 1-A, food packaging and distribution workers, teachers/school staff, childcare providers), adults with high-risk medical conditions who possess risk factors for severe COVID-19 illness, and people 65 years of age or older (including those living in LTCFs)
There may be insufficient COVID-19 vaccine supply initially to vaccinate all those who fall into the Phase 1-A subset, so jurisdictions should plan for additional subsets within that group (see CISA guidance for categories of healthcare personnel).
CISA guidance on essential critical infrastructure workers (explicitly listed in both categories)
Guidance on the Essential Critical Infrastructure Workforce: Ensuring Community and National Resilience in COVID-19 Response
Health/Public Health
-Healthcare providers including, but not limited to, physicians (MD/DO/DPM); dentists; psychologists; mid- level practitioners; nurses; emergency medical services personnel, assistants and aids; infection control and quality assurance personnel; phlebotomists; pharmacists; physical, respiratory, speech and occupational therapists and assistants; social workers; optometrists; speech pathologists; chiropractors; diagnostic and therapeutic technicians; and radiology technologists.
-Workers required for effective clinical, command, infrastructure, support service, administrative, security, and intelligence operations across the direct patient care and full healthcare and public health spectrum. Personnel examples may include, but are not limited, to accounting, administrative, admitting and discharge, engineering, accrediting, certification, licensing, credentialing, epidemiological, source plasma and blood donation, food service, environmental services, housekeeping, medical records, information technology and operational technology, nutritionists, sanitarians, etc.
--Emergency medical services workers including clinical interns.
--Prehospital workers included but not limited to urgent care workers.
Law Enforcement/Public Safety/Other First Responders
-Public, private, and voluntary personnel (front-line and management, civilian and sworn) in emergency management, law enforcement, fire and rescue services, emergency medical services (EMS), and security, public and private hazardous material responders, air medical service providers (pilots and supporting technicians), corrections, and search and rescue personnel.
https://www.cisa.gov/publication/guidance-essential-critical-infrastructure-workforce
American College of Emergency Physicians supports EMS Clinicians being included in Category 1A
American Paramedic Association and the National EMS Managers Association supports EMS Clinicians receiving a COVID-19 vaccination "as soon as possible."
https://www.nemsma.org/resource/resmgr/covid-19/covid-19_vaccination_conside.pdf
EMS included in Category 1A from AIPC and CDC, states may vary.
New York: "ICU, EMS, ED top priority" (other first responders were Phase 2)
New Jersey: "Who are "healthcare personnel" in Phase lA? Healthcare personnel are paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials. This includes any type of worker within a healthcare setting. Examples include, but are not limited to...personnel with variable venues like EMS, paramedics, funeral staff, and autopsy workers."
http://nj.gov/health/legal/covid19/12-10-20_PopulationPrioritizationPOD_memo.pdf
What should we do:
- Taking the vaccine is your individual choice based on your own circumstances
- Even if you don't want the vaccine, or want to wait, you should support EMS clinicians, both public, non-profit, and private, being in Category 1A
- Even if vaccine is offered, we still need:
- Adequate respiratory PPE (half face respirator c P100)
- Face Shields, Goggles, Gloves, and Gowns
- Negative pressure ambulances
- Equipment and Supplies for Cleaning
- High-level decontamination with UV or Hydrogen Peroxide
Monday Dec 14, 2020
Monday Dec 14, 2020
This week, the hosts of the EMS Handoff Podcast are joined by Ed Moreland, NRP. They cover a variety of topics, including advocating for the patient, profession and self.
Ed is a Metro Washington, DC native, a veteran of the United States Marine Corps and PA Army National Guardsman who has been actively engaged in EMS since 1990 when he ran his first EMS call as a volunteer in Montgomery County, PA. A Nationally Registered Paramedic, Ed has worked in a variety of EMS models, including non-profit, for-profit, hospital-based and rural systems. He has served as a paramedic, supervisor, regulator, deputy chief and chief. He is currently working in senior leadership with a national medical transportation provider.
Thursday Dec 10, 2020
Thursday Dec 10, 2020
Explore the stress of a California firefighter during strike teams and the different dynamics during deployment. Hear the optimistic perspective of Darnell Dodson II and how he keeps mentally, spiritually, emotionally and physically well.
"When you are at work, engage.... Learn your partners, even the one you don't get along with." -Darnell Dodson II
Monday Dec 07, 2020
Monday Dec 07, 2020
Join Brett Lyle as she speaks with emsimprov.com's founder and chief facilitator, Eric Chase, as they discuss how improv and creativity can be used as a tool for combating the everyday challenges EMS, first responders, law enforcement and healthcare providers face. They talk resilience, emotional and mental barriers, and Eric shares a few exercises he and his team employ to transform teams into communities of support.
Wednesday Dec 02, 2020
Wednesday Dec 02, 2020
In this week’s episode of the EMS Handoff, the crew talks with Wes Ogilvie, MPA, JD, NRP, LP, as he addresses the “lawyer boogeyman” issue, as well as documentation tips you can use today to improve your practice.
He also discusses Emergency Medical Treatment and Labor Act and its impact on patient care, specifically in stroke and heart attack cases. Being a patient advocate is of supreme importance and has implications medically, legally and ethically for your patient.
Refusals are an often source of medical liability and it's all about consent. Wes discusses best practices for legal consent and the importance of capturing present mental capacity.
Wes wraps up with scene safety considerations, including restraints and excess of force.
Wes is a practicing attorney for the state of Texas. He has been in EMS since 2004 and a paramedic since 2007. His experience has been primarily volunteer with a variety of agencies in Central Texas and the Houston area, both suburban and rural.
Wes is currently a paramedic/field training officer with West EMS and a paramedic with Huffman EMS. He has taught both initial and continuing education EMS courses. Throughout his career, he has been published in several EMS periodicals and co-authored the Medical-Legal chapter of Paramedic Care: Principles and Practice. In addition to both chasing and driving ambulances, he’s an active blogger. Visit his blog at www.theambulancechaser.com.