EMS/Trauma Committee

COMMITTEE REPORT

EMS/Trauma Committee

By Desmond Fitzpatrick, MD, FACEP

Committee Co-Chair

"Sometimes less is more," a quote attributed to Shakespeare, serves as a reminder that all too often, we get fixated with technology and advancement. Instead, it would do our patients and us well to remember that we may have the best outcomes if we focus on delivering simple care well. This BLS before ALS concept frequently gets overlooked. Regarding cardiac arrest outcomes, high-quality CPR and early defibrillation — both BLS skills — greatly outweigh drugs, intubations, or other advanced procedures.

Another helpful reminder comes from Reuben Strayer: "ventilation is the most important skill in airway management. It is more important than laryngoscopy… If you are outstanding at laryngoscopy but average at ventilation, you're in a bad position." He follows with, "this leads to bad patient outcomes and a sad doctor. If you are average at laryngoscopy but outstanding at ventilation, things are good… Regardless of what's happening with laryngoscopy, when you can ventilate, you can take as long as you need, pressure's off; happy day."

The ability to masterfully BVM the most challenging patient is often relegated to the least experienced person on the scene or in the room. This frequently is the opposite of what the patient needs. If we cannot achieve airway and breathing, we should not move on to other therapies.

I urge all levels of providers out there to think about their comfort level with ventilating a difficult patient and learn about ways to improve this skill. Consider practicing, developing a failed ventilation troubleshooting algorithm, and learning about new methods like the two-person "thumbs down technique." Remember, when you can bag a patient, you have time!

Emergency Ventilation by Reuben Strayer

Two thumbs down: EMNote.org

EMS/Trauma Committee Update

Significant leadership changes on the state level have occurred in the past couple of months. Former state EMS Medical Director, Dr. Kenneth Scheppke, has been named Florida's new Deputy Secretary of Health. In his place, Dr. Angus Jameson has taken over as the new state EMS Medical Director. A major congratulations to both! They have set high expectations for the future of EMS in the state of Florida.

FAEMSMD is celebrating its 40th anniversary. More to come regarding events and celebrations from EMLRC and FAEMSMD.

The recording has wrapped up on the EMS educational matching grant, Bytes You can View. Dr. Abo, Dr. Frank, and the team at EMLRC will finish editing these 15-min video modules and make these available for EMS crews across the state. Many thanks to all involved!

Florida EMSC is asking that everyone completes the pediatric readiness surveys. This survey is important for ongoing funding of state EMSC partnership grant programs. To begin, visit emscsurveys.org, select Florida as your state, identify your county from the drop-down menu, then select your agency name. The questionnaire should only take 10-15 minutes to complete. ■

Next EMS/Trauma Committee Meeting

August 5, 2022 at Symposium by the Sea

Stay tuned via email and at fcep.org

COMMITTEE REPORT

Early Career Physicians

By Dakota Lane, MD, FACEP

Subcommittee Co-Chair | FCEP Board Member

It’s 4:00 am in the ED. The end of your shift is in sight, and the empty room in the back corner is inviting you to take a nap. You might have even forgotten for a moment that the shift is single coverage, since the ED has gotten so quiet — I mean, chill. And then it happens: the patient who comes in with everything wrong, needing resources you don’t have. Appropriately caring for this patient requires medications that aren’t in your Pyxis, specialists that aren’t on call, and, oh, by the way, needing that procedure you’ve never done. You know the one I mean: the procedure you’ve secretly hoped for and dreaded, the one you had the lucky misfortune to avoid in residency. It’s the horrifying moment when you look around for an attending and realize, it’s YOU! So, you look for a smarter attending: an “attendier” attending.

Every physician in their early career has had this moment. If you haven’t yet, you will. Although you can’t entirely prepare for them, you can have a plan—and that, somehow, makes it just a little bit easier.

1. Reach for your resources.

Some physicians in their early career feel a mild sense of embarrassment when they use reference materials while on shift, especially when you’ve been out for a few years. Don’t feel embarrassed about this. Anyone with perfect recall of the full breadth of medical knowledge is either fictional or already being studied in Area 51. Our scope is enormous, and we chose a field that requires a lifetime of learning. It doesn’t make you a bad doctor if you need to look up how to place a chest tube because you haven’t done one in two years, or if you can’t remember all of the pediatric ACLS doses. If you feel self-conscious, you can say out loud, “I just want to double check to make sure I got this right.” Practicing emergency medicine is an open book test. Take the win.

2. Call a consult.

Yes, even at 4:00 am. When I use the term “consult” here, I don’t just mean specialists. Think about your former attendings, mentors, colleagues, or EM friend groups. Someone is bound to be up at any time of night. Consider your former residency classmates, who know exactly what you’re going through. At odd hours, talk to a fellow EM doc in another time zone, a nocturnist, or a medical social media group (while keeping HIPAA in mind). Talking through a clinical scenario can help give you new ideas, or catharsis after a tough case. Healthcare functions as a team system because we benefit from the input of multiple minds. Don’t forget about the knowledge of your RTs, veteran ER nurses, or other in-house staff who might have a solution to that major problem in your resuscitation, devastating equipment failure, or whatever weird circumstance arises. Recognize your limitations.

On the topic of actual specialist consultations— don’t be afraid to call a consult, even in the middle of the night. If you’re in a sticky situation that overlaps with the territory of another specialty, get them involved. The worst thing they can say is “sorry, I can’t help,” and the best thing they can say is something that will save your patient’s life.

3. Trust your gut.

You trained for this. Trust the years of residency training that were designed to prepare you for this moment. In those moments of paralyzing indecision, go back to the basics if you need to: the ABCs. You know how to improvise. Follow your instincts. Despite the multiple flaws in the world of medicine pictured in House of God, they did get one piece of advice right: “the first procedure is to take your own pulse.” Slow down and assess the situation. Focus on doing what you can.

In those terrifying moments that come, you won’t be able to save every patient. Some days we fight the god of death and lose. Even though it might feel like you’re alone, you aren’t. You’ve got resources. You’ve got colleagues. Most importantly, you’ve got a residencytrained emergency medicine physician: YOU. ■