Critical Levels

On today’s episode, we carry on last month’s conversation about cardiac arrest management and care. 

Recorded at the Paramedicine Across Canada Expo (PACE) Conference in Saskatoon in September 2022, we’re sitting down with Mike Humphrey and Adam Perrett of Lethbridge Fire and Emergency Services to talk about how they’ve revolutionized the care provided to the citizens of Lethbridge, Alberta. 

We walk through how they train, evaluate, and feedback data with respect to cardiac arrests; how they use a culture of excellence to deliver high performance CPR leading to improved ROSC rates; and they use real time data to track opiate overdoses in their community.  

On today's episode, we chat with Dr. Sheldon Cheskes, principal investigator of the landmark DOSE VF trial. 

In this study, published in the New England Journal of Medicine, Dr. Cheskes and his team wanted to evaluate DSED and VC defibrillation as compared with standard defibrillation in patients who remain in refractory ventricular fibrillation during out-of-hospital cardiac arrest.

In this episode, we walk through the study design, methodology, results, and perhaps most importantly, critically appraise the study to see how it works in the real world!

Timestamps:

02:48: Dr. Cheskes Intro

06:15: Study Intro

16:45: Patients

18:18: Intervention – Vector Change

25:45: Intervention – DSED

37:12: Comparison/Outcome

40:23: Results

54:15: Critical Appraisal

Pain is a condition that we often see in the prehospital world, yet for a variety of reasons, we're bad at treating it.

On today's episode with pain expert Dr. Samina Ali, we go through what pain is, pain assessment, barriers to providing analgesia, and then discuss how we actually treat pain, using both non-pharmacologic and pharmacologic interventions

Join us this month as we chat with Dr. Simon Hatcher, psychiatrist at the Ottawa Hospital and Ottawa Inner City Health, about First Responder Mental Health
 
Who gets PTSD, what’s the pathway/differences to mental health professionals, how do we heal, and how do we get people back to work are all topics we cover, plus more!

IVEGOTYOURBACK911 was started by paramedics Jill Foster & Shaun Taylor in 2014. The goal of the campaign is to spread social awareness worldwide in regards to First Responder mental health issues.

On this month’s episode of Critical Levels, we sit down with Jill & Shaun to learn a little bit more about how and why they started the company, and some of the amazing work that they’re doing to help first responders.

On today’s episode, we chat with Dr. Brodie Nolan, an emergency physician and trauma team leader at St. Michael's Hospital (one of Canada’s largest trauma centres), and a transport medicine physician for ORNGE.

We discuss what trauma is, and how we define hemorrhagic shock. We discuss that trauma triad of death, and why it’s important to get these patients to a lead trauma centre.

These patients ultimately need blood products, so Dr. Nolan walks us through blood/fluid resuscitation, as well as the massive hemorrhage protocol.

Lastly, we cover the prehospital care of these patients: the field trauma triage and air ambulance utilization standards; A-B-Cs (the importance of de-prioritizing intubation and allowing for permissive HYPOtension); the on-scene interventions we should and shouldn’t perform; and what the future looks like for the care of these patients

On today’s episode we sit down with Dr. Sonny Dhanani, Chief of the Pediatric Intensive Care Unit (PICU) at the Children’s Hospital of Eastern Ontario (CHEO).

We discuss the approach and management of the critically ill child, with an in-depth discussion on the A-B-Cs.

With respect to airway, we chat tips/tricks for airway management, as well as intubation.

On the topic of breathing, we chat about bagging and some of the physiological cardio-respiratory concerns of our efforts. We also discuss the causes of arrest and how our interventions may have a role.

Lastly, with respect to the sick child, we cover circulation. Fluid resuscitation (physiology/type/volume/medical vs. trauma), IOs, the symptomatic bradycardic patient(pacing, pressors/medications, etc.), and shock are all topics on the table. 

From here, we pivot to how death is determined, and how organ donation works.

The United Nations (UN) defines human trafficking (HT) as “the recruitment, transport, transfer, harbouring, or receipt of a person by such means as threat or use of force or other forms of coercion, abduction, fraud, or deception for the purpose of exploitation“.

What is human trafficking? How prevalent is it? What are the red flags? How can I use the history and assessment to raise my index of suspicion? How do I advocate for my patient?

Join our conversation with Dr. Lindsay Cheskes, EM Resident at The Ottawa Hospital, to learn the answers to these questions, and more!

Human trafficking: what do paramedics need to know?

After the War in Afghanistan, the Chief of Defence Staff of the Canadian Armed Forces decided to create a brand new forward aeromedical evacuation capability.

This is where our episode’s guest comes in. We speak with Dr. Leilani Doyle, Lt. Col. with the Canadian Armed Forces about her role in the creation of CMERT - the Canadian Medical Emergency Response Team.

Not only are we going to cover the development, roles, training, and capabilities of the team, we’re also going to discuss how to optimize battlefield medicine, and the challenges of providing high quality medical care from the resus bay in the back of the helicopter to the most austere military environments.

Lastly, we cover how the work being done in the military is impacting civilian prehospital care (e.g blood, TXA, invasive procedures, etc.).

Not all paramedics respond to just 911 calls. On today’s episode, we’re chatting with Matt Cruchet and Sgt. Gregory Hudson

Matt is a key member of the Country of Renfrew Paramedic Service’s Sierra Team – essentially their special operations arm.

Sgt. Hudson is a Search and Rescue Technician (SAR Tech) with the 424 Transport and Rescue Squadron based out of CFB Trenton. Covering more than 10 million sq km, the 424 Transport and Rescue Squadron has a huge responsibility for maritime and aeronautical SAR 

We hear about their own unique prehospital roles and responsibilities, then tie it all together using a real case study.