EMS 12 Leads | Tips On D2BT

We have the LifePak, the Zoll, the Phillips monitors. All capable of performing 12 lead ECG’s. Identifying and transmitting the potential STEMI tracing to the ED and PCI center can reduce the D2BT or “Door to balloon time”. Yet as providers we don’t always use this valuable tool soon enough. By using it sooner rather than later we can effectively reduce the D2BT and have better outcomes for our patients.

Check out this weeks video for some tips on reducing D2BT and be sure to post your tips and thoughts below as well.

Links mentioned in the video

The free 12 lead pocket card

12 Lead ECG Challenge

Rapid Interpretation of 12 Lead ECGs


Hemorrhage Types | Bleeding Control

While bleeding control is a basic and common EMS skill, knowing the different types of bleeding can help you anticipate how difficult managing the bleeding will be. It can also help you with your documentation and communication with ED staff.  This weeks episode talks about different hemorrhage types and basic bleeding control techniques.

Psychiatric Patients | Medical, Mental or Both?

Is it Emergency Medical Services or Mental Services? I’m not sure about where you work but by me, psychiatric calls are just as abundant as chest pain calls and MVC’s. Pretty much the one call you can count on every shift.

This week we talk about transporting the psychiatric patient, why EMS is saddled with this often “expensive taxi ride” that stresses providers and the system resources. Is more training for EMS the answer, better utilization of non emergency resources or perhaps a smarter approach to each patient including how and where we transport them.

Show notes

Thanks to Bob Sullivan, Josh Knapp, Brian Breithaupt and Walter Dusseldorp for joining in. Thanks to all who took part in the live chat as well, you made great points that kept the show going.

Here is a position paper by National Association of EMS Physicians that was offered up by Joe P. in the chat room

Patient Restraint in EMS

EMS patient rapport



Master your patient interaction and rapport. Check out the “Art of Patient Rapport” webinar, click here.








I welcome your comments and spirited debate below.

EMS Diabetic Patient Tips

Here is a quick overview of hyper and hypoglycemia. Some key points to look for during your patient assessment and advice on a few other AMS causes.

EMS Alcohol Poisoning Treatment | DT’s

This weeks Minutes I point out some key signs and symptoms along with suggested EMS treatment for acute alcohol intoxicated patients. I also include withdrawal seizures and delirium tremens. See the Youtube video version at http://youtu.be/gCv0wk8mUE8


EMS Protocol Deviation

When do you deviate from your EMS protocols? When is it right  to do so? Many systems leave it vague on how to handle this aspect of EMS and most training and education doesn’t cover why, when or where we should be considering it.

Words like “may, consider, withhold” make it very hit or miss. Add to that the various interpretations by state, regional or even in house QA/QI and you can have providers treating patients in the interest of self preservation and not the best interest of the patient.

This was a great episode and each guest had thoughtful input on this passionate topic.

Show notes

David Aber – The EMS Difference

Bob Sullivan – EMS Patient Perspective

Josh Knapp – WANTYNU

Tim Noonan – Rogue Medic

Articles worth checking out




Pediatric Patients | It’s More Than Just Crying

The pediatric patient. We’ve all heard the little quips before. They’re not little adults, they crash fast, don’t lie to them.

Honestly, I lie to them all the time. It’s the parents I tell the truth to. But still, dealing with pediatrics is more than just calming the crying infant or knowing that “Hey, this isn’t a little adult”. Age groups, diseases, injury types, parents, bystanders and even other providers all play a role in the call and the outcome.

Take a listen to this episode and give your pediatric call tips or tell us a story in the comments below.

Show Notes:

Life Under The Lights post mentioned during the show. 

Josh Knapp – WANTYNU

Join the EMS Web Summit

Dave Aber at The EMS Difference
Follow Dave on Twitter here. 

The Protocol Effect | Airway Management

In this installment of Office Hours we revisit the series “The Protocol Effect” and discuss airway management. Should this be controlled by written guidelines, clinical impressions or current research? Anyone who has been in the field knows a GCS of less than 8 or 10 doesn’t always mean a patient requires intubation or advanced airway management. Yet many protocols say to do just that. This may just be another time when providers need to prove their understanding of these skills, their need and the patients we treat. Take a listen to this episode and tell us about your guidelines and how you interpret them.

Show notes:

Thanks to Mr. JD Graziano for joining me on the show. Check out his podcast at EMSStandingOrders.com and following on Twitter at @AJDGRAZIANO.

Listen to the Standing Orders podcast on The Future Of Airway Management here.

Justifying Your Actions

I was thinking about something that many of us do in variations

Too much, too little or not at all.

Justifying your actions or in many cases in-actions is an important part of not only your documentation but in your treatment and report to the emergency department.

If you do not provide a standard treatment modality, you need to document and be able to verbally substantiate why you did not do it.
If you go beyond basic treatments and perhaps even beyond what is an accepted treatment. You must be able to justify why you did it.

Many instances can dictate why things are omitted during treatment. It can be an uncooperative patient, a patient’s refusal of certain treatments i.e. nitroglycerin because it gives them headaches, your clinical impression vs. protocols, time constraints and possibly even safety issues.

All of these can lead you to not perform what would otherwise be considered standard treatment. The pre hospital environment does not always lend to perfect conditions and you may be questioned on why you couldn’t intubate someone or why you didn’t give a certain medication.

I never judge other pre hospital providers for not doing something. I wasn’t there and I don’t know the circumstances. It’s very easy for others to be backseat drivers and say what should have been done.

The key is to be able to justify your actions and to allow them to be scrutinized. If your treatment and documentation can hold up to others evaluations, then you properly justified your actions.

At the same time, you must not do any harm to the patient. If less than optimal conditions exist in the field, which they usually do. You need to make choices that will most benefit your patient.

The primary concern is to always go back to your basics of ABC’s. Treating the patient with a vectored exam and performing critical tasks first will always allow you to justify your actions.

Decisions we make in the field can affect the outcome of the patient. The idea is to do no harm. Sometimes that may mean a simple transport to the hospital and respecting the patients wishes. By documenting and justifying what you did or did not do, you protect yourself from questions that may arise later. Too many of us do not document enough and leave  ourselves open to problems down the line that could be prevented with a few words on our report.

Justifying why you went beyond what is an accepted practice will require even more careful documentation. But the same principle will hold true. If it can hold up to the scrutiny of others, then your actions will be accepted.

Scenarios of going beyond accepted policies and of not doing enough are plentiful. We all have heard the stories, but remember – we were not there. It is left up to the individuals involved to justify what they did.

Will they hold up to our scrutiny?  More importantly, will our actions hold up to theirs.

The Protocol Effect | Nitroglycerin

One drug that is a staple in EMS is nitroglycerin. Whatever system you work in it is in the protocols. Mostly in ALS guidelines, but you also are seeing it in many BLS protocols as well. This episode will talk about this drug it’s common uses, not so common uses, dangers and benefits. We were also joined by an old friend of mine from my Brooklyn days Randy K. who is a paramedic in FL. Randy gave some of his thoughts on this topic as well.

What about you? How do your protocols use this therapy, how have you used it? Do you have some positive or negative experiences with this protocol choice? Share your thoughts below.

I did have some audio issues on this one so you may hear it cutting in and out. I apologize and I am working to get that fixed.

Show Notes:

Street Watch Notes Of A Paramedic – Nitro post worth reading and discussed during the show.