As I read trade publications, attend conferences, and receive announcements about EMT and Paramedic continuing education programs there are some clear “Hot Topics.”

Hot Topics of Today

These topics are sure to be on every conference program and regularly featured in national magazines today and probably for the next couple of years.

1. End Tidal Capnography

2. Airway Management

3. 12-Lead ECG

4. STEMI

5. EMS Personnel Safety

6. WMD/HazMat (although this topic seems to be fading from its pinnacle in the 3 to 5 years after 9/11)

Hot Topics of the Future

EMS is changing. What we do and what we get paid to do are likely to change in the next 5 to 10 years. Acquiring knowledge and expertise in these niches will likely open doors for you as a conference presenter and EMS publication author.

1. Wound Care

2. Long-Term Care of Diabetes, Heart Failure, Hypertension, COPD, Renal Failure

3. EMS Finance

4. Stroke and Cardiac Arrest Centers of Excellence (like today’s system for trauma)

5. Community Paramedicine

6. Field Imaging of Internal Bleeding and Brain Swelling

Tim Phalen presenting at EMS World Expo 2011

What trends do you see for Hot EMS Topics? 

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A CE Mash-Up is a technique to design and deliver a continuing education program using materials available for use and consumption on the internet. Each CE Mash-Up will suggest content to combine in your own blog post, website, or learning management system.

Slideshare Presentation

View this presentation, innovations in stroke care from EMS Educator Rom Duckworth.

Articles

Search the article archives at EMS1.com, EMSWorld.com, and JEMS.com for articles about updates in stroke care, innovative treatments, and transporting patients to stroke specialty centers.

Podcasts

Look for episodes in the archives of the MedicCast, such as episode 252, about stroke assessment, treatment, and care.

Learn about Stroke Alert

Does your community have a stroke alert program? Check out this video from the HealthONE Stroke Alert program.

What else would you put in a stroke assessment and treatment continuing education mash-up?

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Standing Orders is a new video series from EMS1.com. In this first episode Dr. Tan talks about stroke assessment.

Stroke Assessment Memory Aids

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A patient care protocol is a kind of checklist. A protocol includes a lot of instructions on how to assess and treat a patient. Within a protocol you might also have several checklists to complete to successfully implement the protocol.

For example, you likely have a protocol for a patient with chest pain. The protocol directs assessment of the patient’s pain and measurement of vital signs. It may also direct initial patient treatments. The protocol may also include a checklist of specific actions:

1. Administer medications
2. Acquire, read, and transmit 12-lead

A chest pain protocol may also include a checklist for preparing the patient for the cath lab:

1. Remove patient’s clothing
2. Start at least one IV
3. Shave the patient’s groin
4. Document specific patient history findings

Checklists can also be useful for situations where additional care providers will arrive on-scene to verify that actions have been taken. For example, a cardiac arrest checklist for the second arriving unit might be focused on first assuring minimal interruptions to chest compressions, before other interventions. A later arriving responder, not in the thick of the action, might be best suited to step back and verify completion of assessment and treatment actions with a checklist.

Some specific situations well suited for a checklist:

1. Cardiac arrest
2. Stroke
3. Sepsis
4. Respiratory failure

Do you use checklists? Do you think a checklist is different from a protocol? How can checklists improve patient care and EMS professional safety?

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These are three things strongly associated with denial:

1. Myocardial infarction (heart attack)

2. Cerebrovascular Accident (stroke)

3. Global Climate Change

Here are three more things strongly associated with denial:

1. Efficacy of red lights and sirens response

2. Real risk of driving and using a mobile phone

3. Somebody else will do it

Another three things strongly associated with denial:

1. Rashes

2. Lumps

3. Foul smelling discharge

And a final three things strongly associated with the Nile:

1. Egypt

2. Pyramids

3. Crocodiles

What do you associate with denial?

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Date : July 26th 2010
Time : 1400 (2:00PM) EST

Stroke. EMS Boot Camp will tackle this topic on a leading cause of death with guest speaker Michael Smith. Michael will discuss anatomy through tPA and target specific areas of EMS concern regarding stroke including:

• Blood supply and artery anatomy
• Specific types of CVA
• EMS assessment and use of Cincinnati and LA stroke scales
• Prehospital care from basic monitoring to potential medications
• Stroke alerts, tPA and invasive retrieval
• Stroke differentials

The best part of every EMS Boot Camp session is live question and answer with the guest speaker. Stroke is a vital topic. The content in this session is  sure to help you as a field provider and give you tools you can use right away. Sign up now for the free live session and take advantage of this one of a kind training resource.

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As a college student Joe Clark worked on the ambulance in New York City on nights and weekends to pay for his college and graduate school education. My Ambulance Education  is Joe’s stories of patient encounters, relationships, and events on the streets that shaped him as a person and guided his career choice to become a medical researcher of the causes and treatments for stroke.

About the Book

As an EMT in New York City Joe saw it all. He organized the book into thematic  chapters around themes like drugs, drunks, suicide, birth, and death. Each chapter is a combination of his parallel worlds – patient calls and college studies. The book is a chronology of his time on the ambulance and Joe shares his thought process of first striving to become a paramedic, then becoming a pre-med student, and then deciding to become a medical researcher. He writes:

“I realized a successful physician could treat only one patient at a time … I wanted to do more. I wanted to help people, but a lot of people.”

This realization led Joe to pursue a career in neurology and become a leading researcher in the causes and treatments of stroke. Listen to Joe talk more about the book and his research as a guest on the Medical Author Chat podcast.

The writing in My Ambulance Education  is excellent. The details are vivid and as a reader I could feel his stress and increasing burnout. By writing My Ambulance Education Joe brings the challenges and rewards to a lot of people. EMS professionals toil in relative anonymity. Joe brings the world of EMS to a general audience that is captivating and respectful.

Still Involved with EMS

Joe’s research keeps him connected with EMS professionals and educators. Joe was a panel member for the EMSEduCast Journal Club, has been a guest on the EMS Garage Podcast, and is presenting the EMS Boot Camp session: A Google Search is Not Research. Premium attendees of this EMS Boot Camp session will receive a signed copy of My Ambulance Education direct from Joe.  Visit JosephFClark.com (bio, blog, and more).

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Stroke is the third leading cause of death. Prompt recognition of stroke by lay persons and EMS professionals is critical for stroke patients to receive timely hospital stroke assessment and intervention. There are several acronyms to remember the indicators to assess if a patient is having a stroke. Each acronym is a similar assessment of speech, motor function or control, and presence of paralysis.

The three Stroke Assessment memory aids that I know of are:

1. STROKE. This one was new to me (inexplicably). Learn more about using STROKE from Buck Tilton.

2. FAST. Explained by the Stroke Awareness Foundation. Look on the upper right of the home page for an explanation of FAST.

3. Give Me 5 is a memory aid from the Stroke Collaborative. Learn how to use Give Me 5.

Of course as an EMS professional you should be using either the CPSS or LAPSS for any suspected stroke patients. Don’t know CPSS or LAPSS. Let me know and I will explain in another post.

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Today is World Stroke Day. The purpose of this day is “to communicate a unified message to the world: stroke is a preventable and treatable catastrophe, and together we can fight this growing epidemic.” Learn more about World Stroke Day from the World Stroke Organization.

All EMS Professionals should know the signs and symptoms of a stroke, how to assess a stroke using a prehospital stroke assessment scale, and the most appropriate destination for stroke patients in their service area. Follow these Everyday EMS Tips to learn more about Stroke.

1. Visit RapidCE.com to take a continuing education lesson on stroke assessment and treatment. 1.0 CECBEMS approved CE available for ALS and BLS providers.

2. Listen to an Everyday EMS Tips interview with Dr. Joseph Clark, a neuroscientist at the University of Cincinnati. Dr. Clark is a former EMT that researches medical devices for prehospital stroke detection.

3. Join the MedicCast extra. There you will find numerous articles, podcasts, and other resources about stroke and other medical emergencies.

4. View additional resources on StrokeS from the CDC.

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Stroke symptoms – facial droop, one-sided weakness, inability to speak – are fairly easy to recognize with prehospital stroke assessment tools. More and more EMS providers are going to be asked by patient’s family members or caregivers or directed by protocols to transport stroke patients to a designated stroke center.

What does it mean for a hospital to be a designated stroke center?

The American Stroke Association lists four general criteria for a hospital to have an Acute Stroke Treatment Program or what might be commonly called a Stroke Center:

• Part I: Improve awareness of acute stroke care
• Part II: Improve availability of optimal stroke care
• Part III: Implement secondary stroke prevention
• Part IV: Ensure continuous improvement in stroke outcomes

Part II: Improve availability of optimal stroke care has the most impact on EMS assessment, management, and transport of stroke patients. Specifically a Stroke Center should have these capabilities:

1. Written stroke protocols
2. Organized acute stroke team led by a neurologist, neurosurgeon or other qualified healthcare professional
3. Stroke team lead by qualified physician and nurse (or NP or PA)
4. Acute stroke team is always available and can be at patient’s bedside in 15 minutes or less
5. Developed communication pathway between EMS and stroke team
6. Stroke center assists and/or supports EMS education about stroke at least bi-annually
7. Neuro-imaging services, like CT scans, are always available and can be performed within 25 minutes of order and scans interpreted within 20 minutes of completion
8. Stroke unit capable of caring for stroke patients beyond acute treatment period

Does your nearest hospital meet these criteria for a Stroke Center? Do you have a protocol to transport acute stroke patients to Stroke Centers? In which cases should you transport to the nearest hospital instead of a designated stroke center?

Review the F.A.S.T. Stroke Assessment tool.

Extra content: Legislation in Illinois establishes stroke centers.

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