Episodes 

On today’s episode with Dr. Kyeremanteng, we’re covering all things ROSC: what is ROSC? How do we optimize our patient’s physiology (the A-B-Cs) post-arrest? What happens next – what’s TTM, how does neuroprognostication happen? Lastly, we cover what is the impact to the healthcare system at large.

Obstetrics. Arguably one of the scarier and uncomfortable things we do as paramedics, at least that’s what I think.

If you’re looking for a way to make this tremendously stressful call just a little bit easier, then I think you’ve come to the right spot.

On this engaging episode of Critical Levels, we’re talking with Dr. Glenn Posner about the Prehospital OB assessment, the uncomplicated birth, and how to handle some of the more complicated presentations in the field.

CVA are amongst the top 5 causes of death, and number 1 cause of disability in N.A. Given the associated morbidity and mortality, rapid recognition and aggressive management is of the utmost importance.

Join us as we chat with Dr. Grant Stotts to discuss all things in the prehospital world of stroke: What is a stroke? How do we diagnose it prehospitally? How should we be treating them? What happens once we get to the ED?

A vital part of Ontario’s health care system, Ornge provides high quality air ambulance service and medical transport to people who are ill or injured. In the air and on the ground, our job is to be there for patients, so they can get where they need to be.

Ornge serves more than 13 million people over one million square kilometres of land— the size of France, Spain and the Netherlands combined.

We have the largest air ambulance and critical care land ambulance fleet in Canada, and perform approximately 20,000 patient-related transports per year.

On June 8, 2021, the Honorable Justice Arrell gave his judgement finding two Hamilton Paramedics guilty of failing to provide the necessities of life in relation to a call they attended on December 2nd, 2017. This is potentially a precedent setting case not only for paramedics but for the greater health care community. On todays’ episode we analyze the case and what it means with former paramedic and current lawyer Chris Robertson.

Unlike any other health care professionals, paramedics have the unique opportunity in entering the homes of some of their patients. With this comes a certain responsibility and obligation to report any indications of risk, especially with pediatric populations. With pediatric populations sometimes it is difficult to determine what injuries can be caused by normal childhood behaviour, accidents, or child maltreatment.

In contrast to adult patients, pediatric patients do not follow simple rules and as such, there is no one “magic number” to use as a predictor for patient condition, such as SBP in adults. In contrast, the best predictor for pediatric patients is getting the whole picture. No one vital sign trumps, the other instead they all build on one another to provide a better picture of what is happening. The most important part of a pediatric call is knowing recognizing that they are sick and knowing which tools can be used to help them.

There are several theories that suggest why double sequential defibrillation and/or vector change defibrillation may be effective.

Energy theory: increased energy delivery allows for defibrillation of a critical mass of myocardium terminating the refractory VF.
Setting up theory: the first shock reduces the threshold and results in a more successful second shock.
Multiple vector theory: change in pads (or additional pads) changes the energy vector defibrillating parts of myocardium not adequately defibrillated in standard position.

high-quality BLS management of cardiac arrest is essential. This includes ensuring CPR and ventilation quality including the use of feedback devices and measuring and providing feedback of performance. Once the BLS stuff is taken care of, treatment/management should be dictated by the patient. This may or may not prioritize the airway.

Perhaps most important, is early access and early drug administration. The evidence points that IV access may be better than IO and that medications are still useful, especially early during the resuscitation.

Tactical paramedicine is the provision of prehospital medicine within a hostile environment, that requires knowledge of tactics, special equipment, and specialized personalized protective equipment (PPE). The PPE and the training, is really what separates this team from regular operations.

Emergency medicine and paramedicine, one can argue, are highly cognitive professions. One of the pitfalls to this specialty however is the level of risk involved.

Medical error is the 6th leading cause of death in North America, and some studies have shown that cognitive error or some flaw in decision making – as opposed to lack of knowledge – is present in about 95% of cases where there was a medical error. Moreover, The most recent institute of medicine report says, that as a patient, it’s not if you’ll be subjected to a diagnostic error, but when.

“Pandemics are in a rare and stressful time for health care providers with overwhelming caseloads, rapidly evolving information, and competing priorities of self-protection, while maintaining a high level of patient care.”

In this episode of Critical Levels Jason Buick discusses his recent research article COVID-19: What Paramedics Need To Know and attempts explain and bring some clarity to the many changes Paramedics have faced since the pandemic started. 

Across the world, every death investigation system is different – some are municipal, or state-based, but in Canada, it’s a provincial system. In Ontario, the system is the Office of the Chief Coroner and the Ontario Forensic Pathology Service. In Ontario, all Coroners are licensed physicians (same with PEI), while in other provinces, they are not necessarily physicians

Importantly, the motto of The Office of the Chief Coroner for Ontario is: “We speak for the dead to protect the living”

Part 2 – Paramedics work in a an extremely unique clinical environment. We’re tasked with working in small ad-hoc teams, we’re required to make decisions that can have significant impacts on patient outcomes, and all of this often occurs in novel environments with many external stressors – making these decisions that much more difficult.

Paramedics work in a an extremely unique clinical environment. We’re tasked with working in small ad-hoc teams, we’re required to make decisions that can have significant impacts on patient outcomes, and all of this often occurs in novel environments with many external stressors – making these decisions that much more difficult.

In December 2019, cluster of cases of pneumonia was reported in Wuhan, China and the cause of this cluster was a new coronavirus not previously found in humans.

Coronaviruses are a large group of viruses, that are shaped like a crown. Crown in Latin is “corona”, hence the name coronavirus, and they have been around for decades. Generally, symptoms tend to be mild, and in fact coronaviruses are one of the main causes of the common cold. Every once in a while, we see a more severe strain of the virus, such as SARS (severe acute respiratory syndrome) which arose from civet cats in China in 2003, and MERS (Middle East respiratory syndrome), which was identified in Saudi Arabia in 2012, which are also coronavirus’.

Respiratory pathologies are the most common ED complaint, other than fever, and the most likely reason why children may deteriorate rapidly – In this episode we explore 3 common respiratory pathologies in paediatric patients: Croup, Bronchiolitis and Asthma.

Approximately 1000 kids come to CHEO each year (~3/day) with new concussions, and more kids are being diagnosed with concussion than ever before.

The number of kids diagnosed with concussions has quadrupled over the past 10 years. That doesn’t mean 4 x as many kids are having head injuries, but the awareness and the understanding that these kids need medical assessment/follow-up has increased. More kids are not necessarily getting hurt, but more kids are getting seen. Interestingly, there was a big spike in the number of ED visits related to concussion after Sidney Crosby’s concussion in 2011.

Hello everyone and welcome to “Critical Levels” - a new podcast dedicated to having critical conversations in paramedicine. This episode is a brief introduction to the new “Critical Levels” podcast series - a podcast directed at paramedics, for paramedics, with a Canadian and local bias. Please reach out – email us at info@criticallevels.ca, or connect via social media – I welcome any questions, comments, ideas, and any feedback you have so that we can make this...