EMS Celebration - Honoring the Heroes of 9/11

On September 11, 2001, the world witnessed unparalleled courage and sacrifice as hundreds of brave EMS providers, first responders, and firefighters raced into the heart of danger to save lives. 

These selfless individuals ran toward the very chaos that others fled, driven by a call to serve, protect, and heal. In doing so, many paid the ultimate price.

In Memory of the Fallen:

To the firefighters who climbed the burning towers, the EMS providers who rendered aid in the dust and debris, and the first responders who secured the perimeter in the face of unknown terror — you are more than names on memorials; you are the essence of heroism.

Your final acts of bravery live on as a testament to your character, courage, and unwavering commitment to your fellow human beings. You laid down your lives so that others might live, and the depth of that sacrifice echoes eternally.

For Those Left Behind:

To the families, friends, and colleagues who carry the weight of that day, know that you, too, are remembered in this tribute. Your loved ones’ courage was not theirs alone, but shared with you through a lifetime of dedication and service. Your grief and loss are borne by a grateful nation, and we honor your strength in carrying on their legacy. The pain of their absence is woven into the fabric of our shared memory, and we stand beside you as you navigate the long journey of healing.

We acknowledge the quiet toll it has taken — the children who have grown up without parents, the spouses who have had to rebuild lives, and the colleagues who continue to serve, carrying the memories of those who were lost. Your perseverance and resilience are as much a part of the legacy as the heroism we witnessed on that fateful day.

We Will Never Forget:

In the years since, our world has changed, but the memory of that day remains vivid, and the loss of our heroes is felt in every firehouse, ambulance bay, and police station across the country. As we gather in remembrance, we do so not just in mourning, but in gratitude. We hold close the lessons of that day: the reminder that in our darkest hours, there are those who will step forward to bring light.

To all EMS providers, first responders, and firefighters, those who were taken too soon, and those who continue to serve in their honor: we offer our deepest thanks. Your courage is etched into history, and your sacrifice will be remembered for generations to come.

A Lasting Legacy of Hope and Strength:

While the events of September 11th will forever be a wound in the hearts of many, the resilience, dedication, and unity shown by first responders is an enduring source of inspiration. In your memory, we strive to live lives of service, courage, and kindness.

May we honor your sacrifice not just with words, but through our actions, lifting each other up, and continuing to serve in the spirit of the bravery you showed on that unforgettable day.

Let Us Never Forget.

EMS Equipment - Murphy's Endotracheal Tube

For EMS providers, understanding the Murphy Endotracheal Tube and its key feature, the “Murphy Eye,” is essential for ensuring patient safety during airway management. 

The Murphy eye serves as a critical safety mechanism that prevents complete airway obstruction if the main distal opening of the tube becomes blocked. 

Recognizing this feature and the overall design of the endotracheal tube can help prevent complications during intubation and ensure the continued delivery of oxygen to patients in emergency situations.

The “Murphy Eye” Explained

The Murphy Eye is the eponymous term for a small hole on the side of most endotracheal tubes (ETTs). It functions as a vent, preventing complete obstruction of the patient’s airway if the primary distal opening of the ETT becomes occluded.

Dr. Francis J. Murphy (1900–1972) was a strong advocate for the continuous supply of oxygen during anesthesia. In 1941, he outlined the nine characteristics of the "ideal" endotracheal tube (ETT). In the same article, he introduced two tubes with innovative features. 

One tube was straight with two side holes, while the other was curved with one side hole. Both lacked cuffs and were made from high-quality red rubber that balanced flexibility with resistance to compression or kinking, even after multiple uses and heat sterilizations.

Although most ETTs today are made from disposable plastic, they still require a similar balance of flexibility and resistance to compression. Most continue to incorporate the crucial safety feature that bears Dr. Murphy's name: the "Murphy eye."

The featured image show the orginal tube, owned by Dr. Murphy himself, and bears his initials. It features an inflatable cuff located above the "eye," which is inflated via a small side tube attached to the ETT. 

Further Reading:

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Brown, C. A. (2022) Walls Manual of Emergency Airway Management (5th Ed). Philadelphia, Pennsylvania: Lippincott, Williams & Wilkins.

EMS Medical Terminology - Sellick's Maneuver

EMS providers should be familiar with the Sellick Maneuver, also known as cricoid pressure, as a technique designed to reduce the risk of regurgitation and aspiration during endotracheal intubation, particularly in patients who are not fasting or at high risk of vomiting. It is an example of an eponymous medical terminology.

It was first described by Dr. Brian Sellick in 1961 and has been used in emergency and anesthetic situations ever since. 

However, it’s essential for EMS providers to apply the right amount of pressure and know that this technique is sometimes debated due to concerns that it may obstruct the airway or complicate intubation in some cases.

Here's what they should know:

Key Concepts

Anatomy Involved:

The cricoid cartilage is a ring-shaped structure located just below the thyroid cartilage in the neck.

When performing the Sellick Maneuver, downward pressure is applied to the cricoid cartilage, which in turn compresses the esophagus against the vertebral column, theoretically reducing the chance of regurgitation by preventing stomach contents from moving into the pharynx.

When to Use It:

Primarily used during rapid sequence intubation (RSI) to protect the airway in emergency situations, especially when there's a high risk of vomiting (e.g., trauma patients, those who have recently eaten, or have decreased consciousness).

It may also be employed during bag-valve-mask (BVM) ventilation to prevent gastric insufflation, although this use is somewhat controversial.

How to Perform It:

The provider places firm, continuous pressure using the thumb and forefinger on the cricoid cartilage (located below the Adam’s apple).

The recommended pressure is about 10 Newtons (≈1 kg of force) initially, increasing to 30-40 Newtons (≈3-4 kg of force) once the patient loses consciousness, as the risk of vomiting increases at that point.

Controversies & Limitations:

Questionable Efficacy: Studies over the years have raised doubts about the effectiveness of the Sellick Maneuver in completely preventing regurgitation or aspiration. In some cases, it may even impair ventilation or visualization of the airway during intubation, particularly in difficult airway scenarios.

Potential Complications: Incorrect application of the maneuver (too much force or misplacement of pressure) can result in airway obstruction or displacement of the esophagus laterally rather than compressing it.

Many modern airway protocols have deemphasized its routine use and instead focus on optimal intubation techniques and preparation for managing airway complications.

Training & Clinical Judgment:

EMS providers should be well-trained in applying the maneuver correctly, but also be aware that if it interferes with ventilation or intubation, it should be discontinued.

It’s essential to assess the specific patient scenario (e.g., suspected difficult airway) and weigh the benefits and risks of applying cricoid pressure.

Summary

The Sellick Maneuver was historically considered a key technique for preventing aspiration during emergency intubation, but its effectiveness is now debated. 

EMS providers should understand the anatomy, application method, and potential complications, and apply it judiciously based on the clinical situation.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Brown, C. A. (2022) Walls Manual of Emergency Airway Management (5th Ed). Philadelphia, Pennsylvania: Lippincott, Williams & Wilkins.

Ebright, C. (2024) Unique Patient Signs: A Case Study. EMS1. https://www.ems1.com/patient-assessment/articles/unique-patient-signs-a-case-study-f4CQBuoUo9uTCHrZ/ Accessed May 1, 2024

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

EMS Cardiac Emergencies - Pericarditis

Overview

Pericarditis is the inflammation of the pericardium, the protective sac around the heart. For EMS providers, recognizing pericarditis is critical because it can lead to serious complications like pericardial effusion or cardiac tamponade. 

The condition can be caused by a range of factors, including viral infections, bacterial infections, autoimmune disorders like lupus, trauma, and certain medications. 

It may also occur after a myocardial infarction (post-MI pericarditis or Dressler's Syndrome) or be associated with cancer or renal failure. Understanding the causes can help guide treatment and determine how urgent the patient’s condition may be.

Here are some things an EMS Provider needs to know:

Signs and Symptoms

Patients with pericarditis typically present with chest pain that is sharp, stabbing, and pleuritic in nature, meaning it worsens with deep breaths or coughing. A distinguishing feature of pericarditis-related chest pain is that it often improves when the patient sits up and leans forward, and worsens when lying flat. The pain can radiate to the neck, shoulders, or back, which can sometimes mimic the pain of a myocardial infarction.

In addition to chest pain, fever may be present, especially in cases caused by infections. Patients might also experience dyspnea, particularly if pericardial effusion (fluid buildup around the heart) develops. 

A classic sign detectable on physical examination is a pericardial friction rub, a scratchy or grating sound heard with a stethoscope near the left sternal border. 

EMS Providers may notice widespread ST-segment elevation across multiple leads and PR-segment depression on an EKG, both of which are characteristic of pericarditis. 

These combined symptoms can help differentiate pericarditis from other cardiac conditions, such as myocardial infarction.

Prehospital Treatment

Prehospital care for pericarditis focuses on symptom management and preventing complications. Positioning the patient in an upright or leaning-forward posture can relieve pain, and oxygen should be administered if hypoxia or dyspnea is present. 

NSAIDs, such as aspirin, if within protocol, can be used to alleviate pain and reduce inflammation. 

EKG monitoring is essential to detect any potential changes, such as arrhythmias or signs of tamponade. 

Providers should establish IV access for medications or fluid resuscitation, and if cardiac tamponade is suspected (marked by hypotension, jugular venous distention, and muffled heart sounds a.k.a Beck's Triad), rapid transport to a hospital is critical. 

Early hospital notification can prepare the receiving facility for advanced care.

In-Hospital Treatment

Once in the hospital, patients with pericarditis will undergo diagnostic testing, including an EKG to assess for pericardial effusion, and other tests such as chest X-rays or bloodwork to identify the underlying cause. 

Treatment usually involves anti-inflammatory medications like NSAIDs or colchicine to reduce inflammation and prevent recurrence. In some cases, corticosteroids may be used, but they are typically reserved for autoimmune cases or refractory pericarditis. 

Antibiotics are administered if a bacterial infection is identified. If a large pericardial effusion or cardiac tamponade is detected, emergency pericardiocentesis (draining fluid from the pericardium) is necessary. 

For recurrent or chronic pericarditis, surgical intervention, such as a pericardiectomy, might be considered.

Key Takeaways for EMS Providers

EMS Providers should be able to recognize pericarditis through its hallmark symptoms, including sharp, pleuritic chest pain and characteristic ECG changes. 

Rapid identification and intervention can prevent complications such as cardiac tamponade.

Prehospital care should focus on pain management, patient positioning, and continuous cardiac monitoring, while maintaining a high index of suspicion for worsening conditions. 

Prompt transport to a facility equipped for advanced cardiac care is essential, where definitive treatments, such as anti-inflammatory medications or pericardiocentesis, can be administered. Early intervention and effective prehospital management play a key role in patient outcomes.

Further Reading:

Ari D. Leib; Lisa A. Foris; Tran Nguyen; Karam Khaddour (2023) Dressler Syndrome. Treasure Island, Florida: StatPearls Publishing https://www.ncbi.nlm.nih.gov/books/NBK441988/ Accessed September 7, 2024

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson.

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell.

Xanthopoulos, A. & Skoularigis, J. (2017) Diagnosis of Acute Pericarditis. Journal of Cardiology Practice #15 https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Diagnosis-of-acute-pericarditis Accessed September 6, 2024

EMS Leadership - Embracing a Growth Mindset

As EMS providers, we are constantly in high-stakes situations where quick thinking and adaptability are essential. Carol Dweck’s concept of a growth mindset —believing that abilities and intelligence can develop through dedication and hard work— is gaining traction across various fields, and it's especially relevant in the fast-paced world of emergency medical services.

A growth mindset is not just a trendy term; it has real implications for how we operate in the field, how we approach challenges, and how we support our teams. However, like any popular idea, misconceptions can arise. Some believe a growth mindset is simply about praising effort, but this isn't enough in EMS, where outcomes can be a matter of life or death. Effort matters, but so do results. The key is understanding that while some treatments may not lead to the desired outcome, the lessons learned from these experiences are invaluable.

In EMS organizations, it's common to hear motivational phrases like “adopt a growth mindset, and good things will happen.” It’s easy to agree with ideals such as growth, empowerment, and innovation, but what do these words mean without the policies and support systems to make them attainable? As EMS providers, we must ask: How are these values being put into practice in our everyday operations?

Organizations that truly embrace a growth mindset create an environment where calculated risk-taking is encouraged, knowing that not every decision will have the desired outcome. In these environments, it's not just about whether a protocol worked perfectly; it’s about the critical lessons learned, the shared knowledge within the team, and how we can improve care in the future.

But there's another piece to this puzzle. As individuals, we can't solely rely on our organization to foster this mindset. Whether you’re new to EMS or a seasoned veteran, the responsibility for your growth rests with you. This means continuously developing your skills, learning from your experiences, and seeking feedback. When you take ownership of your growth, you become not only a more effective provider but also a leader who influences the team for the better.

By cultivating a growth mindset on a personal level, you're more likely to become an agent of positive change—both for your patients and within your EMS team. The more invested you are in your own development, the more you contribute to the collective success of the team, enhancing both your leadership skills and your role as an engaged, proactive team member.

Further Reading:

Dweck, C. S. (2007) Mindset: The New Psychology of Success. New York, NY: Ballantine Books

Dweck, C. S. (2016) What Having a “Growth Mindset” Actually Means. Harvard Business Review (January 2016) https://hbr.org/2016/01/what-having-a-growth-mindset-actually-means Accessed September 6, 2024

Dweck, C. S. & Yeager, D. S. (2019) Mindsets: A View From Two Eras. Perspectives on Psychological Science 14 (3):481-496 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594552/ Accessed September 6, 2024

EMS Celebrations - Labor Day Responders

Today, as we celebrate Labor Day, we honor the unwavering dedication of our first responders and EMS personnel. While many enjoy a day of rest, you stand ready, tirelessly serving and protecting our communities.

Your courage, compassion, and commitment do not go unnoticed. Thank you for being the backbone of safety and care, always answering the call to help others in times of need. We are deeply grateful for your service and sacrifice.

Happy Labor Day, to all the heroes working today!