Gregory Ciottone, MD, FACEP, FIBODM

In 2020 the supraglottic airway surpassed the use of ETI in cardiac arrest in the Unites States. On today’s NAEMSP Florida Chapter webinar, prolific EMS researcher, Henry Wang, MD, MPH presented data from over 400,000 pre-hospital advanced airway cases using the ESO dataset. What is your pre-hospital advanced airway algorithm? Does your agency still perform ETI? If so, do you use RSI or DSI? More importantly, beyond what "device" is used, is the respiratory support using that device being performed correctly? Not until we evaluate outcomes against ventilation rates and volumes, can we confidently declare that one airway is better than the other. Huge thanks to Dr. Wang for a great presentation and robust discussion on an important topic to everyone in EMS. Paper Co-authors: Mengda Ivy Yu, MSPH; Remle Crowe, PhD; Michelle M. J. Nassal, MD, PhD; Christopher Craig, MPH; J. Madison Hyer, MD; Jonathan Powell, MPA; Alexander Ulintz, MD; Travis Sharkey-Toppen, MD, PhD; LaiWei, PhD; Kim Moeller, MD; Ashish R. Panchal, MD, PhD

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Most viewed in the last 7 days from JAMA Health Forum: This JAMA Forum discusses the responsibilities of public health agencies that overlap with those of the CDC and argues that the role of the CDC could be redirected to better meet the needs of its core mission. https://ja.ma/40jMUU6

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THREE GOOD REASONS TO LISTEN TO THIS EPISODE Don't miss our conversation with Randall Schaefer, DNP, RN, ACNS-BC, CEN 1. **Insights into Military Medical Innovations**: Listeners will gain an in-depth understanding of the cutting-edge medical practices developed in military settings, particularly those related to trauma care. Dr. Randi Schaefer discusses the advancements in pre-hospital blood administration, which has significant implications for military and civilian emergency medicine. The knowledge shared could be eye-opening for those interested in how high-pressure environments drive medical innovation. 2. **Evolution of Blood Transfusion Practices**: The episode offers a historical and practical perspective on how blood transfusion practices have evolved from reliance on hospital staff donors to implementing whole blood protocols. Those interested in emergency medicine, trauma care, or medical history will learn about the challenges and triumphs in changing hospital policies, the role of the Southwest Texas Regional Advisory Council (STRAC), and how these practices are reducing mortality rates and improving patient outcomes. 3. **Bridging Military and Civilian Medical Care**: The conversation with Dr. Schaefer explains how military medical procedures can be adapted to improve civilian trauma care. Listeners will discover the importance of Tactical Combat Casualty Care (TCCC) training, the influence of military experiences on civilian practices, and innovations like the Vampire Program that enhance pre-hospital care. It's an opportunity to appreciate the symbiosis between combat and civilian medical fields and the shared goal of saving lives. Joint Trauma System (JTS) DoD Center of Excellence for Trauma #transfusion #tccc #prehospitalcare #prolongedfieldcare

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ASCP President Greg Sossaman, MD, MASCP, has reached out to the Trump transition team leaders, Linda McMahon and Howard Lutnick, urging the incoming administration to revoke the U.S. Food and Drug Administration's (FDA) Final Rule regarding oversight of laboratory developed tests (LDTs). The previous Trump Administration had determined that the FDA should not regulate LDTs, with U.S. Health and Human Services Secretary Alex Azar preventing FDA oversight in 2020. This decision was supported by a legal opinion from the General Counsel of the U.S. Department of Health and Human Services, stating that the FDA lacked the necessary statutory authority for LDT oversight. ASCP, actively involved in legal proceedings and congressional testimonies against the Final Rule and the VALID Act, believes that these regulations hinder patient access to quality care by imposing costly and redundant oversight on clinical laboratories without enhancing patient outcomes. By rescinding the FDA's Final Rule, ASCP aims to signal to both the FDA and Congress that current LDT regulations, governed by the Clinical Laboratory Improvement Amendments of 1988, are effective, agile, and devoid of unnecessary bureaucracy. Upholding top-tier patient care involves supporting accredited clinical laboratories in delivering innovative, cost-efficient, and high-quality laboratory services. [Source: ASCP urges Trump transition team to rescind FDA LDT rule]

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EMSC research highlights: 🧠Strategies to support children’s mental health in disasters https://lnkd.in/eBUMJsYF Pediatric Pandemic Network 🤕Efficacy of PECARN mild head injury CT decision guide https://lnkd.in/eXpjvC-q 💬Commentary on PECC research https://lnkd.in/e_jgJkux Find more recent research: https://lnkd.in/e3Jum--S

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Full read review of the benefits & impact of hydroxychloroquine in #SLE. Benefits on: - T cells, cytokines, TLR signaling - VTE prevention - Decr CV risks - Glucose & lipid benefits - Pregnancy

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Section 401 of the #MissionAct required VA to develop a new measure of underservedness in order to improve access to care. The translation to the private sector will require some significant transparency and data-sharing - but the high level approach still is sound. We need more comprehensive methods such as designed here to direct our limited resources to the communities with the greatest #demand. #Supply lines however will continue to perpetuate inequities in the case of #healthcare if we don't adopt forcing mechanisms that deprioritize profit. "The model includes 21 variables to comprehensively capture VHA supply of care and Veteran demand for VHA care. For example, on the supply side, PEPReC includes clinic capacity and clinic efficiency, measures of staffing and productivity, respectively. On the demand side, PEPReC includes the household median income in the area surrounding the VAMC, the percent of Veterans who also have private insurance, Veterans’ Nosos risk scores (a measure of how sick they are), and the percent of Veterans who are 65 or older." https://lnkd.in/eM4svkuu

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Quick summary of the latest CDC updates to its opioid prescribing guidelines, including 12 key recommendations and 5 guiding principles to aid in implementation https://lnkd.in/eXMdQTHt #opioids #medication #painmanagement #primarycare

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It’s Sepsis Awareness Month! Are you looking for peer inspiration to get started on improving Sepsis practices? Check out our 2023 Sepsis Honor Roll hospital journey posterboards, compiled in this Excellence in Practice Hospital Journey virtual booklet. https://hubs.ly/Q02MWxGn0 #SepsisAwarenessMonth

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New study in #HSR from R. Neal Axon MD et al examine changes in hospitalization trends and healthcare utilization among Veterans following Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act implementation. WHAT IS KNOWN Recent federal legislation increased Veterans' access to care in community hospital settings, including the VA Choice Act of 2014 and the MISSION Act of 2018. WHAT THIS STUDY ADDS Veterans with VA-funded community care were estimated to have higher risk of readmission, but lower risk of post-discharge ED utilization compared with those with VA admissions. CONCLUSION MISSION Act implementation was associated with substantial shifts in treatment site and federal payor for Veteran hospitalizations. Post-implementation readmission risk was estimated to be higher for those with CC and CMS index admissions, while post-implementation risk of ED utilization following CC admissions was estimated to be lower compared with VHA index admissions. Reasons for this divergence require further investigation.    FULL ARTICLE: https://lnkd.in/gPWc7jBS #HealthServicesResearch  AcademyHealth  Wiley 

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Dr. Cifu’s defense of the physical exam is more than tepid in this editorial. I am a strong proponent of performing a physical exam, at least a focused one, on all patients who present to urgent care centers. As Dr. Cifu mentioned, at the very least, the ritual or the exam forges the patient-clinician relationship and is expected by most people seeking healthcare. Physical exams have become less important in diagnosing conditions as laboratory and imaging technology have exponentially improved. Still, when employed correctly, the exam directs the clinician to employ diagnostic testing more safely and cost-effectively.

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Coping trajectories of intensive care nurses as second victims: A grounded theory https://lnkd.in/ggNhuX6S

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Hmmmm..... When Generative Autocompleting can't help but fill in the blanks ... Autoregressive LLMs should probably have some controls at development, implementation and risk management, not blind integration into scribing workflows. https://lnkd.in/eqkS58gd

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192 RA pts on MTX: GI Sxs studied w/ MISS (MTX intolerance severity score). GI intolerance seen in 56%, Nausea & pain post-MTX most common. More in afro-descendants, w/ FM, Steroids, or JAKi. MISS results unrelated to Route, Gi Dz, age, MTX dose https://buff.ly/3Sdzp3k

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Prostate Health for Veterans: Key Risk Factors Prostate health is a critical concern for many men, but especially Veterans. While prostate issues are common among men in general, Veterans face some unique risk factors that may increase their susceptibility. Studies have recently shown that former military aviators and aviation support personnel are at a significantly higher risk of developing cancers of many kinds but prostate is always at the top of the list. Age Age is one of the most significant risk factors for prostate health issues. As men age, the risk of developing prostate problems, including benign prostatic hyperplasia (BPH) and prostate cancer, increases significantly. Regular check ups, including prostate-specific antigen (PSA) screening becomes essential as Veterans enter their 40s and beyond. Family History A family history of prostate cancer is a significant risk factor. Men with a close male relative who have had prostate cancer are more likely to develop the disease themselves. Understanding their family medical history is essential, as it can guide when and how often to undergo screenings. In addition, screening protocols, such as genetic testing & advanced biomarker tests, can help identify higher risk & ensure early intervention. Military-Related Exposures Unique to Veterans are exposures which elevate the risk of prostate cancer. A recent study by the Department of Defense with a cohort of over 100,000 subjects focused on cancer incidence in military aviators & aviation support personnel. Compared to a demographically similar U.S. population, aircrew had a 20% higher rate of prostate cancer. Another issue was the median age of diagnosis for malignant cancer of all sites was 55 years in aircrew & 54 years in support personnel. In contract the median age at diagnosis for malignant cancer of all sites was 67 years in the reference U.S. population. Other potential exposures which affect prostate health include ionizing radiation, chemicals, and burn pits, which have been used in various combat zones to dispose of waste. These environmental factors may increase inflammation, disrupt hormonal balance, or cause DNA damage, all of which can contribute to prostate cancer. Lifestyle and Health Factors In addition to age, family history, and military-related exposures, Veterans should be aware of other factors including diet, physical activity, and overall health. Obesity, a lack of physical activity, smoking, and poor diet have been linked to an increased risk of prostate cancer. For Veterans age, family history, and military-related exposures can all contribute to the likelihood of developing prostate issues. However, with awareness and regular screening, Veterans can reduce their risks and catch potential problems early. Understanding these risk factors can empower men to take charge of their prostate health, ensuring a better quality of life as they age. Visit Veterans Prostate Cancer Awareness for more information.

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Are Tourniquets Being Overused? A recent study published in JEMS explores the use of prehospital tourniquets by law enforcement officers and emergency medical services (EMS). While tourniquet placement improves survival in life-threatening extremity hemorrhage, overuse often leads to overtriage, burdening trauma centers with unnecessary activations. https://lnkd.in/gTt_MRXB #CoreCompression #EMS #lawenforcement

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