Rhode Island Metro EMS Association

Nebulization is simply the process of breaking down fluid into such fine particles that they suspend in the air. Nebulizer devices accomplish this through a very simple process utilizing gas flow and a baffle.

Using gas flow and a baffle is just like breaking rocks by throwing them against the concrete. The speed you throw the rock is like the gas flow, and the concrete is like the baffle.

We regret to inform you of the unexpected passing of our Brother, active-duty Captain Patrick Crowley of the Warwick Fire Department, on Wednesday, August 9th, 2023.

Captain Crowley had faithfully served the people of Warwick for nearly 19 years, almost entirely at Engine Co. 9 on Commonwealth Ave. He rose steadily in rank and was the Captain in command of Engine Co. 9 at the time of his passing.

In addition to being incredibly well liked, he earned the reputation of being an excellent firefighter and a respected leader. Captain Crowley’s service was not limited to the people of Warwick but also included the very men and women of the Warwick Fire Department. As creator and leader of our Peer Support Team, Captain Crowley is directly responsible for helping dozens of our members navigate the difficulties of our profession and of life itself.

Captain Crowley led a life of service and dedication. He inarguably left the Warwick Fire Department, Local 2748 and the City of Warwick better off than he found it. As a department and a Union, we are lessened by his passing and he will be intensely missed.

We deeply appreciate the messages of condolence from our neighboring departments and the public as a whole.

Our own thoughts and condolences are extended to the entire Crowley family in this time of great sorrow and we collectively pledge to honor and support them just as Captain Crowley did us.

🇶 ​​​​​Is it time to move the Methylene Blue from the HazMat Box to your Med Box to treat Sepsis?

🔬 New research from Ibarra-Estrada et al. in Critical Care (2023) explores the use of methylene blue (MB) as an early adjunctive treatment in patients with septic shock.

📊 In a randomized controlled trial, patients with septic shock were assigned to receive either MB or a placebo. The primary outcome was the time to vasopressor discontinuation at 28 days.

➽ What were the results?
The Methylene Blue group had:
➊ A shorter time to vasopressor discontinuation (69 hours vs. 94 hours in the control group)
➋ One more day of vasopressor-free days at day 28
➌ A shorter ICU length of stay by 1.5 days
➍ A shorter hospital length of stay by 2.7 days.

✅ Importantly, there were no serious adverse effects related to MB administration.

What is the mechanism for MB in sepsis?
⮕ Sepsis is a host’s dysregulated response to an infection, characterized by endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide (NO) metabolism, vasodilation, among other systemic derangements.
⮕ Methylene blue (MB) is a specific inhibitor of the inducible nitric oxide synthase (iNOS) and its downstream enzyme soluble guanylate cyclase (sGC). Through its indirect pressor effects, it has been shown to restore
vasoregulation in conditions of NO upregulation

🔍 The study's conclusion: In patients with septic shock, early use of MB reduced time to vasopressor discontinuation and increased vasopressor-free days at 28 days. It also reduced the length of stay in ICU and hospital without adverse effects.

👉 This study supports further research on MB in more extensive randomized clinical trials.

🔗 Link to the study: https://ow.ly/o30F50PtoJS

Today the City of Warwick added a 5th Rescue Company to the Warwick Fire Department. It is funded with a grant written by members of this Local. With our ever increasing call volume, it couldn’t have come too soon. R5 went into service at 8:00am. It was dispatched on its first run at 8:26am and was then diverted to a critical call that it was closest to one minute later at 8:27am. Like all of our Rescues, today and everyday, it’s been busy since. Rescue 5 is quartered at Station 9 on Commonwealth Ave.

Albuterol and Atrovent 🫁

If you want to keep a door open, you push it open, and then you place a doorstop to prevent it from closing. You can think of albuterol and atrovent (ipratropium bromide) the same way - albuterol opens the bronchi, and Atrovent keeps them open.

While both medications are typically thought of as ‘bronchodilators,’ albuterol truly is a bronchodilator, and Atrovent is more of an ‘anti-broncho-constrictor.’
There are, of course, more technical terms for these two medications. Albuterol is a sympathomimetic (it mimics the actions of the sympathetic nervous system). Atrovent is a parasympatholytic (it lyses the action of the parasympathetic nervous system).

Every organ in the body is under dual innervation from both sides of the autonomic nervous system.

When we give a medication like albuterol, it strengthens the sympathetic side.

Meanwhile, giving medication like atrovent will weaken the parasympathetic side.

Specifically, albuterol is stimulating the sympathetic nervous system through a beta-2 adrenergic receptor. Atrovent, on the other hand, is blocking the stimulation of the
parasympathetic side via blockade of the muscarinic acetylcholine receptor M3 (“M3 receptor”).

The Town of South Kingstown Emergency Medical Services Department (SKEMS) is recruiting a select number of EMT-Cardiac level providers to join the team at SKEMS and attend a cardiac-to-paramedic bridge program at no cost. We are excited to announce an exclusive hiring and education opportunity for full-time RI EMT-Cardiac providers. This special opportunity will prepare candidates for fulfilling a career as a SKEMS paramedic. The recruitment period for the cardiac to paramedic bridge program ends August 4th, 2023. To apply, please submit a completed employment application, cover letter, resume, and copies of your current certification to [email protected] or by hand or by mail to the Personnel Administrator, Town Hall, 180 High Street, Wakefield RI 02879. Town of South Kingstown RI

SAVE THE DATE! Join us virtually for another year of shared learning from experts across the stroke continuum of care at the 18th Annual Northeast Cerebrovascular Consortium Summit (NECC). This year’s summit will feature two tracks for pre-hospital, acute and post-acute care as well as a featured poster event. Lead researchers will cover new and emerging findings to further bridge the gap between science and implementation. Registration opens soon. We’ll see you there!

Clinical Symptoms of Common Large Vessel Occlusion Stroked 🧠

***UPCOMING FALL PROGRAMS****INTEREST FREE PAYMENT PLANS AVAILABLE****
GROUP PRICING ALSO AVAILABLE.
We offer group pricing for 3 or more students from any service or department
NEPEC/ERG is pleased to announce it's upcoming programs for the Fall of 2023
*EMT-BASIC: October 2023
*ADVANCED EMT/CARDIAC: 09/12/23 TUES/THURS 6-10PM
*AEMT/CARDIAC-PARAMEDIC: 09/11/23
EMT-PARAMEDIC: 09/11/23
REGISTRATION IS NOW OPEN
*Paramedic level programs meet 1 day per week with alternating Saturdays. Please visit ERG-EMS.com or contact us at [email protected] for more information. Thank you!
****NEPEC-ERG is CAAHEP Accredited****

Multifocal Atrial Tachycardia

Happy Independence Day!

Current students/candidates and clinicians- we want to hear from you! Qualified participants will receive a $25 National Registry gift card. Qualified focus group participants will receive an additional $50 National Registry gift card.

Click here to see if you qualify for our study! https://b.link/fb-national-registry

We are hiring! Please visit https://www.cumberlandri.org/Jobs.aspx for more information or to apply.

Diffuse Axonal Injury

****UPCOMING FALL PROGRAMS****
PAYMENT PLANS AVAILABLE
NEPEC/ERG is pleased to announce it's upcoming programs for the Fall of 2023
*ADVANCED EMT/CARDIAC: 09/12/23 TUES/THURS 6-10PM
*AEMT/CARDIAC-PARAMEDIC: 09/11/23
EMT-PARAMEDIC: 09/11/23
REGISTRATION IS NOW OPEN
*Paramedic level programs meet 1 day per week with alternating Saturdays. Please visit ERG-EMS.com or contact us at [email protected] for more information. Thank you!
****NEPEC-ERG is CAAHEP Accredited****

A life saved, and thanks given - EastBayRI.com Steve Oliveira walked into the Tiverton Fire Department headquarters on Main Road one recent morning, bearing coffee, donuts and gift cards for the crew. It was the least he could do, he said, for …

In fond memory of stroke survivor Bill Monroe 🧠 The Strokecast who inspired many of us and will be missed by the stroke community.

RIP Bill-Thank you.
https://wp.me/p4EwZ-5Rf

✅ Initial shockable rhythms are associated with better survival and good neurological outcomes.

But how about a patient who presents with an initial non-shockable rhythms and then converts, during resuscitation, to a shockable rhythm?

What impact does that sequence have on survival ❓

A large, 13-country study looked at this question.

➼ The study included 116,387 cases:
⦿ 11,153 (9.6%) were initial shockable rhythms
⦿ 9,756 (8.4%) converted to shockable rhythms from an initial non-shockable rhythm
⦿ 6,097 (4.3%) converted to a shockable rhythm from Asystole
⦿ 3,035 (2.2%) converted to a shockable rhythm from PEA

Survival with favorable neurological status was as follows:
➡ 19.2% when the rhythm was initially shockable
➡ 1.7% when the rhythm converted to shockable
➡ 1.1% when the rhythm was not shockable at any point

Key takeaways:

1️⃣ Conversion to shockable rhythms from non-shockable rhythms improves survival rates and neurological outcomes, especially in instances of initial asystole.

2️⃣ Interestingly, conversion from initial PEA negatively impacts survival to discharge.

3️⃣ Younger age, witnessed arrests and nonresidential locations are associated with increased conversion to shockable rhythms.

⭐ This study is the first to show that conversion from initial PEA may be adversely associated with survival to discharge.

A better understanding of this process could help refine treatment protocols and improve patient outcomes. More research is needed, especially around the effects of adrenaline on initial non-shockable rhythms.

Stay tuned for more as we continue to unravel the complexities of cardiac care! 💔➡️💖


Read the study here:
http://ow.ly/B8st50OEKCE

Inside you are Old Guard

Outside you're a Boy Scout

Back in my Army days I was talking to a Sgt of mine and saying how
much I loved the Old Guard Sentinels that walk the Tomb of the Unknown Soldier

Telling him how I loved the precision and how squared away they were.

His response? "That's not you."

I was crushed. This was a Sgt I looked up to and respected.

When I asked why he would say that, he said I was a bit too round in the middle and not polished enough for that type of job.

Again... crushed.

That very day, I took stock in myself and my goals as a soldier.

Look, I knew in reality the Old Guard uniform was not for me. But I didn't want anyone to ever
think I couldn't do it. Especially for the reason my Sgt shared.

So, I said goodbye to the pizza and beer I was getting way to accustomed to with my buddies and started to do more.

More PT, more running, more studying. more ironing and less pizza and beer.

It got to the point that I was getting pretty good at running longer and faster. Making my morning PT with the Company easier.

I even started to have some of my friends join me on my evening runs. They saw that I was losing weight, getting more fit and breezing through PT.

My Sgt's and officers also took note and pushed me to become a Sgt.

I have always hated when people say I can't do something and hate it even more when their opinion is due to my own actions.

But sometimes I guess we all need that reality check between what we envision and what we look like to those on the outside.

Especially those that matter.

I tell you this story today after seeing the Old Guard on TV during Memorial Day events and it reminded me of this page in my life.

It also reminds me of being a paramedic.

Sometimes we get to used to the pizza and beer aka. the BS calls, the wrinkly uniform, the act of doing the bare minimum just to keep the gears going.

We need that Sgt that I had to be able to take stock in ourselves and know that a critical call is coming, people take note of our appearance and doing more than the bare minimum can mean someone’s life.

For me I carry the lesson I talked about above with me all the time. I am always trying to be better. To learn just a little more, dress a little better and think "I wonder what the initial impression that person who saw me pull up on scene has".

Maybe I shouldn't care what others think of me.

I tried that route from time to time as well. Not caring.

In the end, I find it's what I think of myself that drives me. It just takes someone else to remind me.

Years ago, I thought of putting together a resource to help EMT's and paramedics be better at their jobs. It was a small CD-ROM with a bunch of study and review content on it.

After a short time, I realized I wanted it to be better. To give more. So, it grew into a 3 DVD set. Jam packed with EMS study gold.

But still, it wasn't enough.

So, I searched for software and for web platforms that would allow me to put it all online and add as much EMS study and review content as I wanted without limits.

This passion of mine is my Old Guard. My way of being a Sentinel for those who want to be great clinicians and not ask them to take out a loan to do it.

This passion if you haven't guessed, is Turbo Medic.

https://turbomedic.com

I hope you will join me there before the Lifetime membership offer expires and become a Sentinel to your own EMS knowledge.

🚑 Be Better At EMS 🚑

****UPCOMING FALL PROGRAMS****
PAYMENT PLANS AVAILABLE
NEPEC/ERG is pleased to announce it's upcoming programs for the Fall of 2023
*ADVANCED EMT/CARDIAC: 09/12/23 TUES/THURS 6-10PM
*ADVANCED EMT/CARDIAC-PARAMEDIC: 09/11/23
EMT-PARAMEDIC: 09/11/23
REGISTRATION IS NOW OPEN
*Paramedic level programs meet 1 day per week with alternating Saturdays. Please visit ERG-EMS.com or contact us at [email protected] for more information. Thank you!
****NEPEC-ERG is CAAHEP Accredited****

🚨🚨 New Date!!

The conference has been rescheduled!!
Same venue! Same important info!

Training is provided at no-cost. Click the link below to register!

https://forms.office.com/Pages/ResponsePage.aspx?id=0OdkN_-PjEy9EwbGiP7XhLFnqlmekL1OnwoAvOLa_NBUMDlMNlVDSk1PMlhLMDVWWDdTWEdCTUE3Ri4u

Master Clinicians: Are You Leveraging Them to Your Best Advantage? On every shift, there's that go-to person. They are irreplaceable assets in your organization.

Don't forget to register!!! RSVP by May 5th.

Training is provided at no-cost but registration is required. Click the link below:

https://forms.office.com/Pages/ResponsePage.aspx?id=0OdkN_-PjEy9EwbGiP7XhLFnqlmekL1OnwoAvOLa_NBURVVBOTlLU0tMTDlTQUlVTUpLWFhTTkRTMy4u

Prehospital treatment options for hyperkalemic emergencies

ECMO CPR, also called eCPR, is expensive, logistically complex, and can only be used on a subset of patients.

You may be wondering, "Why all the hype?"

A recent meta-analysis of the 4 randomized clinical trials was published by Tommaso Scquizzato et al. that highlights the benefits of eCPR.

What did the meta-analysis show?
➼ 433 patients were included.
➼ Overall Neuro-intact Survival was significantly higher:
‣ eCPR - 59/220 [27%]
‣ Conventional CPR: 39/213 [18%].
➼ Neuro-intact survival for initial shockable rhythm was higher:
‣ eCPR - 55/164 [34%]
‣ Conventional CPR: 38/165 [23%]

Many challenges still exist, and this is what future research should focus on.
⦿ What is the most effective strategy to provide extracorporeal CPR based on system-level characteristics,
⦿ What are the logistical barriers of extracorporeal CPR?
⦿ How can we improve patient selection?

What are your thoughts on this meta-analysis?

Read the study here:
http://ow.ly/sHUv50NxUlf

The Mallampati Score