November 16, 2025 • 51 mins
Episode 311: Dr. Peter Antevy returns to Medic2Medic to catch up on what’s new since his last visit, and a lot has happened from stepping into his new role as Chief Medical Officer for Brevard County Fire Rescue. Peter remains one of the most influential voices in emergency medical services today. In this episode, we talk about the 2025 AHA Guidelines, Handtevy, leadership in modern EMS systems, why EMS is the most important sub-specialty of Emergency Medicine, and how pediatric care continues to evolve thanks to his innovative approach. Peter shares real-world insights on translating new evidence into action and offers practical advice for providers on the front lines. If you’re passionate about improving patient care, leadership, and EMS innovation, this episode is a must-listen.
https://www.spreaker.com/episode/episode-310-peter-antevy--68475475
Medic2Medic is back, bringing authentic voices, untold stories, and the human side of Emergency Medical Services and beyond.
https://www.spreaker.com/episode/episode-310-peter-antevy--68475475
Medic2Medic is back, bringing authentic voices, untold stories, and the human side of Emergency Medical Services and beyond.
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Episode Transcript
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Speaker 1 (00:04):
Coating.
Speaker 2 (00:09):
Attention all listeners on this frequency stand by for an
important announcement. Welcome to Medic to Medic podcast, the weekly
podcast for EMS providers, EMS leaders, EMS, medical directors and
others involved in or those who have an interest in
emergency medical services.
Speaker 3 (00:27):
Ladies and gentlemen.
Speaker 2 (00:28):
Here's your host, Steve.
Speaker 3 (00:30):
Cohen, coming from the fern Down.
Speaker 4 (00:34):
Medical Medic Podcast Studios is another episode of Medical Medic Podcast.
You can reach me Steve Cohen at Medical Medic Podcasts
at gmail dot com. That's Medic the number two medic
podcast at gmail dot com. You can download this episode
on Spotify, Speaker, Apple Podcasts, Podbean, and any other your
(00:55):
platform that you want to associate with for your podcast. Well,
welcome back back to another episode of this fine, fine podcast.
I'm your host. As I said before, thanks for tuning in.
Today we welcome back a friend, a very very good
friend of the show, someone whose name is practically synonymous
with innovation, leadership and progress in EMS and pediatric care.
(01:17):
Doctor Peter Antevie is an emergency pediatric emergency physician at
Joe Demashio Children's Hospital, board certified in EMS, and one
of the driving forces behind what we do today in EMS,
especially in pediatric care and other EMS care as well
an adult hospital practice for both EMTs paramedics. He serves
(01:39):
as the medical director for multiple EMS agencies as well
across the South Florida region and MISS He took on
a new role as Chief medical Officer at Brevard County
Fire Rescue. I don't know how you do it all, Peter,
but welcome back to Medical medic Podcast.
Speaker 1 (01:56):
Steve is happy to be here. Thank you so much
for the invite, and whatever you call I will answer.
My friend.
Speaker 4 (02:02):
Great to be here, oh and I do appreciate it.
And as we were talking earlier before we started recording,
it's been a while since and some we saw each
other was very briefly NMSP in San Diego when I
came when doctor Wayne was honored as well. I think
we said hi for a couple of minutes, and then
you were running around off again to your next adventure.
So why don't you catch us up from what's been
(02:24):
new with you?
Speaker 1 (02:25):
A lot going on, you know here in the state
of Florida. Because we're a delegated practice state, we are
able to really make changes that are relevant to our region.
The state has been just incredibly supportive. We obviously have
an EMS person now as our Deputy Secretary of Health.
(02:46):
That's doctor Kenchekey. He's true and true an EMS for
like he's a lifer as you will. We have a
great MS bureau. So from the bottom to the top,
from the top to the bottom, EMS really is thriving, no,
would say in a very strong way in the state
of Florida. What else is going on is that July
(03:07):
first of this year we got up and running an
EMS fellowship. That means that we now have two EMS
fellows that we're training per year. We can bloom out
to six per year and we plan on doing that
over the coming years. That's in a relationship through Florida
Atlantic University and for the listeners. In order to become
an UMS medical director nowadays, unlike when I became one
(03:32):
when there was no subspecialty of VMS, because there is
now a subspecialty of VMS, in order to become a
medical director, you need to not only finish FORGE Medical
school three years of Emergency Medicine Training presidency, you now
have to do a one year additional year and they
call that in the MS fellowship. So basically these are
(03:53):
doctors who can go and be working in a new
r but they choose to take a year and learn
the skill set of being a medical director. And there
are not that many training programs across the country, and
so now we are now the latest one. It's been great.
Each of the fellows has a vehicle. Now, we have
a great administrative staff, we have great faculty, and these
(04:17):
fellows are now riding here throughout my agencies and it's
been a wonderful thing. So really, my long term vision
for EMS here in South Florida is not just to
make South Florida the best place in the world to
be a paramedic, but also to start to seed the
area with well trained EMS medical directors who love EMS
(04:41):
through and through. And then if you look five ten
years down the road, when we will have trained ten,
twenty thirty of these medical directors and they all stayed
in this region if they they can find a job.
I mean after some years, it's going to be harder
and harder, I'm sure, but imagine quality of care that
(05:01):
this area will have just by training EMS boards certified
medical directory because you know, see form end of the
years it's been you could be an obstetrician and you
could be a dermatologist. Those days are over and it's
time that EMS really transitioned all over the country to
(05:24):
qualified board certified EMS medical direction. So that's kind of
a part of the update. But looking forward to the conversation.
Speaker 4 (05:34):
We have a lot of new listeners to the podcast
as we rebooted. I really need to go back to
the beginning on how you started hand heavy. I always
liked that story, and I know there's a lot of
new listeners and I think we need to at least
touch on that.
Speaker 3 (05:49):
Sure.
Speaker 1 (05:50):
Yeah, Well, for those who don't know, I'm a pediatric
er doc by training, and I trained at two of
the top ten children's hospitals. And when you go to
those places, we call those places the Ivory Tower. Everybody
just kind of assumes that when you train at a
place like that, when you leave that you are really
(06:13):
good at all things pediatric. And when you are training
specifically pediatric emergency medicine, which takes a total of six
years of training, not just three, they do six, they
really expect you to be coming out of a place
like that and know what you're doing, especially in resuscitation. Well,
(06:33):
that wasn't the case when I came back to Florida
in two thousand and five, I ended up making a
tenfold medication error. And that girl was about five years old.
She was in severe aphylaxis and I needed to give
EPP and instead of giving zero point two mls, I
(06:57):
gave two mls. Now, Thankfully, the girl didn't have a
bad outcome, but she did end up in the ICU.
Blood pressures were super high, her heart was really high.
She spent in the nine in the ICU. I started
to think to myself, how did that make that mistake?
Not even a month or two goes by, and now
there's a It was seven am. There was an infant
(07:18):
with the parents had slept on. Although this was a
futile case. You know, I just walked into the shift
and I'm at the head of the bed. And when
you're at the head of the bed, everyone's watching you.
You know, for those people who've never been in a
resustination room in the emergency department, there's two things people
look at if you're in that room, the patient and
(07:41):
the person running the code. Usually it's the doctor. You
know that all eyes are on you while I'm running
that code. The nurse handed me the Broslo tape, which
back then people were stealing it, so they put in
a case. It in a six foot piece of wood.
So I'm at the head of the bed. Can you
(08:01):
imagine holding like a two by four? And I'm thinking
to myself, Lord, have mercy, what is going on here?
They never taught me this thing, and I reflected back
upon my days in Los Angeles and Pittsburgh, where we
never used a link based tape. So things started coming
(08:22):
together for me, and I started to recognize that, for
whatever reason, the people at the Ivory Towers were not
doing the same thing as everybody else. After some time,
I finally realized that the people who trained me what
they were using was age. One of the people who
wrote the Pals textbook was my mentor, Bob Hitty. I
(08:43):
called them up and I said, Bob, I'm stressing out here.
I'm making errors. They're giving me this slank based tape,
which we never used in Pittsburgh, and I said, I
need to know. Why didn't you use a length based tape.
I said, You've always used age, and he said, yeah,
age are just easier. We know the age before they
(09:04):
get here. We can set the room up I know
all the doses and all the equipment sizes. I say, yip,
But Bob, when I read the past textbook, you don't
mention that in there, And he says to me, it's
a long story. Without going into the long story, it
turns out that most of the PVR people use age,
and most of the most everybody else is told to
(09:26):
use the lanth based tape. Now there's value in the
length based tape, don't get me wrong. And the value
is that if you don't know the kid's age, or
the kids taller or shorter than they appear, then the
length based tape is valuable. But if you want to
prepare in advance, which is the most important part of
the pediatric resuscitation, is knowing what to do before the
kid gets in front of you, if you have the age,
(09:49):
it enables you to do that. And so, make a
long story short, I ended up using age, and that
really launched me into understanding what not just I needed,
but what other people needed as well. So if you
look at that journey from just understanding that knowing the
(10:12):
age does so many things that open so many doors,
so that before you get to the scene, you know
exactly what to do mentally, emotionally, physiologically. If you're a
clinician going to a two year old and cardiac arrest,
and I told you, Steve, you cannot know anything or
determine anything until you're in front of mom and dad
(10:34):
who's screaming, in front of a dead kid who's lying
there up at the pool, You're gonna say to me,
that's that's insane. But if I said to you, okay, Steve,
we have a six to eight minute ride, it's a
two year old, you're going to get there. The dose
of EPI is this the jewels or this as you
know Igel size as this, and now we can talk
through it and d to the call. It turns out
(10:56):
when you get to the call, your hands are no
longer sweating, your heart was. It's not one ad anymore.
And then maybe the most important thing is when you
get off of your of the truck and mom and
dad are looking at you, what are they looking at?
They're looking at whether or not you are capable of
treating their child. And how does someone determine whether or
(11:20):
not they think you're good enough? It's all by body language. So,
for example, when you approach your family and you're looking
them straight in the eyes. That says something about you
when you're not rushed, when you don't look nervous, when
you're not breathing thirty times a minute, And then you
can speak to them in a calm voice, even when
(11:40):
there's chaos around you. They're saying to themselves, nothing is
verbal here. It's all nonverbal communication. They're saying, this guy
looks good. I trust this guy. I trust his team.
When you have people who are getting off the scene,
who are getting on the scene not making eye contact,
very rush, very nervous, talking loud, and then not really performing,
(12:03):
what did the parents say? Something ain't right here? And
they start spinning. So all of a sudden, the emotions
get out of hand and the medical takes to get
it runs. No one ever communicates with the parent while
we're staying unseen, And then you get an entire department
whose motto is we just load and go, scoop and
run diesel fuel. That's what we do here. And it's
(12:26):
all that was born out of the fact that we
were doing it all backwards and we weren't doing it correctly.
So this whole story that I just told you made
such a big impact on my own professional career, meaning
that I now enjoyed. When the sickest kids were coming in,
(12:46):
the nurses always wanted me at the head of the bed,
and I started to realize that my journey took a while,
and when I became a medical director in twenty ten,
it took me a while to convince my paramedics. But
once that happened, game changer. And here we are fifteen
years later. You come to any of my departments, and
(13:08):
yesterday someone came to visit us from Virginia. He's still
here today in one of my departments. He says to me,
his name is Garrett. He's from Fairfax. He says, I
have to understand how your agencies do what they do.
Come on down and visit. And what he's going to
see when he's here is when you come to work
for Pombach County Fire Rescue or in my agencies, we
(13:29):
put you through a two week boot camp, whether you're
thirty year medic or you just came out of school.
And during those two weeks, we show you the Palm
Beach County Fire Rescue Way. Meaning from you know, from
the moment you hear the word two year old or
sixty two year old, We get you on the floor,
we make you put the equipment of the right place.
(13:50):
I mean, everything is choreographed beautifully, and I have fifteen
hundred minutes at that one department. But you won't see
one cardiac arrest that's done in a hurry. You won't
see one cardiac arrest that's done where people are flustered,
or they leave the scene, or they're not talking to parents.
(14:12):
And all that was done not by me twisting their
arm and forcing them to do it. They recognize that
a two year old and a sixty two year old
require the same level of care. They recognize that a
two year old and sixty two year old algorithm for
cardiac arrest is exactly the same thing. And we had
to undo the many decades of saying that kids are
(14:34):
different than adults. We have to undo this theory that, oh,
the adult we can code right here in the living room,
but in the same living room, the two year old
we need to run to the pediatric hospital because they
told us to run. And by the way, this is
rampant through the house of medicine, where people do stuff
that they shouldn't be doing. And we can get into
(14:54):
that with the aha, etc. But we really have to
take a good look at what we're doing, how we're
doing it, and more importantly, look at your outcomes to
see if what you're doing is working, and if it's
not working, I should probably change it.
Speaker 4 (15:07):
I just want to step back for a second and
talk about the culture change from load and go to
stay and take care of the patient and the family.
How did you step into that? How did you convince
the leaders? And you said you mentioned all your paramedics
and EMTs are able to do that.
Speaker 3 (15:25):
But I know it was easy.
Speaker 4 (15:27):
It couldn't have been an easy road after all the
years of just let's pick up the patient and run
into the hospital so I can get back to the station.
Speaker 1 (15:34):
One of my favorite stories is this one where I
became the medical director for Karl Springs Park and Fire
Department in twenty fifteen. I had been a med upal
director at another department for five years, and now I'm
coming into this department. One of the persons we're doing
is I'm teaching them this whole concept of staying unseen.
And of course I'm getting a lot of people looking
at me and I kind of their hands across and
(15:56):
so they're sitting in the back of the room, but
there is one guy sitting in front of the room.
His name is John Robbins, and he's taking notes, Steve,
like you wouldn't believe. And I'm thinking, nobody takes notes,
but like, this guy's taking notes. And at the very end,
he stood up and he says, Doc, welcome to the department.
I'm John Robbins. He was one of my lieutenants, and
(16:17):
I said, nice to meet you. And now with it.
The following week, I'm riding and I'm with my EMS
chief and he says to me, Doc, you wouldn't believe
what just happened. And I said what he says. Yesterday,
I'm sitting here in the office and I hear a phone.
I hear a call go down for two year old Johnny.
And he said, after you gave that class, I was
(16:40):
convinced that nobody was going to listen to what you
had to say. And he said, so I decided to
jump the call. He said it was right down the street.
So he jumps the call and he gets to the house.
He goes to the backyard and what does he see
by the pool side. Lieutenant John Robbins is resuscitating this
little kid at the pool side, and so he just
(17:00):
standing back kind of like frozen, just watching seeing what
the team is doing. After having just been taught this thing.
Kid comes back to life. About a month or two later,
we're having some event. John Robbins comes up to me.
He said, Doc, you probably don't remember me, but I'm
the one who I met you during the pediatric course
(17:22):
you were giving, and I'm the one who had that
pediatric safe. I'm like, oh, absolutely, tell me the story.
So he said, let me take you to the side.
Takes me to the side, and by the way, this
is an event. I says, you know, we're drinking beer
the whole thing. And he says to me, before you
got here, I had made a pretty bad mistake in
(17:43):
pediatric mistake and the mistake was still bad that I
started drinking. I didn't have good relationships, broke up with
my girlfriend, to be quite honest. He's like, I was
considering killing myself. And he says, when you came here
and there was a pediatric class, I sat in the
front row, and when that kid, when that drowning came
(18:06):
in the last month, He's like, I knew what I
had to do. And he said that that one case
for him was so transformative because now he recognized what
he was doing wrong all those years, but more importantly,
when he made that save the rest of the department.
(18:27):
And this is the point I'm going to get to,
which is that it does take someone, and not because
everyone's doing it. It's not as like, oh my gosh,
you stayed unseen like back then it was like you're
really going to stay on seene. Now it's like, I
think people get it that you've got to stand on scene.
Once you have the very first save in the department,
everybody hears about it and then't have to be a
(18:47):
cardiac orress save. It could be keep receiving in the bedroom.
We got there, We opened his airway, we gave him
an oxygen, we gave him versaid, and the kid stop seating.
We checked the blood shugger, and holy cow, that felt
so good. Right. Once that one case, two cases, three
(19:07):
cases start going out around the department, then you get
the buy in, once they realize that this makes so
much sense physiologically, emotionally, it just makes sense because you
know what you're doing before you get there. All of
a sudden, the next person does it, and the next
(19:28):
person does it, and the next person does it, and
then you have the yearly ceremonies where you have you know,
you're bringing up all the survivors and you start to
transform your organization that way. So if you have a
medical director or an MS chief saying doctor and Tevy
(19:49):
said you must stay unseen, that doesn't work. It turns
out you have to train. You have to teach them
why you're doing what you're doing, and then you have
to just you know, get the reps. And then there's
gonna come that call where you're gonna say two year old. Okay,
so two year old is epidose, airway size, electrical. We've
(20:11):
got those three things, Okay, good, we know that what
the triangle is gonna be the the pit crew. Who's
number one, who's number two, who's number three? And then
you get there and you do the thing, and that's
the transformation. It's a roundabout way of saying that if
you're in a department that has good leadership, that has
a good training, and you follow up on what you're
(20:32):
doing and people are showing you the outcomes that you've had. Right,
so we come to my department, you know, like today
at eleven thirty, we have a survivor reunion at this
fire station. Guy was on a tennis court. We stayed
on scene for thirty minutes. We did double sequential on
that guy. Guy's sixty one years old. We celebrate the wins.
(20:55):
And at that ceremony, I'm gonna say a couple of words.
What am I gonna do? I'm gonna highlight my crew?
So what does the crew say? Our ems leadership is great,
our medical director cares about us, they honor what we do.
After every cardiac arrest, they get an email, really long
email that breaks down every compression at reventilation. It breaks
(21:19):
down every pause chest compression fraction. We know when they
turn the monitor on, We know when they if they
precharge the monitor, We know when the mechanical CPR device
went on. We know all of it, and we write
an email. And this is my team who we've trained
to do this. They write an email that the medic
gets either the same shift or the next shift. And
(21:43):
what does that signal? And by the way, it's not
a punitive email. What does that signal is that I'm
working in the department who cares? They're not you know
slapping me on the wrist, and the next time I'm
on a cardiac arrest, I'm going to work harder. I
want to do better because i want another life to
be saved. There's a lot of things that go into
(22:05):
being a great department. There's a lot of things that
go into confidence. And I always tell people that, yeah,
our app is great, but our app is not what
makes you become great. You really need to have a
foundation that has changed from what they taught you, that
(22:26):
has changed from what the Ivory Tower tells you to do,
and you have to do something that actually makes sense
for you and for the patient, and then you'll do it.
And once you do it, you start to see another save,
another save, another save, and then after about a year
or more, the whole department starts to say, this is
who we are now, and so it's nice to see now.
(22:49):
We have agencies across the country, and I have to admit,
some are amazing at this and they do it very well,
and some will never get out of their own way unfortunately.
What do I mean by that means that you could
have an agency that's so fire heavy they don't that
ems is a side. It's like a side gig doesn't
(23:11):
really matter that from the from the very top to
the very bottom, everybody saying, let's just transport these kids,
and they kind of stay in that motion of I'm
just going to do what we always used to do,
and then they always get the same bad outcome. So
that's the ship that has to happen in order for
this to be something that works.
Speaker 4 (23:29):
Wow, thanks for sharing all that. As I said earlier
before we started recording, I had doctor Emney crow on
I recorded this weekend, and what we talked about is
something just very similar about how are we really don't
do a good job of promoting all the good work
we do. Some apartments do it really well, others don't,
(23:50):
and some people won't get out of their way. Overall,
EMS in general needs to do a better job telling
our story.
Speaker 1 (23:57):
Well, well, I mean that is so important, but I
think it's bigger than It's bigger than that. I'll tell
you why. I now that I've been in the EMS
for fifteen years and I've been in hospitals for twenty five,
I recognize one very important thing, which is that the
folks who work in the hospital don't value what EMS does.
What do I mean by that is that when you
(24:19):
go into any emergency department and you go to a
random emergency medicine physician and you start to ask them, hey,
what do you think EMS? Does none of them understand
what we really do. They don't understand quality, They don't
understand the level of training, They don't understand how high
end the care that we provide is. They don't understand
(24:42):
the value that we bring, whether the it's cardiac arress,
whether it's trauma care with whole blood plasma, which stepsis hair.
And what I've come to realize is that from the
people who write the guidelines to the people who are
in other organizations, when they hear or see EMS, they
don't value us the same as they would if you
(25:04):
said another specialty in the house of medicine. And it's
time that they recognize that EMS is maybe the most
valuable sub specialty in a house of medicine because of
all the things that we can do before we get
to the scene, we talk about mobile integrated health. We
are the social net right, the safety net for many communities,
(25:28):
and a well run EMS system can do much more
than just acute care. But a well run and acute
care EMS organization can bring back so many more people
to life than another one. And all you got to
do is look at the CARES data from twenty twenty
four in their annual report, which I recommend everyone to
look at. And there's a graph that I love to
(25:51):
put up on a slide and show people that they
have about it's probably maybe about one hundred agencies listing
on this one graph. All these agencies are large agencies.
They do two hundred arrests or more a year. On
the left hand side, you see that one agency has
three and a half percent survival. On the right hand side,
(26:15):
you have an agency that has twenty two percent survival.
And you look at that and you say, how in
the world could you have agencies large agencies? Again, if
you're doing over two hundred partiac or the rest of a year,
you're a pretty big sized agency. But the arbitragy between
the best and the worst is nineteen points right. That
(26:38):
makes no sense whatsoever. And then you start to ask
yourself why and why aren't we exposing who the best
are and who the worst are. But at the end
of the day, if you have such a big change
between two agencies of similar sizes, you really have to
start to understand what is it about the best agencies
(26:59):
compared to the worst agencies. And I bet that I
could figure that out in five minutes of being at
a system. Which agencies are the top performers and which
are the bottom performers. And it does come down, unfortunately,
to leadership at those agencies, from the fire chief to
the MS chief to the medical director. And to change
(27:23):
an organization from being a low performing one to a
high performing one that takes commitment, and it takes years
to make that happen.
Speaker 3 (27:33):
Yes, it does.
Speaker 4 (27:34):
And when you look at those graphs, it would be
nice to know what agencies, what their agency names are,
if you're going to put something out there, own up
to it.
Speaker 3 (27:47):
That's just the thought that came to my mind.
Speaker 1 (27:48):
No, So I actually had a post on LinkedIn where
I said exactly what you just said, and I said,
why aren't we exposing each of these agencies and why
isn't that data transparent? Right? It turns out that all
the important data hospital outcomes, hospital quality, that's all being
(28:10):
hidden unfortunately. And then when we are doing things here
in the state of Florida, where other people out there
are saying, oh my gosh, how are you doing that?
But the other day I just put up on LinkedIn
that one of my agencies here are Neuroin tax survival
year to date is twenty two point seven percent, where
(28:31):
the HAIRS has shown Neuroin tax revival for the country
has been was last year eight point three percent. So
we're almost triple the national and there's nobody knocking on
our door from the organization saying, hey, what are you
guys doing? Because in order to get to that level,
(28:52):
it takes commitment. You have to commit to excellence. You
have to commit to doing things like CQI training and
making sure that running an organization that you actually not
that you know what your data is, but that you're
actively seeking to make it better. As we move forward here,
(29:13):
you know what's up and coming are things like tepsis care.
Do people know what their sexist outcomes are? And if
you don't, you should because now that there's some studies
coming out with the fluids and antibotics and sepsis, well,
guess who is going to be taking care of that?
We are an EMS. And if we are an EMS
(29:33):
and you're an agency who doesn't know what your own
data is, how do you expect to get better. How
do you expect to show your crews that, Hey, last year,
our mortality from sepsis was forty percent. This year we're
down to ten percent. Wow, you saved a lot of lives.
That's the way to change an agency with data CQI
training and celebrating the wins.
Speaker 4 (29:56):
Absolutely, And before we move on, I just want to
say we've known each other for a while now and
we've talked quite a few times as well, both on
the podcast and in person. I don't know how you
do it, but you take the data driven side of
things of medicine and EMS, and you do also add
(30:16):
that human side of leadership that is so rare. And
I think EMS and your patients and your services and
the people that you go across the nation to teach,
I just think it's great. So I appreciate you doing that,
and I think it's just so rare that you can
take both sides and you make it so everybody understands it,
(30:38):
which is again rare.
Speaker 3 (30:40):
So thank you very much for doing what you do well.
Speaker 1 (30:42):
I are I can't take any credit for that. I
will tell you that the way that my brain works
is I always tell people that I'm a very simple
minded person, and if something is too complicated for me
to understand, that it's hard for me to digest. But
if you look at everything that we're talking about, if
(31:03):
you bring a fifth grader and you tell them these things,
and you tell them, hey, someone has a really bad
infection and they need antibiotics right away, when should that
antibiotic be given to that person? And a fifth grader
will say, well, as soon as possible. Who came up
with this theory that there's highly qualified, trained personnel sitting
(31:26):
in your home and we should just transport that patient
to another location where it takes those people over an
hour to get the life saving antabotic. When you say
some of these things out loud, it makes no sense
when you say things like stay and play for cardioc orress,
when you say things like double sequential defibrillation, when you
(31:47):
say all these things. But for whatever reason, there's some
really basic, easy, low hanging fruit things that all of
us should be doing. What I would like to see
from people who are listening. And you could be brand
new to EMS, or you could be thirty years into EMS.
It's like, go fight for what it's right, even in
(32:09):
the face of people telling you this is how we've
done it for so long. Well, oftentimes, if you're doing
something for so long and you're getting the same result, then,
as Einstein said, that's the definition of insanity. You should
stop doing that. So I appreciate the accolades, but I
(32:31):
would say that we're in an amazing profession where we
can make such a huge impact in outcomes, and there's
no better place. In my opinion, there's no better specialty
in the world than EMS. I think we have a
lot of work to be done, but people like you
getting the word out that's what we need more of.
Speaker 4 (32:48):
I know you mentioned a few minutes back about the
American Heart Association guidelines, and let's dig into what everyone's
talking about in EMS, the new twenty five guidelines. I
know you've probably been in the thick of translating evidence
into product. I know you reviewed it, and I know
you had almost a two hour webinar I think last
(33:11):
Friday or so. You're any MSP Florida experts on from
your perspective, what stands out?
Speaker 3 (33:18):
What do you like, what don't you like?
Speaker 4 (33:20):
And I know that well, I have a feeling because
I did watch your webinar. Why don't you tell the
listeners that did not watch it that they can't go
and watch it on YouTube as well?
Speaker 1 (33:29):
So yeah, yeah, absolutely, And I guess overall, the statement
I'll start with is that there are folks who take
a lot of time out of their day and schedules
that don't get paid for it. They spend months and
months and months, you know, looking at all the evidence,
writing all the documentation, creating the powerpoints, et cetera, making videos,
(33:50):
et cetera. And I know a lot of the people
who do it, and they're all great people. What I
think has happened over the years is that this entity
of the Guidelines is trying to serve everybody. And whether
you're in business or you're in medicine, if you try
(34:14):
to serve everybody, you end up serving nobody. And that
is true in anything. If you want to go and
start a company and you said I'm just going to
do everything, oh, no one's gonna call you. But if
you say I only install wood floors, I guess what
people are going to find you and they're going to say,
I heard you the best wood floor installer in the world.
(34:35):
You know, I need your help. What's happened with the
guidelines is that they're serving dentists and they're serving you know,
someone who just needs their their parts and I can
say I did it. And then they're serving the EMS community,
and they're serving the emergency medicine community, and they're serving nurses.
(34:56):
And it turns out that all those are very different.
Pre hospital medicine it's its own sub specialty. We see
people who are stuck between a toilet bowl and the wall,
and you're in the emergency department. You're getting someone who's
probably been resuscitated for thirty minutes before you see them,
(35:19):
and now you're in a well lit room with all
the things that you need, but that patient in a
different state by the time you get to them. When
you're in the ICU, you have an a line, you
have a balloon pump, you could have an open chest
in some cases. It's very, very different. And so when
we look at these guidelines, you have to look at
(35:41):
them from the lens of what do I do for
a living, And when you're in EMS, you have to
look at it from a three hospital lens. That's the
lens I look at it from. So, of course my
opinion will differ than somebody else's opinion. But let's just
go through some of the main ones that we talked about.
The first one, which I think is the biggest miss
(36:04):
is the double I should say dual sequential defibrillation DSED.
What was the miss there? You have a patient who's
a refractory VF. You shock the patient and they're still
in VF. So what do you do now? Well, what
you do now is you keep doing your two minute cycles,
(36:24):
you keep shocking the patient, and you bring that patient
to the emergency department. And after five, six, seven, eight shocks,
what is the air doctor going to say, I'm a
death and they'll call the code. So since nineteen ninety
four the initial case reports of dual sequential were reported.
(36:45):
That's nineteen ninety four, right, many many years ago. And
then in twenty twenty two, in November Sheldon Cheskey's out
of Toronto, him and his group published the first randomized
control trial which demonstrated that if you on the fourth shock,
so three standard shocks, on the fourth shock, you add
(37:08):
a second set of heads ap, you will double neuro
and text revival and that was a significant difference. They
published it in New England Journale Medicine lo and behold.
When the guidelines started to unfold, ill CORE, which is
the international group, they released their draft in November of
twenty twenty four. They gave it the nod. They're like, yes,
(37:31):
you should do that. It wasn't the highest class of recommendation,
but it was recommendation. Then we waited until October twenty second,
which is one of the Europeans, and the AHA put
out their recommendations and for some reason they said no, no,
they do not recommend dual sequential. So here's my problem
(37:55):
with that. You have a patient who you know is
going to die, and actually they're actually dead, they're already dead,
and you have a finding in the mainland journal of
a randomized control trial that shows you can double survival.
Why would you not say yes to that? So I
am calling upon the American Art Association to change the
(38:18):
recommendation now I have more data. Turns out, Steve. First
of all, I've been doing this for seven years at
my agency, and we have a number of survivors, including
the one today that I'm going to be going to
in about an hour. There's four trials going on in
Europe right now as we speak, and one of them
just reported their early findings. They report and by the way,
(38:38):
they've moved up double sequential to the second shock, which
I did last this past year, and they're finding that
dual sequential. Again, it's early pilot data. This is not
the BdL and the end L outcome. But the early
data shows forty percent survival for dual seqrunch chop number
(38:59):
two versus seven percent survival for standard care, meaning al
and your shock can keep shocking forty versus seven percent.
So we know from our data that it works. We
know from Cheskey's data that it works. We can see
clearly that what's going on in Europe is going to
change the game. What are these people waiting for? So
(39:21):
that is a huge, huge miss. I will put my
career on the fact that dual sequential should not only
be done, it should be done as soon as possible.
And that's what we have not changed our protocols to
as soon as possible. So that was number one. That
was the first kind of big miss. The second thing
(39:44):
that people were concerned about their recommendation of mechanical CPR.
What's confusing is that they have a class two recommendation
and then they have a Class three recommendation. Once you
get to class three, it means that these are no
benefit or there's harm. They actually say mechanical CPR routine use.
(40:05):
You have to read every word in these guidelines. The
routine use of mechanical CPR is not recommended. But if
you go a little higher up in the box that
they have in the guidelines, they have believe it's a
two B recommendation where if you're in a circumstance where
(40:26):
mechanical CPR would be a benefit, then they say you
can go use it. Now. All the studies that they've done,
there have been many studies of mechanical CPR, all of
them show that there's no benefit compared to standard. To
be quite honest, I never thought that there would be
a benefit. I just didn't want it to be worse. Right,
(40:49):
So if you turns out that if you just install
mechanical CPR in your agency and you don't do it
the right way, your outcomes will decrease. You'll have worse outcomes.
Why Because it turns out that when you're in an
agency and the mechanical CPR device enters the room, everybody
just stops like, oh, there's the Lucas or there's the
(41:12):
autopuls and if you look at your coach stat or
your case review from the monitor, you recognize that there
was like a one minute pause. So we have gone
to an extreme length to teach people how to put
these devices on while CPR is in progress, and we've
succeeded at that. We also say that you should be
(41:37):
doing manual CPR at least for the first ten minutes,
just because the LUCAS is in the room, Like, where
are you going, right, We're not transporting these patients in
the first ten minutes anyway, so what is their rush.
Let's do high quality manual CPR and do the right thing,
and then if you want to transport the patient, because
(41:59):
the patient it needs to be transported, then you can
use the device. So I never want any of my
crews doing CPR in the back of the moving ambulance.
If a patient is a candidate for EKMO, then we
do tend to get them off scene quicker and they
do need a mechanical CPR device, So don't throw the
baby out with the bath water. On this one, I
(42:21):
would say that mechanical CPR devices in ems are invaluable
at the right time it plays correctly by the right
people who've been trained on what to do. If you
have a CQI program that evaluates, I can look at
any one of my codes, I can tell you the
exact moment that was put on, and I will show
you that you can almost not even detect why that
(42:45):
pause was there, because it looks like most every other pause.
It's a little longer, but it's negligible. Why because we
train like hell on it. And that's the sign of
an agency who actually has implemented a device. So at
my twenty two point seven percent neurotax revival agency, we
(43:05):
use mechanical CPR. Well, I'll take you to another agency
out there somewhere who is using mechanical CPR incorrectly, and
their numbers are probably in the three to five percent
range for survival. So my bottom line is this machine
is not good or bad. It's the process, it's the protocol,
(43:28):
it's the implementation that will sway you one way or
the other.
Speaker 4 (43:32):
I would recommend our listeners to go to your Friday
webinar at YouTube. It's well worth listening to and also
hearing from doctor Wayne.
Speaker 3 (43:44):
Was on there.
Speaker 4 (43:44):
You had also had a few other medical directors as well.
I think it's really really worth as an emas provider,
they should go listen to it.
Speaker 3 (43:54):
Not just my recommendation.
Speaker 1 (43:56):
I appreciate that.
Speaker 4 (43:57):
What's new, what excites you, and what's new with I
mean it's also you got to say it, what's new
with HANDEVI thank you.
Speaker 1 (44:04):
I appreciate that. So what's new in the MS. The
biggest thing coming in twenty twenty six we had mentioned
it are antabotics and fluids for sepsis. We published our
paper a few months ago. We had thirteen hundred and
eight cases of stepsis celerity in the Palm Beach County
and we gave all of those patients antabotics and fluids.
(44:30):
Our mortality for those patients is about seven percent. Chldon
Cheskey's out of Toronto is just finishing rolling in his
randomized control trial, which is a it's a crossover randomized
design where they're doing both fluids and antibiotics. They're looking
at the amount of fluid you're giving either normal amount
(44:51):
which is like four hundred tcs versus a leader or more,
and then rostefan or no ro stephan. So it was
a very clever design. They enrolled about twenty two hundred
patients and we're anxiously awaiting the outcomes there. But I
will predict here that the mortality difference will be significant.
(45:11):
I'll predict that the times antabotics will be significant. I'll
predict that the number of ventilator days will be significant,
the number of ICU days will be significant. And when
that study gets published, probably Q one of twenty twenty six,
then every single EMS organization in this country should be
following this guideline of antabotics belong in EMS for sepsis. Now,
(45:35):
I'm not talking about just the patient west fever or
meets to search criteria. We're talking about people who are
you know, septic shock, and there's criteria. I can send
you the protocols. It's very simple. Those patients should be
getting antabotics in EMS. So gane a the days of
the hospital saying you have to bring them to us
because we need blood cultures. That's a myth. Gone of
(45:58):
the days of we have to give the fluids in
the hospital because CMS. No, that's total BS. So I
would recommend that agencies today start looking at your sepsist
patient data. Understand what you're doing today, what what your
outcomes are today? And then when you go and make
the case to the hospital who's going to complain, you
(46:20):
can say, listen, we've been doing it the old way
for a long time. People are dying. Here's another randomizz
controlled trial that shows that we can put mortality in half. Therefore,
we're going to be doing this and so it's going
to take some leadership. It's going to take some hoot
spot when they say, but once you have the data,
(46:41):
you ought to do the right thing for the patient.
So that's an exciting thing that's happening. The other thing
that's happening is many people know that we're using blood products,
whole blood, specifically the Pambach County and the Browner County.
But we have now integrated plasma very heavy and we're
(47:01):
engaged now in an observational trial for plasma for traumatic
brain injury. We've also addited for burns, and now I'm
adding it in for sepsis. So anything that causes leakage
from a capillary. So severe trauma causes leakage, burns cause leakage,
steps as caused leakage, and the phalaxus causes leakage. Turns
(47:24):
out that there is a layer inside the capillary called
the glycoklyx that is removed in those disease sets scenarios,
that plasma will rebuild. And therefore, instead of the normal
saline or the LR that you're giving that just leaking
right out of the vessel, the plasma patches up the vessel,
(47:45):
prevents the leakage, prevents these patients from going into arids,
prevents them from being nine years positive three days vader
in the ICU, and you end up with a future
that never uses nor salient lat tated renders ever again.
And I do believe strongly that once plasma is able
(48:06):
to be sold in a spray dried fashion, which means
just dehydrated, it's put into an empty saline bag. That's
how they'll sell it to you. You'll reconstitute it with
two hundred ccs of sterile water, and now you'll have
this new thing that is much better than the old thing. Now,
(48:28):
studies have to be done, yes, but there's studies down
in plasma for fifteen years now. But the people who
are the naysayers are going to want the randomized controlled
studies and all that will happen within time. But for
right now, we know that normal saline in l R
killed people. There's never been one study to show any benefit,
(48:51):
and we know now that plasma has a very good
safety profile. So we are now going to be engaging
with doctor Holcombe in a pre hospital randomized control trial
for plasma for traumatic brain injury once our observational trial
is completed. So my agencies are now engaging in randomized
control trial research. We're really advancing our game and really
(49:14):
entering into a different level of research for EMS. EMS
needs to be on the map for what it can do,
so it's to kind of end where we started. EMS
is the most important subspecialty for cute care medicine, and
we just have to demonstrate our value. We have to
publish all of our outcomes, and we have to continue
(49:37):
to spread the word that EMS is part of the
continuum and we're not just a kind of like a
red headed step child in the house of medicine. And
that's really kind of my goal throughout my career is
to continue to highlight the value that EMS provides.
Speaker 4 (49:53):
We've covered all the serious topics on this podcast today.
Speaker 3 (49:57):
Very much appreciate it your schedule. We'll make so many people.
Speaker 4 (50:02):
Dizzy, and what you do and all the things you're
doing for EMS and the pediatric field as well.
Speaker 3 (50:08):
What do you do to unwind?
Speaker 1 (50:10):
Great question, Listen, I absolutely love what I do number one.
So for me, you know, yesterday I had a twenty
hour day, but I was just as energized as ever.
I'm very fortunate to have a teams around me that
are just incredible who allow me to do everything that
I'm doing. I don't do it alone. But for me
(50:31):
to unwind is obviously my family is number one and
most important to me. I love playing tennis, So Saturday morning,
don't call me. I'll still enter the phone, but I'll
probably be in the middle of a tennis match. And
Wednesday night I've been a tennis league. We have our dogs,
my wife and we love walking the neighborhood with the dogs.
We'd love to travel we can, but you know, we're young.
(50:52):
We're having a great time and we have met so
many great people because of this wonderful field of VMS
to you, and it's people that I thought full, innovative,
and we recognize that our closest friends come from the
MS community. So it's been it's been a win personally
(51:13):
and professionally.
Speaker 4 (51:14):
Peter, as always, it's an honor to have you on mathematic.
You set the bar so high for what modern em
AS leadership should look like and clinical innovation. Thanks for
sharing your time, your insight, so thank you for joining
me on mathematic.
Speaker 1 (51:29):
Thank you, Steve, happy to come back anytime.
Speaker 3 (51:32):
Thank you very much appreciated
Coating.
Speaker 2 (00:09):
Attention all listeners on this frequency stand by for an
important announcement. Welcome to Medic to Medic podcast, the weekly
podcast for EMS providers, EMS leaders, EMS, medical directors and
others involved in or those who have an interest in
emergency medical services.
Speaker 3 (00:27):
Ladies and gentlemen.
Speaker 2 (00:28):
Here's your host, Steve.
Speaker 3 (00:30):
Cohen, coming from the fern Down.
Speaker 4 (00:34):
Medical Medic Podcast Studios is another episode of Medical Medic Podcast.
You can reach me Steve Cohen at Medical Medic Podcasts
at gmail dot com. That's Medic the number two medic
podcast at gmail dot com. You can download this episode
on Spotify, Speaker, Apple Podcasts, Podbean, and any other your
(00:55):
platform that you want to associate with for your podcast. Well,
welcome back back to another episode of this fine, fine podcast.
I'm your host. As I said before, thanks for tuning in.
Today we welcome back a friend, a very very good
friend of the show, someone whose name is practically synonymous
with innovation, leadership and progress in EMS and pediatric care.
(01:17):
Doctor Peter Antevie is an emergency pediatric emergency physician at
Joe Demashio Children's Hospital, board certified in EMS, and one
of the driving forces behind what we do today in EMS,
especially in pediatric care and other EMS care as well
an adult hospital practice for both EMTs paramedics. He serves
(01:39):
as the medical director for multiple EMS agencies as well
across the South Florida region and MISS He took on
a new role as Chief medical Officer at Brevard County
Fire Rescue. I don't know how you do it all, Peter,
but welcome back to Medical medic Podcast.
Speaker 1 (01:56):
Steve is happy to be here. Thank you so much
for the invite, and whatever you call I will answer.
My friend.
Speaker 4 (02:02):
Great to be here, oh and I do appreciate it.
And as we were talking earlier before we started recording,
it's been a while since and some we saw each
other was very briefly NMSP in San Diego when I
came when doctor Wayne was honored as well. I think
we said hi for a couple of minutes, and then
you were running around off again to your next adventure.
So why don't you catch us up from what's been
(02:24):
new with you?
Speaker 1 (02:25):
A lot going on, you know here in the state
of Florida. Because we're a delegated practice state, we are
able to really make changes that are relevant to our region.
The state has been just incredibly supportive. We obviously have
an EMS person now as our Deputy Secretary of Health.
(02:46):
That's doctor Kenchekey. He's true and true an EMS for
like he's a lifer as you will. We have a
great MS bureau. So from the bottom to the top,
from the top to the bottom, EMS really is thriving, no,
would say in a very strong way in the state
of Florida. What else is going on is that July
(03:07):
first of this year we got up and running an
EMS fellowship. That means that we now have two EMS
fellows that we're training per year. We can bloom out
to six per year and we plan on doing that
over the coming years. That's in a relationship through Florida
Atlantic University and for the listeners. In order to become
an UMS medical director nowadays, unlike when I became one
(03:32):
when there was no subspecialty of VMS, because there is
now a subspecialty of VMS, in order to become a
medical director, you need to not only finish FORGE Medical
school three years of Emergency Medicine Training presidency, you now
have to do a one year additional year and they
call that in the MS fellowship. So basically these are
(03:53):
doctors who can go and be working in a new
r but they choose to take a year and learn
the skill set of being a medical director. And there
are not that many training programs across the country, and
so now we are now the latest one. It's been great.
Each of the fellows has a vehicle. Now, we have
a great administrative staff, we have great faculty, and these
(04:17):
fellows are now riding here throughout my agencies and it's
been a wonderful thing. So really, my long term vision
for EMS here in South Florida is not just to
make South Florida the best place in the world to
be a paramedic, but also to start to seed the
area with well trained EMS medical directors who love EMS
(04:41):
through and through. And then if you look five ten
years down the road, when we will have trained ten,
twenty thirty of these medical directors and they all stayed
in this region if they they can find a job.
I mean after some years, it's going to be harder
and harder, I'm sure, but imagine quality of care that
(05:01):
this area will have just by training EMS boards certified
medical directory because you know, see form end of the
years it's been you could be an obstetrician and you
could be a dermatologist. Those days are over and it's
time that EMS really transitioned all over the country to
(05:24):
qualified board certified EMS medical direction. So that's kind of
a part of the update. But looking forward to the conversation.
Speaker 4 (05:34):
We have a lot of new listeners to the podcast
as we rebooted. I really need to go back to
the beginning on how you started hand heavy. I always
liked that story, and I know there's a lot of
new listeners and I think we need to at least
touch on that.
Speaker 3 (05:49):
Sure.
Speaker 1 (05:50):
Yeah, Well, for those who don't know, I'm a pediatric
er doc by training, and I trained at two of
the top ten children's hospitals. And when you go to
those places, we call those places the Ivory Tower. Everybody
just kind of assumes that when you train at a
place like that, when you leave that you are really
(06:13):
good at all things pediatric. And when you are training
specifically pediatric emergency medicine, which takes a total of six
years of training, not just three, they do six, they
really expect you to be coming out of a place
like that and know what you're doing, especially in resuscitation. Well,
(06:33):
that wasn't the case when I came back to Florida
in two thousand and five, I ended up making a
tenfold medication error. And that girl was about five years old.
She was in severe aphylaxis and I needed to give
EPP and instead of giving zero point two mls, I
(06:57):
gave two mls. Now, Thankfully, the girl didn't have a
bad outcome, but she did end up in the ICU.
Blood pressures were super high, her heart was really high.
She spent in the nine in the ICU. I started
to think to myself, how did that make that mistake?
Not even a month or two goes by, and now
there's a It was seven am. There was an infant
(07:18):
with the parents had slept on. Although this was a
futile case. You know, I just walked into the shift
and I'm at the head of the bed. And when
you're at the head of the bed, everyone's watching you.
You know, for those people who've never been in a
resustination room in the emergency department, there's two things people
look at if you're in that room, the patient and
(07:41):
the person running the code. Usually it's the doctor. You
know that all eyes are on you while I'm running
that code. The nurse handed me the Broslo tape, which
back then people were stealing it, so they put in
a case. It in a six foot piece of wood.
So I'm at the head of the bed. Can you
(08:01):
imagine holding like a two by four? And I'm thinking
to myself, Lord, have mercy, what is going on here?
They never taught me this thing, and I reflected back
upon my days in Los Angeles and Pittsburgh, where we
never used a link based tape. So things started coming
(08:22):
together for me, and I started to recognize that, for
whatever reason, the people at the Ivory Towers were not
doing the same thing as everybody else. After some time,
I finally realized that the people who trained me what
they were using was age. One of the people who
wrote the Pals textbook was my mentor, Bob Hitty. I
(08:43):
called them up and I said, Bob, I'm stressing out here.
I'm making errors. They're giving me this slank based tape,
which we never used in Pittsburgh, and I said, I
need to know. Why didn't you use a length based tape.
I said, You've always used age, and he said, yeah,
age are just easier. We know the age before they
(09:04):
get here. We can set the room up I know
all the doses and all the equipment sizes. I say, yip,
But Bob, when I read the past textbook, you don't
mention that in there, And he says to me, it's
a long story. Without going into the long story, it
turns out that most of the PVR people use age,
and most of the most everybody else is told to
(09:26):
use the lanth based tape. Now there's value in the
length based tape, don't get me wrong. And the value
is that if you don't know the kid's age, or
the kids taller or shorter than they appear, then the
length based tape is valuable. But if you want to
prepare in advance, which is the most important part of
the pediatric resuscitation, is knowing what to do before the
kid gets in front of you, if you have the age,
(09:49):
it enables you to do that. And so, make a
long story short, I ended up using age, and that
really launched me into understanding what not just I needed,
but what other people needed as well. So if you
look at that journey from just understanding that knowing the
(10:12):
age does so many things that open so many doors,
so that before you get to the scene, you know
exactly what to do mentally, emotionally, physiologically. If you're a
clinician going to a two year old and cardiac arrest,
and I told you, Steve, you cannot know anything or
determine anything until you're in front of mom and dad
(10:34):
who's screaming, in front of a dead kid who's lying
there up at the pool, You're gonna say to me,
that's that's insane. But if I said to you, okay, Steve,
we have a six to eight minute ride, it's a
two year old, you're going to get there. The dose
of EPI is this the jewels or this as you
know Igel size as this, and now we can talk
through it and d to the call. It turns out
(10:56):
when you get to the call, your hands are no
longer sweating, your heart was. It's not one ad anymore.
And then maybe the most important thing is when you
get off of your of the truck and mom and
dad are looking at you, what are they looking at?
They're looking at whether or not you are capable of
treating their child. And how does someone determine whether or
(11:20):
not they think you're good enough? It's all by body language. So,
for example, when you approach your family and you're looking
them straight in the eyes. That says something about you
when you're not rushed, when you don't look nervous, when
you're not breathing thirty times a minute, And then you
can speak to them in a calm voice, even when
(11:40):
there's chaos around you. They're saying to themselves, nothing is
verbal here. It's all nonverbal communication. They're saying, this guy
looks good. I trust this guy. I trust his team.
When you have people who are getting off the scene,
who are getting on the scene not making eye contact,
very rush, very nervous, talking loud, and then not really performing,
(12:03):
what did the parents say? Something ain't right here? And
they start spinning. So all of a sudden, the emotions
get out of hand and the medical takes to get
it runs. No one ever communicates with the parent while
we're staying unseen, And then you get an entire department
whose motto is we just load and go, scoop and
run diesel fuel. That's what we do here. And it's
(12:26):
all that was born out of the fact that we
were doing it all backwards and we weren't doing it correctly.
So this whole story that I just told you made
such a big impact on my own professional career, meaning
that I now enjoyed. When the sickest kids were coming in,
(12:46):
the nurses always wanted me at the head of the bed,
and I started to realize that my journey took a while,
and when I became a medical director in twenty ten,
it took me a while to convince my paramedics. But
once that happened, game changer. And here we are fifteen
years later. You come to any of my departments, and
(13:08):
yesterday someone came to visit us from Virginia. He's still
here today in one of my departments. He says to me,
his name is Garrett. He's from Fairfax. He says, I
have to understand how your agencies do what they do.
Come on down and visit. And what he's going to
see when he's here is when you come to work
for Pombach County Fire Rescue or in my agencies, we
(13:29):
put you through a two week boot camp, whether you're
thirty year medic or you just came out of school.
And during those two weeks, we show you the Palm
Beach County Fire Rescue Way. Meaning from you know, from
the moment you hear the word two year old or
sixty two year old, We get you on the floor,
we make you put the equipment of the right place.
(13:50):
I mean, everything is choreographed beautifully, and I have fifteen
hundred minutes at that one department. But you won't see
one cardiac arrest that's done in a hurry. You won't
see one cardiac arrest that's done where people are flustered,
or they leave the scene, or they're not talking to parents.
(14:12):
And all that was done not by me twisting their
arm and forcing them to do it. They recognize that
a two year old and a sixty two year old
require the same level of care. They recognize that a
two year old and sixty two year old algorithm for
cardiac arrest is exactly the same thing. And we had
to undo the many decades of saying that kids are
(14:34):
different than adults. We have to undo this theory that, oh,
the adult we can code right here in the living room,
but in the same living room, the two year old
we need to run to the pediatric hospital because they
told us to run. And by the way, this is
rampant through the house of medicine, where people do stuff
that they shouldn't be doing. And we can get into
(14:54):
that with the aha, etc. But we really have to
take a good look at what we're doing, how we're
doing it, and more importantly, look at your outcomes to
see if what you're doing is working, and if it's
not working, I should probably change it.
Speaker 4 (15:07):
I just want to step back for a second and
talk about the culture change from load and go to
stay and take care of the patient and the family.
How did you step into that? How did you convince
the leaders? And you said you mentioned all your paramedics
and EMTs are able to do that.
Speaker 3 (15:25):
But I know it was easy.
Speaker 4 (15:27):
It couldn't have been an easy road after all the
years of just let's pick up the patient and run
into the hospital so I can get back to the station.
Speaker 1 (15:34):
One of my favorite stories is this one where I
became the medical director for Karl Springs Park and Fire
Department in twenty fifteen. I had been a med upal
director at another department for five years, and now I'm
coming into this department. One of the persons we're doing
is I'm teaching them this whole concept of staying unseen.
And of course I'm getting a lot of people looking
at me and I kind of their hands across and
(15:56):
so they're sitting in the back of the room, but
there is one guy sitting in front of the room.
His name is John Robbins, and he's taking notes, Steve,
like you wouldn't believe. And I'm thinking, nobody takes notes,
but like, this guy's taking notes. And at the very end,
he stood up and he says, Doc, welcome to the department.
I'm John Robbins. He was one of my lieutenants, and
(16:17):
I said, nice to meet you. And now with it.
The following week, I'm riding and I'm with my EMS
chief and he says to me, Doc, you wouldn't believe
what just happened. And I said what he says. Yesterday,
I'm sitting here in the office and I hear a phone.
I hear a call go down for two year old Johnny.
And he said, after you gave that class, I was
(16:40):
convinced that nobody was going to listen to what you
had to say. And he said, so I decided to
jump the call. He said it was right down the street.
So he jumps the call and he gets to the house.
He goes to the backyard and what does he see
by the pool side. Lieutenant John Robbins is resuscitating this
little kid at the pool side, and so he just
(17:00):
standing back kind of like frozen, just watching seeing what
the team is doing. After having just been taught this thing.
Kid comes back to life. About a month or two later,
we're having some event. John Robbins comes up to me.
He said, Doc, you probably don't remember me, but I'm
the one who I met you during the pediatric course
(17:22):
you were giving, and I'm the one who had that
pediatric safe. I'm like, oh, absolutely, tell me the story.
So he said, let me take you to the side.
Takes me to the side, and by the way, this
is an event. I says, you know, we're drinking beer
the whole thing. And he says to me, before you
got here, I had made a pretty bad mistake in
(17:43):
pediatric mistake and the mistake was still bad that I
started drinking. I didn't have good relationships, broke up with
my girlfriend, to be quite honest. He's like, I was
considering killing myself. And he says, when you came here
and there was a pediatric class, I sat in the
front row, and when that kid, when that drowning came
(18:06):
in the last month, He's like, I knew what I
had to do. And he said that that one case
for him was so transformative because now he recognized what
he was doing wrong all those years, but more importantly,
when he made that save the rest of the department.
(18:27):
And this is the point I'm going to get to,
which is that it does take someone, and not because
everyone's doing it. It's not as like, oh my gosh,
you stayed unseen like back then it was like you're
really going to stay on seene. Now it's like, I
think people get it that you've got to stand on scene.
Once you have the very first save in the department,
everybody hears about it and then't have to be a
(18:47):
cardiac orress save. It could be keep receiving in the bedroom.
We got there, We opened his airway, we gave him
an oxygen, we gave him versaid, and the kid stop seating.
We checked the blood shugger, and holy cow, that felt
so good. Right. Once that one case, two cases, three
(19:07):
cases start going out around the department, then you get
the buy in, once they realize that this makes so
much sense physiologically, emotionally, it just makes sense because you
know what you're doing before you get there. All of
a sudden, the next person does it, and the next
(19:28):
person does it, and the next person does it, and
then you have the yearly ceremonies where you have you know,
you're bringing up all the survivors and you start to
transform your organization that way. So if you have a
medical director or an MS chief saying doctor and Tevy
(19:49):
said you must stay unseen, that doesn't work. It turns
out you have to train. You have to teach them
why you're doing what you're doing, and then you have
to just you know, get the reps. And then there's
gonna come that call where you're gonna say two year old. Okay,
so two year old is epidose, airway size, electrical. We've
(20:11):
got those three things, Okay, good, we know that what
the triangle is gonna be the the pit crew. Who's
number one, who's number two, who's number three? And then
you get there and you do the thing, and that's
the transformation. It's a roundabout way of saying that if
you're in a department that has good leadership, that has
a good training, and you follow up on what you're
(20:32):
doing and people are showing you the outcomes that you've had. Right,
so we come to my department, you know, like today
at eleven thirty, we have a survivor reunion at this
fire station. Guy was on a tennis court. We stayed
on scene for thirty minutes. We did double sequential on
that guy. Guy's sixty one years old. We celebrate the wins.
(20:55):
And at that ceremony, I'm gonna say a couple of words.
What am I gonna do? I'm gonna highlight my crew?
So what does the crew say? Our ems leadership is great,
our medical director cares about us, they honor what we do.
After every cardiac arrest, they get an email, really long
email that breaks down every compression at reventilation. It breaks
(21:19):
down every pause chest compression fraction. We know when they
turn the monitor on, We know when they if they
precharge the monitor, We know when the mechanical CPR device
went on. We know all of it, and we write
an email. And this is my team who we've trained
to do this. They write an email that the medic
gets either the same shift or the next shift. And
(21:43):
what does that signal? And by the way, it's not
a punitive email. What does that signal is that I'm
working in the department who cares? They're not you know
slapping me on the wrist, and the next time I'm
on a cardiac arrest, I'm going to work harder. I
want to do better because i want another life to
be saved. There's a lot of things that go into
(22:05):
being a great department. There's a lot of things that
go into confidence. And I always tell people that, yeah,
our app is great, but our app is not what
makes you become great. You really need to have a
foundation that has changed from what they taught you, that
(22:26):
has changed from what the Ivory Tower tells you to do,
and you have to do something that actually makes sense
for you and for the patient, and then you'll do it.
And once you do it, you start to see another save,
another save, another save, and then after about a year
or more, the whole department starts to say, this is
who we are now, and so it's nice to see now.
(22:49):
We have agencies across the country, and I have to admit,
some are amazing at this and they do it very well,
and some will never get out of their own way unfortunately.
What do I mean by that means that you could
have an agency that's so fire heavy they don't that
ems is a side. It's like a side gig doesn't
(23:11):
really matter that from the from the very top to
the very bottom, everybody saying, let's just transport these kids,
and they kind of stay in that motion of I'm
just going to do what we always used to do,
and then they always get the same bad outcome. So
that's the ship that has to happen in order for
this to be something that works.
Speaker 4 (23:29):
Wow, thanks for sharing all that. As I said earlier
before we started recording, I had doctor Emney crow on
I recorded this weekend, and what we talked about is
something just very similar about how are we really don't
do a good job of promoting all the good work
we do. Some apartments do it really well, others don't,
(23:50):
and some people won't get out of their way. Overall,
EMS in general needs to do a better job telling
our story.
Speaker 1 (23:57):
Well, well, I mean that is so important, but I
think it's bigger than It's bigger than that. I'll tell
you why. I now that I've been in the EMS
for fifteen years and I've been in hospitals for twenty five,
I recognize one very important thing, which is that the
folks who work in the hospital don't value what EMS does.
What do I mean by that is that when you
(24:19):
go into any emergency department and you go to a
random emergency medicine physician and you start to ask them, hey,
what do you think EMS? Does none of them understand
what we really do. They don't understand quality, They don't
understand the level of training, They don't understand how high
end the care that we provide is. They don't understand
(24:42):
the value that we bring, whether the it's cardiac arress,
whether it's trauma care with whole blood plasma, which stepsis hair.
And what I've come to realize is that from the
people who write the guidelines to the people who are
in other organizations, when they hear or see EMS, they
don't value us the same as they would if you
(25:04):
said another specialty in the house of medicine. And it's
time that they recognize that EMS is maybe the most
valuable sub specialty in a house of medicine because of
all the things that we can do before we get
to the scene, we talk about mobile integrated health. We
are the social net right, the safety net for many communities,
(25:28):
and a well run EMS system can do much more
than just acute care. But a well run and acute
care EMS organization can bring back so many more people
to life than another one. And all you got to
do is look at the CARES data from twenty twenty
four in their annual report, which I recommend everyone to
look at. And there's a graph that I love to
(25:51):
put up on a slide and show people that they
have about it's probably maybe about one hundred agencies listing
on this one graph. All these agencies are large agencies.
They do two hundred arrests or more a year. On
the left hand side, you see that one agency has
three and a half percent survival. On the right hand side,
(26:15):
you have an agency that has twenty two percent survival.
And you look at that and you say, how in
the world could you have agencies large agencies? Again, if
you're doing over two hundred partiac or the rest of a year,
you're a pretty big sized agency. But the arbitragy between
the best and the worst is nineteen points right. That
(26:38):
makes no sense whatsoever. And then you start to ask
yourself why and why aren't we exposing who the best
are and who the worst are. But at the end
of the day, if you have such a big change
between two agencies of similar sizes, you really have to
start to understand what is it about the best agencies
(26:59):
compared to the worst agencies. And I bet that I
could figure that out in five minutes of being at
a system. Which agencies are the top performers and which
are the bottom performers. And it does come down, unfortunately,
to leadership at those agencies, from the fire chief to
the MS chief to the medical director. And to change
(27:23):
an organization from being a low performing one to a
high performing one that takes commitment, and it takes years
to make that happen.
Speaker 3 (27:33):
Yes, it does.
Speaker 4 (27:34):
And when you look at those graphs, it would be
nice to know what agencies, what their agency names are,
if you're going to put something out there, own up
to it.
Speaker 3 (27:47):
That's just the thought that came to my mind.
Speaker 1 (27:48):
No, So I actually had a post on LinkedIn where
I said exactly what you just said, and I said,
why aren't we exposing each of these agencies and why
isn't that data transparent? Right? It turns out that all
the important data hospital outcomes, hospital quality, that's all being
(28:10):
hidden unfortunately. And then when we are doing things here
in the state of Florida, where other people out there
are saying, oh my gosh, how are you doing that?
But the other day I just put up on LinkedIn
that one of my agencies here are Neuroin tax survival
year to date is twenty two point seven percent, where
(28:31):
the HAIRS has shown Neuroin tax revival for the country
has been was last year eight point three percent. So
we're almost triple the national and there's nobody knocking on
our door from the organization saying, hey, what are you
guys doing? Because in order to get to that level,
(28:52):
it takes commitment. You have to commit to excellence. You
have to commit to doing things like CQI training and
making sure that running an organization that you actually not
that you know what your data is, but that you're
actively seeking to make it better. As we move forward here,
(29:13):
you know what's up and coming are things like tepsis care.
Do people know what their sexist outcomes are? And if
you don't, you should because now that there's some studies
coming out with the fluids and antibotics and sepsis, well,
guess who is going to be taking care of that?
We are an EMS. And if we are an EMS
(29:33):
and you're an agency who doesn't know what your own
data is, how do you expect to get better. How
do you expect to show your crews that, Hey, last year,
our mortality from sepsis was forty percent. This year we're
down to ten percent. Wow, you saved a lot of lives.
That's the way to change an agency with data CQI
training and celebrating the wins.
Speaker 4 (29:56):
Absolutely, And before we move on, I just want to
say we've known each other for a while now and
we've talked quite a few times as well, both on
the podcast and in person. I don't know how you
do it, but you take the data driven side of
things of medicine and EMS, and you do also add
(30:16):
that human side of leadership that is so rare. And
I think EMS and your patients and your services and
the people that you go across the nation to teach,
I just think it's great. So I appreciate you doing that,
and I think it's just so rare that you can
take both sides and you make it so everybody understands it,
(30:38):
which is again rare.
Speaker 3 (30:40):
So thank you very much for doing what you do well.
Speaker 1 (30:42):
I are I can't take any credit for that. I
will tell you that the way that my brain works
is I always tell people that I'm a very simple
minded person, and if something is too complicated for me
to understand, that it's hard for me to digest. But
if you look at everything that we're talking about, if
(31:03):
you bring a fifth grader and you tell them these things,
and you tell them, hey, someone has a really bad
infection and they need antibiotics right away, when should that
antibiotic be given to that person? And a fifth grader
will say, well, as soon as possible. Who came up
with this theory that there's highly qualified, trained personnel sitting
(31:26):
in your home and we should just transport that patient
to another location where it takes those people over an
hour to get the life saving antabotic. When you say
some of these things out loud, it makes no sense
when you say things like stay and play for cardioc orress,
when you say things like double sequential defibrillation, when you
(31:47):
say all these things. But for whatever reason, there's some
really basic, easy, low hanging fruit things that all of
us should be doing. What I would like to see
from people who are listening. And you could be brand
new to EMS, or you could be thirty years into EMS.
It's like, go fight for what it's right, even in
(32:09):
the face of people telling you this is how we've
done it for so long. Well, oftentimes, if you're doing
something for so long and you're getting the same result, then,
as Einstein said, that's the definition of insanity. You should
stop doing that. So I appreciate the accolades, but I
(32:31):
would say that we're in an amazing profession where we
can make such a huge impact in outcomes, and there's
no better place. In my opinion, there's no better specialty
in the world than EMS. I think we have a
lot of work to be done, but people like you
getting the word out that's what we need more of.
Speaker 4 (32:48):
I know you mentioned a few minutes back about the
American Heart Association guidelines, and let's dig into what everyone's
talking about in EMS, the new twenty five guidelines. I
know you've probably been in the thick of translating evidence
into product. I know you reviewed it, and I know
you had almost a two hour webinar I think last
(33:11):
Friday or so. You're any MSP Florida experts on from
your perspective, what stands out?
Speaker 3 (33:18):
What do you like, what don't you like?
Speaker 4 (33:20):
And I know that well, I have a feeling because
I did watch your webinar. Why don't you tell the
listeners that did not watch it that they can't go
and watch it on YouTube as well?
Speaker 1 (33:29):
So yeah, yeah, absolutely, And I guess overall, the statement
I'll start with is that there are folks who take
a lot of time out of their day and schedules
that don't get paid for it. They spend months and
months and months, you know, looking at all the evidence,
writing all the documentation, creating the powerpoints, et cetera, making videos,
(33:50):
et cetera. And I know a lot of the people
who do it, and they're all great people. What I
think has happened over the years is that this entity
of the Guidelines is trying to serve everybody. And whether
you're in business or you're in medicine, if you try
(34:14):
to serve everybody, you end up serving nobody. And that
is true in anything. If you want to go and
start a company and you said I'm just going to
do everything, oh, no one's gonna call you. But if
you say I only install wood floors, I guess what
people are going to find you and they're going to say,
I heard you the best wood floor installer in the world.
(34:35):
You know, I need your help. What's happened with the
guidelines is that they're serving dentists and they're serving you know,
someone who just needs their their parts and I can
say I did it. And then they're serving the EMS community,
and they're serving the emergency medicine community, and they're serving nurses.
(34:56):
And it turns out that all those are very different.
Pre hospital medicine it's its own sub specialty. We see
people who are stuck between a toilet bowl and the wall,
and you're in the emergency department. You're getting someone who's
probably been resuscitated for thirty minutes before you see them,
(35:19):
and now you're in a well lit room with all
the things that you need, but that patient in a
different state by the time you get to them. When
you're in the ICU, you have an a line, you
have a balloon pump, you could have an open chest
in some cases. It's very, very different. And so when
we look at these guidelines, you have to look at
(35:41):
them from the lens of what do I do for
a living, And when you're in EMS, you have to
look at it from a three hospital lens. That's the
lens I look at it from. So, of course my
opinion will differ than somebody else's opinion. But let's just
go through some of the main ones that we talked about.
The first one, which I think is the biggest miss
(36:04):
is the double I should say dual sequential defibrillation DSED.
What was the miss there? You have a patient who's
a refractory VF. You shock the patient and they're still
in VF. So what do you do now? Well, what
you do now is you keep doing your two minute cycles,
(36:24):
you keep shocking the patient, and you bring that patient
to the emergency department. And after five, six, seven, eight shocks,
what is the air doctor going to say, I'm a
death and they'll call the code. So since nineteen ninety
four the initial case reports of dual sequential were reported.
(36:45):
That's nineteen ninety four, right, many many years ago. And
then in twenty twenty two, in November Sheldon Cheskey's out
of Toronto, him and his group published the first randomized
control trial which demonstrated that if you on the fourth shock,
so three standard shocks, on the fourth shock, you add
(37:08):
a second set of heads ap, you will double neuro
and text revival and that was a significant difference. They
published it in New England Journale Medicine lo and behold.
When the guidelines started to unfold, ill CORE, which is
the international group, they released their draft in November of
twenty twenty four. They gave it the nod. They're like, yes,
(37:31):
you should do that. It wasn't the highest class of recommendation,
but it was recommendation. Then we waited until October twenty second,
which is one of the Europeans, and the AHA put
out their recommendations and for some reason they said no, no,
they do not recommend dual sequential. So here's my problem
(37:55):
with that. You have a patient who you know is
going to die, and actually they're actually dead, they're already dead,
and you have a finding in the mainland journal of
a randomized control trial that shows you can double survival.
Why would you not say yes to that? So I
am calling upon the American Art Association to change the
(38:18):
recommendation now I have more data. Turns out, Steve. First
of all, I've been doing this for seven years at
my agency, and we have a number of survivors, including
the one today that I'm going to be going to
in about an hour. There's four trials going on in
Europe right now as we speak, and one of them
just reported their early findings. They report and by the way,
(38:38):
they've moved up double sequential to the second shock, which
I did last this past year, and they're finding that
dual sequential. Again, it's early pilot data. This is not
the BdL and the end L outcome. But the early
data shows forty percent survival for dual seqrunch chop number
(38:59):
two versus seven percent survival for standard care, meaning al
and your shock can keep shocking forty versus seven percent.
So we know from our data that it works. We
know from Cheskey's data that it works. We can see
clearly that what's going on in Europe is going to
change the game. What are these people waiting for? So
(39:21):
that is a huge, huge miss. I will put my
career on the fact that dual sequential should not only
be done, it should be done as soon as possible.
And that's what we have not changed our protocols to
as soon as possible. So that was number one. That
was the first kind of big miss. The second thing
(39:44):
that people were concerned about their recommendation of mechanical CPR.
What's confusing is that they have a class two recommendation
and then they have a Class three recommendation. Once you
get to class three, it means that these are no
benefit or there's harm. They actually say mechanical CPR routine use.
(40:05):
You have to read every word in these guidelines. The
routine use of mechanical CPR is not recommended. But if
you go a little higher up in the box that
they have in the guidelines, they have believe it's a
two B recommendation where if you're in a circumstance where
(40:26):
mechanical CPR would be a benefit, then they say you
can go use it. Now. All the studies that they've done,
there have been many studies of mechanical CPR, all of
them show that there's no benefit compared to standard. To
be quite honest, I never thought that there would be
a benefit. I just didn't want it to be worse. Right,
(40:49):
So if you turns out that if you just install
mechanical CPR in your agency and you don't do it
the right way, your outcomes will decrease. You'll have worse outcomes.
Why Because it turns out that when you're in an
agency and the mechanical CPR device enters the room, everybody
just stops like, oh, there's the Lucas or there's the
(41:12):
autopuls and if you look at your coach stat or
your case review from the monitor, you recognize that there
was like a one minute pause. So we have gone
to an extreme length to teach people how to put
these devices on while CPR is in progress, and we've
succeeded at that. We also say that you should be
(41:37):
doing manual CPR at least for the first ten minutes,
just because the LUCAS is in the room, Like, where
are you going, right, We're not transporting these patients in
the first ten minutes anyway, so what is their rush.
Let's do high quality manual CPR and do the right thing,
and then if you want to transport the patient, because
(41:59):
the patient it needs to be transported, then you can
use the device. So I never want any of my
crews doing CPR in the back of the moving ambulance.
If a patient is a candidate for EKMO, then we
do tend to get them off scene quicker and they
do need a mechanical CPR device, So don't throw the
baby out with the bath water. On this one, I
(42:21):
would say that mechanical CPR devices in ems are invaluable
at the right time it plays correctly by the right
people who've been trained on what to do. If you
have a CQI program that evaluates, I can look at
any one of my codes, I can tell you the
exact moment that was put on, and I will show
you that you can almost not even detect why that
(42:45):
pause was there, because it looks like most every other pause.
It's a little longer, but it's negligible. Why because we
train like hell on it. And that's the sign of
an agency who actually has implemented a device. So at
my twenty two point seven percent neurotax revival agency, we
(43:05):
use mechanical CPR. Well, I'll take you to another agency
out there somewhere who is using mechanical CPR incorrectly, and
their numbers are probably in the three to five percent
range for survival. So my bottom line is this machine
is not good or bad. It's the process, it's the protocol,
(43:28):
it's the implementation that will sway you one way or
the other.
Speaker 4 (43:32):
I would recommend our listeners to go to your Friday
webinar at YouTube. It's well worth listening to and also
hearing from doctor Wayne.
Speaker 3 (43:44):
Was on there.
Speaker 4 (43:44):
You had also had a few other medical directors as well.
I think it's really really worth as an emas provider,
they should go listen to it.
Speaker 3 (43:54):
Not just my recommendation.
Speaker 1 (43:56):
I appreciate that.
Speaker 4 (43:57):
What's new, what excites you, and what's new with I
mean it's also you got to say it, what's new
with HANDEVI thank you.
Speaker 1 (44:04):
I appreciate that. So what's new in the MS. The
biggest thing coming in twenty twenty six we had mentioned
it are antabotics and fluids for sepsis. We published our
paper a few months ago. We had thirteen hundred and
eight cases of stepsis celerity in the Palm Beach County
and we gave all of those patients antabotics and fluids.
(44:30):
Our mortality for those patients is about seven percent. Chldon
Cheskey's out of Toronto is just finishing rolling in his
randomized control trial, which is a it's a crossover randomized
design where they're doing both fluids and antibiotics. They're looking
at the amount of fluid you're giving either normal amount
(44:51):
which is like four hundred tcs versus a leader or more,
and then rostefan or no ro stephan. So it was
a very clever design. They enrolled about twenty two hundred
patients and we're anxiously awaiting the outcomes there. But I
will predict here that the mortality difference will be significant.
(45:11):
I'll predict that the times antabotics will be significant. I'll
predict that the number of ventilator days will be significant,
the number of ICU days will be significant. And when
that study gets published, probably Q one of twenty twenty six,
then every single EMS organization in this country should be
following this guideline of antabotics belong in EMS for sepsis. Now,
(45:35):
I'm not talking about just the patient west fever or
meets to search criteria. We're talking about people who are
you know, septic shock, and there's criteria. I can send
you the protocols. It's very simple. Those patients should be
getting antabotics in EMS. So gane a the days of
the hospital saying you have to bring them to us
because we need blood cultures. That's a myth. Gone of
(45:58):
the days of we have to give the fluids in
the hospital because CMS. No, that's total BS. So I
would recommend that agencies today start looking at your sepsist
patient data. Understand what you're doing today, what what your
outcomes are today? And then when you go and make
the case to the hospital who's going to complain, you
(46:20):
can say, listen, we've been doing it the old way
for a long time. People are dying. Here's another randomizz
controlled trial that shows that we can put mortality in half. Therefore,
we're going to be doing this and so it's going
to take some leadership. It's going to take some hoot
spot when they say, but once you have the data,
(46:41):
you ought to do the right thing for the patient.
So that's an exciting thing that's happening. The other thing
that's happening is many people know that we're using blood products,
whole blood, specifically the Pambach County and the Browner County.
But we have now integrated plasma very heavy and we're
(47:01):
engaged now in an observational trial for plasma for traumatic
brain injury. We've also addited for burns, and now I'm
adding it in for sepsis. So anything that causes leakage
from a capillary. So severe trauma causes leakage, burns cause leakage,
steps as caused leakage, and the phalaxus causes leakage. Turns
(47:24):
out that there is a layer inside the capillary called
the glycoklyx that is removed in those disease sets scenarios,
that plasma will rebuild. And therefore, instead of the normal
saline or the LR that you're giving that just leaking
right out of the vessel, the plasma patches up the vessel,
(47:45):
prevents the leakage, prevents these patients from going into arids,
prevents them from being nine years positive three days vader
in the ICU, and you end up with a future
that never uses nor salient lat tated renders ever again.
And I do believe strongly that once plasma is able
(48:06):
to be sold in a spray dried fashion, which means
just dehydrated, it's put into an empty saline bag. That's
how they'll sell it to you. You'll reconstitute it with
two hundred ccs of sterile water, and now you'll have
this new thing that is much better than the old thing. Now,
(48:28):
studies have to be done, yes, but there's studies down
in plasma for fifteen years now. But the people who
are the naysayers are going to want the randomized controlled
studies and all that will happen within time. But for
right now, we know that normal saline in l R
killed people. There's never been one study to show any benefit,
(48:51):
and we know now that plasma has a very good
safety profile. So we are now going to be engaging
with doctor Holcombe in a pre hospital randomized control trial
for plasma for traumatic brain injury once our observational trial
is completed. So my agencies are now engaging in randomized
control trial research. We're really advancing our game and really
(49:14):
entering into a different level of research for EMS. EMS
needs to be on the map for what it can do,
so it's to kind of end where we started. EMS
is the most important subspecialty for cute care medicine, and
we just have to demonstrate our value. We have to
publish all of our outcomes, and we have to continue
(49:37):
to spread the word that EMS is part of the
continuum and we're not just a kind of like a
red headed step child in the house of medicine. And
that's really kind of my goal throughout my career is
to continue to highlight the value that EMS provides.
Speaker 4 (49:53):
We've covered all the serious topics on this podcast today.
Speaker 3 (49:57):
Very much appreciate it your schedule. We'll make so many people.
Speaker 4 (50:02):
Dizzy, and what you do and all the things you're
doing for EMS and the pediatric field as well.
Speaker 3 (50:08):
What do you do to unwind?
Speaker 1 (50:10):
Great question, Listen, I absolutely love what I do number one.
So for me, you know, yesterday I had a twenty
hour day, but I was just as energized as ever.
I'm very fortunate to have a teams around me that
are just incredible who allow me to do everything that
I'm doing. I don't do it alone. But for me
(50:31):
to unwind is obviously my family is number one and
most important to me. I love playing tennis, So Saturday morning,
don't call me. I'll still enter the phone, but I'll
probably be in the middle of a tennis match. And
Wednesday night I've been a tennis league. We have our dogs,
my wife and we love walking the neighborhood with the dogs.
We'd love to travel we can, but you know, we're young.
(50:52):
We're having a great time and we have met so
many great people because of this wonderful field of VMS
to you, and it's people that I thought full, innovative,
and we recognize that our closest friends come from the
MS community. So it's been it's been a win personally
(51:13):
and professionally.
Speaker 4 (51:14):
Peter, as always, it's an honor to have you on mathematic.
You set the bar so high for what modern em
AS leadership should look like and clinical innovation. Thanks for
sharing your time, your insight, so thank you for joining
me on mathematic.
Speaker 1 (51:29):
Thank you, Steve, happy to come back anytime.
Speaker 3 (51:32):
Thank you very much appreciated
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