Are the Current Trends in Paramedic Education Doing More Harm Than Good?

From: JEMS:

The educational standards for paramedics have risen steadily over the past few decades and some are calling for it to become even higher.  If current trends continue, it won’t be long before one must have at least a bachelor’s degree before they can become a paramedic.

I’ll pose a question that many will find abhorrent: Are these ever increasing educational standards harming our profession more than they’re helping?

Increasing the wages and improving the benefit structure might provide a short-term bandage, but it won’t solve the recruitment and retention problems. Our profession is inevitably 24/7/365 work, and the problem has more to do with lifestyle and status expectations than with financial stability.

It’s without a doubt that the advances in prehospital care over the past few decades, as well as the expanding roles of providers, benefit our patients. I understand that our profession will continue to evolve, and things like the use of point-of-care ultrasounds in the field, along with lab evaluations using portable clinical analysis devices will become a part of the standard of care. As we continue to progress, it’s inevitable that more education will be needed.

I’m not calling for a return to the days when a paramedic course could be taught with the material contained in a trifold pamphlet and a one month field internship. However, if we hope to fortify our profession for the future, paramedicine must be more than a stepping stone. We must work to recruit individuals who will work in the field for more than their “gap” year.

I would never discourage a young person from chasing their dreams, but we must find a way to recruit people whose goals and lifestyle expectations are in line with the realities of working in EMS. This may mean separating ourselves from universities and bachelor’s degrees, and focusing on building an educational model more aligned with technical schools and trade apprenticeships.

Read more here.

Major measurement issues found in emergency department patient experience data

From EurekAlert:

WASHINGTON (Dec. 19, 2017) — There are major measurement issues in patient experience data collected from U.S. emergency departments, including high variability and limited construct validity, according to an analysis published by researchers at the George Washington University (GW) and US Acute Care Solutions.

Patient experience data is becoming increasingly important in healthcare. The data is incorporated into the U.S. Centers for Medicare and Medicaid Services public reporting and value-based purchasing models for inpatient hospital care and will be used in the implementation of the Medicare Access and CHIP Reauthorization Act, known as MACRA. The data is also used to judge physician performance and hospital performance, often driving managerial decisions such as compensation and employment, and how a hospital is perceived in the community.

“The concept of measuring patient experience and rewarding providers who deliver a better experience is absolutely right on. No one argues with that. Yet what we found is that the data currently being gathered is not particularly reliable nor valid,” said Jesse Pines, MD, MBA, director of the Center for Healthcare Innovation and Policy Research and professor of emergency medicine at the GW School of Medicine and Health Sciences.

Pines and his co-authors, including senior author Arvind Venkat, MD, chair of research at US Acute Care Solutions, looked at commercially-generated patient experience data from 2012-15 collected from a large sample of U.S. emergency departments. The data evaluated satisfaction surveys gathered from patients about their experience in the emergency department with questions on how they perceived their physician and the facility. The research team found the data varied greatly month-to-month, with physician variability considerably higher than facility variability.

Epic to release new EHR version, ‘Sonnet,’ in March 2018

From Becker’s:

Epic plans to release a new EHR version, called Sonnet, in March 2018, a company spokesperson said in an emailed statement to Becker’s Hospital Review.

In February, Epic announced its work to develop two new EHR versions, slated to be released by the end of 2017. The additions bring the number of Epic EHR versions to three: the full Epic EHR, called “All-Terrain”; a mid-range Epic EHR with fewer modules, called “Utility”; and “Sonnet,” a slimmed-down Epic EHR with fewer modules and advanced features.

The target market for the two new versions is physician practices and smaller hospitals, such as critical access hospitals, which may benefit from the lower price points and shorter implementation times. Another target market is medium-sized community hospitals, which may want a lower starting price point with the option for a more advanced EHR version later on.

‘Like our gift to the Christians’: Non-Christian doctors volunteer to work Xmas

From CTV:

For millions of Canadians, Christmas brings the perennial promise of turkey, stuffing, and quality time off with family and friends.

In many hospitals, however, a different tradition has been playing out on Dec. 25 — non-Christian doctors have been volunteering to work the holiday to allow colleagues who celebrate Christmas to get the stat off.

“The majority of doctors working on Christmas are not Christians,” says Dr. Joel Lexchin, a Jewish emergency room physician in downtown Toronto who will be working on the holiday. “And it’s not just Jewish and Muslims, it’s expanded to Buddhists, Hindus, and many other groups.”

CMS vetoes Oklahoma’s request for funds to recruit docs

From Modern Healthcare:

The CMS has denied Oklahoma’s request to receive federal Medicaid funds to pay state universities to recruit, train and retain medical professionals and bring more physicians to the state.

Oklahoma had submitted the request over the summer to make supplemental payments to state teaching universities so they could grow and improve the healthcare workforce in the state.

Under the proposal, state universities could receive payments for programs that encouraged students to do their residency in Oklahoma.

Ketamine for Rapid Reduction of Suicidal Thoughts in Major Depression: A Midazolam-Controlled Randomized Clinical Trial

From the American Journal of Psychiatry:

Pharmacotherapy to rapidly relieve suicidal ideation in depression may reduce suicide risk. Rapid reduction in suicidal thoughts after ketamine treatment has mostly been studied in patients with low levels of suicidal ideation. The authors tested the acute effect of adjunctive subanesthetic intravenous ketamine on clinically significant suicidal ideation in patients with major depressive disorder.


In a randomized clinical trial, adults (N=80) with current major depressive disorder and a score ≥4 on the Scale for Suicidal Ideation (SSI), of whom 54% (N=43) were taking antidepressant medication, were randomly assigned to receive ketamine or midazolam infusion. The primary outcome measure was SSI score 24 hours after infusion (at day 1).


The reduction in SSI score at day 1 was 4.96 points greater for the ketamine group compared with the midazolam group (95% CI=2.33, 7.59; Cohen’s d=0.75). The proportion of responders (defined as having a reduction ≥50% in SSI score) at day 1 was 55% for the ketamine group and 30% for the midazolam group (odds ratio=2.85, 95% CI=1.14, 7.15; number needed to treat=4.0). Improvement in the Profile of Mood States depression subscale was greater at day 1 for the ketamine group compared with the midazolam group (estimate=7.65, 95% CI=1.36, 13.94), and this effect mediated 33.6% of ketamine’s effect on SSI score. Side effects were short-lived, and clinical improvement was maintained for up to 6 weeks with additional optimized standard pharmacotherapy in an uncontrolled follow-up.


Adjunctive ketamine demonstrated a greater reduction in clinically significant suicidal ideation in depressed patients within 24 hours compared with midazolam, partially independently of antidepressant effect.

Mayo Clinic to allow physicians, nurses to show tattoos in 2018

From Becker’s:

Rochester, Minn.-based Mayo Clinic physicians and staff will no longer be required to cover their tattoos, with some exceptions, due to a new dress policy set to go into effect Jan. 1, 2018, the Post-Bulletin reports.

Under the updated rule, tattoos “may be visible if the images or words do not convey violence, discrimination, profanity or sexually explicit content. Tattoos containing such messages must be covered with bandages, clothing, or cosmetics. Mayo Clinic reserves the right to judge the appearance of visible tattoos,” according to the report.

Prescriptions for opioid painkillers may come with another Rx, for naloxone

From the Tribune:

Patients who receive prescriptions for opioid painkillers at some Chicago-area hospitals might soon walk away with an additional prescription — for a drug meant to help them if they overdose.

In January, west suburban hospital system Edward-Elmhurst Health plans to start recommending its doctors prescribe naloxone with certain dosages of opioids. Naloxone, which is often sold under the brand name Narcan, can reverse the effects of an opioid overdose. When doctors prescribe certain doses of opioids, Edward-Elmhurst’s electronic system will prompt them to also check a box to prescribe naloxone.

Doctors Diagnose The Injuries In Home Alone

From Distractify (YouTube)

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When death is imminent, end-of-life care decisions sometimes go out the window

From STAT:

Two medics roll Mrs. M into the emergency department. Sweat drips from her forehead. Her chest heaves in and out as she tries to suck every last oxygen molecule from inside the oxygen mask. I introduce myself and she opens her eyes but her glassy stare lands beyond me. “She has metastatic breast cancer,” says one of the medics. “She’s in hospice. But her son wants everything done.”

“Doing everything isn’t a plan that’s compatible with hospice,” I mutter.

“We didn’t know what to do,” says the medic, shaking his head. “She wasn’t this bad when we arrived at her home. She was working to breathe, but not like this.”