The EMS Lighthouse Project Podcast exists to foster knowledge translation from peer-reviewed scientific journals to the street. Join Mike Verkest and Dr. Jeff Jarvis as they shine the bright light of science on EMS practice in an informative and fun way.
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Join Mike Verkest, Paramedic and EMS Training Officer, alongside World-Famous EMS Physician Dr. Ritu Sahni, MD, MPH as they talk about everything EMS. Current topics and trends, EMS advocacy, sports and everything in between. Mike and Ritu welcome the occasional special guest and are going to tackle some non-traditional EMS topics. So, sit back, relax and get ready to punch in for your SecondShift.
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Do you give naloxone to patients who are in cardiac arrest? Should you? Can it possibly provide any benefit at all once you are already providing effective ventilations? Well, Dr. Jarvis certainly thought not. He might have even thought it out loud. Like, loudly out loud. Based on two recent papers looking directly at this question, perhaps he need…
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Remember when we learned interruptions in compressions take a long time to recover blood pressure from? And how, to avoid these, we should do continuous compressions to avoid them. And ventilations aren’t all that important. Right? Right? Well, about that. Maybe the stories of the importance of continuous compressions were greatly exaggerated. Join…
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What’s the best way to pre-oxygenate our patients prior to intubation? The evidence for this question has been mixed for some time. Dr Jarvis discusses the PREOXI Trial, which directly compares preoxygenation with non-invasive ventilation compared to a face mask to see which provides the best protection against peri-intubation hypoxia. This is an i…
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There is evidence that clinician experience with intubation is associated with improved success rates and evidence that missed intubation attempts are associated with worse survival, at least in cardiac arrest. The recent Airway EBG paper recommends EMS agencies with low intubation proficiency should use SGAs instead of intubation in cardiac arrest…
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Description: Let’s say you were looking for a safe and effective BLS option for analgesia. Something other than oral acetaminophen or ibuprofen. You want the Green Whistle (methoxyflurane), but you can’t get the Green Whistle (thanks, FDA!). How about sub-dissociative ketamine by nebulizer? Sounds great, but you’re worried about your colleagues get…
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What value does EtCO2 have when predicting survival from cardiac arrest? We all know a sharp spike in EtCO2 is associated with ROSC, but what about persistently elevated levels? What does this mean for decision-making regarding the termination of resuscitation? Join Drs. Jeff Jarvis, Remle Crowe, and Heidi Abraham for the first episode of “Between …
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E82 - Ketamine v Etomidate for RSI: A Bayesian Meta-Analysis
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The debate about which drug to use for sedation before RSI will... not… die. Advocates for both ketamine and etomidate approach the argument with near-religious zeal. There have been studies. We’ve even covered some here. We need a systematic review and meta-analysis, preferably using an analysis that recognizes this likely isn’t a black-and-white …
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Ep81 - Treatment of Atrial Fib with RVR
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Atrial Fibrillation with rapid ventricular response is a common cause of EMS activations and ED visits. It is associated with chest discomfort, palpitations, and hypotension. Treatment is aimed at either rhythm or rate control, with rate control being the most common first-line approach. EMS has the potential to treat this condition with medication…
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Dr. Jarvis is joined by OG co-host Mike Verkest and Dr. Brent Myers from NAEMSP 2024. We discuss an intriguing concept in cardiac arrest… giving the initial dose of epinephrine IM instead of starting an IV or IO. They discuss a 2021 paper that compared this approach to standard dosing in a feasibility study done in Salt Lake City. Those authors rel…
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EMS History is full of interventions we've rapidly adopted, often at great expense and with disruption of existing processes, that later turned out to, how should I say this..... not work. Want examples? MAST and high-volume crystalloids in trauma. Mechanical compression devices, high-dose epinephrine, indiscriminate calcium administration in cardi…
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LHP E78 – Racial Disparities in EMS Analgesia
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What would you say if I told you that Black patients were less likely to receive pain medication compared with white patients? My guess is you’d either question the methods, assume it isn’t possible, or ask why. Regardless of what your answer is, you’re going to want to listen to this episode. Mikey V returns to co-host a live episode from the ESO …
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LHP E77 – Should We Reduce Sedative Dosing In RSI Of Hypotensive Patients?
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Have you heard that you’re supposed to decrease the dose of your sedative when performing RSI on hypotensive patients? First, avoid asking why you haven’t addressed the hypotension before intubating.. maybe there’s a reason. Maybe. But, regardless of why, intubate you will. What about those doses? I’ve been hearing for years that I should be droppi…
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EMS LHP – E76 – One and Done Epinephrine
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Y’all know I have thoughts on epinephrine in cardiac arrest. Perhaps you might have heard me say epinephrine “saves the heart at the expense of the brain.” I’ve also said I don’t have an issue with any epinephrine in arrest, just how we give it currently, and have wondered if less epi might do the trick. We reviewed the One and Done paper recently …
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We’ve spoken a lot recently about intubation First-Pass Success, including the definition. We’ve also discussed different papers about the impact the type of laryngoscope, video or direct, has on first-pass success. A new paper compares video vs. direct laryngoscopy directly. Join us to discuss the DEVICE trial. Citations: 1) Prekker ME, Driver BE,…
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LHP – E74 – What Even IS First Pass Success
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What even is FPS? There's been a long-running argument about the definition of FPS. By argument, I mean mostly established in the literature, with some people not liking it. FPS is successful ET passage through the cords within 1 attempt at laryngoscopy or when the blade passes the teeth. That definition worked well when we were using direct laryng…
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Ep73 - Post-Mortem CT in Blunt Trauma
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A new study describes the utility of post-mortem CT panscans in patients who died either in the field or in the ED to identify mortal and potentially mortal injuries. This paper has a couple of surprising findings that can help EMS focus our efforts on caring for these patients. Citations: 1. Levin JH, Pecoraro A, Ochs V, Meagher A, Steenburg SD, H…
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DSI (delayed sequence intubation) has been proposed as an alternative to RSI (rapid sequence intubation) for patients who can't tolerate interventions needed to properly pre-oxygenate patients. But does it work? There have been several observational studies (blatant bias acknowledgment: I wrote one of them!) suggesting it is safe and effective, but…
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In episode 69, we interviewed Tanner Smida about his very interesting paper using the ESO dataset. It looked at the association between survival from out-of-hospital cardiac arrest and the type of SGA used (iGel vs. KingLT). He found 36% higher odds of survival with iGel. The ink was barely dry on that paper before he published a follow-up paper lo…
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Ep 70 - Crossover with the EMS Show from Ashland, Oregon!
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Man, did we have fun recording this one? I found myself in a hotel room in Ashland, Oregon, with Drs. Ed Racht, Maia Dorsett, and Ritu Sahni talking about Sepsis. We decided this would make for a great crossover episode with The EMS Show, minus our buddy Mikey V. Anytime I get together with this group of friends, I always have fun. We discuss a new…
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The cage match you've all been waiting for! iGel vs King LT in cardiac arrest. Which is associated with higher survival? Airways-2 was an RCT of iGel vs. ETI in OHCA and found no difference. PART was an RCT of King LT vs. ETI in OHCA and found a slight difference favoring King LT. How about those patients just getting an SGA? How does the iGel comp…
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EMS LHP - Episode 68 - The SAVE Trial
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Remember AIRWAYS-2, the British RCT comparing iGel to ETI in adults with cardiac arrest? Have you wondered if those results would hold up in a different prehospital population? Wonder no more! Dr. Jarvis reviews the SAVE Trial, another RCT of adult, non-traumatic cardiac arrest, comparing iGel to ETI in Taiwan. Citation: Lee AF, Chien YC, Lee BC, e…
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If one is good, two must be better, right? If it applies to cookies and ice cream, why not defibrillators? That’s the question the DOSED-VF trial set out to answer. We’ve covered this topic in episodes 12 and 27, including going over the pilot trial of DOSED-VF. But now the full meal deal is available. And you may have heard it was stopped early be…
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EMS LHP Episode 65: SpO2 vs SaO2 Variations Between Races
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Dr. Crowe returns to the EMS Lighthouse Project Podcast from our “vacation” in Mexico to discuss the impact of variations between pulse oximetry and blood gas values across races. Citations: Sudat SEK, Wesson P, Rhoads KF, et al. Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course. Am J …
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Real World Midazolam Use In Seizures
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National guidelines for the management of seizures recommend midazolam 10 mg IM as first-line therapy. The big question is how often EMS follows this guideline or how well that guideline matches up to real-world use. Dr. Jarvis makes a road trip to ESO headquarters to discuss this paper using the ESO research dataset with newly minted Texan Mike Ve…
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EMS LHP Episode 64: TXA for Epistaxis, Part Trois
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First, there was Episode 31: TXA for Epistaxis (the Zahed RCT from Tehran), then Episode 40: TXA for Epistaxis, Part Deux (the NoPAC trial), and now Episode 64: TXA for Epistaxis, Part Trois, another Iranian RCT. So, we have conflicting evidence, all from RCTs, about whether TXA works for epistaxis. Dr. Jarvis reviews the prior trials and then prov…
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COVID sucks, no doubt about it. Vaccination has been a game changer for how we live through the pandemic, but we still need therapeutics for those breakthrough cases and the unvaccinated amongst us. Paxlovid is a novel anti-viral agent that showed promise in an initial industry-sponsored trial among unvaccinated patients with the delta strain. But …
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EMS LHP - E62 - Esmolol in cardiac Arrest?
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Our good friends at Montgomery County Hospital District EMS in suburban Houston brings us a nice feasibility study about the use of esmolol for refractory v-fib. Dr. Jarvis discusses why this is a helpful study. If you like the show, please give us a 5-star rating wherever you get your podcasts. Did you know our podcast is on YouTube, too? Check us…
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EMS LHP Episode 61: Red Lights & Sirens Collaborative
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Dr. Jarvis interviewed several EMS industry leaders, discussing why we should use Red Lights & Sirens as a clinical intervention and only as indicated. This podcast is part of the first-ever national EMS quality improvement effort led by NEMSQA (https://www.nemsqa.org/lights-and-siren). Join us for interviews with Drs. Doug Kupas, Lawrence Brown, M…
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EMS LHP – Episode 60 – Dueling ECMO Papers
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During my FAST22 talk, I received a great question about what to make of two different papers, seemingly on the same topic, that give different results. In this case, it was about the Prague study Mike and I spoke about on the last episode (E59) and the one from Minneapolis (the ARREST trial). It was a great question that I’ll discuss in this episo…
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LHP E59 - Cardiac Arrest Transport & ECMO
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Mikey V. and Dr. Jarvis get together again “live” from Planet Hollywood in Las Vegas for FAST22! We took the opportunity to sit down and discuss two papers on cardiac arrest. Should we stay and play, or should we load and go? In other words, should we work our arrests to a conclusion where we find them or rapidly transport them? In a paper from Pra…
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EMS LHP – Episode 57 – Bicarb Use In Cardiac Arrest?
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Y’all have had lots of questions about using sodium bicarbonate in cardiac arrest after we ran an interview with Dr. Menegazzi about an abstract he presented showing a benefit with bicarb. You wanted more, so here it is! Dr. Jarvis reviews a paper from British Columbia from 2017 that looks at just this thing! If you like the show, please give us a …
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Join us for a joint release of the first episode of The Pediatric EMS Podcast. We collaborated with the great folks from the PEC podcast and MedicMindset to introduce this new podcast. We discuss the assessment and management of pediatric pain.بقلم FlightBridgeED, LLC.
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EMS LHP – Episode 56 – Atrial Fibrillation Treatment
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Do y'all treat a-fib? Have you wondered what the best method of rate control is? Should you use diltiazem or metoprolol? How about the best pad placement for electrical Cardioversion? Should you go anterior-posterior or anterior-lateral? Great questions! Dr. Jarvis reviews two recent papers to help shed the bright light of science on these two ques…
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EMS LHP – Episode 55 – Research from NAEMSP 2022 – Part 2
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We’re back with the second part of our interviews with researchers from the NAEMSP 2022 conference in San Diego. In this episode, Dr. Jarvis interviews Dr. Brian Miller from Fort Worth, Texas, about his work on “MCD Walk,” i.e., the case of the migratory Lucas device, Dr. Sarah Frances McClure from UT San Antonio about the impact of EMS leadership …
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NAEMSP in Sunny San Diego… Just. SO. MUCH. GREAT. RESEARCH. Dr. Jarvis interviewed a small sample of the great work presented. There was so much we broke it into two parts. This episode features interviews with Dr. Amber Rice from Tucson, Arizona, discussing a secondary analysis of the EPIC trial looking further into the impact of hypotension on TB…
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EMS Lighthouse Project Podcast: Episode 53 - Calcium in Out of Hospital Cardiac Arrest
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Are you still giving Calcium in undifferentiated cardiac arrests? Not those with hyperkalemia or hypocalcemia… you know, when it’s actually indicated. Be honest, now… nobody’s looking. If you are, join us for this episode, where we review a randomized, double-blind, placebo-controlled clinical trial of calcium vs placebo in out-of-hospital cardiac …
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Do you even bougie, bro? Do you use the bougie on every intubation? If so, why? Do you think it improves first-pass success? Well, I certainly did. At least before this trial was released. Join me to discuss this randomized controlled trial of bougie vs no bougie for intubation. I suspect the results will surprise you!…
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Episode 51 – Abstracts from PCRF at EMS Expo 2021 - Part 2
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Dr. Jarvis and Mike Verkest return for part 2 of our interviews with some great researchers at the Prehospital Care Research Forum at the EMS Expo in Atlanta. In this episode, we interview Kevin Collopy on his RCT comparing ketamine and etomidate for RSI, Sean McAllister on Sepsis using the ESO dataset, and David Page about PCRF and his work on com…
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Episode 50 – PCRF Research Abstracts from EMS Expo – Part I
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Dr. Jarvis and Mike Verkest were at the EMS Expo in Atlanta. We recorded some interviews from the FlightbridgeED booth on the exhibitor floor and then discussed them when Mike stopped by Casa Jarvis in Austin a bit later. There was so much goodness that we broke it up into two different episodes to keep these at a reasonable length.…
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Episode 49 – The RACKED Trial, with Dr. Barbic
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Ketamine has been getting a lot of attention recently in the media. It's probably safe to say it’s had a bad year. We like ketamine. We felt bad it’s been having a rough year so we wanted to do something that would lift its spirits. Fortunately, Dr. David Barbic and his colleagues from Vancouver, BC published a wonderful, randomized trial comparing…
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Episode 48 – Airway Updates from NEAR
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Mike and Jeff meet to discuss some airway papers from the National Emergency Airway Registry (NEAR) and float some merch ideas. If you like the show, please give us a like on YouTube and a 5-star rating wherever you get your podcasts. Drop your questions/comments/suggestions for future pods at: Jeff.jarvis@flightbridgeed.com or @DrJeffJarvis.…
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Episode 91 – Vaccine Straight Talk
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Bad information abounds. We wanted to get the band back together and give you a no-nonsense, non-political, non-biased easy to understand podcast about the COVID Vaccines (well, the mRNA versions) and talk about safety, efficacy and everything else you wanted to know. We want you to be able to share this with your non-medical friends and family who…
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Episode 47 – ETI Attempts and Outcomes in Out of Hospital Cardiac Arrest
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In this episode, Dr. Jarvis discusses a paper that is hot off the press, and he’s excited to discuss it. The good folks up in Seattle, WA, and the Seattle FD looked at their cardiac arrest survival rates as a function of the number of intubation attempts needed to secure the airway. Results from this trial might help explain the 2.9% improved survi…
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The weeks keep getting longer, more things are irritating, EMS providers are getting gunned down on calls, it’s too much. This is what we could muster. Are you feeling the same? Take a listen. Thanks for continuing to support our podcast! Did you know many of our episodes can also be watched? Be sure to check out the FlightBridgeED channel on YouTu…
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Episode 46: 2020 EMS LLSA Review with Dr. Casey Patrick
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Every other year, board-certified EMS physicians must take an open book quiz over 20-25 papers felt by the American Board of Emergency Medicine (ABEM) to be something all EMS physicians should know. Dr. Jarvis and Dr. Casey Patrick (@cpatrick_89) from Montgomery County Health District EMS gave a lecture reviewing the 2020 ABEM EMS LLSA articles at …
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Well, it was a hell of a long week and the boys just couldn’t muster the time or energy to meet up at the old church, so what did they do? Just logged on and did a spontaneous live!! New Ketamine LAW in Colorado, the Atlantic Magazine article on Paramedics and a tone more! Take a listen! Thanks for continuing to support our podcast! Did you know ma…
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Episode 45: ESO Ketamine Paperfrom Eagles
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Ketamine is a wonder drug. Ketamine is a tool of systemic racism. Ketamine is impossible to overdose. Ketamine is an inappropriate drug used for inappropriate purposes. So much controversy. What should we believe? When in doubt, follow the data. Dr. Jeff Jarvis reviews a very timely paper just released in Annals of Emergency Medicine using the 2019…
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