Global Emergency Medical Registry

04/04/2025

USE OF ULTRASOUND BY PARAMEDICS REDUCES PATIENT MORTALITY – Michael Christie
https://www.gemr.org/blog/24/ultrasound-reduces-patient-mortality/

The integration of ultrasound technology into paramedic practice significantly enhances the ability to diagnose and treat life-threatening conditions in the prehospital setting, ultimately reducing mortality rates. This assertion is supported by various studies that highlight the impactful role of point-of-care ultrasound (POCUS) among paramedics.

Ultrasound allows paramedics to conduct rapid assessments that can be crucial for early detection of conditions such as pneumothorax, cardiac arrest, and heart failure. For instance, a systematic review emphasized that focused ultrasound examinations could accurately identify cardiac standstill in out-of-hospital cardiac arrest cases with high positive predictive values, which is vital for directing immediate interventions (Bøtker et al., 2018). Furthermore, studies have demonstrated that paramedics can effectively interpret lung ultrasound, which aids in distinguishing between heart failure and other causes of respiratory distress, improving diagnosis and management accuracy (Roche et al., 2024; , Russell et al., 2023). For example, paramedic-performed thoracic ultrasound improved the rate of treatment administration for congestive heart failure by 39% (Fitzgerald et al., 2024).

Training is a crucial component that facilitates the successful implementation of ultrasound in prehospital care. Research indicates that paramedics, even with minimal training, can rapidly acquire the necessary skills to perform ultrasound assessments. A study revealed that with just eight hours of combined theoretical and practical training, many paramedics could proficiently utilize ultrasound equipment with an 82% success rate (Gülünay et al., 2022). Similarly, another study found that novices could capture adequate ultrasound images after approximately two hours of training, demonstrating the feasibility of integrating this technology into their routine practice (Toole et al., 2024).

The potential reduction in patient mortality through timely and accurate diagnosis using ultrasound is significant. Immediate identification of traumatic injuries or life-threatening conditions allows paramedics to initiate appropriate treatment protocols, potentially decreasing time to definitive care (Brooke et al., 2010). The use of ultrasound has been shown to improve paramedic confidence and diagnostic accuracy, which in turn translates to better clinical decisions and resource allocation during emergencies (Amaral et al., 2020; , Donovan et al., 2022).

Moreover, technologies such as remote real-time tele-ultrasound supervision have further propelled the effectiveness of POCUS in the field, providing paramedics with access to expert guidance on ultrasound result interpretation, thereby enhancing patient outcomes in remote or challenging settings (Hermann et al., 2021). Studies indicate that when paramedics performed ultrasound with tele-expert validation, the reliability of their interpretations was markedly high (Russell et al., 2023).

In conclusion, the deployment of ultrasound in paramedic-led emergency care systems serves as a transformative step towards improving diagnostic precision and treatment efficacy. The substantial evidence supporting the adeptness of paramedics in utilizing this technology, coupled with the robust training frameworks emerging from recent studies, underlines the promise of reducing mortality rates in prehospital care settings through effective use of ultrasound (Hon et al., 2018; , Younger et al., 2016).

REFERENCES:
Amaral, C., Ralston, D., & Becker, T. (2020). Prehospital point-of-care ultrasound: a transformative technology. Sage Open Medicine, 8.
https://doi.org/10.1177/2050312120932706
Brooke, M., Walton, J., & Scutt, D. (2010). Paramedic application of ultrasound in the management of patients in the prehospital setting: a review of the literature. Emergency Medicine Journal, 27(9), 702-707.
https://doi.org/10.1136/emj.2010.094219
Bøtker, M., Jacobsen, L., Rudolph, S., & Knudsen, L. (2018). The role of point of care ultrasound in prehospital critical care: a systematic review. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 26(1).
https://doi.org/10.1186/s13049-018-0518-x
Donovan, J., Burton, S., Jones, S., & Meadley, B. (2022). Use of point-of-care ultrasound by non-physicians to assess respiratory distress in the out-of-hospital environment: a scoping review. Prehospital and Disaster Medicine, 37(4), 520-528.
https://doi.org/10.1017/s1049023x22000711
Fitzgerald, E., Parker, S., Hancock, S., Jones, C., Kittel, J., DeAngelis, J., … & Dorsett, M. (2024). Thoracic ultrasound may improve paramedic diagnostic and management accuracy in undifferentiated respiratory distress. Journal of the American College of Emergency Physicians Open, 5(2), e13164.
https://doi.org/10.1002/emp2.13164
Gülünay, B., Günsoy, E., & ÇELİK, Ş. (2022). Evaluation of ultrasound applicability skills of paramedics working in prehospital service. Journal of Eurasian Medical Science, 3(2), 51-57.
https://doi.org/10.5578/jeurmeds.20220202
Hermann, M., Hafner, C., Scharner, V., Hriberšek, M., Maleczek, M., Schmid, A., … & Hamp, T. (2021). Remote real-time supervision of prehospital point-of-care ultrasound: a feasibility study..
https://doi.org/10.21203/rs.3.rs-900534/v1
Hon, S., Fan, M., Leung, L., Mok, K., & Kwok, K. (2018). A short report on the acquisition of point-of-care ultrasound skills and knowledge by the ambulance personnel in hong kong. Hong Kong Journal of Emergency Medicine, 26(2), 80-83.
https://doi.org/10.1177/1024907918783811
Roche, A., Watkins, E., Pettit, A., Slagle, J., Zapata, I., Seefeld, A., … & Mason, N. (2024). Impact of prehospital ultrasound training on simulated paramedic clinical decision-making. Western Journal of Emergency Medicine, 25(5).
https://doi.org/10.5811/westjem.18439
Russell, F., Supples, M., Tamhankar, O., Liao, M., & Finnegan, P. (2023). Prehospital lung ultrasound in acute heart failure: impact on diagnosis and treatment. Academic Emergency Medicine, 31(1), 42-48.
https://doi.org/10.1111/acem.14811
Toole, A., Dhillon, D., Meeker, S., Padilla, R., Vaezazizi, R., Pennington, T., … & Neeki, M. (2024). Perspectives on implementation of point of care ultrasound in prehospital patient care..
https://doi.org/10.21203/rs.3.rs-4940433/v1
Younger, P., Richards, S., & Jarman, B. (2016). Can paramedics perform and evaluate a focused echocardiogram during a simulated 10-second pulse check, after a one-day training course?. British Paramedic Journal, 1(3), 3-8.
https://doi.org/10.29045/14784726.2016.1.3.3

Objectives Recently, attempts have been made to identify the utility of ultrasound in the management of patients in the prehospital setting. However, in the UK there is no directly relevant supporting evidence that prehospital ultrasound may reduce patient mortality and morbidity. The evidence avail...

20/03/2025

CURRENT ADVANCED CARE FOR CRITICAL HYPOTHERMIA PATIENTS – Michael Christie

https://www.gemr.org/blog/23/current-advanced-care-for-critical-hypothermia-patients/

The management of critical hypothermia in patients requires a multifaceted approach that integrates various advanced life support techniques. Hypothermia can lead to severe physiological disturbances, including cardiac arrest, necessitating prompt and effective interventions. Current advanced life support care for hypothermia patients involves a combination of rewarming strategies, cardiopulmonary resuscitation (CPR), and extracorporeal life support (ECLS) when indicated.

Initial management of hypothermia should focus on preventing further heat loss and initiating passive rewarming techniques. This includes removing wet clothing, insulating the patient with dry blankets, and providing warm, non-alcoholic beverages if the patient is conscious and able to swallow (Giesbrecht, 2018; Dow et al., 2019). For patients presenting with moderate to severe hypothermia (core temperature

06/03/2025

CURRENT TREATMENT APPROACH FOR CRITICALLY ILL ENVIRONMENTAL HYPERTHERMIA PATIENT – Michael Christie

https://www.gemr.org/blog/22/current-treatment-approach-for-critically-ill-environmental-hyperthermia-patient/

Heatstroke is a critical medical emergency characterized by a rapid increase in body temperature, often exceeding 40°C (104°F), and is associated with severe physiological disturbances. Prehospital treatment of heatstroke patients is crucial for improving outcomes and reducing morbidity and mortality rates. Effective management strategies include early recognition, rapid cooling, and supportive care, which can significantly influence patient survival rates.

Early recognition of heatstroke is essential, as it allows for timely intervention. Studies indicate that prompt identification and treatment can greatly reduce mortality rates, especially in vulnerable populations such as military personnel and athletes exposed to extreme environmental conditions (Wang et al., 2020; Patel et al., 2023). The implementation of risk assessment tools in prehospital settings can aid in identifying patients at risk for heat-related illnesses, thereby facilitating quicker response times and appropriate treatment measures (Takegawa et al., 2023).

The cornerstone of prehospital treatment for heatstroke is rapid whole-body cooling. This can be achieved through various methods, including immersion in cold water, the application of ice packs to major blood vessels, and the use of cooling blankets (Patel et al., 2023; Davis & Evans, 2024). Research emphasizes that the sooner cooling measures are initiated, the better the clinical outcomes, as prolonged hyperthermia can lead to multi-organ dysfunction and increased mortality (Wu et al., 2021). For instance, a narrative review highlighted the critical role of early cooling in mitigating complications associated with heatstroke, such as acute kidney injury and neurological damage (Patel et al., 2023; Wu et al., 2021).

In addition to cooling, supportive care is vital in the prehospital setting. This includes monitoring vital signs, maintaining airway patency, with decreased level of consciousness the use of medication facilitated endotracheal intubation, and providing intravenous fluids to address dehydration, shock, and electrolyte imbalances (Patel et al., 2023; Griffen & Walter, 2024). Effective communication with emergency medical services (EMS) is also crucial, as it ensures that advanced care is prepared upon the patient's arrival at the hospital (Patel et al., 2023). Training for EMS personnel on the recognition and management of heat-related illnesses is essential, as gaps in knowledge can lead to delays in treatment (Griffen & Walter, 2024).

The universal use of benzodiazepines is not the current recommendation but could be tailored to the shivering, agitated patient or the patient experiencing seizure. There is no role for antipyretics in the treatment of heatstroke patients and may be toxic to the liver. (Morris, 2025)

Furthermore, public health initiatives aimed at increasing awareness and knowledge about heatstroke prevention and first aid can enhance community preparedness. Studies have shown that many individuals lack adequate training in first aid for heat-related illnesses, which underscores the need for educational programs targeting both the general public and specific groups, such as school teachers and agricultural workers (Khalid et al., 2020; Brady et al., 2024). These initiatives can empower bystanders to act swiftly and effectively in the event of a heatstroke incident, potentially saving lives (Xu et al., 2024; Brady et al., 2024).

In conclusion, the prehospital treatment of critical heatstroke patients involves a multifaceted approach that prioritizes early recognition, rapid cooling, and supportive care. Training and public awareness are essential components that can enhance the effectiveness of these interventions, ultimately improving patient outcomes in heatstroke cases.

REFERENCES:
Brady, J., Mizelle, E., Modly, L., Smith, A., Bradford, E., Mac, V., … & Smith, D. (2024). Training nursing students on heat-related illness first aid to protect farmworkers. Nurse Educator, 49(4), E234-E235.
https://doi.org/10.1097/nne.0000000000001588
Davis, P. and Evans, D. (2024). An evidence-based algorithm of management of heatstroke in the emergency department. Advanced Emergency Nursing Journal, 46(1), 3-11.
https://doi.org/10.1097/tme.0000000000000501
Griffen, H. and Walter, E. (2024). Uk prehospital practitioners' knowledge of heat-related illness and heatstroke. Journal of Paramedic Practice, 16(8), 328-336.
https://doi.org/10.12968/jpar.2023.0035
Khalid, T., Bashir, S., Joseph, F., Riaz, H., Hameed, J., Khan, A., … & Mahar, K. (2020). Knowledge, attitude and practices of first aid management among school teachers. Journal of Bahria University Medical and Dental College, 10(4), 306-309.
https://doi.org/10.51985/jbumdc2019111
Koh YH. Heat Stroke with Status Epilepticus Secondary to Posterior Reversible Encephalopathy Syndrome (PRES). Case Rep Crit Care. 2018 Jun 7;2018:3597474. doi: 10.1155/2018/3597474. PMID: 29984005; PMCID: PMC6011167.
Morris A, Patel G. Heat Stroke. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK537135/
Patel, J., Boyer, N., Mensah, K., Haider, S., Gibson, O., Martín, D., … & Walter, E. (2023). Critical illness aspects of heatstroke: a hot topic. Journal of the Intensive Care Society, 24(2), 206-214.
https://doi.org/10.1177/17511437221148922
Takegawa, R., Kanda, J., Yaguchi, A., Yokobori, S., & Hayashida, K. (2023). A prehospital risk assessment tool predicts clinical outcomes in hospitalized patients with heat-related illness: a japanese nationwide prospective observational study. Scientific Reports, 13(1).
https://doi.org/10.1038/s41598-023-28498-z
Wang, X., Xia, D., Wang, Y., Xu, S., & Gui, L. (2020). A cross-sectional study of heat-related knowledge, attitude, and practice among naval personnel in china..
https://doi.org/10.21203/rs.2.20828/v1
Wu, M., Wang, C., Liu, Z., Zhong, L., Yu, B., Cheng, B., … & Liu, Z. (2021). Clinical characteristics and risk factors associated with acute kidney injury inpatient with exertional heatstroke: an over 10-year intensive care survey. Frontiers in Medicine, 8.
https://doi.org/10.3389/fmed.2021.678434
Xu, Y., Chen, J., Du, J., & Jin, Y. (2024). Knowledge, attitudes, and practices among the general community population toward heatstroke. Frontiers in Public Health, 12.
https://doi.org/10.3389/fpubh.2024.1373025

Heatstroke is a critical medical emergency characterized by a rapid increase in body temperature, often exceeding 40°C (104°F), and is associated with severe physiological disturbances. Prehospital treatment of heatstroke patients is crucial for improving outcomes and reducing morbidity and mortal...

22/02/2025

ESMOLOL FOR SEVERE HYPERTENSION WITH AORTIC DISSECTION – Michael Christie

https://www.gemr.org/blog/21/esmolol-for-severe-hypertension-with-aortic-dissection/

Esmolol, a short-acting beta-blocker, is increasingly recognized for its role in managing severe hypertension, particularly in the context of acute aortic dissection (AAD). Aortic dissection is a life-threatening condition characterized by a tear in the aortic intima, leading to the separation of the aortic wall layers. The management of blood pressure is critical in these patients, as uncontrolled hypertension can exacerbate the dissection and increase the risk of complications such as rupture or malperfusion syndromes (Bao et al., 2020; D**g et al., 2019).

The relationship between hypertension and aortic dissection is well established. Hypertension is a significant risk factor, with studies indicating that approximately 70-80% of patients presenting with aortic dissection have a history of hypertension (Yi et al., 2023; Sahni & Bhatia, 2012). In particular, poorly managed hypertension is a critical precipitating factor for the development of AAD, underscoring the importance of effective blood pressure control in these patients (D**g et al., 2019). Esmolol, due to its rapid onset and short duration of action, allows for precise titration of blood pressure, making it an ideal choice in acute settings (Cecchini et al., 2022).

In the context of AAD, the use of esmolol has been advocated as part of anti-impulse therapy. This approach aims to reduce the shear stress on the aortic wall by lowering heart rate and blood pressure, thereby minimizing the risk of further dissection or rupture (Cecchini et al., 2022; Matalanis & Ip, 2018). The rapid titration capability of esmolol is particularly beneficial in acute scenarios where blood pressure can fluctuate significantly. Moreover, esmolol's effectiveness in controlling heart rate and blood pressure can be crucial in patients with concomitant conditions, such as pheochromocytoma, which can lead to severe hypertensive crises and complicate the management of aortic dissection (Yi et al., 2023).

Furthermore, the management of hypertension in the context of aortic dissection is not solely about immediate blood pressure control but also involves long-term strategies to mitigate risk factors. For instance, patients with underlying conditions such as bicuspid aortic valves or connective tissue disorders often present with a higher risk of dissection and require comprehensive management strategies that include pharmacological interventions like beta-blockers (Janík et al., 2014; Anene, 2023). Studies have shown that effective management of hypertension can significantly reduce the incidence of AAD, highlighting the importance of medications like esmolol in both acute and chronic settings (D**g et al., 2019).

In conclusion, esmolol serves as a critical component in the management of severe hypertension associated with aortic dissection. Its rapid action and ability to be finely adjusted make it suitable for acute care settings, where maintaining optimal blood pressure is vital to prevent further complications. The established link between hypertension and aortic dissection emphasizes the need for effective blood pressure management strategies, including the use of esmolol, to improve patient outcomes in this high-risk population.

REFERENCES:
Anene, F. (2023). Extensive aortic dissection in a low-risk male causing acute kidney injury: a case report. Cureus.
https://doi.org/10.7759/cureus.46283
Bao, J., Zheng, S., Huang, C., Tao, J., Tang, Y., Sun, R., … & Zhang, Y. (2020). Association of renal cyst and type a acute aortic dissection with hypertension. Journal of Thoracic Disease, 12(12), 7374-7386.
https://doi.org/10.21037/jtd-20-3422
Cecchini, A., Qureshi, M., Peshin, S., Othman, A., & Gajjar, B. (2022). Type a aortic dissection presenting as acute coronary syndrome in a young male patient: a case report. Cureus.
https://doi.org/10.7759/cureus.31578
D**g, N., Piao, H., Li, B., Xu, J., Wei, S., & Liu, K. (2019). Poor management of hypertension is an important precipitating factor for the development of acute aortic dissection. Journal of Clinical Hypertension, 21(6), 804-812.
https://doi.org/10.1111/jch.13556
Janík, M., Novomeský, F., Stráka, L., Krajčovič, J., Štuller, F., & Hejna, P. (2014). Bicuspid aortic and pulmonary valves complicated by acute aortic dissection in a highly trained athlete – case report and review of the literature. Romanian Journal of Legal Medicine, 22(3), 167-172.
https://doi.org/10.4323/rjlm.2014.167
Matalanis, G. and Ip, S. (2018). Total aortic repair for acute type a aortic dissection: a new paradigm. Journal of Visualized Surgery, 4, 79-79.
https://doi.org/10.21037/jovs.2018.04.04
Sahni, S. and Bhatia, S. (2012). Risk of aortic dissection due to aortic curvature and malignant hypertension..
https://doi.org/10.1109/nebc.2012.6207096
Yi, D., Liu, X., & Fan, L. (2023). Case report: pheochromocytoma complicated by type b aortic dissection. Frontiers in Cardiovascular Medicine, 10.
https://doi.org/10.3389/fcvm.2023.1236896

Esmolol serves as a critical component in the management of severe hypertension associated with aortic dissection.

01/02/2025

What is the best treatment recommendations for neurologically intact survival in critical care drowning patients? - Michael Christie
https://www.gemr.org/blog/20/medical-education-objectives-development/

The development of medical education objectives is a complex process that involves multiple stakeholders and is influenced by various educational frameworks and accreditation standards. The objectives are typically crafted through collaborative efforts among medical schools, licensing bodies, and the practicing medical community, ensuring that they align with the evolving needs of healthcare and the competencies required for effective medical practice.

One of the foundational frameworks for developing medical education objectives is the Medical School Objectives Project (MSOP), which aimed to establish a consensus on the essential skills and knowledge required for medical graduates. This project highlighted the importance of stakeholder input, including educators, practitioners, and learners, in shaping educational goals (Dogra, 2007). The collaborative nature of this process is echoed in the work of Mandin and Dauphinee, who emphasized that successful curriculum development relies on extensive collaboration among various stakeholders to ensure that the objectives are relevant and comprehensive (Mandin & Dauphinee, 2000).

Furthermore, the integration of competencies into medical education objectives has become increasingly important. For instance, the CanMEDS framework in Canada outlines specific competencies that medical professionals should achieve, such as being a Medical Expert, Communicator, and Collaborator. This framework guides the development of educational objectives that are not only focused on clinical skills but also on interpersonal and professional skills essential for modern medical practice (Hung et al., 2012). The Accelerating Change in Medical Education Consortium also underscores the shift towards competency-based education, advocating for individualized pathways that cater to the diverse needs of medical students (Lomis et al., 2020).

In addition to stakeholder collaboration and competency frameworks, the assessment of educational needs plays a crucial role in the development of medical education objectives. Research indicates that understanding the barriers and needs of healthcare providers is essential for tailoring educational programs effectively (Kumar et al., 2019). This need for assessment is further supported by the findings of Jordan et al., who noted that medical education fellowships successfully prepare graduates for academic roles by addressing specific educational needs and gaps in training (Jordan et al., 2021).

Moreover, the incorporation of innovative teaching methods and technologies is reshaping the landscape of medical education. The integration of artificial intelligence and technology literacy into medical curricula reflects the necessity of preparing future physicians for a rapidly evolving healthcare environment (Paranjape et al., 2019; Wang et al., 2021). This trend emphasizes the importance of developing objectives that not only cover traditional medical knowledge but also equip students with skills to navigate technological advancements in healthcare.

In conclusion, the development of medical education objectives is a multifaceted process that requires collaboration among various stakeholders, alignment with competency frameworks, assessment of educational needs, and integration of innovative teaching methodologies. This comprehensive approach ensures that medical education remains relevant and effective in preparing healthcare professionals for the challenges of modern medicine.

References:
Dogra, N. (2007). The views of medical education stakeholders on guidelines for cultural diversity teaching. Medical Teacher, 29(2-3), e41-e46. https://doi.org/10.1080/01421590601034670

Hung, G., Bialy, L., & Cheng, A. (2012). Pediatric emergency medicine fellows education day: addressing canmeds objectives at a national subspecialty conference. Paediatrics & Child Health, 17(10), 544-548. https://doi.org/10.1093/pch/17.10.544

Jordan, J., Ahn, J., Diller, D., Riddell, J., Pedigo, R., Tolles, J., … & Gisondi, M. (2021). Outcome assessment of medical education fellowships in emergency medicine. Aem Education and Training, 5(4). https://doi.org/10.1002/aet2.10650

Kumar, P., Larrison, C., Rodrigues, S., & McKeithen, T. (2019). Assessment of general practitioners' needs and barriers in primary health care delivery in asia pacific region. Journal of Family Medicine and Primary Care, 8(3), 1106. https://doi.org/10.4103/jfmpc.jfmpc_46_19

Lomis, K., Santen, S., Dekhtyar, M., Elliott, V., Richardson, J., Hammoud, M., … & Skochelak, S. (2020). The accelerating change in medical education consortium: key drivers of transformative change. Academic Medicine, 96(7), 979-988. https://doi.org/10.1097/acm.0000000000003897

Mandin, H. and Dauphinee, W. (2000). Conceptual guidelines for developing and maintaining curriculum and examination objectives. Academic Medicine, 75(10), 1031-1037. https://doi.org/10.1097/00001888-200010000-00024

Paranjape, K., Schinkel, M., Panday, R., Car, J., & Nanayakkara, P. (2019). Introducing artificial intelligence training in medical education. Jmir Medical Education, 5(2), e16048. https://doi.org/10.2196/16048

Wang, J., Singh, R., Miselis, H., & Stapleton, S. (2021). Technology literacy in undergraduate medical education: review and survey of the us medical school innovation and technology programs (preprint).. https://doi.org/10.2196/preprints.32183

27/01/2025

GEMR had an invaluable experience with leaders, professionals, and innovators at our recent event! Together, we explored advancements in emergency medical certifications, shared ideas to elevate provider competencies, and discussed how GEMR’s globally recognized standards are shaping the future of EMS in the Caribbean.

We’re grateful to all attendees, speakers, and partners who made this conference such a success. Your passion and commitment to excellence in emergency medical services inspire us to keep pushing the boundaries.

Stay tuned for more updates as we continue building a stronger, more connected EMS community worldwide.