Joshua Kimbrell
@joshkimbre
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Paramedic passionate about Education, Improvement, and Research. Trying to make EMS a better place. Here mostly for #FOAMed .
Brooklyn, NY
Joined November 2011
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I asked an important question yesterday and got the answer I wanted.
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Y'all,
I'm gonna be a doctor! Got the sweet relief of an acceptance today!
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I'm so tired of med directors only getting involved in EMS when someone complains. If you want to get involved in EMS, hop on a bus and see what it's like. Don't just come in for a QA. Get to know your people.
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One really weird thing about EMS is how small the community is. I volunteered in undergrad at Tulane and then at New Orleans EMS early in my career, and Peter worked as an EMT. Years later, he's an EM resident doing a ridealong on my shift!
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Feeling great right now:
-Got a huge grant to work on mental health and resiliency in our EMS department
-Booked a full week in Austin for NAEMSP with my first oral abstract
- Got a promising minor revisions decision on my first manuscript
I'm optimistic about 2024 y'all.
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Just finished Murtagh. What a joy to return to Alagaesia, a world that I loved so dearly in my childhood and continue to adore today.
Thanks
@paolini
for the thrilling read!
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Med school interview ritual. I get up for coffee, then Mojo steals my seat. Good luck on the interview girlie
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The fatal trap taught in EMS classrooms across the country.
Epinephrine is THE standard of care for anaphylaxis. Everything else is extra. Do not hesitate.
@le_chadd
@NoobieMatt
People incorrectly believe that Epi is a “big gun” that is only to be used when the anaphylaxis has become severe. That is wrong. Epi works best when used to prevent the profound systemic cascade. There are multiple fatal cases where Epi has been used too late to prevent death.
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I wish there were a forum at EMS Expo where we could have a discussion about how NAEMT, the Expo partner, decided to join IAFF and sign in opposition the NEMSAC support of degree requirements for paramedics.
NAEMT was supposed to represent our interests?
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One of my favorite ways to recharge in EMS is to go teach a new class of EMTs or Paramedics a basic skill or technique.
Their enthusiasm, passion, and altruism is heartwarming and contagious.
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Researchers examined safety of IV bolus Nitro for acute pulm edema (slow 1mg). n=235 over 4 years.
Median SBP: 198->168
Median HR: 108 -> 103
Median SPO2: 89% -> 98%
Only adverse events:
x3 asymptomatic HTN
Great work
@cpatrick_89
and team.
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Okay Twitter,
My harm reduction volunteering and EMS background have an opportunity to intersect. I'm bringing in a HR outreach coordinator to discuss how we can partner to bring harm reduction to EMS.
What are effective ways EMS can reduce harm in people who use drugs?
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Wow! 🚨🚨🚨
92% of EMS crashes had unrestrained clinicians.
80+% of patients were not restrained with all straps.
If you "believe in evidence-based medicine" but don't use all the straps, you don't actually believe in EBM, you wear it as an accessory.
A new infographic from
@NHTSA
offers a concise overview of ambulance crash data from 2012-2018. Sit down and buckle up.
#EMS
#ambulance
#safety
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64 patients in an metro EMS system had a cardiac arrest < 24h after a patient refusal. What trends were found?
- 84% were Black patients
- Most common complaint: breathing problems
- Tachycardia, HTN, and Hypotension were common VS
- Only 11% achieved ROSC
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Just submitted my first manuscript to a peer-reviewed journal! 🤓
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Going to see Bringing out the Dead in theaters in 30mm film Monday night and I couldn't be more excited about it.
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A few of my favorite photos from the engagement. I know this isn't Instagram but not all of y'all follow me there so figured you could get a few photos.
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Things I'm thinking about while sipping a beer before flying out from
#NAEMSP2023
1) There are so many brilliant minds in EMS. Agencies across the country and the world are pushing the industry forward.
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Came away with an EMS Agency of the Year award!
My time as Quality Manager has come to an end here at MediSys, but I'm thrilled to see where it goes next.
See y'all later, maybe as an EMS physician!
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I am obscenely excited about seeing my published QI poster in NAEMSP.
Have so much room to improve, but moving the right direction!
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MCAT is behind me! Avoided a retake. Onto the next step! 😎
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Who should run EMS?
Physicians, Paramedics, Nurses?
Seems different states and countries handle this differently.
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Starting off EMS week with a trip to the NYC EMS Recognition and Awards ceremony. Weather is perfect too -- 71F and sunny!
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"Society discounted us. We were the throwaways, the unemployables. Society forgot one thing: to tell us. We went on to set the foundation of EMS care today."
- John Moon, Freedom House Paramedic
#NEAMSP2024
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Does Ketamine work better for sedative-assisted intubation (no paralytic) than benzodiazepines alone?
NEMSIS retrospective cohort says no.
#NAEMSP2024
@MedicMacFly
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Another study on pressors post-arrest?
Researchers studied 221 admitted OHCA patients with Epi vs Norepi infusions with 6 hours of arrest.
No diff in arrhythmias
Epi more likely to die (90.0% vs 54.3%)
Epi more likely to re-arrest (55.7% vs 14.6%)
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Ok, just finished American Sirens on my flight to
#NAEMSP2023
and WOW it is phenomenal.
It's moving, well researched, and illuminates the history of the Paramedic in a way that's never been done before.
READ IT!!
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One three-hour delay later, we're off to Dublin. Going to hit the ground running in the morning after a nap across the pond. ☘️
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How well does ProQA dispatch software predict patient acuity?
Work out of Montreal and Calgary says... Not so well.
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Started this Monday off with an acceptance of our paper to PEC!
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Primary applications submitted!
21 schools. Fingers crossed for at least one! 😁
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Instead of mixing push-dose epi, why not draw up 1:10,000 epi into a 1mL syringe?
Give 0.1mL increments. 🤔
If you use Push-Dose
#Epinephrine
in your practice come on over and listen to this
@EMCrit
episode for a new, easier, and potentially safer way to draw it up.
Leave a comment—we want to hear from you!
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It really is that simple.
Harm reduction exists because people who use drugs are humans, and we must advocate for their safety.
If you don't think you know anyone who uses drugs, you might not seem like someone they can trust. Be that person!
It makes me so sad & angry that people don’t think we are worth saving. You’re looking at 8 combined overdoses in this pic. Surviving and thriving. Harm reduction saves lives.
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Stumbled on a spicy old article showing EMTs with all-male crews were 4.75x more likely to RMA a patient than if at least one woman was on board.
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Another day, another NYC EMS death by suicide.
It feels like all the mass shootings. Wash, rinse, repeat.
Death, Grief, Anger, Lip service, half-hearted initiatives, fading into memory, recycle
🔁
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Are you a paramedic recently thrown into a Quality position looking to learn more? Or an EMS Fellow/Director looking to learn about Quality&Safety?
NAEMSP Quality & Safety Course is here! Come build a quality project with us. ☺️
Sign up:
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Had some free time after a call and bummed some glasses. 😎
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The most beautiful and challenging thing about Paramedicine to me is that it does not matter how much you know or how much experience you have, it will humble you.
As soon as you start to think you've got things under control, a patient will challenge you. Stay humble folks!
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New York State: this required "Mental Health of the EMT" training has a question that baffles me.
Does anyone have any idea what the designers of this course were thinking?
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Off to Austin for
#NAEMSP2024
!
Excited for some quality time with some of my favorite EMS nerds around.
🛫✈️🧳🤠
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@JMedic2JDoc
and I are excited to share that our manuscript on false electrical capture in transcutaneous pacing was accepted to Prehospital Emergency Care.
@NAEMSP
@tandfonline
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My favorite part of working as a pediatric/neonatal crit care paramedic is not the physiology or pay or volume-- it's seeing how resilient kids are. Watching a kid who was vented / sedated / ecmo / cvvh months ago walk around and play games with you is incredible.
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Big test tomorrow! Here's the game plan:
6:15 wakeup
6:30 head to Bodega for BEC on croissant with hashbrown and a small light & sweet (normally black but want the boost)
7:00 walk to testing center
7:25 arrive
Snacks include a kind bar, turkey & swiss, and Reese's cups. 📈
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What an amazing privilege to work with badass NAEMSP mentors Rick Allgood,
@maiadorsett
@MTaigman
@NikkiBLittle
@QIPunks
.
So excited to bring all the energy home to the Paramedics and EMTs and patients who are the lifeblood of this work.
Congratulations to the winner of the Quality and Safety Award, which goes to a student from our year-long Quality and Safety course. This year’s winner is
@joshkimbre
!
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How EMS worker burnout compare between 2015 and 2022? I wonder if something happened in 2020 had an impact!
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It's time for some accountability. This crew killed this man. I am so sick after watching this.
@EMSAvenger
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Got to take some time to walk through Central Park today. Something magical about it, especially in Autumn.
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How did a Korean pilot project introducing ALS to their EMS system affect their cardiac arrest care?
- Less SGA, More ETT
- More Epi
- More Mech CPR
- ⛔Worse Surv to Discharge
- no sig diff in neuro-intact survival
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Tuning into
#ParaResearch21
today. Need more leaders in EMS that are actually Paramedics. This is the conference we all needed!
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Paramedics in the USA and abroad who use ultrasound:
What device do you use?
Do you like it?
What are the common indications for use in your agency?
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@SaintsForecast
Hey, Paramedic here.
In all likelihood, the delay was to stabilize the patient. Patients often have rapidly changing arrhythmias and need support for their blood pressure and airway/ventilation.
I don't imagine the delay was for the family, prolly to stabilize a sick patient
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Take home points from
@EricJaegerTNG
in a gut-wrenching talk about death in EMS custody.
#NAEMSP2024
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"Paramedics are primarily taught to care for people who use drugs in an acute drug poisoning response only, with little consideration of holistic care and no meaningful mention of harm reduction. Some stigmatizing language was found."
In BC's curriculum. Great work!
🚨Publication Alert!🚨
In this study, we analyzed curriculum documents associated with drug use at BC’s primary paramedic institutions. Our intention was to evaluate how paramedic education within the province prepares students for practice.
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3) We need data. Systems should be exchanging regular two-way comms between EMS and hospitals across the country. We need an EMS ID to track real info.
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Does a notification improve time to critical action in the trauma?
Not in this system.
#NAEMSP2024
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Two research abstracts accepted at EMS Expo! See y'all in New Orleans. 😎
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Renting an apartment in New York is crazy
Do you have...
2 1/2 months rent?
Co-op application fee?
Credit score > 720?
Income over 40 x Rent?
$25,000 in liquid cash?
5 publications in a high impact journal?
A royal ancestry?
A medal of honor?
The One Ring to rule them all?
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I think I have an activity for the 4+ hr flight to Austin! 🥸
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Girlfriend got laid off last week, which sucks, but we are okay.
After being told she was getting laid off due to a lost contract, she didn't know what to say, so she determined that the appropriate thing was to say "well that's showbiz, baby" and to walk out
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Who here uses Droperidol for agitation? What is your protocol and what are your thoughts?
*Prehospital use only
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The Keith Neely Outstanding Contribution to EMS Award went to
@MTaigman
. An incredible mentor to so many improvers around the world, Mike remains humble and kind. Congrats Mike!
#NAEMSP2024
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Thanks to the great
@jducanto
for taking the time to guide us New York City paramedics through the SALAD technique. What an incredible experience!
Shoutout also to
@le_chadd
and
@ResusOnTheRoad
for some rockstar organization and instruction!!
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I am absolutely baffled at the lack of evidence for external pacing.
I have a 2006 systematic review and a 2020 AHA guideline that references that review.
No wonder AHA says it's a Class 2b recommendation in symptomatic bradycardia
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Just finished a lovely trip to San Francisco this weekend to visit my EMT partner who helped me through my first couple years as a paramedic. First time on the West Coast and I had a great time.
BUT: Shake Shack & Five Guys > In-N-Out
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Does your EMS system use reference cards for memory aids? I.e., Norepinephrine drip rate
We have some digital references but I have had folks ask for a reference card or two, maybe secured to the monitor?
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NAEMSE issues support for graduate degrees for paramedics that increase scope of practice and authorize prescription authority:
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Got two interview invites this week! Things are starting to feel real...💃
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Took a much-needed couple days off for a little getaway in the Hudson Valley. Jess and I found an arcade bar and found our favorite activity: a photobooth!
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On a plane at JFK with quite a few EMTS and Paramedics heading down to New Orleans.
Good place to have an in-flight emergency 🤠
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Mojo said to remind everyone to stop and smell all the flowers this Spring!
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How effective is AI at recognizing cardiac arrest in dispatch calls?
RCT showed that AI was better at recognizing and faster at recognizing than humans.
#NAEMSP2024
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🤦♂️
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Let's take a high-performing EMS system with rockstar leaders in EMS at the top and let the fire department run it. Great idea!
Will MedSTAR long considered a model EMS system soon be dismantled and subservient to fire department authority? It worked really well for adequate representation in FDNY EMS….
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2) Despite our successes, it is imperative that we push forward our profession. We don't provide reliably equitable care, and our workforce is not diverse. Our stroke ID is weak. We are consistently hemorrhaging employees, and we ignore the dangers of fatigue. We must do better.
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@fuzzymittens
Yeah, I get this kind of spam frequently. At first it was all WhatsApp but now via text as well. Here is a substack about it:
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These numbers are brutal.
RCT comparing FPS with DL and VL in neonates.
VL FPS: 74%
DL FPS: 45%
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Favorite part of ESO Wave was definitely hearing Chief Moon talk about the Freedom House experience. Legend!
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Passed my Flight Paramedic Certification test this morning! To think I decided to go to EMT school because I just wanted "to learn a useful skill!"
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EM docs,
What do you want from an EMS verbal handoff for a critical patient?
#MedTwitter
What makes a great handoff report?
Critical pt rolls into resus, what info do u want from EMS & in what order?
few student ride alongs r having a tough time w this so I want to make them a lil a cheat sheet + never hurts to tweak my own w y’all’s valuable input :)
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Some powerful things to do during a death notification from
@EmergResilience
. A wonderful talk!
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Mojo thought the pool was open and dove on top of the tarp 🤔
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Finally got work confirmation about paying for it...
I'm going to ESO Wave and have two posters accepted for QI! Let's go 💪💪💪💪
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8) I want to work on a regional level to mandate access to bougies, pediatric supraglottics, nasal capnography, and more. We are just not meeting the standard.
Okay thoughts are still going but the rant is over for now!
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Mojo hopes you enjoy the October weather as much as she does!
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