Wheels rolling for exciting advance in stroke therapy?

Happy New Year, and welcome back to the sporadic blog known as AmboFOAM.  I thought I would start the year on a positive note, and what better way than by looking at one of the new initiatives happening here in Melbourne: an Australian first Stroke Ambulance!

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Posted in Neurology | Tagged , , , , , | 1 Comment

Smile! You’re on Candid Camera.

As many of you will know, there have been significant changes to Ambulance Victoria in recent years. We have a new board, a new CEO, and arguably a new lease on life. I am excited by the changes, and I think we are going in a good direction. One of the key issues management is addressing is paramedic health and safety, which is fantastic. Paramedicine is inherently unpredictable, and sometimes dangerous, for a variety of reasons.

One of these reasons is violence towards paramedics from patients or bystanders. On this note, there has been an announcement from AV and government this week that we will be trialing body worn cameras for paramedics to reduce occupational violence.

This makes me a little uncomfortable.  Reducing occupational violence is important, and I absolutely believe that the organisation is genuine in their desire to improve paramedic safety.

I’m not sure that cameras will achieve that though. Indeed, in the media campaign, a paramedic recounts being assaulted – while police were on scene. If uniformed, armed law enforcement officers being present doesn’t stop assault occurring, I’m not sure that cameras will.  Violence towards paramedics is a complex issue, with drug and alcohol use, and mental health issues being common factors.  I am not excusing assault of emergency workers, however I don’t know that those who will swing a punch at a uniformed paramedic will be thinking through the ramifications of their actions given the other issues they often have.

With regards to recording patients, issues of consent and privacy also concern me. I am sure AV and government have carefully considered all of these issues and have suitable structures in place to ensure the proper use, as well as storage, and security of footage, however at this stage no detail is available.

Nonetheless, I asked Dr Michael Eburn, barrister and Associate Professor at ANU his opinion on body worn cameras for paramedics. Dr Eburn writes the Emergency Law blog, covering legal issues specific to emergency work, and is also the author of the textbook Emergency Law. Dr Eburn’s post can be read below:

I shared the link to the story on the ABC on the FaceBook page for this blog.  There have been a number of comments on the story as well as some questions sent to me so this post will try to deal w…

Source: Body cameras for Victorian paramedics

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Swimming against the mCPR tide…

I like it when people agree with me.  Most people do.  Sadly, I sometimes don’t have a lot of luck on that front, especially when it comes to mechanical CPR (mCPR), or when I suggest to my wife that we should by a Rocket Mustang (for her that is, I’m not a petrol head)

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Posted in Resuscitation | Tagged , , | 3 Comments

Avoid SMACCRegret!


DasSMACC is coming!  From June 26-29th, an all new, revamped, reimagined, and reinvigorated SMACC will be touching down in Berlin.

There were some dramas with the last ticket release, but an upgraded system means this time you should have more luck with securing a place.

Tickets go on sale 08:00 AEST, 07/12/2016.  An ideal Christmas present!

If you get in quick, you may also be able to secure one of the last afternoon sessions for the SMACC Airway workshop (the morning has sold out sorry!) to come and learn all the tips and tricks from the world’s greatest airway gurus (and me!)

Mark the date, call in sick if you have to, just don’t miss out!

Posted in Airway, Education, SMACC, Social Media | Leave a comment

Esmolol for Refractory VFib

Here’s a good post by Bryan Hayes on the state of evidence for esmolol in refractory VF. There is not a huge amount of data for this, but what there is seems promising. It would seem a reasonable thing to study in a mature EMS setting, and certainly a great deal cheaper than certain mechanical devices…

The PharmERToxGuy

Up until two years ago, beta blocker use for refractory ventricular fibrillation (VFib) had only been studied in animal models with sporadic human case reports. Two studies in humans have now been published and may provide some guidance in managing this difficult-to-treat condition.

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Angling for Trouble? Catch and Release for Heroin Overdose.

Ok, I’ll make this quick, as it’s half time during the Bledisloe Cup, and nothing is more important than seeing Straya get beaten (again).  Therefore, no references – but I’ll follow up with some data once another study has been published (in the pipeline)


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Why I’m not thanking a Paramedic

According to my social media streams, yesterday was “Thank a Paramedic Day”. This seems to have been taken up with enthusiasm by various members of the public who have been telling their stories of being treated by paramedics, or more interestingly, just being treated kindly.  As a paramedic, this all feels quite nice in a way – a recognition of the work we do and how society values it.  But I have some misgivings.

It seems forced. I’m sure there are nothing but good intentions involved, but if I’m to be thanked I’d much rather it be a spontaneous thing in response to a specific thing that I’ve done.  I’m not sure that gratefulness-by-category is all that meaningful.

Sometimes a job is just a job.  I’m often told by non-medical people that they couldn’t do my job.  That may be true, but let’s be honest, I probably couldn’t do their job.  Fair’s fair.  I chose this job and I choose to remain doing it.  It wasn’t forced on me. My work benefits other people, but so do lots of occupations – just usually less conspicuously.

This is not America. A culture seems to have evolved in the USA since the 9/11 attacks where uniformed military personnel are reflexively “thanked for their service”.  Soldiers of my acquaintance have told me a number of times that this has become a kind of social nicety, an obligation, rather than a meaningful act of thanks. It’s lost some of its meaning by becoming encouraged.

I’m not a hero. Heroes go above and beyond in a dramatic way.  I am paid for what I do and the requirements of my job are outlined quite clearly.  Turning up to the “office” in the morning isn’t exactly heroism in my mind.  Friends of mine have started noticing that their takeaway coffees have been having messages written on them like “free coffee for heroes”. We’re not heroes, we’re just people doing a job. Accepting that coffee now feels awkward because of the message. I’m often given free coffee because of my uniform, so my response is to tip the barista the price of the beverage.

The job itself is usually reward enough. People may not believe this, but this is an intensely rewarding job. We all have our bad days, but most of the time the job is hugely satisfying. Adding compulsory adulation on to the top isn’t icing on the cake – it’s almost patronising in a strange way.

Please don’t take this to mean that I don’t appreciate the gestures of individual, heartfelt thanks that I receive in the course of my duties.  They mean the world to me and I am intensely grateful. I am enormously proud of the work that I do. But making this a cultural requirement takes something away from it.  Thank me, but do it in person for something I did for you. That’s when it means something.


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Some people may remember the Great Swine Flu Epidemic of several years ago.  Paramedics and other frontline operators were wearing tyvek suits on a daily basis and the febrile media was spending most of its time freaking out about the end of the world.  We were all excited in particular about Tamiflu, a medication which was supposed to shorten the course of the illness and save lives.

Except that Roche, the company that makes it, was distinctly tardy about releasing actually useful science about the effectiveness of the drug.  Rather, they selectively released flattering information which painted their drug in a good light, and governments around the world spent hundreds of millions of dollars stockpiling it.  With no good evidence.

Well, after a lot of prodding, Roche has finally released the evidence. And it is… shall we say… somewhat lacking. Ben Goldacre, British doctor and journalist, and champion of integrity in medical research, has written about it:

So does Tamiflu work? From the Cochrane analysis – fully public – Tamiflu does not reduce the number of hospitalisations. There wasn’t enough data to see if it reduces the number of deaths. It does reduce the number of self-reported, unverified cases of pneumonia, but when you look at the five trials with a detailed diagnostic form for pneumonia, there is no significant benefit. It might help prevent flu symptoms, but not asymptomatic spread, and the evidence here is mixed. It will take a few hours off the duration of your flu symptoms. But all this comes at a significant cost of side-effects. Since percentages are hard to visualise, we can make those numbers more tangible by taking the figures from the Cochrane review, and applying them. For example, if a million people take Tamiflu in a pandemic, 45,000 will experience vomiting, 31,000 will experience headache and 11,000 will have psychiatric side-effects. Remember, though, that those figures all assume we are only giving Tamiflu to a million people: if things kick off, we have stockpiled enough for 80% of the population. That’s quite a lot of vomit.


Seems like our governments fell for it hook, line and sinker.  Have a read of the Cochrane review here and prepare to weep.

Posted in Ethics, Pharmacology, Respiratory | Tagged , , , | Leave a comment

The drugs don’t work…

At least in cardiac arrest that is.  Maybe…

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Posted in Pharmacology, Research, Resuscitation | 4 Comments

Fever Phobia

Here’s a link to an interesting article on the pathophysiology, and more importantly, the significance of febrile illnesses.

Science-Based Medicine – Fever Phobia

Many people are terrified of fever, especially in children, with no real justification.  The key takeaways are that you should only worry about elevated temperatures if your patient

  • Has a neurological malformation of the hypothalamaus; or
  • Has suffered environmental hypothermia; or
  • Is taking certain uncommon medications which can inhibit temperature regulation

For everyone else, relax!  Fever is a normal part of the healing process. There is no need to interfere in this natural process unless the patient is unreasonably pained or uncomfortable.


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