Steve, Dan, and Holly introduce themselves, and today’s focus, trauma. Steve reviews his educational background, and how his university set him up for success in paramedicine. He then transitions into his craziest trauma call, dispatched a potential stabbing. Walking into the scene, Steve sees his patient, a 20-something-year-old who has been stabbed two times in the chest and once left arm. The crew bandages the superficial bleeding chest laceration, and places and tourniquet on the left arm laceration. When the patient loses consciousness, Steve has to act quickly to handle a tension pneumothorax.

Steve, Dan, and Holly discuss the sequence of assessing a trauma patient. The physiological process of a tension pneumothorax is reviewed. The trio discusses what signs and symptoms indicate the need for a needle decompression in the field. Proper placement of the needle during a chest decompression is outlined. Holly sheds some light on what occurs in the hospital after a patient is dropped off with a decompressed tension pneumothorax.

Dan details his craziest trauma call, which began on the way to a public education event. Enroute, Dan and his partner receive a call, a GSW to the face. The team performs a surgical cricothyroidotomy on scene in order to establish a patent airway. Dan discusses his thought process on the call and outlines his preferred method of performing a surgical cricothyroidotomy. Dan, Holly, and Steve review surgical cricothyroidotomy.

Holly talks about her trauma call, which began as a search and assist on a mountain top. After assistance from a local volunteer firefighter, Holly and her partner arrive on scene to a single-vehicle MVC off the side of a cliffside. Five patients are present, three alive and two deceased. Holly describes the scene, and discusses challenges to care.

Learning Points:

• Organization is imperative when handling the scene of a trauma call, as they are often chaotic
• Stage for law enforcement per dispatch instructions (assaults, GSW’s, stabbings, etc.)
• Tourniquet extremity bleeds that cannot be controlled with pressure
• A tension pneumothorax will present with absent lung sounds on one side, hypotension, and poor SpO2
• Needle decompression is indicated for a patient presenting with a tension pneumothorax
• Ensure the receiving hospital is notified early for patients with a substantial traumatic injury
• Be mindful that a second decompression may need to be performed, as the lung re-inflates
• A chest tube may be inserted in the hospital following a field needle decompression
• Between the 4th and 5th intercostal at the anterior axillary line is becoming the preferred landmark to place the needle in a needle decompression
• In self-inflicted GSW’s to the face, lean the patient forward to protect their airway
• Surgical cricothyroidotomy is indicated if intubation is not possible, and any other ventilation method is not possible

Steve, Holly, and Dan are back with Dr. Brenda Tillman and Ben Wescott in part two of their PTSI series. Dr. Tillman emphasizes how important it is for senior providers to encourage open discussions on mental health. Ben shares his insight on how providers can challenge the stigma of discussing mental health. Ben shares his story and highlights his path to healing. Dr. Tillman and Ben discuss peer support groups and educating departments on PTSI and PTSD symptoms and prevention. Steve, Holly, and Dan field questions to Dr. Tillman and Ben. Dr. Tillman outlines ways departments can implement peer support groups.

Steve, Dan, and Holly introduce Dr. Brenda Tillman and Ben Wescott in their seventh podcast. Dr. Tillman discusses her experience as a clinician, and Ben introduces himself. Dr. Tillman details the difference between PTSD and PTSI, and why those differences are important when diagnosing first responders. Counseling programs for first responders are overviewed, as well as the training process for counselors counseling first responders.

Dr. Tillman reviews the process of EMDR and why it is effective for improving symptoms of PTSI and PTSD. The physiological effects of PTSD and PTSI are detailed. Steve talks about his experience with EMDR. Coping mechanisms in first responders are debated. Dr. Tillman talks about the importance of normalizing the symptoms of PTSI in first responders, and why peer support group and counseling is so essential.

Steve, Holly, and Dan begin their sixth podcast discussing the difference between PTSD and PTSI. Steve touches on his journey with PTSI. The initial triggering call is reviewed, and Steve details the emotional and physiological symptoms he dealt with. Steve talks about his experience with counseling.

The trio overview common emotional and physiological symptoms of PTSI, as well as behaviors that can manifest from it. They describe the difference between debriefing and defusing. The importance of emergency medical responders taking care of themselves is highlighted.

Steve, Dan, and Holly begin their fifth podcast with a case study on a motorcycle accident. Dan describes the logistics of the call and initial patient presentation. Mistakes made during rapid sequence intubation are discussed. The trio talks about the evolution of airway management procedures, such as the process of intubating patients and pre-oxygenation.

Dan discusses his checklist for successful rapid sequence intubation. Steve reviews his checklist, along with his triggers for backup airway placement and cricothyrotomy. Holly recaps a call where she decided against intubation and describes her thought process.