For a number of years—beginning in college and then eventually full-time after graduation—I worked as an EMT on private ambulances. It was initially something I fell into, having taken the EMT course for fun while I was finishing my degree, and then when I found that I enjoyed it more and more (and, of course, needing work after graduating), I kept with it and grew more involved with the field. I worked for several companies in California and in the Boston area, as a field provider (doing both routine transfer work and emergency 911 service) and as an educator.
EMS was my first real career, notwithstanding the intermittent part-time or temporary jobs I held before graduating. It was a rough and sudden introduction into the working world, and it presented me with an enormous number of lessons, tears, and inspirations. Eventually, I understood that while its positives had great appeal for me—a unique opportunity to help people and connect with them by practicing prehospital medicine—the negatives made it an impossibly masochistic long-term career. In 2013, I returned to school (in Maine) for a degree in PA studies, but the EMS bug stayed with me and I continue to maintain a presence in prehospital medicine.
After transitioning to the PA role, I trained at Johns Hopkins with a post-graduate residency in critical care, worked for several years in a trauma SICU, and now staff a mixed-population adult unit in Connecticut.
Some of my projects and activities, both past and ongoing, are below. Most of the EMS activities have become backburnered (if not abandoned) since donning my new hat, but I maintain my certificate and try to stay involved.
- Peak pressure apnea: An under-recognized, high-risk form of ventilator asynchrony: Letter to the editor describing a clinically common phenomenon with little prior attention in the literature. Published in Heart & Lung: The Journal of Cardiopulmonary and Acute Care, February 2020.
- Sudden cardiac arrest survival in HEARTSafe communities: A response: Letter to the editor in response to the Cone et al. study on HEARTSafe communities in Connecticut. Published in Resuscitation, February 2020.
- Early Secondary Neurologic Deterioration After Blunt Spinal Trauma: A Review of the Literature: First author for a systematic review investigating the published evidence behind the oft-reported phenomenon of sudden, catastrophic, movement-provoked neurological deterioration during the acute period after blunt trauma. (Hint: there isn’t much.) Published in Academic Emergency Medicine, October 2015.
- Examples of Precordial ECG Lead Placement Found on Google are Often Incorrect and Lack Gender and Racial Diversity: A "lightning oral" presentation at the May 2017 Society of Academic Emergency Medicine Annual Meeting, discussing the accuracy of the oft-used Google method of checking precordial ECG electrode placement.
- Prone Positioning of the Burn Patient With Acute Respiratory Distress Syndrome: A Review of the Evidence and Practical Considerations.: First author for a case report, review, and expert opinion from the Hopkins Burn Center discussing the challenging proposition of proning severe burn patients. E-published ahead of print in the Journal of Burn Care and Research in June 2017.
- Critical Concepts: an educational website for critical care topics, including mechanical ventilation, literature reviews, pharmacology, procedures, and more.
- EMS Basics [defunct]: an educational website for EMS professionals, with a focus on BLS fundamentals. Topics include patient assessment, pathophysiology, clinical decision-making, patient advocacy, tools and techniques, EMS culture, and more. The EMSB Facebook page is here.
- Scenarioville [defunct]: a regular feature on EMS Basics presenting prehospital scenarios for novice providers to practice their decision-making. Stories took place in a consistent setting (the fictional city of Scenarioville), allowing for a familiarity with the environment and resources similar that acquired in a real-life service. New scenarios would appear weekly with unfolding updates on Monday-Wednesday-Friday.
- Digital Research Library [defunct]: a resource for evidence-based prehospital medicine. Indexed, categorized, and presented searchable meta-information for peer-reviewed research relevant to emergency medicine and EMS, allowing for providers without traditional training and institutional access to review the literature surrounding their care. Maintained by myself and a team of colleagues.
- Lit Whisperers [defunct]: a blog for the Digital Research Library, providing commentary and education on EBM topics from the DRL staff.
- HEARTSafe Communities [defunct/offline]: a resource hub for the HEARTSafe Communities program supporting the chain of survival for sudden cardiac arrest. Now offline as HEARTSafe support has transitioned to the auspices of the Citizen CPR Foundation.
Websites & Podcasts
- Critical Care Scenarios: an educational podcast hosted with Bryan Boling. Teaches diagnosis, management, and practical considerations of caring for the critically ill, using a verbal case-based format and expert guests.
- ACCRAC: guest starred on the Anesthesia and Critical Care Reviews and Commentary podcast, where I discuss with Jed Wolpaw the role of advanced practice providers in the ICU.
- Critical Care Practitioner: guest starred on the Critical Care Practitioner podcast, where I discussed the "Practicing medicine like an adult" piece that originated at Critical Concepts.
- When Thinking is Hard: Managing Decision Fatigue: EMS World cover feature from May 2012 discussing the psychological phenomenon of decision fatigue, how it applies to EMS, and how to best mitigate its effects. Based on this post at EMS Basics.
- Survive and Thrive: How EMS Can Overcome SCA Obstacles: JEMS feature from September 2012 discussing recent trends in resuscitation and systems of sudden cardiac arrest care, practical challenges, and ideas for overcoming them and improving survival.
- Ten Rules for EMS Newbies: EMS World feature from March 2014 offering basic principles to help guide new field providers. Based on this post at EMS Basics.
- What Can an Ombudsman Do for Your Agency?: EMS World feature from August 2014 describing the long-term care ombudsman program and how to enlist its support on behalf of underserved patients.
- How To Craft Continuing Education Worth Attending: Three-part EMS World web article from August through October 2015 discussing ideas and principles for creating efficient, accessible, non-sucky continuing education, seminars, lectures, and in-services. Part one (customizing material for the audience), part two (teaching simply), and Part three (clarifying the take-away points).
- Managing STEMI Mimics in the Prehospital Environment: A PowerPoint presentation intended for use in an ALS-level continuing education course, discussing recognition and management of non-ACS syndromes that can present with ST-segment changes on the 12-lead ECG.