EMS on AIR

S2:E3 - “Fostering a Culture of Continuous Learning - A discussion about EMS and stroke with Seitz and Sirens.” - October 20, 2020

October 23, 2020 EMS on AIR Season 2 Episode 3
EMS on AIR
S2:E3 - “Fostering a Culture of Continuous Learning - A discussion about EMS and stroke with Seitz and Sirens.” - October 20, 2020
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EMS on AIR
S2:E3 - “Fostering a Culture of Continuous Learning - A discussion about EMS and stroke with Seitz and Sirens.” - October 20, 2020
Oct 23, 2020 Season 2 Episode 3
EMS on AIR

When an EMS provider or agency becomes convinced that a stroke severity scale is the right thing to adopt for their system, they often assume the best thing to do is take all stroke patients, or at least those with indicators of LVO, to stroke centers that can provide neuro intervention.  It’s easy to consider bypassing one hospital for another in these situations, but the data clearly shows that the best thing we can do is gather ALL the necessary information related to the patient and their stroke. Then, transport them to the CLOSEST appropriate stroke center, which might not offer neuro interventional services like mechanical thrombectomy.  Either way, it is a data driven decision steeped in evidence.

In this episode, Geoff sits down with Chris and Jason Seitz.  Chris is a traveling ED physician who works around the country in EDs that need the help. His brother Jason is a firefighter/paramedic at the Madison Heights FD.  Together, they own and operate Seitz and Sirens, which provides American Heart Association courses, NREMT prep courses and a litany of other EMS and healthcare education.  I just started collaborating with these gentlemen, and I think we’re onto something.  You can get a hold of them at SeitzandSirens.com.

Visit EMSonAIR.com for the latest information, podcast episodes and other details. 

Follow us on Instagram @EMSOnAIR.

Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR Podcast team by email at QI@OCMCA.org.  

Support the show (https://www.patreon.com/emsonair?fan_landing=true)

Show Notes Transcript

When an EMS provider or agency becomes convinced that a stroke severity scale is the right thing to adopt for their system, they often assume the best thing to do is take all stroke patients, or at least those with indicators of LVO, to stroke centers that can provide neuro intervention.  It’s easy to consider bypassing one hospital for another in these situations, but the data clearly shows that the best thing we can do is gather ALL the necessary information related to the patient and their stroke. Then, transport them to the CLOSEST appropriate stroke center, which might not offer neuro interventional services like mechanical thrombectomy.  Either way, it is a data driven decision steeped in evidence.

In this episode, Geoff sits down with Chris and Jason Seitz.  Chris is a traveling ED physician who works around the country in EDs that need the help. His brother Jason is a firefighter/paramedic at the Madison Heights FD.  Together, they own and operate Seitz and Sirens, which provides American Heart Association courses, NREMT prep courses and a litany of other EMS and healthcare education.  I just started collaborating with these gentlemen, and I think we’re onto something.  You can get a hold of them at SeitzandSirens.com.

Visit EMSonAIR.com for the latest information, podcast episodes and other details. 

Follow us on Instagram @EMSOnAIR.

Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR Podcast team by email at QI@OCMCA.org.  

Support the show (https://www.patreon.com/emsonair?fan_landing=true)

Geoff Lassers:

Hello and welcome to the EMS on-air podcast. The mission of this podcast is to keep healthcare providers safe, informed and prepared. Today is October 23 2020. I'm Geoff Lassers, and I'll be your host. In our last episode, I provided a pretty robust overview of the Oakland County mech control authority stroke systems of care special study, which is designed to evaluate EMS. His ability to measure stroke severity using FAST-ED and FAST-ED, like all the other stroke severity scales is designed to identify LVO stroke patients who may be candidates for mechanical thrombectomy, which is the physical removal of a large clot from one of the larger primary arteries of the brain. Right now, there are many EMS systems across the nation effectively using stroke severity scales, to measure stroke and obtain targeted pieces of information about the patient, all in an effort to get them to the best possible treatment in the quickest and safest manner. And on top of that, there's a lot of stroke severity scales to choose from. And like I've said in previous episodes, most of them are fairly similar and use elements of the National Institute of Health stroke scale, or NIHSS, the NIHSS is the gold standard of measuring stroke in a hospital. So it makes sense to start there and identify key components that could be best used by ems in the field. Over the last few years, we've seen a huge spike in the number and intensity of discussions about the potential of bypassing one hospital that does not have neuro intervention for another hospital that does have neuro intervention. When EMS encounters a patient with a stroke severity score or the presence of criteria that indicates a high likelihood of an LVO stroke. This is a valid discussion, but it might be a little premature in many areas throughout the United States. In many cases, EMS protocol dictates that stroke patients must be transported to the nearest Stroke Center, regardless of certification level to get CT imaging as quick as possible and initiate TPA if indicated. This is especially true in Oakland County, Michigan, where the stroke protocol clearly indicates that all stroke patients must be transported to the closest Stroke Center, a primary Stroke Center at a minimum. here's the rub. When an EMS provider or agency becomes convinced that a stroke severity scale is the right thing to adopt for their system, they often assume the best thing to do is to take all stroke patients, or at least those with indicators of LVO to stroke centers that can provide neuro-intervention. It's easy to consider bypassing one hospital for another in these situations. But the data clearly shows that the best thing we can do is gather all of the necessary information related to the patient and their stroke, then transport them to the closest appropriate Stroke Center which might not offer neuro interventional services like mechanical thrombectomy. Either way, it is a data driven decision steeped in evidence. To talk about this further, I've invited my new buddies Chris and Jason Seitz on the podcast. Chris is a traveling Ed physician who works around the country in ED's that need help and his brother Jason is a firefighter paramedic at the Madison heights Fire Department. Together they own and operate Seitz and Sirens which provides American Heart Association courses, NREMT prep courses and a litany of other EMS and healthcare related education. I just started to collaborate with these gentlemen and I think we're onto something you can get ahold of them at Seitzandsirens.com. That's Seitzandsirens.com. Madison heights Fire Department is the second EMS agency to join the Oakland County Medical control authority stroke study, and Jason Seitz is one of their instructors. Jason. Chris and I discussed some of the key aspects that all EMS agencies must consider when they decide that they want to adopt a stroke severity scale. One of the biggest challenges to get across to EMS is addressing hospital bypass for patients with a high likelihood of LVO stroke, we dive into some of the challenges and some of the benefits of the process. The OCMCA stroke systems of care special study is rapidly expanding. If you'd like more information about this special study, or if your agency or hospital would like to participate, visit OCMCA.org/stroke. There you'll find all the information you need about the study and how your EMS agency or hospital can participate. You'll even find study data as well as a few presentations that you can download. You don't have to be located in Michigan to participate. The OCMCA would love participants from all over the US to help us identify the strengths and weaknesses of implementing a stroke severity scale so that we can share the knowledge amongst the entire pre-hospital community. And finally, please join us on October 30 2020. For the first ever EMS on-air live streaming event that day starting at 9am. We'll be hosting three separate one hour lectures presented by stroke experts, Chris and Jason from Seitz and sirens will be joining me on the interview panel as well. This event will be live streaming only on emsonair.com, go on over to emsonair.com to register for this free event today. Each lecture provides one EMS continuing education credit in the medical category towards your state of Michigan emfs license. EMS CE's Sponsored by the Oakland County Medical control authority CE sponsorship. Please keep emailing your questions, comments, feedback and episode ideas to the EMS on-air podcast at QI@ocmca.org. Also check out our updated website emsonair.com. For the latest information, podcast episodes and other details, follow us on Instagram @ems_on_air. And please whatever podcast platform you use, subscribe to our podcast and leave us a rating and a review because it truly does help us grow the podcast. Enjoy the episode. Good morning, gentlemen. How are you?

Chris Seitz:

Good,

Jason Seitz:

good.

Geoff Lassers:

Well, as we said in the introduction, we're here with the Seitz brothers who are Seitz and Sirens starting with you Jason aka not Dr. Seitz. Can you tell everybody who you are what you do and where you do it?

Jason Seitz:

Yeah, my defining characteristic is that I'm not a doctor. I'm a firefighter paramedic with the city of Madison heights. That's my day job when I'm not doing that I work as the COO. Oh, sounds fancy. I'm just the brother of the boss over at Seitz and Sirens. We are an emergency preparedness company. I kind of keep the ball rolling over there.

Geoff Lassers:

Awesome. And your roll over its Seitz and Sirens? Do you actually enjoy it?

Jason Seitz:

I love it. I do a lot of teaching, I kind of head up the NREMT prep program and do a lot of helping students with getting prepared for their test and we run live lectures with them. We get them up to speed on anything EMS education and keep them going.

Geoff Lassers:

Well, other than that COVID pandemic, we got a shortage of EMS provider. So I'm sure you guys are helping What about you Dr. Seitz, Chris Seitz to be specific and really aka not the taller Seitz. Rather, it's let's be real here. That's what you're known for. So who are you? What do you do? And where do you do it?

Chris Seitz:

So yeah, so I'm Dr.Seitz. I'm an emergency physician, I actually do travel medicine. So I work a couple different hospitals throughout the country helping out where ER's need the help. And then yeah, as Jason said, we started Seitz and Sirens a while back. So we just make up terms. Sometimes I call myself the visionary, as I call myself, you know, the master idea, guy, I don't know. So anyway, so we started Seitz and Sirens, we're having a great time with it doing a lot of MS education and Pacific national registry prep, which is cool. But like I said, as much as it's our kind of side gig, it's really becoming our thing. I love being a doctor. But this is I think more of my what my passion is,

Geoff Lassers:

if you could sum up the mission of Seitz and Sirens, how would you guys do that? What's your mission, intent and purpose?

Chris Seitz:

I think that through our education, and just the medical field in general, specifically emergency medicine, we saw a big need for making education more approachable, making it more fun, making it easier to understand. So our goal was always to make it approachable, make it fun, entertain people, while teaching them and making education not so much of you got to be a genius, or you got to be a nerd or you got to have natural talents in reading textbooks, we wanted to make it simpler to figure out and a lot more entertaining. So our goal was always to take the passion that I think most emergency providers have, and really kind of ignite that in the learning side of it as well. So it's one thing to be passionate about your job and be out in the field or working hard. It's a whole nother thing to be passionate about continuous learning. And we always said you know, mark of a true professionals lifelong learning. We want people before, after and during their program to constantly be learning things and having a good time doing it. So I think that's what we go for.

Geoff Lassers:

So to reach that mission, what are the services you offer?

Chris Seitz:

We are actually National Training Center for the American Heart Association, the American Red Cross American safety Health Institute, we support I think we're up to like four or 500 instructors throughout the country now who are providing this high quality education to students. Our big product right now our kind of flagship product is we do national registry prep. We took the educational standards for the National Registry. We broke them down into easy to understand approachable, fun lectures, like kind of Jason said, along with workbooks and questions to help people get through that national registry exam. We saw such a need there because the pass rates are still so low for that exam. And we'll think they need to be we really think that with really good approach and good study plan, we can get people to pass and we're finding that we can we're having a good time doing it. So just really supporting people in their education.

Geoff Lassers:

tell everybody where they can find you.

Chris Seitz:

So we have a location in Madison heights, Michigan that we teach AHA classes out of ACLS, BLS, PALS, but most of our stuff now we do nationally online. So we teach a lot of instructor courses. like Chris said, we were up to about 400 instructors now. So we're trying to be the guys that you go to when you need to get this instructor training, but you don't necessarily have enough for a plane ticket to get out to us. So we've been doing a lot of stuff, especially with the pandemic online via webinar. We have TCS that can come out and watch your teach and help you learn how to teach. So we're To be a little more national and that side of things, we also do a lot of nationwide corporate trainings for hazmats, confined space, stuff like that. But again, our flagship product that national registry prep, that's all online. So you find this online, but you can go to seitzandsirens.com you can sign up for the program. We live lecture once a week, you got access to this awesome workbook, you can watch our lectures, and we really strive to kind of make it feel like we're in your living room with your teaching, holding your hand and helping you out through the program with a little bit more of a friendly approach than you might see in a typical classroom.

Jason Seitz:

And on the weekends, you can find us paddleboarding on the lake with mimosas and yeah, so

Geoff Lassers:

together?

Jason Seitz:

Yeah, together. Same paddleboard,

Chris Seitz:

right

Geoff Lassers:

same board. really. Okay, right on, you guys the blow up board? Oh, doc bought your fancy one.

Jason Seitz:

Yeah.

Geoff Lassers:

Okay, that's enough. That's the least you can do here. He doesn't pay you. It's okay. I get paid in gum to do this podcast. So that's okay. So the biggest reason you guys are here is because we both appreciate the value of fostering a culture of continuous experiential learning. Now, at the top of every project list for me is that statement all the time, continuous experiential learning, and it must be a culture that we continue to cultivate. I'd like to have a little dialogue with you guys of how you convey that. And we've had in depth discussions outside of here of that we both believe that sentiment to a very deep core,

Chris Seitz:

I think one of the things that I always teach as it you know, if you want to realize that you need to keep learning, keep learning, I think my MD was when I realized how much I don't know, right? I mean, it's not so much like how much I do notice how much I don't know, because you start to realize that man, there is so much out there to understand and it's changing, and the research changes, and the studies change, and you got to adapt and learn. That's not even just you as a practitioner, that's even our patients, we have to educate and re educate and teach them about what's going on with them and things like that. So medicine is education, there really is no difference between the art of medicine and learning method that that is what medicine is, is learning it all the time. Because it's always changing. It's always adapting,

Jason Seitz:

especially emergency medicine.

Chris Seitz:

Yeah, we're finding new and better ways to do things. And when we all come together with that mentality, and that's why we're excited to be here with you. Because sharing that mentality with people, we really can build something great. We really can create an environment and a platform for people to come and really learn and develop themselves continuously forever. Because that's really that's the bottom line.

Jason Seitz:

I think no one wants to train, especially like in the field once you've got your initial education done. Yeah, exactly. No one wants to train No, like be everyone rolls their eyes and like, so I work as an instructor coordinator at Madison heights, so I'm responsible for training my unit, everyone rolls their eyes when they hear training. But if you do it right, everybody walks out of training, feeling kinda like, I'm really glad I did that. And a lot of changing that culture is how you approach the training and how you do it. I always say there's a big difference between, you know, training, teaching and testing. So when we teach something, it's explaining an initial topic, when we train on something, it's then taking that topic and practicing it in a low stakes environment, gradually increasing the stakes, and then a testing environment where up to the challenge. And what happens a lot of times I see this in the fire service a lot. I think our training, we just jumped at testing, especially you see this on the fire ground, right, right, you can just do it, yeah, let's let's pull into the quarter line, you will get there, you're gonna repel from here, and like, we've trained on this for years, and years and years, and we should know it backwards and forwards. And that's what really discourages people. So on the ems side we see this too, I think making training accessible, lowering the stakes of training and having people understand that what training and what testing and what learning is all about is to just increase your education, it is a tool that you use, like a test is a tool to get you to be better. When we understand that we approach that. And we see that Okay, my officer or my IC, or my professor or my instructor, they're here to help me out to become better. And we kind of come into that low stakes environment just with the goal of being better by the end of

Geoff Lassers:

You know, one thing that I've noticed that you it. said at the beginning of this as a training this and for the time I've done if you do it right, you feel better. Yeah, take the word training, and replace it with workout. How many people are like, Oh, yeah, I know I should do this and you feel better afterwards. It's really no difference. When I see a task in front of me, that doesn't sound really fun right now you get that little bit of....ugh..... But when you get through it, you have a sense of accomplishment. And like you're saying doing it right, paying attention, being mindful of what the objectives are, and actually getting something out of it much rewarding all to itself. But that speaks of fostering the culture of continuous learning. I think we can only really do that if we set up the environment to allow people to feel that way. When are we setting something up to work out? Right? Are we just some mid rate, middle school gym teacher blows the whistle and you don't really do anything? Right? What am I getting out of this experience?

Chris Seitz:

So I think that's half the battle. It's changing the culture to make it more approachable and concentrate on that end goal. How you feel the passion, you know, expanding that out, I think in our AHA classes, when we kind of really started we were just a baby company. We started seeing people come into these ACLs classes, being super overwhelmed with what they were going to learn and we spend A good chunk of the class tried to be like, hey, chill out, like everyone's gonna pass, everything's gonna be okay. And that relaxed them. And then by the end of it, they walked out were like, I could do this, I could have taken a normal class and done just great. You know, I could have gone through all the hard tests, and I can do just great. Now I'm very passionate about what I learned. I'm excited about using these tools in the field. Now, I wish I would have known how I feel now, when I walked into the class. So I think half of tackling experiential, continuous learning is fostering a culture of like approachability and getting people comfortable with being able to work on themselves and not be so come in with an ego or come in with a fear but be able to come and relaxed and ready to learn, that blank slate be re dy to go, you know,

Jason Seitz:

I think too, especially in EMS So we talked about training and testing, you can train as much as you want in ems and read the textbooks, you can go through every single course there is and I guarantee you that your patient is going to present in a different way. You just it happens every time, right? And there's no like you're saying in the fire service like we can the testing type of thing. And when we try to bring that into EMS And that's part of the reason Nationally Registery is so difficult, right? Trying to test on things that are always so fluid and changing and depends on a protocol depends on if the patient presented a certain way depends on the demographic, if you're not doing the continuous education, maybe we're starting to get into the realm of danger. I think it's Mark Twain, I'm gonna botch the quote. But Mark Twain said, the most dangerous thing is a man who knows for sure, something that's not true. And I think we have to be really careful in EMS. And I think e're guilty of it. as hysicians, we're guilty as aramedics and EMTs. We think we now and we're maybe not illing, because we don't have hat culture of continuous earning to admit that maybe we on't know. And that can get angerous, we got to be really areful with that, I think so.

Geoff Lassers:

One of the biggest primary drivers of fostering that type of culture for me is bringing EMS and the ED closer. And what I'd like to get into is the value of

Chris Seitz:

Yeah, absolutely. I mean, I think that that is really what ems was meant to be in the beginning anyway, right? EMS should have always been an extension of the emergency department. It's taking that emergency mentality. I think people use us as emergency physicians or emergency providers, and they call it like a jack of all trades. And maybe there's some merit there, but you're really not a jack of all trades, you are a master at resuscitation and stabilization. proactively and systematically bringing EMS and the ED closer EMS was that way of bringing the ER to the field. I think we've lost some of that continuity between that care. And that's to best serve our patients. Now for me, where we can best serve why sometimes I think on the pre hospital side, we get our patients by letting the data tell us where we need to focus discouraged, because, you know, what role are we playing here? our time, energy and resources. There's a number of different and we forget that there is a huge role in being able to examples, but specifically, Chris, as a physician, can you convey a story to the emergency department. You were there, you give us a little bit on the value of us proactively really saw what was what happened. First, you reassess the patient, thinking about how can we leverage EMS and the ED in the b hopefully, three or four times before they got to us that I rely heavily on that to dictate where I'm going to go, what nefit of the healthcare c ntinuum for that patient? pathway I'm going to follow. And if I don't get a clear story, I gotta start from scratch, that delays care, that delays recognition of things that maybe could have been done earlier. And I think that, like I said, we need to again, bridge that gap. Once more of realizing that EMS is an extension there, we all have this role in what really serves the patient is starting that as early as possible. And that's the EMS. That's ems showing up and right at the very beginning as early as we possibly can starting this continuous pathway of treatment and diagnosis and that sort of thing that serves us really well, if it's done well.

Jason Seitz:

Well, and I think that, as an EMS provider, a lot of us get into this field. And we think we're going to be rescuing and solving problems. And a lot of what EMS is isn't necessarily solving an issue, but it's preparing the issue to be solved later down the line. And we've kind of gotten away from that, like I thought that I'd be like setting a bone or like repairing your leg. If you got your leg chopped off. I'd like stitch it back on or something like that. That's not what we do. Right? We stop the bleed, we stop the bad stuff from continuing. So we try to like ebb the flow of the issue. And then we passed that on to someone more important, but we You get the ball rolling in the field, that's what we do, we started passing on without preparing that someone more start a chain of events that is going to ultimately treat the important. In this instance, the ER doctor, the cardiologists, patient, you know, you hear people out and about, say, Oh, yeah, you save lives out there. And I think a lot of experienced the trauma surgeon, we stopped preparing them, we just started dropping the patients off. And what happened was we got away providers kind of roll their eyes at that that will save lives. I'm part of a team. But we do need to realize the value from communicating half of my job, more than half of my job is of that team, right. So I can't do my job without Chris doing to do really good assessment. It's not the treatments that we his job without the cardiologist doing his job without the trauma do in the field that are the most important. It's to do really good assessment and paint a picture for someone like Chris surgeon doing his job. We're all a chain in this. And we have to make sure that we're doing that well and recognize that we're in the ER, to be able to do is job. Well, he's then going to part of a chain, because we'll talk about this later when we do that too. He's going to have to hook them up wit get into the stroke stuff. But a lot of times I think EMS a cardiologist. He's going to h ve to hook them up with a tra providers get discouraged because they think that their ma surgeon. Everything doesn't et solved in the ER like Ch job either doesn't matter, because the ER doctor is just is said, our job is stabilizat on and resuscitation. Our job is going to do it, or the hospital is just going to do it, or they to stop the problem from becom ng worse. It's not necessarily think I should be the one that's fixing the problem. Otherwise, to fix the problem every sin le time and that's what sa everything I'm doing is useless. It's just not the case, a lot of es lives. I mean, stabilization nd resuscitation is what actua our job is to prepare that er, prepare the next person down the ly saves lives. Even you th nk about a limb but pulseless l line and get the ball rolling. And that's what saves lives, mb can stay that way for hours nd still be okay. Like Jason say it's getting the ball rolling early enough, we have to be that ng in terms of EMS. I don't sol e the problem either, as he doe first contact, we got to get the ball going.

Geoff Lassers:

And I think one of the things that I totally the er doctor like I'm not cath ng the MI patient, I'm not tak agree with both you and I think one of the things that can maybe ng out the ruptured appendi , I'm not putting the plate i just add a little bit of detail there is conveying and articulating the gathering of details and information we are the bone. That's been, you kno , again, I'm further stabili ing necessitating a patient so that they can get to that ne much more of an investigator than I think we give ourselves t step of care. And if we can ealize that, that like what ou credit for. And it's never been more evident than in the stroke role is, within that spectru of a health care system, care, STEMI care, the identification of a trauma with I think that's when we start t really be able to serve our pat a fall on blood thinners, time is of the essence. And if that ents, well even be able to prep re the patients for what's really matters, then the information that occurred during oing to be the next step, w at's coming next and things ike that, that's even just in of itself is that's huge. that time really matters. And the more reliable that information is to kind of spin what you guys are saying it allows the physicians at the ED to make quicker decisions to get the right neuro team activated to get them to the definitive care. Because at the end of the day, the next level of care is the surgical suite. The surgical nurses aren't gonna fix them. Well, the neural interventions comes in, let's say they clear a clot and then they go to an ICU. So fixing them isn't fixing them. We all have a different skill set. And we utilize it differently. And I think what thing we're seeing right now is an example locally we're seeing this nationally is the use of stroke severity scales. And what I've seen and I mentioned this in the last podcast is an increased communication between the ems and the ED bringing them closer using something that speaks on the same language about the same patient and we're seeing a positive outcome. This quick commercial break is brought to you by American CME. If you or your EMS agency need to catch up on your stroke knowledge, go on over to AmericanCME.com. There you'll find multiple courses approved for EMS CE's that focus on stroke, I highly recommend the course "identifying large vessel occlusion strokes with FAST-ED" this course walks you through the FAST-ED stroke severity scale step by step shows you how to score the criteria of the scale and provides additional details to successfully guide EMS through the process. Or if you want to focus on the fundamentals, check out the course "anatomy and pathophysiology of stroke" which breaks down each region of the brain. Or check out the "large vessel occlusion stroke course", which introduces EMS to LVO and provides great detail and information. All three of these courses are approved for 0.5 EMS continuing education credits in the medical category. Did I mentioned that you can access all of American CME's content for free? Yeah, free. And now back to the show. So the Oakland County Medical control authority stroke systems of care special study is designed to bring EMS and ED closer so that the patient benefits and it just so happens that Jason Seitz works at Madison heights Fire Department. They're the second agency that has entered the ocmca stroke study. And I'd like to pick your brain a little bit, Jason today on describing what to expect if your EMS agency is looking to adopt a stroke severity scale, and then your agency obviously did. you've joined us with FAST-ED, could you give us a little bit of an overview of your initial thoughts on the use of a stroke severity scale as a paramedic who's new to it? And then as an IC at your agency, how did that go convincing them it was good to use this thing?

Jason Seitz:

I think the first and foremost worry that we have is we have to make sure that we communicate that this is a stroke severity scale. It is not even like a Cincinnati scale where we're identifying that someone has neural deficits or quantifying what the deficits are.

Geoff Lassers:

So let's go back just one second give a little nuance there. Stroke screening tools identify the presence of potential neuro deficits whereas the strokes of various scale like FAST-ED or RACE and quantify or identify the presence of severe strokes.

Jason Seitz:

So right from the get go, if you don't spell that out to the people that you're passing this on to, they're going to go to that same mindset, we were talking earlier, they want to solve the problem. So they want to say I do a Cincinnati, they're having a stroke, I can fix that stroke, we can't do anything in the field for stroke, besides give them a diesel bullets, right, we got to get them to the right spot.

Geoff Lassers:

I'll challenge that, again, I'll go back to the investigation of information to convey what we're doing. That's just changing the mind of the treatment isn't necessarily physical to the patient sometimes, right? So I think you're on that same page, right?

Jason Seitz:

and that's what the problem is, is that it's the providers viewpoint of what they're doing, there's their thinking, I should be able to fix something. And if I can't fix something, it's useless. And that's just not the case. 99% of our job is the assessment, its identification, so that someone down the line again, like Chris can handle that, pass it on to the next person and get the ball rolling. So when we see the severity scale, you have that 100% spell out, you're still doing a Cincinnati, OH, I see neural deficits. Now I want to quantify those neural deficits and get some research, what happens is the people that you get passionate about it, now want to know what the end goal is, right? So let's say in our in our case, FAST-ED, we see this turning into a situation where potentially if the data supports it, we can identify high severity that makes us start thinking about a large vessel occlusion, and then that makes us start thinking, Okay, we're gonna go to a maybe a different hospital that can handle thrombectomy ease and things that can handle LVO's a opposed to a lower tiered neur hospital that can just giv thrombolytics the issue here i just my local level, my guys go Okay, so we're going to do th stroke severity scale. And i the scales high I'm going to ta e them to big Beaumont, and no one of the smaller hospit ls. And that's not what we're do ng that we have to still fo low our protocol, which is nearest hospital, they want to t ke them to the LVO center, because they're assuming that we already have the results of th study, if that makes sens .

Geoff Lassers:

Right. They're assuming that the theory is now put into practice where we all agree that if you use the scale correctly, under the right conditions, it's really accurate, what's most important, and what is the standard of care is taking the patient to the closest stroke center so that imaging can be done. And then if TPA is indicated, you get it either way, there's a stronger system in place than your decision in the field as an EMS provider in 2020. Right now, that just is what it is. Now give me 30 years the use of stroke severity scales and technology, who knows what's gonna happen?

Jason Seitz:

Exactly, think they just want to get to the angle because they're passionate about what it is, but they just want to get to the angle and so they start looking at it as Okay, they score high on the stroke severity scale. I didn't take them to the right hospital.

Geoff Lassers:

right.

Jason Seitz:

No, I'm a bad provider. I don't want to do this anymore. So you have to basically take that passion and redirect it a little bit.

Geoff Lassers:

So may I give a little suggestion. There's one thing I liked always provide with that is the data when we were developing this study we brought in, you mentioned Beaumont and their neuro-stroke coordinator, she came in in the transportation protocol came up and some people thought you should always go to a comprehensive or you should go to primary depending on the situation, Beaumont, they comprehensive at the time said we don't want the transport protocol to change the standard of care and data says to go to the closest facility because that is what the data is telling us You may think and surmise that all of these things are

directed towards:

Oh my God, I'm going to help this person and you think you're doing the right thing. And And trust me, I struggled with this at the beginning too. But I'm telling you right now that data points still going the closest Stroke Center for your protocol.

Jason Seitz:

So paramedics aren't used to being debt collectors, and they want to breed and that's what our job is to help. Right. So that's where it's recognized that these guys have passion, they want to be problem solvers, you have to really explain the process of this is a study, when we get the data for it could turn into something where we're solving bigger problems we don't know yet though. So you have to be able to explain to them the whole process. So if I'm going to Ascension that can't do thrombectomy, and I have a high FAST-ED stroke scale, I don't want to think that I'm doing nothing for the patient. That's not what's happening. There's things happening in the ER where they can prepare that patient, they can do more assessment, they might even move them to an LVO center from there. So I think some of this is again, bridging that gap between the ER and the field. And I think Chris can speak to this a little bit of it's better for us as providers to understand what goes on after we drop this patient off. Because some of these guys think they're going to the wrong place. They think oh, this isn't where we're always going to go. Yes, Chris is doing stuff in that ER, that is very effective to that patient.

Geoff Lassers:

So Chris, yeah, I totally agree. One thing we see from the initial education of any agency as well, I really want to go to this hospital because I feel that they have this going on. But can you give us from the ED perspective, no matter what hospital you're working in, or what facility you're servicing give us a little bit of what to consider if we're on the field making that decision.

Chris Seitz:

I think I can shed some light on why for instance, like Beaumont would not want to change the transport protocol who's because I'll tell you what the research does show and Is that what you have to get first is a CAT scan, you've got to get that CAT scan super early on, because at that CAT scan again this this is a tool we're using to quantify the severity. That's all based on the premise that one this is a thrombotic event and to it's a large enough thrombotic event that it's something that we can go in and extract that doesn't just happen in the ER, you're not rolling and I'm like: Im going to grab that clot out of your brain really quickly, it doesn't happen, right? There's a surgical suite has to get set up. There's a whole system that comes into place. While that's being done, you got to get a CAT scan. That's why we still have to go to the closest centers because you have to get that casket super fast. Because what if it's a bleed? What if something else is going on? If we don't have that data, and we delay getting that data, it's not going to do our patient any good that we they happen to be at a place that could pull out a clot in the next hour or two. Again, I mean, I think that you have to realize, as Jason's mentioned that relaying of information is so incredibly important. If Jason rolls into my ER and says, here's the Cincinnati stroke scale is so I think this guy's having a stroke. And I'm like, yep, sounds good check. And he says, and based on this tool that we use for quantifying severity, it seems like this might be a large vessel occlusion, they may need thrombectomy. Now I can say, okay, cool, send them the CAT scan. And I'm already thinking as soon as I get that CAT scan result back, I can make a call to Beaumont to get their surgical suite set up and get them over for a thrombectomy. That doesn't happen immediately, what has to happen immediately is an aspirin. You know, you're like an Aspirin? Okay, we're going back to basics, right? The CAT scan and the aspirin are what's so important. These tools are another level of care that we can lead or provide to our patient by getting into the right place a little bit earlier, that's huge. But certain things have to be done.

Jason Seitz:

First, the gold standard of care that these guys are waiting for, they want this gold standard of care for their patients, they're not going to not get that gold standard of care, because you took them to another hospital first. And this is where communication is so important is we have to be talking to the ER's more about what they do and understand how their job works. If we want to do our job better, I'm not denying my patient good care, because I didn't go to the gold standard place because we don't even know if they need that gold standard treatment if it even applies to them.

Geoff Lassers:

Right. May I just hit on a couple of points that I consider to be gold standards for any potential stroke patient last known well, blood sugar, time of symptom discovery. Are they on any blood thinners? what is the dose and medication was last time they took it? there is key information that I need to hold myself to the gold standard that no matter what my license level is, I can achieve a gold standard level of investigation into this patient conveyed to Chris you at the end so that you can then have that ear up. This is my potential primary impressions. LVO or severe stroke is still in the ballgame here and then I'm going to cancel them out as I go. But again, I can't say I'm taking you to a gold standard place if I'm not making gold standard decisions on scene.

Chris Seitz:

Well it's like a STEMI conversation, right? Like I can just take every single patient with chest chest pain, right to a STEMI capable facility, because I don't want to be good at my job when it comes to the assessment. But I possibly have passed facilities that could have treated them and they're not having the ST MI. I mean, these facilitie would have been just as goo and not cost my patient time nd muscle.

Geoff Lassers:

Chris, how many times do I need to call you as a EMS provider and give you a false activation of a STEMI? or stroke? Until you stop trusting EMS's notifications?

Chris Seitz:

Yeah, I mean, it's a slippery slope, right. So but again, like kind of back to what you guys have been saying. I mean, if you roll in, and you tell me, hey, based on a Ci cinatti stroke scale, this guy troking out. And also I use thi really cool tool. And I know th t he is probably having an LVO, and I forgot to do the Accu chec . And you know, I haven't done the..... I got to start over got to do those things still, they still have to ge done. His thrombectomy is no happening any sooner, I st ll have to accomplish those thi gs. So you know, again, it's li e you said there is a gold tandard of care. And you rol ing in and telling me that I thi k this guy might be having a str ke period. And then I do a Cincinnati stroke scale or a ull stroke assessment, and the I get the CAT scan. And then I put them through y own risk stratification thing to realize that oh, maybe this is an LVO. Now how much longer as it been where I could have alled that facility that is gonn , it's not like you showed p with the patient. And I'm lik , Oh, it's an LVO? We don't do hose here. poor guy. you don't now, we're still gonna get t em the care they need. It's jus a matter of you know, lik , so again, like relaying that information, you show up, you t ll me I did XYZ. This is the gol standard. Also, I use this res rvation. Cool. I know you g ys don't do that here. But I w nted to give you this picture. h, man, you know how much fast r I can move now? like this, thi patient is going to benefit.

Jason Seitz:

Paramedics and EMTs want their subjective opinion, to be respected. And that's a huge miscommunication thing in the field. Like people don't want to talk to docs, because they felt like the one time when they thought it was an LVO and ended up being something else their opinion wasn't respected. But your subjective opinion is useless in the field without objective data. So if I come to Chris, and I go, Hey, my opinion is this guy's having an LVO or my opinion is this guy's having a full blown STEMI but I don't have any data to back that up. It's useless to Chris and not in the sense that he's going to just disrespect me because he doesn't respect my opinion or me is because he needs to have that objective data in order to get the ball rolling to get them the treatment, the hospital, my job is to do some of Chris's job for him so that he can get to the more important stuff and what we need is these experienced providers who have subjective knowledge and they have these opinions and they know the complicated gray areas but you have to still do the black and white treatments and the black and white objective data in order to get ready for that. So we need experienced providers willing to fit these humble rules. And ego was a big problem out there in the EMS field. And I think sometimes we think I've been doing this so long, I can spot an LVO from across the room, it doesn't work that way, you have to get the Accu-check, you have to do the stroke severity scale, you have to know the last known Well, time he has to have all that information. If you don't do it, he's gonna have to do it.

Chris Seitz:

So if I don't do it, the neurointerventional is gonna have to do it's like we call the neuro interventions being like, hey, me and the medic think this guy's having a big stroke. All right, cool, we got any more, we got a feeling about this. It's just, you know, it's just silly.

Geoff Lassers:

So what's nice about all the advice you're giving is it doesn't really apply to stroke severity scales, either. You can do all of those things minus a stroke severity scale, you don't really need that you could still check an Accu check and do all these things and identify when you had a stroke severity scale is just another piece of information. Every piece of advice I give to an agency that wants to join our study or adopt a stroke severity scale of any type. The first thing I do is I say, how do you inspect what you expect currently, for your stroke patients? Are they documenting all the blood glucose? Are you checking all the radio reports to make sure all these things are being conveyed? When are they being conveyed? Is it before they go on route? Are you looking at how we can clean up all of these things first? and that's always the advice I give them. All of that take into consideration. Let's assume my agencies done all that, as an agency that has adopted this give our listeners as we wrap up some advice on what they should expect or something they can take away from either trying to implement it into their agency or teaching it at their agency when getting down to the skills and understanding and actually the use of the scale rather than the macroscopic, How do we implement it?

Jason Seitz:

The scale itself is not a complicated thing to understand. It's basically just checkboxes, right? We go down a list, we ask these questions. the biggest challenge is getting providers to actually do it and do it completely. And the only way I think that providers are going to do that is if they have a passion for the scale and what the scale stands for in the first place. In order to have that they have to understand what we just talked about, they have to understand that it isn't going to make a huge difference right now with destination of their patient, but it is going to make a huge difference in Chris's job down the line, get that patient getting definitive care. And if we can understand that, that's what paramedicine is about. That's what most of paramedicine is about preparing that ER doctor and getting them going that I think you really have to push that in the education with this, or the scale just won't get done or won't get done fully. Because there's no passion behind why we're doing that.

Geoff Lassers:

Well, thank you very much for that. Jason, I couldn't agree with you more. Chris, one of the things that we run into a lot is we get a lot of passionate, very smart, very capable EMS providers with a lot of fantastic ideas. And it seems to me that there's just not enough ED positions with an EMS background or understanding of EMS to go around. Because I think there's a huge amount of interest for physicians that are in the ED to learn about EMS. That didn't start in EMS. So how would you help EMS approach getting them to help champion these types of ideas?

Chris Seitz:

Yeah, I think that's a big component of it. Because if you you're looking to put this scale into play, at your place of work, you have to have the ER on board in some capacity. Because if you show up, Jason shows up and tells me about a patient and some severity score that I've never heard of, or never been introduced to, like, I'm probably not going to do much with that information, just cuz I don't understand it, right. We need to educate the you know, not only the EMS providers who are using it, but the people who are going to be bringing that information to they need to be a part of it. And I think that it doesn't have to be this big, intimidating thing. Just reach out. I mean, just reach out to your local year and be like, hey, any of your Doc's interested in EMS? even if they're not, I mean, like by default, they have to be right like is this emergency medicine? I think sometimes maybe EMS waits for the physician to come to them. If you came to them as they would be more than happy. They'd be super excited. They want to get involved. They just they don't know they're not educated in that way. Like I'm blessed that I have a huge EMS background grew up in a EMS family. I've got Jason there. I mean it Yeah, like so find someone like me, great, awesome. Yeah, I'll champion any day. But if you don't have someone like me there, there are plenty of doc's there who would love to I mean, they are passionate about this stuff. They really are. They just don't know that you need them. You know me in that way. So we just, you know, I think it's just just reach out and let them know what you're doing and what you're excited about and talking to each other. I think that's the biggest issue right now. We're just not talking to each other who used to need to be talking to each other. That's great advice. I can't imagine that any ED physician is going to immediately turn away they're at least going to listen because it seems to me that every ED physician I come across has an interest in EMS. They see ems all day. Absolutely. You know, where I take patients all the time, they probably see I don't know a dozen different agencies. And if you've seen one, EMS agency, you've seen one ems agency, they're all a little bit different. And I'm willing to bet that there's ED physicians out there that see something that they can help create a continuity of care in their local area. And maybe this is one of those things. So if you're an ED physician or an EMS provider hospital, an agency you're interested in learning more about our stroke study or just FAST-ED in general go to ocmca.org/stroke. Seitz and Sirens, anything to sign off with? Feel free to reach out to us anytime too. Again, like we are passionate about education training, if it's something that we don't think we offer, like, we'll talk to you about it, we would love to you mean like you want it, you want advice on how to implement something like this, you know, give us a call anytime you can email us at training at Seitzandsirens.com. it's Seitzandsirens.com. And again, going back to that just general education, we talked about that understanding the basics, like we're here for you. So if you're studying for your national registry exam, if you're trying to get that understanding of some of these basic topics reach out to us, we're here.

Jason Seitz:

We're the masters of the stupid question. So if you feel like the question is stupid, don't be afraid to reach out. We're happy to help you with

Geoff Lassers:

Yeah, and I have a stupid face. And that's why they're here today. Thank you guys for coming on in. We appreciate you these guys will be back unless we get really bad feedback about you. That's all for the show today, everyone. Thank you to Chris and Jason for joining me. I have a feeling that you guys will be hearing and seeing more of me and the Seitz boys together on some of the EMS education initiatives that we have planned. In our next episode Dr. McGraw and Dr. Faust are back and we'll be covering the OCMCA strok study data that was produce over the first two years. Plea e keep emailing your question , comments, feedback and episo e ideas to the EMS on-air podc st team at QI@ocmca.org. Also, lease check out our updated ebsite: emsonair.com for the la est information podcast ep sodes and other details. Fo low us on Instagram @ems_on_air nd please whatever podcast plat orm you use, subscribe to our odcast and leave us a rati g and a review. It really does help us grow the podcast. Than you for listening to the EMS n-air podcast. Stay safe and h ve a great day.