Things to Know from the Chief Medical Officer

Annual influenza season remains at severe level, update on the opioid crisis, and changes to the guidelines of treatment of acute stroke

Brent Myers

“Knowledge is knowing what to say.  Wisdom is knowing when to say it.”
— Anonymous —

Welcome to the first ESO Chief Medical Officer (CMO) special feature, which we’ll be calling “Things to Know from the CMO.”  The goal is to keep this communication brief and focused; for those of you with greater interest in a particular topic, we will provide references and I am more than happy to engage in one-on-one or one-on-group dialogue about these or any medical topics.  For February:

  • The annual influenza season continues to be more severe than recent ones. We have seen a tripling of EMS interactions with a primary impression of fever/infection/flu, along with signs that some of these patients in our database are very ill, as is evidenced by also seeing a tripling of patients with low blood pressure, fever, and/or rapid heart rate.  Additionally, we have seen a spike in influenza diagnosis from our hospitals participating in HDE.
    Thing to Know:  The influenza vaccine is the most effective measure to prevent the flu, even when the flu strain for a particular season doesn’t exactly “match” the strains targeted by the vaccine.  People who have had the vaccine, particularly those who take the vaccine every year, are less likely to have complications and more likely to have rapid resolution of their symptoms, even if they become infected with the flu.  Source: https://www.cdc.gov/flu/consumer/prevention.htm
  • We are continuing to monitor the effects of the opioid crisis. On January 25th, we deployed a Specialty Patient Form to assist our clients with structured, meaningful data collection.  This month, we will release a brief video designed to provide guidance for EMS professionals who are completing the form, both in advance of its use as well as “just in time” after a potential overdose call.
    Thing to Know:  Incidental exposure to small amounts of power over intact skin is highly unlikely to cause any problems for bystanders or responders who inadvertently encounter presumed opioids – despite what you may have seen on social media or in the news.  As part of our enhanced data collection around this issue, we are specifically seeking completion of elements related to safety of the responding EMS professionals. Source: http://www.naemsp.org/Documents/Press%20Releases/NAEMSP%20Toxicology%20Press%20Release.pdf
  • Finally, as we predicted at the most recent all hands meeting, the guidelines regarding treatment of acute stroke have changed. The limit from time of symptom onset to treatment has historically been 6 hours – it is now up to 16 hours for some patients, and even 24 hours for a select group of patients most likely to benefit.
    Thing to Know:  This is hot off the press, and all of our customers are going to need the support of data to help them make decisions about hospital destination and transport modality to assure patients who are now eligible for these interventions are appropriately evaluated and treated.  This will be a major clinical focus for ESO over the coming months Source: http://www.nejm.org/doi/full/10.1056/NEJMoa1713973, http://www.nejm.org/doi/full/10.1056/NEJMoa1706442,

Finally, if you don’t follow Destin Sandin and the web series “Smarter Everyday”, it is highly encouraged!  We are all on a journey to get smarter every day – we can all learn from him and will be able to discuss “triboluminescence” next month!


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