Peds: Dr. Antevy and the Handtevy Method

Do you ever get a song. This is completely unrelated. Do you ever get a song stuck in your head and it's like the only thing that plays in, like, the cranium? I have that going on right now. I've had it for the past two days. And it's. It's also why I'm like. I feel like I'm scattered brain. Because this one song, like, one melody line, I don't. I don't even know. It's the song that I found. It's very. I don't want to say obscure.

Angel in your eyes by. I don't even know. See a dopel laboratory. I literally don't know. I don't know how I found it. I was shuffling through my, like, songs on Spotify and it came up. I'm like, who are you people and why? Like, what is this? And now, like, it, like, it's good. It's just kind of weird.

Is that by Sia?

Yeah. Like it. It's good. There's just like one specific. I don't know. It's good, but it's also. It's kind of weird. It's not really my style. But, like, it is stuck. Like, we were on a call yesterday and I realized I started humming it halfway through the call, and I was like, what song is. Oh, God, it's still the same.

When I get stuck on a song, sometimes I'll just. I'll just keep playing it. And my kids hate that. They're like, I can go weeks at a time and I'm driving up to school, I'm playing the same song, and they're like, why do you do that? I'm like, I have no idea.

Welcome back to another episode of 22 at the Lips. I'm your host, Alexis Hardwick. Whether you're happy about that or not, here's where we are, friends. If you've been an active listener and slash or viewer of this podcast and the YouTube platform and Apple and Spotify and wherever else you want to find us, thanks for joining us along this journey. And if not, and this is your day one welcome. I don't know how you've gotten to this point in this journey and how you stumbled upon us, but we are the podcast. From EMS personnel to EMS personnel and healthcare personnel and field first responders and the everyday, average bystander who works at wherever you work that is interested in this field. Welcome. So I usually always have somebody on the podcast that either has some kind of cool experience or credentials behind their last name or has done Something in the field that is extraordinary and interesting. And somehow today I've encapsulated all of that in our very special guest of honor, Dr. Peter Ansevi. If you've never heard of him because you live under a rock in this field, he not only is he a medical director and obviously emergency medicine physician with the field focus of pediatric pre hospital.

He is a medical director. He.

Like I said, you'd have to live under a rock to not know who this man is. Hundreds of accolades and awards behind what he's done and so many other things that I know I'm going to miss along the way if I try to highlight. So.

From the man himself, Dr. Peter Ansebi, if you want to tell people who you are, what you stand for, the floor is yours, my guy.

All right, Alexis, thanks so much for having me, first of all, and very excited that you were able to launch a podcast. Keep it going, provide information to everybody out there. I'm a big believer in using social media and getting information out that way. So a little bit about myself. So, like you mentioned, I started off in Los Angeles getting my pediatric training, went to Pittsburgh and got my pediatric ER specialty training. So that's a total of six years for PEDs and pediatric ER. But along the way, I found myself in LA, flying on the helicopter in Pittsburgh. Did a lot of ground ambulance, a lot of helicopter in Pittsburgh. And. And for people who don't know, Pittsburgh is like the Mecca for EMS for a lot of folks. A lot of great people work there. And if you're PGM or EM resident, you're heavily involved in EMS. Came down to Florida in 2005, and I continued educating my local EMS folks just because I love EMS and I wanted to give them more training. And then in 2010, I was working as a pediatric ER doc since 2005 at a Level 1 trauma center children's hospital. And in 2010, one of the nurses came to me and said, hey, Pete.

That fire department that you've been helping is looking for a medical director. And they told me that they wanted you to submit an application. And they said, americar on the pediatric ER doc. And she said, just submit. So I ended up submitting one up against 15 other people, all of whom had EMS experience. I had zero, and I somehow got the job.

And from that moment in 2010, I recognized that that's where I'm supposed to be. And you may ask why? Because that the people in EMS are salt of the earth, smart people who see a problem and they want to get it fixed right away. There's no red tape. I recognize that my personality, which is like to be at the tip of the spear of innovation. It was very easy to innovate in EMs compared to the hospital. I ended up going from one EMS system to another EMS system and adding another EMS system. And I find myself today in 2023 with a number of systems that span from.

All the way down south as far as Miami Dade, Broward County, Palm beach county, and now up in Brevard County. So the total number of paramedics is somewhere between 2,500 and 3,000. Population we cover is about 3 million. And I find myself working with incredible people.

Making incredible saves. And right before I came on the call with you today.

We just had another great save of a 37 year old guy in the softball field. And I mean, we saved his life right on the pitcher's mouth before we got to the er. By the time we got to the er, the guy was fully awake and talking. So why I find myself loving this procession is because it turns out that's where we save lives. And for years, for many years I thought it was those guys are just ambulance drivers and then bring them to that big hospital where we save lives. But boy, was I wrong. So that's why I find myself loving EMS and kind of 80% of what I do day to day and found myself really enjoying it.

I'm only going to take away about 10 points for calling us ambulance drivers. But you didn't know better then back then.

That's exactly right. Back then it was, it was, those folks are just bringing people to us. And believe it or not, many ER docs today still look at us that way. It makes me really upset.

And in fact, that call I just talked to you about, there was an ER doc on the softball field screaming at my guys. And thankfully we just ignored the guy because we ended up staying on scene. By the third shot, this guy came out, but he was having what we call CPR induced consciousness where we had to give him ketamine, which is in our protocol, by the way. And so we, we had an ER doc on the field. There's no concept of what we do and how moodable we are. And so I have to give him a call. I got to find out who he was and give him a call. But it was a perfect kind of contrast to the typical ER doc out there in the world who has no idea what a high performing EMS system looks like. Their protocols and what they do in the hospital are years behind what we do in ems. So just another example of where EMS is shining much greater than what they're doing in a hospital.

And I feel like a big part of that is the kind of. Like we talked about the agency I work for now, which, you know, the medical director, which was really, really cool, having that medical director who not only has the.

What's the word? Pretty much like, has the back of the providers that he has oversight over and like, you know, makes the protocols for. And stuff like that, like his ability to have their back and create these protocols that are more innovating in the field and more helpful in a way. And things that, like, they. The medical director understands the actual field work of the personnel versus somebody that is so far removed from actually, like, knowing what is even in the back of the ambulance and our capabilities. Like, for instance, not throwing shade, but the agency I worked at when I didn't live in Louisiana, great agency, but very limited medications and protocols. And it wasn't necessarily the medical director's fault just because the.

EMS is just a little further behind in the modern times, more or less. But having somebody that is, like, you talk about the tip of the spear and adaptive and in a way almost pushing the envelope because we are so quickly adapting and evolving. I mean, EMS is a baby field in comparison to, I mean, nursing and like, the hospital setting and stuff, but, like, having somebody that's able to like, look around, you realize what's up and coming, what's working and what's not working and adapt to that. It makes a difference for those who are in the field and operating. But also with the morale mindset of, okay, well, if we're doing these things and they matter and they have data and statistics and research behind them and they work and then we're still evolving, it kind of gives almost that confidence boost. Especially like you're talking about in that call with the providers who have to, I mean, with their own education and training and field experience, understand the. The why behind the protocol on the things. But also with.

An ER doctor looking at them and saying to do the. The things. I mean, that's. That's an md, that's somebody with years of study, years of experience, blah, blah, blah, all that stuff. But having that.

What's the word I'm looking for that. That confidence to. Yeah, confidence to, like, look at them and I mean, ignore them, but also know within yourself, like, I'm doing the right thing for my patient because my protocol says with that backup, I mean, I guess confidence again, but like, with that backup of, like, this is what I'm supposed to be doing, and I know this is right.

It.

It makes a world of a difference. It. Congrats on the call. I. Kudos to the team that was in the call. Like, man.

Yeah. You know what I mean? Everything you said. I love what you said. And what I would tell people who are listening to this to think about is how comfortable do you feel calling your medical director? Because what I've noticed is now that I'm with a number of different agencies, the most recent agency that I joined.

They had a culture of not calling the medical director.

And that says to me that there's a cultural problem there. Because if the medical director is not fully engaged, if the medical director doesn't give the paramedic or EMT full open access to them, then that suggests that the type of care that's being delivered and the oversight that is there is not connected well. So if you have an agency where you're out there and you feel like you're all alone and the only thing you hear back from the medical director is when things go wrong and it's something that's punitive, all of a sudden you have a paramedic who.

Is coming to work, maybe in fear that if something happens tomorrow on a call and I don't have anyone to reach out to or I'm not getting feedback that's going to help me in a positive way, you end up having a very bad kind of overall career. And I'll give you a perfect example of this. About a week and a half ago, Palm beach county, we get a call that a lady's giving birth. Nobody likes that call.

Then. So, you know, in Palm beach county, we have, you know, we call them rescues or ambulances. So the ambulance is on its way, the engine's on the way. We also have an EMS captain. The EMS captain is.

Kind of functions like the physician, right? We have. We have nine battalions in Palm beach county, and we have. So we have one EMS captain per battalion. And they cover kind of a large portion of geography, and they only get toned out to the delta and echo calls. So this is a call that they got toned out to. And en route on the mdt, they got the update that the friend who's at the bedside says that there's two feet sticking out. So it's a breach delivery.

This EMS captain has never delivered a breach. So what does he do? He calls the medical director.

He gets input from the medical director. He happens to have called my partner, Dr. Shepke. Who walks him through it. He gets to the call, he sees that he feels the umbilical cord still pulsating, and he says, we're just going to get to the hospital, which is 20 minutes away. But five minutes into the call, he loses the pulse. So if you wouldn't have that ability to call the medical director, because there's two maneuvers that you really need to know when you're delivering a breech baby. And I'm not gonna go through it now, but I posted this on Twitter for everybody's knowledge. But you have to be able to know how to get the arms down one at a time, one arm, then the other arm, and then know how to get the head to flex so when the head flexes, the baby can come out.

But without that knowledge and without the ability to call, that baby would never have come out. And that could have ended this guy's career. Not because he would have been fired, but because he would not have been able to get this baby out. So the baby was delivered. He did successfully deliver the baby. And so it's those types of things that.

You know, if you're an ems, you have to have full engagement of the medical director.

For the individual call and also for education, training, protocol development, all the meetings we have to be at, all the data we have to look at. You really need a fully engaged medical director. So very important you about to have.

Me move into Florida to work under those agencies because, good Lord, I mean.

Done a couple of cool things in this field, but I'm not that I ever want to deliver a breach baby or deliver another baby ever again in my career.

But nobody wants to do that, right?

Dude, the time.

You cannot request the call you get, right, Alexis?

That's the problem, unfortunately.

If I could, it would be 90% Meemaw fell in the kitchen and possible broken head.

No, the one time I've delivered a baby in the back, we got all the way to the hospital. 20 something minute drive all the way to the hospital. We pulled up to the parking lot and she gives that one final push and the head is out. And then we get under the bay and she delivers it. And like, it was. It was a cool experience because I delivered a baby. Whatever. It was also gross. And it was just. It was so much. And then I had to write the second report for the baby because it was technically in our ambulance. Never again, right?

Did they. Did they name the baby Alexis? Did they name.

No, unfortunately. I was like, I told the mom was like even just like a middle name. Like just something she was like, I'm sorry baby, we already decided. I was like, you know, whatever.

That'S too funny.

But speaking of babies and pediatrics, Dr. Antevi, why did you focus on the pediatric pre hospital field? Because, I mean we have, we have the knowledge, we have the training, especially as paramedics, like the further extensive caring for neonatal recess and pediatric calls and stuff like that. However, comma, I fall under the category of pediatric calls scare me. And it's probably lack of confidence in those calls. Like I know what to do, they just still make me a little nervous. So why did you focus on that? Because it, not only are they like, is it the difference of the weight based medications? And they're so growing and there are just so many other things but like they are a class of little peoples all on their own. It is so different from your just regular 50s, 60, 70 year old patient. Like it's, it's a whole different ball game emotionally and physically and mentally. Just what was the draw, my guy? Because no offense, I don't get it, but I'd love to hear why you did.

Yeah, that's a, that's a very good question. There's a lot to unpack in there and I, the way that I look at it, I really transitioned how I think about.

The critical pediatric patient. Whereas when I was in training they said like you just said, kids are different. And if you even dare to say that kids and adults are the same, they get really upset with you. Part of the problem is that we completely.

Scare people into thinking that that kid is very different than the adult when in truth they're not. So I'm going to give you a protocol and you're going to tell me what's the difference between the adults and the kid. Okay, so asthma.

Adult and kid, they both get, they both get beta agonists, they both get steroids, there's no difference. Anaphylaxis, they both get epi, Benadryl, S albuterol, normal salmon, there's no difference. Hypoglycemia, they get dextrose. So cardiac arrest, they get high quality cpr, they get epi. If they're in shockwave rhythm, you know, you'll give them lidocaine or amiodarone, there's no difference. The only difference in all of these protocols is in the symptomatic bradycardia protocol where in pediatrics they want you to give a cardiac arrest dose of EPI, which is EPI, 1 in 10,000.01 mg per kg, whereas an adult, they don't allow you to do that. If you really look at it from 30,000 foot view, there is no difference.

So I would say starting off by kind of retraining the brain, that when it comes to what we do.

There'S nothing different. What is different are the following things. There's. The assessment is very different because you have kids who can't tell you what's wrong with them. So you have to be very good at assessment. You have to be very good at, from across the room, looking at someone and understanding their ABCs just by using your own eyeballs. Very important. Number two, you have to be good at.

Improv. Meaning that you have to be able to engage the family, give them confidence. And the only way to engage the family is by making eye contact. A lot of people when they're. If you're really nervous because they scared you so much about kids en route to the call, your heart rate's 200. When your heart rate's that high and you walk onto the scene, the first, the last thing you want to do is make eye contact. If you don't make eye contact with the family, they lose the confidence in you. Right away, the tension starts to rise. You're nervous, they're nervous. All of a sudden you just like, let me get out of here. So it turns out that although the medicine is the same, the skills and techniques that are used in pediatrics, the soft skills are very different. So what we do and I do is I teach people the soft skills and all of a sudden it opens the door to them to actually just handle the same medicine as they would have in the adult. There's a couple of things that we can do to maneuver people towards great pediatric care.

Really, that's where I found my niche, is to help people get to the promised land.

With using a different route, if you will.

I love the critical pediatric patient. I love speaking to families. I love the high stress situation and bringing down the stress. I found myself wanting to be in those situations. And now that I've been doing it for such a long time, I've been able to kind of understand.

How I could help people get to that same point. And that's what I focused on, you know, with the creation of hand tevy and, and the courses that we've put out in, the education I put out on YouTube and etc. Is to help people understand that if you learn those soft skills, everything else opens up.

Since you brought up the hands heavy, I think one of the most.

I wouldn't, I don't want to say, like, light bulb moments that I've had in this field, but definitely in the top five was I, I didn't even hear about it. I was working with my partner Cody, who he's now a flight medic. Dude is incredible, absolutely incredible guy. But he.

He, he went into EMS pretty much with this idea of like, he wants to give back because his daughter actually was like a super, super sick infant neonate and stuff like that. And he just remembers, like being in the back of the ambulance during like a transport or a transfer or something like that and being so helpless. But, like seeing the, the paramedics and stuff, like work and know what to do and all of this stuff, he was just like, I got to give back. And like, anytime he would talk about it, he would start tearing up. So one shift, he brought up the hand tapping method and I was like, what do you mean? It's doses on the hand. He was like, no, bro, look at this picture. And he went through the ages with the dosages and stuff like that. And I literally, like, I went home, I don't have it anymore because it's ugly. But I drew this giant hand on a poster and I wrote out every single one of them because I was like, there's no way. There's no way it's this simple. I mean, I don't remember it by heart just because now, like, I have my tea, tiny notebook with all my drug dosages right then and there. But it was, it was that moment where like in paramedic school, I remember, but especially like in the field, hearing the stuff and seeing it where I was like, it is that simple. And it kind of took not too much but a little bit of that fear away from pediatric calls because it's like, okay, it's the same medications that we're giving big people so the little people can have it. It's just a different dosage for understandable reasons. So Dr. Ante, the man himself, co founder of the Hand Savvy Method, if you want to talk about it, if you want to go through it real quick, give me a synopsis, like, and then especially, how did you come up with that? Like.

It blows my mind to this day that it all is. It's incredible. So if you want to go ahead and spill about it, I. I'm ready, Michael.

Yeah. Well, I tell you, I was embarrassed for many years to tell this story because the reason I had to do this is because I made a tenfold medication error in 2005. It was a girl, I'll never forget. She was in room four.

The nurse, her name was sky. She came out and she's like, gotta come in here. Kids in anaphylaxis. And back then she brought me out at this hospital that I just started working at. She brought up the Roslo tape.

And I had never used it because in Pittsburgh and in la, we never used length based tape. We used age. So she points to the EPI 1 to 1000. I say, give it. And he gave her 2.1 mls intramuscular instead of 0.21 mls. And the girl's heart rate went through the roof. Blood pressure went through the roof. Her hives went away. But she ended up needing to go to the icu. She ended up doing okay, thank God.

But I made that mistake because I was using a tool that I'd never used before. Listen, it's a great tool. Been a great tool for many years. And Dr. Broslow is considered a legend in the field. But I knew that day when I made that mistake, that it was a problem. Fast forward another month. And we had a code that morning with a 7am code. And I'm sitting at the head of the bed. I'm the physician in charge and I'm going through the stuff. We're doing CPR and the nurse hands me again the Brazil tape. But because people were stealing it, someone decided to put it into a big encasement of wood. So it was like this big six foot piece of wood. And I was holding it literally at the head of the bed. Like if I turn around, I'd kill two people. That's how bad it was. And I'm looking at it, I have no idea what to do with it. So I ended up putting it to the side.

The kid ended up. The kid ended up dying because it was a. Was one of those cases where the kid had been dead for probably a couple hours.

Long story short, I said to myself, there's something wrong here. Where I trained to the top 10 children's hospital in this country. And we never used the link based tape. And now I'm here at a Level 1 trauma center Children's hospital and they're giving me this tape. So I called up my mentor, Bob Hickey in Pittsburgh. I said, bob, big problem here. They're giving me this link based tape. I said, you are one of the authors of pals? He says, yes. I said, but when you read pals, there's nothing about using age, which is what you taught me. He's like, yeah, it's a long story. I said, bob, I said, I'm ready for any story because I'm having a big trouble here. So, you know, I ended up kind of listening to Bob. And when I hung up the phone, I said, you know what? I got to figure this out. So over the, over the next coming months, I struggled. And then finally I, I said, I gotta figure this age thing out. Took a piece of paper, I wrote down, you know, all the ages, 1, 2, 3, 4, 5, 6, 7, 8, whatever. And then.

I said, you know what? There's too many ages. Let me just make five ages. So I ended up figuring out 1, 3, 5, 7, and 9.

I looked at all the formulas out there and I figured out the kilograms that I could associate with those ages. So one year was 10 kilos, three years was 15, five was 20, seven was 25, and nine was 30. So I was like, whoa.

That'S pretty simple. So I wrote 1, 3, 5, 7, 9, 10, 15, 20, 25, 30. I said, okay, now what are the drugs I would need during a code? You know, epi. Back then we still used atropine. Back then we still used bicarb, you know, So I, I wrote all these drugs down. I think I ended up having like, you know, eight medications. And then I just did the calculation where I looked at the volume, not the dose per kilo, which was confusing to me. And I realized that a 1 year old 10 kilo kid, if I just move the decimal point over from the 10, that was my epi and amiodarone dose. So 1 milliliter. I said, wait a minute. So a 15 kilo kid, 1.5 milliliters of epi, 1.5 milliliters of amiodarone. Like, holy cow. And then I started looking at all the other doses, the atropine, the bicarb. Again, this is many years ago. And I was able to look at these drugs and it just jumped out of the paper. And I said, wait a minute, I don't need anything anymore. Now I figured out what Bob never told me, which is that's why all he needed was an age. So that was like 2006, 2007. I had this thing figured out and the nurses were like, whoa. And Tevi, you got much better. Like, what happened to you? I was so embarrassed. I didn't tell anybody. But in each code I was just like 2mL to that 1mL of that, 1.5 of this. And the nurses now are like, okay, he's, he's finally in the, in the Rhythm.

Mericar. Who's the nurse that, you know, kind of changed my life forever. She said to me, hey, Pete, whatever you're doing, when you give that lecture on drowning next week, can you teach them this little trick? And I'm like. I hesitated. I'm like, fine, because I've never told anybody about it. I gave this talk a week later on drowning. I had two slides at the end with the hand. And I taught everybody the method. I said, 1, 3, 5, 7, 9, taught them how to do the epi in the amiodarome. And then I ended the lecture.

And right afterwards. And remember, there were doctors in the room, paramedics, nurses, 200 people in the audience, 50 of them stood in line to come talk to me. I'm like, man, was that drowning talk that good.

But they're like, no, we just want those last two slides.

And that's when I said, okay. I come home to my wife, and I'm like, listen, I gotta tell you this story. So she's like, well, why don't you make a little card? So I'm like, all right. So I went into my computer, made a card, went to FedEx. It was called Kinko's back then. I laminated it, and I made like 20 or 30 of them, brought them to the ER. Within literally an hour, we're gone. I'm like, what just happened here? Everyone just came and just took these cards. So we ended up finding a printer. We started bulk printing them. So I came to the ER with like, a hundred of them. All of a sudden, people coming down from the or. They were coming down from the pacu. The cards were gone. Then I started getting calls from across the country. Hey, we want you to give this little talk you gave. Okay. Anyway, make a long story short. I was giving away thousands and thousands of these cards. I was giving lectures all over the country, all on this hand method thing. People were calling me months later. You wouldn't believe. I saved this kid. I got a call from Las Vegas. I took your. I was at your talk, you gave me your card, and I saved this life. Anyway, just to make a long story longer.

That'S how it all started. And till today, people call me up and say, I mean, obviously, now we have created an app, and it's not just eight drugs, it's 40 drugs and kind of hand. Tabby has become a lot different than just the 1, 3, 5, 7, 9. But we still teach it today in our courses. It's pretty cool.

If you want just one more anecdote to add to. I'm sure you're thousands and thousands of antidotes of how it's help providers.

We responded to an urgent care. It was a one year old who was seizing. And so I'm not going to say I do this for every call, but for any season seizure patient call, I'm like, okay, by the time we get there, it's probably done, you know, whatever. And especially during the call, like by the time we drop the verse said they're probably gonna be done. So like, I mean still, it's a one year old, so I'm still like senses heightened a little bit, but I'm also like, we'll see what happens. But the notes kept coming in of he's still seizing. It's been 15 minutes. And I'm like, oh dear God. And so the agency I work for, we, we have not.

Yet adopted like using the full resource of the hand tabby method. But we have, we have a protocol in our protocols where you grab the bar tape, fling it out, you find the like where the patient is on the colors and stuff like that. I don't know how else to simplify that. You find the color and then we have these sheets of based on the color, like the, the mills already done. So in a way, I mean it's like a dollar tree version of the hand tubby method, but whatever.

My medical director, you didn't hear that from me, but.

So it's cool. But also like I was thinking to myself, I mean this is great to have, but I need right now to know the dosage. I don't have the braslow in front of me. I don't have this kid on the stretcher with the braslo. I don't have like, I don't have this in front of me. And I literally on the way, I'm like, thank God I know this hand tapping method. And I mean I knew it, but also like pulled it up real quick. So I'm like, I'm kind of dumb sometimes. I don't want to, I don't want to make a fool of myself. Of all these moments, this one so. And I mean it came in clutch my guy because as soon as the firefighter came out and he had the kid like in his arms, I mean the, the patient wasn't seizing in that moment. But I'm gosh, golly, if as soon as he was on the stretcher and I went ahead and I was like, if I have to waste it, sorry. I started drawing the verse said and what you Know, as soon as he got on the stretcher, he. So I already have like the first set like drawn up. And as soon as he had this, because we don't carry out a band, but as soon as he hit the stretcher, I was like, oh. And so after the call, like, I mean as we progressed, like I obviously went for my agency's protocols and stuff because I'm not trying to. Never mind. But after the call, my partner's like, how'd you know that from the get go? And I was like, literally I said, let me show you something. Because she. She's about to go back into paramedic school. So I was like, let me show you something my mama. Let me, let me pull something up about to change your life. And so. And then I called Cody after, I'm like, hey, remember that time you showed me the hand tapping method like thank you my guy. Because so it is an incredible resource. And I mean not only is it. Is it a thing where it just. It makes everything click as far as medications and stuff, but it's also.

It.

Mitigates a lot.

For me. It mitigates a lot of that like cognitive.

I don't know how to say it like that overwhelming cognitive information block because there's already so much else to think about. There's already so many other things to take in consideration if I don't have to med math in that moment and I can do something that the patient needs and especially in a pediatric setting. And I mean this is a pride thing, but just being blatantly honest, something that I don't have to sit and pull my phone out and calculate a dosage for in front of parents who. For another thing about pediatric costs for a parent to call 911 and/ or even in the hospital setting to render the care and aid that they can provide for their child to someone else is I don't have a kid, so I don't get it. But I would imagine if it was my dog who is my baby, if I had like when I do that at the vet because like he needs a shot or something like that. It is such a helpless feeling. So to. To be able to better still confidence in that parent of I know what I'm doing. I know the exact drug dosage that I need to have your kid stop seizing this moment. I mean if nothing else, it's worth it for that. But it's also, I mean patient care and stuff, but just that that one less thing of I got to go through and calculate drug dosages and, and especially again those little, even just seconds that it matters because my, my kid went from me having to drop my verse said and then try to calculate mentally or on my calculator and wait that seconds less that he stopped breathing after a seizure, that second less that he, it just, Yep, I'm a huge fan.

Well, well I, I, I'll tell you that, you know, everything you just said there.

If you really break apart that entire sequence, it turns out that the most important part of that entire sequence was prior to arrival on the scene. Your performance on the scene reflects on your pre arrival ability. What we've noticed now our system is now used in 2,500 cities across America. We're also in Canada. We have lots and lots. We have hundreds of thousands of people using, using our system, what we hear over and over again. And now that, now what we teach because we see it and we learn is that the most important part is the pre arrival. So if you're en route to the seizure call and you use midazolam and you know that the concentration of midazolam that you carry is the five and one or the ten and two, same thing. And you know you're going to a one year old patient and you know the volume that you're supposed to give this kid within 30 seconds of you leaving the station. Now you have a, let's say I'm going to make up a six minute ride to the call. You already know the dose, right? Done. Check the cognitive, let's say that's what we call cognitive offloading. That's what you mentioned. Now I'm done with that. Now I can think to myself, okay, what does the pediatric seizure patient really need? What they really need is to have their airway managed. With my two hands you open the airway.

If they need, obviously they all need oxygen at least I would recommend initially. Some of them need an OPA because they can tolerate an opiate. Some of them need a bvm. So the first thing they need is not midazolam versed. The first thing they need is basic BLS stuff because that's what we need to stabilize them. And then in comes the versed at the dose that you already knew before you got there. And because you didn't have to pull out a length based tape and because you're able to speak to mom and dad and look them in the eyes, you're able to calm the entire situation down and not get so crazy about the seizure to want to then run off the scene. So everything that you just mentioned, if you break it down.

Very, very important to have a tool that prior to arrival on scene, you have all the answers so that you can actually function appropriately on the scene. So the people who don't understand pediatrics and pediatric dosing, they don't get that, what I just said. And they're all trying to focus on giving a tool that can only be used after arrival. Like you had mentioned, you take out the tape, which we have a tape too in our system, but you only use it like 10% of the time. If you're having to take a tape out in front of mom and dad, get to the color, go to your dollar tree spreadsheet, right? You're done. You're never going to do that in front of mom and dad because you're going to look amateurish and the parents are going to say, let me. You're doing a calculation in front of me with a spreadsheet. These aren't the right people for me. So I cannot stress how important it is in EMS to have the answers before you get to the scene, for your confidence, for your ability to treat the patient, make an assessment, talk to the family, treat the patient on scene, get a better outcome. And that is in essence, what we've learned, what I've learned.

With respect to treating the pediatric patient. So.

We cannot overstate the that enough. And I think that's the important part of what the people in the academic centers still don't get about pediatric care.

And ems to kind of highlight that.

I want to say in any call in general, but I would say even more especially in pediatric calls, because even still, like that confidence with the parents, you need to go in. I mean, it's looking like you know what you're doing, looking calm. I mean, what's the thing about be like a duck, like, floating on the surface and taking like heck underneath whatever it is. But you need to have that mindset of, like, I have the knowledge, I have the training, I have the confidence, and I need to look like it because these parents are riding on me to know. So especially on the way to pediatric calls that.

Me and my partner did, what's called pre gaming. And it's not every single call, not, not in the alcoholic sense, but.

I would get fired also. That's not good for the patient. So. And it's not every call, just because some calls, it's like, okay, like, you know, we. We kind of know we're going to keep our head on a swivel anyways, just because typically it's the calls that we're like oh my gosh, it's this again. And then we get there, we're like oh, they're coded. So.

But on the way in those calls we're pregaming. It's literally just so that way kind of that game plan of if we see this, then we do this. If we see this happening, we're going to do this. If there really is, I mean even cycles if there really is somebody that's cutting up, I mean I'm going to go ahead, I'm going to go ahead circumstance depending have my hand on the ketamine because I'm not doing this today. Like pre gaming is so important. It's that pre notion of what we're doing. And I mean I, I keep a little notebook to write notes on on calls but also primarily for when you get those pediatric calls if you know that they're seizing. If you know it's this, I mean if even on the way to. We didn't. It wasn't actually thankfully a pediatric cardiac arrest of a two year old. I literally got my notebook. I'm not driving so I mean I've done it before. Like I was driving around, I was the one driving the calls and a call came out and I look at my part, I'm like we gotta switch because I need to write dosages down.

So on the way to that what wasn't a pediatric code literally get my tea. Tiny little notebook writing dosages right then and there. So as soon as we walk in, I mean I have it on a piece of paper, I glance and I know the things it especially with the hand taping method, it's already spelled out for you.

You just whatever. And one, one day when you have the app, you'll just open the app and you'll say two year old and everything will be right in front of you and It'll take about 12 seconds.

And that, that's I think a huge thing where.

Immediately in the call you can bring your heart rate down, you bring your confidence level up, you can pregain appropriately. And that's what I think every EMS system should strive for, whether they use head TAVI or not.

We're working on it.

All good. It's all good.

The 22 at the Lips podcast designed to support, not replace the relationship that exists between a practitioner and his or her medical director. The views opinions expressed in this podcast are those of the host guest and not necessarily of master medics. The information provided during this podcast is intended for educational and informational purposes only is not a substitute for your approved protocols.