ST. CHARLES COUNTY, Mo. — The St. Charles County Ambulance District has launched a podcast that takes listeners inside high-acuity calls and the clinical decisions made by responding paramedics.
“Patient Playback” is hosted by SCCAD Chief Medical Officer and Medical Director Dr. David K. Tan, EMS1/EMS1 Academy’s medical director. Each episode will bring Tan together with clinicians to review patient cases, discuss the reasoning behind treatments and identify possible changes to EMS training, policy or practice.
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The first episode features Captain and Training Officer Andy Law and Lt. Jeff Kremer discussing traumatic circulatory arrest and SCCAD’s use of prehospital packed red blood cells and plasma.
Much of the conversation focuses on how traumatic circulatory arrest differs from a medical cardiac arrest. Rather than automatically following a cardiac arrest algorithm, the clinicians discuss identifying and treating the underlying causes of the patient’s loss of circulation, including hemorrhage, inadequate oxygenation, tension pneumothorax and cardiac tamponade.
The episode also examines situations in which chest compressions may not benefit a trauma patient whose arrest was caused by severe blood loss.
Law said changing the terminology from “traumatic cardiac arrest” to “traumatic circulatory arrest” encourages clinicians to consider what caused the arrest and whether each intervention is helping the patient.
The guests also discuss the logistics of getting blood products to patients without unnecessarily delaying transport. SCCAD crews have used roadside intercepts, allowing a battalion chief carrying blood products to meet an ambulance on its way to a trauma center and begin the transfusion during transport.
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The agency uses component therapy because packed red blood cells and plasma are readily available through its supplier. The clinicians said the model may also give EMS agencies a more accessible starting point than a whole-blood program.
Tan said the podcast is intended to go beyond recounting successful calls.
“Beyond the clinical wins, we’ll have conversations about potential process or policy improvements that we should be considering not just as a singular agency, but as a profession,” Tan said.
The first episode also addresses field termination decisions, including how a patient’s mechanism of injury, presenting rhythm, end-tidal carbon dioxide level, age and distance from a trauma center can affect whether crews continue resuscitation and transport.
The discussion closes with the psychological toll of severe trauma calls. Law and Kremer describe checking on crew members after difficult incidents, conducting after-action discussions and keeping crews together while they recover from a call. SCCAD supervisors can temporarily take a unit out of service when crew members need time or additional support.
“Things that were once thought to be ‘hospital only’ or even ‘ICU only’ are now routinely being practiced in advanced life support units,” Tan said. “Paramedics throughout our nation have demonstrated that they’re ready to expand their role as critical care practitioners.”
SCCAD plans to release hour-long episodes of “Patient Playback” every two weeks. The podcast will be available on YouTube, Spotify, Amazon Music and iHeart.
The third-service EMS agency covers nearly 600 square miles northwest of St. Louis and responds to approximately 60,000 calls annually.
