Journals and Blogs

A while back, I was talking to my partner about something and taught her something new that contrasted with something she had learned in school years ago.  Yay, me!  I love it when that happens.  She asked me how I found new information and kept up with the evolution of medicine.  Simply, I read blogs and journals.  It doesn’t take long – about an hour a week or so, and I think my job is important enough for that time investment to be worthwhile.  Trying to keep up through CE is a joke.  I have to put in the extra work. 

Medicine changes all the time.  I’m thankful for that fact.  I’m thankful that I won’t be bled next time I have a fever, that antibiotics exist, that limbs aren’t commonly sawn off anymore, and that leeches are a minimal part of modern medical practice.  More recently, I’m glad that I neither have to put MAST pants on patients, and that the KED is really just a big flat piece of equipment that can be used however you need it to be used.

With all that in mind, it is important for prehospital providers to stay up to date on current research.  At least a little.  Put a small amount of effort into it.  I wince when I consider how bad a medic I’d be if the only addition to my knowledge base after paramedic school was experiential.  I don’t feel like CE and merit badge classes can keep up with my didactic needs.  Even though most of my practice is based on protocols, expanding my knowledge base with current science is important to keep up.  Finally, let me point out that becoming a subject matter expert is critical to the field of paramedicine being accepted as a career worthy of respect (and pay).  Physicians, psychiatrists, psychologists, biologists, physicists, chemists, dentists, and other professionals keep up with their fields the same way.  Why shouldn’t we, at least within the framework of our career?

So this is how I maintain my knowledge base and interest.  Keep in mind, this is the minimal effort that I will put into my job.  Sometimes I go much further, read new textbooks, and that kind of thing.  Each month I check twelve EMS-related blogs on a weekly basis.  Along with that, I check in with at least nine peer-reviewed journals that relate to EMS.

I read the following blogs once per week.  I usually check in on Sunday, looking for any new posts since I last checked.  Many EMS blogs don’t post on a regular schedule, so I find this is a simple way to keep up.

• Rogue Medic is a controversially-written (argumentative may be a better way to describe it) website, but also more intellectually stimulating than the average.  (Much more stimulating than my blog, for example.)  As the author says: “The purpose of this blog is to frighten, intimidate, or cause emotional distress to those who intend to keep EMS from improving.  If we are interested in the truth, we should question everything – especially anything we take for granted.”  He questions epinephrine, quality assurance, pseudoscience, training programs and merit badge courses, immobilization, and so on.  The great part is that the author backs up his assertions with research.  Sometimes I read this and think, “Jesus.  Is there anything we do that works?!?”  Great stuff to make you think.
• Dr Smith’s ECG Blog is written by Dr Stephen W Smith from Hennepin County Medical Center in Minneapolis.  As the title suggests, it is a great way to improve your ECG skills.  His posts are case studies that illustrate a specific point.  This isn’t a blog to improve your differentiation of sinus versus a-fib, though.  The ECG topics here are more advanced.  His explanations work to make it accessible to anyone with a basic ECG foundation.
• EMS 12-lead is similar to Dr Smith’s blog, but the posts are less regular.  The topics are still advanced level, so it maintains my interest.  One part that I like about this blog is that there are case studies without answers, so you can work out your own response before reading the author’s answer.  I only wish the answer was posted more regularly to the initial post – like 24 hours after, or something.  Sometimes the answer comes a week or more later, so I have already forgotten the original case.  But it is still very much a blog that is worth your time.
• Amal Mattu’s Emergency ECG Video of the Week is posted by Dr Amal Mattu, from the University of Maryland.  His posts are similar to Dr Smith’s, but are posted as YouTube videos.  If you enjoy ECG work but don’t like to read, this is the site for you.  His pearls are phenomenal and I have learned a lot.
• Mill Hill Ave Command is written by Dr Brooks Walsh, from Bridgeport Hospital in Connecticut.  Dr Walsh looks into research as it relates to EMS.  For example, he is currently working through the evidence behind Cyanokit and whether it has been clinically shown to save lives.  This, along with Rogue Medic, is a good site to begin to get into reading research.
• The Ambulance Chaser is written by a licensed Texas paramedic who is also a licensed attorney and unlicensed barbeque critic.  That last one needs to go on my resumé – awesome.  The blog’s point of view is patient oriented, but also gives some legal background without delving into legal advice.  I only found this blog recently and like it a lot.
• EMS Patient Perspective is written by Bob Sullivan, who is an educator in a paramedic program and working paramedic.  His posts focus on EMS as seen from the patient point of view.  These are phenomenal reads.  I hope more EMS providers like Bob start getting their point of view out to the public.
• Captain Chair Confessions unfortunately seems to be dying out.  The blog is a collection of stories that make a point.  Its pretty good reading for funny situations, peeves that hit us all, and a few rants.  The posts make for short reading.
• A Day in the Life of an Ambulance Driver is written by Kelly Grayson.  This blog covers Kelly’s interests, which include firearms and (luckily) EMS.  This is a blog that is similar to Captain Chair Confessions, in that there are short articles telling stories about calls, making points (like his article on dumb EMS sayings), and that kind of thing.
• Burned-Out Medic is grouchy, as his blog title suggests.  The stories and anecdotes here have a more negative tone, which make them funnier to me.  Even if you don’t like his tone, his points are valid and insightful – nurses can be bitchy and patients can waste our time.
• Street Watch: Notes of a Paramedic looks at topics like why we start IVs, presentations from the Eagles conference, and such.  Intelligent, short reads with a academic foundation.  It has the EMS blog shortcoming of being a little streaky, however.
• EM Lyceum is another blog that I only discovered recently.  It is written by a group of physicians at Bellevue Hospital Center.  This is emergency medicine-focused, but there is a lot of information that could inform your prehospital practice.  Each topic is posted for two weeks.  Topics are stuff like upper GI bleeding, or abscesses, or intracranial hemorrhage.  One week will post several questions on the topic and the next week will offer the answers.  This would be incredible for interns in an EM rotation or EM residents.  It can be pretty interesting for medics, too, depending on the topic.

The nine journals* are:

• Prehospital Emergency Care  This is the official journal of the National Associations of EMS Physicians, State EMS Officials, EMS Educators, and EMTs.  It is one of my favorites, and usually generates a few articles from each edition.  It is published four times per year. Essentially every article in the journal relates to EMS practice. The only reason that I don’t read them all is based purely on my own interest level. 
• Prehospital Disaster Medicine This is a journal with a more international flavor, published by the World Association for Disaster and Emergency Medicine.  This is published six times per year, and is most interesting for disaster medical response articles and mass gathering research.  There can be some really good stuff, especially if you are into disaster or large event planning. 
• Annals of Emergency Medicine  This is the official journal of the American College of Emergency Physicians, and it is published monthly.  Many of the articles are focused on emergency department administration and emergency department care, with a small subset looking at prehospital topics.  Example articles include stuff like “Impact of a new senior emergency department on emergency department recidivism, rate of hospital admission, and hospital length of stay” but there are also EMSey articles like “Effect of out-of-hospital noninvasive positive-pressure support ventilation in adult patients with severe respiratory distress: A systematic review and meta-analysis.”  This is one of the primary journals that your ED physicians are reading.
• Academic Emergency Medicine  The Society for Academic Emergency Medicine puts out this journal on a monthly basis. The articles here can be kind of dense and…  um, academic.
• American Journal of Emergency Medicine  This journal doesn’t seem to be specifically related to an association or group, but tries instead to blend academia and practicality on a monthly basis.  It is pretty similar to Annals. You can usually find something good to read from here.
• European Journal of Emergency Medicine  The European Society for Emergency Medicine puts out this periodical on a monthly basis.  It is very similar to Annals and American Journal, as well.  The articles can be pretty good, but be careful about applying all of the information to your system – EMS system design can be pretty different in Europe, with physicians staffing ambulances, and such.
• Western Journal of Emergency Medicine  This journal comes out of California, with associations like California ACEP, UC Irvine School of Medicine, and the California Chapter of the American Academy of Emergency Medicine, along with the American College of Osteopathic Emergency Physicians.  The best part of this journal is that it will occasionally review a topic, like a textbook would, except updated with current data and science. 
• Circulation Arrhythmia and Electrophysiology  The journal Circulation is an important journal for cardiologists, but most of the articles involve cath lab techniques and genetics.  Crazy hard stuff that doesn’t relate to EMS really at all.  The subjournal (for lack of a better term) Arrhythmia and Electrophysiology focuses on the ECG.  Most of the articles revolve around atrial fibrillation, but you can find good stuff about ECG findings here.  I’m an ECG nerd, so this is up my alley.
• Air Medical Journal  Five air medical transport associations combine to publish this periodical.  The focus is, of course, on air medical transport.  But there are good articles about pathophysiology, case studies, and other topics that I enjoy reading.  There are good literature reviews in this journal, as well.  It is probably second to Prehospital Emergency Care in the list of my favorite journals.

I realize that journals can be hard to find, especially if you are a poor paramedic.  Even googling the journal name will usually get you to the current issue’s table of contents, with access to the abstracts.  That’s what the links lead to, above.  One of the best ways to get full-text access is through library systems.  I use the local college library’s website, but public libraries could probably get access too.  Even college libraries, like I use, are usually open to the public in person, and maybe you can get web access from the librarian.  All that means is that you stop by once per month or so.  But if you can find full-text web access, that is certainly easier.

(Side rant.  Many studies are publicly funded, or run from public organizations.  Open the access to publicly funded articles!  Make science accessible!  Rant done.)

I scan through the journal’s table of contents and download interesting articles to read later in the week.  My threshold for readable articles is simple – does the title seem like something that would interest me?  From there, I read through the abstracts to check whether the information will be helpful.  Small studies, simulator-based studies, and self-reported qualitative studies are less interesting.  So I don’t go nuts reading dozens of articles per month.  I end up with ten or fifteen interesting articles from which I read the abstract.  Three to five result in my reading the whole thing.  A few times per year, something pings my interest so well that I end up reading other articles from the bibliography. 

One more note about reading and interpreting research articles: Use caution applying the results of studies to your daily practice.  Your job shouldn't change based on one study.  Rather, use journal readings to inform your knowledge base and understand the direction that medicine is taking.  This helps you to understand protocol changes when they happen.  Applying research to practice is difficult and filled with pitfalls (see therapeutic hypothermia, for example).  Your medical director is trained in this, plus can apply his/her experience and professional insight to protocol changes.  Unless you are an unusually educated medic, be careful citing research.  Look here for a painfully truthful article about the inappropriate application of current research.

Hopefully you will find the time to peruse some of the links above and take control of your own continuing education.  Hopefully, also, the links in this article work.  Pick a topic you like and dive into it!

*JEMS isn’t on the list, is it?  Hmm.