Disaster Podcast

• Changes in AHA CPR and Cardiac Arrest Guidelines Over the Years – Elevated CPR Discussion Part 3

  We are joined by Kurt Bramer from Advanced CPR Solutions again this week to continue the series on Heads Up CPR and other promising sudden cardiac arrest treatments. He and Dr. Joe Holley kicked off the discussion in two previous episodes. Elevated CPR Series Episode One Elevated CPR Series Episdoe Two We open this week’s episode with a holiday severe weather update from our disaster meteorologist, Dan DePodwin. He reports on several storm systems that will impact Thanksgiving holiday travel across the eastern half of the country. Following that update, we kick off episode 3 of our heads-up CPR series with a look at the long history of the evolutionary changes to cardiac arrest treatment. Kurt Bramer from Advanced CPR Solutions leads off with a response to some comments to the first two episodes in this series. A few listeners worried that we might sound like we were criticizing the individual responders on cardiac arrest calls over the low survival rates for the condition. The team made a joint statement that no criticism of providers in the field was intended. We all are providers ourselves and are merely commenting on the results that everyone has been getting in response to treating cardiac arrest. Some systems do better with resource management than others, but even those areas fail to save even a simple majority of their cardiac arrest patients. CARES Registry for Cardiac Arrest Stats Follow up on more of these segments as we continue to look at the current research trends in future episodes and what is on the horizon for the future. The episode was co-hosted by Sam Bradley and Jamie Davis. Scroll down for Podcast Discussion Summary Thank you as always to Paragon Medical Education Group for their long-term support of the Disaster Podcast. Dr. Joe Holley and the team at Paragon continue to provide excellent and customized disaster response training to jurisdictions around the U.S. and internationally as well. Podcast Discussion Summary CPR Challenges and Future Improvements The meeting began with a discussion about travel weather for the Thanksgiving weekend, with Dan DePodwin warning of widespread lake effect snow in the eastern United States and a potential ground blizzard in the Dakotas and Minnesota. The group then transitioned to their main topic, CPR, where Joe clarified that their previous discussion about CPR’s limitations was not meant to criticize CPR providers, but rather to highlight the challenges and lack of progress in the field over the past 50 years. They planned to explore potential improvements to CPR in future episodes. Advancements in CPR Techniques Kurt Bramer, with 40 years of experience in EMS and emergency management, discussed the history of CPR, highlighting its evolution from mouth-to-mouth resuscitation to modern techniques. He emphasized the need for better tools and more effective methods for emergency responders, as current practices are often based on outdated or insufficiently tested techniques. The group acknowledged that while responders are doing their best with limited tools, recent research may lead to positive changes in CPR practices. They also touched on the introduction of high-performance CPR in the 2010s, which aimed to maximize the effectiveness of current technologies and minimize detrimental pauses during resuscitation efforts. Mechanical CPR Guidelines Review The discussion focused on the American Heart Association’s recent guidelines regarding mechanical CPR, which recommend against routine use but allow for exceptions like transport scenarios. Kurt and Joe highlighted that the guidelines lump together different types of mechanical compressors, ignoring their unique physiological effects and training limitations. They emphasized that current research primarily focuses on patient survival as an endpoint, which may not fully capture the benefits of mechanical CPR, such as improved blood flow and reduced pauses during resuscitation. The conversation also touched on the importance of considering neurological outcomes beyond mere survival and the need for better training on integrating mechanical devices into overall cardiac arrest management. Bundle Care Approach in Resuscitation The group discussed the bundle of care approach in resuscitation, focusing on the use of multiple therapies simultaneously to improve patient outcomes. Kurt and Joe highlighted the success of the ITD (Impedance Threshold Device) when used with high-quality CPR, leading to a 50% increase in one-year survival. They also noted that only a small percentage of resuscitation guidelines are supported by randomized control trials, emphasizing the challenges in interpreting research data. The group discussed the importance of disaster preparedness and the role of specialized training, with Jamie highlighting the sponsorship of the Disaster Podcast by Paragon Medical Education Group. Catch the full episode using the player above or on your favorite podcast platform, and don’t forget to subscribe to the Disaster Podcast for weekly insights from leaders in disaster response and research!

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• Flawed Approaches to Sudden Cardiac Arrest Research – Elevated CPR Discussion Part 2

  Kurt Bramer from Advanced CPR Solutions comes back on the show this week to continue the series on Heads Up CPR and other promising sudden cardiac arrest treatments. He and Dr. Joe Holley kicked off the discussion in a previous episode. Elevated CPR Series Episode One Elevated CPR Series Episode Three In this second episode installment of the sudden cardiac arrest and CPR series Kurt and Dr. Joe Holley discuss some key flaws in approaching cardiac arrest research like other medical diseases and treatments. The large number of unknown and uncontrollable variables surrounding sudden cardiac arrest make it hard for randomized control trials to effectively pinpoint positive treatment modalities. CARES Registry for Cardiac Arrest Stats Follow up on more of these segments as we continue to look at the current research trends in future episodes and what is on the horizon for the future. The episode was co-hosted by Sam Bradley and Jamie Davis. Scroll down for Podcast Discussion Summary Thank you as always to Paragon Medical Education Group for their long-term support of the Disaster Podcast. Dr. Joe Holley and the team at Paragon continue to provide excellent and customized disaster response training to jurisdictions around the U.S. and internationally as well. Podcast Discussion Summary Challenges in Resuscitation Research Funding Kurt discussed the paradox between resuscitation research and orphan drugs, highlighting how both lack funding despite their importance. He explained that orphan drugs target rare conditions, making research and development challenging due to limited market potential, similar to the situation in cardiac arrest resuscitation, which is a leading cause of death worldwide but receives limited research funding. Joe agreed, noting that complacency and insufficient focus contribute to the lack of high-quality research and implementation of new techniques in cardiac arrest resuscitation. Sam questioned the reliance on randomized control trials as the gold standard for evaluating resuscitation therapies, suggesting a need to explore alternative research paradigms. Propensity Score Matching in Research Kurt explained the concept of propensity score matching, a statistical analysis tool that allows for patient-to-patient comparisons using control groups not part of randomized trials, by matching variables such as age, downtime, and bystander CPR. Joe elaborated on the challenges of conducting cardiac arrest resuscitation research, highlighting the difficulty of patient participation in randomized trials and the need for large patient numbers to account for numerous impactful details. Jamie questioned the acceptance of different statistical analyses, to which Kurt responded that the issue is primarily one of unfamiliarity, as propensity score matching is widely used in other industries but not yet fully embraced in medicine. Improving CPR Techniques and Trials Joe and Kurt discussed the challenges of conducting randomized controlled trials for cardiac arrest, noting the difficulty in controlling variables and the high cost associated with large-scale studies. They highlighted the importance of using large numbers of patients to account for variables and the need for funding, which is often scarce. Sam brought up the discovery of the ITD and the plunger concept, leading to the suggestion of placing a thumb over the end of the ET tube to enhance pressure differentials and improve blood flow during CPR. Joe explained the hydrodynamic principles behind this technique, emphasizing the role of pressure differentials in creating flow and enhancing cardiac output. Counterintuitive CPR Physiology Insights The group discussed counterintuitive aspects of CPR physiology, including how preventing air from entering the lungs during chest compressions can actually improve blood flow. Kurt shared that many of these discoveries were made serendipitously while studying the body’s response to cardiac arrest. The discussion touched on the challenges of rural emergency response and the importance of data collection in EMS agencies. The participants agreed to continue the series with future episodes focusing on heads-up CPR and various therapies, with Kurt promising to share survival stories in the next installment. The group discussed the importance of disaster preparedness and the role of specialized training, with Jamie highlighting the sponsorship of the Disaster Podcast by Paragon Medical Education Group. Catch the full episode using the player above or on your favorite podcast platform, and don’t forget to subscribe to the Disaster Podcast for weekly insights from leaders in disaster response and research!

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• The Global Disaster of Sudden Cardiac Arrest — Elevated CPR Discussion Part 1

  Kurt Bramer from Advanced CPR Solutions comes on the show this week with Dr. Joe Holley. Kurt has a background in EMS since 1979 and worked as an emergency manager in Minneapolis. He currently works for Advanced CPR Solutions as a clinical educator. Sudden cardiac arrest is a global disaster that rivals the recent viral pandemic in scope. Cardiac arrest is by far the number one killer worldwide according to every public health agency of note. Over the years, treatment of this problem has a less than 4 or 5 percent survival rate with only minor incremental changes to treatment modalities. CARES Registry for Cardiac Arrest Stats Episode 2 of Elevated CPR Series Episode 3 of Elevated CPR Series The regular treatment updates that go out every five years feature only relatively minor adjustments to treatments that aren’t all that effective. Part of the problem is that it’s nearly impossible to accurately study the effects of various treatments on cardiac arrest victims due to the wide variety of variables present. Follow up on more of these segments as we continue to look at the current research trends in future episodes and what is on the horizon for the future. The episode was co-hosted by Sam Bradley and Jamie Davis. Scroll down for Podcast Discussion Summary Thank you as always to Paragon Medical Education Group for their long-term support of the Disaster Podcast. Dr. Joe Holley and the team at Paragon continue to provide excellent and customized disaster response training to jurisdictions around the U.S. and internationally as well. Podcast Discussion Summary Advancing Cardiac Arrest Survival Strategies Jamie, Sam, and Kurt discussed the global disaster of sudden cardiac arrest, highlighting its prevalence and the low survival rate despite advancements in CPR. Kurt explained the distinction between evolutionary and revolutionary changes in resuscitation, emphasizing the need for significant innovations like public access defibrillation and rescue CPR. The group planned to explore these topics further in upcoming episodes, aiming to engage both EMS professionals and emergency managers in addressing this critical issue. CPR Practices and Research Evolution The group discussed the evolution of CPR practices and the impact of scientific research on patient outcomes. Kurt and Jamie shared their experiences with skepticism and complacency among emergency responders regarding cardiac arrest cases, noting that previous protocol changes often had limited effectiveness. The conversation highlighted the importance of evidence-based practices and the potential for new techniques, like active compression and decompression, to improve survival rates. Cardiac Arrest Survival Rates Challenges The group discussed the challenges and limited success rates in resuscitating cardiac arrest patients, with Joe noting that despite advancements, survival rates remain around 10-11%, equivalent to a 90% failure rate. Kurt explained that while the Cardiac Arrest Registry for Enhanced Survival (CARES) data shows a 10% overall survival rate, the rate for neurologically intact survival has remained below 9% since 2013. The discussion highlighted the difficulties in conducting research on cardiac arrest due to variables like CPR quality, EMS response models, and patient characteristics, leading Kurt to suggest that randomized control trials may not be the most effective research paradigm for this field. Challenges in Pre-Hospital RCTs The group discussed challenges in conducting randomized controlled trials (RCTs) for pre-hospital resuscitation, with Joe highlighting significant variability in CPR quality and ventilation techniques. Kurt mentioned Peter Safar’s work and his belief that high-quality animal studies are needed before deploying therapies in uncontrolled EMS environments. The discussion also touched on the American Heart Association’s guidelines, with Joe noting that while these represent the state of science, local factors and resource constraints must be considered when implementing recommendations. Advancing CPR Techniques for Survival The meeting focused on a series discussing cardiac arrest as a global disaster, with a particular emphasis on improving CPR techniques. Kurt Bramer shared a case study from a ski slope where a patient’s recovery was attributed to the use of a rescue pump and the gravitational effect of being in an inclined position. The group discussed the potential of “head-up CPR” as a promising technique, and Jamie Davis announced upcoming episodes in the series. The participants agreed to continue exploring these topics in future discussions. The group discussed the importance of disaster preparedness and the role of specialized training, with Jamie highlighting the sponsorship of the Disaster Podcast by Paragon Medical Education Group. Catch the full episode using the player above or on your favorite podcast platform, and don’t forget to subscribe to the Disaster Podcast for weekly insights from leaders in disaster response and research!

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• United Way Worldwide and Community Resilience Programs

  Marcus Coleman Vice President of Community Resilience Strategy, for the United Way Worldwide joins the podcast episode. He talks with the team about the 138 year history of the United Way and its commitment to 4 areas of community resilience: Disaster, Resilient Ecosystems, Economic Resilience, and Personal Resilience (personal connectedness and social capital). They commit to being there for people before, during, and after disaster strikes. Also joining us to participate in the discussion is our disaster emergency management expert, Becky DePodwin. She brings her background to asking Marcus questions about the ways local communities are adapting to the rapidly changing Federal response system in the current environment. Tip Sheet PDF for United We Prepare Initiative United We Prepare Program Homepage The episode was co-hosted by Sam Bradley and Jamie Davis. Scroll down for Podcast Discussion Summary Thank you as always to Paragon Medical Education Group for their long-term support of the Disaster Podcast. Dr. Joe Holley and the team at Paragon continue to provide excellent and customized disaster response training to jurisdictions around the U.S. and internationally as well. Podcast Discussion Summary Community Resilience and Climate Action The group welcomed Marcus Coleman, Vice President of Community Resilience Strategy for United Way Worldwide, and discussed his role in establishing public-private partnerships to promote community resilience and address the climate crisis. They briefly touched on recent weather patterns and the success of a recent podcast episode. United Way’s Crisis Response Initiatives Marcus explained United Way’s 138-year history as an interfaith organization that mobilizes communities during crises, with a focus on disaster response, environmental resilience, economic resilience, and social connectedness. He detailed how United Ways activate locally during disasters through partnerships with organizations like the Red Cross and Salvation Army, leveraging their 2-1-1 information service and existing community relationships. Marcus highlighted their role in both immediate disaster response, as seen in recent events in Texas and Alaska, and long-term recovery efforts, particularly during the COVID-19 pandemic, where they focused on mental health support and trauma recovery. Mental Health in Disaster Recovery The discussion focused on the importance of mental health support in disaster recovery, with Becky highlighting how survivors cope with both physical and psychological impacts after disasters. Marcus shared an example from Valdosta, Georgia, where the local United Way, in partnership with Resilient Georgia and Legacy Behavioral Health Services, has expanded mental health training and support for both survivors and first responders following three hurricanes in 18 months. The conversation emphasized the role of United Ways in connecting communities to mental health resources, particularly in the long-term recovery phase when emergency responders have departed. United Way Disaster Preparedness Initiative Marcus explained United We Prepare, a national initiative by United Way to enhance disaster preparedness, focusing on risk understanding, family communication plans, and safeguarding valuables. He highlighted the role of local United Ways in coordinating volunteers, supporting caregivers, and integrating preparedness into existing community programs. Marcus also discussed how United Ways conduct community needs assessments to address housing insecurity and provide data for emergency operations planning. United Way’s Disaster Preparedness Efforts Marcus discussed United Way’s efforts in addressing food and financial insecurity, highlighting their partnerships with food banks and financial education initiatives. He also talked about their focus on hurricane recovery and preparedness, emphasizing the importance of building strong relationships with meteorologists and other emergency management professionals. Becky, a meteorologist, agreed on the importance of year-round preparedness and suggested that United Way continue to build relationships with local weather forecasting offices and private sector weather companies. She also expressed interest in how United Way might step in to fill gaps left by the federal government in disaster response. Lessons from FEMA Leadership Marcus reflected on lessons learned from past FEMA administrators, emphasizing the importance of whole community engagement, locally-led emergency management, and maintaining core values such as compassion and fairness. He highlighted the need for continued investment in emergency management systems and the role of United Way in supporting communities during crises. Marcus also discussed the challenges posed by pandemics, extreme weather, and misinformation, and the importance of positioning United Way as a partner of choice in navigating these disruptions. 211 Service Expansion and Impact Marcus explained the role of 211 as a free service connecting people to resources through referrals and partnerships with nonprofit organizations and government agencies. He highlighted that disaster-related assistance calls increased by 50% in 2024, with top needs including housing, utility, and food assistance. Marcus also noted that 211 complements local government services, providing support for non-emergency crises, and praised Heather Black for her leadership in mobilizing 211 systems across the United States and Canada. United We Prepare Initiative Overview Marcus explained the United We Prepare initiative, and discussed how it involves community-based organizations in 14 markets. He emphasized that the initiative provides resources for individual preparedness and encourages collaboration with local United Ways, which cover 95% of the country. Marcus also outlined various ways for individuals and nonprofits to get involved as volunteers, including connecting with local United Ways and utilizing the dedicated volunteer page on the United Way website. Marcus Returns for Disaster Preparedness The conversation ended with positive feedback about Marcus’s participation and an agreement to have him return for future episodes, particularly to discuss disaster preparedness, response, and recovery efforts. Jamie expressed interest in featuring United Way representatives again and encouraged them to reach out for future discussions. Marcus offered to connect Jamie with local CEOs for more localized insights and emphasized the importance of community resilience. The group also discussed the upcoming release of the podcast episode and the potential for sharing it on the United Way’s website. The group discussed the importance of disaster preparedness and the role of specialized training, with Jamie highlighting the sponsorship of the Disaster Podcast by Paragon Medical Education Group. Catch the full episode using the player above or on your favorite podcast platform, and don’t forget to subscribe to the Disaster Podcast for weekly insights from leaders in disaster response and research!

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• Hurricane Melissa Update

  credit — National Hurricane Center Tonight on the Disaster Podcast we dig into the expected impacts Hurricane Melissa will carry into Jamaica as it impacts the island country in the Caribbean. Disaster meteorologist Dan DePodwin and disaster emergency management expert Becky DePodwin join us this evening to look at the storm’s origins and projected track. Melissa threatens multiple countries with hurricane and tropical storm force winds. In addition to Jamaica, Cuba, the Bahamas, and Bermuda are all in the projected cone of travel. Additionally, Haiti and the Dominican Republic are getting peripheral storm effects. The episode was co-hosted by Sam Bradley and Jamie Davis. Scroll down for Podcast Discussion Summary Thank you as always to Paragon Medical Education Group for their long-term support of the Disaster Podcast. Dr. Joe Holley and the team at Paragon continue to provide excellent and customized disaster response training to jurisdictions around the U.S. and internationally as well. Podcast Discussion Summary Hurricane Melissa Impact Discussion Jamie hosted a mid-week update episode of the Disaster Podcast to discuss Hurricane Melissa, which is expected to be the strongest storm recorded worldwide in 2023. Jamie, Sam, and Dan discussed the storm’s potential impact, with concerns raised about entire communities being wiped off the coastline due to storm surge and prolonged winds. The team planned to bring in meteorologists and disaster management experts for further updates, and Jamie noted that this episode would be shorter than usual due to another episode already scheduled for Friday. Category 5 Hurricane Impact Assessment Dan explained that Jamaica and eastern Cuba are facing a dire situation due to an extremely strong Category 5 hurricane, Melissa, which rapidly intensified over the weekend. He noted that the storm is moving unusually slowly, which will prolong the impacts, including prolonged hurricane-force winds, significant infrastructure damage, and several feet of rain. Sam mentioned that this year has seen three Category 5 hurricanes, the most in a single season since 2005, and asked Dan about the rarity of such events, to which Dan responded that it is concerning, especially given the potential impacts of climate change on hurricane intensity. Rapid Hurricane Intensification Trends Dan explained that rapid hurricane intensification, such as Melissa’s recent rapid development, has become more noticeable due to improved monitoring and reporting, though the exact rate of such events is unclear. He noted several recent examples of rapid intensification, including Hurricane Michael and Otis, which caused significant damage. Sam asked about factors influencing hurricane speed, and Dan clarified that steering winds in the atmosphere determine a hurricane’s movement, with weak steering winds allowing Melissa to meander slowly across the Caribbean. Jamie raised concerns about the impact of storm surge on coastal communities, particularly critical infrastructure, and questioned how to effectively communicate such risks to the public. Hurricane Melissa Impact on Jamaica Jamie and Becky discussed the challenges faced by Jamaicans as Hurricane Melissa approaches, noting the lack of evacuation options due to economic dependencies on fishing and limited resources. Becky highlighted the storm’s well-forecasted nature but expressed concern about the prolonged impact and Category 5 intensity, emphasizing the logistical hurdles in providing aid post-storm. Dan provided an update on the storm’s projected path, predicting significant impacts in Jamaica, Cuba, the Bahamas, and Bermuda, with Jamaica expected to bear the brunt as the first landfall. He advised residents to remain in safe shelters and outlined the expected wind, flooding, and landslides in affected areas. Caribbean Hurricane Preparedness Concerns Becky expressed concerns about the impact of the upcoming hurricane in the Caribbean, particularly in Jamaica, noting that while the island has experienced hurricanes before, this one is expected to be significantly more severe. She highlighted the limited evacuation options and infrastructure challenges, suggesting that many residents may not be prepared for the magnitude of the disaster. Jamie mentioned that a Hurricane Hunter flight was aborted due to extreme wind conditions, an unusual occurrence that Dan might be able to provide more context on. Hurricane Hunting and Turbulence Challenges Dan discussed the National Hurricane Center’s report about a NOAA aircraft that encountered severe turbulence while flying through a storm, highlighting the challenges of flying into rapidly intensifying hurricanes. He explained that while commercial flights experience turbulence, hurricane flights can be significantly rougher, with large altitude changes and intense shaking. Dan also mentioned a notable incident during Hurricane Hugo in the late 1980s when an aircraft lost an engine, leading to changes in procedures. Becky and Sam discussed their interest in hurricane hunting, with Becky recalling a Hurricane Hunter Tour event they attended in Harrisburg, and Dan emphasized the importance of these flights for gathering critical data on hurricane structure and intensity. Hurricane Impact and Aid Planning The group discussed the recent hurricane and its impact on the islands, with Dan providing detailed information about weather research planes and their sensor technology. Jamie suggested reaching out to Nick for potential contacts and mentioned that Commonwealth nations might provide aid. The team expressed concern for the islands and emphasized the importance of preparedness, thanking Paragon Medical Education Group for their sponsorship. They agreed to follow up after the storm passes on Thursday and encouraged listeners to check out Paragon’s disaster training programs. Catch the full episode using the player above or on your favorite podcast platform, and don’t forget to subscribe to the Disaster Podcast for weekly insights from leaders in disaster response and research!

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