Episode Chapters
- Introduction – Swami Gets Pumped9:09Rib Fractures in the Elderly15:41Paper Chase 1 – Helmet PAP5:13Dyspnea in the Palliative Care PatientFree Chapter11:58Bouncebacks – Beta Blocker Overdose19:57Paper Chase 2 – Apneic Oxygen and the Airway Hero3:59Ankle Fractures21:16Point of Care Pediatric Urinalysis12:07Paper Chase 3 – Step-by-Step-Again4:23Toxicology Sessions – Loperamide Isn’t So Benign7:02Critical Care Mailbag – Head Trauma Etiquette14:47Nurse Practitioner Response Unit8:44Catheter Directed Thrombolysis for PE22:39Paper Chase 4 – Albuterol, Lactate, and Potassium3:52Lido in the IO4:21Strayerisms – Preventing Alcohol Withdrawal11:57Paper Chase 5 – Flex Ex Gets Spanked4:20Peri-arrest3:46Annals of Emergency Medicine – Postpartum Headache17:23Induction Doses in Shock6:05Summary19:11EM:RAP 2017 January Canadian Edition22:10EM:RAP 2017 January Australian Edition43:30EM:RAP 2017 January German Edition1h, 30mEM:RAP 2017 January French Edition32:33EM:RAP 2017 January Spanish Edition1h, 05m
Nurses Edition Commentary
Lisa Chavez, RN and Kathy Garvin, RN
No me gusta!
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EM:RAP 2017 January Written Summary 926 KB - PDF
How often do you hear someone say, "That person does not need to be in the ED."? What if there were a system where the ED came to them?
Broken Ankles, Ribs, and Pumps Full episode audio for MD edition 227:43 min - 318 MB - M4AEM:RAP 2017 January Canadian Edition Canadian 22:10 min - 31 MB - MP3EM:RAP 2017 January Australian Edition Australian 43:30 min - 60 MB - MP3EM:RAP 2017 January German Edition Deutsche 90:03 min - 124 MB - MP3EM:RAP 2017 January French Edition Français 32:33 min - 45 MB - MP3EM:RAP 2017 January Spanish Edition Español 65:46 min - 90 MB - MP3EM:RAP 2017 January Board Review Answers 220 KB - PDFEM:RAP 2017 January Board Review Questions 202 KB - PDFEM:RAP 2017 January Separate MP3 Files 265 MB - ZIPEM:RAP 2017 January Spanish Written Summary 1 MB - PDFEM:RAP 2017 January Written Summary 926 KB - PDF
Brad N., M.D. - January 31, 2017 9:50 AM
Interesting evolution to pre-hospital care. I'm curious about the economics of this service. Are patient's billed not only for the EMS call, but also billed for the NP services? What is the reimbursement rate, on average? Is the program financially self-sustaining or does it require funding from the county/city (which then is passed on to tax payers)? Thank you for your insight.
Jennifer F. - March 15, 2017 12:24 PM
Sorry for the delay...The overarching goal of the Advanced Practitioner Response Unit is to pursue patient-centered care by ensuring client safety, timely linkage to medical and social services, and providing for a positive experience of care. Upstream dispositioning by experienced NPs has helped a select group of patients save on both the direct and indirect costs of acute care, and this approach has served to highlight and improve systemwide inefficiencies. LAFD also sees the benefits of using Advanced Practitioners to free-up other 911-responders, so these other ambulances in turn can quickly attend the next time-critical emergency in the community. LAFD is currently not billing for this service, and like many mobile integrated healthcare programs around the country, is working on ways to ensure sustainability and improve patient navigation in close collaboration with each client's respective payer. CMS has suggested in the past that mobile integrated healthcare will be re-imbursed using value-based strategies, however these remain to be defined.
William L. - July 1, 2020 9:18 AM
I'm a nurse practitioner certified in both emergency and family practice with over 10 years emergency experience. I recently moved from a group where I had a great deal of autonomy and could choose when to utilize my attending for cases/decisions that I was not comfortable with to a group where I'm expected to report every case and am micromanaged to distraction. I feel like I'm losing my decision making skills for lack of being allowed to make a decision. I feel I have gone from a collaborative relationship with my attending to a subordinate relationship. My question is twofold:
1) Is there any good research and/or articles about the best way to utilize NP/PAs in the emergency department?
2) Is there any good way to let my attending know that I know enough to know what I don't know and will gladly ask their advice in that case. Otherwise, they're just making more work for both of us and destroying my efficacy and job satisfaction in the process?