Josh Kimbrell
@joshkimbre.bsky.social
Paramedic and medical student interested in resuscitation science and health equity. #Medsky
Been away for awhile having the time of my life. I usually stick to medicine here but figured y'all could take a peek at my personal life today.
November 16, 2025 at 2:51 PM
Been away for awhile having the time of my life. I usually stick to medicine here but figured y'all could take a peek at my personal life today.
Main takeaway:
- Delays to defibrillation and chest compressions due to unrecognized prehospital rearrest may contribute to decreased survival outcomes, and patient movement could play a role.
- Delays to defibrillation and chest compressions due to unrecognized prehospital rearrest may contribute to decreased survival outcomes, and patient movement could play a role.
August 25, 2025 at 6:08 PM
Main takeaway:
- Delays to defibrillation and chest compressions due to unrecognized prehospital rearrest may contribute to decreased survival outcomes, and patient movement could play a role.
- Delays to defibrillation and chest compressions due to unrecognized prehospital rearrest may contribute to decreased survival outcomes, and patient movement could play a role.
- Nearly 50% experienced prehospital rearrest.
- Of 10 w/ rearrest rhythm of asystole, 6 had a CPR delay > 10s with a median delay of 18s.
- Of 16 w/ rearrest rhythm of VF, 12 had a defibrillation delay > 10s and 3 were never defibrillated.
- Of 10 w/ rearrest rhythm of asystole, 6 had a CPR delay > 10s with a median delay of 18s.
- Of 16 w/ rearrest rhythm of VF, 12 had a defibrillation delay > 10s and 3 were never defibrillated.
August 25, 2025 at 6:08 PM
- Nearly 50% experienced prehospital rearrest.
- Of 10 w/ rearrest rhythm of asystole, 6 had a CPR delay > 10s with a median delay of 18s.
- Of 16 w/ rearrest rhythm of VF, 12 had a defibrillation delay > 10s and 3 were never defibrillated.
- Of 10 w/ rearrest rhythm of asystole, 6 had a CPR delay > 10s with a median delay of 18s.
- Of 16 w/ rearrest rhythm of VF, 12 had a defibrillation delay > 10s and 3 were never defibrillated.
Please consider joining us for a grand rounds on transcutaneous pacing tomorrow, Thursday, at 1pm ET. No need to register, just log into the Zoom here:
buffalo.zoom.us/j/9848537719...
buffalo.zoom.us/j/9848537719...
April 9, 2025 at 1:42 PM
Please consider joining us for a grand rounds on transcutaneous pacing tomorrow, Thursday, at 1pm ET. No need to register, just log into the Zoom here:
buffalo.zoom.us/j/9848537719...
buffalo.zoom.us/j/9848537719...
In another project, we aimed to improve ECG acquisition for "atypical" ACS symptoms from 25-80%. We used iterative PDSA cycles with targeted education and awareness and found improvement.
January 12, 2025 at 1:05 AM
In another project, we aimed to improve ECG acquisition for "atypical" ACS symptoms from 25-80%. We used iterative PDSA cycles with targeted education and awareness and found improvement.
We also used iterative PDSA cycles to improve pain management with a health equity lens. We identified any patients with pain 5+/10 and paramedics on scene and aimed to improve pain management rates from 25-50% and eliminate the racial disparity.
January 12, 2025 at 1:05 AM
We also used iterative PDSA cycles to improve pain management with a health equity lens. We identified any patients with pain 5+/10 and paramedics on scene and aimed to improve pain management rates from 25-50% and eliminate the racial disparity.
In this quality project, we used iterative PDSA cycles to improve management of pain for injured patients with a pain score of 5+/10.
We used a novel approach, including splinting and ice pack adm as pain management. Through training, champions, and awareness, we saw sustained improvement.
We used a novel approach, including splinting and ice pack adm as pain management. Through training, champions, and awareness, we saw sustained improvement.
January 12, 2025 at 1:05 AM
In this quality project, we used iterative PDSA cycles to improve management of pain for injured patients with a pain score of 5+/10.
We used a novel approach, including splinting and ice pack adm as pain management. Through training, champions, and awareness, we saw sustained improvement.
We used a novel approach, including splinting and ice pack adm as pain management. Through training, champions, and awareness, we saw sustained improvement.
We investigated variability in EMS Transcutaneous Pacing protocols.
- 41% don't mention pad placement
- 37% describe electrical capture
- 11% describe false electrical capture
- 56% recommend confirming capture by pulse palpation
- 11% do not mentioned sedation or analgesia
- 41% don't mention pad placement
- 37% describe electrical capture
- 11% describe false electrical capture
- 56% recommend confirming capture by pulse palpation
- 11% do not mentioned sedation or analgesia
January 12, 2025 at 1:05 AM
We investigated variability in EMS Transcutaneous Pacing protocols.
- 41% don't mention pad placement
- 37% describe electrical capture
- 11% describe false electrical capture
- 56% recommend confirming capture by pulse palpation
- 11% do not mentioned sedation or analgesia
- 41% don't mention pad placement
- 37% describe electrical capture
- 11% describe false electrical capture
- 56% recommend confirming capture by pulse palpation
- 11% do not mentioned sedation or analgesia
We looked at rearrest using defibrillator files to identify delays and a potential relationship with patient movement.
- 44% of ROSC pts rearrested
- 59% of rearrest occured immediately before or after movement
- 16.2% of rearrest had a delay in recognition > 10s
- Median recognition delay: 48s
- 44% of ROSC pts rearrested
- 59% of rearrest occured immediately before or after movement
- 16.2% of rearrest had a delay in recognition > 10s
- Median recognition delay: 48s
January 12, 2025 at 1:05 AM
We looked at rearrest using defibrillator files to identify delays and a potential relationship with patient movement.
- 44% of ROSC pts rearrested
- 59% of rearrest occured immediately before or after movement
- 16.2% of rearrest had a delay in recognition > 10s
- Median recognition delay: 48s
- 44% of ROSC pts rearrested
- 59% of rearrest occured immediately before or after movement
- 16.2% of rearrest had a delay in recognition > 10s
- Median recognition delay: 48s
Here's a 🧵 with some of the research and quality improvement presentations from #NAEMSP2025 this year. #EMSsky
We investigated the # of abstracts presented at NAEMSP that make it to manuscripts, an indicator of science quality. 44% were published and it was higher in orals (60%).
We investigated the # of abstracts presented at NAEMSP that make it to manuscripts, an indicator of science quality. 44% were published and it was higher in orals (60%).
January 12, 2025 at 1:05 AM
Here's a 🧵 with some of the research and quality improvement presentations from #NAEMSP2025 this year. #EMSsky
We investigated the # of abstracts presented at NAEMSP that make it to manuscripts, an indicator of science quality. 44% were published and it was higher in orals (60%).
We investigated the # of abstracts presented at NAEMSP that make it to manuscripts, an indicator of science quality. 44% were published and it was higher in orals (60%).
Dr. Berndston, trauma surgeon local to San Diego, talks about injuries at the US-Mexico border at #NAEMSP2025.
"As the wall height rose, so did trauma admissions." As the Trump administration raised the wall in 2017 to 30ft in many areas, they started seeing more falls.
#EMSsky
"As the wall height rose, so did trauma admissions." As the Trump administration raised the wall in 2017 to 30ft in many areas, they started seeing more falls.
#EMSsky
January 9, 2025 at 5:28 PM
Dr. Berndston, trauma surgeon local to San Diego, talks about injuries at the US-Mexico border at #NAEMSP2025.
"As the wall height rose, so did trauma admissions." As the Trump administration raised the wall in 2017 to 30ft in many areas, they started seeing more falls.
#EMSsky
"As the wall height rose, so did trauma admissions." As the Trump administration raised the wall in 2017 to 30ft in many areas, they started seeing more falls.
#EMSsky
@qipunks.bsky.social leading a debrief after learning about PDSAs through deliberate play at the quality and safety course at #NAEMSP2025.
January 7, 2025 at 7:53 PM
@qipunks.bsky.social leading a debrief after learning about PDSAs through deliberate play at the quality and safety course at #NAEMSP2025.
Gabe Gan presenting a dissection of the anatomy of the run chart. This is one way to measure improvement in your system!
#NAEMSP2025
#NAEMSP2025
January 6, 2025 at 10:19 PM
Gabe Gan presenting a dissection of the anatomy of the run chart. This is one way to measure improvement in your system!
#NAEMSP2025
#NAEMSP2025
At least 20% of EMS patients report with pain, and only 15% of those with a pain score have pain reduced. Prehospital pain management is important, and we suck at it. How do we improve?
Dr. Redlener talking about how to pick an improvement project and set aims at #NAEMSP2025!
#EMSSky
Dr. Redlener talking about how to pick an improvement project and set aims at #NAEMSP2025!
#EMSSky
January 6, 2025 at 6:41 PM
At least 20% of EMS patients report with pain, and only 15% of those with a pain score have pain reduced. Prehospital pain management is important, and we suck at it. How do we improve?
Dr. Redlener talking about how to pick an improvement project and set aims at #NAEMSP2025!
#EMSSky
Dr. Redlener talking about how to pick an improvement project and set aims at #NAEMSP2025!
#EMSSky
While we cannot verify which patients had true mechanical capture, the post-BP was significantly higher in the true electrical capture group.
While median current and survival rates were higher in the true electrical capture group, the samples were too small to detect a difference.
While median current and survival rates were higher in the true electrical capture group, the samples were too small to detect a difference.
December 4, 2024 at 7:45 PM
While we cannot verify which patients had true mechanical capture, the post-BP was significantly higher in the true electrical capture group.
While median current and survival rates were higher in the true electrical capture group, the samples were too small to detect a difference.
While median current and survival rates were higher in the true electrical capture group, the samples were too small to detect a difference.
Despite all 23 having a "palpated pulse," 19 had false electrical capture, an arcing electrical artifact masquerading as electrical capture. See this image from the study where the underlying bradycardic rhythm makes interpretation even more difficult.
December 4, 2024 at 7:45 PM
Despite all 23 having a "palpated pulse," 19 had false electrical capture, an arcing electrical artifact masquerading as electrical capture. See this image from the study where the underlying bradycardic rhythm makes interpretation even more difficult.
Going to provide a brief #MedSky overview of false electrical capture during transcutaneous pacing (TCP) by paramedics in prehospital 9-1-1 response.
🧵
Articles of interest:
www.tandfonline.com/doi/full/10....
www.tandfonline.com/doi/full/10....
onlinelibrary.wiley.com/doi/10.1111/...
🧵
Articles of interest:
www.tandfonline.com/doi/full/10....
www.tandfonline.com/doi/full/10....
onlinelibrary.wiley.com/doi/10.1111/...
December 4, 2024 at 7:45 PM
Going to provide a brief #MedSky overview of false electrical capture during transcutaneous pacing (TCP) by paramedics in prehospital 9-1-1 response.
🧵
Articles of interest:
www.tandfonline.com/doi/full/10....
www.tandfonline.com/doi/full/10....
onlinelibrary.wiley.com/doi/10.1111/...
🧵
Articles of interest:
www.tandfonline.com/doi/full/10....
www.tandfonline.com/doi/full/10....
onlinelibrary.wiley.com/doi/10.1111/...
Who would've seen this coming??
November 25, 2024 at 2:43 PM
Who would've seen this coming??
Hi folks!
We are hosting a chat with @ResusPadawan this evening at 7pm ET about working in CCM, EM, and EMS.
Particularly targeting students and residents. All are welcome!
#emimcc
We are hosting a chat with @ResusPadawan this evening at 7pm ET about working in CCM, EM, and EMS.
Particularly targeting students and residents. All are welcome!
#emimcc
November 14, 2024 at 2:44 PM
Hi folks!
We are hosting a chat with @ResusPadawan this evening at 7pm ET about working in CCM, EM, and EMS.
Particularly targeting students and residents. All are welcome!
#emimcc
We are hosting a chat with @ResusPadawan this evening at 7pm ET about working in CCM, EM, and EMS.
Particularly targeting students and residents. All are welcome!
#emimcc
Mojo thinks it is too cold today.
November 13, 2024 at 12:39 PM
Mojo thinks it is too cold today.