Emergent Leadership – why it works, just ask Google

The concept of Emergent Leadership is evolving as another practical leadership theory; we here at rightseatmedicine believe you may find inherent value in this concept for the prehospital enviornment.

What is Google saying about their hiring practices? Well, lots of things, (you can read the full article in the New York Times here) yet in summary; this is what one of the most successful companies thCA05RIRIis finding in relation to ideal candidate identification, successful behaviours and subsequent emergent leadership within their community.

  •  “G.P.A.’s are worthless as a criteria for hiring, and test scores are worthless. … We found that they don’t predict anything.” He also noted that the “proportion of people without any college education at Google has increased over time” — now as high as 14 percent on some teams.
  • For every job, though, the No. 1 thing we at Google look for is general cognitive ability, and it’s not I.Q. It’s learning ability. It’s the ability to process on the fly. It’s the ability to pull together disparate bits of information. We assess that using structured behavioral interviews that we validate to make sure they’re predictive.”

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AVR STEMI – your LP15 wont interpret this one for you

lmca2AVR STEMI, Left Main Coronary Occlusion (LMCA), proximal LAD occlusion, triple vessel disease… worthy of your attention…for sure.

Will your LP15 flag this one as a STEMI for you. Unfortunately not.AVR STEMI

In the setting of ACS, STE in aVR…

  • + STE in avL = LMCA occlusion
  • + STE in V1 = LMCA or proximal LAD occlusion
  • STE in avR > STE V1 = LMCA occlusion
  • STE in aVR not applicable in setting of SVT or in asymptomatic patients without ischemic symptoms

Regardless, the literature continues to show with increasing consistency that STE in lead aVR in patients with ACS is associated with more ominous coronary occlusions¹˜². aVR positivity was an independent predictor of in-hospital death³. As Dr Amal Mattu presents,

STE in aVR with other ischemic findings on ECG is BAD!

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The 4-7-1 NOLS Leadership Model

The National Outdoor Leadership School (NOLS) succinctly defines leadership as; situationally appropriate action/s that direct/s or guide/s your7-4-1 diagram group to set and achieve realistic goals, and here at Right Seat Medicine we believe both highly appropriate and easily transferrable to the prehospital environment.

The NOLS 4:7:1 Leadership model allows us to separate the often ambiguous and overused term of ‘leadership’ into three distinct categories of 4 roles, 7 skills and one style.  Continue reading

Capnography – ETCO2 monitoring and the way forward

Capnography now readily available to most paramedics and should be the prehospital standard of care for confirmation and continuous monitoring of intubation, as well as for monitoring ventilation and perfusion in any respiratory pt encountered. Additionally, it should see increasing use in the monitoring of any unstable patient of any aetiology, as well as optimizing trending within your perfusion assessment.images

Traditionally (here in the Lower Mainland of BC) in line ETCO2 was used only for the confirmation of tube placement in the intubated patient. Many resourceful practitioners saw the value of this tool and creatively would snip away the in line T piece, inserting the now open hosing into a simple face mask and then having access to microstream™ capnography technology and real time ventilatory telemetry in the conscious patient. Continue reading

Peri-shock Pause: An independent predictor of Survival From Out-of-Hospital Shockable Cardiac Arrest

Dr Sheldon Cheskes (Medical Director, Sunnybrook Centre for Prehospital Medicine) presents their landmark study that focuses on the relationship between shock pause to hospital discharge.

Peri-shock Pause: An independent predictor of Survival From Out-of-Hospital Shockable Cardiac Arrest.

This link has Dr Cheskes presenting the practical applications that can be used in every day prehospital care. Great stuff. Enjoy

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Evidence Based Physical Diagnosis

Another exceptional text for the pre hospital diagnostician.


In the absence of lab results or technological wizardry to the street based pre hospital practitioner (here in the Lower Mainland or any service), this text will serve you well in providing the evidence based weighting of physical findings for application throughout your differential diagnoses.

McGee presents to us  likelyhood ratios and statistical findings based in evidence that allow one to appropriately weight those physical findings of our patients as presented.

A thorough text that nicely encompasses the subtitles of our craft and assists with the evolving differential diagnosis of the pre hospital patient.

Tribal Leadership

A recent epiphany I would like to share after exposed to the Tribal Leadership model as a way to both quantify and identify with various organizational challenges and how

Tribal Leader banner to effect positive change upon an organizational culture.

 It’s not about changing people’s beliefs, attitudes, motivations or ideas. Tribal Leadership focuses on two things, the words people use and the relationships they form.


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Combat Aviation Paradigms for Resuscitationalists


From Emcrit.org, Dr Joe Novak’s podcast on Combat Aviation Paradigms for Resuscitationalists.


Whilst Dr Novak’s language focuses on the physician in hospital, the lessons here within can be easily transitioned into the pre hospital environment.

Particularly the concept of Prioritization of Attention and Tasks;

  1. Resuscitate
  2. Differentiate
  3. Coordinate & Communicate

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