Loss of empathy in medical school understood from the Buddhist concept of non-self

As students progress through medical school the level of empathy they entered with declines during the four years of education. Although no specific aspect of the medical curriculum has been shown to directly decrease empathy, the decline raises concern for adequate patient centered medical education. Such a loss can then lead to an erosion of ethical behavior and patient care. Although there are multiple theories regarding causes for the decline in empathy, I propose that the loss of empathy in medical school correlates with the search for a professional identity and is best understood from the perspective of Buddhist psychological theory

The decline in medical student empathy: a student's perspective

As students progress through medical school the level of empathy they entered with declines during the four years of education. Multiple explanations for the decline have been set forth in the literature such as the stressful medical curriculum, transmission of attitudes from upper level residents, and the displaced professional identity of students. I analyze the empathetic decline through the lens of a third year medical student in order to demonstrate how the challenges of developing a professional identity contribute to the empathetic loss. The decline correlates to a pursuit of self-advancement in a professional sense. I propose that in the end, this decline exists as a logical outcome from the professional expectations that medical students, faculty, and institutions place on graduating seniors. Shifting an understanding of the self away from the purely Western to a more traditionally Eastern view can help reduce the decline

Examination of Disparities in Prehospital Encounters for Pediatric Asthma Exacerbations

INTRODUCTION: There are disparities in multiple aspects of pediatric asthma care; however, prehospital care disparities are largely undescribed. This study\u27s objective was to examine racial and geographic disparities in emergency medical services (EMS) medication administration to pediatric patients with asthma. METHODS: This is a substudy of the Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial, which includes data from pediatric asthma patients ages 2-18 years. We examined rates of EMS administration of systemic corticosteroids and inhaled bronchodilators by patient race. We geocoded EMS scene addresses, characterized the locations\u27 neighborhood-based conditions and resources relevant to children using the Child Opportunity Index (COI) 2.0, and analyzed associations between EMS scene address COI with medications administered by EMS. RESULTS: A total of 765 patients had available racial data and 825 had scene addresses that were geocoded to a COI. EMS administered at least 1 bronchodilator to 84.7% ( CONCLUSIONS: There were no racial differences in EMS administration of medications to pediatric asthma patients. However, there were significantly higher rates of EMS bronchodilator administration for encounters in low/very low COIs. That latter finding may reflect inequities in asthma exacerbation severity for patients living in disadvantaged areas

Areas of Potential Impact of the Patient Protection and Affordable Care Act on EMS: A Synthesis of the Literature

This comprehensive review synthesizes the existing literature on the Patient Protection and Affordable Care Act’s (ACA) as it relates to Emergency Medical Services (EMS) in order to provide guidance for navigating current and future healthcare changes.  Patient usage and access to care, healthcare quality assessments, reimbursement changes, new EMS innovations, and changes to emergency preparedness are the major areas impacted by the ACA. Many changes enacted by the ACA directly affect emergency care with potential indirect effects on EMS systems. New Medicaid enrollees and changes to existing coverage plans may alter EMS transport volumes. Reimbursement changes such as adjustments to the Ambulance Inflation Factor (AIF) alter the yearly increases in EMS reimbursement by incorporating the multifactor productivity value into yearly reimbursement adjustments. New initiatives, funded by the Center for Medicare & Medicaid Innovation (CMMI) are exploring novel and cost effective prehospital care delivery opportunities while EMS agencies individually explore partnerships with healthcare systems

Areas of Potential Impact of the Patient Protection and Affordable Care Act on EMS: A Synthesis of the Literature

Introduction: This comprehensive review synthesizes the existing literature on the Patient Protection and Affordable Care Act (ACA) as it relates to emergency medical services (EMS) in order to provide guidance for navigating current and future healthcare changes. Methods: We conducted a comprehensive review to identify all existing literature related to the ACA and EMS and all sections within the federal law pertaining to EMS. Results: Many changes enacted by the ACA directly affect emergency care with potential indirect effects on EMS systems. New Medicaid enrollees and changes to existing coverage plans may alter EMS transport volumes. Reimbursement changes such as adjustments to the ambulance inflation factor (AIF) alter the yearly increases in EMS reimbursement by incorporating the multifactor productivity value into yearly reimbursement adjustments. New initiatives, funded by the Center for Medicare & Medicaid Innovation are exploring novel and cost-effective prehospital care delivery opportunities while EMS agencies individually explore partnerships with healthcare systems. Conclusion: EMS systems should be aware of the direct and indirect impact of ACA on prehospital care due to the potential for changes in financial reimbursement, acuity and volume changes, and ongoing new care delivery initiatives.[West J Emerg Med. 2017;18(3)446-453.

Impact of an Extraglottic Device on Pediatric Airway Management in an Urban Prehospital System

Introduction: Prehospital pediatric endotracheal intubation has lower first-pass success rates compared to adult intubations and in general may not offer a survival benefit. Increasingly, emergency medical services (EMS) systems are deploying prehospital extraglottic airways (EGA) for primary pediatric airway management, yet little is known about their efficacy. We evaluated the impact of a pediatric prehospital airway management protocol change, inclusive of EGAs, on airway management and patient outcomes in children in cardiac arrest or respiratory failure.Methods: Using data from a large, metropolitan, fire-based EMS service, we performed an observational study of pediatric patients with respiratory failure or cardiac arrest who were transported by EMS before and after implementation of an evidence-based airway management protocol inclusive of the addition of the EGA. The primary outcome was change in frequency of intubation attempts when paired with an initial EGA. Secondary outcomes included EGA and intubation success rates and patient survival to hospitalization and discharge.Results: We included 265 patients age <16 years old, with 142 pre- and 123 post-protocol change. Patient demographics and event characteristics were similar between groups. Intubation attempts declined from 79.6% pre- to 44.7% (p<0.01) post-protocol change. In patients with an intubation attempt, overall intubation success declined from 81.4% to 63.6% (p<0.01). Post-protocol change, an EGA was attempted in 52.8% of patients with 95.4% success.Conclusion: Implementation of an evidenced-based airway management algorithm for pediatric patients, inclusive of an EGA device for all age groups, was associated with fewer prehospital intubations. Intubation success may be negatively impacted due to decreases in procedural frequency