Nick Friedman is an MD Candidate at the Stanford University School of Medicine. His administrative leadership roles and research focus on innovation in emergency medicine, with emphasis on prehospital emergency care and addiction medicine. Nick was selected for the Stanford Healthcare Leadership and Administration Fellowship in the Department of Emergency Medicine and he is currently the Director of Quality Improvement for the Addiction Treatment Services Innovation Hub at the Palo Alto Veterans Affairs Medical Center. He served as Editor-in-Chief of The Journal of Collegiate Emergency Medical Services, and his research and writing have been published in The American Journal of Emergency Medicine, Prehospital Emergency Care, Prehospital and Disaster Medicine, and others.
Additionally, Nick maintains a special interest in philosophy and ethics. He taught philosophy and ethics of science at the high school level and he is the Founding President of the Stanford Philosophy of Medicine Society.
Nick is proud to serve as a soldier in the Army National Guard and remains committed to prehospital emergency care as an Emergency Medical Technician.
Harm reduction and emergency medical services: Opportunities for evidence-based programming.
The American journal of emergency medicine
2023; 72: 85-87
Overdose fatalities are increasingly attributed to synthetic opioids, including fentanyl, which may be added to samples of illicit substances unknowingly to the user. As recently as April 2023, the Centers for Disease Control and Prevention has also raised awareness of the risks of xylazine, an animal tranquilizer that has been found in adulterated samples of illicit substance. A growing body of evidence supports the use of drug testing services, including fentanyl and xylazine test strips, to reduce the risks associated with substance use and prevent fatal overdoses. Emergency medical services clinicians serve on the frontline of the opioid epidemic and are uniquely positioned to distribute harm reduction materials. In this article, we advocate for emergency medical services to distribute fentanyl and xylazine test strips. We also critically evaluate legal and other barriers to implementation.
View details for DOI 10.1016/j.ajem.2023.07.025
View details for PubMedID 37499554
Prehospital Pediatric Emergency Training Using Augmented Reality Simulation: A Prospective, Mixed Methods Study.
Prehospital emergency care
ObjectivePediatric emergencies are high-stakes yet low-volume clinical encounters for emergency medical services (EMS) clinicians, necessitating innovative approaches to training. We sought to explore the acceptability, usability, and ergonomics of a novel augmented reality (AR) software for EMS crisis management training.MethodsThis was a prospective, mixed-methods study employing qualitative and quantitative analyses. We enrolled emergency medical technicians (EMTs) and paramedics at a municipal fire service in Northern California. We ran the Chariot Augmented Reality Medical simulation software (#details_redacted_for_peer_review) on the ML1 headset (Magic Leap, Inc., Plantation, FL), which enabled participants to view an AR image of a patient overlaid with real-world training objects. Participants completed a simulation of a pediatric hypoglycemia-induced seizure and cardiac arrest. Participants subsequently engaged in structured focus group interviews assessing acceptability, which we coded and thematically analyzed. We evaluated the usability of the AR system and ergonomics of the ML1 headset using previously validated scales, and we analyzed findings with descriptive statistics.ResultsTwenty-two EMS clinicians participated. We categorized focus group interview statements into seven domains after an iterative thematic analysis: general appraisal, realism, learning efficacy, mixed reality feasibility, technology acceptance, software optimization, and alternate use cases. Participants valued the realism and the mixed reality functionality of the training simulation. They reported that AR could be effective for practicing pediatric clinical algorithms and task prioritization, building verbal communication skills, and promoting stress indoctrination. However, participants also noted challenges with integrating AR images with real-world objects, the learning curve required to adapt to the technology, and areas for software improvement. Participants favorably evaluated the ease of use of the technology and comfortability of wearing the hardware; however, most participants reported that they would need technical support.ConclusionParticipants positively evaluated the acceptability, usability, and ergonomics of an AR simulator for pediatric emergency management training, and participants identified current technological limitations and areas for improvement. AR simulation may serve as an effective training adjunct for prehospital clinicians.
View details for DOI 10.1080/10903127.2023.2224876
View details for PubMedID 37318845
NURSE, PROVIDER, AND EMERGENCY DEPARTMENT TECHNICIAN: PERCEPTIONS AND EXPERIENCES OF VIOLENCE AND AGGRESSION IN THE EMERGENCY DEPARTMENT
JOURNAL OF EMERGENCY NURSING
2023; 49 (3): 431-440
Patient/visitor violence and aggression (V&A) in the emergency department occurs daily. Few interventions exist to decrease V&A. Research describing prevalence, severity, and perceived safety among ED clinicians is limited.A descriptive survey explored V&A against ED clinicians in one urban emergency department. A sample of nurses, ED technicians, physicians and advanced practice providers participated. Participants completed a demographic survey, Personal Workplace Safety Instrument for Emergency Nurses (PWSI-EN), and ENA V&A frequency checklist. Analysis of Variance (ANOVA) for unadjusted and Analysis of Covariance (ANCOVA) for adjusted associations were used to assess differences in the PWSI-EN survey composite score and "feeling safe in the ED" among ED roles. ANCOVA was adjusted for potential confounders: sex, race, years working in emergency department, and shift worked.Sixty-five (46.4%) of the 140 ED clinicians returned surveys, which were almost evenly distributed between ED clinician roles and sex. Mean age was 37.2 (range: 21-64) years. All (100%) nurses and providers reported being verbally abused. More nurses reported physical violence (n = 21, 87.5%) than providers (n = 7, 36.8%) and ED technicians (n = 11, 55%). Nurses and ED technicians reported experiencing greater prevalence of physical violence than providers (P < .05). Nurses (mean 3.29, range 2.95 to 3.63) were more fearful for their personal safety than ED technicians (mean 3.88, range 3.48 to 4.28) (P < .03).V&A are common creating a fearful environment. However, little research regarding clinician perceptions exists. Our study aids in identifying areas for clinician-targeted strategies to prevent ED V&A.
View details for DOI 10.1016/j.jen.2022.07.008
View details for Web of Science ID 001000339600001
View details for PubMedID 36180265
Promoting a health-centered approach to acute mental health crises on college campuses: The case for collegiate-based emergency medical services
JOURNAL OF AMERICAN COLLEGE HEALTH
As college and university campuses re-open during the COVID-19 pandemic, there is increased concern for mental health crises. Current trends in campus mental health care emphasize providing quality care in a safe, non-judgmental, and non-punitive manner. Collegiate-based emergency medical services organizations are well-positioned to respond to acute mental health crises on college campuses. Campus health professionals and administrators seeking to promote a health-centered approach toward mental health crises should support the growth and development of collegiate-based emergency medical services organizations.
View details for DOI 10.1080/07448481.2022.2104616
View details for Web of Science ID 000838049400001
View details for PubMedID 35943954
Characteristics and outcomes of cardiac arrests reported in the national collegiate emergency medical services foundation data registry.
Journal of American college health : J of ACH
The objective of this study was to identify out-of-hospital cardiac arrest characteristics for patients treated by collegiate-based emergency medical services (CBEMS) organizations.CBEMS organizations provided data via the National Collegiate EMS Foundation Cardiac Arrest Data Registry.CBEMS organization details, patient demographics, cardiac arrest characteristics and treatments, and prehospital outcomes for cases spanning October 2007 to May 2020 were analyzed with descriptive statistics.There were 65 OHCA entries. The majority were for male patients (82%) and a notable number of cases occurred in patients 45 years of age or younger (41%). Cases were frequently witnessed (71%) with high rates of bystander cardiopulmonary resuscitation (57%) and defibrillation (29%) prior to EMS arrival. Almost half of the patients (48%) had achieved return of spontaneous circulation until care was transferred to a provider of equal/higher level.CBEMS organizations may be well situated to respond rapidly to on-campus OHCAs.
View details for DOI 10.1080/07448481.2022.2066976
View details for PubMedID 35472006
Firefighting Induces Acute Inflammatory Responses that are not Relieved by Aspirin in Older Firefighters
JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
2019; 61 (7): 617-622
Sudden cardiac events account for 40% to 50% of firefighter line-of-duty deaths. Inflammatory proteins are strong biomarkers of cardiovascular inflammation. The present study investigated the effects of aspirin supplementation on inflammatory biomarkers following firefighting.Using a randomized, placebo-controlled, double-blind crossover design, 24 male firefighters (48.2 ± 5.9 years) were allocated into four conditions: acute (81 mg; single-dose) aspirin and placebo supplementation, and chronic (81 mg; 14 days) aspirin and placebo supplementation. Inflammatory proteins [interleukin (IL)-6, C-reactive protein (CRP), intracellular adhesion molecule (ICAM)-1, P-selectin, matrix metalloproteinase-9 (MMP-9)] and antioxidant potential [total antioxidant capacity (TAC)] were measured pre- and post-structural firefighting drills.Firefighting activities significantly increased IL-6, MMP-9, and P-Selectin; however, no changes in TAC and ICAM-1 were detected. Neither acute nor chronic aspirin supplementation attenuated this inflammatory response.Firefighting significantly increases inflammatory biomarkers and neither acute nor chronic low-dose aspirin mitigates this response.
View details for DOI 10.1097/JOM.0000000000001626
View details for Web of Science ID 000480785100015
View details for PubMedID 31090673
Implementation of a Mental Health Task Force in a collegiate-based emergency medical services organization
JOURNAL OF AMERICAN COLLEGE HEALTH
2020; 68 (5): 460-464
Objective: A Mental Health Task Force (MHTF) was implemented in 2016 by a collegiate-based emergency medical services (CBEMS) organization to (1) improve mental health emergency response and to (2) address concerns for the mental health of CBEMS providers. Participants: Skidmore College EMS is a Basic Life Support First Response service staffed by volunteer undergraduate students. Methods: In coordination with faculty and staff, students in the MHTF developed trainings, peer support structures, community events, policies, and informational resources. Results: Sixteen students joined the MHTF within 1 year. Over 35 Skidmore College EMS members received training on mental health emergency response, peer-support, and self-care. Debriefing programs, mindfulness-based events, shift-length limitations, and access to informational resources promoted the mental health of Skidmore College EMS members. Conclusions: Implementing an MHTF is an innovative, student-led approach to coupling education on emergency response with programming that supports the mental health of CBEMS providers.
View details for DOI 10.1080/07448481.2019.1583654
View details for Web of Science ID 000465699400001
View details for PubMedID 30946625
Mass-Gathering Medical Care Provided by a Collegiate-Based First Response Service at an Annual College Music Festival and Campus-Wide Celebration
PREHOSPITAL AND DISASTER MEDICINE
2019; 34 (1): 98-103
There is insufficient research on medical care at mass-gathering events (MGEs) on college and university campuses. Fun Day is an annual celebratory day held at Skidmore College (Saratoga Springs, New York USA), a small liberal arts college in the Northeastern United States. Fun Day is focused around an outdoor music festival; students also congregate and celebrate throughout the surrounding campus. To improve care and alleviate strain on local resources, a model was developed for the provision of emergency care by a collegiate-based, volunteer first-response service - Skidmore College Emergency Medical Services (EMS) - in coordination with a contracted, private ambulance service.The aims of this study were to: (1) analyze medical usage rates and case mixes at Fun Day over a four-year period, and to (2) describe the collegiate-based first response model for MGEs.Data were collected retrospectively from event staff, college administrators, and Skidmore College EMS on event-related variables, patient encounters, and medical operations at Fun Day over a four-year period (2014-2017).Annual attendance at the music festival was estimated at 2,000 individuals. Over four years, 54 patients received emergency medical care on campus on Fun Day, and 18 (33.3%) were transported to the emergency department. On-site contracted ambulances transported 77.8% of patients who were transported to the emergency department; mutual aid was requested for the other 22.2% of transports. The mean (SD) patient presentation rate (PPR) was 7.0 (SD = 1.0) per 1,000 attendees. The mean (SD) transport-to-hospital rate (TTHR) was 2.0 (SD = 1.0) per 1,000 attendees. Thirty (55.6%) patients presented with intoxication, seven (13.0%) with laceration(s), and five (9.3%) with head trauma as the primary concern. Medical command was established by volunteer undergraduate students. Up to 16 volunteer student first responders (including emergency medical technicians [EMTs]) were stationed on campus, in addition to two contracted ambulances at the Basic Life Support (BLS) and Advanced Life Support (ALS) levels. Operational strategies included: mobile first response crews, redundant communication systems, preventative education, and harm reduction.High medical usage rates were observed, primarily due to alcohol/illicit substance use and traumatic injuries. The provision of emergency care by a collegiate-based first response service in coordination with a contracted, private ambulance agency serves as an innovative model for mass-gathering medical care on college and university campuses.FriedmanNMG, O'ConnorEK, MunroT, GoroffD.Mass-gathering medical care provided by a collegiate-based first response service at an annual college music festival and campus-wide celebration. Prehosp Disaster Med. 2019;34(1):98-103.
View details for DOI 10.1017/S1049023X18001103
View details for Web of Science ID 000459195300015
View details for PubMedID 30585146