* Solution Looking for a Problem

* Ketamine for Agitated/ Excited Delirium

* Don't Throw the Baby Out with the Bath Water

* Ketamine Lollipops and Training

* Constitutional Rights and Ketamine

* 14,000 vs. 1,400 Patients

* Minimum Competency

* De-escalation versus Pharmacology

* Three Traits of a Professional

This special episode of "Sacred Cows & Data Cubes" was recorded at the HCA (Hospital Corporation of America) EMS Kansas City Symposium in November 2021. It features an emotional anecdote of post-traumatic stress and recovery by Atchison County (KS) EMS captain and retired Fire Chief Rob Brader.

There is safety in numbers: both the math and statistics — and the herd, where one stay anonymous by choice without worry that exorcizing the demons of Mobile Medicine will result in persecution for the dark thoughts that inevitably spawn of this emotional work.  

“Let the numbers do the talking” is a core tenet of the approach first revealed to Jonathon Feit, chief executive of Beyond Lucid Technologies by Ron Nichols, director of Chambers County Emergency Medical Services in Texas. Ron uses a questionnaire to see sparks of mental health stress among his personnel in a manner similar to how others might identify infections (say, COVID-19) before they spiral out of control. His crew members have to write an ePCR after every call; and any member of the crew can catch a bad call. He recognized that this offers two opportunities for insight:

1. The ePCR not only offers details about what happened on the call, it also offers details about what the crew experiencedduring the call;

1. If every member of every crew completes a wellness survey after every call—or even after every call involving specific sentinel events—then the requirement to complete a mental wellness or trauma impact survey becomes, by definition, randomly distributed.  There is no longer a need for anyone to “step forward” because everyone has the same requirement. Anyone can catch an unfortunate call.

The result is compelling: The data in ePCRs become vital to crews’ mental wellness and health.  No longer are ePCRs mere busywork; no longer should they be despised.  Instead, they become something akin to a recurrent Rorschach test for each member of the crew, revealing how they are doing call-by-call, and in aggregate — inviting management to pay attention.  At the end of this discussion, we’ll ask: Can agencies really afford not to step in to help, especially amid a talent crunch?

If the analytics can be automated and tuned to examine ePCRs over time, then they can reveal who needs help without a crew member saying anything.  This empowers watchful management to step ahead of a health crisis in-the-making, bolstering agency morale and resiliency, satisfaction and safety.  ePCR data—maximized to their potential and strung together over time—therefore go beyond the collection of legal, billing, and NEMSIS data.  They become a tool to safeguard Mobile Medicine’s most precious resource: its professionals on the line.

Tim is also the assistant chief of special operations with a county-wide EMS agency based in Florida, where he oversees the planning and logistics sections, special operations functions and community paramedicine programs for the agency.

This podcast, the EMS Handoff crew is going to review Nowak's article, Training Day: 3 options for safely transporting your pediatric patient.

1. Pediatric transports can be challenging!

• Safe versus Not Safe

• “Mom holding onto baby”

2. Best practices for pediatric transport in the ambulance

• The “Working Group Best-Practice Recommendations for the Safe Transport of Children in Emergency Ground Ambulances” https://www.nhtsa.gov/staticfiles/nti/pdf/811677.pdf
• NHTSA 1999 “Dos and Don’ts of Transporting Children in an Ambulance” https://www.nhtsa.gov/staticfiles/nti/pdf/811677.pdf

3. What is acceptable?

• Start with their own car seat
• Parents tend to keep up with their child’s growth
• What if it was in an accident?
  • 2012 NHTSA document https://www.nhtsa.gov/staticfiles/nti/pdf/811677.pdf
  • No visible damage

  • Where do you place them in the vehicle?

4. Car Restraint Systems

• Inflatable car seats
• In-seat/ convertible restraint systems

• Cot-secured, adjustable straps

• Contour-padded restraint systems
• Roll-out restraint systems

5. Four-point shoulder/ chest restrains

• Pad the voids

• Use four-point straps

6. What is not acceptable

• No one in the ambulance – parents, caregivers, medics or other passengers should be unrestrained during transport.

• Consider your options and plan ahead so you are prepared when faced with a pediatric patient.

7. 4 Safety considerations for Pediatric Transport

• Do tightly secure all monitoring devices and other equipment
• Do ensure available restraint systems are used by personnel and other occupants, including the patient.
• Do not have the child/infant held in the parent’s caregiver’s or EMS personnel’s arms or lap during transport.

• Do not allow emergency vehicles to be operated by persons who have not completed an approved driving course.

“The next time you are completing your PCR, take a look at all of the transport options.  Via stretcher leads the pack, but mom holding onto baby…. Well, it is not there for a reason…”

Read the full article on EMS Airway.

https://www.rollingstone.com/culture/culture-news/onlyfans-medic-lauren-kwei-new-york-post-interview-1104943/amp/?__twitter_impression=true&fbclid=IwAR0oIS12IOLfE5cr93J9lI2Th_QybZdwz9bQUAsLhHlo1f9idQRh859Ap-U

Sexy brings readers in, but the point is that medics are not paid enough to survive in NYC

Not just EMS....

Nursing and Only Fans

https://www.buzzfeednews.com/article/otilliasteadman/pandemic-nurses-onlyfans-sex-work

Med Student and Only Fans

https://vt.co/lifestyle/medical-student-makes-over-70000-a-year-selling-pictures-of-her-feet-online

The poster child for the paramedic pay gap - Sexy gets them in the door, then they will hear the underlying point....

Bess Meyerson was the only Jewish Miss America and a heroine to the Jewish community, where "she was the most famous pretty girl since Queen Esther."

https://en.wikipedia.org/wiki/Bess_Myerson

FEMEN

https://en.wikipedia.org/wiki/Femen

https://www.google.com/search?q=femen&newwindow=1&sxsrf=ALeKk01Q7JNZYoNddHbZvgOqv4od0osrCQ:1608402565240&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjB6Lm81trtAhXup1kKHbNcAQ8Q_AUoAXoECAcQAw&biw=1920&bih=1001

Topic #2: Paramedics with Guns

https://www.arkansasonline.com/news/2020/dec/17/pine-bluff-man-fatally-shot-after-shooting-paramed/

-Should be able to carry legal weapons 

-It depends on the culture

As State EMS Director, I made the commitment to go to court with every EMT and paramedic that has been assaulted, so that our county prosecutors (district attorneys) knew that State OEMS was paying attention and wanted to see people charged accurately.  Because the criminal justice system is overwhelmed and wants to plead everything down.

N.J.S.A. 2C:12-1 Assault. 2C:12-1. Assault. b. Aggravated assault. A person is guilty of aggravated assault if he: (5)Commits a simple assault as defined in subsection a. (1), (2) or (3) of this section upon: (c)Any person engaged in emergency first-aid or medical services acting in the performance of his duties while in uniform or otherwise clearly identifiable as being engaged in the performance of emergency first-aid or medical services; or

NY Consolidated Laws, Penal Law §120.08 Assault on a peace officer, police officer, firefighter or emergency medical services professional.

A person is guilty of assault on a peace officer, police officer, firefighter or emergency medical services professional when, with intent to prevent a peace officer, police officer, a firefighter, including a firefighter acting as a paramedic or emergency medical technician administering first aid in the course of performance of duty as such firefighter, or an emergency medical service paramedic or emergency medical service technician, from performing a lawful duty, he or she causes serious physical injury to such peace officer, police officer, firefighter, paramedic or technician. Assault on a peace officer, police officer, firefighter or emergency medical services professional is a class C felony. (3.5-15 years)

Three NJ EMS Clinicians were just suspended this week for punching a patient

https://www.ems1.com/violent-patient-management/articles/nj-emts-accused-of-punching-patient-in-ambulance-say-it-was-self-defense-Veew7de6yOYvMexe/ https://www.state.nj.us/health/ems/documents/reg-enforcement/actions/2020-0109V.EMT.SummarySuspension.Bonvenca.RED.pdf https://www.state.nj.us/health/ems/documents/reg-enforcement/actions/2020-0108V.EMT.SummarySuspension.Han.RED.pdf https://www.state.nj.us/health/ems/documents/reg-enforcement/actions/2020-0107V.MICP.SummarySuspension.Piro.RED.pdf

ONLY two EMS Clinicians have ever been shot in NYC history:

• Kings County Hospital Ambulance Attendant Hannah Callahan was shot and killed by an EDP in December 1954.
• Ambulance Surgeon Thomas Garvey was shot in the shoulder by a drunk Swede in the back of the ambulance on the way to the hospital in Spanish Harlem in September 1894.
• No EMT or Paramedic in NJ to date has ever been shot by somebody else since 1874.

N.J.A.C. 8:40-4.11 (b) Crewmembers shall not wear or carry any weapons or explosives while on duty. For the purpose of this chapter, the terms "weapons" and "explosives" include not only offensive weapons, but also defensive weapons such as stun guns, stun batons, air tasers, pepper spray, mace defensive spray and/or telescopic steel batons.

N.J.A.C. 8:41-3.5 Physical behavioral restraints (d) Crewmembers shall not wear or carry any weapons or explosives while on duty. For the purpose of this chapter, the terms "weapons" and "explosives" include not only offensive weapons, but also defensive weapons such as stun guns, stun batons, air tasers, pepper spray, mace defensive spray and/or telescopic steel batons.

• Should engage in self-defense
• Should be able to carry legal weapons
• Should be punished for going overboard

Dr. Sarah Fabiano and Dr. Jeremy Cushman break down the recent FDA release linking acetaminophen (Tylenol) use during pregnancy to autism spectrum disorder.  They discuss the distinction between association and causation, highlighting how studies can show correlations without proving direct cause and effect. The doctors also address the complexity behind autism diagnoses, genetic and environmental factors, and the known risks of fever during pregnancy.  They emphasize that acetaminophen remains one of the safest and most effective options for pain and fever relief in pregnancy, especially compared to alternatives like ibuprofen or aspirin, which carry documented risks.  This discussion aims to clarify confusion, steer clear of fear-driven decisions and encourage informed use of medication based on current science—not headlines. 

Read more about the program and how you can help by clicking here.

Guest: Joe Slattery, BS Homeland Security & Emergency Management, Certified Healthcare Simulation Educator (CHSE), Certified Healthcare Simulation Operations Specialist (CHSOS)

Overview: In this episode of the EMS Handoff Podcast, Bradley and David welcome Joe Slattery, a dual-certified healthcare simulation expert with over 30 years of experience in EMS. Joe’s extensive background and passion for EMS education, specifically in simulation, shine as he shares insights into his work developing state-of-the-art simulation labs and curriculum for multiple hospitals and residency programs across southeast Florida. His projects aim to elevate EMS education by integrating hands-on, realistic scenarios that build critical thinking and clinical skills for healthcare providers.

Key Takeaways

1. Joe’s Background in Simulation and EMS Education Joe discusses his journey in EMS and simulation-based education, including his academic background in Homeland Security and Emergency Management. He holds dual certifications as a Certified Healthcare Simulation Educator (CHSE) and a Certified Healthcare Simulation Operations Specialist (CHSOS). He has dedicated his career to advancing EMS training and has presented at leading EMS and simulation conferences, including the International Meeting on Simulation in Healthcare (IMSH).
2. Designing Effective Simulation Scenarios Joe dives into the nuances of creating successful simulation scenarios, emphasizing how scenario design can either build or inhibit a learner’s critical thinking. He advocates for a thoughtful approach to setting learning objectives and aligning them closely with scenario details to prevent distractions or misdirected focus.
3. Safety in Healthcare Simulation: A Simple Scenario Joe shares a scenario he uses in his “Safety in Healthcare Simulation” lecture:

• Objective: Assemble a nebulizer and administer 2.5 mg of Albuterol Sulfate.
• Scenario Components: Using a manikin, a nebulizer, saline solution as a substitute for albuterol, and an oxygen source delivering 6-8 LPM.
• Patient Presentation: The manikin should have signs like wheezing, rhonchi, a history of asthma, or possible pneumonia. However, rales/crackles and peripheral edema are intentionally excluded as they would mislead the learner regarding the appropriateness of albuterol.

Connect with Joe Slattery

• Joe shares his passion for teaching and simulation and discusses upcoming projects where he is expanding simulation training in hospitals and residency programs. His expertise is shaping the next generation of EMS professionals, bringing essential skills to the forefront of healthcare education.

Tune In To Learn

• Best practices for simulation-based EMS education.
• How to craft scenarios that support—and not confuse—learning objectives.
• Real-world applications of simulation in healthcare for better patient outcomes.

Whether you're an EMS educator, a simulation enthusiast, or an EMS provider looking to refine your skills, this episode provides valuable insights into making simulations impactful, relevant, and effective for learners.

This commentary reflects the opinion of the Col. Wissemann and does not reflect those of the Department of Defense, the Defense Health Agency or Army Medicine.

This podcast is sponsored by LogRX. For all your medication and narcotic tracking needs, check out the LogRx App, created by career EMS professionals. Visit https://logrx.com/ to learn more.

This podcast is sponsored by ESO.

It’s that time again! ESO just dropped their 2024 EMS Index — a must-read benchmarking tool for every EMS agency. With insights from over 12 million EMS responses in 2023, it covers topics like bystander CPR, ambulance offload times, and opioid overdoses. Your FREE copy is available now at eso.com/ems-pod.

Paramedic Self‐efficacy and Skill Retention in Pediatric Airway Management by Youngquist, S.T. et. al.

Gausche Study: Criticism

1. Good study design, bad application and interpretation

-Intent to Treat Model, when 115 of 420 “Treat” patients had no intervention attempted at all, drives difference between groups to the null hypothesis. -Non-intubation was not considered a protocol violation: "Given that the data were analyzed by intention to treat, it is unlikely this 2.3% protocol violation rate had any effect on study results."

Except that, of course, this was exactly what the study was about!

2. It is the system, not the clinician! -Six hours of training. -No significant clinical exposure to pediatric intubation in operating room, emergency department, or prehospital settings. -Most had no retraining at all.  Two-hundred and twelve did (see second study attached) and only 66% of paramedics tested (139 ⁄ 211) passed skills testing with BMV (with a score of pass or higher), while 42% passed skills testing with ETI (88 ⁄ 212), with the odds of scoring among the higher grade levels on ETI skills testing was statistically lower for each additional month elapsed since initial training. -Here's the problem: They don't recognize that the clinician isn't the problem, the problem is their system's educational methodology (including continuing education): "These results call into question the current practice of paramedics intubating children in an urban, out-of-hospital setting...."  

It is the system, not the clinician!: Endotracheal Intubation: Factors for Success:

Experience2 One study reported that healthcare personnel needed to perform a minimum of 57 intubations before achieving a 90% success rate with this procedure. The authors of this meta-analysis believe that practitioners who intend to perform prehospital advanced airway management are unlikely to achieve high levels of competence without a period of in-hospital anesthetic training followed by an adequate number of intubations to maintain skill levels.  Exposure1 Exposure counts: -Experienced: 99% success ('experienced consultant anesthetists’), -Intermediate: 99% success (‘physicians in training in emergency medicine and anesthesia with some anesthetic experience’), -Basic: 92% success (‘non-physicians or those physicians with only limited anesthetic experience’) Environment2

Prehospital ETI cannot automatically be compared to ETIs performed in the emergency department or in the operating theatre, for two main reasons. Firstly, the majority of prehospital ETIs are done in CA patients or after major trauma in challenging settings, while the majority of in-hospital ETIs are done in a controlled environment. Secondly, prehospital ETIs are challenged by a number of environmental factors that may influence the failure rates and increase adverse events, including....

-Restricted patient access

-Suboptimal patient and operator positioning

-Limited equipment 

-Difficult or hazardous operating environments

Equipment3,1

Physician median (range) ETI success rates were 0.991 (0.973, 1.000) (all had RSI) Paramedic/Nurse c No Medications median (range) ETI success rates for non-physicians were 0.675 (0.491, 0.968) Paramedic/Nurse c Some Medications median (range) ETI success rates for non-physicians were 0.810 (0.755, 0.905) Paramedic/Nurse c RSI median (range) ETI success rates for non-physicians were 0.967 (0.758, 1.000)

A large recent study reported a doubling of the odds of intubation failure where no drugs were used.1

Comparing apples-to-apples for tools, ETI success was 99% for physicians vs 97% for paramedics/nurses....

But they still used biased language, not comparing apples-to-apples for tools (let alone experience or exposure)...

"When comparing physicians to non-physicians, the corresponding median (range) ETI success rates were 0.991 (0.973, 1.000) versus 0.849 (0.491, 0.990)." 

Resources

1. The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis. https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1603-7.
2. Airway management by physician-staffed Helicopter Emergency Medical Services – a prospective, multicentre, observational study of 2,327 patients. https://sjtrem.biomedcentral.com/articles/10.1186/s13049-015-0136-9
3. Patient safety in pre-hospital emergency tracheal intubation: a comprehensive meta-analysis of the intubation success rates of EMS providers. https://ccforum.biomedcentral.com/articles/10.1186/cc11189

Evidence-Based EMS takes the research articles to the ambulance and discusses best evidence based practices in pre-hospital care based on trending science.

Hosted by author and EMS scientific researcher Christian Ventura, NREMT, EMS-I, along with special guest speakers in all aspects of healthcare— this show aims to bridge the gap between the lab and the rig.

Join JEMS Editor Emeritus A.J. Heightman for an in-depth discussion with financial and legislative expert Asbel Montes on the present and future state of EMS. Other topics discussed include:

1. How telehealth has/will change the EMS landscape.
2. Internal financial mitigation solutions during the pandemic.
3. Federal and state solutions to help EMS bridge the financial delta.

Additionally, we discuss his introduction to writing textbooks and his views on EMS education moving into the future.

His wife tells you he has a history of congestive heart failure. He appears pale and diaphoretic, with snoring, slow, shallow breaths and his initial oxygen saturation is 72%. What are the most important first steps in managing his airway and breathing?

Read the full article on EMS Airway.

The bombings took place at two separate highly-frequented bus stops in the city and stirred old traumas from attacks in the early 2000s.

This was the first such terror bombing to take place in the country since 2011.

Trauma Behind the Badge Co-Founder Christopher Scallon shares his truths and vulnerabilities.

Show Highlights:

• Monkeypox threat and guidance
• NREMT Resolution 22-Resolution-13 on accreditation requirement
• Retention and leadership

Don’t forget to go by our website at www.emshandoff.com or reach out to us on our Facebook pages. 

McKee Somerville shares her story about insecurities about entering EMS later in life, balancing motherhood, going through a divorce and pausing and restarting paramedic school.

"It was really hard when the personal side would come in. I wasn't home enough... I was being judged from family and close friends," Somerville said. "Being away from the kids is the hardest thing on my mental wellness, but the one thing they understand, is that I am helping someone."

----more----

Ryan Thorne, founder and CEO of Thorne Ambulance Service, talks about accountability, leadership, retention and more.

The world of EMS in Israel has drastically changed in the past 20 years, from the innovation of the ambucycle, to pocket BVM’s, and the creation of an nationwide Uber-like network of first responders who provide emergency medical services free of charge to anyone, anywhere, United Hatzalah has been at the forefront of technological innovations that have been pushing the field of EMS forward throughout the 21st century. 

And the innovations continue. Due to the magnitude of instances where these devices and technologies have saved lives, this episode will be done in at least two parts. 

Topics for this episode include: Socially disruptive innovation and how we used it to lower response times, putting the community at the forefront of lifesaving and small scale innovations at the scene of an emergency.

In part 2 we will discuss our newer innovations from the past year including our new communications and phone technology, the Carbyne system, and co-sharing collapsible cars.

References

Prehospital Nitroglycerin Safety in Inferior ST Elevation Myocardial Infarction

https://pubmed.ncbi.nlm.nih.gov/26024432/

• NTG administration to patients with chest pain and inferior STEMI is not associated with a higher rate of hypotension compared to patients with STEMI in other territories.

The Era of Reperfusion

https://www.ahajournals.org/doi/10.1161/circ.102.suppl_1.I-172

 JEMS

https://www.jems.com/training-videos/nitro-in-an-inferior-mi/

Inferior Wall Acute Myocardial Infarction: Not as Preload Dependent as Once Thought?

https://www.researchgate.net/publication/312102992_Inferior_Wall_Acute_Myocardial_Infarction_Not_as_Preload_Dependent_as_Once_Thought

https://pubmed.ncbi.nlm.nih.gov/28089058/

Effect of early treatment with anti-hypertensive drugs on short and long-term mortality in patients with an acute cardiovascular event

https://pubmed.ncbi.nlm.nih.gov/19821384/

Doug Wolfberg, a founding member of Page, Wolfberg & Wirth, has been a practicing EMS attorney for 25 years. Doug is a nationally respected EMS leader who has been involved in the profession for over 40 years, having served as an EMS practitioner, a county EMS director and an EMS administrator at the regional, state and federal levels over the course of his career.

"Telling stories is one of the most powerful means that leaders have to influence, teach and inspire,” Anderson said. “What makes storytelling so effective for learning? For starters, storytelling forges connections among people, and between people and ideas. Stories convey the culture, history and values that unite people."

“Therapy has been a godsend," said Hutchinson.

Quick favor: take our 3-minute (anonymous) listener survey to help shape what we cover next: https://sprw.io/stt-lfjMN

The conversation shifts to the unique culture of the fire service, specifically the "sacred" firehouse table where rankings vanish and conflicts are settled in-house rather than through a formal chain of command. Jake also dives into the misunderstood world of Hazmat, demystifying it as a discipline of basic chemistry rather than a horror movie. From sampling jars of menstrual blood at government protests to discussing the "Hazmat Guys" podcast network, this episode offers a grounded look at the reality of special operations and the importance of sharing knowledge to elevate the entire crew.

Quick favor: take our 3-minute (anonymous) listener survey to help shape what we cover next: https://sprw.io/stt-lfjMN

In this conversation, Williams talks about the long road to getting hired, the culture shifts he’s seeing among newer firefighters, and why mentorship inside the firehouse still matters. He also breaks down how a homemade tool he built for forcing doors eventually turned into a widely used product across departments and industries. The story moves from firehouse camaraderie to small business lessons, covering product design, marketing mistakes, fraud scares, and what it actually takes to turn an idea into something firefighters trust on the job.

Key Points: • On-Scene Resuscitation: Emphasis on achieving ROSC on scene rather than rapid transport. • Mechanical CPR Devices: AHA advises against routine use, but paramedics argue they’re essential for small or rural teams. • IV vs. IO Access: IV is prioritized, but practicality for resource-limited teams is questioned. • Empowering EMS Providers: Focus on critical thinking, quality compressions, and timely defibrillation. • Cultural Shift: Training crews for compassionate death notifications and clear family communication.

In this episode of the Not A-fib podcast, Deputy Chief Christopher Keller of New Orleans Emergency Medical Services shares the origins and impact of their innovative body worn camera program.

The program protects staff, supports quality assurance and aids patient care. Keller discusses navigating privacy concerns, storage challenges, and staff buy-in while prioritizing transparency over punishment. He also reflects on the agency’s rapid and coordinated response to the tragic January 1, 2025 Bourbon Street attack, highlighting lessons learned and multi-agency training efforts.

Additionally, Keller provides insight into preparing for massive events like the Super Bowl and Mardi Gras, where public safety coordination is key.

The episode closes with reflections on the department’s experience filming the Nightwatch TV series and the future potential of integrating body cam footage with EMS documentation.

Transporting children in ambulances presents unique challenges that EMS providers face every day. Issues like the correct use of safety equipment, performance of life-saving procedures like CPR, and the absence of universal standards can make pediatric care in emergency settings more difficult than necessary. Dr. Nick Cochran-Caggiano, an emergency physician and researcher, has taken a deep look into these challenges through two pivotal studies that every EMS worker should know about. Both studies were discussed on the latest podcast episode of “EMS Research with Professor Bram.” The Unsafe Reality of Pediatric Transport in Ambulances One of Dr. Cochran-Caggiano’s studies, published in Pediatric Emergency Care (2023), examined how children are secured during ambulance transport. The study reviewed over 3,000 cases by observing video footage of ambulances arriving at a pediatric emergency department. The findings reveal a troubling reality:  Just 53.5% of children were transported using the correct safety device for their weight.  A staggering 77.1% of transport restraints were not used properly, putting children at significant risk.  Commercially made pediatric restraints were found to be the best option, yet these were still improperly used half the time.  For many patients, ambulance cots were the default method of transport, but this was only the correct choice in 18.2% of cases. Dr. Cochran-Caggiano shared his thoughts on this alarming data during a recent interview, emphasizing that the absence of consistent safety standards puts children at unnecessary risk. "Having some sort of ability to transport children safely is a must," he said. He also pointed out the pitfalls of the current patchwork approach to pediatric safety in EMS. "There’s no appropriate way to secure [a child’s car seat] to an ambulance stretcher. You can make a good faith effort, but that’s really all it is." Why This Matters Improper restraint practices don't just violate safety protocols—they create scenarios where otherwise preventable injuries become inevitable. Reflecting on the need for systemic change, Dr. Cochran-Caggiano pushed for a proactive approach, stating, "Let’s make a difference before

Qualitative research often remains a mystery to those in medicine who are accustomed to the clear-cut, numerical results of quantitative studies. Yet, when it comes to understanding complex, human-centric issues, qualitative research is indispensable. Take the COVID-19 pandemic, for example—an event where numbers alone cannot fully capture the profound human experiences involved.

Unlike quantitative research, which answers yes or no questions or delivers numerical data, qualitative methods delve deeper into the human elements of a topic. One powerful approach is conducting interviews, especially when the interviewer shares a cultural or professional background with the participants as an insider to the community. This method promotes openness and authentic disclosure, as demonstrated in two studies exploring the experiences of paramedics during the COVID-19 pandemic.

The recent episode of "EMS Research with Professor Bram" a spotlight was cast on these insights.1 Paramedic researcher Nigel Barr, PhD, RN, RP, from Australia shared his research study where they interviewed Australian paramedics about the challenges and facilitators they faced while responding to COVID-19 cases. His research uncovered themes that included communication, fear and risk, leadership, protective work factors, and change. Intriguingly, some paramedics reported a reduced perception of risk and heightened empathy for COVID-19 patients after personally contracting the virus themselves.2

Highlighting the significance of qualitative research, Dr. Barr remarks, "Numbers work well for testing theories, but when it comes to generating new ones, the hard work of interviews, coding and theming is essential."

Parallel to this, as a paramedic researcher myself, I was conducting a similar study in the United States, interviewing American paramedics. This research was different because it sought to understand how treatment of respiratory patients shifted when looking at the time before covid versus during the pandemic. Findings of this study showed that paramedics had a tendency to over-categorize all respiratory patients as COVID-positive. Also, participants noted changes in practice, such as reduced use of stethoscopes and avoidance of nebulized treatments in confined spaces due to transmission fears.3

These qualitative studies offer insights that mere data cannot, underscoring the need for paramedics to engage in research that directly impacts their field. “We should be trying to support the capacity of paramedics to do research. We should have the control over our own discipline ... Because if we take research from another discipline, another area, another setting, it is always going to be a square peg round hole. We have to test those outcomes in our own environment. We have to find out what works. What doesn't work,” says Dr. Barr.

Research studies involving paramedics in both Australia and the United States demonstrate the unique benefits of qualitative research through interviews. By employing paramedic researchers to engage directly with their peers on topics that deeply impact them, these studies reveal the nuanced understanding that only rich, narrative-driven descriptions can provide. Qualitative interviews shed light on the human side of medical practice, revealing details and challenges that numbers alone might miss. These interviews help us understand the deeper aspects of healthcare, offering insights that go beyond traditional numbers.

References

1. https://youtu.be/_lBTF-8x7p4
2. Howarth, U., Zimmerman, P. A., van de Mortel, T. F., & Barr, N. (2024). Paramedics’ experiences of barriers to, and enablers of, responding to suspected or confirmed COVID-19 cases: a qualitative study. BMC Health Services Research, 24(1), 678.
3. Duffee, B. (2023). COVID-19 and paramedic response: Overcategorization concerns in respiratory patients. Journal of Paramedicine and Emergency Response. Available online https://www.airitilibrary.com/Article/Detail/P20210804002-N202311070009-00029

New Orleans EMS Maj. Tom Dransfield has a wide-ranging conversation with host Eric Chase. Topics include: SPARC Academy, whole blood and blood product initiatives, POCUS, Axon body-worn cameras and more.

He talks about what led him to create his company and the stellar team he's built to deliver high-quality, engaging continuing education.

Finally, he wraps up by talking about his experience as an airway management physician for the Dallas Cowboys.

In this episode, Dr. Johnson leads an engaging conversation with distinguished experts from Norway. We have Dr. Nils Peter Overland, a specialist in air ambulance and anesthesia, and Victoria Vatsvåg, PhD(c), with expertise in ultrasound. Tune in as we explore the intersection of paramedic training, point-of-care ultrasound and resource-limited settings.

Article discussed: O'Kelly, A., & Mallinson, T. (2023). Prolonged field care (austere emergency care) principles in UK paramedic practice. Journal of Paramedic Practice, 15(9), 359-366.

Resources mentioned: Crossing the Chasm by Geoffrey A. Moore; Go for No!: Yes Is the Destination, No Is How You Get There by Andrea Waltz and Richard Fenton; Course: The Science of Well-being, led by Dr. Laurie Santos of Yale University via Coursera.

Welcome to Emergent Leadership where we connect with passionate leaders who just have to share their stories, perspectives, and most importantly, lessons learned.

The need is urgent, the events are critical, and the you of tomorrow is just an episode away!

Join the conversation: If you have a leadership topic, experience, or lesson learned you would like to share or hear more about, send an email at brettlylecoaching@gmail.com or use and follow #emergentleadership to join the conversation. You can also connect to Brett directly through LinkedIn or follow her journey on YouTube.

Read the full article here.

Eric Chase has a conversation with three-time sudden cardiac arrest survivor Steve Dunn.

What happens when a tragedy affects a first responder family? Chief Tray White discusses his own vulnerability during difficult times in his career and personal life.

Listen to Part 1 here.

Operative IQ is committed to serving first response industries with controlled substance tracking, RFID solutions and Operative IQ Front Line to address the need for faster and better answers for managing operational readiness.

"When you are at work, engage.... Learn your partners, even the one you don't get along with." -Darnell Dodson II

This must watch EMS TODAY Show episode zeroes in on not just the tremendous work by FDNY and other New York City 911-contracted EMS responders, but also on the horrible pay and benefit inequity between FDNY EMS personnel and their counterparts in FDNY and the NYPD.

JEMS Editor Emeritus A.J. Heightman talks with Anthony Almojera, a 13-year veteran lieutenant paramedic with FDNY EMS and the vice president of Local 3621, the FDNY EMS Officers' union representing lieutenants and captains. He’s currently assigned to Station 40 in Sunset Park, Brooklyn.

Curtina Blalock shares her family’s cancer journey with Chief Douglas Randell.

In this episode, we’ll be discussing the pandemic of violence against first responders. We delve into the problem of violence, discuss cultural differences, and offer a few suggestions on how to deal with violence if it ever erupts at the scene. We provide a few tried, tested and true tips on how to de-escalate a situation, keeping one’s wits about them and being ready to pull back when necessary. 

More than anything, we wish all of our fellow responders to stay safe out there and be prepared.

This 2023 article is titled “The association of the post-resuscitation on-scene interval and patient outcomes after out-of-hospital cardiac arrest.”

Often relegated to the periphery, the aging population will increase demand for proper dealing with death training. 

This is a perfect podcast for instructors introducing these concepts to students or those who just need a fresh perspective on a very old problem. 

In this installment, the two explore the experience of sharing data with a state immunization registry… only to find errors in one’s own vaccine record.

Listen to part one here.

For EMS providers who respond to a traumatic cardiac arrest, the instinct to initiate CPR is almost automatic. But could this life-saving intervention inadvertently hinder recovery in cases of severe hemorrhagic shock? A recent study, “Effect of Cardiopulmonary Resuscitation on Perfusion in a Porcine Model of Severe Hemorrhagic Shock,” challenges conventional wisdom and offers new insights that could reshape trauma care protocols.

The Study: A Closer Look at CPR in Trauma-Induced PEA

The research, led by Dr. Patrick Greiffenstein, professor of clinical surgery at LSU New Orleans and trauma ICU director at the Norman McSwain Spirit of Charity Trauma Center, addresses a critical gap in trauma care.

While CPR is a cornerstone of resuscitation in cardiac arrest, its application in trauma-induced pulseless electrical activity (PEA) has not been rigorously validated. Trauma PEA, unlike medical cardiac arrest, is a low-flow state caused by severe blood loss (hypovolemia), where the heart shows electrical activity but fails to generate a palpable pulse.

“CPR is a cornerstone of resuscitation and cardiac arrest, but its application in trauma-induced PEA has not really been rigorously evaluated,” explains Dr. Greiffenstein. “Trauma PEA is fundamentally a low-flow state caused by hypovolemia—insufficient blood volume.”

The study aimed to determine how CPR affects tissue perfusion—specifically oxygen delivery to the brain and skin—during severe hemorrhagic shock. Using a porcine model, researchers simulated life-threatening blood loss and compared outcomes between two groups: one receiving automated CPR and the other left untreated during the shock phase.

Key Findings: When CPR May Do More Harm Than Good

The results were both surprising and concerning:

1. No Improvement in Perfusion: CPR did not enhance oxygenation in the brain or skin. In fact, skin perfusion was significantly lower in the CPR group during both the shock and recovery phases.
2. Adverse Hemodynamic Effects: While CPR increased systolic blood pressure (SBP), it significantly reduced diastolic blood pressure (DBP), which is critical for coronary and organ perfusion.
3. Potential Harm: CPR caused a threefold increase in intracranial pressure (ICP), suggesting that chest compressions might disrupt normal blood flow dynamics in the brain.

“Knowing now that extreme efforts like lining people up to do CPR can cause turbulence within the system is a significant advancement,” says Dr. Greiffenstein. “It’s possible to have perfusion at these unreadable MAP scores, which is a critical insight for trauma care.”

Implications for Trauma Care

These findings challenge the one-size-fits-all approach to CPR in cardiac arrest scenarios. In cases of hemorrhagic shock, CPR might:

• Divert attention from more effective interventions, such as rapid blood transfusion or surgical control of bleeding.
• Worsen perfusion to vital organs, potentially exacerbating the patient’s condition.

“In military cases, field medics often don’t have the opportunity to perform full chest compressions on the battlefield. Sometimes, all they can do is drag a person to a safe position,” notes Dr. Greiffenstein. This study underscores the importance of prioritizing interventions that address the root cause of trauma PEA—severe blood loss—over traditional resuscitation techniques.

A Call for Updated Guidelines

The American Heart Association’s current guidelines broadly recommend CPR for all pulseless patients. However, this study adds to a growing body of evidence suggesting that trauma-induced PEA requires a different approach. By focusing on restoring blood volume and controlling bleeding, paramedics and EMTs can improve outcomes for patients in hemorrhagic shock.

As Dr. Greiffenstein puts it, “This research is a step toward more tailored and effective trauma care protocols. It’s about understanding the unique physiology of trauma and adapting our interventions accordingly.”

For EMS providers on the front lines, this study serves as a reminder to critically evaluate the tools and techniques we rely on in emergency care. While CPR remains a vital intervention in many scenarios, its role in trauma-induced PEA warrants careful reconsideration by physician medical directors. By staying informed about the latest research, we can continue to improve outcomes for the patients who depend on us most. Click below to watch the full interview

Reference

Greiffenstein, P., Cavalea, A., Smith, A., Sharp, T., Warren, O., Dennis, J., Gatterer, M. C., Danos, D., Byrne, T. C., Scarborough, A., Deville, P., & VanMeter, K. (2025). Effect of cardiopulmonary resuscitation on perfusion in a porcine model of severe hemorrhagic shock. The Journal of Trauma and Acute Care Surgery, 98(2), 251–257.

RaDonda Vaught was a 39-year old registered nurse serving as the "help-all" nurse (for which there is no specific job description) at Vanderbilt University Hospital on Dec. 26, 2017.  She also had an orientee. She was asked to go down to Radiology PET scan and administer the medication Versed to 75-year old Charlene Murphey who had been hospitalized for a subdural hematoma, because she was not able to tolerate the PET scan procedure or else they would have to send the patient back and reschedule it.

She pulled the medication from the Pyxis and put the medication vial in a baggie and wrote on the baggie, "PET scan, Versed 1-2 mg" and went to Radiology to administer the medication to Murphey. Since she had never been to PET scan before, she had to ask for directions, and once she found it, she checked the patient for her identity, and told her she was there to give him/her something to help him/her relax. She administered the medication and then left the area without continuing to monitor the patient. 

The Errors

The facts currently understood in this case show that Vaught committed at least ten errors when administering the medication to her patient. These errors include, but are not limited to: 

-Searching for the medication by trade name instead of generic, despite being trained to the contrary. 

-Selecting vecuronium instead of midazolam or Versed, even though she reports that she was looking for Versed. 

-Overriding the warning indicating a none-prescribed medication had been selected (potentially could be excused given the documented EMR issues at Vandy) five times

-Ignoring a warning that the selected medication was a paralytic. 

-Failing to note the red all-caps paralytic warning on the cap. 

-Failing to note that the medication name on the vial did not match what was ordered or what she was looking for. 

-Failing to take action to further verify the medication after noting that the medication was in powdered form when the prescribed medication should have been packaged in liquid form (by her own admittance, she found this “odd”). 

-Following the instructions for reconstitution on the vial again without noting that the medication name did not match what was prescribed and that the concentration did not match what was commonly carried in the hospital. 

-Actually administered the wrong dose of the wrong medication (1 mg vecuronium instead of the ordered 2 mg versed). 

-And, last but not least, failing to monitor the patient, even briefly, for any adverse effect after administering the medication.

The Outcome

Within the hour, the Transporter found the patient unresponsive and the Radiology Technician called a rapid response and started CPR. By the time Nurse Vaught arrived, the patient had been intubated and the heart rate had returned to normal. Nurse Vaight told the team that she had administered Versed to the patient only a few minutes before.  Vaught stated RN #2 approached him/her and asked, "Is this the med you gave Ms. Murphey?" and Vaught responded "yes." Vaught then stated RN #2 said, "This isn't Versed, It's Vecuronium." Vaught then went into Murphey's room and informed Physician #2, and the NP that she had made a mistake and administered Vecuronium to Murphey instead of Versed.

Murphey was declared brain dead on January 27th and removed from life support. She died a short time later.

So....Why Might This Be a Good Thing?

1. The "Go Along" Attitude

Clinicians often violate the written policies of the organization because the organization does not want or expect the written policies to be followed.  Murphey's care alone required at least 20 cabinet overrides in just three days, Vaught said. "Overriding was something we did as part of our practice every day," Vaught said. "You couldn't get a bag of fluids for a patient without using an override function." https://www.wesa.fm/2022-03-22/as-a-nurse-faces-prison-for-a-deadly-error-her-colleagues-worry-could-i-be-next

When peers face criminal charges for "going along," the willingness to "go along" comes to a screeching halt, and they will "work to rule".  

Employees can force organizations to stop the "paper policy" model by simply demanding that they be allowed to comply with the actual written rules of the organization.

If the policy says that you need to check out your truck before responding to a job, then refuse (yes, REFUSE) to take a job until you have completely checked out your truck. That's not insubordination, that's the policy of the organization.

1. The Martyr Problem

Clinicians also sacrifice their short- and long-term health and safety in order to try to correct long-standing system problems. 

At several places where I once worked, the BLS crews would transport every patient, no matter how minor, to the hospital with red-lights-and-sirens in order to get available as soon as possible because the system did not have enough ambulances to respond to all of the jobs in the city in a reasonable time.  

Worse, it is common in many places for clinicians to work for less-than-sustenance wages and meager or even non-existent benefits instead of EMS systems demanding that local government appropriately fund EMS costs that are not covered, BY DESIGN, by health insurance. 

When peers face criminal charges for mistakes made (such as recently happened in Hamilton Paramedics Steve Snively and Christopher Marchant in Ontario), the willingness to be a Martyr dissipates once they see that the system does not value their sacrifice. 

You're never going to get enough ambulances if you keep trying to fix the deficit by regularly risking your life. It is actually a compensatory mechanism that is working against your (and your community's) long-term interests.

Plus, if you hit a kid going to the hospital with red-lights-and-sirens with a stable patient, what do you think your department will do- back you up or fire you because you "violated department policy?"

References

CMS Report on Event: https://www.documentcloud.org/documents/5346023-CMS-Report.html?fbclid=IwAR2xQsxlfKxis4mecgrCSt-6XvKnSmKDeN7Sb_20is2oBbFICt_9xUDkyvQ#document/p6

Vanderbilt's Corrective Action Plan: https://www.documentcloud.org/documents/6535181-Vanderbilt-Corrective-Plan.html

Does Your Facility Have Your Back?: https://yournurseattorney.com/does-your-facility-have-your-back/

Vanderbilt Failed To Report Unnatural Patient Death: https://hospitalwatchdog.org/vanderbilt-med-center-cover-up/

At Least 10 Errors: https://www.tennessean.com/story/news/health/2019/03/27/radonda-vaught-vanderbilt-nurse-homicide-trial-vecuronium-versed/3216750002/

Nurses quitting after Vanderbilt Verdict: https://www.npr.org/sections/health-shots/2022/04/05/1090915329/why-nurses-are-raging-and-quitting-after-the-radonda-vaught-verdict

Hamilton Paramedics Get 18-month term for conviction: https://globalnews.ca/news/8518655/hamilton-paramedics-to-be-sentenced-in-al-hasnawi-case/

Medical Errors: https://en.wikipedia.org/wiki/Medical_error

The Checklist, by Awal Gagande: https://www.newyorker.com/magazine/2007/12/10/the-checklist

Institute of Medicine's "To Err is Human" Report: https://nap.nationalacademies.org/catalog/9728/to-err-is-human-building-a-safer-health-system

"Just Culture" https://en.wikipedia.org/wiki/Just_culture#:~:text=Just%20culture%20is%20a%20concept,person%20or%20persons%20directly%20involved.

Agency for Healthcare Research and Quality Patient Safety Network Resources: https://psnet.ahrq.gov/issue/just-culture-guide

Wikipedia page for Outliers, by Malcolm Gladwell:  https://en.wikipedia.org/wiki/Outliers_(book)

Retired U.S. Army Major John Spencer shares his story on his journey through war, family dynamics and his own perspectives of what "strength" means. Spencer has a book coming out that is referenced in the podcast in Spring 2022 called "Connected Soldiers; Life, Leadership, and Social Connections in Modern War."

Eric Chase speaks with Jeff Dill of the Fire Fighter Behavioral Health Alliance about making the internal size-up and helping our brothers and sisters in need.

Carr, the executive director of Prehospital & Ambulatory Virtual Emergency Services (PAVES) at Emory University, says patients in rural counties now have access to doctors and specialists even before they reach the hospital.

We also discuss the benefits of joining the CPS and how EMS agencies become better focused on patient safety.

Finally, we discuss his time as state EMS director for the District of Columbia and the challenges, and benefits, of guiding EMS in our nation's capital. 

Hosts: Bradley Dean and David Blevins

Guest: Dr. Andrew McCoy, MD, assistant professor of Emergency Medicine; medical director for Shoreline Medic One and AMR Puget Sound Operations; program director for the University of Washington EMS Fellowship; and medical director for the Resuscitation Academy.

Episode Summary: In this episode, Bradley Dean and David Blevins sit down with Dr. Andrew McCoy to explore everything about resuscitation and the Resuscitation Academy (RA). Dr. McCoy shares the history of the RA and its mission to improve survival rates for sudden cardiac arrest in communities.

With a focus on resuscitation science and EMS education, the discussion covers the impact of the CAROL Act, improvements in local EMS practices, and the ongoing growth of the RA, including the innovative Lighthouse Program.

Guest Bio: Dr. Andrew McCoy is an assistant professor of Emergency Medicine at the University of Washington and has been a faculty member at the Resuscitation Academy in Seattle for 10 years.

A graduate of the Cleveland Clinic Lerner College of Medicine, Dr. McCoy completed his Emergency Medicine residency in Buffalo, New York, before moving to Seattle for an EMS fellowship.

He now serves as medical director for Shoreline Medic One, American Medical Response (AMR) Puget Sound Operations, and the Resuscitation Academy, where he helps EMS professionals improve cardiac arrest survival rates across the country

Points of Discussion:

• What is the Resuscitation Academy (RA), and its history?
• Bradley’s experience with the RA and improvements made in his community.
• The future of the RA: How the CAROL Act will influence resuscitation efforts and the opportunities for growth.
• The Lighthouse Program and its role in driving continuous improvement in resuscitation practices.

Resources Mentioned:

• Resuscitation Academy: www.resuscitationacademy.org
• CAROL Act: Barr's CAROL Act
• American Heart Association – Resuscitation Guidelines: CPR and ECC Guidelines
• CARES Registry: CARES Registry
• RESUSCITATE!: Resuscitate! Book

Key Takeaways: Sudden cardiac arrest is one of the leading causes of death, but survival rates vary significantly from community to community. The Resuscitation Academy's mission is to train EMS personnel and equip them with the tools and knowledge needed to improve survival rates.

With programs like the Lighthouse Initiative and new legislation like the CAROL Act, the future of resuscitation looks promising, offering pathways to reduce preventable deaths from cardiac arrest.

Listen in to learn more about how your community can improve resuscitation outcomes and get involved with the Resuscitation Academy.

Watch the presentation on JEMS.

• Master's in Public Health with a concentration in Health Policy from Yale Medical School.
• FT Faculty at GWU School of Medicine & Southern Connecticut State University MPH Program, and long-time adjunct faculty at NYMC MPH program in Health Policy.
• Assistant Commissioner of Health at the NYC Department of Health & Mental Hygiene during the first SARS outbreak.
• Served as State EMS Director, Consultant to Public Health Canada, Connecticut Department of Public Health, Local Health Departments.
• (So in other words, I'm not a vaccine expert, but I'm pretty well versed in this stuff)

Flu vaccine is bad example, most vaccines are ~80% effective

• One dose of the MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella. Two doses of MMR vaccine are 97% effective against measles and 88% effective against mumps. MMR is an attenuated (weakened) live virus vaccine.
• The Hepatitis B vaccine is 80% to 100% effective in preventing infection or clinical hepatitis in those who receive the complete vaccine series.
• TDAP vaccines is 80-90% effective after fifth dose, but this decreases to 30-40% after four years. 
• Flu efficacy in the US, by year:

2004

10%

2005

21%

2006

52%

2007

37%

2008

41%

2009

56%

2010

60%

2011

47%

2012

49%

2013

52%

2014

19%

2015

48%

2016

40%

2017

38%

2018

29%

2019

45% est

https://en.wikipedia.org/wiki/Influenza_vaccine#:~:text=A%202012%20meta%2Danalysis%20found,24%20months%20(66%20percent).

https://www.cdc.gov/vaccines/vpd/mmr/public/index.html#:~:text=One%20dose%20of%20MMR%20vaccine%20is%2093%25%20effective%20against%20measles,(weakened)%20live%20virus%20vaccine.

https://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html#:~:text=The%20vaccine%20is%2080%25%20to,receive%20the%20complete%20vaccine%20series.

https://www.cdc.gov/pertussis/about/faqs.html#:~:text=CDC%20estimates%20that%20in%20the,4%20years%20after%20getting%20Tdap.

Time to Develop Vaccine?

• Fastest time to develop vaccine: four years https://www.nytimes.com/interactive/2020/04/30/opinion/coronavirus-covid-vaccine.html
• Average time to develop vaccine: 10 years https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31252-6/fulltext

Historical Vaccine Problems?

• Cutter Incident (1955): Active polio administered to 200,000, with 200 cases of polio, and 10 deaths. This was a live vaccine, compared to the Pfizer and Moderna COVID vaccines that are Messenger RNA (mRNA) which is just a set of instructions that tells your body to make the protein that resembles part of the Coronavirus...(but not a Recombinant DNA vaccine like I said.)

https://www.cdc.gov/vaccinesafety/concerns/concerns-history.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1383764/

https://www.cnbc.com/2020/12/08/pfizer-moderna-covid-vaccine-side-effects-trials.html

COVID vaccine

• Does it work? Yes, it appears to work pretty well.  But no way is it going to be 95% effective in the real world....
• What does 95% efficacy mean? Eight out of 18,198 vaccinated with two doses of vaccine got symptoms and a positive COVID test from seven days after their second vaccination through November 14th, 2020. One hundred and sixty-two out of 18,325 vaccinated with placebo got symptoms and a positive COVID test from seven days after their second vaccination through November 14th, 2020.

What we don't know: 

• How many of the people in the study were exposed to the COVID virus?
• If people who got the vaccine can be asymptomatic spreaders?

What we do know: 

• You need two shots, and you're going to be sick after your second shot...."The most common solicited adverse reactions were injection site reactions (84.1%), fatigue (62.9%), headache (55.1%), muscle pain (38.3%), chills (31.9%), joint pain (23.6%), fever (14.2%); severe adverse reactions occurred in 0.0% to 4.6% of participants, were more frequent after Dose 2 than after Dose 1, and were generally less frequent in participants ≥55 years of age (≤ 2.8%) as compared to younger participants (≤4.6%).”  https://www.fda.gov/media/144245/download
• 2020 Flu vaccine will probably be even less effective because there was not much flu in Australia to base the vaccine on. But get the flu vaccine anyway this year, because you don't want to get the flu and COVID at the same time....https://www.cdc.gov/flu/season/faq-flu-season-2020-2021.htm#Flu-Vaccine
• Emergency Authorization isn't the same as regular approval....they are going to continue to gather data. https://www.fda.gov/vaccines-blood-biologics/vaccines/emergency-use-authorization-vaccines-explained

What's the priority for EMS clinicians?

CDC COVID-19 vaccination program interim playbook

Jurisdictional considerations for Phase 1 subset groups may include, for example: -Phase 1-A: Paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials -Phase 1-B: People who play a key role in keeping essential functions of society running and cannot socially distance in the workplace (e.g., emergency and law enforcement personnel not included in Phase 1-A, food packaging and distribution workers, teachers/school staff, childcare providers), adults with high-risk medical conditions who possess risk factors for severe COVID-19 illness, and people 65 years of age or older (including those living in LTCFs) There may be insufficient COVID-19 vaccine supply initially to vaccinate all those who fall into the Phase 1-A subset, so jurisdictions should plan for additional subsets within that group (see CISA guidance for categories of healthcare personnel).

https://www.cdc.gov/vaccines/imz-managers/downloads/COVID-19-Vaccination-Program-Interim_Playbook.pdf

CISA guidance on essential critical infrastructure workers (explicitly listed in both categories)

Guidance on the Essential Critical Infrastructure Workforce: Ensuring Community and National Resilience in COVID-19 Response

Health/Public Health -Healthcare providers including, but not limited to, physicians (MD/DO/DPM); dentists; psychologists; mid- level practitioners; nurses; emergency medical services personnel, assistants and aids; infection control and quality assurance personnel; phlebotomists; pharmacists; physical, respiratory, speech and occupational therapists and assistants; social workers; optometrists; speech pathologists; chiropractors; diagnostic and therapeutic technicians; and radiology technologists. -Workers required for effective clinical, command, infrastructure, support service, administrative, security, and intelligence operations across the direct patient care and full healthcare and public health spectrum. Personnel examples may include, but are not limited, to accounting, administrative, admitting and discharge, engineering, accrediting, certification, licensing, credentialing, epidemiological, source plasma and blood donation, food service, environmental services, housekeeping, medical records, information technology and operational technology, nutritionists, sanitarians, etc.

--Emergency medical services workers including clinical interns.

--Prehospital workers included but not limited to urgent care workers.

Law Enforcement/Public Safety/Other First Responders

-Public, private, and voluntary personnel (front-line and management, civilian and sworn) in emergency management, law enforcement, fire and rescue services, emergency medical services (EMS), and security, public and private hazardous material responders, air medical service providers (pilots and supporting technicians), corrections, and search and rescue personnel.   

https://www.cisa.gov/publication/guidance-essential-critical-infrastructure-workforce

American College of Emergency Physicians supports EMS Clinicians being included in Category 1A

https://www.acep.org/corona/COVID-19-alert/covid-19-articles/acep-statement-on-ems-professionals-priority-access-to-the-covid-19-vaccine/

American Paramedic Association and the National EMS Managers Association supports EMS Clinicians receiving a COVID-19 vaccination "as soon as possible."  

https://www.nemsma.org/resource/resmgr/covid-19/covid-19_vaccination_conside.pdf

EMS included in Category 1A from AIPC and CDC, states may vary.

New York: "ICU, EMS, ED top priority" (other first responders were Phase 2)

https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/NYS_COVID_Vaccination_Program_Book_10.16.20_FINAL.pdf

New Jersey: "Who are "healthcare personnel" in Phase lA? Healthcare personnel are paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials. This includes any type of worker within a healthcare setting. Examples include, but are not limited to...personnel with variable venues like EMS, paramedics, funeral staff, and autopsy workers."

http://nj.gov/health/legal/covid19/12-10-20_PopulationPrioritizationPOD_memo.pdf

What should we do:

• Taking the vaccine is your individual choice based on your own circumstances
• Even if you don't want the vaccine, or want to wait, you should support EMS clinicians, both public, non-profit, and private, being in Category 1A
• Even if vaccine is offered, we still need:
• Adequate respiratory PPE (half face respirator c P100)
• Face Shields, Goggles, Gloves, and Gowns 
• Negative pressure ambulances
• Equipment and Supplies for Cleaning
• High-level decontamination with UV or Hydrogen Peroxide

How is it possible for metabolic acidosis and anion gap to be remotely interesting? The two words send shivers down most medics’ spine. However, Tyler Christifulli from FoamFrat joins the EMS Handoff crew to make this information not only accessible but fun to learn and review. 

Tyler Christifulli is a flight medic and  co-founder/producer at FOAMfrat where he lends his expertise to educating EMS providers through blogs, podcasts and online content.

Check out their website, and be sure to follow them on Facebook and Instagram.

Deputy Chief Joshua Parish of the Milwaukee (WI) Fire Department checks multiple "diversity" boxes as a Black man in an overwhelmingly white industry, who has risen through the ranks as an unabashed iconoclast.

He has a master's degree from the venerable London School of Economics in an industry that is torn about the fundamental question of whether post-high school education should be considered a "must have."

He is passionate about honing a worldly perspective and loves losing himself in new locales with no choice but to adapt and seek empathy.

It turns out, this same blend of characteristics makes for an excellent medic, because in the real world, biology and chemistry often come secondary to psychology and sociology: understanding human nature.

Following a deep-dive into his origin story, Chief Parish discusses strategies for turning "samurai swords" into "Gerber tools" when training team members – evolving from experts in a single function to team members who can flex as a community's needs evolve – as a way of "future-proofing ourselves." 

Also: Ensuring that mobile medical personnel, in management and on the line alike, reflect -- and embrace -- the mosaic of the communities in which they operate is "good for business" when it comes to recruiting high-potential candidates.

It helps when, say, convincing citizens to stay inside and wear a mask; or to manage diabetes both as a matter of self-care and as a way to show appreciation for their caregivers.

Perhaps most poignant, he reminds us that we need to talk about failures if we are going to learn from them.

In this timely, no-holds-barred interview, Chief Parish explains his approach to language and culture, to relationship-building, and to research (including the need for additional rigor) – these have swirled into a strange brew against the backdrop of the COVID-19 crisis, particularly in Wisconsin, where racial and socioeconomic tensions followed a shooting during protests in nearby Kenosha. 

The Culture of Care: Supporting EMS Providers

Our work is demanding, both physically and emotionally, and the culture within our agencies plays a critical role in our well-being. A recent systematic review in the International Journal of Environmental Research and Public Health revealed that many EMS providers avoid using organizational mental health services due to stigma and a perception that these programs lack genuine care. The study emphasizes the need for person-centered support and a cultural shift that normalizes seeking help as a sign of strength (Johnston et al., 2025).

This cultural component also impacts retention. Another study in the same journal found that agencies with collaborative, team-oriented "clan" cultures had significantly lower turnover rates compared to those with rigid or chaotic structures. For leaders in EMS, fostering a supportive environment is not just about morale. It is a strategic imperative for retaining skilled clinicians (Kamholz et al., 2025).

Professional Recognition: Breaking Barriers

Across the globe, paramedics are striving for recognition as integrated healthcare professionals. A qualitative study in BMC Health Services Research identified common barriers, including outdated legislation, inconsistent regulation, and insufficient funding. While the pandemic temporarily highlighted our capabilities, the momentum has waned. The study calls for targeted policy reforms and investments in education and leadership to solidify our role in the broader healthcare system (Feerick et al., 2025).

Physical Demands and Injury Prevention

The physical toll of our work is undeniable. A scoping review in Applied Ergonomics confirmed that musculoskeletal injuries, particularly to the back, are rampant in EMS. Tasks like handling stretchers and patient extractions are among the most strenuous. The review also highlighted fitness disparities, with male paramedics generally showing more strength but less flexibility than their female counterparts. These findings underscore the need for targeted injury prevention programs and realistic physical standards to keep us safe throughout our careers (Marsh et al., 2025).

Advancements in Cardiac Arrest Care

When it comes to cardiac arrest, every second counts. A study in Resuscitation reinforced the value of bystander CPR, showing that dispatcher-assisted CPR significantly improves outcomes for untrained bystanders. For those with prior CPR training, acting independently yielded even better results. This highlights the importance of public CPR education alongside dispatcher support (Tagami et al., 2025).

On the scene, our interventions matter immensely. Research in The Journal of Emergency Medicine found that for traumatic cardiac arrest patients, aggressive interventions like prehospital thoracostomy can be lifesaving (McWilliam et al., 2025). Meanwhile, a study in Critical Care Medicine revealed that extracorporeal CPR (ECPR) significantly improves outcomes for patients with refractory ventricular fibrillation, emphasizing the need for early transport to specialized centers.

The Role of Technology in EMS

Technology is poised to revolutionize EMS, from dispatch to diagnosis. A study in The American Journal of Emergency Medicine demonstrated that large language models (LLMs) like ChatGPT could prioritize ambulance requests with remarkable accuracy, aligning with expert paramedic decisions over 76 percent of the time. This proof of concept suggests that AI could one day enhance resource allocation in dispatch centers (Shekhar et al., 2025).

On the diagnostic front, machine learning is opening new possibilities. For example, a study in Bioengineering showed that analyzing photoplethysmography waveforms could estimate blood loss in trauma patients, offering a non-invasive way to guide resuscitation (Gonzalez et al., 2025). Similarly, research in Medical Engineering & Physics explored using multidimensional data to differentiate ischemic from hemorrhagic strokes in the field, potentially enabling more targeted prehospital care (Alshehri et al., 2025).

Addressing Disparities in Care

Equity in EMS is a cornerstone of our profession, yet recent studies highlight troubling disparities. Research in JAMA Network Open found that ambulance offload times were significantly longer in communities with higher proportions of Black residents (Zhou et al., 2025). Another study in JAMA Surgery revealed that Black and Asian trauma patients were less likely to receive helicopter transport compared to White patients. These findings are a call to action for all of us to examine our systems and biases to ensure equitable care for every patient (Mpody et al., 2025).

Looking Ahead

The research discussed here represents just a fraction of the advancements shaping EMS today. From improving workplace culture and injury prevention to leveraging AI and addressing systemic inequities, these findings have real-world implications for our protocols, training, and advocacy efforts. As EMS professionals, we have a responsibility to stay informed and apply these insights to our practice.

For a deeper dive into these topics and more, I invite you to listen to the podcast, EMS Research with Professor Bram latest episode, https://youtu.be/rt_1AFzSLIk "Research Highlights and Innovations Shaping Our Field.”

References

Alshehri, A., Panerai, R. B., Lam, M. Y., Llwyd, O., Robinson, T. G., & Minhas, J. S. (2025). Can we identify stroke sub-type without imaging? A multidimensional analysis. Medical Engineering & Physics. https://doi.org/10.1016/j.medengphy.2025.104364

Feerick, F., Coughlan, E., Knox, S., Murphy, A., Grady, I. O., & Deasy, C. (2025). Barriers to paramedic professionalisation: A qualitative enquiry across the UK, Canada, Australia, USA and the Republic of Ireland. BMC Health Services Research, 25(1), 993. https://doi.org/10.1186/s12913-025-10993-7

Gonzalez, J. M., Holland, L., Hernandez Torres, S. I., Arrington, J. G., Rodgers, T. M., & Snider, E. J. (2025). Enhancing trauma care: Machine learning-based photoplethysmography analysis for estimating blood volume during hemorrhage and resuscitation. Bioengineering, 12(8), 833. https://doi.org/10.3390/bioengineering12080833

Johnston, S., Waite, P., Laing, J., Rashid, L., Wilkins, A., Hooper, C., Hindhaugh, E., & Wild, J. (2025). Why do emergency medical service employees (not) seek organizational help for mental health support?: A systematic review. International Journal of Environmental Research and Public Health, 22(4), 629. https://doi.org/10.3390/ijerph22040629

Kamholz, J. C., Gage, C. B., van den Bergh, S. L., Logan, L. T., Powell, J. R., & Panchal, A. R. (2025). Association between organizational culture and emergency medical service clinician turnover. International Journal of Environmental Research and Public Health, 22(5), 756. https://doi.org/10.3390/ijerph22050756

Marsh, E., Orr, R., Canetti, E. F., & Schram, B. (2025). Profiling paramedic job tasks, injuries, and physical fitness: A scoping review. Applied Ergonomics, 125, 104459. https://doi.org/10.1016/j.apergo.2025.104459

McWilliam, S. E., Bach, J. P., Wilson, K. M., Bradford, J. M., Kempema, J., DuBose, J. J., ... & Brown, C. V. (2025). Should anything else be done besides prehospital CPR? The role of CPR and prehospital interventions after traumatic cardiac arrest. The Journal of Emergency Medicine. https://doi.org/10.1016/j.jemermed.2025.02.010

Mpody, C., Rudolph, M. I., Bastien, A., Karaye, I. M., Straker, T., Borngaesser, F., ... & Nafiu, O. O. (2025). Racial and ethnic disparities in use of helicopter transport after severe trauma in the US. JAMA Surgery, 160(3), 313–321. https://doi.org/10.1001/jamasurg.2024.5678

Shekhar, A. C., Kimbrell, J., Saharan, A., Stebel, J., Ashley, E., & Abbott, E. E. (2025). Use of a large language model (LLM) for ambulance dispatch and triage. The American Journal of Emergency Medicine, 89, 27–29. https://doi.org/10.1016/j.ajem.2025.05.004

Tagami, T., Takahashi, H., Suzuki, K., Kohri, M., Tabata, R., Hagiwara, S., ... & Ogawa, S. (2025). The impact of dispatcher-assisted CPR and prior bystander CPR training on neurologic outcomes in out-of-hospital cardiac arrest: A multicenter study. Resuscitation, 110617. https://doi.org/10.1016/j.resuscitation.2025.110617

Zhou, T., Wang, Y., Zhang, B., & Li, J. (2025). Racial and socioeconomic disparities in California ambulance patient offload times. JAMA Network Open, 8(5), e2510325. https://doi.org/10.1001/jamanetworkopen.2025.10325

“I am a student of the job.” - Justin Hester

This has always been the hallmark of those who live and work where the wild spirit of self-reliance abides. But there is something else, too: big skies, clean air, and the ability to better afford life and spend less time in traffic tend to attract those who need to be able to afford aspects of life that would be impossible where the norm is sitting in traffic going back-and-forth from long hours in an office: for example, the time to care for a child or parent who is seriously ill or disabled and need more regular attention.

For this reason, while they have fewer available resources that most cities, countrysides tend to attract a higher concentration of people who themselves — or whose parents or children — are more likely to need emergency healthcare. That sets up a Catch-22 and an important risk of health inequity that rural Mobile Medical agencies navigate around the clock. Reuben Farnsworth, who spearheaded Community Paramedicine, ET3, and other specialty care programs at Colorado’s Delta County Ambulance District — an agency that has won statewide honors, including as the first ambulance service to interoperate with the Quality Health Network health information exchange and local hospitals — will explain how a data — and economics-centric management style has powered his service’s success, from clinical medicine, to education and policy development, to advancing legislative priorities with partners.

What the research tells us is that there are really three big buckets of problems in airway management that contribute to morbidity and mortality: hypoxia, hypotension and multiple intubation attempts; this is the stuff that airway nightmares are made of.

Read the full article on EMS Airway.

Show Highlights 

• Retro EMS in 2021
• Adaptive EMS Mindset
• Adequate Staffing the Clinician of the Future
• Virtual Hospital
• Telehealth, Community Paramedicine, and Home Health
• Auto-ambulances...Roll Out!

From emergency calls of fainting and blood pressure problems to full-on anaphylactic shock and CPRs, Dov, and Raphael talk about a series of real-life stories of medical intervention from 35,000 feet and up. What would you do if you were asked to be the medical responder on-board a mid-air flight?

Article: https://www.jems.com/patient-care/whole-blood-colleton-county/

The deleterious cardiac effects associated with PH (e.g. Right Ventricular disease) render this population particularly susceptible to decompensation. Hypoxemia, acidosis and hypercapnia are not well tolerated in PH and will acutely increase pulmonary artery pressures, leading to hemodynamic collapse.

Read the full article here.

Host Sean J. Britton provides an overview of the protections in place to safeguard deposits at banks and credit unions, and consumer protections in place to safeguard against fraudulent debit and credit card purchases. Additionally, you will be presented with three actionable strategies to protect yourself from credit and debit card fraud.

It’s an uneventful response and you arrive on scene to find what appears to be a male lying in the roadway. There is a minivan next to the patient with the headlights shining over where they’re lying. You see the patient moving their arms and legs ever so slightly and a group of people around them trying to talk to him.

Read the full article on EMS Airway.

Read the full article here.

Chief Mike McEvoy is the EMS Coordinator for Saratoga County, New York, and a nurse clinician in the cardiothoracic surgical ICU at Albany Medical Center where he also chairs the hospital resuscitation committee and teaches critical care medicine. Mike is a paramedic supervisor for Clifton Park & Halfmoon Ambulance, a firefighter/paramedic and chief medical officer for West Crescent Fire Department. He is an EMS section board member for the International Association of Fire Chiefs (IAFC) and in his free time, an avid hiker and winter mountain climber. Mike has been a Nationally Registered paramedic since 1983.

This podcast is brought to you by Medical Shipment: https://medicalshipment.com/

Jonathon Feit and James McLaughlin talk about the real and opportunity costs of community paramedicine/mobile integrated health.

Welcome to Emergent Leadership where we connect with passionate leaders who just have to share their stories, perspectives, and most importantly, lessons learned.

The need is urgent, the events are critical, and the you of tomorrow is just an episode away!

Join the conversation: If you have a leadership topic, experience, or lesson learned you would like to share or hear more about, send an email at brettlylecoaching@gmail.com or use and follow #emergentleadership to join the conversation. You can also connect to Brett directly through LinkedIn or follow her journey on YouTube.

Make sure to subscribe, rate and review.  

Britton is a practicing paramedic and EMS educator at Superior Ambulance Service in Binghamton, New York. Sean is the principal and financial Planner at STAT Financial Health. He was formerly the chair of the EMS workforce committee of the NAEMT.

This video has received publicity on both sides of the conversation. With limited information, we recognize the actions of the partner who went into immediate action for his partner, as well as the attempts to develop material that will help officers everywhere.  What are your thoughts?

 In this treatment-impact episode of The EMS Today Show, JEMS Editor Emeritus A.J. Heightman moderates an outstanding panel of experts who point out that “prone positioning” of patients is now shown to be one of those procedures.  Proning is easy to do, requires no special equipment and can dramatically improve a patient’s oxygen saturation levels.

David A. Farcy MD, FAAEM, FACEP, FCCM, president of the American Academy of Emergency Medicine and chairman, Department of Emergency Medicine and Director, Emergency Medicine Critical Care at Mount Sinai Medical Center and Hildebrandt Emergency Center in Miami Beach, Florida. Dr. Farcy explains patient proning, its history in the treatment of ARDS and the finding that it is extremely effective in the care of patients suffering from COVID-19 infection.

 He stresses that proning has been found to take awake, alert patients presenting as “Happy Hypoxic”. This is defined as being awake but presenting with low pulse oximetry levels that, would cause providers to intubate the patient in the past. With nasal or face mask oxygen, their O2 saturation levels were raised up from 88 to 94 (for example), keeping them from being intubated and, in some cases, being placed on ventilators.

Christian is currently seeking guest speaker nominations. Email him at cventura@wearehames.com.

Read the full article here.

Dov Maisel discusses his own personal experience in delivering more than 100 electrical generators to orphanages, schools, medical clinics, and community centers in need of power. 

Our teams are in the middle of purchasing and dispensing close to 500 generators to those in need across the country. In a country where electrical generators are in scarily short supply and are often used as major currency currently, our teams jumped in to provide these much-needed devices that are actually saving lives.

This collaboration aims to provide valuable resources and support to first responders through monthly blogs, quarterly podcasts & webinars, and the inaugural First Responder Mental Health Week, scheduled for October 7th to 11th, 2024.

As a leading provider of information and news for the improvement of patient care in the prehospital setting, JEMS and JEMS Events & Training are committed to delivering the latest and most reliable information to the EMS community. With a focus on improving prehospital patient care and promoting positive change in EMS, JEMS is a trusted source of education and information for EMS providers, instructors, and administrators.

JEMS seeks to improve prehospital patient care and promote positive change in EMS by delivering information and education from industry leaders, change-makers, and emerging voices. With a rich tradition of editorial excellence and a consortium of subject matter experts, JEMS fulfills its commitment to EMS providers by providing state-of-the-science, high-quality content.

Read more about the announcement on JEMS.

Mike and his wife Sascha recently released their insightful book “Super-Charge Your Stress Management in the Age of COVID-19.” 

Mike Taigman is the leading expert in improvement science, resilience, and stress management at First Watch based out of Carlsbad, California. Mike’s broad experience helps him turn data into actionable information, helps teams build their resilience using our neuroscience-based ResilientFirst system, and teaches stress management techniques that can be used by anyone anywhere.

Mike facilitated the development of EMS Agenda 2050 a vision for EMS in America 30 years in the future. Inspired by the “people centered” aspect of Agenda 2050, Mike works with some of the world leading physicians and researchers to bring evidenced-based leadership, education and practices to the EMS industry. These practices help create organizations where employees are resilient, joyful, thriving, and providing compassionate care during long careers.

As a young street paramedic in Denver, Mike honed his clinical skills caring for patients and helping new paramedics learn to provide solid clinical care with kindness and compassion.

As a popular conference educator, author of more than 600 articles in professional journals, an associate professor in the graduate program in emergency health services management at the University of Maryland Baltimore County, and an associate adjunct professor in the master’s program in healthcare administration and interprofessional leadership at the University of California San Francisco, Mike has focused on helping professionals save more lives, reduce suffering, and be more effective leaders.

As a consultant, Mike has worked with EMS, fire, and public health in 48 of the 50 states, most of the Canadian provinces, Israel, Palestine, Australia and throughout Europe. His expertise includes EMS street survival, patient centered leadership, effective quality/performance improvement, and resiliency. He holds a master’s degree in organizational systems and is frequently part of the faculty for the Institute for Healthcare Improvement.

Mike’s wife Sascha Liebowitz is an accomplished writer and author of “Living Every Minute of It,” a blog about living each day with patience, tolerance, kindness and love towards oneself and others. A former New York lawyer, Sascha now lives in California focusing on family, writing, and being of service to others. She holds a BA from Columbia College and a JD from New York University School of Law.

This episode of the EMS Today Show, and Mike and Sascha’s book “Super-Charge Your Stress Management in the Age of COVID-19,” will give you important tools to develop and maintain resiliency and get through this difficult time in your EMS career.

In a testimonial about the book, Donald M. Berwick, MD, MPP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement said it best, “Managing … stress is a continual task for the healing professions—more challenging perhaps in the era of COVID-19, but, frankly, always with us.”

Dr. Berwick goes on to say that the book “draws on a wide library of science, teachings, and experience and distills it all into a readable and useful collection of practical, attractive techniques. Each one seems not only promising, but frankly, fun.”

His concluding remark really sums up why a book by Mike Taigman will be so helpful to emergency service personnel: “This book brings optimism and oxygen at a time when we badly need both.”

By automatically identifying critical structures like the pleural line or organ interfaces, AI helps paramedics capture crisp, reliable views—even under chaotic field conditions with severe glare, heat, or noise. For trauma and undifferentiated dyspnea calls, prehospital ultrasound delivers vital objective data. Detecting free abdominal fluid or absent lung sliding allows EMS teams to notify receiving trauma centers immediately. This clinical head start mobilizes blood banks, surgical staff, and operating rooms before the ambulance even arrives, cutting down critical time to definitive care.

Read the full article here.

Dr. Ted Lee discusses education as part of EMS Week. The discussion features  Dr. Shira Schlesinger, Dr. Navin Ariyaprakai and Dr. Maia Dorsett

They highlight the importance of transitioning from traditional, time-based training to a more dynamic and critical-thinking-focused curriculum that fosters professional growth and clinical judgment among EMS providers.

The conversation touches on the value of accreditation, the role of preceptor training, and the increasing demand for lifelong learning within the field.

* Patient privacy concerns

* Blurring the line between us and law enforcement

* What is our use of force policy?

* NEMSIS body cam position paper 06/2021

* Video access and QA

* Consent

* Bodycam feedback

* Patient care documentation gap

Project Mayday was founded by three first responders. Get to know their stories on their first podcast and learn their motivations behind the project. Stay tuned for other first responder stories about their journey with mental health.

Check out their website, and be sure to follow them on Facebook and Instagram.

Read the full article on EMS Airway.

Special guests are Shelly Carter and James Garcia.

Dysfunctional workplaces and a lack of control are two causes of burnout in the workplace. Ignored or unaddressed job burnout stressors can have significant consequences on an individual and the organization.

One way to prevent burnout is to advocate for change within your organization and industry as a whole. It is easy to complain about the way things are, but becoming a change agent is one way to gain power.

Dov and Raphael are joined by United Hatzalah's Director of International Emergency Management Gavy Friedson, the mission commander for the organization's relief effort in Puerto after Hurricane Fiona. 

The trio discusses the team's efforts in Puerto Rico and how the Psychotrauma and Crisis Response Unit worked to assist the island's residents while connecting with local service providers and individuals to be a force multiplier for relief efforts.

He discusses how prepping for law school turned into firefighting and a public information officer role, and how those communication and relationship building skills served as the foundation for his recent promotion to assistant chief of administrative services.

Chief Pitassi shares stories of success, but also one of failure following the fatal Yarnell Hill Fire. He explains how he has since used that lesson to become a stronger and more empathetic leader.

Brad explains his PIO mindset, how to manage the face of your organization and describes how investing in social equity strengthens community relations and empowers employees.

Welcome to Emergent Leadership where we connect with passionate leaders who just have to share their stories, perspectives, and most importantly, lessons learned.

The need is urgent, the events are critical, and the you of tomorrow is just an episode away!

Join the conversation: If you have a leadership topic, experience, or lesson learned you would like to share or hear more about, send an email HERE or use and follow #emergentleadership to join the conversation. You can also connect to Brett directly through LinkedIn or follow her journey on YouTube .

Read the full article here.

Greg Johnson joins us for this discussion. He is the EMT/AEMT Coordinator at Columbia State Community College where he leads a highly successful EMT and Advanced EMT program. He is well-versed in didactic, practical, and clinical development of the EMS student and provides a wealth of experience for this discussion. 

* Clinicians versus skill junkies

* Accreditation Critical Question

* Field Start

* Clinicians over Technicians

* Clinical Early Start

* Simulation Training

* Avocado Pit Poisoning

* Crawl- Walk- Run

* Into the Pass Rate Weeds

* Building the Autonomous Role in 15- Weeks

* Are Textbooks Needed?

* Paramilitary Style Approach

* Closing Words

Resources

ET3 Model

Don’t forget to go to our newly redesigned website at www.emshandoff.com.  Subscribe rate and review the EMS Today Podcast by JEMS and the EMS Handoff YouTube Channel.

…and don’t forget to go to www.thepursueco.com and find the great EMS Handoff Merchandise. 

- Risk Mitigation

- Does five minutes now help later?

Potential Recommendations:

- If you have a walker or a cane that you are supposed to use, then use it.            

- Don't get out of bed or up from a chair suddenly. Sit upright, pause, then push up from the bed or chair, while also standing up with the muscles in your legs. 

- Move cords for lights, TVs and other appliances out of walking paths.

- Know where your pets are before you move.

- Use railings when going up or down steps.

- Wear shoes instead of slippers or socks for better traction.

- Don't use slippery area or throw rugs in the kitchen, hallways or bathrooms.

- Install handholds in the tub and near the toilet.

- Don't walk and attempt to use or read your smartphone or tablet at the same time. Especially, if you are walking up or downstairs.

References

National Council on Aging: https://www.ncoa.org/professionals/health/center-for-healthy-aging/national-falls-prevention-resource-center/falls-prevention-awareness-week

Journal Of the American Medical Association: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783628

The People of the State of Colorado vs. RANDY ROEDEMA, JASON ROSENBLATT, NATHAN WOODYARD, JEREMY COOPER, PETER CICHUNIEC, Defendants. 

https://www.pwwemslaw.com/sites/default/files/elijah-mcclain-grand-jury-indictment.pdf

Legal analysis: What the paramedic criminal charges in the Elijah McClain case mean for EMS By Douglas M. Wolfberg, Esq., EMT; and Stephen R. Wirth, Esq., EMT-P Sep 2, 2021 https://www.ems1.com/legal/articles/legal-analysis-what-the-paramedic-criminal-charges-in-the-elijah-mcclain-case-mean-for-ems-wIPxkOn0Hn4ToKVk/

Hamilton, Ontario: Conviction of paramedics following the death of Yosif Al-Hasnawi

R. V. Christopher Marchant and Steven Snively, 2021 ONSC 3901 (CanLII) https://canlii.ca/t/jg9hb

2 paramedics found guilty in death of Hamilton teen Yosif Al-Hasnawi June 8, 2021 https://ca.news.yahoo.com/verdict-expected-tuesday-trial-2-080700585.html

Why the conviction of 2 Hamilton paramedics in Yosif Al-Hasnawi's death may change health care Christine Rankin June 10, 2021 https://www.cbc.ca/news/canada/hamilton/paramedic-trial-guilty-1.6058937

* The "Active" Medical Director

* ASEP Position Statement

* NAEMSP Position Statement

* Pilot programs and new drugs

* Sparse data and medical decisions

* Medical director as conscience of EMS agency

* It's tough to a CQI process

* Top errors in EMS

* Most important approach for ANYONE in the field

* Abnormalities and notation

* Paint the picture of your decision making

* Difference between a clinician and technician

* Acronym courses as continuing education

* Bringing training from Okay to Great

* Patient Outcomes vs. Administrative Outcomes

Quick favor: take our 3-minute (anonymous) listener survey to help shape what we cover next: https://sprw.io/stt-lfjMN

Peter Antevy, MD, who created the Handtevy System, a software-based pediatric resuscitation method and bag system is also an EMS Physician for Palm Beach County (FL) Fire Rescue and he made a post on LinkedIn advocating for abolishing Epinephrine in shockable rhythm protocols. He posts about how his protocol does not follow standard AHA guidelines at Palm Beach County Fire Rescue and their plan for ventricular fibrillation is to use esmolol, but no Epinephrine.

References

1. Boivin, Z., Duignan, K. M., Doko, D., Pugliese, N., & She, T. (2023). Epinephrine in Cardiac Arrest: Identifying a Potential Limit for Resuscitation. Western Journal of Emergency Medicine, 24(6), 1025.

Dr. Zachary Tillett, a paramedic who works as an emergency department physician in Maryland, talks about his new article, “Breaking Bad News in the Prehospital Setting: A Guide for EMS Clinicians.”

They also discuss her work on a peer support committee, working to channel members to the right resources to address mental health issues before they are in crisis.

Article discussed: Hoke, L. (2023, August 22). Not Truly Off-Duty: True ‘First’ Responders in Rural Areas. Journal of Emergency Medical Services. https://www.jems.com/operations/not-truly-off-duty-true-first-responders-in-rural-areas/

Connections: If you want to connect with the Latimer Hoke you can reach him at latimerhoke@gmail.com and to connect with the show, reach out through www.ProfessorBram.com.

Read the full article here.

Some practices of the past served only to disguise deterioration. With everything available to today’s EMS provider, you need some pearls of wisdom for effectively assessing and successfully treating patients having difficulty breathing.

Read the full article here.

They heard about nasal naloxone, so they squirt a vial of naloxone into the patient’s nose with a syringe (1 ml of 0.4 mg). It does not have any effect but they manage to establish an IV and administer another 0.4 mg IV. The patient awakens. Based on this experience, they decide nasal naloxone does not work and resist adoption of the concept during future discussions.

Read the full article here.

Welcome to Emergent Leadership where we connect with passionate leaders who just have to share their stories, perspectives, and most importantly, lessons learned.

The need is urgent, the events are critical, and the you of tomorrow is just an episode away!

Join the conversation: If you have a leadership topic, experience, or lesson learned you would like to share or hear more about, send an email at brettlylecoaching@gmail.com or use and follow #emergentleadership to join the conversation. You can also connect to Brett directly through LinkedIn or follow her journey on YouTube.

JEMS Managing Editor Jeff Frankel talks with Dr. Thomas Lardaro to discuss the critical role of emergency medical services in our communities. Celebrating EMS Recognition Day, Dr. Lardaro reflects on the profound responsibilities and challenges faced by EMS professionals both in urban and rural settings. He highlights the importance of public understanding regarding the unique pressures faced by first responders and the need for meaningful recognition beyond traditional celebrations.

• Digging a hole in the boat
• Let’s talk about the numbers
• Deaths from COVID
• Fall 2021 Resurgence
• Smallpox and COVID
• Science Breakdown

NOTE: The military was officially approved to use FDP in 2018. Efforts started earlier.

Chief Justin Duncan, CEO of Washington County Ambulance District in Missouri, shares insights on pioneering mobile integrated healthcare in a sprawling 1,500-square-mile rural area. Winning the $150,000 Building Bridges to Better Health challenge, his program blends community paramedics, telehealth, and partnerships with federally qualified health centers and social service organizations to close care gaps beyond traditional EMS responses. Duncan discusses the evolution from emergency transport to preventative, holistic care, tackling chronic diseases and social determinants of health, while navigating reimbursement challenges through managed care contracts and advocacy. He highlights the crucial role of public health in community needs assessments and stresses the urgent need to address mental health within EMS, sharing personal stories and calling for cultural change. As president of the Missouri EMS Association and chair of the NAEMT Economics Committee, Duncan emphasizes teamwork, mentorship and engagement at all levels—from local agencies to Capitol Hill—to shape the future of EMS and ensure sustainable, patient-centered care.

Dr. Dorsett writes about the Critical Moment in Patient Care in her article. Her research focuses on barriers to adequate patient care hand-offs, including interruptions in the reporting timeline. 

Jamie Wilson, paramedic and RN, also has a wealth of knowledge both in patient care and research. His article goes in depth both addressing the problem of patient care hand off reports and providing meaningful solutions. 

The group covers the pros and cons of using a structured approach such as MIST to relay information as well as discuss key findings in both guests' research and its impact on EMS providers and their patients today. 

Welcome to Emergent Leadership where we connect with passionate leaders who just have to share their stories, perspectives, and most importantly, lessons learned.

The need is urgent, the events are critical, and the you of tomorrow is just an episode away!

Join the conversation: If you have a leadership topic, experience, or lesson learned you would like to share or hear more about, send an email at brettlylecoaching@gmail.com or use and follow #emergentleadership to join the conversation. You can also connect to Brett directly through LinkedIn or follow her journey on YouTube.

Ed is a Metro Washington, DC native, a veteran of the United States Marine Corps and PA Army National Guardsman who has been actively engaged in EMS since 1990 when he ran his first EMS call as a volunteer in Montgomery County, PA. A Nationally Registered Paramedic, Ed has worked in a variety of EMS models, including non-profit, for-profit, hospital-based and rural systems.  He has served as a paramedic, supervisor, regulator, deputy chief and chief. He is currently working in senior leadership with a national medical transportation provider.  

Probably Shouldn't by J.Lang (c) copyright 2019 Licensed under a Creative Commons Attribution (3.0) license. http://dig.ccmixter.org/files/djlang59/59729 Ft: Mr_Yesterday

This week, Brett is joined by Kristy Van Hoven, director of the National EMS Museum, museum expert, and PhD candidate who is determined to understand how the past plays into the present and how it can be used as a tool for cultural breakthroughs and understanding and progress. 

Kristy shares stories about her time at Mayo Clinic working to understand how artifacts and collections may directly affect brain disorders, explains how the Minneapolis Institute of Art used pain and loss as a way to heal a community, and how museums are able to facilitate emotional progress and strength. 

Storytelling is the first step to healing, and only when we are confident and ready to embrace vulnerability are we able to effectively drive and lead sustainable change. 

Welcome to Emergent Leadership where we connect with passionate leaders who just have to share their stories, perspectives, and most importantly, lessons learned.

The need is urgent, the events are critical, and the you of tomorrow is just an episode away!

Join the conversation: If you have a leadership topic, experience, or lesson learned you would like to share or hear more about, send an email at brettlylecoaching@gmail.com or use and follow #emergentleadership to join the conversation. You can also connect to Brett directly through LinkedIn or follow her journey on YouTube.

Led by Anna Harris, a veteran and the director of Human Chemistry and Talent at NAR, Coffee with Veterans aims to bridge the gap between veterans and first responders and the civilian job market. With many NAR team members hailing from military and first responder backgrounds, this program is a personal passion for the company.

Participants

Jonathon Feit, MBA, MA

Co-Founder & Chief Executive

Beyond Lucid Technologies, Inc.

Mike Touchstone, BSHS, FACPE

Fire Paramedic Deputy Chief, EMS Operations (Retired)

Philadelphia (PA) Fire Department

Past President, National EMS Management Association

This podcast is sponsored by LogRX. For all your medication and narcotic tracking needs, check out the LogRx App, created by career EMS professionals. Visit www.logrx.com to learn more.

In this episode of the JEMS Report Podcast, managing editor Jeff Frankel sits down with Dr. Liz Travis, a maternal care researcher, to discuss the growing challenges EMS providers face with out-of-hospital births. They unpack the critical gaps in traditional EMS training, particularly as maternal care deserts expand, leaving medics increasingly responsible for delivering babies in the field. Dr. Travis shares evidence-based strategies like the importance of delayed cord clamping (“wait for white”), skin-to-skin contact, and encouraging comfortable, non-supine birthing positions to improve outcomes for mother and infant. She advocates for updated, hands-on EMS training that reflects modern obstetric knowledge, including collaboration with midwives and doulas. Above all, Dr. Travis emphasizes that birth is usually natural, not an emergency, encouraging EMS providers to remain calm and focus on simple, effective practices. This episode offers essential insights for paramedics and EMS agencies preparing to meet the demands of maternal care in underserved areas.

The episode focuses on how first responders on the home front are dealing with the fallout of war, both the physical injuries, as well as the psychological traumas. Each person in Israel is carrying around with them a lot of trauma from the war.

How does this play out among the first responders who are already running into often dangerous situations? 

Listen to the episode and be inspired by some stories of resilience that can only happen in war. 

Read the full article here.

Give a listen and write in the comments some of the pet peeves that you've experienced on the job. We'd love to hear from you what really gets your goat on the job.

Together, we may not be able to solve them, but we can all identify with them and empathize with one another.

Dov and Raphael delve into some of the challenges and humorous stories that take place in Israel during the spring holiday seasons. They advise how to avoid the pitfalls that many people find themselves in during this time of year. 

As there currently is a concurrence of three major holidays in Passover, Ramadan, and Easter/Pascha the entire populace is out celebrating the holy and happy time, which means... you guessed it, far more emergency calls. From hiking and water drownings to dehydration and spring/Passover cleaning-related injuries, Dov and Raphael take you behind the scenes into some harrowing calls and talk about how preventable injuries and deaths are really hard to handle. 

Randy Beeman is the current National Emergency Number Association (NENA) chapter president. He is a 30-year retired medic with 40+ years in local government but currently serves as the director of Durham Emergency Communications Center. Randy holds a B.A. in business administration. 

Ollie Wall is a communications shift supervisor at Durham Emergency Communications Center in Durham, NC, and has worked for the department for 20 years. Her career began as a telecommunicator and served as a mentor before stepping into her full-time supervisor role.

Where have all the volunteers gone? The top reason for shifting EMS volunteerism is surprising. After all, there is no better feeling than giving back to your community and knowing you made a difference – but at what cost? Across the country throughout the years, the number of volunteers in EMS, fire and rescue has sharply decreased, especially over the last decade.  Where have all of the volunteers gone? Wes Ogilvie joins the EMS Handoff crew to discuss volunteerism in EMS.

Wes is a renowned EMS advocate and legal expert in EMS and is currently serving as a paramedic/FTO with multiple EMS agencies. Wes is an attorney for Texas state government, has been in EMS since 2004 and has been a paramedic since 2007. Wes is currently a paramedic/FTO with West EMS and a paramedic with Huffman EMS.  Throughout his career, he has been published in several EMS periodicals and co-authored the Medical-Legal chapter of Paramedic Care: Principles and Practice.

Key Points:

• Philadelphia Fire EMS is severely underfunded, with a unit-hour utilization of 1.0, meaning they're busy 100% of the time, leading to a delayed response time
• As a result, critical penetrating trauma patients are transported by police, without any care, in the back of prisoner vans to trauma centers
• But rather than advocating for more ambulances, especially in this era of limiting police scope creep, surgeons consistently try to justify the police transport model

They discuss the differences between leading, managing and having charisma – and the value of each of them. They talk tough conversations. They talk social interactions and interpersonal relationships. They talk feedback. They talk sacrifice.

Steve talks about the burden placed on today’s leaders, explores the value in asking for help and emphasizes the importance of the people you surround yourself with as you navigate your path. 

Welcome to Emergent Leadership where we connect with passionate leaders who just have to share their stories, perspectives, and most importantly, lessons learned.

The need is urgent, the events are critical, and the you of tomorrow is just an episode away!

Join the conversation: If you have a leadership topic, experience, or lesson learned you would like to share or hear more about, send an email at brettlylecoaching@gmail.com or use and follow #emergentleadership to join the conversation. You can also connect to Brett directly through LinkedIn or follow her journey on YouTube.

ChatGPT accurately identified conditions 75% of the time and often erred on the side of caution, potentially reducing dangerous under-triage. Duffee is joined by lead researcher Erik Miller, a nurse practitioner and paramedic turned researcher, who sheds light on the study’s design, limitations, and real-world implications.

They discuss how AI can support—but not replace—the critical thinking skills of EMS providers, the challenges of legal liability, and the risks of overreliance on technology. The conversation also explores future possibilities for AI integration in dispatch and patient care reporting, while emphasizing the irreplaceable human touch in emergency medicine.

Tim Nowak has 14,500 followers. Join this LinkedIn expert and industry conversationalist as he opens up to hostess Brett Lyle about his personal stories and experiences with how the platform has helped him find his voice and how he has perfected the art of using it.

He speaks about the powers of curiosity and targeted networking, discusses challenges that come with developing your personal brand and explores the journey and power in online relationship building.

Tim makes a personal offer to you and leaves motivating words of advice for fellow Emergent Leaders.   

Welcome to Emergent Leadership where we connect with passionate leaders who just have to share their stories, perspectives, and most importantly, lessons learned.

The need is urgent, the events are critical, and the you of tomorrow is just an episode away!

Join the conversation: If you have a leadership topic, experience, or lesson learned you would like to share or hear more about, send an email to brettlylecoaching@gmail.com or use and follow #emergentleadership to join the conversation on LinkedIn. You can also connect to Brett directly through LinkedIn or follow her journey on YouTube.

This episode of the Not A-fib podcast looks into the increasing scrutiny EMS providers face from a legal standpoint, highlighted by high-profile cases like Elijah McClain's tragic death in Aurora, Colorado, and a recent Springfield, Missouri incident. Attorney and EMT Frank Flaspohler, who serves as legal counsel to Missouri ambulance districts, explains the differences between civil and criminal liability in EMS, the limits of governmental immunity, and the critical role of documentation. He discusses the legal thresholds around chemical and physical restraints, the importance of assessing mental capacity in refusals, and the risks tied to improper patient handling. Frank also shares practical advice on maintaining professionalism in reports and on scene, the nuanced challenges rural EMS agencies face, and emerging concerns such as mental health support for first responders.

Read the full article here.

Whether the patient has loved ones by their side or is living alone or in a long-term care facility, this population grouping often requires an extra level of care. We'll discuss tips and ideas on how to provide that, even though these calls are often not the “heroic” ones that EMS personnel respond to. We're here to help the elderly like all our patients, and we'll discuss a specialized program that has been developed in Israel that aims to alleviate non-essential calls while providing routine check-ups for the elderly and at the same time alleviating sensations of loneliness among this target population.

In this episode, the trio shares a first-hand account of just a few of the activities that were undertaken as a part of the overall mission, one of which, was successfully opening Moldovan airspace to humanitarian aid and facilitating the evacuation of refugees via the Chisinau Airport which had been closed since the beginning of the war due to its proximity with Ukraine and Transitania. By doing so, Linor single-handedly made a huge impact on the lives of tens of thousands of refugees who were able to receive medicines, food, and humanitarian aid, as well as depart Moldova for their countries of choice.

During this EMS Handoff, Dr. McCardell discuss the current state of sepsis in the prehospital environment to include SIRS Criteria, continuum of sepsis, early recognition and its effects on morbidity and mortality.

And just when you thought you have enough fluid, think again. About 3% of the calls that EMS agencies run in the United States are related to Sepsis. Putting that into a little more context, that is about 136 calls for service every hour of the day, all year long. Are you ready for that handoff?

You can read the article here.

This podcast is sponsored by ESO.

It’s that time again! ESO just dropped their 2024 EMS Index — a must-read benchmarking tool for every EMS agency. With insights from over 12 million EMS responses in 2023, it covers topics like bystander CPR, ambulance offload times, and opioid overdoses. Your FREE copy is available now at eso.com/ems-pod.

This podcast is sponsored by ESO.

It’s that time again! ESO just dropped their 2024 EMS Index — a must-read benchmarking tool for every EMS agency. With insights from over 12 million EMS responses in 2023, it covers topics like bystander CPR, ambulance offload times, and opioid overdoses. Your FREE copy is available now at eso.com/ems-pod.

This reduction in services not only impacts the immediate area but also places additional strain on neighboring services, creating a domino effect that worsens response times and stretches resources thin across wider regions.  

The two covers everything from operational procedures, heroic stories of volunteers, and straight-out miracles -- all of which culminated in the mobilization of more than 1,000 volunteers in mere hours The lives of more than 3,000 people were saved thanks to the quick response of those volunteers in the organized chaos of the organization's response, all while under live fire. 

Newly retired San Francisco (CA) Fire Department Lt. Cynthia Ricker reflects on her 27-year career and talks about why she chose to retire. She explores how she sustained a long career with calls she still carries.

"I made a pact with myself that if I needed help, I would get it outside of the fire department,” Ricker said.

Article discussed: IPMI. (October 1, 2023). International Prehospital Medicine Institute Literature Review, October 2023. Journal of Emergency Medical Services. https://www.jems.com/patient-care/international-prehospital-medicine-institute-literature-review-october-2023/

Today, we’ll be talking about Bystander CPR 2.0, how engaging the community can – and has – revolutionized the speed at which basic CPR is initiated in cases of sudden cardiac arrest across Israel. In this episode, Dov and Raphael will discuss how a small and inexpensive program became a national initiative that resulted in a shift in the number of bystanders willing and able to perform basic CPR during an emergency.

We will discuss the “Safe Family” education program that involved community members taking a four-hour basic CPR and family safety course which has led to dozens of recent instances where bystanders became the “first” first responders and initiated near-immediate CPR that resulted in lives being saved.

Article discussed: Alzaatreh, M. Y., Alsadi, M. R., Alkhsealat, Y., Alhemedi, M., & Alrabab’a, M. H. (2022). Pre-hospital rapid sequence induction by paramedics: A scoping review. Journal of Emergency Medicine, Trauma & Acute Care (5) 40.

Connections: If you want to connect with Penny Chiasson you can reach her at penny@pennychiasson.com and to connect with the show, reach out through www.ProfessorBram.com.

In this episode, Dov and Raphael go behind the scenes on the recent launch of United Hatzalah's airborne medical unit and new medevac program. The newly launched program will consist of 30 specially trained paramedics who have all just recently graduated from intensive medevac flight training and will operate on three medevac helicopters that will be spread across the country.

This new unit, as all units run by United Hatzalah, will cut down response times a provide an additional option to the government-run medevac program which currently operates two medevac choppers.

With its inauguration, United Hatzalah operates, by land, by sea, and now by air!

The discussion goes far beneath bumper-sticker messages, seeking root causes to develop practical solutions in highly impactful areas of Mobile Medical education, economics, provider mental health and wellness, and management of people and processes. We even discuss issues related to the churn of personnel in and out of the industry — and the associated shortage of qualified new people.  

All against the backdrop of the power of data to inform decision-making that elucidates the “invisible contracts” that operate all around us: assumptions made but infrequently clarified, which can lead to strained relationships in an industry that is built on trust. TRUST is perhaps more critical now than ever as Mobile Medicine seeks to navigate changes from all directions, forcing an evolution of the key skills required of both field crews and managers alike.   

Furthermore, we get into possible cases you may see when it comes to the patients we see in the field. 

* Legal System at Play

* State and Federal Oversight

* THC and CBD Metabolites

* Drug Testing

* Inner cannabinoid system

* Stress and Marijuana

* Hyperemesis Case Study

* Cannabis induced pneumomediastinum

* Final Notes

Resources

Cannabinoid Hyperemsis Syndrome

Is CBD Addictive?

Pneumomediastinum in marijuana users: a retrospective review of 14 cases

Don’t forget to go to our newly redesigned website at www.emshandoff.com.  Subscribe rate and review the EMS Today Podcast by JEMS and the EMS Handoff YouTube Channel.

Don’t forget to go to www.thepursueco.com and find the great EMS Handoff merchandise. 

The world of EMS in Israel has drastically changed in the past 20 years, and United Hatzalah has been at the forefront of technological innovations that have been pushing the field of EMS forward throughout the 21st century. 

In this episode, we will be discussing some of our more recent large-scale innovations, such as the use of the Carbyne communication and location system; our new Rug Gear communications devices and communications technology that we have built with Widebridge systems and the Israeli Pelephone telecommunications network; and our most recent agreement with City Transformer, which will revolutionize the urban EMS system - utilizing a car-sharing program for first response vehicles that can modulate or transform to less than one meter wide. Due to their modular size, these vehicles are easy to park and drive through traffic and allow first responders who are not motorcyclists to respond to medical emergencies faster. 

Chief Casciotti oversees Community Paramedicine/Mobile Integrated Health, infectious disease prevention and control, and COVID-19 response (both exposure tracking and vaccinations).  No holds were barred in this frank discussion, which covers politics, misinformation, the now-very-clear consequences of raiding public health funding for years, and even the ease of documenting -- on white paper cards -- COVID-19 shots that one may or may not have actually taken.

(Coming soon: Part two will explore the experience of sharing data with a state immunization registry...only to find errors in one's own vaccine record.) 

They also get into the biggest concern most firefighters have: drug testing. John shares details from a university-backed study involving the University of Arcadia and the University of Maryland, including how urine samples were tested under strict lab conditions for THC.

Does being an emergency service worker impact your freedom of speech online on social media? Are there pictures you can take on scene? What should you do with pictures you need to delete? You may be surprised to learn what could happen if you delete an image prematurely. 

Chief Curt Varone, a retired fire chief and current practicing attorney, explores social media and its legal impact for those in fire and emergency services. This podcast has valuable information for those entering our service and critical for those currently practicing.

Varone has over 40 years of experience in the fire service, retiring in 2008 as a deputy assistant chief with the Providence (RI) Fire Department. He is a practicing attorney licensed in both Rhode Island and Maine. Varone has written two books on legal issues in the fire service, is a contributing editor for Firehouse and runs Fire Law Blog. He remains active as a deputy chief with the Exeter (RI) Fire Department.

March 17, 2021, marks the 25th anniversary of the merger between FDNY and NY EMS. FDNY EMS Local 2507 President Oren Barzilay was an EMT at the time of this merger. President Oren joins the EMS Handoff crew on this special episode celebrating this momentous occasion discussing not only the history of this merger but where he says FDNY and EMS in the future.

Some links:

Porsche Cayenne ambulance

Toyota Land Cruiser ambulance

Hatzolah

New Jersey ambulance response times

Probably Shouldn't by J.Lang (c) copyright 2019 Licensed under a Creative Commons Attribution (3.0) license. http://dig.ccmixter.org/files/djlang59/59729 Ft: Mr_Yesterday

Welcome to Emergent Leadership where we connect with passionate leaders who just have to share their stories, perspectives, and most importantly, lessons learned.

The need is urgent, the events are critical, and the you of tomorrow is just an episode away!

Join the conversation: If you have a leadership topic, experience, or lesson learned you would like to share or hear more about, send an email at brettlylecoaching@gmail.com or use and follow #emergentleadership to join the conversation. You can also connect to Brett directly through LinkedIn or follow her journey on YouTube.

Welcome to Emergent Leadership where we connect with passionate leaders who just have to share their stories, perspectives, and most importantly, lessons learned.

The need is urgent, the events are critical, and the you of tomorrow is just an episode away!

Join the conversation: If you have a leadership topic, experience, or lesson learned you would like to share or hear more about, send an email at brettlylecoaching@gmail.com or use and follow #emergentleadership to join the conversation. You can also connect to Brett directly through LinkedIn or follow her journey on YouTube.

How do first responders come into a relationship? In this podcast we explore different coping mechanisms, common problems in relationships and some strategies on how to destress before stepping in the door.

Resource: PSI Seminars http://psiseminars.com/basic

Project Mayday was founded by three first responders. Get to know our stories for our first podcast and our motivations behind the project. Stay tuned for other first responder stories about their journey with mental health.

Visit www.stettasleeves.com to learn more.

Quick favor: take our 3-minute (anonymous) listener survey to help shape what we cover next: https://sprw.io/stt-lfjMN

Created by Zach Hamelton, a former TV and film producer turned public information officer, the series blends cinematic storytelling with immersive, real-world footage captured via GoPros and cinema cameras.

Viewers get rare access to intense emergencies, day-to-day station life, technical rescues, and candid conversations revealing the emotional toll on responders.

With a focus on authenticity, the show highlights both heroic moments and routine calls, showcasing the personal bonds and dedication within the crews. It also aims to boost recruitment by letting the community see the people behind the badges.

Brought to you by Stetta Sleeves. www.stettasleeves.com

Brought to you by Stetta Sleeves.   www.stettasleeves.com  

This podcast is sponsored by LogRX. For all your medication and narcotic tracking needs, check out the LogRx App, created by career EMS professionals. Visit www.logrx.com to learn more.

Our teams have been active at the two border crossings connecting the countries, as well as in numerous refugee centers in and around the capital city of Chisinau. We set up a field hospital in the capital and converted an Irish pub that had been closed due to COVID-19 into an industrial kitchen that has provided more than 80,000 hot meals to refugees. We'll go behind the scenes into some of the stories that took place during the past month of our operation and discuss how our EMS organization began a daily airlift operation that has thus far brought more than 2,000 Ukrainian refugees to Israel. 

After getting sober in 2011, Phillip completed a recovery dynamics program, lived in sober living for 2.5 years and has worked hard to mend, maintain and create relationships.

Phillip works with local police departments, fire departments and EMS as a First Responder Liaison to aid in removing the stigma that may come with dealing with substance use disorder. In the past 10 years he has participated in countless local community events such as rallies, legislation days, town hall meetings, street and park cleanups, harm reduction services and Narcan distributions.

He serves currently as the elected Area Chairperson for the St Louis Area of Heroin Anonymous and remains grounded in his own recovery.

This podcast is sponsored by ESO.

It’s that time again! ESO just dropped their 2024 EMS Index — a must-read benchmarking tool for every EMS agency. With insights from over 12 million EMS responses in 2023, it covers topics like bystander CPR, ambulance offload times, and opioid overdoses. Your FREE copy is available now at eso.com/ems-pod.

Find out more about the Training in Motion platform here.

This podcast is sponsored by LogRX. For all your medication and narcotic tracking needs, check out the LogRx App, created by career EMS professionals. Visit https://logrx.com/ to learn more.

Summary: In this episode, Bradley Dean and David Blevins are joined by Jonathan Jenkins from Mutual Aid EMS to explore the integration of customer service principles into the EMS profession.

Does service excellence in EMS translate to better patient outcomes, more repeat business and stronger collections?  The evidence of this in other areas of health care is well documented, so it’s logical to assume those results could be possible in EMS.

The age-old argument, “Those who summon our service are patients and not customers,” completely misses the point. It really doesn’t matter what we call them; individuals who seek medical assistance from EMS deserve to receive excellent service from those who provide care.

Questions….that patients often ask that measure our customer service.

1. Did we arrive in a timely manner?
2. Did we explain the treatment they received?
3. Did we treat them in a respectful manner?
4. Did we take care of their pain and make them comfortable?

The top 10 things for delivering good customer service…..

1. Work together as a team to care for the patient.
2. Control the patient’s pain and suffering.
3. Include patients in their decision about their treatment.
4. Have good skills…. Be able to perform smoothly….
5. Have a good attitude toward the patient’s requests.
6. Address the patient’s emotional needs.
7. Keep the patient informed during your time with them.
8. Be responsive to patients concerns and complaints.
9. Be positive and interact with family when caring for the patient.
10. Be friendly and courteous.

The cases for 2024 are at least four-times higher than in 2023, and many departments have not offered the required Tdap booster to protect healthcare personnel.

An additional dose of Tdap was first recommended in 2005 and then again in 2011. Pertussis is not on the radar, and we need to ensure that healthcare providers are protected. This session addresses vaccine, personal protective equipment and post-exposure medical follow up.

They also explored the concept of competency-based medical education, the use of Learning Management Systems (LMS) in education, and the importance of intrinsic motivation and flexibility in response to changing circumstances.

Lastly, they discussed the upcoming changes in the National Registry and issues related to their respective states, agreeing to further discuss these in the future.

On this episode of the Patient Centered Paramedic Podcast, Catherine Sanderson joins John Sammons. In her book “Why We Act, Turning Bystanders Into Moral Rebels”, she talks about the psychology of bystander action—or inaction. In this talk, we tie this concept into scene management, interpersonal relations and patient advocacy.

Items Discussed

• The belief that field clinicians can/should be trusted to make ethical and moral decisions.

• Are we educating clinicians on how to make such assessments, or are we training clinicians to paint by number/practice by rote protocol?

• Are “thinking” vs. a scientifically informed, protocolized approach mutually exclusive—or can they inform one another?

• Are we training clinicians to develop their moral compasses?

• What happens when science suggests that the moral or ethical thing to do is the suboptimal choice (and by what yardstick is that judged)?

Panelists

Christopher Colwell, MD; chief of Emergency Medicine at Zuckerberg San Francisco (CA) General Hospital and Trauma Center

Michael Dailey, MD; director of Prehospital Care Services & Education at Albany (NY) Medical Center

Abby Dotson, PHD; executive director at the National POLST Collaborative, director of the Oregon POLST Registry

Jonathon Feit, MBA; co-founder and chief executive of Beyond Lucid Technologies, Inc.

Keep the conversation going by using #JEMSTalk on social media.

Read the full article here.

Contact us

Bradley Dean: Bradley.dean@handoffmedia.com

David Blevins: David.blevins@handoffmedia.com

Guests

Jason Brooks. jbrooks@dt4ems.com

JEMS Editor-in-Chief Dr. Ted Lee speaks with Dr. Kathleen Adelgais and Frank St. Denis to learn more about the program.

The PPRP is an initiative to ensure all U.S. EMS agencies and fire-rescue services that respond to public 911 medical calls have essential resources in place to provide high-quality emergency care for children. The project is led by the Emergency Medical Services for Children Program in partnership with more than 30 national organizations and stakeholders.

Learn more about the assessment here.

On arrival, you load your stretcher with all your gear and prepare to get some steps in while traversing the expanse of the warehouse. As you know, warehouses are never built small, and there is always a possibility that the scene awaiting you at the patient is not what you expect.

Read the full article here.

Read the full article on EMS Airway.

In this episode of The Chief’s Cadence, Chief Shane Wheeler sits down with Attorney Steve Wirth, a pioneering paramedic turned attorney and EMS leader, to uncover the complexities of ethical leadership in emergency medical services. Drawing from decades of hands-on experience, Steve explores the hard choices EMS professionals face daily—from patient care errors and scarce resources to the challenge of maintaining compassion amid burnout. They discuss the vital role leaders play in modeling integrity, fostering transparency, and building a culture that empowers staff to speak up about mistakes. Steve also highlights mentorship as a powerful tool for guiding the next generation of EMS leaders through the ethical “gray zones” that often arise. 

Firefighter Fenton opens up about balancing two decades of firefighting with family life, creative content creation and staying true to himself. From the harrowing experience of losing a fire truck amid a wildfire threatening homes—teaching him tough lessons in leadership and priorities—to the lighter side of his persona inspired by a fake mustache and parody videos, Brent shares it all. He discusses the challenges of juggling a full-time career, four kids, homeschooling and his passion for music and comedy. Brant also reveals the power of community within firefighting content creators and how their work brings laughter and healing to those facing dark times. For anyone wanting to create meaningful content, Fenton’s advice rings clear: stay authentic, know your worth beyond the spotlight and never lose sight of what matters most—family and faith.

Introduction

• Welcome back to the EMS Handoff Podcast
• Hosts: David Blevins and Bradley Dean
• Special guest: Debbie Herrell, expert in pediatric burn injuries from the Shriner's Hospital and Terrance Sheehy with Dare County EMS

Overview of Pediatric Burn Injuries

• Unique considerations in treating pediatric burn patients
• Differences in burn classifications and assessing burn depth
• Importance of understanding the susceptibility of children's skin to burns

Pain Management for Pediatric Burn Patients

• Effective methods for providing pain relief to pediatric burn patients
• Pharmacological options and non-pharmacological interventions
• Distraction techniques tailored for pediatric patients

Addressing Emotional and Psychological Impact

• Understanding the long-lasting emotional and psychological effects of burn injuries on children
• Providing psychosocial support to pediatric burn patients and their families
• Involving parents and caregivers in the healing process and connecting them with appropriate resources

Resources and Training Opportunities

• Highlighting organizations such as the American Burn Association and the National Association of Emergency Medical Technicians
• Resources, training programs, and certifications specific to pediatric burn care
• Importance of interagency collaboration between EMS providers and burn centers

Conclusion

• Thanks to Debbie Herrell for sharing her expertise on pediatric burn injuries
• Reminder to subscribe for future episodes of the EMS Handoff Podcast
• Stay safe and keep up the great work in the field

Note: These show notes provide a brief summary of the 65th episode of the EMS Handoff Podcast featuring a discussion on pediatric burn injuries. For a comprehensive understanding, please listen to the full episode.

She clarifies how EMS-specific CDC guidelines account for unique factors like ambulance ventilation systems, the rear exhaust fan and closed suction systems that impact airborne and droplet disease transmission risks.

Katherine addresses the evidence behind mask and respirator use, emphasizing that clinical data since 2015 shows no clear advantage of N95 respirators over surgical masks for many respiratory infections in EMS contexts.

She also highlights post-exposure protocols, explaining why EMS personnel do not require immediate baseline blood testing, unlike hospital staff. Practical advice on COVID-19, tuberculosis, measles, Ebola precautions and aerosolized medication administration underscores why EMS must follow tailored guidelines rather than hospital-based protocols.