EMS Today

Three members of the Cool Fireman Podcast join the Salty Paramedic on Just a Little Salt for a wide-ranging conversation about firehouse culture, leadership, and life on shift. Brian Kelly, Doug "Big City" Bishop, and Adam "Unkie" McCoy discuss crew integrity, how phones and station design have changed the kitchen-table camaraderie, what earns a rookie respect, and leadership lessons like "inspect what you expect" and owning mistakes. They share favorite episodes and guests, podcasting realities, social media’s pros and cons, and even the lighter side — pranks, firehouse food, bourbon and bad meals. If you run shifts, recruit, or lead, this episode digs into practical advice on training, mentorship, and balancing friendship with command.

EMS has long been technologically underserved compared to hospital systems, forcing medics to perform high-stress mental math in the field. On the JEMS Podcast, OneDose co-founders Tristan and Colton Hazlett share how they're changing that dynamic. What started as a hardware project in their parents' basement, resulting in the OneWeight smart gurney scale, has evolved into a comprehensive medication safety platform.   The OneDose app integrates directly with major EPCRs like ESO and ImageTrend to streamline clinical workflows and reduce cognitive load. Its standout features include a voice-to-voice AI Assistant for quick protocol summaries and a digital cross-check system that scans medication vials to flag concentration mismatches. By replacing manual calculations with precise dosing support, OneDose helps medics keep their focus on patients rather than screens.   This podcast is brought to you by OneDose. https://myonedose.com/ems-app/?utm_source=jems&utm_medium=podcast&utm_campaign=ai_healthcare

Tracey Loscar, deputy director-EMS for Matanuska-Susitna Borough (AK) joins the Not A-Fib Podcast. We discuss the challenges of working in Alaska. Some of those challenges include the lack of resources, the distance to care, the difficulties in reaching patients, and all versions of EMS in the state. We also discuss the vastness of the Alaskan wilderness and the long hours of daylight and darkness in the summer and winter, respectively.

Mike Brown and Jesse Carroll from Hamilton Medical break down ventilatory management for the DKA patient and other metabolic-acidosis presentations in the prehospital setting. They focus on why minute ventilation, not just rate, matters when you take a patient's airway: match or exceed the patient’s compensatory minute volume, size tidal volume to ideal body weight), and account for dead space. Practical demos cover when to favor a mechanical ventilator over BVM, using NIV-ST to support fatigued spontaneous breathers, and how to set tidal volume and rate to replace 17–20 L/min minute volumes seen in severe hyperventilation. They also unpack the ICEBERG Study and the concept of driving pressure, why driving pressure may better reflect lung stress than plateau pressure alone, and why higher driving pressures are associated with worse outcomes. The discussion reviews current evidence supporting efforts to keep driving pressure low when clinically feasible.

In this episode we walk through how noninvasive ventilation for pediatric respiratory distress moved from an idea to standard practice in central Ohio. Guests Rob Glaze and Kyle Goodknight describe a child’s near‑miss, the partnership with Nationwide Children’s Hospital, and Westerville Fire’s rollout. They debunk myths—kids won’t tolerate masks, PEEP will harm hypotensive children, blow‑by works—and explain why work of breathing, not SpO2, should trigger CPAP. Check out a link to their ebook here: https://pages.kylegoodknight.com/peds-cpap-landing

Jana Williams, president and CEO of the Association of Air Medical Services (AAMS), joins Mike Brown to discuss the evolving role of air medical and critical care transport. They cover AAMS’ three pillars—advocacy, collaboration, and education—highlighting current priorities: Medicare reimbursement that reflects modern clinical and aviation investments, the mental health and aviation bill, and a cost study showing underpayment. Jana explains how air medical teams act as mobile critical-access beds for rural communities, the expansion of point-of-care diagnostics, ECMO and whole blood transport, and the operational realities driving higher costs. She outlines workforce initiatives: the Flight Ready Institute (formerly the Critical Care Transport Academy), leadership schools (MTI, SMT, LIFT), and the annual Air Medical Transport Conference (MTC).

Matt Zavadsky from PWW Advisory Group (PWW|AG) joins the podcast to discuss the economics of EMS. We discuss the current economic landscape of EMS and how it has strained some services to the point of closure. We also discuss the Medicare Ground Ambulance Data Collection Surveys conducted over the past few years and how some of the data collected were not included in the final results published. We wrap up with a brief discussion on what could be seen in EMS economics and reimbursement in the future.   This podcast is brought to you by Medical Shipment: https://medicalshipment.com/

Dr. Tim Nutbeam, a consultant and professor of emergency and prehospital medicine at a major trauma center in Plymouth, UK, explains evidence that should change how teams manage vehicle entrapment. Key takeaways from the EXIT research program: self extrication often produces less spinal movement than complex “slow and steady” techniques; minimize entrapment time because clinical observations poorly predict rapid deterioration; pelvic binders mainly help rare open book fractures and may be unhelpful or contraindicated for the common lateral compression patterns; long spine boards are for extrication/transfer only; cervical collars can be removed or loosened once a conscious patient is ready to self move, but use briefly for rapid extrication of unconscious patients. Dr. Nutbeam also stresses the human side: assign an extrication buddy, explain noisy steps, hold a hand, and prioritize analgesia and oxygen.

Mike Brown sits down with Dr. Sarah Fabiano and Mike Ellis as they distill pediatric diabetic ketoacidosis into a clear prehospital approach. Using a “sour blood stew” recipe metaphor, they explain how zero units of insulin produces ketones, osmotic diuresis, dehydration, and electrolyte shifts. Key takeaways for EMS: prioritize perfusion with IV fluids (lactated Ringer’s preferred), monitor rhythm, obtain potassium before giving insulin, use a two bag insulin/dextrose strategy to close the anion gap safely, and avoid intubation unless absolutely necessary as spontaneous ventilation supports the physiologic need for higher alveolar tidal volumes.   This podcast is brought to you by Medical Shipment: https://medicalshipment.com/

Paramedic Brad Lawson joins Just a Little Salt to talk about founding the PIERCE Foundation and PIERCE Provisions, running mental wellness summits and a new Responder Fest. Brad explains why cumulative trauma drives PTSD and emotional numbness, how healing looks, and why peer led, story driven summits cut through the usual PowerPoint culture. He announces upcoming events: Responder Fest (Greenville, SC — Sept 10–11), Nashville summit (Oct 5–6) and Asheville (Oct 28–30, couples workshop + themed events).   This podcast is brought to you by Medical Shipment: https://medicalshipment.com/

Melody Mesmer tells the story behind Foundation 1023, a peer driven nonprofit born after a string of 2015 line of duty tragedies.   Melody explains how 1023 (Kristen McLean’s badge number) connects first responders, dispatchers, medical crews, tow operators and families in Texas and Colorado to culturally competent, trauma informed counselors, peer support training, and outdoor resiliency programs like paddle boarding and movement-based therapies.   She covers what early intervention looks like, how peer support reduces isolation, confidentiality protections for peer teams, and practical steps to access help. Melody emphasizes rural volunteer gaps, the importance of community outside the workplace, and why asking for help is a hero’s act.   This podcast is brought to you by Medical Shipment: https://medicalshipment.com/

Mark Flauter sits down with registered nurse Tammy Scott to share her powerful and deeply personal story of survival and advocacy. In April 2022, Tammy was stabbed and critically injured by a patient while working in a St. Louis–area emergency department. She recounts what she remembers from that traumatic day and opens up about her long and challenging journey toward physical and emotional recovery.   Tammy also discusses her experiences navigating the workers’ compensation system and shares her perspective on where hospital administration, and the healthcare system more broadly, can do more to protect frontline professionals from violence. The conversation expands to explore the alarming prevalence of assaults against healthcare workers, both in prehospital settings and inside hospitals, and the troubling normalization of these incidents within the profession.   The episode concludes with a look at Tammy’s ongoing advocacy work, including her foundation, The Nightingale Front, her memoir Frontline Survivor, and her upcoming appearance in the documentary Suck It Up, Buttercup, soon to be available on streaming platforms.   This episode is brought to you by Medical Shipment: https://medicalshipment.com/

On EMS Remembrance Day, we speak with Jana Williams, Tony O’Brien, and James Robinson of the National EMS Memorial Foundation about honoring fallen EMS providers, the annual National EMS Memorial Service, and the drive to build a permanent memorial in Washington, D.C. Learn about Moving Honors (a traveling Tree of Life memorial that visits communities June 1–July 2), the Weekend of Honor (July 17–19, Alexandria, VA), MIT’s pro bono conceptual designs, and how volunteers power this effort. Hear firsthand why memorials matter to families and colleagues and how remembering supports safety and healing. Want to help? Attend or volunteer for events, donate to the three memorial organizations, or contact your senator to support reauthorization in Congress (S.2546). Share this episode to spread the word and help build a permanent home for EMS remembrance and honor our colleagues' service.

Join the JEMS Podcast as we celebrate EMS Week 2026 with Dr. C. Ryan Keay and Chief Christopher Wray. They cover the frontline issues shaping modern prehospital care: sustainability and stewardship of whole blood programs; rural supply-chain challenges and drone delivery ideas; rapid adoption of point-of-care ultrasound; growth of treatment-in-place and mobile integrated health; AI for documentation and decision support; and legal/operational considerations for body-worn cameras. Dr. Keay and Chief Wray share practical examples, federal policy priorities, and how reimbursement and community partnerships can sustain clinical advances. This episode honors paramedics, EMTs, dispatchers, flight crews, educators, and leaders while offering actionable insights for agencies planning new programs, quality review, and cross-sector collaboration.

Mike Brown hosts this JEMS Podcast Save a Life Day special during EMS Week 2026, joined by Chief Rom Duckworth and Dr. Shira Schlesinger. We celebrate EMS professionals and focus on two lifesaving interventions: bystander CPR and bleeding control. Topics include barriers to community CPR, Sidewalk CPR Week and practical, low-cost ways to increase engagement. They discuss Stop the Bleed realities: tourniquet over application concerns, the need for tourniquet correction and conversion by trained prehospital clinicians, and strategies to co locate tourniquets with AEDs.

Mike Brown talks with Dr. Kathleen Adelgais and Dr. Manish Shah during EMS Week 2026’s EMS for Children Day for a conversation about where pediatric readiness in EMS stands, and where it still needs to go. Drawing on findings from the 2024 Pediatric Readiness Project national assessment, they examine the progress agencies have made, the persistent gaps that remain, and the practical steps EMS leaders can take now to better prepare for pediatric patients. With more than 7,000 of roughly 15,000 U.S. EMS agencies participating, the survey produced an overall readiness score of 66, highlighting strengths in equipment and supplies, medication and patient safety, and pediatric protocols, while also revealing continued challenges in family-centered policies, pediatric quality improvement, and disaster preparedness.

Mike Brown hosts an EMS Week Safety Day conversation with Dr. Douglas Kupas, president of the National Association of EMS Physicians, on practical strategies to protect providers and transform EMS into integrated healthcare. Topics include evidence on reducing lights-and-sirens use; rising ambulance thefts and simple vehicle interlocks; low-cost countermeasures like 3D‑printed stretcher buckle covers and pager-sized CO detectors in first-due bags; training options for managing assaults and the shift toward treat-in-place, mobile integrated health programs; and reimbursement reform. This talk offers practical, field-tested ideas for agencies, medical directors, and EMS providers who want safer, smarter EMS operations.

On today’s EMS Week Education Day episode, Mike Brown speaks with Dr. Navin Ariyaprakai and Michael Kaduce about how national partnerships, accreditation, and modern learning strategies are reshaping prehospital care. They explain why accreditation lifts program standards, improves outcomes, and strengthens medical director involvement; and give examples where evidence changes field practice. They cover the difference between initial and continuing education, the value of timely, collegial feedback from medical directors, and pragmatic uses for microlearning and emerging micro‑credentials in continuing education.

In this special 2026 EMS Week episode of the JEMS podcast, Mike Brown hosts Gamunu “Gam” Wijetunge from NHTSA’s Office of EMS and Dr. Nicholas Cozzi, an emergency physician from Chicago. The conversation centers on a significant shift in emergency medicine: moving high-level clinical interventions like blood transfusions directly to the point of injury. With roadway fatalities hovering around 40,000 annually, NHTSA is prioritizing "post-crash care" by aggressive funding through the Safe Streets and Roads for All grant program.   Beyond the equipment, the guests discuss the power of data linkage between dispatch centers and hospitals to measure bystander intervention and long-term patient survival. Dr. Cozzi highlights the human element, sharing how simple acts—like sending letters of praise to field clinicians—boost morale and strengthen the bond between medical directors and front-line providers. From grant deadlines on May 26th to Save a Life Day demonstrations in D.C., this episode outlines how federal advocacy and local clinical excellence are converging to save more lives in the field.

Dr. Jonathan Warren discusses practical uses, evidence, and implementation challenges for prehospital ultrasound. We cover lung ultrasound for acute heart failure and B line quantification, trauma FAST exams, cardiac arrest applications including focused pulse checks and transesophageal echocardiography, and how prehospital transfusion and early diagnostics change diagnostic momentum on ED arrival. Dr. Warren also outlines real-world barriers to sustained uptake—cost, training, tech issues, clinical workflows—and describes a national survey from the ACEP prehospital/austere ultrasound subcommittee aimed at identifying why adoption often dwindles after initial implementation.

At FDIC International 2026, our panel of EMS providers and critical‑care physicians break down ventilation during cardiac arrest: what the science supports, where practice still fails, and practical fixes you can use tomorrow. We cover why bag‑valve‑mask ventilation is a high‑risk skill (and best performed as a two‑person procedure), how over‑ and under‑ventilation change intrathoracic pressure and cardiac output, and why properly opening the airway and achieving a seal are fundamental. We discuss supraglottic airways, intubation pitfalls, CPAP and high‑flow strategies, the pros and cons of mechanical ventilators in the field, and the role of objective feedback devices. The panel emphasizes regular, low‑cost simulation training, equipment readiness, pit‑crew coordination, and the hard truth: patients die from poor ventilation more often than from the absence of intubation.

Dr. Brandon Morshedi, a paramedic turned emergency physician and EMS medical director, joins Eric Chase to map a practical path toward EMS 3.0. He explains his driving “why”: improving the systems of care he and his family rely on. The conversation ranges from training paramedics as clinicians and the realistic role of degrees, to on call decision making—when to contact your medical director versus a receiving hospital. Dr. Morshedi outlines priority research areas (resuscitation science, prehospital transfusion, and low acuity treatment in place), federal traction for alternative reimbursement models, and a ten-year horizon for the paramedic practitioner credential.   Quick favor: take our 3-minute (anonymous) listener survey to help shape what we cover next: https://sprw.io/stt-lfjMN

This episode of the Not a-Fib Podcast features Dr. Sarah Jahnke, someone who spent over a decade researching the health of first responders. The conversation moves past the usual surface-level advice to tackle the deep-seated cultural issues that lead to burnout and chronic disease. Jahnke challenges the "badge of honor" mentality surrounding sleep deprivation, citing evidence that shift work itself is a likely carcinogen. The discussion also reframes mental health through a unique lens, comparing it to hypertension—a condition that requires constant monitoring rather than just emergency intervention. While the statistics on depression and PTSD in the fire service remain high compared to the general population, Jahnke highlights the protective power of the fire service's unique camaraderie.   Quick favor: take our 3-minute (anonymous) listener survey to help shape what we cover next: https://sprw.io/stt-lfjMN

JEMS Development Editor Mike Brown interviews Hannah Herbst, founder and CEO of Golden Hour Medical, about a compact, automatic tourniquet designed to guide anyone through life‑saving hemorrhage control. The device uses audio‑visual prompts and a simple three‑step interface to let a bystander or first responder apply, monitor, and adjust pressure on arm or leg wounds. It initially inflates to 300 mmHg and can be increased in roughly 20 mmHg increments; an internal sensor monitors pulse absence and informs reassessment. The cuff detaches for multi‑patient use, and the unit recharges via USB‑C — batteries last about two years between charges with monthly status updates. Golden Hour pairs the product with online training and a small trauma first‑aid kit.   Quick favor: take our 3-minute (anonymous) listener survey to help shape what we cover next: https://sprw.io/stt-lfjMN

Dr. Alexandra Jabr, a longtime paramedic-turned-educator and founder of Emergency Resilience, tells the story how therapy reshaped her life and purpose. She explains practical boundaries and vulnerability, why collaboration beats competition in EMS education, and how clinicians can support peers after moral injury and critical incidents. Alexandra walks through emerging options for treatment—emphasizing ketamine-assisted therapy only when delivered in a medically supervised, ethically framed model with skilled therapists and integration work—and describes immersive retreats that combine somatic modalities, group therapy, and clinician-led psychedelic-assisted sessions for women first responders. This conversation blends lived experience, clinical nuance, and concrete guidance for providers seeking mental-health resources, workplace culture change, and pathways back to joy.   Quick favor: take our 3-minute (anonymous) listener survey to help shape what we cover next: https://sprw.io/stt-lfjMN

JEMS Development Editor Mike Brown speaks with Dr. Simon Grosjean about shifting EMS from “prehospital transport” toward “territorial medicine.” They unpack alternative transport/non‑conveyance, physician response units, and why many low‑acuity calls may be better managed outside the ED. The conversation contrasts systems across Europe and the UK, highlights gaps in data collection, and exposes practical barriers—staff shortages, fractured clinical records, and reimbursement models—that stop promising approaches from scaling. They also explore where technology and AI can help: rapid chart summarization, context‑aware decision support, microlearning for clinicians, and automated handoffs to primary care.   Quick favor: take our 3-minute (anonymous) listener survey to help shape what we cover next: https://sprw.io/stt-lfjMN

Firefighter Jake Ryks joins the Just a Little Salt podcast to dismantle the "hero" archetype often taught in fire science programs. He reflects on his early career, admitting he’s actually less confident now than as a rookie because he finally understands the sheer depth of the profession.   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

JEMS Development Editor Mike Brown sits down with Dr. Stacy Shackelford, a coauthor of a new JAMA Network Open paper, to unpack findings about calcium abnormalities in trauma patients. The authors tracked a cohort of 1,270 trauma patients arriving at three level I trauma centers and found that 22% presented with hypocalcemia and 5% with hypercalcemia. Early mortality varied significantly by calcium status: 11.9% among hypocalcemic patients, 4.3% among eucalcemic patients, and 22.8% among hypercalcemic patients. Although hypercalcemia was less common than hypocalcemia, it was associated with substantially worse early mortality, suggesting the need for further research into the underlying mechanisms.

Paramedic, educator and consultant John Todaro joins Eric Chase to trace a 49-year career at the intersection of prehospital care, nursing, and public health. Todaro argues for degree-based education for paramedics, emphasizes soft skills—communication, empathy and cultural awareness—and explains how broader clinical training strengthens judgment and the patient narrative. He examines professional tensions between nursing and EMS, advocates collaborative roles instead of hierarchical oversight, and offers organizational culture and work-life balance strategies to reduce burnout and moral injury. Through a vivid helicopter rescue—holding a young trauma patient’s hand and later being recognized by that child—Todaro shows why human connection matters as much as clinical skill.

Jennifer Pearsall joins the Not a-Fib Podcast to share insights from her Naval Postgraduate School thesis on the strengths that can emerge in emergency managers after life‑changing events. We explore her career across local and federal emergency management, the contrasts she encountered along the way, and the experiences that inspired her to create EM Wellness and define its mission. She reflects on her time at the Naval Postgraduate School, and we dive deep into the core findings of her thesis. Our conversation covers the types of transformative events that can lead to post‑traumatic growth, the conditions that make that growth possible, and the personal and organizational factors that either support or hinder it.

In this episode of Just a Little Salt, Cody Spaulding talks with Jon Vought, a firefighter and the owner of Rescue 1 CBD, to break down what CBD actually is and why it’s become a serious topic in the fire service. Jon explains the difference between hemp and marijuana, how cannabinoids interact with the body’s endocannabinoid system, and what the research says about CBD’s impact on inflammation, sleep quality, mood, and anxiety. 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.

Respiratory crises in the field rarely fit textbook categories. JEMS Development Editor Mike Brown talks with Hamilton Medical’s Jesse Carroll to separate Type 1 (hypoxemic) from Type 2 (hypercapnic) respiratory failure and recognize the mixed presentations clinicians actually see. They walk through practical cues (SpO2 trends vs end‑tidal CO2), common causes (CHF, COPD, obesity, neuromuscular weakness), and epidemiology: roughly 360,000 prehospital respiratory calls annually with 41% involving COPD and obesity rates rising from 32% to about 60% since 1988. Jesse explains why pressure, flow and volume, not oxygen alone, drive meaningful physiologic change, how device limitations (disposable CPAP, pneumatic and turbine systems) affect flow delivery, and when early noninvasive strategies can buy time or prevent intubation.

JEMS Development Editor Mike Brown sits down with Jonathan Epstein, who leads the American Red Cross healthcare product management team, to unpack the Red Cross’s new Resuscitation Suite. Jonathan explains how the suite reimagines BLS, ALS and pediatric/neonatal resuscitation with EMS-first blended learning, a “practice as you perform” approach that embeds local protocols and integrated cognitive aids, including a digital app with step-by-step algorithms and clinical decision support. They discuss adaptive learning and computer-adaptive testing that shrink classroom time, an upcoming VR pathway that delivers team-based practice and certification, and realistic expectations for AI, dual sequential defibrillation and mechanical CPR. Ventilation, measurement and device design are highlighted as targets for education and engineering solutions.

Bob Page of the Manual Ventilation Academy walks through why bag-valve-mask (BVM) ventilation often fails in the field and how measurement and real-time feedback fix it. He outlines the four simultaneous skills rescuers must master—opening and holding an airway, achieving an effective mask seal, delivering the correct tidal volume, and timing breaths—and shows why muscle memory alone isn't enough. In multi-center simulations and device head-to-head tests, blinded providers rarely met guidelines. Once teams used point-of-care feedback, performance climbed above target, even on intubated patients and during pediatric scenarios. Two-person BVMs and brief 30:2 pauses for breaths also improved delivery compared with continuous compressions. If you teach or deliver airway care, this podcast lays out practical techniques, device pitfalls, and why Bob's FDIC International course is a rare chance to train with measured, real‑world simulations and evidence.

Trevor Williams didn’t take a typical path into the fire service. He grew up overseas, living in places like Zaire during the Rwandan genocide and later Haiti during periods of civil unrest. His family’s missionary work with humanitarian organizations exposed him early to crisis, relief work, and the reality of helping people when things fall apart. Years later, that mindset carried straight into a career with the Los Angeles County Fire Department.   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.

Flight nurse and creator Nurse Gwenny joins the show to talk frankly about what it really takes to thrive in emergency care when the textbook ends and the hard calls begin. She walks through her path from pre‑med burnout to ER and flight nursing, why traditional courses left her memorizing instead of understanding, and how that frustration drove her to build highly visual, short-form education that actually sticks for busy medics, EMTs, and nurses. Along the way, she shares the cases that still sit with her, the mentors who modeled clinical excellence with zero ego, and concrete ways to protect your mental health in a career built around other people’s worst days.

Infection control consultant Katherine West breaks down the latest HIV post-exposure prophylaxis (PEP) guidelines published in mid-2025. Highlighting key changes since the 2013 update, she explains the shift toward less toxic antiretroviral regimens, elimination of routine baseline lab testing for PEP, and new protocols for exposures involving patients with undetectable viral loads. West emphasizes the importance of expert follow-up care, clarifies who is responsible for source patient testing, and underscores the low risk of occupational HIV transmission. She also discusses challenges faced by emergency providers managing exposures outside regular occupational health hours and the role of 24/7 consultation services. The segment covers legal nuances, especially OSHA and state laws regarding HIV testing consent, and reiterates the CDC’s push for routine HIV screening to aid in the national goal of ending the HIV epidemic by 2030.

Host Chief Shane Wheeler and Assistant Chief Jon Detweiler dive into the complexities of team conflict and the essential role of trust in leadership. Drawing from his decades-long career, Jon shares firsthand experiences managing difficult conversations, especially transitioning from peer to leader. He highlights why many leaders mistakenly view conflict as failure rather than opportunity, and stresses the importance of emotional awareness, asking thoughtful questions, and fostering psychological safety. Jon also emphasizes the power of modeling behavior and setting clear expectations to maintain respect and accountability within teams. Whether you're a new leader or aspiring to grow, this conversation offers practical strategies for creating a culture where honesty, trust, and collaboration thrive, ultimately aligning teams to achieve shared missions effectively.

In this episode of Just a Little Salt, licensed counselor Kimberly Ingram dives deep into the unique challenges first responders face in their relationships. Drawing on her extensive experience working with law enforcement officers, firefighters, and other public safety professionals, Kimberly sheds light on the impact of shift work, chronic stress, and trauma on emotional connection at home. They discuss common misconceptions about therapy, the critical need for culturally competent mental health support, and how partners can build stronger communication even amid the toughest schedules. Kimberly also explores the delicate balance between a first responder’s identity and personal life, the risks of emotional distancing, and practical advice for couples recovering from infidelity.

Matt Aalto shares insights on cultivating a resilient fire department culture through clear expectations and genuine accountability. Drawing from decades of experience leading both volunteer and career crews in Oregon, Matt highlights how trust, communication, and proactive conflict resolution create an environment where firefighters thrive—both on and off duty. The discussion tackles the challenge of managing multiple generations within the ranks, the importance of addressing informal as well as formal expectations, and strategies for improving recruitment and retention by “getting your house in order” before adding new members. Real-world examples illustrate how supportive leadership tackles underperformance and fosters behavior change rather than punishment. Matt also offers practical advice for those looking to develop their voice in the fire and EMS community by writing and speaking.

Eric Chase sits down with John Graham, a respected EMS leader with 27 years of experience, to explore the challenges of mental health in emergency medical services. Reflecting on personal losses within the EMS community and the long-standing culture of “tucking away” trauma, John shares his journey toward embracing vulnerability and therapy. The conversation uncovers the often-unspoken struggles EMS professionals face, the delicate balance between leadership and friendship, and the importance of honest communication—even when it’s uncomfortable. John highlights the value of passion and commitment in leadership roles and stresses the need for grace, both toward oneself and others.    

Mike Brown, William Belk and Mike Doss dive into the challenges and evolving practices of simulation-based training. They explore the idea of designing scenarios where even perfect performance doesn’t guarantee success, emphasizing the need to prepare students for unpredictable, high-stress realities without overwhelming beginners. The conversation highlights the important role structured debriefing to foster reflection and growth, while promoting psychological safety to embrace failure as a powerful learning tool. Incorporating resilience training early on is presented as a game changer for building mental toughness and coping strategies before entering the field. Drawing from decades of frontline and educational experience, the speakers advocate for tailored stress exposure to enhance cognitive function under pressure. Read Mike Doss' article that prompted this podcast here: https://www.jems.com/ems-training/no-win-scenarios-in-emt-and-paramedic-education/

FDNY Chief John Esposito shares insights from his 34-year career, revealing what sets a commissioner apart from a chief, and the realities of managing one of the largest fire departments in the world. Esposito reflects on his early days, the mentors who shaped him, and the profound impact of good leadership in firefighting. He offers a rare glimpse into the toughest decisions made during emergencies and the unique challenges of communication across thousands of personnel. The conversation also highlights firehouse traditions, from memorable meals to the iconic kitchen table, embodying the camaraderie that fuels their work. Chief Esposito closes by emphasizing the meaningfulness of saving lives and the unmatched sense of purpose his job has given him.

Steve Tafoya takes a dive deep into a new bill aimed at transforming treatment-in-place capabilities and establishing Medicare reimbursement models tailored for emergency medical providers. Drawing on 25 years of frontline experience and a strong legal and business background, Steve sheds light on the current reimbursement challenges EMS agencies face, with only about 14-25% of calls being fully reimbursed. The discussion highlights how this legislation could reshape EMS’s role beyond traditional 911 response—integrating community health, alternative destinations, and innovative care models. Steve emphasizes the critical need for provider voices in lawmakers’ offices and urges industry stakeholders to engage with representatives to support this bill. The podcast also explores the expanding career opportunities in EMS, including agency response units and industrial medical teams.

Eric Chase sits down with Jimmy Apple, aka EMS Avenger, to explore the often-overlooked realities behind emergency medical services. Jimmy breaks down the isolation many providers face, emphasizing the power of genuine relationships and networking in advancing EMS careers. They dive deep into the psychological challenges of frontline care, including the emotional toll of death notifications and the importance of accessible mental health support. With a spotlight on evidence-based practice, Jimmy contrasts the intense focus on cardiac arrest resuscitation with the relative neglect of sepsis recognition and treatment, urging a shift in EMS training priorities. Drawing from two decades of experience, he challenges outdated dogma around pediatric and adult care, encouraging providers to overcome fear and trust their skills. This conversation serves as a powerful reminder that EMS isn’t just about protocols—it’s about empathy, accountability, and continuous growth in service of human life.

By Bram Duffee, PhD, EMT-P 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: 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. 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. 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.      

In this candid conversation, Ashlynn O’Dell reflects on the realities of EMS—from first calls amid rural landscapes to navigating complex patient care in unpredictable environments. She shares how EMS became her calling over nursing or firefighting and highlights the often unseen sides of the job: delivering care in difficult living conditions, managing mental health, and staying resilient against workplace judgment. Social media became a powerful outlet, helping her connect with peers and inspire young women entering this male-dominated field. With humor, vulnerability, and insight, she reveals the delicate balance between being serious professionals and embracing levity on the job. The discussion also tackles burnout, workplace culture, and the importance of finding your voice in high-pressure scenes.

Joanna Sokol, a seasoned EMT and paramedic, opens up in this revealing conversation on the EMS Improv podcast. Drawing from 13 years on the frontlines and a trove of personal journals, Joanna discusses the emotional turbulence embedded in EMS—from the constant flood of forgettable calls to the rare moments that “grab you by the throat.” She shares how writing her book, “A Real Emergency,” became a cathartic way to process the human stories often overshadowed by dramatic emergencies portrayed in media. Joanna candidly reflects on the physical and emotional toll EMS careers exact and the harsh reality many face when transitioning to new paths after years in the field. Her perspective on mentorship, resilience, and embracing the everyday reality of EMS work challenges common perceptions and offers raw, valuable insight for providers and those who rely on them alike.

In this episode of Let’s Get It Straight, infection control consultant and host Katherine West tackles the growing challenge of accessing dependable scientific guidance amid shifting government support and archived resources. With traditional CDC documents and expert advisory groups diminished or disbanded, she unpacks how critical recommendations—such as those comparing N95 respirators to surgical masks—are formed using evidence review methods like CHARM and GRADE. Katherine highlights key differences in medical versus EMS settings that affect mask use and safety protocols, and she points to regional alliances stepping up to fill guidance voids. Emphasizing the importance of verifying sources and cross-checking studies before accepting health data, this session arms healthcare professionals with the tools to sift through conflicting info and make informed decisions.

EMS Research Podcast Host Bram Duffee dives into a recent study examining ChatGPT’s ability to predict prehospital patient diagnoses based on paramedic care reports. 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.