Explorez tous les épisodes du podcast Prehospital Paradigm Podcast

Recall your vehicle rescue class when they stressed the basics…. check the car door lock before you break the window? That's what the crew is saying in their summary regarding assessment and treatment of patients with seizures…. basics are important… airway, blood glucose, description of the seizure activity.  Also, they summarize the discussion of the medication to be administered and why.

In Part 2 of the discussion about patients with seizures, the crew gets deeper in a review of the various definitions of seizures.  Dr. Hill reflects the idea that, if the provider happens to not recall the types of seizures by name, they should feel comfortable with describing the seizure activity to the medical command physician. The discussion also includes the standard medication delivery protocol.

Patients experiencing seizure and updated treatment protocols, i.e, use of Ketamine, is what starts this month's topic.  But, the biggest thing to remember with patient's experiencing seizures is BLS!  Hypoxia can be the biggest factor of complications with these patients. Remember the basics!

We are continuing on with the theme of providing a behind-the-scenes look at the University's EMS Institute.  This episode, the crew talk about the Institute's event medicine support capabilities.  From supplemental staffing to communications and patient documentation technology, public screenings, as well as unique medical equipment needed on site, the Institute is prepared.

Bringing this episode to a close, the crew talks specific BLS skills such as AEDs, high-quality compressions, simple head positioning changes, wound packing, hypothermia protection, reassessment and trending of vital signs and the use of a simple phone call to med control. 

As the BLS review and update continues, the discussion of proper ventilation adjuncts and techniques, massive bleeding control, i.e. tourniquets and direct pressure, and recognizing specific conditions ASA, i.e. stroke patients, diabetic emergencies.)

The team assembled to review basic live support assessments, theories and treatment modalities.  This episode discusses the importance of a good BLS background understanding.  BLS squads typically have better outcomes than ALS squads… simply by handling the basics!

In this portion of the podcast, we start talking about how EMS and fire can be a part of prevention of heat emergencies.  In addition, the crew talks about not having "heat emergency tunnel vision" and being sure to assess underlying or additional causes of the patient's status. The crew also addresses the pediatric patient scenarios.

As the team continues the discussion about heat emergencies, the reminder has to be noted that patient medications and medications within the EMS drug box, can affect how a patient responds to heat issues.  This includes the submersion tank treatment.  Just putting a patient into a water bath doesn't complete the treatment.   BTW, if the hospital doesn't have a dunk tank, who does?

Time does matter! The team, minus Scott, get together to talk about heat-related emergencies. Data shows greater than 119,000 ED visits are attributed to heat emergencies annually.  The most "at risk" population is the younger and older population and certainly athletes operating in extreme temperatures. By the way, a cold bath, asap, seems to be the current treatment of choice. 

Behind the EMS Institute - Part 2

As part of our Extra Monday episodes, we are continuing the series of what makes the Institute unique and supportive of public safety/EMS agencies.  From BTS of the UH EMS Drug Box system, how a medication change is made within the protocols as they consider the pharmacy staff, availability of drugs and packaging to the One Dose program and constant education considerations.  This episode looks "behind the curtain!"

Spinal Motion Restrictions for EMS - Part 3

Over all, 20+ studies leading back to 1989,  the research does seem to indicate that restraining the spine has no affect on the patient's outcome and, there are actually 3 studies that show injury caused by spinal motion restrictions.  However, further review of local protocols should be done.

The re-education of spinal immobilization methods continues to be the discussion.  Cervical collars, backboards and vacuum mattresses… all come into question! 

Thanks to the North Ridgeville Fire Department for hosting the podcast crew as we take on an open discussion regarding stroke patient care for EMS.

Dr. Hill, Scott and A.J. Joseph gather to talk about the NAEMSP journal of prehospital care research topic of SMR, Spinal Motion Restrictions.  Hits been a hot topic for years. The research paper associated with this topi is the most downloaded paper in the history of NAEMSP.  Are we harming patients with our backboards and cervical collars?

As the crew heads into part 3, managing the blood pressure of a patient experiencing a possible stroke.  Certainly, the idea of using medical control is the best option.  As the episode comes to a close, the discussion of triaging stroke symptoms on incoming patients for the hospital ED.  Do you use the VAN acronym yet? What about the OneDose app?

The crew and Kelly Montgomery continue the discussion of the assessment an care of patients experiencing strokes.  And what happens when a possible MI becomes a complication?  The crew discusses the consideration of use of prehospital and in-hospital treatments.

The crew meets up with Kelly Montgomery, Stroke Center Supervisor at University Hospitals of Cleveland. In Part 1, the basics of stroke assessment, ischemic vs. thrombotic strokes are discussed as well as the thrombolytic treatment is discussed.

In this episode of the Pre-Hospital Paradigm Podcast, Caleb Ferroni is in the host seat again with co-hosts Dr. John Hill and Ray Pace as they welcome Dr. Garlisi as their guest discussing sepsis for EMS. They will dive into alerts, assessments, and treatment of patients with symptoms of sepsis.

The crew, and Dr. Garlisi, wind up the discussion regarding assessment of and treatment of patients with symptoms of sepsis.  Part of the assessment is... REALLY counting the respirations... not guestimating! 

The crew furthers the discussion of what a "sepsis alert" is.  From the prehospital perspective as well as what occurs within the ED when an alert is activated…such as radiology, the pharmacy and the blood draw teams. Fluid boluses and epinephrine become the tools for the EMS crew to combat the signs of sepsis. Also, what is a basic-level provider to do for a patient with suspected sepsis.

Dr Andrew Garlisi joins the team to go deep on the topic of sepsis. His "why" as to his interest into patients with sepsis is personal.  He starts off with the basics at the metabolic and cellular level to help bring a general understanding.  Does he see administering antibiotic agents prior to hospital arrival and "sepsis alerts?"

We're doing something unique for the Extra Monday Episodes of 2026.  Thanks to Wes' suggestion, we're going to overview with what all the EMS Institute is involved.  EMSI is not just a medical control system.  To start, the team discuses the various geography, hospitals and their specialties and the various work flow processes that have been implemented overall including the new OneDose technology.

In this episode of the Pre-Hospital Paradigm Podcast, Caleb Ferroni is in the host seat with co-host Dr. John Hill. They sit down with Kim Florczyk and Sharon Kozel from Cleveland EMS to discuss the history, clinical operations, and challenges they face as such a large agency. This episode was recorded live from Cleveland EMS Headquarters.

As this episode, and in-depth look into the City of Cleveland's EMS system, the crew talks about their handling of the opioid issues within the city and the handling of Narcan. They also discuss the challenges faced by the agency which includes fleet maintenance, road conditions of the city and internal training challenges for such a large, high-volume service. In the future, they hope to have initiatives that handle the frequent callers that may not need an ambulance but still need a clinical interface individual such as community paramedicine.

The crew continues their discussion about the City of Cleveland's EMS agency.  From blood administration in the prehospital setting to CPAP and BiPAP to multiple way to secure airways and oxygenation... the ladies discuss the clinical operation which includes Paramedics and Basic EMTs.

Caleb is subbing in for Scott this episode as Dr. Hill and Caleb welcome representatives of Cleveland EMS.  In this first episode, we get some history on Cleveland EMS.  The agency is a 3rd service and just celebrated 50 years of service.  The agency runs over 70,000 calls per year with 25 units during daylight hours.

The final episode regarding addiction care wraps up the convo.  We were live at Amherst Fire Department.  If you missed the last 3 episodes, we definitely suggest going back in the timeline.  This episode may challenge your "veteran thoughts" on addiction care.

As the crew starts to wind up this topic, the discussion of the process of opioid withdrawal continues including inducing a more intense, or higher, level of withdrawal to help the patient's recovery progression. The guys discuss the Clinical Opiate Withdrawal Scale (COWS) score, its use and the interpretation of.

KEEPER NOTE: What words should we NOT be using to define these patients with "opiate disease disorder."

Dr. Singer continues to talk to the PPP crew regarding Project DAWN (Deaths Avoided With Naloxone), an Ohio-based network of opioid overdose education and naloxone distribution programs (OENDP) coordinated by the Ohio Department of Health.    Should EMS squads add Buprenorphine to the drug box in the long term?

KEEPER NOTE: The Narcan administration is just the beginning of the patient's opportunity to enter a recovery process. 

A.J. and Dr. Hill join Scott this month, to chat with Dr. Jordan Singer from the UH EMS Institute. What is long-term addiction care?  It's more than just showing up, treating the patient's symptoms, i.e., Narcan, and ending the patient's care once they are resuscitated. The crew digs into the norms and what the future might be including, leaving Narcan behind with family members or the patients.

KEEPER NOTE: If a 20-year-old overdoses once, there is a 1 in 10-20 chance that they will be dead in 1 year.

As the team winds up its discussion of the new Ohio EMS advanced scope of practice regulations, the discussion of oral Zofran for younger patients, ultrasound use for IV assistance and the place of urinary catheters within the scop of a 911 type of call are part of the discussion.

The team starts to discuss specifics of the expanded scope of practice. First up, the epinephrine auto-injector initiated by EMTs. EMTs are now able to give epinephrine via I.M. and broncho-dilators. Reconstituting Glucagon and administering it via IM is also part of the new EMT expanded scope of practice. Needle chest decompression and blood product administrations for advanced providers are also discussed.

Ray Pace has taken a back seat to the pod so that he can focus on his fire chief duties.  Welcome back to A.J. Joseph as one of our rotating co-hosts for 2026. 

The State Board of Emergency Medical, Fire, and Transportation Services (EMFTS Board) expanded the Ohio EMS Scope of Practice on December 17, 2025. First thing the gang discusses is what is and is not the scope of practice.  How do we define it? What can Medical Directors write into protocols?

Key point to take away... just because something is in the expanded scope of practice doesn't mean that you can execute that skill without medical control and training.

The crew welcomes back Dr. Greg Stefano and  Geoff Patty, RN from the interventional cardiology department.  If you're listening to this episode, head over to our YouTube channel to see the visuals of actual cases.

An interesting discussion ensues about human and computer interpretations of various EKG strips.

As the panel discussion continues, the discussion of medical direction arises as well as how to handle the potential rotating staff and continuity of responder training including incident command training. If interested in starting or growing your campus-based EMS system, feel free to get in touch with the National Collegiate EMS Foundation.

The group continues to take questions from the audience regarding how to start a campus-based EMS system, funding, and how to impress upon the university/college administration members the importance of such a in-house response system at any level,

This episode was recorded at the National Collegiate EMS Foundation annual conference. NCEMSF is a group of campus-based EMS agencies that a part of the student organizations.  Some have vehicles. Some respond on foot and mainly are volunteering their time to do this during their college careers.  Let's learn more!  Joining the group is Eric Pohl and Zack Matuzsan. 

The crew gathered at Madison Fire to finish up their discussion of explosive ordnance disposal operations with Detective Brian Yenkevich of the Lake County Bomb Squad.  Thanks to the MFD for hosting us.

In part 3 of our discussion of explosive ordnance disposal operations with Detective Brian Yenkevich of the Lake County Bomb Squad. Oddly enough shooting water and water pellets is one of the main tools and constant research is part of how the team refines their methods between all bomb squads across the country. Finally, they discuss signs of what might be a questionable item on a scene that may be helpful to EMS and fire responders.

The conversation with Lake County Bomb Squad team member, Brian Yenkevich continues. Part of the discussion reviews weapons of mass destruction including radiological and biological weapons and detection equipment.  We also discuss the types of old artillery and suspicious package types of calls and types of responses.

Lake County Bomb Squad team member, Brian Yenkevich joins Dr. Hill, Caleb and Scott for a different kind of discussion.  Explosive Ordnance Disposal Operations. In Part 1, Detective Yenkevich outlines how the team trains, operates and defines its mission.

In this engaging and surprisingly eye-opening episode, the crew sits down with Dr. Jordan Singer, an emergency medicine physician with unique experience providing in-flight medical command. Together, they explore the complexities of managing medical emergencies in one of the most austere environments imaginable—an airplane at cruising altitude. From physiology at altitude and cabin pressurization to legal protections and what's actually in those onboard emergency kits, this episode offers critical insights for any EMS or healthcare provider who's ever heard the overhead call: "Is there a doctor on board?"

In Part 3 the crew addresses some loose ends including why the drop-down masks cannot be used for in flight medical emergencies, what patients should NOT get an a commercial airliner, specific emergencies such as seizures and treatment of and commercial airline diversion decisions.

Dr. Jordan Singer continues his in flight emergency discussion and includes the Aviation Medical Assistance Act which is similar to the Good Samaritan Laws is the discussion on this episode.  You are covered as a trained EMS professional as long it is within reasonable parameters of your typical skills.  There is an interesting caveat to this discussion as far as when flying nondomestic flights.

This episode, we are joined by Dr. Jordan Singer, an Assistant Professor and Core Faculty member in the EMS Fellowship at the University Hospitals of Cleveland.  Part of Dr. Singer's specialty, has become "in flight emergencies" on commercial airlines.  One in twenty flights, globally, experience some type of inflight emergency. In this episode, a general discussion ensues regarding cabin pressure and its affect on the human body.

As has been the routine in 2025, the Extra Monday Episodes are dedicated to interpreting EKG rhythms. This month, the crew discusses, wide complex bradycardias and tachycardias, the symptoms and the treatments.

In this episode of the Pre-Hospital Paradigm Podcast, Dr. Jon Hill and Scott Wildenheim are joined by Tony Crino, a registered respiratory therapist and paramedic. They continue the discussion of the growing role of advanced ventilator management in EMS. Tony Crino brings both respiratory therapy and paramedic perspectives, breaking down the essentials of ventilator physiology, modes, patient-ventilator synchrony, and how these advanced tools can elevate prehospital care.

As the crew starts to summarize their time with Tony, a few things are addressed: What if a department doesn't have the inclination to initiate advanced mechanical ventilation?  If they do, what kind of education needs to be commence and be continued. Also, what about mechanical ventilation in pediatric patients?

Research shows that 93% of clinicians are improperly bagging patients.  Using mechanical ventilation support can be more effective as long as the proper training is done initially and continued regularly.

The crew continues to go through the basics of the respiratory system.... the anatomy, tidal volumes, pressure ventilation, the terminology, etc. As EMS professionals, we need to understand the basics of the respiratory system's operations in detail before mechanical ventilation can be applied. When you think of oxygenation, there are 2 ways to fix it, pharmacologically or with mechanical ventilation.