Robert Vroman, M.Ed., BS NREMT-P

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EMS1 Daily News

Attorney: Ferguson grand jury has reached decision

The St. Louis County prosecutor will reportedly announce a decision Monday afternoon

All responders benefit from sharing critical information

Thirteen years after the World Trade Center attacks, FirstNet progress continues for the benefit of EMS

Jury: EMT 'not guilty' in Ga. jail death

She was charged with involuntary manslaughter after an inmate she was caring for died

Texas EMS gets solar-powered ambulance

It includes LED lights and touch screen technology, and equipment will work even if the vehicle breaks down

Hockey player, paramedic revives fan before game

Gander Flyers goalie Patrick O’Brien ran from the dressing room and began chest compressions on an unresponsive fan in cardiac arrest

Mass. firefighter recovering from on-scene heart attack

Lt. Brian Tredo was helping a 72-year-old victim escape an apartment fire when he collapsed

Study: Telephone CPR is saving more lives in Ariz.

Research shows dispatcher-assisted CPR increases the chance of surviving sudden cardiac arrest

1 killed, dozens hurt in Calif. tour bus crash

The bus went down an embankment and overturned after striking a restaurant overhang earlier; driver fatigue is expected

FCC secures funds for national responder network

The FCC raised $10 billion to move forward with the creation of the high-speed communications network

Ohio EMS handles Ebola scare well

Medics donned PPE before carrying the feverish girls from their home; the scare reassured responders they're equipped to manage the disease

EMS1 Topic Articles

All responders benefit from sharing critical information

Thirteen years after the World Trade Center attacks, FirstNet progress continues for the benefit of EMS

Jury: EMT 'not guilty' in Ga. jail death

She was charged with involuntary manslaughter after an inmate she was caring for died

Texas EMS gets solar-powered ambulance

It includes LED lights and touch screen technology, and equipment will work even if the vehicle breaks down

Hockey player, paramedic revives fan before game

Gander Flyers goalie Patrick O’Brien ran from the dressing room and began chest compressions on an unresponsive fan in cardiac arrest

Mass. firefighter recovering from on-scene heart attack

Lt. Brian Tredo was helping a 72-year-old victim escape an apartment fire when he collapsed

Study: Telephone CPR is saving more lives in Ariz.

Research shows dispatcher-assisted CPR increases the chance of surviving sudden cardiac arrest

1 killed, 30 hurt in Calif. tour bus crash

The bus went down an embankment and overturned after striking a restaurant overhang earlier; driver fatigue is expected

FCC secures funds for national responder network

The FCC raised $10 billion to move forward with the creation of the high-speed communications network

Ohio EMS handles Ebola scare well

Medics donned PPE before carrying the feverish girls from their home; the scare reassured responders they're equipped to manage the disease

Private ambulance services to bid for Ala. EMS calls

This change could cut ambulance response time in half for county residents who live outside the city

EMS1 Columnist Articles

Inside EMS Podcast: Mental health initiatives need agency support

Download this week's episode on iTunes, SoundCloud or via RSS feed

At a recent conference, Inside EMS Podcast co-host Kelly Grayson spoke with a responder who 10 years ago couldn’t save a little girl, and blames himself for what he saw as mistakes that let her murder go free.

“It still affects him deeply enough that he couldn’t keep it together, and stood in the exhibit hall and cried in public,” Grayson said. “His story was a litany of everything that is wrong with how we deal with mental illness, stress and depression among EMS providers.”

In this week's podcast, he and host Chris Cebollero discuss how agencies can offer more support to providers deal with mental health issues and suicide.

“We need to have responsibilities in our own organizations,” Cebollero said, adding that it should also extend to the state and regional level. A call that may not have a lot of meaning to most may in fact be the tipping point for another provider, based on what else is going on in his or her life, they said.

“Agencies need to do a better job protecting their most valuable resource, and that’s their people,” Grayson said.

They also encouraged responders to check out the Code Green Campaign, which aims to raise awareness about responder suicides and mental health issues.


In the news section, they discuss three Texas medics suspended after an internal investigation revealed a powerful sedative was misused on patients in three separate incidents. The original reporting was misleading, implying that administering Versed contributed to the patents’ deaths and led to the suspensions.

“It’s absolutely ridiculous,” Grayson said.

“If they’re guilty of anything, they’re guilty of not following protocol,” Cebollero said. They agreed that in a situation like this, EMS managers have an obligation to correct an inaccurate news story.

They also talk discuss a Calif. woman who says she called 911 for medical assistance after suffering several seizures, only to be forcibly arrested for public intoxication, resisting arrest and battery on a police officer.

“There are a lot of times when we don’t consider metabolic challenges when we deal with these patients,” Cebollero said. In EMS, especially when it comes to frequent fliers, it’s easy to get tunnel vision and miss important patient information.

“I think this is a failure,” Cebollero said.

Grayson agreed.

“When you have a patient with an altered mental status they may be drunk, they may have a head injury, they may be hypoglycemic or they may quite simply be a jerk,” he said. “And it’s all too possible they’re all four things at once.”

In a feel-good moment, they also talk about Buddy, a beagle mix that hitched a ride on the back of an ambulance to be with his elderly owner.

“When they were flagged down, what could they do" They hopped out and let the dog in the back of the truck,” Grayson said. “… Good for the EMTs for allowing it.”

Cebollero agreed, saying sometimes doing the right thing means fracturing a few policies, and it’s great to hear some good news in the media about EMS.

Here are links to some of the articles and other items mentioned on the show:

Patient assaults are not ‘part of the job’

I am disturbed by the increasing frequency of media reports of EMS providers being assaulted while on the job. Let’s cut to the chase: While it’s a risk, it is not acceptable.

There are few other careers out there where being injured by a violent encounter is “part of the job.” Sadly, many front line health care providers are exposed to this issue daily.

For a long time there seemed to be a cultural acceptance by EMS providers that being assaulted was an expected and even normal part of the daily duties or providing emergency care. I’ve heard many stories about on-duty EMTs and medics being punched, scratched or kicked, with no police report filed or criminal charges made against the assailant.

Let’s be clear, I’m not referring to patients who may be medically altered and physically reacting to noxious stimuli. I’m talking about people who consciously and deliberately strike out against us because they are irritated or angry. To not bring legal action against these assailants sends the poor message that it’s okay to hit someone who is trying to help.

This trend is likely to continue, as our society becomes increasingly tolerant of violent behavior. We need to be better trained and prepared to stay safe, recognize unsafe behavior early, and know when to withdraw and de-escalate the situation.

We don’t teach this in primary education programs, and we don’t provide enough training opportunities for existing providers, but courses specifically created for this are out there. There are also local resources that provide basic information about recognition, de-escalation, and defensive tactics that can better prepare our folks to stay safe while working.

It’s not okay to be assaulted. It’s up to us to make sure we minimize that concern.

4 tips for EMS agencies to secure AFG funding

Since 2001, the Assistance to Firefighter Grant has helped firefighters and other first responders obtain critically needed equipment, protective gear, vehicles, training and other resources to protect the public and emergency personnel from fire and related hazards.

Over the last couple of years the grant has shifted to include specific funding for EMS agencies as well. As this is one of the most competitive grants in the country, your agency must set itself apart from the thousands of other applicants to secure funding.

Here on four tips on how to craft a strong application.

1. Time pays off

Make your application a high priority and devote the time and energy necessary to tell your agency’s story.

2. Focus on safety

Focus on how your project enhances the safety and effectiveness of your providers, and demonstrate this in the application. Explain how enhancing EMS also enhances all of public safety.

3. Do your homework

Read and reread the application, guidelines, and all resources that FEMA provides. You don’t want your request to get denied because you missed an important detail.

4. Don't get discouraged

Just because your project was denied in 2013 does not mean it won’t be funded in 2014. Look over your application narratives and make them stronger.

Focus on the above while keeping them clear and concise, and you will improve your chances of receiving funding.

2 time management tricks for EMS chiefs

By Steve Knight, Ph.D.

Time management appears to be another one of those over clichéd management ideals that is easy to repeat and attest to, but very difficult to get a good handle on.

There are times when I believe that executives in the emergency services are more challenged than in other industries because of our conditioning. For example, most agency directors have spent decades in the field responding to the next call or crisis, with little authority over the demands.

Our “can do” and “fix it” conditioning doesn’t magically leave us once we are promoted to an executive-level position.

Pareto’s Principle

The first step to developing a highly effective time-management process is to start saying no. There are limits to how much work we can take on and continue to produce a high-quality outcome.

While employees and directors may differ on their perspectives of how much is too much, we must be able to prioritize our activities. In this way, we can make better decisions on what we should do immediately, what we can delay, what we can delegate, and when we should say no.

The first strategy to share comes from what is known as Pareto’s Principle. Also known as the 80/20 rule, it’s based on a consistent ratio observed for a wide variety of relationships in our world.

In Pareto’s initial work, he found that 20 percent of the population held 80 percent of the wealth. Other researchers have continued to observe this same general ratio in other areas.

For example, 80 percent of the crops come from 20 percent of the plants. In our work environments, we recognize that 80 percent of our productivity comes from 20 percent of our workforce. Conversely, 80 percent of our problems come from 20 percent of our employees.

Therefore, as managers we should identify the 80 percent of our productivity that comes from the 20 percent of our efforts, and focus on those activities that give us the greatest outcomes.

Multitasking is a myth

The second strategy is an understanding that multitasking is a myth. We really don’t multitask even though we think we do.

Studies have confirmed that the startup time consumed as we switch from task to task is tremendous. Our brains do not conduct two processes at the same time ─ rather it is sequential.

So our multitasking is actually rapidly switching from task to task, robbing attention from each individual project and demanding more time between start-up intervals than if we had completed the tasks sequentially.

Therefore, one of the prevailing strategies is to create blocks of uninterrupted time to work toward your goals. Rather than let the day dictate to you what you are going to handle and in what order, create blocks of time for your weekly update, performance numbers, emails, etc., so that you can focus on the task at hand.

Collectively, these two strategies will help you feel like there is considerably more time in your day and give you more control over your schedule.

About the author:

Dr. Steve Knight, a Fitch & Associates consultant, brings more than 25 years of fire and EMS experience to the firm. He served for nearly 17 years as assistant fire chief for the City of St. Petersburg, Fla. He has been a subject matter expert for both the National Fire Academy and the Center for Public Safety Excellence (CPSE), a nonprofit corporation that serves as the governing body for the organizations that offer accreditation, education, and credentialing services to the first responder and fire service industries.

Knight has also served as team leader and assessor for the Commission on Fire Accreditation International and has held multiple faculty appointments in Fire Science and EMS. Prior to coming to Fitch, he served as senior manager of a consulting team within the Center for Public Safety Management.

4 ways to bring order to a chaotic scene

"Thank you."

Two words, spoken too rarely, that makes all the difference in the world for an EMT.

Said with sincerity, it makes up for months of drudgery, long distance transfers, system abuse, hours posting on street corners, and a thousand other tedious realities of EMS.

In this case, those words were spoken to me by a mother of a 4-month-old infant who had just died. I still don’t know why the child died, only that it had been chronically ill with respiratory issues. The cigarette stench that clung to every surface in her home undoubtedly exacerbated those issues.

The apartment was small and dirty, in a housing development where white EMTs are met with the same barely veiled hostility and distrust normally reserved for the local cops.

I doubt whether the care and discharge instructions provided by the child’s pediatrician and the local emergency department were ever followed up on or continued at home. I do know that the mother had drug abuse issues of her own. It wasn’t the first time I had been in that apartment.

We couldn’t have been more different: a young, uneducated, black unwed mother with a drug abuse history, and a white paramedic with a beer belly and a Southern drawl.

Walking clichés, both of us.

Yet none of that mattered when her baby’s life was in danger. She had called for help, and I was the one who showed up. All the ingredients were there for conflict, but because I refused to follow the recipe, so did she.

In my last column, I spoke of the need to put compassion before protocols. Most of the people who commented understood my point.

But a number of people in the various social media sites fixated on the one example where I allowed the mother of an infant to accompany her child in the back of my rig while I performed CPR. The objections were predictable.

  • We don’t have enough room.
  • I’m trying to save a life here. I don’t have the time to calm a distraught parent.
  • Parents should never witness CPR on their child. It’s cruel.
  • Sure, like I’m gonna let a hysterical mother in the back of my rig while I’m trying to work. Not gonna happen.

Most of these objections are based upon two fallacies: that resuscitations are inherently chaotic, and that family cannot handle witnessing such chaos.

Neither of these things is true.

In the case I mentioned, chaos and parental conflict weren’t elements of the call because of the skills I try to bring to every scene: calmness, compassion, command presence, and code choreography.


Unlike most EMTs of my generation and earlier, my role models were not Johnny Gageand Roy DeSoto. I looked up to Hawkeye Pierce from M*A*S*H. Hawkeye faced every situation with humor and insouciance.

Watching him, you got the impression that no situation was beyond his capability to handle, yet no amount of wisecracking made you think he was unconcerned about his patient’s welfare.

Hawkeye knew what many people don’t: medicine is far too important to take seriously.

Humor defuses tension, and keeps everyone else on the team loose and relaxed. Relaxed caregivers make fewer mistakes, and focus better on the quality of their care, rather than just the speed at which it was provided.


There’s an old saying in medicine that goes, "People don’t care how much you know until they know how much you care."

It’s a cliché, but all clichés contain a fundamental truth. Families and patients are largely ignorant of the medical knowledge and skill you possess.

What they notice, and remember long afterward, is the kindness and compassion you display. A blanket and a little hand-holding mean more to them than the fact that you can extract blood from a rock or fall down a flight of stairs and intubate five people on the way down.

That compassion is why many an old country doctor was able to commit acts of medical malpractice long after the science of medicine had passed them by, simply because his patients knew that old Doc Johnson genuinely cared about his patients.

The lesson there is that competence is not an adequate substitute for compassion. You need them both.

Never, ever fall prey to the notion that you don’t have time to be compassionate. It never takes any longer to do your job with compassion, no matter how bad the call.

Command Presence

Once upon a time, many years ago, I had to transport my boss from the local hospital to a chest pain center 40 miles away. When I arrived at the ED, she was being stubborn and difficult with the staff, and refusing to let them treat her.

Her husband — my other boss — was there, as was the ED physician, who happened to be our service’s medical director, and the nursing staff. All of them were friends, and all of them were unsuccessfully pleading with her to accept treatment.

I watched the scene for a few seconds, and then quietly said, “Excuse me.” Every one stopped what they were doing, and stared at me. I made eye contact with my boss, held it, and gently said, “Liz, get on the bed and stop arguing. Give the man your arm and let him start an IV. And do it right now.”

She did.

Twenty minutes later, as I adjusted her nitroglycerin infusion, I asked her, “You sign my paychecks. Why did you obey me and not everyone else"”

She looked surprised, then thoughtful, and then shrugged her shoulders. “It didn’t occur to me not to,” she answered. “You’ve got a quality.”

I’m not sure command presence can be taught. But what I do know is, it has nothing to do with barking orders, or shouting or hurrying.

The times I have seen it in others, it was best described as quiet leadership: thoughtful, unhurried, matter-of-fact. You got the sense that the person in command was a step ahead of everyone else, and was patiently waiting for the rest of the team to catch up.

New EMTs working with me for the first time invariably remark on how rarely I transport with lights and siren, or how they did not appreciate how sick our patient truly was. And the answer I always give them is that the better I do my job, the less dramatic it is.

Planning, thinking, and staying ahead of the treatment curve may not make for a Hollywood-worthy medical drama, but it makes for great patient care.

The attitude you want to project is, "The emergency ended when I arrived on scene."

That doesn’t mean you don’t move with a sense of urgency or that you never feel stress. It simply means that the person in charge should always be the island of calm everyone looks to for guidance.

If that person on scene is not always you, change what you’re doing because it isn’t working.

Code Choreography

If there is one thing I have learned in leading several hundred real resuscitations and several thousand mock ones in teaching ACLS classes, it’s that the smoothness of the code has little to do with the individual skill of the team members.

Resuscitation is a complex ballet of interventions, and the key to making sure all the dancers aren’t stumbling over one another is effective communication. It’s the team leader’s job to know what the dance steps are, and to make sure that all the dancers have their movements synchronized.

I call it " being the stand-back, big-picture, non-interventional paramedic."

It takes open communication and a great deal of practice to do that, but you need not be working a code or even a simulation on a manikin to get that practice.

Game plan with your partner en route to the call. Work out imaginary scenarios in between calls. Critique your performance after calls.

Let mental preparation between you and your partner fill in the gaps between physical activity.

Because I work with a lot of brand new EMTs, I’m frequently required to work a resuscitation before we’ve had the opportunity to do that mental preparation. On the way to the call, they’ll ask nervously, "Sooo … what do you want me to do""

I always answer, "I want you to slow down, because when you hurry you make mistakes. I want you to do CPR. You have the most important job in a code. Don’t interrupt compressions unless I say, and everything else I need to do, I’ll work around you."

On those instances when we’re second-in, I tell my partner to plug themselves into the BLS side. Ask the EMT what still needs to be done, and do it. Then get prepared to switch out compressor roles.

I’ll plug myself in on the ALS side. Sometimes, the lead medic doesn’t know how to be that stand-back, big-picture, non-interventional paramedic, and I assume that role.

But rarely is it ever chaotic and disorganized, and as a result I have no problems allowing family members to witness it, and those families draw strength and calmness from the professionalism of the rescuers on scene.

Remember that calmness, compassion, command presence and code choreography are the tools you need to bring order to chaos. With those in your toolbox, you’ll be surprised how easy it is to be kind while providing excellent patient care.

Clinical solution: College student found unresponsive

Unresponsive patients present a challenge to EMS providers.

The potential causes of unresponsiveness range from head trauma to hypoglycemia, and very often the patient is so altered that he cannot provide answers to many of the common medical history questions.

In these cases, the responding EMS providers must play detective by taking in the scene, asking questions of bystanders, performing a thorough physical assessment and trusting their intuition.


After ruling out trauma initially with a rapid assessment, the next step is to address the “must not miss” diagnoses. Though this patient is young and appears healthy, cardiac causes of unresponsiveness, particularly with hypotension, must be addressed.

A 12-lead ECG (if available and within scope) is a good place to start.

Next, other common causes of unresponsiveness like hypoglycemia and neurological events like a seizure must be considered. Medical alert bracelets or necklaces can provide clues to the presence of certain conditions and are common for diabetics and patients with seizure histories.

While findings like incontinence may point to a seizure, such a finding is no guarantee. Pupillary response is important to check during the physical exam. The appearance of the pupils can provide clues to conditions like hemorrhagic stroke or narcotic overdose.

Based on our patient’s somewhat recent history of a traumatic event (bruised ribs) and the finding of equal, but sluggish pupils and respiratory depression, a follow-up question for his friends about any prescription medications is a wise next step.

If asked, the friends would confirm that the patient has been prescribed Vicodin by the student health center, but that he has also been taking some additional Vicodin his girlfriend was prescribed when she had her wisdom teeth removed.

Possible overdose

An opioid overdose classically presents with depression of the central nervous system, which can manifest as decreased level of consciousness, respiratory depression, bradycardia and hypotension. These effects can be worsened if the opioid medication is mixed with a benzodiazepine or alcohol.

While treatments like oxygen and assisting ventilation can keep a patient from becoming or remaining hypoxic, ultimately the treatment for opioid overdose is to reverse the effects of the drug on the central nervous system. Naloxone ( Narcan) is the commonly used EMS drug for opioid overdose.

Naloxone is classified as an opioid antagonist, meaning the drug disrupts the ability of the opioid molecules to bind to neuroreceptors in the central nervous system.

Naloxone does this by binding to the same receptor sites that an opioid drug would and keeping that drug from affecting the patient. Naloxone may be given through an IV, as an intramuscular injection or even through the intranasal route.

With a recent increase in heroin-related deaths, naloxone has received frequent media attention. Some states have begun to provide naloxone to friends and family of known drug users.

Other states are including naloxone in the medical first responder and EMT scopes of practice. Still other states are stocking law enforcement vehicles with naloxone so that police can treat drug overdoses early in the presentation.

These programs, while helpful for many patients, should be expanded carefully. Naloxone is a largely safe drug to administer, but side effects can include nausea and vomiting, changes in mood with aggressive behavior and pulmonary edema.

Additionally, long-acting opioids like methadone can stay in the patient’s system longer than naloxone, resulting in the patient becoming unresponsive again after a period of being awake. Like all medications, naloxone should be given only with an understanding of the indications, contraindications and side effects.


After obtaining the remainder of the patient’s recent history, you elect to give intranasal naloxone for a suspected narcotic overdose.

After checking the dose, medication, route and expiration, you apply the mucosal atomizer device to the end of the syringe and administer the medication. Shortly after, the patient begins to gag on the OPA. You remove it and exchange the BVM for a nasal cannula.

Upon reassessing the patient, you find that he is gradually waking up and that his vital signs are improving. When he regains consciousness, the patient reports that he was experiencing increased pain in his ribs and took “a handful of Vicodin” in the bathroom.

You begin packaging the patient for transport and when your ALS intercept arrives you proceed to the local hospital for further assessment

How EMS benefits from hospital readmission penalties

Last month, hospital readmissions penalties under the Affordable Care Act were extended to include patients readmitted within 30 days of treatment for chronic obstructive pulmonary disease or total hip or knee replacement.

This is in addition to penalties put into place in 2013 for patients readmitted within 30 days for heart attack, heart failure, or pneumonia.

The penalties, which are aimed at financially punishing poor-quality care, are hitting hospitals hard. Nationally, hospital penalties for preventable readmissions are predicted to hit $756 million in 2014, up from the estimated $227 million in 2013.

These penalties are expected to have a trickle down effect in many other health care industries, including ambulance services and EMS.

An opportunity for EMS

Although paramedics and EMS professionals are not the primary drivers of high-cost, low-quality health care, EMS experts, including Glenn Leland, chief strategy officer at Pro-Transport-1, predict that health care reform could be a tremendous opportunity to reconfigure the role of EMS within an integrated health care system.

“If you step back and look at what’s going on with health care reform … much of the focus is on hospitals,” Leland said. “Hospitals are going through the majority of the change to improve the efficiency of our health care delivery system.

“In fact, EMS is attempting to solve some of the economic efficiency of the Medicare program and readmissions. I see the economic pressure on hospitals as a key, driving pain point for EMS in the future.”

Steve Wirth, one of the nation’s leading EMS attorneys, points to mobile integrated health care as a model for keeping patients out of the hospital and lowering hospital readmissions. These models can also offer greater continuity of care and provide patients with easily accessible primary care services and follow-up care.

Data shows home health care can lead to better patient outcomes. One study from North Shore University Hospital in New York found that among more than post-heart surgery 400 patients, those that did not receive home health care post-surgery were three times more likely to die or be readmitted to the hospital.

Heart surgery patients who received home health care after surgery from a nurse practitioner were significantly less likely to end up back in the hospital within the first month post-discharge.

This kind of positive outcomes data is feeding a growing interest and investment in these new models of care. Mobile integrated health care with EMS and/or nursing professionals can offer greater continuity of care, more hands-on help, and cut down on the need for the most expensive form of care: in-patient hospital care.

Another growing trend is the rise of consumerism in health care. Industry experts argue that EMS and the ambulance service industry must meet and exceed consumer demands to thrive in the new health care environment.

Consumers in the ambulance service industry include:

  • Patients
  • Health care providers
  • Hospitals
  • Health care organizations, such as skilled-nursing and assisted-living facilities

Consumers today expect:

  • Convenience and an easy user experience
  • Proven value for a service, especially a paid service
  • Personal connection
  • Accessibility of services, anywhere, anytime

To fully understand and meet consumer demand, the ambulance service industry has to recognize how consumer needs are shifting due to:

  • An aging population
  • An epidemic of chronic illness including obesity, heart disease, and diabetes
  • A shortage of primary care providers and clinics

“We need to recognize that we’re health care providers, not emergency providers anymore,” said Jerry Overton, chair of the International Academies of Emergency Dispatch. “We have to redesign our systems around who is really calling for help and what kind of help they need. I think that’s the real challenge.”

Why EMS should shift to non-acute care

Increasingly, the ambulance service industry is being asked by patients and industry organizations to provide basic health care. This a fundamental shift for a profession that was created to offer life-saving, acute, on-scene care and transport.

For EMS providers that are willing to embrace and meet changing consumer demands, it is an enormous opportunity. EMS can offer extraordinary added value within an integrated health care system by using innovative non-acute care models to offer these four services.

  • Provide greater continuity of care between health care facilities and the patient’s home.
  • Offer post-discharge follow-up visits to help patients transition to their homes, maintain their care plan, and avoid hospital readmission.
  • Refer patients, when appropriate, to urgent care or primary care facilities.
  • Help patients better navigate the health care system, especially those with chronic co-morbidities or complicated medical conditions.

Some forward-thinking ambulance agencies — including REMSA in Reno, Nevada, MedStar in Ft. Worth, Texas, American Medical Response nationally, MetroAtlanta in Atlanta, Acadian Ambulance in the southern region, WakeMed in North Carolina — are embracing the challenge of meeting these demands.

These organizations have created innovative ways to offer non-acute care with EMS teams and health care professionals, including nursing hotlines, community paramedics, homecare follow-up visit programs, and other cutting-edge care models.[1] [2] [3]

To read more about the health care reform, health care consumerism, and the future of EMS and the ambulance service industry, download the complete whitepaper, “ The Future of the Ambulance Service Industry: Value-Focused, Consumer-Driven & Mobile-Savvy,” which includes “8 Ways Better Technology Platforms Can Improve Ambulance Services.”


1. McCallion, T. Report Card From Reno. EMSWorld News. Oct. 12, 2014.

2. Kizer, KW, Shore, K, Moulin, A. Community Paramedicine: A Promising Model for Integrating Emergency and Primary Care. July 2013.

3. Erich, J. A New Face of Improvement. EMSWorld News. Feb. 5, 2014.

Jay Fitch receives NAEMT's Lifetime Achievement Award

CLINTON, Miss. — Joseph “Jay” Fitch, Ph.D. was presented with the 2014 Rocco V. Morando Lifetime Achievement Award by the National Association of Emergency Medical Technicians (NAEMT). This is NAEMT’s most prestigious award and recognizes a lifetime of commitment and contributions to emergency medical services. This award is generously sponsored by the National Registry of Emergency Medical Technicians (NREMT).

Jay Fitch has had an impressive career driven by his passion for education, public safety and enhancing the EMS profession. Spanning nearly 45 years, he began his career as a volunteer firefighter in Virginia, became a police officer in Missouri, emergency medical technician in Washington, D.C. and later, one of the first certified Paramedics in South Carolina. In 1979, he advanced into management, operations and consulting positions, where he left his mark with improved systems, enhanced clinical performance, and program design.

Currently, a partner and officer with varied EMS groups, Fitch is widely recognized as the pioneer of Fitch & Associates, a company started in 1984 to provide management and information services to healthcare, government and professional associations.

"Jay Fitch embodies the passion and dedication of our nation’s EMS that has — and will — inspire future generations, said Severo “Tré” Rodriguez, executive director of NREMT. “My predecessor, Rocco, would be proud to have Jay be given this prestigious award. Thank you for your leadership and commitment to our nation’s EMS."

Known for an understated but hands-on consulting approach, Fitch’s enthusiasm for EMS has contributed to his lengthy list of achievements, including a master’s degree in public administration from Missouri’s Webster University; leading the turnaround of a troubled EMS system and being named EMS Director in St. Louis, Mo. at the young age of 24; inspiring thousands of EMS leaders through lectures and articles; bringing together our nation’s EMS thought leaders as program chair of the Pinnacle Leadership Conference; serving as author and editor of highly respected reports and publications; and developing learning programs for EMS supervisors and managers. In the early 1980s, Fitch was also instrumental in helping NAEMT transition into an independent national association.

Two founding partners at Fitch & Associates made the following comments. Richard (Rick) Keller said, “Jay’s journey through EMS has extended beyond four decades and around the world. He continues to be passionately committed to improving emergency services for both the patient and the caregiver.”

Christine Zalar continued, “to know Jay is to be consumed by his passion and vision for improving EMS. He has been a driver of leading-edge solutions to problems not yet even fully understood. Jay’s commitment to leadership development has been unwavering since the firm launched. His message to caregivers, clients, students, and colleagues has not changed: “First, take care of the patient — we’ll figure out the rest from there.”

Named after the inaugural recipient and founding NAEMT member, Rocco V. Morando, the Lifetime Achievement Award was first presented 30 years ago in Mississippi. This year’s presentation in Nashville, Tenn. was made on November 10 during NAEMT’s General Membership Meeting. This signature event, held during the NAEMT Annual Meeting, celebrates accomplishments and recognizes the contributions of members toward the success of the association and the betterment of the EMS profession.

“I’ve worked with Jay for decades and with every year, gain more respect for the vision, talent and dedication he brings to our EMS profession,” said NAEMT President Don Lundy. “He’s never lost sight of the importance of EMS to our communities, and has worked tirelessly to help strengthen infrastructures and mentor leadership — all to make EMS systems work better. It is a distinct pleasure to announce Jay Fitch as the recipient of the 2014 Rocco V. Morando Lifetime Achievement Award.”

5 EMS communication tools for major sporting events

Responding to and managing large-scale sporting events can bring a myriad of problems for EMS. Multiple patients, evacuations, delayed response times, compromised safety of responders, limited access, crowd control and poor communication are just a few of the concerns.

Clear and concise communication is a fundamental component that must be implemented at every level.

“For effective communication to work, everyone needs to be one the same page” said Candace G. Johnson, director of event operations for DC Events, which manages several large-scale sporting events including the Rock and Roll DC Marathon finish line festival.

Here are some tools that can help managers communicate before, during and after an event.

1. Mutualink Technology

Mutualink Technology was successfully used for the 2014 Boston marathon. It enables secure interoperable resource sharing of radio, “real time” video, voice, and data across incompatible systems.

Numerous entities can share multimedia information connecting local and state police, fire, emergency operations centers, transit, private companies, hospitals, utilities and federal agencies.

2. Sonim

Ideal for field operations, Sonim, is a back up to the traditional two-way radio. The rugged smart phone offers 24 hours of talk time and 800 hours of standby. The device is waterproof, shock proof and comes with extra loud speakers.

3. OnPage

Text messages are valuable when you can’t hear in the midst of a crowd. OnPage provides text messages directly to the crew’s cell phone. Administrators also receive a notice when a responder delivers, reads, or replies to a text.

4. First Responder Network Authority (FirstNet)

During emergencies wireless circuits can become overloaded, and responders will benefit from their own secure network.

The First Responder Network Authority (FirstNet) is an independent authority within the National Telecommunications and Information Administration, which is working to establish, operate and maintain the first nationwide, high-speed, interoperable broadband network dedicated to public safety and emergency responders. To fulfill these objectives, Congress allotted $7 billion and 20 MHz of valuable radio spectrum to build the network.

5. BeOn

BeOn is a product of Harris Pubic Safety and Professional Communications, and was used in the Texas Ironman to assist with communications and tracking. It extends the radio communication range beyond that of a traditional network, providing access to situational awareness tools that radios networks normally don’t have.

BeOn essentially turns a responder's smartphone into a P25 push-to-talk radio, utilizing enhanced LTE network connectivity. The mapping features also track the locations of first responders and emergency vehicles, enabling them to route appropriate resources and increase overall response efficiency.

8 tips for responding to in-flight emergencies

Last night I went to a Tai Kwon Do black belt testing to watch a friend who was testing for a fourth-dan master belt. It was a pretty impressive affair, capped off by watching my friend break a tall stack of bricks, and break his hand in the process. He then proceeded to walk around the forum shaking hands with everyone using his bloody, broken hand.

I was invited to attend because of a friendship, but it was also made clear by several of the instructors that it would be nice if I could come, you know … "just in case."

This sort of thing happens to all of us from time to time.

As cliché as it sounds, very few of us really take off the uniform when our work day is over. Being an EMT or a paramedic is a 24/7 job.

Our neighbors know that we work in emergency services. Our friends and family look to us for advice and medical guidance.

Happy to help

I’m not complaining. I wouldn’t want it any other way.

In fact, I get a little perturbed when friends or family describe a significant injury or illness that they didn’t tell me about because, "Well, we just didn’t want to bother you."

And don’t even get me started on the time when my father, visiting from out of state, drove himself to the hospital with chest pain because he didn’t want to wake me up.

I think most of us make peace with the fact that we are always on call to some extent. In fact, the majority of us prefer it. I don’t know if it’s like this in other professions. I’ve been in emergency service for my entire working career.

I’m not sure if construction workers or accountants get called to ply their trade outside of their work environment, or if tax preparers ever get the urgent knocks on their door from neighbors who are about to miss a filling deadline.

I don’t know if people who work in sales get calls from friends asking for advice on how to best word their Ebay furniture description or if dental hygienists get asked about the best toothbrush.

I do know that I’ve never heard any of them called for while flying on an airplane.

I have, on several occasions, heard urgent requests for medical assistance while flying. I’ve even responded to these requests when the call went unanswered.

The first time I stood up and offered my help to the flight crew, I had no idea what to expect. Now that I have half a dozen or so of these experiences under my belt, I thought I might pass on a few tips for responding to in-flight emergencies.

1. Don’t depend on the flight crew for medical assistance

They are trained in basic CPR and AED operations. They also receive some basic medical training as part of their annual required emergency training.

They will be more than happy to take direction and bring you things that you need, but they are not clinicians. They are typically very happy to receive your assistance but, for the most part, they will leave the emergency to you.

2. You won’t be the only one

United Airlines reports that three out of four requests for assistance are answered by a qualified medical professional, so it’s likely you won’t be the only one who responds to the call for assistance.

Talk with the other medical providers and decide who would like to take the lead and who would like to assist. Don’t assume that you are the most qualified person to take care of the patient.

Having said that, don’t automatically differ to the highest level of training. A family practice physician or a pediatric nurse may be more comfortable assisting than leading the patient evaluation.

3. Have your ID handy

The plane will likely have a fairly extensive medical kit, but don’t expect to get your hands on it without proper identification. The crew will accept your help, but they can only turn the kit over to someone who has a valid medical identification.

If you don’t have the proper ID, they may not even tell you that the kit exists.

4. Know what you have to work with

Inside the kit you’ll find a blood pressure cuff and a stethoscope, as well as IV supplies, first round cardiac arrest medications and several commonly used emergency medications.

You may also find intubation supplies and basic trauma dressings. Don’t forget you have an AED available as well. Call for it sooner rather than later if you think you might need it.

They also should have supplemental oxygen for one person for the duration of the flight, but if you are using high flow rates you may want to assess the supply. Flight attendants can also apply oxygen but will probably prefer to let you do it.

5. Know your limits

Regardless of what medical equipment is made available to you, you are still obligated to stay within the limits of your scope of practice, your training and your local protocols. Make good clinical decisions and don’t get too far out in the weeds when you’re operating off-duty and outside of your response area.

6. Clear some space

You can ask to move passengers around if you and the patient need more room. Unless the flight is filled, the crew should be able to accommodate you.

You’ll have to decide if you’d prefer to assist the patient and return to your seat to check on them periodically, or if you’d like to remain with them for the duration of the flight.

7. Phone for help if necessary

It’s a good idea to keep your local ER phone numbers in your cell phone. Most planes have several options to make a phone call from inside the plane.

If you’re assisting with a medical emergency, your local doctors back home should be more than happy to help you out with some advice and direction.

8. Advise an emergency landing

If you deem the emergency significant enough to divert to an alternate location, you’ll need to speak with the captain about your options. Remember that you are only there to advise and recommend. It isn’t your aircraft and it isn’t your emergency.

Depending on your location and a myriad of other factors, landing the plane at an alternate location might not be possible even for the most critical of medical emergencies. Act in the patient’s best interest, but understand that diverting to an alternate airport isn’t as easy as steering an ambulance toward a different hospital.

Sometimes, answering the call for assistance on a day off, especially in the middle of a busy travel day at 30,000 feet above ground can be an inconvenience, but most of us wouldn’t want it any other way.

Hopefully, the next time you hear a request for assistance on an airplane, you’ll feel a bit more comfortable about offering your help.


EMS1 Tips

7 ways to best use, or avoid, capnography in the field

EMS1 readers shared their suggestions on how to get the most out of the method

Active shooter response: Are you physically ready?

Normally, I am strong believer that paramedics are at their best when they saunter into a scene, slowly walking and looking for clues and risks. But an active shooter incident is going to require repetitive bursts of significant physical activity.

Energy-saving tips for your station

Earth Day 2012 takes place this Sunday, with events planned held worldwide to increase awareness and appreciation of the Earth's natural environment. So, it's a good time to see what you can do at your agency to save both resources and money.

How this video can "Keep Yourself Safe"

Consider using this PPE safety video in your EMT Basic or Refresher Class.

CPR class instruction: 5 ways to make it great

My most recent healthcare provider recertification was memorable for all of the things the instructors did well.

Patient assessments: How to avoid free-for-alls

Substantial cajoling and adult guidance from mom in a Santa hat was required to initiate an orderly process of taking turns, appreciating a gift after it was opened, and taking occasional pauses for a meal or to welcome additional relatives.

Patient assessment: A non-linear process

On a skill sheet, patient assessment is presented as a linear process: First size up the scene, then complete the primary assessment followed by the secondary assessment.

Blood pressure reading tips and tricks for EMS

One of the things I'm most often asked by students and rookie EMTs is, "Kelly, how am I supposed to hear a blood pressure in the back of the rig?"

How to use Slideshare for EMS

Slideshare is an online community and tool for sharing presentations.

How to get optimal battery life from your devices

The batteries in your wireless cell phone, tablet or laptop are probably not the same old Duracells you used in your childhood walky-talkies.

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