Prehospital Paradigm Podcast

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 cons...

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 technol...

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 ini...

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 3 rd 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...

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 opportuni...

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....

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...

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 d...