Prehospital Paradigm Podcast

The process of CISM, at least in Susie's surrounding area, has become more accepted as a practice. In the meantime, there has been an increase in one-on-one request to talk. Part of the change is not necessarily a critical incident that causes stress but the daily grind of the job. How a peer response team is created is also part of this episode.

Susie Forgacs, RN, Assistant Fire Chief at Rootstown FD and member of the EMS Institute team joins Dr. Hill, Wes and Scott, this month, to talk Critical Incident Stress Management… correct… management… not debriefing.  

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 pro...

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 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...