The JEMS Report

Dr. Tim Nutbeam challenges long-held EMS dogmas surrounding vehicle extrication and post-collision trauma care. Drawing from the landmark EXIT project, Dr. Nutbeam explains why fast extrication takes priority over prolonged, in-vehicle interventions. True physical entrapment is surprisingly rare—occurring in under 10% of cases—and traditional "slow and steady" spinal immobilization doesn't effectively minimize movement or prevent secondary injury. Dr. Nutbeam breaks down the complex physics of crash forces, vehicle safety attenuation, and individual tissue tolerance to show why vitals alone can't predict patient deterioration. He outlines a streamlined, high-efficiency model for first responders: perform rapid critical interventions, give fire crews permission to cut fast, and prepare advanced resuscitation outside the vehicle. He also highlights new global initiatives focusing on standardized post-collision data collection, multi-agency scene ownership, and empowering bystanders.

JEMS Development Editor Mike Brown speaks with Aaron Weedman, PhD, technical lead for machine learning in emergency medicine at the University of Pittsburgh, and Dr. Lenny Weiss, EMS physician and medical director for air and ground services. They discuss how natural language processing can analyze prehospital free-text data, such as chief complaints and 911 call notes, to predict the need for critical interventions like airway management, hemorrhage control, blood transfusions, and CPR. The technology may also help determine whether patients need ALS or BLS resources. Using data (about 10 million chief complaints) and 20,000 to 25,000 911 calls, the researchers found the models performed well and closely matched existing dispatch protocols. The goal is to improve dispatch accuracy, mobilize resources faster, and reduce cognitive workload for busy EMS crews.

Jim McGuire, founder and CEO of Entrotech Incorporated, sat down with JEMS Product Pod Host Mike Brown to discuss the origin and tactical advantages of the Multi-T—a self-recoiling, non-stick compression dressing and tourniquet. Developed alongside military veterans for special operations teams, the device was designed to look like simple tape while offering high-strength occlusion at a fraction of the pressure required by traditional tourniquets like the CAT. McGuire explained how testing on fresh cadavers at Wake Forest University helped earn FDA clearance, clearing a path for the product to transition from military field use to civilian first responders.

Infection control consultant Katherine West explains why current Bundibugyo Ebola activity in the Democratic Republic of Congo and Uganda is considered low risk for the United States. She reviews outbreak drivers—border-spanning transmission, insurgent attacks on treatment centers, community distrust, and limited PPE—and summarizes Uganda’s rapid public-health response (isolation, contact tracing, lab testing) that ended local transmission. West covers clinical features (flu-like “dry” phase, then gastrointestinal “wet” phase; bleeding in about 10%), transmission dynamics, and the role of bats. She recounts U.S. Ebola experience and outlines preparedness measures: airport screening at major hubs, designated treatment centers and transport teams, available PPE and disinfectants, and EMS-specific guidance (droplet/contact precautions, avoid aerosol-generating procedures, mask the patient, use closed suction).

Mark Flauter hosts Dan Gerard and Walter Adler for a frank, policy-focused discussion on recognizing EMS as an essential public good. They unpack the EMS Bill of Rights, why ambulances must be ready 24/7, and how a federal EMS Corps and a Department of EMS could rebuild workforce pipelines and guarantee standards. Dan and Walter explain demonetizing true emergencies, aligning bargaining objectives across municipal, private and hospital systems, and the peril of unfunded “essential” designations. They also confront the crisis in provider mental health and argue for structured peer support, pensions, livable wages and training investments. Practical guidance for local advocacy: engage legislators, partner with hospitals and community groups, and demand clear definitions of “essential.” Listen to learn how unified language, organized labor strategies, and federal support can move EMS from billing-driven survival toward stable, publicly funded readiness.

Point-of-care ultrasound (POCUS) is rapidly transforming emergency medical services, stepping up as the modern equivalent of the 12-lead ECG for today's paramedics, according to Dr. Ross Prager. While portable ultrasound technology was initially developed to miniaturize heavy hospital equipment for field use, widespread adoption faced friction due to complex training demands and accuracy drop-offs in fast-paced environments. AI integration directly tackles these scaling bottlenecks by guiding real-time image acquisition and providing high-level diagnostic interpretation. By automatically identifying critical structures like the pleural line or organ interfaces, AI helps paramedics capture crisp, reliable views—even under chaotic field conditions with severe glare, heat, or noise. For trauma and undifferentiated dyspnea calls, prehospital ultrasound delivers vital objective data. Detecting free abdominal fluid or absent lung sliding allows EMS teams to notify receiving trauma centers immediately. This clinical head start mobilizes blood banks, surgical staff, and operating rooms before the ambulance even arrives, cutting down critical time to definitive care.

FDA has cleared Ezplaz, a shelf‑stable freeze‑dried plasma product, opening new possibilities for prehospital transfusion. In this episode Dr. Matt Levy and Dr. Randi Schaefer walk through the history, physiology, and practical realities of dried plasma: why it can stabilize bleeding patients, how it’s reconstituted, and where it fits alongside whole blood and component therapy. They emphasize that this is not a plug‑and‑go item—dried plasma remains a regulated blood product requiring medical director oversight, temperature management, documentation, and stewardship. Listen for implementation tips, regulatory limitations (approved for adults and currently intended where liquid plasma isn’t available), cost and distribution considerations, and how to prepare your system and crews. NOTE: The military was officially approved to use FDP in 2018. Efforts started earlier.

This episode breaks down the ICEBERG Study and why driving pressure may provide a clearer measure of ventilator stress and patient outcomes than plateau pressure alone. We define driving pressure, explain how it is calculated, and review evidence showing that higher driving pressures are associated with worse outcomes in mechanically ventilated patients. The discussion explores why plateau pressure can be a useful trend but may not fully reflect lung stress, how changes in PEEP can affect driving pressure and lung recruitment, and why monitoring compliance, SpO₂, and end-tidal CO₂ is essential when assessing response to ventilator adjustments. We also examine the rapid changes in lung mechanics that can occur after cardiac arrest or repeated intubations and discuss how driving pressure and compliance data, when available on transport ventilators, can help guide safe ventilator management during transport.

Lt. Stephen Zachar, lead recruiter for the Memphis Fire Department, explains how the department rebuilt recruitment and retention by hiring EMS licensed candidates, fast-tracking recruits with Firefighter I, and using lateral hires to reduce academy time and overtime costs. Learn how the department hired 1,000-plus EMS licensed recruits from 42 states, increased local retention to 77%, saved upward of $2.4M in a year, and staffed a 57-station, 1,700-person department more efficiently. Stephen walks through Memphis’ interview and onboarding and demos ResponderGrid — a new recruiting and networking platform for candidates and agencies (www.respondergrid.com) — and describes how it connects applicants, recruiters, chiefs, and vendors. Visit www.joinmemphisfire.com to learn more.

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/