EMS Today

Firefighter Jake Ryks joins the Just a Little Salt podcast to dismantle the "hero" archetype often taught in fire science programs. He reflects on his early career, admitting he’s actually less confident now than as a rookie because he finally understands the sheer depth of the profession.   The conversation shifts to the unique culture of the fire service, specifically the "sacred" firehouse table where rankings vanish and conflicts are settled in-house rather than through a formal chain of command. Jake also dives into the misunderstood world of Hazmat, demystifying it as a discipline of basic chemistry rather than a horror movie. From sampling jars of menstrual blood at government protests to discussing the "Hazmat Guys" podcast network, this episode offers a grounded look at the reality of special operations and the importance of sharing knowledge to elevate the entire crew.   Quick favor: take our 3-minute (anonymous) listener survey to help shape what we cover next: https://sprw.io/stt-lfjMN

JEMS Development Editor Mike Brown sits down with Dr. Stacy Shackelford, a coauthor of a new JAMA Network Open paper, to unpack findings about calcium abnormalities in trauma patients. The authors tracked a cohort of 1,270 trauma patients arriving at three level I trauma centers and found that 22% presented with hypocalcemia and 5% with hypercalcemia. Early mortality varied significantly by calcium status: 11.9% among hypocalcemic patients, 4.3% among eucalcemic patients, and 22.8% among hypercalcemic patients. Although hypercalcemia was less common than hypocalcemia, it was associated with substantially worse early mortality, suggesting the need for further research into the underlying mechanisms.

Paramedic, educator and consultant John Todaro joins Eric Chase to trace a 49-year career at the intersection of prehospital care, nursing, and public health. Todaro argues for degree-based education for paramedics, emphasizes soft skills—communication, empathy and cultural awareness—and explains how broader clinical training strengthens judgment and the patient narrative. He examines professional tensions between nursing and EMS, advocates collaborative roles instead of hierarchical oversight, and offers organizational culture and work-life balance strategies to reduce burnout and moral injury. Through a vivid helicopter rescue—holding a young trauma patient’s hand and later being recognized by that child—Todaro shows why human connection matters as much as clinical skill.

Jennifer Pearsall joins the Not a-Fib Podcast to share insights from her Naval Postgraduate School thesis on the strengths that can emerge in emergency managers after life‑changing events. We explore her career across local and federal emergency management, the contrasts she encountered along the way, and the experiences that inspired her to create EM Wellness and define its mission. She reflects on her time at the Naval Postgraduate School, and we dive deep into the core findings of her thesis. Our conversation covers the types of transformative events that can lead to post‑traumatic growth, the conditions that make that growth possible, and the personal and organizational factors that either support or hinder it.

In this episode of Just a Little Salt, Cody Spaulding talks with Jon Vought, a firefighter and the owner of Rescue 1 CBD, to break down what CBD actually is and why it’s become a serious topic in the fire service. Jon explains the difference between hemp and marijuana, how cannabinoids interact with the body’s endocannabinoid system, and what the research says about CBD’s impact on inflammation, sleep quality, mood, and anxiety. They also get into the biggest concern most firefighters have: drug testing. John shares details from a university-backed study involving the University of Arcadia and the University of Maryland, including how urine samples were tested under strict lab conditions for THC.

Respiratory crises in the field rarely fit textbook categories. JEMS Development Editor Mike Brown talks with Hamilton Medical’s Jesse Carroll to separate Type 1 (hypoxemic) from Type 2 (hypercapnic) respiratory failure and recognize the mixed presentations clinicians actually see. They walk through practical cues (SpO2 trends vs end‑tidal CO2), common causes (CHF, COPD, obesity, neuromuscular weakness), and epidemiology: roughly 360,000 prehospital respiratory calls annually with 41% involving COPD and obesity rates rising from 32% to about 60% since 1988. Jesse explains why pressure, flow and volume, not oxygen alone, drive meaningful physiologic change, how device limitations (disposable CPAP, pneumatic and turbine systems) affect flow delivery, and when early noninvasive strategies can buy time or prevent intubation.

JEMS Development Editor Mike Brown sits down with Jonathan Epstein, who leads the American Red Cross healthcare product management team, to unpack the Red Cross’s new Resuscitation Suite. Jonathan explains how the suite reimagines BLS, ALS and pediatric/neonatal resuscitation with EMS-first blended learning, a “practice as you perform” approach that embeds local protocols and integrated cognitive aids, including a digital app with step-by-step algorithms and clinical decision support. They discuss adaptive learning and computer-adaptive testing that shrink classroom time, an upcoming VR pathway that delivers team-based practice and certification, and realistic expectations for AI, dual sequential defibrillation and mechanical CPR. Ventilation, measurement and device design are highlighted as targets for education and engineering solutions.

Bob Page of the Manual Ventilation Academy walks through why bag-valve-mask (BVM) ventilation often fails in the field and how measurement and real-time feedback fix it. He outlines the four simultaneous skills rescuers must master—opening and holding an airway, achieving an effective mask seal, delivering the correct tidal volume, and timing breaths—and shows why muscle memory alone isn't enough. In multi-center simulations and device head-to-head tests, blinded providers rarely met guidelines. Once teams used point-of-care feedback, performance climbed above target, even on intubated patients and during pediatric scenarios. Two-person BVMs and brief 30:2 pauses for breaths also improved delivery compared with continuous compressions. If you teach or deliver airway care, this podcast lays out practical techniques, device pitfalls, and why Bob's FDIC International course is a rare chance to train with measured, real‑world simulations and evidence.

Trevor Williams didn’t take a typical path into the fire service. He grew up overseas, living in places like Zaire during the Rwandan genocide and later Haiti during periods of civil unrest. His family’s missionary work with humanitarian organizations exposed him early to crisis, relief work, and the reality of helping people when things fall apart. Years later, that mindset carried straight into a career with the Los Angeles County Fire Department.   In this conversation, Williams talks about the long road to getting hired, the culture shifts he’s seeing among newer firefighters, and why mentorship inside the firehouse still matters. He also breaks down how a homemade tool he built for forcing doors eventually turned into a widely used product across departments and industries. The story moves from firehouse camaraderie to small business lessons, covering product design, marketing mistakes, fraud scares, and what it actually takes to turn an idea into something firefighters trust on the job.

Flight nurse and creator Nurse Gwenny joins the show to talk frankly about what it really takes to thrive in emergency care when the textbook ends and the hard calls begin. She walks through her path from pre‑med burnout to ER and flight nursing, why traditional courses left her memorizing instead of understanding, and how that frustration drove her to build highly visual, short-form education that actually sticks for busy medics, EMTs, and nurses. Along the way, she shares the cases that still sit with her, the mentors who modeled clinical excellence with zero ego, and concrete ways to protect your mental health in a career built around other people’s worst days.

Infection control consultant Katherine West breaks down the latest HIV post-exposure prophylaxis (PEP) guidelines published in mid-2025. Highlighting key changes since the 2013 update, she explains the shift toward less toxic antiretroviral regimens, elimination of routine baseline lab testing for PEP, and new protocols for exposures involving patients with undetectable viral loads. West emphasizes the importance of expert follow-up care, clarifies who is responsible for source patient testing, and underscores the low risk of occupational HIV transmission. She also discusses challenges faced by emergency providers managing exposures outside regular occupational health hours and the role of 24/7 consultation services. The segment covers legal nuances, especially OSHA and state laws regarding HIV testing consent, and reiterates the CDC’s push for routine HIV screening to aid in the national goal of ending the HIV epidemic by 2030.

Host Chief Shane Wheeler and Assistant Chief Jon Detweiler dive into the complexities of team conflict and the essential role of trust in leadership. Drawing from his decades-long career, Jon shares firsthand experiences managing difficult conversations, especially transitioning from peer to leader. He highlights why many leaders mistakenly view conflict as failure rather than opportunity, and stresses the importance of emotional awareness, asking thoughtful questions, and fostering psychological safety. Jon also emphasizes the power of modeling behavior and setting clear expectations to maintain respect and accountability within teams. Whether you're a new leader or aspiring to grow, this conversation offers practical strategies for creating a culture where honesty, trust, and collaboration thrive, ultimately aligning teams to achieve shared missions effectively.

In this episode of Just a Little Salt, licensed counselor Kimberly Ingram dives deep into the unique challenges first responders face in their relationships. Drawing on her extensive experience working with law enforcement officers, firefighters, and other public safety professionals, Kimberly sheds light on the impact of shift work, chronic stress, and trauma on emotional connection at home. They discuss common misconceptions about therapy, the critical need for culturally competent mental health support, and how partners can build stronger communication even amid the toughest schedules. Kimberly also explores the delicate balance between a first responder’s identity and personal life, the risks of emotional distancing, and practical advice for couples recovering from infidelity.

Matt Aalto shares insights on cultivating a resilient fire department culture through clear expectations and genuine accountability. Drawing from decades of experience leading both volunteer and career crews in Oregon, Matt highlights how trust, communication, and proactive conflict resolution create an environment where firefighters thrive—both on and off duty. The discussion tackles the challenge of managing multiple generations within the ranks, the importance of addressing informal as well as formal expectations, and strategies for improving recruitment and retention by “getting your house in order” before adding new members. Real-world examples illustrate how supportive leadership tackles underperformance and fosters behavior change rather than punishment. Matt also offers practical advice for those looking to develop their voice in the fire and EMS community by writing and speaking.

Eric Chase sits down with John Graham, a respected EMS leader with 27 years of experience, to explore the challenges of mental health in emergency medical services. Reflecting on personal losses within the EMS community and the long-standing culture of “tucking away” trauma, John shares his journey toward embracing vulnerability and therapy. The conversation uncovers the often-unspoken struggles EMS professionals face, the delicate balance between leadership and friendship, and the importance of honest communication—even when it’s uncomfortable. John highlights the value of passion and commitment in leadership roles and stresses the need for grace, both toward oneself and others.

Mike Brown, William Belk and Mike Doss dive into the challenges and evolving practices of simulation-based training. They explore the idea of designing scenarios where even perfect performance doesn’t guarantee success, emphasizing the need to prepare students for unpredictable, high-stress realities without overwhelming beginners. The conversation highlights the important role structured debriefing to foster reflection and growth, while promoting psychological safety to embrace failure as a powerful learning tool. Incorporating resilience training early on is presented as a game changer for building mental toughness and coping strategies before entering the field. Drawing from decades of frontline and educational experience, the speakers advocate for tailored stress exposure to enhance cognitive function under pressure. Read Mike Doss' article that prompted this podcast here: https://www.jems.com/ems-training/no-win-scenarios-in-emt-and-paramedic-education/

FDNY Chief John Esposito shares insights from his 34-year career, revealing what sets a commissioner apart from a chief, and the realities of managing one of the largest fire departments in the world. Esposito reflects on his early days, the mentors who shaped him, and the profound impact of good leadership in firefighting. He offers a rare glimpse into the toughest decisions made during emergencies and the unique challenges of communication across thousands of personnel. The conversation also highlights firehouse traditions, from memorable meals to the iconic kitchen table, embodying the camaraderie that fuels their work. Chief Esposito closes by emphasizing the meaningfulness of saving lives and the unmatched sense of purpose his job has given him.

Steve Tafoya takes a dive deep into a new bill aimed at transforming treatment-in-place capabilities and establishing Medicare reimbursement models tailored for emergency medical providers. Drawing on 25 years of frontline experience and a strong legal and business background, Steve sheds light on the current reimbursement challenges EMS agencies face, with only about 14-25% of calls being fully reimbursed. The discussion highlights how this legislation could reshape EMS’s role beyond traditional 911 response—integrating community health, alternative destinations, and innovative care models. Steve emphasizes the critical need for provider voices in lawmakers’ offices and urges industry stakeholders to engage with representatives to support this bill. The podcast also explores the expanding career opportunities in EMS, including agency response units and industrial medical teams.

Eric Chase sits down with Jimmy Apple, aka EMS Avenger, to explore the often-overlooked realities behind emergency medical services. Jimmy breaks down the isolation many providers face, emphasizing the power of genuine relationships and networking in advancing EMS careers. They dive deep into the psychological challenges of frontline care, including the emotional toll of death notifications and the importance of accessible mental health support. With a spotlight on evidence-based practice, Jimmy contrasts the intense focus on cardiac arrest resuscitation with the relative neglect of sepsis recognition and treatment, urging a shift in EMS training priorities. Drawing from two decades of experience, he challenges outdated dogma around pediatric and adult care, encouraging providers to overcome fear and trust their skills. This conversation serves as a powerful reminder that EMS isn’t just about protocols—it’s about empathy, accountability, and continuous growth in service of human life.

By Bram Duffee, PhD, EMT-P For EMS providers who respond to a traumatic cardiac arrest, the instinct to initiate CPR is almost automatic. But could this life-saving intervention inadvertently hinder recovery in cases of severe hemorrhagic shock? A recent study, “Effect of Cardiopulmonary Resuscitation on Perfusion in a Porcine Model of Severe Hemorrhagic Shock,” challenges conventional wisdom and offers new insights that could reshape trauma care protocols. The Study: A Closer Look at CPR in Trauma-Induced PEA The research, led by Dr. Patrick Greiffenstein, professor of clinical surgery at LSU New Orleans and trauma ICU director at the Norman McSwain Spirit of Charity Trauma Center, addresses a critical gap in trauma care. While CPR is a cornerstone of resuscitation in cardiac arrest, its application in trauma-induced pulseless electrical activity (PEA) has not been rigorously validated. Trauma PEA, unlike medical cardiac arrest, is a low-flow state caused by severe blood loss (hypovolemia), where the heart shows electrical activity but fails to generate a palpable pulse. “CPR is a cornerstone of resuscitation and cardiac arrest, but its application in trauma-induced PEA has not really been rigorously evaluated,” explains Dr. Greiffenstein. “Trauma PEA is fundamentally a low-flow state caused by hypovolemia—insufficient blood volume.” The study aimed to determine how CPR affects tissue perfusion—specifically oxygen delivery to the brain and skin—during severe hemorrhagic shock. Using a porcine model, researchers simulated life-threatening blood loss and compared outcomes between two groups: one receiving automated CPR and the other left untreated during the shock phase. Key Findings: When CPR May Do More Harm Than Good The results were both surprising and concerning: No Improvement in Perfusion: CPR did not enhance oxygenation in the brain or skin. In fact, skin perfusion was significantly lower in the CPR group during both the shock and recovery phases. Adverse Hemodynamic Effects: While CPR increased systolic blood pressure (SBP), it significantly reduced diastolic blood pressure (DBP), which is critical for coronary and organ perfusion. Potential Harm: CPR caused a threefold increase in intracranial pressure (ICP), suggesting that chest compressions might disrupt normal blood flow dynamics in the brain. “Knowing now that extreme efforts like lining people up to do CPR can cause turbulence within the system is a significant advancement,” says Dr. Greiffenstein. “It’s possible to have perfusion at these unreadable MAP scores, which is a critical insight for trauma care.” Implications for Trauma Care These findings challenge the one-size-fits-all approach to CPR in cardiac arrest scenarios. In cases of hemorrhagic shock, CPR might: Divert attention from more effective interventions, such as rapid blood transfusion or surgical control of bleeding. Worsen perfusion to vital organs, potentially exacerbating the patient’s condition. “In military cases, field medics often don’t have the opportunity to perform full chest compressions on the battlefield. Sometimes, all they can do is drag a person to a safe position,” notes Dr. Greiffenstein. This study underscores the importance of prioritizing interventions that address the root cause of trauma PEA—severe blood loss—over traditional resuscitation techniques. A Call for Updated Guidelines The American Heart Association’s current guidelines broadly recommend CPR for all pulseless patients. However, this study adds to a growing body of evidence suggesting that trauma-induced PEA requires a different approach. By focusing on restoring blood volume and controlling bleeding, paramedics and EMTs can improve outcomes for patients in hemorrhagic shock. As Dr. Greiffenstein puts it, “This research is a step toward more tailored and effective trauma care protocols. It’s about understanding the unique physiology of trauma and adapting our interventions accordingly.” For EMS providers on the front lines, this study serves as a reminder to critically evaluate the tools and techniques we rely on in emergency care. While CPR remains a vital intervention in many scenarios, its role in trauma-induced PEA warrants careful reconsideration by physician medical directors. By staying informed about the latest research, we can continue to improve outcomes for the patients who depend on us most. Click below to watch the full interview Reference Greiffenstein, P., Cavalea, A., Smith, A., Sharp, T., Warren, O., Dennis, J., Gatterer, M. C., Danos, D., Byrne, T. C., Scarborough, A., Deville, P., & VanMeter, K. (2025). Effect of cardiopulmonary resuscitation on perfusion in a porcine model of severe hemorrhagic shock. The Journal of Trauma and Acute Care Surgery, 98(2), 251–257.