1. President Trump’s impact on EMS and the opioid crisis

On the campaign trail candidate Trump promised voters he would “end the opioid epidemic in America.”

For a President who repeatedly reminds Americans that he is a genius, best dealmaker, top negotiator, and pro-life who knows the best people his actions to keep his promise have been disappointing and deadly.

Trump in Phoenix, Ariz. Photo by Gage Skidmore.

“Trump’s underwhelming declaration of the opioid overdose epidemic as a National Public Health Emergency instead of a National Emergency is set to expire on Jan. 23, just three days into his second year in office.”

With his fondness for EMTs, paramedics, firefighters and police, the “public safety president” can use the bully pulpit to do much, much more for EMS, other public safety personnel, and the communities they protect.

Tom Petty died of an accidental overdose. The opioid epidemic shows no mercy regardless of class, income, talent or access to the best doctors. Petty was “prescribed various pain medications for a multitude of issues including Fentanyl patches.”

The medical examiner also found traces of “oxycodone, temazepam, alprazolam, citalopram, acetylfentanyl and despropionyl fentanyl.”

2. Phoenix 911 callers can get a taxi 

Not every 911 caller is having a life-threatening medical emergency. Phoenix Fire Department is smartly allocating resources by using taxis to transport patients who simply need a ride to the hospital instead of an ambulance with paramedics.

A long and well-researched article in the Arizona Republic describes the history of the program, how paramedics select a taxi and the dispatch process. Every medical transport intervention (remember transport is a treatment) has an inevitable rate of under- or over-triage. I am neither surprised nor disappointed by what the investigative journalist found.

Phoenix FD responded to 164,106 calls in FY 2015. Taxi’s dispatched:

  • 2016: 7,611
  • 2015: 6,741
  • 2014: 5,824
  • 2013: 3,959
  • 2012: 2,891

3. EMT as fictional book character

I am about a third of the way into “Tips for Living“, a recent Kindle First novel, by Renee Shafransky. One of the emerging characters is a volunteer EMT in a small town.



1. Evidence-based fatigue management guidelines

NASEMSO teamed up with the University of Pittsburgh School of Medicine to perform a comprehensive evaluation to provide recommendations on how to fight EMS fatigue, such as napping during shifts and using caffeine.

The guidelines recommend five practices:

  1. Use of fatigue/sleepiness surveys to measure and monitor EMS personnel fatigue.
  2. Limit EMS shifts to less than 24 hours in duration.
  3. Provide EMS personnel access to caffeine to help stave off fatigue.
  4. Allow EMS personnel the opportunity to nap while on duty.
  5. Provide education and training in fatigue risk management to EMS personnel.

Sara A. Jahnke, Ph.D., director of the Center for Fire, Rescue and EMS Health Research at the National Development and Research Institutes writes for EMS1.com:

“While, on the surface, the recommendations appear rather simple and intuitive, the process used to develop them and the implications for current and future practice should not be understated.”

“This landmark work goes beyond a list of recommendations. It summarizes and weighs the pros and cons that should be considered when implementing each recommendation.”

Call to action for leaders and field personnel: “from both the top down and the bottom up to begin considering ways to improve the environments and practices to reduce risk to patients, communities and EMS personnel themselves.”

Get some rest, exercise often, eat well, take a nap and coffee YES!

Sleep is the solution: Dave Konig, the Social Medic, make an important point about caffeine: “Caffeine should be consumed in moderation and as a tool to mitigate fatigue, it is NOT a solution for it. The only safe and proven solution for fatigue is in fact sleep.”

2. Machines and AI for 911 callers

An Artificial Intelligence assistant is on the line with “Copenhagen (Denmark) dispatchers to analyze the caller’s words and background clues in order to determine if the caller is suffering from cardiac arrest and alert the dispatcher in real time.”

Early recognition of cardiac arrest, especially determining that agonal breathing is not actually breathing, is one of the critical steps to initiating dispatcher-assisted CPR.

Words matter: A just published study, “‘She’s sort of breathing’: What linguistic factors determine call-taker recognition of agonal breathing in emergency calls for cardiac arrest?” concluded:

“There is potential for improved recognition of agonal breathing if call-takers are trained to be alert to any qualification following a confirmation that the patient is breathing.”

Shaving a few seconds off call taker recognition with an AI assistant could increase a community’s cardiac arrest survival rate.




EMS Tips – Training Games – FirstNet Quiz – Vehicle in the Window

January 17, 2018

1. Virtual and augmented reality games train teachers, first responders There are lots of ways to prepare teachers, students and first responders for an active shooter incident. A grant-funded project is using virtual reality (Military1.com) to simulate an active shooter incident at a school. “The United States Army and Homeland Security Department are in the midst […]

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EMS Tips – Peak Flu – Dangerous Pathogens Research

January 16, 2018

1. Influenza is everywhere … protect yourself The flu is widespread in all 50 states, according to the CDC. Protect yourself from influenza: Get the flu shot. Wash your hands before and after patient contact. Give oxygen, when indicated, otherwise have the patient wear a surgical mask. Thoroughly clean ambulance surfaces, including the cot, after […]

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EMS Tips – Active Shooter Response – LE Mental Health Funding

January 15, 2018

1. Civilians are part of active shooter response Runners, concertgoers, parishoners, teachers, students and other civilians always begin care before first responders arrive to an active shooter incident. Rob Wylie, FireRescue1.com, applauds the acknowledgement of bystander first care in the provisional NFPA 3000 standard. “The fact of the matter is this: No matter how robust […]

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Are you moving forward in 2018?

January 14, 2018

How are you coming on your New Year’s resolutions? About a month ago you might have proclaimed a stellar goal for 2018 to family or friends or made a silent oath to yourself to make an improvement or accomplish something big. Perhaps you committed to eating healthier, losing 10 pounds, learning more about STEMI treatment […]

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EMS Tips – EMS Predictions – Air Popcorn Popper

January 13, 2018

1. EMS predictions … active shooter incidents, again Ed Racht. MD looked into the future of EMS in 2018 in an email to AMR personnel, reprinted with permission on EMS1.com. “One of the toughest evolving issues in out-of-hospital medicine has become the increasing number of active shooter events. The Oct. 1 shooting in Las Vegas, the worst […]

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EMS Tips – Fitch’s Constant Leadership Learning – Rescue Me Quiz

January 12, 2018

1. Jay Fitch, EMS leader, mentor and educator shares leadership insights In a 40 year career Jay Fitch has been a volunteer firefighter-EMT, paramedic, manager, mentor and owner. One of the things Jay does best is study, discuss and describe leadership. Read and aspire to continue your growth as a leader. 2. Rescue Me quiz […]

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EMS Tips – Opioid Emergency – Do this before next shift bid

January 11, 2018

1. Opioid public health emergency is nearing expiration President Trump’s declaration of a Public Health Emergency for the opioid overdose epidemic is about to expire. (Politico.com) 90-day emergency: “President Donald Trump in October promised to “liberate” Americans from the “scourge of addiction,” officially declaring a 90-day public health emergency that would urgently mobilize the federal government […]

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EMS Tips – Active Shooter NFPA Standard – Retirement Age – Failure to Yield

January 10, 2018

1. Active Shooter NFPA Standard 3000 NFPA 3000, Standard for Preparedness and Response to Active Shooter and/or Hostile Events, gives guidance on active shooter or active threat preparedness and response (EMS1.com). “Hostile events are happening with greater frequency and ferocity today. It’s critical that we take steps to protect people from this increasing threat,” NFPA president […]

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