JEMS - EMS

Immune Checkpoint Inhibitor Reactions in the Out-of-Hospital Setting: ow.ly/PTPX5102rEP Immune-related adverse events should become an important consideration when treating patients receiving or who have been exposed to immune checkpoint inhibitors (especially in the last 1 year) who present with unexplained symptoms. Immune-related adverse events may occur weeks to months after initiation of therapy and, in some cases, even after treatment discontinuation. Unlike traditional chemotherapy toxicities or acute allergic infusion reactions, immune-related adverse events result from dysregulated immune activation against native, healthy tissue. The affected system does not need to be related to the underlying cancer; symptoms may have been triggered by an unregulated response to an environmental exposure (lung, GI, skin). Treatment guidelines recommend early consultation with the patient’s oncology team, symptom management, and glucocorticoids for patients with moderate to severe symptoms. Given the increasing prevalence of ICI therapy and irAEs, EMS systems are encouraged to develop protocols to treat patients with life-threatening ICI presentations. Consensus guidelines recommend prednisone 0.5-1 mg/km for moderate symptoms and 1-2 mg/km for severe symptoms. Dexamethasone 8-10 mg IV is a reasonable bridge to definitive care.

Some days are chaos. Some calls stick with you. Still, you suit up, hit the streets, and do the work that nobody else can. It’s not easy, and today we recognize the grit, skill, and heart you bring to every call.

Implementation of Prehospital ECMO at the New York City Marathon: ow.ly/1Kps5101GGP As participation in marathons and half-marathons continues to climb, rates of cardiac arrest among long distance male runners have increased this decade. Last fall, more than 59,000 runners participated in one of the world’s largest races: the annual TCS New York City Marathon. While non-emergent issues, such musculoskeletal complaints and minor trauma predominate, a 2025 JAMA publication revealed that rates of sudden cardiac arrest (SCA) in male runners completing full or half-marathons increased significantly between 2020 to 2023 compared with prior decades. Extracorporeal membrane oxygenation (ECMO) addresses this significant limitation of ACLS by providing maximal percutaneous circulatory and metabolic support.

Could CPR training be too complicated? Cardiac arrest researcher Tommaso Scquizzato, MD, says training should prioritize recognition and action over unnecessary complexity. When someone collapses, hesitation matters. Hear more on the podcast: ow.ly/z7uU5101ucs

EMS personnel are likely to encounter organ transplant recipients more frequently in the future because of advancements in medical science. In the prehospital environment, distinguishing bacterial, viral, and/or fungal infections from organ rejection in a transplant recipient is extremely difficult because these conditions often present with overlapping and nonspecific symptoms. Understanding the unique presentations and treatment needs of this growing patient population can help guide appropriate prehospital care: ow.ly/my5F51017LK

The Effect of Peak Demand Units on Urban Emergency Medical Services Operations: ow.ly/4i225100Om9 In 2024, over 14,000 emergency medical services (EMS) agencies across the United States responded to 60.3 million incidents, including 911 responses, interfacility and critical care transports, and standby events. Of this 60.3 million, at least 39.5 million incidents were located in urban areas, which was roughly 65% of EMS incident volume. For EMS agencies located in urban counties or townships, this level of incident volume means that unit efficiency is paramount to providing life-saving interventions as soon as possible and maintaining community satisfaction. Balancing the need for unit efficiency and the incidence of employee fatigue can be a difficult, but crucial, task for urban EMS agencies. This narrative review discusses one option for urban EMS agencies seeking to improve efficiency and reduce employee fatigue: the peak demand unit (PDU). PDUs typically operate during a high incident volume portion of the day or week, but they may also operate in a geographical area that has a high incident volume compared to the rest of the agency’s territory. PDUs include transport-capable ambulances and non-transport EMS units.

In the United States, 4.5 million people live in a service desert, which means that they are 25 minutes or more away from a station. And, that statistic does not consider how far they are from hospitals or primary care providers. Service deserts and rural areas make it challenging for residents to access healthcare, both in emergency and non-emergency situations. Community paramedicine will not become a permanent healthcare fixture by accident. It will only happen if healthcare leaders, EMS agencies, and policymakers actively treat it like the essential service it already is. This shift will not happen overnight, but with a few thoughtful steps, we can champion community paramedicine and experience its benefits throughout the country: ow.ly/8uSK5100vaW

When a patient shows signs of a medical emergency, EMS providers have a responsibility to advocate for the care they need. In the case of Lester Isbill, an elderly retired preacher in Tennessee, missed clinical red flags and failures in patient advocacy raise difficult questions about EMS decision making when medical care and law enforcement involvement collide. Paramedics Mike Brown and Adam LaChappelle discuss what providers can learn from this case, including recognizing altered mental status, assessing patient capacity, and knowing when to push for transport. Watch the full episode on YouTube: ow.ly/ptBm51008Ej

WEBINAR TODAY, 1:00 pm ET: ow.ly/zyct50ZTz0v Beyond CPAP: Smarter Respiratory Support in EMS - with Steven LeCroy, (Ret.) MA, CRT, EMTP Prehospital respiratory support has moved well beyond simply applying oxygen or reaching for CPAP. This webinar explores how EMS clinicians can distinguish oxygenation failure from ventilation failure and select the right intervention for each. From CPAP and BPAP to high-flow oxygen and assisted ventilation, the focus is on practical bedside decisions, effective setup and reassessment, troubleshooting common problems, and recognizing when noninvasive support is no longer enough.

The best EMS training does more than teach skills or add a check mark to satisfy a continuing education requirement, it immerses providers in the realities that they may one day face. In 2026, our focus shifted toward an equally challenging but far less commonly trained environment: the hoarder house. The concept was simple in theory, but ambitious in execution. Creating an environment so realistic that participants would forget that they were in a training building that they had been in dozens of times before. Every detail was considered from this point on. Yellow food coloring was added to water in a urinal prompting participants to consider its color and volume during their assessment of the patient. Nearly 100 plastic cockroaches purchased in bulk were strategically placed throughout the environment and stapled to various pieces of furniture. A litter box with silicone pet waste, dried flowers in a soda cup, stained furniture, old clothing and stacks of pizza boxes added authenticity. Even odors were considered. Specialty scent products were used to create unpleasant smells that immediately challenged participants upon entry. The objective was not shock value. The objective was to create an immersive and emotionally engaging learning environment. Every detail was intentionally selected to allow participants to experience the environment through the eyes of both patient and provider. Patients living in hoarding conditions often face stigma, embarrassment, and social isolation. The exercise challenged participants to see beyond the environment and focus on the human being at its center. Every provider was expected to deliver compassionate, patient-centered care regardless of the circumstances at the “scene.” Read more about this training in "Building Reality: How a Labor of Love Became One of the Region’s Most Unique Training Experiences" here: ow.ly/wzLK50ZZmZs

“My foot was shaking as I was driving to the hospital.” Your first cardiac arrest call is one you don't forget. EMS providers, do you remember your first code? Newest "Just A Little Salt" podcast episode live now on YouTube: ow.ly/iPib50ZZ9oP #EMS #Paramedics

The Staffing Crisis Starts Between Calls: ow.ly/Crjm50ZYNgn Every conversation about EMS workforce development eventually arrives at the same conclusion: recruitment alone will not solve this. The field is competing for a shrinking pool of candidates willing to do extraordinarily difficult work, often for compensation that has historically lagged behind the difficulty. Getting people in the door is necessary. It is not sufficient. Retention is the leverage. And retention begins in the ordinary hours, in the moments nobody is tracking. This is where new providers are deciding, often without consciously knowing they’re deciding, whether this work is somewhere they can build a life. What doesn’t show up in vacancy rates or turnover reports is the accumulation of smaller failures that preceded each departure. The rotation schedule that broke a pairing before it could become something. The kitchen table where a new EMT sat alone because everyone else had already formed their orbits. The preceptor relationship that was clinically sound and humanly empty. The first difficult call where nobody followed up because following up wasn’t in the protocol. Those are not staffing failures. They are culture failures. And culture is built, or abandoned, by leaders who decide whether the ordinary hours matter.

The Stroke That Wasn’t: ow.ly/kyCk50ZY9b4 Paramedics are trained to recognize stroke quickly, but speed cannot come at the expense of diagnostic discipline. Hypoglycemia is one of several conditions that can create a convincing stroke-like presentation. This case shows why EMS should treat the complaint as time-critical while still searching for immediately reversible causes. FIELD TAKEAWAY: The safest approach is not “stroke or mimic.” It is to move rapidly on the stroke pathway while testing for reversible abnormalities that can be identified and treated in the field.

WEBINAR TODAY, 1:00 pm ET: ow.ly/yfnB50ZU3ZC Advancing EMS Hemorrhagic Shock Management: New Bleeding Control Technologies and Blood Product Management - with Dan Irizarry, MD When severe bleeding turns to hemorrhagic shock, EMS clinicians need reliable equipment, blood products to transfuse, and training that works. In this webinar, we will explore practical ways to strengthen prehospital hemorrhagic shock management, from the point of injury through agency-wide implementation. For more than 20 years, TacMed Solutions® has supported military, law enforcement, fire, and EMS professionals in tactical medicine, trauma care, and emergency preparedness, and we bring that experience to this session. First, we will examine emerging technologies for prehospital blood transfusion programs and hemorrhage control. We will walk through the new BRIDGE™ Fridge and other passive and active refrigeration options, focusing on key considerations for maintaining blood product integrity, availability, and readiness. We will also preview TacMed's EZ Tourniquet™. Next, we will demonstrate individualized, AI-enhanced distributed learning through the Cerego platform and show how pairing it with high-fidelity simulation builds durable clinical knowledge and operational confidence in your agency's hemorrhagic shock response. We designed this webinar for EMS clinicians, educators, medical directors, and agency leaders. You will leave with a practical framework for evaluating new bleeding control and blood storage technologies, strengthening blood-program readiness, and turning education into reliable field performance.

When Opportunity Disappears: Why EMS Procedural Competency Declines After Certification - ow.ly/seZS50ZXKYo

EMS training is evolving: VRSim’s AI-powered VRNA AEMS immerses you in real-world scenarios to boost skills & fight burnout. Ready to elevate your readiness when it matters most? Discover how: ow.ly/YFpf50ZU7iJ

WEBINAR TODAY, 12:00 pm ET: ow.ly/wPm850ZMKTc A Modern Learning Management System for Fire & EMS: Training That Connects Readiness, Compliance, and Performance - with Kevin Gardiner and Jeff Schneider Training isn't optional for Fire and EMS agencies but managing education, compliance, and readiness across teams too often feels disconnected and manual. Join us for a live webinar where Kevin Gardiner and Jeff Schneider of Clarion pull back the curtain on the Elite Learning Management System. Together they'll show both sides of the story — how it works for your agency and the power behind it from Clarion — and what modern training software looks like when it's built around how agencies actually operate, not just how courses get delivered. You'll see how a connected Learning Management System brings trusted Fire and EMS education together with agency workflows to: -Simplify compliance and certification tracking -Cut down administrative overhead -Give leaders clear visibility into training progress and readiness It's more than a demo — it's a look at how the right Learning Management System can transform readiness across your organization. Ideal for agencies looking to modernize training without starting over, and for leaders responsible for safety, compliance, and long-term workforce development. Save your seat today.

Medical Oversight as a Foundational Requirement for High-Reliability EMS Systems: ow.ly/M2Mq50ZWP66 Medical direction in EMS is frequently misunderstood as a singular role fulfilled by a physician. In practice, effective medical oversight is a system composed of prospective, concurrent, and retrospective elements that collectively ensure the delivery of safe, consistent, and evidence-based care. EMS represents a high-risk, high-consequence component of the healthcare system that demands consistent, evidence-based clinical practice. Achieving this standard requires more than individual competence; it requires intentional system design supported by adequate resources and infrastructure. Offices of the Medical Director provide the framework for managing clinical variability, supporting workforce development, and ensuring patient safety. Under-resourced models of medical direction are insufficient to meet these demands and expose organizations to unnecessary risk. Medical oversight must therefore be recognized as a foundational element of EMS operations, essential to delivering safe, effective, and reliable care. Organizations that invest in this infrastructure position themselves not only to meet regulatory expectations, but also to lead in clinical excellence and system performance.

Seven sports. 93 miles. Seven distinct medical risk environments. Ski to Sea presents a complex planning challenge for EMS teams coordinating resources and patient care across mountains, roads, rivers and open water. Read the breakdown from JEMS: ow.ly/7waU50ZWmOZ