EMS Discussion - Live Tissue Training (LTT)

Live Tissue Training: An Overview

Live tissue training (LTT) involves using live, anesthetized animals to practice surgical and medical skills. While LTT has historically played a role in medical education- particularly in military trauma training - it is also a highly controversial practice due to ethical concerns surrounding animal welfare.

Arguments For LTT

Realism & Fidelity: LTT provides a level of realism that even high-fidelity simulators struggle to replicate, including the dynamic response of living tissue, active bleeding, and physiological changes.

Psychological Fidelity: The lifelike nature of LTT can evoke a stronger emotional and psychological response in trainees, potentially preparing them more effectively for the stress and urgency of real trauma situations.

Hands-on Experience: LTT offers opportunities to practice complex procedures in a setting that delivers immediate feedback based on the animal’s responses.

Confidence Building: Some research suggests that LTT increases self-efficacy and confidence among participants, particularly those preparing for combat deployments.

Arguments Against LTT

Ethical Concerns: Using live animals in training raises significant ethical questions regarding animal rights and welfare. Critics argue that it is inhumane and causes unnecessary harm.

Availability of Alternatives: Advances in simulation technology—including high-fidelity human patient simulators, cadavers, and realistic part-task trainers—are increasingly capable of replicating many aspects of LTT, often at lower cost and without ethical concerns.

Limited Transferability: Anatomical and physiological differences between animals and humans may reduce the direct applicability of skills learned on animals to human patients.

One-time Use: Animals used in LTT are typically euthanized after training, limiting opportunities for repetitive practice and skill refinement.

Policy and Regulations: The U.S. Department of Defense has implemented policies aimed at reducing and replacing LTT with alternative methods where feasible. Additional legislation has been proposed to further restrict its use.

Current Trends

The use of LTT has declined in many civilian trauma training programs, such as the American College of Surgeons’ Advanced Trauma Life Support (ATLS) courses.

However, LTT continues to be used by the military for combat casualty care training, particularly for developing complex procedural skills and preparing personnel for the stresses of battlefield trauma.

Ongoing debate and research continue to evaluate the effectiveness of LTT compared with alternative training modalities, with some studies suggesting comparable skill acquisition and proficiency.

There is also a growing push to apply the 3Rs of humane animal use to LTT:  Replacement, Reduction & Refinement, seeking to minimize reliance on animals and improve their welfare when training does occur.

In Conclusion

Live tissue training presents a complex ethical and educational dilemma. While advocates emphasize its realism and benefits for skill development in high-stakes situations, critics highlight the ethical implications and the growing availability of effective alternatives. 

The overall trend suggests a reduced reliance on LTT, particularly in the civilian sector. However, it remains a component of certain specialized training programs, especially in the military, as efforts continue to balance training effectiveness with animal welfare concerns.

Further Reading

American College of Surgeons (ND). Advanced Trauma Life Support (ATLS)® Program. https://www.facs.org/quality-programs/trauma/education/atls/ Accessed August 13, 2025

Department of Defense Instruction (2019) Use of Animals in DoD Programs. www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/321601p.pdf Accessed August 13, 2025

Liang, J. N., Ciampa, M., Kobylarz, F., Anklowitz, A. J., Barzanji, N. K., Sherman, W., & Faler, B. (2024) Impact of Live Tissue Training on Provider Confidence for Operative Trauma Management. Military Medicine, 190(3–4): e784 - e789. https://doi.org/10.1093/milmed/usae403 Accessed August 13

NAEMT (ND) Tactical Combat Casualty Care www.naemt.org/education/trauma-education/naemt-tccc Accessed August 13, 2025

National Academies of Sciences, Engineering, and Medicine (2018) A Review of the Department of Defense’s Programs for the Use of Animals in Military Medical Training. Washington, DC: The National Academies Press

Physicians Committee for Responsible Medicine (2025) National Physicians Group Celebrates St. Elizabeth for Replacing Animals in Surgeon Training. https://www.pcrm.org Accessed August 12, 2025

Swain, C. S., Cohen, H. M. L., Helgesson, G., Rickard, R. F., & Karlgren, K. (2023) A systematic review of live animal use as a simulation modality (LTT) in the emergency management of trauma. Journal of Surgical Education, 80(9): 1320–1339 https://doi.org/10.1016/j.jsurg.2023.06.018 Accessed Aug 12, 2025

The Life-Saving Evolution of Tourniquet Use: From Battlefield to EMS

The use of tourniquets has transformed trauma care, moving from a once-feared intervention to a cornerstone of life-saving strategies, both on the battlefield and in civilian emergency response.

Navy Captain (Ret.) Dr. Frank Butler, the architect of Tactical Combat Casualty Care (TCCC), helped shift the perception of tourniquets in the 1990s.

Earlier trauma care teachings viewed tourniquets as dangerous due to the risk of limb loss. However, research from past conflicts, and practical experience, revealed that failure to control extremity bleeding was a leading cause of preventable death.

With the rise of TCCC in military settings, particularly during the wars in Afghanistan and Iraq, the widespread adoption of tourniquets helped save thousands of lives by controlling life-threatening hemorrhage early.

This success led to updated guidelines emphasizing tourniquet conversion, replacing the tourniquet with other bleeding control methods within two hours to avoid complications when possible.

Despite its military success, civilian EMS was initially slow to adopt tourniquet use. That changed following the Hartford Consensus and the creation of the Stop the Bleed campaign after the Sandy Hook tragedy.

These efforts brought battlefield lessons to the civilian sector, empowering both the public and EMS providers to take swift action in bleeding emergencies.

The key takeaway for EMS providers is clear:

👉 Uncontrolled bleeding is a time-sensitive emergency

👉 Tourniquets, when used correctly, are a safe and essential tool in prehospital care

👉 Every EMS provider should be trained, equipped, and ready to use a tourniquet when needed

For a deeper dive into the history, science, and best practices behind tourniquet use, you can read the full article here: 

The Evolution of Tourniquet Use in Trauma Care by Public Safety Group, 2025

EMS Words of Wisdom - Always Treat The Patient, Not Just The Problem

 

EMS Health & Welfare - Burnout (Part Two)

In Part One, we explored the definition and root causes of burnout - a chronic state of physical, emotional, and mental exhaustion.

Now, in Part Two, we dive deeper into the unique challenges faced by EMS providers and other frontline healthcare professionals.

These individuals often operate in high-stress, high-stakes environments where long shifts, emotional strain, and cumulative trauma take a heavy toll.

Recognizing the warning signs and proactively addressing burnout isn't just about self-care — it's about preserving our ability to provide lifesaving care to others.

THREE CORE DIMENSIONS OF BURNOUT

Research has consistently identified three dimensions of burnout, particularly in occupational and healthcare settings (Maslach & Jackson, 1981; Maslach, Schaufeli, & Leiter, 2001; Weinberg & Gould, 2019):

1. Emotional Exhaustion

This is the core component of burnout. It refers to feeling emotionally overextended and drained by one’s work. It may manifest in:

• Persistent fatigue, even after rest
• Psychosomatic symptoms (e.g., headaches, back pain, gastrointestinal issues)
• Sleep disturbances
• Difficulty adapting to daily work demands

Note: While physical symptoms like back pain and fatigue can occur, they are often part of a broader pattern of stress-related somatization and should be presented as such (Maslach et al., 2001; Leiter & Maslach, 2016; Lanzi, 2025).

2. Depersonalization / Cynicism

This is the interpersonal dimension of burnout. Individuals begin to detach emotionally from their work, often developing a cynical or negative attitude toward clients, coworkers, or the organization itself. Symptoms can include:

• Irritability and frustration
• Reduced empathy or compassion fatigue
• Feelings of detachment or “numbing”
• Loss of motivation or interest in one’s tasks
• Insomnia, attention difficulties, and increased conflict

This detachment can be a self-protective response to emotional overload (Maslach & Jackson, 1981; Maslach et al., 2001; Lanzi, 2025).

3. Reduced Personal Accomplishment / Inefficacy

This dimension involves a decline in one’s sense of effectiveness and competence at work. The person may feel that they are no longer making a meaningful contribution. This can present as:

• Negative self-appraisal
• Reduced productivity and confidence
• Feelings of incompetence, guilt, or worthlessness
• Decreased coping capacity
• Increased absenteeism or presenteeism

In severe cases, burnout may be accompanied by depression, social withdrawal, substance misuse, or even suicidal ideation — though these represent co-occurring risks rather than diagnostic criteria of burnout itself (Maslach et al., 2001; Weinberg & Gould, 2019; WHO, 2019).

Conclusion

Burnout is not a sign of weakness - it’s a signal that the system, workload, or support structure needs attention.

For EMS providers and healthcare workers, prioritizing mental health and resilience is vital not only for personal well-being, but for patient safety and long-term career sustainability.

By fostering a culture that values rest, boundaries, peer support, and continued education, we can begin to turn the tide on burnout — one shift, one provider, one department at a time.

Further Reading:

• Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001) The Job Demands-Resources Model of Burnout. Journal of Applied Psychology, 86(3), 499–512. https://doi.org/10.1037/0021-9010.86.3.499
• Maslach, C., & Jackson, S. E. (1981) The Measurement of Experienced Burnout. Journal of Occupational Behavior, 2(2), 99–113. https://doi.org/10.1002/job.4030020205
• Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001) Job Burnout. Annual Review of Psychology, 52, 397–422. https://doi.org/10.1146/annurev.psych.52.1.397
• Mental Health First Aid Staff (2015) Mental Health First Aid USA (1st Ed.). National Council for Behavioral Health.
• Lanzi, R. G.(2025) Holistic Health: Bridging Disability and Mental Well Being Promotion Through Community Engagement. ACSM’s Health and Fitness Journal, 29 (2): 48-55
• Leiter, M. P., & Maslach, C. (2016) Understanding The Burnout Experience: Recent Research & Its Implications For Psychiatry. World Psychiatry, 15(2), 103–111. https://doi.org/10.1002/wps.20311
• Weinberg, R. S., & Gould, D. (2019) Foundations of Sport and Exercise Psychology (7th Ed.). Human Kinetics.
• World Health Organization. (2019) Burnout, An “Occupational Phenomenon”: International Classification of Diseases. Retrieved from https://www.who.int/mental_health/evidence/burn-out/en/

EMS Health & Wellness - Burnout (Part One)

Burnout is more than just feeling tired or stressed. It’s a state of emotional, physical, and mental exhaustion caused by prolonged stress — especially when that stress feels unmanageable or unrelenting.

The World Health Organization defines burnout as a syndrome stemming from chronic workplace stress that hasn’t been successfully managed. It has three main features:

• Exhaustion (feeling drained and depleted)
• Cynicism or detachment (mental distance from work or roles)
• Reduced performance or a sense of ineffectiveness (Maslach & Jackson, 1981; World Health Organization, 2019)

In healthcare settings, burnout can also feel like losing the passion or purpose that originally drew you to the profession.

What Causes Burnout?

Burnout often happens when there’s a mismatch between what’s being asked of you and what you realistically have the capacity to deliver (Weinberg & Gould, 2019).

Whether that’s time, emotional energy, physical stamina, or support, when your resources are constantly being outpaced by the demands, the result is chronic stress. Left unaddressed, that stress becomes burnout (Mental Health First Aid, 2015).

This model is supported by decades of research, including the widely recognized Job Demands-Resources (JD-R) model, which explains how high demands and low support/resources can wear people down (Demerouti et al., 2001).

Signs To Watch For

Common warning signs of burnout include:

• Feeling exhausted even after rest
• Becoming more irritable or emotionally numb
• Feeling like your work doesn’t matter anymore
• Struggling to concentrate or feel motivated
• Withdrawing from colleagues, family, or activities you used to enjoy

Conclusion

Burnout isn’t just “part of the job”, it’s a serious, well-documented occupational hazard with real consequences for healthcare workers, patients, and the healthcare system as a whole. 

Recognizing the signs early is the first step toward prevention and recovery. 

From emotional exhaustion to a loss of purpose, these symptoms are not a personal failing, they are a reflection of chronic, systemic strain.

In Part Two, we’ll explore why EMS providers and other frontline healthcare workers are particularly vulnerable to burnout. 

We’ll also highlight strategies to prevent, manage, and recover from burnout - both individually and as a team - so we can protect not only our own well-being, but also the quality of care we deliver every day.

Further Reading:

Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001) The Job Demands-Resources Model of Burnout. Journal of Applied Psychology, 86(3), 499–512. https://doi.org/10.1037/0021-9010.86.3.499
Maslach, C., & Jackson, S. E. (1981) The Measurement of Experienced Burnout. Journal of Occupational Behavior, 2(2), 99–113. https://doi.org/10.1002/job.4030020205
Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001) Job Burnout. Annual Review of Psychology, 52, 397–422. https://doi.org/10.1146/annurev.psych.52.1.397
Mental Health First Aid Staff (2015) Mental Health First Aid USA (1st Ed.). National Council for Behavioral Health.
Lanzi, R. G.(2025) Holistic Health: Bridging Disability and Mental Well Being Promotion Through Community Engagement. ACSM’s Health and Fitness Journal, 29 (2): 48-55
Leiter, M. P., & Maslach, C. (2016) Understanding The Burnout Experience: Recent Research & Its Implications For Psychiatry. World Psychiatry, 15(2), 103–111. https://doi.org/10.1002/wps.20311
Weinberg, R. S., & Gould, D. (2019) Foundations of Sport and Exercise Psychology (7th Ed.). Human Kinetics.
World Health Organization. (2019) Burnout, An “Occupational Phenomenon”: International Classification of Diseases. Retrieved from https://www.who.int/mental_health/evidence/burn-out/en/

EMS Words of Wisdom - Your Patients Deserve Empath

 

EMS Education - Advisor: Basic Life Support (BLS)

 

The Advisor: Basic Life Support (BLS) program is a specialized certification pathway developed by the AHA for individuals who have successfully completed the cognitive portion of the HeartCode® BLS course but cannot physically perform the motor skills of CPR due to a disability.

Rather than demonstrating the physical actions (like chest compressions or AED pad placement), participants demonstrate competency by advising another person through those steps — showing they fully understand the why, when, and how of BLS.

Purpose & Importance

This program:

• Promotes inclusivity in lifesaving education by recognizing that knowledge is just as critical as physical ability.
• Allows people with physical disabilities to become certified in BLS and empowered to guide and direct others during a real cardiac emergency.
• Increases the number of trained individuals in a given community who can contribute during a medical crisis — even if they aren't able to perform CPR themselves.

Eligibility and Certification

To earn the Advisor: BLS certification card, participants must:

1. Pass the HeartCode® BLS Provider Course cognitive exam (the same as all BLS providers).

Successfully demonstrate their ability to verbally direct another person in performing:

• High-quality CPR
• AED use
• Basic resuscitation team skills

This is assessed by an AHA instructor, who ensures that the candidate can provide accurate, timely, and effective instructions that align with AHA guidelines.

The issued certification card is an Advisor: BLS card, which is distinct from the standard BLS Provider card — but still represents formal AHA-recognized certification.

Who Is It For?

This program is designed for:

• Individuals with physical disabilities that prevent them from completing hands-on CPR testing.
• Candidates who want to contribute to emergency preparedness in workplaces, schools, or communities, even if they cannot perform compressions themselves.

Impact and Accessibility

The Advisor: BLS program aligns with the AHA's commitment to diversity, equity, and inclusion in resuscitation science and training. By expanding the definition of who can be trained and certified, the program:

• Acknowledges the contributions and capabilities of persons with disabilities.
• Increases the total number of CPR-capable bystanders in society — a crucial factor in improving out-of-hospital cardiac arrest outcomes.
• Encourages organizations to embrace broader emergency readiness by including all capable team members.

Learn more about it here: https://newsroom.heart.org/news/new-program-developed-for-persons-with-disabilities-to-advise-others-on-cpr

EMS Celebrations - Memorial Day

 

This Memorial Day, we stand in solemn remembrance of the courageous men and women who gave their lives in service to our country. 

Their selfless sacrifice reminds us of the true cost of freedom and the deep responsibility we all share to honor and uphold their legacy.

As EMS providers, we understand the meaning of service, sacrifice, and answering the call when others are in need. 

On this day, we reflect not only as medical professionals, but as grateful citizens, forever indebted to those who gave everything in defense of our nation.

Their courage lives on in the families they left behind, the freedoms they preserved, and in each of us who chooses to serve others with compassion and care. 

We are inspired by their legacy to keep showing up, for our communities, our patients, and for one another.

Please join us in taking a moment to remember and honor those who never came home. 

May their bravery never be forgotten, and may we strive every day to live lives worthy of their sacrifice.

With deepest respect,

Mark Tozer, EMT-Int

EMS Words of Wisdom - Your Impact Is Everlasting

 

EMS Celebrations - EMS Week | Remembrance Day

 

Today, we take a moment to honor the EMS providers who have made the ultimate sacrifice, both over time and in the line of duty.

Together with families, departments, and communities, we reflect on their strength and commitment, which will always remain in our hearts.

As we remember those we have lost, we pay tribute to the impact they have left behind.

Today, I will take the opportunity to celebrate the remarkable life of Jon Wik, a true paramedic extraordinaire from Gillette, Wyoming.

Jon was a man of many facets…great, wild, and undeniably funny. His infectious laughter and larger-than-life personality enriched the lives of everyone around him.

Jon dedicated his life to serving others, never shying away from the challenges that came his way. He faced every call with unwavering courage, often lightening the mood with his quick wit and humor when times were tough.

His ability to bring levity to serious situations made him not only a phenomenal paramedic but also a cherished friend to his colleagues and the community.

Beyond his professional life, Jon was a passionate individual who loved life to its fullest. He embraced every moment with enthusiasm, reminding us all of the importance of joy and connection.

As we remember Jon, let us celebrate the incredible impact he had and carry forward his spirit of compassion, humor, and dedication.

While he may no longer be with us, his memory and laughter will continue to inspire us every day.

Thank you, Jon, for everything. You will be deeply missed.

If you’re remembering a fallen hero today, please feel free to leave a memorial message below.

EMS Health & Wellbeing - Mental Health Awareness Month

It is an important reminder for our community of fellow lifesavers and healthcare professionals that mental health matters.

We must continue to recognize how critical this issue is, not just for our overall well-being, but for the safety of our teams and the patients we serve.

Treating our mental health with the same care and compassion we give to physical injuries isn’t just a matter of wellness, it’s a matter of safety, resilience, and longevity in this demanding field.

Imagine if we were as attuned to stress injuries as we are to sprains or fractures. If we offered ourselves and our colleagues the same support and grace we could change the culture, reduce stigma, and strengthen our community.

EMS Peculiar Patient Presentations - Water On The Brain

A recent medical case has puzzled scientists: a 44-year-old man has been living a seemingly normal life despite having only 10% of his brain tissue remaining.

The patient was diagnosed with hydrocephalus, a condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) in the brain.

In his case, the excess CSF has gradually displaced nearly all of the brain parenchyma, leaving only a thin peripheral rim of functional neural tissue. Imaging studies revealed that the majority of his cranial cavity is occupied by fluid.

Remarkably, despite this profound anatomical abnormality, the man leads a fully functional life.

He is employed as a civil servant, has a family, and possesses a measured IQ of 84 — slightly below the statistical average, but well within the range of independent functioning.

This case calls into question long-standing assumptions about neuroanatomy, brain plasticity, and the localization of consciousness and cognitive functions.

It suggests a remarkable degree of adaptability in the central nervous system, and may prompt a re-evaluation of how essential various brain structures are to everyday functioning.

Further Reading:

Feuillet, L., Dufour, H., & Pelletier, J. (2007) Brain of a White-Collar Worker. The Lancet 370(9583): 262. https://doi.org/10.1016/S0140-6736(07)61127-1 Accessed April 10, 2025