Understanding MARCH - The Importance of Airway Management

Image retrieved from tccc.org.ua

From the MARCH Mnemonic Series – Tactical Trauma Care for EMS Providers

Following the control of massive hemorrhage, the next lifesaving priority in the MARCH algorithm is Airway. 

Without a patent airway, oxygen cannot reach the lungs, and death from hypoxia can occur within minutes. 

While exsanguination kills fastest, airway obstruction follows closely - especially in cases of head or neck trauma, decreased consciousness, or maxillofacial injury.

In tactical environments, airway management must be both rapid and situationally appropriate. Providers balance lifesaving intervention with operational safety - sometimes working under fire or in low-light, resource-limited conditions. 

This article - the second in a five-part series - will focus on that next critical step: 

A – Airway Management

A patent airway is one that is open and unobstructed, allowing air to move freely in and out of the lungs. Even a partial obstruction can reduce oxygen delivery and lead to hypoxia, brain injury, or cardiac arrest. 

According to the National Safety Council (2023), foreign-body airway obstruction remains the fourth leading cause of unintentional death in the United States - emphasizing the universal need for early recognition and decisive management.

Image retrieved from tccc.org.ua

Principles of Airway Management

1. Assess the Airway Early

Assessment begins with observing the casualty’s level of consciousness, respiratory effort, and ability to speak or make sounds. 

The simple question, “Can the patient talk?” remains one of the fastest airway assessments available. 

Look and listen for:

• Gurgling, snoring, or stridor
• Facial or neck trauma
• Blood, vomitus, or foreign bodies in the mouth
• Absent or inadequate respiratory effort

In tactical settings, assessment must be efficient and, if under threat, may need to wait until the situation is secure enough to act safely. 

Image retrieved from tccc.org.ua

2. Basic Airway Maneuvers

If the airway is obstructed or compromised, begin with manual positioning techniques:

- Head-Tilt/Chin-Lift: For non-trauma patients who are unconscious and without suspected spinal injury.

- Jaw-Thrust: For trauma patients or when spinal injury cannot be ruled out.

- Recovery Position: For semi-conscious patients who can maintain their own airway but may vomit.

These simple maneuvers are often enough to restore airway patency temporarily and can be performed quickly even under fire or during evacuation. 

Image retrieved from tccc.org.ua

3. Airway Adjuncts

When manual techniques are insufficient, adjunctive devices can maintain airway patency:

- Nasopharyngeal Airway (NPA): Preferred in tactical and field care. Well tolerated in conscious or semiconscious patients and effective even with facial injuries (unless contraindicated by basilar skull fracture).

- Oropharyngeal Airway (OPA): Used only in unconscious patients without a gag reflex. Easy to insert and effective when bag-valve-mask (BVM) ventilation is required.

Advanced airways (e.g., supraglottic devices, endotracheal intubation, or surgical cricothyrotomy) may be indicated in prolonged field care or when BVM ventilation fails, but such interventions should align with provider scope and environment. 

4. Clear and Control the Airway

If obstruction is caused by a foreign body, blood, or vomitus, clear it quickly:

- Perform the abdominal thrusts in conscious choking patients.

- Use suction, if available, to remove debris or fluids.

- If foreign-body airway obstruction persists in an unresponsive patient, begin CPR following standard resuscitation protocols.

In tactical contexts, effective airway control often means doing the basics well—not overcomplicating care but ensuring the airway remains open during extraction and evacuation. 

5. Ongoing Monitoring and Reassessment

Airway status can change rapidly. A casualty who was breathing adequately moments ago may deteriorate due to swelling, bleeding, or decreased consciousness. 

Reassess frequently- especially after movement or as the tactical situation changes. 

Key Takeaway for EMS and Tactical Providers

Airway management is the second priority in the MARCH sequence, but it’s equally vital to survival. The tactical provider’s goal is to establish and maintain a patent airway using the simplest effective method appropriate to the situation. 

In many cases, that means manual maneuvers and an NPA—reserving advanced interventions for when time, equipment, and safety allow.

In every case, the principle remains: “Keep it open, keep it simple, keep reassessing.” 

Coming Up Next: Part Three – Respiration

With bleeding controlled and the airway secured, attention turns to respiration—assessing and managing chest injuries that can silently compromise ventilation and oxygenation. 

Part Three of our MARCH series will explore the recognition and treatment of life-threatening thoracic trauma, including tension pneumothorax and open chest wounds.

When the airway is open but the chest can’t move air, the mission shifts to restoring the breath.

Further Reading:

American College of Surgeons Committee on Trauma. (2022) Advanced Trauma Life Support (10th Ed). Chicago, IL: American College of Surgeons.

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, MA: Pearson Education

Butler, F. K. (2017) Tactical Combat Casualty Care: Beginnings. Wilderness & Environmental Medicine 28 (2S): S12-S17. 

Retrieved from https://pubmed.ncbi.nlm.nih.gov/28284483/ on October 8, 2025

Butler, F. K., Bennett, B., & Wedmore, C. I. (2017) Tactical Combat Casualty Care and Wilderness Medicine: Advancing Trauma Care in Austere Environments. Emergency Medicine Clinics of North America 35 (2): 391-407. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28411934/ on October 8, 2025

Committee on Tactical Combat Casualty Care (2023) Tactical Combat Casualty Care (TCCC) Guidelines for Medical Personnel. Defense Health Agency, Joint Trauma System. Retrieved from https://jts.health.mil on October 8. 2025

National Association of Emergency Medical Technicians NAEMT (2020) TECC: Tactical Emergency Casualty Care Course Book (2nd Ed). Burlington, MA: Jones & Bartlett Learning

National Association of Emergency Medical Technicians NAEMT (2023) Tactical Emergency Casualty Care (TECC) Guidelines. NAEMT Education Division

National Association of Emergency Medical Technicians NAEMT (2025) 

PHTLS: Prehospital Trauma Life Support, Military Edition eBook (10th Ed). Burlington, MA: Jones & Bartlett Learning 

National Safety Council. (2023) Injury Facts: Choking Statistics. Retrieved from https://injuryfacts.nsc.org on October 8, 2025

EMS Discussion - When Scope Meets Survival

Lessons from Kentucky’s Antivenom Case

When the call comes in, seconds matter. EMS Providers are trained to act decisively, but also within the limits of their medical scope.

What happens when those two imperatives collide—when a patient’s survival depends on a treatment that regulations forbid?

That question faced a Kentucky EMS crew this spring, and the outcome has sparked national discussion about scope of practice, ethics, and the realities of prehospital medicine.

The Case: A Mamba Bite and a Tough Decision

In May 2025, Powell County EMS responded to a call involving James Harrison, director of the Kentucky Reptile Zoo, who had been bitten by a Jameson’s Mamba - one of the world’s most venomous snakes.

As paramedics worked the scene, Harrison reportedly told them, “You have to give it, or I die.” The crew had access to antivenom - normally reserved for hospital or wilderness medicine use - and, after consulting with a physician, decided to administer it while awaiting helicopter transport.

That decision likely saved a life. But it also triggered an investigation.

Under Kentucky EMS regulations, only certified wilderness paramedics are authorized to administer antivenom. The Powell County crew did not hold that certification.

Despite acting under medical consultation and in good faith, they were reported to the Kentucky Board of EMS (KBEMS) for operating outside their scope of practice.

Importantly, the EMS providers self-reported their actions - a key factor later cited in their defense.

The Outcome: Case Dismissed, Questions Remain

In late September, the KBEMS Preliminary Inquiry Board reviewed the case and dismissed it, concluding that while the paramedics acted beyond their formal scope, their actions were justified by the unique circumstances and their immediate self-reporting.

Powell County Judge-Executive Eddie Barnes, who also serves as a paramedic and was part of the crew, expressed no regret, saying he take the same action again if faced with a patient in similar distress.

Kentucky State Senator Brandon Smith publicly supported the EMS team, calling for revisions to EMS regulations so that first responders are not punished for taking life-saving action in good faith. 

Understanding the Regulatory Context

Scope of Practice exists to protect patients and providers alike. It defines what interventions each level of EMS certification can safely and legally perform. But scope is not static - it evolves with medical evidence, training, and policy.

In Kentucky, antivenom administration falls outside the standard paramedic scope because it requires specialized training and monitoring, typically found in wilderness EMS or toxicology units. 

Risks include allergic reactions and the need for prolonged observation - conditions not always manageable in the field.

Still, real-world medicine is messy. In rare, life-threatening situations, rigid adherence to scope can feel incompatible with the provider’s duty to act.

This case underscores the challenge: how can systems preserve safety and standardization without punishing good clinical judgment? 

Ethical and Operational Takeaways for EMS Providers

This incident resonates with every provider who’s ever faced a “gray zone” decision. It highlights several practical lessons:

1. Consult Medical Control Early

When possible, contact online medical control before performing an off-protocol intervention. In this case, consultation reportedly occurred with an emergency physician - a critical step that strengthened the crew’s defense.

2. Document Everything

Thoroughly record your assessment, communications, rationale, and the patient’s condition. Accurate documentation can be your strongest protection in post-incident review.

3. Self-Report and Debrief

Transparency matters. The Kentucky team’s decision to self-report demonstrated integrity and professionalism - and likely influenced the case dismissal.

4. Know Your State’s Regulations

EMS scope and authority differ across states. Understand your protocols, but also be aware of how to escalate unusual situations through medical direction or administrative channels.

5. Advocate for Realistic Policy

This case may prompt states to consider “emergency exception” provisions - protocols that recognize provider discretion in extreme, time-sensitive cases where a patient’s life is at stake. 

A Call for Systemic Reflection

For EMS Leaders, Educators, and Policymakers, the Powell County case is not about right or wrong—it’s about readiness.

Do our systems empower providers to save lives when the textbook no longer fits? Are our regulations flexible enough to adapt to low-frequency, high-acuity calls? Do we support providers after they make those tough calls in good faith?

As medicine advances, so must the frameworks that govern it. No protocol can anticipate every scenario—but policies can be written to support critical thinking, consultation, and accountability without punishing courage. 

Conclusion

The dismissal of the Kentucky antivenom case is more than a regulatory footnote—it’s a reflection of what makes EMS unique.

Prehospital medicine operates in uncertainty, in chaos, and often in the seconds between life and death. This case reminds us that clinical judgment, ethical courage, and transparency remain as vital to patient outcomes as any drug or protocol.

Let it also be a reminder that systems must evolve - to ensure that doing the right thing never becomes a career risk.

Sources & References

Kentucky Board of Emergency Medical Services (2024) Scope of Practice Guidelines

LEX18 News. (2025, September 27) Kentucky paramedics cleared of disciplinary action after antivenom administration. Retrieved from https://www.lex18.com

U.S. Department of Health and Human Services, Office of EMS (2023) National EMS Scope of Practice Model

WBKO News. (2025, September 25) EMS team under fire for treating man with antivenom after mamba bite. Retrieved from https://www.wbko.com

WKYT News. (2025, September 30) Case dismissed against KY EMS team that gave antivenom. Retrieved from https://www.wkyt.com

EMS Discussion - Urban Hospital Wait Time vs. Wall Time

Emergency Department (ED) delays are nothing new, but for EMS Providers, “wall time” is a unique challenge.

Unlike a walk-in patient who simply waits for triage, EMS crews remain fully responsible for their patient until the hospital formally accepts care.

This Ambulance Patient Offload Time (APOT) often ties up both crews and ambulances, straining already thin resources.

Studies show that in some systems, wall times regularly exceed one, two, or even three hours.

Beyond frustration, this means fewer available units, longer response times, and increased operational risk.

For EMS providers on the ground, it also raises questions about supply readiness, patient monitoring, and when exactly responsibility transfers to the hospital under EMTALA.

Some regions, like Sacramento County, CA, are experimenting with solutions, such as streamlined protocols that allow paramedics to place stable patients in waiting rooms, expanded surge plans, and telehealth pilots.

Legislation in California (AB-40) now requires standardized APOT reporting, bringing new transparency and accountability to the issue.

For providers, the takeaways are clear:

• Track your own wall times to build local data.
• Work collaboratively with ED staff and administrators.
• Confirm local protocols for patient care responsibilities during wall delays.
• Be operationally prepared for long waits by keeping supplies stocked and equipment ready.

Wall time isn’t just a hospital problem — it’s a system problem.

By understanding, measuring, and addressing it together, EMS providers can help push for solutions that keep both patients and ambulances moving.

This is a summary of an article written by Bob Elling for the Public Safety Group in August.

Further Reading:

https://www.psglearning.com/blog/psg/2025/08/15/urban-hospital-wait-time-and-wall-time?

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 Celebrations - Presidents' Day

 

This holiday honors the leaders who have shaped our nation, much like EMS Providers shape the lives of their patients every day.

Just as presidents make decisions that impact the future, EMS Providers make life-saving choices in high-pressure situations.

Today, let’s appreciate the leaders in EMS we have today and the important role they play!

EMS Environmental Emergencies - Water Rescue Principles

Understanding and following the “Talk, Reach, Throw, Row, Go Tow” approach ensures that EMS Providers prioritize safety and efficiency during water rescues. 

Each step is designed to minimize risk while maximizing the chances of a successful rescue. Here is a overview of these principles:

1. Talk

Overview: The first step in any water rescue is to establish verbal contact with the victim. This is a crucial initial approach as it avoids placing the rescuer in danger while offering immediate assistance.

Purpose: Engaging with the victim verbally can calm them down, offer reassurance, and direct them on what to do until further help arrives. It’s especially effective if the victim is conscious and within earshot.

Implementation:

Calm the Victim: Use a confident and reassuring voice to reduce panic. Simple commands like “Stay calm,” “Float on your back,” or “Kick your legs toward me” can make a significant difference.

Assess Victim's State: While talking, gauge the victim's physical and mental status, identifying signs of distress or fatigue.

Instructions: If safe, guide them toward a nearby safe zone or floating device. Sometimes, victims can self-rescue if given clear, step-by-step instructions.

2. Reach

Overview: This involves using an extended object such as a pole, branch, or specialized rescue tool to reach the victim while the rescuer remains on solid ground or a stable surface.

Advantages: Keeps the rescuer out of the water, minimizing risk.

Techniques:

Secure Position: Ensure a stable footing or a firm hold on a structure before extending an object to the victim.

Encourage Victim to Hold: Guide them to grasp the object securely before pulling them to safety.

3. Throw

Overview: If the victim is beyond reach, throwing a buoyant object (such as a life ring, rope with a float, or even a makeshift floatation device) is the next option.

Key Points:

Accurate Throw: Aim for the throw to land close to the victim without hitting them.

Communication: Maintain eye contact and provide clear instructions, like “Grab the rope and hold on tight.”

Steady Retrieval: Once the victim has secured the object, slowly pull them to safety, avoiding jerky movements that could cause them to let go.

4. Row

Overview: When a victim is too far for a reach or throw, using a boat or flotation device to approach them is the safest option before entering the water.

Execution:

Boat Handling: EMS providers should be familiar with operating small boats, kayaks, or other flotation devices and should always wear personal flotation devices (PFDs).

Maintain Safety: Keep an eye on currents, waves, and potential obstacles. Approach the victim from downstream or downwind to avoid drifting into them uncontrolled.

Steady Approach: Row steadily and communicate with the victim, preparing them to grab the edge of the boat or flotation device.

5. Go

Overview: This is the most hazardous option and involves entering the water to rescue the victim directly. EMS Providers should only attempt this step if they are properly trained in water rescue techniques and have necessary safety equipment.

Preparation and Equipment:

Wear a PFD: Ensuring the rescuer’s safety is paramount. A PFD reduces the risk of the rescuer becoming another victim.

Rescue Aids: Bring a floatation device or rescue tube to aid in keeping the victim buoyant.

Techniques:

Approach Cautiously: Swim with strong, controlled strokes and avoid sudden movements that might startle the victim.

Contact Rescue: If the victim is panicking, use techniques to maintain distance until they calm down. Only make physical contact when safe, positioning yourself behind the victim to avoid being grabbed and pulled under.

Backup and Teamwork: Always have another team member on standby, either on land or in a secondary boat, to assist if needed.

6. Go Tow (Advanced Step)

Overview: This refinement of the “Go” principle emphasizes the use of towing techniques where the rescuer enters the water but minimizes direct contact by using a floatation device or rope to tow the victim to safety.

When to Use: The “Go Tow” method is ideal when entering the water is necessary, but maintaining distance from the victim is critical for safety.

Execution:

Secure Towing Equipment: Ensure a floatation device is connected to a rope or line that can be held or attached to the rescuer.

Approach and Transfer: Swim to a safe distance from the victim and pass them the floatation device, maintaining communication to keep them calm.

Tow Position: Once the victim has a firm hold on the device, use a strong swim stroke to pull them back to shore or the boat.

Safety Precautions: Regularly practice towing techniques and ensure proper training to avoid potential risks such as being overwhelmed by the victim’s movements.

Key Points for EMS Providers

Personal and Team Safety: Always assess the scene for hazards like strong currents, underwater debris, or dangerous weather conditions.

Call for Backup: Notify specialized water rescue teams when necessary; collaboration enhances the overall safety and efficiency of the operation.

Training: Continuous training in water rescue techniques, such as swift-water rescue, is vital. Familiarity with tools like throw bags, rescue tubes, and PFDs can significantly enhance rescue capability.

By following these structured principles, EMS Providers can effectively respond to water emergencies while ensuring their safety and the safety of their team.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Ferrero, F. (2006) Whitewater Safety & Rescue (2nd Ed). Bangor, Gwynedd: Pesda Press

Grayson, S. & Gandy, W. (2011) Environmental Emergencies. EMS World Online. Accessed November 8, 2024.

Limmer, D., O'Keefe, M. F., & Dickinson, E. T. (2020) Emergency Care (13th Ed) - Chapter 31: Environmental Emergencies. Accessed November 8, 2024

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Ostis, N. (2015) NOLS River Rescue Guide. Mechanicsburg, Pennsylvania: Stackpole Books

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell

Schimelpfenig, T. (2021) NOLS Wilderness Medicine (7th Ed). Mechanicsburg, Pennsylvania: Stackpole Books

Ray, S. (2013) Swiftwater Rescue (2nd Ed). Asheville, North Carolina: CFS Press

EMS Mental Health & Wellness - Responder Support Organizations

ResponderStrong is an organization dedicated to supporting the mental health and overall wellbeing of emergency responders, healthcare workers, and their families. 

Founded in 2016, it offers resources such as mental health curriculums, self-help tools, and crisis support specifically tailored for those in high-stress emergency response roles. 

Its mission is to create a supportive environment by collaborating with researchers, clinicians, and other organizations to address mental health challenges within the responder community.

For more details, visit ResponderStrong.

Responder Alliance is focused on providing resilience training for first responders and outdoor professionals to prevent burnout and traumatic stress injuries. 

Their approach includes tools like the Stress Continuum and the Incident Support Framework, which help teams proactively manage stress and trauma exposure. By integrating scientific validation and practical training, the organization aims to reduce burnout and career turnover in high-risk professions. 

Their curriculum is designed for early stress recognition and support following traumatic events.

For more details, visit Responder Alliance.

EMS Mental Health & Wellness - Caring For Our Own

The article linked below by Dylan Shackelton, NRP, discusses the mental health struggles EMS Providers face due to the traumatic nature of their work and the pervasive culture of stoicism that discourages them from seeking help. 

Despite witnessing severe accidents, overdoses, and violence daily, EMS Providers often suppress their emotions to maintain a tough exterior. This reluctance to acknowledge personal struggles leads to high rates of burnout, depression, and even suicide.

To address these challenges, the author advocates for a shift in the EMS culture to normalize conversations around mental health and prioritize peer support. 

Establishing programs like regular debriefings, easy access to mental health professionals, and mandatory mental health training can help break the stigma and foster a supportive environment. 

Ultimately, taking care of each other’s well-being is crucial for ensuring that EMS professionals can continue providing high-quality care to the community.

For more information, access the complete article here.

EMS In The News - New York Adopts NREMT As Recognized Pathway For Certification

New York has adopted the National Registry of EMTs (NREMT) as an accepted pathway for EMS certification, making it the 50th state to do so. 

This change standardizes EMS certification processes in New York, aligning them with national standards and offering more career flexibility for EMS professionals. 

With over 6,200 Nationally Registered EMS clinicians in the state, the recognition aims to improve care consistency, streamline certification, and expand career opportunities for emergency medical professionals.

The NREMT is a non-profit organization that provides national certification for Emergency Medical Services (EMS) in the United States. 

The NREMT's certification and recertification exams are nationally vetted, and the certification is recognized in 49 other states

This change brings New York in line with national standards and offers several benefits, including: 

Streamlined Process: EMS professionals will benefit from a consistent and standardized certification process. 

Quality of Care: The change ensures a high level of care for patients. 

Career Opportunities: The certification opens up more career opportunities for EMS professionals. 

Flexibility: The certification offers more flexibility for EMS professionals because it's recognized in other states

For more information, access the full article here.

EMS Essentials - Effective Leadership Skills

EMS providers are critical in prehospital care, and strong leadership skills are essential for delivering high-quality, efficient service. 

Here’s a breakdown of key leadership principles:

1. Communication

Clear and Concise Communication: This is vital in ensuring effective teamwork, especially in high-pressure situations. EMS providers must develop the ability to deliver clear instructions and ensure information flows seamlessly between team members and other healthcare professionals.

Active Listening: Effective leaders listen attentively to their team and patients, ensuring concerns are addressed and relevant information is gathered.

Nonverbal Communication: Body language, eye contact, and tone of voice also play a big role, particularly when team members are dealing with chaotic environments or emotional patients.

2. Decision-Making

Critical Decisions Under Pressure: EMS providers often face time-sensitive situations where quick, sound judgment is required. Leadership involves the ability to gather information swiftly, analyze it, and make informed decisions that prioritize patient safety and care.

Calm Under Stress: Remaining calm in high-stress environments helps to foster trust and confidence within the team, promoting clear-headed decision-making.

Risk Assessment: Leaders must weigh risks and benefits in real-time, making adjustments as new information becomes available or as a patient's condition changes.

3. Adaptability

Flexibility: Emergency situations are dynamic, and leadership means being ready to adjust your approach based on changing circumstances. This can include reevaluating a treatment plan, reassessing team assignments, or modifying transport strategies as new challenges arise.

Problem-Solving: Leaders must think on their feet and be resourceful, often working with limited information or resources. Being adaptable also involves having contingency plans and being ready to pivot quickly.

Emotional Adaptability: EMS providers often deal with patients in distress, and leaders must remain emotionally adaptable, balancing compassion with professionalism.

4. Team Management

Fostering Collaboration: As leaders, EMS providers must create an environment where all team members work together effectively. This means encouraging input, maintaining open lines of communication, and resolving conflicts quickly.

Delegation: Effective leadership involves delegating tasks based on each team member’s strengths and capabilities. Trusting others to handle their responsibilities allows for a more coordinated and efficient response.

Motivating & Supporting The Team: A good leader promotes a positive, inclusive work environment by recognizing the contributions of others, providing constructive feedback, and encouraging team members to grow professionally.

5. Continuous Learning

Staying Updated: The medical field is always evolving, and leaders must stay informed about the latest treatments, protocols, and technology. Regularly attending training sessions, workshops, and conferences is key.

Reflective Practice: Taking time to reflect on past experiences allows EMS providers to identify areas for improvement. Leadership involves recognizing mistakes, learning from them, and sharing those lessons with the team.

Professional Development: Leaders encourage both their own growth and that of their team members. They mentor less experienced personnel, fostering a culture of continuous improvement.

Key Leadership Takeaway:

EMS leadership is about more than just making decisions. It’s about ensuring patient safety, fostering a strong, cohesive team, and continuously adapting to both the unpredictable nature of emergencies and the evolving healthcare landscape. 

By focusing on communication, decision-making, adaptability, team management, and lifelong learning, EMS providers can enhance their leadership skills and, in turn, improve patient care outcomes.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Crowe, R. P., Wagoner, R. L., Rodriguez, S. A., Bentley, M. A., & Page, D. (2017) Defining Components of Team Leadership and Membership in Prehospital Emergency Medical Services. Prehospital Emergency Care, 21(5), 645–651 Accessed September 14, 2024

Fernandez, W. G., Benzer, J. K., Charns, M. P., & Burgess, J. F. (2020). Applying a Model of Teamwork Processes to Emergency Medical Services. Western Journal of Emergency Medicine 21(6): 264-271 Accessed September 12, 2024

Fitch & Associates (2019) 6 Common Competencies of Highly Effective EMS Leaders. EMS1. Accessed September 14, 2024

Foster, D. T., Goertzen, B. J., Nollette, C., & Nollette, F, P. (2013) Emergency Services Leadership - A Contemporary Approach. Burlington, Massachusetts: Jones & Bartlett Learning

Knox, A. G. S. (2018) Conflict Resolution & The Importance of Teamwork in EMS. EMS1. Accessed September 12, 2024

Lundy, D (2014) Preparing for Leadership in EMS. NAEMT News: 4 & 9 Accessed September 14, 2024

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

EMS Celebration - Honoring the Heroes of 9/11

On September 11, 2001, the world witnessed unparalleled courage and sacrifice as hundreds of brave EMS providers, first responders, and firefighters raced into the heart of danger to save lives. 

These selfless individuals ran toward the very chaos that others fled, driven by a call to serve, protect, and heal. In doing so, many paid the ultimate price.

In Memory of the Fallen:

To the firefighters who climbed the burning towers, the EMS providers who rendered aid in the dust and debris, and the first responders who secured the perimeter in the face of unknown terror — you are more than names on memorials; you are the essence of heroism.

Your final acts of bravery live on as a testament to your character, courage, and unwavering commitment to your fellow human beings. You laid down your lives so that others might live, and the depth of that sacrifice echoes eternally.

For Those Left Behind:

To the families, friends, and colleagues who carry the weight of that day, know that you, too, are remembered in this tribute. Your loved ones’ courage was not theirs alone, but shared with you through a lifetime of dedication and service. Your grief and loss are borne by a grateful nation, and we honor your strength in carrying on their legacy. The pain of their absence is woven into the fabric of our shared memory, and we stand beside you as you navigate the long journey of healing.

We acknowledge the quiet toll it has taken — the children who have grown up without parents, the spouses who have had to rebuild lives, and the colleagues who continue to serve, carrying the memories of those who were lost. Your perseverance and resilience are as much a part of the legacy as the heroism we witnessed on that fateful day.

We Will Never Forget:

In the years since, our world has changed, but the memory of that day remains vivid, and the loss of our heroes is felt in every firehouse, ambulance bay, and police station across the country. As we gather in remembrance, we do so not just in mourning, but in gratitude. We hold close the lessons of that day: the reminder that in our darkest hours, there are those who will step forward to bring light.

To all EMS providers, first responders, and firefighters, those who were taken too soon, and those who continue to serve in their honor: we offer our deepest thanks. Your courage is etched into history, and your sacrifice will be remembered for generations to come.

A Lasting Legacy of Hope and Strength:

While the events of September 11th will forever be a wound in the hearts of many, the resilience, dedication, and unity shown by first responders is an enduring source of inspiration. In your memory, we strive to live lives of service, courage, and kindness.

May we honor your sacrifice not just with words, but through our actions, lifting each other up, and continuing to serve in the spirit of the bravery you showed on that unforgettable day.

Let Us Never Forget.

EMS Equipment - The Power Paradox

Despite powered advancements in patient movement, the initial ground lift remains a manual task for EMS providers.

The attached JEMS article addresses a critical issue in EMS that despite heavy investments in advanced power stretchers and other power-assisted patient handling devices, the initial task of lifting a patient from the ground remains manual and risky. 

This inconsistency, termed the "power paradox," exposes EMS Providers to significant musculoskeletal injuries, with nearly half of EMS workers experiencing such injuries due to manual patient handling.

While EMS agencies have invested significantly in technologies like power stretchers, power loads, and power stair chairs, they often overlook the necessity of power patient lifts.

The lack of a comprehensive power-assisted patient handling approach leads providers to use makeshift solutions like bedsheets, increasing the risk of injuries to both the patient and the provider. 

Statistics from the National Institute for Occupational Safety and Health (NIOSH) highlight that nearly half of all EMS workers suffer from work-related musculoskeletal injuries, underscoring the need for a complete and integrated approach to patient lifting.

The solution lies in incorporating power patient lifts, which are affordable compared to the costs of potential injuries and liabilities. These lifts can significantly reduce the physical strain on EMS providers and enhance patient safety. 

The article emphasizes that EMS agencies need to prioritize injury prevention by embracing a holistic approach to powered patient handling. 

By doing so, they can protect their personnel, improve patient care, and mitigate liability risks, ensuring the sustainability and effectiveness of EMS operations​.

Journal of Emergency Medical Services 2024 

For more information, access the attached article link.

Images of EMS - In The Midnight Hour

 

EMS Discussion - Use of Lights & Sirens

EMS Providers should be aware of the ongoing discussion surrounding the use of lights and sirens during emergency calls. There is a growing concern about the risks associated with their use, such as an increased likelihood of accidents and harm to patients.

EMS Providers should stay updated on local and national guidelines regarding when to use lights and sirens to ensure the safety of both themselves and the public.

Those operating emergency vehicles must consider alarming statistics showing that ambulance crashes significantly impact clinicians, patients, and the public, with the risk of a crash increasing by over 50% when lights and sirens are activated.

It is crucial for EMS Leaders to implement well-researched guidelines supporting the restricted use of lights and sirens to enhance the safety of all individuals involved in emergency responses.

In an outstanding demonstration of collaboration on provider, patient, and community safety, 13 national and international associations have partnered on the release of a Joint Statement on Lights and Siren Vehicle Operations in Emergency Medical Services (EMS) Responses (NAEMT, 2022).

The statement articulates principles guiding the use of lights and sirens during emergency vehicle responses to medical calls and initiatives to decrease their use safely. EMS vehicle operations using lights and sirens pose significant risks to both providers and the public. Therefore, their use should be limited to situations where time saved is expected to be clinically important to a patient’s outcome (Merill, 2022).

Communication centers should utilize structured call triage and categorization to identify subsets of calls based on the response resources needed and medical urgency. Physician oversight is crucial in developing response configurations and modes for these protocols.

Agency Leadership should monitor the rates of lights and sirens use, appropriateness, compliance, and outcomes related to their use. Municipal Leaders should be aware of the increased crash risks, and quality care metrics should drive contract agreements.

States and provinces should monitor and report on emergency vehicle crashes to better understand the risks associated with lights and sirens use.

Collaboration between EMS and Fire Agency Leaders is essential in understanding public perceptions and improving education about the risks associated with lights and sirens to create safer expectations.

According to a recent presentation by NEMSQA, 87% of EMS responses were made with the use of lights & sirens, while transports nationally used them 51% of the time. The time savings averaged 102-216 seconds during a response and between 42-228 seconds for transports (from multiple recent studies); yet life-saving interventions are being done in only 6.9% of responses (according to an ESO study of 7.5M records).

At the same time, our odds of being involved in an accident increase by 53% in responses and 184% during transports (not to mention accidents in our wake that do not involve an EMS unit). Furthermore, litigations that involve ambulance incidents are 86% when using L&S.

The data presented highlights concerning statistics surrounding the use of lights and sirens in EMS responses and transports. While time savings are evident, life-saving interventions are performed in only a small percentage of responses.

The increased risk of accidents during both responses and transports underscores the need for a shift towards safer practices. Litigations involving ambulance incidents predominantly occur when lights and sirens are used.

It is crucial to view the use of lights and sirens as a clinical treatment and to follow the guidance to "use only as needed" to ensure the safety of patients, the community, and EMS providers. Prioritizing safe ambulance operations is vital for everyone's well-being and to ensure a safe return home after each shift.

Further Reading:

Merrill, L. (2022) 14 Groups Issue Joint Statement on EMS Use Of lights, Sirens https://www.ems1.com/ambulance-safety/articles/14-groups-issue-joint-statement-on-ems-use-of-lights-sirens-AAfswfKx2gaog3dy/ Accessed February 28, 2024

National Association of Emergency Medical Technicians (2022) Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses https://naemt.org/docs/default-source/advocacy-documents/positions/joint-statement-on-red-light-and-siren-operations-with-logos---final.pdf?sfvrsn=e586e893_4 Accessed February 28, 2024

National EMS Quality Alliance (2024) Improving Safety in EMS: Reducing the Use of Lights and Siren https://nemsqa.memberclicks.net/assets/LSChangePackage/Improving%20Safety%20in%20EMS%20Reducing%20the%20Use%20of%20Lights%20and%20Siren.pdf Accessed February 28, 2024

Zavadsky, M. (2023) Culture Shift: Reducing Lights and Siren Vehicle Operation https://www.ems1.com/safe-transport-point-b/articles/culture-shift-reducing-lights-and-siren-vehicle-operation-XDonsygscixIghQT/ Accessed February 28, 2024