COVID and Beyond | Changes To EMS Protocols

As the COVID-19 pandemic continues. The stress on EMS agencies keeps growing. Especially in hot areas like NY and NJ.

Dr Ken Lavelle who is an Emergency Medicine Clinic Instructor and Medical Director for several agencies in NJ and PA, joins Jim on this episode to discuss changes he made to local EMS protocols to help mitigate response, treatment and transport of EMS calls with potential coronavirus symptoms.

We also discuss common struggles when putting new guidelines into play during something like a pandemic and the potential to take a broader look at these changes and others going forward after the pandemic is over.

Check out Dr Lavelle’s training website at Emergency Training here.

As EMS professionals continue to respond and show up to work each day during this pandemic. I wanted to create something that would recognize their professional sacrifice. Not some snarky t-shirt or patch. Here is a Challenge Coin that is currently in production and available. You can get details and claim yours here. 

How Do You Treat Drownings?

ems paramedic questionsThis week Jim, Josh and Dave talk about trauma vs. medical approach in the drowning patient. Most EMS protocols focus on the medical end with a trauma CYA aspect.

How do your guidelines direct you to treat drowning victims? Leave your thoughts below and be sure to share the show on FaceBook to spread the social media lovin’




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EMS Protocol Deviation

When do you deviate from your EMS protocols? When is it right  to do so? Many systems leave it vague on how to handle this aspect of EMS and most training and education doesn’t cover why, when or where we should be considering it.

Words like “may, consider, withhold” make it very hit or miss. Add to that the various interpretations by state, regional or even in house QA/QI and you can have providers treating patients in the interest of self preservation and not the best interest of the patient.

This was a great episode and each guest had thoughtful input on this passionate topic.

Show notes

David Aber – The EMS Difference

Bob Sullivan – EMS Patient Perspective

Josh Knapp – WANTYNU

Tim Noonan – Rogue Medic

Articles worth checking out

EMS Pits Crews | Should A Yellow Flag Be Waved?

You may have heard of the EMS Pit Crew. The popular model is when this is utilized during cardiac arrest calls and each EMS crew member has assigned role. Can this improve outcomes, avoid scene confusion and be the future of cardiac arrest and even patient management in EMS? Or should we be putting up that yellow flag and take a closer look at this model?

Joined by Bob Sullivan and Tim Noonan, we discuss the pros and cons of having these assigned roles. Be sure to comment below and give your take on the EMS Pit Crew.

Show Notes:

Bob Sullivan – EMS Patient Perspective

Tim Noonan – Rogue Medic

Josh Knapp –

Thanks also to David Aber from The EMS Difference for helping out in the chat room along with David Blevins.

Read the article mentioned from JEMS here.


The Protocol Effect | Airway Management

In this installment of Office Hours we revisit the series “The Protocol Effect” and discuss airway management. Should this be controlled by written guidelines, clinical impressions or current research? Anyone who has been in the field knows a GCS of less than 8 or 10 doesn’t always mean a patient requires intubation or advanced airway management. Yet many protocols say to do just that. This may just be another time when providers need to prove their understanding of these skills, their need and the patients we treat. Take a listen to this episode and tell us about your guidelines and how you interpret them.

Show notes:

Thanks to Mr. JD Graziano for joining me on the show. Check out his podcast at and following on Twitter at @AJDGRAZIANO.

Listen to the Standing Orders podcast on The Future Of Airway Management here.

The Protocol Effect | Nitroglycerin

One drug that is a staple in EMS is nitroglycerin. Whatever system you work in it is in the protocols. Mostly in ALS guidelines, but you also are seeing it in many BLS protocols as well. This episode will talk about this drug it’s common uses, not so common uses, dangers and benefits. We were also joined by an old friend of mine from my Brooklyn days Randy K. who is a paramedic in FL. Randy gave some of his thoughts on this topic as well.

What about you? How do your protocols use this therapy, how have you used it? Do you have some positive or negative experiences with this protocol choice? Share your thoughts below.

I did have some audio issues on this one so you may hear it cutting in and out. I apologize and I am working to get that fixed.

Show Notes:

Street Watch Notes Of A Paramedic – Nitro post worth reading and discussed during the show.

What Drives EMS Protocol Changes?

Joined by Mark Albert, Tim Noonan and Josh K, this weeks Office Hours discussed some thought processes behind protocol changes in EMS. Focused at recent changes in Morphine within proposed NYC REMAC guidelines, Mark gave some insight to the process that includes evidence based study, drug make-up and the many steps before a protocol gets changed (sort of like that old PBS skit on how a Bill becomes Law). Tim and Josh gave their insight as well and once again we hit the wall on time. Take a listen and post your thoughts below.

Show links:

CRUSADE Study: article (requires registration but it’s free and gives access to other great articles)

Article from EMS Village on the study.

AHA 2010 ACS

Also check out these results.

The Guests:

Tim Noonan at Rogue Medic

Josh K of  Wantynu

Mark Albert at EMSMedRX



Buck Feris – Gomerville

EMSEducast on Organ & Tissue Procurement

NYC REMAC Study Group Webinar

Patients, Protocols and Practice

As someone who always looks for changes in patient care and ways to improve EMS and the treatment we give. It becomes hard to always walk that line between following protocols set by medical control. Trying to look beyond the cookie cutter formulas and think about a clinical picture being presented by a patient.

Each patient is different and needs to be thought of as perhaps needing a slightly different approach to their care and transport. Now of course there are bigger brains than mine out there that sit and create the protocols I am operating under. I don’t advocate working outside your set protocols provided by your medical control, but I do promote approaching patients with a thought process that goes beyond what is printed in your field guide.

Being a good clinician and thinking about the causes of a patients condition, the effects of treatment you give and the outcome upon arrival to the ED and beyond, is what makes good EMS providers at any level.  We are that extension of the ED and the doctor whose license we are working under via the protocols. So, by looking at the big picture with each patient we can practice as true health care providers and not just a ride to a hospital.

Protocols are guidelines that we follow after we can make that determination as to what the patient may or may not need. Sometimes that determination is made with your partner or with a online medical control consult. Our goal as prehospital care providers should be to blend the patient presentation, the protocols provided to us and practice good clinical judgement.

When new treatment comes along we should be advocates to bring that to the field. When protocols we are using are less than desirable for operating in the field, we should be discussing this with our medical directors to have them adjusted for better patient care and outcomes.

We have to take an active role in our education as well as be more vocal for what we need. Knowledge is the key to better patient care, better utilization of protocols and being EMS practitioners.