Mark Tozer, PhD

EMS News - AHA 2025 Guideline Updates

noreply@blogger.com (Sea Kayak Mark) — Sat, 25 Oct 2025 19:01:00 +0000

The American Heart Association (AHA) has released its 2025 updates to the Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) guidelines, introducing several important changes for both healthcare professionals and everyday responders.

These evidence-based guidelines outline best practices that improve survival from cardiac arrest and other life-threatening cardiovascular emergencies.

A Quick Note for EMS Providers

These updates aim to streamline care, reduce variability in the field, and improve the chain of survival across diverse patient populations.

Many of the changes emphasize consistency, simplified decision-making, and the continued integration of lay rescuers into time-critical care.

At the same time, these updates are written to be accessible to the general public, who play a vital role in early recognition and CPR.

The 2025 release builds on the 2020 guidelines, refining previous recommendations and adding new guidance in areas that had not been previously addressed.

Image from Circulation - AHA / ASA Journals

Below is a summary of several take-home messages and key updates that EMS Providers - and the public - should be aware of:

• Unified Chain of Survival: A single model now applies to all cardiac arrests, regardless of patient age or location, providing a consistent framework for recognizing emergencies and delivering timely interventions.

• Systems of Care: Greater focus on community preparedness, telecommunicator CPR (e.g., 911 Dispatchers), early warning systems, and health equity.

• Remain in Place: It is recommended that resuscitation should be conducted where the patient is found, as long as high-quality cardiopulmonary resuscitation (CPR) can be administered safely and effectively.

• Position and Location of CPR: Quality chest compressions are improved by optimizing the rescuer’s hand placement, body mechanics (i.e., posture), and the patient’s position. When possible, CPR should be performed on a firm surface to maximize compression effectiveness.

• Bariatric Patients: CPR for adult cardiac arrest patients with obesity should be provided by using the same techniques as for the average weight patient.

• Pediatric CPR: The two-thumb encircled or one-hand compression techniques are favored on the the two-finger method.

• Mechanical CPR: The routine use of mechanical CPR devices is not recommended for adults in cardiac arrest. However, mCPR may be considered in specific settings where the delivery of high-quality manual compressions may be challenging or dangerous.

• Assisted Ventilations: It is still considered reasonable for both professional rescuers and lay responders to give breaths - when they are willing and able to do so with an appropriate barrier device - to improve oxygenation during cardiopulmonary resuscitation at a ratio. of 30:2 for adults.

• Choking Response: the updated sequence begins with 5 back blows, followed by 5 abdominal thrusts for all patients (e.g., adults & pediatrics), and continuing to alternate until the object is removed or the person becomes unresponsive.

• Opioid Overdose Response: The guidelines reinforce the importance of rapid naloxone administration and recommends supporting public access to opioid emergency response kits. The BLS algorithm explicitly shows where naloxone fits for suspected opioid overdose during respiratory and cardiac arrest.

Additional updates covering resuscitation education, systems of care, and post-cardiac arrest management are provided in the Highlights of the 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Image from Circulation - AHA / ASA Journals

Why These Changes Matter

Cardiac arrest remains a leading cause of sudden death. Even small improvements in CPR technique or response consistency can dramatically impact survival. The 2025 updates aim to:

Improve clarity during high-stress emergencies
Increase bystander willingness to act
Standardize care across EMS, hospitals, and the community
Enhance oxygenation and compression effectiveness
Support faster opioid overdose interventions

For EMS providers, these recommendations reinforce strong fundamentals, situational awareness, and the life-saving importance of early naloxone access.

What You Can Do Next

Whether you are an EMS professional or a member of the public, you play a vital role in improving survival from cardiac arrest. Here are a few ways to stay prepared:

Review the full AHA 2025 guideline highlights
Refresh your CPR, AED, or First Aid training
Make sure your workplace or community organization has access to naloxone and CPR equipment
Share these updates with colleagues, friends, or family

Understanding MARCH - Preventing Hypothermia & Managing Head Injuries

noreply@blogger.com (Sea Kayak Mark) — Thu, 23 Oct 2025 21:04:00 +0000

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

Preserve and Protect After Stabilization

The final step in the MARCH sequence - Hypothermia & Head Injury - focuses on two conditions that can rapidly worsen outcomes if not addressed early.

After bleeding is controlled, the airway secured, respiration managed, and circulation assessed, providers must work to preserve core body temperature and protect neurological function.

Uncontrolled heat loss accelerates shock, impairs clotting, and undermines every prior intervention. Likewise, traumatic brain injury can progress quickly without vigilant monitoring and early management.

Protecting a patient from heat loss and preserving the brain is essential for preventing secondary injury and supporting long-term survival and neurological recovery.

Image retrieved from tccc.org.ua

H – Hypothermia

Trauma-induced hypothermia is a major contributor to mortality in both military and civilian trauma.

Even in warm climates, a patient can quickly lose body heat through evaporation, convection, and exposure.

Hypothermia worsens the “lethal triad” of trauma - acidosis, coagulopathy & hypothermia - impairing clotting and promoting continued bleeding.

Image retrieved from tccc.org.ua

Recognition of Hypothermia

Look for early indicators, especially when there is significant blood loss or environmental exposure:

Shivering or muscle tremors (may disappear as hypothermia worsens)
Pale, cool, or mottled skin
Slurred speech or confusion
Slowed respirations or heart rate
Core temperature below 95°F (35°C)

Environmental factors such as wind, wet clothing, cold ground, or prolonged evacuation time accelerate heat loss, even in mild weather.

Image retrieved from tccc.org.ua

Hypothermia Prevention and Management

Remove wet clothing when tactically feasible and replace with dry layers.
Insulate from the ground using a poncho, sleeping pad, or casualty blanket.
Cover the casualty completely, including the head, to reduce radiant heat loss.
Use hypothermia prevention kits (e.g., Blizzard Survival Blanket, Ready-Heat™ Active Warming Blanket) if available.
Warm IV fluids or blood products when resources allow.
Monitor core temperature if devices are available, especially in prolonged field care scenarios.

Image retrieved from tccc.org.ua

Key Point: Preventing heat loss is just as vital as stopping bleeding - once the casualty is cold, outcomes worsen rapidly.

Image retrieved from tccc.org.ua

H – Head Injury

The “H” in MARCH also stands for Head Injury, emphasizing early recognition and management of traumatic brain injury (TBI), a leading cause of preventable death and long-term disability in prehospital trauma.

Image retrieved from tccc.org.ua

Recognizing Head Trauma

Watch for the following signs and symptoms:

Decreasing level of consciousness or responsiveness
Unequal or dilated pupils
Repetitive questioning, confusion, or agitation
Persistent vomiting or seizures
Irregular breathing patterns (Cheyne-Stokes or slow respirations)
Obvious penetrating or blunt trauma to the skull or face

Image retrieved from tccc.org.ua

Management Principles

Maintain airway and oxygenation. Keep SpO₂ > 90% and avoid hypoxia, which worsens secondary brain injury.
Prevent hypotension. Maintain systolic BP ≥ 90 mmHg to ensure cerebral perfusion.
Positioning: If spinal injury is not suspected, elevate the head 30° to promote venous drainage.
Avoid hyperventilation unless there are signs of herniation (e.g., blown pupil, rapid deterioration).
Control external bleeding with gentle pressure; do not compress depressed skull fractures or insert dressings into open cranial wounds.
Monitor for changes in mental status using tools like AVPU or GCS if time and environment allow.

In the tactical environment: head injuries often coexist with blast or penetrating trauma. Managing hypoxia and hypotension early has been shown to double the odds of survival in severe TBI (Eastridge et al., 2012).

Image retrieved from tccc.org.ua

Key Takeaway for EMS and Tactical Providers

The 'H' in MARCH is about preservation and protection - maintaining the physiological stability of a casualty who has already survived the most immediate threats.

Hypothermia prevention and head injury management require vigilance, insulation, and gentle handling. In tactical medicine, saving a life doesn’t end with hemorrhage control, it continues with keeping that life viable during evacuation.

In short: preserve the heat, protect the brain

Image retrieved from tccc.org.ua

Conclusion of the MARCH Series

The MARCH sequence - Massive Hemorrhage, Airway, Respiration, Circulation, and Hypothermia/Head Injury - originated in Tactical Combat Casualty Care and remains the foundation of modern field trauma management.

This structured approach guides responders to address the most preventable causes of death in the order they matter most. In this series, each component of MARCH is explored in turn, offering practical guidance for EMS and tactical providers operating in dynamic, resource-limited environments.

From controlling catastrophic bleeding to protecting core temperature and neurological function, the series outlines a clear, evidence-informed pathway for stabilizing trauma patients and improving survivability in the prehospital setting.

Train Hard. Stay Prepared. Save Lives.

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

Understanding MARCH - The Role of Circulation

noreply@blogger.com (Sea Kayak Mark) — Tue, 21 Oct 2025 21:24:00 +0000

Image retrieved from tccc.org.ua

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

After addressing massive hemorrhage, airway, and respiration, the next priority is Circulation, the body’s ability to deliver oxygenated blood to vital organs and tissues.

In trauma, the circulatory system can be compromised by shock, internal bleeding, or poor perfusion, even when obvious external hemorrhage has already been controlled.

Within the tactical environment, circulation assessment focuses on recognition and management of shock, maintaining perfusion, and preventing secondary injury. The goal is to identify subtle but deadly deterioration before it progresses beyond recovery.

C – Circulation

In tactical casualty care, circulation assessment differs slightly from the traditional EMS approach. The emphasis is on speed, simplicity, and practicality in resource-limited or high-threat conditions.

Blood pressure cuffs and monitors may not be available, so providers rely on physical signs and simple indicators to evaluate perfusion. The presence of a radial pulse and normal mental status are key field markers of adequate circulation.

Principles of Circulatory Assessment and Management

1. Check for Pulse and Perfusion

Radial Pulse: Presence suggests systolic blood pressure above roughly 80 mmHg, generally adequate for perfusion in tactical settings.

Weak or Absent Pulse: May indicate hypovolemia or shock; assess for additional signs of poor perfusion such as pallor, clammy skin, or delayed capillary refill.

Mental Status: A sudden change in consciousness (e.g., confusion, lethargy) is often an early sign of inadequate cerebral perfusion.

Remember: weak radial pulse + altered mental status = shock until proven otherwise.

Image retrieved from tccc.org.ua

2. Identify and Manage Non–Life-Threatening Bleeding

Once major bleeding has been controlled, systematically check for and address secondary bleeding sites that may have been overlooked during the initial MARCH sequence.

Apply direct pressure, pressure dressings, or hemostatic agents as needed.

Image retrieved from tccc.org.ua

3. Treat for Shock

Shock - a state of inadequate tissue perfusion - can occur from blood loss (hypovolemic), cardiac injury, or tension pneumothorax.

In tactical medicine, hemorrhagic shock is the most common.

Lay the casualty supine, if tactical conditions allow.

Keep the patient warm, hypothermia worsens coagulopathy and shock (addressed further in Part Five).

Provide fluids only when indicated by TCCC or TECC guidelines

If in shock (weak/absent radial pulse or altered mental status):

Administer whole blood if available; otherwise, 1:1:1 blood component therapy (plasma, platelets, red cells).

If blood products are unavailable, give Hextend or Lactated Ringer’s solution, titrating only to restore a palpable radial pulse or improved mental status (per TCCC guidance).

If the casualty is not in shock and has a palpable radial pulse and normal mental status: no IV/IO fluids are indicated.

Avoid over-resuscitation, too much fluid can dislodge clots and worsen bleeding.

4. Establish IV/IO Access When Appropriate

In tactical field care, IV or intraosseous access is indicated for:

Fluid resuscitation in shock
Medication administration (e.g., analgesics, antibiotics, TXA).

If available, administer Tranexamic Acid (TXA) within three hours of injury for casualties at risk of significant hemorrhage. Early TXA administration has been shown to reduce mortality from bleeding.

5. Continuous Reassessment

Circulation is dynamic, especially in prolonged field care or delayed evacuation.

Regularly recheck:
Pulse quality and rate
Mental status
Skin color, temperature, and moisture
Wound sites for renewed bleeding

Document all findings and interventions clearly for handoff to the next echelon of care.

Image retrieved from tccc.org.ua

Key Takeaway for EMS and Tactical Providers

Circulation management is about detecting shock early, maintaining perfusion, and preventing deterioration.

In the tactical environment, sophisticated monitoring tools are often unavailable, but trained observation remains powerful.

The provider’s mindset should be:

Feel for the pulse, read the patient, and keep the blood where it belongs.

Image retrieved from tccc.org.ua

Coming Up Next: Part Five – Hypothermia and Head Injury

The final step in the MARCH sequence focuses on protecting what you’ve fought to preserve, preventing hypothermia and managing head injuries to maintain survivability after initial stabilization.

In Part Five, we’ll discuss how temperature control, positioning, and neurologic assessment all play critical roles in keeping your casualty alive until evacuation and definitive care.

Because in tactical medicine, saving a life isn’t just about stopping the bleeding—it’s about keeping that life sustained.

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

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

Understanding MARCH - The Relevance of Respiratory Assessment

noreply@blogger.com (Sea Kayak Mark) — Sun, 19 Oct 2025 23:43:00 +0000

Image retrieved from tccc.org.ua
From the MARCH Mnemonic Series – Tactical Trauma Care for EMS Providers

After controlling massive hemorrhage and ensuring a patent airway, the next priority in the MARCH sequence is Respiration.

Effective breathing is critical for oxygen delivery and carbon dioxide removal. When trauma impairs the chest wall or lungs, hypoxia and shock can develop rapidly - even when the airway is clear.

In tactical or prehospital settings, respiratory compromise is often caused by thoracic injury, such as a gunshot, stab wound, or blast trauma.

These injuries can lead to life-threatening conditions like tension pneumothorax or open chest wounds, both of which are preventable causes of death when identified and treated early.

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

R – Respiration

Respiration refers to the body’s ability to move air into and out of the lungs and to exchange gases at the alveolar level.

Any disruption - mechanical, anatomical, or physiological - can cause hypoxia and threaten survival.

The responder’s task is to rapidly assess, seal, decompress, and support breathing as needed.

Image retrieved from tccc.org.ua

Principles of Respiratory Management

1. Assess the Casualty’s Breathing

Begin by evaluating rate, depth, and effort of respirations. Look, listen, and feel for:

Asymmetrical chest rise or movement

Difficulty speaking, gasping, or labored breathing

Cyanosis around lips or fingertips

Tracheal deviation, jugular venous distention, or subcutaneous emphysema

Penetrating trauma to the chest or upper abdomen

If you’re operating in a tactical environment, conduct this assessment as efficiently as safety allows—rapid but systematic.

2. Expose and Inspect for Chest Injuries

Visually inspect the anterior, lateral, and posterior thorax for entry and exit wounds, contusions, or deformities. In low-light or confined spaces, gloved hands may detect what the eyes can’t.

Sucking chest wounds (open pneumothorax) occur when air enters the pleural space through a chest wall defect.

These must be sealed immediately with a vented or occlusive chest seal to prevent the progression to tension pneumothorax.

Modern products like the HyFin® Vent Chest Seal or FoxSeal™ are designed for field reliability and are standard in most tactical trauma kits.

Image retrieved from tccc.org.ua

3. Manage a Tension Pneumothorax

A tension pneumothorax occurs when air becomes trapped in the pleural space and cannot escape, collapsing the lung and compressing the heart and great vessels.
Signs may include:

Severe respiratory distress

Decreased or absent breath sounds on one side

Hypotension and tachycardia

Tracheal deviation (a late sign)

Image retrieved from tccc.org.ua

Intervention:

If tension pneumothorax is suspected and equipment/training allow, perform needle decompression:

Use a 14-gauge, 3.25-inch (8.25 cm) needle or catheter.

Insert into the 5th intercostal space, anterior axillary line (or 2nd intercostal space, midclavicular line if indicated).

Listen for escaping air and observe for improvement in breathing and perfusion.

Always reassess, if symptoms recur, repeat decompression or prepare for chest tube insertion at higher care levels.

Image retrieved from tccc.org.ua

4. Support Oxygenation and Ventilation

If available and appropriate, administer supplemental oxygen to maintain SpO₂ above 94%.

For inadequate respirations, assist with bag-valve-mask (BVM) ventilation while maintaining airway alignment. In prolonged field care, consider monitoring SpO₂ and ETCO₂, if resources allow, to guide ongoing management.

5. Continue Monitoring and Reassessment

The chest is dynamic, bleeding, air leakage, or mechanical disruption can recur with movement or time. Reassess chest rise, breath sounds, and patient condition frequently during evacuation.

Key Takeaway for EMS and Tactical Providers

Thoracic trauma demands vigilance. While hemorrhage and airway compromise often draw attention first, unrecognized respiratory failure can kill just as quickly. The tactical provider must be proficient in identifying chest injuries, applying chest seals, and performing needle decompression when indicated.

In short: find the holes, seal the leaks, relieve the pressure, and keep the oxygen moving.

Coming Up Next: Part Four – Circulation

Once bleeding is controlled, the airway is secure, and breathing is restored, it’s time to assess circulation—the body’s ability to perfuse vital organs.

In Part Four of our MARCH series, we’ll explore recognition and management of shock, fluid resuscitation strategies, and maintaining perfusion in both field and tactical environments.

Because after oxygen, the mission is to keep it flowing where it matters most.

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

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

Understanding MARCH - The Importance of Airway Management

noreply@blogger.com (Sea Kayak Mark) — Fri, 17 Oct 2025 23:08:00 +0000

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

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

Understanding MARCH - A Tactical Approach to Massive Hemorrhage

noreply@blogger.com (Sea Kayak Mark) — Wed, 15 Oct 2025 21:45:00 +0000

Image retrieved from tccc.org.ua

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

In prehospital medicine, chaos is a constant. Whether in combat zones, tactical operations, or austere environments, responders need an effective method to prioritize lifesaving interventions.

The MARCH mnemonic provides that structure.

Used in Tactical Combat Casualty Care (TCCC) and increasingly adapted into Tactical Emergency Casualty Care (TECC), MARCH guides providers through the sequence of treating trauma in order of urgency:

M – Massive Hemorrhage

A – Airway

R – Respiration

C – Circulation

H – Hypothermia/Head Injury

Each step addresses a preventable cause of death, beginning with what kills fastest.

This article - the first in a five-part series - focuses on the first and most critical step:

M - Massive Hemorrhage.

Massive hemorrhage is the leading cause of preventable death in trauma. Life can be lost in minutes from uncontrolled bleeding, making rapid identification and intervention paramount.

Clinically, a massive hemorrhage may be defined as the loss of more than 50% of circulating blood volume within three hours, but in the field, it’s simpler: if it looks bad, treat it fast.

Principles of Care

1. Control the Bleed Immediately

Identify and manage life-threatening external bleeding before addressing airway or breathing. In tactical settings, hemorrhage control often occurs under fire or while the threat is active, emphasizing the importance of speed and training.

2. Direct Pressure

Apply firm, targeted pressure directly over the bleeding source using a gloved hand and dressing. Direct pressure remains the most reliable method of hemorrhage control and should be maintained until bleeding stops or another intervention takes effect.

Image retrieved from tccc.org.ua

3. Tourniquet Application

If the bleeding is from an extremity and direct pressure fails, apply a commercially approved tourniquet as high and tight as possible, proximal to the wound. Tighten until the bleeding stops and document the time of application. Avoid improvised or untested devices, equipment failure can cost lives.

4. Hemostatic and Pressure Dressings

For junctional or compressible areas (e.g., the groin, axilla, or neck), use a hemostatic dressing and apply continuous firm pressure for at least three minutes or as directed by the manufacturer. Secure with a pressure dressing and reassess frequently.

5. Reassess Constantly

Bleeding control is not a one-and-done task. Reassess interventions after movement, transport, or environmental changes. Tourniquets can loosen, and pressure dressings can shift during casualty movement or extraction.

Key Takeaway for EMS and Tactical Providers

Massive hemorrhage is fast, silent, and deadly - but also the most preventable cause of battlefield and tactical death.

Responders must adopt a mindset of “Stop the bleed, then everything else.” Consistent training, reliable equipment, and disciplined reassessment make the difference between life and loss in tactical trauma care.

Coming Up Next: Part Two – Airway

Once life-threatening bleeding is controlled, the next critical step is ensuring the casualty can breathe.

In Part Two of our MARCH series, we’ll examine airway management in tactical and prehospital settings—covering essential assessment, manual maneuvers, airway adjuncts, and when to escalate to advanced interventions.

Because once the bleeding stops, oxygen is your next priority!

Image retrieved from tccc.org.ua

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

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

The MARCH Mnemonic - A Framework for Tactical Trauma Care

noreply@blogger.com (Sea Kayak Mark) — Mon, 13 Oct 2025 16:49:00 +0000

From the MARCH Mnemonic Series – Tactical Trauma Care for EMS Providers
When seconds count and conditions are unpredictable, the MARCH mnemonic. provides a clear, evidence-based sequence for trauma management in both tactical and civilian emergency settings.

Standing for Massive Hemorrhage, Airway, Respiration, Circulation, and Hypothermia/Head Injury, this structured approach originated in Tactical Combat Casualty Care (TCCC) and has become a cornerstone of modern prehospital and field medicine.

From the battlefield to the back roads, MARCH helps rescuers- military medics, EMS providers, law enforcement officers, and trained civilians - prioritize interventions in the order most likely to save lives.

By following this systematic progression, responders can rapidly identify and treat life-threatening conditions while preventing secondary injury and deterioration during evacuation.

Each installment in this upcoming series explores one element of MARCH, offering concise guidance, field considerations and key takeaways tailored for EMS and tactical responders:
Part One: Massive Hemorrhage - Stop the bleed, save the life
Part Two: Airway - Secure it early, maintain it always
Part Three: Respiration - Restore the breath, relieve the pressure
Part Four: Circulation - Preserve perfusion, prevent shock
Part Five: Hypothermia & Head Injury - Protect the head, protect the brain
Whether in an urban response zone, rural rescue, or austere tactical environment, MARCH isn’t just a checklist - it’s a mindset. It empowers providers to think clearly, act decisively, and deliver lifesaving care under pressure.

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

EMS Words of Wisdom - Good Leadership Begets Good Leadership

noreply@blogger.com (Sea Kayak Mark) — Sun, 12 Oct 2025 23:50:00 +0000

EMS Discussion - When Scope Meets Survival

noreply@blogger.com (Sea Kayak Mark) — Thu, 09 Oct 2025 19:52:00 +0000

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 - EMS Leadership During A Time Of Outrage

noreply@blogger.com (Sea Kayak Mark) — Tue, 07 Oct 2025 19:38:00 +0000

The Challenge

Today’s EMS Leaders face more than operational demands - they must also navigate a world shaped by public outrage, political division, and social media amplification.

Every statement, policy, or silence can be scrutinized, criticized, or misinterpreted. Balancing staff expectations, public trust, and professional neutrality is harder than ever.

Why It Matters

Outrage culture can fracture teams, erode trust, and distract from the mission. In EMS, where teamwork and composure are essential, strong leadership in emotionally charged times is critical for morale, credibility, and community confidence.

Core Leadership Strategies

1. Anchor in Mission and Human Impact

Ground decisions in your agency’s purpose: serving patients and protecting the public.
Ask: Does this issue directly affect our people, patients, or mission?
Avoid performative responses that distract from care delivery or operational priorities.

2. Foster Respectful Dialogue

Create safe spaces for staff to share views without fear of retaliation.
Set clear boundaries (no hate speech, no harassment) but allow for conversation.
Model Civility - leaders must demonstrate what respectful disagreement looks like.

3. Engage Employees in Decision-Making

Don’t respond impulsively to every trending issue.
Use consistent criteria to decide which issues merit an organizational response.
Let your workforce have a voice in shaping those priorities.

4. Lead with Consistency and Integrity

Match public words with internal actions.
Empty statements damage credibility — authenticity builds trust.
Ensure policies, behaviors, and culture reflect your stated values.

5. Build New Leadership Skills

Today’s leaders need emotional intelligence, ethical clarity, and communication literacy.
Equip your leadership teams with training in empathy, listening, and conflict navigation.
Recognize that leadership in a polarized era requires as much heart as it does strategy.

6. Protect Leader Well-Being

The emotional toll of constant outrage is real.
Develop personal coping tools, peer support, and boundaries.
“Presilience” - preparing emotionally before the crisis - is as vital as resilience afterward.

In Summary

For EMS leaders and providers, the path forward lies in focusing on purpose, consistency, and humanity. Not every social or political issue requires a public stance; instead, leaders should filter decisions through the organization’s mission and its direct impact on patients and personnel.

Credibility comes from alignment — when an agency’s actions match its stated values, it builds trust both internally and externally.

Leading through outrage demands emotional intelligence, humility, and courage. It means fostering open, respectful dialogue rather than silencing dissent, and recognizing that empathy and transparency often carry more influence than public declarations.

Ultimately, in an era of polarization, EMS can stand as a model of professionalism and composure — reminding communities that compassion and service remain the foundation of effective leadership.

This discussion piece is based on “Leading Through Outrage” by Shannon Gollnick, JEMS (Oct 2025).

Source:

Gollnick, S. (2025) Leading Through Outrage: EMS Leadership in an Age of Polarization. Journal of Emergency Medical Services (JEMS).

https://www.jems.com/exclusives/leading-through-outrage/

EMS Words of Wisdom - Slow & Steady Wins

noreply@blogger.com (Sea Kayak Mark) — Sun, 05 Oct 2025 19:44:00 +0000

Images of EMS - Mobile NICU Unit

noreply@blogger.com (Sea Kayak Mark) — Fri, 03 Oct 2025 19:18:00 +0000

EMS Discussion - Urban Hospital Wait Time vs. Wall Time

noreply@blogger.com (Sea Kayak Mark) — Wed, 24 Sep 2025 21:11:00 +0000

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 Discussion - Live Tissue Training (LTT)

noreply@blogger.com (Sea Kayak Mark) — Wed, 13 Aug 2025 17:05:00 +0000

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

noreply@blogger.com (Sea Kayak Mark) — Tue, 12 Aug 2025 01:23:00 +0000

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

noreply@blogger.com (Sea Kayak Mark) — Mon, 11 Aug 2025 01:26:00 +0000

EMS Health & Welfare - Burnout (Part Two)

noreply@blogger.com (Sea Kayak Mark) — Thu, 26 Jun 2025 16:19:00 +0000

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)

noreply@blogger.com (Sea Kayak Mark) — Tue, 24 Jun 2025 16:21:00 +0000

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

noreply@blogger.com (Sea Kayak Mark) — Sun, 22 Jun 2025 16:17:00 +0000

EMS Education - Advisor: Basic Life Support (BLS)

noreply@blogger.com (Sea Kayak Mark) — Mon, 02 Jun 2025 19:03:00 +0000

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:

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

noreply@blogger.com (Sea Kayak Mark) — Mon, 26 May 2025 16:29:00 +0000

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

noreply@blogger.com (Sea Kayak Mark) — Sun, 25 May 2025 14:00:00 +0000

EMS Celebrations - EMS Week | Remembrance Day

noreply@blogger.com (Sea Kayak Mark) — Sat, 24 May 2025 19:03:00 +0000

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

noreply@blogger.com (Sea Kayak Mark) — Thu, 01 May 2025 15:25:00 +0000

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

noreply@blogger.com (Sea Kayak Mark) — Fri, 18 Apr 2025 22:53:00 +0000

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