Resuscitation: What the @$#! do we know?

Maybe you have been in EMS long enough to remember the good old days of the early 2000’s. I sometimes long for the days where we knew that epinephrine, fluids, airway management and antiarrhythmic medications were lifesaving interventions.

These days I have no idea if the interventions I  perform during resuscitation attempts are  the right thing or not. what the bleep to we know

Should we give epinephrine in cardiac arrest? I don’t know.
What is the optimal ventilation ratio in cardiac arrest? I don’t know.
Are mechanical CPR devices in cardiac arrest beneficial? I don’t know.
Is there a reason to use anti arrhythmic medications in cardiac arrest? I don’t know. Continue reading “Resuscitation: What the @$#! do we know?”

My Baby Looks Hot Tonight: An Open Letter About Light Bondage and The NREMT


I like you, I really do. I think you do some good stuff for EMS. But man, as a friend, I feel the time has come to speak up.  You have become like that friend we all have that is still hung up on that one girl that dumped him eighteen months ago.  He still thinks there is a chance; she has moved on and is now engaged to an investment banker named Brent that she met on It’s over man, move on, stop looking at their Facebook photos of their vacation. 

The time has come to remove seated spinal immobilization testing from the EMT psychomotor exam.  Continue reading “My Baby Looks Hot Tonight: An Open Letter About Light Bondage and The NREMT”

Unsafe At Any Speed: EMS and Fatigue.

I am past the point of being dangerous by the time I realize it. My vision has been blurry for the past twenty miles and I can feel my brain shutting down.

Jesus, did I just fall asleep driving?

I’m not sure, there seems to be a second or two of consciousness missing but we are still on the road so I don’t know. Even though we are just ten miles from the station on a return trip from a midnight transfer I throw in the towel and ask my partner “can you drive?” Continue reading “Unsafe At Any Speed: EMS and Fatigue.”

The Second Death of Marjorie Mangiaruca: The Unjust Culture of EMS Resuscitation.

The first time Marjorie Mangiaruca died was on October 10, 2011. She was 90 years old, suffering from significant dementia and living in a skilled nursing facility.


She was found unresponsive with blue lips, gasping for air at Oakbridge Healthcare Center. EMS was called and they quickly began to transport her to the ER. While en route they tried to establish an airway. Before a definitive airway could be established by EMS the patient suffered a cardiac arrest. The ambulance was pulled to the side of the road and CPR was begun and a tracheostomy* was performed. The patient was given medications to “restart her heart” ( I assume epinephrine, but I do not know) and for reasons that are unexplained she was given paralytics by the EMS crew. Continue reading “The Second Death of Marjorie Mangiaruca: The Unjust Culture of EMS Resuscitation.”

“No evidence of mistakes” is not the same as “evidence of no mistakes.” [1]

Bad paramedics are conspired against by others; they are a victim of circumstances beyond their control and are almost always wrongly persecuted by the QA department. Bad paramedics never make mistakes

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The Six Deadly Sins of EMS Continuing Education Presentations

If you are presenting EMS education at a conference please avoid the six following deadly sins.

Reading power point slides to the audience. No presenter should do this. Ever. If I believed in hell I would hope that there is a special place in the hottest part of it for presenters who do this. EMS is taught to the 10th grade level which means we can all read.

Having slides that suck. See figure one for an example. Few things in this world truly offend in the way a presentation that uses comic sans as a default font does. Additionally the use of WordArt should be kept to a minimum. When a presentation has more than a few slides using Microsoft WordArt there are two possibilities; the slides have not been updated since 2003 or the presenter has the kind of bad taste where they think Olive Garden is a really fancy restaurant (1).

(figure 1) If your slides look like this, you need to read this article.

Continue reading “The Six Deadly Sins of EMS Continuing Education Presentations”

Resuscitation: Nuremberg

This is not a story of heroism.

Danse Macabre by Michael Wolgemutin

People stop you and thank you for the work you do, they tell you that you are a hero, that you save lives, how you are doing God’s work and that what you do is just and right and good. You politely shake their hand and tell them you are just doing your job. Some days you can barely stop yourself from telling them that you are a god damn fraud.

Once, you believed the world to be black and white; assured that you would be able to decipher right from wrong.  You were more idealistic then, perhaps even naïve; you thought saving people from death would always be the right thing to do.

Continue reading “Resuscitation: Nuremberg”