Dave’s Subs

If you are interested in learning about Just Culture I highly recommend the book Dave’s Subs by David Marx.

Dave’s Subs is an easy to read book about applying the Just Culture principals to your workplace and is not nearly as dry as some other works that exist on Just Culture.

Before I read this book I was looking for EMS or at the very least medically related Just Culture Books and education. The reality is that Just Culture principals can be applied universally across any industry.
daves subs

How to do QA Without Being an Asshole.

This is a  rambling, poorly organized blog post about EMS QA that started out as an answer to a question posted on facebook and turned in to a collection of random thoughts on the subject. People often find themselves assuming the role of QA with little to no training on the subject. I know myself and many others have learned quite a few lessons the hard way. Continue reading “How to do QA Without Being an Asshole.”

EMS, PTSD and Russian Video Games: Could Playing Tetris Save Your Life?

You just ran a really bad call, should you take 20 minutes to play some Tetris or Candy Crush?

While more research on a larger scale is needed, it certainly seems plausible that playing video games after a bad call could reduce the amount of flashbacks, a cardinal symptom of PTSD,  that occur.

No research has been published specifically on first responders regarding video games and PTSD. When members of the general public are exposed to traumatic events, playing video games after the event is associated with a lowered number of flashbacks and intrusive memories compared to those in the control group that did not.

The journal Molecular Psychiatry released a studyon March 28th 2017, Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department: a proof-of-concept randomized controlled trial.[1] The study was comprised of 71 people over the age of 18 that went to the emergency room at John Radcliffe Hospital, in Oxford, UK within 6 hours of experiencing or witnessing a motor vehicle accident that met DSM-IV PTSD criterion A1 for traumatic events. This is described as “experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury.”

Participants were randomized, half of them were asked to briefly explain what the worst moments of the accident were and were then instructed to play Tetris for 20 minutes in the ER. The other half of the participants spent an equivalent amount of time writing down all the things they had done in the ER, but did not have the memory cues and did not get to play video games.

The study looked at number of intrusive memories that happened in the 7 days following the accidents. The group that had played Tetris in the ER had significantly less intrusive memories than the control group.

The authors of the study hypothesize that playing Tetris immediately after the exposure to traumatic events causes a competition in the brain between the game with high visuospatial needs and consolidation of the memories, resulting in less intrusive memories.

The authors also stated that it does not have to be Tetris, “but any task with high visuospatial demands is likely to be useful within the procedure (e.g. games such as Candy Crush, drawing).”

This recent study builds on the 2009 study, Can Playing the Computer Game “Tetris” Reduce the Build-Up of Flashbacks for Trauma? A Proposal from Cognitive Science.[2]  where 40 participants watched a 12 minute film with scenes of injuries and death.   Following a short break after the film half of the participants sat quietly for 10 minutes and half of them played Tetris for 10 minutes.  Participants who played Tetris had significantly lower rates of flashbacks over the next 7 days.

2009 tetris
Flashback frequency over one week. From Holmes, et al. 2009.

While further research is needed it might be reasonable to play 20 minutes of Tetris or Candy Crush as soon as possible after completing a bad call. It seems there is at the very least a theoretical benefit and playing video games for 20 to 30 minutes is not likely to be harmful.
Standard disclaimer: I am not a psychologist, psychiatrist, counselor, etc. I had one semester of psychology in college. This blog is not a substitute for seeking care or treatment from a mental health professional. I probably have no idea what I am talking about.


  1. Iyadurai L, Blackwell SE, Meiser-stedman R, et al. Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department: a proof-of-concept randomized controlled trial. Mol Psychiatry. 2017;
  2. Holmes EA, James EL, Coode-bate T, Deeprose C. Can playing the computer game “Tetris” reduce the build-up of flashbacks for trauma? A proposal from cognitive science. PLoS ONE. 2009;4(1):e4153.


Red Badge of Courage: Has PTSD Jumped The Shark in EMS?

I have no doubt this piece will be misunderstood, it will be polarizing and it will make people angry.

PTSD is not something to be proud of, it is not something to brag about, it is not an excuse to act like an asshole and it is not a thing to rally around and sell paracord bracelets or challenge coins about.

With frequent pictures of ghost surrounded, sobbing angel-winged  EMS providers and numerous gofundme sites for nonsense* like horse therapy for EMS providers with PTSD…Are we trivializing those who are really injured?

PTSD is no more glamorous than a work related back injury. It should be treated like any other work place injury, not some sacred cow that is above reproach. It is a very real thing, that is not up for debate. People are exposed to things working in EMS  that may cause a mental or physical injury.  I am asking all of us to really take a look at how we view these injuries and examine how we are portraying them.
Continue reading “Red Badge of Courage: Has PTSD Jumped The Shark in EMS?”

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 Match.com. 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

Continue reading