EMS Today

Exploring the Future of EMS Reimbursement

Steve Tafoya takes a dive deep into a new bill aimed at transforming treatment-in-place capabilities and establishing Medicare reimbursement models tailored for emergency medical providers. Drawing on 25 years of frontline experience and a strong legal and business background, Steve sheds light on the current reimbursement challenges EMS agencies face, with only about 14-25% of calls being fully reimbursed. The discussion highlights how this legislation could reshape EMS’s role beyond traditional 911 response—integrating community health, alternative destinations, and innovative care models. Steve emphasizes the critical need for provider voices in lawmakers’ offices and urges industry stakeholders to engage with representatives to support this bill. The podcast also explores the expanding career opportunities in EMS, including agency response units and industrial medical teams.

Jimmy Apple’s Human Approach to EMS, Mental Health, and Sepsis Care

Eric Chase sits down with Jimmy Apple, aka EMS Avenger, to explore the often-overlooked realities behind emergency medical services. Jimmy breaks down the isolation many providers face, emphasizing the power of genuine relationships and networking in advancing EMS careers. They dive deep into the psychological challenges of frontline care, including the emotional toll of death notifications and the importance of accessible mental health support. With a spotlight on evidence-based practice, Jimmy contrasts the intense focus on cardiac arrest resuscitation with the relative neglect of sepsis recognition and treatment, urging a shift in EMS training priorities. Drawing from two decades of experience, he challenges outdated dogma around pediatric and adult care, encouraging providers to overcome fear and trust their skills. This conversation serves as a powerful reminder that EMS isn’t just about protocols—it’s about empathy, accountability, and continuous growth in service of human life.

Rethinking CPR in Trauma: Insights from a Groundbreaking Study on Hemorrhagic Shock

By Bram Duffee, PhD, EMT-P

For EMS providers who respond to a traumatic cardiac arrest, the instinct to initiate CPR is almost automatic. But could this life-saving intervention inadvertently hinder recovery in cases of severe hemorrhagic shock? A recent study, “Effect of Cardiopulmonary Resuscitation on Perfusion in a Porcine Model of Severe Hemorrhagic Shock,” challenges conventional wisdom and offers new insights that could reshape trauma care protocols.

The Study: A Closer Look at CPR in Trauma-Induced PEA

The research, led by Dr. Patrick Greiffenstein, professor of clinical surgery at LSU New Orleans and trauma ICU director at the Norman McSwain Spirit of Charity Trauma Center, addresses a critical gap in trauma care.

While CPR is a cornerstone of resuscitation in cardiac arrest, its application in trauma-induced pulseless electrical activity (PEA) has not been rigorously validated. Trauma PEA, unlike medical cardiac arrest, is a low-flow state caused by severe blood loss (hypovolemia), where the heart shows electrical activity but fails to generate a palpable pulse.

“CPR is a cornerstone of resuscitation and cardiac arrest, but its application in trauma-induced PEA has not really been rigorously evaluated,” explains Dr. Greiffenstein. “Trauma PEA is fundamentally a low-flow state caused by hypovolemia—insufficient blood volume.”

The study aimed to determine how CPR affects tissue perfusion—specifically oxygen delivery to the brain and skin—during severe hemorrhagic shock. Using a porcine model, researchers simulated life-threatening blood loss and compared outcomes between two groups: one receiving automated CPR and the other left untreated during the shock phase.

Key Findings: When CPR May Do More Harm Than Good

The results were both surprising and concerning:

1. No Improvement in Perfusion: CPR did not enhance oxygenation in the brain or skin. In fact, skin perfusion was significantly lower in the CPR group during both the shock and recovery phases.
2. Adverse Hemodynamic Effects: While CPR increased systolic blood pressure (SBP), it significantly reduced diastolic blood pressure (DBP), which is critical for coronary and organ perfusion.
3. Potential Harm: CPR caused a threefold increase in intracranial pressure (ICP), suggesting that chest compressions might disrupt normal blood flow dynamics in the brain.

“Knowing now that extreme efforts like lining people up to do CPR can cause turbulence within the system is a significant advancement,” says Dr. Greiffenstein. “It’s possible to have perfusion at these unreadable MAP scores, which is a critical insight for trauma care.”

Implications for Trauma Care

These findings challenge the one-size-fits-all approach to CPR in cardiac arrest scenarios. In cases of hemorrhagic shock, CPR might:

• Divert attention from more effective interventions, such as rapid blood transfusion or surgical control of bleeding.
• Worsen perfusion to vital organs, potentially exacerbating the patient’s condition.

“In military cases, field medics often don’t have the opportunity to perform full chest compressions on the battlefield. Sometimes, all they can do is drag a person to a safe position,” notes Dr. Greiffenstein. This study underscores the importance of prioritizing interventions that address the root cause of trauma PEA—severe blood loss—over traditional resuscitation techniques.

A Call for Updated Guidelines

The American Heart Association’s current guidelines broadly recommend CPR for all pulseless patients. However, this study adds to a growing body of evidence suggesting that trauma-induced PEA requires a different approach. By focusing on restoring blood volume and controlling bleeding, paramedics and EMTs can improve outcomes for patients in hemorrhagic shock.

As Dr. Greiffenstein puts it, “This research is a step toward more tailored and effective trauma care protocols. It’s about understanding the unique physiology of trauma and adapting our interventions accordingly.”

For EMS providers on the front lines, this study serves as a reminder to critically evaluate the tools and techniques we rely on in emergency care. While CPR remains a vital intervention in many scenarios, its role in trauma-induced PEA warrants careful reconsideration by physician medical directors. By staying informed about the latest research, we can continue to improve outcomes for the patients who depend on us most. Click below to watch the full interview

Reference

Greiffenstein, P., Cavalea, A., Smith, A., Sharp, T., Warren, O., Dennis, J., Gatterer, M. C., Danos, D., Byrne, T. C., Scarborough, A., Deville, P., & VanMeter, K. (2025). Effect of cardiopulmonary resuscitation on perfusion in a porcine model of severe hemorrhagic shock. The Journal of Trauma and Acute Care Surgery, 98(2), 251–257.

 

 

 

Inside EMS: A Paramedic’s Journey through Challenges, Humor, and Healing

In this candid conversation, Ashlynn O’Dell reflects on the realities of EMS—from first calls amid rural landscapes to navigating complex patient care in unpredictable environments. She shares how EMS became her calling over nursing or firefighting and highlights the often unseen sides of the job: delivering care in difficult living conditions, managing mental health, and staying resilient against workplace judgment. Social media became a powerful outlet, helping her connect with peers and inspire young women entering this male-dominated field. With humor, vulnerability, and insight, she reveals the delicate balance between being serious professionals and embracing levity on the job. The discussion also tackles burnout, workplace culture, and the importance of finding your voice in high-pressure scenes.

Joanna Sokol’s Raw and Honest Chronicle of EMS Life

Joanna Sokol, a seasoned EMT and paramedic, opens up in this revealing conversation on the EMS Improv podcast. Drawing from 13 years on the frontlines and a trove of personal journals, Joanna discusses the emotional turbulence embedded in EMS—from the constant flood of forgettable calls to the rare moments that “grab you by the throat.” She shares how writing her book, “A Real Emergency,” became a cathartic way to process the human stories often overshadowed by dramatic emergencies portrayed in media. Joanna candidly reflects on the physical and emotional toll EMS careers exact and the harsh reality many face when transitioning to new paths after years in the field. Her perspective on mentorship, resilience, and embracing the everyday reality of EMS work challenges common perceptions and offers raw, valuable insight for providers and those who rely on them alike.

Reliable Infection Control in an Evolving Landscape

In this episode of Let’s Get It Straight, infection control consultant and host Katherine West tackles the growing challenge of accessing dependable scientific guidance amid shifting government support and archived resources. With traditional CDC documents and expert advisory groups diminished or disbanded, she unpacks how critical recommendations—such as those comparing N95 respirators to surgical masks—are formed using evidence review methods like CHARM and GRADE. Katherine highlights key differences in medical versus EMS settings that affect mask use and safety protocols, and she points to regional alliances stepping up to fill guidance voids. Emphasizing the importance of verifying sources and cross-checking studies before accepting health data, this session arms healthcare professionals with the tools to sift through conflicting info and make informed decisions.

Can AI Revolutionize Paramedic Diagnoses?

EMS Research Podcast Host Bram Duffee dives into a recent study examining ChatGPT’s ability to predict prehospital patient diagnoses based on paramedic care reports.

ChatGPT accurately identified conditions 75% of the time and often erred on the side of caution, potentially reducing dangerous under-triage. Duffee is joined by lead researcher Erik Miller, a nurse practitioner and paramedic turned researcher, who sheds light on the study’s design, limitations, and real-world implications.

They discuss how AI can support—but not replace—the critical thinking skills of EMS providers, the challenges of legal liability, and the risks of overreliance on technology. The conversation also explores future possibilities for AI integration in dispatch and patient care reporting, while emphasizing the irreplaceable human touch in emergency medicine.

Understanding the New Treatment-in-Place Legislation and Its Impact on Mobile Integrated Health

In this episode of the JEMS Report, Mike Brown sits down with EMS advocates David Blevins and Sam Magill to discuss groundbreaking federal legislation introduced by Senators Collins and Welch that aims to expand treat-in-place programs and establish sustainable funding models for Mobile Integrated Health (MIH). They explore how this legislation could shift EMS from the traditional transport-focused model to one centered on delivering appropriate care at the right place and time—often right in the patient’s home. The conversation highlights the critical role of EMS providers in advocacy, the implications for liability and medical direction, and the potential to reduce hospital overcrowding and healthcare costs. Listeners will also hear about the real-world benefits of MIH programs, including improved patient outcomes and new career pathways within EMS.

Research Highlights and Innovations Shaping Our Field

The world of prehospital medicine is constantly evolving, driven by new research, technological advancements, and a shared commitment to improving patient care and provider well-being. As EMS professionals, staying informed about these developments goes beyond a professional obligation; it is an opportunity to improve our practice, champion our profession, and ultimately make a greater impact on saving lives. In this article, we will explore some of the latest research findings that are reshaping our field, from workplace culture to cutting-edge technology.

 

The Culture of Care: Supporting EMS Providers

Our work is demanding, both physically and emotionally, and the culture within our agencies plays a critical role in our well-being. A recent systematic review in the International Journal of Environmental Research and Public Health revealed that many EMS providers avoid using organizational mental health services due to stigma and a perception that these programs lack genuine care. The study emphasizes the need for person-centered support and a cultural shift that normalizes seeking help as a sign of strength (Johnston et al., 2025).

This cultural component also impacts retention. Another study in the same journal found that agencies with collaborative, team-oriented "clan" cultures had significantly lower turnover rates compared to those with rigid or chaotic structures. For leaders in EMS, fostering a supportive environment is not just about morale. It is a strategic imperative for retaining skilled clinicians (Kamholz et al., 2025).

 

Professional Recognition: Breaking Barriers

Across the globe, paramedics are striving for recognition as integrated healthcare professionals. A qualitative study in BMC Health Services Research identified common barriers, including outdated legislation, inconsistent regulation, and insufficient funding. While the pandemic temporarily highlighted our capabilities, the momentum has waned. The study calls for targeted policy reforms and investments in education and leadership to solidify our role in the broader healthcare system (Feerick et al., 2025).

Physical Demands and Injury Prevention

The physical toll of our work is undeniable. A scoping review in Applied Ergonomics confirmed that musculoskeletal injuries, particularly to the back, are rampant in EMS. Tasks like handling stretchers and patient extractions are among the most strenuous. The review also highlighted fitness disparities, with male paramedics generally showing more strength but less flexibility than their female counterparts. These findings underscore the need for targeted injury prevention programs and realistic physical standards to keep us safe throughout our careers (Marsh et al., 2025).

 

Advancements in Cardiac Arrest Care

When it comes to cardiac arrest, every second counts. A study in Resuscitation reinforced the value of bystander CPR, showing that dispatcher-assisted CPR significantly improves outcomes for untrained bystanders. For those with prior CPR training, acting independently yielded even better results. This highlights the importance of public CPR education alongside dispatcher support (Tagami et al., 2025).

On the scene, our interventions matter immensely. Research in The Journal of Emergency Medicine found that for traumatic cardiac arrest patients, aggressive interventions like prehospital thoracostomy can be lifesaving (McWilliam et al., 2025). Meanwhile, a study in Critical Care Medicine revealed that extracorporeal CPR (ECPR) significantly improves outcomes for patients with refractory ventricular fibrillation, emphasizing the need for early transport to specialized centers.

 

The Role of Technology in EMS

Technology is poised to revolutionize EMS, from dispatch to diagnosis. A study in The American Journal of Emergency Medicine demonstrated that large language models (LLMs) like ChatGPT could prioritize ambulance requests with remarkable accuracy, aligning with expert paramedic decisions over 76 percent of the time. This proof of concept suggests that AI could one day enhance resource allocation in dispatch centers (Shekhar et al., 2025).

On the diagnostic front, machine learning is opening new possibilities. For example, a study in Bioengineering showed that analyzing photoplethysmography waveforms could estimate blood loss in trauma patients, offering a non-invasive way to guide resuscitation (Gonzalez et al., 2025). Similarly, research in Medical Engineering & Physics explored using multidimensional data to differentiate ischemic from hemorrhagic strokes in the field, potentially enabling more targeted prehospital care (Alshehri et al., 2025).

 

Addressing Disparities in Care

Equity in EMS is a cornerstone of our profession, yet recent studies highlight troubling disparities. Research in JAMA Network Open found that ambulance offload times were significantly longer in communities with higher proportions of Black residents (Zhou et al., 2025). Another study in JAMA Surgery revealed that Black and Asian trauma patients were less likely to receive helicopter transport compared to White patients. These findings are a call to action for all of us to examine our systems and biases to ensure equitable care for every patient (Mpody et al., 2025).

 

Looking Ahead

The research discussed here represents just a fraction of the advancements shaping EMS today. From improving workplace culture and injury prevention to leveraging AI and addressing systemic inequities, these findings have real-world implications for our protocols, training, and advocacy efforts. As EMS professionals, we have a responsibility to stay informed and apply these insights to our practice.

For a deeper dive into these topics and more, I invite you to listen to the podcast, EMS Research with Professor Bram latest episode, https://youtu.be/rt_1AFzSLIk "Research Highlights and Innovations Shaping Our Field.”

 

References

Alshehri, A., Panerai, R. B., Lam, M. Y., Llwyd, O., Robinson, T. G., & Minhas, J. S. (2025). Can we identify stroke sub-type without imaging? A multidimensional analysis. Medical Engineering & Physics. https://doi.org/10.1016/j.medengphy.2025.104364

Feerick, F., Coughlan, E., Knox, S., Murphy, A., Grady, I. O., & Deasy, C. (2025). Barriers to paramedic professionalisation: A qualitative enquiry across the UK, Canada, Australia, USA and the Republic of Ireland. BMC Health Services Research, 25(1), 993. https://doi.org/10.1186/s12913-025-10993-7

Gonzalez, J. M., Holland, L., Hernandez Torres, S. I., Arrington, J. G., Rodgers, T. M., & Snider, E. J. (2025). Enhancing trauma care: Machine learning-based photoplethysmography analysis for estimating blood volume during hemorrhage and resuscitation. Bioengineering, 12(8), 833. https://doi.org/10.3390/bioengineering12080833

Johnston, S., Waite, P., Laing, J., Rashid, L., Wilkins, A., Hooper, C., Hindhaugh, E., & Wild, J. (2025). Why do emergency medical service employees (not) seek organizational help for mental health support?: A systematic review. International Journal of Environmental Research and Public Health, 22(4), 629. https://doi.org/10.3390/ijerph22040629

Kamholz, J. C., Gage, C. B., van den Bergh, S. L., Logan, L. T., Powell, J. R., & Panchal, A. R. (2025). Association between organizational culture and emergency medical service clinician turnover. International Journal of Environmental Research and Public Health, 22(5), 756. https://doi.org/10.3390/ijerph22050756

Marsh, E., Orr, R., Canetti, E. F., & Schram, B. (2025). Profiling paramedic job tasks, injuries, and physical fitness: A scoping review. Applied Ergonomics, 125, 104459. https://doi.org/10.1016/j.apergo.2025.104459

McWilliam, S. E., Bach, J. P., Wilson, K. M., Bradford, J. M., Kempema, J., DuBose, J. J., ... & Brown, C. V. (2025). Should anything else be done besides prehospital CPR? The role of CPR and prehospital interventions after traumatic cardiac arrest. The Journal of Emergency Medicine. https://doi.org/10.1016/j.jemermed.2025.02.010

Mpody, C., Rudolph, M. I., Bastien, A., Karaye, I. M., Straker, T., Borngaesser, F., ... & Nafiu, O. O. (2025). Racial and ethnic disparities in use of helicopter transport after severe trauma in the US. JAMA Surgery, 160(3), 313–321. https://doi.org/10.1001/jamasurg.2024.5678

Shekhar, A. C., Kimbrell, J., Saharan, A., Stebel, J., Ashley, E., & Abbott, E. E. (2025). Use of a large language model (LLM) for ambulance dispatch and triage. The American Journal of Emergency Medicine, 89, 27–29. https://doi.org/10.1016/j.ajem.2025.05.004

Tagami, T., Takahashi, H., Suzuki, K., Kohri, M., Tabata, R., Hagiwara, S., ... & Ogawa, S. (2025). The impact of dispatcher-assisted CPR and prior bystander CPR training on neurologic outcomes in out-of-hospital cardiac arrest: A multicenter study. Resuscitation, 110617. https://doi.org/10.1016/j.resuscitation.2025.110617

Zhou, T., Wang, Y., Zhang, B., & Li, J. (2025). Racial and socioeconomic disparities in California ambulance patient offload times. JAMA Network Open, 8(5), e2510325. https://doi.org/10.1001/jamanetworkopen.2025.10325

 

Navigating Death Notifications and Mental Health in Emergency Services

In this episode of Just Little Salt, Dr. Alexandra Jabr, founder of Emergency Resilience and a licensed paramedic, shines a light on the challenges of delivering death notifications in emergency medical services.

Drawing from years on the front lines and her advanced studies in health and depth psychology, Dr. Jabr, a new member of the JEMS Advisory Board, discusses why clear and compassionate communication is crucial and exposes common mistakes that can worsen an already painful moment.

Beyond the call, she tackles the emotional toll first responders face—from coping with repeated trauma to battling numbness and isolation—and the importance of mental health support, including the emerging role of ketamine therapy.

She also shares personal stories, her injury-induced career pivot, and her passion for education and advocacy.