Advertise on podcast: In-Service EMS Podcast

For decades, EMS providers were taught a simple rule in trauma: when in doubt, immobilize. But as evidence, technology, and our understanding of spinal injury have evolved, should some of those long-standing practices evolve with them? In this episode, Dr. Ed Malcom and emergency department charge nurse Andy Gomez join In-Service for a candid discussion about cervical spine precautions, trauma assessment, and the difference between following an algorithm and understanding why an intervention is actually needed. The conversation takes a close look at cervical collars and the shift from traditional spinal immobilization to spinal motion restriction. The group discusses NEXUS and the Canadian C-Spine Rule, mechanism of injury versus physical examination, distracting injuries, intoxication, neurological findings, and when a collar may—or may not—be indicated. Just as importantly, they examine the unintended consequences of unnecessary immobilization, including pain, skin problems, prolonged time in a collar, and delays in emergency department care. The discussion then moves beyond C-spine to the larger challenge of trauma assessment. Why can a seemingly minor ground-level fall be more concerning than a dramatic motor vehicle crash? Dr. Malcom and Andy explore geriatric trauma, anticoagulants, medications that can mask physiologic responses, subtle presentations, and why normal-looking vital signs don't always tell the entire story. The episode reinforces the importance of looking at the whole patient rather than allowing mechanism or a single number to drive clinical decisions. The episode also provides a look at trauma care from the other side of the emergency department doors. Dr. Malcom and Andy explain what information they actually want from EMS, why the paramedic's initial assessment matters, and the value of communicating not only what happened, but what the provider thinks is wrong and why an intervention was performed. The medic was there when the event happened—and that firsthand context can be extremely valuable once the patient reaches the hospital. Ultimately, this episode is about developing clinical judgment. Protocols and decision rules matter, but so does understanding the evidence behind them, recognizing when a patient doesn't fit neatly into an algorithm, and being able to articulate the reasoning behind your decisions. From C-spine precautions to geriatric trauma and EMS-to-ED communication, this conversation challenges providers to move beyond simply asking, “What does the protocol say?”and start understanding why they're doing what they're doing. Enjoyed this episode? Follow the show so you never miss a new release. 📬 Want more? Visit our website and click Newsletter to receive our monthly updates: http://www.in-serviceemspodcast.com Questions or feedback? Email us at [email protected]

What if EMS stopped treating every 911 call the same and started addressing why someone needs help? Patrick Flaherty, Division Chief of EMS and Training for the Sandy Springs Fire Department, joins the In-Service EMS Podcast to discuss how his department is rethinking emergency medical care. Drawing on a career that began in 1991, Patrick shares lessons from his work as a firefighter, paramedic, educator, Marine Corps veteran, tactical medic, police officer, and EMS leader. He recounts a call involving a familiar patient that became a powerful reminder about complacency, assumptions, and approaching every patient with fresh eyes. Patrick explains how Sandy Springs uses community paramedicine, opioid outreach, and physician-supported telehealth to connect patients with more appropriate care. He discusses why EMS cannot solve rising demand by simply adding ambulances—and how alternative responses can reduce unnecessary emergency department visits while still protecting patients. The conversation also explores the Four-Minute Community, an innovative program placing connected AEDs in the hands of trained residents. When cardiac arrest occurs nearby, volunteers can be alerted and begin lifesaving care before traditional responders arrive. Finally, Patrick discusses clinical feedback, critical-thinking skills, psychological safety, and the importance of treating near misses as opportunities to learn rather than reasons for automatic punishment. This episode is a candid look at challenging tradition, supporting EMS professionals, and building systems around the needs of the communities they serve. Enjoyed this episode? Follow the show so you never miss a new release. 📬 Want more? Visit our website and click Newsletter to receive our monthly updates: http://www.in-serviceemspodcast.com Questions or feedback? Email us at [email protected]

What really happens when a patient leaves the ground and enters the world of flight medicine? In this episode of In-Service: EMS Podcast, we take a practical look inside helicopter EMS—from the perspective of a flight paramedic and air base manager who has worked across rural EMS, fire-based EMS, ground operations, and critical care transport. We break down what actually makes someone a flight patient and challenge the idea that a helicopter is simply a faster ambulance. The conversation covers trauma, stroke, burns, pediatric emergencies, rural access to definitive care, and the growing capabilities of ground EMS. We also discuss what flight crews need from ground providers, including patient weights, airway status, treatments performed, and the elements of a strong ground-to-air handoff. The discussion goes deeper into critical care, including RSI, ventilator management, blood products, high-acuity/low-frequency procedures, and the importance of slowing down when the pressure is highest. We also explore aviation safety, weather decisions, landing-zone hazards, crew resource management, fatigue, and why every member of a flight crew has the authority to stop a mission when something doesn’t feel right. Beyond the aircraft, this episode examines what EMS leaders can learn from aviation. From pre-flight briefs and post-flight debriefs to psychological safety, crew rest, communication, and creating an environment where people are expected to speak up, there are lessons here that apply just as much to an ambulance operation as they do to a helicopter base. We also look toward the future of prehospital medicine—including expanded blood programs, ECMO, drones, evolving critical care capabilities, and the continuing challenge of EMS reimbursement. Whether you’re interested in becoming a flight clinician, regularly work with air medical crews, or simply want to become a better ground provider or EMS leader, this conversation offers a look at what happens when experience, critical care, aviation, and EMS leadership come together. Enjoyed this episode? Follow the show so you never miss a new release. 📬 Want more? Visit our website and click Newsletter to receive our monthly updates: http://www.in-serviceemspodcast.com Questions or feedback? Email us at [email protected]

In this episode, nationally registered paramedic and certified flight paramedic Sam Oxford explores what it takes to deliver excellent prehospital care when the stakes are high. Drawing on more than a decade in emergency response, critical care transport, flight medicine and clinical operations, Sam explains how preparation, sound judgment and teamwork shape patient outcomes. Sam shares an early-career call that exposed the limits of his paramedic-school training and transformed his approach to the profession. He discusses learning from mistakes, conducting honest post-call debriefs and using deliberate practice to close knowledge gaps without creating a culture of blame. The conversation also examines stress inoculation for paramedics. Sam explains how realistic, high-pressure simulations can reduce cognitive overload, build confidence and help clinicians remain composed during real emergencies. He also offers practical advice for paramedics interested in flight medicine, from strengthening their credentials to demonstrating honesty, adaptability and the ability to work within a high-performing team. Sam and Jason explore clinical judgment beyond EMS protocols, including how a thorough assessment, reliable vital signs and strong documentation help clinicians make defensible decisions when patients do not fit neatly into established guidelines. They also discuss critical care transports, closed-loop communication, cardiac arrest response and why high-quality compressions and rapid defibrillation are essential to improving survival. Finally, Sam describes the leadership and culture needed to build exceptional EMS teams. From professional accountability and mutual trust to clinical career pathways and continuing education, he makes the case for developing—and retaining—paramedics who want to grow without leaving patient care behind. His message to new clinicians is simple: stay curious, accept that you will not know everything and treat every patient with kindness. Enjoyed this episode? Follow the show so you never miss a new release. 📬 Want more? Visit our website and click Newsletter to receive our monthly updates: http://www.in-serviceemspodcast.com Questions or feedback? Email us at [email protected]

As EMS evolves, the conversation often centers on new procedures, new medications, and expanding scope of practice. But are we asking the right question? In this episode, Dr. Jon Allen and Chief Chad Huff argue that the future of EMS isn’t just about adding more skills—it’s about developing the clinical judgment to know when those skills should, and shouldn’t, be used. Dr. Jon Allen, an emergency physician, EMS medical director, and member of the state’s EMS Medical Directors Advisory Council, joins Chief Chad Huff to discuss where prehospital medicine is headed. From critical care paramedicine and point-of-care ultrasound to blood products, AI, and protocol development, they explore how innovation must be balanced with education, oversight, and evidence-based medicine. The conversation goes beyond medicine into leadership. They discuss why quality assurance, meaningful feedback, mentorship, and strong medical direction are essential to building confident clinicians. Experience, they argue, can’t be replaced by another certification or another piece of equipment—it has to be developed through coaching, repetition, and learning from every patient encounter. Whether you’re an EMT, paramedic, supervisor, educator, or medical director, this episode offers practical insight into building stronger providers and stronger EMS systems. If you care about the future of the profession, this is a conversation you won’t want to miss. Enjoyed this episode? Follow the show so you never miss a new release. 📬 Want more? Visit our website and click Newsletter to receive our monthly updates: http://www.in-serviceemspodcast.com Questions or feedback? Email us at [email protected]

Leadership in EMS is often associated with rank and titles, but Derek Hendren argues that true leadership is built on credibility, trust, and consistency. In this episode, Derek and Jason explore what it takes to earn respect in high-pressure environments where accountability matters. They discuss the importance of transparency, ownership, and follow-through, as well as the damage caused when standards are applied inconsistently or leaders fail to address problems honestly. A central theme of the conversation is the gap between policy and reality. While policies provide structure, successful organizations must ensure those policies support operations rather than create barriers to success. Derek explains why leaders should seek to understand the root causes behind missed expectations before jumping to corrective action, focusing on system improvements and removing obstacles instead of simply assigning blame. The discussion also examines culture and the often-overlooked impact of small issues on frontline crews. What appears minor to leadership can become a daily source of frustration for employees who experience it repeatedly. Derek emphasizes that organizations must remain connected to the realities of field operations and listen to the people closest to the work. Building trust requires leaders to address concerns, communicate openly, and demonstrate that crew priorities matter. The episode concludes with a conversation about developing the next generation of EMS leaders. Derek shares why leadership starts long before a promotion and why future leaders should begin demonstrating accountability, professionalism, and problem-solving skills today. As EMS continues to evolve, he argues that the profession’s future will be shaped by individuals who focus less on titles and more on serving their teams, supporting their communities, and continually improving the systems around them. Enjoyed this episode? Follow the show so you never miss a new release. 📬 Want more? Visit our website and click Newsletter to receive our monthly updates: http://www.in-serviceemspodcast.com Questions or feedback? Email us at [email protected]

In this episode of In-Service: EMS Podcast, Jason Falvey sits down with veteran paramedics Brinker Hoffman and David Manavi for an honest and wide-ranging discussion about the realities of modern EMS. Drawing from decades of field experience, they explore what today’s EMS education system is producing, why soft skills matter as much as clinical skills, and how providers can continue to grow long after they earn their certification. The conversation examines the difference between technicians and clinicians, the challenges facing new EMTs and paramedics entering the profession, and why curiosity may be the single most important trait for a long and successful career. Along the way, Brinker and David share memorable calls, lessons learned under pressure, and powerful stories that highlight the importance of thorough patient assessment, critical thinking, and professional judgment. The discussion also tackles the growing influence of technology, AI, protocol apps, and decision-support tools in EMS. While these resources can reduce cognitive load and improve efficiency, the group argues that no app can replace experience, intuition, or the ability to recognize a critically ill patient from the doorway. Perhaps the most impactful portion of the conversation focuses on emotional resilience. Through candid reflections on tragedy, grief, compartmentalization, detachment, and the psychological toll of emergency medicine, Brinker and David offer practical wisdom on how providers can survive—and thrive—in a profession that regularly exposes them to humanity at its best and worst. Whether you’re a student, a new provider, a seasoned medic, or a healthcare leader, this episode offers valuable insights into what it truly means to practice EMS at a high level. Enjoyed this episode? Follow the show so you never miss a new release. 📬 Want more? Visit our website and click Newsletter to receive our monthly updates: http://www.in-serviceemspodcast.com Questions or feedback? Email us at [email protected]

In this episode of In-Service: EMS Podcast, Jason sits down with Israel Contreras for a deep conversation about the future of EMS and the growing shift from a transportation-based model to a true healthcare delivery system. Israel, currently serving in EMS Transformation and Innovation, explains why the traditional “you call, we haul” approach is no longer sustainable in modern EMS. Together, they explore how systems across the country are beginning to rethink response models, integrate nurse navigation and telehealth, and develop smarter ways to connect patients with the right level of care — not just the nearest emergency room. At the center of the discussion is a powerful idea: EMS is no longer just prehospital care. It is out-of-hospital healthcare. The conversation dives into the operational realities driving that transformation. Israel breaks down the inefficiencies that have become normalized in EMS — chronic hospital wall times, low-acuity call volume, staffing fatigue, reimbursement limitations, and outdated deployment strategies. Rather than simply criticizing the system, he outlines how innovative EMS agencies are using data analytics, AI-assisted dispatching, alternative transport models, and dynamic deployment strategies to improve both patient outcomes and provider availability. Jason and Israel also discuss the resistance that inevitably comes with change and why gaining buy-in from frontline crews, communications centers, hospitals, and leadership teams is critical to making these models actually work on the street. One of the most compelling moments of the episode comes when Israel reflects on a pediatric end-of-life transport that profoundly shaped his perspective on healthcare, compassion, and leadership. The story becomes a thread that runs through the broader discussion on emotional intelligence in EMS and the importance of seeing patients not as call types, but as people in crisis. That conversation naturally evolves into an honest discussion about provider mental health, burnout, and leadership responsibility. Israel speaks candidly about the cultural shift occurring in EMS around psychological wellness, the importance of giving providers permission to process trauma, and why strong leaders must know their people beyond schedules and productivity metrics. The episode also explores the rapid advancement of clinical medicine inside EMS systems. Jason and Israel discuss whole blood programs, trauma care, RSI, ultrasound, AI-generated documentation, predictive deployment software, and the expanding role of technology in field medicine. Rather than viewing innovation as futuristic gimmicks, Israel frames these tools as ways to improve clinical decision-making, reduce provider fatigue, and deliver better care faster. The discussion highlights how progressive EMS systems are increasingly focused on building clinicians — not simply adding protocols and equipment — through stronger education, mentorship, and ongoing professional development. Throughout the episode, Israel returns to a central theme: EMS cannot evolve through isolated efforts. Real transformation requires collaboration between agencies, hospitals, legislators, educators, and frontline providers themselves. He challenges providers to take ownership of the profession’s future by speaking up, participating in professional organizations, investing in education, and contributing ideas instead of simply accepting broken systems as permanent realities. By the end of the conversation, the message is clear — EMS stands at a turning point. The profession has an opportunity to redefine itself not just as emergency transport, but as one of the most adaptive and impactful healthcare systems in modern medicine. Enjoyed this episode? Follow the show so you never miss a new release. 📬 Want more? Visit our website and click Newsletter to receive our monthly updates: http://www.in-serviceemspodcast.com Questions or feedback? Email us at [email protected]

This episode digs into the real-world side of values, ethics, and culture in EMS—where the decisions are rarely clean and the consequences are never theoretical. Dave DiNapoli brings the conversation out of the classroom and onto the truck, exploring how values show up in patient care, how ethics can drift under pressure, and how providers are tested when policy, judgment, bias, and human emotion collide. We talk through the uncomfortable places where EMS providers and leaders are forced to make hard calls: refusals, terminal patients, first responder injuries, frequent callers, unhoused patients, intoxicated patients, and the moments when a policy can become a shield instead of a guide. Dave breaks down how shortcuts become normalized, how compassion fatigue and burnout can quietly change care, and why leaders have to pay attention before those warning signs become culture. The conversation then turns directly toward toxic EMS culture—what it feels like, how it grows, and why it can be so damaging to both providers and patients. When a medic or EMT walks into shift change with a pit in their stomach and says, “I don’t want to be here,” that culture has already redlined. And it did not get there overnight. We also examine the power of informal leaders, gossip, hypocrisy, and respected toxic providers. Policies may be written by leadership, but culture is often shaped in the day room, the ambulance bay, and the conversations leaders never hear. Dave challenges EMS leaders to stop avoiding confrontation, engage the people creating the culture, and understand the difference between managing the operation and actually leading the workforce. At the center of this episode is a simple but demanding standard: patient care has to trump everything else. If leaders tolerate shortcuts, bias, indifference, or toxic behavior, they are not just allowing a personnel problem—they are allowing a patient care problem. This is a hard conversation, but it is exactly the kind EMS leadership needs to keep having. Enjoyed this episode? Follow the show so you never miss a new release. 📬 Want more? Visit our website and click Newsletter to receive our monthly updates: http://www.in-serviceemspodcast.com Questions or feedback? Email us at [email protected]

This episode of In-Service: The EMS Podcast dives into the evolving edge of prehospital care, exploring how advanced interventions like RSI, blood products, and ultrasound are reshaping what it means to be a paramedic. Jason sits down with Michael Henry and Eric Falvey to unpack not only the clinical tools driving modern EMS, but the operational realities of delivering that care in a high-volume, high-acuity environment with massive seasonal population surges. The conversation sets the stage for a deeper look at how systems must adapt when demand, geography, and patient complexity collide. Through personal stories, Mike and Eric ground the discussion in experience—from a first cardiac arrest complicated by CPR-induced consciousness to a seemingly routine transfer that reshaped an entire career perspective. These moments reinforce a core truth: EMS isn’t just about high-acuity interventions—it’s about human connection, decision-making under pressure, and recognizing the weight of every patient interaction. Whether it’s a D-Day veteran or a crashing CHF patient, the impact of care extends far beyond the immediate call. The episode also tackles the real-world challenges of implementing cutting-edge medicine in the field. From the logistics and provider buy-in required for carrying blood, to the cognitive load and safeguards necessary for RSI, to the cautious integration of ultrasound, the discussion highlights a system intentionally pushing forward without losing sight of fundamentals. The theme is clear—technology and capability mean nothing without disciplined providers, strong culture, and leadership that prioritizes both performance and patient outcomes. Ultimately, this conversation shifts toward the bigger picture: the evolution of the paramedic from protocol follower to clinical decision-maker. It explores what separates average providers from exceptional ones, the importance of feedback and continuous learning, and the leadership decisions required to raise the standard across an organization. As EMS continues to straddle the line between public safety and healthcare, this episode makes one thing clear—the future belongs to systems and providers willing to adapt, think critically, and commit to getting better every single call. Enjoyed this episode? Follow the show so you never miss a new release. 📬 Want more? Visit our website and click Newsletter to receive our monthly updates: http://www.in-serviceemspodcast.com Questions or feedback? Email us at [email protected]

In this episode of In Service, Jason Falvey sits down with Wayne Sandford for a wide-ranging conversation on leadership, scale, and service across more than five decades in the fire service. From his beginnings as a firefighter in East Haven, Connecticut, to leading the Connecticut Fire Academy, serving 15 years as fire chief, helping build Connecticut’s Department of Emergency Management and Homeland Security, and later teaching at the University of New Haven, Sandford reflects on the lessons that shaped his approach to leadership. A central theme of the conversation is Sandford’s belief that the chief is not the “chief firefighter.” Rather than stepping in and taking over every incident, he saw his role as developing officers, strengthening decision-making, and preparing others to lead. He shares a pivotal early fire as chief that reinforced the need to coach officers in real time and build their confidence and judgment instead of rescuing them from responsibility. The episode also explores how leadership changes when incidents grow in complexity and scale. Sandford explains the shift from tactical problem-solving to broader system thinking: recognizing when a scene is outgrowing the first plan, calling for resources early, protecting life safety, and seeing the incident beyond the immediate flames. He discusses why smaller departments can struggle with this transition, and why experience, education, and intentional teaching matter so much in preparing leaders to think ahead. Sandford also reflects on major events that shaped emergency management, including 9/11, the evolution of incident command, regional coordination, and the creation of state-level systems for resource deployment, intelligence sharing, and incident management. He shares powerful stories from the fire service response to 9/11, the contamination risks firefighters faced, and the operational realities of trying to protect a local community while also answering a national tragedy. Throughout the episode, one word keeps surfacing: relationships. Whether between chiefs, public works, law enforcement, neighboring departments, or state agencies, Sandford argues that large-scale leadership is built on trust long before the crisis begins. This is a conversation about leadership maturity, officer development, interagency coordination, and what it really means to serve at a higher level when the stakes keep rising. Enjoyed this episode? Follow the show so you never miss a new release. 📬 Want more? Visit our website and click Newsletter to receive our monthly updates: http://www.in-serviceemspodcast.com Questions or feedback? Email us at [email protected]

This episode is a blunt, practical deep-dive into why patient refusals are the most dangerous decision a paramedic can make—not because the paperwork is hard, but because the mindset shifts: crews treat refusals like “not a real call,” cut corners, and then get crushed later when the outcome goes bad. Paul Girard breaks down how refusals become career-ending events through weak assessments, vague documentation, and failure to prove true decision-making capacity. Paul lays out what investigators and plaintiff attorneys actually do: they deconstruct the call to answer whether your actions were reasonable and prudent, and they’ll use far more than your narrative—EPCR metadata, timestamps, geolocation, monitor data, audit trails, and third-party video can all be pulled to expose inconsistencies or outright fraud. His message is simple: you can’t “clean it up later.” If it didn’t happen—and you can’t prove it—it will be assumed it didn’t happen. The core refusal skill is capacity, and Paul defines it in plain terms: the patient’s ability to understand their situation and the risks/benefits of refusing—and your ability to document that understanding. The most common “capacity failures” he sees aren’t exotic—they start with a bad or incomplete assessment, refusals signed by minors or intoxicated patients, and refusals done across language barriers without a real interpreter. He also calls out provider-induced refusals—subtle or direct steering (“the ER is slammed,” “it’s expensive,” “you sure?”) that looks like you’re trying to avoid transport. From there, the conversation goes hard into documentation: stop hiding behind “advised of risks up to and including death.” Paul explains why generalities destroy credibility and what works instead—specific risks tied to your assessment, plus a reasonable “we can’t rule out everything in the field” caveat. He also shares the brutal reality: your report is often your best defense or your demise, and short on-scene times, missing details, or signatures done later can sink you fast. They round out with high-exposure scenarios that trip up even good crews: lift assists as “hidden refusals,” repeat callers (the “boy who cried wolf” problem), police-driven evaluations in custody situations, and when to elevate to online medical control—not because it fixes every refusal, but because sometimes a physician voice gets a patient to go, and it documents prudence. Bottom line: treat refusals like high-acuity events, slow the scene down, do the assessment, and write the report like your career depends on it—because sometimes, it does. 🔗 Website for Paul Girard & Associates – Expert EMS QA/CQI consulting and resources: 👉 https://girardassoc.com/   🎙️ Official Podcast – The G&A Way – Paul and Kevin’s EMS CQI podcast: 👉 https://podcasts.apple.com/us/podcast/the-g-a-way/id1675678712   Enjoyed this episode? Follow the show so you never miss a new release. 📬 Want more? Visit our website and click Newsletter to receive our monthly updates: http://www.in-serviceemspodcast.com Questions or feedback? Email us at [email protected]

Jason Falvey sits down with Dave DiNapoli (former EMT/paramedic, police officer, police chief; now an executive coach) to unpack why strong clinicians often struggle once they step into leadership. Coaching isn’t about giving answers — it’s about creating clarity, pressure-testing decisions, and forcing leaders to confront unintended consequences. Dave breaks down the hardest transition in EMS: moving from line staff to formal leader, where identity, language, and expectations change overnight. They explore why effective leadership requires one eye on the current problem and one eye downrange, how the “broken window” effect applies to EMS culture—where ignoring small behaviors quietly rots the organization—why toxic high performers are unsustainable, and how burnout, emotional reactivity, and imposter syndrome undermine executive presence. The episode also draws a hard line between management and leadership: managers run the playbook, leaders write it. Memorable moment: Dave shares an early-career MVC where a medevac helicopter is talked into the scene without GPS — and why that decision changed regional practice. Enjoyed this episode? Follow the show so you never miss a new release. 📬 Want more? Visit our website and click Newsletter to receive our monthly updates: http://www.in-serviceemspodcast.com Questions or feedback? Email us at [email protected]

The relationship between EMS and hospitals doesn’t begin at the doors of the emergency department—it’s tested there. In this episode of In-Service, Jason sits down with Brandon Carey and Eric Eberly, two professionals who have worked extensively on both the street and inside the hospital system, to unpack one of the most critical—and misunderstood—areas in emergency medicine: the EMS–hospital handoff. Drawing from decades of combined experience in EMS leadership, fire service, and hospital consulting at Emory Healthcare, this conversation explores where trust is built, where it breaks down, and why relationships—not protocols—often determine outcomes for patients and providers alike. Together, they discuss: •Why the handoff zone is where EMS and hospital systems “live or die” •The real causes of wall times and throughput delays •What EMS crews misunderstand about hospital pressures—and vice versa •How trust, professionalism, and simple human decency shape reputation and patient care •Why leadership, humility, and communication matter more than ever in today’s system This is not a complaint session. It’s a candid, experience-driven discussion about bridging the gap between two systems that depend on each other every single day. If you work in EMS, the ER, hospital leadership, or any role where handoffs matter, this episode will change how you see the space between the stretcher and the bed. Enjoyed this episode? Follow the show so you never miss a new release. 📬 Want more? Visit our website and click Newsletter to receive our monthly updates: http://www.in-serviceemspodcast.com Questions or feedback? Email us at [email protected]

In this episode of In-Service: The EMS Podcast, Jason Falvey sits down with Dave Kleiman, a U.S. Army medic turned veteran paramedic, to explore why prehospital blood is no longer a future concept, but a present-day necessity in trauma care. Dave’s career began in the military, where early exposure to battlefield trauma shaped his understanding of hemorrhage, shock, and survival. After transitioning into civilian EMS, he spent more than 30 years on the street before moving into quality improvement and continuing education with Cobb County Fire & Emergency Services. That combination of military experience, street medicine, and system-level leadership positioned him to help lead one of Georgia’s most forward-leaning prehospital blood programs. This conversation dives into why crystalloids alone fail hemorrhagic patients, how permissive hypotension changed trauma care, and what actually happens when blood reaches patients before the hospital. Dave shares firsthand accounts of unresponsive, pulseless trauma patients who woke up after receiving blood in the field — moments that didn’t just save lives, but fundamentally changed hospital decision-making once those patients arrived. But blood doesn’t work in isolation. The episode also breaks down early hemorrhage control, and how tools like TraumaGel, tourniquets, and TXA work together to stop bleeding, preserve clots, and buy time when seconds matter. Dave explains why EMS must control hemorrhage early — or blood won’t matter at all. The discussion then expands into a lesser-known but critical gap in EMS: K9 officer medical care. Dave recounts the call that exposed how unprepared most systems are to treat injured police dogs, and how that moment led to the development of canine treatment protocols, veterinary medical oversight, and specialized training for EMS providers — all while navigating legal gray areas and state-level barriers. Enjoyed this episode? Follow the show so you never miss a new release. 📬 Want more? Visit our website and click Newsletter to receive our monthly updates: http://www.in-serviceemspodcast.com Questions or feedback? Email us at [email protected]