EMS Avenger

04/18/2026

“Preach the gospel at all times. If necessary, use words”. This phrase is often used in the furtherance of Christian evangelism as a means of emphasizing that the gospel as a doctrine or concept is meaningless in the absence of how someone in possession of it supports the people around them without mentioning it.

In the arena of airway management, there is a great deal of discussion of intubation proficiency amongst pre-hospital providers. We keep emphasizing that intubation is definitive airway management or the “Gold Standard” of airway management. This is our doctrine. While the concept of “resuscitate before you intubate” is beginning to trickle down into the most remote areas of the field, we still deal with a very strong inclination towards intubation as a doctrine of airway management rather than acknowledging that the gold standard of airway management, and what should be the gold standard of airway proficiency is the inclination to avoid it in the first place. The mindset should not be "I will serve this patient through intubation", but "I was able to resuscitate this patient, and find that the service of intubation is still required".

In other words "Resuscitate your patients at all times, if necessary, use intubation."

04/18/2026

Most 911 providers aren't equipped to set a patient up, particularly an infant, on a Heated and Humidified High Flow Nasal Cannula. But as much as this series has stayed grounded in the BLS approach to RSV and bronchiolitis, I wanted to hit this beat geared more towards critical care. Make sure you can identify your objectives with setting a pediatric patient up on HFNC with bronchiolitis. It's becoming kind of a supportive standard of care approach that may end up not being in the patient's best interest if we can mitigate tachycardia, tachypnea, and hypoxemia through other means.

https://linktr.ee/emsavenger

04/18/2026

Great insights here from Paramedic Megan Poff. One key element that prompted me to share it was the emphasis on Culture and Leadership messaging. I'm going to be speaking a lot more to culture and leadership later in the year, and putting a focus squarely on leadership to actually build a culture. I'm glad to see others recognizing how centrally important this is.

First responders face high rates of PTSD, depression, and anxiety due to repeated exposure to trauma, affecting their families and relationships, yet stigma prevents them from seeking help.

04/17/2026

This is a repost, but with the amount of followers I get each year it just makes good sense to review previous content. Here we review the Delta Wave, what its significance is, and what we should expect with WPW re-entry rhythms.

04/17/2026

It's easy to get focused on airway and breathing with our RSV kids (And our other "Breathers"). But quite often they are in extremis because of how severely volume depleted they are. We often get to their bedside at about the 3 day mark. Between fluid loss and poor feeding, they can be in dire straits. Often the greatest contribution we can make to their recovery is to replace that volume.

04/16/2026

"One does not simply have a 3 minute conversation with Jeff Jarvis on airway management." This was supposed to be a reel. But, like Dr. Jarvis, I can talk about this stuff all day. So 20 minutes later it became a podcast on airway management in cardiac arrest. I try to hit all of the beats I can when it comes to being practical and pragmatic with our approach, and I don't avoid putting our training paradigm under the microscope. Dr. Jarvis is an airway guru and die-hard intubation enthusiast, so his admission to what our challenges are, and what our practice should probably be is sobering.

https://open.spotify.com/episode/2JMeUZxMt6ucqaKFOJmTzZ?si=QVHNy4PvQ0ijRZtJfVC-2A

EMS Avenger Podcast · Episode

04/16/2026

In the ongoing discussion of how to manage an airway in cardiac arrest, many providers initially resistant to beginning with an SGA will concede the point but then call for the Gold Standard management of airway by way of intubation once ROSC is achieved. But there is little talk of if we actually optimized this patient's perfusion prior to intubating. "Resuscitate Before You Intubate" doesn't just apply to RSI. Any sick, high acuity patient needs to have their perfusion optimized before it's compromised with delays in oxygenation, sedation, analgesia, and even paralytics. This ESPECIALLY includes Post-ROSC patients. They are the most vulnerable to the effects of hypoxemia and hypotension, and we just spent all that effort attempting to reverse terminal hypoxia and hypotension. So maybe even post-ROSC intubation isn't a priority. Obviously there are scenarios where intubation may be called for with expediency, but exceptions don't invalidate the overall approach. Check out this full episode of my podcast on YouTube and on all major Podcast platforms.

04/16/2026

This will be my first visit to Oklahoma. Come make it a special one for me!

THIS IS THE EMS SESSION EVERYONE NEEDS TO HEAR.

Jimmy Apple, EMS Avenger is stepping onto the Heroes in the Heartland stage with a breakout that cuts straight to the core of our profession.

HOW TO SAVE EMS A raw, honest look at the culture, challenges, and future of EMS — told through two powerful, interwoven stories that expose both the heart and the hurt inside this job.

You’ll dive into:
• The paramedic journey from idealism to burnout
• The hidden weight of addiction, compassion fatigue, and bias
• The reality behind “frequent flyers” and the humanity we often miss
• Why real change requires cultural shifts, provider buy in, and system level reform

This isn’t a lecture. It’s a mirror. It’s the conversation EMS has needed for years — and Jimmy brings it with clarity, heart, and fire.

📍 June 8–11 | Norman, Oklahoma
📌 Embassy Suites Hotel & Conference Center
🔗 Register here: www.heroesconference.org

Bring your crew. Bring your honesty. This is a Heroes session that hits where it matters.

04/15/2026

Decadron. Seems like a reasonable intervention in a disease process involving bronchoconstriction and inflammation, right? Imma let you finish, but...

Also, what is a steroid? What is a corticosteroid? WHAT IS A GLUCORTICOID? WHAT IS WITH ALL THE OIDS?! JUST TELL ME WHAT I SHOULD. DO WITH THIS DECADRON IN BRONCHIOLITIS! The AAP has you covered.

https://publications.aap.org/hospitalpediatrics/article-abstract/7/7/403/26489/Corticosteroid-Therapy-During-Acute-Bronchiolitis?redirectedFrom=fulltext

04/15/2026

There has been a lot of public discourse via publication about the practice of spinal immobilization. Dr. Seth Hawkins continues the discourse here and asks, after decades of data, when is it enough to change practice?

We read with interest Millin et al.’s literature review and analysis as well as the letter in response from Calland et al. We were particularly interested in their contention that multidisciplinary...

04/15/2026

You don't want to miss EMS World's inaugural LIVE event in Austin, TX this year. While there is a heavy focus on rapid pace learning, there is also a focus on the personal side of EMS and how it impacts us and on how we impact others. I can't emphasize enough how powerful Liz's story is, and you don't want to miss it at EMS World LIVE! Co-located with FlightBridgeED's FAST26!