Podcasts about nemsis

In this episode of EMS One-Stop, host Rob Lawrence is joined by Dr. Christine Carico and Dr. Matt Levy to discuss the peer-reviewed paper, “Nationwide Trends in Prehospital Blood Product Use After Injury.” The paper, published in “Transfusion” in April 2025, explores the use of blood products in prehospital trauma care. Despite the proven benefits of blood transfusion in the field, their research uncovers the alarming reality that less than 1% of eligible patients receive prehospital blood products. This conversation dives into the study's methodology, key findings and the significant barriers EMS systems face in implementing blood transfusion protocols. The discussion also touches on the evolving role of EMS in trauma care, regional variations in blood product access, and the future of prehospital blood transfusion programs. Dr. Carico and Dr. Levy break down their work and reflect on the data, explaining how the study used National Emergency Medical Services Information System (NEMSIS) data to identify trauma patients who would have benefited from blood transfusions. The episode delves into the operational challenges EMS systems face in obtaining and administering blood products in the field, the financial and logistical obstacles, and the potential life-saving impact of more widespread adoption of these protocols. Timeline 00:00 – Intro and welcome: Rob Lawrence introduces Dr. Matt Levy and Dr. Christine Carico, setting up the discussion on prehospital blood product use 03:00 – Study overview: Dr. Carico explains the methodology of the study, focusing on the use of NEMSIS data and the inclusion criteria for the patient population 07:00 – Key findings: Dr. Carico reveals the key findings of the paper, including the low percentage of eligible patients receiving prehospital blood products 11:00 – Barriers to implementation: Dr. Levy discusses the main barriers to the widespread implementation of blood transfusion protocols in the field, including access to blood, logistics and training 17:00 – Regional variations: The speakers touch on the regional disparities in blood product availability and the differences in protocols across the country 23:00 – Data challenges: Dr. Levy and Dr. Carico discuss the challenges related to data accuracy, particularly in terms of blood product documentation 27:00 – Cost and reimbursement: Dr. Levy addresses the financial aspects of blood product programs, including cost, reimbursement challenges and funding opportunities 32:00 – The future of blood transfusion in EMS: Dr. Levy envisions the future of prehospital blood transfusion programs, including the potential for shelf-stable blood products and regional blood supply systems 37:00 – Closing thoughts: Both guests offer their final thoughts on the importance of continued research and data collection, and the need for EMS to embrace a more integrated role in acute care Additional whole blood resources Carico C, Annesi C, Clay Mann N, Levy MJ, et al. “Nationwide trends in prehospital blood product use after injury,” 2025. Transfusion – Wiley Online Library Tracking the whole blood landscape as updated guidelines allow EMS to carry and administer whole blood EMS One-Stop: Stop the bleed, fill the tank – The New Orleans EMS blood program Insider analysis: Delaware's statewide whole blood rollout sets a new EMS standard Whole blood in EMS promises a revolution in resuscitation: How one county agency is saving lives with prehospital transfusions Matthew Levy | LinkedIn Christine Carico | LinkedIn

EMS agencies are facing mounting challenges, from staffing shortages and rising operational costs to increasingly complex compliance requirements. However, advanced data systems and integrated technology offer solutions to these persistent issues.   In this episode of Inside EMS, Clinical and Business Consultants Jason Bartholomai and Chuck Sweeney of ZOLL Data Systems discuss how robust EPCR systems and streamlined workflows can reduce inefficiencies, improve patient care and ease the burden on EMS teams.   Here are top takeaways leaders can learn from this episode about overcoming today's EMS challenges. 1. Staffing shortages: Doing more with less Use technology to reduce workload inefficiencies and support field personnel.   Staffing shortages are a top concern for EMS leaders nationwide. Long shifts, redundant documentation and poor integration between field and dispatch operations exacerbate the stress on paramedics. EPCR systems can alleviate some of these pressures by: Streamlining documentation with intuitive workflows that reduce time spent on reports Improving coordination between field crews, dispatchers and billing teams through integrated software solutions Enhancing employee satisfaction by minimizing administrative burdens and allowing more focus on patient care and recovery time By implementing systems that improve efficiency, EMS agencies can help retain personnel and maximize the output of limited resources. 2. Compliance made simpler: Staying ahead of standards Holistic software ecosystems can simplify compliance and improve data accuracy.   Compliance with NEMSIS standards and other reporting requirements is growing increasingly complex. Leaders must ensure that their systems capture accurate data to meet clinical, operational and legal standards to: Prevent incomplete reports from moving forward Highlight missing critical fields, such as patient signatures or demographic data, which can stall reimbursement Provide real-time feedback for quality improvement (QA/QI) Integrating compliance directly into workflows ensures fewer errors and smoother billing cycles, saving agencies time and resources. 3. Faster reimbursement through smarter workflows Improving cash flow starts with high-quality data entry at the source.   EMS leaders often overlook how documentation practices impact financial performance. Efficient EPCR systems improve clean claim rates by: Guiding paramedics to include all required information during documentation Automating processes like importing EKG results and demographic data Flagging incomplete or incorrect entries before claims are submitted By speeding up documentation and addressing gaps early, EMS agencies can ensure faster reimbursements and predictable cash flow. 4. Breaking down silos: Building an integrated ecosystem Aligning workflows across departments enhances efficiency and collaboration.   EMS operations are not limited to field crews. Dispatchers, billers and managers play critical roles in delivering care and sustaining operations. Integrated systems ensure that: Dispatchers, paramedics and billers share a unified platform, fostering communication and reducing friction Teams are trained holistically to understand each other's roles and responsibilities Operational, clinical and financial data flow seamlessly across departments Such alignment reduces redundancies, boosts productivity and allows agencies to operate more effectively under tight constraints. 5. Preparing for legal challenges with better documentation Accurate, detailed reports protect EMS providers in legal scenarios.   In EMS, thorough documentation is not just a requirement – it's a safeguard against legal liability. EPCR systems help paramedics document essential details clearly and accurately, reducing the risk of errors that could be exploited in court. Training crews to use these tools effectively ensures that charts provide a source of truth in any legal or compliance review. Final thoughts Jason Bartholomew summed it up best: “Doing something is better than doing nothing.” EMS agencies should start small, focusing on one area for improvement, such as data validation or staff training, before expanding into comprehensive ecosystem integration. Chuck Sweeney emphasized the importance of buy-in from all levels, noting that shared understanding and collaboration across departments are critical to long-term success.   By adopting robust technology and fostering teamwork, EMS leaders can tackle the headaches of staffing shortages, compliance demands, and financial uncertainty – all while improving the quality of patient care.   EMS1 is using generative AI to create some content that is edited and fact-checked by our editors. About the sponsor ZOLL Data Systems' cloud-based solution suite of EMS and Fire solutions covers the scope of your operations, from dispatch to patient care, to incident and operational reporting, to billing. Learn how ZOLL software can help improve clinical, operational and financial performance of your organization at zolldata.com. Rate & Review the Inside EMS Podcast Catch a new episode of the Inside EMS podcast every Friday on Apple Podcasts, SoundCloud, Amazon Music, Stitcher, Spotify, and RSS feed.   Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the Inside EMS team at theshow@ems1.com to share ideas, suggestions and feedback, or let us know if you'd like to join us as a guest.

On this episode of the Australian Property Podcast, Mortgage Broker Chris Bates is joined by Jamie Nemsis founder of Wattle Partners, a prominent financial advisor and retiree specialist. Chris and Jamie are deep-diving into where wealth is sitting and how this is affecting property. Together they discuss the wealth mindset of Baby Boomers, wealth transfer, and retirement. About Jamie Nemsis: Jamie is one of the founders of Wattle Partners. Having been in the industry for more than 20 years. Jamie's career spans the corporate and private sectors, growing and building businesses across financial services. Wattle Partners is one of Australia's most respected advisers, and are specialists in retirees. Insights into the minds of Baby Boomers  How do pre-retirees feel about their home, debt, and investment properties coming into retirement? How do retirees feel about downsizing or treechange? The opportunities and challenges? How has property built wealth for Baby Boomers? Have they made more or less money from residential than other asset classes?  Jamie's personal view on property Financial Advice industry - Jamie's thoughts on conversations around their biggest single assets usually their home/investment properties and debts How do clients feel about helping their kids? If they have enough, do they want to, and even if they don't have enough? Are they worried about future generations or feel they just have to figure it out for themselves? How are they helping their kids and often grandkids? Conversely, How should kids approach their family for help with their property moves? Do they often underspend post-retirement and under save going into it? Buying Residential Property In SMSF Jamie's take on the new Super Tax on bigger balances? Australian Property Podcast resources: Australian Property Podcast online - videos, notes & resources Ask a question Chris' mortgage broking Amy's new property course Amy's 100-point checklist (PDF) Pete Wargent's property coaching Join Owen's Rask Core  membership for $0.99 INFORMATION WARNING! This podcast contains general financial information only. That means the information does not take into account your objectives, financial situation, or needs. Because of that, you should consider if the information is appropriate to you and your needs, before acting on it. If you're confused about what that means or what your needs are, you should always consult a licensed and trusted financial planner. Unfortunately, we cannot guarantee the accuracy of the information in this podcast, including any financial, taxation, and/or legal information. Remember, past performance is not a reliable indicator of future performance. The Rask Group is NOT a qualified tax accountant, financial (tax) adviser, or financial adviser. Full individual disclosures for each guest are available via the show notes page. Owen and The Rask Group Pty Ltd do NOT receive anything for mentioning Super funds, products, shares, bank accounts, etc. Access The Rask Group's Financial Services Guide (FSG): https://www.rask.com.au/fsg Learn more about your ad choices. Visit megaphone.fm/adchoices

Host Jeff Matcha, along with EMS Division Director Dan Pojar, System Medical Director Dr. Weston, Data and Analytics Manager Michelle Anderson and QA Manager Linda Mattrisch, bring you a special edition of Push Dose EMS on the updates coming with NEMSIS 3.5 and what this means for providers, services, and the public.

This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. Page, Wolfberg & Wirth was asked by the National EMS Information System (NEMSIS) Technical Assistance Center (TAC) to research frequently asked questions related to data in EMS patient care reports. PW&W analyzed these questions under applicable laws and guidance, and developed general answers and best practices contained in the new publication, “Patient Care Report Data QuickGuide - FAQs on owning, amending, retaining and sharing patient care report data.” In this week's EMS One-Stop, available in both video and audio versions, Host Rob Lawrence speaks with the PW&W authors of the project, Ryan Stark, managing partner, and Steve Johnson, director of reimbursement consulting. They discuss the guide, why it's needed, and the major FAQs and misconceptions about PCRs. The guide is broken down into four key areas of FAQs: PCRs' legal status Amending PCRs PCR retention Transferring PCR data Top quotes from this episode “I would much rather defend an organization who regularly goes through a quality assurance process, whereby they make the provider and hold them responsible for the accuracy and completeness of the record.” — Ryan Stark “Others may say, we see a lot of amendments to your records. The answer is ‘yes, that's because we care about getting it right' – that's the mantra of our organization.” — Ryan Stark “One of the things behind the importance of documentation is that it doesn't live in a vacuum. We are in a day and age where it's going to follow the patient for their lifetime, so you may have a rehab facility that wants to consult the medical record to determine the mechanism of injury or how the injury occurred and the only person [that knows that] is the EMS practitioner.” — Ryan Stark “Long gone are the days where we can give you a quick ticket, passing along the information to the receiving facility. Now we are marrying up records, electronic health exchanges and other mechanisms and the genesis of all this starts with the original call.” — Steve Johnson “Everyone should sign the patient care report. Why? Because everyone was a function of providing that particular service and we get a lot of pushback and they say ‘well now I'm legally responsible for everything that happened,' and that's not what the law says. The law says, for what you did, you are responsible for what you did and what you didn't do when you had a legal duty to do something or withhold doing something because it was contraindicated. All that indicates is that yes, I reviewed it and to the best of my knowledge it's true and accurate.” — Ryan Stark “The law will impose liability where it lands. Just because you've signed that particular patient care report, doesn't mean you're responsible for all the interventions and everything that I outlined in there, it would be whoever performed or withheld those interventions that would be responsible within the scope of practice.” — Ryan Stark Episode contents 1:09 – Introductions 1:30 – PWW history 3:30 – Introducing the PCR Data QuickGuide 4:20 – The circle of life of a PCR  11:00 – NEMSIS data/research license and EMS by the numbers 13:20 – Who owns PCR data 15:50 – Signatures! And legal responsibility 17:40 – Accuracy of documentation to defend your actions 18:30 – Why does the driver have to sign? 20:00 – Amending PCRs: When and why 22:33 – Who do you tell if a record is amended? 24:30 – Can your state request you to amend your PCR? 27:30 – How long should we keep documents? 30:50 – When an agency closes down or merges 33:30 – Body-worn camera content 35:30 – Transferring paper records to digital 37:15 – Bi-directional data and HIE – responsibilities 40:00 – Final thoughts Additional resources The PCR Data QuickGuide is available now, and we encourage all EMS professionals to download their copies and gain a deeper understanding of PCR data best practices. To download the guide, please follow the link: About NEMSIS About Page, Wolfberg & Wirth About our guests Ryan Stark Ryan Stark is a managing partner with Page, Wolfberg & Wirth, and is the firm's resident “HIPAA guru.”  He counsels clients on labor relations, privacy, security, reimbursement and other compliance matters affecting the ambulance industry.  Ryan started in the healthcare field as a freshman in college, where he worked for a local hospital and a retail pharmacy.  After college, he decided to become a lawyer, hoping to guide healthcare providers through the demanding legal issues they face.  He has been with PW&W since 2007, fulfilling that ambition.   Ryan is passionate about educating EMS professionals and loves collaborating with providers and CEOs alike. He is a featured speaker in PW&W seminars and webinars, including the firm's signature abc360 Conference, where he hosts the abc360 Game Show. Always enthusiastic, Ryan has been invited to speak at many state and regional EMS conferences, as well as national industry events. He is also an adjunct professor at Creighton University in the school's Master of Science in Emergency Medical Services Program.  Ryan developed, and is the primary instructor for, the nation's first and only HIPAA certification for the ambulance industry – the Certified Ambulance Privacy Officer.  He also co-authored PWW's widely used Ambulance Service Guide to HIPAA Compliance.   Ryan volunteers with local community nonprofit organizations. He was also a big brother with the Big Brothers Big Sisters program for over a decade and keeps in touch with his “little.” Ryan also enjoys hiking, running, kayaking and traveling, and spending time with son Oliver.    Steve Johnson Steve began his career in the EMS industry in 1985, gaining valuable experience while serving as an EMT and later as director of a municipal ambulance service in Minnesota. As an ambulance service manager, Steve established his expertise in areas of operations, billing and administration.   Steve also has significant EMS educational experience. He established and served as training coordinator and lead instructor for a State Certified EMS Training Institution for EMTs and First Responders.   Steve served on both the Rules Work Group and the EMS Advisory Council to the Minnesota State Department of Health. He joined the staff of a large, national billing and software company, where he was a frequent lecturer at national events and software user group programs. For over 7 years, Steve served as director of a national ambulance billing service and was responsible for all aspects of managing this company, including reimbursement, compliance and other activities for ambulance services throughout the nation. Steve served as founding executive director of the National Academy of Ambulance Coding (NAAC), overseeing all activities of the Academy, including the Certified Ambulance Coder program, the nation's only coding certification program specifically for ambulance billers and coders.   As the director of reimbursement consulting with Page, Wolfberg & Wirth, Steve is involved in all facets of the firm's consulting practice. Steve works extensively on billing and reimbursement-related activities, performing billing audits and reviews, improving billing and collections processes, providing billing and coding training, conducting documentation training programs, and performing many other services for the firm's clients across the United States.   Steve is also a licensed private pilot, and enjoys an active role in his church. Rate and review the EMS One-Stop podcast Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

There's a new attraction in London, so Crunchy and Hemmingway decide to go and have a look. Mitsuko discovers the joys of domesticity.  X, Squared - the latest audiobook novel by Daniel's Nemesis, follows nervous young wreck Crunchy as he begins work experience at the mysterious organisation The FIB. Things soon decline into a world inspired by German Expressionism and early 2000s Japanese Horror movies.  It's a hoot! (Please forgive the accents!)  There are separate episodes where I give analysis and discussion about the chapters. Check out the feed for those catch-up episodes. One has already been released to explain the origins of the novel.  YouTube channel with full episodes, just the chapters, and podcast highlights: https://www.youtube.com/channel/UCz2-GH1Zuc9He6NKtwr1CeQ  What are your thoughts on this and previous chapters? Have you spotted something that I have missed? Tell me your thoughts at danielsnemesis@gmail.com You can also find me on Twitter to know when a new episode is released at @DanielsNemesis, though nothing much happens there.  

Today on the podcast we are featuring the Los Angeles-based artist NEMSIS. Learn more about her and listen to her track “INNOV8!.” Artist Biography: NEMSIS' aim is to entertain and uplift the hip-hop culture creatively. The Los Angeles-born emcee acquired her stage name, Nemesis, in the early 2000s as she honed her lyrical blade in battles and sessions on the schoolyard. The word nemesis is defined as an unconquerable opponent. So, finding disparity between the ideals that founded hip hop and the pop hip hop that degraded those ideals, Nemesis was emboldened to go worlds beyond mainstream hip hop lyrics, while still delivering the swag and entertainment value that popular hip hop garners. Just popping in to give you a heads up. This podcast contains paid promotional content. That means we were compensated for the feature. All opinions are our own and we only choose to represent music that we truly dig. Now on with the show. Get a full transcript of the show here --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/eat-sleep-breathe-music/message

Leveraging ePCR Data to Identify the Risk of Post-Traumatic Stress Disorder This special episode of "Sacred Cows & Data Cubes" was recorded at the HCA (Hospital Corporation of America) EMS Kansas City Symposium in November 2021. It features an emotional anecdote of post-traumatic stress and recovery by Atchison County (KS) EMS captain and retired Fire Chief Rob Brader. There is safety in numbers: both the math and statistics — and the herd, where one stay anonymous by choice without worry that exorcizing the demons of Mobile Medicine will result in persecution for the dark thoughts that inevitably spawn of this emotional work.   “Let the numbers do the talking” is a core tenet of the approach first revealed to Jonathon Feit, chief executive of Beyond Lucid Technologies by Ron Nichols, director of Chambers County Emergency Medical Services in Texas. Ron uses a questionnaire to see sparks of mental health stress among his personnel in a manner similar to how others might identify infections (say, COVID-19) before they spiral out of control. His crew members have to write an ePCR after every call; and any member of the crew can catch a bad call. He recognized that this offers two opportunities for insight: The ePCR not only offers details about what happened on the call, it also offers details about what the crew experiencedduring the call; If every member of every crew completes a wellness survey after every call—or even after every call involving specific sentinel events—then the requirement to complete a mental wellness or trauma impact survey becomes, by definition, randomly distributed.  There is no longer a need for anyone to “step forward” because everyone has the same requirement. Anyone can catch an unfortunate call. The result is compelling: The data in ePCRs become vital to crews' mental wellness and health.  No longer are ePCRs mere busywork; no longer should they be despised.  Instead, they become something akin to a recurrent Rorschach test for each member of the crew, revealing how they are doing call-by-call, and in aggregate — inviting management to pay attention.  At the end of this discussion, we'll ask: Can agencies really afford not to step in to help, especially amid a talent crunch? If the analytics can be automated and tuned to examine ePCRs over time, then they can reveal who needs help without a crew member saying anything.  This empowers watchful management to step ahead of a health crisis in-the-making, bolstering agency morale and resiliency, satisfaction and safety.  ePCR data—maximized to their potential and strung together over time—therefore go beyond the collection of legal, billing, and NEMSIS data.  They become a tool to safeguard Mobile Medicine's most precious resource: its professionals on the line.

Jonathon Feit, co-founder and CEO of Beyond Lucid Technologies & Consulting joins The Dish on Health IT hosts, Ken Kleinberg, Pooja Babbrah and special guest host Ed Daniels to talk about the role of emergency services (EMS) in the healthcare ecosystem now and in the future and how EMS fits into healthcare's interoperability journey. The hosts, Ken Kleinberg and Pooja Babbrah briefly introduced themselves. Guest host, Ed Daniels introduced himself by saying that the majority of his career has been spent on interoperability, data exchange and HIEs. Ed was a volunteer firefighter for 14 years and is currently working on the development of a multi-stakeholder collaborative on eConsent which is why this discussion was of particular interest to him. Jonathon then introduced himself explaining that he is not a field practitioner or first responder. He shared that he joined the military after September 11, 2001 but discovered that his Tourette's syndrome disqualified him from service, which led him to find another way to serve. He decided to leverage his skills as a technologist to solve problems related to data exchange to support EMS and first responders. Beyond Lucid, the company Jonathon co-founded is focused on solving these issues. Right now, Beyond Lucid spends half of their day in the world of Fast Healthcare Interoperability Resources (FHIR), EMS, critical care both ground and air, the other half of the day is in the world of electronic health records (EHRs) focusing on things like patient matching. Beyond Lucid is currently running the Oregon Portable Orders for Life Sustaining Treatment (POLST) registry from a technology standpoint and are branching into pediatrics and medical complexities. What Jonathon finds interesting about this work is identifying what field providers do and what they need. Using end of life medical orders as an example, Jonathon pointed out that there is really a 0% margin of error. If someone has indicated in their records that they don't want to be resuscitated but first responders are unaware of these records, the patient's wishes may not be followed. Another aspect of data exchange from the field to health systems so that data captured in the field can be incorporated into the patient's record fast enough for it to be useful in how the patient is cared for in the emergency room (ER). The future of Beyond Lucid is focused on car crashes, winning a patent on a system to gather crash intelligence about the passengers such as number of passengers, whether children are in the car, or special medical needs of passengers such as hemophilia. There are mission critical pieces of data that need to be exchanged in real-time. What prompted Jonathon to reach out to Point-of-Care Partners initially was the episode of the Dish on Health IT about social determinants of health (SDOH) because it highlighted patient data that helped look at patients as people. SDOH is important to providing holistic care. Host, Ken Kleinberg asked for a little more context of how EMS fits in the overall healthcare ecosystem, asking specifically about how EMS has historically been billed separately from other healthcare services as transport. Mr Feit explained that yes, it's true that EMS is billed as transport is many places but it's a yes with an asterisk because things are changing due to COVID. He explained that you really have to look more broadly to federal laws and how EMS is regarded. For example, up until the last 18 months, CMS regarded EMS as a supplier to healthcare, not a provider. This impacts not only how services are billed but related to interoperability rules as well.  Meaningful use doesn't apply to EMS which is a big problem because EMS uses a different data set that falls under the department of transportation and not Health and Human Services (HHS). He added that EMS is the most expensive taxi ride you'll ever take. With the exception of one value-based care experiment happening now, EMS services are generally billed on a per mile basis and the rate is cost adjusted based on the experience level of the driver and the severity of the patient. EMS is emerging as a central part of safety net care in rural spaces where there aren't enough doctors to serve the population and the fact that it's a service available 24/7. Viewing EMS as a provider is a critical distinction that's starting to change. Ed agreed with how Jonathon characterized the current view of EMS in healthcare generally and in regulation. Ed explained that historically, ambulances were intended to just get the patient into the hospital as soon as possible but it's changed drastically over the years with life-saving services being performed on site and in transit. Ambulances are no longer just transport but definitely a provider situation. It's time for a change in how this type of care is provided and being billed and reimbursed.Ken observed that it would be a real problem if the patient was charged in hospital for how far they were pushed in a wheelchair from their room to get a test. Ken then asked Pooja if there was a parallel between how pharmacists have transitioned to be part of the care team as opposed to an adjunct service. Pooja responded that she does see some parallels and mentioned reading a CMS blog post by Chiquita Brooks-LaSure and other CMS leaders that discussed the Center for Medicare and Medicaid Innovation (Innovation Center) which explored 50 alternative payment models to fee for service. While only a handful were considered successful, the ones that had some success had mandates to back them up. Pooja added that she thinks that just as the payment model in pharmacy is being revisited, the payment and reimbursement model for EMS should be re-examined as well. Ed added that another scenario where the pay for transport model for EMS just doesn't make sense is when a patient maybe just needs to get emergency care at home but doesn't need to be transported to the hospital. The current reimbursement structure doesn't allow for this. Jonathon pointed out that there is currently an “allergy” in the mobile medical arena to good data. He went on to clarify that when you mention CMS, where they have extremely wonky geeks who are truly good at their job, people forget they need fuel for their work, they need data. Jonathon went onto explain that when creating mandates versus voluntary guidance, you really need not just data but good data to back that up and see what is working and what's not. Right now, entering in information about a patient encounter by EMS staff isn't a priority because there isn't an understanding of how good data could transform things for the better. EMS has so much catching-up to do. Jonathon added that this lack of good data problem isn't unique to EMS by any means but it's an issue that needs to be tackled for us to see real change. Jonathon explained that part of the reason he reached out to Point-of-Care Partners was because he felt we provide a breadth of perspective to these issues in healthcare that reflects the bigger picture. He added that when docs talk to other docs or nurses and EMS techs to talk to Fire fighters, they aren't hearing from outside their environment to gain that broader perspective and close the gaps in understanding about their role in the ecosystem. He continued to say that we need to make the case why it's so important to get good data into the system and for that data to be fluid across environments. Ken interjected and said that now that the now we're getting into the interoperability part of the conversation, he wanted to ask about the system that's generally used by EMS called The National Emergency Medical Services Information System (NEMSIS) and asked if it was connected to EHRs.Jonathon responded that NEMSIS is separate and therefore and unequal data set maintained through the National Highway Safety Administration. It has a rich history of tracking data for car crashes and heart attacks while driving which Jonathon admitted was a gross over-simplification. There is a way for NEMSIS to connect to EHRs but there hasn't been education and discussion from the federal level down to the state, county and regional level on why the data and connecting to EHRs matters. Beyond Lucid was awarded a project in California back in 2015 to build the bridge between NEMSIS using HL7 standards like CCD. Beyond Lucid completed a gap analysis to understand what it would take to go from one to the other. What they found was an 85% overlap between what was required in the EMS system and the HL7 CCD. The 15% gap fell largely in 3 buckets including family history, past encounters and mental health which is very similar to SDOH. There are efforts to plug this hole with real-time data. Jonathon added that there are other efforts giving an example the largest fire service in Southern Denver, Colorado which was the first to send real-time data to Sentara health system in 2018 which shows it can be done, however, Jonathon added that health systems and EMS aren't doing a good job of talking with each other about their respective needs. Ken asked Jonathon to talk about Beyond Lucid being one, if not the first EMS IT vendor to join the Commonwell Health Alliance and whether they are now getting some SDOH data from HIEs. Jonathon explained that about 2 years ago at the National Association of State EMS officials, there was an outcry for SDOH and contextual data. Up until then this demand was mostly at the local level. Beyond Lucid volunteered to be the vendor to make this possible and develop a superset of data and has announced this capability to populate SDOH data for 911 calls. This project made a lightbulb go off for those involved on why this data should be a separate data set when it really should be integrated in the overall record. Jonathon explained that strong ID is really important because especially when you're looking at end of life orders, you want to make sure you're looking at the right patient. Unfortunately, a lot of initiatives required affirmative permission from he patient to look them up but the problem is that this doesn't work in the back of an ambulance. Ultimately the trust framework is critical but right now there is so much dirty data. Jonathon went on to say that now that FHIR V4 has been balloted and approved and Carequality/Sequoia was awarded the trust framework project, it seems progress is being made and EMS is finally at the table. Ken asked Pooja to provide her perspective on how EMS might use SDOH and eConsent and advanced care directives. Pooja shared that when you think about the knowledge first responders gain about a patient's living situation and environmental challenges, it makes sense that they could contribute valuable SDOH data that could be used downstream. It's about time the industry start looking at how the data going into EMS systems can be shared along the care continuum. Jonathon interjected that it's also important for police to have access to some of this information and that Beyond Lucid has helped create a database of medically complex children so police know if they are interacting with someone that perhaps is non-verbal so can't explain their situation or who can't follow verbal commands. Without this information Police encounters can end tragically. Encounter data really needs to flow throughout healthcare and also community services. Ken re-focused the conversation on eConsent. Ed shared that he is working on an initiative now on how to get electronic informed consent and advanced directives. It's a very complicated question and there isn't one answer. Ken began to close out the podcast by asking Jonathon if there was any last topic he'd like to cover suggesting perhaps something about COVID and vaccines since Jonathon had mentioned this in conversations prior to the podcast. Jonathon responded that he knows vaccines can be controversial and really he isn't talking about vaccinations per se but it's important to talk about interoperability and data quality and that for many years vaccination registries didn't talk to each other or couldn't be accessed by providers. This is important in the context of when you're planning to hold someone to account on getting vaccinated and proving they've been vaccinated. Jonathon posed the question that shouldn't there be a single source of truth rather than asking people to hold onto a little card? If we get the smart people in the room to solve these problems, we can make so much progress. Pooja added that in her role on the NCPDP board, they've had many conversations about how to use existing standards to create a central source of truth. Pooja explained that she's glad we were able to have this important discussion. 

Ben Fisher, paramedic and NEMSIS guru, joins us to talk about what NEMSIS is and it's importance to the career field.

In this week's episode of the EMS Handoff Podcast, Eric, Bradley, and David discuss the hot-button topic of body worn cameras in EMS. This is a topic that has made its way through law enforcement, and now with multiple conversations, it is being discussed in EMS. Here are our thoughts.   * Patient privacy concerns * Blurring the line between us and law enforcement * What is our use of force policy? * NEMSIS body cam position paper 06/2021 * Video access and QA * Consent * Bodycam feedback * Patient care documentation gap

In this episode, it's all going to hell fast! Kidnapped on Nemsis, Usagi learns more about the Black Moon clan from Demande, we learn that Chibiusa only looks like a young girl and is really 900 years old! Mako, Rei, and Ami awaken in a chamber within the Black Moon castle only to succumb to an energy sucking corpse, there's implied chemistry between King Endymion and Sailor Pluto, and we absolutely fail at trying to make a 900 titled pun. Justin's Twitter & Instagram: @justingrey22 Podcast Twitter & Instagram: @sailormangapod Podcast Email: sailormangapodcast@gmail.com --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

With Chris Cebollero away, stand-in host Rob Lawrence and regular presenter Kelly Grayson welcome Dr. Jon Krohmer, director of the NHTSA Office of EMS, for an EMS Week chat. Dr. Krohmer explains the role and tasks of the Office of EMS, as well as its interaction with the Federal Interagency Committee on Emergency Medical Services (FICEMS) and National EMS Advisory Council (NEMSAC). Rob also raises the issue of data and the team discusses the NEMSIS weekly "by the numbers" product.

"NEMSIS" Hosts: Darren Weeks, Vicky Davis Show website: https://governamerica.com Vicky's Websites: https://thetechnocratictyranny.com and http://channelingreality.com COMPLETE SHOW NOTES AND CREDITS AT: https://governamerica.com/radio/radio-archives/22369-govern-america-july-18-2020-nemsis LISTEN LIVE EVERY SATURDAY AT 11AM EASTERN DAYLIGHT TIME (8AM PACIFIC) OR 1500 UTC AT: http://live.governamerica.com Deep dive on NG-911, the next generation 911 service and the national emergency management and information system. The National Highway Traffic Safety Administration is now a "public health authority". Extensive research on the far-reaching tentacles of Palantir Technologies and billionaire Bilderberger, Peter Thiel. How the Pentagon's LifeLog program and Peter Thiel connect to Facebook's origin and purpose. Palantir's highly-secretive "preventive policing" initiative that built detailed dossiers on the residents of New Orleans without their knowledge or consent. How many other cities are using similar technologies? Why has the White House has empowered Palantir to handle COVID data for the Department of Health and Human Services? Officials claim COVID cases are rising, and states appear to be headed for another lockdown. But can the numbers be trusted? As mask mandates grow, is society being transformed through psychological manipulation? Anti-beef propaganda continues, as Agenda 21 diets are pushed. This weeks' Twitter hack emphasizes the danger in putting too much trust in Silicon Valley platforms. Atlanta mayor Keisha Bottoms blames lawful gun owners for unlawful shooters, North Carolina town passes reparations for slavery, black Portland cop talks about BLM, and more.

This week Shaun and Chris talk about Nioh 2, the pesky COVID virus, Nemsis's fashion choices and much more!

Show Notes for Episode Twelve of seX & whY: Sex and Gender Differences in CPR Part 1 & 2 Host: Jeannette Wolfe Guest: Dr Justin Morgenstern Two big databases surrounding cardiac arrest Cares- Cardiac Arrest Registry to Enhance Survival which is based on information from national EMS data input via the NEMSIS national EMS information system ROC- Resuscitation Outcomes Consortium (ROC) 2011-2015. The ROC is a network of National Institutes of Health -funded clinical trial network evaluating out of hospital cardiac arrests that collects data from 11 different sites around the United States Here are two great articles that cover this material in depth AHA 2019 stats When the Female Heart Stops: Sex and Gender Differences in Out-of-Hospital Cardiac Arrest Epidemiology and Resuscitation What we know Over 350,000 people will have a cardiac arrest this year Men account for about 2/3 of OHCA average age for men 66 average age for women 72 About 20-25% will occur in public place Men are proportionately more likely to collapse in public place than women (19% versus 8.4% in one study) About half of cardiac arrests are witnessed (about 37% by layperson and 12% by EMS) compared to men, women have higher rate of unwitnessed arrest. (46% vs 52%  in one study) Bystander CPR doubles to triples rates of survival Rates of bystander CPR are highly variable and depend heavily upon where you live and its demographics with CPR being less likely to be started in predominately minority and lower socioeconomic communities. Overall, it appears that about 35-40% or cardiac arrests will get bystander CPR Where you live is also dramatically associated with your rates of leaving the hospital neurologically intact. One study that examined 132 different counties showed, depending upon the county,  functional recovery rates ranging from 0.8%-20% (which again, is likely heavily influenced by  variations in CPR and AED use.) CARES data bank stats suggest that out of hospital cardiac arrest (OHCA) 28% live to hospital 8% leave neurologically intact Usually less than 20% of initial rhythms of OHCA are shockable though sex difference here also (one study 29% men vs women 16% with initial shockable rhythm) Per one survey  about 2/3 of people has some type of CPR training with 20% being currently trained CPR training noted to be lower amongst Hispanics, elderly, lower income, less formally educated Of those trained in CPR only about 1/3 of people will actually step up and do it when indicated First study Gender disparities among adult recipients of bystander cardiopulmonary resuscitations in the Public from Audrey Blewer in Cir Cardiovasc Qual Outcomes 2018 Primary study question- is there an association between an individual's biological sex and the likelihood they will receive bystander CPR Resuscitation Outcomes Consortium (ROC) 2011-2015 This was a retrospective analysis of data collected in a prospectively for several clinical trials in out of hospital cardiac arrests from 7 of these sites. Exclusion: Traumatic arrest Occurs in a residential institution or hospital Less than 18 CPR initiated by someone who was not a layperson (police EMS doc) The variable they used in logistic regression modeling included whether event was witnessed, location, layperson CPR, time of event, and basic demographics including age, race, gender Nontraumatic out of hospital cardiac arrests 19331 events Mean age 64 63% male 17% public location (3297) 82% private (15788) Overall 37% received CPR (38% of men and 35% of women) If collapse occurred in public place 45% of men and 39% of women If collapse occurred in private place 36% of men and 35% of women received CPR Overall: Males had 29% increased odds of survival Bottom line: If you have a OHCA in public you are about 6% more likely to receive CPR if you are a man than a woman This is not the only study showing gender differences in CPR here is a   Netherland study and an avatar study which also highlight these differences. There are also studies suggesting subtle gender differences in EMS treatment of chest pain/cardiac arrest: time to CPR, time to first rhythm strip, IV placement, medication administration likelihood of getting lights and sirens or aspirin Ok so why is that happening? So first let's talk about some general barriers to stepping up and doing CPR in public- A 2008 study by Swor in Annals of EM interviewed almost 700 bystanders to an OHCA. Although about ½ of the bystanders had previous CPR training only about 20% actually started doing CPR. Cited barriers to doing CPR included: - feeling of panic (reported by about 38% ) - concern of doing it incorrectly (9%) - concern they could cause harm (1%) - reluctance to do mouth to mouth (1%) In another study which surveyed community members from areas in which there were low rates of bystander CPR to understand why the rates were so low, answers included:   - fear of getting sued - emotional overtones of the situation - lack of knowledge - situational concerns  A different study suggested that disagreeable physical characteristics- read dentures and vomit-  might hamper CPR initiation. Overall you are more likely to step up and do CPR if CPR training within last 5 years (OR 6.6) in public (OR 3.1) see them collapse (OR 2.3); bystander has greater than a high school education (OR 2.0) So the next question is, are these the reasons why there is a gender difference in who gets bystander CPR or are there additional factors to consider. Second study Public Perceptions on Why Women Receive Less Bystander Cardiopulmonary Resuscitation than Men in Out of Hospital Cardiac Arrest Perman Circulation 2019  Primary Question- what are the public perceptions as to why women are less likely to get bystander CPR?                                             Methods- Electric survey via Amazon's crowdsourcing platform- Mechanical Turk. Participants were English, >18 and familiar with CPR principles Mechanical Turk- have “master users” people achieve this rate by apparently having a history of completing other surveys out appropriately in the past (essentially successfully answering planted “attention” surveys which suggests that they are actually reading the surveys) Participants were asked 11 multiple choice questions and one free text- “ Do you have any ideas on why women may be less likely to receive CPR than men when they collapse in public?” Free text responses were coded and major themes were identified by using an inductive qualitative method.   548 subjects 542 completed surveys average age 38 equal number of males and females about 1% of participants were transgender 81% White 7% Black 6% Asian 3% Hispanic 45% college diploma ½ were trained at some time in CPR (top reasons for training were cited a work or volunteer related requirement) 24 had actually done CPR on a collapsed person- Three major themes evolving: 1) Sexualization of woman's bodies (40% of men mentioned versus 29% of women)      - fear of making incidental contact with a woman's breast “I think that people are afraid to touch the breast region, so hesitate to administer CPR”      - fear of being wrongfully accused of sexual abuse “Bystanders, especially male bystanders, may be afraid to touch women especially in the chest area... anxious that their help my be unnecessary and therefore touching may be misconstrued” “Men are afraid of seeming like perverts” 2) Perception that women are weaker and frailer and thus at greater risk for injury if CPR was not really needed “People might be afraid of hurting them since women tend to be smaller and more fragile looking than men” 3)  Misperception of what actual distress looks like in females ”They are not known to have as many heart attacks in public, they are known to be healthier”  “ Maybe people assume they are being dramatic and overreacting so CPR isn't needed”  Interestingly in the open- ended responses it was frequently implied by use of pronouns that the bystander initiating CPR would be a man. Along these lines, this European paper hints that gender related issues may also influence who steps up to start CPR. My (liberal) summary of paper: “Look I'm not super thrilled about the idea of touching a woman's breast and quite frankly I'm a little scared about being accused of sexual assault.  And also, if I'm honest, I'm a little suspicious that the woman might be collapsing from something less serious, because most cardiac arrests seem to happen in guys. Finally, if I do start CPR on a woman and they really didn't need it, I'm afraid I might accidentally physically hurt her. Five take home points As more than 60% of cardiac arrests do not get bystander CPR, please consider sending out these CPR videos from the American Heart Association and The British Heart Foundation to friends or family members to teach and/or reinforce basic CPR principles as good CPR doubles to triples survival rates. There are innate biological sex differences associated with out of hospital cardiac arrests including: 2/3 of cardiac arrest occur in men who collapse on average collapse about 7-10 years earlier than women. Men are also more likely to have an initial shockable rhythm. Gender related issues, which can notoriously sneak under the radar if we don't intentionally look for them, can also impact cardiac arrests. The study we talked about today suggested about a 5-6% absolute differences in public bystander CPR rates with men receiving more CPR. Concerningly there is similar research suggesting gender based inequities of both the EMS and hospital management level of cardiac arrest and we will continue this discussion in part 2 of our series. Although more deductive research is needed, there are hints that some of these gender related CPR differences are rooted in concerns surrounding sexuality, perceptions about fragility and misconceptions that collapsing women are unlikely to be having a cardiac arrest. The first step to gender- based gaps in cardiac arrest is to simply validate they exist. If you teach CPR, recognize and normalize that for some learners, invading someone's personal space can feel totally awkward and then encourage them to mentally rehearse different scenarios in which they visualize themselves successfully starting CPR.  Using tools like the womanikin can help. As it appears that only about 30% of people who already know CPR, will actually step up to do it, we must work on ways to close this gap. Considering the introduction of stress inoculation and introducing things like Mike Lauria's breath, talk, see and focus technique holds promise. Other references High Sensitivity Troponin and Gender Differences in treatment after ACS North Carolina's Heart Rescue Intervention Article about CPR and Good Samaritan laws

Show Notes for Episode Twelve of seX & whY: Sex and Gender Differences in CPR Part 1 & 2 Host: Jeannette Wolfe Guest: Dr Justin Morgenstern Two big databases surrounding cardiac arrest Cares- Cardiac Arrest Registry to Enhance Survival which is based on information from national EMS data input via the NEMSIS national EMS information system ROC- Resuscitation Outcomes Consortium (ROC) 2011-2015. The ROC is a network of National Institutes of Health -funded clinical trial network evaluating out of hospital cardiac arrests that collects data from 11 different sites around the United States Here are two great articles that cover this material in depth AHA 2019 stats When the Female Heart Stops: Sex and Gender Differences in Out-of-Hospital Cardiac Arrest Epidemiology and Resuscitation What we know Over 350,000 people will have a cardiac arrest this year Men account for about 2/3 of OHCA average age for men 66 average age for women 72 About 20-25% will occur in public place Men are proportionately more likely to collapse in public place than women (19% versus 8.4% in one study) About half of cardiac arrests are witnessed (about 37% by layperson and 12% by EMS) compared to men, women have higher rate of unwitnessed arrest. (46% vs 52%  in one study) Bystander CPR doubles to triples rates of survival Rates of bystander CPR are highly variable and depend heavily upon where you live and its demographics with CPR being less likely to be started in predominately minority and lower socioeconomic communities. Overall, it appears that about 35-40% or cardiac arrests will get bystander CPR Where you live is also dramatically associated with your rates of leaving the hospital neurologically intact. One study that examined 132 different counties showed, depending upon the county,  functional recovery rates ranging from 0.8%-20% (which again, is likely heavily influenced by  variations in CPR and AED use.) CARES data bank stats suggest that out of hospital cardiac arrest (OHCA) 28% live to hospital 8% leave neurologically intact Usually less than 20% of initial rhythms of OHCA are shockable though sex difference here also (one study 29% men vs women 16% with initial shockable rhythm) Per one survey  about 2/3 of people has some type of CPR training with 20% being currently trained CPR training noted to be lower amongst Hispanics, elderly, lower income, less formally educated Of those trained in CPR only about 1/3 of people will actually step up and do it when indicated First study Gender disparities among adult recipients of bystander cardiopulmonary resuscitations in the Public from Audrey Blewer in Cir Cardiovasc Qual Outcomes 2018 Primary study question- is there an association between an individual's biological sex and the likelihood they will receive bystander CPR Resuscitation Outcomes Consortium (ROC) 2011-2015 This was a retrospective analysis of data collected in a prospectively for several clinical trials in out of hospital cardiac arrests from 7 of these sites. Exclusion: Traumatic arrest Occurs in a residential institution or hospital Less than 18 CPR initiated by someone who was not a layperson (police EMS doc) The variable they used in logistic regression modeling included whether event was witnessed, location, layperson CPR, time of event, and basic demographics including age, race, gender Nontraumatic out of hospital cardiac arrests 19331 events Mean age 64 63% male 17% public location (3297) 82% private (15788) Overall 37% received CPR (38% of men and 35% of women) If collapse occurred in public place 45% of men and 39% of women If collapse occurred in private place 36% of men and 35% of women received CPR Overall: Males had 29% increased odds of survival Bottom line: If you have a OHCA in public you are about 6% more likely to receive CPR if you are a man than a woman This is not the only study showing gender differences in CPR here is a   Netherland study and an avatar study which also highlight these differences. There are also studies suggesting subtle gender differences in EMS treatment of chest pain/cardiac arrest: time to CPR, time to first rhythm strip, IV placement, medication administration likelihood of getting lights and sirens or aspirin Ok so why is that happening? So first let's talk about some general barriers to stepping up and doing CPR in public- A 2008 study by Swor in Annals of EM interviewed almost 700 bystanders to an OHCA. Although about ½ of the bystanders had previous CPR training only about 20% actually started doing CPR. Cited barriers to doing CPR included: - feeling of panic (reported by about 38% ) - concern of doing it incorrectly (9%) - concern they could cause harm (1%) - reluctance to do mouth to mouth (1%) In another study which surveyed community members from areas in which there were low rates of bystander CPR to understand why the rates were so low, answers included:   - fear of getting sued - emotional overtones of the situation - lack of knowledge - situational concerns  A different study suggested that disagreeable physical characteristics- read dentures and vomit-  might hamper CPR initiation. Overall you are more likely to step up and do CPR if CPR training within last 5 years (OR 6.6) in public (OR 3.1) see them collapse (OR 2.3); bystander has greater than a high school education (OR 2.0) So the next question is, are these the reasons why there is a gender difference in who gets bystander CPR or are there additional factors to consider. Second study Public Perceptions on Why Women Receive Less Bystander Cardiopulmonary Resuscitation than Men in Out of Hospital Cardiac Arrest Perman Circulation 2019  Primary Question- what are the public perceptions as to why women are less likely to get bystander CPR?                                             Methods- Electric survey via Amazon's crowdsourcing platform- Mechanical Turk. Participants were English, >18 and familiar with CPR principles Mechanical Turk- have “master users” people achieve this rate by apparently having a history of completing other surveys out appropriately in the past (essentially successfully answering planted “attention” surveys which suggests that they are actually reading the surveys) Participants were asked 11 multiple choice questions and one free text- “ Do you have any ideas on why women may be less likely to receive CPR than men when they collapse in public?” Free text responses were coded and major themes were identified by using an inductive qualitative method.   548 subjects 542 completed surveys average age 38 equal number of males and females about 1% of participants were transgender 81% White 7% Black 6% Asian 3% Hispanic 45% college diploma ½ were trained at some time in CPR (top reasons for training were cited a work or volunteer related requirement) 24 had actually done CPR on a collapsed person- Three major themes evolving: 1) Sexualization of woman's bodies (40% of men mentioned versus 29% of women)      - fear of making incidental contact with a woman's breast “I think that people are afraid to touch the breast region, so hesitate to administer CPR”      - fear of being wrongfully accused of sexual abuse “Bystanders, especially male bystanders, may be afraid to touch women especially in the chest area... anxious that their help my be unnecessary and therefore touching may be misconstrued” “Men are afraid of seeming like perverts” 2) Perception that women are weaker and frailer and thus at greater risk for injury if CPR was not really needed “People might be afraid of hurting them since women tend to be smaller and more fragile looking than men” 3)  Misperception of what actual distress looks like in females ”They are not known to have as many heart attacks in public, they are known to be healthier”  “ Maybe people assume they are being dramatic and overreacting so CPR isn't needed”  Interestingly in the open- ended responses it was frequently implied by use of pronouns that the bystander initiating CPR would be a man. Along these lines, this European paper hints that gender related issues may also influence who steps up to start CPR. My (liberal) summary of paper: “Look I'm not super thrilled about the idea of touching a woman's breast and quite frankly I'm a little scared about being accused of sexual assault.  And also, if I'm honest, I'm a little suspicious that the woman might be collapsing from something less serious, because most cardiac arrests seem to happen in guys. Finally, if I do start CPR on a woman and they really didn't need it, I'm afraid I might accidentally physically hurt her. Five take home points As more than 60% of cardiac arrests do not get bystander CPR, please consider sending out these CPR videos from the American Heart Association and The British Heart Foundation to friends or family members to teach and/or reinforce basic CPR principles as good CPR doubles to triples survival rates. There are innate biological sex differences associated with out of hospital cardiac arrests including: 2/3 of cardiac arrest occur in men who collapse on average collapse about 7-10 years earlier than women. Men are also more likely to have an initial shockable rhythm. Gender related issues, which can notoriously sneak under the radar if we don't intentionally look for them, can also impact cardiac arrests. The study we talked about today suggested about a 5-6% absolute differences in public bystander CPR rates with men receiving more CPR. Concerningly there is similar research suggesting gender based inequities of both the EMS and hospital management level of cardiac arrest and we will continue this discussion in part 2 of our series. Although more deductive research is needed, there are hints that some of these gender related CPR differences are rooted in concerns surrounding sexuality, perceptions about fragility and misconceptions that collapsing women are unlikely to be having a cardiac arrest. The first step to gender- based gaps in cardiac arrest is to simply validate they exist. If you teach CPR, recognize and normalize that for some learners, invading someone's personal space can feel totally awkward and then encourage them to mentally rehearse different scenarios in which they visualize themselves successfully starting CPR.  Using tools like the womanikin can help. As it appears that only about 30% of people who already know CPR, will actually step up to do it, we must work on ways to close this gap. Considering the introduction of stress inoculation and introducing things like Mike Lauria's breath, talk, see and focus technique holds promise. Other references High Sensitivity Troponin and Gender Differences in treatment after ACS North Carolina's Heart Rescue Intervention Article about CPR and Good Samaritan laws

In this episode, Ritu and Mike are joined by Dr. Clay Mann, Ph.D. Dr. Mann is the Man when it comes to NEMSIS. NEMSIS? Yea.. you know, the reason we have the ability to look at 31 million EMS encounters across the United States….as the P.I, He is the key holder to unlocking some amazing EMS research. These guys have held up their end of the deal by recording more often, now what you can do is share, rate and leave us some feedback! We appreciate you listening to one of the top 10 EMS podcasts according to EMS1.com. We can’t tell you how much we appreciate you listening and joining in on the discussion!

In space no one can hear your review... Justin and Ricky take time away from exploring the corridors of the Nemsis to discuss and review the game by Awaken Realms. Are they on an express elevator to hell? Don't ask me man, I just work here.

This episode is sponsored by my friends at the PulsePoint Foundation.Episode 125: Greg Mears, MD serves as the Medical Director for ZOLL, providing clinical guidance to ZOLL’s Data and Resuscitation Divisions. Greg has been an Emergency Medical Services Physician, educator, and specialist in performance improvement for more than 25 years. Prior to joining ZOLL, Dr. Mears was a Professor of Emergency Medicine at the University of North Carolina at Chapel Hill and the North Carolina State EMS Medical Director. EMS Agenda 2050, being a State EMS Medical Director, his responsibilities at ZOLL and his love of data and information are some of the topics we discuss. We also touch on the National EMS Information System (NEMSIS), which Greg was a key player. Episode 125: Greg Mears, MD serves as the Medical Director for ZOLL, providing clinical guidance to ZOLL’s Data and Resuscitation Divisions. Greg has been an Emergency Medical Services Physician, educator, and specialist in performance improvement for more than 25 years. His passion is building integrated systems of care and for using real-time data to drive EMS operational and clinical decisions. Greg is the recipient of the Journal of Emergency Medical Services as a Top Innovator in EMS. Prior to joining ZOLL, Dr. Mears was a Professor of Emergency Medicine at the University of North Carolina at Chapel Hill and the North Carolina State EMS Medical Director. EMS Agenda 2050, being a State EMS Medical Director, his responsibilities at ZOLL and his love of data and information are some of the topics we discuss. We also touch on the National EMS Information System (NEMSIS), which Greg was a key player.

Saint Molotov returns this week for a particularly crazy episode. Nemsis starts off by trying to convince SofaBear into a ridiculous cosplay, we discuss the scary origins of warning lablels, our confusion over the Michelin Man, SofaBear rages over in-app purchases, our take on the actors annouced to play Rocket Raccoon and Ultron, a brief look at if Voltron was a rich old man, a look at how games attempt to keep players engaged, we create the worlds worst adult film star, Saint Molotov informs us of the importance of proper unicorn battle armor, and we try to get WebMD to diagnos us with cancer. Starring: SofaBear, Nemesis, Butternubs, and Saint Molotov Runtime: 53min 16sec