two resident physician medical directors. Nealy, along with the support of his medical director, Dr. Levon Vartanian, executive director, Bradley England, and board of directors, built the Axon camera program from the ground up. Safety of the use of group A plasma in trauma: The STAT study. It should be noted that the functionality of cold-stored whole blood decreases dramatically after 21 days. The patient demographics for both data sets were similar regarding patient age, gender, and enrollment status (Table 1). We describe an alcohol refusal 9%, allowing patients to refuse transport who later require care.10, 11. However, in a patient who retains capacity, providers Five years of planning and work finally paid off. Dunbar NM, Yazer MH, Biomedical Excellence for Safer Transfusion(BEST) Collaborative and the STAT Study Investigators. emergency care while also contributing to campus safety and emergency response. Copyright 2023 2017;33(1):1536. A chi-square test was performed and To decrease the amount of time it takes to administer a unit of FWB, the ASBP began shipping cold-stored LTOWB to Afghanistan in March 2016, with the first unit being administered in later the same month. The most severe reactions come from the mismatch of antigens on the surface of red blood cells. 2017;83(1 Suppl 1):S83S91. When you arrive, her husband tells you that shes been experiencing heavy vaginal bleeding for about two weeks. with two full-scale ambulances covering approximately one square mile of urban The existing policy was perceived as Charts were included *https://www.hctax.net/Property/JurisdictionTaxRates, 18334 Stuebner Airline Road Spring, Texas 77379. About 40% of the U.S. population has group O blood, with another 40% having group A. 21. Q&A: Cypress Creek EMS front-line responders try to minimize COVID danger with protocols, Mayor: HISD has two optionsclose school or be taken over, Rare photos show 2 ocelots crossing South Texas road, Eric Gordon trade looking better and better for Houston Rockets, Willie Nelson pays lovely tribute to another country legend, Hiker takes 'once-in-a-lifetime' photo at Brazos Bend State Park, This Texas Hill Country town is the new, cooler Fredericksburg. significant, X2 (1, N = 395) = 51.0, p < 0.05). "Before now, they never were able to see the scene or how the patient presented and behaved prior to intervention by EMS.". Using historical data from World War II, the program defined low titer as immunoglobulin M (IgM) anti-A and anti-B < 256. During the A podcast for Cypress Creek EMS, a progressive EMS service in the Northwest Houston area. HOUSTON On August 24, 2017 at approximately 7:30 pm Cypress Creek EMS became one of only two ground EMS systems in the country to carry Whole Blood in the field 24/7/365. 18. "They were the first in the country to have whole blood on a . Component therapy using a 1:1:1 ratio has several other disadvantages compared to whole blood. Any risk of COVID aerosolizing or any chance of body fluids require gowns. "The video allows for a first of its kind self-QI process. Q&A: Lone Star College-University Park professor offers tips for online learning, 2020 2019 Call Volume in 2020 Compared to 2019 Notes, Feb 3655 3228 Feb of 2020 we were up 427 calls from Feb 2019, Mar 3957 3707 Mar of 2020 we were up 250 calls from Mar 2020, Apr 3304 3567 April of 2020 we were DOWN 263 calls from April 2021, May 3727 3748 May of 2020 we were DOWN 21 calls from May 2022, Jun 3843 3608 June of 2020 we were up 235 calls from June 2019, Jul 4472 3773 July of 2020 we were up 699 calls from July 2024. Routinely, any patient requiring paramedic-level care is transferred to an advanced life support (ALS) EMS agency at the scene. 8. hbbd```b``"H="m@$J!X, H2jj~H`C)$}``bdH 9 The third option is the most feasible for civilian EMS providers. 17. patient transports from GW police department officers to EMeRG medical Pretrauma center red blood cell transfusion is associated with reduced mortality and coagulopathy in severely injured patients with blunt trauma. 12. showed that the relationship between transport requirement and time period was "The only reason the video could be used against a provider is for an illegal, immoral or unethical act," he said. Uhl: Our education facility and admin center which are normally open to the public are closed now. College student drinking and ambulance utilization. Send Sarah an email or reach out on LinkedIn. During the period prior endstream endobj startxref 8. While it might not have been the celebratory confines of a hospital room with excited relatives, it was the safest possible situation for all involved. Dubois: They are supposed to self-monitor every day and submit their results. The effects of prehospital plasma on patients with injury: A prehospital plasma resuscitation. provider. medical technicians (EMT) the opportunity to gain valuable experience in I couldn't find anything on their website. Transfus Med Rev. Following the conclusion of the 2018-2019 academic This conversation between Lynne, Samuel and Steven addresses how to deal with grief. Dr. Ely has a background in EMS and actively worked as a paramedic for a few years before and during medical school. the rate of increase in overall ED visits.7 Binge drinking Dubois: Every shift when they come on will clean the ambulance from top to bottom with a solution that will clean all germs. 23 (See Table 1, p. Resuscitate before you intubate, Laryngoscope as a Murder Weapon (Scott Weingart) Hypotension O2/Hypoxemia pH/acidosis. may choose to implement medical amnesty policies to encourage students calling EMS Copyright 2023 EMS1. . Most services that carry blood components are helicopter-based. Protocols need serious updates, Lack of consistency across the board for disciplinary actions, Body cameras, Call volume, management, their priorities are wrong, field training officers are all . The district assumes no duty to update this website or any information it contains at any time. Additionally, being able to review case studies or near-misses is invaluable in correcting behavior. Hingson R, Zha W, Smyth D. Magnitude and Trends in Heavy Episodic Drinking, Alcohol-Impaired Driving, and Alcohol-Related Mortality and Overdose Hospitalizations Among Emerging Adults of College Ages 18-24 in the United States, 1998-2014. must respect patient wishes even if they contradict medical advice. General PIR:PurposeWhat kinds of patients can be referredWho cannot beWhy a consult is requiredPrehospital discharge instructionsCOVID-19 non-transportPurposeCriteriaProcessHandoutScriptingRecommendations for testing/treatment at home/etc. Population-wise thats larger than the city of Atlanta, Georgia. Harris County ESD 11 operates a fleet of 40 advanced life support ambulances licensed by the state of Texas. Table courtesy Col. Andrew P. Cap, MD, PhD/United States Army Institute of Surgical Research. 26. Please for more information or to help update the list. 2013;163(3):303314. Headquarters. The U.S. military has successfully transfused over 10,000 units of whole blood across the world.20 The body of evidence will grow as more civilian agencies initiate their own whole blood programs. in the study if at least one of the patient complaints or findings included a of EMeRG patients requiring transport are brought to The GWU Hospital, a Cypress Creek EMS is the 9-1-1 emergency medical provider for a portion of Harris County just north of Houston, Texas that is larger in population and land mass than the city limits of Atlanta . Read next: Verbal de-escalation: A magic phrase to stop patient conflicts. refuse care. 5149 0 obj <>/Filter/FlateDecode/ID[<815CE017ACFBE040BE598D9E5B3231B1><5497218DF1D5A5468394CDAEAB3621E8>]/Index[5132 28]/Info 5131 0 R/Length 96/Prev 828644/Root 5133 0 R/Size 5160/Type/XRef/W[1 3 1]>>stream continue to verify the safety of this protocol. (2017-2018), the last year in which the previous alcohol intoxication policy ultrasound monitor while performing a FAST exam, "triggers" that can often preempt an attack, Verbal de-escalation: A magic phrase to stop patient conflicts, Quality assurance/quality improvement review, Open the tools menu in your browser. EMT said Pa. COVID patient didn't need to go to the hospital. hUOSWN{,(fth ne.*(LUG 0"|13i h|mTFE]te{Ls~;}i/ x. alcohol intoxication contributes to 17 to 44% of all university-based ambulance Tell us about Cypress Creek EMS. However, after seeing the success and benefits of the program during the trial, Cypress Creek EMS deployed body cameras systemwide in 2018. outcomes in a student or staff member, we may not be notified of a negative Cypress Creek EMS insights Based on 15 survey responses What people like Time and location flexibility Ability to learn new things Inclusive work environment Areas for improvement Overall satisfaction Sense of belonging Support from manager Great company with a lot of room for advancement 16. "Capturing the line of sight of the paramedic is important to show what the paramedic is seeing. Mullins PM, Mazer-Amirshahi M, Pines JM. Lexipol. Fast forward to December 2019, Cypress Creek EMS took the next step and replaced their in-ambulance camera and driver monitoring system with the Axon Fleet 2 system. The patient must then acknowledge these risks verbally back to the First, whole blood is superior to crystalloids and colloids. In this fictional scenario, an escalation to a potential attack was avoided once the patient realized he was being recorded. Topics covered include: Whats changed with COVID-19, including the new UK and South African virus variants. Platelets are normally kept at room temperature for only five days and must be constantly agitated, but they can also be stored frozen.22. 5. "In the contract between CCEMS and ESD 11, ESD 11 has a blanket right to review CCEMS books and records. The video is stored on the camera.". Nonetheless, Nealy said the body cameras were initially met with apprehension. We were able to find some who were willing to donate and others who sold to us at their cost which was constantly going up because of demand. cause death. Our goal is to help improve all EMS protocols to the current state of the science using evidence-based medicine. Cypress Creek Emergency Medical Services (CCEMS) is a former emergency medical service provider in North Harris County, within greater Houston, Texas.Cypress Creek EMS was brought by Viking Enterprises, DBA City Ambulance Service in late 2022. In this episode, Steven and Samuel sit down with Dr. Jason Ausman, the current EMS fellow, to discuss COVID-19. We are so thankful for your loyalty to CCEMS and in turn, we are committed to keeping you informed.Stay tuned for a question and answer session with Wren Nealy releasing next week on the CCEMS podcast! The list of available protocols is a work in progress. Impact of crystalloids and colloids on coagulation cascade during trauma resuscitation-a literature review. patients intoxicated with alcohol who were evaluated by the George Washington If done properly, whole blood transfusions have a good risk-to-benefit ratio. Uncover why Cypress Creek EMS is the best company for you. They dispatch for Cypress Creek and 16 additional agencies, mostly fire departments, some as far as Pearland and Stafford. Cypress Creek EMS Protocols CTMD Apr 3, 2016 Apr 3, 2016 #1 C CTMD Forum Crew Member 80 13 8 Does anyone know where I can find Cypress Creek EMS' protocols? While we would be informed through the university system of any adverse Today, CCEMS is a model for EMS operations throughout the country. 7. diagnosis of alcohol intoxication.. Annu Rev Public Health.2005;26:259-279. Are your facilities completely closed to the public now? "Our trial will focus on the application of this technology for telemedicine consults and in our mobile integrated health program," Nealy said. Harris County Emergency Services District #48 carries O-negative blood and low-titer A-positive plasma. Photos courtesy Andrew Fisher. intoxication who encounter GW police. Where is the YouTube channel? 2013;53(Suppl 1):107S113S. As Fortunately, plasma transfusion reactions are both less common and less severe than blood cell transfusion reactions.25. This has been shown to be very effective, but it takes a trained responder 815 minutes to collect a single unit. students across the country have experienced adverse outcomes as a results of Institution Lexipol. McLaughlin MP. %%EOF In response to this policy change, EMeRG created a comprehensive transport refusal policy for patients encountered due to concern they might be intoxicated or have consumed alcohol (Figure 1). EMS calls showed ambulance demand exceeds population growth and identified Add the aggressive spread of the coronavirus and their job becomes even more taxing physically and mentally. serious outcomes such as death from alcohol intoxication are relatively rare in If criteria arent met, and providers feel the patient meets the threshold, HCESD 48 Fire Department peronnel are advised to contact the on-call medical director. Emergency Medicine and Health Care. People should feel safe and call 9-1-1 and know that they will be checked out safely, transported safely, and wont be put at risk going to an ER. The ambulances are staffed with experienced Paramedics and Emergency Medical Technicians (EMTs). This university campus is urban and Cypress Creek EMS | 1202 seguidores en LinkedIn. Ultimately, self-improvement, according to Nealy, must start with each provider reviewing and learning from their own videos. Kaczynski J, Wilczynska M, Hilton J, et al. The purpose of this website is to promote openness, discussion and collaboration among system directors in the development of EMS protocols. Head off stretcher works for some, but may actually make things worse as the angle of oropharynx to glottis becomes more steep (glottis more anterior). Component therapy has significantly lower function, with decreases in the percentage of useful red blood cells (hematocrit), platelets and coagulation factors. 14. Dutton RP, Shih D, Edelman BB, et al. Use Next and Previous buttons to navigate. Against all advice: an analysis of out-of-hospital refusals of care. At first, the body cameras were deployed only to supervisors as they responded to all high acuity calls. Since its inception in 1975, CCEMS has established . Resuscitation and transfusion principles for traumatic hemorrhagic shock. All rights reserved. The patient, who seems confused, is restrained. resulted from patient transport refusal under the new protocol. However, it will be expected that any 20. our population, the sample size is limited, and data collection is ongoing to 7111 . Though relatively rare, university As the patient continues to try to escape, he notices a blinking red light attached to your protective eyewear. or need for return visit by EMS for re-evaluation for a chief complaint related 48 (HCESD 48) Fire Department and Cypress Creek EMS (CCEMS) in Houston, Texas, began carrying cold-stored LTOWB for hemostatic resuscitation. "The audit trail documents this and any other activity, which is helpful if the incident ever goes to court.". impact on a non-university affiliate who represented outside our catchment Making a single change in EMS can be difficult. Association of prehospital blood product transfusion during medical evacuation of combat casualties in Afghanistan with acute and 30-day survival. legal liability on the grounds of forced transportation. While you may find opinions and statements elsewhere online, sensationalism and propaganda is widespread. At the time, TASER International, which is now Axon, provided the Flex body camera to all instructors to demo in their courses. It is like they are on autopilot just running down a list of questions, but not really paying attention to the answer," Nealy said. Although the ROLO program was initially designed to deliver fresh whole blood (FWB), the chaotic nature of combat makes drawing a unit of FWB difficult. territory. Group O blood cells lack anti-A and anti-B antigens seen in all other blood types, which is why its considered the universal blood donor. All lead paramedics and supervisors wear the same Axon Flex 2 camera. [1] Realistically, what they have going on will be worse than the virus. Fisher AD, Miles EA, Cap AP, et al. A challenge to the HCESD EMS system is that transport to a Level 1 trauma center may be 20 . alcohol-related visits to the emergency department are increasing at rate that supersedes Are ticket costs pricing Houston Astros fans out of Opening Day? Alcohol-Related Visits to US Emergency Departments, 20012011. The cold-stored LTOWB product is an FDA licensed product, with an IgM anti-A and anti-B titer of < 150. address the risks of morbidity and mortality related to alcohol use in this They provide 24-hour coverage of both Freestanding EDWhat they areWhat they haveWhat kinds of patients should go thereWhat kinds of patients should not. The review of the unique in its geographical setting. Paramedic continuing education classes are offered at the facility regularly to hone the skills of responding personnel to 9-1-1 calls. 2022 Harris County Emergency Services District 11. These field staff providers share their perspective about the latest development in the CCEMS/ESD relationship. 2. of 2018, a university policy change transferred the decision for alcohol-related During Terms of Use, 18334 Stuebner Airline RoadSpring, Texas 77379, Harris County ESD 11 commissioners approve Jamie Chebra as interim CEO, ESD 11 Mobile Healthcare Officials Look Back on 1 Year of Service, REQUEST FOR QUALIFICATIONS FOR AMBULANCE SERVICE SUPPLEMENTAL PAYMENT PROGRAM CONSULTANT, Texas Health and Human Services EMS information. We have to protect everyone including our staff so we can keep doing what were doing and minimize the risk. Each provider went through classroom training on policy and legal aspects, including: "Everyone learned how to use the camera equipment, applications to manage devices and data, and the evidence management system," Nealy said. He is a member of the Texas Press Association and has won numerous state awards. Both data sets were analyzed for the protocols a substitute for good judgment and experience. Uhl: We cover 177 square miles running from just outside Tomball to outside of Humble from east to west. All rights reserved. In a letter addressed to internal Cypress Creek Fire Department staff, District Chief Corthell outlines the newest feature in the Mental Health & Wellness initiative, the Peer Support Program. Youre called to the home of a 38-year-old woman who has been fainting. PLoS ONE,5(5). Nealy, a nearly 30-year EMS veteran, also serves as a captain for the Waller County Sheriff's Office and is a former SWAT commander. All medical procedures have an inherent level of risk if done carelessly or incorrectly. "It maintains the user profiles and authorizations, video retention categories and policies, audit logs, security features that exceed HIPAA and the highest government ratings, a YouTube-style view, and tools to set markers and create clips for viewing important parts of the video. Grant assistance for ZOLL Ventilation products at no cost, Wren Nealy Jr., Cypress Creek EMS chief operating officer, relates how BWCs have contributed to personnel safety, QA/QI. Shock. policy included a reduction number of medically unnecessary patient transports, CCEMS again refused to cooperate, until ESD 11s board of commissioners told CCEMS it would not be paid if it did not comply with PKFs requests. When the crew returns to the station, the lead paramedic or supervisor places the camera on the docking transfer station and the video is automatically uploaded to the Axon cloud-based servers. IRB In this episode, we discuss airways with Dr. Rachel Ely, who is doing a rotation with CCEMS as an Assistant Medical Director as part of the military's EMS and Disaster Medicine Fellowship based at Brooke Army Medical Center in San Antonio. J Trauma Acute Care Surg. Additionally, the trial will also be tested by the communications center supervisor. I think there was some fear and waiting too long to call. Long term effects of COVID-19. Academic Emergency Medicine.2000;7(6):663-669. Much like the body camera acceptance battle they endured from their EMS providers, Nealy said they also quickly realized the importance of involving representatives from their hospital nursing staff early on. SARS among Critical Care Nurses, Toronto. (Community Impact Newspaper staff). A Legacy of Excellence | CCEMS is a 501c3 Non-profit EMS agency specializing in advanced and industry leading Critical Care Transports on the ground and in the air with aggressive evidence-based protocols and off-line medical control supported by the Military EMS and Disaster Medicine Fellowship program as well as the finest tools, equipment . abdominal pain after initially refusing care and transport. PA EMT Said COVID Patient Didnt Need to Go to the NYC Unions Demand Reinstatement, Back Pay for Workers Fired for Refusing President Biden to End COVID-19 Emergencies on May 11. 2003;17(3):223231. The district shall not be liable for any errors, inaccuracies, omissions or untimeliness of information contained in this website. Is it the vocal cords during an intubation or the ultrasound monitor while performing a FAST exam? The average ages were similar: 21 years during the pre-protocol academic year and 23 years during the post-protocol academic year. CYPRESS CREEK - A beleaguered ambulance service that serves about 600,000 people in north Harris County appears to be on life support after reaching an agreement with Emergency Services. the George Washington University (GW) Foggy Bottom and Mount Vernon campuses Treating coagulopathy in trauma patients. When administered to a significantly injured patient, theyre usually transfused in a 1:1:1 ratio of RBC, FFP and platelets, depending on availability and local trauma center protocol. A new study says yes. department visits subsequently found to be unnecessary or punitive. obtained for this study. What that means if we run across a case that is not serious enough for a hospital run, and something that could be treated at a free-standing ER, the paramedics will consult with the assistant medical director or medical director and offer a referral. total all-complaint call volume decreased from 701 to 624 calls between the two The risk of She recently underwent a caesarean-section delivery of her second child. If Plasma and cryoprecipitate can be kept frozen for a year, and once thawed will last for 24 hours. to the new protocol, 92% of patients admitting to alcohol use required transportation Platelets are usually collected separately. He attended Rice University and the University of Houston and has led the news rooms of several newspapers including The Sentinel Newspapers, The Pasadena Citizen, The Examiner Newspapers, and The Observer Group. To ensure the agency implemented the cameras successfully, they started slowly with a trial in 2012 that evolved into a clinical study that lasted 18 months. The Your use of this website means you agree to the terms, conditions and disclaimers. 2005-2022 Community Impact Newspaper Co. All rights reserved. 9. patient transports to the emergency department without increasing adverse patient only 63% were transported. Emerging Infectious Diseases,10(2), 251255. Cypress Creek EMS is dedicated to providing a rewarding atmosphere for the volunteers who make a difference in our organization. was used, were compiled for comparison. What about the mental health of your paramedics? Harris County ESD #13, Cypress Creek Fire Department, would like to congratulate Assistant Fire Chief Jason Blackman on his recent appointment to the Committee on Respiratory Protection Equipment, a sub-committee of the National Fire Protection Association (NFPA). the assessment of capacity may vary amongst types of providers. The plasma can be further prepared into cryoprecipitate. Risk factors for SARS transmission from patients requiring intubation: A multicentre investigation in Toronto, Canada. "There are strict security protocols in place," he said. Ann Surg. revealed few interacts with each other and researches product purchases ESD 11 covers 177 square miles and responds to more than 65,000 emergencies annually. In late August 2017, Harris County Emergency Services District No. Uhl: We run 19 full-time ambulances and just added three in the last four months. Multiple studies have reported that feel safe. "Training was four hours and, with each additional deployment, we have added additional training.". Br J Haematol. Two retrospective from alcohol-related unintentional injuries each year.9, Regardless of intoxication, the Cypress Creek EMS is dedicated to providing a rewarding atmosphere for the volunteers who make a difference in our organization. Strandenes G, Spinella PC. medical services (EMS) agencies across the United States offer collegiate emergency They can be used all the time while U/V light is unsafe for human beings. Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore. trips.1, 2 In addition to acute intoxication, alcohol use can lead to Read more about the latest news from ESD 11, our providers, and the community we serve. And thats only part of how the medical world has changed for first responders who must answer an increasing volume of calls in a virus-laden pandemic that is so easily spread. "The meta data then stays with the video during transfer. There's a huge expectation that first responders should intrinsically understand how to move through the sadness and difficulty of losing a patient, whatever that may look like.This podcast looks at the stages of grief and how they relate to first responders; it is important to be healthy in processing the death of patients, especially when it is traumatic or sudden. of a new alcohol refusal policy will significantly decrease the number of alcohol-related Tension has risen between the two entities since June 2020, when ESD 11 commissioners initially voiced concern over extending the district's contract with CCEMS that provides emergency medical. Weve just stepped it up to make sure that were providing extra protection for people. There are a lot of people who dont wear their clothes home or strip down in the garage. for alcohol intoxication in an emergency department versus those who may safely Noorman F, van Dongen TT, Plat MJ, et al. The other agency. In the future, it may be possible to make component therapy from the unused LTOWB units. Alcohol-associated illness and injury and ambulance calls in a midwestern college town: a four-year retrospective analysis. post-protocol study period, one patient called EMS for re-evaluation for Pre-hospital transfusion of red blood cells in civilian trauma patients. Optimal fluid therapy for traumatic hemorrhagic shock. Drinking to toxicity: college students referred for emergency medical evaluation. on campus. Picture this: You are in the back of an ambulance with a combative patient. Do you require them to change into their clothes at work and shed them the same way before they leave? Bolton-Maggs PH, Cohen H. Serious Hazards of Transfusion (SHOT) haemovigilance and progress is improving transfusion safety. Uhl: We were donated Code 3 white disinfecting lights by Jon Forbes of Lone Star Products and Equipment for all our ambulances. 8:57 PM Jun 25, 2021 CDT, Harris County Emergency Services District No. MMWR. Alcohol and Alcoholism.2016;52(1):119-125. Kharasch SJ, McBride DR, Saitz R, Myers WP. The collection bag has the same type of anticoagulant as the RBCs. Armand R, Hess JR. Weve purchased some new gowns that allow some breathing and theyre happy for that. 1996;161(Suppl):316. This established protocol was coordinated through the HCESD 48 Fire Department EMS chiefs, CCEMS Director of Special Operations John Holcomb, MD, and the Gulf Coast Regional Blood Center. to the emergency department. David Taylor is the reporter/photographer for Houston Community Newspapers / Houston Chronicle and writes news, sports and investigative pieces. Cypress Creek EMS runs approximately 18 ambulances on a 24-hour shift and three peak ambulances, said CCEMS PIO Steven Beesley. Wesley joined Community Impact in May 2021 after graduating from St. Edwards University with a degree in mass communication in 2012. Hewitt: The ambulances are left running all the time and so is the air conditioning. Are you finding any difficulty in finding PPE? Version 22.0 Effective 02 -25-2022 1 . Once you decide they need an advanced airway, give all the oxygen. Similarly, JAMA. Prior to deployment, Cypress Creek EMS was not tracking attacks on providers as a data point. 15. Transfusion: -80 degrees C frozen blood products Are safe and effective in military casualty care. CCEMS is one of the most reliable EMS services in Houston, having a response time of about eight minutes. inappropriately triaged due to the refusal protocol. back if they feel as though their condition is worsening or if they no longer Prehosp Emerg Care.2010;14(4):485-490. Balancing Patient Safety and Hospital Overload through Collegiate EMS Alcohol Refusal Protocol, California EMS Workers Deploy into Skilled Nursing Facilities, UFA Accuses de Blasio of Using First Responders as Pawns Over Federal Funding, Keene (NH) Firefighters Raise Concern about Competition from Cheshire EMS, Enid (OK) Fire Department Begins SWAT Medic Program to Assist Police, Documents Detail EMTs Failure to Aid Tyre Nichols, New Course Lets Bystanders Be the Help Until Help Arrives, Austin-Travis County (TX) EMS Launches Airport Medic Program, Dont Sacrifice Nuance and Throw Ambulances Under the Bus, NJ EMS Task Force Helps Evacuate Hospital, Elite Medical Transport Donates Ambulance, Equipment to Janos, Mexico. University-based volunteer emergency Dubois: I ask our staff how theyre doing physically and mentally to see if they have any needs or have someone they can talk to. This may be called Tools or use an icon like the cog.