Didactics

AbstractAfter a decade of managing EMS consult calls, we have learned that the most challenging cases rarely involve medications, procedures, or protocols. Instead, they involve people—patients, providers, law enforcement officers, families, and clinicians attempting to navigate uncertainty while balancing autonomy, safety, and risk.

In this highly interactive session, participants will embark on a series of guided "quests" based on real-world EMS consult cases. Through live-action role play (LARP), attendees will experience challenging encounters involving psychosis, suicidal ideation, intoxication, refusal of care, protective custody, and conflicting stakeholder priorities. Participants will assume the roles of field providers, consulting physicians, patients, family members, and law enforcement personnel as they work through complex scenarios where there may be no perfect answer.

Along the journey, we will explore the practical application of medical capacity assessment, clarify the distinction between capacity and competency, and discuss approaches to managing situations in which EMS, law enforcement, consulting clinicians, and patients do not share the same goals. Special emphasis will be placed on strategies that improve communication, develop shared mental models, and strengthen relationships between field providers and medical consultation resources.

Whether facing a patient seemingly possessed by "purple slugs," an intoxicated individual refusing care, or a family demanding psychiatric evaluation despite unclear evidence of acute risk, attendees will leave with practical tools to approach difficult consults, improve decision-making, and transform challenging conversations into collaborative problem-solving opportunities.

About the speakerDr. Doug George is an Associate Professor at the University of Vermont Larner College of Medicine and a Prehospital and Emergency Medicine physician with the University of Vermont Health. He serves as an EMS Physician and Medical Director for the University of Vermont Health Critical Care Transport Team and as the District Medical Advisor for Vermont EMS District 3.

Dr. George also functions as an operational physician and Medical Director for Vermont Urban Search and Rescue Task Force 1 (VT-TF1), Vermont State Police Special Operations Group and provides tactical medical support to local, state, and federal agencies.

He is a graduate of Loyola University Chicago Stritch School of Medicine, completed his Emergency Medicine residency at Boston Medical Center, and pursued fellowship training in prehospital medicine at the University of New Mexico.

About the speakerI have 13 years of critical care transport experience and currently function as the clinical coordinator and a flight paramedic for the UVM HealthNet Critical Transport system. I have presented at ECHO, AMTC, and CCTMC in addition to teaching EMS classes for The University of Vermont and abroad in Honduras. Prior to transitioning to critical care, I worked in various EMS systems for 11 years and as the training officer for a combination 911 department. I am also involved with the IBSC as a subject matter expert for the FP-C and CCP-C exams. Functioning as the clinical coordinator and as a subject matter expert require expertise in all areas of clinical care provided in the prehospital setting.

AbstractComplex pelvic fractures are severe injuries associated with substantial morbidity and mortality. Mortality associated with pelvic fractures generally results from hemodynamic instability due to major intrapelvic hemorrhage. Early hemorrhage control is often critical to survival, and over the past few decades, pelvic binders have emerged as an important first-line intervention. Pelvic binders are particularly valuable in the prehospital environment, where definitive hemorrhage control measures are unavailable and rapid, low-risk interventions are essential. They can be applied quickly, require minimal resources, and carry relatively little risk when used appropriately. Although high-quality evidence demonstrating a definitive benefit in mortality or other patient-centered outcomes is lacking, pelvic binders have a strong physiologic rationale and favorable risk profile. Given the potentially catastrophic consequences of uncontrolled pelvic hemorrhage, pelvic binders should remain a mainstay of prehospital trauma care even with limitations in the existing evidence.

Despite their widespread use, the literature consistently identifies opportunities to improve prehospital pelvic binder application. First, pelvic binders are frequently positioned incorrectly. Pelvic binders are intended to be placed over the greater trochanters, but in practice they are often positioned high along the iliac crests. This can result in inadequate volume reduction of the pelvic ring and decrease binder effectiveness. Second, unstable pelvic fractures are commonly missed in the prehospital setting when assessment relies primarily on physical examination. Even within physician-staffed helicopter EMS systems, studies have reported prehospital recognition rates of unstable pelvic fractures as low as 46.5%, with only 44.1% of these patients receiving pelvic binders.

This presentation will review the current evidence supporting pelvic binder use, discuss limitations in the existing literature, and identify common pitfalls in prehospital application. Practical strategies for improvement will be emphasized, including regular skills training, reinforcement of correct placement techniques, and consideration of empiric binder application based on mechanism of injury, hemodynamic status, and overall clinical presentation rather than physical examination findings alone. By improving recognition and application practices, EMS clinicians can optimize the use of a simple, low-risk intervention in patients with potentially life-threatening pelvic injuries.

About the speakerJacob Lilienfeld, MD is a first-year emergency medicine resident physician at the University of Vermont Medical Center. Prior to medical school, he worked as an EMT in mountain rescue and EMS, primarily serving as a ski patroller in Crested Butte, Colorado, while also volunteering with the local mountain rescue team and fire department. He earned his medical degree from the University of Colorado School of Medicine, during which he led a research project focused on developing an algorithmic approach to empiric prehospital pelvic binder placement. His academic interests include prehospital trauma care, wilderness medicine, and evidence-based emergency medicine practice.

AbstractThis is a talk that discusses the pathophysiology of common industrial exposures, specifically as it relates to inhalation injury from airborne chemicals.

It also provides a framework to empirically start treatment based on symptoms.

Based around a real case in Vermont last year, it covers asphyxiants, irritant gases, corrosives and solvents.

About the speakerI am an Emergency medicine Physician working with Dartmouth Health. Outside of the ED, I am also an active member with the Hartford Fire Department and Vermont USAR team.

I am an associate Director for the Wilderness Medicine Fellowship at DHMC. I am the medical director for Brattleboro Fire and Mt. Washington Avalanche center, assistant medical director for the USAR team. I have a strong interest in providing education that bridges the gap between field EMS providers and in hospital care.

AbstractExertional collapse is a sport sideline and prehospital emergency for which rapid, structured triage determines survival. The differential is broad but dominated by five entities: sudden cardiac arrest (SCA), exertional heat stroke (EHS), exercise-associated hyponatremia (EAH), hypoglycemia, and benign exercise-associated postural collapse (EAPC). These conditions may have overlapping presentations but warrant different treatments. The goal of this lecture will be to lay out a systematic field approach using level of consciousness, timing relative to exertion, rectal temperature, and point-of-care testing to expedite diagnosis and management. A foundational point of differentiation is consciousness. Athletes with EHS, EAH, and EAPC typically retain some level of consciousness, whereas SCA produces abrupt, complete loss of consciousness, often with agonal gasping and myoclonic jerking that can be mistaken for seizure. Timing is a second key differentiator as collapse during exertion is a red flag for a cardiac etiology, whereas collapse immediately after cessation of activity favors benign EAPC from loss of the skeletal-muscle pump and venous pooling. Rapid assessment prioritizes a cannot-miss approach. Any collapsed, unresponsive athlete should be presumed to have SCA; immediate CPR and early AED defibrillation are paramount, and defibrillation must not be delayed by movements mimicking seizure or breathing. In the conscious or altered collapsed athlete, field testing can reprioritize the differential: rectal temperature and point of care glucose.

Treatment is condition-specific and time-sensitive. EHS (rectal temperature ≥40°C with CNS dysfunction) mandates a cool-first, transport-second. EAH is suspected in endurance events with high fluid intake, slower finishers, altered mentation, and incoordination; management hinges on avoiding hypotonic fluids and administering hypertonic (3%) saline for severe or symptomatic cases. Hypoglycemia, particularly in athletes with insulin-treated diabetes, is corrected with oral or intravenous glucose. EAPC is self-limiting: supine positioning with leg elevation, oral hydration, and attention to electrolytes, with resolution typically within 15-30 minutes.

Disposition and follow-up are essential. Prolonged recovery (>15 minutes), loss of consciousness during exertion, preceding cardiac symptoms, trauma, or cardiovascular risk factors definitely warrant emergency evaluation and cardiovascular assessment before return to play. This lecture will equip EMS and event-medicine providers with an algorithmic approach to ensure rapid recognition and intervention in high acuity sport emergencies.

About the speakerI am a second-year Emergency Medicine Resident at the University of Vermont. I was an EMT prior to medical school, so EMS is close to my heart. I am also passionate about sports and event medicine and find the connection with EMS to be one of the best parts.

AbstractPrinciples around management of potential spinal injuries have become uncertain, with practices like immobilization considered absolutely critical for decades now being challenged.

This lecture reviews the history of potential spinal trauma and then explores contemporary management proposals. It highlights the recent Wilderness Medical Society clinical practice guidelines (2024), the National Association of EMS Physicians comprehensive literature review and analysis (2025), Nutbeam’s “gentle handling” paradigm (2025), and communications from the American College of Surgeons Committee on Trauma on this subject (2026). While the lecture does review history and evidence, the greater purpose is to build a meaningful and practical practice recommendation for EMS personnel that derives from that history and evidence. In this way the talk is built to be functional, practical, and field-oriented rather than theoretical.

About the speakerDr. Hawkins is a board-certified EMS and emergency medicine physician who is licensed in Vermont, New York, and New Hampshire as well as North Carolina, where he primarily works. He has been the lead author of the Wilderness Medical Society Clinical Practice Guidelines on Spinal Cored Protection for about a decade and has published widely on spinal trauma and current controversies around it. His work is demonstrably engageable and popular—for example, an article he wrote for Wilderness Medicine Magazine on this topic was the most widely-read on-line article of 2025, despite posting in December and only being available for a few weeks of that year.

AbstractSession Description: Traumatic cardiac arrest remains one of the most challenging and high-stakes scenarios in the prehospital setting. Historically, survival from prehospital traumatic cardiac arrest has been viewed as exceedingly rare, leading many systems and clinicians to regard resuscitative efforts as futile. However, contemporary evidence and evolving trauma system experience suggest a more nuanced reality: survival is possible in carefully selected patients, particularly when EMS clinicians rapidly identify reversible causes of arrest, initiate time-sensitive interventions, and transport appropriate patients to definitive trauma care.

This presentation will explore the most up to date guidelines and scientific literature on prehospital trauma arrest, emphasize why traumatic arrest must be approached differently from primary medical cardiac arrest, and introduce Vermont’s newly updated statewide EMS trauma arrest protocol. The protocol is designed to help EMS clinicians distinguish patients who may benefit from aggressive prehospital treatment from those for whom continued resuscitation and transport is truly futile. Special attention will be given to the realities of Vermont EMS practice, including rural response environments, variable proximity to trauma centers, limited ALS capabilities, and the need for clear, reproducible field decision-making.

By reframing traumatic cardiac arrest from a uniformly futile condition to a time-critical, systems-based emergency, this session will provide EMS clinicians, educators, and agency leaders with the clinical rationale and operational confidence needed to implement Vermont’s updated protocol consistently across the state.

About the speakerDr. Ryan B. Gerecht started his career in EMS 20 years ago as an EMT. It was this time spent caring for others in the back of an ambulance that formed the foundation for a career dedicated to serving the sick and injured in the prehospital setting. Today Dr. Gerecht is board certified in both EMS Medicine and Emergency Medicine. He is currently the EMS Medical Director for Dartmouth Hitchcock Medical Center, Alice Peck Day and New London Hospitals. Dr. Gerecht is also Medical Director of Emergency Management at Dartmouth Hitchcock Medical Center and is extensively involved in local, state, and regional disaster preparedness efforts. Prior to joining Dartmouth in 2023 Dr. Gerecht served in multiple EMS Medical Director roles most recently as the Assistant Medical Director of DC Fire and EMS and the Medical Director for Tacoma Fire Department in Tacoma WA.

AbstractEMS research is advancing faster than ever. From blood products and airway management to resuscitation science, artificial intelligence, and pragmatic clinical trials, this session explores the hottest topics shaping the future of prehospital care. Attendees will gain practical insights into emerging evidence, ongoing controversies, and innovations that are changing how EMS clinicians deliver care today and where the profession is headed tomorrow.

About the speakerJonathon has been involved in EMS since 2009 and has been a Pennsylvania and Nationally Registered Paramedic since 2015. Jonathon earned a Bachelor of Science in Emergency Medicine from the University of Pittsburgh in 2016 and a Master of Science in Emergency Medical Services from Creighton University in 2024. Jonathon currently serves as the Clinical Research Education Manager for the Linking Investigations in Trauma and Emergency Services (LITES) Network at the University of Pittsburgh School of Medicine. Prior to joining the LITES Network Team, Jonathon served as the Education and Training Administrator at Mutual Aid Ambulance Service and Program Director of the Mutual Aid-Excela Health Paramedic Training Program, in Westmoreland County, Pennsylvania. Jonathon continues to work clinically as a Paramedic at Lower Burrell EMS in Westmoreland County, in addition to serving as a regional examination evaluator and board member for EMS West, as well as an active member and literature reviewer for multiple state and national EMS organizations.

Jonathon’s academic interests include prehospital blood product administration in hemorrhagic shock, prehospital management of cardiogenic shock, prehospital airway management, and the advancement and development of EMS quality improvement science.

AbstractAdopting Safety Management Systems in EMS: Integrating CAST and STPA for Proactive Risk Management Emergency Medical Services (EMS) operate in one of healthcare’s most complex, time-pressured, and distributed environments. Crews make consequential decisions with incomplete information, changing scene conditions, constrained resources, and handoffs across dispatch, fire, law enforcement, hospitals, medical direction, and public health partners. Yet many EMS safety activities remain rooted in traditional quality assurance (QA): retrospective case review, protocol compliance checks, individual performance concerns, and corrective action after an adverse event or near miss. These activities are necessary, but they are not sufficient to manage risk in a modern EMS system. A Safety Management System (SMS) offers a more comprehensive approach by treating safety as an organizational function that must be designed, monitored, learned from, and continuously improved. This 45-minute session focuses on how EMS agencies can begin adopting an SMS framework and use Causal Analysis based on Systems Theory (CAST) and Systems-Theoretic Process Analysis (STPA) as core methods within that framework. In an SMS, safety management includes leadership accountability, hazard identification, risk assessment, safety controls, operational monitoring, feedback, and learning. CAST strengthens the learning component by helping organizations analyze adverse events and near misses as breakdowns in a broader sociotechnical control structure, rather than as the result of a single error, deviation, or failed provider decision. STPA strengthens the proactive component by identifying unsafe control actions, inadequate feedback, coordination gaps, and design vulnerabilities before harm occurs. Using EMS-relevant examples, participants will explore how CAST and STPA can be embedded into existing EMS structures, including QA/QI, performance improvement, morbidity and mortality review, safety committees, protocol development, simulation, technology implementation, and leadership decision-making. The session will demonstrate how an agency can define system boundaries, map controllers and controlled processes, identify feedback loops, and analyze safety constraints that influence clinical and operational decisions. Examples may include delayed response, medication error, airway management difficulty, equipment malfunction, communication breakdown, high-risk interfacility transfer, or failed escalation of care. The emphasis will be on using these methods not as stand-alone analytical exercises, but as practical SMS tools for strengthening controls, improving feedback, and supporting safer operational design. Attendees will leave with a pragmatic roadmap for moving from reactive review toward a more mature EMS Safety Management System. The presentation will address how to start small, select high-value hazards or cases, engage multidisciplinary stakeholders, translate analysis into actionable safety requirements, and build continuous learning loops across the organization. Adopting an SMS in EMS is not simply about improving investigations; it is about creating the capacity to understand how harm emerges, manage risk continuously, and make resilient performance more likely in the field. CAST and STPA provide EMS leaders with disciplined, systems-based methods for learning from past events while also anticipating future hazards and designing systems that make harm less likely to occur.

About the speakerAbigail R. Williams, RN, BSN, JD, MPH, MS, CPPS, CPHRM, CPHFH, is a Clinical Human Factors and Clinical Safety Management Systems consultant at Synensys with more than 40 years of healthcare experience, including work focused on prehospital care systems. She specializes in patient safety, risk management, human factors engineering, clinical compliance, and the application of Safety Management Systems, CAST, and STPA to healthcare and EMS. Her work helps organizations move beyond reactive event review toward proactive safety design, resilient operations, and sustainable learning systems.

AbstractAnaphylaxis is a life-threatening medical emergency commonly encountered by EMS personnel. Current guidelines and recent evidence recommend the use of weight-based dosing rather than a flat fixed dose of 0.3 mg for all patients. This presentation will review pearls and pitfalls of anaphylaxis management with a focus on appropriate dosing and administration of epinephrine.

About the speakerEM Clinical Pharmacist with 12+ years of experience, board certified in Emergency Medicine Pharmacology, Residency Program Director of the PGY2 EM Pharmacy program, previous state/national level presentations on anaphylaxis

AbstractBag-valve-mask ventilation is one of the first airway skills taught in EMS. It is also one of the hardest to perform well. Maintaining a mask seal, positioning the airway, delivering appropriate ventilations, and simultaneously participating in a cardiac arrest resuscitation can consume both hands and considerable attention. In a small EMS crew, that matters.

With Vermont's 2027 protocol update, supraglottic airways will enter the EMT scope of practice for cardiac arrest. This session will examine how Vermont arrived at that decision, introduce the practical use of supraglottic airways such as the i-gel, and explore how this new capability can change the way BLS and ALS clinicians work together during resuscitation.

We will begin with the protocol-development process. Expanding scope requires more than determining whether a procedure is technically easy to perform. The Airway Subcommittee considered the limitations of bag-valve-mask ventilation, the evidence supporting supraglottic airways in cardiac arrest, experience from other EMS systems, training requirements, and the practical realities of Vermont EMS. We will also discuss one of the more difficult implementation questions considered during the process: the role of waveform capnography and how to balance the value of ETCO2 monitoring against differences in equipment availability across Vermont agencies.

From there, the session will provide a practical introduction to supraglottic airway management. Using the i-gel as an example, participants will review device selection, preparation, insertion, confirmation of effective ventilation, securing the airway, reassessment, troubleshooting, and common causes of failure. The emphasis will be on integrating the airway into a high-quality cardiac arrest rather than treating placement as an isolated procedure.

Finally, we will examine what this change means for the cardiac arrest team. Cardiac arrest creates more simultaneous work than almost any other EMS call: compressions, defibrillation, vascular access, medications, airway management, rhythm interpretation, reversible causes, documentation, scene leadership, and communication all compete for limited personnel. Allowing an EMT to assume responsibility for supraglottic airway placement and ongoing ventilation creates an opportunity to redistribute that workload. An ALS clinician can establish the airway plan, delegate its execution to a trained BLS partner, and devote attention to other aspects of the resuscitation.

Scenario-based discussions involving BLS-first responses, small crews, ALS intercepts, and evolving resuscitation teams will allow participants to consider how this new scope can be incorporated into their own practice.

Vermont previously confronted similar questions when CPAP was expanded to the EMT level. Supraglottic airways represent another step in that evolution: not simply giving EMTs another procedure, but asking how appropriately expanding BLS capability can make the entire EMS team more effective.

About the speakerBrian Canova is a paramedic in his final year of medical school at the University of Vermont Larner College of Medicine. He has spent more than a decade working in EMS and has contributed to Vermont’s statewide protocol development, including efforts to expand CPAP and supraglottic airway use at the EMT level. His interests include EMS education, prehospital protocol development, and critical care medicine. He is applying into Emergency Medicine residency this year.

AbstractWorking in EMS can be challenging. Dealing with personalities different from our own can make the workplace even more difficult. To achieve effective communication and positive teamwork, we must learn to interact with each other professionally; otherwise, we risk creating a toxic work environment. Some of our coworkers may be gossipers, heroes, bullies, complainers, one-uppers, dictators, know-it-alls (but don’t), no-talkers, or perfectionists. These personalities may be frustrating to work with and cause us stress. In this workshop, you will learn to deal with them quickly, professionally, and confidently. Knowing how to deal with different personalities at work will enable you to approach your job with greater enjoyment and your coworkers with increased confidence. This interactive workshop will provide you with tools to use to deal with different types of challenging coworkers.

About the speakerMaria Minor is an AEMT at Fairfax Rescue. She recently retired from teaching at Franklin Pierce University where she taught MBA courses specializing in leadership, communication, and human resources. She was also a private consultant and taught a variety of communication workshops to both profit and non-profit companies. Maria is a lifelong learner and loves to share her knowledge with others.

AbstractHeliService USA started operations in 2026 JAN as the only HEMS program based in Rhode Island. It is an unusual program, primarily serving the offshore windfarm industry. The HEMS component is paramedic level, with hoist operations common. This presentation will review the process of forming and operating this unique HEMS program, and discuss the clinical cases transported to date.

About the speakerKenneth A. Williams, MD, FACEP, FAEMS, is a Professor of Emergency Medicine (Clinician Educator Track) at The Warren Alpert Medical School of Brown University and a leader in emergency medical services (EMS), critical care transport, and disaster medicine. He serves as the Director of the Division of Emergency Medical Services for Brown University Health and as an attending emergency physician at Rhode Island Hospital. Dr. Williams completed his Bachelor of Arts at Hampshire College and earned his Medical Degree from the University of Massachusetts Medical School in 1984, followed by an Emergency Medicine residency and Chief Residency at the University of Pittsburgh. He completed advanced training and fellowships in exercise physiology, medical informatics, and knowledge engineering. Throughout his career spanning more than four decades, Dr. Williams has shaped local, state, and national EMS infrastructure: • EMS & Transport Medicine Leadership: Since 1997, he has served as the State EMS Medical Director for the Rhode Island Department of Health Center for EMS. He founded and serves as Medical Director for LifePACT (formerly Lifeguard EMS), Rhode Island’s critical care transport service, and HeliServiceUSA, Rhode Island’s only HEMS program. Nationally, he is a Past President of the Air Medical Physician Association (AMPA), a past Chair of the National Association of State EMS Officials (NASEMSO) Medical Directors Council, and an ACEP-nominated Director on the Board of Directors of the National Registry of EMTs (NREMT). • Disaster Response & Homeland Security: As the long-standing Chief Medical Officer of the RI-1 Disaster Medical Assistance Team (RI-1 DMAT under HHS/ASPR), Dr. Williams has deployed to major national incidents including the World Trade Center attack on 9/11, the Station nightclub fire, and hurricane Helene. He also serves as the Medical Director for the Providence Emergency Management Agency. • Academic & Scholarly Contributions: Dr. Williams established and directed the ACGME-accredited EMS Fellowship at Brown University and continues to lead the Brown Advanced Emergency Medicine Academies (BAEMA) International Fellowship. He has served as Principal Investigator on federal and institutional research grants totaling millions of dollars—notably leading the NHTSA-funded national evidence-based guidelines for EMS administration of naloxone and the multi-phase Rhode Island Disaster Initiative (RIDI). His scholarly portfolio includes dozens of peer-reviewed publications, textbook chapters, and international presentations on disaster simulation, out-of-hospital resuscitation, protocol development, and transport safety. • Service: In addition to numerous teaching and lifetime achievement awards, Dr. Williams actively serves in the U.S. Coast Guard Auxiliary (District 1 NR, Flotilla 1NR-07-08) as a qualified boat crew member providing operational support in maritime safety and medical training.

AbstractAtrial fibrillation is the most common sustained cardiac dysrhythmia, with an estimated lifetime risk of approximately 25% beginning at age 40. Despite its prevalence, the prehospital management of atrial fibrillation can vary significantly based on the patient’s clinical presentation, hemodynamic stability, comorbidities, and underlying conditions. This lecture will review the recognition and clinical presentation of atrial fibrillation in the EMS setting, with a focus on determining when treatment is indicated and which interventions are appropriate. Through discussion of varying clinical scenarios, participants will explore how the management of atrial fibrillation should be tailored to the individual patient and clinical context.

About the speakerI serve as the Regional Medical Director for Vermont EMS District 6, Associate Medical Director for HealthNet, Medical Director for HealthNet of New York, an Emergency Medicine physician with the University of Vermont Health Network, and Medical Advisor for Colchester Rescue in District 3.

I earned my Doctor of Medicine degree from the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell before completing my Emergency Medicine residency at the University of Vermont Medical Center. I subsequently completed an Emergency Medical Services (EMS) Fellowship at Wake Forest University in North Carolina.

Through my clinical, educational, and leadership roles, I am dedicated to advancing prehospital medicine, supporting EMS clinicians, and improving access to high-quality emergency medical care for rural communities throughout Vermont and New York.

AbstractPulseless. Apneic. Fixed and dilated pupils. Found deep in the backcountry, or down in a back alley. Is this patient dead, or profoundly hypothermic and still salvageable? Hypothermic cardiac arrest breaks many of the usual rules of resuscitation. When is prolonged CPR indicated, and how long should you continue? How do you provide CPR while extricating a patient miles from the road? Can CPR safely be delayed or interrupted? And should you head to the closest ED, or bypass it for an ECMO center? Using dramatic real-world cases, this session will give EMS clinicians a practical approach to recognizing and resuscitating the profoundly hypothermic patient and knowing when “not dead until warm and dead” really matters.

About the speakerDaniel Wolfson, MD, FACEP, FAEMS, is the Vermont State EMS Medical Director and Chief of the Division of Prehospital Medicine at the University of Vermont. He is a practicing emergency physician at the University of Vermont Medical Center and Professor of Emergency Medicine at the UVM Larner College of Medicine. Dr. Wolfson has extensive experience in EMS medical direction, education, and the prehospital management of critically ill and injured patients.

AbstractThe principle of "safety first" has been integration into our language, consciousness, and risk management strategy so much it is rarely questioned. However, is safety really ever first in EMS? This talk explains the Safety Third movement, the main points of which were laid out in a 2018 JEMS article (www.hawkaerie.org/s3). Rather than minimizing safety, this risk management system puts it in the proper context of operational realities. It builds on and complements the work of Mike Rowe, the Safety 2.0 "New View" movement, Dekker's "Safety Differently", the GAR methodology, modern principles of Human & Organization Perforamance (HOP), and Smith's "beneficial risk" theories and his textbook "Safety Science", with a specific focus on Fire-Rescue-EMS operations. Safety Third is engaged primarily in moving these theories into operational and educational improvements for EMS. For example, nearly every oral exam or scenario starts off with the student asking "is the scene safe?", which proposes a binary model of safety (the scene is safe and they proceed, or it is not safe and they do not, and are rewarded for choosing the correct answer). In reality, responders come onto complex scenes that are never exclusively "safe", and what they must actually do is rapid and complex risk management decision-making involving risk assessment and balancing of risk and benefit (or, in Smith's formulation, beneficial risk). This lecture works from the principle that scenes are never inherently safe, that safety is not a binary, and is never exclusively first, and then builds more realistic and efficacious principles from there.

About the speakerDr. Hawkins is an emergency, emergency medical services (EMS), and wilderness medicine physician and a medical and environmental anthropologist. He is dual board certified in emergency medicine and EMS, with a specialization in wilderness medical care. He is the first physician named a Master Fellow of the Academy of Wilderness Medicine (MFAWM), and also has been awarded Fellowship in the Academy of EMS (FAEMS), the American College of Emergency Physicians (FACEP), the American Academy of Emergency Medicine (FAAEM), the Explorer’s Club, and the Society for Applied Anthropology (SfAA). He is the medical advisor for the Student Conservation Association and the NC Outward Bound School and a medical director for the National Association for Search & Rescue (NASAR), North Carolina (NC) State Parks, Landmark Learning, Starfish Aquatics Institute, Eastern Band of Cherokee Indians EMS, and nearly a dozen wildland firefighting medical support teams. He also serves as the local emergency medical advisor (LEMA—federal term for medical director) of all USDA Forest Service (USFS) forests, wilderness areas, and wildland firefighting teams in NC and the USFS Region 1 (Idaho, Montana, and the Dakotas). He also serves as LEMA for the Cape Lookout National Seashore and the Outer Banks Group (Cape Hatteras and associated federal sites) for the National Park Service. He is the editor of the textbook Wilderness Emergency Medicine, co-author of Vertical Aid: Essential Wilderness Medicine for Climbers, Trekkers, and Mountaineers, and serves as Wilderness Medicine Magazine’s editor-at-large; he is also author of numerous clinical practice guidelines and peer-reviewed research. Academically, he is an associate professor of emergency medicine at Wake Forest University, where he also serves as associate director of the Wilderness Medicine Fellowship, and is affiliate faculty in the University of North Carolina at Charlotte’s Department of Anthropology and its College of Health and Human Services.

AbstractImagine you are a critical care transport team walking into an ICU room to pick up a newly post-partum mother. When you walk into the room, she is pale, diaphoretic, tachycardic, and hypotensive. There is no one around except for the nurse who tells you the patient is anxious. When you attempt to begin resuscitation, the doctor states he is uncomfortable with the resuscitation and you need to leave the facility immediately. What are you and your partners' next steps?

Postpartum hemorrhage (PPH) is a life threatening complication that EMS crews may encounter. This presentation will review recognition and treatment of PPH and hemorrhagic shock as well as a unique, transport specific case review of a rare cause of PPH.

Attendees will leave the presentation with increased knowledge of PPH, hemorrhagic shock, and resuscitation with the goal of preventing maternal demise. Additionally conflict resolution, therapeutic communication, and clinical teamwork will be highlighted throughout the case. Providers will view the case through the eyes of the crew, and then transition to the objective measurable outcomes of intervention decisions.

About the speakerCindy Cox is a Registered Nurse with nearly eight years of nursing experience. She has lived and worked in Virginia and Washington D.C., gaining critical care experience prior to transitioning to the transport world. Currently, Cindy works as a Flight Nurse for the Dartmouth Hitchcock Advanced Response Team (DHART) in Manchester, New Hampshire.

About the speakerAdam Hart is a Critical Care Flight Paramedic, Adjunct Professor, and U.S. Coast Guard veteran with 20 years of experience in emergency services. He has led complex medevac missions, mass casualty responses, and technical rescues, earning a citation for bravery from the Governor of Massachusetts. Adam holds a Master’s in Public Administration and is known for his calm, mission-driven leadership and commitment to patient-centered care.

AbstractWhen opioid-associated respiratory depression progresses to cardiac arrest, does naloxone still have a role, or should EMS providers focus exclusively on standard cardiac arrest resuscitation? This question is particularly relevant to prehospital providers who often encounter prolonged transport times, limited personnel, and delayed access to definitive care.

This case-based session will examine the potential role of early naloxone administration during out-of-hospital cardiac arrest (OHCA), with a particular focus on patients presenting with non-shockable rhythms. Beginning with a realistic rural New England cardiac arrest scenario, participants will be asked to prioritize competing resuscitation interventions and consider whether naloxone should remain part of the treatment strategy when cardiac arrest has already occurred.

The session will then review the pathophysiology of opioid-associated cardiac arrest, including the progression from respiratory depression and hypoxia to PEA and asystole and the possibility of pseudo-PEA. The primary evidence discussion will focus on a published secondary analysis of 1,807 EMS-treated, non-traumatic OHCA patients with initial non-shockable rhythms. Among these patients, 57 received naloxone before IV/IO access attempts. Early naloxone administration was associated with higher adjusted odds of ROSC, pulses at emergency department arrival, survival to admission, survival to hospital discharge, and favorable neurologic outcome.

Participants will also review how the evidence has evolved since publication, including the 2025 AHA recommendation that naloxone may be reasonable in suspected opioid-associated cardiac arrest when administration does not interfere with standard resuscitation measures.

The session will translate the evidence into practical prehospital decision-making, including when naloxone can be administered without compromising resuscitation, opportunities for BLS/ALS/law-enforcement collaboration, and considerations for rural systems where staffing, response times, and transport distances may differ substantially from urban environments.

Participants will leave with a framework for determining when naloxone can be added to a cardiac arrest resuscitation without delaying the interventions that matter most.

About the speakerEmergency medicine resident physician at Dartmouth Health. Commissioned military medical officer and has served in military medical roles involving leadership, medical readiness, and healthcare operations. Prior to medical school, spent more than eight years working in 9-1-1 EMS as a paramedic and currently serves as Assistant Medical Director for the Hanover Fire Department. His clinical and academic interests include prehospital and rural emergency medicine, cardiac arrest and resuscitation, EMS systems, and medical education. His research has focused on out-of-hospital cardiac arrest and naloxone use, with additional work in emergency department operations and simulation-based education.

AbstractCardiac arrest data can feel complicated, but it doesn't have to be. Every EMS system, whether career or volunteer, collects valuable information through its cardiac arrest responses, but do we really understand what our CARES and Utstein reports are telling us?

This engaging session will teach both boots- on-the-ground providers and EMS leaders how to quickly navigate CARES reports and identify the numbers that matter most to them. We'll break down cardiac arrest outcomes by witnessed and unwitnessed status and examine neurological outcomes using CPC scores to demonstrate why not all cardiac arrest saves are the same. Understanding these differences can help field providers communicate realistic expectations with families while giving EMS leaders a clearer picture of their system's performance.

But knowing your numbers is only the beginning. What do you do with them? Drawing on lessons from the Resuscitation Academy, we'll explore practical strategies that can move the numbers in the right direction. Focusing on five key areas, we'll show how EMS systems can turn their data into immediate, actionable improvements. Whether you are a new provider or an experienced EMS leader, you will leave with a better understanding of what your CPR data is saying and more importantly, what you can do about it.

About the speakerI bring more than 25 years of EMS experience spanning field operations, education, EMS leadership, and hospital emergency medicine. I have served as an EMS Operations Captain, Battalion Chief involved in EMS, Paramedic FTO, and EMT and Paramedic instructor with UC Davis. I worked in three different emergency departments as a Physician Assistant, providing firsthand perspective on both the prehospital and hospital sides of cardiac arrest care.

This combination of experience gives me a unique understanding of how prehospital decisions, system performance, and hospital outcomes intersect and most importantly, how they affect the patient. My experience analyzing cardiac arrest data and using it to identify opportunities for improvement, combined with my work as an educator and EMS leader, allow me to translate complex data into practical lessons that can be applied by both field providers and EMS leaders.

AbstractPost partum Hemorrhage due to atony is a leading cause of maternal morbidity and mortality. In this presentation, I will give a brief overview of post partum bleeding including causes, treatments, and outcomes. I will introduce the Jada Device- a device for abnormal post partum bleeding that has been shown to control bleeding in a mean of 3 minutes. I will focus on how this is relevant to the EMS world, and how they can manage a patient with a Jada device in place through transport from one facility to another.

About the speakerI have been a Labor and Delivery Nurse for 20 years, and a nurse leader for 12 of those years. I have always been passionate about maternal healthcare and improving outcomes. My role now as a Territory Manager with Laborie is educating facilities across New England on the use of the Jada System and helping them utilize the device in the most effective and impactful way.

AbstractIn rural areas, it's relatively common for EMS personnel to respond via personal vehicle directly to the scene of a 9-1-1 call, also called "jumping" a call. Urban responders may think this sounds insane, but it's not much different than encountering an emergency scene at a supermarket, park, or roadside while off duty. This session will outline best practices for "jumping" calls in rural areas, including legal considerations, and it should give all EMS personnel some tips for managing emergency scenes before the on-duty ambulance crew arrives.

About the speakerLatimer has worked in rural EMS since 2009 in Vermont and Montana (and a bit in Canada). These experiences involve ambulance/first responder services, fire departments, emergency communications, ski patrol, and search and rescue. He has managed supply ordering, served as training officer, and written policies for multiple workplaces. In addition, Latimer holds a Bachelor's degree in Secondary English Education, a Master's degree in Education Leadership, and Senior Alpine certification with the National Ski Patrol.