EMS Research with Professor Bram

Workplace violence is an escalating crisis in EMS, often dismissed as just "part of the job." But what if you could predict which patients were likely to become aggressive before an incident occurred? In this episode, we sit down with researchers Dr. Son Chae Kim and Kathie Dunn to discuss the ABRAT-EMS, a new, evidence-based screening tool designed to help crews spot risk early and stay safe.

We break down how this simple three-item checklist works, the science behind its development from over 9,000 patient encounters, and how you can implement it on your next shift. This is a must-listen for any provider who wants to move from reactive defense to proactive prevention.
In this episode, we cover:

• The rising reality of workplace violence against EMS clinicians
• Why "gut feeling" isn't enough when assessing safety risks
• How the ABRAT-EMS tool was developed using real-world data
• The three specific behaviors that predict violence: agitation, confusion, and aggression
• How to score patients and determine their risk level (Low, Medium, High)
• Practical steps for using the score to make decisions about de-escalation and law enforcement
• Addressing special populations like patients with dementia or intoxication

Resources Mentioned:
Kim, S.C., Dunn, K., Youells, C., Whitmore, G., McComack, A., Dievendorf, E., Bell, C., Burnett, S.J., Kim, S. and Clemency, B., 2025. Aggressive Behavior Risk Assessment Tool for Emergency Medical Services. JACEP Open, 6(3), p.100095.

Disclaimer: This content is for educational and informational purposes only and does not constitute medical advice. Always follow your local protocols and medical direction.

Book announcement: Bram Duffee is a co-author of the latest book about how hypnosis has the potential to revolutionize medical care for those struggling with emergency / acute distress. Hypnotic Communication in Emergency Medical Settings: For Life-Saving and Therapeutic Outcomes demonstrates how hypnotic communication has the potential to improve patient outcomes in emergency care, integrating insights on the connection between mind and body for paramedics and other first responders. https://routledge.pub/Hypnotic-Communication

Stay Connected:
Connect with Us: For more information, visit our website at www.ProfessorBram.com
Subscribe: If you enjoyed this episode, please consider subscribing to EMS Research on YouTube: /@4emsresearch
Monthly Research Review: Stay up to date with the latest research in EMS through the International PreHospital Medicine Institute's monthly article reviews: https://iphmi.com/ems-articles-of-the-month

Gastric lavage, a procedure for pumping the stomach after poisoning, was once a standard of care. Now, it's rarely used due to a lack of evidence and risk of complications. So why are we talking about it in 2026? A recent case report in Prehospital Emergency Care challenges us to reconsider if there’s a narrow, specific role for this intervention in the most critically ill overdose patients.

In this episode, we speak with Dr. Nicholas Studer, one of the study's lead authors, to explore this controversial topic. We'll examine the specific clinical cues that might justify gastric lavage in the field and discuss the strict contraindications that every provider must know. This is a critical conversation about balancing historical practices with modern, evidence-based medicine for the sickest patients.

In this episode, we cover:
• The history of gastric lavage and why its use has declined.
• A breakdown of a recent case where prehospital gastric lavage was successfully used.
• The very specific and narrow indications for considering gastric lavage in 2026.
• Clear contraindications and "hard stops" for the procedure in the field.
• How this procedure fits with current toxicology guidelines.

Resources Mentioned:
Studer, N. M., & Hoffman, R. S. (2025). Prehospital Gastric Lavage for the Treatment of Critically Ill Overdose or Poisonings: A Case Report. Prehospital Emergency Care, 1-3.

Disclaimer: This content is for educational and informational purposes only and does not constitute medical advice. Always follow your local protocols and medical direction.

Book announcement: Bram Duffee is a co-author of the latest book about how hypnosis has the potential to revolutionize medical care for those struggling with emergency / acute distress. Hypnotic Communication in Emergency Medical Settings: For Life-Saving and Therapeutic Outcomes demonstrates how hypnotic communication has the potential to improve patient outcomes in emergency care, integrating insights on the connection between mind and body for paramedics and other first responders. https://www.routledge.com/Hypnotic-Communication-in-Emergency-Medical-Settings-For-Life-Saving-and-Therapeutic-Outcomes/JacobsFourArrows-Duffee/p/book/9781032360027

Stay Connected:
• Connect with Us: For more information, visit our website at www.ProfessorBram.com
• Subscribe: If you enjoyed this episode, please consider subscribing to EMS Research on YouTube: /@4emsresearch
• Monthly Research Review: Stay up to date with the latest research in EMS through the International PreHospital Medicine Institute's monthly article reviews: https://iphmi.com/ems-articles-of-the-month

Domestic violence calls are among the most complex and high-risk situations paramedics encounter. Often, the signs are subtle-confusion, headaches, or a hesitant patient-and mask a much darker reality of non-fatal strangulation or traumatic brain injury. In this episode, we speak with researcher Dr. Rory Marshall about a groundbreaking study that asked survivors of intimate partner violence (IPV) what they really needed from EMS.

Dr. Marshall discusses the disconnect between standard paramedic assessments and the lived reality of survivors. We explore the seven key challenges survivors face, from perceived bias to dangerous perpetrator dynamics on scene. Most importantly, we discuss three practical, actionable steps every medic can take to build trust, create safety, and identify hidden injuries.
In this episode, we cover:

•Why domestic violence calls are high-stakes moments for both patients and providers
•Key insights from survivor interviews about their EMS experiences
•The seven main challenges survivors face during EMS encounters, including bias, inadequate support, and system limitations
•The dangers and recognition of non-fatal strangulation and traumatic brain injury in IPV situations
•Practical steps for paramedics to build trust, foster safety, and communicate effectively on scene
•How to safely create opportunities for private conversation with survivors

Resources Mentioned:
Marshall, R. A., Merritt, N., Stranges, T. N., Bartlett, S., Sawyer, S., & van Donkelaar, P. (2025). “The questions made me realize how many times I could have been saved and removed from that situation”: The experiences of patients attended to by paramedics for intimate partner violence, and actionable implementations for paramedicine. BMC Women's Health, 25(1), 254.

Disclaimer: This content is for educational and informational purposes only and does not constitute medical advice. Always follow your local protocols and medical direction.

Book announcement: Bram Duffee is a co-author of the latest book about how hypnosis has the potential to revolutionize medical care for those struggling with emergency / acute distress. Hypnotic Communication in Emergency Medical Settings: For Life-Saving and Therapeutic Outcomes demonstrates how hypnotic communication has the potential to improve patient outcomes in emergency care, integrating insights on the connection between mind and body for paramedics and other first responders.  https://www.routledge.com/Hypnotic-Communication-in-Emergency-Medical-Settings-For-Life-Saving-and-Therapeutic-Outcomes/JacobsFourArrows-Duffee/p/book/9781032360027

Stay Connected:
For more information, visit our website at www.ProfessorBram.com
If you enjoyed this episode, please consider subscribing to EMS Research on YouTube: /@4emsresearch
Research Review: Stay up to date with the latest research in EMS through the International PreHospital Medicine Institute's monthly article reviews: https://iphmi.com/ems-articles-of-the-month

When does a quality improvement project become human research? If you're reviewing patient charts or surveying new hires, you might be stepping into the world of research ethics without even realizing it. In this episode, we sit down with Dr. Jeffrey Franc to demystify research ethics for EMS professionals. We break down why it's a crucial part of our professional responsibility, not just a bureaucratic hoop to jump through for publishing.

Dr. Franc explains the fundamentals of human participant research, the role of Institutional Review Boards (IRBs), and clears up common misconceptions that can lead to ethical missteps. This conversation is essential for any medic, educator, or leader who wants to improve patient care responsibly and maintain public trust.

Key Points Covered in This Episode:

• Why research ethics matter in the day-to-day practice of EMS
• Understanding what qualifies as "human participant research" and how it applies in EMS
• The key role of Institutional Review Boards (IRBs) and why independent oversight is required
• Clearing up misconceptions: de-identified data, patient consent, and the ethics approval process
• The importance of comprehensive ethical review for quality improvement projects and education-based research
• Practical advice for EMS providers on starting research responsibly and ethically
• Dr. Jeffrey Franc’s expert insights on protecting patients, communities, and professional integrity

Disclaimer: This content is for educational and informational purposes only and does not constitute medical advice. Always follow your local protocols and medical direction.

Book announcement: Bram Duffee is a co-author of the latest book about how hypnosis has the potential to revolutionize medical care for those struggling with emergency/acute distress. Hypnotic Communication in Emergency Medical Settings: For Life-Saving and Therapeutic Outcomes demonstrates how hypnotic communication has the potential to improve patient outcomes in emergency care, integrating insights on the connection between mind and body for paramedics and other first responders. https://routledge.pub/Hypnotic-Commun... 

Resources Mentioned:

Franc, J. M., & O’Mathúna, D. (2025). Navigating Research Ethics for Prehospital and Disaster Medicine. Prehospital and Disaster Medicine, 40(3), 125–128.

Disclaimer: This content is for educational and informational purposes only and does not constitute medical advice. Always follow your local protocols and medical direction.

Stay Connected:

• Connect with Us: For more information, visit our website at www.ProfessorBram.com
• Subscribe: If you enjoyed this episode, please consider subscribing to EMS Research on YouTube: /@4emsresearch
• Monthly Research Review: Stay up to date with the latest research in EMS through the International PreHospital Medicine Institute's monthly article reviews: https://iphmi.com/ems-articles-of-the...

For a pulseless trauma patient, starting CPR is an ingrained response. But in cases of pulseless electrical activity (PEA) from severe blood loss, could chest compressions do more harm than good? Host Bram Duffee, PhD, EMT-P, speaks with Dr. Patrick Greiffenstein, lead study author and Trauma ICU Director at LSU New Orleans, about new research that challenges a core tenet of resuscitation.

Dr. Greiffenstein’s study used a porcine model to simulate severe hemorrhagic shock. Researchers compared key outcomes between a group that received automated CPR during the shock phase and a group that did not, focusing on oxygen delivery to the brain and skin.

Key Findings:
• CPR provided no improvement in brain or skin oxygenation.
• Skin perfusion was significantly lower in the group receiving CPR.
• While systolic blood pressure increased, diastolic blood pressure—critical for organ perfusion—was significantly reduced.
• Intracranial pressure (ICP) showed a threefold increase with CPR, suggesting disruption of normal cerebral blood flow.

Disclaimer: This content is for educational and informational purposes only and does not constitute medical advice. Always follow your local protocols and medical direction.

Book announcement: Bram Duffee is a co-author of the latest book about how hypnosis has the potential to revolutionize medical care for those struggling with emergency / acute distress. Hypnotic Communication in Emergency Medical Settings: For Life-Saving and Therapeutic Outcomes demonstrates how hypnotic communication has the potential to improve patient outcomes in emergency care, integrating insights on the connection between mind and body for paramedics and other first responders. https://routledge.pub/Hypnotic-Communication-in-Emergency-Medical-Settings

Stay up to date: Review the most recent research in EMS through the monthly article reviews put out by the International PreHospital Medicine Institute https://iphmi.com/ems-articles-of-the-month 

Connections: If you want to connect with the EMS Research Podcast staff check out our website at www.ProfessorBram.com If you enjoyed this episode please consider subscribing to EMS Research on YouTube: / @4emsresearch

Reference: Greiffenstein, P., Cavalea, A., Smith, A., Sharp, T., Warren, O., Dennis, J., Gatterer, M. C., Danos, D., Byrne, T. C., Scarborough, A., Deville, P., & VanMeter, K. (2025). Effect of cardiopulmonary resuscitation on perfusion in a porcine model of severe hemorrhagic shock. The Journal of Trauma and Acute Care Surgery, 98(2), 251–257.

Can artificial intelligence tools like ChatGPT help paramedics with differential diagnosis and transport decisions? A groundbreaking new study explores AI's accuracy in prehospital care, offering a glimpse into a future where technology acts as a clinical safety net. Host Bram Duffee, PhD, EMT-P, sits down with lead author Eric D. Miller to discuss his team's fascinating findings. This first-of-its-kind study analyzed 104 real prehospital care records. ChatGPT was tasked with generating the most likely diagnosis, which was then compared to the diagnosis made by the treating paramedic. When the two differed, two emergency physicians reviewed the case to determine the more accurate conclusion.

Key Findings:
• High Accuracy: ChatGPT correctly predicted the diagnosis in approximately 75% of cases.
• Conservative Bias: In 46% of disagreements, the AI identified more critical conditions, suggesting it may help reduce under-triage.
• Strong Safety Profile: In only one case out of 104 did the AI suggest a potentially inappropriate transport decision.
Watch the full interview with Eric D. Miller to understand the nuances of this research. Subscribe for more expert discussions on the future of EMS.

Disclaimer: This content is for educational and informational purposes only and does not constitute medical advice. Always follow your local protocols and medical direction.

Book announcement: Bram Duffee is a co-author of the latest book about how hypnosis has the potential to revolutionize medical care for those struggling with emergency / acute distress. Hypnotic Communication in Emergency Medical Settings: For Life-Saving and Therapeutic Outcomes demonstrates how hypnotic communication has the potential to improve patient outcomes in emergency care, integrating insights on the connection between mind and body for paramedics and other first responders. https://routledge.pub/Hypnotic-Communication-in-Emergency-Medical-Settings

Stay up to date: Review the most recent research in EMS through the monthly article reviews put out by the International PreHospital Medicine Institute https://iphmi.com/ems-articles-of-the-month

Connections: If you want to connect with the EMS Research Podcast staff check out our website at www.ProfessorBram.com If you enjoyed this episode please consider subscribing to EMS Research on YouTube: / @4emsresearch

Reference: Miller, E. D., Franc, J. M., Hertelendy, A. J., Issa, F., Hart, A., Woodward, C. A., Newbury, B., Newbury, K., Mathew, D., Whitten-Chung, K., Bauer, E., Voskanyan, A., & Ciottone, G. R. (2025). Accuracy of commercial large language model (ChatGPT) to predict the diagnosis for prehospital patients suitable for ambulance transport decisions: Diagnostic accuracy study. Prehospital Emergency Care, 29(3), 238–242.

This fast-paced video explores a long list of the latest research innovations shaping EMS with Bram Duffee, PhD, EMT-P including workplace culture, professional recognition, injury prevention, advancements in cardiac arrest care, and the transformative role of technology in the field.

Disclaimer: This content is for educational and informational purposes only and does not constitute medical advice. Always follow your local protocols and medical direction.

Book announcement: Bram Duffee is a co-author of the latest book about how hypnosis has the potential to revolutionize medical care for those struggling with emergency / acute distress. Hypnotic Communication in Emergency Medical Settings: For Life-Saving and Therapeutic Outcomes demonstrates how hypnotic communication has the potential to improve patient outcomes in emergency care, integrating insights on the connection between mind and body for paramedics and other first responders. https://routledge.pub/Hypnotic-Communication-in-Emergency-Medical-Settings

Stay up to date: Review the most recent research in EMS through the monthly article reviews put out by the International PreHospital Medicine Institute https://iphmi.com/ems-articles-of-the-month

Connections: If you want to connect with the EMS Research Podcast staff check out our website at www.ProfessorBram.com If you enjoyed this episode please consider subscribing to EMS Research on YouTube: / @4emsresearch

References:
Alshehri, A. et al. (2025). Can we identify stroke sub-type without imaging? Medical Engineering & Physics. https://doi.org/10.1016/j.medengphy.2025.104364

Feerick, F. et al. (2025). Barriers to paramedic professionalisation: A qualitative enquiry across the UK, Canada, Australia, USA and the Republic of Ireland. BMC Health Services Research. https://doi.org/10.1186/s12913-025-10993-7

Gonzalez, J. M. et al. (2025). Enhancing trauma care: Machine learning-based photoplethysmography analysis for estimating blood volume during hemorrhage and resuscitation. Bioengineering. https://doi.org/10.3390/bioengineering12080833

Johnston, S. et al. (2025). Why do emergency medical service employees (not) seek organizational help for mental health support?: A systematic review. International Journal of Environmental Research and Public Health. https://doi.org/10.3390/ijerph22040629

Kamholz, J. C. et al. (2025). Association between organizational culture and emergency medical service clinician turnover. International Journal of Environmental Research and Public Health. https://doi.org/10.3390/ijerph22050756

Marsh, E. et al. (2025). Profiling paramedic job tasks, injuries, and physical fitness: A scoping review. Applied Ergonomics. https://doi.org/10.1016/j.apergo.2025.104459

McWilliam, S. E. et al. (2025). Should anything else be done besides prehospital CPR? The role of CPR and prehospital interventions after traumatic cardiac arrest. The Journal of Emergency Medicine. https://doi.org/10.1016/j.jemermed.2025.02.010

Mpody, C. et al. (2025). Racial and ethnic disparities in use of helicopter transport after severe trauma in the US. JAMA Surgery. https://doi.org/10.1001/jamasurg.2024.5678

Shekhar, A. C. et al. (2025). Use of a large language model (LLM) for ambulance dispatch and triage. The American Journal of Emergency Medicine. https://doi.org/10.1016/j.ajem.2025.05.004

Tagami, T. et al. (2025). The impact of dispatcher-assisted CPR and prior bystander CPR training on neurologic outcomes in out-of-hospital cardiac arrest: A multicenter study. Resuscitation. https://doi.org/10.1016/j.resuscitation.2025.110617

Zhou, T. et al. (2025). Racial and socioeconomic disparities in California ambulance patient offload times. JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2025.10325

The 2025 AHA Guidelines for CPR and Emergency Cardiovascular Care introduce significant updates, including a focus on on-scene resuscitation, cautious use of mechanical CPR devices, and prioritizing IV over IO access. While these changes aim to improve outcomes, they’ve sparked debate among seasoned paramedics like Jimmy Apple, the “EMS Avenger,” who highlights the challenges of implementation.

Key Points:
• On-Scene Resuscitation: Emphasis on achieving ROSC on scene rather than rapid transport.
• Mechanical CPR Devices: AHA advises against routine use, but paramedics argue they’re essential for small or rural teams.
• IV vs. IO Access: IV is prioritized, but practicality for resource-limited teams is questioned.
• Empowering EMS Providers: Focus on critical thinking, quality compressions, and timely defibrillation.
• Cultural Shift: Training crews for compassionate death notifications and clear family communication.

Disclaimer: This content is for educational and informational purposes only and does not constitute medical advice. Always follow your local protocols and medical direction.

Book announcement: Bram Duffee is a co-author of the latest book about how hypnosis has the potential to revolutionize medical care for those struggling with emergency / acute distress. Hypnotic Communication in Emergency Medical Settings: For Life-Saving and Therapeutic Outcomes demonstrates how hypnotic communication has the potential to improve patient outcomes in emergency care, integrating insights on the connection between mind and body for paramedics and other first responders. https://routledge.pub/Hypnotic-Communication-in-Emergency-Medical-Settings

Stay up to date: Review the most recent research in EMS through the monthly article reviews put out by the International PreHospital Medicine Institute https://iphmi.com/ems-articles-of-the-month

Connections: If you want to connect with the EMS Research Podcast staff check out our website at www.ProfessorBram.com If you enjoyed this episode please consider subscribing to EMS Research on YouTube: / @4emsresearch

Epinephrine is a cornerstone of medical cardiac arrest, but does it provide the same benefit in traumatic cardiac arrest (TCA)? Emerging research challenges long-held protocols, suggesting this go-to drug may not be the life-saver we assume it is—and could even cause harm. Host Bram Duffee, PhD, EMT-P, explores a groundbreaking study that could change how we manage these critical patients. This episode unpacks a February 2025 study in Prehospital Emergency Care that analyzed over 1,600 out-of-hospital trauma arrests. The findings were stark: epinephrine was linked to lower survival in blunt trauma and showed no clear benefit for penetrating injuries.

Lead researcher Dr. Cordelie Witt shares critical insights on why epinephrine may be counterproductive in TCA:
• Physiological Ceiling: Exogenous epinephrine may offer little benefit beyond the body's own sympathetic response to blood loss.
• Myocardial Oxygen Debt: It can increase the heart's oxygen demand when coronary blood flow is already minimal, potentially worsening cardiac function.
• Arrhythmia Risk: Epinephrine may induce arrhythmias in a heart already struggling.
• Worsening Hemorrhage: Raising blood pressure before controlling the source of bleeding may be counterproductive.
Watch the full interview with Dr. Witt to understand the science behind these findings. Don't forget to subscribe for more evidence-based discussions.

Disclaimer: This content is for educational and informational purposes only and does not constitute medical advice. Always follow your local protocols and medical direction.

Book announcement: Bram Duffee is a co-author of the latest book about how hypnosis has the potential to revolutionize medical care for those struggling with emergency / acute distress. Hypnotic Communication in Emergency Medical Settings: For Life-Saving and Therapeutic Outcomes demonstrates how hypnotic communication has the potential to improve patient outcomes in emergency care, integrating insights on the connection between mind and body for paramedics and other first responders. https://routledge.pub/Hypnotic-Communication-in-Emergency-Medical-Settings

Stay up to date: Review the most recent research in EMS through the monthly article reviews put out by the International PreHospital Medicine Institute https://iphmi.com/ems-articles-of-the-month

Connections: If you want to connect with the EMS Research Podcast staff check out our website at www.ProfessorBram.com If you enjoyed this episode please consider subscribing to EMS Research on YouTube: / @4emsresearch

Reference: Witt, C. E., Shatz, D. V., Robinson, B. R. H., Campion, E. M., Shapiro, M. L., Bui, E. H., Meizoso, J. P., & Dorlac, W. C. (2025). Epinephrine in prehospital traumatic cardiac arrest—Life saving or false hope? Prehospital Emergency Care, 1(1), 1–9.

Severe hemorrhage is one of the toughest challenges faced in the pre-hospital environment, especially when every second counts and resources are limited. But a recent study on the use of 25% human serum albumin (HSA) in trauma care could change how responders approach these critical moments. The study was led by United States Army Scientist Alex Penn, Ph.D. The findings from his team suggest that this concentrated protein solution can stabilize blood pressure, reduce the need for additional fluids, and improve circulation in ways traditional methods cannot. For paramedics, this could mean a shelf-stable, easy-to-use solution that saves more lives in the toughest conditions, revolutionizing pre-hospital care as we know it.

Book announcement: Bram Duffee is a co-author of the latest book about how hypnosis has the potential to revolutionize medical care for those struggling with emergency / acute distress. Hypnotic Communication in Emergency Medical Settings: For Life-Saving and Therapeutic Outcomes demonstrates how hypnotic communication has the potential to improve patient outcomes in emergency care, integrating insights on the connection between mind and body for paramedics and other first responders. https://routledge.pub/Hypnotic-Commun... 

Take part in research: If you are a first responder who lives in the United States and would be open to an interview for a research study please connect with Bram Duffee by going to the website https://bduffee0.wixsite.com/ems-conf... 

Stay up to date: Review the most recent research in EMS through the monthly article reviews put out by the International PreHospital Medicine Institute https://iphmi.com/ems-articles-of-the... 

Connections: If you want to connect with the EMS Research Podcast staff check out our website at www.ProfessorBram.com If you enjoyed this episode please consider subscribing to EMS Research on YouTube:    / @4emsresearch  

Reference:
Penn, A. H., Falabella, M., Sanchez, A., Hernandez, O., McFadden, K., & Hutcheson, J. (2023). 25% Human Serum Albumin Improves Hemodynamics and Prevents the Need for Nearly All Pre-Hospital Resuscitation in a Rat (Rattus Norvegicus) Model of Trauma and Hemorrhage. Shock, 10-1097