We're doing something unique for the Extra Monday Episodes of 2026. Thanks to Wes' suggestion, we're going to overview with what all the EMS Institute is involved. EMSI is not just a medical control system. To start, the team discuses the various geography, hospitals and their specialties and the various work flow processes that have been implemented overall including the new OneDose technology.

In this episode of the Pre-Hospital Paradigm Podcast, Caleb Ferroni is in the host seat with co-host Dr. John Hill. They sit down with Kim Florczyk and Sharon Kozel from Cleveland EMS to discuss the history, clinical operations, and challenges they face as such a large agency. This episode was recorded live from Cleveland EMS Headquarters.

As this episode, and in-depth look into the City of Cleveland's EMS system, the crew talks about their handling of the opioid issues within the city and the handling of Narcan. They also discuss the challenges faced by the agency which includes fleet maintenance, road conditions of the city and internal training challenges for such a large, high-volume service. In the future, they hope to have initiatives that handle the frequent callers that may not need an ambulance but still need a clinical interface individual such as community paramedicine.

The crew continues their discussion about the City of Cleveland's EMS agency. From blood administration in the prehospital setting to CPAP and BiPAP to multiple way to secure airways and oxygenation... the ladies discuss the clinical operation which includes Paramedics and Basic EMTs.

Caleb is subbing in for Scott this episode as Dr. Hill and Caleb welcome representatives of Cleveland EMS. In this first episode, we get some history on Cleveland EMS. The agency is a 3rd service and just celebrated 50 years of service. The agency runs over 70,000 calls per year with 25 units during daylight hours.

The final episode regarding addiction care wraps up the convo. We were live at Amherst Fire Department. If you missed the last 3 episodes, we definitely suggest going back in the timeline. This episode may challenge your "veteran thoughts" on addiction care.

As the crew starts to wind up this topic, the discussion of the process of opioid withdrawal continues including inducing a more intense, or higher, level of withdrawal to help the patient's recovery progression. The guys discuss the Clinical Opiate Withdrawal Scale (COWS) score, its use and the interpretation of.

KEEPER NOTE: What words should we NOT be using to define these patients with "opiate disease disorder."

Dr. Singer continues to talk to the PPP crew regarding Project DAWN (Deaths Avoided With Naloxone), an Ohio-based network of opioid overdose education and naloxone distribution programs (OENDP) coordinated by the Ohio Department of Health. Should EMS squads add Buprenorphine to the drug box in the long term?

KEEPER NOTE: The Narcan administration is just the beginning of the patient's opportunity to enter a recovery process.

A.J. and Dr. Hill join Scott this month, to chat with Dr. Jordan Singer from the UH EMS Institute. What is long-term addiction care? It's more than just showing up, treating the patient's symptoms, i.e., Narcan, and ending the patient's care once they are resuscitated. The crew digs into the norms and what the future might be including, leaving Narcan behind with family members or the patients.

KEEPER NOTE: If a 20-year-old overdoses once, there is a 1 in 10-20 chance that they will be dead in 1 year.

As the team winds up its discussion of the new Ohio EMS advanced scope of practice regulations, the discussion of oral Zofran for younger patients, ultrasound use for IV assistance and the place of urinary catheters within the scop of a 911 type of call are part of the discussion.