A new April 2026 cadaveric study put another dent in needle decompression — 76% success in ideal lab conditions. A 2024 retrospective had finger thoracostomy at 93% versus 47%. The evidence has stacked up for a decade. Civilian ground EMS still won't pick up the scalpel.

The 'we're too close for blood' argument collapses under real urban transport-time distributions, the SWiFT/TOWAR fine print, and the Murphy-factor tail. A three-tier framework — with an embedded 5-scenario Decision Engine — that beats the false binary.

Push-dose epinephrine took over prehospital shock management — and brought a nasty error tail with it. A Field Brief on why the mix keeps killing, and what the best protocols do to catch it before it reaches the patient.

The 2020 AHA guidelines say firm surface, and every EMS crew has been arguing about backboards and floor transfers ever since. A 2024 ILCOR meta-analysis and new June 2026 research quietly show the argument is aimed at the wrong variable — and the real fix has nothing to do with the mattress.

Nelson 2026 (Lancet Respir Med) used causal modelling on 6,467 UK major trauma patients to show that prehospital intubation reduces 30-day mortality by an absolute 10.3% — when delivered to the right patient. Here is the Intub-8 predictor set and what every medical director should do Monday morning.

“Sick or not sick” is the first question EMS teaches and the only one you can answer without touching the patient. That is the whole problem. The case for making stability the front-end frame — and a warning about what happens if “stable” becomes a checkmark.

Two NEJM randomized trials in four months — SWiFT and TOWAR — both failed to show prehospital whole blood is superior to component therapy. Here's what the numbers actually say, what they don't, and what your program should do this week.

The 2023 AHA Focused Update said naloxone in cardiac arrest doesn’t improve outcomes. Two cohort studies (UCSF/UC Davis, JAMA Network Open 2024 and 2026) say otherwise. A Field Brief on what the evidence actually shows, the proposed non-opioid mechanism, dosing in arrest, and what to do on your next code — with an embedded 4-case Decision Engine.

Phoenix Fire's March 2026 study in Prehospital Emergency Care evaluated their prehospital cold water immersion protocol across 183 heat stroke patients — and quietly buried the load-and-go dogma civilian EMS has run on for two decades. What the data says, why your cooling rate is the only variable that matters, and what to put on your rig before the next heat wave.

Excited delirium is a discredited term, buried by the AMA, ACEP, and California law. But the hyperthermic, acidotic patient who codes in restraint is real. A BLS and ALS field guide to the myth, the mechanism, and the sedation trap that can kill him.

A working clinician's guide to tranexamic acid in trauma — the why, the when, and the calls people get wrong. Updated for the August 2025 NAEMSP/ACEP/ACS-COT joint position statement.

Why Intraosseous Access Is Still One of the Most Underused Tools in Emergency Care

The May 2026 CoTCCC update expands tourniquet reposition and conversion to ASM and CLS tiers, pulls OTFC and IV fentanyl from first-line analgesia in favor of a suzetrigine-anchored CWMP, and ships the first standalone pediatric TCCC document. Here is what working tac medics — military and civilian — actually need to know.

Sepsis often hids in plain sight. It kills hundreds of thousands of people every year, it took Kyle Busch - what is sepsis and why does it gain the upper hand all-too-often?

Contrary to the common perception of marijuana as a benign substance, evidence-based data reveal significant acute side effects that EMS providers must be prepared to recognize and manage. This report (aka "field guide") provides a detailed overview of cannabis-related emergencies and their prehospital management helping EMS leaders shape protocols and prepare crews for these emerging challenges.

Xylazine – also known by street names like “tranq” or “tranq dope” – is a veterinary sedative that has rapidly infiltrated the illicit drug supply in recent years. Unlike opioids, xylazine is not intended for human use, yet it’s being combined with fentanyl and other drugs, causing unprecedented challenges for emergency medical services (EMS). This report provides a comprehensive overview of xylazine and similar emerging non-opioid drugs tailored for EMS.

It’s 1430 hours when your crew is dispatched to a construction site for a worker who “passed out.”

In August 2025, a major joint position statement was released by NAEMSP, ACEP, and the ACS Committee on Trauma regarding tranexamic acid (TXA) use in trauma care. This represents one of the most unified and significant updates to prehospital hemorrhage management in recent years. Here’s what every EMS clinician should know:

Every shift starts with a cup. For EMS, coffee isn’t just a beverage—it’s part of the culture that fuels early mornings, 24-hour shifts, and the unpredictable chaos of answering the call. But what if your daily cup could do more than just keep you awake? What if it could train better medics and save more lives? That’s exactly why we launched Black Flag EMS Coffee.

7‑OH (7‑hydroxymitragynine) is the potent opioid metabolite in kratom. It depresses respirations, responds to naloxone, and relapses after short wins. Treat it like an opioid tox with extra vigilance for co‑ingestants and rebound sedation.