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Field Brief: Naloxone in Cardiac Arrest — When the Dogma Catches Up to the Street
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.

John Gomez
1 day ago8 min read


Field Brief: Cool First, Transport Second — The Phoenix Cold Water Immersion Study & the New Science of Heat Emergencies
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.

John Gomez
Jun 259 min read


Field Brief: The EMS Blood Reckoning - What SWiFT Actually Says, and What It Doesn't
The largest randomized trial ever run on prehospital whole blood, SWiFT, found it no better than component therapy. Here is what the trial actually says, what it doesn't, and what it means for your cooler, your protocol, and your budget.

John Gomez
May 307 min read


Excited Delirium Is Dead. The Patient Still Codes: A BLS and ALS Guide to Hyperactive Delirium With Severe Agitation
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.

John Gomez
May 2711 min read


The Paramedic's Guide to TXA
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.

John Gomez
May 258 min read


Intraosseous Access: Why Not?
Why Intraosseous Access Is Still One of the Most Underused Tools in Emergency Care

John Gomez
May 2412 min read


Field Brief: TCCC 2026 — Tourniquet Conversion, OTFC Out, and the Pediatric Guidelines We Should've Had a Decade Ago
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.

John Gomez
May 2410 min read


Black Flag EMS Scenario Saturday: Collapse at the Construction Site
It’s 1430 hours when your crew is dispatched to a construction site for a worker who “passed out.”

John Gomez
Oct 4, 20252 min read
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