1 Episode = 1 Hour Of Continuing Education Credit


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00:00 / 1:10:07
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In today’s episode, Steve, Dan, and Holly have the opportunity to discuss an interesting MCI call with guest, Firefighter/Paramedic Kyle Snider. At the time of the incident, Kyle was a new paramedic graduate with wilderness medicine training who was working in a rural department with limited resources. Kyle discusses the call from the point of dispatch to call completion and reviews what he felt went well and what he would have changed. This episode gives the team a chance to discuss how we often leave chaotic scenes feeling overwhelmed and discouraged; however, reviewing the call with others in the field can be helpful to see where we performed well and where or what we could do to make improvements if faced with a similar call in the future. When discussing this call, we see how Kyle managed as the PIC and only paid medic while ensuring all patients received care. He then took what he learned from this call to help make personal and departmental improvements moving forward.

Play/Pause Episode
00:00 / 52:49
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It is no secret that we, as a nation, are experiencing extreme implications of opioid abuse. In this episode, Holly talks about a new program she is helping head, whose goal is to provide treatment to patients suffering from opioid addiction. This cutting-edge program utilizes a medication called buprenorphine to initiate treatment in the field and provide ongoing care for willing patients. While there is still much to learn, Holly discusses the research behind the foundation of this program, its successes thus far, and some learning points. The team discusses how this information is helping shape the current program and providing crucial data for future programs. This episode sheds light on current opioid abuse and overdose statistics, discussion around the steps of behavioral change, and relevant data on what treatment is proving most effective for individuals suffering from opioid addiction.

Show Notes:

  • https://nida.nih.gov/sites/default/files/ClinicalOpiateWithdrawalScale.pdf
  • https://www.cdc.gov/drugoverdose/resources/graphics/illicit-opioid.html
  • https://www.cdc.gov/stopoverdose/fentanyl/pdf/Fentanyl_Fact_Sheet_508c.pdf
  • https://www.oregon.gov/oem/pages/housing-emergency-executive-orders.aspx
  • https://www.cmadocs.org/newsroom/news/view/ArticleId/50024/Congress-eliminates-need-for-waiver-to-treat-opioid-use-disorder
  • https://www.chcf.org/publication/buprenorphine-overview-clinicians/
  • https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheories/behavioralchangetheories6.html
  • https://bridgetotreatment.org/addiction-treatment/ca-bridge/
  • https://www.ems1.com/overdose/pilot-program-allows-portland-first-responders-to-administer-buprenorphine
  • https://www.opb.org/article/2024/01/18/portlands-first-responders-will-give-immediate-opiate-treatment-following-an-overdose/
  • https://www.samhsa.gov/find-help/national-helpline


  1. Wesson, D. R., & Ling, W. (2003). The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs, 35(2), 253–9.
  2. Centers for Disease Control and Prevention. (2023, July 28). Illicit opioid graphics. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/resources/graphics/illicit-opioid.html
  3. Centers for Disease Control and Prevention. (n.d.). The facts about fentanyl – CDC. The Facts About Fentanyl. https://www.cdc.gov/stopoverdose/fentanyl/pdf/Fentanyl_Fact_Sheet_508c.pdf
  4. Oregon.gov. (2023, April 10). Homelessness Emergency Executive Orders. Oregon Department of Emergency Management : Homelessness Emergency Executive Orders : State of Oregon. https://www.oregon.gov/oem/pages/housing-emergency-executive-orders.aspx
  5. California Medical Association . (2023, January 20). Congress eliminates need for waiver to treat opioid use disorder. CMADocs. https://www.cmadocs.org/newsroom/news/view/ArticleId/50024/Congress-eliminates-need-for-waiver-to-treat-opioid-use-disorder
  6. Steiger, S., & DeFries, T. (2024, February 16). Buprenorphine: An overview for clinicians. Buprenorphine: An Overview for Clinicians. https://www.chcf.org/publication/buprenorphine-overview-clinicians/
  7. Boston University School of Public Health. (n.d.). Behavioral change models. The Transtheoretical Model (Stages of Change). https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheories/behavioralchangetheories6.html
  8. CA Bridge. Bridge to Treatment. (2024, January 30). https://bridgetotreatment.org/addiction-treatment/ca-bridge/
  9. Hallman , T. (2024, January 19). Pilot program allows Portland first responders to administer buprenorphine. EMS1. https://www.ems1.com/overdose/pilot-program-allows-portland-first-responders-to-administer-buprenorphine
  10. Wilson, C. (2024, January 18). Portland’s first responders will give immediate opiate treatment after overdoses. opb. https://www.opb.org/article/2024/01/18/portlands-first-responders-will-give-immediate-opiate-treatment-following-an-overdose/
  11. United States Government. (n.d.). SAMHSA’s National Helpline. SAMHSA. https://www.samhsa.gov/find-help/national-helpline
Play/Pause Episode
00:00 / 1:00:51
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In this follow-up episode, Bruce and the team continue discussing ventilation and airway management. This episode goes into greater depth on how ETCO2 can be used to manage an array of patients effectively and how a thorough understanding and monitoring of end-tidal during a resuscitation attempt can help ensure a patient remains neurologically intact, assuming ROSC is achieved. Bruce covers case studies on this topic, and the team has the opportunity to look at the “oscillations” in end-tidal and how they provide vital information on the efficacy of CPR and PPVs. This episode provides unique insight and information on the delivery of effective ventilations and how to best use the tools in our toolbox to ensure our patients receive the highest possible level of care. This episode highlights the central theme of part 1: that airway management should not be lightly handed over to the least experienced provider; instead, thorough training should be provided to all members of a crew to ensure all are competent and understand the weight and importance of the delivery of effective ventilations to not only the management of the patient while they are in crisis, but to their longevity following the incident.

Below are graphics and their descriptions provided by Bruce to help understand concepts discussed in the course.

This example shows “Oscillations, 30:2 Ventilations. This patient is intubated (Patent Airway). Tidal Volume is excellent, and compressions look high quality. You can see it all play out.  Also, notice that in the 30:2, the first end-tidal waveform is shortened.  That is because we are trying to give two really fast breaths, so we interrupt the first breath out with an immediate 2nd breath in, giving it a shortened waveform.  This is trained at TVFR to give your two breaths and then look for a shortened waveform, and the 2nd breath has the compressions.  Appreciate how consistently our variables work together, and the end-tidal is not wavering or all over the place.”

– Bruce Opsal