EMS Training Blog | EMS-MedSim by Global MedOps Command

The EMS-MedSim blog publishes evidence-based EMS training articles written and reviewed by Chester Shermer, MD, FACEP. 46 articles cover prehospital pharmacology, cardiac emergencies, airway management, trauma, NREMT exam preparation, and EMS agency quality improvement.

Cardiology

• CPR and AED Use on Women: Where the Gap Opens and How EMS Closes It — Women in cardiac arrest are less likely than men to get an AED before EMS arrives, and in one U.S. system crews shocked them later. Where the pads go, what the 2025 AHA guideline says about the bra, and what agencies can measure.
• Refractory VF in the Field: Vector Change, DSED, and the Fourth Shock — DOSE VF raised survival with vector change and double sequential defibrillation, yet the 2025 AHA guideline calls both unproven. How EMS should plan the fourth shock.
• SCAPE in the Field: CPAP and Nitroglycerin, Together — SCAPE is an afterload crisis with a breathing problem on top. How EMS crews pair CPAP with sublingual nitroglycerin, screen out the patients nitrates can hurt, and spot CPAP failure early.
• Prehospital Cardiac Arrest Management: High-Performance CPR and ROSC Strategies — Survival from out-of-hospital cardiac arrest hinges on the quality of CPR and the speed of defibrillation. This evidence-based guide covers high-performance CPR techniques, team choreography, ROSC recognition, and post-resuscitation care for EMS providers.
• Prehospital STEMI Equivalents: The High-Risk ECG Patterns That Don't Meet Criteria — The 12-lead ECG is your most powerful prehospital diagnostic tool — but only if you know what you're looking for. This guide covers Wellens syndrome, De Winter T-waves, posterior MI, and other high-risk patterns that don't meet classic STEMI criteria but require immediate cath lab activation.

Pediatric EMS

• Pediatric Seizures in EMS: Getting the First Midazolam Dose Right — In a three-agency study, 36% of pediatric midazolam doses were wrong and most were low. The IM dose, the intranasal evidence, and the trial testing age-based dosing.
• Pediatric EMS Training: Why Providers Struggle with Pediatric Calls — and How to Fix It — Pediatric emergencies are low-frequency, high-stakes calls that expose the limits of EMS training. Here is why providers struggle — and how simulation closes the gap.
• Pediatric Assessment Triangle: A Guide for EMS Providers — Pediatric emergencies are high-stress, low-frequency events for most EMS providers. The Pediatric Assessment Triangle (PAT) gives you a rapid, evidence-based framework for identifying the critically ill child in the first 30 seconds — before you touch the patient.

Neurology

• Low Stroke Scores on Scene: What the Stroke Team Needs From You — A negative FAST or low stroke score does not make a minor call. What EMS must document so the hospital can decide whether a low-score stroke is disabling.
• Prehospital Stroke Protocol: What Your Field Assessment Decides Before the Patient Reaches the CT Suite — Your field assessment decides what the neurology team can do. CPSS limits, the real BE-FAST evidence, LVO screening tools, and why prenotification is not optional.
• Stroke Recognition: Mastering the BE-FAST Protocol — Time is brain — every minute of large vessel occlusion destroys approximately 1.9 million neurons. This guide covers advanced prehospital stroke recognition tools (LAMS, BE-FAST, CPSS), LVO identification, and how to optimize your stroke alert to reduce door-to-needle time.

Trauma

• Prehospital Whole Blood: What the 2026 Trials Mean for EMS — Two 2026 randomized trials did not show prehospital whole blood to be superior to component therapy. Here is what the findings mean for EMS protocols, supply systems, and medical oversight.
• Traumatic Brain Injury in the Ambulance: Prevent the Second Hit — The first injury happens at impact. The next one can happen in the ambulance. A practical field guide to blood pressure, oxygenation, ventilation, reassessment, and destination decisions after suspected traumatic brain injury.
• START Triage in Mass Casualty Incidents: A Prehospital EMS Field Guide — When patients outnumber resources, the START triage algorithm gives EMS providers a systematic framework to sort, tag, and prioritize care. This field guide covers the START algorithm, common pitfalls, ICS integration, and how to maintain situational awareness during a mass casualty incident.
• Prehospital Trauma Assessment: The Errors That Reach the ER Before You Do — The most dangerous trauma assessment errors are not the ones that kill patients in the field. They are the ones that delay definitive care by sending incomplete or incorrect information to the receiving facility.

Airway Management

• Prehospital CPAP: Relief Is Not the Same as Resolution — Prehospital CPAP can ease distress in selected patients. Learn how to choose the patient, reassess response, and know when to escalate.
• Prehospital Airway Management: Mastering RSI Techniques — Rapid Sequence Intubation in the prehospital environment carries unique risks that don't exist in the ED. Dr. Shermer walks through patient selection, drug dosing, failed airway algorithms, and the evidence behind BVM-first strategies.

EMS Agency Operations

• Sepsis in the Ambulance: Screen, Treat, Handoff — A field guide to recognizing possible adult sepsis, using screening tools without false certainty, treating hypoperfusion within protocol, and giving the receiving team a useful handoff.
• When a Patient Refuses EMS Transport: A Safer Field Checklist — A refusal is a clinical disposition, not a signature. This field checklist shows EMS crews how to assess capacity, explain risk, document the encounter, and close the loop safely.
• EMS Quality Improvement: What Your Agency's Data Is Actually Telling You — Most EMS agencies collect more quality data than they act on. The agencies that consistently close performance gaps use QI data to identify specific clinical deficiencies, then drive targeted simulation training to address them.

Pharmacology

• Prehospital TXA After PATCH-Trauma: Who Should Get It? — PATCH-Trauma changed the TXA conversation. Here is how EMS teams can select adult trauma patients, protect the first minutes of care, and hand off the dose clearly.
• The Inferior STEMI Trap: Why Nitroglycerin Can Kill in Right Ventricular Infarction — Nitroglycerin is a reflex treatment for chest pain — but in inferior STEMI with right ventricular involvement, it can cause catastrophic hypotension. Here's the clinical reasoning every prehospital provider must have before administering nitrates.
• Adenosine in WPW: When a First-Line SVT Drug Turns Lethal — Adenosine is a first-line drug for SVT — but in Wolff-Parkinson-White syndrome with a pre-excited rhythm, it can trigger ventricular fibrillation. Here's the clinical reasoning every paramedic needs before reaching for that syringe.
• Paramedic Pharmacology: High-Risk Medications in the Prehospital Setting — A clinical guide to the highest-risk drug categories in paramedic scope of practice — epinephrine, NMBAs, opioids, antiarrhythmics, and benzodiazepines — with simulation-based training strategies for each.
• The 5 Most Dangerous Prehospital Drug Errors (And How to Avoid Them) — Medication errors are among the most preventable causes of prehospital patient harm. Learn the five most dangerous drug errors EMS providers make — epinephrine concentration confusion, succinylcholine in hyperkalemia, naloxone re-narcotization, adenosine in WPW, and nitroglycerin in RVI — and the systematic habits that prevent them.

EMS Technology

• Prehospital POCUS: Scan With a Decision in Mind — Prehospital ultrasound is useful when it changes a decision. A practical EMS framework for focused questions, time limits, interpretation, training, governance, and documentation.
• Prehospital Decision Support: How AI Is Changing the Ambulance — AI-based decision support tools are entering the prehospital environment faster than the training infrastructure needed to use them safely. EMS providers need exposure to AI-assisted clinical decision-making in simulation before they encounter it on a real call.
• Why AI Can't Replace Clinical Judgment on the Ambulance: A Field Framework for EMS — AI is already in dispatch centers and on 12-lead monitors. The gap between a benchmark number and a moving ambulance at 0300 is the problem nobody has solved. A physician-led framework for keeping the paramedic in command.

Environmental

• Heat Stroke in the Field: Cool First, Transport Second — Heat stroke is a cooling emergency, not a transport-only problem. A practical EMS workflow for recognition, active cooling, equipment readiness, and handoff.
• Prehospital Hypothermia Management: Recognition, Rewarming, and Transport Decisions — Hypothermia kills through progressive cardiac and neurological dysfunction, but the prehospital provider who recognizes it early and applies the correct rewarming strategy can dramatically improve outcomes. This guide covers the stages of hypothermia, field rewarming techniques, cardiac arrest management in the cold patient, and the critical transport decision.

EMS Training

• EMS PCR Documentation: What Your Patient Care Report Reveals About Your Clinical Judgment — Your PCR is a legal document the moment you sign it. The documentation errors that follow EMS providers into court — and what a defensible narrative looks like.
• Cardiac Arrest Simulation for Paramedics: Why One Recertification a Year Isn't Enough — CPR skills degrade within months of training. Annual recertification isn't enough. Here's what the evidence says about cardiac arrest simulation and sustained skill performance.
• Tactical EMS: What TEMS Training Looks Like in 2026 — Tactical EMS providers operate in a legally and clinically distinct environment from standard EMS — and their training requirements reflect that. In 2026, effective TEMS preparation means competency in warm zone casualty care, the EMS-law enforcement operational interface, and scenario types that standard EMS simulation does not cover.
• Airway Reps Without Risk: Why Simulation Is the Only Safe Way to Train Prehospital Airway Skills — Prehospital airway management fails when providers lack realistic reps. Simulation-based training is no longer optional — it is the only ethical mechanism for building the decision-making and technical competency that real airway emergencies demand.
• EMS Simulation Training: Why Decision Drills Build Clinical Judgment That Lectures Can't — Lectures teach you what to do. Simulation trains you to do it when it matters. The difference is not just pedagogical — it is neurological.
• What a Real EMS Field Training Officer Does — and How a Virtual FTO Fills the Gap — Field training officers are the most important educators in EMS. They are also the most inconsistent. A virtual FTO provides the structured, evidence-based feedback that real FTOs often cannot.
• Why EMS AI Training Must Move Beyond the Algorithm to Clinical Judgment — AI is already on scene in EMS — but most providers aren't trained to work with it safely. Learn why clinical judgment must lead AI adoption, and how simulation-based training builds the human-in-the-loop oversight skills every provider will need.

Flight Medicine & HEMS

• FP-C Exam Prep: What the Flight Paramedic Certification Actually Tests — The FPC exam is not a harder version of the NREMT. It tests a fundamentally different scope — one built around critical care transport, altitude physiology, and autonomous clinical decision-making in environments where backup is not available.
• Flight Paramedic Training: How Critical Care Transport Providers Stay Sharp Between High-Acuity Calls — Flight paramedics face a paradox: the calls that require the most skill occur least frequently. Maintaining competency between high-acuity calls requires a deliberate training strategy.
• Critical Care Transport Training: What Flight Paramedics Need Beyond the Ride-Along — The ride-along gets you the hours. It does not build the judgment. Critical care transport requires a different kind of training — one that prepares you for the calls you have not seen yet.

EMS Provider Wellness

• EMS Burnout and Moral Injury: Why the System Is Breaking Its Best Providers — EMS burnout and moral injury are not the same condition, and treating them as interchangeable causes real harm to providers and agencies. Burnout is a response to chronic exhaustion. Moral injury is a wound from being forced to act against your values.

NREMT Prep

• NREMT Recertification: What Every EMS Provider Needs to Know About NCCP, CE Credits, and Staying Certified — NREMT recertification is not just about collecting CE credits. It is about demonstrating continued competency. Understanding the NCCP requirements changes how you approach your continuing education.
• How the NREMT's Computerized Adaptive Test Works — and How to Prepare for It — The NREMT is not a standard multiple-choice exam. It is a computerized adaptive test that adjusts difficulty based on your performance. Understanding how the CAT algorithm works changes how you should prepare.
• The 5 NREMT Content Domains Explained: What Each One Tests and How to Prepare — Most NREMT candidates study the wrong way because they don't understand what each content domain is actually measuring. This is a domain-by-domain breakdown of what the exam tests and the specific preparation strategies that work.
• How to Pass the NREMT Cognitive Exam: What Simulation Training Does That Practice Tests Can't — The NREMT cognitive exam fails candidates who study the right material the wrong way. It's a computerized adaptive test built to measure clinical decision-making under pressure — not protocol memorization. Here's what actually works.
• NREMT Cognitive Exam: A Study Strategy Built Around the Adaptive Algorithm — Struggling with the NREMT cognitive exam? Dr. Chet Shermer breaks down the adaptive testing algorithm, highest-yield topic areas, and simulation-based study methods that improve your odds of a first-attempt pass.