Michael R. (Mic) Gunderson, EMT-P (Ret.), FAEMS – President, Center for Systems Improvement; Chief Strategy Officer, Cambridge Consulting Group; Adjunct Faculty, Department of Emergency Health Services, University of Maryland - Baltimore County; Madisonville, TN, USA


Managing Editor

Michael Touchstone, BS, FACPE, Paramedic – Fire Paramedic Deputy Chief, EMS Operations, Philadelphia Fire Department (Retired); Past President, National EMS Management Association (2015-16); Philadelphia, PA, USA


Associate Editors - Peer-Review

Judah P. Goldstein, PCP, PhD – Research Coordinator, Emergency Health Services, Nova Scotia; Assistant Professor, Dalhousie University; Halifax, NS, Canada

Scot Phelps, JD, MPH, Paramedic, FP-C – Englewood Hospital and Medical Center Mobile Intensive Care; Principal Researcher, NYC Ambulance History Project / NJ Ambulance History Project; Bordentown, NJ, USA

Vincent D. Robbins, MSc, FACPE, LFACHE – Founder, President, and Chief Executive Officer, Cambridge Consulting Group; Cambridge, MD, USA

Brett Williams, PhD, FACP – Professor and Head of Department, Monash University; Frankston, VIC, Australia


Associate Editor – Production

James D. Dinsch, MS, NRP, CCEMTP – Director of EMS, LifeCare Medical Center; Executive Director, Florida Association of EMS Educators; Executive Director, Florida Association of EMTs and Paramedics; Roseau, MN, USA


Senior Editors – Statistics and Methodology

Brooke Lerner, PhD, FAEMS – Professor and Vice Chair for Research, Department of Emergency Medicine, University at Buffalo; Buffalo, NY, USA

Sonja Maria, PhD, Paramedic – Associate Head of School, Head of Discipline for Paramedicine, Charles Sturt University; Chair of the Australasian Paramedic Clinical Practice Guidelines SIG, Australasian College of Paramedicine; Bathurst, NSW, Australia

Nikiah Nudell, MS, MPhil, NRP, FACPE – Paramedic Scientist, The Paramedic Foundation; Research Manager, University of Colorado Health; Loveland, CO, USA


Assitant Editor - Layout

Theron Becker, MMPA, FACPE, CP-C - EMS Clinical Cheif, Citizens Memorial Hospital; Bolivar, MO,USA


Assistant Editors – Copyediting and Proofreading

Laura L. Chadwick, BS, MLS(ASCP)CM QLS CM, NRAEMT – Marshfield Clinic Health System (WI), Centerville, GA, USA

Craig Evans, MEd – Assistant Professor, George Washington University; Washington, DC, USA

Martha A. Peribonio - Executive Director, National Association of Mobile Integrated Health Providers; Buford, GA, USA

Brian C. Wilcox, BS, NRP, CCEMTP - Program Director, University of PIttsburgh Medical Center, Chautauqua Regional Paramedic Program; Clinical Coordinator / Paramedic, Alstar EMS; Jamestown, NY, USA


Section Editor – Benchmarks

John R. Clark, JD, MBA, NRP, FP-C, CCP-C, CMTEChief Operating Officer, International Board of Specialty Certification; Apollo, PA, USA

Diane C. Flint, DPA, MS, NRP Assistant Dean, School of Health Professions, Community College of Baltimore County; Baltimore, MD, USA

Ben Neal, BS, NRP Division Chief of EMS, Fern Creek Fire and EMS; Vice-Chair, Kentucky Board of EMS; Louisville, KY, USA

Diane C. Flint, DPA, MS, NRP – Assistant Dean, School of Health Professions, Community College of Baltimore County; Baltimore, MD, USA


Section Editors – Case Scenarios

Becky J. Donelon, EdD, ACP – Paramedic Programs Faculty, Northern Lakes College; Applied Research & Graduate Studies, Justice Institute of British Columbia; Edmonton, AB, Canada

J Paul LeSage – Founding Partner and & Senior Analyst, SG Collaborative Solutions LLC; Portland, OR, USA

Luke A Persin, MS-3, EMT-B – EMT, Mutual Aid Ambulance Service; MS-3, DeBusk College of Osteopathic Medicine; Greensburg PA, USA


Section Editors – Comparisons

Brian A. Donaldson, CCP, ASM, AAS – Director of EMS, Peach County (GA); Centerville, GA, USA

Luc de Montigny, MFR, PhD – Conseiller en Analyse et Recherche Clinique, Urgences-santé; Adjunct Professor, McGill University; Montréal, QC, Canada


Section Editors – Externals

Jenifer A. Swab, PhD, Paramedic – Training Coordinator, Foxwall EMS; Pittsburgh, PA, USA

Robert K. Waddell II – Training Manager, SAM Medical; Beulah, WY, USA


Section Editors – Literature Searches

Shaughn Maxwell, PsyM, EMT-P – Deputy Chief, South County Fire and Rescue; Everett, WA, USA

Brenda M. Morrissey, MS, FP-C, FACPE – Paramedic Communications Coordinator (Quality Management) & EMS Educator, Northwell Health; President, Second Chance Safety, LLC; Floral Park, NY, USA


Section Editors – Paramedicine Contents

Brad Buck, BS, NRP, CP – Community & Emergency Paramedic, Mayo Clinic Ambulance Service; Board of Directors, American Paramedic Association; Rochester, MN, USA

Julius McAdams, BA, Paramedic – AirLink/VitaLink Clinical Education Coordinator, Novant Health-New Hanover Regional Medical Center; Wilmington, NC

Sean M. Teed, CCP, MEd(c) – Paramedic Educator, Nova Scotia Health; Lead Faculty, Interprofessional Practice and Learning; Halifax, NS, Canada


Section Editors – Performance Indicators

Ian E. Blanchard, PhD, ACP – Scientist, Alberta Health Services; Adjunct Assistant Professor, University of Calgary; Calgary, AB, Canada

Todd Hatley, PhD, MBA, MHA – Chief Executive Officer, Integral Performance Solutions; Improvement Advisor, Institute for Healthcare Improvement; Wilmington, NC, USA


Section Editors – Perspectives

Elizabeth Lacy, MPS, BS, Paramedic - EMS Outreach Coordinator LCMC Health - University MedicalCenter New Orleans; New Orleans, LA, USA

Albert Bouwer Monroy, MS-1, NRP, FP-C – Deputy Chief, Foxwall EMS; Medical Student, Lake Erie College of Osteopathic Medicine; Pittsburgh, PA, USA

Michael Thomas, MHA, EMT-B, FACPE – Director of Safety & Government Relations, Deputy Director of Compliance & Human Resources, Jan-Care Ambulance, Inc. / GEMS; Beckley, WV, USA


Section Editors – Podcast / Vlog

Dan Brady, Paramedic – Paramedic, Citrus County Fire Rescue; Brooksville, FL, USA

Dean Pearcy – Video Production Technician, Spokane Fire Department; Spokane, WA, USA

Michael Verkest, AAS, FP-C, CCP-C, C-NPT, Paramedic – Learning Ambassador, ESO; Media Production Manager, FlightBridgeED, LLC; Portland, OR, USA


Section Editors – Profiles

Sean Caffrey, MBA, FACPE, NRP – Chief Executive Officer & Commissioner, Crested Butte (CO) Fire Protection District; President, National EMS Management Association; Crested Butte, CO, USA

Christoph Redelsteiner, DPH, PhDr, MS – FH-Professor DSA Mag., St. Pölten University of Applied Sciences; St. Pölten, Austria


Section Editors – Reflections

Michael S. Gerber, MPH, NRP – Paramedic, Bethesda-Chevy Chase Rescue Squad; Adjunct Instructor, The George Washington University; Washington, DC, USA

Scott A. Lancaster, PhD, MHA, NR-P – Director of Operations, Cataldo Ambulance Service; Adjunct Assistant Professor, Eastern Kentucky University; Goffstown, NH, USA


Section Editor - Social Media / Correspondence

Carl Moen, MPM, EMT-P – Former Executive Director, Southern Alleghenies EMS Council; Everett, PA, USA

Ginny K. Renkiewicz, PhD, MHS, Paramedic, FAEMS – Assistant Professor of Healthcare Administration, Methodist University, Clayton, NC, USA

Sean Ferguson, MCPara, FdSc, MSc, PGCert, FHEA, DDCM – Senior Lecturer, Fatima College of Health Sciences, UAE; Chief Education Officer, Alnawa Medical; Abu Dhabi, United Arab Emirates


Section Editors – Toolbox

Charles A. Foat, PhD, MEdT, NRP – Director of Emergency Medical Science, Johnson County Community College; Olathe, KS, USA

Emily R. Kaplan, DrPH, MPA, EMTP – Director, Clinical Practice Group, DocGo; Adjunct Faculty, Westchester Community College; Mahopac, NY, USA


Editorial Advisory Board


Mary Ahlers, MEd, BSN, ACP, NRP – President & Chief Executive Officer, Paramedic Health Solutions; President, Paramedic Network; Cincinnati, OH, USA

Ahed Al Najjar, FAHA, Paramedic, MPH, RN – EMS Education & Research Manager, National Ambulance; Professor, Trisakti University; Instructor, University of Pittsburgh; Abu Dhabi UAE.

William K. Atkinson, PhD, MPH, MPA, FACHE, FACPE – Senior Advisor, Cambridge Consulting Group; Raliegh, NC, USA

Maria Beermann-Foat, PhD, MBA, NRP – EMS Training Coordinator, Eugene Springfield Fire Department; Battalion Chief of Operations (ret.), Johnson County MED-ACT; Cottage Grove, OR, USA

Scott S Bourn, PhD, RN – Research Chair, Senior Quality Consultant, ESO; Vice President, Clinical Quality & Impact, Securisyn Medical; Parker, CO, USA 

Thomas Bouthillet – Battalion Chief of EMS (Ret.), Hilton Head Island Fire Rescue; Hilton Head Island, SC, USA

Brooke Burton, NRP, FACPE – Quality Improvement / Controlled Substance Manager, Unified Fire Authority; Salt Lake City, UT, USA

Will Chapleau, Paramedic, RN, TNS – Director, International Prehospital Medicine Institute; Chicago Heights, Illinois, USA

Kevin T. Collopy, MHL, FP-C, NRP, CMTE – Clinical Outcomes & Compliance Manager, Novant Health AirLink/VitaLink; Wilmington, NC USA

Claire M. Corbett, MMS, MBA, Paramedic – Director of Performance Excellence, Novant Health; Wilmington, NC, USA

Bruce Evans, MPA, NRP, CFO – Fire Chief, Upper Pine River Fire Protection District; President, National Association of EMTs; Durango, CO, USA

Louis Gonzales, MPH, LP, CPHQ, CPPS – Director of Operations, University of Texas at Austin–EMS for Children Innovation & Improvement Center; Georgetown, TX, USA

Michael W. Hubble, PhD, MBA, NRP – Assistant Professor, Wake Technical Community College; Chapel Hill, NC, USA

J. Sam Hurley, MPH, EMPS, NRP – Director, Maine Bureau of Emergency Medical Services; Standish ME, USA

Michael Jacobs, EMT-P – Manager, Alameda County EMS Specialty Systems of Care; San Leandro, CA, USA

Thomas Judge, CCT-P – Executive Director, LifeFlight of Maine; Camden, MA, USA

Margaret A. Keavney, Esq, MHA – Attorney at Law, Keavney & Streger, LLC; Princeton, NJ, USA

Baxter Larmon, PhD, MICP – Professor, Emeritus Director, David Geffen School of Medicine at UCLA; Ventura, CA, USA

William J. Leggio, EdD, NRP – Chief of Staff, Office of the Chief Medical Officer–City of Austin; Round Rock, TX, USA

Glenn Leland, MBA – Chief Growth Officer, Priority Ambulance, LLC; Principal Instructor, Priority Ambulance Leadership Foundation; Knoxville, TN, USA

Brian J. Maguire, DrPH, MSA, EMT-P – Senior Epidemiologist, Leidos; CT, USA

Gregg Margolis, PhD – Director, Health Policy Fellowships and Leadership Programs, National Academy of Medicine; Adjunct Professor, University of Pittsburgh; Bethesda, MD, USA

Jennifer McCarthy, MAS, NRP, CHSE-A – President, 579Solutions; Director of Clinical Simulation, Seton Hall University; Nutley, NJ, USA

Mike McEvoy, PhD, NRP, RN, CCRN – EMS Coordinator, Saratoga County (NY); Senior Staff RN, Chair, Resuscitation Committee, Albany Medical Center; Waterford, NY, USA

Peter O’Meara, PhD – Adjunct Professor, Monash University; Kangaroo Flat, VIC, Australia

Jerry Overton – President, International Academies of Emergency Dispatch; Salt Lake City, UT, USA

David Page, MS, NRP – Director, Prehospital Care Research Forum at UCLA; Paramedic, Allina Health EMS; Los Angeles, CA, USA

Ernesto M. Rodriguez, MA, LP – EMS Chief (Ret.), Austin-Travis County EMS; Leander, TX, USA

Walt A. Stoy, PhD, EMT-P – Associate Advisor, Cambridge Consulting Group; Professor (Ret.), University of Pittsburgh; Director Emeritus, Center for Emergency Medicine; Pittsburgh, PA, USA

Mike Taigman, MA, FAEMS – Improvement Guide, FirstWatch; Assistant Adjunct Professor, University of California–San Francisco; Santa Barbara, CA, USA

Debbie Vass, RN, EMT-P – Corporate Vice President of Quality Initiatives, PatientCare EMS; Largo, FL, USA

David Wampler, PhD, LP, FAEMS – Professor, University of Texas Health Science Center at San Antonio; Boerne, TX, USA

David M. Williams, PhD – Chief Executive, Medic Health; Principal, DavidMWilliamsPhD.com; Austin, TX, USA




Beth Lothrop Adams, MA, BSN, NRP – Quality Manager, Fairfax County Fire & Rescue Department; Adjunct Assistant Professor, The George Washington University, Washington DC, USA

Rateb A. Abuzeid, PhD, MSc, BSc, RN, Paramedic - Head of Community Relations Unit, Researcher, EMS Faculty, Prince Sultan College for EMS, King Saud University; Riyadh, Kingdom of Saudi Arabia 

Nawfal Aljerian, MD  – Chief Executive Officer, Medical Referrals Center – Ministry of Health; Associate Professor of Emergency Medicine, King Saud bin Abdulaziz University for Health Sciences; Ryadh, Kingdom of Saudi Arabia

David Beckerley, MPA, NRP – Commander, Austin-Travis County EMS; Austin, TX, USA

Deepak L. Bhatt, MD, MPH, FAHA – Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School; Boston, MA, USA

Ron Bowles, PhD – Justice Institute British Columbia; New Westminster, BC, Canada

Jane H. Brice, MD, MPH – Professor and Chair, Department of Emergency Medicine, University of North Carolina; Chapel Hill, NC, USA

Elliot Carhart, EdD, RRT, NRP – Professor, Radford University; Seminole, FL, USA

Alix Carter, MD, MPH, FRCPC – Director, Division of EMS, Dalhousie University; Halifax, NS, Canada

Sally Cascio – Chief Flight Nurse, NorthSTAR / University Hospital; Monroe, NJ, USA

Sheldon Cheskes MD, CCFP (EM), FCFP, DRCPSC – Medical Director, Sunnybrook Centre for Prehospital Medicine; Professor, University of Toronto; Toronto, Ontario, Canada

Carol A. Cunningham, MD, FAAEM, FAEMS – State Medical Director, Division of EMS, Ohio Department of Public Safety; Columbus, OH, USA

Ian R. Drennan, ACP, PhD – Associate Professor, Department of Family and Community Medicine, University of Toronto; Professor, Georgian College; Toronto, ON, Canada

Peter I. Dworsky, MPH, EMT-P, FACPE – President, Outcome Solutions; Edison, NJ, USA

Mary E. Fallat, MD – Professor of Surgery, University of Louisville; Director of Surgical Quality, Norton Children’s Hospital; Louisville, KY, USA

Rob Farmer, MBA, FACPE – Tomball, TX, US

Antonio R. Fernandez, PhD, NRP – Research Scientist, ESO; Adjunct Assistant Professor, University of North Carolina –Chapel Hill; Apex, NC, USA

Jay Fitch, PhD – Founding Partner, Fitch & Associates; Board Member, American College of Paramedic Executives; Natchez, MS, USA

Paul M. Gallo, AAS, EMT-P, EMSI – Assistant Chief, Reading Fire Department; Reading, OH, USA

Erik S. Gaull, NRP, CEM – Paramedic /Firefighter III, Cabin John Park VFD; Cabin John, MD, USA

Mary George, MD – Deputy Associate Director for Science, Senior Medical Officer, Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention; Decatur, GA, USA

Stacy Gerlich, MA, EMT-P – Battalion Chief, Los Angeles City Fire Department (Ret.); Westlake Village, CA, USA

Sean P. Graham, BS, NRP, CCP-C – Medical Science Liaison, Stryker Emergency Care; Bothell, WA, USA

Frank Gresh, MS, BS – Interim Chief Operating Officer, Chief Information Officer, Emergency Medical Services Authority; Oklahoma City, OK, USA

Mike Grill, MS, NRP, EFO – Larkspur, CO, USA

Todd Heffern, MD, FACEP, FAEMS, NRP – Assistant Professor, University of Tennessee Health Science Center; Knoxville, TN, USA

Arthur Hsieh, MA, NRP – Faculty Coordinator, Santa Rosa Community College; Windsor, CA, USA

Jeffrey L. Jarvis, MD, MS, EMT-P – Chief Medical Officer & System Medical Director, MedStar Mobile Healthcare; Fort Worth, TX, USA

Jan L. Jensen ACP, MAHSR – Executive Director, Emergency Health Services Operations; Assistant Professor, Dalhousie University; Dartmouth, NS, Canada

Jon R. Krohmer, MD, FACEP, FAEMS – Adjunct Associate Professor, Department of Emergency Medicine, Michigan State University; Holland, MI, USA

Brian LaCroix, BS, FACPE, CPPS, NRP (Ret.) – Co-Founder, Vice President & Chief Operator Officer, Cambridge Consulting Group; Farmington, MN, USA

Jeffrey T. Lindsey, PhD, PM, EFO – Program Director, University of Florida; Gainesville, FL, USA

Cassie Longhart, DHA, MHA/ED, EMT-I – EMS Data Manager, Office of EMS and Trauma, Department of Public Health; Atlanta, GA, USA

Jon Lovett, AS, NRP – Manager, Prehospital EMS, Lawrence General Hospital; Senior Education Specialist, Boston Children’s Hospital; Plaistow, NH, USA

Robbie MacCue, FP-C, MBA – Founding Partner, EMS Leadership Academy; Assistant Chief, Town of Colonie EMS Department; Albany, NY, USA

Russell D. MacDonald, FRCPC, DRCPSC – Medical Director, Toronto Paramedic Services and Toronto Central Ambulance Communication Centre; Professor, Faculty of Medicine, University of Toronto; Toronto, ON, Canada

Renée S. MacPhee, PhD – Associate Professor, Wilfrid Laurier University; Waterloo, ON, Canada

Kim D. McKenna PhD, RN, NRP – Director of Education (Ret.), St. Charles County Ambulance District; Kirkwood, MO, USA

Russell Metcalfe-Smith, MSc. BSc(Hons), NRP – Executive Director Simulation and IPE; Associate Professor, Department of Surgery, Cedars-Sinai Medical Center; Los Angeles, CA, USA

Dennis M. Mitterer, PhD, BSN, CSP, ARM – Instructional Professor / Advisor, University of Florida; Gainesville, FL, USA

Anne Montera, MHL, BSN, RN – Anne Montera, MHL, BSN, RN – President/Chief Executive Officer, Caring Anne Consulting, LLC; Senior Advisor, Cambridge Consulting Group; Director of Nursing, VRpatients; Oxford, FL, USA

Graham G. Munro, PhD, MHSM, BHSc, GradCert, RP – Adjunct Senior Lecturer, Charles Sturt University; Pyrmont, NSW, Australia

Kenneth Navarro, MEd, LP – Training Specialist III, Emergency Medicine, University of Texas Southwestern Medical Center; Dallas, TX, USA

Jeannie Newton-Riner, EdD, MHS / MHSA, CP-C – Board Member, American Paramedic Association; Part-time Faculty, Kennesaw State University; Acworth, GA, USA

Richard W. Patrick, MS, Paramedic, EFO – Director, National Fire Programs Directorate, U.S. Fire Administration (DHS / FEMA); Frederick, MD, USA

Blaine Patterson, RN, FP-C – Director of EMS, St Luke’s Health System; Boise, ID, USA

Brett A. Patterson – Chair, Medical Council of Standards, International Academies of Emergency Dispatch; Clearwater, FL, USA

Daniel Patterson, PhD, NPR – Associate Professor, University of Pittsburgh; Pittsburgh, PA, USA

Debra G. Perina, MD, FAEMS – Professor Emeritus, Emergency Medicine, University of Virginia; Operational Medical Director, Thomas Jefferson EMS Council; Ruckersville, VA, USA

Les Polk, MS, FACPE, NRP – National Director of Clinical Excellence, DocGo; ALS Educator, RWJ Barnabas Health; Cranbury, NJ, USA

Jonathan Pritchard, RN, MN, CCRN, CEN, CNRN, TCRN, NRP – Deputy Chief, Cottage Grove Fire Department; Staff Nurse, Regions Hospital Emergency Department; Cottage Grove, MN, USA

Louise Reynolds, RP, PhD, FACP – Associate Professor in Paramedicine, Victoria University; Altona North, VIC, Australia

Wayne W. Ruppert, CVT, CCCC, NRP –Director of Clinical Outreach, Bravera Health Hospitals; Wesley Chapel, FL, USA

Ritu Sahni, MD, MPH, FAEMS, FACEP – Medical Director, Clackamas County EMS; Medical Director, Washington County EMS; Lake Oswego, OR, USA

Jose V. Salazar, MPH, NRP, FACEP, LMC – Founder / Owner, High Performance Coaching and Consulting, LLC; Deputy Chief of EMS (Ret.), Loudoun County Fire & Rescue; Sterling, VA, USA

Brian Schaeffer, MPA, EMTP – Fire Chief / Paramedic, Spokane Fire Department; Spokane, WA, USA

Hezedean Smith, DM, CFO, FACPE – Fire Chief, Polk County (FL) Fire Rescue; Adjunct Faculty, Embry Riddle Aeronautical University; Charlottesville, VA, USA

Larry Starr, PhD – Program Director, Leadership Doctorates, Thomas Jefferson University; Assistant Adjunct Professor of Pharmacy Systems Science, Geisinger Commonwealth School of Medicine; Wynnewood, PA, USA

Robert Suter, DO, MHA – Professor, University of Texas Southwestern; Brigadier General, US Army Reserve; Dallas, TX, USA

John Todaro BA, NRP, RN, TNS, NCEE, CHSE, CHSOS – Director, Eagle Emergency Education Consultants; Associate Advisor, Cambridge Consulting Group; Land O Lakes, FL, USA

Robert S. Wales, BS, NRP, ALM – Medical Education Program Manager, Medtronic, Inc.; Plano, TX, USA

Jonathan D. Washko, MBA, FACPE, NRP, AEMD – Assistant Vice President for CEMS Operations, Northwell Health; Northport, NY, USA

Katherine H. West, RN, BSN, MSEd – Consultant, Infection Control, Emerging Concepts, LLC; Palm Harbor, FL, USA

Joseph Williams, IV – National Director, Healthcare IT Products, Quality Outcomes Research Analytics, American Heart Association; Detroit, MI, USA

Joshua A. Worth Sr., BS, NRP, CEMSO – Chief of EMS Operations, Medical Rescue Team South Authority; Board Member, American Paramedic Association; Pittsburgh, PA, USA

Matthew M. Womble EMT-P (Ret.), MHA – Regional Chief Operating Officer, American Red Cross; Edenton, NC, USA