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FlightBridgeED foamED – Podcasts – The EMS Lighthouse Project Podcast

The EMS Lighthouse Project

FlightBridgeED® Studio Production

Ep 83 - EtCO2 in Cardiac Arrest

What value does EtCO2 have when it comes to predicting survival from cardiac arrest? We all know a sharp spike in EtCO2 is associated with ROSC, but what about persistently elevated levels? What does this mean for decision making when it comes to termination of resuscitation? Join Drs. Jeff Jarvis, Remle Crowe, and Heidi Abraham for the first episode of “Between Two Nerds”, a subgenre of the EMS Lighthouse Project podcast suggested in episode 82 by Dr. CJ Winckler, as they run through a new paper that may shed some light on this question. Citation:1. Smida T, Menegazzi JJ,...

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Ep 83 - EtCO2 in Cardiac Arrest

April 21, 2024

What value does EtCO2 have when it comes to predicting survival from cardiac arrest? We all know a sharp spike in EtCO2 is associated with ROSC, but what about persistently elevated levels? What does this mean for decision making when it...

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Ketamine v Etomidate for RSI: A Bayesian Meta-Analysis

April 1, 2024

The debate about which drug to use for sedation prior to RSI will.. just.. not… die. Advocates for both ketamine and etomidate approach the argument with near-religious zeal. There have been studies. We’ve even covered some here. What...

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Treatment of Atrial Fib with RVR

March 11, 2024

Atrial Fibrillation with rapid ventricular response is a common cause of EMS activations and ED visits. It is associated with chest discomfort, palpitations, and hypotension. Treatment is aimed at either rhythm control or rate control with...

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LHP E80 – IM Epi in Cardiac Arrest

January 20, 2024

Dr. Jarvis is joined by OG co-host Mike Verkest and Dr. Brent Myers from NAEMSP 2024. We talk about an intriguing concept in cardiac arrest… giving the initial dose of epinephrine IM instead of starting an IV or IO. They discuss a 2021...

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LHP E79 - Head Up CPR – Not So FAST

December 11, 2023

Show Notes:EMS History is full of interventions we've rapidly adopted, often at great expense and withdisruption of existing processes, that later turned out to, how should I say this..... not work.Want examples? MAST and high-volume...

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LHP E78 – Racial Disparities in EMS Analgesia

October 8, 2023

What would you say if I told you that Black patients were less likely to receive pain medication compared with white patients? My guess is you’d either question the methods, assume it isn’t possible, or ask why. Regardless of what your...

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LHP E77 – Should We Reduce Sedative Dosing In RSI Of Hypotensive Patients?

September 8, 2023

Have you heard that you’re supposed to decrease the dose of your sedative when performing RSI on hypotensive patients? First, avoid the question about why you haven’t addressed the hypotension before intubating.. maybe there’s a...

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EMS LHP – E76 – One and Done Epinephrine

August 28, 2023

Y’all know I have thoughts on epinephrine in cardiac arrest. And perhaps might have heard me say epinephrine “saves the heart at the expense of the brain”. I’ve also said I don’t have an issue with any epinephrine in arrest, just...

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LHP E75 - The Device Trial

July 21, 2023

We’ve spoken a lot recently about intubation First Pass Success, including what the definition is. We’ve also discussed different papers about the impact the type of laryngoscope, video or direct, has on first pass success. There’s a...

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LHP – E74 – What Even IS First Pass Success

July 4, 2023

What even IS FPS? There's been a long running argument about the definition of FPS. And by argument, I mean mostly established in the literature with some people just not liking it. FPS is successful ET passage through the cords within 1...

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Ep73 - Post-Mortem CT in Blunt Trauma

June 17, 2023

A new study came out describing the utility of post-mortem CT panscans in patients who died either in the field or in the ED to identify mortal and potentially mortal injuries. This paper has a couple of surprise findings that can help EMS...

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EMS LHP E72 - DSI vs RSI

June 2, 2023

DSI (delayed sequence intubation) has been proposed as an alternative to RSI (rapid sequence intubation) for patients who can't tolerate interventions needed to properly pre oxygenate patients. But does it work? There have been several...

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Ep 71 - SGA Cage Match: Round 2

May 1, 2023

We interviewed Tanner Smida in episode 69 about his very interesting paper using the ESO dataset looking at the association between survival from out of hospital cardiac arrest and type of SGA used (iGel vs KingLT). He found 36% higher odds...

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Ep 70 - Crossover with the EMS Show from Ashland, Oregon!

April 12, 2023

Man, did we have fun recording this one. I found myself in a hotel room in Ashland, Oregon with Drs. Ed Racht, Maia Dorsett, and Ritu Sahni talking about Sepsis. We decided this would make for a great crossover episode with The EMS Show,...

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Ep 69 - iGel vs King LT in OHCA

March 5, 2023

The cage match you've all been waiting for! iGel vs King LT in cardiac arrest. Which is associated with higher survival? Airways-2 was an RCT of iGel vs ETI in OHCA and found no difference. PART was an RCT of King LT vs ETI in OHCA and...

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EMS LHP - Episode 68 - The SAVE Trial

February 6, 2023

Remember AIRWAYS-2, the British RCT comparing iGel to ETI in adults with cardiac arrest? Have you wondered if those results would hold up in a different prehospital population? Wonder no more. Dr. Jarvis reviews the SAVE Trial, another RCT...

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EMS LHP EP67 - DOSED-VF

December 11, 2022

If one is good, two must be better, right? If it applies to cookies and ice cream, why not defibrillators? That’s the question the DOSED-VF trial set out to answer. We’ve covered this topic in episodes 12 and 27, including going over...

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EMS LHP Episode 65: SpO2 vs SaO2 Variations Between Races

November 21, 2022

Dr. Crowe returns to the EMS Lighthouse Project Podcast from our “vacation” in Mexico to discuss the impact of variations between pulse oximetry and blood gas values across races.   Citation: Sudat SEK, Wesson P, Rhoads KF, et al....

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Real World Midazolam Use In Seizures

September 20, 2022

National guidelines for the management of seizures recommend midazolam 10 mg IM as first line therapy. The big question is how often EMS follows this guideline or how well that guideline matches up to real world use. Dr. Jarvis makes a road...

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EMS LHP Episode 64: TXA for Epistaxis, Part Trois

August 31, 2022

First, there was Episode 31: TXA for Epistaxis (the Zahed RCT from Tehran), then there was Episode 40: TXA for Epistaxis, Part Deux (the NoPAC trial), now there's Episode 64: TXA for Epistaxis, Part Trois, another Iranian RCT. So... we have...

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EMS LHP - E63 - Unpacking Paxlovid

August 4, 2022

Description: COVID sucks, no doubt about it. Vaccination has been a game changer for how we live through the pandemic, but we still need therapeutics for those breakthrough cases and the unvaccinated amongst us. Paxlovid is a novel...

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EMS LHP - E62 - Esmolol in cardiac Arrest?

July 22, 2022

Our good friends at Montgomery County Hospital District EMS in suburban Houston brings us a nice feasibility study about the use of esmolol for refractory v-fib. Dr. Jarvis discusses why this is a helpful study. If you like the show, please...

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EMS LHP Episode 61: Red Lights & Sirens Collaborative

July 7, 2022

Dr. Jarvis interviews several EMS industry leaders discussing why we should use Red Lights & Sirens as a clinical intervention and only as indicated. This podcast is part of the first-ever national EMS quality improvement effort led by...

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EMS LHP – Episode 60 – Dueling ECMO Papers

June 16, 2022

I got a great question during my FAST22 talk about what to make of two different papers, seemingly on the same topic, that give different results. In this case, it was about the Prague study Mike and I spoke about on the last episode (E59)...

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LHP E59 - Cardiac Arrest Transport & ECMO

May 31, 2022

Mikey V and Dr. Jarvis get together again, “live” from Planet Hollywood at Las Vegas for FAST22! We took the opportunity to sit down and discuss two papers on cardiac arrest. Should we stay and play or should we load and go? In other...

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EMS LHP – Episode 57 – Bicarb Use In Cardiac Arrest?

May 29, 2022

Y’all have had lots of questions about using sodium bicarbonate in cardiac arrest after we ran an interview with Dr. Menegazzi talking about an abstract he presented showing benefit with bicarb. You wanted more so here it is! Dr. Jarvis...

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LHP - E58 - Pediatric Pain

May 18, 2022

Join us for a joint release of the first episode of The Pediatric EMS Podcast. We collaborate with the great folks from the PEC podcast, and MedicMindset to introduce this new podcast. We discuss assessment and management of pediatric...

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EMS LHP – Episode 56 – Atrial Fibrillation Treatment

March 22, 2022

Do y'all treat a-fib? Have you wondered what the best method of rate control is? Should you use diltiazem or metoprolol? How about the best pad placement for electrical Cardioversion? Should you go anterior posterior or anterior lateral?...

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EMS LHP – Episode 55 – Research from NAEMSP 2022 – Part 2

March 7, 2022

We’re back with the second part of our interviews with researchers from NAEMSP 2022 conference in San Diego. In this episode, Dr. Jarvis interviews Dr. Brian Miller from Fort Worth, Texas about his work on “MCD Walk”, ie the case of...

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Episode 54 – NAEMSP Research Part I

February 28, 2022

NAEMSP in Sunny San Diego… Just. SO. MUCH. GREAT. RESEARCH. Dr. Jarvis interviewed a small sample of the great work presented. There was so much we broke it into two parts. This episode features interviews with Dr. Amber Rice from Tucson,...

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EMS Lighthouse Project Podcast: Episode 53 - Calcium in Out of Hospital Cardiac Arrest

February 2, 2022

Are you still giving Calcium in undifferentiated cardiac arrests? Not those with hyperkalemia or hypocalcemia… you know, when it’s actually indicated. Be honest, now… Nobody’s looking. If you are, join us for this episode where we...

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Episode 52 – The BOUGIE Trial

January 4, 2022

Do you even bougie, bro? Do you use the bougie on every intubation? If so, why? Do you think it improves first pass success? Well, I certainly did. At least before this trial was released. Join me to discuss this randomized controlled trial...

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Episode 51 – Abstracts from PCRF at EMS Expo 2021 - Part 2

November 19, 2021

Dr. Jarvis and Mike Verkest return for part 2 of our interviews with some of the great researchers at the Prehospital Care Research Forum at EMS Expo in Atlanta. In this episode, we interview: Kevin Collopy on his RCT comparing ketamine and...

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Episode 50 – PCRF Research Abstracts from EMS Expo – Part I

November 4, 2021

Dr. Jarvis and Mike Verkest were at EMS Expo in Atlanta. We recorded some interviews from the FlightbridgeED booth on the exhibit floor and then discussed them when Mike stopped by the Casa Jarvis in Austin a bit later. There was so much...

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Episode 49 – The RACKED Trial, with Dr. Barbic

October 15, 2021

Ketamine has been getting a lot of attention recently in the media. Its probably safe to say it’s had a bad year. We like ketamine. We felt bad it’s been having a rough year so we wanted to do something that would lift its spirits....

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Episode 48 – Airway Updates from NEAR

September 17, 2021

Mike and Jeff get together to discuss some airway papers from the National Emergency Airway Registry (NEAR) and float an idea for some merch. If you like the show, please give us a like on YouTube and a 5-star rating wherever you get your...

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Episode 47 – ETI Attempts and Outcomes in Out of Hospital Cardiac Arrest

August 27, 2021

In this episode, Dr. Jarvis discusses a paper that is hot off the presses and that he’s super excited to talk about. The good folks up in Seattle, WA and the Seattle FD looked at their cardiac arrest survival rates as a function of the...

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Episode 46: 2020 EMS LLSA Review with Dr. Casey Patrick

July 29, 2021

Every other year board certified EMS physicians must take an open book quiz over 20-25 papers felt by the American Board of Emergency Medicine (ABEM) to be something all EMS physicians should know. Dr. Jarvis and Dr. Casey Patrick...

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Episode 45: ESO Ketamine Paperfrom Eagles

June 30, 2021

Ketamine is a wonder drug. Ketamine is a tool of systemic racism. Ketamine is impossible to overdose. Ketamine is an inappropriate drug used for inappropriate purposes. So much controversy. What should we believe? When in doubt, follow the...

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Episode 44: OHCA Update from Bend, OR

June 11, 2021

What is the impact of on-scene resuscitation vs intra-arrest transport on outcomes? Could the differences in first pass success between ETI and King LT have accounted for the differences inoutcome in the PART trial? How about differences in...

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Episode 43: mRNA Vaccines – Real World Efficacy

May 28, 2021

We saw the amazing performance of the two mRNA COVID vaccines from Pfizerand Moderna in their RCTs. As encouraging as trial performance is, we always want to see how those numbers hold up under large-scale, real-world pragmatic conditions....

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Episode 42: Droperidol Black Box Warning

April 2, 2021

December 4, 2001. A bad day, indeed. That’s the day the FDA issued a black box warning for droperidol, citing evidence of QT prolongation, Torsades de Pointes, and death. This was a surprise warning because droperidol had been extensively...

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Episode 41: Breaking News: Johnson and Johnson COVID Vaccine

February 27, 2021

The FDA just granted EUA for the Johnson and Johnson vaccine against COVID. This is a big deal because it is a one-shot vaccination that is much more stable than the two mRNA vaccines. Dr. Jarvis does a quick overview of the data submitted...

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Bonus Episode: Medical Directors Gone Wild, Part Deux

February 11, 2021

LIVE from a virtual Texas EMS Conference, we bring you a session moderated by Mike featuring Drs. Jeff Jarvis, Jason Pickett, and Heidi Abraham. This is the highly anticipated Part Deux of a session we all did at the Texas EMS Conference in...

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Episode 39: Ketamine Only Intubation: Next Great Thing or Procedure In Search of an Indication?

February 1, 2021

Ketamine only intubation has been promoted by some as a safe approach to airway management in patients with anatomically or physiologically difficult airways. It turns out Dr. Jarvis has some thoughts on the subject. He uses a 2020 paper by...

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Episode 38: Pediatric Intubation: Are Children Just Small Adults?

January 5, 2021

Children are often considered to be just small adults, much to the dismay of pediatricians everywhere. But when it comes to peri-intubation cardiac arrest, is it true? We know that, in adults, peri-intubation hypoxia is a strong predictor...

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Special Episode: mRNA Literature Review

December 22, 2020

Dr. Jarvis and Mike Verkest are joined by a trio of guests to discuss the literature surrounding both the Pfizer BionTech and Moderna Vaccines. Dr. Ritu Sahni, Dr Veer Vithilani and Dr. Remle Crowe round out the panel. This episode is...

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Episode 37: Droperidol, Ziprasidone and Lorazepam in Undifferentiated Agitation

November 30, 2020

This episode was a LIVE media broadcast discussing a double-blind trial of IM Droperidol, Ziprasidone and Lorazepam for acute undifferentiated agitation in the emergency department. Join Mike and Jeff as they discuss the paper, take...

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Episode 36: EMS Lighthouse Project Podcast

October 13, 2020

Part pre-recorded, part LIVE! Dr. Jeff Jarvis, Dr. Jason Pickett, and Mike Verkest discuss the results of the Resuscitation Outcomes Consortium TXA in TBI Trial. Thanks for coming to the channel! Be sure to subscribe here and wherever you...

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Episode 35: Capsaicin Cream and Cannabinoid Hyperemesis Syndrome

September 25, 2020

Have you had patients recently with repeat EMS calls and lots of ED visits for nausea and vomiting? They say the only thing th works for them is scalding hot showers and that drug that starts with a "D". Did they just happen to smoke a lot...

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Episode 34: LVO and VAN Scores w/ Guests Dr. Wampler and Kidd

August 7, 2020

Mike and Dr. Jarvis are joined by Drs. David Wampler and Emily Kidd to discuss their study on the performance characteristics of the VAN score for detecting large vessel strokes. Drs. Jarvis and Kidd run through a case of a patient with...

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Episode 33: Headaches with Special Guest Dr. Erin Lincoln

July 8, 2020

We talk headaches in this episode, specifically an RCT comparing haloperidol to placebo for benign headache. Joining us for this episode is special guest Dr. Erin Lincoln (@ErinTWL), EM resident and paramedic. Drs Jarvis and Lincoln will go...

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Episode 32: Near VL vs. aDL

June 18, 2020

VL vs Augmented DL with Special Guest: Dr. George Kovacs. We’re starting a new format with this episode. We kick things off with a review of a paper: Brown CA, et al. Video Laryngoscopy Compared to Augmented Direct Laryngoscopy in Adult...

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Episode 31: TXA for Epistaxis

June 2, 2020

There has been a lot of talk about the benefits of TXA in major trauma with small differences in outcomes. If you’re looking for a big treatment benefit for TXA, look no further than the very sexy nose bleeds. This is an easy and safe...

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Episode 30: COVID Comes to The Nursing Home, With Special Guest Dr. Jason Pickett

May 2, 2020

Are you worried about what might happen in your jurisdiction if COVID breaks out in your nursing homes? You should be. Dr. Jarvis reviews a NEJM paper in this episode: Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled...

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Ep. 29: The Very Special Jarvis COVID Home Party Edition

April 7, 2020

We are living, in a COVID world. And I am a COVID doc. This is a special episode of the EMS Lighthouse Project Podcast. Since the entire Jarvis household is quarantined in our bunker in Central Texas, I brought the family together to...

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Episode 28: Does IV vs. IO Matter with Epi?

March 22, 2020

Remember our podcast where we talked about amiodarone and lidocaine improving survival from arrest when given IV but not IO? Wait! There’s more. Another paper dropped looking at the same thing but with epinephrine instead of...

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Episode 26: REVERT: A New Approach to An Old Technique

March 3, 2020

Have you ever given adenosine to a patient in SVT? Yeah? Did they like it? I didn’t think so. You’ve probably also given up trying to use the Valsalva maneuver because you’ve found it doesn’t work very often. Wouldn’t it be great...

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DOSE VF Pilot – DSD revisited

March 3, 2020

Remember Episode 12 where we reviewed a Houston paper on DSD showing worse outcomes with DSD? At the end of that pod, I spoke about an ongoing RCT trial comparing DSD to standard therapy AND vector change defibrillation. Well, the pilot...

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Episode 25 NAEMSP 2020, Part 4

February 9, 2020

The final part of our coverage of some of the research from NAEMSP2020 in San Diego. If you missed any of the first three episodes, be sure to download them and take a listen. They were great! In this episode, we wrap up the series with...

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Episode 24 NAEMSP 2020, Part 3

February 6, 2020

And…we are back for part 3 of our coverage of some of the research from NAEMSP2020 in San Diego. If you missed parts 1 or 2, be sure to download them and take a listen. They were great! In this episode, we have two great interviews. We...

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Amiodarone and Lidocaine in Cardiac Arrest – Does the Route Matter?

January 28, 2020

What if we told you that neither amiodarone nor lidocaine did any better in cardiac arrest when given by IO? What if we told you neither one improved survival when given by IV? Would you think I was smoking crack? Yeah, I would have thought...

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NAEMSP 2020, Part 2

January 25, 2020

And we’re back for part 2 of our coverage of some of the research from NAEMSP2020 in San Diego. If you missed part 1, be sure to download it and take a listen. It was great! As always, we want to hear your feedback. Let us know what you...

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NAEMSP 2020, Part 1

January 19, 2020

Did y’all make it to NAEMSP 2020 in San Diego? If not, I’m sorry. It was awesome! If you did, you probably had a great time but still missed a lot. There’s just too much going on. Being the research nerds we are, we focused our time...

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The EMS Collaborative Podcast

January 10, 2020

HAPPY NEW YEARS! We hope you are celebrating 2020 at the NAEMSP National Conference in San Diego. If you're around, stop by and say hi to the PEC podcast team! This year, we teamed up with our brand new podcast partners Mike Verkest...

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Episode 19: Dr. Ben Bobrow Interview

January 6, 2020

Dr. Jarvis had an opportunity to sit with Dr. Ben Bobrow at the Texas EMS Conference. Dr. Bobrow is the chair of Emergency Medicine at UT Houston. During his time in Arizona, Dr. Bobrow was instrumental in the studies of Traumatic Brain...

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Episode 18: Roc vs Succ: The Randomized Control Trial!

December 19, 2019

The debate has raged. In this corner, we have our established champion succinylcholine, or, as the oldsters call it, “because we’ve always done it this way”. In that other corner over there, we have the brash newcomer, rocuronium, or,...

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Episode 17: Chillin’ in France with TTM

December 8, 2019

Should we chill out with the non-shockable cardiac arrests? Another look at targeted temperature management. First, we knew early hypothermia after ROSC saved brains. Then, we learned that doing it in the field didn’t make a difference...

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Episode 16: Medical Directors Gone Wild

November 28, 2019

As a special Thanksgiving treat we bring a “Live” panel discussion featuring Drs. Jeff Jarvis, Jason Pickett, Heidi Abraham, and Taylor Ratcliff. Skillfully (and tactfully) moderated by the awesome Ginger Locke....

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Episode 15: Why I Quit The VL Wars

November 21, 2019

You’ve all seen it. Most of you have probably taken (or fired) a round or two in it. It’s the Great Twitter "VL vs DL War". Everyone has their opinion. I certainly did. But now I’ve found peace by retreating from the madness....

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Episode 14: Research from EMS Expo 2019 with Dr. David Wampler

November 7, 2019

More and more EMS research is being presented at the PCRF research forum at EMS Expo. Dr. Jarvis sat down with Dr. David Wampler at EMS Expo 2019 in New Orleans. Dr. Wampler won the award for best research at EMS Expo 2019 for his research...

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Episode 13: TXA for TBI? CRASH-3

October 23, 2019

A variety of papers, including CRASH-2, suggest that TXA can decrease mortality if given early for patients at risk of significant hemorrhage but exclude patients with TBI. CRASH-3 was a large, multi-national placebo-controlled randomized...

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Episode 12: Dual Sequential Defib: Is it better?

October 6, 2019

DSD is the current bright and skinny object. Many agencies (including mine) adopted it based on a few case series. Dr. Jarvis discusses a brand new paper looking at Houston Fire/EMS’ experience with DSD. Should we change our practice?...

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Episode 11: Droperidol Review - Research Update

September 12, 2019

Mike and Ritu bring Dr. Jarvis in the mix for the "cross over episode of the century"…um, described by Mike as a ménage a trois…it's not like that…he just meant it’s a 3 for one…even that doesn't sound right. He is simply saying...

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Episode 10: A closer look at RSI in Stroke

August 22, 2019

This episode was recorded LIVE on Facebook with a ton of fun interaction. Dr. Jeff Jarvis and Mike Verkest look at a recent paper that described stroke patients who underwent RSI had worse outcomes than their non-RSI counterparts! …do...

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Episode 9: A dangerous Proposition: Use of Red Lights and Sirens

August 8, 2019

In this episode of the EMS LHP Podcast, Dr. Jarvis and Mike Verkest take a look at the data regarding responding to and from calls with lights and sirens…you may be surprised and the risks we are taking…do the benefits outweigh the...

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Episode 8: Lessons learned from the EPIC Study

July 23, 2019

In this episode of the EMS LHP Podcast, Dr. Jarvis goes solo and discusses an important paper regarding Airway and TBI. The Excellence in Prehospital Injury Care study (EPIC) published in May of 2019 in JAMA definitely sheds the bright...

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LHP Episode 6 | Subdissociative Ketamine for Pain

June 25, 2019

In this episode of the EMS LHP Podcast, Dr. Jarvis and Mike Verkest are joined by David Olvera to see what the literature says about ketamine for pain. Is it safer? Does it take care of pain any better? Tune in to find out! The EMS...

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LHP Episode 5 | Breaking News! Airway Management and Time To Epi in OHCA

June 7, 2019

In this episode, Dr Jarvis looks at the first secondary analysis from the PART trial of advanced airway management in cardiac arrest (King LT vs. ETI). The analysis looks at the impact of airway type and time to first epinephrine, with an...

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The Lighthouse Project - Airway Management in Cardiac Arrest - Part II

May 29, 2019

In this episode, we continue from part 1 and look at 3 papers that try to answer the question about airway in the adult cardiac arrest. Thank you for supporting the FlightBridgeED network of podcasts. We appreciate the subscriptions,...

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The Lighthouse Project - Airway Management in Cardiac Arrest - Analyzing The Data!

May 18, 2019

In this episode, we look at 3 papers that try to answer the question about airway in the adult cardiac arrest. Put your seat belt on, this episode is nearly 2 hours so we broke it into 2 parts! We are joined By Eric Bauer from the...

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The Lighthouse Project - Making Sense Of Epi in Cardiac Arrest

May 8, 2019

The EMS Lighthouse Project Podcast exists to foster knowledge translation from peer-reviewed scientific journals to the street. Join Mike Verkest and Dr. Jeff Jarvis as they shine the bright light of science on EMS practice in an...

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The Lighthouse Project - Introduction!

May 7, 2019

The EMS Lighthouse Project Podcast exists to foster knowledge translation from peer-reviewed scientific journals to the street. Join Mike Verkest and Dr. Jeff Jarvis as they shine the bright light of science on EMS practice in an...

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