March 2026
Hosts
Caleb Ferroni
John Hill
Kim Florczyk - Sergeant of Education and Training/Clinical Coordinator
Sharon Kozel - Sergeant of Education and Training
Cleveland EMS Part 1
Caleb fills in for Scott; Dr. Hill in his usual seat.
Guests introduced as Cleveland EMS education/training leaders with multiple roles and responsibilities.
Early context: Cleveland EMS runs 120,000+ calls/year with ~73,000 transports/year (as referenced by the host).
Sharon’s path
Inspired by an aunt who worked for Cleveland EMS and told “wild” stories.
Wanted a career outside an office: hands-on work helping people.
Started EMT at 18; hired by Cleveland EMS at 21; paramedic school through the City of Cleveland.
Around 20 years with the service; promoted to sergeant in the last couple years.
Kim’s path
Worked hospice as an aide for years, then wanted to shift from end-of-life care to “saving them.”
Became EMT/paramedic; worked in ERs; joined Cleveland EMS and has stayed ~13 years.
Hospice background helped significantly with family communication during arrests/terminations:
Explaining what’s happening in real time
Supporting families when resuscitation ends
Key teaching point
EMS doesn’t get enough training on death notification and family support.
The table agrees: advocacy includes the patient and the family, and EMS often has “more than one patient” in the room.
Cleveland EMS is a third service (separate from fire), working closely with fire as first responders.
Established 1975; recently celebrated 50 years.
Documentary plug: “Pulse of the City” covers the origin story and evolution.
Early days: police would transport sick/injured patients (or bodies) due to lack of dedicated EMS.
EMS/emergency medicine highlighted as young compared to broader medicine.
Units and shifts
12-hour shifts.
Typical deployment: ~25 ambulances days / ~21 nights (staffing dependent).
Calls per unit per 12-hour shift: roughly 12–16, depending on severity and demand.
Reality check: it’s not unheard of to have zero available ambulances—even overnight.
Crew configuration
Two-person crews:
Paramedic/EMT or double paramedic.
EMT hires generally must obtain paramedic within 3 years (with some grandfathered exceptions).
Cleveland runs predominantly ALS workload.
Dynamic posting
Cleveland uses DSD (Dynamic System Deployment) / dynamic stationing (“posting on corners”).
Not popular, but operationally necessary for coverage.
Fire is routinely dispatched as first response based on call acuity:
Alpha/Bravo: EMS only
Higher acuity (Charlie/Delta/Echo): fire is typically sent
Most firefighters are EMTs; Cleveland Fire also has ALS engines staffed with paramedics (limited number).
Co-location in firehouses improved relationships significantly:
Fire saw the true EMS workload
More conversations → better understanding of policy differences → better teamwork
Fire assists with driving, manpower, and scene operations when needed.
Cleveland EMS operates its own academy.
New hires complete a ~10-week program (described as recently updated):
Initial city onboarding at headquarters
Mixed classroom + ride time with FTOs
Strong retention through academy; rarely lose candidates midstream.
Focus areas:
Skill competency (meds, procedures, protocol application)
Scenarios requiring decision-making and leadership
Refreshing paramedics coming from other environments (e.g., ED-based medics)
Turnover trends (as shared):
2023: 41 lost
2024: 39 lost
2025: 16 lost so far (~5%)
Major driver of improvement: new union contract/raise.
Recruitment surge: 200+ applicants, hiring class of 28.
Acknowledged reality: Cleveland EMS is often a stepping-stone to fire jobs, but that may be changing.
Notable observation from Dr. Hill: more medic students now say they don’t want fire, which is a shift.
Big news
Cleveland EMS deployed prehospital whole blood in 2025.
Claimed as first in Ohio for whole blood (others have component therapy).
Rollout timeline
Deployed June 4, 2025 with one field captain (Southeast side) — chosen due to:
Distance from trauma centers
Higher rates of violent trauma
Expanded to additional captains around Oct 23, 2025 (West/East added).
Utilization & outcomes (as shared)
~45 administrations since launch.
Reported disposition: 32 discharged, 13 deceased (noted as impressive given shock criteria).
Eligibility criteria (trauma-focused)
Must meet mechanism criteria + physiologic triggers:
HR > 110
SBP < 90
EtCO₂ < 25
Two of three required, OR SBP < 70 as standalone
Clinical judgment caveat:
Beta-blockers considered (blunted tachycardia)
“Paint the picture” approach supported by medical direction
Med command available when readings are unreliable
Adjuncts and resuscitation strategy
TXA + Calcium given with blood.
Limit crystalloids; blood prioritized (and Cleveland carries normal saline, not LR).
Emphasis on multiple access points; the blood line becomes the “busy line.”
Rollout
Ventilators deployed service-wide; reported first use Nov 17, 2025 (used within an hour of release).
Adds BiPAP (previously CPAP-only with disposable devices).
Operational notes
Keep legacy CPAP devices because CPAP is an EMT skill, while vent operation is not.
Not used for pediatrics (peds remain on home/facility vent if appropriate caregiver present, or EMS bags).
Vent comfort principle
If patient is stable on their home vent, consider transporting them on what they tolerate best.
If switching vents, confirm tolerance before movement/transport.
“Back to basics” thread
Repeated emphasis: great paramedics are great basics.
BVM, positioning, tourniquets, capnography discipline — these save lives.
AccuVent / assisted BVM coaching
Discussed use of a device that helps prevent overbagging by:
Guiding rate (countdown prompts)
Displaying tidal volume targets
Reinforces lung-protective ventilation during high-stress calls.
Not RSI-certified currently (guests express desire for expanded capabilities).
Sedation approach referenced: ketamine (plus other meds available; conversation includes Ativan/fentanyl).
Discussion highlights:
Modern airway tools (video laryngoscopy, bougie, supraglottics) reduce need for paralysis in many cases.
Bougie use: optional but evidence suggests routine use may improve first-pass success.
Surgical airway:
Cleveland does not currently perform cricothyrotomy; guests want it if within scope.
Urban realities
Short transports can make it harder to justify advanced interventions (“you’re 10 minutes away” argument).
Counterpoint: ED delays and earlier intervention opportunity may still justify expanded scope.
Rural realities
Longer transport times, more reliance on advanced procedures and transport medicine.
Helicopter utilization differs (more common in rural due to time/distance).
Patient population
Urban setting offers constant exposure to diverse patient backgrounds and pathology → rapid experience gain.
Cleveland transmits 12-leads and activates receiving centers.
Discussed improving EMS credibility and the value of listening to prehospital clinicians.
Dr. Hill shares a lesson learned: EMS called a stroke correctly before the ED recognized it — trust prehospital reports.
Overdose workload reportedly trending down (no stats given), but remains a major operational issue.
Cleveland EMS initiatives:
Community outreach / resource linkage team (sergeants doing follow-up, assessments, and referrals)
Distribution of Project DAWN naloxone kits
Kits include fentanyl test strips (as referenced)
Naloxone philosophy:
Goal is restoring respirations—not necessarily waking the patient fully.
Community impact:
Strong acceptance of kits on calls (anecdotally “rarely refused”)
Large distribution volume at events (noted “thousands” of doses/kits)
System stressors
Fleet wear and tear from constant operation, harsh winters, outdoor parking.
Road conditions/potholes, snow operations, and recurring city events that block streets.
Downtime reality
Little to no downtime; crews prioritize basic needs (food, hydration, bathroom).
Training model:
Twice-yearly required HQ training blocks (8 hours/day, multiple days).
Field-based micro-training is harder compared with slower suburban/24-hour fire schedules.
Logistics
Restocking through HQ supply room using OperativeIQ ordering workflow.
QI structure
Dedicated department reviews charts with special focus areas (e.g., refusals, trauma, controlled substances, medical).
Not all runs can be reviewed; select percentage plus mandatory review of certain categories (e.g., blood cases).
Dispatch
City-based, separate from fire and police (all on same floor).
Guests praise dispatch complexity and stress; one guest previously picked up dispatch overtime after a crash course.
Community paramedicine expansion
Commissioner strongly supports building a robust community paramedicine/outreach program.
Goal: reduce frequent callers by addressing root causes (med access, food insecurity, fall risk, social needs).
Acknowledges barriers: reimbursement models still lag behind the clinical value.
Other future-facing ideas
Mobile Stroke Unit already exists (in partnership with Cleveland Clinic).
Ultrasound mentioned as a newly added scope competency and a possible next step.
Continued investment in education, equipment, and clinical advancement emphasized.
“One call at a time.” (managing massive call volume)
“Say they died.” (clear communication in death notification)
“Treat your patient, not the monitor.” (whole blood decision-making)
“I don’t need a paramedic on a critical call — I need a solid EMT.” (foundational skills matter)
“We’re not ambulance drivers.” (clinical identity and professionalism)
Guests publicly recognize Cleveland EMS field crews: hardworking, high-performing, and deserving more recognition.
Hosts encourage Cleveland EMS staff to join future live show Q&A.
Sharon discusses death in field
Kim discusses how documentation works in high volume systems
Dr. Hill discusses staffing
Caleb asks how blood integrates into care