Thursday April 2nd 2015

Do You Know TIM? Appreciation and Knowledge Lack



No, not the guy sitting next to you or the cousin that you see only during family gatherings, but Traffic Incident Management (TIM)? Every year there are numerous responders struck by passing vehicles leading to injuries and deaths. Why is this? Why are we still allowing this to happen? How do YOU manage traffic during a roadway incident?

Join Rob Raheb, Rommie Duckworth, Doug Gadomski, and Kyle David Bates as they discuss roadway incidents and traffic incident management with Eric Rensel from Gannett Fleming. Eric is the project manager for the Traffic Incident Management (TIM) Group as part of the Intelligent Transportation Systems Practice and works with the TIM Network.

Episode References:

National Unified Goal Document

Traffic Incident Responder Training 

USFA/FEMA Traffic Incident Management

Fatality Reports: “A View From the Streets

EMS Voluntary Event Notification Tool

Manual on Uniform Traffic Control Devices

The Responder article on Partnerships

First Few Moments #TIMChat



It’s All About Communications!


Welcome Back! After about a year we return with our studio broadcast!

15 months ago the Sandy Hook tragedy occurred. In recent months the events that day have been evaluated and critiqued. Based upon the Connecticut Post  article “Too Many Ambulances Overwhelmed Newtown Responders” posted on, we revisit this topic as well as previous podcasts that we did around the same time.

Join Rommie Duckworth, Eric Dickinson, Dan McGuire, Ronald Rolfsenn, Wilma Vinton and Kyle David Bates as they readdress the response, recent criticisms, egos, communications, “Tactical Medics” and the often forgotten responder: the dispatcher.



Live from Vegas! EMS World Expo 2013 Ep 44


Kyle David Bates from the First Few Moments podcast sat down with his guests in the ProMed Network podcast studio at EMS World Expo 2013 to talk about EMS provider and ambulance safety. Joining Kyle were Rommie Duckworth, EMS educator and consultant, and two guests from the EMS Safety Foundation, ergonomics expert Chris Fitzgerald and Dr. Nadine Levick. They brought a modular ambulance design to the exhibit hall to show how emergency medical services professionals could be better protected when providing care in the back of an ambulance.

Scene Safety Stinks! A discussion on Situational Awareness Ep 43


Since we began our journey into the world of EMS we have heard, uttered, and been tested on the phrase: “Scene safety…BSI!”

This parrot phrase, which is spoken almost as much as the “eyes are PERL” and “I don’t see any DCAPBTLS,” has lost its purpose. It has become a check-off box on a skill sheet and becomes forgotten as we move along in our assessment process. However in real-life just saying, “Scene is safe,” doesn’t actually make it so. In fact, even if the scene WAS safe where we work is dynamic, it is always changing. Nowhere is this more evident then on the roadway. WIthin seconds your life, or those of your fellow responders, can be changed forever.

Join Steve Murphy, Tim Nonnan, Kyle David Bates, and our special guest Dr. Rich Gasaway as we explore a much better, yet underutilized concept: situational awareness (SA).


Situational Awareness

Dr. Gasaway


At the completion of this podcast the listener will be able to:

  1. Develop their own definition of situational awareness;
  2. Discuss the difference between the phrases “scene safety” and “situational awareness;”
  3. Discuss the importance of having an ever-constant situational awareness while working on or along the roadway.

Not IF but WHEN? Response to violence Episode 42


It seemed that the world came to a stop when 26 people, mostly children, were shot dead at the Sandy Hook Elementary School in Newtown, Connecticut. Ten days later the Nation was shocked again when 4 firefighters were shot, 2 killed, responding to a house fire set by a deranged gunman lying in wait.

Although mass shootings and the targeting of responders are not unheard of, the timing of those 2 events along with others within the past couple of years have really brought safety of the public and responders to the forefront of discussion.

Join Rick Russotti, Eric Dickinson, Eric Richenbach (EJR), Dan McGuire, and Kyle David Bates as they discuss violence against responders, response to known and unknown events, situational awareness, and the psychological impacts that events such as these have upon responders.

This Episode is dedicated to the victims of these 2 horrible tragedies:

West Webster Fire Department

Tomasz Kaczowka Tomasz Kaczowka

Michael J. “Chip” Chiapperini Michael J. “Chip” Chiapperini


Sandy Hook Elementary School

Learn the names of the victims, forget the name of the shooter.



At the completion of this podcast, the listener will be able to:

  1. Identify and discuss recent mass shootings and violence against responders;
  2. Discuss the role of the media;
  3. Discuss safety measures and techniques when responding to known and unknown events of violence;
  4. Discuss the psychological impact of events as such upon the industry.

SAY WHAT?! Communications. Episode 41


Live! From Dufferin County EM Conference in Orangeville, Ontario, Cananda we address communications, technology, and how Steve is old. 

Join Kyle David Bates, Steve Murphy, Alex Buchanan, and Doug Allport as they discuss some new technologies in the area of communications. 

The 4 ‘Ws’ of Pain Management: a discussion – Episode 40


Why do we manage pain?

What do we use to manage pain?

When should pain be managed?

Who gets pharmaceutical pain management?

Join Brad Buck, who through an unfortunate Skyping accident we lost, Tim Noonan, Wilma Vinton, Roland Rolfsen, Kyle David Bates, and Dr. Laurie Roming (the good twin) as they have a lively discussion addressing the 4 ‘Ws’ of pain management.

Learning Objectives

The listener will be able to:

  1. Discuss why pain management is important.
  2. Identify different methods of managing pain.
  3. Argue for the management of pain based-upon the patient.
  4. Identify and discuss possible considerations in the delivery of pharmaceutical pain management.


Truth Hurts

Fentanyl in the out-of-hospital setting: variables associated with hypotension and hypoxemia.


EMS Safety Foundation @ RettMobil 2012, Episode 39


This month we make a return trip to Fulda, Germany with Dr. Nadine Levick and the EMS Safety Foundation. Join Kyle David Bates, Chris Fitzgerald, Dr. Levick, Jim Foster, and Neil Blackington as they discuss industry safety from a world view but with RettMobil as the foundation. 

Click below to learn more about each!



A Chilling Realization – Episode 38


After a little bit of a sabbatical, First Few Moments is back!

As a safety concern at the scene of an MVC we often discuss proper clothing and hydration prior to responding. However our patients rarely plan on being involved in an MVC so they may not always be dressed for the elements and if they are we have always been taught to make them naked. I know what you are saying, “I strip them down in the ambulance.” This is true but is the AC on? Are the doors open? Are you sweating?

This week we sit with Art Hsieh to discuss his article, The Chilling Effect of Hypothermia on Trauma Patients, on Join Art as he engages Rick Russotti, Wilma Vinton, and Kyle David Bates in a thought-provoking discussion as to the  relationship of hypothermia to trauma.















At the completion of the podcast, the listener will be able to:

  1. Identify reasons how hypothermia affects the trauma patient;
  2. Identify common causes of inducing hypothermia in the trauma patient;
  3. Identify preventative measures.

Trauma Criteria: preventative medicine? Episode 37


Over-triage to trauma centers? Poor EMT skills? Paramedics in the way? Care inhibited by the QA/QI process? Anatomicological?! These are some of the topics discussed on this episode of the First Few Moments.

Join Kyle David Bates, Tim Noonan, and Steve Murphy as they talk with Patrick Lickiss about a recent blog post he wrote discussing if Pre-Hospital Trauma Triage are Effective.


At the completion of the podcast, the listener will be able to:

  1. Identify problems with current trauma triage criteria;
  2. Identify possible practices that may prevent proper care;
  3. Give solutions to proper triage and care.




A Change of the Dogma: If it helps only one? Episode 36


**This podcast is not meant to change YOUR current practice, only your medical director can do that! …but nothing says you can’t try to convince them ;) – KDB**

Whoa! Look at that mechanism of Injury! Hope they C-spined her!

A common EMS practice that goes back to the days of Johnny and Roy is that of spinal immobilization…er…ah…spinal motion restriction I am now told. However this skill, which we have spent countless hours learning and practicing is starting to fall out of favor? Why is that? Well, simply put the research says that a) it may not be effective and b) it may actually be harmful. Get that? Harmful!

Join Dr. Laurie Romig, Tim Noonan, Russell Stine, Bob Lutz, Kyle David Bates, and Kelly Grayson as they reference an article written by Kelly regarding spinal immob…oops, spinal motion restriction.

Learning Objectives for this episode:

The Listener will be able to:

  • Discuss the reasonings behind the changes to spinal immobilization



Terrorism @ the North Pole: Burgermeister Meisterburger & Hermie attack! Episode 35


Recently Santa’s Toy Shop was the target of a terrorist attack perpetrated by Mayor Burgermeister Meisterburger and Hermie, the disgruntled dentist. Unfortunately we lost some reindeer, elves, and others but will Christmas still come?

Join Robert Raheb, Rick Russotti, Scott Kier as they discuss the serious sides of  first few moments of a response to a terrorist attack using this parody.

Have a Merry Christmas and Happy Holidays to all!

A Zombie Apocalypse! Episode 34


No Really! Would you be able to handle 240 zombies at a football stadium? Well Delaware County, Ohio found out this past October when they held a disaster drill in which people were turned into, well, um…zombies! But it is not completely their fault…the CDC started it all.

We also discuss a more traditional disaster drill but on a geographically larger scale as well as a one that deals with public preparedness. Which is better? Which is more effective? Which is more fun?

Join Assistant Chief Mike Schuiling from Delaware County EMS, Brain Galligher of Delaware County Office of Homeland Security and Emergency Management, Steve Murphy, Jeremiah Bush, and Kyle David Bates as we talk about disaster preparedness evaluation.

That Doesn’t Happen Here: Oslo Norway Episode 33


On July 22, 2011 life in Norway changed forever when a bomb rocked Oslo killing 8 and then  followed by a mass shooting on the island of Utøya in Tyrifjorden, Buskerud killing 69 attendees, children.

Join Steve Murphy, Tim Noonan, William Random ward, Chris Montera, and Kyle David Bates as they discuss this event with Ronald Rolfsen from Oslo University Hospital in Norway.

Learning Objectives

At the completion of the podcast the listener will be able to:

  1. Discuss response to a potential terrorist attack.
  2. Discuss safety concerns when responding to a potential terrorist attack.

When We DON’T Go: Live from EMS World Expo 2011, Epiode 32


The First Few Moments podcast did record a show at EMS World Expo 2011 in Las Vegas, Nevada despite the fact that FFM host Kyle David Bates was home helping his wife with their new baby. Guest Host Scott Kier, aka MedicSBK on twitter and elsewhere, steps in and takes over for the day. He is joined by Natalie Quebodeaux (host of the GenMed Show).

The discussion kicks off with a chat with Sarah Wilson from episode sponsors Sarah is the Grants Manager at and talks with Scott and Natalie about what services they provide and the availability of grants for EMS services and organizations. Later, Sam Bradley, federal disaster preparedness educator joins the show to talk about disaster preparedness and training for EMS services, agencies and individual EMTs and paramedics.

All of the ProMed Network podcast episodes on Day 2 at EMS World Expo 2011 were produced from the Medtronic Foundation Heart Rescue Project sponsored podcast studio. You can find more recorded coverage from the event here at the site and at

Will Twitter Replace the Siren? Episode 31


In this episode we discuss one municipality’s attempt to decrease intersection collisions by using various technologies. We also discuss, again, driving as there has been continued news feeds of horrible crashes. Finally we end the episode talking engineering controls to improve ambulance safety.

Join Robert Raheb, Steve Murphy, William Random Ward, and Kyle David Bates as they discuss these various topics.

This episode’s curriculum

The listener will be able to:

  1. Discuss and debate whether if technology can help make EV operation  safer;
  2. Identify and discuss engineering controls that can make operating in an ambulance safer;


Helmet use by EMS

High-Tech response

NIOSH Ambulance Safety Bulletin

The Rumbler

Slide, Don’t Lift: Episode 30


Bending, lifting, twisting and essentially turning yourself into a pretzel in a car is how we often work at the scene of an MVC. However are we destined to “just deal with it” or are there some adjustments we can do to make moving and extricating patients safer for us?

Join Scott Kier, Kyle David Bates, and Jeremiah Bush as they discuss this topic with our Australian friend and renowned ergonomist Chris Fitzgerald.

Episode Curriculum
The listener will be able to:

  1. Define ergonomics;
  2. Appreciate the importance of proper body mechanics;
  3. Discuss how typical operations at the scene of a motor vehicle crash can increase your chances of injuries;
  4. Discuss engineering controls and how to alter their habits to work safer.


Lifting cushions

Curved transfer board

More lifting cushions

KFRS casualty extrication highlights


Check Your Pee! Episode 29


Oftentimes we talk about provider rehabilitation only during times of extended operations such as with structure fires. However with the arrival of summer, working on the hot blacktop at the scene of an MVC or during a cardiac arrest in a hot environment can quickly lead to heat-related illness and/or injury.

Join Mike Mcevoy, Russell Stine, Jeremiah Bush, Dr. Jeff Myers,  Steve Murphy, and Kyle David Bates as they discuss essentially how not to end up on the business end of an IV catheter while working at any scene during warm weather.

JEMS article: More Than Just a Standard: NFPA 1584 defines the rehab process

EMS 1: Mike McEvoy: EMS vitals during firefighter rehab

This week’s objectives the listener will be able to:

  1. Define REHABilitation and PREHABilitation;
  2. Defend the importance of Rehab and Prehab;
  3. Perform a self-hydration assessment and care;
  4. Identify situations when rehabilitation may be necessary.

Who is TIMA? Episode 28


Roadway safety isn’t a new topic for emergency responders. People dying, being injured, or damage to vehicles is not new either. So how come we are kicking and screaming when it comes to making our roadway scene operations safe? Why do we only address roadway safety on large highways and during motor vehicle crashes? Why don’t we address roadway safety more often on residential streets or during medical operations when the big blocker truck is not there?

Join Tim Noonan, Brad Buck, Kyle David Bates, and Scott Kier as we discuss these topics.


  1. The listener will be able to argue the need for roadway safety.
  2. The listener will be able to identify when to employ roadway safety techniques.
  3. The listener will be able to discuss and employ engineering controls to make operations on the roadway safer.
  4. The listener will be able to define and discuss the importance of situational awareness while operating on the roadway.

RettMobil Day 3: Ergonomics, Episode 26


This week we return to RettMobil in Fulda, Germany as the guest of Dr. Nadine Levick who is the founder of the EMS Safety Foundation, to discuss ergonomics.

We sit down with Chris Fitzgerald, the EMS Safety Foundation’s world-leading ergonomist, and well as Andrew and Daniel Ronchi of Pro-Active Medical to talk about the research and data gathering that they are doing to help make EMS safer. We also look at some best practices in terms of patient transfer that are quite common abroad but have yet to catch on in the States.

Also, click on the EMS Safety Foundation logo above and it will take you to their website where you can access the fascinating pre-recorded webinars, including one that shows the work Chris, Andrew, and Dan did while at the EMS Safety Foundation’s booth.

RettMobil Day 2: Ambulance Design Ep 25


First Few Moments was honored to be the guest participant in the EMS Safety Foundation’s 2011 Rettmobil Delegation to Fulda Germany lead by Dr. Nadine Levick, who established the Foundation.

This is the first episode that we actually broadcasted from the show floor of RettMobil where Kyle David Bates gives a brief overview of the show and tries to talk with some responders that, well, do not speak English. Then join him with Jonas Liden, an industrial designer from Sweeden, Gary DeCosse of Crestline, USA, and Ronald Rolfsen from Oslo University Hospital in Norway as they compare and contrast European ambulance design against those of North America. Dr. Nadine Levick then steps in at the end to thank Gary DeCosse and Crestline Coach, LTD for being a Corporate Partner.

RettMobil Day 1 Episode 24


Fulda, located towards the middle of Germany, is an old, small town where for the 11th year responders involved in mobile medical care converge. This year there is an expected attendance of over 30,000 people from across Europe to look at the latest in mobile rescue, vehicles (air and ground), extrication equipment, and even a speed track.

This year we are honored to be asked to join the EMS Safety Foundation delegation led by Dr. Nadine Levick, a leader in EMS safety research and information transfer. Join Kyle David Bates as he sits down with Dr. Levick to talk about the Foundation as well as Rettmobil.

“Ya got what ya got!” Rural Disaster Management Ep 23


Once again we are at the 17th Annual Interior Region EMS Council Symposium in Fairbanks, Alaska where we talk with Yvonne Howard from Eagle EMS about 2 major disasters in her area.

Imagine being one of a few responders caring for numerous injured passengers of a tour bus that had crashed. Now imagine being with them alone for hours with only 1 ambulance and its supplies. This is first topic we discuss.

The second disaster Yvonne tells a heart wrenching tale of how Eagle was essentially wiped out by a solid tsunami of ice in May of 2009 and how they have yet to recover.

Join Wilma Vinton, Steve Murphy, and Kyle David Bates as they talk with Yvonne about how small rural communities deal with such disasters.

Our podcast also opens with the winner of the 1st Vendor Sponsorship Drawing, Clint Bodily of Laerdal.


What do you mean ‘Load & Go’? Go Where? Episode 22


Join us again in Alaska as Steve Murphy and Kyle David Bates talk with Rusty Lasell from Tri-Valley Fire Department in Healy, AK about wildland fires, earthquakes, and response to other such disasters in a rural area. We also discuss tourist season, 6-8 hour ambulance runs and how that impacts volunteerism.

Rural Alaska Healthcare Episode 21


If you think that driving an hour with a patient means that you are working within a rural community you have yet to visit Alaska. This week we are at the 17th Annual Interior Region EMS Council Symposium in Fairbanks, Alaska.

Join Steve Murphy, David Akin, Wilma Vinton, and Kyle David Bates as we discuss response in this rural area, the health aide system, and the development of a system.


Why We Do What We Do: a view from the ROUGE Medic Episode 20


Ok, so this is a little late getting out but it is quite worth it!

This week’s episode was recorded LIVE at EMS Today 2011 in Baltimore, Maryland. Scott Keir, Dr. Jeff Myers, Tim Noonan, and Robert Rehab all stop by to discuss  why we do what we do or what we don’t do. We talk about justifying our treatment, contacting and utilizing medical consultation, and conclude with our ever so popular topic of driving safety and training.

…and yes, we did spell it R-O-U-G-E for a reason….love ya Tim!

My Wife is the IC! “The Incident Coordination System” Episode 19


This week we address the Incident Command…no Management…no Comm….oh I don’t know, that system we establish when at the scene of a disaster. Should we go away from the terms management or command to one of coordination? Is all that NIMS training worth it?

Join Brad Buck, Russell Stine, Scott Kier, Robert Lutz, Dr. Jeff Myers, Steve Murphy, Rick Russotti, and Kyle David Bates as they delve into and dissect the use of ICS/IMS.

University Disaster Research Center

N.Y. Trooper Cites Fire Chief for Blocking Highway

Some things to think about… Episode 18


This week as we discuss how an Oregon hospital refused to care for a patient in cardiac arrest in their very own parking lot and how the first responders dealt with it.

We also discuss a recent fatal ambulance crash in Brighton, NY and why we continue to crash our units. We expound on this topic through discussing crash prevention, driver training, and other methods we can do to help reduce these libelous actions.

Join Russell Stine, Scott Kier, Kyle David Bates, Justin Schorr, and Robert Raheb from FAAC as we discuss these issues.

Justin Schorr is driving distracted!

To Cut or Not to Cut? Episode 17


It sometimes seems that we become preoccupied with our tools when trying to get someone out of a vehicle. “Cut here…no here…get the spreader…let’s try…” are all phrases that are often heard while “extricating” a patient.

But what determines the extent of extrication that is required and what techniques should be used? I think that depends upon is the person entrapped or simply just confined? Either way, should we consider an alternative route of removal? Should we consider having the patient just simply step out of the car?

Join JD Graziano of the EMS Standing Orders podcast, Wilma Vinton, Russell Stine, Andrew Rossow, Kyle David Bates, and Rick Russotti as they delve into this topic and stress that communication is the key.

This episode is dedicated to my paramedic preceptor, Mark Falkenhan, who was killed in the LOD fighting a fire on January 19, 2011. Our hearts and prayers go out to Mark’s family and all of my friends and colleagues in Baltimore County Fire.

Our sponsor for this episode is:

The Mitigation Journal podcast: Unique Perspectives on Civil Preparedness and Emergency Response for your Ears

The P-I-O E-I-O of Farmville Episode 16


People often think of the Public Information Officer as the guy, or gal, talking to the press. But should there be more to it then that? What about using social media to communicate road closures or detours? Should the PIO essentially be the one who drew the short straw or, like the fire chief, be predetermined before an event occurs?

Join a specialized panel this week of Rick Russotti, Steve Murphy, Scott Kier, Patrice Cloutier, and special guests from, Greg Friese and David Konig as they discuss this all to forgotten but important branch of the IMS.

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