The final episode regarding addiction care wraps up the convo. We were live at Amherst Fire Department. If you missed the last 3 episodes, we definitely suggest going back in the timeline. This episode may challenge your "veteran thoughts" on addiction care.

As the crew starts to wind up this topic, the discussion of the process of opioid withdrawal continues including inducing a more intense, or higher, level of withdrawal to help the patient's recovery progression. The guys discuss the Clinical Opiate Withdrawal Scale (COWS) score, its use and the interpretation of.

KEEPER NOTE: What words should we NOT be using to define these patients with "opiate disease disorder."

Dr. Singer continues to talk to the PPP crew regarding Project DAWN (Deaths Avoided With Naloxone), an Ohio-based network of opioid overdose education and naloxone distribution programs (OENDP) coordinated by the Ohio Department of Health. Should EMS squads add Buprenorphine to the drug box in the long term?

KEEPER NOTE: The Narcan administration is just the beginning of the patient's opportunity to enter a recovery process.

A.J. and Dr. Hill join Scott this month, to chat with Dr. Jordan Singer from the UH EMS Institute. What is long-term addiction care? It's more than just showing up, treating the patient's symptoms, i.e., Narcan, and ending the patient's care once they are resuscitated. The crew digs into the norms and what the future might be including, leaving Narcan behind with family members or the patients.

KEEPER NOTE: If a 20-year-old overdoses once, there is a 1 in 10-20 chance that they will be dead in 1 year.

As the team winds up its discussion of the new Ohio EMS advanced scope of practice regulations, the discussion of oral Zofran for younger patients, ultrasound use for IV assistance and the place of urinary catheters within the scop of a 911 type of call are part of the discussion.

The team starts to discuss specifics of the expanded scope of practice. First up, the epinephrine auto-injector initiated by EMTs. EMTs are now able to give epinephrine via I.M. and broncho-dilators. Reconstituting Glucagon and administering it via IM is also part of the new EMT expanded scope of practice. Needle chest decompression and blood product administrations for advanced providers are also discussed.

Ray Pace has taken a back seat to the pod so that he can focus on his fire chief duties. Welcome back to A.J. Joseph as one of our rotating co-hosts for 2026.

The State Board of Emergency Medical, Fire, and Transportation Services (EMFTS Board) expanded the Ohio EMS Scope of Practice on December 17, 2025. First thing the gang discusses is what is and is not the scope of practice. How do we define it? What can Medical Directors write into protocols?

Key point to take away... just because something is in the expanded scope of practice doesn't mean that you can execute that skill without medical control and training.

The crew welcomes back Dr. Greg Stefano and Geoff Patty, RN from the interventional cardiology department. If you're listening to this episode, head over to our YouTube channel to see the visuals of actual cases.

An interesting discussion ensues about human and computer interpretations of various EKG strips.