Dr Peter Antevy (Whole Blood in EMS, Ketamine Assisted Psychotherapy and Pediatrics) - Episode 1092

This episode is sponsored by Transcend, a veteran owned and operated performance optimization company that I introduced recently as a sponsor on this show. Well, since then I have actually been using my products and I have had incredible success. There was initial blood work that was extremely detailed and based on that they offered supplementation. So I began taking DHEA BPC157 for inflammation based on the fact that I've been a stuntman, a martial artist and a firefighter my whole life. Lots of aches and pains, Dihexa to help cognition after multiple punches to the head and shift work and peptides. Four months later they did a detailed blood work again and I was actually able to taper off two of the peptides because my body had responded so well to just one of them that it was optimized at that point. So I cannot speak highly enough of the immense range of supplementation that they offer, whether it's male health, female health, peptides to boost your own testosterone, which I would argue is needed by a lot of the fire service, or whether it's exogenous testosterone needed especially after TBIs or advanced age. Now as I mentioned before, the other side of this company is an altruistic arm called the Transcend foundation, which is putting veterans and first responders through some of their protocols free of charge. Now Transcend are also offering you, the audience, 10% off their protocols and you can find that on jamesgeering.com under the products tab. And if you want to hear more about Transcend and their story, listen to episode 808 with the founder Ernie Colling or go to transcendcompany.com.

This episode is.

Sponsored by Team Builder, yet another company.

That'S doing great things for the first responder community. As a strength and conditioning coach myself who also trains tactical athletes, dissemination of wellness information is one of the biggest challenges. Now Team Builder is the premier strength and conditioning software for tactical athletes and there are several features that really impress me. Firstly, there is a full exercise library so you, the personal trainer does not have to create that within your own department. Secondly, you can send out programming but also individualize, which I love. So you blanket program for everyone. Now you can tweak based on someone's injury, someone's need to maybe drop some body composition rather than having to write a program for every single single person on their own. Team Builder also allows you to build custom questionnaires to collate health and wellness data. It integrates with wearables and I think one of the most important things is obviously it tracks to me. It's imperative that we as a profession start tracking our people from day one and then over the full span of their career, therefore catching potential wellness issues and injuries before they happen. Now, if you want to try Team Builder, they are offering you, the audience of the behind the Shield podcast, a free 14 day trial to experience all of the features. And if you want to take a deeper dive into Team Builder, listen to episode 1032 with Melissa Machado or go to teambuilder.com and I'll spell that to you because it's not as you'd think. T E A M B U I l d r.com welcome to the behind the Shield Podcast. As always, my name is James Gearing and this week it is my absolute honor to welcome on the show emergency room physician, medical director and the creator of the han Tevi system, Dr. Peter Antevi. Now, I first sat down with Peter on episode 213 back in 2019, so as you can imagine, there was a huge amount to discuss, from school safety to the use of whole blood in the pre hospital setting to Ketamine therapy and so much more. Now, before we get to this incredible conversation, as I say every week, please just take a moment, go to whichever app you listen to this on, subscribe to the show, leave feedback and leave a rating. Every single 5 star rating truly does elevate this podcast, therefore making it easier for others to find. And this is a free library of all my almost 1100 episodes now. So all I ask in return is that you help share these incredible men and women stories so I can get them to every single person on planet earth who needs to hear them. So with that being said, I welcome back onto the show Dr. Peter and Tevy.

Enjoy.

Well Peter, I want to start by saying firstly, thank you for coming back onto the behind the Shield podcast. We did our first conversation, episode 213 in May 2019. So obviously there's many, many world events that have happened since then that I'd love to kind of, you know, dive into at some point. But I want to start by welcoming you back onto the behind the Shield podcast today.

James, so happy to be back. 2019. I felt like I was just a little baby in EMS at the time, getting my feet wet. A lot of things were happening for me at the time and I've, I've grown quite a bit, I've matured quite a bit and I'm really excited to get back and talk to you about what's happened in the past and maybe even what we're looking forward to in the future?

Absolutely. So even though we took a deep dive before, because it was so long ago, and for anyone that's listened to that episode, there was a screaming AC unit in the background when we were recording. I'd just love to kind of revisit again. So let's start from the very beginning. Tell me where you were born and tell me a little bit about your family dynamic, what your parents did, how many siblings.

Oh, wow. Let's go back to that. So I was born in Hollywood, Florida in 1972. And I say that because my, my parents immigrated to the United States on a boat from Israel into Ellis island with, with my grandfather. And why that's important in my history is because my, my grandfather was born in, in Iraq because of what was all the, all the badness happening there. He left at a very young age to.

Israel before Israel was even a state.

He joined the army. He actually helped create. He was part one of the leaders helping create the state of Israel. And then they got to a point where my grandfather, for some reason, him and his brother said, hey, let's get on a boat and go figure out this place called America. So just imagine the mindset of people who have already left one country for another and then have to go and then going to get on a boat and go to another country and move everybody along with them. They get here and they lose everything. They go back to zero. And at that time, my grandfather is now 52 years old, which is the age I am today, went to zero. And then he just got back up on his feet, didn't complain, never complained about any of the badness that happened and just rebuilt his life and ultimately his daughter, my mom and my dad, after they got married and they ended up doing, we ended up living, growing up very middle class, but very happy. Our three siblings, who we were raised in a very hardworking, very ethical, we care about people, we care more about others than we care about ourselves. But more importantly, there is this kind of innovation mindset. There is a forward moving mindset. There's a don't, don't listen to what other people are saying, but think about what you want to do and then go accomplish that goal.

And so I think that looking back and what I try and give my, my three boys today, Allison and I both try and do this, is that we try to give them that same feeling of remember where you came from, because that's the kind of person that you're going to be and that's the kind of People that your children will end up being. So that's kind of the important part of my background as I see it. And I'm very, very blessed to have the family that I have, the relationships that I have and the upbringing that I had.

When you say your grandfather came from Iraq, was he Jewish in Iraq or was he Muslim? He was Jewish in Iraq, yeah, yeah, yeah.

My family's Jewish and they were, they were being persecuted and there was, you know, because remember back in the day there was many, many Jews in Iraq. It was a huge bustling Jewish place and it was safe for them and then it wasn't. And so they all basically had to leave Iraq and they had to find another place for safety.

Seems again we were just talking before we hit record. The book I just wrote was about generational trauma. And this is what we're seeing even today. I mean, the ripple effect of the good and the ripple effect of the.

It is. And by the way, I'm going to Israel in about two weeks from now. And you know, every day I check, I check my airline to see if they're having canceled it because people there live in fear and it's horrible what's going on over there, but it's very unsafe. And there's a lot of trauma that's occurring today in many people that's going to last them a lifetime.

Absolutely. Well, you mentioned about growing up in a middle class family. What were your parents doing profession wise?

Yeah, so my dad was an upholsterer, right. So you would say, hey, my couch is ripped, or I need new vertical blinds. And we like, literally, my dad had an Econoline 150 white van, which we love because we used to put mattresses in it and go to the keys. It was, you know, it was that kind of childhood. Stated to Howard Johnson's six people in one room, like, that's what I remember. The greatness of my childhood, that's part of it. So my dad was an upholster. His whole career, own, you know, own his own little upholstery shop. My mom. And by the way, he never had a. Never got a degree, never got a high school degree, never got a college degree. My mom never got a college degree until all of us went to college. Then she went and got her AA degree, became a travel agent, obviously was working with my dad in the front office, if you will.

For that time as well. And so, yeah, travel agent and an upholsterer believe that.

So when you were a child, were you already thinking about medicine or was There something else in your mind?

So this is funny. And.

The only way that I know this is true is because my aunt, years ago found the yearbook from my middle school because, you know, her son and I were in the same class, and she kept the yearbook from, you know, I don't know what grade it was, but the picture of me was on a tricycle. Okay, that's just so you understand. And for whatever reason they put. They had every student at the bottom put, what did you want to do when you grow up? And at the bottom of this picture, which I have, it says pediatrician. What?

Not even doctor, specifically pediatrician.

Right. And why? Because my pediatrician, Dr. Patel, may he rest in peace, was a legend. Right? This guy was legendary. And he was so good that when we used to want to have to go somewhere and it was going to the doctor, where every kid would be like, no, I'm not going. We were like, we can't wait to go to Dr. Patel's office. He had, you know, he had toys in there. And you go into that little. Into a little case and you pick up a toy. And he was such. He was just, for whatever reason, exuded something in me that I said, I want to be like that guy. And that's what I wrote.

Beautiful. Well, kind of walk me through your journey then. What was that? Educational journey. And which field did you find yourself in first?

The educational journey. If we had time to talk over bourbon. The interesting part of my educational journey is that I went to college, University of Florida. And then I thought that I'm a smart guy. I'm just going to get into medical school. But it turns out that I didn't get into medical school. I was tutoring all these kids who all got in. They all had worse grades than me. They all got in. I didn't get in. I don't know the reason. Remember, my parents had never been to college before, so there was zero. Like, you know, the parents today are on top of their kids and you write the essay for them. My parents said, what's college?

Make sure you call and what are you eating? Like.

So we had zero. Like, nobody was helping me do anything. So I kind of got there. I did okay, but not good enough, clearly, in their eyes, to get in. So I ended up applying to a foreign medical school in Grenada. Best decision I ever made, looking back at it. And then two years into Grenada. So remember, I'm living on a. On a third world island.

And it was very good for me personally, because here I was surrounded by a Lot of people that I knew and never really came out of my shell there. I suddenly was, I became who I was and I became the class president. No idea about leadership. I just figured people wanted me to become the president. I don't know how all that happened, but I learned more about who I was in Grenada. And then I ended up transferring into University of Miami.

Stroke of luck, right place, right time, persistence, whatever you want to call it. I was one of only, I think, two people who were able to transfer and then graduated University of Miami. And then when I wanted to go to a top pediatric residency program, the dean there said, pete, you come from a foreign medical school. No one's going to take you at a top tier program. And that. So part of who I am is that I do have a chip on my shoulder because of all the things I just told you. And I have the mindset of I'm going to make it, I'm going to work hard to make it. So when someone tells me I can't do it, then that's kind of the challenge that I had to rise to the occasion. So I only applied to the top 10 programs and they thought it was stupid for doing that. And a little bit of luck, right place, right time, persistence, maybe some personal skills.

I landed the Children's Hospital of la, which no one ever believed that, that I would ever get into. And it's a long story how that happened, but I got in. Then I wanted to go to a fellowship in pediatric emergency medicine because when I was in residency in my training, I knew that I belonged in the ER because I just found myself, like, wanting to live in the er. I needed to be where the action was. I love the resuscitations. I just loved every minute of it. And didn't like the ICU because it was more like chronic care for me. I'm more of a treat them and street them kind of thing. Then I applied to one of the top.

Pediatric ER fellowships, which is another three years after training. And everyone said, there's no way they're going to take you. It's a top program.

And I ended up getting into Pittsburgh, which again, all these things I end up along my journey, meeting the best of the best. They all shaped and crafted, you know, who I am today. And it gave me a certain level of understanding, education and know how. So I had that confidence of who is Peter Antevi? Which. Which leads up to today, which is that I am definitely somebody now who. I have a friend, Rob Warner, who used to always say about Me, and I never understood this then, is that I walk to the beat of my own drum, and I will tell you 100% today that that is the line that probably truly defines me the best. Because if I believe something to be true and I can back it with data, and I. I just inherently know that's the answer, then I will continue to march in that direction until I'm proven wrong or that I'm proven right. I won't stop moving in that direction for these very big ideas that just pull me. I cannot pull myself away from it once I see it. And typically when I see something, it's usually years before other people even want to even talk about it. So I had to learn that about myself. That's a good thing, but it's also not a good thing because it's so far in advance that oftentimes people don't even want to engage.

At the time that I've seen it as the truth. So these are the things. And ever since the last conversation we've had, I now know myself so well that I have to temper that with who I'm, you know, kind of based on who I'm talking to, but I also now have an audience who wants to hear those things. And so I found myself in a very interesting place now where I can understand myself so much better, that I know where to push the gas, I know where to put the brakes, I know how to message things. And at the end of the day, I see myself as inspiring other people to at least start walking in that direction. And that's kind of at least where I see myself today. Not. Not going and holding someone's hand and saying, I'm going to change you personally, but getting the message out to people who say, I believe that guy, and I'm going to start walking in that direction and do my own thing. And then I'll call him 10 years later and say, hey, it was a lecture I saw you give. That's that. That made me want to think about doing that. And that's where kind of, that's what gives me the joy today in my personal and my professional life.

It's interesting because when you said, oh, you'll never get in. When I came out of the academy in Orlando and I said, I'm going down south, a number of people that said, oh, you never get hired down unless you're a medic and you speak Spanish and I work for Hialeah, the most Spanish of areas, within a few months of leaving. And then when I tested in California The Hialeah guys told me, oh, you'll never get hired out there, blah, blah, blah. And I always, my whole mindset was just, okay, I just need one of the jobs. Everyone else can have the rest of them. And then now fast forward with the 2472 conversation, which we will, I'm sure, get into. It's the same thing I've been talking about for over eight years and eight years ago, no one wanted to hear it. And now here we are and you're sitting in, literally in a, in a county where they're about to go to it themselves. So I totally understand. And man, you have to have a thick skin at the beginning.

You really do, you do, you do. And you have to be able to. So you're someone who plays the long game, right? Because you have, you have something that matters to you, that's so deeply rooted in who you are and that you know is right, that you, you say, okay, I'm going to take the next five years of just shit and pain and all this negative feedback, but it's going to come full circle. Rather than the folks who are trying to make a quick buck, trying to gain popularity, more clicks, more likes, more subscribers, when, when, when that idea doesn't work, they quickly abandon it because it doesn't really have the true value or true meaning. So I think you and I both come from a place where, and maybe we will talk about the error that I made early in my career, which kind of, you know, really changed my life. And it put me on this mission of I have to fix that problem. The same thing happened to you. So I do see value in having something.

That impacted you in your life that's so strong, that blends in with who you are as a person, your background, how you were raised, that ends up putting you on this trajectory, that your life at the end of the day does have great meaning. And I think that's what everybody should seek is having a life that's worth live. Worth living.

Absolutely. Well, let's talk about that now. Explain that era and how that did have this ripple effect.

Yeah. So I trained in LA Children's and Pittsburgh Children's, two of the top 10 children's hospitals. And I was never trained.

On using a length based tape to dose medications. Why? Because at these children's hospitals, you had. Someone had taken this idea of.

Creating their own manual or booklet, if you will, that had custom dosing based on the age of the child.

Or the weight. The age gets you to the weight. Or if you have the Actual weight. Then I just need to turn to a page that has the actual weight. So what I learned in LA and in Pittsburgh is that we just use age. And it was really mainly in Pittsburgh. One of my mentors, Robert Hickey, Bob Hickey, would walk into a code room and he said, we have a five minute ETA, cardiac arrest, two year old. He says, okay, two year old, that's all I need. The kid weighs 12 kilos. Like he would just hear the age and then next thing you know, we were off and running. Fast forward 2005, I'm in Joe DiMaggio in Tertiary Children's Hospital, Level 1 Trauma Center. The whole nine yards. One of my first calls.

Like my first bad case was a kid who comes in with anaphylaxis. Four year old girl, she was in room number four. I'll never forget the nurse, she runs out of the room and she says, and Tevi, get in here now. This girl's in severe anaphylaxis. And now I'm a new doctor, I have no idea about dosing or anything at this point. And so she has, she has this braslo tape with her. She, she literally had it in her hand. And I'm looking at it, I'm like, I have no idea what that is. So she, she, she, she points to the box, it was the blue box. And she points to EPI 1 to 1000. She's like, here. And I said, 2.1 milliliters. I said, let's do it, let's give it now. I didn't read the writing right above. It said resuscitation and the EPI 1 to 1000. It had two little letters afterward that says ET endotracheal tube, meaning that that was the dose for EPI. If you couldn't get an IV and that you would give 1 to 10,000, you would give 1 to 1000 through the ET tube for cardiac arrest. We don't do that anymore because we have the IO, so that's kind of a thing of the past. So I just said, go ahead and give that. So she gave instead of 0.21 ML IM, which would have been the right dose, which not even listed on the braslow tape. We gave 2.1 mls Im tenfold overdose. The girl's heart rate and blood pressure went through the roof. I mean, her wheezing went away and her eyes got better.

But the mom looks at me and she's like, hey, doctor, why is this alarm ringing? Oh my God. I'm just going to Keep muting it. Muting, muting. Finally the nurse comes in and she's like, hey, this is like, her blood pressure is really high. You know what, let's just get her to the icu. She spends the night in the icu. I then figure out that I ended up giving a tenfold. It wasn't apparent very quickly to me, right, Because I just said, here's the dose, give it. And I didn't know any better. I had to figure that out. So now I'm coming to work the next day and I'm like, oh God, this is not good. Another call, which I don't talk about often, which is a 7am call. I get to work at 7am and we get that dead baby call. Infant 2 month old mom had rolled over at night and slept on the kid, suffocated him to death. So this kid comes in already stiff and dead, right? But again, kid's dead. They're doing cpr. I'm now at the head of the bed. They bring the child in, the mother's standing right there. And now because someone had been stealing the Braslow tapes, they decided to encase it in wood. James, Imagine. Imagine I'm holding a 6 foot 2 by 4.

At the head of the bed. And now I'm thinking to myself, what am I supposed to do with this thing? And the nurses are like, the doses are right there. And now I'm looking, I'm like, are you freaking kidding me? They really want me to hold this thing up. Like if I turned, I would have killed two people.

And so anyway, that code didn't go well, fortunately for me anyway, my mental state, this kid was already dead. We knew that because the kid was already in rigor. Okay, but now you understand where my mindset is. And like, I'm screwed here. Like I'm in a place where it's not Pittsburgh Ivory Tower. It's not la Ivory Tower. I'm in a tertiary community hospital where the people around me, quite frankly, have no idea what they're doing. And so that led me into this whole thing of. I called Bob Hickey in Pittsburgh. I do a lot of research.

I asked Bob, hey, weren't you using age? He says, yeah, I only use age. And I said, well, why isn't the rest of the world using age? And hey, Bob, aren't you the second name in the Pals booklet? Didn't you help write? He's like, yes, I did. Why didn't you actually have ages in Pals? That's a long story. He says, to me, I said, bob, I'm ready for a long story anyway. I'm not going to give that whole explanation, but it's very interesting. But long story short, I then went, took a piece of paper, I wrote down all the ages, 1, 2, 3, 4, 5, 6, 7, 8. I started writing down what drugs I would need during a code. I started looking at formulas and I finally, after a few pieces of blank paper, I got to 1, 3, 5, 7 and 9, because I can count those on my one hand. And then through all these formulas, I got to 10, 15, 20, 25, 30 kg for those respective ages.

I calculated that all the drugs I had like five ended up with eight drugs. And when I looked at the math, when I did the math and I converted it to a volume, so a 1 year old in this example is 10 kilos. I figured out was 1ml of epi 1 to 10,000. I filled up the spreadsheet with just MLS. Every drug was just in volume and a pattern like, not just hit me in the face, it punched me in the face where I could look at this thing. And I said, wait a minute, just give me the age. Now I'll convert it to a weight. And from that weight I can now figure out the volume of. Let's start off with these five drugs. It was like. It was. It was like a miracle. And I started going into the code room and now I had my head up high and I would say, how old is the kid coming in? Three years old. Okay, 1.5 cc's of epi. If he needs amiodarone, that's 1.5 ccs of that. Back then we used atropine, that's 3 ccs.

I just knew everything. The dextrose was 30. And all of a sudden the nurses came to me and said, something has happened to you.

And then my confidence was booming, but I was so embarrassed. This is the important part. I was so ashamed. I never told anybody what I was doing or how I did it. And there's a book I read recently, I don't think it's on my bookshelf here. I think it's at home where it talks about medical errors and the shame that comes along with it and the embarrassment which I felt. And I never wanted to tell anybody for. For years until a nurse came to me and said, hey, Pete, listen, you're giving a talk next week on. I think it was drowning or pediatric shock. She said, can you do me a favor? Just teach everybody whatever trick you've. You have, you have memorized or learned. I said, Fine. 200 people in the audience, paramedics, doctors, nurses. I gave this talk and at the end of my talk, 50 people lined up and I'm like, whoa, was the talk that good? I'm a new speaker. I didn't think I was that good of a speaker. And they said, no, no, no, we don't care about this drowning talk. We want your last two slides. I said, what? And I came home, I'll never forget, came home to my wife and said, alison, I said, I gotta tell you what just happened today. And she's like a very process oriented, she can do anything and she can help me figure out what's in my head. She says, well, why don't you make a little card, a little badger buddy out of it so I never forget. I went on my computer, I made a little image, I went to FedEx, Kinko's. At the time, I laminated like 20 of them, brought them to work the next day. If I tell you, James, within 10 minutes they were gone. And I came home. I'm like, hun, you got to understand what's going on here. And then because of that first lecture, another lecture request, and then another lecture, and then I got a call from Nevada and then from Georgia. Hey. Hey. You guys need anything for me? Yeah, we heard that you give a talk on medication dosing using your hand. I'm like, really? Long story short, I started printing out these cards 100 at a time, bring them to the ER, gone. Bring them to a lecture, gone. And then I start getting phone calls from around the country. Hey. Because I had my email or we had something in the back that you can get in touch with me, say, hey, we just saved a kid on the highway thanks to your card. I'm like, are you kidding me? So anyway, this is not becoming therapy for me because.

I had made those mistakes. And then the mistake that I made that I should probably tell you about, which I tell very few people, is a mistake where an actual girl did die, okay? Because of my error. And it wasn't an error of an overdose or what I call an error of commission, it was an error of omission. It was a seven year old girl who was septic, who I gave everything except the vasopressor because I didn't know the levophed dose. And I knew that if I asked a nurse for levofed that she would ask me what dose? How do you want to run it? How do you want to mix that? So I went outside the room and I Whispered to a nurse, get me Levofed. And the first thing she said to me is, what dose? And I'm like, oh God. So she ended up calling Steve in the pharmacy, third floor. In the meantime, this girl's ready for the icu. We put the monitor on the bed, we start rolling her up. She's like, not doing well, still hypotensive, tachycardic. She had gotten fluid, she got antibiotic, gotten blood work, all that stuff, the regular stuff. But I needed to give her leva fed and I didn't. So I get up to the icu, the door is open. The ICU doctor, his name is Gerald. Not a nice guy. He's a nice guy usually, but like, you know, he expects, he expects you to do the right thing. He looks at me, he says, pete, where's the presser? And I said, I said, gerald, I. I ordered it, it just didn't. He's like. And he looks at me and says, pete, get out of here. And in front of this is, in front of everybody, right? That girl ended up dying the next day, right? So as I sit here today, that death was my fault. Period. End of story. It's hard for me to tell that story today.

That'Ll live with me forever, unfortunately. And the worst part about it is that I ended up in public supermarkets. You know, Publix, you're from Florida. And I'm at the deli counter. This is years later, three, four years later. And this is probably 10, 12 years ago. This is a long time ago. I'm at the deli counter and there's a lot of people at the deli counter waiting to give their order. And I look to my right and I lock eyes with this lady. And it was kind of like she saw me, I saw her. It took us a split second to figure out who each other was.

Once she figured out who it was, you know what she did? She turns around and she beelines out of the store. That's what she did.

So I never saw her again. But she's living there today, knowing that what I didn't do may have led to her daughter's death. I think it did okay, let's be honest. So I didn't give the right care at the time. And I know today that that will live with me forever, unfortunately. So what is driving me today are those errors that I made initially. The error that ended up causing the life of this, of this little seven year old girl. And my purpose today is.

Not to shine light on myself at all. It's to help the next person who's going to be in that situation, who's going to wonder.

Can I do what I'm supposed to do and actually give the right drug? Will I not omit a medication that a child needs because I, for some reason don't know the dose or can't do the math, and that's 100% drives me today, is to make sure that the next person, whether you're a paramedic, a critical care paramedic, an emt, a nurse, a doctor. And I can tell you, I can tell you because now we're in, you know, we're in all 50 states. We have 160,000 active users. We're in the biggest hospitals in America. People call me and they say, they say to me that. And these are like, really smart, amazing people who say that were it not for the dosing tool that you provided us, the app, I never would have been able to do it right. And then the worst part is the hospitals who call us today. I say, not me anymore. But we say, you know, so what made you call us? And 100 out of 100 times, it's, we had a death. We just had a death. Now, they don't give us all the details, or they say we had a bad outcome and we know what the bad outcome is. The bad outcome is they did exactly what I did. Either gave the wrong drug or they didn't give a drug at all. They delayed care, the delayed diagnosis, and they know that they screwed up and now they need help. And so I could tell you, James, it's happening every single day in every single agency in every single hospital. There are kids that are having bad outcomes today because of an issue that I had and that we all have. And that's my goal, is to try and fix that. So long answer. But that's kind of like I went deep down into where it hurts to give you that one.

Well, I appreciate your courageous vulnerability. I mean, this is the moral injury that we all deal with. And I think even when you take your job seriously and you've trained diligently, there are days, I mean, let's just go back to sleep deprivation for a moment, which your community suffered from. Which my community suffered from. There's times where on a good day, you would have remembered those. And that day, you can't for love nor money. And so this is why what you came up with is so important. Because those, you know, the, the algorithms, the, the mega codes, all these things that we go through. If you think about it for a moment. Those are. In an ideal situation, if everything goes correctly, this is what it will look like. Well, we all know that there's many times where it doesn't go correctly, whether it's the location of the patient or you can't get an IV and the IO drill doesn't work for some reason or whatever the thing is. And all of a sudden, you know, there's this moral injury. Now, what if, what if, what if? That being said, though, just staying on this kind of loss that you had, once this little girl got to the icu, I'm assuming she was put on a vasopressor then.

Yeah. Okay, she was put on vasopressor. She was intubated.

Okay. So it wasn't solely just that emission. As much as it haunts you, that drug was put in place, and she was given that opportunity to overcome the challenge that she had.

Yes, yes. But I know so much more now than I did then, to know that.

The speed to treatment is what saves lives. Okay. And if I could take a little detour to what happened to me yesterday, please. Which was maybe the most incredible experience I've had in the least in the last decade. Okay. Clinical. I don't work in the ER anymore. I strictly work in ems. So I was riding out yesterday in Palm Beach Gardens, and we get a call for cardiac arrest. A guy got stung by 10 Hornets, and he's in cardiac arrest. He's a guy who's a landscaper, and as soon as these hornets get to him, he starts running and he collapses like 100ft later. Now he's foaming at the mouth. When the bystander gets to him, the CPR calls 911. Cop gets there, does CPR, we get there. Meaning engine gets their first rescue, gets their second. EMS captain and myself get their third. That's how we get there. The guy already has a proximal humeral IO in and no pulse. Can't get a blood pressure, but he's breathing on his own. So he's got some sort of circulatory flow going. He's clearly not in cardiac arrest, but he's in severe anaphylaxis. Like, severe. Can't hear any breath sounds. Horrible. This is a moment where I'm like, okay, what we do now in the next three to ten minutes is either going to make or break this guy. Right? And now I'm. And I'm linking this back to this other girl who was delayed by 30 minutes. An hour maybe. Right. And why is that important? Because this guy within literally 10 minutes. Because, you know, from the time we were on scene, we gave a bunch of push pressure. Epi, Benadryl, salumedrol, albuterol.

And then I had the AMS captain take out the life flow, which is basically the rapid infuser. And I'm like, I'm not screwing this one up. We're giving this guy a liter right now before we even get to the hospital. And if I tell you this guy went from effectively dead, not looking around, not moving, barely breathing, to literally. James, when we got outside of the. Of the. Right. When we pulled him out of the. Of the ambulance, we're in the. At the. At the ambulance bay, the guy opens his eyes, and I swear to God, he smiles and he gives us a thumbs up.

If this was on video, you would think it was like a, you know, like almost like a joke, like a movie. And the whole ER is waiting for a cardiac arrest from anaphylaxis, from hornets. And we set the guy up. We roll into the emergency department, and people are looking at him, and he's looking around, and he starts answering questions. So I know that I could have done better on that girl many years ago. So, yes, the girl got everything she needed, but she needed it now. She didn't need it from Gerald an hour later, right? If we wouldn't have done what we did for this guy yesterday, you know what would happen to him? We got to the ER with barely any pressure. Somebody would have had the grand idea of intubating him, paralyzing him, taking away his cardiac output. He would have arrested. His lungs were so tight, it wouldn't have been over bagging and popping pneumos. He would have died. This guy would have died. I'm sure of it. I'm sure of it. My team did such an amazing job, right? But it's because we knew what we had to do and we did it. And if this guy yesterday would have died, that would have been a grenade to all the people who were there in the back of that ambulance yesterday. So what we do matters. And what I did many years ago mattered, too. So no one's going to convince me that the girl ended up getting the right. No, she didn't. She needed proper treatment from me, and she didn't get it, period. And that's just. I have to live with that, right? And the fact that I'm telling people the story today is a big improvement for me because I never wanted to tell that story, right? But now I feel like I need to tell that story, it's good for me and it's good for the next person who thinks that, like you had mentioned, like, who in the world should be doing math when there's stress involved. If you read Daniel Kahneman's book, Thinking Fast and Slow, he proves that no one can do math under pressure. But we have paramedic schools today who are, who will fail you if you can't do the rule of sixes or the clock rule, whatever some stupid thing someone created. And that's what they're pushing today in paramedic schools around this country, which is causing the mental health, which is causing these deaths, which is causing the suicides. It's all related, all of it?

Absolutely. Well, I remember when, I think it was at Orange county when I was in Schuster hand Tevy, and that was before the app at that point, but you had the booklet and obviously, you know, all the, I think it was the different pouches with the different colored, you know, for each, each child and each weight. So talk to me about where you are today. We'll stay on hand, Tavi, for a moment. What do the products look like in 2025?

Yeah, it's, it's really significantly improved because, remember, back then it was. Listen, I think that the most important thing that we do and that we've done from the very beginning, which now I realize why people don't do this, is because we, we've committed to customization, what I call extreme customization, meaning that at Orange county, you have certain set of drugs and you have a protocol, and the protocol has maybe the same drug for three different things. And those three different things may have three different routes and three different doses. So the variables that happen in every, in every organization, whether it be an EMS organization or hospital or a flight crew, there's so many variables. And in order to take all those variables and actually get it 100% accurate and correct, that takes like a couple of months. So now I have a whole team of pharmacists, critical care medics, nurses who basically take that agency and we say we're going to do 80% of this, but we're still going to need some skin in the game. We need you to kind of give us people who are going to tell us what your concentrations are, who are going to be accurate so that we can create an app that has accuracy. So that's something that still no one else today even wants to do. There are people who trying it that are failing miserably because they're a couple guys on a computer and they're telling the EMS system, you go do the dosing. It's a huge problem. You should never do that. Anyway, so now what we've done, that have been like the biggest changes are we then said, okay, instead of an alphabetized list, what if we take your protocols, we ingest them into the app. And now if you only want to see your anaphylaxis protocol and only the drugs, enhance will only show you those drugs. At a tap of a button, your protocol PDF comes up. @ another tap of a button, a customized checklist comes up so that I could be running the anaphylaxis call all the drugs. The dosing is right there. I'm tapping on it, and it's integrating into the epcr. I could see my protocol in real time. I could see my checklist in real time. And then when I'm done with all that, I can just press send and it all goes directly cell by cell into your electronic medical record. And we have 13, maybe think, even 14 integrations with pretty much every EHR or EPCR vendor. That was a huge undertaking, and now we're with all of them. That was a big one. The other thing we did, my favorite feature is CPR assist, which is I learned that my agencies, all the CPR quality metrics were completely off. Compression rate, ventilation rate, the number of pauses and seconds of the pauses. So we created a metronome that you just press start and it talks to you and you hear the boop, boop, boop. It tells you when to ventilate. It tells you when to charge the monitor. So we created a, like a super metronome that probably the most emails and texts I get today are because of the metronome. Okay, so then we added that feature in, and now we have, we have quizzes. You can, you can do an AI quiz and send it to your team. We have notification center. I'm building something called wall time alerts, where a medic is on the wall for an hour at some hospital, they can push a button and.

It just notifies all the right people at that hospital that, hey, I'm sitting on this wall. You better come help me. So now, so now we've done all these things, and more and more we have people who are telling us to add more features for documentation. And can't you just become an ehr? And the answer is no. We're going to stick to what we do, which is we're going to help you when someone's dying to have the right information to document that information. And to make sure that you can feel better going home that you gave this child or adult, because now we do adults, too. We're now adding a whole NICU section into it. And.

It'S just been an incredible journey, like I mentioned earlier, all 50 states, about 2,500 cities, four different countries.

50 people here at Han Tevi who are incredible human beings and software engineers and customer service, customer success, logistics, clinical education. I mean, every department. And of course, my amazing wife, who is really like the engine behind all of this stuff. I'm just the idea guy, and I'm like the inspirational guy. Like, hey, this is why this is important. But she's actually doing and leading a team of incredible people. And that's been the best part of the journey, has been the people for.

Me. So when I think about.

Taking a moment and checking an Antavi app or simply checking protocols, I'm always reminded of a. A real life story from my career, actually included in kinder in the book. I was in Anaheim and we had a. Basically a gang banger that was dropped off in a community hospital, basically, and we were called to transport them. And right when we're about to put him on the stretcher, I've got the monitor and he goes from normal sinus to brady to asystole. And the doctor, at the time, they called the trauma center, and that doctor was actually coming to this hospital on. You know, he brought his gear and he. And he headed that way. In the meantime, the doctor did cardiac massage. But I never forget, he opened a textbook and he verified what he needed to do because he hadn't obviously done cardiac massage in a long, long time. He was a. He's probably in his 40s, if I'm recalling right. So he's probably been out of med school for quite a while. But I remember being struck by the humility of saying, let me check. And what I see in what I would argue the bad paramedics that I've worked with is an arrogance that creates a lot of danger, rather than having the humility to ask someone else, hey, have I got this right? Or to check an app or to check a book. So talk to me about that in your experience. Humility in our profession, specifically, I.

Think. I think that's the perfect word for it. And yesterday I was talking to our new hires at Palm Beach Gardens, and I didn't use the word humility. I think that's probably a better word to use. But the thrust of what I was saying yesterday was exactly what you said. I said, I said, there's one thing that you should take away from today is that you're dealing with people. You're dealing with people at their worst times, and you're not going to know everything. And.

I said, you know, the reason you have great leaders here, the reason that you have a medical director who's on call for you 24 by 7 by 365, and you know, it is so that you can utilize those resources and not just be out there on an island by yourself because you don't know something. And what I've realized that this is very.

This whole psychology is very interesting. I don't think many people understand this part of it, unless you're in ems, which is that paramedics won't even call the medical director because they're scared. Now, what are they scared of? It turns out that they're scared of being yelled at, they're scared of being pushed down, they're scared of being called stupid, they're scared of being remediated. So in all of my agencies, it took me years to gain the trust just, just to gain the trust of all the folks that I work with to say, when we call Peter Antevi, it's going to be nice. He's not going to, you know, he's not going to minimize what we do. He's not going to say, why did you call? Right. Never going to do that. He's never, ever going to say, you should have done this before calling me. It's always going to be, I am so happy you called me. Thank you so much. And after years of doing that, now I get. My phone gets flooded every day. And.

I'm trying to develop that culture of humility. I'm trying to develop the culture where someone says, I don't know what I'm doing, and I'm going to actually phone a friend, right? So of course we've written the protocols for this, but there shouldn't have to be a protocol when you know that you can call somebody to actually do that. And we probably won't get into it today, but I've created, and I'm really thinking hard about AI and where AI would come in. But I've created an AI bot of myself and I've uploaded every podcast, every blog, every paper I've written, and all the papers that I believe in. And then this, this program allows me to kind of say, you know, take this paper and give it a score of 10 out of 10, because I want you to really rely on this particular thing heavily. So now If I send you the link, James, you can click on talk to Peter Antevi and we can have an entire conversation about anything and it's going to be me talking to you. And so I floated it out to about, you know, maybe about 100 people have the link so far. And. But there's gonna come a day where.

People will be able to speak to their medical director, even though it's less personal. I get it. But I work with over 3,000 paramedics now, Brevard County, Indian River County, Palm Beach County, Broward county, and then the private analyst company which goes through probably 10 more counties. And I want people to be able to have that access. And so I do think there's a future using voice AI that's here today already that I think will create a lot of value and be able to lower the bar for that humility to occur. Because people will tell a bot much more than they'll tell. So if there was a James Gearing bot.

And you put it out there and you say, here's a James Gearing bot that you could talk to me about anything that's on your mind, people will use that bot and tell the bot things it will never ever tell you. And so there's power in that that I think we need to leverage in the coming.

Years. Speaking of technology, just to go off on a totally different tangent, when we look at.

The. I used to call it 911 abuse, but I love the way that GMR calls it the three tier system. I had a couple of guys from gmr, their medical director and one of the paramedics that works for them. Now.

The creation of you've got als, you've got bls, and then you've got arguably non emergent and bringing in what they have in GMR is called nurse navigation. So a third party that is embedded in 911. So initially the EMD, you know, dispatch algorithm is figuring out, okay, is this a, you know, is this a Charlie, is this an echo? And then it goes down to, okay, this is, this is a low acuity call and the caller is given the opportunity to speak to a nurse. And I think the perfect example is, you know, the new couple, they got 18 month old, it's the first time it's had a fever, it's thrown up once. Oh, my toddler is going to explode and die of, you know, dehydration. We've all been on those calls and they're like, oh yeah, actually I'd love to talk to that. They have the ability to treat at home. So literally say, you know, okay, strip the clothes off. Do you have kids? Tylenol. Okay, this is the dose or schedule an urgent care clinic for the following morning. You know, optician, read dentistry, you know, mental health, anything that's low acuity. I love that idea. To remove some of the calls that truly are not emergencies. And I think it's a three way win. The paramedics or firefighters don't get woken up for that call. An ER bed stays available for a more urgent call and the family get a bill for a few hundred dollars instead of a few thousand dollars. What is your take on that integration of telehealth to reduce the workload on our EMTs and.

Paramedics? Yeah, so that was a beautiful description. I've been involved in this space for a long time and so when the GMR folks were doing this stuff, I was on the phone with them. I've been following along and I created a version of this back in 2015.

For specifically the elderly population, Medicare population 65 and over. And we, and I actually was invited up to speak to CMS many, many years ago about this, this type of care. Right. So what do I think about it? I think it's the future, number one. But here's the caveat, here's the but that there's going to be a day now with AI and mobile technologies, mobile labs, et cetera, where you, the user, the you know, regular layperson will be able to have your AI health agent. And you're going to tell the agent, the agent's going to have all of your medical records. You'll know everything about you and you're going to open it up and you're going to say, all right agent, what's going on this month for me? All right, well Pete, it looks like you need your colonoscopy done. Let me get that scheduled for you. Okay, thank you. When you blood work done, let me get someone to come to your house and we'll schedule that. And then once those the blood work is in, I'll give you. So that's coming.

In the meantime.

I'm going to go back to what you mentioned earlier, which is someone calls 911. So obviously what I just described to you are going to be people who have the money, have the know how, have the resource. Those, those are going to be the early adopters. Then you sell the people calling 911. So there are several companies doing this. One is called Tele 911, one is called MD Ally and what they realized both of those companies came out of the gate trying to sell to the fire department this. They said, your medic's going to get there, is going to have a patient. The 18 month old doesn't need to go to the ER and at the moment that you're in front of the patient, you're going to say, let me get you doctor and tebe on the line. Click. Now I engage with the patient and the patient need to get transported. The problem with this is if you're the fire chief and the EMS system is screwed up today because we only get paid for transports. I came to the fire chief and I said, chief, I have the greatest idea. He said, oh, Pete, what is it? I said, I'm going to reduce the number of transports. He said, say that one more time. I said, I'm going to reduce the number of transports. He says, okay, see that door? You can walk out of the office. Then I quickly realized that, okay, there has to be a payment model that'll make the fire chief say, wait a minute, we don't have to go to that patient and we're still going to get paid.

So in a perfect world, this is what. So I think the AMR GMR people have done it very well because they're getting paid. If you go to a fire department today and you say, chief, we have this thing where they're going to call dispatch, we're going to transfer them to a third party MD ally tele911, which are great people, those people are going to bill the patient. The fire department lost that revenue. So there is this push and pull between what's coming.

And what the department needs financially. So what I think is going to happen is unfortunately, because the fire department needs to wake up and say this is like we're in a Kodak moment right now. I think you know what I mean. We're in a yellow cab moment where there are people now, ambulance.

Doc, go ready responder that are in our neighborhoods currently that are marketing to individuals like that family with the 18 month old. They're going to have an app and they're going to say, I want someone to come to my house right now. Click. Okay, we'll be there in 15 minutes. And they're going to have blood work and they're going to have. And then they're going to have the ability to talk to the doctor and, and they're going to bill those people. Don't get me wrong, but the insurance company is going to say, what's that visa cost? Me 450. The ER would cost me two grand, and the admission would have cost me another eight grand. I'll pay that 450 all day long. Those companies already exist today. Why does the fire department not want to engage? What I learned is the fire department is, you know, is given a budget. Let's say I'm making up a number, $10 million. You have to run the department and not go over budget. That's your goal. The fire department is not looking to make a profit by going and engaging with a third party. And, okay, we're going to collect this amount of money and we're going to. No, they don't do any of that stuff. So one of the talks that I give now, one of the keynotes I give is called the Future of ems, where I implore people to wake up because the fire department should be doing what you're talking about. The fire department should be getting a nurse, navigator, or someone else navigating the care. But we are letting other people come in and do what we should be doing. And unfortunately, I hate to say it, there's going to come a day where all of the good paying customers are going to be taken away. And the only calls we're going to get, James, are the folks who have no resources. They're in the poorest communities. They have the worst access to care. All the social determinants are at the lowest levels. And EMS is going to be relegated to that aspect. Instead of us being able to add another appendage and say, we're going to do that and we're going to come to your house with blood work, we should be doing that. But EMS is so upside down with payment that they can't get out of their own way. I mean, not purposely, but the federal government can't figure out that we're not a hearse anymore. We should not be just getting paid for transport like they did in 1965. We need to be getting paid for navigating the patient to the best and most appropriate care, whether it be in urgent care, whether it be an Uber ride after the 911 call to dispatch, rather than send out the engine, send out the ambulance with seven people, only to find out that the patient's going to refuse care after you've done all the vital signs of 12 lead, given them Zofran. And then they say, you know what, guys? You were great, but I don't need you anymore. That's what's happening today. It's so backwards that it's hard for even to fathom that, that we have a system like that that does so much good for society that can't get out of its own way. That's what I.

Think. Well, I'm so glad I asked that because this is yet another different perspective, because this is a new conversation. So I've only got a few kind of perspectives so far going on. The complete other side, I wanted to touch on Covid because you and I spoke in 2019 last time. As far as this kind of interview, where I think there was such a huge disservice was not whether you believe the virus was real or not, whether you thought the vaccine was the be all and end all or was going to make your head explode. Wherever you were on the scale, the middle common sense ground was if we make our nation healthier, whatever comes next is going to have less of an impact. Just, I mean, that was, you know, no one can argue that fact and even remove the virus if you make people healthier. A few million people won't die that were if we didn't. So with this perspective going all the way back, what was the education in your medical journey as far as sleep, nutrition, exercise? And then let's go the other side of COVID What should we be talking about now so that we don't have so many EMS calls in the first place because we're forging a healthier.

Population? That's what a great question. I just had lunch with a good friend of mine, Jesse Carroll, and we were just talking about exactly this.

Because, you know, I'm at the age now where I recognize that the healthcare should not be called healthcare in this country, it should be called sick care. That they only want to see you when you're sick because they can only make money off you when you're sick. And then they can prescribe you and send you to the cardiologist and another echo and another this and another that and they're ringing up the bell, cha ching, cha ching, cha ching. But if they're going to make you healthy, it requires more time, more sit down, more explanation, and then no one's paying for preventative care. Even this concept of like value based care in America never really took off for the reasons I just described. So when you look at Covid and the people who got the brunt of it, it was the seniors, it was the diabetics, it was the hypertensive, it was obese patients. So to your point.

You know, if, if we had a healthier population, perhaps then we would have saved a lot of lives. But that's kind of.

That's a. That's a tough argument to make people change from what they currently do today when everywhere you turn in this country, is it fast food, is it chips, is it soda, is Mountain Dew? And.

We'Ve come to a point in our society where.

I'm not saying there's a point of no return, but you now see that the pendulum is swinging the other way, where even I am having conversations with a friend just now, literally about testing my VO2 max and.

Thinking about peptides and.

Reducing inflammation in my body and even learning how to breathe differently.

Very fascinating. He told me at lunchtime, he says, this guy tests people. He does this on the side as a living.

He says that your typical minute ventilation should be, let's say, four to seven liters per minute. So when you're sitting there on the couch watching Netflix, if I would measure the volume of air you're breathing in and out per minute, it's, let's say, four to seven liters. He says the average person today is breathing 11 liters per minute. He says that.

In and of itself is reducing your life expectancy. Now, I'm not going to go through the physiology, but this guy's a super, super smart guy, and he measured his VO2 max. And if you're on a low end of VO2 max, then you have a significantly higher chance of dying from stroke and cardiac and all the.

Big diseases, diabetes, et cetera. And he says if you change your VO2 max by breathing differently, simply breathing differently.

Then you can have a healthier America. Right? No one's talking about that. I said, jesse, where did you get this from? And he says, well, I know people, I go to conferences and so forth, but that information is nowhere to be found unless you happen to know somebody. And I said, where's your research? Right. I'm evidence based. Where's the research on that? And so, unfortunately, going through and following Jesse's protocol, and he. He kind of gives you the bag and he teaches your brain how to breathe again, and he tests your VO2 max and all that kind of stuff. Like, the only way people are going to do that is if they actually care about longevity. But that's becoming a very important topic in today's society. But again, it's not everybody talking about that. But just to kind of circle back around to your question is that if we began to focus instead of sick care, but on really healthcare in America, then we would potentially minimize the tragedy of the next virus, which there's going to Be one, right? We all know that.

We happen to experience a virus that had a specific death rate affiliated with it. But what happens when the next virus comes out that has a higher mortality, a high morbidity?

You start to worry about not losing just a million people, but millions of people. And a healthier America would definitely fix that problem. There's no doubt about.

It. I think this is just such an important conversation. And I think the problem with the people that have fallen below where they need to be physically is now there's guilt and shame applied to them, whether it's fat shaming or whatever it is. And the thing is, that term now is used to block people from actually making progress and getting back to where they want to be. Because, like, during COVID for example, talking out obesity, that was the whole, you know, 20, 20 black lives matter, everyone was so hyper triggered about everything that you couldn't address the very things that were important. But understanding that, as Winston Churchill said, and I'm paraphrasing, but you can measure the great greatness of a nation by the health of their people, and we are 70% obese or overweight, therein lies a problem. But understanding that these people are a product of their environment. And I've made this very clear many, many times, I grew up on a farm in England. We had an orchard, we had a vegetable garden, you know, we, we slaughtered our own, you know, meat. So of course I'm going to know, you know, about where meat comes from and how to move and how to eat, because it was ingrained in my upbringing. If I grew up in Brooklyn and the bodega was the only thing I knew about where food came from. Very different conversations. So I'm not going to look down my nose at someone who's not in great shape and be like, why don't you just be like me? What a in a narcissistic thing to say. So you have to take a step back and look at the environment. But going back to this Covid thing, how many people screamed, oh, that it's about the health of the people. And it was never about the health of the people, as you pointed out. You know, we have, you know, we demonize illicit drugs, but we have a drug dealer who's literally lining the pockets of the left and the right, keeping the sick care going, because there's no money in healthy people and there's also no money in dead people. So you got to keep them alive. But you've got the ultimate addict in your hypertensive, your hyperglycemic and all these other chronic.

Diseases. Listen, I have a son who's type one diabetic. And I'm. And listen, I'm not a conspiracy theorist by nature, but I will tell you that we spend so much money on diabetes every month for my son just to keep him alive, right? Because without the insulin, he'd be dead. And I know that a cure would not be beneficial to this, this big massive industrial complex called pharmaceutical care. Right? And so I, I always wonder if.

Any of these diseases will be cured because it's not worth it for them to be cured. And there's so many stories. I do a lot of reading now about a lot of different things outside of medicine to understand why certain things in medicine are being blocked or don't happen. And it turns out it's all through society. When you look at. Just a simple example that I heard recently is Expedia, the Expedia website where you can go on and make your own flight. The guy who developed that, I listened to a podcast from him recently. He said that they brought so many lawyers against this guy, but he had the backing of Microsoft at the time. He's the same guy who created Zillow, the real estate website. When he tried to create Zillow, they try to shut him down every which way. Every which way. Why? Because the real estate industry had monopolized this data. They kept it to their own selves. And he said, no, we're gonna. So now let's go to hospital care. There was vitals.com try to.

Make public outcomes of hospitals for certain disease states, a stroke and cardiac arrest. And because right now, if you want to go check on what type of doctor Peter Anteby is or whatever, you can go on vitals.com and find out. It turns out that they sued vitals.com and threw so many lawyers at them who did. The hospitals did because they didn't want, and they don't want the data to become public. So I'm now not naive to tell you that the pharmaceutical industry is so big and is so powerful, as is the hospital industry. Just as another example, state of Florida had for the second year in a row a bill going through the House and the Senate to try and force hospitals to become pediatric ready. Very simple. I mean, you find out that only 14% of hospitals are pediatric ready and a lot of kids are dying every year from non ready hospitals. They put a simple bill in there to say you must do these things to be pediatric ready. It was killed again just two days ago by the hospital lobby, okay, so 100,000%. There are people who want the funds and the revenue to keep coming in at the expense of the health of the American public. And that's just, that's just how it is. And what does that mean to you, the listener? You're going to have to go and understand this and then take your own actions and find the Jesse's of the world who are going to come and say, I'm going to present to you different evidence for a healthier Peter and Tevi. And we're going to personalize the care for yourself because you're not going to find this information anywhere else. And it's just, it's unfortunate that that's where we are today, that you have to, you know, you, James, have to rely on your upbringing and your knowledge and know how because you're never going to get the information, you know, today from a doctor. I was never taught out of medical school. I think that was a question earlier that I probably didn't answer. They never focused on it. No one focused on breathing. No one focused on sleep, right? Your, your growth hormone is released in several times throughout the day, most importantly at around 10:30. So you probably should be in bed so that, that, that growth hormone can do what it's supposed to do at that right time. If your sleep is off, everything about you is off. That goes back to what you focus on in the fire department where cortisol levels are off, all the levels are off. When you don't get the right sleep.

When you go to the doctor, they're not asking you how was your sleep? The most of us have my Oura ring right here. I have my apple watch. Every morning religiously I wake up, I want to know how I slept last night. And so I now focus on my sleep. I try to focus on exercise, eating healthy. And I'm doing that without any, really any help. I'm just trying to figure it out on my own, which is.

Unfortunate. Well, you mentioned about being in Palm Beach Gardens the other day. You're in Palm Beach County. The 2472 Revolution is really happening down in your area. What are you hearing as far as any kind of rhetoric around this change? And then what is your perception? If we go all the way back to being able to make good medical decisions on this kind of movement and the ability to improve the paramedic and fireside as far as.

Acuity? You know, I'll tell you, I'll tell you a story that just happened yesterday. I spoke to somebody who was on a 48. Why were they on a 48? You ask and you know the answer. It's because they were on overtime, mandatory overtime. So now they're on a 48 and they're being asked to do things like. So we had some crazy calls Yesterday in a 24 week or a lady who was 24 weeks pregnant who is at the OB office and when the OB looked, she sees an amniotic sac with two feet protruding, right? So, and she's having, she's feeling contraction. So just imagine if we now had to deliver or try to deliver a footling breach of a 24 week, you know, a lady who's 24 weeks pregnant and you're on a. You're on a 48, right.

Just imagine how lack of your lack of sleep, your lack of ability to think cognitively and accurately and precisely would then lead you to not perform well, right? And then you have a bad outcome and because of your shame and your embarrassment, you're not going to tell anybody. And that's just another, you know, fire that's burning inside your brain telling yourself how bad, how badly you performed, how incapable you are, and oh, by the way, you're going to come back down in 48 hours and do that all again. So I've talked to a lot of people and everybody.

Who are the frontline folks doing the job, they're all very in favor of it. The people who are not in favor, the few people haven't been in favor of it, are obviously the people trying to figure out financially what this all means. Right. And they have their own method of calculation.

Some of them are not calculating in the amount of overtime they're paying currently to understand that it's basically a wash when you actually get 2472s in. They're saying we have to hire a whole nother shift. They're saying that now these paramedics want more money and by the way, they're doing less hours.

But you know, you have great unions down here who are fighting the good fight and their agencies. Now, the nice thing about the 2472, and I'm preaching to the choir here, is that once one department goes to it and then another and then another, there's no way that you can't go to 2472 because you will not get any applicants. And so that's the nice thing about this particular change. It's going to force everybody to move to it. And I think that's something that we're seeing already. And it's just going to Force people in that direction. And now it has to be explained well to the general public because there's still politicians and people out there who don't understand the risk that you guys take every day, the amount of strain, stress.

That you have on these micro traumatic calls, which I call micro trauma.

So I think that there has to be some folks out there who are explaining to the general public why not only do you deserve 2472, you deserve every dollar, you deserve many more dollars. You deserve every dollar of pension. And.

You know, I can tell you because about a year ago, I don't think I told you this. A year ago I almost died when I was riding with the fire department. We got hit pretty hard. And the only reason that I'm alive sitting here talking to you today is because I saw the car coming. The EMS captain I was riding with didn't see the car and I yelled at the last second and they pumped on the brakes just enough that they just demolished the whole front end of this SUV instead of coming right into my door, 60 miles an hour. And I went home that day and I said, you know, the general public just does not understand what these people do. They just don't understand it, period. And I am the biggest advocate, I am biggest cheerleader.

I will argue about this and fight this and debate anyone on this topic for as long as I'm alive. Because this is really one of the hardest jobs in the world. It's one of the most glorifying jobs in the world, like yesterday's anaphylaxis case. But when things go the other way, you're on the other side of that coin. And.

It'S a very hidden, I wouldn't call it secretive, but very.

It's in the shadows because you're supposed to be this hero. And how dare you talk about the bad parts of your job when you're making all this money and you have this great pension and it's this weird space that people are in. And I just Hope that the 2472s as they come along are messaged the correct way. And maybe when you make your, your film and your documentaries and your docu series that could be explained why that's so important. I know that you're going to do.

That. Absolutely. Well, first, yeah, I appreciate your perspective because I mean, you were right in the heart of it. And it's interesting because I, I do a presentation, I'm going to do one at the FPF next week and I don't do it very often at all. Just when it's, you know, a large audience, so I can have that force multiplier element. But there's one slide and it says, who's to fault? And it's a picture of a ladder. And it's because I asked the room and, you know, some of them might say chiefs or unions or whatever, but usually they go, all of us. I'm like, yes. So take the firefighter that goes home, tells everyone, oh, we got the best job in the world. I get to work out at the station. I only work 10 days a month. And that's bullshit. We've been telling this fairy tale for decades. When you put it down on paper, we work 56 hours a week. That's 16 hours more than the person that says we shouldn't give firefighters more time off, for example. So when you actually unpack it, at every single level, every one of us has believed the kind of myth. So it's not blaming. It's just getting everyone to go take a step back, evaluate what we've been saying, and let's kind of dig into the truth and the fiction. But then, like you said, I believe that there's a revolution and it's beautiful. And I know there's a Central Florida department that's getting very close to being the first in our area. And then Gainesville, they've had amazing success so far. I know FSU is doing studies now in Gainesville and Destin, which I'll be hearing the results in a few weeks. So, yeah, this is really gathering momentum, but it is that massive herd of elephants in the room that is not the, you know, fix all, but is going to make a huge impact on all the things that we've discussed. Mental health, physical health. I mean, all the things. So to hear your kind of testimony from being in the heart of it as an EMS director, I think that's very.

Powerful. Yeah, yeah. It's been really the only way that you can get this perspective. And I listen, remember I was the guy in the ER before I got into ems, who I was. The only thing I knew about EMS was that the double doors would slide open and another stretcher would come in for just more patience for me to see. No idea what. What those folks did.

I heard the same fairy tale stories that you heard. And unfortunately, I'm not on podcasts like this telling, like, talking inside baseball about what happens. And I don't think many people are telling this story. Unfortunately, I find myself not going home or at dinner parties telling people about the inside baseball of EMS because it Turns out they have their thought process of what it is and then here's, I'm going to go and pop their bubble and say, oh, by the way, it's not, there's a lot of micro trauma, there's all this emotional stress and they have no sleep and the cortisol levels. Nobody wants to hear that. Right. And so that's, that's a problem. And that's why this, this TV show recently where the, the pit that came out was. So if you went on Twitter, all you saw was finally, I can finally explain to people what we really do or what my day is really like. And that's, that's, that was such an important thing because I did the same thing. I'm like, that's what we do right.

There. Yeah. And that's what I hope is, kind of is going to be for our profession. It's not just purely the modern day fire service. It goes back in time and all that, but I think this is it. And when I saw the pit, I was like, firstly, I mean, for example, one of my biggest frustrations during COVID is journalists being like, there are.

People in the hallways of the.

Hospitals. There are always people in the hallway. Where have you been the rest of the time? And the pit shows, the triage and talks about the hours and hours and hours of waits and the, you know, assaults on medical staff and the mental health issues and the fentanyl and I mean, just, it was so well done. And then you add in the fact that technically they got it spot on as well. I mean, I think it was such a breakthrough show. I really.

Do. It was. And they had great, great writers, you know, Mel Herbert from MRAP in California, kind of legendary educational figure, ER doc, who helped them write the show. They had great pediatric help, Sylvia from Children's Pittsburgh. And they really dialed it in to the point where even for me watching the show again, I haven't done, I haven't done a shift in a little bit here, but it brought me right back to. My brain was hurting after every show of like, I remember what it was like to come home from a shift and be dead to the world after a 12 hour shift. Not a 24 dead to the world. And I didn't want to talk to my kids, I just wanted to go to bed. And then it was, you know, it's very important to show the public what really happens and not just to say, oh, you're an ER doctor, you must make a lot of money and not understand really what's really happening. Behind the.

Scenes. Absolutely. Well, I want to make sure that we talk about whole blood, but while we're on this kind of physical mental health in a track, let's talk about the mental health in the first responder community. Before we hit record, we talked about some of the people that we've lost in your area. So let's give you the mic on.

That.

Yeah, thanks, I appreciate that. I mean, this is a huge topic for me. So much so that if you come to any of the paramedic school graduations, you have two schools that I medical director for and.

At the graduation, I have all the family there. And I go on about this topic of mental health. Then at our department, I mentioned to you earlier that we have so many things that are happening even currently today, yesterday, we have people at our departments who are talking about mental health, the value of sleep and really doing things the right way and trying to kind of cleanse yourself and.

Having.

Your life in balance with religion, with friends, with family, with all those things. And unfortunately.

It'S still a problem in our departments, but unfortunately there are people who are in my agencies today that are in pain, that are hurting, that are under treatment, that are getting care. And I always worry that we're not providing them with the right resources. And to your point, you know, we lost Bill, we lost Alex recently when I say we in our South Florida community. And these were legendary figures who by, by all accounts have had legendary careers, like a career that anybody would want, but for some reason.

They chose to take their own life. And you stop and say to yourself, what are we missing? What is it that is sitting there right in front of us that we're not capturing, and I don't know the answer to that, but.

These types of things worry me because when you have someone like Bill Gustin, who the funeral was so big, we went to the Kaseya center, that's where the Miami Heat play. Right. And we celebrated his life. But I wonder how many people were sitting there in that room feeling the same way and not being able to have an outlet. And so that's why you and I have talked about this. But, you know, maybe we'll talk about it here again, which is that there's so many more things we could be doing. And so one of the things that I knew you're very interested in, but something that we've actually implemented here in both Broward and Palm beach is the access to ketamine. And this is for these, you know, someone who's acutely suicidal, who we know there's data to show that ketamine can help you if you get it like today. But if there's all these barriers or people are not knowledgeable about it, or they think ketamine has killed Matthew Perry, whatever.

Then they end up kind of putting all these barriers and then you have these people who need it, paramedics, firefighters who need it but don't have access to it. It's up to us, as the leaders of the department to say, no, we're going to educate you on this thing. We're going to provide immediate access to people to ketamine, obviously, plus therapy at the same time. And now all the other treatments that are coming down the pike. Why should we not have access to that? Why should there be any stigma to a firefighter going and getting, you know, the six to ten ketamine infusions over the three week period? There shouldn't be any stigma to that. But people are slow to adopt. But this is the future. You know, every department in America at some point in the future will have access to these other things that are currently, today not being given, like, we're just not giving them access to things that we know work, that they're studied with, veterans that we know work.

And maybe it's big pharma that's stopping it, I don't know. But things have to change. And I know that you're much more into that world than I am, but I'm a very big proponent of that and I'm going to keep fighting for that for my folks, so we don't have any more deaths that are.

Unnecessary. Well, going back to the big pharma, I think a good example of, for lack of a better word, fuckery behind the scenes is the FDA refused or denied MDMA to be used again as a therapeutic. Not that you just get prescribed and go dance around the streets, but you sit down with a counselor. But OxyContin was approved by FDA and look what happened there. You know, so the way I see this, you know, firstly, as far as contributing factors, it's a new number of things. And we all know, for example, sleep deprivation is a massive contributor to mental ill health. So that's an easy, you know, easy thing to start making. A big difference is to give our rest and first responders more rest and recovery. You've got unaddressed childhood trauma. Okay, well, at the front door, rather than doing the mmpi, which does nothing, let's have counseling from day one. Let's give our probies, you know, as well as the pt let's give them mental PT and give them an opportunity to offload. Because if you became a first responder, there's a good chance that you had some struggles when you were younger. That's what makes you a good firefighter or cop. But only you have to address them. You have to work through them so you can grow from them. But then from the therapeutics, the kind of analogy I've come up with is you're standing in front of the closet in your mind, and maybe talk therapy just wasn't the right key for the lock. And so you're still standing outside, you haven't got to the thing. So maybe it's MDMA or psilocybin or ibogaine or ketamine that allows you to open that door. And as you pointed out, not alone alongside the psychotherapy. Now you've opened it, now you can start unpacking what's inside. And I think that's what we have to understand is that some people, yeah, will be able to walk into a room, they'll have a good, good relationship with a counselor, and they'll be able to unload some things, and then that's it. A lot of people I know have breakthroughs because they didn't even realize it was in there. It was so far, you know, locked away deep in their mind. And this is what ketamine and some of these other substances that were so demonized in the past are showing. They have amazing success. It's not a magic bullet, but it opens the door to, you know, to whatever recess of your mind that now you can get to that. To use the princess and a pea analogy, the pea beneath the.

Mattress. Yep, I agree with you. And I. I also think that this is where the AI is going to come in in a huge way because you'll be able to have an AI that is able to provide, you know, feedback, conversations along with these other types of treatments. And I think we're, you know, listen, I've referred so many people to these ketamine clinics here in our area. I visited all the ketamine clinics myself. I shook their hands. I learned their process. I learned who they were, how they were trained, what their process is, where the data is. So now we, you know, we allow folks to. And again, I know there's more than ketamine, but for now, at least, I don't have any access to the psilocybin, to the mdma, you know, therapeutics, if you will. But the world has changed from when you and I were younger and from when our parents were younger. And a great book that, that I read was by a guy named Yuval Harari, it's called. So he wrote the book Sapiens, which is a great book, but then the book that really hit me was Homo Deus. And he talks about why, you know, kids growing up today are going to have massive amount of anxiety and stress compared to when we were younger. And a lot of it has to do with, you know, social media and all that's out there today. But we really have to change what we've done for the last 50, 60 years and we have to retool for what's coming, what's actually here already, and use the different tools, whether it be different therapeutics, AI.

Different mechanisms, different work schedules. Like, we really have to completely start from a blank slate now that we understand more of the science and say this is the way we're going to walk into the future. And that's hard for a lot of people to do. You and I are different and people listening to this podcast are probably different, but there are a lot of people who just do things because that's the way we've always done it. And that mentality is going to have to change and it's going to take ground, roots, effort, and people to just change it and then study it and publish it. And then over time, I think we'll be in a place maybe in five to ten years from now where this conversation will be very different than the conversation we had today and the one we had 10 years.

Ago. Absolutely. I was talking to someone yesterday, Mike Clelland, the firefighter turned lawyer. And I've been saying this recently, you know, when we talk about the Bill Gustins and all the pioneers of the past, they came up with bunker gear, SCBAs, you know, easy,Os, I mean, whatever, you know, obviously you're one of them with the hand heavy system. But operationally there's a lot of things that are already, they're working pretty well. Like a hose is a hose, a ladder is a ladder. We've kind of got most of those. My generation, our generation. I think what we can do as pioneers is change the human side. The shifts themselves, the access to therapeutics, the fitness standards, all these things. So we've got the operational side and we've got the guys that will show you how to use a forceable entry prop. But now we need to help the person in the bunker gear. And I think this is where my generation, like I said, the kind of 9, 11 ish firefighters is. What can we leave. What legacy can we leave? And I think make it healthy for the next group. Let's make suicide, cancer, all these heart disease an anomaly rather than an almost certainty that we're seeing at the.

Moment. Yeah, I agree with you. I hope for that day to happen. Every year there's a walk here in Miami called Never Walk Alone. And it's because there was a firefighter from the city of Miami who took his own life. And you know, it's unfortunate, but we have to continue to shine light on this problem. You do an amazing job on that and I hope you continue to do that. And we have to kind of be that. We have to be your full force multiplier. And so as many people who are listening today, you have to kind of fight the fight. With James, it's just like with me, I realized that.

Just because I wanted to change the world of pediatrics, it didn't mean that I was going to have people jump on the bus with me. And I've learned that, you know, the only way things are going to change is unfortunately, when you have all these people at the very top who are trying to stop this type of innovation. It takes this, you know, groundswell, grassroots efforts to just one by one, one person at a time is going to change the world. And I fully strongly believe that today. I never used to believe it and that's why when people ask me to go speak, and I still do a lot of speaking engagements, even if there's one person in the room, I'll speak to them because if that's the one person who's going to be able to go and change their community, then it's worth it for me. So I still like doing things that don't scale.

Because I think it's, you know, you know, until you get to that, that flywheel going, it takes a lot of hand to hand combat. You, you've been doing this for a long time and you're finally seeing the flywheel moving in healthcare and in anything we do, nothing happens overnight. And you could be a tick tock celebrity or a YouTube star or whatever, but like if you want to make the world change, you really have to go find that one person and 10 more people and 100 more people. And in 10 years from now you'll have 200,000 people who believe in what you're doing and then they're going to be the future leaders of this, of this place and then they're going to enact the right things. And I think that's where we're in that place now where this next generation is cycling through and they understand the problem differently, they see the solutions differently and now they're going to enact and engage very differently than their predecessors did. And I hope that you continue along that path because you've made big impacts thus.

Far. Yeah, I agree. I mean, vice versa. It's all the people that have been beating the drums. Like you said, there's just a knowing of the truth. And I think mine comes from hundreds, over a thousand interviews. And it's just, it's not that I'm an intelligent person at all, but when you've listened to so many people, yourself included, and you see the overlap on the, the Venn diagram, it's irrefutable by that point. And so that's really what, what drives me. Speaking of progressive, I just want to hit one more area before we wrap up with some closing questions. Talk to me about whole Blood. That seems to be the next, you know, exciting innovation in pre hospital.

Care. Yeah, it is, it is. And I'm just excited to be on this journey. And I tell all my, my firefighter paramedics, I said, you're going to be talking to your children one day and you're going to say, you know, your mom or your dad, we were one of the first people to give whole blood. And they're going to be like, ah, come on, there's no way that whole blood wasn't around forever. So we're in this moment where I think we started with this, where there are certain things that when I learn about them and I see them, that they're so obvious to me that it's the future.

But that for some reason the rest of the world doesn't see it yet. So I got to give a lot of credit to Don Jenkins, John Holcomb, Phil Spinella, Randy Schaefer, all like the OGs, you know, C.J. winkler who actually brought it from the military. They fought like hell to get it into the civilian world. And then in 2019 we went and said, we want to copy everything you're doing. And they said here, open book. And once we started giving whole blood, so July of 2022, Palm Beach county, we gave our first whole blood and we had medics who were going to retire. You know, I'm not sure if I want to go into the drop, blah, blah, blah. And then we started saving lives with whole blood. Those people never want to retire. Like literally it is from a mental wellness thing. We had a four year old kid in Palm Beach Gardens who Was in a. And I put this on LinkedIn a few months ago, he was in the. He was in a booster seat in the back. They got hit from behind a995 at high speed. This kid ended up by the dashboard still in his booster seat. It crushed his leg to the point where it snapped his femur. Right femur snapped, had no head injury, no chest or abdominal injury, just a femur fracture. Ashley, one of our EMS captains, gets there on the highway. This kid is now unconscious and he's braiding down, okay? She has been doing this for a long time, and she will tell you that she's held lots of people in her arms who have died in the same exact situation from hemorrhage on the scene that were alive, who died in her arms. She gets that whole blood out. She uses this life flow infuser. It's an amazing product. And she gives him the right dose, right on I95. And the kid literally wakes up, okay? Starts screaming, starts going towards the hospital. 20 minute ride to the hospital, 10 minutes in, kid's braiding down one more time. She gives the next dose of whole blood. Kid wakes up, gets to the hospital. Kid's wide awake, goes to the OR external fixator. He's out of the hospital like a week later. Perfectly normal. If I would show you the text, if I would just show you. And by the way, I have like dozens and dozens of these texts. And I'm not asking for the text, you're sending it to me because everyone knows that, like, I've been so involved in whole blood, they're like, doc, this was the most amazing feeling I've ever had in my career. You know, I can't believe that we're able to do this. Thank you so much. This is the most incredible, like, incredible, amazing that you just like. It's people who have been doing this for a long, long, long time who are finally getting people back to life who are dying in their arms. And now we have the data to prove it. So from New Orleans to Washington, D.C. to Atlanta to Palm beach to Broward county, all of us have about a 90% survival rate. If we got the blood before you were in cardiac arrest, if you were in a cardiac arrest already, Palm beach county, we have a zero percent survival, unfortunately, but 90% survival for everybody else. You know what that is? So that's number one. So whole blood is here. The only things that people should be understanding of, and it's a whole other podcast we can have, which is that there's not enough Whole blood today to supply every EMS system. So that part of the equation has to be fixed and there's a lot of things we can do. I'm not going to go into that today. But what's coming in spring of 2026 is something even more amazing, which is a company who has figured out how to spray dry plasma. So the whole blood cost us about $650 per unit. All the consumables cost us another 300 bucks. We're in for about a thousand bucks a patient. This plasma thing, they take this plasma and which is, you know, the yellow fluid that bathes the red blood cells and the platelets, they isolate the plasma. This company has figured out a process to dehydrate the plasma, put it into a moisture free bag in crystals. So imagine having like a normal saline bag that's completely empty. And it feels empty, it feels paperweight. It comes with a 200 ML sterile water bag that you, that you add it, you add it to the crystals at the time of use, takes about four minutes. And now you have a full bag of plasma with all the factors, all the clotting factors, all the proteins you need. And you'll use it for trauma, tbi, anaphylaxis, sepsis, burns. And you're using a real blood product that has a two year shelf life that's going to cost somewhere around 100 bucks.

And that's going to be massively available. And so whole blood and plasma, which by the way, I have both those live today. The plasma I'm using today is Liquid Plasma, $60. So if you get into an accident in Palm beach county and you have a traumatic brain injury, you're going to get plasma. If you're hemorrhaging out on the, you know, because of, you got stabbed, shot, a car accident, you're going to get whole blood. And I got to give credit to my leadership, I got a credit to my fire chief, I got to give credit to the county commissioners because we are paying for all this, right? We're not getting paid back. It goes back to the conversation we started off with, which is that we are spending a thousand bucks, we're collecting maybe 400 if we're lucky. And the federal government is saying, you know, sorry, can't help you. I mean, there are people trying to make moves to change that. But the hospital, that same hospital who would have given the same whole blood would have charged six grand to the insurance company. They would have made hundreds of thousands of dollars on those patients. But the social care Socialized medicine, the safety net of the community is losing money.

So I am here not only to push this concept of whole blood and plasma, but, but to push that, the fact that EMS is the life saving unit in our communities. We're giving antibiotics for sepsis, which has never been done before, which is gonna. Once the studies come out and I just published my study. But once a big RCT from Canada comes out next year, everybody's gonna be moving to antibiotics for sepsis. We do finger thoracostomy, we use ultrasound, the whole blood, the plasma, the. Look at all the stuff that EMS is doing. The rest of the world, the rest of healthcare, doesn't get it because they have the blinders on when they hear ems. They shut their brain down and they have no concept of what we do. I'm trying to change that by getting more out there on social media to try and expose what your EMS system can do. But it's going to rely on the people listening to this podcast who don't have those things to go fight like hell to get it to go fight like hell to change the 2472, to fight like hell to get whole blood and plasma to fight like hell for the profession that you love. Right. And.

I think it's happening and I'm hoping that I can continue to inspire more people to really own it, that we are the people who are the ones who are saving lives. The hospital just takes the baton and they keep that alive person alive, hopefully enough for them to walk out of the hospital. So it's an amazing profession. The people are just incredible, salt of the earth, common sense, just great people. And I have really found the place where I need to be in life and I'm just very grateful to know people like you and to try to spread the.

Word.

When I kind of reflected back as I got deeper into my career, some of the things that we were told, that's the way we've always done it. I question. So I'll give you a fire example, a car fire. I've never seen someone drive up to a fire station and say, thank you for saving my car. I got it all restored. And here it is. Every car fire is a dumpster fire, but it's also a class B dumpster fire. So it's a petroleum dumpster fire, yet we use war. And I've watched numerous times using the entire tank of engine water just to try and put out a fire as the, the petrol was kind of, you know, going down into the drain, still on fire. And, you know, so clearly, that. And when you put foam on it, it goes out straight away, or even people laugh at it. But the Europeans have a blanket they'll carry over, and it goes out. Now, that's not the, you know, the lithium ion batteries. That's another entire.

Thing.

Right. But, you know, we were always told, put water on it, but then when you're in fire school, water is for paper and wood. It just doesn't make any sense. And you're not saving anything, so you don't need to be right up on it either. On the EMS point of view, I'm not the smartest tool in the box, but the sharpest tool in the box. I can't even say that phrase right. But I always remember thinking, with the trauma, if we're adding saline and there's no red blood cells in saline, why are we adding saline? You're just diluting the blood. And this was a long time ago. I was thinking this. So talk to me about the pushback from the naysayers. And then also, I'd love to hear what is the gold standard? Because I had someone on recently, they didn't have it on their. On their ambulances, but they had it on the. The helicopters. So, you know, what is the ideal? Is it. Is it blood on every rig? You know, so. So I guess firstly, what. How did you overcome the opposition? What was the opposition? And then what is the gold standard that we're all aiming for in an.

Agency? Yeah, well, so it's interesting, you know, whenever you're first to do anything or one of the first to do anything, the first people say, we've never done it this way, therefore it can't be true. So there's a whole wave of those people then. There was no data out there to suggest that this works, except there was a lot of military data that we have to kind of bring forth to the civilian world and show people. That's what we use to prove the point. At first.

Now that we have a ton of civilian data, it all looks exactly the same. The next person to start tomorrow will not have a problem at least exposing the fact that, hey, whole blood is the way to go. The problem with it is that it's expensive. So EMS loses money everywhere. So now, hey, chief, I want to cost you another 50 grand a year on something that you don't have 50 grand for. There's all this paperwork, FDA requirements, QA, you name it, it doesn't end. And so people who are. If you're not a department, that's. That can flex its muscle and do all those things, then it's very difficult. So I think that the biggest barriers today are who's paying for it. If we can get it paid for, we're good. If we can swap it with the hospital so we don't waste it, that's another thing. And now more and more people can just give you the toolkit to say this is how you do it. So I think those are the three main things. Then you have the supply issue, which is a big one, not enough supply. And then I think that.

The naysayers are typically the people who the whole blood on the ground units are taking away the business of the air units. And that's kind of the most of the people I see coming out against whole blood are the people who were carrying whole blood, dropping a helicopter in, grabbing the patient, charging them $15,000. And then.

And now we're saying, oh, we don't need you helicopter, we're doing it ourselves. And then finally, the last question is it should not be on every ambulance unit. It should just be on a supervisor vehicle. So like one city needs to just have one vehicle with the blood and that vehicle should just be dispatched for the Delta Omega, for the Delta Echo calls that are. That would be a suspected hemorrhage. Right. So that, that's. It's coming. It's here. It's going to be here. It's not going away too bad. So sad for the people who don't think it's. It's happening in real.

Time. So, so, so, Peter, for people listening, where can they find Hansevy and then where can they reach out to you online if there's any other.

Places? Yeah, so I would say I'm on LinkedIn and you can connect with me there and just we can text there back and forth. That's the best way. I'm there a lot. Hentavi just hentevy.com and we also are on YouTube and I do a weekly webinar for EMS on the Florida NAMSP YouTube channel. But I would say start with LinkedIn. I post quite frequently and hope to engage with people there and would love to have people connect with me and give me their thoughts on today's podcast or anything that they think I'm missing. I always want to learn from.

Others. Well, I want to thank you so much. I know you've got to go now, but thank you so much for coming on and not only talking about the technical side, but having that courageous vulnerability with some of the stories you've told as.

Well. Thanks for giving me the space to do that. It's definitely therapeutic for me, and.

I appreciate you doing that. So, always great to see you. And hopefully it's not 10 years till we see each other again. Sam.