Preeclampsia and eclampsia are uncommon in EMS, but early recognition and treatment can change a patient’s course. In this episode of EMS Clinical Brief, host Dr. Maia Dorsett is joined by Dr. Jenna White, an emergency and EMS physician at the University of New Mexico and chair of ACOG’s Obstetric Emergencies in Non-Obstetric Settings project, and Tim Hutchings, paramedic. Together, they explore blood pressure thresholds that warrant concern during pregnancy and postpartum, symptoms that are easy to miss, and why magnesium is central to treatment. Through clinical cases and candid reflections on changing what we teach, they unpack the evidence behind current guidance and its application in the field—from recognizing preeclampsia with severe features to managing a patient with ongoing seizures.

References/Resources:

1. ACOG Guidelines for Obstetric Emergencies in Non-Obstetric Settings (EMS): https://naemsp.org/news/now-available-new-ems-obstetric-emergency-guidelines/
2. Duley L, Henderson-Smart DJ, Walker GJ, Chou D. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev. 2010 Dec 8;2010(12):CD000127. doi: 10.1002/14651858.CD000127.pub2. PMID: 21154341; PMCID: PMC7045443.
3. Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet. 1995 Jun 10;345(8963):1455-63.

What does it really take to administer pediatric medications safely in EMS—and what can go wrong even when clinicians use cognitive aids? Host Maia Dorsett interviews Bryan Harmer, a paramedic researcher and expert in pediatric medication safety who has used simulation to directly observe and characterize medication errors. Together, they unpack the often-overlooked microskills involved in pediatric medication administration, from determining weight and calculating doses to preparing, administering, and documenting medications. Drawing on Bryan’s research, they explore how seemingly small errors—including incorrect use of length-based tapes, air in syringes, and bedside dilution—can lead to discrepancies between the dose intended, the dose administered, and the dose documented. They also discuss why cognitive aids alone aren't enough and share practical strategies EMS systems can use to identify hidden risks and improve medication safety through simulation, equipment selection, and medication cross-checks.

References:

1. Hoyle Jr, J. D., Davis, A. T., Putman, K. K., Trytko, J. A., & Fales, W. D. (2012). Medication dosing errors in pediatric patients treated by emergency medical services. Prehospital emergency care, 16(1), 59-66.
2. Hoyle Jr, J. D., Ekblad, G., Hover, T., Woodwyk, A., Brandt, R., Fales, B., & Lammers, R. L. (2020). Dosing errors made by paramedics during pediatric patient simulations after implementation of a state-wide pediatric drug dosing reference. Prehospital Emergency Care, 24(2), 204-213.
3. Harmer, B. M., Hoyle Jr, J. D., Edwards, A., Fredericks, T., Wells, L., Lecznar, A., ... & Fogarty, K. (2026). Assessing the influence of a statewide dosing reference aid on prehospital pediatric medication dosing errors: a mixed-methods simulation-based investigation. Prehospital emergency care, 30(6), 848-855.
4. Harmer, B. M., Hoyle Jr, J. D., Wells, L., Fredericks, T., Edwards, A., Lecznar, A., ... & Fogarty, K. (2026). A Simulation-Based Root Cause Analysis of Pediatric Medication Dosing Errors in Emergency Medical Services. Prehospital emergency care, 1-9.
5. Dorsett, M., O’Donnell, S., Strickland, W., Cheng, W., Sensenbach, B., Cannuli, M., ... & Cushman, J. T. (2026). Improving pediatric medication safety through implementation of evidence-based guidelines. Prehospital Emergency Care, 1-8.

Hospital pre-notification can directly influence how quickly patients receive time-sensitive care. In this episode of the EMS Clinical Brief, host Maia Dorsett is joined by Tyler LeMay and Jennifer McLymond to explore pre-notification as a clinical intervention, focusing on patients whose next critical treatment requires resources beyond the ambulance—including those with suspected occlusion myocardial infarction, stroke, and major trauma. Through practical examples, they discuss when notification should take priority over other prehospital tasks, how early notification enables parallel processing at the receiving hospital, and how to communicate essential information using a concise, structured framework.

References:

1. Nam J, Caners K, Bowen JM, Welsford M, O'Reilly D. Systematic review and meta-analysis of the benefits of out-of-hospital 12-lead ECG and advance notification in ST-segment elevation myocardial infarction patients. Annals of Emergency Medicine. 2014;64(2):176-186.
2. Shavadia JS, Roe MT, Chen AY, Lucas J, Fanaroff AC, Kochar A, et al. Association between cardiac catheterization laboratory pre-activation and reperfusion timing metrics and outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: A report from the ACTION Registry. JACC: Cardiovascular Interventions. 2018;11(18):1837-1847.
3. Nielsen VM, Song G, DeJoie-Stanton C, Zachrison KS. Emergency medical services prenotification is associated with reduced odds of in-hospital mortality in stroke patients. Prehospital Emergency Care. 2023;27(5):639-645.
4. Durr K, Ho M, Lebreton M, Goltz D, Nemnom MJ, Perry J. Evaluating the impact of pre-hospital trauma team activation criteria. Canadian Journal of Emergency Medicine. 2023;25(12):976-983.
5. Deeb AP, Guyette FX, Daley BJ, Miller RS, Harbrecht BG, Claridge JA, et al. Time to early resuscitative intervention association with mortality in trauma patients at risk for hemorrhage. Journal of Trauma and Acute Care Surgery. 2023;94(4):504-512.
6. Ahmed OZ, Yang S, Farneth RA, Sarcevic A, Marsic I, Burd RS. Association between prearrival notification time and Advanced Trauma Life Support protocol adherence. Journal of Surgical Research. 2019;242:231-238.