Inside EMS

The buffer system decoded: Mastering CO2, pH and patient care

In this episode of the Inside EMS podcast, Chris and Kelly are joined by paramedic student April McKenzie — aka “April Anonymous” — for a deep dive into the buffer system and CO2 mapping.

April’s in the thick of paramedic school and like every good learner, she’s asking “why?” — so the guys break down the physiology behind capnography, acid-base balance and the lungs-vs.-kidneys showdown that keeps our patients alive. Plus, they throw in old-school war stories, rant about naloxone misuse and admit that bicarb is no longer the go-to cardiac arrest drug.

If you've ever tried to explain respiratory vs. metabolic acidosis in under 10 minutes, this episode is your cheat sheet. April will be back throughout the year with more student questions, so buckle up for the ongoing EMS education you didn’t know you needed.

Quotable takeaways

• “Just because you see somebody with signs and symptoms and the protocol says, do this; that's OK, but that just makes you a protocol paramedic.”
• “My friend Romy Duckworth calls [capnography] the MVP of vital signs, and that's a good way to remember it — MVP: Metabolism, Ventilation and Profusion. And it will tell you derangement about all three of those things very well once you're proficient at interpreting the waveforms.”
• “Basically, the buffer system is the body's way of keeping the pH stable. So, if we're blowing out, if we're having problems with respiratory acidosis — and let's talk about CDKA, where they're trying to blow off — it's the respiratory systems’ way of making sure that we have homeostasis.”

Enjoying Inside EMS? Email theshow@ems1.com to share feedback or suggest guests for an upcoming episode. 

The National EMS Memorial Bike Ride: Because they mattered — and still do

This week on Inside EMS, Chris Cebollero kicks off 2026 with a heartfelt conversation featuring Eric Morrison, vice president of the National EMS Memorial Bike Ride and EMS director for Iredell County, North Carolina.

The ride, founded 26 years ago, exists to honor the memory of EMS providers who died in the line of duty, from illness or mental health struggles. Each rider wears a dog tag bearing the name of a fallen provider, often connecting with their families along the journey.

Eric shares his personal journey from lifeguard to leader and how his rekindled love for cycling — along with the loss of friend and EMS wellness advocate Brian Fass — led him to the ride. He breaks down what it takes to join (hint: it’s more doable than you think), the logistics of the ride, and how EMS agencies and individuals can support the cause, even off the bike.

Quotable takeaways from Eric Morrison

• “All of us are focused on the idea that our providers matter. They matter to their families, they matter to their communities, and they should matter to all of us.”

• “People that didn't even know that person are recognizing their service. They're recognizing their commitment to the community, and they're honoring them and remembering them.”

• “Once you come out and see what the ride is really about, you understand the mission and you see the impact it has on these families that we're able to meet with.”

Enjoying Inside EMS? Email theshow@ems1.com to share feedback or suggest a guest for a future episode. 

From venomous bites to venomous behavior: A second helping of the top EMS stories of 2025

In this end-of-year special, Chris Cebollero and Kelly Grayson wrap 2025 with their trademark mix of humor, insight and zero sugarcoating. From venomous bites to venomous behavior, the Inside EMS duo continue counting down the top EMS stories that had the industry buzzing this year — and occasionally cringing.

As always, the guys don’t shy away from the tough stuff, but they make sure to end on a note of gratitude for the everyday EMS pros out there doing the job with compassion, competence and quiet heroism.

Quotable takeaways

• “Every day, EMS providers go out there, do their jobs and bring some kindness and some comfort to a really bad day for their patients. And I think we need to look forward to more of that in 2026.”

• “Sometimes we've done things that maybe we shouldn't have, because it isn't in our scope of protocols, but I think we make a difference. Where's the line?”

• “Most of the advantages of mechanical CPR are not advantages at all.”

The top EMS1 stories of 2025

• Representatives Glenn Thompson and John Mannion introduced the EMS Counts Act

• Social Security Fairness Act signed into law, boosting retirement benefits for first responders

• Kentucky EMTs face KBEMS hearing for administering antivenom after mamba bite

• Elkhart firefighter appeals loss of paramedic duties after nurse’s harassment complaint

• American Heart Association's 2025 CPR guidelines: Choking, opioids & survival chain

• Ill. city council makes $500 lift assist fee permanent

• Warren-Wentworth Ambulance shuts down after entire staff quits

• 'Shut the f**k up!': North Babylon Fire Chief Peter Alt on leave after video shows him cursing at patient

• Orange County fire chiefs demand removal of EMS director for halting blood transfusions, ketamine use

• Colo. paramedic charged with manslaughter after sedating, restraining man

• National EMS Advisory Council board members terminated

Enjoying Inside EMS? Email theshow@ems1.com to share feedback or suggest guests for an upcoming episode. 

Callouts, chaos and career killers: The biggest EMS stories of the year

In this special Christmas edition of the Inside EMS podcast, cohosts Chris Cebollero and Kelly Grayson unwrap five of the biggest EMS stories of 2025 — and it’s not all eggnog and cheer. This year delivered more than its fair share of gut punches to the profession, from a paramedic who was charged with manslaughter, to footage of a fire chief yelling at a 10-year-old patient (yeah, that happened).

Next week’s show will break down the final five EMS stories of the year, but in 2026, we’re flipping the spotlight. Chris and Kelly are calling on you to step up and share your real EMS stories — the funny, the frustrating, the calls that changed you. Got a moment that shaped your career? Our cohosts want to hear it, and you might even get an invite to appear on the podcast. ‘Tis the season to be heard; email theshow@ems1.com to share your story!

Quotable takeaways

• “You're the grownup. You can't pitch a fit. You gotta be the grownup in the situation and diffuse it.”

• “If your only incentive for doing the right thing is that somebody might catch you being a jerk on video, then it's time for you to get out of the profession.”

• “The cost of readiness is hugely expensive.”

Enjoying Inside EMS? Email theshow@ems1.com to share feedback or suggest guests for future episodes. 

Why avoiding tough talks is killing your credibility

What do you do when someone on your team is struggling — and it’s on you to say something? In this episode of the Inside EMS podcast, Chris Cebollero and Kelly Grayson dive headfirst into one of leadership’s toughest challenges: holding people accountable without losing your humanity.

This episode challenges leaders to ditch outdated progressive discipline models and start leading with clarity and empathy. Whether you’re a seasoned supervisor or new to the hot seat, this one hits home. And if you’ve been avoiding a conversation, consider this your nudge to stop choosing comfort over your own integrity.

Quotable takeaways

• “Firing people with compassion, managing your ego, their ego, admitting mistakes and just being human — these are the places where real leaders show up.”

• “One of the things I try to teach is that I don't fire anybody — I just process the paperwork. People fire themselves.”

• “EMS is a very egotistical business, and it's that ego that keeps us from asking questions. Because we don't want to look like we don't know what we're talking about in front of our peers.”

Enjoying Inside EMS? Email theshow@ems1.com to share feedback or suggest a guest!

Fire/EMS pay parity and a big helping of cranberry sauce

This week on the Inside EMS podcast, we’re passing the gravy and the hot takes. Cohosts Chris Cebollero and Kelly Grayson serve up a holiday plate full of EMS news — starting with FDNY’s potential EMS split. They dig into what fair pay really looks like, why some EMTs are suing for what they’re owed, and whether big hospital systems like Yale New Haven are reshaping the ambulance game for better or worse.

Whether you’re working a turkey-day shift or finally off duty, this episode hits hard and gives thanks where it’s due.

Quotable takeaways:

• “If you’re gonna be in the EMS business, you’ve gotta be in the EMS business, right?”
• “One thing we need to do as leaders is to make sure we don’t mess with people’s money.”
• “If you’re not giving adequate funding and attention to the EMS side of the house, then that’s a recipe for trouble and it can’t last.”

Enjoying Inside EMS? Email theshow@ems1.com to share feedback or suggest a guest for a future episode. 

Whole blood, dual shocks and why the AHA still doesn’t get us

This week on the Inside EMS podcast, Dr. Peter Antevy returns for another round in the hot seat, and he’s not holding back. In this jam-packed episode, he and host Chris Cebollero tackle trending topics in prehospital care — from the expanding role of whole blood and plasma, to the frustrating gaps in the AHA’s 2025 guidelines.

You’ll hear real-world success stories (like the cardiac arrest survivor who’s back on the tennis court), why dual sequential defibrillation (DSD) should already be your go-to, and the cost-benefit realities of starting a whole blood program. Dr. Antevy also dives into the science behind glycocalyx damage and how plasma could change how we treat sepsis, TBI and burns in the field.

Whether you’re a medic, medical director or just passionate about pushing EMS forward, this episode delivers practical insight, bold opinions and a whole lot of inspiration.

Quotable takeaways from Dr. Antevy

• “The medical establishment does not understand the value of what EMS brings to the table. They don't understand the complexity.”

• “When we said, ‘We'll do the whole blood,’ what did the surgeons do? They went up in arms: ‘What do you mean you're giving whole blood? Bring them to us. We'll give the whole blood.’ No, no, no. We are part of the chain of survival, too.”

• “EMS is a subspecialty in the house of medicine. We all need to rise up to make the hospital folks and the academics aware that EMS is important for trauma, for stroke, for pediatrics, for cardiac. We are the ones who can help bring up those outcomes and that's why I love this field.”

Additional resources: 

• AHA 2025 updates are here: Cue the overreactions and the protocol rewrites
• On-demand: Bringing whole blood to the front lines of EMS
• Stop the bleed, fill the tank – The New Orleans EMS blood program
• Whole blood in EMS promises a revolution in resuscitation

Enjoying Inside EMS? Email theshow@ems1.com to share feedback or suggest a guest for a future episode. 

TikTok star Jimmy Apple is challenging EMS dogma with data and kindness

This week on the Inside EMS podcast, host Kelly Grayson sits down with Jimmy Apple — known as the “EMS Avenger” on TikTok — to explore how he’s challenging long‑standing EMS norms and delivering evidence‑based content at scale. With 22 years in EMS, the pediatric critical‑care paramedic has built a strong digital platform that merges clinical rigor with plain‑spoken commentary.

Whether you’re hung up on “what’s new” or “what really works,” this episode offers a spirited discussion, thoughtful commentary and a call to re‑examine what we do — and why.

Memorable takeaways

• “What we learn tends to define who we are as a provider, particularly when the information was learned during our formative years.”
• “I don’t want to have to spend my time defending a personal position. I would rather talk about how we can guide ourselves based on what we are actually seeing with data that is as objective as we can get it.”

Enjoying Inside EMS? Email theshow@ems1.com to share feedback and suggest guests for future episodes. 

How to lead without being that boss

Let’s face it — most discussions on leadership sound like someone regurgitating a business best seller. Not this time. In this week’s episode of the Inside EMS podcast, cohosts Chris Cebollero and Kelly Grayson get real about the six leadership habits that actually matter when you're running a shift, a truck or a team that relies on each other not to screw it up.

 

This isn’t about titles, org charts or leadership flavor-of-the-month. We’re talking self-awareness, collaboration and adaptability — the stuff that separates real-deal leaders from clipboard-holding disasters.

 

Whether you’re trying to step up or just sick of bad leadership, this episode’s got what you need to lead better — without the cringe.

Memorable quotes

• “What I can't stand in a leader is someone who waffles and is just blown by the wind. I would much rather have somebody say, ‘This is what we're gonna do.’ And then after, ‘Ooh, that was a bad idea. I'm sorry for that. That's on me.’”

• “If the team's confused, it's not a team problem. It's a leadership problem.”

• “Leaders who don’t know themselves lead through ego and insecurity.”

Enjoying Inside EMS? Email theshow@ems1.com to share feedback. 

AHA 2025 updates are here: Cue the overreactions and the protocol rewrites

In this week’s episode of the Inside EMS podcast, cohosts Chris Cebollero and Kelly Grayson dive into the 2025 AHA Guidelines for CPR & ECC and why, for most EMS systems and crews, this feels more like a tune up than a full overhaul. They talk through what is different — like the adult/child choking algorithm change, the inclusion of an opioid overdose response algorithm with public naloxone access, and the shift to a single unified chain of survival across ages and settings.

They also talk about what isn’t new (for example, the recommendation that routine mechanical CPR devices are not better than manual compressions), why that matters, and how agencies should frame this for crews and training programs.

Bottom line: the changes are real, the work is actionable, but this doesn’t feel like a seismic shift — so use that to your advantage in getting buy-in from providers and avoiding the “huge change panic.”

Memorable quotes

• “They're actually saying now, which I think is pretty cool, that individuals 12 and above can be taught CPR and how to use an AED.”

• “The key is early CPR and early defibrillation. And if you'regoing to get more bang for your buck, you need to devote your time to bystander CPR training and public AED access rather than buying fancy gadgets that are appealing but may not actually be supported by science.”

• “I find it interesting that we used to caution against this in CPR class: ‘Don’t give 'em back blows. You may lodge it deeper into the trachea.’ But now, I think they've looked at the data, and back blows are, at the very least, not harmful and may be beneficial.”

• “For those in leadership: audit all your protocols and training materials now. Find out where your system is aligned or out of step.”

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