EMS Geriatric Emergencies - GEMS Diamond Assessment System

The GEMS Diamond Assessment System was developed by the National Association of Emergency Medical Technicians (NAEMT) in collaboration with experts in geriatric care. 

It was created as part of an effort to enhance the education and training of EMS Providers in understanding and managing the unique challenges associated with caring for geriatric patients in prehospital settings. 

This system is integrated into educational programs, such as the Geriatric Education for Emergency Medical Services (GEMS) course, which provides specialized training for emergency medical professionals. 

A Comprehensive Tool for EMS Providers

The GEMS Diamond Assessment System is an essential framework designed to assist EMS providers in navigating the complexities of caring for geriatric patients. 

This tool emphasizes a multifaceted approach that incorporates clinical, environmental, and social elements to ensure comprehensive patient evaluation. 

Here's what EMS providers need to understand about the GEMS system:

G – Geriatric Patient: Geriatric patients often present atypically, meaning that symptoms of serious medical issues may differ from those seen in younger populations. 

For example, conditions like myocardial infarction may present as generalized weakness or confusion rather than the classic chest pain. 

EMS providers should recognize and anticipate normal physiological changes associated with aging, such as decreased skin elasticity, altered pain perception, and slower cognitive responses. 

Importantly, geriatric patients deserve respect and should be approached with patience and empathy, never infantilized.

E – Environmental Assessment: The patient's environment can offer critical clues about their health status and potential risks. 

EMS Providers should take a quick but thorough look at the surroundings to assess whether it’s safe and conducive to the patient’s well-being. 

Indicators to consider include:

- Condition of the Home: Is it clean or cluttered? Is there evidence of neglect, such as dirty living conditions, unventilated spaces, or broken fixtures?

- Safety Hazards: Check for things like trip hazards, excessive clutter, or broken glass.

- Adequacy of Care: If the patient lives with a caregiver or in a nursing home, observe whether the care appears sufficient. 

Signs of elder abuse or neglect, such as the patient being confined to one room or visible signs of poor hygiene, should be taken seriously.

- Signs of Substance Abuse: Empty liquor bottles may indicate alcohol misuse, a common issue in geriatric populations.

- Medication Review: Take note of any outdated medication bottles lying around, as polypharmacy can lead to dangerous drug interactions.

M – Medical Assessment: Geriatric patients often have multiple chronic health issues that can obscure or complicate the assessment of acute symptoms. 

This makes obtaining a detailed and accurate medical history vital, regardless of the patient's chief complaint. 

Conditions such as heart disease, diabetes, and chronic pain syndromes are prevalent and can mask or exacerbate other medical issues. 

EMS providers must exercise vigilance in differentiating between baseline conditions and new or worsening symptoms.

S – Social Assessment: The social well-being of a geriatric patient is an aspect often linked to their overall health. EMS providers should evaluate whether the patient has a support system. 

Key questions include:

Does the patient have friends or family who visit regularly?

Is there evidence of social isolation, which can contribute to or exacerbate depression?

Can the patient manage daily activities such as bathing, dressing, toileting, and eating independently? If not, is there adequate support in place?

Is there regular access to essentials like food and clean water?

A comprehensive social assessment also includes observing the patient's interactions and listening for signs that they may be experiencing loneliness or neglect.

Conclusion

The GEMS Diamond Assessment System serves as a vital guide for EMS providers when managing geriatric patients. 

By focusing on the unique needs and considerations outlined — Geriatric, Environmental, Medical, and Social — providers can deliver a well-rounded, empathetic approach to care. 

In addition to using the GEMS framework, EMS Providers must remain mindful of the importance of thorough injury assessments, effective communication strategies, and maintaining respect for the autonomy and dignity of older adults. 

These practices not only improve the quality of care but also foster trust and cooperation with patients, their families, and caregivers.

As the geriatric population continues to grow, the ability to deliver tailored, patient-centered care becomes increasingly vital. 

By incorporating the GEMS Diamond Assessment System into their practice, EMS providers can confidently navigate the challenges of geriatric emergencies, ensuring safer outcomes and making a meaningful difference in the lives of their patients. 

The GEMS structure exemplifies the intersection of clinical expertise, empathy, and respect that defines high-quality care in emergency medical services.

Further Reading

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

NAEMT (2023) Geriatric Education for Emergency Medical Services (3rd Ed). Burlington, Massachusetts: Jones & Bartlett Learning

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell

Peterson, L. K., Fairbanks, R, J., Hettinger, A. Z., & Shah, M. N. (2009) Emergency Medical Service Attitudes Toward Geriatric Prehospital Care & Continuing Medical Education In Geriatrics. Journal of the American Geriatrics Society 57 (3): 530-5. Accessed November 8, 2024

Shah, M. N., Rajasekaran, K., & Sheahan, W. D., Wimbush T., & Karuza J. (2008) The Effect Of The Geriatrics Education For Emergency Medical Services Training Program In A Rural Community. Journal of the American Geriatrics Society 56 (6):1134-9. Accessed November 8, 2024

EMS Geriatric Emergencies - Common Ailments & Injuries

Geriatric patients represent a significant demographic in the field of prehospital emergency care. 

Due to the complexities that come with aging, older adults are more susceptible to certain medical and traumatic emergencies, often presenting with unique challenges that EMS providers must be prepared to address. 

These cases require a nuanced understanding of age-related physiological changes, atypical symptom presentation, and the impact of comorbidities. 

By recognizing the specific needs of geriatric patients, EMS providers can enhance the quality of care, improve patient outcomes, and better navigate the intricacies involved in emergency scenarios involving this vulnerable population.

Below are some of the most common ailments and injuries EMS providers can expect to encounter when responding to geriatric patients.

1. Cardiovascular Emergencies

- Myocardial Infarction (Heart Attack)

• Geriatric patients often present with atypical symptoms, such as weakness, shortness of breath, confusion, or syncope, rather than the classic chest pain.
• EMS providers should maintain a high index of suspicion for cardiac events, even in the absence of typical symptoms.

- Congestive Heart Failure (CHF)

• Common symptoms include dyspnea, orthopnea, peripheral edema, and pulmonary crackles.
• Many CHF patients take diuretics, which can lead to dehydration and electrolyte imbalances, further complicating their condition.

- Hypertension and Hypotension

• Uncontrolled hypertension increases the risk of strokes, heart attacks, and aneurysms.
• Conversely, geriatric patients are also prone to orthostatic hypotension, which can contribute to falls and syncopal episodes.

2. Respiratory Emergencies

- Chronic Obstructive Pulmonary Disease (COPD)

• COPD, including chronic bronchitis and emphysema, is common in older adults, particularly those with a history of smoking.
• EMS providers should assess for hypoxia, wheezing, or diminished breath sounds and be cautious with oxygen administration in long-term COPD patients.

- Pneumonia

• In geriatric patients, pneumonia may present with confusion, weakness, or decreased appetite rather than fever or cough.
• EMS should assess oxygenation and be prepared for respiratory support.

- Pulmonary Embolism (PE)

• A life-threatening condition that can present with sudden-onset shortness of breath, chest pain, or unexplained hypoxia.
• Risk factors include immobility, recent surgery, and a history of deep vein thrombosis (DVT).

3. Neurological Emergencies

- Stroke / Cerebrovascular Accident

• Stroke symptoms may include unilateral weakness, facial droop, slurred speech, confusion, or altered mental status.
• EMS should perform a rapid stroke assessment and transport patients to a stroke center as quickly as possible for potential thrombolytic treatment.

- Altered Mental Status (AMS)

• AMS can be caused by various conditions, including infection (e.g., sepsis or urinary tract infection), medication interactions, dehydration, or metabolic disorders.
• It is critical for EMS providers to investigate the underlying cause rather than dismissing confusion as normal aging.

- Dementia and Delirium

• Dementia is a progressive cognitive decline, while delirium is a sudden change in mental status, often due to infection, medication effects, or metabolic disturbances.
• EMS should gather history from caregivers and assess for contributing factors.

4. Traumatic Injuries

- Falls and Fractures

• Falls are one of the most common geriatric emergencies and are often caused by balance issues, vision impairment, hypotension, or medication side effects.
• Common fractures include hip, wrist, and vertebral fractures, which can lead to long-term immobility and complications.

- Head Injuries

• Older adults are at higher risk for subdural hematomas, particularly those on anticoagulants.
• Even minor head trauma can result in serious complications, necessitating careful assessment and monitoring.

- Spinal Injuries

• Osteoporosis and degenerative changes increase the likelihood of spinal injuries, even with low-impact trauma.
• Providers should be cautious when performing extrication and spinal immobilization in older patients.

5. Metabolic and Endocrine Emergencies

- Diabetic Emergencies (Hypoglycemia and Hyperglycemia)

• Older diabetics may present with vague symptoms, such as confusion or dizziness, rather than typical signs of hypo- or hyperglycemia.
• Polypharmacy and comorbidities can complicate glucose regulation, increasing the risk of emergency events.

Dehydration and Electrolyte Imbalances

• Older adults often have a diminished thirst response and may not drink adequate fluids, leading to dehydration and imbalances in sodium or potassium levels.
• Dehydration can contribute to confusion, hypotension, and an increased risk of falls.

6. Gastrointestinal Emergencies

Gastrointestinal Bleeding

• Geriatric patients taking anticoagulants or NSAIDs are at higher risk for GI bleeds.
• Signs include hematemesis, melena, or unexplained hypotension and anemia.

- Bowel Obstruction and Constipation

• Decreased motility and medication side effects can lead to severe constipation or bowel obstructions.
• Symptoms include abdominal pain, bloating, nausea, and vomiting.

7. Sepsis and Infection

• Older adults may present with atypical signs of infection, such as confusion, lethargy, or decreased appetite instead of fever or localized pain.
• Urinary tract infections (UTIs) are common and can lead to sepsis, especially in catheterized or immobile patients.
• EMS providers should assess vital signs and be aware that sepsis can progress rapidly in the elderly.

8. Behavioral and Psychiatric Emergencies

- Depression and Suicide Risk

• Depression is frequently underdiagnosed in older adults and may present as withdrawal, appetite changes, or worsening medical conditions.
• Geriatric suicide risk is significant, particularly in men over 65, necessitating thorough screening and intervention.

- Elder Abuse and Neglect

• EMS providers should be vigilant for signs of abuse or neglect, including malnutrition, pressure ulcers, unexplained injuries, or inconsistent histories from caregivers.
• Suspicious findings should be reported to the appropriate authorities for further investigation.

Conclusion:

When providing prehospital care for geriatric patients, it is essential for EMS professionals to remember that while aging brings unique challenges, it does not diminish the value, aspirations, or agency of an individual. 

Utilizing systems like the GEMS diamond can aid in ensuring thorough, empathetic assessments that respect the patient's holistic well-being. 

Approaching geriatric care with the awareness that older patients are driven by the same motivations as their younger peers helps in fostering trust and delivering high-quality, patient-centered care. 

Ultimately, treating older adults with respect and understanding is key to enhancing their experience in prehospital emergencies and supporting their independence and dignity.

Further Reading

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

NAEMT (2023) Geriatric Education for Emergency Medical Services (3rd Ed). Burlington, Massachusetts: Jones & Bartlett Learning

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell

Peterson, L. K., Fairbanks, R, J., Hettinger, A. Z., & Shah, M. N. (2009) Emergency Medical Service Attitudes Toward Geriatric Prehospital Care & Continuing Medical Education In Geriatrics. Journal of the American Geriatrics Society 57 (3): 530-5. Accessed November 8, 2024

Shah, M. N., Rajasekaran, K., & Sheahan, W. D., Wimbush T., & Karuza J. (2008) The Effect Of The Geriatrics Education For Emergency Medical Services Training Program In A Rural Community. Journal of the American Geriatrics Society 56 (6):1134-9. Accessed November 8, 2024

EMS Geriatric Emergencies - Key Considerations

The aging process is frequently misunderstood, leading to varied experiences among clinicians when working with older populations. 

While some EMS Providers excel in managing the complex needs of geriatric patients, others may find it challenging due to the distinct and multifaceted nature of geriatric care. 

To effectively address these challenges, tools such as the GEMS Diamond Assessment System offer an accessible framework for understanding and responding to the key needs of this demographic. 

Recognizing that older patients share the same values — such as independence, freedom, and autonomy — as their younger counterparts is crucial. 

One of the most significant missteps a provider can make is treating older adults in a manner that undermines their dignity or infantilizes them.

EMS providers should be aware that geriatric prehospital emergencies often present differently than those involving younger populations. 

Here are some key considerations:

Atypical Presentations: Older adults may not show classic symptoms of certain medical conditions. For instance, heart attacks may present as general weakness, shortness of breath, or confusion rather than chest pain. 

Similarly, infections like pneumonia or urinary tract infections might lead to altered mental status or fatigue without a fever.

Comorbidities and Polypharmacy: Geriatric patients frequently have multiple chronic conditions, such as hypertension, diabetes, or heart disease. 

This, combined with the common use of multiple medications, can affect how symptoms manifest and complicate diagnosis.

EMS providers should be mindful of potential drug interactions and the effects of medications on vital signs or cognition.

Age-Related Physiological Changes: The aging body undergoes changes such as decreased cardiovascular reserve, reduced lung capacity, and impaired temperature regulation. 

These changes can make older patients more vulnerable to shock, respiratory distress, or hypothermia and can affect their response to treatment.

Falls and Trauma: Falls are a leading cause of injury in older adults, often leading to fractures, head trauma, or spinal injuries. Due to bone density loss and the risk of osteoporosis, even minor trauma can result in significant injury. 

Conclusion

In managing geriatric prehospital emergencies, EMS Providers must integrate knowledge of the distinctive aspects of aging with careful, compassionate care. 

This includes staying vigilant for atypical presentations and being prepared to adapt assessment and treatment strategies to suit the complex health profiles of older adults. 

Prioritizing a patient-centered approach while maintaining strong clinical judgment will ultimately help in delivering efficient, effective, and empathetic care. 

By honing these skills, EMS professionals contribute not only to the immediate health and safety of their geriatric patients but also to the broader goal of fostering a healthcare system that meets the needs of its aging population.

Further Reading

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

NAEMT (2023) Geriatric Education for Emergency Medical Services (3rd Ed). Burlington, Massachusetts: Jones & Bartlett Learning

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell

Peterson, L. K., Fairbanks, R, J., Hettinger, A. Z., & Shah, M. N. (2009) Emergency Medical Service Attitudes Toward Geriatric Prehospital Care & Continuing Medical Education In Geriatrics. Journal of the American Geriatrics Society 57 (3): 530-5. Accessed November 8, 2024

Shah, M. N., Rajasekaran, K., & Sheahan, W. D., Wimbush T., & Karuza J. (2008) The Effect Of The Geriatrics Education For Emergency Medical Services Training Program In A Rural Community. Journal of the American Geriatrics Society 56 (6):1134-9. Accessed November 8, 2024

EMS In The News - ChatGPT 4 Omni’s Pill Identifying Potential

The latest version of ChatGPT 4 Omni has sparked widespread excitement and curiosity, particularly within the EMS community.

With its advanced capabilities, many are pondering the potential roles it could play in revolutionizing emergency medical services.

As first responders often face high-stress situations with limited time and resources, the ability to quickly access crucial information can make a significant difference in patient outcomes. So, where could this technology be useful? Imagine arriving at the scene of an overdose, finding various pills scattered across the table, and only a couple of identifiable pill bottles. In such a chaotic environment, the rapid identification of substances becomes paramount. This is where ChatGPT 4 Omni could shine. With the right resources and a bit of time, ChatGPT could assist EMS Providers in quickly identifying the pills the patient ingested. By inputting descriptions or uploading photos of the pills, responders could receive immediate feedback on what they might be dealing with. This capability could dramatically enhance the decision-making process, allowing for faster and more accurate treatment protocols. Furthermore, having a photo of the pills could be incredibly useful when briefing the doctor in the emergency room.

Instead of relying solely on memory or a vague description, EMS personnel could provide visual evidence, facilitating better-informed medical decisions. This seamless integration of technology into emergency response could bridge information gaps and improve communication between pre-hospital and hospital care. The potential of ChatGPT 4 Omni in identifying pills for EMS providers is a promising development. As this technology continues to evolve, it may well become an invaluable tool in enhancing the efficiency and effectiveness of emergency medical services. ---

The Journal Emergency Medical Services (JEMS) article highlights the transformative potential of AI technology, like ChatGPT 4 Omni, in aiding EMS Providers during critical situations, showcasing how it could improve patient care in emergency settings.

For more information, access the article link below.

Butcher, J, (2024) Evaluating ChatGPT 4 Omni’s Potential in Identifying Pills for EMS Providers. Journal of Emergency Medical Services. Accessed November 7, 2024

EMS Hepatic Emergencies - Adults v Pediatric Jaundice

When EMS Providers encounter jaundice in patients, understanding the differences between adult and pediatric cases is essential for accurate assessment and intervention.

1. Etiology of Jaundice:

Adults: Jaundice in adults is often associated with liver disease, such as hepatitis, cirrhosis, or obstruction due to gallstones or tumors. 

Hemolysis (excessive breakdown of red blood cells) or pancreatic issues can also contribute to jaundice.

Pediatrics: In newborns and infants, jaundice is commonly due to physiological immaturity of the liver, resulting in an inability to process bilirubin efficiently. 

This condition is often benign and termed physiologic jaundice. Pathological causes in children can include hemolytic disease, infections, or biliary atresia.

2. Prevalence and Presentation:

Adults: Jaundice in adults is usually less common and more indicative of a potentially severe underlying condition. 

It may present with other signs of systemic illness, such as fever, weight loss, or abdominal pain.

Pediatrics: Jaundice is quite common in neonates, particularly in the first week of life. It may be noticeable in the eyes (scleral icterus) or skin. 

In older children, it is less common and may point to a serious issue.

3. Assessment Differences:

Adults: EMS providers should look for signs of liver dysfunction, such as changes in mental status (e.g., confusion or altered consciousness), abdominal distention, and a history of alcohol use or liver disease. 

Asking about dark urine or pale stools can also help identify underlying liver or biliary issues.

Pediatrics: In infants, checking for jaundice involves examining the skin under natural light. Special attention should be given to whether the jaundice is spreading from the face downward, which indicates increasing bilirubin levels. 

Noting feeding difficulties, lethargy, or poor weight gain is crucial in assessing severity.

4. Immediate Concerns:

Adults: Jaundice in adults often requires further evaluation for signs of liver failure, coagulopathy (e.g., easy bruising or bleeding), or potential sepsis in cases where infection is suspected.

Pediatrics: For neonates, a high bilirubin level (severe hyperbilirubinemia) can be a medical emergency, as it can lead to kernicterus, a type of brain damage. 

Any signs of jaundice persisting beyond two weeks or coupled with symptoms like high-pitched crying or arching of the back should prompt urgent attention.

5. Management Focus:

Adults: Management is often supportive, with emphasis on addressing the underlying condition. Transporting the patient to a facility equipped to diagnose liver issues is key.

Pediatrics: For neonatal jaundice, EMS Providers should ensure the baby is kept warm and hydrated. 

Transport to a pediatric-capable facility is crucial if severe jaundice or any concerning symptoms are noted.

Understanding these distinctions helps EMS Providers make informed decisions and prioritize care when faced with a jaundiced patient, ensuring they tailor their approach according to the patient's age and likely causes.

Further Reading

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell

EMS Hepatic Emergencies - Scleral Icterus v Jaundice

For EMS providers, understanding the nuances of scleral icterus and jaundice is essential for accurate assessment and early intervention.

1. Scleral Icterus

Definition: Yellowing of the sclera (whites of the eyes) without concurrent skin yellowing.

Clinical Significance: Often the first visible sign of elevated bilirubin levels and an early indicator of liver dysfunction or hemolysis.

Implications: Identifying scleral icterus can suggest underlying conditions such as hepatitis, cirrhosis, or hemolytic anemia. 

Early detection can prompt the EMS Provider to prioritize further evaluation and expedite transport to the appropriate care facility.

2. Jaundice

Definition: Yellowing of both the skin and the whites of the eyes due to high levels of bilirubin in the blood.

Progression: Jaundice usually follows scleral icterus if the underlying cause continues or worsens.

Causes:

Pre-Hepatic: Conditions causing excessive breakdown of red blood cells (e.g., hemolysis).

Hepatic: Liver conditions impairing bilirubin processing (e.g., hepatitis, cirrhosis).

Post-Hepatic: Obstructions in bile flow (e.g., gallstones, tumors).

Symptoms & Associated Signs: Patients may also have dark urine, pale stools, fatigue, abdominal pain, and pruritus (itching).

Key Points for EMS Providers:

Assessment: Use adequate lighting when checking for scleral icterus or jaundice. Assess the patient’s history for recent liver disease, alcohol use, or risk factors for hemolysis.

Documentation: Record any visible signs and associated symptoms such as abdominal pain, confusion, or changes in consciousness, which could indicate worsening liver function or biliary obstruction.

Critical Situations: Rapidly progressive jaundice with symptoms such as altered mental status or significant abdominal pain may indicate acute liver failure or biliary sepsis, requiring urgent care.

Communication: Inform receiving facilities of the findings, which can be crucial for directing lab tests (e.g., liver function tests) and determining appropriate interventions.

Understanding these conditions allows EMS Providers to recognize early signs of potentially serious illnesses and ensure timely and effective patient management. 

Further Reading

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell

EMS In The News - Iowa EMT Fired For Not Doing Job

An EMT was fired after a video he created surfaced showing a patient alone in the back of the ambulance.

The video quickly spread through the community, leading to public outcry and concerns about patient privacy and dignity.

The ambulance service took immediate action in response to the incident, emphasizing their commitment to maintaining professional standards and protecting the rights and privacy of patients.

This incident highlights the importance of ethical behavior in healthcare settings and the potential repercussions of violating patient trust.

For more information, access the article link below.

Kauffman, C. (2024) EMT Fired After Video of Ambulance Patient Spreads Throughout Community. Iowa Capital Dispatch. Accessed November 1, 2024.