Everyday EMS Tips

Wis. PTSD win for EMS

Greg Friese — Mon, 30 Mar 2026 22:22:41 +0000

@gregfriese
Big Wisconsin PTSD workers’ comp update for EMS, #volunteerfirefighter #mentalhealth #ptsdawareness #Legislation
♬ original sound – Greg Friese, MS, NRP – Greg Friese, MS, NRP

2026 Book Log

Greg Friese — Sat, 28 Mar 2026 16:31:40 +0000

I kept a book log in 2019, 2020, 2021, 2022 and 2023. I read a lot in 2024 and 2025, but didn’t document in a book log.

2026 books to date, with favorites in bold.

As Far as She Knew: A novel – Mindy Kaling liked this more than I did.
Project Hail Mary – fun re-read before seeing the movie.
The People’s Library – When AI is reanimates people from the past and is integrated into consciousness without choice.
Tomorrow, and Tomorrow, and Tomorrow: A novel – video gaming, loving and acceptance
Water Lies – murder mystery set in Venice Beach, California

NoDak EMS services losing $500 on every transport

Greg Friese — Mon, 02 Mar 2026 14:21:59 +0000

Interesting (terrifying) findings from a survey of North Dakota EMS agencies.

@gregfriese
Is your ambulance service losing $500 on every response? #TreatmentinPlace #Ambulance EMS Medicare Medicaid NorthDakota #HealthcarePolicy Read the news and view the survey report https://northdakotamonitor.com/2026/02/25/north-dakota-ambulance-providers-losing-money-on-every-run-according-to-survey/
♬ original sound – Greg Friese, MS, NRP – Greg Friese, MS, NRP

How to make your own ACLS Megacode scenarios

Greg Friese — Mon, 09 Feb 2026 10:56:00 +0000

Before my most recent ACLS renewal skills session, I asked ChatGPT to act as an experienced critical care paramedic and advanced cardiac life support instructor “to test my knowledge through a series of adult megacode scenarios.”

ACLS megacode scenario ChatGPT prompt

Here is my starting ChatGPT prompt:

“You are a critical care paramedic and American Heart Association ACLS instructor. Use the information on this page, https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms, to test my knowledge through a series of adult megacode scenarios. Always ask me questions one at time. With each question give me the patient clinical information I need to assess and answer the next question. Let’s start with multiple choice questions.”

I wasn’t disappointed. Chat, asking me questions, one at a time initially served me a megacode with multiple choice responses. After each of my responses, I received detailed feedback before Chat asked me another question.

To continue my megacode review, I began dictating my responses to Chat, as if I were the team leader.

“Oral-board–style, rapid-fire ACLS. No answer choices. You must state the action and brief rationale.”

After each of my responses, Chat delivered a rationale for why my answer was correct or a detailed explanation of what I got wrong. Chat often gave me a clinical pearl and advice for tightening my code commander instructions.

With each question and response, Chat seemed to get better as an instructor. Here is an example of Chat’s feedback to my instruction, “IV push 1 mg of epinephrine while compressions are underway.”

Reverse engineering a transferable prompt

After completing five oral ACLS megacode scenarios, I reverse-engineered a prompt to share with others or to create a GPT.

(Reverse prompt engineering is a technique to ask Chat to create a new prompt from a thread or conversation to make a prompt you can share with others or use to create a GPT. Continue to make refinements to the prompt until you get something you are comfortable using.)

“Based on this interaction and format of questions, my responses, your responses, please create a prompt that I can share with other ChatGPT users or to make an Adult ACLS Review GPT”

Here is the response:

Below is a clean, copy-and-paste–ready prompt you can share with other ChatGPT users or use directly to create a custom Adult ACLS Review GPT. It is written to reliably reproduce the oral-board / megacode training style you just experienced.

(Your success with this prompt may differ than mine. I have a ChatGPT plus subscription and have personalized chat by giving it instructions and background about me.)

Adult ACLS Oral Board & Megacode Trainer – Prompt

You are a critical care paramedic and American Heart Association ACLS instructor.

Your role is to test, challenge, and coach my Adult ACLS knowledge using realistic megacode and oral-board–style scenarios, strictly aligned with the current AHA Adult ACLS algorithms https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms (cardiac arrest, bradycardia, tachycardia, post–cardiac arrest care).

Core Rules

Ask one question at a time
Always provide enough clinical information to assess and act
Do not give multiple steps at once
Escalate difficulty as the scenario progresses
Treat this like an ACLS oral board, not a tutorial

Scenario Style

Use:

Adult patients
Realistic vitals, monitor rhythms, EtCO₂ values
EMS, ED, or ICU contexts
Dynamic deterioration and improvement
Transitions between algorithms (e.g., bradycardia → arrest)

Question Formats

Use a mix of:

Oral-board style questions (no multiple choice)
Megacode sequencing
Algorithm pivot points
High-risk decision traps

When appropriate, you may start with multiple choice, but quickly transition to open-ended oral board questions.

Evaluation Style

After each response:

Clearly state whether the answer passes or fails
Briefly explain why
Correct errors precisely (dose, timing, energy, sequencing)
Point out common ACLS failure points
Then continue the scenario

Be firm, precise, and clinically realistic, but not condescending.

Expectations for Answers

Expect me to:

Name the rhythm correctly
Choose the correct algorithm
State exact interventions
Use proper ACLS terminology
Sequence actions correctly
Justify decisions when asked

If my answer is incomplete or vague:

Ask me to clarify or restate
Do not “fix” my answer for me unless correcting an error

Key Emphases

Continuously test:

Shockable vs non-shockable arrest
Defibrillation energy (biphasic vs monophasic)
Medication timing and dosing
CPR quality and EtCO₂ interpretation
Electrical vs mechanical capture
Hs & Ts under pressure
ROSC recognition
Post–cardiac arrest priorities
STEMI integration
When to switch algorithms immediately

Tone

Professional
Direct
Instructor-level
Exam-focused
No fluff
No emojis

Start the Session

Begin by asking which format I want:

Multiple-choice warm-up
Oral-board scenarios
Full timed megacode
Rapid-fire ACLS review

Then immediately start the first scenario.

2023 Book Log

Greg Friese — Mon, 25 Dec 2023 01:58:06 +0000

I kept a book log in 2019, 2020, 2021 and 2022.

The Stranger in the Woods: The Extraordinary Story of the Last True Hermit – I am a few years late to the story of Christopher Knight and really enjoyed this book.
My Murder: A Novel – interesting novel set in a not to distant future
But what if we’re wrong – I always enjoy Chuck Klosterman on the Bill Simmons podcast.
Influx – A book science and technology what ifs
Please Tell Me – who kidnapped a town’s favorite child
Make Your Bed: Little Things That Can Change Your Life…And Maybe the World – short book of life advice from Admiral William H. McRaven
Lights Out – murder mystery
Florida Roadkill: A Novel – first book in the series
FixIt – 6th book in the Joe Ide IQ series.
The Hanging City – fantasy novel about a human living among trolls.
The Inheritance Games – the first book in the four-book YA series. Looking forward to the next book.
Mothered – an Amazon first reads book.
Heroes of the Frontier – a mom escapes to Alaska with her two children. She is running from a lot of trouble and is still running at the end of the book.
Why we swim – engaging cultural history of why humans swim for survival, food gathering, competition, fitness, mindfulness and fun.
Drift – a short book about making conscious choices and moving past the choices you didn’t make to make choices to be on the path you want to be in.
The Animal Keeprs: the story of an unlikely hero and an unforgettable season – My son finished his final season as a SPASH XC runner a few months ago. The traditions, teamwork, goal setting and sportsmanship Coach Behnke writes about in the Animal Keepers still exist more than 35 years since the storied 1985 season. Cross country, at SPASH and many schools, transforms the lives of the young men and young women who participate.
Thousand-Miler: Adventures Hiking the Ice Age Trail – we’ve got a goal to section hike the entire Ice Age Trail in the next 5 years. Some recon with this helpful book.
Fairy Tale – a 2022 Stephen King book about a young man from Illinois who goes on a fairy tale adventure.
Crazy for the Storm: A Memoir of Survival – Little Norm Ollestad tells the story of surviving a plane crash by alternating the harrowing escape down a mountain after the crash with stories of a father who wanted his best but didn’t always act with Norm’s best interests in mind.
Feral: Losing myself and finding my way in America’s National Parks – Emily Pennington, admist the COVID-19 pandemic and a crushing break-up, realizes a dream by visiting 60+ National Parks.
Pesos: The rise and fall of a border family – family biography of a corrupt (now reformed???) family on the San Diego and Tijuana border.
The Island – two families hunt one another within the confines of an island off the coast of Australia.
2312 – political and social problems in the widely colonized solar system. This was a slog of a book that I started in 2022 and struggled to finish.

Alternate Posting Location: Geriatric Fall Prevention

Greg Friese — Tue, 06 Jun 2023 23:32:51 +0000

After President Biden fell last week at the U.S. Air Force Academy it seemed like a good time to revisit geriatric fall prevention.

Read on EMS1: Geriatric fall prevention tips after POTUS trips, falls

EMS Week 2023

Greg Friese — Fri, 26 May 2023 11:15:44 +0000

Because of EMS, emergency care begins closer to the point of illness or injury than ever before.

Read my full EMS Week article at EMS1.com

Video: What does AVPU mean?

Greg Friese — Thu, 11 May 2023 13:24:16 +0000

Short YouTube video based on this EMS1 article, How to use AVPU to check a patient’s level of consciousness.

Video: The roadway is a hot zone

Greg Friese — Thu, 11 May 2023 12:25:36 +0000

New video on YouTube/Police1. Check out the video, like, share and subscribe. Thanks!

Celebrating 100 YouTube Subscribers

Greg Friese — Sat, 06 May 2023 18:50:20 +0000

The journey to becoming a YouTube creator is slow and steady. For about three months I have been:

Steadily creating YouTube shorts, about 1 per day
Focusing on the niche of outdoor activities
Watching and learning from other creators
Developing an unhealthy obsession of looking at plays and subscribes

Pivot to Video: Never Regret Going Outside

Greg Friese — Mon, 24 Apr 2023 00:56:00 +0000

About two months ago I started creating a daily Short video for YouTube around my outdoor passions and pursuits. Here are links to the channel, @NeverRegretGoingOutside, and three lists of three. After watching, please hit subscribe and like. Thanks!

Trips near and far

Games teenagers make up

Spring Break: Banff National Park

3 things that make Lake Louise a great place to #downhill #ski
Lake Louise #downhill #skiing highlights #shorts
Snowshoe jump by #Adventure #Mom in the #Banff backcountry (this is my most viewed video)

2022 Book Log

Greg Friese — Sat, 24 Dec 2022 11:14:00 +0000

I kept a book log in 2019, 2020 and 2021.

I read a bunch of books this year. Bewilderment, Riverman and Zero Fail were my favorites. I also started but didn’t finish (yet) at least three books in 2022.

The Hive – another murder mystery set in the Pacific Northwest
Hidden in Snow – murder mystery set in a Norway ski resort town
Alias Grace – historical fiction about a double murder in Canada in the late 1840s.
Bewilderment – a novel by Richard Powers that explores the edges of the universe and impending political and climate collapse.
The Hike – a fairly forgettable novel about two sisters and their husbands that go on a day hike that ends in tragedy.
Smoke: An IQ Novel – the 5th book in the IQ series that I have been enjoying for the last several years.
The Time Keeper – a 2012 Mitch Albom book. Enjoy the time you have rather than wishing for more or that it will go faster.
Such a beautiful thing to behold: a novel – a family breaks and reunites during a plague in their small rural town.
Where the crawdads sing – read the book, haven’t seen the movie.
The Intangible: a novel – relationships, as challenging or harder than theoretical math, are at the core of this story.
Running with Sherman: The Donkey Who Survived Against All Odds and Raced Like a Champion – we need animals in our lives and we need to spend time outdoors. Both things will make us physically and mentally healthier and safer.
The Peacekeeper: A Novel (The Good Lands) – an intriguing book that imagines North America without European colonization as the setting for a murder mystery.
Rock Island State Park Guidebook – read while serving as a volunteer docent at the restored and amazing Potawatomie Lighthouse.
Perspectives, Volume I: An Emergency Medicine and Public Safety Anthology – Collection of patients told through the eyes of paramedics, cops, nurses and doctors.
Riverman: An American Odyssey – true story of Dick Conant and the many people he met and inspired on long-distance canoe trips.
Sea of Tranquility – time hoping novel from Emily St. John Mandel, author of Station 11.
Freedom – a series of short books with a book that reflect upon ancient and modern societal meanings of freedom. By Sebastian Junger.
The Escape Artist – the first book in the Zig and Nola Brown series.
The Overstory: a novel – We need trees. More importantly we need to stop and listen to the trees.
Termination Shock – geoengineering to avert climate change disaster in the near future.
Everyone Communicates Few Connect – read for a John Maxwell book club at work.
How to Change: The Science of Getting from Where You Are to Where You Want to Be – An excellent book about building and maintaining habits. EMS1 article, inspired by the book, about “anytime resolutions.”
Sooley – John Grisham writes the fictional story of a basketball prodigy from South Sudan who flew too close to the sun.
Hi Five (An IQ Novel Book 4) – continue to work my way through the IQ series.
Death in the Sunshine (the retired detectives club book 1) – a slow moving who dun’it with too much detail. Not likely I’d read a book 2 in this series.
Among Others – a YA sci fi novel that publisher’s weekly described (aptly) as “turns the magical boarding school story inside out in this compelling coming-of-age tale.”
The Salt Line – post apocolyptic love story. Instead of a viral illness, zombies or vampires the villan in this story is a tick.
Zero Fail: the rise and fall of the Secret Service – when the highest profile Secret Service incidents are told in a continuous sequence it makes for edge-of-the seat and borderline terrifying reading.
Deep Sleep (Devin Gray Book 1) – A vast Russian sleeper cell is conspiring to ruin the U.S. Devin and friends try to stop them.
Wrecked (An IQ Novel Book 3) – Third book in the mordern day Sherlock series set in SoCal.
Righteous (An IQ Novel Book 2) – Isiah Quintabe is a modern day Sherlock in Long Beach, California.

Glacial Trail Run 50k

Greg Friese — Sun, 16 Oct 2022 00:09:55 +0000

It has been a few years since I’ve run a marathon. I am getting back into long-distance running through trail running. Last weekend I ran the Glacial Trail Run 50k in the Kettle Moraine State Forest. It was a glorious fall day and conditions were perfect for running. I last ran this race in 2003, my only other ultramarathon. Applying almost 20 years of runner smarts I managed to run 33 minutes faster than I did 18 years ago.

This was a happy moment pretty early in the race. The hilly course on poorly sorted glacial till is crazy difficult. Really glad I did this and looking forward to more long runs.

Alternate Posting Location: #NeverForget Lt. Alison Russo-Elling, FDNY EMS

Greg Friese — Fri, 30 Sep 2022 20:34:02 +0000

Posted on EMS1

Rapid response: Risk of senseless violence is constantly looming

Lt. Alison Russo-Elling, FDNY EMS, was killed in the line of duty on September 29, 2022. Russo-Elling, 61, was a 25-year veteran of the department and was a World Trade Center first responder who assisted in rescue and recovery efforts, according to an FDNY statement. Russo-Elling began her career as an EMT before becoming a paramedic in 2002. She was promoted to Lieutenant in 2016.

Alternate Posting Location: Viral Radio Traffic

Greg Friese — Wed, 21 Sep 2022 11:59:50 +0000

A Baltimore City EMS provider attracted widespread social media attention for his response to a dispatcher request to return to service.

“For the third time, we told you we are out of service,” an EMT says, repeating himself on a recording of Baltimore City Fire Department radio traffic. “I am completely prepared to tell my driver to disembark, and I will drive this thing in the Inner Harbor.”

Who among us hasn’t been so frustrated by dispatcher requests to return to service that they haven’t snapped back at dispatch – on or off the radio – and imagined parking the ambulance somewhere the sun doesn’t shine.

Continue reading on EMS1.com: Don’t blame paramedics for system problems

Alternate Posting Location: #Spitgate response tips

Greg Friese — Fri, 09 Sep 2022 11:33:30 +0000

Harry might have spit on Chris, but cops, medics, firefighters and correctional officers get spit on all the time. Here are a few thoughts, not about #spitgate, but how to react when a patient, inmate, suspect or bystander spits at you.

Forget the movie star memes, spit is an occupational hazard

Podcast: Paramedics need a thriving wage – The Overrun

Greg Friese — Thu, 01 Sep 2022 17:40:49 +0000

Enjoyed discussing the concept of a “thriving wage” for paramedics with Ed from the Overrun Podcast.

Podcast: Discussing the EMS Trend Report

Greg Friese — Sat, 20 Aug 2022 19:12:31 +0000

Listen to Jim Hoffman, Josh Knapp and me discuss the 2022 EMS Trend Report on the EMS Office Hours podcast.

Download the 2022 EMS Trend Report from EMS1.

Video: 2022 EMS Trend Report quick recap

Greg Friese — Sun, 14 Aug 2022 13:39:28 +0000

I was able to present findings from the 2022 EMS Trend Report at the Pinnacle EMS conference in late July. In this short video, Roxanne Peek and I discuss some of the findings and lessons for EMS leaders we presented.

Download and read the 2022 EMS Trend Report from EMS1, Fitch & Associates and the EMS Survey Team.

Has the iPhone made EMS better?

Greg Friese — Wed, 29 Jun 2022 21:14:04 +0000

Today is the 15th birthday of the iPhone, a device which I use daily and is hardly ever more than an arm’s reach away. But today I take a contrarian view about the impact of the iPhone on EMS.

7 ways the iPhone ruined EMS

https://www.ems1.com/lifestyle/articles/7-ways-the-iphone-ruined-ems-Ji4agtK0UT1gAWnn/