The Unwired Medic

Teaching EMS providers & other public safety pros about using mobile tech to improve their practice, patient care, continuing education, scene safety, general entertainment, & productivity.

July 28, 2016
by The Unwired Medic

O2 Amp Vein Glasses – Product Review

So I’ve seen these glasses advertised around the web and on Facebook talking about how EMT’s and Paramedics are using them to see veins for IV starts and to identify blood pooling, such as in hematomas.  I reached out to O2 Amp by 2ai Labs, and they sent me four different sets of these glasses to evaluate and report back on.

The Claims:O2 Amp by 2ai Labs

See veins more distinctly, identify blood pooling, see shifts in blood concentration in tissues (i.e., blanching, or capillary refill or lack thereof).

The Premise; How does it work:

Color shifts in vision can enhance the viewing of certain color spectra, allowing the user to perceive certain colors with more intensity, such as veins and capillaries.

By tinting the lenses, a color shift is introduces that obscures the undesirable range of color and enhances others. This is a tough one to tackle, because people don’t all perceive colors identically. For instance, I have a bit of color-blindness, which is not uncommon for men. I noticed that I perceived some things less intently than other users I shared this experience with, and other things more intensely than others.O2 Amp Glasses by 2ai Labs

In order for most of these glasses to do what we expect of them, you will require a pretty strong light.  In fact, the manufacturer recommends you start learning how to use these glasses in full sunlight.  I agree.  Alternatively, exam lights and tactical flashlights offer very strong light to help make these glasses work for you most efficiently.  My best results were obtained in direct sunlight.

My results:

I tried taking these to our only regional trauma center’s ER and worked with a couple nurses and a few medics that passed through while I was there.  Results were not exactly overwhelming.  Even with a tactical flashlight emitting over 300 lumens, I and the others that were using them were still not feeling like we had fared any better with or without the glasses.  There are a couple possible reasons that things didn’t go so swimmingly:

  1. Doubt/Bias: Any product that claims to allow one to perceive something differently by just applying a tint to your eyes seems dubious.
  2. Experience: We work under ostentatious circumstances and we in the ER and in the field are often called to be expert phlebotomists, finding veins where there seem to be none readily available and starting IV’s and performing blood draws.  We have additional training and experience in gaining IV access beyond the typical clinical provider.  The only medical staff I have encountered that are on par with emergency personnel are surgical suite medical staff and blood bank phlebotomists (incidentally, I worked in a whole blood donation bank for almost a year and that is where I gained a significant portion of my own phlebotomy skills).  One nurse who tried the glasses said maybe I should take these to the floor nurses and let them try, since they don’t do too many IV’s comparatively.
  3. It’s a scam: Yes, it’s possible, but I don’t think it is likely.  I have read the literature provided by the manufacturer and I don’t believe it is a scam.

O2 Amp Oxy-Iso SunglassesI also took these glasses to my EMS station and worked with a few fellow medics to see what they thought.  We were already outside doing simulations and it seemed like the perfect time.  Of the four varying tints of glasses we tried, they all yielded positive results, but the darkest of the purple tints, the sunglasses style O2 Amp glasses, showed the most benefit in finding veins.  Tactical flashlights just didn’t do these glasses as much justice as the sunlight.  Maybe the LED doesn’t emit a broad enough light spectrum to compare with sunlight.  The end result was that provided you had a bright enough light, like sunlight, they worked fairly well.  In the back of the ambulance with all the lighting up and the tac light, you could still do well with these glasses.

My verdict:O2 Amp Oxy-Iso Sunglasses by 2ai Labs

The O2 Amp glasses by 2ai Labs are a promising development in rapid vein identification.  Caveats are warranted for people with color blindness – your mileage may vary – but that is why I enlisted the help of many other practitioners to help me properly evaluate these glasses.  As the manufacturer claims, they are an alternative to the more expensive Vein Light devices.  They seem to deliver fairly well, when placed under more ideal circumstances.  They may not be the best in helping in low-light circumstances, of which EMS’ers find themselves in abundance of.  I’m happy to have been given the opportunity to try these glasses out.  On another note, I have been in contact with the manufacturer several times since receiving these glasses, and they have been helpful in ensuring I get the best results from my product evaluation.  I think their customer service has been excellent.

Bare Arm - No Glasses

My forearm in bright sunlight. Decent enough veins.

Bare Arm - Oxy-Iso Glasses

Bare arm in direct sunlight. Oxy-Iso Sunglasses placed over the lens of the camera. Results in the image are not as evident as with the naked eye. The blue tint in the veins is more prevalent. Smaller, less bulging veins are more noticeable when viewing through the glasses than through the camera. The difference is probably due to automatic color correction of the camera in processing the digital image.












I have been asked by O2 Amp to include the following notes, which may help their users get the most out of their glasses purchase and to clarify some of the science behind why their product works:

Thanks, Chris, for reviewing our product.

Some follow-up notes:

(1) We like to emphasize that, If one should be wearing protective glasses anyway, then one might as well wear glasses that enhance health signs and veins. If lighting conditions are good, then you get perceptual advantages. But if lighting conditions are not good, well, then it becomes basically clear protective eyewear. So, we view them less as a competitor among the vein finders, and more of a “wear these protective eyewear instead and you’ll sometimes — with good light — get perceptual advantages.”

(2) The Oxy-Iso is stronger in some sense, indeed, than the Oxy-Amp Paramedic Vein Glasses. But (a) the Oxy-Iso also cuts out a lot more light, making it even more difficult indoors, and (b) it blocks the other blood dimension we can see, variations in concentration of blood (what the green Hemo-Iso amplifies), making one better at seeing veins, but potentially worse at seeing clinical signs more generally. That’s why we recommend the Oxy-Amp Paramedic Vein Glasses to paramedics, because it blocks only a very narrow band of bad signal (and the light pink is a functionless side effect of the way we have to manufacture it), and so leaves one’s general clinical sense unhurt, but only better. …because paramedics need their general clinical signs sense intact.

(3) It’s more than just tints that make the tech work. I realize you’re speaking without jargon for a general audience, but, say, merely finding some filter (or colored glass, say) having the same tint won’t reproduce the effect. It has to have the spectral filter function of ours. (Said differently, for any tint, there are infinitely many spectra that differ in how they modify colors, but still all have the same tint.)

(4) In our experience, the Oxy-Amp is not successful for hospital workers — perhaps because they’re more a hostage to interior lighting constraints, or are less the type that carries tool kits around with them — than paramedics, where we have had good results.

(5) Even though paramedics tend to do their procedures inside the truck, their initial encounter is usually outside the truck, and in daylight the Oxy-Amp makes all clinical signs easier to see, not just veins. Out hope is that paramedics have our Oxy-Amp tech as their sunwear, so they get the UV protection needed, but also clinical enhancement.

Thanks again.

Dr. Mark Changizi

June 27, 2016
by The Unwired Medic

Leadership’s Voice

A friend of mine shared an article from EMS Leadership Academy with his link preface saying:

Classic leadership advice: “Its not what you say; its what they think it means.” (sic)

You’re trying to get your message across. Something needs to change, and maybe the impetus for the change wasn’t something negative that happened as you hear everyone suspects. Maybe it was benign or you felt it was a good direction to go, but still, you’re getting pushback. Let me give you a nickel’s worth of free advice…

If they aren’t getting your message, saying it louder won’t change anything.

It’s not a hearing problem. It’s an interpretation problem. Maybe you should consider changing your delivery rather than getting frustrated with their interpretation.

May 7, 2016
by The Unwired Medic

Do you even realize?

You probably pay no mind to it…

We do it every day. We start our shift on the computer, running our checksheets, checking our e-mail, logging in to our ePCR programs to check for QA kickbacks and open charts. We get in the rig. You get assigned a post or a call and you look at the CAD and GPS. You check your smartphone or tablet for CAD info on the call you’re about to go in to. You might start prefilling the ePCR now. Your eyes leave the screen long enough to clear intersections.

You’ve on scene and you’ve made patient contact. You’re back to the screen entering demographics, meds, allergies, vital signs. You move to the box with your patient. All your tech is coming together to form a mural of diagnostics on your patient and it too goes into the ePCR. You make it to the ER and now you have to finish your documentation with your final vitals, handoff report, diagnostics, and what have you. You’re back in the rig and at it all over again.

Maybe you’re lucky enough to have a few minutes to rest, so you pull out your phone and check your texts and Facebook. There’s that viral game everyone is playing and you’ve dropped a bit on the leaderboard, so you pop over to the game and play for just a couple minutes before you get back to charting or working on that online CE due by the end of today. Maybe you’ve got more time and a station. A cushy recliner to fall back into has your name on it, and you need to decompress so you watch a movie with the crew.

Do you even realize?

You’re now spending virtually every waking minute of your day in front of one display screen or another. Do you know what it is you have been unwittingly doing to yourself? Do you realize why you have that mild, nagging headache? Do you realize why you keep rubbing your eyes? You aren’t tired yet. You haven’t felt the need to grab an energy drink. So what could it be?

What you are unwittingly doing to yourself is constantly barraging yourself with artificial blue light (1). Every computer screen, smartphone, tablet, and television we encounter now emits this artificial blue light. It has been linked to sleep disorders by interfering with our Circadian rhythms, and it affects our blink rates, giving us dry eyes, and it even gives us headaches.

Sleep in public safety is precious enough. Need we discuss how many accidents and medical errors are attributed to sleep deprivation? It’s a well-known fact. Dry eyes due to less blinking can cause corneal scarring and abrasions, loss of visual acuity, and even ulcerations (2). There are many things that contribute to headaches, including medications, fatigue, stress, sleep apnea, and eye strain.  Some studies suggest night owls exposure to light contributes to cancer, diabetes, and even more health disorders and recommended wearing blue light blocking eyewear (3).  Emergency Services personnel work around direct blue lights regularly when we are responding to and on scene of emergency calls.

What can you do about it?

Many of us wear corrective lenses now, yours truly no longer being an exception to this. I worked for a blood bank for a year near the beginning of my EMS career and that was where I had my first blood exposure. From that moment on, I vowed to wear some kind of lenses in front of my eyes. I always wore clear lenses, even though I didn’t need them to be corrective. The problem is typical lenses don’t do anything about light outside the non-visible UV spectrum.

Recently, I came across a brand of glasses called “Gunnar”. I found them at the annual CES event in Las Vegas about three years ago, and I tried them out. I found them to be extremely comfortable and after a couple minutes, felt like my eyes weren’t working so hard to focus on the computer displays in their booth.

Gunnar Phenom - Amber Tint

Gunnar Phenom – Amber Tint

Fast forward to the present and I’ve decided to give Gunnars a good long look (pun intended). I work in front of computers constantly in my full-time healthcare IT job where I have a wall of big screen monitors watching the health of hundreds of computer systems and I have three monitors on my desk, and when I’m not there, I’m studying to complete my degree online, I’m frequently on my smartphone, or I’m watching my LCD TV’s, or I’m reading a book on my tablet. On the ambulance, I’m blessed with a somewhat inefficient ePCR system and it isn’t unusual to take an hour or more to fill in a chart and check off all the special little boxes that are required to keep me out of PCR jail.

I’ve gotten out of the habit of turning my screen brightness to max when I can avoid it, and I try to get away from the tech for at least a half hour before bed, but I’m finding I still have headaches quite frequently. I’ll be due for some new eyeware soon under my insurance plan, so I’ll get my own prescription Gunnars then. A coworker of mine has a prescription set and he really enjoys them. They look sharp, are minimal in design, and are even becoming a favorite amongst gamers.

Gunnar has a couple lens tints, including sunglasses, regular clear (they call them “crystalline”), and amber. For what we do in public safety and patient care, I wouldn’t recommend the amber tint lenses, as they will shift color perception, which we depend on to assess a patient’s skin color (think cyanosis, pale, and even jaundice), so I’d stick with the crystalline lenses and the sunglass tints.

Remember, you don’t need a corrective lens prescription to wear these. The most common use of Gunnars is non-prescription. Prescription frames and lenses are available though. A nice feature about Gunnars is that they coat both the outside AND the inside of the lenses with an anti-reflective coating. Personally, I can attest to how annoying it is to have an anti-reflective coating on the outside, only to have a little light cause eye reflection on the inside (where you see your own eye refracting light onto the lens and creating distractions from your view).

They’re reasonably priced, especially given that they completely block the blue light wavelengths from all the assorted displays we spend our days and nights in front of. They also offer a wide range of styles so you can pick what’s best for your face and style. Check them out at On their site, you’ll find a few different pages describing the benefits of each type of frame and lens, and a “How Do They Work” page as well.


I do not own a pair of Gunnars, yet. They are going to be my next prescription eyewear purchase due to the research I have done and due to trying a demo set on and wearing them for a bit to get a feel for them. I believe they are the genuine article and not a gimmick, so much so that I applied to be a brand ambassador for them and was accepted. This status with Gunnar thus far has resulted in me getting a free Gunnar t-shirt and nothing else, so really, I haven’t been incentivized to write this article, as I already have plenty of t-shirts… especially from EMS product and service vendors. 😉

Check out the references I used to compile this article below. If you have any experience with Gunnars, please drop me a comment and let me know what you think of them. Thanks for reading!


(1) – Source: VSP Blog at

(2) – Source: NIH’s National Eye Institute at

(3) – Source: Harvard Health at

February 5, 2016
by The Unwired Medic

When “FREE” isn’t…

I like free as much as the next guy. In fact, I count on it to provide reviews on new tech for public safety here for you to read about.  What I don’t like is false advertising, like when you are given a code to redeem for a “free” product (in this case, a Bluetooth tracker for your keys, purse, or whatever you want to attach it to) and you sign up on the site and are told you’ll get an e-mail with instructions on how to complete the offer redemption.  Now they have the code, probably specially generated for the event or marketing campaign which is fine and probably a smart business decision to track marketing effectiveness, and they also have your e-mail address. Then they send you the “offer” to complete, and it takes you back to their site. The product is free, and suddenly, you see “+ S&H“. REALLY? You didn’t think to mention that when I visited your vendor booth at CES and talked with the rep for 10 minutes about your product, or to put that slightly totally relevant information on the “free” offer card, or on the special website page you dedicated to it BEFORE I submitted my e-mail address? You had to wait until the page where you paroxysmally ask for credit card information?

FREE *plus S&H - image by Fotomedic

…image by Fotomedic

Too bad! I was really looking forward to writing a review article here to share with the public safety community. Wouldn’t a relatively inexpensive product like that be useful for preventing crews from leaving jump bags and $25,000 monitor/defibrillators, or portable ultrasounds, or laptops and tablets, or apparatus and narc cabinet keys on scene?

I’d love to publicly shame the company that opted to use this disappointing tactic on its guests and potential customers, but I apparently have more integrity than they do, and I don’t post negative reviews.

January 29, 2016
by The Unwired Medic

Leave your headphones on while auscultating

Is it possible that you can still keep your Bluetooth headset on while you auscultate a patient’s chest? Absolutely!AfterShokz_Trekz_Titanium_Ocean

At CES 2016, I was fortunate enough to make my way over to the Aftershokz booth in the Health and Fitness exhibit hall. Aftershokz makes a lineup of bone conduction headsets for athletes. The benefit they were touting is that you could still enjoy your music and keep your ears free for hearing traffic, someone approaching, and the general sounds of your environment. Well, that sounded right up the public safety alley to me.

I took a quick tour through their booth and listened to some focused sounds under a few sets of uni-directional speakers with their new premier product, the Trekz Titanium. Impressive is an understatement. The recordings playing for ambience were from CentralAfterShokz_Trekz_Titanium_Ocean_front Park in NYC. I was able to hear the cars driving by, the birds chirping, the conversations of passersby, and more, plus I still heard the music – all of it. At the end of the demo, I was given an opportunity to review this fine headset for myself in a much less controlled environment, so of course, I jumped on it!

Let me say that my experience with them has been mixed. If you were expecting a flawless, OMG, DROP EVERYTHING AND GET THESE kind of review, that’s not exactly what you’ll find, but it’s close. That said, I think this is by far the best Bluetooth headset I’ve come across. No, they aren’t perfect, but they are excellent.

I spent the next day with these things on my head, walking around the CES exhibit halls, which are plenty noisy, listening to music, talking with a couple friends I go with to the annual show, and carrying on conversations with vendors galore. At the end of the day, my ear lobes were sore and I had some pressure sAfterShokz_Trekz_Titanium_Ocean_controlspots developing in front of my ears on my jawbone (not to the point of damaged skin, but noticeable). What I quickly surmised was that you shouldn’t spend an entire day with these headphones on, but that they would still be excellent for even up to four hours of continuous use while engaging in sports and fitness, walking, and even shift work. The rest of the time, they’ll rest unobtrusively around your neck, ready to slip back on to hear that music or take that important phone call. I learned that I can keep them on and running all day long and slip them on and off my head as needed.

Right now, I’m dealing with a doozie of an upper respiratory infection that has managed to work its way into my lungs, flaring up my asthma and giving me bronchitis. Inspiratory and expiratory wheezing, ronchi, and

even diminished bases at times. I was able to distinguish all this without removing my Aftershokz Trekz Titanium bone conduction headset. One of the major drawbacks I have encountered using ANY other Bluetooth headset was that I couldn’t have access to the headset while auscultating a chest. That is no longer going to be a problem for EMS practitioners with the Trekz Titanium.

As far as sound quality goes, I hope you aren’t expecting an audiophilic experience, because you’ll want to get a set of noise-canceling and isolating earbuds, and you might want to upgrade those silicone ear pads to the ones you can get from
the brand Comply (trust me, you won’t be disappointed). You are dealing with bone conduction sound here, so there is some expected drop in audio quality, but it isn’t that much. Although you might miss out on the finer details of a concerto, you’ll have no problem rocking out to your choice of music for a workout at any reasonable volume, from background noise to drowning out the world. Compared to a couple other bone conduction headsets I’ve tried, the Trekz Titanium is by far the best. Volume range is no limitation here either. You can make them uncomfortably loud if needed.

What may surprise you is the superb call quality you’ll experience. Now, I own a Plantronics Voyager Pro headset, given to me at a previous CES a few years ago. I’d consider its call quality to be well above average, but the Trekz Titanium surpasses it. Although I do still work in the field in EMS, my full-time job is in I.T. working in a Data Center for the only trauma center in Northern Nevada. I haven’t been able to find a phone or headset that will allow me to be standing in front of a computer system in the Data Center while talking at a conversational voice to the system engineer on the other end of the line. In my own truck, I have to at the very least roll up my windows or turn off the heater/AC and turn off the stereo, and often just plain pull over to be a part of a phone conversation with even my best Bluetooth or wired headset. The road and ambient noise is just too much, and I have a pretty well-appointed truck. Not so with the Trekz Titanium. I can be standing next to an in
dustrial Data Center Air Conditioner or rolling down the road with my stereo on and AC at full blast and my caller can’t even tell. Noise cancellation is hands down the best I have encountered. I know there are plenty of commercials advertising that their headsets will allow you to talk clearly to someone while you are in a rock concert or by a running locomotive, but this is definitely the real deal.

Placing a call is as easy as pressing and holding the button on the left earpiece. You will be prompted to state your call command and you can say to text or call a person in your contacts, or with my Android, it would eve
n search Google Now. A short press will start music, pause it, and resume it. I used it regularly with Google Music a
nd had no problem starting or stopping music. If the app closed itself, it would open the app and start from the first song in the library. Ideally, you would set your playlist, start it, put your phone away where ever you store it while you work out and just go. Range away from the headset was greater than 30 feet through an exterior building wall for me. I would have liked another set of buttons to skip forward and back on tracks, but that will have to be done on the phone itself.

Battery life has been far in excess of what the advertised expectancy is. I have left them running for several days and only found battery life to be medium after listening to about 3 hours of music per day and taking about half a dozen calls on them. No disappointments here. They recharge with a typical micro-USB charger, like most smartphones and accessories take.

So the pros and cons:

  • Pros:

    • Excellent Outstanding call quality.
    • No removal to auscultate to you can be online with medical control or your supervisor while assessing a patient’s breath and chest sounds or responding to a summons on a 2-way radio.
    • Long battery life – several days with moderate use, and quick to charge.
    • Decent, but not audiophile, audio quality. More than adequate to entertain you while walking, running, working out, etc.
    • Great volume range.
    • Lightweight – your head and neck won’t complain about extra weight wearing you down.
    • The call/voice command button is easy to get to, even with a gloved hand.
    • Includes a carrying case for protection when you are not wearing them – I’ve not used the case because I’m almost always wearing them!
    • Sweat and dust resistant. They are meant for working out with, after all.
  • Cons:

    • One Size Fits All – Non-adjustable headband means that on no necks like me, it sticks out the back making it move off the ideal placement when I lean back, but not really that bothersome. You’ll get use to it in a couple hours and adjust as needed. If you have a muscular head and neck, maybe it wouldn’t be too big of a deal.
    • No padding at all on the ear loops – This hard plastic only headset meant my earlobes were quite tender after wearing for more than about 3-4 hours. For me, I would just leave it on my neck until I was listening to something and then drop them back down when finished.
  • Neither Pro Nor Con:

    • The amount of tension exerted against the law was sufficient to keep the headset in place, which is great for exertional activity, but if left for a couple hours or more, then it could cause skin breakdown. Give yourself a break after a couple hours of use.
Where I'd Rather Be

Where I’d Rather Be

My final verdict

The Trekz Titanium by Aftershokz is a fantastic headset for what we do in public safety, able to handle sweat, snow and drizzle, dust, and you can keep wearing them while you take care of patients, run your patrol beat in a squad or on bike, work out at the station, or even while you hike through the forest on a rescue mission. You don’t have to worry about them incidentally falling off. They offer superb call quality and a pretty good audio quality for music on par with a decent set of headphones, but they leave your ears free to hear your pager, station tones, and 2-way radio, or even somebody walking up to you.

They retail at $129.99 and seem to only be available at the Aftershokz website for now, but older models are available on Amazon, so I suspect since it’s a new model, it’s just a matter of time before they are available elsewhere. They come in Ocean blue (like mine), lime green, and a nice, subtle gray.

Check out the literature and manufacturer specs here:



AfterShokz_Trekz_Titanium_Technology AfterShokz_Trekz_Titanium_How_it_works

January 24, 2016
by The Unwired Medic

New Year’s Resolution

This past year has been full of problems for The Unwired Medic, after dealing with severe allergies and asthma for much of the year, tied with some other medical challenges, and getting behind on completing my courses for my degree, and January 2016 has held much of the same for me, after catching a URI that turned into bronchitis and more acute asthma exacerbation.  It’s tough to stay focused on things like writing blogs when you are always shaky and apprehensive from nebulizers and steroids. I’m on the upswing again and am not feeling so shaky.  I’m confident that will continue.

My New Year’s Resolution (Hey! It’s still January!) is to write a lot more than I did last year (God willing!).  Early January is the annual Consumer Electronics Show (CES) in Las Vegas, and I was able to go this year, and I’ve brought back plenty to talk about. Mobile healthcare and fitness were big last year, but they are HUGE for 2016, and I’ve already been testing some new gadgets I’ll be writing about in the next week.

Thanks for sticking with me! There’s a lot to see this year!

September 3, 2015
by The Unwired Medic
1 Comment

Man up, Marines!

Is there possibly a manlier thing than to be a

United States Marine???

Get Kilted, Get Checked - Kilted To Kick Cancer

A Marine In A Kilt

Why yes, there is! There are Marines in kilts!

Okay, you’re probably already wondering what the heck this is about, so I’ll cut right to the chase. September is Prostate Cancer Awareness month, and a couple of public safety bloggers started this non-profit to raise awareness (and funds) about male-specific cancers.

– 1 in 7 –

That’s the number of men who will be diagnosed with Prostate Cancer. That means if you look at your father, grandfather, uncle, brother, nephew, your son, of even yourself, at least one of you is likely to be diagnosed with it. Your brothers in your platoon, your company, your battalion, all the way up to the CMC and Chesty Puller himself (wherever he is), you’re all at risk… granted it’s (usually, but not always) the 40 and over crowd, but the majority of you aren’t so far away as you think. Most of you will end your careers just before you turn 40, and then what? You’ll get up settled in to whatever you want to do after the mainstream Corps life just to get kicked back down by cancer? Let’s not stop there. 1 in 263 men will be diagnosed with Testicular Cancer, and that is not an old man’s disease. That diagnosis usually comes right in the prime of your life!

– Talk About Privates –

The University of Science, Music, and Culture (U.S.M.C.) is a worldwide organization that is dependent upon healthy men, and they should step up to the plate and make it clear that it’s okay to talk about the privates (and I don’t mean the non-rates!).

Honestly, I don’t know why, but this sort of thing gets pushed aside except when it comes to a dick-measuring contest, then we’re all-in for talking about it. Accept reality… your anatomy plays a significant part in your overall self-image. No, your manhood probably won’t turn green and fall off, but you might experience frequent urination, difficulty urinating (it comes out just a little at a time and it doesn’t happen easily), blood in the urine, hip and back pain, weakness and/or numbness in the legs and feet, and even erectile dysfunction.

– Take Initiative –

It falls squarely on the shoulders of leadership. NCO’s (including you Terminal Lance’s 🙂 and up should be initiating the conversations. Face it, the non-rates are generally just learning about being a real man. They make goofy decisions, have short attention spans, and are trying to live larger than life with no thought to the consequences they’ll reap later on. I sure hope you’re not going to hope and wait for your Corpsman to bring it up.

Wear a kilt! No, you don’t have to be Scottish or Irish. I got my kilt before I had done some homework and determined just how much Scottish and Irish I have in my lineage. Did you know that the Marine Corps has an official Scottish tartan? The Leatherneck tartan is carried by a lot of kiltmakers and retailers. I got my own (pictured above) at Sport Kilt, as part of a special Marine Corps package, which included the sporran (belt pouch) and kilt pin. You can also find them at Stillwater Kilts and Atlanta Kilts. My son (born on November 10th, by the way) has a kid’s kilt in the Leatherneck tartan too and it was only about $20 shipped. These are generally mass-produced and good for everyday wear, and they would probably suffice for wearing to Marine Corps Balls (no pun intended). If you are looking for something a la Steampunk or Utility style, then may I suggest Alt.Kilt? They are a custom kiltmaker and they can do leatherwork and embroidery. Browse around their site and you’ll see why kilts for cancer awareness is a very special subject for them. If you desire a more formal approach, you can get the full, heavy wool kilt from a few places, or get the fabric and have one made for you. Kiltmakers are easy to find online. There are tartans for other branches too, but they’re apparently nowhere near as popular and no one offers a whole kilt package to go with that.

Mustaches are governed by regs anyway, and no one asks why you are wearing a mustache, but I’ve literally been asked why I’m wearing a kilt over a hundred times. It’s a conversation starter. Besides, Dunk Your Mustache just isn’t the same as Dunk Your Junk, which also beats an ALS Ice Bucket Challenge any day of the week and twice on Sunday!

Raise funds for research! We can’t put an end to these cancerous monstrosities in traditional Marine Corps fashion, with an all-out assault, so we have to adapt to overcome! We can do that with research, but R&D requires funding. Invest in your future and your brothers’ too. You can learn more by exploring my blog, then heading over to the Kilted To Kick Cancer website for more information and to donate. I’d sure like it if when you donate, you would put “Team Unwired Medic” in the comments or choose it from the team drop-down so we can conquer the other non-Marine teams, but even if you don’t, I sincerely thank you. You can also find Kilted To Kick Cancer patches, t-shirts, and polo shirts on the site, and your donations should be tax-deductible, to an organization that does not use your donations to pay salaries to the board. The lion’s share of funds pay for research and a tiny bit goes to overhead.

– Take Responsibility –

The most important thing you can do is to get your mean, green butt in to the doc for your annual check-up. Man up! Turn your head and cough! Bend over and grab your ankles! Take one for the Corps! Get your blood draw to check for markers that can show you are at higher risk for Prostate Cancer, like your PSA and your blood counts.

Do a self-exam at least monthly. You’re in the shower, the water is hot, the higher temps cause your scrotum to relax, and it makes it much easier to execute your mandatory hygiene procedures, and to roll your testicles between your fingers and check for lumps that don’t belong there. It’s even better when your best lady is there to help you out.

If you experience the symptoms I mentioned above, get in to see the doc right away. Do NOT put it off! When caught early, male-specific cancers are almost always easily defeated. ASSESS, ASSAULT, and CLAIM VICTORY! No long, protracted battles with the need for logistical support are necessary. That’s the Army’s job anyway.

– Conclusion –

You now know how to act, so it is your responsibility to do it!

You know the definition of Semper Fidelis. What you may have forgotten is that to be faithful to your brethren and your beloved Corps, you need to be faithful to yourself first.

– References and Disclaimers –

All of my statistics are from the American Cancer Society from September 2014 & September 2015.

I have no conflicts of interest here and receive no consideration or compensation for links provided to any other site, manufacturer, or merchant. I wouldn’t mind if you said “The Unwired Medic” referred you, but I will get nothing in return. If you opt to donate with “Team Unwired Medic”, you would be helping me to beat the kilts off the competing teams, and there are prize packages awarded to the top teams, but I’m more interested in seeing Marines win and in beating cancer, which has already affected my life and the lives of many of my friends and family.
— Semper fidelis

To see more articles on this subject, please check out the following links:

September 3, 2015
by The Unwired Medic
1 Comment

Let’s Talk About Your Dangly Bits

Get Kilted, Get Checked! Kilted To Kick CancerWelcome to September 2015! It’s that time of year, when several public safety bloggers unify to present a non-profit organization called “Kilted To Kick Cancer” (KTKC) and their annual drive to bring awareness to male-specific cancers, and to raise funds for research and treatment.

The Hard Facts:

Female SymbolThere is a strong presence for awareness, and research and treatment fundraising for female-specific cancers, such as Invasive Breast Cancer. Undoubtedly, you’ve seen pink ribbon campaigns and catchy slogans like “Save The Tatas” or “Save Second Base”. These are just causes and merit the strong support they receive. Invasive Breast Cancer afflicts 1 in 8 women. Additionally, it will take the life of 1 in 36 women¹ (males excluded from the statistics here, but recognize that, yes, men can get breast cancer too). This is a conversation that’s accepted in virtually any environment or social situation. We talk about it at work, we talk about it at the family dinner table

Male SymbolBut it seems that talking about male-specific cancers is strictly taboo. We don’t talk about it in all but the most trusting social situations, such as a close knit group of guys, or in the bedroom with the missus when the diagnosis has already happened. Why is that? You’ve seen the women’s statistics, now check this out: 1 in 7 men will contract Prostate Cancer. That’s a slightly higher incidence than Invasive Breast Cancer in women. Guess what? It will take the life of 1 in 36 men¹. Testicular Cancer is less prevalent and less fatal, but still a critical part of a man’s whole self. 1 in 263 men will be diagnosed with it. Yes, 1 in 5,000 men² will die from it, which is much better than Prostate Cancer, but one is too many, especially when that one is you or personally affects you and your family. We men don’t have a special ribbon. We only now have catchy slogans thanks to the efforts of KTKC, like “Get Kilted, Get Checked”.

What Can I Do About It?

GET CHECKED! THIS IS THE MOST IMPORTANT STEP!!! Get to the doctor and get your annual checkup, and don’t skip the prostate exam! Men, check your dangly bits while you are in the shower, at least once a month, and even better, get your woman to help!

TALK! Men (and women), we need to get our priorities in order. No more social stigma! Talk about this serious matter! Talk about it with the men you know and care about. Brothers, fathers, grandfathers, uncles, nephews, sons, cousins, mentors, friends, all. If they’re too stubborn to listen, talk to their women and undoubtedly, they’ll help nag them until they get checked and open up to conversation (women: we know you do it strictly out of love and concern!).

And the Kilted Army at KTKC (which includes me) have vowed to make a statement to bring awareness to male specific cancers. We wear kilts every day we can during September, and let me tell you from personal experience, it IS a conversation starter. If a man walks in to a room with a mustache, you’ll probably judge the quality of growth and styling, and once that is done, you’ll likely not give it a second thought, but a man walks into a room with a kilt, and everyone wants to know, “What’s he got on under there?” And people ask! I’ve had literally hundreds of conversations and shared the Kilted To Kick Cancer website (

Kilted To Kick Cancer PatchRAISE FUNDS! I don’t place as much emphasis on raising funds as others, but it is still important. Without funding, there is no research. The goal this year is to break $50,000 with our September campaign. While on the KTKC site, you can read about what the organization is doing with the funds that are raised (important tidbit: none of it pays salaries!). I would be very appreciative if you would go to and make a donation of ANY amount and select “Team Unwired Medic” when checking out. While you are there, you can get the most awesome patch ever created throughout human history! Just read the reviews and you’ll see why…

Part of your purchase is tax-deductible. They also have T-Shirts and Polo Shirts (yours truly sports one) with free custom name/department embroidery available.

WEAR A KILT! No excuses! It doesn’t matter if you aren’t Scottish or Irish. Kilts are for everyone! One of the corporate sponsors is Alt.Kilt and they offer a wide variety of custom and alternative style kilts to suit your mood or purpose for wearing. I personally wear a Sport Kilt. These are great for daily use and you probably won’t shed a tear if you damage one while working or hiking or Tough Mudder-ing. Before I knew I had Scottish and Irish heritage, I knew I am Once A Marine, so I bought the Leatherneck Tartan works package. There are clan tartans, some states have their own tartans, or there are plain colors if plaids are not your thing. There are even firefighter turnout gear kilts! I worked at Burning Man last year and I can tell you, utility-style kilts were all the rage. Men and women everywhere were wearing them. 5.11 Tactical, which ran the Tactical Kilt as an April Fools joke that backfired and became a major real-life seller, runs a limited release every year and it looks like they haven’t sold out this year yet. My mother-in-law and I are working on making me a D-I-Y custom utility kilt from the Instructable directions I found on the web, and with the tips of some other tutorials I found through a web search. There are plenty of other places to shop and they really don’t cost that much. Look on your favorite web search engine (Google, Bing, or [gasp] AOL, et. al.) for Stillwater Kilts, Atlanta Kilts, TactiKilts, Highland Kilt Company, UtiliKilt, etc. A simple, in stock kilt can cost as little as $50, or as much as $1,000 for the most formal getup. Caveat: You do get what you pay for with traditional style kilts, unless you are, or have access to, a seamstress or tailor and can make your own. You can keep it simple and strictly with a kilt, or you can accessorize with traditional garb like flashes, sporran, belts, fly sash, Glengarry, ghillie brogues, sgian dubh, kilt pins, and more. I wear a sporran all year now, usually on my pants belt or just carried in my hand, or I stuff it in my backpack. It carries my EpiPens, MDI’s, and other emergency meds and it’s completely full. I’m going to try my hand at making my own sporran this year to accommodate the meds I now have to carry every day, plus my ID, money, keys, and whatever else I might keep in a pocket.

SHARE! Share my article and connect with me on social media (Facebook, Twitter, Pinterest, Instagram). Help spread the word. You can even create your own fundraising team with KTKC.

Stay tuned to my website throughout the month of September and learn more about the Kilted Army and what I’m doing to help! THANK YOU!

Get Kilted, Get Checked! Kilted To Kick Cancer!


¹- American Cancer Society ( – September 2014

²- American Cancer Society ( – September 2015

August 4, 2015
by The Unwired Medic

Moving To A New Host

Beginning tonight, The Unwired Medic may be intermittently unavailable at times this week as my host (EMS Blogs) is consolidating with First Arriving Networks and their array of public safety blogs. This can only be a positive move for us all as we combine networks to increase our pooled resources, and rumor has it, my site framework will be upgraded to be viewed even better from mobile devices! Thanks for sticking with me during this move! I want to thank Dave Konig, The Social Medic, for all his support and for increasing my blog exposure these last couple of years. I can’t wait to be joining the network along side great blogs like Ambulance Driver Files, Call The Cops, Rescue Humor, The Fire Critic, and Statter911, among others.

April 24, 2015
by The Unwired Medic

Texas ENA’s Unprofessional Attack on EMS

Texas ENA’s Unprofessional Attack on EMS

Author’s note: I generally avoid posting non-tech matters on my blog, but this unprofessional, unsubstantiated, fear-mongering attack of EMS in Texas has me boiling. I present to you something that doesn’t just affect Texas EMS, but EMS in the entirety of the United States of America. This has been fought in other states, and if it isn’t stopped now, will set a precedent and spill into many more states and regions. If you want to advance, you don’t do it by holding your siblings down in mediocrity and attacking their skills and intelligence. They seem to have taken a page out of the book, “How to Get Ahead in Life by Attacking Your Colleagues.” It is uncalled for. It has been professionally sanctioned by the San Antonio Chapter of and the Texas ENA, and they are imploring their members to spread this insult as if it were fact and we will bring the end of competent emergency care. I submit that they owe us a retraction and public, formal apology. My dog in the fight directly is that I have been a Texas Paramedic and if I want to return there in my future, my career options should not be limited by a board that played dirty politics from the word go with lies and mudslinging! My article also appears on Facebook (here) and I invite you to share it ad libitum. I would like to see the NAEMT take a professional position on this matter, and I would appreciate if you took time to contact the Texas NAEMT region board and state leadership, and the Texas EMA, decrying this deplorable behavior.

Warmest regards…


The Texas ENA is pushing to keep their thumb over EMS again and trying to keep EMS providers from crowding “their” domain. Consider asking your political representation to oppose the ENA efforts and to move to allow EMS to practice out of the preshospital-only areas. This push is to allow EMS to work to its full scope, under guidance of a physician, in ER and urgent care type sites, not ICU or other full admissions patient care environments.

I provide my counter-points to the letter at the end, factually debunking most of the ENA letter. Thanks for considering this and please SHARE!

The following is a letter sent to me by a Texas Paramedic:

The following is an email being sent to Texas ENA members in regards
to legislation being considered that would allow Texas EMT’s and
Paramedics to function within their scope in the hospital setting
under the direct supervision of the MD. HB 2020 and SB 1899 would
allow us to perform our clinical abilities in the emergency department
or urgent care setting with a physician in close proximity.
The stance of the Texas ENA essentially states that these procedures
are best performed by and RN and that we do not have the necessary
education or competency to perform these procedures within the hospital
setting despite performing them in the out of hospital setting.
Unfortunately we lack the legislative representation as EMS but if we
all call, write or visit ourstate representatives and senators we
might be able to fight back!
I have copied the email being circulated and you can read it in the
text below. The link is a link that will allow you to contact your
representatives both in the house and senate.
PLEASE SHARE THIS LINK TO ALL IN EMS; even if you do not practice in Texas!

Dear SAENA Member,

The Texas ENA Government Affairs Chair has asked that the following information be sent out to all of Texas ENA members:

House Bill 2020 and Senate Bill 1899 are currently under discussion and maybe moving for vote in the near future.

These bills would change the scope of the EMT-P and licensed paramedic to include the initiation of advanced life support measures such as; IVs, intubation, defibrillation / cardioversion and administration of medications under the supervision of a physician who is present in the same area or an area adjacent to the area. These actions would occur in an emergency or urgent care clinical setting, including a hospital emergency room or a freestanding emergency medical care facility.

The Texas ENA is opposed to the passing of these bills and requests members immediately contact their House and Senate representatives by calling, writing a letter or email, to express opposition to the bills. (To identify your representative, go to…/find-your-representative/ )

The Government Affairs Chair included a letter, written by a member, which identifies the issues related to these bills. Members may use the basic information in the document to compose their own letters to their legislator or to identify points to discuss when speaking to their representative.

I am writing today as a registered voter in opposition to HB2020 relating to the scope of duties of an emergency medical technician-paramedic and a licensed paramedic. This bill allows EMTs and EMT-Paramedics the authority to provide healthcare services including advanced life support in hospital emergency rooms and freestanding emergency medical care facilities under a physician delegation.

As an emergency nurse, I am concerned that this bill will potentially affect the safety and level of care provided to patients in the emergency department and encourage hospitals to utilized less qualified providers for staffing. Currently, EMT and paramedics are provided the authority to provide life saving measures in the pre-hospital environment until the patient can reach the emergency department which is a higher level of care. This role utilizes physician-developed protocols and direct communication with the hospital to direct care until the patient arrives at the emergency department. The focus of the training is on skills. The Texas Board of Nursing rules limits what tasks can be delegated to others. This restricts paramedics from administering medications and intravenous fluids in the hospital setting.

This differs significantly from the registered nurse role which is an autonomous provider who’s training includes independent decision-making in which the RN works collaboratively with the physician to ensure that adequate care is provided to the patient. There is extensive preparation in pathophysiology, pharmacology, skills, and critical thinking/clinical judgment. Current research shows a direct correlation between nursing care and positive patient outcomes. Most emergency departments require that emergency RNs are trained in advanced cardiac life support and trauma nursing care. There is a national certification body that also provides certification in emergency nursing. Furthermore, the Texas Board of Nursing rules does not allow nursing to carry out orders from an EMT or paramedic.

EMTs and EMT-Paramedics temporarily receiving direction for a physician could create a very unsafe situation during the most critical time in the patients hospital stay. Currently they receive directions (delegation) from a nurse so who do they listen to in this critical situation when the nurse needs help and the physician requests their assistance. Who is accountable when they accidentally misunderstand the delegation instructions.

I urge you to vote no on this bill for patient safety reason.’

Attached to this email is a copy of HB 2020 for you to review. In addition, at the end of the email are the names of the committees and links to the specific legislators now discussing these bills. You may contact these legislators even if they are not your district representatives.

I urge you to stand up and be heard! Contact your legislator NOW and tell them to vote NO on HB 2020 an SB 1899.

Carol Twombly


San Antonio Chapter

Texas Emergency Nurses Association

Allow me to dissect their letter, its inaccuracies, outright lies, and unsubstantiated “fact” and offer counter-points:

Using less qualified providers…”

So we’re only less qualified when we pass through the magic portal that separates the ER from the parking lot? I don’t recall a statement in law showing Paramedics are less qualified providers. Desire to compare academic requirements? I do it later in this article. And before the “degree-based” requirement for nursing comes up, perhaps we can make sure to include all the presently certified/licensed nurses who maintain their certification/licenses despite being from diploma-based training programs. It was not very long ago that these were still commonplace and accepted, or has nursing forgotten the inconvenient. We in EMS are clearly moving toward a degree-based requirement as a field. In fact, in Texas, you must have an Associate’s Degree in EMS, or a Bachelor’s degree or higher (any field is allowed) to be a Licensed Paramedic.

a) Requirements for paramedic licensure.  (1) A currently certified paramedic may apply for a paramedic license if the candidate has at least one of the following degrees from an institution of post secondary education which has been accredited by an agency recognized by the U.S. Department of Education as an approved accrediting authority:    (A) an associate degree in emergency medical services (EMS);    (B) a baccalaureate degree; or    (C) a postgraduate degree. (link to Texas Administrative Code here)

So much for the degree argument.

Currently, EMT and paramedics are provided the authority to provide life saving measures in the pre-hospital environment until the patient can reach the emergency department which is a higher level of care.”

So, the issue actually is authority, not skill or qualification.


This differs significantly from the registered nurse role which is an autonomous provider who’s training includes independent decision-making in which the RN works collaboratively with the physician to ensure that adequate care is provided to the patient.”

RN’s are not autonomous providers. Ask an RN for an over-the-counter medication like Acetaminophen while you are a patient. A physician orders, and they execute, no different from Paramedics. You must be a licensed Nurse Practitioner, or more precisely, an Advanced Practice Registered Nurse (APRN) to work completely autonomously ( This also makes it sound as if we don’t work collaboratively with physicians, which although is only implied, it is strongly implied and not true.


“Furthermore, the Texas Board of Nursing rules does not allow nursing to carry out orders from an EMT or paramedic.”

This is completely irrelevant. Under what pretext would this statement be necessary unless nurses were acknowledging that Paramedics are higher levels of practitioners than they. No one has made such an assertion, and no one should. In Texas, a nurse and a Paramedic are neither higher than the other. No authority has been given to nurses to delegate to a Paramedic or EMT either. We are governed by different laws and boards. We take our patient care orders from physicians and other licensed independent providers, not RN’s.

EMTs and EMT-Paramedics temporarily receiving direction for a physician could create a very unsafe situation during the most critical time in the patients hospital stay.”

STOP! There isn’t a shred of evidence presented to support this egregious attack on our clinical competency, and it is nothing less than an attack. How do physicians and nurses interact with Respiratory Therapists, lab technicians, radiology technicians, PA’s, NP’s, RN’s, and LVN’s now? By virtue of this statement, there must be an extraordinary quantity of unsafe situations that already exist in the ER and in urgent care. One might wonder how a patient survives an encounter at the ER at all.

Are we truly supposed to believe adding another clinical professional into the equation will absolutely mean detriment to patient care? It could create a very unsafe situation… It’s absurd and inflammatory. It’s no better than saying, “The end of the world could occur at any moment,” and rather than support this statement with statistics and fact, we should resort to unqualified, unsubstantiated fear-mongering.

Here is the reality… Paramedics are trained extensively to work with physicians and nursing staff in the most critical and emergent situations, and after certification and licensure, we then do it nearly independently in austere and isolated environments, so should we be expected to crumble into babbling, incapable dolts the moment we are suddenly surrounded with an army of physicians, nurses, and other complementary healthcare providers? Hardly, and if anything, it will serve to bolster the patient care competency portfolio (fair note: I cannot substantiate my assertion here, but that isn’t stopping the ENA from urging their members to do that very same thing to us. The difference is I’m not suggesting a class of healthcare providers be prophesied as causing the downfall of emergency care by virtue of its delivery withing a walled building – read: ER or Urgent Care – instead of an uncontrolled physical and social environment – read: everything not an ER or Urgent Care – or a 100 square foot box on wheels).

And lest we forget, Paramedics undergo extensive clinical instruction and precepting in the Emergency Room under the supervision of, that’s correct, physicians and nurses, long before we are deemed competent and permitted to sit for our local and national certification boards. Nurses sign off on this competency! Again, the magic portal that separates the ER from the parking lot has astounding effects, and the best part is that the outcomes of the magic portal are selectively applicable when it suits the nursing lobby! The argument is contradicted within their own presentation against EMS. How can you decry our competence when you signed off on it?

Currently they receive directions (delegation) from a nurse so who do they listen to in this critical situation when the nurse needs help and the physician requests their assistance.

Fact: There exists no authority, whether self-derived from the Board of Nursing, or from any lawful EMS oversight committee or statute, to allow, or even imply a nurse is allowed to provide, direction or delegation to an EMT or Paramedic. If this relationship exists, it is that of a person who also happens to be a Paramedic working as an uncertified, unlicensed technician employee for a hospital, and it is because hospital policies, not law, have placed that person as an ER tech under the direct supervision of a nurse. They are absolutely NOT practicing under their license as a Paramedic… yet. Search job listings for ER Technicians in Texas and you will see that current or past certification and/or licensure is commonly highly recommended. It is not a position where a Paramedic is employed to use his license. Here are a couple major health providers in Texas to show examples from:

Who is accountable when they accidentally misunderstand the delegation instructions.

On its face, this seems like a valid argument, but like all the previous arguments I present from this letter sanctioned by the Texas ENA, it fails to recognize the reality of placing a licensed and/or certified provider in the job. When a certified or licensed Paramedic, employed under their own certification and/or licensure, makes a misunderstanding of delegated instructions in providing prehospital care, it is their own license that is on the line, not a nurse, and rarely a physician is held liable (disclaimer: I’m not an attorney, but a well-respected attorney and Paramedic in Texas has told me as much – I will endeavor to present more fact from case history if requested). It is no different than if a nurse “misunderstands the delegation instructions”. The nurse isn’t magically liable for any other provider’s license, but their own. Again, this statement serves to cloud the issue and incite fear of liability where it doesn’t exist. Logically, if you cannot substantiate your claim on fact, plea to the emotion of the bureaucracy and legislation and use fear-mongering to support your position.

There is extensive preparation in pathophysiology, pharmacology, skills, and critical thinking/clinical judgment.

Again, they imply that Paramedics haven’t this training, which we can document we have as part of the core curriculum of Paramedicine and in the NHTSA educational requirements. I don’t have anything on the national accreditation standards for Paramedic education as required by the NREMT, but I can’t see them negating the national educational model. Requirements from the federal government are the baseline and accreditation would only work its way up. To allay the fears that we are uneducated oafs given power tools and a license to kill, I provide a link below to the national education model standards for Paramedic training. You may find the 385 page outline on the curriculum stimulating, and that’s only the outline, not the multiple-volumes of anatomy, physiology, pathophysiology, pharmacology, life span development, terminology, differentiations from medical and trauma on each major body subsystem and age group, operations, incident response and coordination, documentation, and more, nor does it even touch the prerequisites of our allegedly subpar (per Texas ENA) education. All of that also doesn’t detract from the fact that although nurses are trained holistically and through a complete care cycle from admit to discharge, Paramedics are trained specifically for everything spanning from pre-admit through every conceivable emergency and critical care situation, and for inter-facility transport of the critically and chronically ill. We are emergency care specialists, not medical generalists.

Most emergency departments require that emergency RNs are trained in advanced cardiac life support and trauma nursing care.”

Again, anecdotal, and a broad overgeneralization, completely unsupported by facts and statistics. Texas isn’t most emergency departments. . This is a hospital matter and if it is driven by anything, I would suspect it is accreditation and reimbursement, and certainly not law. What Texas Department of State Health Services EMS (TX DSHS EMS) does regulate is trauma center level designation:$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=25&pt=1&ch=157&rl=125

In other words, this is smoke and mirrors and does not justify the Texas ENA position. ACLS and TNCC (continuing education certification courses for cardiac and trauma care) are not commonplace for typical nurses. ACLS is mandatory for Paramedics to maintain certification and licensure, and it is commonplace to see Paramedics teaching the courses, and we have a couple equivalent courses to TNCC specifically for EMS, or can even take TNCC for ourselves. So why bother bringing this up? To show that after you are licensed you need additional training so you can do what Paramedics had to do before they even left school? It isn’t helping your care, but when taken alone, it sure sounds like you are implying that your skillset exceeds ours.

There is a national certification body that also provides certification in emergency nursing.”

So what? We have a national certification board too. The difference is national certification in emergency nursing (a.k.a., CEN) isn’t required for state licensure, nor is it a regulatory requirement to work in an ER or hospital. In Texas, national certification IS required to obtain new or reciprocal certification and licensure as a Paramedic. The statement implies the untrue, that nursing is more qualified than EMS.

However honorable obtaining this prestigious certification, and it truly is, it is accreditation and reimbursement driven. Most states in the USA require national certification for Paramedics before being granted state or local certification and/or licensure to practice. Additionally, while emergency medicine is fully within our purview, the CEN (Certified Emergency Nursing – certification is not a core requisite of nursing. It is an adjunct certification to demonstrate competency in a specialty field which is not part of the primary nursing curriculum. Emergency medicine, pre-, peri-, and in-hospital, is at the very root of Paramedic education.

According the the BCEN (Board of Certification for Emergency Nurses), currently, more than 30,000 nurses hold the CEN certification. In my experience (anecdote), it is uncommon to encounter a CEN outside a large hospital system. I cannot recall encountering any in my 20 years in EMS that worked in rural hospitals. In fact, I have worked at a few rural places that call the local ambulance to the ER to run their codes (cardiac arrests) for them. You aren’t making a case that nurses are safer than Paramedics in an ER for patient care.

Furthermore, the Texas Board of Nursing rules does not allow nursing to carry out orders from an EMT or paramedic.

So what? The Texas Board of Nursing does not regulate emergency rooms or hospitals, nor does it write Texas law. The Texas Board of Nursing does not regulate EMS providers, either. We have already covered this ground. Under what circumstances would a Paramedic be giving orders? None. They aren’t independent healthcare practitioners. That’s the physician’s job. If a Paramedic were administratively higher than a nurse in an ER or Urgent Care, it would be a hospital decision, not a legislative one. Imagine that, a Charge Paramedic giving staffing orders to nurses. Of course, the Paramedic still could not dictate patient care or give orders. That has to be left to the physician/PA/APRN.

Now, I want to head off the next tired argument before it is presented. Nursing will sing to you of the requirements for continuing education to ensure clinical competency does not stagnate and the nursing practice is forever advanced, and the continuing education opportunities are impressive, to be sure. They are required to obtain a full 20 (twenty) CNE (Continuing Nurse Education) hours per two-year licensure cycle. Ten whole hours per year of class time dedicated to maintaining and expanding their knowledge base in nursing!

However, this pales in comparison to the 144 hours required by TX DSHS EMS for Paramedics (, every four-year certification/licensure cycle. Paramedics have the option of forgoing continuing education for renewal in lieu of sitting for a complete written licensure re-examination. To maintain national certification, the National Registry of EMT’s, our national certification board, requires 72 hours of continuing education every two-year cycle, which is nearly four times the continuing education requirement for nurses in Texas regardless if you look at annual, bi-annual, or four-year cycle. Of course, employers may always opt to require more education for their staff, Paramedic or nurse. As as comparison note, Texas physicians are required to obtain 48 continuing medical education hours per two-year cycle (

I am frankly appalled at the unprofessional, unwarranted, baseless attacks on EMS provided by the Texas ENA and the San Antonio chapter. I respectfully demand they retract their letter to their membership, require their membership that have submitted it to their legislative representation to issue a retraction letter and apology for unprofessional conduct, and issue a public, formal apology to all Texas EMS providers and especially Paramedics, both certified and licensed. Had an EMS organization the audacity to behave in the same manner, I have no doubt there would be attorneys representing nursing breathing down our necks asking this and perhaps more.

Nurses, we have decades working together symbiotically to support the patient care spectrum. We applaud your advancement professionally and encourage it. We have likewise opened our educational offerings to you in good faith, as you have to us. We are modeling your growing pains as a profession and we are walking in your footsteps, striving to implement national degree-based requirements and it will take time for us as it did for you, but this condescending air of superiority has got to stop. We are not your pawns. We are not inferior to you. We are not subordinant providers to you like CNA’s. We are no longer even technicians. We Paramedics are certified and licensed in our own right, just as you are. We are not subject to your boards, rules, and regulations. We are a profession unto our own. We have separate regulatory bodies, enforcement, and accountability. A good big sister helps her siblings grow, mature, and come into their own, leading them to betterment. She doesn’t beat them down every time they try to stand on their own or bully them into submission. Grow up.

Contact the Texas ENA here:

Link to Texas ENA contact information provided by the National ENA

ENA, Texas State Council

ENA, Texas State Council









Contact the San Antonio Chapter of the Texas ENA here:

And the author of the insult letter here:

Carol Twombly, RN at

Carol Twombly, President of San Antonio Chapter of the Texas ENA at or (210) 260-3699

Carol Twombly, President of San Antonio Chapter of the Texas ENA












Contact the NAEMT leadership here and ask them to address this professional misconduct head-on:

Conrad T. “Chuck” Kearns

Dennis Rowe

Terry L. David
Director, Region IV

Troy Tuke
Director, Region IV

Matt Zavadsky
At-Large Director


Ben Chlapek
At-Large Director

National Association of Emergency Medical Technicians
PO Box 1400
Clinton, MS 39060-1400

Physical Address:
132-A East Northside Dr.
Clinton, MS  39056

Phone: 601-924-7744
Toll Free:
Fax: 601-924-7325


I encourage you to read this article from “A Day In The Life Of An Ambulance Driver” for his considerations of this deplorable attack on EMS, and he is offering a template letter for EMS and anyone else to base their own letter to your Texas Legislators.

I invite you to use this preformatted letter as a starting point for your own letter to the Texas Legislature. Please remember to keep your own responses professional, without stooping to unsubstantiated data, opinion, and lies, unlike our colleagues at the Texas ENA.  You may wish to open the PDF and then copy the text into your text editing program (Word, Google Docs, etc.).  Thank you for your support in this matter!

Texas Legislature Preformat Letter for HB2020 – PDF